An evolving medical leadership position. Tomorrow's Vice President for Medical Affairs

The role of medical leadership in hospitals and health systems is under constant scrutiny and change. The nature of the Vice President for Medical Affairs (VPMA) position and its relationship to leadership in the health care system is explored through a national panel survey conducted recently. The effective VPMA will: be an aggressive manager able to implement change, address strategic planning and quality of care issues; have a high level of integrity; and be a good communicator and problem solver. The results of the research are presented in three sections. The first section describes the background characteristics and compensation of the VPMAs who participated in the survey. The second section focuses on the current role of the VPMA, including duties and responsibilities, job performance barriers and required skills. The final section addresses respondents' perceptions regarding areas for improvement in the role of the VPMA, as well as projections for future changes in this position.     

Algorithms for resource allocation of substance abuse prevention funds based on social indicators: a case study on state of Florida--Part 3

The purpose of Part 3 is to develop an algorithm for an equitable distribution of state prevention funds to its substate jurisdictions based on the need for prevention services. In this series, the need for prevention services is measured in terms of the existing social indicators observed at the county level. In order to establish a conceptual link as well as the empirical relevance of the selected social indicators as proxy measurements of the estimated need for prevention at the county level, we have employed both concurrent and construct validity tests using the following three constructs as the criterion variables in a multiple regressing setting: 1) county-based composite drug use index score (COMDRUG) measured via the statewide drug survey; 2) county-based proportions of prevention target populations using the conceptual definition advanced by the Institute of Medicine (IOM); and 3) the composite risk factor score (COMRISK) assembled from a list of twenty-two risk and protective factors observed for each county. These constructs were identified previously in Parts 1 and 2. While employing eight social indicators to estimate the overall prevention needs observed at the county level, the social indicators thus selected were able to explain 69 percent of the variations in COMDRUG, 68 percent of the variation in the proportions of students in need of prevention services using IOM definition, and 60 percent of the variation in COMRISK. Following successful validations of the social indicators as viable media with which to estimate county-based prevention needs, the ensuing multiple regression equation is, then, used to build a resource allocation model by determining the proportion of each county's share of the total statewide COMDRUG-predicted from the social indicators and, then, by weighting the latter proportion by the population size of each county under age eighteen. In this way, we have devised county-based Prevention Needs Index (PNI) scores based solely on social indicators. Finally, the county's share of PNI score is computed as a proportion of to the total statewide PNI score. Following this line of algorithm for resource allocation, we were able to develop yet another resource allocation model solely based on social indicators without the benefits of survey data. Comparing the funding results originating from four resource allocation models (i.e., COMDRUG, IOM Definition, COMRISK, and Social Indicators), it has been learned that there is a remarkable similarity from one funding level to another. Since all four schedules of county-based prevention funding levels have shown very high intercorrelations with a range from .9862 to .9993, it has been determined that these schedules are measuring essentially either the same domain or latent domains that are functionally equivalent to one another. Accordingly, no preference is made among the resource allocation models suggested, although it is suggested that the final decision on the level of funding must be based on the selection of the schedule for resource allocation rather than the suggested amount or level of funding computed for each county.     

Marketing/Finance Executives Personal and Business Value Perspectives: Implications for Market-Focused Management

The concept of Market-Focused Management posits that the ultimate goal of the organization is the satisfaction of custumers' needs. In doing so other objectives of the firm, including financial objectives such as increasing shareholder wealth and long term profitability, will be achieved. The chief marketing and financial officers of the Fortune 1000 firms were surveyed regarding their personal values and a variety of organizational values relating to company stakeholders, organizational goals, appropriate strategies and tactics, competitive strengths and advantages. While both groups exhibited some differences, there was a startling amount of consensus in all areas surveyed. Both groups ranked shareholders and customers as the two most important stakeholders. While the overall goal of customer satisfaction was ranked by both groups as the most important organizational goal, the means to achieving that end differ somewhat. While a large number of organizational values were related to personal value strength, there was little overlap in the relationships between the two groups, although both groups are overwhelmingly driven by other-focused values such as warm relationships with others, sense of belonging and being well respected. Thus, it was concluded that similar personal values lead marketing and financial managers to substantially different attitudinal schema in their approach to managing their responsibilites. This revised version was published online in August 2006 with corrections to the Cover Date.     

