Mixed Levels of Uncertainty in Complex Policy Models

The characterization and treatment of uncertainty poses special challenges when modeling indeterminate or complex coupled systems such as those involved in the interactions between human activity, climate and the ecosystem. Uncertainty about model structure may become as, or more important than, uncertainty about parameter values. When uncertainty grows so large that prediction or optimization no longer makes sense, it may still be possible to use the model as a behavioral test bed to examine the relative robustness of alternative observational and behavioral strategies. When models must be run into portions of their phase space that are not well understood, different submodels may become unreliable at different rates. A common example involves running a time stepped model far into the future. Several strategies can be used to deal with such situations. The probability of model failure can be reported as a function of time. Possible alternative surprises can be assigned probabilities, modeled separately, and combined. Finally, through the use of subjective judgments, one may be able to combine, and over time shift between models, moving from more detailed to progressively simpler order-of-magnitude models, and perhaps ultimately, on to simple bounding analysis.     

Conflict management, Part 1. Conflict management checklist: a diagnostic tool for assessing conflict in organizations

Complex interpersonal conflicts are inevitable in the high speed, high stakes, pressured work of health care. Poorly managed, conflict saps productivity, erodes trust, and spawns additional disputes. Well managed, conflict can enhance the self-confidence and self-esteem of the parties, build relationships, and engender creative solutions beyond expectations. Just as thoughtful differential diagnosis precedes optimum treatment in the doctor-patient relationship, management of conflict is greatly enhanced when preceded by careful assessment. In the first of two articles, the authors present a diagnostic approach, the Conflict Management Checklist, to increase self-awareness and decrease anxiety around conflict.     

Improving performance in a contracted physician network

Health care organizations face significant performance challenges. Achieving desired results requires the highest level of partnership with independent physicians. Tufts Health Plan invited medical directors of its affiliated groups to participate in a leadership development process to improve clinical, service, and business performance. The design included performance review, gap analysis, priority setting, improvement work plans, and defining the optimum practice culture. Medical directors practiced core leadership capabilities, including building a shared context, getting physician buy-in, and managing outliers. The peer learning environment has been sustained in redesigned medical directors' meetings. There has been significant performance improvement in several practices and enhanced relations between the health plan and medical directors.     

Quality costing: a management review

This paper relates a review of the English language literature on quality costing and traces its historical development; it provides authoritative reading on the subject. The review also has a focus on collection and use of quality-costing methods, quantitative cost data and the role and views of accountants in the task of quality-cost collection and reporting. Amongst the main findings is the preoccupation with the prevention – appraisal – failure categorization of quality costs and lack of guidance on definitions. The considerable impact of the American quality profession on the development of quality costing is pointed out along with the increasingly positive stance of accountants.     

Relationships between Sales Management Control, Territory Design, Salesforce Performance and Sales Organization Effectiveness

This research evaluates determinants of sales organization effectiveness in a sample of British companies, and contributes to an important new research stream by following recent empirical studies in the USA and Australia. We discuss a model of sales organization effectiveness determined by salesforce outcome performance and behavioural performance, as well as by the use of a behaviour-based control approach. Sales territory design is also considered as a particularly important managerial variable, which has received little analytical attention in the traditional literature, but which appears to be an important influence on the effectiveness of the sales operation. Our exploratory path analytical model suggests that sales territory design has a large effect on sales organization effectiveness both directly, and indirectly through its relationship with salesforce behavioural performance. These findings are somewhat different to those in similar studies in other countries, and suggest some important implications for managers as well as for researchers in this field.     

Paving the road to hell: why change programs ultimately fail

A successful change program must have clearly delineated and honestly defined goals. Change requires conviction, money, and effort and the willingness to invest all three. Change programs fail when any of these requirements are lacking. Many health care executives have the conviction, but are unwilling to spend the money or expend the effort. Some lack conviction, despite having money; the effort is merely spinning wheels with no forward motion. Often all three are lacking, despite an outward appearance to the contrary--the result of management delusions. Employees are quick to see through misleading and insincere schemes. It is much easier to foster trust from the outset than to rebuild it after it has been violated.     

Intensity of Interaction in Supply of Business Advice and Client Impact: A Comparison of Consultancy,Business Associations and Government Support Initiatives for SMEs

This paper assesses the supply of business advice using new empirical evidence from a large-scale survey of SMEs. The chief focus of the paper is on a comparison of suppliers that operate in different environments of regulation, contract and reputation. The paper argues that interaction intensity varies with the level of information asymmetry of these different environments, between different types of service supplier and their clients. Interaction intensity between suppliers also varies as a result of the level of trust they enjoy: for example, the low trust enjoyed by consultants appears to encourage higher intensity of interaction which improves the tailoring of the service to the client's needs and enhances impact. The paper assesses interaction intensity using the existence of site visits and/or a written brief/contract as indicators. Although these measures have limitations, the paper demonstrates clear and significant differences between suppliers in terms of interaction intensity, use of contracts and impact in three broad categories: private-sector consultancy (low trust, high intensity, high impact), business associations (high trust, low intensity, moderate impact) and government support agencies (moderate trust, moderate to high intensity, moderate or low impact). Multivariate estimation methods demonstrate that significant differences in interaction intensity, use of contracts and impact by client type are much less important than differences in supplier type. This indicates that suppliers generally develop more into niche service fields or groups of services rather than niches related to types of firm.     

Aggregation and Market Demand: An Exterior Differential Calculus Viewpoint

We analyze under which conditions a given vector field can be disaggregated as a linear combination of gradients. This problem is typical of aggregation theory, as illustrated by the literature on the characterization of aggregate market demand and excess demand. We argue that exterior differential calculus provides very useful tools to address these problems. In particular, we show, using these techniques, that any analytic mapping in Rⁿ satisfying Walras Law can be locally decomposed as the sum of n individual, utility-maximizing market demand functions. In addition, we show that the result holds for arbitrary (price-dependent) income distributions, and that the decomposition can be chosen such that it varies continuously with the mapping. Finally, when income distribution can be freely chosen, then decomposition requires only n/2 agents.     

A cross-validation of a structural equation model of accidents: organizational and psychological variables as predictors of work safety

A study to establish a structural equation model of accidents is presented. The eight variables included in the model were those associated with accidents in previous research. The reliability of questionnaires to measure those variables and a structural equation model relating them are provided. The model explaining the occurrence of accidents was cross-validated through three Spanish samples (n=123; 182; 124).The model presented a good fit to data in two samples, while a third had unclear fit indices. Therefore, most relationships among variables did not vary among these three samples. The role of the safety variables in the model is discussed. The discussion is also focused on risk measurement difficulties commonly reported in the literature. Finally, some suggestions for future safety research with structural equation modelling techniques are provided.     

Personality and organizational health: the role of conscientiousness

Organizational health research identifies processes through which the work environment and individual differences combine to influence both individual and organizational outcomes. This study investigated the contribution of conscientiousness to organizational health. Research in the areas of occupational stress, work performance, and organizational climate was used to develop a framework for integrating different elements of organizational health. Within this framework, the work environment was assessed by perceptions of workload and role clarity ; individual well-being was assessed by psychological distress and job satisfaction ; and behaviour important for organizational success was assessed by contextual performance. Conscientiousness was investigated within the framework using self-reports from a sample of 104 Australian employees. Conscientiousness directly influenced contextual performance but did not influence well-being or perceptions of the work environment. Conscientiousness also reduced the impact of role clarity on both psychological distress and job satisfaction. The role of conscientiousness in a comprehensive model of organizational health is discussed.