Improving performance in a contracted physician network

Health care organizations face significant performance challenges. Achieving desired results requires the highest level of partnership with independent physicians. Tufts Health Plan invited medical directors of its affiliated groups to participate in a leadership development process to improve clinical, service, and business performance. The design included performance review, gap analysis, priority setting, improvement work plans, and defining the optimum practice culture. Medical directors practiced core leadership capabilities, including building a shared context, getting physician buy-in, and managing outliers. The peer learning environment has been sustained in redesigned medical directors' meetings. There has been significant performance improvement in several practices and enhanced relations between the health plan and medical directors.     

Which way to the frontier? Physician executives talk about the future

The author interviewed trustees, senior managers, and physicians at Moses Cone Health System in Greensboro, North Carolina, Legacy Health System in Portland, Oregon, and Henry Ford Health System in Detroit, Michigan. These three successful health care systems bracket the national market in size, geography, and managed care penetration. The comments of physicians are presented here, drawn from the book, Designing 21st Century Health Care: Leadership in Hospitals and Healthcare Systems. What emerges most clearly from their comments is the enormity of the task ahead. There is wide-spread agreement that substantial improvements in the quality and cost of care are possible, an encouraging stream of anecdotes and ideas about how to proceed, but a lack of consensus on critical components of how to organize practices and promote effective care.     

The future of American health care in the "post-reform" era

"As the debate over health care reform rages in Washington, the market is reforming itself. For any given market, it's a question of 'How soon will it hit?', not 'Will it hit?'" Health care reform and market restructuring are ushering in a new era of integrated health care. Although the future is not fully clear, there are at least three competing models for the creation of regional and statewide health systems that will integrate the financing and delivery of services to large enrolled populations of consumers: Payer-driven networks. Provider-sponsored systems. Partnership models. Whatever the future scenario, physician executives will play a larger, more dominant role. Research on integrated health systems has identified three critical success factors for future success: physician-hospital integration, clinical integration and information integration. For managed care to be successful, there must be clinical leadership. The essence of managing care is clinical efficiency, based on "critical-path" treatment protocols and real-time patient care management, supported by integrated information systems.     

Cost and quality outcomes of comprehensive epilepsy monitoring review of referrals in a managed Medicaid program

The proceedings of the National Institute of Health's "Consensus Development Conference on Epilepsy Surgery" was published in March 1990. In it, the conclusion was made that, while surgery for intractable epilepsy can stop or decrease documented seizures, "effects in overall health status and quality of life have not been adequately studied." Recommendations for standardized data collection for surgery in qualified, technologically-equipped centers included the need for follow-up studies of outcomes for at least five years. The University of Arizona's Epilepsy Center was established in 1984, and the Arizona Comprehensive Epilepsy Monitoring Program started at the University of Arizona Health Sciences Center in 1990. Patients from various payer sources have been managed, and many surgeries have been performed. This report focuses on patients covered under the state's managed Medicaid program for patients under a full-risk, capitated managed care contract with University Physicians. The Arizona Health Care Cost Containment System (AHCCCS) contracted with University Physicians, Inc., of the University of Arizona Health Sciences Center, for comprehensive health care services under a capitated payment mechanism from 1982 to 1992. Thereafter, University Physicians has provided services through subcontracts with other managed care organizations. This report focuses on this Medicaid population.     

How transformational leadership works during team interactions: A behavioral process analysis

Transformational leadership is generally considered helpful for team functioning. However, the social dynamics underlying the benefits of transformational leadership remain elusive to date. To understand how and why transformational leadership can foster team functioning, this study focuses on leader–follower communication dynamics during team interactions. From the perspective of leadership as social problem solving, we argue that transformational leadership is linked to functional team problem-solving processes because transformational leaders use solution-focused communication (mediator model). In a sample of 30 videotaped problem-solving team meetings from two organizations, we coded transformational leadership style and the verbal behavioral interactions of leaders and team members over the course of their entire meetings (30,128 behavioral units in total). Multilevel results showed that transformational leadership was positively linked to functional problem-solving communication by team members. This positive relationship was mediated by leaders' solution-focused communication. Moreover, at the micro-level of conversational dynamics within the meeting process, lag sequential analysis revealed that leaders' ideas and solutions triggered subsequent solution statements by team members and inhibited counterproductive communication by team members, such as running off topic, criticizing, or complaining. We discuss theoretical and methodological implications for conceptualizing dynamic leader–follower processes as well as managerial implications for leading effective meetings in organizations.     

