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This paper aims to explore how historical context influences the content and selection of rhetorical legitimation strategies. Using case study method, this paper will focus on how insurance companies and labor tried to defend their legitimacy in the context of enactment of Medicare in the USA. What factors influenced the strategic (rhetorical) decisions made by insurance companies and labor unions in their institutional work?

The study is empirically grounded in archival research, involving an analysis of over 9,000 pages of congressional hearings on Medicare covering the period 1958–1965.

The authors show that rhetorical legitimation strategies depend significantly on the specific historical circumstances in which those strategies are used. The historical context lent credibility to certain arguments and organizations are forced to decide either to challenge widely held assumptions or take advantage of them. The authors show that organizations face strong incentives to pursue the latter option. Here, both the insurance companies and labor unions tried to show that their positions were consistent with classical liberal ideology, because of high respect of classical liberal principles among different stakeholders (policymakers, voters, etc.).

It is uncertain how much the results of the study could be generalized. More information about the organizations whose use of rhetorics the authors studied could have strengthened our conclusions.

The practical relevancy of the revised paper is that the authors should not expect hegemony challenging rhetorics from organizations, which try to influence legislators (and perhaps the larger public). Perhaps (based on the findings), this kind of rhetorics is not even very effective.

The paper helps to understand better how organizations try to advance their interests and gain acceptance among the stakeholders.

In this paper, the authors show how historical context in practice influence rhetorical arguments organizations select in public debates when their goal is to influence the decision-making of their audience. In particular, the authors show how dominant ideology (or ideologies) limit the options organizations face when they are choosing their strategies and arguments. In terms of the selection of rhetorical justification strategies, the most pressing question is not the “real” broad based support of certain ideologies. Insurance company and labor union representatives clearly believed that they must emphasize liberal values (or liberal ideology) if they wanted to gain legitimacy for their positions. In existing literature, it is often assumed that historical context influence the selection of rhetorical strategies but how this in fact happens is not usually specified. The paper shows how interpretations of historical contexts (including the ideological context) in practice influence the rhetorical strategies organizations choose.

This study aims to increase awareness and educate the reader about health-care fraud targeting seniors in the USA to help stakeholders better understand, recognize and prevent this type of fraud.

This paper collects statistics on the current state of health care frauds committed against seniors, and examines related cases and laws.

The authors find this type of fraud is highly prevalent and expected to increase. Current laws preventing this fraud from occurring are multifold and complex. While prevention strategies through law enforcement have been somewhat successful, a reduction in resources may put seniors at an increased risk in the years to come.

Without additional prevention strategies, the problem will likely escalate with a growing population of older adults. This study encourages further research into effective prevention strategies and methods to fight health-care fraud against seniors.

Health-care fraud and its associated costs pose a significant threat to the society and economy of the USA. Reducing this fraud will not only reduce the costs to the US economy but also improve the physical and mental well-being of senior victims, reduce their mortality and hospitalization rates and improve the public trust placed to health-care providers.

This study highlights how health-care fraud is committed against seniors. With the projected trend of an aging US population, educating stakeholders, increasing awareness and applying tools to protect seniors will be important to reduce the absolute scope of this problem in the future.

Residents in under-resourced/high-Medicaid (85% or higher) nursing homes on average receive care from relatively lower quality providers and have worse health outcomes, which may increase the risk of higher COVID-19 incidence. This study aims to evaluate if having a culture that encourages employee empowerment results in better quality (lower COVID-19 deaths) in times of crisis, such as the current pandemic. The study combined primary survey data from 391 Directors of Nursing (response rate of 37%), with Centers for Medicare and Medicaid Services’ (CMS) Nursing Home COVID-19 Public File, LTCFocus, Area Health Resource File, and Nursing Home Compare. The dependent variable consisted of the number of COVID-19 death as of November 25, 2021. The independent variables consisted of Likert scale for employee empowerment (Cronbach alpha= 0.82). Control variables consisted of organizational factors (e.g., size, location, and ownership), as well as community factors (e.g., poverty, unemployment, and competition). The results indicated that one unit increase in employee empowerment was associated with 6% lower likelihood of having COVID-19 deaths. Nursing homes, particularly those under-resourced, face difficulty improving the quality of care due to financial constraints. However, the results suggest that adopting a culture that fosters employee empowerment may give nursing homes an edge in improving quality outcomes in crises.

