Eugene S. Schneller

Hip And Knee Implants: Current Trends And Policy Considerations

This paper constitutes an analysis of the issues, relationships, emerging hospital strategies, and policy needs surrounding hip and knee implants. Demand for hip and knee replacements is rising annually, and growth is expected to be substantial. Costs are high, reaching

Hostility to people with AIDS: risk perception and demographic factors.

11 billion for hospitals in 2004 and

The Physician Executive: Role in the Adaptation of American Medicine

5 billion for Medicare in 2006. Relationships among stakeholders add complexity. Case studies reveal emerging strategies by hospitals for management of implants. Policy considerations include development of a national council for data and technology assessment, a national joint registry, price transparency, and incentives.

Professionalism in 21st Century Professional Practice: Autonomy and Accountability in Orthopaedic Surgery

The objectives of this investigation were to determine the associations between perception of AIDS risk, demographic and socio-economic variables and hostility to PWAs. Factor analysis and multiple regression models were used to examine telephone survey data. The principal results show a strong positive association between hostility to PWAs and perception of high AIDS risk from low-risk activities, and between hostility and: non-Hispanic respondents, low-income respondents, respondents with less than a high school education, male respondents and respondents living in rural areas. Conclusions speak for a need for understanding of the multiple outcomes of educational campaigns, pretesting of educational campaigns across multiple populations, and continued study of risk perception, hostility and the effects of stigmatization.

Accountability for Health Care: A White Paper on Leadership and Management for the U.S. Health Care System

In the arena of managed care and large delivery systems, professional associations find it increasingly difficult to influence the environments in which their members practice. Physician executives appear likely to play hey roles in the response of medicine to change. This article discusses how an analysis of the work of physicians involved in management fails to yield a clear analytic distinction between physicians engaged in management and the behavior of others who have managerial responsibility.

Professions and the 21st century: a commentary on the physician as worker.

Orthopaedic surgical practice is becoming increasingly complex. The rapid change in pace associated with new information and technologies, the physician-supplier relationship, the growing costs and growing gap between costs and reimbursements for orthopaedic surgical procedures, and the influences of advertising on the patient, challenge all involved in the delivery of orthopaedic care. This paper assesses the concepts of professionalism, autonomy, and accountability in the 21st century practice of orthopaedic surgery. These concepts are considered within the context of the complex value chain surrounding orthopaedic surgery and the changing forces influencing clinical decision making by the surgeon. A leading impetus for challenge to the autonomy of the orthopaedic surgeon has been cost. Mistrust and lack of understanding have characterized the physician-hospital relationship. Resource dependency has characterized the physician-supplier relationship. Accountability for the surgeon has increased. We suggest implant surgery involves shared decision making and “coproduction” between the orthopaedic surgeon and other stakeholders. The challenge for the profession is to redefine professionalism, accountability, and autonomy in the face of these changes and challenges.

Corporate governance and the adoption of health information technology within integrated delivery systems.

Advancing and managing individual organizational priorities and favorably positioning the organization within the wider system, while remaining within the systems vision, values, mission and strategic plan, constitutes the great the paradox of modern health care management. A new cohort of managers, skilled as change agents for linking-pin organizations, will be necessary to assure accountable management in an environment where no one unit, department, organization, and perhaps no system possesses all of the competencies necessary for provision of care.

The hospitalist movement in the United States: Agency and common agency issues

Eugene S. Schneller, Ph.D., Professor and Director, School of Health Administration and Policy, College of Business, Arizona State University, Tempe, Arizona. For over 300 years prominent social scientists1–5 have written about the professions as very special cases of occupations serving critical functions in the societies of their times. The profession of medicine, the occupational role that ties medical education credentials to clinical function,6 is under siege. Timothy Hoff7 has argued that changes in modern society require a new lens to serve as a generative metaphor to be used by researchers and managers in seeing physicians and their lives in new and different ways. The lens he proffers is that of the “physician as worker” (PAW), a view, he contends, that builds on the professional model and the sociology of medicine. The PAW “portrays physicians as ’active agents’ negotiating the terms of their daily existence in unique ways across a variety of work situations and provides for the study of organization–doctor relationships in a truly cooperative manner.” The result, Hoff argues, is a “humanizing” process that takes into account the issues that physicians face in our society. As employees, physicians are clearly subjected to the variety of problems associated with the conditions of their professional employment and employment issues that are common to all workers. Hoff does not identify or prioritize issues that can be clarified by the PAW view or specify how the issues fit into or transcend analytic models. Concepts such as autonomy, coping with resistance, job satisfaction, stratification, and identification are associated with both the worker and professional view. It is not obvious how the worker lens, grounded in the field of occupational sociology, and guided by the goal of building physician—employer collaboration and efficiencies, serves the best interests of the patient, consumer or profession.

Sage handbook of strategic supply management

Background: Although several previous studies have found “system affiliation” to be a significant and positive predictor of health information technology (IT) adoption, little is known about the association between corporate governance practices and adoption of IT within U.S. integrated delivery systems (IDSs). Purposes: Rooted in agency theory and corporate governance research, this study examines the association between corporate governance practices (centralization of IT decision rights and strategic alignment between business and IT strategy) and IT adoption, standardization, and innovation within IDSs. Methodology/Approach: Cross-sectional, retrospective analyses using data from the 2011 Health Information and Management Systems Society Analytics Database on adoption within IDSs (N = 485) is used to analyze the correlation between two corporate governance constructs (centralization of IT decision rights and strategic alignment) and three IT constructs (adoption, standardization, and innovation) for clinical and supply chain IT. Multivariate fractional logit, probit, and negative binomial regressions are applied. Findings: Multivariate regressions controlling for IDS and market characteristics find that measures of IT adoption, IT standardization, and innovative IT adoption are significantly associated with centralization of IT decision rights and strategic alignment. Specifically, centralization of IT decision rights is associated with 22% higher adoption of Bar Coding for Materials Management and 30%–35% fewer IT vendors for Clinical Data Repositories and Materials Management Information Systems. A combination of centralization and clinical IT strategic alignment is associated with 50% higher Computerized Physician Order Entry adoption, and centralization along with supply chain IT strategic alignment is significantly negatively correlated with Radio Frequency Identification adoption Practice Implications: Although IT adoption and standardization are likely to benefit from corporate governance practices within IDSs, innovation is likely to be delayed. In addition, corporate governance is not one-size-fits-all, and contingencies are important considerations.

Black attrition in physician assistant training programs.

Agency relationships and their effect on patient representation in the hospitalist role are examined in this article. Emphasis is on relationship(s) with patients, primary care physicians, health plans, and hospitals.