What are the steps in the quality improvement model and how is benchmarking involved? 2. What are the stages in which data quality errors found in a health record most commonly occur? 3. What is the definition of risk management? 4. What are the parts

 HS410 Unit 6: Quality Management – Discussion  DiscussionThis is a graded Discussion . Please refer to the Discussion Board Grading Rubric in Course Home / Grading Rubrics.

Respond to all of the following questions and be sure to respond to two of your other classmates’ postings:

 1. What are the steps in the quality improvement model and how is benchmarking involved?  2. What are the stages in which data quality errors found in a health record most commonly occur?  3. What is the definition of risk management? 4. What are the parts of an effective risk management program? 5. What is utilization review and why is it important in healthcare? 6. What is the process of utilization review?  Please paper should be 400-500 words and in an essay format, strictly on topic, original with real scholar references to support your answers.

 NO PHARGIARISM PLEASE! This is the Chapter reading for this assignment:
 
Read Chapter 7 in Today’s Health Information Management. INTRODUCTION

Quality health care “means doing the right thing at the right time, in the right way, for the right person, and getting the best possible results.”1 The term quality, by definition, can mean excellence, status, or grade; thus, it can be measured and quantified. The patient, and perhaps the patient’s family, may interpret quality health care differently from the way that health care providers interpret it. Therefore, it is important to determine—if possible—what is “right” and what is “wrong” with regard to quality health care. The study and analysis of health care are important to maintain a level of quality that is satisfactory to all parties involved. As a result of the current focus on patient safety, and in an attempt to reduce deaths and complications, providing the best quality health care while maintaining cost controls has become a challenge to all involved. Current quality initiatives are multifaceted and include government-directed, private sectorsupported, and consumer-driven projects.

   This chapter explores the historical development of health care quality including a review of the important pioneers and the tools they developed. Their work has been studied, refined, and widely used in a variety of applications related to performance-improvement activities. Risk management is discussed, with emphasis on the importance of coordination with quality activities. The evolution of utilization management is also reviewed, with a focus on its relationship to quality management.

   In addition, this chapter explores current trends in data collection and storage, and their application to improvements in quality care and patient safety. Current events are identified that influence and provide direction to legislative support and funding. This chapter also provides multiple tips and tools for both personal and institutional use.
DATA QUALITY

Data quality refers to the high grade, superiority, or excellence of data. Data quality is intertwined with the concept of quality patient care; it refers to data that can demonstrate and represent in an objective sense the delivery of quality patient care. When the data collected are reflective of the care provided, one can reach conclusions about the quality of care the patient received.
Historical Development

The concept of studying the quality of patient care has been a part of the health care field for almost 100 years. Individual surgeons, such as A. E. Codman, pioneered the practice of monitoring surgical outcomes in patients and documenting physician errors concerning specific patients. These physicians began the practice of conducting morbidity and mortality conferences as a means to improve patient care. Building on the prior work of individual surgeons, the American College of Surgeons (ACS) created the Hospital Standardization Program in 1918. This program served as the genesis for the accreditation movement of the 20th century, which included the concept of quality patient care and the formation of the Joint Commission on Accreditation of Hospitals (JCAH) in 1951. The ACS transferred the Hospital Standardization Program to the JCAH in 1953.

   Efforts to improve the quality of patient care have varied during the 20th century, beginning with the establishment of formalized mechanisms to measure patient care against established criteria. A timeline illustrating these efforts is shown in Figure 7-1. These mechanisms focused on an organization’s reaction to individual events and the mistakes of individual health care providers. A variety of quality efforts followed, including ones developed in other industries that were adapted to the health care environment. The concepts of total quality management, defined as the organization-wide approach to quality improvement, and continuous quality improvement, defined as the systematic, team-based approach to process and performance improvement, introduced the team-based approach to quality health care. These newer efforts moved the focus from individual events and health care providers to an organization’s systems and their potential for improvement.
Figure 7-1 | Quality management timeline

   Accompanying the change in focus were new terms such as quality management, quality assurance, process improvement, and performance improvement. Quality management generally means that every aspect of health care quality may be subject to managerial oversight. Quality assurance refers to those actions taken to establish, protect, promote, and improve the quality of health care. Process improvement refers to the improvement of processes involved in the delivery of health care. Performance improvement refers to the improvement of performance as it relates to patient care. Regardless of the names applied and their respective approaches, most health care organizations in the 21st century are bound by the requirements of various accrediting and regulatory bodies to engage in some function that focuses on the quality of patient care.2

   In order to measure patient care for quality purposes, one must first possess data. The data crucial to supporting any quality initiative are the data found in the patient health record. These data must be reliable with respect to quality. Data errors can be made during many stages, such as when data are entered into the record (the documentation process), when data are retrieved from the record (the abstracting process), when data are manipulated (the coding process), when data are processed (the indexing and registry processes), and when data are used (the interpreting process). At each stage, the data must be both consistent and accurate. Furthermore, good quality data are the result of coordinated efforts to ensure integrity at each stage. A recent focus on the legibility of handwritten data, the appropriate use of abbreviations, and their relationship to medication errors has increased pressure from accrediting agencies to improve the quality of data as a means to improve patient safety.

   Quality health care management is the result of the dedication of a variety of professionals working in all levels of employment and in all aspects of health care. These professionals are supported by governmental offices at the federal, state, and local levels that define what data they require to be reported to them. When data definitions are not specified by the agency or organization requiring a report, the responsibility to define the data falls to the team or group that is responsible for collecting and disseminating the data. Fundamental to the collection and dissemination of data is the application of the appropriate collection format and reporting tools. However, before data collection can begin, there must be consensus on the perimeters of the data to be collected. The team or group should also select an assessment model, such as quality circles, PDSA, or FOCUS PDCA. Quality circles are small groups of workers who perform similar work that meet regularly to analyze and solve work-related problems and to recommend solutions to management. These groups are also known as Kaizen teams, a Japanese term meaning to generate or implement employee ideas.3 PDSA (Plan, Do, Study, Act), also known as PDCA (Plan-Do- Check-Act),4 is illustrated in Figure 7-2. FOCUS PDCA5 involves finding a process to improve, organizing a team that knows the process, clarifying the current knowledge of the process, understanding the causes of special variation, and selecting the process improvement. Figure 7-3 illustrates the FOCUS PDCA approach.

   Essentially, these assessment models provide groups with guidance about how to organize the process. These models were developed largely as a result of the manufacturing industry quality movement of the 1950s and 1960s led by W. Edwards Deming, J. M. Juran, and Philip Crosby. In the 1960s, these models were applied to the health care sector by Avedis Donabedian, who separated the quality of health care measures into three distinct categories: structure, process, and outcomes.6 In the 1970s, when the Joint Commission on Accreditation of Healthcare Organizations, now known as the Joint Commission, and the Health Care Financing Administration (HCFA), now known as Centers for Medicare and Medicaid Services (CMS), began to mandate quality initiatives, health care looked to the successes of the manufacturing industry for direction and ideas.
Figure 7-2 | Plan, do, study (or check), and act assessment model
Figure 7-3 | FOCUS assessment model

   The quest for quality, and the tools necessary to achieve it, eventually led to the development of the Malcolm Baldrige National Quality Award. The U.S. Congress created this award in 1987,7 which led to the creation of a new public-private partnership. Principal support for the award comes from the Foundation for the Malcolm Baldrige National Quality Award. The U.S. president announces the award annually. The award initially recognized the manufacturing and service sectors, including both large and small businesses, but it was expanded in 1999 to include the education and health care sectors; several health care organizations have applied for and received this award since then. In 2006, the program expanded even further to consider nonprofit and governmental organizations in the application process. The seven categories in which participants are judged for the Malcolm Baldrige Award are listed in Table 7-1. The focus of the evaluation centers on total quality management with emphasis on sustaining results.
Table 7-1 | Health Care Criteria in the Malcolm Baldrige Award

Leadership

Strategic planning

Customer and market focus

Measurement, analysis, and knowledge management

Workforce focus

Operations focus

Business results

Source: Malcolm Baldrige National Quality Award, http://www.quality.nist.gov Courtesy of The National Institute of Standards and Technology (NIST).

   Early pioneers who applied the Malcolm Baldrige concepts found it difficult at times to achieve effective implementation and/or sustain improvement. In an effort to achieve the greatest possible savings from the improvement projects, the Juran Institute, working with Motorola, developed a methodology called Six Sigma.8 Six Sigma is defined as the measurement of quality to a level of near perfection or without defects. General Electric (GE) and Allied Signal (now Honeywell) also contributed to the development and popularity of the methodology. Part of its success is attributed to the organization of training and leadership. High-level executives are trained and appointed as “champions” to drive the program, and employees receive training and support to become certified internal experts. The amount of training one receives results in different belt levels: black belts are technical personnel who are trained to apply the statistically based methodology. Master black belts coach black belts and coordinate projects. The project team members are referred to as green belts and also receive basic process-improvement training.

   The Six Sigma Improvement Methodology is similar to that of PDCA and FOCUS PDSA, but it uses five steps, known as (D)MAIC: Define, Measure, Analyze, Improve, and Control. Many components of the health care industry have applied the Six Sigma improvement methodology toward the elimination of errors rather than the correction of defects (as it has been applied in industry). The approach is similar and both ultimately strive for perfection. In light of the fact that one error can be of catastrophic consequence if it involves a sentinel event or even death, the concept of near perfection in the Six Sigma standards is important for all applications of health care delivery.

Federal Efforts Whereas the quest for quality led to the development of the Baldrige Award and Six Sigma, efforts at the federal level resulted in the formation of the Agency for Health Care Policy and Research (AHCPR) in 1989. Later changed to the Agency for Healthcare Research and Quality (AHRQ) as part of the Healthcare Research and Quality Act of 1999, this body is a scientific research agency located within the Public Health Service (PHS) of the U.S. Department of Health and Human Services. AHRQ focuses on quality of care research and acts as a “science partner” between the public and private sectors to improve the quality and safety of patient care. Over time, the agency has changed its focus from developing and supporting clinical practice guidelines to developing evidence-based guidelines. AHRQ’s mission is to develop scientific evidence that enables health care decision makers to reach more informed health care choices. The agency assumes the responsibility to conduct, support, and disseminate scientific research designed to improve the outcomes, quality, and safety of health care. The agency is also committed to supporting efforts to reduce health care costs, broaden access to services, and improve the efficiency and effectiveness of the ways health care services are organized, delivered, and financed.

   AHRQ has achieved numerous accomplishments since its inception. These accomplishments range in focus from the Medical Expenditure Panel Survey (MEPS), the Healthcare Cost and Utilization Project (HCUP), and the Consumer Assessment of Healthcare Plans Survey (CAHPS), to the grant component of AHRQ’s Translation of Research into Practice (TRIP) activity and the Quality/Safety of Patient Care program. The latter program encompasses both the Patient Safety Health Care Information program and the Health Care Information Technology program. Each of the programs listed here provides valuable information to the agency. For example, the Medical Expenditure Panel Survey (MEPS) serves as the only national source for annual data on how Americans use and pay for medical care. The survey collects detailed information from families on access, use, expense, insurance coverage, and quality. This information provides public and private sector decision makers with important data to analyze changes in behavior and the market. The Healthcare Cost and Utilization Project (HCUP) also provides information regarding the cost and use of health care resources but focuses on how health care is used by the consumer. HCUP is a family of databases containing routinely collected information that is translated into a uniform format to facilitate comparison. The Consumer Assessment of Health Plans (CAHP) uses surveys to collect data from beneficiaries about their health care plans. The grant component, Translation of Research into Practice (TRIP), provides the financial support to initiate or improve programs where identified. Patient safety research is also an important element of these activities and includes a significant effort directed toward promoting information technology, particularly in small and rural communities where health information technology has been limited due to cost and availability. Other research efforts for patient safety are focused on reducing medical errors and improving pharmaceutical outcomes through the Centers of Excellence for Research and Therapeutics (CERT) program.

E-HIM

AHRQ has provided grants to increase the use of health information technology, including electronic health records.

   As a result of the growing concern for the increased use of health information technology (HIT) to improve the quality of health care and control costs, AHRQ awarded $139 million in contracts and grants in 2004 to promote the use of health information technology. The goals of the AHRQ projects are listed in Table 7-2. Grants were awarded to providers, hospitals, and health care systems, including rural health care settings, critical access hospitals, hospitals and programs for children, as well as university hospitals in urban areas. The locations were spread throughout the country from coast to coast, border to border, and included Alaska and Hawaii. Many grant recipients sought to develop HIT infrastructure and data-sharing capacity among clinical provider organizations. Other grant recipients sought to improve existing systems that were considered outdated, or to install technology where it had not previously existed, such as pharmacy dispensing systems, bar coding, patient scheduling, and decision-support systems. Some grants went toward the construction of a fully integrated electronic health record (EHR), such as one effort by the Tulare District Hospital Rural Health Consortium. Some universities received grants to employ technology for disease-specific projects, such as the Trial of Decision Support to Improve Diabetes Outcomes at Case Western Reserve University; others sought to develop cancer care management programs, such as the Technology Exchange for Cancer Health Network (TECH-Net) established by the University of Tennessee; and others worked to automate tracking of adverse events, such as the Automated Adverse Drug Events Detection and Intervention System established by Duke University. Still other grants focused on promoting statewide and regional networks for health information exchange, sometimes referred to as regional health information organizations (RHIOs). The goal of these projects is to develop a health information exchange that connects the systems of various local health care providers so they can better coordinate care and enable clinicians to obtain patient information at the point of care.9 More information concerning the work of RHIOs is found in Chapter 10, “Database Management.”
Table 7-2 | Goals of the AHRQ Projects

Improve patient safety by reducing medical errors

Increase health information sharing between providers, labs, pharmacies, and patients

Help patients transition between health care settings

Reduce duplicative and unnecessary testing

Increase our knowledge and understanding of the clinical, safety, quality, financial, and organizational values and benefits of HIT

© 2014 Cengage Learning, All Rights Reserved.

   Among its accomplishments of the 21st century, the AHRQ has begun certifying patient safety organizations (PSOs). These organizations were created pursuant to the Patient Safety and Quality Improvement Act of 2005 and are designed to serve as independent entities that collect, analyze, and aggregate information about patient safety. They use this data to identify the underlying causes of lapses in patient safety. PSOs gather data through the voluntary reporting of health care providers and organizations according to the terms of the Patient Safety and Quality Improvement Final Rule (Safety Rule).

   A second 21st century accomplishment of the AHRQ involves the creation of the National Strategy for Quality Improvement in Health Care (National Quality Strategy). Created pursuant to the Patient Protection and Affordable Care Act, the National Quality Strategy aims to improve the overall quality of patient care, reduce costs, and improve patient health. AHRQ developed the National Quality Strategy using evidence-based results of medical research and input from a wide range of stakeholders across the health care system.

   A similar effort at the federal level to improve quality patient care initiated in the U.S. Department of Health and Human Services and resulted in creation of the Center for Medicare and Medicaid Innovation. Also created pursuant to the Patient Protection and Affordable Care Act, the Center is designed to test innovative care and payment models and encourage adoption of practices that reduce costs, while simultaneously delivering highquality patient care at lower cost.

E-HIM

The U.S. President connects the use of electronic health records with improvement in quality patient care.

   One of the most significant efforts to focus attention on the importance of advancing health information technology as a means to improve the quality of patient care was made by U.S. President George W. Bush. In his State of the Union Address on January 20, 2004, he stated, “By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.”10 He acted on this statement shortly thereafter, establishing a national coordinator for health information technology within the U.S. Department of Health and Human Services. This coordinator announced that a 10-year plan would be developed to outline the steps necessary to transform the delivery of health care by adopting health information technology in both the public and private sectors. Included in these steps are the EHR and a national health information infrastructure (NHII), topics that are addressed in further detail in Chapter 10, “Database Management,” and Chapter 11, “Information Systems and Technology.”

Private Efforts Concern for improving the quality of health care also moved others to action. The Institute of Medicine, a private nonprofit organization that provides health policy advice under a congressional charter granted to the National Academy of Sciences, conducted an in-depth analysis of the U.S. health care system and issued a report in 2001. This report, Crossing the Quality Chasm: A New Health System for the 21st Century,11 identified a significant number of changes that had affected the delivery of health care services, specifically the shift from care of acute illnesses to care of chronic illnesses. The report recognized that current health care systems are more devoted to dealing with acute, episodic conditions, and are poorly organized to meet the challenges of continuity of care. The report challenged all health care constituencies—health professionals, federal and state policy makers, purchasers of health care, regulators, organization managers and governing boards, and consumers—to commit to a national statement of purpose and adopt a shared vision of six specific aims for improvement.

   The report did not include a specific “blueprint” or standard for the future because it encouraged imagination and innovation to drive the effort. Specific recommendations included a set of guiding principles known as the Ten Steps for Redesign, the establishment of the Health Care Quality Innovation Fund to initiate the process of change, and development of care processes for common health conditions—most of them chronic—that afflict great numbers of people. This report served as a driving force behind the funding of grants through AHRQ and the other programs that have already been identified.

   The National Committee for Quality Assurance (NCQA) is another organization involved in improving health care quality. Established in 1990, this organization focuses on the managed care industry. It began accrediting these organizations in 1991 in an effort to provide standardized information about them. Its Managed Care Organization (MCO) program is voluntary, and approximately 50 percent of the current HMOs in this country have undergone review by NCQA. Earning the accreditation status is important to many HMOs, because some large employers refuse to conduct business with health plans that have not been accredited by NCQA. In addition, more than 30 states recognize the accreditation for regulatory requirements and do not conduct separate reviews.

   In 1992, NCQA assumed responsibility for management of the Health Plan Employer Data and Information Set (HEDIS), a tool used by many health plans to measure performance of care and service. Purchasers and consumers use the data to compare the performances of managed health care plans. Because more than 60 measures are present in the data set, containing a high degree of specificity, performance comparisons are considered very reliable and comprehensive. The NCQA has designed an audit process that utilizes certified auditors to assure data integrity and validity. HEDIS data are frequently the source of health plan “report cards” that are published in magazines and newspapers. Included in HEDIS is the CAHPS 3.0H survey that measures members’ satisfaction with their care in areas such as claims processing, customer service, and receiving needed care quickly. The data are also used by the plans to help identify opportunities for improvement. A sample of HEDIS measures is shown in Table 7-3.
Table 7-3 | Sample HEDIS Measures, Addressing a Broad Range of Important Topics

Asthma medication use

Controlling high blood pressure

Antidepressant medication management

Smoking cessation programs

Beta-blocker treatment after a heart attack

Source: Information compiled from the National Association for Healthcare Quality (NAHQ), http://www.nahq.org.

Courtesy of the National Association for Healthcare Quality.

   The NCQA also operates recognition programs for individual physicians and medical groups. These programs are voluntary, and physicians may apply through NCQA. Doctors who qualify must meet widely accepted evidence-based standards of care. One program includes a Diabetes Physician Recognition Program that was developed in conjunction with the American Diabetes Association. This program recognizes physicians who keep their patients’ blood sugar and blood pressure at acceptable levels and routinely perform eye and foot examination. The Heart/Stroke Recognition Program (HSRP) is a partnership with the American Heart Association/American Stroke Association and recognizes doctors and practices that control their patients’ blood pressure and cholesterol levels, prescribe antithrombotics such as aspirin, and provide advice for smokers looking to quit.
Table 7-4 | NCQA Accrediting Domains for Accountable Care Organizations

Domain
   

Content

ACO structure and operations
   

The organization clearly defines its organizational structure, demonstrates capability to manage resources and aligns provider incentives through payment arrangements and other mechanisms to promote the delivery of efficient and effective care.

