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Risky investment choices, not COVID, put U.S. hospitals in the red

Marianne Klinker — Thu, 02 Mar 2023 15:49:57 +0000

Risky investment choices, not COVID, put U.S. hospitals in the red Marianne Klinker Thu, 03/02/2023 - 10:49

Financially troubled U.S. hospitals are petitioning for more support from the federal government, but handouts won’t fix the underlying problem.

As the United States takes steps to move past the pandemic, its health care system is in a fragile financial state. At the end of 2022, about half of U.S. hospitals were in the red—making it the worst year for the industry since the start of the pandemic. No wonder, then, that hospitals are petitioning Congress for help and protesting the pending cessation of COVID funding from the federal government.

At first glance, the industry’s pleas appear justified. After all, COVID hit hospitals like a tidal wave, filling beds with patients requiring arduous, expensive care. At the same time, hospitals suffered from the same supply chain and workforce issues as virtually every other public-facing facility. And since the vaccine rollout, COVID’s waning lethality has produced an influx of patients who had delayed seeking treatment during the height of the pandemic—and whose health problems may have worsened in the interim.

Seb Demirkan

However, Sebahattin Demirkan, an associate professor of accounting at 91��, says that the true source of the industry’s financial woes may lie beyond COVID. For Health Affairs Forefront, Demirkan and co-authors Ge Bai of Johns Hopkins University and Christopher M. Whaley of RAND Corporation took a deep dive into the most recent financial reports issued by ten of the U.S.’s largest nonprofit health care systems.

Contrary to the COVID-caused-it narrative, they found that, on average, revenue from patient care actually increased (albeit by less than 1 percent) between 2021 and 2022. Investment revenue, on the other hand, declined by a disastrous 185 percent over the same period. These are heavy but not totally surprising losses, seeing as how 2022 was the worst year for financial markets since the Great Recession. However, they cast doubt on the contention that hospitals’ financial struggles are primarily due to operational challenges brought on by the pandemic.

Without understanding the primary driver of hospitals’ financial strain, policymakers cannot make evidence-based decisions that benefit hospitals and patients in the long run.

For Demirkan, getting the origin story right is critical for policymakers weighing the current situation. As the article states, “Without understanding the primary driver of hospitals’ financial strain, policymakers cannot make evidence-based decisions that benefit hospitals and patients in the long run.” Clearly, if the health care system’s exposure to downside risk is to blame, more federal funding alone wouldn’t resolve the issue. Even if federal bailout money were restored to 2020 levels, hospitals would be in danger of yet further losses via their investment portfolio.

Demarkan’s main concern is for the taxpayers who may be stuck with the bill, through increased taxes and/or rising patient fees and insurance premiums. “While hospitals are critical for patients and communities, resources used to pay for hospital care come from those same patients and communities,” the article states.

He points to a possible contradiction between the non-profit status of these institutions and their investment strategy, which he says resembles that of a hedge fund. Such an approach is likely to reap outsized gains in bull markets—in bear markets (as in 2022), above-average losses. “If they behave like any other for-profit company or financial company, then it is not going to serve the entire nation, the taxpayers or people. All stakeholders will be hurt, basically,” Demirkan says.

As one possible remedy, he suggests regulators could insist that non-profit hospitals limit risk exposure across their portfolio as a precondition for public assistance. “They may say, ‘if you want to invest extra cash, invest in ETFs or mutual funds. FedEx, Amazon etc.—less volatile and less risky financial instruments and stocks.” Still, Demirkan acknowledges that attempts to ratchet up oversight or accountability would run afoul of the influential health care lobby.

At the very least, therefore, he advises the government not to “with blind eyes, give away money to these hospitals, and just look at how they use that money if they are nonprofit hospitals. And basically, use your judgment accordingly.”

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In This Story

An 'ethics of care' for journalists covering mass shootings

Jennifer Anzaldi — Wed, 31 Aug 2022 15:00:17 +0000

An 'ethics of care' for journalists covering mass shootings Jennifer Anzaldi Wed, 08/31/2022 - 11:00

In This Story

Ashley Yuckenberg

Ashley Yuckenberg

Before May 24 of this year, much of the country had never heard of Uvalde, Texas. But the horrific incidents of that day catapulted the small city to national consciousness. Its name became synonymous with the crisis of gun violence gripping the United States. In the process, a local tragedy was made part of a sorrowful lineage—only the latest, and fully expected not to be the last, in a string of similar calamities. Yet the 21 lives lost, among them 19 children, were unique individuals whose loss caused unimaginable grief for their community.

