Zeroing in on leadership effectiveness: The methodological challenges of benchmarking leadership practices

Business success in the 21st century will be based on the widespread mastery of leadership roles, rather than on the directives of a professional or leadership elite. The first step for systematically enacting a leadership development agenda for our nation is to identify the factors, values or qualities most important to leadership effectiveness. Next, we must improve our understanding of how these guiding ideas and insights translate into what successful leaders do. As we perfect this understanding, we will need to operationally define the best practices of successful leaders. These best practices must then become benchmarks for intensive leadership development efforts.This article considers nine methodological challenges of the first agenda item-identification of the factors, values or qualities most important to leadership effectiveness. To illustrate these challenges, the authors use their own business leadership research as a case study. This research surveys 127 chairmen, chief executive officers, and presidents-a cross section of successful U.S.A. business leaders, including men and women from all parts of the nation who have diverse industry, racial, ethnic and religious backgrounds. The authors identify where methodological improvements are needed to cope with the challenges of leadership research. They suggest important directions for methodological development and propose three minimum standards for future leadership research.     

Corporate compliance programs: risk management for the future

The Department of Justice has estimated that the government loses $100 billion annually in health care fraud. Consequently, the government's health care fraud enforcement activities with respect to all health care providers and suppliers continue to grow. Last year alone, the government collected more than $8 billion in settlements, fines, and penalties involving health care fraud. Recent settlements with the government have begun to include corporate compliance programs that require continued government oversight of the health care organization as an essential part of the settlement. The first section of this article describes the legal significance of health care companies' having corporate compliance programs. The second section provides a sample list of topics that should be included in any corporate compliance program. Finally, we describe various issues related to the creation and implementation of corporate compliance programs.     

A hospital protocol to resolve complaints against staff physicians

Complaints of discrimination or harassment in the workplace have become almost commonplace in recent years, increasing in both frequency and variety. In the hospital setting, this trend is manifested in allegations against members of the medical staff by hospital employees as well as by patients or their families. Whether real or fancied, such allegations are reflective of a potentially disruptive undercurrent of organizational tensions. Left unresolved, they can erode the essential partnership between staff physicians and other members of the health care delivery team. Unsatisfactory patient experiences may also damage the reputation of the institution and thereby undermine its viability. With either group of complainants, allegations of malfeasance that are not resolved at the source in a timely manner are far more likely to result in expensive, time-consuming, and potentially damaging litigation.     

A model of numbers of births in three countries,with persistent forty-year cycles

This paper describes a model which relates fertility to partner availability, an aspect of relative cohort size. Partner availability is affected by the tendency for males to reproduce at a later age than females. For women born at a time of rising birth rates, there is a shortage of slightly older men as potential partners. Women born when birthrates are falling enjoy a surplus of older men from which to choose. This model is believed to be the first non-linear demographic feedback model involving feedbacks through marriage squeezes in which empirically estimated values of the parameters imply persistent limit cycles. The deterministic model makes births in each five-year period a function of births in previous five-year periods. The form of the function is chosen to model the effect of partner availability upon entry into reproductive relationships, and therefore on age-specific fertility. Marriage rates are not modeled directly. The model was developed from data for more than a century from England and Wales, New Zealand, and the US. The demographic transition is modeled with a logistic function and age-specific fertility rates are estimated using lognormal distributions. The stepwise inclusion of a partner availability estimate in the model showed that it accounts for 29% of otherwise unexplained variance. Projected future births stabilize in sustained or limit cycles with periods a little longer than 40 years, and amplitudes of at least 7% of the mean. The necessary conditions for cycle persistence are outlined on a graph of maximum and minimum fertility parameters.     

Measuring credibility of compensatory preference statements when trade-offs are interval determined

This paper studies how an overall fuzzy preference relation can be constructed in the compensatory context of the simple additive difference model, when imprecision on the trade-offs has to be taken into account. Three credibility indices of preferences are analysed and illustrated by a numerical example. Arguments are presented supporting the use of the third index, for which an interesting transitivity property (which was an open problem) is proved.     

The ascendancy of primary care: permanent or temporary?

The conventional wisdom strongly suggests a health care provider food chain for the future: Primary care physicians (PCPs), principally family practitioners, on the top playing the lead role, distantly followed by specialists, with hospitals and other ancillary services even further down the line. Is this a reasonable expectation? Will PCPs dominate the new systems? Or will they be but one of many equally necessary components of these developing integrated health care delivery organizations? Looking at the various models now developing, it would seem that future integrated delivery systems will utilize both PCPs and specialists, but with strong augmentation from a diverse assortment of other health care professionals, including nonphysician providers, educators, and administrators. To separate the illusion of primary care dominance of the coming health care system from the likely reality, we should first determine what is driving the apparent present demand for primary care physicians. Next, we will examine the possible and probable reactions to that demand from an economic standpoint and from the points of view of both health care professionals and the public. Finally, we must try to picture how health care provider organizations of the future are likely to look and how they will integrate their health care professionals.     

