This dissertation offers insight into the organizational lives of small and new not-for-profits. The first essay used three different estimation strategies to model the role of revenue type in the growth in young and small not-for-profits. We find that increases in the percentage of a not-for-profit’s revenue portfolio going to dues, indirect support, or non-mission income will suppress growth and that there is no “optimal” model across subsectors. The second essay uses over twenty years of panel data to predict which factors indicate the impending recovery of a financially vulnerable small and young nonprofit. Support for hypotheses based in the literature is mixed, but the key insight is that nonprofits need to save if they want to get healthy: bringing in revenues is not enough. Finally, the third essay uses a qualitative approach on young and new mental health not-for-profits in the state of New York. Using comparative case studies, this study analyzes the internal and external factors surrounding the demise of small and young mental health nonprofits. This study finds support for several of the potential causes of nonprofit demise in a newly proposed typology.

This thesis stems from academic research following my MPhil in 1992. It presents a portfolio of fourteen selected papers offering insights on major issues affecting the accountancy-related areas of external auditing (EA) and corporate governance (CG) in the small state of Malta. The commentary (Chapter 1) presents a background to the development of the portfolio and overviews the theoretical framework and methodology. It then introduces each paper, underlining common sub-themes. The contributions of the papers to knowledge are then indicated by (i) overviewing the development of each sub-theme contributing to the academic discourses in EA and CG, and (ii) laying out the relevance to the wider debates relating to small state literature. The commentary concludes by looking at the follow-up research agenda and the beckoning future. Chapters 2 to 15 then reproduce fourteen papers an introductory paper and thirteen others in two parts. The introductory paper includes most major small state sub-themes recurring in different ways in the subsequent papers: issues relating to close relationships and independence, discipline, resistance to change, regulation, secrecy, small business units and other small state issues. The following first part includes seven papers on Maltese external auditing in owner-managed companies, auditor changes, auditor perceptions, qualified opinions, first-time auditor selection, fee development and dysfunctional audit behaviour. The second part then comprises six papers on Maltese CG including the CG statement, internal audit benchmarking, conflicts of interest in co-operatives, the board/management relationship, a CG index, and small shareholder participation in the AGM. The portfolio contributes to literature notably by its original highlighting of the significance of the above-mentioned sub-themes on various aspects of EA and CG in a small state. Furthermore, the portfolio impacts Maltese EA and CG practices, particularly by emphasising the need to go beyond the adoption of imported regulatory frameworks.

Open innovation is a phenomenon that has gained vast attention since its introduction in 2003. It has been identified that organizations are experiencing a shift from the innovation process towards an open innovation approach. However, research on open innovation in small and medium-sized enterprises (SMEs) has shown to require more attention in the literature. This study investigated the effect of resources and capabilities in Swedish SMEs to address the challenges of liability of smallness. The purpose of this research is to investigate the challenges that Swedish SMEs in the high-tech industry face while opting for an open innovation approach. For that, the following research question was answered: How do resources and capabilities affect Swedish SMEs in engaging in open innovation to overcome the liability of smallness?  A resource-based theory has been implied in this study which examines from five distinct perspectives namely, strategy, process, corporate structure, cross-company network, and culture.  This thesis paper is a qualitative study that has been conducted by semi-structured interviews with five Swedish SMEs. The empirical data was then thematically analyzed and seven themes have been developed from the data analysis. The findings reveal that firstly, Swedish SMEs in the high-tech industry are open to external collaboration and accepting innovative ideas coming from both internal and external sources. Therefore, empirical evidence shows that Swedish SMEs are not always reluctant to make a shift towards open innovation. Rather it has been found that SMEs are open to opportunities to tackle the obstacle of smallness. Secondly, resources and capabilities have a positive effect on the performance of the SMEs. Allocation of resources both financial and human resources results in the successful commercialization of a project, thus by gaining a competitive advantage the performance of the firm improves significantly. Thirdly, whilst the liability of smallness has shown to have an impact on Swedish SMEs in the high-tech industry, it has also been identified how smallness also can be viewed as an asset. Smallness as an asset has been found to make an impact on Swedish SMEs in the high-tech industry and the unique opportunities that they possess. Leveraging open innovation and capitalizing on flexibility, linear corporate structure, inclusive culture, and leveraging formal and informal networks to engage in external collaboration has been shown to have an effect on SMEs and contribute to smallness as an asset. Therefore, a comprehensive conceptual framework has been developed in this study that integrates insights gained from the research.

