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Nearly 4,000 cities on our planet today have populations of 100,000 people or more. We know their names, locations, and approximate populations from maps and other data sources, but there is little comparable knowledge about all these cities, and none that can be described as rigorously scientific. Planet of Cities together with its companion volume, Atlas of Urban Expansion, contributes to developing a science of cities based on studying all these cities together—not in the abstract, but with a view to preparing them for their coming expansion.

The book puts into question the main tenets of the familiar Containment Paradigm, also known as smart growth, urban growth management, or compact city, that is designed to contain boundless urban expansion, typically decried as sprawl. It examines this paradigm in a broader global perspective and shows it to be deficient and practically useless in addressing the central questions now facing expanding cities outside the United States and Europe.

In its place Shlomo Angel proposes to revive an alternative Making Room Paradigm that seeks to come to terms with the expected expansion of cities, particularly in the rapidly urbanizing countries in Asia and Africa, and to make the minimally necessary preparations for such expansion instead of seeking to contain it.

Background

Medicare will soon implement hospital value-based purchasing (VBP), using a scoring system that rewards both achievement (absolute performance) and improvement (performance increase over time).  However, improvement is defined so as to give less credit to initial low performers than initial high performers.  Since initial low performers are disproportionately hospitals in socioeconomically disadvantaged areas, these institutions stand to lose under Medicare’s VBP proposal. 

Methods

We developed an alternative improvement scale, and applied it to hospital performance throughout the US.   Using 2005-2008 Medicare process measures for acute myocardial infarction (AMI) and heart failure (HF), we calculated hospital scores using Medicare’s proposal and our alternative.  Hospital performance scores were compared across 5 locational dimensions of socioeconomic disadvantage: poverty, unemployment, physician shortage, high school and college graduation rates.

Results

Medicare’s proposed scoring system yielded higher overall scores for the most locationally advantaged hospitals for 4 out of 5 dimensions in AMI and 2 out of 5 for HF.  Using our alternative, differences in overall scores between hospitals in the most and least advantaged areas were attenuated, with locationally advantaged hospitals having higher overall scores for 3 out of 5 dimensions in AMI and 1 out of 5 dimensions for HF. 

Conclusions

Using an alternative VBP formula that reflects the principle of “equal credit for equal improvement,” resulted in a more equitable distribution of overall payment scores, which could allow hospitals in both socioeconomically advantaged and disadvantaged areas to succeed under VBP.

This paper examines the question of whether there is any correlation between the prevalence of nonprofit organizations with property, plant, and equipment exempt from property taxation and the property tax burden for homeowners. Data from the Tax Foundation and Internal Revenue Service was used to analyze general-purpose local governments within larger counties (populations greater than 65,000) in the United States for years 2005 and 2006. Several econometric specifications were used to estimate homeowner property tax burden as a function of the value of nonprofit fixed assets, government tax structure characteristics, and a series of control variables. Our estimates suggest that county geographies with greater presence of nonprofits tend to have higher homeowner tax burdens on average. Specifically, the value of nonprofit tax-exempt fixed assets within a county geography that is 10% above the mean of $15.4 million is generally associated with a median property tax paid by homeowners as a % of household income that is between 0.0009% and 0.0154% above the mean or between $2 and $24 higher on average. The median property tax paid as a % of homeowner’s home value would be between 0.0006% and 0.0069% above the mean or between $3 and $12 higher on average. Overall, we find a strong, positive correlation between nonprofit fixed assets and property tax burden for homeowners at the local level.

There has been a significant amount of work done on the private funding of nonprofits. Yet, despite the enormous size of the nonprofit sector as a whole, the importance of private donations to the sector, and the significance of the sector to public finances, there has been very little empirical research done on the capital structure of nonprofit organizations, and none has examined the potential effects of borrowing on individual contributions. Debt might affect donations because programmatic expansion might “crowd-in” additional donors, the use of debt might “crowd-out” current donors since expansion is undertaken at the behest of the organization (and not due to donor demand for increased output), donors might have a preference for funding current output rather than past output, or because of concerns that the nonprofit will be unable to maintain future programmatic output. These potential effects of debt on giving by individuals have not been the focus of research to date. The primary data for this paper come from the “The National Center on Charitable Statistics (NCCS)-GuideStar National Nonprofit Research Database” that covers fiscal years 1998 through 2003. The digitized data cover all public charities required to file the Form 990. The final sample contains 460,577 observations for 105,273 nonprofit entities. The results for the full sample support a “crowding-out” effect. The analysis is repeated on a subsample of nonprofits more dependent upon donations, following Tinkelman and Mankaney (2007). The restricted sample contains 121,507 observations for 36,595 nonprofit organizations. The results for the subsample are more ambiguous: secured debt has little or no effect, while unsecured debt has a positive effect. The empirical analysis is then expanded to test whether nonprofits with higher than average debt levels have different results than nonprofits with below average debt levels. The results suggest that donors do remove future donations when a nonprofit is more highly leveraged compared to similar organizations.
Nonprofits may fear that the use of debt signals mismanagement or bad governance, worrying that donors will punish the organization by removing future donations. The results presented here suggest a more complicated relationship between nonprofit leverage and donations from individuals than this simple calculus. On the one hand, increases in secured debt ratios (from mortgages and bonds) seems to reduce future contributions, possibly because donors are wary of government or lender intervention in the nonprofit’s management, or possibly because of the lack of flexibility inherent in repaying such rigid debt. On the other hand, unsecured debt, while more expensive, seems to crowd-in donations, even at increasingly higher levels when compared to similar organizations. There are at least two important conclusions from this analysis. First, during times of fiscal stress, nonprofits are often tempted to use restricted funds in ways inconsistent with donor intent simply to ensure organizational survival. Rather than violate the trust of certain donors, the results here suggest that nonprofits would be better off utilizing unsecured (possibly short-term) borrowing to smooth out cash flow needs. This option, however, assumes that nonprofits have access to some type of borrowing which is not true for many organizations. A second conclusion one might draw, therefore, is that policy considerations should be made to expand access to debt for nonprofits. The results here suggest that certain types of unsecured debt might in fact draw in additional resources, allowing nonprofits to leverage these borrowings for additional resources. By encouraging this type of policy option, nonprofits would not only gain access to increased revenue sources, but might be able to maintain programmatic output during times of fiscal stress.

Evidence on the relationship between political contributions and legislators’ voting behavior is marred by concerns about endogeneity in the estimation process. Using a legislator’s offspring sex mix as a truly exogenous variable, we employ an instrumental variable estimation procedure to predict the effect of voting behavior on political contributions. Following previous research, we find that a legislator’s proportion daughters has a significant effect on voting behavior for women’s issues, as measured by score in the “Congressional Record on Choice” issued by NARAL Pro-Choice America. In the second stage, we make a unique contribution by demonstrating a significant impact of exogenous voting behavior on PAC contributions, lending further credibility to the hypothesis that Political Action Committees respond to legislators’ voting patterns by “rewarding” political candidates that vote in line with the positions of the PAC, rather than affecting those same votes – at least in this high-profile policy domain.

Research on the effects of Vietnam military service suggests that Vietnam veterans experienced significantly higher mortality than the civilian population at large. These results, however, may be biased by nonrandom selection into the military if unobserved background differences between veterans and nonveterans affect mortality directly. To generate unbiased estimates of exposure to conscription on mortality, the present study compares the observed proportion of draft-eligible male decedents born 1950–1952 to the (1) expected proportion of draft-eligible male decedents given Vietnam draft-eligibility cutoffs; and (2) observed proportion of draft-eligible decedent women. The results demonstrate no effect of draft exposure on mortality, including for cause-specific death rates. When we examine population subgroups—including splits by race, educational attainment, nativity, and marital status—we find weak evidence for an interaction between education and draft eligibility. This interaction works in the opposite direction of putative education-enhancing, mortality-reducing effects of conscription that have, in the past, led to concern about a potential exclusion restriction violation in instrumental variable (IV) regression models. We suggest that previous research, which has shown that Vietnam-era veterans experienced significantly higher mortality than nonveterans, might be biased by nonrandom selection into the military and should be further investigated.

China's rapid industrialization has led to a severe deterioration in water quality in the country's lakes and rivers. By exploiting variation in pollution across China's river basins, I estimate that a deterioration of water quality by a single grade (on a six-grade scale) increases the digestive cancer death rate by 9.7%. The analysis rules out other potential explanations such as smoking rates, dietary patterns, and air pollution. I estimate that doubling China's levy rates for wastewater dumping would save roughly 17,000 lives per year but require an additional [dollar]500 million in annual spending on wastewater treatment.

Careers in health administration continue to grow despite an overall downturn in the economy. This is a field that offers tremendous job opportunities across the spectrum of healthcare delivery and payment organizations. 101 Careers in Healthcare Management is the only comprehensive guide to careers in health administration, ranging from entry-level management positions to the most senior executive opportunities. The guide clearly explains the responsibilities and duties of each of these careers and how they differ from other management jobs. It describes the integral role of healthcare administrators in creating and sustaining the systems that allow healthcare clinicians to do their best work.

The book covers educational requirements, opportunities, traditional and nontraditional career pathways, and helps students assess whether they are temperamentally and intellectually suited to a career in healthcare management. Based on the most current data from the U.S. Department of Labor and professional societies in healthcare management, the guide describes careers in 14 different healthcare and related settings. These include long-term care, physician practices, commercial insurance, consulting firms, pharmaceuticals, medical devices, information technology, and biotechnology. Additionally, the book offers numerous interviews with health administrators, from those in entry-level positions to CEOs, to more vividly portray potential careers.

Objectives: To investigate trends in official development assistance for health, HIV and non-HIV activities over time and to discuss the efficiency implications of these trends in the context of achieving universal access to treatment and health systems.

Methods: Official development assistance for health, HIV programmes and non-HIV programmes were tracked using data from 2000 to 2009. A review of the literature on efficiency, treatment and health systems was conducted. Findings The rate of growth of donor funding to HIV programmes has slowed in recent years at levels below those required to sustain programmes and to move towards universal access to treatment. These trends are likely due to increased pressure on foreign aid budgets and donor fatigue for HIV programmes.

Conclusions: There is great need to consider how the limited resources available can be used most efficiently to increase the number of lives saved and to ensure that these resources also benefit health systems. Improving efficiency is much more than just improving the productive efficiency and also about ensuring that resources are going to where they will be the most beneficial and making investments that are the most efficient over time. These choices may be essential to achieving the goal of universal access to treatment as well as the sustainability of these programmes. 

OBJECTIVE:
To assess the association of the severity of obesity with diagnosis and health education, and to identify any differences within demographic or other subgroups.
DESIGN:
Clinician visits for 2-18 year olds from the 2005-2008 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey were combined. Descriptive, bivariate and multivariate analyses were used to compare diagnosis of obesity and health education (nutrition, exercise and weight reduction) across elevated body mass index (BMI) groups (overweight, obese and extreme or very obese, defined as >120% of the 95th percentile for age and gender), patient socio-demographic characteristics, physician specialty and type of visit (well child visits (WCV) versus non-well child visits (non-WCV).
RESULTS:
A total of 17 808 visits had a calculated BMI, of which 5.8% were extremely obese, 13% were obese and 15.2% were overweight, with the highest percentages among older children, blacks and Hispanics. Diagnosis and weight reduction education were higher among children with an extreme BMI. Nutrition and exercise education were not correlated with severity of obesity. Race, ethnicity or gender biases were not identified. Severity of obesity was significantly associated with presentation to a non-WCV rather than a WCV.
CONCLUSION:
Extremely obese children have higher, but still insufficient, rates of diagnosis and health education. Nutrition and exercise education are not prevalent throughout all age groups. Providers may be relying inconsistently and insufficiently on visual cues to drive their obesity prevention practices. Furthermore, lower rates of diagnosis and education at non-WCV may result in a missed opportunity to prevent comorbidities. This is of particular concern as overweight children are less likely to be seen at WCV than non-WCV.International Journal of Obesity advance online publication, 24 January 2012; doi:10.1038/ijo.2012.1.

We cannot understand Manhattan in the 21st century by relying on conventional measures of urban activity. Simply put, Manhattan consists of much more than its residential population and daily workforce. This island, measuring just 22.96 square miles, serves approximately 4 million people on a typical weekday, 2.9 million on a weekend day, and a weekday night population of 2.05 million. Manhattan, with a residential population of 1.6 million more than doubles its daytime population as a result of the complex network of tunnels, bridges, railroad lines, subways, commuter rail, ferry systems, bicycle lanes, and pedestrian walkways that link Manhattan to the surrounding counties, cities and towns.

This transportation infrastructure, largely built during the twentieth century, is operated by the City of New York, Metropolitan Transportation Authority, and Port Authority of New York & New Jersey. The infrastructure network generates a constant flow of people who are responsible for Manhattan's emergence as a world capital for finance, media, fashion, and the arts.

The residential population count does not include the 1.6 million commuters who enter Manhattan every weekday, or the hundreds of thousands of visitors who use Manhattan's tourist attractions, hospitals, universities, and nightclubs. This report analyzes the volume of people flowing in and out of Manhattan during a 24-hour period; we provide an upper estimate of the actual number of people in Manhattan during a typical work day.

Clinical guidelines and quality measures are important new paradigms for conceptualizing and managing quality in the United States. Researchers have proposed that professional elites-including members of academic medicine-were an important cause of the shift to guidelines and measures. This paper draws on content analysis of abstracts focused on quality in major American medical journals between 1975 and 2009 to empirically assess whether and how paradigms for managing quality changed in academic medicine. The content analysis shows that guidelines- and measures-based approaches to quality increased in prominence. Individual expertise-based approaches to quality, however, remain important. Concurrent with changing paradigms in academic medicine, there was a reorientation of policy toward increased use of guidelines and measures the late 1980s and early 1990s in the United States. This policy reorientation was informed by earlier work by medical researchers proposing new approaches to quality. The policy reorientation was followed by an increase in the prominence of guidelines and measures in medical research.

Declining birth rates, increasing longevity and urbanization have created a new challenge for cities: how to respond to an ageing population. Although population ageing and urbanization are not new concerns for national governments around the world, the consequences of these trends for quality of life in cities has only recently started to receive attention from policy makers and researchers. Few comparative studies of world cities examine their health or long-term care systems; nor have comparisons of national systems for the provision of long-term care focused on cities, let alone world cities.

By extending the work of the CADENZA and World Cities Projects , this report investigates how three world cities -- Hong Kong, New York and London -- are coping with this challenge. These world cities are centers of finance, information, media, arts, education, specialized legal services and advanced business services, and contribute disproportionate shares of GDP to their national economies. But are these influential centers prepared to meet the challenge posed by the “revolution of longevity?” How will these world cities accommodate this revolutionary demographic change? Are they prepared to implement the health and social policy innovations that may be required to serve their residents, both old and young? Will they be able to identify the new opportunities that increased longevity may offer? Can they learn from one another as they seek to develop creative solutions to the myriad issues that arise? Finally, can other cities learn from the experience of these three cities as they confront this challenge?

To address these questions, we examine comparable data on the economic and health status of older persons, as well as the availability and use of health, social and long-term care across and within these cities. In the report “How Well Are Seniors in Hong Kong Doing? An International Comparison”, a first attempt was made to compare the situation in Hong Kong with five economically developed countries. This report extends this study by comparing the situation in Hong Kong with two other world cities—New York City and London, which are more comparable in terms of population size and economic characteristics.

Without a governance structure, IT at many hospitals and healthcare systems is a haphazard endeavor that typically results in late, over-budget projects and, ultimately, disparate systems. IT Governance in Hospitals and Health Systems offers a practical “how to” in creating an information technology governance process that ensures the IT projects supporting a hospital or health systems’ strategy are completed on-time and on-budget. The authors define and describe IT governance as it is currently practiced in leading healthcare organizations, providing step-by-step guidance of the process so readers can replicate these best practices at their own hospital or health system. The book provides an overview of what IT governance is and why it is important to a healthcare organization. In addition, the book examines keys to IT governance success, as well as common mistakes to avoid; governance processes, workflows and project management; and the important roles that staff, a board of directors and committees play. Special features in the book include case studies from hospitals and health systems that have successfully developed an effective IT governance structure for their organization. 2012.

Medicare’s flagship hospital pay-for-performance program, the Premier Hospital Quality Incentive Demonstration, began in 2003 but changed its incentive design in late 2006. The goals were to encourage greater quality improvement, particularly among lower-performing hospitals. However, we found no evidence that the change achieved these goals. Although the program changes were intended to provide strong incentives for improvement to the lowest-performing hospitals, we found that in practice the new incentive design resulted in the strongest incentives for hospitals that had already achieved quality performance ratings just above the median for the entire group of participating hospitals. Yet during the course of the program, these hospitals improved no more than others. Our findings raise questions about whether pay-for-performance strategies that reward improvement can generate greater improvement among lower performing providers. They also cast some doubt on the extent to which hospitals respond to the specific structure of economic incentives in pay-for-performance programs.

Health care policymakers have cited transportation
barriers as key obstacles to providing health care to
low-income suburbanites, particularly because suburbs have
become home to a growing number of recent immigrants
who are less likely to own cars than their neighbors. In a
suburb of New York City,we conducted a pilot survey of low
income, largely immigrant clients in four public clinics, to
find out how much transportation difficulties limit their
access to primary care. Clients were receptive to the opportunity
to participate in the survey (response rate = 94%).
Nearly one-quarter reported having transportation problems
that had caused them to miss or reschedule a clinic
appointment in the past. Difficulties included limited and
unreliable local bus service, and a tenuous connection to a
car. Our pilot work suggests that this population is willing to
participate in a survey on this topic. Further, since even
among those attending clinic there was significant evidence
of past transportation problems, it suggests that a populationbased
survey would yield information about substantial
transportation barriers to health care.

At A Time When Health Care Organizations Face Unprecedented Financial Challenges, Understanding Financial Accounting Is Important For All Health Care Professionals, Especially Those Who Manage A Department And A Budget. Designed For Both Students And Professionals, Accounting Fundamentals For Health Care Management, Second Edition Clearly Explains Accounting Principles And Applies Them To The Health Care Environment.Critical Topics Such As Recording And Reporting Financial Information, Depreciation, And Financial Statement Analysis Are All Thoroughly Covered The Second Edition Offers: New Co-Author, Thad Calabrese New Chapter (Chapter 2) Provides An Excel Tutorial. New Discussion Of The Impact Of Health Care Reform In Chapter 3 Updated Throughout With Information On IFRS Coverage Of Cash Basis Vs. Accrual Basis New Discussion Of Fair Value Simplified Discussion Of MACRS New Discussion Of Sarbanes-Oxley Act Many General Updates

Objective:To determine clinical characteristics, demographics and short-term outcomes of neonates diagnosed with fetomaternal haemorrhage (FMH).

Design:The authors analysed the Nationwide Inpatient Sample, 1993 to 2008. Singleton births diagnosed with FMH were identified by International Classification of Diseases (ICD-9) code 762.3. Descriptive, univariate and multivariable regression analyses were performed to determine the national annual incidence of FMH over time as well as demographics and clinical characteristics of neonates with FMH.ResultsFMH was identified in 12 116 singleton births. Newborns with FMH required high intensity of care: 26.3% received mechanical ventilation, 22.4% received blood product transfusion and 27.8% underwent central line placement. Preterm birth (OR 3.7), placental abruption (OR 9.8) and umbilical cord anomaly (OR 11.4) were risk factors for FMH. Higher patient income was associated with increased likelihood of FMH diagnosis (OR 1.2), and Whites were more likely to be diagnosed than ethnic minorities (OR 1.9). There was reduced frequency of diagnosis in the Southern USA (OR 0.8 vs the Northeastern USA).

Conclusions: Diagnosis of FMH is associated with significant morbidity as well as regional, socioeconomic and racial disparity. Further study is needed to distinguish between diagnostic coding bias and true epidemiology of the disease. This is the first report of socioeconomic and racial/ethnic disparities in FMH, which may represent disparities in detection that require national attention. 

The obesity epidemic has transformed children's healthcare, such that diabetes, hypertension and the metabolic syndrome are phrases more commonly used by child health providers than ever before. This article reviews the economic consequences of this epidemic for healthcare delivery systems, both in the short term when obesity has been associated with increased utilization, and in the long term where increased likelihood of adult obesity and cardiovascular disease is well documented. Large investments through research and prevention are needed and are likely to provide strong returns in cost savings, and would optimally emerge through a cooperative effort between private and government payers alike. 

Effective means of transport are critical under both normal and extreme conditions, but modern transport systems are subject to many diverse demands. This path-breaking book uniquely draws together the typically conflicting arenas of transport, the environment and security, and provides collective solutions to their respective issues and challenges.

From a primarily urban perspective, the author illustrates that the fields of transportation, environment (with an emphasis on climate change) and security (for both natural hazards and terrorism) and their interconnections remain robust areas for policy and planning. Synthesizing existing data, new analyses, and a rich set of case studies, the book uses transportation networks as a framework to explore transportation in conjunction with environment, security, and interdependencies with other infrastructure sectors. The US rail transit system, ecological corridors, cyber security, planning mechanisms and the effectiveness of technologies are among the topics explored in detail. Case studies of severe and potential impacts of natural hazards, accidents, and security breaches on transportation are presented. These cases support the analyses of the forces on transportation, land use and patterns of population change that connect, disconnect and reconnect people from their environment and security.

The book will prove a fascinating and insightful read for academics, students, and practitioners across a wide range of fields including: transport, environmental economics, environmental management, urban planning, public policy, and terrorism and security.

Children's trauma-related mental health problems are widespread, largely untreated and constitute significant barriers to academic achievement and attainment. Translational research has begun to identify school-based interventions to prevent violence, trauma and psychopathology. We describe in detail the findings to date on research evaluating one such intervention, the Reading, Writing, Respect, and Resolution (4Rs) Program. The 4Rs Program has led to modest positive impacts on both classrooms and children after 1 year that appear to cascade to more impacts in other domains of children's development after 2 years. This research strives not only to translate research into practice but also translate practice into research. However, considerable challenges must be met for such research to inform prevention strategies at population scale.

While current rates of sea level rise and associated coastal flooding in the New York City region appear to be manageable by stakeholders responsible for communications, energy, transportation, and water infrastructure, projections for sea level rise and associated flooding in the future, especially those associated with rapid icemelt of the Greenland and West Antarctic Icesheets, may be outside the range of current capacity because extreme events might cause flooding beyond today's planning and preparedness regimes. This paper describes the comprehensive process, approach, and tools for adaptation developed by the New York City Panel on Climate Change (NPCC) in conjunction with the region's stakeholders who manage its critical infrastructure, much of which lies near the coast. It presents the adaptation framework and the sea-level rise and storm projections related to coastal risks developed through the stakeholder process. Climate change adaptation planning in New York City is characterized by a multi-jurisdictional stakeholder-scientist process, state-of-the-art scientific projections and mapping, and development of adaptation strategies based on a risk-management approach.

Prior researchers have deployed the Vietnam-era draft lottery as an instrument to estimate causal effects of military service on health and earnings. However, household and residential outcomes may be more sensitive to the psychological effects of military service. Using 2SLS analyses of the 2000 Census and the 2005 American Community Survey, we find mixed results for residential stability, housing tenure, and extended family residence. While in the ACS white veterans are less mobile, veteran status has no effect on homeownership. Veteran status reduces extended family living for whites in the Census but increases it for ACS veterans of "other" races.

Public and private decision-makers continue to seek risk-based approaches to allocate funds to help communities respond to disasters, accidents, and terrorist attacks involving critical infrastructure facilities. The requirements for emergency response capability depend both upon risks within a region's jurisdiction and mutual aid agreements that have been made with other regions. In general, regions in close proximity to infrastructure would benefit more from resources to improve preparedness because there is a greater potential for an event requiring emergency response to occur if there are more facilities at which such events could occur. Thus, a potentially important input into decisions about allocating funds for security is the proximity of a community to high concentrations of infrastructure systems that potentially could be at risk to an industrial accident, natural disaster, or terrorist attack. In this paper, we describe a methodology for measuring a region's exposure to infrastructure-related risks that captures both a community's concentration of facilities or sites considered to be vulnerable and of the proximity of these facilities to surrounding infrastructure systems. These measures are based on smoothing-based nonparametric probability density estimators, which are then used to estimate the probability of the entire infrastructure occurring within any specified distance of facilities in a county. The set of facilities used in the paper to illustrate the use of this methodology consists of facilities identified as vulnerable through the California Buffer Zone Protection Program. For infrastructure in surrounding areas we use dams judged to be high hazards, and BART tracks. The results show that the methodology provides information about patterns of critical infrastructure in regions that is relevant for decisions about how to allocate terrorism security and emergency preparedness resources.

