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Universal Wellness Network: a study of a promising practice

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Universal Wellness Network: a study of a promising practice

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Content Running head: UNIVERSAL WELLNESS NETWORK 1

UNIVERSAL WELLNESS NETWORK: A STUDY OF A PROMISING PRACTICE
by
Erik W. Hollander

A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION

May, 2020

Copyright 2020 Erik W. Hollander

UNIVERSAL WELLNESS NETWORK 2
ACKNOWLEDGEMENTS
So here we are at the conclusion of my formal educational journey and a place I was not
always quite sure I would find myself. A doctorate leading to the suffix of Doctor. Something
about those words that brings about respect to a profession to some yet bring about a weight of
emotion for all of the trials and tribulations one must encounter on this type of journey. We can
reflect back and appreciate the personal commitment, sacrifices, emotions, persistence,
endurance, and desire to cross the finish line. However, none of this effort would have been
possible without the dear and deserved acknowledgement of those who helped get me to this
point:
To Beth, my most amazing partner and spouse. Thank you for all of your undying
support of me heading to the office the majority of our weeks over the past three years. Thank
you for understanding even on vacations when I needed to either join class or work on
components of my dissertation. Thank you for allowing me to fulfill a lifetime dream to prove to
myself that I could do this. I love you with all my heart and cannot thank you enough!
To Aiden and Keegan, my wonderful, energetic and understanding children. Thank you
for understanding that Daddy had a lot of class and homework to do that needed my attention.
Thank you for knowing once Daddy gets this done you get me back 100%! I have enjoyed
watching you both grow during this journey and look forward to you joining me in this ceremony
as we celebrate this as a family win!
To my family and in-laws, thank you for your understanding and support watching the
kids, checking on my progress, and supporting me throughout this journey. It means so much
that you care and I am forever grateful for your support.
To my friends, again I left you for a number of years to put my complete focus on this
program so that I could balance my work and family. I know we will celebrate and I look
UNIVERSAL WELLNESS NETWORK 3
forward to thanking each of you in person. My sincere gratitude to have such a great group of
people in my life.
To my Dean, Academic office, and colleagues, I thank you for your commitment and
support to allow me to pursue this goal. I thank you for helping block my schedule, support my
advanced study leave, and put me in a position to complete this.
To Dr. Judy Tjoe and David Straseski, thank you for being my professional coaches,
champions and supporters. I couldn’t have completed this journey without your guidance.
To my committee: Dr. Ken Yates, Dr. Maria Ott, Dr. Susanne Foulk and Dr. Lisa
Benson. I could not have been more lucky to have you in my corner to support me, guide me,
and motivate me. Thank you for critical eye, expertise, tough love, and genuine encouragement.
To the USC OCL Cohort 9, WE DID IT! Thanks for keeping each other in check. I am
honored to have gone through this program with so many talented people. We took on a short-
term inconvenience for a lifetime of opportunity. I look forward to taking on the world, making
change and leaving our marks. Fight On!
To my AEO fellas: Todd, Jordan, Trucker, Rich, and Rob, I am beyond honored,
humbled, and lucky to have met you all at the first immersion; where, little did we know a
lifetime friendship would turn into a brotherhood. I love you guys and would not have made it
without each of you! Honestly, loyalty, encouragement, and the opportunity to see each other to
motivate, endure, overcome and lay this paper to rest. My sincere thanks!
The CEO, leadership and Staff at UWN; my sincere thanks for letting me into your world
to learn! I am your biggest champion!
UNIVERSAL WELLNESS NETWORK 4
TABLE OF CONTENTS
Acknowledgements 2
List of Tables 7
List of Figures 8
Abstract 9
Chapter One: Introduction 10
Introduction of the Problem of Practice 10
Organizational Context and Mission 11
Organizational Performance Status 12
Related Literature 13
Importance of a Promising Practice Project 14
Organizational Performance Goal 14
Performance Impacting the Problem 16
The Key Performance Measure 16
Description of Stakeholder Groups 17
Stakeholders Groups’ Performance Goals 17
Stakeholder Group for the Study 19
Purpose of the Project and Questions 20
Methodological Framework 20
Definitions 21
Organization of the Project 22
Chapter Two: Review of the Literature 24
Cost Savings Promising Practice in Healthcare: UWN 24
Healthcare in the United States 24
Increasing Cost of Healthcare in the United States 25
Stakeholders’ Contribution to Healthcare in the United States 26
Stakeholders 26
Impact of Costs and the Economy in the United States 28
Impact and the Economy 28
Insurance Role and Impact on Healthcare Delivery in the United States 29
Insurance and Healthcare Delivery 29
U.S. Billing and Reimbursement 30
Future Healthcare Changes/Reform in the United States 32
Healthcare Changes and Reform 33
Clark and Estes’ (2008) Knowledge, Motivation and Organizational Influences Framework 34
Stakeholder Knowledge, Motivation and Organizational Influences 34
Knowledge and Skills 35
Motivation 41
Organization 46
Conclusion 53
Chapter Three: Methods 54
Research Questions 54
Participating Stakeholders 54
Survey Sampling Criteria and Rationale 55
Observation Sampling Criteria and Rationale 56
Observation Sampling (Access) Strategy and Rationale 57
Document Analysis Sampling Criteria and Rationale 57
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Qualitative Data Collection and Instrumentation 58
Interviews 59
Observation 60
Documents and Artifacts 62
Alignment of KMO Influences and Data Collection Methods and Instruments 63
Data Analysis 66
Credibility and Trustworthiness 67
Validity and Reliability 68
Ethics 68
Limitations and Delimitations 70
Chapter Four: Results and Findings 72
Participating Stakeholders 73
Determination of Assets and Needs 73
Results and Findings for Knowledge Causes 75
Factual Knowledge 75
Conceptual Knowledge 77
Procedural Knowledge 81
Metacognitive Knowledge 83
Results and Findings for Motivation Causes 86
Self-Efficacy 86
Collective Efficacy 88
Utility Value 91
Attribution 93
Results and Findings for Organization Causes 94
Cultural Models 94
Cultural Settings 98
Summary of Validated Influences 102
Knowledge 103
Motivation 103
Organization 104
Chapter Five: Recommendations and Evaluation 105
Purpose of the Project and Questions 105
Introduction and Overview 105
Recommendations for Practice to Address KMO Influences 106
Knowledge Recommendations 106
Motivation Recommendations 113
Organization Recommendations 122
Integrated Implementation and Evaluation Plan 126
Implementation and Evaluation Framework 126
Organizational Purpose, Need and Expectations 127
Level 4: Results and Leading Indicators 127
Level 3: Behavior 129
Level 2: Learning 132
Level 1: Reaction 135
Evaluation Tools 136
Data Analysis and Reporting 136
Summary of the Implementation and Evaluation Plan 137
Limitations and Delimitations 137
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Recommendations for Future Research 138
Conclusion 139
References 140
Appendix A: IRB Research Interview Participation Solicitation Email Template 152
Appendix B: Interview Protocol Participation Information Sheet 153
Appendix C: Training Evaluation Form 155

UNIVERSAL WELLNESS NETWORK 7
LIST OF TABLES
Table 1: Organization’s Mission, Global Goal, and Stakeholder Performance Goals 19
Table 2: Knowledge Influence, Knowledge Type, and Knowledge Influence Assessment 40
Table 3: Assumed Motivation Influence and Motivational Influence Assessments 45
Table 4: Stakeholder Organization Influences 49
Table 5: Data Collection Methods for Assumed Knowledge, Motivational, and
Organizational Influences 63
Table 6: Knowledge Assets or Needs as Determined by the Data 103
Table 7: Motivation Assets or Needs as Determined by the Data 103
Table 8: Organizational Assets or Needs as Determined by the Data 104
Table 9: Knowledge Influence, Knowledge Type, and Knowledge Influence Assessment 108
Table 10: Summary of Motivation Influences and Recommendations 115
Table 11: Summary of Organization Influences and Recommendations 123
Table 12: Outcomes, Metrics, and Methods for External and Internal Outcomes 128
Table 13: Critical Behaviors, Metrics, Methods, and Timing for Evaluation 129
Table 14: Required Drivers to Support Critical Behaviors 130
Table 15: Evaluation of the Components of Learning for the Program 134
Table 16: Components to Measure Reactions to the Program 135

UNIVERSAL WELLNESS NETWORK 8
LIST OF FIGURES
Figure 1. U.S. Spending two times that of other developed countries. Source: Adapted
from Peter G. Peterson Foundation, 2018. 13
Figure 2. Interaction of stakeholder knowledge, motivation and organizational cultural
models and cultural settings. 52

UNIVERSAL WELLNESS NETWORK 9
ABSTRACT
This study utilized the gap analysis model, which systematically and analytically clarifies
organizational goals to identify the current and preferred performance level within an
organization. The purpose of this study was to examine Universal Wellness Network (UWN, a
pseudonym) as a promising practice due to its ability to achieve and maintain a cost savings on
month-to-month medical costs between 7% and 30%, providing the highest level of quality at the
lowest cost compared to other companies providing similar services. This qualitative study used
interviews with executive leadership team members and support team members, observations at
UWN’s organization, organizational artifacts, and document analysis to reveal the knowledge,
motivation, and organizational assets that contribute to UWN as a promising practice in the
industry. Findings from this study identified assets for factual and conceptual knowledge,
motivation related to self/collective efficacy and attribution, and organizational influences for
cultural models and settings. This study identified key influences to sustain this promising
practice while providing and contributing a guide by way of recommendations for other
organizations in this field to attain the level of this promising practice.

UNIVERSAL WELLNESS NETWORK 10
CHAPTER ONE: INTRODUCTION
Introduction of the Problem of Practice
While many industries have an effect on a number of stakeholders, no other industry has
such an immediate impact on every person in the United States as the healthcare industry. The
following work addressed some of the aspects related to the problem of excess cost related to
healthcare in the United States. The healthcare-related costs in the United States currently exceed
two trillion dollars per year, and, in some situations, health insurance premiums are growing up
to four times faster than wages (Paterick, Paterick & Waterhouse, 2009), which further
demonstrates that excess healthcare cost is a problem. The economic strain has exacerbated the
increase in healthcare cost and, according to Chen, Liang and Lin (2016), cost of medical care is
increasing faster than that of overall inflation. From 1960 to 2013, health care costs increased
over 1,800%, or almost 10 times that of the growth of our own GDP per capita. The increase in
healthcare costs was about three times higher than the rate of inflation during the same time,
which further highlights this is a problem (Chen et al., 2016).
Additionally, with an aging population that will need and seek more healthcare, many
healthcare leaders suggest it is imperative for a new solution to be determined. There is a
growing subset of the population that is 80 years of age and over who also require increased
healthcare that is more expensive. It should be noted that people 65 years of age and older also
consume more healthcare than those under that age (Hosseini, 2015). The problem of increased
healthcare costs is important to address because the financial stability of the United States
healthcare market is a major concern for the government and its stakeholders (Paterick et al.,
2009). There are, however, organizations that do provide high-quality healthcare at lower than
average cost. This study examined one such organization as a promising practice.

UNIVERSAL WELLNESS NETWORK 11
Organizational Context and Mission
Universal Wellness Network (UWN; a pseudonym), founded in 2014 in the Midwest,
administers a cloud-based technology solution called The Superior Choice (a pseudonym) by a
team of dedicated healthcare professionals. This product connects providers offering value-
oriented services in the form of flat rates and bundles to self-funded, full-pay entities seeking the
most direct connection possible. The UWN provides support to a number of clients with a varied
demographic background who primarily focus on those between 18 and 65 years of age. The
Superior Choice provides the quality, efficiency and value that is demanded from each client
UWN serves. The Superior Choice is a free-market solution that gives control of healthcare to
the client by providing them access to thousands of flat-rate bundled medical events via their
proprietary, fully-customizable, cloud-based platform. UWN provides administrators the tools
and flexibility they need to effectively control costs and educate patients on value, affording
employers and others who administer self-funded plans the opportunity to take control of costs.
This is accomplished through four distinct areas: providers, employers, patients and distribution
partners with the goal for UWN to increase the number of lives covered (UWN, 2018).
Thousands of providers across the country have joined The Superior Choice. This is due
to the cloud-based technology solution that links full-pay patients to their services, which are
typically paid for within 21 days. This idea is based on revenue cycle management. Revenue
cycle management, according to the Healthcare Business Management Association (2018), is the
administration of financial transactions that result from the medical encounters between a patient
and a provider, facility, and/or supplier. These transactions include billing, collections, payer
contracting, provider enrollment, coding, data analytics, management, and compliance. UWN
connects full-pay patients and timely payments to providers electronically with the commitment
that the client’s employees and all members are patients. As such, they deserve the best care
UNIVERSAL WELLNESS NETWORK 12
possible at a price everyone can afford. The Superior Choice allows patients to shop for
common, non-emergent medical procedures like outpatient surgeries and lab work at no cost, or
very low cost, to them.
Patient mix, revenue and innovation have been leading the way with change in the
healthcare environment. UWN provides a solution to assist with these challenges by connecting
providers and payers directly to eliminate non-value-add middlemen to optimize revenue. The
bundles are a way for providers to deliver predictable value to self-funded plans and other
payment agents, including insurance companies. UWN works with numerous employers to
analyze their historical expenditures and assist in retaining talent by reducing healthcare costs
while providing clients and their employees the best quality at a cost that is fully transparent
(UWN, 2018). The ability to leverage tens of thousands of covered lives will increase the
leveraging power for UWN to provide the lowest cost and increase medical cost savings.
Organizational Performance Status
Healthcare costs in the U.S. continue to increase and will not be a sustainable model of
care for the future. The market forces include the insurance and pharmaceutical companies as
well as those delivering healthcare, such as physicians, health systems, government aid, federally
qualified health systems, hospitals, and clinics. Providers have a strong impact on the consumer,
and, whether an individual, family and/or a business. It is the responsibility of the government
and organizations to ensure affordable care for their citizens and employees. However, this has
not been the case over the past few years with more healthcare costs being expected of the
employee/citizen (Sherman, Gibson, Lynch, & Addy, 2017). UWN’s ability to consistently save
7% to 30% for a company is a critical option that will save consumers money (UWN, 2018).
Considering that UWN’s closest competitors can only save between 1% and 3% due to medical
spending, UWN is considered a promising practice.
UNIVERSAL WELLNESS NETWORK 13
Related Literature
The increasing costs of healthcare in the U.S. and the impact these may have on access,
quality, and affordability, nationally and regionally, indicate that a solution must be determined
before the U.S. GDP becomes greater than what can be supported. The World Health
Organization (WHO) conducted a report of 191 health systems in 2000 and ranked the U.S. at
the top with the highest health expenditure per capita. In 2000, the U.S. spent around 13%, or
approximately $4,600 per person, of its GDP on healthcare, and, in 2015, that number rose to
around 18%, or approximately $9,000 per person ( Sawyer & Cox, 2017). This is illustrated in
Figure 1 below.

Figure 1. U.S. Spending two times that of other developed countries. Source: Adapted from
Peter G. Peterson Foundation, 2018.

One midwestern state’s situation is no different from the national trend. According to the
Kaiser Family Foundation (2014), this midwestern state’s healthcare expenditures per capita
were $8,702. When comparing costs, the U.S. spends more than many other countries to provide
healthcare to its citizens. In 2009, research conducted by Nordal (2012) found that about 1% of
UNIVERSAL WELLNESS NETWORK 14
the U.S. population accounted for roughly 22% of all total health expenditures. Furthermore,
Nordal expects that, by 2020, the GDP related to healthcare expenditures in the U.S. is expected
to surpass 20% of the GDP. This is a cause for concern because Americans spend more than
double per capita on healthcare than the average spent in other developed countries, resulting in
almost two-thirds of personal bankruptcies being due to medically related bills (Swensen et al.,
2011). The U.S. must bend the curve of healthcare spending, as the rising costs of healthcare has
become one of the greatest concerns for generations to come (Rother, 2017).
Importance of a Promising Practice Project
It is important to examine this organization’s performance in relation to their
performance goal of consistently providing between 7% and 30% cost savings on medical
spending by increasing the number of lives covered as a promising practice for a variety of
reasons. The ability for more organizations to work with UWN and/or other competitors to
increase their cost savings will have an instrumental and fundamental impact on how healthcare
is delivered and throughout the U.S. This ability for collaborative work with UWN supports the
national issue of debate within healthcare as it relates to increasing costs and arguable
inconsistency in delivering high-quality care. The consequences of not studying promising
practices like UWN will lead to more spending, sub-par quality outcomes, and minimal change
to a system that must be redesigned to provide sustainability for future generations.
Organizational Performance Goal
UWN’s performance measures measure the percentage of dollars saved for an
organization related to medical costs, number of new clients obtained per year, number of
existing clients retained from year prior, and customer feedback. Of these measures, the strongest
indication of defined success for UWN is the ability to consistently provide the highest-quality
care at the lowest possible price while saving organizations between 7% and 30% in medical
UNIVERSAL WELLNESS NETWORK 15
spending annually. Aside from that indicator is the number of lives covered to help support that
cost savings work. For example, UWN’s goal is to have, by January 1, 2019, an additional
150,000 to 200,000 lives covered and currently in August of 2018 has 120,000 lives covered
contracted and on paper (UWN CEO, personal communication, 2018). With a few large
contracts out for bid, the possibility for UWN to meet and/or surpass that goal is anywhere from
35,000 to over 1.4 million lives covered by a larger more complex contract opportunity. This
defined success can also be compared to Marsh and Farrell’s (2015) definition of success as
interventions being implemented as designed and the process running smoothly.
As mentioned previously, in this industry, UWN is able to consistently provide cost
savings for medical spending between 7% and 30% while the competition can only consistently
provide between 1% and 3% costs savings. This goal was determined by the UWN executive
leadership team (ELT) to remain consistent and realistic in their efforts to grow based on
previous year-over-year reports. During monthly and quarterly meetings, the ELT members
utilize reports and reviews current contracts using a simple system like a stoplight to project
traction towards these covered lives and costs savings goals. Contracts that are strongly aligned
and close to signing are considered green and can be included in future projections. Contracts
that may have some additional complexities, thereby finding them in a 50/50 position for
executing or terminating, are yellow and not included in future projections. Finally, contracts that
are least likely to close but may have a small percentage of being executed fall under the red
category and are monitored and worked, but not included in future projections.
Finally, as it relates to UWN’s goal of providing coverage to an additional 150,000 to
200,000 covered lives while maintaining cost savings, the goal is almost met. However, UWN is
in negotiation with large, well-known national retailers, which, if successful, would exceed that
goal. That signifies the importance and impact that UWN is having in this space when those
UNIVERSAL WELLNESS NETWORK 16
large organizations are considering using UWN’s products as a cost-savings mechanism,
knowing there is not a better option available in the market.
Performance Impacting the Problem
UWN will benchmark itself against another like company, Blankdeck (pseudonym),
which also works to minimize organizations’ health care costs. Blankdeck operates in the same
geographic region and provides a similar product with little overhead, but it does not have the
capacity that UWN has. Along with Blankdeck are a couple of other close competitors. Doc-hold
(pseudonym) has a similar product as UWN and Blankdeck but are also limited to capacity. The
Money-Doc (pseudonym) is maybe closest overall versus one product working exclusively in the
ambulatory/surgery arena with a strong footprint across the country but UWN’s ability to
leverage previous success to be approached by large Fortune 100 organizations demonstrates
another reason why UWN is a promising practice, as they are the best at what they do.
The Key Performance Measure
The most important performance measure that UWN uses to define success is the ability
to repeatedly save clients between 7% and 30% on medical costs while consistently providing
high-quality care at a low price and increasing the number of lives covered. This is important for
UWN and is an important benchmark for each of the companies against which UWN
benchmarks itself. This is because that cost savings is both large and valuable. For any company,
money saved can be dollars to allocate to other areas of need. For example, when an organization
spends most of its money on health insurance covering their employees, a single organization
with anywhere from 1,000 to 5,000 employees may find some reasonable rates to negotiate with
insurers to provide health coverage to its employees. Adding a larger client and employee base
(live covered/represented) and putting together three to five organizations each with 5,000
employees, those 15,000 to 25,000 employees have increased leveraging power. This is where
UNIVERSAL WELLNESS NETWORK 17
UWN and its competitors come in to provide cost savings to organizations. A review of four
company websites used to benchmark UWN shows only UWN openly states the cost savings.
This is due to the fact that its cost savings are higher than those of competition, and UWN has
consistently delivered high value quality care and low price.
Description of Stakeholder Groups
The stakeholder groups are UWN administrators, providers, employers, and patients. The
UWN administration includes the three co-founders, the ELT, and the seven members of the
support team (ST). The ELT works to increase partnering organizations and maintain/increase
cost savings. The providers include those providing the medical interventions and the delivery of
healthcare to another stakeholder group, patients, who are those employed by the employers. The
providers work to provide the highest level of care to each employee/patient at the lowest cost.
The employees also serve as the patients while the employee organization serves as the
employer. The employees work to take information and benefits from the providers and
organization to assist them in self-regulating their wellness needs/wants.
Stakeholders Groups’ Performance Goals
The stakeholders of focus for this study are the administrators (three co-founders), who
are referred to as the ELT, and the seven members of the ST. Although all stakeholders support
the overall goal, UWN administrators have the largest influence on this continued success and
rely on continued expansion of stakeholder organizations and employees to maintain the cost-
savings rate. The ability to leverage relationships to expand services to reach more employee
organizations is the priority for UWN’s administration. This goal, supported by the ELT, is to
maintain, or increase, the month-to-month cost savings for an organization and its employees
using The Superior Choice product. Compliance with monthly meetings on strategy to measure,
UNIVERSAL WELLNESS NETWORK 18
review, update and evaluate partnerships will allow UWN to serve and save over $10 million
collectively to date while expanding to several thousand lives covered.
The UWN administrators will work to ensure each stakeholder upholds their role in
meeting goals to ensure the goal of 7% to 30% costs savings is met or exceeded. The providers
will continue to provide the highest level of care at the lowest cost for their patients (UWN
employees). The patients (UWN employees) will continue to utilize the information and benefits
provided to them from the providers and the UWN to monitor/adapt their wellness needs/wants.
UWN has seen an extensive increase year after year since 2014 in covered lives using The
Superior Choice while also expanding into other states. This expansion allows UWN to continue
toward its organizational goal of increasing the number of covered lives while saving clients and
users money at this rate through 2020. Non-compliance will lead to increased costs for clients
and employees and will hinder UWN from reaching the goal of maintaining or increasing the 7%
to 30% cost savings month-to-month by December 2020. The organization’s mission, global
goal, and each stakeholders performance goal is described in Table 1.

UNIVERSAL WELLNESS NETWORK 19
Table 1
Organization’s Mission, Global Goal, and Stakeholder Performance Goals
Organizational Mission
Universal Wellness Network (UWN) is a revolutionary solution that makes offering and
administering a select panel of providers a simple turn-key process that can be customized to any
plan.
Organizational Performance Goal
Universal Wellness Network’s (UWN) goal is to maintain a 7% to 30% cost reduction in medical
spending month-to-month for its clients and users from 2018 to 2020.
UWN Administration Providers Organizations
Employees (Patients)
Employers
(Organizations)
By December 2019,
UWN Administration
will continue to
maintain (or increase)
the 7% to 30% cost
savings on month-to-
month medical costs
by increasing or
maintaining the
number of partnering
organizations while
increasing the number
of lives covered by
between 150,000 to
200,000.
By December 2019,
Providers will continue
to provide the highest
level of care to
employees by staying
current on best
practices by reviewing
current literature and
participating in any/all
continuing education
credits/opportunities
deemed appropriate for
their field(s).
By December 2019,
Organizations clients
will utilize benefits
and information
provided by
employers to self-
regulate personal
wellness needs. They
will do this by
participating in any
information sessions,
workshops, and
utilizing
tools/programs
provided by the
provider and/or
organization.
By December 2019,
Employers will
continue to provide
the highest level of
care at the least cost to
its employees
(patients). They will
do this by continuing
to leverage the
contractual
agreements, payment
(fee) schedules, and
reimbursement
through an evidence-
based data driven
approach.

Stakeholder Group for the Study
Completing a thorough analysis would include all stakeholder groups, but, for practical
purposes, it was important to understand and focus on the primary stakeholders for this
promising practice. The primary stakeholders were the members of the ELT. Focusing on this
primary group was important due to the influence and impact they have on both the
organizational goals and on driving the organization as the best in its field and industry.