The COVID-19 pandemic created a broad array of challenges for hospitals. These challenges included restrictions on admissions and procedures, patient surges, rising costs of labor and supplies, and a disparate impact on already disadvantaged populations. Many of these intersecting challenges put pressure on hospitals' finances. There was concern that financial pressure would be particularly acute for hospitals serving vulnerable populations, including safety-net (SN) hospitals and critical access hospitals (CAHs). Using data from hospitals in Washington State, we examined changes in operating margins for SN hospitals, CAHs, and other acute care hospitals in 2020 and 2021. We found that the operating margins for all three categories of hospitals fell from 2019 to 2020, with SNs and CAHs sustaining the largest declines. During 2021, operating margins improved for all three hospital categories but SN operating margins still remained negative. Both changes in revenue and changes in expenses contributed to observed changes in operating margins. Our study is one of the first to describe how the financial effects of COVID-19 differed for SNs, CAHs, and other acute care hospitals over the first two years of the pandemic. Our results highlight the continuing financial vulnerability of SNs and demonstrate how the factors that contribute to profitability can shift over time.

The learning outcomes are as follows: understanding the impact on company growth through identification and alignment of stakeholder priorities in a project for SME in an emerging market; analyzing the impact of stakeholder alignment and relationship management on the project outcome; and evaluating the importance of Stakeholder Management for effective Project Management.

The case of ‘Hospedia Medicare,’ a medical device manufacturing company based in India, was started by a family involved in the medical devices business for over two decades. The company began operations in a new avatar and focused on one medical device or product by 2013. The product was designed with quality features to solve customer problems, making the cost relatively high compared to other domestic peers. Creating new product lines or updating the existing product attributes was imperative for the company to attain its growth objectives. The protagonist was dealing with a dilemma involving managing various stakeholders, aligning the project scope to create a growth story for the company in line with its vision and managing the stakeholders by understanding and analyzing their needs, expectations and interest, thus influencing the project outcome. The case can be used by instructors to identify, understand and evaluate the importance of different stakeholders on project outcome or success. Furthermore, it can be used to analyze and critique the impact of stakeholders on project scope, which can affect the long-term sustainability of the company, as different stakeholders have different expectations and needs. The case also details how regular communication, collaboration and awareness became essential for the project's success. Lack of an effective engagement strategy at the project planning stage can have risks concerning cost and achieving the overall vision, which creates a positive outcome for all the stakeholders.

The case study can be introduced to graduate and undergraduate students to reflect on and critique the importance of Stakeholder Management in Project Management. It can be used for, entrepreneurship, project management, operations and strategy, particularly emphasizing for small and medium enterprises (SMEs).

Teaching notes are available for educators only.

CSS 9: Operations and Logistics.

This chapter provides an overview of the role of technology and policy in shaping care plans for patients. Historically, healthcare has lagged behind other industry sectors in adopting and deploying useful technologies, and policy surrounding use is an important component of establishing a long-term strategy. This chapter evaluates the current state of technology in the clinical setting and extends the widely adopted policy-based approaches into the palliative care context.

The purpose of this study is to investigate how two types of drivers, namely, executive compensation and market competition, can affect hospital quality in the USA. Recently, patients, insurers and regulators have increasingly focused on hospital quality. Understanding the interplay of incentives in this industry is important because in 2019, hospital treatment contributed $1.161bn to health-care costs in the USA. This study answers the call for more studies in the so-called “mixed” industry, where ownership differences can affect organizational objectives and operating constraints.

This study explores the roles of hospital executive compensation and industry competition as determinants of health-care quality. Specifically, the study probes the heterogeneity in the factors that influence quality across hospital types in the USA.

Using California hospital data from 2006 through 2020, the findings show that the effects of compensation and competition on hospital quality differ by ownership type. Executive compensation is positively associated with quality in for-profit hospitals but is not associated with that of nonprofit hospitals, suggesting for-profit hospitals are more likely to use higher levels of compensation to attract managers with higher ability, whereas the utility function for nonprofit managers may be multidimensional. Within the nonprofit hospital group, competition is more positively associated with quality for religious nonprofits relative to secular nonprofits, suggesting that competition provides more monitoring for religious hospitals.

Taken together, the findings provide evidence that the drivers of quality vary across hospitals in ways consistent with differences in constraints and objectives across ownership types. The findings are important for regulators seeking to incentivize higher quality. For example, Medicare in the USA has incorporated quality measures into its new hospital reimbursement scheme (value-based purchasing) to incentivize quality. This study proposes that regulators should consider differences across ownership types when evaluating the best ways to incentivize hospital quality.

