Physician career management: organizational strategies for the 21st century.

Burnout is a state of physical, emotional, and mental exhaustion caused by long-term involvement in situations that are emotionally demanding. It is not stress, per se, that causes burnout, as many thrive in stressful, demanding careers. Rather, burnout results when stress continuously outweighs the sense of effectiveness, accomplishment, and reward. And, this fate is sealed when one feels helpless to effect significant change in the conditions that fuel the stress. Establishing an organizational environment that reduces the risk of physician burnout requires a new commitment of resources, one that can be challenging to justify to decision-makers with a strictly short-term, bottom line orientation. The key issues to consider in shaping a physician career management program include: (1) entry of new physician employees into the organization; (2) productivity measures; (3) responsiveness to safety concerns; (4) administrative and policy issues; and (5) variety and growth opportunities.     

Computerization: reengineering the lawyering process for the 21st century

Alvin and Heidi Toffler, describe the benefits of "informationware" and how one of the most tradition-bound organizations, the armed forces, has substantially changed its operations. According to the authors, mere knowledge is not sufficient to prevail; how one manages or uses knowledge separates winners from losers. Further, the authors say "...basically add new elements or create new combinations of old elements within an existing 'game.' A true revolution goes beyond that to change the game itself, including its rules, its equipment, the size and organization of the 'teams,' their training, doctrine, tactics, and just about everything else. Even more important, it changes the relationship of the game to society itself." Application of this theory to today's litigation is obvious and compelling. The ways in which clients and defense counsel obtain, analyze, and strategically apply evidence and legal principles must change to incorporate the informationware this society uses in other lines of business. This means more extensive and appropriate usage of computer hardware in a software environment that fully supports emerging client and defense counsel needs. The computer system must provide case direction, helpful suggestions, and direct, rapid access to data bases containing information presently available only through person-to-person networking.     

Leading health care into the 21st century.

If there is a consistency in the professional lives of those who manage in the health care field, surely it is characterized by inconsistency. Change. For more nearly two decades now, since the full impact of the Medicare/Medicaid legislation hit, the health care industry has undergone profound, continual, and lasting change. Success can be measured largely in terms of how well a professional or an organization accommodates and manages these changes, making sure that they work for the organization and the career and not against them. The 1990s can be expected to be just as full of change and turmoil as have the past two decades. "What's past is prologue," Shakespeare wrote. The health care field is not apt to see the murderous machinations of The Tempest, but clearly exciting and challenging times lie ahead, and perhaps the outcome will be as positive as Shakespeare's. The scenario that follows provides a glimpse at the issues of change that will occupy the time and energy of physician executives for the coming decade.     

ROI: the building blocks for successful global organizations in the 21st century

As organizations move into the 21st century, past measures of organizational performance based largely on accounting and financial statements will be insufficient to meaningfully assess value. Short- and long-term performance will be increasingly determined by three resources: ideas, information, and investment capital, of which only investment capital is measured in traditional accounting and financial statements. Consequently, the 20th century orientation of return on investment needs to be expanded to include and account for both return on ideas and return on information. By focusing on these three measures of ROI the organization will be able to unleash creativity and obtain a sustainable competitive advantage. In this paper it is suggested that organizations should balance their focus on return on ideas, return on information, and return on investment, a ROI³ orientation for assessing organizational performance.     

Physician executives in the 21st century: new realities, roles, and responsibilities

This article is based in part on responses from 150 physician executives who participated in an interactive discussion of future trends at the American College of Physician Executives' 1999 Spring Institute and Senior Executive Focus, in Las Vegas, Nevada, on May 13, 1999. The session included electronic polling on 40 predictions, such as the future composition of the clinical workforce and how technology will affect the way that medicine is practiced and the patient-physician relationship. The prediction for physician executives? A growing number of physician executives will find themselves at the top of their careers in the next decade. The physician executive of the future will have a broad array of management opportunities and career choices. More doctors will be managers. Physician executives will work at every level of health care organizations, across the continuum of care, from large complex urban systems to small rural settings.     

Toyota in the 21st century in Asian countries: Information exchange system and best mix

This article explains the general nature of the business style of Toyota management strategy, its specific performance, and its development in China. It is quite difficult to find specific revolutionary policies and unusual strategies for the success of the Toyota Motor Corporation.     