UNIVERSAL WELLNESS NETWORK 20
Purpose of the Project and Questions
The purpose of this promising practices project was to examine UWN’s ability to achieve
and maintain month-to-month medical cost savings while providing the highest level of quality
at the lowest cost. As it would be almost impossible to obtain all current data for all stakeholders,
for practical purposes, the primary stakeholder of focus for this study was the ELT; however a
secondary group, Support Team (ST), was also interviewed. As such, the questions that guided
the promising practice study are the following:
1. What are the knowledge and motivation assets related to Universal Wellness Network
ELT’s high achievement of its goal of saving 7% to 30% of month-to-month medical
costs and increasing the number of lives covered by an additional 150,000 to 200,000
lives?
2. What is the interaction between organizational culture and context and ELT’s knowledge
and motivation?
3. What recommendations in the areas of knowledge, motivation, and organizational
resources may be appropriate for solving the problem of practice at other organizations?
Methodological Framework
The Clark and Estes (2008) gap analysis framework was used for this study. This
framework suggests that organizational performance can be examined using three dimensions.
The knowledge framework was used to examine UWN’s ELT and their collective understanding
of the industry and the variables contributing to cost savings that puts them ahead of their
competitors. The motivation framework was used to examine how UWN’s culture provides the
motivation to continue to strive to be the leader in the industry. Finally, the organizational
framework suggests that UWN provides a collaborative setting which allows each member to
UNIVERSAL WELLNESS NETWORK 21
contribute their expertise, leading to the collective output that no other organization can
replicate, which, in turn, creates the promising practice.
For this study, the Clark and Estes (2008) framework was adapted to examine the
promising practices of UWN as they influence the organization’s high performance. As such,
knowledge, motivation and organization factors were examined as assets that influence
performance. A mixed-methods data gathering and analysis process was undertaken to study
UWN’s assets in the areas of knowledge, motivation and organizational resources. Staff
members’ assets were studied through observations, focus groups, interviews, and content
analysis.
Definitions
The following words and terms appear throughout the remainder of this study. For that
reason, the following terms have been listed below to provide an explanation of their meaning
within this study. Many of these terms may have other meanings, but the definitions and
explanations have been provided related to the context of how they are used within this study.
Bundles (bundled payments) – The Bundled Payments for Care Improvement (BPCI)
initiative comprises four broadly defined models of care which link payments for the multiple
services beneficiaries receive during an episode of care. Under the initiative, organizations enter
into payment arrangements that include financial and performance accountability for episodes of
care. These models may lead to higher quality and more coordinated care at a lower cost to
Medicare.
ELT – Executive leadership team for the UWN.
Flat rates – With the flat-fee pricing, the medical billing company charges a fixed rate
for each claim submitted or a static monthly fee, regardless of the size of the claims.
UNIVERSAL WELLNESS NETWORK 22
Gross Domestic Product (GDP) – the broadest quantitative measure of a nation’s total
economic activity. Specifically, GDP represents the monetary value of all goods and services
produced within a nation’s geographical borders over a specified period of time.
Health expenditures – Historical spending measures annual health spending in the U.S.
by type of good or service delivered (hospital care, physician and clinical services, retail
prescription drugs, etc.), source of funding for those services (private health insurance, Medicare,
Medicaid, out-of-pocket spending, etc.) and by sponsor (businesses, households and
governments).
Lives covered – the number of people and their dependents enrolled in a particular health
insurance program.
Patient mix – distribution of demographic variables in a patient population, often
represented by the percentage of a given race, age, sex or ethnic derivation.
Per capita – equally to each individual; per unit of population; by or for each person.
Premiums – The amount paid for health insurance every month.
UWN – Universal Wellness Network.
Value-oriented (value-based) services – Value-based healthcare is a healthcare delivery
model in which providers, including hospitals and physicians, are paid based on patient health
outcomes. Under value-based care agreements, providers are rewarded for helping patients
improve their health, reduce the effects and incidence of chronic disease, and live healthier lives
in an evidence-based way (NEJM group, 2017).
Organization of the Project
Five chapters are used to organize this study. This chapter provides the reader with the
key concepts and terminology commonly associated with a healthcare perspective. The
organization’s mission, goals and stakeholders as well as the initial concepts of gap analysis are
UNIVERSAL WELLNESS NETWORK 23
introduced. Chapter Two provides a review of current literature surrounding the scope of the
study. Topics of medical spending, healthcare costs, and healthcare policy will be addressed.
Chapter Three details the assumed causes for this study as well as methodology when it comes to
choice of participants, data collection and analysis. In Chapter Four, the data and results are
assessed and analyzed. Chapter Five provides solutions, based on data and literature, for closing
the perceived gaps as well as recommendations for an implementation and evaluation plan for
organizations aspiring to mirror the work of this promising practice..

UNIVERSAL WELLNESS NETWORK 24
CHAPTER TWO: REVIEW OF THE LITERATURE
This literature review presents the impact of increasing healthcare costs in the United
States. This is important to study because it directly impacts each person and organization in the
United States. This chapter first reviews the overall impact of increasing costs in the United
States. Next, the chapter discusses the evolution and history of United States healthcare’ inflation
as compared to other countries and its surpassing of inflation rates. A review of a promising
practice, UWN, based in Wisconsin, will provide perspective on how this organization is leading
its industry with cost savings as it relates to medical costs and how that could impact the way
healthcare is covered and delivered across the country. This is followed by an explanation of the
knowledge, motivation, and organizational influences used in this study of a promising practice
and how it is already impacting the healthcare industry and future of healthcare in the United
States. A conceptual framework is used to illustrate the connections between influences, UWN’s
ELT, and UWN’s mission and goals.
Cost Savings Promising Practice in Healthcare: UWN
Healthcare in the United States
The historical context in which the problem of practice is situated provides an
understanding of the way healthcare has been delivered in the United States for decades. The
literature will provide that historical context on healthcare delivery with a focus on the high costs
of care. As many organizations have worked to save on healthcare spending, the context
provided demonstrates why this promising practice was studied due to the increasing costs of
healthcare in the United States.
U.S. healthcare historical context. Both Americans and organizations in the United
States are seeing the consequences of increasing costs of healthcare. As of 2020, a doctor visiting
a patient’s home is mostly uncommon, and a hospital has historically been a place to die (Shi &
UNIVERSAL WELLNESS NETWORK 25
Singh, 2017). After the 1900s, the medical community evolved past hospitals being a place for
the poor and into their being more of an ambulatory setting. This idea was accelerated when
insurance was introduced as a way to recruit employees.
The evolution of insurance in the United States has played a significant role for
employers and employees. Most familiar is the current Blue Cross Blue Shield, which evolved
shortly after World War II and the Great Depression as a result of workers compensation.
Around the same time, a similar model for teachers was started at Baylor University that later
became adopted by Blue Cross and evolved through the 1940s and 1950s until finally becoming
amended through Congress as employer-supported insurance coverage. Again, this was a tool
used to attract talent only a couple of decades earlier (Shi & Singh, 2017).
Increasing Cost of Healthcare in the United States
The cost of healthcare in the United States has continued to climb over the past several
decades with no signs of slowing down. According to Chen et al. (2016), the cost of medical care
increased faster than overall inflation from 1960 to 2013. Health care costs grew over 1,800%, or
almost 10 times the growth of GDP per capita. The increase in healthcare costs was about three
times higher than the rate of inflation during the same time, which further highlights this is a
problem. Healthcare-related costs currently exceed 2 trillion dollars per year, and, in some
situations, health insurance premiums have grown up to four times faster than wages (Paterick et
al., 2009). Even as recently as 2000, the United States spent around 13% ($4,600) per person of
its GDP on healthcare, and, 15 years later in 2015, this number rose to around 18% ($9,000) per
person (CMS, 2015). Nordal (2012) suspects that this number may exceed over 20% of GDP on
healthcare as soon as 2020.
The cost of healthcare in the United States has continued to increase at a rate that is not
sustainable and continues to have a significant impact on the economy, including those slowly
UNIVERSAL WELLNESS NETWORK 26
being unable to afford the costs of care. The cost of healthcare can be complex to determine, and
one way of comparing these costs against other countries and other healthcare delivery models is
to compare the per capita expenditures. According to the Organisation for Economic Co-
operation and Development (OECD, 2015),
the amount that each country spends on health, for both individual and collective
services, and how this changes over time can be the result of a wide array of social and
economic factors, as well as the financing and organisational structures of a country’s
health system, is called healthcare per capita. (p. 164)
This comparison provides a level perspective as the number of resources, population size, and
models for care are different. With the cost of healthcare increasing, many are looking for one
entity, with many pointing toward our government, for the reason behind increasing costs.
However, as we continue to explore and extract the real culprits, we see how many stakeholders
actually contribute to the current state of healthcare in the United States.
Stakeholders’ Contribution to Healthcare in the United States
Many stakeholders contribute in different ways to the healthcare delivery systems in the
United States. The list includes many areas, such as pharmaceuticals, physicians, legal and
compliance, patients and consumers, education, competition and our own government.
Stakeholders
Stakeholders within healthcare represent a number of groups, but each contribute in their
own way to the overall delivery and cost of healthcare, meaning all share in historical
responsibility for where we are and in accountability regarding necessary change. As part of the
stakeholders, one aspect is the value of consolidation and, in most cases, the removal of
competition that is highlighting prices to be driven up and quality to be sacrificed in some cases.
UNIVERSAL WELLNESS NETWORK 27
One such force is that of Medicare and Medicaid, which has historically underpaid for services,
forcing other stakeholders to absorb costs (Rosenberg, 2018).
Pharmaceuticals, physicians, consumers, systems, and government. As we continue
to move through the changes of healthcare, many stakeholders will be impacted: from the
clinicians and healthcare systems to pharmaceuticals to the patients and the interaction and/or
intervention of the government. These groups all play a role in the future of healthcare in the
United States.
The U.S. Department of Health and Human Services and the Joint Commission on
Accreditation of Hospital Organizations have been monitoring a number of stakeholders. One
common thread is the rising financial burden from a number of perspectives. This falls under
executive leadership, practitioners, staff, reimbursement, supply chain, and the patient. In an
article by Birk (2016), these stakeholders are highlighted in a number of scenarios experienced
by hospitals and health systems.
Healthcare administration. In this domain, administrators are constantly debating the
hiring of non-medical professionals versus physicians based on compensation when, in fact,
compensation equals out over time but does not take into consideration other intangibles in some
cases (Birk, 2015). This point is further illustrated by an article from 2003 by Woolhandler,
Campbell, and Himmelstein published in The New England Journal of Medicine discussing how
healthcare costs were around $294 billion in 1999. Woolhandler and Himmelstein (2017) later
published a paper stating 2017 administrative spending was over $1 trillion.
Reimbursement through the clinician, consumer, government, and systems. A
number of resources have played a role under the eyes of transparency related to pricing. In most
cases, what is found is that the cost of a procedure at one hospital is significantly different than at
another hospital a few miles away. While confounding variables may be a way to partially
UNIVERSAL WELLNESS NETWORK 28
explain these differences, such as academic institutions or geographic location or even cost of
living, the fact is, when most variables are the same or similar, those explanations are left to be
answered, causing problems for patients, insurance, clinical providers, and others (Birk, 2015).
Pharmaceuticals. Other substantial stakeholders are the pharmaceutical companies. Cost
for drugs can be as much as one billion dollars when marketing and sales are considered as well
as research and development. This is compounded by the number of regulatory bodies, only to
ensure they recuperate some of that money while creating additional and unnecessary barriers for
clinical providers and patients to have treatments and therapies approved (Birk, 2015).
Consumers. Consumers have been creating a new type of expectation as they have
become more informed, prepared, and armed with knowledge they print from websites,
information from commercials, and their own research on cost comparisons they have conducted
for what seems like similar procedures to combat cost estimates shared by their provider. This
idea has created a savvy group of consumers with information accessible at any time holding
systems and providers more accountable to justify each recommended solution to care (Santilli &
Vogenberg, 2015). The type of consumer behavior illustrated above has expanded quality
metrics, different payment models, specialized and personalized care, and communication and
consolidation to improve quality and maximize reimbursement for care.
Impact of Costs and the Economy in the United States
Healthcare in the United States is a multi-billion dollar business and segment of the
overall economy. Healthcare is closing in on being around 20% of the United States’ GDP, and
that trend is not going to be sustainable for much longer.
Impact and the Economy
The overall impact that health care has on the United States’ economy continues to grow,
and that trend must change if the U.S. wants to reduce healthcare costs. Many researchers
UNIVERSAL WELLNESS NETWORK 29
speculate this increased trend will continue, and Rother (2017) suggests rising healthcare costs
may be one of the primary concerns for the future. This idea is compounded by Swensen et al.’s
(2011) statement that the United States spends more than double per capita on healthcare than
any other country, and these costs cause two-thirds of all personal bankruptcies.
Many stakeholders contribute to the rising costs with additional outlying impact on those
needing it the most. The current pace of increasing costs will not be sustainable. Although
healthcare as an industry sees between one-fifth and one-quarter of this country’s GDP, there is a
need to examine other aspects that may have a larger impact on improvements and cost savings.
The impact and trend of rising healthcare costs in the U.S., as compared to other
countries, has many factors. For example, the U.S. has a significantly higher number of machines
like MRIs and DaVinci robots for surgery, which increases costs to consumers to make up for
the high costs of the machines and technology. According to Fuchs (2014), while the U.S. has
more machines to increase access, these increase costs. Additionally, the U.S. occupancy rates
for acute care hospitals is much higher in the U.S. than other OECD countries, which can cause
delays and build capacity issues into increased costs. Treatment of sick and/or elderly individuals
falls in many intensive care units where other countries only provide palliative care. The
increased desire and demand by consumers for privacy and more amenities adds to the list of
variables contributing to these increases compared to other OECD countries.
Insurance Role and Impact on Healthcare Delivery in the United States
The role of insurance and the impact the industry has on healthcare in the United States is
unprecedented given the amount of power and money held at this level.
Insurance and Healthcare Delivery
Insurance companies play a large role with every entity of healthcare. This mechanism
has contributed to increased costs and lower reimbursements working as an intermediary
UNIVERSAL WELLNESS NETWORK 30
between numerous stakeholders, leading to increased costs. These mechanisms led to a review of
how healthcare is delivered in the U.S. to control costs, increase access, and increase quality.
Looking into the future, a challenge will arise as brick and mortar locations for care are evolving
to other methods to provide services that are far more unconventionally developed (Beale &
Kittredge, 2014). One example is care being provided at a local Walgreens, CVS, or Walmart
and what that means to the retailing of healthcare on local, regional, and national scales (Beale &
Kittredge, 2014).
The healthcare delivery mechanism plays a central role in how reimbursement and access
are achieved across the country. With the baby boomer generation increasingly needing care, the
conversation on this concern is the balance between brick and mortar and the new technology
and demands of in-home and care to triage common health interventions at a fraction of the cost.
U.S. healthcare delivery. The models for delivery have shifted over the past several
years, going from the fee-for-service model where care is provided a la carte, which has proven,
in some cases, to be more costly, to the value-based care model where the a la carte items are
bundled and dollars are allocated to episodes of care. This model is changing how healthcare is
delivered and provides an opportunity to innovate and shape what healthcare in the U.S. will
look like in the future.
U.S. Billing and Reimbursement
The fee-for-service model has been forced to change from the external influences by way
of the government and payors regarding how systems and clinicians are reimbursed to the value-
based model. The value-based approach is intended to increase quality and reduce costs. As
stated by Swensen et al. (2011); Chen et al. (2016); Paterick et al. (2009); and Nordal (2012),
rising healthcare costs are a challenge, but the old fee-for-service model was cause for some of
the most excessive use of services and low efficiencies the U.S. health system has experienced
UNIVERSAL WELLNESS NETWORK 31
(Garber & Skinner, 2008). This model has transitioned to a new focus that is intended to increase
quality while reducing costs that innately bring about efficiencies not found in the old fee-for-
service model. Markets across the country have worked to evolve this model locally and
regionally, leading to companies like the one studied herein (Pizzo & Cohen, 2016).
The transition from the previous fee-for-service model in healthcare is already occurring
moving to the new value-based reimbursement model and this is something all systems in the
U.S. will need to navigate to remain current but to remain open. The value-based model,
according to CMS, is the change from quantity of care to quality of care (CMS, 2018).
Third-party payors. These entities work to manage reimbursement and health care
expenses and include insurance companies, government agencies, and employers. The goal of
the payor is to secure contracts from the provider and negotiate rates for reimbursement and
expenses. This process can cause delays in care due to pre-authorizations, required referrals, or
other contractual requirements. However, over the past several years, groups have emerged like
UWN, the Zero Card, MD Save and PriceMD who are fighting to disrupt this system for stronger
reimbursement to providers and less interaction by consumers to streamline the processes. This
has created increased efficiencies and cost savings that are appealing to a number of
organizations.
UWN. In this new model, companies work using over bundled episodes of care, and, for
UWN, that amounts to over 1,600 pre-determined and pre-contracted episodes of care to offer.
This provides an employer-sponsored healthcare option to an organization, and it reaps
significant cost savings. When compared to other PPO plans, UWN plans save 10-80% (UWN,
2020). Additionally, focused on using The Superior Choice product, UWN has created a free-
market solution by providing accessible, flat-rate bundled medical events at a low cost to its
UNIVERSAL WELLNESS NETWORK 32
employees (UWN, 2018). This solution has allowed UWN to consistently provide annual costs
savings for its clients of between 7% and 30%.
Competitors. The direct competitors of UWN include the Zero Card, MDSave and
PriceMDs. These groups provide similar products and cost savings mechanisms but not to the
same level as that of UWN on an annual basis. Similarly, each group offers predetermined
bundle rates for services suggesting high-quality care and access for consumers while providing
cost savings to both the user (consumer) and client (self-pay organization).
UWN has a clear advantage in its work that continually puts it at the top of its industry as
a promising practice but must continue to recognize its competition to stay ahead of the ever-
changing dynamics of healthcare in the U.S. Its innovative direction provide a clear competitive
advantage in both the delivery of care to clients and significant costs savings. With third-party
payors continuing to shape the healthcare landscape through employer-sponsored healthcare
using a pricing and transparency model to provide significant medical cost savings, we must
continue to examine how this evolves with additional variables for the future consumption of
healthcare in the U.S.
Future Healthcare Changes/Reform in the United States
Healthcare is seemingly following the old adage that the only constant in business is
change. Over the past several years, a constant in and around healthcare in the U.S. is change.
This change takes into consideration a historical foundation and the passing of the Patient
Protection and Affordable Care Act (PPACA) in 2010 as well as the recent efforts to repair
and/or replace that legislation. Either way, change is again occurring as there is a need to find a
bipartisan solution to the current challenges in healthcare delivery. We must work within the
constructs set by the government and other regulatory bodies to do the best with what we have.

UNIVERSAL WELLNESS NETWORK 33
Healthcare Changes and Reform
The importance of the future delivery of healthcare in the United States hinges on how
our healthcare reform evolves through current and future administrations to make the changes
necessary for future sustainability. While moving forward leaves many to speculate on what
changes, if any, may be made to our healthcare system, one suggested resolution is Medicare for
all or some type of single-payer system. Another suggestion is from Bohigian and Klingele
(2018) of maintaining the old fee-for-service model for Medicare, keeping the same age, over 65,
with no changes. There would potentially be no uninsured. For those under the poverty level,
Medicaid would cover deductibles. PPACA changes in Medicaid would be rolled back.
Deductibles are essential to control costs. Under this model, Bohigian and Klingele suggest this
program would cost less than private insurance-based PPACA and their research suggests 54%
of physicians favor increasing Medicare coverage to lower-age groups (Bohigian & Klingele,
2018, p. 127).
The PPACA was enacted during President Obama’s presidency to address the need to
change healthcare coverage for the uninsured (PPACA, 2010). Many argue some additional
challenges are to be faced under this legislation, as the individual mandate requiring Americans
to buy their own health insurance or pay a penalty if they are not covered by employer or a
government program, to change in 2019. Pauly and Field (2018) suggest another idea that
focuses on changes with Medicaid and Medicare while parallel conversations to address the
opioid epidemic exist. It is unclear which direction some of these topics will go but the only
known is that they will need to be addressed.
The best practices in health care delivery will continue to follow the third-party payors,
specifically how UWN leads the way. The best practice now is UWN in their operationalization
UNIVERSAL WELLNESS NETWORK 34
of these future practices in one system. The examination of best practices as instantiated at UWN
was through the frame of the gap analysis.
Clark and Estes’ (2008) Knowledge, Motivation and Organizational Influences Framework
This study embraced the Clark and Estes (2008) gap analysis framework, which is a
research-based conceptual framework that guides organizational and stakeholder performance
goals and identifies assumed performance gaps within the knowledge (K), motivation (M), and
organizational (O) barriers, also referred to as the KMOs. The Clark and Estes framework is
supported by a substantial body of educational and organizational research that has been shown
to improve individual and organizational performance. In this case, achieving the stakeholder
goal and maintaining the high level of performance as a promising practice required evaluating
the stakeholders’ assumed factual, conceptual and procedural knowledge and skills to determine
if there was a gap in achieving the desired goal (Clark & Estes, 2008; Krathwohl, 2002).
Following this evaluation of knowledge, the next evaluation focused on the stakeholders’
assumed motivations in the form of self-efficacy, collective efficacy, and utility value to
determine if a gap exists in achieving the desired goal (Clark & Estes, 2008; Rueda, 2011).
Finally, an evaluation of the assumed organizational barriers, such as the KMOs was used to
determine whether a gap existed in achieving the desired goal (Clark & Estes, 2008; Rueda,
2011). Identifying these assumed KMO performance gaps is essential in validating UWN as a
promising practice in meeting its goal of maintaining (or increasing) the 7% to 30% medical cost
savings.
Stakeholder Knowledge, Motivation and Organizational Influences
This review of current scholarly research focuses on the promising practice of UWN and
how the organization can consistently provide high-quality care at a low cost. The stakeholder
UNIVERSAL WELLNESS NETWORK 35
group’s performance goal was to continually deliver, at a minimum, a medical cost savings of
between 7% and 30% for the organizations they work with through December 2019.
Knowledge and Skills
The first area required for UWN’s CEO and administrative team to reach their goal
pertains to knowledge influences. Clark and Estes (2008) share a common understanding that
businesses set goals to make a profit. Many organizations work to achieve this and go so far as to
benchmark themselves in an attempt to equal or surpass the industry leader’s current
performance. However, in this example of a promising practice, UWN is the industry leader,
What remains unknown is what allows the organization to continually stay at the top. These
authors suggest that, although many organizations struggle with managing goals and clearly
communicating them or setting effective goals, when top levels of an organization support the
routine setting, translating, and communicating of goals, almost any type of performance is
possible (Clark & Estes, 2008), which is something that UWN wants to continue to improve
upon.
While being on top has its advantages, any industry-leading executive will share the old
adage of not to rest on your laurels, suggesting efforts might be working to lead someone to
meet or beat you. In this case, for UWN to continually improve, its leaders need to understand
the ingredients for keeping the upward trajectory, and one of those is the aforementioned area of
knowledge. One such supporting mechanism related to this is what Clark and Estes (2008)
suggest as “people’s knowledge and skills” (p. 43). Ensuring people know how to achieve their
goals is important. If people have the knowledge, they have the power to achieve. Although
knowledge seems simple and straightforward, Rueda (2011) suggests it is much more complex.
Anderson and Krathwohl (2001) highlight four knowledge types needed for employees to
achieve their goals. The first type of knowledge is factual. Factual knowledge helps employees
UNIVERSAL WELLNESS NETWORK 36
understand what facts are needed to solve their performance problems (Anderson & Krathwohl,
2001). Facts are basic, isolated elements, terminology, or details specific to domains, contexts, or
disciplines (Anderson & Krathwohl, 2001). Conceptual knowledge is the second type of
knowledge. Conceptual knowledge focuses on what concepts employees must understand to
solve their performance problems (Krathwohl, 2002). While Krathwohl (2002) generalizes that
conceptual knowledge is complex forms of knowledge, Rueda (2011) specifies that conceptual
knowledge includes “categories, classifications, principles, generalizations, theories, models, or
structures” (p. 28). The third type of knowledge is procedural. Procedural knowledge helps
employees understand how to solve a problem (Anderson & Krathwohl, 2001). Metacognitive
knowledge is the fourth type of knowledge. Metacognitive knowledge helps employees be aware
of their own mental processes in solving problems (Anderson & Krathwohl, 2001).
Metacognitive knowledge allows an employee to know the when and why about solving a
problem (Rueda, 2011). In the next section, the author uses a review of the current research and
three knowledge influences that contribute to UWN’s stakeholder goal followed by an
explanation related to the different types of knowledge used to determine the methods to assess
knowledge gaps among UWN’s competitors.
ELT has the knowledge of the payment schedules and structures from several insurance
companies allowing them to better understand the potential for profit margins. The first
knowledge influence that UWN has that their competition may not is knowing the differentiating
payment schedules and fee structures from several insurance companies that allows them to
better understand the potential for profit margins. This knowledge influence is categorized as
factual knowledge and as a gap that exists among UWN’s competitors, as this is, in healthcare,
basic “people’s knowledge and skills” (Clark & Estes, 2008, p. 43). The idea of people knowing
how to achieve their goals is important, but they need the knowledge to achieve such goals, as
UNIVERSAL WELLNESS NETWORK 37
noted by Rueda (2011). Factual knowledge, as described by Anderson and Krathwohl (2001),
provides employees facts needed to solve performance problems by way of basic terminology or
details or contexts. Without this basic knowledge, many of UWN’s competitors struggle to make
progress, as this basic knowledge will be used in other formats and complexities that will
influence the ability to consistently perform at a high level within their industry.
ELT members understand the billing and reimbursement complexities among hospitals,
clinics, and the inpatient/outpatient care settings. The second knowledge influence that UWN has
that their competition may not is knowing the unique billing and reimbursement complexities
among hospitals, clinics, and the inpatient/outpatient care settings. This knowledge influence is
also categorized as conceptual knowledge and as a gap that exists among UWN’s competitors, as
it is centered on the idea that the ELT members understand how this information works between
a complex group of healthcare settings. Understanding these concepts allowed the ELT to know
whom to contact and how to have claims processed. This knowledge influence that UWN has
that their competition may not have also relates to the complexities among the different billing
structures (i.e., hospital, clinic, inpatient, and outpatient) in terms of costs and reimbursement of
services provided.
Aside from employee salaries, healthcare costs are at the top of an organization’s costs.
This provision of healthcare services at a reasonable cost is a worldwide challenge and one many
are seeking a solution for, especially in the United States as healthcare-related costs are
increasing rapidly (Asay, Roy, Lang, Payne, & Howard, 2016; Gallegos, 2007; Hamel,
Blumenthal, Stremikis, & Cutler, 2013; Hayati, Bastani, Kabir, Kavosi, & Sobhani, 2018;
Hosseini, 2015; Nordal, 2012; Sherman et al., 2017; WHO, 2000). As noted earlier, it is
important to know this specific knowledge, where to look for it, and whom to contact. Therefore,
the method to further assess whether a procedural gap exists was through interviews and surveys
UNIVERSAL WELLNESS NETWORK 38
of the UWN’s administrative team. The focus of the interviews was to seek the understanding of
these procedural complexities the UWN’s team has versus its competitors.
ELT can differentiate the comorbidities related to outcomes. Again, the second
knowledge influence that UWN has that their competition may not is the complex understanding
of the patient population’s comorbidities in the markets they operate related to patient outcomes,
satisfaction, compliance, and how these relate to costs and reimbursement. This knowledge
influence relates directly to conceptual knowledge. To understand the conceptual knowledge,
one must understand what the term comorbidities means, and, according to Merriam-Webster
(2018) the base word “comorbid” means existing simultaneously with and usually independently
of another medical condition. Areas of health risk may include weight, high blood pressure, and
diabetes.
In addition to the factual knowledge, procedural knowledge plays a role in understanding
how comorbidities influence other health risks and factors. One study highlighted conceptual
knowledge to better understand the association between health care expenditures relative to
change in health risk, or what one might call part of comorbidities of over 50,000 employees
over three years. The health risk assessment suggested that significantly higher health care
expenditures were associated with those who moved from low risk to medium or high risk,
compared to those who remained low risk (Musich et al., 2014). This idea regarding
comorbidities was discussed in Navarro’s (2000) review of the seminal study from the WHO
(2000) listing and accounting for some of the variables and comorbidities of other nations as
compared to the United States.
Moreover, the ideas of patient satisfaction, compliance, and quality as a few other
variables that affect outcomes for performance reimbursement are other significant areas of
knowledge (Asay et al., 2016; Gallegos, 2007; Heijink, Koolman, & Westert, 2013; Hosseini,
UNIVERSAL WELLNESS NETWORK 39
2015; Kumar, Ghildayal, & Shah, 2011; Naidu, 2009; Navarro, 2000; Nordal, 2012; Weil, 2013).
This knowledge influence is also categorized as conceptual knowledge and as a gap that exists
among UWN’s competitors, as it is centered on having specific knowledge about something. In
this case, the specific knowledge of how payment schedules and reimbursement work is
knowledge possessed from the leadership team’s prior experience. This method to assess
whether a conceptual gap exists was through interviews, observations, and document analysis
with the UWN’s administrative team. The focus of the interviews was to seek understanding of
these complexities the UWN’s team has versus other competitors. Table 2 illustrates an overview
of the two knowledge influences, the corresponding knowledge types, and methods to assess
knowledge gaps that may impact the stakeholder and organizational goals as well as the mission
of the organization.
ELT members know how to onboard clients to optimize services with the
appropriate product. The third knowledge influence that the ELT members have is their ability
to onboard clients in an efficient and effective way by assisting them in choosing the most
appropriate product(s). This knowledge influence relates directly to procedural knowledge.
Procedural knowledge relates to the ELT members’ ability to carry out and follow a specific
task. Procedural knowledge is a critically important component in goal attainment and mastery of
a task (Krathwohl, 2002). The procedural knowledge that the ELT members must possess is key
to their ability to onboard clients to optimize and leverage the potential products most
appropriate for each client.
ELT members monitor and evaluate their progress toward achieving the client’s
goals. The fourth knowledge influence the ELT members have is the ability to monitor and
evaluate their progress toward achieving the client’s goals, which are part of the overall UWN’s
goal for medical cost savings. This knowledge influence relates directly to metacognitive
UNIVERSAL WELLNESS NETWORK 40
knowledge. This knowledge relates to the ELT members’ awareness of their own knowledge and
abilities in achieving their clients’ goals. Metacognition comes with two parts: knowledge about
cognition and self-regulation. The ability to self-regulate can be a predictor to performance, and
achievements outcomes can be determined by the level and degree to which one can self-regulate
(Rueda, 2011; Stanton, Neider, Gallegos, & Clark, 2015). It is critical for the ELT to both
regulate and understand this awareness to keep an eye on clients, competitors, and the industry.
Table 2
Knowledge Influence, Knowledge Type, and Knowledge Influence Assessment
Organizational Mission
We give ELT the tools and flexibility they need to effectively control costs and educate patients on
value, affording employers and others that administer self-funded plans the opportunity to take control
of costs.
Organizational Global Goal
Universal Wellness Network’s (UWN) goal is to maintain a 7% to 30% cost reduction in medical
spending month-to-month for its clients and users from 2018 to 2020.
Stakeholder Goal
It is the goal of the UWN administration to increase or maintain the number of partnering organizations
while maintaining (or increasing) the 7% to 30% cost reduction in medical spending month-to-month
for its clients and users by December 31, 2019.
Knowledge Influence Knowledge Type (i.e.,
declarative (factual or
conceptual),
procedural, or
metacognitive)
Knowledge Influence
Assessment
ELT has the knowledge of the payment
schedules and structures from several insurance
companies allowing them to better understand
the potential for profit margins.
Factual Interviews, Observations
ELT members understand the billing and
reimbursement complexities among hospitals,
clinics, and the inpatient/outpatient care settings.
Conceptual Interviews, Observations,
Document Analysis

