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Originally developed by the Japanese firm Toyota in the 1950s, the core innovation of lean production is to reorient all organizational activity around continuous improvement and the elimination of waste. We use the case of lean production in two healthcare organizations to explore the process of translating management models into new environments (Czarniawska & Sevón, 1996; Mohr, 1998). We draw on insights from organizational sociology and social movement theory to understand the strategies of actors as they attempt to overcome opposition to model transfer (Battilana, Leca, & Boxenbaum, 2009; Friedland & Alford, 1991; Snow, Rochford, Worden, & Benford, 1986). We examine two attempts to export lean production to healthcare organizations: Riverside Hospital, a research and teaching institution, and Lakeview Associations, a managed health provider. We use these cases to illustrate two ways that management models can get lost in the process of institutional translation: model attenuation, and model decoupling.

Administering healthcare within developing contexts of Africa presents a myriad of challenges. This includes competing priorities, cultural differences, language barriers, resource limitations, supply chain management disruptions, and an infinite array of ever-changing political, social, environmental, and economic dynamics. However, leadership and more specifically, intentional relationship development grounded in strategic diffusion networks have the potential to mitigate these challenges and maximize the adoption of life-saving technologies, pharmaceuticals, and treatment plans. This chapter provides context for the systemic healthcare challenges facing developing contexts across Africa, utilizes the theoretical frameworks of adaptive leadership and complexity leadership to create a holistic approach to relationship-building within these contexts, and illuminates the strategic influence, agency, and adoption and diffusion strategies that ultimately have the potential to create pathways to promise and save lives within underserved and under-resourced communities.

This mixed-methods study reports on an outreach clinics program designed to deliver genetic services to medically underserved communities in Wisconsin.

We show the geographic distribution, funding patterns, and utilization trends for outreach clinics over a 20-year period. Interviews with program planners and outreach clinic staff show how external and internal constraints limited the program’s capacity. We compare clinic operations to the conceptual models guiding program design.

Our findings show that state health officials had to scale back financial support for outreach clinic activities while healthcare providers faced increasing pressure from administrators to reduce investments in charity care. These external and internal constraints led to a decline in the overall number of patients served. We also find that redistribution of clinics to the Milwaukee area increased utilization among Hispanics but not among African-Americans. Our interviews suggest that these patterns may be a function of shortcomings embedded in the planning models.

Planning models have three shortcomings. First, they do not identify the mitigation of health disparities as a specific goal. Second, they fail to acknowledge that partners face escalating profit-seeking mandates that may limit their capacity to provide charity services. Finally, they underemphasize the importance of seeking trusted partners, especially in working with communities that have been historically marginalized.

There has been little discussion about equitably leveraging genetic advances that improve healthcare quality and efficacy. The role of State Health Agencies in mitigating disparities in access to genetic services has been largely ignored in the sociological literature.

In an era of increasing demand for healthcare coupled with decreasing availability of highly skilled healthcare professionals, healthcare administrators are increasingly concerned with how they might recruit and retain talent. Increasingly, they are focusing on compensation strategies to support their recruitment and retention objectives. This article investigates the organizational efficiency and financial performance implications for hospitals of using a hybrid relative wage strategy to compensate their nursing professionals. Considering three types of nursing professionals, registered nurses (RNs), licensed practical nurses (LPNs), and nurse assistants (NAs), we investigated the effectiveness of paying market leading wages to higher skilled nurses and market lagging wages to lower skilled nurses. On the basis of prior utility analyses of the importance of pay practices at particular organizational levels, we hypothesize positive performance consequences as a result of pursuing these relative wage strategies. Using data from 352 short-term stay acute care hospitals in California, we found that a lead pay policy among RNs and a lag pay policies among LPNs and NAs were associated with higher Return on Assets (ROA) (i.e., financial performance) and shorter Average Length of Stay (ALOS) (i.e., organizational efficiency).

