Delayed creative destruction and the coexistence of technologies

Disruptive innovations often engage in a fierce battle with incumbent technologies for hegemony. Past studies on technological innovations are silent about factors that extend the duration of the ‘era of ferment’—that is, the period during which competing technologies fight for dominance. We argue that complexity of the underlying technology, ecological and institutional dynamics may permit coexistence of competing technology regimes. The paper illustrates such coexistence by discussing the persistence of disparate technologies in steel making and kidney disease treatment. We conclude that the process of ‘creative destruction’ can be delayed in certain settings.     

Get real: what will draw physicians to the Web?

What are physicians waiting for? What will it take to stimulate widespread adoption of Internet medical systems? How can health care leaders and physicians help the technology innovators and the executives of technology firms understand the components necessary to assure physician acceptance and utilization of new tools? (1) Don't underestimate the personal nature of a physician's practice. It really isn't a "business." (2) Most physicians are not Luddites; they are just extremely pragmatic and practical. (3) For the majority of physicians to adopt a new technology in their private office practice, it must address three major issues: money, hassle, and patient care. There are many obstacles to adopting the new technologies that are the result of physician training and expectations and the current models of payment and revenue generation. Some technological innovations are presented to physicians without sufficient respect for their knowledge of how medical practices really work. The benefits promised often don't match with the needs structure of the physicians. As a consequence, the cycle of diffusion of these new systems is extended and delayed.     

A Probabilistic Analysis of the Passive–Restraint Question

The benefits and costs of automobile safety policies are compared using a methodology which explicitly quantifies the uncertainties. The policies addressed include both voluntary and compulsory manual belt usage, nondetachable passive (automatic) seat belts, and air bags. Estimates of the effectiveness and usage rates of these alternatives were obtained in the form of subjective probability distributions from eight experts. Their opinions were combined using equal weighting. The direct economic costs of the technologies were also estimated probabilistically. The number of lives saved and the net benefits of the policies were calculated probabilistically for a range of values of lifesaving. Probabilistic computations and sensitivity analysis were performed by the Demos modelling system using Monte Carlo simulation. The results are highly uncertain and quite sensitive to the value of lifesaving. Nevertheless, they imply that repeal of the passive-restraint standard is defensible according to the net-benefit criterion only if a relatively low value is assigned to lifesaving. The degree of uncertainty emphasizes the potential value of demonstration programs to obtain better information.     

Stress management can lead to reduced malpractice.

The prevention of medical malpractice is not an easy task. There is no one factor that can be said to be the "cause" of malpractice claims. Many areas have been targeted for concern--interaction between an individual professional and the patient, interaction among members of the professional staff, use and outcome of the application of medical technology, management practices, occupational environment, level of education and training, and personal coping styles. Although the degree to which attention to stress management techniques can be expected to reduce malpractice claims is unclear, it seems certain that attempts to alleviate occupational stress would be productive.     

Nanotechnology risk perceptions and communication: emerging technologies, emerging challenges

Nanotechnology involves the fabrication, manipulation, and control of materials at the atomic level and may also bring novel uncertainties and risks. Potential parallels with other controversial technologies mean there is a need to develop a comprehensive understanding of processes of public perception of nanotechnology uncertainties, risks, and benefits, alongside related communication issues. Study of perceptions, at so early a stage in the development trajectory of a technology, is probably unique in the risk perception and communication field. As such it also brings new methodological and conceptual challenges. These include: dealing with the inherent diversity of the nanotechnology field itself; the unfamiliar and intangible nature of the concept, with few analogies to anchor mental models or risk perceptions; and the ethical and value questions underlying many nanotechnology debates. Utilizing the lens of social amplification of risk, and drawing upon the various contributions to this special issue of Risk Analysis on Nanotechnology Risk Perceptions and Communication, nanotechnology may at present be an attenuated hazard. The generic idea of "upstream public engagement" for emerging technologies such as nanotechnology is also discussed, alongside its importance for future work with emerging technologies in the risk communication field.     

