Strategic Purchases of Bundled Products in a Health Care Supply Chain Environment*

Recent articles in the Wall Street Journal summarize the state of business practice in American hospitals by shedding light on the state of supply chain management practices and foci in today's health care supply chains. In health care, the single largest cost after labor is materials, and it has been documented that health care facilities can reduce the environmental impacts of the products and services they consume before regulatory problems arise or waste disposal costs increase by focusing on their upstream activities. Health care systems around the country consume significant quantities and varieties of products within the health delivery processes. Solving these environmental problems requires a much broader view involving collaborative efforts of professionals from different areas of health care to meet these challenges. The purchasing function bridges the gaps by providing a healthy dialogue on key environmental attributes within the health care supply chain. The concept of bundling new with refurbished products is gaining a lot of attention in the health care supply chain. This research describes a health care purchasing problem for bundling new and refurbished products of the type facing a growing number of large health care providers, and then proposes a methodology for evaluating the complex tradeoffs involved in bundling decisions for refurbished health care products. By exploiting some useful properties of the problem structure, our results provide buyers with useful insights for examining and selecting suppliers who are willing to offer bundles of new and refurbished products.     

Complexity Theory and Strategic Change: an Empirically Informed Critique*

We present a four‐year ethnographic study of a public‐sector organization and use narrative to describe its development in terms of four complexity theory concepts: sensitivity to initial conditions, negative and positive feedback processes, disequilibrium and emergent order. Our study indicates that order emerges at the boundary between the organization's legitimate and shadow systems. We suggest that the underlying dynamic leading to the emergent order is the need to reduce anxiety. Our findings cause us to question the assertion that organizations are naturally complex adaptive systems producing novel forms of order. We propose an alternate view that in social systems, equilibrium‐seeking behaviour is the norm; such systems can self‐organize into hierarchy. We draw attention to some of the difficulties we found in applying complexity‐theory concepts to a social system and conclude by advocating the development of complexity theory through the incorporation of insights from psychology and social theory.     

Patterns of Strategic Change in the Development of Human Resource Management

In addition to being characterized by the consistency of employment decisions one with another and their alignment with business strategy, human resource management (HRM) has also been deeply involved in the reshaping of organization structures in the 1980s, under conditions of increased external and internal complexity, and in managing other aspects of strategic change. These have contributed to the distinctive character of HRM and the shift away from a style of personnel management focused on administration and industrial relations. This evolution is explored through the concept of life-cycle change in a sample of ten firms that underwent major transformation during the 1980s.     

From Change to Change: Patterns of Continuing Administrative Reform in Europe

This paper examines the continuing reform of the public sector in European countries. While reform fatigue might be expected after the major efforts at reforming that were undertaken during the 1980s and into the 1990s, there is apparently little loss of fervor about reform. The reasons for the continued reform efforts are discussed in administrative and political terms. Likewise, the logic of the continuation of reform in the contemporary era, as contrasted to earlier periods of reform, is discussed.     

Health Care Supply Chain Design: Toward Linking the Development and Delivery of Care Globally*

This article is motivated by the gap between the growing demand and available supply of high‐quality, cost‐effective, and timely health care, a problem faced not only by developing and underdeveloped countries but also by developed countries. The significance of this problem is heightened when the economy is in recession. In an attempt to address the problem, in this article, first, we conceptualize care as a bundle of goods, services, and experiences—including diet and exercise, drugs, devices, invasive procedures, new biologics, travel and lodging, and payment and reimbursement. We then adopt a macro, end‐to‐end, supply chain–centric view of the health care sector to link the development of care with the delivery of care. This macro, supply chain–centric view sheds light on the interdependencies between key industries from the upstream to the downstream of the health care supply chain. We propose a framework, the 3A‐framework, that is founded on three constructs—affordability, access, and awareness—to inform the design of supply chain for the health care sector. We present an illustrative example of the framework toward designing the supply chain for implantable device–based care for cardiovascular diseases in developing countries. Specifically, the framework provides a lens for identifying an integrated system of continuous improvement and innovation initiatives relevant to bridging the gap between the demand and supply for high‐quality, cost‐effective, and timely care. Finally, we delineate directions of future research that are anchored in and follow from the developments documented in the article.     

Capacity Management in Health Care Services: Review and Future Research Directions*

Health care has undergone a number of radical changes during the past five years. These include increased competition, fixed-rate reimbursement systems, declining hospital occupancy rates, and growth in health maintenance organizations and preferred provider organizations. Given these changes in the manner in which health care is provided, contracted, and paid for, it is appropriate to review the past research on capacity management and to determine its relevance to the changing industry. This paper provides a review, classification, and analysis of the literature on this topic. In addition, future research needs are discussed and specific problem areas not dealt with in the previous literature are targeted.     

