The Effect of Integrated Scheduling and Capacity Policies on Clinical Efficiency

In outpatient healthcare clinics, capacity, patient flow, and scheduling are rarely managed in an integrated fashion, so a question of interest is whether clinic performance can be improved if the policies that guide these decisions are set jointly. Despite the potential importance of this issue, we find surprisingly few studies that look at how the allocation of capacity, paired with various appointment scheduling policies and different patient flow configurations, affects patient flow and clinical efficiency. In this paper, we develop an empirically based discrete‐event simulation to examine the interactions between patient appointment policies and capacity allocation policies (i.e., the number of available examination rooms) and how they jointly affect various performance measures, such as resource utilization and patient waiting time. Findings suggest that scheduling lower‐variance, shorter appointments earlier in the clinic (and, conversely, higher‐variance, longer appointments later) results in less overall patient waiting without reducing physician utilization or increasing clinic duration. Additionally, exam rooms exhibited classic bottleneck behavior: there was no effect on physician utilization by adding exam rooms beyond a certain threshold, but too few exam rooms were devastating to clinic throughput. Some significant interactions between these variables were observed, but were not influential to the level of managerial concern. Clinicians' intuition about managing capacity in healthcare settings may differ substantially from best policies.     

Nonprofit and Social Marketing

Marketing Social Change: Changing Behavior to Promote Health, Social Development, and the Environment, by Alan R. Andreasen. San Francisco: Jossey-Bass, 1995. 367 pp., $30.95 cloth. Marketing Strategies for Nonprofit Organizations, by Siri Espy. Chicago, Ill.: Lyceum Books, 1993. 165 pp., $19.95 paper. Marketing Nonprofit Programs and Services: Proven and Practical Strategies to Get More Customers, Members, and Donors, by Douglas B. Herron. San Francisco: Jossey-Bass, 1997. 282 pp., $32.95 cloth.     

Multicultural Meanings of Social Support among Immigrants and Refugees

Canada continues to be a prominent immigrant and refugee‐receiving country in worldwide migration, resettlement, and search for refuge, yet there is a gap in our understanding of these newcomers’ views of the specific meanings of social support and their support needs and resources. The purpose of this study was to understand the meanings of social support for immigrants and refugees in Canada, and to explore the types and adequacy of formal supports. Individual interviews were conducted with 60 service providers and policymakers initially (Phase 1), and 120 immigrants and refugees (60 Chinese, 60 Somali) in the second phase. The implications of these findings were elicited in group interviews (Phase 3) of policy decision‐makers, advocates, service providers, and managers. This investigation revealed many interrelated challenges facing refugees and immigrants such as language difficulties, inadequate information on services, poor health, racism, needs for retraining, rejection of foreign qualifications, unemployment, social isolation, social insecurity, dwindling social networks, and family conflicts. The study also illuminated culturally and socio‐economically determined perceptions of social support and support‐seeking strategies. Limited personal resources and dwindling social networks are an impediment to coping with integration and settlement challenges. In many cases, newcomers’ efforts to seek help are thwarted by systemic obstacles. Newcomers experienced extensive unmet support needs, which service providers cannot adequately meet due to bureaucratic and resource constraints. Policies in various sectors that affect the lives of immigrants and refugees are inadequate for bridging their support deficiencies. These support gaps hinder the successful settlement and integration of newcomers. Policies and programs fostering culturally relevant support, and inter‐sectoral collaboration among organizations addressing the support needs of immigrants and refugees are timely.     

Reducing Palilalia by Presenting Tact Corrections to Young Children with Autism

Palilalia, the delayed repetition of words or phrases, occurs frequently among individuals with autism and developmental disabilities. The current study used a combined multiple baseline and reversal design to investigate the effectiveness of presenting tacts as corrections for palilalia. During baseline, five preschoolers with autism emitted high rates of palilalia and low rates of mands and tacts during play and instructional activities. During treatment, when experimenters presented opportunities to echoically tact actions and objects following the emission of palilalia, its frequency decreased to low and stable levels and mands and tacts increased. Functional relationships between the tact corrections and emissions of palilalia, mands, and tacts were established during reversals to baseline and treatment conditions. Similar trends in responding were found for frequency of palilalia, mands, and tacts in non-treatment settings.     