Public administration and management (PAM) scholars have long recognized that financial resources are the lifeblood of public organizations. Less appreciated is how the study of public financial management (PFM) can inform the theory, research, and practice of PAM broadly. In this article, we argue that PFM research brings a variety of conceptual, analytical, and empirical insights to bear on some of public administration and management's timeless questions. To illustrate this claim, we synthesize findings from a variety of research across the PFM subfield.

The increasing need to educate healthcare IT leaders will require the use of other educational methods in addition to classroom instruction, seminars at conferences and webinars. The author has 12 years experience offering a "blended" course on healthcare IT for managers and clinicians in an MBA program. The course combines face-to-face classroom instruction with on-line discussion. This reduces the time away from work and travel required. But it has far greater benefits, including the development of a capacity to analyze situations and develop and defen solutions. Participants share knowledge and begin to grasp the differences in their environments that require attention. This method is compared with other teaching methods and its advantages are explained.

Public administration scholars answer the question: What might Alexander Hamilton, John Jay and James Madison, who between October 1787 and August 1788 penned the Federalist Papers promoting ratification of the U.S. Constitution, add now to the pamphlets, in view of changes in the administration of our government over the past two and a quarter centuries? Are these foundational essays still relevant? How might key pamphlets be updated to reflect new realities?

Federalist No. 85 offers a synopsis of the overall case for the Constitution. Describing the dangers of a nation without a national government as an "awful spectacle," the paper provides a rebuttal to the active opposition to ratification. Focusing entirely on the operations of government, this essay examines contemporary challenges to faithfully executing the laws and offers an analysis of comprehensive reforms for creating greater accountability, efficiency, and productivity.

Faulty and dysfunctional incentive systems have long interested, and frustrated, managers and organizational scholars alike. In this analysis, we pick up where Kerr (1975) left off and advance an explanation for why bad incentive systems are so prevalent in organizations. We propose that one contributing factor lies in the psychology of people who occupy managerial roles. Although designing effective incentive systems is a challenge wrought with perils for anyone, we believe the psychological consequences and correlates of higher rank within organizations make the challenge more severe for managers. Patterns of promotion and hiring typically yield managers that are more competent than their employees, and ascending to management positions increases individuals' workload and power. In turn, these factors make managers more egocentrically anchored and cognitively abstract, while also reducing their available cognitive capacity for any given task, all of which we argue limits their ability to design effective incentives for employees. Thus, ironically, those with the power to design incentives may be those least able to effectively do so. We discuss four specific types of bad incentive systems that can arise from these psychological tendencies in managers: those that over-emphasize compensation, generate weak motivation, offer perverse motivation, or are misaligned with organizational culture.

Italians have engaged in the tradition of the “passeggiata” for centuries. In villages and neighborhoods, residents come out each evening to stroll. On these strolls, they see and are seen, and they exchange pleasantries, gossip, and news. Today, however, a new, decentralized kind of passeggiata may be arising, thanks to high levels of mobility and the unprecedented availability of location-based information through mobile devices and other information technologies (IT).

As social networking accelerates, and individuals share ever more information with their community, the inclusion of location in that mix will facilitate a decentralized passeggiata where community members continually meet up across the city to reinforce the ties initially made through social networking. This travel will take advantage of the relatively high levels of mobility, whether by car or transit, available to many city dwellers. This research reviews the literature of several disciplines into order to understand information technologies’ potential effect on travel behavior. The review suggests that such technologies may encourage an increase in social travel, or at least a change in social travel patterns. A 2007 Chicago-area travel survey is used to test the hypothesis that availability of information technologies would result in an increase in non-work, social trips to places beyond what would normally be considered an individual’s “home range.”Results, while preliminary, do indicate a positive relationship between a particular type of information technology, the cellphone, and social travel across longer distances, and to neighborhoods on the edge of urban core. Further, the use of cellphones appears to have a particular effect on the location of walk trips, facilitating pedestrian social and recreational activities a long way from home.

The influence of social networking platforms and location information on activity and travel behavior represents a further evolution in the structure of cities and their role in people’s lives, facilitating ever more complex and flexible patterns of activity through the urban milieu. Expanded social travel presents planners with opportunities to energize less-known and potentially neglected parts of a region, as well as the challenges of sustainably providing access between all parts of that region.

This report demonstrates that New York City has successfully achieved almost all of the key elements in the NYC2012 Olympic Plan, despite the fact that it was not chosen to host the 2012 Games. For New York City, planning for the 2012 Olympics provided the framework to shape the future of the city, through new mass transit, rezoning, and investment in parks, recreational facilities, and housing throughout the city. Long neglected and underused industrial areas have been transformed as a result of the NYC2012 Plan, including the far west side of Manhattan, which will soon be linked to the rest of the city through an extension of the #7 subway line. This report describes how many projects, long the subject of public discussion and civic debate, were able to be carried out as a result of the NYC2012 Olympic Plan.

This study examines the role of mobile communications in urban transportation systems and analyzes American metropolitan regions best positioned to capitalize on the growth of mobile technologies. This paper identifies three critical factors—data accessibility, mobile network strength, and mobile tech user/developer demographics—and uses data from several public resources in an analysis of major Metropolitan Statistical Areas (MSAs). The authors explore trends and public policy implications for furthering the use of mobile communications in the transportation systems of metropolitan regions.

The rankings revealed that metropolitan regions each have areas of strength and weakness. In fact, no MSA ranked in the top five for each category, suggesting that though several cities were very strong (top five) in two categories (San Jose, San Francisco, Washington DC, San Diego), every MSA has substantial room for improvement.

Nonprofit organizations are a critical part of society as well as a growing sector of the economy. For funders there is an increasing and pressing need to ensure that society reaps the most social benefit for their money while also developing the nonprofit sector as a whole. By routinely scrutinizing nonprofit reports in an effort to deduce whether a nonprofit organization is efficient, funders may believe that they are, in fact, giving responsibly. However, we find that these nonprofit reports are unreliable, supporting a myriad of empirical research and revealing that report-based funding methods do not facilitate efficient allocation of funds. In response, we develop audit contracts that put funders in a position to enact change. Auditing, perhaps obviously, supports funders; however, we find that it also benefits the population of nonprofits. Moreover, auditing results in improved efficiency for the nonprofit sector overall. Indeed, our conclusions indicate that nonprofits may want to work with funders to increase the use of auditing, consequently increasing efficiency for the sector overall and impacting society as a whole.

This paper examines the impact of institutional change on patient care. Using panel data on obstetric deliveries from the state of California in the United States between 1983 and 2001, it develops and tests hypotheses predicting impacts of three features of institutional change-managed care insurance, changing professional controls and public attention to cost-control practices-on cesarean use and geographic variation in cesarean deliveries. It finds that managed care insurance promotes the diffusion of cost-effective patient care practices, reducing cesarean use and increasing variation. I found that over time, managed care patients experience continued lower use and reduced geographic variation as new practices become established. The combined effects of changing professional controls-the growing importance of clinical guidelines-and public attention to cost-control practices also diffuses cost-effective practices, increasing variation and decreasing cesarean use. Cesarean use increases and geographic variation declines in a period of managed care retreat in the late 1990s. The analysis extends prior research by documenting the impact of institutional change on health services use and variation and by suggesting that geographic variation is caused, in part, by the diffusion of new patient care practices

The purpose of this effort has been to foster a dialogue among peers at transportation and planning agencies about their experiences with promoting public transit and, in particular, the challenges they face related to bus rapid transit (BRT) projects, as well as the solutions that they have developed in response. Agencies from dozens of large cities around the United States participated at three (3) peer-to-peer exchanges in New York City, Los Angeles, and Cleveland. The facilitated discussions were structure to address the unique barriers to BRT implementation on the streets of dense and/or highly congested large urban centers. Three major themes were the focus of the workshops: Network, Route and Street Design, Traffic Operations, and BRT as a Driver of Economic Development; Building Political, Interagency and Stakeholder Support. The results of the workshops make clear that better public transportation in general and BRT in particular can be cost-effective and useful tools for improving transportation, the environment and for restoring the livability of America‘s large cities.

The present study examines the model of freight consolidation platforms, and urban distribution centers (UDCs) in particular, as a means to solve the last mile problem of urban freight while reducing vehicle miles traveled and associated environmental impacts. This paper attempts to identify the key characteristics that make UDCs successful and discuss under what contextual settings (e.g., institutional, policy) they work best. After an extensive review of UDC cases already implemented in other countries, the study examined three UDCs cases with potential applicability to the New York metropolitan region, discussing models and relevant features and elements that may be transferred to the New York context.

This month, Chairman of the House Budget Committee Representative Paul Ryan, the Congressional Progressive Caucus (CPC) and President Obama shared three very different FY 2012 budget proposals and deficit reduction strategies. The CPC's People's Budget calls for investments in job creation and deficit elimination by increasing tax revenues from the wealthy. President Obama's deficit reduction plan combines spending cuts, tax reform and enhancing the Affordable Care Act to reduce growth in health care spending. Representative Ryan's proposal extends tax cuts to wealthy individuals and corporations, while cutting social safety net programs such as food stamps, housing assistance, and Pell Grants. This policy brief evaluates each proposal's impact on people of color and recommends investing in job creation and infrastructure to strengthen communities in times of hardship and prosperity.

Substance use (SU) disorders adversely impact health status and contribute to inappropriate health services use. This qualitative study sought to determine SU-related factors contributing to repeated hospitalizations and to identify opportunities for preventive interventions. Fifty Medicaid-insured inpatients identified by a validated statistical algorithm as being at high-risk for frequent hospitalizations were interviewed at an urban public hospital. Patient drug/alcohol history, experiences with medical, psychiatric and addiction treatment, and social factors contributing to readmission were evaluated. Three themes related to SU and frequent hospitalizations emerged: (a) barriers during hospitalization to planning long-term treatment and follow-up, (b) use of the hospital as a temporary solution to housing/family problems, and (c) unsuccessful SU aftercare following discharge. These data indicate that homelessness, brief lengths of stay complicating discharge planning, patient ambivalence regarding long-term treatment, and inadequate detox-to-rehab transfer resources compromise substance-using patients' likelihood of avoiding repeat hospitalization. Intervention targets included supportive housing, detox-to-rehab transportation, and postdischarge patient support.

Abstract

Background: Pay-for-performance is an increasingly popular approach to improving health care quality, and the US government will soon implement pay-for-performance in hospitals nationwide. Yet hospital capacity to perform (and

improve performance) likely depends on local resources. In this study, we quantify the association between hospital performance and local economic and human resources, and describe possible implications of pay-for-performance for socioeconomic equity.

Methods and Findings: We applied county-level measures of local economic and workforce resources to a national sample of US hospitals (n = 2,705), during the period 2004–2007. We analyzed performance for two common cardiac conditions (acute myocardial infarction [AMI] and heart failure [HF]), using process-of-care measures from the Hospital Quality Alliance [HQA], and isolated temporal trends and the contributions of individual resource dimensions on performance, using multivariable mixed models. Performance scores were translated into net scores for hospitals using the Performance Assessment Model, which has been suggested as a basis for reimbursement under Medicare’s ‘‘Value-Based Purchasing’’ program. Our analyses showed that hospital performance is substantially associated with local economic and workforce resources. For example, for HF in 2004, hospitals located in counties with longstanding poverty had mean HQA composite scores of 73.0, compared with a mean of 84.1 for hospitals in counties without longstanding poverty (p,0.001). Hospitals located in counties in the lowest quartile with respect to college graduates in the workforce had mean HQA composite scores of 76.7, compared with a mean of 86.2 for hospitals in the highest quartile (p,0.001). Performance on AMI measures showed similar patterns. Performance improved generally over the study period. Nevertheless, by 2007—4 years after public reporting began—hospitals in locationally disadvantaged areas still lagged behind their locationally advantaged counterparts. This lag translated into substantially lower net scores under the Performance Assessment Model for hospital reimbursement.

Conclusions: Hospital performance on clinical process measures is associated with the quantity and quality of local economic and human resources. Medicare’s hospital pay-for-performance program may exacerbate inequalities across regions, if implemented as currently proposed. Policymakers in the US and beyond may need to take into consideration the balance between greater efficiency through pay-for-performance and socioeconomic equity.

Please see later in the article for the Editors’ Summary.

This study capitalizes on recent advances in the reliable and valid measurement of classroom-level social processes known to influence children's social–emotional and academic development and addresses a number of limitations in our current understanding of teacher- and intervention-related impacts on elementary school classroom processes. A cluster randomized controlled trial design was employed to (a) examine whether teacher social–emotional functioning forecasts differences in the quality of 3rd-grade classrooms, (b) test the experimental impact of a school-based social–emotional learning and literacy intervention on the quality of classroom processes controlling for teacher social–emotional functioning, and (c) examine whether intervention impacts on classroom quality are moderated by these teacher-related factors. Results indicated (a) positive effects of teachers' perceived emotional ability on classroom quality; (b) positive effects of the 4Rs Program on overall classroom quality, net of teacher social–emotional functioning indicators; and (c) intervention effects that are robust to differences in these teacher factors. These findings support and extend recent research examining intervention-induced changes in classroom-level social processes fundamental to positive youth development.

Research suggests advances in students’ multicultural competence following multicultural counseling training. Increasingly, however, multicultural counseling courses have emphasized self awareness, which has increased the affective demands of these courses and student resistance to learning the material. This paper proposes a pedagogical model to enhance multicultural counseling training that attends both to content and process variables that may impact classroom learning. Its fundamental premise is that psychological safety, the belief that the classroom is safe for taking interpersonal risks, must be present for increasing knowledge and awareness around the charged, and often taboo, topics of race and culture in multicultural counseling training. The model integrates research from psychology, education, and management, including identity threat, culture-centered teaching practices, racial identity, and learning frames. The authors conclude with implications for classroom teaching.

From September 2008 to April 2009, the New York Metropolitan Transportation Council collaborated with the NYU Wagner Rudin Center on a unique program to offer training courses to professional transportation staff from regional transportation agencies. The Program consisted of 23 courses organized within three distinct modules, Skill Building, Transportation Policy, and Tools and Methods. Tailored for line and mid-level staff as a parallel and complimentary track to the already established NYMTC Executive Education Program developed in the 1990s, 86% of Program participants reported the curriculum to be of strong content and with high relevance to their jobs and professional development. The Program offers a model for MPO and university research center collaboration on continuing professional education for transportation professionals. Connecting agencies through MPOs with university educational resources aligns the training goals to the MPO's regional objectives as well as national transportation education initiatives.

Ample research documents the ubiquity of routines in street-level practice. Some individual-level and organizational-level research has explored how to break street-level routines, but little has looked at the work group level. Our study observed teams of state child welfare workers over 2.5 years, documenting whether they discarded old routines and learned new ones. Results suggest that team characteristics such as clear direction and reflective behaviors had greater influence on team learning than individual characteristics such as stress level, tenure, and educational level. We suggest that group-level factors be included in future models of what enables the re-creation of street-level practice.

New York. London. Paris. Although these cities have similar sociodemographic characteristics, including income inequalities and ethic diversity, they have vastly different health systems and services. This book compares the three and considers lessons that can be applied to current and future debates about urban health care.

Highlighting the importance of a national policy for city health systems, the authors use well-established indicators and comparable data sources to shed light on urban health policy and practice. Their detailed comparison of the three city health systems and the national policy regimes in which they function provides information about access to health care in the developed world's largest cities.

The authors first review the current literature on comparative analysis of health systems and offer a brief overview of the public health infrastructure in each city. Later chapters illustrate how timely and appropriate disease prevention, primary care, and specialty health care services can help cities control such problems as premature mortality and heart disease.

In providing empirical comparisons of access to care in these three health systems, the authors refute inaccurate claims about health care outside of the United States.

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Whether newer pharmaceuticals justify their higher costs by reducing other health expenditures has generated significant debate. We replicate a frequently cited paper by Lichtenberg on drug “offsets” and find the results disappear using a more appropriate model or updated dataset. Further, we test the suitability of similar methods using newer hypertension drugs. We find our observational results run counter to well-established clinical evidence on comparative efficacy and conclude that our model, as well as other studies that do not adequately control for unobserved characteristics that jointly determine drug choice and health expenditures, are likely subject to significant bias.

In this research, we examine the relationship between power and three characteristics of construal-abstraction, valence, and certainty-in individuals' verbatim reactions to the events of September 11, 2001 and during the immediate aftermath of the terrorist attacks. We conceptualize power as a form of social distance and find that position power (but not expert power) was positively associated with the use of language that was more abstract (vs. concrete), positive (vs. negative), and certain (vs. uncertain). These effects persist after controlling for temporal distance, geographic distance, and impression management motivation. Our results support central and corollary predictions of Construal Level Theory (Liberman, Trope, & Stephan, 2007; Trope & Liberman, 2003) in a high-consequence, real-world context, and our method provides a template for future research in this area outside of the laboratory.

Questions of how public organizations control and manage resources have been relegated to an insular subfield of contemporary public management. This is both unfortunate and unnatural because insights from the study of budgeting and financial management have traditionally been a driving force of public management's conceptual and empirical development. In this paper we seek to address this problem by reconnecting contemporary findings from the budgeting and financial management subfield to broader concerns in public management. We focus our discussion on the centrality of management technique in contemporary public management, and we argue that research in select areas of contemporary public budgeting and financial management has and will continue to illuminate the implications of reform and innovation in management technique, particularly in our current environment of amorphous institutional arrangements and diffuse, shared power.

We explore attention to Clinton's health care reform proposal, ongoing debates, and its political demise to develop theory that explains how events create opportunities for cognitive realignment and transformation in institutional logics. Our case analysis illustrates how a bottom-up process of environmental sensemaking led to the emergence and adoption of a logic of managed care, which provided new organizing principles in the hospitals' organizational field. In addition to theorization, highlighted by prior research, we propose a second mechanism of environmental sensemaking: representation of change through exemplars and environmental features. The interplay between theorization, representation, and ongoing event attention can lead to change in institutional logics over an event's life course. We found that the managed care logic did not emerge in a fully formed fashion, but that actors theorized individual dimensions of the logic consistent with changing representations of hospitals' relationships with other actors in the field. As the event unfolded, the individual dimensions came to be theorized as part of an overall managed care logic. The label "managed care," previously understood as a specific organizational form, took on a new meaning to symbolize the organizing principles for hospitals' relationships with a variety of institutional actors as alternative models not congruent with the changing organizational field were abandoned.

Objective
To determine whether a diabetes case management telemedicine intervention reduced healthcare expenditures, as measured by Medicare claims, and to assess the costs of developing and implementing the telemedicine intervention.
Design
We studied 1665 participants in the Informatics for Diabetes Education and Telemedicine (IDEATel), a randomized controlled trial comparing telemedicine case management of diabetes to usual care. Participants were aged 55 years or older, and resided in federally designated medically underserved areas of New York State.
Measurements
We analyzed Medicare claims payments for each participant for up to 60 study months from date of randomization, until their death, or until December 31, 2006 (whichever happened first). We also analyzed study expenditures for the telemedicine intervention over six budget years (February 28, 2000- February 27, 2006).
Results
Mean annual Medicare payments (SE) were similar in the usual care and telemedicine groups, $9040 ($386) and $9669 ($443) per participant, respectively (p>0.05). Sensitivity analyses, including stratification by censored status, adjustment by enrollment site, and semi-parametric weighting by probability of dropping-out, rendered similar results. Over six budget years 28 821 participant/months of telemedicine intervention were delivered, at an estimated cost of $622 per participant/month.
Conclusion
Telemedicine case management was not associated with a reduction in Medicare claims in this medically underserved population. The cost of implementing the telemedicine intervention was high, largely representing special purpose hardware and software costs required at the time. Lower implementation costs will need to be achieved using lower cost technology in order for telemedicine case management to be more widely used.

OBJECTIVE:

To determine the trends in incidence of diagnosis of bronchopulmonary dysplasia (BPD) and associated health services use for the neonatal hospitalization of patients with BPD in an era of changing definitions and management.

PATIENTS AND METHODS:

All neonatal hospitalization records available through the Nationwide Inpatient Sample, 1993-2006, were analyzed. Multivariable regression analyses were performed for incidence of BPD diagnosis and associated hospital length of stay and charges. Multiple models were constructed to assess the roles of changes in diagnosis of very low birth weight (VLBW) neonates and different modalities of respiratory support used for treatment.

RESULTS:

The absolute incidence of diagnosis of BPD fell 3.3% annually (P = .0009) between 1993 and 2006 coincident with a 3.5-fold increase in the use of noninvasive respiratory support in patients with BPD. When data were controlled for demographic factors, this significant decrease in incidence persisted at a rate of 4.3% annually (P = .0002). All models demonstrated a rise in hospital length of stay and financial charges for the neonatal hospitalization of patients with BPD. The incidence of BPD adjusted for frequency of prolonged mechanical ventilation also decreased but only by 2.8% annually (P = .0075).

CONCLUSIONS:

The incidence of diagnosis of BPD decreased significantly between 1993 and 2006. In well-controlled models, birth hospitalization charges for these patients rose during the same period. Less invasive ventilatory support may improve respiratory outcomes of VLBW neonates.

Victor Rodwin, professor of health policy and management at NYU Wagner, and his colleague Didier Tabuteau, counselor of state and professor of health policy at the Institut d'Etudes Politiques and the University of Paris Descartes, have published a new book (published by Editions Jacob Duvernet) in which they challenge the conventional wisdom that the French health care system is a government-managed, public and collective enterprise and the American system a private, market-oriented and individualist system. Based on six months of debates in Paris while Professor Rodwin held the Fulbright-Toqueville Chair (spring semester, 2010), this book compares public health, health insurance, the power of physicians, health care reform, and the silent revolution that is transforming health care organization in both France and the United States.

Policy makers generally agree that childhood obesity is a national problem. However, it is not always clear whether enough is being spent to combat it. This paper presents nine scenarios that assume three different degrees of reduction in obesity/overweight rates among children in three age groups. A mathematical model was then used to project lifetime health and economic gains. Spending $2 billion a year would be cost-effective if it reduced obesity among twelve-year-olds by one percentage point. The analysis also found that childhood obesity has more profound economic consequences than previously documented. Large investments to reduce this major contributor to adult disability may thus be cost-effective by widely accepted criteria.

Too often in the fast-moving healthcare field, decision makers rely primarily on what has worked before. Evidence-Based Management in Healthcare explains how healthcare leaders can move from making educated guesses to using the best available information to make decisions.

Collaborations between nonprofit and public sector organizations have become an increasingly important phenomenon in state and local public service delivery since the publication of the Winter Commission report in 1993. This article focuses on one of the less studied types of public–nonprofit collaborations, those in which philanthropic support from nonprofit organizations supplements the resources and activities of public agencies. Drawing on the case of "nonprofit-as-supplement collaborations" that support park services in New York City, this article documents the benefits and drawbacks associated with such collaborations. While they can provide increased resources and encourage management innovations, they also can lead to inequities in the availability and quality of services, the preponderance of particularistic goals over the broader public interest, and the politicization of previously bureaucratic decision making. The authors offer two strategies for public managers to realize more effectively the benefits yet mitigate the shortcomings of these collaborations.

In this paper the causes and consequences of accidents in US hazardous liquid pipelines that result in the unplanned release of hazardous liquids are examined. Understanding how different causes of accidents are associated with consequence measures can provide important inputs into risk management for this (and other) critical infrastructure systems. Data on 1582 accidents related to hazardous liquid pipelines for the period 2002–2005 are analyzed. The data were obtained from the US Department of Transportation’s Office of Pipeline Safety (OPS). Of the 25 different causes of accidents included in the data the most common ones are equipment malfunction, corrosion, material and weld failures, and incorrect operation. This paper focuses on one type of consequence–various costs associated with these pipeline accidents–and causes associated with them. The following economic consequence measures related to accident cost are examined: the value of the product lost; public, private, and operator property damage; and cleanup, recovery, and other costs. Logistic regression modeling is used to determine what factors are associated with nonzero product loss cost, nonzero property damage cost and nonzero cleanup and recovery costs. The factors examined include the system part involved in the accident, location characteristics (offshore versus onshore location, occurrence in a high consequence area), and whether there was liquid ignition, an explosion, and/or a liquid spill. For the accidents associated with nonzero values for these consequence measures (weighted) least squares regression is used to understand the factors related to them, as well as how the different initiating causes of the accidents are associated with the consequence measures. The results of these models are then used to construct illustrative scenarios for hazardous liquid pipeline accidents. These scenarios suggest that the magnitude of consequence measures such as value of product lost, property damage and cleanup and recovery costs are highly dependent on accident cause and other accident characteristics. The regression models used to construct these scenarios constitute an analytical tool that industry decision-makers can use to estimate the possible consequences of accidents in these pipeline systems by cause (and other characteristics) and to allocate resources for maintenance and to reduce risk factors in these systems.

