Organizational Design and Culture

This paper aims to discuss the changes in organizational structure of healthcare institutions. In particular, it is necessary to show how workplace hierarchy in these hospitals was restructured and how the administration modified means of coordinating and monitoring work of healthcare professionals.Advertising We will write a custom essay sample on Organizational Design and Culture specifically for you for only $16.05 $11/page Learn More Furthermore, we need to evaluate the efficiency of these changes and the improvements they brought. Overall, it is possible to argue that the majority of hospitals attempt to become less bureaucratic and turn themselves into adhocratic organizations. This means that they try to eliminate formal barriers between the top managers and their subordinates in effort to improve the quality of healthcare and remove time-consuming red tape (Mintzberg Ghoshal, 2003, p 464). One of the most common changes, underwent by many hospit als nowadays is the creation of interdisciplinary teams (Aikman et al, 1998). The members of these teams may belong to different departments or units, yet, they focus on the needs of a certain group of patients. To better illustrate this concept, we can draw such an example as Toronto East General Hospital (TEGH); the administration of this institution decided to form workgroups that would address the needs of a specific population, namely pregnant women. These workgroups included obstetricians, counselors, midwifes, psychologists, and nurses; in turn, the decisions about healthcare were formed within these teams (Aikman et al, 1998, p 29). To some degree, the formation of this mix groups can be regarded as a step toward a matrix management. The key principle of matrix management is that a healthcare professional can work under direction of several managers and support organizational activities. The main objective of this organizational change in TEGH was to provide medical workers with a higher degree of autonomy and better opportunity for decision-making (Aikman et al, 1998, p 34). Another form of organizational change is the delayering of the workplace hierarchy. This policy is based on the premise that a medical worker, who is supervised by many layers of management, cannot perform his duties efficiently because he has to constantly ask for the authorization of the superior manager and other authorities in order to take any decision about patient care (Mintzberg Ghoshal, 2003, p 172). This argument is particularly relevant, if we are speaking about nurses who are closely monitored by head nurses, unit-directors, and case managers at the same time. Due to this continuous supervision they are virtually powerless. Therefore, the purpose of delayering is to make senior management more close their subordinates and ensure that both sides are able to quickly share information with one another.Advertising Looking for essay on business economics? Let's see i f we can help you! Get your first paper with 15% OFF Learn More To better explain the process of delayering, we need to refer to such organization as Saint Fransis Community Hospital. In this organization, the front-line workers are accountable only to the heads of interdisciplinary teams (Saint Fransis, 2010, unpaged). Subsequently, these heads of multi-disciplinary teams report to unit directors and vice presidents. The key issue is that members of these multi-disciplinary teams do not have to wait for the approval of head nurses and unit-directors. Judging from these examples, it is possible for us to argue that modern healthcare organizations attempt to erase bureaucratic borders by relaxing supervision over healthcare workers and by reducing workplace hierarchy. To some degree, this tendency can be described as the move toward adhocracy. Yet, this process is far from being complete, even despite the fact that the necessity for organizational change in healthcare organi zations became evident several decades ago. Reference List Aikman. P. , Andress I. Goodfellow I. LaBelle N. (1998). System Integration: A Necessity. The Journal of Nursing Administration. 28 (2), p 28-34. Mintzberg. H. Ghoshal S. (2003). The strategy process: concepts, contexts, cases.  NY: Pearson Education. Saint Fransis Community Hospital. (2010). The official website. Web. This essay on Organizational Design and Culture was written and submitted by user Ayanna Herman to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

What Cheating Out and Other Theater Jargon Means

