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Diffusion of innovations, defined as the adoption and implementation of new ideas, processes, products, or services in health care, is both particularly important and especially challenging. One known problem with adoption and implementation of new technologies is that, while organizations often make innovations immediately available, organizational actors are more wary about adopting new technologies because these may impact not only patients and practices but also reimbursement. As a result, innovations may remain underutilized, and organizations may miss opportunities to improve and advance. As innovation adoption is vital to achieving success and remaining competitive, it is important to measure and understand factors that impact innovation diffusion. Building on a survey of a national sample of 654 clinicians, our study measures the extent of diffusion of value-enhancing care delivery innovations (i.e., technologies that not only improve quality of care but has potential to reduce care cost by diminishing waste, Faems et al., 2010) for 13 clinical specialties and identifies healthcare-specific individual characteristics such as: professional purview, supervisory responsibility, financial incentive, and clinical tenure associated with innovation diffusion. We also examine the association of innovation diffusion with perceived value of one type of care delivery innovation – artificial intelligence (AI) – for assisting clinicians in their clinical work. Responses indicate that less than two-thirds of clinicians were knowledgeable about and aware of relevant value-enhancing care delivery innovations. Clinicians with broader professional purview, more supervisory responsibility, and stronger financial incentives had higher innovation diffusion scores, indicating greater knowledge and awareness of value-enhancing, care delivery innovations. Higher levels of knowledge of the innovations and awareness of their implementation were associated with higher perceptions of the value of AI-based technology. Our study contributes to our knowledge of diffusion of innovation in healthcare delivery and highlights potential mechanisms for speeding innovation diffusion.

Collaborative product commerce (CPC) techniques are being applied with greater frequency in the health care sector. The purpose of this paper is to explore the potential barriers to their success in influencing cost and quality.

The health care supply chain (SC) is analyzed and five national health initiatives attempting to apply CPC techniques are described.

Five national‐level programs designed to improve health care quality and control costs use a variety of CPC techniques to create incentives and/or disincentives to influence suppliers’ behavior. Six barriers to success are identified that threaten healthcare CPC initiatives. They include: widespread resistance to change; information system limitations; the Health Insurance Portability and Accountability Act (HIPAA); the required time investment; lack of commitment to CPC principles; and the sustainability of the CPC business model.

Investigation into the barriers to success is warranted to develop evidence‐based solutions to improve effectiveness of CPC approaches in health care.

No national health care initiative to date can be described as an unqualified success in terms of its ability to align the SC. Nevertheless, individually, and to some extent collectively, the aforementioned programs are making some headway.

This work is one of the first to present information on how collective CPC efforts are taking shape in health care and to describe key national‐level projects currently underway in the field. Such information can offer policymakers and employers insight into how CPC techniques might improve effectiveness in health benefit contracting.

This chapter aims to provide a descriptive analysis and a theoretical interpretation of the challenges for international expansion of four large multinationals of each of the BRIC countries (JBS from Brazil, VimpelCom from Russia, Tata Motors from India, and Lenovo from China).

This study employs a qualitative approach, following a multiple-case study methodology, by analyzing four prominent cases of the internationalization of BRIC multinationals.

The internationalization process of the studied BRIC multinationals was influenced by the type of inputs and resources that each company had in their home country and the search for needed resources in other firms abroad that may have helped them to complement their business assets. The international expansion of these firms have been characterized by overcoming of several obstacles through the possession of firm-specific advantages, mainly composed of managerial capabilities, expertise, and knowledge about the markets and their companies.

Since construction workers often need to carry various types of loads in their daily routine, they are at risk of sustaining musculoskeletal injuries. Additionally, carrying a load during walking may disturb their walking balance and lead to fall injuries among construction workers. Different load carrying techniques may also cause different extents of physical exertion. Therefore, the purpose of this paper is to examine the effects of different load-carrying techniques on gait parameters, dynamic balance, and physiological parameters in asymptomatic individuals on both stable and unstable surfaces.

Fifteen asymptomatic male participants (mean age: 31.5 ± 2.6 years) walked along an 8-m walkway on flat and foam surfaces with and without a load thrice using three different techniques (e.g. load carriage on the head, on the dominant shoulder, and in both hands). Temporal gait parameters (e.g. gait speed, cadence, and double support time), gait symmetry (e.g. step time, stance time, and swing time symmetry), and dynamic balance parameters [e.g. anteroposterior and mediolateral center of pressure (CoP) displacement, and CoP velocity] were evaluated. Additionally, the heart rate (HR) and electrodermal activity (EDA) was assessed to estimate physiological parameters.

