Falling from the top: the fired physician executive

Today's health care market is volatile, and the job of a physician executive is becoming more risky. Recognizing signs of trouble and taking immediate action is essential. Ten early warning signs that you could be fired are: (1) Net profits dip unexpectedly; (2) investment income can't cover operating losses; (3) bond rating is downgraded; (4) revenues are not rising as fast as costs; (5) senior executives leave the team; (6) wage increases don't improve nursing vacancy rate; (7) unions begin whisper campaign; (8) medical staff elect an SOB; (9) hospital is slapped with a costly lawsuit; and (10) recruiters call to check on your status. Physician executives are quickly learning what it takes to overcome tough challenges and prevent premature job termination: Communication; no-surprise performance; continuous monitoring of key indicators; openness and plain talk; and no-more-business-as-usual attitude. What can you do to make your job loss as painless as possible? (1) Negotiate a contract upfront; (2) don't lose your temper; (3) ask for your wish list quickly; (4) be reluctant to sue your former employer; (5) tell your family as soon as possible; (6) take only a brief vacation; (7) consider a temporary assignment; (8) be prepared to be re-employed by your former employer; and (9) keep a positive attitude.     

Complementary person-supervisor fit: An investigation of supplies-values (S-V) fit,leader-member exchange (LMX) and work outcomes

By applying the supplies-values (S-V) fit approach from the complementary person-environment (P-E) fit literature to the leader-employee perspective, and drawing upon social exchange theory, we examine how fulfillment of different work values is related to Leader-Member Exchange (LMX) and work outcomes. First, polynomial regression analyses combined with response surface analysis of data collected at two time points (N = 316) showed that LMX (Time 2) was higher the more the leader fulfills the employee's work values (Time 1). Second, LMX (Time 2) was higher when leader supplies (Time 1) and employee work values (Time 1) were both high than when both were low. Third, analyses of data from a sub-sample of matched leader-employee dyads (N = 140), showed that LMX (Time 2) played a mediating role on the relation between S-V fit (Time 1) and work outcomes (Time 2). Specifically, we found eight out of 10 relationships between S-V fit (Time 1) and leader-rated task performance and OCB (Time 2) to be fully mediated by LMX (Time 2). LMX (Time 2) partially mediated the relation between S-V fit (Time 1) and job satisfaction (Time 2) as only two out of five relationships were fully mediated.     

Confucian values and the implications for international HRD

Abstract

The consideration of cultural issues has become increasingly important in scholarly inquiry and explorative practice in international human resource development (HRD). We review and explore the core characteristics of Confucian-based culture in relation to organizations and unfold how these Confucian values may affect organizational and management practices in China and other Asian countries. Five major aspects of Confucianism are examined. They are: (a) hierarchy and harmony, (b) group orientation, (c) guanxi networks (relationships), (d) mianzi (face) and (e) time orientation. The impact of these values on management practices in the Chinese organizational context is presented in four areas: (a) working relationships, (b) decision-making processes, (c) ruling by man (ren zhi) instead of by law (fa zhi) and (d) HR practices. Implications for organizations and international HRD are also discussed.     

Towards an evaluation of a business school graduate programme

An evaluation research methodology, which has been validated in a previous study, and which was developed to be both scientifically defensible and feasible from a practical point of view, is described. This involves collecting course participants' judgements about the effects of the course, and taking steps to ensure that the process by which the participants arrive at these judgements is sound. The application of this methodology to a course in business administration revealed the following effects or consequences: (1) Access to and progress in successful careers; (2) Flexibility and mobility in careers; (3) Ability to take overall view of problems; (4) Personal confidence; (5) Awareness of own aspirations and career fit; (6) Frustration from unused skills and unfulfilled expectations; (7) High salaries; (8) General reasoning and problem solving ability; (9) Economic/commercial understanding; (10) Understanding of organisation and human behaviour; (11) Useful work, career and personal contacts; (12) Social skills.     

