Problem defining and the consulting/intervention process

Although many different approaches are currently being used to create planned change in organizations, Kilmann and Mitroff feel that too little attention has been paid to determining the effectiveness of these different methods in solving the organizations' problems. Based on intervention theory and the consulting process, the authors offer a method of evaluating an organization's approach to change to determine if it is well-suited to the types of problems being experienced. The process of change is diagrammed as a five-step cycle: 1) sensing problems; 2) defining problems; 3) deriving solutions; 4) implementing solutions; and 5) evaluating outcomes. Most consultants enter the process at step 3 which increases the probability that they will try to solve the wrong problem (termed Type III error). A second source of trouble is that consultants are usually trained in one or two disciplines and, therefore, see problems primarily in those perspectives. Kilmann and Mitroff suggest the use of teams of consultants so the problems can be conceptualized from a number of different viewpoints.     

Interdisciplinary, functional approach to quality review

Dramatic changes in the standards of the Joint Commission on Accreditation of Healthcare Organizations, as part of its "Agenda for Change," pose new challenges for health care managers. The goal of the "Agenda for Change" is to focus accreditation on the actual performance of important functions while continuously stimulating improvement in the organization's performance and outcomes of care. In 1994, seven important functions--improvement of performance, leadership, management of information, assessment of patients, education of patients and families, operative and other procedures, and treatment of patients--were identified by JCAHO. Performance, as defined by JCAHO, can be measured through observing specific dimensions, such as, availability, safety, timeliness, effectiveness, continuity, efficiency, and respect and caring. These are considered important elements in the determination of quality, value, cost, and patient outcome. In 1995, JCAHO identified 11 important functions--patient rights and organizational ethics, assessment of patients, care of patients, education, continuum of care, improving organizational performance, leadership, management of the environment of care, management of human resources, management of information, and prevention and control of infection. In addition each institution has the opportunity to decide by prioritization where it wants to devote resources. This article reports on one hospital's response to the new JCAHO initiatives.     

Emigration dynamics in Pakistan

This study of emigration dynamics in Pakistan focuses on Pakistan's position as one of the world's leading manpower exporters. The study opens with a review of the history of international labor from the subcontinent. The second section looks at the problems with the collection of data on international migration and then considers the volume of international migration, migrant destinations, return migration, undocumented migration, and the stock of migrant workers abroad. The third section describes the economic and demographic context for overseas migration through a consideration of gross national product and the remittances of migrant workers, growth in gross domestic product, poverty and income distribution, the state of the population, labor force and employment, a profile of migrant workers, and the government's employment policy. The political and social context for overseas migration is the topic of the next section, and the discussion centers on emigration policy, institutional arrangements for manpower export and the welfare of migrants, and the economic resettlement of return migrants. Consideration of the future trends in international migration from Pakistan focuses on the cyclic nature of overseas labor migration, the existence of networks to facilitate such migration, uneven distribution of enabling resources in Pakistan, the paucity of available data, and governmental/cultural factors that promote and restrict such migration. It is concluded that both individual Pakistanis and the government consider overseas migration a positive force but that a reliance on such an ad hoc measure has costs that have not been considered by Pakistan's policy-makers.     

The physical, mental, and social health status of older Chinese: a cross-national study

This article reports data on 16 indicators of the physical, mental, and social health status of older Chinese living in Beijing, Guangzhou, and Los Angeles. Both the frequency distributions of these indicators and their factor structures are different among the three cities. These differences may have implications for the planning of public health services. Either they are the result of differences in the way in which people in each of these cities think about illness or they are the result of differential experiences with disease. Although these data cannot resolve this issue, both the frequency distributions and the severity ratings for nine chronic diseases also differed markedly among the three cities.     

Sight or insight? Child therapy with a blind clinician

The process of a blind second-year social work student's play therapy with sighted children is analyzed and discussed. The ensuing limitations, compensatory issues, and unexpected opportunities are highlighted. The student's experience in becoming blind, her adaptation to it, and discrimination experienced seeking employment are described. Major themes in describing the child therapy focus on compensation for visual cues, utilization of the guide dog as a pet therapist, proxemics and mirroring in relation to blindness, and the impact of the wounded healer on clients. The student's work with a 13 year old girl illustrates the major concepts.     

Demographic and socio-economic status of women in different family structures in a rural area of south India

The authors study "women's demographic and socio-economic position in different family types...[using data] from a sample survey conducted in a rural area of Tamil Nadu [India] during May and June of 1988....Comparison of demographic characteristics of ever-married women in the reproductive age, such as marital status, age, marriage duration, age at marriage and living children, and socio-economic characteristics, such as educational status, occupational status, per capita annual income of the family and number of rooms in the house, is made between family types."