Search results

Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway.

We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models.

The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners.

While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization.

Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices.

Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats.

This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.

The Royal Commission appointed “to inquire into the relation of human and animal tuberculosis” has issued its final report, just ten years after it commenced its work.

Inspectors visiting districts in connection with the Foreign Meat and Unsound Food Regulations have made detailed inquiries in certain instances in regard to local methods of administration of the Sale of Food and Drugs Acts. Special visits for this purpose have also been made to other districts where inquiry appeared to be specially called for. In the course of these inquiries it was found that in some instances the public analyst had made a report to his local authority on some special investigation which had been undertaken in the district respecting a particular article of food, but that copies of such report had not always reached the Board. During an inquiry in the county of Cheshire Dr. Coutts ascertained that the county analyst had made valuable reports in regard to butter and Cheshire cheese of which the Board were unaware. Reports of this nature are of much interest to this sub‐department, and it would be of advantage if local authorities would send to the Board copies of all special reports made by the public analyst.

The attention of the Board is drawn from time to time to advertisements in trade papers and circulars of preservative substances sold under proprietary names. These consist for the most part of well‐known preservatives or mixtures of preservatives which are easily detected by the analyst in food substances to which they have been added. A new preservative, sold under the name of “Mystin,” for preserving milk and cream has recently been advertised as possessing the advantage that its presence cannot be detected by analysis. Samples have been sent to farmers and milk vendors accompanied by a trade circular from which the following extracts have been taken:—

We review the state of the literature concerning work–family conflict in the military, focusing on service members’ parenting roles and overall family and child well-being. This includes recognition that for many women service members, parenting considerations often arise long before a child is born, thereby further complicating work–family conflict considerations in regard to gender-specific conflict factors such as pregnancy, childbirth, postpartum, and breastfeeding. Subsequently, we consider more gender-invariant conflict factors, such as the nature of the work itself as causing conflict for the service member as parent (e.g., nontraditional hours, long separations, and child care challenges) as well as for the child (e.g., irregular contact with parent, fear for parent’s safety, and frequent relocations), and the ramifications of such conflict on service member and child well-being. Finally, we review formalized support resources that are in place to mitigate negative effects of such conflict, and make recommendations to facilitate progress in research and practice moving forward.

Two major reform movements have shaped child and adolescent mental health services over the past quarter-century: the Systems of Care movement, and more recently, the movement toward evidence-based practice. Results from several studies indicate that youth served in traditional residential or inpatient care may experience difficulty re-entering their natural environments, or were released into physically and emotionally unsafe homes (Bruns & Burchard, 2000; President's Commission on Mental Health, 1978; Stortz, 2000; Stroul & Friedman, 1986; U.S. Department of Health and Human Services, 1999). The cost of hospitalizing youth also became a policy concern (Henggeler et al., 1999b; Kielser, 1993; U.S. Department of Health and Human Services, 1999). For example, it is estimated that from the late 1980s through 1990 inpatient treatment consumed nearly half of all expenditures for child and adolescent mental health care although the services were found not to be very effective (Burns, 1991; Burns & Friedman, 1990). More recent analyses indicate that at least 1/3 of all mental health expenditures for youth are associated with inpatient hospitalization (Ringel & Sturm, 2001).

It is a matter of common knowledge that beer, in its several varieties, is by no means the same thing to‐day as it was a generation or less ago; the progress of chemical and biological knowledge on the one hand, and the keenness of competition on the other, have led to great alterations both in the materials used in its production and the methods by which it is produced. Exact or reliable knowledge about this, however, is far from being common; vehement assertions are made that all or almost all the changes are for the better, and also that beer is now a manufactured chemical product of deleterious nature, in which little or nothing of genuine material is used. Such statements are rendered unacceptable by the existence of self‐interest on one side and prejudice on the other. A short account of some of the facts concerned may, therefore, be of service.