What Cheating Out and Other Theater Jargon Means Drama class and theater rehearsals are some of the only places where cheating is encouraged. No, not cheating on a test. When  actors  cheat  out, they position themselves towards the audience, they share their bodies and voices so that audiences can see and hear them better. To Cheat Out means that the performer readjusts his or her body with an audience in mind. This might mean that the actors stand in a way thats not quite natural - which is why this practice cheats reality just a bit. But at least the audience will be able to see and hear the performer! Very often, when young  actors are  rehearsing on stage, they might turn their backs to the audience, or offer only a limited view. The director then might say, Cheat out, please. Ad Lib During a performance of a play, if you forget your line and cover for yourself by saying something off-the-top of your head, you are ad-libbing, creating dialogue on the spot. The abbreviated term ad lib comes from the  latin phrase:  ad libitum  which means At ones pleasure.But sometimes resorting to an ad lib is anything but pleasurable. For an actor who forgets a line during the middle of a show, an ad lib might be the only way to keep the scene going. Have you ever ad-libbed your way out of a scene? Have you ever helped a fellow actor who forgot his or her lines with an ad lib? Actors have an obligation to learn and deliver the lines of a play precisely as the playwright wrote them, but its good to practice ad-libbing during rehearsals. Off Book When actors have completely memorized their lines, they are said to be off book. In other words, they will be rehearsing with no script (book) in their hands. Most rehearsal schedules will establish a deadline for actors to be off book. And many directors will not allow any scripts in hand - no matter how poorly prepared the actors may be - after the off book deadline. Chewing the Scenery This piece of theatrical jargon is not complimentary. If an actor is chewing the scenery, it means that he or she is over-acting. Speaking too loudly and theatrically, gesticulating largely and more than necessary, mugging for the audience - all of these are examples of chewing the scenery. Unless the character you play is supposed to be a scenery-chewer, its something to avoid. Stepping on Lines Although it is not always (or usually) intended, actors are guilty of stepping on lines when they deliver a line too early and thereby skip over another actors line or they start their line before another actor has finished speaking and thus speak on top of another actors lines. Actors are not fond of the practice of stepping on lines. Breaking Curtain When audiences attend a theatrical production, they are asked to suspend their disbelief - to agree to pretend that the action onstage is real and is happening for the first time. It is the responsibility of the productions cast and crew to help the audience do this. Thus, they must refrain from doing things like peeking out at the audience before or during a performance, waving from offstage to audience members they know, or appearing in costume off the stage during intermission or after the performance ends. All of these behaviors and others are considered breaking curtain. Paper the House When theaters give away a large amount of tickets (or offer the tickets at a very low rate) in order to gain a large audience, this practice is called papering the house. One of the strategies behind papering the house is to create positive word-of-mouth about a show that might otherwise suffer from low-attendance. Papering the house is also helpful to the performers because it is more satisfying and realistic to play to a  full or almost full house than to play for a sparsely populated set of seats. Sometimes papering the house is a rewarding way for theaters to offer seats to groups that might not otherwise be able to afford them.

The Changing US Political Symbolism of Blue and Red

The Changing US Political Symbolism of Blue and Red The Changing US Political Symbolism of Blue and Red The Changing US Political Symbolism of Blue and Red By Maeve Maddox In British politics, blue is associated with Britain’s conservative party, the Tories, whereas red is associated with the Labour Party. The same association of blue with political conservatism was once common in US politics, but now red is associated with the conservative party. This change became fixed following the presidential election of 2000. The reversal was driven by the use of colored maps to track election returns in the media. The first giant election map was introduced by NBC television in 1976. States in which the majority voted for the Republican candidate (Gerald Ford) were lighted in blue. States in which the vote went to the Democratic candidate (Jimmy Carter) were lighted in red. In 1980, both NBC and CBS used red for Carter (D) and blue for Reagan (R), but ABC, to the confusion of channel-switching viewers, used blue for Carter and red for Reagan. In 1984, ABC and CBS used red for Republicans and blue for Democrats, but NBC retained blue for Republicans and red for Democrats. NBC consistently used blue for Republicans and red for Democrats from 1976 to 1988, the period during which Roy Wetzel was the general manager of NBC’s election unit. Whereas the other networks seemed to have used the colors arbitrarily, Wetzel gave a reason for his consistency: â€Å"Without giving it a second thought, we said blue for conservatives, because that’s what the parliamentary system in London is, red for the more liberal party. And that settled it.