Small businesses are an important part of innovation, competitiveness and economic development. Support systems such as business incubators have emerged with the purpose of helping these startups develop. The startups which are in focus in this thesis operate in different industries, in technology-based industries where commercialization and growth is in focus, to creative industries which focus on developing individual talent and creativity. The characteristics and core of the businesses differ, giving them different business logics by which the startups operate. The business logic leads the startups to face different challenges, which the thesis considers to regard liabilities of smallness, liabilities of newness and liabilities of uniqueness as well as organizing.  These variations give the startups differences in how they operate and hence, also a need for different types of support given by business incubators. Business incubator support is in the thesis categorized into three components of Networks, Infrastructure and Business Services, as suggested in a triad model of Carvalho & Galina (2015). As varying business logics makes a difference on what type of value startups produce, it is important to study the relationship between these logics and the support provided by an incubator. It is important in order to understand how incubators can adapt their support more effectively to help entrepreneurs overcome their challenges.  The thesis purpose is to broaden the understanding of how business logics and challenges of startups adhere to the industry they are in, and how the support given by business incubators can help the businesses to overcome challenges associated with these business logics. The research design was qualitative, and data was collected by performing six semi-structured interviews with entrepreneurs within creative and technology-based industries, enrolled at business incubators with these specializations.  The study results in a proposed model, giving extension to the original triad model by Carvalho & Galina (2015). In the proposed model, new dimensions of the support system as well as the nature of the startups’ business logics, and challenges are addressed. The proposed model and the study’s results may act as a guiding framework for future research in the field, aiming to gain a better understanding of the reality of startups with different business logics.

Studies on the internationalization of entrepreneurial firms have ignored women's entrepreneurship as a distinct research area before the 1970s. However, women's entrepreneurship started to get the attention of researchers a few decades ago and it is still in the adolescence stage. In addition, there is very little research on the internationalization of women entrepreneurial firms from emerging markets particularly those from Bangladesh. Researches that have been conducted on the challenges of Bengali women entrepreneurial firms often focused on the challenges of developing a business within the domestic context. The study seeks to fill this knowledge gap by exploring the challenges the women entrepreneurs in emerging markets are facing while growing a business within the international context, with a focus on Bangladeshi women entrepreneurial firms. This study was conducted using qualitative case studies using semi-structured interviews of three women entrepreneurial firms. The empirical findings show that two Bengali women entrepreneurs are involved with both inward and outward internationalization and one is involved with outward internationalization. The research identified networking as the greatest challenge faced by women entrepreneurs when it comes to internationalizing the business from an emerging market where insufficient funding is also another greatest obstacle. The findings also revealed that entrepreneurs should concentrate on expanding their knowledge and learning further in order to improve their skills and dynamic capacities, which is still insufficient and requires extensive effort to ensure the successful internationalization of the businesses. The findings also showed that Bangladesh is still lagging behind other developed economies in terms of digitalization and innovation. The smallness of the business also significantly affects the business activities when it comes to competing globally.

