Sample records for hospital-physician joint ventures
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Overview of physician-hospital ventures.
Cohn, Kenneth H; Allyn, Thomas R; Rosenfield, Robert H; Schwartz, Richard
2005-01-01
An ongoing environment of reimbursement lagging behind escalating expenses has led physicians to explore new sources of revenue. The goal of physician-hospital ventures is to create a valuable entity that benefits patients, physicians, and the hospital. Physicians may choose to invest in healthcare facilities to improve patient care and obtain increased control over daily operations. If so, they should seek counsel to avoid violating Stark laws and anti-kickback laws. Modalities for investing in physician-hospital ventures are joint equity (stock) ventures, participating bond transactions (PBTs), and contractual integration, a new method to align the goals of specialists and hospital management without using joint equity ventures. Physicians and management should invest time in developing a shared vision of the future before beginning contract negotiations. Successful partnering requires transparency and stepwise building of trust. The greatest gain in joint ventures arises when both sides become active owners, rather than passive investors.
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The MeSH model for hospital-physician joint ventures.
Anderson, J G
1985-01-01
The MeSH (Medical Staff-Hospital Joint Venture Company) concept has arisen to meet the perceived need for hospital-physician cooperation in a modern age of prospective payment systems, increased supply of health-care providers, cost conscious consumers, corporate health care organizations, and a general trend toward industrialization of health care. Supply and demand economics have created a situation which threatens the autonomy and financial integrity of both hospitals ans physicians, forcing cooperation or mutual destruction. MeSH seeks to preserve the autonomy and financial integrity of both parties through the creation of a free-standing business entity jointly owned by a hospital and those members of its medical staff who choose to participate. This article presents reasons for the need for cooperation, the objectives of MeSH, a description of its structure and operation, and a list of potential projects the program could include.
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Joint-venture proposals strengthen hospital-physician relationship.
Rovinsky, M
2000-12-01
By proposing the joint-venture development of an ambulatory surgery center and medical office space with a group practice, one hospital succeeded in enhancing its relationship with the practice and paved the way for future collaboration. Although the hospital's proposal to jointly develop an ambulatory surgery center was not accepted, the hospital was able to dissuade the group practice from developing a competing ambulatory surgery facility while increasing the group's trust in and loyalty to the hospital. As a result, the hospital potentially will benefit from increased inpatient admissions.
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Shorr, A B
1987-02-01
This four part series, "The Physician/Hospital Joint Venture: Developing a Win/Win Strategy," will examine the philosophical basis of marketing to physicians, the options for the organization in formulating a strategy for joint venture development, structuring and negotiating the deal, and finally how to build the physician loyalty and commitment essential for the joint venture's continued success. In this first article, the author emphasizes the organization's need to develop a strategic plan that includes a program for attracting physicians. It also points out the need for sensitivity to physicians' concerns and provides examples of successes and failures.
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A guide to organizing joint ventures with physicians.
Peters, G R
1986-12-01
Catholic health care facilities must consider the business and legal risks, canon law, and other constraints when planning a joint venture with physicians. Participants should first establish goals and compatibility, then determine the venture's type (property, service), form ("true," lease, contract), and structure (corporation, partnership, joint property ownership, trust). The administrator must decide whether the facility will participate directly in the venture or form a separate organization. Participants must determine their relationships with the venture, choosing among many options. The administrator should consider whether a venture raises any canon law issues, especially regarding ecclesiastical and secular assets, approval by the local bishop or Holy See, and need for consultation. Other pertinent legal issues include: Fraud and abuse. The venture should not appear as compensation to induce referrals. Physician referrals. Many states prohibit or restrict referrals by physician participants. Antitrust law. Participants may be liable for actions constituting on antitrust violation. Securities low. Organizers must clarify Securities and Exchange Commission registration exemptions and observe state "blue sky" laws. Tax issues. Catholic health care facilities must consider such factors as tax-exempt status, unrelated business income, taxable subsidiaries, and public charity status. Other considerations include tax ramifications for physicians; tax shelter registration; certificate of need (CON), licensing, and building standards; effects on reimbursement and pension plans; organizational and bond documents; corporate medical practice and fee-splitting questions; and labor and contractual issues.
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The impact of joint ventures on U.S. hospitals.
Harrison, Jeffrey P
2006-01-01
This quantitative research study assesses the organizational characteristics, market factors, and profitability of US hospitals that operate joint ventures with other health care organizations. Data was obtained from the 2001 American Hospital Association annual survey, the Area Resource File, and the Center for Medicare and Medicaid Services Minimum Data Set. These data files provide essential information on individual acute care hospitals, the communities they serve, and the level of financial performance. Descriptive statistics were evaluated and a logistic regression model was utilized to examine hospitals operating joint ventures. The study found hospitals that operate joint ventures are located in communities with more elderly patients, lower unemployment, and lower HMO penetration. From an operating performance perspective, hospitals that operate joint ventures have a higher occupancy rate, a higher average length of stay, more clinical services, lower long-term debt, and a greater number of managed care contracts. The results also appear to indicate that joint ventures have a positive financial impact on US hospitals. The study has managerial implications supporting the use of joint ventures to improve hospital performance and policy implications on resource allocation.
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Pros and cons of the ambulatory surgery center joint venture.
Giannini, Deborah
2008-01-01
If a physician group has determined that it has a realistic patient base to establish an ambulatory surgery center, it may be beneficial to consider a partner to share the costs and risks of this new joint venture. Joint ventures can be a benefit or liability in the establishment of an ambulatory surgery center. This article discusses the advantages and disadvantages of a hospital physician-group joint venture.
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An evaluation of charity care for tax-exempt hospitals engaging in joint ventures.
Smith, Pamela C
2006-01-01
The study examines whether the level of charity care and financial stability contribute to a nonprofit hospital's motivation for partnering with a for-profit hospital through a joint venture. The Internal Revenue Service (IRS) has heightened its scrutiny of joint ventures within the health care sector. Considering recent calls to investigate the merit of the tax-exempt status of hospitals engaged in joint ventures, this research will assist policy makers in the evaluation of nonprofit hospitals. Constituents will continue to question whether joint ventures contribute to a reduced focus on charitable activities. Results indicate that the propensity to engage in a joint venture significantly increases with increased levels of charity care. Furthermore, nonprofit hospitals with lower profitability are more likely to engage in joint ventures. These results are useful to policy makers when evaluating the level of charity care provided by hospitals seeking alternative strategic alliances. Considering many critics allege hospitals are reducing the provision of charity care to the community, it is imperative for management to be conscious of the impact of joint ventures on the provision of charity care.
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Joint ventures: to pursue or not to pursue?
Blaszyk, Michael D; Hill-Mischel, Jody
2007-11-01
Hospitals should carefully select joint venture partners. The joint venture evaluation process should involve a high-level screen of strategic opportunities. Hospitals should develop a full business plan for the joint venture.
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The joint venture alternative to mergers.
Enders, R J
1995-02-01
However, while a joint venture may be "safe" from antitrust challenge, it is not without some practical difficulties, especially with respect to consolidating services at one location or jointly offering services provided at multiple facilities. These practical concerns include: 1. Who will exercise operational management of the joint venture? 2. How will the joint venture deal with different pricing for services that will be provided at multiple locations? 3. What criteria will be used to decide the location at which consolidated tertiary services will be offered? 4. In what circumstances can the joint venture be unwound, either in its entirety or as to discrete functions? When clinical services have been consolidated at one location, there is an appropriate concern by the other hospital that it will be unable to provide or re-enter the market for those services if the joint venture dissolves. These operational concerns, of course, are not addressed in the Consent Decree. Thus, even if a joint venture relationship survives antitrust scrutiny, the parties must still negotiate and resolve these operational issues in order for the joint venture to be viable.
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The physician as a source of hospital capital.
Fried, J M
1984-06-01
As hospitals search for means of financing renovation during the next decade, physicians will represent a source of capital through tax-shelter financing. Limited partnerships, condominiums , and joint ventures in acquiring medical equipment or syndicating existing facilities are among the most promising investment vehicles for taking advantage of tax benefits that normally do not apply to nonprofit institutions. In a hospital-physician limited partnership, tax deductions are passed through to the partners, of which there are two kinds: general partners and limited partners. Income (or loss) and tax credits from the entire venture can be divided among the partners and reflected on an individual limited partner's tax return. Rather than shouldering the whole cost of renovating a medical office building, thereby losing the potential tax credit, a hospital could carry out the renovation through a limited partnership with physicians. This would reduce the hospital's capital costs and debt requirements, maintain its credit, and enable it to take advantage of the depreciation deduction. In a condominium venture, the individual physician actually owns the office within which he or she works. As with the limited partnership, the hospital will want to restrict physicians' ability to dispose of their ownership interests.(ABSTRACT TRUNCATED AT 250 WORDS)
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DEFF Research Database (Denmark)
Sørensen, Karsten Engsig
2001-01-01
The article analysis problems connected with corporate joint ventures. Among others the possible conflicts between the joint venture agreement and the statutes of the companies is examined, as well as certain problems connected to the fact that the joint venture partners have created commen control...... over their joint company....
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DEFF Research Database (Denmark)
Sørensen, Karsten Engsig
Afhandlingen analysere de konkurrenceretlige og selskabsretlige regler som er bestemmende for hvordan et joint venture samarbejde er struktureret......Afhandlingen analysere de konkurrenceretlige og selskabsretlige regler som er bestemmende for hvordan et joint venture samarbejde er struktureret...
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The impact of the Tulane-HCA joint venture on academic and clinical missions.
Whitecloud, T S; Smathers, J E; Barrack, R L
2001-10-01
As with any joint venture in any given industry, positive and negative impacts are felt. Tulane University School of Medicine experienced impacts on its academic and clinical missions as a result of the joint venture between Tulane University and HCA, a for-profit public company. The laws of business had entered the halls of medicine. Although patients, personnel, and physicians experienced culture shock and inconveniences, Tulane University School of Medicine has been able to maintain viable training programs, and its faculty physicians have a hospital and corporately run clinics across the street. In addition, multidisciplinary centers of excellence, long spoken of in the academic realm, came to fruition through the corporate world. This may not have been the case, had Tulane University not entered into ajoint venture with HCA. Is it worth the effort? For Tulane University, whether one likes the entire package or not, the answer must be yes. The greatest impact is that the orthopaedic surgeons still are in a position to fulfill their academic and clinical missions.
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Forming a multinational joint venture
International Nuclear Information System (INIS)
Bhatia, N.K.; Garb, R.H.; Statton, T.D.
1990-01-01
This paper discusses the basis and mechanics for forming a multinational joint venture. The topics of the paper include the motivations for a joint venture, selection of the appropriate co-venturer, management of the multinational joint venture, and the joint venture agreement. The authors state that a joint venture is not applicable or desirable in all instances and to be successful, must be carefully planned
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There's no profiting from a joint venture misadventure.
Herschman, Gary W
2004-10-01
In St. David's vs. IRS, a not-for-profit health system effectively challenged the IRS's determination that the system should be disqualified from tax exemption because it had entered a 50/50 joint venture with a for-profit system. The court decisions in St. David's, coupled with a recent IRS ruling, Revenue Ruling 2004-51, provide insight into how a not-for-profit hospital can structure such a joint venture to avoid jeopardizing its tax-exempt status.
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12 CFR 347.107 - Joint ventures.
2010-01-01
... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Joint ventures. 347.107 Section 347.107 Banks... INTERNATIONAL BANKING § 347.107 Joint ventures. (a) Joint ventures. If a bank, directly or indirectly, acquires or holds an equity interest in a foreign organization that is a joint venture, and the bank or its...
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15 CFR 296.8 - Joint venture agreement.
2010-01-01
... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Joint venture agreement. 296.8 Section... PROGRAM General § 296.8 Joint venture agreement. NIST shall not issue a TIP award to a joint venture and no costs shall be incurred under a TIP project by the joint venture members until such time as a...
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22 CFR 228.34 - Joint ventures.
2010-04-01
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Joint ventures. 228.34 Section 228.34 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT RULES ON SOURCE, ORIGIN AND NATIONALITY FOR COMMODITIES AND... Financing § 228.34 Joint ventures. A joint venture or unincorporated association is eligible only if each of...
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Russian upstream joint ventures logging progress
International Nuclear Information System (INIS)
Anon.
1992-01-01
This paper reports that Occidental Petroleum Corp. has begun exporting oil from Russia as part of an enhanced recovery joint venture in western Siberia. Oxy holds a 50% interest in the joint venture company, Vanyoganneft, and will market the oil. In other activity, two Canadian companies are marking progress with Russian upstream joint ventures
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Internationale joint ventures - udvalgte selskabsretlige problemstillinger
DEFF Research Database (Denmark)
Sørensen, Karsten Engsig
2001-01-01
Artiklen behandler en række problemstillinger som er særlige for joint ventures stiftet i selskaber af aktie-, anpartsselskabstypen. Bl.a. behandles en række problemer omkring joint venture aftalens forhold til selskabets vedtægter samt en række problemstillinger knyttet til det forhold at der er...... etableret fælles kontrol over joint venture selskabet....
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15 CFR 296.7 - Joint venture registration.
2010-01-01
... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Joint venture registration. 296.7 Section 296.7 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade NATIONAL... PROGRAM General § 296.7 Joint venture registration. Joint ventures selected for assistance under the...
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Campus/Industry Joint Ventures.
McDonald, Eugene J.
1985-01-01
Opportunities for joint economic ventures of colleges and industry are discussed, and a variety of ventures undertaken by Duke University are outlined, including a health club, hotel, and office building. Tax and financing considerations are noted. (MSE)
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Essays on equity joint ventures, uncertainty and experience
Cuypers, I.R.P.
2009-01-01
Amidst increasingly global competition during the last decades, we observed a sharp increase in the number of joint ventures. As a result, joint ventures have triggered considerable enthusiasm in recent years among scholars and practitioners. However, studies have shown that most joint ventures fail
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PRN 2011-1: Residential Exposure Joint Venture
This PR Notice is to advise registrants of an industry-wide joint venture, titled the Residential Exposure Joint Venture (REJV), which has developed a national survey regarding residential consumer use/usage data for pesticides.
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16 CFR 801.40 - Formation of joint venture or other corporations.
2010-01-01
... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Formation of joint venture or other... § 801.40 Formation of joint venture or other corporations. (a) In the formation of a joint venture or... contributing to the formation of a joint venture or other corporation and the joint venture or other...
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Joint Ventures: A New Agenda for Education.
Griffin, Dean
1989-01-01
The author states that vocational education can join in partnerships with industry, labor, and government to contribute to economic development. Examples of current programs are included. The "joint venture" concept is explained and ideas for forming joint ventures are shared. (CH)
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Joint Venture Health Plans May Give ACOs a Run for Their Money.
Reinke, Thomas
2016-12-01
Joint venture plans are starting to demonstrate their ability to implement clinical management and financial management reforms. A JV health plan replaces the offloading of financial risk by health plans to ill-equipped providers with an executive-level cost management committee stated jointly by the hospital and payer.
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What Determines Joint Venture Termination?
DEFF Research Database (Denmark)
Nielsen, Bo Bernhard
2012-01-01
Joint venture (JV) research continues to flourish as researchers seek to advance our understanding of why so many JVs fail. Cui and Kumar (this issue) take a contingency approach to explain how and why business relatedness may provide new insights as to what determines JV termination. This commen......Joint venture (JV) research continues to flourish as researchers seek to advance our understanding of why so many JVs fail. Cui and Kumar (this issue) take a contingency approach to explain how and why business relatedness may provide new insights as to what determines JV termination...
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Practical issues in selecting a joint venture partner
International Nuclear Information System (INIS)
Hillary, R.B.
1999-01-01
Some general issues regarding joint ventures and how they come about were discussed. The first section of the presentation identified potential joint venture candidates as being gas suppliers, project developers, steam hosts, financiers, facility owners, fuel managers and non-regulated utility affiliates. An explanation of the joint venture process and the motives driving it was then presented. There are many sources of potential conflicts of interest in a cogeneration venture. These include changes in either deregulation, prices markets, competitive environment or financial position of participants. Another section of this paper discussed some of the lessons learned from forced cogeneration restructuring and buyouts. Three examples of cogeneration projects which did not survive the challenges of partnership were presented. These included the New York cogeneration project at a manufacturing plant, the Pacific Northwest cogeneration project at a refinery, and the Quebec City cogeneration project at a pulp and paper mill. The last section of this paper discussed the pros and cons of joint venture and other types of deals
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The post-formation management of international joint ventures
DEFF Research Database (Denmark)
Dao, Li
2014-01-01
International joint venture (IJV) is not a new organizational phenomenon in international business. Existing research in IJVs has provided a well-established body of knowledge informing much of the joint venture process from parent firms’ strategic consideration to implementation phase...... a sensemaking approach to IJV post-formation management in search of capturing such ‘soft’, invisible managerial processes in a visible conceptualization that contributes to a better understanding of this complex organizational phenomenon. Empirical insights from cases of Danish – Vietnamese joint ventures...
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15 CFR 296.9 - Activities not permitted for joint ventures.
2010-01-01
... joint venture of any product, process, or service, other than the distribution among the parties to such venture, in accordance with such venture, of a product, process, or service produced by such venture, the... INNOVATION PROGRAM General § 296.9 Activities not permitted for joint ventures. The following activities are...
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UK manufacturers construction joint venture
Energy Technology Data Exchange (ETDEWEB)
NONE
1999-07-01
This report examines the legal and commercial framework for UK manufacturers to collaborate in a construction venture for a small combustion/steam cycle power plant fueled with biomass. The integration of technology and project plan, the working capital and capitalisation, financial aspects, the market plan, turnkey packages, joint venture entities, and collaboration are discussed. (UK)
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46 CFR 67.37 - Association or joint venture.
2010-10-01
... 46 Shipping 2 2010-10-01 2010-10-01 false Association or joint venture. 67.37 Section 67.37... DOCUMENTATION OF VESSELS Citizenship Requirements for Vessel Documentation § 67.37 Association or joint venture. (a) An association meets citizenship requirements if each of its members is a citizen. (b) A joint...
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International Nuclear Information System (INIS)
Blaha, M.
2008-01-01
In this chapter author reviewed the story of the EMO joint venture, joint-stock company, between Slovenske elektrarne, a. s. and EdF. EMO joint venture, joint-stock company, was established to complete the Mochovce nuclear power plant. EMO joint venture, joint-stock company was closed after one year of work. History of EMO joint venture, joint-stock company, was described by its former general manager Mr. Ladislav Loerinc.
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How to establish and sustain a joint venture in China.
Lee, Paul
2008-01-01
Joint ventures with Chinese companies provide one of the most effective ways for international companies to establish a foothold in the booming Chinese economy. The benefits, opportunities and challenges of establishing a joint venture are explored here. Current partnering trends and successful Sino-foreign joint ventures in the fast-growing medical device industry in China are also highlighted.
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U.S.-Soviet joint venture near final terms
International Nuclear Information System (INIS)
Anon.
1991-01-01
This paper reports that U.S. and Russian partners expect late this moth to register their second oil and gas joint venture in western Siberia. If plans proceed on schedule following registration, Golden Mammoth partners about June 1992 will begin drilling joint venture wells in the Bakhilovsk region
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The Cultural Context of Learning in International Joint Ventures.
Liu, Shimin; Vince, Russ
1999-01-01
A study of Chinese-Western joint business ventures showed that cultural context and different modes of managing and organizing must be considered. Successful joint ventures involve a process of collective, two-way learning. (SK)
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United States -- Mexican joint ventures: A case history approach
Energy Technology Data Exchange (ETDEWEB)
Moore, N.L.; Chidester, R.J.; Hughes, K.R.; Fowler, R.A.
1993-03-01
Because the Mexican government has encouraged investment in Mexico by increasing the percentage of ownership of a Mexican business that a US company can hold, joint ventures are more attractive now than they had been in the past. This study provides preliminary information for US renewable energy companies who are interested in forming a joint venture with a Mexican company. This report is not intended to be a complete reference but does identifies a number of important factors that should be observed when forming a Mexican joint venture: (1)Successful joint ventures achieve the goals of each partner. (2)It is essential that all parties agree to the allocation of responsibilities. (3)Put everything in writing. (4)Research in depth the country or countries in which you are considering doing business.
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15 CFR 295.23 - Dissolution of joint research and development ventures.
2010-01-01
... Development Ventures § 295.23 Dissolution of joint research and development ventures. Upon dissolution of any joint research and development venture receiving funds under these procedures or at a time otherwise... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Dissolution of joint research and...
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Infrastructure Joint Venture Projects in Malaysia: A Preliminary Study
Romeli, Norsyakilah; Muhamad Halil, Faridah; Ismail, Faridah; Sufian Hasim, Muhammad
2018-03-01
As many developed country practise, the function of the infrastructure is to connect the each region of Malaysia holistically and infrastructure is an investment network projects such as transportation water and sewerage, power, communication and irrigations system. Hence, a billions allocations of government income reserved for the sake of the infrastructure development. Towards a successful infrastructure development, a joint venture approach has been promotes by 2016 in one of the government thrust in Construction Industry Transformation Plan which encourage the internationalisation among contractors. However, there is depletion in information on the actual practise of the infrastructure joint venture projects in Malaysia. Therefore, this study attempt to explore the real application of the joint venture in Malaysian infrastructure projects. Using the questionnaire survey, a set of survey question distributed to the targeted respondents. The survey contained three section which the sections are respondent details, organizations background and project capital in infrastructure joint venture project. The results recorded and analyse using SPSS software. The contractors stated that they have implemented the joint venture practice with mostly the client with the usual construction period of the infrastructure project are more than 5 years. Other than that, the study indicates that there are problems in the joint venture project in the perspective of the project capital and the railway infrastructure should be given a highlights in future study due to its high significant in term of cost and technical issues.
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Infrastructure Joint Venture Projects in Malaysia: A Preliminary Study
Directory of Open Access Journals (Sweden)
Romeli Norsyakilah
2018-01-01
Full Text Available As many developed country practise, the function of the infrastructure is to connect the each region of Malaysia holistically and infrastructure is an investment network projects such as transportation water and sewerage, power, communication and irrigations system. Hence, a billions allocations of government income reserved for the sake of the infrastructure development. Towards a successful infrastructure development, a joint venture approach has been promotes by 2016 in one of the government thrust in Construction Industry Transformation Plan which encourage the internationalisation among contractors. However, there is depletion in information on the actual practise of the infrastructure joint venture projects in Malaysia. Therefore, this study attempt to explore the real application of the joint venture in Malaysian infrastructure projects. Using the questionnaire survey, a set of survey question distributed to the targeted respondents. The survey contained three section which the sections are respondent details, organizations background and project capital in infrastructure joint venture project. The results recorded and analyse using SPSS software. The contractors stated that they have implemented the joint venture practice with mostly the client with the usual construction period of the infrastructure project are more than 5 years. Other than that, the study indicates that there are problems in the joint venture project in the perspective of the project capital and the railway infrastructure should be given a highlights in future study due to its high significant in term of cost and technical issues.
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Clinic, hospital try to fulfill vision of coordinated care with joint venture company.
2000-09-01
Coordinated Care Services Inc., a joint venture of Carle Foundation and Carle Clinic Association in Urbana, IL, shares its initial successes and ongoing challenges after one year of operation. The biggest barrier to further improvements remains insufficient information management capability.
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Joint ventures between industry and government
International Nuclear Information System (INIS)
Vant, T.R.
1991-01-01
Joint venture projects undertaken between government and industry in western Canada are reviewed. The first significant involvement of the Alberta government was with the Syncrude oil sands project. In 1974, one of the original participants, Atlantic Richfield, pulled out of Syncrude for financial reasons. After a government review and search for replacement participation, three provincial governments took equity positions in the project. The Syncrude project has since had a very significant impact on Alberta and Canada in terms of oil production, employment, investment, and profits. The Other Six Leases Operation (OSLO), the OSLO New Ventures Project, and the Lloydminster Bi-Provincial Upgrader would also not have advanced to their present stages of development without government participation. Since oil sand/heavy oil development requires significant capital investment over long lead times, and since there are few private companies that can undertake such a commitment, government assistance is often required. It also makes sense for governments to share upfront risk in such projects for both the long-term economic gain and such immediate benefits as job creation and energy supply security. An industry/government joint venture provides a means of getting large, inherently economic projects such as oil sands developments under way while protecting taxpayers' interests. The success of such a joint venture depends not only on the financing brought to the project but also on the expertise, decision making capability, and balanced management of regulatory and policy issues
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Finishing touch to joint venture
2003-01-01
"A new process for polishing titanium and its alloys has been announced following an agreement between Bripol (an Anopol/Delmet joint venture) of Birmingham and the European Organisation for Nuclear Reseach (CERN) in Geneva" (1 paragraph).
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Gulf Canada's Russian joint venture
International Nuclear Information System (INIS)
Motyka, D.
1992-01-01
After three years of evaluating prospects and negotiating with government and industry representatives, Gulf Canada established its first joint venture in the Russian Federation with Komineft, a production association from the Komi autonomous republic. Komineft has a 50% share of the venture, and the rest is shared equally between Gulf and British Gas. The operating area is at the Vozey and Upper Vozey fields in the Timan-Pechora Basin, some 1,500 km northeast of Moscow just inside the Arctic Circle. An attractive feature of the Upper Vozey project is low development costs of ca $2/bbl. In the Vozey field, the venture will set up an enhanced oil recovery demonstration project to test techniques perfected in Alberta. About 60 Canadians are involved on the project, and headquarters are in Usinsk, ca 100 km south of the oil fields. In the first half of 1992, oil production in the first phase of the venture averaged around 10,000 bbl/d and continues to increase
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R & D joint ventures and tacit product market collusion
DEFF Research Database (Denmark)
Martin, Stephen
1996-01-01
It is shown that R & D joint ventures make it more likely that firms will be able to sustain tacit product-market collusion, all else equal......It is shown that R & D joint ventures make it more likely that firms will be able to sustain tacit product-market collusion, all else equal...
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Hoechst and Wacker plan joint venture in PVC
International Nuclear Information System (INIS)
Young, I.
1992-01-01
Restructuring of Europe's petrochemical industry has taken a further step with the announcement that Hoechst (Frankfurt) and Wacker Chemie (Munich) are planning a joint venture in polyvinyl chloride (PVC). The venture would include production, R ampersand D, sales and marketing, plus both companies' PVC recycling activities. However, their vinyl chloride monomer (VCM) plants, and Hoechst's Kalle PVC film business, have been left out. Erich Schnitzler, head of Hoechst's PVC business unit, does not anticipate problems with the European Community's competition directorate. We are both among the middle-sized European PVC producers, and together we would have a 9%-10% market share. Our joint venture would not limit competition. Both partners are hoping for approval from Brussels in first-quarter 1993. Hoechst has 255,000 m.t./year of PVC capacity at Gendorfand Knapsack, while Wacker has 365,000 m.t./year at Burghausen and Cologne. All the units, except Wacker's Cologne plant, are back integrated to VCM. The joint venture would buy VCM from the two parent companies and on the merchant market
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Joint Ventures: The Promise, Power and Performance of Partnering.
Francisco, Grace; Hannah, Kathryn Covier; Keller, Shelly G.; Waters, Joan; Wong, Patricia M. Y.
This document provides case studies that represent a sampling of successful public library joint ventures in California and other U.S. cities and counties. Chapter 1 defines what a partnership is and how a joint venture differs from a partnership. It also describes the benefits of partnering, the knowledge, attitude, and skills required, and how…
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24 CFR 943.151 - What procurement standards apply to a joint venture itself?
2010-04-01
... a joint venture itself? 943.151 Section 943.151 Housing and Urban Development Regulations Relating... HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT PUBLIC HOUSING AGENCY CONSORTIA AND JOINT VENTURES Subsidiaries, Affiliates, Joint Ventures in Public Housing § 943.151 What procurement standards apply to a...
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Duke University: Licensing and Real Estate Joint Ventures.
McDonald, Eugene J.
1984-01-01
Joint ventures undertaken by Duke University with industry are reported that illustrate the imaginative arrangements and economic and otherwise advantageous structures possible in co-ventures. They include patent and trademark licensing, travel agency commissions, a racquetball and health club, a hotel, and an office building. (MSE)
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Perestroika, Soviet oil, and joint ventures
International Nuclear Information System (INIS)
Churkin, M. Jr.
1991-01-01
Glaznost, the freedom of expression in both the public and private sectors of the Soviet Union, has rapidly transformed the country form a largely isolated and closed society to one that is rapidly becoming more cosmopolitan and open to the West. Now that the Soviet Union is moving toward a free-market economy, a number of new laws are being generated to create a favorable environment for Western investment, especially joint ventures. First, crude oil sales have provided over 75% of much-needed hard currency, and oil has been the principal barter for manufactured goods produced in eastern Europe. Second, joint oil ventures with Western companies can reverse declining production levels and provide sufficient stimulus to turn around the economic recession. The Soviet Union has a very large inventory of discovered but undeveloped oil and gas fields. Most of these fields are difficult for the Soviets to produce technically, financially, and environmentally safely, and they are actively seeking appropriate Western partners. From an exploration point of view, the Soviet Union has probably the largest number of undrilled and highly prospective oil basins, which may replenish declining reserves in the West. Finally, the Soviet Union represents in the long term a large unsaturated market eager to absorb the surplus of goods and services in the Western world. Again, joint oil ventures could provide the convertible currency to increase East-West trade
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JOINT VENTURE: STRATEGY TO OBTAINTHE MANAGERIAL COMPETITIVENESS IN PERU
Maguiña F., Raúl
2014-01-01
This article proposes a managerial competitiveness strategy using the Joint- Venture enterprise, rising out of alliances linking business units, by analizing its making-up process through legal and clear compromise requirements, framed within the peruvian law, and with the purpose of getting feasibility of various investment projects, in any production sector in our country. El artículo propone una estrategia de competitividad empresarial utilizando el joint venture, a partir de alianzas q...
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24 CFR 943.150 - What procurement standards apply to a PHA's joint venture partner?
2010-04-01
... a PHA's joint venture partner? 943.150 Section 943.150 Housing and Urban Development Regulations... HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT PUBLIC HOUSING AGENCY CONSORTIA AND JOINT VENTURES Subsidiaries, Affiliates, Joint Ventures in Public Housing § 943.150 What procurement standards apply to a PHA...
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Interdependency in joint ventures: The relationship between dependency asymmetry and performance
Kemp, R.G.M.; Ghauri, P.N.
2001-01-01
This paper reports the results of a survey on joint venture collaborations. It focuses on the relations between the level and intensity of conflict, trust and norms of exchange, and ultimately the performance of a joint venture, in case of dependency asymmetry between the partners. In management
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'Soft' human resource management in small international joint ventures
DEFF Research Database (Denmark)
Dao, Li
2012-01-01
This paper examines the value creation aspects of HRM in international joint ventures of a relatively small size and their implications for strategic management. We assume that HRM in this context is rather a process than a function, and a ‘soft’ – humanistic rather than a ‘hard’, instrumentalist...... of joint venture autonomy. A conceptual framework developed from these empirical insights invites further generalizing efforts, and more importantly, contributes to a dynamic understanding of HRM in small IJVs....
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Evolution of the uranium joint venture
International Nuclear Information System (INIS)
Bloomenthal, H.S.
1976-01-01
This paper concentrates on the economic realities of the joint venture in order to anticipate the basic problems that will be encountered so as to permit legislating by contrast how the problems are to be handled as between the parties
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MIT Experiments with Joint Venture Contract.
American School and University, 1981
1981-01-01
A new dormitory at Massachusetts Institute of Technology was constructed using a joint venture contract with safeguards and incentives that brought university, architect, and building contractor into a closer and more productive relationship than under conventional contract arrangements. (Author/MLF)
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JOINT VENTURE UM ARCABOUÇO TEÓRICO SOBRE A ESTRATÉGIA ENTRE EMPRESAS
Directory of Open Access Journals (Sweden)
Kelen Renata Knopp Barroca Souza
2015-03-01
Full Text Available The joint venture talk about union of two or more business with common goals forming another independent business with a different team for take care about your own concern, that may partner member's capital or not. The present work had as goal: analyse the reasons that are influencing many business to choose joint venture, your importance for them, and the obtained results. the methodology used was the multicases study of business that adopt join ventures from analysis of documents, files, and administrative publications, and also having secondary sources as bibliographic researches consulting articles and books about the history of the subject, adopting the deductive method for the conclusion of joint venture project. We conclude that joint ventures can be advantageous for business, decreasing risks, increasing profits , making business involved in the alliance earn more space on market.
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Health care joint ventures between tax-exempt organizations and for-profit entities.
Sanders, Michael I
2005-01-01
Health care exempt organizations have many options regarding their structure and affiliations with for-profit entities. As long as any joint ventures are carefully structured and the nonprofit retains control over the exempt health care activities, the Internal Revenue Service should not question the structure. However, as outlined above, if the for-profit entity effectively gains control over the activities of the venture, the structure is not likely to be upheld by the IRS or the courts, and either the exempt status of the nonprofit will be denied or revoked, or health care income will be subject to the unrelated business income tax. In summary, the health care industry has been severely impacted by many economic forces, including uncertainty in the area of joint ventures between nonprofits and for-profit health care systems. The uncertainty as to whether the joint venture would negatively impact the nonprofit's tax-exempt status undoubtedly caused many nonprofits to form for-profit subsidiaries and otherwise expanded operations in a for-profit marketplace. Fortunately, with the guidance that is currently available in the form of Revenue Ruling 98-15, Redlands, St. David's, and now Revenue Ruling 2004-51, health care institutions can move forward with properly structured joint ventures with greater confidence that the joint venture will not endanger the tax-exempt status of the nonprofit.
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Migratory Bird Joint Ventures of New Mexico
Earth Data Analysis Center, University of New Mexico — A joint venture is a self-directed partnership of agencies, organizations, corporations, tribes, or individuals that has formally accepted the responsibility of...
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24 CFR 943.148 - What procurement standards apply to PHAs selecting partners for a joint venture?
2010-04-01
... PHAs selecting partners for a joint venture? 943.148 Section 943.148 Housing and Urban Development... VENTURES Subsidiaries, Affiliates, Joint Ventures in Public Housing § 943.148 What procurement standards apply to PHAs selecting partners for a joint venture? (a) The requirements of part 85 of this title are...
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Trust in international joint venture relationships
Boersma, Margreet Francina; Ghauri, Pervez N.; Buckley, Peter J.
2004-01-01
International joint ventures (IJVs) are frequently stated to be increasingly popular but with significant managerial dissatisfaction in their operations (Madhok, 1995a). Therefore, a great deal of attention has been paid to the performance of IJVs (e.g. Contractor and Lorange, 1988; special issue of
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La joint venture contractual en el ámbito internacional
Directory of Open Access Journals (Sweden)
Ana Michavila Núñez
2014-06-01
Full Text Available La joint venture ha surgido en los negocios internacionales al margen de los marcos jurídicos establecidos. Sus rasgos característicos la definen como un acuerdo de cooperación para la realización de un negocio en común, en el que las partes realizan sus aportaciones, mantienen su autonomía y comparten el control sobre el negocio. La modalidad conocida como contractual o non-equity joint venture, habitualmente olvidada por la doctrina jurídica, participa de los mismos elementos y naturaleza que la equity o incorporated, si bien se distingue de ésta por los instrumentos utilizados por las partes para su implementación. Abarca todas aquellas joint ventures en las que las partes no eligen una corporation o una sociedad con personalidad jurídica para su instrumentación, sino cualquier otra forma jurídica prevista por un ordenamiento nacional o bien una diseñada a la medida por las partes en todos sus extremos. En cualquier caso, la voluntad de las partes debe plasmarse detalladamente en el acuerdo de base o contrato joint venture y, en su caso, en los contratos de aplicación o contratos satélites. Es preciso determinar en cada supuesto el régimen jurídico aplicable, puesto que no existe en la mayoría de los ordenamientos jurídicos una regulación de esta figura
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Russian joint ventures, upstream deals hit fast clip
International Nuclear Information System (INIS)
Anon.
1992-01-01
This paper reports that Russia is stepping up the pace of joint ventures and imports of petroleum technology and hardware. Among the latest action: Polar Lights, a 50-50 venture of Conoco Timan-Pechora Ltd. and Arkhangelskgeologia (AAG), started drilling in the first new-field oil-development project in Russia to include a US partner; The governments of Oman and the Kazakhstan republic signed an agreement covering oil and gas exploration, field development, and production in Kazakhstan; Phibro Energy Inc., Greenwich, Conn., last week reported the sale and delivery of the first full cargo of Russian crude oil produced and exported by a Russian-American joint venture; Era Aviation Inc., Anchorage, Alas., is sending two helicopters with crewmen to Russia to help assess the feasibility of oil and gas development off Sakhalin Island; In deals involving Canadian companies, SNC-Lavalin Inc., Montreal, received a contract for initial work on a $350 million (US) modernization of the Volvograd refinery in southern Russia
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Joint venture versus outreach: a financial analysis of case studies.
Forsman, R W
2001-01-01
Medical centers across the country are facing cost challenges, and national commercial laboratories are experiencing financial declines that necessitate their capturing market share in any way possible. Many laboratories are turning to joint ventures or partnerships for financial relief. However, it often is in the best interest of the patient and the medical center to integrate laboratory services across the continuum of care. This article analyzes two hypothetical joint ventures involving a laboratory management agreement and full laboratory outsourcing.
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TRANSFER OF MARKETING KNOWLEDGE IN THAI INTERNATIONAL JOINT VENTURE FIRMS
Directory of Open Access Journals (Sweden)
Osman Mohamad
2010-07-01
Full Text Available The focus of this study is the transfer of marketing knowledge within Thai joint venture firms. The perspectives of Thai managers were surveyed using a structured instrument. The analysis identifies seven dimensions of marketing management knowledge: promotion management, price management, logistics management, product innovation management, strategic marketing management, cross-cultural management, and target marketing management. The incidence of transfer is highest for activities in strategic marketing management, followed by price management. Transfer in product innovation management and target marketing management tends to vary with the age of the joint venture. Joint venture firms with foreign partners originating from Western, advanced, industrialised nations recorded the highest incidence of knowledge transfer occurring within product innovation management. This trend also holds true for the management of promotion activities. The incidence of transfer in target marketing management is lowest among firms with foreign partners from neighbouring nations. The incidence of knowledge transfer within product innovation and target marketing also tends to vary with the age of the joint venture. An analysis based on industry classification revealed that the transfer of knowledge regarding logistics management occurs most for firms in the manufacturing sector. In the service sector, the highest incidence of knowledge transfer within the areas of promotion management and target marketing management occurred in the agricultural sector.
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Individual learning effects on knowledge transfer in international joint ventures
DEFF Research Database (Denmark)
Dao, Li Thuy; Napier, Nancy
2016-01-01
This paper examines micro (individual-level) aspects of knowledge transfer and learning in international joint ventures in an emerging economy context. Learning by expatriate and local managers appears far more complex, mutually dependent, and significant to the knowledge transfer process than...... suggested in existing literature. Building upon conceptualizations of individual learning and cognitive – behavioural effects in an organisational context while drawing evidence from two cases of Danish – Vietnamese joint ventures, we propose a model of individual-level knowledge transfer and learning...
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Joint venture schemes in Limpopo Province and their outcomes on smallholder farmers livelihoods
Mapedza, Everisto; van Koppen, Barbara; Sithole, Pinimidzai; Bourblanc, Magalie
2016-04-01
Joint Venture schemes based on the floppy irrigation technology are being promoted in the post-Apartheid South Africa's Limpopo Province. Access to land and water resources in South Africa are largely viewed as a mechanism for re-dressing the Apartheid injustices. This research was part of a broader applied research to help inform irrigation practise in the Limpopo Province. The research used literature review, key informant interviews and a questionnaire survey. The overall research question sought to understand how the Joint Venture Schemes had benefited the smallholder farmers. This paper argues that the joint venture partnership created a new injustice. Firstly, the Joint Venture Scheme design is fundamentally a bad idea which disempower farmers not only to water access but also land as well. The choice of the 'efficient' floppy irrigation technology was made by the state and entailed that land had to be managed as a single unit. In order to make more effective use of this highly sophisticated new technology, the smallholder farmers also needed to go into a joint venture partnership with a white commercial farmer. By virtue of signing the Joint Venture agreement the farmers were also forfeiting their land and water rights to be used for crop production. The smallholder farmers lost access to their water and land resources and were largely relegated to sharing profits - when they exist - with hardly any skills development despite what was initially envisaged in the Joint Venture partnership. Secondly, the implementation of the JVS has been skewed from the start which explains the bad results. This paper further shows how the negative outcomes affected women in particular. As the smallholder farmers argue the technological options chosen by the state have excluded both male and female farmers from accessing and utilising their land and water resources in order to improve their livelihoods; it has entrenched the role of the state and the private interests at the
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Joint ventures are seen as a way to increase returns on under performing assets. How are they doing?
International Nuclear Information System (INIS)
Stanway, D.M.
1998-01-01
The challenges faced by the petroleum industry in establishing successful joint ventures are discussed. Good management practices are cited as one of the most important factors in ensuring the success of joint ventures. There are several reasons why companies pursue joint ventures. They often search for the competitive advantages that can arise from rationalization of operations and facilities, consolidation of management tasks and new opportunities for technological innovation. Joint ventures also allow companies to spread risk, get more capital and improve collective competencies. The importance for Canadian companies to make greater efforts at improving their international joint ventures, was emphasized. An 'alliance building capacity' to manage joint ventures was recommended. 18 refs., 3 figs
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Bird Habitat Conservation at Various Scales in the Atlantic Coast Joint Venture
Andrew Milliken; Craig Watson; Chuck Hayes
2005-01-01
The Atlantic Coast Joint Venture is a partnership focused on the conservation of habitats for migratory birds within the Atlantic Flyway/Atlantic Coast Region from Maine south to Puerto Rico. In order to be effective in planning and implementing conservation in this large and diverse area, the joint venture must work at multiple spatial scales, from the largest ?...
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Joint Venture Modes of Water Conservancy and Hydroelectric Engineering
Directory of Open Access Journals (Sweden)
Zhiding Chen
2013-07-01
Full Text Available With the long construction period, the giant scope and complex technology, water conservancy and hydroelectric engineering construction has large investment. In the fully competitive water conservancy and hydropower project construction contracting market, it is almost impossible for a company to contract with a water conservancy and hydropower project independently. Therefore, water conservancy and hydropower project construction can be contracted by several construction companies together, to play each company's strengths, lower offer, improve project quality, shorten the construction period and win the competition. In this paper, we started from the definition of Joint Venture, summed up the forms of Joint Venture in water conservancy and hydropower engineering, proposed that the JV modes can be divided into domestic and international union, tight mode, half-tight mode, loose mode, incorporation and consortium. Furthermore, we analyzed the advantages and disadvantages of Joint Venture. Put forward that the JV can relieve the owner from interfacial administrative work, reduce risk of engineering, and raise the success rate of engineering contract, improve the correctness of price and increase the opportunity of project contracting, Learn from other members, enhance technology and management and make full use of idle resources
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2010-04-01
... subsidiary, affiliate, or joint venture have on financial accountability to HUD and the Federal government... URBAN DEVELOPMENT PUBLIC HOUSING AGENCY CONSORTIA AND JOINT VENTURES Subsidiaries, Affiliates, Joint Ventures in Public Housing § 943.146 What impact does the use of a subsidiary, affiliate, or joint venture...
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Designing an International Joint Venture Negotiation Game.
Kenkel, Phil; And Others
1996-01-01
Evaluates a simulation game that models management problems encountered in negotiating and managing international joint ventures. Designed to instruct executives of state-owned agribusinesses in Indonesia in abstract concepts such as partner rapport, transfer price conflicts, and marketing disagreements, its success suggests that simulation games…
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R&D returns, market structure and research joint ventures
DEFF Research Database (Denmark)
Amir, Rabah
2000-01-01
(one firm endogenously exiting). Two research joint venture schemes and the noncooperative solution are compared. Due to built-in symmetry, a joint lab does not always lead to the best performance. Overall, our findings differ quite substantially from those based on strongly decreasing R&D returns...
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Soviet efforts to attract foreign E and P investment through joint ventures
International Nuclear Information System (INIS)
Gochenour, D.T.
1991-01-01
This paper reports that since 1987, Soviet efforts to attract Western E and P investment have been evolving through the framework provided by the 1987 Joint-Venture Law. While this law and dozen or so regular acts, decrees, and amendments have sought to stimulate interest, they have failed to address significant failings in the Soviet Union's institutional organization of the petroleum industry. While we anticipate that institutional authority will continue to devolve away from the All-Union central control in Moscow to the republican authorities, many obstacles to investors still have not been addressed by the joint-venture laws. Among these are the export regime, fiscal regime (which we expect will get stiffer), and the rules for joint-venture capitalization and valuation
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2010-01-01
... transfers between separately-owned joint venture members. 295.25 Section 295.25 Commerce and Foreign Trade...-Led Joint Research and Development Ventures § 295.25 Special rule for the valuation of transfers between separately-owned joint venture members. (a) Applicability. This section applies to transfers of...
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Combinations of partners’ joint venture formation motives
Klijn, E.; Reuer, J.J.; Buckley, P.J.; Glaister, K.W.
2011-01-01
Purpose – Prior research on joint venture (JV) formation often examines a single focal firm and assumes it has a single motive for collaboration. This study seeks to investigate how formation motives of partner firms are symmetrically coupled. It considers motives in the context of different
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El Control y la Confianza: dos rivales en las "International Joint Ventures"
Directory of Open Access Journals (Sweden)
Francisco Puig Blanco
2013-02-01
Full Text Available Las empresas conjuntas internacionales(International Joint Ventures se caracterizan pordos factores íntimamente relacionados: el control y eloportunismo. En este trabajo, trataremos de analizarla relación entre ambos factores y estudiaremos quétipos de control ayudarían a prevenir o a reducirel oportunismo en este tipo de empresas. Además,trataremos de identificar las ventajas e inconvenientesasociados al control y analizaremos el caso de unaInternational Joint Venture formada por dos empresas,una española y la otra americana, cuyo fracaso se debió,en gran parte, a la ausencia de control (confianza y aloportunismo. ABSTRACT International Joint Ventures are distinguished bytwo closely related factors: control and opportunism.In this paper we will try to analyze the relationshipbetween both factors and we will study what controlswould help prevent or reduce opportunism in thisclass of enterprises. Besides, we will attempt to identifythe advantages and inconveniences associated withcontrol, and analyze one case of an International JointVenture comprised by two companies, a Spanish and anAmerican one whose failure was largely due to lack ofcontrol (trust and opportunism.
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H.G. Barkema (Harry); G.A.M. Vermeulen (Freek)
1997-01-01
textabstractAn international joint venture implies that a firm has to cooperate with a partner with a different cultural background. In this study, hypotheses about which differences in national culture are most disruptive for international joint ventures were developed and tested using Hofstede's
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Application of Delphi expert panel in joint venture projects
Adnan, H.; Rosman, M. R.; Rashid, Z. Z. Ahmad; Mohamad Yusuwan, N.; Bakhary, N. A.
2018-02-01
This study was conducted with the aim to identify the application of the Delphi Technique in validating findings obtained from questionnaire surveys and interviews done in- depth on the subject of joint venture projects in Malaysia. The Delphi technique aims to achieve a consensus of opinion amongst expert panellist that were selected on the primary factors in JV projects. To achieve research objectives, a progressive series of questions was designed where a selected panel of expert to confirm and validate the final findings. The rationale, benefits, limitations and recommendations for the use of Delphi were given in this study. From the literature review done, twenty-one factors were identified as critical factors to the making any joint venture project successful. Detail information from contractors were obtained by using the questionnaire survey method and forty-three in-depth interviews were carried out. Trust between partners, mutual understanding, partner selection criteria, agreement of contract, objective compatibility, conflict, and commitment were confirmed by the Delphi panel to be the critical success factors besides another fourteen factors which were found to be the Failure Reduction Criteria. Delphi techniques has proven to successfully assist in recognising the main factors and would be beneficial in supplementing the success of joint venture arrangements application for construction projects in Malaysia.
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The steps to forming a joint venture IPP in Poland
Energy Technology Data Exchange (ETDEWEB)
Allen, Z.; Colligan, M.J.
1998-07-01
Poland represents the largest market in Central Europe with 38 million people and an installed electrical generating capacity of about 32 gigawatts. Since 1989, when the process of governmental restructuring along free market principals began, the allure to IPP developers has been evident, but is of yet unrealized. The natural model for IPP development in Poland would seem to be joint ventures with Polish generating companies. These enterprises already have sites, franchises, and a going business to contribute to a joint company. There are a number of reasons why so few deals have been concluded in Poland to date, and a number of barriers still exist that tend to hamper the realization of project finance funded power joint ventures. But, these barriers are not insurmountable. Overcoming them in the context of a joint venture relationship with a domestic partner requires patience, work, and an ability to bridge the gaps between the realities of working in a post-Communist environment and the practicalities of structuring projects that can be financed in the international capital markets. The new Energy Law in Poland establishes a framework for a viable private sector power generation business. But the enabling regulations are yet to be published or approved. There is still effective political risk on account of the uncertainty this creates. Pressure is mounting on the Polish Government, especially due to its expressed interest in joining the EU, to get the power sector to operate on private sector terms, if not in private hands. The trends are pointing in the direction of increased market driven policies and practices. The conclusion is that, despite the delays of the past, independent power projects will start to happen in Poland on a joint venture basis, with increasing frequency in the next years.
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2010-04-01
... of a subsidiary, affiliate, or joint venture have on a PHA? 943.144 Section 943.144 Housing and Urban... CONSORTIA AND JOINT VENTURES Subsidiaries, Affiliates, Joint Ventures in Public Housing § 943.144 What financial impact do operations of a subsidiary, affiliate, or joint venture have on a PHA? Income generated...
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2010-01-01
... connection with the formation of certain joint ventures or other corporations. 802.42 Section 802.42... acquisitions in connection with the formation of certain joint ventures or other corporations. (a) Whenever one or more of the contributors in the formation of a joint venture or other corporation which otherwise...
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Joint ventures and concentrations in oil market
International Nuclear Information System (INIS)
Tabarelli, D.
1996-01-01
Many are the joint ventures taken during last year by the oil companies as a move towards the ever existing rules of the oil market: integration, economies of scale and reduction of competitive market uncertainty. This article discusses some of the most interesting points of the recent events and the initiatives in the Italian market
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Managing international joint venture relationships - A longitudinal perspective
Hyder, A.; Ghauri, P.N.
The purpose of the study is to describe and analyse the formation and development of international joint venture processes and relationships between the partners over time. Moreover, the study analyzes how far foreign partners have been successful in developing new contacts and in expanding their
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Cooperation and conflict in international joint venture relationship
Kemp, Ron
1999-01-01
This article reports the results of an empirical study focusing on the relationship between the relative dependence asymmetry of partners in a joint venture, the level and intensity of conflict between the partners, the level of trust and norms of exchange between the partners, and the performance
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Working Partnerships: A Joint Venture in Vocational Education.
Campbell, Clifton P.
Joint Ventures in Vocational Education projects link participating businesses with secondary vocational programs in a cooperative relationship. These are voluntary arrangements between vocational programs and a public or private sector agency that combine the energies and resources of the partners to enrich various aspects of the vocational…
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2010-04-16
... Production Act of 1993 Joint Venture Under Tip Award Number: 7ONANB1OHOO1 Notice is hereby given that, on..., 15 U.S.C. 4301 et seq. (``the Act''), the Joint Venture under TIP Award Number: 7ONANB1OHOO1... Trade Commission disclosing (1) the identities of the parties to the venture and (2) the nature and...
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2010-03-24
... Production Act of 1993--Joint Venture Under Tip Award No. 70NANB10H014 To Perform Project Entitled: Automated..., 15 U.S.C. 4301 et seq. (the Act''), the Joint Venture under TIP Award No. 70NANB10H014 to Perform... Commission disclosing (1) the identities of the parties to the venture and (2) the nature and objectives of...
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2010-02-22
... Production Act of 1993--Joint Venture Under TIP Award Number: 70NANB10H012 Notice is hereby given that, on..., 15 U.S.C. 5 4301 et seq. (``the Act''), the Joint Venture under TIP Award Number: 70NANB10H012... Commission disclosing (1) the identities of the parties to the venture and (2) the nature and objectives of...
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2010-02-23
... Production Act of 1993--Joint Venture Under Tip Award No. 70NANB10H009 Notice is hereby given that, on..., 15 U.S.C. 4301 et seq. (``the Act''), the Joint Venture under TIP Award No. 70NANB10H009 (``JV TIP... Commission disclosing (1) the identities of the parties to the venture and (2) the nature and objectives of...
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Cultural Distance and the Performance of International Joint Ventures
DEFF Research Database (Denmark)
Christoffersen, Jeppe; Globerman, Steven; Nielsen, Bo Bernhard
2013-01-01
This study provides a critical summary and assessment of the empirical literature on the relationship between cultural distance and the performance of international joint ventures (IJVs) based on studies published over the period 1993-2008. The existing literature reports inconsistent and largely...
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2010-05-07
... Production Act of 1993--Joint Venture To Perform Project Entitled Versatile Onboard Traffic Embedded Roaming... Cooperative Research and Production Act of 1993, 15 U.S.C. 4301 et seq. (``the Act''), Joint Venture to..., Trilion Quality Systems, Plymouth Meeting, PA, has been added as a party to this venture. Also, Witten...
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International Nuclear Information System (INIS)
Raineri, Ricardo; Contreras, Gonzalo
2010-01-01
We develop a model for a power market with the characteristics of the Chilean power supply industry, which is an integrated system with a system operator (SO) with a vast authority to define the dispatch of the system. We evaluate whether a large joint power generator project made up by the two largest power generators is an anti-competitive project. Considering four investment technologies for power generation, namely, hydro, coal, diesel, and an advantageous hydro technology which can only be built in a large scale (HidroAysen) for the joint venture case, we use an oligopolistic Cournot model and a Benevolent Social Planner, both calibrated to the Chilean power industry, in order to assess the efficiency of alternative investment strategies and conditions whether the HidroAysen joint venture project can be barred to be judged as anti-competitive. Results suggest that the joint venture is an efficient investment and there is a pro-competitive behaviour on the part of the two power generators, and that there are benefit to consumers, who should expect non-increasing energy prices as a result of the advantageous hydrotechnology.
