The co-evolution of firms and their environment is a central topic in strategic management research. On the one hand, as their environment changes, firms need to adapt to these changes by updating their knowledge base. An important pillar of a firm’s continued sourcing for new knowledge is the integration of externally developed knowledge, which is labeled as external knowledge sourcing. On the other hand, firms’ actions influence their environment. Hence, firms proactively design strategies that allow them to shape the future business environment to their benefit. In my dissertation, I examine both strategic actions by firms: adaptation and shaping. Adaptation In Chapter 2, I provide an overview of the literature on external knowledge sourcing. I assess and integrate the research on the antecedents as well as the outcomes of knowledge sourcing for the sourcing firm. Creating this overview, I find that the antecedents for a firm’s choice of external knowledge sourcing governance mode are rooted in the technology, firm, and industry level. I also highlight the importance of recognizing the dyadic character of interfirm collaboration when studying these antecedents. Regarding the outcomes, I find that innovation performance has extensively been studied, while other potential outcomes of knowledge sourcing have received scant attention. Avenues for future research are proposed. In Chapter 3, I present my research on the influence of the structure of a target firm’s intrafirm inventor network on post-acquisition leverage of its knowledge by the acquirer. More specifically, the study investigates if more centralized inventor networks facilitate post-acquisition leverage of a target’s knowledge. It is theorized that central inventors, inherently present in networks with a highly centralized structure, will function as directories of the target’s knowledge, in turn facilitating transfer and leverage of this knowledge by the acquiring firm. The predictions are empirically tested using 323 US domestic full acquisitions between 1980 and 2009. The results show that, in accordance with the predictions, there exists a positive relationship between the degree of centralization of a target’s inventor network and post-acquisition knowledge leverage. This relationship is contingent on the relatedness of the knowledge bases of the acquirer and target, and the coherence of the knowledge of the target’s inventors. Shaping Chapter 4 presents research that provides a first quantitative approach towards firms’ shaping strategies. A taxonomy of shaping activities is developed using data from the photovoltaic cell industry. Building upon this taxonomy we categorize firms’ innovative activities as either shaping or adaptation activities. This categorization allows us to examine antecedents shaping firms have in common. Moreover, we explore the special case of shaping by firms in the aftermath of the emergence of a dominant design. / Business Administration/Strategic Management

Inadequate public and grant funding often inhibits social service agencies from covering all of their program participant and agency needs. Compounding this problem, funders now have greater expectations that agencies demonstrate a return on investment, document their success, and demonstrate benefits to the community. This has led agencies to seek or develop more effective tools to evaluate program impact. In this study, I drew from the literature a proposed approach of social impact measurement that was applied as a four-step blueprint for social impact program evaluation, also referred to as “blueprint” later in the study, in order to demonstrate greater effectiveness of program goals and outcomes, justify current and future funding needs, and ultimately validate social impact. My first and second studies explored 1) the usefulness of a new approach for identifying and quantifying the impact of social service programs and 2) the pros and cons of involving stakeholders throughout the social impact measurement process, and whether stakeholder involvement substantially changed the process and results. My third study further explored the social impact measurement process with additional consideration emphasizing funders and policy advocates as stakeholders and investigated their impressions and influence on the measurement process. This social impact measurement approach consists of four steps: applying the Theory of Change to assist with appropriately identifying the program’s long-term goals; initiating a Logic Model to improve the connection between inputs, activities, outputs, outcomes and impact with the long-term goals; designing an Impact Measurement analysis to connect the specific outcomes with the intrinsic value each outcome creates for the well-being of the program participants; and the involvement of stakeholders throughout the impact-oriented program evaluation process to utilize published and program-specific evaluation studies to calculate the Social Return on Investment. To learn more about the potential and pitfalls of the proposed four-step model of social impact measurement, I partially applied this model to one program at my organization, the Philadelphia Corporation for Aging, for my first study. Following the application of the proposed blueprint at my organization, challenges emerged related to the lack of stakeholder involvement, which led to the inclusion of stakeholders in the blueprint application for my second study. Practitioner literature suggests that involving stakeholders in every step of impact-oriented program evaluation will strengthen the quality of the Impact Measurement. Utilizing action research, I sought to understand this contention by comparing levels of stakeholder involvement across programs and different organizations to explore the ways in which stakeholder involvement might help or hinder Impact Measurement. The results suggest that exclusively relying on homogeneous workgroups to provide deeper insights regarding program impact to the community, or solely relying on external stakeholders that lack the micro-level nuances of the program processes and procedures, does not lead to well-rounded social impact measurement. However, combining internal and external stakeholders in a workgroup seems to provide the best and most consistent path to effective social impact measurement by diversifying perspectives and leading to the development and application of metrics that are both reflective of community impact and practical to track. My third study focused on gaining additional insights regarding the usefulness of engaging funders and policy advocates in the design and implementation of the social impact measurement model and the usefulness of a new approach for identifying and quantifying the impact of social service programs. For this stage of my study, semi-structured interviews were completed with leadership from State Units on Aging throughout the nation with differing demographic compositions. Additional interviewees included leaders from the Aging Network with a broad perspective of the Area Agency on Aging (AAA) Network including an executive from a key trade association, a former cabinet level staff member within a former Governor’s administration, and key leaders from managed long-term service and support system payors in different states. To better understand the influence of funders as stakeholders, the Resource Dependence Theory, highlighting the delicate balance of power between funders and recipient organizations (Hung, C., and Berrett, J., 2021), and strategies used in the acquisition of resources, was further explored (Klein, L. L. and Diniz Pereira, B. A., 2016). While several challenges were presented regarding why impact measurement strategies have not progressed further, progress was noted when leadership identified successful strategies utilized by other industries or government agencies, or when they sought individuals with specific skillsets to strengthen their internal processes. Many of these strategies were possible due to the support of leadership and the addition of requisite state resources. However, the additional resources would often avoid duplicating resources that funders were initiating, and strategies would be considered if they did not significantly challenge funders or jeopardize funding. My study contributions include combining existing theoretical concepts into a proposed four-step blueprint for social impact program evaluation that focused on impact and outcomes for study one, which was further refined with the addition of stakeholders in study two, and study three continued to explore the role that stakeholders, including influential ones like funders, played in developing and applying social impact measurement tools. Additionally, study three further contributes to Resource Dependence Theory research by further assessing the balance of power between organizations and the leveraging of stakeholder partnerships to acquire resources from the external environment to minimize the dependence on funders. Strengthening the social impact measurement alignment between funders and funding recipients has the capacity to improve the consistency in the Impact Measurement processes. Utilizing the strategies from this study provides a pathway to align policies and procedures between funders and funding recipients; encourage the transition from measuring outputs to outcomes; lead to collaboration that increases organizational resources from external sources, which aids the balance of power between funding and funding recipient and minimizes dependence; and provides a potential for a replicable tool that can be used nation-wide and across different types of social service agencies. / Business Administration/Interdisciplinary

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As demand for healthcare increases, hospital managers are faced with the prevalent challenge associated with patient flow and capacity management. Patient flow is the movement of patients through a healthcare facility (Hall 2013). The aim of this dissertation is to investigate how the behavior and decisions of workers and hospital managers improve these issues. Specifically, I am interested in understanding 1) hospitals' response to boarding crises, and 2) organizational approaches to improve patient flow. In Chapter 1, we examine the impact of two responses, urgent response [code yellow (CY)]: a Massachusetts mandated policy to reduce boarding crises whenever patients in the ED experience long wait times, and prevention response [pre-discharge orders (PDO)]: a health IT coordination tool to facilitate patient discharge, on patient length of stay. Using three years of inpatient level data, we find that patients with a PDO have a shorter length of stay (LOS) compared to patients without a PDO after accounting for endogeneity using an instrumental variable (IV). Conversely, using a survival analysis approach, we find there is no significant impact on LOS for patients who experience a CY during their hospital stay versus patients who do not. We also find the urgent response crowds out the prevention response. The likelihood of physicians using PDOs decreases when hospital managers call a CY. Furthermore, we find that PDO results in more discharges in a day compared to CY and that the use of PDOs often reduces the need to trigger a CY. Thus, we find that the state-mandated urgent response creates a state of chaos that deters physicians from investing in actions that could prevent future boarding crises. The study provides empirical evidence that demonstrates pressure to produce results today impedes workers’ efforts to improve future performance. In Chapter 2, we investigate the impact of external collaborative coordination in improving the efficiency of a dedicated observation unit (DOU). The DOU is a unit in the hospital designed to treat observation patients. In July 2018, the unit expanded to treat patients with higher medical complexity which increased the demand and variability in the unit. Using difference-in-difference with inverse probability weights and instrumental variables (IV) approach we examine the operational cost and the efficiency gain respectively, of this expansion. We find that the observation LOS increases in the unit after the unit expanded. However, using an IV approach, the DOU gains efficiency that results in a reduction in LOS for the observation patients cared for in the unit compared to observation patients cared for off-service in the inpatient unit. We find that our results are driven by external collaborative coordination, which enables coordination amongst the cross-functional team as well as external collaborators. In Chapter 3, we study the impact of dedicated capacity on overall hospital performance. In this essay, we study the potential benefit of pulling short-stay patients out of the inpatient unit to be cared for in the DOU thus freeing up beds for vulnerable patients. Using a difference-in-difference approach with propensity score matching, we find that boarding time decreases for vulnerable patients as a result of bed availability in the inpatient unit. However, LOS in the inpatient unit increases. Furthermore, we find no impact on 30-day readmission. We attribute the increase in LOS to the higher volume of vulnerable patients who are now able to receive care in the inpatient unit. Together, these studies extend current knowledge and provide new insights to current studies addressing the movement of patients through a healthcare facility particularly when there is supply and demand mismatch. Through this dissertation, contribution is made to literature on patient flow, capacity management and coordination. Furthermore, it offers practical implications for hospital managers by demonstrating that complex operational problems can be minimized by reducing information gap through coordination.

Three waves of tort reform occurred during mid-1970s, mid-1980s and early 2000s to deal with the liability “crises”. The inflationary pressures drove up the medical costs and social inflation pushed up the damage awards size, which led to the tort reform waves. We could see a potential today when the inflation continues to increase. Tort reforms have been widely studied for its impact on the litigation costs and benefits, through which physicians and insurers’ liability burden can be affected. While the liability markets have been relatively calm recently, legislative and academic debates over the efficacy of tort reforms and how they influence litigation behavior is not yet resolved. Whether tort reforms work to reduce the medical expenses and exert spillover effect on other insurance line market needs to be tested. A thorough analysis of tort reforms effect will benefit policymakers, regulators, insurers, and physicians and patients. This dissertation consists of three chapters to study how tort reforms affect the insurance markets, with a focus on health insurance markets. Chapter 1 assesses whether the effect of tort reform on the healthcare expenditures depends on the contract conditions under which physicians are paid for their professional services. Chapter 2 explores the potential for tort reforms to improve health insurers’ performance by boosting their efficiency. Chapter 3 looks at other types of state reforms and policies influencing liability costs to assess the effect on both medical liability and health insurance markets. / Business Administration/Risk Management and Insurance

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