Forming physician organizations. Part 2: The underlying reason a PO succeeds: an offense, not defense

How has Community Health Partners been able to move the ball down the field toward the goal of a preferred network in its community? What are the specific offensive strategies CHP has implemented to bring about its vision? Part 1 of this series explored five reasons for CHP's progress: (1) A working, knowledgeable board of respected physicians, (2) A board that moves ahead on simultaneous tracks, (3) a willingness to affiliate with any hospital or payer that really knows how to partner with physicians, (4) developing quick wins and communicating the progress, and (5) educating physicians about the new ground rules for capitation. Here are six more reasons for CHP's success in forming a PO.     

Conflict management, Part 1. Conflict management checklist: a diagnostic tool for assessing conflict in organizations

Complex interpersonal conflicts are inevitable in the high speed, high stakes, pressured work of health care. Poorly managed, conflict saps productivity, erodes trust, and spawns additional disputes. Well managed, conflict can enhance the self-confidence and self-esteem of the parties, build relationships, and engender creative solutions beyond expectations. Just as thoughtful differential diagnosis precedes optimum treatment in the doctor-patient relationship, management of conflict is greatly enhanced when preceded by careful assessment. In the first of two articles, the authors present a diagnostic approach, the Conflict Management Checklist, to increase self-awareness and decrease anxiety around conflict.     

Physician anger, Part 2. More on the dance of anger.

This article is a follow-up to an interview with Charles Dwyer, PhD, which appeared in the 1999 March/April issue of The Physician Executive. He described how physician executives can change the perceptions of today's beleaguered physicians and help them cope with change. We then asked him for some hands-on strategies to deal with physician anger, fear, and resentment. After much contemplation on providing a list of "fixes" that will restore each of us to a state of greater satisfaction, Dr. Dwyer concludes that there are no generalizable solutions because there are too many variables that come into play in each organization, individual, or group. Attending to the self can provide both individual rescue from these turbulent times and the best hope for changes in the system from which patients and health care providers can benefit. If physicians are to regain their power and maintain, or even improve, their quality of life, clearly changes are called for. And these are changes that require persistent effort and uncomfortable adjustments.     

Physician executives in the '90s: report of a national survey

In fall 1990, Witt Associates again catalogued the progress of physicians as they obtain management positions of increasing importance. The firm has conducted a continuing study of the position since 1979. The current survey of vice presidents of medical affairs/medical directors renders a candid portrait of the physician manager. The profile that emerges is a 53-year-old white male, working almost 50 hours a week in a full-time position, appointed by the hospital and reporting to the Chief Executive Officer. This individual is board certified and has major responsibilities for quality assurance, credentialing, risk management, and utilization review. His or her salary is into six figures.     

Physician executives report high job satisfaction. Summary of findings from a survey of senior physician executives

The role of the senior physician executive is well established in American hospitals and health systems. There is little research, however, on overall physician executive job satisfaction, their perceptions of their organizational role and job performance, or their views of the medical staffs with which they work. A recent survey of physician executives examined these and other areas. It found physician executives to be quite satisfied with their jobs. What follows is a summary of the findings. An article based on the survey will be featured in a future issue of The Physician Executive.     

Physician report cards: now and in the future

The six methods used to create physician performance reports-a less pejorative term than physician report cards-are seriously flawed. These current approaches are peer review, essay-style reports, raw data, statistical reports, outcome analysis, and aggregate variation from guidelines. We must deliver what we promise in information designed to confirm dependable practitioner performance. Otherwise, we risk confirming, instead, the public's suspicion that the emphasis in "managed care" is too much on managing profit and too little on patient care. This article explores a plan for how to proceed with evaluating physician performance.     

Constructing a market domain model for start-up software technology companies: A case study

The market for a complex technology product is sometimes called reference business because references are emphasized by corporate customers. A first customer reference is especially important for a start-up technology company attempting to enter the business-to-business market with complex products. Topics relating to customer references have received scant attention from scholars although they embed substantial business relevance. This case study concentrates on evaluating concepts that are central to customer references from the viewpoint of the start-up technology companies. Of concepts prevalent in current literature, those concerning the use of the first customer references, in particular, form an inadequate base for research and are often vague. The purpose here is to introduce a domain model that describes the key concepts and the relationships between them concerning the focus of this present article. The domain modeling technique is a well-known and widely used tool for defining concepts for large-scale information systems. Domain modeling increases understanding of the present problem domain by structuring knowledge into classes, attributes, and relations. This case study approaches the identification of concepts via an illustrative example from software business. Previously known concepts, close to the topic of this present article, are then re-evaluated based on our literature review. Redefinitions of the customer reference and related concepts are introduced.     

Medicare's ESRD Program, Part 1: Dialysis.

The federal End State Renal Disease (ESRD) program was created by statute in 1972 as a general population entitlement to be administered by Medicare. The program extends all Medicare benefits to patients, regardless of age, who are diagnosed as having ESRD, as long as they are fully insured for old age and survivor insurance benefits (Social Security), are entitled to monthly insurance benefits under the Social Security Act, or are spouses or dependent children of individuals with the foregoing Social Security benefits. About 7 percent of all ESRD patients are excluded from this entitlement by these criteria. The two major therapies embraced by the ESRD program are renal dialysis and kidney transplantation. In this first part of a two-part article, dialysis is the focal point. Kidney transplants will be covered in the May-June issue of Physician Executive.     

A conceptual framework of the adoption of innovations in organizations: a meta-analytical review of the literature

Journal of Management and Governance - Studies on the adoption of innovations in organizations are abundant and have introduced many different factors that are likely to influence adoption...     

Reflections on operational research. A report from the Euro II Congress

The EURO II Congress at Stockholm contained a set of Invited Papers. The set included a group that appeared to be attempting a major review of the role of Operational Research (OR). We try here to give a short summary and a representative selection of extracts from these papers. This is done partly because the papers will not be easily available to all OR workers who are interested, but mainly because of the emphasis they place on the need for truly interdisciplinary OR which recognizes the complex and potentially partisan nature of what we do. Related work in the UK is noted in order to emphasise the beginning of a widespread concern over such issues. The remainder of the Congress demonstrated a distinctly different view of OR, which was characterized by a disregard for the nature of human behaviour and of power in organizations and society. We suggest that the reflections made by the Invited Speakers demonstrate again the need for a fundamental reorientation of OR.     

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.     

Strategic planning—A contingency approach—Part 1. The strategic analysis

This article emphasizes a certain approach to business strategy formation exercise, i.e. the adaptive mode. As the 1970s emerge into the uncertain 1980s, and as sophisticated extrapolation is becoming increasingly valueless, there is an even greater case for business planning with the required degree of responsiveness built into it. The authors support this case from literature survey and an actual case study. This is the first of two articles on this subject.     

Trends in managed care organizations: implications for the physician executive.

The rapid change in the managed health care industry is placing substantial demands on the managerial and leadership skills of physician executives. These changes are forcing a reevaluation of the fundamental principles of managed care organizations, specifically in terms of patient satisfaction, cost containment, and quality health care. Additionally, the physician executive will be confronted with substantial issues concerning future staffing needs. This article assesses the health care industry's environment to suggest where managed care is going and how physician executives should position themselves to optimize their position in the marketplace.     

Strategic positioning. Part 1: The sources of value under managed care

Part 1 of this series organizes and discusses the sources of value against a background of an evolving managed care market. Part 2 will present, in more detail, the marketing and financial challenges to organizational positioning and performance across the four stages of managed care. What are the basic principles or tenets of value and how do they apply to the health care industry? Why is strategic positioning so important to health care organizations struggling in a managed care environment and what are the sources of value? Service motivated employees and the systems that educate them represent a stronger competitive advantage than having assets and technology that are available to anyone. As the health care marketplace evolves, organizations must develop a strategic position that will provide such value and for which the customer will be willing to pay.