Examining the role of value congruence, professional identity, and managerial job engagement in the budgetary participation-performance link.

BACKGROUND: In health care, important phenomena of perceived incompatibility between professional and managerial values have emerged as consequences of New Public Management reforms. Although there is a growing evidence on the variation in the enactment of hybrid roles by medical managers, existing research in health care management is mostly descriptive with little emphasis on the conditions under which hybrid roles are enacted and, importantly, on the effects of this variation on performance. PURPOSE: In this article, we seek to fill this research gap by empirically examining (a) whether budgetary participation aligns professional and organizational values, (b) the impact of this alignment on employees' work-related feelings and managerial performance, and (c) the effect of professional identity on value congruence. METHODOLOGY: Data were collected by a survey conducted in an Italian hospital, and partial least square was used to test the relationships among variables. RESULTS: Overall, results show that (a) high involvement in budgeting is instrumental in facilitating medical managers' value congruence, and this, in turn, positively effects managerial job engagement; (b) the effect of budgetary participation on value congruence depends on the extent of professional identity; and (c) as a result of enhanced value congruence and managerial job engagement, employees tend to deliver superior role performance. PRACTICE IMPLICATION: Findings of this study provide some guidance for managers on how organizations can take steps to guarantee effective support to hybrid professionals.

Embarking on performance improvement.

Healthcare organizations should approach performance improvement as a program, not a project. The program should be led by a guidance team that identifies goals, prioritizes work, and removes barriers to enable clinical improvement teams and work groups to realize performance improvements. A healthcare enterprise data warehouse can provide the initial foundation for the program analytics. Evidence-based best practices can help achieve improved outcomes and reduced costs.

Supplier transaction, TMT characteristics, and the persistence of earnings: do their relationship contribute towards sustainable performance of Chinese listed manufacturing sector firms?

The construction of supplier transaction is one of the strategic choices of many firms. However, the impact of business strategies on the persistence of earnings remains to be further investigated. The innovation of this paper lies in interpreting the impact of supplier transaction on earnings persistence from the perspective of characteristics of the top management team (TMT). We consider Chinese listed manufacturing firms from 2012 to 2019 to examine the relationship between the supplier transaction and the persistence of earnings. Statistical results show that supplier transaction characteristics of the TMT have a significant moderating effect on the relationship between the supplier transaction and the persistence of earnings. This implies that the behavior of TMT can be vital to the firm in maintaining sustainable performance. The higher age level or longer average tenure of TMT can significantly improve the positive effect of the supplier transaction tenure heterogeneity of TMT that will significantly improve the negative effect. This paper expands the literature on supplier relationship, and corporate earnings from a new perspective that improves the empirical evidence of the upper echelons theory, and also provides evidence support for the construction of supplier relationship and TMT.

Human resources needed to perform antimicrobial stewardship teams' activities in French hospitals.

OBJECTIVE: In January 2015, the French ministry of Health set up a task force on antibiotic resistance. Members of the task force's "antimicrobial stewardship" group conducted a study to evaluate the human resources needed to implement all the required activities of the multidisciplinary antimicrobial stewardship teams (AST - antibiotic/infectious disease lead supervisors, microbiologists, and pharmacists) in French healthcare facilities. METHODS: We conducted an online cross-sectional nationwide survey. The questionnaire was designed based on regulatory texts and experts' consensus. The survey took place between March and May 2015. We used the mailing list of the French Infectious Diseases Society (SPILF) to send out questionnaires. RESULTS: A total of 65 healthcare facilities completed the questionnaire. The human resources needed to implement all AST's activities were estimated at 3.6 full-time equivalent (FTE) positions/1000 acute care beds for antibiotic/infectious disease lead supervisors, at 2.5 FTE/1000 beds for pharmacists, and at 0.6 FTE/1000 beds for microbiologists. This almost amounts to a total of 2000 FTE positions for all healthcare facilities (public and private) in France and to an annual cost of 200 million euros. CONCLUSION: Dedicated and sustainable funding for AST is urgently needed to implement comprehensive and functional AST programs in all healthcare facilities.

Using financial metrics to prove and communicate value to management. Occupational health nurses as key players on the management team.

Successfully communicating value to management starts by gaining visibility and by knowing what management wants to hear. Communicating budget information, including cost savings and time value of money, is an essential skill for the occupational health nurse. The occupational health nurse must be able to speak the language of business to make a meaningful impact in the 21st century work environment.

Want to save millions? Innovative teams go out on a limb to shape new cost structures.