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Joint ventures e a política antitruste brasileira
Directory of Open Access Journals (Sweden)
Ana Paula Avellar
2012-12-01
Full Text Available As políticas de defesa da concorrência integram atualmente o conjunto fundamental de instituições necessárias à promoção do crescimento e a busca das sociedades por arranjos mais eficientes. O presente trabalho tem como objetivo realizar uma análise da política antitruste brasileira concentrando-se no tratamento dado pelas autoridades à constituição de joint ventures. Na realização dessa tarefa, foram feitas revisões teóricas, constatações acerca dos procedimentos de autoridades internacionais sobre o assunto e um estudo empírico abordando casos julgados no Brasil entre os anos de 2002 e 2010. O resultado encontrado revela a inexistência de normatização específica para o tratamento das joint ventures no Brasil, culminando, assim, em uma relativa discricionariedade por parte dos órgãos do SBDC na análise desses atos.
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BP/Mobil. Joint-venture directions for use
International Nuclear Information System (INIS)
Anon.
1997-01-01
This paper analyzes the economical reasons which have led BP and Mobil companies to join their forces in 1996. Thanks to their complementarity and to their European implantation, the two companies could win the first or second position in petroleum products marketing in 8 European countries. The cumulated petrol sales and the number of petrol stations of the BP/Mobil joint venture are the highest in Europe (800 petrol stations in France). (J.S.)
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2010-05-21
... Manufacturing, Inc., Formerly a Joint Venture of General Motors Corporation, and Toyota Motor Corporation, Including On- Site Leased Workers From Corestaff, ABM Janitorial, and Toyota Engineering and Manufacturing... joint venture of General Motors Corporation and Toyota Motor Corporation, including on-site leased...
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2010-10-08
... Manufacturing, Inc. Formerly a Joint Venture of General Motors Corporation and Toyota Motor Corporation Including On- Site Leased Workers From Corestaff, ABM Janitorial, Toyota Engineering and Manufacturing North... Manufacturing, Inc., formerly a joint venture of General Motors Corporation and Toyota Motor Corporation...
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2011-02-24
... Manufacturing, Inc., Formerly a Joint Venture of General Motors Corporation and Toyota Motor Corporation, Including On- Site Leased Workers From Corestaff, ABM Janitorial, Toyota Engineering and Manufacturing North... Motor Manufacturing, Inc., formerly a joint venture of General Motors Corporation and Toyota Motor...
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Les Joints-Venture Internationales dans La Construction Europeénne
DEFF Research Database (Denmark)
Bonke, Sten; Campacnac, Elisabeth; Stanghellini, Stefano
This text presents a condensed, yet comprehensive review of the methodology and interim findings of a large international comparative study. Construction joint-ventures in five European countries have been investigated with the aim of identifying preconditions to and consequenses...
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Analysis of Cooperative Education as a Work/Education Joint Venture.
Wilson, James W.
1984-01-01
Examines why joint ventures are formed and discusses a number of factors related to the success of such interaction. Focus is on four factors: goal compatibility, boundary-spanning structures and processes, locus of need satisfaction, and organizational incentives. (CT)
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2010-05-12
... Manufacturing, Inc., Formerly a Joint Venture of General Motors Corporation and Toyota Motor Corporation... United Motor Manufacturing, Inc., formerly a joint venture of General Motors Corporation and Toyota Motor... reviewed the certification for workers of the subject firm. The workers assemble the Toyota Corolla and the...
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Colorado River Sewer System Joint Venture to Upgrade Wastewater System
SAN FRANCISCO -Today, the Colorado River Sewer System Joint Venture, located in Parker, Ariz. entered into an agreement with the EPA to upgrade their wastewater treatment system to meet stringent water quality standards. The cost of the upgrade is ap
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Endangered Species and North American Waterfowl Management Plan Joint Venture Areas
National Research Council Canada - National Science Library
Allred, Karla
1996-01-01
...) Endangered Species Recovery Plans that meet the recovery plan requirements; and the percent of Corps acreage included within North American Waterfowl Management Joint Venture Implementation Plans where proposed work has been accomplished...
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Coherence between harvest and habitat management -- Joint venture perspectives
Baxter, C.K.; Nelson, J.W.; Reinecke, K.J.; Stephens, S.E.
2006-01-01
Introduction: In recent months, an ad hoc group of waterfowl scientists, representing the International Association of Fish and Wildlife Agencies (IAFWA) Adaptive Harvest Management (ARM) Task Force and the North American Waterfowl Management Plan (NAWMP) Committee, have collaborated as a Joint Task Group (JTG) to assess options for unifying the population goals guiding waterfowl harvest management and habitat management. The JTG has been charged with bringing coherence to the population goals of the two programs. Characterizing the problem as one of coherence indicates value judgments exist regarding its significance or perhaps existence. For purposes of this paper, we characterize the lack of coherence as the absence of consistent population goals in the two related components of waterfowl conservation habitat and harvest management. Our purpose is to support continued dialogue on the respective goals of these programs and the possible implications of discordant goals to habitat joint ventures. Our objectives are two-fold: (1) illustrate how NAWMP habitat management goals and strategies have been interpreted and pursued in both breeding and wintering areas, and (2) provide perspectives on the linkages between regional habitat management programs and harvest management. The Lower Mississippi Valley and the Prairie Pothole joint ventures (LMVJV and PPJV, respectively) will be used as examples.
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Structuring oil and gas joint ventures with aboriginal communities: conference papers conference
International Nuclear Information System (INIS)
1999-01-01
The Insight Conference featured twelve articles on the following topics: 1 - researching and understanding your legal partners; II - an aboriginal game plan - a plan for success; III - legal and management issues relating to aboriginal ventures; IV - tax status of reserve-based aboriginal people and businesses under the Indian Act; v - first nations as exempt bodies under the Income Tax Act; V I - innovative options for structuring oil and gas leases and exploration permits on aboriginal lands; VII - joint venture and partnership arrangements; V III - the impact of taxation on aboriginal ventures; I X - bankruptcy and insolvency issues for on-reserve businesses; X - financing options for oil and gas ventures with first nations; XI - Syncrude's commitment to aboriginal development; and X II - structuring oil and gas ventures with aboriginal communities. Articles abstracted/indexed separately include: I, II, V I (2), V III, X, XI, and X II
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Directory of Open Access Journals (Sweden)
Andrea Ruiz Restrepo,
2009-06-01
Full Text Available Although equity-based arrangements, particularly Joint Ventures, are more effective than the contractual ones when trying to have access to knowledge needed for innovation, research on the factors on how to successfully achieve the development and implementation of this strategy is scarce and scattered. From the Upper Echelon Theory, the objective of this work is to develop a review and integration of the literature about shared control Joint Ventures, top management teams and innovation and to propose a framework of relationships. The role and implications of the top management team in carrying out a Joint Venture created to innovate is analyzed in this article, having as a conclusion that the diversity of the TMT (top management team can positively or negatively influence the results of such innovation. The directive nature of their work in relation to the parent companies may hinder the achievement of the objectives for which they were created. Other factors that may help correct the negative implications about innovation, created by the team composition and the characteristics of their work, are also considered.Aunque los acuerdos basados en capital, especialmente las Joint Ventures, son más efectivos que los contractuales a la hora de acceder al conocimiento necesario para la innovación, la investigación sobre los factores favorables al éxito en el desarrollo y consecución de esta estrategia es escasa y dispersa. A partir de la Upper Echelon Theory, el objetivo de este trabajo es desarrollar una revisión e integración de las literaturas sobre Joint Ventures de control compartido, equipos de alta dirección e innovación y proponer un marco de relaciones. Se analiza el papel y las implicaciones del equipo de alta dirección en el desempeño de una Joint Venture creada para innovar. Se concluye que la diversidad de los EAD puede incidir positiva o negativamente en los resultados de tal innovación. Las características de su labor
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Directory of Open Access Journals (Sweden)
Ru Liang
2018-01-01
Full Text Available The magnitude of business dynamics has increased rapidly due to increased complexity, uncertainty, and risk of large-scale infrastructure projects. This fact made it increasingly tough to “go alone” into a contractor. As a consequence, joint venture contractors with diverse strengths and weaknesses cooperatively bid for bidding. Understanding project complexity and making decision on the optimal joint venture contractor is challenging. This paper is to study how to select joint venture contractors for undertaking large-scale infrastructure projects based on a multiattribute mathematical model. Two different methods are developed to solve the problem. One is based on ideal points and the other one is based on balanced ideal advantages. Both of the two methods consider individual difference in expert judgment and contractor attributes. A case study of Hong Kong-Zhuhai-Macao-Bridge (HZMB project in China is used to demonstrate how to apply these two methods and their advantages.
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Ozturgut, Osman
2008-01-01
This qualitative study explored the political, economic, socio-cultural, and educational challenges of administering a Sino-U.S. joint-venture campus in the People's Republic of China. China American University (CAU) is an educational joint venture between China Investment Company (CIC) and American University (AU) in the U.S. that resulted in…
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Joint Venture Manufacturing in China : an Exploratory Investigation
Zhang, Lihong; Goffin, Keith
1999-01-01
International joint venture (IJV) manufacturing is important for both the Chinese economy and a large number of foreign investors. A review of the literature from both Western and Chinese researchers showed that although the purpose and advantages of IJV manufacturing in China are known, a vital aspect – operations management – has largely been ignored. Therefore, exploratory interviews with managers at six companies were conducted to investigate the operations management is...
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Chen, Antonia F; Pflug, Emily; O'Brien, Daniel; Maltenfort, Mitchell G; Parvizi, Javad
2017-07-01
The recent emergence of physician-owned specialty hospitals has sparked controversy about overutilization. Thus, the purpose of this study was to compare utilization patterns of total joint arthroplasty (TJA) between physician-specialty hospitals (PSHs) and acute care hospitals (ACHs). A retrospective study was conducted from January 2010 to August 2014 comparing primary TJA patients between a PSH and an ACH; 103 PSH patients were matched to 103 ACH patients by age, gender, BMI, and ASA classification with similar case distribution between facilities. All surgeons in the study operated at both hospitals and were shareholders of the PSH. Information on nonoperative treatments, and timing to the initial appointment, consent, and surgery were analyzed using univariate analysis. Nonoperative treatments before surgery were similar between hospitals (P = 1.00). The time from the initial appointment to consent was longer for PSH (P = .0001). However, the time from consent to the date of surgery (P = .04) and the timing from symptoms to initial appointment (P = .006) was shorter for PSH. The time from initial appointment to the day of surgery was similar between groups (P = .20). Patients were more likely to be consented for surgery on their first clinic visit when undergoing surgery at ACH (87 of 103, 84.4%) compared to PSH (61 of 103; 59.2%; P total knee arthroplasty (P = .001) and total hip arthroplasty patients (P = .001) at PSH. Facility ownership in PSH resulted in similar conservative treatment before TJA. The time to surgical consent after the initial appointment was longer PSH, whereas the time from consent to the date of surgery was shorter at the PSH. Copyright © 2017 Elsevier Inc. All rights reserved.
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10 CFR 1021.216 - Procurement, financial assistance, and joint ventures.
2010-01-01
... competitive solicitations, unless the action is categorically excluded from preparation of an EA or EIS under...-source joint ventures, unless the action is categorically excluded from preparation of an EA or EIS under... reasoned decision. (g) The environmental critique will focus on environmental issues that are pertinent to...
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Dao, Li
2012-01-01
This paper examines the value creation aspects of HRM in international joint ventures of a relatively small size and their implications for strategic management. We assume that HRM in this context is rather a process than a function, and a ‘soft’ – humanistic rather than a ‘hard’, instrumentalist managerial approach. Using cases from a modest sample of Danish – Vietnamese joint ventures, we propose that HRM is significantly associated with creating a healthy and adaptive environment for mutua...
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Joint Venture Arrangement for RN to BSN: A Model of Synergy between Academia and Service.
Bargagliotti, L. Antoinette; And Others
1991-01-01
Joint venture among educational and practice institutions is well on its way toward becoming the norm in nursing education and practice. Kaiser Permanente and the University of San Francisco School of Nursing offer a venture that allows registered nurses to pursue a bachelor of science in nursing degree. (JOW)
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Launching a world-class joint venture.
Bamford, James; Ernst, David; Fubini, David G
2004-02-01
More than 5,000 joint ventures, and many more contractual alliances, have been launched worldwide in the past five years. Companies are realizing that JVs and alliances can be lucrative vehicles for developing new products, moving into new markets, and increasing revenues. The problem is, the success rate for JVs and alliances is on a par with that for mergers and acquisitions--which is to say not very good. The authors, all McKinsey consultants, argue that JV success remains elusive for most companies because they don't pay enough attention to launch planning and execution. Most companies are highly disciplined about integrating the companies they target through M&A, but they rarely commit sufficient resources to launching similarly sized joint ventures or alliances. As a result, the parent companies experience strategic conflicts, governance gridlock, and missed operational synergies. Often, they walk away from the deal. The launch phase begins with the parent companies' signing of a memorandum of understanding and continues through the first 100 days of the JV or alliance's operation. During this period, it's critical for the parents to convene a team dedicated to exposing inherent tensions early. Specifically, the launch team must tackle four basic challenges. First, build and maintain strategic alignment across the separate corporate entities, each of which has its own goals, market pressures, and shareholders. Second, create a shared governance system for the two parent companies. Third, manage the economic interdependencies between the corporate parents and the JV. And fourth, build a cohesive, high-performing organization (the JV or alliance)--not a simple task, since most managers come from, will want to return to, and may even hold simultaneous positions in the parent companies. Using real-world examples, the authors offer their suggestions for meeting these challenges.
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Preparing for Organisational Learning by HK Infrastructure Project Joint Ventures Organizations.
Walker, Derek H. T.; Johannes, Derick S.
2003-01-01
Interviews with nine Hong Kong managers involved in joint ventures with other organizations focused on the organizational learning aspects of collaboration: attitudes toward interorganizational learning, acquisition of knowledge assets, and learning motivation. An important motivation for developing alliances was to learn from each other, fill…
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Curricular Joint Ventures: A New Chapter in US Cross-Border Education?
Eckel, Peter D.; Green, Madeleine F.; Affolter-Caine, Britany
2004-01-01
For universities in industrialized nations such as the United States, globalization poses relatively little threat and offers many benefits. This article identifies and describes one trend emerging from globalization--how American colleges and universities are leveraging their curricula internationally through joint ventures between universities…
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Directory of Open Access Journals (Sweden)
Mohammad Khasro Miah
2017-05-01
Full Text Available The purpose of this research is to examine the conditions of home and host country culture as well as country of origin effect of HRM practices and its result on organizational performance (OP. The empirical findings showed that Japanese and U.S subsidiaries and joint ventures adapt localization practices with their modifying home host technique with the local business environment. The findings recommend that managers in the US and Japanese subsidiaries and joint ventures in Bangladesh are more strongly influenced by its host country’s national culture (as an adoptive host country national and corporate culture. Finally, it can be stated that foreign subsidiaries and joint ventures are trying to achieve the location advantage to create a particular type of HRM practices, with a combined and confined HRM practice that can fit for better organizational performance.
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Lack of production sharing laws slows joint ventures in Russia
International Nuclear Information System (INIS)
Knott, D.
1995-01-01
When Russia opened its doors to foreign oil companies in 1990, there was a rush to secure a piece of the country's potentially vast oil wealth. Since then, many of the ventures between Russian and non-Russian partners have become bogged down with operational problems and an ever changing tax and legal regime. There is a stockpile of massive developments building, while government grinds with seeming reluctance toward passing laws that will allow outside firms to do big business. For major development projects the main stumbling block is the lack of production sharing contract legislation. The paper describes the problems, the current legislation, and operating problems, then highlights several joint ventures that have been successful and several that have ended in pullouts of the foreign investor
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Stereosat: A proposed private sector/government joint venture in remote sensing from space
Anglin, R. L.
1980-01-01
Stereosat, a free flying Sun synchronous satellite whose purpose is to obtain worldwide cloud-free stereoscopic images of the Earth's land masses, is proposed as a joint private sector/government venture. A number of potential organization models are identified. The legal, economic, and institutional issues which could impact the continuum of potential joint private sector/government institutional structures are examined.
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Affiliation, joint venture or PSO? Case studies show why provider strategies differ.
1998-03-01
Joint venture, affiliation or PSO? Here are three case studies of providers who chose different paths under Medicare risk, plus some key questions you'll want to ask of your own provider organization. Learn from these examples so you'll make the best contracting decisions.
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Directory of Open Access Journals (Sweden)
Subiakto Soekarno
2012-01-01
Full Text Available Insurance industry stands as a service business that plays a significant role in Indonesiaeconomical condition. The development of insurance industry in Indonesia, both of generalinsurance and life insurance, has increased very fast. The general insurance industry itselfdivided into two major players which are local private company and Joint Venture Company.Lately, the use of statistical techniques and financial ratios models to asses financial institutionsuch as insurance company have been used as one of the appropriate combination inpredicting the performance of an industry. This research aims to distinguish between JointVenture General Insurance Companies that have a good performance and those who are lessperforming well using Discriminant Analysis. Further, the findings led that DiscriminantAnalysis is able to distinguish Joint Venture General Insurance Companies that have a goodperformance and those who are not performing well. There are also six ratios which are RBC,Technical Reserve to Investment Ratio, Debt Ratio, Return on Equity, Loss Ratio, and ExpenseRatio that stand as the most influential ratios to distinguish the performance of joint venturegeneral insurance companies. In addition, the result suggest business people to be concernedtoward those six ratios, to increase their companies’ performance.Key words: general insurance, financial ratio, discriminant analysis
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Provider-sponsored HMOs: make, buy, or joint venture?
Clay, S B
1997-03-01
Providers can sponsor their own HMOs in one of three ways: by creating their own HMO, by joint venturing with an existing HMO, or by purchasing an existing HMO. When selecting the best option, providers must consider various market conditions. Managed care penetration in the area, potential competitive responses of existing HMOs, market demand, provider reputation, and provider marketing ability will all influence the feasibility of each option. Providers also must examine their own organizational identity, their ability to raise the necessary capital to start an HMO, their managed care expertise and risk contracting experience, and their information systems capabilities.
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Long-Run Effects of Public-Private Research Joint Ventures:
DEFF Research Database (Denmark)
Kaiser, Ulrich; Kuhn, Johan Moritz
Subsidized research joint ventures (RJVs) between public research institutions and industry have become increasingly popular in Europe and the US. We study the long-run effects of such a support scheme that has been maintained by the Danish government since 1995. To cope with identification...... problems we apply nearest neighbor caliper matching and conditional difference-in-difference estimation methods. Our main findings are that (i) program participation effects are instant for annual patent applications and last for three years, (ii) employment effects materialize first after one year...
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Working abroad, working with others: How firms learn to operate international joint ventures
H.G. Barkema (Harry); O. Shenkar (Oded); G.A.M. Vermeulen (Freek); J.H.J. Bell (John)
1997-01-01
textabstractSuccessful international joint ventures entail both learning to operate across national boundaries and learning to cooperate. Hypotheses grounded in organizational learning theory were tested with event-history analysis and data on 1,493 expansions of 25 large Dutch firms between 1966
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ASPECTS CONCERNING THE JOINT VENTURE UNDER THE REGULATION OF THE NEW CIVIL CODE
Directory of Open Access Journals (Sweden)
Ana-Maria Lupulescu
2013-11-01
Full Text Available The New Civil Code makes the transition, for the first time in the Romanian legal system, from the duality to the unity of private law. Consequently, the Civil Code contains a legal regulation more structured and comprehensive, although not entirely safe from any criticism, in relation to the company, with particular reference to the simple company, regulation that expressly characterizes itself as the common law in this field. Within these general provisions, the legislator has considered the joint venture, to which, however, as in the previous regulation contained in the old Commercial Code – now repealed –, it does not devote too many legal provisions, in order to maintain the flexibility of this form of company. Therefore, this approach appears particularly useful for analysts in law and, especially, for practitioners, since it aims to achieve a comprehensive analysis of the joint venture, form of company with practical incidence.
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Getting Financed : 9 Tips for Community Joint Ventures in Tourism
World Bank Group; World Wildlife Fund
2014-01-01
Like many organizations working in the tourism sector, the authors believe that private sector investment is one of the key drivers of development. Over the past few years, the private sector has been a central innovator in forging business partnerships with local communities for tourism purposes around the world. Having demonstrated some extraordinary development results, joint ventures increasingly need to demonstrate their commercial viability over the long term. Moving out of the donor an...
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The increased risk of joint venture promotes social cooperation.
Directory of Open Access Journals (Sweden)
Te Wu
Full Text Available The joint venture of many members is common both in animal world and human society. In these public enterprizes, highly cooperative groups are more likely to while low cooperative groups are still possible but not probable to succeed. Existent literature mostly focuses on the traditional public goods game, in which cooperators create public wealth unconditionally and benefit all group members unbiasedly. We here institute a model addressing this public goods dilemma with incorporating the public resource foraging failure risk. Risk-averse individuals tend to lead a autarkic life, while risk-preferential ones tend to participate in the risky public goods game. For participants, group's success relies on its cooperativeness, with increasing contribution leading to increasing success likelihood. We introduce a function with one tunable parameter to describe the risk removal pattern and study in detail three representative classes. Analytical results show that the widely replicated population dynamics of cyclical dominance of loner, cooperator and defector disappear, while most of the time loners act as savors while eventually they also disappear. Depending on the way that group's success relies on its cooperativeness, either cooperators pervade the entire population or they coexist with defectors. Even in the later case, cooperators still hold salient superiority in number as some defectors also survive by parasitizing. The harder the joint venture succeeds, the higher level of cooperation once cooperators can win the evolutionary race. Our work may enrich the literature concerning the risky public goods games.
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The increased risk of joint venture promotes social cooperation.
Wu, Te; Fu, Feng; Zhang, Yanling; Wang, Long
2013-01-01
The joint venture of many members is common both in animal world and human society. In these public enterprizes, highly cooperative groups are more likely to while low cooperative groups are still possible but not probable to succeed. Existent literature mostly focuses on the traditional public goods game, in which cooperators create public wealth unconditionally and benefit all group members unbiasedly. We here institute a model addressing this public goods dilemma with incorporating the public resource foraging failure risk. Risk-averse individuals tend to lead a autarkic life, while risk-preferential ones tend to participate in the risky public goods game. For participants, group's success relies on its cooperativeness, with increasing contribution leading to increasing success likelihood. We introduce a function with one tunable parameter to describe the risk removal pattern and study in detail three representative classes. Analytical results show that the widely replicated population dynamics of cyclical dominance of loner, cooperator and defector disappear, while most of the time loners act as savors while eventually they also disappear. Depending on the way that group's success relies on its cooperativeness, either cooperators pervade the entire population or they coexist with defectors. Even in the later case, cooperators still hold salient superiority in number as some defectors also survive by parasitizing. The harder the joint venture succeeds, the higher level of cooperation once cooperators can win the evolutionary race. Our work may enrich the literature concerning the risky public goods games.
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Directory of Open Access Journals (Sweden)
Glenn Baxter
2018-03-01
Full Text Available This paper presents a case study of the DHL Express and Lufthansa Cargo strategic joint venture cargo airline ‘AeroLogic’, the global air cargo industry’s largest operative joint venture between an airline and a leading international express and logistics provider. The study used a qualitative research approach. The data gathered for the study was examined by document analysis. The strategic analysis of the AeroLogic joint venture was based on the use of Porter’s Five Forces framework. The study found that the AeroLogic joint venture airline has provided synergistic benefits to both partners and has allowed the partners to access new markets and to participate in the evolution of the air cargo industry. The new venture has also enabled both joint venture partners to enhance their competitive position in the global air cargo industry through strengthened service offerings and has provided the partners with increased cargo capacities, a larger route network, and greater frequencies within their own route networks. The study also found that the AeroLogic business model is unique in the air cargo industry. A limitation of the study was that AeroLogic’s annual revenue or freight traffic data was not available. It was, therefore, not possible to analyse the business performance of the joint venture.
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Directory of Open Access Journals (Sweden)
Y.V. Soni
2012-01-01
Full Text Available
ENGLISH ABSTRACT: This article investigates the concept of joint ventures in the international energy sector and develops a joint venture model, as a business development and assessment tool. The joint venture model presents a systematic method that relies on modern business intelligence to assess a potential business venture by using a balanced score card technique to screen potential partners, based on their technological and financial core capabilities. The model can be used by business development managers to harness the potential of joint ventures to create economic growth and sustainable business expansion. Furthermore, partnerships with local companies can help to mitigate econo-political risk, and facilitate buy-in from the national governments that are normally the primary stakeholders in the energy sector ventures (directly or indirectly. The particular case of Eskom Enterprises (Pty Ltd, a wholly owned subsidiary of Eskom, is highlighted.
AFRIKAANSE OPSOMMING: Hierdie artikel ondersoek die begrip gesamentlike onderneming in die internasionale energiesektor en ontwikkel 'n gesamentlike-onderneming-model as 'n sake-ontwikkeling- en takseermodel. Die gesamentlike-onderneming-model bied 'n stelselmatige metode wat op moderne sake-intelligensie staat maak om 'n potensiële sake-onderneming op grond van die tegnologiese en finansiële kernvermoëns daarvan te takseer deur 'n gebalanseerdepuntekaart-tegniek te gebruik. Die model kan deur sake-ontwikkelingsbestuurders gebruik word om die potensiaal van gesamentlike ondernemings in te span om ekonomiese groei en volhoubare sake-uitbreiding daar te stel. Verder kan venootskappe met plaaslike maatskappye help om die ekonomiese risiko te verminder en inkoop te vergemaklik van die nasionale regerings wat gewoonlik die primêre belanghebbendes in die energiesektorondernemings is (hetsy regstreeks of onregstreeks. Die besondere geval van Eskom Enterprises (Edms Bpk, 'n vol filiaal van Eskom
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Long-Run Effects of Public–Private Research Joint Ventures
DEFF Research Database (Denmark)
Kaiser, Ulrich; Kuhn, Johan Moritz
2012-01-01
Subsidized research joint ventures (RJVs) between public research institutions and industry have become increasingly popular in Europe and the US. We study the long-run effects of such a support scheme that has been maintained by the Danish government since 1995. To cope with identification...... problems we apply nearest neighbor matching and conditional difference-in-difference estimation methods. Our main findings are that (i) program participation effects are instant for annual patent applications and last for three years, (ii) employment effects materialize first after one year and (iii...
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Passion Research: A Joint Venture To Interest High School Students in Chemistry.
Carriere, Francois J.; Abouaf, Madeleine
1997-01-01
Describes a joint venture between the Centre National de la Recherche Scientifique (CNRS) and the Department of Education in France that was created to allow students to do practical scientific work with the help of a CNRS researcher. Presents two practical projects done by students on organic polymers and on color. Concludes that this increases…
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The characteristics and performance of international joint ventures in Thailand
Suwannarat, P
2010-01-01
The importance of strategic alliances in the form of international joint ventures (IJVs) is growing in the present international business environment where competition is on a global scale. A review of the IJV literature, especially in developing countries, shows an over-emphasis on China and the NIEs (the first tier newly-industrialising economies: Taiwan, Singapore, Hong Kong, and South Korea). To date, relatively little attention has been paid to the ASEAN4 countries (the high-performing e...
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2010-03-24
... Production Act of 1993--Joint Venture To Perform Project Entitled Robotic Rehabilitation of Aging Water... Cooperative Research and Production Act of 1993, 15 U.S.C. 4301 et sect. (``the Act''), Joint [[Page 14191
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Directory of Open Access Journals (Sweden)
Violeta Iftinchi
2018-03-01
Full Text Available As part of their political risk management strategy, multinational corporations (MNCs can use joint ventures as a tool to reduce their exposure to political risks in international activities. The aim of this article is to present the main benefits for MNCs in using joint ventures with a local partner to mitigate political risks in developing countries and to put forward three risks that MNCs have to consider when choosing the local partner (the risk of opportunistic expropriation, the risk associated with transferring of intellectual property rights and reputational risk.
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The optimality of hospital financing system: the role of physician-manager interactions.
Crainich, David; Leleu, Hervé; Mauleon, Ana
2008-12-01
The ability of a prospective payment system to ensure an optimal level of both quality and cost reducing activities in the hospital industry has been stressed by Ma (Ma, J Econ Manage Strategy 8(2):93-112, 1994) whose analysis assumes that decisions about quality and costs are made by a single agent. This paper examines whether this result holds when the main decisions made within the hospital are shared between physicians (quality of treatment) and hospital managers (cost reduction). Ma's conclusions appear to be relevant in the US context (where the hospital managers pay the whole cost of treatment). Nonetheless, when physicians partly reimburse hospitals for the treatment cost as it is the case in many European countries, we show that the ability of a prospective payment system to achieve both objectives is sensitive to the type of interaction (simultaneous, sequential or joint decision-making) between the agents. Our analysis suggests that regulation policies in the hospital sector should not be exclusively focused on the financing system but should also take the interaction between physicians and hospital managers into account.
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Energy Technology Data Exchange (ETDEWEB)
Repsold, Junior, Hugo [PETROBRAS, Rio de Janeiro, RJ (Brazil); Carpio, Lucio Guido Tapia [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Coordenacao dos Programas de Pos-graduacao de Engenharia (COPPE). Programa de Planejamento Energetico
2004-07-01
Joint Ventures have been used as an important toll to improve the cooperation between firms and have gained a significant status since the recent opening of emerging countries economies to foreign investments. This work presents a study on the determinants of the Joint Ventures structure and an analysis of the cooperation process in the upstream of the petroleum industry. The subject of this study is a farm out process in which a firm sells part of its interest in a concession in order to form a Joint Venture. An analytical solution is presented to find the acceptable conditions for each firm and the negotiation process is also analyzed as a game in which decision makers try to rationally maximize the expected profit. (author)
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Personnel decision-making in wholly-owned foreign subsidiaries and in international joint ventures.
Zeira Y; Shenkar O
1986-01-01
ILO pub. Working paper, research report on personnel management decision making in foreign owned subsidiarys of multinational enterprises and international joint ventures - discusses legal aspects, the role of absentee top management, host country employers organizations and other interest groups, etc.; examines employees attitudes, management attitudes, trade union attitudes government attitude, particularly regarding workers participation, recruitment and promotion. References, statistical ...
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Proposed Chevron Tengiz venture stalls amid Soviet political squabble
International Nuclear Information System (INIS)
Anon.
1991-01-01
This paper reports on the status of foreign investment in Soviet oil and gas joint ventures which has reached a critical juncture. Just as the U.S. is considering granting most favored nation trade status to the U.S.S.R., the joint venture petroleum deal seen as the litmus test for such deals-Chevron Corp.'s proposed addition of supergiant Tengiz oil field to its Caspian Sea joint venture-has stalled amid controversy. Unconfirmed reports from Soviet officials and other foreign joint venture participants in the U.S.S.R. have Chevron pulling out of the long negotiated, multibillion dollar project after the Soviets rejected the company's terms. Chevron, however, insists the project is still alive
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J.A. Talman (Joke)
2009-01-01
textabstractThis paper addresses the question what determines management control in joint ventures. The model developed for this purpose draws on two existing frameworks. The first, by Dekker (2004), shows how control in strategic alliances can be structured around two control problems, coordination
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Directory of Open Access Journals (Sweden)
Pierre-Xavier Meschi
2007-06-01
Full Text Available This article aims at identifying the individual and joint impact of two « country-level variables », namely national distance and country risk, on the survival of international joint ventures in emerging countries. Research hypotheses predicting the negative impact of national distance and country risk on survival are formulated in this article. These research hypotheses are tested in a sample of 165 international joint ventures that were formed in Brazil between 1974 and 2003. These joint ventures were subjected to an event history analysis over a period of time ranging from 1974 to 2005. The empirical results show that the intercultural dynamics increases the instability of international joint ventures whereas the survival of these alliances does not seem to be affected by the economic and political uncertainty of Brazil. Furthermore, the national distance between local and foreign partners has effects on survival that are variable according to the life cycle of international joint ventures.
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Directory of Open Access Journals (Sweden)
Marina D’Agostini
2014-08-01
Full Text Available Este artigo tem como objetivo analisar a formação de joint-ventures de dois fabricantes da indústria automobilística, compreendendo aspectos estratégicos e relacionais destas alianças. A pesquisa caracterizou-se por ser um estudo de casos múltiplos, qualitativo e exploratório, onde foi possível realizar uma melhor compreensão das duas subsidiárias nacionais e suas respectivas joint-ventures localizadas nos Estados Unidos (EUA, Alemanha, México e Egito. A coleta dos dados foi feita por meio da observação participante e roteiro de entrevista semi-estruturado. Os dados foram analisados por meio da análise de conteúdo. Dentre os resultados, foi identificado como primordial para o sucesso da implementação deste tipo de aliança, a realização de um detalhado estudo de viabilidade que deve anteceder a formação da joint-venture, seguido de um alinhamento entre os interesses das sócias. As adaptações aos aspectos culturais aparecem como um ponto forte para a sobrevivência das joint-ventures. As informações obtidas neste estudo convergem com a teoria estudada e conduzem a novas oportunidades de pesquisas relacionadas ao tema. Palavras-chave: Aliança estratégica. Joint-venture. Indústriaautomobilística. STRATEGIC AND RELATIONAL ASPECTS OF JOINT-VENTURE ALLIANCES: THE CASE OF TWO MANUFACTURERS OF THE AUTOMOTIVE INDUSTRY ABSTRACT This article aims to analyze the formation of joint ventures formed by two manufacturers from automobile industry, understanding strategic and relational aspects of these alliances. This research is characterized by a qualitative and exploratory multiple case study, where it was possible to conduct a comparison of two subsidiary and their joint ventures located in the United States (USA, Germany, Mexico, and Egypt. The data collection was done through participant observation and semi-structured interviews. The data were analyzed using content analysis technique. Among results, it was
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Japan-U.S. Joint Ventures in Higher Education: Language Education in an Uncertain Future.
Clayton, Thomas
1991-01-01
Examines Japanese-U.S. joint venture language or U.S.-style education programs in Japan. These programs offer language and cultural education classes for those interested in English and for students who have failed in the Japanese education system. Problems facing these programs and the need to explore new, English-language education markets are…
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Ross, Fiona; Woodfield, Steve
2017-01-01
As market-led higher education systems become the "new normal", a wider variety of organisational forms is likely to emerge. This paper reports on the findings of a qualitative and historical study that aimed to explore the meaning of collaborative governance in a unique and long-standing higher education joint venture in England.…
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Export eller joint venture? : Ett litet företags internationella expansion.
Hamilton, Tobias; Tenne, Fredrik
2006-01-01
För små till medelstora företag (SMEs) vars kännetecken är bristande resurser kan konsekvensen av ett felaktigt etableringssätt vid internationell expansion vara skillnaden mellan överlevnad och konkurs (Kuo & Li 2003). Etableringar på utländska marknader kan genomföras via en rad olika etableringssätt. Två av dessa kommer att behandlas i denna uppsats; export och joint venture. Det amerikanska SME-företaget Pro Spot tillverkar svetsar till bilverkstäder och önskar expandera på den europe...
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Aksa plans polypropylene joint venture
International Nuclear Information System (INIS)
Alperowicz, N.
1992-01-01
Turkish acrylic fiber maker Aksa (Yalova), part of the Akkok textile conglomerate, is studying construction of a world-scale polypropylene (PP) plant as part of its diversification plans. The company says it is engaged in discussions with three 'multinations in the PP business' on the possibility of a joint venture. One of the firms is understood to be Amoco. Aksa is looking at three possible locations for the 100,000 m.t.-150,000 m.t./year plant: Yalova, near Istanbul, where its existing plants are located; Zonguldak, on the Black Sea coast; and within one of the existing complexes or a new site belonging to state-owned Petkim. Aksa has not yet discussed that option with Petkim, which recently received approval to build a $2.5-billion petrochemical complex. The Aksa PP plant would cost about $100 million and would use propylene from world markets. The onstream date depends on Aksa's ability to link up with a foreign partner, but it hopes to complete the unit within three years. Turkey has only one PP plant, a 65,000-m.t./year Petkim unit at Aliaga. The domestic market is currently two to three times that amount and is growing. Petkim also plans a 200,000-m.t./year PP plant as part of its new complex
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International Nuclear Information System (INIS)
Kremnev, V.; Gavrilov, S.; Fedunina, A.; Hladky, E.
1993-01-01
High technology, science and capital intensive productions of nuclear power and industry have considerable possibilities for developing by cooperation with different countries, corporations and firms, especially on plant life extension, decommissioning, and radioactive waste treatment. One of the first joint ventures is JV DECOM set up in 1989. JD VECOM is a multinational firm whose main activities are concerned with plant life extension and decommissioning. Issues which favor this development and have contributed to the success of JD VECOM are described
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Fazekas Balazs
2014-01-01
JEREMIE (Joint European Resources for Micro to Medium Enterprises) program was implemented as a part of the EU cohesion policy in the framework of 2007-2013 programming period. The primary objective of the program was to enhance the financing prospects of SME’s through structural funds that provide financial engineering instruments like loan, guarantee and venture capital. This paper focuses on the effects of JEREMIE on Hungary’s venture capital market. Since 2010, 28 JEREMIE backed venture c...
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2010-07-07
... Manufacturing, Inc., Formerly a Joint Venture of General Motors Corporation and Toyota Motor Corporation, Including On- Site Leased Workers From Corestaff, ABM Janitorial, Toyota Engineering and Manufacturing North... Corporation and Toyota Motor Corporation, including on-site leased workers from Corestaff, ABM Janitorial, and...
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2010-08-06
... Manufacturing, Inc., Formerly a Joint Venture of General Motors Corporation and Toyota Motor Corporation, Including On- Site Leased Workers From Corestaff, ABM Janitorial, Toyota Engineering and Manufacturing North... of General Motors Corporation and Toyota Motor Corporation, including on-site leased workers from...
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Kotb, Amany Ali; Mohamed, Khalid Abd-Elmoez; Kamel, Mohammed Hbany; Ismail, Mosleh Abdul Rahman; Abdulmajeed, Abdulmajeed Ahmed
2014-01-01
The burnout syndrome is characterized by emotional exhaustion, depersonalization, and low personal accomplishment. It is associated with impaired job performance. This descriptive study examined 171 physicians for the presence of burnout and its related risk factors. The evaluation of burnout was through Maslach Burnout Inventory (MBI). The participant was considered to meet the study criteria for burnout if he or she got a "high" score on at least 2 of the three dimensions of MBI. In the current study, the prevalence of burnout in hospital physicians (53.9%) was significantly higher than family physicians (41.94%) with (p=0.001). Participants who work in the internal medicine department scored the highest prevalence (69.64%) followed by Surgeons (56.50%) and Emergency doctors (39.39%). On the other hand, Pediatricians got the lowest prevalence (18.75%). Working in the teaching hospital and being married are strong predictors for occurrence of burnout. There is a significant difference of burnout between hospital physicians and family physicians among the study subjects. Working in the teaching hospital and being married are strong predictors for occurrence of burnout.
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Tailoring hospital marketing efforts to physicians' needs.
Mackay, J M; Lamb, C W
1988-12-01
Marketing has become widely recognized as an important component of hospital management (Kotler and Clarke 1987; Ludke, Curry, and Saywell 1983). Physicians are becoming recognized as an important target market that warrants more marketing attention than it has received in the past (Super 1987; Wotruba, Haas, and Hartman 1982). Some experts predict that hospitals will begin focusing more marketing attention on physicians and less on consumers (Super 1986). Much of this attention is likely to take the form of practice management assistance, such as computer-based information system support or consulting services. The survey results reported here are illustrative only of how one hospital addressed the problem of physician need assessment. Other potential target markets include physicians who admit patients only to competitor hospitals and physicians who admit to multiple hospitals. The market might be segmented by individual versus group practice, area of specialization, or possibly even physician practice life cycle stage (Wotruba, Haas, and Hartman 1982). The questions included on the survey and the survey format are likely to be situation-specific. The key is the process, not the procedure. It is important for hospital marketers to recognize that practice management assistance needs will vary among markets (Jensen 1987). Therefore, hospitals must carefully identify their target physician market(s) and survey them about their specific needs before developing and implementing new physician marketing programs. Only then can they be reasonably confident that their marketing programs match their customers' needs.
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Burriss, Annie Hunt
2010-01-01
One innovative, higher-education response to globalization and changing fiscal realities is the curricular joint venture (CJV), a formal collaboration between academic institutions that leverages missions through new joint degrees and research not previously offered by collaborating institutions (Eckel, 2003). In 1997, a pioneering biomedical…
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King, Marta A; Nkoy, Flory L; Maloney, Christopher G; Mihalopoulos, Nicole L
2015-10-01
To determine how frequently physicians identify and address overweight/obesity in hospitalized children and to compare physician documentation across training level (medical student, intern, resident, attending). We conducted a retrospective chart review. Using an administrative database, Centers for Disease Control and Prevention body mass index calculator, and random sampling technique, we identified a study population of 300 children aged 2-18 years with overweight/obesity hospitalized on the general medical service of a tertiary care pediatric hospital. We reviewed admission, progress, and discharge notes to determine how frequently physicians and physician trainees identified (documented in history, physical exam, or assessment) and addressed (documented in hospital or discharge plan) overweight/obesity. Physicians and physician trainees identified overweight/obesity in 8.3% (n = 25) and addressed it in 4% (n = 12) of 300 hospitalized children with overweight/obesity. Interns were most likely to document overweight/obesity in history (8.3% of the 266 patients they followed). Attendings were most likely to document overweight/obesity in physical examination (8.3%), assessment (4%), and plan (4%) of the 300 patients they followed. Medical students were least likely to document overweight/obesity including it in the assessment (0.4%) and plan (0.4%) of the 244 hospitalized children with overweight/obesity they followed. Physicians and physician trainees rarely identify or address overweight/obesity in hospitalized children. This represents a missed opportunity for both patient care and physician trainee education. Copyright © 2015 Elsevier Inc. All rights reserved.
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Factors driving physician-hospital alignment in orthopaedic surgery.
Page, Alexandra E; Butler, Craig A; Bozic, Kevin J
2013-06-01
The relationships between physicians and hospitals are viewed as central to the proposition of delivering high-quality health care at a sustainable cost. Over the last two decades, major changes in the scope, breadth, and complexities of these relationships have emerged. Despite understanding the need for physician-hospital alignment, identification and understanding the incentives and drivers of alignment prove challenging. Our review identifies the primary drivers of physician alignment with hospitals from both the physician and hospital perspectives. Further, we assess the drivers more specific to motivating orthopaedic surgeons to align with hospitals. We performed a comprehensive literature review from 1992 to March 2012 to evaluate published studies and opinions on the issues surrounding physician-hospital alignment. Literature searches were performed in both MEDLINE(®) and Health Business™ Elite. Available literature identifies economic and regulatory shifts in health care and cultural factors as primary drivers of physician-hospital alignment. Specific to orthopaedics, factors driving alignment include the profitability of orthopaedic service lines, the expense of implants, and issues surrounding ambulatory surgery centers and other ancillary services. Evolving healthcare delivery and payment reforms promote increased collaboration between physicians and hospitals. While economic incentives and increasing regulatory demands provide the strongest drivers, cultural changes including physician leadership and changing expectations of work-life balance must be considered when pursuing successful alignment models. Physicians and hospitals view each other as critical to achieving lower-cost, higher-quality health care.
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13 CFR 127.506 - May a joint venture submit an offer on an EDWOSB or WOSB requirement?
2010-01-01
... BUSINESS ADMINISTRATION WOMEN-OWNED SMALL BUSINESS FEDERAL CONTRACT ASSISTANCE PROCEDURES Federal Contract... project manager responsible for the performance of the contract; (d) The joint venture must perform the applicable percentage of work required of the EDWOSB or WOSB offerors in accordance with § 125.6 of this...
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Kertz, Consuelo Lauda; Hasson, James K., Jr.
1986-01-01
Features of the federal income tax law applying to income received from commercially funded university-based scientific research and development activities are discussed, including: industry-sponsored research contracts, separately incorporated entities, partnerships and joint ventures, subsidiaries and unrelated income consequences of…
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ROLE OF JOINT VENTURE “SOVHISPAN” IN NORMALIZATION OF THE SOVIET-SPANISH BILATERAL RELATIONS
Directory of Open Access Journals (Sweden)
Марина Николаевна Мосейкина
2016-12-01
Full Text Available The object of this research is to support the statement about the prevalence of the economic interest over the political ones, taking as an example the reestablishment of the Soviet-Spanish bilateral relations. The historical context of the creation of the Soviet-Spanish joint venture “Sovhispan”is highlighted as the final outcome of the secret negotiations and previous business practices between Spain and the Soviet Union in the late 1960s. The Soviet-Spanish economic relations started ten years before their normalization in 1977, the Canary Islandsbeing one of the places of their development. The principal conclusions of the research are: the geostrategic position of Spain was appreciated by the USA, via installation of the military bases on the mainland, and the USSR, using the Canary Islands as an operational base for the Soviet Fishing Fleet. “Sovrybflot”, an internal structure of the Ministry of Fisheries of the USSR, managed the overseas activity of the Soviet Fishing fleet abroad. Thus, the arrival of avast Soviet fishing fleet in the Canary Islands and the creation of the joint venture “Sovhispan” was a result of its work. “Sovhispan” was a “bridge” in the normalization of the Soviet-Spanish bilateral relations, and bankrupted with the dissolution of the USSR.
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Knowledge Creation in International Joint Ventures in Emerging Economies
DEFF Research Database (Denmark)
Nielsen, Ulrik B.
Entering and developing presence in emerging economies often require foreign firms to set up International Joint Ventures (IJVs) with local partners, especially when the prime motive of the operation is to capture opportunities in the local markets (Mohr & Puck, 2005). IJVs have therefore become...... an important way for firms to enter these markets and a significant force in shaping a firm’s global strategy in expanding international activities abroad. However, research has shown that IJVs in emerging economies are unstable, and firms have experienced that performance of their IJVs in these emerging...... economies often does not meet their expectations (Fang & Zou, 2010). Extant research has shown that, in general, management of IJVs appears to be a difficult issue. 60-70% of all partnerships are not successful (Lambe, Spekman, & Hunt, 2002). Inter-partner learning has been proposed in the literature...
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13 CFR 124.513 - Under what circumstances can a joint venture be awarded an 8(a) contract?
2010-01-01
...; and (ii)(A) For a procurement having a revenue-based size standard, the procurement exceeds half the... an employee-based size standard, the procurement exceeds $10 million; (2) For sole source and... the purpose of performing one or more specific 8(a) contracts. (2) A joint venture agreement is...
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Menahem, Sasson; Roitgarz, Ina; Shvartzman, Pesach
2011-04-01
HospitaL admission is a crisis for the patient and his family and can interfere with the continuity of care. It may lead to mistakes due to communication problems between the primary care physician and the hospital medical staff. To explore the communication between the primary care physician, the hospital medical staff, the patient and his family during hospitalization. A total of 269 questionnaires were sent to all Clalit Health Services-South District, primary care physicians; 119 of these questionnaires (44.2%) were completed. Half of the primary care physicians thought that they should, always or almost always, have contact with the admitting ward in cases of internal medicine, oncology, surgery or pediatric admissions. However, the actual contact rate, according to their report, was only in a third of the cases. A telephone contact was more common than an actual visit of the patient in the ward. Computer communication between the hospital physicians and the primary care physicians is still insufficiently developed, although 96.6% of the primary care physicians check, with the aid of computer software, for information on their hospitalized patients. The main reasons to visit the hospitalized patient were severe medical conditions or uncertainty about the diagnosis; 79% of the physicians thought that visiting their patients strengthened the level of trust between them and their patients. There are sometimes communication difficulties and barriers between the primary care physicians and the ward's physicians due to partial information delivery and rejection from the hospital physicians. The main barriers for visiting admitted patients were workload and lack of pre-allocated time on the work schedule. No statistically significant differences were found between communication variables and primary care physician's personal and demographic characteristics. The communication between the primary care physician and the hospital physicians should be improved through
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U.S. Department of Health & Human Services — Section 6001 of the Affordable Care Act of 2010 amended section 1877 of the Social Security Act to impose additional requirements for physician-owned hospitals to...
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Can doctors and administrators work together?
Gill, S L
1987-01-01
The working relationship between physicians and health care organizations has dramatically changed since the introduction of competitive factors. Fifer suggests that future doctors may have as many as five or six economic relationships with their associated health care system, in contrast to the singular role as admitting physician of the past. The physician will continue to admit patients, but may also belong to an HMO or some other joint venture (freestanding ambulatory care center, outpatient laboratory, etc.), be salaried part time for leadership roles, be a leader in some other parallel economic venture, etc. Physicians are already assuming multiple roles as health care providers, private entrepreneurs, and joint venture partners with hospitals. Hospitals and health care systems also continue to change through vertical and horizontal integration. Traditional clinical departments are becoming blended into product line entities, and a sophisticated executive team of market-oriented specialists now augments the traditional administrative leadership. So, from a tradition of predictable roles, relationships, and authority structures, we are now attempting to thrive and prosper with many new partners in an integrated, complex, and conflict-ridden set of interrelationships.
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New ventures shape up for Russian projects
International Nuclear Information System (INIS)
Anon.
1991-01-01
This paper reports that the foreign presence in the Soviet oil industry is destined to grow as a result of ventures by Canadian, British, and French companies. Gulf Canada Resources Ltd., Calgary, last week disclosed the government of the Russian republic has granted approvals necessary to enable Gulf Canada and British Gas plc's KomiArctic Oil joint venture to begin production operations immediately. The approvals follow the registration of Komi Arctic Oil by the Minister of Finance of the Russian Federation in November, at which time it became a legally constituted independent company in Russia. Canadian Fracmaster Ltd., also of Calgary, disclosed it plans to spend $75-100 million on three new joint venture production deals in the Russian republic in 1992
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How to govern physician-hospital exchanges: contractual and relational issues in Belgian hospitals.
Trybou, Jeroen; Gemmel, Paul; Annemans, Lieven
2014-07-01
Our aim was to investigate contractual mechanisms in physician-hospital exchanges. The concepts of risk-sharing and the nature of physician-hospital exchanges - transactional versus relational - were studied. Two qualitative case studies were performed in Belgium. Hospital executives and physicians were interviewed to develop an in-depth understanding of contractual and relational issues that shape physician-hospital contracting in acute care hospitals. The underlying theoretical concepts of agency theory and social exchange theory were used to analyse the data. Our study found that physician-hospital contracting is highly complex. The contract is far more than an economic instrument governing financial aspects. The effect of the contract on the nature of exchange - whether transactional or relational - also needs to be considered. While it can be argued that contractual governance methods are increasingly necessary to overcome the difficulties that arise from the fragmented payment framework by aligning incentives and sharing financial risk, they undermine the necessary relational governance. Relational qualities such as mutual trust and an integrative view on physician-hospital exchanges are threatened, and may be difficult to sustain, given the current fragmentary payment framework. Since health care policy makers are increasing the financial risk borne by health care providers, it can be argued that this also increases the need to share financial risk and to align incentives between physician and hospital. However, our study demonstrates that while economic alignment is important in determining physician-hospital contracts, the corresponding impact on working relationships should also be considered. Moreover, it is important to avoid a relationship between hospital and physician predominantly characterized by transactional exchanges thereby fostering an unhealthy us-and-them divide and mentality. Relational exchange is a valuable alternative to contractual
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Cho, Na-Eun; Chang, Jongwha; Atems, Bebonchu
2014-11-01
To determine the impact of health information technology (HIT) adoption and hospital-physician integration on hospital efficiency. Using 2010 data from the American Hospital Association's (AHA) annual survey, the AHA IT survey, supplemented by the CMS Case Mix Index, and the US Census Bureau's small area income and poverty estimates, we examined how the adoption of HIT and employment of physicians affected hospital efficiency and whether they were substitutes or complements. The sample included 2173 hospitals. We employed a 2-stage approach. In the first stage, data envelopment analysis was used to estimate technical efficiency of hospitals. In the second stage, we used instrumental variable approaches, notably 2-stage least squares and the generalized method of moments, to examine the effects of IT adoption and integration on hospital efficiency. We found that HIT adoption and hospital-physician integration, when considered separately, each have statistically significant positive impacts on hospital efficiency. Also, we found that hospitals that adopted HIT with employed physicians will achieve less efficiency compared with hospitals that adopted HIT without employed physicians. Although HIT adoption and hospital-physician integration both seem to be key parts of improving hospital efficiency when one or the other is utilized individually, they can hurt hospital efficiency when utilized together.
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Cuypers, I.R.P.; Martin, Xavier
2010-01-01
This paper examines the boundaries of real options logic, with an application to joint ventures (JVs). We distinguish between forms of uncertainty that are resolved endogenously and those that are resolved exogenously, and theorize that only exogenous uncertainty will have the impact predicted by
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Huff, C
They're the designated drivers of inpatient care, cutting hospital stays by 19 percent on average. Yet as venture capital firms infuse hospitalist startup companies, some primary care doctors complain that their sickest patients are being taken away from them.
