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This study examines the relationship between economic policy uncertainty (EPU) and managers' ex ante strategic choice on firms’ fixed and variable costs structure, i.e. cost rigidity and the moderating effect of government contracts and political connections.

Using a sample of 4,162 US firms during 2003–2019 and EPU measure from Baker et al. (2016), the authors examine the association between EPU and cost rigidity using multivariate regression analysis. The authors also examine the moderating effects of government customers and political connections using the subsampling method.

This study finds that increases in EPU leads to higher cost rigidity, suggesting that managers tend to look ahead and make an ex ante commitment to invest more in fixed costs to avoid congestion costs in anticipation of future product demand during EPU. The study also finds that the presence of government customers and political connections moderates the need for adopting greater cost rigidity.

This study measures firms' cost rigidity based on archival data. Future studies could utilize managers' cost structure choices using firms' internal management cost structure forecasts data to measure cost rigidity to examine the relationship between cost rigidity and EPU.

This study demonstrates that managers tend to make a proactive commitment to invest in fixed inputs when facing demand uncertainty from EPU to avoid congestion costs. This study also highlights the value of having government contracts and political connections by demonstrating that managers are less concerned about the congestion costs, hence weakening the impact of EPU on cost rigidity when they have government as major customers and/or political connections.

This study extends the management accounting literature by documenting that cost rigidity is related to EPU and that the relationship between cost rigidity and EPU also depends on whether the firm has government as major customers and/or political connections or not.

Drawing upon the stimulus-organism-response model, this study aims to explore the impact of soft aspects of service quality on revisit intention through the mechanism of perceived empathy.

For the examination of the hypothesized relationships, the study adopts structural equation modelling to analyse the data of 562 respondents (i.e. 281 family members and 281 inpatients).

The empirical results suggest that service quality increased family member empathy perception, which, in turn, improved inpatients’ revisit intentions.

Past studies have focused on the roles of overall service quality. The authors have extended the literature by examining the specific but important aspect of service quality and its effects on emotional response. Importantly, the study explains that the affective reactions of a patient’s family, fastened with perceived empathy, have a central role in influencing the patients’ subsequent reactions. Moreover, the prior studies collected the data either from hospital employees or patients. However, in the present study, the authors used a unique sample (family members as well as patients) to have a deeper understanding. Thus, the study enhances the literature on the stimuli-response (i.e. service quality – revisit intentions) relationship in the context of service marketing in general and health care in specific. Important academic and managerial contributions and recommendations for future research are discussed.

This study examines potential ways to break the inequality reproduction circle faced by ethnic minority health workers and sustained by key performance indicators (KPIs)-centred management in the National Health Service (NHS) in England. It does so through the lens of signalling theory.

Three years panel data for 2018–2020 covering 207 hospitals was compiled from the annual NHS staff survey and matched with relevant administrative records. Structural equation modelling was used to test the proposed hypotheses at the organisational level.

The moderated mediating model reveals that persistent racial discrimination by managers and coworkers can disadvantage the career progression of ethnic minority health workers, which in turn reinforces and reproduces economic and health inequalities among them. More importantly, we show how the collective agreement that the senior management team acts (SMTA) on staff feedback can break this vicious circle.

While our research focuses on the not-for-profit health care sector, it opens important opportunities to extend the proposed model to understand organisational inequality and how to address it.

Perceived SMTA can send strong signals to reduce deep-rooted discrimination (race, gender, age, etc.) through resource allocations and instrumental functions. This is also a way to address the current staff burnout and shortage issues in the healthcare sector.

This article reveals why the purpose of organisations that provide public service to reduce social inequality was comprised during their business-like operations and more importantly, how to reflect their foundational purpose through management practice.

This study offers a way forward to resolve one of the unintended consequences of KPI-centred management in the not-for-profit sector through unpacking the process of inequality reproduction and, more importantly, how it is possible to break this vicious circle.

This study aims to examine the performance implications of an information governance (IG) framework for managing, controlling access to and securing information, focusing on (1) the performance benefits of an organization's IG orientation and (2) how the configuration of IG orientation and supply chain (SC) strategy type relate to performance outcomes.

This study leverages multiple secondary sources for US hospitals, serving as the context for the study. It also employs cluster analysis to develop an SC strategy taxonomy, namely sophisticated and delivery-focused SC strategies. The proposed research model is tested using a robust regression to mitigate the influence of outliers and produce more accurate estimates.

IG orientation is positively associated with financial performance and patient experience, and IG-oriented hospitals with a sophisticated SC strategy realize more financial benefits and achieve better patient care experiences compared to other configurations. Regardless of SC strategy type, IG-oriented hospitals offer better care experiences than non-IG-oriented hospitals.

This paper offers empirical evidence that a hospital's IG orientation and SC strategy jointly affect financial outcomes and patient experience. For hospitals, an organization-wide framework for governing information streamlines both intra- and inter-organizational information flows and improves care delivery throughout a patient's care experience.

