Physician resiliency?

The profound changes in the health care industry have led to the anger, frustration, and unhappiness that physicians are feeling. It is important to examine physicians' responses to the threats to their professional autonomy, image, lifestyles, and relationships with their patients. The "learned helplessness" behavior exhibited by physicians is astounding, considering the education, status, and reputation of physicians as healers for those in need. This article explores the concept of resiliency among physicians and describes why physicians as a group may be less resilient than other individuals. In fact, the structure and training of the medical profession stacks the deck against those who want to change or to be resilient in the face of the changing environment.     

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.     

The evolving role of the primary care physician

In today's climate of health care reform, the title of this article might more appropriately be "Is the Role of the Primary Care Physician Evolving or Going the Way of the Dinosaur?" According to Koop, primary care is in trouble. Whereas only 29 percent of U.S. physicians are primary care physicians, in Great Britain, 72 percent of physicians are primary care physicians and in Europe and Canada the average is 50 percent. Many U.S. primary care physicians are in the later stages of their careers and nearing retirement age. Unless the supply increases, this number will dwindle further. However, in 1992, only 14 percent of U.S. medical school graduates were headed for primary care careers. Even if the supply of primary care graduates were increased to 50 percent of the graduating medical school class, it would be well into the next century before the ratio of primary care physicians to specialists would be equal. Primary care is at a critical juncture and the next few years will decide the fate of the primary care physician. Given the state of primary care today, I believe that a fundamental look at the assumptions regarding the role of primary care physicians is in order. The current health reform movement has placed a major responsibility on primary care to solve many of the problems in health care delivery today, such as cost, utilization, and prevention. Many health care organizations are planning strategies involving primary care providers, and physician executives can play a key role in these decisions.     

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.     

Negotiating. Biases physicians bring to the table

What are some of the obstacles that physicians face as they seek to become more effective at the bargaining table? The author's thesis, based on experience in both the classroom and the front lines of medical practice, is that physicians face a set of systematic "biases" derived from physician training and professional culture that make negotiation especially difficult for them. They outline the biases they have observed, explore some possible explanations, and suggest solutions for physicians who wish to negotiate more effectively.     

Recognizing the power of diversity

"The trouble with the future is that it usually arrives before we are ready for it." While Arnold H. Glasgow did not have diversity in mind when he made this statement, his thought is relevant to that topic nevertheless. In fact, almost everything in the health care environment of the 1990s is fluid, making the future a question mark. Among these changes is the demographic composition of students entering medical school and of patients. Consider the following. While 14 percent of today's physicians are people of color, that number increases to 25 percent for current medical students. In the past 10 years, the number of female physicians has seen the largest percentage growth, followed by American Indians, Blacks, and Hispanics. Physician executives who have vision and energy can capitalize on this demographic revolution and convert diversity into a competitive advantage once its boundaries are understood.     

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.     

Developing loyal physicians: a five-point plan

Now, more than ever, health care centers are forced to compete for physicians. There could be no greater argument in favor of establishing the position of Vice President for Medical Services. A physician executive is infinitely more qualified and better prepared to understand the probable reaction of different types of physicians when "loyalty" to the organization is the central issue. The Vice President for Medical Services seems best positioned to remind the Chief Executive Officer and the Board to keep sight of the legal, and moral, duty to "exercise reasonable care in the selection of a medical staff and in granting specialized privileges," including selecting practitioners who are "worthy in character and matters of professional ethics."     

Due process key element of physician grievance.

The concept of grievance procedures, when applied to physicians, has a foreign ring to it. We ordinarily associate grievance procedures with unions and labor relations activities unrelated to professional conduct and behavior. As described in the preceding article, grievance procedures usually are extremely limited, having been created to resolve very specific violations of collective bargaining agreements in a unionized company or of conflict resolution policies in a nonunion environment. In health care organizations, "due process provisions" are designed to resolve specific conflicts in the relationship between the medical staff and individual medical practitioners.     

The courageous follower

With the recent changes in the delivery of medical care in the United States, physicians are being thrust into new and unsettling roles. Many are finding themselves for the first time in the role of the follower, subject to myriad types of leadership. Leaders frequently complain that leading physicians is like "herding cats." What are the characteristics of followers? Do physicians make good followers? This article examines the role of the "cats"--what is effective followership, why physicians may fall short in followership skills, and how physicians might become better "followers."     

Models for medical practice integration

Decreased physician income, increased administrative burdens, and interference with the compassionate delivery of high-quality medical care are threatening the independent practice of medicine in solo and small group practices. Many established physicians, and the hospitals with which they relate, are searching for organizational models that, by integrating some or all aspects of their practices, will preserve incomes and reduce regulatory and administrative burdens. This article will describe several "practice integration models," pointing out advantages and disadvantages to physicians in established practices. (Many of the same arguments could be made for physicians new to practice, with different emphasis). The continuum of integration models is shown in figure 1, page 19. The group practice without walls and its two submodels, the independent group practice without walls (IGWW) and the affiliated medical practice corporation (AMPC) are more recent and more effective models and will be covered in depth in the article.     

