Aspects of quality . . . and world domination!

Training, learning and development tend to be regarded as central to the success of every organization and the nation. However, not all organizations are able or willing to invest resources in such processes. The paper presents a view that training, learning and development occur as a consequence of successful persuasive actions in a chain of talk, which draw on the discursive and rhetorical resources of an emerging learning movement. Utilizing the findings from an examination of data from the UK Department of Education and Skills-sponsored National Training Award winners, the paper provides an employment of actor-network theory and the sociology of translation to show how some organizations make the case for training, learning and development as a virtuous endeavour. It concludes by suggesting that what is needed is a more detailed understanding of how the case for the adoption of training, learning and development, or not, within organizations is made meaningful.     

LOAD CUBING AT R. J. REYNOLDS

R. J. Reynolds Tobacco USA (RJR) is currently implementing a microcomputer-based decision support system to computerize and optimize the selection of patterns for loading cases of finished product into truck trailers at RJR's Central Distribution Center. This system allows for the efficient loading of trucks with less supervision. Total annual savings from reduced personnel and shipping costs is approximately $850,000. In addition to these benefits, the system is a stepping stone for trailer loading automation and the integration of a comprehensive load planning system.     

Failings in U.K. transport planning

This discussion of British Government policy on transport, highlights the absence of a coherent strategic plan as a guideline for individual decision-making. Without this framework and a recognition of the close connection between transport and land use planning, conventional methods of project appraisal produce an unsatisfactory piecemeal transport system. As an example, the 1973 Channel Tunnel proposals are examined and found inappropriate for either of the main possible directions of progress sketched out.     

The value circle. A profile of J. Richard Gaintner, MD.

This article describes how the arrival of CEO J. Richard Gaintner, MD, at Shands HealthCare signaled a time for refocusing the organization's direction and helping physicians to cope with the changes buffeting the industry. He saw angst and disenfranchisement, sentiments that characterized not only Shands and the University of Florida Health Science Center, but also the entire establishment of American scientific medicine. Gaintner believes--and continually preaches--that practicing medicine in a cost-effective manner will improve, not harm, the quality of care. His willingness to face reality objectively is perhaps his greatest asset in helping physicians deal with managed care. He conveys heartfelt empathy with the day-to-day conflicts they face. But he does not allow himself the temporary luxury of cynicism, and he refuses to accept negativity and pessimism in others. Rather, he asks that physicians and managers understand the system and develop the capacity to work within it and take responsibility for improving it. Beyond exhorting physicians to be accountable for the success of the enterprise, Gaintner creates mechanisms for meaningful physician participation in enterprise management.     

Complementary and alternative medicine. The daunting challenge.

There is no question that the past few years have seen a tremendous surge in interest in what has come to be known as complementary and alternative medicine (CAM). Health plans contemplating adding CAM benefits face a daunting challenge. How should a plan define CAM benefits? How should a plan define appropriate CAM providers? How can these benefits be managed? Will the addition of CAM benefits undermine coverage policies for conventional biomedicine? The answer to these questions lies largely in uncharted waters, as even CAM advocates will agree that many alternative therapies (even those like Oriental medicine which has been in practice for some 5,000 years) have not yet undergone the type of rigorous, evidence-based analysis that is required to validate conventional biomedicine. This article explores options for CAM benefit design by considering two basic approaches-creating an uninsured benefit or insured benefit.     

U.S. Aviation Regulations Increase Probability of Midair Collisions

A purely stochastic Monte Carlo model is used to compare the relative midair collision course probabilities and mean closing velocities of four systems of rules for aircraft cruising altitudes as a function of altitude error: (1) current U.S. federal rules, (2) random altitudes, and (3) two proposed alternatives to the current rules. This model increments error while: (1) counting collisions among cruising pairs of aircraft following the four rules being tested on random headings between randomly placed airports, and (2) calculating mean closing velocities for each rule. The calculations verify that: (1) federal rules increase collision course probabilities by about four times more than for a chaotic system of aircraft cruising at randomly selected altitudes, (2) risk is directly proportional to the level of compliance, and (3) mean closing velocities resulting from the current rule are slightly less than for random altitudes, while being almost twice as high as for the proposed rules. High closing velocities are shown to increase the collision probability.     

Effects of the Canada-U.S. Trade Agreement on U.S. agricultural exports

This paper investigates the effects of the Canada-U.S. Trade Agreement (CUSTA) on U.S. exports of agricultural products. Econometric analysis found that CUSTA has had a large impact on many U.S. agricultural export categories. All of the consumer-oriented products (except wine and beer), five of the intermediate products, and four of the bulk products had significant CUSTA effects. It is clear that the CUSTA effects have been larger for consumer-oriented food products. There is also evidence that U.S. affiliate sales in Canada have stimulated U.S. exports of consumer-oriented products and intermediate products.     

