Chief of staff and medical director: conflict or cooperation?

Inevitably as the role of the medical director expands, it will directly affect power structures already existing in the hospital hierarchy, including department chiefs, other administrators, and the chief of staff. This article will attempt to define the roles of the medical director and the chief of staff, explore possible conflicts, and provide suggestions to help avoid confrontation. Finally, an attempt will be made to look into the future direction of the medical director's position.     

Working on professional development of faculty staff in higher education: investigating the relationship between social informal learning activities and employability

In this study, we examined how social informal learning and formal learning of faculty staff in higher education relate to their employability. Data were collected from 209 faculty staff members working at a Dutch university. Results showed that social informal learning was related to the employability of faculty staff. Further analysis revealed that especially external information seeking and acting upon feedback from colleagues and not formal learning predicted the employability of faculty staff. The finding suggests that institutes of higher education should especially foster the professional development of their faculty staff by stimulating exchange of information and seeking and using feedback with colleagues in a proactive manner.     

Approximation of knapsack problems with conflict and forcing graphs

We study the classical 0–1 knapsack problem with additional restrictions on pairs of items. A conflict constraint states that from a certain pair of items at most one item can be contained in a feasible solution. Reversing this condition, we obtain a forcing constraint stating that at least one of the two items must be included in the knapsack. A natural way for representing these constraints is the use of conflict (resp. forcing) graphs. By modifying a recent result of Lokstanov et al. (Proceedings of the 25th annual ACM-SIAM symposium on discrete algorithms, SODA, pp 570–581, 2014) we derive a fairly complicated FPTAS for the knapsack problem on weakly chordal conflict graphs. Next, we show that the techniques of modular decompositions and clique separators, widely used in the literature for solving the independent set problem on special graph classes, can be applied to the knapsack problem with conflict graphs. In particular, we can show that every positive approximation result for the atoms of prime graphs arising from such a decomposition carries over to the original graph. We point out a number of structural results from the literature which can be used to show the existence of an FPTAS for several graph classes characterized by the exclusion of certain induced subgraphs. Finally, a PTAS for the knapsack problem with H-minor free conflict graph is derived. This includes planar graphs and, more general, graphs of bounded genus. The PTAS is obtained by expanding a general result of Demaine et al. (Proceedings of 46th annual IEEE symposium on foundations of computer science, FOCS 2005, pp 637–646, 2005). The knapsack problem with forcing graphs can be transformed into a minimization knapsack problem with conflict graphs. It follows immediately that all our FPTAS results of the current and a previous paper carry over from conflict graphs to forcing graphs. In contrast, the forcing graph variant is already inapproximable on planar graphs.     

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.     

Corporate governance and stakeholder conflict

The stakeholder management literature is dominated by the ‘shareholder value’ and ‘inclusive stakeholder’ views of the corporation. Each views the governance problem in terms of inter-functional conflicts between stakeholder groups, such as between investors and managers or managers and employees, and rests on the assumption of an idealized corporate structure characterized by the separation of ownership from management. Our review of corporate governance and stakeholder conflict shows that such functional-based characterization is too simplistic and fails to account for important intra-functional conflict. Through a comparative review that considers managerial, stakeholder and family systems of governance, we demonstrate that, while the modality of conflict varies by system, substantial intra-functional conflict is endemic to each. We integrate the findings of the agency and comparative stakeholder theories of corporate governance to offer an authority-based framework with three different governance structures that offers complementary insights into stakeholder conflicts. Thus, our study highlights the important, but often neglected, intra-stakeholder type of conflict in various organizations and provides a basis for understanding their various manifestations and consequences under the different systems of governance.     