A simplified framework for 21st century leader development

A simplified framework for leader development, structured into webs of belief, is proposed as a starting point for learning to lead in complex contexts and environments. The framework (a) provides a simplified belief set adaptable to changing contexts and conditions, and (b) engages the developing leader in ongoing constructive self and other development practices. The five webs of belief proposed for 21st century leader development are learning, reverence, service, authenticity, and flaneur. The five constructs are cognitive schemas for the developing leader to use as guiding principles, then adapt with new information, new experiences, new levels of complexity and new contexts over the course of the life and career spans.     

The new age of ethical marketing for the 21st century

The premise of this paper is that the strong trends toward ever increasing centralization in the agricultural producing sector of the United States in the 1980s will exacerbate in the middle-to-late 1990s. This, in turn, will lead to both radical changes in the consumer movement by the year 2000, and also to a completely redefined mission for the corporate marketing function as well. Specifically, the deliberate federal policies of the 1980s which led to a “shake-out” of the small family farm units in favor of large agri-business concerns in order to reduce federal subsidies will lead, in the 1990s, to the most noted of deleterious consequences of monopolization, namely ever increasing prices and lowered quality. The authors believe that by the late 1990s the American public will perceive this state of affairs as being intolerable and it will lead them to organize “Big Consumerism”, a cohesive, much strengthened version of the consumer movement of the 1980s. This movement will, among other major activities, establish consumer cooperatives as a way to control costs through the elimination of unnecessary middlemen. In addition, this new consumerism will demand a change in the ethical standards of business behavior which, in turn, will result in a reformation in the role of the “New Marketer”. This “New Marketer” function will be envisioned and practiced by incumbents as informational and educational, adhering to the highest standards of truthfulness concerning the products they are attempting to market. In this regard, the role of governmental agencies will be greatly strengthened and expanded to insure that the marketing profession lives up to these highest ethical standards and practices.     

4. Personal initiative: An active performance concept for work in the 21st century

This article reports on the development of a concept of personal initiative (PI). Personal initiative is a work behavior defined as self-starting and proactive that overcomes barriers to achieve a goal. It is argued that future workplaces will require people to show more PI than before, and that current concepts of performance and organizational behavior are more reactive than desirable. The facets of PI are developed along the lines of goals, information collection, plans, and feedback. Personal initiative enables people to deal with job difficulties more actively, for example, with stressors, unemployment, career changes, or becoming an entrepreneur. High PI changes the work situation of employees and relates to success as an entrepreneur. Personal initiative is seen to sharpen and partly modify the concepts of reciprocal determinism, organizational citizenship behavior, innovation, entrepreneurship, work performance, intrinsic motivation, and self-regulation.     

Health care in the 21st Century

Our primary agenda for the 21st Century is the reinvention of America. We must reinvent democracy, capitalism, entrepreneurism, and community. Indeed, we must recreate all of our major social institutions. This includes health care. A design for a new society requires a new design for health care. In fact, health care enjoys a special privilege in this regard. It is the gateway to total societal redesign. Health is the common denominator in any society. If you loose your health you cannot work, you cannot play, you cannot study; and, if you lose it sufficiently, you cannot even pray. Health and well-being create the foundation for all other constructive human endeavors. Therefore, the design of healthy communities is the necessary first step in the redesign of total human habitats. This massive redesign effort will take a century. However, it will be launched in the next few years.     

A Saul Alinsky primer for the 21st century: The roles of cultural competence and cultural brokerage in fostering mobilization in support of change

How can a proponent of change mobilize groups and organizations in support of a common project? Building on an extensive review of social movement theorizing and action, we argue that shared interests, network connections, the availability of resources, and the emergence of political, market and corporate opportunities (the standard topics discussed in extant literature) may be necessary, but are often insufficient for spurring mobilization. Conversely, cultural factors such as frames, identities, or practices are essential. Their presence can facilitate coordinated action even among unlikely allies, and their absence can prevent such action. Inspired by the work of Saul Alinsky (1909–1972), along with contemporary illustrations, we construct a two-step model of the role of culture in mobilizing for change. We bring attention to a change proponent’s cultural competence – skill in appreciating the different cultural meanings and values of those involved in a particular project of change – and cultural brokerage – skill in bridging and negotiating among actors with different cultural repertoires, to reach a temporary truce or covenant. We focus on two types of activities that define cultural brokerage, integration and redefinition, and apply them to the cultural factors of frames, identities, and/or practices. Our paper contributes to contemporary research on social movements, institutional theory, and cultural sociology.