Template for a 48”x36” poster Environmental Sense Making in the Hospice Care Industry: Strategic Groups and Outcomes Eric G. Kirby, Ph.D. Professor of Management, McCoy College of Business Administration, Texas State University Abstract   Purpose As a result of a drastic increase in new patients, two major shifts are occurring in the U.S. hospice care industry: (1) an increase in the number of for-profit provider, and (2) hospices are increasing in size through acquisitions and mergers. Hospices are trying to both increase the number of innovative programs they offer and decrease their operating expenses to improve their margins and attract more patients. This study seeks to investigate if strategic groups exist within the industry as hospices try to become more innovative and efficient, which grouping factors are most significant, and if there is a relationship between group membership and performance. Design/Methodology/Approach Cluster analysis and ANOVA are used to analyze data from 93 California hospices. Findings Three strategic groups exist within the market, innovative practices significantly affect group membership, and innovation-oriented groups outperform others in terms of quality of care. Practice Implications Many hospices focus on innovation, and evidence suggests that continued pursuit of innovative practices is critical, whereas efficiency does not appear to have a significant impact on quality of care. Focus on such evidence-based practices is important of long-term success. Originality/Value This is the first study to investigate strategic group formation in the hospice care industry. Availability This study was originally published as: Kirby, E. G. 2012. Strategic groups and outcomes in the U.S. hospice care industry. Journal of Health Organization and Management, 26(5): 641-654. It was selected as an “Emerald Gem” best paper by Emerald Publishing and reprinted in: New Perspectives in Health Care: Impacts of Regulation, Organization, Reform and Change in the United States Health System, Emerald Group Publishing Ltd: London, UK, 2015, pp 135-150. Introduction and Methods Trends Rapid growth in marketplace Consolidation Increase in percentage of market controlled by for-profits Increased competitive pressures Research Questions Are all hospices pursuing the same responses to prevailing industry trends? Are there different strategic groupings within the industry based on the pursuit of innovation and efficiency? If these groups exist, do differences in performance (quality of care) exist between groups?    Measures Data from 93 of 172 California hospices Measures of efficient business practices Measures of innovative business practices Measures of program characteristics Measures of financial and quality-of-care performance  Methods Cluster analysis ANOVA Other Studies in Research Stream Innovation and Efficiency Hospice care organizations have responded to changing environmental pressures by pursuing more efficient and innovative business practices. Drawing upon institutional theory, this study addressed whether quality of care provided to hospice patients is affected as organizations respond to environmental pressures for innovative and efficient business practices. Using hierarchical regression to analyze data from 111 hospices, this study found that innovative practices were positively related to quality of care. However, efficient practices had no significant relationship with quality of care. Published as Kirby, E. G., Keeffe, M. K., & Nicols, K. M. 2007. A study of the effects of innovative and efficient practices on the performance of hospice care organizations. Health Care Management Review, 32(4): 352-359. Employee Turnover To reduce the significant risk of employee turnover, hospice care organizations have responded to increased competitive pressures. Does the use of patient-centered approaches to meeting client needs reduce turnover in the nursing staff? Using hierarchical regression to analyze organizational, market, and personnel data from 695 hospices across the United States, this study found PCC practices were significantly related to reduced nursing turnover. Published as Kirby, E. G. In press. Patient centered care and turnover in hospice care organizations. Journal of Health and Human Services Administration. Sustainability A growing concern is the importance of sustainable business practices, defined as balancing economic, environmental and social concerns. While interviewing hospice care administrators during my last developmental leave, I found that none of them were engaged in significant sustainability efforts. With developmental leave in Fall 2017, I will follow up with interviews of hospice administrators to better understand their thoughts and actions towards sustainable business practices. I am interested in exploring what pressures they perceive their organizations are facing now, and how their organizations are responding. . Results . .