Changing the face of emergency medicine

Discover how one hospital in Salt Lake City nearly eliminated patient waiting time in its emergency department and the department essentially became the front door to the hospital.     

Professionalism in medicine: the new authority

Examine some ways that the health care profession could regain lost ground and begin exerting more influence in the marketplace to help offset the pressures from insurance companies, consumers, and the government.     

Fresh in the saddle: The influence of a new CEO's vision and origin,and CEO succession type on market actors' reactions

CEO succession is a critical event in the life of a company. How external stakeholders respond to it, can affect the company's valuation. This study investigates how securities analysts' and investors' reactions to CEO succession are affected by the interplay between the charisma of the new CEO's vision, the new CEO's origin (whether an insider or outsider), and the type of CEO succession (whether routine, dismissal or interim). Drawing on the literature on signaling, we suggest that because a charismatic vision emits a positive signal about the company's future performance, it will affect market actors' reactions by either weakening or strengthening the influence of the signals emitted by other succession context contingencies, namely, CEO origin and succession type. To test our predictions regarding analysts' and investors' reactions, we respectively analyze panel data and conduct an event study. The results support most of our predictions. We discuss the study's contributions and implications.     

Cross-cultural re-entry for missionaries: a new application for the Dual Process Model

Nearly half a million foreign aid workers currently work worldwide, including over 140,000 missionaries. During re-entry these workers may experience significant psychological distress. This article positions previous research about psychological distress during re-entry, emphasizing loss and grief. At present there is no identifiable theoretical framework to provide a basis for assessment, management, and prevention of re-entry distress in the clinical setting. The development of theoretical concepts and frameworks surrounding loss and grief including the Dual Process Model (DPM) are discussed. All the parameters of the DPM have been shown to be appropriate for the proposed re-entry model, the Dual Process Model applied to Re-entry (DPMR). It is proposed that the DPMR is an appropriate framework to address the processes and strategies of managing re-entry loss and grief. Possible future clinical applications and limitations of the proposed model are discussed. The DPMR is offered for further validation and use in clinical practice.     

Corporate Governance is Directors Making Decisions: Reforming the Outward Foundations for Inside Decision Making

Journal of Management and Governance -     

The need for a new model of care: revisiting the archetype

Managed care organizations are refusing to accept the traditional academic health center's uncoordinated teaching model for their patients. They know that successful capitation can only be achieved when care is viewed from a population perspective, managed along a continuum, and coordinated at every point. Of the many changes that must occur, the care delivery paradigm, is a major area that needs to be redesigned.     

Opportunities of Reforming the WTO: Resistance and Potentials of Change

This paper intends to show both that a reform of the WTO is severely needed in order to establish a fairer international trade order but also that it is possible. The first section of this paper analyzes the functioning and the most controversial rules of the organization. The second and third sections intend to look for current opportunities of reforming the WTO by analyzing the main existing critical responses to the institution’s deficiencies—namely coalitions of southern Nation-States and global civil society movements—and their potential to achieve some change. It is concluded that these two key group actors, while playing different roles, do have common goals on selected issues of international trade and if so, their combined negotiating power is considerably increased for achieving a progress in the direction of a positive reform of the WTO for the developing world.

Scenarios for industrial relations: Sweden evolves a new consensus

The consensus approach to industrial relations has served Sweden well for 30 years in achieving industrial peace, thus enabling the economy to thrive. In recent years the consensus approach has broken down in three important areas, namely the worker funds, the law on co-determination at work and in pay negotiations. The causes of the breakdown are analysed and possible future developments are discussed with some reference to the political and economic background. The author charts the major trends and develops a number of scenarios for the future.     

Psychiatric home care: a new tool for crisis intervention

The cost of psychiatric care has been rapidly increasing in recent years. Between 1984 and 1987, there was a 46 percent increase in psychiatric hospitals beds and a 60 percent increase in psychiatric units in general hospitals. This reflected a recognition by many health care systems that psychiatric patients were a good source of revenue. With this push toward more and more inpatient programs, crucial aspects of psychiatric care were left behind. Specifically, the limitations of inpatient therapy have not been recognized. Within the past five years, a new program has been developed and pioneered to use home care to prevent psychiatric hospitalizations and to also prevent the difficult transitions for psychiatric patients. Over a two-year period, this program was studied for its impact on the quality and cost of psychiatric care.     

Shared planning: a new foundation for quality criteria.

The Chinese word for crisis has two characters. One for danger and one for opportunity. A crisis is a time for awakening to new perspectives and for asking different questions. The widely touted "liability crisis" in the health care field provides just such a time for new approaches. Perhaps there is a way to establish market mechanisms for decision making that gives expression to the desires and values of consumers while respecting the abilities and preferences of physicians. Quality might then be the result of natural selection or, more accurately, of market demand. Such a system would acknowledge that quality in medicine is not for defining. It's for having. Quality should be obtained in bargaining for services, not in mandates of professional regulation.     

