Workforce Issues in the Greater Boston Health Care Industry: Implications for Work and Family

Interviews with more than 40 leaders in the Boston area health care industry have identified a range of broadly-felt critical problems. This document synthesizes these problems and places them in the context of work and family issues implicit in the organization of health care workplaces. It concludes with questions about possible ways to address such issues. The defining circumstance for the health care industry nationally as well as regionally at present is an extraordinary reorganization, not yet fully negotiated, in the provision and financing of health care. Hoped-for controls on increased costs of medical care – specifically the widespread replacement of indemnity insurance by market-based managed care and business models of operation--have fallen far short of their promise. Pressures to limit expenditures have produced dispiriting conditions for the entire healthcare workforce, from technicians and aides to nurses and physicians. Under such strains, relations between managers and workers providing care are uneasy, ranging from determined efforts to maintain respectful cooperation to adversarial negotiation. Taken together, the interviews identify five key issues affecting a broad cross-section of occupational groups, albeit in different ways: Staffing shortages of various kinds throughout the health care workforce create problems for managers and workers and also for the quality of patient care. Long work hours and inflexible schedules place pressure on virtually every part of the healthcare workforce, including physicians. Degraded and unsupportive working conditions, often the result of workplace "deskilling" and "speed up," undercut previous modes of clinical practice. Lack of opportunities for training and advancement exacerbate workforce problems in an industry where occupational categories and terms of work are in a constant state of flux. Professional and employee voices are insufficiently heard in conditions of rapid institutional reorganization and consolidation. Interviewees describe multiple impacts of these issues--on the operation of health care workplaces, on the well being of the health care workforce, and on the quality of patient care. Also apparent in the interviews, but not clearly named and defined, is the impact of these issues on the ability of workers to attend well to the needs of their families--and the reciprocal impact of workers' family tensions on workplace performance. In other words, the same things that affect patient care also affect families, and vice versa. Some workers describe feeling both guilty about raising their own family issues when their patients' needs are at stake, and resentful about the exploitation of these feelings by administrators making workplace policy. The different institutions making up the health care system have responded to their most pressing issues with a variety of specific stratagems but few that address the complexities connecting relations between work and family. The MIT Workplace Center proposes a collaborative exploration of next steps to probe these complications and to identify possible locations within the health care system for workplace experimentation with outcomes benefiting all parties.

A HOLISTIC APPROACH TO MANUFACTURING SYSTEM DESIGN IN THE DEFENSE AEROSPACE INDUSTRY

Manufacturing has evolved to become a critical element of the competitive skill set of defense aerospace firms. Given the changes in the acquisition environment and culture; traditional “thrown over the wall” means of developing and manufacturing products are insufficient. Also, manufacturing systems are complex systems that need to be carefully designed in a holistic manner and there are shortcomings with available tools and methods to assist in the design of these systems. This paper outlines the generation and validation of a framework to guide this manufacturing system design process.

An Assessment of the Degree of Implementation of the Lean Aerospace Initiative Principles and Practices within the US Aerospace and Defense Industry

This report is a formal documentation of the results of an assessment of the degree to which Lean Principles and Practices have been implemented in the US Aerospace and Defense Industry. An Industry Association team prepared it for the DCMA-DCAAIndustry Association “Crosstalk” Coalition in response to a “Crosstalk” meeting action request to the industry associations. The motivation of this request was provided by the many potential benefits to system product quality, affordability and industry responsiveness, which a high degree of industry Lean implementation can produce.

Applications of Lean Ideas to the Aerospace Industry

• Lean Aerospace Initiative origin and mission • Functional lean successes • Successes through interaction between functions • Success through enterprise integration and value creation • Total enterprise integration of all stakeholders • Enterprise transformation insights

Benefits of Implementing Lean Practices and the Impact of the Lean Aerospace Initiative in the Defense Aerospace Industry and Government Agencies

In the 1980’s, many United States industrial organizations started developing new production processes to improve quality, reduce cost, and better respond to customer needs and the pressures of global competition. This new paradigm was coined Lean Production (or simply “Lean”) in the book The Machine That Changed The World published in 1990 by researchers from MIT’s International Motor Vehicle Program. In 1993, a consortium of US defense aerospace firms and the USAF Aeronautical Systems Center, together with the AFRL Materials and Manufacturing Directorate, started the Lean Aircraft Initiative (LAI) at MIT. With expansion in 1998 to include government space products, the program was renamed the Lean Aerospace Initiative. LAI’s vision is to “Significantly reduce the cost and cycle time for military aerospace products throughout the entire value chain while continuing to improve product performance.” By late 1998, 23 industry and 13 government organizations with paying memberships, along with MIT and the UAW were participating in the LAI.

