Becoming a company person.

Physicians face a management challenge in adjusting to being part of a larger organization. By nature, physicians are not "company people." For physician executives, whose instincts can still lean toward being ferociously independent and individualistic--therein lies the struggle. Here are a few suggestions to help physician executives make the adjustments that are required of a "company person": (1) Be in the right place; (2) abandon critical/negative thinking; (3) focus on the issues; (4) maintain solidarity; and (5) make your boss look good.     

The Power of Perception: Health Risk Attributed to Air Pollution in an Urban Industrial Neighbourhood

This paper describes a multi-stakeholder process designed to assess the potential health risks associated with adverse air quality in an urban industrial neighborhood. The paper briefly describes the quantitative health risk assessment conducted by scientific experts, with input by a grassroots community group concerned about the impacts of adverse air quality on their health and quality of life. In this case, rather than accept the views of the scientific experts, the community used their powers of perception to advantage by successfully advocating for a professionally conducted community health survey. This survey was designed to document, systematically and rigorously, the health risk perceptions community members associated with exposure to adverse air quality in their neighborhood. This paper describes the institutional and community contexts within which the research is situated as well as the design, administration, analysis, and results of the community health survey administered to 402 households living in an urban industrial neighborhood in Hamilton, Ontario, Canada. These survey results served to legitimate the community's concerns about air quality and to help broaden operational definitions of health. In addition, the results of both health risk assessment exercises served to keep issues of air quality on the local political agenda. Implications of these findings for our understanding of the environmental justice process as well as the ability of communities to influence environmental health policy are discussed.     

A great position before a great 'package'

Should employment agreements (EAs) be the deciding factor in considering a new position? EAs are details--important details, but background just the same--to the key issue: Do you want the job? And because of the way many health care organizations create their EAs, there really is little room for negotiation. Perceptions persist that this is an entirely open area, a blank canvas upon which each physician executive, in each situation, must don his or her battle gear and fight fiercely for the best possible deal. And yet, this is an area in which you are unlikely to have control.     

Independent social choice correspondences

A fixed agenda social choice correspondence on outcome set X maps each profile of individual preferences into a nonempty subset of X. If satisfies an analogue of Arrow's independence of irrelevant alternatives condition, then either the range of contains exactly two alternatives, or else there is at most one individual whose preferences have any bearing on . This is the case even if is not defined for any proper subset of X.     

Risk as Analysis and Risk as Feelings: Some Thoughts about Affect, Reason, Risk, and Rationality

Modern theories in cognitive psychology and neuroscience indicate that there are two fundamental ways in which human beings comprehend risk. The “analytic system” uses algorithms and normative rules, such as probability calculus, formal logic, and risk assessment. It is relatively slow, effortful, and requires conscious control. The “experiential system” is intuitive, fast, mostly automatic, and not very accessible to conscious awareness. The experiential system enabled human beings to survive during their long period of evolution and remains today the most natural and most common way to respond to risk. It relies on images and associations, linked by experience to emotion and affect (a feeling that something is good or bad). This system represents risk as a feeling that tells us whether it is safe to walk down this dark street or drink this strange‐smelling water. Proponents of formal risk analysis tend to view affective responses to risk as irrational. Current wisdom disputes this view. The rational and the experiential systems operate in parallel and each seems to depend on the other for guidance. Studies have demonstrated that analytic reasoning cannot be effective unless it is guided by emotion and affect. Rational decision making requires proper integration of both modes of thought. Both systems have their advantages, biases, and limitations. Now that we are beginning to understand the complex interplay between emotion and reason that is essential to rational behavior, the challenge before us is to think creatively about what this means for managing risk. On the one hand, how do we apply reason to temper the strong emotions engendered by some risk events? On the other hand, how do we infuse needed “doses of feeling” into circumstances where lack of experience may otherwise leave us too “coldly rational”? This article addresses these important questions.     

Boldly going where no one has gone before

With all the changes occurring in the U.S. health care system come new opportunities for physician executives willing to boldly go where no one has gone before. These positions are being newly created and thus are somewhat undefined and uncharted. Health care organizations want individuals for high-risk positions with unique skill sets and bright, new ideas. Organizations want to find people who can do what has never been done before-for them, at least, if not anywhere in the universe. How does that translate into experiences that you might want to acquire? Most organizations today are looking for individuals with some networking experience, but analogous experience (such as in a multi-site medical group or active involvement in formation of IPAs) is often a good alternative. In addition, true line experience in one or more organizations is a solid credential. Knowledge of where managed health care dollars begin and end is a necessity. As always, executive style and presence are expected.     

The estimated cost of project labor agreements on federal construction

I estimate the cost of President Clinton’s June 1997 executive memorandum encouraging federal departments and agencies to use project labor agreements (PLAs) on “large and significant” construction projects. Based on the higher wage costs associated with PLAs, the cost of federally owned construction will rise by 1.7 to 7.0 percent annually. Over the three years for which the memorandum will apply, federally owned construction costs will increase by $844 million to $3.44 billion. If the memorandum is interpreted to apply to state and local construction projects funded with federal money, the cost could range between $3.2 and $13.0 billion. The author thanks Ken Deavers, Anita Hattiangadi, Edward Potter, and Gary Shiu for their suggestions and help in the preparation of this paper.