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QMHC interview: Alan C. Brewster, M.D.. Interview by Marie E. Sinioris.

Information systems for severity-of-illness measurement and case mix adjustment are at the cutting edge of health care quality technology. The rapid rise of these systems in the past decade has paralleled hospital needs for better data on clinical processes and the burgeoning need among health care customers for better data on clinical outcomes and the relative performance of providers. The dual nature of the demand is fueling what promises to be a decade of growth for the developers of severity systems. To get a better handle on the status of these software-based tools, QMHC interviewed Alan C. Brewster, M.D., Vice Chairman and cofounder of MediQual Systems, Inc., and a principal developer of the widely used MedisGroups system.

Diagnosis-Related Groups↗

QMHC interview: Karl Albrecht. Interview by Marie E. Sinioris.

For over a decade, Karl Albrecht has helped health care and other organizations focus on creating superior value for customers. In his books Service America! and The Only Thing That Matters, he developed a model of organizational improvement called Total Quality Service that is tailored to service organizations. One of the principles underlying this model is that service industries are fundamentally different from manufacturing industries. Thus, the approach to quality improvement in services should not be based on a manufacturing mentality. QMHC interviewed Karl Albrecht to catch up with his latest thinking on value creation, leadership, and innovation in health care and elsewhere.

Consumer Behavior↗

The power of virtual integration: an interview with Dell Computer's Michael Dell. Interview by Joan Magretta.

Michael Dell started his computer company in 1984 with a simple business insight. He could bypass the dealer channel through which personal computers were then being sold and sell directly to customers, building products to order. Dell's direct model eliminated the dealer's markup and the risks associated with carrying large inventories of finished goods. In this interview, Michael Dell provides a detailed description of how his company is pushing that business model one step further, toward what he calls virtual integration. Dell is using technology and information to blur the traditional boundaries in the value chain between suppliers, manufacturers, and customers. The individual pieces of Dell's strategy--customer focus, supplier partnerships, mass customization, just-in-time manufacturing--may be all be familiar. But Michael Dell's business insight into how to combine them is highly innovative. Direct relationships with customers create valuable information, which in turn allows the company to coordinate its entire value chain back through manufacturing to product design. Dell describes how his company has come to achieve this tight coordination without the "drag effect" of ownership. Dell reaps the advantages of being vertically integrated without incurring the costs, all the while achieving the focus, agility, and speed of a virtual organization. As envisioned by Michael Dell, virtual integration may well become a new organizational model for the information age.

Community Participation↗

Fast, global, and entrepreneurial: supply chain management, Hong Kong style. An interview with Victor Fung. Interview by Joan Magretta.

Li & Fung, Hong Kong's largest export trading company, has been an innovator in supply chain management--a topic of increasing importance to many senior executives. In this interview, chairman Victor Fung explains both the philosophy behind supply chain management and the specific practices that Li & Fung has developed to reduce costs and lead times, allowing its customers to buy "closer to the market." Li & Fung has been a pioneer in "dispersed manufacturing." It performs the higher-value-added tasks such as design and quality control in Hong Kong, and outsources the lower-value-added tasks to the best possible locations around the world. The result is something new: a truly global product. To produce a garment, for example, the company might purchase yarn from Korea that will be woven and dyed in Taiwan, then shipped to Thailand for final assembly, where it will be matched with zippers from a Japanese company. For every order, the goal is to customize the value chain to meet the customer's specific needs. To be run effectively, Victor Fung maintains, trading companies have to be small and entrepreneurial. He describes the organizational approaches that keep the company that way despite its growing size and geographic scope: its organization around small, customer-focused units; its incentives and compensation structure; and its use of venture capital as a vehicle for business development. As Asia's economic crisis continues, chairman Fung sees a new model of companies emerging--companies that are, like Li & Fung, narrowly focused and professionally managed.

Commerce↗

An interview with Leon Davis. Interview by Al Nash.

Leon Davis, founder of District 1199, represents the origin of hospital unionization. Known for his devotion to District 1199, Davis was imprisoned several times as a result of his activities as union president. The following interview with the now retired union activist, traces his impact on the union, discusses conflicts between union and management, changes in today's union, plus other first hand insights regarding this issue.

