Schizophrenia Essay -- essays research papers

SCHIZOPHRENIA Schizophrenia, from the Greek word meaning â€Å"split mind†, is a mental disorder that causes complete fragmentation in the processes of the mind. Contrary to common belief, schizophrenia does not refer to a person with a split personality or multiple personalities, but rather to a condition which affects the person’s movement, language, and thinking skills. The question of whether schizophrenia is a disease or collection of socially learned actions is still a question in people’ mind. People who are suffering from schizophrenia think and act in their own the world and put themselves in a way that is totally different from the rest of society. In other words, they have lost in touch with the reality. Most schizophrenics accept the fact that they have this disorder and are willing to receive necessary treatment and listen to, if not follow, professional advice. However there are cases where patients have lost insight and do not acknowledge the fact that they suffer from a mental disorder. As a result, these people do not have the treatment normally patients with schizophrenia do. To observers, schizophrenia may seem like a disease or madness because people who have this disorder behave differently to the people that are considered â€Å"normal.† It impairs a person from doing work, going to school, taking care of his/herself or having a social relationship with others. Yet, by looking at some of the symptoms, it is sometimes hard to classify schizophrenia as a disease because it enables those inflicted with it to develop new ways of communication intellectually and creatively, as well as enhancing artistic abilities. A disease is usually some kind of sickness that will lead to death or under heavy medication. However, this is not the case. For now, there is no cure but only treatment to help people with schizophrenia to live more productive lives. Generally, schizophrenia carries enormous threats to the society. About one percent of the people in United States develop schizophrenia and the probability of developing this disorder is independent of the patient’s gender, race or culture. Women are as likely to develop schizophrenia as men but women tend to have less severe symptoms with fewer hospitalizations and are generally able to cope better in the community. About ten percent of the people who have schizophrenia commit suicide and many others attempt... ...asms or cramps, and tremors. One of the major side affects is tardive dyskinesia, a permanent condition when the lips, mouth, and tongue move without any control. Besides medications and therapies, family intervention programs exist which focus on the families of the schizophrenics instead of the patients themselves. This is particularly useful since family members can learn and understand how to cope with the patient and provide for them a low-stress environment and aiding them as much as possible. By looking at all the aspects of schizophrenia, it is very hard to believe schizophrenia is a type of disease. Different from AIDS or cancer that may lead to death, schizophrenia alone will not kill the patient. In contrast, schizophrenics become more gifted and inventive in their way of thinking. The inability of the â€Å"normal† people to understand the patients’ styles of presentation does not mean those patients are abnormal or have a disease. When viewing from thei r world, schizophrenics may think that the â€Å"normal† people are the ones who display bizarre behaviour. Schizophrenia can be called a disorder, a collection of socially learn actions, an illness but never called a disease.

International business Essay -- essays research papers fc

Protectionism in the global economy The global economy has seen a dramatic increase in services trade between countries. The regulation and monitoring of service trade between countries has become much harder. As highlighted by Johnson, trading in services was the fastest growing constituent of global trade during the 80’s and 90’s. Cross border transactions include anything from banking to software. When services are offered to another country, the provider has to interact with the customer through either, cross border communications, movement of the provider or the consumer moving to the supplier’s state of residence. Technology has made international trade much easier and more feasible; this has lead countries to boost services being exported to other countries. IT has decreased the cost of communication between countries. As a result it has made it more feasible for businesses to introduce new products and modify services abroad. This spark in global trade of services has its downfalls. The lib eralization of services goes against certain countries’ development strategies. Areas like health and education needs the provisional planning of governments. The interference from abroad has hindered the governments’ strategic planning with respect to these services. This takes us to the importance of regulating services coming in from abroad through protectionism. Regulations on services can be a burden on service providers which can consequently weaken the liberalization of tr...

The Percept of Pain Essay -- Biology Essays Research Papers

The Percept of Pain: Where does it come from? In class we have discussed the concept of pain, concluding that a conflict between what the brain anticipates occurring and what actually occurs has the potential to cause the perception of pain. Furthermore, it was suggested that genetics might have a role in the experience of pain, particularly when applied to the discussion of phantom limb pain. However, I found these inferences a bit unsatisfying and walked away with more questions than answers. Where does chronic pain come into the picture? Why is a stimulus that is painful for one person not for another? And the question that puzzled me the most: how, from a neurobiological perspective, can an individual experience pain in her arm if she was born without one? Pain, a component of the somatosensory system, is defined by the International Association for the Study of Pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" (1). The perception of pain serves as a defense system to maintain homeostasis, warning of injury that should be avoided and/or treated. Injured limbs actually inhibit voluntary movement to promote necessary healing processed (2). So essential is the painful response that those individuals born with congenital pain insensitivity do not react to pain, often resulting in severe, permanent tissue damage, and even premature death. A crucial concept in the definition of pain is that it is indeed a perception, therefore involving the brain's rumination and elaboration on corresponding input. This may be paralleled to another sensory perception, vision. Although the optic nerve head should cause a "hole" in an individual's... ...ally cynical about notions that are not physiologically observable, I am surprisingly excited by the idea of a neuromatrix and look forward to rethinking my pervious understandings of the nervous system's workings. It may be interesting to see how the I-function is involved with this process and why pain treatments such as biofeedback have been known to produce positive results. References This paper reflects the research and thoughts of a student at the time the paper was written for a course at Bryn Mawr College. Like other materials on Serendip, it is not intended to be "authoritative" but rather to help others further develop their own explorations. Web links were active as of the time the paper was posted but are not updated. Contribute Thoughts | Search Serendip for Other Papers | Serendip Home Page http://serendip.brynmawr.edu/cgi-bin/comments

Powder †Story Analysis Essay

Powder is a straightforward story about an adolescent boy and his father on a ski trip. It is a first person story; written from the boy’s point of view who is also a central character in this story. The parents are separated or divorced; the father has promised to have the boy back to his mother in time for Christmas Eve dinner. But the father tarries, deciding to get in a few more runs, and by the time they set off, the mountain road they must take is closed and guarded by a state trooper. Eventually the trooper leaves his post and the father decides to risk the snow-covered road. In this story, everything seems to point to disaster. The narrator (an older version of the boy) consistently conveys a sense of worry, at first only that he will be late for Christmas Eve dinner (which has added importance because the father wants to win back the favor of his wife and is screwing this up), but later we fret about their physical well-being. The father sternly warns the boy against such foolhardy behavior. Disaster looms. Yet the boy, who is so tightly wired that he numbers his clothes hangers, is finally able to relax, to trust his father, to accept his fate and enjoy the journey. â€Å"If you haven’t driven fresh powder,† he says at the end, â€Å"you haven’t driven. † Really helps to wrap up this short story nicely. This story captures the two characters as images very well as we are drawn into their lives by the author (character as presented by the author). For example — â€Å"Criminy. This will have to be a fast one. † Expressed by the father give the reader, a sense of urgency and you can visualize this character on the slope with the proper expression. Then the line â€Å"My father in his forty-eighth year, rumpled, kind, bankrupt of honor, flushed with certainty. He was a great driver. † As expressed by the POV Character kind of brings it all together. The characters were alive from the beginning of this story and it was due to the really good characterization that was done by this author.