Organ transplantation criteria represent insurer dilemma

In its simplest form, technology assessment, as used for coverage decision making, involves an analysis of published data regarding the safety and effectiveness of a technology, either on its own merits or in comparison with a competing technology. However, while the medical literature, and thus technology assessments, typically focus on a well-defined population, a positive coverage policy almost immediately creates pressure for broadening patient selection criteria. A variant on this phenomenon is the patient selection criteria for organ transplantation. These criteria are based not only on the scientific merits of the procedure but also on frequently ill-defined notions of the most appropriate allocation of a scarce resource, which in turn is determined by supply and demand at individual transplant centers. In these cases, the payer may defer to the patient selection criteria of the individual transplant center. However, the situation arises when a patient, rejected at one transplant center, "shops" and finds another center that has more favorable selection criteria. How, then, can the payer resolve these discrepancies and establish consistent policy guidelines? Should allocation of scarce donor organs be part of a technology assessment and coverage decision? The case of liver transplantation will be used here to illustrate the insurer's dilemma.     

Improving medical decision-making with a management science game theory approach to liver transplantation

Even though nowadays medicine is necessarily linked with technology, it is still a service involving human interaction, which frequently requires the help of management science tools. Indeed, a medical consultation can be an extremely complex example of human interaction. Management science, operations research and in particular game theory may play a key role in helping to improve the results of medical decision-making processes. Game theory is widely used in a large variety of decision-making studies, but there is little application to health care issues, namely the doctor-patient relationship. This paper uses game theory to model the liver transplantation consultation for patients suffering from Alcoholic Liver Disease. This disease is very delicate, and patients at its end-stages require special dedication where management science tools are of utmost importance. They may try to deceive doctors, which may lead to bad outcomes. The Nash equilibrium behaviors by doctor and patient are obtained. Results show some health policy and managerial implications on the decision-makers’ parameters and on the order of play so as to achieve, for instance, higher rates of patient’s cooperation.     

技术的演化与锁定

试用演化经济理论研究与市场用户具有动态回报递增和动态回报递减关系的两类技术的演化问题 .通过建立一个动态随机系统模型 ,论证了这类技术演化的长期均衡对应于某个函数的稳定不动点 ,提出了动态回报递增效应技术演化的多重均衡性和主导技术出现的可能性 ,分析了动态回报递减效应技术演化的不同特征 ,最后给出了一些政策含义     

The ultimate goal? It depends

The knowledge that cervical cancer should be a preventable disease has provided the impetus to improve the Pap smear. Now, for the first time in 50 years, two new computerized technologies are available--the AutoPap and Papnet systems--that could change the way they are interpreted. Of course, these new innovations come at a price, perhaps doubling or tripling the cost--by one estimate, the new technologies could add $1 billion per year. The health policy issue is whether these innovations address the limitations of cervical cancer screening programs in an efficient way. The analysis is entirely different when cast as an individual patient care issue. Here the patient and physician, who serves as her advocate, want to use the best screening method. The goal is not how to best allocate resources to improve the health of the overall population, but instead how to get the best care for the individual patient.     

The use of imperfect data in managed care organizations

Two critical milestones appear to be occurring in the development of medical groups moving to improve medical care effectiveness. These include the abilities to work with imperfect and unflattering data. There is a clear linkage between these two concepts, because forward clinical improvement or business planning is often delayed as individual physicians seek to await "perfect data" when confronted with unflattering information. In the form of "profiles" in particular, providers often react negatively, with complaints that the information is "imperfect" or that it fails to capture some nuance of their sicker or unique patient populations. The translation of imperfect information to effective clinical practice anyway remains a success fundamental to managing highly competitive medical groups and health plans. It is centrally dependent on the understanding, use, and application of "imperfect data".     

后发复杂产品系统制造企业的技术演化:一个探索性案例研究

本文采用探索性嵌入式单案例研究,以北车集团大连机车车辆有限公司八类复杂产品系统的技术发展历程为分析单元,研究发现:后发复杂产品系统制造企业的技术系统包括架构、元件和测试技术,测试技术是联接架构与元件技术的纽带;从技术获取到自主研发,三类技术分别经历了引进、消化吸收、系列化,引进、国产化与周边元件改进、核心元件研发与元件改进,以及匹配性测试、周边元件性能与匹配性测试、元件性能与匹配性测试三个发展阶段。最后通过与"简单"产品制造企业技术演化特征的比较,提出后发复杂产品系统制造企业的技术演化具有架构与元件技术并行消化吸收、测试技术促进架构与元件技术发展、核心元件技术研发模式多样的特征。     

