Managerial work roles of health care executives in the changing environment of academic medical centers

The current U.S. health care system faces numerous environmental challenges. To compete and survive, health care organizations are developing strategies to lower costs and increase efficiency and quality. All of these strategies require rapid and precise decision making by top level managers. The purpose of this study is to determine the relationship between the environment, made up of unfavorable market conditions and limited resources, and the work roles of top level managers, specifically in the settings of academic medical centers. Managerial work roles are based on the ten work roles developed by Henry Mintzberg, in his book, The Nature of Managerial Work (1973). ^ This research utilized an integrated conceptual framework made up of systems theory in conjunction with role, attribution and contingency theories to illustrate that four most frequently performed Mintzberg's work roles are affected by the two environment dimensions. The study sample consisted of 108 chief executive officers in academic medical centers throughout the United States. The methods included qualitative methods in the form of key informants and case studies and quantitative in the form of a survey questionnaire. Research analysis involved descriptive statistics, reliability tests, correlation, principal component and multivariate analyses. ^ Results indicated that under the market condition of increased revenue based on capitation, the work roles increased. In addition, under the environment dimension of limited resources, the work roles increased when uncompensated care increased while Medicare and non-government funding decreased. ^ Based on these results, a typology of health care managers in academic medical centers was created. Managers could be typed as a strategy-formulator, relationship-builder or task delegator. Therefore, managers who ascertained their types would be able to use this knowledge to build their strengths and develop their weaknesses. Furthermore, organizations could use the typology to identify appropriate roles and responsibilities of managers for their specific needs. Consequently, this research is a valuable tool for understanding health care managerial behaviors that lead to improved decision making. At the same time, this could enhance satisfaction and performance and enable organizations to gain the competitive edge . ^

Associations between SOX 404 opinions and auditors, audit committees, and executives

This dissertation examined three issues associated with Section 404 of the Sarbanes-Oxley Act (SOX) that are of current interest to regulators and the accounting profession. For the first essay, I examined auditor changes from 2003 to 2005 for 2,454 non-financial firms that filed their initial SOX 404 opinions prior to July 1, 2005. My results showed that there is a significant association between the receipt of an adverse SOX 404 opinion and auditor resignations - both before and after the issuance of the SOX 404 opinion. The data related to auditor dismissals show that clients are not successful in opinion shopping, since clients dismissing the auditor before the SOX 404 report also are more likely to receive an adverse SOX 404 opinion than clients not changing auditors. My second essay examined the relation between audit committee characteristics and changes in material weaknesses in internal control over financial reporting under the new SOX regime. My results showed that improvements in internal control in the second year of SOX are associated with: (1) the number of audit committee members and (2) financial expertise of audit committee members. My third essay examined the relation between the appointment of the new executives and the subsequent receipt of initial section 404 of SOX opinions. My results showed that adverse SOX 404 reports will be more likely at firms that recently hired a new chief financial officer (CFO).

Consequences of financial restatements for auditors and top executives

This dissertation consists of three essays and investigates issues related to the impact of financial restatements on auditor change, shareholder actions, and executive turnover in the post-Sarbanes Oxley Act (SOX) period. For the first essay, we examined auditor change at 569 restatement firms and 5,605 control firms for 2004. We found that restatement announcements significantly increased the likelihood of auditor resignation and dismissal in the post-SOX period. The second essay examines shareholder voting on auditor ratifications in 2006 following restatement announcements by SEC registrants in 2005. The proportion of votes not supporting auditor ratification is low even in the presence of a restatement. However, we find that shareholders are more likely to vote against auditor ratification after a restatement when compared to votes at (a) films without restatements, or (b) restating firms in the preceding period. The third essay examines the consequences of financial restatements on the turnover of chief financial officers (CFO). We find that restatement announcements do significantly increase the likelihood of CFO turnover no matter whether the departure is voluntary or forced in nature. Also, the significant relationship is present even after controlling for the effect of CEO turnover.

