U.S. health care in conflict--Part I. The challenges of balancing cost,quality and access

Grappling with a technology explosion, an aging population and a growing number of uninsured, our health care system faces an uncertain and troubling future. Examine the critical issues influencing health care policy development and think about ways to address the dilemma of balancing cost, quality and access.     

Flexible multi-manned assembly line balancing problem: Model,heuristic procedure,and lower bounds for line length minimization

Assembly lines dedicated to the production of large products often allow multiple workers to perform tasks simultaneously on the product. Previous works on such multi-manned lines define workstations with fixed, discrete, and restrictive frontiers, despite commonly considering continuous paced line control. This paper proposes flexible station frontiers for multi-manned lines and shows that such innovation allows significantly shorter line lengths. A new Mixed Integer Linear Programming model and a novel model-based heuristic procedure are presented to describe and optimize lines. Algorithmic lower bounds are also introduced for the problem. The formulation was compared to a literature benchmark of regular multi-manned solutions. These experiments showed that flexible multi-manned formulations can lead to line length reductions of up to 42%. Such reductions were obtained for most instances (81 out of 88), with an average value of 18%. The relationship between cycle time and minimal line length is also analyzed, demonstrating that efficient solution sets can be continuous or discrete, depending on the instance.     

U.S. health care in conflict--Part II. The challenges of balancing cost quality and access

Faced with the technology explosion, the aging population and the growing uninsured, our health care system confronts an uncertain and troubling future. In this second part of a two-part series, look at some proposed solutions to the problems.     

Bringing Japanese Continuous Improvement Approaches to U.S. Manufacturing: The Roles of Process Orientation and Communications*

Continuous improvement (CI) has played a key role in Japan's quality management. U.S. companies have begun to adopt CI in recent years. This paper studies the implementation of CI in seven U.S. manufacturing companies. We view values as the core concept of culture that impacts CI effectiveness. Using both qualitative and quantitative data with a sample of seven companies, we observe empirically a relationship between process-oriented values and CI effectiveness. We also find that communications involving workers is strongly associated with CI effectiveness. Finally, we find an association between process orientation and communication frequency, and argue that communications act as an intervening variable between process orientation and effectiveness.     

The Impact of Process Variation on Customer Dissatisfaction: Evidence from the U.S. Domestic Airline Industry

This paper investigates how process variation reduction affects customer dissatisfaction in the context of the U.S. domestic airline industry. We use quarterly data on all major carriers, available since the introduction of required reporting of service indicators to the U.S. Department of Transportation (DOT). Specifically, we investigate how both average performance and variation performance (consistency) of certain processes affect customer dissatisfaction. Our empirical results show that the relationship between process variation and customer dissatisfaction is contingent upon a company's average performance with regard to each process. Consistency is at least as important as average performance for high performers, while it has limited impact for low performers.     

Structuring Supplier Involvement in New Product Development: A China–U.S. Study

Buying and supplying organizations rely on each other for developing better products in an efficient manner, which explains the popularity of involving suppliers in new product development (NPD). However, such involvement is not always successful, partially due to the challenges of structuring a buyer–supplier team to manage joint dependence and dependence asymmetry. This study adopts an organizational dependence view to examine how three types of intergroup structures—administrative (formalization and centralization), task (task interdependence), and physical (colocation)—influence project performance and buyer learning in NPD projects. Furthermore, adopting a contingency theory perspective, we study whether the national context moderates the effects of intergroup structures on project outcomes. We adopt a two‐group structural equation modeling approach to test hypotheses with survey responses from a sample of NPD projects in the United States (US) and China. Results show different ways in which intergroup structures influence project performance and buyer learning in the two culturally, economically, and institutionally distinct countries. We discuss the implications of these new findings and present directions for future research.     

Supplier Opportunism in Buyer–Supplier New Product Development: A China‐U.S. Study of Antecedents,Consequences, and Cultural/Institutional Contexts

Collaborating with a supplier in a buying firm's new product development (NPD) project is commonly advocated and adopted, but does not always improve project performance. Some pre‐existing collaboration contexts, such as buyer–supplier NPD projects, are especially exposed to supplier opportunism due to the uncertain nature of the collaboration process. Adopting agency theory and transaction cost theory perspectives, we examine: (i) contextual antecedents and project consequences of supplier opportunism and (ii) if these causal influences vary in different cultural and institutional contexts. Using a survey sample of 214 United States (U.S.) and 212 Chinese buying firms’ responses about buyer–supplier NPD projects, we find that supplier opportunism is significantly influenced by the task and relational contexts. We also show that supplier opportunism damages both design quality and efficiency, two aspects of project performance. When comparing U.S. to China, we find that task and relational contexts have a greater impact on supplier opportunism in the U.S., but design efficiency is less hurt by supplier opportunism there. Finally, we show challenges of preventing supplier opportunism in certain NPD collaboration contexts, and offer solutions for overcoming these challenges.     

A Comparative Analysis of Quality Practice in Manufacturing Firms in the U.S. and Taiwan*

The aim of this paper is to determine if there is a causal relationship between multivariate constructs for quality (i.e., customer satisfaction, employee satisfaction, and employee service quality) and organizational performance. The presence of such relationships, as well as the identification of key indicators within each quality construct for different types of firms, are explored in this empirical study on the perceptions of middle managers in Taiwan and the United States. The study found a significant causal relationship between the quality constructs and organizational performance. These relationships are different, however, for the four types of firms based on age and size. Also, within the same firm types, there are differences among countries. For example, for older firms, Taiwanese managers tend to perceive customer satisfaction as the most important quality construct in improving organizational performance, while U.S. managers tend to perceive employee satisfaction as the most important. For younger firms, U.S. managers perceive customer satisfaction as influencing organizational performance, while Taiwanese managers perceive both customer satisfaction and employee satisfaction as doing so. A further breakdown of the quality constructs identified the key indicators within each construct that separates “better performers'’from “lesser performers'’in both countries for the four types of firms. These indicators are dissimilar, thus suggesting that focus on quality constructs may lead to improvements in organizational performance by focusing on different indicators in different environments. These results have implications for the adoption and implementation of quality practices in different countries.     

