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Costello College of Business health care research puts “patients at the center”

Jennifer Anzaldi — Tue, 11 Mar 2025 15:55:18 +0000

Costello College of Business health care research puts “patients at the center” Jennifer Anzaldi Tue, 03/11/2025 - 11:55

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Nirup Menon

Like virtually every other industry, health care is increasingly prioritizing digital transformation. The sector is unique, however, in that its results are measured not only in business terms but also tangible outcomes for people—often, literal life and death. So are newly acquired technologies actually paying off for patients?

Nirup Menon, a professor of information systems at the Donald G. Costello College of Business at �鶹��Ƶ, says that the answer is “not always.”

Nirup Menon

His recently published paper in Decision Support Systems tackles the so-called “HIT paradox,” or the widespread perception that health information technologies (HIT) have not yet moved the needle on important outcomes such as productivity, quality of care, and patient safety.

Menon co-authored the paper with Costello colleagues Amitava Dutta and Sidhartha Das.

Based on comprehensive survey data from approximately 6,000 U.S. hospitals, the research team looked into whether those that adopted Clinical Decision Support Systems (CDSS) saw lower mortality rates for cardiac patients.

“CDSS is not only for cardiologists,” Menon explains. “It is hospital-based—a system that helps with clinical decision-making. But we know that many cardiac patients may not necessarily have cardiac as their only problem. There are probably decisions being made about them using all kinds of ailments and medications, and so on.”

The basic idea behind CDSS is to use technology to mine actionable insights from a wealth of patient data, giving clinicians key tools to make informed decisions at the point of care. Theoretically, a hospital with CDSS solutions should be much better equipped to handle complex cases—such as a heart-attack sufferer with diabetes or another comorbidity—in real time than one without.

However, Menon and his co-authors discovered that when it came to preventing deaths from cardiac emergencies, the impact of CDSS was context-specific. Their paper finds a number of complementary effects suggesting that health care technologies need help from their environment in order to be most effective. For example, the presence of cardiac medical services (CMS), e.g. diagnostic catheterization and electrophysiology, was unsurprisingly associated with lower mortality rates—but CMS combined with CDSS was more impactful than either on its own.

“The labor force—by which I mean the physician and the entire team of nurses and technicians—should be trained to use this technology appropriately,” Menon summarizes. “You also need real-time integration between CDSS and other IT systems, because if it’s not well-integrated, the provider will not have all the data at their fingertips. If you don’t provide the right inputs into a CDSS, it’s not going to give you the right outputs.”

Menon points out that the “HIT paradox” isn’t limited to CDSS or any single technology. President Obama’s 2009 economic stimulus package, after all, included tens of billions in financial incentives for health care providers to digitize their patient records. By 2017, 95 percent of U.S. hospitals had adopted electronic patient records. Yet, as Menon tells it, “hospitals are just chugging along. The quality remains the same and the costs are just increasing. Or you might see improvements in one small department. So we are trying to find the variables that create complementarities within large samples.”

Menon knows, however, that the applications of health care tech can be closely targeted to relatively tiny patient populations, too. Another recent paper of his, published in JMIR Medical Informatics, uses causal survival forests, a machine-learning algorithmic technique, to determine which of two chemotherapy drugs promoted the most longevity for terminal prostate cancer patients. Taking into account age, race and comorbidity symptoms, their analysis produced an easy-to-use prescription policy tree that, by itself, could extend patients’ lives by almost two months—if the test sample, comprised of 2,886 veterans treated at VA health centers, was representative of the wider patient population.

“If you go down every branch of the policy tree, the numbers become very small,” Menon says. “It almost becomes like personalized medicine, because you can factor in age, race, gender—although gender didn’t matter in our study—PSA numbers, bilirubin numbers, etc.”

Menon has ongoing research projects aimed at improving health care through technology, at both the patient level (a la the prostate cancer study) and the ecosystem level (a la the CDSS study). One paper in progress focuses on Covid-19 and how the data-sets research scientists selected for their studies influenced their findings. Another looks at telemedicine’s effects on quality of care.

“My foray into health care began with my PhD dissertation, which was on IT in hospitals,” Menon says. “At that time, I was working primarily from a hospital administration point of view. As a business school researcher, it seemed logical to stay there. But as you come across more problems, and you read more, you realize that the patient is the center of everything, not the hospital.”