The manifold meanings of traumatic events like Uvalde and other mass shootings create thorny ethical dilemmas for journalists, over and above their usual concerns about accuracy and the ideal of non-intervention. Beneath the blinding light of the national stage, there is an ever-present risk that in trying to get the story right, reporters may inadvertently add to the violence’s toxic aftereffects.

In her 2021 dissertation, Ashley Yuckenberg, a trained journalist and assistant professor of business communications at 91��, plumbs the ethical quandaries of crisis coverage and provides a framework for guiding journalists through them.

Yuckenberg completed the dissertation, titled “Ethical Implications of Communicating Risk in the Media: A Heuristic for Reporting on Crisis Events with a Focus on Mass School Shootings,” for a PhD in Writing and Rhetoric from Mason. Her research builds upon concepts from late-20th-century feminist philosophers, who argued against ethical absolutism and for an “ethics of care” that considers actions in light of their effect on others. Yuckenberg was also strongly influenced by the 2008 book Horrorism, in which feminist thinker Adriana Cavarero explores the uniquely traumatic characteristics of contemporary violence targeting the most vulnerable (e.g., suicide bombings and school shootings).

But Yuckenberg’s interest in the issue is more than theoretical. “As a K-12 teacher for eight years, I had to take students through active shooter drills, and we had to be aware,” she says.

The 2007 Virginia Tech shooting also touched Yuckenberg personally as a community resident. “The shooter went to high school with me. He was a year younger than me. And one of my friends lost his sister.”

Her research took her to the Library of Congress, where she analyzed a total of around 700 articles about the Columbine, Virginia Tech, and Parkland school shootings. Yuckenberg used local newspapers—rather than, say, the New York Times—because their closeness to the affected communities increased the immediacy of their coverage as well as its emotional impact for those most directly traumatized by the event. She opted for print editions over digital articles so she could capture subtleties of journalistic presentation such as the original headlines, selection and placement of photos, etc.—suggestive nuances that can influence how readers interpret the news.

Through the evolution of media narratives, Yuckenberg was able to track how journalistic missteps (which were no doubt well-intentioned) in the wake of the violence distorted the national conversation. On the day of the 1999 Columbine shooting, for example, reporters interviewed traumatized students fresh from the scene of slaughter. False rumors circulating amongst the teenagers ended up being reported as fact, e.g., that the perpetrators had formed a gang called the Trench Coat Mafia to avenge supposed bullying. These questionable accounts, related as part of a breaking news story, helped form a terrifying template of the disaffected school shooter that stalks the American imagination to this day. They also introduced elements into the national discourse that arguably had no business being there, such as the putative role of goth culture in motivating school shootings.

In 2017, the Centers for Disease Control (CDC) issued guidance for reporters covering mass shootings, including a sensible crop of general principles such as avoiding angles and language that could glamorize the carnage, thereby inspiring copycats. Yuckenberg drew upon her journalistic training, as well as her research and theoretical framework, to translate the CDC’s guidelines into a practicable technique for journalists. Just as the “five W’s” are a near-universal reference point for structuring news stories, Yuckenberg hopes her mnemonic device—or, in academic parlance, “heuristic”—will be widely adopted by journalists covering crisis events.

Her dissertation’s “WHIMM” heuristic acronymizes five essential ethical trouble spots for journalists:

Witnesses—Relying on unverified information from witnesses—who may still be in shock—may result in misinformation.

Harm—Gratuitous details about the crimes may satisfy a certain craving for sensationalism among some segments of the public, but can re-traumatize affected communities. Information should be included in stories only if the benefit to society as a whole (e.g., helping prevent future shootings) justifies the potential for emotional distress.

Influence—By indulging the shooter’s desire for widespread infamy, journalists can influence others who feel they have nothing to lose to chase fame through a copycat crime.

Missing side—Offering differing perspectives to contextualize information can prevent harmful misconceptions from forming. For example, facts about a shooter’s psychological history could be offset by quotes from experts clarifying that only a small minority of mentally ill people commit acts of violence.

Missing information—Especially as the crisis event is unfolding, facts usually filter out in piecemeal fashion. Situations change from hour to hour, sometimes moment to moment. This can plunge the news audience, primarily in the affected community, into a state of serial trauma as updates continually arrive. Yet the absence of information can produce excruciating suspense, an emotional trade-off calling for the utmost delicacy.

Yuckenberg’s dissertation was completed before the tragic events in Uvalde. Reflecting on the news coverage to date of this latest school shooting, she renders a mixed verdict. “I think they did a better job than they had in the past with Parkland and Columbine” in terms of focusing on the victims instead of the shooter, she concludes. However, the conflicting and changing reports in the hours and days after the shooting could have been curbed or condensed out of respect for the community.