Urban-rural differentials in infant mortality in Victorian England

This paper examines the magnitude of urban-rural differentials in infant mortality in England during the nineteenth and early twentieth centuries and also compares the timing of decline for a selection of towns of varying size, and their immediate rural hinterlands. Most towns continued to experience short-term fluctuations in infant mortality until the very end of the nineteenth century; however, in some of the adjacent rural communities--where levels of infant mortality were much lower--conditions were sufficiently favourable to allow a continuous decline in infant mortality from at least the 1860s, if not before. The final part of the paper considers the causes of these patterns and their implications for explanations of infant mortality decline.     

A Generalized QMRA Beta‐Poisson Dose‐Response Model

Quantitative microbial risk assessment (QMRA) is widely accepted for characterizing the microbial risks associated with food, water, and wastewater. Single‐hit dose‐response models are the most commonly used dose‐response models in QMRA. Denoting as the probability of infection at a given mean dose d, a three‐parameter generalized QMRA beta‐Poisson dose‐response model, , is proposed in which the minimum number of organisms required for causing infection, K_min, is not fixed, but a random variable following a geometric distribution with parameter . The single‐hit beta‐Poisson model, , is a special case of the generalized model with K_min = 1 (which implies ). The generalized beta‐Poisson model is based on a conceptual model with greater detail in the dose‐response mechanism. Since a maximum likelihood solution is not easily available, a likelihood‐free approximate Bayesian computation (ABC) algorithm is employed for parameter estimation. By fitting the generalized model to four experimental data sets from the literature, this study reveals that the posterior median estimates produced fall short of meeting the required condition of = 1 for single‐hit assumption. However, three out of four data sets fitted by the generalized models could not achieve an improvement in goodness of fit. These combined results imply that, at least in some cases, a single‐hit assumption for characterizing the dose‐response process may not be appropriate, but that the more complex models may be difficult to support especially if the sample size is small. The three‐parameter generalized model provides a possibility to investigate the mechanism of a dose‐response process in greater detail than is possible under a single‐hit model.     

The Impact of Transformational Leadership on Organizational Citizenship Behaviours: The Contingent Role of Public Service Motivation

In this paper we examine whether the relationship between transformational leadership and organizational citizenship behaviours (OCBs) is contingent on public service motivation (PSM). We propose that PSM may reduce the motivational influences of transformational leaders’ behaviours on followers’ OCBs in public sector organizations. Using a sample of Mexican employees we tested this proposition with structural equation modelling. Our results show that the motivational effects of transformational leadership were less for public sector followers higher in PSM than for those lower in PSM. A follow‐up study in private sector organizations did not reveal a similar interaction effect. These findings appear consistent with previous research demonstrating that PSM is more aligned to the goals and values of public rather than private sector organizations. Nevertheless, the direct effects of PSM on OCBs remained in the private sector.     

Value provided by interfamily economic exchange of goods and services in two cultures

The value of goods and services provided through interfamily economic exchange is examined from a household survey. The existence of an exchange system in society was documented. Over half of the respondents reported that economic transfers between families were important to the quality of their life. Estimated values varied with personal health conditions, importance attached to providing goods and services, years of residence in the community, primary recipient of services, ethnic culture, sex of respondent, and type of service provided. Estimated values can be used for calculating economic loss in community disruption and relocation, measuring family full income, and estimating the importance of nonmarket economic activity in society.The study contributes to interregional Agricultural Experiment Station Research Project NC-128 Quality of Life as Affected by Area of Residence. Cooperating States: Arizona, California, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, Nevada, and Texas.Dr. Williams is an Associate Professor in the Department of Consumer Sciences and Retailing, Purdue University, West Lafayette, Indiana 47907. Her Ph.D. was received from Purdue in Family Economics and Management. Current research areas are income adequacy, economic security, financial problems, and financial counseling.