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Volume 49, Number 6
November/December 2004

I. INTERVIEW 

Interview with James G. Springfield, FACHE, president and chief executive officer, Valley Baptist Health System, Kyle L. Grazier

II. PHYSICIAN-EXECUTIVE RELATIONS

Communicate for Change, Barbara LeTourneau

III. REPLACEMENT FACILITIES

Activation and Operational Planning: Ensuring a Successful Transition, Mark N. Wilson, William J. Hejna, and James E. Hosking

IV. ARTICLES
  • The Demography, Career Pattern, and Motivation of Locum Tenens Physicians in the United States, Arthur B. Simon and Angelo A. Alonzo
  • Occupational Violence in an Australian Healthcare Setting: Implications for Managers, Christian Alexander and John Fraser
  • The Role of Middle Managers in the Transmission and Integration of Organizational Culture, Caterina Lucia Valentino
V. Fellow Project

Development and Implementation of a Bloodless Medicine and Surgery Program, Carol Jefferson Ratcliffe

Executive Summary

The Demography, Career Pattern, and Motivation of Locum Tenens Physicians in the United States, Arthur B. Simon and Angelo A. Alonzo

The objective of this study was to provide a profile of locum tenens providers and their motivation for choosing this practice pattern. The research design used was a cross-sectional mailed survey questionnaire. Participants included the 1,662 physicians who accepted at least one locum tenens assignment in 2001 from one physician staffing service. They were asked to complete a 50-element questionnaire; 776 (47 percent) responded.

The average age of respondents was 53.0 years. Men represented 70.3 percent of the sample and were significantly older (56.3 years) than women providers who responded (45.3 years). One-third considered a locum tenens practice pattern permanent. Primary care locums were younger than specialists and subspecialists. Female providers were disproportionately practicing in primary care specialties (43.9 percent); 64 percent used locum income as their sole source of support and were frequently (31 percent) motivated by a need for a flexible work schedule. Male locum physicians were weighted toward the subspecialties and were motivated mostly (62 percent) by a desire to continue to practice part time. They used locum income as a secondary means of support (33 percent) or to augment pension and retirement resources (38 percent).

A physician workforce from most major specialties and subspecialties and all age groups and career stages fulfills career and economic goals by working in a short-term, temporary employment pattern. Locum tenens appeals to physician providers who desire a healthier, more controllable lifestyle.

Executive Summary

Occupational Violence in an Australian Healthcare Setting: Implications for Managers, Christian Alexander and John Fraser

Occupational violence is a worldwide, multifaceted problem affecting all industries, including healthcare. We conducted a cross-sectional survey of the experiences of 158 allied health professionals, 135 doctors, and 1,229 nurses working in a rural area in eastern Australia. Response rates were 72 percent for allied health professionals and 62 percent for general practitioners (GPs) and nurses. Proportionately more nurses experienced occupational violence than did allied health providers and GPs. During the past 12 months (August 2001 to July 2002), 68 percent of nurses, compared with 47 percent of allied health providers and 48 percent of GPs, reported violence. All three professional groups indicated that the most distressing occupational violence was perpetrated by patients, followed by patients’ relatives.

The most frequent form of occupational violence was verbal abuse, followed by threatening behavior, physical violence, and obscene behavior. No statistically significant difference in the prevalence of violence was found among the different allied health professional disciplines or fields of nursing. Health services management strategies addressing occupational violence need to be comprehensive and multidisciplinary in scope. Strategies to minimize violence need to focus on resource allocation, cultural change, and perseverance. Systems to monitor violence are a priority. Further research into the determinants of this pattern of violence is required.

Executive Summary

The Role of Middle Managers in the Transmission and Integration of Organizational Culture, Caterina Lucia Valentino

When organizations merge, the role of the middle manager as an agent of change is to make sense of, unite, and transmit the organization’s culture. This process is complicated because the manager must get deep inside a new organization’s culture and come to know its needs, processes, and people in a relatively short period of time to weld them all together into a smoothly functioning entity. Schein (1999) proposes eight essential steps that the manager must accomplish if cultural change is to occur. Bennis’s (1989) four competencies of leadership is a framework to categorize and record actions that create a milieu of clear-cut goals, values, and basic assumptions for the organization’s employees. Combining these two theoretical models illustrates how middle managers are able to create a “pull” style of influence (Kotler 2000) to attract and energize people to enroll in the new organization’s vision of the future.