The future of medical practice

Managed care of some kind will dominate the future of health care, but the unresolved crucial question concerns ownership of the managed care plans. An investor-owned managed care industry now holds sway, but I do not expect it to last very long. In the long run, physicians must be in charge of medical care, but they must live within budgets and be accountable to payers and to their patients. The only solution that makes sense to me is one based on multiple local physician networks, organized on a not-for-profit basis. I predict that staff and group-model HMOs will be the mainstay of the medical care delivery system within a few decades.     

The medical practice as business organization

Medical practices historically have not been examined in terms of their organizational structures and of the appropriateness of their structures for survival as business entities. In this paper, we propose a model for the typical medical practice and discuss its fit with current organizational theory. It is apparent that the medical practice organization does not fit with the demands of a rapidly changing and complex environment. To survive and grow, the medical practice organization must align itself with others that have an interest and stake in the health care system, develop teamwork among physicians, bridge the gap between physicians and others in the organization, and recognize that the work done in the organization depends on other components of the organization.     

No longer a solo practice: how physician leaders lead

The authors conducted a national study to determine the factors associated with the success of physician leaders. They utilized the Leadership Practices Inventory (LPI) and a demographic survey followed by individual interviews with respondents. Data analysis revealed several implications for the selection, training, management, and career development of physician leaders. The results suggest that: Physician leadership training should have a strong focus on the "human side" of management, including negotiation, organizational "politics," conflict resolution, team building, and motivation. Data management and finance should be a focus represented in the curriculum. Mentoring relationships should be developed as an aspiring physician leader pursues a career shift. Self assessment, including an analysis of style, strengths, best potential organizational fit, and specific areas of strength and weakness should be an integral part of the development of an aspiring physician leader. Screening mechanisms to ascertain a physician's motivation to move toward a full-time leadership role should be developed to ensure appropriate intent. To facilitate this implication, more effective assessment tools need to be developed.     

Targeted searches: a double-edged sword

Besides being discriminatory, there are short- and long-term problems inherent in targeted searches. What are the issues rarely considered by companies looking for a quick diversity fix? (1) Internal candidates will bolt when they figure out what's going on. (2) Most top candidates hate targeted searches. (3) Many search firms don't like targeted searches, and some won't even participate in them. (4) Targeted searches can set up new hires for failure. These issues are useful to consider when you begin the search process for your next star.     

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.     

The implications of practice guidelines for physician medical malpractice liability

Medical practice guidelines are increasingly coming into use, and as more and more physicians are presented with guidelines to follow in the delivery of health care, the question arises of whether these guidelines will become instruments for imposing greater medical malpractice liability on physicians. This column will briefly describe what guidelines are, how they are developed, and how they have been and may be used in litigation against physicians, hospitals, and other health care institutions. As hospitals and managed care organizations continue to implement guidelines, the role these guidelines play in malpractice cases can be expected to increase. It appears, however, that, although guidelines will contribute to the establishment of the standard of care by which a physician's actions will be measured, they are not likely to become the standard that all physician treatment decisions must meet.     

Clinical practice guidelines and medical malpractice

As clinical practice guidelines become more and more prevalent, they will define the requisite "standard of care" for medical treatment and impact medical malpractice litigation. They may even replace expert testimony.     

Organizational transformation: Handling the double-edged sword of urgency

A central idea in organizational research and practice is that change efforts demand a sense of urgency. It is also commonly accepted that renewal beyond incremental improvements demand individuals and teams to have what earlier research has called a “promotion focus”—to think innovatively, see opportunities, and think long term. Urgency, however, leads to a “prevention focus,” with which teams and their members are more inclined to seek incremental improvements and error reduction. Hence, urgency seems to both support change and prevent it. Earlier research has not established the conditions under which urgency may lead to creative and productive outcomes. This paper aims to do so. In a study of seven change initiatives at a large media company undergoing a serious crisis, we found that urgency cues could be productively handled by managers and project team members when they addressed three core relationships: (a) the success-failure relationship, (b) the safety-accountability relationship, and (c) the operative-strategic relationship. We make three related theoretical propositions regarding the role of urgency in innovation-driven change and transformation.     

