The effects of external factors on corporate social responsibility behaviors in healthcare organizations: Responses and outcomes

To understand corporate social responsibility behaviors and their management in healthcare organizations, the evidence-based research approach was utilized to identify the external factors that influence such behaviors to determine which behaviors are needed to respond most effectively to those factors and to analyze the outcomes of those behaviors. Review and analysis of the literature showed that external factors influencing healthcare organizations’ corporate social responsibility behaviors include government and industry regulation, community expectations, economic crisis, and media awareness. Research also showed that necessary responses by healthcare organizations to these influences include regulatory compliance, responsiveness to stakeholders, ethical practices, and effective communications. Finally, the findings showed that corporate social responsibility behaviors lead to success by healthcare organizations in establishing and maintaining needed partnerships, access to capital, positive recognition, and improved community relations. These benefits indicate that, for stakeholders in healthcare organizations, corporate social responsibility is both the “right thing” as well as the “smart thing” to do. Individual healthcare organizations can use the proposed research model, “Influence = Behaviors = Benefits”, to understand and manage their corporate social responsibility activities, build appropriate supporting programs, and achieve similarly successful outcomes.Running head: SOCIAL RESPONSIBILITY IN HEALTHCARE 1 The Effects of External Factors on Corporate Social Responsibility Behaviors in Healthcare Organizations: Responses and Outcomes By: Faustina Dalaba-Roohi Dissertation submitted to the Faculty of the Graduate School of Management of the University of Maryland University College in partial fulfillment of the requirements for the degree of Doctor of Management Submitted to: Dr. G. David Andersen, Ed.D. and Dr. Eric Dent, Ph.D April 11, 2013SOCIAL RESPONSIBILITY IN HEALTHCARE 2 Abstract To understand corporate social responsibility behaviors and their management in healthcare organizations, the evidence-based research approach was utilized to identify the external factors that influence such behaviors to determine which behaviors are needed to respond most effectively to those factors and to analyze the outcomes of those behaviors. Review and analysis of the literature showed that external factors influencing healthcare organizations’ corporate social responsibility behaviors include government and industry regulation, community expectations, economic crisis, and media awareness. Research also showed that necessary responses by healthcare organizations to these influences include regulatory compliance, responsiveness to stakeholders, ethical practices, and effective communications. Finally, the findings showed that corporate social responsibility behaviors lead to success by healthcare organizations in establishing and maintaining needed partnerships, access to capital, positive recognition, and improved community relations. These benefits indicate that, for stakeholders in healthcare organizations, corporate social responsibility is both the “right thing” as well as the “smart thing” to do. Individual healthcare organizations can use the proposed research model, “Influence = Behaviors = Benefits”, to understand and manage their corporate social responsibility activities, build appropriate supporting programs, and achieve similarly successful outcomes. Keywords: corporate social responsibility, healthcare organizations, stakeholdersSOCIAL RESPONSIBILITY IN HEALTHCARE 3 Dedication This dissertation is dedicated to my husband and best friend, Behzad Roohi for his unconditional love and support. SOCIAL RESPONSIBILITY IN HEALTHCARE 4 Acknowledgements Special thanks to Dr. G. David Andersen, EdD and Dr. Eric Dent, PhD for their knowledge, commitment, and patience. Dr. G. David Andersen was the primary advisor to this researcher. He was a perfect fit for this role because he is the embodiment of the type of scholar that the University of Maryland University College (UMUC) Doctor of Management (DM) program is striving to develop— expert practitioner-scholars who are credible consumers and producers of management research. Dr. Andersen is an outstanding practitioner-scholar who has a wealth of experience in teaching and consulting at UMUC and at the learning center of the Government Accountability Office. Dr. Andersen’s guidance, prompt and constructive feedback has been priceless to this researcher. Special thanks to Dr. Robert Bromber; Dr. Subash Bijlani, Dr Leonard Vernick, Dr. Anthony Sterns, Dr. James Brown and Dr. John Sherlock for their patience, guidance, and for helping me develop my doctoral competences in preparation for this laudable achievement. I also want to thank Dr. Antonio Vives, Dr. Mark Addleson, and Dr. David Zoogah, who agreed to serve as Subject Matter Experts for my dissertation. Their insight and comments on the first two chapters helped to further direct the focus of the dissertation. Dr. Vives, Dr. Addleson , and Dr. Zoogah's contribution to the overall quality of the dissertation is invaluable. To members of my cohort: Mark De Jong, Jack Wayne Hawkins, Jeffrey Lewis Hillard, Edward Jenkins, Dayo Oyeleye, and William Rebarick, I say thank you for your support. We have accomplished something incredible and I am grateful to have had you with me through this journey.SOCIAL RESPONSIBILITY IN HEALTHCARE 5 To my in-laws, Homa Roohi, Behnam Roohi, Becky Roohi, Behyar Roohi and Sita Roohi thank you for believing in me with your sincere kindness and generosity. I am most grateful. The final thanks go to Dr. Dominic Ayine for his kindness and being supportive of my studies. SOCIAL RESPONSIBILITY IN HEALTHCARE 6 Table of Contents Abstract .......................................................................................................................................... 2 Dedication...................................................................................................................................... 3 Acknowledgements........................................................................................................................ 4 Table of Contents........................................................................................................................... 6 LIST OF FIGURES ...................................................................................................................... 11 LIST OF TABLES........................................................................................................................ 11 CHAPTER 1 ................................................................................................................................ 12 INTRODUCTION .................................................................................................................... 12 Purpose of the Study ................................................................................................................. 17 Statement and Significance of Problem.................................................................................... 