Labor Unions↗

Interview: Iceland's health care system. Interview by Susan Reeves.

Iceland has a well established system of socialized medicine and national health insurance. Its small homogeneous population has enabled Iceland to computerize and process data concerning quality of patient care, volume and type of drugs prescribed, and pertinent epidemiological information. In the following interview, Dr. Gudjon Magnusson discusses the development, maintenance, and operational costs of such a health care system.

Iceland↗

The national effort to improve access to trauma care: an interview with U.S. Representative Henry A. Waxman. Interview by Cynthia A. Brown.

The United States Congress is currently considering legislation to encourage states to plan, develop, and implement regional trauma care systems. The two bills--S. 10, introduced by Senator Alan Cranston (D-CA), and H.R. 3133, introduced by Representative Jim Bates (D-CA)--would require that these systems comply with the trauma care standards developed by the American College of Surgeons' Committee on Trauma. Significant progress is being made toward enactment of the House bill, H.R. 3133, due in large part to the efforts of the proposal's original cosponsor, Representative Henry A. Waxman (D-CA). Representative Waxman is Chairman of the Energy and Commerce Subcommittee on Health and the Environment, which has jurisdiction over federal programs involving emergency medical services systems, and he has played a key role in shaping and refining the House bill. In recognition of recent Congressional action designating May as National Trauma Awareness Month, Representative Waxman agreed to be interviewed for the Bulletin and to discuss H.R. 3133 and his view of the federal government's role in improving access to expert care for victims of injury.

General Surgery↗

Organizing for empowerment: an interview with AES's Roger Sant and Dennis Bakke. Interview by Suzy Wetlaufer.

The topic of empowerment is receiving a lot of attention, but how many employees are truly empowered? At the global electricity giant AES Corporation, the answer is all 40,000 of them. In this interview, chairman Roger Sant and CEO Dennis Bakke reflect on their trials and triumphs in creating an exceptional company and explain how their employee-run company works. When they founded AES in 1981, Sant and Bakke set out to create a company where people could have engaging experiences on a daily basis--a company that embodied the principles of fairness, integrity, social responsibility, and fun. Putting those principles into action has created something unique--an ecosystem of real empowerment. What does that system look like? Rather than having a traditional hierarchical chain of command, AES is organized around small teams that are responsible for operations and maintenance. Moreover, AES has eliminated functional departments; there's no corporate marketing division or human resources department. For the system to work, every person must become a well-rounded generalist--a mini-CEO. That, in turn, redefines the jobs of the people at headquarters. Instead of setting strategy and making the "the big decisions," Sant and Bakke act as advisers, guardians of the principles, accountability officers, and chief encouragers. Can other companies successfully adopt the mechanics of such a system? Not unless they first adopt the shared principles that have guided AES since its inception. "Empowerment without values isn't empowerment," says Sant. "It's just technique," adds Bakke.

Commerce↗

A career of disease prevention, detection and control: an interview with Dr. Denny Donnell, State Epidemiologist of Missouri. Interview by Thomas Eppright, Shane Bradley, Maureen A. Allwood, James R. Slaughter.

Denny Donnell began his tenure as Missouri State Epidemiologist in 1973. Since that time, he has been instrumental in the prevention, detection and control of disease across the state. In this interview he reflects on the path that led him to disease control and he emphasizes the need for further training opportunities for physicians who wish to battle disease beyond the realm of one person at a time.

Epidemiology↗

The medical director as educator: an interview with Elizabeth M. Gallup, MD, JD, MBA. Interview by Richard L. Reece.

Richard L. Reece, MD, interviewed Elizabeth M. Gallup, MD, JD, MBA, on July 9, 1999, to talk about the evolving role of the physician executive. Dr. Gallup discusses how medical directors have evolved from a purely clinical role to participating in the business side of medicine as well. The traditional medical director, a Dr. No who denies treatment and watches clinical performance, is now becoming an educator helping physicians to manage their behavior and change their practices based on comparative data. Her book, How Physicians Can Avoid Surrender and Lead Change: Gaining Real Influence in Your Own Health Care Organization Before It's Too Late, (American College of Physician Executives, 1996) promotes acting together as a group if physicians want to stay independent and not become employed. Independent physicians can form IPAs and act together as a group, avoiding some antitrust laws. Unless physicians get together and act as a group, she says, they are doomed to further and further erosion of their economic interests as well as their clinical autonomy.