Management knowledge and skills required by U.K. and U.S. medical directors

A survey was undertaken of the medical directors of National Health Service trusts in the South Thames Regional Health Authority of the United Kingdom. The purpose of the survey was to ascertain medical directors' views regarding the importance of various areas of administrative practice, their preparedness in these areas of administrative knowledge prior to taking up their roles as medical directors, and their views as to the body of knowledge required for future medical directors. The study was compared with a similar study undertaken in the United States. While there were many areas of agreement between the English and the American medical administrators, there were also areas of significant differences of opinion. The need to develop a recognized training program in medical administration is acknowledged.     

Analyzing the Homeland Security of the U.S.-Mexico Border

We develop a mathematical optimization model at the intersection of homeland security and immigration, that chooses various immigration enforcement decision variables to minimize the probability that a terrorist can successfully enter the United States across the U.S.-Mexico border. Included are a discrete choice model for the probability that a potential alien crosser will attempt to cross the U.S.-Mexico border in terms of the likelihood of success and the U.S. wage for illegal workers, a spatial model that calculates the apprehension probability as a function of the number of crossers, the number of border patrol agents, and the amount of surveillance technology on the border, a queueing model that determines the probability that an apprehended alien will be detained and removed as a function of the number of detention beds, and an equilibrium model for the illegal wage that balances the supply and demand for work and incorporates the impact of worksite enforcement. Our main result is that detention beds are the current system bottleneck (even after the large reduction in detention residence times recently achieved by expedited removal), and increases in border patrol staffing or surveillance technology would not provide any improvements without a large increase in detention capacity. Our model also predicts that surveillance technology is more cost effective than border patrol agents, which in turn are more cost effective than worksite inspectors, but these results are not robust due to the difficulty of predicting human behavior from existing data. Overall, the probability that a terrorist can successfully enter the United States is very high, and it would be extremely costly and difficult to significantly reduce it. We also investigate the alternative objective function of minimizing the flow of illegal aliens across the U.S.-Mexico border, and obtain qualitatively similar results.     

Just row.

To learn anything outside of our usual experience is to try on a new way of being. Doing something new--dealing with change--calls for a commitment to be where you are, to be present in the experiment, even while you are uncertain about the outcome. Being present and committed to the moment is as essential in management or self-management as it is in rowing a boat. How, for instance, can you tell the difference between intuition and fear? In the midst of a crisis, a change, a white water passage, a "learning opportunity," what if you get this gut feeling that something is wrong? If the feeling goes away when you drop into the present, into your body, and "just row," it's not an intuition, it's fear. The opportunity is to know the difference between opinion and intuition, between judgments and experience. Because judgments and opinions carry extraordinarily high price tags.     

Attracting qualified physicians to underserved areas. Part 2. Pay physicians more to practice in underserved areas.

With health networks searching for additional market share and with a projected 30.2 million to be enrolled in Medicaid HMOs by 2000, more health executives will be weighing various strategies of how to attract qualified physicians to practice in poor inner-city and rural areas. Most frequently cited as solutions are supplying more physicians, encouraging more medical school graduates to pursue primary care residencies, and modifying the number of international medical graduates entering U.S. residency programs. Part I of this article, which appeared in the November/December issue of The Physician Executive, reviewed the efficacy of these approaches. The second part explores a more pragmatic option: to simply improve the working conditions and pay substantially more to physicians who practice in "less desirable" locations. Although this idea is consistent with economic principles, drawbacks must be considered, such as: (1) the American taxpayers' reluctance to finance a more costly health care delivery system for the poor; (2) the inherent conceptual difficulties of a capitated Medicaid HMO serving as the linchpin for organizing, financing, and delivering care for the underserved; and, (3) many providers being expected to react in a fairly litigious manner to such an approach.     

Performance evaluations of physician executives. Interview by Barbara J. Linney.

Six senior physician executives were interviewed to see how they were doing or not doing performance reviews in their organizations. There seems to be a trend toward doing them, but it is in the beginning stages. Of the physician executives surveyed, the experience ranges from formal lengthy evaluations with rating scales to reviewing a short list of goals. Several are in the process of developing new systems or revising old ones. Probably the most useful part of a performance evaluation is the conversation between the physician executive and the person he or she reports to. If you can stop approaching performance evaluations as passing negative judgments on people, but as having a conversation to hear their concerns, learn what their goals are, and offer ways to help them achieve their potential, they can be useful, enjoyable experiences for both people.     

Acquiring companies in the U.S.A.

