The physician executive "arrives"--a new generation prepares for the future

The recent rise in the number of physician executives in the health care industry vividly demonstrates that a genuinely new generation of physician executives is seeking to combine the sensitivity of their clinical skills with the business acumen that today's health care organizations need to prosper and grow. But physicians who are preparing themselves to be selected one day as chief executive officers by hospitals, integrated systems, and managed care organizations should understand that the CEO role is radically different from that of the CEO of a physician practice. The corporate CEO role requires the management of managers and responsiveness to the organization's board. Those who imagine that the corporate CEO role bears any resemblance to the autonomous, independent existence of the practitioner are certain to have a rough time.     

Spirituality and the physician executive

The "s" word can now be spoken without flinching in health care organizations. Spirituality is becoming a common topic in management conferences around the world. Many U.S. corporations are recognizing the role of spirituality in creating a new humanistic capitalism that manages beyond the bottom line. Spirituality refers to a broad set of principles that transcend all religions. It is the relationship between yourself and something larger, such as the good of your patient or the welfare of the community. Spirituality means being in right relationship to all that is and understanding the mutual interdependence of all living beings. Physician executives should be primary proponents of spirituality in their organizations by: Modeling the power of spirituality in their own lives; integrating spiritual methodologies into clinical practice; fostering an integrative approach to patient care; encouraging the organization to tithe its profits for unmet community health needs; supporting collaborative efforts to improve the health of the community; and creating healing environments.     

Physician career development: toward building a model

Virtually no managed care organization provides a comprehensive and integrated program for physician career development. That's the principal finding of a survey we carried out in Spring 1994 in which we interviewed several individuals who have proven instrumental in the creation of career development programs at their managed care organizations. We started our research with the hypothesis that career development programs for physicians--frequently the most highly paid category of employees and the ones often most directly involved in the delivery of health care--should parallel the mission of the organization. In many of the organizations we surveyed, the mission included clinical excellence, managerial competence, research, teaching, community service, and building shareholder equity. While each organization offered some component of career development--usually clinical improvement and management development--very few offered programs that fostered the continued professional development of physicians in other aspects of their missions. In most cases, even in organizations with stronger career development agendas, the programs were passive and were rarely linked to the overall "corporate" goal of the managed care institution. This critical disconnect makes it extremely difficult for health care organizations to develop a workable system of accountability for their career development programs.     

Effective health care corporate compliance

The pace and intensity of oversight and investigation of health care organizations has greatly increased at all levels. Well run organizations with ethical management committed to following all laws and regulations are still at risk for compliance violations and punitive penalties. Under the Federal Sentencing Guidelines, organizations with an "effective" corporate compliance program may receive reduced penalties. The seven components of an effective program as defined in the guidelines are: (1) Standards and procedures; (2) oversight responsibilities; (3) employee training; (4) monitoring and auditing; (5) reporting systems; (6) enforcement and discipline; and (7) response and prevention. Lack of a compliance program needlessly exposes the organization to an avoidable risk of damage from non-compliance--whether intentional or not. Moreover, an effective program can contribute to the efficient operation of the organization and be a key piece of its corporate culture.     

Important points in managed care contracts

Health care is increasingly managed through some contractual relationship. Such contracts vary and the contracting entities may be clinics, universities, health maintenance organizations, individual practitioner organizations, preferred provider organizations, corporate health plans, or other structures. It is estimated that within 10 years more than 70 percent of all health care will be provided through some type of managed care plan.     

Hospital-physician relations: overcoming barriers to cooperation.

In the September-October 1986 issue of Physician Executive, we discussed the application of strategic business units (SBUs) to health care. SBUs are those corporate entities that market similar products to one or more target populations with similar characteristics. Examples of SBUs in health care are obstetrics, cardiology, orthopedics, etc. When the services within each SBU are linked together, they might resemble a vertically integrated health care system. In the case of obstetrics, a woman may have contact with physicians, a hospital, home care nurses, house-cleaning services, birthing teachers, and maternity clothing boutiques. Each of these are products/services within the SBU of obstetrics. Strategy development by SBU implies an external focus on the marketplace in terms of the specific mission of the SBU (clinical specialty). It also implies responding to the needs of consumers for whom the historical and present divisiveness between hospitals and physicians is immaterial and irrelevant. In this article, we will focus on ways to stabilize the relationship between hospitals and physicians within an SBU context in order to compete more successfully as a team in today's health care environment.     

Serf or citizen: physician status and organizational structure

For more than a decade, dynamic changes in the health care industry have created new organizations for physicians. The major change for physicians has not been the organization itself, but the principles by which it is governed. This fundamental shift is studied with its impact on physicians, by analogy, becoming more like serfs or more like citizens. A review of the general organizational direction and results of non-physician health care organizations is made followed by the statistical trends of physician groups. Historical comparisons of non-health care industries are made with current organizational choices of physicians and physician groups. Observations of physician decisions are made identifying the direction they send physician status along the continuum from serf to citizen. Physicians are unknowingly making decisions regarding the principles by which they will be governed in new organizations. The choices they are making give them less autonomy and less opportunity to make future choices. The seductive invitation to spend less time in administrative matters and more time practicing medicine is a siren's call that will diminish the status of physicians and the autonomy by which medicine is practiced.     

