Global ETD Search

31	Stimulating the diffusion of environmental technologies through export Kanda, Wisdom January 2017 (has links) Contemporary environmental problems represent complex societal challenges, and as these problems become increasingly global, the international diffusion of environmental technologies is essential. One way to diffuse technologies internationally is through export. Despite the potential benefits from the adoption of environmental technologies, their export is stifled by externalities and free-rider problems. From this background, the aim of this thesis is to analyse how to stimulate the diffusion of environmental technologies through export. This aim is operationalised using four research questions, which focus on governmental initiatives to promote environmental technology export and their perceived effectiveness among targeted firms, obstacles to and drivers for export among municipally owned companies, the use of international city networks to facilitate environmental technology export and components of business concepts for environmental technology export. These questions are explored in the Swedish context using document analyses, interviews and internet surveys in a compilation thesis which consists of a cover essay and an appendix of five scientifically peer-reviewed and published journal articles. The conclusions are that governmental export promotion initiatives are often generic for all kinds of exporters, including environmental technologies, and comprise financial support, information provision, education and training, and trade and mobility-related programs, often with little incorporation of the specific characteristics of environmental technologies which many exporters perceive as ineffective. Municipally owned companies experience different barriers to and drivers for engaging in international activities compared to privately owned companies, and are often involved in international projects which are not always commercial export. International city networks serve as important arenas for bi-directional information sharing and learning regarding market characteristics, environmental challenges and potential solutions, building legitimacy for technologies and their suppliers. Regarding components of business concepts for the export of environmental technologies, regulation, legitimacy and private-public partnership are identified as particularly important based on the complexity and systemic nature of environmental technologies. Altogether, this thesis makes a contribution by conceptualising the export of environmental technologies with emphasis on technology characteristics, the technology supplier including their business concepts, obstacles to and drivers for export, technology adopters and their characterisation, communication channels and the diffusion context. For policy makers, a dynamic approach to environmental technology export promotion, in which specific attributes of environmental technologies and their suppliers are considered along their international business development, is suggested as a complement to existing generic initiatives. The possibility to provide such support should be reconciled with resource effectiveness, heterogeneity among companies and the complementary role of governmental interventions to market initiatives. Finally, partnerships between publicly and privately owned companies are suggested as particularly relevant since they build on the long-term experience, functioning proof-of-concept and legitimacy of publicly owned companies together with the competitiveness and flexibility of privately owned companies. These attributes could help overcome the liabilities of foreignness and newness, as well as resource constraints which challenge environmental technology export. / De stora miljöproblemen innebär komplexa samhällsutmaningar och allt eftersom miljöproblemglobaliseras ökar behovet av en internationell spridning av miljöteknik. Export är ett sätt attsprida teknologier internationellt, men trots de potentiella fördelarna med miljöteknikexportstöter det ofta på hinder. Exempel på sådana hinder är externa effekter som att miljönytta intetillfaller det exporterande företaget, och att konkurrenter åker snålskjuts på de företag som tar deinitiala stegen. Utifrån denna bakgrund syftar den här avhandlingen till att analysera hur miljöteknikexport kanstimuleras ytterligare. För att besvara syftet har fyra frågeställningar utformats som fokuserar påstatliga initiativ för att främja export av miljöteknik och hur deras effekter uppfattas bland företagi målgruppen; hinder och drivkrafter för export hos kommunala bolag; internationella nätverkmellan storstäder som arenor för att underlätta export av miljöteknik; samt affärsmodeller för attexportera miljöteknik. Frågeställningarna utforskas i ett svenskt sammanhang genomdokumentanalys, intervjuer och enkäter. Avhandling bestående av en sammanfattande ”kappa”och fem publicerade vetenskapliga artiklar. Resultaten från avhandlingen visar att statliga initiativ för att främja export oftast är generiska förolika typer av exportörer inklusive miljöteknikföretag. Initiativen inkluderar vanligtvis finansielltstöd, information, utbildning samt stöd för marknadsbesök och mobilitet. Dock tas ingen störrehänsyn till de särskilda egenskaperna hos miljöteknik vid utformandet av stödet. Stödet uppfattasdessutom av många miljöteknikexportörer som ineffektivt. Kommunala bolag har andra hinderoch drivkrafter än privata företag för att engagera sig internationellt och är oftast involverade iprojekt som inte är direkta exportaktiviteter. Internationella nätverk mellan städer kan fungerasom arenor för informationsutbyte och lärande