Partial Comparative Messages in Competition

Partial comparative messages comprise a mixture of comparative and non-comparative claims. This study demonstrates how the extent to which non-comparative (NC), partial comparative (PC) and complete comparative (CC) messages influence consumer preference depends on the comparisons (i.e. NC, PC or CC) made by the messages promoting the two competing brands. A 3 (brand A used NC, PC or CC message) × 3 (brand B used NC, PC or CC message) design was used. Two studies (n=284, 283, respectively) show that participants preferred (1) the first brand they saw when both brands were promoted by NC messages, (2) neither brand when both brands were promoted by messages containing comparative claims, (3) the brand promoted by a PC message when the other brand was promoted by an NC message, and (4) the brand promoted by an NC message when the other brand was promoted by a CC message.     

12 ways to be a better leader

What are the prerequisites for leading successfully in today's turbulent health care environment? An entrepreneurial attitude, an emphasis on people management, and the ability to lead and manage change. This article offers a dozen suggestions for fostering adaptability and helping sustain the organization's purpose/mission: (1) Celebrate the workforce; (2) remove barriers; (3) allow people to take risks; (4) stop managing other people's problems; (5) prioritize organizational values; (6) stop managing for consensus; (7) segment your marketplace; (8) understand who the competition really is; (9) establish new relationships; (10) forget about employee satisfaction; (11) stop budgeting departmentally; and (12) beware of sacred cows. Courage is perhaps the single greatest attribute of transformational leadership.     

Estimation of Benchmark Dose of Lifetime Cadmium Intake for Adverse Renal Effects Using Hybrid Approach in Inhabitants of an Environmentally Exposed River Basin in Japan

The aim of this study is to estimate the reference level of lifetime cadmium intake (LCd) as the benchmark doses (BMDs) and their 95% lower confidence limits (BMDLs) for various renal effects by applying a hybrid approach. The participants comprised 3,013 (1,362 men and 1,651 women) and 278 (129 men and 149 women) inhabitants of the Cd‐polluted and nonpolluted areas, respectively, in the environmentally exposed Kakehashi River basin. Glucose, protein, aminonitrogen, metallothionein, and β₂‐microglobulin in urine were measured as indicators of renal dysfunction. The BMD and BMDL that corresponded to an additional risk of 5% were calculated with background risk at zero exposure set at 5%. The obtained BMDLs of LCd were 3.7 g (glucose), 3.2 g (protein), 3.7 g (aminonitrogen), 1.7 g (metallothionein), and 1.8 g (β₂‐microglobulin) in men and 2.9 g (glucose), 2.5 g (protein), 2.0 g (aminonitrogen), 1.6 g (metallothionein), and 1.3 g (β₂‐microglobulin) in women. The lowest BMDL was 1.7 g (metallothionein) and 1.3 g (β₂‐microglobulin) in men and women, respectively. The lowest BMDL of LCd (1.3 g) was somewhat lower than the representative threshold LCd (2.0 g) calculated in the previous studies. The obtained BMDLs may contribute to further discussion on the health risk assessment of cadmium exposure.     

Popularity kills the Talentstar? Einflussfaktoren auf Superstargeh?lter in der NBA

The observation that top athletes earn top salaries is well known. The (controversial) debate on superstar-salaries is mainly based on the two competing but equally plausible explanations outlined by Rosen (Am Eco Rev 71(5):845–858, 1981) and Adler (Am Eco Rev 75(1):208–212, 1985). Although both authors illustrate conclusive arguments, the discussion which of these two theories is more adequate in explaining superstar salaries still remains unsolved. The present paper analyzes salary information from the National Basketball Association (NBA) to explore the effect of Rosen’s (Am Eco Rev 71(5):845–858, 1981) talent approach versus the network and media approach by Adler (Am Eco Rev 75(1):208–212, 1985). Using innovative indicators for talent (draft position) and popularity (Facebook fans) in one model, the results of our preferred quantile regression specification indicates that player talent is stronger related to earning than popularity, particularly in the upper quantiles.     