Explaining Anomalous High Performance in a Health Care Supply Chain*

An implicit assumption in distributing and coordinating work among independent organizations in a supply chain is that a focal organization can use financial or contractual mechanisms to enforce compliance among the other organizations in meeting desired performance objectives. Absent contractual agreement or financial gain, there is little incentive for independent organizations to coordinate their process improvement activities. In this study, we examine a health care supply chain in which the work is distributed among independent organizations. We use a detailed case study and an abductive reasoning approach to understand how and why the independent organizations choose to coordinate and collaborate in their work. Our study makes two contributions to the literature. First, we use well‐established lean principles to explain how independent organizations achieve superior performance despite highly uncertain and variable customer demand—a context considerably different from the origins of lean principles. Second, we forward relational coordination theory to explain why the organizations in this decentralized supply chain coordinate their work. Relational coordination includes the use of shared goals, shared knowledge, and mutual respect for one another's work as primary mechanisms to explain process improvement in the absence of any contractual incentives. Our study constitutes a first step in generating theory for work design and its improvement in decentralized supply chains.     

Constructing Scientific Authorities: Issue Framing of Chlorinated Disinfection Byproducts in Public Health

The practice of chlorine disinfection of drinking water to reduce microbial risks provides substantial benefits to public health. However, increasing concern around potential risks of cancer associated with exposure to chlorinated disinfection byproducts confuses this issue. This article examines the science agenda regarding chlorinated disinfection byproducts (CDBP) and cancer in Canada and the United States, focusing on the social construction of scientific knowledge claims and evidence. Data for this analysis were obtained from published documents as well as from in-depth interviews with epidemiologists and toxicologists centrally involved with the issue in both countries. Results of the analysis suggest that toxicological scientists want to close the door on the "chloroform issue" due to increasing evidence that chloroform is safe at low doses, because epidemiological scientists can no longer move forward the cancer science until significant improvements can be made in assessing human exposures, and because the scientific foci of research on DBP have shifted accordingly. Further, a distinction emerges in terms of how scientific uncertainties are interpreted when they cross-cut disciplines in the context of human health risk assessment. We suggest this tension reflects a balance of how uncertainty and authorities are managed in a mandated science-policy domain. Sufficient evidence was provided to keep the DBP issue on the regulatory agenda and to generate additional research, yet authorities and concomitant interpretations of uncertainty were contested. Such science generation and contestation inevitably influences complex risk assessment processes with respect to what water-related health risks are addressed and how.     

Extending the Cognitive Approach to Strategic Change in Organizations: Some Theory

This paper claims that organizational cognitions are manifested as argumentation. Such argumentation can be represented as organizational construct systems (systems of constructs shared by important organization members). Such organizational construct systems enable us to detect structural features of an organization's cognition which indicate its chances of survival or failure.     

A Demonstration of Methods for Studying Negotiations Between Physicians and Health Care Managers*

Decision analysis was used to study negotiations in the health care context. This paper found that analytical methods could answer several important questions related to complex negotiations, including whether contracts promote the interest of both parties, whether a decision aid could better meet the priorities of both parties, and whether one negotiator is more successful than the other in repeated negotiations. The paper concluded that micro-health care negotiations can be traced and studied with existing mathematical theories of negotiation.     

Social Structures and Resistance to Strategic Change: British Manufacturers in the 1980s1

This article examines the refusal of two UK manufacturers to adapt their strategic ‘repertoires’ to the recessionary and structural changes of the 1980s. From being industry leaders in 1980, both companies were relegated to overseas control by the end of the decade. Developing both institutionalist and contextualist approaches to organization, the article argues that this fatal resistance to change derived from the deep social structural roots of these two companies' politics and cultures. Conservative managers were able to defy new capitalist logics by drawing upon alternative social structural sources of power, legitimacy and inspiration. The article concludes by considering the implications of this plural structuring of organizations both for organizational theory and for the management of change in practice.     

New CEO Openness to Change and Strategic Persistence: The Moderating Role of Industry Characteristics

Drawing on the upper echelons, managerial discretion and strategic contingency perspectives we examine the relationships between newly chosen CEOs' openness to change and firm strategic persistence in the post-succession phase. This study is different from prior studies on the consequences of CEO succession in that it focuses on specific characteristics of the new CEO (that reflect his/her knowledge-base and cognitive orientations) and the industry context rather than purely on the event of succession. Based on a sample of 132 successions in 118 firms in the US manufacturing sector, and after controlling for industry concentration, board power, firm size and pre-succession performance, we find a negative relationship between CEOs' openness to change and post-succession strategic persistence. Interestingly, our findings indicate that this relationship is moderated by industry characteristics in that the negative association between CEO openness to change and strategic persistence is significant in high-discretion but not in low-discretion industries. Contributions of the paper to the CEO succession and strategic change literatures along with the managerial implications of our findings are discussed in the concluding section of the paper.     

Examining the Rhetoric: The Strategic Implications of Climate Change Policy

Many companies today are taking proactive steps on climate change by reducing or even sequestering their greenhouse gas emissions. But one cannot, as many now do, generalize from these examples the proposition that all companies can benefit from greenhouse gas reductions. Climate change controls represent a market shift; the formation of new markets in pollution, pollution credits, money and emission abatement technology. And in any such transition, there will be winners and losers, those that embrace the shift and those that resist it. The difference between these two postures lies in strategic factors such as capital asset management, market competencies, global competitiveness and managing institutional change. The paper discusses each in turn and concludes with commentary on how present US policy towards the Kyoto Protocol is actually contrary to business interests.     