This article lists the five important characteristics for the ideal acquisition candidate for investment in the United States. A good and long-lasting relationship takes much thought, planning and patience and the authors set out practical guidelines for companies seeking to acquire U.S. companies.     

Sage advice. Experienced physician executives share the secrets of their success. Interview by David O. Weber

Seven successful physician executives, now retired from distinguished careers, look back over their experiences and offer advice for those who follow. Be a good doctor first, and never let business interests undermine the ethics of the health care profession. Prepare for management responsibilities with business training. Seek out mentors and develop a network of knowledgeable colleagues and advisors. Exert leadership rather than authority. Expect disappointments and arm yourself for them.     

Present at the creation. Interview by Wesley Curry.

This is the inaugural issue of Physician Executive under the auspices of the new American College of Physician Executives. In this and subsequent issues of the journal, we will feature an interview with a prominent figure in the health care delivery system. We begin with Robert A. Henry, MD, FACPE, President and CEO of SwedishAmerican Corporation, Rockford, III. A Distinguished Fellow of the American College of Physician Executives, Dr. Henry is a Past President of both the American College of Physician Executives and the American Academy of Medical Directors. He currently serves as Chairman of the Board of Directors of the Physician Executive Management Center. Dr. Henry entered medical management in the early days of the profession and is a long-time member of the Academy and College, becoming a member of the former in 1975. He became a member of the College in 1980 and a Fellow in 1981. He became a Distinguished Fellow of the College upon its creation on January 1 of this year. He has followed the growth of the Academy and of the medical management profession for several years and has been an active contributor to the success of both. He is uniquely qualified to discuss both the profession and the professional organization that serves it. The following is a report on a conversation that was conducted with Dr. Henry in early November 1988 while he was in Tampa for a meeting of the Board of Directors of the Physician Executive Management Center.     

Home ownership in the U.K. in the 1980s

1980 saw the highest mortgage rate ever, and yet the demand for owner-occupation and hence for mortgage finance continues. Although the costs of mortgage finance are considerable, particularly for people who have just bought their first homes, there are substantial benefits as well which are more than sufficient to compensate for the cost. This article looks at both the costs and the benefits of a mortgage and considers whether people's enthusiasm for buying their own homes with the help of a mortgage will continue in the changing circumstances of the 1980s.     

Crisis management. Putting out forest fires.

A crisis can hit any business. It can hurt cash flow, productivity, the public's faith, and the company's image. The adverse effects come in two major areas: public image and cash flow, both of which can be devastating. Lack of planning ensures maximum pain and the greatest chance of future collapse. A proactive stance can lessen the pain and give the best chance of recovery. Like a forest fire, a crisis can be sniffed early or it can destroy thousands of 'acres.' The best manager will have plans for crisis management and will be able to smell the smoke before the blaze consumes the forest.     

Venice Hospital decision vacated. Key Enterprises of Delaware, Inc. v. Venice Hospital

The United States Court of Appeals for the Eleventh Circuit recently ordered an en banc rehearing of its widely reported hospital downstream diversification antitrust case. The so-called Venice Hospital case had found antitrust liability in the operation of a durable medical equipment (DME) joint venture between a hospital and a DME vendor. The Eleventh Circuit, however, has vacated its prior decision and, pending its en banc opinion, reinstated the district court's decision that the defendants did not violate antitrust law.     

How U.S. and Japanese CEO's spend their time

Managing Directors (CEOs) in a number of large U.S. and Japanese corporations were asked to write a detailed diary of a typical working day, and they were asked what kind of information was useful for certain kinds of decisions. Some of the results of the survey are described in this article. It was found that the average age of the CEOs in the two countries was about the same—60 years old, but CEOs in the United States stayed longer in the position than Japanese CEOs because they were promoted at a younger age. CEOs in the United States worked a longer day than the Japanese. American chief executives spent about 3 hours longer in meetings than their Japanese counterparts. In Japanese corporations the information is distributed and the negotiating is done beforehand, so meetings tend to be shorter. In America contacts with businessmen outside the company were important sources of information, for strategic decisions in particular.     

Distribution and Expected Time of Residence for U.S. Households

For risk assessments, the average current residence time (time since moving into current residence) has often been used as a surrogate for the average total residence time (time between moving into and out of a residence). Since the distributions of the two quantities are not necessarily the same, neither are their averages. Housing surveys provide current residence time data; total residence times must, therefore, be inferred. By modeling the moving process, the total residence time distribution can be estimated from current residence time data. Using 1985 and 1987 U.S. housing survey data, distributions and averages for both current and total residence times were calculated for several housing categories. The average total residence time calculated for all U.S. households, 4.6 ( se = 0.6) years, is less than half the average current residence time, 10.6 ( se = 0.1) years.