Global ETD Search

31	A Social-Ecological Understanding of Urbanization: A Case of Wuhan, China Zhang, Li Qin 27 September 2021 (has links) Since the introduction of economic reforms in the late 1970s, China has experienced phenomenal economic growth along with rapid urbanization. The accelerated urbanization coincides with remarkable social-economic transformations and urban landscape changes. A city, as an urban system, is composed of social and physical subsystems that interact with each other. Equally assessing each component is necessary for a comprehensive understanding of the urbanization process. The goal of this thesis research is to deconstruct the urbanization process through a social-ecological perspective. More specifically, this study examines social transformations, physical evolutions, and their relationships. Four research questions are proposed as (1) How does urban social landscape transform in time and space? (2) What trends are apparent in the urban land growth process and spatial heterogeneity? (3) How does social transformation relate to urban land growth, within a spatio-temporal perspective? and (4) How do social-demographic features relate to residents’ use and perception of urban green open spaces, focusing on the ecological services provided by and the need to improve those spaces? Given the lack of research on second-tier cities’ growth processes, this study selects Wuhan, a megacity in central China, as a case study, with a focus on its urban development zone (UDZ). A social-ecological approach is applied to study the multi-dimensional features of an urban system. The thesis is in paper format, containing five chapters. Besides the Introduction (Chapter 1) and Conclusion (Chapter 5), the main body consists of three articles. These three articles correspond to the four research questions proposed. Chapter 2 responds to the first research question by addressing how the urban social landscape transforms. Chapter 3 seeks to answer the second and third questions by evaluating urban land growth and its links with social factors from a spatio-temporal perspective. Chapter 4 matches the fourth question by seeking to understand residents’ preferences and feelings toward the urban green open space. Chapter 1 introduces the research context, reviews the urban ecology theory and relevant empirical research, as well as assesses the social-ecological approach related to studying the urban system. In this chapter, we also propose an improved social-ecological system (ISES) framework which guides the equally weighted study of both social and physical subsystems in an urban area. Chapter 2 (the first paper) seeks to investigate progressive transformations in the social dimensions of Wuhan UDZ while also focusing on their spatial transformations, using national census data in 1990, 2000, and 2010. We used varimax rotated principal component analysis (PCA) for the extraction of social dimensions and ArcMap for spatial visualization. This allows us to further analyze the spatial distribution of social clusters. The results suggest that industrial relocation, educational attainment increase, population aging, and migration are the main characteristics of social transformation during 1990 and 2010. Industrial relocation along with the spatial separation appeared as principal social dimensions in the 1990s but became more prominent in the 2000s, accompanied by the improvement of workers’ education levels. Aging population presented spatial movement outward from the city center. Population mobility increased significantly, and immigration became an important social dimension and presented spatial expansion in the 2000s. The socio-spatial patterns transform with a combination of concentric rings and sectoral clusters in different stages. These transformations are formed by the regional push-pull forces and the centripetal-centrifugal forces inside the city. We conclude that the social landscape transforms in a way with diversity and inclusion. Government dominates socio-spatial transformations in the initial stages, while market plays an increasing role in the later stages. To build a more inclusive society requires continuous and systematic improvement of relevant policies. Chapter 3 (the second paper) discusses urban land growth patterns and answers how social factors are associated with the evolution patterns between 1990 and 2010. We extract land cover information based on Landsat images with the vegetation area – impervious surface –water area (V-I-W) model and examine the urban growth patterns during various stages using landscape metrics of the area, aggregation, and