The changing professional organization: A review of competing archetypes

The aim of this paper is to summarize literature relevant to the professional organization and to present a contemporary analysis of the archetype concept in this field. In order to understand recent and ongoing changes in professional organizations, the paper begins with a review of how the professional archetype evolved from the 1960s to 1990. Then, with examples from contemporary accounting, health care and law organizations, it considers the processes by which an institutionalized archetype can change. Forces for change – such as deregulation, competition, technology and globalization – can challenge the interpretive scheme and eventually delegitimize the existing archetype. At the same time, significant environmental changes can override isomorphic pressures and de‐institutionalize the long‐accepted structures. Thus we herald the emergence a new professional archetype – or perhaps several competing archetypes. Finally, the paper reviews the evolving field of professional organization as a whole, and understands the extant archetypes. A typology of professional organizations is proposed that currently seems to have three clusters of organizations – possibly three competing archetypes – namely, the traditional professional partnership, the specialized ‘Star’ form and the corporate global professional network, or GPN.     

Quality assessment tools add value

The rapid evolution of the health care marketplace can be expected to continue as we move closer to the 21st Century. Externally-imposed pressures for cost reduction will increasingly be accompanied by pressure within health care organizations as risk-sharing reimbursement arrangements become more commonplace. Competitive advantage will be available to those organizations that can demonstrate objective value as defined by the cost-quality equation. The tools an organization chooses to perform quality assessment will be an important factor in its ability to demonstrate such value. Traditional quality assurance will in all likelihood continue, but the extent to which quality improvement activities are adopted by the culture of an organization may determine its ability to provide objective evidence of better health status outcomes.     

Can doctors and administrators work together?

The working relationship between physicians and health care organizations has dramatically changed since the introduction of competitive factors. Fifer suggests that future doctors may have as many as five or six economic relationships with their associated health care system, in contrast to the singular role as admitting physician of the past. The physician will continue to admit patients, but may also belong to an HMO or some other joint venture (freestanding ambulatory care center, outpatient laboratory, etc.), be salaried part time for leadership roles, be a leader in some other parallel economic venture, etc. Physicians are already assuming multiple roles as health care providers, private entrepreneurs, and joint venture partners with hospitals. Hospitals and health care systems also continue to change through vertical and horizontal integration. Traditional clinical departments are becoming blended into product line entities, and a sophisticated executive team of market-oriented specialists now augments the traditional administrative leadership. So, from a tradition of predictable roles, relationships, and authority structures, we are now attempting to thrive and prosper with many new partners in an integrated, complex, and conflict-ridden set of interrelationships.     

Organizational Slack and Corporate Greening: Broadening the Debate

Organizational slack seems to have an ambiguous relationship with corporate greening. On the one hand, excess resources can be used to experiment with new environmental innovations, or potential green market segments. On the other, excess resources can be used to build corporate buffers against pressures for environmental improvement, such as large corporate environmental departments or environmental lobbying activity, and resist changes to the core of the organization. This paper begins to resolve these conflicting arguments by broadening the debate on organizational slack and corporate greening. It builds on recent empirical studies of slack and corporate greening, and recognizes the many potential roles that different types of slack may play in a dynamic decision–making context. Using a theoretical framework suggested by Bourgeois (1981), the paper systematizes and draws lessons from examples of the roles of slack encountered in a recent series of 35 interviews within UK public limited companies. It concludes that future treatments of slack and environmental management should incorporate a more holistic view of slack, which recognizes its dynamic, complex and often contradictory effects on decision–making in organizations.     

The health of health care organizations

Abstract

This paper explores the nature and development of health care organizations in terms of a model of organizational healthiness. The model places particular emphasis on the psychosocial subsystems which describe the subjective organization. These represent the perceived internal functioning of the organization in terms of task completion, problem solving and staff development. The implications of such a model for the well-being of health care staff and for the evaluation of service delivery are discussed.     

Will your academic department survive managed care?

The current form of academic department is likely to vanish from many institutions. Changes occurring in health care are part of the evolution other industries have experienced, following the product life cycle. Physicians are becoming "deprofessionalized" and as such are beginning to resemble technical workers seen in other industries. The rearrangements in health care are bringing together organizations with different missions, priorities, culture and even language. An academic department may not be considered as an asset to the larger organization or network, representing but one option for product differentiation in the market place. There are strategies for maintaining the viability of the academic component of an organization that necessitate congruence with the overall strategy for the greater organization.     

DRAM: a model of health care resource allocation in czechoslovakia

This paper presents an application to data from Czechoslovakia of a health care resource allocation model called DRAM (Disaggregated Resource Allocation Model). DRAM was developed by the health care systems modelling group at the International Institute for Applied Systems Analysis (IIASA). It attempts to predict the consequences of resource-level changes, in terms of the numbers of patients treated in each clinical category and the quality of care they receive in each mode of treatment. In this application, seven acute clinical categories and two types of resources (hospital doctors and hospital beds) are selected for examination in one mode of treatment—in-patient care. Some parallels are drawn with a comparable application in the UK.     

