The sequential path to transformation management

The requirement for organizational transformation presents a troubling paradox for would-be leaders of change. To achieve significant and lasting transformation, everything about the organization must change. But changing everything at once is simply impossible. In seeking a way through this paradox, the article suggests a sequence of interventions. This is what needs to occur first, second, third, and so on, if transformation is to be effective. Underlying that sequence are the concepts of customer alignment and learning. Driving that sequence is a transformation in leadership style that addresses first sequentially and then simultaneously the twin demands of what Bert Spector refers to a ‘taking charge and letting go’.     

Physician-nurse migration to the United States: regional and health status origins in relation to legislation and policy

This article examines the origins of physicians and nurses who were admitted as permanent immigrants to the US from 1962-1979. Data are mainly from the Immigration and Naturalization Service. Countries used in the developmental analysis are only those whose population was estimated at 1 million or more as of mid-1979, encompassing 99% of the physicians and 97% of the nurses. Life expectancy at birth is the criterion used to differentiate origin countries by developmental dimension of health status. During the study period, health workers constituted about 30% of immigrants admitted to the US; of these, nurses and physicians constituted 72-82% throughout the study period. The period 1962-1979 has 4 distinct phases, marked by important legislative and/or policy changes; 1) 1962-1965, when the McCarran-Walter Act prevailed; 2) ending in 1968, the 2nd phase covers the transition mandated under the 1965 Immigration Act, which encouraged physician immigration; 3) the 3rd phase, 1969-1976, covers the transition to the 1976 Immigration and Nationality Act amendments; and 4) the 4th stage is 1977-1979. Results show that 1) under the McCarran-Walter Act, North America became the dominant physician source; 2) from 1966-1968, Asia attained dominance as the physician source and became even more predominant after 1968; 3) North America produced relatively few physicians in the early 1970s; 4) Europe produced substantially fewer physicians in the 1970s than in the 1960s; 5) South America, Africa, and Oceania were the lowest contributors of physicians; 6) during the McCarran-Walter years, North America and Europe produced almost 90% of nurses admitted into the US; 7) the 1965 Immigration Act and its aftermath resulted in Asia becoming the dominant source of nurses; 8) prior to the 1965 Immigration Act, Canada generated 20% of the aggregate number of physicians; 9) the Philippines surpassed Canada during the transition and India led after the transition; and 10) Canada supplied 30% of the nurses up through the transition, with the Philippines in the lead 1969-1979. Low health status countries were a relatively minor nurse source. Health status at the origin was a far less significant determinant of physician immigration than that of nurses. English language high and low health status country groups produced substantially more physician and nurse immigrants that their corresponding non-English language counterparts. The US attracted more physicians and nurses from less developed countries than more developed countries after 1968.     

The influence of income on family fertility in the light of the results of empirical studies

Based on data from the 1973-83 Polish Family Budget Survey, this study examines the influence of income as a source of maintenance and income as a determinant of childbearing on family parity. It is assumed that income influences parity as a source of maintenance and as an influence on lifestyle or reproductive behavior. As a source of maintenance, the influence will be positive. As a life-style factor, it could be positive or negative. The hypotheses are 1) that positive influences are characteristics of older couples with a lower educational level and living in villages and small towns and income is a source of maintenance, and 2) a negative influence on parity reflects younger couples with higher educational levels from larger cities and income is a life-style factor. Some examples of how the theory of income influences total fertility are given in addition to a further elaboration of the theory. Other concepts introduced, as related to childbearing, are the value of goods and services with unchanged preferences and an increase in income, with preferences changing with income increases, with income preferences for nonprocreational and for procreational needs, and income as a factor influencing procreational needs and behavior. Correlation analysis is conducted for 33 subpopulations based on duration of marriage, educational level of the household, and size of residence. The results indicate that, in years 1973, 1975, and 1978 when income and parity are significant, the sign is positive. In 1980, there was a decrease in the number of subpopulations with a significant relationship, and in 3 subpopulations the results were negative. The 13 positive subpopulations were similar to those in the 1970s. In 1983, income explained an even smaller amount of parity. The subpopulations with a postive relationship usually have longer marriage durations, which suggest income as a source of maintenance. Negative results were among subpopulations with shorter marriage durations, which suggests life-style factor effects of income.     