shape. Then, we apply geographically weighted regression (GWR) to depict the link between urban land metrics and social factors. The results show that urban land coalescence and diffusion simultaneously exist; the city center is dominated by redevelopment, infilling, edge expansion; and the peripheral areas by outlying expansion. GWR coefficient surfaces show little differences in the models between social factors and urban land area metrics PLAND while remarkable differences are present in the coefficients of GWR models for the urban land patch shape irregularities and social factors. Urban land growth patterns relate to the government-led land supply system, the functional zoning of urban space planning, and the agglomeration and dispersion of social space under the market orientation. The authors conclude that urban management should consider the coexistence of different spatial growth modes and introduce factors such as social preferences in the urban land layout. This may apply to rapidly urbanizing areas. Chapter 4 (the third paper) aims to understand social-natural relationships, with a focus on how socio-demographic features can shape residents’ preference toward green open spaces and their perceptions of ecological services and improvements. Data is collected through online questionnaire surveys and interviews. The results indicate that preferences toward green open spaces vary among different social groups. Demands for improvement to green open spaces are rooted in residents’ appreciation for daily relaxation and health benefits, and link with their preference for visiting. However, how residents perceive green open spaces’ benefits does not rely only on an in-person visit. Interaction experience with nature and knowledge of natural development affect perception of daily use and health-related services. Residents’ perceptions of green open space’s ecological functions are associated with the changes in nature reported by those respondents. Responses to improving green open space reflect the residents’ pursuit of the aesthetics and practicality of such spaces. Though respondents are commonly aware of the ecological importance of green open space, there are differences in their willingness to voluntarily participate in its management. We conclude that to encourage the public to participate in configuration and improvement of green open spaces through a variety of ways, including considering residents’ opinions, is an efficient way in order to better social-ecological relationships. Chapter 5 reviews the main findings and conclusions, research limitations as well as future possibilities. This study establishes a dialogue between urban social and physical subsystems, with an integrated quantitative study of the urbanization process, emphasizing the relationships between two urban subsystems. It provides a comprehensive social-ecological view on a second-tier city based on the social and physical transformations that occurred in Wuhan during a transitional period of a socialist market economy. We conclude that the development of China's second-tier cities between 1990 and 2010 is characterized by the transformations of social dimensions and landscape, the coexistence of multiple urban spatial development modes, and the spatial differentiation between the center and the periphery of the city. The GWR models present spatial non-stationary relationships between social factors and the urban patch shape regularities. The further examination of social-natural relationships finds that residents’ social-demographic features and environmental experience affect their perceptions toward green open space, especially ecological services and improvement necessity. The evolution of urban social and physical systems and their relationships has brought increased attention to inclusive urban social management, public participatory planning, and people-centered social and ecological interactions. This research provides a constructive rethinking of second-tier cities’ growth in China and may serve as a reference for other rapidly urbanizing areas. Urbanization Social ecological approach Urban social dimension Social landscape transformation Urban land growth Landscape ecology Public perception Green open space Principal component analysis Geographically weighted regression Remote sensing Wuhan China