Health Maintenance Organizations↗

Hired, fired, and not retired: an interview with a physician executive who has run the career gauntlet. Interview by Richard L. Reece.

Richard L. Reece, MD, interviewed Robert J. Hudson, MD, on April 24, 2000 to discuss his experiences as a physician executive who has made the career transition from practicing physician to managed care executive to biotech entrepreneur. Along the way, he's hired and fired others, and been fired himself. Painful as it is, many physician executives' career realities include being fired. Organizations, after all, are living organizations--they grow, wither, and molt. And as they molt, organizations shed and regrow new skin. What do physician executives do when they've been fired? They go through their own cycle and retreat, reflect, and re-emerge, often reinventing themselves as they go. An essential part of this process is looking within to plumb likes and dislikes, strengths and weaknesses, nightmares and dreams, and positive and negative experiences. For most executives, out of these experiences has come a circle of friends and a Rolodex. Start by reaching out to the circle, by going through your Rolodex, and you can broadcast the news of your rebirth.

Career Mobility↗

The rudiments of an Internet-based health plan for consumers: an interview with John Danaher, MD, MBA. Interview by Richard L. Reece.

Richard L. Reece, MD, interviewed John Danaher, MD, MBA, on August 16, 2000, to discuss how his new company is preparing for the perfect storm--the looming convergence of demanding consumers, defined contributions, and Internet-based health plans. He describes how his firm is putting financial and clinical tools in the hands of consumers and physicians, so consumers can be more enlightened in their health care choices. Danaher says, "We're not about buying goods and services online. We are transforming the way consumers buy health care and seek insurance. We're trying to be a 401 k where people get on, knowing their risk profile and return horizons. We aim to motivate consumers to be proactive in making health care choices. How do we make consumers responsible and motivated enough to take control of managing their health care costs? How well we articulate this call to consumer action will be the key to our success."

Community Participation↗

High tech the old-fashioned way. An interview with Tom Siebel of Siebel Systems. Interview by Bronwyn Fryer.

There is a growing awareness among corporations that the quality of the customer experience they provide directly affects their bottom line. Many are turning to high-flying software maker Siebel Systems for help in managing those relationships. The young company holds a leadership position in an explosive market-enterprise application software. But customer satisfaction, not dot-com chic, is foremost on the mind of Siebel Systems' founder, chairman, and CEO, Tom Siebel. The buttoned-down Siebel rejects the freewheeling management style and culture that characterize many Silicon Valley companies. As the former CEO of Gain Technology and a former executive at Oracle, Siebel believes in putting customers ahead of technology, discipline ahead of inspiration. In this interview, conducted at the company's San Mateo, California, headquarters, Siebel describes how this obsessive focus on customer satisfaction has been the driving force behind the company's success. He talks about how the organization remains true to its core values: a deep commitment to providing customer satisfaction; responsible fiscal practices that have created a cash-positive business amid today's cash-negative dot-coms; and general professionalism. "The notion of dressing in jeans and a T-shirt to greet the CEO of a major financial institution who just got off the plane from Munich is not acceptable," he says. Siebel Systems rejects the concept of going to war with rivals; instead, the CEO says, the company has forged an ecosystem of partnerships that allows it to support and integrate its own systems with other companies' software products and ultimately ease the customer's software installations. Indeed, Siebel says, the CEO's most important job is to understand what customers need and deliver that.

Commerce↗

Physician behavior at the e-technology/learning intersection: an interview with Elliott Masie. Interview by Richard L. Reece.

Richard L. Reece, MD, interviewed Elliott Masie on January 16, 2001, to talk about the Internet learning world--that vast intersection of e-technology, learning, and human behavior. He describes how he looks beyond the hype of technology into how human beings behave and what they crave in social experiences. The real question, he says, is how do we have knowledge experiences and blend them with social experiences to achieve the optimal mix? Masie emphasizes, "The magic of learning is in the mix--what happens online and then what happens informally when we have a cup of coffee with a colleague." He continues, "Many of the capital market folks hate to hear about the human element, because they want to believe we'll be able to do everything from our PCs. But that's not how humans behave. It's the mixture that gets results. That's where the real excitement occurs."