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Robinson, James C; Miller, Kelly
Hospitals are rapidly acquiring medical groups and physician practices. This consolidation may foster cooperation and thereby reduce expenditures, but also may lead to higher expenditures through greater use of hospital-based ambulatory services and through greater hospital pricing leverage against health insurers. To determine whether total expenditures per patient were higher in physician organizations (integrated medical groups and independent practice associations) owned by local hospitals or multihospital systems compared with groups owned by participating physicians. Data were obtained on total expenditures for the care provided to 4.5 million patients treated by integrated medical groups and independent practice associations in California between 2009 and 2012. The patients were covered by commercial health maintenance organization (HMO) insurance and the data did not include patients covered by commercial preferred provider organization (PPO) insurance, Medicare, or Medicaid. Total expenditures per patient annually, measured in terms of what insurers paid to the physician organizations for professional services, to hospitals for inpatient and outpatient procedures, to clinical laboratories for diagnostic tests, and to pharmaceutical manufacturers for drugs and biologics. Annual expenditures per patient were compared after adjusting for patient illness burden, geographic input costs, and organizational characteristics. Of the 158 organizations, 118 physician organizations (75%) were physician-owned and provided care for 3,065,551 patients, 19 organizations (12%) were owned by local hospitals and provided care for 728,608 patients, and 21 organizations (13%) were owned by multihospital systems and provided care for 693,254 patients. In 2012, physician-owned physician organizations had mean expenditures of $3066 per patient (95% CI, $2892 to $3240), hospital-owned physician organizations had mean expenditures of $4312 per patient (95% CI, $3768 to $4857), and
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Dheensa, Sandi; Carrieri, Daniele; Kelly, Susan; Clarke, Angus; Doheny, Shane; Turnpenny, Peter; Lucassen, Anneke
2017-07-01
Advances in genomics often lead healthcare professionals (HCPs) to learn new information, e.g., about reinterpreted variants that could have clinical significance for patients seen previously. A question arises of whether HCPs should recontact these former patients. We present some findings interrogating the views of patients (or parents of patients) with a rare or undiagnosed condition about how such recontacting might be organised ethically and practically. Forty-one interviews were analysed thematically. Participants suggested a 'joint venture' model in which efforts to recontact are shared with HCPs. Some proposed an ICT-approach involving an electronic health record that automatically alerts them to potentially relevant updates. The need for rigorous privacy controls and transparency about who could access their data was emphasised. Importantly, these findings highlight that the lack of clarity about recontacting is a symptom of a wider problem: the lack of necessary infrastructure to pool genomic data responsibly, to aggregate it with other health data, and to enable patients/parents to receive updates. We hope that our findings will instigate a debate about the way responsibilities for recontacting under any joint venture model could be allocated, as well as the limitations and normative implications of using ICT as a solution to this intractable problem. As a first step to delineating responsibilities in the clinical setting, we suggest HCPs should routinely discuss recontacting with patients/parents, including the new information that should trigger a HCP to initiate recontact, as part of the consent process for genetic testing. Copyright © 2017 The Authors. Published by Elsevier Masson SAS.. All rights reserved.
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Physician-Hospital Alignment in Orthopedic Surgery.
Bushnell, Brandon D
2015-09-01
The concept of "alignment" between physicians and hospitals is a popular buzzword in the age of health care reform. Despite their often tumultuous histories, physicians and hospitals find themselves under increasing pressures to work together toward common goals. However, effective alignment is more than just simple cooperation between parties. The process of achieving alignment does not have simple, universal steps. Alignment will differ based on individual situational factors and the type of specialty involved. Ultimately, however, there are principles that underlie the concept of alignment and should be a part of any physician-hospital alignment efforts. In orthopedic surgery, alignment involves the clinical, administrative, financial, and even personal aspects of a surgeon's practice. It must be based on the principles of financial interest, clinical authority, administrative participation, transparency, focus on the patient, and mutual necessity. Alignment can take on various forms as well, with popular models consisting of shared governance and comanagement, gainsharing, bundled payments, accountable care organizations, and other methods. As regulatory and financial pressures continue to motivate physicians and hospitals to develop alignment relationships, new and innovative methods of alignment will also appear. Existing models will mature and evolve, with individual variability based on local factors. However, certain trends seem to be appearing as time progresses and alignment relationships deepen, including regional and national collaboration, population management, and changes in the legal system. This article explores the history, principles, and specific methods of physician-hospital alignment and its critical importance for the future of health care delivery. Copyright 2015, SLACK Incorporated.
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2010-01-01
... general, the relationship of joint venture is created when two or more persons combine their money... return of 8 percent of the amount advanced plus 20 percent of any gain. Like a lender of securities... to the principal portion of any appreciation in their value, bears the principal risk of loss should...
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International Nuclear Information System (INIS)
Rowley, D.A.
1992-01-01
We have witnessed major changes in the 1980s in the US fuel, energy and environmental areas. From the structure of heavily-regulated local and regional monopolies that predated World War 2, Federal and State governments have begun moving toward a more market-oriented approach to fuel supply, fuel transport and power generation with the goal of increasing competition to effect lower prices for consumers. Although some utilities have resisted this trend - arguing, for example, that third-party power purchasing threatens system reliability - others have joined the market by diversifying into the non-regulated side of the industry. Similarly, beginning with creation of the Superfund, continuing with last year's amendments to the Clean Air Act, and on into the future with anticipated changes for water, solid waste, and other areas, Congress and the EPA have created a regulatory structure that cries out for more capital yet makes such investment more risky. This paper examines joint venture strategies in the context of developing new business in the energy and environmental areas. This paper focuses on the interaction of three aspects of such efforts: (1) the issues of primary importance to the entity engaging in such efforts, (2) the impact of various strategies on the resolution of the issues, and (3) the use of joint ventures to maximize benefits and minimize risks
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2010-01-01
... procurement having a revenue-based size standard, the procurement exceeds half the size standard corresponding to the NAICS code assigned to the contract; and (ii) For a procurement having an employee-based size... for the purpose of submitting an offer for a HUBZone contract. The joint venture itself need not be...
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ATMEA and medium power reactors. The ATMEA joint venture and the ATMEA1 medium power reactor
International Nuclear Information System (INIS)
Mathet, Eric; Castello, Gerard
2012-01-01
This Power Point presentation presents the ATMEA company (a joint venture of Areva and Mitsubishi), the main features of its medium power reactor (ATMEA1) and its building arrangement, indicates the general safety objectives. It outlines the features of its robust design which aim at protecting, cooling down and containing. It indicates the regulatory and safety frameworks, comments the review of the safety options by the ASN and the results of this assessment
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Nunnenkamp, Peter; Sosa Andrés, Maximiliano
2013-01-01
Using count data on Indian joint ventures (JVs) and wholly owned subsidiaries (WOS), we present an empirical analysis of FDI-related ownership choices and their relation with host country characteristics and indicators of transaction costs. Our Negative Binomial regression models offer only weak support for the bargaining perspective, according to which JVs should be more likely if the host countries were particularly attractive in terms of market access or resource endowments. Geographical a...
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Financial capital and intellectual capital in physician practice management.
Robinson, J C
1998-01-01
Medical groups need financial resources yet most retain no earnings and have no reserves. Physician practice management (PPM) companies have recognized the need for investment and the scarcity of indigenous capital in the physician sector and are rushing to fill the void. Resources are being contributed by venture capitalists, bond underwriters, private investors, pharmaceutical manufacturers, health plans, hospital systems, and public equity markets. The potential contribution of PPM firms is to nurture the intellectual capital of leading physician organizations and diffuse it throughout the health care system. The risk is that short-term financial imperatives will impede necessary long-term investments.
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Murtagh, D S
1995-07-01
While many physicians and physician groups are forging alliances with other groups, with hospitals, and with other elements of the health care delivery system, an Ohio group decided that the loss of autonomy involved in these approaches was not acceptable. Instead, the group became the core of a new entity aimed at restoring physician control over the provision of and payment for health care services. In an interview with the principal of the new organization, Physician Executive learned the basis for the venture.
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International Nuclear Information System (INIS)
Chukwueke, T.
2002-01-01
Oil companies make a business by bearing the risks of investing in, and making profits from, oil and gas operations. International Oil Companies (IOC) are the recognised leaders in technology and develop expertise in the management of technical such as subsurface and surface uncertainties through seismic surveys, well drilling and production facilities. In export oriented oil and gas developments, IOCs also carry the commercial risks associated with the export market (ups and downs in the demand for oil and gas) that could make the project non-profitable, if not properly managed.Conversely, Local Oil Companies (LOCs), i.e. indigenous private or state owned companies, are more adapt at developing expertise in the management of the local environmental, domestic market and political risks associated with the area or country of operations. It is recognised that in certain countries some LOCs are also making significant progress in the acquisition of modern technology. Any critical business risks which cannot be adequately managed by either the IOC or the LOC will require the involvement of third party, who will normally provide guarantee or securitisation in one form or another.A partnership between local and international oil companies has become accepted to be the most secure and profitable arrangement in international oil and gas business. In the Niger Delta, which is mature oil and gas province and as such non-market related risks, particularly technical and supply risks, are substantially reduced, Joint Venture type of arrangement is considered the most suitable form of partnership. Joint Venture arrangement allows each partner to fund the venture in direct proportion to its participation interest. Because of the reduced risks profile, the joint venture is more bankable; each partner can therefore secure funding for its share with its revenue profile. In Nigeria, however, where the revenue profile (and consequently development budget) of the dominant local player
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Solar energy: Shell buys up the shares of Siemens and E.ON in their joint-venture
International Nuclear Information System (INIS)
Anon.
2002-01-01
The anglo-Dutch petroleum firm Royal Dutch/Shell has announced its intention to buy up the shares of its German partners Siemens and E.ON in their joint-venture specialized in the solar energy. If the buying up is authorized by the proper authorities, the firm will be held at 100% by Shell. Shell intends indeed to invest 500 millions to 1 milliard of dollars on 5 years in the development of renewable energies. (O.M.)
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Ruslan, Siti Zaharah Mohd; Jaffar, Maheran Mohd
2017-05-01
Islamic banking in Malaysia offers variety of products based on Islamic principles. One of the concepts is a diminishing musyarakah. The concept of diminishing musyarakah helps Muslims to avoid transaction which are based on riba. The diminishing musyarakah can be defined as an agreement between capital provider and entrepreneurs that enable entrepreneurs to buy equity in instalments where profits and losses are shared based on agreed ratio. The objective of this paper is to determine the internal rate of return (IRR) for a diminishing musyarakah model by applying a numerical method. There are several numerical methods in calculating the IRR such as by using an interpolation method and a trial and error method by using Microsoft Office Excel. In this paper we use a bisection method and secant method as an alternative way in calculating the IRR. It was found that the diminishing musyarakah model can be adapted in managing the performance of joint venture investments. Therefore, this paper will encourage more companies to use the concept of joint venture in managing their investments performance.
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Physicians' job satisfaction and motivation in a public academic hospital.
de Oliveira Vasconcelos Filho, Paulo; de Souza, Miriam Regina; Elias, Paulo Eduardo Mangeon; D'Ávila Viana, Ana Luiza
2016-12-07
Physician shortage is a global issue that concerns Brazil's authorities. The organizational structure and the environment of a medical institution can hide a low-quality life of a physician. This study examines the relationship between the hospital work environment and physicians' job satisfaction and motivation when working in a large public academic hospital. The study was restricted to one large, multispecialty Brazil's hospital. Six hundred hospital physicians were invited to participate by e-mail. A short version of the Physician Worklife Survey (PWS) was used to measure working satisfaction. Physicians were also asked for socio-demographic information, medical specialty, and the intention to continue working in the hospital. Data from 141 questionnaires were included in the analyses. Forty-five physicians graduated from the hospital's university, and they did not intend to leave the hospital under any circumstance (affective bond). The motivating factor for beginning the career at the hospital and to continue working there were the connection to the medical school and the hospital status as a "prestigious academic hospital"; the physicians were more satisfied with the career than the specialty. Only 30% completely agreed with the statement "If I had to start my career over again, I would choose my current specialty," while 45% completely agreed with the statement "I am not well compensated given my training and experience." The greater point of satisfaction was the relationship with physician colleagues. They are annoyed about the amount of calls they are requested to take and about how work encroaches on their personal time. No significant differences between medical specialties were found in the analysis. The participants were satisfied with their profession. The fact that they remained at the hospital was related to the academic environment, the relationship with colleagues, and the high prestige in which society holds the institution. The points of
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The Effects of Hospital-Level Factors on Patients' Ratings of Physician Communication.
Al-Amin, Mona; Makarem, Suzanne C
2016-01-01
The quality of physician-patient communication influences patient health outcomes and satisfaction with healthcare delivery. Yet, little is known about contextual factors that influence physicians' communication with their patients. The main purpose of this article is to examine organizational-level factors that influence patient perceptions of physician communication in inpatient settings. We used the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and American Hospital Association data to determine patients' ratings of physician communication at the hospital level, and to collect information about hospital-level factors that can potentially influence physician communication. Our sample consisted of 2,756 hospitals. We ran a regression analysis to determine the predictors of poor physician communication, measured as the percentage of patients in a hospital who reported that physicians sometimes or never communicated well. In our sample of hospitals, this percentage ranged between 0% and 21%, with 25% of hospitals receiving poor ratings from more than 6% of patients. Three organizational factors had statistically significant negative associations with physician communication: for-profit ownership, hospital size, and hospitalists providing care in the hospital, On the other hand, the number of full-time-equivalent physicians and dentists per 10,000 inpatient days, physician ownership of the hospital, Medicare share of inpatient days, and public ownership were positively associated with patients' ratings of physician communication. Physician staffing levels are an understudied area in healthcare research. Our findings indicate that physician staffing levels affect the quality of physician communication with patients. Moreover, for-profit and larger hospitals should invest more in physician communication given the role that HCAHPS plays in value-based purchasing.
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Financing models for HTR plants: Co-financing, counter trade, joint ventures
International Nuclear Information System (INIS)
Bogen, J.; Stoelzl, D.
1987-01-01
Structure and volume of investment cost for HTR nuclear power plants are different in comparison to other types of nuclear power plants. Even if the share of local participation is in comparable order of magnitude to other nuclear power plants, the required technical infrastructure for HTR plants is more suitable for existing and still practised technologies in countries which are in development processes. These HTR specific features offer special possibilities in HTR project financing. Various models are discussed in respect of the special HTR situation. Even if it is not possible to point out in a general manner the best solution - due to national, local and time dependant situations - this paper discusses the HTR specific impacts to buyer's credit financing, supplier's credit financing, barter trades or joint ventures and combined financing. (author). 4 refs, 9 figs
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ACA Marketplace premiums and competition among hospitals and physician practices.
Polyakova, Maria; Bundorf, M Kate; Kessler, Daniel P; Baker, Laurence C
2018-02-01
To examine the association between annual premiums for health plans available in Federally Facilitated Marketplaces (FFMs) and the extent of competition and integration among physicians and hospitals, as well as the number of insurers. We used observational data from the Center for Consumer Information and Insurance Oversight on the annual premiums and other characteristics of plans, matched to measures of physician, hospital, and insurer market competitiveness and other characteristics of 411 rating areas in the 37 FFMs. We estimated multivariate models of the relationship between annual premiums and Herfindahl-Hirschman indices of hospitals and physician practices, controlling for the number of insurers, the extent of physician-hospital integration, and other plan and rating area characteristics. Premiums for Marketplace plans were higher in rating areas in which physician, hospital, and insurance markets were less competitive. An increase from the 10th to the 90th percentile of physician concentration and hospital concentration was associated with increases of $393 and $189, respectively, in annual premiums for the Silver plan with the second lowest cost. A similar increase in the number of insurers was associated with a $421 decrease in premiums. Physician-hospital integration was not significantly associated with premiums. Premiums for FFM plans were higher in markets with greater concentrations of hospitals and physicians but fewer insurers. Higher premiums make health insurance less affordable for people purchasing unsubsidized coverage and raise the cost of Marketplace premium tax credits to the government.
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Dow, Ewan G.
2010-01-01
This article makes the case--in three parts--that many Anglo-Chinese university collaborations (joint ventures) to date have seriously underestimated Chinese (student) history, the Chinese university setting and Chinese national governmental steering as part of the process of "glocalisation". Recent turbulence in this particular HE…
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The effect of hospital-physician integration on health information technology adoption.
Lammers, Eric
2013-10-01
The US federal government has recently made a substantial investment to enhance the US health information technology (IT) infrastructure. Previous literature on the impact of IT on firm performance across multiple industries has emphasized the importance of a process of co-invention whereby organizations develop complementary practices to achieve greater benefit from their IT investments. In health care, employment of physicians by hospitals can confer greater administrative control to hospitals over physicians' actions and resources and thus enable the implementation of new technology and initiatives aimed at maximizing benefit from use of the technology. In this study, I tested for the relationship between hospital employment of physicians and hospitals' propensity to use health IT. I used state laws that prohibit hospital employment of physicians as an instrument to account for the endogenous relationship with hospital IT use. Hospital employment of physicians is associated with significant increases in the probability of hospital health IT use. Therefore, subsidization of health IT among hospitals not employing physicians may be less efficient. Furthermore, state laws prohibiting hospitals from employing physicians may inhibit adoption of health IT, thus working against policy initiatives aimed at promoting use of the technology. Copyright © 2012 John Wiley & Sons, Ltd.
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Landy, Rachel
2012-01-01
Starr v. Sony BMG Music Entertainment illustrates the inherent tension between copyright holders seeking to enforce their exclusive rights and antitrust doctrine. In Starr, competing record labels pooled their copyrights into digital distribution joint ventures, MusicNet and Pressplay. Such collaboration toes a thin line between cartel-like ...
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The JOVE initiative - A NASA/university Joint Venture in space science
Six, F.; Chappell, R.
1990-01-01
The JOVE (NASA/university Joint Venture in space science) initiative is a point program between NASA and institutions of higher education whose aim is to bring about an extensive merger between these two communities. The project is discussed with emphasis on suggested contributions of partnership members, JOVE process timeline, and project schedules and costs. It is suggested that NASA provide a summer resident research associateship (one ten week stipend); scientific on-line data from space missions; an electronic network and work station, providing a link to the data base and to other scientists; matching student support, both undergraduate and graduate; matching summer salary for up to three faculty participants; and travel funds. The universities will be asked to provide research time for faculty participants, matching student support, matching summer salary for faculty participants, an instructional unit in space science, and an outreach program to pre-college students.
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Directory of Open Access Journals (Sweden)
Fazekas Balazs
2014-07-01
Full Text Available JEREMIE (Joint European Resources for Micro to Medium Enterprises program was implemented as a part of the EU cohesion policy in the framework of 2007-2013 programming period. The primary objective of the program was to enhance the financing prospects of SME’s through structural funds that provide financial engineering instruments like loan, guarantee and venture capital. This paper focuses on the effects of JEREMIE on Hungary’s venture capital market. Since 2010, 28 JEREMIE backed venture capital funds were founded in four rounds and 130 billion HUF capital was allocated into these funds with the contribution of Hungarian government. A well-established venture capital market can boost entrepreneurship and innovation, therefore economic growth which is the foundation of government involvement. On the other hand, there is an extensive literature highlighting the limits and possible drawbacks of the active role of public sector in the venture capital market. There is a consensus in the literature that in the long run the extensive role of government in venture capital industry is counterproductive. Substituting market participants by government agencies will hardly result in a competitive and efficient market. However, temporarily as a catalyst public sector can contribute to the development of venture capital market. Direct government intervention supportable temporarily only in the infancy of the industry. The primary objective of every program must be to develop the market to the level where it becomes self-sustaining. This way the success of these programs must not be measured only by the amount of invested capital, financial performance of venture capital funds and venture capital backed companies. Raising private sector awareness and the progress of necessary institutions are also the criteria of a successful program. During the design and implementation of venture capital agendas these aspects must be taken into consideration. This
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Attitudes of pharmacists and physicians to antibiotic policies in hospitals.
Adu, A; Simpson, J M; Armour, C L
1999-06-01
Antibiotic therapy in hospitals has substantial impact on patient outcome and the pharmacy drug budget. Antibiotic policies have been implemented by some hospitals to improve the quality of patient outcome and cost of antibiotic therapy. Antibiotic policies impose certain requirements on pharmacists and physicians. Pharmacists' and physicians' attitudes to and opinions about antibiotic policies are likely to affect the usefulness of such policies. To determine the attitudes of pharmacists and physicians to antibiotic policies in New South Wales (NSW) hospitals. Pharmacists and physicians in NSW public hospitals were surveyed to determine their attitudes to and opinions on antibiotic policies. A simple one-stage cluster sample of 241 pharmacists and a two-stage cluster sample of 701 physicians were obtained. Factor analysis was used to identify the attitudinal dimensions. General linear modelling was used to investigate the effects of predictor variables on outcome variables. The response rates were 91% and 77% for pharmacists and physicians, respectively. Factor analysis identified three dimensions of attitude to antibiotic policies: that they encourage rational antibiotic use; that they improve the quality of antibiotic prescribing and that they are associated with some problems. The reliability of these factors (Cronbach's alpha) ranged from 0.71 to 0.74, and was 0.90 for the overall attitude scale. Pharmacists and physicians had a positive overall attitude to antibiotic policies. Whereas physicians recognize that antibiotic policies improve the quality of prescribing, this was highly correlated with identification of problems (alpha = 0.71). In urban hospitals, pharmacists were more likely than physicians to associate antibiotics with problems. There was a positive overall attitude to hospital antibiotic policies expressed by pharmacists and physicians.
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Hospital employment of physicians does not improve quality
Robbins RA
2016-01-01
No abstract available. Article truncated at 150 words. The Annals of Internal Medicine posted a manuscript online today reporting that the growing trend of physician employment by hospitals does not improve quality (1). In 2003, approximately 29% of hospitals employed members of their physician workforce, a number that rose to 42% by 2012. The authors conducted a retrospective cohort study of U.S. acute care hospitals between 2003 and 2012 and examined mortality rates, 30-day readmission rate...
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Lin, Qiu-hong; Jiang, Chao-qiang; Liu, Yi-min; Guo, Jing-yi; Lam, Tai Hing
2013-12-01
To investigate the influential factors for job burnout among the managerial staff in a Sino-Japanese joint venture automobile manufacturer in Guangzhou, China. A total of 288 managers in a Sino-Japanese joint venture automobile manufacturer were surveyed using the Occupational Stress Indicator, Maslach Burnout Inventory (MBI), Eysenck Personality Questionnaire, Simplified Coping Style Questionnaire, and Social Support Rating Scale. On the depersonalization dimension, the male managers had significantly higher scores than the female managers. The scores of emotion exhaustion and depersonalization of MBI showed significant differences among the managers with different levels of occupational stress. The path analysis showed that occupational stress, neuroticism, and psychoticism had negative effects on emotion exhaustion, while job satisfaction and utilization of social support had direct positive effects on emotion exhaustion. Occupational stress, psychoticism, and passive coping style had direct negative effects on depersonalization, while job satisfaction, objective support, and utilization of social support had positive effects on depersonalization. Job satisfaction and active coping style had positive effects on sense of personal accomplishment, while passive coping style had a negative effect on sense of personal accomplishment. Personality exerted its effect on social support through coping style and thus on job satisfaction and job burnout. Male managers have a greater propensity to depersonalization than their female counterparts. High occupational stress is a risk factor for job burnout. Personality, social support, and coping style are influential factors for job burnout.
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Referring physician satisfaction: toward a better understanding of hospital referrals.
Ponzurick, T G; France, K R; Logar, C M
1998-01-01
Customer satisfaction literature has contributed significantly to the development of marketing strategies in the health-care arena. The research has led to the development of hospital-driven relationship marketing programs. This study examines the inclusion of referring physicians as partners in the hospital's relationship marketing program. In exploring this relationship, medical and hospital facility characteristics that referring physicians find important in making patient referrals to specialty care hospitals are identified and analyzed. The results lead to the development of strategic initiatives which hospital marketers should consider when developing relationship marketing programs designed to satisfy their referring physicians.
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Trends in hospital-physician integration in medical oncology.
Clough, Jeffrey D; Dinan, Michaela A; Schulman, Kevin A
2017-10-01
Hospitals have rapidly acquired medical oncology practices in recent years. Experts disagree as to whether these trends are related to oncology-specific market factors or reflect a general trend of hospital-physician integration. The objective of this study was to compare the prevalence, geographic variation, and trends in physicians billing from hospital outpatient departments in medical oncology with other specialties. Retrospective analysis of Medicare claims data for 2012 and 2013. We calculated the proportion of physicians and practitioners in the 15 highest-volume specialties who billed the majority of evaluation and management visits from hospital outpatient departments in each year, nationally and by state. We included 338,998 and 352,321 providers in 2012 and 2013, respectively, of whom 9715 and 9969 were medical oncologists. Among the 15 specialties examined, medical oncology had the highest proportion of hospital outpatient department billing in 2012 and 2013 (35.0% and 38.3%, respectively). Medical oncology also experienced the greatest absolute change (3.3%) between the years, followed by thoracic surgery (2.4%) and cardiology (2.0%). There was marked state-level variation, with the proportion of medical oncologists based in hospital outpatient departments ranging from 0% in Nevada to 100% in Idaho. Hospital-physician integration has been more pronounced in medical oncology than in other high-volume specialties and is increasing at a faster rate. Policy makers should take these findings into consideration, particularly with respect to recent proposals that may continue to fuel these trends.
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Midwest Joint Venture high-grade uranium mining
International Nuclear Information System (INIS)
Fredrickson, H.K.
1992-01-01
Midwest Joint Venture (MJV) owns a high-grade uranium deposit in northern Saskatchewan. The deposit is located too deep below surface to be mined economically by open pit methods, and as a consequence, present plans are that it will be mined by underground methods. High-grade uranium ore of the type at MJV, encased in weak, highly altered ground and with radon-rich water inflows, has not before been mined by underground methods. The test mining phase of the project, completed in 1989, had three objectives: To evaluate radiation protection requirements associated with the handling of large quantities of radon-rich water and mining high-grade uranium ore in an underground environment; to investigate the quantity and quality of water inflows into the mine; and, to investigate ground conditions in and around the ore zone as an aid in determining the production mining method to be used. With information gained from the test mining project, a mining method for the production mine has been devised. Level plans have been drawn up, ventilation system designed, pumping arrangements made and methods of ore handling considered. All this is to be done in a manner that will be safe for those doing the work underground. Some of the mining methods planned are felt to be unique in that they are designed to cope with mining problems not known to have been encountered before. New problems underground have required new methods to handle them. Remote drilling, blasting, mucking and backfilling form the basis of the planned mining method
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Hospital-physician relations: overcoming barriers to cooperation.
Orr, S R; Siegal, J T
1986-01-01
In the September-October 1986 issue of Physician Executive, we discussed the application of strategic business units (SBUs) to health care. SBUs are those corporate entities that market similar products to one or more target populations with similar characteristics. Examples of SBUs in health care are obstetrics, cardiology, orthopedics, etc. When the services within each SBU are linked together, they might resemble a vertically integrated health care system. In the case of obstetrics, a woman may have contact with physicians, a hospital, home care nurses, house-cleaning services, birthing teachers, and maternity clothing boutiques. Each of these are products/services within the SBU of obstetrics. Strategy development by SBU implies an external focus on the marketplace in terms of the specific mission of the SBU (clinical specialty). It also implies responding to the needs of consumers for whom the historical and present divisiveness between hospitals and physicians is immaterial and irrelevant. In this article, we will focus on ways to stabilize the relationship between hospitals and physicians within an SBU context in order to compete more successfully as a team in today's health care environment.
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Hospital employment of physicians and supply chain performance: An empirical investigation.
Young, Gary J; Nyaga, Gilbert N; Zepeda, E David
2016-01-01
As hospital employment of physicians becomes increasingly common in the United States, much speculation exists as to whether this type of arrangement will promote hospital operating efficiency in such areas as supply chain management. Little empirical research has been conducted to address this question. The aim of this study was to provide an exploratory assessment of whether hospital employment of physicians is associated with better supply chain performance. Drawing from both agency and stewardship theories, we examined whether hospitals with a higher proportion of employed medical staff members have relatively better supply chain performance based on two performance measures, supply chain expenses and inventory costs. We conducted the study using a pooled, cross-sectional sample of hospitals located in California between 2007 and 2009. Key data sources were hospital annual financial reports from California's Office of Statewide Health Policy and Development and the American Hospital Association annual survey of hospitals. To examine the relationship between physician employment and supply chain performance, we specified physician employment as the proportion of total employed medical staff members as well as the proportion of employed medical staff members within key physician subgroups. We analyzed the data using generalized estimating equations. Study results generally supported our hypothesis that hospital employment of physicians is associated with better supply chain performance. Although the results of our study should be viewed as preliminary, the trend in the United States toward hospital employment of physicians may be a positive development for improved hospital operating efficiency. Hospital managers should also be attentive to training and educational resources that medical staff members may need to strengthen their role in supply chain activities.
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Rural Hospital Employment of Physicians and Use of Cesareans and Nonindicated Labor Induction.
Prasad, Shailendra; Hung, Peiyin; Henning-Smith, Carrie; Casey, Michelle; Kozhimannil, Katy
2018-02-01
Workforce issues constrain obstetric care services in rural US hospitals, and one strategy hospitals use is to employ physicians to provide obstetric care. However, little is known about the relationship between hospital employment of maternity care physicians and use of obstetric care procedures in rural hospitals. We examined the association between obstetric physician employment and use of cesareans and nonindicated labor induction. We conducted a cross-sectional analysis of a telephone survey of all 306 rural hospitals providing obstetric care in 9 states from November 2013 to March 2014 and linked the survey data (N = 263, 86% response rate) to all-payer childbirth data on maternity care utilization from 2013 Statewide Inpatient Database (SID) hospital discharge data. Using logistic regression models, we assessed the proportion of a hospital's maternity care physicians employed by the hospital and estimated its association with utilization of low-risk and nonindicated cesareans, and nonindicated labor induction. Rural hospitals that employed family physicians but not obstetricians had lower cesarean rates among low-risk pregnancies. Rural hospitals that employed only obstetricians did not show a relationship between employment and procedure utilization. Across hospitals with both obstetricians and family physicians, a 10% higher proportion of obstetricians employed was associated with 4.6% higher low-risk cesarean rates (4.6% [0.7%-8.4%]), while no significant relationship was found for the proportion of family physicians employed by a hospital. In rural US hospitals, associations between physician employment and obstetric procedure use differed by physician mix and the types of physicians employed. © 2017 National Rural Health Association.
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Work hours and turnover intention among hospital physicians in Taiwan: does income matter?
Tsai, Yu-Hsuan; Huang, Nicole; Chien, Li-Yin; Chiang, Jen-Huai; Chiou, Shu-Ti
2016-11-21
Physician shortage has become an urgent and critical challenge to many countries. According to the workforce dynamic model, long work hours may be one major pressure point to the attrition of physicians. Financial incentive is a common tool to human power retention. Therefore, this large-scale physician study investigated how pay satisfaction may influence the relationship between work hours and hospital physician's turnover intention. Data were obtained from a nationwide survey of full-time hospital staff members working at 100 hospitals in Taiwan. The analysis sample comprised 2423 full-time physicians. Dependent variable was degree of the physicians' turnover intention to leave the current hospital. The pay satisfaction was assessed by physicians themselves. We employed ordinal logistic regression models to analyze the association between the number of work hours and turnover intention. To consider the cluster effect of hospitals, we used the "gllamm" command in the statistical software package Stata Version 12.1. The results show that 351 (14.5%) of surveyed physicians reported strong intention to leave current hospital. The average work hours per week among hospital physicians was 59.8 h. As expected, work hours exhibited an independent relationship with turnover intention. More importantly, pay satisfaction could not effectively moderate the positive relationship between work hours and intentions to leave current hospital. The findings show that overtime work is prevalent among hospital physicians in Taiwan. Both the Taiwanese government and hospitals must take action to address the emerging problem of physician high turnover rate. Furthermore, hospitals should not consider relying solely on financial incentives to solve the problem. This study encouraged tackling work hour problem, which would lead to the possibility of solving high turnover intention among hospital physicians in Taiwan.
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Impact of HMO market structure on physician-hospital strategic alliances.
Burns, L R; Bazzoli, G J; Dynan, L; Wholey, D R
2000-04-01
To assess the impact of HMO market structure on the formation of physician-hospital strategic alliances from 1993 through 1995. The two trends, managed care and physician-hospital integration have been prominent in reshaping insurance and provider markets over the past decade. Pooled cross-sectional data from the InterStudy HMO Census and the Annual Survey conducted by the American Hospital Association (AHA) between 1993 and the end of 1995 to examine the effects of HMO penetration and HMO numbers in a market on the formation of hospital-sponsored alliances with physicians. Because prior research has found nonlinear effects of HMOs on a variety of dependent variables, we operationalized HMO market structure two ways: using a Taylor series expansion and cross-classifying quartile distributions of HMO penetration and numbers into 16 dummy indicators. Alliance formation was operationalized using the presence of any alliance model (IPA, PHO, MSO, and foundation) and the sum of the four models present in the hospital. Because managed care and physician-hospital integration are endogenous (e.g., some hospitals also sponsor HMOs), we used an instrumental variables approach to model the determinants of HMO penetration and HMO numbers. These instruments were then used with other predictors of alliance formation: physician supply characteristics, the extent of hospital competition, hospital-level descriptors, population size and demographic characteristics, and indicators for each year. All equations were estimated at the MSA level using mixed linear models and first-difference models. Contrary to conventional wisdom, alliance formation is shaped by the number of HMOs in the market rather than by HMO penetration. This confirms a growing perception that hospital-sponsored alliances with physicians are contracting vehicles for managed care: the greater the number of HMOs to contract with, the greater the development of alliances. The models also show that alliance formation is
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Mitchell, Jean M
2008-07-01
Although physician-owned specialty hospitals have become increasingly prevalent in recent years, little research has examined whether the financial incentives linked to ownership influence physicians' referral rates for services performed at the specialty hospital. We compared the practice patterns of physician owners of specialty hospitals in Oklahoma, before and after ownership, to the practice patterns of physician nonowners who treated similar cases over the same time period in Oklahoma markets without physician-owned specialty hospitals. We constructed episodes of care for injured workers with a primary diagnosis of back/spine disorders. We used pre-post comparisons and difference-in-differences analysis to evaluate changes in practice patterns for physician owners and nonowners over the time period spanned by the entry of the specialty hospital. Findings suggest the introduction of financial incentives linked to ownership coincided with a significant change in the practice patterns of physician owners, whereas such changes were not evident among physician nonowners. After physicians established ownership interests in a specialty hospital, the frequency of use of surgery, diagnostic, and ancillary services used in the treatment of injured workers with back/spine disorders increased significantly. Physician ownership of specialty hospitals altered the frequency of use for an array of procedures rendered to patients treated at these hospitals. Given the growth in physician-owned specialty hospitals, these findings suggest that health care expenditures will be substantially greater for patients treated at these institutions relative to persons who obtain care from nonself-referral providers.
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Reimbursement in hospital-based vascular surgery: Physician and practice perspective.
Perri, Jennifer L; Zwolak, Robert M; Goodney, Philip P; Rutherford, Gretchen A; Powell, Richard J
2017-07-01
The purpose of this study was to determine change in value of a vascular surgery division to the health care system during 6 years at a hospital-based academic practice and to compare physician vs hospital revenue earned during this period. Total revenue generated by the vascular surgery service line at an academic medical center from 2010 through 2015 was evaluated. Total revenue was measured as the sum of physician (professional) and hospital (technical) net revenue for all vascular-related patient care. Adjustments were made for work performed, case complexity, and inflation. To reflect the effect of these variables, net revenue was indexed to work relative value units (wRVUs), case mix index, and consumer price index, which adjusted for work, case complexity, and inflation, respectively. Differences in physician and hospital net revenue were compared over time. Physician work, measured in RVUs per year, increased by 4%; case complexity, assessed with case mix index, increased by 10% for the 6-year measurement period. Despite stability in payer mix at 64% to 69% Medicare, both physician and hospital vascular-related revenue/wRVU decreased during this period. Unadjusted professional revenue/wRVU declined by 14.1% (P = .09); when considering case complexity, physician revenue/wRVU declined by 20.6% (P = .09). Taking into account both case complexity and inflation, physician revenue declined by 27.0% (P = .04). Comparatively, hospital revenue for vascular surgery services decreased by 13.8% (P = .07) when adjusting for unit work, complexity, and inflation. At medical centers where vascular surgeons are hospital based, vascular care reimbursement decreased substantially from 2010 to 2015 when case complexity and inflation were considered. Physician reimbursement (professional fees) decreased at a significantly greater rate than hospital reimbursement for vascular care. This trend has significant implications for salaried vascular surgeons in hospital
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Rosta, Judith; Gerber, Andreas
2007-01-01
Objectives: To determine correlations between excessively long working hours and subjectively experienced somatic health complaints among hospital physicians. Methods: Quantitative data were collected as part of the survey “Working life, Lifestyle and Health of Hospital Physicians in Germany 2006” using self-reporting questionnaires. The individually experienced health was assessed on the basis of Zerssen’s [1] list of somatic complaints. The indicator of excessively long working hours was de...
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Determinants of workplace violence against clinical physicians in hospitals.
Wu, Jeng-Cheng; Tung, Tao-Hsin; Chen, Peter Y; Chen, Ying-Lin; Lin, Yu-Wen; Chen, Fu-Li
2015-01-01
Workplace violence in the health sector is a worldwide concern. Physicians play an essential role in health-care teamwork; thus, understanding how organizational factors influence workplace violence against physicians is critical. A total of 189 physicians from three public hospitals and one private hospital in Northern Taiwan completed a survey, and the response rate was 47.1%. This study was approved by the institutional review board of each participating hospital. The 189 physicians were selected from the Taipei area, Taiwan. The results showed that 41.5% of the respondents had received at least one workplace-related physical or verbal violent threat, and that 9.8% of the respondents had experienced at least one episode of sexual harassment in the 3 months before the survey. Logistic regression analysis revealed that physicians in psychiatry or emergency medicine departments received more violent threats and sexual harassment than physicians in other departments. Furthermore, physicians with a lower workplace safety climate (OR=0.89; 95% CI=0.81-0.98) and more job demands (OR=1.15; 95% CI=1.02-1.30) were more likely to receive violent threats. This study found that workplace violence was associated with job demands and the workplace safety climate. Therefore, determining how to develop a workplace safety climate and ensure a safe job environment for physicians is a crucial management policy issue for health-care systems.
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Chapman, J F; Cook, R
2002-10-01
The Blood Stocks Management Scheme (BSMS) has been established as a joint venture between the National Blood Service (NBS) in England and North Wales and participating hospitals to monitor the blood supply chain. Stock and wastage data are submitted to a web-based data-management system, facilitating continuous and complete red cell data collection and 'real time' data extraction. The data-management system enables peer review of performance in respect of stock holding levels and red cell wastage. The BSMS has developed an innovative web-based data-management system that enables data collection and benchmarking of practice, which should drive changes in stock management practice, therefore optimizing the use of donated blood.
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Ground Support Strategies at the Turquoise Ridge Joint Venture, Nevada
Sandbak, L. A.; Rai, A. R.
2013-05-01
Weak rock masses of high grade Carlin-trend gold mineralization are encountered in the Turquoise Ridge Joint Venture underground mine. The sediments consist of very weak and altered limestone, mudstone, and carbon-rich clays. The rock mass ratings are described as very poor to poor (Bieniawski in Proceedings of the symposium on exploration for rock engineering, Johannesburg, South Africa, pp. 97-106, 1976). The undercut and fill or boxes stoping mining methods are used because of the low dipping ore body geometry, complex geology, and weak rock mass. Design criteria are chosen to keep openings in weak rock as small as possible to prevent unraveling and to minimize supplementary support. Typical ground support for drifting includes the use of bolts, mesh, spiling, and shotcrete. Quality control of cemented rock fill (CRF) through sampling and aggregate sieve testing is necessary to insure high support strength. Specific support may include shotcrete arches with steel ring sets and CRF "arches" as a replacement of weak rock masses around long-term mine openings. Movement monitoring is utilized in problem areas and is needed to quantify and validate computer modeling.
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Work hours and turnover intention among hospital physicians in Taiwan: does income matter?
Directory of Open Access Journals (Sweden)
Yu-Hsuan Tsai
2016-11-01
Full Text Available Abstract Background Physician shortage has become an urgent and critical challenge to many countries. According to the workforce dynamic model, long work hours may be one major pressure point to the attrition of physicians. Financial incentive is a common tool to human power retention. Therefore, this large-scale physician study investigated how pay satisfaction may influence the relationship between work hours and hospital physician’s turnover intention. Methods Data were obtained from a nationwide survey of full-time hospital staff members working at 100 hospitals in Taiwan. The analysis sample comprised 2423 full-time physicians. Dependent variable was degree of the physicians’ turnover intention to leave the current hospital. The pay satisfaction was assessed by physicians themselves. We employed ordinal logistic regression models to analyze the association between the number of work hours and turnover intention. To consider the cluster effect of hospitals, we used the “gllamm” command in the statistical software package Stata Version 12.1. Results The results show that 351 (14.5% of surveyed physicians reported strong intention to leave current hospital. The average work hours per week among hospital physicians was 59.8 h. As expected, work hours exhibited an independent relationship with turnover intention. More importantly, pay satisfaction could not effectively moderate the positive relationship between work hours and intentions to leave current hospital. Conclusions The findings show that overtime work is prevalent among hospital physicians in Taiwan. Both the Taiwanese government and hospitals must take action to address the emerging problem of physician high turnover rate. Furthermore, hospitals should not consider relying solely on financial incentives to solve the problem. This study encouraged tackling work hour problem, which would lead to the possibility of solving high turnover intention among hospital physicians in
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Venture financing of start-ups: A model of contract between VC fund and entrepreneur
Directory of Open Access Journals (Sweden)
Osintsev Yury
2010-01-01
Full Text Available Venture capital has become one of the main sources of innovation in the modern, global economy. It is not just a substitute for bank loans: it has proven to be a more efficient way of financing projects at different stages. On one hand, venture financing allows for projects with higher risk, which leads to the possibility of higher returns on investment. On the other hand, venture investors who usually have managerial experience often participate in governing the business, which certainly adds value to the enterprise. In this paper we establish the model of contract between the venture capital fund and the entrepreneur, focusing on probably the most important issue of this contract: the shares of the parties in the business. The shares in the company determine the distribution of the joint surplus. The expected joint profits are not just exogenously specified in the contract but are dependent on the behavioral variables of both parties at the stage of fulfilling the contract. We call the behavioral variable of the entrepreneur ‘effort’ and the one of the venture fund ‘advice’. The probability of the project’s success, and hence the expected joint revenues, are increased by these two. However, both kinds of effort are costly to the respective parties that have made them. Based on this fact we can elaborate the profit functions of both sides of the contract. Our model can be considered as a basis for specifying contracts concerning venture financing. It can provide the logic for how the equilibrium shares of entrepreneur and venture fund are obtained.
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Improving patient safety and physician accountability using the hospital credentialing process
Forster, Alan J; Turnbull, Jeff; McGuire, Shaun; Ho, Michael L; Worthington, JR
2011-01-01
Abstract The lack of systematic oversight of physician performance has led to some serious cases related to physician competence and behaviour. We are currently implementing a hospital-wide approach to improve physician oversight by incorporating it into the hospital credentialing process. Our proposed credentialing method involves four systems: (1) a system for monitoring and reporting clinical performance; (2) a system for evaluating physician behaviour; (3) a complaints management system; ...
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Burns, L R; Robinson, J C
1997-01-01
Physician practice management companies (PPMCs) are one of the most visible entrants into the industry of managing physician practices, and anywhere from 100-150 are already in operation. Although PPMCs and hospital-based integrated delivery systems (IDSs) differ from each other in many ways, they share a number of common features, including the pursuit of capitation contracts from payors. As a result, PPMCs pose a growing, direct threat to hospital systems in competing for managed care contracts that cover physician service. PPMCs also provide an alternative to hospital-based IDSs at the local market level for physician group consolidation. This article looks at the structure, operation, and strategy of PPMCs and examines what implications their growth will have for hospital-based IDSs.
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The Potential for Joint Farming Ventures in Irish Agriculture: A Sociological Review
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Cush Peter
2016-03-01
Full Text Available Joint farming ventures (JFVs are promoted within Irish and EU policy discourses as strategies that can enhance the economic and social sustainability of family farming. Research has shown that JFVs, including arrangements such as farm partnerships, contract rearing and share farming, can potentially enable farmers to work cooperatively to improve farm productivity, reduce working hours, facilitate succession, develop skills and improve relationships within the farm household. In the context of increasing policy promotion of JFVs, there is a need to make some attempt at understanding the macro socio-cultural disposition of family farming to cooperation. Reviewing sociological studies of agricultural cooperation and taking a specific focus on the Irish contextual backdrop, this paper draws the reader’s attention to the importance of historical legacy, pragmatic economic and social concerns, communicative norms, inter-personal relationships, individualism and, policy and extension stimuli, all of which shape farmers’ dispositions to cooperation and to JFVs specifically.
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Hospital employment of physicians does not improve quality
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Robbins RA
2016-09-01
Full Text Available No abstract available. Article truncated at 150 words. The Annals of Internal Medicine posted a manuscript online today reporting that the growing trend of physician employment by hospitals does not improve quality (1. In 2003, approximately 29% of hospitals employed members of their physician workforce, a number that rose to 42% by 2012. The authors conducted a retrospective cohort study of U.S. acute care hospitals between 2003 and 2012 and examined mortality rates, 30-day readmission rates, length of stay, and patient satisfaction scores for common medical conditions for 803 hospitals that switched to the employment model compared with 2085 control hospitals that did not switch. Switching hospitals were more likely to be large (11.6% vs. 7.1% or major teaching hospitals (7.5% vs. 4.5% and less likely to be for-profit institutions (8.8% vs. 19.9% (all p values <0.001. The authors used Medicare Provider Analysis and Review File (MedPAR from 2002 to 2013 to calculate hospital-level risk-adjusted performance on mortality ...
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Directory of Open Access Journals (Sweden)
Nishikitani Mariko
2010-06-01
Full Text Available Abstract Background Continual collaboration between physicians and hospital-based palliative care teams represents a very important contributor to focusing on patients' symptoms and maintaining their quality of life during all stages of their illness. However, the traditionally late introduction of palliative care has caused misconceptions about hospital-based palliative care teams (PCTs among patients and general physicians in Japan. The objective of this study is to identify the factors related to physicians' attitudes toward continual collaboration with hospital-based PCTs. Methods This cross-sectional anonymous questionnaire-based survey was conducted to clarify physicians' attitudes toward continual collaboration with PCTs and to describe the factors that contribute to such attitudes. We surveyed 339 full-time physicians, including interns, employed in a general acute-care hospital in an urban area in Japan; the response rate was 53% (N = 155. We assessed the basic characteristics, experience, knowledge, and education of respondents. Multiple logistic regression analysis was used to determine the main factors affecting the physicians' attitudes toward PCTs. Results We found that the physicians who were aware of the World Health Organization (WHO analgesic ladder were 6.7 times (OR = 6.7, 95% CI = 1.98-25.79 more likely to want to treat and care for their patients in collaboration with the hospital-based PCTs than were those physicians without such awareness. Conclusion Basic knowledge of palliative care is important in promoting physicians' positive attitudes toward collaboration with hospital-based PCTs.
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Physicians lead the way at America's top hospitals.
Weber, D O
2001-01-01
The 100 Top hospitals are selected annually based on seven critical parameters for each of the 6,200-plus U.S. hospitals with 25 or more beds. They include the previous year's risk-adjusted patient mortality and complication rates, severity-adjusted average patient lengths of stay, expenses, profitability, proportional outpatient revenue, and asset turnover ratio (a measure of facility and technological pace-keeping ability). The winners are selected from five comparable size groupings--small, medium, large community, teaching, and large academic hospitals. Conspicuous among the winners at every level are physician-led organizations. Even in the majority of hospitals headed by non-physician administrators, however, the managerial capabilities of medical directors are the key to success. The most common characteristic of these award-winning hospitals is that the leadership is working together and communicating the institution's goals effectively to all levels of the organization.
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Feasibility and acceptability of a workers' health surveillance program for hospital physicians.
Ruitenburg, Martijn M; Plat, Marie-Christine J; Frings-Dresen, Monique H W; Sluiter, Judith K
2015-01-01
A Workers' Health Surveillance (WHS) program is an occupational health strategy used to detect and address the health of individual workers to improve their ability to work. This study aims to investigate the feasibility and acceptability of a new job-specific WHS for hospital physicians. All hospital physicians of the general surgery, radiotherapy and obstetrics and gynecology departments from 1 academic hospital were invited to participate in the WHS by the in-company occupational health service. An occupational physician and a medical assistant were trained to use the protocol. Feasibility was operationalized as the received and delivered dose, observed success factors and potential obstacles. Acceptability was assessed by asking whether the WHS was desirable and feasible for future use and by estimating the effects on health and work ability. Written questions and semi-structured interviews were conducted with the participating physicians, 5 department managers and the 2 occupational health professionals involved in the study. One-third of the hospital physicians (34%) participated in every part of the WHS. The delivered dose was 77/84 (92%). Almost all hospital physicians who received recommendations expected to adhere to this advice. The study participants appreciated the organization of the WHS. This WHS was positively graded (8 out of 10 max) in terms of acceptability. Positive effects of the WHS on health, work functioning and long-term work ability were perceived by 2/3 of the physicians. The new job-specific WHS for hospital physicians showed good feasibility and acceptability among participating hospital physicians, occupational health professionals and medical managers. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.
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Feasibility and acceptability of a workers’ health surveillance program for hospital physicians
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Martijn M. Ruitenburg
2015-08-01
Full Text Available Objectives: A Workers’ Health Surveillance (WHS program is an occupational health strategy used to detect and address the health of individual workers to improve their ability to work. This study aims to investigate the feasibility and acceptability of a new job-specific WHS for hospital physicians. Material and Methods: All hospital physicians of the general surgery, radiotherapy and obstetrics and gynecology departments from 1 academic hospital were invited to participate in the WHS by the in-company occupational health service. An occupational physician and a medical assistant were trained to use the protocol. Feasibility was operationalized as the received and delivered dose, observed success factors and potential obstacles. Acceptability was assessed by asking whether the WHS was desirable and feasible for future use and by estimating the effects on health and work ability. Written questions and semi-structured interviews were conducted with the participating physicians, 5 department managers and the 2 occupational health professionals involved in the study. Results: One-third of the hospital physicians (34% participated in every part of the WHS. The delivered dose was 77/84 (92%. Almost all hospital physicians who received recommendations expected to adhere to this advice. The study participants appreciated the organization of the WHS. This WHS was positively graded (8 out of 10 max in terms of acceptability. Positive effects of the WHS on health, work functioning and long-term work ability were perceived by 2/3 of the physicians. Conclusions: The new job-specific WHS for hospital physicians showed good feasibility and acceptability among participating hospital physicians, occupational health professionals and medical managers.
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Griffith, G M
1996-01-01
On March 15, 1995, the Internal Revenue Service (IRS) announced a proposed revenue ruling stating how certain physician recruitment practices could be implemented without threatening hospitals' tax-exemption. As proposed, the IRS ruling would provide flexibility for recruitment incentives rather than a list of strict physician recruitment guidelines. The proposed ruling is not legally binding until issued in final form, and there is no deadline for finalizing it. In the meantime, however, the standards outlined in the proposed ruling reflect arrangements the IRS likely would approve, which should be an incentive for tax-exempt hospitals to follow reasonable physician recruitment practices. Assuming a hospital complies with other legal requirements such as fraud and abuse laws, it must answer two key tax-exempt status questions for its recruitment or retention package: Will the incentives result in a disguised distribution of profits from the operation of the organization? Is the total incentive package reasonable under all the facts and circumstances, both in absolute total value for physician(s) recruited and in relation to services required by the hospital and the community? The proposed ruling also provides guidance on basic documentation requirements and a process for approving recruitment arrangements.
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The organizational commitment of emergency physicians in Spanish public hospitals
Noval de la Torre, A; Bulchand Gidumal, J; Melián González, S
2016-12-30
Background. There are not too many studies that deal with the organizational commitment of emergency physicians. This commitment has been shown to impact organizational performance. The aim of this paper is to analyse the degree of commitment of the emergency physicians in Spanish public hospitals and the factors that may influence it. Method. Online survey using SurveyMonkey to emergency physicians in Spanish public hospitals. Results. Two hundred and five questionnaires were received, 162 from physicians and 43 from heads of the emergency service. Results show an intermediate level of commitment, with affective commitment showing the lowest level and continuance commitment showing the highest level. The capabilities of the physician have an influence on their affective commitment; specific training in emergency procedures and seniority has an influence on their continuance commitment; and the opinion they hold about the organization of their service influences affective commitment. Conclusions. Emergency physicians show an average involvement in the hospital in which they work (average 3.8 on a range of 1 to 5), feel an average affection for it (3.4), and have a high intention to keep working there (4.0). The resources the hospital has due to its level do not have an influence on this commitment, while the training and perceptions of the service do have an influence.
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Front-Line Physicians' Satisfaction with Information Systems in Hospitals.
Peltonen, Laura-Maria; Junttila, Kristiina; Salanterä, Sanna
2018-01-01
Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.
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Investigation of the Effect of Cultural Adaptation on International Joint Venture Performance
ÖZORHON, Beliz; ALTUN, Hasan
2017-01-01
Internationaljoint ventures (IJVs) have a great importance as a strategic alternative inglobal competition. Cultural differences between partners from differentcountries may cause lower performance levels in such ventures. The majorobjective of this study is to investigate the influence of national andorganizational culture adaptation of partnerson the IJV performance. In this respect, a questionnaire survey wasadministered to medium to large scale contractors,thgat are members of the Turkish...
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Kowalski, Christoph; Nitzsche, Anika; Scheibler, Fueloep; Steffen, Petra; Albert, Ute-Susann; Pfaff, Holger
2009-12-01
To examine whether patients' perception of a hospital's organizational climate has an impact on their trust in physicians after accounting for physicians' communication behaviors as perceived by the patients and patient characteristics. Patients undergoing treatment in breast centers in the German state of North Rhein-Westphalia in 2006 were asked to complete a standardized postal questionnaire. Disease characteristics were then added by the medical personnel. Multiple linear regressions were performed. 80.5% of the patients responded to the survey. 37% of the variance in patients' trust in physicians can be explained by the variables included in our final model (N=2226; R(2) adj.=0.372; porganizational climate. The impact of their perception of physicians' communication behaviors persists after introducing hospital organizational characteristics. Perceived physician accessibility shows the strongest association with trust. A trusting physician-patient relationship among breast cancer patients is associated with both the perceived quality of the hospital organizational climate and perceived physicians' communication behaviors. With regard to clinical organization, efforts should be put into improving the organizational climate and making physicians more accessible to patients.
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5 CFR 890.905 - Limits on inpatient hospital and physician charges.
2010-01-01
... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Limits on inpatient hospital and physician charges. 890.905 Section 890.905 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... Inpatient Hospital Charges, Physician Charges, and FEHB Benefit Payments § 890.905 Limits on inpatient...
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Physician recruitment in Ontario Provincial Psychiatric Hospitals.
Draper, R; Galbraith, D; Frost, B
1989-11-01
Recruitment of Physicians/Psychiatrists to staff the Ontario Provincial Psychiatric Hospitals remains an ongoing problem despite the introduction of measures such as University Affiliation and Incentive Grants. Historically there has been heavy reliance upon Foreign Medical Graduates (GOFM's) who have been denied the possibility of professional mobility and advancement because of restrictive licences. Recent changes in regulations have severely restricted the recruitment of GOFM's. During 1987, details of all physicians employed in the provincial hospitals during the preceeding five years were entered into a computerized data base. This paper presents some initial analyses which indicate that Canadian graduates have provided low levels of service, especially outside major urban centres, quite insufficient to replace the GOFM's. These findings raise urgent social and professional concerns.
