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ABSTRACT
To better manage costs and effectiveness of a team or enterprise, the organizational sciences, social sciences and medical field are seeking new theory to transform teams and enterprises with computational models of complex social behavior that create “smart” systems. We have proposed to fulfill these calls with new theory, but ours is still under development. In a field application, we studied an electronic Institutional Review Board (eIRB) operating across a large complex of military medical scientists and researchers in Department of Defense (DoD) hospitals and clinics. As part of a field study of how the eIRB has transformed processes for DoD, we completed three comparable focus groups at a small and three focus groups at a large research site, one focus group of the eIRB's system managers, and one focus group of a competing eIRB operating in DoD (the latter group results are not reviewed at this time). We found tentative support for our theory: more noise (entropy) is being generated at the small site along with less research performed; cultural noise at both sites reflected an intransigence by sites to be transformed by adopting standardized forms; and the meaning of the findings differed between the small and large sites.
Acknowledgments
For the first author, this material is based upon work supported by, or in part by, DoD funding in 2013–2014 from the Advanced Medical Technology Initiative (AMEDD).
Notes
1 In 2007–2008, we participated on a team that was instrumental in getting an electronic Institutional Review Board, or eIRB, adopted by the Department of Defense for the review of human and animal research protocols (Lawless et al., Citation2010).
2 The DoD grant was funded to study its eIRB system as a comprehensive web-based solution for research management, compliance and oversight needs. We plan to analyze current business process metrics for the program management office being established for DoD leadership management decisions. See Acknowledgments.
3 U.S. Department of Healthcare & Human Services, Agency for Healthcare Research and Quality, Chapter 5. Conclusions and Recommendations, retrieved 3/11/12 from www.ahrq.gov/qual/medteam/medteam5.htm.
4 Health care providers are believed by some health care providers to be shifting from seeking cures to palliative care and euthanasia to contain costs (Wall Street Journal, 2012, 3/16, “Notable & Quotable, Dr. Jeffrey A. Singer on the medical profession's move from the Hippocratic oath toward the “veterinary” ethic.” Wsj.com).
5 For example, accountable care organizations (ACOs) are increasing in response to the economic rules in the new health-care law, where an ACO is a collective of “medical care providers who band together under one business umbrella” to reduce costs and increase profits (The New York Times, 2012, 3/12, “Small-picture approach flips medical economics”, nytimes.com).
6 Illusions and multiple interpretations reigned after the market fell about 1,000 points on May 6, 2010, leading to an extraordinary coordination across Europe and the USA. (Washington Post Book Review, 2013, 3/29), “Three days that saved the world financial system.” A review of N. Irwin's The Alchemists. Three central bankers and a world on fire. NY: Penguin Press).
7 As an example of continuing conflict from dueling interpretations, see the New York Times (2013, 9/26), “In JPMorgan Case, a Missed Opportunity to Charge Its Executives”, from https://dealbook.nytimes.com/2013/09/25/in-jpmorgan-case-a-missed-opportunity-to-charge-its-executives/
8 As an example from accounting, “Andersen likely will face questions on a host of fronts. Among them are whether Andersen should have required Enron to better explain its dealings with several partnerships operated by former Enron officers before agreeing to bless the company's financial statements. Securities-law specialists said Andersen likely will face questions about why it agreed to sign off on Enron's decision not to consolidate several off-balance-sheet financial vehicles whose debts ultimately were Enron's responsibility. The firm likely will also face questions about whether it was unduly influenced by the unusually large fees Enron paid Andersen over the years.” (From Wall Street Journal (2001, 11/30), “SEC Starts Probe of Enron Audits Conducted by Arthur Andersen”, from https://www.wsj.com/articles/SB1007059096430725120)
9 NPR (2013, 8/28), “Taking A Closer Look At Milgram's Shocking Obedience Study”, http://www.npr.org/2013/08/28/209559002/taking-a-closer-look-at-milgrams-shocking-obedience-study
10 Major League Baseball data from http://espn.go.com/mlb/stats/rpi
11 “MTT [Medical Team Training has] produced sustained improvement in OR team functions, including decreased delays and improved case scores.” (Wolf, Way & Stewart, Citation2010), from https://www.ncbi.nlm.nih.gov/pubmed/20739848
12 New York Times (2012, 6/19), “Walgreen to take stake in Alliance Boots for $6.7 Billion”. Walgreen, to avoid decline and while suffering at home, expands overseas with a merger to become a global leader; from https://dealbook.nytimes.com/2012/06/19/walgreens-to-take-45-stake-in-alliance-boots-for-6-7-billion/?mtrref=www.google.com&gwh=4C5CECC756A8354ED305F9269E7AD58B&gwt=pay
13 e.g., IEEE Lifesciences (2013), “Printing body parts–A sampling of progress in biological 3D printing.” An overview of an emerging market for applications of ‘bioprinting’ described as “the construction of a biological structure by computer-aided, automatic, layer-by-layer deposition, transfer, and patterning of small amounts of biological material” (from Wiktionary.org).
