What is quality, and how is it measured?

There is currently no universally accepted definition of "quality of care." This article describes two aspects of measurement that contribute to an assessment of quality--the perception of quality of care held by patients and comparisons of clinical care to established standards. Ongoing monitors that lead to this assessment of quality in a large HMO are described in detail. They include patient satisfaction surveys, quality of care evaluations, comparative medical expense reports, cost-effectiveness studies, and a unique physician incentive bonus plan.     

A Manager is a Manager is a Manager? Race and Managerial Impact on Organizational Performance

Contemporary scientific analyses of public organizations underscore the salience of management for understanding how governmental bureaucracies perform. Yet little is known of administrators from minority social groups, and whether their organizations perform better or worse than other bureaucracies. Emphasizing the impact of network engagement on organizational performance, this exploratory study addresses this important research deficiency. A critical component of the analysis presented is the differential impact of administrative engagement with internal and external networks on minority and status quo clientele outcomes. The findings have important implications for studies of managerial networking, equity, and representation in public organizations.     

How much administration is today's physician doing?

The substantial changes in the organization and financing of health care services that have occurred in the United States over the past decade have helped to facilitate a growing role for physicians in health care management. These administrative roles for physicians are becoming increasingly important within many health care institutions with regard to such issues as cost containment and cost effectiveness, quality assurance and professional standards, and access to care. The growing complexity and diversity of the delivery system have created the need for more physicians to become involved in "orchestrat(ing)" the management of the medical-industrial complex."     

Health care evolution. Or is it?

Should we be using evolution as our theory for understanding the radical changes overtaking medicine? Evolution is a theory for explaining changes in biological systems. The power and simplicity of evolutionary theory have made it the major scientific framework for looking at why certain animals and plants dominate ecosystems, and why one species dies out only to be replaced by another. Health care is a socio-economic system--changes occur because of scientific, economic, and political reasons. Using evolutionary jargon and examples can lead us astray. So, why do we often use evolutionary language and ideas and what is a better way of looking at the changes confronting the industry at such a rapid pace? This author finds the answer in dialectic thinking.     

When is a physician network a group?

Developing a network of physicians into a high-performing group requires a cultural transformation. The hallmarks, as well as the obstacles, to achieving this are reviewed by two experienced consultants. The requirements of highly successful physician organizations range from sharing a common mission, vision, and values to developing an effective infrastructure to having visionary leadership. Barriers to successful physician groups include a lack of clarity of purpose and goals, lack of quality standards, and an absence of shared learning. A blueprint on how to become a successful physician group is provided.     

Telemedicine: where is technology taking us?

Five years ago, a few zealots in Switzerland, at the CERN Laboratory, were contemplating using the Internet for hypertext and for transfer of still images, recorded sounds, and compressed video files. Five years later, the World Wide Web defines a set of standards for packaging and routing information over the Internet that involve millions of people and personal computers and that allowed a start-up Netscape to enjoy a capitalization of more than $2 billion when it sold stock to the public recently. Now, video-conferencing and multimedia electronic mail over the Internet are the fascinations of engineers at NASA, and the MBONE Information Web, the province of technophiles with UNIX workstations. Five years from now, you may be participating in telemedicine sessions frequently, from your workstation, and think nothing of it.     

Shifting power: is the consumer next?

Consumers are not likely to act as patients much longer. They'll demand the same level of information and service they receive from every other sector of the economy. Dozens of new, innovative companies are changing the health care coverage purchasing methods to allow more control and accountability for consumers. They can be broadly categorized into four groups: (1) the "Charles Schwab" clones, (2) spot markets, (3) "make me a doctor," and (4) personalized health care systems. Physicians become directly accountable to their patients in these new models. But choosing health plans may not be enough. It is only a matter of time before consumers demand the right to build their own customized heath plans using the defined contributions from their employers. This article describes the benefits of personalized health care systems and why the death of medical necessity is not far away.     

