A case study: the executive leadership response at a community hospital to the value-based purchasing requirements of the Patient Protection and Affordable Care Act

This qualitative case study examined the perceived effectiveness of executive leadership team processes at a community hospital in the southeastern U.S. in relation to the Value-Based Purchasing (VBP) requirements of the Patient Protection and Affordable Care Act (PPACA) through an analysis of documents and a repository database (http:www.hospitalcompare.hhs.gov) relating to service quality, patient satisfaction, and governmental reimbursements; and, structured interviews. Today, the PPACA or “Obamacare” continues to challenge the executive leadership teams at U.S. hospitals to effectively navigate the intricacies of the legislation in order to remain solvent in a volatile healthcare arena. The Plan-Do-Check-Act (PDCA) model was utilized to guide the theoretical framework for this qualitative case study in terms of process improvement. Hill’s (2010) team leadership model was also applied to examine the perceived effectiveness of the executive leadership team processes in terms of analyzing any change in core measures and patient satisfaction scores from the federal fiscal year (FFY) 2013 and 2014, respectively. The VBP data reflected consistent core measure scores in the 48th percentile and an increase in patient satisfaction scores from the 20th to 33rd percentile. The results revealed that the executive leadership team processes were perceived by the researcher as effective as evidenced by a strong collaboration among administration, the bord, and medical staff in implementing several strategies via a team oriented approach that impacted Medicare patients during the FFY of 2013-2014. This study offers a starting point in terms of generating more understanding of the importance of executive leadership team processes at a community hospital in relation to the VBP requirements of the PPACA which can be studied on a broader scale in the future

An enquiry into the temporal coordination of Groupware Calendar Systems (GCS): Conceptualizing the private and public perspectives

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.Groupware Calendar Systems (GCS), asynchronous on-line meeting schedulers are designed to fulfil the increased need for coordination of work, by supporting time management of temporally and geographically dispersed individuals and groups. From a study of the literature on GCS adoption, a premise was constructed that temporal coordination of GCS requires a marriage of conflicting private and public perspectives. This is based on the fact that firstly, the system has to support both individual and group work, and secondly, generally considered `private' information has to be publicized by individuals. However, there is a lack of understanding of the dynamism of these perspectives especially in relation to the process of temporal coordination in GCS. The aim of this thesis is to understand and conceptualize temporal coordination of GCS. The research strategy of this thesis adopts a `grounded approach' together with a `progressive research approach' to investigate the GCS phenomenon. The actions and processes of GCS-in-use are examined using the case study method. The research design progressively refines and reflects upon the findings in two stages: stage-one, two pilot studies and stage-two, two case studies. A selection of data collection techniques were used in order to obtain a rich data set via semi-structured in-depth interviews, observations, questionnaires, documentation and photographs. The analysis employed a pattern-matching technique and the `SCOT' framework, modified to examine the process of temporal coordination and the dynamic relationships produced in GCS which led to the construction of a new conceptual model. This model of 'reflective temporal equilibrium' presents the state of temporal coordination, formed by the phenomenon of continuous conflict between the private and public perspectives. The outcomes of this thesis provide a clearer theoretical picture of GCS, consequently leading to implications for its future design and adoption for better coordination and collaboration of work

Knowledge Boundaries Shape the Cognitive and Structural Foundations of Innovation: Dyad-Level Expertise Exchange in Teams of Specialists