14 MarketWatch (2013, 9/24), “Why Wall Street couldn't say ‘sell’ on BlackBerry. Commentary: Until the bitter end, worst analyst rating was ‘hold’.” from https://www.marketwatch.com/story/closing-blackberrys-barn-after-horses-left-2013-09-24
15 “Commissioned by the Food & Drug Administration in response to the apparent increase in medical device recalls due to failures and patient injuries over recent years, the report is expected to propose more stringent industry-wide regulations such as tougher approval processes … [countered by] the medical device industry that … more regulation would slow innovation, harm patients and cost jobs.” (New York Times (2011, 6/28), “Institute of Medicine to release controversial report on medical device approval Friday”), from https://www.medgadget.com/2011/07/institute-of-medicine-to-release-controversial-report-on-medical-device-approval-on-friday.html
16 An example is concierge medicine for the wealthy. In Wall Street Journal (2012, 10/29), “‘Concierge’ Medicine, ObamaCare and the End of Empathy.Traditional primary-care doctors are finding themselves, and their patients, squeezed by the government and the marketplace.” From https://www.wsj.com/articles/SB10000872396390443768804578034172542214016
17 Boston Scientific, struggling with sales, wants to merge with Cameron Health, innovator of the world's first implanted cardioverter defibrillator system, pending FDA approval (Wall Street Journal (2012, 3/9), “Boston Scientific Looks To Jolt Sales With Cameron Buy”, www.wsj.com ).
18 Questions remain about the value of mergers (New York Times, 2010, 8/13, “In Retrospect, Most Big Deals Were Bad Ideas”; from https://dealbook.nytimes.com/2010/08/13/in-retrospect-most-big-deals-were-bad-ideas/?mtrref=www.google.com&gwh=C9B7A91D7CF7434943F0F6E91893CE90&gwt=pay), now occurring rapidly in the health care industry (Wall Street Journal, 2012, 3/18, “Regulators Seek to Cool Hospital-Deal Fever”, from https://www.wsj.com/articles/SB10001424052702303863404577286071837740832).
19 Health Care: “Thanks to ObamaCare, Cheesecake Factory medicine is already becoming a reality. Irving Levin Associates, a research firm that tracks health-care mergers and acquisitions, reports that M&A hit $61.2 billion in the second quarter and the highest annual levels since the 1990s. Three of five hospitals now belong to a parent company's network, while more than half of physicians are employed by hospitals or systems, not independent practitioners.” (Wall Street Journal (2012, 8/26), “Cheesecake Factory Medicine”; from https://www.wsj.com/articles/SB10000872396390444358404577605233123916096).
20 Norman, L. & Gross, J. (2017, 12/8), “U.K., EU Reach Deal on Brexit Divorce Terms. The agreement means EU leaders are likely to agree for talks to advance on a trade deal”, Wall Street Journal, from https://www.wsj.com/articles/u-k-european-union-reach-deal-on-brexit-divorce-terms-1512716442
21 Fritz, B., Mattioli, D. & Flint, J. (2017, 12/13), “Disney Nears Pact to Acquire Assets From 21st Century Fox. Deal would value assets Disney is acquiring at $60 billion, including debt”, Wall Street Journal, from https://www.wsj.com/articles/disney-finalizing-pact-to-acquire-assets-from-21st-century-fox-1513203075
22 Safdar, K. (2017, 12/13), “Target to Buy Grocery Delivery Startup Shipt for $550 Million. Moving to match services rolled out by rivals Amazon, Wal-Mart”, Wall Street Journal, from https://www.wsj.com/articles/target-to-buy-grocery-delivery-startup-shipt-for-550-million-1513181845
23 News (2012), Science 335: 1291.
24 DoD grant application (2012, 2/23), “Protocol for Clinical Investigation—Human” (all names of individuals, groups and sites have been removed; new acronyms have been invented and substituted for the actual ones).
26 New York Times (2013, 9/18), “Medicine's Search for Meaning”.