UNIVERSAL WELLNESS NETWORK 41
Table 2, continued
Knowledge Influence Knowledge Type (i.e.,
declarative (factual or
conceptual),
procedural, or
metacognitive)
Knowledge Influence
Assessment
ELT members understand the differences
associated with many comorbidities related to
patient outcomes, compliance, and how that
plays a role in costs and reimbursement.
Conceptual Interviews, Observations,
Document Analysis

ELT members know how to onboard clients to
optimize services with the appropriate product.
Procedural Interviews, Observations,
Document Analysis
ELT members monitor and evaluate their
progress toward achieving the client’s goals.
Metacognitive Interviews, Surveys,
Document Analysis

Motivation
Motivation is the second area required for UWN’s ELT to achieve their stakeholder goal.
Clark and Estes (2008) explain that motivation is based on people’s personal beliefs about
themselves and their coworkers. The authors assert that motivation requires three process areas:
active choice, when people act upon their decision to work toward a goal; persistence, when
people continue working toward their goal despite barriers and distractions; and, mental effort,
when people decide the amount of effort to put into working toward their goal, and then do so.
Clark and Estes caution that employee challenges in any of these three motivational process
areas can hinder performance. By assessing and addressing motivational challenges, the authors
affirm that organizations can assist employees in closing the gaps between their current
performance levels and their performance goals. Clark and Estes further state that when
employee performance gaps are closed, the organization’s ability to achieve its organizational
goals increases.
Self-efficacy theory. The first motivational influence related to UWN’s ELT achieving
their stakeholder goal is self-efficacy. Pajares (2006) and Rueda (2011) define self-efficacy as
UNIVERSAL WELLNESS NETWORK 42
people’s beliefs or confidence levels about their capabilities in performing tasks. This belief or
confidence level is based on factors like prior successes or failures when performing the task,
feedback received regarding doing the task, and prior knowledge about doing the task (Pajares,
2006; Rueda, 2011). The central premise of self-efficacy theory is that individuals will be more
motivated to perform a task when they have higher self-efficacy regarding the task (Pajares,
2006; Rueda, 2011). As also noted by Graham and Weiner (1996), self-efficacy has proven to be
a more consistent predictor of behavioral outcomes than have any other motivational constructs.
To achieve their stakeholder goal, UWN’s ELT must be confident that they are capable
of consistent delivery of high-quality care at a low cost. Those with higher levels of confidence
in their capabilities will have higher levels of self-efficacy. The performance that keeps UWN at
the top of the industry will continue to motivate and to persist leadership in achieving their
stakeholder goal. Based on the self-efficacy motivation influence, the methodology to assess
whether a motivation gap exists was through interviews of the ELT members.
Collective efficacy. The second motivational influence related to UWN’s ELT achieving
their stakeholder goal is collective efficacy. According to Bandura (1982), “collective efficacy
will influence what people choose to do as a group, how much effort they put into it and the
staying power when group efforts fail to produce results” (p. 143). Perceived collective efficacy
fosters groups’ motivational commitment to their missions, resilience to adversity, and
performance accomplishments (Bandura, 2000). Perceived efficacy plays a key role in human
functioning because it affects behavior both directly and by its impact on other determinants such
as goals and aspirations, outcome expectations, affective proclivities, and perception of
impediments and opportunities in the social environment (Bandura, 2000; Hoyt, Murphy,
Halverson, & Watson, 2003; Tasa, Taggar, & Seijts, 2007).
UNIVERSAL WELLNESS NETWORK 43
Statistical analyses that combine the findings of numerous studies confirm the influential
role of perceived self-efficacy in human adaptation and change. The shared beliefs in collective
power produce desired results and are not just a sum of an individual’s beliefs, but the power
perceived that resides in the minds of the collective group causing it to operate in a coordinated
manner on a shared set of beliefs. A growing body of research attests to the impact of perceived
collective efficacy on group functioning. Some of these studies have assessed the motivational
and behavioral effects of perceived collective efficacy using experimental manipulations to
instill differential levels of perceived efficacy (Durham, Knight, & Locke, 1997; Earley, 1994;
Hodges & Carron, 1992; Prussia & Kinicki, 1996). Other investigations have examined the
effects of naturally developed beliefs of collective efficacy. It is suggested that other studies have
analyzed diverse social systems, including educational systems (Bandura, 1997), business
organizations (Earley, 1994; Hodges & Carron, 1992; Little & Madigan, 1994), athletic teams
(Carron, 1984; Feltz & Lirgg, 1998; Mullen & Cooper, 1994; Spink, 1990), combat teams (Jex &
Bliese, 1999; Lindsley, Mathieu, Heffner, & Brass, 1994), and urban neighborhoods (Sampson,
Raudenbush, & Earls, 1997). These findings can be summarized by the understanding that, the
higher the perceived collective efficacy, the higher the group’s overall motivation is in seeing
through the desired goals regardless of barriers or setbacks and the greater the outcomes of their
collective performance.
Utility value. The third motivational influence related to UWN’s ELT achieving their
stakeholder goal is utility value. As part of task value discussed by Wigfield and Eccles (2000)
utility value refers to how useful one believes a task or activity is for achieving some future goal
(Rueda, 2011). The utility value for UWN’s ELT members follows the idea that they need to find
the value in providing the mechanism that consistently reduces medical costs while providing
high-quality care to their customers or potential customers. The utility value could be further
UNIVERSAL WELLNESS NETWORK 44
supported by the ideas on motivation discussed by Mayer (2011) when discussing areas like
motivation related to goals: the idea that a person or organization might work harder to perform
well rather than avoid performing poorly. The utility (usefulness) can also relate to how the tasks
fits into future plans like a strategic plan; when doing an activity out of utility value, the activity
is a means to an end rather than the end itself. The utility can also cause reflection on how the
activity ties and connects to personal goals, possible organizational goals, and a sense of self
(Eccles, 2006; Ryan & Deci, 2000, 2009).
Based on the value motivation influence, the methodology to assess whether a motivation
gap existed for UWN or its competitors was through interviews. Table 3 illustrates an overview
of how two of the motivation influences of UWN’s ELT support their stakeholder goal and the
methods to assess any motivation gaps impacting the stakeholder and organizational goals and
the mission of the organization.
Attribution theory. The fourth motivational influence to UWN’s ELT achieving their
stakeholder goal is attribution theory. With this theory, the ELT would either feel their success or
failures are related directly to their own efforts (Malle, 2008). As noted by Fritz Heider, part of
attribution theory is a secondary area called personal causality, meaning someone caused
something else to occur intentionally, and that action was purposive (Malle, 2008). With the ELT
their purposive intent can be directly attributed to their success or their failure toward UWN’s
stakeholder goals. This awareness is another key component for the ELT to remain successful
knowing their own efforts intentionally reflect their intended goals.

UNIVERSAL WELLNESS NETWORK 45
Table 3
Assumed Motivation Influence and Motivational Influence Assessments
Organizational Mission
We give ELT the tools and flexibility they need to effectively control costs and educate patients on
value, affording employers and others that administer self-funded plans the opportunity to take
control of costs.
Organizational Global Goal
Universal Wellness Network’s (UWN) goal is to maintain a 7% to 30% cost reduction in medical
spending month-to-month for its clients and users from 2018 to 2020.
Stakeholder Goal
It is the goal of the UWN administration to increase or maintain the number of partnering
organizations while maintaining (or increasing) the 7% to 30% cost reduction in medical spending
month-to-month for its clients and users by December 31, 2019.
Assumed Motivation Influences
(Choose 2)
Motivational Influence Assessment
Self-Efficacy – ELT members are
confident of achieving the high cost
savings for their clients suggested by
UWN

“Tell me about your team.”

“Tell me about your confidence about your
ability to work with clients to reduce spending
related to medical costs for their organization
and employees”

Interview item:
“How do you feel about your ability to work
with UWN to reduce your medical spending
costs?”
Collective efficacy – ELT members are
confident that the team can achieve the
annual medical costs savings of 7% to
30% in addition to the number of lives
covered with each client. Organizations
need to find the motivational commitment
to their mission, resilience to adversity
and performance accomplishments UWN
provides in reducing medical costs while
providing high-quality care.
Interview item: Tell me about how confident
you are in the team’s ability to reach UWN’s
cost-savings goal on an annual basis with its
clients.
Utility Value – ELT members value
organizations’ needing to find the value
that UWN provides in reducing medical
costs while providing high-quality care
Interview item: Tell me about how you find
value in the products UWN provides its clients.

Tell me about how clients find value with the
products UWN offers.
UNIVERSAL WELLNESS NETWORK 46
Table 3, continued
Assumed Motivation Influences
(Choose 2)
Motivational Influence Assessment
Attribution:
ELT members attribute their success or
failure to achieve cost savings for their
clients to their own efforts.
Interview item:
Describe to me how well you believe the ELT
did with your stakeholder goals.

Organization
General theory. Organizational influences are the final area the ELT will need to address
regarding how they achieve their stakeholder goal. Clark and Estes (2008) state, “the final cause
of performance gaps is the lack of efficient and effective organizational work processes and
material resources” (p. 103). These work processes are further defined by Clark and Estes as the
way that materials, equipment, and people interact to produce a desired goal over time. Processes
not properly aligned with an organization’s goals result in failure. Material resources are the
tools and equipment needed to achieve goals (Clark & Estes, 2008). Clark and Estes suggest that
the material resources have been an issue for organizations for years and, because of that, are
often overlooked as a cause of performance gaps. Furthermore, along with materials resources
are the value chains and streams. These essential areas provide identification of the processes
that are most influential in achieving business goals (Clark & Estes, 2008). An organization will
be unable to achieve its goals if it does not have the material resources necessary to equip its
employees with knowledge. Lastly, organizational culture can impact the achievement of
performance goals.
Culture can be described as the beliefs, emotions, values and processes that develop over
time and are often difficult to measure as these shared beliefs, emotions, values and processes
become “the lay of the land” and the invisible norm (Clark & Estes, 2008; Rueda, 2011; Schein,
2017). Within culture is the concept of cultural models and cultural settings, as suggested by
UNIVERSAL WELLNESS NETWORK 47
Gallimore and Goldenberg (2001). Cultural models are the processes or the way things are done
that are invisible norms of the organization. Cultural settings, on the other hand, are the visible
behaviors, such as a lack of communication or trust in the organization that create the cultural
model (Gallimore & Goldenberg, 2001).
Stakeholder specific factors. A cultural model exists within the ELT and their use of
collaboration. Catmull (2014) discusses the need and desire to build support for collaboration in
his book, Creativity Inc. This book highlights the success of Pixar but shares the strong value of
self-expression and in Catmull’s expression of what visitors feel when leaving Pixar. Catmull
states, “a palpable energy, feeling of collaboration and unfettered creativity, a sense, not to be
corny, of possibility” (2014, p. x). This feeling is further depicted in The Innovator’s DNA when
Steve Jobs, former CEO of Apple Inc., stated, “Creativity is connecting things” (Dyer,
Gregersen, & Christensen, 2011, p. 41). People on teams perform better when there is a strong
mutual commitment to their joint work. This commitment creates strong emotional bonds as the
team believes that they, as a team, will all fail or succeed together (Hill & Lineback, 2012). This
idea around collaboration fosters an environment and culture that promotes this belief even
further.
Another cultural model that exists within the ELT is their ability to promote and support
change and innovation in the workplace. After reading The Innovator’s DNA and Creativity, Inc.,
it was clear that the ideas, concepts, and behaviors would change going forward. For example,
the early chapters of The Innovator’s DNA discuss disruptive innovators and associational
thinking becoming more relevant to daily work. Also, Creativity, Inc. presented the discovery
skills paired with techniques nurtured by the evolution of Pixar (Catmull, 2014; Dyer et al.,
2011). The ability for the ELT members to foster innovative ways to determine their solutions
for their customers further enhances UWN’s ability to remain a promising practice. These two
UNIVERSAL WELLNESS NETWORK 48
cultural models are part of the way of doing business that is difficult to name but easy to
recognize in speaking or working with these teams.
The first cultural setting is unparalleled commitment to the organization by way of
teamwork. The team functions using Lencioni’s (2002) framework around five common areas
for pitfalls: absence of trust, fear of conflict, lack of commitment, avoidance of accountability,
and inattention to results (Lencioni, 2002). Each member believes in their contribution to
something larger than themselves and provides and promotes others’ continued buy-in to the
second cultural setting supporting the leadership decision-making and direction. Similar to many
successful companies, UWN has strong and intelligent leaders but the difference is why they are
different. Cultural settings are critical for success, and UWN follows the basic human principles
of dignity, teamwork, discipline, trust, and joyful success (Sheridan, 2015). Having a blend of
structure without bureaucracy to make decisions while removing fear and building positive
energy by removing ambiguity is part of what makes it UWN (Sheridan, 2015). Table 4
illustrates how the two cultural models and two cultural settings influence UWN’s ELT and the
methods to assess any organizational gaps affecting the stakeholder goals, organizational goals,
and organization’s mission.

UNIVERSAL WELLNESS NETWORK 49
Table 4
Stakeholder Organization Influences
Organizational Mission
We give the ELT the tools and flexibility they need to effectively control costs and educate patients
on value, affording employers and others that administer self-funded plans the opportunity to take
control of costs.
Organizational Global Goal
Universal Wellness Network’s (UWN) goal is to maintain a 7% to 30% cost reduction in medical
spending month-to-month for its clients and users from 2018 to 2020.
Stakeholder Goal (If Applicable)
It is the goal of the UWN administration to increase or maintain the number of partnering
organizations while maintaining (or increasing) the 7% to 30% cost reduction in medical spending
month-to-month for its clients and users by December 31, 2019.
Assumed Organizational Influences Organization Influence Assessment
Cultural Model Influence 1: The ELT needs to
continue to work within a collaborative culture
Interview questions that will demonstrate the
ELTs shared vision by all stakeholders.
Cultural Model Influence 2: The ELT needs to
continue to promote and support change and
innovation in the workplace
Interview questions reflect the skills present by
all UWN members.
Cultural Setting Influence 1: The staff is
continuing to be committed to the
organization’s overall success
Interview questions about the appropriate
product for the clients but how The Superior
Choice works best for most.
Cultural Setting Influence 2: The staff is
continuing to support leadership direction
Interview questions about “onboarding” of
clients.

Conceptual Framework: The Interaction of Stakeholders’ Knowledge and Motivation and
the Organizational Context
In a broad sense, a conceptual framework can be defined as a system of assumptions,
expectations, beliefs, theories, and concepts that support and inform research (Maxwell, 2013).
Furthermore, a conceptual framework is the explanation of the interaction and relationship
between various factors represented in a study (Maxwell, 2013). According to this perspective, a
conceptual framework should serve as a tool to structure inquiry and as a map that connects the
point of departure on the quest for research (i.e., the problem) and the potential destination(s) or
UNIVERSAL WELLNESS NETWORK 50
possible solutions to the research problem, with all the stops throughout the journey that further
justifies the research and assists in identifying the most appropriate methods for exploring the
research questions (Kumar & Antonenko, 2014; Maxwell, 2013). This study considered previous
work but also recognized the context provided, from a practical perspective, that allows this
promising practice to flourish. With this understanding, the achievement of the stakeholder’s
goal was considered, assisting the researcher in identifying the methods that were most
appropriate to determine why UWN is a promising practice. Both a worldview perspective and
the assumed knowledge, motivation and organizational influences must be addressed
simultaneously for goal achievement to occur (Clark & Estes, 2008).
The worldviews that converge to inform this study are focused on positivism and
constructivism from an overarching broader view of pragmatism. The overarching view suggests
the approach of the pragmatist, using multiple approaches. We see what looks like a blend of
these views that work to inform one another using the approach with pragmatism. Pragmatism is
the view that “arises out of the actions, situations and consequences rather than antecedent
conditions” (Creswell, 2014, p. 10). However, to that point, this study sought what would work
in a situation and used multiple approaches to address the research problem of how and why
UWN is a promising practice.
Therefore, two worldviews become more of a focus. The first was the positivist approach.
The positivist is the worldview that seeks reality as being real and avoiding bias. In this
worldview, causal relationships often come forth with a belief that it is likely that x caused y,
which is a logical relationship between factors (Creswell, 2014). This knowledge is based on
careful observations and measurement of the objective reality that exists in the world (Creswell,
2014). This view follows more of a true quantitative research approach where the constructivist
leans more toward the qualitative approaches.
UNIVERSAL WELLNESS NETWORK 51
The second view is that of the constructivist, which is where the researcher uses the
process of interaction where meaning is made subjectively through personal interaction
(Creswell, 2014). This is illustrated when Creswell (2014) states, “The more open-ended
questioning the better” (p. 8). The researcher, following this belief, intended to find meaning
from others in the world (Creswell, 2014). The positivist will look to measure these reasons
while the constructivist will offer the perspective of meaning like why a set of leaders, teams, or
assets contribute to that success, and the pragmatist will want to bring in both sides using both
qualitative and quantitative processes to better understand this success from multiple
perspectives while generating new knowledge from the study (Creswell, 2014).
Previously mentioned was each of the constructs of the assumed knowledge, motivation,
and organizational influences highlighting, in tandem, achievement of the ELT’s goal of a
continued month-to-month medical costs savings of between 7% and 30% for its clients. Figure
2 below illustrates this conceptual framework.
UNIVERSAL WELLNESS NETWORK 52

Figure 2. Interaction of stakeholder knowledge, motivation and organizational cultural models
and cultural settings.

This figure outlines the relationships among the factors influencing the ELT and the
organizational culture and settings that contribute to the overall organizational goal. Specifically,
the solid orange circle to within which everything resides represents the UWN organization.
Inside that orange circle is the solid blue oval representing the ELT, and housed within that team
is the organizational goal. Additionally listed in Figure 2 above is acknowledgement of the
UNIVERSAL WELLNESS NETWORK 53
stakeholder influences that cause UWN to be a promising practice and the interactions that lead
to other outcomes supporting the ELT’s goal. Within this goal are the knowledge and motivation
influences that impact the overall goal. The knowledge influences are factual, procedural and
conceptual in how they are classified and support the ELT’s goal. The motivation influences
include self-efficacy theory, collective efficacy, and utility value. These influences must also
interact with one another for the achievement of the goal (Clark & Estes, 2008). Interacting with
each other within the larger organizational context, these influences are represented by these
shapes and images and are addressed simultaneously to best support growth towards the
stakeholder goal (Clark & Estes, 2008).
Conclusion
Several influences provide a glimpse into an often difficult to define construct known as
culture. Some of those influences are history, geography and family. Culture and its processes
are often difficult to measure, define, and operationalize for many reasons. As a model, culture
can be used to describe individuals and organizations, as culture is shared ideas and beliefs on
how the world works or ought to (Gallimore & Goldenberg, 2001; Rueda, 2011). Understanding
these organizational influences and factors as they relate to the culture, such as a belief in how
certain things get done and why certain policies exist, may be referred to as the “lay of the land”
(Rueda, 2011, p. 59). This explanation helps us to better understand the importance of the
organizational influences and how they relate to UWN as a promising practice. This framework
offers a tentative theory on how the KMO addressed simultaneously, as Clark and Estes (2008)
suggest, explain why the promising practice is more likely to occur.
UNIVERSAL WELLNESS NETWORK 54
CHAPTER THREE: METHODS
A review of a promising practice, UWN, will provide perspective on how this
organization is leading its industry with medical cost savings and how that could impact the way
healthcare is covered and delivered across the country. Healthcare-related costs continue to rise
and currently exceed 2 trillion dollars per year, and, in some cases, the cost of insurance
premiums is growing four times faster than wages (Keehan et al., 2016). This is not a sustainable
practice for healthcare delivery in the United States. In this study, the researcher utilized
qualitative methods for data collection and analysis. The researcher sought to answer the
following questions in this study.
Research Questions
1. What are the knowledge and motivation assets related to Universal Wellness Network
ELT’s high achievement of its goal of saving 7% to 30% of month-to-month medical
costs and increasing the number of lives covered by an additional 150,000 to 200,000
lives?
2. What is the interaction between organizational culture and context and ELT’s knowledge
and motivation?
3. What recommendations in the areas of knowledge, motivation, and organizational
resources may be appropriate for solving the problem of practice at other organizations?
This study used interviews with ELT members, observations in UWN’s organization, and
artifact and document analysis to seek the knowledge, motivation and organizational assets
which lead UWN to be considered a promising practice as an industry leader.
Participating Stakeholders
The stakeholders for this study are the ELT members. These primary stakeholders
represent the sample of the leadership team to provide critical input for the study because of the
UNIVERSAL WELLNESS NETWORK 55
importance they have in terms of the influence and impact they collectively instill toward both
the organizational goals and the ability to drive the organization as the best in its field and
industry.
Survey Sampling Criteria and Rationale
Due to a small number of participants within the stakeholder group of focus, surveys
were not used in this study.
Interview and/or focus group sampling criteria and rationale. All four members of
the ELT were the population for this study. Of these, five were interviewed separately to allow
for a complete collection of data in response to the questions this study sought to answer using
the conceptual framework from which the questions were derived. The rationale for including all
six ELT members was the influence and impact they collectively have toward both the
organizational goals and ability to drive the organization as the best in its field and industry.
They were also with UWN since its inception. Additionally, due to accessibility, more interviews
were conducted, resulting in 10 interviews (four with ELT and 6 with ELT) with an average time
of 27 minutes per interview. Of the 10 interviews, eight were conducted at UWN’s offices while
the other two were conducted over the phone. Three participants did not respond, including two
ST and one of the co-founders. The eight interviews were conducted at the UWN offices due to
mutual scheduling and convenience. The two phone interviews were conducted using that
medium, as geographical constraints did not allow for timely meeting face to face.
Interview sampling (recruitment) strategy and rationale. The justification behind
interviewing the six ELT members is strongly supported by Merriam and Tisdell (2016) in that
purposeful sampling is effective when a researcher seeks to gain an understanding of a particular
phenomenon and must seek out the sample that will allow them to learn more about this
phenomenon. Interviews were the first data collection method used, followed by observations
UNIVERSAL WELLNESS NETWORK 56
and document/artifact analysis. Additionally, Merriam and Tisdell (2016) share that, when
subjects of a research study are few, it is then appropriate to include them all as part of the
sample. Given the ELT consists of only six members, a purposeful and convenient sample
including the whole ELT was most appropriate. Purposeful sampling provided information-rich
observations that exposed deeply rooted insight on the phenomenon that was the focus of this
study. Conducting interviews with the four ELT members provided rich data related to their
knowledge and motivation, which provided context and a unique culture sharing on how these
two areas interact with organizational influences to ensure the ELT’s continue success with
UWN.
This approach alone may not provide enough data to draw conclusions. Therefore, the
author depended on triangulation, as supported by Maxwell (2013) suggesting that triangulation,
which involves collecting information from multiple sources, reduces the risk of biased
outcomes and enhances the ability to assess the explanations from qualitative research. Using
this triangulation approach provided a more robust explanation of the phenomenon being
studied.
Observation Sampling Criteria and Rationale
Criterion 1. To observe ELT members by shadowing at least three of the six to obtain
insight to their daily routines, interactions, requests, directions and focus.
Criterion 2. To observe team or department leads to allow for the collection of rich data
to support the effectiveness and influence the ELT has throughout UWN.
Criterion 3. To observe team meetings that include the ELT to further support the
collection of rich data through triangulation.

