Reducing Central Line-Associated Blood Stream Infections

Reducing Central Line-Associated Blood Stream Infections Literature Review: Reducing Incidences of Central Line-Associated Blood Stream Infections A bundle is a group of interventions related to a disease process, that when executed together, produce better outcomes than when implemented individually. Numerous studies done in the developed countries have shown that proper implementation of evidence based practices grouped together as central venous catheter bundle had brought a dramatic reduction in the incidence of CLABSI. Studies in developing countries had also shown high incidence of CLABSI and reduction in CLABSI rate albeit lesser than that of developed countries. Studies from India have a shown a higher incidence of CLABSI and poor adherence to central line catheter bundle. Morbidity and mortality due to CLABSI is considerably high despite underreporting of such events. The development and publication of guidelines often does not lead to changes in clinical behavior and guidelines are rarely if ever, integrated into bedside practice in a timely fashion. The most effective means for achieving knowledge transfer remains an unanswered question across all medical disciplines. Our study aims to determine the compliance with CVC bundle in management of patients in medicine wards and ICU at All India Institute of Medical Sciences New Delhi and the impact of intervention in the form of periodic physician education and feedback in compliance with CVC bundle and central line catheter related complications. Review of literature Ever since the introduction of central venous catheters in the early 1950s, it had varied uses and later numerous studies revealed that it was associated with a varied number of complications. Although mechanical complications were common in the early years of CVC use CLABSIs quickly became recognized as a serious complication associated with their usage. Central venous catheter is defined as a catheter whose tip terminates in the great vessels. The great vessels are the aorta, pulmonary artery, superior vena cava,inferior vena cava, brachiocephalic veins, internal jugular veins,subclavian veins, external iliac veins, common iliac veins,femoral veins, and, in neonates, the umbilical artery/vein. Types : Common types of central venous catheters are Non tunneled catheters, Tunneled catheters, Implantable ports, PICC. A peripherally inserted central catheter (PICC) is peripherally placed, but is considered a central catheter because its tip terminates in the central circulation. These venous catheters can also have single, double or triple lumens although single lumens are frequently used and are for intermediate to long term therapy for blood draws or infusions. Complications of CVC: Mechanical complications(4,9)include Pneumothorax is a common complication with subclavian and IJV cannulations without the use of ultrasound. The use of real time ultrasound reduces the number of attempts and associated with a significantly lower failure rate with internal jugular vein ( Relative risk 0.14, 95% confidence interval 0.06 to 0.33). Limited evidence also exists for sublclavian and femoral routes in this metanalysis. Thus the chances of pneumothorax will be greatly reduced. Pneumothorax is usually apparent immediately on Chest X rays and management may vary from simple observation to ICD placement with needle drainage needed for tension pneumothorax as emergency(11). Delayed pneumothorax is also known to occur with an incidence of 0.4%, more common with subclavian and with multiple attempts(12). Bedside ultrasonography allows diagnosis of pneumothorax to be made immediately with high sensitivity by clinician but is operator dependent(13). Misplacement of catheters occur commonly such as tip malposition or rarely such as within artery. It is common practice to assess tip position lying above carina for right sided catheters assuming pericardial reflection below carina and below carina for left sided catheters in view of acute angulation to superior venacava(14). Management varies depending on the complication such as repositioning of tip for tip malposition lying below carina or when lying with an artery, interventional radiologist or vascular surgeon opinion is sought and removed accordingly(15). Arterial injuries are more common with femoral and internal jugular rather than subclavian approach. A systematic review of complications of central venous catheters revealed significantly more arterial punctures (3.0% vs 0.5%) and less malpositions(5.3% vs 9.3%) with jugular access(16). It leads to hematoma in approximately 40% of patients. The best way to prevent arterial injury is by ultrasound assistance during cannulation(17). Other rarer complications are local hematomas,cerebrovascular accidents mostly seen with arterial injuries via internal jugular access, arrhythmias, perforation of the vein or right atrium, chylothorax, pseudo aneurysm, AV fistulas, cardiac tamponade, guidewire loss and catheter embolisation etc. have been reported. These complications largely depend on the site of insertion and on operator experience. Such complications can be prevented by ultrasound guidance and proper techniques. Infectious complications are most dreaded as it is associated with mortality rates upto 25% and in developing countries even up to 60% and prolong the duration of hospital stay and are largely preventable. Evidence based guidelines have been developed as the central venous catheter bundle which significantly decreases the incidence of infections as shown in below studies.CVC use in non ICU settings is associated with at least a 2 fold rise in infection rate than in ICU settings. However studies are very limited on the infection rates as well as on the preventive measures in non ICU settings. Thrombotic complications range from 1.2 to 3 % in subclavian veins to up to 8 to 34% in femoral cannulations. Merrer et al in a randomized control trial found significantly increased incidence of thrombotic complications(21.5% vs1.9%,p