A Holistic Approach to Manufacturing System Design in the Defense Aerospace Industry

Manufacturing has evolved to become a critical element of the competitive skill set of defense aerospace firms. Given the changes in the acquisition environment and culture; traditional “thrown over the wall” means of developing and manufacturing products are insufficient. Also, manufacturing systems are complex systems that need to be carefully designed in a holistic manner and there are shortcomings with available tools and methods to assist in the design of these systems. This paper outlines the generation and validation of a framework to guide this manufacturing system design process.

Beyond the blue horizon : the role of industry in global environmental politics

by Joanne M. Kaufman.

Suppliers' Associations in the Japanese Automobile Industry

This paper analyzes the structure and functions of suppliers' associations (kyoryokukai) in the automobile industry in Japan. The bilateral assembler-supplier relationship has received much attention recently as a source of Japanese industrial competitiveness. However, this paper argues that the hitherto neglected area of inter-supplier coordination in technology diffusion is at least as important as the bilateral assembler-supplier relationship in accounting for the overall performance of the Japanese automotive industry. On the basis of company visits and a largescale survey of first-tier suppliers conducted by the author, the paper analyzes the reasons why suppliers' associations were established, why they continue to exist today, and their effects on economic performance.

The causes of illegal drug industry growth in the Andes, Anti-Drug Policies and their effectiveness

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Análisis de la iniciativa de cluster de petróleo y gas en la región del Magdalena Medio como herramienta para la competitividad

En el mundo organizacional surge una gran incógnita sobre el por qué unos sectores económicos adquieren un alto grado de competitividad en ciertas partes del mundo mientras que en otras estos mismos van en decadencia. Este patrón puede ser explicado bajo el enfoque de competitividad, debido a que el comercio, la política, la industria, la educación y otros factores dejaron de tener una prelación local y empezaron a contemplar el plano mundial. Después de la segunda guerra mundial, nacieron nuevas amistades entre oriente y occidente, nuevos mercados, productos y necesidades, dando origen a la globalización y a una competencia internacional, por lo anterior, potencias como Estados Unidos incursionaron en los sectores de automotores y tecnológico, consolidándose como líderes, pero que ha venido en caída y por la falta de innovación, investigación y desarrollo, factores que si están siendo aprovechados por países como Japón, que ha acaparado gran parte del mercado que pertenecía a los norteamericanos; pero los factores anteriormente mencionados no son suficientes para mantenerse, por eso surge el interrogante de cómo es posible que un sector específico sobresalga sobre los demás y en un país determinado. El profesor Michael Porter en sus libros y publicaciones expresa que esto es posible mediante la adquisición de ventajas competitivas sostenibles que son obtenidas siempre y cuando las empresas tengan definidas: las condiciones de factores de producción, de demanda, los grupos conexos y de apoyo, y la estructura adecuada para la competencia, estos factores en su conjunto dan forma al “Diamante de Competitividad”, pero para entrar en detalle, primero es necesario tener claro el concepto de competitividad, la cual se ha vuelto un factor importante para los gobiernos y la industria. Una empresa debe tener la capacidad de interpretar el entorno económico, político, social y cultural al cual está sometida, con el fin de determinar si tiene la idoneidad para crear o mantener una ventaja competitiva de proyección internacional y un alto nivel de competitividad, estos factores contribuyen al fortalecimiento de los sectores económicos predominantes y a conservar la imagen del país como una potencia mundial.

Los intereses de las Organizaciones No Gubernamentales en la preservación de la fauna en Canadá

Esta investigación tiene como objetico explicar por qué Greenpece y Sea Shepherd tienen interés en intervenir en la conservación y uso de las focas arpas en Canadá. Se defenderá el papel que han ejercido las ONG como la promulgación de la información,pero no se han generado soluciones para otras problemáticas que tiene la especie. La presente es una investigación cualitativa, ya que se ahondara en la caza de focas arpas, y como diseño metodológico se tendrá en cuenta fuentes primarias, como los tratados internacionales, como La Conservación Sobre el Comercio Internacional de Especies Amenazadas de Fauna y Flora Silvestre. A su vez se enfocara en los conceptos de interés, influencia y estrategia basados en las teorías criticas de relaciones internacionales.

Continuous improvement programs as processes for organizational learning: a case study of a company in the food products industry

This article intends to show the relationships between quality practices and the process of organizational learning. When we look at the literature about programs of continuous improvement we see that theoreticians consider that the process of organizational learning is a superior stage in the quality culture adopted by companies. To investigate this possibility, we put together a series of indicators taken from classic authors who have written about organizational learning. Adopting a multiple methodology, we applied these indicators to two plants belonging to the Nestlé food product company which have introduced continuous improvement programs over the last two years.