“If we’re going to have an ongoing debate about how police should be responding to school shootings, it’s important that we have accurate information,” Yuckenberg says. “The more eager you are to release anything that comes through from a source for clickbait purposes or whatever, the more you risk muddying those waters and making it impossible to get your hands on the facts.”

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At the frontiers of public health

Jennifer Anzaldi — Tue, 16 Aug 2022 11:54:21 +0000

At the frontiers of public health Jennifer Anzaldi Tue, 08/16/2022 - 07:54

In This Story

Ajay Vinzé, PhD

Dean Ajay Vinzé

As we all now know from bitter experience, there’s more to proper pandemic response than pills and vaccines. Medical authorities must identify potential hot spots before widespread infection becomes manifest, through early-detection methods such as wastewater testing. With these warning signals, health departments can take preventive action – lockdowns, school closures, etc. – to stop the spread. To build the systems that can make this possible, skilled epidemiologists need to work side-by-side with data scientists who can help them crunch the numbers and predict possible outcomes of various interventions.

Long before COVID was a household word, Dr. Ajay Vinzé, now dean of Mason’s business school, helped pioneer just such a collaboration with public-health officials in Maricopa County, which includes Phoenix and is the fourth-largest county in the United States by population. Vinzé calls this nearly decade-long partnership “a major part of my research and professional journey.”

According to Vinzé, the collaboration began in late 2002 with a missed flight in the Dallas airport. He found himself sitting next to another Phoenix-bound traveler, and the two struck up a conversation. At the time, Vinzé was an associate professor at W.P. Carey School of Business at Arizona State University researching artificial intelligence applications for business problem-solving, including how viruses spread on computer networks, in close collaboration with companies such as Intel and IBM. One of his ongoing research projects focused on failure analysis and failure identification (FA/FI). As Vinzé described his work, his impromptu travel companion – who, as it turned out, was Jonathan Weisbuch, then Director and chief health officer for the Maricopa Department of Public Health – listened closely, asked pertinent questions, and finally invited Vinzé to sit down with a group of leading Arizona epidemiologists.

Why would a top health officer for Arizona’s largest county want his colleagues to listen to an information systems professor? Because Weisbuc recognized that, as Vinzé says, “Computer networks are similar to human systems. Failure means not being able to detect early on that certain propagation is imminent. That’s the same thing you do in computer security.” The two fields also share basic preventive principles and best practices. “To inoculate yourself against viruses on the computer, you need to know the characteristics of the virus, how it spreads, and what happens after infection … and pertinent policy to control the same. Same thing for humans!”

Sarah Santana, Maricopa’s director of epidemiology, found common cause with Vinzé, enlisting him and his colleagues in her department’s efforts to refine post-9/11 surveillance protocols for handling the threat of bio-terrorism. Their work together ultimately led to an article in Information Systems Frontiers (co-authored by Minu Ipe and T.S. Raghu) examining the parallels between “information supply chains”, e.g. Arizona’s state-wide MEDSIS online public-health surveillance network, and e-commerce platforms such as Amazon. In both cases, so-called “information intermediaries” can play a vital role including, but not limited to, aligning incentives and reducing information asymmetry among multiple stakeholders. The paper details how Arizona’s public health department acted as intermediary, paving the way for Maricopa County to join the state-wide system instead of managing its own data independently.

Vinzé gives Santana immense credit for her foresight and openness in allowing ideas imported from business research into public-health emergency preparedness and response. In turn, Santana introduced Vinzé to contexts and questions from beyond academia that widened the aperture of his research lens.

The particularities of the human organism, after all, rarely enter into information systems research but are pivotal to the success of public-health initiatives. Vinzé observes that this comes into play when deciding on key metrics: “How do you attribute value to saving one human life?” The human element also brings a host of contingencies and complications that aren’t salient when dealing with machines.

Vinzé’s gradual coming-to-grips with these intricacies culminated in a 2012 paper for ACM Transactions on Management Information Systems (co-authored by Hina Arora and T.S. Raghu) modeling dynamic interactions between disease transmission, pharmaceutical interventions (e.g. vaccines), and policy-based interventions (e.g. school closures). “It’s a rich simulation exercise – we built the system and turned it over to the county,” Vinzé explains. Using actual characteristics from the 2009 H1N1 pandemic as a test case for various policy approaches, the mathematical model generated numerous insights for guiding public-health policymakers not just in Maricopa and the southwest United States, but perhaps worldwide. For example, the simulation showed that rolling school closures of two to four weeks were not only less effective at reducing transmission than county-wide, eight-week closures – but they also resulted in more weeks of shutdown over the length of the pandemic. Additionally, the results reinforced the researchers’ intuition that the quality of pandemic response hinges upon finding the right mix of pharmaceutical and non-pharmaceutical interventions. Years later, these data-driven principles would be put to the ultimate test during the COVID pandemic.

