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 . ^

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. ^

Environment for Future Conference Centers: Perception of Managers

Socio-cultural, economic, political, and technological trends are likely to impact the future conference center industry. This article is based on a survey of the members of the International Association of Conference Centers; it identifies the perceptions of conference center executives of future industry trends and provides them with environmental information so that they can better plan for management in the future.

Improving resource management in virtualized data centers using application performance models

The rapid growth of virtualized data centers and cloud hosting services is making the management of physical resources such as CPU, memory, and I/O bandwidth in data center servers increasingly important. Server management now involves dealing with multiple dissimilar applications with varying Service-Level-Agreements (SLAs) and multiple resource dimensions. The multiplicity and diversity of resources and applications are rendering administrative tasks more complex and challenging. This thesis aimed to develop a framework and techniques that would help substantially reduce data center management complexity.^ We specifically addressed two crucial data center operations. First, we precisely estimated capacity requirements of client virtual machines (VMs) while renting server space in cloud environment. Second, we proposed a systematic process to efficiently allocate physical resources to hosted VMs in a data center. To realize these dual objectives, accurately capturing the effects of resource allocations on application performance is vital. The benefits of accurate application performance modeling are multifold. Cloud users can size their VMs appropriately and pay only for the resources that they need; service providers can also offer a new charging model based on the VMs performance instead of their configured sizes. As a result, clients will pay exactly for the performance they are actually experiencing; on the other hand, administrators will be able to maximize their total revenue by utilizing application performance models and SLAs. ^ This thesis made the following contributions. First, we identified resource control parameters crucial for distributing physical resources and characterizing contention for virtualized applications in a shared hosting environment. Second, we explored several modeling techniques and confirmed the suitability of two machine learning tools, Artificial Neural Network and Support Vector Machine, to accurately model the performance of virtualized applications. Moreover, we suggested and evaluated modeling optimizations necessary to improve prediction accuracy when using these modeling tools. Third, we presented an approach to optimal VM sizing by employing the performance models we created. Finally, we proposed a revenue-driven resource allocation algorithm which maximizes the SLA-generated revenue for a data center.^

Factors Affecting the Adoption of New Technology: the case of 311 Government Call Centers

Government call centers (311) were first created to reduce the volume of non-emergency calls that were being placed to emergency 911 call centers. The number of 311 call centers increased from 57 in 2008 to about 300 in 2013. Considering that there are over 2,700 municipal government units across the United States, the adoption rate of the 311 centers is arguably low in the country. This dissertation is an examination of the adoption of 311 call centers by municipal governments. My focus is specifically on why municipal governments adopt 311 and identifying which barriers result in the non-adoption of 311 call centers. This dissertation is possibly the first study to examine the adoption of 311 call centers in the United States. The dissertation study has identified several significant factors in the adoption and non-adoption of 311 government call centers. The following factors were significant in the adoption of 311 government call centers: managerial support, financial constraints, organizational responsiveness, strategic plan placement, and technology champion. The following factors were significant barriers that resulted in the non-adoption of a 311 government call center; no demand from citizens, start up costs, annual operating costs, unavailability of funding, and no obvious need for one.If local government entities that do not have a 311 government call center decide to adopt one, this study will help them identify the conditions that need to be in place for successful adoption to occur. Local government officials would first need to address the barriers in setting up the 311 call centers.

A study of the top executive conference centers in the United States and an examination of the corresponding corporate meetings market

Introduction: The United States today has become "meeting-conscious." The complexity of conducting business has led to the need for sophisticated coordination of decision-making processes on all levels of the organization. Company meetings have played an increasingly important role in the success and future of many companies. Strategies and decisions are developed at meetings that can determine future policies of crucial importance. Executive training can mean the difference in whether the company will even survive. Large and growing companies have increased their off-premise meeting budgets annually in spite of the state of the economy. however, the rising costs of travel and lodging have made management monitor these budgets more closely than ever. Thus, the need to use every dollar efficiently has compelled companies to examine newer methods of running meetings and alternatives to the usage of typical off-premise meeting facilities. The importance of off-premise meetings in the United States economy has greatly increased due to the billions of dollars spent annually. These factors make it vital to explore the effectiveness of time and monetary expenditures. Up until the mid-1960's, company meetings were held in facilities of various design and purpose, none of which were specifically designed for the small to medium corporate meeting. Upon gathering information concerning the meetings market and the corporate meeting planner, certain individuals endeavored to change the situation. This study is designed to investigate this new concept, which will hereafter be referred to as "conference center." For the purpose of this study, the following two definitions will be used. 1. Conference center - that meeting facility primarily marketing its facilities for the small to medium-sized corporate meeting. The center is operated by specialists aware of market needs in as much detail as are those people working for the company involved. On-premise sleeping rooms are not mandatory provided such facilities are within easy access. 2. Meeting planner - that person within an organization who has primary responsibility for arranging off-premise meetings and all other related items necessary for meeting effectiveness. This person may spend anywhere from 10 to 100l of his time in this capacity. The conference center has effectively satisfied the need for specialized corporate meeting facilities. This study will show the depth of the corporate meetings market and trace the growth and development of this relatively new conference center concept. Information will also be compiled on the top centers in the country. It is hoped that by presenting this research meeting planners will become more aware of the nature and location of these centers, especially for use by the small to medium-sized company. Such exposure of the centers will hopefully increase existing demand and enable the construction of new, innovative centers.

