A rational approach to career change

Recently, the number of physicians who have been interested in alternative careers has vastly increased. Many physicians express dissatisfaction with clinical practice, but they are uncertain about which nonclinical options are appropriate for them. Pursuing a different career after many years of studying and practicing medicine can seem like an overwhelming task. In this article, the author briefly outlines a decision-making process that can be used in analyzing career options and suggests some careers that have provided challenging opportunities for physicians.     

A comparison of quality and utilization problems in large and small group practices

Physicians practicing in large, multispecialty medical groups share an organizational culture that differs from that of physicians in small or independent practices. Since 1980, there has been a sharp increase in the size of multispecialty group practice organizations, in part because of increased efficiencies of large group practices. The greater number of physicians and support personnel in a large group practice also requires a relatively more sophisticated management structure. The efficiencies, conveniences, and management structure of a large group practice provide an optimal environment to practice medicine. However, a search of the literature found no data linking a large group practice environment to practice outcomes. The purpose of the study reported in this article was to determine if physicians in large practices have fewer quality and utilization problems than physicians in small or independent practices.     

Ascendancy of primary care will create role intensification for physician executives

The need for physicians in management roles in the health care system has never been greater. And the years ahead will see that need broadened and intensified. To maintain their leadership role in medical affairs in hospitals and other types of health care delivery organizations, physician executives will have to envision provider organizations and systems that have not yet been conceived, let alone developed and implemented. They have to become totally open-minded and futuristic in their thinking. And they will have to help other physicians accommodate this new way of thinking if the medical profession is to continue in a leading role in health care matters. Although numerous factors will have to be anticipated and analyzed by these new physician leaders, the ascendancy of primary care in a managed health care world long dominated by the technical and technological superiority of hospital care will present a particular challenge to the physician executive.     

When push comes to shove: implementing VBAC practice guidelines

The dramatic increase in U.S. cesarean sections over the past two decades has been significantly driven by repeat C-sections. In response to this trend, clinical guidelines recommending vaginal birth after cesarean-section (VBAC) have been promulgated by national organizations. Adherence to these guidelines would reduce the number of repeat C-sections, lower the overall C-section rate, and improve both the quality and the cost of health care. While these guidelines have received professional endorsement, their implementation has been clouded by issues of patient acceptance and provider payment. To examine implementation of these guidelines by health care organizations, the authors surveyed 156 members of the American College of Physician Executives to determine their policies, practices, and attitudes toward VBAC guidelines. Those surveyed generally were medical directors in HMOs, hospitals, and other practice settings. The findings indicate that the health care organizations represented by these physician executives have not consistently implemented VBAC guideline and that they are reluctant to hold physicians, their patients, or hospitals accountable for the financial, utilization, and quality impact of the elective decision ot to pursue appropriate VBACs. We conclude that, even when widely accepted, clinical practice guidelines may be ineffective in reducing the costs or improving the quality of medical care.     

Decisions to Outsource Information Systems Functions: Testing a Strategy-Theoretic Discrepancy Model

In recent years, the decision to outsource information systems (IS) functions has become a viable strategic alternative in managing the increasingly complex IS functions. In this study, the IS outsourcing phenomenon is conceptualized as a strategic decision in the organization. Drawing on resource-based theories, resource dependence theories, and other theories of strategic management, a discrepancy model of this decision is developed. Relationships between a number of strategy-theoretic factors and the IS outsourcing decision are hypothesized. These factors include IS resource performance discrepancies manifested in the form of gaps in information quality, IS support quality, IS cost effectiveness and financial performance, as well as the strategic orientation of the firm. Results of the study indicate that, while cost consideration and the firm's financial performance are not associated with the IS outsourcing decision, difficulties in providing good information outputs and IS support services are associated with the decision. Overall, the findings suggest that the current trend toward outsourcing represents a continuing evolution of the IS function as it attempts to fulfill its traditional mission of providing high quality information resource to the firm. When the performance of the delivered resource begins to slip in the current environment of rising expectation and technological complexity, outsourcing may become a strategic response of necessity. The paper concludes with a discussion of the implications of the results for practicing managers and suggestions for future research.     