This dissertation focuses on the formation, growth and discontinuance of business populations and firms in Sweden during the 20th century. It addresses some key issues in the domain of economic and social sciences, and in particular entrepreneurship and small business research: if and when firms grow, stagnate and decline, as well as how long firms survive and when they are likely to disband. Previous research has primarily analyzed these questions from a short time frame. Further, an individual or firm-oriented focus is commonly assumed. In that, alternative or complementary explanations to the growth and survival of firms may be disregarded. In contrast to much previous research, this dissertation assumes a micro-to-macro, longitudinal and demographic population approach. The period of investigation is over one hundred years. In addressing the growth and survival of firms, it takes into account the impact of firm-specific structural factors (such as firm age and size), generation (cohort) effects, as well as the influence of macroeconomic, exogenous factors. Further, the relationship between managerial/ownership succession and firm performance is also addressed. Both cross-sectional and longitudinal databases are employed in the dissertation. Its main empirical material consists of unique longitudinal data on new business firms, traced at the firm level from their birth to their termination. More specifically, seven birth cohorts – generations – of approximately 2,200 firms founded in 1899, 1909, 1912, 1921, 1930, 1942 and 1950 are included. The main findings show that ownership/management succession in firms had a quite weak correlation with firm performance and survival. At least at an aggregate level, and with some exceptions, it is debatable if the loss and replacement of owner-managers in small and in larger firms have any observable effects on firm performance. Furthermore, macroeconomic phenomena influence the conditions of individual firms as well as populations/aggregates of businesses. Both the growth and termination of firms and firm populations are found to be related to real economic (environmental) conditions; e.g. favorable macroeconomic conditions implied that firms grew in size. At the same time, under certain circumstances, the influence of structural variables (firm age and size) – as suggested in much previous research – is found to be of importance. As concerns firm growth, as well as firm termination, the economic environment and structural factors interact. These findings challenges individual or firm-level research that mainly focus on personal traits and behaviors in explaining firm success and failure. Other previous assumptions are also challenged when taking a longer time perspective into consideration. For decades, organization and business research have acknowledged a liability of newness and of size for business firms. While this might be true under some conditions, this liability of newness is falsified in the study: the termination behavior of some firm generations did not correspond with these assumptions. Thus, the perspectives and methodology applied in the dissertation complement earlier approaches in entrepreneurship and small business research.

[ES] La tesis doctoral analiza las contaminaciones de la arquitectura que afloran al transformar los grandes contenedores multifuncionales o hasta los edificios complejos más recientes de menor tamaño que son el resultado de una hibridación entre arquitectura, paisaje e infraestructuras. Trámite la perspectiva de la dimensión hibrida, se va perfilando, en realidad, una evolución conceptual y productiva significativa. Con este enfoque de investigación, lo híbrido se concibe como un agente teórico que se desglosa primero como contenedor híbrido (objeto-arquitectónico), luego como hibridación (arquitectura-paisaje), y por último como ámbito híbrido (arquitectura-infraestructura). Así se establece un ámbito teórico con la capacidad de reconectar los elementos en un sistema y lograr renovar constantemente el significado. Es decir que, primero, las obras ponen de relieve un desacoplamiento entre contenido y contenedor, entre forma y función, en donde se detecta una espacialidad interior dilatada, un paisaje indoor definido por la envoltura estática, donde lo híbrido se manifiesta como una presencia intrínseca que representa el concepto de “ciudad en la ciudad”, un espacio centrípeto, que se proyecta por completo hacia el interior del volumen arquitectónico. Sucesivamente dicho desacoplamiento se encamina hacia una difuminación de los límites dentro de los que trabaja la arquitectura, llegan-do luego a definir