In summary, these exemplary non-profit organizations were often very strategic in how they framed problems, solutions and the people they served. This suggests that public organizations could also be more deliberate in their framing processes. Organizational leaders might want to talk explicitly about the shifts they are trying to create, and whether these fit together or act at cross purposes, in addition to how well they match the organization’s goals and mission. Prompting cognitive shifts is at the heart of public leadership.

Patients with frequent hospitalizations generate a disproportionate share of hospital visits and costs. Accurate determination of patients who might benefit from interventions is challenging: most patients with frequent admissions in 1 year would not continue to have them in the next. Our objective was to employ a validated regression algorithm to case-find Medicaid patients at high-risk for hospitalization in the next 12 months and identify intervention-amenable characteristics to reduce hospitalization risk. We obtained encounter data for 36,457 Medicaid patients with any visit to an urban public hospital from 2001 to 2006 and generated an algorithm-based score for hospitalization risk in the subsequent 12 months for each patient (0 = lowest, 100 = highest). To determine medical and social contributors to the current admission, we conducted in-depth interviews with high-risk hospitalized patients (scores >50) and analyzed associated Medicaid claims data. An algorithm-based risk score >50 was attained in 2,618 (7.2%) patients. The algorithm’s positive predictive value was equal to 0.67. During the study period, 139 high-risk patients were admitted: 60 met inclusion criteria and 50 were interviewed. Fifty-six percent cited the Emergency Department as their usual source of care or had none. Sixty-eight percent had >1 chronic medical conditions, and 42% were admitted for conditions related to substance use. Sixty percent were homeless or precariously housed. Mean Medicaid expenditures for the interviewed patients were $39,188 and $84,040 per patient for the years immediately prior to and following study participation, respectively. Findings including high rates of substance use, homelessness, social isolation, and lack of a medical home will inform the design of interventions to improve community-based care and reduce hospitalizations and associated costs.

The question posed in this paper is whether single-payer health care systems

are more likely to provide equal treatment for equal need (horizontal equity) than are multipayer systems. To address this question, we compare access to primary and specialty health care services across selected neighborhoods, grouped by average

household income, in a single-payer system (the English NHS), a multiple-payer system with universal coverage (French National Health Insurance), and the U.S. multiple-payer system characterized by large gaps in health insurance coverage. We find that Paris residents, including those with low incomes, have better access to health care than their counterparts in Inner London and Manhattan. This finding casts doubt on the notion that the number of payers influences the capacity of a health care system to provide equitable access to its residents. The lesson is to worry less about the number of payers and more about the system’s ability to assure access to primary and specialty care services.

The paper provides a mid-course assessment of the Bronx Health REACH faith-based initiative four years into its implementation.

The continuing rise in obesity rates across the United States has proved impervious to clinical treatment or public health exhortation, necessitating policy responses. Nearly a decade’s worth of political debates may be hardening into an obesity issue regime, comprising established sets of cognitive frames, stakeholders, and policy options.

Six experiments investigate the hypothesis that social targets who display a greater action orientation are perceived as having more power (i.e., more control, less dependence, and more influence) than less action-oriented targets. I find evidence that this inference pattern is based on the pervasive belief that individuals with more power experience less constraint and have a greater capacity to act according to their own volition. Observers infer that targets have more power and influence when they exhibit more implementation than deliberation in the process of making decisions in their personal lives (Study 1a), in a public policy context (Study 1b), and in small groups (Study 2). In an organizational context, observers infer that a target who votes for a policy to change from the status quo has more power than a target who votes not to change from the status quo (Study 3). People also infer greater intra-organizational power and higher hierarchical rank in targets who take physical action toward a personal goal than in those who do not (Studies 4–5).

In this research, we examine the relationship between power and three characteristics of construal-abstraction, valence, and certainty-in individuals' verbatim reactions to the events of September 11, 2001 and during the immediate aftermath of the terrorist attacks. We conceptualize power as a form of social distance and find that position power (but not expert power) was positively associated with the use of language that was more abstract (vs. concrete), positive (vs. negative), and certain (vs. uncertain). These effects persist after controlling for temporal distance, geographic distance, and impression management motivation. Our results support central and corollary predictions of Construal Level Theory (Liberman, Trope, & Stephan, 2007; Trope & Liberman, 2003) in a high-consequence, real-world context, and our method provides a template for future research in this area outside of the laboratory.

During the past fifty years, federal disaster policy in the United States has been shaped by an ongoing conflict between proponents who favor federal intervention following a disaster and those who believe disaster response should be the responsibility of state and local governments and charity. This article explores the existing federal disaster policy landscape within the United States with a focus on the Stafford Act, the cultural and political forces that produced it, and how the current system is ill equipped to aid in the response and recovery from major catastrophes. The Stafford Act defines how federal disasters are declared, determines the types of assistance to be provided by the federal government, and establishes cost sharing arrangements among federal, state, and local governments. The Federal Emergency Management Agency (FEMA) carries out the provisions of the Stafford Act and distributes much of the assistance provided by the Act. With the establishment of the U.S. Department of Homeland Security, the threat of domestic terrorism, and large-scale natural disasters like Hurricane Katrina, the limits of the Stafford Act and FEMA have been shown. We look at several areas where the shortcomings of the Stafford Act have emerged and propose directions for reform.

The U.S. health care system faces well-known problems: 47 million people without health insurance, rapidly rising costs that consume 16 percent of the country'e economic output, and widely uneven quality of care. Even many people with coverage are experiencing serious problems paying for the rapidly rising costs of health care and insurance.

This book--a joint product of the National Academy of Public Administration and the National Academy of Social Insurance--undertakes a sweeping analysis of the management and administrative issues that arise in expanding health care coverage. The book identifies the core administrative functions that need to be performed in assuring access to health coverage, describes how these functions are performed at present and under proposed alternatives, draws lessons from experience in the U.S. and abroad, and assesses suggested administrative approaches designed to facilitate the improvement and expansion of health care coverage.

Adequate health care is one of today's most crucial domestic policy concerns. Expanding Access to Health Care is designed to bring together in one place some of the best thinking on the subject, not as an exercise in advocacy, but rather to lay out the issues in a balanced way so that policymakers, researchers, and citizens can better understand the complex details of health care reform.

Leadership studies focusing on race–ethnicity provide particularly rich contexts to illuminate the human condition as it pertains to leadership. Yet insights about the leadership experience of people of color from context-rich research within education, communications and black studies remain marginal in the field. Our framework integrates these, categorizing reviewed studies according to the effects of race–ethnicity on perceptions of leadership, the effects of race–ethnicity on leadership enactments, and actors' approach to the social reality of race–ethnicity. The review reveals a gradual convergence of theories of leadership and theories of race–ethnicity as their relational dimensions are increasingly emphasized. A shift in the conceptualization of race–ethnicity in relation to leadership is reported, from a constraint to a personal resource to a simultaneous consideration of its constraining and liberating capacity. Concurrent shifts in the treatment of context, power, agency versus structure and causality are also explored, as are fertile areas for future research.

Victor G. Rodwin, qui tiendra une conférence à Marseille le 22 janvier prochain, explique en quoi la réforme
du système de santé est si difficile à mettre en oeuvre aux États-Unis. Si le Président Obama a surmonté
les premières difficultés, la course d'obstacles n'est pas pour autant terminée. Rodwin reconnaît l'excellence
du système médical français tout en contestant la première place attribuée par l'OMS à notre pays.

A comprehensive and concise guide to performance improvement in healthcare, Performance Improvement in Hospitals and Health Systems describes the management engineering principles focused on designing optimal management and information systems and processes. The book covers topics such as:

• Key terminology and concepts in PI
• Scope, value and management of performance improvement projects
• Developing and leading performance improvement departments
• Simulation methods in patient flow
• Understanding cost and quality relationships
• Six Sigma and Lean in healthcare
• Data mining methods for process improvment
• Integrating nursing/clinical staff with performance improvement
• Evaluation and selection criteria for projects
• Decision support systems

Written for management engineers, performance improvement professionals, quality managers and internal consultants who use a combination of methods to improve systems and processes, this book has timely, practical and actionable information and valuable insights into improving the healthcare environment.

Leading change is a topic of paramount importance. But a missing ingredient for many such leaders has been how to translate concepts into actions, continuous improvements and sustainable results. This toolkit by Wallace Senior Education Program Officer Jody Spiro was developed to fill that need in several key areas of the change process: assessing and improving participants' readiness; engaging stakeholders; planning "early wins;" minimizing resistance; using collaborative planning methods; and developing ways to bring initiatives to scale and sustain them over time.

Purpose – Recent years have witnessed a national policy shift towards involving state and local police in enforcing US federal immigration laws. Critics argue that involving local police in enforcing immigration law will decrease Latino(a) and immigrant residents' willingness to report crime and their cooperation with the police, and will also increase racial profiling and negatively impact documented and undocumented residents. This paper aims to examine Latino(a) residents' perceptions of the police before and after an extended local controversy about involving police in enforcing immigration laws in Costa Mesa, California.

Design/methodology/approach – The paper reports findings of a before-and-after study in the Westside area of the City of Costa Mesa, California. Methods include Spanish and English language telephone surveys of Latino(a) and non-Latino(a) residents in the Westside (n=169 respondents before and n=91 respondents after), conducted in 2002 and in 2007.

Findings – In survey responses, Latino(a) residents report that they are more likely to be stopped by the police in 2007 compared to 2002. Latino(a) respondents also have more negative perceptions of the police, find the police less helpful, feel less accepted in the community, and say that they are less likely to report crimes after the controversy, compared to before.

Originality/value – The findings show the importance of policies that encourage cooperation with and trust of the police. These results can help inform cities about the potential impacts of involving local police in immigration enforcement.

This article uses the evaluation of the Robert Wood Johnson Foundation’s (RWJF) Urban Health Initiative (UHI), a 10-year effort to improve health and safety outcomes in distressed cities, to demonstrate the strength of an evaluation design that integrates theory of change and quasiexperimental
approaches, including the use of comparison cities. This paper focuses on the later stages of implementation and, especially, our methods for estimating program impacts. While the theory of change was used to make preliminary identification of intended outcomes, we used the sites’ plans and early implementation to refine this list and revisit our strategy for estimating impacts. Using our integrated design, differences between program and comparison cities are considered impacts only if they were predicted by program theory, local plans for action, and early implementation. We find small, measurable changes in areas of greatest programmatic effort. We discuss the importance of the integrated design in identifying impacts.

Many policy problems require governmental leaders to forge vast networks beyond their own hierarchical institutions. This essay explores the challenges of implementation in a networked institutional setting and incentives to induce coordination between agencies and promote quality implementation. It describes the national evaluation of the Assuring Better Child Health and Development program, a state-based program intended to increase and enhance the delivery of child development services for low-income children through the health care sector, using Medicaid as its primary vehicle. Using qualitative evaluation methods, the authors found that all states implemented programs that addressed their stated goals and made changes in Medicaid policies, regulations, or reimbursement mechanisms. The program catalyzed interagency cooperation and coordination. The authors conclude that even a modest level of external support and technical assistance can stimulate significant programmatic change and interorganizational linkages within public agencies to enhance provision of child development services.

Racial disparities are a ubiquitous feature of the US medical landscape, with health care delivery substantially segregated by race/ethnicity. Recent evidence from hospitals,1-3 nursing homes,4-5 and physicians' offices6 suggests that those caring for minority patients do not perform as well as those who care for nonminority patients, on average. This evidence is troubling but hardly surprising because the limited resources of those who care for the poor have helped to create and sustain racial disparities. As the United States enters an era of accountability in health care, it is time to consider these familiar circumstances from a new perspective.

Structural equation modeling was used to compare 6 competing theoretically based psychosocial models of the longitudinal association between life stressors and depressive symptoms in a sample of early adolescents (N= 907; 40% Hispanic, 32% Black, and 19% White; mean age at Time 1 = 11.4 years). Only two models fit the data, both of which included paths modeling the effect of depressive symptoms on stressors recall: The mood-congruent cognitive bias model included only depressive symptoms to life stressors paths (DS→S), whereas the fully transactional model included paths representing both the DS→S and stressors to depressive symptoms (S→DS) effects. Social causation models and the stress generation model did not fit the data. Findings demonstrate the importance of accounting for mood-congruent cognitive bias in stressors–depressive symptoms investigations.

Although power is often conceptualized as the capacity to influence others, the current research explores whether power psychologically protects people from influence. In contrast to classic social psychological research demonstrating the strength of the situation in directing attitudes, expressions, and intentions, 5 experiments (using experiential primes, semantic primes, and role manipulations of power) demonstrate that the powerful (a) generate creative ideas that are less influenced by salient examples, (b) express attitudes that conform less to the expressed opinions of others, (c) are more influenced by their own social value orientation relative to the reputation of a negotiating opponent, and (d) perceive greater choice in making counterattitudinal statements. This last experiment illustrates that power is not always psychologically liberating; it can create internal conflict, arousing dissonance, and thereby lead to attitude change. Across the experiments, high-power participants were immune to the typical press of situations, with intrapsychic processes having greater sway than situational or interpersonal ones on their creative and attitudinal expressions.

How do we understand and also assess the health care of America? Where is health care provided? What are the characteristics of those institutions which provide it? Over the short term, how are changes in health care provisions affecting the health of the population, the cost of care, and access to care? These core issues regarding our health policy are answered in this text.This is a textbook for course work in health care, the handbook for administrators and policy makers, and the standard for in-service training programs

How do we understand and also assess the health care of America? Where is health care provided? What are the characteristics of those institutions which provide it? Over the short term, how are changes in health care provisions affecting the health of the population, the cost of care, and access to care? Health Care Delivery in the United States, 8 th Edition discusses these and other core issues in the field. Under the editorship of Dr. Kovner and with the addition of Dr. James Knickman, Senior VP of Evaluation, Robert Wood Johnson Foundation, leading thinkers and practitioners in the field examine how medical knowledge creates new healthcare services. Emerging and recurrent issues from wide perspectives of health policy and public health are also discussed. With an easy to understand format and a focus on the major core challenges of the delivery of health care, this is the textbook of choice for course work in health care, the handbook for administrators and policy makers, and the standard for in-service training programs.

How do we understand and also assess the health care of America? Where is health care provided? What are the characteristics of those institutions which provide it? Over the short term, how are changes in health care provisions affecting the health of the population, the cost of care, and access to care? These core issues regarding our health policy are answered in this text.This is a textbook for course work in health care, the handbook for administrators and policy makers, and the standard for in-service training programs

Thoroughly presents today's health care system, its administration and its dissemination.

The federal government is having increasing difficulty faithfully executing the laws, which is what Alexander Hamilton called "the true test" of a good government. This book diagnoses the symptoms, explains their general causes, and proposes ways to improve the effectiveness of the federal government. Employing Hamilton's seven measures of an energetic federal service, Paul Light shows how the government is wanting in each measure.

After assessing the federal report card, Light offers a comprehensive agenda for reform, including new laws limiting the number of political appointees, reducing the layers of government management, reducing the size of government as its baby-boom employees retire, revitalizing the federal career, and reducing the heavy outsourcing of federal work. Although there are many ways to fix each of the seven problems with government, only a comprehensive agenda will bring the kind of reform needed to reverse the overall erosion of the capacity to faithfully execute all the laws.

Hierarchy is such a defining and pervasive feature of organizations that its forms and basic functions are often taken for granted in organizational research. In this review, we revisit some basic psychological and sociological elements of hierarchy and argue that status and power are two important yet distinct bases of hierarchical differentiation. We first define power and status and distinguish our definitions from previous conceptualizations. We then integrate a number of different literatures to explain why status and power hierarchies tend to be self-reinforcing. Power, related to one's control over valued resources, transforms individual psychology such that the powerful think and act in ways that lead to the retention and acquisition of power. Status, related to the respect one has in the eyes of others, generates expectations for behavior and opportunities for advancement that favor those with a prior status advantage. We also explore the role that hierarchy-enhancing belief systems play in stabilizing hierarchy, both from the bottom up and from the top down. Finally, we address a number of factors that we think are instrumental in explaining the conditions under which hierarchies change. Our framework suggests a number of avenues for future research on the bases, causes, and consequences of hierarchy in groups and organizations.

In two studies, we investigate the effects of individuals’ power motivation on decision-making. We distinguish between two types of power motivation [McClelland, D. C. (1970). The two faces of power. Journal of International Affairs, 24, 29–47; Winter, D. G. (1973). The power motive. New York: The Free Press] and demonstrate that both types of power motivation facilitate influential decision-making but that each type plays a different role in different contexts. In a conflict context (Study 1), individuals’ personalized (self-serving) power motivation was associated with antisocial decisions, and in a healthcare context (Study 2), individuals socialized (other-serving) power motivation was associated with prosocial decisions. Furthermore, the type of power motivation elicited in each context was associated with less perceived need to deliberate over the relevant policy decision. In separating out the independent effects of each type of power motivation, we are able to explain more variance in decision-making behavior across various contexts than in models using aggregate power motivation (personalized plus socialized).

In two studies, we investigate the effects of individuals' power motivation on decisionmaking. We distinguish between two types of power motivation [McClelland, D. C. (1970). The two faces of power. Journal of International Affairs, 24, 29-47; Winter, D. G. (1973). The power motive. New York: The Free Press] and demonstrate that both types of power motivation facilitate influential decision-making but that each type plays a different role in different contexts. In a conflict context (Study 1), individuals' personalized (selfserving) power motivation was associated with antisocial decisions, and in a healthcare context (Study 2), individuals socialized (other-serving) power motivation was associated with prosocial decisions. Furthermore, the type of power motivation elicited in each context was associated with less perceived need to deliberate over the relevant policy decision. In separating out the independent effects of each type of power motivation, we are able to explain more variance in decision-making behavior across various contexts than in models using aggregate power motivation (personalized plus socialized).

Developing community capacity to improve health is a cornerstone of community-based public health. The concept of community capacity reflects numerous facets and dimensions of community life and can have different meanings in different contexts. This paper explores how members of one community identify and interpret key aspects of their community's capacity to limit the availability and use of tobacco products. Particular attention is given to examining the interrelationship between various dimensions of community capacity in order to better understand the processes by which communities are able to mobilize for social change. The study is based on qualitative analysis of 19 in-depth interviews with key informants representing a variety of community sectors in Harlem, New York City. Findings indicate that the community is viewed as rich in human and social resources. A strong sense of community identity and connectedness underlies this reserve and serves as a catalyst for action.

Abstract Survival among perinatally infected children and youth with HIV has been greatly extended since the advent of highly active antiretroviral therapies. Yet, adherence to HIV medication regimens is suboptimal and decreases as children reach adolescence. This paper reports on a qualitative study examining psychosocial factors associated with adherence among perinatally infected youth ages 10-16 years. The study was based on in-depth interviews with a sample of 30 caregivers participating in a comprehensive health care program in New York City serving families with HIV. A subsample comprising 14 caregivers of children ages 10 and above is the focus of this paper. The analysis identified a number of themes associated with the psychosocial context of managing adherence among older children. Maintaining adherence was an ongoing challenge and strategies evolved as children matured. Regimen fatigue and resistance to taking the medications were major challenges to maintaining adherence among the oldest children. In other cases, caregivers developed a kind of partnership with their child for administering the medications. Disclosure to the child of his or her HIV status was used as a strategy to promote adherence but seemed to be effective only under certain circumstances. Social support appeared to have an indirect influence on adherence, primarily by providing caregivers with temporary help when needed. Health care professionals were an important source of disclosure and adherence support for parents. The study illustrates the interplay of maturational issues with other contextual psychosocial factors as influences on adherence among older children and adolescents.

A collection of writings by leading experts and newer researchers on the SARS outbreak and its relation to infectious disease management in progressively global and urban societies.

To analyze long-term consequences of homelessness, the authors compared 388 formerly homeless children 55 months after shelter entry with 382 housed peers, birth to 17, using mother- and child-reported health, mental health, community involvement, cognitive performance, and educational records. Both groups scored below cognitive and achievement norms. Small group differences favored housed 4- to 6-year-olds on cognition and 4- to 10-year-olds on mental health only. Child care and recent stressful events, which were high, were as or more important than prior homelessness. Only children living with mothers were included, potentially biasing results. Policy implications are discussed.

This paper examines the spatial and temporal distribution of failures in three critical infrastructure systems in the United States: the electrical power grid, hazardous liquids (including oil) pipelines, and natural gas pipelines. The analyses are carried out at the state level, though the analytical frameworks are applicable to other geographic areas and infrastructure types. The paper also discusses how understanding the spatial distribution of these failures can be used as an input into risk management policies to improve the performance of these systems, as well as for security and natural hazards mitigation.

This paper's first goal is to evaluate the evolution and state of scholarship in public administration. It begins with a question: How far have public administration theory and research advanced since 1940, when the self-aware study of public administration, as a field if not a discipline, took root in the United States? This paper argues that scholars of public administration in the U.S. and abroad continuously advance the scientific rigor of research and are cognizant of the real-world challenges faced by policymakers and public servants of all sorts. Nonetheless, it is further argued, there remains room for improving our scientific understanding of the public service in the twenty-first century. Turning to practice, the second section identifies how we might better link our scientific findings to the lessons we provide in the classroom. Finally, the paper concludes with a discussion on preparing the public service of the twenty-first century and beyond to manage some of the considerable challenges it will encounter.

The article discusses the improvement of care management for high-cost Medicaid patients. It explores on Medicaid budgets which have prompted policymakers to redouble efforts to explore ways of boosting efficiency in care delivery, particularly for people with high-cost and chronic conditions. It also illustrates John Billings and Tod Mijanovich's article which examines the cost-effectiveness of care management for chronic disease patients treated in fee-for-service practice. The authors present an algorithm that identifies patients at high risk of future hospitalizations and offer a business-case analysis about the rate of reduction in future hospitalization and the cost of the intervention.

Objective. To identify strategies that facilitate readiness for local Institutional Review Board (IRB) review, in multicenter studies.

Study Setting. Eleven acute care hospitals, as they applied to participate in a foundation-sponsored quality improvement collaborative.

Study Design. Case series.

Data Collection/Extraction. Participant observation, supplemented with review of written and oral communications.

Principal Findings. Applicant hospitals responded positively to efforts to engage them in early planning for the IRB review process. Strategies that were particularly effective were the provisions of application templates, a modular approach to study description, and reliance on conference calls to collectively engage prospective investigators, local IRB members, and the evaluation/national program office teams. Together, these strategies allowed early identification of problems, clarification of intent, and relatively timely completion of the local IRB review process, once hospitals were selected to participate in the learning collaborative.

Conclusions. Engaging potential collaborators in planning for IRB review may help expedite and facilitate review, without compromising the fairness of the grant-making process or the integrity of human subjects protection.

PURPOSE:
Focusing on guidelines governing medication use in nursing homes, in this study we explore the ways in which clinical professionals perceive and apply treatment guidelines, and how interprofessional interactions shape the delivery of pharmacotherapies to residents.

DESIGN AND METHODS:
Seventeen semistructured interviews were conducted with physicians, nursing staff, and consultant pharmacists in 4 purposefully selected nursing homes in Michigan.

RESULTS:
Perceptions of guidelines varied by clinical groups, with physicians perceiving them as reference tools, whereas nurses and consultant pharmacists saw them as rules to which clinical practices should adhere. Key external factors including resident and family demands, economic constraints, limited face-to-face contact, and the organizational hierarchy further drove clinical personnel to use guidelines differently and induced interprofessional conflicts. These negative interactions make facility-wide guideline adherence challenging by undermining the regulatory role of consultant pharmacists.

IMPLICATIONS:
This study provides important insight on work-related factors that hinder the implementation of treatment guidelines in nursing homes.

Few communities welcome federally subsidized rental housing, with one of the most commonly voiced fears being reductions in property values. Yet there is little empirical evidence that subsidized housing depresses neighborhood property values. This paper estimates and compares the neighborhood impacts of a broad range of federally subsidized rental housing programs, using rich data for New York City and a difference-in-difference specification of a hedonic regression model. We find that federally subsidized developments have not typically led to reductions in property values and have, in fact, led to increases in some cases. Impacts are highly sensitive to scale, though patterns vary across programs.

This book helps nurses develop and refine good budgeting skills - a necessity in today's economy-driven health care system. Clearly written and thoroughly understandable, this new edition shows first-line nurse managers and their immediate supervisors how to work effectively with financial staff and management, and how to develop, monitor, and maintain departmental and institutional budgets. It is written at a level that assumes no previous financial management experience or expertise on the part of the reader.

