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Increasingly, addressing healthcare's grand challenges requires complex system-level adaptations involving continuously evolving teams and leaders. Although leadership development strategies have been shown to improve individual leader effectiveness, much less is known about how organization-level leadership development affects organization-level outcomes. To begin building an evidence base as well as encouraging evidence-based practices, the US-based National Center for Healthcare Leadership developed a program capitalizing on leaders' demonstrated interest in organizational competitiveness: the biennial Best Organizations for Leadership Development (BOLD) program. In this chapter, we describe the philosophy behind this unique survey program and summarize research to date on relationships between survey dimensions and organizational outcomes such as patient experience and financial performance. We conclude with a description of promising areas for future study.

Hospitals catering to the unique needs of international patients often make substantial investments in their international program. Research has yet to evaluate the return on investment (ROI) of establishing these programs. The purpose of this paper is to quantify the economic benefits and costs of international patient programs and evaluate the ROI of international patients for US hospitals by program maturity and size.

Operational information about 29 health systems with international patient programs in the USA was obtained from the US Cooperative for International Patient Programs (USCIPP) Annual Benchmarking Survey. A Spearman correlation coefficient was used to test the association between international program investments and revenue. Mann–Whitney U tests were used to test whether ROI differs significantly by program maturity and size.

It was found that 14 (48.3 per cent) international programs were established and 10 (34.5 per cent) programs were large in size. The median estimated organizational total gross revenue less operating expense for all programs was positive ($15.6m). Total gross revenue less operating expense was higher for large programs ($105.6m) than for small programs ($9.2m) (p < 0.001) and higher for established programs ($40.2m) than for new programs ($8.5m) (p < 0.001).

The results suggest that hospital investment in international programs yields substantial returns for the health systems studied. New programs rely on staff from other areas of the organization while developing operational processes and relationships with providers and payers abroad. Examining the ROI can help hospitals develop a business case for an international program and understand any economies of scale from increased investment.

The purpose of this paper is to examine the relationship between country-of-origin (COO) and brand positioning in the context of the high-involvement service of health care. This paper compares and analyzes different positioning strategies used in Europe, North America and the Middle East.

This paper uses content analysis of promotional materials for a sample of 168 health-care organizations located in 14 countries to identify brand positioning strategies used, such as foreign, local and global consumer culture positioning. A chi-square analysis and post hoc testing is used to examine how positioning strategies differ among regions.

The findings indicate that European and Middle Eastern health-care organizations most frequently use foreign consumer culture positioning, while North American institutions tend to use global consumer culture positioning. The findings indicate that health-care organizations in countries with a better reputation for care use different positioning strategies than in countries with a lesser reputation for quality care.

The findings are of value to international advertising and marketing professionals and hospitals seeking to attract patients globally in a competitive marketplace. Hospitals must consider their positioning relative to both domestic and international competitors and the COO of their target audience.

COO is important in high-involvement service industries because consumers lack the information needed to evaluate service quality. Consumers may rely on COO and brand positioning signals more heavily relative to goods or low-involvement services. However, little prior research exists examining COO effects and brand positioning for high involvement services and for health care specifically. This paper makes a unique contribution by filling this gap.

Interest has grown among U.S. academic medical centers in developing international benchmarks for excellence in process and outcomes. Drivers behind this trend, as well as barriers to the development of useful benchmarks, are explored in this invited commentary.

The commentary is based on the authors’ conversations with members of the U.S. Cooperative for International Patient Programs as well as the University Healthsystem Consortium (UHC).

Six key themes are summarized in this commentary, including four key drivers and two barriers.

The practice-based perspectives this commentary summarizes provide a useful starting point for researchers and practitioners interested in establishing international comparison with the United States.

Personnel costs typically account for 60% or more of total operating expenses in health systems, and as such beome a necessary focus in most if not all substantive health reform adaptations. This study sought to assess whether strategic alignment of the human resource (HR) and learning functions was associated with greater adaptive capacity in U.S. health systems.

Data were gathered using a survey that was distributed electronically to chief human resource officers from two U.S.-based associations. The survey included questions about organizational structure, strategic human resource management, strategic learning, and organizational response to health reform.

Significant correlations were found between strategic alignment of HR and HR’s involvement in responses related to cost control (r=0.46, p<0.01); quality improvement (r=0.45, p<0.01), and patient access (r=0.39, p<0.01). However, no significant relationships were found between strategic alignment of organizational learning and HR involvement with these responses.

Results suggest that HR structure may affect an organization’s capacity for adaptive response. Top-management teams in health systems should consider positioning HR as part of the core leadership team, with a reporting relationship that allows HR to maximally participate in formulating and implementing organizational adaptation.

Despite hospitals’ efforts to reduce health care-associated infections (HAIs), success rates vary. We studied how leadership practices might impact these efforts.

We conducted eight case studies at hospitals pursuing central line-associated blood stream infection (CLABSI)-prevention initiatives. At each hospital, we interviewed senior leaders, clinical leaders, and line clinicians (n=194) using a semi-structured interview protocol. All interviews were transcribed and iteratively analyzed.

We found that the presence of local clinical champions was perceived across organizations and interviewees as a key factor contributing to HAI-prevention efforts, with champions playing important roles as coordinators, cheerleaders, and advocates for the initiatives. Top-level support was also critical, with elements such as visibility, commitment, and clear expectations valued across interviewees.

Results suggest that leadership plays an important role in the successful implementation of HAI-prevention interventions. Improving our understanding of nonclinical differences across health systems may contribute to efforts to eliminate HAIs.

Health care in the United States is on the verge of substantial change. Health reform legislation, and the goals it seeks to pursue, are likely to drive transformational change across many corners of the health care system. Preparing for and navigating these changes will, in turn, require health care leaders to learn new approaches to many of the core parts of their jobs (Clark, Savitz, & Pingree, 2010; Shortell & Casalino, 2010). The sheer magnitude of change and uncertainty also seems a likely driver of the uptick in CEO retirement, which rose almost to an annual rate of 18% in 2009, the highest rate increase since the American College of Health care Executives began tracking the statistic in 1981 (American College of Healthcare Executives, 2010). Taken together, these trends suggest the need for leadership development and succession planning has never been greater.

The purpose of this paper is to study recently published research to identify findings that provide research‐based guidance to organizational change agents and managers in addressing individual resistance to organizational change initiatives.

The paper examines published research appearing in peer‐reviewed journals since 1998 that focus on exploring individual resistance to organizational change.

Recent published research provides considerable practical guidance to organizational change agents and managers in understanding and dealing with resistance to change. Recent research examines the cognitive, affective, and behavioral dimensions of individual resistance and how it is influenced by: individual predispositions towards openness and resistance to change; individuals' considerations of threats and benefits of change; communication, understanding, participation, trust in management, management styles, and the nature of relationships with the change agents.

This paper is limited to research articles involving resistance to organizational change published in peer‐reviewed journals from 1998 to 2009. Also, the paper finds that reported research used primarily self‐report questionnaires to gather data, which are quantitatively analyzed. Such a lack of diversity of research methodologies provides a limited perspective of resistance to organizational change that might have been broadened by qualitative and practice‐based methods (e.g. case studies and action research).

A framework is presented linking organizational change research findings to specific change practitioner recommendations. Limitations of recent research are also discussed.

Most studies provide an examination of a limited number of variables influencing resistance to change, and are not necessary designed to provide practical guidance to change practitioners. This paper provides a comprehensive framework of constructs and variables specifically aimed at linking research‐based findings to guidance for change practitioners.