Access to needed providers
   

The organization has sufficient numbers and types of practitioners and provides timely access to culturally competent health care.

Patient-centered primary care
   

The primary-care practices within the organization act as medical homes for patients.

Care management
   

The organization collects, integrates and uses data from various sources for care management, performance reporting, and identifying patients for population health programs. The organization provides resources to patients and practitioners to support care management activities.

Care coordination and transitions
   

The organization facilitates timely exchange of information between providers, patients, and their caregivers to promote safe transitions.

Patient rights and responsibilities
   

The organization informs patients about the role of the ACO and its services. It is transparent about its clinical performance and any performance-based financial incentives offered to practitioners.

Performance reporting and quality improvement
   

The organization measures and publicly reports performance on clinical quality of care, patient experience, and cost measures. The organization identifies opportunities for improvement and brings together providers and stakeholders to collaborate on improvement initiatives.

Source: National Committee on Quality Assurance, www.ncqa.org.

Courtesy of the National Committee on Quality Assurance.

   In 2011, NCQA began accrediting accountable care organizations, an entity created pursuant to the Affordable Care Act of 2010. An accountable care organization (ACO) refers to a group of providers and suppliers of services (e.g., hospitals, physicians, and others involved in patient care) that work together to coordinate care for the patients who receive Medicare health benefits. An ACO is designed to focus on preventive care, coordinate care among providers to reduce error and duplication of services, involve patients in their health care, and contain costs. The accreditation domains to be applied by NCQA to accountable care organizations are listed in Table 7-4.

   The organization that brings all of the professionals involved in quality health care management together is the National Association for Healthcare Quality (NAHQ). This organization is based on the idea that quality health care professionals drive the delivery of vital data for effective decision making in health care systems. Organized in 1975 as the National Association for Quality Assurance Professionals (NAQAP) to represent these health care workers, the organization provides educational, research, and certification programs to its membership. Members include a wide range of professionals who focus on quality management, quality improvement, case/care/disease/utilization management, and risk management. The membership is composed of all levels of employment from all types of health care settings. Members achieve certification through examination and earn the credential of Certified Professional in Healthcare Quality (CPHQ); the examination recognizes professional and academic achievement. The organization also promotes networking and mentoring through educational meetings and publications. Membership includes physicians, nurses, health information management professionals, health care management professionals, information systems management professionals, social workers, and physical and occupational therapists, all with a common focus on improving the outcomes of health care.
Tools

Equally important as selecting a methodology is using assessment tools effectively. Several tools are often employed, including idea generation, data gathering and organizing techniques, cause analysis, and data display methods. While each tool is applicable in many environments, they apply especially well in the context of data quality because they assist in identifying progress, relationships, and the presence or absence of trends. This process of identification leads to a determination of the presence, absence, or level of quality. One useful resource for quality assessment tools is the Web site of the American Society for Quality (http:// www.asq.com), where instructions and samples are available.

   When new ideas are needed to address an issue or problem, brainstorming and benchmarking are often employed. Brainstorming refers to an idea-generating tool in which ideas are offered on a particular topic, in an unrestrained manner, by all members of a group within a short period of time. Brainstorming can be structured or unstructured, and it generally employs guidelines to assure that ideas are not criticized and that all ideas are accepted during the process. Benchmarking refers to the structured process of comparing outcomes or work practices generated by one group or organization against those of an acknowledged superior performer as a means of improving performance.

   Once ideas are generated, the challenge lies in organizing them into a fashion in which they can be processed or analyzed. Organizational tools frequently used include affinity diagrams, nominal group techniques, Gantt charts, and PERT. An affinity diagram refers to a diagram that organizes infor

What are the steps in the quality improvement model and how is benchmarking involved? 2. What are the stages in which data quality errors found in a health record most commonly occur? 3. What is the definition of risk management? 4. What are the parts

 HS410 Unit 6: Quality Management – Discussion  DiscussionThis is a graded Discussion . Please refer to the Discussion Board Grading Rubric in Course Home / Grading Rubrics.

Respond to all of the following questions and be sure to respond to two of your other classmates’ postings:

 1. What are the steps in the quality improvement model and how is benchmarking involved?  2. What are the stages in which data quality errors found in a health record most commonly occur?  3. What is the definition of risk management? 4. What are the parts of an effective risk management program? 5. What is utilization review and why is it important in healthcare? 6. What is the process of utilization review?  Please paper should be 400-500 words and in an essay format, strictly on topic, original with real scholar references to support your answers.

 NO PHARGIARISM PLEASE! This is the Chapter reading for this assignment:
 
Read Chapter 7 in Today’s Health Information Management. INTRODUCTION

Quality health care “means doing the right thing at the right time, in the right way, for the right person, and getting the best possible results.”1 The term quality, by definition, can mean excellence, status, or grade; thus, it can be measured and quantified. The patient, and perhaps the patient’s family, may interpret quality health care differently from the way that health care providers interpret it. Therefore, it is important to determine—if possible—what is “right” and what is “wrong” with regard to quality health care. The study and analysis of health care are important to maintain a level of quality that is satisfactory to all parties involved. As a result of the current focus on patient safety, and in an attempt to reduce deaths and complications, providing the best quality health care while maintaining cost controls has become a challenge to all involved. Current quality initiatives are multifaceted and include government-directed, private sectorsupported, and consumer-driven projects.

   This chapter explores the historical development of health care quality including a review of the important pioneers and the tools they developed. Their work has been studied, refined, and widely used in a variety of applications related to performance-improvement activities. Risk management is discussed, with emphasis on the importance of coordination with quality activities. The evolution of utilization management is also reviewed, with a focus on its relationship to quality management.

   In addition, this chapter explores current trends in data collection and storage, and their application to improvements in quality care and patient safety. Current events are identified that influence and provide direction to legislative support and funding. This chapter also provides multiple tips and tools for both personal and institutional use.
DATA QUALITY

Data quality refers to the high grade, superiority, or excellence of data. Data quality is intertwined with the concept of quality patient care; it refers to data that can demonstrate and represent in an objective sense the delivery of quality patient care. When the data collected are reflective of the care provided, one can reach conclusions about the quality of care the patient received.
Historical Development

The concept of studying the quality of patient care has been a part of the health care field for almost 100 years. Individual surgeons, such as A. E. Codman, pioneered the practice of monitoring surgical outcomes in patients and documenting physician errors concerning specific patients. These physicians began the practice of conducting morbidity and mortality conferences as a means to improve patient care. Building on the prior work of individual surgeons, the American College of Surgeons (ACS) created the Hospital Standardization Program in 1918. This program served as the genesis for the accreditation movement of the 20th century, which included the concept of quality patient care and the formation of the Joint Commission on Accreditation of Hospitals (JCAH) in 1951. The ACS transferred the Hospital Standardization Program to the JCAH in 1953.

   Efforts to improve the quality of patient care have varied during the 20th century, beginning with the establishment of formalized mechanisms to measure patient care against established criteria. A timeline illustrating these efforts is shown in Figure 7-1. These mechanisms focused on an organization’s reaction to individual events and the mistakes of individual health care providers. A variety of quality efforts followed, including ones developed in other industries that were adapted to the health care environment. The concepts of total quality management, defined as the organization-wide approach to quality improvement, and continuous quality improvement, defined as the systematic, team-based approach to process and performance improvement, introduced the team-based approach to quality health care. These newer efforts moved the focus from individual events and health care providers to an organization’s systems and their potential for improvement.
Figure 7-1 | Quality management timeline

   Accompanying the change in focus were new terms such as quality management, quality assurance, process improvement, and performance improvement. Quality management generally means that every aspect of health care quality may be subject to managerial oversight. Quality assurance refers to those actions taken to establish, protect, promote, and improve the quality of health care. Process improvement refers to the improvement of processes involved in the delivery of health care. Performance improvement refers to the improvement of performance as it relates to patient care. Regardless of the names applied and their respective approaches, most health care organizations in the 21st century are bound by the requirements of various accrediting and regulatory bodies to engage in some function that focuses on the quality of patient care.2

   In order to measure patient care for quality purposes, one must first possess data. The data crucial to supporting any quality initiative are the data found in the patient health record. These data must be reliable with respect to quality. Data errors can be made during many stages, such as when data are entered into the record (the documentation process), when data are retrieved from the record (the abstracting process), when data are manipulated (the coding process), when data are processed (the indexing and registry processes), and when data are used (the interpreting process). At each stage, the data must be both consistent and accurate. Furthermore, good quality data are the result of coordinated efforts to ensure integrity at each stage. A recent focus on the legibility of handwritten data, the appropriate use of abbreviations, and their relationship to medication errors has increased pressure from accrediting agencies to improve the quality of data as a means to improve patient safety.

   Quality health care management is the result of the dedication of a variety of professionals working in all levels of employment and in all aspects of health care. These professionals are supported by governmental offices at the federal, state, and local levels that define what data they require to be reported to them. When data definitions are not specified by the agency or organization requiring a report, the responsibility to define the data falls to the team or group that is responsible for collecting and disseminating the data. Fundamental to the collection and dissemination of data is the application of the appropriate collection format and reporting tools. However, before data collection can begin, there must be consensus on the perimeters of the data to be collected. The team or group should also select an assessment model, such as quality circles, PDSA, or FOCUS PDCA. Quality circles are small groups of workers who perform similar work that meet regularly to analyze and solve work-related problems and to recommend solutions to management. These groups are also known as Kaizen teams, a Japanese term meaning to generate or implement employee ideas.3 PDSA (Plan, Do, Study, Act), also known as PDCA (Plan-Do- Check-Act),4 is illustrated in Figure 7-2. FOCUS PDCA5 involves finding a process to improve, organizing a team that knows the process, clarifying the current knowledge of the process, understanding the causes of special variation, and selecting the process improvement. Figure 7-3 illustrates the FOCUS PDCA approach.

   Essentially, these assessment models provide groups with guidance about how to organize the process. These models were developed largely as a result of the manufacturing industry quality movement of the 1950s and 1960s led by W. Edwards Deming, J. M. Juran, and Philip Crosby. In the 1960s, these models were applied to the health care sector by Avedis Donabedian, who separated the quality of health care measures into three distinct categories: structure, process, and outcomes.6 In the 1970s, when the Joint Commission on Accreditation of Healthcare Organizations, now known as the Joint Commission, and the Health Care Financing Administration (HCFA), now known as Centers for Medicare and Medicaid Services (CMS), began to mandate quality initiatives, health care looked to the successes of the manufacturing industry for direction and ideas.
Figure 7-2 | Plan, do, study (or check), and act assessment model
Figure 7-3 | FOCUS assessment model

   The quest for quality, and the tools necessary to achieve it, eventually led to the development of the Malcolm Baldrige National Quality Award. The U.S. Congress created this award in 1987,7 which led to the creation of a new public-private partnership. Principal support for the award comes from the Foundation for the Malcolm Baldrige National Quality Award. The U.S. president announces the award annually. The award initially recognized the manufacturing and service sectors, including both large and small businesses, but it was expanded in 1999 to include the education and health care sectors; several health care organizations have applied for and received this award since then. In 2006, the program expanded even further to consider nonprofit and governmental organizations in the application process. The seven categories in which participants are judged for the Malcolm Baldrige Award are listed in Table 7-1. The focus of the evaluation centers on total quality management with emphasis on sustaining results.
Table 7-1 | Health Care Criteria in the Malcolm Baldrige Award

Leadership

Strategic planning

Customer and market focus

Measurement, analysis, and knowledge management

Workforce focus

Operations focus

Business results

Source: Malcolm Baldrige National Quality Award, http://www.quality.nist.gov Courtesy of The National Institute of Standards and Technology (NIST).

   Early pioneers who applied the Malcolm Baldrige concepts found it difficult at times to achieve effective implementation and/or sustain improvement. In an effort to achieve the greatest possible savings from the improvement projects, the Juran Institute, working with Motorola, developed a methodology called Six Sigma.8 Six Sigma is defined as the measurement of quality to a level of near perfection or without defects. General Electric (GE) and Allied Signal (now Honeywell) also contributed to the development and popularity of the methodology. Part of its success is attributed to the organization of training and leadership. High-level executives are trained and appointed as “champions” to drive the program, and employees receive training and support to become certified internal experts. The amount of training one receives results in different belt levels: black belts are technical personnel who are trained to apply the statistically based methodology. Master black belts coach black belts and coordinate projects. The project team members are referred to as green belts and also receive basic process-improvement training.

   The Six Sigma Improvement Methodology is similar to that of PDCA and FOCUS PDSA, but it uses five steps, known as (D)MAIC: Define, Measure, Analyze, Improve, and Control. Many components of the health care industry have applied the Six Sigma improvement methodology toward the elimination of errors rather than the correction of defects (as it has been applied in industry). The approach is similar and both ultimately strive for perfection. In light of the fact that one error can be of catastrophic consequence if it involves a sentinel event or even death, the concept of near perfection in the Six Sigma standards is important for all applications of health care delivery.

Federal Efforts Whereas the quest for quality led to the development of the Baldrige Award and Six Sigma, efforts at the federal level resulted in the formation of the Agency for Health Care Policy and Research (AHCPR) in 1989. Later changed to the Agency for Healthcare Research and Quality (AHRQ) as part of the Healthcare Research and Quality Act of 1999, this body is a scientific research agency located within the Public Health Service (PHS) of the U.S. Department of Health and Human Services. AHRQ focuses on quality of care research and acts as a “science partner” between the public and private sectors to improve the quality and safety of patient care. Over time, the agency has changed its focus from developing and supporting clinical practice guidelines to developing evidence-based guidelines. AHRQ’s mission is to develop scientific evidence that enables health care decision makers to reach more informed health care choices. The agency assumes the responsibility to conduct, support, and disseminate scientific research designed to improve the outcomes, quality, and safety of health care. The agency is also committed to supporting efforts to reduce health care costs, broaden access to services, and improve the efficiency and effectiveness of the ways health care services are organized, delivered, and financed.

   AHRQ has achieved numerous accomplishments since its inception. These accomplishments range in focus from the Medical Expenditure Panel Survey (MEPS), the Healthcare Cost and Utilization Project (HCUP), and the Consumer Assessment of Healthcare Plans Survey (CAHPS), to the grant component of AHRQ’s Translation of Research into Practice (TRIP) activity and the Quality/Safety of Patient Care program. The latter program encompasses both the Patient Safety Health Care Information program and the Health Care Information Technology program. Each of the programs listed here provides valuable information to the agency. For example, the Medical Expenditure Panel Survey (MEPS) serves as the only national source for annual data on how Americans use and pay for medical care. The survey collects detailed information from families on access, use, expense, insurance coverage, and quality. This information provides public and private sector decision makers with important data to analyze changes in behavior and the market. The Healthcare Cost and Utilization Project (HCUP) also provides information regarding the cost and use of health care resources but focuses on how health care is used by the consumer. HCUP is a family of databases containing routinely collected information that is translated into a uniform format to facilitate comparison. The Consumer Assessment of Health Plans (CAHP) uses surveys to collect data from beneficiaries about their health care plans. The grant component, Translation of Research into Practice (TRIP), provides the financial support to initiate or improve programs where identified. Patient safety research is also an important element of these activities and includes a significant effort directed toward promoting information technology, particularly in small and rural communities where health information technology has been limited due to cost and availability. Other research efforts for patient safety are focused on reducing medical errors and improving pharmaceutical outcomes through the Centers of Excellence for Research and Therapeutics (CERT) program.

E-HIM

AHRQ has provided grants to increase the use of health information technology, including electronic health records.

   As a result of the growing concern for the increased use of health information technology (HIT) to improve the quality of health care and control costs, AHRQ awarded $139 million in contracts and grants in 2004 to promote the use of health information technology. The goals of the AHRQ projects are listed in Table 7-2. Grants were awarded to providers, hospitals, and health care systems, including rural health care settings, critical access hospitals, hospitals and programs for children, as well as university hospitals in urban areas. The locations were spread throughout the country from coast to coast, border to border, and included Alaska and Hawaii. Many grant recipients sought to develop HIT infrastructure and data-sharing capacity among clinical provider organizations. Other grant recipients sought to improve existing systems that were considered outdated, or to install technology where it had not previously existed, such as pharmacy dispensing systems, bar coding, patient scheduling, and decision-support systems. Some grants went toward the construction of a fully integrated electronic health record (EHR), such as one effort by the Tulare District Hospital Rural Health Consortium. Some universities received grants to employ technology for disease-specific projects, such as the Trial of Decision Support to Improve Diabetes Outcomes at Case Western Reserve University; others sought to develop cancer care management programs, such as the Technology Exchange for Cancer Health Network (TECH-Net) established by the University of Tennessee; and others worked to automate tracking of adverse events, such as the Automated Adverse Drug Events Detection and Intervention System established by Duke University. Still other grants focused on promoting statewide and regional networks for health information exchange, sometimes referred to as regional health information organizations (RHIOs). The goal of these projects is to develop a health information exchange that connects the systems of various local health care providers so they can better coordinate care and enable clinicians to obtain patient information at the point of care.9 More information concerning the work of RHIOs is found in Chapter 10, “Database Management.”
Table 7-2 | Goals of the AHRQ Projects

Improve patient safety by reducing medical errors

Increase health information sharing between providers, labs, pharmacies, and patients

Help patients transition between health care settings

Reduce duplicative and unnecessary testing

Increase our knowledge and understanding of the clinical, safety, quality, financial, and organizational values and benefits of HIT

© 2014 Cengage Learning, All Rights Reserved.

   Among its accomplishments of the 21st century, the AHRQ has begun certifying patient safety organizations (PSOs). These organizations were created pursuant to the Patient Safety and Quality Improvement Act of 2005 and are designed to serve as independent entities that collect, analyze, and aggregate information about patient safety. They use this data to identify the underlying causes of lapses in patient safety. PSOs gather data through the voluntary reporting of health care providers and organizations according to the terms of the Patient Safety and Quality Improvement Final Rule (Safety Rule).

   A second 21st century accomplishment of the AHRQ involves the creation of the National Strategy for Quality Improvement in Health Care (National Quality Strategy). Created pursuant to the Patient Protection and Affordable Care Act, the National Quality Strategy aims to improve the overall quality of patient care, reduce costs, and improve patient health. AHRQ developed the National Quality Strategy using evidence-based results of medical research and input from a wide range of stakeholders across the health care system.

   A similar effort at the federal level to improve quality patient care initiated in the U.S. Department of Health and Human Services and resulted in creation of the Center for Medicare and Medicaid Innovation. Also created pursuant to the Patient Protection and Affordable Care Act, the Center is designed to test innovative care and payment models and encourage adoption of practices that reduce costs, while simultaneously delivering highquality patient care at lower cost.

E-HIM

The U.S. President connects the use of electronic health records with improvement in quality patient care.