Mortality among three Puerto Rican populations: residents of Puerto Rico and migrants in New York City and in the balance of the United States, 1979-81

"This study attempts to explain similarities and differences in the mortality experience of three population groups: Puerto Ricans on the island commonwealth, Puerto Rican born persons in New York City and Puerto Rican born persons in the rest of mainland United States. Mortality is much higher among Puerto Ricans in New York City than among those residing elsewhere. Much of the difference is due to excess mortality caused by cirrhosis of the liver and homicide. Puerto Rican born persons living on the mainland but outside New York City generally have low mortality, even when compared with U.S. whites."     

Gambling and the Law®: Endless fields of dreams

This article examines the current trends of proliferation of commercial gaming, especially in the United States, in the context of the third wave of legalization of gambling that has been experienced since the founding of the nation. The author looks at the historic foundations of the spread of casino-style gambling, and notes the types of casino gaming that have led the way in the current expansion. He also points out why it is reasonable to expect that this wave too may come crashing down, as general acceptance of wide-spread casino gaming in America may indeed be short-lived.Gambling and the Law^® is a registered trademark of I. Nelson Rose.     

South-East Asia

This article reviews the literature on migration and HIV infections in the Mekong Region countries of Cambodia, China, Laos, Myanmar, Thailand, and Viet Nam. The HIV/AIDS situation is profiled in each country. The populations at risk include legal and undocumented cross-border migrants, internal migrants, sex workers, and mobile occupational persons, such as truck drivers, fishermen, seafarers, and cross-border traders. Currently, there is little regional cooperation on the issue of HIV among migrants. Prevalence is high in most of the region. Programs range from being very developed in Thailand to minimal in China. Recently, nongovernmental organizations have created innovative models. AIDSCAP studies have focused on river trade routes along the Thai-Lao border and fishing ports in Thailand and Cambodia. The Asian Research Center for Migration has researched fishermen in 6 countries; Burmese women in Thailand; migrants along the Thai-Myanmar borders; and the impact of transportation routes on the spread of HIV/AIDS along six main inter-country routes. Coordination of Action Research has engaged in research and action projects in 8 southeast Asian countries. The region would benefit from information exchanges about lessons learned and best practices. Field researchers could use better technical support. Regional strategies are useful for providing support from origin to destination.     

Clinical supervision: Its role in “Containing” countertransference responses to a filicidal patient

This paper illustrates the role of supervision in processing countertransference responses with might have disrupted the therapist's empathy with a patient who had killed her child. The clinical material demonstrates how the therapist's responses of initial denial and subsequent disgust and fear were dealt with in supervision. As a result, the treatment process led to genuine, albeit limited, therapeutic change in a patient with severe character pathology.This paper is developed from a presentation of the case of Mrs. Jay at Department of Psychiatry Grand Rounds, University of Cincinnati College of Medicine, on May 2, 1989.     

The NTEE classification system: tests of reliability/validity in the field of higher education

An analysis of the field of higher education reveals a surprisingly large number of classification errors within the (US) National Taxonomy of Exempt Entities database. Of the nearly 4,000 non-profit entities coded within the universe of institutions of higher education, we estimate that approximately 60 per cent were incorrectly included (Type II errors). Institutions incorrectly excluded from the higher education universe (Type I errors) represent roughly 10 per cent of the institutions coded correctly. These errors result primarily from assigning codes on the basis of the names of organisations (for example, College Park Towers is classified as a college, when it is in fact a housing complex for senior citizens) and from trying too hard to assign codes in ambiguous situations. The consequences can be significant for the users of these data, and we recommend raising bright warning flags while simultaneously enlisting the help of the entire non-profit sector in improving the classification coding process.The authors are with The Andrew W. Mellon Foundation. In addition to our colleagues on the staff of the Foundation, we wish to thank Helmut Anheier, Ted Bozovich, Harvey Dale, Virginia Hodgkinson, Stephen Noga and Christopher Toppe for helpful suggestions.