Housestaff coverage in a nonteaching community hospital

In August 1992, a project team of senior medical and administrative personnel was formed (Housestaff Coverage Project Team) at the Park Ridge Health System, Rochester, N.Y.. The team was given a mandate to address housestaff coverage, primarily from an economic standpoint. Through total quality management (TQM), the project team sought to develop a house coverage plan that was sustainable, efficient, and effective. A plan was developed that includes three layers of service. A minimum "standard hospital coverage" would be available to all physicians and their patients and cover the basic needs of admission, crisis intervention, and issues of length of stay. A complete level of service would be available under the title of "case management" and would consist of total patient management, under the direction of the attending physician, from admission through discharge. The third level of service available to both "standard" and "case managed" patients would be a "consultative service." The latter would function as a traditional in-house medical service and would bill for its services. Park Ridge Hospital believes it has developed a system of housestaff coverage that is sustainable, efficient, and effective. An evaluation mechanism, primarily addressed at length of stay, will tell if we are correct in this assumption.     

Physician financial relationships in the new regulatory environment

In recent months, physicians have been under scrutiny by the federal government with respect to their financial relationships with both drug manufacturers and home care companies. This heightened scrutiny can be attributed, in part, to the attention that has been placed on health care fraud and abuse in this country as a major cause of rising health care costs. Federal investigators currently are examining physician financial relationships in light of the Medicare/Medicaid antikickback statute to determine whether certain payments made to physicians are intended as inducements to refer patients or to prescribe certain products. "Health Law" is a regular feature of Physician Executive contributed by Epstein Becker & Green. Mark Lutes of the law firm's Washington, D.C., offices serves as column editor.     

Integrating acquired physician practices

Many strategies have been suggested to accomplish successful physician integration, including stock ownership in a for-profit entity created by the health system, sharing in the cost efficiencies caused by changing practice patterns, and compensation attached to service and access standards. One thing that executives overlook goes beyond financial concerns and yet hits at the heart of what is important to most physicians. That is maintaining their ability to make decisions regarding their own practice environment both clinically and administratively. United Health describes its physician-administrator team model, developed to enhance the physician integration process.     

Visual management system to improve care planning and controlling: the case of intensive care unit

Health Lean Management (HLM) is usually implemented to enhance the operational performance in health care; nevertheless, scant attention is devoted to visual control and daily accountability processes. This paper aims at investigating how to adopt a visual management system to: plan and control patient journey in health care operations and perform a continuous improvement process. Conducting in-depth interviews and observations, participating in meetings and collecting documentation, the patient journey board and daily briefings of an Intensive Care Unit were studied and improved. In the patient journey board, the Plan, Do and Check phases were reported, distinguishing between actual and planned actions for the patient care. The daily meetings were organised and a continuous improvement board was also developed to solve specific issues (Act phase), by creating ad-hoc teams, involving the staff and reporting transparently on the board. Operational and sociotechnical performance, before and after the adoption of HLM, were assessed demonstrating the effectiveness and efficiency of visual management tools.     

The looming millennium bug

Evaluating and fixing date sensitive systems by the year 2000 is a significant challenge for the health care industry. Health care executives will be engrossed in this important management activity over the next several months. By now all critical business functions should have been identified and remediated. Contingency planning to ensure the continuity of high quality systems is an essential next step. Physician executives need to have a contingency plan in case Y2K-related failures occur. Most health care facilities have a disaster plan that has been tested in clinical scenarios. These plans should be reviewed to ensure they include procedures for handling problems with office operations, power outages, equipment failure, supply or pharmaceutical shortages, and patient evacuation. Financial systems are at risk at multiple points, including determining eligibility, claims submission, billing, and payments.     