Circadian rhythm disruption and post-surgical recovery

Circadian rhythms, patterns of each twenty-four hour period, are found in most bodily functions. The biological cycles of between 20 and 28 hours have a profound effect on an individual's mood, level of performance, and physical well being. Loss of synchrony of these biological rhythms occurs with hospitalization, surgery and anesthesia. The purpose of this comparative, correlational study was to determine the effects of circadian rhythm disruption in post-surgical recovery. Data were collected during the pre-operative and post-operative periods in the following indices: body temperature, blood pressure, heart rate, urine cortisol level and locomotor activity. The data were analyzed by cosinor analysis for evidence of circadian rhythmicity and disruptions throughout the six day study period which encompassed two days pre-operatively, two days post-operatively, and two days after hospital discharge. The sample consisted of five men and five women who served as their own pre-surgical control. The surgical procedures were varied. Findings showed evidence of circadian disruptions in all subjects post-operatively, lending support for the hypotheses.

Does Obesity Affect Outcomes in Children Admitted from Trauma Centers?

Introduction and Research Objectives: Pediatric obesity has reached epidemic proportions in the United States. In the critical care setting, obesity has yet to be fully studied. We sought to evaluate the effects of obesity in children who are admitted to a hospital from trauma centers using Kid's Inpatient Database (KID) during 2009. Methods: The study examined inpatient admissions from pediatric trauma patients in 2009 using the Kids´ Inpatient Database (KID). Patients (n=27599) were selected from the KID based on Age (AGE>1) and Admission Type (ATYPE=5) and assessed on Race, Sex, Length of Stay (LOS), Number of Diagnoses and Procedures, Severity of Illness (SOI), Risk of Mortality (ROM), Co-morbidities, and Intubation by comparing obese and non-obese cohorts. Chi-square test and student t-test were used to analyze the data. All variables were weighted to get national estimates. Results: The overall prevalence of obesity (those coded as having obesity as co-morbidity) was 1.6% with significantly higher prevalence among Blacks (1.8%), Hispanics (2.3%), and Native Americans (4.1%; p<0.001). Obesity was more prevalent among females (2.4% vs 1.2%; p<.001). Overall mortality in the cohort was 4.8%. Obesity was significantly lower among children who died during hospitalization (0.5% vs 1.6%; p<0.002). However, obese children had significantly longer LOS, greater number of diagnoses, more procedures and greater than expected loss of function due to SOI when compared with nonobese cohort (p<.001). Deficiency anemia, diabetes, hypertension, liver disease, and fluid and electrolyte disorders are all strongly associated with the presence of obesity (p<.005). The rate of intubation is similar between obese and non-obese cohorts. Conclusion: Our study using KID national database found that obese children who are admitted from trauma centers have a higher morbidity and LOS but lower mortality. Racial and gender inequalities of obesity prevalence is consistent with previous reports.

Does Obesity Affect Outcomes In Children Admitted From Trauma Centers?