基于Simpson公式改进的FAGM(1,1)模型及其应用研究

本文分析了传统FAGM（1,1）模型建模过程中存在的误差,提出了一种基于Simpson公式改进的FAGM（1,1）模型。首先,基于分数阶累加生成算子和分数阶累减生成算子建立分数阶FAGM（1,1）模型。其次,利用Simpson积分公式对FAGM（1,1）模型的背景值进行改进,建立SFAGM（1,1）模型。进一步,应用遗传算法确定SFAGM（1,1）模型的最优阶数以提高模型的预测精度。最后,以中国人均GDP为例,对比分析GM（1,1）模型、Simpson改进的GM（1,1）模型（SGM（1,1））、FAGM（1,1）模型、SFAGM（1,1）模型的模拟结果,并对"十三五"时期的人均GDP进行预测,其结果表明SFAGM（1,1）模型比GM（1,1）、SGM（1,1）、FAGM（1,1）在人均GDP的预测方面有更高的精度,"十三五"期间人均GDP年平均增长率为10.64%,到2020年达到83146.97元,是2010年人均GDP的2.69倍,以2010年的人均GDP为基准,到2020年将能够实现翻一番的目标。     

What physician executives and health care organizations should expect from each other

Today, interest in defining the role of the physician executive and ensuring this individual is effectively integrated into the organization is high for good reason--the ranks of physician executives are growing. What attributes should health care organizations look for when hiring physician executives and what should they should expect of them once they are on the job? Physician executives should: (1) have demonstrated clinical and management skills; (2) have a comfort level with participatory decision-making; (3) have superb interpersonal skills; and (4) be a champion of the patient. Physician executives should expect the following support from their organizations: (1) varied roles and responsibilities; (2) mentoring by other senior executives; (3) lifelong learning opportunities; and (4) complete support of the management team.     

Risk evaluation of investment projects

A survey is given of techniques for evaluation of risk in individual capital investment projects. The paper identifies the four types of relationships affecting project uncertainty: (1) Accounting-type relationships defining cash flow; (2) Statistical relationships among variables in a given time period; (3) Autocorrelation relationships among cash flows over time; and (4) Uncertainty about project life. Two types of decisions also can affect project profitability and uncertainty: (1) Strategy decisions; and (2) Abandonment decisions. Four types of models for risk evaluation are identified: (1) Certainty model; (2) Hillier model; (3) Monte Carlo model; and (4) Decision Tree model. These four types of models are compared and evaluated in terms of how easily they can incorporate the relationships and decisions mentioned above. Computational issues are also discussed. Suggestions are made for further research.     

Performance Assessment in Support of the 1996 Compliance Certification Application for the Waste Isolation Pilot Plant

The conceptual and computational structure of a performance assessment (PA) for the Waste Isolation Pilot Plant (WIPP) is described. Important parts of this structure are (1) maintenance of a separation between stochastic (i.e., aleatory) and subjective (i.e., epistemic) uncertainty, with stochastic uncertainty arising from the many possible disruptions that could occur over the 10,000-year regulatory period that applies to the WIPP, and subjective uncertainty arising from the imprecision with which many of the quantities required in the analysis are known, (2) use of Latin hypercube sampling to incorporate the effects of subjective uncertainty, (3) use of Monte Carlo (i.e., random) sampling to incorporate the effects of stochastic uncertainty, and (4) efficient use of the necessarily limited number of mechanistic calculations that can be performed to support the analysis. The WIPP is under development by the U.S. Department of Energy (DOE) for the geologic (i.e., deep underground) disposal of transuranic (TRU) waste, with the indicated PA supporting a Compliance Certification Application (CCA) by the DOE to the U.S. Environmental Protection Agency (EPA) in October 1996 for the necessary certifications for the WIPP to begin operation. The EPA certified the WIPP for the disposal of TRU waste in May 1998, with the result that the WIPP will be the first operational facility in the United States for the geologic disposal of radioactive waste.     