In the eye of the beholder? An eye-tracking experiment on emergent leadership in team interactions

Integrating evolutionary signaling theory with a social attention approach, we argue that individuals possess a fast, automated mechanism for detecting leadership signals in fellow humans that is reflected in higher visual attention toward emergent leaders compared to non-leaders. To test this notion, we first videotaped meetings of project teams and collected leadership ratings for the team members from three rating sources. Second, we provided 18 naïve observers with 42 brief, muted video clips of the team meetings and analyzed their eye gazing patterns. Observers gazed at emergent leaders more often, and for an average longer duration, than at non-leaders. Gender effects occurred such that male emergent leaders received a higher number of fixations than female emergent leaders. Non-verbal behavior analysis indicated that emergent leaders showed a higher amount of active gestures and less passive facial expressions than non-leaders. We discuss theoretical and methodological directions for emergent leadership research in teams.     

Health care's power brokers in the 21st Century. Interview by Donna Vavala

Health care has undergone turbulent change in the 20th Century. In addition to dramatic pharmaceutical and technological advances, the entire health care delivery system has been significantly improved. Through all the turmoil, hospitals have been at the center of the health care universe. But, as the 21st Century approaches, that may change, too. What will become of hospitals, which for most of this century have played a commanding role? Will managed care organizations and group practices come out on top? And, once the new power broker takes over, what will be the impact on providers, insurers, and the government, and how will their relationships to each other change? Jeff Goldsmith, PhD, President of Health Futures, Inc., Bannockburn, Ill., and health care futurist, examines tomorrow's health care delivery system and makes some eye-opening predictions.     

7. A contingent configuration approach to understanding the role of personality in organizational groups

We argue that past research has taken one of three basic theoretical approaches to explaining the nature of member personality effects on group process and team performance: (1) universal - certain traits always predict teamwork success; (2) contingent - certain traits predict team performance depending on the task or organizational culture; and (3) configuration - the mix of traits within a group, or the “fit” of individual members with each other, predicts team performance. Each of these three approaches to personality in groups has received significant empirical support in the literature and yet has some shortcomings. We offer suggestions for improving research using each approach but argue that a full understanding of the role of personality in group processes must integrate all three of these approaches into what we call the contingent configuration approach. We conclude by discussing the implications of adopting this approach to understanding the role of personality in organizational groups.     

Joint strategic planning between health and local authorities

This paper describes an approach to joint consideration of strategic planning problems between Health Authorities and Local Authorities. It is currently being pilot tested in the UK by two Area Health Authorities and their corresponding County Councils. The approach is most effective in planning the provision of health and social services for periods between three and ten years ahead and has been particularly designed for planning the non-acute services. These are the services for which joint planning between the health and social services is most important. Depending on local needs and planning priorities the approach may be used for one or more ‘client groups’ (the Elderly, Mentally Ill, Mentally Handicapped, Physically Handicapped etc.). In the pilot applications the approach is being used in planning for the Elderly client group only. The model now used relies on very simple assumptions, arithmetic calculations, and a heuristic optimisation algorithm, in place of a previous mathematical programming model originally aimed at national planning needs and then adapted to local planning. The revised model has achieved these simplifications, while extending the power of the model to fit local needs, by separating out different parts of the problem corresponding to different stages in the planning process, and developing techniques appropriate to each. In a companion paper² in this issue authors from the participating Authorities put their views on the pilot applications of the approach.     

Leadership clarity and team innovation in health care

The relationships among leadership clarity (i.e., team members' consensual perceptions of clarity of and no conflict over leadership of their teams), team processes, and innovation were examined in health care contexts. The sample comprised 3447 respondents from 98 primary health care teams (PHCTs), 113 community mental health teams (CMHTs), and 72 breast cancer care teams (BCTs). The results revealed that leadership clarity is associated with clear team objectives, high levels of participation, commitment to excellence, and support for innovation. Team processes consistently predicted team innovation across all three samples. Team leadership predicted innovation in the latter two samples, and there was some evidence that team processes partly mediated this relationship. The results imply the need for theory that incorporates clarity and not just style of leadership. For health care teams in particular, and teams in general, the results suggest a need to ensure leadership is clear in teams when innovation is a desirable team performance outcome.     