† - â€Å"When Republicans Were Blue and Democrats Were Red,† Smithsonian Magazine, Oct. 31, 2012. Note: Graphics in British newspapers usually assign blue to Conservatives, red to Labour, and yellow to Liberal Democrats. In 2000, two of the networks, ABC and NBC, used red for Republicans and blue for Democrats on their election maps. NBC’s election chief, Tim Russert, is credited with popularizing the phrases â€Å"red states† and â€Å"blue states.† Reinforcing the red/blue associations in 2000 were two newspaper maps that came out two days after the disputed election. The New York Times and USA Today both published color-coded maps that assigned red to Bush and blue to Gore. By the time the next presidential election rolled around in 2004, all three networks had adopted the imagery of red for Republican and blue for Democrat. The terms â€Å"red states† and â€Å"blue states† are now common in American political discourse: While the Republican Party is poised to make major gains in red states in the battle for the U.S. Senate, the situation is flipped in governors’ races, where Republicans are facing a tough time defending chief executives who won office in blue states in the Obama backlash of 2010.- The Washington Times. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the General category, check our popular posts, or choose a related post below:Creative Writing 101What is the Difference Between Metaphor and Simile?7 Other Types of Pronouns

Article on the reflection of media on new scientific research Essay

Article on the reflection of media on new scientific research - Essay Example Rossi brings about an understanding that previously used techniques firstly are extremely inefficient and do not always produce a true IPS. Secondly, due to the use of a retroviral vectors the cells tend to reject the attempt of incorporating the modified RNA and view the viruses as infectious threat leading them to undergo apoptosis and activation of interferon pathways. Furthermore, due to the nature of retroviral integration the cells become prone to mutagenesis leading to cancer due to activation of Onco-genes. Thirdly, once an IPS cell is produced by the old method there is a question of how closely these cells are able to act as the Gold Standard ES Embryonic Stem cells, and if they are prone to reversing back to their pre- induced state. Lastly, the future of IPS is to have them generated specifically for each patient and the old ways of Pluripotency Induction are very limited and only a small amount of Pluripotent cells are able to be derived (Johnson, 2010). New IPS cell der ivation technique is quite impressive in a number of ways; primarily in the derivation simplicity and then in the technique itself. Above all Rossi states there is no need for a specialized lab, as any scientist with basic RNA modifying equipment is able to create the IPS cells, the media realizes this opens up enumerate possibilities for not only future research but also gene therapy(Warren et al., 2010). These therapies will be able tobe carried out all over the world as regular scientist will be able to modify cells in not only high tech labs such as Harvard Univerity but also in remote places as hospitals across Africa. The IPS generation technique described in the Rossi article entitled â€Å"Highly Efficient Reprogramming to Pluripotency and Directed Differentiation of Human Cells with Synthetic Modified mRNA† discusses that the induction discovered by Yamanaka requires the manipulation of only four Genes; KLF4, c-MYC, OCT4, and SOX2 (KMOS) are the four strips of RNA th at are required as transcription factors to re-set a skin cell in to an IPS cell. As it turns out the new induction procedure is also faster at producing IPS cells; Lowry and Takahashi found that the new technique produces IPS cells with efficiency thirty six times the previously used method, this indicates an enumerate improvement on IPS cell production efficiency, and opens opportunities for larger scale treatments in the future. As the comparative research carried out by Chan and Lowry indicates the new technique produces IPS colonies within seventeen days, which is roughly twice as fast then the four week minimum it would take using the out dated technique. Over all, the media reporters seem to be moving in the direction of how this research will effect the general population, clinical stem cell application and future research. Their curiosity is in the right place as this research will revolutionize the way stem cells are perceived by the general public, since we probably will no longer require cells from aborted fetuses. Moreover, due to the quantity and speed of production of IPS cells researchers may conduct mass scale clinical

Jellyfish Essay Example | Topics and Well Written Essays - 1000 words

