IT Governance Characteristics,Electronic Medical Records Sophistication,and Financial Performance in U.S. Hospitals: An Empirical Investigation

As a result of a recent federal government mandate, an increasing number of hospitals have decided to adopt electronic medical record (EMR) systems. This initiative is expected to lead toward more efficient and higher quality health care; however, little is known about governance characteristics and organizational performance for EMR adopters. Our goal is to inform theory and practice by examining hospitals with a sophisticated EMR and comparing those hospitals to similar hospitals (with a less sophisticated EMR) to understand the association between information technology (IT) governance characteristics and the implications on financial performance. Leveraging elements of the upper echelon theory, we posit that hospitals in which the chief information officer (CIO) reports to the chief executive officer, CIO turnover is low, and an IT steering committee is present are more likely to have a sophisticated EMR. We argue that EMR sophistication leads to improved financial performance. Our results underscore the importance of continuity in the CIO position on successful EMR implementations. Results also show that hospital size and financial performance are strongly associated with EMR sophistication. In addition, we find that a sophisticated EMR appears to be a fundamental element in improving hospitals’ revenue cycle management. Moreover, we find that hospitals with a sophisticated EMR appear to be more profitable. Finally, we observe that total payroll expense adjusted by total discharges drops among the sophisticated hospitals, potentially due to an increase in employee productivity. These insights can serve as a basis for tempering expectations relative to the financial impact of EMR adoption.     

Cross‐Cultural Differences in Risk Perceptions of Disasters

Public risk perceptions of mass disasters carry considerable influences, both psychologically and economically, despite their oft‐times imprecise nature. Prior research has identified the presence of an optimistic bias that affects risk perception, but there is a dearth of literature examining how these perceptions differ among cultures—particularly with regard to mass disasters. The present study explores differences among Japanese, Argentinean, and North American mental health workers in their rates of the optimistic bias in risk perceptions as contrasted between natural disasters and terrorist events. The results indicate a significant difference among cultures in levels of perceived risk that do not correspond to actual exposure rates. Japanese groups had the highest risk perceptions for both types of hazards and North Americans and Argentineans had the lowest risk perceptions for terrorism. Additionally, participants across all cultures rated risk to self as lower than risk to others (optimistic bias) across all disaster types. These findings suggest that cultural factors may have a greater influence on risk perception than social exposure, and that the belief that one is more immune to disasters compared to others may be a cross‐cultural phenomenon.     

Nano Risk Analysis: Advancing the Science for Nanomaterials Risk Management

Scientists, activists, industry, and governments have raised concerns about health and environmental risks of nanoscale materials. The Society for Risk Analysis convened experts in September 2008 in Washington, DC to deliberate on issues relating to the unique attributes of nanoscale materials that raise novel concerns about health risks. This article reports on the overall themes and findings of the workshop, uncovering the underlying issues for each of these topics that become recurring themes. The attributes of nanoscale particles and other nanomaterials that present novel issues for risk analysis are evaluated in a risk analysis framework, identifying challenges and opportunities for risk analysts and others seeking to assess and manage the risks from emerging nanoscale materials and nanotechnologies. Workshop deliberations and recommendations for advancing the risk analysis and management of nanotechnologies are presented.     

An Alternative FMEA Method for Simple and Accurate Ranking of Failure Modes

Failure modes and effects analysis (FMEA) is a methodology for prioritizing actions to mitigate the effects of failures in products and processes. Although originally used by product designers, FMEA is currently more widely used in industry in Six Sigma quality improvement efforts. Two prominent criticisms of the traditional application of FMEA are that the risk priority number (RPN) used to rank failure modes is an invalid measure according to measurement theory, and that the RPN does not weight the three decision criteria used in FMEA. Various methods have been proposed to mitigate these concerns, including many using fuzzy logic. We develop a new ranking method in this article using a data‐elicitation technique. Furthermore, we develop an efficient means of eliciting data to reduce the effort associated with the new method. Subsequently, we conduct an experimental study to evaluate that proposed method against the traditional method using RPN and against an approach using fuzzy logic.     

