How strategic decisions are made

The aim of this article is to shed some light on how strategic decisions and actions occur in organizations. The fundamental argument is that the traditional literature fails to provide an adequate understanding of how such decisions are made and that a new focus is needed. Drawing on organizational theory, the author approaches a new focus on decision-making, having the first described the traditional approaches.     

What are dynamic capabilities and are they a useful construct in strategic management?

The dynamic capability perspective extends the resource-based view argument by addressing how valuable, rare, difficult to imitate and imperfectly substitutable resources can be created and how the current stock of valuable resources can be refreshed in changing environments. The concept of dynamic capabilities emerged in the 1990s, and the field has advanced considerably since. This paper presents a review as well as a synthesis of the extant literature. This synthesis first highlights, that dynamic capabilities are shaped by enabling and inhibiting variables within and outside the firm, including the perceptions and motivations of managers; secondly, it identifies processes that create dynamic capabilities; and thirdly, it explains that dynamic capabilities do not automatically lead to performance improvements. Finally, the paper addresses some areas of confusion and contradiction that hamper the development of the literature.     

Becoming who you are.

It's difficult to predict success based only on educational background and career experience, important as they are. More is needed. And one of the aspects that needs to be evaluated is the degree of self-actualization. Self-actualized individuals have worked out their personal issues well enough that their personal life no longer has to intrude into their professional lives and actions. In a word, they are free people. In career terms, self-actualized people are "company people," but not "yes-people." They are executives who have freed themselves to be able to internalize the growth, development, and strategic planning of their organization--because they are able to rise above personal considerations, to shed emotionalism, and see more clearly. Some methods you can use to figure out where you stack up are: Conduct a self-evaluation; identify role models; do what is called "a 360 evaluation."     

How effective are models?

This article discusses a number of common interpretations of ‘implementation’ in the literature, and how these have been confused. Various different levels of implementation are then discussed, including the concept of model effectiveness. This is concerned with both the operational effectiveness of the model, as shown by a tangible improvement in the system modelled, and the personal effectiveness in helping users learn more about the system itself. Research is then described to explore various aspects of model usage and effectiveness. The research took place in the context of a business game used by a large number of practising managers. An unusual feature of the game was the fact that participants were offered the use of a number of models to aid their decisions. The usage of the models, and their effects, were measured objectively. Results showed that models were used extensively, and their effects were advantageous in a number of ways. The implications of this work are discussed.     

Why doctors are afraid of numbers

Physicians are said to be data-driven. However, their behavior frequently is at odds with this belief. Physicians often protest when presented with unfavorable data, complaining that the data are not applicable to them. Take a look behind this behavior.     

We are our brothers' keepers.

An essential element of leadership for the physician executive is working with impaired physicians, whether their handicap is temporary or long-term, to make them fully contributing members of the health care team. Physicians must not only make themselves and their immediate staffs sensitive to the problem and its solutions, but also instill a helping environment for the overall organization.     

Everywhere,planners are in pain

In this provocative article the author suggests that planners should now leave the field of rational decision-making to high technology machines and should themselves concentrate on the non-rational judgmental aspects of human activity. Management is not and never can be a science, and with the growing awareness among businessmen and academics that over-rationality is eventually harmful, planners should be adding qualitative analysis and interpretation to their role and becoming more aware of the complexities of the non-rational aspects of managerial planning.     

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.     

So you are not paying attention

In May 1993, a 13-item questionnaire was sent to physicians and nonphysicians who have attended the ACPE-sponsored program "The Management of Professionals" (now called "Building Organizational Cooperation: The ABCs of Win-Win Relationships." Of the 125 questionnaires distributed, 52 were returned. The objective of this article is to share some of the findings of the survey on win-win behaviors that can be of use to physician executives.     

Organization theory: Where are you?

This paper seeks to summarize the present state of organization theory. It takes as its starting-point the work of early organization theorists and demonstrates that their work has been challenged in basically four different ways, i.e. regarding the view on (a) individuals in organizations, (b) the interaction among individuals in organizations, (c) the relationship between organizations and their environments and (d) the technology of organizations. The implications of these qualifications are discussed with reference to recent literature. These discussions led to the conclusion that the number of research questions have increased rather than decreased over the years. Thus, a unified organization theory may be less valid today than at the beginning of the century. This circumstance, however, it is argued, should not be considered a regression but rather a sign of increasing insight.     

The times, they are a changin'

Significant changes are taking place and will continue to take place in U.S. health care and medicine. Many of these changes are not, and will not be, to the benefit of physicians. Reduced personal autonomy, probably lower compensation than expected, fewer and less adequate resources, and overall significantly reduced power are some of the likely outcomes of the changes underway. Perhaps of greatest personal interest is the high likelihood of lack of employment in medicine for upwards of 200,000 physicians over the next 20 years.     

