Physician support groups in a multispecialty group practice setting

With a moderate expenditure of time and energy on the part of a physician executive, the group support concept can be used in any organization to help physicians overcome social obstacles and learn to cope with the disturbing changes that are occurring in medicine. By selecting the most suitable candidates, anticipating obstacles, and simply beginning an effort, one can bring about optimal change for physician members of an organization despite their apparent reluctance. The optimal time for suggesting help in this group support manner is when the problem is acute and significant, i.e., "a crisis."     

Futures research: Is it used?

Every organization, whether it be in the profit or non-profit sector, functions in an environment from which the necessary resources (i.e. workers, machines, money etc.) are bought and to which the finished products (goods and services) are sold. For its survival it is imperative that a company or organization should be in a well-balanced relationship with its environment. Hence strategic planning deals with the adjustment problems between the organization and its environment.Over the past few decades the view of what strategy is or ought to be has undergone considerable changes. For a deeper insight into these changes this paper discusses and analyses this development briefly. The relationship between strategic management and futures research are then dealt with, and the extent to which futures research plays a part in developing a strategy. The results of practical research evidence in Holland and in other countries is discussed and the problem of the credibility of the results of futures research analysed.     

从不确定性看管理研究逻辑及和谐管理理论的启示

在复杂多变的环境下,组织管理面临着因果链无法追踪、整体性割裂和快速应变三大挑战。从组织管理应对不确定性的视角出发,结合对组织管理应对挑战的传统方法的解读,提出和谐管理应对不确定性的思路：以愿景和使命来应对组织目标的不确定性,同时降低因果链无法追踪的影响;以“和则”和“谐则”作为应对不确定性的2种互动机理,在保证效率的同时提高应变能力;以和谐主题和和谐耦合机制来应对组织运行中的不确定性并提升整体性。最后,基于这一思想,提出未来的管理研究应注重愿景和使命的导引作用,和谐主题的合目的性整合作用,以及理性设计的有效实施与诱导演化主动应对互动耦合的支撑作用,特别是日益复杂多变环境下的组织领导人及其团队的作用。     

A framework of managerial promotion in a lifetime employment organization: The D bank

From existing formal personnel policies in a Korean bank, a set of internally consistent career system properties are logically inferred for an organization with the strategic human resource objective of lifetime employment. It is argued that the policy emphasis accorded particular functional personnel activities is inherent in the choice of human resource utilization strategy. It is recognized, however, that certain contextual features (e.g., the legal environment, cultural norms) may either constrain or facilitate the choice.     

Political behavior in organizations—A cross-cultural comparison

The purpose of this study is to explore the differences in the meaning attached to organizational politics (OP) across cultures. A critical incidents scale was distributed to two samples of university faculty, one in Canada and one in Israel. Three aspects relevant to the perception of OP were investigated : (1) the role that elements previously identified in the literature play in the actual perception of OP by employees; (2) the extent to which OP is perceived as moral; and (3) the degree to which OP is perceived to be prevalent or likely to occur in the subjects’ organization. The results showed that the Canadian sample perceived the various elements in the scale as generally more political, less moral, and less prevalent in their organization than the Israeli sample. Both samples considered informal influence attempts as more political than formal or illegal ones. The two samples also considered illegal influence attempts as less moral than formal or informal ones. Elements defined in our study as circumstantial, i.e, “conflict,” “power attainment,” “concealment of motive,” and “acting against the organization,” were found to make a smaller contribution to the perception of situations as political than elements defined as behavioral, i.e., “formal,” “informal,” and “illegal,” influence attempts.     