New governance for a new era: issues and challenges for integrating systems

In this first part of a two-part column, Dr. Ruffin introduces seven key factors that will govern the operations of integrated systems. It is important to understand, he says, that, in the movement from a fee-for-service payment mechanism, in which the various elements of the health care field bill for their services independently and according to rules designed for their benefit, to an intregrated system, in which such independence can only lead to confusion in information systems, very substantial changes will be required in the governance of our health care institutions and organizations. In the second part of the column, Dr. Ruffin will elaborate on the seven factors that must be considered in the transition.     

New governance for a new era: issues and challenges for integrating systems

In this second part of a two-part column, Dr. Ruffin provides greater detail on seven key factors that he believes will govern the operations of integrated systems. Successful systems, he says, will be those that attract and retain physicians, have disciplined governance, integrate care through sharing of information among system elements, conserve capital, ensure strategic growth, control costs, and are proficient at processing information. It is important to understand, he says, that, in the movement from a fee-for-service payment mechanism, in which the various elements of the health care field bill for their services independently and according to rules designed for their benefit, to an integrated system, in which such independence can only lead to chaos, very substantial changes will be required in the governance of our health care institutions and organizations.     

People perception: Social vision of groups and consequences for organizing and interacting

An enormous amount of research on person perception exists. This literature documents how people form impressions of one another and how these impressions influence behavior. However, this literature surprisingly has not been extended to people perception—how people visually perceive and judge groups (e.g., teams, classrooms, boards, crowds) rather than individuals. We propose a model of people perception processes, including three stages of Selection, Extraction, and Application (the SEA model). We integrate this model with literature from organizational, social, cognitive, and visual sciences to describe the important role of people perception in organizational and social behavior. We focus our discussion on organizational and social phenomena such as group tone, group hierarchy, and group evaluation.     

Reforming the strategic planning process: Integration of social responsibility and business needs

In this article the author argues that one of the prime organizational imperatives for the development of a responsive, operational, ‘corporate social policy’ must be reform of the strategic planning process. Indeed he argues that this reform is the essential pre-requisite to making the true integration of social responsibility and business needs.     

Problem solving: not good medicine for health care

Explore the challenging paradoxes that run throughout health care and consider ways to accept them into an organization.     

Spotting a market gap for a new product

Many new products and substitute technologies fail because they enter markets too late or with too little price/performance advantage. Essentially, these products have missed their window for successful market entry. To avoid this type of product entry error, management should locate and define the boundaries of the strategic entry window for their products or technologies.     

A model for a new society: Values,ethics, and the global economy

Increasing interdependencies and vulnerabilities in the global economy appear to require a re-examination of our neoclassical economic individualism. The philosophy of Alfred North Whitehead provides a fundamentally new framework for a view of reality based on organic and social models rather than on mechanistic and individualistic ones. This article summarizes Whitehead's central concepts and explores the ethical implications of his social conception of reality for economic behavior. It also draws ecological implications from his thought and makes suggestions for management behavior. This article concludes that a new way of thinking is required to function ethically in a socially interdependent universe.     

Internet support groups for suicide survivors: a new mode for gaining bereavement assistance

Taken among parents who sustained the loss of a child to suicide this study explores the participation of parents in Internet support groups, comparing their demographic and loss-related characteristics (N = 104) to other parent survivors participating in face-to-face support groups (N = 297). Contrary to expectations that Internet affiliates would be concentrated in under-served rural areas, we found similar levels of urban, suburban, small city and rural residents in both Internet and face-to-face subsamples. Bivariate and multivariate analyses suggested several important factors contributing to interest in Internet grief support including: 24/7 availability and opportunities to invest more time into this type of support group experience. Compared to their face-to-face group counterparts, Internet affiliates experienced greater suicide stigmatization from their families and other associates. Unable to find ready comfort and support from their personal communities, Internet users-and especially highly depressed survivors-sought and obtained valuable help from the Internet support resource.     

Culture in chaos: the need for leadership and followership in medicine.

The health care industry is changing at a dizzying pace and most of its players are struggling to maintain some form of the status quo. But resisting change will not prove fruitful--ultimately, it will rob physician executives of the opportunity to be architects in designing a new, more efficient health care system and their role in it. Because health care is a complex adaptive system (CAS)--change occurs rapidly and events are unpredictable--the old command and control style of leadership and a linear way of interpreting events is too rigid and, therefore, an ineffective model for guiding change. Complexity science offers insights about leading for change. In CASs, changes emerge in response to environmental demands for adaptability. Since the nature of these demands is unpredictable, the role of leadership is to manage the relationships and context out of which these changes emerge. A leadership style is called for that leads to purpose, makes positive changes by influencing context and relationships, and takes followers to a better place.