Marriage and family Essay

Lincoln married Marry Todd (see Fig. 3) on November 4, 1842 who was the daughter of a well-known slave-owner family coming from Kentucky. The couple had several offspring’s but only one had survived towards adulthood, Robert Todd Lincoln was born on August 1, 1843 at Springfield Illinois; the other children that died either during their teen years or early years were: Edward Baker (born March 10, 1846 and died February 1, 1850), William Wallace Lincoln (born December 21, 1850 and died February 20, 1862), and Thomas Lincoln (born April 4, 1853 and died July 16, 1871). Figure 2. Photograph of Mary Lincoln Legislative Activity In 1846, Lincoln was elected as a member of the United States’ House of Representatives. As a neophyte member, he was not predominantly influential or a powerful figure. Nonetheless, he relentlessly argued his objections on the Mexican-American War. He eventually challenged the then President Polk’s desire of a â€Å"military haven† and eagerly demanded for a resolution to know the exact spot on the US area the blood was first spilled. After two weeks, President Polk sent a letter of peace treaty to the Congress. 5 Lincoln later on damaged his political figure when he made a speech on the killings of children, women, and men of those murderers and â€Å"demons†, and God has forgotten to shield the innocent and the weak. This statement drew outrage among the Democrats and was held against him when he applied for a post in the administration of President Taylor. He decided to give up his political activities for a number of years and concentrated on practicing law. In his practice of law in the mid-1850, Abraham Lincoln handled a vast amount of cases focusing on different aspects. Some were common but others were celebrated such as the case of the Alton and Sangamon railroad of 1851, the civil case of Hurd V. Rock Island Bridge Company, the criminal trial of William Anderson, to name a few. Lincoln was involved in almost 5,000 cases during his 23 years of practicing law during which he appeared almost 400 times on the Supreme Court of Illinois State. Republican Politics Abraham Lincoln returned to politics as a reaction to the Kansas-Nebraska Act, which was authored by Stephen Douglas of the Democrat. Douglas argued that in a democratic settings the people have the right to choose whether or not their state will allow slavery or not, and the Congress should not impose any decisions on them. Lincoln argued on the matter and established a new Republican Party. Accepting his nomination as a Republican Senator in 1858, Lincoln delivered his famous speech where it created a reminiscent image of the possible break up or disunion caused by the slave issue. The 1860 Presidential Election Lincoln was then elected as the Republican candidate for the 1860 Presidential elections. The bearings why he was elected as the candidate stood on the premise of his stand on slavery, in addition to his perceived western origins. It was thought of he could get the West and the North was the distressed party. During the electoral campaign, Lincoln did not make any speeches for many of the Republicans handled their own State and County. Little effort was made to alter non-Republicans, and there were no relative campaigns in the South. But in the North, a large-scale campaign took place with Republicans speaking on assemblies, leaflets, and editorial newspapers were eminent. 6 The campaign focused on the platform of the party, on Lincoln’s childhood and his rise from poverty, it also showcased his natural gift of intelligence and was given several nicknames such as â€Å"Rail-Splitter† and â€Å"Honest Abe†. The campaign also emphasized on how a common farm boy can rise to adversity and become successful in life. After the election, Lincoln won the Presidency garnering a vast 39. 9% of the total votes, next is Douglas with 29. 5% of the total votes. Presidency and Civil War. After Abraham Lincoln won the Presidency n 1860, several uprisings were eminent coming from the South. On December 20, 1860, South Carolina took the first step to leave the Union, and soon followed afterwards by six other States in the South. These seven States established a new nation called the Confederate States of America. The new nation consists the States of Maryland, Delaware, North Carolina, Kentucky, Tennessee, Arkansas, and Virginia, The newly –elected President Lincoln and former President Buchanan both refused to distinguish the newly established confederacy. Though there were several attempts to compromise, such as the Crittenden Compromise, but President Lincoln denounced the proposal and maintained his position for a unified States. He successfully evaded the assassination plot on him in Baltimore on February 23, 1861 and on his inauguration as President on March 4, 1861. Sizable troops of German- American Turners were front-lined during on his first inaugural Address. He emphasized on a unified State with strong reference on the United States constitution. But even though he exerted tremendous effort to maintain a unified State, the Confederacy was able to establish itself: therefore compromise seemed to be impossible. The inevitable happened on April 1861 when the Union troops were forced to give up the Fort Surnter and eventually surrender. The event forced President Lincoln to call some 75,000 troops to restore the forts, protect the capital state, and eventually preserved the Union. Almost 18,000 rebels were arrested and held in prison, at the same time President Lincoln negotiated with the uprising States. In July 1862, the Second Confiscation Act was implemented liberating the slaves owned by the rebels. The goal of the Act was to weaken the rebellion, which was relatively controlled and led by slave owners. This new law was termed the â€Å"Emancipation Proclamation†, had the support of the Congress for the enactment. To end slavery was the primary objective of Abraham Lincoln’s administration, but the American people were relatively slow to clinch the idea. The Act took effect in January 1, 1863 and slaves were freed on territories not under the control of the Union. As the army of the Union continued to march south, more and more slaves were freed until almost the entire Confederate’s army (mostly slaves) was liberated (approximate 3 Million people). During the war, the Battle of Gettysburg was considered the most devastating and bloodiest among the casualties of both parties. It has brought a big blow to Lincoln’s effort towards war and sentiments greatly rose on the war and to President Lincoln. Though political sentiments were eminent, Lincoln was able to establish victories on Vicksburg, Gettysburg, and Chattanooga: major victory was at hand. The Confederate army continued to weaken but with high casualties on the part of the Union. As the next election was near, there were fear and doubts if Lincoln would be able to sustain his leadership and win again. At the Republican convention, He was then again elected to run for Presidency alongside with Andrew Johnson. They were able to unite the War Democrats and the Republicans under a new-formed Union Party. Lincoln, with the concern of having the possibility of being defeated, made a pledge that if so he would continue to beat the Confederate before turning over the post. This pledge was sealed and signed by him and all of the representatives of the Republican Party. The eventual splitting of the Democratic Party led to the landslide victory of Lincoln garnering a total of 212 out of 233 electoral votes. He outstandingly delivered his second inaugural speech on March 4, 1865 with the victory over the Confederacy was eminent, the slavery was abolished, and he was looking forward for a new future of the Nation. Reconstruction began and his subordinates initiated the integration of the Southern States, what would be the course of action towards the defeated Confederate leaders, and also for the slaves who were freed. Amnesties were given and each affected State was under reconstruction policies. Governors were appointed on Louisiana, Tennessee, and Arkansas. The war has officially ended on April 9, 1865 with the Confederate surrendered at the court house in Appromatox. The other rebels also surrendered and there have been no any signs of rising guerilla conflict. During the war, Lincoln has subsequently used his political powers: formed a blockade, suspended relatively the writ of habeas corpus, used huge amount of money without any authorization from Congress, imprisoned without trial some 18,000 alleged Confederate leaders and sympathizers. Assassination Though Lincoln was able to unite the States and abolished slavery, many of his detractors were eagerly anticipating a hostage or a possible assassination plot against him. 7 On April 14, 1865, John Wikes Booth, a Confederate spy, shot Lincoln to the head. With only a single bodyguard on his post, Booth waited for the main line of the play, Our American Cousin, where the audience would be all laughing. He hoped that the magnitude of the audiences’ laughter would camouflage the gunshot noise. As the main line was told, Booth immediately jumped on the state box and shot Lincoln at point blank. Major Henry Rathbone struggled with Booth but eventually was injured by Booth’s knife. He jumped from the box to escape and was chased by Federal agents. A nationwide manhunt were conducted for 12 days before he was consequently cornered and shot in a barn house at Virginia, he died soon after. Abraham Lincoln, with a bullet on his skull was comatose for 9 hours before finally death crossed his path on April 15, 1865. His remains were returned to the White House and laid inside the East room. A train in a funeral grand procession passing through several states on its journey back to Illinois carried his body. Several bronze statues of himself and the tomb stood at 54 m. tall surrounded the Lincoln Tomb located at Oak Ridge Cemetery. To prevent continuous attempts to steal and hold Lincoln’s cadaver for ransom, Robert Lincoln decided to exhume the body of his father and re-buried back with several feet thick of concrete encasement. His death consequently made him a martyr and repeated polls indicated him as one of the most popular and greatest President of the United States. 8 He was clearly personified as an epitome of values in terms of integrity, honesty, love for freedom, respect for minority and individual rights. He was named after several corporations and structures such as the Lincoln National Corporation, the aircraft carrier Abraham Lincoln, and the ballistic missile Abraham Lincoln, to name a few. He had several memorial statues in different States, his birthday was declared a President’s holiday, the Abraham Lincoln National Cemetery, and the Abraham Lincoln Memorial (see figure 3). Figure 3. The Abraham Lincoln Memorial Abraham Lincoln, the orator and the great debater, can be considered one of the finest Presidents of the United States. Having the gift of extraordinary knowledge, being formally educated only for 18 months, he diligently worked hard and self-studied to become a successful lawyer. He represents the common people that strived and worked hard to achieve one’s ambition. He was the pioneer in the attempt to abolished slavery, he was an advocate of human rights, and strength fully kept and re-united the States in times of rebellion and uprisings. His death, being the first U. S. President to be assassinated, was symbolic and paved the way for him to become an icon of peace, honesty, respect, and love for freedom. References [1] Thomas, Benjamin T. 1952. Abraham Lincoln: A Biography. University Press, 18. [2] Kunhardt, Philip G. 1992. Lincoln: An Illustrated Biography. Gramercy Books New York, 324 – 450. [3] Lea, Henry James D.1909. The Ancestry of Abraham Lincoln. Houghton Miffin, 65. [4] Goodwin, Doris K. 2005. Team of Rivals: The Political Genius of Abraham Lincoln. McGraw Hill, 101. [5] Waugh, John C. 2007. One Man Great Enough: Abraham Lincoln’s Road to Civil War. Harcourt Publishing, 156. [6] Donald, David E. 2003. Lincoln Reconsidered: Essay on the Civil War Era. Simon and Schuster, 176. [7] Gienapp, William C. 2002. Abraham Lincoln and Civil War America: A Biography. McGraw Hill Publishing, 267. [8] Basler, Roy L. 1955. Collected Works of Abraham Lincoln. Rutg.

