ABSTRACT HOSPITALS WITH PHYSICIAN CEOS: AN INSTITUTIONAL THEORY PERSPECTIVE By: Jeremy S. Zoch, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Health Related Sciences at Virginia Commonwealth University. Virginia Commonwealth University, 2011 Major Director: Kenneth R. White, Ph.D. Professor Department of Health Administration The complexities of the healthcare industry at the beginning of the 21st century continue to challenge hospitals to optimize their operations. A key leadership position in the overall success of a hospital is the role of the Chief Executive Officer. The purpose of this study was to determine the kind of leader that hospitals have in place and to analyze more closely those specific organizations that have physician CEOs. This study had three distinct objectives. The first was to describe the organizational variables for American Hospital Association (AHA) hospitals with CEOs who are physicians. The second objective was to analyze the organizational and market characteristics of hospitals with physician CEOs. The final objective was to examine the similarities and differences between hospitals that have a CEO who is a physician and those headed by a CEO who is not a physician. Institutional theory was utilized to form a theoretical model and to develop the relevant hypotheses. The study was a retrospective, cross-sectional study of over 5600 American Hospital Association (AHA) short-term, acute care hospitals located in the United States. Data sources utilized were the AHA’s Annual Survey of Hospitals, the Area Resource File, Centers for Medicaid and Medicare Services, HealthLeaders-Interstudy, and SK&A from 2007-2008. There were 118 hospitals out of 5,671 with a physician CEO in 2008. The descriptive statistics and multivariate logistic regression analyses revealed that although hospitals with physician CEOs are located in many different locations and types of hospitals, they are some attributes that indicate a greater likelihood. Hospitals with physician CEOs are most prevalent in the northeast. The multivariate logistic regression analyses revealed there is a greater likelihood that hospitals with physician CEOs are more likely to be larger, specialty, not-for-profit and non-church operated, teaching, and be in a market with higher physicians per capita. The study also found that there wasn’t more likelihood for a hospital to have a physician CEO when comparing with US News top hospitals, based on affluence of a market, based on the competition in the market, or the managed care penetration. The study identified several of the components and how they positively relate to the institutional theory model that was developed. The study also identified several limitations that could further be improved using additional research approaches and obtaining more data. Overall, the study has furthered the information available about hospitals with CEOs who are also physicians and their corresponding organizational and market characteristics.

Evidence has shown that internationalizing firms operating in emerging markets are facing institutional challenges different and more distinctive from those existing in developed markets. This requires firms to adapt their strategic management by taking institutional impact into consideration. Research providing knowledge on how to manage this issue is very limited, especially in the context of Thailand. This thesis aim to explore and provide knowledge about the institutional settings in Thailand and analyse how it impacts the strategic management of Swedish firms. “How do legal, political and cultural institutions impact the strategic management of Swedish manufacturing firms operating in Thailand?” This is a qualitative thesis which follows a deductive research approach. It takes an exploratory design, where semistructured interviews were conducted with five managers representing Swedish firms in Thailand. Political, legal and cultural institutions impact the strategic management of Swedish firms in different ways; the most evident challenges stemming from the legal institutions. It can further be concluded that it is of high relevance for firms to take the institution based view into consideration when formulating and implementing their strategies the Thai market, since it is easier to carry out intended strategies when possessing institutional knowledge International business;

George Dickie’s Institutional Theory of Art satisfies necessary and sufficient conditions for definition, but by leaving evaluation open cannot address artistic capacities to outstrip the usefulness of the theory for appreciating the concept of art comprehensively or meaningfully. Artworks that are known to members of the central and peripheral artworld seep into the general purview of the population at large as known “great works” of art. Upon examination of works that garner significant cultural influence, works broadly appreciated as great works, we find that their resistance to Dickie’s concept of “the artworld” and its associated behaviors is that which makes them conspicuously significant.

