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In the face of growing demand for care and tightening resource constraints, hospitals need to ensure access to care that is affordable and effective. Yet, the multiplicity of objectives is a key challenge in this industry. An understanding of the interrelationships (tradeoffs) between the multiple outcome objectives of care (throughput, experiential and financial performance) and returns to operational inputs (diversification of care) is fundamental to improving access to care that is effective and affordable. This study serves to address this need.

The empirical analysis in the study builds on an output-oriented distance function model and uses a longitudinal panel dataset from 153 hospitals in California.

This study results point to key insights related to output–output tradeoffs along the production frontier. Specifically, the authors find that higher throughput rates may lead to significantly lower levels of experiential quality, and net revenue from operations, accounting for the clinical quality of care. Similarly, the authors’ findings highlight the resource intensity and operational challenges of improving experiential quality of care. In regards to input–output relationships, this study finds diversification of care is associated with increased throughput, improvements in service satisfaction and a corresponding increase in the net revenue from operations.

Highlighting the tradeoffs along the production frontier among the various outcomes of interest (throughput, experiential quality and net revenue from operations), and highlighting the link between diversification of care and care delivery outcomes at the hospital level are key contributions of this study. An understanding of the tradeoffs and returns in healthcare delivery serves to inform policy-making with key managerial implications in the delivery of care.

Care farming is an underexplored example of agricultural diversification. In their process of diversification, care farmers are newcomers to the healthcare sector, facing high entry barriers and lacking the skills required to build a solid and legitimate presence in this new domain. Changes in the care regime have provided opportunities for new players, like regional organizations of care farmers, to gain access to care budgets. The purpose of this paper is to describe and analyze how strategies designed to establish regional organizations of care farms with similar access to institutional resources unfold and are translated into entrepreneurial behavior, organizational identity and legitimacy, and help provide access to care budgets.

Using entrepreneurship, identity formation and legitimacy building as guiding concepts, the authors interviewed stakeholders and analyzed activities and documents to gain a broad perspective with regard to the organizations, skills and activities.

The authors identified two types of regional care farm organizations: a cooperative and a corporate type. While the corporate type clearly exhibited entrepreneurial behavior, leading to a trustful and appealing organizational identity, substantial fund-raising and an early manifestation of institutional and innovative legitimacy in the care sector, the cooperative type initially lacked entrepreneurial agency, which in turn led to a lack of legitimacy and a slow development toward a more professional market-oriented organization. Manifesting entrepreneurial behavior and strategically aligning the healthcare and agricultural sectors, and building up both institutional and innovative legitimacy in the care sector proved to be crucial to the successful development of regional organizations of care farms. This study contributes to existing literature by exploring relationships between entrepreneurial and institutional strategies, legitimacy, organizational identity and logics.

This study contributes to the literature by exploring how in times with changes in institutional logics, strategies to establish new organizations unfold. The authors have shown how differences in strategy to establish new organizations with similar access to institutional resources unfold and are translated into diverging organizational identities and degrees of legitimacy. Entrepreneurial behavior is the key to create a trustful and appealing identity and innovative and institutional legitimacy which is important for providing access to an institutionalized sector.

