Helath & Medical Analysis of a Pertinent Topic Related to Ageing Essay

Helath & Medical Analysis of a Pertinent Topic Related to Ageing Essay

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Type: Essay (any type) Service: Writing Pages: 5 pages / 1375 words (Double spacing) Level: College Language: English (US) Deadline: Oct 23, 11:30 PM Topic: Analysis of an Age Related topic Subject: Nursing Sources: 1 source required Style: APA 7th edition Description Analysis of an Age Related Topic In a Microsoft Word document of 5-6 pages formatted in APA style conduct in-depth analysis of a pertinent topic related to aging. Include the following in your analysis: Define the problem. Identify the specific population affected. Describe cultural implications. Describe financial/legal/ethical implications for the population related to the problem. Describe 2-3 interventions that can be used to improve the problem. Describe resources available to improve the problem. Describe costs associated with the interventions identified. Discussed sustainability of the interventions. Support your responses with examples. On a separate references page, cite all sources using APA format. The American Psychological Association website also provides detailed guidance on formatting, citations, and references at APA Style. • APA Citation Helper • APA Citations Quick Sheet • APA-Style Formatting Guidelines for a Written Essay • Basic Essay Template
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PU Headache Migraine with Toxic Exposure Risk Activity Essay

PU Headache Migraine with Toxic Exposure Risk Activity Essay

Question Description

I’m working on a health & medical discussion question and need guidance to help me learn.

 

Please add your own opinion and review the following examples of supporting evidence.

-Cites Medical Literature with an explanation on how the literature applies to the veteran.

-Rules out any other possible etiologies.

-Discusses continuity and chronicity of the condition.

 

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1 Page

PU Hypertension with Toxic Exposure Risk Activity in Military Question

PU Hypertension with Toxic Exposure Risk Activity in Military Question

Question Description

I’m working on a health & medical discussion question and need guidance to help me learn.

 

Please add your own opinion and review the following examples of supporting evidence.

-Cites Medical Literature with an explanation on how the literature applies to the veteran.

-Rules out any other possible etiologies.

-Discusses continuity and chronicity of the condition.

 

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1 Page

PU Health & Medical A Progressive Mental Health Problem Essay

PU Health & Medical A Progressive Mental Health Problem Essay

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INSTRUCTIONS

This requires your opinion in addition to the supporting evidence. Please add your own opinion and review the following examples of supporting evidence.

-Cites Medical Literature with an explanation on how the literature applies to the veteran.

-Rules out any other possible etiologies.

-Discusses continuity and chronicity of the condition.

MEDICAL OPINION 1 OF 1) PLEASE COMPLETE SECTION THREE AND STATE WHETHER THE VETERAN’S MEDICAL RECORDS SUPPORT THAT ANY CURRENTLY DIAGNOSED CONDITION(S) RELATED TO THE VETERAN’S CLAIMED SLEEP APNEA, IS/ARE AT LEAST AS LIKELY AS NOT (LIKELIHOOD IS AT LEAST APPROXIMATELY BALANCED OR NEARLY EQUAL, IF NOT HIGHER) INCURRED IN OR CAUSED BY THE COMPLAINT OF SLEEP APNEA DURING SERVICE.

 

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UM Requirement of Referral from The Primary Care Physicians Question

UM Requirement of Referral from The Primary Care Physicians Question

Question Description

I’m working on a health & medical discussion question and need the explanation and answer to help me learn.

 

Does the requirement of referral from the primary care physicians (gate keeper) for a specialty doctor keep costs down?

 

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The United States Health Care System: Combining Business, Health, and Delivery Third Edition Chapter 3 The Payment Process: Insurance and Third-Party Payers Copyright © 2017, 2012 Pearson Education, Inc. All Rights Reserved Figure 3.1 The Simple Payment Process What Is Health Insurance?  Insurance: the business of shifting the risk of loss from the individual to a third party.  The insurance company is predicting they will make a profit by taking in more money than they will have to pay out.  The process is known as risk pooling. Who Is Insured?  5% of Americans under age 65 purchase private individual health care insurance.  How do the other 95 percent pay for health care services?  Americans under the age of 65 are:  covered by insurance as part of an employer-sponsored plan.  covered by Medicaid, Medicare, and other government programs.  do not have health insurance. Who Is Insured?  What did the Affordable Care Act require?  Companies must offer insurance that will pay for up to 60 percent of expenses.  The premium cannot exceed 9.5 percent of family income.  Employees can opt not to participate in their employer’s plan. Who Is Insured?  Health care is an expensive benefit for an employer to offer to its employees.  In 2014, the average premium for single coverage was $6,025  For family coverage it was $16,834. Who Is Insured?  In 2014 the average employee contribution for single coverage was $1,081.  For family coverage the average was $4,823.  It is higher today  Most plans cover common areas of preventive care.  Uninsured are twice as likely to postpone or go without care due to cost.  More likely to do without prescription drugs  Most of the uninsured are from low-income families. How Does “Insurance” Work?  The Patient/Employer–Third-Party Payer Relationship  Insurance company, government agency, or managed care organization (MCO) is known as the third-party payer.  The third-party payer will set a price for the benefit package.  The price is determined by the number of people being insured and the general state of their health.  Once the employer has negotiated an agreement with the insurer, the employer can offer health care benefits to its employees (they also decide what portion of the premium to pay for their employees) How Does “Insurance” Work?  The insurance plan is a legally binding contract known as a policy.  If an individual purchased the insurance directly they are the insured.  Enrollment period: time period when employees can take advantage of the benefit being offered by the employers.  If they take the benefit, they are known as enrollees. How Does “Insurance” Work? Figure 3.2 The Third-Party Payer Process How Does “Insurance” Work?  The Patient–Provider Relationship  Even if a patient has insurance there are still some out of pocket expenses that occur  Deductible  Copayment  A patient may be insured under more than one policy.  A coordination of benefits clause will determine which third party pays for services. How Does “Insurance” Work?  The Provider–Third-Party Payer Relationship  After services have been rendered, the provider files a claim with the insurance company  A health insurance claim is a request for reimbursement for the services that have been provided.  This is where coding becomes vital How Does “Insurance” Work?  The Provider–Third-Party Payer Relationship  ICD-10-CM  International Classification of Diseases, 10th Revision, Clinical Modification  Used in physician’s offices  HCPCS  Healthcare Common Procedure Coding System  Consists of two levels:  Current Procedural Terminology (CPT)  National codes (HCPCS level II codes)  Used in hospitals/outpatient facilities and clinics How Does “Insurance” Work?  The Provider–Third-Party Payer Relationship  Billing  Process of charging the patient/employer for services  Claims are transmitted to the thirdparty payer.  The third-party payer sends the insured an explanation of benefits (EOB).  Tells insured how much they are going to pay and if any part of the claim has been denied  Payment is sent to provider. Types of Third-Party Payers  Indemnity Insurers  The insurance carrier agrees to pay (indemnify) the insured loss.  With health insurance, the loss is the need to obtain health care services.  Once the patient has paid the provider for services, the insurance company reimburses the patient.  The insurance company may also reimburse the provider directly.  Payment is not made to the provider of services until covered services are used. Types of Third-Party Payers  Self-Insurers  The employer assumes the risk of loss for medical costs instead of a commercial insurance company or MCO.  Often a third-party administrator (TPA) is hired by the employer to administer the health care benefits and process claims.  Self-insured plans are exempt from state insurance regulation.  They are regulated by Employee Retirement Income Security Act of 1974 (ERI SA). Types of Third-Party Payers  Blue Cross/Blue Shield  Teachers started Blue Cross in the 1920s.  Paid monthly sum in return for 21 days in yearly hospitalization.  In 2015, more than 106 million Americans were enrolled.  Was originally not for profit; some plans converted to for-profit in the 1990s.  Individuals subscribe to a plan.  A prepaid service; the subscriber is still responsible for deductibles, copayments, and any noncovered services. Types of Third-Party Payers  Managed Care Models  Gatekeeping  Patient can only access certain services from the primary care provider.  Can only obtain specialist and rehabilitative services if referred by the primary provider.  Almost all workers covered by an employer plan are enrolled in managed care. Types of Third-Party Payers  Managed Care Structures  Health Maintenance Organizations (HMOs)  Preferred provider organizations (PPOs)  Exclusive provider organizations (EPOs)  In 2009, the majority of employees were enrolled in one of these variations.  Health Maintenance Act of 1973 was a strong incentive for the growth of HMOs. Types of Third-Party Payers  Health Maintenance Organizations (HMOs)  Prepaid health plans (PHPs)  Traditionally hire physicians and staff to work for them  Pay for services by capitation  Each patient or group has a fixed dollar amount of services provided over a time period. Types of Third-Party Payers  Health Maintenance Organizations Structures (HMOs)  Staff model HMO  Prepaid group practice model  Network HMO  Independent practice association (I PA) model Types of Third-Party Payers  Managed Care Structures  Preferred provider organizations (PPOs)  A delivery network.  Patient may choose his or her physician or hospital.  If insured goes to a PPO, the cost of care is lower  Exclusive provider organizations (EPOs)  Patient must select his or her care providers from those in the network.  If the patient chooses to go outside the network, then those services are not covered. Regulation of Third-Party Payers  Insurance companies are regulated by state and federal rules.  Insurance companies must be licensed.  HMOs and other managed care organizations are regulated differently.  HIPAA regulates portability, access, and mandated benefits. Regulation of Third-Party Payers  Consolidated Omnibus Budget Reconciliation Act  COBRA  Employees may continue health benefits after leaving employer for a time period and self pay  The 2010 Patient Protection and Affordable Care Act has numerous provisions that regulate the actions of insurers.  The law requires that states establish American Health Benefit Exchanges and Small Business Health Options Program Exchanges so that the uninsured and small businesses can obtain coverage.
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WU Moral Imagination for Organizations Discussion