Critical research and entrepreneurship: A cross-disciplinary conceptual typology

Critical perspectives of entrepreneurship have gained increasing traction over the last two decades. The transformative potential of critical research resides in challenging some of entrepreneurship research's epistemological, ontological and theoretical assumptions, with a view to offering a range of alternatives. Critical research in entrepreneurship has remained fragmented, however, due to its heterogeneous theoretical lineages and compartmentalized and niche interests. Addressing this situation, our objective is to intensify the space of critique in entrepreneurship research by offering a theoretically informed typology that delineates different manifestations of ‘criticalness’. Our overarching contribution is to advance a typology distinguishing four ideal types of critical entrepreneurship research based on evaluative emphases (referred to as ‘valence’) and the meta-theoretical assumptions informing its critical operation (called ‘paradigmatic orientation’). By demonstrating the variegated political, ethical and ideological interests and preoccupations that critical studies serve within different management sub-disciplines, the typology provides a conceptual vocabulary for making sense of and synthesizing critical perspectives across scholarly boundaries. Also, it helps to reposition understandings of critique as gestures of negativity by stimulating a greater appreciation of the generative potential of critique and the theoretical and philosophical possibilities that this can bring to our scholarly community.     

Pathways to pleasure: Older adult women’s reflections on being sexual beings

Older adult women make up a growing part of the population, and yet literature on the sexual activity over their life spans is lacking. This qualitative interview study explored the experience of 16 women aged 57–91 to better understand sexual pleasure over a lifetime. The participants described having to challenge cultural rules to create a supportive environment for sexual expression. Having access to Novel contexts in which to learn, cultivating Intimacy with partners and with oneself, being Creative with sexual activities, and Extending one’s sense of sexual possibility into advanced age (NICE) supported sexual pleasure as women aged.     

Modeling binary responses with stochastic covariates

In a traditional binary regression model, covariates are assumed to be fixed by design. In practice, however, they are most likely to be stochastic and non-normally distributed. We develop modified maximum likelihood estimators for such situations. We show that these estimators are more efficient than the traditional binary regression estimators and robust to data anomalies. We illustrate our results using a real life example.     

Women's desire for the kaleidoscope of authenticity,balance and challenge: A multi‐method study of female health workers’ careers

Improved health care and increased life expectancy have extended working lives and changed the nature of work for many women. The aim of this research is to explore women's kaleidoscope career intentions of authenticity, balance and challenge, and understand the impact of life roles on their career choices. The research comprises two studies. In Study 1, interviews with 14 female hospital pharmacists demonstrate how their desire to increase non‐work life roles while caring for ageing parents has influence over their career choices. In Study 2, a survey of 178 female direct care workers confirms life roles’ impact on their kaleidoscope career intentions. Findings demonstrate that different life roles strongly influence women's career choices in a number of ways, primarily their desire to increase their leisure and engagement with activities outside work. In later life, carer responsibilities play an influential role in female career choices, particularly those related to eldercare. Finally, kaleidoscope career intentions may be influenced by life roles. These findings have considerable implications for both the expansion of careers and gender theory, and development of public and business policies aimed at attracting and retaining human resources.     

Advancing relationship management theory: Mapping the continuum of relationship types

Building on the literature of relationship management, this study explores the way organization type influences the nature of the organization–public relationship. Three types of organization–public relationship were examined (nonprofit organization–volunteer, retailer–consumer, and political party–member) and which were mapped to Hung's (2005) continuum of relationships, ranging from communal to exploitive. Four dimensions of the relationship were examined: trust, control mutuality, satisfaction, and commitment. Surveys were completed by 313 respondents to measure their relationships with all three organizational types. Significant differences were detected between organizations which were deemed high, medium and low in communality. Results provide insight into the role that communality plays in levels of relationship quality in the organization–public relationship.     

Implementing Single Session Family Consultation: A Reflective Team Approach

Setting up and implementing a single session family consultation in a specialist child and adolescent mental health setting, which for a long time has been an organisation and culture that has undertaken a traditional detailed child and family assessment and treatment, brings with it challenges. This paper will look at the history of single session consultation within the field of child and family services and, in particular, child and family services in mental health. It will also look at the development and implementation of a single session therapy program, and associated research on the effectiveness of the program, at the Alfred Child and Youth Mental Health Service. Clinical examples will assist in illustrating the program and its model and structures. Lastly, it will review the research data and compare this with other research data in the field.