Raft2 Sentinel Event

Sentinel Event: Child Abduction Description of Event A three-year-old patient presented to the hospital for outpatient surgery of bilateral myringotomies with mother. After the patient was registered, consent for surgery signed by mother, and prepped for surgery, the mother gave the pre-op nurse her phone number and left to run an errand with instructions to be called if her daughter was finished with surgery sooner than expected. The mother was expecting the patient would be ready to go home in about 2 hours.The pre-op nurse stated that she wrote down the mother’s phone number in her own notepad to call her. The patient completed surgery and was taken to recovery. At this time the recovery nurse paged out to the waiting room for the mother as parents are encouraged to come back to the recovery area as the children come out of anesthesia. With no answer from the page and the patient awake and stable, the patient was then given to the post op nurse for discharge. The post op nu rse stated that the recovery nurse had tried to page the mother, but made no mention of trying herself.The patient was becoming upset because she had not yet seen her mother. The security personnel called informing the nurse that the patient’s father had arrived and the patient happily met the â€Å"father,† so the discharge nurse waited another thirty minutes before releasing the patient to the father as there was no sign of the mother. When the mother of the patient arrived thirty minutes after the patient had been discharged looking for the patient, security was called, an internal code pink was initiated and law enforcement notified.Security stated that the mother informed them she had full custody of the patient and that the parents were divorced. The patient was found within thirty minutes in the care of the patient’s father at home. No charges were filed against the father. Roles of Personnel Registrar: A hospital registrar â€Å"performs scheduling, reg istration, verification and reception for all outpatient surgical patients (Northeast Health, 2012). † A hospital registrar is very important to hospitals, as they are the people who obtain insurance and billing information so that the hospital can get paid for the services it provides.The registrar at Nightingale Hospital stated that she entered the patient’s demographics and insurance information, obtained consent to treat the patient, and copied the patients insurance card. She did identify that, as it is not standard process, she did not ask for any other form of identification from the patient’s mother or ask about custody. At most hospitals that deal with pediatric patients, a standard part of the registration process is to have the parent’s present identification and a social security card of the patient. This is one way to help identify the parents as the parents of the patient.While custody information does not have to be given, as part of the con sent for treatment there is a clause stating that the parents who bring the child in are the only people to whom the child will be released upon discharge. Usually an identifier is placed on the parents by registration, such as a matching wristband that has the patient information and says parent, which helps staff know who to release the patient too. As there is no such process in place at Nightingale Hospital to verify parent identification, the registrar completed her job and moved on to the next patient.Pre-Op Nurse: The pre-op nurse is responsible for getting the patient ready for surgery. From â€Å"assess patient’s status, to reviewing the chart, identifying the patient, verifying the surgical site and marks site per institutional policy, establishing IV line, giving medications, and providing emotional support (Nurselabs, 2012). † The pre-op nurse stated in her interview that she was very busy the day of the patient’s surgery and did her usual assessment s and patient preparation, however she did have to run around to track down a gown.The nurse also stated that she wrote the mother’s phone number down on a notepad that she carries with her at all times. The mother requested to be called when the surgery was complete. The nurse made no mention of passing the phone number off to any of the other nurses or making a note on the chart for the other nurses to see regarding the mothers wish to be called and the number she could be reached at. The nurse also stated that she did not ask for custody information and felt that the doctor’s office should be responsible to get and give that information to the hospital.Overall the nurse did her basic work to prepare the patient for surgery. OR Nurse: The next nurse to receive the patient and have contact with her was the OR nurse. This nurse â€Å"maintains aseptic technique, controls the environment of the OR suite, transfers patient to operating room bed or table and positions th e patient: function alignment, exposure of surgical site, applies grounding device to patient, ensures that the sponge, needle, and instrument counts are correct and completes intraoperative documentation (Nurselabs, 2012). The OR nurse expressed concern in her interview that there was a possibility of this type of incident happening in other areas or departments in the facility as the OR is not the only area that separates children and parents to do procedures or tests. Overall the nurse did not identify much of her role and interactions with the patient or other staff in her interview. It is therefore assumed she did her role as described above but nothing further. Recovery Nurse: After the OR the patient was then sent to the recovery nurse.His role is to â€Å"determine the patient’s immediate response to surgical intervention, monitor patient’s physiologic status, assess and reassess patient’s pain level and administers appropriate pain relief measures, mai ntains patient’s safety (airway, circulation, prevention of injury), and assess readiness to be discharged or admitted (Nurselabs, 2012). † The recovery nurse stated that he received report from the OR nurse and took care of the patient as described above. As the patient woke up he â€Å"paged† to the waiting area to have the mom brought back.She did not answer and as the patient was stable and awake he took her to the post op nurse. There was no mention of the recovery nurse calling the mother as she had expressed to the pre-op nurse. The recovery nurse did not appear to know of these wishes, have her phone number, or be aware that the mother was not going to be in waiting room. The lack of communication from one staff member to another becomes apparent at this point in the patient’s care. The recovery nurse did not have any ideas on how to improve the system, but did express concern over lengthy and formal hand off report among nurses.The recovery nurse did not think outside of the normal standard when it came to trying to contact the patient’s mother, however he did his job according to hospital standards. Post-Op Nurse: The last phase of the patient’s care was to be transferred to the Post-Op nurse for â€Å"continued monitoring of patient’s physical and psychological response to surgical intervention, provides teaching to patient and family for discharge (Nurselabs, 2012). † The nurse stated that she was informed that the recovery nurse could not reach the mother via page.There is no mention of her trying to obtain a phone number to reach the mother. The nurse expressed that the patient was very distraught over not having her mother there. When security notified her that a person who stated he was the father was there, the nurse agreed to let him in and the patient was very happy to see him. The nurse stated in her interview that she waited for the mother, but when she did not show agreed to discharge the patient to the father’s care. The nurse did not check any identification from the father that acknowledged he was in fact the patient’s father.While the nurse did not have a specific hospital policy to follow regarding discharge of a patient, there was no extra effort on the part of the nurse to contact the mother per her report. Had there been notification on the patient chart regarding custody or a phone number the nurse could have easily verified information and not let the patient leave or gotten the mother’s approval for discharge. The nurse adequately took care of the patient during her time in the nurse’s care, however her choice to discharge the patient home without the mother was a lapse in judgment causing an error that could have potentially harmed the patient.Security: A security officer at a hospital has many responsibilities and depending on the needs of the hospital those duties may vary. Overall the officer is supposed to â€Å"write daily reports regarding the activities and disturbances (if any) that occur during his serving period, checks lights, alarm system, windows, doors, and gates, gives access to family members to see their patients, responds to any fire alarms, violent patients, and assists with helicopter landings (Sandhyarani, Ningthoujam, 2011). The security officer at Nightingale Hospital was responsible for bringing the â€Å"father† of the patient to the post-op care area to meet the patient, as well as responding to the â€Å"code pink† and notifying law enforcement of the abduction. The officer expressed concern over the delay in time of reporting the abduction when in fact, the nurse was unaware that the mother did not know the child had been discharged. The officer had an idea for using the same alarm coded bands used in the OB department with any pediatric patient and placing sensors around the hospital.It is great that he is thinking of new ways to help improve the system fro m a security standpoint. The officer responded to the situation quickly and efficiently using the information and resources he had available at the time. In the end the child was found and he therefore performed his duty quickly and efficiently. Surgeon: The surgeon’s responsibilities include ensuring that the patient is a good candidate for surgery, preparing the parents and patients for surgery, performing the surgery, overseeing the patients care post surgery. The urgeon who worked on the patient at Nightingale Hospital stated that he is the #1 ENT physician at the hospital. That implies he is very good at what he does. He stated that his office had records that state the mother is the primary custody holder of the patient and that the hospital did not get those records. While the hospital could have obtained the records, simply adding the question to the registration process would rectify the situation. The surgeon is very angry that this incident occurred and he does hav e a right as this is his patient and if these things continue to happen he will not have patients.The surgeon role is the overseer of the patient’s care before, during and after surgery. The surgeon completed the surgery and care of the patient as part of his job. Chief Nursing Officer: This person is responsible for just about anything that happens in the hospital from a nursing standpoint. This means that anything that is going right or wrong they deal with. The officer usually sits on many different committees to help with improving and maintaining staff education, competence, patient safety, and hospital management.The officer was not involved in the sentinel event, however it will be her responsibility to form committee, to complete the documentation, and to develop a way to ensure the event does not