Why is the Return to Training So High?

Abstract. Cross‐sectional results show that training increases wages by 5 per cent. This return is on a par with the return to 1 year of education. Considering that the average duration of training is very short, this result is strange and needs further examination. After leaving out the importance of measurement error, we control for accumulated stock of firm‐specific skills, unobserved heterogeneity in wage levels, heterogeneity in training returns, and heterogeneity in wage growth. By this we manage to reduce the return considerably. Unobserved heterogeneity in wage levels is the most important contributor to the ‘too high’ returns to training.     

Is it change? Or is it noise?

How can you tell the difference between mere noise, and a profound change headed your way? Your gut instincts may not always be a reliable gauge. It takes a long time for most people to become an executive leader. If you are typical, you were raised and trained in a different era, with different expectations. You see things with different lenses. So what can you trust? You can trust first principles. Ask yourself what you know about the reasons that changes are happening in this environment. Then ask yourself about what is being proposed--how does it fit with the roots of the changes in health care and your organization? The three change filters presented here can help you to figure out if it's change or just noise. Ask yourself: (1) what are the changes occurring in the health care industry; (2) is your organization ready for change; and (3) how likely is it that your organization will easily adopt this particular change? These three filters together will help you decide what is a truly important change, how ready your organization is for change, and whether it will adapt to this change with ease or difficulty.     

Union Density and Relative Wages: What is the Relationship?

ABSTRACT: This paper examines the impact of union density on relative wages under decentralised bargaining settings. Whilst, traditionally, empirical studies have focused on the impact of union status on wages (either at the individual or at the plant level), here it is argued that local trade union density can have an independent (positive) effect on wages. This occurs through the threat of collective action and the ability of the union to impose costs onto employers. First, a Nash bargaining model is presented under efficient-bargaining settings, and a wage-membership equation is derived. Wages are shown to be an increasing and convex function of union membership. Second, an empirical specification of the wage-membership equation, suitable for estimation, is obtained and fitted to establishment-level data for the Italian metal-mechanical engineering industry. A positive monotonic relationship between wages and union density is detected. Furthermore, wages are shown to be increasing with union density even where no formal local bargaining agreement is in force, thus suggesting that “union-threat” effects might be relevant.     

Reality check: is your behavior aligned with organizational goals?

Strong, well thought out organizational behaviors help instill confidence in patients and allow physicians to take a leadership role in health care.     

Sad to say: is it time for Sorrow Management Theory?

Terror Management Theory (TMT) research often asks respondents to describe their personal death. This exposure enables the testing of hypotheses regarding defenses ("buffers") against the anxious awareness of death. Curiously, though, the respondents' narratives are not analyzed or reported. The present study offers a qualitative analysis of 209 college student narrative responses provided for this purpose by TMT researchers Jeff Greenberg and Nathan Heflick. The narratives are reviewed with attention to affect (adjectives), semantic structure, and theme. Many responses are marked by anxiety, but sorrow is also pervasive. Individual differences in response substance and structure invite further exploration. It is suggested that our understanding of the response to personal death threat could be enhanced by encompassing sorrow as well as anxiety within the same conceptual framework. Several specific hypotheses and suggestions are offered.     

Anonymizing binary and small tables is hard to approximate

The problem of publishing personal data without giving up privacy is becoming increasingly important. An interesting formalization recently proposed is the k-anonymity. This approach requires that the rows in a table are clustered in sets of size at least k and that all the rows in a cluster become the same tuple, after the suppression of some records. The natural optimization problem, where the goal is to minimize the number of suppressed entries, is known to be NP-hard when the values are over a ternary alphabet, k=3 and the rows length is unbounded. In this paper we give a lower bound on the approximation factor that any polynomial-time algorithm can achieve on two restrictions of the problem, namely (i) when the records values are over a binary alphabet and k=3, and (ii) when the records have length at most 8 and k=4, showing that these restrictions of the problem are APX-hard.