Over the course of his long collaboration with Santana and the Maricopa health authorities, Vinzé got the chance to view public-health challenges from virtually every angle. “We did survey research for them, sometimes experimental research, sometimes systems-building,” he says. He even served on a healthcare-focused working group as part of the planning process for Super Bowl XLII (2008), and subsequently Super Bowl XLIX (2015) both held in Glendale, Arizona. In 2012, Vinzé was recognized with a Faculty Achievement Award from Arizona State University for “defining edge research and creative work for professional application” recognizing high impact research over a ten-year period – his association with public health was acknowledged as a main driver of impact.

In hindsight, Vinzé suggests that his foray into public health spotlights and clarifies certain aspects of digital transformation. He points out that technological advancement comes in waves, producing sudden surges in computing power, processing speed and data accessibility. With each wave, public- and private-sector actors alike experience a tidal force of opportunity (for leaders) or adversity (for laggards). Collaborations between academia, business and government can help translate technological evolution into positive outcomes for the economy, communities and the wider society.

“Each wave has an implication on the workforce of that time. We’re going through this big wave as we speak, coming out of COVID. The question is, are we ready?” Vinzé says.

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The Link Between Abortion and Peer-to-Peer Lending

Jennifer Anzaldi — Tue, 29 Mar 2022 15:09:36 +0000

The Link Between Abortion and Peer-to-Peer Lending Jennifer Anzaldi Tue, 03/29/2022 - 11:09

In This Story

Brad Greenwood

The U.S. Supreme Court’s 1973 decision in Roe v. Wade established a woman’s constitutional right to terminate a pregnancy in the first trimester. But a legal right is not the same as guaranteed access. In the years since Roe, state and federal regulations have increased the financial hurdles involved in obtaining an abortion.

It stands to reason that capital constraints would have a suppressive effect on abortion rates. But how much of an effect? And can it be quantified? Brad Greenwood, associate professor of information systems and operations management at 91�� School of Business, recently launched a research study designed to answer those questions.

The resulting paper (co-authored by GT Ozer of University of New Hampshire and Anand Gopal of NTU-Singapore), forthcoming at Information Systems Research, explores what happens to a community’s abortion rates when a workaround for capital constraints becomes available.

Greenwood says, “I believe we show, and fairly cleanly, that when you democratize access to capital in forms of lending, and specifically lending where there is some level of anonymity or privacy, you do see a small but notable increase in the number of women who elect not to carry to term.”

The researchers reasoned that peer-to-peer (P2P) lending platforms such as LendingClub can provide women access to capital under conditions of anonymity that evade the widespread social stigma attached to abortion. LendingClub, registered in 49 states, operates like an online bank, whose members can obtain personal loans of up to $40,000 at standard interest rates, as well as other financial products.

The professors compared detailed data on the timing of LendingClub’s entry into specific U.S. states, with county-level per-capita abortion rates for the years 2005-2010. They also looked at other county-specific factors (population, demographic makeup, education level, etc.), which served as controls and comparisons.

Performing systematic comparisons between demographically similar counties both with and without access to LendingClub, Greenwood and his co-authors found that the P2P platform was associated with a significant increase in abortion rates. All told, results suggest that the entry of LendingClub is associated with an increase of between 278 and 675 abortions annually in the U.S. Keep in mind, LendingClub is just one of many fintech platforms providing alternative avenues for access to capital, and Greenwood indicates that the research team obtained similar results when Prosper entered the market.

How you interpret these findings may depend on your position on abortion. Pro-life advocates may be reassured that the strategy of staunching capital flows has been at least minimally successful. But the democratization of access to capital – through innovations such as LendingClub -- may undermine this strategy over time, as suggested by Greenwood’s results.

Greenwood believes that in the post-Roe legal context, his findings may also be relevant for supporters of a woman’s right to choose. In a famous 1992 opinion (Planned Parenthood of Southern PA v. Casey), Supreme Court Justice Sandra Day O’Connor wrote that states could regulate abortion prior to fetal viability (usually considered to be 23-24 weeks), provided they didn’t place an “undue burden” on the mother. What “undue burden” means when applied to abortion is still being decided on a case-by-case basis in the courts. But as Greenwood points out, research studies such as this one may strengthen legal challenges to state-level regulations using the “undue burden” standard, since it shows that women are indeed foregoing their legal right to abortion for lack of funds.

