This article examines the influence of business model workforce configurations on value creation and capture in a skills-based service setting, extending previous research on business model performance. We investigate workforce configurations (higher versus lower stability and skills) and value creation and appropriation in aged care organisations. More skilled and stable workforces are associated with greater value creation but not appropriation, while less skilled and less stable workforces are associated with lower value creation and higher appropriation. This informs a substantive challenge in delivering value creation while ensuring financially viable business models in a sector with significant consequences for quality failure.
JEL Classification: J24 - Human Capital • Skills • Occupational Choice • Labor Productivity; L2 - Firm Objectives, Organization, and Behavior; M12 - Personnel Management; I11 - Analysis of Health Care Markets
Aged Care Financing Authority (2019) Sixth report on the funding and financing of the aged care sector – July 2018. Report, Australian Government Department of Health, Canberra, ACT, Australia, July.
2.
Aged Care Financing Authority (2020) Eighth report on the funding and financing of the aged care industry – May 2020. Australian Government Department of Health, Canberra, ACT, Australia, June.
3.
Aged Care Workforce Strategy Taskforce (2018) A matter of care: Australia’s aged care workforce strategy. Report, Australian Government Department of Health, Canberra, ACT, Australia, June.
4.
AllanC (2000) The hidden organisational costs of using non-standard employment. Personnel Review29: 188–206.
5.
AmitRZottC (2001) Value creation in e-business. Strategic Management Journal22: 493–520.
6.
AndersonKBirdMMacPhersonS, et al. (2016) How do staff influence the quality of long-term dementia care and the lives of residents? A systematic review of the evidence. International Psychogeriatrics28: 1263–1281.
7.
Baden-FullerCMorganMS (2010) Business models as models. Long Range Planning43: 156–171.
8.
BauerMFetherstonhaughDHaeslerE, et al. (2018) The impact of nurse and care staff education on the functional ability and quality of life of people living with dementia in aged care: A systematic review. Nurse Education Today67: 27–45.
9.
BörjessonUBengtssonSCedersundE (2014) ‘You have to have a certain feeling for this work’: Exploring tacit knowledge in elder care. SAGE Open4: 1–9.
10.
BörjessonUCedersundEBengtssonS (2015) Reflection in action: Implications for care work. Reflective Practice16: 285–295.
11.
BourbonniereMFengZIntratorO, et al. (2006) The use of contract licensed nursing staff in U.S. nursing homes. Medical Care Research and Review63: 88–109.
12.
Casadesus-MasanellRZhuF (2013) Business model innovation and competitive imitation the case of sponsor-based business models. Strategic Management Journal34: 464–482.
13.
CastleNG (2009) Use of agency staff in nursing homes. Research in Gerontological Nursing2: 192–201.
14.
CastleNG (2021) Measuring caregiver retention in nursing homes. The Gerontologist61: e118–e128.
15.
Dall’OraCMaruottiAGriffithsP (2020) Temporary staffing and patient death in acute care hospitals: A retrospective longitudinal study. Journal of Nursing Scholarship52: 210–216.
16.
DaviesBFernándezJ (2000) Equity and Efficiency Policy in Community Care Needs, Service Productivities, Efficiencies and Their Implications. London: Routledge.
17.
De YoungR (2005) The performance of internet-based business models: Evidence from the banking industry. Journal of Business78: 893–948.
18.
DeckerFH (2008) The relationship of nursing staff to the hospitalization of nursing home residents. Research in Nursing & Health31: 238–251.
19.
DeckerFHCastleNG (2011) Relationship of the job tenure of nursing home top management to the prevalence of pressure ulcers, pain, and physical restraint use. Journal of Applied Gerontology30: 539–561.
20.
DellefieldMECastleNGMcGiltonKS, et al. (2015) The relationship between registered nurses and nursing home quality: An integrative review (2008-2014). Nursing Economics33: 95–108116.
21.
Department of Health (2019) 2018–19 report on the operation of the Aged Care Act 1997. Australian Government Department of Health, Canberra, ACT, Australia, November.