UNIVERSAL WELLNESS NETWORK 57
Observation Sampling (Access) Strategy and Rationale
Observations were part of the triangulation and approach to collect rich data to assist in
answering the research questions. Observations provide an opportunity to “spend [a] substantial
amount of time in the natural setting” (Merriam & Tisdell, 2016, p. 18) to allow for data
collection related to the phenomenon studied in this research. Observers can benefit from a
checklist similar to that used in interviews, according to Merriam and Tisdell (2016), and one
might consider how structured the observations may be. In this case, the researcher used the
physical setting to observe and take note of participants during interactions, taking note of
behavior and conversations. The observations were conducted following the interviews of the
four ELT members. Furthermore, Bogdan and Biklen (2011) provide suggestions for how
observers can be in a stronger position to obtain data. Some of those suggestions are
introductions to staff, keeping initial observations short, working to be unobtrusive and simply
being honest and friendly with what you are doing. Given the richness of the observations and
how they play in the triangulation method, this approach was the most appropriate for this study.
Document Analysis Sampling Criteria and Rationale
Criterion 1. Personal documents and memos were sought to obtain personal insight on
communications expressing knowledge, motivation, and cultural influences.
Criterion 2. Popular culture, popular media, and other visual documents were used to
identify other knowledge, motivation, and cultural influences.
Criterion 3. Policies and procedures were used to further identify knowledge and
cultural influences.
Document analysis comes using a broadly expressed word and one that can include many
areas for data mining. For that reason, it was included as part of the method of triangulation of
data. In this study, documents and sources were analyzed following the interviews and
UNIVERSAL WELLNESS NETWORK 58
observations to show distinct and specific indicators related to the knowledge, motivation and
cultural influences for this study. As suggested by Merriam and Tisdell (2016) the use and
inclusion of documents and artifacts in a study can help uncover meaning, develop understanding
and discover insights relevant to the research problem.
Qualitative Data Collection and Instrumentation
This study incorporated interviews, observations, and document analysis. The intent of
the interview questions was to discover the knowledge, motivation, and organizational needs of
the ELT members as they continue to lead their competitors in their industry. Observations
provided rich insight into the daily interactions between ELT members, department leads, staff
and clients to further validate the findings from the interviews. The document analysis was a
final step in corroborating interviews and observations as a means for triangulation. These
qualitative data collection methods are well supported by literature. These approaches provide
means for rich data and reduced weakness and bias of data (Creswell, 2014; Merriam & Tisdell,
2016). McEwan and McEwan (2003) suggest different methods to be considered for support
validity and reliability for good research. With this rationale shared for the qualitative data
collection selected for this study, the following sections further explain those areas of data
collection.
For data collection, the researcher used several qualitative methods for triangulation to
answer the research questions. Part of those methods are observations, in-person interviews, and
document analysis. This structured approach was intended to ensure comparability of data across
individuals, times, and settings (Maxwell, 2013). Additionally, the pre-structuring of methods
can assist in reducing the amount of data, simplifying the analytic work required (Miles &
Huberman, 1994). Each method in this research helped further support the KMO influences
framework described earlier in this study. The in-person interviews provided insight and
UNIVERSAL WELLNESS NETWORK 59
supported the KMO framework but may also focus on the K. The document analysis focused on
the K and O. This approach only included several qualitative methods used when little is known
about a particular population or subject, and having a promising practice lends to this approach
to extract this information for the purpose of triangulation tying back to the research questions.
The following methods are described in further detail below.
Interviews
Interview protocol. This protocol was in the form of semi-structured interviews from a
neo-positivist approach making use of open-ended questions paired with some guidance for
questions that would provide richer information and data. This neo-positivist approach is where
the skillful interviewer asks good questions while minimizing bias to generate quality data
(Merriam & Tisdell, 2016). As part of this approach, the interviews helped gain information
about different aspects of the organization being studied. This approach, using multiple sources
and methods, can also bring forth added credibility versus the limitation of using only one source
or method (Maxwell, 2013).
Interview procedures. The interviews were conducted from September to October 2019
for two reasons. The first is that it was past the rush of work with clients for the organization
being studied, and second was for the researcher to have more flexibility in conducting the
interviews. Additionally, having the ability to interview prior to document analysis helped drive
what documents or types of documents were reviewed and analyzed as part of the study based on
the results of the interviews. This approach allowed for a timelier execution to obtain the
documents for review or access to them in a more direct, coordinated manner, making the effort
more coordinated and less disruptive to those at the organization. Each interview with the four
executives was intended not to exceed 60 minutes and averaged 27 minutes per interview.
However, the ELT member interviews were twice as long as those of the ST participants.
UNIVERSAL WELLNESS NETWORK 60
Fortunately, no interviews needed to be rescheduled, including any follow-up with any questions
that were not addressed during the initial interview. Each interview yielded more than enough
information. The data for these interviews were captured using two recording devices that
quickly transitioned solely to one due to the ease and accuracy of the technology for capturing
the audio and immediately transcribing upon conclusion of each interview through transcription
services provided by Rev.com.
Observation
Observation protocol. In addition to interviews, observations are a primary source of
qualitative data and generally take place in a setting where the behavior of interest naturally
occurs to provide a firsthand experience with this behavior of interest (Merriam & Tisdell, 2016).
Using the observation method worked to support exploration of the KMO framework as a
promising practice study allowing the researcher to observe the K, M, and O behaviors that are
difficult to see, feel, or measure by any other method. Knowledge can be measured through some
interview approaches and document analysis, but it is difficult to validate until observed on how
the unique skill(s) for each executive leadership person on the executive team is used in a normal
capacity. This same idea fits specifically for observation to measure the motivation approach as,
at times, motivation itself is something that cannot always be seen, touched, or measured. These
observations allowed for that opportunity. Finally, the organizational influences approach
benefited from the observation to better understand how the complex work, team composition,
and execution work together. This approach, again, allowed for a mix of methods to triangulate
data and information to further validate findings.
While the details of how many observations and duration are difficult to quantify based
on several factors (Merriam & Tisdell, 2016), the researcher intended to be both a complete
observer and participant observer for a minimum of three two-hour blocks of time onsite at the
UNIVERSAL WELLNESS NETWORK 61
UWN offices to further observe the interactions of the ELT and the rest of the employees as
these relate to the research questions, but specifically the KMO methods. Having the ability to
first observe only and then ask questions helped to further verify the KMO approaches,
providing additional validity and reliability to the experienced observations. In these roles the
researcher used a combination of hand-written notes, laptop and verbatim notes to capture
observations.
Observation procedures. Observations were conducted with a cohort sample at the
convenience of the team’s availability in their home office. Three formal observations included a
general observation day that included 6 to 10 staff members throughout the day, leadership team
meeting that included approximately six staff members, and an all-staff meeting that included 13
staff members at that time of the observation. Observations procedures followed the observation
protocol as suggested by Creswell (2014) to record descriptive notes (portraits of participants,
reconstruction of dialogue, description of physical setting, accounts of particular activities) from
reflective notes on the “researchers personal thoughts, feelings, problems, hunches, impressions
and prejudices” (Bogdan & Biklen, 1992, p. 121). These observations were a follow-up method
after having conducted all of the interviews with the available ELT members.
Following the observation phase was the document/artifacts collection, so the researcher
would have a stronger context as to what documents/artifacts he needed to review and collect to
further verify or validate any other observations or support any findings from the interview
and/or observations data. As noted earlier, the researcher was both a complete observer and
participant observer for a minimum of three two-hour blocks of time onsite to further observe the
interactions of each member of the ELT and the rest of the employees using a combination of
hand-written notes, laptop, and verbatim notes to capture observations. The researcher completed
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three observations: an ELT meeting in October 2019, an all-staff meeting in September 219, and
an all-staff meeting in October, 2019.
Documents and Artifacts
Analysis of documentation and artifacts is due to the fact that qualitative and
observational research has the potential drawback of misinterpretation of participant thoughts,
word, and/or actions (Merriam & Tisdell, 2016). Document analysis offers the ability to prevent
methodological bias, providing a check and balance to assist in validating and triangulating the
responses from quantitative and qualitative approaches (Maxwell, 2012; McEwan & McEwan,
2003). In this study, the document and artifact review occurred following the qualitative efforts
to provide a stronger understanding of the documents and artifacts being reviewed (Creswell,
2014; Merriam & Tisdell, 2016).
As noted by McEwan and McEwan (2003) the review of documents and artifacts
provides the means for triangulating and closing the gaps between surveys and observations. The
collective analysis of these approaches using documents and artifacts as the final phase provided
additional understanding of the assumed KMO influences that are the driving force behind the
research questions for this study. In this study, review of memos within the organization related
to growth, culture, or strategic plans were also analyzed. Additionally, a review of policies and
procedures related to customer interaction, fostering, and securing as clients was undertaken. The
author already had access to the originally published white papers and other research-focused
publications posted on UWN’s website that were included in the document/artifact review and
analysis. Toward the end of the interview and observation process, one of the co-founders and
ELT members offered to assist the researcher in aligning UWN’s internal policies and
procedures to the KMO influences.

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Alignment of KMO Influences and Data Collection Methods and Instruments
Table 5 shows each KMO influence and the method used to measure the influence.
Alignment of the methods and methods is demonstrated through the rows.
Table 5
Data Collection Methods for Assumed Knowledge, Motivational, and Organizational Influences
Organizational Mission
We give the ELT the tools and flexibility they need to effectively control costs and educate patients on
value, affording employers and others that administer self-funded plans the opportunity to take control
of costs.
Organizational Global Goal
Universal Wellness Network’s (UWN) goal is to maintain a 7% to 30% cost reduction in medical
spending month-to-month for its clients and users from 2018t o 2020.
Stakeholder Goal
It is the goal of the ELT to increase or maintain the collaborating partners while maintaining (or
increasing) the 7% to 30% cost reduction in medical spending month-to-month for its clients and users
by December 31, 2019.
Knowledge Influences
Assumed Knowledge
Influences
Knowledge Type &
Influence Assessment
Interviews and Focus
Group Questions
Document
Observation
Analysis Triangulation
ELT members have
knowledge of the
payment schedules and
structures from several
insurance companies,
allowing them to better
understand the potential
for profit margins.
Factual
ELT members will be
asked what they know
about payment
schedules and
structures.
Would you please walk
me through how you save
7% to 30% on medical
costs for your clients
annually? (Probe for
specifics, including merits
and shortcomings of
each.)
The presence or
absence of the
payment schedules
from hospitals and/or
insurance companies.
ELT members
understand the billing
and reimbursement
complexities among
hospitals, clinics, and
the inpatient/outpatient
care settings
Conceptual
ELT members will be
asked what they know
about billing and
reimbursement
between the
inpatient/outpatient
settings.
What processes must you
take to ensure
reimbursement occurs?
What are the processes for
inpatient and outpatient
settings?
The presence or
absence of examples
of reimbursement and
the inpatient/outpatient
billing settings.

UNIVERSAL WELLNESS NETWORK 64
Table 5, continued
Assumed Knowledge
Influences
Knowledge Type &
Influence Assessment
Interviews and Focus
Group Questions
Document
Observation
Analysis Triangulation
ELT members
understand the
differences associated
with many
comorbidities related to
patient outcomes,
compliance, and how
that plays a role in costs
and reimbursement.
Conceptual
ELT will be asked
about their
understanding of other
variables that
influence their work
with clients.
What processes
allow you to assist
organizations in
their cost savings?
How do you provide
your product(s) to
your client(s)?
The presence or
absence of examples
of billing,
reimbursement
models,
comorbidities, health
related outcomes for
client employees.
ELT members know
how to onboard clients
to optimize services
with the appropriate
product.

Procedural
ELT follows specific
steps to provide all
options of products
for clients before
finalizing most
appropriate.
What products do
you discuss with
your clients?

How do you
determine the most
appropriate product
for your client?
The presence or
absence of steps to
follow providing all
product options to
clients before
finalizing most
appropriate.
ELT members monitor
and evaluate their
progress toward
achieving the client’s
goals.
Metacognitive
ELT members will be
asked to reflect on
how they monitor and
evaluate their progress
with clients.
What processes
have you used or
will you use to
monitor and
evaluate your
progress toward
achieving the
client’s desired
goals?
The presence or
absence of examples
that would show the
ELT processes for
monitoring and
evaluating progress
with clients.
Motivational Influences
Assumed Motivation
Influences
Motivational
Influence Assessment
Interviews and
Focus Group
Questions
Document Analysis
Triangulation
Self-Efficacy – ELT
members are confident
of achieving the high
cost savings for their
clients suggested by
UWN
Interview,
Observations
Interview item:
How do you feel
UWN can
continually save
clients between 7%
and 30% of their
annual medical
spending?
The presence or
absence of
information
demonstrating
continued annual
cost savings for
clients.

UNIVERSAL WELLNESS NETWORK 65
Table 5, continued
Motivational Influences
Assumed Motivation
Influences
Motivational
Influence Assessment
Interviews and
Focus Group
Questions
Document Analysis
Triangulation
Collective Efficacy -
ELT members are
confident that the team
can achieve the annual
medical costs savings
of 7% to 30% in
addition to the number
of lives covered with
each client.
Organizations need to
find the motivational
commitment to their
mission, resilience to
adversity and
performance
accomplishments UWN
provides in reducing
medical costs while
providing high-quality
care.
Interview,
Observations
What do you
attribute your
success to?
How do you go
about setting and
achieving your
annual goals?
Tell me about how
confident you are in
the team’s ability to
reach UWN’s cost-
savings goal on an
annual basis with its
clients.
The presence or
absence of
information
demonstrating
continued annual
costs savings for
clients.
Utility Value – ELT
members value
organizations’ needing
to find the value that
UWN provides in
reducing medical costs
while providing high-
quality care
Interviews,
Observations
Interview item: Tell
me about how you
find value in the
products UWN
provides its clients.

Tell me about how
clients find value
with the products
UWN offers.
The presence or
absence of
information
demonstrating
continued annual
costs savings for
clients.
Attribution:
ELT members attribute
their success or failure
to achieve cost savings
for their clients to their
own efforts.
Interviews,
Observations
Describe to me how
well you believe the
ELT did with your
stakeholder goals.
Presence or absence
of related success or
failure to that of the
efforts of the ELT

UNIVERSAL WELLNESS NETWORK 66
Table 5, continued
Organizational Influences
Assumed
Organizational
Influences
Organizational
Influence Assessment
Interviews and
Focus Group
Questions
Document Analysis
Triangulation
Cultural Model
Influence 1:
The ELT needs to
continue to work within
a collaborative culture
Interviews,
Observations
Tell me about the
culture of the ELT
collaboration.

How do you create a
culture of
collaboration
throughout the
company?
The presence or
absence of
documents
demonstrating
collaboration efforts
with UWN staff
and/or clients.
Cultural Model
Influence 2:
The ELT needs to
continue to promote
and support change and
innovation in the
workplace
Interviews,
Observations
Tell me about how
you promote and
support change and
innovation with
your teams.
The presence or
absence of
documents
encouraging
innovative efforts
within UWN and
with clients.

Cultural Setting
Influence 1:
The staff is continuing
to be committed to the
organization’s overall
success

Interviews,
Observations
Tell me about your
efforts to maintain
the staff’s
commitment to the
organization’s
overall success
The presence or
absence of
documents
demonstrating
engagement by staff
toward UWN’s
goals.
Cultural Setting
Influence 2:
The staff is continuing
to support leadership
direction
Interviews,
Observations
Tell me about how
staff should support
the leadership
direction.
The presence or
absence of
documentation
demonstrating staff
support to
leadership.

Data Analysis
Data analysis for this study began during the data collection through interviews,
observations, and document analysis. Following each interview, the researcher scribed analytical
memos including documentation of thoughts, concerns, and initial conclusions about the data
related to the study’s conceptual framework and research questions. Interview transcriptions
were captured through two recording devices and uploaded using Rev. However, after the first
UNIVERSAL WELLNESS NETWORK 67
couple of interviews, only one device was used due to the ease and accuracy of using Rev.com.
The interviews were then coded from the first through tenth interviews prior to the observations
and were broken into ELT and ST. In the first phase of analysis, a priori codes from the study’s
conceptual framework were applied (i.e., codes pertaining to the knowledge, motivation, and
organization needs and assets of the ELT), in addition to open codes (i.e., those outside the
knowledge, motivation, and organization framework). A second phase of analysis was conducted
where a priori and open codes are aggregated into analytical/axial codes. The third phase of data
analysis identified pattern codes and themes that emerge in relation to the conceptual framework
and study questions.
Credibility and Trustworthiness
For a study to serve as a guide for changing the aspects of the methods of research and
data collection, it must be credible and the trustworthiness of the investigator, including their
intentions and unwavering respect for participants must be impeccable (Clark & Estes, 2008).
This study used a qualitative approach with three sources of data: interviews, observations, and
documents. Securing the trust of UWN’s ELT was a key aspect of gaining useful data.
According to Merriam and Tisdell (2016) a combination of sincerity, transparency, and ethical
rigor must apply to all aspects of the study, as these approaches guided the collection of data and
interpretation of all aspects of the study.
The use of triangulation through interviews, observations, and document/artifact analysis
was maximized to further results that increased and validated information and improved
credibility by use of multiple sources (Creswell, 2014; Merriam & Tisdell, 2016). To this point,
Maxwell (2012) suggests that triangulation by itself does not ensure credibility but seeks to
remove potential biases on the part of the respondent and investigator. It is that inherent risk of
investigator bias that follows all researchers, and recognizing this risk is a critical step (Merriam
UNIVERSAL WELLNESS NETWORK 68
& Tisdell, 2016). The manner in which the researcher set up the phases of the study in a specific
order built on the opportunities for the researcher to gain additional trust. For example,
interviewing the ELT members first provided a stronger interpersonal connection for the purpose
of the research in that they saw why the research was conducted, which led to trust from the
employees who then became familiar with the researcher’s presence and were more open and
willing to allow the researcher to conduct observations in their natural environment. This
credibility and trust ensured a final opportunity to obtain the remaining documents/artifacts for
analysis to conclude the study’s findings, allowing for analysis of all of the data.
Validity and Reliability
The validity and reliability of research was another key component of its successful
execution and was approached through careful attention from the overall vision of the study
down to the way in which data were collected, analyzed, and interpreted as well as presented
(Merriam & Tisdell, 2016). “Validity is one of the strengths of qualitative research and is based
on determining whether the findings are accurate from the standpoint of the researcher, the
participant, or the readers of an account” (Creswell, 2014, p. 201).
Ethics
As an integral part of research, ethics must be considered for protection for and against
potential participants and for the integrity, validity and reliability of the data and information
being obtained to analyze as a product of the study. This integral part is essential for qualitative
research, and the ethical approach should be considered in every aspect of the design of the
research to be respectful of participants’ time and responses (Creswell, 2014; Maxwell, 2013;
Merriam & Tisdell, 2016). Ultimately, the protections in place by institutional review boards
(IRB) for all academic institutions was to serve the primary purpose of protecting the participants
from harm.
UNIVERSAL WELLNESS NETWORK 69
It is imperative to have a strong understanding and ability to adapt to participants’
concerns. Anticipating problems, including perception, fear, and power differences and how
these were addressed should be included in the planning and explanation (Maxwell, 2013).
Participants will be more likely to assist in completing surveys and interviews given previous
understanding of the explanation for and purpose of the study (Maxwell, 2013).
For purposes of this explanatory sequential mixed-methods study, three integral
protections were involved prior to the collection of data to serve as additional ethical procedures:
University of Southern California (USC) approval, participant review and signature of informed
consent forms, and general data collection procedures. A discussion of each follows sequentially.
First, approval for this study was subject to USC IRB approval processes. IRB approval
is required to protect participants, investigators, and the institutions (Glesne, 2011; Rubin &
Rubin, 2012). Second, informed consent releases signed by each participant ensure proper
understanding of the study’s purpose and scope. The forms follow recommendations by Glesne
(2011) and Rubin and Rubin (2012) addressing the voluntary nature of participation and the right
of the participant to withdraw at any point. Third, general research procedures value participant
privacy and protection over data collection. The priority of the investigator was to ensure the
confidentiality of those who may be identified during the interviews. Additionally, all
participants were notified of recording processes used in official data collection. Another
important aspect to the researcher was participant review of interview transcripts, specifically
regarding direct quotations. Finally, participants did not receive incentives in violation of or
against policies within UWN or any of its direct affiliates or clients.
In this research, the investigator is not an employee, client, or otherwise related affiliate
of UWN and did not receive any direct benefits related to this study outside of access to
information related to the study, including access to data, clients, and staff. While the results of
UNIVERSAL WELLNESS NETWORK 70
this study may be of interest to others, they were shared only with the acting CEO of UWN
unless otherwise directed by the CEO. Due to the investigator being outside of UWN, steps were
taken to keep access limited through the use of a memorandum of understanding that was
executed between the investigator and UWN’s CEO in March 2018. The support provided by the
CEO was a result of the investigator’s dissertation experience and solely used for that purpose
unless directed otherwise by the CEO of UWN. In accordance with Merriam and Tisdell (2016)
and Creswell (2014), the investigator must remain neutral in the data collection efforts.
Therefore, all steps listed in this ethics section were taken to protect the participants, the study,
the investigator, UWN, and the University of Southern California.
Limitations and Delimitations
There are several limitations and delimitations associated with this study. First, the small
number of stakeholders of focus dismisses broad generalizations related to the findings. Second,
the time allotted to complete the study curtailed the complete validation of the assumed
influences, including the stakeholder assets and needs. To test this premise, the researcher
experienced activities with the ELT in hopes of seeking support as to whether the knowledge,
motivation, and organization needs and assets of the ELT were explicitly expressed.
The role of the researcher brings a delimitation of application to the study. While the
researcher is not an employee of UWN, having access to sensitive information and
interoperability may have caused heightened sensitivity around confidentiality, leaving the
researcher in a position of vulnerability in attempting to obtain trust from all employees and ELT
members for the purpose of this study. To protect this, the researcher signed a memorandum of
understanding with the CEO of UWN laying out roles and responsibilities related to the study’s
intent, purpose, and follow-through from beginning to end of the study.
UNIVERSAL WELLNESS NETWORK 71
The final delimitation relates to the primary stakeholder group. Much of the success for
the study relies on the group of four ELT members and their cooperation to allow the researcher
the opportunity to conduct and engage in research methods to discover, explore, and further
understand the knowledge, motivation, and organizational influences acting on them that support
UWN’s annual goals.

UNIVERSAL WELLNESS NETWORK 72
CHAPTER FOUR: RESULTS AND FINDINGS
The purpose of this project was to examine why UWN should be considered a promising
practice for continually and annually replicating their desired stakeholder goal of saving 7% to
30% of month-to-month medical costs and increasing the number of lives covered by an
additional 150,000 to 200,000 lives by December 2020. Specifically, the study focused on three
research questions to inform the development of recommendations to address the findings.
1. What are the knowledge and motivation assets related to Universal Wellness Network
ELT’s high achievement of its goal of saving 7% to 30% of month-to-month medical
costs and increasing the number of lives covered by an additional 150,000 to 200,000
lives?
2. What is the interaction between organizational culture and context and ELT’s knowledge
and motivation?
3. What recommendations in the areas of knowledge, motivation, and organizational
resources may be appropriate for solving the problem of practice at other organizations?
The presentation of findings was centered on a set of influences related to three KMO
areas. These areas were supported through a conceptual framework to delineate assumed causes,
thereby putting findings for this study into areas of needs or assets. For each finding, qualitative,
interview, observation, or document analysis from a single source a singular methodology for
understanding the themes was drawn from the entirety of the study and not from a singular
perspective. As part of this structure, the findings align with and follow the KMO order provided
in Chapter Two to create the pathway followed by relevant qualitative assessments and
document analysis to collate and connect the findings to the research questions.

