Breaking the glass ceiling

The glass ceiling is a form of organizational bias and discrimination that prevents qualified professionals from achieving positions of top governance and leadership. This article examines glass ceiling barriers that keep physicians from the upper reaches of management. While these factors apply mainly to women and minority physicians in academia, and are attributable to sexual harassment and discrimination, physicians as a class are frequently denied executive management positions. Such denial results from inadequate preparation for a career in health care administration. Important issues in the professional development of physician executives include mentoring, training and education, administrative experience, and cultural and personality factors. All of those must be considered when making the transition from medicine to management.     

The old ways of doing medical business are passing

Doctors must realize that the ?us and them? labels have to be discarded. No longer do physicians wield the ultimate power. We've lost our patients to insurance companies and part of our medical knowledge rests with nonphysicians. Likewise, physicians must accept the reality that all doctors aren't going to be in the same practice setting: some will work for hospitals, some for insurance companies, some for HMOs, some for themselves. But we're all members of a great profession that has proven its ability to give high-quality care to our patients, and now more than ever with more attention paid to costs.     

Embracing risk as a core competence: The case of CEMEX

In this paper we argue that risk management can be an important source of competitive advantage for firms. For this to happen, managers must overcome four deep-seated notions about the management of risk: the myopic conception that risk is a collection of unconnected threats to the survival of a firm, the belief that risk management is largely a financial activity, the idea that risk management is solely a top management team task, and a blind faith that CEOs can continuously anticipate the risks that firms must address on an ongoing basis. Challenging these four misconceptions reveals that risk management can be an activity that is value creating, not just value preserving. Indeed, rather than indiscriminately shedding all types of risks, companies can develop new sources of competitive advantage by embracing those risks that they are relatively better at managing than their rivals. We illustrate our arguments by analyzing the risk management practices at CEMEX, the Mexican cement manufacturer.     

Medical staff handling of concerns with physicians' performance

Medical staff organizations and their leaders are frequently confronted with concerns about physician knowledge, performance, or behavior. Dealing with these concerns is a serious and time-consuming task. Poorly handled issues may result in serious legal consequences. In highly structured organizations, authority for responsibilities, income, and employment rests with individuals who must manage these problems, but medical staff structures do not always lend themselves to dealing with these issues. Introduction of quality improvement processes into medicine has been received as a panacea for physician problems. Certainly the majority of physicians understand quality improvement and work toward common goals to improve patient care. Unfortunately, a small minority remain problem physicians. Steps that can be taken to deal with problem physicians, particularly for issues of quality management, are described in this article.     

New contracts: The key to change

Successfully managing change in an organization is very difficult. Paul Strebel sets out a new way of doing this, based on contract theory which states that stakeholders have both an explicit and implicit individual contract with their companies. These contracts must be modified if corporate change is to proceed.The author develops five propositions about the role of contracts in change management. Change can only succeed if these five propositions are satisfied and the operational implications fully understood and implemented.     

Twenty steps to survive managed care.

The health care industry is in the midst of discounted, price-driven, managed care. Many older physicians, not wanting to practice in this environment, are opting for early retirement. Others sell their clinical practices to management companies or hospitals to avoid the economic reality of day-to-day financial management. Most of these private practices are losing money every year. However, there still are a large number of physicians who have not sold their practice. As capitation continues to grow, these physicians will experience severe cash flow problems unless their financial plight is addressed rapidly. If it is not, the resultant cash flow problems will cause accounts payable to grow. Twenty steps are outlined that a physician or group should take right away to maintain a healthy cash flow. These include: Instituting a nurse triage system, setting up an after-hours clinic, getting the co-pay at the time of service, implementing a patient satisfaction questionnaire, monitoring the capitation reports, and checking capitation lists.     

Steps Towards Sustainable Development at Brødrene Hartmann A/S

In recent years a number of new demands on and expectations from companies have been put forward. These requirements involve the concept of sustainable development, which has emerged as a leading principle of the future. The principle requires companies like Brødrene Hartmann A/S to implement sustainable development throughout the entire organisation. This means that the environmental, economic and social aspects of sustainability must be part of the overall mission and business policies of the organisation. In order to meet these new expectations Hartmann has developed global lifecycle based management models called the STEP-models. STEP stands for Sustainability Tools for the Entire Product chain. The STEP-model was formed with the objective of making holistic environmental and social work concrete, systematic and operational. Today it constitutes a joint management concept for Hartmann, and this concept is the Group's idea of how sustainable development can be implemented.     