On the etiology of conflict cultures

Conflict has long been conceived as a fundamental part of all organizational systems. Yet the literature on conflict is largely divorced from its organizational roots and instead focuses on general processes of conflict management at the individual and small group levels of analysis. To re-establish the organizational basis of conflict, we develop a macro-theory of conflict cultures, or shared norms that specify how conflict should be managed in organizational settings. We propose a typology of conflict cultures that draws upon two dimensions – active versus passive conflict management norms and agreeable versus disagreeable conflict management norms – and discuss the etiology of four distinct conflict cultures: dominating conflict cultures (active and disagreeable), collaborative conflict cultures (active and agreeable), avoidant conflict cultures (passive and agreeable), and passive–aggressive conflict cultures (passive and disagreeable). We discuss top-down processes (e.g., leadership, organizational structure and rewards, industry, community, and societal factors) and bottom-up processes (e.g., personality, demographics, values and social networks) through which these conflict cultures develop. We explore both positive and negative organizational outcomes associated with each conflict culture, as well as moderators of proposed effects. We conclude with theoretical, practical, and empirical implications of a conflict culture perspective.     

Medical staff handling of concerns with physicians' performance

Medical staff organizations and their leaders are frequently confronted with concerns about physician knowledge, performance, or behavior. Dealing with these concerns is a serious and time-consuming task. Poorly handled issues may result in serious legal consequences. In highly structured organizations, authority for responsibilities, income, and employment rests with individuals who must manage these problems, but medical staff structures do not always lend themselves to dealing with these issues. Introduction of quality improvement processes into medicine has been received as a panacea for physician problems. Certainly the majority of physicians understand quality improvement and work toward common goals to improve patient care. Unfortunately, a small minority remain problem physicians. Steps that can be taken to deal with problem physicians, particularly for issues of quality management, are described in this article.     

The chief of staff and the medical director

To understand the roles of the medical director and the chief of staff, it is important to consider the environment in which they operate. If both the environment and the roles are designed for collaboration and cooperation, these physicians can contribute to the success of the institution.     

Myths and misconceptions of the medical staff organization

Many of the problems that confront hospitals in a rapidly changing and increasingly hostile environment are of their own making. Chief among these self-destructive tendencies has been misjudgment of the characteristics and functions of the medical staff organization. This article explores some common misconceptions and provides a more plausible reality.     

Re-forming the traditional organization medical staff

The traditional, two-bylaws-model organized medical staff was created in another age (1919) to serve a simple health care system, controlled by physicians, in which the only players were patients, doctors, nurses, and small hospitals. This medical staff model does not meet the needs of the U.S. health care system of the 1990s. The purpose of this article is to provide the physician executive with a resource to use when he or she is called on to help determine what, if any, changes are needed in his or her organization to make the role of physician leaders more effective. Finding the right answer to this question is part of discovering ways to reduce health care costs without reducing the funds available to pay for direct delivery of health care services. Maintaining traditional, bureaucratic, legalistic organized medical staff activities is a very expensive game that we can no longer afford to play.     

New Methods for Resolving Conflicting Requests with Examples from Medical Residency Scheduling

In scheduling medical residents, the objective is often to maximize resident satisfaction across the space of feasible schedules, relative to the many hard constraints that ensure appropriate patient coverage, adequate training opportunities, etc. A common metric of resident satisfaction is the number of time‐off requests that are granted. Simply maximizing this total, however, may lead to undesirable schedules since some requests have higher priority than others. For example, it might be better to grant one resident's request for a family member's wedding in place of two residents’ requests to attend a rugby game. Another approach is to assign a weight to each request and maximize the total weight of granted requests, but determining weights that accurately represent residents’ and schedulers’ preferences can be quite challenging. Instead, we propose to identify the exhaustive collection of maximally feasible and minimally infeasible sets of requests which can then be used by schedulers to select their preferred solution. Specifically, we have developed two algorithms, which we call Sequential Request Selection Via Cuts (Sequential RSVC) and Simultaneous Request Selection Via Cuts (Simultaneous RSVC), to identify these sets by solving two sequences of optimization problems. We present these algorithms along with computational results based on a real‐world problem of scheduling residents at the University of Michigan C.S. Mott Pediatric Emergency Department. Although we focus our exposition on the problem of resident scheduling, our approach is applicable to a broad class of problems with soft constraints.     

