Exploring personal interests of physicians in hospitals and specialty clinics.

Physicians' interests substantially influence intra-organizational dynamics in hospitals, though little is known about the actual content and structure of these interests. The objective of this study was to both identify and build a structured model of physicians' interests. Based on literature and 27 semi-structured interviews with physicians, a questionnaire containing 10 interests was developed. Next, 1475 physicians in the Netherlands filled out an online survey. Analyses of the data revealed a distinction between the primary interest of 'helping patients as well as possible' and nine secondary interests. Factor analysis identified the main secondary interest dimensions as work-related, setting-related, and life-related. Value attached to interests differs between specialties and types of hospitals. The influence of hospital type on the value attached to interests is stronger than the influence of specialty group on the value attached to interests. Insight in the relative importance of different interests may help policy-makers make decisions that foster shared interests.

Improving value assessment of high-risk, high-reward biotechnology research: the role of 'thick tails'.

This paper presents work toward improving the efficacy of financial models that describe the unique nature of biotechnology firms. We show that using a 'thick tailed' power law distribution to describe the behavior of the value of biotechnology R&D used in a Real Options Pricing model is significantly more accurate than the traditionally used Gaussian approach. A study of 287 North-American biotechnology firms gives insights into common problems faced by investors, managers and other stakeholders when using traditional techniques to calculate the commercial value of R&D. This is important because specific quantitative tools to assess the value of high-risk, high-reward R&D do not currently exist. This often leads to an undervaluation of biotechnology R&D and R&D intensive biotechnology firms. For example, the widely used Net Present Value (NPV) method assumes a fixed risk ignoring management flexibility and the changing environment. However, Real Options Pricing models assume that commercial returns from R&D investments are described by a normal random walk. A normal random walk model eliminates the possibility of drastic changes to the marketplace resulting from the introduction of revolutionary products and/or services. It is possible to better understand and manage biotechnology research projects and portfolios using a model that more accurately considers large non-Gaussian price fluctuations with thick tails, which recognize the unusually large risks and opportunities associated with Biotechnology R&D. Our empirical data show that opportunity overcompensates for the downside risk making biotechnology R&D statistically more valuable than other Gaussian options investments, which may otherwise appear to offer a similar combination of risk and return.

Intra-organizational dynamics as drivers of entrepreneurship among physicians and managers in hospitals of western countries.

During the past decade, entrepreneurship in the healthcare sector has become increasingly important. The aging society, the continuous stream of innovative technologies and the growth of chronic illnesses are jeopardizing the sustainability of healthcare systems. In response, many European governments started to reform healthcare during the 1990s, replacing the traditional logic of medical professionalism with business-like logics. This trend is expected to continue as many governments will have to reduce their healthcare spending in response to the current growing budget deficits. In the process, entrepreneurship is being stimulated, yet little is known about intra-hospital dynamics leading to entrepreneurial behavior. The purpose of this article is to review existing literature concerning the influence of intra-organizational dynamics on entrepreneurship among physicians and managers in hospitals of Western countries. Therefore, we conducted a theory-led, systematic review of how intra-organizational dynamics among hospital managers and physicians can influence entrepreneurship. We designed our review using the neo-institutional framework of Greenwood and Hinings (1996). We analyze these dynamics in terms of power dependencies, interest dissatisfaction and value commitments. Our search revealed that physicians' dependence on hospital management has increased along with healthcare reforms and the resulting emphasis on business logics. This has induced various types of responses by physicians. Physicians can be pushed to adopt an entrepreneurial attitude as part of a defensive value commitment toward the business-like healthcare logic, to defend their traditionally dominant position and professional autonomy. In contrast, physicians holding a transformative attitude toward traditional medical professionalism seem more prone to adopt the entrepreneurial elements of business-like healthcare, encouraged by the prospect of increased autonomy and income. Interest dissatisfaction and competing value commitments can also stimulate physicians' entrepreneurship and, depending on their relative importance, determine whether it is necessity-based or opportunity-driven.