Covering the financial topics all nurse managers need to know and use, this book explains how financial management fits into the healthcare organization. You'll study accounting principles, cost analysis, planning and control management of the organization's financial resources, and the use of management tools. In addition to current issues, this edition also addresses future directions in financial management.

Essentials of Cost Accounting for Health Care Organizations, Third Edition is a comprehensive text that applies the tool and techniques of cost accounting to the health services field. It is an essential tools for all professionals who need to deal with the challenges of managing health facilities in a difficult economic environment.

Sensegiving -- shaping how people understand themselves, their work, and others engaged in that work -- is critical to the work of organizational leadership. We propose the cognitive shift, a change in how an organizational audience understands an important element of the organization's work, as a desired outcome of the sensegiving process. Organizations try to spur these shifts in two categories: about their issue and about their primary constituency, the population it is designed to serve or mobilize. This approach makes two contributions: It re-directs attention from individual leaders' behaviors and characteristics to the work of leadership, as opposed to the agents through which it is carried out. Second, it operationalizes the intangible process of meaning-making by breaking it down into discrete units that are relatively equivalent and, therefore, comparable, providing a systematic way to analyze and map cognitive leadership processes.

There is little doubt that globalization, however defined, has hit the field of
professional policy education in the twenty years since APPAM’s Hiltonhead conference on the future of policy education first took stock of a largely American landscape. Despite the title of this session, the relevant development is not merely the accretion of public policy schools and programs around the world. It is the recognition of international dimensions of the policy education enterprise that, if taken seriously (and participants in this discussion argued that it must), promises to change the way we conduct business on multiple levels. This report of the lively discussion generated in the wake of Iris Geva-May and her coauthors’ stimulating conference paper1 explores why and how.

Purpose – The paper explores an emerging challenge for large public-sector bureaucracies: developing information and performance measurement systems that support anti-corruption efforts.
Design – An analytical framework linking functions and contexts of performance measurement to anti-corruption requirements is presented. The framework is used to explore a case study of the World Bank’s ongoing efforts to strengthen anti-corruption information systems in Indonesia.
Findings – A range of organizations are increasingly turning to performance measurement systems to fulfill several functions related to organizational integrity: to hold organization’s accountable for reaching publicly stated standards of fiduciary responsibility and corruption control; to identify vulnerable operational points in multi-faceted public enterprises; and to facilitate organizational learning regarding ‘what works’. Yet corruption is difficult to measure, and corruption vulnerabilities often arise from informal practices, insufficient incentives for enforcement or adherence to standards, and managerial blindspots. Enhanced information systems need to be coupled with effective and multi-directional accountability arrangements in order for performance measurement to contribute effectively to corruption control.
Practical implications – Improved information systems and a reassessment of managerial incentives and attitudes are both essential in order to reduce organizational vulnerability to corruption and to the public backlash that follows in the wake of corruption scandals.
Originality/value – Focus on an emerging area of performance management likely to gain increasing visibility as large bureaucracies attempt to institutionalize public commitments to high anti-corruption standards

Developing countries that were early, enthusiastic adopters of Primary Health Care often developed an extensive – but eventually dilapidated and under-utilized – network of public clinics at the grassroots. As paradigms and investment patterns of health sector reform have shifted, the question of what role these public clinics can meaningfully play, and how best to revitalize them, has become important in a number of countries. This paper evaluates the strategy taken by, and outcomes of, a major attempt in Vietnam to revitalize the grassroots infrastructure of primary health care against the backdrop of the country’s economic transition. The project’s substantial supply-side investments in infrastructure led to marginal increases in utilization and the quality of preventive health services  provided by the centers. But because the project failed to take adequate stock of broader, public sector-wide trends and reforms over the transition, the investments had little impact on the incentives, accountability patterns and capacities of clinic staff and the local authorities. Such institutional factors are heavily implicated, in Vietnam as elsewhere, in the substantial and often increasing disparities in service access and quality that continue to afflict transitional health sectors.

The study of the health workforce has gained in prominence in recent years, as the dynamic interconnections between human resource issues and health system effectiveness have come into sharper focus. This paper reviews lessons relating to strategic management challenges emerging from the growing literature in this area. Workforce issues are strategic: they affect overall system performance as well as the feasibility and sustainability of health reforms. Viewing workforce issues strategically forces health authorities to confront the yawning gaps between policy and implementation in many developing countries.

Lessons emerge in four areas. Once concerns imbalances in workforce structure, whether from a functional specialization, geographical or facility lens. These imbalances pose a strategic challenge in that authorities must attempt to steer workforce distribution over time using a limited range of policy tools. A second group of lessons concerns the difficulties of central-level steering of the health workforce, often critically weak due to the lack of proper information systems and the complexities of public sector decentralization and service commercialization trends affecting the grassroots. A third cluster examines worker capacity and motivation, often shaped in developing countries as much by the informal norms and incentives as by formal attempts to support workers or to hold them accountable. Finally, a range of reforms centering on service contracting and improvements to human resource management are emerging. Since these have as a necessary (but not sufficient) condition some flexibility in personnel practices, recent trends towards the sharing of such functions with local authorities are promising. The paper identifies a number of current lines of productive research, focusing on the relationship between health policy reforms and the local institutional environments in which the workforce, both public and private, is deployed.

Catastrophic events are an ongoing part of life, affecting society both locally and globally. Recruitment, development, and retention of volunteers who offer their knowledge and skills in the event of a disaster are essential to ensuring a functional workforce during catastrophes. These opportunities also address the inherent need for individuals to feel necessary and useful in times of crisis. Universities are a particularly important setting for voluntary action, given that they are based in communities and have access to resources and capabilities to bring to bear on an emergency situation.

The purpose of the study was to discern how one large private organization might participate and respond in the case of a large scale disaster. Using a 2-phase random sample survey, 337 unique respondents (5.7%) out of a sample of 6000 replied to the survey. These data indicate that volunteers in a private organization are willing to assist in disasters and have skills that can be useful in disaster mitigation.

Much is to be learned related to the deployment of volunteers during disaster. These findings suggest that volunteers can and will help and that disaster preparedness drills are a logical next step for university-based volunteers.

An interdisciplinary examination of rates of avoidable hospitalizations in France and England to evaluate access to primary care and identify the extent to which these countries may be able to reduce hospital costs by investing in disease management and primary care. The policy brief was published under the Alliance for Health & the Future, a partnership between ILC-USA, ILC-UK and ILC-France.

In his essay “All Community Is Local,” political scientist William Schambra urges that researchers and activists “direct our gaze away from the failed project of national community and focus once again on the churches, voluntary associations, and grass-roots groups that are rebuilding America’s civil society one family, one block, one neighborhood at a time.” Schambra’s is a rather extreme version of a view expressed by many theorists of citizenship, as well as by political figures from both right and left: that the nation is too distant from most people’s lives (or its governing officials too impersonal or corrupt) to inspire a sense of shared purposes or civic spirit. Only intense local involvement yields rightly-constituted citizens, and small communities are the likeliest realm for realizing the public good.[1]

A book for senior executives, managers and clinicians that covers the "before, during and after" stages of a health care information technology (IT) project and provides guidance on how projects can be successfully managed. It shows readers how to assess IT project value before approval, monitor whether projects are on-time and ­on-budget, and measure performance after implementation. Case studies and effective project management tools and techniques help readers maximize project benefits.

To ensure that an information technology project is a success, health care leaders must first define the benefits, then manage the project and realize its benefits.

When health care executives complain that information technology projects are late, over budget or fail to deliver the expected benefits, the underlying cause is likely to be the absence of a defined, uniform and enforced project management process implemented by staff trained in project management. A complex construction project wouldn't proceed without a qualified, experienced construction manager, but multimillion-dollar health IT projects often are implemented by staff without project management expertise. It also is common for CIOs to be responsible for dozens of current projects yet never receive comprehensive reports on their statuses. As a result, controlling staff resources and making tough decisions on changes in the timeline, scope and budget of projects becomes impossible. The need for accessible project status reports and an inventory of projects in order for the CIO to maintain control is obvious.

Social entrepreneurship has come to be synonymous with the individual visionary - the risk taker who goes against the
tide to start a new organization to create dramatic social change. The problem with focusing so much attention
on the individual entrepreneur is that it neglects to recognize and support thousands of other individuals, groups, and organizations that are crafting solutions to troubles around the globe.

From everyday support requests to large capital projects, the IT department's ability to meet demand is limited. Organizational and IT leaders need to proactively address this issue and do a better job of predicting when services will be needed and whether appropriate resources will be available. This article describes the common issues that healthcare IT departments face in the efficient delivery of services as a result of factors such as budget constraints, skill sets and project dependencies. Best practices for controlling demand are discussed, including resource allocation, governance processes and a graphical analysis of forecasted vs. actual thresholds. Using specific healthcare provider examples, the article intends to provide IT management with an approach to predicting and controlling resource demand.

Purpose: Focusing on guidelines governing medication use in nursing homes, in this study we explore the ways in which clinical professionals perceive and apply treatment guidelines, and how interprofessional interactions shape the delivery of pharmacotherapies to residents.

Design and Methods: Seventeen semistructured interviews were conducted with physicians, nursing staff, and consultant pharmacists in 4 purposefully selected nursing homes in Michigan.

Results: Perceptions of guidelines varied by clinical groups, with physicians perceiving them as reference tools, whereas nurses and consultant pharmacists saw them as rules to which clinical practices should adhere. Key external factors including resident and family demands, economic constraints, limited face-to-face contact, and the organizational hierarchy further drove clinical personnel to use guidelines differently and induced interprofessional conflicts. These negative interactions make facility-wide guideline adherence challenging by undermining the regulatory role of consultant pharmacists.

Implications: This study provides important insight on work-related factors that hinder the implementation of treatment guidelines in nursing homes.

OBJECTIVES:

We examined the mechanisms by which living in a disadvantaged minority community influences smoking and illegal cigarette sale and purchasing behaviors after a large cigarette tax increase.

METHODS:

Data were collected from 14 focus groups (n=104) that were conducted during the spring of 2003 among Blacks aged 18 years and older living in New York City.

RESULTS:

A large tax increase led to what focus group participants described as a pervasive illegal cigarette market in a low-income minority community. Perceived pro-smoking community norms, a stressful social and economic environment, and the availability of illegal cigarettes worked together to reinforce smoking and undermine cessation.

CONCLUSIONS:

Although interest in quitting was high, bootleggers created an environment in which reduced-price cigarettes were easier to access than cessation services. This activity continues to undermine the public health goals of the tax increase.

Incident data about disruptions to the electric power grid provide useful information that can be used as inputs into risk management policies in the energy sector for disruptions from a variety of origins, including terrorist attacks. This article uses data from the Disturbance Analysis Working Group (DAWG) database, which is maintained by the North American Electric Reliability Council (NERC), to look at incidents over time in the United States and Canada for the period 1990-2004. Negative binomial regression, logistic regression, and weighted least squares regression are used to gain a better understanding of how these disturbances varied over time and by season during this period, and to analyze how characteristics such as number of customers lost and outage duration are related to different characteristics of the outages. The results of the models can be used as inputs to construct various scenarios to estimate potential outcomes of electric power outages, encompassing the risks, consequences, and costs of such outages.

Aims To assess the relative cost-effectiveness of lower versus higher cost prize-based contingency management (CM) treatments for cocaine abuse.

Design Cost-effectiveness analyses based on resource utilization, unit costs and outcomes from a previous CM efficacy trial.

Setting Two community-based treatment centers.

Participants Patients (n = 120) enrolled in out-patient treatment for cocaine abuse.

Intervention Random assignment to one of three 12-week treatment conditions: standard treatment (STD) alone or two variants of STD combined with prize based CM. In CM, drawing for prizes was available to those submitting drug-free urine samples and completing goal-related activities. There were two levels of pay-out (referred to as $80 versus $240) based on the potential value of prizes won.

Measurements Costs per participant associated with counseling utilization, urine and breathalyzer testing, and operation of the prize-drawing procedure were derived from a survey conducted at 16 clinics that had participated in CM studies. The three measures of effectiveness were: (1) longest duration of consecutive abstinence; (2) percentage completing treatment; and (3) percentage of samples drug-free.

Findings The higher magnitude CM produced outcomes at a lower per unit cost than did the lower magnitude prize CM treatment. This was the case for all three outcome measures examined and held across various assumptions in the sensitivity analysis.

Conclusions Cost-effectiveness analyses can inform policy decisions regarding selection of one treatment model over another. Decisions on adoption of new evidence-based treatments would be aided by more information on society's willingness to pay for incremental gains in effectiveness.

This study examines whether rules, particular participants, and executive politics in state tax revenue estimation exert measurable influences on forecast error. Fixed-effects estimation using data from states’ respective fiscal years 1994 to 2003 indicates that all impact state tax revenue forecast accuracy in varying ways, and results suggest that policy can be crafted to effectively mitigate forecast error. Further examination of the quality of participation in tax revenue forecasting as well as the mechanisms of political involvement in this arena is suggested.

The trend toward greater decentralization of governance activities, now accepted as commonplace in the West, has become a worldwide movement. Today s world demands flexibility, adaptability, and the autonomy to bring those qualities to bear. In this thought-provoking book, the first in a new series on Innovations in Governance, experts in government and public management trace the evolution and performance of decentralization concepts, from the transfer of authority within government to the sharing of power, authority, and responsibilities among broader governance institutions.

The contributors to Decentralizing Governance assess emerging concepts such as devolution and capacity building; they also detail factors driving the decentralization movement such as the ascendance of democracy, economic globalization, and technological progress. Their analyses range across many regions of the world and a variety of contexts, but each specific case explores the objectives of decentralization and the benefits and difficulties that will likely result.

We examine the size and distribution of the gap in test scores across races within New York City public schools and the factors that explain these gaps. While gaps are partially explained by differences in student characteristics, such as poverty, differences in schools attended are also important. At the same time, substantial within-school gaps remain and are only partly explained by differences in academic preparation across students from different race groups. Controlling for differences in classrooms attended explains little of the remaining gap, suggesting little role for within-school inequities in resources. There is some evidence that school characteristics matter. Race gaps are negatively correlated with school size-implying small schools may be helpful. In addition, the trade-off between the size and experience of the teaching staff in urban schools may carry unintended consequences for within-school race gaps. © 2006 by the Association for Public Policy Analysis and Management.

We examine the size and distribution of the gap in test scores across races within New York City public schools and the factors that explain these gaps. While gaps are partially explained by differences in student characteristics, such as poverty, differences in schools attended are also important. At the same time, substantial within-school gaps remain and are only partly explained by differences in academic preparation across students from different race groups. Controlling for differences in classrooms attended explains little of the remaining gap, suggesting little role for within-school inequities in resources. There is some evidence that school characteristics matter. Race gaps are negatively correlated with school size - implying small schools may be helpful. In addition, the trade-off between the size and experience of the teaching staff in urban schools may carry unintended consequences for within-school race gaps.

Background: Access to timely and effective medical services can reduce rates of premature mortality attributed to certain conditions. We investigate rates of total and avoidable mortality (AM) and the percentage of avoidable deaths in France, England and Wales and the United States, three wealthy nations with different health systems, and in the urban cores of their world cities, Paris, Inner London and Manhattan. We examine the association between AM and an income-related variable among neighbourhoods of the three cities. Methods: We obtained mortality data from vital statistics sources for each geographic area. For two time-periods, 1988–90 and 1998–2000, we assess the correlation between area of residence and age- and gender-adjusted total and AM rates. In our comparison of world cities, regression models are employed to analyse the association of a neighbourhood income-related variable with AM. Results: France has the lowest mortality rates. The US exhibits higher total, but similar AM rates compared to England and Wales. Rates of AM are lowest in Paris and highest in London. Avoidable mortality rates are higher in poor neighbourhoods of all three cities; only in Manhattan is there a correlation between the percentage of deaths that are avoidable and an income related variable. Conclusions: Beyond the well-known association of income and mortality, persistent disparities in AM exist, particularly in Manhattan and Inner London. These disparities are disturbing and should receive greater attention from policy makers.

Context The Centers for Medicare & Medicaid Services (CMS) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) measure and report quality process measures for acute myocardial infarction (AMI), but little is known about how these measures are correlated with each other and the degree to which inferences about a hospital's outcomes can be made from its performance on publicly reported processes.

Objective To determine correlations among AMI core process measures and the degree to which they explain the variation in hospital-specific, risk-standardized, 30-day mortality rates.

Design, Setting, and Participants We assessed hospital performance in the CMS/JCAHO AMI core process measures using 2002-2003 data from 962 hospitals participating in the National Registry of Myocardial Infarction (NRMI) and correlated these measures with each other and with hospital-level, risk-standardized, 30-day mortality rates derived from Medicare claims data.

Main Outcome Measures Hospital performance on AMI core measures; hospital-specific, risk-standardized, 30-day mortality rates for AMI patients aged 66 years or older.

Results We found moderately strong correlations (correlation coefficients ≥0.40; P values <.001) for all pairwise comparisons between beta-blocker use at admission and discharge, aspirin use at admission and discharge, and angiotensin-converting enzyme inhibitor use, and weaker, but statistically significant, correlations between these medication measures and smoking cessation counseling and time to reperfusion therapy measures (correlation coefficients <0.40; P values <.001). Some process measures were significantly correlated with risk-standardized, 30-day mortality rates (P values <.001) but together explained only 6.0% of hospital-level variation in risk-standardized, 30-day mortality rates for patients with AMI.

Conclusions The publicly reported AMI process measures capture a small proportion of the variation in hospitals' risk-standardized short-term mortality rates. Multiple measures that reflect a variety of processes and also outcomes, such as risk-standardized mortality rates, are needed to more fully characterize hospital performance.

This report makes the case that it is possible to lower Medicaid expenditures by about $5.8 billion annually, without reducing the program's effectiveness in helping low-income New Yorkers obtain needed care. These significant savings are feasible by addressing the three main areas where New York's program differs drastically from those of other states:

 New York extends Medicaid eligibility to the non-poor or middle class for longterm
care.
 New York pays some institutional providers, specifically hospitals, nursing homes
and institutions for the disabled, at rates above competitive costs.
 New York allows excessive use of some types of services, specifically personal care
and inpatient hospital care.

This report describes these differences and makes three recommendations to bring New York's program more in line with national norms:

 Limit Medicaid eligibility to the poor.
 Reduce payment rates to competitive levels.
 Reduce excessive use of personal care and hospital inpatient care.

Most government workers are paid more than their private sector counterparts, so more generous and expensive
retirement benefits are no longer justified.

Substantial national attention is being directed at enhancing the competency levels of early careerists in healthcare management. In this study, we examined preceptors' ratings of administrative resident/fellow competencies in multiple domains, and we compared those to our previous results of self-rated competency by residents/fellows. In this national sample of preceptors (n=61) of administrative residency/fellowship program listed with the American College of Healthcare Executives, competency in the information management domain was ranked highest, with more than half of preceptors (55.7%) giving their residents/fellows an "A" rating. Fewer preceptors (between 30.0% and 39.2%) gave their residents/fellows an "A" rating in domains of interpersonal and emotional intelligence, analytic and conceptual reasoning, and clinical operations. Less than 20% of preceptors rated competencies as "A" level in the domains of human resources/marketing/public affairs, financial management, fund raising, and facilities management. There were significant differences in preceptor ratings compared with resident/fellow self-ratings, with preceptors often providing lower ratings than provided by resident/fellows. The findings highlight the need not only to enhance competency levels of graduates but also to address the potential mismatch in early careerists' and preceptors' views about required and attained competency levels.

Nonprofit organizations play a critical role in U.S. housing policy, a role typically justified by the claim that their housing investments produce significant neighborhood spillover benefits. However, little work has actually been done to measure these neighborhood impacts. This paper compares the neighborhood spillover effects of city-supported rehabilitation of rental housing undertaken by nonprofit and for-profit developers, using data from New York City. To measure these benefits, we use increases in neighboring property values, estimated from a difference-in-difference specification of a hedonic regression model. We study the impacts of about 43,000 units of city-supported housing completed during the 1980s and 1990s, and our sample of property transactions includes nearly 300,000 individual sales. We find that both nonprofit and for-profit projects generate significant, positive spillover effects. This finding in itself is significant, given the widespread skepticism about the impact of subsidized housing on neighborhoods. We also find some differences across sectors. First, the impact of nonprofit housing remains stable over time, whereas the effect of for-profit housing declines with time. Second, while large for-profit and nonprofit developments deliver similar benefits, in the case of small projects, for-profit developments generate greater impacts than their nonprofit counterparts. These differences are consistent with theoretical predictions. In particular, in the presence of information asymmetries with respect to housing quality, the nondistribution constraint should lead nonprofits to deliver more durable housing, by softening incentives to shirk on quality and maintenance. Meanwhile, the fact that scale makes a difference to nonprofit impacts may reflect the capacity problems often faced by smaller nonprofits.

Accounting Fundamentals for Health Care Management is ideal for an introductory course in financial accounting in both undergraduate and graduate programs. This is the first book that focuses on basic accounting in health care management. This essential book contains the vocabulary of, and an introduction to, the tools and concepts employed by finance officers. It will help anyone assess financial information, ask the appropriate questions, and understand the jargon-laden answers. This book is indispensable for anyone who manages a department and a budget.

Four experiments and a correlational study explored the relationship between power and perspective taking. In Experiment 1, participants primed with high power were more likely than those primed with low power to draw an E on their forehead in a self-oriented direction, demonstrating less of an inclination to spontaneously adopt another person's visual perspective. In Experiments 2a and 2b, high-power participants were less likely than low-power participants to take into account that other people did not possess their privileged knowledge, a result suggesting that power leads individuals to anchor too heavily on their own vantage point, insufficiently adjusting to others' perspectives. In Experiment 3, high-power participants were less accurate than control participants in determining other people's emotion expressions; these results suggest a power-induced impediment to experiencing empathy. An additional study found a negative relationship between individual difference measures of power and perspective taking. Across these studies, power was associated with a reduced tendency to comprehend how other people see, think, and feel.

The article presents information on the role of power in negotiation. Power could generate competition or conflict in negotiations, however, effective channelization of power helps in bringing the win-win situation to both the parties. Social psychologists have described power as lack of dependence on others. Individuals possessing power tend to have the approach related to the behavior that includes positive mood or searching for rewards in their environment. On the other hand, powerless individuals show a great deal of self-inhibition and fear towards potential threats. INSETS: WOMEN: INCREASE YOUR POWER AT THE TABLE;POWER ACROSS CULTURES.

More and more, healthcare providers are committing to evidenced-based clinical practice as a rational way to deliver care. Rather than make decisions anecdotally, clinicians find that the addition of research provides statistical evidence for their decisions, and thus should result in better, more consistent care. But, what about management decisions? Shouldn't evidence also be sought by hospital executives before making strategic decisions that will affect their organizations? Do not these decisions also affect the quality and safety of patient care? And if so, what is preventing executives from using such evidence before making these decisions? This issue of Frontiers explores these questions from both the research and practitioner points of view. In the feature article, "Evidence-Based Management Reconsidered," Anthony Kovner, PhD (professor of health policy and management at New York University), and Thomas Rundall, PhD (professor of organized health systems at University of California-Berkeley), make the case for why evidence-based health services management (EBHSM) can and should be used. Kovner and Rundall suggest that EBHSM can be applied to core business transactions, as well as to operational and strategic management, and they elaborate on a five-step process for making that happen. Acknowledging that there is little use of the EBHSM approach in the field today, the authors recommend strategies to facilitate greater use of this model.

The three commentaries explore the issues raised in the above articles. All of the authors agree that evidence-based management is an idea whose time has come. From all the "evidence," it has become clear that more often than not clinical errors occur as a result of a system failure-management-type decisions made without the proper knowledge and information. So, what will it take to get EBHSM implemented throughout healthcare? Hopefully, some of the ideas and strategies presented in this issue will get us closer to that goal.

Objective: To use publicly available secondary data to assess the impact of Brazil's Family Health Program on state level infant mortality rates (IMR) during the 1990s.

Design: Longitudinal ecological analysis using panel data from secondary sources. Analyses controlled for state level measures of access to clean water and sanitation, average income, women's literacy and fertility, physicians and nurses per 10 000 population, and hospital beds per 1000 population. Additional analyses controlled for immunisation coverage and tested interactions between Family Health Program and proportionate mortality from diarrhoea and acute respiratory infections.

Setting: 13 years (1990-2002) of data from 27 Brazilian states.

