When push comes to shove: implementing VBAC practice guidelines

The dramatic increase in U.S. cesarean sections over the past two decades has been significantly driven by repeat C-sections. In response to this trend, clinical guidelines recommending vaginal birth after cesarean-section (VBAC) have been promulgated by national organizations. Adherence to these guidelines would reduce the number of repeat C-sections, lower the overall C-section rate, and improve both the quality and the cost of health care. While these guidelines have received professional endorsement, their implementation has been clouded by issues of patient acceptance and provider payment. To examine implementation of these guidelines by health care organizations, the authors surveyed 156 members of the American College of Physician Executives to determine their policies, practices, and attitudes toward VBAC guidelines. Those surveyed generally were medical directors in HMOs, hospitals, and other practice settings. The findings indicate that the health care organizations represented by these physician executives have not consistently implemented VBAC guideline and that they are reluctant to hold physicians, their patients, or hospitals accountable for the financial, utilization, and quality impact of the elective decision ot to pursue appropriate VBACs. We conclude that, even when widely accepted, clinical practice guidelines may be ineffective in reducing the costs or improving the quality of medical care.     

The computerized patient record and confidentiality. The nabobs of negativism are wrong

The handwritten medical record has been the method of choice for documenting health care data since the last millennium. Given this successful tenure, it would be natural to greet any new information system that purports to be an advancement with skepticism. Moreover, physicians as a group are hardly progressive. Yet health care is taking a giant leap and is finally accepting computerization. The advantages and drawbacks of computerized information systems have long been thoroughly tested in such diverse industries as the military, banking, and the airlines. It is difficult to imagine any of these industries in their modern form without an advanced information system.     

Characteristics of a central change programme within a governmental bureaucracy: a grounded theory study

Purpose The purpose of the paper is to present a theory of organisational change within the setting of a governmental bureaucracy. Design/methodology/approach Orthodox grounded theory is employed in the setting of a change programme in 12 Audit departments of the Dutch Ministries (public-sector). Findings The examined organisational change has specific characteristics. The Dutch ‘ministerial autonomy’ and the clearly recognizable role types of the key figures involved have a strong impact on the change programme and the realisation of its goals. Research limitations/implications Findings are derived on the basis of a substantive case study of the change programme of the Dutch Departmental Audit function. The research sheds new light on characteristics related to the occupational group of Chartered Accountants and characteristics of a governmental bureaucracy and it helps to understand change programmes within this bureaucracy. Practical implications The grounded theoretical model draws attention to the impact of key figures and circumstances on a change programme within the central government. Originality/value The paper builds on theories of organisational change but applies them in the typical context of the Dutch civil service where ministerial autonomy, on the one hand, and a move in the direction of more centrally organised activities (concern idea), on the other, require a difficult balancing act of all players in the change arena.     

现代消费主义的理性思考

消费是人为了生存而进行的一种基本活动,一种生活方式。但随着科学技术的发展和经济的增长,现代社会已经进入到了生产过剩的时代,这必然引起大量的挥霍性消费随之而来。为此,本来作为人的生存方式的消费就成为一种违背人类可持续生存和发展利益的消费,最终也成为人类生存的最大威胁之一,因而,再次审视现代社会的消费观的理论基础是一项迫切的任务。     

An empirical application of multidimensional scaling to advertising pretesting

One of the least-managed aspects of advertising management may well be that of effectiveness measurement. The problem of obtaining satisfactory indications of advertising effectiveness is particularly critical in pretesting since the rationale for pretesting is to evaluate advertisements before their release for broadscale media distribution. Therefore, the primary purpose of the research reported here is to provide empirical evidence of the value of multidimensional scaling methods to pretesting advertising. The article demonstrates how nonmetric methodology obviates the disadvantages of such methods as consumer jury tests and rating scales. A secondary purpose of the research project is to demonstrate the value of pretesting itself by comparing the perceptions of target market consumers with those of selected group of advertising professionals.     

Loan performance and race

Recent studies find evidence of racial discrimination in mortgage markets. Although these studies explore loan approval rates for whites versus minorities, they do not specifically consider loan performance, either in the form of default rates or loan administration costs. This study considers discrimination in the used car credit market, where the collateral is not subject to location externalities, collateral value and quality do not vary as much as in real estate, and the loan terms are shorter. We find administration costs and default rates are higher for minorities than for whites, controlling for age, income, home ownership, wealth, occupation, loan terms, and geographic location.     

OR in the paper industry

The paper reviews the applications of OR in the paper industry and concludes that acceptance of OR is in general very poor. Some of the possible reasons for this are discussed, along with prospects for the future.