In the year 1900 Koch expressed the view that human and bovine tuberculosis were distinct diseases, that the bacillus of bovine tuberculosis could not produce this disease in the human subject, and that the bacillus of human tuberculosis could not set it up in the bovine species. As is now well known. these conclusions have not received the slightest confirmation from other workers in the same field, and it may be said that the consensus of scientific opinion is now to the effect that the bacilli of human and bovine tuberculosis are identical—at any rate, so far as the effects attributed to them are concerned. The Royal Commission appointed in 1901, and consisting of the late Sir MICHAEL FOSTER, Drs. SIMS WOODHEAD, SIDNEY MARTIN, MACFADYEAN, and BOYCE, have issued a further interim report on their investigations. The first interim report was published in 1904, the conclusions stated in it being to the effect that the human and animal diseases were identical, and that no characteristics by which the one could be distinguished from the other had been discovered. The report now issued shows that these conclusions are confirmed by the results of a very large number of fresh experiments. The main conclusions set forth in the present report are as understated :—

The purpose of this paper is to investigate the process of management accounting change within an Egyptian organization that implemented an extranet.

Old institutional economic (OIE) theory and Hardy's model of power mobilisation are chosen as a theoretical framework to inform the analysis of the case.

The results show that the extranet facilitated changes in information availability and business process re‐design. The findings confirm that management accounting practices have changed in the case under study and show how management accountants have become more involved in planning and control. The case highlighted some factors that facilitate the natural processes of routinisation and institutionalisation over time.

It could be argued that one limitation of this research is related to the gap between the change in leadership in TexCo (1993) and the timing of the visits (2001, 2002, 2003 and 2005). However, this problem has been minimized by crosschecking memories of events through interviews. Another limitation of this study is that the author was not allowed to review some of the financial documents in TexCo. However, the author tried to verify the financial figures given by them through inter‐subject checking.

This paper fills a gap in the literature as it focuses on the process of management accounting change associated with the implementation of business‐to‐business (B‐to‐B) e‐commerce. The findings, indicate that the B‐to‐B e‐commerce has facilitated the change in the management accounting practices towards decision support and control. Implementing the B‐to‐B e‐commerce system in TexCo facilitated greater control over inventory and invoicing. It improved the planning process through providing the accountants with accurate and real time information about sales, receivables, cash collection and inventory turnover. The system also facilitated the settlement process, the performance evaluation of TexCo's exhibitions; and saved the time and effort of the accountants during the stocktaking process. The case suggested that there are some factors that may facilitate the processes of routinisation and institutionalisation.

Purpose – Research on hospital system organization is dated and cross-sectional. We analyze trends in system structure during 2000–2010 to ascertain whether they have become more centralized or decentralized.

Design/Methodology/Approach – We test hypotheses drawn from organization theory and estimate empirical models to study the structural transitions that systems make between different “clusters” defined by the American Hospital Association.

Findings – There is a clear trend toward system fragmentation during most of this period, with a small recent shift to centralization in some systems. Systems decentralize as they increase their members and geographic dispersion. This is particularly true for systems that span multiple states; it is less true for smaller regional systems and local systems that adopt a hub-and-spoke configuration around a teaching hospital.

Research Limitations – Our time series ends in 2010 just as health care reform was implemented. We also rely on a single measure of system centralization.

Research Implications – Systems that appear to be able to centrally coordinate their services are those that operate in local or regional markets. Larger systems that span several states are likely to decentralize or fragment.

Practical Implications – System fragmentation may thwart policy aims pursued in health care reform. The potential of Accountable Care Organizations rests on their ability to coordinate multiple providers via centralized governance. Hospitals systems are likely to be central players in many ACOs, but may lack the necessary coherence to effectively play this governance role.

Originality/Value – Not all hospital systems act in a systemic manner. Those systems that are centralized (and presumably capable of acting in concerted fashion) are in the minority and have declined in prevalence over most of the past decade.

The general quality of milk supplied by the cows will also affect the question, and in this connection it may be noted that Mr. Lehmann stated to the Departmental Committee that Dutch cows do not produce a milk so rich in fat as these of Switzerland; an examination of the figures given tends to corroborate this view. Dutch milks appear to require concentration to a higher degree in order to provide as large a proportion of fat as Swiss or Norwegian made milk.