Jellyfish - Essay Example Jellyfish have no head, spine, heart, eyes, or brain. Instead of having a brain, the creature has a nervous system also referred as the nerve net that consists of receptors that detect the odor, light, and other responses. Additionally, Jellyfish has sensory organs known as Rhopalia that helps in maintaining balance. They have a primitive sense that consists of the neural net and eye spots commonly used to sense dark and light. Jellyfishes’ body is comprised of three layers. The outer layer referred as epidermis, the inner layer known as the gastrodermis, and the middle layer referred as the mesoglea. The epidermis is the most important layer that covers the external body of this creature. The epidermis protects the skin from the invasion of harmful substances in the body. The gastrodermis protects the inner layer of the jellyfish. Typically, Jellyfish has a simple digestive cavity referred as the coelenterons that are used as the stomach and excretory organ. The coelenterons operate like a gullet, intestines, and stomach through the mouth. On average, the length of jellyfish tentacle is two to ten meters and the length can grow tremendously. A study conducted by King (22), indicates that the longest jellyfish to have lived was 120 feet. Jellyfish are carnivores and they tend to increase rapidly when the food is plentiful. These creatures feed on small crustaceans and zooplankton just to name a few. Jellyfish are nonaggressive, free-swimming, and surrounded by tentacles with poisoning and stinging cells. The tentacles contain sacs filled with poison that can be life-threatening. With its severity in mind, researchers have provided facts and information on how to treat this sting. To remove the sting, one should use tweezers, thick clothing, gloves, or sticks (Lindeen 33). According to this research, one should not touch the sting with bare skin since the sting is poisonous and can severely affect the skin. One should throw away the item used for removing the sting to avoid stinging yourself later. To fully deactivate the poisonous sting, one should pour vinegar on the stung for

Care Theory for Adults With Learning Disabilities

Care Theory for Adults With Learning Disabilities Critically discuss care theory in relation to social work with adults with learning disabilities. Social work has undergone a radical transformation in the last two decades. Today ideas about the multi-layered nature of disabilities and the complexity of needs are commonplace in the public discourse on welfare and social work. People with learning disabilities and their carers and families have formulated their urgent demands upon society while academics and practitioners have supported this re-shaping of the social care agenda and the government has attempted to integrate the various challenges and interests in new and significant policy documentation such as Valuing People (2001). This essay will deal with three interrelated issues that are of particular importance to people with learning disabilities and their quality of life. It will (1) explore the relationship between care theory and the issues of ethical practice when dealing with adults with learning disabilities. It will look at the rules of engagement that have found their way into the various codes of practice for soci al work practitioners and the ethical problems that they may give rise to. And (3) it will consider the link between anti-discriminatory practice and the rights that service clients have and how these rights may influence the way in which practitioners may discharge their responsibilities throughout the social service sector. Within the confines of this essay, (1-3) will be examined through the following lens. Given the existing code of practice and policy stipulations, what could self-determination mean for people with learning disabilities? And how do ethical difficulties find their expression in particular practices of social work for adults with learning disabilities, such as person-centred planning and direct payments. There have been several attempts to regulate and standardise work practice for employees and employers of social work practitioners in the UK. These attempts have deep historical roots, such as the Hippocratic oath (Loewenberg 1992: 36). Yet the more recent attempt by the Scottish Councils to draw up a conclusive list of responsibilities and duties of social workers and their employers has been triggered by the desire to introduce reliability and transparency into a field of social care which has hitherto featured a plethora of often conflicting norms and standards. The code of practice sets out (for the first time) the expectations, obligations and duties under which social workers and their employers ought to operate. It is supposed to be the initial step in a broader process of standardisation of the social services (Codes 2001: 13). It echoes the definitions of the nature, aims and guiding principles of social work given in the Code of Practice by the British Association of Socia l Workers (BASW 1986 and Codes 2001). The various values that inform social work are human dignity and worth, social justice, service to humanity and integrity and competence of practitioners (BASW and CoP) In particular, the Code emphasises the right of individuals to control their lives and the obligation of