Introduction and Research Objectives: Pediatric obesity has reached epidemic proportions in the United States. In the critical care setting, obesity has yet to be fully studied. We sought to evaluate the effects of obesity in children who are admitted to a hospital from trauma centers using Kid's Inpatient Database (KID) during 2009. Methods: The study examined inpatient admissions from pediatric trauma patients in 2009 using the Kids´ Inpatient Database (KID). Patients (n=27599) were selected from the KID based on Age (AGE>1) and Admission Type (ATYPE=5) and assessed on Race, Sex, Length of Stay (LOS), Number of Diagnoses and Procedures, Severity of Illness (SOI), Risk of Mortality (ROM), Co-morbidities, and Intubation by comparing obese and non-obese cohorts. Chi-square test and student t-test were used to analyze the data. All variables were weighted to get national estimates. Results:The overall prevalence of obesity (those coded as having obesity as co-morbidity) was 1.6% with significantly higher prevalence among Blacks (1.8%), Hispanics (2.3%), and Native Americans (4.1%; p Conclusion: Our study using KID national database found that obese children who are admitted from trauma centers have a higher morbidity and LOS but lower mortality. Racial and gender inequalities of obesity prevalence is consistent with previous reports.

Factors affecting the adoption of new technology: The case of 311 government call centers

Government call centers (311) were first created to reduce the volume of non-emergency calls that were being placed to emergency 911 call centers. The number of 311 call centers increased from 57 in 2008 to about 300 in 2013. Considering that there are over 2,700 municipal government units across the United States, the adoption rate of the 311 centers is arguably low in the country. This dissertation is an examination of the adoption of 311 call centers by municipal governments. My focus is specifically on why municipal governments adopt 311 and identifying which barriers result in the non-adoption of 311 call centers. This dissertation is possibly the first study to examine the adoption of 311 call centers in the United States. ^ The dissertation study has identified several significant factors in the adoption and non-adoption of 311 government call centers. The following factors were significant in the adoption of 311 government call centers: managerial support, financial constraints, organizational responsiveness, strategic plan placement, and technology champion. The following factors were significant barriers that resulted in the non-adoption of a 311 government call center; no demand from citizens, start up costs, annual operating costs, unavailability of funding, and no obvious need for one. ^ If local government entities that do not have a 311 government call center decide to adopt one, this study will help them identify the conditions that need to be in place for successful adoption to occur. Local government officials would first need to address the barriers in setting up the 311 call centers. ^

Retail centers for community : addressing both pedestrian and car traffic

The purpose of this thesis was to redesign a commercial center in Miami, Florida in a manner that incorporates the needs of pedestrians as well as the automobile. In my research, I studied projects that had been successful at integrating cars in retail design. I applied the strategies learned from this research to the design of a center that creates a positive interaction of pedestrian and car traffic, addressing the needs of the surrounding community. I designed a master plan that includes a mix of residential, retail, commercial and parking space. The parking is designed so that the retail center is not dominated by surface parking. Rather, the automobile is introduced into the different layers of the proposed buildings. The design focused on connecting pedestrian plazas and parking areas beneath them through the introduction of light and greenery. The findings show how a shopping center might transform the area around it by including spaces for residential, civic, cultural and social functions, as well as for the automotive infrastructure that make those functions possible.

Improving Resource Management in Virtualized Data Centers using Application Performance Models

The rapid growth of virtualized data centers and cloud hosting services is making the management of physical resources such as CPU, memory, and I/O bandwidth in data center servers increasingly important. Server management now involves dealing with multiple dissimilar applications with varying Service-Level-Agreements (SLAs) and multiple resource dimensions. The multiplicity and diversity of resources and applications are rendering administrative tasks more complex and challenging. This thesis aimed to develop a framework and techniques that would help substantially reduce data center management complexity. We specifically addressed two crucial data center operations. First, we precisely estimated capacity requirements of client virtual machines (VMs) while renting server space in cloud environment. Second, we proposed a systematic process to efficiently allocate physical resources to hosted VMs in a data center. To realize these dual objectives, accurately capturing the effects of resource allocations on application performance is vital. The benefits of accurate application performance modeling are multifold. Cloud users can size their VMs appropriately and pay only for the resources that they need; service providers can also offer a new charging model based on the VMs performance instead of their configured sizes. As a result, clients will pay exactly for the performance they are actually experiencing; on the other hand, administrators will be able to maximize their total revenue by utilizing application performance models and SLAs. This thesis made the following contributions. First, we identified resource control parameters crucial for distributing physical resources and characterizing contention for virtualized applications in a shared hosting environment. Second, we explored several modeling techniques and confirmed the suitability of two machine learning tools, Artificial Neural Network and Support Vector Machine, to accurately model the performance of virtualized applications. Moreover, we suggested and evaluated modeling optimizations necessary to improve prediction accuracy when using these modeling tools. Third, we presented an approach to optimal VM sizing by employing the performance models we created. Finally, we proposed a revenue-driven resource allocation algorithm which maximizes the SLA-generated revenue for a data center.