32	Virtual Reality Language Learning : Designing some VR Wor(l)ds Mitsigkola, Sofia January 2022 (has links) This thesis project explores the application of the ecological approach to learning in Virtual Reality (VR), investigates the role of educational games in language learning, creates a playground and a modified game for Swedish language, and proposes the concept VR wor(l)ds for language learning and practice. Following an Interaction Design methodology and drawing from ecological psychology, game studies and user research, the qualities of a virtual language learning environment are established. By modifying and playtesting charades game and then sketching in VR two main levels are being formed. A Playground, that first serves as an introduction where players explore and interact with the language, and then a gamespace that is designed to host a Charades Mod in VR. Lastly, two prototypes are developed and tested to finalise the proposed concept of the VR wor(l)ds. The final concept contributes to the understanding of approaching VR language learning games with a focus on player’s experience. Virtual Reality Games Educational Games Learning Games Play Language Learning Games Language Learning Training System Interaction Collaboration Situated Learning Ecological Approach to learning Unity Design Design Human Computer Interaction
33	An ecological approach to seeking and utilising the views of young people with intellectual disabilities in transition planning Small, Neil A., Raghavan, R., Pawson, Nicole January 2013 (has links) No / Transition planning using a person-centred approach has, in the main, failed to shape service provision. We offer an alternative based on an ecological understanding of human development linked to public health approaches that prioritise whole system planning. A total of 43 young people with intellectual disabilities, in Bradford, England, who were approaching transition from school or college were recruited to a qualitative study. Their ethnic breakdown was as follows: 16 white British, 24 Pakistani, 2 Bangladeshi and 1 Black African. Each young person was interviewed twice, at recruitment and a year later, to observe any changes in their social networks during transition. Interviews were undertaken with a semi-structured interview schedule and with the pictorial approach of Talking Mats. Both the networks the young people live within, and their sense of what the future might hold for them, are described and linked to Bronfenbrenner's ecological model of human development. The importance of the family and school is emphasised, as is the absence of engagement in leisure activities and work. Transition planning needs to start with mapping the systems individuals live within, areas of strength should be supported and parts of the system, which are not fit for purpose for these young people, should be prioritised for interventions. Adolescent Adult Cohort studies England Female Follow-up studies Humans Intellectual disability Interview Male Patient care planning Patient-centred care Public health Qualitative research Transition to adult care Young adult Ecological approach Ethnicity Intellectual disability Person-centred planning Transition planning
34	Transformation of a service organisation through participatory action research Harrison, Elaine Sonet 11 1900 (has links) The research aimed to pro-activeiy embark in an internal transformation process, in order to improve efficiency of the Social Work Department of Gauteng Medical Command of the South African Military Health Service. Participatory action research as a qualitative research design was- used. The intervention identification process was implemented as a problem-solving technique to direct the process of transformation-change. The research was conducted by a research group often social workers from the South African National Defence Force. The results of the research were the implementation of interventions on identified systems, namely the service delivery system and the performance management system of the Social Work Department of Gauteng Medical Command. The use of particpatorv action research as a process to address problems in an organisation was confirmed. The contribution of the participatory action process to process outcomes, such as empowerment and learning, was also indicated in the findings. / Social Work / MA(SS) (Mental Health) Ecosystemic perspective Ecological approach Learning organisations Participatory action research Intervention identification process Transformation Change South African National Defence Force 361.968 Human services -- Research Action research Medical care -- Research -- Methodology Adjustment (Psychology) Public welfare -- South Africa Social service -- South Africa Social change -- South Africa Participant observation Community development -- South Africa National Defence Force (South Africa)