The career development of Black female chief nurse executives

This qualitative study was designed to explore the career development of Black female chief nurse executives. Although a small proportion of Black female nurses have achieved positions at the nurse executive level, there remains a paucity of Black female nurse executives in this crucial position which raised the question of what factors contributed to this lack of advancement, but, more important, what factors have contributed to the success of the few who have achieved such level of success in healthcare organizations. The purpose of the study was to explore the career paths of Black female chief nurse executives with a view of understanding the factors which both facilitate and hinder the career development of these leaders in healthcare organizations. The guiding research question was, How do Black female nurse executives in this sample describe their career development? The participants in this study were Black female chief nurse executives located throughout the United States who, for the most part, were raised in segregation with a strong family foundation. To collect data, semistructured telephone interviews were conducted with 10 Black female chief nurse executives throughout the United States. The transcripts from the interviews were transcribed, coded, and analyzed. Using Super’s (1990, 1996), and Gottfredson’s (1981, 1996, 2002, 2005) career development theories and critical race theory (Crenshaw, 1995; Delgado, 2000) as the theoretical framework, the researcher found that the participants’ career development was influenced by (a) strong support system, (b) guidance, (c) influence of diversity, and (d) servant leadership. The findings help us understand the factors that have contributed to their successes as Black chief nurse executives. With the increasingly diverse population and concurrent increasing diversity in nursing and concerns about healthcare disparities, it is imperative that organizations attract, hire, develop, retain, and advance qualified Black nurses. Future studies addressing not only the career development of Black nurses but nurses in general might be informed by the present study’s findings. Recommendations are offered for nursing practice, education, and organizational policy.

Revisiting the Ethics of Financial Executives in the Lodging Industry

This study revisited ethics in the hospitality industry and involved a randomly selected sample of lodging financial executives taken from the current membership roster of the Hospitality Financial and Technology Professionals (HFTP). After responding to a number of demographic questions, financial executives were asked to respond to 16 business scenarios that involved the issue of ethics. In addition, financial executives were asked if they would or would not do what the controller did in each scenario. Finally, responses of financial executives in the current study were compared to the responses of financial executives in a previous study. Findings indicate that there is considerable disagreement among financial executives regarding the ethical dimensions of common business scenarios

Job Satisfaction of Club Financial Executives

Studying the job satisfaction of financial management personnel in the club industry may offer additional information to management of clubs to better work with and retain their associates. It is also hoped that the results of this study will provide hospitality students aspiring to become financial management personnel in the club industry with a glimpse of the job satisfaction level of financial executives in the club industry

The Emotional Intelligence of National Automatic Merchandising Association (NAMA) Vending and Coffee Services Industries Executives: A Pilot Study

The authors report the pilot study focused on identifying the emotional intelligence (El) of leaders in the automatic merchandising and coffee service industries. The data were collected from 39 executives, members of National Automatic Merchandising Association (NM), who attended 2005 Executive Development Program on the campus of Michigan State University. Three elements of EI- IN, OUT, RELATIONSHIP for these leaders are discussed.

The Career Development of Black Female Chief Nurse Executives

This qualitative study was designed to explore the career development of Black female chief nurse executives. Although a small proportion of Black female nurses have achieved positions at the nurse executive level, there remains a paucity of Black female nurse executives in this crucial position which raised the question of what factors contributed to this lack of advancement, but, more important, what factors have contributed to the success of the few who have achieved such level of success in healthcare organizations. The purpose of the study was to explore the career paths of Black female chief nurse executives with a view of understanding the factors which both facilitate and hinder the career development of these leaders in healthcare organizations. The guiding research question was, How do Black female nurse executives in this sample describe their career development? The participants in this study were Black female chief nurse executives located throughout the United States who, for the most part, were raised in segregation with a strong family foundation. To collect data, semistructured telephone interviews were conducted with 10 Black female chief nurse executives throughout the United States. The transcripts from the interviews were transcribed, coded, and analyzed. Using Super’s (1990, 1996), and Gottfredson’s (1981, 1996, 2002, 2005) career development theories and critical race theory (Crenshaw, 1995; Delgado, 2000) as the theoretical framework, the researcher found that the participants’ career development was influenced by (a) strong support system, (b) guidance, (c) influence of diversity, and (d) servant leadership. The findings help us understand the factors that have contributed to their successes as Black chief nurse executives. With the increasingly diverse population and concurrent increasing diversity in nursing and concerns about healthcare disparities, it is imperative that organizations attract, hire, develop, retain, and advance qualified Black nurses. Future studies addressing not only the career development of Black nurses but nurses in general might be informed by the present study’s findings. Recommendations are offered for nursing practice, education, and organizational policy.