Forget the fiddling and tinkering that accompany budget reductions of 2 and 3 percent; in fact, forget the entire status quo of cost containment. Even in markets where managed care is not yet a major force, proactive CEOs in places like Middletown, CT, and Johnson City, TN, are challenging their staffs to undergo the most strenuous fitness tests of their professional lives, as they bring cost-cutting to new levels.

Pay for performance: what trustees should be applauding.

The responsibilities of the board's compensation committee go beyond just determining annual pay. The committee must develop a plan that outlines organizational goals and identifies the CEO's accountabilities. Then trustees can fulfill their fiduciary and stewardship roles by providing continuous feedback to their CEO.

Integrated enterprise management: a look at the functions, the enterprise, and the environment--can you see the difference?

The performance of an organization is paced by its use of resources, including its ability to acquire, access, and use knowledge. A high-performance organization, more than likely, has structured its resources around process linkages and is characterized by a horizontal organization chart, teams and teamwork, empowerment, and operational excellence. Organizational researchers hypothesize that performance improves with fuzzy internal boundaries, cross-functional participation, and goals anchored in the interests of customers and other external stakeholders. This article looks at the competitive need for more integration of resources and greater sharing of knowledge, the integrated nature of work within emerging types of organizations, how expanded views can improve the marketplace centering of processes and individuals, and how combining a model of integration and individual work challenges thinking and actions in the new environment.

Implementing CQI projects in hospitals.

BACKGROUND: Quality improvement approaches such as continuous quality improvement (CQI) and total quality management are widely used, but little is known about how much it costs to use the principles and techniques required to implement CQI processes. In the Robert Wood Johnson Foundation's Improving the Quality of Hospital Care (IQHC) program, four consortia of hospitals were funded in the early 1990s. Interviews with quality managers at 38 of the consortia hospitals were conducted in 1995 to determine the costs of conducting CQI projects to allow an estimation of the marginal cost of using CQI processes (particularly cross-disciplinary teams) to improve quality of care. CQI PROJECTS: Quality managers described 69% of project outcomes as critical to clinical services. Team members identified the issues their teams addressed and selected the project 64% of the time, the methods of analysis 87% of the time, and the approaches to resolving the problem or issue 97% of the time. Most of the respondents agreed that the team members had the authority to resolve the problem without appealing to higher levels of management. Costs for hospitals' most recently completed projects varied widely, from $148 for the entire project to $18,590. The length or duration of the projects also varied widely, from 1 month to 66 months. DISCUSSION: In the hospitals included in this sample, all of which were highly self-selected (evidenced by their participation in a voluntary consortium of hospitals focused on quality of care), knowledge of CQI processes appeared to be fairly thorough. Teams appeared to have a reasonable amount of autonomy. New CQI projects should be subjected to scrutiny in terms of their likely contribution to quality of care, as distinct from other positive outcomes.

A partnership to affect real cost reduction: a guaranteed savings of $20 million.

In 1994 Brigham and Women's Hospital and Massachusetts General Hospital joined forces to form Partners HealthCare System, Inc. (Boston, MA), an integrated healthcare delivery system. Both teaching affiliates of Harvard Medical School, the two hospitals comprise approximately 1,750 beds with 80,000 inpatient admissions and 1.3 million outpatient visits annually. The two campuses have over 16,000 employees in facilities covering 6.5 million square feet. The key goals of their partnership were to reduce cost and improve quality. Partners HealthCare System (PHS) set a goal to save $240 million in the first three years. These savings were to be achieved through consolidating departments and programs, adopting best practices between institutions, and wise purchasing. This article looks at the supplier partnering process followed by PHS to affect a guaranteed savings of $20 million.

Participation as a complicating mechanism: the effect of clinical professional and middle manager participation on hospital performance.

One way hospitals complicate themselves is by increasing the participation of clinical professionals and middle managers in making strategic decisions. Using a survey methodology this article investigates the relationships between the participation of clinical professionals (MDs and RNs) and middle managers with hospital costs, as well as the possible moderating effect of strategic complexity.

Role of medical, technical, and administrative leadership in the human resource management life cycle: a team approach to laboratory management.

We believe the team approach to laboratory management achieves the best outcomes. Laboratory management requires the integration of medical, technical, and administrative expertise to achieve optimal service, quality, and cost performance. Usually, a management team of two or more individuals must be assembled to achieve all of these critical leadership functions. The individual members of the management team must possess the requisite expertise in clinical medicine, laboratory science, technology management, and administration. They also must work together in a unified and collaborative manner, regardless of where individual team members appear on the organizational chart. The management team members share in executing the entire human resource management life cycle, creating the proper environment to maximize human performance. Above all, the management team provides visionary and credible leadership.