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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Propuesta académica para la Universidad del Rosario: Maestría en Administración Deportiva

Consiste en la propuesta de un programa de maestría para la Universidad Del Rosario en Administración Deportiva. Esto teniendo en cuenta el espacio para la profesionalización de este campo en el país

La estructura y funcionalidad de los sistemas en el modelo de Bronfenbrenner y su utilidad en entornos empresariales

El proyecto será desarrollado en base al modelo ecológico del desarrollo humano, (Bronfenbrenner, 1999) partiendo desde la explicación y conceptualización del modelo en términos generales, guiando la investigación hacia un ámbito organizacional en donde se podrá aplicar la teoría descrita por Bronfenbrenner y así, determinar cuál es la estructura y funcionalidad de los sistemas en el modelo además de establecer qué utilidad tiene en entornos empresariales por medio del análisis de los múltiples sistemas, relaciones, interacciones y efectos que tienen y que desarrollan las empresas u organizaciones en el transcurso de su vida. A lo largo de la investigación se hará referencia a diferentes conceptos relacionados tanto con el modelo como con el mundo en que se desarrollan las organizaciones, tales como clusters, sistemas, sectores, estrategias, marketing relacional, comunidad, interacciones, influencias, entre otros; los cuales permitirán acercar lo mayor posible el modelo de Bronfenbrenner al mundo empresarial y lograr desarrollar de mejor manera la intención de aplicar el modelo al mundo organizacional.

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.

La gestión de relaciones con clientes (CRM): sector de seguridad privada

Esta tesis pretende describir la situación actual del sector de seguridad privada, al implementar y adoptar estrategias de CRM. Con una revisión confiable y el estudio de casos relacionados con el tema, lo cual permitirá constatar la realidad en cuanto la aplicación del modelo, en el sector de seguridad privada, según lo planteado por diversos autores. Los resultados obtenidos permitirán, de este modo, al sector y a sus gerentes, desarrollar estrategias que ayuden a la satisfacción de sus clientes y a la prestación de un mejor servicio. En el campo académico, este estudio servirá como guía teórico-práctica para estudiantes y profesores, de modo que permitirá afianzar conocimientos en cuanto al CRM, al marketing relacional y su uso en el sector de seguridad privada. Según este modelo la información acerca de los clientes, es una información estratégica vital para las organizaciones que ayuda a la toma de decisiones, pronosticar cambios en cuanto a demanda, además de establecer control sobre procesos en los que se involucre el cliente; de modo que la adopción e implementación de CRM, ayude a la empresa, en este caso a las del sector de seguridad privada, a estar atentos a la manera como se interactúa con el cliente y por ende mejorar el servicio, lo que tendrá repercusión en la percepción que tenga de la organización el cliente. De este modo, se ve como en la actualidad las estrategias de CRM definen el rumbo de una empresa, ayudando atraer nuevos clientes y además de esto, ayuda de igual modo a mantener felices a los clientes actuales; lo cual repercute en la demanda o el requerimiento del servicio, y así en una mejor rentabilidad para las empresas del sector. Razones por las que el sector de vigilancia se verá beneficiado por medio de las estrategias del CRM, lo que lo llevara a ofrecer mejores servicios a sus clientes.

Los clusters como mecanismo para la generación de economías a escala en el sector de medicamentos de alto costo en Colombia

La presente investigación tiene por objeto considerar los cluster en la industria farmacéutica Colombiana, como un mecanismo para la disminución de los sobrecostos de los medicamentos, que han impactado de forma importante, entre otras causas, al sistema de salud, con unos recobros (por concepto de medicamentos No POS) que superan el billón de pesos, situación que dada la crisis que enfrenta al respecto, el Estado Colombiano, ha propuesto una quinta reforma que cursa actualmente en el Congreso de la República. Se trata de una investigación cualitativa tipo estudio de caso, en la que se presenta el modelo Colombiano de Salud y las cifras de recobros de las Empresas Prestadoras de Servicios de Salud (EPS), cantidad que representó el 0.4% del PIB (Producto Interno Bruto) en el 2009. Para tal fin se analizará el comportamiento de los recobros durante el año 2012, en cuarenta y una (41) EPS reconocidas del sector. Subsecuentemente se estudian las diferentes estrategias para la generación de economías de escala y dentro de ellas, los clusters como un posible modelo a seguir hacia la disminución de estos costos en salud, se analizan sus componentes y su posible constitución dentro del entorno Colombiano. Al final del estudio se establece como conclusión, que existen suficiente evidencia para apoyar la implementación de un cluster farmacéutico dentro del territorio Colombiano.