New media economics are transforming consumer relations

The introduction of new IT-based technologies is often said to revolutionize media and retail competition, change the power of brands, and make ‘smart shopping’ or ‘e-commerce’ the future of consumer relations. Other sources, however, caution that the underlying ideas are neither new nor likely to significantly change the market environment. It is the purpose of this article to present a brief perspective on:

• 1. 

  1.|Why current changes in media will alter consumer relations;

• 2. 

  2.|Which means of consumer access is likely to dominate;

• 3. 

  3.|How the result affects the case for e-commerce; and

• 4. 

  4.|How this shapes the evaluation of commercial opportunities for established players as well as newcomers.

     

When are two multivariate random processes indistinguishable

Prediction error identification methods have been recently the objects of much study, and have wide applicability. The maximum likelihood (ML) identification methods for Gaussian models and the least squares prediction error method (LSPE) are special cases of the general approach. In this paper, we investigate conditions for distinguishability or identifiability of multivariate random processes, for both continuous and discrete observation time T. We consider stationary stochastic processes, for the ML and LSPE methods, and for large observation interval T, we resolve the identifiability question. Our analysis begins by considering stationary autoregressive moving average models, but the conclusions apply for general stationary, stable vector models. The limiting value for T → ∞ of the criterion function is evaluated, and it is viewed as a distance measure in the parameter space of the model. The main new result of this paper is to specify the equivalence classes of stationary models that achieve the global minimization of the above distance measure, and hence to determine precisely the classes of models that are not identifiable from each other. The new conclusions are useful for parameterizing multivariate stationary models in system identification problems. Relationships to previously discovered identifiability conditions are discussed.     

On solutions that are better than most

A programmatic approach to solving decision problems by the use of ‘better than most’ (BTM) solutions is introduced. The BTM approach is contrasted to approaches that seek a solution whose outcome would be the best of all outcomes for feasible solutions, again according to criteria taken to represent the decision maker's objectives. This BTM approach is illustrated in terms of a decision problem in binary decision variables. This is followed by a discussion of (1) some of the probabilistic aspects of BTM solutions, including calculational experience, (2) a central BTM problem, akin to the problem of finding optimal methods in the more traditional approaches, (3) some ad hoc methods for overcoming this and other problems associated with the BTM approach, and (4) similarities and differences between the BTM approach and other approaches.     

Cost-plus pricing when joint costs are present

Companies using cost-plus pricing often produce products that entail joint cost allocation. A problem they have encountered is that, while product prices are a function of the full cost, joint cost allocation methods using net realizable values depend on the product prices. This paper shows that when all costs and production quantities are known (or can be budgeted), it is possible to simultaneously determine unique product prices and cost allocations using the net realizable value method.     

What employers are looking for right now

What specific skills are employers and recruiters looking for in physician executive candidates? Here are the top dozen characteristics that were invariably mentioned in interviews with high profile headhunters, as well as in analyzing open job orders. The most sought-after skill is leadership. Employers want someone who has courage. Expect this list to change in 1997 as the industry changes. However, there will be more additions than deletions, in keeping with overall trends toward higher, not lower, expectations of physician managers.     

What to do while things are changing

No longer able to support an entitlement culture, the business of health care is rapidly giving way to a culture of marketability. However, effective career management within a changing professional landscape doesn't have to be nightmare. Physician executives can learn to work with the dynamics and principles of change management to significantly reduce their error rate and increase their chances for success. Using change management strategies and tools effectively is the best way to transform any sense of urgency you may feel into energy, information, and action. This is the optimal time to create a better work environment for yourself, and become a better resource for the community you serve.     

The ethical mirage: A temporal explanation as to why we are not as ethical as we think we are

This paper explores the biased perceptions that people hold of their own ethicality. We argue that the temporal trichotomy of prediction, action and recollection is central to these misperceptions: People predict that they will behave more ethically than they actually do, and when evaluating past (un)ethical behavior, they believe they behaved more ethically than they actually did. We use the “want/should” theoretical framework to explain the bounded ethicality that arises from these temporal inconsistencies, positing that the “should” self dominates during the prediction and recollection phases but that the “want” self is dominant during the critical action phase. We draw on the research on behavioral forecasting, ethical fading, and cognitive distortions to gain insight into the forces driving these faulty perceptions and, noting how these misperceptions can lead to continued unethical behavior, we provide recommendations for how to reduce them. We also include a call for future research to better understand this phenomenon.     

Delivery and funding are provincial matters in Canada

The following article is one of a series that deal with the provision of health care services around the world. Other countries in the series include Germany, Italy, Japan, Mexico, the Netherlands, and the United States. Countries scheduled for coverage in the series include Austria, France, Singapore, Spain, and the United Kingdom. The countries are described using a grid of characteristics so that comparisons may be made more easily. All of the analyses, along with further comparative data, will be gathered into a freestanding book to be published later in the year. Dr. Mendoza serves as editor for the project.