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George �鶹��Ƶ professor furthers impact of telemedicine in Ukraine

Jennifer Anzaldi — Tue, 14 Jan 2025 22:39:16 +0000

George �鶹��Ƶ professor furthers impact of telemedicine in Ukraine Jennifer Anzaldi Tue, 01/14/2025 - 17:39

Ukraine’s health care system has been hit hard amid the ongoing war. Power outages, staffing shortages, and the destruction of hospitals have added up to a drastic reduction in available care for the already-vulnerable population. In a desperate attempt to bridge the gap, Ukraine’s Ministry of Health opened the country to telehealth solutions from overseas. But will these prove to be a successful substitute for at least some necessary services, or turn out to be no better than a tech Band-Aid?

Answering that question is where Mariia Petryk, assistant professor of information systems and operations management at the Costello College of Business at �鶹��Ƶ, comes in. In her spare time, she works as volunteer director of analytics for TeleHelp Ukraine (THU).

Mariia Petryk

Founded by a cross-disciplinary group of Stanford students shortly after the war’s inception, THU was designed to succeed where other telemedicine initiatives in crisis-affected areas have failed. The founders worked tirelessly to assemble an international volunteer network comprising medical professionals, translators, interpreters and administrative “health navigators.” Aware that medical consultations were only part of the patient journey, THU’s founders sought to address the entire continuum of care.

Petryk stresses that while the project originated at Stanford, the technical team included “people from Chicago, Boston, other California schools…some very active volunteers were in Australia, South Korea, Canada and other countries.”

Petryk, herself of Ukrainian descent, was honored to lend her data science expertise to this worthy project. As analytics director, she manages a dozen or so number-crunching volunteers who measured and documented THU’s impact upon Ukraine’s displaced population during the initiative’s first full year.

As Petryk explains, “The Russian invasion created a humanitarian crisis where a lot of people were internally displaced. And when people relocate to a new place, they don’t know where to go for health care. They also are at higher risk for many issues, including mental health problems. And they don’t know where to turn to treat chronic diseases they may have.”

THU’s primary focus during its first year was delivering much-needed services to this population of war-ravaged internal exiles.

Petryk’s analytical work gave rise to a recent case study of THU published in Journal of Global Health. The paper’s other lead author was Aditya Narayan, a Stanford medical student and THU’s director of implementation and evaluation.

Their findings describe some impressive early successes. THU facilitated more than 1,200 virtual patient appointments from May 2022 to May 2023 alone. Despite often-chaotic conditions, patient attendance rates were above 70 percent for nine of the 13 months studied. As the first year wore on, the THU team found ways to prevent no-shows—for example, employing the popular texting platform Viber to communicate with patients and assigning an individual health navigator to each patient.

Even more impressively, 96 percent of patients reported that their health complaints were at least partially resolved during their visit.

The paper argues that aspects of THU’s model could be adapted for use in other humanitarian contexts. In its initial growth phase, THU had access to advanced technological infrastructure and a wide network of medical providers, by dint of its academic origins. This implies that partnerships with academia could be critical to replicating THU’s success outside Ukraine.

Petryk remains proud of THU’s impact and her role in helping define it. “Based on actual appointments and how much that amount of care would cost at a hospital, THU delivered an estimated $1 million worth of services in its first 13 months,” she says.

Looking ahead to THU’s future, she says, “I can only wish to see this ‘start-up,’ as it were, go for the IPO.”

For more information and to explore volunteering opportunities, visit THU’s website.

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When CEOs are haunted by memories of past recessions

Jennifer Anzaldi — Tue, 12 Nov 2024 19:43:41 +0000

When CEOs are haunted by memories of past recessions Jennifer Anzaldi Tue, 11/12/2024 - 14:43

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David S. Koo

The economy, we’re often reminded, is cyclical. But we all hope our careers won’t be. That means those of us who make it to the very top—CEOs, for instance—may be unduly influenced by memories of prior economic go-rounds. David Koo, assistant professor of accounting in the Donald G. Costello College of Business at �鶹��Ƶ, has found that memories of past recessions, triggered by recent ones, can weigh on chief executives’ decisions, literally for years.