基于DEA的作业消耗资源效率分析

将数据包络分析(DEA)引入了作业成本管理(ABM),给出了适用的定量化分析方法,从不同角度分析了作业消耗资源的效率.确定作业消耗资源的DEA有效性;确定各DMU在有效生产前沿面上的"投影",并为下一期间的作业改进提供信息;确定资源投入的总体利用率和各项输入可变资源的利用率.最后,用该模型对某企业的作业进行了实证分析.     

Hiding Customer Complaints: Studying the Motivations and Forms of Service Employees' Complaint Concealment Behaviours

This study aims to explore both how and why customer service employees conceal the complaints made by customers. Using an exploratory qualitative approach, data were gathered through the in‐depth interviewing of 25 managers, 25 supervisors and 57 front‐line employees of UK general retailers/supermarkets. Data analysis reveals that the concealment of customer complaints by store employees of all hierarchical levels is common. Front‐line, customer‐contact employees were found to conceal complaints in four ways: through (1) misleading customers, (2) complaint resolution without logging, (3) concealing recorded complaints and (4) falsification of recorded complaints. Store‐level supervisory and managerial employees were also found to conceal complaints in four ways: through (1) complaint resolution without logging, (2) concealing recorded complaints, (3) the non‐recording of complaints and (4) the disregarding of ‘minor’ complaints. The motives for complaint concealment differed between managerial/supervisory and front‐line employees but included reasons of (1) personal protection, (2) perceived customer unpleasantness, (3) serial complaint avoidance, (4) alienation, (5) friends or family protection, (6) instrumental gain, (7) avoidance of additional work, (8) perceived unfairness and (9) limited time. These findings suggest that theorists and practitioners need to acknowledge the existence and prevalence of these motives and behaviours and incorporate them into their conceptualizations and practices.     

消化内镜护理风险控制中引入PDCA循环模式价值分析

目的探讨采用PDCA循环模式实施消化内镜护理风险控制后获得应用效果。方法选取2020年03月31日~2021年03月31日收治的80例消化内镜检查患者进行护理管理研究;随机分为常规护理管理组(常规护理管理)和PDCA循环管理组(PDCA循环模式管理),各40例;比较两组患者护理满意度(护理细节、护理质量、护理规则、护理严谨、护理态度)评分以及差错发生率。结果PDCA循环管理组护理细节(91.25±2.59)分、护理质量(91.33±3.02)分、护理规则(91.49±4.21)分、护理严谨(91.82±5.35)分、护理态度(91.96±6.03)分均高于常规护理管理组护理细节(79.31±4.06)分、护理质量(72.86±4.79)分、护理规则(79.66±5.23)分、护理严谨(80.19±6.52)分、护理态度(81.79±5.85)分(P<0.05);PDCA循环管理组差错发生率(2.50%)低于常规护理管理组(20.00%)。结论PDCA循环模式有效运用后,观察护理满意度以及护理风险差错事件发生率,改善程度显著,可促进消化内镜患者整体护理效果显著提升。     

Exposure Assessment of TSEs from the Landspreading of Meat and Bone Meal

Recent changes in European legislation have meant that certain processed abattoir waste, which has been appropriately heat treated and ground to a specified particle size, can be spread on nonpasture agricultural land. This has opened the way for the potential landspreading of mammalian meat and bone meal (mMBM) derived from animals slaughtered for human consumption. This article reports on two separate case studies (Study 1 carried out in Great Britain (GB) and Study 2 carried out in Ireland) on the potential exposure to TSE infectivity following the spreading of abattoir waste (derived from animals slaughtered for human consumption) on nonpasture agricultural land. For Study 1, the average TSE infectivity on nonpasture agricultural land per year from sheep with scrapie was found to be higher (five orders of magnitude) than that estimated for BSE in cattle (3.9 x 10(-3) Ovine Oral ID(50)/ton of soil compared to 3.3 x 10(-8) Bovine Oral ID(50)/ton of soil). The mean estimate for BSE in sheep was 8.1 x 10(-6) Ovine Oral ID(50)/ton of soil. The mean level of infectivity in mMBM was assessed to be 1.2 x 10(-5) and 2.36 x 10(-5) ID(50)/ton of mMBM for Study 1 and 2, respectively. For Study 2 the spreading of mMBM was estimated to result in infectivity on nonpasture land of 1.62 x 10(-8) Bovine Oral ID(50)/m(3). The mean simulated probability of infection per year per bovine animal was 1.11 x 10(-9). Given the low infectivity density and corresponding low risks to bovines the spreading of mMBM could be considered a viable alternative for the utilization of mMBM.     