Toward the new pattern of medical practice

As this article is being written, in the fall of 1993, we are waiting for the details of the President's plan for extending health insurance coverage of some kind to all members of the population while also containing costs. All observers, including practicing members of the medical profession itself, believe that a sharp break with the past is developing, most particularly a break with the old pattern of practice that flourished during the golden years between the end of World War II and the end of the 1960s, when the federal government made its first effort to control costs. In this article, I will discusses changes in the conditions of American medical practice that most observers can agree on. Then, I will summarize the major conceptions of the future shape of medical practice. I will conclude with my own view of critical issues in the constitution of practice, issues whose resolution depends not only on broad public policy initiatives, but also on the activities of physician executives within the medical community.     

Hospital-sponsored networks. The rush to consolidate and the future of medical practice

As the medical delivery system undergoes fundamental change, there is a growing pressure on hospitals to form networks with physicians. The prime motivation for these entities is to preserve market share and fill beds. There is likewise intense pressure on physicians to join them, even if these networks do not serve their best interests, or the goal of fostering physician-centered practice. A transformation is under way, however, that may well place doctors again in the central role of guiding the new modes of medical practice in the United States.     

Effects of medical practice structure on resource use

The drive to national health care reform has made a central issue of variations among physicians in the use of resources to treat similar cases. While much research exists on this issue, little of it concentrates on the impact of practice structure on resource use. In this column, the author comments on that research. This column is intended as a point of ongoing analysis of health services research of importance to physician executives. The column is edited by John Kralewski, PhD, who heads the Institute for Health Services Research at the University of Minnesota.     

The double-edge sword effect of interorganizational trust on involvement in interorganizational networks: The mediator role of affective commitment

Some organizations collaborate with other partner organizations to reach common goals, establishing interorganizational networks. The governance of the network is often enacted by an interorganizational governing team composed of the directors or top managers of the partner firms. This team plans, manages, and supervises the advancement of the network’s common goals. The success of the network depends, to a large extent, on the involvement of the members of the governing team. In this study, we tested a multilevel model of the antecedents of the involvement of governing team members in the management activities of interorganizational networks. We examined whether the relationship between team interorganizational trust, as a team level construct, and individual involvement in management activities is partially mediated by individual affective commitment. Using a sample of 101 respondents belonging to 28 interorganizational governing teams, we tested a multilevel mediation model. Results showed, as expected, a positive indirect effect of team interorganizational trust on individual involvement through individual affective commitment. However, unexpectedly, team interorganizational trust also showed a negative direct relationship with individual involvement. Based on our findings, we highlight the need to also consider the “dark side” of interorganizational trust, and we propose potential mediators to explain the unexpected negative relationship.     

Critical success factors of medical technology supply chains

This paper investigates Critical Success Factors that affect the performance of organizations involved in Medical Technology supply chains (MTSCs) in Germany. The Medical Technology sector in Germany is considered an innovative, fast-growing and promising industry, being third behind the USA and China as the biggest market in the world, worth 29.9 billion euros in 2017. MTSCs in this country are under pressure from health service funding and cheaper imports, primarily from China. Consequently, supply chain success is of high importance and OEM operational improvements are critical. This exploratory study involved a multiple case study approach where 15 OEMs within German MTSCs were investigated. Following within-case and cross-case analysis, empirical results led to the development of testable propositions, which constitute a foundation for further research investigation. The findings show that there are six, prioritized Critical Success Factors for MTSCs that include sales and operations planning, product development process and quality and compliance. These findings challenge existing assumptions about Critical Success Factors within MTSCs, providing practitioners with strategies showing that re-prioritized CSFs should improve the operational performance of OEMs.     

Using real-time simulations to make medical technology decisions

Study how one health care organization evaluated various vendors of evidence-based content for making clinical decisions.