una hibridación que actúa en el espacio intermedio, como presencia liminar que se concentra en el perímetro y en el borde, como ámbitos de acoplamiento entre arquitectura y paisaje: desde esta óptica el papel más significativo de la superficie conlleva una atenuación del vínculo volumétrico. Las delimitaciones reglamentarias, por consiguiente, se van difuminando, facilitadas por el empuje vital que ofrece el paisaje. En la tesis doctoral se recoge, además, otra brecha conceptual debida a la capacidad de los elementos de organizarse en un sistema que actúa en un ámbito con mayores posibilidades de acoplamiento trámite un rebasamiento que elimina los casos anteriores. El planteamiento arquitectónico se enmarca así en un ámbito de infraestructuras más amplio, un ámbito híbrido extendido que se caracteriza por una presencia extrínseca del híbrido. De esta forma se genera un espacio centrífugo que logra crear conexiones de gran alcance acoplando arquitectura e infraestructuras trámite orientaciones de intensidad e imágenes de la extensión. El rebasamiento representa una fase nueva en la que la arquitectura alcanza una conciencia identitaria nueva mediante una ampliación de sus atribuciones y de los instrumentos teóricos y operativos. La tesis doctoral profundiza en el ámbito de la metrópolis contemporánea que se caracteriza por el paulatino abandono de los modelos urbanos reconocibles, porque se abre y acoge las contradicciones, lo plural y lo heterogéneo. La difuminación de los límites tradicionales implica un replanteamiento de la ciudad concebida ahora como un sistema abierto que se transforma indefinidamente (Sennett, 2018). La incesante urbanización y la elevada densidad implican un cambio de los valores asignados al espacio tradicional de las ciudades que tienden a estructurar-se con formas mutantes, generando fragilidad dentro a la ciudad misma: bienvenida ¡cultura de la congestión! (Koolhaas, 2001). Se analiza el enriquecimiento del ámbito específico de la arquitectura que acoge la esencia de las otras disciplinas para lograr así una difuminación de la idea de producir objetos aislados, al incorporarlos dentro de un espacio más extenso de relaciones. Esta es la idea subyacente a la noción de antiobjeto elaborada por el arquitecto japonés Kengo Kuma (Kuma, 2014), que propugna abandonar definitivamente el edificio como objeto arquitectónico y apunta en cambio a crear una red de interrelaciones e interconexiones con el entorno que lo rodea. La noción final de anti-objeto, a la que se refiere la tesis doctoral, marca el ápice de una estrategia de acciones que analizan la difuminación de la arquitectura identitaria tradicional y destacan el inicio de una relación nueva con el territorio y el paisaje. Por último, otra fase conceptual es la afirmación de la condición de ámbito híbrido (Allen 1999). Lo híbrido a este respecto opera anulando las jerarquías y facilitando los intercambios que se generan por la condición de libertad. Por su capacidad de desplazarse entre las diferentes disciplinas y las diferentes escalas, lo híbrido demuestra su fuerza transversal en términos de interescalaridad. El acoplamiento entre arquitectura, paisaje e infraestructura conlleva un potencial emancipador de los dogmas compositivos, un replanteamiento del enfoque proyectual desde su origen, es decir una revisión radical de sus elementos. Desde esta perspectiva nueva, la arquitectura se considera como un soporte y parrilla que puede ajustarse de modo flexible a los cambios. Una disciplina que no ofrece respuestas inflexibles y que actúa en una zona liminar entre ámbitos diferentes tratando de plasmar una actitud proyectual abierta que logre encarar los eventos imprevisibles y respaldar las transformaciones futuras. / [EN] The dissertation analyses architectural contaminations emerging from the development from large multifunctional containers to most recent smaller complex buildings, resulting from a hybridisation between architecture, landscape and infrastructure. Through the lens of the hybrid dimension, a significant conceptual and productive evolution emerges. In this perspective of study, the hybrid is interpreted as a theoretical operator and is developed as hybrid container (architecture-object) at first, then as Hybridisation (architecture-landscape), and finally as hybrid field (archi-tecture-infrastructure). Therefore, the theoretical scope is characterised by the systemic reconnection of elements and the constant creation of new meanings. In other words, at first the architectural works highlight the disconnection between content and container, shape and function, where internal space is extended, as