   One of the most significant efforts to focus attention on the importance of advancing health information technology as a means to improve the quality of patient care was made by U.S. President George W. Bush. In his State of the Union Address on January 20, 2004, he stated, “By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.”10 He acted on this statement shortly thereafter, establishing a national coordinator for health information technology within the U.S. Department of Health and Human Services. This coordinator announced that a 10-year plan would be developed to outline the steps necessary to transform the delivery of health care by adopting health information technology in both the public and private sectors. Included in these steps are the EHR and a national health information infrastructure (NHII), topics that are addressed in further detail in Chapter 10, “Database Management,” and Chapter 11, “Information Systems and Technology.”

Private Efforts Concern for improving the quality of health care also moved others to action. The Institute of Medicine, a private nonprofit organization that provides health policy advice under a congressional charter granted to the National Academy of Sciences, conducted an in-depth analysis of the U.S. health care system and issued a report in 2001. This report, Crossing the Quality Chasm: A New Health System for the 21st Century,11 identified a significant number of changes that had affected the delivery of health care services, specifically the shift from care of acute illnesses to care of chronic illnesses. The report recognized that current health care systems are more devoted to dealing with acute, episodic conditions, and are poorly organized to meet the challenges of continuity of care. The report challenged all health care constituencies—health professionals, federal and state policy makers, purchasers of health care, regulators, organization managers and governing boards, and consumers—to commit to a national statement of purpose and adopt a shared vision of six specific aims for improvement.

   The report did not include a specific “blueprint” or standard for the future because it encouraged imagination and innovation to drive the effort. Specific recommendations included a set of guiding principles known as the Ten Steps for Redesign, the establishment of the Health Care Quality Innovation Fund to initiate the process of change, and development of care processes for common health conditions—most of them chronic—that afflict great numbers of people. This report served as a driving force behind the funding of grants through AHRQ and the other programs that have already been identified.

   The National Committee for Quality Assurance (NCQA) is another organization involved in improving health care quality. Established in 1990, this organization focuses on the managed care industry. It began accrediting these organizations in 1991 in an effort to provide standardized information about them. Its Managed Care Organization (MCO) program is voluntary, and approximately 50 percent of the current HMOs in this country have undergone review by NCQA. Earning the accreditation status is important to many HMOs, because some large employers refuse to conduct business with health plans that have not been accredited by NCQA. In addition, more than 30 states recognize the accreditation for regulatory requirements and do not conduct separate reviews.

   In 1992, NCQA assumed responsibility for management of the Health Plan Employer Data and Information Set (HEDIS), a tool used by many health plans to measure performance of care and service. Purchasers and consumers use the data to compare the performances of managed health care plans. Because more than 60 measures are present in the data set, containing a high degree of specificity, performance comparisons are considered very reliable and comprehensive. The NCQA has designed an audit process that utilizes certified auditors to assure data integrity and validity. HEDIS data are frequently the source of health plan “report cards” that are published in magazines and newspapers. Included in HEDIS is the CAHPS 3.0H survey that measures members’ satisfaction with their care in areas such as claims processing, customer service, and receiving needed care quickly. The data are also used by the plans to help identify opportunities for improvement. A sample of HEDIS measures is shown in Table 7-3.
Table 7-3 | Sample HEDIS Measures, Addressing a Broad Range of Important Topics

Asthma medication use

Controlling high blood pressure

Antidepressant medication management

Smoking cessation programs

Beta-blocker treatment after a heart attack

Source: Information compiled from the National Association for Healthcare Quality (NAHQ), http://www.nahq.org.

Courtesy of the National Association for Healthcare Quality.

   The NCQA also operates recognition programs for individual physicians and medical groups. These programs are voluntary, and physicians may apply through NCQA. Doctors who qualify must meet widely accepted evidence-based standards of care. One program includes a Diabetes Physician Recognition Program that was developed in conjunction with the American Diabetes Association. This program recognizes physicians who keep their patients’ blood sugar and blood pressure at acceptable levels and routinely perform eye and foot examination. The Heart/Stroke Recognition Program (HSRP) is a partnership with the American Heart Association/American Stroke Association and recognizes doctors and practices that control their patients’ blood pressure and cholesterol levels, prescribe antithrombotics such as aspirin, and provide advice for smokers looking to quit.
Table 7-4 | NCQA Accrediting Domains for Accountable Care Organizations

Domain
   

Content

ACO structure and operations
   

The organization clearly defines its organizational structure, demonstrates capability to manage resources and aligns provider incentives through payment arrangements and other mechanisms to promote the delivery of efficient and effective care.

Access to needed providers
   

The organization has sufficient numbers and types of practitioners and provides timely access to culturally competent health care.

Patient-centered primary care
   

The primary-care practices within the organization act as medical homes for patients.

Care management
   

The organization collects, integrates and uses data from various sources for care management, performance reporting, and identifying patients for population health programs. The organization provides resources to patients and practitioners to support care management activities.

Care coordination and transitions
   

The organization facilitates timely exchange of information between providers, patients, and their caregivers to promote safe transitions.

Patient rights and responsibilities
   

The organization informs patients about the role of the ACO and its services. It is transparent about its clinical performance and any performance-based financial incentives offered to practitioners.

Performance reporting and quality improvement
   

The organization measures and publicly reports performance on clinical quality of care, patient experience, and cost measures. The organization identifies opportunities for improvement and brings together providers and stakeholders to collaborate on improvement initiatives.

Source: National Committee on Quality Assurance, www.ncqa.org.

Courtesy of the National Committee on Quality Assurance.

   In 2011, NCQA began accrediting accountable care organizations, an entity created pursuant to the Affordable Care Act of 2010. An accountable care organization (ACO) refers to a group of providers and suppliers of services (e.g., hospitals, physicians, and others involved in patient care) that work together to coordinate care for the patients who receive Medicare health benefits. An ACO is designed to focus on preventive care, coordinate care among providers to reduce error and duplication of services, involve patients in their health care, and contain costs. The accreditation domains to be applied by NCQA to accountable care organizations are listed in Table 7-4.

   The organization that brings all of the professionals involved in quality health care management together is the National Association for Healthcare Quality (NAHQ). This organization is based on the idea that quality health care professionals drive the delivery of vital data for effective decision making in health care systems. Organized in 1975 as the National Association for Quality Assurance Professionals (NAQAP) to represent these health care workers, the organization provides educational, research, and certification programs to its membership. Members include a wide range of professionals who focus on quality management, quality improvement, case/care/disease/utilization management, and risk management. The membership is composed of all levels of employment from all types of health care settings. Members achieve certification through examination and earn the credential of Certified Professional in Healthcare Quality (CPHQ); the examination recognizes professional and academic achievement. The organization also promotes networking and mentoring through educational meetings and publications. Membership includes physicians, nurses, health information management professionals, health care management professionals, information systems management professionals, social workers, and physical and occupational therapists, all with a common focus on improving the outcomes of health care.
Tools

Equally important as selecting a methodology is using assessment tools effectively. Several tools are often employed, including idea generation, data gathering and organizing techniques, cause analysis, and data display methods. While each tool is applicable in many environments, they apply especially well in the context of data quality because they assist in identifying progress, relationships, and the presence or absence of trends. This process of identification leads to a determination of the presence, absence, or level of quality. One useful resource for quality assessment tools is the Web site of the American Society for Quality (http:// www.asq.com), where instructions and samples are available.

   When new ideas are needed to address an issue or problem, brainstorming and benchmarking are often employed. Brainstorming refers to an idea-generating tool in which ideas are offered on a particular topic, in an unrestrained manner, by all members of a group within a short period of time. Brainstorming can be structured or unstructured, and it generally employs guidelines to assure that ideas are not criticized and that all ideas are accepted during the process. Benchmarking refers to the structured process of comparing outcomes or work practices generated by one group or organization against those of an acknowledged superior performer as a means of improving performance.

   Once ideas are generated, the challenge lies in organizing them into a fashion in which they can be processed or analyzed. Organizational tools frequently used include affinity diagrams, nominal group techniques, Gantt charts, and PERT. An affinity diagram refers to a diagram that organizes infor

What are the steps in the quality improvement model and how is benchmarking involved? 2. What are the stages in which data quality errors found in a health record most commonly occur? 3. What is the definition of risk management? 4. What are the parts

 HS410 Unit 6: Quality Management – Discussion  DiscussionThis is a graded Discussion . Please refer to the Discussion Board Grading Rubric in Course Home / Grading Rubrics.

Respond to all of the following questions and be sure to respond to two of your other classmates’ postings:

 1. What are the steps in the quality improvement model and how is benchmarking involved?  2. What are the stages in which data quality errors found in a health record most commonly occur?  3. What is the definition of risk management? 4. What are the parts of an effective risk management program? 5. What is utilization review and why is it important in healthcare? 6. What is the process of utilization review?  Please paper should be 400-500 words and in an essay format, strictly on topic, original with real scholar references to support your answers.

 NO PHARGIARISM PLEASE! This is the Chapter reading for this assignment:
 
Read Chapter 7 in Today’s Health Information Management. INTRODUCTION

Quality health care “means doing the right thing at the right time, in the right way, for the right person, and getting the best possible results.”1 The term quality, by definition, can mean excellence, status, or grade; thus, it can be measured and quantified. The patient, and perhaps the patient’s family, may interpret quality health care differently from the way that health care providers interpret it. Therefore, it is important to determine—if possible—what is “right” and what is “wrong” with regard to quality health care. The study and analysis of health care are important to maintain a level of quality that is satisfactory to all parties involved. As a result of the current focus on patient safety, and in an attempt to reduce deaths and complications, providing the best quality health care while maintaining cost controls has become a challenge to all involved. Current quality initiatives are multifaceted and include government-directed, private sectorsupported, and consumer-driven projects.

   This chapter explores the historical development of health care quality including a review of the important pioneers and the tools they developed. Their work has been studied, refined, and widely used in a variety of applications related to performance-improvement activities. Risk management is discussed, with emphasis on the importance of coordination with quality activities. The evolution of utilization management is also reviewed, with a focus on its relationship to quality management.

   In addition, this chapter explores current trends in data collection and storage, and their application to improvements in quality care and patient safety. Current events are identified that influence and provide direction to legislative support and funding. This chapter also provides multiple tips and tools for both personal and institutional use.
DATA QUALITY

Data quality refers to the high grade, superiority, or excellence of data. Data quality is intertwined with the concept of quality patient care; it refers to data that can demonstrate and represent in an objective sense the delivery of quality patient care. When the data collected are reflective of the care provided, one can reach conclusions about the quality of care the patient received.
Historical Development

The concept of studying the quality of patient care has been a part of the health care field for almost 100 years. Individual surgeons, such as A. E. Codman, pioneered the practice of monitoring surgical outcomes in patients and documenting physician errors concerning specific patients. These physicians began the practice of conducting morbidity and mortality conferences as a means to improve patient care. Building on the prior work of individual surgeons, the American College of Surgeons (ACS) created the Hospital Standardization Program in 1918. This program served as the genesis for the accreditation movement of the 20th century, which included the concept of quality patient care and the formation of the Joint Commission on Accreditation of Hospitals (JCAH) in 1951. The ACS transferred the Hospital Standardization Program to the JCAH in 1953.

   Efforts to improve the quality of patient care have varied during the 20th century, beginning with the establishment of formalized mechanisms to measure patient care against established criteria. A timeline illustrating these efforts is shown in Figure 7-1. These mechanisms focused on an organization’s reaction to individual events and the mistakes of individual health care providers. A variety of quality efforts followed, including ones developed in other industries that were adapted to the health care environment. The concepts of total quality management, defined as the organization-wide approach to quality improvement, and continuous quality improvement, defined as the systematic, team-based approach to process and performance improvement, introduced the team-based approach to quality health care. These newer efforts moved the focus from individual events and health care providers to an organization’s systems and their potential for improvement.
Figure 7-1 | Quality management timeline

   Accompanying the change in focus were new terms such as quality management, quality assurance, process improvement, and performance improvement. Quality management generally means that every aspect of health care quality may be subject to managerial oversight. Quality assurance refers to those actions taken to establish, protect, promote, and improve the quality of health care. Process improvement refers to the improvement of processes involved in the delivery of health care. Performance improvement refers to the improvement of performance as it relates to patient care. Regardless of the names applied and their respective approaches, most health care organizations in the 21st century are bound by the requirements of various accrediting and regulatory bodies to engage in some function that focuses on the quality of patient care.2

   In order to measure patient care for quality purposes, one must first possess data. The data crucial to supporting any quality initiative are the data found in the patient health record. These data must be reliable with respect to quality. Data errors can be made during many stages, such as when data are entered into the record (the documentation process), when data are retrieved from the record (the abstracting process), when data are manipulated (the coding process), when data are processed (the indexing and registry processes), and when data are used (the interpreting process). At each stage, the data must be both consistent and accurate. Furthermore, good quality data are the result of coordinated efforts to ensure integrity at each stage. A recent focus on the legibility of handwritten data, the appropriate use of abbreviations, and their relationship to medication errors has increased pressure from accrediting agencies to improve the quality of data as a means to improve patient safety.

   Quality health care management is the result of the dedication of a variety of professionals working in all levels of employment and in all aspects of health care. These professionals are supported by governmental offices at the federal, state, and local levels that define what data they require to be reported to them. When data definitions are not specified by the agency or organization requiring a report, the responsibility to define the data falls to the team or group that is responsible for collecting and disseminating the data. Fundamental to the collection and dissemination of data is the application of the appropriate collection format and reporting tools. However, before data collection can begin, there must be consensus on the perimeters of the data to be collected. The team or group should also select an assessment model, such as quality circles, PDSA, or FOCUS PDCA. Quality circles are small groups of workers who perform similar work that meet regularly to analyze and solve work-related problems and to recommend solutions to management. These groups are also known as Kaizen teams, a Japanese term meaning to generate or implement employee ideas.3 PDSA (Plan, Do, Study, Act), also known as PDCA (Plan-Do- Check-Act),4 is illustrated in Figure 7-2. FOCUS PDCA5 involves finding a process to improve, organizing a team that knows the process, clarifying the current knowledge of the process, understanding the causes of special variation, and selecting the process improvement. Figure 7-3 illustrates the FOCUS PDCA approach.

   Essentially, these assessment models provide groups with guidance about how to organize the process. These models were developed largely as a result of the manufacturing industry quality movement of the 1950s and 1960s led by W. Edwards Deming, J. M. Juran, and Philip Crosby. In the 1960s, these models were applied to the health care sector by Avedis Donabedian, who separated the quality of health care measures into three distinct categories: structure, process, and outcomes.6 In the 1970s, when the Joint Commission on Accreditation of Healthcare Organizations, now known as the Joint Commission, and the Health Care Financing Administration (HCFA), now known as Centers for Medicare and Medicaid Services (CMS), began to mandate quality initiatives, health care looked to the successes of the manufacturing industry for direction and ideas.
Figure 7-2 | Plan, do, study (or check), and act assessment model
Figure 7-3 | FOCUS assessment model

   The quest for quality, and the tools necessary to achieve it, eventually led to the development of the Malcolm Baldrige National Quality Award. The U.S. Congress created this award in 1987,7 which led to the creation of a new public-private partnership. Principal support for the award comes from the Foundation for the Malcolm Baldrige National Quality Award. The U.S. president announces the award annually. The award initially recognized the manufacturing and service sectors, including both large and small businesses, but it was expanded in 1999 to include the education and health care sectors; several health care organizations have applied for and received this award since then. In 2006, the program expanded even further to consider nonprofit and governmental organizations in the application process. The seven categories in which participants are judged for the Malcolm Baldrige Award are listed in Table 7-1. The focus of the evaluation centers on total quality management with emphasis on sustaining results.
Table 7-1 | Health Care Criteria in the Malcolm Baldrige Award

Leadership

Strategic planning

Customer and market focus

Measurement, analysis, and knowledge management

Workforce focus

Operations focus

Business results

Source: Malcolm Baldrige National Quality Award, http://www.quality.nist.gov Courtesy of The National Institute of Standards and Technology (NIST).

   Early pioneers who applied the Malcolm Baldrige concepts found it difficult at times to achieve effective implementation and/or sustain improvement. In an effort to achieve the greatest possible savings from the improvement projects, the Juran Institute, working with Motorola, developed a methodology called Six Sigma.8 Six Sigma is defined as the measurement of quality to a level of near perfection or without defects. General Electric (GE) and Allied Signal (now Honeywell) also contributed to the development and popularity of the methodology. Part of its success is attributed to the organization of training and leadership. High-level executives are trained and appointed as “champions” to drive the program, and employees receive training and support to become certified internal experts. The amount of training one receives results in different belt levels: black belts are technical personnel who are trained to apply the statistically based methodology. Master black belts coach black belts and coordinate projects. The project team members are referred to as green belts and also receive basic process-improvement training.

   The Six Sigma Improvement Methodology is similar to that of PDCA and FOCUS PDSA, but it uses five steps, known as (D)MAIC: Define, Measure, Analyze, Improve, and Control. Many components of the health care industry have applied the Six Sigma improvement methodology toward the elimination of errors rather than the correction of defects (as it has been applied in industry). The approach is similar and both ultimately strive for perfection. In light of the fact that one error can be of catastrophic consequence if it involves a sentinel event or even death, the concept of near perfection in the Six Sigma standards is important for all applications of health care delivery.

Federal Efforts Whereas the quest for quality led to the development of the Baldrige Award and Six Sigma, efforts at the federal level resulted in the formation of the Agency for Health Care Policy and Research (AHCPR) in 1989. Later changed to the Agency for Healthcare Research and Quality (AHRQ) as part of the Healthcare Research and Quality Act of 1999, this body is a scientific research agency located within the Public Health Service (PHS) of the U.S. Department of Health and Human Services. AHRQ focuses on quality of care research and acts as a “science partner” between the public and private sectors to improve the quality and safety of patient care. Over time, the agency has changed its focus from developing and supporting clinical practice guidelines to developing evidence-based guidelines. AHRQ’s mission is to develop scientific evidence that enables health care decision makers to reach more informed health care choices. The agency assumes the responsibility to conduct, support, and disseminate scientific research designed to improve the outcomes, quality, and safety of health care. The agency is also committed to supporting efforts to reduce health care costs, broaden access to services, and improve the efficiency and effectiveness of the ways health care services are organized, delivered, and financed.

   AHRQ has achieved numerous accomplishments since its inception. These accomplishments range in focus from the Medical Expenditure Panel Survey (MEPS), the Healthcare Cost and Utilization Project (HCUP), and the Consumer Assessment of Healthcare Plans Survey (CAHPS), to the grant component of AHRQ’s Translation of Research into Practice (TRIP) activity and the Quality/Safety of Patient Care program. The latter program encompasses both the Patient Safety Health Care Information program and the Health Care Information Technology program. Each of the programs listed here provides valuable information to the agency. For example, the Medical Expenditure Panel Survey (MEPS) serves as the only national source for annual data on how Americans use and pay for medical care. The survey collects detailed information from families on access, use, expense, insurance coverage, and quality. This information provides public and private sector decision makers with important data to analyze changes in behavior and the market. The Healthcare Cost and Utilization Project (HCUP) also provides information regarding the cost and use of health care resources but focuses on how health care is used by the consumer. HCUP is a family of databases containing routinely collected information that is translated into a uniform format to facilitate comparison. The Consumer Assessment of Health Plans (CAHP) uses surveys to collect data from beneficiaries about their health care plans. The grant component, Translation of Research into Practice (TRIP), provides the financial support to initiate or improve programs where identified. Patient safety research is also an important element of these activities and includes a significant effort directed toward promoting information technology, particularly in small and rural communities where health information technology has been limited due to cost and availability. Other research efforts for patient safety are focused on reducing medical errors and improving pharmaceutical outcomes through the Centers of Excellence for Research and Therapeutics (CERT) program.

