Management competencies required in ambulatory care settings

A study was conducted to identify the most important competencies physician executives in medical groups and other ambulatory settings will need to have in the next five years. The specific job skills, knowledge, and abilities (SKA) that physician executives will need to acquire these competencies were also explored. The Delphi techniques were used to analyze responses from two surveys from members of the American College of Medical Practice Executives. The most important competencies were grouped into 13 management domains, each with specific SKAs. "Managing health care resources to create quality and value" and "fundamentals of business and finance" were rated as the most important competencies. The most frequently rated SKA was the "ability to build and maintain credibility and trust."     

Making the health care delivery system accountable.

Accountability has become the fact of life for the health care provider and the delivery system. Until recently, accountability has been viewed primarily through the judicial process as issues of fraud and liability, or by managed care entities through evaluation of the financial bottom line. It is this second consideration and its ramifications that will be explored in this article. Appropriate measurement tools are needed to evaluate services, delivery, performance, customer satisfaction, and outcomes assessment. Measurement tools will be considered in light of the industry's unique considerations and realities. All participants, including insurers, employers, management, and health care providers and recipients, bear responsibilities which necessitate assessment and analysis. However, until the basic question, "Who is the customer?" is resolved, accountability issues remain complex and obscured. Accountability costs and impacts must be evaluated over time. They go way beyond bottom line cost containment and reduction. Accountability will be accomplished when the health care industry implements quality and measurement concepts that yield the highest levels of validity and appropriateness for health care delivery.     

Quantifying the Distribution of Inhalation Exposure in Human Populations: 2. Distributions of Time Spent by Adults, Adolescents, and Children at Home, at Work, and at School

Using distributions of time spent at various ventilation levels, ranges of inhalation exposure in the population can be established. Distributions of exposure time were determined using results of a study by the California Air Resources Board (CARB) which focused on time spent by humans participating in various activities and the locations where the activities occurred. The daily at-home activities from the CARB study were assigned to one of three ventilation levels, generating aggregate time periods. Distinct age and gender populations were identified, and distributions for aggregate time were established for these populations at each of the ventilation levels. In addition to aggregate time spent at home, distributions for various ages and genders were established for aggregate time spent at school and work. By combining distributions of aggregate time with corresponding ventilation rates, the distribution of inhalation rates can be established for at home, at work, and at school exposures.     

The EPA Health Risk Assessment of Methylcyclopentadienyl Manganese Tricarbonyl (MMT)

This paper describes the U.S. Environmental Protection Agency's assessment of potential health risks associated with the possible widespread use of a manganese (Mn)-based fuel additive, methylcyclopentadienyl manganese tricarbonyl (MMT). This assessment was significant in several respects and may be instructive in identifying certain methodological issues of general relevance to risk assessment. A major feature of the inhalation health risk assessment was the derivation of Mn inhalation reference concentration (RfC) estimates using various statistical approaches, including benchmark dose and Bayesian analyses. The exposure assessment component used data from the Particle Total Exposure Assessment Methodology (PTEAM) study and other sources to estimate personal exposure levels of particulate Mn attributable to the permitted use of MMT in leaded gasoline in Riverside, CA, at the time of the PTEAM study; on this basis it was then possible to predict a distribution of possible future exposure levels associated with the use of MMT in all unleaded gasoline. Qualitative as well as quantitative aspects of the risk characterization are summarized, along with inherent uncertainties due to data limitations.     

Methodological Approaches to Assessing Risk Perceptions Associated with Food-Related Hazards

The psychometric approach developed by Slovic and his co-workers has been effectively used to assess risk perceptions associated with different food-related hazards. However, further examination (using questionnaire data and partial correlation techniques) has indicated that technological hazards are highly differentiated from lifestyle hazards, in terms of both hazard control and knowledge about the hazard. Optimistic bias was also seen to vary between hazards. Further research has focused on a particular hazard, genetic engineering. Risk perceptions associated with genetic engineering are underpinned by ethical concern and questions relating to perceived need for the technology, as well as perceptions of risk or harm. However, increasing the specificity of hazard stimuli was found to alter the factor structure of underlying risk perceptions. The utility of preference mapping procedures in determining individual differences in trust in risk regulators is also discussed.     

Impact of Hazardous Substances Regulations on Small Firms in Delaware and New Jersey

Regulations under the 1990 Amendments to the Clean Air Act impose significant requirements on firms handling hazardous chemicals. The nature of the regulations would suggest that small firms, because of limited resources and other structural limitations, would experience more difficulty complying with the regulations than large firms. To understand the difficulties imposed by the regulations on small firms, we interviewed ten small firms in Delaware and New Jersey, states with existing hazardous regulations similar to those being considered by the U.S. Environmental Protection Agency, and evaluated their responses to state regulations. The impacts of the environmental regulations on the firms and on the risk levels of their businesses are discussed. Propositions for research into small firms compliance are developed. Possible means for reducing the regulatory burden on small firms while enhancing regulatory effectiveness are suggested.     

Rewarding growth or profit?: Top management team compensation and governance in Japanese MNEs

Japanese multinational enterprises (MNEs) have been popularly characterized as pursuing competitive strategies emphasizing long-term performance, especially growth in sales and market share, rather than shorter term profit performance. Though prior research has emphasized the importance of linking compensation to organizational goals and performance, the relationship between performance and compensation of Japanese executives has received limited empirical attention. This paper provides a preliminary examination of how Japanese top management teams in the 106 largest industrial MNEs were compensated, particularly for performance on sales growth and profitability criteria, over the 1976–1993 time period. The relationships revealed between organizational performance and the bonus compensation of top management teams suggest that the emphasis of Japanese industrial MNEs regarding sales growth versus profitability may not be as simple as suggested by prior studies and popular characterizations.     

Learning by Objectives for Adaptive Shop-Floor Scheduling*

Effective production scheduling requires consideration of the dynamics and unpredictability of the manufacturing environment. An automated learning scheme, utilizing genetic search, is proposed for adaptive control in typical decentralized factory-floor decision making. A high-level knowledge representation for modeling production environments is developed, with facilities for genetic learning within this scheme. A multiagent framework is used, with individual agents being responsible for the dispatch decision making at different workstations. Learning is with respect to stated objectives, and given the diversity of scheduling goals, the efficacy of the designed learning scheme is judged through its response under different objectives. The behavior of the genetic learning scheme is analyzed and simulation studies help compare how learning under different objectives impacts certain aggregate measures of system performance.     

Staffing a Multiskilled Workforce with Varying Levels of Productivity: An Analysis of Cross-training Policies*

Service operations that utilize cross-trained employees face complex workforce staffing decisions that have important implications for both cost and productivity. These decisions are further complicated when cross-trained employees have different productivity levels in multiple work activity categories. A method for policy analysis in such environments can be beneficial in determining low-cost staffing plans with appropriate cross-training configurations. In this paper, we present an integer linear programming model for evaluating cross-training configurations at the policy level. The objective of the model is to minimize workforce staffing costs subject to the satisfaction of minimum labor requirements across a planning horizon of a single work shift. The model was used to evaluate eight cross-training structures (consisting of 36 unique cross-training configurations) across 512 labor requirement patterns. These structures, as well as the labor requirement patterns, were established based on data collected from maintenance operations at a large paper mill in the United States. The results indicate that asymmetric cross-training structures that permit chaining of employee skill classes across work activity categories are particularly useful.