Main results: From 1990 to 2002 IMR declined from 49.7 to 28.9 per 1000 live births. During the same period average Family Health Program coverage increased from 0% to 36%. A 10% increase in Family Health Program coverage was associated with a 4.5% decrease in IMR, controlling for all other health determinants (p<0.01). Access to clean water and hospital beds per 1000 were negatively associated with IMR, while female illiteracy, fertility rates, and mean income were positively associated with IMR. Examination of interactions between Family Health Program coverage and diarrhoea deaths suggests the programme may reduce IMR at least partly through reductions in diarrhoea deaths. Interactions with deaths from acute respiratory infections were ambiguous.

Conclusions: The Family Health Program is associated with reduced IMR, suggesting it is an important, although not unique, contributor to declining infant mortality in Brazil. Existing secondary datasets provide an important tool for evaluation of the effectiveness of health services in Brazil.

Today's healthcare IT departments are challenged with understanding the total service demand imposed by their user communities and how much of their limited resources are available to meet that demand.This challenge is being addressed through the use of new IT management and governance (IT-MG) systems.This software supports IT governance and project and portfolio management. IT-MG is a relatively new term to healthcare; it entails reviewing and managing demand for IT services from inception to completion through the application of IT resources. These systems help save time through automated reporting and quicker delivery of services; they save money by more effectively addressing resource needs
on time and on budget.The systems also reduce the number of administrative tasks through process automation; increase customer satisfaction by communicating services and deliverables more quickly and accurately; and help executives make better and more informed decisions about priorities and expectations through reporting that was previously nonexistent.This article will explore IT-MG systems and present a case study of a hospital that rapidly implemented this type of system.

The Robert T. Stafford Disaster Relief and Emergency Assistance Act (the Stafford Act) is the principal legislation governing the federal response to disasters within the United States. The act spells out - among other things - how disasters are declared, the types of assistance to be provided, and the cost sharing arrangements between federal, state, and local governments. The Federal Emergency Management Agency (FEMA) is the primary federal agency responsible for responding to disasters within the United States, carrying out the provisions of the Stafford Act, and distributing assistance provided by the act. The Stafford Act establishes two incident levels - emergencies and major disasters. Emergencies tend to be smaller events where a limited federal role will suffice. Major disasters are larger events - but this can run the gamut from a blizzard in Buffalo to a major earthquake in southern California that affects millions. In other words, no distinction, and no special response, is provided in the Stafford Act following catastrophes such as major earthquakes and hurricanes. The Stafford Act should be amended to establish a response level for catastrophic events. The Stafford Act does not adequately recognize 21st century threats. For example, the definition of a major disaster does not cover chemical, biological, radiological, or nuclear attacks or accidents. The act should further be amended to encompass 21st century threats.
This report does not focus on the performance of government agencies immediately following a disaster- these have been well documented by others. Rather, this report focuses on the federal role in the long-term recovery and rebuilding process following catastrophes, and what can be done to improve the effectiveness of the federal government in aiding these efforts.

This paper contributes to the literature on information systems in crisis management by providing an overview of
emerging technologies for sensing and recording sociological data about disasters. These technologies are transforming our capacity to gather data about what happens during disasters, and our ability to reconstruct the social dynamics of affected communities. Our approach takes a broad review of disaster research literature, current research efforts and new reports from recent disasters, especially Hurricane Katrina and the Indian Ocean Tsunami. We forecast that sensor networks will revolutionize conceptual and empirical approaches to research in the social sciences, by providing unprecedented volumes of high-quality data on movements, communication and response activities by both formal and informal actors. We conclude with a set of recommendations to designers of crisis management information systems to design systems that can support social science research, and argue for the inclusion of post-disaster social research as a design consideration in such systems.

The intellectual property system has fostered many debates, including recent ones, regarding how the system affects access to knowledge. Yet, before one can access, one must preserve. Two interconnected problems posed by the growth of online creation illustrate the predicament. First, unlike analog creations, important digital creations such as e-mails and word-processed documents are mediated and controlled by second parties. Thus, although these creations are core intellectual property, they are not treated as such. Service providers and software makers terminate or deny access to people’s digital property all the time. In addition, when one dies, some service providers refuse to grant heirs access to this property. The uneven and unclear management of these creations means that society will lose access to perhaps the greatest chronicling of human experience ever. Accordingly, this Article investigates and sets forth the theoretical foundations to explain why and how society should preserve this property. In so doing the Article finds that a second problem, which can be understood as one of control, arises.

This Article is the first in a series of works aimed at investigating the nature and extent of control one may have or exert over a work. As such, this Article begins the project by examining the normative theories behind creators’, heirs’, and society’s interests in the works. All three groups have interests in preservation, but the basis for the claims differs. In addition, an examination of the theoretical basis for these claims shows that the nature of the attention economy in conjunction with labor- and persona-based property theories support the position that in life a creator has strong claims for control over her intangible creations. Yet, the Article finds that historical and literary theory combined with recent economic theory as advanced by Professors Brett Frischmann and Mark Lemley regarding spillovers—positive externalities generated by access to ideas and information—reveals two points. First, these views support the need for better preservation of digital intellectual property insofar as it is infrastructure and has the potential for spillover effects. Second, although the creator may be best placed to manage and exert control of the works at issue, once the creator dies, literary, historical, and economic theory show that the claims for control diminish if not vanish. The explication and implications of this second point are explored elsewhere. This Article lays the groundwork for seeing that creators may need and have powerful claims for access and control over their works but that these same claims are necessarily limited by an understanding of the nature of creation and creative systems. The dividing line falls between life and death. The life and death distinction that this Article offers seeks to balance creators’ interests in control over a work and society’s interests in fostering later expressions and creations of new works. This Article examines the life side of the line.

In a critical examination of some of the most topical and challenging issues confronting the public sector in developing counties in an era of globalization, the contributors to this book examine the potential and limits of managerial, fiscal and decentralization reforms, and highlight cases where selective use of some of the new management reforms has delivered positive results. A common thread that runs through the book is the challenges of capacity to improve public services. Looking beyond the past and the present into the future, the book provides lessons from the experience of implementing public sector reforms in developing countries.

Federal social program evaluation has blossomed over the past quarter century. Despite this growth, there has been little accompanying public debate on research ethics. This essay explores the origins and the implications of this relative silence on ethical matters. It reviews the federal regulations that generally govern research ethics, and recounts the history whereby the evaluation of federal programs was specifically exempted from the purview of those regulations. Through a discussion of a recent evaluation that raised ethical concerns, the essay poses - but does not answer - three questions: (1) Are there good reasons to hold federal social program evaluations to different standards than those that apply to other research?; (2) If so, what ethical standards should be used to access such evaluations?; and (3) Should a formal mechanism be developed to ensure that federal social program evaluations are conducted ethically?

Written by an international panel of distinguished global health experts, this book distills valuable lessons from a wide variety of successful health programs that have been implemented around the world. "Global Health Leadership and Management gives practical suggestions for enhancing and developing the essential skills of leadership, management, communication, and project planning for health care leaders. The book will assist health leaders to work well within their communities and effectively plan, direct, implement, and evaluate effective programs and activities. "Global Health Leadership and Management outlines and describes such core competencies as Identifying challenges and developing and managing policy Developing strategies, pathways, and solutions Creating networks and partnerships and planning for change Learning from experience to build a generation of leaders Leading and managing teams by recognizing and celebrating success

A traditional view of scholarly quality defines rigor as the application of method and assumes an implicit connection with relevance. But as an applied field, public administration requires explicit attention to both rigor and relevance. Interpretive scholars' notions of rigor demand an explicit inclusion of relevance as an integral aspect of quality. As one form of interpretive research, narrative inquiry illuminates how this can be done. Appreciating this contribution requires a deeper knowledge of the logic of narrative inquiry, an acknowledgement of the diversity of narrative approaches, and attention to the implications for judging its quality. We use our story about community-based leadership research to develop and illustrate this argument.

Comments on the use of evidence-based approach in the area of health care financial management. Limitation of benchmarking; Barriers to the introduction of evidence-based financial management in health care; Responsibility of health care financial management educators.

This is one of the only books available that addresses financial and managerial accounting within the framework of the three major areas of the public sector. Clear and comprehensive, Finkler's unique and accessible text provides the fundamentals of financial management for those who lack a financial background so that readers can access and apply financial information more effectively. Details the many aspects of strategic and budgetary planning. Outlines the processes involved in implementing and controlling results. Features aspects of accounting unique for Health Care, not-for-profit organizations and state and local governments. Explains balance sheets, operating and cash flow statements. Provides basic foundation for financial analysis. For managers and policy-makers in public service organizations who want to make more efficient use of their organization's financial information.

In this article, I reflect on how my white racial identity shaped and, in turn, was shaped by my dissertation data collection. I identify specific choices and experiences in the research interviews that were influenced by my race, using data both from my own journal as well as feedback about my interviews from two informants of color. I also trace how conducting the interviews and writing about them in my journal affected how I make meaning of my racial identity. I offer these reflections as a contribution to two conversations, both related to exploring and learning about race. First, my discussion of how being white influenced my study contributes to important dialogues about how researcher identities reverberate through the research process. Second, my consideration of the change in my racial identity suggests implications for those interested in learning from and about race. Specifically, it suggests that whites must claim a voice on race in order to contribute meaningfully to cross-racial learning.

Implementation of anti-corruption programs is plagued by a paradox: the very actors posited to be the source of the problem are those most critical to implementation success. This paper presents a framework for understanding the large gaps that exist between policy intentions and outcomes in anti-corruption programs. It applies this to ‘grassroots democratization’ as an anti-corruption initiative in Vietnam, a high-profile policy mandating greater transparency in local budget use and participation in decisionmaking. Local leaders in this case face weak incentives for implementation that stem from both poor policy design and local institutional environments. But as with many anti-corruption programs in adverse environments, potential exists for the initiative to
provide tools with which reform-minded leaders and social groups can challenge local governance practices in unanticipated ways.

Health services research is, by nature, multidisciplinary, for it draws on the methods,concepts and theories of social sciences, which are relevant to the study of how the organization and financing of health services can improve the delivery of health care services (Gray, et al., 2003). While medicine and public health, too, are multidisciplinary enterprises drawing on such disciplines as molecular biology, physiology, anatomy, genetics, epidemiology and more, health services research departs from these disciplines in focusing not on the nature of disease and health but rather on the financing and organization of health systems.

So it is with urban health services research albeit that this field is more narrowly focused on health services in cities. The city focus has resulted in a large body of research on vulnerable groups, barriers to service access, public health clinics and community health centers. Likewise, it has led to important investigations of safetynet institutions, e.g. public hospitals and health centers, which serve a disproportionate share of uninsured and low-income patients. In addition, urban health services research has focused on a host of specific services associated with subpopulations suffering from TB, HIV/AIDS, drug addiction and other social pathologies that are typically associated with the "inner city."

Some of the highest rates of curable sexually transmitted diseases in the USA are found among adolescents. Routine, comprehensive health care that includes a sexual history may contribute to alleviating this problem. We designed and ran a three-session small-group workshop for adolescents, using local community organizations as intervention sites, with peers (typically 2-3 years older) helping facilitate the interactive sessions. Outcomes are summarized elsewhere: in this paper, we present an examination of theoretically based psychological mediating factors that we sought to influence during the intervention. Adolescents' health care-seeking beliefs, general attitudes to seeking care, and intentions to do so all changed such that they held more positive beliefs, evaluated health care more favorably, and developed stronger intentions to seek care. Furthermore, relationships among these constructs were strengthened according to theoretical precepts. Adolescents' self-efficacy and their perceptions of social norms pertaining to health care-seeking, however, were unaffected by the intervention. We explored gender differences in mediating factors, finding no interaction, although females did score higher on post-intervention attitude and intention measures.

Simply stated, health literacy is the ability to obtain, understand, and effectively use health-related information. In a recent report entitled "Health Literacy: A Prescription to End Confusion," the Institute of Medicine estimated that 90 million adults may lack the needed literacy skills to effectively use the U.S. health care system. Extrapolating from the National Adult Literacy Survey, approximately 36 percent of New York City adults would not be able to identify the name of a hospital in a short article; an additional 27 percent would not be able to fill out a standard health insurance form. Health care providers and patients typically do not identify low health literacy as a major issue, but both groups are well aware of its consequences. Health care professionals know they need improved communication with their patients so that they can better understand patient concerns and priorities, engage them as active partners in their care, improve their grasp of protocols for care management and the need for preventive care and screening, and ensure that they know when and where to seek care and how to navigate the health care system. Conversely, adults with low literacy skills often feel intimidated by the complexity of the health care system, by the forms and instructions, and by medical terminology. To avoid appearing ignorant, they may be hesitant to ask questions or express concerns, thereby compounding the problem. All of these difficulties are exacerbated when patients do not speak English well and are unfamiliar with the U.S. health care system.

The USA is deeply implicated in European dreams of a more perfect union. This chapter investigates three aspects of the European-American nexus. First, it focuses on the striking gap between politics and administration in contemporary Europe, and reflects on the implications for democracy. Second, it examines recent tensions between the USA and European governments, arguing that the source goes far deeper than the bare-knuckles diplomacy of the current Bush Administration. Finally, it examines the early history of US national unity as a model for European efforts.

Details the hospital experience of a health professional who underwent cardiac arterial bypass graft on the said urban medical center. Errors or potential errors that were cited in the way that ancillary staff, nurses and even some physicians failed in or neglected their responsibilities, both medical and humane; System failures observed, largely in the provision of nonclinical, so called hotel services; Possible cause of many of the problems identified.

How do we understand and also assess the health care of America? Where is health care provided? What are the characteristics of those institutions which provide it? Over the short term, how are changes in health care provisions affecting the health of the population, the cost of care, and access to care?

Health Care Delivery in the United States, 8th Edition discusses these and other core issues in the field. Under the editorship of Dr. Kovner and with the addition of Dr. James Knickman, Senior VP of Evaluation, Robert Wood Johnson Foundation, leading thinkers and practitioners in the field examine how medical knowledge creates new healthcare services. Emerging and recurrent issues from wide perspectives of health policy and public health are also discussed.

Whatever his legacy as an architect of the war in Iraq, Defense Secretary Donald Rumsfeld has already earned a place in American bureaucratic history as one of its most ambitious organizational reformers. Rumsfeld is determined to complete a top to bottom overhaul of his department before he leaves office. Rumsfeld may be one of history's most ambitious reformers, but his actual impact is far from assured. He still faces intense resistance from the armed services, especially the Army, which has the most to lose in the movement to a much lighter military. And many of his proposals are either still under consideration in Congress or only in the early stages of implementation in the department. This is very much Rumsfeld's revolution to win or lose it is highly dependent upon his congressional support, which has ebbed and flowed with the fortunes of war, on the urgency of the war on terrorism, which continues to fade with memories of September 11, and on his relationship with the armed services, which has been shaken by the controversy surrounding the equipping of U.S. troops in Iraq. It also depends on his public reputation, which has dropped in the wake of the prison abuse scandals at Abu Ghraib and Guantanamo Bay. In October 2001, for example, the Harris Poll reported that 78 percent of Americans rated Rumsfeld's job performance as excellent or pretty good; by June 2005, the percentage had fallen to just 42 percent.

The question for this paper is not whether social entrepreneurs exist, however, but whether the field of social entrepreneurship is too exclusive for its own good. The field has mostly defined social entrepreneurs as individuals who launch entirely new social-purpose nonprofit ventures. In doing so, the field may have excluded large numbers of individuals and entities that are equally deserving of the support, networking, and training now reserved for individuals who meet both the current definitional tests of a social entrepreneur and the ever-growing list of exemplars.
Not only does this definition deny the possibility that the intensity and quantity of social entrepreneurship might vary over time and across individuals and entities, it also substantially reduces the population of entrepreneurs who might form the basis for the kind of evidence-based, large-sample, control-group research needed to determine what truly matters to successful social entrepreneurship.

Four years after September 11th, public confidence in charitable organizations remains stuck at a contemporary low. According to a telephone survey of 1,820 randomly-selected Americans interviewed on behalf of NYU Wagner's Organizational Performance Initiative during the summer of 2005, confidence has held virtually constant since it bottomed out after months of controversy
surrounding disbursement of the September 11th relief funds. As of last summer, 15 percent of Americans said they had a great deal of confidence in charitable organizations, 49 percent said a fair amount, 24 percent said not too much, and 7 percent said none at all. Public views of how charitable organizations operate also remain unchanged. Only 19 percent of Americans said charitable organizations do a very good job running their programs and services, while just 11 percent said the same about spending money wisely. In addition, 66 percent of Americans said that charitable organizations waste a great deal or fair amount of money, while almost half said the leaders of charitable organizations are paid too much. If the past is prologue, these views will continue to drive higher levels of legislative and media scrutiny, which in turn, may further erode public confidence. The survey also suggests that rebuilding confidence must involve sustained investment in strengthening the capacity of charitable organizations to achieve measurable impacts toward their missions.

A summary and the reaction of ILO’s management to the report is accessible at http://www.ilo.org/public/english/standards/relm/gb/docs/gb294/pdf/pfa-8-2.pdf

Maintaining a vibrant field of public administration requires ongoing efforts to link the worlds of academic researchers and practitioners. We suggest that research itself, traditionally pursued by academics, is a promising mechanism for making this connection. In particular, researchers and practitioners in public administration can do research together in a way that enhances mutual learning, draws on the strengths of each to create useful knowledge of high quality, appreciates and tolerates of each others' worlds, styles, and contributions. Using research to promote connectedness means rethinking the roles that practitioners and academics play in generating knowledge in the field. In our project, insights from the assumptions and practices of narrative inquiry helped us to identify three research roles for practitioners: as sources of knowledge, as producers of knowledge, and as active consumers who inform the research process.

How do we understand and also assess the health care of America? Where is health care provided? What are the characteristics of those institutions which provide it? Over the short term, how are changes in health care provisions affecting the health of the population, the cost of care, and access to care? These core issues regarding our health policy are answered in this text.This is a textbook for course work in health care, the handbook for administrators and policy makers, and the standard for in-service training programs.

We tested the association between the availability of primary care and income inequality on several categories of mortality in US counties. Methods. We used cross-sectional analysis of data from counties (n=3081) in 1990, including analysis of variance and multivariate ordinary least squares regression. Independent variables included primary care resources, income inequality, and sociodemographics. Results. Counties with higher availability of primary care resources experienced between 2% and 3% lower mortality than counties with less primary care. Counties with high income inequality experienced between 11% and 13% higher mortality than counties with less inequality. Conclusions. Primary care resources may partially moderate the effects of income inequality on health outcomes at the county level.

Although political forces have largely driven decentralization in East Asia and most countries face similar reform challenges, their decentralization
experiences are far from uniform. Countries have adopted different intergovernmental structures,
proceeded at uneven paces, and adopted a wide range of implementation strategies. This diversity is not surprising, as East Asian countries vary greatly
in geographical size, population, history, economic structure, and political and institutional dynamics, all of which influence the form that decentralization
can and should take. This chapter provides expanded context for the analysis presented in chapter 1 and lays a foundation for later chapters. After reviewing the origins of decentralization, it compares the basic intergovernmental frameworks, structures, and processes
evolving in Cambodia, China, Indonesia, the Philippines, Thailand, and Vietnam.1 The chapter focuses, in turn, on enabling frameworks, the governance environment, fiscal decentralization, and the management and implementation of decentralization reforms.

Evidence of the health-promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system. This evidence shows that primary care helps prevent illness and death, regardless of whether the care is characterized by supply of primary care physicians, a relationship with a source of primary care, or the receipt of important features of primary care. The evidence also shows that primary care (in contrast to specialty care) is associated with a more equitable distribution of health in populations, a finding that holds in both cross-national and within-national studies. The means by which primary care improves health have been identified, thus suggesting ways to improve overall health and reduce differences in health across major population subgroups.

Analyses at the county level show lower mortality rates where there are more primary care physicians, but this is not the case for specialist supply. These findings confirm those of previous studies at the state and other levels. Increasing the supply of specialists will not improve the United States' position in population health relative to other industrialized countries, and it is likely to lead to greater disparities in health status and outcomes. Adverse effects from inappropriate or unnecessary specialist use may be responsible for the absence of relationship between specialist supply and mortality.

A growing body of research supports the role of outdoor air pollutants in acutely aggravating chronic diseases in children, and suggests that the pollutants may have a role in the development of these diseases. This article reviews the biologic basis of children's unique vulnerability to highly prevalent outdoor air pollutants, with a special focus on ozone, respirable particulate matter (PM 2.5 [<2.5 microm in diameter] and PM 10 [<10 microm in diameter]), lead, sulfur dioxide, carbon monoxide, and nitrogen oxides. We also summarize understanding regarding health effects and molecular mechanisms of action. Practitioners can significantly reduce morbidity in children and other vulnerable populations by advising families to minimize pollutant exposures to children with asthma, or at a broader level by educating policymakers about the need to act to reduce pollutant emissions. Management of children with asthma must expand beyond preventing exposures to agents that directly cause allergic reactions (and therefore can be diagnosed by means of skin tests) and must focus more attention on agents that cause a broad spectrum of nonspecific, generalized inflammation, such as air pollution.

To assess the cost-effectiveness of Intervention for HIV-Seropositive injection drug users-Research and Evaluation (INSPIRE), designed to reduce risky sexual and needle-sharing behaviors in research sites in four US cities (2001-2003). Methods: We collected data on program and participant costs. We used a mathematical model to estimate the number of sex partners of injection drug users expected to become infected with human immunodeficiency virus (HIV) (with and without intervention), cost of treatment for sex partners who became infected, and the effect of infection on partners' quality-adjusted life expectancy. We determined the minimum effect that INSPIRE must have on condom use among participants for the intervention to be cost-saving (intervention cost less than savings from averted HIV infections) or cost-effective (net cost per quality-adjusted life year saved less than $50,000). Results: The intervention cost was $870 per participant. It would be cost-saving if it led to 53 percent reduction in the proportion of participants who had any unprotected sex in 1 year and cost-effective with 17 percent reduction. If behavior change lasted 3 months, the cost-effectiveness threshold was 66 percent; if 3 years, the threshold was 6 percent. Conclusions: Although cost-saving thresholds may not be achievable by the intervention, we anticipate that cost-effectiveness thresholds will be attained.

Objectives. We evaluated the effectiveness of an intervention designed to increase preventive health care seeking among adolescents.

Methods. Adolescents and young adults aged 12 to 21 years, recruited from community-based organizations in 2 different communities, were randomized into either a 3-session intervention or a control condition. We estimated outcomes from 3-month follow-up data using logistic and ordinary least squares regression.

Results. Female intervention participants were significantly more likely than female control participants to have scheduled a health care appointment (odds ratio [OR]=3.04), undergone a checkup (OR=2.87), and discussed with friends or family members the importance of undergoing a checkup (OR=4.5). There were no differences between male intervention and male control participants in terms of outcomes.

Conclusions. This theory-driven, community-based group intervention significantly increased preventive health care seeking among female adolescents. Further research is needed, however, to identify interventions that will produce successful outcomes among male adolescents.

Diagnosing historical incidents of terrorism events within a risk management framework is an important tool for understanding the likelihood and form of future terrorist attacks and their consequences, particularly for critical infrastructure. Critical infrastructure is a key potential terrorism target, and government concerns are reflected in numerous laws and documents on critical infrastructure protection. Given the lack of historical precedent for infrastructure attacks in the U.S., other approaches to estimate consequences of attacks are needed to fill a critical knowledge gap. Using electric power as an example, databases of selected terrorist attacks on electric power infrastructure worldwide are evaluated to infer potential consequences of such attacks against U.S. electric power infrastructure. The focus is on electric power system components that are attacked, and consequences of outages from interdependencies with other infrastructure. In addition to analytical results, this work suggests a framework for a tool for decision-makers.

The usefulness of patient decision aids (PtDAs) is well documented, yet they are not in widespread use. Barriers include assuring balance and fairness (auspices matter), the cost of producing and maintaining them, and getting them into the hands of patients at the right time. The Foundation for Informed Medical Decision Making and its for-profit partner, Health Dialog, have developed a creative business model that helps overcome these barriers and has greatly expanded the reach of decision aids.

Like many schools of public policy and management, New York University's Wagner School offers a capstone course in which teams of MPA students provide consultation to client organizations, This year, as the they began to assign students to teams, some members of the faculty sounded an alarm. Several of the projects might involve interviewing service recipients about sensitive issues. Other projects would give teams access to confidential information. Faculty members experience with their university human subjects review board knew that such projects, where they to be undertaken in a research context, would require lengthy and cumbersome review. Did the capstone projects need to go through the human subjects review process? If the answer was yes, the program would come to a grinding halt, given the open-endness of a capstone assignments and the bureaucratic nature of the committee application and approval process.