22.
DonabedianA (1988) The quality of care: How can it be assessed?JAMA260: 1743–1748.
23.
EagarKGordonRSnoekMF, et al. (2020) The Australian National Aged Care Classification (AN-ACC): A new casemix classification for residential aged care. Medical Journal of Australia213: 359–363.
24.
EagarKWesteraASnoekM, et al. (2019) How Australian residential aged care staffing levels compare with international and national benchmarks. RCACQS research paper 1. Report, Canberra, ACT, Australia: Australian Health Services Research Institute at the University of Wollongong, Royal Commission into Aged Care Quality and Safety, October.
25.
EastonTMilteRCrottyM, et al. (2016) Advancing aged care: A systematic review of economic evaluations of workforce structures and care processes in a residential care setting. Cost Effectiveness and Resource Allocation14: 1–19.
26.
EtteltSWilliamsLDamantJ, et al. (2020) What kind of home is your care home? A typology of personalised care provided in residential and nursing homes. Ageing and Society. Epub ahead of print 30October. DOI: 10.1017/S0144686X20001142.
27.
FieltE (2013) Conceptualising business models: Definitions, frameworks and classifications. Journal of Business Models1: 85–105.
28.
FjeldstadØDSnowCC (2018) Business models and organization design. Long Range Planning51: 32–39.
29.
FlourisTWalkerT (2007) Financial comparisons across different business models in the Canadian airline industry. Journal of Air Transportation12: 25–52.
30.
FossNJSaebiT (2018) Business models and business model innovation: Between wicked and paradigmatic problems. Long Range Planning51: 9–21.
31.
GilbertASGarrattSMKosowiczL, et al. (2021) Aged care residents’ perspectives on quality of care in care homes: A systematic review of qualitative evidence. Research on Aging43: 294–310.
32.
GletteMKRaiseOKringelandT, et al. (2018) Nursing home leaders’ and nurses’ experiences of resources, staffing and competence levels and the relation to hospital readmissions – a case study. BMC Health Services Research18: 955.
33.
GriffithsPBallJBloorK, et al. (2018) Nurse staffing levels, missed vital signs and mortality in hospitals: Retrospective longitudinal observational study. Health Services and Delivery Research6: 1–120.
34.
HarringtonCZimmermanDKaronSL, et al. (2000) Nursing home staffing and its relationship to deficiencies. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences55: S278–S287.
35.
HarrisonSLDyerSMMilteR, et al. (2019) Alternative staffing structures in a clustered domestic model of residential aged care in Australia. Australasian Journal on Ageing38: 68–74.
36.
HausmanJALeonardGK (1997) Superstars in the National Basketball Association: Economic value and policy. Journal of Labor Economics15: 586–624.
37.
HeerenPVan de WaterGDe PaepeL, et al. (2014) Staffing levels and the use of physical restraints in nursing homes. Journal of Gerontological Nursing40: 48–54.
38.
HeidAREshraghiKDuntzeeCI, et al. (2014) ‘It depends’: Reasons why nursing home residents change their minds about care preferences. The Gerontologist56: 243–255.
39.
HendersonJBlackmanIWillisE, et al. (2018) The impact of facility ownership on nurses’ and care workers’ perceptions of missed care in Australian residential aged care. Australian Journal of Social Issues53: 355–371.
40.
HicksLLRantzMJPetroskiGF, et al. (2004) Nursing home costs and quality of care outcomes. Nursing Economics22: 178–192.
41.
HurstKSmithA (2011) Temporary nursing staff – cost and quality issues. Journal of Advanced Nursing67: 287–296.
42.
InacioMCLangCCaugheyGE, et al. (2020) The Registry of Senior Australians outcome monitoring system: Quality and safety indicators for residential aged care. International Journal for Quality in Health Care32: 502–510.
43.
KimHHarringtonCGreeneWH (2009) Registered nurse staffing mix and quality of care in nursing homes: A longitudinal analysis. The Gerontologist49: 81–90.
44.