The chapter summarizes key literature, including emerging ideas, that is pertinent to the question of how organizations and their leadership deal with and are resilient through crises – highlighting what works in surviving unexpected crises. The chapter presents an illustration of organizational response; it concludes with an analysis of what is missing from the literature and recommends a path forward to expanding actionable knowledge in this area. Multiple, interdependent factors that foster resilience are identified including (1) being sensitive to possible threats – even seemingly small failures, (2) not relying on simple interpretations of events but rather seeking diversity to create a complete view of the environment, (3) leadership that embraces communication, transparency, and continuous learning, (4) valuing expertise and allowing expert staff to make decisions during a crisis, and (5) a cultural commitment to a resiliency mindset that accepts failures as opportunities to learn and improve. Emerging concepts that may foster resilience but require more research include managing paradox, emotional ambivalence and diversity. Additional areas for fruitful research include: the impact of short-term versus long-term, or successive, crises; external versus internal shocks and the framing of the source of shocks; how crisis affect the pace of innovation and change; the role of diversity in organizational responses to crises; and a set of methodological opportunities to leverage natural experiments or simulations in ways that allow for longitudinal data illuminating the full cycle of crises across organizations from anticipation, to response, to longer-term adaptation to the new normal.

It is an ill wind that blows nobody good, and the British public may be congratulated on the salutary, if rude, awakening which the gale raised in Chicago has given them. Peacefully slumbering, and content for years to accept as gospel truths the asseverations of all sorts and conditions of food‐fakers, both of home and foreign growth, the “Britisher” has suddenly received a shock from which it will take him a long time to recover. The abominable crime of milk‐adulteration—striking as it does at helpless infancy and at the vitality of the infirm and the weak; the “doctoring” of food products with a variety of pernicious drugs on the pleas of “preservation” and of meeting “public wants,” but in reality done for the sake of sordid gain; the gigantic meat and butter frauds, whereby largely the agricultural interest of this country has been brought to its present pass; the faking of beer and the wholesale arsenical poisoning which was one of its direct consequences; the denaturing of other foods by abstraction, substitution, and sophistication—all these things have been regarded by the “man in the street” with a sort of languid interest; have, at most, called forth passing comment from the lay press, and cheap sneers about faddery and faddists from various ignorant scribblers; while a succession of lethargic and feeble administrations have shelved the reports of their own Committees and Commissions, and, except under rare and abnormal pressure, have been content to adopt a policy of laissez faire.

The danger attending the use of the insufficiently purified waters derived from the Thames and Lea should, we think, be constantly pressed upon the attention of the Legislature and of the public. We regard it as a duty to endeavour to prevent the continued neglect of the warnings which have been put forward from time to time by those who have made a careful and unbiassed study of the subject, and which have recently been again uttered and emphasised by SIR A. BINNIE, the late Engineer of the London County Council. In the public interest it is greatly to be regretted that the system of analytical control, which was maintained by certain London Borough Councils with regard to the water supplied within the areas under their jurisdiction, has been discontinued. The local checks referred to were of the greatest value to the inhabitants of the districts concerned by affording timely warning when water of dangerous character was being supplied, thus enabling some protective measures to be taken. They also served the useful purposes of keeping public attention fixed upon the matter.

While uncertainty has always been a feature of the healthcare environment, its pace and scope are rapidly increasing, fueled by myriad factors such as technological advancements, the threat and frequency of disruptive events, global economic developments, and increasing complexity. Contemporary healthcare organizations thus persistently face what is known as “deep uncertainty,” which obscures their ability to predict outcomes of strategic action and decision-making, presenting them with novel challenges and threatening their survival. Persistent, deep uncertainty challenges us to revisit and reconsider how we think about uncertainty and the strategic actions needed by organizations to thrive under these circumstances. Simply put, how can healthcare organizations thrive in the face of deeply uncertain environments? We argue that healthcare organizations need to employ both adaptive and creative strategic approaches in order to effectively meet patients' needs and capture value in the long-term future. The chapter concludes by offering two ways organizations can build the dynamic capabilities needed to employ such approaches.