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The long-term financial stability of hospital systems represents a “grand challenge” in health care. New ownership forms, such as private equity (PE), promise to achieve better financial performance than nonprofit or for-profit systems. In this study, we compare two systems with many similarities, but radically different ownership structures, missions, governance, and merger and acquisition (M&A) strategies. Both were nonprofit, religious systems serving low-income communities – Montefiore Health System and Caritas Christi Health Care.

Montefiore's M&A strategy was to invest in local hospitals and create an integrated regional system, increasing revenues by adding primary doctors and community hospitals as feeders into the system and achieving efficiencies through effective resource allocation across specialized units. Slow and steady timing of acquisitions allowed for organizational learning and balancing of debt and equity. By 2019, it owned 11 hospitals with 40,000 employees and had strong positive financials and low reliance on debt.

By contrast, in 2010, PE firm Cerberus Capital bought out Caritas (renamed Steward Health Care System) and took control of the Board of Directors, who set the system's strategic direction. Cerberus used Steward as a platform for a massive debt-driven acquisition strategy. In 2016, it sold off most of its hospitals’ property for $1.25 billion, leaving hospitals saddled with long-term inflated leases; paid itself almost $500 million in dividends; and used the rest for leveraged buyouts of 27 hospitals in 9 states in 3 years. The rapid, scattershot M&A strategy was designed to create a large corporation that could be sold off in five years for financial gain – not for health care integration. Its debt load exploded, and by 2019, its financials were deeply in the red. Its Massachusetts hospitals were the worst financial performers of any system in the state. Cerberus exited Steward in 2020 in a deal that left its physicians, the new owners, holding the debt.

Tribeca is a predominantly wealthy, white neighborhood in New York City and is a microcosm of the service-and-information-based economy that characterizes many communities in global cities today. Tribeca residents are mostly affluent and work in high-end, service-oriented professions, consuming low-end personal services produced locally. Many of the people who provide these personal services in Tribeca are foreign-born. This chapter explores the nature of intergroup contact between native residents and immigrant service workers to understand how they navigate social boundaries of race/ethnicity, nation-of-origin, occupation, and social class.

This chapter is based on six years of ethnographic data collection and participant observation, in addition to interviews with 66 informants, including both immigrant service workers and Tribeca residents.

This research highlights the importance of local contextual factors in shaping how people perceive one another and interact. Although in Tribeca this intergroup contact fails to alter boundaries of race, class, and nation-of-origin, residents and immigrants still have meaningful interpersonal contact, which is the result of bridging, or overlooking, existing social boundaries.

The results of this research challenge the assumption that relations between natives and immigrants in stratified settings are characterized by resentment or hostility. Instead, contextual factors in Tribeca shape intergroup perceptions and contact in a way that allows for positive interpersonal, albeit largely superficial, relationships to take root.

This study extends work from home (WFH) literature by recasting WFH performances that emphasise agents’ manipulation of scene. Drawing on the dramatist paradigm, the study uses Burke’s pentadic criticism to code the social media application Pinterest’s ‘work from home’ and ‘home office’ pinboards for act, agent, agency, scene, and purpose. Pinterest is a social media application that users post pins (images with verbal tags and link to external sites, especially blog sites) and collect pins by subject on an electronic pinboard, which other users can like, follow, and share. Analysis of WFH pins reveals that the agent–scene ratio saturates pins emphasising the agency of WFH agents to control their scenes or home office spaces. The idealism of the agent–scene ratio in pins further demonstrates an unrealistic approach to popular culture’s shift to WFH and a romanticisation of WFH as idyllic working conditions. Scripts for employees and employers are explored to equip them with the rhetorical resources to more closely align their agent–scene ideals with the scene–agent realities.

The law in a liberal state is often a violent instrument. So said Robert Cover. Among those communities to which the law has been particular cruel are Native Americans. Indeed, the traditions and practices of Native American tribes have spawned rich and fascinating narratives. Each tribe has created its own “nomos – its own normative universe” – with a distinct set of rules, expectations, and tenets. Even still, the state and federal governments have historically challenged Native American traditions and culture with various legal and judicial policies. Insofar as the state-imposed law is blunt and imprecise, certain Native American narratives are thus threatened. Over the past decade, several judicial cases have highlighted the clash between the state’s imperial authority and Native American narratives. Our chapter explores these court cases with an eye to the inevitable conflicts that emerge when law exists uneasily in a liberal state.

Current research about American Indians of all ages is in short supply, yet design and allocation of public services and resources are increasingly guided by ‘evidence’ provided by research. The health and wellness of this population is persistently poorer than that of other marginalized populations. American Indian tribes have been beset progressively since the earliest arrival of European settlers by both malevolent and well-intentioned assaults on their cultures and peoples. This long history of cultural and physical genocide continues into the present and undermines the effectiveness of Eurocentric processes for research that have been shaped by values and beliefs antithetical to those of most tribes (e.g. individualism, proprietary ownership, science as the way of knowing). Individual and collective historical trauma is present in all of the more than 500 federally recognized tribes in the United States of America, and a lack of trust further compromises the validity and positive impact of most research. This chapter describes the roots and foundations of flawed and successful research and identifies practical resources and approaches that are valid and beneficial for conducting research with indigenous people. The processes described in this chapter are grounded in the experiences of tribes in the United States of America; however, parallel experiences of indigenous populations that have a continuing legacy of trauma are found in many other countries (such as in Brazil and New Zealand) and the insights and approaches found in this chapter may be applicable to some degree.