WU Moral Imagination for Organizations Discussion

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MORAL IMAGINATION

Most are familiar with Nestlé, one of the world’s largest food producers, whose marketing slogan is: “Good food, Good life.” On its website, the corporation states that its three main ambitions are helping children live healthier lives, improving livelihoods in communities, and striving for zero environmental impact (Nestlé, n.d.). These are commendable goals that generated considerable positive publicity; however, recent allegations and court proceedings have suggested that the company may not actually be achieving those ambitions. Nestlé has been accused of using child labor in its cocoa supply chain in Western Africa, using forced slave labor in its seafood supply chains in Southeast Asia, and overusing diverted water from a national forest in drought-stricken California (Singh, 2021). These allegations illustrate that—even when companies adopt policies to promote ethical behavior—serious lapses can occur.

To prepare for this Discussion:

Review the article titled “Mental Models, Moral Imagination and System Thinking in the Age of Globalization” (located in this week’s Learning Resources) and think about how organizations apply these models.

Consider an organization with which you are familiar. This can be a current or former employer. Focus specifically on the organization’s ethics and sustainability policies, practices, and goals, and identify one issue you think the organization should improve upon with regard to its moral imagination and action.

Post a synthesis of how your selected organization could use a moral imagination framework to address issues and create positive social change. In your synthesis, do the following:

Briefly describe your selected organization and identify one issue the organization should improve upon with respect to its moral imagination and action. Provide a rationale.

Explain how Werhane’s moral imagination framework could be applied to the issue you identified to help create positive social change within the organization or its stakeholder context.

 