公司信息的纵向与横向溢出效应:公司品牌与产品品牌组合视角

很多企业已横跨多种产品业务,不同产品业务存在地位差异,公司层信息对不同地位产品评价是否存在差异化影响,不同地位产品之间信息如何流动,这是现有文献的研究断层.本文通过两个实验,检验了公司信息的纵向(公司层→产品层)和横向(产品→产品)溢出效应.研究发现,在纵向溢出中存在非对称效应,旗舰产品评价受社会责任信息的影响效应更大;非旗舰产品评价受公司能力信息的影响效应更大.在横向溢出中,存在旗舰产品对非旗舰产品评价的影响,但不存在非旗舰产品对旗舰产品的影响.本文的理论创新点在于,将产品区分为旗舰和非旗舰产品,从而得出公司层信息对不同产品的非对称溢出效应以及旗舰产品到非旗舰产品的非对称溢出效应.     

The Courage Factor: Living People-Based Leadership by Geller,E. S. & Veazie,B

We adapted the Performance Diagnostic Checklist to analyze the environmental events contributing to safe and at-risk behaviors by employees in organizations. We then used the resulting tool, the Performance Diagnostic Checklist–Safety (PDC-Safety), to identify variables contributing to unsafe equipment usage by 3 members of a landscaping crew at a private university. Based on PDC-Safety results, an intervention consisting of graphic feedback was implemented. The intervention increased safe performance for all participants.     

Internal and External Integration for Product Development: The Contingency Effects of Uncertainty,Equivocality, and Platform Strategy

Effective product development requires firms to unify internal and external participants. As companies attempt to create this integrated environment, two important questions emerge. Does a high level of internal integration lead to a higher level of external integration? In the context of product development, this study considers whether internal integration in the form of concurrent engineering practices affects the level of external integration as manifested by customer integration, supplier product integration, and supplier process integration. External integration, in turn, may influence competitive capabilities, namely product innovation performance and quality performance. Second, using contingency theory, do certain contextual variables moderate the linkages between integration strategy (external and internal) and performance? Specifically, this study considers whether uncertainty, equivocality, and platform development strategy change the relationships among internal integration, external integration, and competitive capabilities. Data collected from 244 manufacturing firms across several industries were used to test these research questions. The results indicate that both internal and external integration positively influence product innovation and quality and ultimately, profitability. With respect to contingency effects, the results indicate that equivocality moderates the relationships between integration and performance.     

The medical director as educator: an interview with Elizabeth M. Gallup, MD, JD, MBA. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed Elizabeth M. Gallup, MD, JD, MBA, on July 9, 1999, to talk about the evolving role of the physician executive. Dr. Gallup discusses how medical directors have evolved from a purely clinical role to participating in the business side of medicine as well. The traditional medical director, a Dr. No who denies treatment and watches clinical performance, is now becoming an educator helping physicians to manage their behavior and change their practices based on comparative data. Her book, How Physicians Can Avoid Surrender and Lead Change: Gaining Real Influence in Your Own Health Care Organization Before It's Too Late, (American College of Physician Executives, 1996) promotes acting together as a group if physicians want to stay independent and not become employed. Independent physicians can form IPAs and act together as a group, avoiding some antitrust laws. Unless physicians get together and act as a group, she says, they are doomed to further and further erosion of their economic interests as well as their clinical autonomy.     

Performance-Based Budgeting: The U.S. Experience

In the United States, it is premature to claim that performance-based budgeting (PBB) will replace line-item budgeting in near future, particularly at the federal and state level. This article attempts to (1) provide a brief historical context of PBB in the U.S.; (2) identify some challenges associated with the theoretical underpinnings and operational principles of PBB; (3) document current practice and research pertaining to designing and implementation; and (4) discuss the prospect of PBB. The locus of PBB in the 21St century will be local, the focus will be comparative, and the impetus will come mainly from the media.     

The Effect of Team Leader Characteristics on Learning,Knowledge Application,and Performance of Cross‐Functional New Product Development Teams

This study examines how leadership characteristics in new product development teams affect the learning, knowledge application, and subsequently the performance of these teams. Using data from a study of 229 members from 52 high‐tech new product projects, we empirically demonstrate that team learning has a strong positive effect on the innovativeness and speed to market of the new products. Moreover, a democratic leadership style, initiation of goal structure by the team leader, and his or her position within the organization were positively related to team learning. Managerial implications of these results are discussed.     

Large courts,small justice!: The inefficiency and the optimal structure of the Italian justice sector

An important problem in the public sector, given the lack of output prices and exit decisions to sanction inefficient units, is finding the optimal industry structure. We apply a novel approach to Italian courts of justice, a typical example of a small sector in the public domain but with important effects on economic agents׳ behavior, firm size, FDI, and on the overall economy. The suggested approach enables us to break down the aggregate court inefficiency into different sources and to investigate the optimal structure of the justice sector. Results show that technical inefficiency (lack of best practice) accounts for more than one third (38%) of total inefficiency, while size inefficiency (courts that are too big) is about 22–25%. The remaining inefficiency is represented by a sub-optimal allocation of inputs (30–40%). If reallocation is confined to macroregional or regional borders, then technical and size inefficiencies increase in relative terms compared to reallocation inefficiency. We suggest that, together with reallocating inputs by merging smaller courts, a complementary set of policy interventions would be to adopt best practices and split larger courts.