A Path Analytic Model of a Theory of Quality Management Underlying the Deming Management Method: Preliminary Empirical Findings*

Despite the impact that Deming and his 14 Points have had on the practice of quality management, empirical support for the effectiveness of the Deming Management Method has not advanced beyond the presentation of anecdotal, case-study evidence. In part, this is because theory to guide the conduct of empirical research has not been available. Only recently has such a theory of quality management to describe and explain the effectiveness of the Deming Management Method been articulated in the literature. This paper continues the journey of theory development; it reports the results of an exploratory empirical analysis of an articulated theory of quality management underlying the Deming Management Method. The constructs in the proposed theory are operationalized using measurement statements developed by the World-Class Manufacturing research project team at the University of Minnesota and Iowa State University. Path analysis is applied to the World-Class Manufacturing project data to explore the empirical strength of relationships advanced in the theory. The path analytic results provide support for several of the proposed relationships in the theory, and more importantly, suggest a number of new relationships which have not heretofore been proposed.     

Improved Transferability of Data‐Driven Damage Models Through Sample Selection Bias Correction

Damage models for natural hazards are used for decision making on reducing and transferring risk. The damage estimates from these models depend on many variables and their complex sometimes nonlinear relationships with the damage. In recent years, data‐driven modeling techniques have been used to capture those relationships. The available data to build such models are often limited. Therefore, in practice it is usually necessary to transfer models to a different context. In this article, we show that this implies the samples used to build the model are often not fully representative for the situation where they need to be applied on, which leads to a “sample selection bias.” In this article, we enhance data‐driven damage models by applying methods, not previously applied to damage modeling, to correct for this bias before the machine learning (ML) models are trained. We demonstrate this with case studies on flooding in Europe, and typhoon wind damage in the Philippines. Two sample selection bias correction methods from the ML literature are applied and one of these methods is also adjusted to our problem. These three methods are combined with stochastic generation of synthetic damage data. We demonstrate that for both case studies, the sample selection bias correction techniques reduce model errors, especially for the mean bias error this reduction can be larger than 30%. The novel combination with stochastic data generation seems to enhance these techniques. This shows that sample selection bias correction methods are beneficial for damage model transfer.     

Intra-industry diversification effects under firm-specific contingencies on the demand side

How do firm-specific, demand-related factors influence the relationship between intra-industry diversification (IID) and performance? Recent findings regarding the performance effects of IID depict a complex picture with curvilinear relationships and several contingencies. However, firm-specific contingencies on the demand side have remained unexplored. We analyze how IID relates to firm performance (market share) in the German automotive industry using panel data between 1999 and 2008. We specifically focus on a firm's high-quality brand image as a demand-side contingency. We find support for our hypotheses of complex curvilinear relationships as well as for moderating effects of brand quality. Our results have significant theoretical implications for the IID literature.     

The relationship between presenteeism and job satisfaction: A mediated moderation model using work engagement and perceived organizational support

Research on presenteeism has largely focused on its prevalence, determinants and consequences on the health of both employees and organizations. To date, few studies have examined the influence of presenteeism on workers’ attitudinal and motivational responses. Based on the Effort–Recovery Theory, this study evaluates the mediating effect of work engagement in the relationship between presenteeism and job satisfaction. Building on previous work, this study also proposes to consider perceived organizational support as a moderator of the work engagement–job satisfaction relationship. Presented in the form of a mediated moderation model, the results of bootstrapped regression analyses show three main results. First, presenteeism is negatively associated with work engagement and job satisfaction. Secondly, work engagement is one of the factors through which presenteeism influences job satisfaction. Thirdly, perceived organizational support moderates the association between work engagement and job satisfaction so that, at a low level of work engagement, feeling supported by the organization makes a difference on job satisfaction. Overall, this research is part of the limited number of studies that have focused on the interplay existing between presenteeism and its consequences in terms of job attitudes.