35	區域發展與政黨競爭－台灣立法委員選舉之研究（1989~1995） / Development of Regions and Party Competition: Taiwan Legislative election Research(1989~1995) 李信達, HsinTa Lee Unknown Date (has links) 本研究以台灣地區（包括台北市、高雄市與台灣省）為範圍，鄉鎮市區為基本單元，1989年到1995年的立法委員選舉為標的，使用人文區位研究途徑，來分析區域發展與政黨競爭之間的關係。在代表政黨競爭的自變項上，分別以各政黨在立法委員選舉中的得票率競爭程度，以及各政黨的得票率為變數。至於描述區域發展的自變項上，主要可分成兩個部分。橫斷面上由自然區位因素（包括都市化程度、工商業場所單位經營狀況、藍領階級比例、年輕人口比例、外省人口比例），以及政治區位因素（包括決算補助比例、縣市票源凝聚程度、鄉鎮市區票源凝聚程度、縣市地方派系強度虛擬變項、鄉鎮市區派系強度虛擬變項）作為自變項。在縱剖面上，則以時間的虛擬變項作為自變項，以反映長期的影響因素。在以各政黨當屆立委得票率為依變項時，則再加入當屆省市議員與上屆立法委員各政黨的得票率，來測量選舉慣性的影響力。此外，並分別由區分為三個集群的集群面，以及整體面來進行迴歸分析。研究結果發現，在各模型中較為重要而顯著的變數都與假設方向一致。其中都市化程度、工商業場所單位經營狀況、年輕人口比例，以及縣市票源凝聚程度會升高政黨競爭程度；而決算補助比、鄉鎮市區票源凝聚程度，以及縣市級地方派系則會減弱政黨競爭程度。都市化程度、工商業場所單位經營狀況，以及縣市票源凝聚程度對國民黨得票率不利，而外省人口比例則由1992年之前的有利，轉向為1995年的不利；但決算補助比例、縣市級地方派系強，以及鄉鎮市區票源凝聚程度都對國民黨得票率有利。都市化程度、工商業場所單位經營狀況以及縣市票源凝聚程度對民進黨得票率有利；而外省人口比例、決算補助比，以及鄉鎮市區票源凝聚程度則對民進黨得票率不利。都市化程度、工商業場所單位經營狀況、外省人口比例，以及年輕人口比例，均對新黨得票率有利；決算補助比、鄉鎮市區票源凝聚程度，以及各級地方派系不論強弱，均對新黨得票率不利。在合併時間序列的分析上，隨著時間的推演，政黨得票率競爭程度也隨之升高，同時對國民黨得票率愈來愈不利，而對民進黨得票率愈來愈有利。此外不論是對哪一個政黨的得票率來說，選舉慣性因素的影響力都相當顯著。不過不同選舉還是有所不同，以同類型的選舉影響較大。另一方面，經由對R 值的觀察，我們也發現政治區位因素在多數的情況下，其解釋力會大於自然區位因素。同時區位因素最適合用以解釋新黨的得票率，不過整體而言多數模型都有解釋力愈來愈高的趨勢，顯示近年來區域發展因素對於政黨競爭的解釋力較過去提升不少。最後，透過區分集群的方式，有助於突顯出特定區域類型，以表現出其中更為強烈或更為微弱的，區域發展與政黨競爭之間的關係。可避免僅就整體面進行分析，使這些集群的特性消失，反倒不易瞭解區域發展與政黨競爭之間的真正關係的缺失。第一章　緒論壹、政黨競爭與選舉貳、台灣的選舉競爭：國民黨的控制與反對黨的興起參、選舉研究：個體或總體肆、區域與區域發展伍、台灣的區域發展：進步但不均衡陸、區域發展與政黨競爭第二章文獻檢閱壹、區域發展與人文區位指標貳、選舉競爭與總體資料研究參、整合性研究的需要第三章理論架構與研究方法壹、研究範圍與內容貳、研究架構與假設參、變數建構與資料來源肆、統計方法第四章變數的典型相關與鄉鎮市區的集群分析壹、典型相關分析貳、集群分析參、依變項在整體面與集群面上之觀察肆、討論與小結第五章區域發展因素對政黨競爭的影響－集群面的觀察壹、第一集群的分析結果貳、第二集群的分析結果參、第三集群的分析結果肆、討論與小結第六章區域發展因素對政黨競爭的影響－整體面的觀察壹、影響政黨得票率競爭程度的區域發展因素研究貳、影響政黨得票率的區域發展因素研究參、整體面與集群面的比較參、討論與小結第七章結論壹、研究回顧與成果貳、檢討與建議參考書目附錄一國內以人文區位指標進行區域發展研究的相關論文列表附錄二國內以人文區位途徑進行選舉研究的相關論文列表附錄三各變數之相關係數、平均數與標準差附錄四各迴歸分析詳細列表附錄五各變數資料 / The thesis is an ecological analysis of competition between major parties (the KMT, DPP, and NP) in the 1989, 1992, and 1995 elections for Taiwan's Legislative Yuan. The unit of analysis is the "Hsiang" (rural township), "Chen" (urban township), "Shih" (county city), or "Ch'u" (precict), and we separate all of the local area units into three clusters to obtain the ecological determinants of the degree of competition between major parties. We explore the relative influence of ecological conditions of local units on the election returns over the six year period. The results of regression analysis indicate that major significant variables are in accordance with theoretical assumptions. Urbanization, development of industry and commerce, high percentage of youth in the population, and high degree of voting consistency in a county can raise the degree of competition between major parties, but a high percentage of the budget from subsidies, law degree of voting consistency in a township, and strong county factions can reduce it. Urbanization, development of industry and commerce, and degree of voting consistency in a county have influence on the percentage of the vote lost by the KMT's candidates, and percentage of the budget from subsidies and strong local county factions influence the percentage of the vote won by the KMT's candidates. A high percentage of mainlanders contributes to the KMT's vote share before 1992, but becomes disadvantageous in 1995. Urbanization, development of industry and commerce, and degree of voting consistency in a county are beneficial to the DPP, but a high percentage of mainlanders, a high percentage of the budget from subsidies, and a high degree of voting consistency in a township are harmful to it. Urbanization, development of industry and commerce, a high percentage of mainlanders, and a high percentage of youth in the population have a positive influence on the NP's vote, but a high percentage of the budget from subsidies, a high degree of voting consistency in a township, and strong local factions have a negative influence towards it. Longitudinal analyses find that the time factor intensifies the degree of competition between major parties in favor of the DPP. Electoral inertia, or the retrospective effects of the last election, has a powerful influence on the vote share of the KMT, DPP, and NP. Also the same type of elections has more influence than different types. Finally, through clusters analyses we can identify various types of groups which reveal various relationships between development of regions and competition between major parties. 區域發展政黨競爭立法委員選舉研究人文區位研究途徑總體資料投票行為 development of regions party competition legislative election research ecological approach aggregate data voting behavior