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Trybou, Jeroen; Gemmel, Paul; Desmidt, Sebastian; Annemans, Lieven
2017-01-13
To be successful, hospitals must increasingly collaborate with their medical staff. One strategic tool that plays an important role is the mission statement of hospitals. The goal of this research was to study the relationship between the fulfillment of administrative and professional obligations of hospitals on physicians' motivation to contribute to the mission of the hospital. Furthermore the mediating role of the physicians' emotional attachment to the hospital and moderation effect of the exchange with the head physicians were considered. Self-employed physicians of six hospitals participated in a survey. Descriptive analyses and linear regression were used to analyse the data. The results indicate that affective commitment mediated the relationship between psychological contract fulfillment and mission statement motivation. In addition, the quality of exchange with the Chief Medical Officer moderated the relationship between the fulfillment of administrative obligations and affective commitment positively. This study extends our understanding of social exchange processes and mission statement motivation of physicians. We showed that when physicians perceive a high level of fulfillment of their psychological contract they are more committed and more motivated to contribute to the mission statement. A high quality relationship between physician and Chief Medical Officer can enhance this reciprocity dynamic.
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Current market trends in hospital/physician integration.
Bauman, Randy R
2009-01-01
This article explores recent trends that are dramatically changing the landscape of typical hospital/physician integration models and provides the reader with useful insights to better evaluate this dynamically changing marketplace.
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The impact of the hospital work environment on social support from physicians in breast cancer care.
Ansmann, Lena; Wirtz, Markus; Kowalski, Christoph; Pfaff, Holger; Visser, Adriaan; Ernstmann, Nicole
2014-09-01
Research on determinants of a good patient-physician interaction mainly disregards systemic factors, such as the work environment in healthcare. This study aims to identify stressors and resources within the work environment of hospital physicians that enable or hinder the physicians' provision of social support to patients. Four data sources on 35 German breast cancer center hospitals were matched: structured hospital quality reports and surveys of 348 physicians, 108 persons in hospital leadership, and 1844 patients. Associations between hospital structures, physicians' social resources as well as job demands and control and patients' perceived support from physicians have been studied in multilevel models. Patients feel better supported by their physicians in hospitals with high social capital, a high percentage of permanently employed physicians, and less physically strained physicians. The results highlight the importance of the work environment for a good patient-physician interaction. They can be used to develop interventions for redesigning the hospital work environment, which in turn may improve physician satisfaction, well-being, and performance and consequently the quality of care. Health policy and hospital management could create conditions conducive to better patient-physician interaction by strengthening the social capital and by increasing job security for physicians. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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Jabson, Jennifer M; Mitchell, Jason W; Doty, S Benjamin
2016-03-12
Some physicians lack knowledge and awareness about health issues specific to sexual and gender minority (SGM) individuals. To help improve this, hospitals have implemented policies that mandate non-discrimination and training to promote sexual and gender minority health. There is limited evidence about how such policies relate to physicians' knowledge, attitudes, and gender and sexual minority affirmative practices. A random sample of 1000 physicians was recruited from a complete list of physicians affiliated with one of two university Hospitals located in Tennessee and 180 physicians completed the survey concerning attitudes and knowledge about SGM individuals. Physicians were affiliated with either Hospital A that had not implemented policies for non-discrimination and training, or Hospital B that did. Physicians held different attitudes about SGM patients than non-patients. Physicians affiliated with Hospital A held more negative attitudes about SGM individuals who were non-patients than physicians affiliated with Hospital B. There were no differences between the two hospitals in physicians' attitudes and knowledge about SGM patients. Policies that mandate non-discrimination and training as they currently exist may not improve physicians' attitudes and knowledge about SGM individuals. Additional research is needed to understand how these policies and trainings relate to physicians' SGM affirmative practices.
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Neprash, Hannah T; Chernew, Michael E; Hicks, Andrew L; Gibson, Teresa; McWilliams, J Michael
2015-12-01
Financial integration between physicians and hospitals may help health care provider organizations meet the challenges of new payment models but also may enhance the bargaining power of provider organizations, leading to higher prices and spending in commercial health care markets. To assess the association between recent increases in physician-hospital integration and changes in spending and prices for outpatient and inpatient services. Using regression analysis, we estimated the relationship between changes in physician-hospital integration from January 1, 2008, through December 31, 2012, in 240 metropolitan statistical areas (MSAs) and concurrent changes in spending. Adjustments were made for patient, plan, and market characteristics, including physician, hospital, and insurer market concentration. The study population included a cohort of 7,391,335 nonelderly enrollees in preferred-provider organizations or point-of-service plans included in the Truven Health MarketScan Commercial Database during the study period. Data were analyzed from December 1, 2013, through July 13, 2015. Physician-hospital integration, measured using Medicare claims data as the share of physicians in an MSA who bill for outpatient services with a place-of-service code indicating employment or practice ownership by a hospital. Annual inpatient and outpatient spending per enrollee and associated use of health care services, with utilization measured by price-standardized spending (the sum of annual service counts multiplied by the national mean of allowed charges for the service). Among the 240 MSAs, physician-hospital integration increased from 2008 to 2012 by a mean of 3.3 percentage points, with considerable variation in increases across MSAs (interquartile range, 0.8-5.2 percentage points). For our study sample of 7,391,335 nonelderly enrollees, an increase in physician-hospital integration equivalent to the 75th percentile of changes experienced by MSAs was associated with a mean
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Straley, P F; Swaim, C R
1994-01-01
Employers seeking to reduce health care expenditures are turning to direct contracting as a way to control provider cost increases. In a direct contract, the participation of third parties is minimized. The health care provider and a corporate buyer directly negotiate a price agreement for the delivery of health care services. However, as managed care penetration increases, the ability of hospitals and physicians to assume risk while providing high quality, cost effective care will be paramount. Physicians and hospitals who choose to work together may find a physician-hospital organization an effective vehicle to meet the current and future market challenges of direct contracting.
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Physician-hospital relationships: from historical failures to successful "new kids on the block".
Payton, Bruce
2012-01-01
Trends in healthcare reveal that increasing numbers of physicians prefer to work directly with hospitals-whether through employment models, new or revived partnership structures, or other such "deals". Meanwhile, hospital executives are vigorously seeking ways to create win-win arrangements that satisfy both parties-models that will ensure medical coverage for the hospital, along with revenue gains and cost savings when possible. Add to this a competitive environment, physician shortages, and high regulatory activity and healthcare reform, and the path to clinical, operational, and financial viability in the context of a hospital/physician partnership can be a challenging one. Models such as The physician enterprise and co-management agreements are gaining popularity, each with distinct benefits. With market forces dynamically changing, along with accountable care, it is time for hospitals, health systems, and physicians to prioritize their partnering relationships, a strategy that is now key to achieving success in the future...and that's a trend that's likely to continue far into the years ahead.
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Shapleigh, C
1985-10-01
Physician-practice patterns are discussed, and programs of decentralization designed to reduce ancillary use are described. The New England Medical Center (NEMC) conducted a study with two other major hospitals in Boston comparing physician-practice patterns for patients who had had carotid endarterectomies. The indications for surgery for these patients did not appear to be different among the hospitals; however, average charges and length of stay varied considerably. Operating-room time and postoperative management also varied substantially. Strategies to change physician-practice patterns must address the issues of incentives to physicians and hospitals. At NEMC, a program of decentralization is being implemented that involves physician participation in budgeting hospital resources. A program of product pricing has been developed, whereby the NEMC offers an HMO a fixed price for certain kinds of cases upon admission. A daily use report was started to report resource use for specific cases compared with annual medians for that type of case. Case types from many different surgical specialties are involved. The reports show physicians the difference between the actual and expected costs in terms of variances. The NEMC has reoriented its budgeting process to include clinical divisions. Clinical services are planning to budget the use of intermediate products across different cost centers. The clinical budgeting program makes the planning process more objective, lowers the use of ancillary services, and reduces costs.
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ALI AZEEZ ALI AL-JUMAILI
2016-08-01
Full Text Available The objectives of this study were to measure the incidence and types of medication prescribing errors (MPEs in Iraqi hospitals, to calculate for the first time the percentage of physician agreement with pharmacist medication regimen review (MRR recommendations regarding MPEs, and to identify the factors influencing the physician agreement rate with these recommendations. Methods: Fourteen pharmacists (10 females and 4 males reviewed each hand-written physician order for 1506 patients who were admitted to two public hospitals in Al-Najaf, Iraq during August 2015. The pharmacists identified medication prescribing errors using the Medscape WebMD, LCC phone application as a reference. The pharmacists contacted the physicians (2 females and 34 males in-person to address MPEs that were identified. Results: The pharmacists identified 78 physician orders containing 99 MPEs with an incidence of 6.57 percent of all the physician orders reviewed. The patients with MPEs were taking 4.8 medications on average. The MPEs included drug-drug interactions (65.7%, incorrect doses (16.2%, unnecessary medications (8.1%, contra-indications (7.1%, incorrect drug duration (2%, and untreated conditions (1%. The physicians implemented 37 (37.4% pharmacist recommendations. Three factors were significantly related to physician acceptance of pharmacist recommendations. These were physician specialty, pharmacist gender, and patient gender. Pediatricians were less likely (OR= 0.1 to accept pharmacist recommendations compared to internal medicine physicians. Male pharmacists received more positive responses from physicians (OR=7.11 than female pharmacists. Lastly, the recommendations were significantly more likely to be accepted (OR= 3.72 when the patients were females. Conclusions: The incidence of MPEs is higher in Iraqi hospitalized patients than in the U.S. and U.K, but lower than in Brazil, Ethiopia, India, and Croatia. Drug-drug interactions were the most common type of
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Hospital's activity-based financing system and manager-physician [corrected] interaction.
Crainich, David; Leleu, Hervé; Mauleon, Ana
2011-10-01
This paper examines the consequences of the introduction of an activity-based reimbursement system on the behavior of physicians and hospital's managers. We consider a private for-profit sector where both hospitals and physicians are initially paid on a fee-for-service basis. We show that the benefit of the introduction of an activity-based system depends on the type of interaction between managers and physicians (simultaneous or sequential decision-making games). It is shown that, under the activity-based system, a sequential interaction with physician leader could be beneficial for both agents in the private sector. We further model an endogenous timing game à la Hamilton and Slutsky (Games Econ Behav 2: 29-46, 1990) in which the type of interaction is determined endogenously. We show that, under the activity-based system, the sequential interaction with physician leader is the unique subgame perfect equilibrium.
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THE PREVALENCE OF STRESS AND BURNOUT SYNDROME IN HOSPITAL DOCTORS AND FAMILY PHYSICIANS.
Stanetic, Kosana D; Savic, Suzana M; Racic, Maja
2016-11-01
Introducti on. Burnout syndrome is the result of chronic emotional stress. It is characterized by high levels of emotional exhaustion and depersonalization, and reduced level of personal accomplishment. The aim of this study was to determine the level of stress and risk ror burnout syndrome in doctors employed in health centers and hospitals, and to investigate the impact of socio-derrdgraphic characteristics on the level of stress and the o ccurrence of burnout syndrome. A cross-sectional study was conducted in the period from October I to December 31, 2015 in three health centers and in the University Clinical Center of the Republic of Srpska. The survey was anonymous. A socio-demographic questionnaire and a questionnaire for self-assessment of the level of stress and Maslach Burnout Inventory were used as research instruments. Out of 151 doctors included in the study, 49% were family physicians, and 51% were hospital doctors. The analysis of responses to questionnaires for self-assessment of stress level revealed that 51.7% of participants had high levels of stress (52.7% of family physicians, 50.6% of doctors working in hospital). A high degree of emotional exhaustion was found in 27.2% of participants (29.7% of fam ily physicians, 24.6% of doctors working in hospital), high depersonalization was found in 23.8% of participants (25.7% of family physicians, 22. 1% of doctors working in hospital), a low level of personal accomplishment was found in 39.7% of participants (37.8% of family physicians. 41.6% of doctors working in hospital). No statistically significant difference regarding stress degree, emotional exhaustion and depersonalizaion and personal accomplishment was found between hospital doctors and family physicians. The physicians aged over 45 years had a significantly (p = 0.030) higher level of emotional exhaustion than their younger colleagues. This study found that there was a high risk of burnout syndrome in physicians in the Republic of Srpska
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Hospital restructuring and physician job satisfaction: an empirical study.
Mascia, Daniele; Morandi, Federica; Cicchetti, Americo
2014-02-01
The adoption of clinical directorates through the internal reconfiguration of hospital organizations has been one of the most widespread restructuring interventions in many Western European countries. Despite its extensive adoption, a lack of knowledge remains on the analysis of how this reorganization affects professionals' job satisfaction. This paper contributes to the debate on clinical directorates by exploring how the structural characteristics of newly adopted organizational models influence physician's job satisfaction. More than 300 physicians in 18 clinical directorates in the Italian National Health Service were surveyed regarding their overall job satisfaction following the introduction of departmental arrangements. Survey results were then linked to another survey that classified newly adopted models according to the criteria used to merge hospital wards into directorates, by recognizing "Process-integration", "Specialty-integration" and "Mixed-integration" types of directorates. Our findings show that structural aspects of change significantly influenced overall job satisfaction, and that a physician's openness to experience moderated the adoption and implementation of new clinical directorates. Specifically, results demonstrate that physicians with high openness to experience scores were more receptive to the positive impacts of change on overall job satisfaction. Implications for how these findings may facilitate organizational shifts within hospital settings are discussed. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
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Universities Venture into Venture Capitalism.
Desruisseaux, Paul
2000-01-01
Reports that some universities are starting their own venture-capital funds to develop campus companies, or are investing endowment funds with established venture-capital firms inclined to finance potential spinoffs from campus research. Examples cited are from the University of Alabama, Vanderbilt University (Tennessee), University of…
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A survey of workplace violence against physicians in the hospitals, Myanmar.
Kasai, Yuichi; Mizuno, Tetsutaro; Sakakibara, Toshihiko; Thu, Si; Kyaw, Thein Aung; Htun, Kyaw Aung
2018-02-15
Workplace violence in hospitals is recently becoming a major global concern in many countries. However, in Myanmar, we have felt that patients and their families have rarely made unreasonable complaints in hospitals, and then, the purpose of this study is to report the current state of workplace violence in hospitals in Myanmar. Participants are 196 physicians (108 males and 88 females) in hospitals in Myanmar. A descriptive survey was conducted in regard to verbal abuse and physical violence from patients or the people concerned. At the results of this study, the percentages of physicians who have encountered verbal abuse and those who have encountered physical violence are markedly low (8.7 and 1.0%, respectively). The present study is the first to report the frequencies of verbal abuse and physical violence against physicians in a least developed country, and the results of the present study are important in terms of discussing workplace violence in hospitals.
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Sommersguter-Reichmann, Margit; Stepan, Adolf
2017-12-01
Institutional corruption in the health care sector has gained considerable attention during recent years, as it acknowledges the fact that service providers who are acting in accordance with the institutional and environmental settings can nevertheless undermine a health care system's purposes as a result of the (financial) conflicts of interest to which the service providers are exposed. The present analysis aims to contribute to the examination of institutional corruption in the health sector by analyzing whether the current payment mechanism of separately remunerating salaried hospital physicians for treating supplementary insured patients in public hospitals, in combination with the public hospital physician's possibility of taking up dual practice as a self-employed physician with a private practice and/or as an attending physician in private hospitals, has the potential to undermine the primary purposes of the Austrian public health care system. Based on the analysis of the institutional design of the Austrian public hospital sector, legal provisions and directives have been identified, which have the potential to promote conduct on the part of the public hospital physician that systematically undermines the achievement of the Austrian public health system's primary purposes.
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Trybou, Jeroen; Gemmel, Paul; Van Vaerenbergh, Yves; Annemans, Lieven
2014-01-01
Background: Belgian hospitals face a growing shortage of physicians and increasingly competitive market conditions. In this challenging environment hospitals are struggling to build effective hospital-physician relationships which are considered to be a critical determinant of organizational success. Methods: Employed physicians of a University hospital were surveyed. Organizational attributes were identified through the literature and two focus groups. Variables were measured using valida...
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Trybou, Jeroen; Gemmel, Paul; Van Vaerenbergh, Yves; Annemans, Lieven
2014-05-21
Belgian hospitals face a growing shortage of physicians and increasingly competitive market conditions. In this challenging environment hospitals are struggling to build effective hospital-physician relationships which are considered to be a critical determinant of organizational success. Employed physicians of a University hospital were surveyed. Organizational attributes were identified through the literature and two focus groups. Variables were measured using validated questionnaires. Descriptive analyses and linear regression were used to test the model and relative importance analyses were performed. The selected attributes predict hospital attractiveness significantly (79.3%). The relative importance analysis revealed that hospital attractiveness is most strongly predicted by professional attributes (35.3%) and relational attributes (29.7%). In particular, professional development opportunities (18.8%), hospital prestige (16.5%), organizational support (17.2%) and leader support (9.3%) were found to be most important. Besides these non-economic aspects, the employed physicians indicated pay and financial benefits (7.4%) as a significant predictor of hospital attractiveness. Work-life balance and job security were not significantly related to hospital attractiveness. This study shows that initiatives aimed at strengthening physicians' positive perceptions of professional and relational aspects of practicing medicine in hospitals, while assuring satisfactory financial conditions, may offer useful avenues for increasing the level of perceived hospital attractiveness. Overall, hospitals are advised to use a differentiated approach to increase their attractiveness to physicians.
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Directory of Open Access Journals (Sweden)
Rosta, Judith
2007-11-01
Full Text Available Objectives: To determine correlations between excessively long working hours and subjectively experienced somatic health complaints among hospital physicians. Methods: Quantitative data were collected as part of the survey “Working life, Lifestyle and Health of Hospital Physicians in Germany 2006” using self-reporting questionnaires. The individually experienced health was assessed on the basis of Zerssen’s [1] list of somatic complaints. The indicator of excessively long working hours was defined as 10 or more working hours per working day and 6 or more on-call shifts a month among full-time employees. The net sample consisted of 3295 randomly selected physicians from 515 hospitals. Results: The response rate was 58% (n=1917. Physicians with excessively long working hours (19% had significantly higher sum score of health complaints (p=0.0001 and significantly increased mental and physical fatigue symptoms (feeling faint, languor, uneasiness, heavy legs, excessive need for sleep, trembling; p=0.0001 to 0.047, mood changes (irritability, brooding; p=0.008 to 0.014, gastrointestinal (nausea, loss of weight; p=0.0001 to 0.014 and heart disorders (lumpy sensation in the throat, chest pain; p=0.0001 to 0.042. When the sum score of health complaints was controlled for selected confounders, being female (B=-3.44, p=0.0001 and having excessively long working hours (B=2.76, p=0.0001 were significantly correlated with health complaints. In a separate gender analysis, being exposed to excessively long working hours remained a significant predictor for health complaints among both females (B=3.78, p=0.001 and males (B=2.28, p=0.004. Conclusions: Excessively long working hours are associated with an increased risk of health complaints. Reducing working hours may be the first step to improving physicians' health.
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How Korean Venture Capitals Invest In New Technology Ventures
Directory of Open Access Journals (Sweden)
Youngkeun Choi
2013-01-01
Full Text Available In the entrepreneurship field, this study examines what kinds of external endorsements are helpful for venture capitals investment and the growth of new technology ventures in developing countries. This study uses the signalling theory and the methodologies of multiple regression and survival analysis with the panel data of the ventures in Korea. In the results, collaboration with business groups and certification of government are positively influential in attracting venture capitals’ investment, which accelerate the growth of new technology ventures. The practical implication for entrepreneurs is that they need to obtain the endorsement from business groups and governments strategically.
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Engelhard and IFP/Procatalyse set up worldwide catalysts venture
International Nuclear Information System (INIS)
Hunter, D.
1992-01-01
The new joint venture between Engelhard (Iselin, N) and Procatalyse (Paris), jointly owned by process licenser Institut Francais de Petrole (IFP; Rueil Malmaison, France) and Rhone-Poulenc (RP; Paris), marks the latest episode in the worldwide catalyst industry's restructuring. The operation will combine Engelhard's catalyst line, apart from its fluid catalytic cracking (FCC) and emission catalysts, with Procatalyse's offering. To be launched at the beginning of 1993, the venture will have annual sales of about $75 million. Reforming catalysts will be the biggest part of the venture's lineup at the outset, making it number three in the US, behind UOP - which dominates the sector - and Criterion. IFP is starting to establish a presence in North America with its reforming technology. But flat gasoline demand and reductions on aromatics in gasoline limit requirements for new reforming units, comments one competitor. Although lower sulfur specifications are putting some new demand into the hydrodesulfurization (HDS) catalyst market, both partners play down their prospects. The sector, whose leaders are Akzo and Crtierion, is continuing to suffer from severe overcapacity. Procatalyse's HDS business is mainly linked to IFP licensees, while Engelhard is due to mothball its Salt Lake City HDS catalyst plant by year-end, transferring output to Elyria
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How to create a marketing strategy based on hospital characteristics that attract physicians.
Nordstrom, R D; Horton, D E; Hatcher, M E
1987-03-01
Through use of multivariate statistical and research techniques, the authors analyzed 30 hospital features that contribute to a physician's image of a hospital as being a good or a poor place for patient admission and in which to practice. Use of the data obtained in this study can enable a hospital administrator to monitor changes in physicians' attitudes, plan strategies to encourage quality physicians to admit their patients, improve aspects perceived to be weak or unresponsive, and capitalize on strengths.
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Much ado about nothing? The financial impact of physician-owned specialty hospitals.
Chakravarty, Sujoy
2016-06-01
The U.S. hospital industry has recently witnessed a number of policy changes aimed at aligning hospital payments to costs and these can be traced to significant concerns regarding selection of profitable patients and procedures by physician-owned specialty hospitals. The policy responses to specialty hospitals have alternated between payment system reforms and outright moratoriums on hospital operations including one in the recently enacted Affordable Care Act. A key issue is whether physician-owned specialty hospitals pose financial strain on the larger group of general hospitals through cream-skimming of profitable patients, yet there is no study that conducts a systematic analysis relating such selection behavior by physician-owners to financial impacts within hospital markets. The current paper takes into account heterogeneity in specialty hospital behavior and finds some evidence of their adverse impact on profit margins of competitor hospitals, especially for-profit hospitals. There is also some evidence of hospital consolidation in response to competitive pressures by specialty hospitals. Overall, these findings underline the importance of the payment reforms aimed at correcting distortions in the reimbursement system that generate incentives for risk-selection among providers groups. The identification techniques will also inform empirical analysis on future data testing the efficacy of these payment reforms.
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Takamuku, Masatoshi
2015-01-01
University hospitals, bringing together the three divisions of education, research, and clinical medicine, could be said to represent the pinnacle of medicine. However, when compared with physicians working at public and private hospitals, physicians working at university hospitals and medical schools face extremely poor conditions. This is because physicians at national university hospitals are considered to be "educators." Meanwhile, even after the privatization of national hospitals, physicians working for these institutions continue to be perceived as "medical practitioners." A situation may arise in which physicians working at university hospitals-performing top-level medical work while also being involved with university and postgraduate education, as well as research-might leave their posts because they are unable to live on their current salaries, especially in comparison with physicians working at national hospitals, who focus solely on medical care. This situation would be a great loss for Japan. This potential loss can be prevented by amending the classification of physicians at national university hospitals from "educators" to "medical practitioners." In order to accomplish this, the Japan Medical Association, upon increasing its membership and achieving growth, should act as a mediator in negotiations between national university hospitals, medical schools, and the government.
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Baker, Laurence C; Bundorf, M Kate; Kessler, Daniel P
2014-05-01
We examined the consequences of contractual or ownership relationships between hospitals and physician practices, often described as vertical integration. Such integration can reduce health spending and increase the quality of care by improving communication across care settings, but it can also increase providers' market power and facilitate the payment of what are effectively kickbacks for inappropriate referrals. We investigated the impact of vertical integration on hospital prices, volumes (admissions), and spending for privately insured patients. Using hospital claims from Truven Analytics MarketScan for the nonelderly privately insured in the period 2001-07, we constructed county-level indices of prices, volumes, and spending and adjusted them for enrollees' age and sex. We measured hospital-physician integration using information from the American Hospital Association on the types of relationships hospitals have with physicians. We found that an increase in the market share of hospitals with the tightest vertically integrated relationship with physicians--ownership of physician practices--was associated with higher hospital prices and spending. We found that an increase in contractual integration reduced the frequency of hospital admissions, but this effect was relatively small. Taken together, our results provide a mixed, although somewhat negative, picture of vertical integration from the perspective of the privately insured.
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An investigation on physicians' acceptance of hospital information systems: a case study.
Chen, Rai-Fu; Hsiao, Ju-Ling
2012-12-01
Information technology is used to support a wide range of highly specified healthcare tasks and services. There is, therefore, a need to understand the factors affecting the acceptance of this technology by healthcare professionals. Physicians are key providers of healthcare services and are among the principal users of hospital information systems. Their acceptance of hospital information systems is hence of great significance when evaluating the success of those systems. The survey methodology was employed to targeted physicians in the selected case hospital for investigating factors affecting physicians' acceptance of hospital information systems. A total of 202 questionnaires were sent out, with 124 completed copies returned, indicating a valid response rate of 61.4%. We used structural equation modeling to analyze the data. The results indicated that top management support (γ=0.431, psystem quality (γ=0.369, pinformation systems. Physicians' perceptions of the usefulness (β=0.132, pinformation systems had a significant impact on the acceptance of the systems, accounting for 81.4% of total explained variance. Through the understanding of the identified critical factors affecting physicians' HIS acceptance, the planners and managers should ensure that hospital information systems to be introduced into a hospital are useful and ease to use. Effort should be focuses on providing sufficient top management support, selecting qualified project team members, and delivering higher system quality in addressing physicians' clinical needs. Thus, our research results can help planners and managers understand key considerations affecting HIS development and use, and may be used as a reference for system design, development and implementation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
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The Joint Venture Model of Knowledge Utilization: a guide for change in nursing.
Edgar, Linda; Herbert, Rosemary; Lambert, Sylvie; MacDonald, Jo-Ann; Dubois, Sylvie; Latimer, Margot
2006-05-01
Knowledge utilization (KU) is an essential component of today's nursing practice and healthcare system. Despite advances in knowledge generation, the gap in knowledge transfer from research to practice continues. KU models have moved beyond factors affecting the individual nurse to a broader perspective that includes the practice environment and the socio-political context. This paper proposes one such theoretical model the Joint Venture Model of Knowledge Utilization (JVMKU). Key components of the JVMKU that emerged from an extensive multidisciplinary review of the literature include leadership, emotional intelligence, person, message, empowered workplace and the socio-political environment. The model has a broad and practical application and is not specific to one type of KU or one population. This paper provides a description of the JVMKU, its development and suggested uses at both local and organizational levels. Nurses in both leadership and point-of-care positions will recognize the concepts identified and will be able to apply this model for KU in their own workplace for assessment of areas requiring strengthening and support.
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Bartek, Ronald J
2014-01-01
The business model for medical therapy development has changed drastically. Large companies that once conducted their own Research and Development (R&D) and funded all the preclinical studies, all phases of clinical development and marketing of the products are increasingly turning to others for more and more of the earlier work in hopes of being able to in-license a de-risked program well downstream, take it through the final phases of clinical development and into the marketplace. This new paradigm has required patient-advocacy foundations, especially in the rare-disease space, to become far more effective in building relationships with all the players along the therapy-development pathway -- academic scientists, government agencies, other foundations with overlapping interests, biotechs, small biopharmaceutical entities and even the larger industry companies. From the perspective of the patient-advocacy community, these increasingly essential public-private partnerships have taken on the nature of what could be called joint-venture philanthropy and involve a broad spectrum of collaborations and financial relationships between foundations and industry partners that are not without concerns about potential conflicts of interest.
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Energy Technology Data Exchange (ETDEWEB)
Lennie, D. [Inuvialuit Development Corp., NT (Canada)
2003-07-01
Year 2002 marks the twenty-fifth anniversary of the Inuvialuit Development Corporation (IDC), a management holding company owned by the Inuvialuit Regional Corporation which represents the interests of Inuvialuit under the Inuvialuit Final Agreement, and the Inuvialuit Land Claim Settlement. The Inuvialuit are the Inuit of Canada's western Arctic. In 2000, the Inuvialuit Land Corporation offered certain petroleum and natural gas rights to interested parties through a bidding process. The package provided a royalty regime and a requirement for exploration activities in relation to the land. The Inuvialuit Petroleum Corporation currently holds one third interest in the Ikhil Project, a joint venture with Enbridge and AltaGas which operate a natural gas production facility, a pipeline, and distribution system serving Inuvik. In addition, IDC and Akita Drilling together own four Arctic drilling rigs. IDC is at an advantage coming from the land claim and having expertise operating in the north. Over the past 25 years, it has seen both successes and failures and has learned from each experience to achieve consistent profitability year after year.
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Friesike, Sascha; Gassman, Oliver; Schweitzer, Fiona
2013-01-01
Google Ventures - the venture capital department of Google - couples the idea of a corporate incubator with the methods of a classical venture capital firm. A corporate incubator strives to create innovation, whereas a venture capital firm's idea is to create money. As such, corporate incubators
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Outcome of out-of-hospital cardiac arrest--why do physicians withhold resuscitation attempts?
DEFF Research Database (Denmark)
Horsted, Tina I; Rasmussen, Lars S; Lippert, Freddy K
2004-01-01
To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts.......To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts....
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Texaco, carbide form hydrogen plant venture
International Nuclear Information System (INIS)
Anon.
1992-01-01
This paper reports that Texaco Inc. and Union Carbide Industrial Gases Inc. (UCIG) have formed a joint venture to develop and operate hydrogen plants. The venture, named HydroGEN Supply Co., is owned by Texaco Hydrogen Inc., a wholly owned subsidiary of Texaco, and UCIG Hydrogen Services Inc., a wholly owned subsidiary of UCIG. Plants built by HydroGEN will combine Texaco's HyTEX technology for hydrogen production with UCIG's position in cryogenic and advanced air separation technology. Texaco the U.S. demand for hydrogen is expected to increase sharply during the next decade, while refinery hydrogen supply is expected to drop. The Clean Air Act amendments of 1990 require U.S. refiners to lower aromatics in gasoline, resulting in less hydrogen recovered by refiners from catalytic reforming units. Meanwhile, requirements to reduce sulfur in diesel fuel will require more hydrogen capacity
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2014-01-01
Background Belgian hospitals face a growing shortage of physicians and increasingly competitive market conditions. In this challenging environment hospitals are struggling to build effective hospital-physician relationships which are considered to be a critical determinant of organizational success. Methods Employed physicians of a University hospital were surveyed. Organizational attributes were identified through the literature and two focus groups. Variables were measured using validated questionnaires. Descriptive analyses and linear regression were used to test the model and relative importance analyses were performed. Results The selected attributes predict hospital attractiveness significantly (79.3%). The relative importance analysis revealed that hospital attractiveness is most strongly predicted by professional attributes (35.3%) and relational attributes (29.7%). In particular, professional development opportunities (18.8%), hospital prestige (16.5%), organizational support (17.2%) and leader support (9.3%) were found to be most important. Besides these non-economic aspects, the employed physicians indicated pay and financial benefits (7.4%) as a significant predictor of hospital attractiveness. Work-life balance and job security were not significantly related to hospital attractiveness. Conclusions This study shows that initiatives aimed at strengthening physicians’ positive perceptions of professional and relational aspects of practicing medicine in hospitals, while assuring satisfactory financial conditions, may offer useful avenues for increasing the level of perceived hospital attractiveness. Overall, hospitals are advised to use a differentiated approach to increase their attractiveness to physicians. PMID:24884491
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HOW DOES THE JEREMIE PROGRAM AFFECT THE HUNGARIAN VENTURE CAPITAL MARKET?
Directory of Open Access Journals (Sweden)
Zsuzsanna Széles
2011-01-01
Full Text Available In the 2007-2013 EU's budgetary period a new program was introduced for SMEs. JEREMIE - Joint European Resources for Micro to medium Enterprises - offers to EU Member States and regions the possibility to invest some of their EU structural funds allocations in revolving funds and so recycle financial resources in order to enhance and accelerate investments in enterprises. The market for venture capital and private equity is relatively small in Central and Eastern Europe, but has matured during the past decade and yields are better than in Western Europe. In 2009 Hungary got the first notification for the venture capital part of the JEREMIE program, and started to organize the channel to distribute this renewable source for Hungarian start-up and innovative (from micro to medium enterprises. 2010 was the first year of the “JEREMIE venture capital funds” in Hungary. There are no tangible results yet, but a snapshot could be taken about how this program affects the Hungarian venture capital market.
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Körber, Michael; Schmid, Klaus; Drexler, Hans; Kiesel, Johannes
2018-05-01
Medical and nursing shortages in rural areas represent a current serious public health problem. The healthcare of the rural population is at risk. This study compares perceived workload, job satisfaction and work-life balance of physicians and nurses at a clinic in a rural area with two clinics of a University hospital. Physicians and nurses were interviewed anonymously with a standardized questionnaire (paper and pencil), including questions on job satisfaction, subjective workload and work-life balance. The response rate was almost 50% in the University hospital as well as in the municipal hospital. 32 physicians and 54 nurses from the University hospital and 18 physicians and 137 nurses from the municipal hospital participated in the survey. Nurses at the University hospital assessed the organization of the daily routine with 94.1% as better than those at the municipal hospital (82.4%, p=0.03). Physicians at the University hospital were able to better implement acquired knowledge at a University clinic with 87.5% than their counterparts at the municipal hospital (55.5%, p=0.02). In contrast to their colleagues at the municipal hospital, only 50% of the physicians at the University hospital subjectively considered their workload as just right (83.3% municipal, p=0.02). 96.9% of the physicians at the University hospital were "daily" or "several times a week" under time pressure (municipal 50%, pwork and family life (62.9% University hospital, 72.8% Municipal hospital). In contrast, only 20% of the physicians at the University Hospital but 42.9% of the physicians of the municipal hospital had sufficient opportunities to balance workload and family (p=0.13). The return rate of almost 50% can be described as good. Due to the small number of physicians, especially from the municipal hospital, it can be assumed that some interesting differences could not be detected. There were only slight differences between the nurses from the two hospitals. In contrast, subjective
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The Ideal Hospital Discharge Summary: A Survey of U.S. Physicians.
Sorita, Atsushi; Robelia, Paul M; Kattel, Sharma B; McCoy, Christopher P; Keller, Allan Scott; Almasri, Jehad; Murad, Mohammad Hassan; Newman, James S; Kashiwagi, Deanne T
2017-09-06
Hospital discharge summaries enable communication between inpatient and outpatient physicians. Despite existing guidelines for discharge summaries, they are frequently suboptimal. The aim of this study was to assess physicians' perspectives about discharge summaries and the differences between summaries' authors (hospitalists) and readers (primary care physicians [PCPs]). A national survey of 1600 U.S. physicians was undertaken. Primary measures included physicians' preferences in discharge summary standardization, content, format, and audience. A total of 815 physicians responded (response rate = 51%). Eighty-nine percent agreed that discharge summaries "should have a standardized format." Most agreed that summaries should "document everything that was done, found, and recommended in the hospital" (64%) yet "only include details that are highly pertinent to the hospitalization" (66%). Although 74% perceived patients as an important audience of discharge summaries, only 43% agreed that summaries "should be written in language that patients…can easily understand," and 68% agreed that it "should be written solely for provider-to-provider communication." Compared with hospitalists, PCPs preferred comprehensive summaries (68% versus 59%, P = 0.002). More PCPs agreed that separate summaries should be created for patients and for provider-to-provider communication than hospitalists (60% versus 47%, P summary" (44% versus 23%, P summary" (60% versus 38%, P summaries should have a standardized format but do not agree on how comprehensive or in what format they should be. Efforts are necessary to build consensus toward the ideal discharge summary.
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Economic analysis of venture capital funds rate of return on venture activity
Directory of Open Access Journals (Sweden)
Usatenko O.V.
2017-08-01
Full Text Available The research deals with the topic of the analysis of venture capital funds’ rate of return on venture activity. The discovered venture capital funds have such a peculiarity as the involved investors of various types and concentrated financial resources, which lead to advantages in investing. Based on the analyzed scientific approaches to the evaluation of income rate met by various economic entities the paper determines the optimal indicators of such an analysis developed due to the article research. They are supposed to improve significantly the process of making decisions on venture capital investments. The author suggests to evaluate venture capital funds rate of return on venture activity by means of the basic four indicators usually employed for investment efficiency definition: net profit, internal rate of return, return period and return index. The research presents the examination of rates of return on venture activity of venture capital funds being controlled by a single asset management company. Thus, one can estimate not only the rate of return on venture activity, but also the efficiency of control taken by an asset management company.
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The catastrophic collapse of morale among hospital physicians in Japan
Directory of Open Access Journals (Sweden)
Hideo Yasunaga
2008-11-01
Full Text Available Hideo YasunagaDepartment of Health Management and Policy, Graduate School of Medicine, University of Tokyo, Tokyo, JapanAbstract: The past few decades have witnessed bleak pictures of unhappy physicians worldwide. Japanese physicians working in hospitals are particularly distressed. Today, Japan’s healthcare system is near collapse because physicians are utterly demoralized. Their loss of morale is due to budget constraints, excessive demands, physician shortages, poor distribution, long working hours, hostile media, increasing lawsuits, and violence by patients. Severe cost-saving policies, inadequate distribution of healthcare resources, and the failure to communicate risks has damaged physicians’ morale and created conflicts between physicians and society. Physicians should communicate the uncertainty, limitations, and risks of modern medicine to all members of society. No resolution can be achieved unless trust exists between physicians, patients, the public, the media, bureaucrats, politicians and jurists.Keywords: physician’s morale, physician shortages, overwork, health policy
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Billaux, Mathilde; Borget, Isabelle; Prognon, Patrice; Pineau, Judith; Martelli, Nicolas
2016-06-01
Objectives Many university hospitals have developed local health technology assessment processes to guide informed decisions about new medical devices. However, little is known about stakeholders' perceptions and assessment of innovative devices. Herein, we investigated the perceptions regarding innovative medical devices of their chief users (physicians and surgeons), as well as those of hospital pharmacists, because they are responsible for the purchase and management of sterile medical devices. We noted the evaluation criteria used to assess and select new medical devices and suggestions for improving local health technology assessment processes indicated by the interviewees. Methods We randomly selected 18 physicians and surgeons (nine each) and 18 hospital pharmacists from 18 French university hospitals. Semistructured interviews were conducted between October 2012 and August 2013. Responses were coded separately by two researchers. Results Physicians and surgeons frequently described innovative medical devices as 'new', 'safe' and 'effective', whereas hospital pharmacists focused more on economic considerations and considered real innovative devices to be those for which no equivalent could be found on the market. No significant difference in evaluation criteria was found between these groups of professionals. Finally, hospital pharmacists considered the management of conflicts of interests in local health technology assessment processes to be an issue, whereas physicians and surgeons did not. Conclusions The present study highlights differences in perceptions related to professional affiliation. The findings suggest several ways in which current practices for local health technology assessment in French university hospitals could be improved and studied. What is known about the topic? Hospitals are faced with ever-growing demands for innovative and costly medical devices. To help hospital management deal with technology acquisition issues, hospital
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Courtney, P Maxwell; Darrith, Brian; Bohl, Daniel D; Frisch, Nicholas B; Della Valle, Craig J
2017-11-15
Concerns about financial incentives and increased costs prompted legislation limiting the expansion of physician-owned hospitals in 2010. Supporters of physician-owned hospitals argue that they improve the value of care by improving quality and reducing costs. The purpose of the present study was to determine whether physician-owned and non-physician-owned hospitals differ in terms of costs, outcomes, and patient satisfaction in the setting of total hip arthroplasty (THA) and total knee arthroplasty (TKA). With use of the U.S. Centers for Medicare & Medicaid Services (CMS) Inpatient Charge Data, we identified 45 physician-owned and 2,657 non-physician-owned hospitals that performed ≥11 primary TKA and THA procedures in 2014. Cost data, patient-satisfaction scores, and risk-adjusted complication and 30-day readmission scores for knee and hip arthroplasty patients were obtained from the multiyear CMS Hospital Compare database. Physician-owned hospitals received lower mean Medicare payments than did non-physician-owned hospitals for THA and TKA procedures ($11,106 compared with $12,699; p = 0.002). While the 30-day readmission score did not differ significantly between the 2 types of hospitals (4.48 compared with 4.62 for physician-owned and non-physician-owned, respectively; p = 0.104), physician-owned hospitals had a lower risk-adjusted complication score (2.83 compared with 3.04; p = 0.015). Physician-owned hospitals outperformed non-physician-owned hospitals in all patient-satisfaction categories, including mean linear scores for recommending the hospital (93.9 compared with 87.9; p CMS payment methodology. Our findings suggest that physician-owned hospitals are associated with lower mean Medicare costs, fewer complications, and higher patient satisfaction following THA and TKA than non-physician-owned hospitals. Policymakers should consider these data when debating the current moratorium on physician-owned hospital expansion. Therapeutic Level III. See
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Rundall, Thomas G; Shortell, Stephen M; Alexander, Jeffrey A
2004-01-01
This article proposes a theory of physician-hospital integration. The theory is developed by building on three streams of scholarship: "new" institutionalism, "old" institutionalism, and the theory of economic markets. The theory uses several key concepts from these theoretical frameworks, including the notions of environmental demands for legitimacy, market demands for efficiency, and agency. To enhance the predictive power of the theory, two new concepts are introduced: directionality of influence between institutional and market forces at the macro-societal level, and degree of separation of institutional and market domains at the local level--which add important predictive power to the theory. Using these concepts, a number of hypotheses are proposed regarding the ideal types of physician-hospital arrangements that are likely to emerge under different combinations of directionality of influence and institutional and market domain separation. Moreover, the theory generates hypotheses regarding organizational dynamics associated with physician-hospital integration, including the conditions associated with high and low prevalence of physician-hospital integration, the extent to which the integrated organization is physician-centric or hospital-centric, and whether physician-hospital integration is likely to be based on loose contractual arrangements or tight, ownership-based arrangements.
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Directory of Open Access Journals (Sweden)
Schwappach David
2008-10-01
Full Text Available Abstract Background Germany currently experiences a situation of major physician attrition. The incompatibility between work and family has been discussed as one of the major reasons for the increasing departure of German physicians for non-clinical occupations or abroad. This study investigates predictors for one particular direction of Work-Family Conflict – namely work interfering with family conflict (WIF – which are located within the psychosocial work environment or work organisation of hospital physicians. Furthermore, effects of WIF on the individual physicians' physical and mental health were examined. Analyses were performed with an emphasis on gender differences. Comparisons with the general German population were made. Methods Data were collected by questionnaires as part of a study on Psychosocial work hazards and strains of German hospital physicians during April–July 2005. Two hundred and ninety-six hospital physicians (response rate 38.9% participated in the survey. The Copenhagen Psychosocial Questionnaire (COPSOQ, work interfering with family conflict scale (WIF, and hospital-specific single items on work organisation were used to assess WIF, its predictors, and consequences. Results German hospital physicians reported elevated levels of WIF (mean = 74 compared to the general German population (mean = 45, p p Conclusion In our study, work interfering with family conflict (WIF as part of Work-Family Conflict (WFC was highly prevalent among German hospital physicians. Factors of work organisation as well as factors of interpersonal relations at work were identified as significant predictors for WIF. Some of these predictors are accessible to alteration by improving work organisation in hospitals.
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Burns, Lawton Robert; Muller, Ralph W
2008-09-01
Hospital-physician relationships (HPRs) are an important area of academic research, given their impact on hospitals' financial success. HPRs also are at the center of several federal policy proposals such as gain sharing, bundled payments, and pay-for-performance (P4P). This article analyzes the HPRs that focus on the economic integration of hospitals and physicians and the goals that HPRs are designed to achieve. It then reviews the literature on the impact of HPRs on cost, quality, and clinical integration. The goals of the two parties in HPRs overlap only partly, and their primary aim is not reducing cost or improving quality. The evidence base for the impact of many models of economic integration is either weak or nonexistent, with only a few models of economic integration having robust effects. The relationship between economic and clinical integration also is weak and inconsistent. There are several possible reasons for this weak linkage and many barriers to further integration between hospitals and physicians. Successful HPRs may require better financial conditions for physicians, internal changes to clinical operations, application of behavioral skills to the management of HPRs, changes in how providers are paid, and systemic changes encompassing several types of integration simultaneously.
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Medical tourism in India: perceptions of physicians in tertiary care hospitals.
Qadeer, Imrana; Reddy, Sunita
2013-12-17
Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians' however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical
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PELAKSANAAN ITIKAD BAIK MEMORY OF UNDERSTANDINGDALAM PERJANJIAN JOINT VENTUREPERUSAHAAN MODAL ASING
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Heru Guntoro
2014-11-01
Full Text Available This paper examines the perspective of law in implementation good conviction memory of understanding in joint venture agreement and the result from law implementation memory of understanding in join venture agreement in the supreme court decision. This research is a literary research, the legal matters are analyzed qualitatively using normatif and juridical approach. From research can concludes, implementation from good conviction Memory of Understanding in the joint venture agreement are command of regulation with there are measure and explisit sanction to they who break a promise. Tulisan ini bertujuan untuk mengkaji perspektif hukum perdata terhadap pelaksanaan itikad baik dan akibat hukum pelaksanaan Memory of Understandingdalam perjanjian joint venturePerusahaan Modal Asing dalam Putusan Mahkamah Agung. Penelitian yang dilakukan adalah penelitian kepustakaan, bahanbahan hukum yang dianalisis secara kualitatif dengan pendekatan yuridis normatif dan komparatif. Dari penelitian yang dilakukan dapat disimpulkan bahwa: pelaksanaan itikad baik Memory of Understandingdalam perjanjian joint venturePerusahaan Modal Asing merupakan perintah Undang-Undang serta ada tindakan dan sanksi tegas bagi mereka yang telah melakukan wanprestasi (beritikad tidak baik.
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Yarnell, Christopher J; Shadowitz, Steven; Redelmeier, Donald A
2016-07-01
Physician call schedules are a critical element for medical practice and hospital efficiency. We compared readmission rates prior to and after a change in physician call system at Sunnybrook Health Sciences Centre. We studied patients discharged over a decade (2004 through 2013) and identified whether or not each patient was readmitted within the subsequent 28 days. We excluded patients discharged for a surgical, obstetrical, or psychiatric diagnosis. We used time-to-event analysis and time-series analysis to compare rates of readmission prior to and after the physician call system change (January 1, 2009). A total of 89,697 patients were discharged, of whom 10,001 (11%) were subsequently readmitted and 4280 died. The risk of readmission was increased by about 26% following physician call system change (9.7% vs 12.2%, P system change (95% confidence interval, 22%-31%; P system change persisted across patients with diverse ages, estimated readmission risks, and medical diagnoses. The net effect was equal to 7240 additional patient days in the hospital following call system change. A modest increase was observed at a nearby acute care hospital that did not change physician call system, and no increase in risk of death was observed with increased hospital readmissions. We suggest that changes in physician call systems sometimes increase subsequent hospital readmission rates. Further reductions in readmissions may instead require additional resources or ingenuity. Copyright © 2016 Elsevier Inc. All rights reserved.
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Fuss, Isabelle; Nübling, Matthias; Hasselhorn, Hans-Martin; Schwappach, David; Rieger, Monika A
2008-10-07
Germany currently experiences a situation of major physician attrition. The incompatibility between work and family has been discussed as one of the major reasons for the increasing departure of German physicians for non-clinical occupations or abroad. This study investigates predictors for one particular direction of Work-Family Conflict--namely work interfering with family conflict (WIF)--which are located within the psychosocial work environment or work organisation of hospital physicians. Furthermore, effects of WIF on the individual physicians' physical and mental health were examined. Analyses were performed with an emphasis on gender differences. Comparisons with the general German population were made. Data were collected by questionnaires as part of a study on Psychosocial work hazards and strains of German hospital physicians during April-July 2005. Two hundred and ninety-six hospital physicians (response rate 38.9%) participated in the survey. The Copenhagen Psychosocial Questionnaire (COPSOQ), work interfering with family conflict scale (WIF), and hospital-specific single items on work organisation were used to assess WIF, its predictors, and consequences. German hospital physicians reported elevated levels of WIF (mean = 74) compared to the general German population (mean = 45, p work, elevated number of days at work despite own illness, and consequences of short-notice changes in the duty roster. Good sense of community at work was a protective factor. Compared to the general German population, we observed a significant higher level of quantitative work demands among hospital physicians (mean = 73 vs. mean = 57, p work ability, and higher satisfaction with life in general. Compared to the German general population, physicians showed significantly higher levels of individual stress and quality of life as well as lower levels for well-being. This has to be judged as an alerting finding regarding the state of physicians' health. In our study, work
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Directory of Open Access Journals (Sweden)
Zupanc Andrea
2009-06-01
Full Text Available Abstract Background Hospital physicians' time is a critical resource in medical care. Two aspects are of interest. First, the time spent in direct patient contact – a key principle of effective medical care. Second, simultaneous task performance ('multitasking' which may contribute to medical error, impaired safety behaviour, and stress. There is a call for instruments to assess these aspects. A preliminary study to gain insight into activity patterns, time allocation and simultaneous activities of hospital physicians was carried out. Therefore an observation instrument for time-motion-studies in hospital settings was developed and tested. Methods 35 participant observations of internists and surgeons of a German municipal 300-bed hospital were conducted. Complete day shifts of hospital physicians on wards, emergency ward, intensive care unit, and operating room were continuously observed. Assessed variables of interest were time allocation, share of direct patient contact, and simultaneous activities. Inter-rater agreement of Kappa = .71 points to good reliability of the instrument. Results Hospital physicians spent 25.5% of their time at work in direct contact with patients. Most time was allocated to documentation and conversation with colleagues and nursing staff. Physicians performed parallel simultaneous activities for 17–20% of their work time. Communication with patients, documentation, and conversation with colleagues and nursing staff were the most frequently observed simultaneous activities. Applying logit-linear analyses, specific primary activities increase the probability of particular simultaneous activities. Conclusion Patient-related working time in hospitals is limited. The potential detrimental effects of frequently observed simultaneous activities on performance outcomes need further consideration.
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Directory of Open Access Journals (Sweden)
Erol EREN
2003-01-01
Full Text Available Firms have started to cooperate with other firms due to globalization and rapidly increasing competition. They can have quick access to the most recent technology and different markets by cooperating with other firms. Thus by increasing their cross-border operations, multinational companies prefer to establish joint ventures. Joint ventures are the forms of cooperation that is widely used by multinational firms. In Turkey, Foreign Capital Law (No : 6224 has been enacted on January, 18th, 1954. This law has been enacted to encourage foreign capital investments. Even though, it is quite liberal, the amount of foreign capital inflow is not at a desirable level. Therefore, it is necessary and very important to research the reasons for the inadequacy in foreign capital inflows to Turkey. In this paper, the performance of joint ventures in electronic, chemistry and cement sectors are studied. The joint ventures in which the foreign partner has an equity share of less than ninety percent are included in the scope of the study.
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Quantifying culture gaps between physicians and managers in Dutch hospitals: a survey
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Meerdink Nienke
2010-04-01
Full Text Available Abstract Background The demands in hospitals for safety and quality, combined with limitations in financing health care require effective cooperation between physicians and managers. The complex relationship between both groups has been described in literature. We aim to add a perspective to literature, by developing a questionnaire which provides an opportunity to quantitatively report and elaborate on the size and content of differences between physicians and managers. Insight gained from use of the questionnaire might enable us to reflect on these differences and could provide practical tools to improve cooperation between physicians and managers, with an aim to enhance hospital performance. Methods The CG-Questionnaire was developed by adjusting, pre-testing, and shortening Kralewski's questionnaire, and appeared suitable to measure culture gaps. It was shortened by exploratory factor analysis, using principal-axis factoring extraction with Varimax rotation. The CG-Questionnaire was sent to all physicians and managers within 37 Dutch general hospitals. ANOVA and paired sample T-tests were used to determine significant differences between perceptions of daily work practices based in both professional cultures; culture gaps. The size and content of culture gaps were determined with descriptive statistics. Results The total response (27% consisted of 929 physicians and 310 managers. The Cronbachs alpha's were 0.70 - 0.79. Statistical analyses showed many differences; culture gaps were found in the present situation; they were even larger in the preferred situation. Differences between both groups can be classified into three categories: (1 culture gaps in the present situation and not in the preferred, (2 culture gaps in the preferred situation and not in the present, and (3 culture gaps in both situations. Conclusions With data from the CG-Questionnaire it is now possible to measure the size and content of culture gaps between physicians and
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Blumenthal, Daniel M; Olenski, Andrew R; Tsugawa, Yusuke; Jena, Anupam B
2017-12-05
Use of locum tenens physicians has increased in the United States, but information about their quality and costs of care is lacking. To evaluate quality and costs of care among hospitalized Medicare beneficiaries treated by locum tenens vs non-locum tenens physicians. A random sample of Medicare fee-for-service beneficiaries hospitalized during 2009-2014 was used to compare quality and costs of hospital care delivered by locum tenens and non-locum tenens internal medicine physicians. Treatment by locum tenens general internal medicine physicians. The primary outcome was 30-day mortality. Secondary outcomes included inpatient Medicare Part B spending, length of stay, and 30-day readmissions. Differences between locum tenens and non-locum tenens physicians were estimated using multivariable logistic regression models adjusted for beneficiary clinical and demographic characteristics and hospital fixed effects, which enabled comparisons of clinical outcomes between physicians practicing within the same hospital. In prespecified subgroup analyses, outcomes were reevaluated among hospitals with different levels of intensity of locum tenens physician use. Of 1 818 873 Medicare admissions treated by general internists, 38 475 (2.1%) received care from a locum tenens physician; 9.3% (4123/44 520) of general internists were temporarily covered by a locum tenens physician at some point. Differences in patient characteristics, demographics, comorbidities, and reason for admission between locum tenens and non-locum tenens physicians were not clinically relevant. Treatment by locum tenens physicians, compared with treatment by non-locum tenens physicians (n = 44 520 physicians), was not associated with a significant difference in 30-day mortality (8.83% vs 8.70%; adjusted difference, 0.14%; 95% CI, -0.18% to 0.45%). Patients treated by locum tenens physicians had significantly higher Part B spending ($1836 vs $1712; adjusted difference, $124; 95% CI, $93 to $154
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Trybou, Jeroen; De Caluwé, Gaelle; Verleye, Katrien; Gemmel, Paul; Annemans, Lieven
2015-02-17
Hospitals face increasingly competitive market conditions. In this challenging environment, hospitals have been struggling to build high-quality hospital-physician relationships. In the literature, two types of managerial strategies for optimizing relationships have been identified. The first focuses on optimizing the economic relationship; the second focuses on the noneconomic dimension and emphasizes the cooperative structure and collaborative nature of the hospital-physician relationship. We investigate potential spillover effects between the perceptions of physicians of organizational exchange and their customer-oriented behaviors. A cross-sectional study was conducted on 130 self-employed physicians practicing at six Belgian hospitals. Economic exchange was measured using the concept of distributive justice (DJ); noneconomic exchange was measured by the concept of perceived organizational support (POS). Our outcomes consist of three types of customer-oriented behaviours: internal influence (II), external representation (ER), and service delivery (SD). Our results show a positive relationship between DJ and II (adjusted R(2) = 0.038, t = 2.35; p = 0.028) and ER (adjusted R(2) = 0.15, t = 4.59; p relationship between POS and II (adjusted R(2) = 0.032, t = 2.26; p = 0.026) and ER (adjusted R(2) = 0.22, t = 5.81; p relationship was present between DJ (p = 0.54) or POS (p = 0.57) and SD. Organizational identification positively moderates the relationship between POS and ER (p = 0.045) and between DJ and ER (p = 0.056). The relationships between POS and II (p = 0.54) and between DJ and II (p = 0.99) were not moderated by OI. Professional identification did not moderate the studied relationships. Our results demonstrate that both perceptions of economic and noneconomic exchange are important to self-employed physicians' customer-oriented behaviours. Fostering organizational identification could enhance this reciprocity dynamic.