UNIVERSAL WELLNESS NETWORK 73
Participating Stakeholders
In this study the researcher approached, using a solicitation email (Appendix A), 13
potential participants, and 10 participants engaged in the qualitative interviews. Interviews
followed a semi-structured interview protocol (Appendix B). Two of the interviews were
conducted via telephone given schedule and geographic challenges. Eight of the interviews were
conducted at the UWN home offices. Interviewing these 10 participants provided strong enough
responses to the research questions to reach saturation. Recording and transcription of each
interview was conducted using Rev.com. Additionally, document analysis played a role in the
analysis for purposes of triangulation of sources.
Determination of Assets and Needs
According to McEwan and McEwan (2003), triangulation is the use of multiple data
collection methods primarily used in qualitative research. This approach requires the researcher
to disclose personal biases, predispositions and even connections to the subject of study
(McEwan & McEwan, 2003). This researcher disclosed those components but, more importantly,
used these methods to take a deeper dive into the data to decrease the likelihood of any
conclusions being drawn from limited data. Therefore, the researcher used the combination of
interviews, observations, and document analysis to assess the promising influences related to
knowledge, motivation, and cultural influences by the stakeholder group.
Interviews were conducted until saturation occurred among the majority of the
participants. Saturation included agreement among responses from all participants. This is
further supported by Merriam and Tisdell (2016) when they suggest that saturation is complete
when no new information has been shared. Additionally, analysis of data produced enough data
to create categories, themes or other findings (Merriam & Tisdell, 2016).
UNIVERSAL WELLNESS NETWORK 74
To determine if information was deemed an asset or need, the information was first
broken into two groups: the primary stakeholder group, the ELT and the secondary stakeholder
group, the ST. The ELT was the initial stakeholder group to be studied; however, due to access
to the ST group and the idea of additional data that may support findings, it was determined that
both groups would be interviewed. Therefore, findings are notated addressing both stakeholder
groups in the following sections of this chapter. Once in these groups, it was determined the ELT
that all ELT members must agree or information must have been presented by all four ELT
members, for it to be considered an asset. The ST group included six participants, and it was
determined that three of the six ST had to agree or information had to be presented by at least
three ST members for it to be considered an asset. The same criteria remained in place for the
observations to determine if information was an asset for both ELT and ST groups. Documents
were paired with characteristics and influences through the guidance of two ELT members
working to assign correlating documents under each supporting influence in knowledge,
motivation and organizational context.
Document analysis was initially pursued by the researcher to extract which documents,
policies, and/or procedures best aligned with each of the K, M, and O influences to assist in
triangulating the findings. One of the ELT participants who was also a co-founder suggested it
might be easier for them to take the list of interview questions and overlay that with the plethora
of documents they have to provide the researcher with a more accurate listing of which
document supports each influence under the K, M, O structure. With this co-founder’s assistance
and that of their team, the researcher obtained a more accurate list of the documents, policies,
and/or procedures which best aligned with each of the identified influences.

UNIVERSAL WELLNESS NETWORK 75
Results and Findings for Knowledge Causes
The findings are centered on the KMO influences derived from the conceptual
framework. Under knowledge, four types of knowledge were analyzed: factual, conceptual,
procedural and metacognitive (Anderson & Krathwohl, 2001). Each qualitative finding and
document analysis from a single data source coalesce to deliver a singular methodology for
understanding the themes drawn from the entirety of this study and not from a singular
perspective. The structure for the findings follows the order of the KMOs provided in earlier
chapters to lead the discussion to link findings to the research questions of this study. As noted
above, for these findings, two groups are reported out: ELT and ST. To this point, evidence
supporting each group includes excerpts from ELT stakeholder group (Participants 1, 4, 8, and 9)
as well as excerpts from the ST stakeholder group (Participants 2, 3, 5, 6, 7, and 10).
Factual Knowledge
Influence 1: ELT members have knowledge of the payment schedules and structures
from several insurance companies, allowing them to better understand the potential for
profit margins. The ELT members know the payment structures and schedules from the
insurance companies. The ELT members understand how those variables impact profits. Due to
this knowledge, the ELT members understand the potential for increased profit margins.
Survey results. No survey was conducted for this study.
Interview findings. ELT interviewees were asked what role they played in achieving
goals for their clients. Many of the participants play a specific role, but others have caveats to
their role or additional responsibilities. For instance, Participant 1 works more closely with
human resources functions while Participant 4 shared, “I really wear four or five hats.”
Participant 8 works with providers on specific areas like contracting rates while Participant 9
focuses on compliance contracting. All four ELT participants were able to state their
UNIVERSAL WELLNESS NETWORK 76
understanding and role in supporting this influence. Therefore, this influence was determined to
be an asset for the ELT group.
The ST interviewees were asked what role they played in achieving goals for their
clients. Similar to the ELT participants, some may cross over with job responsibilities, but many
have a narrower focus. For example, Participants 2 and 3 work with insurance and the bundled
payments whereas Participants 5 and 10 focused on something similar with members.
Participants 6 and 7 focused mostly on IT related issues. All six ST participants were able to
state their understanding and role in supporting this influence. Therefore, this influence was
determined to be an asset for the ST group.
Observation. Through three observations, it was clear that the ST deferred to the ELT no
less than three times during formal meetings for clarification related to processes or procedures
involving insurance, particular payment structures (strong referral to bundled payments), and
profits. This was evident during all three observations. After presentations of formal reports or
specific information, the dialogue that often followed was that of an ELT member sharing
specific information to clarify and/or provide direction related to specific questions and actions
to the ST participants. Therefore, this influence was determined to be an asset for both ELT and
ST participants.
Document analysis. Components of the payments, bundles, contracts and subsequent
lead to profit can also be documented in the Full Implementation Checklist utilized by UWN for
successful and efficient implementation of products with a client. According to Participant 10,
this checklist is used for each new client, and implementation is typically achieved in 45 to 60
days. Participant 1 also stated components of this influence are noted in their use of the Provider
Implementation Checklist and Claims Process Procedures.
UNIVERSAL WELLNESS NETWORK 77
Summary. The assumed influence that ELT members have knowledge of the payment
schedules and structures from several insurance companies, allowing them to better understand
the potential for profit margins was determined to be an asset through analysis of data from all
three sources: interviews, observations and documents. The consistent referral to ELT members
in both interviews and observations was evident as well as these influences being captured in a
policy or process being utilized on a regular basis was evident. Therefore, this influence was
determined to be an asset for both ELT and ST groups.
Conceptual Knowledge
Influence 2: ELT members understand the billing and reimbursement complexities
among hospitals, clinics, and the inpatient/outpatient care settings. The ELT members
understand the different payment structures related to the setting in which care is provided. This
understanding provides ELT members the opportunity to structure payments in a bundle method
versus the traditional fee-for-service method.
Survey results. No survey was conducted for this study.
Interview findings. ELT interviewees were asked to walk through how UWN saves 7%
to 30% on medical costs for their clients. Participants shared specific examples and larger, more
strategic viewpoints. For example, Participant 1 shared a specific example of working with
providers and insurance companies to ensure the patient does not see a bill. Similarly,
Participant 8 shared specific examples of working with providers to secure fixed episodic direct
contracting rates. Participant 4 had a more strategic perspective discussing how UWN must
understand the market to best identify ways to narrow in on the “sweet spot.” Likewise,
Participant 9 shared they work with provider groups and shared how they could be a part of
UWN’s work by seeing what options UWN has and how they may be able to provide a value
price for those options. All four ELT members were able to state their understanding and role in
UNIVERSAL WELLNESS NETWORK 78
supporting this influence. Therefore, this influence was determined to be an asset for ELT
participants.
ST interviewees were asked to walk through how UWN saves 7% to 30% on medical
costs for their clients. Three of the ST participants clearly stated how UWN works with bundled
payments and single CPT coding to ensure a streamlined approach working with insurance
companies to keep patients from receiving bills while allowing for providers to be paid in full.
The ST had three of six participants able to state their understanding and role in supporting this
influence. Therefore, this influence was determined to be an asset for the ST group.
Observation. Through three observations, it was clear the ELT understood the billing and
reimbursement complexities among hospitals, clinics, and inpatient/outpatient care settings. This
was evident in all three observations. After presentations of formal reports or specific
information, the dialogue that often followed was that of an ELT member sharing specific
information to clarify and/or provide direction related to specific questions and actions to the ST
participants. It was clear that about half of the ST participants understood the billing and
reimbursement components. Therefore, this influence was determined to be an asset for both
ELT and ST participants.
Document analysis. During the interviews, participants shared that a number of policies,
checklists, and procedures support this influence. Although not examined personally by the
researcher, the participants stated that these policies and checklists provide structure supporting
work on contract negotiation, working with the bundled payments, and working with the
billing/reimbursement areas.
Summary. The assumed influence that the ELT members understand the billing and
reimbursement complexities among hospitals, clinics, and inpatient/outpatient care settings was
determined to be an asset through analysis of data from all three sources: interviews,
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observations and documents. The consistent referral to ELT participants by ST participants in
both interviews and observations was evident, and these influences were captured in a policy or
processes utilized regularly. Therefore, this influence was determined to be an asset for both ELT
and ST groups.
Influence 3: ELT members understand the differences associated with many
comorbidities related to patient outcomes, compliance, and how that plays a role in costs
and reimbursement. The ELT members understand these differences and how costs and
reimbursement play a role as well. The ELT members specialize in a few of these areas, as do
some of the ST participants.
Survey results. No survey was conducted for this study.
Interview findings 1. ELT interviewees were asked what they attribute success to. There
was a clear agreement of a dynamic team that contributes to success. This might look different
from different perspectives but Participant 1 and 4 agree the teams are what makes the difference
and Participant 9 agrees that the team understands where needs are. However, Participant 8
focused specifically on getting contracts in and signed as a key to success. All four ELT
members were able to state their understanding in supporting this influence. Therefore, this
influence was determined to be an asset for ELT participants.
ST interviewees were asked what they attribute success to. Only two of the six ST
interviewees provided this clear understanding. Participant 3 referred to the understanding of the
market and the sweet spot mentioned earlier. Participant 6 referred to the collective experience of
the ELT and ST together. Only two of six ST members were able to state their understanding in
supporting this influence. Therefore, this influence was determined to be a need for ST
participants.
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Interview findings 2. ELT interviewees were also asked what unique skills their ELT had
that their competitors did not have that make them successful. There was a clear agreement from
the ELT members that the healthcare background of the co-founders plays a role but, more
importantly, that they come from the provider side. Additionally, ELT interviewees felt their
clear vision and attention to detail play a role in their overall success that set them aside from
others. All four ELT members were able to state their understanding in supporting this influence.
It is important to note that one ELT member was found to state their understanding in notes but
not on the transcript, as it was cut-off and unable to be re-captured. Therefore, this influence was
determined to be an asset for ELT participants.
ST interviewees were also asked what unique skills their ELT had that their competitors
did not have that make them successful. Overwhelmingly, the ST interviewees referred to the
ELT’s significant healthcare experience and background as the unique differentiator. The
knowledge alone was another consistent reference from this group referencing the ELT.
Succinctly put by Participant 2, “I know we all have a medical background.” This was echoed by
Participant 5 shared when they said, “We have people here that have a great knowledge base, a
lot of areas in healthcare” while Participant 6 repeated this theme stating, “The biggest one
would be the knowledge of health care. That would be the number one thing.” Then, Participant
7 stated, “I see a very deep knowledge base.” There was clear agreement with the ST
interviewees. The ST had four of six participants able to state their understanding in supporting
this influence. Therefore, this influence was determined to be an asset for the ST participants.
Observation. Through three observations, it was clear that the ELT members understand
the differences associated with many comorbidities related to patient outcomes, compliance, and
how that plays a role in costs and reimbursement. On several occasions a team member asked for
clarification as to why a process or step must be taken, not completely understanding the
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background that this influence suggests. It was during those conversations that ELT members
relayed their knowledge and application of this influence to the ST participants. After
presentations of formal reports or specific information, the dialogue that often followed was that
of an ELT member sharing specific information to clarify and/or provide direction related to
specific questions and actions to the ST participants.
Document analysis. During the interviews, participants shared that a number of policies,
checklists, and procedures support this influence. Although not examined personally by the
researcher, the participants stated that these policies and checklists provide support for
compliance related to patient outcomes, compliance and the role of costs and reimbursement.
Therefore, this influence was determined to be an asset to the ELT and partial asset to remaining
team members, as they only know their specific component and not this influence in its entirety.
Summary. The assumed influence that ELT members understand the differences
associated with many comorbidities related to patient outcomes, compliance, and how that plays
a role in costs and reimbursement was determined to be an asset through analysis of data from all
three sources: interviews, observations and documents. However, this was only completely
evident with each ELT member and only applicable to team members based on which
component was discussed. The consistent referral of ST participants seeking clarification from
the ELT was also evident in all areas. Therefore, this influence was determined to be an asset for
the ELT and ST participants.
Procedural Knowledge
Influence 4: ELT members know how to onboard clients to optimize services with
the appropriate product. ELT is aware of the sweet spot to attract clients and onboard them
effectively in a timely manner.
Survey results. No survey was conducted for this study.
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Interview findings. ELT interviewees were asked how their team approaches new clients.
ELT interviewees were also asked the following probing questions: How do you approach
existing clients? How do you determine who you work with? What role do you play with new or
existing clients? ELT participants provided different responses to these questions but clearly
shared how each member has a specialized area that contributes to working with new clients as
well as existing clients. For example, Participant 1 focused on the provider side while
Participant 4 shared more detail about how UWN really has three types of clients, including the
providers that Participant 1 mentioned. The remaining ELT members still provided details but
from different perspectives. All four ELT members were able to state their understanding in
supporting this influence. Therefore, this influence was determined to be an asset for ELT
participants.
ST interviewees were asked how their team approaches new clients. ST interviewees
were also asked the following probing questions: How do you approach existing clients? How do
you determine who you work with? What role do you play with new or existing clients? ST
interviewees shared specific details about the different roles that ST participants play with new
and existing clients. Participant 2 focused on work with the brokers while Participants 5 and 10
focused on support roles on how they, and others, are brought into the process. The ST had three
of six participants able to state their understanding in supporting this influence. Therefore, this
influence was determined to be an asset for the ST participants.
Observation. Through three observations, it was clear the ELT members know how to
onboard clients to optimize services with the appropriate product. The interesting observation
coincides with what was found in the interviews in that only one ELT participant fully
understands all of the process for onboarding. The remaining ELT participants and ST
participants each provide a very specific component to that process. Therefore, this influence is
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an asset for the one ELT participant, but, in conjunction with the ST participants, an asset for the
organization.
Document analysis. During the interviews, participants shared that a number of policies,
checklists, and procedures support this influence. Although not examined personally by the
researcher, the participants stated that these policies and checklists provide direction on how to
onboard clients to optimize services with the appropriate product but does not include each team
member unless a specific component applies to them. Therefore, this influence was determined
to be an asset to the one ELT member.
Summary. The assumed influence that ELT members know how to onboard clients to
optimize services with the appropriate product was only applicable to one ELT participant.
Overall, each remaining ELT participant and ST participant did not know all of the different
onboarding components, but only their area of expertise. However, without each team member’s
contribution, the onboarding cannot be achieved successfully and is seemingly not completely
dependent on the one ELT participant being involved in each onboarding opportunity. Therefore,
there is a need with respect to this influence.
Metacognitive Knowledge
Influence 5: ELT members monitor and evaluate their progress toward achieving
the client’s goals. The ELT and ST participants utilize numerous reports to assist them in
monitoring and evaluating progress toward goals. This progress is monitored in weekly and
monthly meetings. Any corrective or urgent action is taken to address any concerns related to
anything that is detracting from progress toward goals.
Survey results. No survey was conducted for this study.
Interview findings 1. ELT interviewees were asked to describe how their team develops
and sets annual goals. Interviewees were asked two additional probing questions: Who leads this
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process? How long does it take to set these goals? The ELT consensus from three of four
participants was that this is derived from the CEO. Both Participants 8 and 9 stated, “The CEO
definitely does” and “You know, that’s a question for our CEO,” respectively. Participant 4 also
shared more detail about how goals are developed but in agreement with the other participants.
With this understanding, the ELT had three of four participants agree and state their
understanding in supporting this influence. Therefore, this influence was determined to be a need
for the ELT participants.
ST interviewees were asked to describe how their team develops and sets annual goals.
Interviewees were asked two additional probing questions: Who leads this process? How long
does it take to set these goals? No ST participants were able to state their understanding and role
in supporting this influence. Therefore, this influence was determined to be a need for the ST
participants.
Interview findings 2. ELT interviewees were asked how their team goes about managing
and monitoring progress toward those goals. ELT interviewees were asked two additional
probing questions: What intervals do you check progress? What do you do if you are not on
track? Each ELT participant was able to share how goals are measured through the use of various
reports to track metrics. Goals were discussed at the departmental and organizational levels as
well. With this understanding, the all four ELT participants agreed and stated their understanding
in supporting this influence. However, with the missing connection to the ST, this seems to be a
need for the ELT as well. Therefore, this influence was determined to be a need for the ELT
participants.
ST interviewees were asked how their team goes about managing and monitoring
progress toward those goals. ST interviewees were asked two additional probing questions: What
intervals do you check progress? What do you do if you are not on track? Interestingly, each ST
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participant was able to articulate with some degree of clarity that goals are measured and
checked, but not how they were developed. In one case, a participant shared how they bring a
client on and then pass them to another colleague, but that counts as a goal working on the same
team through different responsibilities. Participant 3 was specific about goal setting when they
stated, “we meet weekly, but we meet all the time. I mean we’re in communication every day to
see who’s coming on board.” Participant 5 focused on metrics and using those metrics to guide
achievement towards goals. All ST participants were able to state some form of a goal but
unclear as to how it is developed, who leads the process, or how long it takes to develop goals.
Therefore, this influence was determined to be an asset for the ST participants.
Observation. Through three observations, it was clear that the ELT was highly dependent
on the reports being provided to track metrics related to goals and onboarding. These reports
seemed to play a critical role in providing the opportunity to take corrective action for any
scenarios that were deemed either off-track or in need of further or immediate support. Through
various reports, both ELT and ST participants are able to track and monitor goals in real-time to
make corrective action for anything demanding more immediate action as it relates to goals.
Therefore, this influence is considered an asset for both the ELT and ST participants.
Document analysis. In reviewing a number of policies, checklists, and procedures, it is
clear that the ELT is highly dependent and diligent about monitoring and evaluating progress
toward achieving desired goals. This comes directly from a number of reports that share
information on utilization rates, claims processing, onboarding checklists, and single-case
agreements. Therefore, this influence is considered to be an asset for both the ELT and ST
participants.
Summary. The assumed influence that the ELT members monitor and evaluate their
progress toward achieving the client’s goals was not determined to be an asset in all areas;
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therefore, it was determined to be a need for the ELT and ST. Overall, the ELT members utilize
a number of strategies to measure metrics and sub-parts of metrics to provide them real-time
information to ensure goals are on track while allowing for immediate opportunities to
implement corrective action steps. Additionally, this was also noted as a need for the ST
participant as well. Therefore, this influence is considered a need for both ELT and ST
participants.
Results and Findings for Motivation Causes
Self-Efficacy
Influence 1. ELT members are confident of achieving the high cost savings for their
clients suggested by UWN. Each of the interviewed co-founders and ELT participants shared
that they are able to achieve high cost savings for their clients. After explaining to clients how
their products work, the ELT members see success once clients allow them the chance to prove
how their product works.
Survey results. No survey was conducted for this study.
Interview findings. ELT interviewees were asked two questions: In what ways do you
work with your clients to deliver your product(s)? What role do you play in achieving goals for
your clients? ELT participants were very clear in sharing the role they play working with clients
to achieve UWN and client goals. Each participant focused on their individual role specifically,
but each covers multiple areas. Participant 9 supported this idea of participants covering multiple
areas when they stated the following, “I mean we’re a small group of people, so we do quite a
bit.” With this understanding, all ELT participants agree and state their understanding in
supporting this influence. Therefore, this influence was determined to be an asset for the ELT
participants.
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ST interviewees were asked two questions: In what ways do you work with your clients
to deliver your product(s)? What role do you play in achieving goals for your clients? Similar to
the ELT participants, ST participants were very clear in sharing the role they play working with
clients to achieve UWN and client goals. Also, another response similar to that of the ELT
participants was that each covers multiple areas, causing them to know several areas of the
business to ensure success. With this understanding, all ST participants agree and state their
understanding in supporting this influence. Therefore, this influence was determined to be an
asset for the ST participants.
Observation. After three observations, it was clear that the ELT participants felt
confident that their work provided clients with significant cost savings. On numerous occasions
in these meetings, the focus by ELT members was getting clients onboarded smoothly but as
quickly as possible to begin to demonstrate the cost savings to them or by physically providing
them a report showing those results to be true. Likewise, the ST participants often discussed as a
team or from input from the ELT how to resolve challenges to help them obtain data or
information showing the cost savings. In a few cases, an ELT member was asked to accompany
an ST participant to a meeting with a client to further illustrate these positive findings. Therefore,
this influence is considered an asset for both the ELT and ST participants.
Document analysis. In reviewing a number of policies, checklists, and procedures, it is
clear that the ELT participants are highly dependent on reports and data to support them in
articulating findings to the clients illustrating costs savings. Specifically, the reports include
topics like utilization rates, claims processing, and, single-case agreements to help support those
efforts. Therefore, this influence is considered to be an asset for both the ELT and ST
participants.
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Summary. The assumed influence that the ELT participants are confident of achieving
the high cost savings for their clients suggested by UWN was determined to be an asset through
analysis of data from all three sources: interviews, observations and documents. Overall, the ELT
unanimously expressed their ability to provide cost savings to clients. Additionally, this was also
noted to be an asset for the ST participants as well. Therefore, this influence is considered an
asset for both ELT and ST participants.
Collective Efficacy
Influence 1. ELT members are confident that the team can achieve the annual
medical costs savings of 7% to 30% in addition to the number of lives covered with each
client. Organizations need to find the motivational commitment to their mission, resilience to
adversity, and performance accomplishments UWN provides in reducing medical costs while
providing high-quality care. The ELT participants are both confident in achieving the goal in a
rather short turnaround time. This includes a very hands-on approach by the ELT members to
onboard a number of clients simultaneously.
Survey results. No survey was conducted for this study.
Interview findings 1. ELT interviewees were asked to walk through how they save 7% to
30% on medical costs for their clients. ELT participants were very clear in sharing the role they
play in saving money for clients, but each focused on the specific roles they play. Participant 4
shared detail and a more strategic overview following three principles in the market that guide
each participant in their work. These principles are the prevailing market, hospital and provider
contracting, and how to attract patients to the sweet spot for your business. Each participant is
working to contribute their efforts to get everyone to the sweet spot described by Participant 4.
With this understanding, all ELT participants agree and state their understanding in supporting
this influence. Therefore, this influence was determined to be an asset for the ELT participants.
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ST interviewees were asked to walk through how they save 7% to 30% on medical costs
for their clients. Not surprisingly, the ST participants described more operationally related details
on the role they play and how the process they are involved in supports the cost savings for
clients. That being said, the overwhelming phrase or idea shared by most ST participants was
that of “providing value.” For example, keeping prices low is the value-add, and prompt payment
to providers demonstrates value for clients. Participant 5 was more direct, stating, “It is by
providing value to the providers.” With this understanding, all ST participants agree and state
their understanding in supporting this influence. Therefore, this influence was determined to be
an asset for the ST participants
Interview findings 2. ELT interviewees were also asked how they were motivated by the
ELT. Participant 9 summarized this by stating the following, “Well, you motivate them the way
others are motivated through bonuses, through opportunities to earn equity in the company.”
This was the theme echoed by each ELT member in regards to motivation, discussing something
related to incentives and stock options. With this understanding, the all ELT participants agree
and state their understanding in supporting this influence. Therefore, this influence was
determined to be an asset for the ELT participants.
ST interviewees were also asked how they were motivated by the ELT. Interestingly, the
ST participants made little mention of the stock options for equity or financial incentives but
focused more on the work environment that seemingly includes a level of trust in the work they
do while receiving positive yet critical feedback along the way. Participant 5 was the only ST
participant who discussed stock options and had this to say, “Additionally, they provided us
options in the company, which motivates us obviously because we can succeed as much as the
company succeeds.” Only one ST participant stated there was no level of motivation provided or
present. With this understanding, the ST had four of six participants able to share either directly
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or indirectly their collective confidence to provide clients with cost savings. Therefore, this
influence was determined to be an asset for the ST participants.
Observation. Through three observations, it was clear that the ELT members were
confident that the team can provide clients with cost savings. However, it was also clear that not
all ST participants can see the big picture sharing an emerging theme that increased
communication in the future may be an area of opportunity to ensure that all participants share in
the understanding and confidence while being uniquely motivated to support and assist clients.
With this said, three of six ST participants are confident the team can provide clients with cost
savings. Therefore, this influence is considered an asset for both the ELT and ST participants.
Document analysis. During the interviews, participants shared that a number of policies,
checklists, and procedures support this influence. Although not examined personally by the
researcher, the participants stated that the ELT is highly confident that the team can provide cost
savings for clients. The use of those documents and the specific assignment of roles by ST
participants utilizing their specific expertise demonstrates that this influence is an asset for both
ELT and ST participants.
Summary. The assumed influence that ELT members are confident that the team can
achieve the annual medical costs savings of 7% to 30% in addition to the number of lives
covered with each client. Organizations need to find the motivational commitment to their
mission, resilience to adversity, and performance accomplishments UWN provides in reducing
medical costs while providing high-quality care was determined to be an asset through analysis
of data from all three sources: interviews, observations and documents. Overall, the ELT is
extremely confident of the team’s ability to provide cost savings to clients. Additionally, this was
also noted to be an asset for the ST participants as well. Therefore, this influence is considered
an asset for both ELT and ST participants.
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Utility Value
Influence 1. ELT members value organizations’ needing to find the value that UWN
provides in reducing medical costs while providing high-quality care. The ELT participants
shared, on numerous occasions, how they only needed the opportunity to prove how their
product works for clients to realize the potential for cost savings.
Survey results. No survey was conducted for this study.
Interview findings. ELT interviewees were asked to describe how the ELT shares the
mission and vision of the organization. ELT interviewees were also asked how the team
approaches new clients and how they approach existing clients. It is clear that the ELT finds
value in sharing the mission and vision in monthly meetings, as two ELT participants
specifically agreed that providing ST participants with a sense of voice or belonging also
contributed to the continued acceptance of understanding the mission and vision and carrying it
through in the work they do. Participant 1 stated, “I think it’s important for the executive team to
show the employees, no matter who you are, that they’re just as important as they are in building
this business.” In a similar perspective, Participant 9 expanded on this stating,
You have to listen to their ideas, you have to accept feedback. You have to adapt
processes that are good ideas. You have to give them credit where credit is due, and
honestly just be really open and approachable. Every employee there feels like they have
a voice in what goes on in that company because they do, and we listen.
With this understanding, the ELT had four of four participants agree and state their
understanding in supporting this influence. Therefore, this influence was determined to be an
asset for the ELT participants.
ST interviewees were asked to describe how the ELT shares the mission and vision of the
organization. ST interviewees were also asked how the team approaches new clients and how
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they approach existing clients. The ST participants also mentioned the use of monthly meetings
but cited specific ways they see and feel the work of the mission and vision being shared by the
ELT. Participant 3 stated, “I think it’s because of that passion with helping people that our
morale and bringing it through the team, it really transcends into a team that’s looking to work
together. And that’s daily, weekly, you know.” Likewise, Participant 5 had this to say, “So they
first, I can say they live and breathe it right.” With this understanding, all six ST participants
stated their understanding in supporting this influence. Therefore, this influence was determined
to be an asset for the ST participants.
Observation. Through three observations, it was clear that the ELT and ST participants
strongly believe in the utility and value their products provide to their clients. Numerous
comments and anecdotal notation working with clients from onboarding to a full monthly cycle
or longer of how clients are already seeing and feeling not just the cost savings but the ease in
using their products, portal, and receiving a high level of customer experience. Therefore, this
influence is considered an asset for both the ELT and ST participants.
Document analysis. In reviewing a number of policies, checklists, and procedures, it is
clear that the ELT and ST participants find the utility and value in what their product(s) provide
to their clients. This can be further documented through onboarding checklists and follow-up
procedures with clients. Therefore, this influence is considered to be an asset for both the ELT
and ST participants.
Summary. The assumed influence that ELT members value organizations’ needing to
find the value that UWN provides in reducing medical costs while providing high-quality care
was determined to be an asset through analysis of data from all three sources: interviews,
observations and documents. Overall, the ELT and ST participants are extremely confident in the
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utility and value being provided to their clients. Therefore, this influence is considered an asset
for both ELT and ST participants.
Attribution
Influence 1. ELT members attribute their success or failure to achieve cost savings
for their clients to their own efforts. ELT participants pride themselves on making connections
with clients and ensuring what they do has a direct benefit to each client.
Survey results. No survey was conducted for this study.
Interview findings. ELT interviewees were asked three questions: to what do they
attribute their success? How does their team replicate success year after year? What unique skills
does your ELT have that your competitors do not have that make you successful? Each ELT
participant provided their perspective on defining success and were clear that it is due to their
own efforts and that of other team members. ELT participants presented a mix of definitions of
success as a team effort. With this understanding, the four ELT participants agree and state their
understanding in supporting this influence. Therefore, this influence was determined to be an
asset for the ELT participants.
ST interviewees were asked three questions: What do they attribute success to? How does
their team replicate success year after year? What unique skills does your ELT have that your
competitors do not have that make you successful? Likewise, ST participants were able to
discuss how they define success, that ELT participants provide a great deal of support, and that
ST participants have roles within the teams. However, it is not entirely clear from the ST
participants if they believe their efforts contribute to successes or failures. They understand how
different types of success or failure occur and both the ELT and ST teams overall experience in
healthcare is useful and helpful to give them an edge. But, again, ST participants fail to clearly
share how they attribute success or failure to their own efforts. With this understanding, none of
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the six ST could clearly state their understanding to support this influence. Therefore, this
influence was determined to be a need for the ST participants.
Observation. Through three observations, it was clear that the ELT and ST participants
consistently acknowledge action directly attributed to each of their own efforts and how those
direct efforts correlate to the successes and failures of their clients. Therefore, this influence is
considered an asset for both the ELT and ST participants.
Document analysis. In reviewing a number of policies, checklists, and procedures, it is
clear that the ELT and ST participants believe their efforts contribute to the successes and/or
failures of their clients. Each document created is to promote and assist each participant for both
the ELT and ST in supporting their clients. The ability to utilize those documents contributes to
how each participant feels they attribute their efforts to those successes and/or failures of clients.
Therefore, this influence is considered to be an asset for both the ELT and ST participants.
Summary. The assumed influence that ELT members attribute their success or failure to
achieve cost savings for their clients to their own efforts was determined to be an asset through
analysis of data from all three sources: interviews, observations and documents. Overall, the ELT
and ST participants attribute the success or failure of their clients to their efforts. But, again, ST
participants fail to clearly share how they attribute success or failure to their own efforts.
Therefore, this influence is considered an asset for the ELT and a need for the ST participants.
Results and Findings for Organization Causes
Cultural Models
Influence 1. The ELT needs to continue to work within a collaborative culture. ELT
members continue to work in a collaborative culture. They have revised appropriation of duties
to the ELT and brought in a few ST team members to mentor them, demonstrating further
collaboration.
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Survey results. No survey was conducted for this study.
Interview findings. ELT interviewees were asked what they attribute success to. ELT
interviewees were also asked how their team replicates success year after year. ELT members
were in agreement that success was and is derived from having a diverse set of personnel on the
team. This was evident in many of the ELT participants’ comments. This included examining
factors that provided success and others that did not to reflect on the cause(s) to improve actions
for the future. Participant 8 stated, “there’s always things to be learned from each client launch,”
suggesting they are still learning along the way, which inherently incorporates collaboration
among the team. Additionally, Participant 1 stated, “I don’t think one person can do it alone.
Everybody brings something different. Everybody has different ideas.” With this understanding,
all four ELT participants agree and state their understanding in supporting this influence.
Therefore, this influence was determined to be an asset for the ELT participants.
ST interviewees were asked what they attribute success to. ST interviewees were also
asked how their team replicates success year after year. ST members agreed that communication
plays a role in success and collaboration and that each member brings forth a unique set of skills.
Participant 1 stated, “Well, I think everybody contributes to the dynamic. I don’t think it’s one
person in particular. I just feel like it’s just a mix of personalities, strengths, and weaknesses.”
Participant 10 stated, “I think it’s truly pulling from everybody’s strengths because everybody
has a unique set of information characteristics to bring to the table, and you learn something new
from everybody each and every day from every interaction.” Participants have a clear
understanding of how the team must collaborate for success. With this understanding, the ST had
five of six participants agree and state their understanding in supporting this influence.
Therefore, this influence was determined to be an asset for the ST participants.
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Observation. Through three observations, it was clear that the ELT and ST participants
consistently understood the importance of collaboration for the betterment of their clients and,
innately, the organization. Therefore, this influence is considered an asset for both the ELT and
ST participants.
Document analysis. In reviewing a number of policies, checklists, and procedures, it is
clear that the ELT and ST participants see the benefit of collaboration. This is clear with the
direct and indirect work related to clients transfers and onboarding of clients. Therefore, this
influence is considered to be an asset for both the ELT and ST participants.
Summary. The assumed influence that the ELT members need to continue to work within
a collaborative culture was determined to be an asset through an analysis of data from all three
sources: interviews, observations and documents. However, a unique finding was that, in some
cases, the overall communication between ELT and ST participants should and could be
improved. Overall, the ELT and ST participants are very cognizant of how they can create more
opportunities for themselves and clients while strengthening their efforts through the means of
collaboration. Therefore, this influence is considered an asset for both ELT and ST participants.
Influence 2. The ELT needs to continue to promote and support change and
innovation in the workplace. In the ever-evolving world of healthcare, the ELT needs to
continue working on how to evolve their current practices by providing an environment that
promotes innovation and openness to new ways of doing things.
Survey results. No survey was conducted for this study.
Interview findings. ELT interviewees were asked in what ways they work with their
clients to deliver their product(s). ELT interviewees were asked what unique skills their ELT
members have that competitors do not have and which make them successful. Of the four ELT
participants, only one was able to share any information that would suggest the ELT is
UNIVERSAL WELLNESS NETWORK 97
promoting and supporting change and innovation in the workplace. This discussion pertained to
the launch of a product early in 2020 that would be something new that clients and investors
would be interested in. The majority of discussion was about systems, processes, and operational
work. With this understanding, the ELT had one of four participants state their understanding in
supporting this influence. Therefore, this influence is considered a need for ELT participants.
ST interviewees were asked in what ways they work with their clients to deliver their
product(s). ST interviewees were asked what unique skills their ELT members have that
competitors do not have and which make them successful. Of the ST participants, only one
shared information related to promoting and supporting change and innovation by the ELT.
Similar to the conversation with the one ELT member, this conversation with one ST participant
was also related to the launch of a product early in 2020.With this understanding, the ST had one
of six participants state their understanding in supporting this influence. Therefore, this influence
is considered a need for ST participants.
Observation. Through three observations, it was clear that the majority of the ELT and
ST participants did not discuss or share information related to the promotion and support of
change and innovation by the ELT. However, minimal discussion around a new platform was
shared at one of the formal observations. That was the extent of the idea of this influence being
shared during observations. Therefore, this influence is considered a need for both the ELT and
ST participants.
Document analysis. In reviewing a number of policies, checklists, and procedures, it is
clear that the ELT and ST participants do not have present work that promotes and supports
change and innovation by the ELT. Therefore, this influence is considered to be a need for both
the ELT and ST participants.
UNIVERSAL WELLNESS NETWORK 98
Summary. The assumed influence that the ELT members need to continue to promote
and support change and innovation in the workplace was determined to be a need through
analysis of data from all three sources: interviews, observations and documents. However, a
unique finding was some discussion in interviews about a new platform that would be promoting
this change and innovation. It may be too early in the process for this topic to be more readily or
frequently discussed, as it would not be available until early in 2020. Overall, the ELT and ST
participants did not share much related to this influence. Therefore, this influence was considered
to be a need for both ELT and ST participants.
Cultural Settings
Influence 1. The staff is continuing to be committed to the organization’s overall
success. For any organization to be successful, a plethora of work must be successfully handled,
keeping the customer in mind. Having support from the staff is essential for continued and future
success of the organization.
Survey results. No survey was conducted for this study.
Interview findings. ELT interviewees were asked the following four questions: What role
they play in achieving goals for their clients? How do they work with new and existing clients?
In what ways do you work with your clients to deliver your product(s)? How do you motivate
your employees? While the ELT members are committed to the organization, many of their
responses initially related to the roles they play and how that work supports overall goals,
ultimately resulting in success for clients and the organization. In speaking in more detail with
the ELT participants, it was clear that, while they are trying to save clients money, they are also
working to support both the clients and patients as best they can. Participant 4 brings this idea to
the forefront: “The stakeholders in healthcare, there are only three. It’s patients, and they’re the
number one.” Additionally, providing incentives and equity in the company, as previously
UNIVERSAL WELLNESS NETWORK 99
discussed, assisted in bringing in further support for all employees to support the overall success
of the organization. With this understanding, the four ELT participants agree and state their
understanding in supporting this influence. Therefore, this influence was determined to be an
asset for the ELT participants.
ST interviewees were asked the following four questions: What role do they play in
achieving goals for their clients? How do they work with new and existing clients? In what ways
do you work with your clients to deliver your product(s)? How do you motivate your employees?
Similar to the ELT responses, the ST participants initially shared more about their individual
contribution and role, but, over the duration of the interviews, their focus also switched over to
the patients and then to the providers. Participant 5 stated, “For one, it’s definitely the people”
and “It’s finding people that have that natural customer service ability” in referencing the team,
ensuring they have great people who can relate to the customer and patients. ST participants
mentioned they work with patients and the customer service aspect as important factors to the
overall success of the organization. Additionally, similarly discussed with ELT participants, the
inclusion of company equity and other incentives further supports staff to support the
organization’s overall success. With this understanding, the ST had five of six participants agree
and state their understanding in supporting this influence. Therefore, this influence was
determined to be an asset for the ST participants.
Observation. Through three observations, it was clear that the majority of the ELT and
ST participants discussed how they are committed to the organization’s overall success. In most
cases now, almost all employees have equity in the company that provides them additional
motivation toward overall success, but that is paired with innate and genuine feelings of helping
others out by way of the products UWN provides to clients. Therefore, this influence is
considered an asset for both the ELT and ST participants.
UNIVERSAL WELLNESS NETWORK 100
Document analysis. In reviewing a number of policies, checklists, and procedures, it is
clear that the ELT and ST participants are engaged in supporting the overall success of the
organization. The purpose of the policies, checklists, and procedures is to further aid employees
toward that mutually shared and desired goal of overall success. Therefore, this influence is
considered to be an asset for both the ELT and ST participants.
Summary. The assumed influence that the staff is continuing to be committed to the
organization’s overall success was determined to be an asset through analysis of data from all
three sources: interviews, observations and documents. The support to this influence was clear
and both ELT and ST participants mentioned the importance of providing clients and patients
great customer service as factors leading to organizational success. The inclusion of the equity
opportunities and other incentives has further promoted ELT and ST participants’ commitment to
the organization’s overall success. Therefore, this influence was considered to be an asset for
both ELT and ST participants.
Influence 2. The staff is continuing to support leadership direction. Having strong
leadership is certainly important but all for not if you do not have strong support from staff. The
staff at UWN are very supportive of leadership and the direction they are going.
Survey results. No survey was conducted for this study.
Interview findings. ELT interviewees were asked three questions. The first was to
describe how their team develops and sets annual goals. ELT interviewees were also asked how
their team goes about managing and monitoring progress toward goals. The third question asked
them to describe how their team shares the mission and vision of the organization. ELT
participants not only support one another but really focus on providing the staff with information
by being transparent. They work to help in setting up organizational and departmental goals,
providing opportunities to share feedback, updates on progress toward goals, and the state of the
UNIVERSAL WELLNESS NETWORK 101
union of the organization to ensure all are on the same page. Monthly meetings provide
opportunities to share updates to ST participants while also receiving feedback.
Additionally, sharing the mission and vision in meetings and through one on one
conversations provide ST participants with ways to feel engaged that equate to a commitment to
support leadership. Participant 4 provides a reminder with the mission that supports the
leadership where everyone wins when he stated, “This is about the patient. If we focus on our
patient every time, everyone else just wins inherently.” Participant 8 added, “Our goals as a
whole are to always have an option for our clients.” The focus is on patients and clients, but the
ELT members understand that and support each other in this process. With this understanding,
the ELT had four of four participants agree and state their understanding in supporting this
influence. Therefore, this influence was determined to be an asset for the ELT participants.
ST interviewees were asked three questions. The first was to describe how their team
develops and sets annual goals. ST interviewees were also asked how their team goes about
managing and monitoring progress toward goals. The third question asked them to describe how
their team shares the mission and vision of the organization. ST participants often referred back
to the ELT participants seeking direction but certainly following their guidance. It is a theme that
is consistently bringing up how the ELT provides direction that ST participants support.
Participant 2 simply stated, “They keep us really updated.” To this point, Participant 3 stated,
“We all flow hand in hand together, I guess, and end up all working as one big team.” Participant
10 states this about the mission and motivation suggesting their buy-in to support the leadership,
“I think it’s talked about and exemplified every single day.” With this understanding, the ST had
five of six participants agree and state their understanding in supporting this influence.
Therefore, this influence was determined to be an asset for the ST participants.
UNIVERSAL WELLNESS NETWORK 102
Observation. Through three observations, it was clear that the ELT and ST participants
discussed how they support the leadership direction. This was obvious in meetings and a theme
that was repeatable in seeking guidance to support the leadership, ideas, and actions. Therefore,
this influence is considered an asset for both the ELT and ST participants.
Document analysis. In reviewing a number of policies, checklists, and procedures, it is
clear that the ELT and ST participants are engaged in supporting the leadership direction. The
purpose of the policies, checklists, and procedures is to further aid employees in supporting the
leadership. Therefore, this influence is considered to be an asset for both the ELT and ST
participants.
Summary. The assumed influence that the staff is continuing to support leadership
direction was determined to be an asset through analysis of data from all three sources:
interviews, observations and documents. The support to this influence was clear and both ELT
and ST participants mentioned supporting leadership’s direction through current and/or future
opportunities and actions. Therefore, this influence was considered to be an asset for both ELT
and ST participants.
Summary of Validated Influences
Tables 6, 7, and 8 show the knowledge, motivation and organization influences for this
study and their determination as an asset or a need for a promising practice.