Bayesian utilitarianism and probability homogeneity

This paper investigates, within the axiomatic framework of Jeffrey-Bolker decision theory, two kinds of conditions and the relation between them: (1) The Utilitarian condition that social rankings of prospects be representable by an expected utility function that is a weighted sum of the expected utility functions representing individual rankings; and (2) Homogeneity conditions on the probabilities and preferences of individuals. In particular, we show that identity of individuals’ probabilities is necessary and sufficient for the Utilitarian condition to hold and that the homogeneity of individuals’ probabilities can be derived from a Pareto condition on the relation between individual and social rankings, provided that these rankings are separable in a particular sense.This paper has considerably benefited from comments by John Broome, Isaac Levi and an anonymous referee. Special thanks to Philippe Mongin who provided encouragement, help and careful criticism throughout the development of this paper.     

The Impact of the Affordable Care Act Young Adult Provision on Childbearing: Evidence From Tax Data

We use panel U.S. tax data spanning 2008–2013 to study the impact of the Affordable Care Act (ACA) young adult provision on an important demographic outcome: childbearing. The impact is theoretically ambiguous: gaining insurance may increase access to contraceptive services while also reducing the out-of-pocket costs of childbirth. Because employer-reported U.S. Wage and Tax Statements (W-2 forms) record access to employer-provided benefits, we can examine the impact of the coverage expansion by focusing on young adults whose parents have access to benefits. We compare those who are slightly younger than the age threshold with those who are slightly older. Our results suggest that the ACA young adult provision led to a modest decrease in childbearing.     

Using process evaluation to determine effectiveness of participatory ergonomics training interventions in construction

The construction industry continues to experience high rates of musculoskeletal injuries despite the widespread promotion of ergonomic solutions. Participatory ergonomics (PE) has been suggested as one approach to engage workers and employers for reducing physical exposures from work tasks but a systematic review of participatory ergonomics programs showed inconclusive results.. A process evaluation is used to monitor and document the implementation of a program and can aid in understanding the relationship between the program elements and the program outcomes. The purpose of this project is to describe a proposed process evaluation for use in a participatory ergonomic training program in construction workers and to evaluate its utility in a demonstration project among floor layers.     

Neural Correlates of Pathological Gamblers Preference for Immediate Rewards During the Iowa Gambling Task: An fMRI Study

The Iowa Gambling Task (IGT) involves exploratory learning via rewards and penalties, where most advantageous task performance requires subjects to forego potential large immediate rewards for small longer-term rewards to avoid larger punishments. Pathological gambling (PG) subjects perform worse on the IGT compared to controls, relating to their persistence at high risk decisions involving the continued choice of potential large immediate rewards despite experiencing larger punishments. We wished to determine if neural processing of risk and reward within striatal and frontal cortex is associated with this behaviour observed in PG. Functional magnetic resonance imaging (fMRI) was used to assess brain activity in response to a computerized version of the IGT. Thirteen male PG subjects with no active comorbidities were compared to 13 demographically matched control subjects. In agreement with previous behavioural studies, PG subjects performed worse on the IGT and made more high-risk choices compared to controls, particularly after experiencing wins and losses. During high-risk gambling decisions, fMRI demonstrated that PG subjects exhibited relatively increased frontal lobe and basal ganglia activation, particularly involving the orbitofrontal cortex (OFC), caudate and amygdala. Increased activation of regions encompassing the extended reward pathway in PG subjects during high risk choices suggests that the persistence of PG may be due to the increased salience of immediate and greater potential monetary rewards relative to lower monetary rewards or potential future losses. Whether this over activation of the reward pathway is associated with the development of PG warrants further investigation.     

Changes following Premarital Education for Couples with Differing Degrees of Future Marital Risk

The present study explored changes in individuals' relationship cognitions and behaviors following premarital education for couples with different risk profiles. The sample consisted of 63 couples who completed the PREPARE program and were classified for future marital risk based on dyadic information. A significant interaction effect was found between risk and time, with individuals in relationships classified as high risk exhibiting greater change at 4 weeks postprogram compared to low‐risk individuals. Perceived helpfulness of topics also varied by couple type. Findings provide support for adapting premarital education programs for high‐risk couples and offer clinicians and educators specific insights for areas of emphasis when working with different types of couples.