Lonely at the top and loving it: physicians as CEOs

As little as five years ago, most hospital board members scoffed at the idea of hiring physicians as chief executive officers or chief operating officers. Physicians, they maintained, belonged at the bedside, not in the board room. For the most part, physicians didn't take issue with this thinking. Profit and loss statements, strategic planning, and other CEO duties were alien. Besides, being a "suit" was unconscionable, a total fall from the true grace of medicine: patient care. Dramatic changes in health care have wrought dramatic changes in the mindsets of both board members and physicians. Today, both sides have developed a new perspective on physicians in top hospital administrative positions. In this article, the author reports on the experiences of physician executives who have made the trip to the top.     

Implementing a quality assessment program

It is difficult to imagine a more stressed organization than today's hospital. If the scope of change is not a sufficient challenge, the rate of the change is staggering, especially in quality assessment. Now we are poised for continuous quality improvement, whereby outcomes identified by quality assessment become the focus for system and process review and modification. It is imperative that a good quality assessment program be in place before implementing and integrating a continuous quality improvement process. The purpose of this article is to show how a quality assessment system can be implemented in a community hospital, regardless of size or scope of services. Key to the process is making all staff members part of the system's development and operation.     

Risk, Statistical Inference, and the Law of Evidence: The Use of Epidemiological Data in Toxic Tort Cases

Toxic torts are product liability cases dealing with alleged injuries due to chemical or biological hazards such as radiation, thalidomide, or Agent Orange. Toxic tort cases typically rely more heavily than other product liability cases on indirect or statistical proof of injury. There have been numerous theoretical analyses of statistical proof of injury in toxic tort cases. However, there have been only a handful of actual legal decisions regarding the use of such statistical evidence, and most of those decisions have been inconclusive. Recently, a major case from the Fifth Circuit, involving allegations that Benedectin (a morning sickness drug) caused birth defects, was decided entirely on the basis of statistical inference. This paper examines both the conceptual basis of that decision, and also the relationships among statistical inference, scientific evidence, and the rules of product liability in general.     

Management leadership and productivity improvement programs

The intent of this empirical research is to identify the critical factors that are potentially fatal to productivity improvement programs and to analyze these factors relative to management leadership concepts. From this analysis we determine that these “fatal” factors can be prevented by the pre-existence of a leadership-based program that requires participative involvement of all members of an organization through good performance measurement and a sound reward system.     

My network,my self: A social network approach to work-based identity

As the organizational landscape becomes increasingly turbulent and the gig economy grows, the conventional anchors for a work-based sense of identity – a relatively stable organization, workgroup, and occupation – are losing relevance. We argue that a “network identity,” defined as the core, distinctive, and more or less enduring character of a set of social ties (e.g., “we are high-achievers”), helps fill this growing void because individuals’ networks often reflect agency and have more or less fluid boundaries and portability. These attributes enable individuals to develop or join networks that may transcend specific contexts and adapt to change. An individual’s network identity simultaneously implicates all three levels of self – individual, relational, and collective – such that it is a potentially very powerful means for realizing his or her identity motives. Crossing the dimensions of network boundary strength and network density, we offer a 2 × 2 typology of networks and discuss their implications for members’ network identities and what kinds of individuals might prefer each network.     

企业失败预测模型研究——来自台湾的证据

以台湾上市公司公开的财务比率数据,探讨财务比率之间的领先和滞后情况,以期修正过去财务危机文献所忽略的时间落差因素.根据领先变量和滞后变量建构上市公司财务危机预测模型,以期由模型的预测为政府、监督机关、投资人和债权人探讨台湾资本市场发生财务危机提供一个参考.实证结果显示,标准化数据(考虑产业因素)比非标准化数据(未考虑产业因素)更具预测能力,故在进行财务危机方面预测性研究时应将产业因素予以控制或消除;负债比率和营业利益率是两个最早期用于判别的领先指标,若仅以这两个指标预测公司的状况,则在发生危机的前一季,其准确率可以高达 90%; 若加入流动比率、存货周转率、总资产周转率和现金流量比率综合观察,则在危机发生前一季时,可有 95% 的高预测能力.     

Dialectical contradictions experienced when a loved one is dying in a hospital setting

A family member who is present when a loved one is dying in a hospital setting may be profoundly affected by interactions with others in that setting, including the dying person. Interaction shapes how one experiences a loved one's death and dying. Framed in relational dialectics theory, this qualitative case study describes dialectical contradictions I experienced in the context of my grandmother dying in a hospital setting. Personal journals were analyzed, with three primary dialectics being identified: certainty-uncertainty, control-lack of control, and autonomy-connection. Understanding dialectical contradictions experienced by a family member when a loved one is dying in a hospital setting could lead to enhanced support services for family members.     