Marginal Trust in Risk Managers: Building and Losing Trust Following Decisions Under Uncertainty

Although a considerable amount of research has examined correlates of baseline public trust in risk managers, much less research has looked at marginal changes in public trust following specific events. Such research is important for identifying what kinds of events will lead to increases and decreases in public trust and thus for understanding how trust is built and lost. Using a taxonomy based upon signal detection theory (SDT), the current article presents two experimental studies examining marginal trust change following eight different types of events. Supporting predictions, cautious decisionmakers who accepted signs of danger (Hits and False Alarms) were more likely to be trusted than those who rejected them (All Clears and Misses). Moreover, transparency about an event was associated with higher levels of marginal trust than a lack of transparency in line with earlier findings. Contrary to predictions, however, trust was less affected by whether the decisions were correct (i.e., Hits and All Clears) or incorrect (i.e., False Alarms and Misses). This finding was primarily due to a "False Alarm Effect" whereby Open False Alarms led to positive increases in trust despite being incorrect assessments of risk. Results are explained in terms of a cue diagnosticity account of impression formation and suggest that a taxonomy of event types based on SDT may be useful in furthering our understanding of how public trust in risk managers is gained and lost.     

Is it change? Or is it noise?

How can you tell the difference between mere noise, and a profound change headed your way? Your gut instincts may not always be a reliable gauge. It takes a long time for most people to become an executive leader. If you are typical, you were raised and trained in a different era, with different expectations. You see things with different lenses. So what can you trust? You can trust first principles. Ask yourself what you know about the reasons that changes are happening in this environment. Then ask yourself about what is being proposed--how does it fit with the roots of the changes in health care and your organization? The three change filters presented here can help you to figure out if it's change or just noise. Ask yourself: (1) what are the changes occurring in the health care industry; (2) is your organization ready for change; and (3) how likely is it that your organization will easily adopt this particular change? These three filters together will help you decide what is a truly important change, how ready your organization is for change, and whether it will adapt to this change with ease or difficulty.     

Physician anger, Part 2. More on the dance of anger.

This article is a follow-up to an interview with Charles Dwyer, PhD, which appeared in the 1999 March/April issue of The Physician Executive. He described how physician executives can change the perceptions of today's beleaguered physicians and help them cope with change. We then asked him for some hands-on strategies to deal with physician anger, fear, and resentment. After much contemplation on providing a list of "fixes" that will restore each of us to a state of greater satisfaction, Dr. Dwyer concludes that there are no generalizable solutions because there are too many variables that come into play in each organization, individual, or group. Attending to the self can provide both individual rescue from these turbulent times and the best hope for changes in the system from which patients and health care providers can benefit. If physicians are to regain their power and maintain, or even improve, their quality of life, clearly changes are called for. And these are changes that require persistent effort and uncomfortable adjustments.     

Leadership for organizational adaptability: A theoretical synthesis and integrative framework

One of the biggest challenges facing leaders today is the need to position and enable organizations and people for adaptability in the face of increasingly dynamic and demanding environments. Despite this we know surprisingly little about this topic. In this paper we provide a theoretical synthesis and integrative review of research from strategy, organization theory, innovation, networks, and complexity to provide a framework of leadership for organizational adaptability. Our review shows that leadership for organizational adaptability is different from traditional leadership or leading change. It involves enabling the adaptive process by creating space for ideas advanced by entrepreneurial leaders to engage in tension with the operational system and generate innovations that scale into the system to meet the adaptive needs of the organization and its environment. Leadership for organizational adaptability calls for scholars and practitioners to recognize organizational adaptability as an important organizational outcome, and enabling leadership (i.e., enabling the adaptive process through adaptive space) as a critical form of leadership for adaptive organizations.     

Supply Chain Design and Carbon Penalty: Monopoly vs. Monopolistic Competition

This paper studies whether imposing carbon costs changes the supply chain structure and social welfare. We explore the problem from a central policymaker's perspective who wants to maximize social welfare. We consider two stakeholders, retailers, and consumers, who optimize their own objectives (i.e., profits and net utility) and three competitive settings (i.e., monopoly, monopolistic competition with symmetric market share, and monopolistic competition with asymmetric market share). For the monopoly case, we find that when the retailer's profit is high, imposing some carbon emission charges on the retailer and the consumers does not substantially change the supply chain structure or the social welfare. However, when the retailer's profit is low, imposing carbon costs optimally can lead to a significant increase in social welfare. Moreover, the impact of imposing carbon emission charges becomes more significant when the degree of competition increases. Additionally, the quantum of benefit may depend only on factors common across industries, such as fuel and carbon costs.     