The 13 errors.

The reality is that most change efforts fail. McKinsey & Company carried out a fascinating research project on change to "crack the code" on creating and managing change in large organizations. One of the questions they asked--and answered--is why most organizations fail in their efforts to manage change. They found that 80 percent of these failures could be traced to 13 common errors. They are: (1) No winning strategy; (2) failure to make a compelling and urgent case for change; (3) failure to distinguish between decision-driven and behavior-dependent change; (4) over-reliance on structure and systems to change behavior; (5) lack of skills and resources; (6) failure to experiment; (7) leaders' inability or unwillingness to confront how they and their roles must change; (8) failure to mobilize and engage pivotal groups; (9) failure to understand and shape the informal organization; (10) inability to integrate and align all the initiatives; (11) no performance focus; (12) excessively open-ended process; and (13) failure to make the whole process transparent and meaningful to individuals.     

The quality and use of regulatory analysis in 2008

This article assesses the quality and apparent use of regulatory analysis for economically significant regulations proposed by federal agencies in 2008. A nine-member research team used a six-point (0-5) scale to evaluate regulatory analyses according to criteria drawn from Executive Order 12866 and Office of Management and Budget Circular A-4. Principal findings include: (1) the average quality of regulatory analysis, though not high, is somewhat better than previous regulatory scorecards have shown; (2) quality varies widely; (3) biggest strengths are accessibility and clarity; (4) biggest weaknesses are analysis of the systemic problem and retrospective analysis; (5) budget or "transfer" regulations usually receive low-quality analysis; (6) a minority of the regulations contain evidence that the agency used the analysis in significant decisions; (7) quality of analysis is positively correlated with the apparent use of the analysis in regulatory decisions; and (8) greater diffusion of best practices could significantly improve the overall quality of regulatory analysis.     

Comparison of the Dependence of the TD50 on Maximum Tolerated Dose for Mutagens and Nonmutagens

The relationship between the minimum TD50 (i.e., the TD50 measured at the most sensitive site) and the maximum dose administered (maxD) in rodent carcinogenicity bioassays was investigated separately for mice and rats. The relationship between log(1/TD50) and log(1/maxD) was analyzed as a function of (1) mutagenicity and (2) the statistical significance cutoff for selecting the minimum TD50 values. For rat bioassays, the variance of log(1/TD50) is larger and the correlation of log(1/TD50) with log(1/maxD) is weaker for mutagens than for nonmutagens, suggesting that the relationship between minimum TD50 and MTD is, in general, stronger for nonmutagens than for mutagens. The difference in correlation does not depend on the TD50 statistical significance cutoff, but the difference in variance is not significant for the most stringently selected dataset. For mouse bioassays, no significant mutagen/nonmutagen differences in log(1/TD50) variance are found. A significantly weaker correlation of log(1/TD50) with log(1/maxD) for mutagens in comparison to nonmutagens occurs only for the dataset with minimum TD50 chosen at the least stringent level, suggesting that this difference may be due to chance variation. We also looked for changes in correlation and regression parameters as a function of mutagenic potency in Salmonella; the variance of log(1/TD50) and its correlation with log(1/maxD) are not found to vary in a consistent manner. Taken as a whole, our results indicate that (1) mutagenicity is a determinant of the TD50/maxD relationship in rats and (2) any effect that mutagenicity may exert on the TD50/maxD relationship in mice is unimportant.(ABSTRACT TRUNCATED AT 250 WORDS)