E-HIM

AHRQ has provided grants to increase the use of health information technology, including electronic health records.

   As a result of the growing concern for the increased use of health information technology (HIT) to improve the quality of health care and control costs, AHRQ awarded $139 million in contracts and grants in 2004 to promote the use of health information technology. The goals of the AHRQ projects are listed in Table 7-2. Grants were awarded to providers, hospitals, and health care systems, including rural health care settings, critical access hospitals, hospitals and programs for children, as well as university hospitals in urban areas. The locations were spread throughout the country from coast to coast, border to border, and included Alaska and Hawaii. Many grant recipients sought to develop HIT infrastructure and data-sharing capacity among clinical provider organizations. Other grant recipients sought to improve existing systems that were considered outdated, or to install technology where it had not previously existed, such as pharmacy dispensing systems, bar coding, patient scheduling, and decision-support systems. Some grants went toward the construction of a fully integrated electronic health record (EHR), such as one effort by the Tulare District Hospital Rural Health Consortium. Some universities received grants to employ technology for disease-specific projects, such as the Trial of Decision Support to Improve Diabetes Outcomes at Case Western Reserve University; others sought to develop cancer care management programs, such as the Technology Exchange for Cancer Health Network (TECH-Net) established by the University of Tennessee; and others worked to automate tracking of adverse events, such as the Automated Adverse Drug Events Detection and Intervention System established by Duke University. Still other grants focused on promoting statewide and regional networks for health information exchange, sometimes referred to as regional health information organizations (RHIOs). The goal of these projects is to develop a health information exchange that connects the systems of various local health care providers so they can better coordinate care and enable clinicians to obtain patient information at the point of care.9 More information concerning the work of RHIOs is found in Chapter 10, “Database Management.”
Table 7-2 | Goals of the AHRQ Projects

Improve patient safety by reducing medical errors

Increase health information sharing between providers, labs, pharmacies, and patients

Help patients transition between health care settings

Reduce duplicative and unnecessary testing

Increase our knowledge and understanding of the clinical, safety, quality, financial, and organizational values and benefits of HIT

© 2014 Cengage Learning, All Rights Reserved.

   Among its accomplishments of the 21st century, the AHRQ has begun certifying patient safety organizations (PSOs). These organizations were created pursuant to the Patient Safety and Quality Improvement Act of 2005 and are designed to serve as independent entities that collect, analyze, and aggregate information about patient safety. They use this data to identify the underlying causes of lapses in patient safety. PSOs gather data through the voluntary reporting of health care providers and organizations according to the terms of the Patient Safety and Quality Improvement Final Rule (Safety Rule).

   A second 21st century accomplishment of the AHRQ involves the creation of the National Strategy for Quality Improvement in Health Care (National Quality Strategy). Created pursuant to the Patient Protection and Affordable Care Act, the National Quality Strategy aims to improve the overall quality of patient care, reduce costs, and improve patient health. AHRQ developed the National Quality Strategy using evidence-based results of medical research and input from a wide range of stakeholders across the health care system.

   A similar effort at the federal level to improve quality patient care initiated in the U.S. Department of Health and Human Services and resulted in creation of the Center for Medicare and Medicaid Innovation. Also created pursuant to the Patient Protection and Affordable Care Act, the Center is designed to test innovative care and payment models and encourage adoption of practices that reduce costs, while simultaneously delivering highquality patient care at lower cost.

E-HIM

The U.S. President connects the use of electronic health records with improvement in quality patient care.

   One of the most significant efforts to focus attention on the importance of advancing health information technology as a means to improve the quality of patient care was made by U.S. President George W. Bush. In his State of the Union Address on January 20, 2004, he stated, “By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.”10 He acted on this statement shortly thereafter, establishing a national coordinator for health information technology within the U.S. Department of Health and Human Services. This coordinator announced that a 10-year plan would be developed to outline the steps necessary to transform the delivery of health care by adopting health information technology in both the public and private sectors. Included in these steps are the EHR and a national health information infrastructure (NHII), topics that are addressed in further detail in Chapter 10, “Database Management,” and Chapter 11, “Information Systems and Technology.”

Private Efforts Concern for improving the quality of health care also moved others to action. The Institute of Medicine, a private nonprofit organization that provides health policy advice under a congressional charter granted to the National Academy of Sciences, conducted an in-depth analysis of the U.S. health care system and issued a report in 2001. This report, Crossing the Quality Chasm: A New Health System for the 21st Century,11 identified a significant number of changes that had affected the delivery of health care services, specifically the shift from care of acute illnesses to care of chronic illnesses. The report recognized that current health care systems are more devoted to dealing with acute, episodic conditions, and are poorly organized to meet the challenges of continuity of care. The report challenged all health care constituencies—health professionals, federal and state policy makers, purchasers of health care, regulators, organization managers and governing boards, and consumers—to commit to a national statement of purpose and adopt a shared vision of six specific aims for improvement.

   The report did not include a specific “blueprint” or standard for the future because it encouraged imagination and innovation to drive the effort. Specific recommendations included a set of guiding principles known as the Ten Steps for Redesign, the establishment of the Health Care Quality Innovation Fund to initiate the process of change, and development of care processes for common health conditions—most of them chronic—that afflict great numbers of people. This report served as a driving force behind the funding of grants through AHRQ and the other programs that have already been identified.

   The National Committee for Quality Assurance (NCQA) is another organization involved in improving health care quality. Established in 1990, this organization focuses on the managed care industry. It began accrediting these organizations in 1991 in an effort to provide standardized information about them. Its Managed Care Organization (MCO) program is voluntary, and approximately 50 percent of the current HMOs in this country have undergone review by NCQA. Earning the accreditation status is important to many HMOs, because some large employers refuse to conduct business with health plans that have not been accredited by NCQA. In addition, more than 30 states recognize the accreditation for regulatory requirements and do not conduct separate reviews.

   In 1992, NCQA assumed responsibility for management of the Health Plan Employer Data and Information Set (HEDIS), a tool used by many health plans to measure performance of care and service. Purchasers and consumers use the data to compare the performances of managed health care plans. Because more than 60 measures are present in the data set, containing a high degree of specificity, performance comparisons are considered very reliable and comprehensive. The NCQA has designed an audit process that utilizes certified auditors to assure data integrity and validity. HEDIS data are frequently the source of health plan “report cards” that are published in magazines and newspapers. Included in HEDIS is the CAHPS 3.0H survey that measures members’ satisfaction with their care in areas such as claims processing, customer service, and receiving needed care quickly. The data are also used by the plans to help identify opportunities for improvement. A sample of HEDIS measures is shown in Table 7-3.
Table 7-3 | Sample HEDIS Measures, Addressing a Broad Range of Important Topics

Asthma medication use

Controlling high blood pressure

Antidepressant medication management

Smoking cessation programs

Beta-blocker treatment after a heart attack

Source: Information compiled from the National Association for Healthcare Quality (NAHQ), http://www.nahq.org.

Courtesy of the National Association for Healthcare Quality.

   The NCQA also operates recognition programs for individual physicians and medical groups. These programs are voluntary, and physicians may apply through NCQA. Doctors who qualify must meet widely accepted evidence-based standards of care. One program includes a Diabetes Physician Recognition Program that was developed in conjunction with the American Diabetes Association. This program recognizes physicians who keep their patients’ blood sugar and blood pressure at acceptable levels and routinely perform eye and foot examination. The Heart/Stroke Recognition Program (HSRP) is a partnership with the American Heart Association/American Stroke Association and recognizes doctors and practices that control their patients’ blood pressure and cholesterol levels, prescribe antithrombotics such as aspirin, and provide advice for smokers looking to quit.
Table 7-4 | NCQA Accrediting Domains for Accountable Care Organizations

Domain
   

Content

ACO structure and operations
   

The organization clearly defines its organizational structure, demonstrates capability to manage resources and aligns provider incentives through payment arrangements and other mechanisms to promote the delivery of efficient and effective care.

Access to needed providers
   

The organization has sufficient numbers and types of practitioners and provides timely access to culturally competent health care.

Patient-centered primary care
   

The primary-care practices within the organization act as medical homes for patients.

Care management
   

The organization collects, integrates and uses data from various sources for care management, performance reporting, and identifying patients for population health programs. The organization provides resources to patients and practitioners to support care management activities.

Care coordination and transitions
   

The organization facilitates timely exchange of information between providers, patients, and their caregivers to promote safe transitions.

Patient rights and responsibilities
   

The organization informs patients about the role of the ACO and its services. It is transparent about its clinical performance and any performance-based financial incentives offered to practitioners.

Performance reporting and quality improvement
   

The organization measures and publicly reports performance on clinical quality of care, patient experience, and cost measures. The organization identifies opportunities for improvement and brings together providers and stakeholders to collaborate on improvement initiatives.

Source: National Committee on Quality Assurance, www.ncqa.org.

Courtesy of the National Committee on Quality Assurance.

   In 2011, NCQA began accrediting accountable care organizations, an entity created pursuant to the Affordable Care Act of 2010. An accountable care organization (ACO) refers to a group of providers and suppliers of services (e.g., hospitals, physicians, and others involved in patient care) that work together to coordinate care for the patients who receive Medicare health benefits. An ACO is designed to focus on preventive care, coordinate care among providers to reduce error and duplication of services, involve patients in their health care, and contain costs. The accreditation domains to be applied by NCQA to accountable care organizations are listed in Table 7-4.

   The organization that brings all of the professionals involved in quality health care management together is the National Association for Healthcare Quality (NAHQ). This organization is based on the idea that quality health care professionals drive the delivery of vital data for effective decision making in health care systems. Organized in 1975 as the National Association for Quality Assurance Professionals (NAQAP) to represent these health care workers, the organization provides educational, research, and certification programs to its membership. Members include a wide range of professionals who focus on quality management, quality improvement, case/care/disease/utilization management, and risk management. The membership is composed of all levels of employment from all types of health care settings. Members achieve certification through examination and earn the credential of Certified Professional in Healthcare Quality (CPHQ); the examination recognizes professional and academic achievement. The organization also promotes networking and mentoring through educational meetings and publications. Membership includes physicians, nurses, health information management professionals, health care management professionals, information systems management professionals, social workers, and physical and occupational therapists, all with a common focus on improving the outcomes of health care.
Tools

Equally important as selecting a methodology is using assessment tools effectively. Several tools are often employed, including idea generation, data gathering and organizing techniques, cause analysis, and data display methods. While each tool is applicable in many environments, they apply especially well in the context of data quality because they assist in identifying progress, relationships, and the presence or absence of trends. This process of identification leads to a determination of the presence, absence, or level of quality. One useful resource for quality assessment tools is the Web site of the American Society for Quality (http:// www.asq.com), where instructions and samples are available.

   When new ideas are needed to address an issue or problem, brainstorming and benchmarking are often employed. Brainstorming refers to an idea-generating tool in which ideas are offered on a particular topic, in an unrestrained manner, by all members of a group within a short period of time. Brainstorming can be structured or unstructured, and it generally employs guidelines to assure that ideas are not criticized and that all ideas are accepted during the process. Benchmarking refers to the structured process of comparing outcomes or work practices generated by one group or organization against those of an acknowledged superior performer as a means of improving performance.

   Once ideas are generated, the challenge lies in organizing them into a fashion in which they can be processed or analyzed. Organizational tools frequently used include affinity diagrams, nominal group techniques, Gantt charts, and PERT. An affinity diagram refers to a diagram that organizes infor

Exercise 7.2. Identifying Effective Strategies for Multicultural TeamsKristin Behfar, Mary Kern, and