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 Springer 2007 Journal of Business Ethics (2008) 78:463–474 DOI 10.1007/s10551-006-9338-4 Mental Models, Moral Imagination and System Thinking in the Age of Globalization ABSTRACT. After experiments with various economic systems, we appear to have conceded, to misquote Winston Churchill that ‘‘free enterprise is the worst economic system, except all the others that have been tried.’’ Affirming that conclusion, I shall argue that in todayÕs expanding global economy, we need to revisit our mind-sets about corporate governance and leadership to fit what will be new kinds of free enterprise. The aim is to develop a values-based model for corporate governance in this age of globalization that will be appropriate in a variety of challenging cultural and economic settings. I shall present an analysis of mental models from a social constructivist perspective. I shall then develop the notion of moral imagination as one way to revisit traditional mind-sets about values-based corporate governance and outline what I mean by systems thinking. I shall conclude with examples for modeling corporate governance in multi-cultural settings and draw tentative conclusions about globalization. KEY WORDS: corporate governance, free enterprise, globalization, mental models, moral imagination Patricia H. Werhane is the Wicklander Chair of Business Ethics and Director of the Institute for Business and Professional Ethics at DePaul University with a joint appointment as the Peter and Adeline Ruffin Professor of Business Ethics in the Darden School at the University of Virginia. Professor Werhane has published numerous articles and is the author or editor of twenty books including Persons, Rights and Corporations, Adam Smith and His Legacy for Modern Capitalism, Moral Imagination and Managerial Decision-Making with Oxford University Press and Employment and Employee Rights (with Tara J. Radin and Norman Bowie) with BlackwellÕs. She is the founder and former Editor-in-Chief of Business Ethics Quarterly, the journal of the Society for Business Ethics. Patricia H. Werhane Introduction1 After experiments with various economic systems, we appear to have conceded, to misquote Winston Churchill that ‘‘free enterprise is the worst economic system, except all the others that have been tried.’’2 Affirming that conclusion, I shall argue that in todayÕs expanding global economy, we need to revisit our mind-sets about corporate governance and leadership to fit what will be new kinds of free enterprise. The aim is to develop a values-based model for corporate governance in this age of globalization that will be appropriate in a variety of challenging cultural and economic settings. In what follows I shall begin with an analysis of mental models from a social constructivist perspective. I shall then develop the notion of moral imagination as one way to revisit traditional mindsets about values-based corporate governance and outline what I mean by systems thinking. I shall conclude with examples for modeling corporate governance in multi-cultural settings and draw tentative conclusions about globalization. Mental models, mind-sets, and social constructivism Although the term is not always clearly defined, the term, ‘mental modelÕ or ‘mind-setÕ connotes the idea that human beings have mental representations, cognitive frames, or mental pictures of their experiences, representations that model the stimuli or data with which they are interacting, and these are frameworks that set up parameters though which experience or a certain set of experiences, is 464 Patricia H. Werhane organized or filtered (Gentner and Whitley, 1997, pp. 210–211; Gorman, 1992; Senge, 1990, Chapter 10; Werhane, 1999). Mental models might be hypothetical constructs of the experience in question or scientific theories, they might be schema that frame the experience, through which individuals process information, conduct experiments, and formulate theories. Mental models function as selective mechanisms and filters for dealing with experience. In focussing, framing, organizing, and ordering what we experience, mental models bracket and leave out data, and emotional and motivational foci taint or color experience. Nevertheless, because schema we employ are socially learned and altered through religion, socialization, culture, educational upbringing, and other experiences, they are shared ways of perceiving, organizing, and learning. Due to of the variety and diversity of mental models, none is complete, and ‘‘there are multiple possible framings of any given situation’’ (Johnson, 1993; Werhane, 1999). By that we mean that each of us can frame any situation, event, or phenomenon in more than one way, and that same phenomenon can also be socially constructed in a variety of ways. It will turn out that the way one frames a situation is critical to its outcome, because ‘‘[t]here are…different moral consequences depending on the way we frame the situation,’’ (Johnson, 1993). Our views of the world, of ourselves, of our culture and traditions and even our values orientation are constructions – all experiences are framed ordered and organized from particular points of view. These points of view or mental models are socially learned, they are incomplete, sometimes distorted, narrow, single-framed. Since they are learned they are changeable, revisable, etc. But all experience is modeled – whatever our experiences are about – their content – cannot be separated from the ways we frame that content. Mental models, as Peter Senge carefully reminds us, (Senge, 1990) function on the organizational and systemic levels as well as in individual cognition. Sometimes, then, we are trapped within an organizational culture that creates mental habits that preclude creative thinking. Similarly a political economy can be trapped in its vision of itself and the world in ways that preclude change on this more systemic level.3 Let me illustrate. Mental models in the age of Wal-Mart: ‘‘The Wal-Mart Paradox’’ (Waddock, 2006) Wal-Mart is the largest retailer in the world. Last year its revenues were 2.13 billion dollars, and it employs 1.8 million people. Its stores are located across the United States and now in many parts of the world. Its mission is ‘‘Always low prices – ALWAYS.’’ It has enormous stores many of which now include food supermarkets, it has extremely low prices, often forcing competition out of business, it has good quality merchandise and of course, there is the unparalleled customer convenience of finding almost everything at one location (Fishman, 2006). The company is a publicly traded corporation. It has been very successful and almost every pension fund in America includes in its portfolio Wal-Mart stock. It is the ‘darlingÕ of Wall Street and conservatives, according to a recent article in Business Week (2004). Wal-Mart provides much-needed local jobs. In a recent store opening on the South side of Chicago, for example, 25,000 applications vied for 325 positions (Smith, 2006). It has recently instituted health care coverage for long-term part-time employees who can afford the $11/month. Unfortunately, however, most part-time employees cannot afford the health care, and many Wal-Mart employees, paid under the poverty level, are also on Medicaid. The new CEO, Lee Scott, has developed environmentally sustainable initiatives aimed at selling food that is organically grown, fish that are reproducible, and the company is focussing on selling a variety of products that are in various ways ‘greenÕ. Wal-Mart is well-known in other respects. Where there are Wal-Mart stores, often small shops, who ordinarily cannot compete with its low prices, are forced out of business. Moreover, none of WalMartÕs stores are unionized; Wal-Mart forbids unions in its stores, and works to prevent them in its supplier organizations. In the recent past it has had problems with the treatment of some of its employees, and in some locations employees have been denied bathroom and lunch breaks and worked over 80 hours per week. Most interesting, despite its new focus on environmental sustainability, much of Wal-MartÕs merchandise, and almost all its apparel, is manufactured off-shore, by companies under contract with but not owned by Wal-Mart, often under Mental Models, Moral Imagination and System Thinking extremely horrifying sweatshop conditions. (By the term ‘sweatshopÕ I meant a factory that does not meet minimum working standards in the country in which it is operating, e.g., by working employees long hours without overtime pay, paying under minimum wage, not following minimum standards for ventilation, lunch rooms, restrooms, maternity leave, days off, etc. as mandated in the country in which the factory operates (Arnold and Hartman, 2005).4 Of course, Wal-Mart does not own any of these operations (Fishman, 2006; Waddock, 2006). Linking this description back to the analysis of mental models, the way one approaches Wal-Mart and measures it successes and/or failures frames oneÕs conclusions about its moral successes and failures. For example, if one concludes that customer satisfaction and shareholder value are primary then WalMart is a great success. If one approaches Wal-Mart from an environmental point of view, its new push to become ‘greenÕ is clearly a very admirable initiative. Examining Wal-Mart using a standard stakeholder map (Figure 1) one concludes that this company creates value-added for a number of its stakeholders, in fact, the majority: its executives, customers, shareholders, and those in the community worried about the environment. Figure 1, as a model for dealing with ethical issues, places the corporation, in the middle of the graphic. Our mental model is partly constructed by the graphic, so that our focus is first on the company, only secondarily on its stakeholders, despite, from a stakeholder theory perspective, the claim that all stakeholders, those who affect or are affected by the company, have, or should have, equal claims on value-added (Freeman, 2002). W a l -M a r t Executives Suppliers and F ra n c h ise s E m p l o ye e s W a l-M a r t W a l- M a r t Communities C u sto m e r s (you and me) Sh a reh o lder s (including al l o f u s ) Figure 1. ‘‘Standard’’ stakeholder map (Freeman, 2002). 