Interdisciplinary, functional approach to quality review

Dramatic changes in the standards of the Joint Commission on Accreditation of Healthcare Organizations, as part of its "Agenda for Change," pose new challenges for health care managers. The goal of the "Agenda for Change" is to focus accreditation on the actual performance of important functions while continuously stimulating improvement in the organization's performance and outcomes of care. In 1994, seven important functions--improvement of performance, leadership, management of information, assessment of patients, education of patients and families, operative and other procedures, and treatment of patients--were identified by JCAHO. Performance, as defined by JCAHO, can be measured through observing specific dimensions, such as, availability, safety, timeliness, effectiveness, continuity, efficiency, and respect and caring. These are considered important elements in the determination of quality, value, cost, and patient outcome. In 1995, JCAHO identified 11 important functions--patient rights and organizational ethics, assessment of patients, care of patients, education, continuum of care, improving organizational performance, leadership, management of the environment of care, management of human resources, management of information, and prevention and control of infection. In addition each institution has the opportunity to decide by prioritization where it wants to devote resources. This article reports on one hospital's response to the new JCAHO initiatives.     

Book Reviews

PRINCIPLES OF HEALTH RISK ASSESSMENT Paolo F. Ricci, Prentice-Hall, 1985, $50.00.
RISK THEORY: THE STOCHASTIC BASIS OF INSURANCE Third Edition, R. E. Beard, T. Pentikainen, and E. Pesonen, Metheun, Inc., 1984, $24.00 pb, $49.95 hb.
TOXICITY TESTING: NEW APPROACHES AND APPLICATIONS IN HUMAN RISK ASSESSMENT Li et al , (eds.) Raven Press, 1985, $47.00
TOXICOLOGICAL RISK ASSESSMENT Clayson et al , (eds.), CRC Press, 1985, $82.00.     

A Comparative Exposure Assessment of Campylobacter in Ontario,Canada

To inform source attribution efforts, a comparative exposure assessment was developed to estimate the relative exposure to Campylobacter, the leading bacterial gastrointestinal disease in Canada, for 13 different transmission routes within Ontario, Canada, during the summer. Exposure was quantified with stochastic models at the population level, which incorporated measures of frequency, quantity ingested, prevalence, and concentration, using data from FoodNet Canada surveillance, the peer‐reviewed and gray literature, other Ontario data, and data that were specifically collected for this study. Models were run with @Risk software using Monte Carlo simulations. The mean number of cells of Campylobacter ingested per Ontarian per day during the summer, ranked from highest to lowest is as follows: household pets, chicken, living on a farm, raw milk, visiting a farm, recreational water, beef, drinking water, pork, vegetables, seafood, petting zoos, and fruits. The study results identify knowledge gaps for some transmission routes, and indicate that some transmission routes for Campylobacter are underestimated in the current literature, such as household pets and raw milk. Many data gaps were identified for future data collection consideration, especially for the concentration of Campylobacter in all transmission routes.     

案例:对信雅达创新能力提升机制的研究

本案例以信雅达系统工程股份有限公司的13年发展过程为背景,通过为期九个月的蹲点调研的方式来跟踪企业创新的全过程,并采用深入访谈和二手资料收集的方式采集数据,进而分析其创新能力提升的动力机制.访谈对象的范围跨越公司决策层、管理层和执行层.我们认为,第一,创新具有全面性,企业绩效的提升需要以各要素能力的提升为基础;第二,政府政策、企业家、新产品开发、创新者、IT技术是企业创新能力的重要推动者;第三,企业的战略协调能力是企业创新能力提升的关键,战略、文化、技术、市场等要素之间的动态匹配程度决定了企业创新的效率和效果.     

Book Reviews

Book Reviewed in this Article:
Engineering Risk and Hazard Assessment Edited by Abraham Kandel and Eitan Avni Boca Raton, FL: CRC Press, Inc.
Applied Decision Support By Michael W. Davis Englewood Cliffs, NJ: Prentice Hall
Health Effects of Electric and Magnetic Fields: Research, Communication, Regulation International Utility Symposium Toronto, Canada: Electric Power Research Institute, Canadian Electrical Association, Edison Electric Institute, National Rural Electric Cooperative Association, Bonneville, Power Administration
Petroleum Hydrocarbons and Organic Chemicals in Ground Water: Prevention, Detection, and Restoration The Association of Ground Water Scientists and Engineers Dublin, OH: National Water Well Association
Fault Detection and Reliability: Knowledge Based and Other Approaches Edited by M. G. Singh, K. S. Hindi, G. Schmidt, and S. Tzafestas Oxford: Pergamon Press
Air Pollution, the Automobile, and Public Health Edited by Ann Y. Watson, Richard R. Bates, and Donald Kennedy Washington, D.C.: National Academy Press
Pollution Threat of Heavy Metals in Aquatic Environments By Geoffrey Mance London: Elsevier Applied Science     