Koo’s paper, co-authored by Isabel Wang of Michigan State University and Shuting Wu of Cal State Fullerton, is forthcoming in Management Science.

David Koo

The paper was inspired by trends in research outside the accounting field. “In the economics area, they have started looking at how executives’ memories of recessions can affect important decision-making right now,” Koo says. “We are trying to connect these emerging trends to the accounting area by focusing on pessimistic bias in their outlook of the company’s performance.”

The researchers adopted the 2008 financial crisis as a key moment for triggering veteran CEOs’ memories of prior financial downturns. They analyzed annual management earnings forecasts for U.S. public companies for the period 2002-2018, alongside the characteristics and career histories of the CEOs who issued them. “We used the first forecast of the year for each year, because on average these are more optimistic,” Koo explains. “Usually, nobody wants to say anything negative at the beginning of a year.” The final data-set comprised 3,678 earnings forecasts from 466 CEOs.

Koo and his co-authors discovered that CEOs who had previously led companies through at least one past recession issued significantly more pessimistic forecasts post-2008 than they had before the crisis. As a general rule, the more recessions a CEO had undergone in their tenure at the top, the more pessimistic their post-crisis forecasts tended to be.

The same pessimistic pattern was not evident for CEOs who had not experienced a recession before 2008. Translating their findings into economic terms, the researchers concluded that one standard deviation of the memory-triggered pessimism effect was equivalent to 0.23-0.29 percent of share price.

Further, the post-crisis pessimism did not make the forecasts more accurate. It’s safe to say, then, that the memory-triggered CEOs were, knowingly or not, displaying excessive caution and conservatism in their earnings forecasts. To be sure, anyone’s outlook can darken with age, independent of their real-world experience. So the researchers performed subsequent checks to determine whether the increased pessimism was more closely related to growing older, or to specific memories of past recessions.

“Our takeaway is, if we have two same-age CEOs, one who has experience navigating recessions as a CEO and one who does not, the first one will become more pessimistic after the crisis,” Koo says.

The more highly skilled CEOs (as measured by a widely accepted scale for managerial ability) exhibited less memory-induced pessimism, while CEOs who led more complex firms with a lot of moving parts were more prone to pessimism. “We expected that the manager-specific effect would be more significant when managers were under more demanding pressure or had more discretion,” Koo explains.

As the 2008 financial crisis itself faded into memory, seasoned CEOs gradually let go of their pessimistic bias. But it took three years, on average, for their forecasts to fully recover. We normally think of past experience as an aid to learning, but here it seems that the opposite was the case: Memories of past experiences with recessions slowed down CEOs’ post-crisis learning process.

“Prior research has found that past experiences can help people more rationally and then more wisely handle an ongoing crisis,” Koo says. “But at the same time, executives are also human beings. They may be scarred by their experiences and that can induce them to be excessively negative or pessimistic when they go through a financial crisis.”

Of course, that doesn’t mean that the veteran CEOs were less effective at guiding their firms through post-crisis recovery. Koo emphasizes that his findings do not capture whether, and how quickly, companies bounced back from the 2008 recession.

“Memory may not be the most dominant factor in our decision-making, but it still can influence executives even in their managerial decision-making,” Koo advises.

The lesson, then, is one for investors and other market players to store in their own memories for the next economic downturn: Take CEOs’ post-crisis predictions with at least a grain of salt.

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The work-from-home blues have a secret source: nostalgia

Jennifer Anzaldi — Thu, 19 Sep 2024 14:25:23 +0000

The work-from-home blues have a secret source: nostalgia Jennifer Anzaldi Thu, 09/19/2024 - 10:25

For at least two years, CEOs have been trying to bring employees back to the office, citing remote work’s supposed negative effects on productivity, morale, and creative collaboration. Managers, we’re told, are having a hard time monitoring and motivating dispersed teams. But what if bringing employees back to the office won’t put the genie back in the bottle?

Kevin Rockmann, professor of management at the Donald G. Costello College of Business at �鶹��Ƶ, argues that the furor over remote work masks deeper cultural issues at play in many organizations. This cultural malaise has employees pining for an imagined past where they felt grounded and connected with their colleagues. In short, remote workers aren’t unmanageable—they’re suffering from pangs of nostalgia.

