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Biomedical subjects

P C Nutt

Publications and source records attributed to P C Nutt.

17 recordsLinked to original sources
PubMed1996

Views of implementation approaches by top managers in health service organizations.

This study examined how top managers view the prospects of success and resistance when using four implementation approaches in participative and control cultures that foster climates more or less conducive to change. An accommodation approach was viewed as having the best prospect of success and of lowering resistance in a participative culture. Bargaining and incentive approaches were thought to have successful and low resistance outcomes, which were just below those of accommodation, in a control type of culture. A persuasion approach was thought to be the least effective implementation approach in a control-oriented culture. These preferences differ from prescriptions found in the implementation literature. Assuming that preferences influence behavior, implementation success could be improved if managers selected an implementation approach according to the demands of the situation. More research is needed to appreciate fully the rationale that lies behind the preferences uncovered in this research.

Analysis of Variance↗
PubMed1992

Contract management and institutional cost control.

The ability of contract management to control hospital cost is explored. Trends in cost-related performance factors for 61 contract-managed hospitals, three years pre- and three years postcontract, omitting the contract year, are examined. The study also considers factors derived from contract features and hospital characteristics that have been missing from past studies and more than doubles the data base of previously reported studies. To focus on current policy needs, cost-containment issues are emphasized. Analysis of these data suggests that contract management contained costs in the small isolated hospitals that have historically purchased these services during a period when cost containment was not rewarded by reimbursement policy.

Contract Services↗
PubMed1991

How top managers in health organizations set directions that guide decision making.

Cases describing strategic decisions made in health care organizations were analyzed to determine how top managers set directions that guide decision making. Four tactics were identified--issue, idea, objective, and reframing. Decision-adoption rates, decision merit, and duration of the decision-making process were used to determine the effectiveness of each tactic. The effects that stem from using each tactic were qualified by factors describing urgency, importance, and differences between the tactics used by CEOs and middle managers (leverage). Tactics were found to have more influence on decision effectiveness than the intervening variables of urgency, importance, and leverage. Reframing was found to be the most effective tactic under all conditions but was the least frequently used by decision makers. Issue and idea tactics were the least effective, but idea tactics were used more often than any other tactic. Issue tactics were even less effective when applied to urgent and important decisions. Objectives were surprisingly effective in a crisis and for the more important decision.

Analysis of Variance↗
PubMed1984

Decision-modeling methods used to design decision support systems for staffing.

This paper explores the merits of two methods that extract the decision models of experts to serve as a decision support mechanism for staffing. One method has experts make judgments about hypothetical cases and the other has experts decompose the decision into criteria weighting and scaling. Staffing models were developed for each method using nurses who work in neonatology wards in two large hospitals. The four decision models were used to predict the demands for nursing time in both hospitals, which were compared with an ex post facto assessment of needs to validate the models. To measure transportability, the author used the model developed in one site to predict nursing hours for the other site. Both methods were found to be acceptable when applied at the site where they were developed. However, the ability to transport either model was negligible, suggesting that universal protocols for staffing do not exist.

Decision Making↗
PubMed1984

Types of organizational decision processes.

Seventy-eight case studies of decision making were profiled to identify the nature of the process. Analysis revealed evaluative, historical model, off-the-shelf, search, and nova process types. These processes differ in their approach to idea generation, the guarantors applied, and process-management rationale. Variations in each type are described to lay out the distinctions between the processes. The study found that managers do not use the normative methods prescribed by scholars for good decision making. Most decision processes were found to be solution centered, which seemed to restrict innovation, limit the number of alternatives considered, and perpetuate the use of questionable tactics.

Canada↗
PubMed1984

The decision process used for hospital bond rating--and its implications.

Investigation of the process of hospital bond rating related the ratings assigned by Moody's and Standard and Poors to indicators of hospital financial condition (such as debt per bed and peak debt coverage), institutional factors (including size, occupancy, and local market competition), indenture provisions (such as reserves), and contextual factors. The criteria used by Moody's and Standard and Poors to rate hospital bonds were revealed to be similar, but not identical. Criteria used in the bond rating process have several important implications: the rating approach provides strong financial incentives for increases in hospital size and complexity, for example, and hospitals that rely on extensive amounts of public financing appear to be penalized in the rating process.

Bed Occupancy↗
PubMed1984

The effectiveness of group-purchasing organizations.

The prices paid for routine medical supply items by six hospital group-purchasing systems and a control group of 24 nonaffiliated hospitals were compared to determine the effects of group purchasing. Each of the six group-purchasing systems obtained lower prices for supply items used in the study, ranging from 12 to 26 percent average savings. The enforcement of written contracts among the plan's members and the percentage of plan member participation appeared to explain effectiveness. Size of the plan and volume of purchases did not influence the percentage of saving realized among the groups.

Costs and Cost Analysis↗
PubMed1983

On teaching planning.

This paper constructed 13 planning methods that can be used to carry out the creative stages of planning: formulation, conceptualization, and detailing. First, sets of techniques for each stage were identified. Six options for discovery, two ways to structure, two decision models, and five voting techniques were used to define 120 approaches useful in formulating planning problems. For conceptualization, technique strings were created by combining the creativity and structuring phases of model building. Six ways to enhance creativity and four options to structure provided 24 approaches for model development. For detailing, constructive and interrogative phases were identified. Three constructive techniques and four interrogative techniques identified 12 approaches for the detailing stage. Acceptance, innovation, and quality were key requirements which could be placed on a plan. All combinations of these requirements were used to define eight archetype projects. Planning methods were identified for each project, showing how an integrated planning course can be taught in a health administration program.

Group Processes↗
PubMed1979

Some considerations in selecting interactive and analytical decision approaches for EMS councils.

The application of analytical and interactive decision models to decisions, in EMS councils, with various levels of uncertainty is described. Uncertainty is defined as having temporal, procedural, quantifiability, and environmental attributes. Highly uncertain decisions are unique, with unknown decision procedures. Decision premises, like available funds or demands for services, are constantly shifting in uncertain environments. Low uncertainty occurs when decisions are repeatable and follow known procedures. Past practice can be used as templates when uncertainty is "low" because funding levels and use rates are predictable. The results (e.g., validity, risk of omission, etc.) of applying interactive and analytical decision models under varying levels of uncertainty are discussed.

Conflict, Psychological↗
PubMed1979

Calling out and calling off the dogs: managerial diagnosis in public service organizations.

Decision-makers spend their professional lives identifying situations that merit action. Nutt defines this process of placing problems in action or deferred categories as "managerial diagnosis." It is felt that this is a critical aspect of managerial action because it rests on assumptions that need to be considered in project planning and evaluation. To facilitate future studies of the effectiveness of managerial behavior, a framework of fourteen propositions which describe the process of managerial diagnosis is presented. The author says that: 1) the manager will defer those perceptions where performance exceeds expectations; 2) decision-makers are goaded into evaluation (a process used to measure performance or comparative alternatives) by stimuli such as conflict, uncertain performance, and uncertain expectations; and 3) evaluation findings are deemed acceptable only when they reduce conflict.

Administrative Personnel↗