This paper investigates whether the influence of institutional regulatory pressures emanating from the enactment of the Sarbanes-Oxley Act and subsequent nonprofit legislation and disclosure requirements improves nonprofit hospital audit quality. Drawing on institutional theory, we argue that increased regulatory attention can shift the audit firm's judgment regarding the choice and inference of previously acceptable audit procedures and heighten the importance of reputational capital as an incentive for audit firms to improve audit quality. We examine two measures of audit quality: internal control deficiencies and discretionary accruals. The results reveal that the audit quality of nonprofit hospitals improves, suggesting that audit firms have responded to regulatory pressures and enhanced their audit and engagement practices for the benefit of nonprofit hospitals and stakeholders. The findings provide regulators and public interest groups with evidence that desired nonprofit oversight and accountability may have already been attained via improved audit quality. Data Availability: Data are available from public sources cited in the text.

Research methodology The case was developed by interviewing Rizwan Koita, CitiusTech chief operating officer (CEO) and cofounder. Case overview/Synopsis CitiusTech, Inc. was a privately held health-care technology and consulting services provider with over 6,000 employees worldwide, with the majority in India. Since 2015, CitiusTech has been certified as one of India's best workplaces by the Great Place to Work Institute®.The case is set in 2020 when CitiusTech's business operations were severely disrupted as its customers suspended work on health-care technology projects to focus on responding to the COVID-19 pandemic. As a result, Rizwan Koita, CitiusTech's CEO and cofounder, suddenly found himself with a considerably large, highly qualified, underused talent pool and a significant loss in revenue. Instead of laying off highly skilled and trained employees, CitiusTech took a long-term view of the situation, believing that business would pick up in the third or fourth quarters and there would be a need to scale up teams. However, as 2020 was closing, Koita wondered if he had done enough to enhance employee engagement amid the disruption caused by COVID-19. Complexity academic level This case is intended for use in undergraduate courses focusing on leadership, industrial and organizational psychology or human resources management. This case may be positioned after students have been familiarized with the fundamental concept of employee engagement.

Healthcare provider burnout has been shown to result in lower staff engagement levels and reduced work satisfaction, which correlates with lower patient experience scores, lower productivity, and increased workplace accidents. By making work engaging and restoring joy, healthcare leadership can reframe barriers to reduce burnout. This paper presents the results of an organizational system-wide intervention designed to rethink the approach to lowering burnout by improving joy in work to address provider well-being at the Guthrie healthcare system. System wide and targeted area strategies were used to create change over a 1-year interval of intervention. After endpoint data was collected, eight power items had positive change for this healthcare system. Scheduling and recognition emerged as system wide areas in need of reform.