Ounces of malpractice prevention

The source of malpractice claims, contrary to widely held views, is not simply improper or inadequate medical care. In the majority of cases, malpractice litigation ensues because of negative nonclinical factors and the incidence of an unexpected result in medical treatment. High on the list of nonclinical causes are faults in the physician-patient relationship. Patients who are unhappy with the manner in which they have been treated by physicians are much more likely to sue when the outcome is even moderately untoward. Key to reducing the incidence of malpractice suits is helping physicians understand that attention has to be paid to their behavior.     

Constitutional rights versus malpractice insurance settlements

The increasing costs and complexity of malpractice litigation have created an statutory right that allows malpractice insurance companies to settle malpractice claims regardless of the desires of the defendant physician. In the past, the consequences of settling a malpractice claim out of court were not as important as they are today. The Health Care Quality Improvement Act of 1986 mandates that any settlement in behalf of a physician be documented in the National Practitioner Data Bank (NPDB), which must be consulted every time the physician is credentialed. This NPDB requirement denies due process to health care providers and thus becomes a violation of the federal and many state constitutions. Physician executives and medical leaders must bring these issues to the table and negotiate solutions before damage to practicing physicians and the U.S. health care delivery system caused by this legal paradox become too severe.     

The new health care civilization: integration of physician land and manageria

Changes occurring in health care demand that physicians expand their professional knowledge and skills beyond the medical and behavioral sciences. Subjects absent from traditional medical education curricula, such as the economics and politics of health care, practice management, and leadership of professional organizations, will become important competencies, particularly for physicians who serve in management roles. Because physicians occupy a central role in planning and allocating medical care services and other health care resources, they must be better prepared to work with other health care professionals to create a new civilization, even if this means leaving the cloistered domain of "physician land" to serve as interface professionals between the delivery of medical services and the management of health care. Our research findings and conclusions strongly suggest that economic, management, and leadership competencies need to be incorporated into the professional development of physicians, especially in postgraduate and continuing education curricula.     

Clinical guidelines: a defense in medical malpractice suits

Clinical pathways, or practice guidelines, have been gaining wider acceptance from physicians and hospitals seeking to constrain increasing operating costs for inpatient care. The authors believe that properly developed and agreed upon guidelines can also be used in certain cases as appropriate standards of care in determining if medical malpractice has occurred. Adherence to the guidelines could then be asserted by defendants as an affirmative defense in a medical malpractice suit.     

Reducing litigation costs through better patient communication

The most common cause of malpractice suits is failed communication with the patients and their families. Explore ways that better communication could lead to fewer malpractice claims and allow health care organizations to reduce litigation costs.     

Three Lenses on Occupations and Professions in Organizations: Becoming,Doing, and Relating

Management and organizational scholarship is overdue for a reappraisal of occupations and professions as well as a critical review of past and current work on the topic. Indeed, the field has largely failed to keep pace with the rising salience of occupational and professional (as opposed to organizational) dynamics in work life. Moreover, not only is there a dearth of studies that explicitly take occupational or professional categories into account, but there is also an absence of a shared analytical framework for understanding what occupations and professions entail. Our goal is therefore two-fold: first, to offer guidance to scholars less familiar with this terrain who encounter occupational or professional dynamics in their own inquiries and, second, to introduce a three-part framework for conceptualizing occupations and professions to help guide future inquiries. We suggest that occupations and professions can be understood through lenses of “becoming”, “doing”, and “relating”. We develop this framework as we review past literature and discuss the implications of each approach for future research and, more broadly, for the field of management and organizational theory.     

Clinical practice guidelines and medical malpractice

As clinical practice guidelines become more and more prevalent, they will define the requisite "standard of care" for medical treatment and impact medical malpractice litigation. They may even replace expert testimony.     