全球化挑战与管理变革——第6届管理国际大会综述

简要介绍了第6届管理国际大会的概况,并以物流与运作管理,信息管理与电子商务,决策与优化,战略管理,营销管理,人力资源与组织行为学,财会与金融,宏观管理、政策与创新管理8个专题简要介绍了学术交流的内容。     

Health care futures. Part 2: The future of physician executives? Panel discussion

What is the future of health care in America? This is Part 2 of The Physician Executive panel discussion that explores the future of health care in America. To narrow this ambitious focus somewhat, the future is defined as five to 10 years hence. In Part 1, which was published in the May/June issue, Russell C. Coile, Jr., Barbara LeTourneau, MD, MBA, FACPE, James Reinertsen, MD, Uwe Reinhardt, PhD, Marshall Ruffin, MD, MPH, MBA, FACPE, and David Vogel, MS, shared their opinions about what the future holds in managed care, information technology, and biotechnology. In Part 2, Susan Cejka, Barbara LeTourneau, MD, MBA, FACPE, John Henry Pfifferling, PhD, Uwe Reinhardt, PhD, and James Todd, MD, share their views on the future of medical education and physician executives.     

Barriers to green innovation initiatives among manufacturers: the Malaysian case

This study investigated the internal and external barriers to green innovation initiatives among Malaysian manufacturers. Data was gathered through a survey of 153 manufacturing companies in Malaysia. Data was analyzed using the partial least squares technique. Results indicated that the barriers to green products, processes, and systems innovations are different. Issues of environmental resources, attitude and perception, business practices, government support, and customer demand were found to be the barriers to green product innovations, whereas attitude and perception, business practices, poor external partnerships, insufficient information, lack of customer demand, and environmental commercial benefits were determined to be the factors that negatively affect green process innovations. As regards green system innovation, environmental resources, attitude and perception, business practices, technical barriers, government support, and environmental and commercial benefits presented themselves as the internal and external barriers that need to be addressed. The results have important implications for managers of manufacturers that have plans of promoting green products, processes, and system innovations.     

基于XML的通用关联规则挖掘应用模式

本文分析了关联规则挖掘应用中在通用性、用户简易性以及可扩展性方面所面临的一些困难,提出了一种基于XML的通用关联规则挖掘应用模式。该模式充分利用了XML在自描述能力、异质系统数据交换能力以及可扩展性方面的优势,提供了一个模块化、易于集成、适合于最终用户使用的应用框架。     

An Integrated Approach to Oversight Assessment for Emerging Technologies

Analysis of oversight systems is often conducted from a single disciplinary perspective and by using a limited set of criteria for evaluation. In this article, we develop an approach that blends risk analysis, social science, public administration, legal, public policy, and ethical perspectives to develop a broad set of criteria for assessing oversight systems. Multiple methods, including historical analysis, expert elicitation, and behavioral consensus, were employed to develop multidisciplinary criteria for evaluating oversight of emerging technologies. Sixty‐six initial criteria were identified from extensive literature reviews and input from our Working Group. Criteria were placed in four categories reflecting the development, attributes, evolution, and outcomes of oversight systems. Expert elicitation, consensus methods, and multidisciplinary review of the literature were used to refine a condensed, operative set of criteria. Twenty‐eight criteria resulted spanning four categories: seven development criteria, 15 attribute criteria, five outcome criteria, and one evolution criterion. These criteria illuminate how oversight systems develop, operate, change, and affect society. We term our approach “integrated oversight assessment” and propose its use as a tool for analyzing relationships among features, outcomes, and tradeoffs of oversight systems. Comparisons among historical case studies of oversight using a consistent set of criteria should result in defensible and evidence‐supported lessons to guide the development of oversight systems for emerging technologies, such as nanotechnology.     

