Physician executives in the 21st century: new realities, roles, and responsibilities

This article is based in part on responses from 150 physician executives who participated in an interactive discussion of future trends at the American College of Physician Executives' 1999 Spring Institute and Senior Executive Focus, in Las Vegas, Nevada, on May 13, 1999. The session included electronic polling on 40 predictions, such as the future composition of the clinical workforce and how technology will affect the way that medicine is practiced and the patient-physician relationship. The prediction for physician executives? A growing number of physician executives will find themselves at the top of their careers in the next decade. The physician executive of the future will have a broad array of management opportunities and career choices. More doctors will be managers. Physician executives will work at every level of health care organizations, across the continuum of care, from large complex urban systems to small rural settings.     

The Use of Computer-mediated Communication in an Interorganizational Context

The rapid growth of global telecommunication networks, and in particular the Internet, has placed emphasis on electronic mail's potential as an interorganizational communication medium allowing people from different organizations to communicate, gather information, form teams, and pass knowledge across time and place. An important area of research is to understand those factors affecting interorganizational computer-mediated communication usage decisions. This study examines how interorganizational electronic mail (email) systems are being used and what factors relate to this use. This was accomplished by electronically surveying a randomly selected sample of interorganizational email users. The 613 Internet-based respondents were located in 20 different countries and were from education, business, and government. This research examines the characteristics of interorganizational email users, their perceptions of task and channel attributes, and the relationship between these characteristics and interorganizational email use. Three empirically derived patterns of interorganizational email use emerged that showed it was regularly used for broadcast, task, and social communication. Broadcast usage, which reflects an informationgathering communication function, most likely through public bulletin boards, electronic discussion groups, and list servers, was the most frequent use of interorganizational email. Multivariate regression tests showed that the three different usage types were best predicted from different sets of independent variables. Results support past claims that there is a need to differentiate among types of use in explaining computermediated communication usage behavior. Implications and recommendations for both researchers and practitioners are drawn from the results.     

Paving the way for electronic medical records

This article explores the reasons why electronic medical records have not become widely deployed in the health care industry. Y2K moved to center stage and fears of computer meltdowns became the single greatest obstacle to overcome before considering new technology possibilities. Almost every other information technology initiative in health care was delayed or suspended, while the issues of compatibility with four-digit dates were examined. Finding systems and devices that weren't Y2K compliant and replacing or working around their deficiencies left precious few resources available for other tasks. Another issue is standardization. The potential and promise of electronic records can only be realized if a standard way to describe clinical information can be agreed upon and implemented in practice situations. Clients have been reluctant to purchase electronic records while vendors are offering nonstandard solutions. Obstacles and benefits to implementing EMR systems are outlined. Despite some of the barriers to implementing EMRs, the future is bright for their widespread deployment.     

Emergency risk communication and sensemaking during smoke events: A survey of practitioners

Emergency risk communication (ERC) for smoke emitted from major fires continues to challenge governments. During these events, practitioners (including scientific, communication, and emergency response government staff) are tasked with quickly making sense of the public health risks and the communication options available. Practitioners’ sensemaking—the process of creating meaning from information about an unfolding emergency—is key to effective ERC. This article identifies the factors that ERC practitioners consider the most important to their sensemaking for smoke events. A survey of practitioners (n = 86) was conducted to elicit their views on the level of importance of 22 different factors (individual, organizational, and contextual) on their sensemaking. The results indicate that the majority of the factors tested are very important to practitioners. This finding likely reflects the multidimensional nature of emergency smoke events and provides evidence as to why practitioners are challenged when trying to make sense of emergency situations. Despite multiple factors being considered very important to practitioners, the time-limited nature of emergencies means that practitioners will inevitability be forced to prioritize in their sensemaking efforts. Our results also provide insight into practitioners’ prioritization of different information sources. Specifically, practitioners prioritize their own knowledge and the knowledge of other practitioners. The two most important factors were information from other incident management stakeholders and the practitioners’ past experience. Other information, including community-based and academic knowledge, appear to be of lower priority for practitioners. Based on the study results, recommendations for practice and future research are discussed.     

Capitation and informatics

When physicians, hospitals, and allied health professionals bill for services they render, their information processing requirements are relatively simple, at least compared to those of capitated organizations. When payers (insurers or employers) accept financial risk for the health care services of beneficiaries, they have usually invested in claims processing, membership tracking, and, under managed care, utilization review and provider profiling systems. But payers, for the most part, have not invested in electronic collection of clinical information about beneficiaries, nor have they tended to keep all claims they have processed in electronic form for study after accounts are settled and payments disbursed. In this article, we will explore why informatics is so important to capitated organizations and why payers that have traditionally taken financial risk for insuring the health care costs of populations are also learning about the importance of informatics.     