UNIVERSAL WELLNESS NETWORK 103
Knowledge
Table 6
Knowledge Assets or Needs as Determined by the Data
Assumed Knowledge Influence ELT Promising
Practice?
ST Promising
Practice?
Factual - ELT members have knowledge of the payment
schedules and structures from several insurance
companies, allowing them to better understand the
potential for profit margins.
Yes Yes
Conceptual - ELT members understand the billing and
reimbursement complexities among hospitals, clinics, and
the inpatient/outpatient care settings.
Yes Yes
Conceptual - ELT members understand the differences
associated with many comorbidities related to patient
outcomes, compliance, and how that plays a role in costs
and reimbursement.
Yes Yes
Procedural - ELT members know how to onboard clients
to optimize services with the appropriate product.
No No
Metacognitive - ELT members monitor and evaluate
their progress toward achieving the client’s goals.
No No

Motivation
Table 7
Motivation Assets or Needs as Determined by the Data
Assumed Motivation Influence ELT Promising
Practice?
ST Promising
Practice?
Self-Efficacy - ELT members are confident of achieving
the high cost savings for their clients suggested by UWN
Yes Yes
Collective Efficacy - ELT members are confident that
the team can achieve the annual medical costs savings of
7% to 30% in addition to the number of lives covered
with each client. Organizations need to find the
motivational commitment to their mission, resilience to
adversity and performance accomplishments UWN
provides in reducing medical costs while providing high-
quality care.
Yes Yes
Utility Value - ELT members value organizations’
needing to find the value that UWN provides in reducing
medical costs while providing high-quality care
Yes Yes
Attribution - ELT members attribute their success or
failure to achieve cost savings for their clients to their
own efforts.
Yes No

UNIVERSAL WELLNESS NETWORK 104
Organization
Table 8
Organizational Assets or Needs as Determined by the Data
Assumed Organizational Influence ELT Promising
Practice?
ST Promising
Practice?
Cultural Model Influence 1: The ELT needs to
continue to work within a collaborative culture
Yes Yes
Cultural Model Influence 2: The ELT needs to
continue to promote and support change and
innovation in the workplace
No No
Cultural Setting Influence 1: The staff is
continuing to be committed to the organization’s
overall success
Yes Yes
Cultural Setting Influence 2: The staff is
continuing to support leadership direction
Yes Yes

In the following chapter, relevant and applicable recommendations based on empirical
based evidence will be suggested. The recommendations will use the outlined knowledge,
motivation, and organizational influences of the promising practice and identify
recommendations to address needs at UWN.

UNIVERSAL WELLNESS NETWORK 105
CHAPTER FIVE: RECOMMENDATIONS AND EVALUATION
Purpose of the Project and Questions
The purpose of this promising practices project is to examine UWN’s ability to achieve
and maintain medical cost savings month-to-month between 7% and 30% while providing the
highest-quality care. As it would be almost impossible to obtain all current data for all
stakeholders, for practical purposes, the stakeholders of primary focus for this study were the
members of the ELT; and additionally the ST was interviewed as well. As such, the questions
that will guide the promising practice study are the following:
1. What are the knowledge and motivation assets related to Universal Wellness Network
ELT’s high achievement of its goal of saving 7% to 30% of month-to-month medical
costs and increasing the number of lives covered by an additional 150,000 to 200,000
lives?
2. What is the interaction between organizational culture and context and ELT’s knowledge
and motivation?
3. What recommendations in the areas of knowledge, motivation, and organizational
resources may be appropriate for solving the problem of practice at other organizations?
Introduction and Overview
The research questions above were first identified and supported through literature and
then reaffirmed through this study and will utilize specific evidence-based recommendations for
addressing influences in this promising practice model for UWN. Clark and Estes (2008)
provided a conceptual framework using KMO influences. Each of these influences are examined
using principles derived from the literature to provide an appropriate recommendation based on
the identified principles.
UNIVERSAL WELLNESS NETWORK 106
Using the New World Kirkpatrick Model for organizational change (Kirkpatrick &
Kirkpatrick, 2016), an evaluation plan was determined that included a recommended
implementation plan. This model works in reverse, beginning with Level 4 high-level
organizational outcomes. Following this are Level 3 critical behaviors used to drive the outcomes
to then be used in Level 2 as learning outcomes that support the critical behaviors. Next is
Level 1, where reaction measurements assist in providing more immediate feedback based on
participants’ instruction. Finally, a program that consists of all four levels is developed and
integrated for the desired organizational changes to occur. Included in this program are
instruments and processes for monitoring progress at all four levels intended to obtain feedback
on progress.
As part of this process, the intent is to identify all assets and needs to maintain the
promising practice that UWN has established. As part of this effort, UWN must continue to
onboard new team members by ensuring they know they are expected is to adhere to the current
culture in all aspects to maintain the promising practice. In addition, the ability to maintain and
continue to improve shall serve as a guide for other organizations looking to follow this model.
Recommendations for Practice to Address KMO Influences
Knowledge Recommendations
Introduction. This review of current scholarly research focuses on the promising
practice of UWN and how they can consistently provide high-quality care at a low cost. The
knowledge influences are represented in Table 9 and have been validated through a review of the
literature in Chapter Two. The taxonomy of Anderson and Krathwohl (2001) is used to outline
the declarative, procedural, and metacognitive factors. Recommendations are shown below in
Table 9 related to each knowledge influence. The table below represents the stakeholder group’s
UNIVERSAL WELLNESS NETWORK 107
performance goals to continually deliver, at a minimum, a cost savings of between 7% and 30%
on medical spending for the organizations they work with through December 2019.
While being a market leader has its advantages, strong leaders will ensure no
complacency seeps into practice. In this case, for UWN to continually improve, its leaders need
to understand part of those ingredients for keeping their trajectory upward. One of those is the
aforementioned area of knowledge. One such supporting mechanism related to this is what Clark
and Estes (2008) suggest as “people’s knowledge and skills” (p. 43). Ensuring people know how
to achieve their goals is important. If people have the knowledge, they have the power to
achieve. Although knowledge seems simple and straightforward, Rueda (2011) suggests it is
much more complex. Anderson and Krathwohl (2001) highlight the four knowledge types
needed for employees to achieve their goals: factual, conceptual, procedural, and metacognitive.
The next presents a review of the current research, three knowledge influences that contribute to
UWN’s stakeholder goal, and an explanation related to the different types of knowledge used to
determine the methods to assess knowledge gaps among UWN’s competitors.

UNIVERSAL WELLNESS NETWORK 108
Table 9
Knowledge Influence, Knowledge Type, and Knowledge Influence Assessment
Assumed
Knowledge
Influence
Asset or
Need
Priority
Yes, No
(Y, N)
Principle and Citation Context-Specific
Recommendation
ELT members
have knowledge of
the payment
schedules and
structures from
several insurance
companies,
allowing them to
better understand
the potential for
profit margins. (D)
Asset

Y The idea of people
knowing how to achieve
their goals is important but
they need the knowledge
to achieve such goals as
noted by Rueda (2011).

Factual knowledge
provides employees
information needed to
solve performance
problems by way of basic
terminology or details or
contexts. (Anderson &
Krathwohl, 2001)
Provide ELTs and ST
with knowledge of
payment schedules and
structures from
insurance companies
allowing them to better
understand the
potential for profit
margins

This information will
be provided in the form
of tables or
infographics.
ELT members
understand the
billing and
reimbursement
complexities
among
hospitals,
clinics, and the
inpatient/outpati
ent care settings
(D/C)
Asset

Y How individuals organize
knowledge
influences how they learn
and apply what
they know (Schraw &
McCrudden, 2006).
Provide ELTs and ST
in the form of tables or
infographics
with knowledge of the
billing and
reimbursement
complexities among
hospitals, clinics, and
the inpatient/outpatient
care settings.
ELT members
understand the
differences
associated with
many
comorbidities
related to
patient
outcomes,
compliance, and
how that plays a
role to costs and
reimbursement.
(D)
Asset

Y How individuals organize
knowledge
influences how they learn
and apply what they know
(Schraw & McCrudden,
2006).
Provide ELTs and ST
in the form of tables or
infographics with
knowledge that include
the variables related to
patient outcomes, costs
and reimbursement.

UNIVERSAL WELLNESS NETWORK 109
Table 9, continued
Assumed
Knowledge
Influence
Asset or
Need
Priority
Yes, No
(Y, N)
Principle and Citation Context-Specific
Recommendation
ELT members
know how to
onboard clients to
optimize services
with the
appropriate
product. (P)
Asset

Y Modeling to-be-learned
strategies or behaviors
improves self-efficacy,
learning, and performance
(Denler, Wolters, &
Benzon, 2009).

To develop mastery,
individuals must acquire
component skills, practice
integrating them, and
know when to apply what
they have learned (Schraw
& McCrudden, 2006).
Provide ELT and ST
training
(demonstrations,
practice and feedback)
to onboard clients to
optimize services with
the appropriate product.

Feedback that is private,
specific, and timely
enhances performance
(Shute, 2008).

Procedural knowledge is
a critically important
component in goal
attainment and mastery of
a task (Krathwohl, 2002)

ELT members
monitor and
evaluate their
progress toward
achieving the
client’s goals.
(M)
Need

The use of metacognitive
strategies
facilitates learning (Baker,
2006).
Provide ELTs and ST
with opportunity to
monitor and self-
evaluate through
practice.
Providing ELT and ST
opportunities to
identify what they
know, what they don’t
know and to further
engage in guided self-
monitoring.

