Building a culture of learning through organizational development: the experiences of the Marin County Health and Human Services Department

After determining a need for organizational change informed by changes in workforce demographics, community demographics, the socio-political and economic environment, and constraints on resources, one agency sought to transform its organizational culture into that of a learning organization. An external organizational development consultant was hired to work with agency leadership to identify ways that would help move the agency's culture towards one that was conducive to learning. Specifically, the agency director sought to create a culture where communication is encouraged both vertically and horizontally, frontline level workers are engaged and their voices heard, cross-departmental problem solving is practiced, innovative ideas are supported, and evidence-informed practice regularly implemented. This case study describes the experiences of this agency and the process taken toward engaging an external consultant and moving towards the development of a culture of learning.     

Linking an agency strategic review to increase knowledge management: San Francisco County Human Service Agency

Led by the agency director, the agency engaged in a Strategic Review, based on a comprehensive assessment of agency performance that identified strategies to improve organizational effectiveness through increased data-informed practice and knowledge management. The Strategic Review gathered information on staff perceptions, perceptions of external stakeholders, changing citywide and neighborhood demographics, policy mandates, and budget and workload issues. The need for the review was based upon multiple, substantial changes not addressed in the 2000 Strategic Plan, including the 2004 merger of the Department of Human Services and the Department of Aging and Adult Services, changes among the executive management team, transitions among key political entities, new policy mandates and changing budget allocations. This case study describes the Strategic Review process and content, summarizing key challenges and lessons related to addressing workload demands, fostering positive staff attitudes, balancing internal and external information needs, and integrating data use and planning processes across the agency.     

Exercise self-regulation among older women participating in a heart disease-management intervention

Using behavioral self-regulation processes may facilitate exercise among older women with heart disease. Data from women in a heart disease-management program (n = 658, mean 73 years), was used to explore associations among exercise self-regulation components (i.e., choosing to improve exercise and observing, judging, and reacting to one's behavior) and exercise capacity. General linear models showed that choosing exercise predicted higher exercise self-regulation scores postprogram and 8 months later. In turn, these scores predicted greater improvements in exercise capacity concurrently and 8 months later. Interaction analyses revealed that the effect of self-regulation on exercise capacity was stronger among women who chose to work on exercise.     

Dissemination to research subjects: operationalizing investigator accountability

Recent articles have argued from principles of bioethics for the right of research subjects to receive the results of the studies in which they have participated. We argue that accountability is a powerful tool of meso-level analysis appropriate to reasoning about answerability in research ethics, and that it captures the responsibility of researchers to disseminate study results to research subjects. We offer the following features of the research situation as relevant to the manner of dissemination to study subject, in addition to factors already proposed in the literature (risk and impact on health outcome): (a) features of the research subject in relation to identity, personal investment, disease, and community; (b) characteristics of the research study and field of inquiry in relation to certainty and significance; and (c) relationships among the research subjects and the healthcare workers involved in their care and in the research.     

教育陷入困境:如何适应信息社会?

随着经济向信息时代过渡,美国工人将经历一次重大的劳动力调整。预计在下一个10年内,电子计算机将导致所有其他工业中新兴产业的增长。实际上,劳工统计资料表明:增长最快的职业中有60%属于与计算机有关的职业。工人的技能也在提高。例如,在过去20年间,     

如何成为即兴发挥的高手？

不管是什么谈判,成功的即兴发挥都取决于谈判者本身的技能技艺纯熟的即兴演奏者每天都要独自练习数个小时,并且年复一年,以便掌握音符、音阶、和弦及声部和谐。经过所有这些练习后,他上台演奏,开始即兴发挥。结果,乐师与听     

别人为什么要接受你的领导

如果你想使一屋子的高级管理人员鸦雀无声,不妨试试下面这个小花招。向他们提一个问题: “别人为什么愿意接受 你的领导?”十年来,本文作者在为欧美的几十家公司提供咨询的过程中经常提这个问题。结果是百试百灵,高管们总是 不知该如何回答。究竟什么样的人才能成为领导?作者经过25年的研究,发现具有感召力的领导人都具备四大特质:     

Pay for performance--a clash of cultures

Implementation of pay for performance is being widely heralded as a new paradigm. However, the concept is not only alien to physicians, but may be ethically abhorrent, as well.     

Evaluating risk: global fees and episodic care

In 1999, two articles in The Physician Executive -- "Part I: Global Theory and the Nature of Risk (July-August)." and "Part II: Towards a Choice-Based Model of Managed Care (October-November)" -- outlined the flaws of orthodox managed care theory and highlighted the unique advantages of moving to a genuinely market-based model, which included the concept of direct contracting for integrated episodes of care. This follow-up focuses on comparing an episode contracting system to a traditional capitated program and outlines the features that make this approach much more attractive to physicians, payers, and most importantly patients.