happen again. Barriers There are many different barriers that can impede effective interactions among people. These include physical, emotional, communication, language and cultural barriers (Ivanov, Tatyana, n. d). Physical barriers include demand of the nurse’s jobs including being short staffed, time constraints, technology, and unable to do face to face hand off reports. Emotional barriers include stereotyping, fear, anger, frustration, and mistrust.Communication barriers can encompass all the types of barriers. This barrier inhibits people’s ability to speak so that others understand, not all the information is given, and an inability to fully listen to what is said. Language and Cultural barriers include not being able to understand someone due to an accent, different meanings of words when translated from one language to another, and not understanding or respecting cultural views or practices. In this situation all of the staff experienced some form of barrier during the course of the patients visit. The biggest barriers appear to be communication and emotional barriers.A lack of proper hand-off report from one staff member to the next and nurses who appeared to feel overwhelmed and unsure of themselves or what to do next contributed to the patient being discharged to the wrong parent. Ways to decrease the presence of barriers and improve the staff interactions include a standardized hand off report, decreasing use of jargon or slang, giving timely feedback, decreasing physical barriers and talking in person, and learning about other cultures (Neusom, Ruby, n. d. ). Knowledge is power and the more the staff knows the better equipped they will be to identify and handle barriers as they arise.Getting a team of nurses together from multiple departments to help develop a standardized hand off report for staff will ensure that important information is passed on and not missed. In this report, staff must relay vital information for that patient as well as give report in person so that technology and language are not barriers. This will allow the staff to work together to improve their areas and it allows them to ta ke ownership of the project, meaning they will be more likely to utilize the hand off process in the future.Another way to improve interactions is to include barriers as a topic of education in the annual risk management education that staff completes each year. By helping staff to see and identify potential barriers they can hopefully prevent them from impeding patient care in the future. Quality improvement Method The quality improvement is a concept that not only hospitals but companies all over the world have been using for a very long time. Quality improvement is the process of looking forward and backward at company, process, policy, and/or safety. It is simply the process of making things better or improving them.It can be done to correct something that went wrong or used to prevent something bad from happening in the future. The method the Nightingale hospital needs to utilize is the FADE method. Focus, analyze, develop, and execute/evaluate (Wiseman, Beau and Kaprielian, Vi ctoria S, 2005). While there are many different models available in the business world today, they all have the common theme of analysis, implementation and reviewing. Different businesses tend to have different needs and therefore no model is better than another. The FADE model is useful to the hospital’s root cause analysis as it gives guidance and direction.The reason this model was chosen was because of the ease of use, the detailed direction and instruction, and the completeness of the model. This model allows the staff or committees to look at all angles of the situation and work to improve it. It is a complex model not a basic simple one, which gives better instruction. The first step of FADE is to focus. This means the hospital needs to identify a problem within the hospital and write a problem statement to help narrow down what is being looked at. The current issue is how to prevent child abductions within the hospital.While the OR is where the current event happened , it can easily become an issue for other areas of the hospital who care for children. The next step is to analyze the data and determine influential factors. This means the hospital will need to compile lists of what information is important to this case and what information is not. Collect any data about patterns and things that influence the outcomes or contribute to the problem or solution. This is the time for the hospital to evaluate what went wrong that lead to the child being discharged to a person that potentially could have not been the child’s relative.The more data that is gathered and analyzed the better understanding and better outcome the hospital can hope for in fixing the problem. The third step is to develop a plan of action. After gathering and reviewing all the information provided regarding the issue at hand. The hospital must develop a plan that helps to solve the problem. This is the time when getting people from multiple departments and areas of the ho spital will be important as each area will have a different view point that may help develop a plan that works for the majority of the people.During this stage not only does a plan need to be made but also planning to implement the plan. New policies and procedures cannot be implemented over night and expect all staff to agree and utilize it. All staff must complete proper training regarding the new plan before it can be put into use. For the hospital a plan needs to be developed that includes the input of security, OR staff, ER staff, OB staff, radiology, and administration. As multiple areas of the hospital will be affected by the new plan for pediatric patients, all those working with them should be included in the planning process.Once a plan is developed to prevent child abduction from happening again, education of all staff will be required. The last step in the quality improvement method is execute and evaluation. After staff has been trained it is time to put the plan into a ction. This is the time when committees will need to be organized to continue to evaluate and monitor the progress of the plan, keep records of the impact the plan has, and most important execute the plan. As time passes the committees will need to continue to evaluate the plan for success.If it is successful then continued monitoring is all that is needed. If the plan is not successful then the quality improvement methods starts again. It is during this phase that the hospital will need to ensure that every aspect of the plan is in place in a timely manner so that it can be properly evaluated. In this stage maintenance of the equipment and technologies will need to be completed as well as any minor adjustments to the plan that need to be made to better serve the entire staff and ensure the safety of the pediatric patients.Overall quality improvement is vital to patient safety and necessary for the continued advancement and improvement of patient care. By utilizing this method the h ospital will be able to complete a thorough root cause analysis that focuses, analyzes, develops, executes and evaluates the success and failure of the hospital. The Joint Commission requires that all sentinel events be reported and that the hospital develop a reason and solution to the problem. This method allows the hospital to follow Joint Commission Standards ensuring they keep their Joint Commission Accreditation.Corrective Action Plan: The development of risk management officers and committees started when lawsuits and insurance premiums began to rise. The goal of these people was to establish guidelines in which to help reduce and prevent errors, increase safety, and decrease financial loss. While the committees work daily to accomplish these things by utilizing a process of identifying, analyzing, treating and controlling, and evaluating (Chubb Healthcare, n. d. ), it is important to note that all staff must take an active role in risk management to ensure the hospital maint ains its high standards of care.It is the responsibility of all staff to identify areas of concern and report to the risk management committee so that changes can be made. Annual education of all staff is required on this subject to ensure that everyone is doing all they can to decrease risk. A thorough risk management program includes policies and procedures on the running of a risk management committee as well as maintenance and changes to the company’s policies and procedures to ensure compliance and proper utilization. It also has formal incident reporting, tracking and trends, and staff education.These are the basics of a very complex program that helps to decrease risk in the hospital setting. The areas that need to be changed and addressed in regards to the Nightingale Hospital is the area of policies and procedures that are related to patient safety. In ensuring patient safety the hospital can decrease the occurrence of lawsuits, decrease insurance costs, and increase staff awareness. While the risk management committee will be doing much of the initial review of the incident and changes to the policies, other committees and staff must be included in the change process.These resources include quality assurance, administration, safety and security, legal, and nurses, physicians, and other ancillary staff. The risk management committee should be reviewing the hospitals policies and procedures on a routine basis, at least annually, to look for areas of improvement, compliance with Joint Commission standards, and changes in healthcare advancements that therefore make the policies outdated. This area of the risk management program is clearly not being followed if there is no policy or procedure in place to prevent child abductions from happening in areas outside of the OB department.The risk management committee needs to address this lapse in protocol by taking five simple steps. First a review of the incident that happened, second gathering resource s to help gain insight into the different areas of the hospital, third developing a new hospital policy, fourth implementing the policy and educating staff, and lastly reviewing the policy on a annual basis to ensure compliance and monitor the need for improvement (Chubb Healthcare, n. d. ). In doing these steps the risk management committee can decrease the potential for child abductions in the hospital.First the committee must review the formal incident report, looking at the who, what, where, when, why, and how of the situation. Review any prior claims, patient complaints, staff complaints, and quality assurance reports (Chubb Healthcare, n. d. ). These allow the risk team to identify the problem and start to pinpoint the areas that need changing. The risk committee will need to work closely with the quality assurance committee, who likely have already gathered much of this information.They also will be a resource with regards to the requirements of the Joint Commission standards and be able to help identify any missteps that are resulting in non-compliance. This step needs to be completed in a timely manner, the longer it takes to get the information the longer it will take to get a new policy in place. The risk committee should set a deadline of no more than one month to complete this step. It is more likely that the committee could complete this step in two weeks but as many members may be working on other projects at the time, the