Is the Precautionary Principle Used to Cover Up Ignorance?

The precautionary principle is rapidly spreading in risk management in spite of vague understanding of its consequences. Some caveats are presented in this commentary, and some principles proposed for improved risk assessment/risk management procedures. Improvement is especially needed in such cases where the risks of different management options must be compared.

There's no 'I' in 'team'

McKesson Corp. CEO John Hammergren shies away from the spotlight. He credits a strong staff and customer focus for the company's success.

The role of professional expertise in the purchasing of health services

Using data gathered from a mixture of quantitative and qualitative tools, this research into the purchasing of health services, namely occupational health services, is utilized to build an understanding of the role of service professionals in the purchasing of health services. In analysing the themes emerging from the interviews it was found that, typical of a complex, highly intangible professional service, the buyers found it difficult to objectively evaluate the service. The purchasing of occupational health services, similar to other professional services, was perceived to be an uncertain and risky process. The high uncertainties and risk of purchasing occupational health services lead to the utilization of the expertise of the service providers as a risk-reducing mechanism. This understanding of the role of health professionals in the purchasing of health services illustrates that the service characteristics enables the health professionals to utilize their expertise in influencing all stages of this process.

What makes an effective executive

An effective executive does not need to be a leader in the typical sense of the word. Peter Drucker, the author of more than two dozen HBR articles, says some of the best business and nonprofit CEOs he has worked with over his 65-year consulting career were not stereotypical leaders. They ranged from extroverted to nearly reclusive, from easygoing to controlling, from generous to parsimonious. What made them all effective is that they followed the same eight practices: They asked, "What needs to be done?" They also asked, "What is right for the enterprise?" They developed action plans. They took responsibility for decisions. They took responsibility for communicating. They were focused on opportunities rather than problems. They ran productive meetings. And they thought and said "we" rather than "I." The first two practices provided them with the knowledge they needed. The next four helped them convert this knowledge into effective action, for knowledge is useless to executives until it has been translated into deeds. The last two ensured that the whole organization felt responsible and accountable. Effective executives know that they have authority only because they have the trust of the organization. This means they must think of the needs and opportunities of the organization before they think of their own needs and opportunities. The author also suggests a ninth practice that's so important, he elevates it to the level of a rule: Listen first, speak last. The demand for effective executives is much too great to be satisfied by those few people who are simply born to lead. Effectiveness is a discipline. And, like every discipline, it can be learned and must be earned.

The risky business of hiring stars

With the battle for the best and brightest people heating up again, you're most likely out there looking for first-rate talent in the ranks of your competitors. Chances are, you're sold on the idea of recruiting from outside your organization, since developing people within the firm takes time and money. But the authors, who have tracked the careers of high-flying CEOs, researchers, software developers, and leading professionals, argue that top performers quickly fade after leaving one company for another. To study this phenomenon in greater detail, the authors analyzed the ups and downs of more than 1,000 star stock analysts, a well-defined group for which there are abundant data. The results were striking. After a star moves, not only does her performance plunge, but so does the effectiveness of the group she joins--and the market value of her new company. Moreover, transplanted stars don't stay with their new organizations for long, despite the astronomical salaries firms pay to lure them from rivals. Most companies that hire stars overlook the fact that an executive's performance is not entirely transferable because his personal competencies inevitably include company-specific skills. When the star leaves the old company for the new, he cannot take with him many of the resources that contributed to his achievements. As a result, he is unable to repeat his performance in another company--at least not until he learns to work the new system, which could take years. The authors conclude that companies cannot gain a competitive advantage or successfully grow by hiring stars from outside. Instead, they should focus on cultivating talent from within and do everything possible to retain the stars they create. Firms shouldn't fight the star wars, because winning could be the worst thing that happens to them.