Market definition in industrial high-technology markets

This dissertation analyzes how marketers define markets in technology-based industries. One of the most important strategic decisions marketers face is determining the optimal market for their products. Market definition is critical in dynamic high technology markets characterized by high levels of market and technological uncertainty. Building on literature from marketing and related disciplines, this research is the first in-depth study of market definition in industrial markets. Using a national, probability sample stratified by firm size, 1,000 marketing executives in nine industries (automation, biotechnology, computers, medical equipment and instrumentation, pharmaceuticals, photonics, software, subassemblies and components, and telecommunications) were surveyed via a mail questionnaire. A 20.8% net response rate yielding 203 surveys was achieved. The market structure-conduct-performance (SCP) paradigm from industrial organization provided a conceptual basis for testing a causal market definition model via LISREL. A latent exogenous variable (competitive intensity) and four latent endogenous variables (marketing orientation, technological orientation, market definition criteria, and market definition success) were used to develop and test hypothesized relationships among constructs. Research questions relating to market redefinition, market definition characteristics, and internal (within the firm) and external (competitive) market definition were also investigated. Market definition success was found to be positively associated with a marketing orientation and the use of market definition criteria. Technological orientation was not significantly related to market definition success. Customer needs were the key market definition characteristic to high-tech firms (technology, competition, customer groups, and products were also important). Market redefinition based on changing customer needs was the most effective of seven strategies tested. A majority of firms regularly defined their market at the corporate and product-line level within the firm. From a competitive perspective, industry, industry sector, and product-market definitions were used most frequently.

Matching human resource and corporate strategies

Increasing use of the term, Strategic Human Resource Management (SHRM), reflects the recognition of the interdependencies between corporate strategy, organization and human resource management in the functioning of the firm. Dyer and Holder (1988) proposed a comprehensive Human Resource Strategic Typology consisting of three strategic types--inducement, investment and involvement. This research attempted to empirically validate their typology and also test the performance implications of the match between corporate strategy and HR strategy. Hypotheses were tested to determine the relationships between internal consistency in HRM sub-systems, match between corporate strategy and HR strategy, and firm performance. Data were collected by a mail survey of 998 senior HR executives of whom 263 returned the completed questionnaire. Financial information on 909 firms was collected from secondary sources like 10-K reports and CD-Disclosure. Profitability ratios were indexed to industry averages. Confirmatory Factor Analysis using LISREL provided support in favor of the six-factor HR measurement model; the six factors were staffing, training, compensation, appraisal, job design and corporate involvement. Support was also found for the presence of a second-order factor labeled "HR Strategic Orientation" explaining the variations among the six factors. LISREL analysis also supported the congruence hypothesis that HR Strategic Orientation significantly affects firm performance. There was a significant associative relationship between HR Strategy and Corporate Strategy. However, the contingency effects of the match between HR and Corporate strategies were not supported. Several tests were conducted to show that the survey results are not affected by non-response bias nor by mono-method bias. Implications of these findings for both researchers and practitioners are discussed. ^

Managing conflict in user-oriented development environments: Effects on information systems success

