A comparison of quality and utilization problems in large and small group practices

Physicians practicing in large, multispecialty medical groups share an organizational culture that differs from that of physicians in small or independent practices. Since 1980, there has been a sharp increase in the size of multispecialty group practice organizations, in part because of increased efficiencies of large group practices. The greater number of physicians and support personnel in a large group practice also requires a relatively more sophisticated management structure. The efficiencies, conveniences, and management structure of a large group practice provide an optimal environment to practice medicine. However, a search of the literature found no data linking a large group practice environment to practice outcomes. The purpose of the study reported in this article was to determine if physicians in large practices have fewer quality and utilization problems than physicians in small or independent practices.     

The Need to Reconcile Concepts that Characterize Systems Facing Threats

Desirable system performance in the face of threats has been characterized by various management concepts. Through semistructured interviews with editors of journals in the fields of emergency response and systems management, a literature review, and professional judgment, we identified nine related and often interchangeably used system performance concepts: adaptability, agility, reliability, resilience, resistance, robustness, safety, security, and sustainability. A better understanding of these concepts will allow system planners to pursue management strategies best suited to their unique system dynamics and specific objectives of good performance. We analyze expert responses and review the linguistic definitions and mathematical framing of these concepts to understand their applications. We find a lack of consensus on their usage between interview subjects, but by using the mathematical framing to enrich the linguistic definitions, we formulate comparative visualizations and propose distinct definitions for the nine concepts. We present a conceptual framing to relate the concepts for management purposes.     

Financial instruments used by Polish municipalities in response to the first wave of COVID-19

Public Organization Review - Studies on the influence of COVID-19 on municipalities are scarce, although it was precisely municipalities that stood in the first line of combat. It is important to...     

Tough Love and Creativity: How Authoritarian Leadership Tempered by Benevolence or Morality Influences Employee Creativity

Influenced by Amabile's views on the intrinsic nature of creative motivation (T. M. Amabile (1988). A model of creativity and innovation in organizations’. In B. M. Staw and L. L. Cummings (eds), Research in Organizational Behavior, Vol. 10, pp. 123–167. Greenwich, CT: JAI Press), researchers have focused primarily on supportive leadership, with authoritarian leadership known to negatively influence employee creativity. Arguing from social information processing theory, the authors show that low levels of authoritarian leadership act as a stressor encouraging creativity, while high levels discourage creativity. Authoritarian leadership is one component of a larger constellation of leader behaviours known as paternalistic leadership. Under paternalistic leadership, authoritarian leadership is combined with benevolence and morality and these interact with authoritarianism. The authors argue that the presence of benevolence and moral leadership causes subordinates to view the leader's authoritarian actions as serving a positive purpose, and show that both benevolence and moral leadership act to offset the negative effects of authoritarian leadership on creativity.     

Deep Uncertainties in Sea-Level Rise and Storm Surge Projections: Implications for Coastal Flood Risk Management

Sea levels are rising in many areas around the world, posing risks to coastal communities and infrastructures. Strategies for managing these flood risks present decision challenges that require a combination of geophysical, economic, and infrastructure models. Previous studies have broken important new ground on the considerable tensions between the costs of upgrading infrastructure and the damages that could result from extreme flood events. However, many risk-based adaptation strategies remain silent on certain potentially important uncertainties, as well as the tradeoffs between competing objectives. Here, we implement and improve on a classic decision-analytical model (Van Dantzig 1956) to: (i) capture tradeoffs across conflicting stakeholder objectives, (ii) demonstrate the consequences of structural uncertainties in the sea-level rise and storm surge models, and (iii) identify the parametric uncertainties that most strongly influence each objective using global sensitivity analysis. We find that the flood adaptation model produces potentially myopic solutions when formulated using traditional mean-centric decision theory. Moving from a single-objective problem formulation to one with multiobjective tradeoffs dramatically expands the decision space, and highlights the need for compromise solutions to address stakeholder preferences. We find deep structural uncertainties that have large effects on the model outcome, with the storm surge parameters accounting for the greatest impacts. Global sensitivity analysis effectively identifies important parameter interactions that local methods overlook, and that could have critical implications for flood adaptation strategies.     

Evaluation of Multicriteria Decision Analysis Algorithms in Food Safety: A Case Study on Emerging Zoonoses Prioritization

Decision making in food safety is a complex process that involves several criteria of different nature like the expected reduction in the number of illnesses, the potential economic or health-related cost, or even the environmental impact of a given policy or intervention. Several multicriteria decision analysis (MCDA) algorithms are currently used, mostly individually, in food safety to rank different options in a multifactorial environment. However, the selection of the MCDA algorithm is a decision problem on its own because different methods calculate different rankings. The aim of this study was to compare the impact of different uncertainty sources on the rankings of MCDA problems in the context of food safety. For that purpose, a previously published data set on emerging zoonoses in the Netherlands was used to compare different MCDA algorithms: MMOORA, TOPSIS, VIKOR, WASPAS, and ELECTRE III. The rankings were calculated with and without considering uncertainty (using fuzzy sets), to assess the importance of this factor. The rankings obtained differed between algorithms, emphasizing that the selection of the MCDA method had a relevant impact in the rankings. Furthermore, considering uncertainty in the ranking had a high influence on the results. Both factors were more relevant than the weights associated with each criterion in this case study. A hierarchical clustering method was suggested to aggregate results obtained by the different algorithms. This complementary step seems to be a promising way to decrease extreme difference among algorithms and could provide a strong added value in the decision-making process.     

The Aversion to Tampering with Nature (ATN) Scale: Individual Differences in (Dis)comfort with Altering the Natural World

People differ in their comfort with tampering with the natural world. Although some see altering nature as a sign of human progress, others see it as dangerous or hubristic. Across four studies, we investigate discomfort with tampering with the natural world. To do so, we develop the Aversion to Tampering with Nature (ATN) Scale, a short scale that is the first to directly measure this discomfort. We identify six activities that people believe tamper with nature (geoengineering, genetically modified organisms, pesticides, cloning, gene therapy, and nanoparticles) and show that ATN scores are associated with opposition to these activities. Furthermore, the ATN Scale predicts actual behavior: donations to an anti-tampering cause. We demonstrate that ATN is related to previously identified constructs including trust in technology, naturalness bias, purity values, disgust sensitivity, aversion to playing God, and environmental beliefs and values. By illuminating who is concerned about tampering with nature and what predicts these beliefs, the ATN Scale provides opportunities to better understand public opposition to technological innovations, consumer preferences for “natural” products, and strategies for science communication.     

Measurement of the effect of wool advertising

The paper reports a recent International Wool Secretariat (I.W.S.) study to measure the overall effect on sales of fibre advertising, based on annual data for eight major wool-consuming countries, collected from 1960 to 1970. An economic model of the fibre market is set up, and multiple linear regression is used to demonstrate a significant positive relationship between fibre sales and advertising. The effect of wool advertising is quantified, using the estimated regression coefficients, and its cost is compared with the estimated benefits to the wool industry in terms of increased revenue. Possible drawbacks of the approach described are considered, and aspects of the work requiring further study are also mentioned.     

A productivity study in a chemical plant

This paper describes a case study in the application of a productivity analysis model in a plant producing industrial gases. Although the process is a relatively simple one, several inputs (labour, electricity, capital and some materials) and several outputs (liquid and gaseous oxygen, gaseous nitrogen, argon and a hydrogen-nitrogen mixture) are involved. The case study demonstrates how measures of total input and total output can be applied and analyses the performance of the plant over a 15-month period in terms of a variety of managerial control ratios.