Managerial work roles of health care executives in the changing environment of academic medical centers

The current U.S. health care system faces numerous environmental challenges. To compete and survive, health care organizations are developing strategies to lower costs and increase efficiency and quality. All of these strategies require rapid and precise decision making by top level managers. The purpose of this study is to determine the relationship between the environment, made up of unfavorable market conditions and limited resources, and the work roles of top level managers, specifically in the settings of academic medical centers. Managerial work roles are based on the ten work roles developed by Henry Mintzberg, in his book, The Nature of Managerial Work (1973). ^ This research utilized an integrated conceptual framework made up of systems theory in conjunction with role, attribution and contingency theories to illustrate that four most frequently performed Mintzberg's work roles are affected by the two environment dimensions. The study sample consisted of 108 chief executive officers in academic medical centers throughout the United States. The methods included qualitative methods in the form of key informants and case studies and quantitative in the form of a survey questionnaire. Research analysis involved descriptive statistics, reliability tests, correlation, principal component and multivariate analyses. ^ Results indicated that under the market condition of increased revenue based on capitation, the work roles increased. In addition, under the environment dimension of limited resources, the work roles increased when uncompensated care increased while Medicare and non-government funding decreased. ^ Based on these results, a typology of health care managers in academic medical centers was created. Managers could be typed as a strategy-formulator, relationship-builder or task delegator. Therefore, managers who ascertained their types would be able to use this knowledge to build their strengths and develop their weaknesses. Furthermore, organizations could use the typology to identify appropriate roles and responsibilities of managers for their specific needs. Consequently, this research is a valuable tool for understanding health care managerial behaviors that lead to improved decision making. At the same time, this could enhance satisfaction and performance and enable organizations to gain the competitive edge . ^

A comparative analysis of self-determined evaluations of work performance and support needs by adults with mental retardation in supported work and in sheltered workshop environments

The purpose of this study was to determine if there was a difference in the self-determined evaluations of work performance and support needs by adults with mental retardation in supported employment and in sheltered workshop environments. The instrument, Job Observation and Behavior Scale: Opportunity for Self-Determination (JOBS: OSD; Brady, Rosenberg, & Frain, 2006), was administered to 38 adults with mental retardation from sheltered workshops and 32 adults with mental retardation from supported employment environments. Cross-tabulations with Chi-square tests and independent samples t-tests were conducted to evaluate differences between the two groups, sheltered workshop and supported work. Two Multivariate Analyses of Variance (MANOVAs) were conducted to determine the effect of work environment on Quality of Performance (QP) and Types of Support (TS) test scores and their subscales. ^ This study found that there were significant differences between the groups on the QP Behavior and Job Duties subscales. The sheltered workshop group perceived themselves as performing significantly better on job duties than the supported work group. Conversely, the supported work group perceived themselves to have better behavior than the sheltered workshop group. However, there were no significant differences between groups in their perception of support needs for the three subscales. ^ The findings imply that work environment affects the self-determined evaluations of work performance by adults with mental retardation. Recommendations for further study include (a) detailing the characteristics of supported work and sheltered workshops that support and/or discourage self-determined behaviors, (b) exploring the behavior of adults with mental retardation in sheltered workshops and supported work environments, and (c) analysis of the support needs for and understanding of them by adults with mental retardation in sheltered workshops and in supported work environments. ^

Self-esteem and job satisfaction of adults with mild mental retardation in sheltered workshops and supported employment programs

A sample of 200 adults with mild mental retardation were assessed on overall job satisfaction and self-esteem using the Vocational Program Evaluation Profile and the Coopersmith Self-esteem Inventory. The subjects worked either in a sheltered workshop or in a supported employment setting. Results indicated that there was a significant relationship between self-esteem and job satisfaction for both groups of subjects. In addition, subjects who worked in supported employment reported significantly higher levels of job satisfaction also. There was also an interaction between place of residence and place of employment when looking at self-esteem; those who live in a semi-independent home and work in supported employment reported the highest levels of self-esteem. These results are discussed in terms of the social validity of supported-employment for persons with mild mental retardation. ^

Geochemical variation among small eruptive centers in the central SVZ of the Andes: An evaluation of subduction, mantle and crustal influences

Subduction zone magmatism is an important and extensively studied topic in igneous geochemistry. Recent studies focus on from where arc magmas are generated, how subduction components (fluids or melts) are fluxed into the source of the magmas, and whether or how the subduction components affect partial melting processes beneath volcanic arcs at convergent boundaries. ^ At 39.5°S in the Central Southern Volcanic Zone of the Andes, Volcano Villarrica is surrounded by a suite of Small Eruptive Centers (SEC). The SECs are located mostly to the east and northeast of the stratovolcano and aligned along the Liquine-Ofqui Fault Zone, the major fracture system in this area. Former studies observed the geochemical patterns of the SECs differ distinctively from those of V. Villarrica and suggested there may be a relationship between the compositions of the volcanic units and their edifice sizes. This work is a comprehensive geochemical study on the SECs near V. Villarrica, using a variety of geochemical tracers and tools including major, trace and REE elements, Li-Be-B elements, Sr-Nd-Pb isotopes and short-lived isotopes such as U-series and 10Be. In this work, systematic differences between the elemental and isotopic compositions of the SECs and those of V. Villarrica are revealed and more importantly, modeled in terms of magmatic processes occurring at continental arc margins. Detailed modeling calculations in this work reconstruct chemical compositions of the primary magmas, source compositions, compositions and percentages of different subduction endmembers mixed into the source, degrees of partial melting and different time scales of the SECs and V. Villarrica, respectively. Geochemical characteristics and possible origins of the two special SECs—andesitic Llizan, with crustal signatures, and Rucapillan, to the northwest toward the trench, are also discussed in this work. ^