mellan olika aktörers marknadsegenskaper,miljöproblem och potentiella lösningar samt bidra till legitimitet för tekniken och dessleverantörer. När det gäller utveckling av affärsmodeller för att exportera miljöteknik framstårlagstiftning, legitimitet, och samarbete mellan privata och offentliga aktörer som särskilt viktigt attbeakta på grund av miljöteknikens komplexitet och systemiska natur. Sammanfattningsvis bidrar avhandlingen till en konceptualisering av miljöteknikexport genom attfokusera på teknikens egenskaper, dess leverantörers affärsmodeller, hinder och drivkrafter förexport, de som köper tekniken och deras egenskaper, kommunikationskanaler samt sammanhangdär spridningen sker. En rekommendation är att politiska beslutsfattare borde stödja export avmiljöteknik på ett dynamiskt sätt där specifika egenskaper hos miljöteknik och dess leverantörerbeaktas i takt med deras internationella affärsutveckling. En dynamisk ansats kan vara ett brakomplement till många befintliga generiska statliga initiativ för att främja export av miljöteknik.En sådan ansats bör ta hänsyn till resurseffektivitet, olikheter mellan företag, samt varakomplementär till de icke-statliga initiativ som redan finns på marknaden. Slutligen föreslåssamarbeten mellan offentliga och privatägda företag, vilket anses högst relevant eftersomoffentliga företag kan bidra till att kombinera den mångåriga erfarenheten av miljötekniskalösningar samt den legitimitet som sådana företag kan ha med privata företags styrkor så somkonkurrenskraft och flexibilitet. Dessa förslag kan bidra till att minska de exporthinder som haratt göra med att miljöteknik ofta är ny och främmande, samt miljöteknikföretagens oftabegränsade resurser. Environmental Technology Technology Diffusion Export Internationalisation Environmental Management Miljöledning Social Sciences Interdisciplinary Tvärvetenskapliga studier Business Administration Företagsekonomi Information Systems, Social aspects History of Technology Teknikhistoria
32	An Institutional perspective on change management : a case study of an open source enterprise content management system (ECM) in the South African Public Sector Weilbach, Elizabeth Helena (Lizette) January 2014 (has links) ICT development and deployment and supporting policies take place within a fiercely contested globalised political economy. For organisations there is a pervasiveness of change processes, often externally imposed, which are rising with these globalising effects. This not only implies that the context in which organisations are situated is continuously changing, but also that the nature of the organisation itself is subject to change (Van Tonder, 2004). However, the external influences imposed on an organisation are often heterogeneous and make the management of adapting to the external environment extremely complex. This thesis explores such an externally imposed change on an organisation around the implementation of a contentious national policy. This entails not only dealing with the more usual dimensions of change in an organisation, but also the implications of the national debate and contentions around the national policy playing out in the local setting of the organisation. In this thesis the change explored is within a government department from a proprietary Enterprise Content Management (ECM) system to an open source ECM system. An interpretative approach was followed, using a longitudinal case study. Two main aspects of this change process are explored. The first is the impact of the national open source policy on government departments - an externally imposed change of mission, vision and values. The second is how internally the government department changed its internal work processes and information systems to comply with that policy. These two aspects are intertwined. Alignment of the organisation mission, values and objectives, with the proposed technological innovation and change management models emerges as a necessary condition for managing change. However, what emerged as a more challenging issue was whether internal organisational changes can be aligned with contentious national policy imperatives. Three theoretical lenses are used to explore this contentious issue: the HEM model of Du Plooy’s (1998); the improvisational change management model of Orlikowski and Hofman (1997); and institutional theory as it applies to Information Systems. The improvisational change model of Orlikowski and Hofman (1997) in combination with Du Plooy’s (1998) HEM model, was used to understand the change process unfolding in the implementation of an OS ECM system in a Government department in SA. The result of this application is some practical recommendations for government officials on future OS implementations, as well as a theoretical add-on to extend the change management model applied. The researcher found that models can increase our understanding and reveal how one can ‘cultivate’ the human environment within which technology is to be implemented. However, the process of developing an understanding of how national policy was developed and the rationale for it was also found to be important, as is developing an understanding of the rationale of this particular department for choosing to implement the OS ECM system. By adding to, or expanding on Orlikowski and Hoffman’s (1997) model to include a fourth element, indicating the external forces in the environment, such as government regulations; government policy; and the debate on global and national FOSS versus PS, highlights the need for this external alignment as well as prevents the focus on internal alignment only. Institutional theory was consequently applied in an attempt to unpack