Building better boards

Companies facing new requirements for governance are scrambling to buttress financial-reporting systems, overhaul board structures--whatever it takes to comply. But there are limits to how much good governance can be imposed from the outside. Boards know what they ought to be: seats of challenge and inquiry that add value without meddling and make CEOs more effective but not all-powerful. A board can reach that goal only if it functions as a high-performance team, one that is competent, coordinated, collegial, and focused on an unambiguous goal. Such entities don't just evolve; they must be constructed to an exacting blueprint--what the author calls board building. In this article, Nadler offers an agenda and a set of tools that boards can use to define and achieve their objectives. It's important for a board to conduct regular self-assessments and to pay attention to the results of those analyses. As a first step, the directors and the CEO should agree on which of the following common board models best fits the company: passive, certifying, engaged, intervening, or operating. The directors and the CEO should then analyze which business tasks are most important and allot sufficient time and resources to them. Next, the board should take inventory of each director's strengths to ensure that the group as a whole possesses the skills necessary to do its work. Directors must exert more influence over meeting agendas and make sure they have the right information at the right time and in the right format to perform their duties. Finally, the board needs to foster an engaged culture characterized by candor and a willingness to challenge. An ambitious board-building process, devised and endorsed both by directors and by management, can potentially turn a good board into a great one.

Reclaim your job

Ask most managers what gets in the way of their success, and you'll hear the familiar litany of complaints: Not enough time. Limited resources. No clear sense of how their work fits into the grand corporate scheme. These are, for the most part, excuses. What really gets in the way of managers' success is fear of making their own decisions and acting accordingly. Managers must overcome the psychological desire to be indispensable. In this article, the authors demonstrate how managers can become more productive by learning to manage demands, generate resources, and recognize and exploit alternatives. To win the support they want, managers must develop a long-term strategy and pursue their goals slowly, steadily, and strategically. To expand the range of opportunities, for their companies and themselves, managers must scan the environment for possible obstacles and search for ways around them. Fully 90% of the executives the authors have studied over the past few years wasted their time and frittered away their productivity, despite having well-defined projects, goals, and the necessary knowledge to get their jobs done. Such managers remain trapped in inefficiency because they assume they do not have enough personal discretion or control. They forget how to take initiative--the most essential quality of any truly successful manager. Effective managers, by contrast, are purposeful corporate entrepreneurs who take charge of their jobs by developing trust in their own judgment and adopting long-term, big-picture views to fulfill personal goals that match those of the organization.

The manager and continuing education

Continuing education in health care organizations consists of that which is required by law or regulation and that which is optional. The required is done because it must be done; the other, including most management development and some staff education, is often ignored. Nonrequired education is one of the first items to go during budget-cutting exercises. Yet continuing education at all levels, for managers as well as nonmanagers, is essential in keeping health care workers abreast of rapid change. Much continuing education, even that for rank-and-file staff, is up to the department manager, and with few exceptions, the pursuit of continuing management development is left largely to the individual manager. The department manager is an educator of staff and is also largely responsible for self-development.

Identifying and assessing competencies: a strategy to improve healthcare leadership

There appears to be a growing consensus that better leadership is needed in healthcare, although there is much less agreement on the specific knowledge and skills required to improve performance. This commentary suggests that the articulation of healthcare leadership and management competencies provides a framework and a language for identifying the leadership knowledge and skills required for high-quality healthcare in the 21st century.

"Nihil nocere" and beyond: the issue of leadership in healthcare

The quality of leadership is usually assessed in terms of business performance, which is reflected in expenditure and revenue figures. Although cost efficiency becomes an ever more important factor in healthcare, financial revenue is not the only defining factor for quality of leadership in a business where the consequence of failure may be deadly in the true sense of the word. Moreover, since "health" and "well-being" are both complex issues involving a variety of psychological variables, customer satisfaction in this field is not always strictly related to the quality of the delivered care. This difficulty in the definition of an accomplished leader in healthcare may have added to the negligence in developing leadership in this field.

Special considerations for hiring an office manager

Medical practice office managers come in many varieties. They can be hired from the outside or promoted from within. They can have a great deal of experience working in medical practices or practically none. Which type of office manager is the best choice for your practice? This article will help you decide. It describes three types of office managers and considers the pros and cons of each. It explores the characteristics, advantages, and disadvantages of lay administrators hired from the outside, office managers promoted from the ranks, and "super-aides" who are asked to manage while doing their old jobs. This article also offers a list of 10 characteristics to look for in office manager candidates, as well as six areas of overall responsibility for your office manager. Finally, it includes a quick checklist of 20 required duties of typical medical practice office managers that can help you shape your office manager's job description.

