Persuasion strategies for physician executives: Part I--Influencing superiors

Little is known about the way physicians function as managers in influence situations. In an effort to fill this gap in the literature and to illuminate how a "target's" communication style affects "agents" strategic decisions, this study examined 222 physician executives' choices of compliance-gaining strategies when seeking to influence superiors who communicate with them in attractive and unattractive styles.     

Physician leadership. How do physician executives view themselves?

Most physician executives today have acquired substantial management training and experience, and many have worked with and relied on the expertise of mentors for their career guidance and development. Physician executives are actually becoming executives who happen to be physicians. They view themselves first as leaders, then as physicians, and finally as managers. That is a remarkable transformation in perception. To chronicle this process, Witt/Kieffer, Ford, Hadelman & Lloyd conducted a national survey this spring among senior physician executives in both payer and provider organizations. The data provide a "snapshot" of their role, and may also suggest some future scenarios for the industry. The primary reasons for choosing to pursue a management role noted by most participants include a desire to be part of the health care solution and an interest in management and leadership challenges.     

Customized clinical case management for chronically ill patients. Health system sees remarkable results with teams of case managers,physicians, patients

Securing excellent care and positive outcomes for seriously ill, high-risk patients requires extraordinary measures. A health system in Georgia is experiencing strong results by taking a team approach to health care with case managers, physicians and patients working together.     

DISTANCE TO FRONTIER,SELECTION, AND ECONOMIC GROWTH

We analyze an economy where firms undertake both innovation and adoption of technologies from the world technology frontier. The selection of high‐skill managers and firms is more important for innovation than for adoption. As the economy approaches the frontier, selection becomes more important. Countries at early stages of development pursue an investment‐based strategy, which relies on existing firms and managers to maximize investment but sacrifices selection. Closer to the world technology frontier, economies switch to an innovation‐based strategy with short‐term relationships, younger firms, less investment, and better selection of firms and managers. We show that relatively backward economies may switch out of the investment‐based strategy too soon, so certain policies such as limits on product market competition or investment subsidies, which encourage the investment‐based strategy, may be beneficial. However, these policies may have significant long‐run costs because they make it more likely that a society will be trapped in the investment‐based strategy and fail to converge to the world technology frontier. (JEL: O31, O33, O38, O40, L16)     

Role stress among physician executives

On the one hand, physician executives are clinicians who place value on professional autonomy. As clinicians, the best interests of the patient drive their decision making and their value system. On the other hand, as managers, physician executives serve as agents of an organization. Because of the differences in the two cultures, some physicians have called the physician executive position a "no man's land" To address these issues and answer the questions that surround them, the authors developed a survey that was mailed to a random sample of the membership of the American College of Physician Executives. Parts of the survey served in other studies of role conflict and role ambiguity. Parts of the survey are new, developed specifically to analyze the physician executive role. The findings are reported in this article.     

The value circle. A profile of J. Richard Gaintner, MD.

This article describes how the arrival of CEO J. Richard Gaintner, MD, at Shands HealthCare signaled a time for refocusing the organization's direction and helping physicians to cope with the changes buffeting the industry. He saw angst and disenfranchisement, sentiments that characterized not only Shands and the University of Florida Health Science Center, but also the entire establishment of American scientific medicine. Gaintner believes--and continually preaches--that practicing medicine in a cost-effective manner will improve, not harm, the quality of care. His willingness to face reality objectively is perhaps his greatest asset in helping physicians deal with managed care. He conveys heartfelt empathy with the day-to-day conflicts they face. But he does not allow himself the temporary luxury of cynicism, and he refuses to accept negativity and pessimism in others. Rather, he asks that physicians and managers understand the system and develop the capacity to work within it and take responsibility for improving it. Beyond exhorting physicians to be accountable for the success of the enterprise, Gaintner creates mechanisms for meaningful physician participation in enterprise management.     

Administrative fellowships in emergency medicine

Physicians today need to be effective managers, as well as clinicians. In previous years, physicians gained managerial experience either through on-the-job training, degree programs, or continuing medical education courses. The specialty of emergency medicine began its first administrative fellowship in 1990 in California. Currently, three administrative fellowships exist nationally in emergency medicine. This article will describe the purpose of the fellowships and their curricula. Each fellowship has a different emphasis, with the goal to educate physicians who are interested in developing administrative skills to manage emergency departments or management groups or accept roles in hospital leadership. The existence of these fellowships will ideally influence the establishment of administrative fellowships in other specialties.     

The new physician role as employee.

Rapid and ongoing changes in the way in which medicine is practiced and health care services delivered have made employees of physicians who were once the very definition of entrepreneurs. If this new role is difficult for physicians, it is doubly difficult for those who must manage such employees. To be effective managers of other physicians, physician executives must be aware of the historical and sociological basis of the physician profession.     