Team Receptivity to Newcomers: Five Decades of Evidence and Future Research Themes

Reviews of research on newcomers mostly address socialization processes, focusing on individual adjustment. This article takes a different approach by examining the ways in which teams adapt to newcomers, indicating team receptivity. We review the empirical research published over the last five decades (1960–June 2012) that examines the antecedents of three team receptivity components—team reflection, team knowledge utilization, and newcomer acceptance—across different research disciplines and team settings. Drawing on this literature, we propose that team receptivity to newcomers can have positive consequences for sustained team performance, provided that team reflection and team knowledge utilization coincide with newcomer acceptance. We challenge scholars to tackle these three components simultaneously and provide methodological recommendations for doing so. To facilitate such efforts, we present a conceptual multi-level model specifying team, oldtimer, and newcomer characteristics that contribute to team receptivity and are amenable to managerial intervention.     

"I am stuck in meetings": Understanding the relation of CEO time management with TMT size and gender diversity

Time is a scarce resource, especially at the apex of firms. CEOs’ time management became a hot topic in recent academic and practice-oriented literature, which stressed the fact that CEOs are usually stuck in meetings. In this paper, I advance the nascent literature on the CEOs’ time management by focusing on the time the CEOs spend in meetings and on their choice of scheduling group meetings instead of bilateral meetings. Doing so, I study the relation of the CEOs’ time management with their top management team’s (TMT’s) size and gender diversity. Empirical analyses over a sample of 170 CEOs revealed a positive and significant relation between the size of the TMT and the time the CEOs spend in meetings with the top executives belonging to the TMT, while no significant relation emerged between the TMT’s gender diversity and the CEOs’ time in meetings. Conversely, while the TMT’s size does not significantly relate to the amount of time the CEOs spend in group meetings, a U-shaped relation emerged with the TMT’s gender diversity: the time spent in group meetings is higher when the TMT is homogeneous in gender, while CEOs prefer bilateral meetings when the TMT is heterogeneous.     

The Politics of ‘Social Accountability’ in England and Germany: Democratic Control and Moral Imperatives

This article investigates how politicians in England and Germany approach social accountability during the introduction of markets in the national health care systems. It analyses the discourse among members of parliament during the law making process of the 2012 NHS Health Care Act in England and the 2011 Act for Financing of Statutory Health Insurance in Germany. Generally, the new social accountability reform agenda is attractive to policy makers as it foregrounds public engagement and bottom-up participation (Peters 2001). Social accountability refers to institutional practices that favour participatory and horizontal mechanisms that depart from traditional hierarchical Principal-Agent forms.     

The Effects of Knowledge Management on Team Members' Ratings of Project Success and Impact*

Many organizations are trying to improve the generation and utilization of knowledge. The activities associated with these efforts are identified as organizational knowledge management (KM). While much has been written about knowledge management from the organizational level, the success of such efforts over the long run will depend upon on how KM activities impact important outcomes as perceived by those at the employee level who actually implement the activities. This study used the input‐process‐output framework of team effectiveness to investigate the relationship between selected KM‐related activities on integrated product and process development team members' satisfaction with their project's success and the impact they expected it to have on the organization. The results indicate that team‐level leadership and support (i.e., inputs), along with knowledge generation and dissemination (i.e., processes), are key drivers of member performance‐related ratings (i.e., outputs). Finally, and possibly most importantly, a number of interactions were evident suggesting that the KM processes moderate the effects of the KM inputs. These findings and their implications are discussed.     

不同主体层次中组织知识转化的影响因素研究

基于不同主体层次中组织知识转化的影响因素及其研究假设,采用向每个样本企业发放三份调查问卷的方式获得相关的数据,进行深入地实证分析发现:需求-激励-联系是影响组织知识转化的最主要因素,信任和学习起到一种调节及保障的作用,而我国企业的组织知识嵌入程度不高;不同所有制企业之间在组织知识转化影响因素上不存在显著差异,但是各主体层次中的知识转化过程差异性显著;需求-激励-联系和学习对各个主体层次中知识转化都具有显著的正向影响,信任对个人层次知识转化具有显著的正向影响,而对团队和组织层次知识转化没有显著影响,嵌入对各主体层次知识转化都没有任何的显著影响。