The implications of practice guidelines for physician medical malpractice liability

Medical practice guidelines are increasingly coming into use, and as more and more physicians are presented with guidelines to follow in the delivery of health care, the question arises of whether these guidelines will become instruments for imposing greater medical malpractice liability on physicians. This column will briefly describe what guidelines are, how they are developed, and how they have been and may be used in litigation against physicians, hospitals, and other health care institutions. As hospitals and managed care organizations continue to implement guidelines, the role these guidelines play in malpractice cases can be expected to increase. It appears, however, that, although guidelines will contribute to the establishment of the standard of care by which a physician's actions will be measured, they are not likely to become the standard that all physician treatment decisions must meet.     

Exploring the use of virtues to facilitate identity construction among management students

This paper explores the challenges and opportunities facing educators who wish to facilitate management students’ identity construction as a means to foster their students’ emergent professional identities and post-graduate career attainments. We look to medical and law schools’ recent advancements, alongside their traditional dissemination of knowledge and technical skills, in better aligning students’ developing identities and related behaviors with respective professional ideals. Drawing on insights from these professional schools, we examine whether the concept of “professional virtues” that’s proven valuable in these contexts might also be used to facilitate students’ professional identity construction within management education.     

When bankers feel guilty–Employees’ vicarious guilt and the support of moral business practices

Media regularly report on misconduct and ethical transgression in a variety of professions, including banking. This research investigates the conditions under which individual employees experience guilt for wrongdoings on behalf of their profession. In a sample of 295 bankers, I find an inverted u-shaped relationship between professional identification and collective guilt. Furthermore, the data indicates a positive relationship between levels of experienced guilt and degree of moral intentions, such as supporting stricter regulations that aim to prevent future professional malpractice. The study's results present guilt as a central factor related to professional identification and intentions towards improving ethical business practices.     

信息性与控制性:工作压力源的性质研究

本研究在自我决定理论(self-determination theory,SDT)的框架指导下,对264名企业员工所感受的压力源的性质进行了分析.结果发现,根据作用方式或者个体评价方式的不同,同一个压力源可以再分为信息性或控制性;信息性压力源所产生的压力感受显著地低于控制性的压力源所产生的压力感受;人际与角色压力、工作特征压力、组织结构和氛围压力均可以再分为信息性与控制性,两种性质的压力源产生的压力感受均存在显著性的差异;对不同代际的员工而言,两种性质的压力源所产生的压力感受存在显著性的差异.研究结论启发管理者应关注员工对压力源的个人评价,同时注意不同年龄的员工所感受到的压力特点,在压力源无法改变的前提下,为员工创造信息性的环境,可以显著缓解员工的压力感受.     

Managing health care quality.

Using the cited principles of professional staff credentialing and quality assurance, a department chairman, medical director, or other health care executive will be in an excellent position to assess quality of care against established standards and manage problems in the routine provision of medically appropriate care. He or she will also be able to assure the hospital's board that the hospital and its medical staff are well positioned to meet future challenges to provide effective quality, utilization, and risk management.     

Effectiveness, accountability, and efficiency

Management of health care is compromised by its singular reliance on billing information--i.e., a claims trail tells little of what providers think. It relates to neither prevention of disease nor reduction of unnecessary health care costs. Billing information is not the substrate to be used in the pursuit of appropriateness, effectiveness, and value. To improve medical management of health care, a protected, but accessible clinical database is needed.     

Medicine, management, and me.

What is medical management? How do you learn about it? How do you get into it? Is there a future in it? Is medical management for you? Can you do it? What will it mean to your original plans for your life in medicine? Is it worth the sacrifice? Get comfortable. I have a story to tell you. It may help if you hear about medical management from a medical director who has preceded you. I doubt I can answer all your questions. I can, however, tell you about one physician's visions, expectations, decisions, experiences, and rewards from what can be loosely called "medical management." If you find something of help in your decision making in this account, my telling it is worthwhile.     