Prior COVID-19, the World Health Organization (WHO) reported that less than 50% of the world's population was able to obtain essential health services. These numbers have decreased with the onset of the pandemic. Concurrently, the pandemic has amplified the gaps in access and extended inequality in African contexts. This requires a concerted effort to reimagine and rebuild Africa's healthcare system to inclusively attend to the needs of society's most vulnerable populations. Women in leadership provide an opportunity to do this. Through the advancement of strategic leadership development focused on women and girls, developing African healthcare contexts have the potential to aid in the eradication of endemics like gender-based violence, extend community sustainability, and elevate the collective consciousness for women, girls, and other marginalized populations. Through this chapter, the authors present a compelling and holistic conceptual model and the accompanying practice grounded in transformational and adaptive leadership, systems thinking, and strategic social influence that creates the foundation for the development of women in leadership to advance developing African healthcare contexts. The implications for this emergent strategy advance the field of leadership calling for applied leadership within African healthcare contexts, advance society through a coordinated and integrated approach to healthcare service and patient care, and create direct linkages to the UN Sustainable Development Goal (SDG) 3 – Good Health and Well-being, SDG 5 – Gender Equality, SDG 10 – Reduce Inequalities, and SDG 11 – Sustainable Cities and Communities, while advancing our collective global community.

This study investigates service excellence and hospitality perceptions in a hospital setting for an exploratory study of the familiarity of hospital administration with the topic of hospitality and service excellence. It is unique from other hospitality and service research in that it considers hospitality and service excellence as separate concepts, and specifically considers hospitality, such as service excellence, as a philosophy that may be transcend its traditional industries of origin. Part of the premise of this study explores how hospitality in a healthcare setting extends past service excellence in offering a service to a patient to create a comfortable and welcoming environment to combat patient anxiety and stress. This exploratory research provides a necessary foundation for more extensive empirical testing of the premise.

Using a qualitative case study, this research measured top management's perceptions of service excellence and hospitality within one community-based hospital located in Orlando, Florida. Three conclusions were revealed: (1) a mixed commitment by top management to concepts of service excellence and hospitality, (2) the terms “service excellence” and “hospitality” were generally discussed as though they were equivalent, and (3) significant external and internal barriers to the delivery of service excellence and hospitality in the hospital setting were identified.

The study has implications for healthcare organizations seeking to implement practices of hospitality and service management to improve overall healthcare service delivery. Additionally, the study of hospitality outside of its traditional industry boundaries may result in the generation of new improvement options/opportunities for traditional managers of hospitality businesses and organizational researchers. The study can be used as a foundation for the formulation of additional studies in the area of service excellence and hospitality applied to other layers in an organization irrespective of industry setting.

This chapter integrates organization design and sustainability concepts to describe an accelerated transformational change at the Fairview Medical Group (United States).

A case study of the transformation at Fairview Medical Group’s primary care clinics was developed from interviews and first-person accounts of the change. Objective data regarding outcomes was used to evaluate the effectiveness of the redesign process.

The Fairview Medical Group developed an innovation and change capability to transform 35 primary care clinics in six months. All of the clinics were certified by the state of Minnesota as complying with their healthcare standards. Clinical outcomes, costs, and employee and physician engagement also increased. All of the improved measures are sustained.

Healthcare reform in the United States struggles because the organization design challenges are great and the change difficulties even greater. Fairview’s experience provides important evidence and lessons that can help advance our understanding of effective healthcare and create more sustainable healthcare systems. This chapter provides healthcare system administrators evidence and alternatives in the pursuit of implementation.

Autonomy has long been established as a critical component of professional work. Traditionally, autonomy has been examined as the extent to which an individual or a professional group controls the decisions and knowledge used in their work. Yet, this framework does not capture the additional work activities that professionals are increasingly expected to perform. Therefore, this chapter argues for theoretically expanding our understanding of professional autonomy by bringing in the concept of articulation work. Using the case of healthcare organisational change, this study assesses how shifts in work practices impact autonomy. Data come from longitudinal ethnographic fieldwork and in-depth interviews conducted at a Neonatal Intensive Care Unit as it underwent significant structural changes. Findings show that professionals were forced to change articulation work strategies in response to new organisational structures. This included changes in the way professionals monitored, assessed, coordinated and collaborated around patient care. Furthermore, these shifts in articulation work held important implications for both workplace and professional autonomy, as professionals responded to changes in their work conditions.