Thesis advisor: Ted Youn / The intent of this single-case study was to explore the effects of a competitive environment on organizational decision making. The study examines the decision making processes that resulted in the adoption of an undergraduate business major at a traditional, middle-tier Liberal Arts College and offers an analysis of academic leaders’ perspectives on institutional identity, environmental pressures, strategic decision making and organizational change. This qualitative study uses Institutional theory to examine organizational behavior in competitive environments. Analysis of interviews and institutional data revealed four important findings. 1. The external environment defined the organizational reality and significantly influenced and shaped behavior and decision making; 2. A unique organizational culture and identity moved the organization to rely on rules and routines which reflected historic institutional values; 3. Responses to uncertainty produced an organizational adaptation that reflected a decoupling of one subunit which represented a new institutional strength, and 4. The environment exerted isomorphic pressure on the College to adopt a change that was incongruent with its historic values. The implications of the study include identifying the pressing need for new revenue streams that strengthen the financial model for tuition-dependent liberal arts colleges while preserving the values of a liberal education. Also, organizations should find ways to extend and share leadership in order to facilitate necessary organizational learning and time-bound responses to organizational threats. / Thesis (PhD) — Boston College, 2017. / Submitted to: Boston College. Lynch School of Education. / Discipline: Educational Leadership and Higher Education.

Thesis advisor: Mary Ann Glynn / Institutional Theory has responded to early criticism that actors are characterized as passive "cultural dopes" primarily through work on Institutional Entrepreneurship, which implicitly links actors' agency to institutional change or creation. In this dissertation, I decouple change from agency, examining how actors work to maintain existing institutional arrangements that have come under threat. Through inductive, qualitative analysis of the creation of the Securities Exchange Commission in 1934, focusing primarily on the legislative history, I ground my analysis in the speech events of the actors involved in stabilizing the securities markets as an institution after the Crash begun in 1929, identifying different forms of Institutional Guardianship aimed at preserving different aspects of the institution. I then generalize across actors to present an abstracted model of Institutional Guardianship. / Thesis (PhD) — Boston College, 2010. / Submitted to: Boston College. Carroll School of Management. / Discipline: Organization Studies.

Thesis advisor: Michael G. Pratt / Through two inductive qualitative studies, this dissertation explores the surprising emergence, and members’ subsequent responses, to value-laden claims regarding “why we exist” – what members themselves and scholarship refers to as organizational purpose. Study One finds that, although unintended, the implementation of specific practices within this organization generated powerful emotional energy amongst members. Leaders subsequently grafted this energy into organizational symbols and engaged in meaning-making to articulate what this energy meant for why the organization existed. This study advances theories of organizational identity formation and Selznick’s institutionalism by highlighting an alternative unit of analysis focused on features of shared experiences rather than discourse, documenting an alternative generative mechanism focused on emotional energy, and recasting leaders not as ideological visionaries engaged in sensegiving, but by setting in place conditions to build, harvest, and articulate emotional energy. Study Two examines members subsequent responses to these value-laden claims, finding that members either broadly rejected claims finding them akin to a desired projected image or broadly accepted claims finding them to be real and implicating of the organization itself. These responses varied depending on various ways members construed the credibility of the organization, as well as the plausibility of the organization’s claims. This study advances theories of how members accept or reject organizational meanings by highlighting the ways in which members anthropomorphize organizations – treating them as if they were human beings – and evaluating claims in light of what they see as organizational traits, motives, and intentions. I addition, this study advances theory by identifying the critical importance of perceiving how products and services – “what we do” – is linked to claims regarding “why we exist.” / Thesis (PhD) — Boston College, 2015. / Submitted to: Boston College. Carroll School of Management. / Discipline: Management and Organization.

As evidenced by the rapid increase of United Nations Principles for Responsible Investment (UNPRI) signatories, the integration of environmental, social and governance indicators (ESG) in investment decisions has become a popular topic. However, despite its popularity, there is no consensus among practitioners on what this actually means and how it should be tackled. The obvious lack of standardization is reflected by divergent ESG rating procedures, incomparable company sustainability reports and the widely differing strategies by asset managers and asset owners. This is a substantial hurdle as it can cause misalignment of perspectives within the investment chain, which keeps ESG from being pushed up the agenda. There appear to be substantial struggles on the road to ESG integration and several questions arise; are the perspectives on ESG integration aligned between companies, asset managers and asset owners? Where do possible obstacles on the road to responsible investment reside, what are they and how can they be overcome? My main findings are four-fold. First, I find ESG reporting fatigue among companies due to the sheer number of ESG ratings and rankings. Companies should not let this overwhelm them and be clear that they only respond to a handful. Investors should only use it as a starting point and ensure that it does not become a substitute for a real conversation with their portfolio companies about ESG. This interest is necessary for top management to sign off on sustainability initiatives. Second, I find that asset owners are not as convinced of the business case of ESG as asset managers and companies are. This is often reflected in the way they select, monitor and review their asset managers. Third, the lack of in-depth ESG due diligence by asset owners likely lets asset managers get away with decoupling statements from actions. More specifically, it appears that ESG and finance are often still separated. Lastly, companies are more reactive than proactive when it comes to ESG efforts. The main driver for them to embark on their ESG journey is the consumer. We can therefore play a significant role in creating a more sustainable world, either as the beneficiary or the consumer.