ICT-based solution approach for collaborative delivery of customised products

Growing interest on business collaboration motivates today’s industries, especially small and medium enterprises (SMEs) to establish and manage dynamic and non-hierarchical business networks to respond to market opportunities with added business benefits. This business environment requires concurrent work and real-time information sharing between key business partners in order to design and develop customised products. The use of traditional communication media such as e-mail, phone and fax is not satisfactory to get real-time information and is time-consuming and most often ineffective. In such environments, an Information and Communication Technology (ICT)/Web-based technology supports real-time information sharing among networked SMEs for the collaborative design and manufacturing of customised products. This study proposes an innovative ICT platform supporting SMEs collaboration, through Web and the Internet of Things technologies, which follows the Net-Challenge conceptual approach and methodological guidelines for SMEs to form and operate virtual organisations for the collaborative development and delivery of customised products. The ICT Platform was assessed in three different industry domains, namely the textile and apparel, the footwear and the machine tools, respectively. This ICT solution promotes collaboration, with substantial advantages for SMEs including the reduction of costs and delivery time and improvement of the innovation potential.     

The Value of Instructional Communication in Crisis Situations: Restoring Order to Chaos

This article explores the nature of instructional communication in responding to crisis situations. Through the lens of chaos theory, the relevance of instructional messages in restoring order is established. This perspective is further advanced through an explanation of how various learning styles impact the receptivity of various instructional messages during the acute phase of crises. We then summarize an exploratory study focusing on the relationship between learning styles and the demands of instructional messages in crisis situations. We conclude the article with a series of conclusions and implications.     

The nature of the work-leisure relationship

This article is concerned with the development of an analytical framework, developed from a social psychological perspective, for viewing the nature of the work ethic and its changed character in contemporary industrial life. Toward this end, an analysis of how a typical Western person's attitudes toward work and leisure are formed is presented. The interdependent influence of this attitude upon the worker's mental health is examined. The influence of social evolution in Western culture seems to be altering work-leisure attitudes and this phenomenon is studied. Finally, based on the previous analysis, social policy recommendations for increasing the self-actualizing potential of both work and leisure are offered.     

Food manufacturing: The future prospect

This article provides an analysis of the environmental factors which are likely to influence the nature and level of activity in Britain's food industry over the next 10–15 years, and in particular planning for human resources. The article covers the historical perspective: the present market position and the consequences of misplaced optimism; examines the prospects for the medium and longer term in relation to the world food problem and the industry's opportunities: and considers some of the manpower implications.     

Health‐Care Reform and ESI: Reconsidering the Relationship Between Employment and Health Insurance

The health‐care reform promised by the Patient Protection and Affordable Care Act of March 2010 continues our dependence on a central feature of the American health‐care system: employer‐sponsored insurance (ESI). In this article I will criticize the assumptions regarding market and welfare concerns on which this dependence is based and argue that efforts to mandate ESI ignore both the dynamics of the employment relation and the nature of health‐care needs. A comparison between investing in employee education and investing in employee health will reveal the pragmatic challenges to ESI and the covert appeal to employer beneficence on which ESI rests. This paper argues that relying on ESI to guarantee appropriate care for a significant segment of the population is undesirable and unsustainable from both market and moral perspectives.     

Perception and Communication of Flood Risks: A Systematic Review of Empirical Research

Flood hazards are the most common and destructive of all natural disasters. For decades, experts have been examining how flood losses can be mitigated. Just as in other risk domains, the study of risk perception and risk communication has gained increasing interest in flood risk management. Because of this research growth, a review of the state of the art in this domain is believed necessary. The review comprises 57 empirically based peer‐reviewed articles on flood risk perception and communication from the Web of Science and Scopus databases. The characteristics of these articles are listed in a comprehensive table, presenting research design, research variables, and key findings. From this review, it follows that the majority of studies are of exploratory nature and have not applied any of the theoretical frameworks that are available in social science research. Consequently, a methodological standardization in measuring and analyzing people's flood risk perceptions and their adaptive behaviors is hardly present. This heterogeneity leads to difficulties in comparing results among studies. It is also shown that theoretical and empirical studies on flood risk communication are nearly nonexistent. The article concludes with a summary on methodological issues in the fields of flood‐risk perception and flood‐risk communication and proposes an agenda for future research.     

Ethical leadership supports safety voice by increasing risk perception and reducing ethical ambiguity: Evidence from the COVID-19 pandemic

Misconduct by business and political leaders during the pandemic is feared to have impacted people's adherence to protective measures that would help to safeguard against the spread of COVID-19. Addressing this concern, this article theorizes and tests a model linking ethical leadership with workplace risk communication—a practice referred to as ‘safety voice’ in the research literature. Our study, conducted with 511 employees from UK companies, revealed that ethical leadership is positively associated with greater intention to engage in safety voice regarding COVID-19. We also find that this association is mediated by relations with the perceived health risk of COVID-19 and ambiguity about ethical decision making in the workplace. These findings therefore underscore the importance of good ethical conduct by leaders for ensuring that health and safety risks are well understood and communicated effectively by organizational members particularly during crises. We discuss the theoretical and practical implications of our study and highlight further opportunities for future research to address the ethical dimensions of leadership, risk management, and organizational risk communication.     

