Creating customer value by streamlining business processes

Much of the strategic preoccupation of senior managers in the 1990s is focusing on the creation of customer value. Companies are seeking competitive advantage by streamlining the three processes through which they interact with their customers: product creation, order handling and service assurance. 'Micro-strategy' is a term which has been coined for the trade-offs and decisions on where and how to streamline these three processes. The article discusses micro-strategies applied by successful companies.     

Clinical program renovation management

The day-to-day management of medical practice is so heavily influenced by tactical imperatives that few physicians have the time to think strategically. Traditionally, the difference between tactics and strategy is not a major concern of most physician executives. The realm of tactics is the short run, when managers must make do with the fixed resources at hand. Strategy addresses the long run, when all resources and markets are variable. A tactical focus is understandable, maybe even acceptable, in industries where nothing challenges traditional approaches to production of an established product or service. However, medical care in the 1990s is changing so fast that a physician executive must devote an incredible amount of time and effort just to stay confused about what is going on.     

"The responsibility to inform, the power to act": a conference for New England college newspaper editors on the role of the campus press in addressing substance use issues.

College newspapers are a powerful but underutilized medium for educating students on health issues, including those related to drug and alcohol use on campus. Editors of these publications are in a position to wield significant influence among their readers. In addition to communicating factual information about the prevalence and impact of substance use among college students, editors can use the press to advocate changes in students' attitudes and behaviors and in college or community policies that affect substance use. A pilot conference was held to help New England college newspaper editors perceive the importance of their role in educating their peers about substance use and other health-related issues, and to offer concrete suggestions as to how they can incorporate these topics into an "activist" campus press.     

Socialization to dying: social determinants of death acknowledgement and treatment among terminally ill geriatric patients.

Although the vast majority of deaths occur among terminally ill geriatric patients, little is known about the etiology of these patients' death acknowledgement and ultimate type of treatment. Based on interviews with 76 triads composed of physicians, terminally ill patients, and primary caregivers, this study uses the socialization perspective to identify the actors and actions that most strongly affect the patient's death acknowledgment and receipt of exclusively palliative care (i.e., socialization to the dying role). Whereas patient preferences and sociodemographic characteristics do not influence significantly the patient's odds of death acknowledgment, these odds are increased if their primary caregivers accept death, their physicians are not affiliated with a teaching hospital, and the terminal prognosis is disclosed to them and disclosed "matter-of-factly." Patients who acknowledge death, whose agents value pain alleviation over life-prolongation, and whose physicians are not affiliated with a teaching hospital, are substantially more likely to receive exclusively palliative rather than curative terminal treatment.     

Migration research and immigration policy

The author briefly reviews the impact of migration research on U.S. immigration policy over the period 1964-1992. Consideration is given to legal and illegal migrants and refugees.     

Realities of life and future prospects within two cultures: unaccompanied minor refugees from South East Asia in the Federal Republic of Germany

From August 1979 on, more than 30,000 refugees from South East Asia were accepted in the Federal Republic of Germany as quota refugees in a special program; among them were 1600 unaccompanied minor refugees. About 1500 were accompanied Vietnamese children and youths who had fled their home country as 'boat people' across the South China Sea. Unaccompanied minor refugees have, like all other recognized refugees, a legal claim to family reunion in the Federal Republic. Today, only parents can join their children and vice versa, and spouses their spouses. The 1st phase of socialization in the lives of the unaccompanied minor refugees evolved in the cultural traditions of their South East Asian country of origin up to the age of 10 to 15 years. In the 2nd phase of socialization--the enculturation--the child establishes its culturally specific emotionality, language, mentality, and patterns of behavior through interaction and verbal communication with the people nearest him. The 3rd phase of socialization begins at school age and reaches full significance at the age of starting to work, with the accompanying expectations of society. Most of the minor unaccompanied refugees from South Asia had already completed their enculturation--the establishment of their cultural identity. The realities of life the young single refugees as foreigners in German society are determined by 4 special factors: 1) the great cultural differences between their country of originin South East Asia and the resettlement country, 2) the young people left their homes as refugees and their resettlement in the Federal Repulic was determined by chance events, 3) they have to live there alone and without the emotional support of their families in a situation of cultural change, and 4) because of their Asian physiognomy they will always appear as foreigners even if they have integrated well. The future prospects of the young South East Asian refugees in German society will be determined primarily by to what extent they will be able to find a satisfactory place within both cultures.