Is leadership born or made?

Is leadership born or made? By profiling three colleagues who made the transition from clinician to top-flight executive in a health care organization, the author provides case studies from which to discuss leadership issues. An evolutionary pattern has developed with respect to physicians changing careers: The first model was the medical director, followed by the vice president for medical affairs, and finally the move to managing the health care system, group practice, or managed care organization. Are physician executives fundamentally different from clinicians in terms of leadership characteristics? What are the essential qualities needed to lead health care organizations? These questions are explored in-depth.     

Does the Stock Market Gender Stereotype Corporate Boards? Evidence from the Market's Reaction to Directors' Trades

Attitudes towards male and female managers within organizations are well documented, but how the stock market perceives their relative capabilities is less studied. Recent evidence documents a negative short‐run market reaction to the appointment of female chief executive officers and suggests that female executives are less informed than their male counterparts about future corporate performance. These results appear to dispute the stock market value of having women on corporate boards. However, such short‐run market reactions may retain a ‘gender bias’, reflecting the prevalence of negative stereotypes, where the market reacts to ‘beliefs’ rather than ‘performance’. This study tests for such bias by examining the stock market reaction to directors' trades in their own companies' shares, by measuring both the short‐run and longer‐term returns after the directors' trades. Allowing for firm and trade effects, some evidence is found that, in the longer term, markets recognize that female executives' trades are informative about future corporate performance, although initially markets underestimate these effects. This has important implications for research that has attempted to assess the value of board diversity by examining only short‐run stock market responses.     

Clinical reengineering. Integrating medical and operational management

In the continuing push for cost containment in health care, many organizations have turned to cost reduction methods that fundamentally change the way care is delivered. As health care organizations continue to make financially-driven staffing changes that impact patient care, medical leadership must take on greater responsibility for operational management. Physician executives are uniquely qualified to take on leadership roles in work redesign, and must do so to ensure excellent and fiscally-responsible patient care. This article presents a proven methodology for work redesign that helps physician executives apply their clinical skills to operational management in designing new health care delivery models.     

基于免疫的组织健康捍卫机制建构:一个案例

本文借鉴医学免疫和健康的新视角,试图建构基于组织免疫行为的组织健康捍卫机制分析框架,探讨组织健康状态的理论维度和组织免疫行为如何捍卫组织健康状态并发挥作用的机制,同时,选取广东粤电集团沙角C电厂进行了案例研究。本文的研究揭示出,组织监视、组织防御和组织记忆是组织免疫过程的主要行为维度,而组织健康的理论维度,包括组织结构均衡性、功能活跃性、社会和谐性和环境适应性,组织免疫行为对组织健康有捍卫作用,任何一个要素和环节的缺失或失灵都会破坏组织健康状态,组织免疫系统的建立对于避免复杂系统的运行失败是非常关键的。     

Health care costs: saving in the private sector

Robeson offers a number of options to employers to help reduce the impact of increasing health care costs. He points out that large organizations which employ hundreds of people have considerable market power which can be exerted to contain costs. It is suggested that the risk management departments assume the responsibility for managing the effort to reduce the costs of medical care and of the health insurance programs of these organizations since that staff is experienced at evaluating premiums and negotiating with third-party payors. The article examines a number of short-run strategies for firms to pursue to contain health care costs: (1) use alternative delivery systems such as health maintenance organizations (HMOs) which have cost-cutting potential but require marketing efforts to persuade employees of their desirability; (2) contracts with third-party payors which require a second opinion (peer review), a practice which saved one labor union over $2 million from 1972 to 1976; (3) implementation of insurance coverage for less expensive outpatient care; and (4) the use of claims review. These strategies are compared in terms of four criteria: supply of demand for health services; management effort; cost; and time necessary for realized savings. Robeson concludes that development of a management plan for containing health care costs requires an extensive analysis of alternatives, organizational objectives, existing policies, and resources, and offers a table summarizing the cost-containment strategies that a firm should consider.     

The Strategic Management of IT Investment Decisions: A Research Note

The concept that Information Technology can be used as part of an organization's strategy changes its role in the organization. Whilst investments associated with current or ‘more of the same’ computer systems are proposed by the DP manager, requests for investments associated with the use of IT as a competitive weapon come from a much wider audience. Since the size of the investment may be large and its potential impact on the organization profound there is a need to objectively analyze and manage such investments at the strategic level. Sophisticated models exist in the literature (Butler, 1988; Porter, 1988; Marsden, 1988; Synott, 1987) and there is much research to support the view that IT and corporate strategic models need to be aligned (Feeney & Brownlee, 1986; Haffenden, 1988 and Brewer, 1987). However the results from in-depth interviews with highly placed managers suggest that the decisions are based on more informal processes and that there exists differing views on the relationship between IT and corporate strategies.