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Crisis in healthcare: Tactical approaches influencing patient engagement, leadership diversity, and cultural competence
No full textPatient engagement, population health management, and clinical outcomes are suffering from
significant disparities resulting from healthcare organizations’ inability to demonstrate cultural
competence in the workforce. A distinct failure of healthcare organizations to create leadership
structures that reflect the ethnography of the communities they serve is systemic and
problematic. The purpose of this study is to explore the management issue of social injustice in
healthcare delivery systems and to explore strategic interventions that reinforce diversity in
executive leadership. The framework applies Albert Bandura's reciprocal determinism theory,
which implies that personal factors and the social environment have a direct impact on
behavioral outcomes. This study used a thematic synthesis of factors that prior researchers
identified as contributing success factors. A model that includes diversity in executive leadership
and care provider roles can improve workforce development and health success factors. The
research concludes with major findings that reveal health system network integration, diversity
in populations, leadership, training, education, and workforce development as the primary
success factors to patient engagement.Running Head: A TACTICAL APPROACH TO PATIENT ENGAGEMENT
ABSTRACT
Title of Dissertation: CRISIS IN HEALTHCARE: TACTICAL
APPROACHES INFLUENCING PATIENT
ENGAGEMENT, LEADERSHIP DIVERSITY,
AND CULTURAL COMPETENCE
Chad L. Key,
Doctor of Business Administration, 2020
A TACTICAL APPROACH TO PATIENT ENGAGEMENT
Patient engagement, population health management, and clinical outcomes are suffering from
significant disparities resulting from healthcare organizations’ inability to demonstrate cultural
competence in the workforce. A distinct failure of healthcare organizations to create leadership
structures that reflect the ethnography of the communities they serve is systemic and
problematic. The purpose of this study is to explore the management issue of social injustice in
healthcare delivery systems and to explore strategic interventions that reinforce diversity in
executive leadership. The framework applies Albert Bandura's reciprocal determinism theory,
which implies that personal factors and the social environment have a direct impact on
behavioral outcomes. This study used a thematic synthesis of factors that prior researchers
identified as contributing success factors. A model that includes diversity in executive leadership
and care provider roles can improve workforce development and health success factors. The
research concludes with major findings that reveal health system network integration, diversity
in populations, leadership, training, education, and workforce development as the primary
success factors to patient engagement.
Keywords: c-suite diversity, value-based models, population health management,
patient engagement, cultural competence, and clinical outcomes.
A TACTICAL APPROACH TO PATIENT ENGAGEMENT
A TACTICAL APPROACH TO PATIENT ENGAGEMENT
CRISIS IN HEALTHCARE: TACTICAL APPROACHES TO INFLUENCE PATIENT
ENGAGEMENT, LEADERSHIP DIVERSITY, AND CULTURAL COMPETENCE
By
Chad Lamar Key
Dissertation submitted to the Faculty of the Graduate School of the
University of Maryland Global Campus, in partial fulfillment
of the requirements for the degree of
Doctor of Business Administration
2020
Dissertation Committee Chairs
Dr. Richard Milter (Primary)
Dr. Walter Cason (Secondary)
A TACTICAL APPROACH TO PATIENT ENGAGEMENT
© Copyright by
Chad Lamar Key
2020
A TACTICAL APPROACH TO PATIENT ENGAGEMENT
ii
Preface
While the research presented here stems from two personal experiences, it is The Civil
Rights Act of 1964 that marks the researcher’s personal fight for freedom and equality, and yet
the healthcare climate silently holds onto generations of bias that continues to impact patient
care. As the world moves further into population health management, a patient-centric model to
focus on organic integration at the fundamental human level is necessary. This study, combined
with other scholarly works, generated progress in patient engagement success, leading to better
management of healthcare disparities and greater influence on social determinants. This study
expands the extant literature, offers solutions to remove barriers of access to quality care, and
provides a framework for future generations.
It is my life's work to devote my passion in the diversity and inclusion workspace to
create opportunities for healthcare executives, patient-facing providers, physicians, nurses,
boards of directors, and design interventions that foster success. In truth, I would not have
achieved my current level of success without someone willing to give me an opportunity, and my
goal is to pay that philosophy forward so that others who share my aspirations are afforded the
same advancements. I thank the leaders and healthcare network professionals where I have
served, who were able to recognize and develop my talent, and allow me to demonstrate a
capacity of influence to impact patient and employee engagement.
A TACTICAL APPROACH TO PATIENT ENGAGEMENT
ii
Foreword
This study addresses the complexity of health disparities and the importance of
population health management through patient engagement, with an evidence-based practitioner
lens and a scholarly perspective on the influence of leadership diversity and cultural competence.
This body of research emphasizes the lack of minority representation in healthcare executive
leadership, and it explores the notion that demonstration of cultural competence generates
successful patient engagement outcomes and shows the value of cultural competence in the
workforce.
I write with a personal conviction, to harness individual experiences, with hope to formalize
a life plan that aligns with a mission to address social factors that prohibit access to quality
healthcare. The two experiences below represent the life events that attach to the purpose of this
study.
1. During a recruitment experience for a health system c-suite position in 2018, I was told
after several interviews that I had the talent for the role but was not selected because the
CEO did not feel the organization was ready for a senior minority leader.
2. In that same year, I had a culturally insensitive experience with a physician who cared for
my mother during a surgical consultation.
I desire to use my platform as a senior leader in the healthcare arena to provide insights
for CEO’s and Board of Director’s that increase cultural awareness and encourage minority
representation. In 2013, according to a study by the American Hospital Association's Institute for
Diversity and Health Equity, only 14% of hospital board members and 9% of the CEO
population were minorities, and the contrasting patient populace of minorities made up a large
one-third of the total patient population (Livingston, 2018). Hospital c-suites and boards in the
A TACTICAL APPROACH TO PATIENT ENGAGEMENT
iii
United States remain devastatingly Caucasian, while minorities are on trend to become the
majority in the patient population. This underrepresentation is arguably a significant contributor
to a growing lack of alignment in patient engagement.
Thus, my intention is toward the discovery of the social dynamic of racial inequality in
healthcare executive and practitioner roles to shine light upon the value of diversity as it relates
to positively influencing patient experience results.
This process is liberating, yet cumbersome, and builds individual character. I am indebted to
my family, friends, colleagues, cohorts, and professors who encouraged me. I appreciate the
support I have received over the years.
A TACTICAL APPROACH TO PATIENT ENGAGEMENT
iv
Dedication
First, I want to thank God for guiding my steps to this new plateau. I pray to discover a
sense of renewed spiritual obedience and dutiful loyalty to carry out the social mission targeted
by this research topic. The sentiments regarding minority advancement, disparities in healthcare,
and cultural competence: I aspire to use in my professional and practitioner-based assertion as an
executive of an integrated health network to create opportunities for minorities and influence
patient outcomes.
I dedicate my dissertation to that little African American boy inside of me, who never felt
like he was enough, realizing now that my experiences serve as a testament of progress for those
who precede me and inspiration to those still on their way. A special feeling of humbled
gratitude to my mother, Barbara A. Key, for all the times you showed up in my life, for trying to
overcompensate for the absence of my father, for every life achievement and success: you were
front row. Thank you for every tuition payment, graduation attendance, and constant
encouragement throughout my life. You taught me ambition with humility, good manners, to
never settle for mediocrity, and the ability to work beyond life's obstacles. Mom, you believed in
me when I was too stubborn to admit you were right. I would not be half the man I am today had
you not sacrificed so that I would have the best of everything and demonstrated a moral compass
of personal integrity. For everything that I am, for all that I will become, I pay you homage and
deference.
I devote this body of work to my loving family. My grandmother, Geraldine E. Myers-
Sands, is the matriarch of our family who possesses a pearl of unmatched wisdom beyond
anything I could learn in a book. My uncle, Charles E. Lewis, whom I thank for showing me how
to be a man, teaching me a work ethic that would allow me to accomplish my goals, and serving
A TACTICAL APPROACH TO PATIENT ENGAGEMENT
v
as my role model even when he did not know I was watching. My aunt, Rita E. Lewis, for
demonstrating unconditional love, being thoughtful and kind, and always encouraging me to live
my life beyond any circumstance. My aunt, Pamela A. Sands, for always being my biggest
cheerleader, ratifying my risk strategies in life, demonstrating leadership, and being a confidant.
My uncle, Gregory A. Sands, taught me to be true to self in everything I do. My cousins Denique
Lewis, Kia Lewis-Ahmed, Tenille Sands-Clark, Quentin Saunders, Kierra Frisby, serve as
siblings, and we stand together through it all. My namesake, Morgan T. Key, has never left my
side, and I am so proud of the woman you are becoming. My godchildren, Kaylha I. Campbell,
Kierstin I. Campbell, Pyper C. Smith, Tatum H. Smith, and Michael D. Jones Jr., I hope I have
served you well and provided you tools to navigate life and love beyond your wildest
imagination. My niece and nephew, Chandler and Nicolas Bastfield, are my heartbeats, and the
world is their oyster. In memory of my grandfather, Robert V. Bailey, and my great aunt, Mamie
Bailey-Downey, I miss you both, and I carry your legacies with me.
I dedicate this dissertation work and give special thanks to my life-long special sibling-friends
Pasua Anderson-Smith, Ambrose Jones, Ona Reckling, Chanel Bastfield, Rodney Wyatt
who travel this journey beside me and are extensions of my family. My tribe has shared my
success, failures, joy, pain, laughter, hurt, the full gamut of emotions, and the biggest one of all
love that I have for each of them.
A TACTICAL APPROACH TO PATIENT ENGAGEMENT
vi
Acknowledgements
"Americanization means the process of becoming an American. It means civic
incorporation, becoming a part of the polity - becoming one of us. But that does not mean
conformity. We are more than a melting pot, we are a kaleidoscope, where every turn of history
refracts new light on the old promise" (Jordan, 2020, p. 1).
I want to acknowledge my primary dissertation advisor, Dr. Richard Milter, you lend
your healthcare expertise, a breadth of experience, encouraging me to exhaust the content of the
literature, and to bring my personality to my research. You ask probing questions to foster
critical-thinking abilities, guiding the research structure with meaningful ideas, and help to
narrow and simplify the research so it is digestible to the reader. Your attributes honed my
research techniques, while your practitioner knowledge of the discipline offers a myriad of
applied principles to the scholarship of healthcare disparity, and your support fosters
management and leadership innovation. I also appreciate your insights on critical patient and
provider intuitions, as it relates to social determinants in medicine.
I would also like to acknowledge my secondary dissertation advisor, Dr. Walter Cason,
who was open to sharing your personal and professional stories that offered guidance to the
disposition of learning and direction to my course to complete the dissertation. Your lecture
during the residency lent support to the process, helped to influence my thoughts on teaching,
and passing the torch to future graduate students.
Third, I would like to acknowledge the late Dr. Kriesta Watson personally, I wish I could
put into words the time I spent under your tutelage. I am grateful to you for passing on your
legacy to me before your untimely death. I hope to carry out your wishes to the best of my ability
and to make an impact on the world for other aspiring doctoral scholars. Your focus on the
A TACTICAL APPROACH TO PATIENT ENGAGEMENT
vii
technology and emphasis to develop the layers of my writing would push me to a higher
capacity. I will forever remember the Watson terminology such as "drive-by," and I appreciate
you helping me to understand that the complexity in my sentence structure is my unique selling
point. I feel your presence is here with me during this process.
Dr. Walter McCollum, thank you for caring enough to hold the mirror up in front of me
so that I could see that the constructs I had created for myself were detractors of my growth. I
appreciate you having the courage to challenge my ego in a meaningful way, giving me the
confidence to share my work with others, and showing me how to use my professional platform
to showcase the research.
I want to express my sentiments to faculty, cohorts, and fellow scholars who have
provided me with feedback and contributed to my academic pursuits. Thank you, Dr. Booth, Dr.
Dinauer, Dr. Bouchard, Dr. Anderson, Dr. Witz, and Mrs. Caminis, Mrs. Audrey Brownlee, and
Ms. Crystal Martinez, Mr. Braden Myers, Mr. Emil Moumani, Mr. Joseph Solomon Britto, Mr.
Christopher Allen, and Mr. Fidelis Elikwu. Each of you have tested my thought process, raised
my research capability, and donated your practitioner and scholarly perspective to my efforts.
Finally, I would like to acknowledge the subject matter experts that offered insight into
various topics, exploration of cultivating my research themes, and sharing knowledge from their
career experiences. Thank you, Dr. David Lee, Dr. Kwase Dowe, Mr. Rashad Shedd, Ms. Debra
De Santiago, Ms. Stacy Holloway, Mr. David Jones, Dr. Dennis Haghighat, and the other SME's
listed who offered insights via published articles, postings, and LinkedIn correspondences.
Thank you for providing the technical guidance in your respective disciplines and assistance to
my learning process.
A TACTICAL APPROACH TO PATIENT ENGAGEMENT
viii
Table of Contents
Preface ............................................................................................................................................ ii
Foreword ........................................................................................................................................ ii
Dedication ..................................................................................................................................... iv
Acknowledgements ........................................................................................................................ vi
Table of Contents ......................................................................................................................... viii
Chapter 1: Introduction and Overview of the Management Problem ........................................... 10
Background and Overview ....................................................................................................... 10
Problem Statement and Significance of the Problem ............................................................... 12
The Research Question ............................................................................................................. 14
The rationale for the study ........................................................................................................ 14
Organization of the Dissertation ............................................................................................... 15
Chapter 2: Scoping Literature Review and Theoretical Frame .................................................... 16
Introduction ............................................................................................................................... 16
Definitions................................................................................................................................ 16
Health System and Integrated Health Networks ................................................................... 16
Leadership Diversity ............................................................................................................. 17
Cultural Competence ............................................................................................................ 18
Patient Engagement .............................................................................................................. 19
The Literature Landscape ......................................................................................................... 20
Apertures in Population Health Literature ............................................................................ 20
Value-Based Care Healthcare as a Business ......................................................................... 21
Cultural Competency and Leadership Diversity as a Value Proposition .............................. 22
Theoretical Framework ............................................................................................................. 22
Contextual Scenarios- Reciprocal Behaviors in Motion ....................................................... 23
Interpretation of the Conceptual Model ................................................................................ 25
Chapter Summary ..................................................................................................................... 25
Chapter 3: Methods ....................................................................................................................... 27
Introduction .................................................................................................................................. 27
Evidence-Based Methodology ...................................................................................................... 27
Initiation of Research and Evidence Tools ............................................................................... 31
Rationale for Systematic Review .......................................................................................... 33
Extraction of the Data ................................................................................................................... 35
Thematic Synthesis-Systematic Review ................................................................................... 36
Inclusion and Exclusion Criteria ........................................................................................... 39
Quality Appraisal ...................................................................................................................... 40
Transparency and Rigor ............................................................................................................ 40
The Quality Framework ............................................................................................................ 41
Qualitative Data Analysis and Coding ...................................................................................... 43
Coding ...................................................................................................................................... 44
NVIVO Descriptive and Analytical Themes ............................................................................ 46
Quality Appraisal Categorical Rating ....................................................................................... 49
Subject Matter Experts .............................................................................................................. 50
Chapter Summary ..................................................................................................................... 52
Chapter 4: Analysis and Findings ................................................................................................. 54
A TACTICAL APPROACH TO PATIENT ENGAGEMENT
ix
Review of Research Questions ................................................................................................. 54
Preliminary Results ................................................................................................................... 54
Results of the Thematic Synthesis of the Articles in the Data Set ............................................ 55
Description of the Data Set ....................................................................................................... 59
Results of the Quality Appraisal of the Data Set ...................................................................... 59
Results of Interventions Derived from Main Themes ............................................................... 60
Entrepreneurship in healthcare: Can physicians’ entrepreneurial skills and entrepreneurial interventions improve care and control cost?
No full textDespite physicians and healthcare providers delivering unprecedented healthcare improvements, the U.S. healthcare delivery system is still plagued with inefficiencies. The consequences of these preventable inefficiencies result in unnecessary patient health complications, fatalities, and waste of resources. This study is a systematic review that explored if physicians' entrepreneurial acumens can drive efficiencies in healthcare management to improve quality of care and lower cost. Considering the interconnected systems in U.S.healthcare, the author conducted this research within the framework of the systems theory. To complete this systematic review, the author collected 62articles—a combination of systematic reviews, qualitative, and quantitative articles—and followed the rigorous review process of Gough et al. (2012). Literature review shows healthcare management and decision-making lacks physicians ’participation.This study shows that when physicians—with their entrepreneurial skill—are integrated in management and the decision-making,hospitals delivered better quality patient care, increased efficiencies,and drove down cost.ENTREPRENEURSHIP IN HEALTHCARE 1
Entrepreneurship in Healthcare: Can Physicians’ Entrepreneurial Skills and
Entrepreneurial Interventions Improve Care and Control Cost?
By
Ennaji Benhammou
A Dissertation Completed in Fulfillment of the Graduate School of the
University of Maryland University College Requirements for the Degree of
Doctor of Business Administration
2020
ENTREPRENEURSHIP IN HEALTHCARE 2
Abstract
Despite physicians and healthcare providers delivering unprecedented healthcare improvements,
the U.S. healthcare delivery system is still plagued with inefficiencies. The consequences of
these preventable inefficiencies result in unnecessary patient health complications, fatalities, and
waste of resources. This study is a systematic review that explored if physicians' entrepreneurial
acumens can drive efficiencies in healthcare management to improve quality of care and lower
cost. Considering the interconnected systems in U.S. healthcare, the author conducted this
research within the framework of the systems theory. To complete this systematic review, the
author collected 62 articles—a combination of systematic reviews, qualitative, and quantitative
articles—and followed the rigorous review process of Gough et al. (2012). Literature review
shows healthcare management and decision-making lacks physicians’ participation. This study
shows that when physicians—with their entrepreneurial skill—are integrated in management and
the decision-making, hospitals delivered better quality patient care, increased efficiencies, and
drove down cost.
Keyword terms: entrepreneurship in healthcare, entrepreneurship in delivering healthcare,
intrapreneurship in healthcare, cost of healthcare, waste in healthcare, stakeholders and
healthcare practices, quality of healthcare, innovation in healthcare.
ENTREPRENEURSHIP IN HEALTHCARE 3
© Copyright by
Ennaji Benhammou
2020
ENTREPRENEURSHIP IN HEALTHCARE 4
Dedication
I want to celebrate reaching this milestone by thanking my family and friends. Without their
support, I would not have had the might to embark on this journey and the strength to keep up
with its challenges. Special thanks to my wife Shimako for her encouragements when they were
needed the most and deep appreciation to my children, Touria and Faridah, for their patience
with me in the past three years. I want to take this opportunity to thank my Mom for her support
and pay special tribute to my late father for motivating me always to pursue knowledge and
education. He didn’t get to celebrate this major achievement with us. I also want to give a shout
out to my siblings and their children for their support and recognition.
This journey was paved by many friends who were generous with their time, academic, clinical,
and professional advice from their extensive and rich experience. Thank you, Dr. Faroque A.
Khan, Dr. Tanveer Mir, Dr. Isma Chaudhry, Dr. Olajid Oladipo, Dr. Rosanna Perotti, Dr. Unni
Mooppan, Dr. David Berman, and Mr. Faroque Khawaja. To my cohort that became close
friends, thank you for everything!
To UMGC’s faculty, thank you for facilitating challenging and rewarding courses. I want to
acknowledge with great appreciation my professors, Dr. Booth, Dr. Breckon, Dr. Vernon, Dr.
Drasin, Dr. Blaney, Dr. Marbury, and Dr. De Jong. To my advisor, Dr. Laura Witz, I can’t thank
you enough for your support, encouragement, diligence, rigor, and your pedagogical ways of
guiding me through this journey.
Thank you!!!
ENTREPRENEURSHIP IN HEALTHCARE 5
Table of Contents
Abstract .......................................................................................................................................... 2
Dedication ...................................................................................................................................... 4
Table of Contents ............................................................................................................................ 5
List of Tables ................................................................................................................................. 7
List of Figures ................................................................................................................................ 8
Chapter 1: Introduction and Overview of the Management Problem ............................................. 9
Physicians as employees ....................................................................................................... 17
The Research Question ............................................................................................................. 18
Organization of the Dissertation ............................................................................................... 18
Chapter 2: Scoping Literature Review and Theoretical Framework ............................................ 19
Physicians and Healthcare Spending .................................................................................... 24
Entrepreneurism Defeats Waste ............................................................................................ 24
Reclaiming Lost Entrepreneurial Skills ................................................................................ 27
Desirable Outcomes of Entrepreneurship ............................................................................. 29
Healthcare ............................................................................................................................. 31
Theoretical Framework ............................................................................................................. 35
Chapter 3: Method ........................................................................................................................ 39
The Evidence-Based Research Framework .............................................................................. 39
Stages of the Systematic Review .............................................................................................. 40
Review Initiation—Subject Matter Experts (SMEs) ................................................................ 41
Review Question & Methodology ............................................................................................ 41
Search Strategy ......................................................................................................................... 42
Description of Study Characteristics ........................................................................................ 45
Quality and Relevance Appraisal.............................................................................................. 46
Synthesis .................................................................................................................................. 48
Using Reviews .......................................................................................................................... 49
Chapter 4: Analysis and Findings ................................................................................................. 51
Subject Matter Experts (SMEs) Feedback and Guidance ......................................................... 51
Review of the Research Question ............................................................................................. 53
Analysis of the Existing Evidence ............................................................................................ 53
Results of the Quality Appraisal of Selected Articles .............................................................. 57
ENTREPRENEURSHIP IN HEALTHCARE 6
Theme 1: Physicians Face Challenges in Leading Patient Care ........................................... 60
Theme 2: Physicians Suffer Financial Hardships When Operating Under Managed Care
Models.................................................................................................................................. 62
Theme 3: Clinical Entrepreneurship and Innovation are Essential to Successful Medical
Practice ................................................................................................................................. 65
Theme 4: Data Analytics Can Reveal Areas Needing Clinical Entrepreneurship ................ 68
Chapter 5: Conclusions and Implications ..................................................................................... 72
Discussion and Conclusion ................................................................................................... 73
Limitations ............................................................................................................................ 81
Future Research .................................................................................................................... 82
Conclusion ............................................................................................................................ 83
References .................................................................................................................................... 85
Appendix A. ............................................................................................................................... 104
Appendix B. ............................................................................................................................... 110
ENTREPRENEURSHIP IN HEALTHCARE 7
List of Tables
Table 2.1 Waste in healthcare spending by category 25
Table 3.1 List of deductive codes for thematically organizing collected data 46
Table 4.1 String-search results from UMGC OneSearch 54
ENTREPRENEURSHIP IN HEALTHCARE 8
List of Figures
Figure 2.1 Physicians as connectors 36
Figure 3.1 Common stages in a systematic review 40
Figure 4.1 The article selection process 55
Figure 4.2 The appraisal process of the selected articles. 59
ENTREPRENEURSHIP IN HEALTHCARE 9
Chapter 1: Introduction and Overview of the Management Problem
This study is a systematic review designed to answer the research question, “How can
physicians’ entrepreneurial skills and entrepreneurial interventions contribute to improved
medical practice, coordination of care, and cost-effectiveness?” The purpose of the study is to
explore the use of entrepreneurial skills in a clinical setting. The aim of the study is to determine
the value, if any, of entrepreneurial skills and entrepreneurial interventions to medical
practitioners, specifically physicians.
Healthcare is a consumer/retail business where individuals in need of preventative, acute,
and chronic medical care, voluntarily and involuntarily, become part of a healthcare delivery
system and value chain. In the United States healthcare delivery system, third-party payers, such
as health insurance companies, pay most, if not all, of the medical bills generated by patients.
Consequently, a simple patient visit may involve a physician, diagnostics laboratory, radiology,
pharmacy, and a health insurance provider. This is an example of how healthcare is made up of
multiple constituents that are interconnected and dependent upon each other for healthcare
provisions to take place.
Physicians are at the focal point of the U.S. healthcare delivery system. In the United
States, healthcare is unlike any other consumer-based business. For example, the patient cannot
prescribe his/her medication or medical intervention; a physician is needed for that. What makes
healthcare a system is that healthcare providers and third-party payers all intersect in response to
meeting a patient’s need. The constituents converge to provide care by diagnosing the patient’s
condition, exploring intervention options, selecting and implementing the best option, and
supporting the financial obligations of all involved in the system.
ENTREPRENEURSHIP IN HEALTHCARE 10
The Federal, Food, Drug, and Cosmetic Act (as amended through P.L. 116–22, enacted
June 24, 2019) mandates that in order to have access to a prescription drug, patients need to have
either a physician or medical practitioner’s written prescription. Sage & Hyman (2014) estimated
that physicians, due to their position in the healthcare delivery system, drive two-thirds of
healthcare spending within the United States.
The influence physicians have on the quality of care and its cost evolved with the way
medicine is practiced. Physicians are instrumental in providing effective and safe care to patients
(Dressler et al., 2014; Holak, Kaslow, & Pagel, 2010); however, the ecosystem where care takes
place is complex (Darling, 2006; Wickramasinghe, 2003). In today’s healthcare system,
delivering care to patients is beyond the traditional physician individual care due to advances in
medicine, innovation, technology, escalating costs, and regulators stepping in to ensure quality
and to control cost (Harris, Holm, & Inniger, 2015; Larson et al., 2004; O’Connor, Solberg, &
Baird, 1998).
The essential skills for physicians to deliver medical care are clinical and academic. To
operate and deliver quality care in the current healthcare environment, physicians need to adopt
new technologies, products, and skills; adapt to changes in the sector; and drive change by
negotiating and coordinating care (Groves, 2011; Harris et al., 2015; Saxton, Pawlson, &
Finkelstein, 2013). These skills are characteristics of entrepreneurship. Guo (2006) defines
entrepreneurship in healthcare as being able to generate innovation and drive activities that
improve sustainability. Yarzebinski (1992) views entrepreneurs as agents and/or champions of
change, and they remain proactive to stay ahead of market competitive conditions.
Physicians can act entrepreneurially in the clinical environment. For example, in 2015 a
cardiologist and a physician assistant of nuclear medicine (PANM) financed a start-up mobile
ENTREPRENEURSHIP IN HEALTHCARE 11
nuclear stress test practice. This business venture could be considered as a stress test clinic on
wheels that travels to physicians’ offices. The main component of the business is the imaging
equipment. With the advent of technology, the equipment, a treadmill-type machine, is small
enough to fit in a small truck and can be wheeled in and out of a medical practice. The PANM
administers the test. The use of this innovative way of administering stress tests improved access
to this diagnostic service for patients, opened new revenue streams to medical practices without
having to invest in the equipment, and opened up a new business opportunity to its founders
(physician entrepreneurs).
Physicians receive rigorous training in clinical and academic skills (Ekman & Krasner,
2017; Schuetz, Mann, & Everett, 2010); however, they lack training in entrepreneurial skills that
capitalize on opportunities. Opportunities, such as the nuclear medicine stress test example,
could improve patient care, and lower the costs that impact clinical stakeholders (Büchler,
Martin, Knaebel, & Büchler, 2006; Miron-Shatz, Shatz, Becker, Patel, & Eysenbach, 2014;
Saxton et al., 2013). To influence efficiency, quality, and cost, authors Pepicello & Murphy
(1996) highlighted the importance of taking action on operational complexity. Studies show that
there are opportunities for physicians’ entrepreneurial skills to positively influence patient care
and its costs (Gibelman & Demone, 2002; Guo, 2006; Jacobson, Wasserman, Wu, & Lauer,
2015).
Certainly, physicians’ entrepreneurial skills should leverage innovation and technology
to improve the healthcare delivery process, patient care, and cost. Clearly, advances in medicine,
innovative ways to deliver care, and personalized biomedical treatments are providing a wide
range of patient care options for physicians to choose from (Büchler et al., 2006). However,
physicians also have a fiduciary responsibility to control costs, as well as a mandate to improve
ENTREPRENEURSHIP IN HEALTHCARE 12
the quality of the care delivery process (Bauchner & Fontanarosa, 2019; Wanke et al., 2015).
Guo (2006) described entrepreneurship as “acts of innovation. It is a multidimensional process
involving the environment, organizations and individuals, and profitability” (Guo, 2006, p. 505).
Physicians’ entrepreneurial skills—those driving efficiency and affordability—are becoming just
as important as their clinical and academic skills.
To deliver patient care, physicians rely on diagnostics, radiology, and other tools to
identify the root causes of patients’ symptoms and to decide on treatment. The costs of such
diagnostic tools have been increasing and driving healthcare spending to surpass 3.5 trillion per
year (Bauchner & Fontanarosa, 2019), and weighing on the U.S. gross domestic product (GDP)
by as much as 17.8% (Papanicolas, Woskie, & Jha, 2018). These increasing costs and the burden
on the U.S. GDP are not sustainable. Something must be done to interrupt and redirect the
current trend; physicians are in an ideal position to act as change agents.
This dissertation studies the effects of physicians’ involvement from one aspect:
physicians’ entrepreneurial skills’ impact on patient quality care and operational cost efficiency
(Sage & Hyman, 2014). De Koning et al. (2006) concluded that if nothing is done about the
inefficiencies of our healthcare system, its cost, and the lack of entrepreneurial exploitation of
technical advances in medicine, this sector will have an even heavier weight on the U.S.
economy in the future. It is assumed that physicians have the ability to drive quality
improvements and costs, given their central role in the healthcare system (ordering diagnostic
tests, prescribing treatments, etc.). This is especially important in light of the ever-increasing
medical needs of a growing and aging population.
ENTREPRENEURSHIP IN HEALTHCARE 13
Problem Statement and Significance of the Problem
The business problem addressed in this study is that physicians lack the entrepreneurial
skills and interventions needed to improve medical practice, coordination of care, and cost-effectiveness.
Despite physicians and healthcare providers delivering unprecedented healthcare
improvements, the U.S. healthcare delivery system is still plagued with inefficiencies, including
medical errors that lead to patient health complications and fatal outcomes (Abbas, Quince,
Wood, & Benson, 2011; Larson, 2004; Schroeppel, Fischer, Magnotti, Croce, & Fabian, 2009). It
is estimated that healthcare inefficiencies contribute to waste in excess of 760 billion every year
(Bauchner & Fontanarosa, 2019). The contributing factors of this waste are failure of care
delivery, failure of care coordination, overtreatment or low-value care, pricing failure, fraud,
abuse, and administrative complexity (Bauchner & Fontanarosa, 2019; Clarke, Bourn, Skoufalos,
Beck, & Castillo, 2017; J. M. Hughes, 1998). There are estimates that more than 250,000
patients lose their lives each year while under the care of healthcare facilities (Abbasi, 2016;
Makary & Daniel, 2016). The study uses an evidence-based systematic review to answer the
research question, “How can physicians’ entrepreneurial skills and entrepreneurial interventions
contribute to improved medical practice, coordination of care, and cost effectiveness?”
Deficiencies in the U.S. healthcare system are impacting patient care (Clarke et al., 2017;
James, 2005; Larson, 2004). The deficiencies are defined as the medical service process, medical
service logistical support, administrative support services, and a fragmented healthcare delivery
system (de Koning, Verver, van den Heuvel, Bisgaard, & Does, 2006; Papanicolas et al., 2018;
Randa, 2010). The consequences of these deficiencies are captured in a report issued by The
Joint Commission Company, a nonprofit tax-exempt 501 organization that accredits more than
22,000 U.S. healthcare organizations and programs. Annually, approximately 700 women die
ENTREPRENEURSHIP IN HEALTHCARE 14
from pregnancy-related complications that could have been prevented (The Joint Commission,
Oct 2019). In the first six months of 2018 alone, 350 sentinel events were reported (Palmer,
2018). Sentinel events are defined by The Joint Commission as “an unexpected occurrence
involving death or serious physical or psychological injury, or the risk thereof. Serious injury
specifically includes loss of limb or function. The phrase ‘or the risk thereof’ includes any
process variation for which a recurrence would carry a significant chance of a serious adverse
outcome.” (Thejointcommission.org, 2012). After including other conditions such as hospital-acquired
pressure injury, that number jumped to as much as 2.5 million cases a year (Shieh et al.,
2018).
Recent innovati
The impact of organizational complex adaptive system constraints on strategy selection: A systematic review of the literature
No full textThe purpose of this study is threefold: (a) to create new knowledge that addresses strategies related to managing constraints, (b) to capture relevant data that is generalizable to strategy selection in judgment and decision-making processes, and (c)explain relevant data in terms that produce actionable for recommendations for planning and decision-making practitioners. The methodologyused was a Systematic Review of the Literature that is part of an evidence-based management framework. This framework incorporated evidence from a dataset consisting of 43 scholarly articles used to answer the research question: What are the impacts of complex adaptive system constraints on strategy selection as a component of decision-making in organizations?The systematic review and analysis produced four analytic themes: (a)organizational complex adaptive system constraints,(b) framing constraint-based problems, (c)constraint circumvention strategies, and (d)complexity and predictability. From a further exploration of the four analytic themes,bounded rationality, time, and constraints originating in complex adaptive systems. Practical implications include the development of a model that recognizes the potential of constraints increasing as adaptations to complex systems are made. Adaptation based on these recognitions require analysis to identify and frame potential constraints in order to develop circumventions.THE IMPACT OF ORGANIZATIONAL COMPLEX ADAPTIVE SYSTEMS 1
Abstract
Title of Dissertation: THE IMPACT OF ORGANIZATIONAL COMPLEX
ADAPTIVE SYSTEM CONSTRAINTS ON
STRATEGY SELECTION: A SYSTEMATIC
REVIEW OF THE LITERATURE
David E. McCullin
Doctor of Management, 2020
The purpose of this study is threefold: (a) to create new knowledge that addresses
strategies related to managing constraints, (b) to capture relevant data that is generalizable to
strategy selection in judgment and decision-making processes, and (c) explain relevant data in
terms that produce actionable for recommendations for planning and decision-making
practitioners. The methodology used was a Systematic Review of the Literature that is part of an
evidence-based management framework. This framework incorporated evidence from a dataset
consisting of 43 scholarly articles used to answer the research question: What are the impacts of
complex adaptive system constraints on strategy selection as a component of decision-making in
organizations? The systematic review and analysis produced four analytic themes: (a)
organizational complex adaptive system constraints, (b) framing constraint-based problems, (c)
constraint circumvention strategies, and (d) complexity and predictability. From a further
exploration of the four analytic themes, bounded rationality, time, and constraints originating in
complex adaptive systems. Practical implications include the development of a model that
recognizes the potential of constraints increasing as adaptations to complex systems are made.
Adaptation based on these recognitions require analysis to identify and frame potential
constraints in order to develop circumventions.
Key Terms: constraints, judgment and decision-making, strategy selection, organizational
complex adaptive systems, game theory.
THE IMPACT OF ORGANIZATIONAL COMPLEX ADAPTIVE SYSTEMS 2
THE IMPACT OF ORGANIZATIONAL COMPLEX ADAPTIVE SYSTEM
CONSTRAINTS ON STRATEGY SELECTION: A SYSTEMATIC REVIEW OF THE
LITERATURE
By
David E. McCullin
Dissertation submitted to the Faculty of the Graduate School of the University of
Maryland University College, in partial fulfillment of the requirements for the degree of
Doctor of Management
2020
THE IMPACT OF ORGANIZATIONAL COMPLEX ADAPTIVE SYSTEMS 3
© Copyright by
David E. McCullin
2020
THE IMPACT OF ORGANIZATIONAL COMPLEX ADAPTIVE SYSTEMS 4
THE IMPACT OF ORGANIZATIONAL COMPLEX ADAPTIVE SYSTEMS 5
Dedication
Although this dissertation created knowledge that is ripe for new innovations in
judgement and decision-making, the personal aspects of the dissertation are equally important.
This is true for the transforming I have undergone by completing this credential and the sense of
accomplishment it has evoked. For me, the personal aspects go beyond self. The support and
motivation I received that helped me through this process will be dedicated both personally and
professionally. Personally, in the dedications that follow and professionally in the
acknowledgements. The people I identify are identified in a personal way which will be
ambiguous to everyone except the person for whom it was intended.
Epp, Hohe-Crash and Case, I dedicated this to you hoping you understand that you
should never stop learning. Glank and Kubla I hope by this dedication I can convey to you
credentialed learning is also for black men. Pear and Cinamo you never get too old.
Pookie, we both did this late in life, we both helped each other and are both looking at the
next phase. Would not have wanted to do this without you and fortunately for me, I didn’t have
to.
The brothers who are not here but their influence remains: Thumbsy, you explained the
value of education to me in a way young man could identify with; Dirty Bert, you broke ground
in your educational process by going for it in spite of how it looked—that was not lost on me.
Myrex, this is dedicated to you because of your 30-year educational-trek and for knowing
the meaning of every word I ever asked you without looking it up.
Finally, my faith in God has always made the difference in anything I tried to do. This is
no exception…Whosoever shall say unto this mountain...Mark 11:23.
THE IMPACT OF ORGANIZATIONAL COMPLEX ADAPTIVE SYSTEMS 6
Acknowledgements
I hereby acknowledge the following persons with a personal message of thanks.
To Dr Brekon, collegiate professor: You put program ideals first and demonstrated to me
a willingness to solve problems. I thank you.
To Dr Holiday my third dissertation defense committee member: Your open mindedness
and adherence to scholarship helped me develop an idea into a dissertation. I thank you.
To Dr Sherlock my second reader: Your inquiries and insights and obvious passion for
systematic review kept the bar high and that is reflected in my work. I thank you.
To Cynthia Thomes our doctoral librarian: I have relied on your professional expertise on
numerous occasions and you have always been there with a cool calm demeanor that helps us
maintain our sanity.
To Marina Caminis: You are the friend when a friend is in need. You really seem to love
what you do, and it shows. You help make this program what it is. I thank you.
And finally, to Dr Bouchard my dissertation mentor:
You are a “stand up person” like a stand-up guy
An APA perfectionist with an eagle eye
An evidence-based enthusiast through and through
With only one attitude, can do, can do
Wanted to express in a way that’s unique
In way and beyond what a simple thanks could speak
Ok so I said it my own way
I hope you liked it, “ain’t no more to say.”
THE IMPACT OF ORGANIZATIONAL COMPLEX ADAPTIVE SYSTEMS 7
Table of Contents
Abstract ......................................................................................................................................................................... 1
Dedication .................................................................................................................................................................... 5
Acknowledgements .................................................................................................................................................. 6
List of Figures .......................................................................................................................................................... 12
List of Tables ............................................................................................................................................................ 13
Chapter 1: Introduction and Overview of the Management Problem ................................................. 1
Problem Statement and Significance of the Problem ................................................................................. 5
Problem Statement .............................................................................................................................................. 5
Significance of the Problem .............................................................................................................................. 6
Modeling Judgment and Decision-Making for Research ...................................................................... 6
Constraints .............................................................................................................................................................. 9
Purpose of the Study and Research Question ................................................................................................ 9
Purpose Statement .............................................................................................................................................. 9
Research Question ................................................................................................................................................. 10
CIMO ....................................................................................................................................................................... 10
Development of the Research Question ................................................................................................... 10
Rationale for the Study ........................................................................................................................................ 11
Definitions and Terminology ............................................................................................................................. 12
Availability Bias ................................................................................................................................................. 12
Bounded Rationality ........................................................................................................................................ 12
THE IMPACT OF ORGANIZATIONAL COMPLEX ADAPTIVE SYSTEMS 8
Constraints ........................................................................................................................................................... 13
Complex Adaptive Systems ............................................................................................................................ 13
Confirmation Bias ............................................................................................................................................. 13
Non-Cooperative Game ................................................................................................................................... 14
Organizational Systems .................................................................................................................................. 14
Satisficing .............................................................................................................................................................. 14
Strategy Selection ............................................................................................................................................. 14
Organization of the Dissertation ...................................................................................................................... 15
Chapter 2: Scoping Literature Review and Theoretical Frame ........................................................... 16
Important Scholarly Works ........................................................................................................................... 16
Complex Adaptive Systems ............................................................................................................................ 16
Judgment and Decision-Making ................................................................................................................... 18
Constraints ........................................................................................................................................................... 21
Game Theory and Strategy Selection ......................................................................................................... 23
Theoretical Framework ...................................................................................................................................... 26
Rationale for Theoretical Perspective ....................................................................................................... 28
Complex Adaptive Systems (CAS) ............................................................................................................... 28
Bounded Rationality ........................................................................................................................................ 29
Constraints ........................................................................................................................................................... 30
Strategy Selection: Game Theory ................................................................................................................ 30
Highlights of the Relevant Literature ........................................................................................................ 31
THE IMPACT OF ORGANIZATIONAL COMPLEX ADAPTIVE SYSTEMS 9
Chapter Summary .................................................................................................................................................. 31
Chapter 3: Method ................................................................................................................................................. 33
Research Question Development Restated ............................................................................................. 33
The Evidence-Based Management Framework .................................................................................... 33
The Search Process ........................................................................................................................................... 35
Search Strings ..................................................................................................................................................... 36
Inclusion and Exclusion Criteria ...................................................................................................................... 37
Method of Critical Appraisal .......................................................................................................................... 37
Analysis and Synthesis Methodology ............................................................................................................. 40
Thematic Synthesis .......................................................................................................................................... 40
Subject Matter Experts ........................................................................................................................................ 41
Chapter Summary .................................................................................................................................................. 43
Chapter 4: Analysis and Findings ..................................................................................................................... 45
Review of the Research Questions .................................................................................................................. 45
Description of the Data Set ................................................................................................................................ 45
Results of the Critical Appraisal ....................................................................................................................... 46
Findings and Discussion ..................................................................................................................................... 47
Finding 1: Organizational Complex Adaptive Systems Constraints ............................................. 47
Finding 2: Framing Constraints ................................................................................................................... 50
Finding 3: Circumventing Constraints ...................................................................................................... 53
Finding 4: Complexity and Predictability ................................................................................................ 56
THE IMPACT OF ORGANIZATIONAL COMPLEX ADAPTIVE SYSTEMS 10
Emergence of Additional Analytic Themes ............................................................................................. 59
Finding 5: Constraints Originating in Complex Adaptive Systems .................................................... 59
Finding 6: Bounded Rationality as a Constraint ........................................................................................ 60
Finding 7: Time as a Constraint ........................................................................................................................ 61
Final Analytic Themes Recapped ..................................................................................................................... 62
Conceptual Framework ....................................................................................................................................... 62
Chapter Summary .................................................................................................................................................. 63
Chapter 5: Conclusions and Implications ..................................................................................................... 64
Review of the Research .................................................................................................................................. 64
Answer to the Research Question ............................................................................................................... 64
Implementing Factors .......................................................................................................................................... 65
Factor 1 .................................................................................................................................................................. 66
Factor 2 .................................................................................................................................................................. 66
Factor 3 .................................................................................................................................................................. 67
Factor 4 .................................................................................................................................................................. 68
Factor 5 .................................................................................................................................................................. 69
Recommendations for Management Practice ............................................................................................. 69
COMPSS, PREANSS, and CONTSS Explained ........................................................................................... 72
Risk Assessment Key Questions .................................................................................................................. 78
Key Questions: Diagnostic Framing (Triggers) ..................................................................................... 78
Key Questions: Diagnostic Framing (Continuum) ............................................................................... 78
THE IMPACT OF ORGANIZATIONAL COMPLEX ADAPTIVE SYSTEMS 11
Key Questions: Diagnostic Framing (Stakeholders) ........................................................................... 78
Key Questions: Diagnostic Framing (Space) .......................................................................................... 78
Key Questions: Operational Strategies ..................................................................................................... 79
Key Questions: Predictive Circumvention Strategies ......................................................................... 79
Key Questions: Contingency Circumvention Strategies .................................................................... 79
Limitations of the Research ............................................................................................................................... 79
Areas for Future Research ................................................................................................................................. 82
Final Summary and Conclusion ........................................................................................................................ 83
References ................................................................................................................................................................. 85
Nash, J, (2002). The Essential John Nash, Oxford University Press. ................................................... 94
Appendix A .............................................................................................................................................................. 101
Appendix B ............................................................................................................................
Intergenerational mentoring: A systematic review of facilitating knowledge transfer in a multigenerational work environment
No full textThis presentation explores how a mentoring program can influence knowledge transfer throughout a
multi-generational workforce and the best strategies to consider when implementing a mentoring program.Intergenerational Mentoring: A
Systematic Review of Facilitating
Knowledge Transfer in a
Multigenerational Work Environment
Candace Pruett, D.B.A. Candidate
Dr. Raymond Marbury, Advisor
Methods
Problem & Research Questions
Future Research & Limitations
The largest generation within the workforce, the
baby boomers, are now retiring, leaving a
knowledge and experience gap as the population of
millennials in the workforce increases.
RQ1: How can a mentoring program influence
knowledge transfer throughout a
multigenerational workforce?
RQ2: What are the best strategies to consider
when implementing a mentoring program?
Knowledge-Based Theory- An organization’s
ability to manage knowledge is vital for their
survival, growth, and success.
Social Exchange Theory- The exchanging of
relationships is mutually rewarding.
Generational Cohort Theory- The understanding
of differences in generations including different
values, attitudes, and beliefs.
Does informal or formal mentoring work best in
an intergenerational mentoring model?
Does intergenerational mentoring lead to higher
employee retention?
Lack of clear definition of “knowledge”.
Limited literature on Intergenerational mentoring.
Mentoring Influences
Knowledge Transfer in
a Multigenerational
Workforce
Collaborative
relationships build
communication and
trust.
Mitigates negative
stereotypes and
provides access to a
larger social network.
Enhances knowledge
sharing of both
individuals
(mentor/mentee).
Increases technology
adaptability throughout
the organization.
Best Strategies to
Consider When
Implementing a
Mentoring Program
Management support
is crucial for the
success.
Embracing a
knowledge-sharing
culture.
Intergenerational
mentoring implies
traditional and reverse
mentoring roles.
Theories
Conceptual Framework
Systematic Review- Thematic Synthesis.
Search Strings- ((mentor OR mentoring) AND
("knowledge transfer" OR "knowledge sharing" OR
"knowledge exchange" OR "succession planning")).
(ABSTRACT).
Inclusion Criteria- Scholarly (peer-reviewed)
journals, Grey Literature (research papers, conceptual
and theoretical models, etc.), and literature published
between 2005-2019 were included based on relevance.
Exclusion Criteria- Non-English articles.
Search (704)
• Databases:
ABI/INFORM,
Business Source
Complete, Emerald,
ERIC, PsycINFO, &
Scopus
• Snowballing Method
Screen (209)
• Remove Duplication
• Reviewed Title,
Abstract
Synthesizing &
Coding (43)
• Article Quality
Assessment:
TAPUPAS & WoE
• Meta & Thematic
Coding: Excel &
Atlas.tiTM
Implications
Results
Greater knowledge sharing among employees across
generations, could potentially lead to a quicker training for
replacing leadership positions.
Intergenerational mentoring leads to an increase of
workplace collaborative relationships that has organizational
benefits.
To learn more about the research, poster,
and presenter use the QRL code below
Telework decision strategy: A systematic review
No full textThis presentation explores how federal manager’s decision strategy for authorizing telework can enhance employee
participation without compromising productivity.Telework Decision Strategy:
A Systematic Review
Maritza R. Lopez , D.B.A. Candidate
Telework has a positive direct of indirect effect on
productivity, performance, job satisfaction and employee
well-being.
To increase employee participation management needs to
envision telework as a strategic tool; structure the work
environment to best fit people, available technology, job
tasks, and organization; thereby providing employees the
option to telework not only as an employee benefit, but also
as an organization best practice.
Problem
Research Question
Findings
Methodology
Systematic Review
Conceptual Framework
1128
• 15 Databases (DB) Searched
105
• Records Screened Title/Abstract
78
• 36 Eligible from Full Text Review
• 42 Snowball
Under-utilization of telework within federal
executive agencies undermine the benefits
sought by Congress with the passage of the
Telework Enhancement Act of 2010. Telework
participation rates have stagnated at 2012
levels--40 percent of population is considered
eligible, and of those eligible 50 percent are
teleworking at least once per month. In 2018,
there was a slight decline. There is a need to
assess telework program, implementation, and
execution to ensure compliance with the Act,
yet more significantly obtain the expected
benefits of the telework.
How can a federal manager’s decision strategy for
authorizing telework enhance employee
participation without compromising productivity?
Theoretical Framework
Organizational Perspective
- Social Technical Systems Theory (Trist 1950; Emery
1959, Belanger, Watson- Manheim & Swan)
--Environment
-- Social (People & Structure)
--Technical (Technology & Tasks)
--Optimization to achieve desired outcomes
Leadership Perspective
- Instrumental Leadership Theory (Antonakis & House,
2001; Rowold, 2014)
-- Strategic Leadership -- environmental
monitoring & strategy formulation and
implementation
-- Follower work facilitation -- path goal
facilitation & outcome monitoring
• Telework has a direct or indirect positive
impact on productivity
- Also increased performance,
job satisfaction and employee well-being
- Increased or stayed the same
- Many factors affect the magnitude of the
positive effect on outcomes.
• Senior leader belief in telework is
important for agency-wide adoption of
telework
- Communicates agency telework philosophy
- Strategic or HRM tool
- Sets tone for subordinate managers
• Employee participation rates dependent on
option and employee assessment of benefit
• Government agencies should develop a
telework strategy in line with their vision,
mission and goals
• Managers/first level supervisors should
structure the work environment to best fit
people, available technology, job tasks and
organization.
- Assess training needs and provide tools
- Clear expectations and work processes
- Measure performance
- to best fit people, available technology, job
tasks, and organization; thereby providing
employees the option to telework not only as
an employee benefit, but also as an
organization best practice to best fit people,
available technology, job tasks, and
organization; thereby providing employees the
option to telework not only as an employee
benefit, but also as an or
Business Implication
Rebrand like a butterfly: Preparing organizations to make rational model rebranding d
No full textThis presentation will investigate factors that may influence
organizations’ preparedness to make rational rebranding decisions.Rebranding Decision Readiness
Preparing Organizations to make Rational Model
Rebranding Decisions
Stakeholder
Theory
Considers all stakeholders to
include owners, employees,
customers, suppliers,
and society.
Ensures transparency across
stakeholder groups.
Stakeholder
Advocacy
Clearly defines the
intended perception of the
product, service,
or idea.
Organizational/brand
culture supports the
intended perception.
Organizational
Identity Theory
Brand Identity
Resource-based
View Theory
Leverages valuable, rare,
and appropriate resources
for competitive advantage.
Supports organizational
identity and core strategy.
Brand Strategy
Rational
Rebranding
Decision
Theoretical Framework
Rebranding is forecasted to cost
organizations as much as 144.5 billion
dollars in 2020.
Organizations are engaging in rebranding
initiatives before determining their level of
preparedness to make a
rational decision.
Management Problem
To determine whether and how considering
key factors that influence rebranding
decisions will prepare organizations to make
rational rebranding decisions.
Research Purpose
Will considering the three factors:
stakeholder advocacy, brand identity, and
brand strategy prepare organizations to
make rational rebranding decisions?
Considering stakeholders, especially employees, is
critical in the rebranding decision process.
Establishing brand identity facilitates better
rebranding decision-making.
Leveraging brand strategy challenges and
opportunities support improved
rebranding decisions.
Findings
Research Question
Maria Harsanyi | D.B.A. | Mentor: Dr. Laura Witz
Scan the QR code to read about my
previous research on the primary factors
that influence rebranding decisions in U.S.
based organizations on LinkedIn.
Ensure stakeholder involvement and buy-in, starting
with the employees.
Focus on the brand identity by aligning with the
organizational identity and identifying the
brand strategy that supports the
brand identity.
Be prepared to reevaluate the organizational
rebranding decision readiness.
Management Recommendations
Employees are the most influential stakeholders
when establishing brand identity and leveraging
brand strategy in making organizational
rebranding decisions.
Systematic Review and Thematic Synthesis
Article Search (3157)
OneSearch, ABI/INFORM, Scopus
Database Alerts
Abstract/Full-Text Screening (1802)
Excluded non-English articles
Excluded studies that were not organizational rebranding
Quality Appraisal Screening (62)
TAPUPAS and Weight of Evidence (WoE)
Excluded < Med QA Rating
Included Articles (47)
Research Method
Brand Identity
Change Event
(Rebranding
Trigger)
Employees Brand
Identity
Other
Stakeholders
Rebranding
Decision
Readiness
READY
REEVALUATE
Stakeholder involvement
and buy-in assessment
Organizational
Identity
Brand
Strategy
Organizational
Strateg
Servitization in the era of industry 4.0-A realist review to identify enablers of servitization for business-to-business models in the manufacturing industry globally
No full textBusiness customers of manufacturing organizations globally seek superior customer service from the manufacturer, the practical usage of digital product monitoring services, predictive maintenance for products, and relief from buying capital expenditure products for products as a service. This dissertation aims to identify enablers that leaders within manufacturing firms should consider as they transform from a product-centric to a service-centric business model –a move known as servitization. With the advent of Industry 4.0 and the latest technological evolutions, the concepts and process of servitization implementation profoundly impact the manufacturer's business models by enabling newer revenue streams. Purpose: This dissertation aims to bridge the existing knowledge gap in the available scholarly literature by providing a holistic overview of servitization enablers in the era of industry 4.0. Scope: The research scope is limited to global manufacturing firms operating within the business-to-business domain. Method: This dissertation leverages a realist inquiry using multiple search strategies to retrieve 218 articles from academic, industry, and grey literature leading to 59 quality appraised articles from the last seven years for inclusion in the synthesis. The dynamic capabilities theory and its aspects of sensing, seizing, and transforming guide this research. Findings: The synthesis conducted as part of this dissertation yields four findings and 10sub findings constituting the areas of continuous innovation, customer focus, and organizational transformation as enablers. Limitations: Areas that the literature did not sufficiently address include (a)the correlation between implementing servitization of business and the revenue generated by the manufacturing organization, (b)the correlation between implementing servitization models and the manufacturing industry sectors, and (c)the impact of using newer and advanced technologies on servitization models. Implications: The manufacturing organization leaders should conduct a maturity assessment, review an awareness checklist, and consider investments and partnerships as proposed by this research to support their servitization of business journey. Originality/Value: The results of this dissertation will allow manufacturing organizations to distinguish themselves from the competition and show more significant revenue potential for their shareholders by effectively deploying critical organizational actors in the servitization journey to transform their business into effective service-centric manufacturing organizations.SERVITIZATION ENABLERS FOR B2B MANUFACTURING
i
ABSTRACT
Title of Dissertation: SERVITIZATION IN THE ERA OF INDUSTRY
4.0 – A REALIST REVIEW TO IDENTIFY
ENABLERS OF SERVITIZATION FOR
BUSINESS-TO-BUSINESS MODELS IN THE
MANUFACTURING INDUSTRY GLOBALLY
Alok Tewari,
Doctor of Management, 2020
Business customers of manufacturing organizations globally seek superior customer service
from the manufacturer, the practical usage of digital product monitoring services, predictive
maintenance for products, and relief from buying capital expenditure products for products as a
service. This dissertation aims to identify enablers that leaders within manufacturing firms
should consider as they transform from a product-centric to a service-centric business model – a
move known as servitization. With the advent of Industry 4.0 and the latest technological
evolutions, the concepts and process of servitization implementation profoundly impact the
manufacturer's business models by enabling newer revenue streams. Purpose: This
dissertation aims to bridge the existing knowledge gap in the available scholarly literature by
providing a holistic overview of servitization enablers in the era of industry 4.0. Scope: The
research scope is limited to global manufacturing firms operating within the business-to-business
domain. Method: This dissertation leverages a realist inquiry using multiple search
strategies to retrieve 218 articles from academic, industry, and grey literature leading to 59
SERVITIZATION ENABLERS FOR B2B MANUFACTURING
ii
quality appraised articles from the last seven years for inclusion in the synthesis. The dynamic
capabilities theory and its aspects of sensing, seizing, and transforming guide this research.
Findings: The synthesis conducted as part of this dissertation yields four findings and 10 sub
findings constituting the areas of continuous innovation, customer focus, and organizational
transformation as enablers. Limitations: Areas that the literature did not sufficiently address
include (a) the correlation between implementing servitization of business and the revenue
generated by the manufacturing organization, (b) the correlation between implementing
servitization models and the manufacturing industry sectors, and (c) the impact of using newer
and advanced technologies on servitization models. Implications: The manufacturing
organization leaders should conduct a maturity assessment, review an awareness checklist, and
consider investments and partnerships as proposed by this research to support their
servitization of business journey. Originality/Value: The results of this dissertation will allow
manufacturing organizations to distinguish themselves from the competition and show more
significant revenue potential for their shareholders by effectively deploying critical
organizational actors in the servitization journey to transform their business into effective
service-centric manufacturing organizations.
Keywords: servitization, industry 4.0, industrial IoT, as-a-service, manufacturing,
dynamic capabilities
SERVITIZATION ENABLERS FOR B2B MANUFACTURING
iii
SERVITIZATION IN THE ERA OF INDUSTRY 4.0 – A REALIST REVIEW TO
IDENTIFY ENABLERS OF SERVITIZATION FOR BUSINESS-TO-BUSINESS
MODELS IN THE MANUFACTURING INDUSTRY GLOBALLY
By
Alok Tewari
Dissertation submitted to the School of Business,
University of Maryland Global Campus, in partial fulfillment
of the requirements for the degree of
Doctor of Management
2020
© Copyright by
[ALOK TEWARI]
2021
SERVITIZATION ENABLERS FOR B2B MANUFACTURING
iv
Preface
This dissertation is being submitted in partial fulfillment of the requirements for the
degree of Doctor of Management at the University of Maryland Global Campus. The evidence-based
management research described herein was conducted under the supervision of Dr.
Deborah Wharff between January 2020 and December 2020.
To the best of my knowledge, this work is original except where acknowledgments and
references are made to the previous work. Neither this nor any similar dissertation has been
submitted for any other degree, diploma, or other qualification at any other university or
degree-granting institution. Permission for use has been obtained for all reprinted or adapted
figures. Any such figure, not explicitly stating that permission has been granted, did not require
permission.
The world around us is changing fast in the form of business model disruptions. Business
models that did not exist even a decade ago have become an integral part of our lives. With
technology at the forefront, creativity and imagination are having a lasting change on humanity.
With this dissertation, I aim to contribute to one such domain of the business-to-business
manufacturing industry.
Alok Tewari
December 2020
SERVITIZATION ENABLERS FOR B2B MANUFACTURING
v
Dedication
To my wife. She has been and remains my biggest supporter and mentor over the last 18
years.
SERVITIZATION ENABLERS FOR B2B MANUFACTURING
vi
Acknowledgments
My doctoral journey started with Dr. Deborah Wharff as the professor for my very first
academic course in 2017. My doctoral journey ends in December 2020, with Dr. Deborah
Wharff as my dissertation advisor and mentor for the past year. I thank Dr. Wharff for keeping
me motivated on this journey and getting me through the finish line. With this dissertation
process, Dr. Wharff has guided, mentored, and coached me on transforming my learning,
writing, and thought process. Dr. Wharff is a perfectionist and works hard to coach and attain
the same level of perfection from her students. I will always be grateful to Dr. Wharff for her
dedication to the evidence-based management domain and, most importantly, for showing me a
path to lifelong learning.
I am thankful to the faculty members of the Doctor of Management program at the
University of Maryland Global Campus (UMGC) for their teachings and for helping me discover
myself in the process. Thanks are due to Dr. James Gelatt for being the second reader for this
dissertation and providing invaluable feedback and support. I am thankful to the following
coursework professors: Dr. Marcia Bouchard, Dr. Joseph Drasin, Dr. Lisa Pearo, Dr. Tacy
Holliday, Dr. Laura Witz, and Dr. Walter McCollum. A special thanks to Dr. Walter McCollum
for helping me discover myself as a scholar-practitioner. I also want to thank the doctoral
program management at UMGC, including Dr. Bryan Booth and Dr. Ravi Mittal, for sharing
their insights and keeping me motivated. This doctoral journey was made possible with the
administrative support and guidance of Marina Caminis and UMGC doctoral program librarian
Cynthia Thomes.
The executive summary of this dissertation was shared with academic and industry
subject matter experts. My gratitude is due to Professor Tim Baines for his prompt response to
my requests and his guidance over the last year. I am thankful to Professor Christian
Kowalkowski, for taking the time to provide valuable feedback, including the history of
servitization and providing key points that aided my research. I am grateful to Dr. Giuliano
SERVITIZATION ENABLERS FOR B2B MANUFACTURING
vii
Marodin for pointing me to Dr. Alejandro Frank to become a subject matter expert for this
dissertation. Dr. Frank very promptly provided me detailed feedback on the executive summary
of this dissertation. Dr. Frank’s feedback brought forward many valuable points that have
solidified my research and have added tremendous value.
From the manufacturing industry perspective, I am incredibly grateful and thankful to
Mr. Ron Giuntini for spending time with me in lengthy discussions and advising me on the
direction of servitization and the manufacturing industry in general. The white papers, talks,
and information shared by Ron have contributed to the practitioner knowledge that has aided
my dissertation. Gratitude is also due to Mr. John Stokes, who agreed to become a subject
matter expert for this dissertation. I have thoroughly enjoyed the conversations and insights
that John has brought forward. His willingness to go above and beyond in helping me is deeply
appreciated. I am also thankful to Mr. David Reiling for reviewing the executive summary for
this dissertation and providing a relevant industry perspective. David’s promptness and insights
were immensely helpful.
I am also thankful to my cohort members who provided me the opportunity to learn and
refine my thinking abilities by sharing unique and thought-provoking perspectives. This journey
would not have been complete without their support. In alphabetical order of first name, they
are Bernard Rizkallah, Bill Woody, Darven Mobley, David McCullin, Flore Nadine Storey,
Heather Johnson, Hiwot Mengesha, Katherine Kemmerer, Kristen Tarr, Mahasin Abdullah,
Maribel Lee, Michael Harrison, Louis Eguzo, and Osama El-Lissy.
Lastly, this dissertation would not have been possible without the support and
motivation from my wife. She not only convinced me to begin this journey, but she kept me
going through both the challenging and good times.
SERVITIZATION ENABLERS FOR B2B MANUFACTURING
viii
Table of Contents
ABSTRACT .......................................................................................................................... I
PREFACE .......................................................................................................................... IV
DEDICATION ..................................................................................................................... V
ACKNOWLEDGMENTS ..................................................................................................... VI
TABLE OF CONTENTS .................................................................................................... VIII
LIST OF TABLES ............................................................................................................ XIII
LIST OF FIGURES ............................................................................................................ XV
LIST OF ABBREVIATIONS ............................................................................................. XVI
CHAPTER 1: INTRODUCTION AND OVERVIEW OF THE MANAGEMENT PROBLEM ......... 1
BACKGROUND AND OVERVIEW ........................................................................................................................ 2
Move to Servitization ............................................................................................................................... 3
Industry 4.0 and Technology .................................................................................................................. 4
Servitization in the Era of Industry 4.0 .................................................................................................. 6
PROBLEM STATEMENT AND SIGNIFICANCE OF THE PROBLEM ........................................................................... 7
Problem Relevancy ................................................................................................................................. 7
Research Gap .......................................................................................................................................... 9
PURPOSE OF THE RESEARCH AND THE RESEARCH QUESTION ......................................................................... 10
Scope of Research .................................................................................................................................. 10
Research Question ................................................................................................................................. 15
Significance of the Research .................................................................................................................. 16
DISCUSSION OF THEMES IDENTIFIED FROM SCOPING REVIEW ........................................................................ 18
DEFINITIONS AND TERMINOLOGY .................................................................................................................. 19
CHAPTER SUMMARY ..................................................................................................................................... 21
ORGANIZATION OF THE DISSERTATION .......................................................................................................... 23
CHAPTER 2: SCOPING LITERATURE REVIEW AND THEORETICAL FRAME ................... 24
THEORETICAL FRAMEWORK .......................................................................................................................... 27
Dynamic Capabilities Theory ................................................................................................................ 27
Servitization in Dynamic Capabilities Theory Context ........................................................................ 29
SCOPING LITERATURE REVIEW ..................................................................................................................... 30
SERVITIZATION ENABLERS FOR B2B MANUFACTURING
ix
Information and Communication Technology ..................................................................................... 31
Customer Focus ..................................................................................................................................... 34
Partnerships .......................................................................................................................................... 36
Culture and Organizational Change Management ............................................................................. 38
Risks with Servitization ........................................................................................................................ 40
CONCEPTUAL FRAMEWORK ........................................................................................................................... 41
CHAPTER SUMMARY ..................................................................................................................................... 43
CHAPTER 3: METHOD ...................................................................................................... 45
REVIEW DESIGN AND METHODOLOGY ........................................................................................................... 45
The Evidence-Based Research Framework .......................................................................................... 45
Systematic Reviews ............................................................................................................................... 46
Systematic Review Process .................................................................................................................... 47
Search Strategy .................................................................................................................................... 50
Method of Quality Appraisal of the Included Studies .......................................................................... 55
PRISMA diagram .................................................................................................................................. 58
ANALYSIS AND SYNTHESIS METHODOLOGY .................................................................................................... 59
Method of Synthesis .............................................................................................................................. 60
SUBJECT MATTER EXPERTS ........................................................................................................................... 61
SME Acquisition Process ....................................................................................................................... 63
SME Questionnaire ............................................................................................................................... 64
CHAPTER SUMMARY ..................................................................................................................................... 65
CHAPTER 4: ANALYSIS AND FINDINGS ........................................................................... 66
DESCRIPTION OF THE DATA SET .................................................................................................................... 67
Identification of Academic Literature .................................................................................................. 68
Identification of Snowballed Literature ............................................................................................... 69
Identification of Grey Literature ........................................................................................................... 69
Screening Results .................................................................................................................................. 70
RESULTS OF THE QUALITY APPRAISAL OF THE DATA SET ................................................................................ 70
SERVITIZATION ENABLERS FOR B2B MANUFACTURING
x
Quality Appraisal Results ...................................................................................................................... 71
Articles selected for Coding and Analysis ............................................................................................. 71
Final PRISMA Details ............................................................................................................................ 72
RESULTS OF THE CODING PROCESS ................................................................................................................ 73
FINDINGS AND DISCUSSION ........................................................................................................................... 76
Finding 1: Engaged Leadership, Vision, and Organizational Culture ................................................ 77
Finding 2: Change Management and Organizational Structure ....................................................... 83
Finding 3: Inculcating Customer Focus Across the Entire Organizational Value Chain .................. 89
Finding 4: Investing in Continuous Innovation ................................................................................. 103
SUMMARY OF FINDINGS .............................................................................................................................. 112
Finding 1 and Enablers ........................................................................................................................ 113
Finding 2 and Enablers ....................................................................................................................... 114
Finding 3 and Enablers ....................................................................................................................... 114
Finding 4 and Enablers ........................................................................................................................ 115
REVISED CONCEPTUAL FRAMEWORK ........................................................................................................... 116
CHAPTER SUMMARY
Proactive change management framework: A systematic review of the literature
No full textThis dissertation is designed to explore steps that organizations could take to adopt proactive change management that increases organizational performance. Despite scholarly developed change management tools and the concerted efforts of leaders in carrying out effective change management, many organizations fail to achieve their desired objectives. The preponderance of change models and frameworks seem to be inherently reactive,forthey were designed to aid organizations to respond to changes that had already occurred. Change is inevitable. Therefore, for organizations to remain viable, one must ask: Could proactive change management be an effective solution for organizations to overcome challenges that come with the traditional, reactive response to changes? Method: An evidence-based research framework was used to address the research question, including an electronic literature search of the UMGC library for change management. Screening articles for relevancy and applying a critical appraisal process, which yielded 40articlesthatwere included in the coding and thematic analysis. Results: The coding and thematic analysis converged into five overarching themes that were related to successful organizational proactive change management: (a) role of leadership; (b) communication and employee engagement; (c) organizational culture; (d) operational procedures; and (e) proactive change management. Themes 1–4 reflect a well-established scholarly body of work in the literature on change management in general. However, Theme 5 brings to bear additional information on approaches by which potential changes might be identified, evaluated, and implemented proactively. Specifically, organizations could take six steps for proactive change management: (a) identify and evaluate potential changes proactively; (b) develop a shared assessment and value; (c) evaluate options and solutions; (d) develop specific plans to incorporate changes; (e) implement changes; and (f) evaluate results.Conclusions: Practitioners in private and public organizations could use the proactive change management framework to overcome challenges associated with the inherently reactive approach to change management and ultimately enhance organizational performance. Limitations: Additional research to validate (ground truth) the framework in different organizational environments and settings is necessary to verify its effectiveness. Implications: This dissertation will influence management practice on change management, thereby,increasing organizational performance, survival, and thrive in an ever-changing environment.Abstract
Title of Dissertation:
PROACTIVE CHANGE MANAGEMENT FRAMEWORK: A SYSTEMATIC REVIEW OF THE LITERATURE
Osama El-Lissy, Doctor of Management, 2020
This dissertation is designed to explore steps that organizations could take to adopt proactive change management that increases organizational performance. Despite scholarly developed change management tools and the concerted efforts of leaders in carrying out effective change management, many organizations fail to achieve their desired objectives. The preponderance of change models and frameworks seem to be inherently reactive, for they were designed to aid organizations to respond to changes that had already occurred. Change is inevitable. Therefore, for organizations to remain viable, one must ask: Could proactive change management be an effective solution for organizations to overcome challenges that come with the traditional, reactive response to changes? Method: An evidence-based research framework was used to address the research question, including an electronic literature search of the UMGC library for change management. Screening articles for relevancy and applying a critical appraisal process, which yielded 40 articles that were included in the coding and thematic analysis. Results: The coding and thematic analysis converged into five overarching themes that were related to successful organizational proactive change management: (a) role of leadership; (b) communication and employee engagement; (c) organizational culture; (d) operational procedures; and (e) proactive change management. Themes 1–4 reflect a well-established scholarly body of work in the literature on change management in general. However, Theme 5 brings to bear additional information on approaches by which potential changes might be identified, evaluated, and implemented proactively. Specifically, organizations could take six steps for proactive change management: (a) identify and evaluate potential changes proactively; (b) develop a shared assessment and value; (c) evaluate options and solutions; (d) develop specific plans to incorporate changes; (e) implement changes; and (f) evaluate results. Conclusions: Practitioners in private and public organizations could use the proactive change management framework to overcome challenges associated with the inherently reactive approach to change management and ultimately enhance organizational performance. Limitations: Additional research to validate (ground truth) the framework in different organizational environments and settings is necessary to verify its effectiveness. Implications: This dissertation will influence management practice on change management, thereby, increasing organizational performance, survival, and thrive in an ever-changing environment.
Keywords: proactive change management, leadership, organizational culture, organizational performance
PROACTIVE CHANGE MANAGEMENT FRAMEWORK: A SYSTEMATIC REVIEW OF THE LITERATURE
By
Osama El-Lissy
Dissertation submitted to the Faculty of the Graduate School of the
University of Maryland Global Campus, in partial fulfillment
of the requirements for the degree of
Doctor of Management
2020
© Copyright by
[Osama El-Lissy]
2020
ii
Preface
This dissertation was prepared to fulfill the requirement of the Doctor of Management program at the University of Maryland Global Campus. The purpose of this dissertation was to identify a potential solution for an ongoing organizational management problem.
The primary focus of this research was to investigate whether a proactive approach to change management could be a more effective alternative to the traditional, reactive response to change. The motivation for this research stems from the desire to identify effective solutions designed to aid organizations in both public and private sectors to overcome challenges posed by the ever-changing environment, including economic, social, and political structures around the world. Organizations that are able to cope effectively with internal and external changes are able not only to survive, but also to thrive in today’s fierce competitive environment.
The main source of data used in this research was collected through a systematic literature review of scholarly published journals related to change management. iii
Dedication
This dissertation is dedicated to the memory of my mother, Ferial. Although she was my inspiration to continue learning, she was unable to see my graduation. This doctoral degree is for her. iv
Acknowledgements
Firstly, I would like to express my sincere gratitude to my mentor, Dr. James Gelatt, for his astute insights and expert knowledge throughout the entire dissertation process. With his guidance, consistent encouragement, and emotional support, I was able to complete this dissertation. I could not have imagined a better advisor and mentor for my dissertation. I also thank Dr. Denise Breckon for her insightful comments, encouragement, and for the hard questions that prompted me to adjust the scope of my research. I’m grateful to Dr. Walter McCullum for sharing his personal experience in overcoming some of the most complex and seemingly insurmountable challenges, for it was such an up-lifting and inspiration for me to persist in this journey. Ultimately, I am indebted to Dr. Gelatt, Dr. Breckon, and Dr. McCullum for their invaluable input and guidance as members of the dissertation committee. I also give my sincere thanks to Ms. Cynthia Thomes for providing me with insights and instruction for critical search of the University of Maryland Global Campus library in support of my research. Her consistent, thorough, and timely response was invaluable, especially when faced with extreme time constraints. I am grateful to our academic program coordinator, Ms. Marina Caminis, for her tireless commitment and enthusiastic support throughout the entire program, particularly during residencies. I also want to thank all the professors and my colleagues in this cohort who inspired my drive, expanded my thinking, and enriched my experience throughout the entire journey. Last, but not least, cheers go to my wife, Wendy, and son, Ramy, for their understanding and steadfast support throughout the entire doctoral program. Their constant encouragement has been unmatched. v
Table of Contents
Preface............................................................................................................................................ ii
Dedication ..................................................................................................................................... iii
Acknowledgements ........................................................................................................................ iv
Table of Contents ............................................................................................................................ v
List of Tables ............................................................................................................................... vii
List of Figures .............................................................................................................................. viii
Chapter 1: Introduction and Overview of the Management Problem ............................................. 1
Background and Overview ......................................................................................................... 1
Problem Statement and Significance of the Problem ................................................................. 3
Research Question ...................................................................................................................... 5
Definitions and Terminology ...................................................................................................... 6
Organization of the Dissertation ................................................................................................. 6
Chapter Summary ....................................................................................................................... 7
Chapter 2: Scoping Literature Review and Theoretical Framework .............................................. 8
The Literature Landscape ........................................................................................................... 8
Change and Change Management .......................................................................................... 8
Leadership ............................................................................................................................... 9
Organizational Culture ............................................................................................................ 9
Proactive Change Management ............................................................................................ 10
Theoretical Background ............................................................................................................ 11
Theoretical Framework ............................................................................................................. 13
Chapter Summary ..................................................................................................................... 15
Chapter 3: Method ........................................................................................................................ 16
Search Strategy and Inclusion/Exclusion Criteria .................................................................... 16
Study Selection ......................................................................................................................... 18
Critical Appraisal ...................................................................................................................... 18
Data Extraction ......................................................................................................................... 19
Analysis and Coding ................................................................................................................. 22
Chapter Summary ..................................................................................................................... 22
Chapter 4: Analysis and Findings ................................................................................................. 23
Selected Articles ....................................................................................................................... 23
Coding and Thematic Analysis Results .................................................................................... 24
Theme One – Role of Leadership ......................................................................................... 27
Theme Two – Importance of Employee Engagement and Communication ......................... 28
Theme Three – Organizational Culture ................................................................................ 29
Theme Four – Operational Procedures and Systems ............................................................ 30
Theme Five – Proactive Change Management ..................................................................... 31
Summary .................................................................................................................................. 34
Chapter 5: Conclusions and Implications ..................................................................................... 35
Role of Leadership .................................................................................................................... 36
Employee and Stakeholder Engagement .................................................................................. 36
Organizational Culture .............................................................................................................. 37
Operational Procedures and Systems ........................................................................................ 38 vi
Proactive Change Management ................................................................................................ 38
Identify and Evaluate Potential Changes Proactively ........................................................... 38
Develop a Shared Assessment and Value: Engage Employees and Stakeholders................ 39
Evaluate Options and Solutions ............................................................................................ 39
Develop Specific Plans to Incorporate Changes ................................................................... 40
Implement Changes (Kotter Model) ..................................................................................... 40
Evaluate Results of Changes ................................................................................................. 41
Case Studies .............................................................................................................................. 42
Case Study 1 – Customer Shopping Preference ................................................................... 42
Case Study 2 – COVID-19 Pandemic ................................................................................... 45
Conclusion and Recommendations ........................................................................................... 48
Limitations and Future Research .............................................................................................. 49
Final Summary .......................................................................................................................... 50
References .................................................................................................................................... 52
Appendix A. Number of Retrieved Articles from Databases using Prescribed Search Statements .............................................................................................................. 75
Appendix B. List of Eligible Articles .......................................................................................... 77
Appendix C. TAPUPAS and Weight of Evidence Framework Scoring Scale ............................ 89
Appendix D. Data Extraction and Six Levels of Appropriateness Analysis ............................. 104
Appendix E. Coding and Thematic Analysis ............................................................................. 129
vii
List of Tables
Table 1 Kotter’s Eight Steps Change Management Model and Modified Model for Proactive Change Management ..................................................................................... 41
viii
List of Figures
Figure 1. Proactive Change Management Framework ................................................................ 14
Figure 2. PRISMA Chart Indicating the Screening Processes and Resulting Number of Articles Included in the Synthesis ................................................................................ 21
Figure 3. Number of Articles Grouped by Publication Year ....................................................... 24
Figure 4. Five Themes Extracted From the Selected Articles ..................................................... 26
Figure 5. Number of Articles Directly Reporting on Proactive Change Management, 2000–2020 .............................................................................................................................. 27
Figure 6. Depiction of the Five Change Management Themes That Were Positively Related to Organizational Performance ..................................................................................... 33
Figure 7. Diagram Listing the Six Steps That Organizations Can Take to Successfully Adopt and Implement Proactive Change Management ................................................ 34
Figure 8. Proactive Change Management Framework ................................................................ 49
1
Chapter 1: Introduction and Overview of the Management Problem
Background and Overview
Organizations have been faced with globalization, exponential advancements in technology, rapid increase in knowledge and access to information, and integration of economic, social, and political structures around the world (Burke, 2008; Cawsey & Deszca, 2007; Manzo et al., 2012). To cope with these changes, scholars and practitioners have long recognized the need for change management. Lewin’s (1947) seminal field theory work provided the basis for the Lewin model of change, which offers a guide for successful transformation, both for individuals and organizations (DK, 2012, p. 220). Lewin’s (1947) model of change consists of three phases: (a) unfreezing—behavior that increases the receptivity to a possible change in the distribution and balance of social forces; (b) moving—altering the magnitude, direction, or number of driving and resisting forces, consequently shifting the equilibrium to a new level; and (c) freezing—reinforcing the new distribution of forces, thereby maintaining and stabilizing the new social equilibrium.
Building on Lewin’s (1947) model of change, hands-on guides and frameworks have been developed to aid organizations with change management; among them are those by Hall (1991), Judson (1991), Burke and Litwin (1992), Kanter et al. (1992), Thomas and Robertshaw (1999), Bridges (2003), and Schein (2004). Each of the frameworks underscored specific aspects of change management. For example, Hall (1991) emphasized the importance of employee engagement and evaluation of the change plan; Judson (1991), employee communication and institutionalizing new changes; Burke and Litwin (1992), the role of leadership and top managers as central to successful change management; Kanter et al. (1992), leadership and creating an enabling structure to successfully implement changes; Thomas and Robertshaw (1999), 2
leadership and ongoing evaluation of change plans and the flexibility to making adjustments during the implementation phase; Bridges (2003), managing employees’ emotions during change; and Schein (2004), organizational culture as a support system of change management. Burnes (2004) and Paton and McCalman (2008) emphasized in their frameworks change management at the organizational strategic level; explaining the importance of mapping changes within specific organizations and incorporating potential intervention in the organizational strategic plans. Another framework that has been used to institute change is Enterprise Change Management (Miller & Proctor, 2016), which was designed to bridge the gap between what organizations would like to deliver and their capabilities. The Six Sigma framework provides a set of steps—define, measure, analyze, improve, and control—to facilitate change through process improvement (Pande et al., 2000). McKinsey’s 7S framework (strategy, structure, systems, shared values, style, staff and skills) has also been used in assessing and analyzing internal changes of organizations (as cited in Waterman et al., 1980; Peters & Waterman, 1982). The ADKAR (awareness, desire, knowledge, ability, and reinforcement) is another model designed to guide individual and organizational change (Hiatt, 2006). These change management fram
Authentic inclusion and building cultures that go beyond diversity: A systematic review of the literature
No full textThe purpose of this study is to explore the current factors that hinder an organization from moving beyond implicit racial and gender bias to a culture of authentic inclusion of diversity in an organization. The problem is that organizations have not moved beyond diversity to an authentic, inclusive workplace due to implicit bias and the overall lack of current diversity in an organization. Explored are factors that hinder diversity in the workplace. If these factors are not portrayed in a positive light, t he organization will not be authentically inclusive and will fail at a diverse and inclusive workplace. A structured, systematic review process was used to examine previous research to determine how implicit racial and gender bias affect diversity in an organization trying to become an authentically inclusive workplace. The findings suggest that three main factors, implicit racial bias, implicit gender bias, and the overall diversity of an organization, will affect an organization in negative ways if not combatted properly. Those three factors are why many organizations cannot move beyond diversity to become an authentic, inclusive workplace. Organizations must learn how to change the current work environment to become inclusive. Implications for management are also provided, including the role leadership must take to help an organization become authentically inclusive.AUTHENTIC INCLUSION AND BUILDING CULTURES i
ABSTRACT
Title of Dissertation: AUTHENTIC INCLUSION AND BUILDING
CULTURES THAT GO BEYOND
DIVERSITY: A SYSTEMATIC REVIEW OF
THE LITERATURE
Mahasin S. Abdullah,
Doctor of Management, 2020
The purpose of this study is to explore the current factors that hinder an organization from
moving beyond implicit racial and gender bias to a culture of authentic inclusion of diversity in
an organization. The problem is that organizations have not moved beyond diversity to an
authentic, inclusive workplace due to implicit bias and the overall lack of current diversity in an
organization. Explored are factors that hinder diversity in the workplace. If these factors are not
portrayed in a positive light, the organization will not be authentically inclusive and will fail at a
diverse and inclusive workplace. A structured, systematic review process was used to examine
previous research to determine how implicit racial and gender bias affect diversity in an
organization trying to become an authentically inclusive workplace. The findings suggest that
three main factors, implicit racial bias, implicit gender bias, and the overall diversity of an
organization, will affect an organization in negative ways if not combatted properly. Those three
factors are why many organizations cannot move beyond diversity to become an authentic,
inclusive workplace. Organizations must learn how to change the current work environment to
become inclusive. Implications for management are also provided, including the role leadership
must take to help an organization become authentically inclusive.
Keywords: Implicit bias, culture, diversity, inclusion, authentic inclusion
AUTHENTIC INCLUSION AND BUILDING CULTURES ii
AUTHENTIC INCLUSION AND BUILDING CULTURES THAT GO BEYOND
DIVERSITY: A SYSTEMATIC REVIEW OF THE LITERATURE
By
Mahasin S. Abdullah
Dissertation submitted to the School of Business,
University of Maryland Global Campus, in partial fulfillment
of the requirements for the degree of
Doctor of Management
2020
AUTHENTIC INCLUSION AND BUILDING CULTURES iii
© Copyright by
Mahasin S. Abdullah
2020
AUTHENTIC INCLUSION AND BUILDING CULTURES iv
Dedication
I dedicate my dissertation work to my mother, Yvonne Abdullah, and my Aunt Charisse
Chappell, who taught me how to persevere with continued words of encouragement. My sisters
Tiana, Lemyel, Halimah, and Adel who listened to all my complaints. My fiancé William
Midgette who has been by my side through the happy and hard times of this process—who never
let me give up and always prayed with me to have the strength to continue in order to succeed.
To my daughter Jurnee Aromashodu who is one of my best cheerleaders and has been
there for me not only through this doctoral program but through every school program that
prepared me for this point never complaining about the time I could not share with her. To my
bonus children Aniyla, Dior, and King who are finally happy I am done school work so I can
play. To my best friend Leteshia Riddick, who never stop singing words of encouragement and
pushing me along although she was miles away. Lastly, I dedicate this dissertation to all the men
and women who have faced police brutality, been discriminated against, and have been unfairly
treated.
AUTHENTIC INCLUSION AND BUILDING CULTURES v
Acknowledgements
This dissertation would not have been possible without the coaching and dedication from
a strong team. I would like to acknowledge my mentor Dr. Marcia Bouchard and second reader
Dr. John Sherlock. I would like to thank all the doctoral professors who helped push me along
and taught ways that will last me a lifetime. To my cohort who stuck it out with me and pushed
each other the entire program.
I would like to give thanks to God. Without faith and prayer this path would have never
happened. I would like to thank my Church City of Praise Family Ministries for always
providing a word that help hit my reset button to understand this is part of my calling.
AUTHENTIC INCLUSION AND BUILDING CULTURES vi
Contents
ABSTRACT .................................................................................................................................... i
Dedication ..................................................................................................................................... iv
Acknowledgements ......................................................................................................................... v
Contents ........................................................................................................................................ vi
List of Tables ................................................................................................................................ ix
List of Figures ................................................................................................................................ x
Chapter 1: Introduction and Overview of the Management Problem ........................................... 11
Background ............................................................................................................................... 12
Implicit Racial Bias ................................................................................................................... 13
Implicit Gender Bias ................................................................................................................. 14
Diversity and Inclusion ............................................................................................................. 15
Organizational Culture .............................................................................................................. 16
Leadership ................................................................................................................................ 16
Problem Statement ........................................................................................................................ 17
Significance of the Problem .......................................................................................................... 17
Purpose of the Study ..................................................................................................................... 19
Research Question ........................................................................................................................ 20
Rationale for the Study ................................................................................................................. 21
Definitions and Terminology .................................................................................................... 22
Chapter Summary ......................................................................................................................... 23
Organization of the Dissertation ............................................................................................... 23
Chapter 2: Scoping Literature Review and Theoretical Frame .................................................... 25
History of Workforce Diversity ................................................................................................ 25
Explicit and Implicit Bias in the Workforce Today .................................................................. 27
Diversity and Inclusivity ........................................................................................................... 29
Theories on Culture, Leadership, and Diversity ........................................................................... 30
Organizational Culture Theory .................................................................................................. 30
Servant Leadership .................................................................................................................... 33
Diversity Management .............................................................................................................. 34
Institutional Theory ............................................................................................................... 35
Resource Theory .................................................................................................................... 35
Conceptual Framework ............................................................................................................. 37
Chapter Summary ......................................................................................................................... 38
AUTHENTIC INCLUSION AND BUILDING CULTURES vii
Chapter 3: Method ........................................................................................................................ 39
Research Question ..................................................................................................................... 40
Search Strategy .......................................................................................................................... 40
Search Strings ........................................................................................................................ 40
Inclusion and Exclusion Criteria ............................................................................................... 42
Method of Quality Appraisal of the Included Studies ............................................................... 43
TAPUPAS ................................................................................................................................ 44
PRISMA Diagram ..................................................................................................................... 44
Analysis and Synthesis Methodology ....................................................................................... 47
Method of Synthesis .............................................................................................................. 47
Coding ...................................................................................................................................... 47
First Line Coding ................................................................................................................... 48
Second Line Coding .............................................................................................................. 49
Subject Matter Experts .................................................................................................................. 49
Chapter Summary ......................................................................................................................... 50
Chapter 4: Analysis and Findings ................................................................................................. 51
Description of Data Set ................................................................................................................. 51
Findings........................................................................................................................................ 52
Review of the Research Question ............................................................................................. 54
Discussion .................................................................................................................................... 55
Theme I--Gender Discrimination: Men versus Women ............................................................ 55
Findings ................................................................................................................................ 55
Discussion .............................................................................................................................. 56
Theme II: Racial Discrimination ............................................................................................... 60
Findings ................................................................................................................................ 60
Discussion .............................................................................................................................. 60
Sub-Theme - Skin Tone Discrimination ................................................................................ 65
Findings ................................................................................................................................ 65
Discussion .............................................................................................................................. 65
Theme III – The Work Place: Challenge of Diversity in the Workforce .................................. 66
Findings ................................................................................................................................ 66
Discussion .............................................................................................................................. 67
Summary of Findings .................................................................................................................... 71
Revised Conceptual Framework ................................................................................................... 71
Chapter Summary ......................................................................................................................... 74
Chapter 5: Conclusions and Implications ..................................................................................... 75
Answer to the Research Question ............................................................................................. 75
Authentic Inclusion ................................................................................................................... 76
Implications and Recommendations for Practitioners .................................................................. 77
Implications ............................................................................................................................... 77
AUTHENTIC INCLUSION AND BUILDING CULTURES viii
Human Resource Management Practices .............................................................................. 77
Gender Empowerment ........................................................................................................... 78
Recommendations ..................................................................................................................... 79
Parts of a Diversity and Inclusion Framework ...................................................................... 79
Leadership Change Initiative Team .......................................................................................... 85
Leadership and Diversity Chart ............................................................................................. 87
A Focus on Training .................................................................................................................. 87
Third-Party Assistance .......................................................................................................... 88
Diversity Training Taskforce ................................................................................................. 88
Manager Training .................................................................................................................. 88
Pilot Program ......................................................................................................................... 89
Limitations of the Study................................................................................................................ 89
Future Research ............................................................................................................................ 90
Chapter Summary ......................................................................................................................... 91
References .................................................................................................................................... 93
Appendix A ................................................................................................................................ 107
Appendix B ................................................................................................................................ 108
Appendix C ................................................................................................................................ 110
Appendix D ................................................................................................................................ 117
Appendix E ................................................................................................................................ 123
Appendix F................................................................................................................................. 125
Appendix G ................................................................................................................................ 129
AUTHENTIC INCLUSION AND BUILDING CULTURES ix
List of Tables
Table 1: Codes of themes ..............................................................................................................52
Table 2: Standout Articles .............................................................................................................54
AUTHENTIC INCLUSION AND BUILDING CULTURES x
List of Figures
Figure 1: Organizational Culture Theory ......................................................................................32
Figure 2: Servant Leadership Theory ............................................................................................34
Figure 3: Diversity Management ...................................................................................................36
Figure 4: Conceptual Framework ..................................................................................................37
Figure 5: PRISMA ........................................................................................................................46
Figure 6: Standout Articles ............................................................................................................52
Figure 7: Revised Conceptual .......................................................................................................73
Figure 8: Action Plan .....................................................................................................................84
AUTHENTIC INCLUSION AND BUILDING CULTURES
11
Chapter 1: Introduction and Overview of the Management Problem
In the 21st century workplace, diversity and inclusion should become a strategic goal for
generating a positive work climate for employees. An organization’s goal should be to become
authentically inclusive for the betterment of the organization. Leadership, organizational culture,
and diversity and inclusion all play a major role in the overall organizational success. Parris and
Peachey (2013) discuss, all of which have been comprehensively researched in different aspects
of philosophy, social influence, and behavior. The success of organizational systems depends on
the effective and efficient guidance of the leaders of these systems (p. 377). One can argue that
the more important part of building an organization with the legacy of success is the people in it,
including followers and leaders.
However, diversity and inclusion have been a challenge for management of organizations
for decades. A problem for management is that organizations are struggling to move beyond
diversity to become authentically inclusive. Managers have not been able to successfully combat
factors that do not allow the organization to become inclusive. Leaders and managers must work
together to find new ways to help an organization move forward in a positive way, to incorporate
diversity and inclusion.
Having authentic leadership helps foster workplace inclusion (Boekhorst, 2015, p. 241).
Organizations are growing every day and need to grow in a positive comprehensible manner.
The importance of a positive climate for inclusion is needed for organizations to say they are
diverse successfully. Because organizations are experiencing a more diverse workforce, there is a
growing need for leaders to effectively attend to the changing nature of the workplace