Change in ownership among U.S. community hospitals has been frequent and, not surprisingly, remains an important issue for both researchers and public policy makers. In the past, investor-owned hospitals were long suspected of pursuing financial over other goals, culminating in several reviews that found few differences between for-profit and nonprofit forms (Gray, 1986; Sloan, 2000; Sloan, Picone, Taylor, & Chou, 2001). Nevertheless, continuing to the present day, several states prohibit investor-ownership of community hospitals. Conversions to investor-ownership are only one of six types of ownership change, however, with relatively less attention paid to the other types (e.g., for-profit to nonprofit, public to nonprofit). This study has two parts. We first review the literature on the various types of ownership conversion among community hospitals. This review includes the rate at which conversions occur over time, the relative frequency in conversions between specific ownership categories and the observed effects of conversion on hospital operations (e.g., strategic direction and decision-making processes) and performance (e.g., access, quality, and cost). Overall, we find that the impact of ownership conversion on the different measures is mixed, with slightly greater evidence for positive effects on hospital efficiency. As one explanation for these findings, we suggest that the impact of ownership conversion on hospital performance may be mediated by changes in the hospital's strategic content and process. Such a hypothesis has not been proposed or examined in the literature. To address this gap, we next study the role of strategic reorientation following hospital conversion in a field study. We conceptualize ownership conversion within a strategic adaptation framework, and then analyze the changes in strategy content and process across sixteen hospitals that have undergone ownership conversions from nonprofit to for-profit, public to for-profit, public to nonprofit, and for-profit to nonprofit. The field study findings delineate the strategic paths and processes implemented by new owners post-conversion. We find remarkable similarity in the content of strategies undertaken but differences in the process of strategic decision making associated with different types of ownership changes. We also find three main performance effects: hospitals change ownership for financial reasons, experience increases in revenues and capital investment post-conversion, and pursue labor force reductions post-conversion. Membership in a multi-hospital system, however, may be a major determinant of both strategy content and decision-making process that is confounded with ownership change. That is, ownership conversion may mask the impact of system membership on a hospital's strategic actions. These findings may explain the pattern of performance effects observed in the literature on ownership conversions.

The aim of this chapter was to analyze of the most hazardous aspects of home care work in Italy.

The chapter is based on a multi-method analysis conducted in Italy, including a survey on a sample of 867 home care assistants, and four focus groups organized with home care assistants.

The data collected show that: (1) there is a strong correlation between the physical and emotional complexity of the work and the workers’ malaise; (2) the live-in formula is not clearly linked with high levels of psychophysical malaise, while isolation is associated much more strongly with a high index of malaise; and (3) violence in the workplace is clearly one of the main risks to which home care assistants are exposed.

The findings may suffer from limitations due to the type of data collected. First, it was a convenience survey, so the results are not generalizable and they may be negatively influenced by bias relating to sample self-selection. Second, the empirical research was not designed to investigate occupational health alone, so accurate information on symptoms, causes of ill-health, experiences of violence, and the meaning of respondents’ malaise and of the episodes of violence were not available. Third, with the help of an epidemiologist, we could have included some diagnostic tests to better ascertain the workers’ state of health.

The chapter offers an original contribution to sociological research on the occupational health hazards from a gender-specific perspective. First, it investigates workers’ health risks in an understudied and highly feminized and racialized occupational sector. It also analyzes the implications of both the emotional and the body work on the workers’ health. It deals with the correlation between cohabitation and health problems. Finally, it looks into the impact of workplace violence on workers’ health, which is a strongly gendered issue, and rooted in social processes that stigmatize and racialize migrant women employed as home care assistants.

The strategic management perspective suggests that organizations structure their governing boards to complement the strategic goals of the organization. In contrast, the institutionalization perspective holds that organizations structure their governing boards to respond to institutional pressures in their task environment. Regardless of which perspective is followed, three structural dimensions of governing boards are expected to be affected: size, diversity of composition, and medical staff representation. A study was conducted to relate the institutional requirements and strategies of acute care hospitals to the structural characteristics of their boards of directors. Results indicated that, after controlling for organizational size and membership in a multihospital system, the governing board structure of 109 acute care hospitals varied significantly both as a function of their overall business strategy and as a function of institutional linkages. However, the proportion of the total variance in board structure accounted for by strategy variables was approximately twice as much as that accounted for by institutional variables.

The objective is to explore how the professionalisation of care jobs is constructed in the public and private sectors and to discuss whether the instruments used by public and private care providers contribute to solve the ambiguities linked to this type of work and which are the consequences for caregivers.

This paper compares the way in which the professionalisation of home care services for elderly people is achieved in the public and private sectors in the region of Brussels. The findings are based on the analysis of interviews with professional actors working in the care sector in Brussels.

The analysis shows that there is no agreement over the best way of professionalising home care services for the elderly and that the efforts made by public and private providers are profoundly different.

The divergencies are not only the result of the strict institutional framework to which public care providers are bound, in opposition to the relative freedom of the private sector, but they also derive from a different understanding of care work.

Since the 1970s, the healthcare industry has undergone significant changes. Using neo‐institutional and resource dependency theories, the purpose of this paper is to explore how managers perceive constraint and enact agency amidst these historic challenges – perhaps most significantly, declining funding and increasing regulation.