This is one of a few studies that empirically examine the performance implications of governance of information in the domain of supply chain management (SCM). This study also develops an SC strategy taxonomy for the healthcare context and offers a springboard for research in service SC strategy.

The purpose of this research is to investigate how different accountability practices might be observed in the annual reports of non-government organisations (NGOs) in Bangladesh. The study further aims to understand whether such accountability disclosures support NGO legitimacy in Bangladesh and if so, in what form.

To fulfil this objective, a content analysis was conducted on the annual reports of 24 selected leading NGOs operating in Bangladesh. The data were then analysed through the not-for-profit accountability framework of Dhanani and Connolly (2012). Theoretical constructs of legitimacy were further mobilised to corroborate the evidence.

It was found that NGOs operating in Bangladesh discharged all four types of accountability, i.e., strategic, fiduciary, financial and procedural (Dhanani and Connolly, 2012) through annual reports. The findings further suggested that carrying out these accountabilities supported the legitimation process of NGOs. Moreover, we found that NGOs took care of the needs of both primary and secondary stakeholders although they widely used self-laudatory positively charged words to disclose information about their accountabilities.

The study contributes to the limited accounting research on the public disclosures of NGOs and not-for-profit firms particularly in emerging economy settings. Also, we contribute to the limited research on the accountability-legitimacy link of NGOs evident in public disclosures like annual reports.

Many healthcare institutions, such as hospitals, have recently implemented quality improvement initiatives such as Lean Six Sigma (LSS). However, only a few have sustained the initiatives and remained successful. One of the main reasons for the failure of LSS implementation is that managers tend to view LSS as individual projects. Managers lack a Change Management (CM) focus during the implementation. The primary purpose of this study is to document the implementation of LSS through a CM approach to improve sustainability.

Define-Measure-Analyse-Improve-Control (DMAIC) and the Awareness-Desire-Knowledge-Ability-Reinforcement (ADKAR), a popular CM approach, are combined to propose a new framework. The usefulness of the proposed framework is demonstrated using a case study in a multispeciality hospital located in southern India.

The study found that several factors are responsible for the high Length of Stay (LOS) for patients in the Emergency Department (ED). By implementing this proposed model to implement LSS and taking corrective actions, the average LOS was reduced from 267 to 158 min (a 40% reduction approximately).

The complete step-by-step approach is explained, and the LOS was considerably reduced during the pilot project. The findings will provide valuable insights for healthcare practitioners to understand the steps involved in the combined DMAIC-ADKAR model. The findings would also give healthcare practitioners the confidence to identify suitable tools and implement LSS in organisations where the practitioners work.

According to the authors' knowledge, this is the first study that synergises two models (DMAIC and ADKAR) into a single framework to implement in a hospital.

Healthcare property has become an important alternate property sector in recent years for many international institutional investors. The purpose of this paper is to assess the risk-adjusted performance, portfolio diversification benefits and performance dynamics of French healthcare property in a French property portfolio and mixed-asset portfolio over 1999–2020. French healthcare property is seen to have different performance dynamics to the traditional French property sectors of office, retail and industrial property. Drivers and risk factors for the ongoing development of the direct healthcare property sector in France are also identified, as well as the strategic property investment implications for institutional investors.

Using annual total returns, the risk-adjusted performance, portfolio diversification benefits and performance dynamics of French direct healthcare property over 1999–2020 are assessed. Asset allocation diagrams are used to assess the role of direct healthcare property in a French property portfolio and in a French mixed-asset portfolio. The role of specific drivers for French healthcare property performance is also assessed. Robustness checks are also done to assess the potential impact of COVID-19 on the performance of French healthcare property.

French healthcare property is shown to have different performance dynamics to the traditional French property sectors of office, retail and industrial property. French direct healthcare property delivered strong risk-adjusted returns compared to French stocks, listed healthcare and listed property over 1999–2020, only exceeded by direct property. Portfolio diversification benefits in the fuller mixed-asset portfolio context were also evident, but to a much lesser extent in a narrower property portfolio context. Importantly, this sees French direct healthcare property as strongly contributing to the French property and mixed-asset portfolios across the entire portfolio risk spectrum and validating the property industry perspective of healthcare property being low risk and providing diversification benefits in a mixed-asset portfolio. However, this was to some degree to the loss or substitution of traditional direct property exposure via this replacement effect. French direct healthcare property and listed healthcare are clearly shown to be different channels in delivering different aspects of French healthcare performance to investors. Drivers of French healthcare property performance are also shown to be both economic and healthcare-specific factors. The performance of French healthcare property is also shown to be different to that seen for healthcare property in the UK and Australia. During COVID-19, French healthcare property was able to show more resilience than French office and retail property.