in an indoor landscape defined by the static nature of the container and the hybrid is presented as an intrinsic presence representing the idea of a “city in a city”, a centripetal space, fully extended within the architectural volume. Subsequently, the afore mentioned disconnection moves towards the thinning of the boundaries in which architecture operates, to then de-fine a hybridisation operating on intermediate space as a liminal presence concentrating on the perimeter and the edge, as the reconnecting area of architecture and landscape. In this perspective, the enhanced role of the surface leads to reduced volume constraints. Disciplinary boundaries move towards their dissolution encouraged by the vital impulse provided by the landscape. The dissertation highlights also a further conceptual shift caused by the capacity of the elements to organise into a system, by acting in a freer field for reconnection through a trespassing which addresses the previous instances. Therefore, the architectural discourse expresses itself within a larger infrastructure scope, a hybrid expanded field characterised by the extrinsic presence of the hybrid. In this way, a centrifugal space, capable of large-scale connections, joining architecture and infrastructure through 13 intensity trajectories and shapes with different extensions, is created. The trespassing represents a new phase when architecture acquires renewed awareness of its identity through the extension of its attributions and its theoretical and operational tools. The focus area of the dissertation is the contemporary metropolis, charac-terised by the progressive abandonment of recognisable urban models, to embrace, contradictions, multiplicity and heterogeneity. The dissolution of traditional constraints leads to the rethinking of the city conceived now as an open system in constant transformation (Sennett, 2018), where constant urbanisation and its high density introduce a change in the values given to the traditional space of the city which tends to configurate in discontinuous forms, causing internal fragility for the city: welcome to the culture of congestion! (Koolhaas, 2001). The Enrichment of the scope of architecture is therefore explored as it welcomes the spirit of other disciplines, and by doing so reaches the dis-solution of the idea of the production of isolated objects, by reconnecting them into a larger space of relationships. This is the idea underlying the notion of anti-object, elaborated by the Japanese architect, Kengo Kuma (Kuma, 2014), who wishes for the permanent abandonment of the build-ing as architectural objects and aims at creating a network of relationships and interconnections with the surroundings. The final notion of anti-ob-ject referred to in the dissertation, marks the apex of a strategy of actions exploring the dissolution of architecture in terms of traditional identity and marks the beginning of a renewed relationship with the territory and the landscape. A further conceptual shift is finally represented by the affirmation of the notion of Hybrid field (Allen 1999). In this case, the hybrid operates by nullifying hierarchies and favouring interchanges produced by a condition of freedom. Due to its ability to move between different disciplines and scales, the hybrid shows its transversal strength in terms of interscalarity. The reconnection between architecture, landscape and infrastructure carries with it a potential freedom from the compositional dogmas, and the rethinking of the projectual approach starting from its origin, that is a radical revision of its elements. In this new perspective, architecture is seen as a support and a palimpsest able to address changes in a flexible manner. A discipline that doesn’t provide fixed answers but operates at the border between different areas and tries to build an open projectual attitude capable of facing up to unpredictable events and supporting future transformations. / [IT] La dissertazione analizza le contaminazioni dell’architettura che emergono nella trasformazione dai grandi contenitori multifunzionali fino ai più recenti edifici complessi di minori dimensioni e che sono il frutto di una ibridazione tra architettura, paesaggio e infrastruttura. Attraverso la lente della dimensione ibrida, infatti, emerge una significativa evoluzione concettuale e produttiva. In questa prospettiva di studio, l’ibrido viene letto come un operatore teorico e si declina prima come contenitore ibrido (oggetto-architettonico), poi come ibridazione (architettura-paesaggio), infine come campo ibrido (architettura-infrastruttura). Si afferma così un ambito teorico caratterizzato