Ex Ante and Ex Post Values for Changes in Risks

In this paper, I take risk to mean a composite of the probability of an adverse event and the severity of the consequences of the event. I explore two issues in the economic valuation of changes in individual risks brought about by public policies. These are: (1) the relationship between the values of risk prevention (i.e., the lowering of the probabilities of adverse events) and risk reduction (i.e., the reduction of the severity of the consequences of adverse events); and (2) the relationship between ex ante and ex post measures of the value of changes in risk.     

Unitary, Divisional, And Matrix Forms As Political Governance Systems

In this study I reassess a set of fundamental organization forms (unitary, divisional, and matrix) as agenda-setting and political governance systems. My method of analysis is based on how political scientists study agendas in committees. Specifically, I first recount that moving from a functional (unitary) to a product-line (divisional) structure increases the types of conflict referred from lower to higher levels of the hierarchy, but does not increase the amount of conflict referred. I then show that moving from a product-line to a matrix structure increases the amount and the types of conflict referred to higher levels of the hierarchy; that it is possible in matrix forms that no conflict is resolved at the lowest levels of the hierarchy; and, that accountability is reduced for those who are able to refer conflict. The study reveals implications for matrix forms that derive from this view of organizations as agenda-setting and political governance systems. This analysis fits with the recent history of matrix forms in a variety of organizations.     

5 Public Administration and Organization Studies

Abstract

The study of public organizations has withered over time in mainstream organization studies research, as scholars in the field have migrated to business schools. This is so even though government organizations are an important part of the universe of organizations—the largest organizations in the world are agencies of the U.S. government. At the same time, the study of public administration, once in the mainstream of organization studies, has moved into a ghetto, separate and unequal. Centered in business schools, mainstream organization research became isomorphic to its environment—coming to focus on performance issues, which are what firms care about. Since separation, the dominant current in public administration has become isomorphic with its environment. In this case, however, this meant the field moved backward from the central reformist concern of its founders with improving government performance, and developed instead a focus on managing constraints (i.e., avoiding bad things, such as corruption or misuse of power, from occurring) in a public organization environment. Insufficient concern about performance among public administration scholars is particularly unfortunate because over the past 15 years, there has occurred a significant growth of interest among practitioners in improving government performance. The origins and consequences of these developments are discussed, and a research agenda for organization studies research that takes the public sector seriously is proposed.     

A construal level analysis of organizational change processes

To effectively manage planned change and understand differences in leaders’ and recipients’ responses to it, it is essential to understand how change is cognitively represented by organization members. In this theory-development article, we draw upon construal-level theory (CLT) and conceptually explore the role of change construal level in explaining responses to organizational change. We discuss differences between change leaders’ and recipients’ change construals, and differences in the relationships between change construal level and the response to change as a function of the change activities taking place. Specifically, we argue that high-level (i.e., abstract) construals of change will facilitate the effective initiation of change when the focus is on equilibrium-breaking activities, and that low-level (i.e., concrete) construals will facilitate the effective implementation of change when the focus is on institutionalization of the change. We further propose that leaders’ engagement in visionary leadership increases the likelihood that their generally higher level construal of change will be integrated into recipients’ change construals, elaborating and elevating them, and that recipients’ engagement in upward prohibitive voice behaviors will increase the likelihood that their generally lower construal of change will be integrated into leaders’ change construals, elaborating and concretizing them. We discuss theoretical and practical implications of our framework.     

Is the German system of corporate governance converging towards the Anglo-American model?