the organisational and change management dimensions of the change model, aiming at understanding the institutional forces which legitimates or contradicts the technical/rational ideas and actions of the change. The findings were threefold. Firstly, the role played by IS as an institutional process in and of itself and the way in which this could have affected the implementation of the new OS ECM system was discussed, pointing to the possibility that the new system was not necessarily being implemented to streamline the work practices, but rather due to its institutional status of being a ‘rational myth’; something which had to be done as ‘it’s just the right thing to do.” Secondly, OSS and PS were argued to be different ‘types’ of institutions. Using the institutional pillars it was argued that OSS and PS were driven by different institutional forces, with PS leaning towards the regulative pillar and OSS being more in line with the normative pillar. These two institutions were found to mainly differ with regard to their basis of compliance and the logic behind them. The insights offered by this argument revealed that when changing from OSS to PS, it would be very valuable to recognise that OSS and PS are two different ‘types’ of institutions, and to not only understand that the new system could therefore change the organisational processes when it is implemented, but to also acknowledge the change which will take place within the IS/IT institution itself – moving from the regulative to the normative. The change should thus be understood both within the two different IS innovations themselves, and in how these two innovations interact. Lastly, the research in this thesis went beyond the technical/rational actions of the stakeholders, and included an in depth analysis of the institutional forces at play in the broader social context of the Government department. It explained the institutions which were at play on the international, national and organisational levels, pointing out which of these forces worked in favour of or against the technical/rational actions, and in the process contributed to the unexpected outcome of the new OS ECM implementation process. / Thesis (PhD-- University of Pretoria, 2014 / Informatics / unrestricted IT change management Social context of IT Institutional theory UCTD Open source software adoption Information technology diffusion Open source software (OSS) Information technology adoption Public Sector Change management Improvisational change model Emergent change Institutional theory
33	THREE ESSAYS ON PRODUCTIVITY AND CROSS-SECTIONAL ASSET PRICING Anand, Punit January 2021 (has links) It is a sandwich Thesis. The first and the second essay are joint works with my Supervisor, Dr. Ronald Balvers. The third essay is joint work with Fangxing Liu, a Ph.D. candidate (Finance) at DeGroote School of Business, where we have equally shared the work responsibility. / First essay deals with Productivity shocks. Productivity shocks transmitted from productivity leaders to trailing sectors are systematic sources of risk. Global technology and knowledge diffusion leads to predictable patterns in productivity dynamics across countries and industries. Productivity gaps determine the level of exposure to the systematic leader productivity shocks. Firms in a country-industry with larger productivity gaps relative to the world leader are more dependent on the leader's innovations compared to their own productivity improvements. They thus have higher loadings on the leader productivity shocks and higher average stock returns. For OECD panel data, a country-industry's productivity gap significantly predicts the stock returns of the country-industry: holding the quintile of country- industry portfolios with the largest gaps and shorting the quintile with the smallest gaps generates annual returns of 9.8% (6.7% after risk adjustment with standard factors). A factor associated with the productivity gap explains country-industry portfolio returns substantially better than standard factor models. Loadings on leader-country-productivity shocks are found to have substantial correlation with productivity gaps, and leader productivity shocks are more important for stock returns than idiosyncratic productivity shocks. These findings suggest that the productivity gaps and associated higher average returns are indeed tied to systematic risk. The second essay deals with Technology shocks. Technology shocks from technological frontier economies are a critical determinant of productivity shocks. These shocks spill over, pervading all lagging economies and are true systematic shocks. A country's aggregate technology gap with the frontier determines the potential for the systematic innovation shocks to affect it, but the country's absorption capacity determines its effective sensitivity to these shocks. We find conforming evidence that the technology gap, R&D intensity, and absorption capacity can explain stock returns. For OECD panel data, a one standard deviation increase in the technology gap increases excess stock returns by 0.578 percent per month. A one standard deviation increase in R&D intensity increases the excess return by 0.637 percent per month. An increase in absorption capacity of one standard deviation increases the excess return by 0.275 percent per month. When global FF factors are included, the results are diluted, which suggests that the FF factors may alias for the three variables associated with the systematic risk arising from frontier technology shocks. The third essay deals with Political risk. We find that the differences in Hassan et al. (2019) political Risk proxy derived from text processing of analyst transcripts can price cross-sectional returns after controlling for standard factor risks. A mimicking factor for the political risk measure, when added to the standard Fama French 5 factor model or the Q5 model, explains the test asset returns better than these models. In our limited sample, the changes in PRisk measure captures more information about political risk than the traditional measures from Baker et al. (2016), which suggests that one can start using changes in PRisk characteristic as a political risk proxy. / Thesis / Doctor of Philosophy (PhD) Production-Based Asset Pricing Productivity Gap Total Factor Productivity OECD Countries Technology Shocks Technology Gap R&D Stocks R&D Intensity Global Differences in Equity Returns Technology Diffusion Political Risk