过程系统管理与技术的综合集成

在激烈的市场竞争中,过程企业不仅要重视技术、更要加强管理,实现全局优化运行。提高过程企业的市场竞争能力必须全面综合集成人、组织、战略管理、经营管理、过程管理及信息自动化技术等因素。本文以石化企业为背景,对过程企业面临的问题及发展趋势进行了分析,并且对过程企业管理模式、过程企业的体系结构以及过程集成与优化技术进行了探讨。     

Physician-centered management guidelines.

The "Fortune 500 Most Admired" companies fully understand the irreverent premise "the customer comes second" and that there is a direct correlation between a satisfied work force and productivity, service quality, and, ultimately, organizational success. If health care organizations hope to recruit and retain the quality workforce upon which their core competency depends, they must develop a vision strategic plan, organizational structure, and managerial style that acknowledges the vital and central role of physicians in the delivery of care. This article outlines a conceptual framework for effective physician management, a "critical pathway," that will enable health care organizations to add their name to the list of "most admired." The nine principles described in this article are based on a more respectful and solicitous treatment of physicians and their more central directing role in organizational change. They would permit the transformation of health care into a system that both preserves the virtues of the physician-patient relationship and meets the demand for quality and cost-effectiveness.     

Constitutional rights versus malpractice insurance settlements

The increasing costs and complexity of malpractice litigation have created an statutory right that allows malpractice insurance companies to settle malpractice claims regardless of the desires of the defendant physician. In the past, the consequences of settling a malpractice claim out of court were not as important as they are today. The Health Care Quality Improvement Act of 1986 mandates that any settlement in behalf of a physician be documented in the National Practitioner Data Bank (NPDB), which must be consulted every time the physician is credentialed. This NPDB requirement denies due process to health care providers and thus becomes a violation of the federal and many state constitutions. Physician executives and medical leaders must bring these issues to the table and negotiate solutions before damage to practicing physicians and the U.S. health care delivery system caused by this legal paradox become too severe.     

The new health care civilization: integration of physician land and manageria

Changes occurring in health care demand that physicians expand their professional knowledge and skills beyond the medical and behavioral sciences. Subjects absent from traditional medical education curricula, such as the economics and politics of health care, practice management, and leadership of professional organizations, will become important competencies, particularly for physicians who serve in management roles. Because physicians occupy a central role in planning and allocating medical care services and other health care resources, they must be better prepared to work with other health care professionals to create a new civilization, even if this means leaving the cloistered domain of "physician land" to serve as interface professionals between the delivery of medical services and the management of health care. Our research findings and conclusions strongly suggest that economic, management, and leadership competencies need to be incorporated into the professional development of physicians, especially in postgraduate and continuing education curricula.     

How practicing physicians are adjusting to managed care

Managed care is here to stay. In fact, for the foreseeable future, health care will become increasingly more managed each year. The purpose of this article is to help physician leaders and executives understand how clinicians are reacting and adjusting to managed care. Those of us who are doing primarily management activities have our own set of problems and adjustments. Sometimes we can be insensitive to the problems that physicians who are primarily treating patients can have as a result of managed care. Health care executives who are managing physicians or attempting to influence their behavior must attempt to understand clinicians' feelings, reactions, and coping mechanisms.     

Developing a company's strategic management capability

Companies vary widely in their strategic management capabilities. Some still rely almost entirely on ‘fire-fighting’. Many others are slowly developing their capabilities but there are only a few which do give due attention to strategic issues and implement their decisions effectively. To be effective a corporate planner must assist this process of development of strategic ability and must adapt his role as the company's capability changes. In the most successful corporate planning units it is clear that this change in role is occuring, but is there not also a largely untapped market for consultants to assist companies in developing these capabilities?     