Book Reviews

Book Review in this article:
Petroleum Contaminated Soils, Vol. 1: Remediation Techniques, Environmental Fate, Risk Assessment Edited by Paul T. Kostecki and Edward J. Calabrese Chelsea, Michigan: Lewis Publishers, 1989 260 pp, $55.50 hb
Managing Industrial Hazardous Waste: A Practical Handbook Gary Lindgren Chelsea, Michigan: Lewis Publishers, 1989 350 pp., $59.95 hb
Risk Analysis Section, Oak Ridge National Laboratory, Chinn Building, MS-6492, Oak Ridge, Tennessee 37831.
Health Effects of Drinking Water Treatment Technologies Drinking Water Health Effects Task Force Chelsea, Michigan: Lewis Publishers, 1989 145 pp., $37.50
Chemical Hazards in the Workplace Ronald M. Scott Chelsea, Michigan: Lewis Publishers, 1989 196 pp., $39.95
Environmental Chemistry and Toxicology of Aluminum Edited by Timothy E. Lewis Chelsea, Michigan: Lewis Publishers, 1989 344 pp., $59.95 hb
Light Water Reactor Safety Bengt Pershagen New York: Pergamon Press, 1989 470 pp., $90.00
Biologically Based Methods for Cancer Risk Assessment Edited by Curtis C. Travis New York: Plenum Press, 1989 355 pp.
Social Decision Methodology for Technological Projects Edited by Charles Vlek and George Cvetkovich Boston: Kluwer Academic Publishers, 1989 343 pp., $87.00     

Coopetition,value co-creation,and knowledge-enhancement in the UK alpaca industry: A multi-level mechanism

Notwithstanding the increasing interest in coopetition, relevant research is still composed of loosely connected themes with little contextual focus. Little attention has been paid to explain coopetition at multiple stages and levels, in various industries, and between micro-firms. This paper addresses these gaps by proposing a multi-level mechanism, unravelling the relationship between coopetition management, value co-creation, knowledge-enhancement, and superior performance achievement in micro-businesses. Using qualitative methods, we look at the non-high tech alpaca industry. Results reveal that the successful coopetition management in various coopetition stages, at an individual, organizational, and industry level, leads to value co-creation, knowledge-enhancement, and to the VRIO resources development, and thus drive positive outcomes for the individuals and organizations engaged and for the industry as a whole. This mechanism is influenced by industrial, market, and institutional factors.     

社会转型风险的衡量方法与经验研究(1993～2004年)

中国在经历迅速的转型与发展的同时,也正步入一个高风险时代。本文从简要评述人类社会风险的历时变迁入手,从社会紧张、社会脆弱和社会不安全3个维度界定中国正在经历的“社会转型风险”,构建了衡量社会转型风险的指标体系,并利用层次分析法(AHP)确定各类指标的权重,基于统计年鉴和相关文献提供的数据,具体计算了1993～2004年间的社会转型风险指数,发现这期间社会风险的平均增长速度快于经济增长,尤以社会不安全指数的增长最快,但近年来增速呈现下降趋势,在未来几年可能在高位进入“平台期”。最后,作者结合转型期中国社会的一些新特点,从5个方面简要讨论了中国在转型期社会风险快速增长的发生机制。     

The Roads Ahead: Collision Risks, Trends, and Safety of Drivers

The propensity of fatal traffic collisions transcends driver age and reinforces the need to evaluate, among other factors, the impact of roadway lighting and other features of driver vision, perception, and performance. Collisions may result from a driver's inability to notice delineation, recognize warnings, and other possible road safety controls during various lighting conditions. Hence we compare the relative accident involvement ratio (RAIR) of collisions of millions of drivers from two U.S. States over an 11-year period, 1991–2001. We associate collision trends through RAIR with bathtub curves that are commonly identified with product failure and reliability engineering. Hence we observe the need for improved and automated driver's license testing techniques and applications, especially as these relate to the visual and cognitive abilities of drivers of all ages. Our findings may ultimately improve motorist safety, save lives, and benefit numerous other states, countries, and agencies, including, but not limited to, aviation, commercial vehicles, maritime, and rail sectors, among others.     

管理研究与实践脱节的原因以及应对策略

管理研究与管理实践脱节最近引起研究者的强烈关注。它是指管理研究所得出的发现,或发展出来的理论并没有在具体实践之中得到有效应用。论文将其归纳为无关型、超脱型、应用型、传递型、落后型五种类型的脱节,并对脱节的原因进行了深入分析。我们认为,建立合理的管理研究成果评价机制、进行以问题和变革驱动的情境化研究、综合运用多种研究范式、成立跨学科的研究机构、建立有效的科学研究共同体、建立学术知识转化机制、强化研究的规范性,将是弥合管理研究与实践距离的有效对策。     

基于信息度量的企业组织系统协同性评价

提出组织协同性一些新的概念和理论;建立了评价组织协同性指标体系;定义了企业组织系统固有协同性、应变协同性、管理层次、管理跨度、关系集合结构、关系水平、协同跨度、协同轨迹、协同机制、协同方式、协同职能幅度、职能凝聚度、协同效率等协同性参量.同时应用管理熵理论的基本原理,拓展了复杂性理论结构学派的研究方法应用于组织系统协同性运行度量尺度建模、量化评价、理论方法研究,从协同结构、协同方式和协同功能等多维度建立协同性熵信息评价数学模型,给出适应于非同维度协同问题求解的降维方法,并结合企业协同管理活动进行了应用与实证研究.     

