Formatting and presenting quality data to medical staffs and hospital boards

A host of historical and practical precedents have made hospitals responsible for the quality of care rendered within their facilities. The medical staff and the board of trustees share in this responsibility. Increasing demands for demonstrative evidence of the quality of care in an institution have made the process data-based. There is no substitute for specific data on the performance of both the hospital and its providers in the delivery of care. The trick, however, is in presenting this information to the medical staff and the board in a fashion that will be understandable and that will still maintain confidentiality of provider and patient. The authors offer a presentation system that has met with success in their community hospital.     

The Role of Effort in Shifting Preference for Feedback Stimuli

ABSTRACT

Researchers have examined preference for the format of delivery of feedback, however little research has examined strategies to increase feedback and praise desirability. The current study aimed to evaluate whether preference shifted for stimuli that signaled work and for manager-praise stimuli that were delivered after work. Moreover, we sought to understand if these preference shifts were greater when the work was higher-effort compared to lower-effort work tasks (a phenomenon described in the basic literature as within-trial contrast). The study took place in a simulated work environment. Sixteen university students clicked on a shape that produced the work task, completed a mock medical data-entry task, and received manager-praise on an FR1 and FR20 schedule. At the start of the study and following each contingency exposure trials, they completed a preference assessment for both the shapes and the manager-feedback stimuli. The primary dependent variable was the percentage of preference change for two categories of stimuli – shapes presented at the beginning of trials that signaled which condition participants were in and manager-praise stimuli presented at the end of trials. Preference for the shape stimuli for both high- and low-effort stimuli decreased indicating that stimuli that signal work may become less preferred. Preference for the manager-praise stimuli for both high- and low-effort stimuli increased suggesting that stimuli that follow work may become more preferred. Overall, these data suggest that the conditions under which managers deliver feedback and praise may influence preference for those stimuli.     

Willingness to Pay for Shifting Inventory Risk: The Role of Contractual Form

In order to reduce their inventory risk, firms can attempt to contract with their suppliers for shorter supply lead‐times, with their buyers for longer demand lead‐times, or both. We designed a controlled laboratory experiment to study contracts that shift a focal firm's inventory risk to its supply chain partners and address two questions. First, is it more effective if the cost of shifting inventory risk is framed as a fixed fee or in per‐unit cost terms? We find that, generally, our participants are willing to pay more to avoid supply–demand mismatches than the expected costs from such mismatches. This tendency to overpay is mitigated under fixed fee schemes. Second, does it matter whether the option to reduce inventory risk is the outcome of either increased responsiveness from the upstream supplier or advanced demand information from the downstream buyer? Our results suggest that this difference, when only a matter of framing, has no significant effect on willingness‐to‐pay.     

税制改革、工资跨期转移与公司价值

税收是影响公司薪酬契约订立和执行的重要因素。截至目前,学术界已有大量研究表明税收会影响公司薪酬契约形式的选择,然而关于税收与薪酬契约时间选择的问题还较少被学者们关注。鉴于此,本文以我国2008年企业所得税改革为契机,检验计税工资限额扣除政策取消是否会引起工资的跨期转移行为,在此基础上,进一步检验工资跨期转移的影响因素和经济后果。实证检验结果表明:在新税法实施前后相邻的两个季度(2007年第4季度和2008年第1季度)之间,受计税工资限额扣除政策取消影响,公司存在显著的推迟支付工资现象;该现象在税率较高、经营活动现金流水平较低、规模较大以及成长性较强的公司中更为明显,另外,非国有企业推迟工资现象比国有企业更为明显;资本市场对计税工资制改革引起的工资推迟行为给予了正面反应,工资推迟行为显著地提高了公司价值。本文的研究发现不仅提供了税收与薪酬契约时间选择方面的经验证据,填补了该领域的研究空白,而且还对税制改革的政策效果评价有重要的参考价值。     

Models for medical practice integration

Decreased physician income, increased administrative burdens, and interference with the compassionate delivery of high-quality medical care are threatening the independent practice of medicine in solo and small group practices. Many established physicians, and the hospitals with which they relate, are searching for organizational models that, by integrating some or all aspects of their practices, will preserve incomes and reduce regulatory and administrative burdens. This article will describe several "practice integration models," pointing out advantages and disadvantages to physicians in established practices. (Many of the same arguments could be made for physicians new to practice, with different emphasis). The continuum of integration models is shown in figure 1, page 19. The group practice without walls and its two submodels, the independent group practice without walls (IGWW) and the affiliated medical practice corporation (AMPC) are more recent and more effective models and will be covered in depth in the article.     

