If patients are now "customers," what does that make physicians?

As patients become "members" and "customers," as physicians become "practitioners" and "providers," the practice of medicine becomes more complex and more demanding. The changes that have affected the daily lives of physicians across America will continue and will likely become even more dramatic in the future. There is much to mourn in the passing of the medical practice of the recent past, but there is every reason to celebrate the ongoing triumphs of medicine and its successes in improving the human condition. The job of being a physician is not becoming any less important. The job has just gotten tougher. Successful physicians will cope with the multitude of changes in which the health care field is engaged and make themselves effective agents of change within their organizations.     

Leading beyond the bottom line, Part 4. The questions it has raised

The Leading Beyond the Bottom Line article series has received an overwhelming response from ACPE members, mostly in enthusiastic support of this new leadership concept. Some of the important questions raised by members are presented with answers from the authors. This article also explores the moral challenge of leadership and why health care is more than a business. In recent years, there's been confusion about the role of the health care enterprise, its leadership and its management. We have lost our way about the "moral" thing, the "right" thing, because we have no philosophy to guide us. To manage or lead in this "business" of health care, a philosophy is required that recognizes the multiple elements to which the leader has responsibility and obligations: the customers, community, employees, and, certainly, the financial assets.     

What business are you in?

Ths structure of the health care delivery system continues to evolve, old organizational types taking new forms and new entities joining in a sometimes helter-skelter array. What is missing is order and purpose. Most health care organizations have not yet asked the critical questions, "What business are we in?" and "Who are our customers?" The authors suggest that what is needed is a strategic business unit approach to the process of business development.     

Strategic Alternative Responses to Risks of Terrorism

The terrorist acts of September 11, 2001 were a wake‐up call for changing our traditional response to risks of terrorism. Given that government and worldwide think‐tank organizations maintain that risks of terrorism will continue for the indefinite future, the following questions deserve strategic answers. How long can we respond to terrorism with tactical measures only, sustain current curtailments of some of our freedoms, travel, and quality of life, and absorb losses in human life and properties? Should not underlying strategic motivation lead to the tactical measures? Why do so many groups and individuals in some developing countries hate us? Is it because they fear that the ideas we export through television, movies, literature, and music have a corrupting influence on their cultures? Is it because of past operations that we conducted in such countries as Iran, Nicaragua, El Salvador, and Granada? Can the genesis of the risks of terrorism to the homeland be traced to the unfavorable socioeconomic conditions in less‐privileged and developing countries, where civil and religious freedoms are close to nonexistent, and sanitary conditions, health and education, and critical infrastructures of essential utilities are almost at the same level that existed in the United States almost a century ago? If we could make progress at improving the quality of life of the billions of people in the developing countries and become more sensitive to their needs, cultures, and heritage, would their hatred subside? What other measures can we take to reduce their hatred, without compromising our basic cultural and democratic principles or their cultural and social heritage?     

What to do next

Why do we work? While there may be some obvious, practical answers to this question, like needing to make money to survive, there are other reasons that people work. These include working: to have stimulation and excitement--to meet new challenges and have variety in your life; for love and affection--to be with colleagues, clients, customers and to provide security and protection for family and friends; and to leave a thumbprint on the world and change individuals, systems, and institutions. For quality life, it is necessary not only to work but to enjoy your work. For physicians considering careers in medical management, the key to success is being truly excited about management activities. If you are heading towards management, you need to view some of the tasks as fun or you probably won't stay with it very long.     

The medical director as educator: an interview with Elizabeth M. Gallup, MD, JD, MBA. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed Elizabeth M. Gallup, MD, JD, MBA, on July 9, 1999, to talk about the evolving role of the physician executive. Dr. Gallup discusses how medical directors have evolved from a purely clinical role to participating in the business side of medicine as well. The traditional medical director, a Dr. No who denies treatment and watches clinical performance, is now becoming an educator helping physicians to manage their behavior and change their practices based on comparative data. Her book, How Physicians Can Avoid Surrender and Lead Change: Gaining Real Influence in Your Own Health Care Organization Before It's Too Late, (American College of Physician Executives, 1996) promotes acting together as a group if physicians want to stay independent and not become employed. Independent physicians can form IPAs and act together as a group, avoiding some antitrust laws. Unless physicians get together and act as a group, she says, they are doomed to further and further erosion of their economic interests as well as their clinical autonomy.     

