Reporting quality of health care to the board

The reporting of quality of health care to the governing board has long been an enigma. Now we are in the midst of a revolution in health care, as we shift our focus from solely the clinical performance of individuals to a broader scope of assessing and improving all activities around patient services and patient care--i.e., management outcomes integrated with clinical outcomes to help identify opportunities to improve patient care. In addition, apprised of corporate liability for the quality of care provided in health care organizations, governing boards are raising questions and demanding more information. To maintain this high degree of interest in quality of health care, information should be restricted to what the board needs to know. This article will be confined to the hospital's organizationwide quality system of monitoring and evaluating. While medical staff credentialing and privileging are also board responsibilities and quality management activities should be used in the privileging and credentialing process, they will not be addressed in this article.     

Yes-no voting

Yes-No (Y-N) voting is a voting method for choosing a governing coalition in a parliament after the seating of its members. Each member can designate a party to be Y (it must be included in the governing coalition), N (it must be excluded from the governing coalition), or neither (it may be either in or out of the governing coalition). The majority coalition acceptable to the most voters, because it includes all parties that these voters designate Y and no parties that they designate N, is given the first opportunity to form a government. Possible combinations of majority coalitions that a member might vote for are derived, including ones based on consistent and interval voting strategies. Examples illustrate a number of different phenomena, such as when a rational voter might not be loyal to his or her party by designating it Y.     

Separating marginal utility and probabilistic risk aversion

This paper is motivated by the search for one cardinal utility for decisions under risk, welfare evaluations, and other contexts. This cardinal utility should have meaningprior to risk, with risk depending on cardinal utility, not the other way around. The rank-dependent utility model can reconcile such a view on utility with the position that risk attitude consists of more than marginal utility, by providing a separate risk component: a probabilistic risk attitude towards probability mixtures of lotteries, modeled through a transformation for cumulative probabilities. While this separation of risk attitude into two independent components is the characteristic feature of rank-dependent utility, it had not yet been axiomatized. Doing that is the purpose of this paper. Therefore, in the second part, the paper extends Yaari's axiomatization to nonlinear utility, and provides separate axiomatizations for increasing/decreasing marginal utility and for optimistic/pessimistic probability transformations. This is generalized to interpersonal comparability. It is also shown that two elementary and often-discussed properties — quasi-convexity (aversion) of preferences with respect to probability mixtures, and convexity (pessimism) of the probability transformation — are equivalent.     

The rhetorical construction of efficiency: Restructuring and industrial democracy in Mondragón,Spain

This paper examines the tension between the struggle to survive in a competitive economy and efforts to create more democratic workplaces in the Basque worker cooperative complex in Mondragón, Spain. Data from archival research, participant observation, and interviews are used to outline the historical context of structural change and policy-making in the complex. Language used in internal policy discussions is analyzed to explore the way in which arguments about efficiency have shaped interpretations of structural change and these organizations' policy responses. It is argued that in these cooperatives, the concept of efficiency does not operate as a neutral, objective benchmark of organizational performance, but is socially and rhetorically constructed. The predominant approach to efficiency that is emerging in Mondragón aims to make the cooperatives more competitive, but also facilitates a gradual displacement of collectively established organizational objectives such as relative equality, job security, and favorable work conditions for ones that privilege institutional interests of profitability and stability. More importantly, it has helped usher in important changes in the policy-making process itself, limiting the range of legitimate participation and weakening broad-based control over the identification of appropriate objectives and means. The paper suggests that reframing an existing rhetorical strategy to highlight more clearly the link between efficiency and any given set of objectives would stimulate a broader discussion of policy issues and help balance more effectively the diverse interests at stake in Mondragón's restructuring.An earlier version of this paper was presented at the 1992 annual meetings of the American Sociological Association in Pittsburgh, Pennsylvania.     

The future of U.S. government—corporate relations

The future of government—corporate relations in the United States was studied using the Delphi research methodology. An expert panel estimated the dates of occurrence for 55 events, forming a futures scenario. The events were grouped into the five topic areas of the natural environment, employment, corporate governance, the economy and regulation/planning. The findings from the research indicated that the federal government will play an increasingly active and important role in the regulation of business over the next 20 years. However, there will not be drastic changes in structure or major discontinuities in the institutional relationships.     

International Joint Ventures: Partnering Skills and Cross-Cultural Issues

Cooperative activity has become an important element of strategic behaviour and, with increasing globalisation, many alliances are being formed across national boundaries, with the attendant challenges of surmounting linguistic and other cultural barriers. This article provides new perspectives on the partnering skills needed for success in such international joint ventures (IJVs). Based on the analysis of 60 personal interviews from a sample of 20 Anglo-European JVs, four categories of skills are analysed: inter-partner skills, managing the IJV managers, the “upward management” skills of IJV managers managing the ‘parent’ partners, and those of managing the IJV itself. The article presents a matrix to examine the four categories of skill in the context in which each are used. Serving both as an analytical device and a diagnostic tool, this matrix offers results that have important implications for the management of IJVs with regard to the selection and training of managers and the inculcation of the skills required for each level of operation.     

Efficiency Wages: Signals or Incentives An Empirical Study of the Relationship between Wage and Commitment

Efficiency wage theories arguethat firms induce their employees to work in a moredisciplined way by paying high wages. Two basicmechanisms have been pointed out in economics about how these wage premia motivate employees.The incentives-driven `shirking model' impliesthat employees who have a highly paid job workin a more disciplined way so as to avoid beingdismissed. The ``gift exchange' model is basedon the assumption that high wages change therelationship between employer and employee.Empirical evidence on the incentives approachis mixed and a thorough competitive testingagainst the gift exchange model was notpossible due to the fact that the latter wasnot worked out enough. However, there is a relational theory of efficiency wages which isworked out in detail in order to allow directcompetitive testing. This relationalsignaling approach, as it is called, is basedon framing effects and comes to specifichypotheses about the conditions under whichefficiency wages work. These hypothesescontrast sharply with predictions from theincentives approach. The paper presents anempirical test of the theories and shows thatthe data clearly reject the incentive-basedpredictions and confirm the relationalsignaling predictions.