social workers to promote the right to self-fulfilment by clients (Codes 2001: 15 and BASW 1986: 2). This agglomeration of values and norms that ought to inform social care practice however raises some serious questions when it comes to their application in the social work with people with learning disabilities. First of all, it is generally acknowledged by analysts of the service as well as by practitioners that the particular interpretation of the notion of self-determination is a culturally contingent idea. Loewenberg as well as Watson acknowledge that the ethical principles and rules of social work are derived from societal norms (Loewenberg 1992: 38; Watson 1985: 22). However, modern society encompasses a multitude of often conflicting social norms and it is this plurality of notions of a good life and standards of social agency which creates problems. The code explicitly urges social service professionals to take account of their client’s understanding of self-determination and individual independence. Yet, within a culturally diverse population, different notions of what is acceptable and desirable with respect to the independence of people with learning disabilities prevail. To promote independence of an adult or child with learning disabilities in a community that traditional ly places a fundamental emphasis on continuous care within the family can pose a particular dilemma to social workers. More generally, however, governmental policy and the codes of practice can produce significant problems for social care workers. The government has made inclusion one of the main policy priorities with regard to people with learning difficulties. Mainstreaming employment for individuals with learning disabilities is a pillar of this new approach. However, the competitiveness of the first labour market has traditionally represented a considerable barrier to finding viable employment for people with learning disabilities or emotional behaviour problems. Social care workers are tasked to identify problems that impact on the quality of life and decrease the chances of self-fulfilment for their clients. But often they are neither trained nor have access to resources in order to identify and put in place support programmes that ensure that adults with learning difficulties can find employment in the first labour market. The compartmentalisation of services continues to produce additional b arriers that prevent social care workers from discharging their duties with regard to their clients. Let us consider an example. Let us suppose that a social worker has the responsibility to support some individuals with learning disabilities which live in group homes (Beckett 2005: 138). One of the residents approaches him and tells him that she has got into a muddle with her benefits with the result that she has run out of money and is very distressed about this. The social care worker calms her down and places some phone calls to the local benefits office and sorts it out for his client. In a way, the social worker ‘has respected [the client’s] wishes and done exactly what she asked of him. Has he therefore supported her right to determine her own life?’ (Beckett 2005: 138) His commitment to support her desire to self-determine her life here clearly conflicted with her desire to draw on needed support. The real crux of the problem however lies elsewhere. The client has been unable to get sufficient support from the benefits office and therefore felt unable to sort out the issue on her own. In fact, the lack of adequate support on the side of the benefits office, possibly the absence of a trained worker in the office who has the skills and training to deal with people with learning disabilities has made it impossible for her to deal with it independently. Additionally, the social worker may have chosen to limit his support by assisting her in dealing with the benefits office rather than sorting it out himself. In this way, policy and practice may substantially collide when it comes to practical issues for individuals with learning disabilities. The codes of practice fail to give any meaningful guidance in these cases. This criticism is not new. Academic observers have repeatedly noted that the codes of practice are too abstract and cease to have any meaning unless sufficient resources are made available to enable service professionals to act in a positive way towards service clients (Watson 1985: 31). More worryingly, Watson writes: ‘the abstraction of the code of practice renders principles not simply incapable of application, but capable of application in a number of ways – only some of which are consistent with the conception of professional social work.’ (Watson 1985: 31) Again, this gives rise to some serious problems with regard to care for people with learning disabilities. Let us consider another example. The conception of self-determination as enshrined in the Codes of Practice draws on culturally contingent notions of autonomy. On the other hand they also pay respect to the need to recognise other culture’s diverse social commitments. The code however fails to recognise that these two principles conflict. For some families and carers who belong to ethnic minorities, service support may be seen as contradicting cultural norms and standards and the family may be the preferred vehicle for support. Societal inclusion and integration in the wider community may therefore be barred as an option. Social workers are in a dilemma here. It is their obligation to promote the self-determination of their clients, this however may contravene the cultural and religious norms prevalent in some families. This demonstrates that the Codes of Practice are bas ed on an understanding of social life that is predominantly Western in character. Different stipulations of the Code are therefore inconsistent with each other. As Beckett writes, the notion of individual autonomy may be differently stressed in the various cultures (Beckett 2005: 132), Often the rights of individuals with learning disabilities may run counter to the interests of the rights of particular groups or communities (Beckett 2005: 132). The second way of framing the idea of social care and its conflict with particular practices is utilitarian in nature. Social workers and their management may be led by calculations of expediency in determining the right way of dealing with problems of people with learning disabilities. Resource allocation and budget constraints are the primary factors in these considerations. This approach is however often detrimental to the interests of adults with learning disabilities. Their interests are defined through the limitations and budgetary restrictions that are placed on the service. The individual with learning disability is not placed at the centre of planning and support packages. One particular practice has tried to square the constraints placed on the service with the ethical demands under which social workers operate. Direct payments have been actively promoted by central government and are often seen as a way to empower clients with learning disabilities. They are considered as an appropriate means to re-focus the delivery of social services on the needs of the individual with learning disabilities as well as represent a viable answer to the resource allocation problem. Clients are granted a particular budget and exercise total control over its spending. Adults with learning disabilities become buyers in a market of social and care services, or so the theory goes. At a first glance this will alleviate several acute problems. It enhances the (chances for) independence of clients and motivates them to make their own choices about important life decisions. It increases their participation in the decision making process and improves quality of life. It also ef fects a significant shift away from total care packages which are expensive to the tax payer and facilitates the involvement of clients in more task-centred care packages which are less expensive (Mansell 2005: 20). It therefore adequately and neatly addresses resource constraints while mirroring the move to individualised care and support plans (Mansell 2005: 20). This way it mirrors the stipulation of the Code of Practice which places the duty on social workers to maximise participation of clients in the decision making process (BASW 1986: 5; Codes 2001: 16). However, it works with a very lop-sided notion of independence. While participation in the labour market may still be prevented to clients with learning disabilities, acting as a buyer in an economic relationship is seen as a form of empowerment. The conception of social agency is severely restricted to co-operative schemes that are economic in character. The enhancement of social involvement may benefit little from this. This demonstrates that ethical issues in social work are often critically influenced by practices that are understood to reflect universal cultural attitudes but, more appropriately, may only resonate with erroneous and impoverished notions of social agency. Bibliography Beckett, Chris and Andrew Maynard (2005), Values and Ethics in Social Work. An Introduction. London e.a.: Sage British Association of Social Workers [1986], A Code of Ethics for Social Work, Birmingham: BASW Codes of Practice for Social Service Workers and Employees (2001), Scottish Social Services Council, Dundee 2005 Loewenberg, Frank M. and Ralph Dolgoff (1992), Ethical Decisions for Social Work Practice, Itasca: F.E. Peacock Mansell, Jim and Julie Beadle-Brown (2005), Person Centred Planning and Person-Centred Action. A Critical Perspective, in Person Centred Planning and Care Management with People with Learning Disabilities, London and Philadelphia: Jessica Kingsley, pp.19-33 Watson, David (1985), What’s the point of A Code of Ethics for Social Work? In A Code of Ethics for Social Work. The Second Step, edited by David Watson, London e.a.: Routledge and Kegan Paul, pp.20-39 Valuing People (2001). A New Strategy for Learning Disability for the twenty-first century, London: The Stationary Office

Organizational Systems Essay

