Accelerating acceptance

Innovations are either accepted or rejected in large part because of their implementation--sometimes without regard to improvements over existing techniques. By understanding the dynamics of how innovations are adopted and by whom, physician executives will have insight into influencing others. All adopters are not created equal. They fall into five categories, beginning with those who embrace innovation, even seek it out. In any given organization, or the population in general, there are: (1) innovators (2.5 percent); (2) early adopters (13.5 percent); (3) early majority (34 percent); (4) late majority (34 percent); and (5) laggards (16 percent). As these categories imply, each group has specific personalities related to adopting innovations that can be identified and used to implement new policies and procedures. By identifying and encouraging innovators and early adopters to think outside the box and then gaining critical mass through the early majority, who also act as opinion leaders, organizations can accelerate the pace of adopting innovations. New processes are adopted when opinion leaders initiate new practices, whose results can be tangibly discerned by the majority of adopters.     

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.     

Gender and physician-assisted suicide: an analysis of the Kevorkian cases, 1990-1997

This study examines the seventy-five suicide cases Dr. Jack Kevorkian acknowledged assisting during the period between 1990-1997. Although these cases represent a range of regional and occupational backgrounds, a significant majority are women. Most of these individuals had a disabling, chronic, nonterminal-stage illness. In five female cases, the medical examiner found no evidence of disease whatsoever. About half of the women were between the ages of forty-one and sixty, and another third were older adults. Men's conditions were somewhat less likely than women's to be chronic and nonterminal-stage. The main reasons for the hastened death mentioned by both the person and their significant others were having disabilities, being in pain, and fear of being a burden. The predominance of women among Kevorkian's assisted suicides contrasts with national trends in suicide mortality, where men are a clear majority. It is possible that individuals whose death was hastened by Kevorkian are not representative of physician-assisted suicide cases around the country, because of Kevorkian's unique approach. Alternatively, the preponderance of women among Kevorkian's assisted suicides may represent a real phenomenon. One possibility is that, in the United States, assisted suicide is particularly acceptable for women. Individual, interpersonal, social, economic, and cultural factors encouraging assisted suicide in women are examined.     

Residential Building Codes,Affordability, and Health Protection: A Risk-Tradeoff Approach

Residential building codes intended to promote health and safety may produce unintended countervailing risks by adding to the cost of construction. Higher construction costs increase the price of new homes and may increase health and safety risks through income and stock effects. The income effect arises because households that purchase a new home have less income remaining for spending on other goods that contribute to health and safety. The stock effect arises because suppression of new-home construction leads to slower replacement of less safe housing units. These countervailing risks are not presently considered in code debates. We demonstrate the feasibility of estimating the approximate magnitude of countervailing risks by combining the income effect with three relatively well understood and significant home-health risks. We estimate that a code change that increases the nationwide cost of constructing and maintaining homes by $150 (0.1% of the average cost to build a single-family home) would induce offsetting risks yielding between 2 and 60 premature fatalities or, including morbidity effects, between 20 and 800 lost quality-adjusted life years (both discounted at 3%) each year the code provision remains in effect. To provide a net health benefit, the code change would need to reduce risk by at least this amount. Future research should refine these estimates, incorporate quantitative uncertainty analysis, and apply a full risk-tradeoff approach to real-world case studies of proposed code changes.     

International migration and the global agenda: reflections on the 1998 UN Technical Symposium

This article reviews the nature of discussions at the 1998 UN Technical Symposium on International Migration and Development. The Symposium reviewed the literature linking migration and development and successful policy approaches. Several themes emerged. A research framework is needed for accounting for all types of population mobility at all stages of the migratory process. Research should integrate contributions from a range of disciplines. The influence of social networks and cultural capital has grown in importance. Strategies need to account for women's experiences, which involve both empowerment and exploitation. Strategies need to consider return migration and better public information on migration and settlement. It was agreed that there is a need for a variety of quantitative and qualitative approaches and multidimensional analysis. The links between migration and development are complex, but sufficient information is available to greatly improve policy formation and international cooperation. National level responses have occasionally eroded the rights and protection of migrants. Few countries have adopted the 1990 UN Convention on the Rights of Migrant Workers and their Families and ILO Conventions 97 and 143. A prominent realization was that international cooperation did matter. International migration should be viewed as an opportunity for cooperation and development.     

Marriages and fertility among Turkish and Moroccan women in Belgium: results from census data

The patterns of family formation and fertility behavior of Turkish and Moroccan women in Belgium are changing rapidly. The census data (1991) indicate a fertility decline. The reasons are changes in the nuptiality patterns, contraceptive behavior, and migratory flows. The changes are not identical in both communities. Young cohorts postpone their marriage, but this is most prominent among Moroccan women. On the other hand, young Turkish women have a clear preference for smaller families. The changes also differentiate according to migrant "generation" and level of education. The changes are not restricted to Belgium but are also observed in the countries of origin.     

Death at the border

"Debates about United States border control policies have generally ignored the human costs of undocumented migration. We focus attention on these costs by estimating the number, causes and location of migrant deaths at the southwest border of the United States between 1993 and 1997.... Deaths from hyperthermia, hypothermia and dehydration increased sharply from 1993 to 1997 as intensified border enforcement redirected undocumented migration flows from urban crossing points to more remote crossing areas where the migrants are exposed to a greater risk of death."     

A method to obtain a randomized control group where it seems impossible. A case study in program evaluation

Randomization of program participants into control and experimental groups is often not feasible in field settings. The researcher's desire to evaluate a program with a rigorous experimental design is often incompatible with the objective of serving the expressed needs of the program participants. However, opportunities do arise when a randomized control group can be constructed without disregarding the participants' wish to be included in the treatment group. This article describes a method that uses the participants' compliance to program instructions as a means of classifying participants and, thereby, obtains a randomized control group for a subset of participants. A large smoking intervention project is used to illustrate two variations of this method.     

The Chicago School,So-Called

Many sociologists believe in the myth of a Chicago School, a unified and coherent body of thought and research practice carried on at the University of Chicago from the 1920s through the 1960s. Chicago never constituted such a coherent system and is better understood as a school of activity, a group of people who cooperated in the day-to-day running of a major department.     

The Doldrums

Journal of Population Research -