Attitude of Health Personnel↗

Mastering the value chain. An interview with Mark Levin of Millennium Pharmaceuticals. Interview by David Champion.

As today's business leaders are all too aware, a new scientific or technological break-through can quickly transform an industry's competitive landscape. The upheaval is often traumatic for the companies involved, forcing them to rethink their strategies and redefine their boundaries. But an industry in flux also creates vast opportunities. To seize them, companies must see how the current upheavals will affect the future distribution of profits--and then reinvent themselves to capitalize on the new sources of value. In this interview with HBR senior editor David Champion, Mark Levin, the founder and CEO of Millennium Pharmaceuticals, describes his vision of the future of the pharmaceutical industry in the wake of the genetics revolution and new technologies that have altered the economics of drug development. No company, he argues, will create serious long-term value by staying in just one or two stages of the value of chain. That's why Millennium, which started out doing basis research into genes and proteins and selling its findings to pharmaceutical giants, has moved downstream - toward the patients who actually use and pay for the drugs. He explains why the research end has become less lucrative than the more mechanical tasks of identifying, testing, and manufacturing molecules. Levin talks about the changes Millennium has undergone since its inception in 1993-from 30 workers to more than 1,000, and from one end of the value chain to the other. He discusses the company's cultural transformations as well as the partnerships and acquisitions that have helped millennium become involved in every stage of the chain-from gene to patient. Levin's vigorous approach to balancing long-term strategy with short-term tactics offers important lessons to any executive facing an industry upheaval.

Drug Design↗

Interview with Dr. Oleg Atkov [interview by Winston Huff].

Last summer International Space University (ISU) was held in Huntsville, Alabama. Leading international space experts came to take part in the activities. Dr. Oleg Atkov, a Russian cardiologist who was also a cosmonaut for eight months in 1984, has extensive experience in cardiovascular medicine and first-hand experience in issues of life support, making him a valuable resource. He also serves on the Journal's Advisory Board. Winston Huff took advantage of the unique opportunity of having Valery Aksamentov, Paul Wieland, and Dr. Atkov together in Huntsville to conduct a general discussion of issues important to those studying life support. Dr. Valery Aksamentov was involved for many years in the development of the Russian life support systems. Dr. Aksamentov now leads the only university program specializing in life support at the University of Alabama in Huntsville. His command of both languages and his technical knowledge were critical to the success of this discussion. Paul Wieland from NASA Marshall Space Flight Center is involved with the development of the life support systems for the space station. He and Dr. Aksamentov are topic coordinators for the Journal. The following interview was conducted at the University of Alabama in Huntsville on August 16, 1993.

Ecological Systems, Closed↗

Randomised controlled trials in nursing and midwifery: an interview with Maralyn Foureur. Interview by Pamela J. Wood.

Randomised controlled trials are considered to be one of the best research designs for determining effective care in the clinical setting. Relatively few randomised controlled trials, however, have been carried out in nursing or midwifery practice, so few examples of the practical realities of this research methodology are readily accessible. This is the sixth article in a series based on interviews with nursing and midwifery researchers, designed to offer the beginning researcher a first-hand account of the experience of using particular methodologies. This article focuses on the randomised controlled trial as experienced by Maralyn Foureur (RGON, RM, BA, Grad Dip Clin Epidem, PhD) who used this methodology to demonstrate the effectiveness of a continuity of care model in midwifery practice.

Continuity of Patient Care↗

HMO, insurance policies threaten HIV care: interview with Dr. X. Interview by John S. James.

Many health plans use various means to discourage HIV specialty care--even though such care clearly benefits patients, and costs less, compared to non-specialist care--in order to avoid attracting expensive patients into their plans. This problem is much worse in HIV than in cancer and other catastrophic illnesses with more established specialties. AIDS Treatment News interviewed an AIDS doctor who provides details--but who must remain anonymous to avoid retaliation by some of the health plans.

Adult↗