166 research outputs found

    Physician Practice Patterns and Variation in the Delivery of Preventive Services

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    BACKGROUND: Strategies to improve preventive services delivery (PSD) have yielded modest effects. A multidimensional approach that examines distinctive configurations of physician attributes, practice processes, and contextual factors may be informative in understanding delivery of this important form of care. OBJECTIVE: We identified naturally occurring configurations of physician practice characteristics (PPCs) and assessed their association with PSD, including variation within configurations. DESIGN: Cross-sectional study. PARTICIPANTS: One hundred thirty-eight family physicians in 84 community practices and 4,046 outpatient visits. MEASUREMENTS: Physician knowledge, attitudes, use of tools and staff, and practice patterns were assessed by ethnographic and survey methods. PSD was assessed using direct observation of the visit and medical record review. Cluster analysis identified unique configurations of PPCs. A priori hypotheses of the configurations likely to perform the best on PSD were tested using a multilevel random effects model. RESULTS: Six distinct PPC configurations were identified. Although PSD significantly differed across configurations, mean differences between configurations with the lowest and highest PSD were small (i.e., 3.4, 7.7, and 10.8 points for health behavior counseling, screening, and immunizations, respectively, on a 100-point scale). Hypotheses were not confirmed. Considerable variation of PSD rates within configurations was observed. CONCLUSIONS: Similar rates of PSD can be attained through diverse physician practice configurations. Significant within-configuration variation may reflect dynamic interactions between PPCs as well as between these characteristics and the contexts in which physicians function. Striving for a single ideal configuration may be less valuable for improving PSD than understanding and leveraging existing characteristics within primary care practices

    Complexity Theory for a New Managerial Paradigm: A Research Framework

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    In this work, we supply a theoretical framework of how organizations can embed complexity management and sustainable development into their policies and actions. The proposed framework may lead to a new management paradigm, attempting to link the main concepts of complexity theory, change management, knowledge management, sustainable development, and cybernetics. We highlight how the processes of organizational change have occurred as a result of the move to adapt to the changes in the various global and international business environments and how this transformation has led to the shift toward the present innovation economy. We also point how organizational change needs to deal with sustainability, so that the change may be consistent with present needs, without compromising the future

    Tendencias de la cultura y cambio organizacional: estudio de caso

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    La imagen corporativa en relación con el medio se evidencia en el informe de Deloitte (2018) sobre tendencias del capital humano, en donde se reportan alrededor de 11.000 cuestionarios aplicados a gerentes de 140 países y 150 líderes de empresas colombianas, el planteamiento realizado sugiere que el capital social cobra tanto importancia como el físico y el financiero. Estos aspectos están relacionados con la identidad corporativa y cómo se relaciona a su vez con la cultura y la gestión del en la organización. La cultura y la gestión del cambio han cobrado mucho interés para las personas que guían las organizaciones, los estudios realizados por Deloitte en 2017 se focalizaron en la relación de la cultura y el compromiso como elementos importantes del empleado; los resultados del estudio dejan en evidencia cómo la habilidad de las organizaciones para afrontar inconvenientes de compromiso y cultura tenían una reducción del 14% con respecto al año anterior, estos datos permiten entender la complejidad del ambiente en el ámbito laboral y dan cuenta de la importancia de desarrollar conocimiento válido que oriente a académicos y empresarios para que puedan abordar de una manera adecuada estos aspectos.1a edició

    Problematizing fit and survival: transforming the law of requisite variety through complexity misalignment

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    The law of requisite variety is widely employed in management theorizing and is linked with core strategy themes such as contingency and fit. We reflect upon requisite variety as an archetypal borrowed concept. We contrast its premises with insights from the institutional literature and commitment literature, draw propositions that set boundaries to its applicability, and review the ramifications of what we call “complexity misalignment.” In this way we contradict foundational assumptions of the law, problematize adaptation- and survival-centric views of strategizing, and theorize the role of human agency in variously complex regimes

    A framework for examining leadership in extreme contexts

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