Today, many organizations are turning to new approaches to building and maintaining information systems (I/S) to cope with a highly competitive business environment. Current anecdotal evidence indicates that the approaches being used improve the effectiveness of software development by encouraging active user participation throughout the development process. Unfortunately, very little is known about how the use of such approaches enhances the ability of team members to develop I/S that are responsive to changing business conditions.^ Drawing from predominant theories of organizational conflict, this study develops and tests a model of conflict among members of a development team. The model proposes that development approaches provide the relevant context conditioning the management and resolution of conflict in software development which, in turn, are crucial for the success of the development process.^ Empirical testing of the model was conducted using data collected through a combination of interviews with I/S executives and surveys of team members and business users at nine organizations. Results of path analysis provide support for the model's main prediction that integrative conflict management and distributive conflict management can contribute to I/S success by influencing differently the manifestation and resolution of conflict in software development. Further, analyses of variance indicate that object-oriented development, when compared to rapid and structured development, appears to produce the lowest levels of conflict management, conflict resolution, and I/S success.^ The proposed model and findings suggest academic implications for understanding the effects of different conflict management behaviors on software development outcomes, and practical implications for better managing the software development process, especially in user-oriented development environments. ^

A case study of the Ellison model's use of mentoring as an approach toward inclusive community building

The Ellison Executive Mentoring Inclusive Community Building (ICB) Model is a paradigm for initiating and implementing projects utilizing executives and professionals from a variety of fields and industries, university students, and pre-college students. The model emphasizes adherence to ethical values and promotes inclusiveness in community development. It is a hierarchical model in which actors in each succeeding level of operation serve as mentors to the next. Through a three-step process—content, process, and product—participants must be trained with this mentoring and apprenticeship paradigm in conflict resolution, and they receive sensitivity and diversity training through an interactive and dramatic exposition. ^ The content phase introduces participants to the model's philosophy, ethics, values and methods of operation. The process used to teach and reinforce its precepts is the mentoring and apprenticeship activities and projects in which the participants engage and whose end product demonstrates their knowledge and understanding of the model's concepts. This study sought to ascertain from the participants' perspectives whether the model's mentoring approach is an effective means of fostering inclusiveness, based upon their own experiences in using it. The research utilized a qualitative approach and included data from field observations, individual and group interviews, and written accounts of participants' attitudes. ^ Participants complete ICB projects utilizing The Ellison Model as a method of development and implementation. They generally perceive that the model is a viable tool for dealing with diversity issues whether at work, at school, or at home. The projects are also instructional in that whether participants are mentored or serve as apprentices, they gain useful skills and knowledge about their careers. Since the model is relatively new, there is ample room for research in a variety of areas including organizational studies to determine its effectiveness in combating problems related to various kinds of discrimination. ^

The advantage of Spanish multinational enterprises in Latin America

Multinational enterprises (MNEs) from Spain made large foreign direct investments (FDIs) in Latin America between 1990 and 2002, making Spain the second largest direct investor in this region since 1998, behind the United States. This dissertation explains the reasons that led Spanish firms to make these FDIs, as well as their operations in Latin America. Seven Spanish MNEs were included in this study, BBVA and SCH (banking), Telefónica (telecommunications), Endesa, Iberdrola and Unión Fenosa (public utilities), and Repsol-YPF (oil and natural gas). Quantitative and qualitative data were used. Data were collected from the firms' annual reports, from their archives and from personal interviews with senior executives, as well as from academic and specialized publications. ^ Results indicate that the large Spanish FDIs in Latin America were highly concentrated in a few firms from five sectors. The FDIs of these firms alone accounted for 70 percent of total Spanish FDI in Latin America in this period. The reasons for these investments were firm-specific and sector specific. A series of institutional conditions existed in Spain between the 1970s and the 1990s that allowed the employees of the firms to develop the knowledge and devise strategies to adjust to that set of conditions. First, the policies of the Spanish state favored the creation of large firms in these sectors, operating under conditions of monopoly sometimes. Secondly, the consumers put pressure on the firms to provide better and cheaper products as the Spanish economy grew and modernized. Thirdly, the employees of the firms had to adjust their services and products to the demands of the consumers and to the constraints of the state and the market. They adjusted the internal organization of the firm to be able to produce the goods and services that the market demanded. Externally, they also adopted patterns of interaction with outside agents and institutions. This patterned behavior was the “corporate culture” of each firm and the “normative framework” in which their employees operated. When the managers of the firms perceived that there were similar conditions in Latin America, they decided to operate there as well by making FDIs. ^