The MBA mystique

Is an MBA the solution for you? Do physician executives need to have a business degree to compete in today's competitive marketplace? What are clients looking for when they make hiring decisions? The answers may surprise you. This column is an attempt to dispel myths about physician executives and the MBA degree. Clients want to attract and hire physician executives who possess sometimes intangible skills--with or without the MBA credential. These intangible skills include the ability to educate other physicians to the new health care realities, a sales orientation emphasizing effective communication that focuses on patients and payers as customers, comfort with ambiguity, flexibility, and tact and sensitivity in negotiations.     

After the revolution: the physician executive of the future

There is a revolution in health care occurring in our midst. The roots of this revolution are explored. The physician executive of the future will need a new set of skills because the health care system will change. This new, evolving set of skills includes being: Savvy about business; simultaneously employer- and customer-focused; and technologically driven. This manager must be a team builder rather than a lone ranger. These skills are learnable, just like piloting a plane or doing a surgery. None of us was born with the skill to practice medicine any more than we were born with business skills. While many physicians are depressed by the present health care climate, feeling a loss of power and a loss in spirit, the vision of the physician manager must carry them and the organizations they build forward through uncharted waters to a future which is every bit as exciting as our past.     

Not your father's health care

We in health care are living and working in a world that, for all its technical changes, differs little in its basic assumptions, structures, payment systems, beliefs, expectations, and job titles from the world of health care a generation back. How much change can we expect over the coming years? A lot more than we are prepared for. Look at the array of new technologies headed our way, from genomic sciences to customized vaccinations. Many of the breakthroughs promise incredible abilities to prevent disease, to profile our proclivities, and to manage our genetic predispositions over long periods of time, rather than merely wait until the disease manifests in an acute phase, then treat the symptoms. Digital technologies bring physicians executives enormous opportunities for new ways of gathering, storing, and mining information, for new types of communication between medical professionals, for new communications with customers, and new ways of steering large, complex enterprises. Unprecedented opportunities for change keep piling in through the door. Vast pressures for change keep building from every side. And the rewards for anyone who can lead the change keep compounding.     

Conflict of values— the central strategy problem

There is growing evidence that the central strategy question for business is no longer ‘what business are you in?’ but‘why are you in business?’ The traditional answers to this question—‘to make profits’, ‘to grow’ and ‘to give an adequate return to the shareholder’, are all being questioned. In their place others are being suggested—‘to provide satisfying jobs’, ‘to help solve social problems’, ‘to assist in urban and regional development’.In this article, Bernard Taylor suggests that the conflict between business goals and social goals has become the central strategy problem. Business enterprises like other organizations tend to develop their own distinctive sub-cultures with their own value systems which may differ markedly from the values accepted in society generally. The more effective the selection, training and reward systems, the more these business values will be reinforced.But this can lead to difficulties when society begins to reject business values in favour of other social goals; particularly at a time when the power and autonomy of management is being challenged and Corporate Planning is being transformed from an internal dialogue between managers at headquarters and managers in divisions into an open debate involving public servants, employees and self-appointed representatives of community interests.     