The right-to-die movement: extrapolating from the National Hemlock Society U.S.A. membership survey

A national membership survey of Hemlock Society USA was conducted by Fox and Kamakahi (1995). Respondents (N=6398) were asked a variety of questions, but in this paper we perform a longitudinal analysis of the characteristics of Hemlock Society USA members. Hemlock Society USA members are divided into three 5-year cohorts: Early Joiners (11 or more years of membership), Middle Joiners (6 to 10 years membership), and Late Joiners (5 or fewer years of membership). Differences between cohorts are examined and extrapolations made regarding Hemlock Society USA and the Right-to-Die Movement. A series of one-way ANOVAs were used with Scheme post-hoc comparisons as heuristic tools for assessing between-cohort differences. Late Joiners are different from earlier members, but are more like other Hemlock Society USA members than the adult U.S. population at large. Hemlock Society USA members are essentially societal "elites" (based on socio-demographic variables) who work in social environments that are decidedly split on the issue of voluntary suicide and euthanasia.     

Examining Pathways from Innovation Orientation to Patient Satisfaction: A Relational View of Healthcare Delivery*

The federal government and industry leaders view innovation as a potentially fruitful way to improve hospital performance, specifically patient satisfaction. However, translating a hospital's innovation orientation into improved performance is challenging given that important network participants—namely physicians—may possess different aims. Grounded in Relational RBV, this study tests a model linking innovation orientation to patient satisfaction through a pathway of knowledge‐sharing routines (physician partnering and customer relationship management) and complementary capabilities (hospital responsiveness). Further, this study investigates the moderating role of physician employment (a form of governance) by examining hospitals with high and low levels of employed physicians. Structural Equation Modeling results from a paired sample of primary survey and secondary data from 173 acute care hospitals in the USA reveal the following. Hospitals with high levels of employed physicians translate innovation orientation into patient satisfaction by using customer relationship management (CRM) programs to influence hospital responsiveness directly, ultimately leading to patient satisfaction. Hospitals with low levels of physician employment use CRM programs in a fully mediated fashion to inform physician partnering activities, which influence hospital responsiveness, driving patient satisfaction.     

The Economic Value of a Sustainable Supply Chain

The economic rationale to operate a global supply chain in a sustainable manner is developed. Arguments are made based on marketing, finance, and production theories that by engaging in socially responsible behavior the firm will increase sales, decrease costs, reduce financial risk, and increase profits, which will ultimately increase returns to the firm's shareholders. A model is developed of the mechanism by which modern production methods such as lean production and quality management result in sustainable corporate behavior that, in the long run, translates into higher stock valuations. The production effects cause marketing and financial risk effects that are complementary, and all three channels of influence synergistically result in higher stock values in the model. These effects also provide important benefits to other stakeholders of the firms including employees, customers, the environment, and the community. An important ethical issue in global supply chains is working conditions in foreign plants often leading to allegations of sweatshop labor conditions. This issue is used to illustrate how lean production practices can affectconsumers, employees, and financial risk. Conclusions from the sweatshop labor issue are shown to apply to other sustainability issues as well.     

Keeping partners together: algorithmic results for the hospitals/residents problem with couples

The Hospitals/Residents problem with Couples (HRC) is a generalisation of the classical Hospitals/Residents problem (HR) that is important in practical applications because it models the case where couples submit joint preference lists over pairs of hospitals (h _i ,h _j ). We consider a natural restriction of HRC in which the members of a couple have individual preference lists over hospitals, and the joint preference list of the couple is consistent with these individual lists in a precise sense. We give an appropriate stability definition and show that, in this context, the problem of deciding whether a stable matching exists is NP-complete, even if each resident’s preference list has length at most 3 and each hospital has capacity at most 2. However, with respect to classical (Gale-Shapley) stability, we give a linear-time algorithm to find a stable matching or report that none exists, regardless of the preference list lengths or the hospital capacities. Finally, for an alternative formulation of our restriction of HRC, which we call the Hospitals/Residents problem with Sizes (HRS), we give a linear-time algorithm that always finds a stable matching for the case that hospital preference lists are of length at most 2, and where hospital capacities can be arbitrary.     

The dysfunctions of power in teams: A review and emergent conflict perspective

We review the new and growing body of work on power in teams and use this review to develop an emergent theory of how power impacts team outcomes. Our paper offers three primary contributions. First, our review highlights potentially incorrect assumptions that have arisen around the topic of power in teams and documents the areas and findings that appear most robust in explaining the effects of power on teams. Second, we contrast the findings of this review with what is known about the effects of power on individuals and highlight the directionally oppositional effects of power that emerge across different levels of analysis. Third, we integrate findings across levels of analysis into an emergent theory which explains why and when the benefits of power for individuals may paradoxically explain the potentially negative effects of power on team outcomes. We elaborate on how individual social comparisons within teams where at least one member has power increase intra-team power sensitivity, which we define as a state in which team members are excessively perceptive of, affected by, and responsive to resources. We theorize that when power-sensitized teams experience resource threats (either stemming from external threats or personal threats within the team), these threats will ignite internal power sensitivities and set into play performance-detracting intra-team power struggles. This conflict account of power in teams integrates and organizes past findings in this area to explain why and when power negatively affects team-level outcomes, and opens the door for future research to better understand why and when power may benefit team outcomes when power’s dark side for teams is removed.     