18 Importance of the Study to Management and Academics .................................................... 22 Research Questions................................................................................................................... 23 Definition of Terms................................................................................................................... 23 Organization of the dissertation................................................................................................ 25 CHAPTER 2 ................................................................................................................................ 26 LITERATURE REVIEW............................................................................................................. 26 Introduction.............................................................................................................................. 26 Historical Development of Corporate Social Responsibility.................................................... 26 The Pre-1950s ....................................................................................................................... 26 The 1960s to the 1980s ......................................................................................................... 29 The 1990s to Present............................................................................................................. 31 Defining Corporate Social Responsibility ................................................................................ 32 Theoretical Foundations............................................................................................................ 33 SOCIAL RESPONSIBILITY IN HEALTHCARE 7 Social Theory........................................................................................................................ 33 Stakeholder Theory............................................................................................................... 34 Ethical Theory....................................................................................................................... 34 Stewardship Theory .............................................................................................................. 35 Corporate Social Responsibility in Healthcare Organizations.................................................. 36 External Factors Influencing Corporate Social Responsibility Behaviors in Healthcare Organizations ............................................................................................................................ 38 Government and Industry Regulation................................................................................... 38 Economic Crisis .................................................................................................................... 42 Community Expectations...................................................................................................... 42 Media Awareness.................................................................................................................. 43 Responsive Corporate Social Responsibility Behaviors by Healthcare Organizations............ 44 Regulatory Compliance ........................................................................................................ 44 Ethical Practices.................................................................................................................... 46 Responsiveness to Stakeholders ........................................................................................... 47 Effective Communication ..................................................................................................... 49 Outcomes of Healthcare Organizations’ Responsive Corporate Social Responsibility Behaviors ................................................................................................................................. 51 Needed Partnerships.............................................................................................................. 51 Increased Access to Capital .................................................................................................. 53 Positive Recognition ............................................................................................................. 54 Improved Community Relations........................................................................................... 55 SUMMARY............................................................................................................................. 57 CHAPTER 3 ................................................................................................................................ 58 CONCEPTUAL FRAMEWORK................................................................................................. 58 SOCIAL RESPONSIBILITY IN HEALTHCARE 8 Introduction to Conceptual Framework .................................................................................... 58 The Message in the Literature Review ..................................................................................... 58 The Conceptual Framework...................................................................................................... 61 External Factors Influencing CSR Behaviors in Healthcare..................................................... 61 Government and industry regulations................................................................................... 62 Economic crisis..................................................................................................................... 63 Community expectations. ..................................................................................................... 63 Media awareness................................................................................................................... 64 Needed and Effective CSR Behaviors ...................................................................................... 64 Compliance to regulations. ................................................................................................... 65 Responsiveness to stakeholders. ........................................................................................... 66 Effective communication. ..................................................................................................... 66 Ethical behavior. ................................................................................................................... 67 Outcomes of CSR Behavior in Healthcare ............................................................................... 68 Needed partnerships.............................................................................................................. 68 Increased access to capital. ................................................................................................... 69 Positive recognition. ............................................................................................................. 70 Improved community relations. ............................................................................................ 