New challenges for medical directors

Much of the future success of managed care organizations will depend on the quality of the direction provided by medical directors. The increasing complexity of the health care industry, manifested by intense competition for patients and reduced levels of reimbursement, will necessitate that HMOs, PPOs, IPAs, and utilization review firms begin to differentiate their services according to clinical protocols and outcome measures.     

Theme-Based Book Review: Shifting Views of Public Sector Corruption

This theme-based book review considers three recent titles related to public sector corruption: Populism and corruption: The other side of the coin, edited by Jonathan Mendilow and Eric Phelippeau; Critical perspectives on public systems management in India, by Amar KJR Nayak and Ram Kumar Kakani; and Handbook on corruption, ethics and integrity in public administration, edited by Adam Graycar.

     

以民意所求调整好换届心态

2006年是地方各级党委的集中换届年。换届意味着领导职位的变动、人员的调整,意味着干部队伍的新老交替,同时,也意味着一大批干部要经受进退留转的考验。面对这些,绝大多数领导干部能讲党性、顾大局、守纪律,正确对待进退留转,保持着淡泊平和的心态和积极向上的精神状态。但是,也有少数干部对进退留转缺乏正确的态度,他们干工作不是从党和人民的利益出发,而是过多地考虑个人的利害得失,遇到干部调整、换届等关键时刻,他们更是惴惴不安,无心工作,甚至跑官要官,搞非组织活动,生怕错过升迁机会。这些干部之所以会有错误的态度,原因是多方面的,…     

Income Shifting in Italian Business Groups and some Governance Implications

This paper explores the relationship among group control, financial reporting strategies and governance implications in the pursuit of domestic tax planning. A very large number of papers deals with international tax planning in multidivisional enterprises, but very few are devoted to exploring significant incentives for national business groups to engage in tax planning strategies. In this paper we propose a one-period model relating to the tax incentives of income shifting in Italian business groups. We show that, given the total amount of expected earnings before taxes and the dividends received by the firms belonging to a business group, an optimal solution to the problem of minimizing the group tax burden exists. The optimal solution involves a gain in value for the group as a whole; nevertheless, since in business groups ownership is often differentiated among shareholders (often because of the separation between ownership and control), income shifting may determine wealth transfers, often in favor of the controlling shareholder. We therefore analyze the management and governance implications of such income shifting, for both shareholders and stakeholders (i.e. managers). This revised version was published online in July 2006 with corrections to the Cover Date.     

Shifting Concepts of Autonomy in the Hong Kong Hospital Authority

The Hong Kong Hospital Authority is the main provider of public health care services in Hong Kong. It operates 41 public hospitals, 74 general out-patient clinics and 45 specialist out-patient clinics. This article examines the reason for its establishment as a statutory body in 1990 and offers an assessment of its success in meeting the goals of the reformers. A belief that health care service delivery would be improved is largely supported by the evidence, but this may have more to do with budget and policy consistency than management autonomy and flexibility. Statutory independence, with its promise of improved efficiency, has its limits in the highly complex field of health where there are multiple players and where professional autonomy remains a key claim. In recent times, the authority has been subject to several reform attempts and, together with the SARS epidemic in 2003, these have had a significant impact on its organizational structure and practices, in particular, on its degrees of autonomy.

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Shifting Paradigms in Corporate Environmentalism: From Poachers to Gamekeepers

This article provides an insight into the changing role of businesses in dealing with the natural environment issues. From being regarded as poachers of the natural environment, many businesses have now started to position themselves as gamekeepers of the natural environment. This article traces the events and factors that have contributed toward this shift. The article starts with an introduction to the current state of the natural environment. It then discusses the role that businesses have traditionally played in contributing toward the rapid deterioration of the natural environment. The article then traces the events that have gradually resulted in businesses accepting that they have a responsibility to address environmental issues. This is followed by an overview of the business responses, to the risks and opportunities, posed by changes in the natural environment. The article then provides a brief overview of the various phase models that attempt to categorize business responses to environmental issue. The conclusion focuses on the challenges that lie ahead.     