Root Cause Analysis (RCA) is a tool designed to help identify not only what and how an event occurred, but also why it happened. We can see from this scenario that the root cause is the lack of oxygen given to this patient, however it is not the only cause. A string of events lead to this patients demise. The first and most important cause was that hospital policy was overlooked. In the scenario it stated. Root Cause Analysis (RCA) is a tool designed to help identify not only what and how an event occurred, but also why it happened. We can see from this scenario that the root cause is the lack of oxygen given to this patient, however it is not the only cause. A string of events lead to this patients demise. The first and most important cause was that hospital policy was overlooked. In the scenario it stated â€Å"A moderate sedation/analgesia (â€Å"conscious sedation†) policy requires that the patient remains on continuous B/P, ECG, and pulse oximeter throughout the procedur e and until the patient meets specific discharge criteria (i.e., fully awake, VSS, no N/V, and able to void).† The trained nurse had the equipment to insure that this policy was followed, however failed to perform her duties as required by this policy. The second event is that the LPN reset the alarm and made no effort to provide an intervention for the alarm. The LPN did not inform the RN of the O2 Saturation level. The LPN Was not trained properly. The third event was that there was not enough staff called in for the level of acuity that these patients had. The administration should have been made aware of the emergency coming in and called in more staff to accommodate the staffing need. The errors or hazards in care in the scenario were that the RN failed to follow hospital policy to continuous monitor the patient. LPN was not properly trained to handle patients with a higher acuity. LPN failed to report and respond to the alarm. It would be helpful if the parties involved with this event come together and discuss on what failed and how they can improve the system. To decrease the likelihood of this happening again the data collected from the RCA needs to  be presented and a plan needs to be implemented so that all the staff can know what to do if this situation occurs in the future. Implementing a plan where all the parties are involved will insure that policy that is implemented will be followed through and a since of teamwork and collaboration will be felt. Lewin’s change model talks about people that are frozen in their idea of how certain processes should work, and need to be unfrozen in their process in order to make a change. In the scenario, the staff may be stuck in a process of how they perform their job. When things in the ER got busy, The nurse may have felt that since she has experience and is qualified she could handle things in the ER with just the help of the LPN. If this Nurse was not frozen in her old ways she would have realized that knowing when to call for help early enough is a nursing key behavior. Sometimes being stuck in your old ways is not what is best for the patient or yourself. If the future with change this Nurse has the potential to be a good advocate for other nurses and staff. She will be helpful in supporting change for the better of the patient. Lewin’s second model talks about what needs to be changed in a situation. In the scenario, the process of how moderate sedation is performed and followed up for each and every patient in any department needs to be changed. In order to make a change, staff needs to become involved and understand why this change will benefit the patient and the nursing staff. In order to make a change and have it successful the staff will need intrinsic motivators. According to Lewin’s change theory the staff will need to first, be open to the idea of this change and second, see how it can benefit the quality of care given to patients. Updating the moderate sedation policy to include a one on one â€Å"qualified† staff member to stay with the patient after sedation at all times until discharge criteria is met. Staff education, annual education and possibly mock sedation scenerio’s could help the staff learn in a â€Å"real life† situation what could go wrong and what could be done better. When the change has been introduced. Trial and errors are started and perfected and staff starts to use these changes in practice. It has a possibility to become normal to them and then the â€Å"refreezing† process can begin. Lewin’s refreezing process is referred to as, once new change is in practice the staff will then start to implement that changed process in everyday procedure, cause a refreezing process of new and improved procedure. After, Nurse J and the other staff members in  the ER and everywhere else in the hospital, practice and start applying these new changes into their everyday routine after several weeks, it will become second nature to them! (â€Å"Change theory,† February) Failure modes and effects analysis (FMEA) identifies all possible failures in a service rendered. â€Å"Failure modes† means the ways, or