465 Wa l – Ma r t Suppliers and Franchises Employees Sweatshop W o rk e rs C u s to m e r s (you and me) Wal-Mart Communities Shareholders (including all of us ) Figure 2. Revised stakeholder map. On the other hand, if one is interested in employees and the employees of Wal-MartÕs suppliers, who after all are people as well, one becomes much more critical of Wal-Mart. If Wal-Mart is contributing to a culture of welfare, and/or if its goods are made under less that minimum working conditions, then moral questions arise. Is this company creating harms that are not counterbalanced by its value added in price, convenience, and shareholder returns? Is the preoccupation with ‘‘always low prices…ALWAYS’’ framing the companyÕs decision-making in such as way that employment issues do not surface or surface sufficiently to be adequately addressed in all instances? And what happens to our mental models if we redraw the stakeholder map with employees in the middle, or, say, sweatshop workers in the middle? (Figure 2) Now one cannot ignore the existence of these workers, they are no longer on the periphery of oneÕs focus, even if there is still a preoccupation with low prices. Moreover, while it is hard to wrap oneÕs mental images around 1.8 million workers, if I tweak the graphic further and place the picture of a Bangladeshi sweatshop worker in the middle, her concrete presence begins to affect our thinking about Wal-MartÕs anti-union global practices. In the Wal-Mart case, how we look at this situation, how we draw the maps, where we focus our attention and preoccupations, our tradition and our assumptions frame these scenarios. If I tweak the maps, if I merely shift around the focus of the stakeholder map and add a picture of a real person, my frame is altered. Thus I have introduced an element of moral imagination – looking at a 466 Patricia H. Werhane situation from a different and even more challenging perspective. Moral imagination and mental models Moral imagination can be defined as ‘‘…the ability to discover, evaluate and act upon possibilities not merely determined by a particular circumstance, or limited by a set of operating mental models, or merely framed by a set of rules’’ (Werhane, 1999, p. 93). Thus moral imagination entails the ability to get out of a particular mind-set or mental trap, and to evaluate both that mind set or mental model and, in some cases, its traps. What, in detail does moral imagination include? On the individual level, being morally imaginative includes: • Self-reflection about oneself and oneÕs situation. • Disengaging from and becoming aware of oneÕs situation, understanding the mental model or script dominating that situation, and envisioning possible moral conflicts or dilemmas that might arise in that context or as outcomes of the dominating scheme. Second, • Moral imagination entails the ability to imagine new possibilities. These possibilities include those that are not context-dependent and that might involve another mental model. • Third, moral imagination requires that one evaluate from a moral point of view both the original context and its dominating mental models, and the new possibilities one has envisioned (Werhane, 1999, 2002a). But how do we engage in this analysis while at the same time taking into account situational peculiarities, social context, and the system in which we are embedded? How do we act in a morally reasonable manner and trigger moral imagination? I think it is possible to get at, understand, revise, and critique our operative mental models, but only from another perspective which itself is a set of mental models. This shortcoming should not deter us, however, since a critical perspective is essential if we are to get out of our mental traps, in Wal-MartÕs case, the driving force of its cost-driven mission. Looking at Wal-Mart, one begins with that mission. Then one tries to disengage from that mission and ask, ‘WhatÕs going on here?Õ How does that mission affect all that we do and blind us to become aware of other possibilities? – What mental models are at play? – What moral conflicts are operative? – What is left out or ignored, e.g., employees and the workers in their supplier factories? – What are other, new possibilities? Then one engages the productive imagination: What are some alternatives that fit societal norms, corporate values, and personal ethics? Why do employees matter? What is wrong with sweatshops in developing countries particularly in areas where there is massive unemployment? Moreover, Wal-Mart does not own any of these factories. So how could we place responsibility for working conditions on them? What are some alternatives that challenge the status quo? Here again, redrawing oneÕs stakeholder map is invaluable. What happens to oneÕs thinking when I give a sweatshop worker a ‘name and face?Õ (Benhabib, 1992; McVea and Freeman, 2005). Figure 3 illustrates this kind of graphic. In the center is a picture of a 14-year old Bangladeshi sweatshop worker, whose average workweek is 80–100 hours, under sub-human working conditions W a l -M a r t Employees Suppliers and Franchises Cu s to m e r s (you and me) Wal-Mart Communities Shareholders (including all of us) Figure 3. ‘‘Names and faces’’ (McVea and Freeman, 2005). Mental Models, Moral Imagination and System Thinking by Bangladesh legally mandated standards (National Labor Committee, 2000, 2005). Continuing the process of moral imagination, one then engages in creative reflection and evaluation. What are some other possibilities? What are other values at stake besides low prices? How can we change the operative mental models without losing our focus on customer pricing and shareholder value? Before we can use this model to present an alternative to Wal-Mart thinking, we have to remind ourselves that all of these individuals and organizations engaged in the Wal-Mart phenomenon are in interlocking networked relationships. While it is true that moral imagination often facilitates, rather than corrupts, moral judgment, the temptation is to focus primarily on individuals and individual moral judgments. But, I shall now suggest, this is an oversight. Taking the lead from Susan WolfÕs (1999) and Linda EmanuelÕs (2000) work on systems thinking, and developing ideas from work on mental models and moral imagination, I shall argue that what is often missing in organizational decision-making is a morally imaginative systemic approach. Moral imagination is not merely a function of the individual imagination. Rather, moral imagination operates on organizational and systemic levels as well, again as a facilitative mechanism that may encourage sounder moral thinking and moral judgment. Moral imagination and systems thinking5 A system is a complex of interacting components together with the networks of relationships among them that identify an entity and/or a set of processes (Laszlo and Krippner, 1998, p. 51). A truly systemic view considers how a set of individuals, institutions, and processes operates in a system involving a complex network of interrelationships, an array of individual and institutional actors with conflicting interests and goals, and a number of feedback loops (Wolf, 1999). A systems approach presupposes that most of our thinking, experiencing, practices and institutions are interrelated and interconnected. Almost everything we can experience or think about is in a network of interrelationships such that each element of a particular set of interrelationships affects some other 467 components of that set and the system itself, and almost no phenomenon can be studied in isolation from other relationships with at least some other phenomenon. Systems are connected in ways that may or may not enhance the fulfillment of one or more goals or purposes: they may be micro (small, self-contained with few interconnections), mezzo (within healthcare organizations and corporations), or macro (large, complex, consisting of a large number of interconnections). Corporations and healthcare organizations are mezzo-systems embedded in larger political, economic, legal, and cultural systems. Global corporations are embedded in many such systems. These are all examples of ‘complex adaptive systemsÕ, a term used to describe open interactive systems that are able to change themselves and affect change in their interactions with other systems, and as a result are sometimes unpredictable (Plsek, 2001). What is characteristic of all types of systems is that any phenomenon or set of phenomena that are defined as part of a system has properties or characteristics that are, altered, lost or at best, obscured, when the system is broken down into components. For example, in studying corporations, if one focusses simply on its organizational structure, or merely on its mission statement, or only on its employees or customers, one obscures if not distorts the interconnections and interrelationships that characterize and affect that organization in its internal and external relationships. Since a system consists of networks of relationships between individuals, groups, and institutions, how any system is construed and, how it operates, affects and is affected by individuals. The character and operations of a particular system or set of systems affects those of us who come in contact with the system, whether we are individuals, the community, professionals, managers, companies, religious communities, or government agencies. An alteration of a particular system or corporate operations within a system (or globally, across systems) will often produce different kinds of outcomes. Thus part of moral responsibility is incurred by the nature and characteristics of the system in which a company operates (Emanuel, 2000). For example, how Wal-Mart contracts with its suppliers affects those suppliers and their employees, as well as Wal-MartÕs customers and shareholders. 468 Patricia H. Werhane What companies and individuals functioning within these systems focus on, their power and influence, and the ways values and stakeholders are prioritized affect their goals, procedures, and outcomes as well as affecting the system in question. On every level, the way individuals and corporations frame the goals, the procedures and what networks they take into account makes a difference in what is discovered or neglected. These framing mechanisms will turn out to be important normative influences of systems and systems thinking (Werhane, 2002a). Adopting a systems approach Mitroff and Linstone in their book, The Unbounded Mind, argue that any organizational action needs to be analyzed from what they call a Multiple Perspective method. Such a method postulates that any phenomenon, organization, or system or problems arising for or within that phenomenon of system should be dealt with from a variety of disparate perspectives, each of which involves different world views where each challenges the others in dynamic exchanges of questions and ideas (Mitroff and Linstone, 1993, Chapter 6). A multiple perspectives approach takes into account the fact that each of us individually, or as groups, organizations, or systems creates and frames the world through a series of mental models, each of which, by itself, is incomplete. While it is probably never possible to take account all the networks of relationships involved in a particular system, and surely never so given these systems interact over time, a multiple perspectives approach forces us to think more broadly, and to look at particular systems or problems from different points of view. This is crucial in trying to address the Wal-Mart paradox. Since each perspective usually ‘‘reveals insights…that are not obtainable in principle from others’’ (Mitroff and Linstone, 1993, p. 98). It is also invaluable in trying to understand other points of view, even if, eventually one disagrees or takes another tactic (Werhane, 2002a). So a multiple perspectives approach is, in part, a multiple stakeholder approach, but with many configurations and accountability lines. It is also an attempt to shake up our traditional mind-sets without at the same time ascribing too much in the way of obligation to a particular individual or organization. A multiple perspectives approach also takes into account the fact that each of us individually, or as groups, organizations, or systems creates and frames the world through a series of mental models, each of which, by itself, is incomplete. While it is probably never possible to take account all the networks of relationships involved in a particular system, and surely never so given these systems interact over time, a multiple perspectives approach forces us to think more broadly, and to look at particular systems or problems from different points of view. This is crucial in trying to avoid problems such as BangladeshÕs, because each perspective usually ‘‘reveals insights…that are not obtainable in principle from others’’ (Mitroff and Linstone, 1993, p. 98). It is also invaluable in trying to understand other points of view, even if, eventually one disagrees or agrees to disagree. A Multiple Perspectives approach is essential if, for example, as Wal-Mart thinks about itself as a global company that affects and is affected by its suppliers and their employees and the various communities in which it contracts or operates. It is, then, part of a network as depicted in Figure 4. There is one more element to this approach. In every stakeholder map we draw, we prioritize our stakeholders, that is, we give them value. When Wal-Mart prioritizes low prices it is prioritizing its customers, particularly those who cannot afford fancy stores and high-priced goods. This is terrific. But these set of values, important as it is, needs to be put in a matrix with basic minimum moral standards for the treatment of every human being. If you sell goods that have been produced at under basic minimum human working conditions in the country where these goods are produced, by underpaid workers who at best, have 2 days leave a month (National U. S. E mp l o y ee s C u st o m e r s Local Governments and Political Systems Wal-Mart Franchises OffShore Wor k ers Social Norms and C u s to m s S u p p li e r s H om e Government Ecosystem Figure 4. Stakeholder network. S h ar eh ol d er s Communities Mental Models, Moral Imagination and System Thinking Labor Committee, 2005), one needs to rethink whether the positive value of low prices in developed countries preempts this value degradation where workers are frankly worse off than if they were unemployed. There is one more consideration, that of individual responsibility, the responsibilities of the politicians, professionals, managers, and of individual citizens. A systems approach should not be confused with some form of abdication of individual responsibility. As individuals we are not merely the sum of, or identified with, these relationships and roles, we can evaluate and change our relationships, roles, and role obligations, and we are thus responsible for them. That is, each of us is at once byproducts of, characters in, and authors of, our own experiences. We can comprehend, evaluate, and change our mental models. Not to do so, is to misunderstand how important human choice and responsibility is to our lives (Werhane, 1999). Globalization and other models It would be unconscionable to criticize Wal-Mart without presenting a viable model for corporate governance that does not merely recommend closing this company. Its focus on low prices and the job opportunities if offers cannot be ignored. So let us take the case of Nike. Nike makes nothing it sells, nothing. All of its goods are produced by independent suppliers, most of whom are in developing countries. Recently Nike made headlines by being accused of buying goods from plans producing its products under sweatshop conditions where allegedly at least in Indonesia, women workers were beaten if they did not keep up their productivity. (Hartman et al., 2003) Nike, as Hartman, Arnold and Wokutch write (2003) has had a similar sweatshop problem. Nike owns almost no factories; rather it buys its goods from numerous manufacturers around the world. So it would appear that what these manufacturers do to get Nike goods to market has nothing to do with Nike. Often Nike had little knowledge of what went on in the plants that produced its shoes and other products. This changed, of course, when the media began to focus on the working conditions, pay, and safety in plants producing Nike products. 469 Still, why is Nike, rather than these plants responsible, and what is the extent of that? As a result of public pressure Nike began to ‘look in the mirrorÕ at its mission, corporate image, and challenged itself to think about extending the scope of its responsibilities, engaging in what has become a consorted effort to improve sweatshop conditions not merely in the factories from which it buys but also with the suppliers to those factories. But Nike did not see this problem as merely its problem; rather it has taken what I called a systems perspective. That is, it sees its responsibilities as extending beyond its own employees to the system in which its products are produced. It not merely developed a strong Code of Conduct. It has expanded its influence, its employee standards, and monitoring system to its franchises and gradually, to their suppliers as well (Hartman et al., 2003). In this sort of case one might think of NikeÕs scope of responsibility in terms of gradually widening concentric circles. Its first responsibility is to its employees, customers, and shareholders; its next circle is to its contracted suppliers, the third to the suppliers of materials for those suppliers. Figure 5 depicts those relationships. Notice that this is a model of relationships between stakeholders in a global economy where the company, Nike, is not the only focus, thus not in the center of the graphic. It is a modification of the confusing global stakeholder networks map, that obviously has more practical applications. Other Sports Clothes Cos. Media N i ke Alliance Sub- N ik e Management and E mp l o y e e s C o u n t ry ( s ) and Local Traditions Off-shore workers Co n t ra c t o r s Franchises Figure 5. NikeÕs alliance model (Model Courtesy of Mary Ann Leeper, COO, Female Health Company). 470 Patricia H. Werhane In other words, Nike put names and faces on its suppliers and their workers. Moreover they formed an alliance with their primary stakeholders using their mission and code as the binding factor. Today they are working to get commitments with their sub-contractors, those companies that supply materials to the factories making Nike goods. Nike cannot monitor everything; it is not and cannot be responsible for everything that goes on in the countries in which it has suppliers; but because of its buying power it can leverage influence and affect supplier conduct. Not to do so would be, from its own perspective, avoiding its obligations (Hartman et al., 2003). Wal-Mart might do well to heed NikeÕs approach. To illustrate that NikeÕs approach is not unique, let us look at another company, Exxon-Mobil. The first is ExxonMobilÕs exploration of oil in Chad and the development of a pipeline through Cameroon. Chad and Cameroon are two of the poorest and most corrupt countries in the world (Transparency International, 2005). For example, ExxonÕs 2001 revenues were $190 billion; ChadÕs yearly gross domestic product was 1.4 billion. However, ExxonMobil, in partnership with ChevronTexaco and Petron as is investing $3.5 billion in drilling in Chad and in building a 600-mile pipeline through Cameroon. The project should generate $2 billion in revenues for Chad and $500 million for Cameroon over the 25-year projected drilling period. (World Bank, 2000). Still, from ExxonMobilÕs perspective carrying out this project is morally risky since, as Fortune speculates, the president of Chad, Idriss Déby, who ‘‘has a flair for human rights abuses, …. could ‘pull a MobutuÕ’’ (Ussem, 2002). ExxonMobil is a company created by the merger of Exxon and Mobil, and prior to the merger, each was a multi-billion dollar oil company. Exxon was best known for the Exxon Valdez oil spill, and Mobil, according to Forbes, in the early 1990s, became involved with a certain James Giffen, known as a ‘fixerÕ. It is alleged, but not yet proven, that Giffen, in collaboration with a Mobil executive, were engaged in a questionable payment scheme with the Kazakh government in order to get access to KazakhstanÕs oil fields (Fisher, 2003, p. 84). There is a perception, at least partly true, that until very recently (and this still sometimes occurs) oil companies simply went into a region with a team of expatriate ‘foreigners,Õ drilled, dug pipelines, pumped oil, and left. Given that perception and ExxonMobilÕs spotty past, what is interesting about the Chad-Cameroon project, is Exxon MobilÕs approach. ExxonMobil has created an alliance with the Chad and Cameroon governments, the World Bank, a number of NGOs, and indigenous populations in the region. Before approving the project the World Bank created a series of provisos to ensure that there is sound fiscal management of the revenues receive Chad and Cameroon, it set up strict environmental and social policies, and it consulted with a number of NGOs to protect the rights and welfare of indigenous people in these regions (World Bank, 2002). By the middle of 2002 the project employed more than 11,000 workers, of whom at least 85% are from Chad or Cameroon. Of these local workers, more than 3700 have received high-skills training in construction, electrical and mechanical trades, and 5% of the local workers have supervisory positions. In addition, local businesses have benefitted from the project to a total of almost $100 million. The Bank has developed micro lending projects accompanied with fiscal and technical training. The aim is to establish permanent micro lending banks in Chad and Cameroon. In partnership with ExxonMobil the World Bank have created new schools and health clinics, provided HIV education and vaccines against tuberculosis and medical staff to monitor the distribution, and distributed thousands of mosquito nets for protection against malaria, and provided farm implements and seeds to develop indigenous agriculture. NGOs have worked with local Pygmy and Bantu tribes to alleviate disruption from the pipeline installation. The Chad and Cameroon governments, in turn, have pledged to use the profits they received from the venture to improve the standard of living of their citizens. (Ussem, 2002; World Bank, 2002) To date Exxon/Mobil has not encouraged substantive input from the various indigenous tribes in the region. Nevertheless it is an attempt to take the interests of the Pygmy and Bantu tribes into account, and that, surely is a positive step.6 (Mead et al., 2002) It would appear that, at least on the surface, ExxonMobil is attempting to apply a systems approach to this drilling, with some success. Its approach then, is holistic, envisioning the company as part of an Mental Models, Moral Imagination and System Thinking Exxon/ Environmental Agencies Mobil W o rl d Bank Chevron/ Alliance Texaco Cha d NGOs and Social Market Or gs . Cameroon Petronas Figure 6. ExxonMobilÕs alliance model (Model Courtesy of Mary Ann Leeper, COO, Female Health Company). alliance that takes into account and is responsible to multiple stakeholders, not merely shareholders and oil consumers (Figure 6). Note that there is no individual, tribe, or institution in the center of the graphic in Figure 6. The idea is that each of these stakeholders (and there are others I have left out) have a stake in this project; each is responsible – not just ExxonMobil – for the outcomes of this project and each is accountable.7 This involvement by all stakeholders and their places in an alliance model distinguishes this approach from some of the CSR approaches that place the primary onus of responsibility on the corporation. The global challenge ExxonMobil has tried to rethink its approach to drilling operations through an alliance model, and as Nike has expanded its stakeholder accountability relationships. Employing this model requires proactive corporate initiatives and the adoption of a systems approach to their operations. Still, we must ask, why would any company engage in this program? These programs take a great deal of time, effort, and ingenuity, and positive outcomes are slow to be realized. Nike has not ‘convertedÕ all its suppliers to a gentler work environment. Worse, Exxon/Mobil has run into serious problems in Chad. The Chad government, led by its internationally recognized corrupt president, first 471 name Isriss Deby, has confiscated much of its royalty monies and converted that currency into arms. Little of nothing has been done to improve the economy of Chad. Other companies who are engaging in these processes are also finding that this enterprise is enormously difficult. Why, then should ExxonMobil persist? Why not revert to an older model of maximizing shareholder value by pumping as much oil as possible out of Chad without taking into account Chad and Cameroon communities, economic largess, environmental sustainability, etc. ExxonMobil, to their credit, has not reverted to this model, but that takes a great deal of courage not to do so in the deteriorating political environment in Chad. There are a number of good reasons why a systems approach is worthwhile. First, and most obviously, with the globalization of capitalism, for better or worse, corporations are now required to take into account all their primary internal and external stakeholders. Many companies have always done so. The difference, using this model, is the adaptation of multiple perspectives, trying to get at the mind-set of each set of stakeholders from their points of view. Second, from the point of view of rights and justice, an alliance model brings into focus the responsibilities as well as rights of various stakeholders, not merely the corporation, to the individuals who affect and are affected by corporate actions. Third, if Prahalad is correct, global marketing to what he calls ‘the bottom of the pyramid,Õ the less economically developed but most populous countries, is critical for the survival and well-being of global markets Figure 7. (Prahalad, 2005; Ahmad et al., 2004) Only a systemic approach will be successful in those markets. A company like The Challenge 75-100 million people Tier 1 Ri c h e s t N a t i on s & Shrinking Markets Tier 2 1.5 to 2 billion people Tier 3 Tier 4 Po or e s t N a t i o n s & Largest Markets 4 billion people Tier 5 Figure 7. The challenge: Poorest nations and largest markets (from Prahalad, 2005, p. 4). 472 Patricia H. Werhane Wal-Mart will defend itself in this regard, since by ordering from factories in less developed countries, they are thereby providing jobs and contributing to the economic growth of that country. But let us think about that claim, a claim commonly made by global corporations. As we learned from Adam Smith over 200 years ago, ‘‘by uniting, in some measure, the most distant parts of the world, by enabling them to relieve one anotherÕs wants, to increase one anotherÕs enjoyments, and to encourage one anotherÕs industry, their general tendency would seem to be beneficial’’ (Smith, 1776; rpt. Sachs, 2005). If workers are paid minimum wages or below minimum wage in the country where they live and work, particularly in a less developed country where these wages are very low,8 they are very unlikely to have any funds left over after basic food and shelter. So they have no economic purchasing power, thus cannot contribute to increasing the demand curve necessary for economic growth. What sweatshop work does is actually take labor resources out of LDCs without increasing purchasing power in those countries. Thus economic development at the ‘bottom of the pyramidÕ is often not increased. (Figure 7). If a global economy depends on new markets and if these are increasingly at the bottom of the pyramid as Prahalad demonstrates, how should these markets be developed? Jeffrey Sachs and others have argued that the rich nations have not given enough in various forms of focussed long-term foreign aid to improve country transportation, agriculture development and land reform, water, sanitation, and other macro development initiatives, health care improvement, nutrition and education, and protection against natural disasters (Sachs, 2005). These proposals depend on stable government/public-private partnerships and a developed rule of law. In many countries of the world neither is possible. In addition, Sachs recognizes the importance of microfinancing and public/private partnerships on the village or tribal level, particularly in countries where the government is likely to be corrupt as we saw with Chad. Thus all is not without hope. Returning to our alliance model, this model has been replicated with great success in Bangladesh, a country with an unstable rule of law and lack of financing to develop a decent infrastructure, a welfare system, transportation, etc. all the elements necessary for foreign aid to have an impact. Nevertheless, in the last several years, Bangladeshi economy has grown at over 5% per year (Sachs, 2005, p. 13). At least part of the reason for this growth is due to two institutions: the Grameen Bank of Bangladesh, a private banking institution, and BRAC, the Bangladesh Rural Advancement Committee, a not-for profit internationally funded organization. Their contributions that have contributed to economic growth can be found primarily in their massive microfinancing projects throughout the rural communities in this over populated extremely poor flood-infested country that Transparency International yearly ranks at the bottom of the corruption index (Transparency International, 2005). Again, these are alliance projects, as illustrated by the Grameen BankÕs lending microfinance initiatives, which to date has moved over two million women and their families out of poverty. (Figure 8) Conclusion In a global world where companies are exploring as well as exploiting new markets, such globalization requires new ways of thinking, what I have described as systems thinking. The use of moral imagination helps managers to question and revisit their traditional and sometimes parochial models for corporate governance and valuation, changing the focus of attention from the company to its alliance Grameen Bank G rameen Industries International communities Alliance Competitors (e.g., B R A C, W o rl d Bank) Bangladesh Government and Culture Communities Grameen Foundation (Villages) Gr a m een M e mb e r s Figure 8. The Grameen Bank model for poverty elimination in Bangladesh. Mental Models, Moral Imagination and System Thinking partners. While this way of thinking might appear ‘belieÕ profitability, with an unexploited market at the ‘bottom of the pyramid,Õ companies engaged in long-term strategies for survival and growth might want to heed the possibilities in this market sector (Amhad et al., 2004). But without recognizing the value of worker contributions and the positive market effects of paying workers living wages, this exploration will merely be exploitation. As developed markets become saturated, this strategy is bound to lead to corporate failure. At least, that is my conclusion. Notes 1 A version of this article originally presented at the IESE Business School, University of Navarra, for the 14th International Symposium on Ethics, Business and Society: ‘‘Towards a Comprehensive Integration of Ethics Into Management: Problems and Prospects’’. May 18–19, 2006. 2 Churchill is quoted as claiming, ‘‘It is said that democracy is the worst form of government except all those other forms that have been tried from time to time’’ (Churchill, 1947). 3 This section on mental models derives from my earlier work on this topic. See Werhane, (1999, 2002a). 4 In Bangladesh, for example, where a number of factories produce clothing for Wal-Mart the law specifies minimum wages of $20/month, the law requires decent lunch and bathroom facilities, scheduled breaks, pay for overtime, and maternity leaves. Yet many factories in this country flout these regulations, and unfortunately there is not enforcement of these requirements. 5 This section on systems thinking is a revised version of a previous publication. See Werhane (2002a, b). 6 This case is reproduced from Mead et al. (2002), reprinted in a revised form with permission of Darden Publishing. 7 This approach does not always guarantee moral success, however. A recent report cites ChadÕs government as withdrawing from its agreement with the World Bank to channel its oil revenues into poverty alleviation (Polgreen, 2005, A15). 8 The counter example is the existence of foreign workers in industrialized countries. Although often paid poorly by those country standards, if these workers come from poor countries they are able to save, living by their native country standards. 473 References The Costco Way: 2004, Business Week. April 12, 49. Ahmed, P., M. E. Gorman and P. H. Werhane: 2004, ‘Hindustan Lever and Marketing to the Fourth TierÕ, International Journal of Entrepreneurship and Innovation Management 4, 495–511. Arnold, D. and L. Hartman: 2005, ÔBeyond Sweatshops: Positive Deviancy and Global Labor PracticesÕ, Business Ethics: A European Review 14, 425–6461. Benhabib, S.: 1992, Situating the Self (Routledge, New York). Churchill, W.: 1947, Speech to the House of Commons, November 11. Emanuel, L.: 2000, ÔEthics and the Structures of Health CareÕ, Cambridge Quarterly 9, 151–168. Fisher, D.: 2003, ‘Dangerous Liaisons: Selling Oil Means Cutting Deals with Dictators. Nobody Does it Better than ExxonMobilÕ, Forbes, April 28:84. Fishman, C.: 2006, The Wal-Mart Effect (Penguin Press, New York). Freeman, R. E.: 2002, ÔStakeholder Theory of the Modern CorporationÕ, in T. Donaldson, P. Werhane and M. Cording (eds.), Ethical Issues in Business7th ednth edition, (Prentice Hall, Upper Saddle River, NJ), pp. 38–49. Gentner, D. and E. W. Whitley: 1997, ÔMental Models of Population GrowthÕ, in M. Bazerman, D. Messick, A. Tenbrunsel and K. A. Wade-Benzoni (eds.), Environment, Ethics, and Behavior (New Lexington Press, San Francisco). Gorman, M.: 1992, Simulating Science (Indiana University Press, Bloomington, IN). Hartman, L., D. Arnold and R. Wokutch: 2003, Rising Above Sweatshops (Praeger Press, Westport, CT). Johnson, M.: 1993, Moral Imagination (University of Chicago Press, Chicago). Laszlo, A. and S. Krippner: 1998, ÔSystems Theories: Their Origins, Foundations and DevelopmentÕ, in J. Scott Jordan (eds.), Systems Theories and a Priori Aspects of Perception (Elsevier, Amsterdam), pp. 47–74. McVea, J. and R. E. Freeman: 2005, ÔA Names-and-Faces Approach to Stakeholder ManagementÕ, Journal of Management Inquiry 14, 57–69. Mead, E., P. Werhane and A. Wicks: 2002, ExxonMobil in Chad and Cameron (UVA E 202, Darden Publishing, Charlottesville, VA). Mitroff, I. and H. Linstone: 1993, The Unbounded Mind (Oxford University Press, New York). National Labor Committee: 2000, The Hidden Face of Globalization: What the Corporations DonÕt Want us to Know, Video documentary. 474 Patricia H. Werhane National Labor Committee: 2005, www.nlc.org (accessed April 5, 2005). Plsek, P.: 2001, ‘Redesigning Health Care with Insights from the Science of Complex Adaptive SystemsÕ, Crossing the Quality Chasm: A New Health System for the 21st Century (National Academy Press, Washington, DC), pp. 310–333. Polgreen, L.: 2005, ‘Chad Backs Out of Pledge to Use Oil Wealth to Reduce PovertyÕ, New York Times, December 13, A15. Prahalad, C. K.: 2005, The Fortune at the Bottom of the Pyramid (Pearson Education, Upper Saddle River, NJ). Sachs, J.: 2005, The End of Poverty (Penguin Press, New York). Senge, P.: 1990, The Fifth Discipline (Doubleday, New York). Smith, A.: 1776 and 1976, ‘The Wealth of NationsÕ, in R. H. Campbell and A. S. Skinner (eds.), (Oxford University Press, Oxford). Smith, S. D.: 2006 ‘Wal-Mart gets 25 Thousand applications for its Evergreen Park StoreÕ, CrainÕs Chicago Magazine January 25, p. 1. Transparency International, http://www.trans.de/index.html, accessed 2005. Ussem, J.: 2002, ‘ExxonÕs African AdventureÕ, Fortune, April 15, pp. 102–114. Waddock, S.: 2006, forthcoming., ‘Corporate Citizenship: The Dark-Side Paradoxes of SuccessÕ, in G. Cheney, S. K. May and J. Roper (eds.), 2006 (forthcoming), The Debate Over Corporate Social Responsibility. (Oxford University Press, New York). Werhane, P. H.: 1999, Moral Imagination and Management Decision-Making (Oxford University Press, New York). Werhane, P. H.: 2002a, ÔMoral Imagination and Systems ThinkingÕ, Journal of Business Ethics 38, 33–42. Werhane, P. H.: 2002b, ÔBusiness Ethics, Organization Ethics, and Systems Ethics for Health CareÕ, in N. Bowie (eds.), The Blackwell Guide to Business Ethics (BlackwellÕs, Boston), pp. 289–312. Wolf, S.: 1999, ÔToward a Systemic Theory of Informed Consent in Managed CareÕ, Houston Law Review 35, 1631–1681. World Bank: 2000, ÔProject Appraisal Document-Chad/ Cameroon Petroleum Development and Pipeline ProjectÕ, Washington, DC, The World Bank, Report# 19627-CM, Annex 14, March 30, 2000, p. 139. World Bank: 2002, www.worldbank.org/afr/ccproj/ project/pro_overview.htm, Accessed January 15, 2002. The Darden Business School, University of Virginia, 100 Darden Boulevard, Charlottesville, VA, 22903, USA E-mail: PWERHANE@depaul.edu
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MDC Chronic Disease Medication Management Using Technology Paper

MDC Chronic Disease Medication Management Using Technology Paper

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Write a paper addressing the sections below of the research proposal.

Introduction

Background and Significance of the Problem

Statement of the Problem and Purpose of the Study

Research Questions, Hypothesis, and Variables with Operational Definitions

Research Question

  • Hypothesis: Research and Null
  • Identifying and Defining Study Variables

Operationalize Variables

Research Question

  • How does the integration of technology, such as mobile applications and digital tools, improve medication adherence in patients with chronic diseases, and what role does patient education through these technologies play in enhancing adherence and overall health outcomes?
  • Problem Statement

Medication non-adherence is a significant challenge for patients with chronic diseases. Integrating technology, such as mobile applications and digital tools, has the potential to improve medication adherence in these patients (Volpi et al., 2021). Patient education through these technologies may play a crucial role in enhancing adherence and overall health outcomes.

Research Purpose

The purpose of this research is to investigate how the integration of technology, specifically mobile applications and digital tools, can improve medication adherence in patients with chronic diseases. Additionally, the study aims to explore the role of patient education through these technologies in enhancing adherence and overall health outcomes.

PICOT Question

Patient, Population or Problem: The characteristics of the patients in this context are individuals with chronic diseases. The specific condition or disease is not mentioned in the question, but it refers to any chronic disease that requires medication management.

Intervention or exposure: The intervention in this case is the integration of technology, such as mobile applications and digital tools, into the medication management process for patients with chronic diseases. These technologies can assist with reminders, tracking medication usage, and providing educational resources.

Comparison: The alternative to the intervention would be the standard medication management without the integration of technology. This could involve traditional methods like paper-based medication schedules or relying solely on healthcare providers for reminders and education.

Outcome: The relevant outcomes in this context are improved medication adherence and overall health outcomes. Medication adherence refers to the extent to which patients take their prescribed medications as instructed. The overall health outcomes can include improved disease management, reduced hospitalizations, better quality of life, and prevention of complications (Kuwabara, Su, Krauss, 2019).

Research Question: How does the integration of technology, such as mobile applications and digital tools, improve medication adherence in patients with chronic diseases, and what role does patient education through these technologies play in enhancing adherence and overall health outcomes?

References

Kuwabara, A., Su, S., & Krauss, J. (2019). Utilizing Digital Health Technologies for Patient Education in Lifestyle Medicine. American journal of lifestyle medicine, 14(2), 137–142. https://doi.org/10.1177/1559827619892547

Volpi, S. S., Biduski, D., Bellei, E. A., Tefili, D., McCleary, L., Alves, A. L. S., & De Marchi, A. C. B. (2021). Using a mobile health app to improve patients’ adherence to hypertension treatment: a non-randomized clinical trial. PeerJ, 9, e11491. https://doi.org/10.7717/peerj.11491

SEU Telehealth Patient Privacy Survey Paper

SEU Telehealth Patient Privacy Survey Paper

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The Ministry of Health has developed rules, regulations, and standard operating procedures concerning telehealth services. Review these documents and draft a survey you can provide to patients to determine whether the organization is following these requirements.

Address the following requirements in the survey:

Draft at least 10 survey questions.

Draft questions related to medical privacy and telehealth services.

  • Include questions that will lead to determining whether the facility is following the Standard Operating Procedures.
  • Include a paragraph with each survey question detailing how you feel this question will help improve patient privacy regarding telehealth services in your country.

PHC 375 SEU Promoting Physical Activity and Health Paper

PHC 375 SEU Promoting Physical Activity and Health Paper

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ASSIGNMENT COVER SHEET Course name: Promoting Physical Activity and Health Course number: PHC 375 CRN: 34658 Paper Assignment Assignment title or task: (You can write a question) ● Identify a common health risk factor in Saudi Arabia (obesity, high blood pressure, hyperlipidemia, smoking, diabetes, cancer, CVD, etc) and explain how physical activity can enhance their health and overall fitness. ● Include ideas to promote physical activity. Student Name: Student ID: Submission Date: Instructor name: Grade: Out of 10 Instructions for submission: ● Make sure to fill out all the relevant information on the coversheet. ● Your response should be a minimum of 250 words but should not exceed 500 words (Excluding references). ● Support your answer with examples. ● Font size should be 12 ● Font type should be Times New Roman ● Heading should be Bold ● Colour should be Black ● The paragraph must be justified. ● Double line spacing. ● Use proper references in APA style ● AVOID PLAGIARISM ● Due date; 11/11/2023 11:59 PM Best of Luck
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250 words

HCM 500 SEU Healthcare System Of The United Kingdom Questions

HCM 500 SEU Healthcare System Of The United Kingdom Questions

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Chapter 10 THE UNITED KINGDOM Chapter 10: Overview • Country Description • Brief History of the Healthcare System • Description of the Healthcare System • Evaluation of the Healthcare System • Emerging Challenges • Conclusion Country Description • History • Government or Political System • Macroeconomics • Major Industries, Ports and Airports, and Infrastructure and Transportation Development Demographics • Age Distribution of the Population • Education Levels of the Population • Major Religious Groups Brief History of the Healthcare System • Pre-World War II – Hospitals – General practice – Payment • Private • Government Brief History of the Healthcare System • Post-World War II – Emergence of the modern system – Development of the Ministry of Health Description of the Healthcare System • Delivery at the local level • Connecting for Health Description of the Healthcare System • Primary Care – Community based – Practice-based Commissioning • Others Care Description of the Healthcare System • Secondary Care – NHS Acute Trusts – NHS Foundation Trusts Description of the Healthcare System • Secondary Care – Employment of professional staff • Long-term care • Private sector Description of the Healthcare System • Facilities – GP surgeries – Hospitals Description of the Healthcare System • Workforce – Medical education • Technology and equipment Evaluation of the Healthcare System • Cost – Funding – NHS Plan Evaluation of the Healthcare System • General Medical Services contract – Payment for results • Primary Medical Services Evaluation of the Healthcare System • Quality – Population health measures • Access • Innovation Current and Emerging Issues and Challenges • Increase in private sector participation • Waiting times • Utilization review • Increasing costs and budget restraints Current and Emerging Issues and Challenges • Growing and aging population is increasing demand • Significant pressure on the government to erase a budget deficit • Budget restraint is for NHS trusts and foundation trusts • Passage of the Health and Care Act of 2016 lays the groundwork for improvement Conclusion • Continues as a fairly stable health system • Political upheaval and budget pressure affecting the health system’s stability • System is designed for primary, public health, and tertiary care • Health outcomes some of the best in the world • Aging population remains a major challenge This Section Reserved for Instructors Suggested Discussion or Research Questions General Question Categories • • • • • • • • • Structure and Evaluation Healthcare Services and Systems Global Burden of Disease Cultural Influences Medical Travel and Tourism and Off Shoring Health Communication, Marketing, Social Marketing Data and Measurement Policy, Strategy, and the Regulatory Environment Global Health Leadership International Best Practices Discussion or Research Questions • Some experts state the National Health System (NHS) in the United Kingdom is ‘not fit for the future’ and unless it undergoes radical change. Many think it may be forced to abandon free healthcare for all. Do you believe this statement? Why or why not? • What types of organizations are responsible for the delivery of care in the National Health Services? • Delivery of care is divided into primary and secondary systems. Who is responsible for funding and providing care within each of the systems? Discussion or Research Questions • Describe the role of the private sector in the national healthcare delivery system. • How are primary care services reimbursed and describe the pay-for-performance component of the reimbursement system? Suggested Topic Areas To Use When Facilitating Discussions, Projects, or Case Studies • Engagement of stakeholders • Effectively working in and managing teams • Learning how to get in front of the problem or identify opportunities • Learning to communicate effectively • Assessment of solutions that fit the country • Embracing systems thinking • Recognize and embrace diversity • Sustaining the mission of health as well as health care Links to Suggested Images • https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialca re/healthcaresystem/articles/expenditureonhealthcareintheuk/2015-03-26 • http://evidencenetwork.ca/archives/24206 • http://www.commonwealthfund.org/publications/fundreports/2014/jun/mirror-mirror • https://www.avert.org/professionals/hiv-around-world/western-centraleurope-north-america/uk
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