UNIVERSAL WELLNESS NETWORK 110
Table 9, continued
Assumed
Knowledge
Influence
Asset or
Need
Priority
Yes, No
(Y, N)
Principle and Citation Context-Specific
Recommendation
Additionally,
monitoring each of
their own
metacognition
processes by
monitoring their
progress toward
achieving the client’s
goals.
*Indicate knowledge type for each influence listed using these abbreviations: (D)eclarative;
(P)rocedural; (M)etacognitive

Declarative knowledge. One of the three declarative knowledge influences listed in
Table 9 regarding the ELT members’ knowledge of payment schedules and structures provides a
strong starting point to understand the other two declarative influences. The results of this study
highlight the specific need for other organizations attempting to replicate this promising practice
that they must possess key information, or knowledge: “people’s knowledge and skills” as
suggested by Clark and Estes (2008, p. 43). The idea of people knowing how to achieve their
goals and to be provided facts to employees needed to solve performance problems are also key
(Anderson & Krathwohl, 2001; Rueda, 2011).
The first declarative knowledge influence analyzed in this study, regarding ELT members
knowledge of the payment schedules and structures, aligns with the other influences as a key
component of knowledge for this promising practice. Rueda (2011) suggests that knowing how
to achieve goals is important. Rueda also suggests people need knowledge to achieve goals.
Factual knowledge provides employees information needed to solve performance problems by
way of basic terminology or details or contexts (Anderson & Krathwohl, 2001). Therefore, an
organization looking to replicate this promising practice should provide their team members with
UNIVERSAL WELLNESS NETWORK 111
knowledge of the billing process using infographics and/or tables illustrating these processes.
The recommendation, then, is for an organization to provide these tools.
The second declarative knowledge influence analyzed in this study, regarding ELT
members understanding billing and reimbursement complexities, aligns with the other influences
as a key component to the knowledge for this promising practice. How individuals organize
knowledge influences how they learn and apply what they know (Schraw & McCrudden, 2006).
Therefore, an organization looking to replicate this promising practice should provide their team
members with knowledge of billing and reimbursement complexities using infographics and/or
tables illustrating these processes. The recommendation, then, is for an organization to provide
these tools.
The third declarative knowledge influence analyzed in this study, regarding ELT
members understanding the differences associated with comorbidities and their role in costs and
reimbursement, aligns with the other influences as a key component of knowledge for this
promising practice.
How individuals organize knowledge influences how they learn and apply what they
know (Schraw & McCrudden, 2006). Therefore, an organization looking to replicate this
promising practice should provide its team members with knowledge of comorbidities related to
patient outcomes, compliance, and the role they play in costs and reimbursement using
infographics and/or tables illustrating these processes. The recommendation, then, is for an
organization to provide these tools.
Procedural knowledge. This study examined only one procedural knowledge influence,
which pertained to the ELT members knowing how to onboard clients to optimize services with
the appropriate product. This type of knowledge is critically important in goal attainment and
mastery of a task, according to Krathwohl (2002). Procedural knowledge helps employees
UNIVERSAL WELLNESS NETWORK 112
understand how to solve a problem (Anderson & Krathwohl, 2001). This procedural knowledge
influence aligns with the other influences as a key component to the knowledge for this
promising practice. Modeling to-be-learned strategies or behaviors improves self-efficacy,
learning, and performance (Denler, Wolters, & Benzon, 2009). To develop mastery, individuals
must acquire component skills, practice integrating them, and know when to apply what they
have learned (Schraw & McCrudden, 2006). Feedback that is private, specific, and timely
enhances performance (Shute, 2008). Procedural knowledge is a critically important component
in goal attainment and mastery of a task (Krathwohl, 2002). Therefore, an organization looking
to replicate this promising practice should provide their team members with training on
onboarding clients to optimize services with the appropriate product. The recommendation, then,
is for an organization to provide these tools.
Metacognitive knowledge. This study examined one metacognitive knowledge
influence: the ELT members monitoring and evaluating their progress toward achieving clients’
goals. This monitoring and evaluating represent a key area of focus in repeating success for this
promising practice. The ability to self-regulate can be a predictor to performance and
achievements outcomes can be determined by the level and degree to which one can self-regulate
(Rueda, 2011; Stanton et al., 2015). Metacognitive knowledge helps employees be aware of their
own mental processes in solving problems (Anderson & Krathwohl, 2001). Metacognitive
knowledge allows an employee to know the when and why about solving a problem (Rueda,
2011). This metacognitive knowledge influence aligns with the other influences as a key
component to the knowledge for this promising practice. The use of metacognitive strategies
facilitates learning (Baker, 2006). Therefore, an organization looking to replicate this promising
practice should provide their team members with monitoring tools to track their progress toward
UNIVERSAL WELLNESS NETWORK 113
achieving the client’s goals. The recommendation, then, is for an organization to provide these
tools.
Motivation Recommendations
Introduction. Motivation is the second area required for UWN’s ELT to achieve their
stakeholder goal. Clark and Estes (2008) suggest that motivation is based on people’s personal
beliefs about themselves and their coworkers. The authors assert that motivation is observed by
three processes: active choice, persistence, and mental effort. Clark and Estes caution that
employee challenges in any of these three motivational process areas can hinder performance.
Assessing and addressing motivational challenges can help employees closing gaps between
their current performance levels and their performance goals (Clark & Estes, 2008). The authors
note that the organization’s ability to achieve its organizational goals increases when employee
performance gaps are closed (Clark & Estes, 2008). These motivational influences can be seen
with their corresponding recommendations below in Table 10.
Furthermore, Pajares (2006) and Rueda (2011) define self-efficacy as people’s beliefs or
confidence levels about their capabilities of doing tasks. The authors assert that this belief or
confidence level is based on various factors like previous successes or failures at a task, feedback
received, and prior knowledge about the task. Pajares (2006) and Rueda (2011) explain that the
central premise of the self-efficacy theory is that the higher the level of people’s self-efficacy in
doing a task, the more motivated they will be to do the task.
Based on the self-efficacy motivation influence, the methodology to assess whether a
motivation gap exists will be through primary interviews of the ELT and secondary interviews
with the ST. Perceived efficacy plays a key role in human functioning because it affects behavior
not only directly, but by its impact on other determinants such as goals and aspirations, outcome
expectations, affective proclivities, and perception of impediments and opportunities in the social
UNIVERSAL WELLNESS NETWORK 114
environment (Bandura, 2000; Hoyt et al., 2003; Tasa et al., 2007). A growing body of research
attests to the impact of perceived collective efficacy on group functioning. Some of these studies
have assessed the motivational and behavioral effects of perceived collective efficacy using
experimental manipulations to instill differential levels of perceived efficacy (Durham et al.,
1997; Earley, 1994; Hodges & Carron, 1992; Prussia & Kinicki, 1996). The utility (usefulness)
can also relate to how the tasks fits into future plans like a strategic plan where when doing an
activity out of utility value the activity is a means to an end rather than the end itself. The utility
can also cause reflection on how the activity ties and deeply connects to personal goals, possible
organizational goals and a sense of self (Eccles, 2006; Ryan & Deci, 2000, 2009). With this
theory the ELT would either believe their success or failures are related directly to their own
efforts (Malle, 2008). This awareness is another key component for the ELT to remain successful
knowing their own efforts intentionally reflect the outcomes of their intended goals.

UNIVERSAL WELLNESS NETWORK 115
Table 10
Summary of Motivation Influences and Recommendations
Assumed Motivation
Influence
Asset or
Need
Priority
Yes, No
(Y, N)
Principle and Citation Context-Specific
Recommendation
Self-Efficacy – ELT
members are
confident of
achieving the high
cost savings for their
clients suggested by
UWN
Need Y Pajares (2006) and
Rueda (2011) define
self-efficacy as people’s
beliefs or confidence
levels about their
capabilities of doing
tasks.

Feedback and modeling
increases self-efficacy
(Pajares, 2006).
Additionally, surveying
the confidence of a team
with regards to specific
aspects, synthesizing those
findings and providing
accurate credible feedback
and modeling on progress
to the learning and
performance.

Collective efficacy –
ELT members are
confident that the
team can achieve the
annual medical costs
savings of 7% to
30% in addition to
the number of lives
covered with each
client. Organizations
need to find the
motivational
commitment to their
mission, resilience to
adversity and
performance
accomplishments
UWN provides in
reducing medical
costs while
providing high-
quality care
Asset Y Perceived collective
efficacy fosters groups’
motivational
commitment to their
missions, resilience to
adversity, and
performance
accomplishments
(Bandura, 2000).

Focusing on mastery,
individual
improvement, learning,
and progress promotes
positive motivation
(Yough & Anderman,
2006).

Aspiring organizations
could use training to
understand that each role
within an organization
holds merit to the overall
outcomes and in the case
of a promising practice
demonstrates how
collective efficacy
contributes to overall
success.

Either observing or
learning more about how
this can be used, seen, and
implemented (through
verbal support methods
like self-report surveys,
interviews, think-alouds,
or stimulated recall) would
be beneficial for an
aspiring organization.

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Table 10, continued
Assumed Motivation
Influence
Asset or
Need
Priority
Yes, No
(Y, N)
Principle and Citation Context-Specific
Recommendation
Utility Value – ELT
members value
organizations’
needing to find the
value that UWN
provides in reducing
medical costs while
providing high-
quality care
Asset Y As part of task value
discussed by Wigfield
and Eccles (2000) the
utility value refers to
how useful one believes
a task or activity is for
achieving some future
goal (Rueda, 2011).

Activating and building
upon personal interest
can increase
learning and motivation
(Schraw & Lehman,
2009).
A recommendation
providing training to
understand the
relationship that utility
value has relating to
motivating employees to
see how the work UWN
(or an aspiring
organization) does
provides value to others,
the community, and the
industry.
Attribution-
ELT members
attribute their success
or failure to achieve
cost savings for their
clients to their own
efforts.
Asset Y With this theory the
ELT would either feel
their success or failures
are related directly to
their own efforts
(Malle, 2008).

Learning and
motivation are
enhanced when
individuals attribute
success or failures to
effort rather than ability
(Anderman &
Anderman, 2009).
Provide organizations
training and learning on
attribution and how other
variables
internally/externally can
influence outcomes aside
from what we attribute as
a success or failure
leading up to a particular
goal around cost savings.

Self-efficacy. This study examined the self-efficacy motivation influence, ELT members
are confident of achieving the high cost savings for their clients suggested by UWN, aligns with
the other influences as a key component to the motivation for this promising practice. Pajares
(2006) and Rueda (2011) define self-efficacy as people’s beliefs or confidence levels about their
capabilities of doing tasks. Feedback and modeling increases self-efficacy (Pajares, 2006).
Therefore, an organization looking to replicate this promising practice should provide team
members training to understand the relationship that utility value has relating to motivating
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employees to see how the work UWN (or an aspiring organization) does provide value to others,
the community, and the industry be surveyed for the confidence of a team with regards to
specific aspects, synthesizing those findings and providing accurate credible feedback on
progress to the learning and performance monitoring tools to track their progress toward
achieving the client’s goals. The recommendation, then, is for an organization to create and
conduct these assessments.
The recommendation, then, is surveying the confidence of a team with regards to specific
aspects around knowledge, motivation and cultural influences, synthesizing those findings and
providing accurate credible feedback on progress to the learning and performance. Teaching
strategies around confidence and following and measuring learning obtained using rewards to
support progress would also be beneficial. Specific aspects might include other complex
constructs as suggested by Stajkovic and Luthans (1998) such as confidence in understanding of
roles and responsibilities, different motivational strategies and confidence around how the
organizational culture influences outcomes, information processing, cognitive processing and
other behavioral implications.
This was evident for all members of the team but even more predominant for those in
managerial or leadership roles. Pajares (2006) and Rueda (2011) explain that the central premise
of the self-efficacy theory is that the higher the level of people’s self-efficacy in doing a task, the
more motivated they will be to do the task. Also, self-efficacy has proven to be a more consistent
predictor of behavioral outcomes than have any other motivational constructs (Graham &
Weiner, 1996). Bandura (1982) and other self-efficacy researchers have highlighted the role of
complexity of the task being performed, suggesting other constructs play a role as well
(Stajkovic & Luthans, 1998). This is further illustrated by Hoyt et al. (2003) as they discuss the
works of Bandura, Cervone, and Wood who state that empirical studies of self-efficacy have
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yielded some consistent findings. Substantial literature shows that self-efficacy influences what
people choose to do, their persistence in the face of difficulties, and how much effort they put
forth (Bandura, 1982; Bandura & Cervone, 1983; Bandura & Wood, 1989).
Collective efficacy. This study examined a collective efficacy motivation influence
regarding ELT members’ confidence in the team’s achieving goals regarding annual medical
costs savings and number of lives covered. The notion that organizations need to find the
motivational commitment to their mission, resilience to adversity and performance
accomplishments UWN provides in reducing medical costs while providing high-quality care
aligns with the other influences as a key component to motivation for this promising practice.
Perceived collective efficacy fosters groups’ motivational commitment to their missions,
resilience to adversity, and performance accomplishments (Bandura, 2000). Focusing on
mastery, individual improvement, learning, and progress promotes positive motivation (Yough &
Anderman, 2006). Therefore, if an organization was looking to replicate this promising practice,
its team members should either be observed or learn more about how these recommendations can
be used, seen, and implemented through verbal support methods like self-report surveys,
interviews, think-alouds, or stimulated recall. The recommendation, then, is for an organization
to create and conduct these assessments.
The findings of this study provided strong evidence that collective efficacy is an asset for
ELT members, as they are confident that the team can achieve the annual medical costs savings
of 7% to 30% in addition to the number of lives covered with each client. A principle rooted in
organizational change theory that supports these findings is collective efficacy. Findings suggest
this process has been replicated several times. The perceived collective efficacy fosters groups’
motivational commitment to their missions, resilience to adversity, and performance
accomplishments (Bandura, 2000). Perceived efficacy affects behavior, goals, aspirations,
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outcome expectations, affective proclivities, and perception of impediments and opportunities in
the social environment (Bandura, 2000; Hoyt et al., 2003; Tasa et al., 2007). Therefore, the
recommendation, then, is to provide formal observation in combination with formal learning
about how this can be achieved and implemented for an organization wishing to accomplish
similar goals. Organizations need to find the motivational commitment to their mission,
resilience to adversity and performance accomplishments UWN provides in reducing medical
costs while providing high-quality care.
Collective efficacy is not simply an extension of self-efficacy principles from the
individual to the aggregate (Bandura, 2000; Zaccaro, Blair, Peterson & Zazanis, 1995). Group
dynamics theorists and researchers have pointed out that the behavior of a group cannot
adequately be predicted by summing up behaviors of the individual members (Carron, 1988). A
group’s performance is the result not simply of the aggregation of the shared abilities, skills, and
knowledge of the individual members but also of the interactive and synergistic dynamics of
their exchanges (Bandura, 2000). Although they are independent constructs, research has shown
self- and collective efficacy to be related (Hoyt et al., 2003).
Utility value. This study examined the utility value motivation influence that ELT
members value organizations’ needing to find the value that UWN provides in reducing medical
costs while providing high-quality care. Results show this influence aligns with the other
influences as a key motivation component for this promising practice. Utility value refers to how
useful one believes a task or activity is for achieving some future goal (Rueda, 2011; Wigfield &
Eccles, 2000). Activating and building upon personal interest can increase learning and
motivation (Schraw & Lehman, 2009). Therefore, an organization looking to replicate this
promising practice should have their team members either be observed or learn more about how
these recommendations can be used, seen, and implemented through verbal support methods like
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self-report surveys, interviews, think-alouds, or stimulated recall. The recommendation, then, is
for an organization to create and conduct these assessments and opportunities.
The findings of this study provided strong evidence that ELT members value
organizations’ needing to find the value that UWN provides in reducing medical costs while
providing high-quality care. A principle rooted in organizational theory that further supports this
is utility value is a present asset within UWN. Utility value refers to how useful one believes a
task or activity is for achieving some future goal (Rueda, 2011). This would suggest that UWN
employees feel what they have to offer clients is of great value to other organizations and clients.
Therefore, the recommendation, then, is to provide training to understand the relationship that
utility value has relating to motivating employees to see how the work UWN (or another
organization) does provides value to others, the community, and the industry.
The utility value (Wigfield & Eccles, 2000) for UWN’s ELT members is that they need
to find the value in providing the mechanism that consistently reduces medical costs while
providing high-quality care to their customers or potential customers. The utility value is
supported by Mayer (2011) when discussing motivation related to goals in that a person or
organization might work harder to perform well rather than to avoid performing poorly. The
utility can also relate to how the task fits into future plans. The utility can also cause reflection
on how the activity ties to personal goals, possible organizational goals ,and a sense of self
(Eccles, 2006; Ryan & Deci, 2000).
Attribution. This study examined the attribution motivation influence, ELT members
attribute their success or failure to achieve cost savings for their clients to their own efforts,
aligns with the other influences as a key component to the motivation for this promising practice.
With this theory the ELT would either feel their success or failures are related directly to their
own efforts (Malle, 2008). Learning and motivation are enhanced when individuals attribute
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success or failure to effort rather than ability (Anderman & Anderman, 2009). Therefore, if an
organization was looking to replicate this promising practice, it should provide team members
training and learning on attribution and how other internal/external variables can influence
outcomes aside from that to which we attribute success or failure leading up to a particular goal
around cost savings. This training can be implemented through methods like self-report surveys,
interviews, think-alouds, or stimulated recall. The recommendation, then, is for an organization
to create and conduct these assessments and use these tools.
The findings of this study provided strong evidence that ELT members attribute their
success or failure to achieve cost savings for their clients to their own efforts. A principle rooted
in organizational change theory that has been proved to be an asset for UWN is attribution.
Based on this theory, the ELT would either feel their success or failures are related directly to
their own efforts (Malle, 2008). This would suggest that future collaborative teamwork and effort
might result in a stronger climate leading toward increased attribution. The recommendation,
then, is to provide organizations training and learning on attribution to enhance a positive
emotional climate and understand how other variables internally/externally can influence
outcomes aside from that to which we attribute success or failure leading up to a particular goal
around cost savings.
Bachrach, Bendoly, and Podsakoff (2001) bring about the idea of attribution related to
group performance. The topic of organizational citizenship behaviors (OCBs) has received a
great deal of attention during the past 15 years. Much of this interest seems to be based on the
assumption that OCBs enhance organizational effectiveness (Bachrach et al., 2001). In contrast,
it is also possible that groups given high performance feedback tend to attribute their
performance both to cohesiveness (e.g., Staw, 1975) and to OCBs because these two factors are
perceived by group members to covary with each other (Bachrach et al., 2001). As noted by
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legendary attribution theorist, Fritz Heider, part of attribution theory is a secondary area called
personal causality, meaning that someone caused something else to occur intentionally and that
action was purposive (Malle, 2008). Furthermore, learning and motivation are enhanced when
learners attribute success or failure to effort rather than ability (Anderman & Anderman, 2009).
Organization Recommendations
Introduction. The organizational influences outlined in Table 11 show the assumed
influences that were identified through a review of literature and validated through data
collection in partnership with UWN. As discussed by Rueda (2011), concepts of cultural models
and settings suggested by Gallimore and Goldenberg (2001) were applied. Each influence is
discussed below as it applies to the stakeholder goal and has been validated as recommended
practices to follow for other organizations seeking similar results of this promising practice.
These principles supporting each assumed influence and the evidence-based recommendations
are noted below in Table 11.
Organizational influences are the final area the ELT will need to address regarding how
they achieve their stakeholder goal. As previously mentioned, Clark and Estes (2008) state, “the
final cause of performance gaps is the lack of efficient and effective organizational work
processes and material resources” (p. 103). These work processes are the way that materials,
equipment, and people interact to produce a desired goal, and not properly aligning the resources
with an organization’s goals results in failure (Clark & Estes, 2008). Material resources are the
tools and equipment needed to achieve goals, which have historically been overlooked causes of
performance gaps. Along with materials resources are the value chains and streams which
identify the most influential processes in achieving business goals (Clark & Estes, 2008). An
organization will be unable to achieve its goals if it does not have the material resources
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necessary to equip its employees with knowledge. Lastly, organizational culture can impact the
achievement of performance goals.
Culture encompasses beliefs, emotions, values and processes that become the invisible
norm (Clark & Estes, 2008; Rueda, 2011; Schein, 2017). Within culture are cultural models and
cultural settings (Gallimore & Goldenberg, 2001). Cultural models are the processes that are the
invisible norms of the organization. Cultural settings are the visible behaviors that create the
cultural model (Gallimore & Goldenberg, 2001).
Table 11
Summary of Organization Influences and Recommendations
Assumed
Organization
Influence
Asset
or
Need
Priority
Yes, No
(Y, N)
Principle and
Citation

Context-Specific Recommendation
Cultural Model
Influence 1:
The ELT needs
to continue to
work within a
collaborative
culture
Asset Y Effective change
efforts are
communicated
regularly and
frequently to all
key stakeholders.
(Clark & Estes,
2008)

Create a stronger process for
communication that provides daily and
weekly meetings for progress to
address anything needing corrective
action

How does the team currently consume
information? What other methods may
work better? What resources does the
team use most?.=
Cultural Model
Influence 2:
The ELT needs
to continue to
promote and
support change
and innovation
in the workplace
Asset Y Before launching a
new initiative,
effective change
efforts establish a
“cut your losses”
benchmark and a
“Plan B” in the
event that the
initiative needs to
be aborted (Clark
& Estes, 2008)
Organizations need to create a process
for all team members to voice ideas on
how to improve processes, increase
efficiencies and effectiveness whereby
supporting change and innovative
ways to conduct business.

Additionally, is the team anticipating
other ways to do things? Does the
team have established criteria for what
areas may need improvements or how
ideas will be shared, tested,
implemented?

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Table 11, continued
Assumed
Organization
Influence
Asset
or
Need
Priority
Yes, No
(Y, N)
Principle and
Citation

Context-Specific Recommendation
Cultural Setting
Influence 1:
The staff should
continue to be
committed to the
organization’s
overall success
Asset Y Effective change
efforts use
evidence-based
solutions and
adapt them, where
necessary, to the
organization’s
culture (Clark &
Estes, 2008).
Organizations need to create a
structure and processes to align with a
clear mission and vision with specific
ways to measure progress at specific
intervals to track advancement.

Additionally, what are stakeholders
most afraid of losing in any change
process? What could be done to
preserve what matters most to
stakeholders, without sacrificing the
“guts” of the change effort(s)?
Cultural Setting
Influence 2:
The staff should
continue to
support
leadership
direction
Asset Y Having a blend of
structure without
bureaucracy to
make decisions
while removing
fear and building
positive energy by
removing
ambiguity is part
of what makes it
UWN (Sheridan,
2015).

Effective
organizations
insure that
organizational
messages,
rewards, policies
and procedures
that govern the
work of the
organization are
aligned with or are
supportive of
organizational
goals and values
(Clark & Estes,
2008).

Organizations who have dynamic
leaders need to engage staff in all
processes for input so staff understand
how, why and where decisions are
being made that impact the team and
all stakeholders. Allowing staff to
shadow or providing them with more
transparent communication may better
support leadership direction.

Are policies in line with supporting
leadership? What are the unspoken
rules that operate in the organization?

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Cultural model for collaboration and ability to promote and support change and
innovation in the workplace. The results of this study show the organizational influences
extend into numerous areas that allow for this promising practice to replicate success annually.
As sociocultural theorists (Kozulin, Gindis, Ageyez, & Miller, 2003; Rogoff, 2003) remind us,
behavior and social context are highly intertwined. A principle rooted in organizational change
theory is that the importance of stakeholder engagement cannot be overstated when instituting
changes to resources, policies, and procedures (Russakoff, 2014). Another principle rooted in
organizational change theory is the importance of trust and collaboration. People follow leaders
who engender trust, compassion, stability, and hope (Rath & Conchie, 2009). The
recommendation is a strong line of communication, both internal and external, to include all
stakeholders. This line of communication provides trust that encompasses collaboration.
Catmull (2014) discusses the need and desire to build support for collaboration, and Dyer
et al. (2011) mention teams perform better when there is a strong mutual commitment to their
joint work. This commitment leads team members to believe that they, as a team, will all fail or
succeed together (Hill & Lineback, 2012). The ability for the ELT to foster innovative ways to
determine their solutions for their customers further enhances UWN’s ability to remain a
promising practice.
Cultural setting promotes teamwork through leadership decision-making and
direction. The results of the study suggest that teamwork and strong leadership play a key role in
achieving stakeholder goals. A principle rooted in organizational change theory is organizational
change can take root and produce intended results when leaders focus on the climate of their
organizations (Schneider, Brief, & Guzzo, 1996). The leader must provide stability and
emotional reassurance while solutions are being worked on (Schein, 2017). Another principle
rooted in organizational change theory is that many organizations are afraid to rock the boat or
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fail to be cordial and civil behind closed doors. Pluralistic organizations may adapt and evolve
their culture (Morrison & Milliken, 2000). The recommendation is the proper and appropriate
placement of resources, documents, and personnel support teamwork and to provide
organizational leaders the ability to make key decisions in the best interest of all stakeholders.
The team functions using Lencioni’s (2002) framework of absence of trust, fear of
conflict, lack of commitment, avoidance of accountability, and inattention to results. Each
member believes in their contribution to something larger than themselves and provides and
promotes others’ continued buy-in to the second cultural setting supporting leadership decision-
making and direction: supporting the leadership in their decision-making and direction. As many
successful companies, UWN has strong and intelligent leaders, but the difference why they are
different. Cultural settings are critical for success, and UWN follows the basic human principles
of dignity, teamwork, discipline, trust, and joyful success (Sheridan, 2015). Structure without
bureaucracy to make decisions without fear and building positive energy by removing ambiguity
are part of what makes it UWN (Sheridan, 2015).
Integrated Implementation and Evaluation Plan
Implementation and Evaluation Framework
This study makes use of the concepts applied from the New World Kirkpatrick Model for
organizational change that is based on a framework using four levels of evaluation in today’s
environment (Kirkpatrick & Kirkpatrick, 2016). In this new approach to evaluation, the authors
suggest that these four levels are approached and used in the reverse order, which goes against
traditional evaluation models. To begin this reverse order, the authors suggest starting with the
fourth level, describing the broader organizational objectives. At the third level, the authors
suggest using leading indicators identified as short-term observations and measurements deriving
from critical behaviors. These critical behaviors are paired with required drivers: “processes and
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systems that reinforce, monitor, encourage, and reward performance of critical behaviors on the
job” (Kirkpatrick & Kirkpatrick, 2016, p. 14). The authors also suggest “this active execution
and monitoring of required drivers is perhaps the biggest indicator of program success for any
initiative” (Kirkpatrick & Kirkpatrick, 2016, p. 14). Following this framework will position the
remaining implementation and evaluation components to ensure that the remaining levels
achieve the desired results for the intended organizational change in a manner that is measurable.
Organizational Purpose, Need and Expectations
UWN administers a cloud-based technology solution that connects providers offering
value-oriented services in the form of flat rates and bundles to self-funded, full-pay entities
seeking the most direct connection possible. This promising practice continues to maintain a 7%
to 30% medical cost reduction month-to-month for its clients and users from 2018 to 2020. It has
been suggested that organizations seeking replication of UWN’s success consider
recommendations that further position them for similar success. This includes the hiring of key
personnel, observations and training, and concrete policies and communication plans to execute
key influences, attributes, and assets.
The key stakeholder groups that the study examined were the ELT and ST. Completing a
thorough analysis would include all stakeholder groups, but, for practical purposes, it is
important to understand and focus on the primary stakeholders. Focusing on this primary group it
served to better understand how UWN thrives as a promising practice to create a template, best
or promising practice, which other like organizations can strive to replicate, creating a larger
impact on how healthcare is delivered.
Level 4: Results and Leading Indicators
If the Level 4 result of achieving the cost savings between 7% and 30% is to be obtained
by an organization, it must be supported by both leading indicators and recommendations
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including the Level 3 critical behaviors. A leading indicator would be commitment from an
organization in allocating resources to recruit and hire an industry leader who possesses similar
knowledge and experience as observed at UWN. Additionally, other leading indicators include
the allocation of funds for ongoing training and observation, enhanced policies, and procedures
supporting the Level 4 goal and a strongly defined communication plan that supports internal and
external communication. As suggested by Kirkpatrick and Kirkpatrick (2016), “the introduction
of leading indicators creates the opportunity for formative measures” (p. 63). With these leading
indicators, organizations aspiring to replicate UWN’s success must formally begin these steps to
review budgetary means to recruit and hire key leadership personnel, develop policies, and create
a communication plan that is simple to measure. An organization is either actively working
toward these or not. Having full adherence to these indicators would support the Level 4 desired
outcome as shown in Table 12.
Table 12
Outcomes, Metrics, and Methods for External and Internal Outcomes
Outcome Metric(s) Method(s)
External Outcomes
Increased clients Addition of new clients Work with Sales team and ELT to
measure increase of new clients
Increased retainment of
clients
Retaining 90% or more of
previous year clients into
next year
work with ELT members / Members
services to measure retainment year over
year
Maintain 7% to 30% cost
savings
Annual review of cost
savings per client
Work with the ELT members to review
through reports
Creation of new Integrated
Marketing/Communication
Plan (a.k.a. IMC)
Completion of IMC
Plan/documents/collateral
Combined work between Sales,
Marketing, Client Services and ELT to
develop and execute IMC

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Table 12, continued
Outcome Metric(s) Method(s)
Internal Outcomes
Increased hiring of key
leadership personnel
Number of new hires. HR and ELT to work on recruitment
plan, budget allocation, job description
for new personnel
Increased number of policies
and procedures for
onboarding, HR policies, etc.
Number of newly created
and/or revised policies and
procedures
HR and ELT to prioritize and revise
and/or develop policies and procedures
Creation of new Integrated
Marketing and
Communication Plan (a.k.a.
IMC)
Number of completed IMC
plan/documents/collateral
Combined work between Sales,
Marketing, Client Services and
ELT to develop and execute IMC
Increased oversight of
budget for resource
allocation
Amount of reallocated funds to
support other parallel leading
indicators
Formal Report on review of
available budget funds to ELT via
Finance

Level 3: Behavior
Critical behaviors. The critical stakeholder behaviors that support the Level 4 outcome
in Table 13 are initiative, follow-through, and due diligence in the creation, implementation and
execution of the preceding leading indicators. The table below lists three critical behaviors with
associated metrics related to those outlined behaviors.
Table 13
Critical Behaviors, Metrics, Methods, and Timing for Evaluation
Critical Behavior Metric(s)
Method(s)
Timing
ELT updates the
organization’s
knowledge of
services and products
daily.
Number of staff updates ELT and ST track number
of updates
Daily
ELT onboard staff
and clients to
optimize services
with the appropriate
product for clients.
Number of staff training
for updated products..