Exercise 7.2. Identifying Effective Strategies for Multicultural TeamsKristin Behfar, Mary Kern, and Jeanne M. Brett(Reprinted by permission of the authors)Directions: To begin this exercise read “Part 1. Four Types of Strategy for Multicultural Teams.†You may want to print out the definitions of these strategies, because in Part 2 you will need to choose a management strategy to handle each of eighteen real multicultural team challenges. Following the challenges is Part 3, a description of our research methods, which involved an analytical technique called concept mapping. You can read the research methods section before or after completing the problems.Your instructor can give you further information about what the team(s) actually did in the face of these challenges.Part 1. Four Types of Strategy for Multicultural TeamsPlease read the definitions of the strategies for intervention.Structural Intervention. Structural interventions are deliberate reorganizations or reassignments of roles or group members in order to reduce interpersonal friction or remove a source of conflict or of advantage or disadvantage for one or more subgroups. These interventions can be initiated by either team members or managers.Adaptation. Adaptation refers to team member actions that find alternative working arrangements or address challenges without the intervention of a manager. That is, the team finds a way to either change or work with or around the challenge. This can include adapting work practices or attitudes but not making changes to the group membership or role assignments.Managerial Intervention. Managerial intervention refers to arbitration or resolution of a problem by a manager or leader. For example, the leader may break a stalemate, make a final decision, or choose a solution for the team to perform. In essence, the manager creates the solution and the team follows. Managerial interventions are typically one-time interventions and are not negotiated by the team.Exit. Exit means that one or more team members leave the team or organization. This represents a lack of resolution or lack of a strategy to effectively address the challenge.Part 2. The ProblemsFor each problem, study the “Challenge†and consider the pros and cons of each of the four management strategies for intervening in the challenge.Problem Cluster 1: Thought You Had an AgreementProblem 7.1. Communication Gaps.Project. “My job as engineer was to do a checkout of the refinery I was working at in China. And they had a lot of problems and safety hazards. So we would do a punch list to document the problems and then try to get them to fix everything that was a problem.â€Team. “In addition to myself, there were three people who worked around the clock doing shift work and a chief process adviser who was like the head representative at site. We also had some other technical people that came and went over the course of the job. On the Chinese side were lower-level people that operated the plant, and the maintenance people. It was actually very easy to deal with them other than the technical barrier and the language barrier. The upper management was more difficult. I’m not sure if it was a political issue or if they just felt a higher level of arrogance or ego, but they were the ones that gave us the problems.â€Challenge. “So even though we were trying to help them, it turned into a political issue where it was more important for them to save face for their own nationality or their own company rather than actually submit and fix the problems. [It was] a clash of egos, and we were trying to do due diligence, whereas they were more concerned about saving face.â€Your Answer?Problem 7.2. “Meant to Tell You It Can’t Be Done.â€Project. “We were launching a gift card. In order to hit the peak season, we needed to have that product out [by the] end of November.â€Team. “I’m a [bank] product manager and I also manage projects. One [team member was a] gentleman whose dominant culture was Colombian and was one level above me. He was responsible for all of our advertising and marketing design and production. There was a female from Puerto Rico, also a manager, one level above me, working in the balance and control department. The third member of the team was a gentleman who grew up in Puerto Rico. He was my level; we worked in the same department, and he had experience with the issue that was at hand. So our manager brought him onto the project as a guide. [The fourth and last team member] was a gentleman whose dominant culture was Indian. He was a manager one level above me with the technology group. He was a liaison with our outsource vendor. So it was his responsibility to make sure all of the programming was done so that the reporting that we needed was transmitted at the right time. We were all onsite in the U.S.â€Challenge. “If somebody says something is finished, I consider it finished—it doesn’t have to be completely overhauled or have another week or two weeks’ worth of meetings to address some sort of an issue. A lot of times they would test something, it didn’t work, and then they would stop but never let me know.â€Your Answer?Problem Cluster 2: Direct Versus Indirect ConfrontationProblem 7.3. Delivering Bad News.Project. “We had a program going on in the U.S., a new product that we were trying to launch. The project was to interface with the India team and to get a major component actually designed and manufactured in India. Goals were getting a cost reduction for the overall product itself [and] transferring expertise and knowledge to the India team—getting them up to speed on what the whole thing was about.â€Team. “The lead was a U.S. manager in [the] U.S. The interviewee was also in the U.S., of Indian background, and felt the India team treated him as an American. [Team members in India included] four from India and one from France.â€Challenge. “In the U.S., even though it’s bad news, people are more open to saying [something like], ‘This part of the program has a lot of risks, and just today I found a few more issues and that are going to delay the program by so many weeks.’ [In the United States], I think people are a lot more open to saying that [in India].â€Your answer?Problem 7.4. Passive-Aggressive Team Member Behavior.Project. Sales team.Team. Manager and interviewee, Mexican-American; other members South African, Romanian, African American, and Filipino-Thai.Challenge. “One guy who is half Filipino and half Thai, he even said that he tends to be a little more passive-aggressive at times. He equated that to his Filipino culture and his Filipino upbringing that they tend to be a little more passive-aggressive, he kind of expected you to understand that. And a lot of the times we don’t understand how he’s feeling so it gets to almost like a tipping point to where he’s kind of had enough and it’ll escalate almost into an argument at times. He has a hard time verbalizing.â€Your answer?Problem Cluster 3: Norms for Problem Solving and Decision MakingProblem 7.5. Explicit Directions.Project. “I had to make sure that we had technical infrastructure (servers, software, interfacing to other systems, and so on) in place for the project that we worked on. Onshore resources in Japan were responsible for all of the master data that needed to be loaded into the system for, say, customer ship-tos and bill-tos and anything [involved in] the order-to-cash process.â€Team. “Myself [U.S. female] and three Japanese members [male] [with whom I worked]. I know there were more people on this project, but they don’t let you have access to people directly. They’ll interface for you.â€Challenge. “The need to follow the direction from the top is explicit in Japan. If the president or leader of the company mandates an action, process, procedure, or policy, it is considered ‘law.’ The protocol is strict. Hierarchical structure shall not be deviated from. Whatever way the leader says, goes. No one bucks the system, even if it causes hardship. If hardship occurs, employees are expected to endure the hardship.â€Your answer?Problem 7.6. No Initial Agreement.Project. “It was Bosnia 1996. A peacekeeping effort to do the first mass grave exhumation in Bosnia.â€Team. “Really a challenge because none of the four countries had really worked closely together in peacekeeping operations. And the first time that four large countries like that had taken a step together in Bosnia to put a team together and do something jointly as opposed to the U.S. doing something or the Russians doing something. I think the U.S. had been there at that point probably about four months, and we were forming a team with the U.S., Germany, Turkey, and Russia.â€Challenge. “We didn’t initially have agreement on where we were going. We would sit down and kind of talk about the pros and cons of the situations. There were some heated moments.â€Your answer?Problem Cluster 4: Time, Urgency, and PaceProblem 7.7. Timeline.Project. “The project was relatively high-dollar, lots of people, lots of visibility. We were looking for commonalities of process; for opportunities for us to consolidate things that happen to be done differently in different places.â€Team. “The team was three people: one from the U.S., one from Germany, one from India. People lived in their respective countries and were flown in to work on the project.â€Challenge. “We did not come up with a timeline. . . . [Higher-ups] would say for us to accomplish fourteen to fifteen [units], and we figured a year and a half. The U.S. guy would say, ‘Well, it’s probably four to five months. It’s not a big deal. It’ll be simple.’ There was never really an agreement on that.â€Your answer?Problem 7.8. Pressure to Make Something Happen.Project. “As an international marketing manager I cover the Asia Pacific region from North America. One of my recent jobs was to negotiate a custom software feature package for our customer in Japan.â€Team. “Members of the team were myself and a salesman who was part of my company, but located in Tokyo, and the customer, our contact at the customer’s end, whom I also consider part of the team. And we also had executives who were pretty much riding each of us. So we had three workers and three executives. One executive was in Japan, one was in Singapore, and one was in [the] U.S. We were trying to negotiate price and contents of the custom work for this customer.â€Challenge. “My boss was just frustrated. He didn’t understand the situation, didn’t have patience for it. So he put a lot of pressure on me to make something materialize that couldn’t possibly materialize. We had an ongoing relationship [with the Japanese]. You can’t just pressure somebody, no matter who they are, into doing something before they are ready. It’s like a marriage, and he [the boss] was pretty short term. I think basically Japan, all of Asia really, has a long-term view of things, and the U.S. is very quarterly–based, especially in the last couple of years.â€Your answer?Problem Cluster 5: Differences in Work Norms and BehaviorsProblem 7.9. Outlining a Business Concept.Project. “The team was to outline what the business concept would be to take our existing business to Japan. And that involved an eight-month-long project. Four months living in Japan and using experts and associates and senior consultants from this consulting firm based in Tokyo and then also some of their retail experts throughout the world. And we would do everything from consumer research to competitive analysis to considering mergers and acquisitions.â€Team. “The team consisted of myself, a female and one of the youngest members on the team, by twenty years. Three older gentlemen from my company and then our counterparts on the consulting side consisted of an engagement manager who was from Germany, but fluent in English and had been living in the United States for three years, a Canadian consultant who was based out of Ontario, then two Japanese consultants, as well as all the experts in Japan that we would interact with.â€Challenge. “Japanese associates would definitely not participate when the group got bigger than a few. [They] would not speak on topics that weren’t their responsibility.â€Your answer?Problem 7.10. Attention to the Process.Project. “It was a consulting project supporting our client, which was a French-Dutch merger. We were supporting both sides.â€Team. “The team was working a few days a week in the Netherlands and a few days in France with a French leader and another French consultant, and myself (Dutch).â€Challenge. “What I saw in France was that the people were really paying a lot of attention to the process. I think the way we work with clients in Holland is more direct. We really believe that [we wouldn’t do] something if it would not make sense to do it. We couldn’t go that route. I saw in France that the way they work with their clients is much more like doing whatever they say for the sake of process and making sure that they comfort the client in any case.â€Your answer?Problem Cluster 6: Violations of Respect and HierarchyProblem 7.11. Low Level Over High Level.Project. An audit project in Panama.Team. Asian, Latin American, and U.S. nationals.Challenge. “Because it was an American project, there were times when Latin American people who were higher in the hierarchy in their office would be working for people who were lower in the hierarchy in the American company. For people of American culture, this was not so bad because they said, ‘Well we’re in a different country.’ I think for Latin American people it was sort of a double-edged sword.â€Your answer?Problem 7.12. Contacting Top Management.Project. “Due diligence for the acquisition of a Korean company by an American company.â€Team. “Korean investment bankers (interviewee was Korean), representing the Korean seller. Also on the team were Americans from a U.S. bank representing the U.S. buyer.â€Challenge. “U.S. people tried to contact the top management [of the Korean firm] directly. That really didn’t turn out well. The top management in the Korean firm, they’re really high-level managers, and there is a certain amount of respect, certain processes that they expect people to go through before they actually get contacted and work on the issue. But the U.S. company circumvented the bankers and the working-level people on the due diligence team. The high-level Korean management was pissed because they’d got a call (from the Americans) saying this is not working out, what’s happening. And that was somewhat of an affront to them. The working-level people (at the Korean bank) were also very concerned because they were in a very hierarchical structure. Just the fact that something like that (this is not working out) was communicated to higher management of the client firm was a blow to their (the Korean bankers) credibility.â€Your answer?Problem Cluster 7: Intergroup PrejudicesProblem 7.13. Peacekeeping Operations.Project. “It was Bosnia 1996. A peacekeeping effort to do the first mass grave exhumation in Bosnia.â€Team. “Really a challenge because none of the four countries had really worked closely together in peacekeeping operations. And the first time that four large countries like that had taken a step together in Bosnia to put a team together and do something jointly as opposed to the U.S. doing something or the Russians doing something. I think the U.S. had been there at that point probably about four months, and we were forming a team with the U.S., Germany, Turkey, and Russia.â€Challenge. “Everyone kind of viewed the Turks as a second-class military. The Germans and the Russians didn’t really hit it off too well. And we [Americans] were viewed with kind of different levels of trust or skepticism by everybody else.â€Your answer?Problem 7.14. Too Many Contracts?Project. An investment banking team representing a Korean seller to a Chinese buyer.Team. “[The] interviewee was Korean, working for a Korean bank representing the Korean seller. Also on the team were Chinese from a Chinese bank representing the Chinese buyer.â€Challenge. “There was an incredible amount of distress between [the two companies]. Even though they wanted the deal, and it should happen for the good of both, they had a hard time. There were lots of contracts, and the Chinese company was like, ‘If you had trust in us, you would not ask us for these kind of contracts or these continuous contracts to be signed or certain deposits to be made. If you want this deal to go through and you don’t trust us, how can we work with you?’ The Korean company is, ‘Well, we had a bad experience before and this is just so that you guarantee that you go through with your agreement. I don’t understand why you won’t be able to do this.â€Your answer?Problem Cluster 8: Lack of Common GroundProblem 7.15. Crude Language.Project. To develop and implement systems for customers in the field.Team. Software engineers from Ireland, India, Bulgaria, Taiwan, and the United States. All were hired for their technical competency, not their English-language skills.Challenge. “[One] person’s language was crude and direct and at times offended other people in the team, making inappropriate jokes [about cultural differences].â€Your answer?Problem 7.16. Dealing with Perception.Project. “The team was to outline what the business concept would be to take our existing business to Japan. And that involved an eight-month-long project. Four months living in Japan and using experts and associates and senior consultants from this consulting firm based in Tokyo and then also some of their retail experts throughout the world. And we would do everything from consumer research to competitive analysis to considering mergers and acquisitions.â€Team. “The team consisted of myself, a female and one of the youngest members on the team, by twenty years. Three older gentlemen from my company and then our counterparts on the consulting side consisted of an engagement manager who was from Germany, but fluent in English and had been living in the United States for three years, a Canadian consultant who was based out of Ontario, then two Japanese consultants, as well as all the experts in Japan that we would interact with.â€Challenge. “So it was a struggle. Because you are dealing with subtlety. You are dealing with perception. You know there’s knowledge that she (the Japanese consultant) has, but because she’s in the culture, she has preconceived ideas of what she should find. And because we’re coming from another culture, we have preconceived ideas of what we should find. And so sometimes it was difficult when interpreting the data about what it (the data) really meant or what was the most important issue.â€Your answer?Problem Cluster 9: Fluency, Accents, and VocabularyProblem 7.17. Outsourced Calling.Project. “The team was making phone calls to customers to collect delinquent bills.â€Team. “I was the accounts receivable manager for my business. I had twenty-six people in India working for me. I never met them. They actually didn’t work for my company but for an outsourcing company.â€Challenge. “We certainly had issues with having them call our customers. I don’t care if you say you’re Sue from Indiana, they know you’re not. And our customers are—I’m in the rail business and our customers are very old boy. I got a lot of negative feedback. Most of it was, ‘we don’t understand what they’re saying’ because of the accent, especially over the phone. If you’re with someone, you can see them and you can understand better what they’re saying. But over the phone, especially over the phone lines to India, you’ve got an accent, you’ve got static, you’ve got ten thousand miles of fiberoptics.â€Your answer?Problem 7.18. I Know I Have an Accent.Project. To develop systems to sell and implement for customers in the field.Team. Software engineers from Ireland, India, Bulgaria, Taiwan, and the United States, all hired for their technical competency, not their English-language skills.Challenge. “There were people on the team who were not as used to dealing with foreigners, complaining about language issues, and saying that it is difficult.â€Your answer?Part 3. Research MethodsThe preceding challenge statements were drawn from a set of data that was gathered, analyzed, and finally clustered, using a method of qualitative data analysis known as concept mapping. Following an explanation of this process, we also describe how we arrived at the four types of strategy.Samples and ParticipantsWe conducted and recorded telephone interviews in English with forty members or managers of multicultural teams. We asked each interviewee to describe one or more challenging multicultural team experiences, saying that team members could be citizens of different countries (for example, the United States, India, or Japan) or citizens of the same country (for example, the United Kingdom) but with very different cultural backgrounds (for example, U.K.-Indian, U.K.-Russian, U.K.-American, and so on). We looked for teams that did at least part of their work face-to-face and did not interact exclusively via technology. The interviewer probed for details about the challenge, who was involved, what the cultural issues were, and what the team or team members did about the challenge.Interviewees came from multicultural teams in military, legal, high-tech, and business settings. They described challenges within their teams, challenges stemming from the need to coordinate between the team and other parts of the organization, and challenges stemming from the need to interact with clients, customers, or counterparts from other cultures.Most of the forty interviewees were employed full time; all were completing their M.B.A. degrees. The average age was twenty-nine; the average work experience was seven years. They had worked in a variety of countries on all continents except Antarctica. Culturally, 47 percent were American or Canadian, 15 percent were Latin American, 15 percent were Asian (including Indian and Turkish), and 23 percent were European.In selecting participants, we were not interested in how their culture of origin shaped their perceptions of challenges, but rather in the fact that they perceived there to be a challenge. Other than having participants from a variety of cultures, we were not concerned with participants’ cultures as an explanation for why they perceived a challenge. Our focus was on the challenges participants experienced and the strategies used to manage the challenges.We recruited participants through their association with international business coursework during their M.B.A. program. We used an online survey to prescreen participants for experience in multicultural teams. The team tasks that participants reported on included corporate (such as banking-finance or marketing, 44 percent); special projects (20 percent); technical (15 percent); consulting (13 percent); and military (8 percent).Prior to the interview, participants received an overview of the study, the interview protocol, and a consent form. The interviewer asked for verbal consent to participate and reminded the participants that the interview would be recorded and that no names should be used. All participants were entered into a lottery for one of four $150 prizes. Each author conducted about one-third of the interviews. All interviews were transcribed.Data AnalysisThere were three stages of data analysis: (1) identifying responses on the transcripts that represented specific challenges; (2) creating units of analysis; and (3) analyzing the data with the concept mapping method (Jackson and Trochim, 2002).Identifying Challenges and Creating Units of Analysis. Each researcher independently reviewed each transcript, marking passages that described a challenge and any corresponding passage about the management of that challenge. The rate of consistency between the three researchers in identifying the same passages was 77 percent. Passages were excluded from further analysis for one or the other of the following reasons—either the passage represented the same idea as another unanimously identified passage (repeated again in the transcript) or it did not really describe a challenge (it was more of a description of the team). This culling resulted in 160 passages.Next, two of the researchers read all the passages independently, looking for redundancy. Working together they deleted or merged twenty-two passages. They merged passages when there was complete redundancy with another passage from the same interview, and they deleted passages that did not describe a challenge (for example, when the interviewee talked about culture in general). These two researchers then lightly edited passages for clarity and simplicity (spelling was corrected, extraneous words were deleted, dropped words were put in brackets, and so on). The result was 138 statements about challenges faced by multicultural teams, an average of three to four statements per interview. These statements became our units of analysis.Statements were typically one to four sentences long and represented one idea about a challenge experienced by a multicultural team. For example, “In South America . . . when we go into a meeting, we don’t eat and drink. . . . here is different ([people from the] U.S. eat and drink during brainstorming meetings). . . . I think that at some point maybe the internationals look at each other like, ‘Hey these guys are not taking this as seriously as I am . . . or what’s wrong with this guy coming here with a sandwich and eating over the computer and having a conversation at the [same] time he eats?’â€Here is another statement example: “The level of commitment and your word meaning something was different. So in the U.S. I don’t think our words are a promise. When I say ‘Yeah, I’ll get it to you on Friday,’ and perhaps it’s a week late, there is no penalty. However in Japan, if they say, ‘Yes, I will place the P.O. in six months,’ they mean it. You can take it to the bank. It’s going to be there, and if it wasn’t they would lose face. Every time I would go back, or our president would go back, and ask for the P.O., they would say, ‘We told you it would be six months, don’t you believe us?’ In effect, we were being rude to them by continuing to ask.â€Concept Mapping and Clustering Challenges. The next step in the analysis was concept mapping or “participatory content analysis†(Jackson and Trochim, 2002). It is a hybrid of traditional content analysis and semantic mapping analysis. We chose this method because our research objective was to identify the different types of challenges faced by multicultural teams and then associate those challenges with the strategies used to address them. We judged that forcing responses to fit an a priori category scheme (such as with traditional content analysis) would introduce an unacceptable level of researcher bias.Concept mapping as applied to qualitative data analysis (Jackson and Trochim, 2002) combines exploratory statistical analysis (multidimensional scaling and cluster analysis) with the judgments of those doing the concept mapping to produce clusters of similar thematic categories. The analysis is a five-step process: (1) determining units of analysis, (2) sorting units, (3) multidimensional scaling analysis, (4) cluster analysis, and (5) cluster labeling.1. Determining Units of Analysis. We described this step earlier. Each unit (each statement of a challenge) was given a random number and placed on an index card.2. Sorting Units. To avoid introducing researcher bias into the analysis, we did not do this sorting ourselves. Instead, we used twenty M.B.A. students as sorters—excluding any who had been interview participants, in order to protect their privacy (Jackson and Trochim, 2002)—because they were reasonable proxies for the original participants in terms of their work experience and coursework. We chose M.B.A. students who had completed coursework related to understanding cultural issues.We instructed them to sort the 138 index cards into piles based on their judgment of the similarity between statements. We did not limit the number of piles sorters could create (they created piles ranging in number from five to thirty-one). The only limitation was that they could not create a miscellaneous pile. If a statement did not fit with any other, sorters were instructed to leave the statement in its own pile. We also asked sorters to name each pile.3. Multidimensional Scaling Analysis. Next we ran a multidimensional scaling analysis (MDS) on the sorted data to create a visual display or map of conceptual similarity among the statements based on the aggregated similarity judgments of the sorters. We constructed a 138 x 138 binary square matrix (rows and columns represent statements) for each sorter. Cell values represented whether the sorter placed a pair of statements into the same pile (1) or not (0). The sorters’ twenty individual matrices were aggregated to serve as the matrix input into MDS. The MDS solution generated coordinate estimates for each statement and a two-dimensional map of distances between the statements. The final stress value was .33 after nine iterations, indicating a reasonable fit of the map to the similarity matrix that came directly from the sorters for a two-dimensional solution (Davidson, 1982). We chose a two-dimensional solution because it provides the most useful foundation for the next step in this type of tex

Exercise 7.2. Identifying Effective Strategies for Multicultural TeamsKristin Behfar, Mary Kern, and