The impact of institutional complexity and top management characteristics on executive compensation and firm performance

While most studies take a dyadic view when examining the environmental difference between the home country of a multinational enterprise (MNE) and a particular foreign country, they ignore that an MNE is managing a network of subsidiaries embedded in diverse environments. Additionally, neither the impacts of global environments on top executives nor the effects of top executives’ capabilities to handle institutional complexity are fully explored. Thus, using a three-essay format, this dissertation tried to fill these gaps by addressing the effects of institutional complexity and top management characteristics on top executive compensation and firm performance. ^ Essay 1 investigated the impact of an MNE’s institutional complexity, or the diversity of national institutions facing an MNE’s network of subsidiaries, on the top management team (TMT) compensation. This essay proposed that greater political and cultural complexity leads to not only greater TMT total compensation but also to a greater portion of TMT compensation linked with long-term performance. The arguments are supported in this essay by using an unbalanced panel dataset including 296 U.S. firms with 1,340 observations. ^ Essay 2 explored TMT social capital and its moderating role on value creation and appropriation by the chief executive officer (CEO). Using a sample with 548 U.S. firms and 2,010 observations, it found that greater TMT social capital does facilitate the effects of CEO intellectual capital and social capital on firm growth. Finally, essay 3 examined the performance implications for the fit between managerial information-processing capabilities and institutional complexity. It proposed that institutional complexity is associated with the needs of information-processing. On the other hand, smaller TMT turnover and larger TMT size reflect larger managerial information-processing capabilities. Consequently, superior performance is achieved by the match among institutional complexity, TMT turnover, and TMT size. All hypotheses in essay 3 are supported in a sample of 301 U.S. firms and 1,404 observations. ^ To conclude, this dissertation advances and extends our knowledge on the roles of institutional environments and top executives on firm performance and top executive compensation.^

Analysis of Housing Partnerships using the Balanced Scorecard framework

Housing Partnerships (HPs) are collaborative arrangements that assist communities in the delivery of affordable housing by combining the strengths of the public and private sectors. They emerged in several states, counties, and cities in the eighties as innovative solutions to the challenges in affordable housing resulting from changing dynamics of delivery and production. ^ My study examines HPs with particular emphasis upon the identification of those factors associated with the successful performance of their mission of affordable housing. I will use the Balanced Scorecard (BSC) framework in this study. The identification of performance factors facilitates a better understanding of how HPs can be successful in achieving their mission. The identification of performance factors is significant in the context of the current economic environment because HPs can be viewed as innovative institutional mechanisms in the provision of affordable housing. ^ The present study uses a mixed methods research approach, drawing on data from the IRS Form 990 tax returns, a survey of the chief executives of HPs, and other secondary sources. The data analysis is framed according to the four perspectives of BSC: the financial, customer, internal business, and learning and growth. Financially, revenue diversification affects the financial health of HPs and overall performance. Although HPs depend on private and government funding, they also depend on service fees to carry out their mission. From a customer perspective, the HPs mainly serve low and moderate income households, although some serve specific groups such as seniors, homeless, veterans, and victims of domestic violence. From an internal business perspective, HPs’ programs are oriented toward affordable housing needs, undertaking not only traditional activities such as construction, loan provision, etc., but also advocacy and educational programs. From an employee and learning growth perspective, the HPs are small in staff size, but undertake a range of activities with the help of volunteers. Every part of the HP is developed to maximize resources, knowledge, and skills in order to assist communities in the delivery of affordable housing and related needs. Overall, housing partnerships have played a key role in affordable housing despite the housing market downturn since 2006. Their expenses on affordable housing activities increased despite the decrease in their revenues.^