“We postulate about burden, but can we test whether or not there’s a change in the burden? The answer appears to be yes,” Greenwood says.

As polarizing as abortion is, not everyone takes an extremist position. “If you are one of the Americans—and polling from numerous sources suggests this is the largest contingent of the electorate—who believe abortion should be ‘safe, legal and rare,’ the secondary findings of the paper may be of interest to you,” Greenwood says. LendingClub’s entry had less of an effect on abortion rates in counties whose residents were better educated. Further curtailing of the effect was seen in counties with mandatory sex education. Finally, the effect was significantly stronger in deeply religious counties—i.e., those with a higher percentage of people observing a particular religion.

“If we really want to reduce the number of abortions that occur, we need to reduce the number of unwanted pregnancies,” Greenwood says. “Education literature would corroborate that’s a function of increased use of contraception and awareness about safe sex.” By contrast, abstinence-only education programs, which are disproportionately favored by religious communities, received over $100 million in federal funds last year alone.

To be sure, upcoming holdings from the Court may overturn Roe entirely. Nullifying this precedent would also presumably reduce the need for pro-life lawmakers to attempt to defund the practice. However, Greenwood’s findings seem to support the common pro-choice assertion that any “abortion ban” would affect poor women first and foremost.

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A Brain-Based Approach to Change Management

Jennifer Anzaldi — Thu, 10 Mar 2022 19:48:37 +0000

A Brain-Based Approach to Change Management Jennifer Anzaldi Thu, 03/10/2022 - 14:48

In This Story

Victoria Grady

Today’s world is changing so fast. As soon as you feel you’ve caught up, another crisis comes and knocks you for a loop. In this environment, there’s a heightened danger that we’ll fail to adapt fast enough. Inability or unwillingness to keep pace with change can leave us feeling stuck—incapable of moving forward.

Victoria Grady

If you can relate, Victoria Grady, an associate professor of management and program director of the Masters of Science in Management at Mason, has some consolation for you. Stuck-ness isn’t a sign that’s something wrong with you. It’s related to how our brains are wired. The even better news? If you understand the possibilities of the brain, you can climb out of the rut and help other people, even entire organizations, do the same.

Grady’s new book, Stuck: How to WIN at Work by Understanding LOSS, is the result of years of research and writing with her co-author Patrick McCreesh, an adjunct management professor at Mason. Stuck plumbs an area of psychology known as attachment theory, first developed in the mid-20^th century by John Bowlby, a British psychoanalyst.

In brief, attachment theory concentrates on how very young children learn to regard themselves as independent individuals, apart from but still linked to primary caregivers. It’s a slow, symbolic weaning process involving so-called “transitional objects” kids use to anchor themselves psychologically as they discover more about the world. For some kids, the transitional object of choice is a favorite blanket; for others, it’s a teddy bear. As we get older, the objects change but the mechanism formed in childhood remains essentially intact.

“This is an instinctual process,” Grady says. “You cannot make this go away. The only ones who do not have this are an extremely small percentage of the population who often struggle throughout life.”

Big organizational change—e.g., shifting to remote/in-person hybrid working, or business model transformation—inevitably disturbs employees, customers, shareholders, etc. who are attached to the status quo. Yet attachment theory is not part of the usual change management toolkit. Grady suggests that could be one reason why most change management initiatives fail to achieve their desired outcome. Stuck is a call to action for the largely process-based field of change management—the best-laid plans for organizational transformation are often thwarted by human psychology.

Although each of us may be unique in our attachments and preferred transitional objects, the ways in which we latch onto these things can be generalized into a limited number of basic categories, known as attachment styles. These styles originate from early childhood, when they are encoded into the limbic, or intuitive, system within the brain.

For organizational purposes, Grady and McCreesh have identified four attachment styles: stable, autonomous, distracted, and insecure. They write, “There is no right type of attachment style and each provides different value in different situations.”

Grady and McCreesh define the four attachment styles as follows: A stable attachment style arises from having been given a “secure base” for attachments in early childhood—e.g., attentive parents or other caregivers—and is conducive to generally positive and productive relationships in life and work. Autonomous attachment styles are the product of a childhood where one has learned to be independent emotionally—these individuals often have admirable attention spans but can struggle to connect with others. Distracted attachment styles lean toward the opposite extreme: intense dependence on the support of others and strong relational orientation. Finally, insecure attachment styles veer toward social anxiety that can lead to either hypersensitivity and burnout, or (with the help of a smart manager) unswerving organizational loyalty.