Innovation in academia and industry is increasingly achieved via complex problem solving in teams making use of knowledge from multiple areas of expertise. These expertise-diverse teams have proliferated in response to the demands of contemporary knowledge work, and members often possess intellectually distant skillsets that impose novel constraints on the means by which they must collaborate—in particular, they must rely more on distributed taskwork. Yet, research continues to place emphasis on the goal of enabling teams to achieve innovation by increasing knowledge shared in common, overcoming obstacles to cognitive parity, or via sustained periods of problem solving by the team as a whole. Instead, this study shows—and supports using a field experiment—that expertise-diverse teams heavily emphasize skillset complementarity and dyadlevel expertise exchange, allowing team-level innovation to emerge from smaller interactions in which concrete, actionable expertise is transferred directly between members. As such, members from partly incommensurate expertise domains can still contribute to one another’s work, raising the chance of breakthrough innovation across domains at the team level. Teams were randomly assigned to one of two training interventions emphasizing either dyadic or entirely group-level interaction. Results revealed that dyadic interaction was more strongly related to innovativeness and integrative complexity of team knowledge products. Measured expertise exchange in dyads also predicted team outcomes, a finding mediated by transactive memory—teams with more differentiated transactive memory systems were more effective. This study resolves incoherence about the impact of expertise diversity on teamwork, how to operationalize team cognition, and the contributions of structural features (e.g., interdependence) to team cognition and innovation

WAGE DISPARITY IN THE ACCOUNTING PROFESSION AND INFORMATION QUALITY

Does wage disparity, measured as the difference between highest and lowest paid workers, affect the quality of reported financial information? I collect accounting professional wage data from an international accounting and finance employment placement firm for the period of 1972 to 2017. I investigate to what degree wage disparity in corporate and public accounting has affected accounting information quality by testing predictions derived from equity theory and tournament theory. I find that vertical wage disparity within, as well as horizontal wage disparity between, corporate and public accounting is associated with measures of the relevance and reliability of accounting information. Specifically, pay disparity within corporate accounting is associated with a significant reduction in earnings persistence, in the earnings-returns relationship, in the accruals-cashflow relationship, and with higher levels of absolute abnormal accruals. In tests of pay disparity within the public accounting profession I find evidence of improved information quality associated with higher pay disparity. These findings are consistent with the different structures of employment and career advancement within the corporate and public accounting professions

Towards a moderated-trust governance theory : explaining the dimensional structure of trust and distrust between a board of directors and a CEO

Trust is a central feature in corporate-governance theory and practice. While trust is advanced as a motivational factor in dominant organisational theories and practices, it is conspicuously absent in corporate-governance literature. At one extreme, scholars discount trust, which leads to theories that characterise the relationship between governance actors as goal-conflicted and as something that potentially exposes organisations to distress. At the other, scholars approach trust as a given and characterise governance actors as locked in mutually beneficial relationships that inspire trust, even if organisational distress also occurs. Neither extreme characterisation has been useful in explaining how governance actors organise themselves to avoid or escape financial distress. Using a multiple-casestudy method, underpinned by a critical-realist perspective, this study provides an explicit exploration of trust and its complement—distrust—and explains the complexity of the trust relationship between governance actors such as chief executive officers, board chairmen, and board directors. This study seeks to demonstrate that distrust, as characterised within agency theory, and trust, as portrayed within stewardship theory, detract from understanding effective board task-performance. Some scholars have relied on proxy variables such as board composition and financial performance to assess board task-performance, but this often leads to weak theoretical explanations. Moreover, this study specifies how optimal levels of trust and distrust could explain effective board task-performance, which scholars have shown partially contributes to financial performance. This study proposes that optimal trust and distrust between governance actors occurs where levels of trust and distrust are simultaneously high. This study develops a theory of moderated-trust governance that is underpinned by generative processes with supporting propositions. Therefore, this study contributes to literature on both trust and corporate governance.Thesis (PhD)--University of Pretoria, 2018.Gordon Institute of Business Science (GIBS)PhDUnrestricte

The Antinomies of Autonomy: The Social Structures of Stressors in Ireland and Denmark