Values, Sex Differences and Psychological Androgyny

The research literature on sex (male/female) andgender (masculine, feminine, psychological androgyny,undifferentiated) differences in value structures iscontradictory and has generally been limited tocivilian samples, with little research on militarymiddle-level managers. This study investigated thosedifferences in a stratified random sample of 200military middle-level managers (125 males, 75females). While ANCOVA with demographic variables asthe covariates was established as the standard testfor hypothesis significance, the research data wereexplored using a variety of statistical techniques forcomparison purposes (transformed and non-transformedprocedures using the t-test versus ANCOVA, ANOVAversus ANCOVA, and Pearson and Spearmans correlationanalysis). Both sex and gender differences existed inthe value structures of middle-level managers, for allthe different statistical techniques. Implications forresearchers, limitations of the study, and adiscussion of the findings were presented.     

Quality versus variance: a plea for a different focus and terminology

Much has been written about quality assurance in medical practice over the past 15 years. Medicine suddenly found itself trying to design systems that ensured that medicine was being practiced according to standards of quality when it had neither a definition of its product nor defined standards of practice. Consequently, early quality assurance programs focused primarily on documentation of patient care. As the process matured, it evolved to generic screens, with tolerances and outliers. The theory was that the quality of medical care was enhanced by physicians who practiced within often artificially established norms and was diminished by physicians who practiced outside those same norms. It was much like saying that the quality of manufacturing a new car could be improved by reducing all systems down to one of closely standardizing, observing, and documenting how each individual assembly worker put on a lock nut and then holding each worker independently accountable for the final quality of the care. Physicians felt they were being held responsible for conforming to a rigid set of poorly designed and retrospectively applied standards. Moreover, they were held accountable for applying those standards to all practice situations. Understandably, physicians felt at the mercy of nonphysician quality assurance "detectives" in hospitals and became increasingly suspicious of nurses and administrators, who were perceived as abusing the system at the expense of the physicians. Because of these inadequacies of the earlier quality assurance programs, paranoia among physicians about the quality assurance process remains rampant today. The use of blind outcome scores and practice patterns in credentialing and the reporting of these data to databanks have reinforced the paranoia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Doing physician terminations right

Few managers have the training or the expertise to terminate a physician. Some managers are uncomfortable with this process and may even subvert, delegate, or fumble the process. A properly performed termination will leave the physician with understanding of the termination and may assist in his or her development. A poor termination can cause ill effects not only with the involved physician, but also with the organization terminating the physician. Many physicians are leery of working for an organization that has the reputation of unfairly terminating physicians. They are also concerned with their job security. Potential legal ramifications make the process even more difficult.     

Legal issues in accepting capitation

The effort to reduce the cost of medical, hospital, and ancillary services increasingly focuses on shifting the financial risk for the cost of these services to those who provide them. Shifting arrangements include capitation for physicians classified as "primary care" physicians; capitation arrangements that include primary and specialty services; risk shifting to medical groups, IPAs, and other physician organizations; as well as the packaging of physician and hospital services on a "full risk," "per case," or other basis. Accepting financial risk for the cost of medical and other health care services, as well as the responsibility for managing the provision of services, may very well be the only remaining opportunity for providers to maximize reimbursement and maintain administrative and clinical self-direction. However, physicians must work with managed care organizations (MCOs) through negotiation of contracts and throughout the relationship to make sure: Unnecessary financial and legal risks to the MCO and physicians are eliminated. Risks that cannot be eliminated are apportioned between the MCO and physicians. All risks are managed in a coordinated fashion between the MCO and physicians.     

金融契约、控制权配置与企业过度投资

以金融契约理论为基础,从控制权视角考察了企业"核心控制权"、"一般控制权"和"现金流权"的交互关系及其对过度投资的影响效应,并利用中国上市公司数据进行实证检验。研究发现:(1)管理者利用控制权地位攫取私利是引发企业过度投资的主要诱因,随着管理者控制权强度增加,过度投资水平明显上升;(2)投资者拥有的核心控制权能够对管理者一般控制权行使产生有效约束,相比较于股权分散、负债较少的企业,股权集中、负债较多企业投资者拥有的核心控制权更集中、干预动机更强,因而企业过度投资水平明显降低。     

Examining Links Between Sign-Out Reporting During Shift Changeovers and Patient Management Risks