Risk Perception and Social Acceptability of Technologies: The French Case

The authors present results of a February 1987 survey on judged frequency of mortality causes and risk perception of technologies in a representative sample of the French population. Although the French context is very different, and the impact of public controversies have been very limited on technological choices such as the nuclear energy program, strong similarities in risk perception of technologies are observed with results from U.S. surveys. Results, which could be worthwhile for other countries, suggest that risk perception is influenced by two different types of components. The first influence is the global feeling of "security" that society procures to its members. Such feeling depends on the individual's socioeconomic status, subjective state of health, and personal discomfort in daily life, and explains individual aversion to risk independently of the mortality causes or technologies involved. The second influence is the degree of perceived social legitimization of the activities involving risks. Risks of medical and transportation activities are strongly opposed to illegitimate risky behaviors (smoking, drugs, alcohol); technologies which have been an object of public debate (nuclear plants, the chemical industry, lead in gasoline) have an intermediate position reflecting the remaining uncertainties of public opinion about their risk–benefit balancing. Tentative conclusions for risk communication are proposed.     

技术驱动的管理科学与工程研究

科技创新引领技术变革，加速变革的科技正在重塑世界政治、经济和社会发展的新格局、新形势。一系列新场景、新环境下的管理决策问题，如新一代移动通讯、人工智能、物联网、轨道交通与建筑工程、医疗工程、能源环境工程等，开启了管理科学与工程学科研究的新局面，并提出了全新的要求和挑战。本文通过系统梳理和总结相关文献和课题项目，阐述管理科学与工程领域的关键技术发展态势，并结合领域权威专家的问卷和访谈结果，立足新技术融合和新产业应用两个方面概括了技术驱动下管理科学与工程的主要研究方向。     

EXPLORING THE LIMITS OF THE TECHNOLOGY S-CURVE. PART I: COMPONENT TECHNOLOGIES

The technology S-curve is a useful framework describing the substitution of new for old technologies at the industry level. In this paper I use information from the technological history of the disk drive industry to examine the usefulness of the S-curve framework for managers at the firm level in planning for new technology development. Because improvements in over-all disk drive product performance result from the interaction of improved component technologies and new architectural technologies, each of these must be monitored and managed. This paper focuses on component technology S-curves, and a subsequent paper, also published in this issue of the journal, examines architectural technology Scurves. Improvement in individual components followed S-curve patterns, but I show that the flattening of S-curves is a firm-specific, rather than uniform industry phenomenon. Lack of progress in conventional technologies may be the result, rather than the stimulus, of a forecast that the conventional technology is maturing, and some firms demonstrated the ability to wring far greater levels of performance from existing component technologies than other firms. Attacking entrant firms evidenced a distinct disadvantage versus incumbent firms in developing and using new component technologies. Firms pursuing aggressive Scurve switching strategies in component technology development gained no strategic advantage over firms whose strategies focused on extending the life of established component technologies.     

How to shape positive relationships in medical practices and hospitals

Managing workplace conflict is one of the most important, stressful, and time-consuming tasks faced by today's medical leaders. Poorly managed workplace conflict can alienate patients, demoralize staff, increase turnover, damage relationships with valued referral sources and third party carriers concerned about patient satisfaction, and lead medical practices to costly "corporate divorces." Physician executives cannot solve the problems caused by disruptive doctors simply by bolstering their own conflict management skills or by policing offenders. The larger contexts within which inappropriate workplace behavior occurs must also be assessed and addressed. The true leadership challenge is to intervene in ways that help to foster a "culture" of appropriate interpersonal dynamics throughout your organization. This requires learning to think and to intervene systematically.     

Improving "medical necessity" acceptance by health care providers and consumers

A major problem for patients and providers has existed since establishment of peer review and authorization agency medical necessity guide lines, because physicians and patients who receive denial of proposed procedures and tests on the basis of so called "medical necessity" presume that the authorization agency considers the proposed procedure or test to be medically unnecessary, meaning of no health value to the patient. This may well not be the case. Both providers and consumers can be expected to be more accepting of negative authorization decisions if the principles of continuous quality improvement are brought to bear on the authorization process.     

A new industrial order for physicians: a talk with Jeff C. Goldsmith, PhD. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed Jeff C. Goldsmith, PhD, President of Health Futures, Inc. on October 12, 1999 to discuss how the Internet will affect health care delivery in the millennium. One of the most profound changes that he sees is how the relationship between physicians and patients will be altered. Empowered consumers are where the real revolution is happening--a trend sometimes overlooked by physicians. Goldsmith says, "The key thing physicians have missed is that the patient is in charge of the process.... The Internet has enabled patients to aggregate their collective experience across disease entities." But there is too much information. "It is almost universally acknowledged by patients and physicians that there is a terrible quality problem. Getting from information to knowledge is a huge commercial opportunity for somebody." He doesn't think that people have put enough emphasis on the collective learning part of this new technology.     