KimJ (2019) Customers’ value co-creation with healthcare service network partners. Journal of Service Theory and Practice29: 309–328.
45.
KingDSvenssonSWeiZ (2017) Not always a quick fix: The impact of employing temporary agency workers on retention in the Australian aged care workforce. Journal of Industrial Relations59: 85–103.
46.
KnightGWeiZ (2015) Isolating the determinants of temporary agency worker use by firms: An analysis of temporary agency workers in Australian aged care. Australian Journal of Labour Economics18: 205–237.
47.
KobelCEagarK (2020) Technical mapping between ACFI and AN-ACC. Research paper 10. Canberra, ACT, Australia: Royal Commission into Aged Care Quality and Safety, August.
48.
KonetzkaRTSpectorWShafferT (2004) Effects of nursing home ownership type and resident payer source on hospitalization for suspected pneumonia. Medical Care42: 1001–1008.
49.
Korn Ferry Hay Group (2018) Reimagining the aged care workforce. Report prepared for the aged care workforce strategy taskforce, Australian Government Department of Health, March, Canberra, ACT, Australia.
50.
LøwendahlBRRevangØFosstenløkkenSM (2001) Knowledge and value creation in professional service firms: A framework for analysis. Human Relations54: 911–931.
51.
LaaschO (2018) Beyond the purely commercial business model: Organizational value logics and the heterogeneity of sustainability business models. Long Range Planning51: 158–183.
52.
LepakDSmithKTaylorM (2007) Value creation and value capture: A multilevel perspective. The Academy of Management Review32: 180–194.
53.
LinH (2014) Revisiting the relationship between nurse staffing and quality of care in nursing homes: An instrumental variables approach. Journal of Health Economics37: 13–24.
54.
LiuJTongTWSinfieldJV (2021) Toward a resilient complex adaptive system view of business models. Long Range Planning54: 102030.
55.
McNamaraPPeckSISassonA (2013) Competing business models, value creation and appropriation in English football. Long Range Planning46: 475–487.
56.
MassaLTucciCLAfuahA (2017) A critical assessment of business model research. Academy of Management Annals11: 73–104.
57.
MavromarasKKnightGIsherwoodL, et al. (2017) The Aged Care Workforce, 2016: National Aged Care Workforce Census and Survey. Adelaide, SA, Australia: Australian Government Department of Health, National Institute of Labour Studies at Flinders University.
58.
MorrisMHShirokovaGShatalovA (2013) The business model and firm performance: The case of Russian food service ventures. Journal of Small Business Management51: 46–65.
59.
NakremSVinsnesAGSeimA (2011) Residents’ experiences of interpersonal factors in nursing home care: A qualitative study. International Journal of Nursing Studies48: 1357–1366.
60.
NishikawaM (2011) (Re)defining care workers as knowledge workers. Gender, Work & Organization18: 113–136.
61.
PatiRKNandakumarMKGhobadianA, et al. (2018) Business model design–performance relationship under external and internal contingencies: Evidence from SMEs in an emerging economy. Long Range Planning51: 750–769.
62.
PedullaDS (2013) The hidden costs of contingency: Employers’ use of contingent workers and standard employees’ outcomes. Social Forces92: 691–722.
63.
PetersMDJMarnieCButlerA (2021) Delivering, funding, and rating safe staffing levels and skills mix in aged care. International Journal of Nursing Studies119: 103943.
64.
PriemRLWenzelMKochJ (2018) Demand-side strategy and business models: Putting value creation for consumers center stage. Long Range Planning51: 22–31.
65.
RahmanAStrakerJKManningL (2009) Staff assignment practices in nursing homes: Review of the literature. Journal of the American Medical Directors Association10: 4–10.
66.
RichardsonJ (2008) The business model: An integrative framework for strategy execution. Strategic Change17: 133–144.
67.
RosenSSandersonA (2001) Labour markets in professional sports. The Economic Journal111: 47–68.
68.