Emigration dynamics from and within South Asia

This review of current knowledge about emigration dynamics from and within South Asia (Bangladesh, India, Pakistan, and Sri Lanka) opens with a brief history of the three phases of emigration from the area since the 1830s (plantation labor; postindependence to the UK, US, Canada, and Australia; and labor migration to the oil-exporting countries). The influence of the creation of Pakistan and Bangladesh is also covered as are British colonial and commonwealth policies. It is noted that migration data are incomplete and that India exhibits an ambivalence about collecting such information. The discussion then turns to emigration since 1970 and considers permanent migration from South Asia to the traditional receivers; South Asian asylum seekers in Europe; South Asian refugees, illegal migrants, migrant workers (flows and destinations), the stock of contract migrant workers (and their characteristics); returnee migrant workers; and skill levels. Analysis is provided of macro level determinants of emigrations such as gross national product (level and growth), the general demographic and social situation, labor force growth and structure, poverty and inequality, and internal and international migration. Environmental factors causing displacement in Southern Asia include floods, cyclones, river bank erosion, drought, and desertification. Global warming could displace millions of people in the region, and development projects have contributed to displacement. The remainder of the report covers political and ethnic factors, micro-factors influencing migration decision-making, the policies of sending and receiving countries, the consequences of emigration, and the potential for migration in the future.     

Drawing households and other living spaces in the process of assessment and psychotherapy

This paper introduces a drawing technique developed by the author for use in the assessment and treatment of individuals and families. The client is invited to draw a floor plan of his or her home or apartment, or an aerial view of un outdoor area. The drawing is then discussed and considered as a means of understanding critical elements of the experience of life space. The material derived is discussed from the eerspectives of family systems, psychodynamic, and abuse treatment theories, with special reference to notions of family structure, boundary, the self, and memory. Emphasis is placed on the actual physical layout of the home, as well as the subjective experience of it. Applications of the drawing technique for exploring memories are illustrated. Case examples are presented from clinical trials with children and adults in residential treatment, inpatient, and outpatient settings.The Heller Financial Corporation generously supports the development of household and spatial drawings for treatment and prevention. A version of this paper was presented at the 43rd Annual Meeting of the American Association of Psychiatric Services for Children, New Orleans, February 26, 1992. The author wishes to thank Robert B. Bloom, Ph.D., Excutive Director of JCB, for supporting the development of ideas and techniques discribed in this paper.     

International migration: demographic and socioeconomic consequences in the United Kingdom and Europe

"This article evaluates the consequences of international migration since World War II, with particular reference to Great Britain. It emphasizes the substantial differences between the origins and responses to immigration in the United Kingdom and that of the rest of Western Europe." It is found that "people of non-European origin from Commonwealth countries have predominated in postwar immigration to the United Kingdom. That migration neutralized the previously dominant pattern of emigration and increased U.K. population by about 3 million people through immigration and higher fertility, with only slight effects upon the age distribution."     

Grandmothers' influence on mother and child health

This study is based on interviews with grandmothers during July-September 1992-93 in Sudan. The study shows that grandmothers play a significant role in health education and child care within families in the Sudan. Grandmothers, who are not aware of the changes in knowledge, also promote harmful traditions. The authors recommend that health education be directed to elderly women and grandmothers in order to change beliefs and practices that continue to be harmful to children and mothers. Grandmothers were found to give sound advice on child birth, such as movement during labor, breast feeding immediately after birth, and birth intervals of 2-4 years. Grandmothers also gave sound advice on good nutritional practices during pregnancy and use of fermented cereals as weaning foods. Grandmothers recommended use of fenugreek for lactating mothers and use of mint and haharaib for stomach upsets, remedies that are beneficial. Babul is useful after an episiotomy for its antibacterial effects. Harmful advice includes recircumcision after delivery, short birth intervals, and avoidance of contraception. Female genital mutilation (FGM) is a major practice that exposes girls and mothers to a greater risk of mortality during childbirth and pregnancy. The sample of grandmothers agreed on the importance of sex education for a girl before marriage. Unfortunately, 57% of grandmothers recommended 14 years as a suitable age for marriage. Grandmothers generally believed wrongly that riding bicycles, drinking coffee, and wearing trousers by girls would increase their sexual desires. Grandmothers explained menstruation to granddaughters and offered home-made remedies for cramps. 45% believed that there were no disadvantages to FGM and recommended FGM at ages 2-5 years. Most viewed fevers as a danger that required a doctor's care. Advice varied among grandmothers according to socioeconomic class.