Hired, fired, and not retired: an interview with a physician executive who has run the career gauntlet. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed Robert J. Hudson, MD, on April 24, 2000 to discuss his experiences as a physician executive who has made the career transition from practicing physician to managed care executive to biotech entrepreneur. Along the way, he's hired and fired others, and been fired himself. Painful as it is, many physician executives' career realities include being fired. Organizations, after all, are living organizations--they grow, wither, and molt. And as they molt, organizations shed and regrow new skin. What do physician executives do when they've been fired? They go through their own cycle and retreat, reflect, and re-emerge, often reinventing themselves as they go. An essential part of this process is looking within to plumb likes and dislikes, strengths and weaknesses, nightmares and dreams, and positive and negative experiences. For most executives, out of these experiences has come a circle of friends and a Rolodex. Start by reaching out to the circle, by going through your Rolodex, and you can broadcast the news of your rebirth.     

Assessing Engineering Resilience for Systems with Multiple Performance Measures

Recently, efforts to model and assess a system's resilience to disruptions due to environmental and adversarial threats have increased substantially. Researchers have investigated resilience in many disciplines, including sociology, psychology, computer networks, and engineering systems, to name a few. When assessing engineering system resilience, the resilience assessment typically considers a single performance measure, a disruption, a loss of performance, the time required to recover, or a combination of these elements. We define and use a resilient engineered system definition that separates system resilience into platform and mission resilience. Most complex systems have multiple performance measures; this research proposes using multiple objective decision analysis to assess system resilience for systems with multiple performance measures using two distinct methods. The first method quantifies platform resilience and includes resilience and other “ilities” directly in the value hierarchy, while the second method quantifies mission resilience and uses the “ilities” in the calculation of the expected mission performance for every performance measure in the value hierarchy. We illustrate the mission resilience method using a transportation systems‐of‐systems network with varying levels of resilience due to the level of connectivity and autonomy of the vehicles and platform resilience by using a notional military example. Our analysis found that it is necessary to quantify performance in context with specific mission(s) and scenario(s) under specific threat(s) and then use modeling and simulation to help determine the resilience of a system for a given set of conditions. The example demonstrates how incorporating system mission resilience can improve performance for some performance measures while negatively affecting others.     

Health professionals' attitudes toward abortion

Attitudes toward abortion, as obtained in a 1971 nationwidesurvey, are presented for students and faculty in nursing, medicine,and social work, and are compared to attitudes of the generalpopulation. Attitudinal differences are examined among the professions,between students and faculty, and in terms of religion. Theresults reveal implications for the abortion-related servicesprovided by health professionals.     

A Comparison of Child-sex-abuse-related and Mental-disorder-related Suicide in a Six-year Cohort of Regional Suicides: The Importance of the Child Protection-Psychiatric Interface

Correspondence to: Professor Colin Pritchard, Department of Mental Health, School of Medicine, Southampton University, Royal South Hants Hospital, Southampton SO14 0YG, UK. E-mail: cp1{at}soton.ac.uk Summary The study compares Mental-Disorder-Related (MDR) suicide rateswith Child-Sex-Abuse-Related (CSAR) suicide of ‘Victims’and ‘Perpetrators’ of child sex abuse, based uponan examination of all Coroners’ inquest files over a six-yearperiod (n = 1,017). Census data, psychiatric case register andpolice records were used to calculate the potential MDR andCSAR populations. There were five main findings: (i) male andfemale CSAR victim suicide rates were 2.2. and 2.5 times theGeneral Population Suicide Rate (GPSR), respectively; (ii) everyfemale, and 80 per cent of male CSAR victim suicides, also hada mental disorder but none of the CSAR perpetrator suicides;(iii) male and female MDR suicide rates were 5 and 6 times theCSAR Victim rates; (iv) the sex abuser perpetrators’ suiciderate was more than 3 times the male MDR rate; (v) the intra-and extra-familial perpetrator suicide rates, were 25 and 78times the GPSR, respectively. Possible explanations for thesesurprising results are briefly discussed. They confirm the overrepresentationof people with mental disorder amongst suicides, and identifyan overrepresentation of CSAR suicides, particularly perpetrators.The results have implications for suicide prevention programmes,whilst highlighting the importance of the child protection-psychiatricinterface, and indicates the futility of simple explanationsin an area of practical and moral complexity.     

Transmuted generalized exponential distribution: A generalization of the exponential distribution with applications to survival data

In this article, we investigate the potential usefulness of the three-parameter transmuted generalized exponential distribution for analyzing lifetime data. We compare it with various generalizations of the two-parameter exponential distribution using maximum likelihood estimation. Some mathematical properties of the new extended model including expressions for the quantile and moments are investigated. We propose a location-scale regression model, based on the log-transmuted generalized exponential distribution. Two applications with real data are given to illustrate the proposed family of lifetime distributions.     

The eligibility question – the real source of depersonalisation?

There have been a number of high-profile strategies over recent decades to raise social care above what is widely regarded as an unacceptable service in the United Kingdom. Quite apart from all too frequent high-profile scandals, it is seen as a service that is depersonalising and stigmatising. None of the strategies to bring about change, most of them introduced to great fanfares, have delivered the changes they promised. This article sets out a view that the reason why they have all failed is that none of them have identified or therefore tackled the underlying problem, which is the relationship between needs and resources. Underfunding has long been a serious concern for campaigning organisations. The article does not detract from that contention. However, it sets out how strategies to manage the gap between needs and resources, more than the funding gap per se, are themselves the root cause of depersonalised and chronically impoverished services. The unlikely source of these strategies can be traced to the unintended consequences of an Act of Parliament that had the best of intentions.