36	Transformation of a service organisation through participatory action research Harrison, Elaine Sonet 11 1900 (has links) The research aimed to pro-activeiy embark in an internal transformation process, in order to improve efficiency of the Social Work Department of Gauteng Medical Command of the South African Military Health Service. Participatory action research as a qualitative research design was- used. The intervention identification process was implemented as a problem-solving technique to direct the process of transformation-change. The research was conducted by a research group often social workers from the South African National Defence Force. The results of the research were the implementation of interventions on identified systems, namely the service delivery system and the performance management system of the Social Work Department of Gauteng Medical Command. The use of particpatorv action research as a process to address problems in an organisation was confirmed. The contribution of the participatory action process to process outcomes, such as empowerment and learning, was also indicated in the findings. / Social Work / MA(SS) (Mental Health) Ecosystemic perspective Ecological approach Learning organisations Participatory action research Intervention identification process Transformation Change South African National Defence Force 361.968 Human services -- Research Action research Medical care -- Research -- Methodology Adjustment (Psychology) Public welfare -- South Africa Social service -- South Africa Social change -- South Africa Participant observation Community development -- South Africa National Defence Force (South Africa)
37	La pensée sonore du corps : Pour une approche écologique à la médiation technologique, au mouvement et à l'interaction sonore / The auditory thought of the body : For an ecological approach to mediation technology, movement and sound interaction Giomi, Andrea 08 December 2017 (has links) Au cours des dernières années, l’avènement des technologies de captation du mouvement a radicalement transformé l’univers de la pratique artistique tout en ouvrant des perspectives inédites pour la recherche scientifique. La musique est actuellement l’un des domaines les plus impliqués dans ce renouvellement expressif et épistémologique. Dans ce cadre, les processus d’interaction entre médiation technologique, mouvement et son, semblent se décliner selon deux modalités majeures : d’une part, les technologies d’analyse du mouvement permettent d’étudier expérimentalement la connexion mutuelle entre phénomène acoustique et système sensori-moteur; de l’autre, la compréhension de la nature incarnée de l’expérience musicale oriente la conception et le développement de technologies interactives pour la performance vers un modèle plus holistique. En partant de ces prémisses, cette thèse porte sur la manière dont la transformation des aspects imperceptibles du mouvement en données perceptibles – sous forme de son – permet de prendre conscience des processus physiologiques et figuratifs qui sont à la base du geste. Dans ce contexte, la relation entre mouvement et feedback sonore est analysée selon une perspective écologique visant à mettre en lumière comment la médiation technologique induit un processus d’extension et d’intensification autopoïétique de l’anatomie corporelle. Notamment dans le cas de la pratique performative, l’interaction sonore offre alors au performeur la possibilité de redéfinir sa propre organisation perceptive sur la base d’un un nouveau répertoire des données sensorielles, lui permettant ainsi de repenser la composition expressive du mouvement. / During the last years, motion sensing technologies have radically transformed the universe of the artistic practice. This dramatic change has recently inspired new perspectives in scientific research. Music is actually among the most affected domaines by this expressive and epistemological renewal. The interactive relation between mediation technology, movement and sound, seems to be declined into two main modalities : on one hand, movement analysis’ technologies allow to study mutual connections between acoustic phenomenon and sensorimotor system, on the other hand, embodied understanding of musical experience can help to devise an holistic approach to interactive systems conception and development. Given this background scenario, this thesis focuses on how movement’s qualities transformation into sound allows the performer to become aware of physiological and imaginative processes in gesture composition. In this framework, sound feedback-movement relation is analyzed from an ecological point of view. According to this approach, mediation technology seems to elicit an autopoietic process of extension and intensification of corporeality. Especially in the artistic performance, sound interaction offers to performer a new sensorial geography that allows him/her to renew his/her perceptive organization and thereby rethink expressive composition of movement. Nouvelles technologies Cognition Musicale Incarnée Geste Musical Phénoménologie Interaction Art-Science Performance Théorie de la Perception Mouvement Arts numériques Énaction Approche écologique Interface Motion sensing technologies Embodied Music Cognition Musical Gesture Phenomenology Interaction Art-Science Performance Theory of Perception Movement Digital Art Enaction Ecological Approach Interface
38	From victim to victory: the experiences of abused women and the salience of the support they encounter Van Rensburg, Madri Stephani Jansen 30 November 2004 (has links) This thesis includes four studies investigating the experiences of abused women. According to ecological approaches different systems should be considered when conducting research into abused women and their experiences. The first study involved women who successfully left an abusive relationship. An ecological approach was used to investigate the experiences of the women in the different phases of their relationship, including the initial attraction to the partner, the development and sustaining of the abuse and her attempts to leave until her final decision to leave permanently. An important finding was the importance of considering and investigating all systems and levels when dealing with abused women, including those who have left and those who are contemplating leaving this relationship. The second study found that women who experienced physical abuse were often hurt in anatomical locations that were indicative of impulsive violence. The abuser used any object in the heat of the moment to attack the victim and no premeditated planning was evident in the type of injuries sustained. The women further reported that medical practitioners did not investigate the causes of injuries and that they were not referred to social services or organisations dealing with abused women, although they were recognised as suffering from abuse. The intersection of abuse of women and HIV was the topic of focus of the third study. A review of the records of abused women revealed that many abused women were subjected to risk factors for contracting HIV, with counsellors focussing only on abuse issues. Longitudinal case studies, of women exposed to both conditions, revealed that they lacked social support and were often secondarily victimised by the social welfare systems. An environmental scan found that social and health care services were not accessible to these women. The final study investigated intervention strategies to combat burnout in workers at an organisation dealing with abused women. The importance and effectiveness of creative exercises and art sessions were determined in combination with debriefing and supervision sessions. The studies all considered systems that are important in service delivery to abused women. A holistic and systemic investigation and treatment of abused women is shown to be essential, as is the importance of grass roots research. / Psychology / D. Phil. (Psychology) Social support Resilience Interpersonal violence Domestic Violence Battering Women Abuse Gender Based Violence Ecological Approach 362.82920968 Wife abuse -- South Africa Women -- South Africa -- Psychology Abused women -- South Africa Family violence -- South Africa
39	From victim to victory: the experiences of abused women and the salience of the support they encounter Van Rensburg, Madri Stephani Jansen 30 November 2004 (has links) This thesis includes four studies investigating the experiences of abused women. According to ecological approaches different systems should be considered when conducting research into abused women and their experiences. The first study involved women who successfully left an abusive relationship. An ecological approach was used to investigate the experiences of the women in the different phases of their relationship, including the initial attraction to the partner, the development and sustaining of the abuse and her attempts to leave until her final decision to leave permanently. An important finding was the importance of considering and investigating all systems and levels when dealing with abused women, including those who have left and those who are contemplating leaving this relationship. The second study found that women who experienced physical abuse were often hurt in anatomical locations that were indicative of impulsive violence. The abuser used any object in the heat of the moment to attack the victim and no premeditated planning was evident in the type of injuries sustained. The women further reported that medical practitioners did not investigate the causes of injuries and that they were not referred to social services or organisations dealing with abused women, although they were recognised as suffering from abuse. The intersection of abuse of women and HIV was the topic of focus of the third study. A review of the records of abused women revealed that many abused women were subjected to risk factors for contracting HIV, with counsellors focussing only on abuse issues. Longitudinal case studies, of women exposed to both conditions, revealed that they lacked social support and were often secondarily victimised by the social welfare systems. An environmental scan found that social and health care services were not accessible to these women. The final study investigated intervention strategies to combat burnout in workers at an organisation dealing with abused women. The importance and effectiveness of creative exercises and art sessions were determined in combination with debriefing and supervision sessions. The studies all considered systems that are important in service delivery to abused women. A holistic and systemic investigation and treatment of abused women is shown to be essential, as is the importance of grass roots research. / Psychology / D. Phil. (Psychology) Social support Resilience Interpersonal violence Domestic Violence Battering Women Abuse Gender Based Violence Ecological Approach 362.82920968 Wife abuse -- South Africa Women -- South Africa -- Psychology Abused women -- South Africa Family violence -- South Africa
40	Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital Lucas, D. Pulane 24 April 2013 (has links) Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs. Disruptive Disruptive Innovation Theory Disruptive Transformations Disruptive Innovation Innovation Technology Technological Innovation Medical Innovation Medical Technology Medical Advancement Laparoscopy Laparoscopic Surgery open surgery appendectomy cholecystectomy bariatric surgery weight loss surgery appendectomies cholecystectomies inpatient outpatient ambulatory ambulatory surgery ambulatory surgery center acute care general hospital hospital acute care hospital general hospital health care healthcare hospital industry health care industry Clayton Christensen Clayton M Christensen Michael Porter Harvard Business School Virginia Commonwealth University CMS Health policy public policy public administration organizational theory organization theory Population Ecology Theory Competitive Strategy policy analysis John Kimberly Organization Size Structural Inertia liability of smallness health spending health care cost specialty medical facility open system niche width dynamic outpatient department technology shift surgical setting surgical setting shift medical facility shift substitution threat health system system level analysis Ecological Approach hospital trends ambulatory surgery trends reimbursement rate Medicare CMS coverage decision P J DiMaggio DiMaggio and Powell w w Powell Hannan and Freeman M T Hannan Organizational change minimally invasive surgery less invasive surgery Prospective Payment System Outpatient Prospective Payment System entreprenuerial physician health care organization health care management Roice Luke Carl Ameringer new technology surgical utilization elective surgery Medicare Payment Advisory Commission MedPAC coverage decision trends in surgery abdominal surgery surgical variation physician-owned physician ownership physician autonomy outpatient clinic utilization trends unnecessary surgery Pfeffer Salancik technology diffusion redefining health care interdisciplinary research health care delivery panel design diffusion of hospital technology state variation regional variation local health care market government intervention medical facility health care capacity focused factory advances in health care physician organization relationship hospital competition medical specialization hospital expansion medical arms race integrated care integrated health system J E Wennberg health care transformation reimbursement scheme surgical volume Florida Wisconsin policy making health policy analysis competitive dynamics center of excellence intervening factor service line competition service-line competition surgical reimbursement innovative business model innovative technology environmental influence established firm new market entrant patient safety sophisticated technology Harvard Divinity School Social and Behavioral Sciences

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