Physician anger, Part 2. More on the dance of anger.

This article is a follow-up to an interview with Charles Dwyer, PhD, which appeared in the 1999 March/April issue of The Physician Executive. He described how physician executives can change the perceptions of today's beleaguered physicians and help them cope with change. We then asked him for some hands-on strategies to deal with physician anger, fear, and resentment. After much contemplation on providing a list of "fixes" that will restore each of us to a state of greater satisfaction, Dr. Dwyer concludes that there are no generalizable solutions because there are too many variables that come into play in each organization, individual, or group. Attending to the self can provide both individual rescue from these turbulent times and the best hope for changes in the system from which patients and health care providers can benefit. If physicians are to regain their power and maintain, or even improve, their quality of life, clearly changes are called for. And these are changes that require persistent effort and uncomfortable adjustments.     

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.     

Psychosocial versus biomedical risk factors in Kevorkian's first forty-seven physician-assisted deaths

This article examines biomedical and psychosocial data on the first forty-seven cases of physician-assisted suicide (PAS) of Kevorkian as collected by means of both a physical autopsy and a preliminary psychological autopsy. The following patterns emerge: 1) The physical condition of these PAS patients was not typical of the conditions that lead to death in the United States. 2) Consistent with the above findings, our pilot data indicate that only 31.1 percent of these patients were terminal. While 73.9 percent were described as reporting pain, only 42.6 percent were revealed at autopsy to have a specific anatomical basis for their pain. However 36 percent were described as depressed, 66 percent as having some disability, and perhaps of key importance, 90 percent expressed a fear of dependency. Most important, our pilot data suggest the possibility of large gender differences, since 3) 68.1 percent of these forty-seven PAS's are women and only 31.9 percent are men. This represents the reverse of the gender pattern for completed suicides in the United States in 1995, resembling instead the approximate pattern for unsuccessful suicide attempts. 4) Approximately 75 percent of both men and women in the above sample were described as reporting pain. Men were almost twice as likely to have had an anatomical basis for the pain and three times as likely to be terminal. Our pilot data indicate PAS women are more likely to be described as depressed and twice as likely to have had a history of previous unsuccessful suicide attempts. 5) Kevorkian's patients were older than the typical unaided suicides in America. Reported pain decreases with age as does depression; however anatomical basis for pain increases slightly with age, and no age effect emerges for terminality. 6) Approximately two-thirds of those physician-assisted suicides were at middle SES levels. History of disability was the biggest risk factor for the low SES patients and fear of dependency for the high SES patients.     

Competence and Competitive Advantage: Towards a Dynamic Model

Over the last ten years the concept of ‘competence’ has emerged as a central concept for competitive strategy. Several rich theoretical streams have contributed an extensive array of frameworks, definitions and papers using the concept. There is now a need to integrate these many contributions. Indeed, some of the frustration expressed recently by academics may be due to the large volume of conversation and the low level of integration. A concept that is considered so useful that many writers have incorporated it in their work will be of little value if it takes on different meanings for every use. If competence is to be used to explain relationships among variables and to build richer understandings of the roots of competitive advantage, then the field needs to engage in a serious conversation that attempts to focus this concept. Competence needs to be understood in a way that is faithful to its theoretical roots, allows the multiple dimensions that underpin competitive advantage to be meaningfully integrated and is specific enough that meaningful differences can emerge when used as a variable in empirical research. This paper seeks to begin a conversation toward that end by presenting a conceptualization that meets all of these requirements. The paper builds its conceptualization around satisfying the elements of a dynamic model of the relationship between competence and competitive advantage.     

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.     

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.     

Health Risk Assessment of a Modern Municipal Waste Incinerator

During the modernization of the municipal waste incinerator (MWI, maximum capacity of 180,000 tons per year) of Metropolitan Grenoble (405,000 inhabitants), in France, a risk assessment was conducted, based on four tracer pollutants: two volatile organic compounds (benzene and 1, 1, 1 trichloroethane) and two heavy metals (nickel and cadmium, measured in particles). A Gaussian plume dispersion model, applied to maximum emissions measured at the MWI stacks, was used to estimate the distribution of these pollutants in the atmosphere throughout the metropolitan area. A random sample telephone survey (570 subjects) gathered data on time-activity patterns, according to demographic characteristics of the population. Life-long exposure was assessed as a time-weighted average of ambient air concentrations. Inhalation alone was considered because, in the Grenoble urban setting, other routes of exposure are not likely. A Monte Carlo simulation was used to describe probability distributions of exposures and risks. The median of the life-long personal exposures distribution to MWI benzene was 3.2·10^–5 g/m³ (20th and 80th percentiles = 1.5·10^–5 and 6.5·10^–5 g/m³), yielding a 2.6·10^–10 carcinogenic risk (1.2·10^–10–5.4·10^–10). For nickel, the corresponding life-time exposure and cancer risk were 1.8·10^–4 g/m³ (0.9.10^–4 – 3.6·10^–4 g/m³) and 8.6·10^–8 (4.3·10^–8–17.3·10^–8); for cadmium they were respectively 8.3·10^–6 g/m³ (4.0·10^–6–17.6·10^–6) and 1.5·10^–8 (7.2·10^–9–3.1·10^–8). Inhalation exposure to cadmium emitted by the MWI represented less than 1% of the WHO Air Quality Guideline (5 ng/m³), while there was a margin of exposure of more than 10⁹ between the NOAEL (150 ppm) and exposure estimates to trichloroethane. Neither dioxins nor mercury, a volatile metal, were measured. This could lessen the attributable life-long risks estimated. The minute (VOCs and cadmium) to moderate (nickel) exposure and risk estimates are in accord with other studies on modern MWIs meeting recent emission regulations, however.