The strategies and methods used by the New York Immigration Coalition (NYIC) are attracting increased attention for their sustainable collaborative systems that address critical social and economic needs. This case focuses on the evolution of NYIC's successful methods for building bridges across sectors and among a diverse group of immigrant communities, and the leadership approach that made it work.

For more than sixteen years, Jeffrey Hollender has presided over Seventh Generation, a world leader in manufacturing environmentally friendly, nontoxic household products. What Matters Most illuminates the successful practices of Seventh Generation-and many other pioneering companies around the world-to demonstrate the pragmatic aspects of a corporate strategy that hardwires social and environmental concerns into the company's culture, operating systems, and business relationships. It shows business leaders how to assess their own company's performance, adopt a socially responsible approach to doing business, and embark on a path of long-term growth.

An invisible network of digital technology systems underlies the highly visible networks of roads, waterways, satellites, and power-lines. Increasingly, these systems are becoming the "infrastructure's infrastructure," providing a crucial array of data on network demand, performance, reliability, and security. "Digital Infrastructures" presents an interdisciplinary analysis of the technological systems that envelop these networks. The book balances analyses of specific civil and environmental infrastructures with broader policy and management issues, including the challenges of using IT to manage these critical systems under crises conditions. "Digital Infrastructures" addresses not only the technological dimension but, importantly, how social, organizational and environmental forces affect how IT can be used to manage water, power, transport and telecommunication systems. The book is organized four sections. First, fundamental themes of policy, management, and technology are presented to frame the domain of digital infrastructures. Second, the way in which information technologies are applied in specific infrastructure sectors provides an in-depth assessment of what the advantages and disadvantages have been over time. Third, cross-cutting themes of economics, earth systems engineering, and international sustainability show how various systems perspectives approach some of the barriers to integrating information technology and infrastructure. Finally, the concluding section looks at some of the new directions and challenges being posed by issues such as security. "Digital Infrastructures" is the first integrated treatment of how IT technology is fundamentally affecting how critical infrastructures are managed. It is geared to provide the new infrastructure professional with state of the art concepts, methods, and examples for use in creating public policies, strategic plans, and new systems. It will be an essential book for upper level undergraduate and graduate courses in infrastructure management, critical infrastructure, environmental systems management, and management of IT systems.

Managers of a healthcare organization have numerous demands on their time, their skills, their knowledge, and their budgets. They are responsible for adapting to change, managing their office, making effective decisions, among countless other tasks.

This text�newly revised to include readings, commentary, and cases�offers a bridge from management theory to the actual world of healthcare management.

Throughout its past editions, Health Services Management has featured the best literature on health services management to help readers understand the role of the manager, organizational design and control, the blending of organization and health professionals, change (adaptation), and responsiveness (accountability). This new edition continues that effort, and features new readings.

The cases take place in a variety of organizations, including a faculty practice, a neighborhood health center, a small rural hospital, an HMO, as well as a variety of other settings.

Managers of a healthcare organization have numerous demands on their time, their skills, their knowledge, and their budgets. They are responsible for adapting to change, managing their office, making effective decisions, among countless other tasks. This text-newly revised to include readings, commentary, and cases-offers a bridge from management theory to the actual world of healthcare management that will help your students learn the role of manager in a healthcare organization.

Throughout its past editions, Health Services Management has featured the best literature on health services management to help learners understand the role of the manager, organizational design and control, the blending of organization and health professionals, change (adaptation), and responsiveness (accountability). This new edition continues that effort, and features new readings and classroom-tested cases.

The cases take place in a variety of organizations, including a faculty practice, a neighborhood health center, a small rural hospital, an HMO, as well as a variety of other settings. This book will prepare your future managers for the multitude of healthcare settings they could face in their careers.

The Commission has provided the essential outlines for strengthening our intelligence community and homeland security institution. It is now up to Congress and the president to exercise its judgment on whether and how to proceed, including areas that the Commission did not address.

This article is adapted from a new book by Paul Light entitled Sustaining Nonprofit Performance: The Case for Capacity Building and the Evidence to Support It, published in 2004 by the Brookings Institution Press.

Imagine a nonprofit's life as a journey up and down a development spiral. All organizations would start with a simple idea for some new program or service and then move up the spiral toward greater and greater impact, progressing through five landings, or stops, along the climb: (1) the organic phase of life, in which they struggle to create a presence in their environment; (2) the enterprising phase, in which they seek to expand their size and scope; (3) the intentional phase, in which they become focused more tightly on what they do best; (4) the robust phase, in which they strengthen their organizational infrastructure to hedge against the unexpected; and (5) the reflective phase, in which they address longer-term issues of succession and legacy.

The past half century has witnessed a slow, but steady thickening of the federal bureaucracy as Congress and presidents have added layer upon layer of political and career management to the hierarchy. The past six years have been no different. Despite the president's promise to bring business-like thinking to the federal government, the Bush administration has overseen, or at the very least permitted, a significant expansion in both the height and width of the federal hierarchy. There have never been more layers at the top of government, nor more occupants at each layer.

O objetivo da pesquisa foi adaptar e aplicar um instrumento para medir dimensões organizacionais do sistema de atenção básica no município de Petrópolis (RJ), comparando as dimensões organizacionais selecionadas em dois tipos de unidades: as do Programa Saúde da Família (PSF) e as Unidades Básicas de Saúde (UBS) tradicionais. A pesquisa utilizou a metodologia de informantes-chave. A ferramenta testada foi aplicada de forma rápida o que sugere que ela pode ser empregada nas avaliações regulares do desempenho das unidades. Conclui-se que apesar de Petrópolis ter realizado avanços importantes na atenção básica, enfrenta vários desafios, incluindo: melhorar acesso, reforçar o papel da atenção básica como porta de entrada no sistema, alcançar maior integralidade na atenção à saúde, melhorar a coordenação e aumentar a orientação para a comunidade.

Background: Retesting 3 to 4 months after treatment for those infected with chlamydia and/or gonorrhea has been recommended.

Goal: We compared various methods of encouraging return for retesting 3 months after treatment for chlamydia or gonorrhea.

Study: In study 1, participants were randomly assigned to: 1) brief recommendation to return, 2) intervention 1 plus $20 incentive paid at return visit, or 3) intervention 1 plus motivational counseling at the first visit and a phone reminder at 3 months. In study 2, participants at 1 clinic were randomly assigned to 4) intervention 1, 5) intervention 1 plus phone reminder, or 6) intervention 1 plus motivational counseling but no telephone reminder.

Results: Using multiple logistic regression, the odds ratios for interventions 2 and 3, respectively, compared with intervention 1 were 1.2 (95% confidence interval [CI], 0.6-2.5) and 2.6 (95% CI, 1.3-5.0). The odds ratios for interventions 5 and 6 compared with intervention 4 were 18.1 (95% CI, 1.7-193.5) and 4.6 (95% CI, 0.4-58.0).

Conclusions: A monetary incentive did not increase return rates compared with a brief recommendation. A reminder phone call seemed to be the most effective method to increase return.

The purpose was to examine attitudinal and contextual factors associated with the occurrence of sexual health assessments during adolescent primary care visits. A total of 313 primarily African-American youth aged 11-21 years from 16 community-based organizations in suburban Maryland and in New York City completed questionnaires focusing on sexually transmitted diseases (STD) and health care. The analysis examined the relationship of sexual activity, attitudes, and presence of the parent at the health care visit with discussion of three sexual health topics and testing for STD at the most recent health care visit. Data were analyzed using Chi-square tests and logistic regression. Overall, 74% of respondents reported that they had talked about at least one sexual health topic at their last health care visit but only 32% had discussed all three topics of sexual behavior, birth control, and STD. Females were more likely than males to discuss birth control although there were no gender differences in the overall likelihood of talking about a sexual health topic. Few adolescents initiated discussion of sexual issues. Positive attitudes toward discussing sexual issues with a provider and absence of a parent at the visit were independently associated with higher odds of discussing at least one sexuality topic and STD testing. Although relatively large numbers of adolescents in the sample received sexual health assessments, the proportion was below recommended guidelines. The opportunity to speak privately with a clinician and having positive attitudes about discussing sex with a doctor appear to be important influences on the receipt of sexual health assessments. Improving the quality of adolescent preventive care will require creating a health care environment that facilitates discussion of sexual health issues

An invisible network of digital technology systems underlies the highly visible networks of roads, waterways, satellites, and power-lines. Increasingly, these systems are becoming the "infrastructure's infrastructure," providing a crucial array of data on network demand, performance, reliability, and security. Digital Infrastructures presents an interdisciplinary analysis of the technological systems that envelop these networks. The book balances analyses of specific civil and environmental infrastructures with broader policy and management issues, including the challenges of using IT to manage these critical systems under crises conditions.

Digital Infrastructures addresses not only the technological dimension but, importantly, how social, organizational and environmental forces affect how IT can be used to manage water, power, transport and telecommunication systems. The book is organized four sections. First, fundamental themes of policy, management, and technology are presented to frame the domain of digital infrastructures. Second, the way in which information technologies are applied in specific infrastructure sectors provides an in-depth assessment of what the advantages and disadvantages have been over time. Third, cross-cutting themes of economics, earth systems engineering, and international sustainability show how various systems perspectives approach some of the barriers to integrating information technology and infrastructure. Finally, the concluding section looks at some of the new directions and challenges being posed by issues such as security.

Digital Infrastructures is the first integrated treatment of how IT technology is fundamentally affecting how critical infrastructures are managed. It is geared to provide the new infrastructure professional with state of the art concepts, methods, and examples for use in creating public policies, strategic plans, and new systems. It will be an essential book for upper level undergraduate and graduate courses in infrastructure management, critical infrastructure, environmental systems management, and management of IT systems.

The results-oriented management reforms fostered by the New Public Management movement are often argued to emphasize the search for efficiency, quality and other typical market values at the expense of democratic accountability. On the other hand, challenging this view, some authors claim that results-based management reforms have the potential to enhance political accountability and representative democracy. There is however, limited empirical evidence of this relationship. This article uses some of the findings from a comparative study of public management evaluation systems in four Latin American countries to illuminate this relationship in practice. We discuss the fact that, in two of the four countries surveyed, the design features of the new systems were based on the explicit search for increased political accountability and the deepening of democracy. We also discuss the possible causes for the finding that the outcome and performance information generated is not being applied for decision-making purposes yet, as expected.

Background: Gender disparities in the treatment of coronary artery disease (CAD) have been extensively documented in studies from the United States. However, they have been less well studied in other countries and, to our knowledge, have not been investigated at the more disaggregated spatial level of cities.

Objective: This study tests the hypothesis that there is a common international pattern of gender disparity in the treatment of CAD in persons aged ≥65 years by analyzing data from the United States, France, and England and from their largest cities-New York City and its outer boroughs, Paris and its First Ring, and Greater London.

Methods: This was an ecological study based on a retrospective analysis of comparable administrative
data from government health databases for the 9 spatial units of analysis: the 3 countries, their 3 largest
cities, and the urban cores of these 3 cities. A simple index was used to assess the relationship between
treatment rates and a measure of CAD prevalence by gender among age-adjusted cohorts of patients.
Differences in rates were examined by univariate analysis using the Student t test for statistical differences
in mean values.

Results: Despite differences in health system characteristics, including health insurance coverage, availability
of medical resources, and medical culture, we found consistent gender differences in rates of percutaneous
transluminal coronary angioplasty and coronary artery bypass grafting across the 9 spatial units.
The rate of interventional treatment in women with CAD was less than half that in men. This difference
persisted after adjustment for the prevalence of heart disease.

Conclusions: A consistent pattern of gender disparity in the interventional treatment of CAD was seen
across 3 national health systems with known differences in patterns of medical practice. This finding is
consistent with the results of clinical studies suggesting that gender disparities in the treatment of CAD
are due at least in part to the underdiagnosis of CAD in women.

Canada is the United State's strongest trading partner, exceeding trade with Mexico and with the European Union. On land, this trade flows through 22 principal border crossings between the United States and Canada, with 90% of the value and three-quarters of the tonnage and truck trips originating in or destined for locations beyond the border states. Three of the six crossings are in New York State. However, up to one-half of the trips originate in or are destined for locations beyond the border states. Thus, while they generate economic value nationally, the burdens they bring are concentrated in border states. Recognizing the significance of the border states and the need for transportation corridors throughout the country to facilitate the projected growth in trade, Congress established the Coordinated Border Infrastructure Program and the National Corridor Planning and Development Program in 1998. However, these programs have fallen short of their goals, principally as a result of under-funding and earmarking. If the current funding levels and practices of the Borders and Corridors Program continue, there is concern that freight volume at the key crossings in New York will continue to grow without the ability to effectively and efficiently service it. This study assesses the implications for New York State and for the country if New York's border and corridor needs are unmet.

Study objective: The study tests the extent to which primary care physician supply (office based primary care physicians per 10 000 population) moderates the association between social inequalities and infant mortality and low birth weight throughout the 50 states of the USA.

Design: Pooled cross sectional, time series analysis of secondary data. Analyses controlled for state level education, unemployment, racial/ethnic composition, income inequality, and urban/rural differences. Contemporaneous and time lagged covariates were modelled.

Setting: Eleven years (1985-95) of data from 50 US states (final n = 549 because of one missing data point).

Main results: Primary care was negatively associated with infant mortality and low birth weight in all multivariate models (p<0.0001). The association was consistent in contemporaneous and time lagged models. Although income inequality was positively associated with low birth weight and infant mortality (p<0.0001), the association with infant mortality disappeared with the addition of sociodemographic covariates.

Conclusions: In US states, an increased supply of primary care practitioners-especially in areas with high levels of social disparities-is negatively associated with infant mortality and low birth weight.

Indonesia is currently facing some severe challenges, both in political affairs and in economic management. One of these challenges is the recently enacted decentralization program, now well underway, which promises to have some wide-ranging consequences. This edited volume presents original papers, written by a select group of widely recognized and distinguished scholars, that take a hard, objective look at the many effects of decentralization on economic and political issues in Indonesia. There are many questions about this program: how will it be implemented, is there capacity at the local level to implement its reforms, is there sufficient local political accountability to make it work, and how will the decentralization affect the broader program of economic growth and stabilization? Topics covered include: the historical and political dimensions of decentralization, its macroeconomic effects, its effects on poverty alleviation, the assignment of expenditure and revenue functions across levels of government, the design of transfers, the role of natural resource taxation and the effects of local government borrowing. An authoritative, comprehensive collection, Reforming Intergovernmental Fiscal Relations and the Rebuilding of Indonesia will be of interest to economists and policy makers as well as students of public finance, development, and Asian economics.

An invisible network of digital technology systems underlies the highly visible networks of roads, waterways, satellites, and power-lines. Increasingly, these systems are becoming the ''infrastructure's infrastructure'' providing a crucial array of data on network demand, performance, reliability, and security. Digital Infrastructures presents an interdisciplinary analysis of the technological systems that envelop these networks. The book balances analyses of specific civil and environmental infrastructures with broader policy and management issues, including the challenges of using IT to manage these critical systems under crises conditions.

Digital Infrastructures addresses not only the technological dimension but, importantly, how social, organizational and environmental forces affect how IT can be used to manage water, power, transport and telecommunication systems. The book is organized four sections. First, fundamental themes of policy, management, and technology are presented to frame the domain of digital infrastructures. Second, the way in which information technologies are applied in specific infrastructure sectors provides an in-depth assessment of what the advantages and disadvantages have been over time. Third, cross-cutting themes of economics, earth systems engineering, and international sustainability show how various systems perspectives approach some of the barriers to integrating information technology and infrastructure. Finally, the concluding section looks at some of the new directions and challenges being posed by issues such as security.

Digital Infrastructures is the first integrated treatment of how IT technology is fundamentally affecting how critical infrastructures are managed. It is geared to provide the new infrastructure professional with state of the art concepts, methods, and examples for use in creating public policies, strategic plans, and new systems. It will be an essential book for upper level undergraduate and graduate courses in infrastructure management, critical infrastructure, environmental systems management, and management of IT systems.

An invisible network of digital technology systems underlies the highly visible networks of roads, waterways, satellites, and power-lines. Increasingly, these systems are becoming the "infrastructure's infrastructure," providing a crucial array of data on network demand, performance, reliability, and security. "Digital Infrastructures" presents an interdisciplinary analysis of the technological systems that envelop these networks. The book balances analyses of specific civil and environmental infrastructures with broader policy and management issues, including the challenges of using IT to manage these critical systems under crises conditions. "Digital Infrastructures" addresses not only the technological dimension but, importantly, how social, organizational and environmental forces affect how IT can be used to manage water, power, transport and telecommunication systems. The book is organized four sections. First, fundamental themes of policy, management, and technology are presented to frame the domain of digital infrastructures. Second, the way in which information technologies are applied in specific infrastructure sectors provides an in-depth assessment of what the advantages and disadvantages have been over time. Third, cross-cutting themes of economics, earth systems engineering, and international sustainability show how various systems perspectives approach some of the barriers to integrating information technology and infrastructure. Finally, the concluding section looks at some of the new directions and challenges being posed by issues such as security. "Digital Infrastructures" is the first integrated treatment of how IT technology is fundamentally affecting how critical infrastructures are managed. It is geared to provide the new infrastructure professional with state of the art concepts, methods, and examples for use in creating public policies, strategic plans, and new systems. It will be an essential book for upper level undergraduate and graduate courses in infrastructure management, critical infrastructure, environmental systems management, and management of IT systems.

An invisible network of digital technology systems underlies the highly visible networks of roads, waterways, satellites, and power-lines. Increasingly, these systems are becoming the "infrastructure's infrastructure," providing a crucial array of data on network demand, performance, reliability, and security. "Digital Infrastructures" presents an interdisciplinary analysis of the technological systems that envelop these networks. The book balances analyses of specific civil and environmental infrastructures with broader policy and management issues, including the challenges of using IT to manage these critical systems under crises conditions. "Digital Infrastructures" addresses not only the technological dimension but, importantly, how social, organizational and environmental forces affect how IT can be used to manage water, power, transport and telecommunication systems. The book is organized four sections. First, fundamental themes of policy, management, and technology are presented to frame the domain of digital infrastructures. Second, the way in which information technologies are applied in specific infrastructure sectors provides an in-depth assessment of what the advantages and disadvantages have been over time. Third, cross-cutting themes of economics, earth systems engineering, and international sustainability show how various systems perspectives approach some of the barriers to integrating information technology and infrastructure. Finally, the concluding section looks at some of the new directions and challenges being posed by issues such as security. "Digital Infrastructures" is the first integrated treatment of how IT technology is fundamentally affecting how critical infrastructures are managed. It is geared to provide the new infrastructure professional with state of the art concepts, methods, and examples for use in creating public policies, strategic plans, and new systems. It will be an essential book for upper level undergraduate and graduate courses in infrastructure management, critical infrastructure, environmental systems management, and management of IT systems.

In a world that continues to increase in size and complexity, the dependence on information technologies (IT) that drive our life support systems is growing rapidly. Few other technologies have spread as rapidly. This book addresses the pervasive influence that IT has had on infrastructure, namely transportation, water supply and wastewater management, energy, and telecommunications, and its users. This is especially timely in light of the growing need for critical policy, management and technological choices about the reliability and security of IT and infrastructure systems, and in particular what was deemed critical infrastructure by the President's Commission on Critical Infrastructure Protection in 1997 (US Department of Commerce, Critical Infrastructure Assurance Office 1997) and again in 2003 by the White House (White House 2003).

One of the challenges in monitoring the Nation's health care safety net is that safety net services are provided in a myriad of different configurations, largely at the local level. Book 1. Data for Metropolitan Areas presents data from 90 metropolitan areas in 30 States and the District of Columbia, including 354 counties and 171 cities. The data describe the health care safety net where 80 percent of Americans with family incomes below the Federal poverty line live.

Intelligent transportation systems (ITS) have gone beyond futuristic ideals and are becoming mainstream tools for managing highway and transit systems, as well as for providing information to the public. ITS has shown itself to be a cost-effective means for making best use of the current transportation system in an environment where the ability to expand capacity has become increasingly more difficult and expensive. There are several projects already in place at the regional level (e.g. E-ZPass, Transcom's IRVIN system, and MetroCard) and at the local level (e.g. sub-area traffic management centers and transit system real-time train information systems). More major ITS systems are expected in the next few years.

This reader uses an alternative approach to gender at work to provoke new thinking about traditional management topics, such as leadership and negotiation.Presents students with an alternative conceptual approach to gender in the workplace. Connects gender with other dimensions of difference such as race and class for a deeper understanding of diversity in organizations. Illustrates how traditional images of competence and the ideal worker result in narrow ways of thinking about work, limiting both opportunity and organizational effectiveness. Provokes new ways of thinking about leadership, human resource management, negotiation, globalization and organizational change.

This reader uses an alternative approach to gender at work to provoke new thinking about traditional management topics, such as leadership and negotiation. Presents students with an alternative conceptual approach to gender in the workplace. Connects gender with other dimensions of difference such as race and class for a deeper understanding of diversity in organizations. Illustrates how traditional images of competence and the ideal worker result in narrow ways of thinking about work, limiting both opportunity and organizational effectiveness. Provokes new ways of thinking about leadership, human resource management, negotiation, globalization and organizational change.

There is a growing movement toward evidence-based management in healthcare. This movement extends to healthcare financial management. However, there are barriers to the use of evidence by healthcare financial managers. These barriers are largely the result of culture (management culture is substantially different from clinical culture) and education. If healthcare financial managers are to become better at generating and using evidence, educators must do a better job of preparing them to do so. If we provide more education regarding the goals of research and about the different types of research methods, then healthcare financial managers can become educated consumers of evidence. If we provide more examples of evidence that has been generated by research in our classes, and if we give the students experience in gathering evidence, we have a chance of increasing the use of evidence-based management in healthcare.

In the present research, the authors examined the effect of a message recipient's power on attitude change and introduced a new mechanism by which power can affect social judgment. In line with prior research that suggested a link between power and approach tendencies, the authors hypothesized that having power increases confidence relative to being powerless. After demonstrating this link in Experiment 1, in 4 additional studies, they examined the role of power in persuasion as a function of when power is infused into the persuasion process. On the basis of the idea that power validates whatever mental content is accessible, they hypothesized that power would have different effects on persuasion depending on when power was induced. Specifically, the authors predicted that making people feel powerful prior to a message would validate their existing views and thus reduce the perceived need to attend to subsequent information. However, it was hypothesized that inducing power after a message has been processed would validate one's recently generated thoughts and thus influence the extent to which people rely upon their thoughts in determining their attitudes.

Highlights the "Agenda Setting for Health Care Management Research," conference held in New York City on January 23-24, 2003. Generating research funding; Barriers to using management research; Overcoming barriers to funding.

Testimony regarding the Bush Administration's competitive sourcing initiative, which promises to subject at least 50 percent of the Federal Activities Inventory Reform Act (FAIR Act) not-inherently governmental jobs up for competition by some as-yet-to-be-determined date.

It was twenty-five years ago that this Committee took up the Civil Service Reform Act of 1978. That statute reflected an effort to modernize a personnel system that had not been reformed since 1946, and addressed many of the issues embedded in this bill. Launched in a bipartisan spirit by the Carter-Mondale Administration, the act was designed to create a new era in human resources management. It contained new procedures for pay for performance, accelerated hiring, and waivers for experimentation. It also created the Senior Executive Service, and sought to modernize the outmoded job classification system that governed the hiring and promotion of civil servants.
It is time to pass this bill and begin the next generation of reform. Civil service reform is not a Democratic issue or a Republican issue; it is a good government issue. It should be designed first and foremost to assure that talented Americans have the chance to serve their country. As President Carter argued in 1977, the public deserves a government as good as its people. There is overwhelming empirical evidence that this proposal would advance that cause.

Reorganization offers a significant opportunity to align agencies by mission rather than constituencies. If done well it can strengthen accountability, reduce wasteful duplication and overlap, tighten administrative efficiency, improve employee motivation, and provide the kind of integration that leads to impact. The question before this Committee today is not whether reorganization can provide needed improvements in government performance, however, but whether Congress should give the President of the United States reorganization authority of some kind. Light believes the answer is absolutely yes, particularly if granted through the expedited model envisioned by the National Commission on the Public Service chaired by former Federal Reserve Board Chairman Paul
Volcker.

In all rich countries, firms organized on a not-for-profit basis produce cultural goods and services, along with for-profit firms (including independent professional artists) and the state. This is also true in many poorer countries. Non-profit firms are defined as organizations that have a formal structure and governance, which differ greatly among countries but share the characteristics that (1) the managers of the organization do not own the enterprise or have an economic interest that can be sold to other firms or individuals and (2) any surplus of revenue over expenditure may not be appropriated by the managers of the organization, but must be reinvested in ways that further the stated purposes of the organization. Obviously, such organizations will not be formed and continue to exist unless the organizers and managers expect and realize some economic rewards, including money compensation for their own services and non-financial rewards like consumption benefits (producing cultural goods and services that they want to enjoy but which will not be produced without their efforts) and personal status.