Environmental Performance as a Basis for Competitive Strategy: Opportunities and Threats

Increasingly, companies are considering environmental differentiation as a basis for their competitive strategy. As they formulate and implement their strategy, these companies must decide upon an appropriate device to signal a superior environmental performance to consumers and other stakeholders. This article examines three of these devices: Corporate environmental reports (CER), eco-labeling programs, and the ISO 14001 environmental management systems (EMS) standard. Specific challenges and limits associated with their use are discussed and insight into ways to overcome potential barriers are offered. One of these challenges relates to skepticisms, whereas another resides with the risk of imitation from competitors. Hence, companies must both build trusting relationships, and continuously maintain and develop resources and competencies that will enable them to sustain their competitive advantage over competitors.     

Physician managers can play key financial management role

Societal and technological changes experienced in the past few years have been instrumental in the creation of a new medical specialty--medical management. In this age of scarce resources for health care, physicians must be involved in management and leadership roles in the financial, managerial, and strategic planning aspects of their institutions.     

Environmental proactivity and business performance: an empirical analysis

This paper analyses the relationship between environmental proactivity and business performance on a sample of 186 industrial companies. This relationship is approached by studying a bundle of relationships between different dimensions or manifestations of environmental proactivity and different measures of business performance. The analysis in part supports the idea that environmental management can bring about competitive opportunities for companies, although it also reveals that some environmental practices produce negative effects. It is thus concluded that there is no one single response for the question of whether environmental proactivity has positive effects on business performance and that this relationship must be disaggregated into more specific and concrete relationships.     

Inter-firm collaborations and supply chain coordination: review of key elements and case study

Considering the effects of globalisation, the increase of production and energy costs, and the introduction of advanced technologies, companies need to change their way of doing business if they want to stay competitive. One way of doing this is to establish collaborations with suppliers, distributors and retailers, in order to exchange products efficiently and create value for customers. Nevertheless, the structure of the collaboration must be designed carefully and some coordination mechanisms must be implemented to support this way of doing business. In this article, we first analyse: why companies work together, how they should build their partnership, and which strategies they can implement to facilitate coordination of supply chain activities. We then report a case study of collaboration in the forest industry that shows the benefits of implementing coordination mechanisms as well as the necessity of using incentives to better share these benefits.     

Generalists or specialists--who does it better?

Managed care companies encourage primary care physicians to limit referrals to specialists and provide as much of the needed services themselves. As a result, generalist and specialist physicians are now in direct competition with one another. Is the care provided by generalist and specialist physicians different in terms of quality and cost? The authors reviewed the literature over the past five years and found 21 articles comparing the care between specialists and generalists. They realized asking who does it better, the generalists or the specialists, is the wrong question to explore. Physicians must come together to design systems of care that maximize the long-term health of patients and deliver care in a coordinated and efficient manner. The emphasis should be on creating value for the consumer across the continuum of providers and through time. Competition between generalists and specialists in a fragmented system only serves to further weaken the position of physicians in the health care industry.     

Customer–supplier relationship management in an intelligent supply chain network

Outsourcing is leading to more and more complex industrial organisations. This can be attributed to the fact that several decision centres interact. As a consequence, changes in customer–supplier relationships can be noticed. In recent years, these relations have strongly evolved to lead to better internal management of each partner and a better general performance to satisfy customers. These evolutions created a new approach to the relationship between companies, called ‘industrial partnership’, in the form of a network. Networks induce a need at customer–supplier relation control level. The contribution and participation of each of the partners are thus fundamental to make supply chain management (SCM) a successful project. The control system of each actor partner must thus be adaptable enough to satisfy the production requirements. Our contribution to the improvement of customer–supplier relationship is a decentralised self-organised control model based on the concept of holon. In this model, the decision system manages a group of actors’ operations who are in a partnership. In this paper in particular a process for the evaluation of the suppliers network is discussed.     

Human relations in industry

In developed societies, good human relations become of crucial importance as people demand treatment as individuals. However, many in management positions pay only lip service to the implications of this need. The main reasons for this are that good human relations are very expensive in terms of both money and management effort and require fundamental revision of many inherited attitudes. They require appropriate organizational provision, good working conditions and amenities together with broad-ranging welfare facilities. Perhaps more important than these, however, are the intangible factors of caring and involvement by management and workers. Such principles have reached a high and successful stage of development in the author's company. Examples from several companies highlight the value of such hygiene conditions in diminishing disputes and facilitating essential change.Leadership is crucial both in management and trades unions but effective leadership is only possible against a background of good human relations.