店铺形象和店铺位置在O2O环境中还重要吗？

O2O模式，因为其能够通过渠道间的整合充分发挥线上和线下渠道各自的优势，为企业带来更高的利润和客户保留率，而受到很多企业的追捧。而渠道整合的过程中店铺形象、店铺位置是否还会发挥作用等问题还没有明确的答案。本研究应用网络数据爬虫和问卷调查的方法，收集了北京市西城区、朝阳区、海淀区、东城区的148家开展了在线外卖服务的餐馆数据，利用Smart PLS2.0对数据分析后发现，在O2O环境中，店铺形象尤其是线上店铺形象对渠道整合、企业绩效都发挥着重要的作用，而店铺位置是调节渠道整合的一个重要因素。这些研究发现不仅增加了我们对渠道整合环境中店铺形象、线下店铺位置作用的认识和理解，对开展O2O业务的企业也有着重要的借鉴和参考价值。     

Who is it That Would Make Business Schools More Critical? Critical Reflections on Critical Management Studies

We suggest in this paper that whilst exploring how to make business schools more critical we must also turn a critical and reflexive lens upon ourselves, critical management thinkers. Our endeavour is outlined here as a 'reflexive journey' in which we turn upon ourselves, academics who identify as 'critical' thinkers, the theories we use to analyse others. Our focus is upon critical management education. We use three vignettes drawn from our previous research. One is of graduands from the postgraduate programmes on which two of us teach, the second an analysis of knowledge transfer programmes in which we have participated, and the third a study of the construction of academic identities. The first study shows the academic teacher may become an internalized, judgemental gaze, the second that what we see as a critical approach may be construed by our students as another 'truth' that fails to encompass the complexities of organizations and management, and the third encourages us to ask some questions about our own positions. This causes us to ask some uncomfortable questions about our own positions as critical management scholars and the ways in which we conceptualize business schools and our colleagues who work in them.     

Reflections on customers’ primary role in markets

Technology developments have transformed the business landscape by accelerating connectivity, transparency and unpredictability. We argue that the most dramatic consequence is not the possibilities created for companies but rather the challenges that emerge as a result of customer behaviour undergoing fundamental changes. Technology transformation has paved the way for empowered customers who are increasingly influencing businesses and markets, and the challenge for practitioners and researchers alike is to make sense of the role of these customers in such business environments. These developments have yielded a need to revise companies’ business models and to innovate new offerings. In scholarly research on marketing, this need has become evident and, beyond suggesting new concepts, completely new marketing management perspectives have been proposed, and each has its own core assumptions and focus. Broader views have emerged, and these stress the applicability of these perspectives not only to the top-level management of businesses but also to any non-commercial organisation.In this article, we reflect on the customer-dominant logic (CDL) of marketing, which stresses the customer's primary role in business. As such, CDL differs from approaches that focus on the provider's perspective. The CDL approach is an expression of the research ideals and goals that are based on the Nordic School of Service Management. We argue that CDL is well aligned with emerging challenges in most markets, both established and nascent, and that it is more managerially relevant than many other perspectives. This is also in line with the recent calls for a soul of relevance for European management research (Chia, 2014; Hernes, 2014).     

Physician acceptance of new medical information systems: the field of dreams

Physicians often fail to embrace a complex information system, may not see its relevance to their practices, and are characteristically reluctant to invest the time and energy to be trained in its use. Why is widespread physician buy-in so difficult to achieve? From physicians overwhelmed with change to failing to begin with an adequate physician base of support, this article explores some of the reasons that physicians demonstrate little buy-in to this process and offers suggestions to help create a more successful implementation. Ways to build acceptance include acknowledging the importance of physicians as customers and training them early and often.     

Strategic Community Management with Customers: Case Study on Innovation Using IT and Multimedia Technology in Education, Medical and Welfare Fields

This paper discusses the management processes for forming strategic communities by means of strategic partnerships between businesses and customers, for introducing into the Strategic communities the knowledge of customers with a high degree of learning experience with respect to the products and services provided by the businesses, thereby creating new business models and at the same time extending the results of the strategic communities to many other associated customers. Innovations in the fields of education, medicine and welfare utilizing IT and multimedia technology over the past four years are taken as examples in this case study. Here a strategic community of business and innovative customers has established a new business model in the fields of education, medicine and welfare on the basis of IT and multimedia technology. The results of the activities of the strategic community of innovative customers were then extended to many other related customers in a chain of community creation, and the new systems were widely proliferated throughout Japan. This revised version was published online in July 2006 with corrections to the Cover Date.     

