The development of the physicians' end-of-life care attitude scale

The Physicians' End-of-Life Care Attitude Scale (PEAS) was developed as an outcome measure for palliative care education. PEAS assesses the willingness of medical trainees to care for dying patients. Sixty-four Likert-type questions were created on the basis of discussions with focus groups of medical trainees, then administered to sixty-two medical students and residents. Total PEAS scores as well as personal preparation and professional role subscales (where higher scores indicated greater concern) possessed excellent internal consistency and reliability. In addition, there were substantial correlations between PEAS scores and the CA-Dying scale, a measurement of laypersons' fears about interacting with dying persons. Thus, PEAS adequately assesses the unique communication concerns of physicians in training regarding working with dying persons and their families. Correlations between PEAS scores and age were negative, while those who had experienced the death of a loved one had higher PEAS scores than those who did not. This suggests that for some persons, life experiences may lessen difficulties in dealing with dying persons, while for others, personal losses may exacerbate such concerns. The utility of PEAS in evaluating the efficacy of palliative care education as well as its potential to measure medical trainee's willingness to care for the terminally ill is discussed.     

On the Measurements of Board Composition: Poor Consistency and a Serious Mismatch of Theory and Operationalization

Over two dozen operationalizations of board composition can be identified from the empirical literature. A structural equations confirmatory factor analysis (LISREL 8.03) suggests that these operationalizations do not constitute a single construct of board independence. Instead, analyses strongly indicate three separate constructs. Common operationalizations of board composition, then, are neither tenable surrogates for one another nor are they interchangeable. Implications for empirical aggregation of studies, theory/measurement convergence, and the current corporate governance public policy debate are discussed.     

LINKING PROCESS CHOICE WITH PLANT-LEVEL DECISIONS ABOUT CAPITAL AND HUMAN RESOURCES

We examine how process choice links with design decisions about capital and human resources. Our analysis confirms empirically most expected differences between process- and product-focused plants for these decisions. What is unexpected is how top-performing plants resemble other plants within the same process choice category in most respects, while distinguishing themselves on a few selected process attributes. For example, better performing process-focused plants not only achieve higher machine flexibility levels and lower overhead costs as expected, but also have more intensive preventive maintenance programs. Similarly, product-focused plants that achieve certain hallmarks of process-focused plants also enjoy superior performance.     

A cross-validation of a structural equation model of accidents: organizational and psychological variables as predictors of work safety

A study to establish a structural equation model of accidents is presented. The eight variables included in the model were those associated with accidents in previous research. The reliability of questionnaires to measure those variables and a structural equation model relating them are provided. The model explaining the occurrence of accidents was cross-validated through three Spanish samples (n=123; 182; 124).The model presented a good fit to data in two samples, while a third had unclear fit indices. Therefore, most relationships among variables did not vary among these three samples. The role of the safety variables in the model is discussed. The discussion is also focused on risk measurement difficulties commonly reported in the literature. Finally, some suggestions for future safety research with structural equation modelling techniques are provided.     

Time management as a moderator of relations between stressors and employee strain

The purpose of this study was to examine whether time management behaviours moderated relations between stressors (role conflict, role overload, work-family conflict, and family-work conflict) and strain, as measured by scores on the General Health Questionnaire. It was predicted that use of time management behaviours would be negatively associated with strain. These relations, however, were expected to be mediated by feelings of control over time. It was further predicted that the use of time management behaviours would attenuate stressor-strain relations. Data collected from 525 employed men and women indicated, as predicted, that use of time management behaviours was negatively associated with strain. These relations were partially mediated by feelings of control over time. Moderator tests failed to provide support for time management behaviour as a moderator of stressor-strain relations. Implications of findings are discussed and future directions for time management research are suggested.     

Mixed Levels of Uncertainty in Complex Policy Models

The characterization and treatment of uncertainty poses special challenges when modeling indeterminate or complex coupled systems such as those involved in the interactions between human activity, climate and the ecosystem. Uncertainty about model structure may become as, or more important than, uncertainty about parameter values. When uncertainty grows so large that prediction or optimization no longer makes sense, it may still be possible to use the model as a behavioral test bed to examine the relative robustness of alternative observational and behavioral strategies. When models must be run into portions of their phase space that are not well understood, different submodels may become unreliable at different rates. A common example involves running a time stepped model far into the future. Several strategies can be used to deal with such situations. The probability of model failure can be reported as a function of time. Possible alternative surprises can be assigned probabilities, modeled separately, and combined. Finally, through the use of subjective judgments, one may be able to combine, and over time shift between models, moving from more detailed to progressively simpler order-of-magnitude models, and perhaps ultimately, on to simple bounding analysis.     

Challenges to the Acceptance of Probabilistic Risk Analysis

This paper discusses a number of the key challenges to the acceptance and application of probabilistic risk analysis (PRA). Those challenges include: (a) the extensive reliance on subjective judgment in PRA, requiring the development of guidance for the use of PRA in risk-informed regulation, and possibly the development of robust or reference prior distributions to minimize the reliance on judgment; and (b) the treatment of human performance in PRA, including not only human error per se but also management and organizational factors more broadly. All of these areas are seen as presenting interesting research challenges at the interface between engineering and other disciplines.     

Physician-centered management guidelines.

The "Fortune 500 Most Admired" companies fully understand the irreverent premise "the customer comes second" and that there is a direct correlation between a satisfied work force and productivity, service quality, and, ultimately, organizational success. If health care organizations hope to recruit and retain the quality workforce upon which their core competency depends, they must develop a vision strategic plan, organizational structure, and managerial style that acknowledges the vital and central role of physicians in the delivery of care. This article outlines a conceptual framework for effective physician management, a "critical pathway," that will enable health care organizations to add their name to the list of "most admired." The nine principles described in this article are based on a more respectful and solicitous treatment of physicians and their more central directing role in organizational change. They would permit the transformation of health care into a system that both preserves the virtues of the physician-patient relationship and meets the demand for quality and cost-effectiveness.     

How to shape positive relationships in medical practices and hospitals

Managing workplace conflict is one of the most important, stressful, and time-consuming tasks faced by today's medical leaders. Poorly managed workplace conflict can alienate patients, demoralize staff, increase turnover, damage relationships with valued referral sources and third party carriers concerned about patient satisfaction, and lead medical practices to costly "corporate divorces." Physician executives cannot solve the problems caused by disruptive doctors simply by bolstering their own conflict management skills or by policing offenders. The larger contexts within which inappropriate workplace behavior occurs must also be assessed and addressed. The true leadership challenge is to intervene in ways that help to foster a "culture" of appropriate interpersonal dynamics throughout your organization. This requires learning to think and to intervene systematically.