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Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway.

We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models.

The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners.

While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization.

Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices.

Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats.

This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.

Purpose – This chapter explores the use of adaptive and disruptive change strategies to create an integrated health care delivery system that is both economically sustainable and patient-centered.

Design/methodology – This case study of Montefiore Medical Center is based on a year of research that included focus-group interviews; individual interviews with executives, frontline staff, and union leaders; site visits; analysis of internal data; and a literature review.

Findings – Montefiore Medical Center is using both adaptive and disruptive strategies to develop an integrated delivery system driven by capitated payments from health insurance companies, a focus on primary care and chronic disease management programs, and community outreach. The growth of these delivery system components in conjunction with Montefiore's Care Management Corporation (to help manage the health plan contracts) has contributed to an affordable cost of care, improved clinical outcomes, and proactive patient and community engagement.

Originality and value – There is a paucity of case studies describing how safety-net hospitals – and health systems in general – can integrate the services they provide to create a positive, seamless, and economical patient experience. The story of Montefiore Medical Center offers an overview of how health care infrastructure and payment methods can be transformed to align financial and clinical incentives and to better serve a patient population that largely depends on government health insurance.

Employee turnover is a growing challenge for health-care providers delivering patient care today. US population demographics are shifting as the population ages, which leaves the field of health care poised to lose key leaders and employees to retirement at a time when patient care has grown more complex. This means health care will lose its core of key employees at a time when skilled leadership and specialized knowledge is most needed and directly impacts health care's ability to deliver quality care. Operational succession planning (OSP) may be one solution to manage this looming challenge in health care, as the process identifies and develops the next generation of leadership. Thus, this exploratory national study used a quantitative and cross-sectional design to examine the relationship between OSP and employee turnover. Demographic and 10-point Likert scale data were collected from n = 66 medical practices, using an online survey instrument. Data were analyzed using various descriptive and inferential statistical methods. Distribution (frequency and chi-square) analyses of the study sample, one-way analysis of variance (ANOVA), and regression analyses were performed across seven demographic characteristics of the medical practices: Specialty, Ownership Structure, Number of full-time equivalent (FTE) Physicians, Number of FTE Clinical Employees, Number of FTE Nonclinical Employees, Number of FTE Employees Left Position, and Region. Study results provided statistically significant evidence to support the relationship between OSP and employee turnover, highlighting that OSP was associated with lower employee turnover. The finding suggests that OSP can serve as an effective mechanism for increasing employee retention.

Adopting an agentic positioning, we question and compare competing logics hybridization within French hospitals and universities facing major reforms inspired by new public management. In addition to the resulting forms of hybridization exposed in the literature (accepted or refused), we observe four additional modes: instrumentalized, uncomfortable, reformulated, and suffered. They all reveal the varied manner with which each professional faces reform. However, we develop a new argument: the ways professionals hybridize (or do not) their prevailing logic depends on an overarching mode of hybridization that characterizes the way their organization deals with reform. We identify two contrasting modes: overarching strategic logics hybridization and overarching enforced logics hybridization. They give insight into how actors decouple structure from practices. We contribute to the literature on logics hybridization by first analyzing the role of specific actors who act as either a translator-actor or a closure-actor to respectively facilitate appropriation of the reforms or to protect professionals against the growing dominance of the new logic introduced by the law; and secondly by discussing importance of articulating higher and lower organizational levels all involved in hybridization.

This chapter explores the adoption and implementation of a conflict management system (CMS) in a hospital setting. In particular, it uncovers the different motivations and challenges associated with a CMS across various stakeholders within the organization.

The chapter is based on qualitative research conducted in a large American hospital that adopted and implemented a CMS over the course of 15 months. The author conducted extensive interviews with stakeholders across the organization, including top management, union leaders, middle managers, clinicians, and frontline staff. Findings are also based on an array of observations, including stakeholder meetings and conflict management sessions.

The case study demonstrates the centrality of underexplored, generalizable, and industry-specific pressures that may lead organizations to reconsider their use of traditional dispute resolution practices and to institute a CMS. It also highlights the inherent organizational ambivalence toward the design and adoption, initiation and implementation, and routine use of a CMS and it documents the different types of outcomes delivered to various stakeholders.

The chapter provides a nuanced portrait of the antecedents to and consequences of the transformation of conflict management within one organization. It contributes to the existing body of research exploring the 30-year rise of alternative dispute resolution and CMSs in a growing proportion of firms in the United States. The use of an in-depth case-study method to examine this CMS experience offers a number of important insights, particularly regarding different stakeholder motivations and outcomes.

We utilise the actor-network theory (ANT) – based especially on Latour (2005) – to examine how management accounting tools affect physicians’ representations and new managerial practices in French public hospitals currently undergoing reform.

We conducted a longitudinal case study – based on interviews and observations – in a large French public hospital in which dashboards are diffused to physicians and nurses dealing with both medical and managerial activities.

The case shows that head physicians and nurses are implicated in their new managerial tasks and spend time analysing dashboards. Management accounting tools thus play a role, as mediators, in organising new managerial practices, and dashboards are a means of materialising and giving structure to new managerial practices and enabling discussions and exchanges to take place between actors who were previously separated.

The case shows that management accounting tools are not necessarily useful because they help in decision-making or control – as in the dominant paradigm; rather, they are beneficial because they may help in changing representations and building a new collective organisation. Future research should therefore expand on the organisational and social roles of management accounting tools, especially in the healthcare field.

Most ANT-inspired studies in management accounting focus on explaining changes in accounting practices, which are perceived as a consequence of an ANT process. This chapter, however, analyses the practices by which management accounting tools act as a vehicle to organisational change.

This paper examines how medical practice, like all other productive activities, has been subject to the transformative elements of the forces and the relations of production involving class struggle and intra-class conflict. It will explore changes in the relations of production of medical practice which have been catalyzed by powerful productive forces. The current period of medical production involves the transformation of simple commodity production into a transitional stage of capitalist production with the seemingly unbounded growth of the medical productive forces. This development was precipitated by the intervention of capital as a whole, to restrict the drain on their variable capital through the placement of units of financial capital into the management of medical production, using the leverage of access to patients. In response, physicians have consolidated and centralized their practices to create enterprises with market power to limit the extraction of surplus by financial capital, and by their own employment of productive labor to extract surplus from hired physician labor and other clinical workers. Rationalization of the production of medical service commodities, and the sharing of surplus generated from exploitation of an expanded labor force by managed care financial capital and their capitalist partners owning medical enterprises, constitutes the contemporary relations of production. The contradictions of this mode of medical production and the potential for its reproduction will be analyzed.

My discussion of intersexuality's changing exemplificatory position within feminist studies of science explains how its medical management has emerged as an exemplary injustice of recognition. Specifically, the surgical protocol that aims to make unusual genitalia invisible, and the medical obfuscation of intersexuality's ramifications for the cultural construction of gender, have been written as a wrong by Anne Fausto-Sterling and Suzanne Kessler. By mapping intersex treatment as a discursively produced injustice, I argue that it is accordingly within discourse that the wrongs of intersex treatment may be redressed – not by undoing past surgeries, or by punishing clinicians as personally “guilty.”

Background: Artificial intelligence (AI) is a booming sector that has profoundly influenced every walk of life, and the education sector is no exception. In education, AI has helped to develop novel teaching and learning solutions that are currently being tested in various contexts. Businesses and governments across the globe have been pouring money into a wide array of implementations, and dozens of EdTech start-ups are being funded to capitalise on this technological force. The penetration of AI in classroom teaching is also a profound matter of discussion. These have garnered massive amounts of student big data and have a significant impact on the life of both students and educators alike.

Purpose: The prime focus of this chapter is to extensively review and analyse the vast literature available on the utilities of AI in health care, learning, and development. The specific objective of thematic exploration of the literature is to explicate the principal facets and recent advances in the development and employment of AI in the latter. This chapter also aims to explore how the EdTech and healthcare–education sectors would witness a paradigm shift with the advent and incorporation of AI.

Design/Methodology/Approach: To provide context and evidence, relevant publications were identified on ScienceDirect, PubMed, and Google Scholar using keywords like AI, education, learning, health care, and development. In addition, the latest articles were also thoroughly reviewed to underscore recent advances in the same field.

Results: The implementation of AI in the learning, development, and healthcare sector is rising steeply, with a projected expansion of about 50% by 2022. These algorithms and user interfaces economically facilitate efficient delivery of the latter.

Conclusions: The EdTech and healthcare sector has great potential for a spectrum of AI-based interventions, providing access to learning opportunities and personalised experiences. These interventions are often economic in the long run compared to conventional modalities. However, several ethical and regulatory concerns should be addressed before the complete adoption of AI in these sectors.

Originality/Value: The value in exploring this topic is to present a view on the potential of employing AI in health care, medical education, and learning and development. It also intends to open a discussion of its potential benefits and a remedy to its shortcomings.

This chapter draws on a study conducted in the mid 1990s to compare management differences between three different groups of South African hospitals, in order to understand how these differences might have affected hospital functioning. The groups were public hospitals; contractor hospitals publicly funded but privately managed; and private hospitals owned and run by private companies. Public sector structures made effective management difficult and were highly centralized, with hospital managers enjoying little autonomy. In contrast, contractor and private groups emphasised efficient management and cost containment. These differences appeared to be reflected in cost and quality differences between the groups. The findings suggest that in the context of a country such as South Africa, with a relatively well-developed private sector, there is potential for the government to profit from the management expertise in the private sector by identifying lessons for its own management structures, and by contracting-out service management.