The authors examine how physician staffing, human capital and knowledge spillovers are related to multiple dimensions of hospital operational and financial performance at the organizational level.

The authors use a data set assembled from multiple sources for more than 1,300 US hospitals and employ hierarchical linear regression to test this study’s hypotheses. The authors use multiple quality, efficiency and financial measures of performance for these hospitals.

The authors find that higher levels of staffing, skills and knowledge spillovers associated with physicians were positively associated with multiple dimensions of hospital performance. The authors find linear and nonlinear relationships between experience and performance, with the relationships primarily negative, and nonlinear relationships between spillovers and quality performance.

Hospital managers should consider increasing physician staffing levels if possible. In addition, the overall Final MIPS Score from the Centers for Medicare and Medicaid Services might be included as a factor in determining which physicians practice in a hospital. Finally, if possible, encouraging physicians to practice at multiple hospitals will likely be beneficial to hospital performance.

This study’s findings are original in that they explore how physician-specific staffing and human capital, which have received comparatively little attention in the literature, are related to several different dimensions of hospital-level operational and financial performance. To the best of the authors’ knowledge, this paper is also the first to examine the relationship between the construct of physician knowledge spillovers and hospital-level operational and financial performance.

High-quality nursing home (NH) care has long been a challenge within the United States. For decades, policymakers at the state and federal levels have adopted and implemented regulations to target critical components of NH care outcomes. Simultaneously, our delivery system continues to change the role of NHs in patient care. For example, more acute patients are cared for in NHs, and the Center for Medicare and Medicaid Services (CMS) has implemented value payment programs targeting NH settings. As a part of these growing pressures from the broader healthcare delivery system, the culture-change movement has emerged among NHs over the past two decades, prompting NHs to embody more person-centered care as well as promote settings which resemble someone's home, as opposed to institutionalized healthcare settings.

Researchers have linked culture change to high-quality outcomes and the ability to adapt and respond to the ever-changing pressures brought on by changes in our regulatory and delivery system. Making enduring culture change within organizations has long been a challenge and focus in NHs. Despite research suggesting that culture-change initiatives that promote greater resident-centered care are associated with several desirable patient outcomes, their adoption and implementation by NHs are resource intensive, and research has shown that NHs with high percentages of low-income residents are especially challenged to adopt these initiatives.

This chapter takes a novel approach to examine factors that impact the adoption of culture-change initiatives by assessing knowledge management and the role of knowledge management activities in promoting the adoption of innovative care delivery models among under-resourced NHs throughout the United States. Using primary data from a survey of NH administrators, we conducted logistic regression models to assess the relationship between knowledge management and the adoption of a culture-change initiative as well as whether these relationships were moderated by leadership and staffing stability. Our study found that NHs were more likely to adopt a culture-change initiative when they had more robust knowledge management activities. Moreover, knowledge management activities were particularly effective at promoting adoption in NHs that struggle with leadership and nursing staff instability. Our findings support the notion that knowledge management activities can help NHs acquire and mobilize informational resources to support the adoption of care delivery innovations, thus highlighting opportunities to more effectively target efforts to stimulate the adoption and spread of these initiatives.

The study examines health care inequities in viral load testing among hepatitis C (HCV) antibody-positive patients. The analysis predicts whether individual and census tract sociodemographic characteristics impact the likelihood of viral load testing.

This a study of 26,218 HCV antibody-positive patients in Orange County, California, from 2010 to 2020. The case data were matched with the 2017 American Community Survey to help understand the role of neighborhood socioeconomic characteristics in testing for viral load. Multivariable logistic regression was used to predict the probability of ever testing for HCV viral load.

Thirty-six percent of antibody-positive persons were never viral load tested. The results show inequalities in viral load testing by sociodemographic factors. The following groups were less likely to ever test for viral load than their counterparts: (1) individuals under 65 years old, (2) females, (3) residents of census tracts with lower levels of health insurance enrollment, (4) residents of census tracts with lower levels of government health insurance, and (5) residents of census tracts with a higher proportion of non-white residents.

This is a secondary database from public health department reports. Using census tract data raises the issue of the ecological fallacy. Detailed medical records were not available. The results of this study emphasize the social inequality in viral load testing for HCV. These groups are less likely to be treated and cured, and may spread the disease to others.

This chapter is unique as it combines routinely collected public health department data with census tract level data to examine social inequities associated with lower rates of HCV viral load testing.