This article proposes a theory of how mandated institutional cooperation transforms into individual cooperative behavior. Using qualitative strategies, we draw insights about cooperation in three public-sector efforts of labor-management cooperation (LMC). We report an association between critical shifts in the roles of stakeholders and the change from adversarial to cooperative labor relations. While managers became team players along with their employees, labor representatives assumed managerial responsibilities. These changes were also associated with a service-oriented perspective, better understanding of the other's experiences, and a view of cooperation as partnership. At the heart of these transformations, we found critical changes in communication patterns associated with incrementally growing levels of trust. We propose a model that depicts the links between collective and individual levels of organizational action related to LMC. We conclude that the positive shifts in mental models regarding work and the value of cooperation justify the promotion of LMC efforts.

Public agencies have the mandate to consider the plurality of values, concerns and voices of the larger population in their work, as well as to include a wide variety of citizens in their workforce. When diversity is pursued as an organizational objective, more efficient management and the democratic values of responsiveness and representation in public administration are both said to be better achieved.

The public sector currently employs around 40 percent of all union members in the United States. Pressures for cost-effective and quality government services have placed new demands on the labor-management relationship. A fluctuating set of expectations about the appropriate responsibilities of government and a shifting political culture are severely testing the ability of the public sector to meet demands for increased accountability and expanded services. Especially in an age of knowledge workers, the traditional division between labor and management regarding leadership and work may no longer be viable. Going Public examines the forces affecting labor and management and the prospects for adopting service-oriented cooperative relationships as a key strategy for meeting the expanded demands on the public sector.

The management of international organizations is attracting growing attention. Most of this attention is highly critical of both the UN system and International NGOs. Sometimes, this criticism lacks depth or reflects insufficient understanding of these organizations, or is based on narrow, and sometimes biased, internal political concerns of a particular country. International relations theory has insufficiently studied the type of linkages that these organizations provide between international decision-making and Northern fundraising on the one hand, and practical action in the South on the other. As a result, current theory too rarely focuses on the inner functioning of these organizations and is unable to explain the deficiencies and negative outcomes of their work. While the authors identify and describe the pathologies of international organizations in, for example, international diplomacy, fundraising, and implementation, they also stress positive elements, such as their intermediary role. The latter form the basis for more efficient and effective policies and action that, in addition to some recent political trends also described in this volume, hold hope for a stronger functioning of these organizations in the future.

Studies over the last decade have demonstrated the effectiveness of public health interventions based on social and behavioral science theory for many health problems. Little is known about the extent to which health departments are currently utilizing these theories. This study assesses the application of social and behavioral science to programs in the New York City Department of Health (NYCDOH). Structured open-ended interviews were conducted with executive and program management staff of the health department. Respondents were asked about the application of social and behavioral sciences within their programs, and about the benefits and barriers to increasing the use of such approaches. Themes related to the aims of the study were identified, a detailed coding manual developed, narrative data were coded independently by two investigators (kappa.85), and data analyzed. Interviews were conducted with 61 eligible individuals (response rate 88%). The most common applications of social and behavioral science were individual-level behavior change to prevent HIV transmission and community-level interventions utilizing community organizing models and/or media interventions for health promotion and disease prevention. There are generally positive attitudes about the benefits of utilizing these sciences; however, there are also reservations about expanded use because of resource constraints. While NYCDOH has successfully applied social and behavioral sciences in some areas of practice, many areas use them minimally or not at all. Increasing use will require additional resources. Partnerships with academic institutions can bring additional social and behavioral science resources to health departments and benefit researchers understanding of the health department environment.

After the terrorist attacks on the World Trade Center in New York City on September 11, 2001, the ability to rapidly restore transportation, power, water, and environmental services to users was absolutely critical, especially to those involved in the immediate search, rescue, and recovery operations. What better way could infrastructure serve its users-both emergency workers and the general public-than to be able to respond quickly in a crisis? The ability to provide these services required a degree of flexibility, often unanticipated and unplanned, that only became apparent as the response efforts unfolded. The capability of basic infrastructure service providers to respond to public needs for transportation, energy, communication, water, sanitation, and solid waste removal after the September 11th attacks was to a great extent influenced by the flexibility of the initial infrastructure design and management functions to respond to normal system disruptions and to extreme, but not necessarily terrorist-related, events.

A major issue on the national agenda in the United Kingdom is how to improve public services. There is no single, simple solution. A serious commitment to that goal will require additional resources and innovative leadership that can use the funding wisely. Such an effort also will require new organizational forms for the delivery of services. Alternatives to both traditional public bureaucracies and for-profit businesses are likely to be an essential component of designs for more cost effective public services. The Public Management Foundation (PMF) in London is a ‘think tank' that has begun to address the emerging need for new organizational structures. Their suggestion is to develop an entity that they call a ‘public interest company' (PIC). Such a body is proposed as one of many ways to help improve services: ‘Our collective point is that the way in which the British system allows organisations to deliver public services has been too restrictive and a far wider variety of organisational forms for public service delivery needs to be encouraged. The public interest company will be just one of these.'

The purposes of this paper are to (1) review the 24-hour intake of a nationally representative sample of adolescents, (2) describe data from a 24-hour food intake record from a sample of adolescents with diabetes, and (3) discuss the implications of this nutritional information for diabetes health providers.

Issued in June, 2002, the report discusses major sources of mercury and methylmercury to the Harbor. It identifies pathways of mercury into the harbor, discusses environmentally sound and economically feasible strategies to avoid this pollution, and identifies the key players in implementing these strategies.

Discusses the challenges posed by incorporating Statement No. 34 of the U.S. Governmental Accounting Standards Board, Basic Financial Statements-and Management's Discussion and Analysis-for State and Local Governments (GASB 34) in the core curriculum of a school. Generally accepted accounting principles and GASB 34; Pedagogical issues in GASB 34; Dynamism in learning governmental accounting.

For all entrepreneurs and nonfinancial professionals with budget and/or P&L responsibilities, Finance and Accounting for Nonfinancial Managers provides the basics necessary to make a solid contribution to the financial goals and success of their companies. This indispensable and easy-to-read primer gives all entrepreneurs and managers in nonfinancial areas--sales, marketing, production, and more--a complete understanding of financial terms, statements, and ratios and how they affect the operations of a business or corporation. With this information, financial managers will be able to understand: owners' equity, ratio analysis; balance sheets; income statements; LIFO liquidations; asset valuation; cash flow statements; capital leasing; liabilities; present value; operating leverage; breakeven analysis; and more. New to the third edition are chapters covering: basic tax concepts; capital structure; business plans; working capital management and banking relationships; personal finances; and accountability and controls.

How do we understand and also assess the health care of America? Where is health care provided? What are the characteristics of those institutions which provide it? Over the short term, how are changes in health care provisions affecting the health of the population, the cost of care and access to care? These core questions regarding our health policy are answered in this text.

How do we understand and also assess the health care of America? Where is health care provided? What are the characteristics of those institutions which provide it? Over the short term, how are changes in health care provisions affecting the health of the population, the cost of care and access to care? These core questions regarding our health policy are answered in this text.

The nonprofit sector will survive the current weak economy because it has the most dedicated workforce in the nation. It is a workforce that comes to work in the morning motivated primarily by the chance to do something worthwhile, savoring the chance to make decisions on its own, take risks, and try new things, and puts mission above all else.

This collection of original manuscripts-representing a cross-section of the timeliest scholarship in public personnel administration-explores the theme of "problems and prospects" in public personnel administration. The contributions are organized into four broad sections: The Setting, The Techniques, The Issues, and Reform and the Future. Section One focuses primarily on the social, political, economic, and legal trends that have served as catalysts in the transformation of public personnel administration. Section Two is composed of selections that summarize developments in the practice of HRM, with special emphasis on emerging personnel techniques and the ways that traditional approaches to the staffing function are being revised. Section Three discusses and suggests responses to some of the most troublesome or pervasive issues in modern personnel management. The final section assesses the probable trends in the field's future, and analyzes the efficacy of recent reform efforts. For human resource personnel looking to broaden their perspective in the field.

Consumers dissatisfied with their health plan can either "exit" (switch service providers) or "voice" (complain to the current provider). Policymakers' efforts to help consumers voice their dissatisfaction to health plans or external mediators have been disappointing, in part because little is known about the determinants of voice. This article represents the first comprehensive assessment of voicing in response to problematic experiences with health plans. A national consumer survey from 1999 is used to test hypotheses about characteristics of problems, patients, and settings that might inhibit voice and assess state regulations intended to enhance voice. Although problems associated with plans led to more voice than exit, voice is circumscribed by several factors: certain groups, such as racial minorities, do not express their grievances as often; episodes with severe health consequences for patients are not reported as regularly. The findings suggest that even though regulatory initiatives have not increased the frequency of voice, they have made grievances more effective, at least in jurisdictions where citizens know about the laws.

This study assessed the effectiveness of a sexually transmitted disease (STD)/HIV behavior change intervention in increasing women's use of the female condom. Methods. A total of 604 women at high risk for STDs and HIV in New York City, Baltimore, Md, and Seattle, Wash, enrolled in a randomized controlled trial of a small-group, skills-training intervention that included information and skills training in the use of the female condom. Results. In a logistic regression, the strongest predictors of use were exposure to the intervention (odds ratio [OR] = 5.5; 95% confidence interval [CI] = 2.8,10.7), intention to use the female condom in the future (OR = 4.5; 95% CI = 2.4, 8.5), having asked a partner to use a condom in the past 30 days (OR = 2.3; 95% CI = 1.3, 3.9), and confidence in asking a partner to use a condom (OR = 1.9; 95% CI = 1.1, 3.5). Conclusions. Clinicians counseling women in the use of the female condom need to provide information, demonstrate its correct use with their clients, and provide an opportunity for their clients to practice skills themselves.

Community interventions are rare in the field of sexually transmitted disease (STD) control and prevention. The goals of the Gonorrhea Community Action Project are to design and implement interventions for the reduction of gonorrhea in high-prevalence areas and to increase the appropriateness and effectiveness of STD care in the participating communities. Key to conducting the formative research and developing the interventions was the creation of a community-academic-health department collaborative partnership. Using a staged model, this article presents a case study of collaboration development in the community of Harlem, New York.

This report recommends a comprehensive reassessment of federal health policies, programs, and processes, including federal-state roles and relationships, and some immediate actions to promote and protect the nation's health and to provide leadership in world health. The report concentrates on the challenges facing the secretary of the U.S. Department of Health and Human Services (DHHS) as the head of the lead health agency in the federal government. The federal government is responsible for five main functions related to health policy: financing; public health protection; collecting and disseminating information about U.S. health and health care delivery systems; capacity building for population health; and direct management of services.

Unlike the current categorical, or highly specialized, approach leading to policies and programs addressing the needs of a specific population, illness, or organizational constituency, a new, comprehensive approach to policy for the 21st century should promote coordinated efforts across programs in order to achieve three goals:

* create conditions that lead to longer, healthier lives for all Americans;
* eliminate health disparities;
* protect communities from avoidable health hazards and help them to address their own health problems.

Scholars may argue about the effectiveness of the "reinvention movement" at the state and federal level. At the local level, the managers of urban police forces have in fact reinvented American police administration, and in doing so have contributed to dramatic reductions in crime all across the nation. The story of this reinvention is complex, but central to it is a radical shift in the way police organizations strategically use information about performance to achieve greater managerial accountability. Because these new performance management techniques were pioneered in New York City in the mid-1990s, the development and implementation of Compstat by the New York City Police Department (NYPD) is a valuable case study of this new approach to policing.

Managers of a healthcare organization have numerous demands on their time, their skills, their knowledge, and their budgets. They are responsible for adapting to change, managing their office, making effective decisions, among countless other tasks.

This book, newly revised to include readings, commentary, and cases, offers a bridge from management theory to the actual world of healthcare management. Throughout its past editions, Health Services Management has featured the best literature on health services management to help readers understand the role of the manager, organizational design and control, the blending of organization and health professionals, change (adaptation), and responsiveness (accountability). This edition continues that effort, and features new readings.

This book helps nurses develop and refine good budgeting skills - a necessity in today's economy-driven health care system. Clearly written and thoroughly understandable, this new edition shows first-line nurse managers and their immediate supervisors how to work effectively with financial staff and management, and how to develop, monitor, and maintain departmental and institutional budgets. It is written at a level that assumes no previous financial management experience or expertise on the part of the reader.

One of the few books that addresses financial and managerial accounting within the three major areas of the public sector � government, health, and not-for-profit�the Second Edition provides the fundamentals of financial management for those pursuing careers within these fields. With a unique presentation that explains the rules specific to the public sector, this book outlines the framework for readers to access and apply financial information more effectively. Employing an engaging and user-friendly approach, this book clearly defines essential vocabulary, concepts, methods, and basic tools of financial management and financial analysis that are imperative to achieving success in the field. This book is intended for financial managers and general managers who are required to obtain, understand, and use accounting information to improve the financial results of their organizations, specifically within the areas of government or public policy and management, not-for-profit management, and health policy and management.

The superior performance of HMOs in providing preventive care--both in the population at-large (Miller and Luft, 1994), and within the elderly Medicare population (Ballard et al., 1997; Potosky et al., 1998; Retchin and Brown, 1990)--may be due to the favorable organizational, infrastructural, or cultural characteristics of managed care systems. For example, HMOs have historical roots in a health maintenance and wellness orientation (Lawrence, Mattingly, and Ludden, et al., 1997). HMOs also encourage patients to have a primary care provider, and they have been leaders in the use of technologies like computerized reminder systems, which are effective in promoting the regular use of preventive care services (Mandelson and Thompson, 1998). However, other factors may also contribute to HMO successes in the preventive care arena. Managed care enrollees typically face few financial barriers to care. To the extent that HMOs offer no-cost or low-cost preventive care services, and to the extent that cost is a barrier to receiving preventive care in the FFS sector, HMOs are likely to perform better. It is also possible that those who enroll in HMOs are attitudinally and behaviorally more receptive to preventive care. For example, some studies have found HMO enrollees to be better educated, healthier, and more optimistic about the benefits of preventive care than their FFS counterparts (Bernstein, Thompson, and Harlan, 1991; Porrell and Turner, 1990; Lichtenstein et al., 1992).

Focuses on the importance of adequate management information for the performance of hospital boards in the United States. Responsibilities of board members in healthcare organizations; Adaptation of organization mission and strategy; Key recommendations to board members and managers.

Managers of a healthcare organization have numerous demands on their time, their skills, their knowledge, and their budgets. They are responsible for adapting to change, managing their office, making effective decisions, among countless other tasks. This text-newly revised to include readings, commentary, and cases-offers a bridge from management theory to the actual world of healthcare management that will help your students learn the role of manager in a healthcare organization.

This book of updated cases emphasizes a manager's need for skills in strategy, operations, and relations. To aid both professors and students, the cases are divided into the same categories as are used in Health Services Management: Readings and Commentary, Seventh Edition: role of the manager, control, organizational design, professional integration, adaptation, and accountability. All of the cases have been tested in the classroom.

This book explores the role of community in facilitating the transition to market relationships in economic development, and in controlling and sustaining local public goods such as irrigation, forests, grazing land, and fishing grounds. Previously it was customary to classify economic systems in terms of varying combinations of state and market control of resource allocation. In contrast, this book recognizes community as the third major element of economic systems. This new approach also departs from the conventional view that markets and community norms should be treated as mutually exclusive means of organizing economic activity, instead clarifying the situations in which they may become complementary. Further discussion focuses on the conditions under which management of local commons can, and should, be delegated to local communities rather than subjected to the control of central government.

The new century has been marked by a generalized sense that traditional work arrangements are inadequate to address the challenges organizations encounter today. The shifts from an industrial to an information-based society, and from a manufacturing to a service economy, compounded by the forces of globalization, have propelled revolutionary changes on work place arrangements. These trends have affected work not only in industrialized societies, but in all nations. Many assumptions about how to best organize tasks and people - as well as the solutions to organizational problems based on those assumptions - do not seem to make sense any more. A paradigmatic shift is taking place in how we think about contemporary organizations and their governance.

In this paper I explore the managerial challenges posed by diversity in addressing traditional and new requirements for effective performance in public organizations. I survey the core dimensions, concepts and approaches to diversity in reference to organizations dependent of civil
service as their core employment system. In doing so, I expect to show that the mandate to manage diversity in the civil service cannot be based on a one-size-fits-all strategy (Mor Barak, 2000). Designing and implementing this agenda requires a deliberate and methodical managerial strategy that starts with a diagnosis of how diversity affects organizational performance. It
continues with an analysis of the extent to which civil service rules and regulations, its practices and the underlying managerial philosophies about people promote or inhibit public agencies to advance through what scholars call ‘the diversity continuum' (Minors, 1996; Ospina, 1996), from exclusionary to multicultural workplaces (Cox, 1993). Only considering the degree of diversity and the historical, political, cultural and economic contexts of public employment in a given jurisdiction, can a tailored diversity agenda work.
The paper is structured as follows. First, focusing on the conceptual foundations of the diversity agenda, I use organization and management theory to explore what is diversity and why it is an imperative for all organizations. In a transitional section, I then discuss the implications of ‘what' and ‘why', for the agenda of managing diversity. Third, moving into the world of practice, I provide an overview of diversity approaches and strategies, highlighting the benefits of systemic,
proactive strategies to diversity management in contemporary public organizations. I return in the conclusion to the implications of the approaches presented for managing diversity in civil service.

This paper considers recent thinking on and experience with decentralization and local government reform in developing countries, primarily from the perspective of national policy. The paper begins by reviewing why decentralization has re-emerged as an important development trend and considers whether this is sensible. The third section examines why recent attempts to decentralize have not been particularly successful.  The fourth section selectively summarizes a few experiences from the 1990s in which attempts were made to overcome common obstacles to decentralization. The paper closes with a few modest lessons for the design and implementation of decentralization and local government reform programs.

Performance measures are central to managing infrastructure assets, since they provide quantitative benchmarks and express values and preferences that are important for decision making. For example, one performance measure for decisions on upgrading an electrical power line is the improvement in service reliability, measured in terms of annual customer interruption hours. This paper first presents an overall framework for developing performance measures for infrastructure decision-making. The framework is then illustrated with an example that involves a decision of whether or not to place overhead power lines underground in order to improve performance measured as service reliability, health and safety, operation and maintenance cost, and impacts on property values.

The international scientific community has begun to focus upon the reality of global climate change and sophisticated research techniques provide increasingly accurate models of the potential impacts of associated weather extremes, disease outbreaks, and global and local environmental destruction. Yet decision-making institutions have not, for the most part, incorporated global climate change in their policies and planning efforts. This report presents the implications of climate change, thus far considered largely in a global context, in very local terms. As research and discussion of climate change begin to focus on anticipated regional impacts, decision-makers in the Metropolitan East Coast (MEC) Region and elsewhere should begin to consider and implement practical adaptation policies affecting land use, infrastructure, natural resource management, public health, and emergency and disaster response.

Objective. We sought to understand why certain Medicaid managed care organizations (MMCOs) implemented child development services or programs and how they had done so. We also sought to identify barriers and facilitators to successful initiation and implementation of child development programs.

Methods. We conducted 9 key informant interviews and 4 site visits, and performed qualitative analyses to identify major themes across responses.

Results. We identified a small number of MMCOs with child development services. High-level support was crucial for program initiation; physician buy-in, staff support, and strong working relationships with outside health professionals or agencies were principal factors in successful program implementation.

Conclusions. MMCOs that were committed to implementing child development services were successful in doing so, without external funding or regulatory mandate. The results provide valuable strategies for MMCOs interested in developing programs and for researchers and advocates interested in promoting child development services for low-income children. Key words: Medicaid managed care, child development services.

In the absence of universal coverage and an effective primary care delivery system for vulnerable populations, hospital emergency departments (EDs) are the ultimate safety net for many patients. This is especially true in New York City, where nearly 75 percent of ED visits in 1998 were for nonemergent care, or for emergent care that could have been treated in a doctor's office.1 Another 7 percent of visits required care in the ED, but were for potentially preventable conditions such as acute flare-ups of asthma or diabetes. New Yorkers who rely on EDs lack continuity in their health care and end up using costlier services. Why do so many patients depend on hospital emergency departments for primary care? Do they seek emergency care immediately, or do they have time and opportunity to obtain care at a doctor's office or neighborhood clinic? Do these patients have a usual source of care other than the ED? Do they have any contact with the health care system prior to their ED visit? Does insurance status, race, ethnicity, national origin, or gender have an influence on ED use?

To answer these questions, the Center for Health and Public Service Research at New York University conducted face-to-face interviews with 669 emergency department patients ages 18 to 55 at four hospitals in the Bronx.

The inability of the nation's health care delivery system to assure access to basic primary care services for large segments of the population has meant that hospital emergency departments (EDs) are the providers of first and last resort for millions of Americans. Individuals who cannot afford the cost of an office visit, or who are unwilling to wait for care in overcrowded and understaffed community clinics or hospital outpatient departments, rely on EDs for primary care. But reliance on the ED means patients lack continuity in their health care and use costlier services. Moreover, economic constraints cause many of the uninsured to delay seeking treatment until their medical condition has seriously worsened. Had they received treatment earlier in an ambulatory care setting, the trip to the ED might have been avoided.

For the uninsured and many low-income people, hospital emergency departments (EDs) are a crucial entryway to the health care system. New York City's uninsured-27 percent of the nonelderly population in 1998, up from 20 percent in 1990-rely heavily on the ED for their medical care. Residents who regularly get their health care at an ED do not have regular doctors or continuity in their care, use costlier services, and often receive treatment that could have been avoided. Low-income New Yorkers may be depending on emergency department care even more as Medicaid enrollment declines and physician reimbursement rates are cut. This Issue Brief describes patterns of ED use throughout
New York City and discusses some of the ways to improve the availability of primary care services and reduce ED dependency.

In recent years, it has become common for physicians to become managers of new programs and ventures. In some cases, the physician is acting as a manager of a large organization, such as a hospital, nursing home, or integrated delivery system. In other cases, the physician my be acting as an owner of a sole or group practice. In all cases, the physician decision maker needs tools to ascertain the likely profitability of the new programs and ventures. Break-even analysis can be a helpful tool in such situations.

Covering the financial topics all nurse managers need to know and use, this book explains how financial management fits into the healthcare organization. You'll study accounting principles, cost analysis, planning and control management of the organization's financial resources, and the use of management tools.

A letter to the editor and a response to the letter by Nancy L. Van Devanter about the shortage of public health professionals and the need to support efforts to enhance public health training are presented.

Learn the professional and personal skills necessary to succeed as a healthcare executive. This book covers everything from finding your niche to working with clinicians. Topics covered include: * Where health services managers work * How to build an ideal career * What skills make a good manager * How to manage physicians, boards, and others * How to advance within an organization and within the industry

Explores the concept of evidence-based management, demonstrates how it can enhance health management practice, and introduces an organizational structure for promoting the evidence-based approach. Challenge of making better-informed strategic decisions; Management research in healthcare; Approaches related to evidence-based management; Evidence-based management decision making; Case vignettes.

In Making Nonprofits Work, Paul C. Light charts the current trends of management reform in the nonprofit sector and assesses the climate for reform at the local and national levels.

Light examines the four popular philosophies, or "tides," being advocated- scientific management, liberation management, war on waste, and watchful eye-offering examples and caveats from a portfolio of recent experience. Drawing on confidential interviews with leaders in nonprofit management reform, a detailed search of Internet sources, and a survey of state associations of nonprofit organizations, Light's findings suggest that the nonprofit sector has a remarkable opportunity to prevent the excesses and fadism that have dominated reform efforts in government and the private sector. He cautions leaders in the nonprofit sector to recognize the limits of various reform models, to set priorities carefully, and to limit investments of reform energy to a handful of priorities. Finally, he urges reformers to boost the sector's ability to implement new systems and reforms by focusing more closely on capacity building.

For the first time in more than four decades, the federal budget has registered two consecutive surpluses, and the need to reduce the deficit is not casting a pall over the policy debate. This new, highly accessible book examines the policy options that are available in this new environment to address the new and recurring challenges that face the nation.

The book, which continues the Brookings Institution's highly acclaimed and influential Setting National Priorities series, will serve as a guide for understanding many of the complex issues that will be discussed during the presidential and congressional campaigns of 2000. The book centers around three themes: providing opportunity in the domestic arena, restoring confidence in government, and adapting to the post-Cold War international environment. It tackles such critical issues as Medicare and social security, tax reform, and foreign policy spending, as well as many area not included in previous editions; namely, education, urban problems, the environment, trade, government renewal and reform, crime and drugs, and families.