Information systems and occupational stress: a theoretical framework

The information systems (IS) profession is a stressful profession. However, there is little theoretical or empirical research on the effects of occupational stress on IS professionals. A major reason is because IS professionals and researchers are unaware of the consequences of occupational stress and unfamiliar with the occupational stress literature. The purpose of this paper is to propose a theoretical framework of occupational stress for IS professionals. Based on a review of the IS, psychology, and general management literature, 12 occupational stress models are identified. These stress models are analyzed along the two dimensions of focus and theoretical foundation. The analysis shows that most of the occupational stress models consider stress to be the consequence of the interaction between an environmental stimulus and the idiosyncratic response of the individual. Further analysis of these models suggests that nine key points are critical in developing a theoretical framework of occupational stress for IS professionals. A mapping of how the existing stress models incorporate the nine key points is also presented. The findings of this paper can provide a theoretical basis for further research on the occupational stress of IS professionals. Finally, an agenda for further research into this issue is presented.     

Help for impaired physicians.

A physician is considered to be impaired when personal problems (e.g., chemical dependence, emotional disorders, physical disability) or professional difficulties (e.g., malpractice litigation stress, incompetence) begin to interfere with the ability to function in the profession and in personal life. In this article, the nature of the impairment problem is briefly described and the issues of prevention, early recognition, effective and humane treatment, and the recovery process are addressed.     

Scared silent: the clash between malpractice lawsuits & expert testimony

As the Bush administration pushes Congress to place a $250,000 cap on pain and suffering awards in medical malpractice lawsuits, other moves quietly afoot by state medical boards, state medical associations, and specialty societies may reduce liability insurance premiums by limiting the number of suits.     

Resolving conflicts: principles and practice

Physicians and other medical professionals undergo extensive professional training for the privilege of obtaining their professional licenses. For most physicians, clinical training is conducted in extremely competitive circumstances. Many physicians endorse competition as an appropriate method for producing greater individual and collective competence within the profession. Competition, however, is a very limited way to resolve conflicts. And, in the current environment of greater resource restrictions and reform, the competitive model, at best, seems short-sighted. Many of the current relationships involving physicians and others are transitional, involving various partners in numerous practice and professional relationships. For example, medical practices are merging; hospitals are engaging physicians in numerous business structures, even employment. However, longer term relationships are enhanced by mutual respect and collaboration, rather than chronic competition to "win" one's rights over another. Thus, the need among physicians to enhance their conflict resolution skills is expanded in today's environment.     

Burn-out as a crisis in self-efficacy: Conceptual and practical implications

This paper reviews the central role of self-efficacy expectations in a variety of approaches to organizational performance and management. It also explores the implications of self-efficacy for the study of psychological burn-out. It is proposed that conceptualizing burn-out as a crisis in self-efficacy would allow a more reasonable understanding of moderate instances of the syndrome, and would differentiate the concept of burn-out distinctly from the related field of occupational stress. The paper proposes the utility of a more specific construct of professional efficacy in light of the essential achievement experiences which occur in the workplace. It is proposed that a clearer delineation of the role of professional efficacy throughout these research approaches would enhance the coherence of the field. In conclusion the paper discusses implications for research and practice.     

Inequity at work: Its measurement and association with worker health

Abstract

This paper considers the extent to which stress-induced illness can be regarded as a personal injury that could give rise to civil action for damages against employers in the UK. It outlines the results of a brief survey of personal injury solicitors, which indicates that claims are already being initiated by employees who allege they have suffered a stress-induced illness. The potential for claims within industrial tribunal cases that have already been decided is also examined. Consideration is given to the hurdles that litigants will have to surmount, such as proving that their condition was in fact caused by some feature of their working conditions, showing that it was foreseeable that they would suffer a stress-based injury, and demonstrating that their employer was in some way at fault. This leads to a questioning of what employers can do to protect themselves from such claims, or at least defend them successfully. The paper points out that success is likely to depend heavily upon the quality of expert medical opinion, and also upon policy conditions that may influence those adjudicating on such cases. It is concluded that the cost of losing claims may be significant, and that employees who ignore the warning signs do so at their peril.