Abstract: This case tells how a leader of a health care institution used systems thinking as a foresight tool to help survive the Great Recession of 2008. The original study on which this case is based sought to understand the essence of leaders’ interior response to the Great Recession of 2008 with regard to sustainability and leadership. The impact of the Great Recession of 2008 on organizational leaders with regards to sustainable policy making was examined by addressing: (a) how sustainability is defined, (b) the philosophy that underlies sustainable thinking within organizations, (c) leadership elements that are important to sustainable implementation, and (d) how system breaking points provide the opportunity for sustainable transformation. Due to the leader’s systems thinking perspective, several behavior themes emerged. Organizational policies were then developed to help institutionalize these behaviors, and which prepared the organization for a successful and sustainable response to the oncoming catastrophe. Strategic management strategies, supporting futures thinking, ultimately guided and stabilized the organization throughout this economic crisis, effectively leading to future growth.Abstract: This case tells how a leader of a health care institution used systems thinking as a foresight tool to help survive the Great Recession of 2008. The original study on which this case is based sought to understand the essence of leaders’ interior response to the Great Recession of 2008 with regard to sustainability and leadership. The impact of the ...Show More
Abstract: Objective- To identify measures of surgeon performance that are valid, reliable, and capable of classifying the risk of surgeon performance. Data Sources- A surgical quality improvement program, dataset unique to selected hospitals and surgeons containing abstracted surgical case records. Study Design- Six criteria were employed to assess the validity of 24 candidate measures of surgeon performance: 1) the presence of a surgeon random intercept; 2) a surgeon signal that is greater than zero; 3) surgeon majority control; 4) reliability of the surgeon random intercept of at least 0.7; 5) the capacity to identify both low- and high-risk surgeons and 6) the presence of a learning/improvement effect. Data collection/Extraction methods- Surgical case review nurses abstracted cases for each surgeon using a structured sampling and abstraction methodology. Principal findings- Comparing outcomes requires risk adjustment and the use of the "true score" approach but is limited by case volume constraints and a confounding factor, i.e., the hospital, if used to judge surgeons' performance. Assessing surgeon performance requires a measure of the surgeon's effects on the consequences (postoperative occurrences) of surgical procedures, i.e., the surgeon-specific random intercept, which is a product of a multilevel risk adjustment model. Conclusion- Morbidities and mortality lack the characteristics necessary to be used as measures of surgeon performance. However, the process (task-time) measures LOS and OT both have high event rates, high reliability, and are capable of classifying surgeon risk.Abstract: Objective- To identify measures of surgeon performance that are valid, reliable, and capable of classifying the risk of surgeon performance. Data Sources- A surgical quality improvement program, dataset unique to selected hospitals and surgeons containing abstracted surgical case records. Study Design- Six criteria were employed to assess the valid...Show More