Autonomy is a core aspect of the labour process, working conditions, and the relationship between working conditions and well-being. Developments in techno-economic capacities, networked production, occupational structures, and organisational flexibility, have altered the dynamics of autonomy. High levels of work autonomy can now present counter-intuitive demands and contradictions which challenge the experience of self-regulation, discretion, and freedom at work - the Antinomies of Autonomy. In negotiating the decisive and interlinked post-industrial work bargains of effort, boundaries, and employment, different antinomies emerge which can present unique forms of stressors. The interrelated dynamics of the autonomy and antinomies within these post-industrial work bargains present difficulties for models linking working conditions and well-being outcomes (Bakker and Demerouti 2007, Karasek 1979, Siegrist 1996). The key mechanisms shaping the impact of work on psychological well-being go beyond the individual and a work 'place'. The thesis thus presents a sociological framework centred on a stressor (Wheaton 1999) - capability (Sen 1999, Hobson 2014) pathway. Employing a comparative case study method, the research draws from in-depth semi-structured interviews with IT workers in Ireland (n=17) and Denmark (n=14) to explore the antinomies, strategies and stressors of autonomous working lives and how they are shaped by different institutional contexts. The interviews involved psychosocial work environment and job related feelings surveys, alongside more detailed discussions of work and employment conditions in IT. The survey data shows an association between high autonomy and high demands for the Irish interviewees but not the Danish, and a surprising lack of feelings of excitement, enthusiasm, and calmness at work. The qualitative analysis identifies three mutually reinforcing antinomies of autonomy - interdependence, boundarylessness, and fusion - occurring within the labour process, working conditions, and the employment relationship respectively. The strategies and stressors emerging from these conditions are based on the 'capability sets' available within each institutional context. The analysis shows how Danish interviewees drew on more collective and institutional resources and norms in developing working life strategies. The Irish interviewees described strategies sourced and sustained mainly at the individual level. The thesis illustrates the complex interplay of post-industrial work bargains, the antinomies of autonomy, institutional capabilities, and the social structure of stressors of working life

Integrating Total Disability Management in a Climate of Change: A Case Study

Integrated disability management (IDM) is a cost-containment strategy increasingly being employed by human resources and risk management departments to address occupational and non-occupational illness and injury in a consistent manner. The goal is to both reduce on-the-job injury and minimize the loss of work time due to injury or illness. Although a large number of organizations have embraced the IDM concept, implementing IDM often is difficult because of the complex array of contracts, policies, procedures, corporate cultures and structures. Although extensive research has examined leaders\u27 influence on change in various types of businesses, to date, research has not specifically explored major change strategies utilized by leaders to help organizations adapt their programs in ways that facilitate IDM implementation. This study began to explore this topic. It was a qualitative case study of one organization\u27s efforts to implement IDM. The study employed observations and document reviews, along with interviews with a variety of stakeholders, to investigate the IDM change process, in general, and leaders\u27 actions, in particular. The research questions of the study were: (a) Does evidence support the existence of an IDM program in this site? (b) If so, what did leaders do to contribute to implementing IDM? The study utilized two conceptual frameworks. One framework, developed from the IDM literature, consisted of four indicators signaling IDM program achievement (e.g., common reporting, injury prevention/management, a clear return-to-work policy and employing data management systems). The second framework, taken from the change literature, articulated eight indicators of leader behavior associated with successful change initiatives. These indicators were: instilling urgency, utilizing teamwork, creating/communicating vision, empowering subordinates, insuring short-term wins, consolidating gains, and transforming organizational culture. The findings of the study reveal that the site exhibited all four of the characteristics of IDM. Injury prevention strategies, however, were incorporated into the program design only after a change in risk management leadership occurred; significant cost containment also did not occur until this change occurred. The evidence also reveals that program leaders employed most of the strategies associated with successful change initiatives, though there was limited evidence to support claims about fundamental cultural change

A Historical Analysis of the Evolution of the Administrative and Organizational Structure of the University of Central Florida as it Relates to Growth

This was a qualitative historical study, which was recounted chronologically and organized around the terms of the four full-time presidents of the university. The review addressed the processes associated with the establishment and development of Florida Technological University beginning in 1963 through its name change to the University of Central Florida in 1979, concluding in 2013. The organization\u27s mission, vision, and goals, how they evolved and the impact they had on the university were of particular interest. The study was focused on the administrative actions and organizational changes that took place within the university to assist faculty in teaching, research, and service as well as external conditions and events which impacted the university and shaped its development. The growth of the university, as well as the productivity of the faculty, were of interest in the study