Management education for medical students.

There is little doubt that the economics, management, and delivery of health care in the United States are currently in an unprecedented state of flux. Prospective payment, cost containment, and corporatization of health care delivery are rapidly replacing retrospective fee-for-service reimbursement and unmanaged provider practice patterns. Though ultimately certain to affect significantly physicians now in training, these changes have been afforded little attention in the undergraduate medical curriculum. At Hahnemann University, this is no longer the case. "Management Education for Medical Students" is an elective, intensive, eight-week experience for senior medical students. Following a thorough orientation to the workings of organizations through which health care is delivered, medical students receive both didactic and project-oriented instruction in university hospital administration during the first four weeks. During the course's second half, students are offered specialized training in the part of medical management that links the clinical and the financial aspects of health care management.     

Compensation for elected hospital medical staff leadership

As physicians' practices become more complex and their practice incomes more difficult to maintain, hospitals concurrently require more physician input into organizational, utilization, and strategic planning matters. Physicians and hospitals across the country are discussing the question of financial compensation to physicians for the time they spend performing these hospital administrative tasks. It is already common practice for hospitals to pay a salary for medical direction of hospital departments such as intensive care units or pulmonary laboratories. The question has become whether this practice should be extended to elected medical staff leadership.     

Paving the way for electronic medical records

This article explores the reasons why electronic medical records have not become widely deployed in the health care industry. Y2K moved to center stage and fears of computer meltdowns became the single greatest obstacle to overcome before considering new technology possibilities. Almost every other information technology initiative in health care was delayed or suspended, while the issues of compatibility with four-digit dates were examined. Finding systems and devices that weren't Y2K compliant and replacing or working around their deficiencies left precious few resources available for other tasks. Another issue is standardization. The potential and promise of electronic records can only be realized if a standard way to describe clinical information can be agreed upon and implemented in practice situations. Clients have been reluctant to purchase electronic records while vendors are offering nonstandard solutions. Obstacles and benefits to implementing EMR systems are outlined. Despite some of the barriers to implementing EMRs, the future is bright for their widespread deployment.     

Behavioral Determinants of Target Shifting and Deterrence in an Analog Cyber-Attack Game

This study examines how exploiting biases in probability judgment can enhance deterrence using a fixed allocation of defensive resources. We investigate attacker anchoring heuristics for conjunctive events with missing information to distort attacker estimates of success for targets with equal defensive resources. We designed and conducted a behavioral experiment functioning as an analog cyber attack with multiple targets requiring three stages of attack to successfully acquire a target. Each stage is associated with a probability of successfully attacking a layer of defense, reflecting the allocation of resources for each layer. There are four types of targets that have nearly equal likelihood of being successfully attacked, including one type with equally distributed success probabilities over every layer and three types with success probabilities that are concentrated to be lowest in the first, second, or third layer. Players are incentivized by a payoff system that offers a reward for successfully attacked targets and a penalty for failed attacks. We collected data from a total of 1,600 separate target selections from 80 players and discovered that the target type with the lowest probability of success on the first layer was least preferred among attackers, providing the greatest deterrent. Targets with equally distributed success probabilities across layers were the next least preferred among attackers, indicating greater deterrence for uniform-layered defenses compared to defenses that are concentrated at the inner (second or third) levels. This finding is consistent with both attacker anchoring and ambiguity biases and an interpretation of failed attacks as near misses.     

中国可耗竭资源型企业转移行为的特征和趋势

本文基于企业战略管理和系统工程理论,从2000年-2009年我国境内可耗竭资源型企业转移的112个项目中提炼描述了企业转移的特征行为,分析揭示了可耗竭资源型企业转移行为的驱动因素,研究构建了可耗竭资源型企业转移行为的过程激励模型,同时开展了问卷调查和行为度量,进行了行为四分图及趋势面图分析。研究发现:(1)企业转移行为主要集中于"高成本-高收益转移行为"和"低成本-低收益转移行为";(2)发生频次较高的企业转移行为明显集中在收益较高、成本略高的区域,并且在成本相近的区域行为发生的频次有随收益提高而上升的趋势。