Medicine, management, and me.

What is medical management? How do you learn about it? How do you get into it? Is there a future in it? Is medical management for you? Can you do it? What will it mean to your original plans for your life in medicine? Is it worth the sacrifice? Get comfortable. I have a story to tell you. It may help if you hear about medical management from a medical director who has preceded you. I doubt I can answer all your questions. I can, however, tell you about one physician's visions, expectations, decisions, experiences, and rewards from what can be loosely called "medical management." If you find something of help in your decision making in this account, my telling it is worthwhile.     

What physician executives and health care organizations should expect from each other

Today, interest in defining the role of the physician executive and ensuring this individual is effectively integrated into the organization is high for good reason--the ranks of physician executives are growing. What attributes should health care organizations look for when hiring physician executives and what should they should expect of them once they are on the job? Physician executives should: (1) have demonstrated clinical and management skills; (2) have a comfort level with participatory decision-making; (3) have superb interpersonal skills; and (4) be a champion of the patient. Physician executives should expect the following support from their organizations: (1) varied roles and responsibilities; (2) mentoring by other senior executives; (3) lifelong learning opportunities; and (4) complete support of the management team.     

Complementary and alternative medicine. The daunting challenge.

There is no question that the past few years have seen a tremendous surge in interest in what has come to be known as complementary and alternative medicine (CAM). Health plans contemplating adding CAM benefits face a daunting challenge. How should a plan define CAM benefits? How should a plan define appropriate CAM providers? How can these benefits be managed? Will the addition of CAM benefits undermine coverage policies for conventional biomedicine? The answer to these questions lies largely in uncharted waters, as even CAM advocates will agree that many alternative therapies (even those like Oriental medicine which has been in practice for some 5,000 years) have not yet undergone the type of rigorous, evidence-based analysis that is required to validate conventional biomedicine. This article explores options for CAM benefit design by considering two basic approaches-creating an uninsured benefit or insured benefit.     

The importance of data warehouses for physician executives

Soon, most physicians will begin to learn about data warehouses and clinical and financial data about their patients stored in them. What is a data warehouse? Why are we seeing their emergence in health care only now? How does a hospital, or group practice, or health plan acquire or create a data warehouse? Who should be responsible for it, and what sort of training is needed by those in charge of using it for the edification of the sponsoring organization? I'll try to answer these questions in this article.     

Physician leadership. Physician executives share insights

Senior physician executives were asked to share their insights about how the medical management field has evolved. The Physician Executive Management Center, a Tampa, Florida-based search firm, has been surveying senior physician executives each year for the past decade. This year's report on physician executive compensation and duties in hospitals, managed care organizations, and group practices provides an excellent picture of the growth of the profession, as well as a broad perspective of anticipated changes for the future of medical management. The respondents addressed the following questions: What are the skills necessary for success? How have their jobs changed over the years? Have they made the right choice in pursuing medical management careers?     

Coaching im Mittelstand – Wer ist der Mittelstand?

Medium-Sized companies usually have a specific organizational structure and corporate culture. This has implications for Human Resource Management, which is less systematized in medium-sized companies in comparison to larger organizations. What does ?medium-sized business“ mean and who is meant with that? Which typical values form its culture? What are the specific conditions for coaching in medium-sized businesses? Does a coach need special qualifications for this sector? This paper attempts to answer these questions and stays close to the everyday business of medium-sized companies. Concrete Examples will explain specific topics and coaching solutions for medium-sized businesses.     

Artificial Intelligence for Natural Hazards Risk Analysis: Potential,Challenges, and Research Needs

Artificial intelligence (AI) methods have seen increasingly widespread use in everything from consumer products and driverless cars to fraud detection and weather forecasting. The use of AI has transformed many of these application domains. There are ongoing efforts at leveraging AI for disaster risk analysis. This article takes a critical look at the use of AI for disaster risk analysis. What is the potential? How is the use of AI in this field different from its use in nondisaster fields? What challenges need to be overcome for this potential to be realized? And, what are the potential pitfalls of an AI-based approach for disaster risk analysis that we as a society must be cautious of?     

Head for open space

Is it possible that the herd mentality, the "Follow The Other Guy" idea is not the golden road to transformation? In fact, the three questions that are most helpful in deciding your path, as a person or an organization, lie almost completely in the other direction: (1) "What am I really good at?" (2) "What am I afraid of?" and (3) "What is no one else doing?" Heading for the open space means looking for the hole in the market, searching for what no one else is doing. Only by going toward open space can you or your organization stay ahead of the pack in a turbulent health care environment. Get out in front of the pack, either as a leader or quarry, and you have a measure of control. How does the quarry control the pack that is hunting it? By choosing the terrain, choosing the ground on which the chase will take place.     