Corporate Social Responsibility (CSR) has become an increasingly significant element in contemporary business. Globalisation, a growing concern for environmental degradation, and evident social inequality have installed CSR on the global agenda. Companies around the world are introducing CSR programs, and many of the Schools of Management or Business Schools have CSR courses in their core programmes, including their MBAs. Organisations such as EFMD (www.efmd.org), ABIS (www.abis.org) and PRME (www.prme.org) are prompting universities and business schools to implement CSR as well as sustainability courses and seminars. Conceptual research concerned with the influences on firms’ socially responsible actions has recently emphasized the importance of institutional factors. However, current institutional accounts of corporate social responsibility implicitly assume the presence of well-developed and relatively stable institutional characteristics found in developed countries. In order to address this gap, this thesis presents a conceptual model, which explores how institutional pressures configure a local company’s CSR practices in developing countries. This thesis presents empirical findings drawn from in depth open-ended interviewees to managers of local companies in Argentina, taking into account type of industry, size, and the presence of multinational companies (MNCs). In so doing, this study contributes to extending the application of institutional theory to developing countries context and to theoretical analysis of local companies CSR practices in such contexts. Within this analysis, this study places particular emphasis on the role of MNC and the State in the processes of adoption of CSR practices by local companies in a developing country. Finally, this thesis contributes with practical implications for mangers of local companies and managers of MNCs’ subsidiaries in developing countries.

The successful institutionalisation of digitally-enabled service transformation (DEST) in the UK public sector has always been a challenge for the government. Associated with technology and managerial impediments, the derailment of several DEST projects in recent years has attracted much scholarly debate. Nonetheless, overt emphasis on the antecedents and effects of DEST institutionalisation has concealed the real events underpinning the transformation process, especially the 'social' interactions between the institutional actors and structures, as well as their role in the DEST institutionalisation process. Hence, this research aims to explore the roles of the actors and structures in DEST institutionalisation as working practice in public institutions. To do so, this research develops a conceptual framework grounded on Institutional Theory and Structuration Theory concepts, derived from the analysis of four past DEST cases in the UK. The framework is used in a qualitative enquiry that explores the well-publicised Universal Credit transformation case through interviews, focus groups and review of documentary and parliamentary-select-committee-media evidence. The findings offer insights into the deinstitutionalisation and structuration processes in the study of DEST institutionalisation to better understand the implementation of change in public institutions. This study concludes that actors and structures play important roles in structuring the DEST institutionalisation process as working practice in public institutions. Actors could manipulate structures of meaning, power and norms to promote desired actions in shaping practices that support DEST institutionalisation.

Prior research has studied extensively technology mediation in services. Yet, much of this work focuses on the consumer (or customer) viewpoint and there is a scarcity of research that focuses on the service provider perspective. By extension, there is little empirical work on how service providers experience and interpret technology use that is discretionary in nature (i.e., not imposed at an organisational/firm level). This study focuses on the context of healthcare and aims to unpack healthcare service providers discretionary use of mobile applications (apps). The aim of this thesis is to gain new insights on the discretionary use of technology in professional services by investigating its multifaceted nature. In doing so, I bring together the theoretical constructs of legitimacy, institutional work, and institutional logics of neo-institutional theory, role theory, as well as theories of professional identity construction to study healthcare service providers experiences. The emergent findings are structured upon three chapters (articles) and develop specific research questions that address the overarching aims and objectives of the thesis. In essence, this research highlights three core aspects of discretionary technology use; (a) how it is experienced by service providers in regards to the logics and rules of a given institutional context (macro level), (b) how it is approached by service providers based on changes in their roles in the organisation (meso level), and (c) how it is interpreted by service providers in relation to their professional identity (micro level).