Healthcare property is an alternate property sector that has become increasingly important in recent years. The results highlight the important role of direct healthcare property in a French property portfolio and in a French mixed-asset portfolio, with French healthcare property having different investment dynamics to the other traditional French property sectors. The strong risk-adjusted performance of French direct healthcare property compared to French stocks, listed healthcare and listed property sees French direct healthcare property contributing to the mixed-asset portfolio across the entire portfolio risk spectrum. French healthcare property’s resilience during COVID-19 was also an attractive investment feature. This is particularly important, as many institutional investors now see healthcare property as an important property sector in their overall portfolio; particularly with the ageing population dynamics in most countries and the need for effective social infrastructure. The importance of French direct healthcare property sees direct healthcare property exposure accessible to investors as an important alternate real estate sector for their portfolios going forward via both non-listed healthcare property funds and the further future establishment of more healthcare REITs to accommodate both large and small institutional investors respectively. The resilience of French healthcare property during COVID-19 is also an attractive feature for future-proofing an investor’s portfolio.

This paper is the first published empirical research analysis of the risk-adjusted performance, diversification benefits and performance dynamics of French direct healthcare property, and the role of direct healthcare property in a French property portfolio and in a French mixed-asset portfolio. This research enables empirically validated, more informed and practical property investment decision-making regarding the strategic role of French direct healthcare property in a portfolio; particularly where the strategic role of direct healthcare property in France is seen to be different to that in the UK and Australia via portfolio replacement effects. Clear evidence is also seen of the drivers of French healthcare property performance being strongly influenced by healthcare-specific factors, as well as economic factors.

Within the context of the nonprofit resiliency framework, the authors use nonprofit functional expenses and contribution revenue to explore how the COVID-19 pandemic affected the ability of nonprofits in different subsectors to carry out their mission, as well as their ability to “pivot” fundraising strategies to integrate social media and digital engagement.

The authors use IRS form 990 return data for organizations with a year-end return that includes at least six months of COVID-19 impact (“Wave 1 Effects” period) and also have a prior-year return (“Business as Usual” period). The authors use Wilcoxon signed rank tests to examine whether there are differences in our variables of interest between the two periods.

While the majority of nonprofits in most subsectors experienced a significant decrease in program spending, fundraising spending and fundraising efficiency ratios between the two time periods, the authors found variation in the change in contribution revenue and fundraising ratio between the two periods between subsectors. The authors also find that the percentage of nonprofits able to “pivot” their fundraising strategies varies by subsector between 13.33 and 31.23%.

This paper provides new information regarding the pandemic's initial effect on nonprofit program and fundraising spending, the related contribution revenue and the ability of nonprofits to “pivot” fundraising to remote strategies. The authors propose a more robust fundraising efficiency measure and a new measure indicating a nonprofit's “ability to pivot” their fundraising strategy. The authors encourage future researchers to conduct further longitudinal studies to understand how these effects may continue or change.

Research has examined how new ventures strengthen local economic outcomes; however, limited research examines health-oriented ventures and their impact on social outcomes, including health outcomes. Increased VC investment in healthcare service start-ups signals more activity toward this end, and the need for further academic inquiry. We examine the relationship between these start-ups and county-level health outcomes, health factors, and hospital utilization.

Data on start-ups funded via institutional venture capital from PitchBook were merged with US county-level outcomes from the County Health Rankings and Area Health Resources Files for 2010 to 2019. We investigated how the number of VC-funded healthcare service start-ups, as well as a subset defined as innovative, were associated with county-level health measures. We used panel models with two-way fixed effects and Propensity Score Matched (PSM), controlling for demographics and socioeconomic factors.

Each additional VC-funded healthcare service start-up was related to a significant 0.01 percentage point decrease in diabetes prevalence (p < 0.01), a decrease of 1.54 HIV cases per 100,000 population (p < 0.1), a 0.02 percentage point decrease in obesity rates (p < 0.01), and a 0.03 percentage point decrease in binge drinking (p < 0.01). VC-funded healthcare service start-ups were not related to hospital utilization.

This work expands our understanding of how industry-specific start-ups, in this case healthcare start-ups, relate to positive social outcomes. The results underscore the importance of evidence-based evaluation, the need for expanded outcome measures for VC investment, and the possibilities for integration of healthcare services and entrepreneurship ecosystems.

The creation of positive social change (PSC) is considered the primary success criterion when evaluating social enterprise performance. However, despite a proliferation of PSC-measurements, their empirical validity and applicability in emerging economies remain largely unclear. The quantitative study examines the validity of the PSC-measurement approaches proposed by Bloom and Smith (2010; Bloom and Smith approach [BSA]) and Weaver (2020b; Weaver approach [WA]) in South Africa.

Investigating a representative sample of 347 social entrepreneurs from Gauteng and Limpopo provinces, the authors use questionnaire data to explore the factorial, convergent and discriminant validity of both PSC-measurement approaches. Statistically, this is done by applying factorial and correlation analyses.

The results yield acknowledgeable differences. BSA has a high factorial and convergent validity, while its discriminant validity remains doubtful. For WA, problems concerning factorial validity occur.

Despite limited generalizability, the authors provide a first guideline for scholars regarding the empirical validity of BSA and WA outside the context of developed economies.

The current study sheds light on the validity of two PSC-measurement approaches in an emerging economy context. This way, the authors contribute to the field by addressing the scarcity of empirical research and the restricted scope of developed economies regarding PSC-measurement.