Kevin Rockmann

Rockmann’s recently published research paper in Journal of Management (co-authored by Jessica Methot of Rutgers University and Emily Rosado-Solomon of Babson University) documents the results of surveys conducted during the height of Covid (September 2020). The thrice-daily surveys were delivered over a two-week period to 110 full-time professionals. Respondents were asked to report on their feelings of nostalgia, as well as emotional coping strategies, task performance, and counterproductive work behaviors (e.g. withholding support from colleagues and stealing time from their employer).

The overwhelming majority of participants (98 out of 110) admitted to experiencing nostalgia for life before Covid. And these feelings could have either positive or negative outcomes, depending on how the respondents dealt with them. Rockmann points to two pathways that showed up across the surveys as a whole, which he labels “approach” and “avoid.”

One way respondents reacted to nostalgia was to use so-called “cognitive change” strategies, which help regulate emotions through shifts in perspective. For example, someone feeling sad about being trapped at home during the pandemic could think to themselves, “It could be so much worse. At least I don’t have Covid like so many others.” These strategies seemed to evoke empathetic responses, leading the survey participants to reach out to colleagues to check in or offer assistance.

Equally prevalent in Rockmann’s results, however, was a much darker pathway. Instead of reaching out to others in response to nostalgia, respondents tended to turn inward in an attempt to minimize the emotional discomfort. Psychological researchers call this sort of reaction “attentional deployment.” “It’s a defense mechanism whereby you don’t feel you have the means to really connect with others, so you leverage your attention away from the source of pain,” Rockmann explains. This pathway led to incidents of “acting out”—the above-mentioned counterproductive work behaviors.

Rockmann says these Covid-era findings remain relevant for at least two reasons. First, survey respondents’ written comments sound like they could have been written yesterday, rather than four years ago. Common nostalgic themes revolved around co-workers, the structure of co-located work, etc.—all oft-heard plaints of remote workers in 2024. Second, the normalization of remote work well predated Covid—as Rockmann’s past research on the topic has documented. Covid accelerated an inevitable transition that was already well underway. Therefore, workers of a certain age would likely be feeling some nostalgia, even if there had never been a Covid pandemic.

“While return-to-office may make sense for some companies, I would emphasize that nostalgia cannot be fixed that way. Nostalgia is about longing for the past—or, more accurately, longing for a return to how we remember the past, usually through rose-colored lenses.”

How can organizations help employees conquer nostalgia, or at least encourage healthier ways of coping with nostalgia? The obvious answer might be what CEOs are trying to do—end remote work altogether. “While return-to-office may make sense for some companies, I would emphasize that nostalgia cannot be fixed that way. Nostalgia is about longing for the past—or, more accurately, longing for a return to how we remember the past, usually through rose-colored lenses,” Rockmann says.

Any political demagogue will tell you that people are most susceptible to nostalgia when they feel isolated and afraid. The fact that nostalgia is so widespread in today’s workplace would seem to confirm Rockmann’s past research showing how organizational cultures fail to promote positive relationships among employees.

Combating the nostalgia epidemic will require a cultural reset for many organizations. “Managers will need to engage much more closely with employees, asking sensitive questions (e.g. “What do you miss about working here before Covid?”) and co-creating individualized solutions to help employees fully adjust to the major changes in their working environment,” Rockmann says.

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When expressing gratitude, it’s all in the timing

Jennifer Anzaldi — Wed, 04 Sep 2024 14:42:32 +0000

When expressing gratitude, it’s all in the timing Jennifer Anzaldi Wed, 09/04/2024 - 10:42

Thanks so much for reading this article all the way to the end! No, that wasn’t an editorial error. It’s a savvy managerial motivation strategy lurking somewhere in almost every employee’s inbox or Slack channel.

Mandy O’Neill, an associate professor of management at the Donald G. Costello College of Business at �鶹��Ƶ, has discovered a potential new addition to the annals of managerial motivation techniques: anticipatory gratitude.