The barrier effect of conflict with superiors in the relationship between employee empowerment and organizational commitment

The author proposes the idea that conflict with superiors has a barrier effect in the positive relationship between employee empowerment and organizational commitment. Superiors with higher authority rankings set and pursue organizational goals and values to which employees with lower authority rankings are expected to become committed. Conflicts with those superiors may hinder empowered employees to develop or maintain high levels of organizational commitment. A questionnaire survey among 91 secondary school teachers in The Netherlands provides empirical support for this suggestion. The moderator effect of conflict with superiors that was proposed and found in this study suggests that psychological empowerment in the workplace interacts with other employee experiences in its effects on an employee's commitment to the organization.     

Ambidexterity as a dynamic capability: Resolving the innovator's dilemma

How do organizations survive in the face of change? Underlying this question is a rich debate about whether organizations can adapt—and if so how. One perspective, organizational ecology, presents evidence suggesting that most organizations are largely inert and ultimately fail. A second perspective argues that some firms do learn and adapt to shifting environmental contexts. Recently, this latter view has coalesced around two themes. The first, based on research in strategy suggests that dynamic capabilities, the ability of a firm to reconfigure assets and existing capabilities, explains long-term competitive advantage. The second, based on organizational design, argues that ambidexterity, the ability of a firm to simultaneously explore and exploit, enables a firm to adapt over time. In this paper, we review and integrate these comparatively new research streams and identify a set of propositions that suggest how ambidexterity acts as a dynamic capability. We suggest that efficiency and innovation need not be strategic tradeoffs and highlight the substantive role of senior teams in building dynamic capabilities.     

The barrier effect of conflict with superiors in the relationship between employee empowerment and organizational commitment

The author proposes the idea that conflict with superiors has a barrier effect in the positive relationship between employee empowerment and organizational commitment. Superiors with higher authority rankings set and pursue organizational goals and values to which employees with lower authority rankings are expected to become committed. Conflicts with those superiors may hinder empowered employees to develop or maintain high levels of organizational commitment. A questionnaire survey among 91 secondary school teachers in The Netherlands provides empirical support for this suggestion. The moderator effect of conflict with superiors that was proposed and found in this study suggests that psychological empowerment in the workplace interacts with other employee experiences in its effects on an employee's commitment to the organization.     

Misbehaving physicians and professional ethics

Consider a true story about physician misbehavior and see how it was handled. Sometimes a gentle touch works well in situations of unexpected and unintended behavioral problems.     

Is the professional self-managing or is there really a need for professional management?

Is the professional self-managing or is there really a need for professional management? The answer to that question is in both cases: “Yes”. The professional is largely responsible for directing his own activities. Managers must take due account of this by applying rules and procedures on a modest scale and aiming to achieve maximum harmonisation of the objectives of the organisation and the personal objectives of the people working there. If they can do that then there can be said to be professional management.The difficulty in managing professionals is the difficulty in steering the force and the direction of the thinking of others who are — by nature - often differently-minded: professionals have generally followed a specialised, usually scientific education, enjoy a high social standing, like to “perform solo”, have a dislike of management both in the active and the passive sense and the output of their work is difficult for others to evaluate because there is generally no clear consensus on the definition of performance indicators.Managing professionals could be considered as managing brain capacity and that calls for more than just good sense. A manager of a group of professionals can even sometimes experience a great deal of professional pleasure in his work if he is capable of acting as a specialised generalist, pacemaker and coach for his or her team.     

职场高情商的负向效应及化解策略

职场中高情商之人往往容易重人际,轻效益;重周到,轻诚意;重安稳,轻创新;重全面,轻特点。究其根本,在于追求要点偏离,利益焦点错位,关注重点有误,行动难点移位。想要真正发挥高情商的价值,就需情感、行为均周到,感受、诉求均尊重,一般、个性均兼顾,回应、落实均到位。     

为竞争上岗工作解难

近年来,竞争上岗的改革措施在激活机关用人机制、改善机关干部结构、扩大干部工作中的民主、增强机关活力等方面取得了明显成效,并越来越受到广大干部群众的拥护和欢迎.但目前在具体操作中,对有些难点问题把握不准,解决不好,在一定程度上影响了竞争上岗工作推行的力度和效果.