Rating Threat Mitigators: Faith in Experts,Governments, and Individuals Themselves to Create a Safer World

This research explores public judgments about the threat-reducing potential of experts, individual behavior, and government spending. The data are responses of a national sample of 1225 to mail surveys that include measures of several dimensions of public judgments about violent crime, automobile accidents, hazardous chemical waste, air pollution, water pollution, global warming, AIDS, heart disease, and cancer. Beliefs about who can best mitigate threats are specific to classes of threats. In general, there is little faith that experts can do much about violent crime and automobile accidents, moderate faith in their ability to address problems of global warming, and greater expectations for expert solutions to the remaining threats. People judge individual behavior as effective in reducing the threats of violent crime, AIDS, heart disease, and automobile accidents but less so for the remaining threats. Faith in more government spending is highest for AIDS and the other two health items, lowest for the trio of violent crime, automobile accidents, and global warming, and moderate for the remaining threats. For most threats, people are not distributed at the extremes in judging mitigators. Strong attitudinal and demographic cleavages are also lacking, although some interesting relationships occur. This relative lack of sharp cleavages and the generally moderate opinion indicate ample opportunity for public education and risk communication.     

Vertical Integration under Competition: Forward,Backward, or No Integration?

We consider two competing supply chains, each consisting of supplier, a manufacturer, and a retailer. The suppliers exert effort to improve product quality, and the retailers sell products competitively. Each manufacturer chooses one of the three strategies: forward integration, backward integration, or no vertical integration. We seek for a subgame perfect Nash equilibrium and study the resulting market structure. Moreover, we characterize the effect of vertical integration on profitability, product price, and quality in a competitive setting. Existing literature has shown that, when manufacturers consider only forward integration, they may choose not to vertically integrate in equilibrium. In contrast, we find that, when both forward and backward integration options are considered, disintegration cannot be an equilibrium outcome. In this case, both manufacturers either forward or backward integrate, and the degree of product perishability, cost of quality, and how much consumers value quality are critical for the chosen direction of integration. Furthermore, competition increases attractiveness of backward integration relative to forward integration. We show that, while integrating backward unilaterally is always beneficial, unilateral forward integration can harm a manufacturer's profitability. Finally, vertical integration can result in a better quality product sold at a lower price.     

Ethics,character, and authentic transformational leadership behavior

The morality of transformational leadership has been sharply questioned, particularly by libertarians, “grass roots” theorists, and organizational development consultants. This paper argues that to be truly transformational, leadership must be grounded in moral foundations. The four components of authentic transformational leadership (idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration) are contrasted with their counterfeits in dissembling pseudo-transformational leadership on the basis of (1) the moral character of the leaders and their concerns for self and others; (2) the ethical values embedded in the leaders' vision, articulation, and program, which followers can embrace or reject; and (3) the morality of the processes of social ethical choices and action in which the leaders and followers engage and collectively pursue.The literature on transformational leadership is linked to the long-standing literature on virtue and moral character, as exemplified by Socratic and Confucian typologies. It is related as well to the major themes of the modern Western ethical agenda: liberty, utility, and distributive justice Deception, sophistry, and pretense are examined alongside issues of transcendence, agency, trust, striving for congruence in values, cooperative action, power, persuasion, and corporate governance to establish the strategic and moral foundations of authentic transformational leadership.     

New governance for a new era: issues and challenges for integrating systems

In this second part of a two-part column, Dr. Ruffin provides greater detail on seven key factors that he believes will govern the operations of integrated systems. Successful systems, he says, will be those that attract and retain physicians, have disciplined governance, integrate care through sharing of information among system elements, conserve capital, ensure strategic growth, control costs, and are proficient at processing information. It is important to understand, he says, that, in the movement from a fee-for-service payment mechanism, in which the various elements of the health care field bill for their services independently and according to rules designed for their benefit, to an integrated system, in which such independence can only lead to chaos, very substantial changes will be required in the governance of our health care institutions and organizations.