This article reports on a qualitative study that investigated how various risk factors associated with the process of sign-out reporting across shifts in critical care hospital environments could lead to flawed communication and thus to increased risk of poor patient outcomes. The study was performed in two critical care hospital units: the pediatric intensive care unit (PICU) and the postanesthesia care unit (PACU). We collected data from observations of eight nurses and four resident physicians in the PICU and four nurses and four resident physicians in the PACU giving sign-out reports during their shift changes. In addition, we conducted semi-structured interviews with a separate sample of medical providers consisting of nurse managers, attending physicians, nurses, and residents from each of these two units. The issues that were addressed in these interviews included how various methods of conducting sign-outs and factors such as personality and experience could impact the effectiveness of communication during sign-out reporting. We also collected data from these medical providers on how failures in communication during sign-out reporting could lead to potentially adverse patient outcomes. The article concludes with the presentation of a modeling framework that demonstrates how the combined influences of risk factors can generate a particularly important type of failure mode in communication and how interventions can be targeted to serve as barriers to such events. A number of recommendations intended for reducing risks associated with the communication of sign-out reports are also presented.     

Physician anger, Part 2. More on the dance of anger.

This article is a follow-up to an interview with Charles Dwyer, PhD, which appeared in the 1999 March/April issue of The Physician Executive. He described how physician executives can change the perceptions of today's beleaguered physicians and help them cope with change. We then asked him for some hands-on strategies to deal with physician anger, fear, and resentment. After much contemplation on providing a list of "fixes" that will restore each of us to a state of greater satisfaction, Dr. Dwyer concludes that there are no generalizable solutions because there are too many variables that come into play in each organization, individual, or group. Attending to the self can provide both individual rescue from these turbulent times and the best hope for changes in the system from which patients and health care providers can benefit. If physicians are to regain their power and maintain, or even improve, their quality of life, clearly changes are called for. And these are changes that require persistent effort and uncomfortable adjustments.     

供需中的Hockey-stick现象分析及对策研究

许多公司的产品需求在连续而固定的周期会出现前低后高,即 Hockey-stick 现象,这种现象普遍存在于供应链之中并困扰着许多的企业管理者.不认为其产生的原因是公司对销售人员的周期性考评的传统观点,并以快速消费品行业为背景,通过建立模型,得出了这种现象主要是公司普遍采用的总量折扣(Volume Discounts)价格政策导致的结论,并提出了公司可以通过多产品组合定价等方法缓和这个问题,最后通过一个实例证实了文章的观点.     

I can't believe they think I'd...

Many physician executives experience a personal jolt as they move to work in a very different relationship with their colleagues. What happens? How can we understand this phenomenon? What can we do to minimize the personal toll so often exacted by the transition to leadership? This paper will focus on these essential questions. The inevitable discomfort encountered during this learning curve, which can last from two months to two years, often comes as a surprise. Many physicians who have been elevated to leadership positions because of their success and interpersonal acceptance, have not had to struggle with this sense of being "a fish out of water" since very early in their professional careers. Unless there is someone in place to reassure and mentor, the resulting confusion can be quite unnerving, resulting in reflex defensiveness.     

Business values in the Republic of South Africa and the United States: A tale of two countries

This paper reports on a study of the values of two samples of South African managers over a ten year period. It then compares those values to a group of U.S. entrepreneurs, using the same instrument, the Allport-Vernon-Lindzey Study of Values, for both groups. The comparison with the early sample of South African managers noted similarities between the value systems of the two groups. The comparison with the most recent group of managers indicates a shift in the values of the South African managers. There appeared to be little difference between the values of the latter group of managers on the basis of age. This was similar to the findings in the U.S. sample as well as the earlier South African sample. There were differences in the strength of the values, but less of a difference in the pattern of values exhibited based on industry backgrounds. The reasons for these shifts are discussed, including the potential impact on the education process in South Africa.     

Making a match: inexperienced physician executives and the job market

Hospitals and other health care organizations are adding physician executives at such a rate that demand is outstripping supply-there are more opportunities for seasoned physician executives than there are physicians with track records as medical managers. It is possible that hiring management will have to consider the employment of a physician who wants to be in management but has no track record as a physician executive. In some cases, it may even be preferable to employ a neophyte physician executive, especially when the physician is a respected clinician already on the organization's medical staff. In selecting such a physician, however, an evaluation must be made of the probability that the physician will be successful in the new role. The author points to 10 criteria that the hiring organization should observe in hiring inexperienced managers.     

Can good health be just a fad?

A number of studies have identified health education and promotion as important contributors to health improvement. Still, a number of factors, not the least of which is the dominance of the health care system by a disease orientation, have kept the health promotion movement from making even more significant contributions to the nation's health. The knowledge and technology to make health promotion a key part of the health care system are clearly in place. What is needed is greater involvement in the movement by physicians. Physician managers can play a leading role in bringing physicians into the mainstream of health promotion activities.