Planning Forward by Looking Backward: Retrospective Thinking in Strategic Decision Making*

Retrospective thinking occurs whenever one remembers something from the past, but one can also think retrospectively about hypothetical future events, by imagining that the event has already transpired and then working backward in the mind from the future toward the present. Designers, artists, planners, and other creative individuals utilize retrospective thinking when they mentally envision the object they wish to create and then thinkabout how it might be constructed. Some theorists and some previous research have suggested that forward and backward thinking are different cognitive processes, but there has been little investigation on the nature of these differences. This article examines the literature and describes a laboratory study designed to investigate retrospective thinking as a technique for increased idea generation. Subjects (n=64) were professional planners and managers with an average business experience of over 20 years. In a planning task, significantly more ideas were generated in the retrospective thinking mode than in the prospective mode, but the ideas were not found to be of greater quality. Evidence emerged that a subset of subjects were better able to make use of the retrospective technique, suggesting that selection along with training may be appropriate for the technique's mosteffective use.     

The Co-pay in Dutch Health Care: Policy and Effectiveness

This article describes the results of an empirical study into the design and effectiveness of the co-pay in Dutch Health care. With a reconstruction of the policy theory and the application of "the instrument theory" of Bressers and Klok, we are able to predict that the co-pay would not be effective. A process evaluation and an effect evaluation show that this is indeed the case. Not surprisingly, the second Kok administration determined that the instrument would be terminated.     

Understanding Patterns of Publishing Activity in Academic Research Occupations*

While it is widely understood that faculty in various disciplines tend to publish at different rates and in different forms, knowledge of these differences is too limited to facilitate systematically differentiated performance appraisal and reward systems. In this study, theory concerning knowledge production system characteristics as influences on individual performance is applied to academic research occupations using a classification scheme developed by Biglan [4]. Regression analysis is applied to a general (industry-wide) sample of United States faculty, with publishing patterns as performance measures. Each dimension of the classification scheme is found to have predictive validity. Output patterns are consistent with a conceptualization of research occupations in terms of (1) transformational/technological processes, (2) research mission, and (3) input/subject matter characteristics. The results offer a basis for generating disciplinary publishing norms and differentiated reward systems.     

Strategic Assessment Model (SAM): A Multiple Criteria Decision Support System for Evaluation of Strategic Alternatives*

The evaluation of strategic alternatives is a particularly difficult task. This difficulty is due to the complexities inherent in the evaluation process and the lack of structured information. The evaluation process must consider a multitude of relevant information from both the internal and external environments of the organization. Various analytical and normative models have helped decision makers utilize large volumes of information in strategic evaluation; however, most of these models have some limitations. We present a multiple criteria decision support system, called strategic assessment model (SAM), that addresses some of the limitations inherent in the existing models. SAM captures the decision maker's beliefs through a series of sequential, rational, and analytical processes. The environmental forces—decomposed into internal, task, general opportunities, and threats—are used along with the analytic hierarchy process (AHP), subjective probabilities, the entropy concept, and utility theory to enhance the decision maker's intuition in evaluating a set of strategic alternatives.     

Participation in Strategic Decision Making: The Role of Organizational Predisposition and Issue Interpretation*

Each time managers are faced with a strategic decision they decide how to decide. Specifically, they make choices about who has necessary information and, therefore, who needs to participate in the decision. Such responses to strategic issues are believed to be affected by the way in which decision makers interpret issues. However, organizations develop habitual responses to issues and may be predisposed because of their attention to rules and routines, or because of past performance, to respond to strategic issues in certain ways regardless of how issues are interpreted. We examined the direct and indirect effects of predisposition (rule orientation and past financial performance) and interpretation of strategic issues on the participation of internal stakeholder groups in strategic decision making. Executives in 52 organizations indicated that rule orientation and performance are directly linked to participation in strategic decision making, and that interpretation and rule orientation are directly linked to each other. Implications for managers include the notion that any effort to improve decision-making effectiveness by shaping how organizational members frame and interpret issues will be constrained by the organization's existing routines as well as its past performance.     

Application of the Fuzzy Weighted Average in Strategic Portfolio Management*

We propose a systematic approach that incorporates fuzzy set theory in conjunction with portfolio matrices to assist managers in reaching a better understanding of the overall competitiveness of their business portfolios. Integer linear programming is also accommodated in the proposed integrated approach to help select strategic plans by using the results derived from the previous portfolio analysis and other financial data. The proposed integrated approach is designed from a strategy‐oriented perspective for portfolio management at the corporate level. It has the advantage of dealing with the uncertainty problem of decision makers in doing evaluation, providing a technique that presents the diversity of confidence and optimism levels of decision makers. Furthermore, integer linear programming is used because it offers an effective quantitative method for managers to allocate constrained resources optimally among proposed strategies. An illustration from a real‐world situation demonstrates the integrated approach. Although a particular portfolio matrix model has been adopted in our research, the procedure proposed here can be modified to incorporate other portfolio matrices.