dalla capacità di riconnettere a sistema gli elementi e approdare a significati costantemente rinnovati.In altri termini, dapprima le opere evidenziano una disgiunzione tra contenuto e contenitore, tra forma e funzione, in cui si rileva una spazialità interna dilatata, un paesaggio indoor fissato dalla staticità dell’involucro, dove l’ibrido si manifesta come una presenza intrinseca rappresentativa di un’idea di “città nella città”, uno spazio centripeto, tutto proiettato all’interno del volume architettonico. Successivamente detta disgiunzione si orienta verso un assottigliamento dei confini entro i quali opera l’architettura, giungendo poi a definire un’ibridazione che agisce sullo spazio intermedio, come presenza liminare che si concentra sul perimetro e sul bordo, quale ambito di ricongiunzione tra architettura e paesaggio: in questa prospettiva il ruolo più significativo della superficie porta a un affievolimento del vincolo volumetrico. Le perimetrazioni disciplinari si avviano dunque a una dissoluzione, favorita dallo slancio vitale offerto dal paesaggio.La dissertazione coglie infine un ulteriore scarto concettuale, determinato dalla capacità degli elementi di organizzarsi a sistema agendo in un campo più libero di riconnessione tramite uno sconfinamento che riassorbe le istanze precedenti. Il discorso architettonico si esprime così in un ambito di infrastrutturazione più ampio, un campo ibrido espanso caratterizzato da una presenza estrinseca dell’ibrido. In questo modo si genera uno spazio centrifugo in grado di compiere connessioni ad ampio respiro con un congiungimento tra architettura e infrastruttura attraverso direttrici di intensità e figure dell’estensione. Lo sconfinamento rappresenta una nuova fase in cui l’architettura acquisisce una rinnovata consapevolezza identitaria mediante una dilatazione delle sue attribuzioni e degli strumenti teorici ed operativi. Ambito di approfondimento della dissertazione è la metropoli contemporanea, connotata dal progressivo abbandono di modelli urbani riconoscibili, per aprirsi ad accogliere le contraddizioni, il molteplice e l’eterogeneo. La dissoluzione dei limiti tradizionali porta a un ripensamento della città vista ora come sistema aperto e in continua trasformazione (Sennett, 2018), in cui l’incessante inurbamento e l’elevata densità introducono un cambio dei valori attribuiti allo spazio urbano tradizionale che tende a configurarsi in forme discontinue, generando una fragilità interna alla città stessa: benvenuta cultura della congestione! (Koolhaas, 2001). Si esplora dunque un arricchimento del campo stesso dell’architettura che accoglie lo spirito delle altre discipline e così facendo giunge a una dissoluzione dell’idea di una produzione per oggetti isolati, reinserendoli all’interno di uno spazio più ampio di relazioni. Questa è l’idea alla base della nozione di anti-oggetto elaborata dall’architetto giapponese Kengo Kuma (Kuma, 2014), che auspica il definitivo abbandono dell’edificio come oggetto architettonico e mira invece a intrecciare una rete di interrelazioni e interconnessioni con l’intorno circostante. La nozione finale di anti-oggetto, cui la dissertazione fa riferimento, segna l’apice di una strategia di azioni che esplorano la dissoluzione dell’architettura in termini identitari tradizionali e segnano l’avvio di un ritrovato rapporto con il territorio e il paesaggio. Un ulteriore passaggio concettuale è infine rappresentato dall’affermazione della condizione di campo ibrido (Allen 1999). L’ibrido a questo punto opera annullando le gerarchie favorendo interscambi generati da una condizione di libertà. Per questa sua capacità di muoversi tra le diverse discipline e alle diverse scale, l’ibrido mostra la sua forza trasversale in termini di inter-scalarità. La ricongiunzione tra architettura, paesaggio e infrastruttura porta con sé un potenziale liberatorio dai dogmi compositivi, un ripensamento dell’approccio progettuale partendo all’origine, ossia una radicale revisione dei suoi elementi. In questa nuova ottica, l’architettura viene vista quale supporto e palinsesto in grado di rispondere in modo flessibile ai cambiamenti. Una disciplina che non fornisce risposte rigide ma si muove su un terreno liminare tra ambiti differenti e cerca di costruire un atteggiamento progettuale aperto che possa fronteggiare gli eventi imprevedibili e supportare future trasformazioni. / Gironi, R. (2021). Gulliver en busca de Liliput. La dimensión híbrida de la Arquitectura [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/170334 / Premios Extraordinarios de tesis doctorales

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.