committee will be allowed one month to complete this step.Next the risk management committee must meet with the different resources available to discuss the changes that need to be made to patient ensure safety. During this time the committee will hear from the legal department, safety and security department, staff from all areas of the hospital, and administrative staff. The point of this step is to gather as many ideas for change and improvement as possible from as many different aspects. As child abduction prevention is no t just security’s responsibility it will be important to understand what all staff can do (CNA, 2006).The legal department will be able to give feedback on what the hospital can and cannot do to ensure that the hospital does not develop a potential lawsuit from the new policy or lack of any previous policies. The safety and security department will be a huge resource for the risk committee as their job is to ensure that everyone stays safe. The new policy will greatly impact the security department as they will be required to potentially perform â€Å"code pink† drills, research and obtain new monitoring and sensor equipment or even increase staff levels to accommodate the increased security measures.Ensuring that the safety and security department is working closely with the risk committee will be key to ensuring a policy that is beneficial to everyone. The administrative staff involvement will be important as they will be looking at the information from a corporate s tandpoint. Their input on the policy will be centered on what is best for the hospital and how it ties into the values and standards of the corporation as a whole. They also will know budgets available for changes that need to be made to staff or security systems.The administrative resource is important because they look at the whole picture. The last resource that the risk committee will be utilizing is the staff, both clinical and non-clinical staff. This includes input from physicians, nurses, maintenance, environmental, technical support, and volunteers. These are the front line defenders when an abduction happens. These are the staff members that are present when it happens. Their input is key to being able to ensure that a new policy will help prevent any future abduction.As these staff live the day-to-day responsibilities of caring for patients, their suggestions and points of view are important. Also by having staff involved in the planning process they will be more likely t o adopt the new policy and follow it, because it will make sense to them and fit into their needs for the hospital. By utilizing all these different resources a proper policy can then be developed. This step should only take two weeks to complete. Taking longer may cause delay in development of the policy that is needed.The thirds step is to develop the new hospital policy utilizing all the information gathered from the sentinel event, quality assurance committee, and the hospital resources. The new policy must meet Joint Commission requirements for standards of care and safety of patients, as well as the hospitals needs (Chubb Healthcare, n. d. ). During this time, research for any new technology or materials to implement the new policy must be completed and quotes for pricing submitted to administration for approval. When the risk committee writes the new policy it must be written in a way that everyone can understand.This step should take no more than one month to complete. The c ommittee should spend a week reviewing all the notes and information gathered from the first two steps, then one week gathering the pricing information needed to implement the plan and then two weeks to have a completed policy. Everyone on the committee and in administration must be aware of these deadlines so that the policy can be implemented in a timely manner and all approvals completed in the appropriate deadlines. Next, the risk committee must ensure the staff is educated on the new policy and implement the policy.Live classes and computer-based learning will be important to educate all staff in the hospital on the new policy, technologies, and equipment (CNA, 2006). It is during this time that any new technology, forms, or other materials must be installed, printed, and dispersed so that when training is completed it will be ready for staff to use. This includes but is not limited to new forms for registration, new matching armbands for the children and parents, sensors aroun d the hospital that connect with the sensors in the armbands of the children, increased security staffing, etc.This step may take up to two months to complete depending on the ability of the committees to get the materials needed for training as well as materials installed and dispersed. Lastly the risk committee must continue to monitor the policy and compliance for any issues that may arise and make changes accordingly. It is recommended that with any new policy the risk committee monitor progress, compliance, and whether it is working or not by compiling risk reports on â€Å"code pinks† or other child safety reports as indicated in the policy monthly for the first year.As the hospital becomes more comfortable with the policy and it is changed to fit the needs of the hospital, and the policy has not been changed for six months; the policy can go into the yearly review area. The quality assurance committee can then continue to monitor the policy for compliance, impact, and maintenance. This last step can take up to a year, if not longer to complete depending on the needs of the hospital. Conclusion In the end a child being abducted whether by a parent who does not have custody or by a stranger is an emotionally trying experience for any parent as well as the child.All measures must be taken to ensure that the sentinel event does not occur again. By working with the quality assurance committee to utilize FADE (focus, analyze, develop, execute/evaluate), the risk management committee to create a new hospital policy, and the entire hospital staff, this will hopefully never happen again. While there are always legal and financial issues involved when something happens to a patient to compromise their safety, care, or well being, it is important that the hospital learns from these mistakes and takes action to correct them for the future.

Manage Resistance to Change Proactively Essay

Register for this journal is available at http://www. emeraldinsight. com/researchregister The current issue and full text archive of this journal is available at http://www. emeraldinsight. com/0262-1711. htm Managing diversity using a strategic planned change approach Earnest Friday Management in the College of Business Administration, Florida International University, Miami, Florida, USA, and Managing diversity 863 Received October 2002 Revised February 2003 Accepted February 2003 Shawnta S. Friday School of Business and Industry at Florida A&M University, Tallahassee, Florida, USA Keywords Diversity management, Strategic management, Change management Abstract Many organizations have implemented various types of initiatives within the last few decades in an effort to deal with diversity. A possible missing vinculum (link) between how an organization deals with diversity and its impact on the bottomline is a corporate diversity strategy that is executed using a planned change approach to systemically manage diversity. While many organizations have implemented a corporate diversity strategy, most have not used a â€Å"planned change-corporate diversity strategy†. The lack of a â€Å"planned change-corporate diversity strategy† is quite likely to inhibit managing diversity from becoming systemic to an organization’s culture and its way of doing business, thus tending to disallow the potential bene? ts of diversity to be maximized. Hence, this paper offers a framework for using a â€Å"planned change-corporate diversity strategy† to: progress along the â€Å"diversity continuum† starting with acknowledging to valuing, and ultimately to managing diversity; and systemically managing diversity using a eight-step â€Å"managing diversity process†. Introduction Over the past few decades, academicians, practitioners and organizational researchers have recognized that diversity is a phenomenon that has a wide array of affects within the workplace, and society in general (Koonce, 2001; Stark, 2001; Williams and O’Reilly, 1997). In this paper, diversity refers to any attribute that happens to be salient to an individual that makes him/her perceive that he/she is different from another individual (Williams and O’Reilly, 1997). Some widely accepted differentiating attributes include racioethnicity (which encompasses race and ethnicity), gender, nationality, religion, functional expertise, and age. Even though racioethnic and gender diversity tend to receive the majority of the attention in the organizational diversity literature (Stark, 2001; Williams and O’Reilly, 1997), this de? ition allows for the frameworks offered to be applied to any type of organizational diversity salient to members. Diversity programs have been implemented in many multinational organizations, primarily, in an effort to improve working relationships Journal of Management Development Vol. 22 No. 10, 2003 pp. 863-880 q MCB UP Limited 0262-1711 DOI 10. 1108/02621710310505467 JMD 22,10 864 between white males, whose relative numbers continue to decrease, and demographically different individuals, whose numbers continue to increase in the workplace (Friedman and DiTomaso, 1996). While many multinational organizations have a corporate diversity strategy, most have not implemented it using the suggested planned changed approach posited in this paper. Given the intensifying â€Å"war for talent† in today’s competitive, global business environment, it is imperative that the execution and evaluation of a corporate diversity strategy use a planned changed approach to not only acknowledge and value diversity, but to also systemically manage and inculcate diversity into an organization’s corporate culture. This type of approach can contribute immensely to an organization’s ability to use all of its human capital as a strategic means to gain and maintain a competitive advantage in today’s dynamic, global marketplace (Richard, 2000). It has been purported that if diversity can be effectively managed in an organization, some potential bene? ts to the organization include greater creativity and innovation, and improved decision-making (Cox, 1991). Conversely, if diversity is not managed effectively, some potential major costs to the organization include, at a minimum, breakdowns in communication, interpersonal con? ict, and higher turnover (Cox, 1991). While there may not be much empirical evidence to substantiate claims that effectively managed diversity directly leads to bottomline increases (Chatman et al. , 1998; Richard, 2000; Stark, 2001), there is real-world evidence (e. g. Coca-Cola, Denny’s, Publix, and Texaco settlements) to suggest that not effectively managing gender and racioethnic diversity has been, and can be, detrimental to organizations and their bottomlines. Thus, it is a logical extrapolation that an organization’s ability or inability to create a culture in which diversity is systemically acknowledged, valued, and effectively managed is more likely to determine the affects diversity will have on it’s bottomline. Many organizations have implemented various diversity initiatives as a part of their corporate