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Depressive symptoms and overwork among physicians employed at a university hospital in Japan
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Toru Maruyama
2017-11-01
Full Text Available Introduction: The excessive workload of Japanese hospital physicians is a serious social problem due to effects on their mental health status, as well as the potential for medical errors and lawsuits. The extent of overwork among resident physicians employed at national university hospitals in Japan is unknown and needs to be investigated. Methods: This study used a questionnaire recommended by the Japanese Ministry of Health for hospital physicians working overtime, administered through an interview carried out by an occupational physician during the health surveillance to evaluate: 1 the severity of chronic fatigue; 2 the burden of work; 3 an overwork score derived from these two measures; and 4 presence of depressive symptoms. After the feasibility of the questionnaire was confirmed, both a cross-sectional and a longitudinal study were performed, while statistics analysis included multiple linear regression analysis and chi-square test set at P < 0.05. Results: Most of the overworked physicians were young medical staffs (48%, whereas postgraduate residents formed a small group (10%. In the cross-sectional study (n = 135; mean age 32.7 years ± 5.6, the histograms of scores for the four factors investigated showed a strong positive skewness, while overtime histograms showed a negative skewness at 4, 3, and 2 months prior to the interview with occupational physician, but positive skewness 1 month prior to the interview. The longitudinal study (n = 26 showed an increase or reduction of overtime respectively having a significant impact on exacerbation or improvement of the overwork score (P = 0.028 and depressive symptoms (P = 0.025. Discussion and Conclusions: A strong positive skewness of the histograms for items related to overwork might indicate fear of stigma of mental illness amongst young physicians. Physicians employed at Japanese national university hospitals should be protected by the institution, and the roles of occupational physician
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O'Neill, Sean M; Seresinghe, Sarah; Sharma, Arun; Russell, Tara A; Crawford, L'Orangerie; Frencher, Stanley K
2018-01-01
Stewarding of physician privileges wisely is imperative, but no guidelines exist for how to incorporate system-level factors in privileging decisions. A newly opened, safety-net community hospital tailored the scope of surgical practice through review of physician privileges. Martin Luther King, Jr. Community Hospital is a public-private partnership, safety-net institution in South Los Angeles that opened in July 2015. It has 131 beds, including a 28-bed emergency department, a 20-bed ICU, and 5 operating rooms. Staff privileging decisions were initially based only on physicians' training and experience, but this resulted in several cases that tested the boundaries of what a small community hospital was prepared to handle. A collaborative, transparent process to review physician privileges was developed. This began with physician-only review of procedure lists, followed by a larger, multidisciplinary group to assess system-level factors. Specific questions were used to guide discussion, and unanimous approval from all stakeholders was required to include a procedure. An initial list of 558 procedures across 11 specialties was reduced to 321 (57.5%). No new cases that fall outside these new boundaries have arisen. An inclusive process was crucial for obtaining buy-in and establishing cultural norms. Arranging transfer agreements remains a significant challenge. Accumulation of institutional experience continues through regular performance reviews. As this hospital's capabilities mature, a blueprint has been established for expanding surgical scope of practice based explicitly on system-level factors. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.
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Laerum, Hallvard; Karlsen, Tom H; Faxvaag, Arild
2003-01-01
It is not automatically given that the paper-based medical record can be eliminated after the introduction of an electronic medical record (EMR) in a hospital. Many keep and update the paper-based counterpart, and this limits the use of the EMR system. The authors have evaluated the physicians' clinical work practices and attitudes toward a system in a hospital that has eliminated the paper-based counterpart using scanning technology. Combined open-ended interviews (8 physicians) and cross-sectional survey (70 physicians) were conducted and compared with reference data from a previous national survey (69 physicians from six hospitals). The hospitals in the reference group were using the same EMR system without the scanning module. The questionnaire (English translation available as an online data supplement at ) covered frequency of use of the EMR system for 19 defined tasks, ease of performing them, and user satisfaction. The interviews were open-ended. The physicians routinely used the system for nine of 11 tasks regarding retrieval of patient data, which the majority of the physicians found more easily performed than before. However, 22% to 25% of the physicians found retrieval of patient data more difficult, particularly among internists (33%). Overall, the physicians were equally satisfied with the part of the system handling the regular electronic data as that of the physicians in the reference group. They were, however, much less satisfied with the use of scanned document images than that of regular electronic data, using the former less frequently than the latter. Scanning and elimination of the paper-based medical record is feasible, but the scanned document images should be considered an intermediate stage toward fully electronic medical records. To our knowledge, this is the first assessment from a hospital in the process of completing such a scanning project.
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Philanthropies croisées: a joint venture in public health at Lyon (1917-1940).
Saunier, Pierre-Yves; Tournès, Ludovic
2009-01-01
Since the end of the First World War the Rockefeller Foundation has spearheaded a large-scale programme in the field of education for the health professions (doctors and nurses). In several countries throughout the world, but with its efforts concentrated on Europe, it has financed schools, constructed information networks, granted research scholarships and awarded training bursaries. In so doing it has not, however, been in the business of propagating an irresistible "American model," nor has it pursued a huge undertaking in disinterested aid. Through an attempt to contextualize these programmes, to bring to light the existence of common reference points, to retrace the work with local participants and to appraise cleavages within the philanthropic apparatus, this article proposes a fine-grained reading of the role of the Rockefeller Foundation at the Faculté de Médecine (Faculty of Medicine) and the Ecole d'Infirmières et d'assistantes sociales (Training School for Nurses and Social Workers) in Lyon between 1917- and 1940. It analyses these institutions in terms of the transactions, negotiations and appropriations that highlight their joint-venture character and it identifies their varied impact.
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Vu, Michelle; White, Annesha; Kelley, Virginia P.; Hopper, Jennifer Kuca; Liu, Cathy
2016-01-01
Background The Affordable Care Act (ACA) healthcare reforms, centered on achieving the Centers for Medicare & Medicaid Services (CMS) Triple Aim goals of improving patient care quality and satisfaction, improving population health, and reducing costs, have led to increasing partnerships between hospitals and insurance companies and the implementation of employee wellness programs. Hospitals and insurance companies have opted to partner to distribute the risk and resources and increase coordination of care. Objective To examine the ACA's impact on the health and wellness programs that have resulted from the joint ventures of hospitals and health plans based on the published literature. Method We conducted a review of the literature to identify successful mergers and best practices of health and wellness programs. Articles published between January 2007 and January 2015 were compiled from various search engines, using the search terms “corporate,” “health and wellness program,” “health plan,” “insurance plan,” “hospital,” “joint venture,” and “vertical merger.” Publications that described consolidations or wellness programs not tied to health insurance plans were excluded. Noteworthy characteristics of these programs were summarized and tabulated. Results A total of 44 eligible articles were included in the analysis. The findings showed that despite rising healthcare costs, joint ventures prevent hospitals from trading-off quality and services for cost reductions. Administrators believed that partnering would allow the companies to meet ACA standards for improving clinical outcomes at reduced costs. Before the implementation of the ACA, some employers had wellness programs, but these were not standardized and did not need to produce measurable results. The ACA encouraged improvement of employee wellness programs by providing funding for expanded health services and by mandating quality care. Successful workplace health and wellness
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Directory of Open Access Journals (Sweden)
Kaihong Wang
2016-01-01
Full Text Available When venture capital has been invested into venture companies, venture capitalists and venture entrepreneurs form a principal-agent relationship. Take into account the fact that the venture entrepreneur’s effort is a long process, because the effort is not the same at different stage. Therefore, efforts variables are seen as the multistage dynamic variable, and venture investment principal-agent model with venture entrepreneurs having multistage efforts is constructed on the basis of the classic principal-agent theory in the paper. Further, in the later stage effort of venture entrepreneurs is affected by the size of prestage benefit with venture capitalists and venture entrepreneurs; thus the fairness preference model is improved, and venture investment principal-agent model with venture entrepreneurs having multistage efforts is constructed on the basis of fairness preference theory. Both theoretical derivation and simulation have demonstrated that, under the condition of information asymmetry, if the fairness preference of venture entrepreneurs holds, then (1 venture capitalists provide venture entrepreneurs with level higher than that without fairness preference, (2 in every single stage venture entrepreneurs make efforts higher than those without fairness preference, and (3 in two periods both venture investors and venture entrepreneurs gain total real gains higher than those in two periods without fair preference.
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Case study: improving efficiency in a large hospital laboratory.
Bartel, Marilynn
2004-01-01
Saint Francis Health System (SFHS) consists of three hospitals and one clinic: Saint Francis Hospital (SFH); Broken Arrow Medical Center; Laureate Psychiatric Hospital; and Warren Clinic. SFHS has 670 physicians on staff and serves medical (oncology, orthopedic, neurology, and renal), surgical, cardiac, women and infant, pediatric, transplant, and trauma patients in Tulsa County, Oklahoma, which has a population of 660,000. SFH incorporates 706 staffed beds, including 126 pediatric beds and 119 critical care beds. Each year, the health system averages 38,000 admissions, 70,000 emergency department visits, 25,000 surgeries, and 3,500 births. Saint Francis Laboratory is located within the main hospital facility (SFH) and functions as a core lab for the health system. The lab also coordinates lab services with Saint Francis Heart Hospital, a physician-system joint venture. The Optimal Equipment Configuration (OEC) Project was designed by the Clinical Laboratory Services division of Premier, a group purchasing organization, with the goal of determining whether laboratories could improve efficiency and decrease unit cost by using a single-source vendor. Participants included seven business partners (Abbott, Bayer, Beckman/Coulter, Dade/Behring, J&J/ Ortho, Olympus, and Roche) and 21 laboratory sites (a small, mid-sized, and large site for each vendor). SFH laboratory staff embraced Premier's concept and viewed the OEC project as an opportunity to "energize" laboratory operations. SFH partnered with Abbott, their primary equipment vendor, for the project. Using resources and tools made available through the project, the laboratory was re-engineered to simplify workflow, increase productivity, and decrease costs by adding automation and changing to centralized specimen processing. Abbott and SFH shared a common vision for the project and enhanced their partnership through increased communication and problem solving. Abbott's area representatives provided for third
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Sports activity after total joint arthroplasty: recommendations for the counseling physician.
Buza, John A; Fink, Leslie A; Levine, William N
2013-02-01
Sports activity after total joint arthroplasty (TJA) has become an increasingly important topic, as many younger patients seeking TJA have higher postoperative expectations with regard to return to athletic activity. Our current knowledge of this area is largely based on retrospective clinical studies and surveys of surgeon recommendations. The decision to participate in sports after TJA depends on the patient's general health, prior athletic experience, type of TJA, and desired sporting activity. Ultimately, patients should discuss these factors with their physician in order to make an educated decision regarding sports activity after TJA. This article summarizes the best available evidence to help guide physicians in their conversation with patients regarding safe and appropriate sports activity after TJA.
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Medical tourism in india: perceptions of physicians in tertiary care hospitals
2013-01-01
Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical
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IMPLEMENTING HEALTH TECHNOLOGY ASSESSMENT-BASED RECOMMENDATIONS IN FINLAND
DEFF Research Database (Denmark)
Sihvo, Sinikka; Ikonen, Tuija; Mäkelä, Marjukka
2017-01-01
Objectives: The Managed Uptake of Medical Methods Program (MUMM) started 10 years ago as a joint venture of the Finnish Office for Health Technology Assessment (Finohta) and the twenty hospital districts in Finland. The aim is to offer information on the effectiveness, safety, organizational...... in decision making. Conclusions: HTA-based MUMM recommendations were well received by physicians but in practice they are less used than clinical practice guidelines. Short-form electronic surveys were a useful way of gathering information about awareness and implementation. The surveys also functioned...... as another method of informing key physicians about the recommendations....
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Job satisfaction and the work situation of physicians: a survey at a German university hospital.
Laubach, Wilfried; Fischbeck, Sabine
2007-01-01
Job demands and workload of hospital physicians are increasing. The object of this survey was to examine the factors that constitute job satisfaction and to analyse physicians' work situation in the area of in-patient care. 447 physicians at a German University Hospital received questionnaires with regard to work situation, job satisfaction and personal health. Data were analysed by MANOVA and multiple regression models. A first regression model explained 53% of the variance in satisfaction with "work and profession". Among the explanatory variables "superiors and hierarchy" showed the highest beta-weight (beta = -0.49). "Personal health" also determined job satisfaction, for female physicians stronger (beta = -0.31) than for male physicians (beta = -0.11). In a second regression model on satisfaction with "Financial situation" only 18% of the variance was explained, whereby "work condition on the ward", "personal health" and "collaboration between occupational groups" showed the highest beta-weights. Among resident physicians, work conditions, superiors, hierarchy, transparency and participation in decisions are very important variables for job satisfaction. Improvements in these aspects may improve job satisfaction and help to reduce physician shortage in hospitals.
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2010-10-01
... furnished to beneficiaries in teaching hospitals. 415.162 Section 415.162 Public Health CENTERS FOR MEDICARE... BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.162 Determining payment for physician services...
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Adaptive Fusion of Information for Seeing into Ordos Basin, China: A China-Germany-US Joint Venture.
Yeh, T. C. J.; Yin, L.; Sauter, M.; Hu, R.; Ptak, T.; Hou, G. C.
2014-12-01
Adaptive fusion of information for seeing into geological basins is the theme of this joint venture. The objective of this venture is to initiate possible collaborations between scientists from China, Germany, and US to develop innovative technologies, which can be utilized to characterize geological and hydrological structures and processes as well as other natural resources in regional scale geological basins of hundreds of thousands of kilometers (i.e., the Ordos Basin, China). This adaptive fusion of information aims to assimilate active (manmade) and passive (natural) hydrologic and geophysical tomography surveys to enhance our ability of seeing into hydrogeological basins at the resolutions of our interests. The active hydrogeophysical tomography refers to recently developed hydraulic tomgoraphic surveys by Chinese and German scientists, as well as well-established geophysical tomography surveys (such as electrical resistivity tomography, cross-borehole radars, electrical magnetic surveys). These active hydrogeophysical tomgoraphic surveys have been proven to be useful high-resolution surveys for geological media of tens and hundreds of meters wide and deep. For basin-scale (i.e., tens and hundreds of kilometers) problems, their applicabilities are however rather limited. The passive hydrogeophysical tomography refers to unexplored technologies that exploit natural stimuli as energy sources for tomographic surveys, which include direct lightning strikes, groundwater level fluctuations due to earthquakes, river stage fluctuations, precipitation storms, barometric pressure variations, and long term climate changes. These natural stimuli are spatially varying, recurrent, and powerful, influencing geological media over great distances and depths (e.g., tens and hundreds of kilometers). Monitoring hydrological and geophysical responses of geological media to these stimuli at different locations is tantamount to collecting data of naturally occurring tomographic
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Venture capital and internationalization
Schertler, A.G.; Tykvova, T.
Cross-border investments represent a substantial share of venture capital activities. We use a comprehensive dataset on investments worldwide to analyze the internationalization of venture capital financing. We postulate that cross-border activity is shaped by macroeconomic factors in the venture
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Physician entrepreneur: lessons learned in raising capital for biomedical innovation.
Soleimani, Farzad; Kharabi, Darius G
2010-04-01
The funding landscape for medical devices is becoming increasingly difficult and complex. The purpose of this article is to provide the physician entrepreneur with a review of the main sources of capital available to fund the development and commercialization of biomedical innovations, and to highlight some of the important nuances of these funding sources that the physician entrepreneur should consider. The article examines the benefits and drawbacks of funding from venture capital firms, grants, friends and family, angel investors, incubators and industry partners from the perspective of the physician entrepreneur, and provides some key points to consider when selecting and working with an investor. The article's recommendations include: in selecting an investor, seek those whose investment thesis, areas of expertise and desired company stage (early vs. late) match the technology and the objectives of the company. In negotiating with an investor, an effective way to increase the company's valuation is to bring multiple bidders to the table. In working with an investor, respect junior staff members as much as senior partners and be wary of conflicts of interest with venture capital entrepreneurs-in-residence. There are both advantages and disadvantages to each of the funding sources examined here, and the choice of a funding partner depends significantly on the stage of development (in both corporate and technology) of the physician entrepreneur's venture and the role that the physician entrepreneur desires to play in it.
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International Nuclear Information System (INIS)
1998-01-01
The 15 presentations at this conference focused on the structuring of joint ventures with the petroleum industry and First Nations communities in the wake of the recent Delgamuukw decision of the Supreme Court of Canada, issued in December 1997. This decision asserted the right of Aboriginal communities to exclusive use and occupation of their land. The decision has created an urgent need to re-examine business relationships with Aboriginal communities and led to an increase in interest by resource industry people in Aboriginal practices, customs and traditions. Accordingly, speakers at this conference explored the consequences of self government by native communities, native cultural issues that influence the way Aboriginal people conduct business and the effect of the Supreme Court decision on land use planning in the resource-rich provinces of Canada. refs., tabs., figs
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Wide variation in hospital and physician payment rates evidence of provider market power.
Ginsburg, Paul B
2010-11-01
Wide variation in private insurer payment rates to hospitals and physicians across and within local markets suggests that some providers, particularly hospitals, have significant market power to negotiate higher-than-competitive prices, according to a new study by the Center for Studying Health System Change (HSC). Looking across eight health care markets--Cleveland; Indianapolis; Los Angeles; Miami; Milwaukee; Richmond, Va.; San Francisco; and rural Wisconsin--average inpatient hospital payment rates of four large national insurers ranged from 147 percent of Medicare in Miami to 210 percent in San Francisco. In extreme cases, some hospitals command almost five times what Medicare pays for inpatient services and more than seven times what Medicare pays for outpatient care. Variation within markets was just as dramatic. For example, the hospital with prices at the 25th percentile of Los Angeles hospitals received 84 percent of Medicare rates for inpatient care, while the hospital with prices at the 75th percentile received 184 percent of Medicare rates. The highest-priced Los Angeles hospital with substantial inpatient claims volume received 418 percent of Medicare. While not as pronounced, significant variation in physician payment rates also exists across and within markets and by specialty. Few would characterize the variation in hospital and physician payment rates found in this study to be consistent with a highly competitive market. Purchasers and public policy makers can address provider market power, or the ability to negotiate higher-than-competitive prices, through two distinct approaches. One is to pursue market approaches to strengthen competitive forces, while the other is to constrain payment rates through regulation.
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Building a Physician Culture for Healthcare Transformation: A Hospital's Leadership Challenge.
Hemker, Robert A; Solomon, Leslie A
2016-01-01
Engaging and integrating physicians has become the veritable "brass ring" for many hospital systems: many attempts and few actual wins. This is especially true in California's managed care environment and for public entities such as Palomar Health in Escondido, California. Our commitment to engage and integrate physicians continues to be a vital element of a larger cultural shift toward delivery of care that puts the patients' needs first. A key determinant of success has been the ability to align a diverse medical staff culture with administrative priorities. This alignment involves a carefully executed strategy and a structure to build a collective identity among diverse players. Palomar Health is in the third year of the journey. Some of the critical milestones have been the implementation of a physician leadership development process, creation of a physician onboarding process to codify the desired physician culture, delineation of roles and expectations for physician leadership, and formalization of dyad and triad partnerships between physicians and their clinical and administrative partners.
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Directory of Open Access Journals (Sweden)
Satar Rezaei
2016-06-01
Full Text Available Introduction: Inequality is prevalent in all sectors, particularly in distribution of and access to resources in the health sector. The aim of current study was to investigate the distribution of physicians and hospital beds in Iran in 2001, 2006 and 2011. Methods: This retrospective, cross-sectional study evaluated the distribution of physicians and hospital beds in 2001, 2006 and 2011 using Gini coefficient and Lorenz curve. The required data, including the number of physicians (general practitioners and specialists, number of hospital beds and number of hospitalized patients were obtained from the statistical yearbook of Iranian Statistical Center (ISC. The data analysis was performed by DASP software. Results: The Gini Coefficients for physicians and hospital beds based on population in 2001 were 0.19 and 0.16, and based on hospitalized patients, were 0.48 and 0.37, respectively. In 2006, these values were found to be 0.18 and 0.15 based on population, and 0.21 and 0.21 based on hospitalized patients, respectively. In 2011, however, the Gini coefficients were reported to be 0.16 and 0.13 based on population, and 0.47 and 0.37 based on hospitalized patients, respectively. Although distribution status had improved in 2011compared with 2001 in terms of population and number of hospitalized patients, there was more inequality in distribution based on the number of hospitalized patients than based on population. Conclusion: This study indicated that inequality in distribution of physicians and hospital beds was declined in 2011 compared with 2001. This distribution was based on the population, so it is suggested that, in allocation of resource, the health policymakers consider such need indices as the pattern of diseases and illness-prone areas, number of inpatients, and mortality.
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Koelewijn, Wout T; de Rover, Matthijs; Ehrenhard, Michel L; van Harten, Wim H
2014-05-19
Challenges brought about by developments such as continuing market reforms and budget reductions have strained the relation between managers and physicians in hospitals. By applying neo-institutional theory, we research how intra-organizational dynamics between physicians and managers induce physicians to become entrepreneurs by starting a specialty clinic. In addition, we determine the nature of this change by analyzing the intra-organizational dynamics in both hospitals and clinics. For our research, we interviewed a total of fifteen physicians and eight managers in four hospitals and twelve physicians and seven managers in twelve specialty clinics. We found evidence that in becoming entrepreneurs, physicians are influenced by intra-organizational dynamics, including power dependence, interest dissatisfaction, and value commitments, between physicians and managers as well as among physicians' groups. The precise motivation for starting a new clinic can vary depending on the medical or business logic in which the entrepreneurs are embedded, but also the presence of an entrepreneurial nature or nurture. Finally we found that the entrepreneurial process of starting a specialty clinic is a process of sedimented change or hybridized professionalism in which elements of the business logic are added to the existing logic of medical professionalism, leading to a hybrid logic. These findings have implications for policy at both the national and hospital level. Shared ownership and aligned incentives may provide the additional cement in which the developing entrepreneurial values are 'glued' to the central medical logic.
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The value captor's process: getting the most out of your new business ventures.
McGrath, Rita Gunther; Keil, Thomas
2007-05-01
The high failure rate among new business ventures is usually chalked up to the fundamental uncertainty of the process. In actuality, say McGrath and Keil, flawed ways of assessing and managing ventures may account for the disappointing amount of value they generate. Instead of taking the go/no-go approach, whereby a project either advances toward launch or is killed, decision makers should consider a range of alternatives: recycling the venture by aiming it at a new target market; spinning it off to other owners or a joint venture; spinning it in to an established business unit; or salvaging useful elements such as technologies, capabilities, knowledge, and patents. Firms that excel in value extraction--the "value captors" whose practices and mind-set this article explores--have created formal processes to systematically mine successes, failures, and everything in between. They know that a venture should be treated like a scientific experiment, in which learning plays a critical role. They are ready to seize new opportunities if a venture falters on its original course. They foster networks to promote cooperation and collaboration between established business leaders and venture teams and involve people from throughout the company in the venture review process. They don't allow financial criteria to dominate the reviews, and they recognize that the best people to launch a business may not be the ones who developed the idea. If your innovation pipeline is dry, your promising projects are being strangled for lack of a speedy payback, or someone else has made a fabulous business out of a slightly altered idea that you abandoned, consider the value captor's path.
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The Federal Trade Commission, clinical integration, and the organization of physician practice.
Casalino, Lawrence P
2006-06-01
This article examines Federal Trade Commission (FTC) policy--in particular, the agency's controversial 1996 statements on clinical integration--toward joint negotiations for nonrisk contracts with health plans by physicians organized into independent practice associations (IPAs) and (with hospitals) into physician-hospital organizations (PHOs). The article concludes that the policy is consistent with anti-trust principles, consistent with current thinking on the use of organized processes to improve medical care quality, specific enough to provide guidance to physicians wanting to integrate clinically, and general enough to encourage ongoing innovations in physician organization. The FTC should consider stronger sanctions for IPAs and PHOs whose clinical integration is nothing more than a sham intended to provide cover for joint negotiations, should give the benefit of the doubt to organizations whose clinical integration appears to be reasonably consonant with the statements, and should clarify several ambiguities in the statements. Health plans should facilitate IPA and PHO efforts to improve care by rewarding quality and efficiency and by providing clinically integrated organizations with claims information on individual patients. Though creating clinically integrated organizations is difficult and expensive, physicians should recognize that clinical integration can help them both to gain some negotiating leverage with health plans and to improve the quality of care for their patients.
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Hospital diversification: how to involve the pharmacy.
Smith, J E; Black, B L
1987-05-01
Participation by hospital pharmacy departments in planning and development of diversified services is described. Diversification requires market planning. Seven basic marketing steps are identification of mission, goals, and objectives; identification of growth strategies (market penetration, market development, product development, and diversification); market analysis of external factors (size, growth, and logistics; reimbursement and financial considerations; competition; regulatory issues; and legal issues); market analysis of internal factors (departmental organization and reporting lines, demographics of the institution, and costs and productivity associated with the new service); program development and design; implementation; and evaluation. Hospitals can diversify by expanding acute-care services through management contracts and mergers; developing new services to include long-term-care, ambulatory-care, occupational-health, and wellness programs; starting other health-care ventures, such as consulting, continuing medical education, and continuing education for nurses; and expanding into non-health-care businesses. Vertical diversification is finding new markets for existing services; horizontal diversification is development of new services for new markets. To diversify, an institution may need to change its corporate structure; it may form a family of corporations that includes a university, nonprofit hospitals, holding companies, for-profit corporations, joint ventures, and service organizations. Through diversification, institutions and pharmacy departments can create alternative sources of funding and offer more comprehensive services to patients.
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Maternity Care Services Provided by Family Physicians in Rural Hospitals.
Young, Richard A
The purpose of this study was to describe how many rural family physicians (FPs) and other types of providers currently provide maternity care services, and the requirements to obtain privileges. Chief executive officers of rural hospitals were purposively sampled in 15 geographically diverse states with significant rural areas in 2013 to 2014. Questions were asked about the provision of maternity care services, the physicians who perform them, and qualifications required to obtain maternity care privileges. Analysis used descriptive statistics, with comparisons between the states, community rurality, and hospital size. The overall response rate was 51.2% (437/854). Among all identified hospitals, 44.9% provided maternity care services, which varied considerably by state (range, 17-83%; P maternity care, a mean of 271 babies were delivered per year, 27% by cesarean delivery. A mean of 7.0 FPs had privileges in these hospitals, of which 2.8 provided maternity care and 1.8 performed cesarean deliveries. The percentage of FPs who provide maternity care (mean, 48%; range, 10-69%; P maternity care who are FPs (mean, 63%; range, 10-88%; P maternity care services in US rural hospitals, including cesarean deliveries. Some family medicine residencies should continue to train their residents to provide these services to keep replenishing this valuable workforce. © Copyright 2017 by the American Board of Family Medicine.
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Dückers, Michel L A; Stegeman, Inge; Spreeuwenberg, Peter; Wagner, Cordula; Sanders, Karin; Groenewegen, Peter P
2009-08-01
The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation, between the extent to which physicians notice their CEOs stimulate improvement initiatives and the number of projects joined by physicians, is moderated by the consensus among physicians working in the same hospital. Multilevel analyses are applied on data of 286 physicians from eight hospitals to: (1) estimate whether participation depends on noticing if CEOs stimulate improvement, (2) test if an individual's participation differs when more colleagues have the same opinion (effect modification). Significant moderator effects are found. The participation of physicians, noticing that CEOs stimulate improvement is higher when more colleagues share this opinion. For physicians not knowing whether improvement is encouraged, higher consensus coincides with lower participation. Project involvement of physicians depends on their consensus about encouragement by CEOs. This confirms the importance of strategic leaders in dissemination programs. Further research is recommended into causes of CEO leadership visibility and methods to strengthen leadership climate.
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Sullivan, T J
1992-01-01
The pressure to maintain adequate operating margins has forced many not-for-profit hospitals to adopt more overtly competitive behavior than they have in the past. However, in struggling to remain economically viable, these facilities should carefully avoid actions that would threaten their tax-exempt status. Not-for-profit facilities should be particularly careful that their arrangements with physicians, which often appear designed to increase referrals, do not violate the criteria according to which the Internal Revenue Code extends tax exemption to charitable organizations. Section 501(c)(3) of the code exempts organizations "no part of the net earnings of which inures to the benefit of any private shareholder or individual." According to this provision, "insiders" (i.e., those with a personal interest in or opportunity to influence organization activities from the inside) are entitled to no more than reasonable payment for their goods or services. The Internal Revenue Service (IRS) takes the position that, as employees or individuals having a close professional working relationship with a hospital, physicians are insiders. Thus a hospital that pays physicians what the IRS judges to be more than fair market value for services (or charges physicians less than fair market value for office rental) may find its exemption in jeopardy. If not-for-profit hospitals want to maintain their tax-exempt status, they must be certain the arrangements they enter into with physicians truly further their exempt purpose: to promote the health of the community.
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DEFF Research Database (Denmark)
Hamilton, Annika; Steinmetz, Jacob; Wissenberg, Mads
2016-01-01
AIM: Sudden out-of-hospital cardiac arrest (OHCA) is an important public health problem. While several interventions are known to improve survival, the impact of physician-delivered advanced cardiac life support for OHCA is unclear. We aimed to assess the association between prehospital physician...
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Directory of Open Access Journals (Sweden)
Patricia A Janssen
Full Text Available Home birth is available to women in Canada who meet eligibility requirements for low risk status after assessment by regulated midwives. While UK researchers have reported lower costs associated with planned home birth, there have been no published studies of the costs of home versus hospital birth in Canada.Costs for all women planning home birth with a regulated midwife in British Columbia, Canada were compared with those of all women who met eligibility requirements for home birth and were planning to deliver in hospital with a registered midwife, and with a sample of women of similar low risk status planning birth in the hospital with a physician. We calculated costs of physician service billings, midwifery fees, hospital in-patient costs, pharmaceuticals, home birth supplies, and transport. We compared costs among study groups using the Kruskall Wallis test for independent groups.In the first 28 days postpartum, we report a $2,338 average savings per birth among women planning home birth compared to hospital birth with a midwife and $2,541 compared to hospital birth planned with a physician. In longer term outcomes, similar reductions were observed, with cost savings per birth at $1,683 compared to the planned hospital birth with a midwife, and $1,100 compared to the physician group during the first eight weeks postpartum. During the first year of life, costs for infants of mothers planning home birth were reduced overall. Cost savings compared to planned hospital births with a midwife were $810 and with a physician $1,146. Costs were similarly reduced when findings were stratified by parity.Planned home birth in British Columbia with a registered midwife compared to planned hospital birth is less expensive for our health care system up to 8 weeks postpartum and to one year of age for the infant.
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Energy Technology Data Exchange (ETDEWEB)
Teppo, T. [Helsinki Univ. of Technology, Espoo (Finland). Development and Management in Industry
2006-07-01
Many factors have emerged for change towards cleaner and more efficient technologies and services: climate change, increasing oil demands, and rising living standards in many parts of the world are putting an ever-increasing strain on the environment. Recently, these drivers have fueled the formation of a clean energy venture capital market where both independent venture capitalists (VCs) and corporate venture capitalists (CVCs) have invested in clean energy start-ups. Financing of clean energy market creation is the focus of this dissertation. The dissertation contributes to several bodies of literature in the area of entrepreneurship, new industry creation, corporate venturing, and venture capital research. The dissertation uses a grounded theory approach. The study is guided by three data collection approaches with an emphasis on the first two. First, interviews with European and North American VC and CVC firms that have invested in the clean energy sector were carried out. Second, a clean energy venture financing survey that consisted of qualitative, essay-format questions and some quantitative questions was carried out. Third, interviews with clean energy stakeholders were carried out in order to gain a better understanding of the emerging sector. The research results consist of three main findings. First, the research results suggest that clean energy ventures face the following three main entrepreneurial challenges: financing, market education, and growth management. A further study of three clean energy industry categories revealed additional challenges that varied according to the industry development stage. Second, the results demonstrate that, from a venture capitalist perspective, clean energy venture risk characteristics can be divided into two groups: generally recognized risk characteristics and cognitive risk characteristics. The identified generally recognized risk characteristics were market demand and adaptation, incompatibility with the VC model
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Shanley, Leticia; Mittal, Vineeta; Flores, Glenn
2013-07-01
The goal of this study was to identify the proportion of dehydration-related ambulatory care-sensitive condition hospitalizations, the reasons why these hospitalizations were preventable, and factors associated with preventability. A cross-sectional survey of primary care providers (PCPs), inpatient attending physicians, and parents was conducted in a consecutive series of children with ambulatory care-sensitive conditions admitted to an urban hospital over 14 months. Eighty-five children were diagnosed with dehydration. Their mean age was 1.6 years; most had public (74%) or no (17%) insurance, and were nonwhite (91%). The proportion of hospitalizations assessed as preventable varied from 12% for agreement among all 3 sources to 45% for any source. Parents identified inadequate prevention (50%), poor self-education (34%), and poor quality of care (38%) as key factors. PCPs identified parents providing insufficient home rehydration (33%), not visiting the clinic (25%), and not calling earlier (16%) as reasons. Inpatient attending physicians cited home rehydration (40%), delays in seeking care (40%), and lacking a PCP (20%) as contributors. Physicians (PCPs and inpatient attending physicians) were more likely than parents to describe the admission as inappropriate (75% vs 67% vs 0%; P dehydration-related hospitalizations may be preventable. Inadequate parental education by physicians, insufficient home rehydration, deferring clinic visits, insurance and cost barriers, inappropriate admissions, poor quality of care, and parental dissatisfaction with PCPs are the reasons that these hospitalizations might have been prevented.
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Sharing the Proceeds from a Hierarchical Venture
DEFF Research Database (Denmark)
Hougaard, Jens Leth; Moreno-Ternero, Juan D.; Tvede, Mich
2017-01-01
We consider the problem of distributing the proceeds generated from a joint venture in which the participating agents are hierarchically organized. We introduce and characterize a family of allocation rules where revenue ‘bubbles up’ in the hierarchy. The family is flexible enough to accommodate...... the no-transfer rule (where no revenue bubbles up) and the full-transfer rule (where all the revenues bubble up to the top of the hierarchy). Intermediate rules within the family are reminiscent of popular incentive mechanisms for social mobilization or multi-level marketing....
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NSGIC Local Govt | GIS Inventory — Fire and EMS Districts dataset current as of 2010. This data is being developed as a joint venture between the City of Yuma, Yuma County and all other municipalities...
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Zhang, Lin; Huang, Lei; Liu, Meng; Yan, Hong; Li, Xiue
2016-06-01
This study aims to explore the impact of physician-nurse collaboration on nurse job satisfaction and turnover in a dental hospital. Physician-nurse collaboration is important for the stability of the entire nursing team. Few studies have shown the impact on job satisfaction and turnover among nurses working in Chinese dental hospitals. This was a prospective, cross-sectional study and investigated nurses from a tertiary dental hospital in Beijing using convenience non-randomized sampling. A structured questionnaire was used to collect data, which included general information, the Index of Work Satisfaction, the Nurse-Physician Collaboration Scale and the Turnover Intention Scale. The scores of physician-nurse collaboration correlated positively with those for job satisfaction and negatively with the stated likelihood of turnover intention. Physician-nurse collaboration scores positively predicted job satisfaction and negatively predicted the likelihood of quitting the current job. In conclusion, improving the level of physician-nurse collaboration is helpful to enhance job satisfaction and reduce turnover among nurses in a dental hospital. © 2016 John Wiley & Sons Australia, Ltd.
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Zider, B
1998-01-01
The popular mythology surrounding the U.S. venture-capital industry derives from a previous era. Venture capitalists who nurtured the computer industry in its infancy were legendary both for their risk taking and for their hands-on operating experience. But today things are different, and separating the myths from the realities is crucial to understanding this important piece of the U.S. economy. Today's venture capitalists are more like conservative bankers than the risk takers of days past. They have carved out a specialized niche in the capital markets, filling a void that other institutions cannot serve. They are the linch-pins in an efficient system for meeting the needs of institutional investors looking for high returns, of entrepreneurs seeking funding, and of investment bankers looking for companies to sell. Venture capitalists must earn a consistently superior return on investments in inherently risky businesses. The myth is that they do so by investing in good ideas and good plans. In reality, they invest in good industries--that is, industries that are more competitively forgiving than the market as a whole. And they structure their deals in a way that minimizes their risk and maximizes their returns. Although many entrepreneurs expect venture capitalists to provide them with sage guidance as well as capital, that expectation is unrealistic. Given a typical portfolio of ten companies and a 2,000-hour work year, a venture capital partner spends on average less than two hours per week on any given company. In addition to analyzing the current venture-capital system, the author offers practical advice to entrepreneurs thinking about venture funding.
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Alliances and joint ventures - M and A fever in the U.S. downstream
International Nuclear Information System (INIS)
Burke, B.
1998-01-01
The trend toward restructuring and consolidation in the petroleum refining industry has accelerated during 1998. The primary focus of this paper was on the trend toward consolidation in the refining industry in the United States. A similar trend is occurring in the petrochemical industry and in associated downstream industries. Industry perspectives, providing a basic framework of expectations for the U.S. refining industry, driving forces behind the merger and acquisition fever, potential benefits of consolidation, and future perspectives on the industry were addressed. Poor profitability and crude oil price volatility were identified as the principal underlying causes of consolidation. No recovery in crude oil prices was expected to occur in the foreseeable future, although an eventual recovery to a price level in the $16-$18/barrel range was considered a reasonable expectation. Further challenges, by way of trends in crude oil quality, developments in product markets, environmental issues, technological change and the potential threat from alternative fuels will continue to plague the industry for some time to come. It is safe to predict that because of poor profitability (average of 2.4 per cent over the past 10 years), the refining industry will continue to focus on improving its profit margin, and to reduce the cost of its operations within existing facilities. Diversification, optimization of links to retail/marketing, integration of petrochemicals, restructuring, consolidation and ownership changes, joint ventures were predicted as the features that will best characterize the industry in the foreseeable future. 24 figs
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Directory of Open Access Journals (Sweden)
Lauridsen KG
2017-03-01
Full Text Available Kasper G Lauridsen,1–3 Anders S Schmidt,1–3 Philip Caap,3,4 Rasmus Aagaard,2,3,5 Bo Løfgren1,3,4 1Department of Internal Medicine, 2Clinical Research Unit, Regional Hospital of Randers, Randers, 3Research Center for Emergency Medicine, Aarhus University Hospital, 4Institute of Clinical Medicine, Aarhus University, Aarhus, 5Department of Anesthesiology, Randers Regional Hospital, Denmark Background: The quality of in-hospital resuscitation is poor and may be affected by the clinical experience and cardiopulmonary resuscitation (CPR training. This study aimed to investigate the clinical experience, self-perceived skills, CPR training and knowledge of the guidelines on when to abandon resuscitation among physicians of cardiac arrest teams. Methods: We performed a nationwide cross-sectional study in Denmark. Telephone interviews were conducted with physicians in the cardiac arrest teams in public somatic hospitals using a structured questionnaire. Results: In total, 93 physicians (53% male from 45 hospitals participated in the study. Median age was 34 (interquartile range: 30–39 years. Respondents were medical students working as locum physicians (5%, physicians in training (79% and consultants (16%, and the median postgraduate clinical experience was 48 (19–87 months. Most respondents (92% felt confident in treating a cardiac arrest, while fewer respondents felt confident in performing intubation (41% and focused cardiac ultrasound (39% during cardiac arrest. Median time since last CPR training was 4 (2–10 months, and 48% had attended a European Resuscitation Council (ERC Advanced Life Support course. The majority (84% felt confident in terminating resuscitation; however, only 9% were able to state the ERC guidelines on when to abandon resuscitation. Conclusion: Physicians of Danish cardiac arrest teams are often inexperienced and do not feel competent performing important clinical skills during resuscitation. Less than half have
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Does Venture Capital Spur Innovation?
Samuel Kortum; Josh Lerner
1998-01-01
While policymakers often assume venture capital has a profound impact on innovation, that premise has not been evaluated systematically. We address this omission by examining the influence of venture capital on patented inventions in the United States across twenty industries over three decades. We address concerns about causality in several ways, including exploiting a 1979 policy shift that spurred venture capital fundraising. We find that the amount of venture capital activity in an indust...
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Kaissi, Amer
2010-01-01
Retail clinics have experienced an exponential growth in the last few years. While the majority of retail clinics are freestanding, venture-backed companies affiliated with retail hosts, an increasing number of hospital systems have decided to develop their own retail clinics or partner with existing national companies. Using a stakeholder approach, the purpose of this article is to assess the strategic considerations behind these decisions and the operational challenges associated with them and to use the results to develop a questionnaire that can be applied in future research in a national sample of healthcare executives. We conducted eight in-depth interviews with administrative and clinical leaders in seven hospital systems across the United States that have or had a relationship with retail clinics in the last three years. Our findings show that the hospital systems' association with retail clinics involves two main models: an affiliation with retail chains that operate the clinics and ownership of the clinics with an arms-length relationship with the retail chain. Hospital systems are engaging in these relationships for several strategic reasons: to increase market share through enhanced referrals to physician offices and hospitals, to become closer to consumers, and to experiment with nontraditional ways of delivering health care. Operational challenges included physician resistance and skepticism, poor financial performance, people's perception of retail clinics, staffing issues, and the newness of the business model. Six out of eight respondents thought that hospital affiliation with/ownership of retail clinics is a trend that is here to stay, although many provided caveats and stipulations. Further research is needed to provide more evidence about this emerging way of healthcare delivery.
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Solvoll, Terje; Scholl, Jeremiah; Hartvigsen, Gunnar
2013-03-07
A common denominator of modern hospitals is a variety of communication problems. In particular, interruptions from mobile communication devices are a cause of great concern for many physicians. To characterize how interruptions from mobile devices disturb physicians in their daily work. The gathered knowledge will be subsequently used as input for the design and development of a context-sensitive communication system for mobile communications suitable for hospitals. This study adheres to an ethnographic and interpretive field research approach. The data gathering consisted of participant observations, non-structured and mostly ad hoc interviews, and open-ended discussions with a selected group of physicians. Eleven physicians were observed for a total of 135 hours during May and June 2009. The study demonstrates to what degree physicians are interrupted by mobile devices in their daily work and in which situations they are interrupted, such as surgery, examinations, and during patients/relatives high-importance level conversations. The participants in the study expected, and also indicated, that wireless phones probably led to more interruptions immediately after their introduction in a clinic, when compared to a pager, but this changed after a short while. The unpleasant feeling experienced by the caller when interrupting someone by calling them differs compared to sending a page message, which leaves it up to the receiver when to return the call. Mobile devices, which frequently interrupt physicians in hospitals, are a problem for both physicians and patients. The results from this study contribute to knowledge being used as input for designing and developing a prototype for a context-sensitive communication system for mobile communication suitable for hospitals. We combined these findings with results from earlier studies and also involved actual users to develop the prototype, CallMeSmart. This system intends to reduce such interruptions and at the same time
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Plochg, Thomas; Arah, Onyebuchi A; Botje, Daan; Thompson, Caroline A; Klazinga, Niek S; Wagner, Cordula; Mannion, Russell; Lombarts, Kiki
2014-04-01
Clinical management is hypothesized to be critical for hospital management and hospital performance. The aims of this study were to develop and validate professional involvement scales for measuring the level of clinical management by physicians and nurses in European hospitals. Testing of validity and reliability of scales derived from a questionnaire of 21 items was developed on the basis of a previous study and expert opinion and administered in a cross-sectional seven-country research project 'Deepening our Understanding of Quality improvement in Europe' (DUQuE). A sample of 3386 leading physicians and nurses working in 188 hospitals located in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. Validity and reliability of professional involvement scales and subscales. Psychometric analysis yielded four subscales for leading physicians: (i) Administration and budgeting, (ii) Managing medical practice, (iii) Strategic management and (iv) Managing nursing practice. Only the first three factors applied well to the nurses. Cronbach's alpha for internal consistency ranged from 0.74 to 0.86 for the physicians, and from 0.61 to 0.81 for the nurses. Except for the 0.74 correlation between 'Administration and budgeting' and 'Managing medical practice' among physicians, all inter-scale correlations were measurement instrument can be used for international research on clinical management.
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Klingler, Corinna; Marckmann, Georg
2016-09-23
With Germany facing a shortage of doctors, hospitals have been increasingly recruiting physicians from abroad. Studies in other countries have shown that migrant physicians experience various difficulties in their work, which might impact the quality of patient care, physician job satisfaction, and, accordingly, retention. The experiences of migrant doctors in Germany have not been systematically studied so far and will likely differ from experiences migrant physicians make in other contexts. A thorough understanding of challenges faced by this group, however, is needed to develop adequate support structures-as required by the WHO Global Code of Practice on the International Recruitment of Health Personnel. A qualitative study was conducted to give an overview of the multifaceted difficulties migrant physicians might face in German hospitals. Twenty semi-structured interviews with foreign-born and foreign-trained physicians were conducted in German. Participants were recruited via the State Chambers of Physicians and snowballing based on a maximum variation sampling strategy varying purposefully by source country and medical specialty. The interviews were recorded, transcribed verbatim, and analysed using qualitative content analysis. Participants described difficulties relating to healthcare institutions, own competencies, and interpersonal interactions. Participants experienced certain legal norms, the regulation of licensure and application for work, and the organization of the hospital environment as inadequate. Most struggled with their lack of setting-specific (language, cultural, clinical, and system) knowledge. Furthermore, behaviour of patients and co-workers was perceived as discriminating or inadequate for other reasons. This is the first study to describe the broad range of issues migrant physicians experience in Germany. Based on this information, institutional actors should devise support structures to ensure quality of care, physician wellbeing, and
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Investment Timing for New Business Ventures
George W. Blazenko; Andrey D. Pavlov
2010-01-01
A key requirement for the start of many entrepreneurial businesses is private equity or venture capital financing. In the traditional approach to entrepreneurial investment analysis, an entrepreneur starts a new venture and a venture capitalist finances the new venture when business return exceeds the financial opportunity cost for comparable risk the cost of capital for the new venture. The real options literature recommends that entrepreneurs delay business start due to investment irreversi...
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International Nuclear Information System (INIS)
Duyck, P.; Pynoo, B.; Devolder, P.; Voet, T.; Adang, L.; Vercruysse, J.
2008-01-01
Purpose: radiology departments are making the transition from analog film to digital images by means of PACS (Picture Archiving and Communication System). It is critical for the hospital that its physicians adopt and accept the new digital work method regarding radiological information. The aim of this study is to investigate hospital physicians' acceptance of PACS using questionnaires pre- and post-implementation and to identify main influencing factors. Materials and methods: the study was conducted in an 1169 bed university hospital. The UTAUT (Unified Theory of Acceptance and Use of Technology) questionnaire was administered at two times: one month pre-implementation (T1) and 1.5 years post-implementation (T2) of PACS, targeting all hospital physicians with the exemption of radiologists. The UTAUT scales (Behavioral Intention BI; Facilitating Conditions FC; Effort Expectancy EE; Performance Expectancy PE; Anxiety ANX; Social Influence SI; System Use USE; Attitude toward technology ATT; Self-Efficacy SE) were used to assess questions regarding: (a) PACS' usefulness, (b) PACS' ease of learning/using, (c) PACS support availability, (d) the perceived pressure to use PACS, (e) physicians' attitude towards PACS and (f) physicians' intention to use and actual use of PACS. Results: at T1 scale ratings were positive toward the PACS implementation. The ratings on all scales with the exception of self-efficacy improved at T2. Regression analysis revealed that the key factor for intention to use PACS at T1 was the usefulness of PACS, while the availability and awareness of support was its most important predictor at T2. Overall, PE was the best predictor of BI, but all four UTAUT-determinants (PE, FC, EE and SI) were salient for its prediction. Variance explained in BI ranged from 31 to 37% while variance explained in USE was very low (3%). (orig.)
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Bao, Yuhua; Fan, Guanrong; Zou, Dongdong; Wang, Tong; Xue, Di
2017-01-01
Over 90% of outpatient care in China was delivered at public hospitals, making outpatient experience in this setting an important aspect of quality of care. To assess outpatient experience with different aspects of physician services at China's public hospitals and its association with overcrowding of the hospital outpatient departments. Retrospective analysis of a large survey of outpatient experience in Shanghai, China. We tested the hypotheses that patient experience was poorer with physician-patient communication, education, and shared decision-making and where and when there was greater overcrowding of the hospital outpatient departments. Ordered logistic models were estimated separately for general and specialty hospitals. 7,147 outpatients at 40 public hospitals in Shanghai, China, in 2014. Patient experience with physician services were self-reported based on 12 questions as part of a validated instrument. Indicators of overcrowding included time of visit (morning vs. afternoon, Monday vs. rest of the week) and hospital outpatient volume in the first half of 2014. Overall, patients reported very favorable experience with physician services. Two out of the 12 questions pertaining to both communication and shared decision-making consistently received lower ratings. Hospitals whose outpatient volumes were in the top two quartiles received lower patient ratings, but the relationship achieved statistical significance among specialty hospitals only. Inadequate physician-patient communication and shared decision-making and hospital overcrowding compromise outpatient experience with physician services at Chinese public hospitals. Effective diversion of patients with chronic and less complex conditions to community health centers will be critical to alleviate the extreme workloads at hospitals with high patient volumes and, in turn, improve patient experience.
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Malaysian group looks to invest in China petchems venture
International Nuclear Information System (INIS)
Alperowicz, N.
1992-01-01
The Kuok Group, owned by Malaysian tycoon Robert Kuok, has emerged as the latest potential investor in a petrochemicals joint venture in China. The group, which has assets including the Shangri-La chain of hotels and several urea formaldehyde plants in Malaysia and Singapore, has signed a memorandum of understanding with the local authorities of Beihai, Guangxi province to study a $3-billion refinery and petrochemicals complex. Beihai, in coastal southwestern China, is near the Vietnam border. The project, understood to be in the preliminary scoping phase, would include a 100,000-bbl/day refinery and a world-scale 450,000-m.t./year cracker that would feed a 450,000-m.t./year polyethylene unit. To make the operation competitive, the group is considering building an ethylene cracker and looking for a cheap source of natural gas. It is understood that an undisclosed Western company has joined forces in the joint venture, which is not one of the 14 petrochemicals complexes currently planned in China. Kuok, who has good contacts in China and has just agreed to develop a commercial complex in Shanghai's Zhabei district, has been approached by the Beihai authorities. Beihai, an economic development zone, would like its own refinery. The closest one is in Maoming. A decision is expected by the end of then year
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Malaysian group looks to invest in China petchems venture
Energy Technology Data Exchange (ETDEWEB)
Alperowicz, N.
1992-11-25
The Kuok Group, owned by Malaysian tycoon Robert Kuok, has emerged as the latest potential investor in a petrochemicals joint venture in China. The group, which has assets including the Shangri-La chain of hotels and several urea formaldehyde plants in Malaysia and Singapore, has signed a memorandum of understanding with the local authorities of Beihai, Guangxi province to study a $3-billion refinery and petrochemicals complex. Beihai, in coastal southwestern China, is near the Vietnam border. The project, understood to be in the preliminary scoping phase, would include a 100,000-bbl/day refinery and a world-scale 450,000-m.t./year cracker that would feed a 450,000-m.t./year polyethylene unit. To make the operation competitive, the group is considering building an ethylene cracker and looking for a cheap source of natural gas. It is understood that an undisclosed Western company has joined forces in the joint venture, which is not one of the 14 petrochemicals complexes currently planned in China. Kuok, who has good contacts in China and has just agreed to develop a commercial complex in Shanghai's Zhabei district, has been approached by the Beihai authorities. Beihai, an economic development zone, would like its own refinery. The closest one is in Maoming. A decision is expected by the end of then year.
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McCullough, Jeffrey S; Snir, Eli M
2010-05-01
We study the relationship between physician-hospital integration and its relation to monitoring IT utilization. We develop a theoretical model in which monitoring IT may complement or substitute for integration and test these relationships using a novel data source. Physician labor market heterogeneity identifies the empirical model. We find that monitoring IT utilization is increasing in integration, implying that expanded firm boundaries complement monitoring IT adoption. We argue that the relationship between monitoring IT and firm boundaries depends upon the contractibility of the monitored information.