Shades of Grey: Guidelines for Working with the Grey Literature in Systematic Reviews for Management and Organizational Studies

This paper suggests how the ‘grey literature’, the diverse and heterogeneous body of material that is made public outside, and not subject to, traditional academic peer‐review processes, can be used to increase the relevance and impact of management and organization studies (MOS). The authors clarify the possibilities by reviewing 140 systematic reviews published in academic and practitioner outlets to answer the following three questions: (i) Why is grey literature excluded from/included in systematic reviews in MOS? (ii) What types of grey material have been included in systematic reviews since guidelines for practice were first established in this discipline? (iii) How is the grey literature treated currently to advance management and organization scholarship and knowledge? This investigation updates previous guidelines for more inclusive systematic reviews that respond to criticisms of current review practices and the needs of evidence‐based management.     

Designing computer models that work

The techniques of financial modelling are becoming more popular and accepted as a useful information processing tool. However, what is ‘financial modelling’ and does the term adequately describe current applications? Why has financial modelling been such a growth area and what are the benefits? Given a desire to build models, where does the manager begin? What type of system and language should be used and by whom? What type of computing facility is most suitable? Which modelling system should be selected and what features are important? As well as an increase in the number of financial modelling applications they are now more complex. What guidelines can one use when designing large and complex models? This article seeks to answer these questions, concentrating on the large and more complex models, particularly for long term planning and budgeting applications. Finally an example is given illustrating how a large modelling system can be constructed and maintained with little technical computer expertise.     

Life after retirement. Interview by Barbara J. Linney

Are you thinking about retirement? Here are interviews with four physician executives who have made the transition. Some are recently retired, while others have been retired for many years. The good news is that all of them are productive and exploring interests and hobbies that their careers had taken precedence over. All of them were asked the following: (1) How have you felt about retirement? (2) What are some interesting things you've done? (3) What advice would you give to others who are planning for it?     

Strategic planning in a turbulent international environment

What we have argued in this paper is that fundamental changes in the multinational corporate environment are taking place raising proaches to multinational environmental surveillance and multinational strategic management. We arenot offering this as a forecast of what the future will bring. Instead, we are proposing this framework to point to the need for greater environmental orientation and adaptation. MNCs are now in a double squeeze and managers must unlearn past models and criteria to understand problem. But the challenge is more than conventional corporate planning. The problematique can be decribed as one of multinational strategic management. In the area of environment we need research and learning to address three basic questions:What is the MCE? What concepts of the environment should be considered for strategic management? What parameters should be monitored? What are some consequences of the concept of interdependence and turbulence?What multinational environmental surveillance should be done? What methodologies are needed? How can these be made operational? How can the corporation be educated to behave in the new mode required in view of these changes?What new strategic issues and challenges lenges emerges from the MCE? What new demands must be factored into the multinational corporate planning processes? What new content does the changing environment procedure? How can the broadening field of opportunities and threats be systematically mapped and understood?     

Watching the falling barometer

How can physician executives create a vision, a strategy, in the face of such overwhelming forces for change? The answer has two pieces. The first is the Weather Channel: scanning the future for warning, for opportunities, for new business possibilities. The second leads us to such questions as: What is your situation? Financially? In market terms? It leads us, as well, back to the question: For you and your institution, what is your reason for being in this business? In other words, what is your foundation? If you can become clear about who you are and what you are here for in the long run, and match that with some sense of the technologies and the political and financial pressures headed your way, then you can begin to create a vision of a future that works for you. In the coming years, we will begin to create entire new ways of doing health care, new roles for hospitals, new types of medicine--and the time to begin the creation is now. If you wait until the hurricane hits, it will be too late.     

Trade Dynamics in the Market for Federal Funds

We develop a model of the market for federal funds that explicitly accounts for its two distinctive features: banks have to search for a suitable counterparty, and once they meet, both parties negotiate the size of the loan and the repayment. The theory is used to answer a number of positive and normative questions: What are the determinants of the fed funds rate? How does the market reallocate funds? Is the market able to achieve an efficient reallocation of funds? We also use the model for theoretical and quantitative analyses of policy issues facing modern central banks.     

The new look of office politics

Is a sea change occurring in the organizational politics of health care institutions? How is information informally spread throughout the office? It used to be that gossip was the vehicle by which employees learned much about the organization's culture and news. But now, organizations are characterized by a growing faction of staff who are emotionally detached and have a "day-laborer" mentality. The grapevine is not as effective as it once was. Non-participation includes ignoring the grapevine both as listener and feeder. What implications does this have for your organization?     