Exercise 7.2. Identifying Effective Strategies for Multicultural TeamsKristin Behfar, Mary Kern, and Jeanne M. Brett(Reprinted by permission of the authors)Directions: To begin this exercise read “Part 1. Four Types of Strategy for Multicultural Teams.†You may want to print out the definitions of these strategies, because in Part 2 you will need to choose a management strategy to handle each of eighteen real multicultural team challenges. Following the challenges is Part 3, a description of our research methods, which involved an analytical technique called concept mapping. You can read the research methods section before or after completing the problems.Your instructor can give you further information about what the team(s) actually did in the face of these challenges.Part 1. Four Types of Strategy for Multicultural TeamsPlease read the definitions of the strategies for intervention.Structural Intervention. Structural interventions are deliberate reorganizations or reassignments of roles or group members in order to reduce interpersonal friction or remove a source of conflict or of advantage or disadvantage for one or more subgroups. These interventions can be initiated by either team members or managers.Adaptation. Adaptation refers to team member actions that find alternative working arrangements or address challenges without the intervention of a manager. That is, the team finds a way to either change or work with or around the challenge. This can include adapting work practices or attitudes but not making changes to the group membership or role assignments.Managerial Intervention. Managerial intervention refers to arbitration or resolution of a problem by a manager or leader. For example, the leader may break a stalemate, make a final decision, or choose a solution for the team to perform. In essence, the manager creates the solution and the team follows. Managerial interventions are typically one-time interventions and are not negotiated by the team.Exit. Exit means that one or more team members leave the team or organization. This represents a lack of resolution or lack of a strategy to effectively address the challenge.Part 2. The ProblemsFor each problem, study the “Challenge†and consider the pros and cons of each of the four management strategies for intervening in the challenge.Problem Cluster 1: Thought You Had an AgreementProblem 7.1. Communication Gaps.Project. “My job as engineer was to do a checkout of the refinery I was working at in China. And they had a lot of problems and safety hazards. So we would do a punch list to document the problems and then try to get them to fix everything that was a problem.â€Team. “In addition to myself, there were three people who worked around the clock doing shift work and a chief process adviser who was like the head representative at site. We also had some other technical people that came and went over the course of the job. On the Chinese side were lower-level people that operated the plant, and the maintenance people. It was actually very easy to deal with them other than the technical barrier and the language barrier. The upper management was more difficult. I’m not sure if it was a political issue or if they just felt a higher level of arrogance or ego, but they were the ones that gave us the problems.â€Challenge. “So even though we were trying to help them, it turned into a political issue where it was more important for them to save face for their own nationality or their own company rather than actually submit and fix the problems. [It was] a clash of egos, and we were trying to do due diligence, whereas they were more concerned about saving face.â€Your Answer?Problem 7.2. “Meant to Tell You It Can’t Be Done.â€Project. “We were launching a gift card. In order to hit the peak season, we needed to have that product out [by the] end of November.â€Team. “I’m a [bank] product manager and I also manage projects. One [team member was a] gentleman whose dominant culture was Colombian and was one level above me. He was responsible for all of our advertising and marketing design and production. There was a female from Puerto Rico, also a manager, one level above me, working in the balance and control department. The third member of the team was a gentleman who grew up in Puerto Rico. He was my level; we worked in the same department, and he had experience with the issue that was at hand. So our manager brought him onto the project as a guide. [The fourth and last team member] was a gentleman whose dominant culture was Indian. He was a manager one level above me with the technology group. He was a liaison with our outsource vendor. So it was his responsibility to make sure all of the programming was done so that the reporting that we needed was transmitted at the right time. We were all onsite in the U.S.â€Challenge. “If somebody says something is finished, I consider it finished—it doesn’t have to be completely overhauled or have another week or two weeks’ worth of meetings to address some sort of an issue. A lot of times they would test something, it didn’t work, and then they would stop but never let me know.â€Your Answer?Problem Cluster 2: Direct Versus Indirect ConfrontationProblem 7.3. Delivering Bad News.Project. “We had a program going on in the U.S., a new product that we were trying to launch. The project was to interface with the India team and to get a major component actually designed and manufactured in India. Goals were getting a cost reduction for the overall product itself [and] transferring expertise and knowledge to the India team—getting them up to speed on what the whole thing was about.â€Team. “The lead was a U.S. manager in [the] U.S. The interviewee was also in the U.S., of Indian background, and felt the India team treated him as an American. [Team members in India included] four from India and one from France.â€Challenge. “In the U.S., even though it’s bad news, people are more open to saying [something like], ‘This part of the program has a lot of risks, and just today I found a few more issues and that are going to delay the program by so many weeks.’ [In the United States], I think people are a lot more open to saying that [in India].â€Your answer?Problem 7.4. Passive-Aggressive Team Member Behavior.Project. Sales team.Team. Manager and interviewee, Mexican-American; other members South African, Romanian, African American, and Filipino-Thai.Challenge. “One guy who is half Filipino and half Thai, he even said that he tends to be a little more passive-aggressive at times. He equated that to his Filipino culture and his Filipino upbringing that they tend to be a little more passive-aggressive, he kind of expected you to understand that. And a lot of the times we don’t understand how he’s feeling so it gets to almost like a tipping point to where he’s kind of had enough and it’ll escalate almost into an argument at times. He has a hard time verbalizing.â€Your answer?Problem Cluster 3: Norms for Problem Solving and Decision MakingProblem 7.5. Explicit Directions.Project. “I had to make sure that we had technical infrastructure (servers, software, interfacing to other systems, and so on) in place for the project that we worked on. Onshore resources in Japan were responsible for all of the master data that needed to be loaded into the system for, say, customer ship-tos and bill-tos and anything [involved in] the order-to-cash process.â€Team. “Myself [U.S. female] and three Japanese members [male] [with whom I worked]. I know there were more people on this project, but they don’t let you have access to people directly. They’ll interface for you.â€Challenge. “The need to follow the direction from the top is explicit in Japan. If the president or leader of the company mandates an action, process, procedure, or policy, it is considered ‘law.’ The protocol is strict. Hierarchical structure shall not be deviated from. Whatever way the leader says, goes. No one bucks the system, even if it causes hardship. If hardship occurs, employees are expected to endure the hardship.â€Your answer?Problem 7.6. No Initial Agreement.Project. “It was Bosnia 1996. A peacekeeping effort to do the first mass grave exhumation in Bosnia.â€Team. “Really a challenge because none of the four countries had really worked closely together in peacekeeping operations. And the first time that four large countries like that had taken a step together in Bosnia to put a team together and do something jointly as opposed to the U.S. doing something or the Russians doing something. I think the U.S. had been there at that point probably about four months, and we were forming a team with the U.S., Germany, Turkey, and Russia.â€Challenge. “We didn’t initially have agreement on where we were going. We would sit down and kind of talk about the pros and cons of the situations. There were some heated moments.â€Your answer?Problem Cluster 4: Time, Urgency, and PaceProblem 7.7. Timeline.Project. “The project was relatively high-dollar, lots of people, lots of visibility. We were looking for commonalities of process; for opportunities for us to consolidate things that happen to be done differently in different places.â€Team. “The team was three people: one from the U.S., one from Germany, one from India. People lived in their respective countries and were flown in to work on the project.â€Challenge. “We did not come up with a timeline. . . . [Higher-ups] would say for us to accomplish fourteen to fifteen [units], and we figured a year and a half. The U.S. guy would say, ‘Well, it’s probably four to five months. It’s not a big deal. It’ll be simple.’ There was never really an agreement on that.â€Your answer?Problem 7.8. Pressure to Make Something Happen.Project. “As an international marketing manager I cover the Asia Pacific region from North America. One of my recent jobs was to negotiate a custom software feature package for our customer in Japan.â€Team. “Members of the team were myself and a salesman who was part of my company, but located in Tokyo, and the customer, our contact at the customer’s end, whom I also consider part of the team. And we also had executives who were pretty much riding each of us. So we had three workers and three executives. One executive was in Japan, one was in Singapore, and one was in [the] U.S. We were trying to negotiate price and contents of the custom work for this customer.â€Challenge. “My boss was just frustrated. He didn’t understand the situation, didn’t have patience for it. So he put a lot of pressure on me to make something materialize that couldn’t possibly materialize. We had an ongoing relationship [with the Japanese]. You can’t just pressure somebody, no matter who they are, into doing something before they are ready. It’s like a marriage, and he [the boss] was pretty short term. I think basically Japan, all of Asia really, has a long-term view of things, and the U.S. is very quarterly–based, especially in the last couple of years.â€Your answer?Problem Cluster 5: Differences in Work Norms and BehaviorsProblem 7.9. Outlining a Business Concept.Project. “The team was to outline what the business concept would be to take our existing business to Japan. And that involved an eight-month-long project. Four months living in Japan and using experts and associates and senior consultants from this consulting firm based in Tokyo and then also some of their retail experts throughout the world. And we would do everything from consumer research to competitive analysis to considering mergers and acquisitions.â€Team. “The team consisted of myself, a female and one of the youngest members on the team, by twenty years. Three older gentlemen from my company and then our counterparts on the consulting side consisted of an engagement manager who was from Germany, but fluent in English and had been living in the United States for three years, a Canadian consultant who was based out of Ontario, then two Japanese consultants, as well as all the experts in Japan that we would interact with.â€Challenge. “Japanese associates would definitely not participate when the group got bigger than a few. [They] would not speak on topics that weren’t their responsibility.â€Your answer?Problem 7.10. Attention to the Process.Project. “It was a consulting project supporting our client, which was a French-Dutch merger. We were supporting both sides.â€Team. “The team was working a few days a week in the Netherlands and a few days in France with a French leader and another French consultant, and myself (Dutch).â€Challenge. “What I saw in France was that the people were really paying a lot of attention to the process. I think the way we work with clients in Holland is more direct. We really believe that [we wouldn’t do] something if it would not make sense to do it. We couldn’t go that route. I saw in France that the way they work with their clients is much more like doing whatever they say for the sake of process and making sure that they comfort the client in any case.â€Your answer?Problem Cluster 6: Violations of Respect and HierarchyProblem 7.11. Low Level Over High Level.Project. An audit project in Panama.Team. Asian, Latin American, and U.S. nationals.Challenge. “Because it was an American project, there were times when Latin American people who were higher in the hierarchy in their office would be working for people who were lower in the hierarchy in the American company. For people of American culture, this was not so bad because they said, ‘Well we’re in a different country.’ I think for Latin American people it was sort of a double-edged sword.â€Your answer?Problem 7.12. Contacting Top Management.Project. “Due diligence for the acquisition of a Korean company by an American company.â€Team. “Korean investment bankers (interviewee was Korean), representing the Korean seller. Also on the team were Americans from a U.S. bank representing the U.S. buyer.â€Challenge. “U.S. people tried to contact the top management [of the Korean firm] directly. That really didn’t turn out well. The top management in the Korean firm, they’re really high-level managers, and there is a certain amount of respect, certain processes that they expect people to go through before they actually get contacted and work on the issue. But the U.S. company circumvented the bankers and the working-level people on the due diligence team. The high-level Korean management was pissed because they’d got a call (from the Americans) saying this is not working out, what’s happening. And that was somewhat of an affront to them. The working-level people (at the Korean bank) were also very concerned because they were in a very hierarchical structure. Just the fact that something like that (this is not working out) was communicated to higher management of the client firm was a blow to their (the Korean bankers) credibility.â€Your answer?Problem Cluster 7: Intergroup PrejudicesProblem 7.13. Peacekeeping Operations.Project. “It was Bosnia 1996. A peacekeeping effort to do the first mass grave exhumation in Bosnia.â€Team. “Really a challenge because none of the four countries had really worked closely together in peacekeeping operations. And the first time that four large countries like that had taken a step together in Bosnia to put a team together and do something jointly as opposed to the U.S. doing something or the Russians doing something. I think the U.S. had been there at that point probably about four months, and we were forming a team with the U.S., Germany, Turkey, and Russia.â€Challenge. “Everyone kind of viewed the Turks as a second-class military. The Germans and the Russians didn’t really hit it off too well. And we [Americans] were viewed with kind of different levels of trust or skepticism by everybody else.â€Your answer?Problem 7.14. Too Many Contracts?Project. An investment banking team representing a Korean seller to a Chinese buyer.Team. “[The] interviewee was Korean, working for a Korean bank representing the Korean seller. Also on the team were Chinese from a Chinese bank representing the Chinese buyer.â€Challenge. “There was an incredible amount of distress between [the two companies]. Even though they wanted the deal, and it should happen for the good of both, they had a hard time. There were lots of contracts, and the Chinese company was like, ‘If you had trust in us, you would not ask us for these kind of contracts or these continuous contracts to be signed or certain deposits to be made. If you want this deal to go through and you don’t trust us, how can we work with you?’ The Korean company is, ‘Well, we had a bad experience before and this is just so that you guarantee that you go through with your agreement. I don’t understand why you won’t be able to do this.â€Your answer?Problem Cluster 8: Lack of Common GroundProblem 7.15. Crude Language.Project. To develop and implement systems for customers in the field.Team. Software engineers from Ireland, India, Bulgaria, Taiwan, and the United States. All were hired for their technical competency, not their English-language skills.Challenge. “[One] person’s language was crude and direct and at times offended other people in the team, making inappropriate jokes [about cultural differences].â€Your answer?Problem 7.16. Dealing with Perception.Project. “The team was to outline what the business concept would be to take our existing business to Japan. And that involved an eight-month-long project. Four months living in Japan and using experts and associates and senior consultants from this consulting firm based in Tokyo and then also some of their retail experts throughout the world. And we would do everything from consumer research to competitive analysis to considering mergers and acquisitions.â€Team. “The team consisted of myself, a female and one of the youngest members on the team, by twenty years. Three older gentlemen from my company and then our counterparts on the consulting side consisted of an engagement manager who was from Germany, but fluent in English and had been living in the United States for three years, a Canadian consultant who was based out of Ontario, then two Japanese consultants, as well as all the experts in Japan that we would interact with.â€Challenge. “So it was a struggle. Because you are dealing with subtlety. You are dealing with perception. You know there’s knowledge that she (the Japanese consultant) has, but because she’s in the culture, she has preconceived ideas of what she should find. And because we’re coming from another culture, we have preconceived ideas of what we should find. And so sometimes it was difficult when interpreting the data about what it (the data) really meant or what was the most important issue.â€Your answer?Problem Cluster 9: Fluency, Accents, and VocabularyProblem 7.17. Outsourced Calling.Project. “The team was making phone calls to customers to collect delinquent bills.â€Team. “I was the accounts receivable manager for my business. I had twenty-six people in India working for me. I never met them. They actually didn’t work for my company but for an outsourcing company.â€Challenge. “We certainly had issues with having them call our customers. I don’t care if you say you’re Sue from Indiana, they know you’re not. And our customers are—I’m in the rail business and our customers are very old boy. I got a lot of negative feedback. Most of it was, ‘we don’t understand what they’re saying’ because of the accent, especially over the phone. If you’re with someone, you can see them and you can understand better what they’re saying. But over the phone, especially over the phone lines to India, you’ve got an accent, you’ve got static, you’ve got ten thousand miles of fiberoptics.â€Your answer?Problem 7.18. I Know I Have an Accent.Project. To develop systems to sell and implement for customers in the field.Team. Software engineers from Ireland, India, Bulgaria, Taiwan, and the United States, all hired for their technical competency, not their English-language skills.Challenge. “There were people on the team who were not as used to dealing with foreigners, complaining about language issues, and saying that it is difficult.â€Your answer?Part 3. Research MethodsThe preceding challenge statements were drawn from a set of data that was gathered, analyzed, and finally clustered, using a method of qualitative data analysis known as concept mapping. Following an explanation of this process, we also describe how we arrived at the four types of strategy.Samples and ParticipantsWe conducted and recorded telephone interviews in English with forty members or managers of multicultural teams. We asked each interviewee to describe one or more challenging multicultural team experiences, saying that team members could be citizens of different countries (for example, the United States, India, or Japan) or citizens of the same country (for example, the United Kingdom) but with very different cultural backgrounds (for example, U.K.-Indian, U.K.-Russian, U.K.-American, and so on). We looked for teams that did at least part of their work face-to-face and did not interact exclusively via technology. The interviewer probed for details about the challenge, who was involved, what the cultural issues were, and what the team or team members did about the challenge.Interviewees came from multicultural teams in military, legal, high-tech, and business settings. They described challenges within their teams, challenges stemming from the need to coordinate between the team and other parts of the organization, and challenges stemming from the need to interact with clients, customers, or counterparts from other cultures.Most of the forty interviewees were employed full time; all were completing their M.B.A. degrees. The average age was twenty-nine; the average work experience was seven years. They had worked in a variety of countries on all continents except Antarctica. Culturally, 47 percent were American or Canadian, 15 percent were Latin American, 15 percent were Asian (including Indian and Turkish), and 23 percent were European.In selecting participants, we were not interested in how their culture of origin shaped their perceptions of challenges, but rather in the fact that they perceived there to be a challenge. Other than having participants from a variety of cultures, we were not concerned with participants’ cultures as an explanation for why they perceived a challenge. Our focus was on the challenges participants experienced and the strategies used to manage the challenges.We recruited participants through their association with international business coursework during their M.B.A. program. We used an online survey to prescreen participants for experience in multicultural teams. The team tasks that participants reported on included corporate (such as banking-finance or marketing, 44 percent); special projects (20 percent); technical (15 percent); consulting (13 percent); and military (8 percent).Prior to the interview, participants received an overview of the study, the interview protocol, and a consent form. The interviewer asked for verbal consent to participate and reminded the participants that the interview would be recorded and that no names should be used. All participants were entered into a lottery for one of four $150 prizes. Each author conducted about one-third of the interviews. All interviews were transcribed.Data AnalysisThere were three stages of data analysis: (1) identifying responses on the transcripts that represented specific challenges; (2) creating units of analysis; and (3) analyzing the data with the concept mapping method (Jackson and Trochim, 2002).Identifying Challenges and Creating Units of Analysis. Each researcher independently reviewed each transcript, marking passages that described a challenge and any corresponding passage about the management of that challenge. The rate of consistency between the three researchers in identifying the same passages was 77 percent. Passages were excluded from further analysis for one or the other of the following reasons—either the passage represented the same idea as another unanimously identified passage (repeated again in the transcript) or it did not really describe a challenge (it was more of a description of the team). This culling resulted in 160 passages.Next, two of the researchers read all the passages independently, looking for redundancy. Working together they deleted or merged twenty-two passages. They merged passages when there was complete redundancy with another passage from the same interview, and they deleted passages that did not describe a challenge (for example, when the interviewee talked about culture in general). These two researchers then lightly edited passages for clarity and simplicity (spelling was corrected, extraneous words were deleted, dropped words were put in brackets, and so on). The result was 138 statements about challenges faced by multicultural teams, an average of three to four statements per interview. These statements became our units of analysis.Statements were typically one to four sentences long and represented one idea about a challenge experienced by a multicultural team. For example, “In South America . . . when we go into a meeting, we don’t eat and drink. . . . here is different ([people from the] U.S. eat and drink during brainstorming meetings). . . . I think that at some point maybe the internationals look at each other like, ‘Hey these guys are not taking this as seriously as I am . . . or what’s wrong with this guy coming here with a sandwich and eating over the computer and having a conversation at the [same] time he eats?’â€Here is another statement example: “The level of commitment and your word meaning something was different. So in the U.S. I don’t think our words are a promise. When I say ‘Yeah, I’ll get it to you on Friday,’ and perhaps it’s a week late, there is no penalty. However in Japan, if they say, ‘Yes, I will place the P.O. in six months,’ they mean it. You can take it to the bank. It’s going to be there, and if it wasn’t they would lose face. Every time I would go back, or our president would go back, and ask for the P.O., they would say, ‘We told you it would be six months, don’t you believe us?’ In effect, we were being rude to them by continuing to ask.â€Concept Mapping and Clustering Challenges. The next step in the analysis was concept mapping or “participatory content analysis†(Jackson and Trochim, 2002). It is a hybrid of traditional content analysis and semantic mapping analysis. We chose this method because our research objective was to identify the different types of challenges faced by multicultural teams and then associate those challenges with the strategies used to address them. We judged that forcing responses to fit an a priori category scheme (such as with traditional content analysis) would introduce an unacceptable level of researcher bias.Concept mapping as applied to qualitative data analysis (Jackson and Trochim, 2002) combines exploratory statistical analysis (multidimensional scaling and cluster analysis) with the judgments of those doing the concept mapping to produce clusters of similar thematic categories. The analysis is a five-step process: (1) determining units of analysis, (2) sorting units, (3) multidimensional scaling analysis, (4) cluster analysis, and (5) cluster labeling.1. Determining Units of Analysis. We described this step earlier. Each unit (each statement of a challenge) was given a random number and placed on an index card.2. Sorting Units. To avoid introducing researcher bias into the analysis, we did not do this sorting ourselves. Instead, we used twenty M.B.A. students as sorters—excluding any who had been interview participants, in order to protect their privacy (Jackson and Trochim, 2002)—because they were reasonable proxies for the original participants in terms of their work experience and coursework. We chose M.B.A. students who had completed coursework related to understanding cultural issues.We instructed them to sort the 138 index cards into piles based on their judgment of the similarity between statements. We did not limit the number of piles sorters could create (they created piles ranging in number from five to thirty-one). The only limitation was that they could not create a miscellaneous pile. If a statement did not fit with any other, sorters were instructed to leave the statement in its own pile. We also asked sorters to name each pile.3. Multidimensional Scaling Analysis. Next we ran a multidimensional scaling analysis (MDS) on the sorted data to create a visual display or map of conceptual similarity among the statements based on the aggregated similarity judgments of the sorters. We constructed a 138 x 138 binary square matrix (rows and columns represent statements) for each sorter. Cell values represented whether the sorter placed a pair of statements into the same pile (1) or not (0). The sorters’ twenty individual matrices were aggregated to serve as the matrix input into MDS. The MDS solution generated coordinate estimates for each statement and a two-dimensional map of distances between the statements. The final stress value was .33 after nine iterations, indicating a reasonable fit of the map to the similarity matrix that came directly from the sorters for a two-dimensional solution (Davidson, 1982). We chose a two-dimensional solution because it provides the most useful foundation for the next step in this type of tex

Exercise 7.2. Identifying Effective Strategies for Multicultural TeamsKristin Behfar, Mary Kern, and