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Wang, Hongmei; Kim, Jungyoon; Su, Dejun; Xu, Liyan; Chen, Li-Wu; Huang, Terry T-K
2014-10-09
Reducing childhood obesity remains a public health priority given its high prevalence and its association with increased risk of adult obesity and chronic diseases. The objective of this study was to examine the joint influence of multiple risk factors on adolescent overweight status. We conducted a random-digit-dialed telephone survey of adolescents aged 12 to 19 years in fall 2008 in a Midwestern city in Nebraska. On the basis of survey data for 791 youths aged 12 to 18 years, we conducted latent class analysis to group youths by the joint occurrence of dietary behavior, physical activity, parenting practices, and physician advice. We then examined the association between the groups and overweight status by using logistic regression, controlling for age, sex, race/ethnicity, and parent and family information. Youths were clustered into 3 groups. Group I (52%) were youths with healthy dietary behavior and physical activity, less permissive parenting practices, and physician advice; Group II (30%) were youths with moderately healthy dietary behavior and physical activity, less permissive parenting practices, and no physician advice; and Group III (18%) were youths with unhealthy dietary behavior and physical activity, permissive parenting practices, and physician advice. Youths in Groups I and II were less likely to be overweight than youths in Group III. Youths with healthier behavior and less permissive parenting practices were less likely to be overweight. Study findings highlight the need to address obesity risk factors among youths with unhealthy dietary behavior, inadequate exercise, permissive parenting practices, and some physician advice. Tailored interventions should be used to target youths with different obesity risk factors.
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Janssen, Patricia A; Saxell, Lee; Page, Lesley A; Klein, Michael C; Liston, Robert M; Lee, Shoo K
2009-09-15
Studies of planned home births attended by registered midwives have been limited by incomplete data, nonrepresentative sampling, inadequate statistical power and the inability to exclude unplanned home births. We compared the outcomes of planned home births attended by midwives with those of planned hospital births attended by midwives or physicians. We included all planned home births attended by registered midwives from Jan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada (n = 2889), and all planned hospital births meeting the eligibility requirements for home birth that were attended by the same cohort of midwives (n = 4752). We also included a matched sample of physician-attended planned hospital births (n = 5331). The primary outcome measure was perinatal mortality; secondary outcomes were obstetric interventions and adverse maternal and neonatal outcomes. The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00-1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00-1.43) among women attended by a midwife and 0.64 (95% CI 0.00-1.56) among those attended by a physician. Women in the planned home-birth group were significantly less likely than those who planned a midwife-attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95% CI 0.29-0.36; assisted vaginal delivery, RR 0.41, 95% 0.33-0.52) or adverse maternal outcomes (e.g., third- or fourth-degree perineal tear, RR 0.41, 95% CI 0.28-0.59; postpartum hemorrhage, RR 0.62, 95% CI 0.49-0.77). The findings were similar in the comparison with physician-assisted hospital births. Newborns in the home-birth group were less likely than those in the midwife-attended hospital-birth group to require resuscitation at birth (RR 0.23, 95% CI 0.14-0.37) or oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24-0.59). The findings were similar in the comparison with
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Jennings, P; Lotito, A; Baysson, H; Pineau-Blondel, E; Berlioz, J
2017-03-01
The purpose of the study was to evaluate physician's satisfaction with the clinical pharmacy activities in a French regional hospital. Data were collected by face-to-face interviews carried out by a public health intern with physicians from 14 different departments of medicine and surgery. A specifically designed questionnaire was used for this study. This contained 18 closed-ended questions, 3 open-ended questions and 6 questions relating to the multidisciplinary analysis of prescriptions of elderly patients. The questionnaire was proposed to 78 physicians, of which 62 replied (participation rate of 79%). Thirty-seven percent were interns (23/62), 19% were assistants (12/62) and 44% were senior physicians (27/62). Clinical pharmacy satisfaction levels were generally very high. In regard to clinical skills, 87% of the physicians were satisfied with pharmacists' competencies and 91% by the pertinence of transmitted information. Ninety-five percent of the physicians were also satisfied by the logistical aspect and the relationship with pharmacists (reactivity, availability and communication). Analysis of the open-ended questions showed that physicians were in favour of the increased presence of clinical pharmacists on the wards. This study shows a high level of physician satisfaction in relation to the clinical pharmacy activities in our hospital, and should be viewed as a strong endorsement of the work of the clinical pharmacy. This study highlights some areas of improvement such as increase presence of the clinical pharmacists on the wards. In order to assess periodically our activity, this study must be repeated in the future. Copyright © 2016 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.
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International New Venture Legitimation
DEFF Research Database (Denmark)
Turcan, Romeo V.
2013-01-01
the process of their emergence. It is a longitudinal, multiple-case study research that employs critical incident technique for data collection, analysis and interpretation. Following theory driven sampling, five international new ventures were selected that were operating in the software sector in the UK......There is limited theoretical understanding and empirical evidence for how international new ventures legitimate. Drawing from legitimation theory, this study fills in this gap by exploring how international new ventures legitimate and strive for survival in the face of critical events during......, and had internationalized and struggled for survival during the dotcom era. Grounded in data, this study corroborates a number of legitimation strategies yielded by prior research and refutes others. It further contributes to our understanding of international new venture legitimation by suggesting new...
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Bekelis, Kimon; Missios, Symeon; MacKenzie, Todd A
2018-01-24
The quality of physicians practicing in hospitals recognized for nursing excellence by the American Nurses Credentialing Center has not been studied before. We investigated whether Magnet hospital recognition is associated with higher quality of physicians performing neurosurgical procedures. We performed a cohort study of patients undergoing neurosurgical procedures from 2009-2013, who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Propensity score adjusted multivariable regression models were used to adjust for known confounders, with mixed effects methods to control for clustering at the facility level. An instrumental variable analysis was used to control for unmeasured confounding and simulate the effect of a randomized trial. During the study period, 185,277 patients underwent neurosurgical procedures, and met the inclusion criteria. Of these, 66,607 (35.6%) were hospitalized in Magnet hospitals, and 118,670 (64.4%) in non-Magnet institutions. Instrumental variable analysis demonstrated that undergoing neurosurgical operations in Magnet hospitals was associated with a 13.6% higher chance of being treated by a physician with superior performance in terms of mortality (95% CI, 13.2% to 14.1%), and a 4.3% higher chance of being treated by a physician with superior performance in terms of length-of-stay (LOS) (95% CI, 3.8% to 4.7%) in comparison to non-Magnet institutions. The same associations were present in propensity score adjusted mixed effects models. Using a comprehensive all-payer cohort of neurosurgical patients in New York State we identified an association of Magnet hospital recognition with superior physician performance.
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Trimmel, Helmut; Beywinkler, Christoph; Hornung, Sonja; Kreutziger, Janett; Voelckel, Wolfgang G
2017-04-26
Pre-hospital airway management is a major challenge for emergency medical service (EMS) personnel. Despite convincing evidence that the rescuer's qualifications determine efficacy of tracheal intubation, in-hospital airway management training is not mandatory in Austria, and often neglected. Thus we sought to prove that airway management competence of EMS physicians can be established and maintained by a tailored training program. In this descriptive quality control study we retrospectively evaluated all in- and pre-hospital airway cases managed by EMS physicians who underwent a structured in-hospital training program in anesthesia at General Hospital Wiener Neustadt. Data was obtained from electronic anesthesia and EMS documentation systems. From 2006 to 2016, 32 EMS physicians with 3-year post-graduate education, but without any prior experience in anesthesia were trained. Airway management proficiency was imparted in three steps: initial training, followed by an ongoing practice schedule in the operating room (OR). Median and interquartile range of number of in-hospital tracheal intubations (TIs) vs. use of supra-glottic airway devices (SGA) were 33.5 (27.5-42.5) vs. 19.0 (15.0-27.0) during initial training; 62.0 (41.8-86.5) vs. 33.5 (18.0-54.5) during the first, and 64.0 (34.5-93.8) vs. 27 (12.5-56.0) during the second year. Pre-hospitaly, every physician performed 9.0 (5.0-14.8) TIs vs. 0.0 (0.0-0.0) SGA cases during the first, and 9.0 (7.0-13.8) TIs vs. 0.0 (0.0-0.3) SGA during the second year. Use of an SGA was mandatory when TI failed after the second attempt, thus accounting for a total of 33 cases. In 8 cases, both TI and SGA failed, but bag mask ventilation was successfully performed. No critical events related to airway management were noted and overall success rate for TI with a max of 2 attempts was 95.3%. Number of TIs per EMS physician is low in the pre-hospital setting. A training concept that assures an additional 60+ TIs per year appears to
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Koelewijn, Wout T; Ehrenhard, Michel L; Groen, Aard J; van Harten, Wim H
2012-09-01
During the past decade, entrepreneurship in the healthcare sector has become increasingly important. The aging society, the continuous stream of innovative technologies and the growth of chronic illnesses are jeopardizing the sustainability of healthcare systems. In response, many European governments started to reform healthcare during the 1990s, replacing the traditional logic of medical professionalism with business-like logics. This trend is expected to continue as many governments will have to reduce their healthcare spending in response to the current growing budget deficits. In the process, entrepreneurship is being stimulated, yet little is known about intra-hospital dynamics leading to entrepreneurial behavior. The purpose of this article is to review existing literature concerning the influence of intra-organizational dynamics on entrepreneurship among physicians and managers in hospitals of Western countries. Therefore, we conducted a theory-led, systematic review of how intra-organizational dynamics among hospital managers and physicians can influence entrepreneurship. We designed our review using the neo-institutional framework of Greenwood and Hinings (1996). We analyze these dynamics in terms of power dependencies, interest dissatisfaction and value commitments. Our search revealed that physicians' dependence on hospital management has increased along with healthcare reforms and the resulting emphasis on business logics. This has induced various types of responses by physicians. Physicians can be pushed to adopt an entrepreneurial attitude as part of a defensive value commitment toward the business-like healthcare logic, to defend their traditionally dominant position and professional autonomy. In contrast, physicians holding a transformative attitude toward traditional medical professionalism seem more prone to adopt the entrepreneurial elements of business-like healthcare, encouraged by the prospect of increased autonomy and income. Interest
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Study on promotion of venture business
International Nuclear Information System (INIS)
Kim, Hwa Sup; Song, Ki Dong; Chung, Whan Sam; Pae, Jang In; Choi, Young Duck; Rhee, Yong Duck; Kim, Seung Sim; Jeon, Hyoung Won
2002-10-01
This study reviewed the concepts of venture business and surveyed venture business support system nationwide. The venture business support system is summarized in depth to help the pre-entrepreneurs under establishing venture business. This study also reviewed the technology management system of KAERI and surveyed its historical accomplishment of technology transfer. Then, this study suggested its future direction by surveying the system of advanced countries and also suggested the measures to meet the future direction. The main finding of this study is that the direct investment to venture business by KAERI could greatly contribute to promoting venture business. Therefore, the government and KAERI should make efforts to change the technology management system toward the direct investment. Finally, this study concluded by offering policy suggestions to the government on improvement of technology management system
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Directory of Open Access Journals (Sweden)
Kidong Kim
Full Text Available This study aimed to determine the factors influencing patients' choice of physician at the first visit through database analysis of a tertiary hospital in South Korea. We collected data on the first treatments performed by physicians who had treated patients for at least 3 consecutive years over 10 years (from 2003 to 2012 from the database of Seoul National University's affiliated tertiary hospital. Ultimately, we obtained data on 524,012 first treatments of 319,004 patients performed by 115 physicians. Variables including physicians' age and medical school and patients' age were evaluated as influencing factors for the number of first treatments performed by each physician in each year using a Poisson regression through generalized estimating equations with a log link. The number of first treatments decreased over the study period. Notably, the relative risk for first treatments was lower among older physicians than among younger physicians (relative risk 0.96; 95% confidence interval 0.95 to 0.98. Physicians graduating from Seoul National University (SNU also had a higher risk for performing first treatments than did those not from SNU (relative risk 1.58; 95% confidence interval 1.18 to 2.10. Finally, relative risk was also higher among older patients than among younger patients (relative risk 1.03; 95% confidence interval 1.01 to 1.04. This study systematically demonstrated that physicians' age, whether the physician graduated from the highest-quality university, and patients' age all related to patients' choice of physician at the first visit in a tertiary university hospital. These findings might be due to Korean cultural factors.
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The tectonic plates are shifting: cultural change vs. mural dyslexia.
Cohn, Kenneth; Friedman, Leonard H; Allyn, Thomas R
2007-01-01
In response to a rapidly changing healthcare marketplace, a variety of new business models have arisen, including new specialties (hospitalists), selective care (concierge medicine), and joint ventures (ambulatory surgical centers, specialty hospitals), some with hospitals and others with independent vendors. Since both hospitals and physicians are feeling the squeeze of rising expenses, burdensome regulations, heightened consumer expectations, and stagnant or decreasing reimbursement, the response to global economic competition and the need to improve clinical and financial outcomes can bring physicians and hospitals together rather than drive them farther apart. In response to perceived threats, physicians and hospital executives can engage in defensive reasoning that may feel protective but can also lead to mural dyslexia, the inability or unwillingness to see the handwriting on the wall. The strategies of positive deviance (finding solutions that already exist in the community rather than importing best practices), appreciative inquiry (building on success rather than relying solely on root-cause analyses of problems), and structured dialogue (allowing practicing physicians to articulate clinical priorities rather than assuming they lack the maturity and will to come to consensus) are field-tested approaches that allow hospital leaders to engage practicing physicians and that can help both parties work more interdependently to improve patient care in a dynamically changing environment. Physician-hospital collaboration based on transparency, active listening, and prompt implementation can offer sustainable competitive advantage to those willing to embark on a lifetime learning journey.
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Mjaaland, Trond A; Finset, Arnstein; Jensen, Bård Fossli; Gulbrandsen, Pål
2011-09-01
Patients express their negative emotions in medical consultations either implicitly as cue to an underlying unpleasant emotion or explicitly as a clear, unambiguous concern. The health provider's response to such cues and concerns is important for the outcome of consultations. Yet, physicians often neglect patient's negative emotions. Most studies of this subject are from primary health care. We aimed to describe how physicians in a hospital respond to negative emotions in an outpatient setting. Ninety six consultations were videotaped in a general teaching hospital. The Verona Coding Definitions of Emotional Sequences was used to identify patients' expression of negative emotions in terms of cue and concern and to code physicians' subsequent responses. Cohen's kappa was used as interrater reliability measure. Acceptable kappa level was set to .60. We observed 163 expressions of negative emotions. In general, the physician responses to patients' cues and concerns did not include follow up or exploration. Concerns more often than cues led to lack of emotional exploration. When patients expressed negative emotions or cues to such, hospital physicians tended to move away from emotional communication, particularly if the emotion was expressed as an explicit concern. Medical training should enable physicians' to explore the patients' emotions in situations where it will improve the medical treatment. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
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Luboga, Sam; Hagopian, Amy; Ndiku, John; Bancroft, Emily; McQuide, Pamela
2011-01-01
Uganda faces a colossal shortages of human resources for health. Previous literature has largely focused on those who leave. This paper reports on a study of physicians working in 18 public and private facilities in Uganda as part of a larger study of more than 641 hospital-based health workers in Uganda. We report what could entice physicians to stay longer, satisfaction with current positions, and future career intentions. This study took place in 18 Ugandan hospitals. We describe the 49 physicians who participated in 11 focus groups and the 63 physicians who completed questionnaires, out of a larger sample of 641 health workers overall. Only 37% of physicians said they were satisfied with their jobs, and 46% reported they were at risk of leaving the health sector or the country. After compensation, the largest contributors to dissatisfaction among physicians were quality of management, availability of equipment and supplies (including drugs), quality of facility infrastructure, staffing and workload, political influence, community location, and professional development. Physicians in our study were highly dissatisfied, with almost half the sample reporting a risk to leave the sector or the country. The established link in literature between physician dissatisfaction and departure from the health system suggests national and regional policy makers should consider interventions that address the contributors to dissatisfaction identified in our study. Copyright © 2010 John Wiley & Sons, Ltd.
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The ties that bind: an integrative framework of physician-hospital alignment
Directory of Open Access Journals (Sweden)
Gemmel Paul
2011-02-01
Full Text Available Abstract Background Alignment between physicians and hospitals is of major importance to the health care sector. Two distinct approaches to align the medical staff with the hospital have characterized previous research. The first approach, economic integration, is rooted in the economic literature, in which alignment is realized by financial means. The second approach, noneconomic integration, represents a sociological perspective emphasizing the cooperative nature of their relationship. Discussion Empirical studies and management theory (agency theory and social exchange theory are used to increase holistic understanding of physician hospital alignment. On the one hand, noneconomic integration is identified as a means to realize a cooperative relationship. On the other hand, economic integration is studied as a way to align financial incentives. The framework is developed around two key antecedent factors which play an important role in aligning the medical staff. First, provider financial risk bearing is identified as a driving force towards closer integration. Second, organizational trust is believed to be important in explaining the causal relation between noneconomic and economic integration. Summary Hospital financial risk bearing creates a greater need for closer cooperation with the medical staff and alignment of financial incentives. Noneconomic integration lies at the very basis of alignment. It contributes directly to alignment through the norm of reciprocity and indirectly by building trust with the medical staff, laying the foundation for alignment of financial incentives.
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The ties that bind: an integrative framework of physician-hospital alignment.
Trybou, Jeroen; Gemmel, Paul; Annemans, Lieven
2011-02-15
Alignment between physicians and hospitals is of major importance to the health care sector. Two distinct approaches to align the medical staff with the hospital have characterized previous research. The first approach, economic integration, is rooted in the economic literature, in which alignment is realized by financial means. The second approach, noneconomic integration, represents a sociological perspective emphasizing the cooperative nature of their relationship. Empirical studies and management theory (agency theory and social exchange theory) are used to increase holistic understanding of physician hospital alignment. On the one hand, noneconomic integration is identified as a means to realize a cooperative relationship. On the other hand, economic integration is studied as a way to align financial incentives. The framework is developed around two key antecedent factors which play an important role in aligning the medical staff. First, provider financial risk bearing is identified as a driving force towards closer integration. Second, organizational trust is believed to be important in explaining the causal relation between noneconomic and economic integration. Hospital financial risk bearing creates a greater need for closer cooperation with the medical staff and alignment of financial incentives. Noneconomic integration lies at the very basis of alignment. It contributes directly to alignment through the norm of reciprocity and indirectly by building trust with the medical staff, laying the foundation for alignment of financial incentives.
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How to Define the Content of a Job-Specific Worker's Health Surveillance for Hospital Physicians?
Ruitenburg, Martijn M.; Frings-Dresen, Monique H. W.; Sluiter, Judith K.
2016-01-01
Background: A job-specific Worker's Health Surveillance (WHS) for hospital physicians is a preventive occupational health strategy aiming at early detection of their diminished work-related health in order to improve or maintain physician's health and quality of care. This study addresses what steps
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[Notifiable infectious diseases: knowledge and notification among hospital physicians].
Rubio-Cirilo, Laura; Martín-Ríos, M Dolores; de Las Casas-Cámara, Gonzalo; Andrés-Prado, M José; Rodríguez-Caravaca, Gil
2013-12-01
Notifiable infectious diseases represent a public health hazard, which is why they are under surveillance and must be reported. We tried to assess hospital physicians' knowledge of hospital physicians on notifiable infectious diseases and their self-reported attitudes to notification. An observational study was conducted using a questionnaire with 11 multiple choice questions, two yes/no questions and one short-answer question. It was distributed to all senior doctors and residents in 19 medical and surgical departments. A total of 248 questionnaires were sent out, with a response rate of 79.84%. More than three-quarters (76.3%) of the respondents were senior doctors. As regards specific knowledge about whether a particular disease is a notifiable disease, 29.5% identified correctly 100% of the named diseases, 3.2% could not identify any of them. All urgent named notifiable infectious diseases were correctly identified by 25.3% of physicians. Statistically significant differences were found in the knowledge of notifiable diseases knowledge in medical and surgical departments, as well as for senior doctors (P=.047) and residents (P=.035). A high percentage of medical services (40%) and surgical (70%) department reported never failing to notify. When asked about the causes of under-reporting, 72% did not know whether notification was mandatory or not, and 88% did not know what diseases must be notified. Although many respondents are aware that diseases notification is part of their daily activity, many of them admit under-reporting. There is insufficient knowledge about what diseases are considered notifiable infectious diseases and how to notify them. Copyright © 2012 Elsevier España, S.L. All rights reserved.
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Directory of Open Access Journals (Sweden)
Lockey David
2011-10-01
Full Text Available Abstract Background Physician-manned emergency medical teams supplement other emergency medical services in some countries. These teams are often selectively deployed to patients who are considered likely to require critical care treatment in the pre-hospital phase. The evidence base for guidelines for pre-hospital triage and immediate medical care is often poor. We used a recognised consensus methodology to define key priority areas for research within the subfield of physician-provided pre-hospital critical care. Methods A European expert panel participated in a consensus process based upon a four-stage modified nominal group technique that included a consensus meeting. Results The expert panel concluded that the five most important areas for further research in the field of physician-based pre-hospital critical care were the following: Appropriate staffing and training in pre-hospital critical care and the effect on outcomes, advanced airway management in pre-hospital care, definition of time windows for key critical interventions which are indicated in the pre-hospital phase of care, the role of pre-hospital ultrasound and dispatch criteria for pre-hospital critical care services. Conclusion A modified nominal group technique was successfully used by a European expert group to reach consensus on the most important research priorities in physician-provided pre-hospital critical care.
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Brown, Kyla N; Leigh, Jeanna Parsons; Kamran, Hasham; Bagshaw, Sean M; Fowler, Rob A; Dodek, Peter M; Turgeon, Alexis F; Forster, Alan J; Lamontagne, Francois; Soo, Andrea; Stelfox, Henry T
2018-01-28
Little is known about documentation during transitions of patient care between clinical specialties. Therefore, we examined the focus, structure and purpose of physician progress notes for patients transferred from the intensive care unit (ICU) to hospital ward to identify opportunities to improve communication breaks. This was a prospective cohort study in ten Canadian hospitals. We analyzed physician progress notes for consenting adult patients transferred from a medical-surgical ICU to hospital ward. The number, length, legibility and content of notes was counted and compared across care settings using mixed-effects linear regression models accounting for clustering within hospitals. Qualitative content analyses were conducted on a stratified random sample of 32 patients. A total of 447 patient medical records that included 7052 progress notes (mean 2.1 notes/patient/day 95% CI 1.9-2.3) were analyzed. Notes written by the ICU team were significantly longer than notes written by the ward team (mean lines of text 21 vs. 15, p notes; mean agreement of patient issues was 42% [95% CI 31-53%]. Qualitative analyses identified eight themes related to focus (central point - e.g., problem list), structure (organization, - e.g., note-taking style), and purpose (intention - e.g., documentation of patient course) of the notes that varied across clinical specialties and physician seniority. Important gaps and variations in written documentation during transitions of patient care between ICU and hospital ward physicians are common, and include discrepancies in documentation of patient information.
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Multistage Selection and the Financing of New Ventures
Jonathan T. Eckhardt; Scott Shane; Frédéric Delmar
2006-01-01
Using a random sample of 221 new Swedish ventures initiated in 1998, we examine why some new ventures are more likely than others to successfully be awarded capital from external sources. We examine venture financing as a staged selection process in which two sequential selection events systematically winnow the population of ventures and influence which ventures receive financing. For a venture to receive external financing its founders must first select it as a candidate for external fundin...
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Pelland, Kimberly D; Baier, Rosa R; Gardner, Rebekah L
2017-06-30
nBACKGROUND: Electronic health records (EHRs) may reduce medical errors and improve care, but can complicate clinical encounters. To describe hospital-based physicians' perceptions of the impact of EHRs on patient-physician interactions and contrast these findings against office-based physicians' perceptionsMethods: We performed a qualitative analysis of comments submitted in response to the 2014 Rhode Island Health Information Technology Survey. Office- and hospital-based physicians licensed in Rhode Island, in active practice, and located in Rhode Island or neighboring states completed the survey about their Electronic Health Record use. The survey's response rate was 68.3% and 2,236 (87.1%) respondents had EHRs. Among survey respondents, 27.3% of hospital-based and 37.8% of office-based physicians with EHRs responded to the question about patient interaction. Five main themes emerged for hospital-based physicians, with respondents generally perceiving EHRs as negatively altering patient interactions. We noted the same five themes among office-based physicians, but the rank-order of the top two responses differed by setting: hospital-based physicians commented most frequently that they spend less time with patients because they have to spend more time on computers; office-based physicians commented most frequently on EHRs worsening the quality of their interactions and relationships with patients. In our analysis of a large sample of physicians, hospital-based physicians generally perceived EHRs as negatively altering patient interactions, although they emphasized different reasons than their office-based counterparts. These findings add to the prior literature, which focuses on outpatient physicians, and can shape interventions to improve how EHRs are used in inpatient settings.
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Predictors of distress in hospital physicians: protective and vulnerability factors
Directory of Open Access Journals (Sweden)
Fermín Martínez-Zaragoza
2014-05-01
Full Text Available This study investigates the relationship between protective and vulnerability factors affecting health (distréss in medical staff. Participants were 127 doctors from four public hospitals, who were administered the Occupational Stress in Health Professionals Inventory, the Ways of Coping Questionnaire, the Maslach Burnout Inventory, the Symptom Check-list-90 Revised Questionnaire, and the Flow Trait Scale-2. Following the methodology of Partial Least Squares modeling (PLS, an explanation is given for distréss in hospital physicians, where the avoidance coping strategy produces distréss directly (β = .296 and indirectly (β = .139 th rough its influence on the increase of burnout (β = .314, which in turn is increased by occupational stress (β = .209. Professional flow, measured by professional efficacy and flow, acts as a good protector against distréss (β = -.133, partly compensating the effects of the variables which have an increasing impact on an individual's distréss (GoF = .983. To sum up, when trying to predict a physician's distréss, four key elements should be considered: avoidance coping and its indirect effect through burnout on distréss; the burnout construct itself and professional flow.
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Directory of Open Access Journals (Sweden)
Sjahril Effendy
2017-08-01
Full Text Available Penanaman modal asing memegang peranan penting dalam perekonomian. Keberhasilan suatu pembangunan nasional tidak dapat dipisahkan dari penanaman modal asing sebagai faktor penunjang dan turut menentukan pembangunan ekonomi, antara lain dapat menciptakan pekerjaan, terjadinya alih teknologi, memberikan masukan dari segi perpajakan dan pendapatan negara dan daerah. Menciptakan kepastian hukum terhadap investor asing perusahaan joint venture sebagai bentuk perlindungan hukum. Pemerintah Kabupaten Deli Serdang dalam pembangunan sektor air bersih juga memberlakukan Undang-Undang No.25 Tahun 2007 tentang Penanaman Modal walaupun belum sepenuhnya diterapkan. Hambatan-hambatan yang dihadapi antara lain berupa perjanjian kerjasama dengan PDAM Tirtanadi tidak sepenuhnya dilaksanakan, penyerahan air bersih merupakan objek PPN padahal menurut ketentuan merupakan objek yang bebas dari PPN, dan UU No.13 Tahun 2003 tentang Ketenagakerjaan telah disalahgunakan oleh oknum serikat pekerja perusahaan. Penyelesaian sengketa berpedoman kepada perjanjian kerjasama antara PT. Tirta Lyonnaise Medan dengan PDAM Tirtanadi Provinsi Sumatera Utara.
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Reyniers, Thijs; Houttekier, Dirk; Pasman, H Roeline; Stichele, Robert Vander; Cohen, Joachim; Deliens, Luc
2014-01-01
Family physicians play a pivotal role in providing end-of-life care and in enabling terminally ill patients to die in familiar surroundings. The purpose of this study was to explore the family physicians' perceptions of their role and the difficulties they have in preventing and guiding hospital admissions at the end of life. Five focus groups were held with family physicians (N= 39) in Belgium. Discussions were transcribed verbatim and analyzed using a constant comparative approach. Five key roles in preventing and guiding hospital admissions at the end of life were identified: as a care planner, anticipating future scenarios; as an initiator of decisions in acute situations, mostly in an advisory manner; as a provider of end-of-life care, in which competency and attitude is considered important; as a provider of support, particularly by being available during acute situations; and as a decision maker, taking overall responsibility. Family physicians face many different and complex roles and difficulties in preventing and guiding hospital admissions at the end of life. Enhancing the family physician's role as a gatekeeper to hospital services, offering the physicians more end-of-life care training, and developing or expanding initiatives to support them could contribute to a lower proportion of hospital admissions at the end of life. © 2014 Annals of Family Medicine, Inc.
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Quantifying culture gaps between physicians and managers in Dutch hospitals: A survey
Klopper-Kes, A.H.J.; Siesling, Sabine; Meerdink, Nienke; Wilderom, Celeste P.M.; van Harten, Willem H.
2010-01-01
Background: The demands in hospitals for safety and quality, combined with limitations in financing health care require effective cooperation between physicians and managers. The complex relationship between both groups has been described in literature. We aim to add a perspective to literature, by
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Physician use of updated anti-virus software in a tertiary Nigerian hospital.
Laabes, E P; Nyango, D D; Ayedima, M M; Ladep, N G
2010-01-01
While physicians are becoming increasingly dependent on computers and the internet, highly lethal malware continue to be loaded into cyberspace. We sought to assess the proportion of physicians with updated anti-virus software in Jos University Teaching Hospital Nigeria and to determine perceived barriers to getting updates. We used a pre-tested semi-structured self-administered questionnaire to conduct a cross-sectional survey among 118 physicians. The mean age (+/- SD) of subjects was 34 (+/- 4) years, with 94 male and 24 female physicians. Forty-two (36.5%) of 115 physicians with anti-virus software used an updated program (95% Cl: 27, 45). The top-three antivirus software were: McAfee 40 (33.9%), AVG 37 (31.4%) and Norton 17 (14.4%). Common infections were: Trojan horse 22 (29.7%), Brontok worm 8 (10.8%), and Ravmonlog.exe 5 (6.8%). Internet browsing with a firewall was an independent determinant for use of updated anti-virus software [OR 4.3, 95% CI, 1.86, 10.02; P malware producers and anti-virus software developers.
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2015-11-24
This final rule implements a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CJR) model, in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedure will be included in the episode of care. We believe this model will further our goals in improving the efficiency and quality of care for Medicare beneficiaries with these common medical procedures.
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How to Define the Content of a Job-Specific Worker's Health Surveillance for Hospital Physicians?
Ruitenburg, Martijn M; Frings-Dresen, Monique H W; Sluiter, Judith K
2016-03-01
A job-specific Worker's Health Surveillance (WHS) for hospital physicians is a preventive occupational health strategy aiming at early detection of their diminished work-related health in order to improve or maintain physician's health and quality of care. This study addresses what steps should be taken to determine the content of a job-specific WHS for hospital physicians and outlines that content. Based on four questions, decision trees were developed for physical and psychological job demands and for biological, chemical, and physical exposures to decide whether or not to include work-related health effects related to occupational exposures or aspects of health reflecting insufficient job requirements. Information was gathered locally through self-reporting and systematic observations at the workplace and from evidence in international publications. Information from the decision trees on the prevalence and impact of the health- or work-functioning effect led to inclusion of occupational exposures (e.g., biological agents, emotionally demanding situations), job requirements (e.g., sufficient vision, judging ability), or health effects (e.g., depressive symptoms, neck complaints). Additionally, following the Dutch guideline for occupational physicians and based on specific job demands, screening for cardiovascular diseases, work ability, drug use, and alcohol consumption was included. Targeted interventions were selected when a health or work functioning problem existed and were chosen based on evidence for effectiveness. The process of developing a job-specific WHS for hospital physicians was described and the content presented, which might serve as an example for other jobs. Before implementation, it must first be tested for feasibility and acceptability.
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Directory of Open Access Journals (Sweden)
Widy S. Abdulkadir
2017-09-01
Full Text Available Collaboration of physicians and pharmacists is very important in providing treatment to patients. Collaboration includes an exchange of views or ideas that give perspective to all collaborators. In order to make collaborative relationship optimal, all members of the different professions should have a desire to cooperate. Pharmacists and physicians should plan and practice as colleagues, work interdependence within the limits of the scope of practice with a variety of values and knowledge. The role of director in cooperation between doctor and pharmacist takes decision-making which refers to treatment of patients to be decided together between health professionals (physician and pharmacist. The study was a quasi-experimental design with a pre-test-post-test control group design, using paired t-test analysis. The study was conducted from October 2012 until February 2013. The paired t-test results showed that the variable of teamwork effectiveness in M. M. Dunda Hospital increased significantly (p=0.038, which means that the three-party (physician-pharmacist-director collaboration model may increase teamwork effectiveness. Three-party collaboration model can improve physician-pharmacist relationship in the hospital. Leadership has a positive and significant effect on employees’ organizational commitment. Director can be an inspiration in the work and determine the direction and goals of the organization. Therefore, the three-party (physician-pharmacist-director collaboration model can improve the quality of the relationship between the two professions, physician and pharmacist.
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Kerkemeyer, L; Reifferscheid, A; Pomorin, N; Wasem, J
2016-11-01
Background and research question: The hospital sector is currently characterized by a high economic pressure. As well the DRG system as the investment financing by the federal states imply financial limitations. Hospitals react to this situation by trying to reduce costs and to increase case volume. It is questionable whether and to what extent patient care and the working conditions of the physicians are affected by these circumstances. Especially, gastroenterological patients were considered to be insufficiently covered by the DRG system in the past. Therefore, this study focuses on the gastroenterology. Method: Based on prior studies and several semi-structured interviews with gastroenterologists working in hospitals a discipline-specific questionnaire was developed. Three versions of the questionnaire were differentiated to correspond to the respective experiences of the target population (chief physician, senior physician, assistant physician). All in all, 1751 members of the "Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten" (DGVS) were addressed. The questionnaire was answered by 642 participants resulting in a response rate of 36.7 %. The answers were interpreted by using descriptive and multivariate analyses. Results: A significant economic pressure is perceived by the participating gastroenterologists. This pressure manifests itself primary in perceived deficits in nursing care and human attention towards the patients. Moreover, the work satisfaction is negatively affected. Identified difficulties in the personnel recruitment can only be partially attributed to economic reasons. However, rationing of services is relatively seldom. Also, a financially-oriented overprovision is not perceived as a primary concern. In general, assistant physicians were a bit more skeptical about the situation in the gastroenterology, e. g. patient care, than the chief physicians. Conclusions: In total, the situation in the
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Mudaraba-Venture Capital Closed-end Mutual Funds and Mudaraba-Venture Capital Open-end Mutual Funds
Halil Ibrahim Bulut
2008-01-01
The important part of this study attempts to explain that both venture capital and interest-free financing are based on similar ground, if not the same. Two new models called Mudaraba-Venture Capital Closed-End Mutual Funds and Mudaraba-Venture Capital Open-End Mutual Funds, based on both the similarities and the needs of financial innovation in the interest-free financing system, are detailed. It is believed that the development of these two models could make some improvements not only in th...
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de Bie, J.; Cuperus-Bosma, J.M.; van der Jagt, M.A.; Gevers, J.K.M.; van der Wal, G.
2005-01-01
Occurrence of problems with, refusals of orders and contemplated refusals of orders for risky procedures by nurses in Dutch hospitals and views on the safety of performance was studied using postal questionnaires (600 physicians and 3200 nurses, response 60-71%). Of the respondents, 11-30%
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Directory of Open Access Journals (Sweden)
Jennifer M. Jabson
2016-03-01
Full Text Available Abstract Background Some physicians lack knowledge and awareness about health issues specific to sexual and gender minority (SGM individuals. To help improve this, hospitals have implemented policies that mandate non-discrimination and training to promote sexual and gender minority health. There is limited evidence about how such policies relate to physicians’ knowledge, attitudes, and gender and sexual minority affirmative practices. Method A random sample of 1000 physicians was recruited from a complete list of physicians affiliated with one of two university Hospitals located in Tennessee and 180 physicians completed the survey concerning attitudes and knowledge about SGM individuals. Physicians were affiliated with either Hospital A that had not implemented policies for non-discrimination and training, or Hospital B that did. Results Physicians held different attitudes about SGM patients than non-patients. Physicians affiliated with Hospital A held more negative attitudes about SGM individuals who were non-patients than physicians affiliated with Hospital B. There were no differences between the two hospitals in physicians’ attitudes and knowledge about SGM patients. Conclusion Policies that mandate non-discrimination and training as they currently exist may not improve physicians’ attitudes and knowledge about SGM individuals. Additional research is needed to understand how these policies and trainings relate to physicians’ SGM affirmative practices.
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CAPITAL STRUCTURE AND VENTURE CAPITAL
Directory of Open Access Journals (Sweden)
Becsky-Nagy Patricia
2015-07-01
Full Text Available Venture capital significantly changes the capital structure of the portfolio company at the time of the investment. Venture capitalists contribute to the company’s success through their active involvement in the management and their added value appears in the increase of the value of the equity. At the same time with taking active role in the management, agency problem occurs, that complicates the cooperation and the success of exit. In this article we search the answer for the question whether the preferred equity, that are commonly used in the US for bridging the agency problem, are used and able to help Hungarian venture capitalists to manage agency problems. On the other hand we examined how the venture capital affect capital structure, how the venture capitalists value added appear in the capital structure. During the evaluation of the three case studies, we came to the conclusion, that the venture capital investments have positive effect on the liabilities of the enterprises, as the capital structure indexes show. However, the investors need the ownership, which help them to step up resolutely, when things change for the worse, and companies need the expertise, which the investors bring with their personal assistance. The investor’s new attitude also has positive effect on a mature company, which has an experienced leader, because he can show another aspect, as a person who come from outside. During the examination of the capital structure, we cannot disregard the events of the company’s environment, which have effects on the firm. The investor’s decisions also appear different ways. Because of this, every venture capital investment is different, just as the capital structure of the firms, in which they invest.
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Reyniers, T.; Houttekier, D.; Pasman, H.R.; Stichele, R.V.; Cohen, J.; Deliens, L.
2014-01-01
CONCLUSIONS Family physicians face many different and complex roles and difficulties in preventing and guiding hospital admissions at the end of life. Enhancing the family physician’s role as a gatekeeper to hospital services, offering the physicians more end-of-life care training, and developing or
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Sakashita, Akihiro; Kishino, Megumi; Nakazawa, Yoko; Yotani, Nobuyuki; Yamaguchi, Takashi; Kizawa, Yoshiyuki
2016-07-01
To clarify how highly active hospital palliative care teams can provide efficient and effective care regardless of the lack of full-time palliative care physicians. Semistructured focus group interviews were conducted, and content analysis was performed. A total of 7 physicians and 6 nurses participated. We extracted 209 codes from the transcripts and organized them into 3 themes and 21 categories, which were classified as follows: (1) tips for managing palliative care teams efficiently and effectively (7 categories); (2) ways of acquiring specialist palliative care expertise (9 categories); and (3) ways of treating symptoms that are difficult to alleviate (5 categories). The findings of this study can be used as a nautical chart of hospital-based palliative care team (HPCT) without full-time PC physician. Full-time nurses who have high management and coordination abilities play a central role in resource-limited HPCTs. © The Author(s) 2015.
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Youth and young adults with cerebral palsy: their use of physician and hospital services.
Young, Nancy L; Gilbert, Thomas K; McCormick, Anna; Ayling-Campos, Anne; Boydell, Katherine; Law, Mary; Fehlings, Darcy L; Mukherjee, Shubhra; Wedge, John H; Williams, Jack I
2007-06-01
To examine patterns of health care utilization among youth and young adults who have cerebral palsy (CP) and to provide information to guide the development of health services for adults who have CP. This study analyzed health insurance data for outpatient physician visits and hospital admissions for a 4-year period. Six children's treatment centers in Ontario, Canada. The sample included 587 youth and 477 adults with CP identified from health records. Youths were 13 to 17 years of age, and adults were 23 to 32 years of age at the end of the data range. Not applicable. We computed the annual rates of outpatient physician visits and hospitalizations per 1000 persons and compared these with rates for the general population. Annual rates of outpatient physician visits were 6052 for youth and 6404 for adults with CP, 2.2 times and 1.9 times higher, respectively, than rates for age-matched peers (P<.01). Specialists provided 28.4% of youth visits but only 18.8% of adult visits. Annual hospital admission rates were 180 for youth and 98 for adults with CP, 4.3 times and 10.6 times higher, respectively, than rates for age-matched peers (P<.01). It appears that youth and adults with CP continue to have complex care needs and rely heavily on the health care system. Comprehensive services are essential to support their health as they move into youth and adulthood. However, there appear to be gaps in the adult health care system, such as limited access to specialist physicians.
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Alshora, Weam Bashier I; Mohammad Kalo, Bakr
2018-04-01
Medical profession is a stressful occupation as it carries potential risk for pregnancy outcome. There is lack of researches regarding the pregnancy loss among physicians working in hospitals in Saudi Arabia. The current study aims at estimating the prevalence and factors associated with pregnancy loss among female physicians working at King Abdul-Aziz University Hospital in Jeddah, September, 2015. A cross sectional study has been conducted, which included all the female physicians working at King Abdul-Aziz University Hospital in Jeddah by filling a self-administered online questionnaire. Out of all responding physicians (n = 92), the majority were Saudis (93.5%), who were mostly married (89.1%) and rest were either divorced (8.7%) or widowed (2.2%). Seventeen female physicians had pregnancy loss before (18.5%) with a total of 25 losses, which were mostly occurred during first trimester, especially while working as residents (40%), the average monthly working hours in the first pregnancy loss was (median; IQR, 160, 110-198 h). No statistically significant difference could be detected regarding the variation in pregnancy losses according to nationality marital status nor specialty. Most of the pregnancy losses in physicians occurred in first trimester during residency with a relatively longer monthly working hours. Further researches are needed on a larger sample and wider scale with inclusion of other pertinent factors to enable judging on the independent relationship of pregnancy loss and medical profession. Copyright © 2018. Published by Elsevier B.V.
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Feasibility and acceptability of a workers' health surveillance program for hospital physicians
Ruitenburg, Martijn M.; Plat, Marie-Christine J.; Frings-Dresen, Monique H. W.; Sluiter, Judith K.
2015-01-01
A Workers' Health Surveillance (WHS) program is an occupational health strategy used to detect and address the health of individual workers to improve their ability to work. This study aims to investigate the feasibility and acceptability of a new job-specific WHS for hospital physicians. All
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A consensus-based template for documenting and reporting in physician-staffed pre-hospital services
DEFF Research Database (Denmark)
Kruger, Andreas J; Lockey, David; Kurola, Jouni
2011-01-01
-staffed pre-hospital services in Europe. METHODS: Using predefined criteria, we recruited sixteen European experts in the field of pre-hospital care. These experts were guided through a four-step modified nominal group technique. The process was carried out using both e-mail-based communication and a plenary...... have established a core data set for documenting and reporting in physician-staffed pre-hospital services. We believe that this template could facilitate future studies within the field and facilitate standardised reporting and future shared research efforts in advanced pre-hospital care....
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Business Plans in New Ventures : An Institutional Perspective
Karlsson, Tomas
2005-01-01
This thesis is about business plans in new ventures. It takes an institutional perspective with a particular focus on how external actors influence ventures through norms, regulations and way of thinking. Through an intensive study of six new ventures at a business incubator, and a structured, computer-aided analysis, this study probes the following questions: How are new ventures influenced to write business plans, and what sources influence them? What strategies do new ventures use to deal ...
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Hospital Medicine and Fellowship Program in Rural North Dakota - A Multifaceted Success Story.
Hyder, S S; Amundson, Mary
2017-11-01
Recruitment of hospitalists and primary care physicians for Critical Access Hospitals and tertiary care hospitals in North Dakota is difficult. To address this challenge, 2 programs were implemented in Bismarck, North Dakota. St. Alexius Medical Center created a hospitalist fellowship training program in collaboration with the University of North Dakota School of Medicine and Health Sciences and physicians willing to work in Critical Access Hospitals were offered a joint appointment to teach hospitalist fellows and obtain a clinical academic appointment at the university. Since it was created in 2012, 84 physicians have applied for 13 fellowships. Of the 11 fellows who have completed the program, 64% (7/11) remained in North Dakota to practice. Physicians are more likely to work in a rural Critical Access Hospital if they spend time working at a tertiary care center and have clinical academic appointments. Where recruitment is challenging, hospitalist fellowship programs are helpful in meeting the health care workforce demand.
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Physicians' perceptions of physician-nurse interactions and information needs in China.
Wen, Dong; Guan, Pengcheng; Zhang, Xingting; Lei, Jianbo
2018-01-01
Good communication between physicians and nurses is important for the understanding of disease status and treatment feedback; however, certain issues in Chinese hospitals could lead to suboptimal physician-nurse communication in clinical work. Convenience sampling was used to recruit participants. Questionnaires were sent to clinical physicians in three top tertiary Grade-A teaching hospitals in China and six hundred and seventeen physicians participated in the survey. (1) Common physician-nurse interactions were shift-change reports and provisional reports when needed, and interactions expected by physicians included face-to-face reports and communication via a phone or mobile device. (2) Most respondents believed that the need for information in physician-nurse interactions was high, information was moderately accurate and timely, and feedback regarding interaction time and satisfaction indicated that they were only average and required improvement. (3) Information needs in physician-nurse interactions differed significantly according to hospital category, role, workplace, and educational background (p < .05). There was a considerable need for information within physician-nurse interactions, and the level of satisfaction with the information obtained was average; requirements for the improvement of communication differed between physicians and nurses because of differences in their characteristics. Currently, the use of information technology in physician-nurse communication was less common but was highly expected by physicians.
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Venture Capital and Innovation Strategies
Da Rin, M.; Penas, M.F.
2015-01-01
Venture capital is a specialized form of financial intermediation that often provides funding for costly technological innovation. Venture capital firms need to exit portfolio companies within about five years from the investment to generate returns for institutional investors. This paper is the
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Consumer attitudes toward healthcare marketing practices: a comparison of hospitals vs. physicians.
Lim, J S; Zallocco, R
1997-01-01
This study investigates consumer attitudes toward the use of marketing practices by the health care industry. The survey results show significant differences in consumers' attitude toward the use and effects of various marketing practices by the two types of provider (hospital and physician). Theoretical and empirical implications are discussed.
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Directory of Open Access Journals (Sweden)
Khaliq Muhammad
2012-07-01
Full Text Available Abstract Background To determine the behavior of physicians regarding medical literature reading and participation in research activities at one of the largest teaching hospitals in Pakistan. Method This descriptive, cross-sectional study was conducted by interviewing the house officers, residents and fellows of six major specialties (Medicine, Surgery, Pediatrics, Psychology, Obstetrics & Gynecology and Anesthesia in Civil Hospital, Karachi between August and December, 2011. The questionnaire elicited responses regarding the reading habits of physicians, preferred sources of information, their participation in research activities (publication & supervision and views regarding journal club. SPSS 17.0 was used for data entry and analysis. Result A total of 259 completely filled questionnaires were returned with a response rate of 85.19%. Mean age of the participants was 29.67 ± 7.65 years. Books were selected by 71.4% doctors as their preferred source of information, regardless of their clinical specialties. (p Conclusion Urgent intervention is required to promote healthcare literature reading and writing practice in our physicians. Easy access to workplace computers with internet and subscription of paid journals will facilitate physicians. Lack of supervisors and busy schedule were reported to be important contributors for not participating in research. Addressing these issues will encourage doctors to participate more in research activities.
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Venture Capitalists in Systems of Innovation
DEFF Research Database (Denmark)
Munk, Kasper B.; Vintergaard, Christian
regional innovation systems.In attempt to locate and determine the potentials and importance of the venture capitalists in the innovationsystem a two-dimensional taxonomy is constructed and used to illuminate their role and position. Thetaxonomy gains insights through theoretical reasoning and the possible...... initiatives to be taken to raise venture capitalists to a more direct and formal role in the contextof systems of innovation.Key words: Venture capital, innovation systems, innovation....
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Ruitenburg, Martijn M.; Frings-Dresen, Monique H. W.; Sluiter, Judith K.
2012-01-01
Background: We studied the prevalence of common mental disorders among Dutch hospital physicians and investigated whether the presence of a mental disorder was associated with insufficient self-reported work ability. Methods: A questionnaire was sent to all (n = 958) hospital physicians of one
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Venture Capital and Innovation Strategies
Da Rin, Marco; Penas, Maria
2015-01-01
Venture capital investors are specialized financial intermediaries that provides funding for technological innovation with the goal of realizing a capital gain within a few years. We are the first to examine the association of venture capital funding with a company’s choice of innovation strategies.
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Venture capital and innovation strategies
Da Rin, Marco; Penas, Fabiana
2017-01-01
Venture capital investors are specialized financial intermediaries that provide funding for technological innovation with the goal of realizing a capital gain within a few years. We are the first to examine the association of venture capital funding with a company's choice of innovation strategies.
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Blish, Christi; Proctor, Rita; Fletcher, Suzanne W.; O'Malley, Michael
1983-01-01
As part of a new automated ambulatory medical record, a computerized outpatient medication system was developed for a teaching hospital general medicine group practice. Seven months after its implementation, the system was evaluated to determine physician acceptance and approval. Practice physicians were surveyed, and 94% of the respondents approved of the system. Over 90% thought that the computerized system had improved the completeness and accuracy of medication information as well as thei...
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Bartiaux, M; Mols, P
2017-01-01
patient management in the acute and sub-acute setting of an Emergency Department is challenging. An assessment of the quality of provided care enables an evaluation of failings. It contributes to the identification of areas for improvement. to obtain an analysis, by hospital-ward physicians, of adult patient care management quality, as well as of the correctness of diagnosis made during emergency admissions. To evaluate the consequences of inadequate patient care management on morbidity, mortality and cost and duration of hospitalization. prospective data analysis obtained between the 1/12/2009 and the 21/12/2009 from physicians using a questionnaire on adult-patient emergency admissions and subsequent hospitalization. questionnaires were completed for 332 patients. Inadequate management of patient care were reported for 73/332 (22 %) cases. Incorrect diagnoses were reported for 20/332 (6 %) cases. 35 cases of inadequate care management (10.5 % overall) were associated with morbidity (34 cases) or mortality (1 case), including 4 cases (1.2 % ) that required emergency intensive-care or surgical interventions. this quality study analyzed the percentage of patient management cases and incorrect diagnoses in the emergency department. The data for serious outcome and wrong diagnosis are comparable with current literature. To improve performance, we consider the process for establishing a diagnosis and therapeutic care.
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Hellesø, Ragnhild; Sogstad, Maren Kristine Raknes
2014-01-01
Hospital nurses' and physicians' production and exchange of accurate information between levels of care are crucial for ensuring safe and seamless care for patients in transition. We report on a study in which we explored hospital providers' use of information sources when they prepared discharge information for colleges in the community health-care sector. In this cross-sectional study, 510 nurses and 236 physicians responded through a questionnaire. Our findings show that nurses and physici...
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2012-01-01
Background Violence against healthcare workers in Palestinian hospitals is common. However, this issue is under researched and little evidence exists. The aim of this study was to assess the incidence, magnitude, consequences and possible risk factors for workplace violence against nurses and physicians working in public Palestinian hospitals. Methods A cross-sectional approach was employed. A self-administered questionnaire was used to collect data on different aspects of workplace violence against physicians and nurses in five public hospitals between June and July 2011. The questionnaires were distributed to a stratified proportional random sample of 271 physicians and nurses, of which 240 (88.7%) were adequately completed. Pearson’s chi-square analysis was used to test the differences in exposure to physical and non-physical violence according to respondents’ characteristics. Odds ratios and 95% confidence intervals were used to assess potential associations between exposure to violence (yes/no) and the respondents’ characteristics using logistic regression model. Results The majority of respondents (80.4%) reported exposure to violence in the previous 12 months; 20.8% physical and 59.6% non-physical. No statistical difference in exposure to violence between physicians and nurses was observed. Males’ significantly experienced higher exposure to physical violence in comparison with females. Logistic regression analysis indicated that less experienced (OR: 8.03; 95% CI 3.91-16.47), and a lower level of education (OR: 3; 95% CI 1.29-6.67) among respondents meant they were more likely to be victims of workplace violence than their counterparts. The assailants were mostly the patients' relatives or visitors, followed by the patients themselves, and co-workers. Consequences of both physical and non-physical violence were considerable. Only half of victims received any type of treatment. Non-reporting of violence was a concern, main reasons were lack of
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Venture Capitalist Enabled Entrepreneurial Mentoring
DEFF Research Database (Denmark)
Agrawal, Anirudh
2018-01-01
Traditionally the success of a venture capital model has been anchored around two dimensions‚ namely equity as a trade for investment and start-up valuation and profitable exits. Scholars have focused less on the inter-organizational interaction between the venture capital (VC) and start-up entre...
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National Research Council Canada - National Science Library
Lister, M. J; Andreassen, A; Bales, Shanda; Biddle, J. G; Chang, M. M; McCormick, R; Packard, W. J; Sun, T
2006-01-01
Leveraging venture capital to the advantage of the Naval Services should be viewed as part of the larger project of reforming the acquisition system to permit rapid introduction of new technologies...
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Staged Financing in Venture capital market.
Damania, Priti
2009-01-01
The report shows the venture capital decision making in staged financing from a real option perspective. The report also describes entrepreneur-venture capital relationship from a prisoner's dilemma approach.
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Jong, J.D. de; Westert, G.P.; Lagoe, R.; Groenewegen, P.P.
2006-01-01
OBJECTIVE: To test the hypothesis that physicians who work in different hospitals adapt their length of stay decisions to what is usual in the hospital under consideration. DATA SOURCES: Secondary data were used, originating from the Statewide Planning and Research Cooperative System (SPARCS).
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Perceptions of effective and ineffective nurse-physician communication in hospitals.
Robinson, F Patrick; Gorman, Geraldine; Slimmer, Lynda W; Yudkowsky, Rachel
2010-01-01
Nurse-physician communication affects patient safety. Such communication has been well studied using a variety of survey and observational methods; however, missing from the literature is an investigation of what constitutes effective and ineffective interprofessional communication from the perspective of the professionals involved. The purpose of this study was to explore nurse and physician perceptions of effective and ineffective communication between the two professions. Using focus group methodology, we asked nurses and physicians with at least 5 years' acute care hospital experience to reflect on effective and ineffective interprofessional communication and to provide examples. Three focus groups were held with 6 participants each (total sample 18). Sessions were audio recorded and transcribed verbatim. Transcripts were coded into categories of effective and ineffective communication. The following themes were found. For effective communication: clarity and precision of message that relies on verification, collaborative problem solving, calm and supportive demeanor under stress, maintenance of mutual respect, and authentic understanding of the unique role. For ineffective communication: making someone less than, dependence on electronic systems, and linguistic and cultural barriers. These themes may be useful in designing learning activities to promote effective interprofessional communication.