Grady has co-developed a diagnostic tool called the Attachment Styles Index (ASI) that companies can use to better understand their workforce. One of Stuck’s chapters tells how the ASI was used by the Federal Aviation Administration (FAA) as the agency successfully overhauled its Flight Standards Service division. FAA change managers discerned in the data some key mismatches between team leaders’ and followers’ attachment styles, which were hindering communication and fostering mistrust. For example, stable-attachment leaders can have trouble empathizing with followers who don’t share their style of attachment. Managers who know the attachment styles of their team members can create transitional objects that provide psychological shelter through the storm of change.

Sometimes, leaders themselves can fulfill that critical transitional object function. Leaders with distracted attachment styles seem especially good at sensing the struggles of others, regardless of the individual’s respective style.

“Organizations can do better for change efforts by more effectively aligning leaders and followers based on attachment styles to create a better sense of support through change,” the authors write.

Grady says that Stuck is also pertinent for companies looking to hold onto their talent amid the Great Resignation. The pandemic played havoc with people’s workplace attachments. Using herself as an example, Grady says “The commute for me was the biggest loss. I was so used to the hour it took me to get to the office—I would think, talk, record stuff—I loved that time…We are attached to our routines. So many of my friends have lunch voids; they didn’t know how to have lunch by themselves. The organization has to respond to the changing environment.”

Managers can neither turn back time nor slow down the pace at which the world is changing. But they can work harder to understand their employees’ varied attachments and help create psychological lifelines to get people un-stuck.

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How Can Companies Balance Profits With Social Responsibility?

Marianne Klinker — Mon, 06 Dec 2021 17:24:38 +0000

How Can Companies Balance Profits With Social Responsibility? Marianne Klinker Mon, 12/06/2021 - 12:24

In This Story

Toyah Miller

Sometimes, the headline says it all. In 1970, economist Milton Friedman published an essay in the New York Times titled, “A Friedman doctrine—The Social Responsibility of Business Is to Increase Its Profits.” Few pieces of such brevity have been as influential. Until very recently, the Friedman Doctrine held almost uncontested sway among the leaders of large, publicly traded U.S. companies. For adherents to the doctrine, delivering shareholder returns was the paramount consideration; all other consequences of business activity were secondary.

But now, the Friedman Doctrine is facing its most serious challenge yet as modern corporations are finding increased demands from the public for accountability and performance beyond financial returns. Although the demand for corporate social responsibility has increased steadily over the past decade, this past year—amid a pandemic, economic instability, and social unrest—saw increasing instances of shareholders seeming to reject the doctrine designed to privilege their interests above all others. Proposals calling for action on climate change, sustainability, health, and human rights issues were some of the most common forms of stakeholder pushback. In fact, proposals for corporate diversity disclosure have doubled since last year. Big Oil companies are changing course on carbon emissions due to investor opposition.

Toyah Miller

It’s an exciting but also potentially confusing time for leaders, says Toyah Miller, professor of strategy and entrepreneurship at Mason. The call to prioritize social responsibility alongside profits can often create “an institutional contradiction” with “increased potential for conflict.” Bridging the areas of management, innovation and entrepreneurship, Miller’s research illuminates the issues that will determine whether companies succeed or fail in their newly broadened mission.

This is well-trodden territory for Miller. She began her career as an Ernst & Young consultant who loved talking strategy with top leaders of organizations such as Time Warner and Bell South. At the same time, she sought opportunities to make a difference in the wider world, not just for companies. Growing up, she saw her mother organize outreach programs to help the elderly and other vulnerable groups, driven by “a strong sense of values, connection to her community and the idea that she had a role to play even if no one assigned her that role.”

Her career crossroads came after developing educational programs for a children’s home and thinking “Could I turn this into a venture?” From there, she became fascinated by the often-overlooked questions and problems of making social entrepreneurship work. Unpacking these dilemmas would require fusing her social mission with knowledge gained from her past experience as a strategy consultant. As she terms it, “I got the PhD bug,” pursuing a doctorate at Mays Business School at Texas A&M University, and later joining the faculty of University of Oklahoma, Indiana University—Kelley School of Business, and University of Texas at Dallas before coming to Mason this year.

Miller’s research on social entrepreneurs shows how identity and cognition help shape their entrepreneurial strategy. “A lot of the way [social entrepreneurs] behave or react to challenges is influenced by their own background,” she says. Values, education, and work experience play a role in influencing cognitive styles and biases used to evaluate entrepreneurial opportunities. For example, an Academy of Management Review paper Miller co-authored in 2012 posited compassion as a driving force for venture creation in social entrepreneurs that encourages integrative thinking and personal commitment to a cause that even overrides traditional cost-benefit analysis. But she has also found that the emotional investment of social entrepreneurs can make them highly resistant to inevitable trade-offs between societal mission and business needs.

Now that a counterweight to the Friedman Doctrine is gathering strength, corporate managers of all stripes are encountering these trade-offs—as social entrepreneurs always have. In fact, she is exploring the newly emerging phenomena of activist CEOs that embrace the role of societal leaders, advancing social change inside and outside their organizations. CEOs of companies like Delta Airlines and others are becoming more comfortable in the social space. The good news is that social and financial objectives do not necessarily clash; in fact, they can be highly compatible. A diverse leadership team, for instance, may devise better strategies than a more homogeneous one, because “having different people with different experiences in life and different points of view...could help the firm have access to needed information to navigate change,” Miller says.

Organizational reality, though, is often more complicated than that. In a 2013 paper in Organization Science, Miller and her co-authors found that gender-diverse boards improved the ability of the firm to enact strategic change under certain conditions and not others. When the board is not experiencing a threat due to low firm performance and women directors have greater power, the relationship between board gender diversity and strategic change is the most positive. Conversely, when the board is threatened by low firm performance and women directors have greater power, the relationship between board gender diversity and strategic change is the most negative.

The study yielded two meaningful takeaways, Miller says. First, diverse perspectives can be beneficial when there is enough time to hear everyone out and integrate their contributions. In times of low performance, the needs are more pressing and time is short. The cognitive conflict induced from diversity during times of stress can immobilize board decision-making rather than aid it. Second, having women on the board made no difference one way or the other when they were not empowered.

Diversity and inclusion, then, could have good or bad effects, or no effect, depending on how it’s done. Miller recommends that leaders ask themselves, “‘How am I taking on this idea of being inclusive?’ It may need to look differently when you’re bringing people into the fold.” Miller will continue to delve into these issues as they overlap with her interests in entrepreneurship. Her ongoing research looks at entrepreneurial mentoring in accelerators by examining gender differences on feedback framing and their impact on ventures.

In her role as director of research of the Business for a Better World Center at Mason’s School of Business, she hopes to promote more research at the intersection of business in society. Citing the impressive achievements of the center in its short life so far, Miller hopes to add to that track record. “My contribution is developing avenues for researchers to identify social problems or investigate how business can be used to address social problems or play a greater leadership role in society,” she says.

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Researching Solutions to Public Health Care Challenges in India

Marianne Klinker — Fri, 03 Dec 2021 19:59:26 +0000

Researching Solutions to Public Health Care Challenges in India Marianne Klinker Fri, 12/03/2021 - 14:59

In This Story

Amitava Dutta

In developing countries, public health care delivery has experienced chronic performance problems in access, availability, and quality. Amit Dutta, information systems and operations management professor, and LeRoy Eakin endowed chair at the School of Business, together with international colleagues Biju Paul Abraham, Rahul Roy, and Priya Seetharaman from the Indian Institute of Management in Calcutta, India, conducted research that identified structural mechanisms underlying these performance problems and suggested constructive managerial interventions to alleviate them.

Amit Dutta

“Despite sustained government investment, the public health care organization in the state of West Bengal, India, suffers from chronic problems including uneven utilization of capacity across different tiers of care and increased out of pocket expenses for the needy who most depend on it,” says Dutta. “We wanted to find out why these problems persisted despite additional resources being allocated year after year.”

“By modeling the public health care organization as a system of interconnected parts, we were able to use systems theory to show that the myopic solution of referrals to private hospitals is actually counter-productive in achieving the long run objectives of ensuring affordable, accessible and good quality public health care services. Referrals to private providers increases patient out-of-pocket expenses and makes care less accessible since most private providers aren’t located in areas where they cannot be profitable, such as the rural hinterland.”

Dutta says their research underscores the need for leaders to think systemically when making decisions, particularly strategic decisions. “Humans are very good at reasoning locally in space and time but are downright awful at deducing long term and organizationally distributed consequences of a network of interactions,” says Dutta. “Our research shows how they can use simple concepts like feedback loops and system archetypes to exercise some discipline and rigor to reason through the consequences of intended actions, in order to improve decision making and business performance.”

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Using Process Management to Examine Unintended Consequences of Health Care Regulation

Marianne Klinker — Fri, 12 Nov 2021 18:53:13 +0000

Using Process Management to Examine Unintended Consequences of Health Care Regulation Marianne Klinker Fri, 11/12/2021 - 13:53

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Hang Ren

In his research, Hang Ren, an assistant professor of information systems and operations management, is investigating whether a 2012 federal regulation called the Hospital Readmissions Reduction Program (HRRP)—intended to improve patient care in hospitals by targeting readmissions for six targeted diagnoses or treatments—is fundamentally flawed in reducing readmissions or improving patient care.