交互式多属性群决策评价方法研究

针对多属性群决策中属性指标权重的确定,将群体看作由多个被评价且参与权重决策的独立成员组成,提出一种交互式迭代算法,以均等属性权重为起点进入迭代过程,每一次迭代在当前给定的权重参数下求解含参规划模型并计算得到新的权重参数。迭代过程终止于任一群成员在相邻两次迭代的参数权重下加权综合属性值的绝对差异控制在非阿基米德无穷小量以内,此时使用的参数权重即为各属性的最优权重。实际迭代计算过程以及属性指标权重由所有群体成员共同参与和决定,故可以认为最终优化和选择结果为绝大部分成员所接受并满意。通过一个算例以及一个关于研发项目选择的实例,说明该交互式群决策评价方法的可行性和有效性。     

Teamsupervision mit variablen Settings

Team supervision in varying settings The author describes a team supervision regarding the question, whether it is meaningful to work with a team in supervision always as a total or in varying settings, if required by spicific situations. Sometimes, team members of different levels may more easily discuss their problems in an open way, if there is at first the opportunity of an interchange on an equal level of hierarchy, in order to finally develop outcomes in a supervision with the complete team, that are accepted by all team members.     

Associations between stress at work and attitudes towards retirement in hospital physicians

Abstract

There is a need to understand the associations between attitudes towards retirement in specific occupations and various psychosocial and work-related factors. This study identified correlates of retirement thoughts and retirement preference in hospital physicians. The sample comprised 447 (251 male and 196 female) physicians from three hospital districts in Finland. After adjustment for gender, age and salary, minor psychiatric morbidity increased likelihood of retirement thoughts and retirement preference. Retirement thoughts and retirement preference were more common in doctors reporting low job control, poor teamwork and unjust supervision than in doctors perceiving their working conditions more favorably. Work preference was associated with high overwork. The associations of work characteristics with retirement thoughts and retirement preference largely persisted after control for indicators of health and social circumstances. In conclusion, in addition to demographic and financial factors and health, retirement attitudes in hospital physicians seem to be related to organizational and managerial factors that are potentially amendable to intervention. This has implications for retaining hospital physicians who might otherwise retire.     

Associations between stress at work and attitudes towards retirement in hospital physicians

There is a need to understand the associations between attitudes towards retirement in specific occupations and various psychosocial and work-related factors. This study identified correlates of retirement thoughts and retirement preference in hospital physicians. The sample comprised 447 (251 male and 196 female) physicians from three hospital districts in Finland. After adjustment for gender, age and salary, minor psychiatric morbidity increased likelihood of retirement thoughts and retirement preference. Retirement thoughts and retirement preference were more common in doctors reporting low job control, poor teamwork and unjust supervision than in doctors perceiving their working conditions more favorably. Work preference was associated with high overwork. The associations of work characteristics with retirement thoughts and retirement preference largely persisted after control for indicators of health and social circumstances. In conclusion, in addition to demographic and financial factors and health, retirement attitudes in hospital physicians seem to be related to organizational and managerial factors that are potentially amendable to intervention. This has implications for retaining hospital physicians who might otherwise retire.     

Assessing the impact of uncertainty and the level of aggregation in case mix planning

In this article, we present a framework for evaluating the impact of uncertainty and the use of different aggregation levels in case mix planning on the quality of strategic decisions regarding the case mix of a hospital. In particular, we analyze the effect of modeling (i) demand, (ii) resource use, and (iii) resource availability as stochastic input parameters on the performance of case mix planning models. In addition, the consequences of taking the weekly structure with inactive days without surgeries into account are assessed (iv). The purpose of this paper is to provide a guideline for the decision-maker planning the case mix on the consideration of stochastic aspects and different aggregation levels. We formulate a mixed integer programming model for case mix planning along with different stochastic and deterministic extensions. The value of the different extensions is analyzed using a factorial design. The resulting stochastic models are solved using sample average approximation. Simulation is used to evaluate the strategies derived by the different models using real-world data from a large German hospital. We find that highly aggregated basic case mix planning models can overestimate the objective value by up to 10% and potentially lead to biased results. Refining the problem decreased the gap between projected case mix planning results and simulated results considerably and led to improved solutions.     

Problem structuring methods as intervention tools: Reflections from their use with multi-organisational teams

Problem structuring methods (PSMs), also known as soft OR approaches, are most commonly employed with teams formed by members who tend to operate within an overall framework of authority and accountability, and most of whom have the ‘power to act’ on their recommendations. However, other PSM users include teams whose members are drawn from different organisational settings to work on a problem of common interest. The multi-organisational nature of such multi-organisational teams (MOTs) adds further complexity to the PSM modelling and facilitation processes by increasing the potential for conflict regarding the problem. In addition, members of MOTs tend not to operate within an overall framework of authority and accountability and, therefore, do not necessarily have full authority to commit themselves to their joint agreements. This paper reports on the design and application of a PSM-based methodology with three such groups, within the context of a multi-organisational collaboration in the UK construction industry. The paper reflects on the apparent success of the intervention, discusses the appropriateness of PSMs in this particular intervention context, as well as the generalisibility of the findings to other PSMs and/or multi-organisational contexts. Directions for the research and practice of PSMs with MOTs are also presented.