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Purpose: While COVID-19 has upended lives, it has also catalyzed innovation with potential to advance health delivery. Yet, we know little about how the delivery system, and primary care in particular, has responded and how this has impacted vulnerable patients. We aimed to understand the impact of COVID-19 on primary care practice sites and their vulnerable patients and to identify explanations for variation. Approach: We developed and administered a survey to practice managers and physician leaders from 173 primary care practice sites, October-November 2020. We report and graphically depict results from univariate analysis and examine potential explanations for variation in practices' process innovations in response to COVID-19 by assessing bivariate relationships between seven dependent variables and four independent variables. Findings: Among 96 (55.5%) respondents, primary care practice sites on average took more safety (8.5 of 12) than financial (2.5 of 17) precautions in response to COVID-19. Practice sites varied in their efforts to protect patients with vulnerabilities, providing care initially postponed, and experience with virtual visits. Financial risk, practice size, practitioner age, and emergency preparedness explained variation in primary care practices' process innovations. Many practice sites plan to sustain virtual visits, dependent mostly on patient and provider preference and continued reimbursement. Value: While findings indicate rapid and substantial innovation, conditions must enable primary care practice sites to build on and sustain innovations, to support care for vulnerable populations, including those with multiple chronic conditions and socio-economic barriers to health, and to prepare primary care for future emergencies.

This article examines how a profit-centered restructuring of labor relations in an academic medical center undermined team-based care practices in its intensive care unit. The Institute of Medicine has promoted team-based care to improve patient outcomes, and the staff in the intensive care unit researched for this paper had established a set of practices they defined as teamwork. After hospital executives rolled out a public relations campaign to promote its culture of teamwork, they restructured its workforce to enhance numerical and functional flexibility in three key ways: implementing a “service line” managerial structure; cutting a range of staff positions while combining others; and doubling the capacity of its profitable and highly regarded intensive care unit. Hospital executives said the restructuring was necessitated by changes to payment models brought forth by the Affordable Care Act. Based on 300 hours of participant-observation and 35 interviews with hospital staff, findings show that the restructuring lowered staff resources and intensified work, which limited their ability to practice care they defined as teamwork and undermined the unit’s collective identity as a team. Findings also show how staff members used teamwork as a sensitizing concept to make sense of what they did at work. The meanings attached to teamwork were anchored to positions in the hospitals’ organizational hierarchy. This paper advances our understanding of he flexible work arrangements in the health care industry and their effects on workers.

Social media tools such as Facebook and Twitter are increasingly being integrated into recruiting and outreach activities across the US universities. Despite their popularity among staff, resources on best practices in higher education remain sparse. As new communication tools evolve and transform higher education, researchers must adapt their approaches to understand these tools and collect relevant data. This study presents and tests new methods for conducting research in higher education communications. The author presents digital ethnography as a relevant methodological approach for researching and understanding online communities in higher education. Using an exploratory online survey distributed through online social networks as an example, the author gathers data on the use of social media in international higher education recruiting and outreach. The exploratory survey sought information on which social media tools were being used by university staff, the perceived benefits and drawbacks of social media use in international recruiting and outreach, and how universities measured social media for international recruiting purposes. Using a digital ethnographic approach, the author gathered relevant, timely data from international higher education professionals and gained insight into the norms, rules, and workings of social networking communities. Results point to new methods for understanding the evolution of higher education communications for researchers and university staff alike. Data from the exploratory study of international higher education communications are presented as an example of the rich amount of data obtained through the approach.

In this chapter we question whether current conceptualizations of global leadership competencies adequately address the dynamic and complex nature of the multinational team (MNT) context. We report findings from a study that incorporated the perspectives of MNT leaders as well as members on MNT leadership. We asked MNT leaders and their team members to identify the competencies that they believe are needed for effectively managing MNTs. The findings from this study promise to enhance our understanding about the specific nature of the MNT context, as viewed by the two parties that are at the frontline of multinational teamwork: team members and leaders. We use this dual perspective to clarify global competencies that MNT leaders may need to develop in themselves, and to propose a framework that may assist multinational organizations in identifying, rewarding, and developing MNT leaders.

This chapter explores the concept of an entrepreneurship education ecosystem. The concept of ecosystem comes from the natural sciences, but is increasingly applied to regional development, or clusters, which focus on firm inter-organizational relationships. Building on the idea of the university is a key player in a local entrepreneurship ecosystem, this chapter provides a framework for examining a school’s role in this process. A typology is presented that articulates roles that schools may pursue in developing their own internal entrepreneurship education ecosystem.

Purpose – This chapter explores the use of adaptive and disruptive change strategies to create an integrated health care delivery system that is both economically sustainable and patient-centered.

Design/methodology – This case study of Montefiore Medical Center is based on a year of research that included focus-group interviews; individual interviews with executives, frontline staff, and union leaders; site visits; analysis of internal data; and a literature review.

Findings – Montefiore Medical Center is using both adaptive and disruptive strategies to develop an integrated delivery system driven by capitated payments from health insurance companies, a focus on primary care and chronic disease management programs, and community outreach. The growth of these delivery system components in conjunction with Montefiore's Care Management Corporation (to help manage the health plan contracts) has contributed to an affordable cost of care, improved clinical outcomes, and proactive patient and community engagement.

Originality and value – There is a paucity of case studies describing how safety-net hospitals – and health systems in general – can integrate the services they provide to create a positive, seamless, and economical patient experience. The story of Montefiore Medical Center offers an overview of how health care infrastructure and payment methods can be transformed to align financial and clinical incentives and to better serve a patient population that largely depends on government health insurance.

This chapter draws on a study conducted in the mid 1990s to compare management differences between three different groups of South African hospitals, in order to understand how these differences might have affected hospital functioning. The groups were public hospitals; contractor hospitals publicly funded but privately managed; and private hospitals owned and run by private companies. Public sector structures made effective management difficult and were highly centralized, with hospital managers enjoying little autonomy. In contrast, contractor and private groups emphasised efficient management and cost containment. These differences appeared to be reflected in cost and quality differences between the groups. The findings suggest that in the context of a country such as South Africa, with a relatively well-developed private sector, there is potential for the government to profit from the management expertise in the private sector by identifying lessons for its own management structures, and by contracting-out service management.