The data come from ten interviews with healthcare managers, spanning for‐profit, non‐profit, and government legal forms and hospital and nursing home sub‐industries in both Queensland, Australia and North Carolina, USA. The authors look for patterns across the interviews.

The paper shows that governments and umbrella “parent” organizations force managers to adhere to institutional expectations in exchange for resource investment. Managers navigate these environmental obstacles using a shared business‐minded approach and competitive differentiation. Yet various interest groups – including front‐line workers, physicians, and patients – challenge this paradigm, as they demand a focus on quality of care. Managers' efforts are likewise curbed by the very resource and institutional pressures they resist.

The authors understand changes in the healthcare industry as resulting from an increasingly powerful managerial logic, at odds with traditional professional and societal values. Interest groups are best positioned to challenge this logic.

The success ofIn recent years, there has been significant interest in the application of continuous quality improvement (CQI) and total quality management (TQM), and patient‐focused care (PFC) in health care organisations around the globe. The hospital industry has substantially embraced the concepts of CQI and TQM with the belief that these concepts and programmes will lead to an improvement in both the quality and efficiency with which health services are delivered. The objective of this article is to achieve better outcomes in health care services with fewer resources by studying the implementation of patient‐focused care in the health care provision context and particularly in the area of pharmaceutical care management as an integrated process in the delivery of health care in a hospital setting. The changes in health care provision have in many instances meant that the provision of pharmaceutical services needed re‐assessing.

Amongst the alternate property sectors, healthcare property has recently become an important property sector for major investors such as pension funds in the global property landscape; particularly in the UK, and being driven by the ageing population demographics. The purpose of this paper is to assess the significance, risk-adjusted performance and portfolio diversification benefits of UK healthcare property in a UK property and mixed-asset portfolio over 2007–2016. Both healthcare property and listed healthcare property channels are assessed. Drivers and risk factors for the on-going development of the healthcare property sector are also identified.

Using annual total returns, the risk-adjusted performance and portfolio diversification benefits of UK healthcare property over 2007–2016 is assessed. An asset allocation diagram is used to assess the role of both healthcare property channels in a UK property portfolio and in a UK mixed-asset portfolio.

Both UK healthcare property and listed healthcare property delivered superior risk-adjusted returns compared to UK property, stocks and listed property over 2007–2016, with portfolio diversification benefits in the fuller mixed-asset portfolio context, but not in a narrower property portfolio context. Importantly, this sees both UK healthcare property channels as strongly contributing to the UK property and mixed-asset portfolios across the entire portfolio risk spectrum and validating the property industry perspective of healthcare property being low risk and providing diversification benefits in a mixed-asset portfolio. However, this was not to the loss or substitution of traditional direct property exposure.

Healthcare property is an alternate property sector that has become increasingly important in recent years. The results highlight the important role of both healthcare property channels in a UK property portfolio and in a UK mixed-asset portfolio. The strong risk-adjusted performance of both UK healthcare property compared to UK property, stocks and listed property sees both UK healthcare property channels contributing to the mixed-asset portfolio across the entire portfolio risk spectrum. This is particularly important, as many investors (e.g. pension funds) now see healthcare property as an important property sector in their overall portfolio; particularly with the ageing population dynamics in most countries. The importance of both healthcare property channels sees healthcare property exposure accessible to both small investors and large investors.

This paper is the first published empirical research analysis of the risk-adjusted performance of UK healthcare property, and the role of healthcare property in a UK property portfolio and in a UK mixed-asset portfolio. This research enables empirically validated, more informed and practical property investment decision-making regarding the strategic role of both healthcare property and listed healthcare property in a portfolio.

Three diversification strategies (related, unrelated, and related‐Jinked) are reviewed in terms of their organizational arrangements (coordination and control mechanisms), managerial mind sets (corporate managers' ways of doing business), and organizational learning climates (learning capacity and learning needs). It is suggested that conventional organization development techniques (both human‐processual and technostructural) are relevant for developing the necessary organizational arrangements and managerial mindsets of diversifies. The organizational transformation perspective of managing change is proposed as an effective way to develop the required organizational learning climate of diversified firms due to its dynamic and proactive nature.