This paper analyses whether the German corporate governance is converging towards Anglo-American practices. We summarise the extant empirical evidence on the various governance mechanisms that economic theory suggests ensure efficiency and describe recent legal developments. We find no clear signs of convergence in form, i.e. the main distinctive features of the German system have remained largely unaltered. However, changes occurred over the last decade (specially in the legal framework) suggest a certain convergence in function, i.e. some governance mechanisms have effectively incorporated aims and/or goals generally associated with the Anglo-American model.

基于免疫的组织健康捍卫机制建构:一个案例

本文借鉴医学免疫和健康的新视角,试图建构基于组织免疫行为的组织健康捍卫机制分析框架,探讨组织健康状态的理论维度和组织免疫行为如何捍卫组织健康状态并发挥作用的机制,同时,选取广东粤电集团沙角C电厂进行了案例研究。本文的研究揭示出,组织监视、组织防御和组织记忆是组织免疫过程的主要行为维度,而组织健康的理论维度,包括组织结构均衡性、功能活跃性、社会和谐性和环境适应性,组织免疫行为对组织健康有捍卫作用,任何一个要素和环节的缺失或失灵都会破坏组织健康状态,组织免疫系统的建立对于避免复杂系统的运行失败是非常关键的。     

The Effects of Knowledge Management on Team Members' Ratings of Project Success and Impact*

Many organizations are trying to improve the generation and utilization of knowledge. The activities associated with these efforts are identified as organizational knowledge management (KM). While much has been written about knowledge management from the organizational level, the success of such efforts over the long run will depend upon on how KM activities impact important outcomes as perceived by those at the employee level who actually implement the activities. This study used the input‐process‐output framework of team effectiveness to investigate the relationship between selected KM‐related activities on integrated product and process development team members' satisfaction with their project's success and the impact they expected it to have on the organization. The results indicate that team‐level leadership and support (i.e., inputs), along with knowledge generation and dissemination (i.e., processes), are key drivers of member performance‐related ratings (i.e., outputs). Finally, and possibly most importantly, a number of interactions were evident suggesting that the KM processes moderate the effects of the KM inputs. These findings and their implications are discussed.     

Instilling a mediation-based conflict resolution culture

Conflict thrives and grows in the increasingly competitive and uncertain health care environment. Conflict impacts health care organizations' performance in several areas: (1) patient grievances and health plan member disputes; (2) internal employee and management disputes; and (3) payer, provider, and vendor disputes. "Grief Budgets," the hard costs and soft costs due to disputes that are poorly handled and conflicts that are ignored, detract from an organizations health mission and erode its bottom line. This article offers a strategy to solve conflict at an early stage in all three areas, with measurable results that strengthen profits and improve customer service by instilling a mediation-based conflict resolution culture throughout the organization. Mediation is non-adversarial, neutral, proactive, and collaborative. It is also confidential and always protects the future relationship between the parties. The challenge, therefore, is to strategically implant mediation into the health care organization's structure, to intercept and solve conflict early on. The article provides an overview of the steps needed to install a dispute resolution program.     

Renegotiating health care. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed Leonard Marcus, PhD, on May 21, 1999, to talk about his book, Renegotiating Healthcare, Resolving Conflict to Build Collaboration, and the Program for Healthcare Negotiation and Conflict Resolution he directs at the Harvard School of Public Health. Dr. Marcus discusses conflict management and negotiation in an industry besieged by change . He says, "we are, in effect, renegotiating the very assumptions and premises that have guided the health care system over the last few decades." In such a turbulent environment, it is crucial that all stakeholders can move to higher ground and resolve their differences instead of escalating the war. The key, Marcus says, is providing options through interest-based negotiation and mediation, so that the parties can look at the bigger picture and reconnect with what they are all committed to accomplishing in health care. While conflict can be destructive, it also can provide opportunities for people to look at where there are problems, to identify and correct those problems, and achieve something even better than what they began with through the process.