34	Espacer l'organisation : trajectoires d'un projet de diffusion de la science et de la technologie au Chili Vásquez Donoso, Consuelo 08 1900 (has links) Comprendre le mode d’existence de l’organisation est certainement l’un des plus grands défis que se sont donnés les chercheurs qui s’intéressent à ce domaine d’étude. La littérature nous présente ainsi plusieurs images, métaphores et perspectives qui, combinées, dressent un portrait hybride de ce type de collectif. Je propose, dans cette thèse, de reconnaître et exploiter ce caractère hybride de l’organisation en partant d’une réflexion centrée sur l'espace. En m’inspirant particulièrement des travaux de la géographe Doreen Massey (1999, 2005), le concept d'espace auquel je souscris est celui d’un espace ouvert et dynamique (qui incorpore le temps), basé sur une relationalité matérielle et hétérogène, supposant des acteurs humains et non humains en interaction. L'espace peut donc être compris comme la coexistence d’ontologies hétérogènes, ce que Massey (2005) nomme une coexistence de trajectoires comme stories-so-far. Il s’agit ici d’une vision performative de l’espace organisationnel qui est constitué dans la relation de trajectoires distinctes qui coexistent, se rencontrent, s’affectent, entrent en conflit ou coopèrent (Massey, 1999). Je postule que pour assurer une certaine continuité et cohérence dans la coexistence de trajectoires hétérogènes, un travail d’alignement et d’ordonnancement est mis à l’oeuvre, et ce, par le suivi d’une trajectoire principale — ce que je nomme une trajectoire scriptée. Suivre cette trajectoire permet ainsi à l’organisation de s’étendre, de se rendre présente dans le temps et dans l’espace, sans pour autant perdre son identité : to be here and there at the same time, now and then at the same place. À partir de cette définition de l’espace, je propose d’« espacer l’organisation », et plus particulièrement d’« espacer » Explora, un programme d’éducation non formelle du gouvernement du Chili visant la diffusion et la valorisation de la science et de la technologie. Cette proposition est double : elle renvoie aux pratiques d’espacements — des pratiques hybrides, collectives et situées — des agents organisationnels (dans ce cas, aux pratiques des agents d’Explora impliqués dans l’organisation d’un projet, celui de la Semaine de la science 2006),mais aussi à une pratique de recherche. « Espacer l’organisation » veut donc dire déployer ces espaces pleins, déplier l’organisation, accroître la série des simultanéités-successions pour ainsi créer plus d’espace-temps. / To understand the organization’s mode of being is certainly one of the most important challenges faced by researchers who are interested in this field of study. The literature presents several images, metaphors and perspectives which, combined, draw up a hybrid portrait of this type of collective. In this dissertation, I propose to recognize and exploit this hybrid character by starting from a reflection on space. Inspired especially by the work of the geographer Doreen Massey (1999, 2005), the concept of space to which I subscribe is that of an open and dynamic space (which incorporates time), based on a material and heterogeneous relationality, which supposes human and nonhuman actors in interaction. Space can thus be understood as the coexistence of heterogeneous ontologies, what Massey (2005) calls a “coexistence of trajectories as stories-so-far”. It is then a performative vision of organizational space which is constructed through the relation of distinct trajectories that coexist, meet, affect each other, enter in conflict or cooperate (Massey, 1999). I argue that to guarantee a certain form of continuity and coherence in the coexistence of heterogeneous trajectories, a work of alignment and ordering is put at work, and this, by the following-up of a main trajectory — what I call a scripted trajectory. By following this trajectory the organization can then extend itself, making itself present in time and space, without loosing its identity: it can be “here and there at the same time, now and then at the same place.” Starting from this definition of space, I propose to “space the organization,” and more specifically to “space” Explora, a non formal educational program of the Chilean government, which aims to diffuse and promote science and technology. Spacing an organization implies a double proposal: it refers to the spacing practices — hybrid, collective and situated practices — enacted by organizational agents (in this case, Explora’s agents implicated in the organization of a project, that of the Science week 2006), but also to a research practice. “Spacing the organization” consists of deploying these full spaces, unfolding the organization, and increasing the series of simultaneities-successions in order to create more space-time. Processus organisants Pratiques d'espacement Communication organisationnelle Organisation par projet Modes d'ordonnancement Filature Analyse des interactions Sociologie de la traduction Géographie d'espace-temps Organizing Spacing practices Organizational communication Project organization Modes of ordering Shadowing Interactional analysis Science and technology diffusion Actor network theory Space-time geography