Vulnerability,Risk Perception,and Health Profile of Marginalized People Exposed to Multiple Built‐Environment Stressors in Worcester,Massachusetts: A Pilot Project

Millions of low‐income people of diverse ethnicities inhabit stressful old urban industrial neighborhoods. Yet we know little about the health impacts of built‐environment stressors and risk perceptions in such settings; we lack even basic health profiles. Difficult access is one reason (it took us 30 months to survey 80 households); the lack of multifaceted survey tools is another. We designed and implemented a pilot vulnerability assessment tool in Worcester, Massachusetts. We answer: (1) How can we assess vulnerability to multiple stressors? (2) What is the nature of complex vulnerability—including risk perceptions and health profiles? (3) How can findings be used by our wider community, and what lessons did we learn? (4) What implications arise for science and policy? We sought a holistic picture of neighborhood life. A reasonably representative sample of 80 respondents captured data for 254 people about: demographics, community concerns and resources, time‐activity patterns, health information, risk/stress perceptions, and resources/capacities for coping. Our key findings derive partly from the survey data and partly from our experience in obtaining those data. Data strongly suggest complex vulnerability dominated by psychosocial stress. Unexpected significant gender and ethnic disease disparities emerged: notably, females have twice the disease burden of males, and white females twice the burden of females of color (p < 0.01). Self‐reported depression differentiated by gender and age is illustrative. Community based participatory research (CBPR) approaches require active engagement with marginalized populations, including representatives as funded partners. Complex vulnerability necessitates holistic, participatory approaches to improve scientific understanding and societal responses.     

Procedural Justice in Procurement Management and Inclusive Interorganizational Relations: An Institutional Perspective

This paper applies the concept of procedural justice to one of the most important focal points of interorganizational relations: the purchaser–supplier relationship. The few extant studies of the concept in the purchaser–supplier domain have overlooked an important aspect of this key relationship: that is, inclusiveness in procurement. This is despite the fact that interest in the specific empirical context of supply chain links between large purchasing organizations (LPOs) and ethnic minority suppliers (EMSs) from disadvantaged communities proceeds apace on both sides of the Atlantic. Institutional theory is used to examine the form that procedural justice takes in eight case studies of LPOs from the private and public sectors, which actively engage with inclusive procurement management initiatives in England. The guiding question is twofold: ‘What may LPO approaches to installing procedural justice in procurement management entail?’ and ‘How are these approaches shaped?’ This paper identifies specific approaches to installing procedural justice for inclusive procurement and submits theoretical propositions about how these are shaped. The study contributes to a macro‐level assessment of procedural justice, i.e. interorganizational procedural justice, as a significant aspect of inclusive interorganizational relationships, which is a domain in need of theoretical development.     

Health data privacy

How can the tradition of patient-provider confidentiality be preserved and still meet the changing information needs of insurers, employers, public health agencies, policy analysts, and researchers? As countries grapple with the issue of a patient's right to medical record privacy, actions that the U.S. takes in this area will set precedents and have implications for nearly every health care electronic transaction. The Health Insurance Portability and Accountability Act requires the Secretary of Health and Human Services (HHS) to recommend standards for electronic financial and administrative transactions. The HHS focused on the confidentially of patient's health care information, guided by five principles in developing recommendations: (1) Boundaries; (2) Security; (3) Consumer Control; (4) Accountability; and (5) Public Responsibility.     

6 Pay and Performance: Individuals,Groups, and Executives

Abstract

In this chapter, we address three pay for performance (PFP) questions. First, what are the conceptual mechanisms by which PFP influences performance? Second, what programs do organizations use to implement PFP and what is the empirical evidence on their effectiveness? Third, what perils and pitfalls arise on the way from PFP theory to its execution in organizations? We address these questions in general terms, but also highlight unique issues that arise in PFP for teams and for executives. We highlight the fact that research and practice in the area of PFP requires one to deal with a number of trade‐offs. For example, strengthening PFP links can generate powerful motivation effects, but sometimes these are in unintended and unanticipated directions, resulting in undesirable effects. In addition, there are also trade‐offs in deciding the degree of emphasis to give to individual versus team performance and to results versus behaviors in PFP plans. What all this means is that, as in other areas of management, “one best way” advice (e.g., do or do not use individual PFP plans) or “sound‐bite” conclusions (e.g., PFP does not exist; PFP does or does not motivate) are rarely valid, but rather depend on the circumstances and the organization. In the realm of executive pay, we question the current conventional wisdom in the management literature that there is little or no PFP. We close the chapter with a discussion of our key conclusions and suggestions for what we think would be the most interesting and useful future research areas. We encourage the management literature, which has increasingly become interested in the concept of evidence‐based management, to execute this concept more effectively in its research and when talking or writing about pay.     

Job Losses,Unemployment Duration and New Jobs in Spain

Abstract. This article focuses on workers who permanently lost their jobs for involuntary reasons in Spain. We use a 1985 representative survey of the Spanish labor force containing retrospective questions related to workers' mobility. We evaluate several characteristics of job losers, as compared to other unemployed workers with experience by the end of 1985. Thereafter, an analysis of job losses addresses the following questions: (1) What types of jobs were lost? (2) How did workers perform after their job loss? (3) How long have they been out of work? (4) What are the characteristics of the new jobs found?