Increasingly, nonprofit, for-profits, and public organizations have been cooperating in producing and distributing a wide range of goods and services. In many cases, the partnerships have arisen from the recognition that different activities are best suited to different governance structures. Yet, working through a cross-sectoral partnership can bring with it complicated managerial issues. This article explores partnering in two important sectors: higher education and welfare reform. In both areas, cooperation across the sectors is widespread and follows lines of comparative advantage. At the same time, there is ample evidence in our cases of classic transactions costs in implementing cross-sectoral partnerships. The article explores ways in which organizations deal with problems of opportunism and imperfect information in contracting across the sectors.

Improvements in health care and declining birth rates have combined to create rapidly aging populations throughout the industrialized world. By 2020, for example, nearly seventeen percent of the US population is expected to be over the age of sixty-five. In Japan that mark has already been passed, with more than one-quarter of the population expected to be over sixty-five by 2020. At the same time, the world's population is increasingly concentrated in urban areas: the United Nations estimates that by 2025, sixty-one percent of the world's population will live in cities. As both urbanization and population aging increase, we will need models of how to accommodate this population shift and examples to emulate in dealing with these phenomena.

Thoroughly presents today's health care system, its administration and its dissemination.

Water pollution from agricultural pesticides continues to be a public concern. Given that the use of such pesticides on the farm is largely governed by voluntary behavior, it is important to understand what drives farmer behavior. Health belief models in public health and social psychology argue that persons who have adverse health experiences are likely to undertake preventive behavior. An analogous hypothesis set was tested here: farmers who believe they have had adverse health experiences from pesticides are likely to have heightened concerns about pesticides and are more likely to take greater precautions in dealing with pesticides. This work is based on an original survey of a population of 2700 corn and soybean growers in Maryland, New York, and Pennsylvania using the U.S. Department of Agriculture data base. It was designed as a mail survey with telephone follow-up, and resulted in a 60 percent response rate. Farm operators report experiencing adverse health problems they believe are associated with pesticides that is equivalent to an incidence rate that is higher than the reported incidence of occupational pesticide poisonings, but similar to the reported incidence of all pesticide poisonings. Farmers who report experiencing such problems have more heightened concerns about water pollution from fertilizers and pesticides, and illness and injury from mixing, loading, and applying pesticides than farmers who have not experienced such problems. Farmers who report experiencing such problems also are more likely to report using alternative pest management practices than farmers who do not report having such problems. This implies that farmers who have had such experiences do care about the effects of application and do engage in alternative means of pest management, which at least involve the reduction in pesticide use.

According to Paul C. Light's controversial new book, The New Public Service, this January's 4.8 percent federal pay increase will do little to compensate for what potential employees think is currently missing from federal careers. Talented Americans are not saying "show me the money" but "show me the job." And federal jobs just do not show well.

All job offers being equal, Light argues that the pay increase would matter. But all offers are not equal. Light's research on what graduates of the top public policy and administration graduate programs want indicates that the federal government is usually so far behind its private and nonprofit competitors that pay never comes into play.

Light argues that the federal government is losing the talent war on three fronts. First, its hiring system for recruiting talent, top to bottom, underwhelms at almost every task it undertakes. Second, its annual performance appraisal system so inflated that federal employees are not only all above average, they are well on their way to outstanding. Third and most importantly, the federal government is so clogged with needless layers and convoluted career paths that it cannot deliver the kind of challenging work that talented Americans expect.

None of these problems would matter, Light argues, if the government-centered public service was still looking for work. Unfortunately, as Light's book demonstrates, federal careers were designed for a workforce that has not punched since the 1960s, and certainly not for one that grew up in an era of corporate downsizing and mergers. The government-centered public service is mostly a thing of the past, replaced by a multisectored public service in which employees switch jobs and sectors with ease.

Light concludes his book by offering the federal government a simple choice: It can either ignore the new public service and troll further and further down the class lists for new recruits, while hoping that a tiny pay increase will help, or it can start building the kind of careers that talented Americans want

This book addresses a seemingly simple question: Just how many people really work for the federal government? Official counts show a relatively small total of 1.9 million full-time civil servants, as of 1996. But, according to Paul Light, the true head count is nearly nine times higher than the official numbers, with about 17 million people actually providing the government with goods and services. Most are part of what Light calls the "shadow of government"-nonfederal employees working under federal contracts, grants, and mandates to state and local governments. In this book--the first that attempts to establish firm estimates of the shadow work force-- he explores the reasons why the official size of the federal government has remained so small while the shadow of government has grown so large.

Light examines the political incentives that make the illusion of a small government so attractive, analyzes the tools used by officials to keep the official headcount small, and reveals how the appearance of smallness affects the management of government and the future of the public service. Finally, he points out ways the federal government can better manage the shadow work force it has built over the past half-century.

Without discounting the significant downsizing that has occurred, only one of the two ingredients for a leaner, more efficient government is in place. The girth of government-measured by the total number of federal employees-may be shrinking, but its height-measured by the management tiers between the top and bottom-continues to climb. Every year fewer front-line employees are reporting upward through what appears to be an ever-lengthening chain of command.

Objective
To assess the extent of physical disability in juvenile rheumatoid arthritis (JRA), classified according to subtype, and whether synovitis or flexion contractures are present on examination.

Methods
This retrospective study included 88 JRA patients and 50 controls without musculoskeletal disease. The outcome measure was the disability index (DI) derived from the Childhood Health Assessment Questionnaire (CHAQ).

Results
DI scores for JRA patients with synovitis (mean 0.49, range 0-1.88) and without synovitis (mean 0.37, range 0-1.75) were significantly higher (P < 0.001 for both groups) than for controls (mean 0.06, range 0-0.75, P < 0.001), but not significantly different from one another. Similarly, DI scores for JRA patients with and without any flexion contractures were higher than for controls, but not significantly different from one another. DI scores for JRA patients with both synovitis and flexion contractures were significantly higher than DI scores for JRA patients with neither, but were not distinguishable from JRA patients with synovitis only or flexion contractures only. Likewise, DI scores for JRA patients lacking synovitis and flexion contractures were not significantly different than those for JRA patients with one or the other. DI scores for systemic and polyarticular patients were higher than for pauciarticular patients, and DI scores for all 3 subtypes were higher than for controls.

Conclusion
Our findings suggest that many JRA patients, including those with pauciarticular JRA, have problems with physical function, even when synovitis and flexion contractures are not present. Further attention and research is needed to elucidate the causes or origins of disability in JRA patients with seemingly well-controlled disease. We recommend that health status instruments like the CHAQ be more widely used for JRA patients to complement other assessments, especially in planning occupational and physical therapy.

Presents a case study of a managerial training program implemented in a large nonprofit organization. Suggestion that human resources managers can enhance the effectiveness of managerial training programs by providing opportunities for horizontal and vertical integration; Consequences of implementing this approach, including an expanded communications process and bonding between team members.

Italian Statistical Association, 1999.

Study objectives: The purpose of this study was to confirm the validity of a brief screen for pediatric asthma in schools.

Background: Asthma is the most common chronic disease of childhood, yet the frequency with which this condition is recognized among school-aged children varies widely. Several methods are used to increase the accuracy of detection of asthma, but many are cumbersome and difficult to apply on a large scale.

Design: We elected to validate a five-question instrument, the Brief Pediatric Asthma Screen (BPAS), to screen for the presence of asthma among children attending school in Region 5 of the Chicago school district, where the schools report a 2.7% frequency of asthma. The questionnaire was distributed to the parents of grade-school children at the time of report-card pick-up.

Setting: A clinical assessment was performed on a selected group of children whose parents completed the questionnaire in a school and in a hospital outpatient clinic.

Participants: Of 4,147 questionnaires that we distributed, 1,796 (43%) were returned. We excluded 341 children (19% of the total sample) whose parents reported that they had been diagnosed with asthma. The remaining pool indicated that the children of 183 responders (10%) had symptoms suggestive of asthma, while 1,272 parents (71%) indicated that their children did not have symptoms of asthma.

Measurements and results: We selected 90 of the respondents who did not indicate that their children had a diagnosis of asthma. Of this group, 81 completed the validation, in which their responses suggested symptoms of asthma (n = 34) or no asthma symptoms (n = 47). The children of these respondents were given a blinded clinical evaluation consisting of history, physical examination, and spirometry. The survey demonstrated a sensitivity of 75% and a specificity of 81.2% for the presence of asthma among those who were unaware of the diagnosis.

Conclusions: The BPAS is brief, can be filled out by parents, and appears accurate in detecting asthma.

To determine the effects of aspects of residency training on AIDS-related treatment practices. METHOD: The authors conducted a nationwide longitudinal panel study of 394 physicians who graduated in 1989 from six medical schools in New York State. Data were collected during the participants' fourth year of medical school, their third year of residency training, and six years after they had graduated from medical school. Questionnaires sought information about AIDS-related practice behaviors, including avoiding invasive procedures, minimizing contact, emphasizing AIDS prevention and education, and volume of people with AIDS treated. RESULTS: Aspects of residency training had a sustained impact on how the physicians cared for patients with AIDS but not on the numbers of patients they treated. Determinants of treatment practices included aspects of the residency environment (e.g., emphasis on problem solving, student orientation; p < .01), characteristics of the faculty (e.g., commitment to teaching, tolerance of varied viewpoints), cynicism about patient care (p < .001), social biases (homophobia and aversion to intravenous drug users; p < .001), and AIDS-related attitudes (p < .01). CONCLUSIONS: Fundamental changes to residency training, all of which are associated with learner-centered education, can improve physicians' treatment of their patients with HIV and AIDS.

Natural Disaster Management was produced to mark the end of the International Decade for Natural Disaster Reduction (IDNDR), a United Nations initiative to reduce the negative effects of natural disasters. Natural Disaster Management communicates solutions to the problems associated with natural disasters, stimulating discussion and improvements in methods of protecting people and property. The volume includes contributions from over 100 experts in hazard observation and helps to raise the profile of the IDNDR initiative, bringing issues concerning natural disaster management to a wider audience.

This book is a collection of 18 essays by health services researchers that analyze Medicaid managed care, its historical context, its implementation in several states, its applicability to disabled and other special needs populations, and its potential for monitoring quality and provider performance.

The infrastructure of the Metro East Coast region (MEC, with New York City at its core) is the largest, oldest, densest, and busiest in the nation. It serves some 20 million people and built assets exceed $1 trillion. Currently there is considerable stress on the system with key problems identified as: undercapacity, underinvestment, inconsistent management suburban sprawl, and lack of long-term integrated region-wide planning. These problems are exacerbated by fragmentation of governance across competing jurisdictions. Unclear funding mechanisms, spotty economic performance, and deferred infrastructure maintenance are severe stress factors. Spatial and functional inter-connectedness between different types of infrastructure allows failures to cascade through the system - at times even shutting down substantial segments, all at a high societal cost. A special problem is lack of a farsighted solid waste management strategy. Despite these severe stresses, the system somehow manages to deliver essential services to a large population.

Any organization can innovate once. The challenge is to innovate twice, thrice, and more?to make innovation a part of daily good practice. This book shows how nonprofit and government organizations can transform the single, occasional act of innovating into an everyday occurrence by forging a culture of natural innovation.

Filled with real success stories and practical lessons learned, Sustaining Innovation offers examples of how organizations can take the first step toward innovativeness, advice on how to survive the inevitable mistakes along the way, and tools for keeping the edge once the journey is complete.

Light also provides a set of simple suggestions for fitting the lessons to the different management pressures facing the government and nonprofit sector. Unlike the private sector, where innovation needs only to be profitable to be worth doing, government and nonprofit innovation must be about doing something worthwhile. It must challenge the prevailing wisdom and advance the public good. Sustaining Innovation gives nonprofit and government managers a coherent, easily understood model for making this kind of innovation a natural reality.

Explains several accounting approaches for healthcare organizations planning to acquire physician and ambulatory care practices. Acquisition arrangements; Historical cost; Constant dollar value; Replacement/economic cost; Opportunity-cost approach; Income approach; Enhancement opportunities.

To develop and validate a measure of contemporary life stressors. STUDY SETTING: Three interview studies: Study 1 (pilot), 32 caregivers receiving case management services for a child with chronic illness; Study 2 (validation), 311 caregivers of children receiving general pediatric care at a university clinic; Study 3 (reliability), 17 caregivers of children with a complex medical diagnosis. STUDY DESIGN: Study 1: item development via discussions with case managers; piloted with caregivers. Study 2 examined psychometric properties of the measure and correlated it with the CES-D, a measure of depressive symptomatology and the PRQ85-Part 2, a measure of perceived social support, to establish its convergent construct validity. Study 3 established the test-retest reliability of the measure over two weeks by correlating two administrations of the index. DATA COLLECTION: Face-to-face interviews in homes (Study 1) or in clinic waiting rooms (Studies 2 and 3) and by telephone (Study 3 retest). PRINCIPAL FINDINGS: The CRISYS is a flexible, multidimensional tool that demonstrates strong face, content, and construct validity, and excellent test-retest reliability. The format is easy to use and well accepted by respondents and is suitable for low-income populations. CONCLUSIONS: Researchers will find the CRISYS useful when evaluating the success of a clinical model or a healthcare system, and the effectiveness of an insurance plan or a government program. Clinicians may also find that the CRISYS is an effective screen for family needs.

Explores approaches in improving the effectiveness of nonprofit hospitals' boards of trustees as shown by the Alpha Health Care System and Beta Hospital. Kellogg project on effective governance; Factors influencing changes; Board assessment; Initiation of board development; Importance of time management; Chief executive officer's support to strengthen board effectiveness.

The past six decades have witnessed acceleration in both the number and variety of major administrative reform statutes enacted by Congress. This increase can be explained partly by the increased involvement of Congress, a parallel decrease in activity and resistance by the presidency, and heightened public distrust toward government. At least part of the variation in the tides or philosophies of reform involves a "field of dreams" effect in which the creation of new governmental structure during the 1940s, 1950s, and 1960s generated increased interest in process reforms. However, part of the acceleration and variety of reform appears to be related to the lack of hard evidence of what actually works in improving government performance. Measured by federal employees' perceptions of organizational performance, what matters most is not whether organizations were reformed in the past, but whether organizations need reform in the future and can provide essential resources for achieving their mission.

This article explores public-sector succession in the U.S. Most literature on succession and succession planning begin with a familiar lament: executive-level transition merits more attention than it gets in the literature. It is a serious matter that succession planning in the public sector, especially below the presidential level, has not received much attention in the literature. However, a more critical issue is that it has not received much attention in the actual world of public service. This omission, in part, reflects the fact that leaders in the public sector have themselves not taken the issue of succession planning seriously, except for obvious concerns like elections and mandates. Doing strategic executive searches in the public sector is difficult, but that is a secondary factor. What is primary is changing public-sector culture so that focusing on succession and beyond becomes a hallmark of strategic leadership. There are actually two challenges to managing succession: technology and turbulence. Public-sector leaders have limited access to search technology and search firms; they may not even understand the steps in a strategic search process. Public-sector leaders too often allow the turbulence to limit their scope of action, whereas private-sector leaders are expected to manage the turbulence.

In a randomised clinical trial, quality of health care as reflected in patient outcomes and cost of health care was compared between two groups of high-risk childbearing women: women diagnosed with diabetes or hypertension in pregnancy. The control group was discharged routinely from the hospital. The intervention group was discharged early using a model of clinical nurse specialist transitional follow-up care. During pregnancy, the intervention group had significantly fewer rehospitalisations than the control group. For infants of diabetic women enrolled in the study during their pregnancy, low birth weight was three times more prevalent in the control group than in the intervention group. The postpartum hospital charges for the intervention group were also significantly less than for the control group. The mean total hospital charges for the intervention group were 44 percent less than for the control group. The mean cost of the clinical specialist follow-up care was two percent of the total hospital charges for the control group. A net savings of $13,327 was realised for each mother-infant dyad discharged early from the hospital.

This book bridges the gap between the many different disciplines used in applications of risk analysis to real world problems. Contributed by some of the world's leading experts, it creates a common information base and language for all risk analysis practitioners, risk managers, and decision makers. Valuable as both a reference for practitioners and a comprehensive textbook for students, Fundamentals of Risk Analysis and Risk Management is a unique contribution to the field. Its broad coverage ranges from basic theory of risk analysis to practical applications, risk perception, legal and political issues, and risk management.

Reports on the rates of preventable hospital admissions among low-income populations in the United States even with the efforts of improving primary health care. Comparison of low-income populations health outcomes between U.S. and Canada; Implications of results for U.S. policy makers.

Discusses the importance of case discussion teaching method in training professionals on public policy. Analysis and action cycle; Experience with issues of risk and uncertainty; Work with enactments to generate learning from parallel processes; Hazards of case teaching.

Examines a demonstration program to develop skills and experience for middle managers ar a mid-sized urban hospital in the United States. Background information on the management development program at the New York Downtown Hospital; Participation by middle and senior management; Program curriculum; Program weaknesses, opportunities, threats; Recommendations for replication.

This case examines the expanding role of managed care programs in improving health care for the poor while controlling runaway health care costs. The case asks what the commissioner of health in a large eastern state should do to effectively monitor Medicaid managed care programs in her state. The commissioner faces intense pressures for cost containment and strong, but not universal, support for the managed care solution to health care cost problems. The commissioner is herself concerned that the cost savings attributed to managed care may not be real and that the unintended effects on health care may be adverse. Her immediate challenge is to determine what kinds of data she should require service providers to submit to her agency so that she may effectively monitor managed care programs for health care quality, provide positive feedback to health care providers, and establish politically credible program oversight.

Few instruments exist for the assessment of adolescent mental health. In order to examine the appropriateness of the Mental Health Inventory (MHI) for use with adolescents, secondary analyses were conducted of the large subsample (n = 953) of adolescents who participated in the community-based Rand Health Insurance Study. The reliability and readability of the MHI were confirmed. Subscales reflecting Psychological Well-Being and Psychological Distress were derived. The MHI, with its adolescent norms, is recommended for the assessment of adolescent mental health, particularly in studies in which comparison to a nonpsychiatric, normative adolescent population is indicated.

The impact of training on physicians' commitment to professional values is examined, using a cohort design to assess the evolution of attitudes toward AIDS during residency training. Cohorts of surgeons training in the same six residency programs were followed at key junctures, and their outlooks on three AIDS-related attitudes were examined: willingness to treat people with AIDS (PWAs), concern about exposure to HIV, and perceived benefits of treating AIDS. The findings revealed a consistent, negative impact of training on all three attitudes. Cohort and period (historical) effects were limited: younger cohorts more often viewed treating PWAs as a clinically valuable experience, and greater concern about exposure was evidenced as training progressed. The findings yield new evidence of the importance of residency training to professional socialization. More knowledge of alterable aspects of residency training that play a role is key to assuring that physicians emerge with a dedication to fulfilling their social responsibilities.

Understanding the impact of training on the development of physicians' attitudes toward AIDS is important to furthering our knowledge of the mechanisms through which socialization affects professional outlook, as well as promoting an adequate supply of providers to treat people with AIDS (PWAs). This prospective panel study collected data on 383 physicians at two critical stages: as fourth year medical students and as third-year residents. Aspects of residency training (e.g., residents' morale and positive faculty role models) were the most powerful predictors of increase in willingness was primarily a product of negative social attitudes - homophobia and IVDU-phobia (aversion to intravenous drug users). Cynicism toward patient care acted as a trigger activating the negative effects of IVDU-phobia; having an acquaintance who is HIV positive mediated the negative impact of homophobia. Notably, cynicism was associated with basic aspects of training (specific characteristics of the faculty and of the educational milieu). The findings support a view of socialization as pervasive process implicating intrinsic aspects of training and having an impact on a broad spectrum of outlooks. Accordingly, interventions must address structural characteristics that transcend AIDS-specific concerns.

The objective is to examine whether the higher hospital admission rates for chronic medical conditions such as asthma, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and diabetes in low-income communities resulted from community differences in access to care, prevalence of the diseases, propensity to seek care, or physician admitting style.

This report examines the high cost of City health insurance. The approach includes both an historical review of the City's program and comparative analysis of the practices of other large public and private employers. The report recommends structural reforms that would yield nearly $600 million in recurring savings and still provide employees and retirees with benefits better than most of their counterparts in government and business.

This report is the first in a series of studies that will examine the growth prospects of the New York City economy. This first study analyzes the financial services, legal services, and accounting and management consulting sectors, and combines original data obtained through detailed interviews with 25 firms in these industries with existing data from previously published analyses and surveys. The study concludes that while New York will continue to be a global center for these industries, the shape of these industries within the city will change, and the industries are unlikely to be the significant source of employment growth in the future that they have been in the past. The report includes 36 tables with longitudinal data examining employment and business activity in these sectors of the New York City economy, as well as the relationship between these sectors and the larger domestic and international markets.

Talks about the significance of capitated arrangements in hospitals. Detail about the financial incentives under capitation.

Thoroughly presents today's health care system, its administration and its dissemination.

Presents the text of the presidential address given at the Fall 1994 meeting of the Association for Public Policy Analysis and Management by Ellen Schall. Reflection and learning from experience; Why reflective, swamp learning should be taken seriously; Development of new ways to investigate and frame theories for public management in the swamp.

Offers suggestions on how to remove the barriers to recruiting minority faculty. Obstacles to recruitment; Position description; Search for the position; Making a short list; Evaluation of criteria to be used in reviewing specific files; Interviews; Extra time for reflection and debate.

Analyzes whether short-term cutbacks made during a fiscal crisis become permanent once fiscal conditions improve. Economic and fiscal history of New York City from the 1970s through the 1980s; Framework for studying the long-term effects of budgetary cutbacks; Methodology for studying the long-term effects of 1976 and 1977 budgetary cutbacks; Effects on dollars, services, teacher characteristics and capital constructions.

Recommends how the Offices of Inspector General (OIG) can end the war of attribution in which they mop up the fraud, waste and abuse in government offices. OIGs prospering in the eighties; Attacking the enemy at the source; Starting with a modern financial management system.

Many organizations, especially public agencies, are in need of revitalization. Often the arrival of a new leader is an opportune moment to reinvigorate the agency, yet the yield from this opportunity critically depends on the way in which the leader joins with the existing staff. The following article examines some of the dynamics of a new leader's arrival and explores the power of a strategic theme to link the leader and the inherited staff productively. We examine the early phases of the emergence of a strategic theme and look at the critical transition when the theme begins to shape behavior. We conclude with advice on the use of themes as vehicles for revitalization.

This article addresses the importance of economic and demographic assumptions in framing the public policy process. It examines functions of such assumptions as an important aspect of government and as a new challenge for public managers. Using Social Security as a case study, the article suggests that recent fore- casts have been inaccurate for four basic reasons: (I) the social and economic environment, (2) technique, (3) assumption drag, and (4) politics. Nevertheless, the assumptions have been crucial at several key legislative turning points in recent Social Security reforms. The article reviews the impact of political pressure in three specific instances and suggests an emerging pattern in the use and misuse of assumptions. The article concludes with suggestions on how to address the importance of assumptions in the public policy process.

Examines the relationship between emergency management and governmental policies on technological disasters. Exploration of whether or not disasters exist from man-made technologies involving hazardous materials and what mechanisms are currently in place to cope with such emergencies; Review of incidents involving environmental contamination; Regulations in place to deal with contaminations; Conclusion that laws have become powerful tools for detecting and mitigating against environmental problems.

One hundred and seventy-eight denial laboratory technicians and 69 non-exposed controls participated in an epidemiological respiratory study. Eight technicians who had a mean of 28 years' grinding nonprecious metal alloys were diagnosed as having a simple pneumoconiosis by chest radiograph. Mean value for per cent predicted FVC and FEV[sub 1] were reduced among male nonsmoker technicians compared to male nonsmoker controls: after controlling for age. there was also a reduction in spirometry with increasing work years. An industrial hygiene survey was conducted in 13 laboratories randomly selected from 42 laboratories stratified by size and type of operation in the Sah Lake City, Utah metropolitan area. Personal exposures to beryllium and cobalt exceeded the Threshold Limit Values (TLVs) in one laboratory. Occupational exposures ia dental laboratories need to be controlled to prevent beryllium-related lung disorders as well as simple pneumoconiosis.

Examines ways in which organizations adapt to changing risk assessments in the U.S. through the development of organizational forms during times of crisis. Emergence of institutional conflict in setting risk standards; Organization adaptation to high risk environments; Patterns for the formation of organizations; Differences and conflicts among administrative agencies involved in risk management.

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