Attracting qualified physicians to underserved areas. Part 2. Pay physicians more to practice in underserved areas.

With health networks searching for additional market share and with a projected 30.2 million to be enrolled in Medicaid HMOs by 2000, more health executives will be weighing various strategies of how to attract qualified physicians to practice in poor inner-city and rural areas. Most frequently cited as solutions are supplying more physicians, encouraging more medical school graduates to pursue primary care residencies, and modifying the number of international medical graduates entering U.S. residency programs. Part I of this article, which appeared in the November/December issue of The Physician Executive, reviewed the efficacy of these approaches. The second part explores a more pragmatic option: to simply improve the working conditions and pay substantially more to physicians who practice in "less desirable" locations. Although this idea is consistent with economic principles, drawbacks must be considered, such as: (1) the American taxpayers' reluctance to finance a more costly health care delivery system for the poor; (2) the inherent conceptual difficulties of a capitated Medicaid HMO serving as the linchpin for organizing, financing, and delivering care for the underserved; and, (3) many providers being expected to react in a fairly litigious manner to such an approach.     

Conflict management, Part 1. Conflict management checklist: a diagnostic tool for assessing conflict in organizations

Complex interpersonal conflicts are inevitable in the high speed, high stakes, pressured work of health care. Poorly managed, conflict saps productivity, erodes trust, and spawns additional disputes. Well managed, conflict can enhance the self-confidence and self-esteem of the parties, build relationships, and engender creative solutions beyond expectations. Just as thoughtful differential diagnosis precedes optimum treatment in the doctor-patient relationship, management of conflict is greatly enhanced when preceded by careful assessment. In the first of two articles, the authors present a diagnostic approach, the Conflict Management Checklist, to increase self-awareness and decrease anxiety around conflict.     

What physician executives and health care organizations should expect from each other

Today, interest in defining the role of the physician executive and ensuring this individual is effectively integrated into the organization is high for good reason--the ranks of physician executives are growing. What attributes should health care organizations look for when hiring physician executives and what should they should expect of them once they are on the job? Physician executives should: (1) have demonstrated clinical and management skills; (2) have a comfort level with participatory decision-making; (3) have superb interpersonal skills; and (4) be a champion of the patient. Physician executives should expect the following support from their organizations: (1) varied roles and responsibilities; (2) mentoring by other senior executives; (3) lifelong learning opportunities; and (4) complete support of the management team.     

Quality costing: a management review

This paper relates a review of the English language literature on quality costing and traces its historical development; it provides authoritative reading on the subject. The review also has a focus on collection and use of quality-costing methods, quantitative cost data and the role and views of accountants in the task of quality-cost collection and reporting. Amongst the main findings is the preoccupation with the prevention – appraisal – failure categorization of quality costs and lack of guidance on definitions. The considerable impact of the American quality profession on the development of quality costing is pointed out along with the increasingly positive stance of accountants.     

The Role of Organizational and Information Technology Antecedents in Reengineering Initiation Behavior*

Business Process Reengineering (BPR) has been a major catalyst of the pervasive organizational change we have witnessed over the past decade. Although one can speculate on the reasons for the popularity of this phenomenon, it is important that we carefully examine its underlying antecedents for initiation, implementation, and ultimately success, if we are to add value to practitioners of this concept. This study empirically examines the importance of facets of the organizational structure, IT knowledge resources and infrastructure, and the IS function in the initiation of BPR. Data from 313 corporations were gathered using a carefully validated survey, and initiators were compared with noninitiators. The results strongly suggest that client-server architectures, the strategic integration of IS, and cross departmental interaction are among the more important factors facilitating initiation and can be important inputs in a BPR decision-making process. The study attempts to build a contingent theory for BPR, and the more sustainable notion of fundamental process change.     

Changes in physician and non-physician relationships

At the end of World War II, one-third of the nation's hospital administrators were physicians. During the 1950's through the mid-1980's a new breed of masters'level administrator, with well-honed coordinating skills, orchestrated a major expansion of new programs, services, and facilities. With the advent of the Medicare prospective payment system (PPS), more governing boards restructured their administrative staffs with corporate titles. Meanwhile, physicians sensed that trustees were becoming far more concerned with bottom line performance to repay a mounting debt that hospitals had incurred to remain technologically competitive. Since mergers and integrated health systems by themselves will be unable to generate significant operating efficiencies, governing boards will be forced to change direction and shift back to recruiting physicians as their CEOs or in other senior positions to assure themselves of the clinical leadership required to implement the managed care concepts of reducing utilization and cost, and simultaneously enhancing quality of patient care.     

The Determinants of Trust and Credibility in Environmental Risk Communication: An Empirical Study

This study examines a key component of environmental risk communication; trust and credibility. The study was conducted in two parts. In the first part, six hypotheses regarding the perceptions and determinants of trust and credibility were tested against survey data. The hypotheses were supported by the data. The most important hypothesis was that perceptions of trust and credibility are dependent on three factors: perceptions of knowledge and expertise; perceptions of openness and honesty; and perceptions of concern and care. In the second part, models were constructed with perceptions of trust and credibility as the dependent variable. The goal was to examine the data for findings with direct policy implications. One such finding was that defying a negative stereotype is key to improving perceptions of trust and credibility.     

Estimation from Zero-Failure Data

When performing quantitative (or probabilistic) risk assessments, it is often the case that data for many of the potential events in question are sparse or nonexistent. Some of these events may be well-represented by the binomial probability distribution. In this paper, a model for predicting the binomial failure probability, P , from data that include no failures is examined. A review of the literature indicates that the use of this model is currently limited to risk analysis of energetic initiation in the explosives testing field. The basis for the model is discussed, and the behavior of the model relative to other models developed for the same purpose is investigated. It is found that the qualitative behavior of the model is very similar to that of the other models, and for larger values of n (the number of trials), the predicted P values varied by a factor of about eight among the five models examined. Analysis revealed that the estimator is nearly identical to the median of a Bayesian posterior distribution, derived using a uniform prior. An explanation of the application of the estimator in explosives testing is provided, and comments are offered regarding the use of the estimator versus other possible techniques.     

What are Research Expectations? A Comparative Study of Different Academic Disciplines

This paper is intended to assist professors, administrators, librarians and other members of university level committees that must consider research expectations and research quality in academic fields that they lack. While this is not a problem for field experts, it is a difficulty when people are asked to make decisions in areas of study other than their own. This is commonly the case for senior university professors, librarians and administrators in regards to university wide decisions. The paper investigates this gap, through a study of 27 academic fields in 348 highly regarded universities. We find that there are almost always statistically significant differences in activity between academic fields, regardless of the metric one considers. However, it is possible to understand these differences by comparing the distribution of a known academic field to that of a field that one is not familiar with. Tables and information are provided to assist in the comparison of different fields of study on metrics such as: departmental publications and researcher level metrics of publications, citations, H-index, and total number of co-authors. The information can also be used to support decisions associated with promotion to senior posts such as endowed chairs and professorships. Information regarding specific universities and researchers are included in the data supplement.