diversity strategy (Koonce, 2001), but most have not used a planned change approach to strategically align their initiatives with their long-term objectives and strategic positioning. It is highly probable that this lack of planned strategic alignment contributes immensely to the purported ineffectiveness of many diversity initiatives (Stark, 2001). Consequently, an organization that seeks to maximize the potential bene? s of diversity should devise a â€Å"planned change-corporate diversity strategy† prior to implementing diversity initiatives. The purpose of the planned change-corporate diversity strategy is to align the organization’s diversity initiatives (designed to manage diversity) with the organization’s strategic goals, and ultimately make managing diversity an integral part of the organization’s culture. An aligned planned change-corporate diversity st rategy will contribute immensely to the long-term effectiveness of diversity initiatives aimed at better managing all of he organization’s human resources. This is especially signi? cant for organizations with a highly diversi? ed workforce. With a planned change-corporate diversity strategy, diversity initiatives are aligned with organizational policies, procedures, and systems. Such alignment is desired to systemically reinforce an organizational culture that encourages the effective management of all employees in order to garner diversity’s purported bene? ts, including the end goal of increasing the bottomline. Thus, frameworks are presented for using a planned change-corporate diversity strategy to: advance from the initial passive states of acknowledging and valuing diversity to the ? nal active state of managing diversity on the â€Å"diversity continuum†; and systemically manage diversity using the speci? c eight-step â€Å"managing diversity process†. The diversity continuum and the planned change approach Valuing diversity and managing diversity as distinct phenomena Over the last few decades, a myriad of articles have been written on the subjects of valuing diversity and managing diversity (Wanguri, 1996). In some cases, valuing diversity and managing diversity have been considered, and sometimes used, interchangeable when, in fact, they are two different phenomena (Jenner, 1994). By the very nature of their de? nitions, valuing and managing diversity are distinctly different. Valuing refers to the relative worth, importance, or signi? cance of something, whereas managing refers to taking charge or coordinating and supervising situations. Given these de? nitions, valuing diversity should be considered a more passive phenomenon, where importance or signi? ance is given to individuals’ differences, which does not automatically lead to visible actions or reactions on the part of the individuals valuing the diversity or differences. Managing diversity, on the other hand, should be considered an active phenomenon, which involves supervising or coordinating and directing the diversity or differences individuals bring to the organization to ensure the organization’s strategic go als are being fully and effectively met. In other words, it refers to successfully organizing the organizational inputs of individuals with diverse backgrounds. This de? nition is consistent with the managing diversity de? nition given by Thomas’ (1991): â€Å"a ‘way of thinking’ toward the objective of creating an environment that will enable all employees to reach their full potential in pursuit of organizational objectives†. The diversity continuum As a result of the confusion in the literature between the two phenomena, valuing diversity and managing diversity, it is not dif? cult to understand why consensus does not exist on the claims of bottomline bene? s as a result of the attempts organizations have made to value and/or manage diversity. In addition to the confusion, lack of consensus could also be a function of the Managing diversity 865 JMD 22,10 866 complexity of the diversity concept in the organizational context. Given the complexity of diversity within an organizational setting, it is possible that perceiving it in terms of a set of three elements that delineates what to do with diversity may serve t o simplify or clarify the confusion in the diversity literature. Therefore, a diversity continuum is offered to guide researchers and practitioners in moving from the more passive states of acknowledging diversity and valuing diversity, on through to the more active state of managing diversity. As individuals ? nd themselves in situations with diverse individuals, they are likely to take one of two courses of action: avoid dealing with the diversity, or recognize that the diversity exists. In the case where individuals avoid diversity, they do not face the fact that diversity is an issue. It is likely that these individuals do not accept the idea that they are likely to be biased in their interactions with others that they perceive to be different from themselves. Although avoiding diversity is viewed as a possible response to diversity, it is not included in the diversity continuum. The diversity continuum is based on the assumption that individuals take the second course of action and recognize diversity. Once diversity is recognized, as previously stated, the diversity continuum serves as a framework to delineate the three potential states of dealing with diversity: acknowledging, valuing, and managing diversity. The three sequential components of the diversity continuum are: acknowledging diversity; valuing diversity; and managing diversity (see Figure 1). Acknowledging diversity, the ? rst component, refers to recognizing the existence of diversity or the individual differences individuals bring with them to a particular setting. In order for individuals to truly acknowledge diversity, they must be exposed to it, experience it, acquire knowledge about it, and they must develop an understanding of diversity. The second component of the diversity continuum is valuing diversity. Valuing diversity, as de? ed above, refers to the signi? cance or importance being given to the diversity or differences individuals bring with them to a particular setting. Having an appreciation for, as well as respect for, the differences that diverse individuals bring with them to the work setting can lead to the last component. The last component of the diversity continuum is managing diversity. As stated above, m anaging diversity refers to the planning, organizing, leading of individuals with differences or diversity in a particular setting, such that their inputs are used to accomplish the organization’s strategic goals. Even in racioethnically homogeneous organizational settings, organizations make large investments to ensure an appropriate organizational culture is fostered. An appropriate organizational culture is desirous, such that individuals are systemically managed to perform and accomplish its goals, not just hoping that their performance will somehow lead to the accomplishment of the organizations’ desired goals. Thus, similar systemic efforts are necessary in order to manage Managing diversity 867 Figure 1. The strategic management process emographically diverse individuals such that the organization can gain the maximum synergistic bene? ts from their contributions as well. The planned change approach Rather than being reactive and waiting for a â€Å"diversity crisis† to take place before a change is made (i. e. Coca-Cola, Denny’s, Publix, and Texaco settlements), an organization should be proactive in systemically Managing Diversity. Hence, an organization and its m embers should make the necessary changes to proactively move from just settling for the ? rst stage of acknowledging diversity to the ? al stage of managing diversity. The Lewin-Schein change model is offered as the theoretical framework to proactively and systemically facilitate the management of diversity in organizations. This planned change model is based on the premise that the organizational forces propelling change must subdue the forces resisting change for highly effective change to occur. Therefore, it is posited in this paper that the Lewin-Schein change model is a framework that can assist organizations and individuals in moving through the sequential elements of the diversity continuum. It is also posited that this model can be applicable at JMD 22,10 868 both the organizational and individual level for managing diversity. While Allen and Montgomery (2001) offered the Lewin-Schein change model as a framework for creating diversity, the model is offered in this paper as a framework for Managing Diversity. The Lewin-Schein change model involves three stages: unfreezing, change (moving), and refreezing (Lewin, 1951; Schein, 1992). For the organization or individual to experience successful change, the three stages need to be addressed in succession. Unfreezing using a planned change-corporate diversity strategy In the unfreezing stage, the organization’s or individual’s present culture (which includes perceptions, attitudes, and behaviors) toward diversity, needs to be unfrozen. This means there needs to be enough motivation within the organization or individual to want to change from its present state to the new desired state. Thus, in moving from one end of the diversity continuum to the other end, with managing diversity being the desired outcome, management must desire that its members move from just acknowledging and valuing diversity to managing diversity. As presented previously, managing diversity refers to systemically organizing and directing the inputs of all organizational members (including diverse individuals) to ensure the organization’s strategic goals are met. Likewise, the individual must want to move from just acknowledging and/or valuing diversity to the ? nal phase of managing diversity. At the individual level, this movement involves governing one’s actions toward diverse individuals in a way that allows for healthy, productive interaction with those diverse others. Therefore, to unfreeze the organization’s culture and its members’ current state of mind toward diversity, a planned change-corporate diversity strategy should be devised and aligned with the organization’s strategic positioning to reduce the forces that are striving to maintain the status quo (Dobbs, 1998). A ? rm’s strategic positioning The strategic management process is employed by many organizations in order to distinguish themselves from their competitors in the marketplace (David, 2001; Porter, 1985; Steiner, 1997). Although there are several schools of thought in the strategic management ? ld, the generally accepted components of the strategic management process are: strategy formulation, strategy implementation, and strategy evaluation as explained in Figure 2 (David, 2001; Hill and Jones, 1998). Strategy formulation is comprised of developing or reviewing the organization’s mission, vision, and long-term goals; conducting internal and exte rnal assessments to identify the organization’s strengths, weaknesses, opportunities, and threats (SWOT); setting selection criteria and selecting the strategies that will afford the organization the best strategic positioning relative to its competitors (David, 2001; Steiner, 1997). Strategy implementation entails allocating the appropriate resources to ensure the Managing diversity 869 Figure 2. The three levels of organizational strategy selected strategies are properly executed (David, 2001; Steiner, 1997). Strategy evaluation