Mandy O'Neill

We all know that thanking people for a job well-done, or a much-needed favor, is an effective form of positive reinforcement. Psychology researchers classify gratitude as a “socially engaging emotion” that promotes prosocial behavior and strong interpersonal relationships. In the course of exploring how employees cope with high-stress or frustrating work situations, O’Neill and her co-author Hooria Jazaieri of Santa Clara University discovered an interesting wrinkle in what we thought we knew about this popular emotion: Gratitude can be used as a form of emotion regulation and, when expressed ahead of time instead of after the fact, can produce that extra “oomph” when it comes to employee resilience and persistence.

Their paper is in press at Academy of Management Discoveries.

The researchers stumbled upon the power of anticipatory gratitude while researching organizational culture and change within the intensive care units of a leading U.S. hospital. It’s difficult to imagine a more gut-wrenching, high-stakes work environment: The ICU units in question receive what one employee called “the sickest of the sickest” from throughout the region. To decompress and process their emotions after especially difficult shifts, employees routinely emailed the group using an internal listserv. O’Neill and Jazaieri were forwarded four years’ worth of messages, which they analyzed with the help of direct experience gained from extensive site visits to the hospital.

In addition to writing heartfelt outpourings of post facto gratitude, ICU colleagues thanked one another for rising to occasions that had not yet occurred. Some of these emails were pre-emptively apologetic (“I may have to take a day or two off from time to time…Thank you for your patience and understanding”). Others seemed to function as pep talks, inspiring teams to keep up the good work (“Thank you…for bringing your a-game to work every day”).

As O’Neill describes it, “The ‘thanks in advance’ phenomenon involves an awareness that you’re going to be annoyed or upset by what I’m asking you to do, so I infuse you with the positivity of that feeling you get when someone expresses gratitude to you. Think about it as an emotional buffer. It helps with the inevitable distress of the task that’s going to happen later. It makes those negative emotions less salient, less powerful, and less insidious.”

The researchers launched several follow-up studies to learn more about the effects of anticipatory gratitude. They chose a context—Amazon’s Mechanical Turk (MTurk) gig-work platform—that was in many ways the polar opposite of the ICU. “You go from the ultimate interdependent work environment to the ultimate transactional work environment,” O’Neill explains.

“The ‘thanks in advance’ phenomenon involves an awareness that you’re going to be annoyed or upset by what I’m asking you to do, so I infuse you with the positivity of that feeling you get when someone expresses gratitude to you. Think about it as an emotional buffer."

The MTurk workers were assigned to solve extremely difficult puzzles. After completing the paid task, they received negative feedback about their performance and were offered the opportunity to do additional puzzles without being paid. MTurkers who had seen a message of gratitude before the main task voluntarily took on significantly more unpaid work than those who received a similar message after the paid exercise.

“What’s so compelling and surprising for us is that anyone who does work with experienced online gig worker populations knows it’s nearly impossible to induce workers to go beyond their assignment, even by 30 extra seconds, which is about what we were asking for,” O’Neill says.

Questionnaires administered during the study revealed that anticipatory gratitude enhanced feelings of communal self-worth, which contributed to the participant’s resilience, that is, their ability to “bounce back” after the initial failure. In a third study, the researchers found anticipatory gratitude was better than a related positive affect—anticipatory hope—at motivating MTurkers to persevere at (i.e., spend more time on) a different set of challenging puzzles.

At this point, the potential for managerial manipulation should be crystal clear. Indeed, it was evident even to some of the gig workers, who wrote private messages such as, “It may be partial trickery for academic purposes but it was still nice to hear.”

"Gratitude can’t be a substitute for fair pay and decent work conditions...But our findings are clear: anticipatory gratitude works; it is effective.”

For O’Neill, these findings show that gratitude is more complicated than we previously thought. “This paper is one of the very few to show that gratitude isn’t always authentic and prosocial. It can be used strategically, especially for managers,” she says.

Sincerity and strategy are not mutually exclusive. Empathic managers whose feelings of gratitude are so strong that they have to be expressed beforehand could still be taking advantage of the “thanks in advance” phenomenon.

“In all organizations, you need people to stick with difficult or thankless or boring tasks. The challenge, of course, is how to do so ethically. Gratitude can’t be a substitute for fair pay and decent work conditions, for example. But our findings are clear: anticipatory gratitude works; it is effective,” O’Neill says.