Unique qualities define successful healthcare leaders

The complexity, structure, pace of change and distribution of authority in healthcare institutions make them radically different in terms of leadership required than businesses, the military or the government. With multiple internal and external stakeholders, the perception of leadership may be as important as its actual quality, making it much more difficult to define, evaluate and replicate in healthcare.

Developing your leadership pipeline

Why do so many newly minted leaders fail so spectacularly? Part of the problem is that in many companies, succession planning is little more than creating a list of high-potential employees and the slots they might fill. It's a mechanical process that's too narrow and hidebound to uncover and correct skill gaps that can derail promising young executives. And it's completely divorced from organizational efforts to transform managers into leaders. Some companies, however, do succeed in building a steady, reliable pipeline of leadership talent by marrying succession planning with leadership development. Eli Lilly, Dow Chemical, Bank of America, and Sonoco Products have created long-term processes for managing the talent roster throughout their organizations--a process Conger and Fulmer call succession management. Drawing on the experiences of these best-practice organizations, the authors outline five rules for establishing a healthy succession management system: Focus on opportunities for development, identify linchpin positions, make the system transparent, measure progress regularly, and be flexible. In Eli Lilly's "action-learning" program, high-potential employees are given a strategic problem to solve so they can learn something of what it takes to be a general manager. The company--and most other best-practice organizations--also relies on Web-based succession management tools to demystify the succession process, and it makes employees themselves responsible for updating the information in their personnel files. Best-practice organizations also track various metrics that reveal whether the right people are moving into the right jobs at the right time, and they assess the strengths and weaknesses not only of individuals but of the entire group. These companies also expect to be tweaking their systems continually, making them easier to use and more responsive to the needs of the organization.

Managing change in the culture of general practice: qualitative case studies in primary care trusts

OBJECTIVES

To explore the potential tension between the need for managers to produce measurable change and the skills required to produce cultural change, and to investigate how managers of primary care trusts are attempting to deal with this tension.

DESIGN

Qualitative case studies using data derived from semistructured interviews and a review of published documents. An established cultural framework was to used to help interpret the findings.

SETTING

Six primary care trusts in England purposefully sampled to represent a range of cultural, structural, geographical, and demographic characteristics.

PARTICIPANTS

42 interviews with 39 different senior and middle primary care trust managers conducted over an 18 month period.

RESULTS

We found two distinct and polarised styles of management. One group of managers adopts a directive style and challenges the prevailing norms and values of clinicians, an approach characteristically seen in organisations with hierarchical cultures. This group is made up mostly of senior managers who are driven principally by the imperative to deliver a political agenda. Managers in the second group are more inclined to work with the prevailing cultures found in general practice, attempting to facilitate change from within rather than forcing change from outside. This management style is characteristically seen in organisations with a clan-type culture. The approach was manifest mostly by middle managers, who seem to act as buffers between the demands of senior managers and their own perception of the ability and willingness of health professionals to cope with change. The different management approaches can lead to tension and dysfunction between tiers of management.

CONCLUSIONS

The development of primary care depends on high quality managers who are able to draw on a range of different management skills and styles. Managers are most likely to be effective if they appreciate the merits and drawbacks of their different styles and are willing to work in partnership.

A comparison of food safety knowledge among restaurant managers, by source of training and experience, in Oklahoma County, Oklahoma

The annual incidence of illness related to food consumption continues to present a challenge to environmental health management. A significant fraction of cases have been attributed to consumption of food in restaurants, and as the number of meals eaten away from the home continues to rise, the potential for large-scale foodborne-disease outbreaks will continue to increase. Food handlers in retail establishments contribute to the incidence of foodborne disease; therefore, it is essential that workers and management staff have a thorough understanding of safe food practices. Since the training, certification, and experience of food service managers vary greatly, it is also likely that managers' knowledge base may differ. In the study reported here, restaurant managers were administered a survey designed to measure their understanding of basic food safety principles. The sources of training, certification, and experience were found to significantly affect the level of food safety knowledge; however, increased hours of training did not increase knowledge. In addition, the time lapsed since training did not significantly affect the level of knowledge.