Hang Ren

Ren’s research, which he is conducting with colleagues Tolga Tezcan from the London Business School and Kenan Arifoglu from University College London, is under review at the prestigious peer-reviewed journal Management Science.

HRRP reduces overall Medicare reimbursement to hospitals by up to 3 percent if a hospital’s readmissions rates for six targeted diseases and treatments—acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, pneumonia, coronary artery bypass surgery, and hip and knee replacement—are above the national average.

The research, “Hospital Readmissions Reduction Program Does Not Provide the Right Incentives: Issues and Remedies,” uses analytical modeling developed in process-management scholarship to project the potential for HRRP to achieve the goals government regulators intended.

“It’s not unusual for government to use a very blunt instrument to try to influence a complex issue,” says Ren. “We are concluding that the financial penalties HRRP creates don’t provide a meaningful disincentive for correcting high readmission rates and fail to provide meaningful incentives for improved performance.”

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Costello Research Corporate Governance

Costello Research Managing Change

Tech Talent Investment Pipeline (TTIP)

TTIP

Tech Talent Investment Program

Nirup Menon is Motivated to Uncover Disparities in our Health Care System

Marianne Klinker — Tue, 24 Aug 2021 19:32:20 +0000

Nirup Menon is Motivated to Uncover Disparities in our Health Care System Marianne Klinker Tue, 08/24/2021 - 15:32

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Nirup Menon

Using statistics, econometrics, and data mining techniques Nirup Menon is hard at work trying to understand how unequal access to health care technology might be linked to unequal outcomes in health care.

Nirup Menon

Menon, a professor in the information systems and operations management area, has published more than 25 peer-reviewed journal articles in domains such as health technology, information security, privacy, enterprise systems, and online platforms. His current work, examining and trying to understand the unequal outcomes in our health care system, is of particular interest to the Business for a Better World Center (B4BW). Additionally, Menon is actively working on a Smart City Initiative, focused on data privacy, after winning a grant from Arlington County and Virginia Commonwealth Cybersecurity Initiative.

Recently, Menon generously gave us some time to discuss what sparked his interest in health care disparities, his current research efforts, and a great idea he has for B4BW to connect businesses and researchers.

What motivated you to start working in the racial equity and health care disparity space?

Much of my prior research was on the hospital as an organization and how hospitals manage technologies. I spent several years studying health care improvements after the adoption of various information technologies. For all practical purposes, I thought of each patient as an “average” patient. I did not pay attention to the fact that not all patients have the same access to health care, or the same hospitals and its technology. Then I learned about Cara Frankenfeld’s work on racial disparities during the Provost’s Multidisciplinary Research event. It struck me then, that in order to seriously address technology management in hospitals, I must study whether hospitals are able to equitably dispense health care to all – to study if all patients are equally enjoying the benefits of the technological progress that we are making.

What can you tell us about your ongoing research?

I am continuing my research on health care disparity. Through our research on racial disparities in colon cancer outcomes, we found evidence of outcome disparities that could be linked to unequal access of health care technologies for groups of people. I am now working on analyzing over 6 million patient records, of which more than two million records are COVID-19 positive patients, to see if racial disparities played a role in how patients received treatment during the pandemic last year.

In my other research streams, I am working on the business of online platforms, including crowdsourcing platforms. We are looking at how a company posting an online contest should frame their challenge to attract more qualified contestants to participate and provide innovative solutions. Cybersecurity is another research stream that I am focusing on, specifically security governance in organizations. I am also working on a project on digital resilience when an organization is faced with an upheaval such as a pandemic.

But you’re doing more than just research, can you describe some of your other activities?

Sure. I am also a teacher. I teach data mining. I contribute to my profession. I am an associate editor for a peer-reviewed journal. I am also an administrator at the School of Business. I just stepped down as the area chair for information systems and operations management. I am now serving as the associate Dean for Arlington Ventures and Strategy.

Nirup, thank you so much for your work in this field and your commitment to B4BW. What could we be doing to support you and your colleagues’ research and other efforts?

B4BW has been successful in inviting great speakers from the business community to present during its seminars. This is helping me understand what is important to businesses from an equity and responsibility point of view. It would be great if B4BW reached out to businesses to learn the problems that they want solved to become a responsible business, and then ask researchers such as myself to work with those companies on those problems.

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Costello Research Data Analytics

SBUS Information Systems and Operations Management Department

Business for a Better World Affiliate Faculty in the News

Business for a Better World Center News