Perspectives on Incorporating Human Neurobehavioral End Points in Risk Assessments

Three topics are addressed: (1) measurement issues (e.g., the reliability and validity of neurobehavioral test scores), (2) general principles of assessment, including test selection, and (3) interpretation of scores. Psychological tests generally perform as well as medical tests in terms of reliability and validity. Test manuals, assessment textbooks, and psychologists are useful resources to the risk assessor. The variety of different tests employed in neurobehavioral studies complicates interstudy comparisons. In addition, tests that ostensibly assess the same general domain of function might assess somewhat different abilities within that domain. Although a uniform battery for use in all studies seems desirable, the battery appropriate for a specific study depends on study goals, knowledge about the mechanism(s) of neurotoxicity, nature of the study population, and pattern of exposure. Exposure-related neurobehavioral deficits are generally indicators of "altered function" rather than of "clinical disease." Limiting concern to end points corresponding to clinical disease might not be appropriate. Many neurobehavioral diagnoses are phenomenological and a neurotoxicant might cause a unique pattern of deficits for which no label has been created. The concern that a small shift in the central tendency of a distribution of test scores has no significance for the individual should be reexamined in light of the prevention paradox, formulated on the basis of epidemiologic studies of chronic disease. Poor performance on a neurobehavioral test does not necessarily map clearly onto underlying behavioral or neural substrate. The absence of such linkages, given current knowledge about brain-behavior relationships, should not reduce confidence in neurobehavioral end points. Use of neurobehavioral test scores involves considerations that differ little from those that the risk assessor routinely addresses in using end points commonly used in research on other topics in environmental epidemiology.     

Perspectives on Incorporating Human Neurobehavioral End Points in Risk Assessments

Three topics are addressed: (1) measurement issues (e.g., the reliability and validity of neurobehavioral test scores), (2) general principles of assessment, including test selection, and (3) interpretation of scores. Psychological tests generally perform as well as medical tests in terms of reliability and validity. Test manuals, assessment textbooks, and psychologists are useful resources to the risk assessor. The variety of different tests employed in neurobehavioral studies complicates interstudy comparisons. In addition, tests that ostensibly assess the same general domain of function might assess somewhat different abilities within that domain. Although a uniform battery for use in all studies seems desirable, the battery appropriate for a specific study depends on study goals, knowledge about the mechanism(s) of neurotoxicity, nature of the study population, and pattern of exposure. Exposure-related neurobehavioral deficits are generally indicators of "altered function" rather than of "clinical disease." Limiting concern to end points corresponding to clinical disease might not be appropriate. Many neurobehavioral diagnoses are phenomenological and a neurotoxicant might cause a unique pattern of deficits for which no label has been created. The concern that a small shift in the central tendency of a distribution of test scores has no significance for the individual should be reexamined in light of the prevention paradox, formulated on the basis of epidemiologic studies of chronic disease. Poor performance on a neurobehavioral test does not necessarily map clearly onto underlying behavioral or neural substrate. The absence of such linkages, given current knowledge about brain-behavior relationships, should not reduce confidence in neurobehavioral end points. Use of neurobehavioral test scores involves considerations that differ little from those that the risk assessor routinely addresses in using end points commonly used in research on other topics in environmental epidemiology.     

Housestaff coverage in a nonteaching community hospital

In August 1992, a project team of senior medical and administrative personnel was formed (Housestaff Coverage Project Team) at the Park Ridge Health System, Rochester, N.Y.. The team was given a mandate to address housestaff coverage, primarily from an economic standpoint. Through total quality management (TQM), the project team sought to develop a house coverage plan that was sustainable, efficient, and effective. A plan was developed that includes three layers of service. A minimum "standard hospital coverage" would be available to all physicians and their patients and cover the basic needs of admission, crisis intervention, and issues of length of stay. A complete level of service would be available under the title of "case management" and would consist of total patient management, under the direction of the attending physician, from admission through discharge. The third level of service available to both "standard" and "case managed" patients would be a "consultative service." The latter would function as a traditional in-house medical service and would bill for its services. Park Ridge Hospital believes it has developed a system of housestaff coverage that is sustainable, efficient, and effective. An evaluation mechanism, primarily addressed at length of stay, will tell if we are correct in this assumption.