Royal Commission into Aged Care Quality and Safety (2021) Final Report: Care, Dignity and Respect – Volume 4A. Hearing Overviews and Case Studies. Canberra, ACT, Australia: Roal Commission into Aged Care Quality and Safety.
69.
SabatierVCraig-KennardAMangematinV (2012) When technological discontinuities and disruptive business models challenge dominant industry logics: Insights from the drugs industry. Technological Forecasting & Social Change79: 949–962.
70.
SjögrenKLindkvistMSandmanPO, et al. (2017) Organisational and environmental characteristics of residential aged care units providing highly person-centred care: A cross sectional study. BMC Nursing16: 1–9.
71.
Smith C and Office of the Royal Commission into Aged Care Quality and Safety (2019) Navigating the maze: An overview of Australia’s current aged care system. Background paper 1. Canberra, ACT, Australia: Royal Commission into Aged Care Quality and Safety, February.
72.
SpilsburyKHewittCStirkL, et al. (2011) The relationship between nurse staffing and quality of care in nursing homes: A systematic review. International Journal of Nursing Studies48: 732–750.
73.
StewartBrown (2019) Aged Care Financial Performance Survey: Aged Care Sector Report. Sydney, NSW, Australia: Stewartbrown.
74.
StrzalkaAHavensDS (1996) Nursing care quality: Comparison of unit-hired, hospital float pool, and agency nurses. Journal of Nursing Care Quality10: 59–65.
75.
SvejenovaSPlanellasMVivesL (2010) An individual business model in the making: A chef’s quest for creative freedom. Long Range Planning43: 408–430.
76.
TaranYNielsenCMontemariM, et al. (2016) Business model configurations: A five-V framework to map out potential innovation routes. European Journal of Innovation Management19: 492–527.
77.
TeeceDJ (2010) Business models, business strategy and innovation. Long Range Planning43: 172–194.
78.
TeeceDJ (2018) Business models and dynamic capabilities. Long Range Planning51: 40–49.
79.
TsengS-MWuP-H (2014) The impact of customer knowledge and customer relationship management on service quality. International Journal of Quality and Service Sciences6: 77–96.
80.
University of Queensland (2020) The cost of residential aged care. Research paper 9. Canberra, ACT, Australia: Royal Commission into Aged Care Quality and Safety, August.
81.
Weech-MaldonadoRMeret-HankeCLNeffCM, et al. (2004) Nurse staffing patterns and quality of care in nursing homes. Health Care Management Review29: 107–116.
82.
Weech-MaldonadoRNeffGMorV (2003a) Does quality of care lead to better financial performance? The case of the nursing home industry. Health Care Management Review28: 201–216.
83.
Weech-MaldonadoRNeffGMorV (2003b) The relationship between quality of care and financial performance in nursing homes. Journal of Health Care Finance29: 48–60.
84.
Weech-MaldonadoRPradhanRDayamaN, et al. (2019) Nursing home quality and financial performance: Is there a business case for quality?INQUIRY: The Journal of Health Care Organization, Provision, and Financing56: 1–10.
85.
WhiteheadNParsonsMDixonR, et al. (2015) Quality and staffing: Is there a relationship in residential aged care?Kai Tiaki Nursing Research6: 28–35.
86.
WillisECarryerJHarveyC, et al. (2017) Austerity, new public management and missed nursing care in Australia and New Zealand. Journal of Advanced Nursing73: 3102–3110.
87.
YangBKCarterMWTrinkoffAM, et al. (2021) Nurse staffing and skill mix patterns in relation to resident care outcomes in US nursing homes. Journal of the American Medical Directors Association22: 1081–1087.
88.
ZhaoYVon DelftSMorgan-ThomasA, et al. (2020) The evolution of platform business models: Exploring competitive battles in the world of platforms. Long Range Planning53: 101892.
89.
ZottCAmitR (2007) Business model design and the performance of entrepreneurial firms. Organization Science18: 181–199.
90.
ZottCAmitR (2008) The fit between product market strategy and business model: Implications for firm performance. Strategic Management Journal29: 1–26.