Exercise 7.2. Identifying Effective Strategies for Multicultural TeamsKristin Behfar, Mary Kern, and Jeanne M. Brett(Reprinted by permission of the authors)Directions: To begin this exercise read “Part 1. Four Types of Strategy for Multicultural Teams.†You may want to print out the definitions of these strategies, because in Part 2 you will need to choose a management strategy to handle each of eighteen real multicultural team challenges. Following the challenges is Part 3, a description of our research methods, which involved an analytical technique called concept mapping. You can read the research methods section before or after completing the problems.Your instructor can give you further information about what the team(s) actually did in the face of these challenges.Part 1. Four Types of Strategy for Multicultural TeamsPlease read the definitions of the strategies for intervention.Structural Intervention. Structural interventions are deliberate reorganizations or reassignments of roles or group members in order to reduce interpersonal friction or remove a source of conflict or of advantage or disadvantage for one or more subgroups. These interventions can be initiated by either team members or managers.Adaptation. Adaptation refers to team member actions that find alternative working arrangements or address challenges without the intervention of a manager. That is, the team finds a way to either change or work with or around the challenge. This can include adapting work practices or attitudes but not making changes to the group membership or role assignments.Managerial Intervention. Managerial intervention refers to arbitration or resolution of a problem by a manager or leader. For example, the leader may break a stalemate, make a final decision, or choose a solution for the team to perform. In essence, the manager creates the solution and the team follows. Managerial interventions are typically one-time interventions and are not negotiated by the team.Exit. Exit means that one or more team members leave the team or organization. This represents a lack of resolution or lack of a strategy to effectively address the challenge.Part 2. The ProblemsFor each problem, study the “Challenge†and consider the pros and cons of each of the four management strategies for intervening in the challenge.Problem Cluster 1: Thought You Had an AgreementProblem 7.1. Communication Gaps.Project. “My job as engineer was to do a checkout of the refinery I was working at in China. And they had a lot of problems and safety hazards. So we would do a punch list to document the problems and then try to get them to fix everything that was a problem.â€Team. “In addition to myself, there were three people who worked around the clock doing shift work and a chief process adviser who was like the head representative at site. We also had some other technical people that came and went over the course of the job. On the Chinese side were lower-level people that operated the plant, and the maintenance people. It was actually very easy to deal with them other than the technical barrier and the language barrier. The upper management was more difficult. I’m not sure if it was a political issue or if they just felt a higher level of arrogance or ego, but they were the ones that gave us the problems.â€Challenge. “So even though we were trying to help them, it turned into a political issue where it was more important for them to save face for their own nationality or their own company rather than actually submit and fix the problems. [It was] a clash of egos, and we were trying to do due diligence, whereas they were more concerned about saving face.â€Your Answer?Problem 7.2. “Meant to Tell You It Can’t Be Done.â€Project. “We were launching a gift card. In order to hit the peak season, we needed to have that product out [by the] end of November.â€Team. “I’m a [bank] product manager and I also manage projects. One [team member was a] gentleman whose dominant culture was Colombian and was one level above me. He was responsible for all of our advertising and marketing design and production. There was a female from Puerto Rico, also a manager, one level above me, working in the balance and control department. The third member of the team was a gentleman who grew up in Puerto Rico. He was my level; we worked in the same department, and he had experience with the issue that was at hand. So our manager brought him onto the project as a guide. [The fourth and last team member] was a gentleman whose dominant culture was Indian. He was a manager one level above me with the technology group. He was a liaison with our outsource vendor. So it was his responsibility to make sure all of the programming was done so that the reporting that we needed was transmitted at the right time. We were all onsite in the U.S.â€Challenge. “If somebody says something is finished, I consider it finished—it doesn’t have to be completely overhauled or have another week or two weeks’ worth of meetings to address some sort of an issue. A lot of times they would test something, it didn’t work, and then they would stop but never let me know.â€Your Answer?Problem Cluster 2: Direct Versus Indirect ConfrontationProblem 7.3. Delivering Bad News.Project. “We had a program going on in the U.S., a new product that we were trying to launch. The project was to interface with the India team and to get a major component actually designed and manufactured in India. Goals were getting a cost reduction for the overall product itself [and] transferring expertise and knowledge to the India team—getting them up to speed on what the whole thing was about.â€Team. “The lead was a U.S. manager in [the] U.S. The interviewee was also in the U.S., of Indian background, and felt the India team treated him as an American. [Team members in India included] four from India and one from France.â€Challenge. “In the U.S., even though it’s bad news, people are more open to saying [something like], ‘This part of the program has a lot of risks, and just today I found a few more issues and that are going to delay the program by so many weeks.’ [In the United States], I think people are a lot more open to saying that [in India].â€Your answer?Problem 7.4. Passive-Aggressive Team Member Behavior.Project. Sales team.Team. Manager and interviewee, Mexican-American; other members South African, Romanian, African American, and Filipino-Thai.Challenge. “One guy who is half Filipino and half Thai, he even said that he tends to be a little more passive-aggressive at times. He equated that to his Filipino culture and his Filipino upbringing that they tend to be a little more passive-aggressive, he kind of expected you to understand that. And a lot of the times we don’t understand how he’s feeling so it gets to almost like a tipping point to where he’s kind of had enough and it’ll escalate almost into an argument at times. He has a hard time verbalizing.â€Your answer?Problem Cluster 3: Norms for Problem Solving and Decision MakingProblem 7.5. Explicit Directions.Project. “I had to make sure that we had technical infrastructure (servers, software, interfacing to other systems, and so on) in place for the project that we worked on. Onshore resources in Japan were responsible for all of the master data that needed to be loaded into the system for, say, customer ship-tos and bill-tos and anything [involved in] the order-to-cash process.â€Team. “Myself [U.S. female] and three Japanese members [male] [with whom I worked]. I know there were more people on this project, but they don’t let you have access to people directly. They’ll interface for you.â€Challenge. “The need to follow the direction from the top is explicit in Japan. If the president or leader of the company mandates an action, process, procedure, or policy, it is considered ‘law.’ The protocol is strict. Hierarchical structure shall not be deviated from. Whatever way the leader says, goes. No one bucks the system, even if it causes hardship. If hardship occurs, employees are expected to endure the hardship.â€Your answer?Problem 7.6. No Initial Agreement.Project. “It was Bosnia 1996. A peacekeeping effort to do the first mass grave exhumation in Bosnia.â€Team. “Really a challenge because none of the four countries had really worked closely together in peacekeeping operations. And the first time that four large countries like that had taken a step together in Bosnia to put a team together and do something jointly as opposed to the U.S. doing something or the Russians doing something. I think the U.S. had been there at that point probably about four months, and we were forming a team with the U.S., Germany, Turkey, and Russia.â€Challenge. “We didn’t initially have agreement on where we were going. We would sit down and kind of talk about the pros and cons of the situations. There were some heated moments.â€Your answer?Problem Cluster 4: Time, Urgency, and PaceProblem 7.7. Timeline.Project. “The project was relatively high-dollar, lots of people, lots of visibility. We were looking for commonalities of process; for opportunities for us to consolidate things that happen to be done differently in different places.â€Team. “The team was three people: one from the U.S., one from Germany, one from India. People lived in their respective countries and were flown in to work on the project.â€Challenge. “We did not come up with a timeline. . . . [Higher-ups] would say for us to accomplish fourteen to fifteen [units], and we figured a year and a half. The U.S. guy would say, ‘Well, it’s probably four to five months. It’s not a big deal. It’ll be simple.’ There was never really an agreement on that.â€Your answer?Problem 7.8. Pressure to Make Something Happen.Project. “As an international marketing manager I cover the Asia Pacific region from North America. One of my recent jobs was to negotiate a custom software feature package for our customer in Japan.â€Team. “Members of the team were myself and a salesman who was part of my company, but located in Tokyo, and the customer, our contact at the customer’s end, whom I also consider part of the team. And we also had executives who were pretty much riding each of us. So we had three workers and three executives. One executive was in Japan, one was in Singapore, and one was in [the] U.S. We were trying to negotiate price and contents of the custom work for this customer.â€Challenge. “My boss was just frustrated. He didn’t understand the situation, didn’t have patience for it. So he put a lot of pressure on me to make something materialize that couldn’t possibly materialize. We had an ongoing relationship [with the Japanese]. You can’t just pressure somebody, no matter who they are, into doing something before they are ready. It’s like a marriage, and he [the boss] was pretty short term. I think basically Japan, all of Asia really, has a long-term view of things, and the U.S. is very quarterly–based, especially in the last couple of years.â€Your answer?Problem Cluster 5: Differences in Work Norms and BehaviorsProblem 7.9. Outlining a Business Concept.Project. “The team was to outline what the business concept would be to take our existing business to Japan. And that involved an eight-month-long project. Four months living in Japan and using experts and associates and senior consultants from this consulting firm based in Tokyo and then also some of their retail experts throughout the world. And we would do everything from consumer research to competitive analysis to considering mergers and acquisitions.â€Team. “The team consisted of myself, a female and one of the youngest members on the team, by twenty years. Three older gentlemen from my company and then our counterparts on the consulting side consisted of an engagement manager who was from Germany, but fluent in English and had been living in the United States for three years, a Canadian consultant who was based out of Ontario, then two Japanese consultants, as well as all the experts in Japan that we would interact with.â€Challenge. “Japanese associates would definitely not participate when the group got bigger than a few. [They] would not speak on topics that weren’t their responsibility.â€Your answer?Problem 7.10. Attention to the Process.Project. “It was a consulting project supporting our client, which was a French-Dutch merger. We were supporting both sides.â€Team. “The team was working a few days a week in the Netherlands and a few days in France with a French leader and another French consultant, and myself (Dutch).â€Challenge. “What I saw in France was that the people were really paying a lot of attention to the process. I think the way we work with clients in Holland is more direct. We really believe that [we wouldn’t do] something if it would not make sense to do it. We couldn’t go that route. I saw in France that the way they work with their clients is much more like doing whatever they say for the sake of process and making sure that they comfort the client in any case.â€Your answer?Problem Cluster 6: Violations of Respect and HierarchyProblem 7.11. Low Level Over High Level.Project. An audit project in Panama.Team. Asian, Latin American, and U.S. nationals.Challenge. “Because it was an American project, there were times when Latin American people who were higher in the hierarchy in their office would be working for people who were lower in the hierarchy in the American company. For people of American culture, this was not so bad because they said, ‘Well we’re in a different country.’ I think for Latin American people it was sort of a double-edged sword.â€Your answer?Problem 7.12. Contacting Top Management.Project. “Due diligence for the acquisition of a Korean company by an American company.â€Team. “Korean investment bankers (interviewee was Korean), representing the Korean seller. Also on the team were Americans from a U.S. bank representing the U.S. buyer.â€Challenge. “U.S. people tried to contact the top management [of the Korean firm] directly. That really didn’t turn out well. The top management in the Korean firm, they’re really high-level managers, and there is a certain amount of respect, certain processes that they expect people to go through before they actually get contacted and work on the issue. But the U.S. company circumvented the bankers and the working-level people on the due diligence team. The high-level Korean management was pissed because they’d got a call (from the Americans) saying this is not working out, what’s happening. And that was somewhat of an affront to them. The working-level people (at the Korean bank) were also very concerned because they were in a very hierarchical structure. Just the fact that something like that (this is not working out) was communicated to higher management of the client firm was a blow to their (the Korean bankers) credibility.â€Your answer?Problem Cluster 7: Intergroup PrejudicesProblem 7.13. Peacekeeping Operations.Project. “It was Bosnia 1996. A peacekeeping effort to do the first mass grave exhumation in Bosnia.â€Team. “Really a challenge because none of the four countries had really worked closely together in peacekeeping operations. And the first time that four large countries like that had taken a step together in Bosnia to put a team together and do something jointly as opposed to the U.S. doing something or the Russians doing something. I think the U.S. had been there at that point probably about four months, and we were forming a team with the U.S., Germany, Turkey, and Russia.â€Challenge. “Everyone kind of viewed the Turks as a second-class military. The Germans and the Russians didn’t really hit it off too well. And we [Americans] were viewed with kind of different levels of trust or skepticism by everybody else.â€Your answer?Problem 7.14. Too Many Contracts?Project. An investment banking team representing a Korean seller to a Chinese buyer.Team. “[The] interviewee was Korean, working for a Korean bank representing the Korean seller. Also on the team were Chinese from a Chinese bank representing the Chinese buyer.â€Challenge. “There was an incredible amount of distress between [the two companies]. Even though they wanted the deal, and it should happen for the good of both, they had a hard time. There were lots of contracts, and the Chinese company was like, ‘If you had trust in us, you would not ask us for these kind of contracts or these continuous contracts to be signed or certain deposits to be made. If you want this deal to go through and you don’t trust us, how can we work with you?’ The Korean company is, ‘Well, we had a bad experience before and this is just so that you guarantee that you go through with your agreement. I don’t understand why you won’t be able to do this.â€Your answer?Problem Cluster 8: Lack of Common GroundProblem 7.15. Crude Language.Project. To develop and implement systems for customers in the field.Team. Software engineers from Ireland, India, Bulgaria, Taiwan, and the United States. All were hired for their technical competency, not their English-language skills.Challenge. “[One] person’s language was crude and direct and at times offended other people in the team, making inappropriate jokes [about cultural differences].â€Your answer?Problem 7.16. Dealing with Perception.Project. “The team was to outline what the business concept would be to take our existing business to Japan. And that involved an eight-month-long project. Four months living in Japan and using experts and associates and senior consultants from this consulting firm based in Tokyo and then also some of their retail experts throughout the world. And we would do everything from consumer research to competitive analysis to considering mergers and acquisitions.â€Team. “The team consisted of myself, a female and one of the youngest members on the team, by twenty years. Three older gentlemen from my company and then our counterparts on the consulting side consisted of an engagement manager who was from Germany, but fluent in English and had been living in the United States for three years, a Canadian consultant who was based out of Ontario, then two Japanese consultants, as well as all the experts in Japan that we would interact with.â€Challenge. “So it was a struggle. Because you are dealing with subtlety. You are dealing with perception. You know there’s knowledge that she (the Japanese consultant) has, but because she’s in the culture, she has preconceived ideas of what she should find. And because we’re coming from another culture, we have preconceived ideas of what we should find. And so sometimes it was difficult when interpreting the data about what it (the data) really meant or what was the most important issue.â€Your answer?Problem Cluster 9: Fluency, Accents, and VocabularyProblem 7.17. Outsourced Calling.Project. “The team was making phone calls to customers to collect delinquent bills.â€Team. “I was the accounts receivable manager for my business. I had twenty-six people in India working for me. I never met them. They actually didn’t work for my company but for an outsourcing company.â€Challenge. “We certainly had issues with having them call our customers. I don’t care if you say you’re Sue from Indiana, they know you’re not. And our customers are—I’m in the rail business and our customers are very old boy. I got a lot of negative feedback. Most of it was, ‘we don’t understand what they’re saying’ because of the accent, especially over the phone. If you’re with someone, you can see them and you can understand better what they’re saying. But over the phone, especially over the phone lines to India, you’ve got an accent, you’ve got static, you’ve got ten thousand miles of fiberoptics.â€Your answer?Problem 7.18. I Know I Have an Accent.Project. To develop systems to sell and implement for customers in the field.Team. Software engineers from Ireland, India, Bulgaria, Taiwan, and the United States, all hired for their technical competency, not their English-language skills.Challenge. “There were people on the team who were not as used to dealing with foreigners, complaining about language issues, and saying that it is difficult.â€Your answer?Part 3. Research MethodsThe preceding challenge statements were drawn from a set of data that was gathered, analyzed, and finally clustered, using a method of qualitative data analysis known as concept mapping. Following an explanation of this process, we also describe how we arrived at the four types of strategy.Samples and ParticipantsWe conducted and recorded telephone interviews in English with forty members or managers of multicultural teams. We asked each interviewee to describe one or more challenging multicultural team experiences, saying that team members could be citizens of different countries (for example, the United States, India, or Japan) or citizens of the same country (for example, the United Kingdom) but with very different cultural backgrounds (for example, U.K.-Indian, U.K.-Russian, U.K.-American, and so on). We looked for teams that did at least part of their work face-to-face and did not interact exclusively via technology. The interviewer probed for details about the challenge, who was involved, what the cultural issues were, and what the team or team members did about the challenge.Interviewees came from multicultural teams in military, legal, high-tech, and business settings. They described challenges within their teams, challenges stemming from the need to coordinate between the team and other parts of the organization, and challenges stemming from the need to interact with clients, customers, or counterparts from other cultures.Most of the forty interviewees were employed full time; all were completing their M.B.A. degrees. The average age was twenty-nine; the average work experience was seven years. They had worked in a variety of countries on all continents except Antarctica. Culturally, 47 percent were American or Canadian, 15 percent were Latin American, 15 percent were Asian (including Indian and Turkish), and 23 percent were European.In selecting participants, we were not interested in how their culture of origin shaped their perceptions of challenges, but rather in the fact that they perceived there to be a challenge. Other than having participants from a variety of cultures, we were not concerned with participants’ cultures as an explanation for why they perceived a challenge. Our focus was on the challenges participants experienced and the strategies used to manage the challenges.We recruited participants through their association with international business coursework during their M.B.A. program. We used an online survey to prescreen participants for experience in multicultural teams. The team tasks that participants reported on included corporate (such as banking-finance or marketing, 44 percent); special projects (20 percent); technical (15 percent); consulting (13 percent); and military (8 percent).Prior to the interview, participants received an overview of the study, the interview protocol, and a consent form. The interviewer asked for verbal consent to participate and reminded the participants that the interview would be recorded and that no names should be used. All participants were entered into a lottery for one of four $150 prizes. Each author conducted about one-third of the interviews. All interviews were transcribed.Data AnalysisThere were three stages of data analysis: (1) identifying responses on the transcripts that represented specific challenges; (2) creating units of analysis; and (3) analyzing the data with the concept mapping method (Jackson and Trochim, 2002).Identifying Challenges and Creating Units of Analysis. Each researcher independently reviewed each transcript, marking passages that described a challenge and any corresponding passage about the management of that challenge. The rate of consistency between the three researchers in identifying the same passages was 77 percent. Passages were excluded from further analysis for one or the other of the following reasons—either the passage represented the same idea as another unanimously identified passage (repeated again in the transcript) or it did not really describe a challenge (it was more of a description of the team). This culling resulted in 160 passages.Next, two of the researchers read all the passages independently, looking for redundancy. Working together they deleted or merged twenty-two passages. They merged passages when there was complete redundancy with another passage from the same interview, and they deleted passages that did not describe a challenge (for example, when the interviewee talked about culture in general). These two researchers then lightly edited passages for clarity and simplicity (spelling was corrected, extraneous words were deleted, dropped words were put in brackets, and so on). The result was 138 statements about challenges faced by multicultural teams, an average of three to four statements per interview. These statements became our units of analysis.Statements were typically one to four sentences long and represented one idea about a challenge experienced by a multicultural team. For example, “In South America . . . when we go into a meeting, we don’t eat and drink. . . . here is different ([people from the] U.S. eat and drink during brainstorming meetings). . . . I think that at some point maybe the internationals look at each other like, ‘Hey these guys are not taking this as seriously as I am . . . or what’s wrong with this guy coming here with a sandwich and eating over the computer and having a conversation at the [same] time he eats?’â€Here is another statement example: “The level of commitment and your word meaning something was different. So in the U.S. I don’t think our words are a promise. When I say ‘Yeah, I’ll get it to you on Friday,’ and perhaps it’s a week late, there is no penalty. However in Japan, if they say, ‘Yes, I will place the P.O. in six months,’ they mean it. You can take it to the bank. It’s going to be there, and if it wasn’t they would lose face. Every time I would go back, or our president would go back, and ask for the P.O., they would say, ‘We told you it would be six months, don’t you believe us?’ In effect, we were being rude to them by continuing to ask.â€Concept Mapping and Clustering Challenges. The next step in the analysis was concept mapping or “participatory content analysis†(Jackson and Trochim, 2002). It is a hybrid of traditional content analysis and semantic mapping analysis. We chose this method because our research objective was to identify the different types of challenges faced by multicultural teams and then associate those challenges with the strategies used to address them. We judged that forcing responses to fit an a priori category scheme (such as with traditional content analysis) would introduce an unacceptable level of researcher bias.Concept mapping as applied to qualitative data analysis (Jackson and Trochim, 2002) combines exploratory statistical analysis (multidimensional scaling and cluster analysis) with the judgments of those doing the concept mapping to produce clusters of similar thematic categories. The analysis is a five-step process: (1) determining units of analysis, (2) sorting units, (3) multidimensional scaling analysis, (4) cluster analysis, and (5) cluster labeling.1. Determining Units of Analysis. We described this step earlier. Each unit (each statement of a challenge) was given a random number and placed on an index card.2. Sorting Units. To avoid introducing researcher bias into the analysis, we did not do this sorting ourselves. Instead, we used twenty M.B.A. students as sorters—excluding any who had been interview participants, in order to protect their privacy (Jackson and Trochim, 2002)—because they were reasonable proxies for the original participants in terms of their work experience and coursework. We chose M.B.A. students who had completed coursework related to understanding cultural issues.We instructed them to sort the 138 index cards into piles based on their judgment of the similarity between statements. We did not limit the number of piles sorters could create (they created piles ranging in number from five to thirty-one). The only limitation was that they could not create a miscellaneous pile. If a statement did not fit with any other, sorters were instructed to leave the statement in its own pile. We also asked sorters to name each pile.3. Multidimensional Scaling Analysis. Next we ran a multidimensional scaling analysis (MDS) on the sorted data to create a visual display or map of conceptual similarity among the statements based on the aggregated similarity judgments of the sorters. We constructed a 138 x 138 binary square matrix (rows and columns represent statements) for each sorter. Cell values represented whether the sorter placed a pair of statements into the same pile (1) or not (0). The sorters’ twenty individual matrices were aggregated to serve as the matrix input into MDS. The MDS solution generated coordinate estimates for each statement and a two-dimensional map of distances between the statements. The final stress value was .33 after nine iterations, indicating a reasonable fit of the map to the similarity matrix that came directly from the sorters for a two-dimensional solution (Davidson, 1982). We chose a two-dimensional solution because it provides the most useful foundation for the next step in this type of tex