35	Espacer l'organisation : trajectoires d'un projet de diffusion de la science et de la technologie au Chili Vásquez Donoso, Consuelo 08 1900 (has links) Comprendre le mode d’existence de l’organisation est certainement l’un des plus grands défis que se sont donnés les chercheurs qui s’intéressent à ce domaine d’étude. La littérature nous présente ainsi plusieurs images, métaphores et perspectives qui, combinées, dressent un portrait hybride de ce type de collectif. Je propose, dans cette thèse, de reconnaître et exploiter ce caractère hybride de l’organisation en partant d’une réflexion centrée sur l'espace. En m’inspirant particulièrement des travaux de la géographe Doreen Massey (1999, 2005), le concept d'espace auquel je souscris est celui d’un espace ouvert et dynamique (qui incorpore le temps), basé sur une relationalité matérielle et hétérogène, supposant des acteurs humains et non humains en interaction. L'espace peut donc être compris comme la coexistence d’ontologies hétérogènes, ce que Massey (2005) nomme une coexistence de trajectoires comme stories-so-far. Il s’agit ici d’une vision performative de l’espace organisationnel qui est constitué dans la relation de trajectoires distinctes qui coexistent, se rencontrent, s’affectent, entrent en conflit ou coopèrent (Massey, 1999). Je postule que pour assurer une certaine continuité et cohérence dans la coexistence de trajectoires hétérogènes, un travail d’alignement et d’ordonnancement est mis à l’oeuvre, et ce, par le suivi d’une trajectoire principale — ce que je nomme une trajectoire scriptée. Suivre cette trajectoire permet ainsi à l’organisation de s’étendre, de se rendre présente dans le temps et dans l’espace, sans pour autant perdre son identité : to be here and there at the same time, now and then at the same place. À partir de cette définition de l’espace, je propose d’« espacer l’organisation », et plus particulièrement d’« espacer » Explora, un programme d’éducation non formelle du gouvernement du Chili visant la diffusion et la valorisation de la science et de la technologie. Cette proposition est double : elle renvoie aux pratiques d’espacements — des pratiques hybrides, collectives et situées — des agents organisationnels (dans ce cas, aux pratiques des agents d’Explora impliqués dans l’organisation d’un projet, celui de la Semaine de la science 2006),mais aussi à une pratique de recherche. « Espacer l’organisation » veut donc dire déployer ces espaces pleins, déplier l’organisation, accroître la série des simultanéités-successions pour ainsi créer plus d’espace-temps. / To understand the organization’s mode of being is certainly one of the most important challenges faced by researchers who are interested in this field of study. The literature presents several images, metaphors and perspectives which, combined, draw up a hybrid portrait of this type of collective. In this dissertation, I propose to recognize and exploit this hybrid character by starting from a reflection on space. Inspired especially by the work of the geographer Doreen Massey (1999, 2005), the concept of space to which I subscribe is that of an open and dynamic space (which incorporates time), based on a material and heterogeneous relationality, which supposes human and nonhuman actors in interaction. Space can thus be understood as the coexistence of heterogeneous ontologies, what Massey (2005) calls a “coexistence of trajectories as stories-so-far”. It is then a performative vision of organizational space which is constructed through the relation of distinct trajectories that coexist, meet, affect each other, enter in conflict or cooperate (Massey, 1999). I argue that to guarantee a certain form of continuity and coherence in the coexistence of heterogeneous trajectories, a work of alignment and ordering is put at work, and this, by the following-up of a main trajectory — what I call a scripted trajectory. By following this trajectory the organization can then extend itself, making itself present in time and space, without loosing its identity: it can be “here and there at the same time, now and then at the same place.” Starting from this definition of space, I propose to “space the organization,” and more specifically to “space” Explora, a non formal educational program of the Chilean government, which aims to diffuse and promote science and technology. Spacing an organization implies a double proposal: it refers to the spacing practices — hybrid, collective and situated practices — enacted by organizational agents (in this case, Explora’s agents implicated in the organization of a project, that of the Science week 2006), but also to a research practice. “Spacing the organization” consists of deploying these full spaces, unfolding the organization, and increasing the series of simultaneities-successions in order to create more space-time. Processus organisants Pratiques d'espacement Communication organisationnelle Organisation par projet Modes d'ordonnancement Filature Analyse des interactions Sociologie de la traduction Géographie d'espace-temps Organizing Spacing practices Organizational communication Project organization Modes of ordering Shadowing Interactional analysis Science and technology diffusion Actor network theory Space-time geography
36	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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