Active Versus Passive Mind Debate Essay

Étienne Bonnot de Condillac an 18th-century French philosopher contended that the senses are the foundation for all ideas and other functions carried out in the mind. Another prominent French philosopher, Renà © Descartes supported the Rationalistic theory; an explanation of behavior based on logic that has nothing to do with the senses. Condillac’s Sensationalism premise and Descartes theory of Rationalism serve as fuel for the classic active versus passive mind debate. The passive mind theory suggests that all learning occurs through the experience of sensations, in the absence of voluntary mind control processes, while the active mind theory claims the exact opposite; that individuals actively focus certain mental processes on the subject matter and the senses play no part in the process. Descartes also believed that sensory data was inclined to be false and was therefore useless, suggesting that mathematical deduction was the only path to the truth. Justin Skirry 2008 I believe that both theories have some validity. The problem arises for me with the use of the word all by Condillac, and the use of the word only by Descartes, which is what takes the theories from the moderate part of the continuum to the extreme. Sensory learning is of course a proven fact, but it is also a fact that active learning occurs as well. It is not unusual for a philosopher to be both a sensationalist and a rationalist at the same time. I tend to trust my deductive powers of reasoning more than my senses, because many outside forces can alter the senses. Take emotion for instance, I am aware of the role unchecked emotions can play in faulty decision-making. I have learned not to make important decisions when I am in a highly emotional state.

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.

The Cognitive Therapy And Narrative Therapy Model

Questions: 1. Compare and contrast how two different models of counselling would understand and approach treating Jim. Both the Cognitive Behavioral therapy and Narrative Therapy model are used to help persons with a wide variety of problems (addictions being one) learn how to view their world a bit differently. Cognitive therapy helps people to look at and to change disruptive beliefs which have a detrimental impact on our behaviors, emotions and overall quality of life. Narrative therapy helps people to put more attention on the positive storylines that make up their reality rather than just the negative. Both hold that positive thoughts and positive self-narratives tend to have a positive or advantageous impact on a person’s behaviors and emotions. For Jim treatment approaches with the CBT model would most likely consistent of Cognitive Psychotherapeutic interventions. This type of interventions for Jim would be used to help him focus his attention on the disruptive thoughts and beliefs in his life that lead him to drink. In Jim’s case these thoughts may be directly related to the trauma he suffered as a result of the war, his own father alcoholism and the tension and stress cause from traveling for work and at home. The aim for Jim with this type model of counselling would be to adjust these thoughts and belief so that the no longer are risk factors that bare a substantial negative impact on a Jim’s life. Specific techniques that Jim would likelyShow MoreRelatedTreatment Models Chosen For Comparison1241 Words   |  5 Pages Treatment Models Chosen for Comparison 1. Narrative Therapy the role of the therapist, views of people and their problems, and the approach for helping. Narrative therapy is a way to look at a person’s life story and their struggles from an outside looking in approach. The problems become separate from the individual. Narrative therapy helps the client examine their life story from a strengths perspective. Instead of focusing on the problems the worker helps the client identify their strengthsRead MoreMultiple Theories Influenced The Development Of My Personal Model And Therapeutic Approach For Couples And Families1668 Words   |  7 Pagestheories have influenced the development of my personal model and therapeutic approach to couples and families. Three theories in particular that I draw my therapeutic approach from includes: narrative therapy, emotionally focused couple’s therapy, and attachment theory. I will articulate the theoretical underpinnings of these three theories and integrate them in one cohesive personal model called Emotional Enhanced Attachment Narrative Therapy. 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According to Mayo Clinic in Rochester, Minnesota it describes Cognitive Behaviour therapy as a form of psychotherapy that with the help of a therapist or psychotherapist, allows you to become aware of inaccurate or negative thinking with the purpose thatRead MoreCognitive Behavioral Therapy And Narrative Therapy1706 Words   |  7 PagesThis paper is going to look into two models of intervention that Ben and I think might help him cope with things going on in his every day life. The two that we have chosen are Cognitive-behavioral therapy and Narrative therapy. We will look into both of these and also as we do that we will find out what the role of the social worker is in both cases. Cognitive-behavioral therapy can help you notice the discouraging thoughts that make you feel bad. These thoughts are sometimes called irrationalRead MoreThe Relationship Between Regenerate And Unregenerate Thought Processes Essay1089 Words   |  5 Pagespeople are fundamentally born imperfect; one of the major goals of the therapy assists people to learn to accept their personalities as well as others unconditionally. God s unconditional love for humanity regardless its imperfection is an all-encompassing recurring theme in the Bible. For example, God demonstrated his love for us through the death of his son Jesus when humanity plunged into sin. Similarly, cognitive-based therapy promotes a more realistic view of the self and others, which is in agreementRead MoreCognitive Behavioral Therapy And Narrative Therapy1706 Words   |  7 PagesThis paper is going to look into two models of intervention that Ben and I think might help him cope with things going on in his every day life . The two that we have chosen are Cognitive-behavioral therapy and Narrative therapy. 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