动态环境下联盟竞合、治理机制与创新绩效的关系研究

本文从竞合视角审视联盟组合,结合动态关系观探讨有效的联盟治理机制,揭示了联盟组合中竞合关系(横向竞合、纵向竞合)、治理机制(契约治理、关系治理)和创新绩效之间的关系,并考察了动态环境特征(技术波动、竞争强度)的二次调节作用。在不同的竞合关系中,由于合作和竞争的强度不同,契约治理与关系治理机制的作用也存在差异,同时,治理机制与创新绩效之间的关系也受到两种不同环境动态性特征的影响。研究结果显示,在纵向竞合中,运用关系治理比运用契约治理能更好地提升创新绩效,技术波动正向调节契约治理、关系治理与创新绩效间的关系。在横向竞合中,运用契约治理比运用关系治理有效,竞争强度加强了契约治理对创新绩效的影响,即关系治理在波动的环境中更有效,契约治理在竞争的环境中更有效。本文为企业开展研发联盟组合管理提供了新的视角和管理对策。     

Suggestions for management training of residents

In addition to having medical expertise, physicians must possess managerial skills to deal with the ever-changing business environment of the practice of medicine. This article addresses the need for management training of physicians and calls for management training during residency and medical school. It also describes one residency program's efforts to provide comprehensive management training to its residents in pathology.     

The physician executive can help improve doctor-patient relationships

An integral part of the physician executive's job, but one that is not relished, is confronting clinicians when they are doing something wrong. If the problem involves medical skills, the confrontation cannot be delayed, but if it involves interpersonal relationships, individuals and organizations will sometimes let the issue slide too long. If physicians have good clinical skills but bad bedside and office manners, they will lose patients. As competition increases, organizations are increasingly realizing that they must address these problems and solve them quickly before patients take their business elsewhere.     

The Impact of Competitive Strategy and Supply Chain Strategy on Business Performance: The Role of Environmental Uncertainty*

This article investigates the relationships among competitive strategy, supply chain strategy, and business performance while examining the moderating effect of environmental uncertainty. A total of 604 questionnaires were collected from three cities in China, and the statistical results show significant moderating effects of external environment on the relationships among competitive strategy, supply chain strategy, and business performance. Firms that primarily focus on a differentiation strategy emphasize an agile supply chain strategy. Cost leaders are inclined to implement both lean and agile supply chain strategies, but their emphasis on agile strategy is significantly greater in a volatile environment than in a stable environment. The choice of supply chain strategy does not appear to be an “either‐or” decision and firms could adopt either a lean or an agile strategy, or both, depending on the environment. This article provides significant managerial implications for supply chain practitioners to co‐align supply chain strategy and competitive strategy with the environment to improve performance.     

Coaching für ?rztinnen in der Facharztausbildung

The article describes a form of group coaching for female physicians during their medical specialty training. The basic approach of the coaching is solution and resource oriented and it comprises five sessions. Participants from different departments are given the opportunity to discuss aspects of their recent working experiences under professional guidance. Participants are therefore able to determine the topics to be discussed by themselves. Interest in the offer of coaching was very high and participants who completed the five sessions rated it very positively. The positive feedback allows us to conclude that as few as five coaching sessions can have a positive impact and can be of support for this target group.     

Why an MBA?

As physicians move into medical management, leaving clinical practice behind to play a major role in managing physician performance and clinical processes, they are having to deal in the business world. Physician executives are donning the pinstripe suit instead of the white coat, and adding a business acumen to their clinical skills. Many have opted to pursue executive MBA programs to learn the business competencies they need to manage health care organizations. This article summarizes the educational opportunities available in executive MBA programs and discusses the value of business training for aspiring physician executives.     

Can physicians lead other physicians into the future?

This article reflects upon some of the dynamics that prevent physicians from successfully engaging change. Physicians are enculturated to the competitive and hierarchical, and to value personal autonomy. These traits promote distrust and inhibit the formation of collaborative relationships. At this time of growing complexity, when most other industries are developing styles of work based on teamwork, worker empowerment, cross training, and information sharing, physicians cling to the metaphor of the ship's captain, a lone decision-marker and authoritarian possessor of grand knowledge. And yet, in order to lead, physicians need to learn to work differently and nurture a more collaborative approach. The author's blueprint for change includes: Stop trying to manage consensus; commit to measured accountability; think systemically; don't make the mistake of thinking that people will follow because you are right; and, most importantly, create relationships based on shared purpose and principles.     

I can't believe they think I'd...

Many physician executives experience a personal jolt as they move to work in a very different relationship with their colleagues. What happens? How can we understand this phenomenon? What can we do to minimize the personal toll so often exacted by the transition to leadership? This paper will focus on these essential questions. The inevitable discomfort encountered during this learning curve, which can last from two months to two years, often comes as a surprise. Many physicians who have been elevated to leadership positions because of their success and interpersonal acceptance, have not had to struggle with this sense of being "a fish out of water" since very early in their professional careers. Unless there is someone in place to reassure and mentor, the resulting confusion can be quite unnerving, resulting in reflex defensiveness.     

The Effects of Competitive Environment on Supply Chain Information Sharing and Performance: An Empirical Study in China

Information sharing in supply chains has become an important topic over the past decade. This study uses data from 617 Chinese manufacturing firms to investigate the relationships among competitive environments, supply chain information sharing (SCIS), and supply chain performance. The results of structural equation modeling analysis show that (i) international competition is positively related to all three types of SCIS whereas local competition is not significantly related to any of the three types, (ii) internal information sharing is positively related to external information sharing with suppliers and customers, and (iii) internal information sharing and information sharing with customers are positively related to superior supply chain performance, whereas supplier information sharing is not significantly related to performance. The findings enhance our understanding of the relationships among competitive environment, SCIS, and supply chain performance in Chinese manufacturing settings.