modes, in which something might fail. Failures are any errors or defects, especially ones that affect the customer, and can be potential or actual. â€Å"Effects analysis† refers to studying the consequence of those failures. (The Quality Toolbox.2004) The interdisciplinary team that should be included in the RCA and FMEA are everyone involved like all doctors, RN’s, LPN, administrators, and the joint commission. We would start by developing steps to assess risks of failure to patients in the process that is being used. The pre-steps needed to implement FMEA is that the interdisciplinary team needs to be in agreement with how many steps and the steps that accurately describe the process. For each Failure mode the team needs to assign a risk priority number (RPN), this is used to detect the likelihood of occurrence, detection an d severity. For every failure mode identified, the team should answer the following questions and assign the appropriate score. (the team should do this as a group and have consensus on all values assigned) 1) How likely is it that this failure mode will occur? 2)Assign a score between 1 and 10, with 1 meaning â€Å"very unlikely to occur† and 10 meaning â€Å"very likely to occur.† And 3) How likely will the error be caught before causing harm to the patient. (IHI.pdf) The first step in FMEA is to analysis how likely is it that this failure mode will occur and its severity of affect on the patient. To do this the hospital would assign a severity number to the process step that they are testing. The FMEA would have number 1 through 10. 1 would mean no harm would be done to the patient, 5 would be moderate harm to the patient and 9 or 10 would mean that the severity would be very bad with the worst possible outcome for the patient. Like in the case scenario if the process step they chose was: with no equipment for monitoring of a patient after sedation and without staff present or staff present and all equipment was present. The process failure mode was that the patient stops breathing and no one or no equipment was present. The number value for this scenario would then be assigned the highest number because of the high likelihood that it would have the worst outcome for the patient. The second step in the FMEA is  to analyze how often the error or potential problem is likely to happen in the process. The occurrence scale also has a numeric value of 1 to 10. 1 would be that the problem could occur in under 0.01 to every 1,000 people, 5 would represent about 5 people to every 1,000 people and 10 would have the highest occurrence of over 100 people to every 1,000 people, which would make it very likely that the event will occur. The hospital staff would than take their process step of not monitoring a patient after sedation and rate the occurrence of the process at how likely the event would happen. The hospital then can look at data from other hospitals that did not monitor patients after sedation to see the likelihood that they stop breathing to rate the number. The third and last step is how likely the error or problem can be caught before reaching the patient and on what degree of harm it can cause to the patient. The same principle applies to the detection scale of a scale of 1 to 10. All of the numerical scores would then be multiplied together: Severity x Occurrence x Detection = Score. A score over 100 would prompt the hospital to look into the problem more closely and anything below that number they may want to take off their agenda and focus on the more dangerous outcomes for the patients. (Forrest, 2010) The key role nurses would play in improving the quality of care in this situation. Are to implement a plan of action. They can sponsor classes for other staff to get educated. They can attend drills to rehearse different scenarios to be prepared for other events. Having nursing staff advocate for the change will also help the other staff follow by example when changes are made, especially if they know the reason is to help prevent harm to patients in their care. Nurses with the right tools, guidelines and policies are able to make sure that the care is the best quality for their patients. References Change theory. (January, 2014, 02). Retrieved February 20, 2015, from http://wgu.hosted.panopto.com/Panopto/Pages/Viewer.aspx?id=e348f20b-e819-43e4-abcaf191f99bc Failure Modes and Effects Analysis (FMEA) Tool. (n.d.). Retrieved February 20, 2015, from http://www.ihi.org/resources/FailureModesandEffectsAnalysisFMEATool_IHI.pdf Forrest, G. (2010, December 31). Quick guide to failure mode and effects analysis. Retrieved February 20, 2015, from http://www.isixsigma.com/tools-templates/fmea/quick-guide-failure-mode-and-effects-analysis/ IHI Institution for Healthcare Improvement. (n.d.). Lesson 5 testing changes (Pages 1-2). Retrieved from http://www.ihi.org/education/ihiopenschool/Pages/default.aspx Policy name: Root cause analysis. (n.d.). Retrieved from www.precisionlens.net/UserFiles/rootcause-analysis.doc Nancy R. Teague The Quality toolbox, 2nd edition, ASQ Quality Press, 2004, pages 236-240.