The volunteer's dilemma and alternate solutions for ensuring responsibility within accountable care organizations

ABSTRACT

The emphasis on accountable care organizations (ACOs) in recent health care reform increases the potential for social dilemmas such as the volunteer's dilemma within networks of providers who collectively share responsibility for a patient population. Providers in an ACO often receive financial incentives based on how well the group performs in defined quality measures. Care interventions may be indicated for certain patients, such as postdischarge follow-up to prevent readmission. However, the providers conducting the interventions may be unreliable if they vary in their belief in the intervention's effectiveness. We characterize such potential for care coordination failures as instability of an asymmetric equilibrium, illustrated by an example in which ACO patients would benefit from interventions to prevent readmission but individual providers or care teams do not perceive sufficient value in conducting the intervention. We then propose three economic mechanisms that can help ensure that patients receive indicated interventions, illustrate the impact of each with an example, and explore conditions that lead to significant improvements in overall utility.     

Rationality,foolishness, and adaptive intelligence

Technologies of model‐based rationality are the core technologies of strategic management, having largely replaced earlier technologies that placed greater reliance on traditional practice or on communication either with the stars or with the gods. The technologies used by organizations in their pursuit of intelligence can be imagined to change over time as a result of responding to the successes and failures associated with the technologies. Although technologies of rationality seem clearly to be effective instruments of exploitation in relatively simple situations and to derive their adaptive advantage from those capabilities, their ventures in more complex explorations seem often to lead to huge mistakes and thus unlikely to be sustained by adaptive processes. Whether their survival as instruments of exploratory novelty in complex situations is desirable is a difficult question to answer, but it seems likely that any such survival may require hitchhiking on their successes in simpler worlds. Survival may also be served by the heroism of fools and the blindness of true believers. Their imperviousness to feedback is both the despair of adaptive intelligence and, conceivably, its salvation. Copyright © 2006 John Wiley & Sons, Ltd.     

机械故障的形成和预防

机械经过长期的使用后,零件或者配合件由于磨损变形,疲劳、腐蚀、穴蚀松动或者其他原因失去了原始的工作性能,使机械的技术状态逐渐变差,出现了工作不正常,甚至不能继续工作的现象,这种现象通称为机械故障,为了使机器处于正常良好的技术状态,必须设法防止和减少故障的发生,机器事故性破坏是可以避免的,但自然损坏不能完全避免,只要掌握零件的磨损规律,采取各种预防措施,是可以大大减轻的。     

ZBB,MBO, PPB and their effectiveness within the planning/marketing process

Substantial attention has recently been focused on the reported failures of zero-base budgeting (ZBB), management by objectives (MBO), and planning, programming, and budgeting (PPB) as management techniques for corporations as well as governmental agencies. This writer has determined that these failures occur because the ZBB, MBO, and PPB techniques are used in lieu of an integrated planning/marketing process and fail to recognize the process or the limitations and scope of these techniques. The techniques can and do work well where they are treated as part of, rather than as a substitute for, the planning/marketing process, and are modified to function efficiently within the process. All elements of the planning/marketing process must be given a fair share of attention if the profit or non-profit enterprise is to succeed.     

Plant modifications: Maintain your mechanical integrity

Upon initial review of the proposed subject, Plant Modifications and Mechanical Integrity, there is a bit of a disappointment, a lot of the subject matter can easily be placed under the heading “Common Sense.” However, after reviewing successes and failures in this area one finds that common sense may not be as common as one would like. While the successes are much more frequent than the failures, the failures tend to overwhelm the impact of the successes.     

Reliability performance of fault-tolerant digital control systems

This paper presents the results of a generic reliability analysis of fault-tolerant digital control systems (F-T DCS). This analysis differs from previous efforts at estimating the reliability performance of F-T DCS in the sense that this analysis relies extensively on actual experience with redundant computer systems rather than on theoretical evaluations. The dominant contributors to the frequency of failure of F-T DCS are (1) failures within common or shared equipment, (2) software failures, and (3) inadvertent operator actions. Other contributors include loss of electric power, spurious signals that originate from within the DCS, lack of coverage, common cause failure (CCF) of redundant hardware, CCF of instrument channels, and physical damage from externally initiated events (e.g., high temperature). Much variation is expected in the reliability performance of F-T DCSs. Although some systems may operate for 10 or 15 years without experiencing system failures, other systems may fail several times during the same time interval. This variation is expected among systems of different architectures as well as among systems of the same architecture. Because most failures of DCSs can be traced to some kind of CCF, particularly software failures and inadvertent operator actions, CCFs should probably receive more attention than they are presently given when selecting an F-T DCS.     

Project Suspensions and Failures in New Product Development: Returns for Entrepreneurial Firms in Co‐Development Alliances

Entrepreneurial biotech and large pharmaceutical firms often form alliances to co‐develop new products. Yet, new product development (NPD) is fraught with challenges that often result in project suspensions and failures. Considering this, how can firms increase the chances that their co‐development alliances will create value? To answer this question, the authors build on insights from signaling theory to argue that prior project suspensions provide positive signals leading to an increase in value creation, while project failures have the opposite effect. In addition, drawing on insights from temporal construal theory, this research predicts that the strength of these effects is contingent on the stage along the exploration–exploitation continuum at which the alliance is formed. The authors undertook event study analyses of 248 alliances formed by 104 biotechnology firms from the United States and Europe listed on eight stock exchanges over an 8‐year period between 1996 and 2003. The results confirm that prior NPD project suspensions have a stronger value creation effect (or prior failures have a weaker value destruction effect) in the case of exploration alliances in the upstream of NPD processes than in the case of moderate‐scale exploitation alliances in the downstream of NPD. This study is among the first to examine how both prior NPD project suspensions and failures of firms affect the abnormal returns achieved from co‐development alliances. This research therefore contributes to the innovation literature by honing a better understanding of setbacks and failures in NPD. Moreover, the findings contribute to the literature on strategic alliances by identifying new conditions under which firms can create or preserve value. This research also contributes to signaling theory by providing evidence of the moderation effect caused by the signaling environment. Finally, this study contributes to the entrepreneurial literature on value creation for entrepreneurial firms in alliances following adverse events.     

Integration Theory and European Labour Markets

Standard integration theory assumes that the law of the price holds within individual countries which can thus be treated as homogeneous units. Integration of two or more countries then amounts to removing the barriers to free exchange between them. Recently this conventional approach has been increasingly called into question. In the first place, as economic interpenetration grows, it becomes more important to recognize that national systems display many internal disparities and heterogeneities. Moreover, as recent advances in economic theory emphasize, transaction costs and lack of information prevent market agents from taking advantage of all profitable exchanges. As a result, most market situations cannot be seen as self-clearing or capable of integrating spontaneously. Thus, institutional interventions and other co-ordination mechanisms are required to promote economic adaptability. Viewed from this standpoint, the Social Charter and related initiatives can be seen as promoting orderly integration of the Community's labour market.     

Agricultural factor markets in Sub-Saharan Africa: An updated view with formal tests for market failure

This paper uses the recently collected Living Standard Measurement Study–Integrated Surveys on Agriculture Initiative data sets from five countries in Sub-Saharan Africa to provide a comprehensive overview of factor market participation by agrarian households and to formally test for failures in rural markets. Under complete and competitive markets, households can solve their consumption and production problems separately, so that household factor endowments do not predict input demand. This paper implements a simple, theoretically grounded test of this separation hypothesis, which can be interpreted as a reduced form test of market failure. In all five study countries, the analysis finds strong evidence of factor market failure. Moreover, those failures appear general and structural, not specific to subpopulations defined by gender, geography, human capital, or land quality. However, we show that rural markets are not generally missing in an absolute sense, suggesting that market existence is less of a problem than market function.     

How America's fragmented approach to public safety wastes money and spectrum

Emergency responders such as firefighters, police, and paramedics depend on reliable and ubiquitous wireless communications. Failures in these communications systems can cost lives. Particularly since 9/11, there has been great concern in the US about the possibility of failures due to lack of interoperability, and failures due to a shortage of public safety spectrum. This paper shows how both of these and other serious problems are a logical consequence of America's fragmented approach to public safety, in which thousands of local agencies make independent decisions without a coherent strategy to unify or guide them. Because of this fragmented approach, public safety agencies build more infrastructure than they should, spend more tax-payer money than they should, and consume more scarce spectrum than they should, all for a system that is unnecessarily prone to interoperability failures. This paper also considers the most widely cited estimates of public safety's spectrum needs, which predict a serious shortage unless considerably more spectrum becomes available to public safety by 2010. This paper shows that estimates for the amount of spectrum needed in 2010 would be vastly lower if the US adopted an effective national strategy that included coordinated planning and modern technology. On the other hand, if the US retains today's fragmented approach, regions where coordination among local public safety agencies is particularly weak may need more spectrum than popular estimates would indicate, leading to an even greater shortage. Thus, the federal government should start playing a large role in setting the direction of public safety communications, rather than leaving this to many independent local governments.     

Market power and banking failures

We investigate whether more competition in the banking industry necessarily results in a higher probability of banking failures, as it is often suggested. In our model borrowers face a moral hazard problem, which induces banks to choose between costly monitoring and credit rationing. We show that investment decreases with the lending rate and increases with monitoring effort. Since incentives to monitor are enhanced by market power, the relationship between market structure and investment is ambiguous. In the presence of non-diversifiable risk and decreasing returns to scale, more investment implies higher failure rates. As a result, the relationship between market power and banking failures is ambiguous.     

New product success factors: A comparison of 'kills' versus successes and failures

The paper reports an analysis of the characteristics of those new projects that are killed, that is, terminated before commercialisation. Such projects constitute the majority of new product projects. The authors' aim was to learn from the differences between 'kills' and those that are commercialised. The latter may, of course, turn out to be successes or failures.
Their sample consisted of 250 new projects of which 123 were ultimately successful, 80 failed and 47 were kills. Two hypotheses were tested: that kills and failures had similar characteristics and that kills differed from successes in the way that failures differed from successes. Four groups of multidimensional project characteristics were measured: product advantage, market attractiveness, competitive situation, and synergy/familiarity.
The results showed that neither hypothesis was generally supported, The patterns of characteristics observed were complex but were unravelled through a computer model simulating how managers perform the evaluation process. It showed that the results could be explained on the basis that errors could be made in evaluation. For example, it is difficult to evaluate product advantage. Surprisingly, competitive situation is not a discriminator between successes, failures and kills but managers treat it as if it were. Some characteristics are perceived by managers to be negative although they are, in fact, favourable to project success.
The authors claim that these results should lead to better allocation of R&D resources among proposed projects.     

An Ecological Perspective on New Product Failure: The Effects of Competitive Overcrowding

Practitioners and researchers have carefully explored the causes of new product failures. Studies have been conducted, results analyzed, and recommendations offered. Yet despite these efforts, new product failure rates have not decreased. In fact, they appear to be increasing in some product categories. Are we missing something? Noting that most research on new product failures has focused on a firm's activities in specific projects, William H. Redmond proposes that new product outcomes might also be influenced by macro-level or environmental factors. By focusing on environmental factors rather than a firm's activities in specific projects, we might better understand why competent firms in one industry consistently experience higher failure rates than those of firms that are no more competent, but operate in a different industry. For example, failure rates for new food products are consistently higher than those for new industrial products. With no evidence that product development professionals in industrial firms are simply superior to their counterparts in the food industry, Dr. Redmond suggests that we need to look beyond specific product development projects and consider the effects of the market in which these products are introduced. Encouraged by past successes, many firms in the food manufacturing business seek sales growth through the development and introduction of additional new products. Over time, this creates a market in which customer demand is fragmented into increasingly small niches and distribution channels are flooded with product choices. As a result, the failure of a new product is more likely than it might have been under less crowded conditions. In much the same way that the population of deer on an island is limited by the available food and physical space, food products are apparently faced with the market equivalent of natural selection. In the absence of available market niches and a clear competitive advantage, a new product's chances for success are meager. In a market that is overcrowded by existing products and new product introductions, it becomes increasingly difficult and uneconomical to identify opportunities for meaningful differentiation. On the other hand, industrial products face a much different set of environmental conditions. Compared to the food manufacturing business, relatively few new industrial products are introduced, and those introductions are typically successful. In most cases, the new products are simply replacements for inefficient or obsolete products. In such an environment, failed introductions are probably the result of errors in the product development process.     

Why are you really losing sales opportunities? A buyers' perspective on the determinants of key account sales failures

Key account sales are important for business organizations. Understanding why some of these sales proposals fail from the buyer's perspective has organization-wide implications for improving firm performance. Extant literature lacks a clear understanding of the process-based determinants of sales failure within a key account context. Another problem with this research stream is its reliance on data from the salesperson, sales manager, and/or selling firm, which can introduce attribution biases. Our research overcomes sales failure attribution biases by collecting data from the industrial buying center's perspective. Thirty-five semi-structured interview cases were conducted with buying decision makers following failed key account sales proposals. The result of this inquiry is a model which outlines the determinants of sales failures. We identify three common drivers of sales failure: adaptability, relationship-potential, and cost considerations. Results indicate that these established constructs are more complex than previously specified, each having multiple attributes as defined by key account buyers.     

The effect of managerial distribution of scientific and technical information on company performance

272 scientific and technical personnel working in the R&D departments of 25 firms in the electronics/instrumentation field noted how often their managers engaged in different forms of influencing them to use scientific and technical information originating outside the firm (STI). The firms were classified as either 'high performers' or as 'low performers' on the basis of their sales growth and return on assets. Managers in the high performing firms were perceived to make significantly more use of the following forms of influence than those in low performing firms; supporting professional visits and continuing education, routing literature and references to scientific and technical staff, directing their staff to use STI and purchasing STI services. There was no difference between the two groups of managers in their perceived use of organizational efforts to increase use of STI, such as changing work and personnel and altering hiring and promotional policies. These findings suggest that company performance can be improved if managers take specific steps to encourage their staff to use STI.     

碳化硅材料在机械密封中的应用

针对密封环材料的性能直接影响机械密封的使用性能和寿命,讨论了机械密封对密封副材料的各种性能要求,介绍了机械密封常用碳化硅材料的种类和特点。通过与碳化钨对比,指出碳化硅具有密度低、耐腐蚀性能和热力性能好,与碳石墨配对以及自身配对时摩擦系数低、硬度极高等优良性能,由此分析可知碳化硅密封环可应用于高温、高压、高转速、腐蚀性介质和含有固体颗粒介质等工况下的机械密封中。结果表明,碳化硅是作为机械密封硬环最理想的材料。     

the evaluation of innovation projects

Abstract . Any realistic assessment of research projects must allow for possible failures. Scaling down the Potential gain from each project by its probability of achievement ignores the expenditure on unsuccessful projects and is therefore misleading. The method proposed here is more sound: it uses a concept termed the Survival Probability Function, which is simply the probability that a Project will still exist at various times in the future. This function can be derived from estimates for the survival factors and durations of project stages. The function can then be used to calculate the statistics of project successes and failures, and can be employed in a standard Risk Analysis. More simply, if can be used as a weighting function for cash flow patterns. This leads to a comparison method for projects with different risks and different potential returns, and thus to project portfolio selection.     

Understanding sales force automation outcomes: A managerial perspective

Despite the growing importance and potential of sales force automation (SFA), failure rates for SFA implementations have been reported to be as high as 55-80%. Given the growth of SFA programs, the potential effectiveness and efficiency SFA can bring to the sales force, and the magnitude of SFA failures, it is surprising that relatively few studies have addressed this important and timely topic. Many of the early studies have focused on the adoption and diffusion/infusion of SFA programs from an information technology perspective. The results of these studies have been inconclusive in explaining SFA implementation failures. The purpose of this study is to add to our understanding of SFA failures by investigating a broader set of implementation factors than those typically included in acceptance of technology studies. We conducted in-depth personal interviews with executives from three global organizations who were responsible for SFA initiatives in their firm. Results from the in-depth analyses yield recommendations and a proposed model to assist managers in the implementation of their SFA as well as getting their salespeople to “buy-in” to the SFA, and ultimately reduce SFA failures.     

Rational Versus Intuitive Gatekeeping: Escalation of Commitment in the Front End of NPD

The unwillingness of a gatekeeper to let go of a fruitless new product development (NPD) project wastes valuable resources and hampers NPD performance. The onset of such escalation of commitment is likely to occur already in the front end of NPD, where high ambiguity and complexity make it hard to distinguish fruitless from potentially successful projects. This study investigates if a gatekeeper’s thinking style—whether they think rationally or whether they follow their intuition—can prevent escalation of commitment in the front end. Theory on cognition provides arguments for and against either thinking style’s influence on escalation of commitment, but empirical evidence on this matter is lacking. Our study demonstrates that gatekeepers who think rationally are less likely to escalate their commitment than those who follow their intuition. This result holds both in a correlational study of dispositional thinking styles, as well as in an individual‐level randomized experiment in which the thinking style of experienced practitioners before they take gate decisions is induced. Our findings provide ample opportunities for improving existing front end gate review practices, such as allocating candidates for gatekeeper positions based on their thinking style, training gatekeepers to think rationally, and increasing the use of gate‐decision rules and templates.