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The Institute for Healthcare Improvement (IHI) has broadened their campaign focus to include protecting hospital patients from five million incidents of medical harm through 2008. A critical component of this campaign is the engagement of governance in the process, noting evidence of better patient outcomes for hospitals with governing boards that spend at least 25% of their time on quality and safety. St. Francis Medical Center (SFMC), a 384-bed hospital in Southeast Los Angeles serving a high number of uninsured and underinsured patients and a population characterized by significant poverty, has initiated through a top-down approach, an aggressive plan to improve the care at its facilities through a call to action by its board of directors. In this article innovative methods are shared, tools are provided, and the initial positive results achieved are reported which show how a cultural change is occurring regarding quality and patient safety (QPS) at this hospital's organizational and delivery system level.

Persistent change has placed considerable pressure on organizations to keep up or fade into obscurity. Firms that remain viable, or even thrive, are staffed with decision-makers who capably steer organizations toward opportunities and away from threats. Accordingly, leadership development has never been more critical. In this chapter, the authors propose that leader development is an inherently dyadic process initiated to communicate formal and informal expectations. The authors focus on the informal component, in the form of organizational politics, as an element of leadership that is critical to employee and company success. The authors advocate that superiors represent the most salient information source for leader development, especially as it relates to political dynamics embedded in work systems. The authors discuss research associated with our conceptualization of dyadic political leader development (DPLD). Specifically, the authors develop DPLD by exploring its conceptual underpinnings as they relate to sensemaking, identity, and social learning theories. Once established, the authors provide a refined discussion of the construct, illustrating its scholarly mechanisms that better explain leader development processes and outcomes. The authors then expand research in the areas of political skill, political will, political knowledge, and political phronesis by embedding our conceptualization of DPLD into a political leadership model. The authors conclude by discussing methodological issues and avenues of future research stemming from the development of DPLD.

We study the decision-making process behind business model change, focusing specifically on the tactics managers employ to gain support for such changes. We first argue for the prominent role of middle management in business model change, and second, we revisit the literature on issue selling and championing as they may apply to business model change decision-making. We subsequently analyze the case of a business model change initiative in the Dutch water authority sector, revealing two specific tactics that middle management employed to obtain top management’s agreement to business model change: leveraging external agreements and continuously informing top management. We discuss how these findings extend and in some ways suggest a rethink of the literature on organizational change. Finally, we describe the specificities of business model change that distinguish it from other types of change. In sum, this paper demonstrates the interest of research at the nexus of business models and organizational change.

At the beginning of the 20th century, three intertwined ambitions drove federal legislation over wildlife and biodiversity: establishment of multiple-use federal lands, the economic development of natural resources, and the maintenance of option values. We examine this federal intervention in natural resource use by analyzing roll call votes over the past century with a Random Utility Model (Manski, 1977) and conclude that economics mattered. So did ideology, but not uniformly. After World War II, the pro-environment vote which had been conservative shifted to being liberal. All these votes involved decisions regarding public land that reallocated the returns to users by changing the asset’s physical character or its usage rights. We suggest that long-term consequences affecting current resource allocations arose from disparities between broadly dispersed benefits and locally concentrated socioeconomic and geophysical (spatial) costs. We show that a primary intent of public land management has become to preserve multiple-use option values and identify important factors in computing those option values. We do this by demonstrating how the willingness to forego current benefits for future ones depends on the community’s resource endowments. These endowments are defined not only in terms of users’ current wealth accumulation but also from their expected ability to extract utility from natural resources over time.