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In Louisiana's coastal communities with traditions of heavy dependence on the oil industry, cycles of industrial uncertainty have become routine, eliciting a set of coping responses from local government and community institutions. However, recent industrial restructuring within the context of globalization, accompanied by shifts in the climate of federal and state policy, have significantly disrupted traditional support mechanisms and threatened their survival. This article explores the realities that two South Louisiana communities impacted by the offshore oil industry face at the close of the 20th century, with a focus on health service institutions. It also explores community efforts in managing local housing and workforce preparation issues.

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.

The following is an introductory profile of the fastest growing firms over the three-year period of the study listed by corporate reputation ranking order. The business activities in which the firms are engaged are outlined to provide background information for the reader.

We examine the emotional lives of the loyal opposition: those who remain steadfast in their duty-oriented, deontological ethical commitment to their workplace organization, but are in conflict with the dominant, utilitarian ethical view emphasizing practicality and revenue. When one is an “outsider” or even an “outcast” due to their deontological ethics, this conflict between personal and organizational ethics can result in a wide variety of emotions ranging from fear and sadness to alienation, and even rarely, to joy. Using qualitative methods, we analyze interview and observational data sets from two distinct populations within different workplace organizations: non-profit human service workers and faculty members who teach ethics in business schools. In both data sets, negative and positive emotions were experienced by participants immersed in a workplace environment characterized by ethical conflict. Though tension between the deontological and utilitarian ethical positions generated powerful emotions among the employee populations, it was not necessarily detrimental to the organization and in fact seemed to have a constructive, steadying influence. Ethical conflict can be constructive, function to make an organization stronger, and contribute positively to organizational success. The likelihood of positive outcomes increases if the emotional work entailed is sufficiently recognized and addressed.

Community health clinics serving the poor and underserved are geographically expanding due to changes in U.S. health care policy. This paper describes the experience of a collaborative alliance of health care providers in a large metropolitan area who develop a conceptual and mathematical decision model to guide decisions on expanding its network of community health clinics.

Community stakeholders participated in a collaborative process that defined constructs they deemed important in guiding decisions on the location of community health clinics. This collaboration also defined key variables within each construct. Scores for variables within each construct were then totaled and weighted into a community-specific optimal space planning equation. This analysis relied entirely on secondary data available from published sources.

The model built from this collaboration revolved around the constructs of demand, sustainability, and competition. It used publicly available data defining variables within each construct to arrive at an optimal location that maximized demand and sustainability and minimized competition.

This is a model that safety net clinic planners and community stakeholders can use to analyze demographic and utilization data to optimize capacity expansion to serve uninsured and Medicaid populations.

Communities can use this innovative model to develop a locally relevant clinic location-planning framework.