The gait speed was significantly higher when the load was carried in both hands compared to other techniques (Hand load, 1.02 ms vs Head load, 0.82 ms vs Shoulder load, 0.78 ms). Stride frequency was significantly decreased during load carrying on the head than the load in both hands (46.5 vs 51.7 strides/m). Step, stance, and swing time symmetry were significantly poorer during load carrying on the shoulder than the load in both hands (Step time symmetry ration, 1.10 vs 1.04; Stance time symmetry ratio, 1.11 vs 1.05; Swing time symmetry ratio, 1.11 vs 1.04). The anteroposterior (Shoulder load, 17.47 mm vs Head load, 21.10 mm vs Hand load, −5.10 mm) and mediolateral CoP displacements (Shoulder load, −0.57 mm vs Head load, −1.53 mm vs Hand load, −3.37 ms) significantly increased during load carrying on the shoulder or head compared to a load in both hands. The HR (Head load, 85.2 beats/m vs Shoulder load, 77.5 beats/m vs No load, 69.5 beats/m) and EDA (Hand load, 14.0 µS vs Head load, 14.3 µS vs Shoulder load, 14.1 µS vs No load, 9.0 µS) were significantly larger during load carrying than no load.

The findings suggest that carrying loads in both hands yields better gait symmetry and dynamic balance than carrying loads on the dominant shoulder or head. Construction managers/instructors should recommend construction workers to carry loads in both hands to improve their gait symmetry and dynamic balance and to lower their risk of falls.

The potential changes in gait and balance parameters during various load carrying methods will aid the assessment of fall risk in construction workers during loaded walking. Wearable insole sensors that monitor gait and balance in real-time would enable safety managers to identify workers who are at risk of falling during load carriage due to various reasons (e.g. physical exertion, improper carrying techniques, fatigue). Such technology can also empower them to take the necessary steps to prevent falls.

This is the first study to use wearable insole sensors and a photoplethysmography device to assess the impacts of various load carrying approaches on gait parameters, dynamic balance, and physiological measures (i.e. HR and EDA) while walking on stable and unstable terrains.

This chapter explores distributed leadership in volunteer multistakeholder groups tackling complex problems, focusing on community organizing practices to bridge the gap between health and health care in Columbia, South Carolina. Columbia faces increasing chronic disease, high rates of uninsured, unequal access to healthcare services, and rising costs. Regional leaders periodically tackled these problems together but faced challenges common to multistakeholder groups. In 2010, leaders from Columbia partnered with the authors in a learning enterprise to find new, more sustainable ways to address these challenges. Together we adapted a community organizing approach to develop distributed leadership skills necessary to overcome the challenges of volunteer multistakeholder groups and transform the health system in a local area. In the first year, teams provided health screenings to over 1,000 residents; over 3,000 residents exercised leadership to improve community health; over 5,000 residents pledged to improve their health. Clinic hours were extended; new health coaches focused on primary care and wellness programs. Providers and payers committed to reinvesting a share of savings in the community, which has a voice in their use. We show that developing distributed leadership via community organizing offers an approach to solving seemingly intractable community problems.

Most academic work on sustainability has been focused on the organizational level, reflecting the popular “business case for sustainability” idea. However, organizations are certainly not the only locus of entrepreneurial action for sustainability, nor are they the most ideal. This chapter reports on a six-year study of the Sustainability Consortium, a collaboration started in 1999 between large companies that were seeking to lead their industry through innovative initiatives for sustainability. The findings, based on 60 interviews and many other sources of data, identify eight “ecologies of entrepreneurial action,” all of which were critical for driving change. These ecologies are: Individual Aspiration; Network Affiliation; Process Optimization; Entrepreneurial Innovation; Value Chain Collaboration; Industry/Sector Coordination; System-Wide Integration; and Social Transformation. As shown by complexity theory, the interdependent and interconnected nature of these ecologies means that only by expanding beyond organizationally focused endeavors can we help generate the social transformation that will lead to a sustainable world.