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Macleod, Anne Marie; Gollish, Jeffrey; Kennedy, Deborah; McGlasson, Rhona; Waddell, James
2009-01-01
The Joint Health and Disease Management Program in the Toronto Central Local Health Integration Network (TC LHIN) is envisioned as a comprehensive model of care for patients with hip and knee arthritis. It includes access to assessment services, education, self-management programs and other treatment programs, including specialist care as needed. As the first phase of this program, the hospitals in TC LHIN implemented a Hip and Knee Replacement Program to focus on improving access and quality of care, coordinating services and measuring wait times for patients waiting for hip or knee replacement surgery. The program involves healthcare providers, consumers and constituent hospitals within TC LHIN. The approach used for this program involved a definition of governance structure, broad stakeholder engagement to design program elements and plans for implementation and communication to ensure sustainability. The program and approach were designed to provide a model that is transferrable in its elements or its entirety to other patient populations and programs. Success has been achieved in creating a single wait list, developing technology to support referral management and wait time reporting, contributing to significant reductions in waits for timely assessment and treatment, building human resource capacity and improving patient and referring physician satisfaction with coordination of care.
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Sinaiko, Anna D; Eastman, Diana; Rosenthal, Meredith B
2012-03-01
Public report cards with quality and cost information on physicians, physician groups, and hospital providers have proliferated in recent years. However, many of these report cards are difficult for consumers to interpret and have had little impact on the provider choices consumers are making. To gain a more focused understanding of why these reports cards have not been more successful and what improvements could be made, we interviewed experts and surveyed registrants at the March 2011 AHRQ National Summit on Public Reporting for Consumers in Health Care. We found broad agreement that public reporting has been disconnected from consumer decisions about providers because of weaknesses in report card content, design, and accessibility. Policy makers have an opportunity to change the landscape of public reporting by taking advantage of advances in measurement, data collection, and information technology to deliver a more consumer-centered report card. Overcoming the constraint of limited public funding, and achieving the acceptance of providers, is critical to realizing future success.
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Weigl, Matthias; Müller, Andreas; Sevdalis, Nick; Angerer, Peter
2013-03-01
Simultaneous task performance ("multitasking") is common in hospital physicians' work and is implicated as a major determinant for enhanced strain and detrimental performance. The aim was to determine the impact of multitasking by hospital physicians on their self reported strain and performance. A prospective observational time-and-motion study in a Community Hospital was conducted. Twenty-seven hospital physicians (surgical and internal specialties) were observed in 40 full-shift observations. Observed physicians reported twice on their self-monitored strain and performance during the observation time. Associations of observed multitasking events and subsequent strain and performance appraisals were calculated. About 21% of the working time physicians were engaged in simultaneous activities. The average time spent in multitasking activities correlated significantly with subsequently reported strain (r = 0.27, P = 0.018). The number of instances of multitasking activities correlated with self-monitored performance to a marginally significant level (r = 0.19, P = 0.098). Physicians who engage in multitasking activities tend to self-report better performance but at the cost of enhanced psychophysical strain. Hence, physicians do not perceive their own multitasking activities as a source for deficient performance, for example, medical errors. Readjustment of workload, improved organization of work for hospital physicians, and training programs to improve physicians' skills in dealing with multiple clinical demands, prioritization, and efficient task allocation may be useful avenues to explore to reduce the potentially negative impact of simultaneous task performance in clinical settings.
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Physician job satisfaction in Saudi Arabia: insights from a tertiary hospital survey.
Aldrees, Turki; Al-Eissa, Sami; Badri, Motasim; Aljuhayman, Ahmed; Zamakhshary, Mohammed
2015-01-01
Job satisfaction refers to the extent to which people like or dislike their job. Job satisfaction varies across professions. Few studies have explored this issue among physicians in Saudi Arabia. The objective of this study is to determine the level and factors associated with job satisfaction among Saudi and non-Saudi physicians. In this cross-sectional study conducted in a major tertiary hospital in Riyadh, a 5-point Likert scale structured questionnaire was used to collect data on a wide range of socio-demographic, practice environment characteristics and level and consequences of job satisfaction from practicing physicians (consultants or residents) across different medical specialties. Logistic regression models were fitted to determine factors associated with job satisfaction. Of 344 participants, 300 (87.2%) were Saudis, 252 (73%) males, 255 (74%) married, 188 (54.7%) consultants and age [median (IQR)] was 32 (27-42.7) years. Overall, 104 (30%) respondents were dissatisfied with their jobs. Intensive care physicians were the most dissatisfied physicians (50%). In a multiple logistic regression model, income satisfaction (odds ratio [OR]=0.448 95% CI 0.278-0.723, P job satisfaction identified in this study should be addressed in governmental strategic planning aimed at improving the healthcare system and patient care.
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International Nuclear Information System (INIS)
Bunn, M.
1996-01-01
The paper gives an outline of a concept which has the potential to provide both substantial financing needed for disposition of plutonium from excess nuclear weapons and the long-term management structure required to implement this effort. The three most important issues were underlined. First, it is urgent to modernize security and accounting systems for all weapon-usable nuclear materials, particularly from former Soviet Union. Second, excess plutonium and Highly Enriched Uranium (HEU) must be brought under international monitoring to ensure irreversibility of nuclear arms reduction. Third, quick move should be done towards actual disposition of excess plutonium and HEU. Technology already exists, but the key issues are how to get finance and manage this operation, particularly given its immense scope and controversial nature. An international joint venture 'Enterprise for nuclear Security' that would build and operate plutonium disposition facilities under stringent non-proliferation controls, financed through additional sales of HEU is a potentially promising approach to addressing the most difficult issues facing the disposition problem
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Awareness of Stroke Risk after TIA in Swiss General Practitioners and Hospital Physicians.
Streit, Sven; Baumann, Philippe; Barth, Jürgen; Mattle, Heinrich P; Arnold, Marcel; Bassetti, Claudio L; Meli, Damian N; Fischer, Urs
2015-01-01
Transient ischemic attacks (TIA) are stroke warning signs and emergency situations, and, if immediately investigated, doctors can intervene to prevent strokes. Nevertheless, many patients delay going to the doctor, and doctors might delay urgently needed investigations and preventative treatments. We set out to determine how much general practitioners (GPs) and hospital physicians (HPs) knew about stroke risk after TIA, and to measure their referral rates. We used a structured questionnaire to ask GPs and HPs in the catchment area of the University Hospital of Bern to estimate a patient's risk of stroke after TIA. We also assessed their referral behavior. We then statistically analysed their reasons for deciding not to immediately refer patients. Of the 1545 physicians, 40% (614) returned the survey. Of these, 75% (457) overestimated stroke risk within 24 hours, and 40% (245) overestimated risk within 3 months after TIA. Only 9% (53) underestimated stroke risk within 24 hours and 26% (158) underestimated risk within 3 months; 78% (473) of physicians overestimated the amount that carotid endarterectomy reduces stroke risk; 93% (543) would rigorously investigate the cause of a TIA, but only 38% (229) would refer TIA patients for urgent investigations "very often". Physicians most commonly gave these reasons for not making emergency referrals: patient's advanced age; patient's preference; patient was multimorbid; and, patient needed long-term care. Although physicians overestimate stroke risk after TIA, their rate of emergency referral is modest, mainly because they tend not to refer multimorbid and elderly patients at the appropriate rate. Since old and frail patients benefit from urgent investigations and treatment after TIA as much as younger patients, future educational campaigns should focus on the importance of emergency evaluations for all TIA patients.
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Awareness of Stroke Risk after TIA in Swiss General Practitioners and Hospital Physicians.
Directory of Open Access Journals (Sweden)
Sven Streit
Full Text Available Transient ischemic attacks (TIA are stroke warning signs and emergency situations, and, if immediately investigated, doctors can intervene to prevent strokes. Nevertheless, many patients delay going to the doctor, and doctors might delay urgently needed investigations and preventative treatments. We set out to determine how much general practitioners (GPs and hospital physicians (HPs knew about stroke risk after TIA, and to measure their referral rates.We used a structured questionnaire to ask GPs and HPs in the catchment area of the University Hospital of Bern to estimate a patient's risk of stroke after TIA. We also assessed their referral behavior. We then statistically analysed their reasons for deciding not to immediately refer patients.Of the 1545 physicians, 40% (614 returned the survey. Of these, 75% (457 overestimated stroke risk within 24 hours, and 40% (245 overestimated risk within 3 months after TIA. Only 9% (53 underestimated stroke risk within 24 hours and 26% (158 underestimated risk within 3 months; 78% (473 of physicians overestimated the amount that carotid endarterectomy reduces stroke risk; 93% (543 would rigorously investigate the cause of a TIA, but only 38% (229 would refer TIA patients for urgent investigations "very often". Physicians most commonly gave these reasons for not making emergency referrals: patient's advanced age; patient's preference; patient was multimorbid; and, patient needed long-term care.Although physicians overestimate stroke risk after TIA, their rate of emergency referral is modest, mainly because they tend not to refer multimorbid and elderly patients at the appropriate rate. Since old and frail patients benefit from urgent investigations and treatment after TIA as much as younger patients, future educational campaigns should focus on the importance of emergency evaluations for all TIA patients.
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Venture business and control of ь organizations under globalization
Ostap Boiko; Olga Pogaidak; Petro Khariv
2015-01-01
The activity of venture companies and peculiarities of each management stage of venture financing which in modern terms is quite risky has been described in the article. The state of venture entrepreneurship in the world and in Ukraine has been analyzed, the main problems faced by domestic venture enterprises have been outlined and ways of their solution have been determined. The method of forming the system for the venture controlling at industrial...
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Yoo, Sooyoung; Kim, Seok; Kim, Taegi; Kim, Jon Soo; Baek, Rong-Min; Suh, Chang Suk; Chung, Chin Youb; Hwang, Hee
2012-12-01
The cloud computing-based virtual desktop infrastructure (VDI) allows access to computing environments with no limitations in terms of time or place such that it can permit the rapid establishment of a mobile hospital environment. The objective of this study was to investigate the empirical issues to be considered when establishing a virtual mobile environment using VDI technology in a hospital setting and to examine the utility of the technology with an Apple iPad during a physician's rounds as a case study. Empirical implementation issues were derived from a 910-bed tertiary national university hospital that recently launched a VDI system. During the physicians' rounds, we surveyed patient satisfaction levels with the VDI-based mobile consultation service with the iPad and the relationship between these levels of satisfaction and hospital revisits, hospital recommendations, and the hospital brand image. Thirty-five inpatients (including their next-of-kin) and seven physicians participated in the survey. Implementation issues pertaining to the VDI system arose with regard to the highly availability system architecture, wireless network infrastructure, and screen resolution of the system. Other issues were related to privacy and security, mobile device management, and user education. When the system was used in rounds, patients and their next-of-kin expressed high satisfaction levels, and a positive relationship was noted as regards patients' decisions to revisit the hospital and whether the use of the VDI system improved the brand image of the hospital. Mobile hospital environments have the potential to benefit both physicians and patients. The issues related to the implementation of VDI system discussed here should be examined in advance for its successful adoption and implementation.
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Corporate Venturing, Allocation of Talent, and Competition for Star Managers
De Bettignies , Jean-Etienne; Chemla , Gilles
2008-01-01
We provide new rationales for corporate venturing, based on competition for talented managers. As returns to venturing increase, firms engage in corporate venturing for reasons other than capturing these returns. First, higher venturing returns increase managerial compensation, to which firms respond by increasing incentives. Managers increase effort, prompting firms to reallocate them to new ventures, where the marginal product of effort is highest. Second, as returns to venturing become lar...
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Physician leadership is essential to the survival of teaching hospitals.
Schwartz, R W; Pogge, C
2000-06-01
Academic medical centers (AMCs) face severe financial constraints because they must now compete directly with private providers that focus exclusively on cost-effective healthcare delivery. Educational and research capacities developed at AMCs have been supported by government and third party payers, but government support is diminishing. Physicians are ill-equipped to respond to market pressures. Analyses of cultural change and restructuring in corporate giants such as Greyhound, IBM and FedEx are relevant to teaching hospitals. To succeed, organizations must flatten hierarchy, empower staff, train leaders, and mobilize intellectual capital. Effective leadership is essential. Physicians must educate themselves on forces impacting the AMC, understand changes needed in the structure and processes of AMC governance and acquire competencies for leadership and management if AMCs are to survive and thrive. Surgeons should acquire competencies that will enable them to become leaders in the process of AMC transformation.
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Everson, Jordan; Lee, Shoou-Yih Daniel; Adler-Milstein, Julia
2016-12-01
In response to evolving policies and conditions, hospitals have increased health information technology (HIT) adoption and strived to improve hospital-physician integration. While evidence suggests that both HIT and integration confer independent benefits, when combined, they may provide complementary means to achieve high performance or overlap to offset each other's contribution. We explore this relationship in the context of hospital adherence to evidence-based practices (EBPs). Using the American Hospital Association's Annual and IT Supplement surveys, and Centers for Medicare and Medicaid Services's Hospital Compare, we estimate the independent relationships and interactions between HIT and hospital-physician integration with respect to EBP adherence. HIT adoption and tight (but not loose) integration are independently associated with greater adherence to EBPs. The interaction between HIT adoption and tight integration is negative, consistent with an offsetting association between HIT adoption and integration in their relationship to EBP adherence. This finding reveals the need to be aware of potential substitutive effects from simultaneous pursuit of multiple approaches to performance improvement. © The Author(s) 2016.
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Directory of Open Access Journals (Sweden)
Kimberly D Pelland
2017-06-01
Full Text Available Background: Electronic health records (EHRs may reduce medical errors and improve care, but can complicate clinical encounters. Objective: To describe hospital-based physicians’ perceptions of the impact of EHRs on patient-physician interactions and contrast these findings against office-based physicians’ perceptions Methods: We performed a qualitative analysis of comments submitted in response to the 2014 Rhode Island Health Information Technology Survey. Office- and hospital-based physicians licensed in Rhode Island, in active practice, and located in Rhode Island or neighboring states completed the survey about their Electronic Health Record use. Results: The survey’s response rate was 68.3% and 2,236 (87.1% respondents had EHRs. Among survey respondents, 27.3% of hospital-based and 37.8% of office-based physicians with EHRs responded to the question about patient interaction. Five main themes emerged for hospital-based physicians, with respondents generally perceiving EHRs as negatively altering patient interactions. We noted the same five themes among office-based physicians, but the rank-order of the top two responses differed by setting: hospital-based physicians commented most frequently that they spend less time with patients because they have to spend more time on computers; office-based physicians commented most frequently on EHRs worsening the quality of their interactions and relationships with patients. Conclusion: In our analysis of a large sample of physicians, hospital-based physicians generally perceived EHRs as negatively altering patient interactions, although they emphasized different reasons than their office-based counterparts. These findings add to the prior literature, which focuses on outpatient physicians, and can shape interventions to improve how EHRs are used in inpatient settings.
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Sustainable Venture Capital Investments: An Enabler Investigation
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Elena Antarciuc
2018-04-01
Full Text Available Investing in sustainable projects can help tackle the current sustainability challenges. Venture capital investments can contribute significantly to the growth of sustainable start-ups. Sustainable venture capital (SVC research is just emerging. This paper identifies enablers for sustainable venture capital investments in Saudi Arabia taking into account different stakeholders and firm’s tangible and intangible resources. Using perspectives from venture capital experts in Saudi Arabia and the grey-based Decision-Making Trial and Evaluation Laboratory (DEMATEL method, this study pinpoints the most critical enablers and investigates their causal and effect interconnections. The methodological process consists of reviewing the SVC literature and consulting the experts to identify the SVC enablers, creating a questionnaire, acquiring the answers from four experts, analyzing the data with grey-based DEMATEL and performing a sensitivity analysis. The government use of international standards, policies and regulations for sustainable investments, the commitment of the venture capitalists to sustainability and their deep understanding of sustainable business models are the most influential enablers. The paper concludes with implications for different actors, limitations and prospective directions for the sustainable venture capital research.
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First and foremost, physicians: the clinical versus leadership identities of physician leaders.
Quinn, Joann Farrell; Perelli, Sheri
2016-06-20
Purpose - Physicians are commonly promoted into administrative and managerial roles in US hospitals on the basis of clinical expertise and often lack the skills, training or inclination to lead. Several studies have sought to identify factors associated with effective physician leadership, yet we know little about how physician leaders themselves construe their roles. The paper aims to discuss these issues. Design/methodology/approach - Phenomenological interviews were performed with 25 physicians at three organizational levels with physicians affiliated or employed by four hospitals within one health care organization in the USA between August and September 2010. A rigorous comparative methodology of data collection and analysis was employed, including the construction of analytic codes for the data and its categorization based on emergent ideas and themes that are not preconceived and logically deduced hypotheses, which is characteristic of grounded theory. Findings - These interviews reveal differences in how part- vs full-time physician leaders understand and value leadership roles vs clinical roles, claim leadership status, and identify as physician leaders on individual, relational and organizational basis. Research limitations/implications - Although the physicians in the sample were affiliated with four community hospitals, all of them were part of a single not-for-profit health care system in one geographical locale. Practical implications - These findings may be of interest to hospital administrators and boards seeking deeper commitment and higher performance from physician leaders, as well as assist physicians in transitioning into a leadership role. Social implications - This work points to a broader and more fundamental need - a modified mindset about the nature and value of physician leadership. Originality/value - This study is unique in the exploration of the nature of physician leadership from the perspective of the physician on an individual, peer
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Velasco, Edward; Ziegelmann, Antina; Eckmanns, Tim; Krause, Gérard
2012-01-01
To better understand physicians' views on factors of influence for the prescribing of antibiotics and on antibiotic resistance in the Berlin region, Germany. Qualitative study with focus groups. Outpatient care and hospital care practice in the Berlin region, Germany. 7 General practitioners, two urologists, one paediatrician from outpatient care and eight internists, two paediatricians, two ear, nose and throat specialists and two urologists from hospital care. Physicians showed differential interest in topics related to antibiotic prescribing and antibiotic resistance. Outpatient care physicians were interested in topics around their own prescribing, such as being able to diagnose and prescribe precisely, and topics about patient demand and non-compliance. Hospital care physicians were interested in hygiene challenges, limited consult time and multi-resistant pathogens. Physicians considered the development of resistance to be more in the domain of clinical treatment than that of the patient. Major challenges related to antibiotic resistance for this group of physicians are access to and clarity of treatment recommendations, implementation of hygienic measures, as well as increased outsourcing of laboratory services. Results raise questions about whether meeting physicians' expectations should be a focus when developing intervention that aims to influence antibiotic resistance in this and other areas of Germany.
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The Perfect Storm of Business Venturing? The Case of Entomology-Based Venture Creation
Pascucci, S.; Dentoni, D.; Mitsopoulos, D.
2015-01-01
In this paper we discuss how cooperation and trust among entrepreneurs can be challenged when they are dealing with venture creation in the context of radical innovation. Entomology-based foods are considered as one of the most promising innovation in the food sector. However they impose radical changes in food consumption habits with high risk of low consumer acceptance. Four European entrepreneurs joined forces in a new venture operating in this sector, trying to make it a successful busine...
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Directory of Open Access Journals (Sweden)
Kitaneh Mohamad
2012-12-01
Full Text Available Abstract Background Violence against healthcare workers in Palestinian hospitals is common. However, this issue is under researched and little evidence exists. The aim of this study was to assess the incidence, magnitude, consequences and possible risk factors for workplace violence against nurses and physicians working in public Palestinian hospitals. Methods A cross-sectional approach was employed. A self-administered questionnaire was used to collect data on different aspects of workplace violence against physicians and nurses in five public hospitals between June and July 2011. The questionnaires were distributed to a stratified proportional random sample of 271 physicians and nurses, of which 240 (88.7% were adequately completed. Pearson’s chi-square analysis was used to test the differences in exposure to physical and non-physical violence according to respondents’ characteristics. Odds ratios and 95% confidence intervals were used to assess potential associations between exposure to violence (yes/no and the respondents’ characteristics using logistic regression model. Results The majority of respondents (80.4% reported exposure to violence in the previous 12 months; 20.8% physical and 59.6% non-physical. No statistical difference in exposure to violence between physicians and nurses was observed. Males’ significantly experienced higher exposure to physical violence in comparison with females. Logistic regression analysis indicated that less experienced (OR: 8.03; 95% CI 3.91-16.47, and a lower level of education (OR: 3; 95% CI 1.29-6.67 among respondents meant they were more likely to be victims of workplace violence than their counterparts. The assailants were mostly the patients' relatives or visitors, followed by the patients themselves, and co-workers. Consequences of both physical and non-physical violence were considerable. Only half of victims received any type of treatment. Non-reporting of violence was a concern, main
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Venture capital: Generator of growth of SME investment activities
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Dželetović Milenko
2017-01-01
Full Text Available The aim of the paper is to point out the importance and role of venture capital in creation of new values based on the knowledge economy. By reviewing relevant literature about venture capital, this paper presents the importance of the venture capital investments in innovative activities of SMEs that have an impact on economic growth. Pointing to the importance and quantifying the overall effects of venture capital investments, will be used the overview and trends in venture capital investments in the sectors of economy in Europe which generate a larger number of patents. According to data during the period of 2007 - 2015 will be defined venture capital investments and number of registered patents in the sectors of the knowledge economy. Empirical analysis indicated that the venture investments in the sectors of the knowledge economy generated more patents in those sectors. In addition, the paper analyzes the venture capital investment and innovation activities of SMEs, which are reflected in patent activities, where the result is a correlation between these activities in the European economies.
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Reduction of Hospital Physicians' Workflow Interruptions: A Controlled Unit-Based Intervention Study
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Matthias Weigl
2012-01-01
Full Text Available Highly interruptive clinical environments may cause work stress and suboptimal clinical care. This study features an intervention to reduce workflow interruptions by re-designing work and organizational practices in hospital physicians providing ward coverage. A prospective, controlled intervention was conducted in two surgical and two internal wards. The intervention was based on physician quality circles - a participative technique to involve employees in the development of solutions to overcome work-related stressors. Outcome measures were the frequency of observed workflow interruptions. Workflow interruptions by fellow physicians and nursing staff were significantly lower after the intervention. However, a similar decrease was also observed in control units. Additional interviews to explore process-related factors suggested that there might have been spill-over effects in the sense that solutions were not strictly confined to the intervention group. Recommendations for further research on the effectiveness and consequences of such interventions for professional communication and patient safety are discussed.
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International New Venture Legitimation: An Exploratory Study
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Romeo V. Turcan
2013-11-01
Full Text Available There is limited theoretical understanding and empirical evidence for how international new ventures legitimate. Drawing from legitimation theory, this study fills in this gap by exploring how international new ventures legitimate and strive for survival in the face of critical events during the process of their emergence. It is a longitudinal, multiple-case study research that employs critical incident technique for data collection, analysis, and interpretation. Following theory driven sampling, five international new ventures were selected that were operating in the software sector in the UK, and had internationalized and struggled for survival during the dotcom era. Grounded in data, this study corroborates a number of legitimation strategies yielded by prior research and refutes others. It further contributes to our understanding of international new venture legitimation by suggesting new types of legitimation strategies: technology, operating, and anchoring. Studying international new ventures through theoretical lenses of legitimation is a promising area of research that would contribute to the advancement of international entrepreneurship theory.
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DEFF Research Database (Denmark)
Vintergaard, Christian
path of an entrepreneurial opportunity of the Danish corporate venture capitalist,Danfoss A/S. This paper distinguishes itself from previous research done on entrepreneurialopportunities by creating a holistic and conceptual framework, which broadens and expands theperception of the market participants...
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van Harten, Willem H.
2010-01-01
Background: Effective cooperation between physicians and managers is difficult to achieve but is an important factor in successfully implementing improvement initiatives in hospitals. Intergroup literature suggests that large differences between groups hinder effective cooperation. - Purposes:
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Taxation and venture capital-backed entrepreneurship
DEFF Research Database (Denmark)
Keuschnigg, Christian; Nielsen, Søren Bo
2003-01-01
In recent years, venture capital has increasingly become a factor in thefinancing of new firms. We examine how the value of mature firms determinesthe incentives of entrepreneurs to start up new firms and of venture capitaliststo finance and advise them. We examine how capital gains taxes as well...... assubsidies to start-up costs of new firms affect venture capital-backedentrepreneurship. We also argue that dividend and capital gains taxes onmature firms have important consequences for start-up firms as well.JEL Classification: D82, G24, H24 and H25Keywords: double moral hazard, entrepreneurship, taxes...
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A survey of venture capital research
Hellmann, T.; Puri, M.L.; Da Rin, M.; Constantinides, G.; Harris, M.; Stulz, R.
2013-01-01
This survey reviews the growing body of academic work on venture capital. It lays out the major data sources used. It examines the work on venture capital investments in companies, looking at issues of selection, contracting, post-investment services and exits. The survey considers recent work on
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A Survey of Venture Capital Research
Da Rin, M.; Hellmann, T.; Puri, M.L.
2011-01-01
This survey reviews the growing body of academic work on venture capital. It lays out the major data sources used. It examines the work on venture capital investments in companies, looking at issues of selection, contracting, post-investment services and exits. The survey considers recent work on
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Haliko, Shannon; Downs, Julie; Mohan, Deepika; Arnold, Robert; Barnato, Amber E
2018-04-01
Variation in the intensity of acute care treatment at the end of life is influenced more strongly by hospital and provider characteristics than patient preferences. We sought to describe physicians' mental models (i.e., thought processes) when encountering a simulated critically and terminally ill older patient, and to compare those models based on whether their treatment plan was patient preference-concordant or preference-discordant. Seventy-three hospital-based physicians from 3 academic medical centers engaged in a simulated patient encounter and completed a mental model interview while watching the video recording of their encounter. We used an "expert" model to code the interviews. We then used Kruskal-Wallis tests to compare the weighted mental model themes of physicians who provided preference-concordant treatment with those who provided preference-discordant treatment. Sixty-six (90%) physicians provided preference-concordant treatment and 7 (10%) provided preference-discordant treatment (i.e., they intubated the patient). Physicians who intubated the patient were more likely to emphasize the reversible and emergent nature of the patient situation (z = -2.111, P = 0.035), their own comfort (z = -2.764, P = 0.006), and rarely focused on explicit patient preferences (z = 2.380, P = 0.017). Post-decisional interviewing with audio/video prompting may induce hindsight bias. The expert model has not yet been validated and may not be exhaustive. The small sample size limits generalizability and power. Hospital-based physicians providing preference-discordant used a different mental model for decision making for a critically and terminally ill simulated case. These differences may offer targets for future interventions to promote preference-concordant care for seriously ill patients.
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Zhu, Junya
2018-06-11
Self-report instruments have been widely used to better understand variations in patient safety climate between physicians and nurses. Research is needed to determine whether differences in patient safety climate reflect true differences in the underlying concepts. This is known as measurement equivalence, which is a prerequisite for meaningful group comparisons. This study aims to examine the degree of measurement equivalence of the responses to a patient safety climate survey of Chinese hospitals and to demonstrate how the measurement equivalence method can be applied to self-report climate surveys for patient safety research. Using data from the Chinese Hospital Survey of Patient Safety Climate from six Chinese hospitals in 2011, we constructed two groups: physicians and nurses (346 per group). We used multiple-group confirmatory factor analyses to examine progressively more stringent restrictions for measurement equivalence. We identified weak factorial equivalence across the two groups. Strong factorial equivalence was found for Organizational Learning, Unit Management Support for Safety, Adequacy of Safety Arrangements, Institutional Commitment to Safety, Error Reporting and Teamwork. Strong factorial equivalence, however, was not found for Safety System, Communication and Peer Support and Staffing. Nevertheless, further analyses suggested that nonequivalence did not meaningfully affect the conclusions regarding physician-nurse differences in patient safety climate. Our results provide evidence of at least partial equivalence of the survey responses between nurses and physicians, supporting mean comparisons of its constructs between the two groups. The measurement equivalence approach is essential to ensure that conclusions about group differences are valid.
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Dückers, Michel L.A.; Stegeman, Inge; Spreeuwenberg, Peter; Wagner, Cordula; Sanders, Karin; Groenewegen, Peter P.
2009-01-01
Objectives: The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation,
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Duckers, M.L.A.; Stegeman, I.; Spreeuwenberg, P.; Wagner, C.; Sanders, K.; Groenewegen, P.P.
2009-01-01
OBJECTIVES: The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation,
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Dückers, M.L.A.; Stegeman, I.; Spreeuwenberg, P.; Wagner, C.; Sanders, K.; Groenewegen, P.P.
2009-01-01
Objectives: The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation,
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de Bie, J.; Cuperus-Bosma, J.M.; van der Jagt, M.A.; Gevers, J.K.M.; van der Wal, G.
2005-01-01
Occurrence of problems with, refusals of orders and contemplated refusals of orders for risky procedures by nurses in Dutch hospitals and views on the safety of performance was studied using postal questionnaires (600 physicians and 3200 nurses, response 60-71%). Of the respondents, 11-30%
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Sun, Jing; Ma, Jing; Hu, Guangyu; Zhao, Qi; Yuan, Changzheng; Si, Wen; Zhang, Xinqing; Liu, Yuanli
2017-07-01
Little national data are available on Chinese physicians' welfare, wellness, and job satisfaction. We conducted a self-administered smartphone-based national survey in early 2016 of 17 945 physicians from 136 tertiary hospitals across 31 provinces in China. In addition to collecting the physicians' basic information, we also measured 5 domains (the ethical and working environments, welfare, wellness, and job satisfaction). Half of the physicians reported a hospital-based annual income of less than RMB 72 000 ($10 300), and 60.31% of them did not think that the current medical pricing system reflects physicians' value. More than half (58.64%) of them did not have or did not know about medical malpractice insurance. These physicians worked long hours (an average of 10 h) and slept short hours (average 6 h). Only 35.78% of them thought that they were in good health, and 51.03% were in good mental health. Approximately, a quarter of them had helped to pay medical bills for patients who could not afford care, and 1 in 7 has been penalised for seeing patients who generated bad debts. Only 33.42% of them thought that their occupation receives social recognition and respect, and 70.98% would not encourage their children to pursue a medical career. The top 3 factors that may influence physician job satisfaction as chosen by the physicians were as follows: (1) the income distribution policy (45.92%), (2) working environment safety (25.86%), and (3) public trust and respect for their job (16.10%). In conclusion, we found that Chinese physicians bear heavy physical, mental, and financial stress, and many of them lack confidence that they receive trust and respect from society. Copyright © 2017 John Wiley & Sons, Ltd.
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Foreign Venture Capital Firm - Skye in China.
Hu, XiaoRui
2007-01-01
The reasons of why Tom Skype paid more attention to Venture Capital management have received more and more attentions from academic researchers in many current business studies. Based upon one case study in the Skype, this research has analyzed the significant of the Venture Capital. This research listed some differences of the situations in for the Skype and how it set up the Venture Capital strategic in China, then gave the author's own opinions to the research question.
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Financing of Competing Projects with Venture Capital
Goldfain, Ekaterina; Kovac, Eugen
2005-01-01
We analyze innovation race in a moral hazard setting. We develop a model in which two competing entrepreneurs work independently on the same project. The entrepreneurs do not possess any wealth of their own and their research is financed by a venture capitalist. The project, if successful, generates a prize, which is to be shared between the winning entrepreneur and the venture capitalist. The venture capitalist cannot observe the allocation of funds he provides, which creates a moral hazard ...
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Strategies for Creating New Venture Legitimacy
Karlsson, Tomas; Middleton, Karen Williams
2015-01-01
New ventures, being heavily subjected to liabilities of newness, are seen to engage in legitimacy strategies to overcome these liabilities. Building on an adapted theoretical framework of organizational legitimacy, self-reported weekly diaries of twelve entrepreneurs were analysed to identify strategies used by new ventures to create legitimacy.…
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Directory of Open Access Journals (Sweden)
Prescott C. Ensign
2016-01-01
Full Text Available This case study chronicles the timeline of a new venture – Keenga Research. Keenga Research has a novel proposition that it is seeking to introduce to the market. The business concept is to ask entrepreneurs to review the venture capital (VC firm that funded them. Reviews of VC firms would then be developed and marketed to those interested (funds and perhaps enterprises seeking funding. What makes this case unique is that Keenga Research was a lean start-up. Bootstrapping is a situation in which the entrepreneur chooses to fund the venture with his/her own personal resources. It involves self-funding (family and friends, tight monitoring of expenses, and maintaining control of ownership and management (Winborg & Landstrom 2001; Perry, Chandler, Yao, & Wolff, 2011; Winborg, 2015. The lean start-up approach favors experimentation over elaborate planning, customer feedback over intuition and iterative design over traditional big upfront research and development. This case study requires the reader to consider a number of the basic challenges facing all entrepreneurs and new ventures. Is the concept marketable? Can the concept be developed and brought to market in a timely manner? Will the product generate revenue? How? When? What are the commitments of the entrepreneurs? Have they considered the major challenges to be faced? Since this venture involved gathering and developing research information and then creating an online platform, Keenga Research faced significant concept-to-market challenges. The research method used in this case study is first person participant observation and interviews. One of the authors was a team member so the contextual details come from direct observation and first-hand knowledge. This method of research is often used in anthropology, sociology, and social psychology where an investigator studies the group by sharing in its activities. The other author provided an objective and conceptual perspective for analyzing
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Directory of Open Access Journals (Sweden)
Elaheh Salimi
2016-05-01
Full Text Available Coagulase-negative staphylococci (CoNS have been identified as a major cause of nosocomial infections. Nasal carriage of CoNS in nurses and physicians is known to be an important risk factor for potential hospital infections. This study was carried out to investigate the prevalence of nasal carriage of uncommon coagulase-negative staphylococci among nurse and physician staffs of Tehran University Hospitals. A total of 116 CoNS were isolated from anterior nares of the study participants working in different wards of the hospitals. Thirteen uncommon CoNS were identified using phenotypic and biochemical methods, were subsequently confirmed by API kits. Staphylococcus xylosus, Staphylococcus haemolyticus, and Staphylococcus capitis species accounted for 53.85%, 30.77%, and 15.38% from the isolates, respectively. Six isolates (46.15% were found to be resistant to methicillin. In conclusion, screening of healthcare workers for uncommon CoNS colonization along with identification and testing for susceptibility of cultured isolates is of paramount importance in strengthening effective nosocomial infection control and prevention measures.
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Sharing competences in strategic alliances: a case study of the Cosan and Shell biofuel venture
Directory of Open Access Journals (Sweden)
Luciana Florêncio de Almeida
2013-06-01
Full Text Available In a competitive world, the way a firm establishes its organizational arrangements may determine the enhancement of its core competences and the possibility of reaching new markets. Firms that find their skills to be applicable in just one type of market encounter constraints in expanding their markets, and through alliances may find a competitive form of value capture. Hybrid forms of organization appear primarily as an alternative to capturing value and managing joint assets when the market and hierarchy modes do not present any yields for the firm's competitiveness. As a result, this form may present other challenging issues, such as the allocation of rights and principal-agent problems. The biofuel market has presented a strong pattern of changes over the last 10 years. New intra-firm arrangements have appeared as a path to participate or survive among global competition. Given the need for capital to achieve better results, there has been a consistent movement of mergers and acquisitions in the Biofuel sector, especially since the 2008 financial crisis. In 2011 there were five major groups in Brazil with a grinding capacity of more than 15 million tons per year: Raízen (joint venture formed by Cosan and Shell, Louis Dreyfus, Tereos Petrobras, ETH, and Bunge. Major oil companies have implemented the strategy of diversification as a hedge against the rising cost of oil. Using the alliance of Cosan and Shell in the Brazilian biofuel market as a case study, this paper analyses the governance mode and challenging issues raised by strategic alliances when firms aim to reach new markets through the sharing of core competences with local firms. The article is based on documentary research and interviews with Cosan's Investor Relations staff, and examines the main questions involving hybrid forms through the lens of the Transaction Cost Economics (TCE, Agency Theory, Resource Based View (RBV, and dynamic capabilities theoretical approaches. One
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TENDENCY OF IMPROVEMENT ANALYSIS OF VENTURE ACTIVITY FOR MANAGEMENT DECISIONS
Directory of Open Access Journals (Sweden)
G.Yu. Iakovetс
2015-03-01
Full Text Available The questions concerning the definition of current trends and prospects of venture financing new innovative enterprises as one of the most effective and alternative, but with a high degree of risk financing sources of the entity. The features of venture financing that is different from other sources of business financing, as well as income from investments of venture capital can greatly exceed the volume of investments, but at the same time such financing risks are significant, so it all makes it necessary to build an effective system of venture capital investments in the workplace. In the course of the study also revealed problems of analysis and minimization of risks in the performance of venture financing of innovative enterprises. Defining characteristics analysis and risk assessment of venture financing helps to find ways to minimize and systematization, avoidance and prevention of risks in the performance of venture capital. The study also identified the major areas of improvement analysis of venture capital for management decisions.
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Energy Technology Data Exchange (ETDEWEB)
NONE
2001-03-01
The venture capitals and businesses in Australia are surveyed and reported. Venture Capital Guide (2000), annually issued by Polliticon Publications, estimates a total of 120 venture businesses raise a total funds B$7.393 from the domestic sources, of which B$3.546 is invested on 1113 enterprises as of the end of December, 2000. Of the enterprises on which the funds are invested, 766 are currently of portfolio enterprises and 347 have completely disposed them. The Government of Australia has introduced several venture capital supporting schemes, including PDF (Pooled Development Funds) to supply equity capitals to small- to medium-sized enterprises over extended periods, IIF (Innovation Investment Funds) to encourage early-stage investments on innovative small- to medium-sized enterprises, R and D Start to provide increased funds for small- to medium-sized enterprises now considering production on a commercial basis, COMET (Commercialising Emerging Technologies) and BITS (Building on Information Technology Strengths). (NEDO)
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How to Define the Content of a Job-Specific Worker's Health Surveillance for Hospital Physicians?
Directory of Open Access Journals (Sweden)
Martijn M. Ruitenburg
2016-03-01
Conclusion: The process of developing a job-specific WHS for hospital physicians was described and the content presented, which might serve as an example for other jobs. Before implementation, it must first be tested for feasibility and acceptability.
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What Happens To International New Ventures beyond Start-up
DEFF Research Database (Denmark)
Turcan, Romeo V.; Juho, Anita
2014-01-01
ventures: strategic experimentation, tensions in organizational gestalt, and legitimacy lies. We conjecture that international new ventures do not reach a made-it point if they only manage to develop substantive capabilities to produce desired outputs at various levels within the venture, but fail...
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Learning from Success & Failure: International Joint Ventures in Emerging Markets
DEFF Research Database (Denmark)
Nielsen, Ulrik B.
their expectations. Inter-partner learning has been proposed in the literature as a major cause of IJV instability. However, current research indicates that when IJV partners engage in joint learning to create new IJV-specific knowledge that benefits both partners it stabilizes and sustains the IJV. Yet, joint......, especially when the prime motive of the operation is to capture opportunities in the local markets. However, the performance of IJVs generally turns out to be quite poor whether measured in economic value added, parent organization’s satisfaction or survival. For instance, termination rates of IJVs...
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Directory of Open Access Journals (Sweden)
Aldo De Ferrari
Full Text Available BACKGROUND: The interaction between physicians and the pharmaceutical industry influences physicians' attitudes and prescribing behavior. Although largely studied in the US, this topic has not been well studied in resource-poor settings, where a close relationship between physicians and industry still exists. OBJECTIVE: To describe physician interactions with and attitudes towards the pharmaceutical industry in a public general hospital in Lima, Peru. DESIGN: Descriptive, cross-sectional study through an anonymous, self-filled questionnaire distributed among faculty and trainee physicians of five different clinical departments working in a Peruvian public general hospital. A transcultural validation of an existing Spanish questionnaire was performed. Exposure to marketing activities, motivations to contact pharmaceutical representatives and attitudes towards industry were studied. Collected data was analyzed by degree of training, clinical department, gender and teaching status. Attitudes were measured on a four-point LIKERT scale. RESULTS: 155 physicians completed the survey, of which 148 were included in the study sample. 94.5% of attending physicians reported ongoing encounters with pharmaceutical representatives. The most common industry-related activities were receiving medical samples (91.2%, promotional material (87.8% and attending meetings in restaurants (81.8%. Respondents considered medical samples and continuing medical education the most ethically acceptable benefits. We found significant differences between attendings and residents, and teaching and non-teaching attendings. An association between the amount of encounters with pharmaceutical representatives, and attitudes towards industry and acceptance of medical samples was found. CONCLUSIONS: A close physician-industry relationship exists in the population under study. The contact is established mainly through pharmaceutical representatives. Medical samples are the most received
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Directory of Open Access Journals (Sweden)
Jeroen Trybou
2015-04-01
Full Text Available Background: Hospitals and physicians lie at the heart of our health care delivery system. In general, physicians provide medical care and hospitals the resources to deliver health care. In the past two decades many countries have adopted reforms in which provider financial risk bearing is increased. By making providers financially accountable for the delivered care integrated care delivery is stimulated.Purpose: To assess the evidence base supporting the relationship between provider financial risk bearing and physician–hospital integration and to identify the different types of methods used to measure physician–hospital integration to evaluate the functional value of these integrative models.Results: Nine studies met the inclusion criteria. The evidence base is mixed and inconclusive. Our methodological analysis of previous research shows that previous studies have largely focused on the formal structures of physician–hospital arrangements as an indicator of physician–hospital integration.Conclusion: The link between provider financial risk bearing and physician–hospital integration can at this time be supported merely on the basis of theoretical insights of agency theory rather than empirical research. Physician–hospital integration measurement has concentrated on the prevalence of contracting vehicles that enables joint bargaining in a managed care environment but without realizing integration and cooperation between hospital and physicians. Therefore, we argue that these studies fail to shed light on the impact of risk shifting on the hospital–physician relationship accurately.
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Directory of Open Access Journals (Sweden)
Jeroen Trybou
2015-04-01
Full Text Available Background: Hospitals and physicians lie at the heart of our health care delivery system. In general, physicians provide medical care and hospitals the resources to deliver health care. In the past two decades many countries have adopted reforms in which provider financial risk bearing is increased. By making providers financially accountable for the delivered care integrated care delivery is stimulated. Purpose: To assess the evidence base supporting the relationship between provider financial risk bearing and physician–hospital integration and to identify the different types of methods used to measure physician–hospital integration to evaluate the functional value of these integrative models. Results: Nine studies met the inclusion criteria. The evidence base is mixed and inconclusive. Our methodological analysis of previous research shows that previous studies have largely focused on the formal structures of physician–hospital arrangements as an indicator of physician–hospital integration. Conclusion: The link between provider financial risk bearing and physician–hospital integration can at this time be supported merely on the basis of theoretical insights of agency theory rather than empirical research. Physician–hospital integration measurement has concentrated on the prevalence of contracting vehicles that enables joint bargaining in a managed care environment but without realizing integration and cooperation between hospital and physicians. Therefore, we argue that these studies fail to shed light on the impact of risk shifting on the hospital–physician relationship accurately.
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Venture funding for science-based African health innovation.
Masum, Hassan; Chakma, Justin; Simiyu, Ken; Ronoh, Wesley; Daar, Abdallah S; Singer, Peter A
2010-12-13
While venture funding has been applied to biotechnology and health in high-income countries, it is still nascent in these fields in developing countries, and particularly in Africa. Yet the need for implementing innovative solutions to health challenges is greatest in Africa, with its enormous burden of communicable disease. Issues such as risk, investment opportunities, return on investment requirements, and quantifying health impact are critical in assessing venture capital's potential for supporting health innovation. This paper uses lessons learned from five venture capital firms from Kenya, South Africa, China, India, and the US to suggest design principles for African health venture funds. The case study method was used to explore relevant funds, and lessons for the African context. The health venture funds in this study included publicly-owned organizations, corporations, social enterprises, and subsidiaries of foreign venture firms. The size and type of investments varied widely. The primary investor in four funds was the International Finance Corporation. Three of the funds aimed primarily for financial returns, one aimed primarily for social and health returns, and one had mixed aims. Lessons learned include the importance of measuring and supporting both social and financial returns; the need to engage both upstream capital such as government risk-funding and downstream capital from the private sector; and the existence of many challenges including difficulty of raising capital, low human resource capacity, regulatory barriers, and risky business environments. Based on these lessons, design principles for appropriate venture funding are suggested. Based on the cases studied and relevant experiences elsewhere, there is a case for venture funding as one support mechanism for science-based African health innovation, with opportunities for risk-tolerant investors to make financial as well as social returns. Such funds should be structured to overcome the
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CPOE in Iran--a viable prospect? Physicians' opinions on using CPOE in an Iranian teaching hospital.
Kazemi, Alireza; Ellenius, Johan; Tofighi, Shahram; Salehi, Aref; Eghbalian, Fatemeh; Fors, Uno G
2009-03-01
In recent years, the theory that on-line clinical decision support systems can improve patients' safety among hospitalised individuals has gained greater acceptance. However, the feasibility of implementing such a system in a middle or low-income country has rarely been studied. Understanding the current prescription process and a proper needs assessment of prescribers can act as the key to successful implementation. The aim of this study was to explore physicians' opinions on the current prescription process, and the expected benefits and perceived obstacles to employ Computerised Physician Order Entry in an Iranian teaching hospital. Initially, the interview guideline was developed through focus group discussions with eight experts. Then semi-structured interviews were held with 19 prescribers. After verbatim transcription, inductive thematic analysis was performed on empirical data. Forty hours of on-looker observations were performed in different wards to explore the current prescription process. The current prescription process was identified as a physician-centred, top-down, model, where prescribers were found to mostly rely on their memories as well as being overconfident. Some errors may occur during different paper-based registrations, transcriptions and transfers. Physician opinions on Computerised Physician Order Entry were categorised into expected benefits and perceived obstacles. Confidentiality issues, reduction of medication errors and educational benefits were identified as three themes in the expected benefits category. High cost, social and cultural barriers, data entry time and problems with technical support emerged as four themes in the perceived obstacles category. The current prescription process has a high possibility of medication errors. Although there are different barriers confronting the implementation and continuation of Computerised Physician Order Entry in Iranian hospitals, physicians have a willingness to use them if these systems
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Spychalla, Megan T; Heathman, Joanne H; Pearson, Katherine A; Herber, Andrew J; Newman, James S
2014-01-01
Hospital medicine is a growing field with an increasing demand for additional healthcare providers, especially in the face of an aging population. Reductions in resident duty hours, coupled with a continued deficit of medical school graduates to appropriately meet the demand, require an additional workforce to counter the shortage. A major dilemma of incorporating nonphysician providers such as nurse practitioners and physician assistants (NPPAs) into a hospital medicine practice is their varying academic backgrounds and inpatient care experiences. Medical institutions seeking to add NPPAs to their hospital medicine practice need a structured orientation program and ongoing NPPA educational support. This article outlines an NPPA orientation and training program within the Division of Hospital Internal Medicine (HIM) at the Mayo Clinic in Rochester, MN. In addition to a practical orientation program that other institutions can model and implement, the division of HIM also developed supplemental learning modalities to maintain ongoing NPPA competencies and fill learning gaps, including a formal NPPA hospital medicine continuing medical education (CME) course, an NPPA simulation-based boot camp, and the first hospital-based NPPA grand rounds offering CME credit. Since the NPPA orientation and training program was implemented, NPPAs within the division of HIM have gained a reputation for possessing a strong clinical skill set coupled with a depth of knowledge in hospital medicine. The NPPA-physician model serves as an alternative care practice, and we believe that with the institution of modalities, including a structured orientation program, didactic support, hands-on learning, and professional growth opportunities, NPPAs are capable of fulfilling the gap created by provider shortages and resident duty hour restrictions. Additionally, the use of NPPAs in hospital medicine allows for patient care continuity that is otherwise missing with resident practice models.
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Building new businesses through corporate venturing at the danish NKT group
DEFF Research Database (Denmark)
Skat-Rørdam, Peter
2005-01-01
An in depth case study of how the danish NKT group used corporate venturing over a 25 year period to build new businesses. The study provides insights on purposes, drivers and results of corporate venturing and examines factors contributing to venture success and failure.......An in depth case study of how the danish NKT group used corporate venturing over a 25 year period to build new businesses. The study provides insights on purposes, drivers and results of corporate venturing and examines factors contributing to venture success and failure....
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Directory of Open Access Journals (Sweden)
Fikadu Balcha Hailu
Full Text Available Nurse-physician communication has been shown to have a significant impact on the job satisfaction and retention of staff. In areas where it has been studied, communication failure between nurses and physicians was found to be one of the leading causes of preventable patient injuries, complications, death and medical malpractice claims.The objective of this study is to determine perception of nurses and physicians towards nurse-physician communication in patient care and associated factors in public hospitals of Jimma zone, southwest Ethiopia.Institution based cross-sectional survey was conducted from March 10 to April 16, 2014 among 341 nurses and 168 physicians working in public hospitals in Jimma zone. Data was collected using a pre-tested self-administered questionnaire; entered into EpiData version 3.1 and exported to Statistical Package for Social Sciences (SPSS version 16.0 for analysis. Factor analysis was carried out. Descriptive statistics, independent sample t-test, linear regression and one way analysis of variance were used. Variables with P-value < 0.05 were considered as statistically significant.The response rate of the study was 91.55%. The mean perceived nurse-physician communication scores were 50.88±19.7% for perceived professional respect and satisfaction, and 48.52±19.7% for perceived openness and sharing of patient information on nurse-physician communication. Age, salary and organizational factors were statistically significant predictors for perceived respect and satisfaction. Whereas sex, working hospital, work attitude individual factors and organizational factors were significant predictors of perceived openness and sharing of patient information in nurse-physician communication during patient care.Perceived level of nurse-physician communication mean score was low among nurses than physicians and it is attention seeking gap. Hence, the finding of our study suggests the need for developing and implementing nurse-physician
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Good to great: using 360-degree feedback to improve physician emotional intelligence.
Hammerly, Milton E; Harmon, Larry; Schwaitzberg, Steven D
2014-01-01
The past decade has seen intense interest and dramatic change in how hospitals and physician organizations review physician behaviors. The characteristics of successful physicians extend past their technical and cognitive skills. Two of the six core clinical competencies (professionalism and interpersonal/communication skills) endorsed by the Accreditation Council for Graduate Medical Education, the American Board of Medical Specialties, and The Joint Commission require physicians to succeed in measures associated with emotional intelligence (EI). Using 360-degree anonymous feedback surveys to screen for improvement opportunities in these two core competencies enables organizations to selectively offer education to further develop physician EI. Incorporating routine use of these tools and interventions into ongoing professional practice evaluation and focused professional practice evaluation processes may be a cost-effective strategy for preventing disruptive behaviors and increasing the likelihood of success when transitioning to an employed practice model. On the basis of a literature review, we determined that physician EI plays a key role in leadership; teamwork; and clinical, financial, and organizational outcomes. This finding has significant implications for healthcare executives seeking to enhance physician alignment and transition to a team-based delivery model.
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Post, Brady; Buchmueller, Tom; Ryan, Andrew M
2017-08-01
Hospital-physician vertical integration is on the rise. While increased efficiencies may be possible, emerging research raises concerns about anticompetitive behavior, spending increases, and uncertain effects on quality. In this review, we bring together several of the key theories of vertical integration that exist in the neoclassical and institutional economics literatures and apply these theories to the hospital-physician relationship. We also conduct a literature review of the effects of vertical integration on prices, spending, and quality in the growing body of evidence ( n = 15) to evaluate which of these frameworks have the strongest empirical support. We find some support for vertical foreclosure as a framework for explaining the observed results. We suggest a conceptual model and identify directions for future research. Based on our analysis, we conclude that vertical integration poses a threat to the affordability of health services and merits special attention from policymakers and antitrust authorities.
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Directory of Open Access Journals (Sweden)
Ceren G. ARTUNER
2012-07-01
Full Text Available Döküm sanayinde yabancı firmalarla yerli firmalar arasında ortak girişim yoluyla oluşturulan yeni yapılar içerisinde faaliyetine devam eden üç firma nezdinde gerçekleştirilen durum çalışması aracılığıyla söz konusu ortak girişim olgularına yol açtığı düşünülen temel motivasyonların belirlenmesi amaçlanmış ve Kaynak Bağımlılığı Teorisi’nin Türk Döküm Sanayi’nde yabancı ortaklarla yerli firmalar arasında gerçekleşen ortak girişim olgularını tek başına açıklayıcı gücü sorgulanmıştır.Yürütülen araştırma neticesinde, Kaynak Bağımlılığı Teorisi’nin açıklayıcı gücünün söz konusu ortak girişim olgularını tek başına açıklamakta yetersiz kaldığı, oluşturulan dört teorik çatı arasında açıklayıcı gücü en yüksek yaklaşımın Firma Teorisi olduğu ve Firma Teorisi’nin de Türk Döküm Sanayi’nde örneklemimiz dahilinde ele aldığımız ortak girişim olgularını diğer üç teorik çatının yardımıyla açıkladığı tespit edilmiştir.-Through the medium of case studies covering three casting firms which pursue their operations after being involved in newly established structures by joint ventures between foreign and national companies, it is aimed to reveal the underlying motivations considered as responsible for the joint venture phenomena. Accordingly, the explanatory power of the Resource Dependence Theory in explaining joint venture phenomena with foreign partners as a single theory in Turkish Casting Industry has been tested.As a result of the undertaken research, we have concluded that the explanatory power of the Resource Dependence Theory wasn’t strong enough to explain by itself the joint venture phenomena in question and that the propositions of the Firm Theory have found the strongest support among these four theoretical frames. However, it was stated that the Firm Theory explains the joint venture phenomena within our sample
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Bekelis, Kimon; Missios, Symeon; MacKenzie, Todd A; O'Shaughnessy, Patrick M
2017-07-01
It is unclear whether publicly reported benchmarks correlate with quality of physicians and institutions. We investigated the association of patient satisfaction measures from a public reporting platform with performance of neurosurgeons in New York State. This cohort study comprised patients undergoing neurosurgical operations from 2009 to 2013 who were registered in the Statewide Planning and Research Cooperative System database. The cohort was merged with publicly available data from the Centers for Medicare and Medicaid Services Hospital Compare website. Propensity-adjusted regression analysis was used to investigate the association of patient satisfaction metrics with neurosurgeon quality, as measured by the neurosurgeon's individual rate of mortality and average length of stay. During the study period, 166,365 patients underwent neurosurgical procedures. Using propensity-adjusted multivariable regression analysis, we demonstrated that undergoing neurosurgical operations in hospitals with a greater percentage of patient-assigned "high" scores was associated with higher chance of being treated by a physician with superior performance in terms of mortality (odds ratio 1.90, 95% confidence interval 1.86-1.95), and a higher chance of being treated by a physician with superior performance in terms of length of stay (odds ratio 1.24, 95% confidence interval 1.21-1.27). Similar associations were identified for hospitals with a higher percentage of patients who claimed they would recommend these institutions to others. Merging a comprehensive all-payer cohort of neurosurgery patients in New York State with data from the Hospital Compare website, we observed an association of superior hospital-level patient satisfaction measures with objective performance of individual neurosurgeons in the corresponding hospitals. Copyright © 2017 Elsevier Inc. All rights reserved.
