Medicine, management, and me.

What is medical management? How do you learn about it? How do you get into it? Is there a future in it? Is medical management for you? Can you do it? What will it mean to your original plans for your life in medicine? Is it worth the sacrifice? Get comfortable. I have a story to tell you. It may help if you hear about medical management from a medical director who has preceded you. I doubt I can answer all your questions. I can, however, tell you about one physician's visions, expectations, decisions, experiences, and rewards from what can be loosely called "medical management." If you find something of help in your decision making in this account, my telling it is worthwhile.     

E.D. Smith and Sons,Ltd.

Lew Smith, the chairman of a privately owned Canadian processor, must decide whether his company will build a plant in the United States. He has been asked to do so by one of his major customers, Loblaw. The company has been making many improvements to its operations but it’s performance has been hurt by the Free Trade Agreement between Canada and the United States. The company has been doing very well, however, as it shifts its focus from making private label to controlled label. Is now the right time to expand the business into a foreign market?     

Scenarios, past, present and future.

A key point in considering strategic planning is that it is not forecasting. The future is unpredictable and is not a product of the past. This low opinion of forecasting has gained in influence recently. But such an approach creates a dilemma for the strategic planner. He needs to take into account potential future forces--but he can only do this with inadequate means. Forecasting methods, however, can suggest trends and it is possible to reduce the number of possible futures to a manageable number. This is, in effect, creating scenarios. The concept of using alternative scenarios in planning was popularized some 20 years back. The proviso was made that they should not be interpreted as forecasts. The methods have proved highly flexible and include the consensus technique, the iteration-through-synopsis technique, and the cross-impact method. Various studies using one or more of these have been implemented, perhaps the best known being by Meadows and by Mesarovic. These have been based on the so-called 'hard' method, using computers. 'Soft' methods are based more on the mind and use psychology and sociology, the most familiar being the Delphi method. A somewhat more sophisticated version is Cross-Impact Analysis.     

Risk, Trust, and Safety Culture in U.K. Train Operating Companies

Organizational safety culture reflects the attitudes and behaviors that individuals share in considering and reacting to hazards and risks. We first argue that trust is an underdeveloped and important concept in relation to theories of safety culture and high-reliability organizations. The article then reports findings from a two-year qualitative study of train operating companies (TOCs) in the United Kingdom, which sought to explore in detail the linkages between safety culture and the postprivatized railway industry. In-depth interviews and focus groups were carried out with a sample of over 500 employees, from four organizations, and representing all key functional levels. Our analysis suggests that the 1993 privatization, and subsequent organizational restructuring of the U.K. railway industry, has had important repercussions for both safety culture and trust relationships. We explore our findings in relation to three key constructs within "safe organizations" theories (namely, flexibility, commitment, and learning), and discuss how the safe organization model might be usefully supplemented by a consideration of trust issues.