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Defuse anger in the workplace with humor, �鶹��Ƶ expert says

Colleen Rich — Fri, 28 Apr 2023 15:10:05 +0000

Defuse anger in the workplace with humor, �鶹��Ƶ expert says Colleen Rich Fri, 04/28/2023 - 11:10

Whether it is pressing deadlines, overwork, or employees feeling they are not being supported, anger in a work environment can be unavoidable. Over time, the anger and frustration can compound, causing anger to spread through the entire team or organization, creating what �鶹��Ƶ expert Mandy O’Neill calls a “culture of anger.”

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In her research, O’Neill, an associate professor of management at �鶹��Ƶ’s School of Business, found that a culture of anger not only leads to problems for individuals, such as increased alcohol consumption, work-family conflict, and high-risk behaviors, but it also presents problems for teams as a whole.

In a study of a large retail organization, O’Neill found that employee anger stemmed from a culture in which employees did not feel supported by their managers, leading to more employee absences and higher turnover. Additionally, individual high-risk behaviors can lead to a decrease in workplace safety as a whole, including safety violations, accidents, and injuries.

Mandy O'Neill. Photo by Creative Services

Recognizing a culture of anger

O’Neill explains that when dealing with anger in a team environment, whether it’s a workplace, group project, or sports team, it’s important to draw a line between a team experiencing occasional anger and a team defined by a culture of anger.

“All emotions have a social functional purpose,” said O’Neill. “Anger can serve important purposes around, for example, moral outrage against social injustice, or action tendencies that cause a person to rise up against obstacles thrown in their way.”

However, in a culture of anger, “it's not just one incident, one time that made everybody angry. Rather, it's when anger is kind of everybody’s default emotion,” O’Neill said.

Dos and don’ts

O’Neill highlights two common methods of fighting anger that can actually make matters worse. “Emotion suppression, which is essentially to put the lid on an emotion and not let it be expressed, is very destructive,” said O’Neill. “Even if you think you're not expressing [anger], it leaks out in ways that you may not necessarily be aware of or able to control.”

Additionally, O’Neill found that allowing members of a team to vent their anger without restraint can serve to intensify the anger. Paradoxically, venting can reactivate and spread anger rather than resolving or calming the feeling.

So, what can be done to help improve an angry team culture?

Through interviewing emergency responders at fire stations in the southeastern United States, O’Neill found that the most effective teams were those who supplemented feelings of anger with joviality.

“Expression of joviality and humor is a way of channeling anger in ways that actually can promote group bonding,” said O’Neill.

She also found that companionate love, "the connection felt between people whose lives are closely intertwined,” also helps fight anger. Affection and caring, for example, creates a sense of familiarity between members of a team that helps to resolve issues, and can make a jovial culture easier to foster as members of the team know how and when to use humor without going too far.

O’Neill believes that introducing joviality and companionate love to a team can help team members work with anger to turn it into a positive, productive emotion. “Anger paired with positive emotions lends itself to a very different scenario than if you have anger without these emotions,” she said.

O'Neill is actively engaged in organizational research, employing both quantitative and qualitative methods to the study of employees and organizational units. She has worked with organizations across a wide range of industries including health care, technology, emergency services, and retail.

To reach Mandy O’Neill directly, contact her at ooneill@gmu.edu.

For more information, contact Benjamin Kessler at bkessler@gmu.edu.

�鶹��Ƶ �鶹��Ƶ

�鶹��Ƶ is Virginia’s largest public research university. Located near Washington, D.C., �鶹��Ƶ enrolls nearly 40,000 students from 130 countries and all 50 states. �鶹��Ƶ has grown rapidly over the last half-century and is recognized for its innovation and entrepreneurship, remarkable diversity, and commitment to accessibility. In 2023, the university launched �鶹��Ƶ Now: Power the Possible, a $1 billion comprehensive campaign to support student success, research, innovation, community, and sustainability. Learn more at www.gmu.edu.

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

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

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

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

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

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

Seb Demirkan

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

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

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

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

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

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

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

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

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An 'ethics of care' for journalists covering mass shootings

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

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

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Ashley Yuckenberg

Ashley Yuckenberg

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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At the frontiers of public health

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

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

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Ajay Vinzé

Dean Ajay Vinzé

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

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

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

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

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

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

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

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

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

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

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

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