e‐Integration in the Supply Chain: Barriers and Performance*

Current opinion holds that Internet‐based supply chain integration with upstream suppliers and downstream customers (called “e‐integration” in this paper) is superior to traditional ways of doing business. This proposition remains untested, however, and similarly we know little about what are the upstream, internal, and downstream barriers to implementing e‐integration. This paper empirically addressed these questions using data from a large single nation study, and found (1) a positive link between e‐integration and performance, and (2) that internal barriers impeded e‐integration more than either upstream supplier barriers or downstream customer barriers. Findings from this study contribute to our theoretical understanding of implementing change in contemporary supply chains, and have important implications for manufacturers interested in improving their supply chain's performance using the Internet.     

关系投资和价格促销的价值比较研究

过去营销界一直把关系投资和价格促销策略作为获得新顾客和提高现有顾客满意度的主要工具。然而关系投资和价格促销作为流失顾客的赢回策略,对于失而复得的顾客而言,哪种策略能令顾客更满意,购买更多,能使厂商绩效更好,是我们需要解答的问题。本文通过对酒店业的抽样调查数据分析发现:第一,用关系投资策略赢回顾客的满意度和购买份额较用价格促销策略赢回的顾客更高。第二,在关系投资策略的影响下,价格敏感度高(低)的顾客满意度与购买份额之间拟合的函数曲线边际递减(递增);在价格促销策略影响下,价格敏感度高(低)的顾客满意度与购买份额之间拟合的函数曲线边际递增(递减)。第三,注重价格促销策略的酒店,其绩效低于注重关系投资策略的酒店,绩效的稳定性也相对较差。研究对指导企业管理实践具有重要参考价值。     

Corporate Control of Information: Business and the Freedom of Expression

Control over information is essential to business. This has become increasingly true in an era in which technological advances have enabled the rapid globalization of business. This article explores the implications of this control of information for freedom of speech and information. Four different situations are considered: censorship of the Internet by search engines albeit at the direction of a government; restrictions on Internet content by Internet Services Providers acting on their own; decisions by retail businesses not to sell various DVDs, CDs, etc. to their customers; and legal suits brought against individuals and groups by businesses seeking to prevent the further spread of information they deem injurious to their products or activities. The paper seeks to sort out the various rights and values involved in these cases, when a business may be justifiably said to be violating individuals' rights to freedom of information, and when customers and citizens do not have justified complaints against business decisions not to provide them with certain information products.     

Strategic Capacity Management When Customers Have Boundedly Rational Expectations

In retailing industries, such as apparel, sporting goods, customer electronics, and appliances, many firms deploy sophisticated modeling and optimization software to conduct dynamic pricing in response to uncertain and fluctuating market conditions. However, the possibility of markdown pricing creates an incentive for customers to strategize over the timing of their purchases. How should a retailing firm optimally account for customer behavior when making its pricing and stocking/capacity decisions? For example, is it optimal for a firm to create rationing risk by deliberately under stocking products? In this study, we develop a stylized modeling framework to answer these questions. In our model, customers strategize over the timing of their purchases. However, customers have boundedly rational expectations in the sense of anecdotal reasoning about the firm's fill rate, i.e., they have to rely on anecdotes, past experiences, or word‐of‐mouth to infer the firm's fill rate. In our modeling framework, we distinguish two settings: (i) capacity commitment, where the firm commits to its capacity level in the long run, or (ii) the firm dynamically changes it in each season. For both settings, within the simplest form of anecdotal reasoning, we prove that strategic capacity rationing is not optimal independent of customer risk preferences. Then, using a general form of anecdotal reasoning, we provide sufficient conditions for capacity rationing to be optimal for both settings, respectively. We show that the result of strategic capacity rationing being suboptimal is fairly robust to different valuation distributions and utility functions, heterogeneous sample size, and price optimization.