involves setting control processes to continuously review, evaluate, and provide feedback concerning the implemented strategies to determine if the desired results are being accomplished, such that corrective measures may be taken if warranted (Hill and Jones, 1998; Steiner, 1997). As illustrated in Figure 3, there are usually three levels of strategy associated with large-scale organizations. The corporate level strategy de? nes the organization’s purpose and the lines of businesses in which it plans to operate, thereby providing the overarching direction for the organization. If an organization only operates in one line of business, its corporate level strategy and business level strategy are effectively one in the same (David, 2001; Hill and Jones, 1998). A business level strategy is the blueprint that should enable an organization to leverage its resources in order to differentiate itself from the competition within a particular line of business (David, 2001; Hill and Jones, 1998). The functional-level strategies serve to support the organization’s business-level strategy by providing direction for the appropriate short-term activities required by each functional area to meet the goals established in the business-level strategy (David, 2001; Hill and Jones, 1998). Consequently, having properly aligned corporate, business, and functional level strategies aid an organization in its efforts to accomplish its goals, thereby strategically positioning itself to successfully compete within the marketplace (David, 2001; Hill and Jones, 1998; Porter, 1985). Combining highly differentiated and ef? cient human capital with clearly delineated corporate, business, and functional level strategies can prove to be a competitive advantage for an organization (Barney, 1991, 1997; Wright et al. , 1995). An organization must view strategies for developing and managing its employees JMD 22,10 870 Figure 3. Alignment between corporate strategy and planned change-corporate diversity strategy as a part of its overarching corporate level strategy if it desires to have highly differentiated and ef? ient human capital in today’s competitive, global environment. Therefore, one argument of this paper is that any organization seeking to realize the maximum bene? t from having a diversi? ed workforce should have a planned change-corporate diversity strategy that is aligned with the organization’s overall strategic positioning. Developing a planned change-corporate diversity strategy The organization â€Å"wishing to create an environment that enables all employees to reach their full potential will have to . . . change organizational practices as necessary† (Thomas, 1991). However, prior to changing any organizational practice, a comprehensive strategy for how to accomplish that change should be devised based on an in-depth understanding of relevant organizational dynamics (i. e. culture, structure, ? nancial position, strategic initiatives, etc). Theoretically, a strategy should precede the structure of an organization. Consequently, a planned change-corporate diversity strategy should be devised to align with the organization’s corporate strategy before structuring diversity initiatives (as illustrated in Figure 4), and reinforced using a planned change approach. Organizations that have elevated their diversity strategist to executive-level management are likely to have an overarching corporate diversity strategy in place. But, it is not as likely that the diversity strategist is using a corporate-wide planned change approach to systemically reinforce the proposed changes in the corporate diversity strategy throughout all of the Managing diversity 871 Figure 4. The diversity continuum organization’s policies, procedures, and systems. Regardless of whether an organization has a corporate diversity strategy or not, it may be necessary to superimpose a planned change-corporate diversity strategy over existing disjointed diversity strategies and initiatives. At the onset of such an endeavor or superimposition, corporate diversity mission statement, vision, and goals must be formulated to articulate the purpose diversity initiatives will serve within the organization and the desired outcomes to be achieved from such initiatives. The delineated desired outcome should be designed to systemically manage diversity. Conducting internal and external assessments are essential steps in devising a planned change-corporate diversity strategy. An internal assessment will allow the diversity strategist to decide how to position diversity strategies and initiatives within the organization’s structure, and to align them with all of the organization’s policies, procedures, and systems. To assess the external environment, the diversity strategist should use environmental scanning tools to extract best practices based on benchmarked diversity strategies and initiatives at other leading organizations. Through the internal assessment, the diversity strategist should become intimately familiar with the organization’s values, vision, mission, strategies, goals, and initiatives, all of which constitute a sound basis for understanding the organization’s culture, policies, procedures, systems, and overall strategic positioning. The diversity strategist must become equally familiar with the bene? ts and shortfalls of various diversity initiatives. The strategist must conduct an analysis to determine the most appropriate linkages between the organization’s overall strategic positioning, policies, procedures, systems, and its diversity initiatives. Before proceeding, the diversity strategist must recognize and effectively articulate a clear strategic ? t and alignment amongst the organization’s overall strategic positioning, policies, procedures, systems, JMD 22,10 872 and diversity. Both strategic ? t and strategic alignment are necessary to strengthen the business case for allocating resources to support the planned change-corporate diversity strategy. In order to realize the maximum bene? ts from diversity, the planned change-corporate diversity strategy needs to be properly executed, evaluated and refrozen to ensure that the stated goals are being met, and that the organization’s culture and members are moving toward and sustaining the desired state of systemically managing diversity. Moving to systemically managing diversity Once the present state is unfrozen, the move that will allow the organization’s culture and members to advance to the desired state should be put in place. In this case, the move is to culturally reengineer the organization and its members to the true state of managing diversity by implementing the managing diversity process. The social learning theory (Bandura, 1977) is offered as the theoretical framework for the managing diversity process. It has also been offered as the theoretical framework for developing training programs in the cross-cultural and expatriate literature (Black and Mendenhall, 1989; Harrison, 1994). There are four major tenets of social learning theory: motivation, attention, retention, and reproduction (Bandura, 1977). These tenets are re? ected in the eight steps of the managing diversity process. In an effort to truly manage diversity, a change in the attitudes and behaviors of individuals, and in organizations’ systemic and institutional ways of doing business is required. Therefore, it is posited that utilizing the tenets of social learning theory can aid in the acquisition of the learning that is necessary for organizations to maximize the inputs of all of its diverse members. The planned change-corporate diversity strategy serves as the motivation for the learning of new behaviors and attitudes. Hence, once the planned change-corporate diversity strategy is articulated, the move through the eight steps of the managing diversity process should be instituted to assist individuals and organizations in culturally reengineering and moving to the desired state of managing diversity. The eight sequential steps of the managing diversity process include: (1) exposure; (2) experience; (3) knowledge; (4) understanding; (5) appreciate; (6) respect; (7) modify attitudes and behavior; and (8) healthy interaction. All of these are undergirded by tolerance (see Figure 5). The acknowledging diversity component of the diversity continuum is composed of steps (1)-(4), and they re? ect the â€Å"attention tenet† of social learning theory. The valuing diversity component of the diversity continuum is comprised of steps (5) and (6), and is re? ective of the â€Å"retention tenet† of social learning theory. Steps (7) and (8) constitute the managing diversity component of the diversity continuum and the â€Å"reproduction tenet† of social learning theory. The movement through each of the eight steps requires individuals to progressively develop appropriate skills to enable them to manage how they deal with individuals whom they consider different from themselves. Therefore, executing the eight steps in the managing diversity process serve as the necessary movement required to progress from acknowledging and valuing diversity to managing diversity. The true movement through the eight steps from acknowledging diversity to managing diversity is a paradigm shift, in that it entails a change in the treatment of diverse individuals (Fitzpatrick, 1997). Managing diversity 873 Diversity training In order for an organization to realize the potential bene? ts that can be afforded by employing diverse individuals, there needs to be a paradigm shift in which the inputs of diverse individuals are systemically managed within an organization to enable the successful accomplishment of its strategic goals. Training of individuals is viewed as a necessary tool to facilitate the organization in achieving its goals. Diversity training should be viewed no differently than any other type of training in which an organization invests. Therefore, it should also be viewed as a necessary tool to manage members’ behaviors and their ability to work productively with diverse individuals. After canvassing the literature, it has been noted that most diversity training programs merely raise individuals’ awareness of or sensitivity to diversity (Grubb, 1995; Jenner, 1994). Some few diversity training programs go as far as attempting to change individuals’ perceptions of diversity and how they communicate with people different from themselves (Grubb, 1995). However, these programs tend to be offered to only select employees, and they tend to be short in duration, ranging from a one-hour session to a series of one-day sessions several times a year (Koonce, 2001). The major drawbacks to most existing diversity training programs are that: . they do not build skills to facilitate individuals’ ability to actually manage their interactions with individuals different from themselves; . they are not rigorous nor time-intensive enough to create a paradigm shift in individuals’ treatment toward individuals different from themselves; and JMD 22,10 874 Figure 5. The continuous managing diversity process . there are no enduring reinforcement mechanisms embedded in the organization’s culture to ensure all individuals’ inputs are successfully managed to met the organization’s strategic goals. Managing diversity As a result, most (if not all) existing diversity programs have not been successful in creating enduring change in the way individuals interact with individuals different from themselves, nor have they been successful in changing