70 The Conceptual Framework...................................................................................................... 71 SUMMARY............................................................................................................................. 72 CHAPTER 4 ................................................................................................................................ 74 METHODOLOGY ....................................................................................................................... 74 Introduction to Methodology .................................................................................................... 74 Discussion of Evidence-Based Research and Methodology..................................................... 74 SOCIAL RESPONSIBILITY IN HEALTHCARE 9 Methodology Process................................................................................................................ 78 Personal Assessment Tool (PAT) ............................................................................................. 81 Subject Matter Experts Process and Selection.......................................................................... 84 Expert Panel Feedback.......................................................................................................... 85 Panel Members’ Contribution............................................................................................... 88 SUMMARY............................................................................................................................. 89 CHAPTER 5 ................................................................................................................................ 91 ANALYSIS AND DISCUSSION OF FINDINGS....................................................................... 91 Introduction.............................................................................................................................. 91 Purpose of the Study ................................................................................................................. 91 Presentation and Analysis of Findings...................................................................................... 92 Introduction: The Recap ....................................................................................................... 92 Research Question #1. Why does the HC industry embrace CSR in their community? .......... 93 Findings #1............................................................................................................................ 93 Findings # 2........................................................................................................................... 94 Findings # 3........................................................................................................................... 96 Findings # 4........................................................................................................................... 98 Research Question # 2. How do HC organizations successfully respond with CSR behaviors to serve the community? ............................................................................................................... 99 Findings # 1........................................................................................................................... 99 Findings # 2......................................................................................................................... 100 Finding # 3. ......................................................................................................................... 100 Findings # 4......................................................................................................................... 102 Research Question # 3. What are the outcomes of CSR behaviors in HC?............................ 103 Findings # 1......................................................................................................................... 103 SOCIAL RESPONSIBILITY IN HEALTHCARE 10 Findings # 2......................................................................................................................... 105 Findings # 3......................................................................................................................... 106 Findings # 4......................................................................................................................... 107 CONCLUSIONS.................................................................................................................... 108 ALTERNATIVE PERSPECTIVES........................................................................................ 112 SUMMARY........................................................................................................................... 114 CHAPTER 6 ............................................................................................................................... 115 CONCLUSIONS, IMPLICATIONS, AND RECOMMENDATIONS FOR FUTURE RESEARCH............................................................................................................................... 115 Introduction............................................................................................................................ 115 Overall Conclusions................................................................................................................ 116 CONCLUSION: Pressure from External Factors Compel the HC Industry to Embrace CSR117 CONCLUSION: The HC industry uses CSR to successfully respond to their communities. 119 CONCLUSION: There are several desired outcomes to engaging in CSR behaviors in HC. 120 Implications for Management ................................................................................................. 121 Implication of Trends.............................................................................................................. 123 Limitations of Study ............................................................................................................... 125 Areas for Future Research ...................................................................................................... 125 SUMMARY........................................................................................................................... 126 References.............................................................................................................................. 128 Appendices................................................................................................................................. 152 Appendix 1: Invitation to Participate on Expert Panel .......................................................... 152 Appendix 2: Email Template .................................................................................................. 154 Appendix 3: Detailed Feedback from Dr. Antonio Vives ...................................................... 155 Appendix 4: Detailed Feedback from Dr. Mark Addleson.................................................... 157 SOCIAL RESPONSIBILITY IN HEALTHCARE 11 Appendix 5: Detailed Feedback from Dr. David Zoogah.....................................................