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Founders hope new venture-capital fund will spur medical, biotechnology research
Gray, Charlotte
1995-01-01
Lack of a coherent industrial strategy and venture capital have hindered scientific researchers in Canada, but the Canadian Medical Discoveries Fund (CMDF) Inc. hopes to change that. Under the leadership of Dr. Henry Friesen, president of the Medical Research Council of Canada, and Dr. Calvin Stiller, head of the multiorgan transplant unit at University Hospital, London, Ont., the new fund proposes to invest in promising medical and biotechnology research companies in Canada. The research council's peerreview system gives the new fund scientific credibility.
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THE IMPORTANCE OF VENTURE CAPITAL
Directory of Open Access Journals (Sweden)
IRINA ANGHEL-ENESCU
2013-05-01
Full Text Available Created in the United States of America, Venture Capital is an asset class which attracted recently the attention of the policy makers all over the world. But the concept is still not clearly defined and understood. This paper attempts at introducing in the concept, its characteristics, and reviewing some of the benefits Venture Capital investments can bring at both the macroeconomic level, by looking at the correlation with the economic growth, and at the microeconomic level, for the portfolio companies.
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Physician Appraisals: Key Challenges
Directory of Open Access Journals (Sweden)
Klich Jacek
2017-06-01
Full Text Available The main purpose of the article is to identify key criteria being used for physician appraisals and to find how communication skills of physicians are valued in those appraisals. ScienceDirect and EBSCOhost databases were used for this search. The results show that a physician appraisal is underestimated both theoretically and empirically. The particular gap exists with respect to the communication skills of physicians, which are rarely present in medical training syllabi and physician assessments. The article contributes to the theoretical discourse on physician appraisals and points out at the inconsistency between the high status of physicians as a key hospital resource on the one hand and, on the other hand, at inadequate and poorly researched assessment of their performance with a special emphasis on communication skills. The article may inspire health managers to develop and implement up-to-date assessment forms for physicians and good managerial practices in this respect in hospitals and other health care units.
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Interorganizational imitation and acquisitions of high-tech ventures
Ozmel, Umit; Reuer, J. J.; Wu, Cheng-Wei
2017-01-01
Research summary: This article shows that there is a positive association between the changes in the number of prior acquisitions or the changes in the prominence of prior acquirers within the focal venture's subfield and the venture's likelihood to be acquired. Results are in line with the existence of frequency- and trait-based imitation in acquisitions targeting tech ventures. More importantly, these positive associations are more pronounced when (a) exogenous technological uncertainty wit...
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The dual role of external corporate venturing in technological exploration
DEFF Research Database (Denmark)
Li, Ying; van de Vrande, Vareska; Vanhaverbeke, Wim
2009-01-01
Innovating firms can not only explore new technologies from its innovation partners, but also explore new technologies from the organizations to which the innovating firm has had no prior relationships. Prior studies have mostly focused on a firm's exploratory learning from its venturing partners...... ("exploration from partners" or "EFP"). There has been little insight on how external corporate venturing may affect the exploratory learning beyond the venturing partnerships ("exploration beyond partners" or "EBP"). We claim that prior venturing relations have a dual role: First, the innovation firm can learn...... from knowledge embedded in its partners. Second, it can also learn from through its partners about knowledge developed by other firms or organizations with whom the innovating firm had no external venturing relations before. In this paper, we are interested how external corporate venturing partnerships...
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A Cadaveric Study on Sacroiliac Joint Injection
Zou, Yu-Cong; Li, Yi-Kai; Yu, Cheng-Fu; Yang, Xian-Wen; Chen, Run-Qi
2015-01-01
The scope of this study was to explore the possibility as well as the feasibility of sacroiliac joint injection following simple X-ray clip location. For the cadaveric study, 10 fixed sacroiliac joint (SIJ) sectional specimens, 4 dried cadaveric pelvises and 21 embalmed adult cadaveric pelvises were dissected, followed by an injection of contrast agent into the joint. The irrigation of the agent was observed through CT scanning. For the radiologic study, 188 CT scans of ankylosing spondylitis patients (143 male, 45 female) were collected from 2010 to 2012, in Nanfang Hospital. What was measured was (1) Distance between the posterior midline and sagittal synovium; (2) Length of the sagittal synovium; (3) Distance between the midpoint of the sagittal synovium and posterior superior iliac spine; and (4) Distance between the superficial skin vertical to the sagittal synovium point were measured. For the practice-based study: 20 patients (17 males and 3 females) with early ankylosing spondylitis, from Nanfang Hospital affiliated with Southern Medical University were recruited, and sacroiliac joint unguided injections were done on the basis of the cadaveric and radiologic study. Only the inferior 1/3rd portion parallel to the posterior midline could be injected into since the superior 2/3rd portion were filled with interosseous ligaments. Thirteen of the 20 patients received successful injections as identified by CT scan using the contrast agent. Sacroiliac joint injection following simple X-ray clip location is possible and feasible if the operation is performed by trained physicians familiar with the sacroiliac joint and its surrounding anatomic structures. PMID:25692437
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Richter, Astrid; Kostova, Petya; Harth, Volker; Wegner, Ralf
2014-01-01
With the increasing number of female medical students physicians' need for work-life balanced hospital jobs rises at all career stages. The Working Time Act (Arbeitszeitgesetz, ArbZG), an implementation of the European Working Time Directive into German law in 2004, should have improved the general conditions for creating flexible work. Nevertheless, the vast majority of female physicians still report an incompatibility of work and family. So far, little is known about mothers working on leading positions in the medical field. The presented study focuses on gender differences in the level of emotional exhaustion between child-rearing junior and senior physicians and different predictors of burnout. Three years after the ArbZT-enactment, 994 physicians from the listed hospital physicians in the Medical Register of the city of Hamburg participated in the cross-sectional study and completed a 60-item questionnaire (return rate of 46,5%). The questionnaire included a 22-item version of the German translation of the Maslach Burnout Inventory whereat emotional exhaustion was interpreted as the crucial predictor of burnout. Results of an univariate covariance analysis and regression analyses are reported. In the level of emotional exhaustion no gender differences were found between junior and senior physicians with children in the overall analysis. Support by the superior was the only overall predictor of burnout. Female senior physicians having children presented the highest risk of burnout. Only in this group parenting contributed significantly to the risk of burnout. Support by the superior and the relationship to colleagues are generally important predictors of burnout among hospital physicians. Parenthood only gets a crucial influence on psychomental health for female senior physicians. Still conservative role models are common in this group, thus dealing with the triple burden of work, leadership responsibility and child rearing seems to be a special female
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Physician self-referral and physician-owned specialty facilities.
Casalino, Lawrence P
2008-06-01
Physician self-referral ranges from suggesting a follow-up appointment, to sending a patient to a facility in which the doctor has an ownership interest or financial relationship. Physician referral to facilities in which the physicians have an ownership interest is becoming increasingly common and not always medically appropriate. This Synthesis reviews the evidence on physician self-referral arrangements, their effect on costs and utilization, and their effect on general hospitals. Key findings include: the rise in self-referral is sparked by financial, regulatory and clinical incentives, including patient convenience and doctors trying to preserve their income in the changing health care landscape. Strong evidence suggests self-referral leads to increased usage of health care services; but there is insufficient evidence to determine whether this increased usage reflects doctors meeting an unmet need or ordering clinically inappropriate care. The more significant a physician's financial interest in a facility, the more likely the doctor is to refer patients there. Arrangements through which doctors receive fees for patient referrals to third-party centers, such as "pay-per-click," time-share, and leasing arrangements, do not seem to offer benefits beyond increasing physician income. So far, the profit margins of general hospitals have not been harmed by the rise in doctor-owned facilities.
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Raising venture capital in the biopharma industry.
Leytes, Lev J
2002-11-15
Raising venture capital (VC) is both an art and a science. Future entrepreneurs should carefully consider the various issues of VC financing that have a strong impact on the success of their business. In addition to attracting the best venture capital firms, these issues include such subtle but important points as the timing of financing (especially of the first round), external support sources, desirable qualities of a VC firm, amount to be raised, establishing a productive interface between the founders and the venture capitalists, and most importantly the effects of well-executed VC funding on hiring senior executives and scientific leaders.
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How to Create an Effective Venture Capitalist–Entrepreneur Relationship
Directory of Open Access Journals (Sweden)
Edmée van Dijk
2014-10-01
Full Text Available This study investigated the relationship between venture capitalists and entrepreneurs from an entrepreneur’s perspective. Its goal was to examine how perceived justice affects psychological contract breach (PCB and how PCB evokes reactions in the venture capitalist–entrepreneur relationship. The study was performed according to the grounded theory method. After a literature review, six entrepreneurs were interviewed who had founded a venture that received venture capital investment. Results indicate that distributive justice, formal procedures, informational justice, and interpersonal justice, among others, are important factors that can influence responses to the breach. This article discusses implications for both venture capitalists and entrepreneurs to make better decisions concerning ways to manage an effective relationship. In addition, a conceptual model is presented as a suggestion for future research.
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Directory of Open Access Journals (Sweden)
Zhao HW
2016-10-01
Full Text Available Huiwen Zhao,1 Wen Luo,1 Rose C Maly,2 Jun Liu,1 Junyi Lee,1 Yaning Cui1 1Joint Department, The 2nd Ward of Joint Surgery, Tianjin Hospital, Tianjin, the People’s Republic of China; 2Department of Family Medicine David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA Objectives: This study aimed to assess the reliability and validity of the Chinese version of the 10-item Perceived Efficacy in Patient–Physician Interaction (PEPPI-10 scale in hospitalized patients with severe knee osteoarthritis in the People’s Republic of China. Methods: Between January and March 2015, the Chinese versions of PEPPI, self-efficacy for exercise scale, osteoporosis self-efficacy scale, and modified fall efficacy scale were applied to assess 110 severe knee osteoarthritis patients who were hospitalized in the second ward of the department of arthroplasty surgery of Tianjin Hospital. Results: The Chinese version of the PEPPI-10 scale had a high coefficient of internal consistency (Cronbach’s α coefficient, 0.907. The score of the Chinese version of PEPPI was weakly correlated with the scores of the Chinese versions of self-efficacy for exercise scale, osteoporosis self-efficacy scale, and modified fall efficacy scale. Conclusion: The Chinese version of the PEPPI-10 scale exhibits sufficient internal consistency and convergent validity in hospitalized patients with severe knee osteoarthritis in the People’s Republic of China. Keywords: assessment of osteoarthritis, patient–physician communication, self-efficacy, instrument validation
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Venture funding for science-based African health innovation
Directory of Open Access Journals (Sweden)
Daar Abdallah S
2010-12-01
Full Text Available Abstract Background While venture funding has been applied to biotechnology and health in high-income countries, it is still nascent in these fields in developing countries, and particularly in Africa. Yet the need for implementing innovative solutions to health challenges is greatest in Africa, with its enormous burden of communicable disease. Issues such as risk, investment opportunities, return on investment requirements, and quantifying health impact are critical in assessing venture capital’s potential for supporting health innovation. This paper uses lessons learned from five venture capital firms from Kenya, South Africa, China, India, and the US to suggest design principles for African health venture funds. Discussion The case study method was used to explore relevant funds, and lessons for the African context. The health venture funds in this study included publicly-owned organizations, corporations, social enterprises, and subsidiaries of foreign venture firms. The size and type of investments varied widely. The primary investor in four funds was the International Finance Corporation. Three of the funds aimed primarily for financial returns, one aimed primarily for social and health returns, and one had mixed aims. Lessons learned include the importance of measuring and supporting both social and financial returns; the need to engage both upstream capital such as government risk-funding and downstream capital from the private sector; and the existence of many challenges including difficulty of raising capital, low human resource capacity, regulatory barriers, and risky business environments. Based on these lessons, design principles for appropriate venture funding are suggested. Summary Based on the cases studied and relevant experiences elsewhere, there is a case for venture funding as one support mechanism for science-based African health innovation, with opportunities for risk-tolerant investors to make financial as well as social
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Hsu, Min-Huei; Yeh, Yu-Ting; Chen, Chien-Yuan; Liu, Chien-Hsiang; Liu, Chien-Tsai
2011-03-01
Doctor shopping (or hospital shopping), which means changing doctors (or hospitals) without professional referral for the same or similar illness conditions, is common in Hong Kong, Taiwan and Japan. Due to the lack of infrastructure for sharing health information and medication history among hospitals, doctor-shopping patients are more likely to receive duplicate medications and suffer adverse drug reactions. The Bureau of National Health Insurance (BNHI) adopted smart cards (or NHI-IC cards) as health cards in Taiwan. With their NHI-IC cards, patients can freely access different medical institutions. Because an NHI-IC card carries information about a patient's prescribed medications received from different hospitals nationwide, we used this system to address the problem of duplicate medications for outpatients visiting multiple hospitals. A computerized physician order entry (CPOE) system was enhanced with the capability of accessing NHI-IC cards and providing alerts to physicians when the system detects potential duplicate medications at the time of prescribing. Physician responses to the alerts were also collected to analyze changes in physicians' behavior. Chi-square tests and two-sided z-tests with Bonferroni adjustments for multiple comparisons were used to assess statistical significance of differences in actions taken by physicians over the three months. The enhanced CPOE system for outpatient services was implemented and installed at the Pediatric and Urology Departments of Taipei Medical University Wan-Fang Hospital in March 2007. The "Change Log" that recorded physician behavior was activated during a 3-month study period from April to June 2007. In 67.93% of patient visits, the physicians read patient NHI-IC cards, and in 16.76% of the reads, the NHI-IC card contained at least one prescribed medication that was taken by the patient. Among the prescriptions issued by physicians, on average, there were 2.36% prescriptions containing at least one
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The Internationalization of Venture Capital: Challenges and Opportunities
Thomas Gstraunthaler; Galina Sagieva
2011-01-01
This paper attempts to summarize and systematize the landscape of the global venture capital industry. It presents major basic business models and investment strategies, assesses the contribution of venture capital (VC) to economic growth, and the incentives and constraints for VC’s development, and it identifies research gaps in this area. Venture capital is often regarded as the only source of support for start-ups, particularly for those in high-tech innovative sectors. The authors explore...
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Puna Geothermal Venture Hydrologic Monitoring Program
Energy Technology Data Exchange (ETDEWEB)
None
1990-04-01
This document provides the basis for the Hydrologic Monitoring Program (HMP) for the Puna Geothermal Venture. The HMP is complementary to two additional environmental compliance monitoring programs also being submitted by Puma Geothermal Venture (PGV) for their proposed activities at the site. The other two programs are the Meteorology and Air Quality Monitoring Program (MAQMP) and the Noise Monitoring Program (NMP), being submitted concurrently.
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Ruitenburg, M.M.
2016-01-01
A Workers’ Health Surveillance (WHS) can serve as an occupational health strategy to maintain or promote work-related health and work functioning of employees. The aims of this thesis were to assess the evidence-based content of a job-specific WHS for hospital physicians (medical specialists and
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Vásquez-Silva, Luis; Facultad de Medicina. Universidad Peruana Cayetano Heredia. Lima, Perú. Hospital Nacional Cayetano Heredia. Lima, Perú.; Ticse, Ray; Facultad de Medicina. Universidad Peruana Cayetano Heredia. Lima, Perú. Hospital Nacional Cayetano Heredia. Lima, Perú.; Alfaro-Carballido, Luz; Hospital Nacional Cayetano Heredia. Lima, Perú.; Guerra-Castañon, Felix; Facultad de Medicina. Universidad Peruana Cayetano Heredia. Lima, Perú. Hospital Nacional Cayetano Heredia. Lima, Perú.
2015-01-01
We assessed the access, use and preferences of information and communication technology (ICT) by physicians who practice at Cayetano Heredia National Hospital. The questionnaire explored the availability and skills of ICT, time, educational activities, search engines and technological applications most used as well as ICT preferences in education.211 physicians were surveyed; laptop use was 93%, tablet and smartphone use was 66% and 88%.68% havemobile Internet. Differences were evident in the...
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Lin, Blossom Yen-Ju; Wan, Thomas T H; Hsu, Chung-Ping Cliff; Hung, Feng-Ru; Juan, Chi-Wen; Lin, Cheng-Chieh
2012-05-01
Given the limited studies on emergency care management, this study aimed to explore the relationships of emergency department (ED) culture values to certain dimensions of ED physicians' and nurses' work satisfaction and intent to leave. Four hundred and forty-two emergency medical professionals completed the employee satisfaction questionnaire across 119 hospital-based EDs, which had culture value evaluations filed, were used as unit of analysis in this study. Adjusting the personal and employment backgrounds, and the surrounded EDs' unit characteristics and environmental factors, multiple regression analyses revealed that clan and market cultures were related to emergency physicians' work satisfaction and intent to leave. On the other hand, adhocracy, market and hierarchical cultures were related to emergency nurses' work satisfaction. There do exist different patterns among various culture types on various work satisfaction dimensions and intent to leave of emergency physicians and nurses. The findings could offer hospital and ED leaders insights for changes or for building a better atmosphere to enhance the work life of emergency physicians and nurses.
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Directory of Open Access Journals (Sweden)
H Dargahi
2005-05-01
Full Text Available Background: This research have presented focuses upon the cultural side of managerial coordination and control as manifested in Telemedicine Technology. Specifically, the research seeks to analyze and determines the attitude of clinical physicians about the role of specific dimensions of organizational culture and organizational structure may have upon effective managerial coordination and control in Telemedicine Technology in TUMS hospitals. Materials and methods: We assessed the attitude of 82 clinical physicians in five randomly selected TUMS teaching hospitals in a mixed method of pooling Quantitative and Qualitative data using unstructured interview technique. Results: For successful telemedicine utilization, most of clinical physicians believed that we need organic organizations that have involved leadership, open and free communication of mistakes and success, desire to experiment with new ideas, support for continuing education, support for new things, clear rules to follow and acknowledge performance goals. Conclusion: The data indicate that organizational is most important to utilize successfur telemedicine technology.
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Venture Capital Financing, Moral Hazard and Learning
Bergemann, D.; Hege, U.
1997-01-01
We consider the provision of venture capital in a dynamic agency model. The value of the venture project is initially uncertain and more information arrives by developing the project. The allocation of the funds and the learning process are subject to moral hazard. The optimal contract is a
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International venture capital perspective
International Nuclear Information System (INIS)
Carter, D.
2004-01-01
'Full text:' The emerging fuel cell industry is characterized by global cooperation and partnerships in commercial, technical, and financial aspects. In this talk, we would like to provide observations about international venture capital focused on fuel cells globally. The talk will refer to experiences Conduit Ventures has had with its portfolio companies and other investors in various countries. We discuss our approach to working with portfolio companies who are geographically remote from our main office in London. We also discuss the process of making investment decisions on possible investments in various countries. The talk will conclude with insights and 'lessons learned' which may be of interest to fellow members of Fuel Cells Canada. (author)
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Taxes and Venture Capital Support
DEFF Research Database (Denmark)
Keuschnigg, Christian; Nielsen, Søren Bo
2003-01-01
In this paper we set up a model of start-up finance under double moral hazard.Entrepreneurs lack own resources and business experience to develop their ideas.Venture capitalists can provide start-up finance and commercial support. The effortput forth by either agent contributes to the firm......-set may paradoxically contribute to higher quality of venturecapital finance and welfare. Subsidies to physical investment in VC-backed startupsare detrimental in our framework.Keywords: Venture capital, capital gains taxation, double moral hazard.JEL-Classification: D82, G24, H24, H25...
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Eich, Christoph; Russo, Sebastian G.; Heuer, Jan F.; Timmermann, Arnd; Gentkow, Uta; Quintel, Michael; Roessler, Markus
Background: In Germany, as in many other countries, for the vast majority of cases, critical out-of-hospital (OOH) paediatric emergencies are attended by non-specialised emergency physicians (EPs). As it is assumed that this may lead to deficient service we aimed to gather robust data on the
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New venture creation as emerging interdependencies
DEFF Research Database (Denmark)
van Oorschot, Robin; Gottlieb, Frederik
2015-01-01
into an evocative and analytical direction which is rarely touched upon in the dominant literature on entrepreneurship. We illustrate the value of narrative research in enabling us to investigate what new venture creation is, from an involved participant perspective. We find interdependencies as enabling...... constraints between the persons involved in creating the new venture, paradoxically at the same time opening up and closing down opportunities, which affects the decision making....
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Entrepreneurial Learning, Heuristics and Venture Creation
RAUF, MIAN SHAMS; ZAINULLAH, MOHAMMAD
2009-01-01
After rigorous criticism on trait approach and with the emergence of behavioral approach in entrepreneurship during 1980s, the researchers started to introduce learning and cognitive theories in entrepreneurship to describe and explain the dynamic nature of entrepreneurship. Many researchers have described venture creation as a core and the single most important element of entrepreneurship. This thesis will discuss and present the role of entrepreneurial learning and heuristics in venture cre...
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African Journals Online (AJOL)
AmL
doctors and retention of the existing doctors, in addition to the ... an employee's well-being Examples of job resources are job ..... increase physician job satisfaction for ensuring the .... both pay and benefits physicians at private hospitals.
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Venture Capital Initiative: Ohio's School Improvement Effort.
Yoo, Soonhwa; Loadman, William E.
In 1994 the Ohio State Legislature established Venture Capital to support school restructuring. The Venture Capital school initiative is a concept borrowed from the business community in which the corporate entity provides risk capital to parts of the organization to stimulate creative ideas and to provide opportunities for local entities to try…
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[Work engagement of hospital physicians: do social capital and personal traits matter?].
Susanne Lehner, Birgit; Kowalski, Christoph; Wirtz, Markus; Ansmann, Lena; Driller, Elke; Ommen, Oliver; Oksanen, Tuula; Pfaff, Holger
2013-03-01
Work engagement has been proven to be a viable indicator of physical and mental well-being at work. Research findings have shown a link between work engagement and both individual and organizational resources. The aim of the present study is to test the hypothesized relationships between personal traits (Big-5), the quality of the social work environment (social capital) and work engagement among hospital (n=35) physicians (n=387) in North-Rhine-Westphalia, Germany. Structural equation modeling (SEM), combining confirmatory factor analysis (CFA) and path analysis, was employed to conduct the statistical analyses. The results of the SEM indicated that social capital and neuroticism were significantly associated with work engagement. The relationship between agreeableness and work engagement was fully mediated by social capital. Findings suggest that social capital plays a key role in promoting work engagement of physicians. © Georg Thieme Verlag KG Stuttgart · New York.
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Directory of Open Access Journals (Sweden)
Bram Pynoo
2013-06-01
Full Text Available In view of the tremendous potential benefits of clinical information systems (CIS for the quality of patient care; it is hard to understand why not every CIS is embraced by its targeted users, the physicians. The aim of this study is to propose a framework for assessing hospital physicians' CIS-acceptance that can serve as a guidance for future research into this area. Hereto, a review of the relevant literature was performed in the ISI Web-of-Science database. Eleven studies were withheld from an initial dataset of 797 articles. Results show that just as in business settings, there are four core groups of variables that influence physicians' acceptance of a CIS: its usefulness and ease of use, social norms, and factors in the working environment that facilitate use of the CIS (such as providing computers/workstations, compatibility between the new and existing system.... We also identified some additional variables as predictors of CIS-acceptance.
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Factors related to the capital structure of small new ventures
Harms, Rainer; Breitenecker, R.; Schwartz, E.J.; Wdowiak, M.A.
2012-01-01
In the literature, there exists evidence on the capital structure determinants for small ventures, but empirical research for new ventures is limited. We seek to address this gap by presenting a confirmatory analysis of determinants of capital structure of a sample of small new ventures in Austria.
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Adams, Kristen; Cimino, Jenica E W; Arnold, Robert M; Anderson, Wendy G
2012-10-01
To describe hospital-based physicians' responses to patients' verbal expressions of negative emotion and identify patterns of further communication associated with different responses. Qualitative analysis of physician-patient admission encounters audio-recorded between August 2008 and March 2009 at two hospitals within a university system. A codebook was iteratively developed to identify patients' verbal expressions of negative emotion. We categorized physicians' responses by their immediate effect on further discussion of emotion - focused away (away), focused neither toward nor away (neutral), and focused toward (toward) - and examined further communication patterns following each response type. In 79 patients' encounters with 27 physicians, the median expression of negative emotion was 1, range 0-14. Physician responses were 25% away, 43% neutral, and 32% toward. Neutral and toward responses elicited patient perspectives, concerns, social and spiritual issues, and goals for care. Toward responses demonstrated physicians' support, contributing to physician-patient alignment and agreement about treatment. Responding to expressions of negative emotion neutrally or with statements that focus toward emotion elicits clinically relevant information and is associated with positive physician-patient relationship and care outcomes. Providers should respond to expressions of negative emotion with statements that allow for or explicitly encourage further discussion of emotion. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
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Rashed, Anan; Hamdan, Motasem
2015-06-22
Underreporting of incidents that happen in health care services undermines the ability of the systems to improve patient safety. This study assessed the attitudes of physicians and nurses toward incident reporting and the factors influencing reporting in Palestinian hospitals. It also examined clinicians' views about the preferred features of incident reporting system. Cross-sectional self-administered survey of 475 participants, 152 physicians and 323 nurses, from 11 public hospitals in the West Bank; response rate, 81.3%. There was a low level of event reporting among participants in the past year (40.3%). Adjusted for sex and age, physicians were 2.1 times more likely to report incidents than nurses (95% confidence interval, 1.32-3.417; P = 0.002). Perceived main barriers for reporting were grouped under lack of proper structure for reporting, prevalence of blame, and punitive environment. The clinicians indicated fear of administrative sanctions, social and legal liability, and of their competence being questioned (P > 0.05). Getting help for patients, learning from mistakes, and ethical obligation were equally indicated motivators for reporting (P > 0.05). Meanwhile, clinicians prefer formal reporting (77.8%) of all type of errors (65.5%), disclosure of reporters (52.7%), using reports to improve patient safety (80.3%), and willingness to report to immediate supervisors (57.6%). Clinicians acknowledge the importance of reporting incidents; however, prevalence of punitive culture and inadequate reporting systems are key barriers. Improving feedback about reported errors, simplifying procedures, providing clear guidelines on what and who should report, and avoiding blame are essential to enhance reporting. Moreover, health care organizations should consider the opinions of the clinicians in developing reporting systems.
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kahouei, Mehdi; Alaei, Safollah; Shariat Panahi, Sohaila Sadat Ghazavi; Zadeh, Jamileh Mahdi
2015-05-01
It is important for physicians, medical students and health care organizations of developing countries to use reliable clinical information in order to deliver the best practice. Therefore, health sector of Iran endeavored to encourage physicians and medical students to integrate research findings into practice since 2005. Several educational interventions in the areas of information technology and databases were performed. Digital library was introduced in the teaching hospitals. The purpose of this study was to investigate whether these interventions increased the use of evidence-based health information resources among physicians, medical residents and students. This descriptive study involved 315 physicians, assistants and medical students in affiliated hospitals of Semnan University of medical sciences in 2013. A total 52.9% of physicians and 79.5% of medical residents and students always used patient data. 81.3% of physicians and 67.1% of medical residents and students reported using their own experiences, 26.5% of physicians and 16.9% of medical residents and students always used databases such as PubMed and MEDLINE for patient care. Our results revealed that in spite of providing educational and technical infrastructures for accomplishment of research utilization in medical education, the study subjects often identified and used what they regarded as reliable and relevant information from sources that do not truly represent the best evidence that is available. © 2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.
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von Babo, Michelle; Chmiel, Corinne; Müggler, Simon Andreas; Rakusa, Julia; Schuppli, Caroline; Meier, Philipp; Fischler, Manuel; Urner, Martin
2018-01-01
Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC) greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland. In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed. 560 physicians of 71 hospitals (64%) responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.
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The Determinants of Venture Capital Portfolio Size: Empirical Evidence
Douglas J. Cumming
2006-01-01
This paper explores factors that affect portfolio size among a sample of venture capital financing data from 214 Canadian funds. Four categories of factors affect portfolio size: (1) the venture capital funds' characteristics, including the type of fund, fund duration, fund-raising, and the number of venture capital fund managers; (2) the entrepreneurial firms' characteristics, including stage of development, technology, and geographic location; (3) the nature of the financing transactions, i...
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Hayes, Chris; Yousefi, Vandad; Wallington, Tamara; Ginzburg, Amir
2010-01-01
There is increasing recognition of the need for physician leadership in quality and patient safety, and emerging evidence that physician leadership contributes to improved care. Hospitals are beginning to establish physician leader positions; however, there is little guidance on how to define these roles and the strategies physician leaders can use toward improving care. This case study examines the roles of four physician leaders, describes their contribution to the design and implementation of hospital quality and patient safety agendas and discusses the creation of a physician network to support these activities. The positions were established between July 2006 and April 2009. All are corporate roles with varying reporting and accountability structures. The physician leads are involved in strategic planning, identifying and leading quality and safety initiatives, physician engagement and culture change. All have significantly contributed to the implementation of hospital improvement activities and are seen as influential among their peers as resources and mentors for local project success. Despite their accomplishments, these physician leads have been challenged by ambiguous role descriptions and difficulty identifying effective improvement strategies. As such, an expanding physician network was created with the goal of sharing approaches and tools and creating new strategies. Physician leaders are an important factor in the improvement of safety and quality within hospitals. This case study provides a template for the creation of such positions and highlights the importance of networking as an effective strategy for improving local care and advancing professional development of physician leaders in quality and patient safety.
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13 CFR 108.10 - Description of the New Markets Venture Capital Program.
2010-01-01
... Venture Capital Program. 108.10 Section 108.10 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM Introduction to Part 108 § 108.10 Description of the New Markets Venture Capital Program. The New Markets Venture Capital (“NMVC”) Program is a...
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Matrix organization increases physician, management cooperation.
Boissoneau, R; Williams, F G; Cowley, J L
1984-04-01
Because of the development of multihospital systems and the establishment of diagnosis related groups, hospitals increasingly will establish matrix organizations for their corporate structures. St. Luke's Hospital adopted the matrix concept in the mid-1970s, utilizing program administrators for each specialty service or "clinical center of excellence." Such centers have been developed in digestive diseases, cardiovascular and pulmonary medicine, orthopedics and rheumatology, ophthalmology, and behavioral health. The program administrator's functions are diverse: To serve as primary liaison between physicians and the hospital; To project levels of program utilization and patient and physician satisfaction, to identify areas requiring administrative and marketing emphasis, and to develop the program's marketing plan; To develop, implement, and evaluate the program's strategic, operational, and financial plans; To recruit physicians to practice at St. Luke's and to cultivate referrals from outside physicians; To participate in selecting members of all board and medical staff committees relating to the particular specialty area; and To determine the need for new programs within the specialty area and to develop services. As indicated by a medical staff survey, most physicians at St. Luke's believe that the program administrator system has improved communication with the hospital administration, that the program administrator is able to respond effectively to physician requests and problems, and that the quality of patient care has been enhanced. A great majority said they would recommend the system to other hospitals.
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The start-up processes of academic spin-offs and non-academic ventures
Roininen, Sari
2006-01-01
New and small firms are important for the national economic growth, and hence there is a growing interest among policy makers and researchers in understanding the start-up processes among new ventures in order to facilitate more new venture creations. Prior research addressing new ventures' start-up processes focus mainly on the individual behind the venture or different activities in the start-up process. The overall purpose of this study is to increase the understanding of new venture s...
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Vásquez-Silva, Luis; Ticse, Ray; Alfaro-Carballido, Luz; Guerra-Castañon, Felix
2015-01-01
We assessed the access, use and preferences of information and communication technology (ICT) by physicians who practice at Cayetano Heredia National Hospital. The questionnaire explored the availability and skills of ICT, time, educational activities, search engines and technological applications most used as well as ICT preferences in education.211 physicians were surveyed; laptop use was 93%, tablet and smartphone use was 66% and 88%.68% have mobile Internet. Differences were evident in the frequency of use of ICT in 25-34 year old age group as well as a higher level of skills (pWhatsApp as a means of exchanging images and data related to health, 50% participated in medical blogs, online courses or videoconferences. The use and access of ICT is common among doctors in this hospital and there is positive interest in its use in education.
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In Bern high-energy physics shares proton beams with the hospital
CERN Bulletin
2011-01-01
A joint venture bringing together public institutions and private companies is building a new facility on the campus of Inselspital, Bern’s university hospital. The facility will host a cyclotron for the production of radiopharmaceuticals for use in PET as well as in multidisciplinary research laboratories for the development of new products for medical imaging. The Laboratory for High Energy Physics (LHEP) of Bern University, which is deeply involved in the project, will have access to a dedicated beam line and specialized labs. Construction of the new facility is ongoing at Bern's University Hospital, where the cyclotron will be installed. The first Bern Cyclotron symposium will take place on 6 and 7 June this year. The event is being organised by LHEP in collaboration with Bern’s Inselspital and will bring together experts – including several from CERN – to promote research activities at the new Bern Cyclotron Laboratory. &ld...
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provider venture capital funds: investing in innovation.
Potter, Mary Jo; Wesslund, Rick
2016-05-01
As health systems continue to embrace disruptive innovation, they are increasingly likely to consider making a move into venture capital. Working in venture capital can benefit a health system in several ways, including: Allowing it to operate outside of bureaucracy and align projects with its core values. Encouraging innovation within the organization. Enabling it to respond quickly to changes in the market.
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Instant Internationalization of Emerging Economy New Ventures
DEFF Research Database (Denmark)
Turcan, Romeo V.
2012-01-01
Being positioned and the intersection of international entrepreneurship and institutional theory, this study explores the process of instant internationalization of new ventures from emerging economies. It adopts a single-case study methodology, purposefully selecting an information-rich case where...... context of an emerging industry. Yet another set of contributions concerns the legitimation process of internationalization of a new venture from an emerging economy. A number of propositions are put forward to guide future research....... the phenomenon is manifested intensely, but not extremely. A family-owned venture located in Moldova that is in the business of processing fruit and vegetables was selected for this study. It started up in 2000 and from its inception the sales from exports grew almost 120% per year. Data collection took place...
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Drug-food interaction counseling programs in teaching hospitals.
Wix, A R; Doering, P L; Hatton, R C
1992-04-01
The results of a survey to characterize drug-food interaction counseling programs in teaching hospitals and solicit opinions on these programs from pharmacists and dietitians are reported. A questionnaire was mailed to the pharmacy director and the director of dietary services at teaching hospitals nationwide. The questionnaire contained 33 questions relating to hospital characteristics, drug-food interaction counseling programs, and the standard calling for such programs issued by the Joint Commission on Accreditation of Healthcare Organizations. Of 792 questionnaires mailed, 425 were returned (response rate, 53.7). A majority of the pharmacists and dietitians (51.2%) did not consider their drug-food interaction counseling program to be formal; some had no program. The pharmacy department was involved more in program development than in the daily operation of such programs. The most frequent methods of identifying patients for counseling were using lists of patients' drugs and using physicians' orders. A mean of only five drugs were targeted per program. Slightly over half the respondents rated the Joint Commission standard less effective than other standards in its ability to improve patient care. A majority of teaching hospitals did not have formal drug-food interaction counseling programs. Pharmacists and dietitians did not view these programs as greatly beneficial and did not believe that the Joint Commission has clearly delineated the requirements for meeting its standard.
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International Nuclear Information System (INIS)
Johansen, P.; Johnson, J.P.; Lundsager, P.
1990-01-01
The Commission of the European Communities and the Zhejiang Provincial Science and Technology Commission have together supported the Decentralized Energy Systems for China Project. The paper presents the approach, methods and results of the wind/diesel part of the project, which aimed at supporting the establishment of a joint venture between a European wind turbine manufacturer and a Chinese industrial partner to produce wind/diesel systems for the local market. A comprehensive integrated approach to the project was chosen, the parts of which are discussed in the paper. The paper provides evidence of the good conditions for local production but also indicates why the joint venture has not been established. (Author)
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Duarte, Jurandir Godoy; Azevedo, Raymundo Soares
2017-06-01
To evaluate the satisfaction and expectations of patients and physicians before and after the implementation of an electronic health record (EHR) in the outpatient clinic of a university hospital. We conducted 389 interviews with patients and 151 with physicians before and after the implementation of a commercial EHR at the internal medicine clinic of Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HC-FMUSP), Brazil. The physicians were identified by their connection to the outpatient clinic and categorized by their years since graduation: residents and preceptors (with 10 years or less of graduation) or assistants (with more than 10 years of graduation). The answers to the questionnaire given by the physicians were classified as favorable or against the use of EHR, before and after the implementation of this system in this clinic, receiving 1 or 0 points, respectively. The sum of these points generated a multiple regression score to determine which factors contribute to the acceptance of EHR by physicians. We also did a third survey, after the EHR was routinely established in the outpatient clinic. The degree of patient satisfaction was the same before and after implementation, with more than 90% positive evaluations. They noted the use of the computer during the consultation and valued such use. Resident (younger) physicians had more positive expectations than assistants (older physicians) before EHR implementation. This optimism was reduced after implementation. In the third evaluation the use of EHR was higher among resident physicians. Resident physicians perceived and valued the EHR more and used it more. In 28 of the 57 questions on performance of clinical tasks, resident physicians found it easier to use EHR than assistant physicians with significant differences (pclinical setting should be preceded by careful planning to improve physician's adherence to the use of EHR. Patients do not seem to notice much difference to the
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Venture Capital Investment in the Life Sciences in Switzerland.
Hosang, Markus
2014-12-01
Innovation is one of the main driving factors for continuous and healthy economic growth and welfare. Switzerland as a resource-poor country is particularly dependent on innovation, and the life sciences, which comprise biotechnologies, (bio)pharmaceuticals, medical technologies and diagnostics, are one of the key areas of innovative strength of Switzerland. Venture capital financing and venture capitalists (frequently called 'VCs') and investors in public equities have played and still play a pivotal role in financing the Swiss biotechnology industry. In the following some general features of venture capital investment in life sciences as well as some opportunities and challenges which venture capital investors in Switzerland are facing are highlighted. In addition certain means to counteract these challenges including the 'Zukunftsfonds Schweiz' are discussed.
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Patterns of venturing financing: The case of Chinese entrepreneurs
Liao, Jianwen; Welsch, Harold; Pistrui, David
2003-01-01
This study examines the sources of venture financing of Chinese entrepreneurs in Wuhan, China. Based on a sample of 222, we found that Chinese entrepreneurs in Wuhan mainly rely on venture financing on their own or parties that are within their close social networks such as parents, relatives and friends. External financing sources are notably missing. We also found that entrepreneurs who use significantly more personal saving in venture financing are older (>37 years), female, with high scho...
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Venture capital performance: the disparity between Europe and the United States
Schwienbacher, A.; Hege, U.; Palomino, F.
2009-01-01
Abstract: This paper compares the success of venture capital investments in the United States and in Europe by analyzing individual venture-backed companies and the value generated within the stage financing process. We document that US venture capitalists generate significantly more value with
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Creswick, Nerida; Westbrook, Johanna Irene
2015-09-01
To measure the weekly medication advice-seeking networks of hospital staff, to compare patterns across professional groups, and to examine these in the context of prescribing error rates. A social network analysis was conducted. All 101 staff in 2 wards in a large, academic teaching hospital in Sydney, Australia, were surveyed (response rate, 90%) using a detailed social network questionnaire. The extent of weekly medication advice seeking was measured by density of connections, proportion of reciprocal relationships by reciprocity, number of colleagues to whom each person provided advice by in-degree, and perceptions of amount and impact of advice seeking between physicians and nurses. Data on prescribing error rates from the 2 wards were compared. Weekly medication advice-seeking networks were sparse (density: 7% ward A and 12% ward B). Information sharing across professional groups was modest, and rates of reciprocation of advice were low (9% ward A, 14% ward B). Pharmacists provided advice to most people, and junior physicians also played central roles. Senior physicians provided medication advice to few people. Many staff perceived that physicians rarely sought advice from nurses when prescribing, but almost all believed that an increase in communication between physicians and nurses about medications would improve patient safety. The medication networks in ward B had higher measures for density, reciprocation, and fewer senior physicians who were isolates. Ward B had a significantly lower rate of both procedural and clinical prescribing errors than ward A (0.63 clinical prescribing errors per admission [95%CI, 0.47-0.79] versus 1.81/ admission [95%CI, 1.49-2.13]). Medication advice-seeking networks among staff on hospital wards are limited. Hubs of advice provision include pharmacists, junior physicians, and senior nurses. Senior physicians are poorly integrated into medication advice networks. Strategies to improve the advice-giving networks between senior
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Recruiting physicians without inviting trouble.
Hoch, L J
1989-05-01
Many hospitals use physician recruitment strategies--generally assistance or employment strategies--to ensure medical staff loyalty. Although these strategies appeal to both hospitals and physicians, they are becoming increasingly problematic. Over the past three years, the government has issued pronouncements that question their legality. Thus any hospital considering physician recruitment strategies would be wise to evaluate them in light of various legal issues. such as reimbursement, nonprofit taxation, corporate practice of medicine, and certificate-of-need statutes. The consequences of failing to consider these issues can be ominous. The penalties for violating the proscribed remuneration provision of the Medicare act can include a fine, imprisonment, suspension from the Medicare and Medicaid programs, or loss of license. Payment issues can result in reduced reimbursement levels. Nonprofit taxation issues can trigger the loss of tax exemption. As a result of the corporate practice of medicine, a physician recruitment strategy may not be reimbursable by third-party payers or may even constitute the unauthorized practice of medicine. Finally, in some states, physician recruitment may trigger certificate-of-need review.
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Ishikawa, Hirono; Eto, Masato; Kitamura, Kiyoshi; Kiuchi, Takahiro
2014-09-01
This study aimed to explore the relationships among physicians' confidence in conducting medical interviews, their attitudes toward the patient-physician relationship, and undergraduate training in communication skills among resident physicians in Japan. Participants were 63 first-year resident physicians at a university hospital in Tokyo. The Physician Confidence in the Medical Interview scale (PCMI) was constructed based on the framework of the Calgary-Cambridge Guide. Additionally, participants' attitudes toward the patient-physician relationship (Patient-Practitioner Orientation Scale; PPOS), undergraduate experience of communication skills training, and demographic characteristics were assessed through a self-reported questionnaire. The internal consistency of the PCMI and PPOS scales were adequate. As expected from the undergraduate curriculum for medical interviews in Japan, residents had relatively higher confidence in their communication skills with respect to gathering information and building the relationship, whereas less confident about sharing information and planning treatment. The PCMI was associated with a more patient-centered attitude as measured by the PPOS. These scales could be useful tools to measure physicians' confidence and attitudes in communicating with patients and to explore their changes through medical education. Residency programs should consider including systematic training and assessment in communication skills related to sharing information and planning treatment. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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Bridging a divide: architecture for a joint hospital-primary care data warehouse.
An, Jeff; Keshavjee, Karim; Mirza, Kashif; Vassanji, Karim; Greiver, Michelle
2015-01-01
Healthcare costs are driven by a surprisingly small number of patients. Predicting who is likely to require care in the near future could help reduce costs by pre-empting use of expensive health care resources such as emergency departments and hospitals. We describe the design of an architecture for a joint hospital-primary care data warehouse (JDW) that can monitor the effectiveness of in-hospital interventions in reducing readmissions and predict which patients are most likely to be admitted to hospital in the near future. The design identifies the key governance elements, the architectural principles, the business case, the privacy architecture, future work flows, the IT infrastructure, the data analytics and the high level implementation plan for realization of the JDW. This architecture fills a gap in bridging data from two separate hospital and primary care organizations, not a single managed care entity with multiple locations. The JDW architecture design was well received by the stakeholders engaged and by senior leadership at the hospital and the primary care organization. Future plans include creating a demonstration system and conducting a pilot study.
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Inter-rater reliability of diagnostic criteria for sacroiliac joint-, disc- and facet joint pain.
van Tilburg, Cornelis W J; Groeneweg, Johannes G; Stronks, Dirk L; Huygen, Frank J P M
2017-01-01
Several diagnostic criteria sets are described in the literature to identify low back pain subtypes, but very little is known about the inter-rater reliability of these criteria. We conducted a study to determine the reliability of diagnostic tests that point towards SI joint-, disc- or facet joint pain. Inter-rater reliability study alongside three randomized clinical trials. Multidisciplinary pain center of general hospital. Patients aged 18 or more with medical history and physical examination suggestive of sacroiliac joint-, disc- and facet joint pain on lumbar level. Making use of nowadays most common used diagnostic criteria, a physical examination is taken independently by three physicians (two pain physicians and one orthopedic surgeon). Inter-rater reliability (Kappa (κ) measure of agreement) and significance (p) between raters are presented. Strengths of agreement, indicated with κ values above 0,20, are presented in order of agreement. One hundred patients were included. None of the parameters from the physical investigation had κ values of more than 0.21 (fair) in all pairs of raters. Between two raters (C and D), there was an almost perfect agreement on three parameters, more specifically ``Abnormal sensory and motor examination, hyperactive or diminished reflexes'', ``Sitting exam shows no reflex, motor or sensory signs in the legs'' and ``Straight leg raising (Laségue) negative between 30 and 70 degrees of flexion''. The ``Drop test positive'' parameters had moderate strength of agreement between raters A and D and fair strength between raters A and B. The ``Digital interspinous pressure test positive'' had moderate strength of agreement between raters C and D and fair strength of agreement between raters A and B as well as raters B and C. Three other parameters had a fair strength of agreement between two raters, all other parameters had a slight or poor strength of agreement. Inter-rater reliability, confidence intervals and significance of
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Physician alignment strategies and real estate.
Czerniak, Thomas A
2012-06-01
When addressing locations of facilities after acquiring physician practices, hospitals should: Acknowledge the hospital's ambulatory plan is the driver rather than real estate assumed with the physician practices, Review the hospital ambulatory service plan for each submarket, Review the location of facilities within the service area and their proximity to one another, Sublease or sell existing facilities that are not appropriate, Ensure that the size and characteristics of each facility in the market are appropriate and consistent with the hospital's image.
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How does venture capital operate in medical innovation?
Lehoux, P; Miller, F A; Daudelin, G
2016-07-01
While health policy scholars wish to encourage the creation of technologies that bring more value to healthcare, they may not fully understand the mandate of venture capitalists and how they operate. This paper aims to clarify how venture capital operates and to illustrate its influence over the kinds of technologies that make their way into healthcare systems. The paper draws on the international innovation policy scholarship and the lessons our research team learned throughout a 5-year fieldwork conducted in Quebec (Canada). Current policies support the development of technologies that capital investors identify as valuable, and which may not align with important health needs. The level of congruence between a given health technology-based venture and the mandate of venture capital is highly variable, explaining why some types of innovation may never come into existence. While venture capitalists' mandate and worldview are extraneous to healthcare, they shape health technologies in several, tangible ways. Clinical leaders and health policy scholars could play a more active role in innovation policy. Because certain types of technology are more likely than others to help tackle the intractable problems of healthcare systems, public policies should be equipped to promote those that address the needs of a growing elderly population, support patients who are afflicted by chronic diseases and reduce health disparities.
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Directory of Open Access Journals (Sweden)
Ruitenburg Martijn M
2012-08-01
Full Text Available Abstract Background We studied the prevalence of common mental disorders among Dutch hospital physicians and investigated whether the presence of a mental disorder was associated with insufficient self-reported work ability. Methods A questionnaire was sent to all (n = 958 hospital physicians of one academic medical center, using validated scales to assess burnout, work-related fatigue, stress, posttraumatic stress disorder (PTSD, anxiety and depression. Furthermore, respondents were asked to rate their current work ability against the work ability in their own best period (adapted version of the first WAI item. The prevalence of each common mental disorder was calculated. In addition, odds ratios of reporting insufficient work ability for subjects with high complaint scores compared to physicians with low complaint scores were calculated for each mental disorder. Results The response rate was 51%, and 423 questionnaires were eligible for analysis. The mental disorder prevalence rates were as follows: work-related fatigue 42%, depression 29%, anxiety 24%, posttraumatic stress complaints 15%, stress complaints 15% and burnout 6%. The mean score for self-reported work ability was 8.1 (range 0–10, and 4% of respondents rated their own work ability as insufficient. Physicians with high mental health complaints were 3.5- for fatigue, 5.6- for PTSD, 7.1- for anxiety, 9.5- for burnout, 10.8- for depression and 13.6-fold for stress more likely to report their work ability as insufficient. Conclusions The prevalence of common mental disorders among hospital physicians varied from 6% for burnout to 42% for work-related fatigue. Those physicians with high complaints had significantly 4- to 14 times increased odds of reporting their own work ability as insufficient. This work suggests that to ensure future workers health and patients safety occupational health services should plan appropriate intervention strategies.
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External legitimation in international new ventures
DEFF Research Database (Denmark)
Turcan, Romeo V.
2012-01-01
This paper explores within the framework of new venture legitimation how and why international new ventures acquire external legitimacy and strive for survival in the face of critical events. Following a longitudinal multiple-case study methodology that was adopted for the purpose of theory...... building, the paper introduces the typology of captivity, and the four types that have emerged: captive industry supplier, captive dyadic partner, captive market leader, and free market leader. The effects of captivity types on the acquisition of external legitimacy and its survival, on reaching legitimacy...
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Fueling innovation in medical devices (and beyond): venture capital in health care.
Ackerly, D Clay; Valverde, Ana M; Diener, Lawrence W; Dossary, Kristin L; Schulman, Kevin A
2009-01-01
Innovation in health care requires new ideas and the capital to develop and commercialize those ideas into products or services. The necessary capital is often "venture capital," but the link between public policy and the venture capital industry has not been well examined. In this paper we explore the link between venture capital and innovation in health care, and we present new descriptive data from a survey of health care venture capital fund managers. Respondents generally viewed policy levers (for example, reimbursement and regulations) as important risks to venture capital investments, potentially affecting their ability to raise capital for early-stage investment funds.
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Directory of Open Access Journals (Sweden)
E Emami
2014-01-01
Full Text Available Introduction: Hospital information system (HIS is a computerized system used for management of hospital information as an electronic device and has an indispensible role in the field of qualified healthcare services. Nevertheless, compared to other industrial and commercial systems, this information system is lagged in using the information technology and applying the controlling standards for satisfying the customers. Therefore, the present study aimed to evaluate HIS, identify its strength and weak points, and improve it in the teaching hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Method: The present descriptive, cross-sectional study was conducted in the 8 teaching hospitals of Shiraz University of Medical Sciences which used HIS in 2011. The study data were collected through interview and direct observation using the criteria of American Physician College check-list. Finally, SPSS statistical software was used to analyze the data through descriptive statistics. Results: The study results showed that laboratory and medical records had respectively the most %43.5 and the least %21.03 conformity to the criteria of American College of Physicians. Also, Faghihi and Zeinabiye hospitals respectively had the most %41.8 and the least %25.2 conformity to the American College of Physicians’ criteria. In pharmacy, data entrance mechanism and presentation of reports had complete conformity to the scales of American College of Physicians, while drug interactions showed no conformity. In laboratory, data entrance mechanism had complete conformity to the above-mentioned criteria and keeping the test history had %87.5 conformity. The possibility of receiving information from centers out of laboratory had no conformity to the desired criteria. In the radiology department, data entrance mechanism had complete conformity to the above-mentioned criteria and keeping the test history had %87.5 conformity. Besides, the possibility
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Yackanicz, Lori; Kerr, Richard; Levick, Donald
2010-01-01
Implementing an EMR in an ambulatory practice requires intense workflow analysis, introduction of new technologies and significant cultural change for the physicians and physician champion. This paper will relate the experience at Lehigh Valley Health Network in the implementation of an ambulatory EMR and with the physician champions that were selected to assist the effort. The choice of a physician champion involves political considerations, variation in leadership and communication styles, and a cornucopia of personalities. Physician leadership has been shown to be a critical success factor for any successful technology implementation. An effective physician champion can help develop and promote a clear vision of an improved future, enlist the support of the physicians and staff, drive the process changes needs and manage the cultural change required. The experience with various types of physician champions will be discussed, including, the "reluctant leader", the "techie leader", the "whiny leader", and the "mature leader". Experiences with each type have resulted in a valuable, "lessons learned" summary. LVHN is a tertiary academic community medical center consisting of 950 beds and over 450 employed physicians. LVHN has been named to the Health and Hospital Network's 100 Top Wired and 25 Most Wireless Hospitals.
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A Case Report of an Acromioclavicular Joint Ganglion Associated with a Rotator Cuff Tear.
Tanaka, Suguru; Gotoh, Masafumi; Mitsui, Yasuhiro; Shirachi, Isao; Okawa, Takahiro; Higuchi, Fujio; Shiba, Naoto
2017-04-13
We report a case of subcutaneous ganglion adjacent to the acromioclavicular joint with massive rotator cuff tear [1-7]. An 81-year-old woman presented with a ganglion adjacent to the acromioclavicular joint that had first been identified 9 months earlier. The ganglion had recurred after having been aspirated by her local physician, so she was referred to our hospital. The puncture fluid was yellowish, clear and viscous. Magnetic resonance imaging identified a massive rotator cuff tear with multi- lobular cystic lesions continuous to the acromioclavicular joint, presenting the "geyser sign". During arthroscopy, distal clavicular resection and excision of the ganglion were performed together with joint debridement. At present, the ganglion has not recurred and the patient has returned to normal daily activity. In this case, the ganglion may have developed subsequent to the concomitant massive cuff tear, due to subcutaneous fluid flow through the damaged acromioclavicular joint.