Number of “client
onboardings”
ELT and ST track number
of staff trainings and client
“onboarding”
Daily
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Table 13, continued
Critical Behavior Metric(s)
Method(s)
Timing
ELT frequently
communicates the
organization’s
motivational
commitment to their
mission, resilience to
adversity and
performance
accomplishment in
reducing costs related
to medical spending.
Number of written or
oral communications.
ELT and ST track the
number of written
communications via
“newsletters” and oral
communications in staff
meetings.
Weekly
ELT promotes a
collaborative culture
to support innovation
and cost savings for
clients.

Number of mentions of
collaboration to achieve
success in written and
oral communications.
ELT and ST track the
number of written
communications via
“newsletters” and oral
communications in staff
meetings.
Weekly

Required drivers. Earlier in this chapter, recommendations were presented for each of
the knowledge, motivation and organizational influences and will be used to support the drivers
linked to the critical behaviors. The critical behaviors listed in the column to the far right of
Table 14 below are indicated by the associated number from the previous table.
Table 14
Required Drivers to Support Critical Behaviors
Method(s) Timing
Critical Behaviors Supported
1, 2, 3 Etc.
Reinforcing
Job aids (K) in defining/revising
policies and procedures, updating
data and communications.
Daily 1,2,3,4
Self-monitoring (K) for due
diligence of reviewing finances,
cost schedules.
Daily 1,2,3,4

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Table 14, continued
Method(s) Timing
Critical Behaviors Supported
1, 2, 3 Etc.
Encouraging
Mentoring and coaching on
revision of policies/procedures,
enhancing culture, and
communication.
Quarterly 1,2,3,4
Rewarding
Compensation for success Annually 1,2,3,4
Recognition (M) of successful
goal achievement by the
organization’s staff/
shareholders.
Annually 1,2,3,4
Monitoring
ELT and ST self-monitor
progress
Ongoing 1,2,3,4
ST and departments provide data
to ELTs
Ongoing 1,2,3,4
Board of Directors oversight Quarterly 1,2,3,4

Organizational support. Based on the recommendations in the above tables, the
organization will need to support the stakeholder’s critical behaviors four different ways. First,
the organization will need to ensure all departments are provided the noted resources to support
the required drivers. Second, it will have to focus on mentoring and coaching to encourage
collaboration resulting in innovative considerations. This would include weekly staff meetings
for ELT and ST members to openly communicate progress and offer support as needed. On a
quarterly basis, this may include the use of external consulting and mentoring to assist ELT
members. Third, timely data collection with dedicated time to review information is required.
Weekly reports must be reviewed by all appropriate staff prior to meetings. Reporting of
progress toward desired outcomes related to the organization’s goals must occur weekly and
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monthly to the ELT and ST. Finally, information must be shared and reported to the board of
directors to maintain their support of the ELT for the organization’s overall goals.
Level 2: Learning
Learning goals. Supporting the critical behaviors noted above requires
1. Organizations’ ELTs to describe the data of the payment schedules, billing,
reimbursement and structures,
2. ELTs to explain how this information provides potential for profit margins that directly
related to providing cost savings for clients,
3. ELTs to apply strategies for onboarding for both ELT and ST members as well as
onboarding of clients,
4. ELTs to apply communication strategies supporting these necessary resources,
onboarding, coaching, and mentoring,
5. ELTs to apply strategies for enhancing and promoting a stronger culture focused on
doing things the UWN way, and
6. ELTs to support collaboration and innovation through team-building activities and
strategies.
Program. The learning goals listed above should be achieved for the ELT to achieve
their desired organizational goals. First, having an ELT leader who possesses the key
information noted above is critical. Second, ELT must provide training to the ST members to
equip them with the tools and resources to support the ELTs organizational goals. Third, the ELT
and ST team members need to provide a consistent onboarding process to ensure the culture of
the organization is shared along with expectations and information necessary for new hires.
Finally, the ELT team needs to provide time for reflection and evaluation including analyzing
data. Additionally, ELT members must provide consistent communication with ST members to
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promote culture, track progress toward the annual goals, and provide motivation as needed to
ensure tracking is accurate and any modifications may be instituted through corrective action.
These planned activities address knowledge, skills, attitude, confidence and commitment
supporting the critical behaviors to accomplish the stakeholder and organizational goals.
To accomplish these goals UWN’s ELT members should bring in a coach to reinforce
these skills for leadership, mentoring, coaching, and motivation of ST members. This may
include both a facilitator and illustrator to allow the ELT to focus on the exercises and
enhancement of skills provided by the facilitator. The ideas, information and goals can be
brought to life in a visual format by way of the illustrator who can help in organizing innovative
and collaborative ideas discussed during the training. The ELT should provide an employee
retreat for a team of 15 over 1 to 2 days with more intense morning training sessions of team-
building exercises/activities and free time in the afternoons. The morning sessions will be led by
a coach or facilitator who specializes in providing scenarios to practice feedback. The ability to
follow the demonstration, practice and feedback model will ensure that ELT and ST members
will enhance and/or learn these skills.
Evaluation of the components of learning. Kirkpatrick and Kirkpatrick (2016) define
Level 2 evaluation as “the degree to which participants acquire the intended knowledge, skills,
attitude, confidence, and commitment based on their participation in the training”(p. 42). As
mentioned previously, this approach uses both formative and summative evaluation to measure
that learning has, in fact, occurred. Declarative and procedural knowledge are both necessary and
pivotal in their use in critical behaviors (Kirkpatrick & Kirkpatrick, 2016). Formative feedback
will take place during training and follow-up meetings to ensure a common understanding of the
declarative knowledge. Continued practice and competent performance will demonstrate
UNIVERSAL WELLNESS NETWORK 134
procedural ability of stakeholders performing the critical behaviors. Table 15 below lists the
timing and components of the learning method or activity.
Table 15
Evaluation of the Components of Learning for the Program
Method(s) or Activity(ies) Timing
Declarative Knowledge “I know it.”
Knowledge checks will be in place by training
instructor asking stakeholder participant to recite any
declarative knowledge that was shared
Formative: to be done daily and throughout the
retreat with all participating stakeholders
Incentives will be offered and conducted as check
points for successfully retaining information and
demonstrating proper use/format of information
learned
Summative: To be done during the retreat at
the conclusion of each session. Upon return to
work to be conducted weekly and monthly in
pre-meeting leading up to team/department
meetings
Procedural Skills “I can do it right now.”
Simulation assessment will be conducted at the retreat
and periodically end of each week allowing
participants to provide a walk-through experience
with a “potential” client and the strategies contained
in the learning goals.
Formative: Procedural skills will be
demonstrated during simulation assessment
exercise conducted during the retreat through
role-playing activities.
Attitude “I believe this is worthwhile.”
Documented observations indicating non-verbal
reactions of participants will be used. For any non-
verbal action perceived as negative, participants will
be asked for clarification regarding those indications
and will be provided corrective action strategies.
Formative: Multiple observers will notate
these reactions for immediate and reflective
follow-up.

Summative: A reflection indicating session
type and/or non-verbal action will be notated
for future use.
Confidence “I think I can do it on the job.”
Discussion in small groups of concerns and/or
barriers
During and after the retreat
Peer mentorship/coaching/peer check-ins During and after the retreat

UNIVERSAL WELLNESS NETWORK 135
Table 15, continued
Method(s) or Activity(ies) Timing
Commitment “I will do it on the job.”
The Level 1 Reaction instrument will gather feedback
based on the following statement. “Moving forward
from today, I am personally committed to actively
using the information I have learned in today’s
session.” A Likert scale will be used.
Feedback will be documented on the Likert
sheet during retreat sessions, at the conclusion
of the retreat sessions and following
conclusion of training session(s) at the end of
the retreat.

Level 1: Reaction
Kirkpatrick and Kirkpatrick (2016) define Level 1 evaluation as “the degree to which
participants find the training favorable, engaging, and relevant to their jobs”(p. 39). This level is
one of the most familiar to professionals and most simplistic to evaluate but also provides a
method to efficiently evaluate the three components: engagement, relevance and customer
satisfaction (Kirkpatrick & Kirkpatrick, 2016). Table 16 below lists the timing and components
for measuring reactions (method or tool).
Table 16
Components to Measure Reactions to the Program
Method(s) or Tool(s) During and End of Retreat
Engagement
Likert scale item: “The training assisted me in
learning.”
Pulse check midway and End of Training survey
Likert Scale item: “My participation was
beneficial to me and was encouraged by the
trainer.”
Pulse check midway and End of Training survey
Likert Scale item: “This training kept my
attention for the duration of the session.”
Pulse check midway and End of Training survey
Relevance
Likert Scale item: “My participation in this
training will allow me to do my job better.”
Pulse check and End of Training survey
Likert Scale item: “The information in the
training is applicable to my job.”
Pulse check and End of Training survey
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Table 16, continued
Method(s) or Tool(s) During and End of Retreat
Customer Satisfaction
Likert Scale item: “I would participate in a
future training.”
Pulse check and End of Training survey
Open-ended: “Are you in need of additional
clarification or training moving forward?”
End of Training written open-ended question

Evaluation Tools
Immediately following the program implementation. The items above will be
discussed in a training follow-up meeting to openly discuss how the training components went
based on the facilitator’s pulse checks as described in the items for Level 1 above. Appendix C
provides the constructed form of this instrument as it will be utilized related to engagement,
relevance and satisfaction during the training. The same instrument will be used in hard copy
form and the conclusion of each training and collected by the facilitator for data collection,
analysis, and reporting.
Delayed for a period after the program implementation. Both Level 2 and Level 1
evaluations will be addressed in the same instrument at the end of each training as a
comprehension check in which participants will have demonstrated working knowledge from the
training applied during a teach back. Participants will be retested within 72 hours as a recheck of
learning. Those results will be collected, analyzed, and used for future reporting during a
predetermined wrap-up meeting that will be held within one week of the formal training.
Data Analysis and Reporting
While long comprehensive reports are useful, it is rare for people to read them in their
entirety. Kirkpatrick and Kirkpatrick (2016) suggest dashboards provide a simple and effective
way to share key program data. They are also dynamic, and many find them helpful (Kirkpatrick
& Kirkpatrick, 2016). In keeping with this theme, a simple dashboard will be utilized showing
UNIVERSAL WELLNESS NETWORK 137
progress related to knowledge, critical behaviors, and intended outcomes for organizations
seeking to replicate this promising practice. Chapter Four presents information.
Summary of the Implementation and Evaluation Plan
This section was scaffolded around the New World Kirkpatrick Model (Kirkpatrick &
Kirkpatrick, 2016). The focus of this model is on the program outcomes, which, in this case, is
replicating a promising practice. This outcome is supported by leading indicators aligning with
critical behaviors that support this outcome. Each level supports the previous one, allowing for
adjustments along the way. Following this model through both learning and evaluation will assist
in identifying the knowledge, motivation and organizational influences identified in literature to
support UWN as a promising practice. The use of parallel and corroborating evidence can help
ensure replication of organizations to that of UWN’s successes.
Limitations and Delimitations
Research embarks on a path that focuses on the core ability for researchers to provide
results that are both valid and reliable. In addition to those aspects, Merriam and Tisdell (2016)
discuss the importance of trustworthiness and rigor in conducting qualitative research. Due to
this perspective, data and information were collected through interviews, observations and
documents. However, with any study, limitations and delimitations still exist, and the following
passages acknowledge those findings.
The first limitation was self-selection bias. Participation was voluntary. Due to legal
research guidelines, this was not controllable. While 10 participants were interviewed at length,
three responses did not include a key stakeholder. The researcher’s position or reflexivity should
also be considered. While the researcher is not directly employed at the research site, the
researcher has a strong background related to the industry and business being studied. Given this
background, unforeseen biases and assumptions could have been present.
UNIVERSAL WELLNESS NETWORK 138
Constructs fall under delimitations that are often referred to as factors or variables.
According to Leedy and Ormrod (2005), this refers to “what the researcher is not going to do.”
Participation in this study was delimited to a small sample from a small organization and did not
include any of the studied organization’s clients. Another delimiting factor was timing, as the
organization has downsized significantly from a prior, and data collection fell prior to a large
project being exposed that may have had a significant impact on participants’ responses.
Recommendations for Future Research
Future research is always a consideration in research. According to Kirkpatrick and
Kirkpatrick (2016), evidence needs to be provided that supports the training being implemented
and the organization’s mission and goals. As a result, several recommendations are suggested.
First, it would be critical to interview both the ELT and ST stakeholders following the
release of a large new platform being introduced in early 2020. This follow-up data may take
into consideration a few influences that were not addressed in the original interviews due to the
focus of the participants in preparing to launch this new product. This follow-up process would
provide the opportunity to further support the promising practice of UWN and the validated
influences.
Secondly, interviewing UWN clients would be useful. This approach would provide a
rich and detailed experience of how clients found UWN. Additionally, this would provide a
stronger level of validity and reliability to an investigation focusing on utility value among the
motivational influences. Likewise, a third opportunity would be to interview patients of UWN’s
clients to seek similar rich and detailed experiences. This would support a number of validated
influences and the idea of this promising practice.

UNIVERSAL WELLNESS NETWORK 139
Conclusion
UWN is considered a promising practice because the organization provides, annually and
consistently, medical cost savings to clients of between 7% and 30%. Three validated influences
were identified for knowledge, four for motivation, and three for organization for the ELT
participants. Secondarily, three validated influences were identified for knowledge, three for
motivation, and three for organization for the ST participants. The influences were validated
through interviews, observations, and document analysis. Given the intersection of the validated
influences, a combination of high-priority influences were selected to include further evaluation
to design appropriate recommendations.
Identification of these influences provides a guideline and blueprint for organizations
seeking to replicate the work of UWN. A clear inclusion of veteran experienced healthcare
leaders to guide an organization is essential as well as a team of diverse individuals who all have
experience in the industry. Interestingly, a strong background on the provider side has proven to
be a consistent element shared by both ELT and ST participants, noting success from having that
perspective. Therefore, UWN’s validated knowledge, motivational, and organizational influences
evidenced through triangulated data collection can be utilized by other organizations seeking to
replicate the early success of UWN in providing significant cost savings for clients.

UNIVERSAL WELLNESS NETWORK 140
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UNIVERSAL WELLNESS NETWORK 152
APPENDIX A
IRB Research Interview Participation Solicitation Email Template
Dear [Insert Team member name],
Hello, my name is Erik Hollander and I am a doctoral student at USC. By now you have
probably received an email providing you some background as to my intent to interview you as
part of my research collaboration with Eric studying Access Healthnet seeking to better
understand why AHN is a best practice in its industry.
To do so I am looking to interview several folks at AHN, including yourself, for approximately
45-60 minutes. This is confidential in nature and is being used for my learning. If possible I
would like to interview at a time convenient for you between the hours of 9:30am – 3pm (CST)
over the next couple of weeks. I will be out of the office on 9/16-9/18 but am mostly available
anytime outside of those days.
Please let me know of a few dates/times you might be available as I would love the opportunity
to learn more about AHN from your perspective.
Thank you in advance for your time and consideration.
I look forward to hearing back from you in the near future.
Warm regards,

Erik

UNIVERSAL WELLNESS NETWORK 153
APPENDIX B
Interview Protocol Participation Information Sheet
I. Introduction
I would like to begin by thanking you Eric. I have thoroughly enjoyed working with you and
your team. I am continually impressed with how you and your team push the envelope forward
on how healthcare might look in the future. It is no surprise to me how your team can meet and
exceed your goals each year with this momentum you have started. I also want to thank you and
your team for agreeing to participate in the data collection component of my dissertation. I
genuinely appreciate the time you have set aside to answer my questions. This interview should
take about an hour.
Before we get started, I want to provide you with a brief overview of what we will be talking
about today and answer any questions you may have about participating. I will be having
conversations with all of the core members of your Executive Leadership Team (ELT) charged
with obtaining your lives covered goals and those directly involved in assisting Universal
Wellness Networks ability to provide cost savings to your clients. Even though we have had
many conversations that led up to this formalized opportunity it is my hope that these
conversations will allow me to obtain a more holistic view of the needs and assets influencing
the team’s ability to reach your cost savings and lives covered goals annually far beyond that of
your competitors. I am the Principal Investigator (PI) for this study and I am conducting it as part
of the degree requirements of the Doctor of Education – Organizational Change and Leadership
program offered through the University of Southern California’s Rossier School of Education.
Do you have any questions about the study or purpose of today’s conversation?
I want to assure you that everything said here today is strictly confidential. All of the findings for
this study will be reported using pseudonyms unless directed to change to use the actual names
per our previously signed and active agreement. When I use an actual quote from an interview
like this one, I will indicate that it is from “a leadership team member from the Universal
Wellness Network.” No names will ever be associated with any and all findings, again, unless
otherwise directed or preferred as noted in our agreement. I also want to ensure that none of the
information being collected will be shared with anyone else in this organization. Do you have
any questions for me?
If you have questions about your rights while taking part in this study, or you have concerns or
suggestions and want to talk to someone other than me about the study, please call XXX-XXX-
XXXX or email XXXXXXX. You can reference IRB# XXXXX. In addition, if you feel in any
way uncomfortable at any time with participating in this study, or with withdrawing your consent
to participate as the study progresses, please feel free to escalate your concerns to my dissertation
chair Dr. Kenneth Yates.
In closing of this explanation I would like to discuss the logistics of the interview process itself. I
have brought two recorders with me today so that I can accurately capture what you share. The
recorders help me focus on our conversation today and not on taking notes. If at any time you
wish to turn off the recorders you can push this button (show button) and you make comments
“off the record.” Upon completion of our interview I will work expeditiously to upload and
transcribe the information I need for this study where it will be securely protected in files that
nobody can access. I will then erase our conversations from my recorders as an added layer of
protection. Your participation in all aspects in this process is completely voluntary. May I have
your permission to move forward and record to begin?
Begin recording, mention date/time and interviewee name
UNIVERSAL WELLNESS NETWORK 154
II. Interview – Knowledge, Motivation and Organizational Influences
I would like to begin our interview by capturing some basic background information.
1. What role do you play in achieving goals for your clients? [K,M,O]
You have had a lot of success with UWN and the work you have done and continue to do is quite
impressive. If I could I would like to walk through a series of questions that focus on your
interactions with your clients.
2. Would you please walk me through how you save 7%-20% on medical costs for your
clients?[K, O]
2a. Probe – what information and process allow you assist organizations in their cost
savings?
2b. Probe – What resources do you need/use to achieve those goals for your clients?
3. How does your team approach new clients? [M,O]
3a. Probe – How do you approach existing clients?
3b. Probe – How do you determine who to work with?
4. In what ways do you work with your clients to deliver your product(s)? [M,O]
I would now like to focus on UWN’s goals with your work teams and organization.
5. Describe how your team develops and sets annual goals? [K,O]
5a. Probe – Who leads this process? How long does it take to set these goals?
6. How does your team go about managing and monitoring progress toward those goals? [O]
6a. Probe – What intervals to you check progress?
6b. Probe – What do you do if you are not on track?
7. How does your team replicate success year after year? [M,O]
8. What do you attribute this success to? [K,M,O]
I would like to focus a few questions on the Executive Leadership Team (ELT).
9. Describe how your team shares the mission and vision of the organization? [M,O] 10. How do
you motivate your employees? Teams? [M]
11. What unique skills does your ELT have that your competitors do not have that make you
successful? [K,M,O]
12. How does your ELT measure cost savings? [O]
12a. Probe – How does that compare to how others report out?
12b. Probe – What does your industry use as the benchmark?
13. Is there anything else you would like to share about your organization or anything we have
discussed today that could be expanded or covered? [K,M,O]
III. Closing & Follow-up
Thank you so much for sharing your insights with me today. I sincerely appreciate your time and
willingness to share while supporting this endeavor. Everything we have discussed today is
relevant to my dissertation. If I am unclear about anything or have follow-up questions would
you be okay with me to continue to reach out to you directly? Again, my sincere thanks for
participating.

UNIVERSAL WELLNESS NETWORK 155
APPENDIX C
Training Evaluation Form

(Level 1 and 2 Assessment)
Instructions:

● For questions 1-6, please use the following rating scale:
0 = strongly disagree 10 = strongly agree
● Please circle the appropriate rating to indicate the degree to which you agree with each statement.
● Please provide comments to explain your ratings.
● For question 7, please provide your comments related to that question.
______________________________________________________________________________
Rating
Strongly Disagree Strongly Agree
0 1 2 3 4 5 6 7 8 9 10 1. The training assisted me in learning.
Comments:

Rating
Strongly Disagree Strongly Agree
0 1 2 3 4 5 6 7 8 9 10 2. My participation was beneficial to me and
Comments: was encouraged by the trainer.

Rating
Strongly Disagree Strongly Agree
0 1 2 3 4 5 6 7 8 9 10 3. This training kept my attention for the
Comments: duration of the session.

Rating
Strongly Disagree Strongly Agree
0 1 2 3 4 5 6 7 8 9 10 4. My participation in this training will
Comments: allow me to do my job better.

Rating
Strongly Disagree Strongly Agree
0 1 2 3 4 5 6 7 8 9 10 5. The information in the training is
Comments: applicable to my job.

Rating
Strongly Disagree Strongly Agree
0 1 2 3 4 5 6 7 8 9 10 6. I would participate in future training.
Comments:
______________________________________________________________________________

7. Are you in need of additional clarification or training moving forward?

Abstract (if available)

Abstract This study utilized the gap analysis model, which systematically and analytically clarifies organizational goals to identify the current and preferred performance level within an organization. The purpose of this study was to examine Universal Wellness Network (UWN, a pseudonym) as a promising practice due to its ability to achieve and maintain a cost savings on month-to-month medical costs between 7% and 30%, providing the highest level of quality at the lowest cost compared to other companies providing similar services. This qualitative study used interviews with executive leadership team members and support team members, observations at UWN’s organization, organizational artifacts, and document analysis to reveal the knowledge, motivation, and organizational assets that contribute to UWN as a promising practice in the industry. Findings from this study identified assets for factual and conceptual knowledge, motivation related to self/collective efficacy and attribution, and organizational influences for cultural models and settings. This study identified key influences to sustain this promising practice while providing and contributing a guide by way of recommendations for other organizations in this field to attain the level of this promising practice.

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Asset Metadata

Creator Hollander, Erik Whitmore (author)

Core Title Universal Wellness Network: a study of a promising practice

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Publication Date 04/21/2020

Defense Date 02/05/2020

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag attribution,collective efficacy,conceptual knowledge,cost-savings,cultural models,cultural settings,factual knowledge,gap analysis model,healthcare,healthcare costs,Knowledge,Motivation,OAI-PMH Harvest,organizational assets,self efficacy,third-party,Universal Wellness Network

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Yates, Kenneth (committee chair), Benson, Lisa (committee member), Foulk, Susanna (committee member), Ott, Maria (committee member)

Creator Email erik.hollander@cuw.edu,erikholl@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-284946

Unique identifier UC11673202

Identifier etd-HollanderE-8278.pdf (filename),usctheses-c89-284946 (legacy record id)

Legacy Identifier etd-HollanderE-8278.pdf

Dmrecord 284946

Document Type Dissertation

Rights Hollander, Erik Whitmore

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA