Performance analysis of a focused hospital unit: The case of an integrated trauma center

The concept of focus [Skinner, W., 1974. The focused factory. Harvard Business Review 52 (3), 113–121], notably operationalized in manufacturing entities like cells and focused factories, has also been adopted by the health care industry. Examples include patient-focused care systems and product/service lines. Despite its longevity, there is a paucity of studies analyzing the focus concept and its link to performance, especially in health care. This research is aimed at enhancing our understanding of how a focus-based approach to organization redesign in health care affects processes and practices, and what operational, clinical, and financial outcomes result from such a change. The research setting is a single case site within a large medical center for which costs for trauma care used to exceed income. Using a structured framework, we document the design and operation of this physically and organizationally integrated Level I trauma care center and compare it to its preceding operation. Its pre- and post-conversion performance is analyzed using symmetric event windows covering three-year periods before and after the focused hospital unit (FHU) was established. Under a sizable increase in workload, we find no change in mortality, moderate improvement in length of stay, and a large improvement in net operating margins. Surprisingly, the latter stem not from reductions in cost but in sharply increased hospital reimbursements. Previous studies of hospital restructuring involving focused patient populations have not conclusively supported a positive link between focus and outcomes. However, this investigation of a specific FHU suggests, conceptually as well as quantitatively, that focus can be an attractive element in health care system design.     

Reforming the Labour Market: An Assessment of the UK Policies of the Thatcher Era

Under Thatcher the United Kingdom introduced a major program of labour market deregulation, claimed to have made the United Kingdom one of the least regulated labour markets in the OECD. This paper reviews the measures implemented and assesses their impact. Trade union membership declined steeply, and collective bargaining was curtailed even more sharply. The impact of the legislation curbing unions can be exaggerated, given that it coincided with wider developments. At the microeconomic level there is some evidence that the decline of unions contributed to productivity gains, but no clear evidence on employment, investment, profitability or wage premia. UK macroeconomic performance improved, but not dramatically. The most marked features of the more flexible labour markets are the growth of part-time and temporary work, while job insecurity has become a common perception. The most striking development is the growth in earnings inequality, in part reflecting the weakening of collective bargaining. The evolution and consequences of inequality will be a major criterion in assessing the moves to labour market flexibility.     

Backlash Hits Business Ethics: Finding Effective Strategies for Communicating the Importance of Corporate Social Responsibility

Recently, several articles have asserted that corporate social responsibility programs have gone too far and need to be reigned in. These critics have charged that corporate social responsibility is to be regarded with skepticism and that any changes in corporate accountability should be superficial at best. I will examine a␣number of these objections; I conclude that these critiques are largely ill founded, but that their increasing frequency in popular media is a cause for concern. I argue that these purported objections are better understood as one part of a long-term cycle that generally accompanies positive moral change in institutions. Using the feminist movement as a touchstone, I examine the similarities between backlash against the movement for corporate accountability as compared to backlash against feminists. I␣also suggest ways in which successful strategies adopted by feminists could be used effectively to communicate the aims of those working to increase awareness of business accountability.     

Paradigm,paradox, paralysis: An epistemic process

The potential of the transformative capacity of education requires critique of a dominant paradigm, in order to apprehend the unconscious acceptance of capital markets as solutions to societies’ woes. We engaged with media texts as practicum which advocated carbon markets to mitigate carbon pollution: a contemporary issues in society. We found that although we critique the dominant paradigms upheld by the media texts which we chose, our engagement had the potential to reinforce the status quo. Once this paradox is evident, it precipitates a paralysis of the educative process. However, this is not an end state but the struggle to overcome the paralysis mobilises a reconsideration of the paradigm and opens new possibilities. We argue that the collision of the concepts of paradigm, paradox and paralysis demonstrates an epistemic process which has emancipatory possibilities.     

A dyadic study of interpersonal information search

Although interpersonal word-of-mouth communication, by definition, takes place between two people, rarely has the phenomenon of word of mouth been studied using both members of the dyad. Building on the literature, this article offers a model of active interpersonal information search that is tested by using a method in which information seeker and source perceptions were obtained. Source characteristics were important determinants of interpersonal influence, but seeker characteristics also played an important role. Interestingly, it proved useful to distinguish between demographic and attitudinal homophily of seeker and source as the former was inversely and the latter directly related to interpersonal influence. Mary C. Gilly is an associate professor in the Graduate School of Management and associate dean of Graduate Studies at the University of California, Irvine. Her Ph.D. is in marketing from the University of Houston. Her research interests include the unintended effects of marketing actions, such as the effects of advertising on employees. She also has interests in services marketing, such as customer service, including consumer complaint handling, and cross-cultural service encounters. Her work has been published in theJournal of Marketing, theJournal of Consumer Research, theJournal of Business Research, and other academic journals. John L. Graham is a professor in the Graduate School of Management at the University of California, Irvine. His Ph.D. is in marketing from the University of California, Berkeley. His primary research interests regard international marketing, international business negotiations, and structural equations modeling. His work has been published in theJournal of Marketing, theJournal of Consumer Research, Marketing Science, theJournal of International Business Studies, Management Science, and other academic journals. Mary Finley Wolfinbarger is an associate professor at California State University, Long Beach and is doing research on the topics of internal marketing and gift giving. She teaches Marketing Principles and Marketing Research. She received her Ph.D. in marketing from the University of California, Irvine. Her work has appeared in theJournal of Marketing and other academic journals. Laura J. Yale came to Fort Lewis College in 1991. She holds degrees in Hotel, Restaurant, and Travel Administration from the University of Massachusetts, Amherst, and received her Ph.D. from the University of California, Irvine. She teaches a variety of courses in Marketing and Travel and Tourism Administration, including Marketing Research, International Marketing and Services. Her industry experience and most of her research interest are in the services sector, particularly the tourism industry. She is on sabbatical leave this academic year, writing an introductory textbook on the tourism industry. She will return to teaching in September 1998.     

Budget deficits and stock prices: International evidence

The purpose of this research is to provide empirical evidence regarding deficits and their effects on stock prices. We investigate whether changes in deficits cause changes in stock prices and if so, in what direction. We use Granger causality tests and impulse response analysis of vector autoregressive models to assess the relationship between budget deficits and stock prices in several industrialized nations. The evidence from impulse response analysis and Granger causality tests shows that only in the U.S. deficit reductions have an inverse effect on equity returns.     

Railroad Development and Land Value

Land owners in the rural Midwest experienced significant capital gains during the late 1840s and early 1850s. A primary catalyst of increasing land values was the construction of new railroads. Land in close proximity to new railroads became more valuable because of decreased transportation costs. We use a straightforward model of land price determination to estimate the impact on land values of distance from the railroad. The estimates allow us to infer a lower bound for capital gains attributable to the construction of railroads in Knox County, Illinois, during the 1850s. Knox County landowners reaped capital gains of more than $270,000—9% of the value of land.