Reporting quality of health care to the board

The reporting of quality of health care to the governing board has long been an enigma. Now we are in the midst of a revolution in health care, as we shift our focus from solely the clinical performance of individuals to a broader scope of assessing and improving all activities around patient services and patient care--i.e., management outcomes integrated with clinical outcomes to help identify opportunities to improve patient care. In addition, apprised of corporate liability for the quality of care provided in health care organizations, governing boards are raising questions and demanding more information. To maintain this high degree of interest in quality of health care, information should be restricted to what the board needs to know. This article will be confined to the hospital's organizationwide quality system of monitoring and evaluating. While medical staff credentialing and privileging are also board responsibilities and quality management activities should be used in the privileging and credentialing process, they will not be addressed in this article.     

Informing the Public About Uncertain Risks

Many problems arise in connection with the communication of risk information. In this article the content of the information communicated is taken as a starting-point for analyzing the risk communication process. We studied the way in which authorities communicated health risks to local residents in Dutch soil pollution situations and found that communication problems were characterized more by misunderstanding and conflict between parties with different views and interests than by a lack of understanding. Therefore, it is important to look more closely at the way the communicators of information (in our cases, officials) select risk information from risk assessments, and to study the effects that the information selected has on the receivers (in our cases, residents). Both the process of selection by the officials and the process of interpretation by the residents will be shown to be influenced by the different institutional backgrounds. The article presents a new approach to risk communication. Both the risk information presented by the authorities and the public reactions to this risk information are considered to reflect the institutional background of authorities and residents, and can be analyzed in these terms. Such an approach has consequences for the study of risk communication and the manner in which it is practiced.     

Ethical Issues in Risk Communication: Continuing the Discussion

Proposed in this article is one possible framework for classifying multiple types of ethical issues in risk communication research and practice to help continue a discussion initiated in 1990 by Morgan and Lave. Some of the questions that each stage of the process for planning risk communication strategies appears to pose for ethics are discussed (e.g., selecting issues to be communicated, knowing the issue, dealing with constraints). Also discussed briefly are some issues raised by the possibility that risk communicators aspire to the status of a profession. The purpose is to foster discussion rather than issue a conclusive statement on the topic, because its very nature makes a definitive pronouncement indefensible.     

Marketing and the medical specialist in the managed care environment

Marketing means more than just communicating or advertising to potential patients; marketing means identifying your customers and working to meet or exceed their expectations. There are five key areas of a marketing plan: (1) Establish the foundation, beginning with your mission statement; (2) Assess your marketing environment by internal and external research; (3) Target your efforts, looking at image and perception; (4) Develop your particular mix of product, price, place of distribution, and promotion; and (5) implement and evaluate your marketing process. This article discusses the importance of a marketing plan for the medical specialist and highlights the features unique to a practice working in a system of capitated reimbursement. Applying these principles will help to demonstrate added value, protect the fundamental role of the patient-physician relationship, ensure that our efforts are aligned with professional missions and goals, and ultimately increase profitability and professional success.     

Toward an Ethical Model of Effective Crisis Communication

The goal of this study was to develop and demonstrate a new ethical model for crisis communication. This article examined the crisis communication practices as well as literature and found essential elements—what, how, and when—for ethical and effective crisis communication. Based on these three variables, a new three‐part model, the TTR Test, was proposed, utilizing three principles: Transparency (what), Two‐way symmetrical communication (how), and Right time (when). To investigate how the test can be applied to the real world, this article examined BP's crisis communication during the 2010 Gulf of Mexico oil spill.     

NERJIT: Using Net Requirement Data in Kanban‐Controlled Jumbled‐Flow Shops

The bold lines that have separated the application of specific production planning and control techniques to specific production systems are being blurred by continuous advances in production technologies and innovative operational procedures. Oral communication among dispatchers and production units has given way to electronic communication between production planners and these units by continuous progress in information technologies. Current production literature alludes to the idea that, collectively, these advances have paved the way for application of Just‐In‐Time (JIT) production concepts, which were originally developed for mass production systems, in intermittent production systems. But this literature does not actually consider the possibility. This article presents a modification to JIT procedures to make them more suitable for jumbled‐flow shops. This article suggests providing real‐time information about net‐requirements for each product to each work center operator for setting production priorities at each work center. Simulation experiments conducted for this study show that using Net‐Requirements in JIT (NERJIT) reduces customer wait time by 45–60% while reducing inventory slightly. The analysis of work centers’ input and output stock‐point inventories shows that using the information about net‐requirements results in production of items that are in current demand. NERJIT results in smaller input stock‐point inventory and availability of products with higher priority in the output stock‐points of work centers.