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.     

Manufacturing in the Nineties By H.J. STRUDEL and P.DESRUELLE(Van Nostrand Reinhold,New York, 1992). £31.50.

Abstract

Looking for a world model for the manufacturing information flow diagram has brought us to the conclusion that it is impossible to build an all-encompassing, all-inclusive system. The redundancy and overlap would make the system excessively complex and ineffective. The best way to generalize a model of this type is to simplify. The result is that we eliminate nearly the entire production control mechanism that is found in the labour intensive MRP system (Fig. 1). We come up with a system that is much closer to the material intensive JIT system (Fig. 2). The conclusion is that effective production control requires that you choose which resource you wish to optimize, and then select a system that controls the plant around the selected resource base. This is the function of books like International Management and Production. A second conclusion would be that complexity (MRP—Fig. 1) gains very little over simplicity (JIT—Fig. 2 or World Model—Fig. 4) in productivity or efficiency. As Shozo Hibino says in his book Breakthrough Thinking, we need to run our plants smarter, not harder.     

Biographical Notes - James H. Reynierse; Dennis Ackerman; Alexis A. Fink; John B. Harker; James T. Scarnati; David Boyd; Jay A. Halfond; Barbara A. Edwards; Tomas Brytting; Claes Trollestad; Margaret Ryan

Biography

Biographical Notes - James H. Reynierse; Dennis Ackerman; Alexis A. Fink; John B. Harker; James T. Scarnati; David Boyd; Jay A. Halfond; Barbara A. Edwards; Tomas Brytting; Claes Trollestad; Margaret Ryan     

LOAD CUBING AT R. J. REYNOLDS

R. J. Reynolds Tobacco USA (RJR) is currently implementing a microcomputer-based decision support system to computerize and optimize the selection of patterns for loading cases of finished product into truck trailers at RJR's Central Distribution Center. This system allows for the efficient loading of trucks with less supervision. Total annual savings from reduced personnel and shipping costs is approximately $850,000. In addition to these benefits, the system is a stepping stone for trailer loading automation and the integration of a comprehensive load planning system.     

Life after retirement. Interview by Barbara J. Linney

Are you thinking about retirement? Here are interviews with four physician executives who have made the transition. Some are recently retired, while others have been retired for many years. The good news is that all of them are productive and exploring interests and hobbies that their careers had taken precedence over. All of them were asked the following: (1) How have you felt about retirement? (2) What are some interesting things you've done? (3) What advice would you give to others who are planning for it?     

Performance evaluations of physician executives. Interview by Barbara J. Linney.

Six senior physician executives were interviewed to see how they were doing or not doing performance reviews in their organizations. There seems to be a trend toward doing them, but it is in the beginning stages. Of the physician executives surveyed, the experience ranges from formal lengthy evaluations with rating scales to reviewing a short list of goals. Several are in the process of developing new systems or revising old ones. Probably the most useful part of a performance evaluation is the conversation between the physician executive and the person he or she reports to. If you can stop approaching performance evaluations as passing negative judgments on people, but as having a conversation to hear their concerns, learn what their goals are, and offer ways to help them achieve their potential, they can be useful, enjoyable experiences for both people.     

Leading an organization through change. Interview by Barbara J. Linney

Robert Jamplis, MD, FACPE, has been President and CEO of the Palo Alto Medical Foundation for the past 30 years. During those years, he has led his group through many of the changes that are just occurring in other medical group practices--movement away from long hospital stays and toward large integrated health care systems. In an interview conducted late in 1994, the author asked Dr. Jamplis to describe the major changes that have taken place in his organization during his tenure and the leadership skills he used to make them happen. His comments are summarized in the following report.