their organization’s culture to one that systemically manages diversity. In order to create enduring change in individuals and the organization’s culture, members of the organization at all levels need to participate in diversity training that encapsulates the comprehensive managing diversity process. The outcomes that should be expected from participation include, but are not limited to, skill building in the following areas: the ability to clearly articulate their ideas and feelings; con? ict management skills; effective giving and receiving of feedback; effective listening; group observation skills; and group decision-making skills, all of which will facilitate modi? d attitudes and behaviors, and healthy interaction with diverse individuals. Individuals have to come to grips with their feelings, thoughts, attitudes, and behaviors toward diversity and others with whom they are different. In the ? rst step of Exposure, individuals provide public notice of where they are at that point. They do this by: laying open who they are; divulging where the y are; unmasking themselves; and receiving others’ culture. Step (2), experience, involves gathering information through personal involvement, encountering, seeing ? rst-hand, and living through events. In the third step of Knowledge, individuals become well informed, thus able to be conversant because they become familiar or acquainted with the culture of others. Knowledge serves as the basis for step (4), understanding. Because of their grasp of cultural realities, individuals are able to comprehend (understanding) relevant cultural dynamics, which leads them to be sensitive, and enables them to share unique insights and perceptions. In step (5), appreciate, individuals’ acceptance of the worth of a person’s culture and values makes it easier for them to welcome and â€Å"justly† estimate diverse individuals. Resultantly, individuals are able to respect (step (6)) diverse individuals; thus, they are able to pay attention, pay deference, and pay tribute to the values, worth, and culture of diverse others, as well as give personal consideration to the diverse individuals. Successful movement through the ? rst six steps, along with tolerance underpinning each step, should lead to modi? cations in individuals’ attitudes and behaviors toward diverse individuals, which is step (7), modify attitudes and behaviors. This change in attitudes and behaviors, again, along with tolerance should lead to healthy interaction (step (8)) with and amongst diverse individuals. Step (8) is a function of continuous acceptance and execution of steps (1)-(7). Therefore, this is a ? uid (not static) process that must be recognized for its ever-changing and 875 JMD 22,10 876 evolving nature. The requirements for successful execution of the managing diversity process are strenuous and time intensive because it requires individuals to modify their attitudes and behaviors. Thus, they must modify the way they interact with individuals different from themselves, and not just expect that they either avoid, acknowledge, or value those individuals that are different. Given that all individuals in today’s global business environment are likely to encounter others that are different from themselves on a frequent basis, the managing diversity process should be viewed as analogous to the open systems approach – it is a continuous process that maintains a constant reciprocal relationship with the environment. Refreezing the systemic management of diversity Successful movement through the managing diversity process requires individuals to change. Resistance to change is inherent in any change process, and it will be no different in this process (Harrison, 1994). Therefore, the managing diversity process is a ? uid, continuous process that needs to be systematically reinforced and embedded in the organization’s culture and individuals’ interactions, such that the organization’s culture and its members do not revert back to just acknowledging or valuing diversity. Hence, refreezing the desired state of managing diversity requires reinforcing the new perceptions, attitudes, and behaviors with emphasis on the modi? ed behaviors and healthy interactions individuals have adopted as a result of going through the managing diversity process. In order for individuals and organizations not to revert back to their previous states, the new desired state must go through the refreezing stage to be institutionalized. This should be accomplished through systemic, on-going training and daily interactions at the individual level, and through revised policies, procedures, and systems at the organizational level. At the individual level, the systemic, on-going training should not be just periodic training that merely exposes individuals to diversity. A great deal of time is necessary to cement these newly adopted attitudes, behaviors, and skills for healthy interaction. This kind of cementation is required for these newly acquired attitudes, behaviors, and skills to become totally embedded in the individuals’ natural way of interacting with diverse individuals. The systemic, on-going training needs to be skill-based and experiential in nature to promote long-term changes in the way individuals work with individuals different from themselves. This type of reinforcement at the individual level will contribute to the cultural reengineering that also must take place at the organizational level. To reinforce the desired state of managing diversity at the organizational level, revised recruiting, appraisal, development, and reward systems, as well as an enforceable diversity policy need to be implemented (Allen and Montgomery, 2001; Hemphill and Haines, 1998; Miller, 1998). The revised policies, procedures, and recruiting, appraisal, development, and reward systems need to re? ct the organization’s position on how the inputs of diverse individuals will be managed, such that their contributions fully aid the organization in meeting its strategic goals. A written, enforceable diversity policy, stating the systemic action steps and behaviors expected by all employees is a must as it relates to effectively managing the organizational inputs of all individuals. Everyone’s inputs should be effectively managed to contri bute to the achievement of the organization’s strategic goals. The revised policies, procedures, and systems should also align with the planned change-corporate diversity strategy. Given the resources and time required to revise and initiate implementation of the revised organizational policies, procedures, and systems, individuals are likely to resist these changes initially. Therefore, it is quite likely to be a dif? cult and time-consuming process to make the appropriate and necessary revisions to the organization’s policies, procedures, and systems. This is an essential and critical step necessary to ensure the organization and its members do not revert back to their previous attitudinal and behavioral states. It is paramount that revised policies, procedures, systems, and planned change-corporate diversity strategy are clearly communicated to all members of the organization to ensure that it can be appropriately recognized, executed, evaluated, and reinforced. To reinforce this cultural reengineering effort, management needs to initiate and actively participate in the refreezing stage, the same as they must genuinely participate at the unfreezing and moving stages. Potential limitations As with any theoretical model, there are limitations. One potential limitation of this notional model is that no matter how well it is implemented, there are likely to be some individuals whose attitudes may never change or they may continue to consciously or unconsciously show favoritism toward those whom they consider to be similar to themselves (Gilbert and Ivancevich, 2000; Miller, 1998). Another potential limitation is that subtle forms of biases against diverse individuals may still exist informally within the organization and/or outside of the work environment; thus, highly impacting individuals within the organization. Backlash is also a potential limitation; members of the majority are likely to perceived that they are being excluded at the expense of including diverse individuals (Hemphill and Haines, 1998). Additionally, if the training initiated to implement the managing diversity process is perceived as a bad experience, the organization’s leadership may abandon the initial implementation, hence dooming all future diversity efforts. However, by using the suggested planned change approach along with well enforced diversity policies and disciplinary procedures for violations of the diversity policy, it is more likely that individuals’ behaviors can be altered to be more tolerant of others whom they consider to be Managing diversity 877 JMD 22,10 different (Gilbert and Ivancevich, 2000). This will allow the talents, skills, and abilities of all individuals in the work setting to be used to meet organizational objectives. Conclusion Given that individuals are less willing to leave their differences outside the doors of the workplace (Thomas, 1991), an organization’s ability to systemically manage diversity will become more important, in years yet to come, if it wants to ensure its ability to compete successfully in the global marketplace. This paper suggests that, ? rst, a planned change approach should be used to systemically manage diversity, by developing and implementing a planned change-corporate diversity strategy. Second, organizations should execute their cultural reengineering efforts to move individuals and the organizational culture along the diversity continuum from the states of acknowledging and valuing diversity to the desired state of managing diversity. Movement to the desired state of managing diversity can be achieved by using the managing diversity process. It is also suggested that the organization needs to provide on-going training, and needs to institute new policies and procedures. Additionally, it must engage in appropriately different recruiting, appraisal, development, and reward systems that systemically reinforce the cultural reengineering of moving to the state of managing diversity. These new undertakings will ensure that the newly reengineered culture of managing diversity is inculcated into the organization’s culture, and its way of conducting business domestically and abroad. By adopting and executing the frameworks offered in this paper for ystemically managing diversity through a strategic planned change approach, managers will have created an organizational environment where they will be able to enjoy healthy, innovative, and productive interactions amongst diverse members of the organization. The following is a list of other potential bene? ts that may be derived from using the offered frameworks: . in general, individuals will develop an increased knowledge of and appreciation for other cultures; . individuals will learn to value and respect the cultural norms, behaviors, and attitudes of others; . here is likely to be a greater receptivity to necessary organizational changes; . there is likely to be a lessening of workplace anxieties; . a reduction in organizational con? ict; . a more pleasant work environment; and . increased performance and productivity. 878 In conclusion, the proactive management of diverse human resources will aid organizations in gaining and sustaining a competitive advantage in today’s dynamic global marketplace.