Exercise 7.2. Identifying Effective Strategies for Multicultural TeamsKristin Behfar, Mary Kern, and

Exercise 7.2. Identifying Effective Strategies for Multicultural TeamsKristin Behfar, Mary Kern, and Jeanne M. Brett(Reprinted by permission of the authors)Directions: To begin this exercise read “Part 1. Four Types of Strategy for Multicultural Teams.†You may want to print out the definitions of these strategies, because in Part 2 you will need to choose a management strategy to handle each of eighteen real multicultural team challenges. Following the challenges is Part 3, a description of our research methods, which involved an analytical technique called concept mapping. You can read the research methods section before or after completing the problems.Your instructor can give you further information about what the team(s) actually did in the face of these challenges.Part 1. Four Types of Strategy for Multicultural TeamsPlease read the definitions of the strategies for intervention.Structural Intervention. Structural interventions are deliberate reorganizations or reassignments of roles or group members in order to reduce interpersonal friction or remove a source of conflict or of advantage or disadvantage for one or more subgroups. These interventions can be initiated by either team members or managers.Adaptation. Adaptation refers to team member actions that find alternative working arrangements or address challenges without the intervention of a manager. That is, the team finds a way to either change or work with or around the challenge. This can include adapting work practices or attitudes but not making changes to the group membership or role assignments.Managerial Intervention. Managerial intervention refers to arbitration or resolution of a problem by a manager or leader. For example, the leader may break a stalemate, make a final decision, or choose a solution for the team to perform. In essence, the manager creates the solution and the team follows. Managerial interventions are typically one-time interventions and are not negotiated by the team.Exit. Exit means that one or more team members leave the team or organization. This represents a lack of resolution or lack of a strategy to effectively address the challenge.Part 2. The ProblemsFor each problem, study the “Challenge†and consider the pros and cons of each of the four management strategies for intervening in the challenge.Problem Cluster 1: Thought You Had an AgreementProblem 7.1. Communication Gaps.Project. “My job as engineer was to do a checkout of the refinery I was working at in China. And they had a lot of problems and safety hazards. So we would do a punch list to document the problems and then try to get them to fix everything that was a problem.â€Team. “In addition to myself, there were three people who worked around the clock doing shift work and a chief process adviser who was like the head representative at site. We also had some other technical people that came and went over the course of the job. On the Chinese side were lower-level people that operated the plant, and the maintenance people. It was actually very easy to deal with them other than the technical barrier and the language barrier. The upper management was more difficult. I’m not sure if it was a political issue or if they just felt a higher level of arrogance or ego, but they were the ones that gave us the problems.â€Challenge. “So even though we were trying to help them, it turned into a political issue where it was more important for them to save face for their own nationality or their own company rather than actually submit and fix the problems. [It was] a clash of egos, and we were trying to do due diligence, whereas they were more concerned about saving face.â€Your Answer?Problem 7.2. “Meant to Tell You It Can’t Be Done.â€Project. “We were launching a gift card. In order to hit the peak season, we needed to have that product out [by the] end of November.â€Team. “I’m a [bank] product manager and I also manage projects. One [team member was a] gentleman whose dominant culture was Colombian and was one level above me. He was responsible for all of our advertising and marketing design and production. There was a female from Puerto Rico, also a manager, one level above me, working in the balance and control department. The third member of the team was a gentleman who grew up in Puerto Rico. He was my level; we worked in the same department, and he had experience with the issue that was at hand. So our manager brought him onto the project as a guide. [The fourth and last team member] was a gentleman whose dominant culture was Indian. He was a manager one level above me with the technology group. He was a liaison with our outsource vendor. So it was his responsibility to make sure all of the programming was done so that the reporting that we needed was transmitted at the right time. We were all onsite in the U.S.â€Challenge. “If somebody says something is finished, I consider it finished—it doesn’t have to be completely overhauled or have another week or two weeks’ worth of meetings to address some sort of an issue. A lot of times they would test something, it didn’t work, and then they would stop but never let me know.â€Your Answer?Problem Cluster 2: Direct Versus Indirect ConfrontationProblem 7.3. Delivering Bad News.Project. “We had a program going on in the U.S., a new product that we were trying to launch. The project was to interface with the India team and to get a major component actually designed and manufactured in India. Goals were getting a cost reduction for the overall product itself [and] transferring expertise and knowledge to the India team—getting them up to speed on what the whole thing was about.â€Team. “The lead was a U.S. manager in [the] U.S. The interviewee was also in the U.S., of Indian background, and felt the India team treated him as an American. [Team members in India included] four from India and one from France.â€Challenge. “In the U.S., even though it’s bad news, people are more open to saying [something like], ‘This part of the program has a lot of risks, and just today I found a few more issues and that are going to delay the program by so many weeks.’ [In the United States], I think people are a lot more open to saying that [in India].â€Your answer?Problem 7.4. Passive-Aggressive Team Member Behavior.Project. Sales team.Team. Manager and interviewee, Mexican-American; other members South African, Romanian, African American, and Filipino-Thai.Challenge. “One guy who is half Filipino and half Thai, he even said that he tends to be a little more passive-aggressive at times. He equated that to his Filipino culture and his Filipino upbringing that they tend to be a little more passive-aggressive, he kind of expected you to understand that. And a lot of the times we don’t understand how he’s feeling so it gets to almost like a tipping point to where he’s kind of had enough and it’ll escalate almost into an argument at times. He has a hard time verbalizing.â€Your answer?Problem Cluster 3: Norms for Problem Solving and Decision MakingProblem 7.5. Explicit Directions.Project. “I had to make sure that we had technical infrastructure (servers, software, interfacing to other systems, and so on) in place for the project that we worked on. Onshore resources in Japan were responsible for all of the master data that needed to be loaded into the system for, say, customer ship-tos and bill-tos and anything [involved in] the order-to-cash process.â€Team. “Myself [U.S. female] and three Japanese members [male] [with whom I worked]. I know there were more people on this project, but they don’t let you have access to people directly. They’ll interface for you.â€Challenge. “The need to follow the direction from the top is explicit in Japan. If the president or leader of the company mandates an action, process, procedure, or policy, it is considered ‘law.’ The protocol is strict. Hierarchical structure shall not be deviated from. Whatever way the leader says, goes. No one bucks the system, even if it causes hardship. If hardship occurs, employees are expected to endure the hardship.â€Your answer?Problem 7.6. No Initial Agreement.Project. “It was Bosnia 1996. A peacekeeping effort to do the first mass grave exhumation in Bosnia.â€Team. “Really a challenge because none of the four countries had really worked closely together in peacekeeping operations. And the first time that four large countries like that had taken a step together in Bosnia to put a team together and do something jointly as opposed to the U.S. doing something or the Russians doing something. I think the U.S. had been there at that point probably about four months, and we were forming a team with the U.S., Germany, Turkey, and Russia.â€Challenge. “We didn’t initially have agreement on where we were going. We would sit down and kind of talk about the pros and cons of the situations. There were some heated moments.â€Your answer?Problem Cluster 4: Time, Urgency, and PaceProblem 7.7. Timeline.Project. “The project was relatively high-dollar, lots of people, lots of visibility. We were looking for commonalities of process; for opportunities for us to consolidate things that happen to be done differently in different places.â€Team. “The team was three people: one from the U.S., one from Germany, one from India. People lived in their respective countries and were flown in to work on the project.â€Challenge. “We did not come up with a timeline. . . . [Higher-ups] would say for us to accomplish fourteen to fifteen [units], and we figured a year and a half. The U.S. guy would say, ‘Well, it’s probably four to five months. It’s not a big deal. It’ll be simple.’ There was never really an agreement on that.â€Your answer?Problem 7.8. Pressure to Make Something Happen.Project. “As an international marketing manager I cover the Asia Pacific region from North America. One of my recent jobs was to negotiate a custom software feature package for our customer in Japan.â€Team. “Members of the team were myself and a salesman who was part of my company, but located in Tokyo, and the customer, our contact at the customer’s end, whom I also consider part of the team. And we also had executives who were pretty much riding each of us. So we had three workers and three executives. One executive was in Japan, one was in Singapore, and one was in [the] U.S. We were trying to negotiate price and contents of the custom work for this customer.â€Challenge. “My boss was just frustrated. He didn’t understand the situation, didn’t have patience for it. So he put a lot of pressure on me to make something materialize that couldn’t possibly materialize. We had an ongoing relationship [with the Japanese]. You can’t just pressure somebody, no matter who they are, into doing something before they are ready. It’s like a marriage, and he [the boss] was pretty short term. I think basically Japan, all of Asia really, has a long-term view of things, and the U.S. is very quarterly–based, especially in the last couple of years.â€Your answer?Problem Cluster 5: Differences in Work Norms and BehaviorsProblem 7.9. Outlining a Business Concept.Project. “The team was to outline what the business concept would be to take our existing business to Japan. And that involved an eight-month-long project. Four months living in Japan and using experts and associates and senior consultants from this consulting firm based in Tokyo and then also some of their retail experts throughout the world. And we would do everything from consumer research to competitive analysis to considering mergers and acquisitions.â€Team. “The team consisted of myself, a female and one of the youngest members on the team, by twenty years. Three older gentlemen from my company and then our counterparts on the consulting side consisted of an engagement manager who was from Germany, but fluent in English and had been living in the United States for three years, a Canadian consultant who was based out of Ontario, then two Japanese consultants, as well as all the experts in Japan that we would interact with.â€Challenge. “Japanese associates would definitely not participate when the group got bigger than a few. [They] would not speak on topics that weren’t their responsibility.â€Your answer?Problem 7.10. Attention to the Process.Project. “It was a consulting project supporting our client, which was a French-Dutch merger. We were supporting both sides.â€Team. “The team was working a few days a week in the Netherlands and a few days in France with a French leader and another French consultant, and myself (Dutch).â€Challenge. “What I saw in France was that the people were really paying a lot of attention to the process. I think the way we work with clients in Holland is more direct. We really believe that [we wouldn’t do] something if it would not make sense to do it. We couldn’t go that route. I saw in France that the way they work with their clients is much more like doing whatever they say for the sake of process and making sure that they comfort the client in any case.â€Your answer?Problem Cluster 6: Violations of Respect and HierarchyProblem 7.11. Low Level Over High Level.Project. An audit project in Panama.Team. Asian, Latin American, and U.S. nationals.Challenge. “Because it was an American project, there were times when Latin American people who were higher in the hierarchy in their office would be working for people who were lower in the hierarchy in the American company. For people of American culture, this was not so bad because they said, ‘Well we’re in a different country.’ I think for Latin American people it was sort of a double-edged sword.â€Your answer?Problem 7.12. Contacting Top Management.Project. “Due diligence for the acquisition of a Korean company by an American company.â€Team. “Korean investment bankers (interviewee was Korean), representing the Korean seller. Also on the team were Americans from a U.S. bank representing the U.S. buyer.â€Challenge. “U.S. people tried to contact the top management [of the Korean firm] directly. That really didn’t turn out well. The top management in the Korean firm, they’re really high-level managers, and there is a certain amount of respect, certain processes that they expect people to go through before they actually get contacted and work on the issue. But the U.S. company circumvented the bankers and the working-level people on the due diligence team. The high-level Korean management was pissed because they’d got a call (from the Americans) saying this is not working out, what’s happening. And that was somewhat of an affront to them. The working-level people (at the Korean bank) were also very concerned because they were in a very hierarchical structure. Just the fact that something like that (this is not working out) was communicated to higher management of the client firm was a blow to their (the Korean bankers) credibility.â€Your answer?Problem Cluster 7: Intergroup PrejudicesProblem 7.13. Peacekeeping Operations.Project. “It was Bosnia 1996. A peacekeeping effort to do the first mass grave exhumation in Bosnia.â€Team. “Really a challenge because none of the four countries had really worked closely together in peacekeeping operations. And the first time that four large countries like that had taken a step together in Bosnia to put a team together and do something jointly as opposed to the U.S. doing something or the Russians doing something. I think the U.S. had been there at that point probably about four months, and we were forming a team with the U.S., Germany, Turkey, and Russia.â€Challenge. “Everyone kind of viewed the Turks as a second-class military. The Germans and the Russians didn’t really hit it off too well. And we [Americans] were viewed with kind of different levels of trust or skepticism by everybody else.â€Your answer?Problem 7.14. Too Many Contracts?Project. An investment banking team representing a Korean seller to a Chinese buyer.Team. “[The] interviewee was Korean, working for a Korean bank representing the Korean seller. Also on the team were Chinese from a Chinese bank representing the Chinese buyer.â€Challenge. “There was an incredible amount of distress between [the two companies]. Even though they wanted the deal, and it should happen for the good of both, they had a hard time. There were lots of contracts, and the Chinese company was like, ‘If you had trust in us, you would not ask us for these kind of contracts or these continuous contracts to be signed or certain deposits to be made. If you want this deal to go through and you don’t trust us, how can we work with you?’ The Korean company is, ‘Well, we had a bad experience before and this is just so that you guarantee that you go through with your agreement. I don’t understand why you won’t be able to do this.â€Your answer?Problem Cluster 8: Lack of Common GroundProblem 7.15. Crude Language.Project. To develop and implement systems for customers in the field.Team. Software engineers from Ireland, India, Bulgaria, Taiwan, and the United States. All were hired for their technical competency, not their English-language skills.Challenge. “[One] person’s language was crude and direct and at times offended other people in the team, making inappropriate jokes [about cultural differences].â€Your answer?Problem 7.16. Dealing with Perception.Project. “The team was to outline what the business concept would be to take our existing business to Japan. And that involved an eight-month-long project. Four months living in Japan and using experts and associates and senior consultants from this consulting firm based in Tokyo and then also some of their retail experts throughout the world. And we would do everything from consumer research to competitive analysis to considering mergers and acquisitions.â€Team. “The team consisted of myself, a female and one of the youngest members on the team, by twenty years. Three older gentlemen from my company and then our counterparts on the consulting side consisted of an engagement manager who was from Germany, but fluent in English and had been living in the United States for three years, a Canadian consultant who was based out of Ontario, then two Japanese consultants, as well as all the experts in Japan that we would interact with.â€Challenge. “So it was a struggle. Because you are dealing with subtlety. You are dealing with perception. You know there’s knowledge that she (the Japanese consultant) has, but because she’s in the culture, she has preconceived ideas of what she should find. And because we’re coming from another culture, we have preconceived ideas of what we should find. And so sometimes it was difficult when interpreting the data about what it (the data) really meant or what was the most important issue.â€Your answer?Problem Cluster 9: Fluency, Accents, and VocabularyProblem 7.17. Outsourced Calling.Project. “The team was making phone calls to customers to collect delinquent bills.â€Team. “I was the accounts receivable manager for my business. I had twenty-six people in India working for me. I never met them. They actually didn’t work for my company but for an outsourcing company.â€Challenge. “We certainly had issues with having them call our customers. I don’t care if you say you’re Sue from Indiana, they know you’re not. And our customers are—I’m in the rail business and our customers are very old boy. I got a lot of negative feedback. Most of it was, ‘we don’t understand what they’re saying’ because of the accent, especially over the phone. If you’re with someone, you can see them and you can understand better what they’re saying. But over the phone, especially over the phone lines to India, you’ve got an accent, you’ve got static, you’ve got ten thousand miles of fiberoptics.â€Your answer?Problem 7.18. I Know I Have an Accent.Project. To develop systems to sell and implement for customers in the field.Team. Software engineers from Ireland, India, Bulgaria, Taiwan, and the United States, all hired for their technical competency, not their English-language skills.Challenge. “There were people on the team who were not as used to dealing with foreigners, complaining about language issues, and saying that it is difficult.â€Your answer?Part 3. Research MethodsThe preceding challenge statements were drawn from a set of data that was gathered, analyzed, and finally clustered, using a method of qualitative data analysis known as concept mapping. Following an explanation of this process, we also describe how we arrived at the four types of strategy.Samples and ParticipantsWe conducted and recorded telephone interviews in English with forty members or managers of multicultural teams. We asked each interviewee to describe one or more challenging multicultural team experiences, saying that team members could be citizens of different countries (for example, the United States, India, or Japan) or citizens of the same country (for example, the United Kingdom) but with very different cultural backgrounds (for example, U.K.-Indian, U.K.-Russian, U.K.-American, and so on). We looked for teams that did at least part of their work face-to-face and did not interact exclusively via technology. The interviewer probed for details about the challenge, who was involved, what the cultural issues were, and what the team or team members did about the challenge.Interviewees came from multicultural teams in military, legal, high-tech, and business settings. They described challenges within their teams, challenges stemming from the need to coordinate between the team and other parts of the organization, and challenges stemming from the need to interact with clients, customers, or counterparts from other cultures.Most of the forty interviewees were employed full time; all were completing their M.B.A. degrees. The average age was twenty-nine; the average work experience was seven years. They had worked in a variety of countries on all continents except Antarctica. Culturally, 47 percent were American or Canadian, 15 percent were Latin American, 15 percent were Asian (including Indian and Turkish), and 23 percent were European.In selecting participants, we were not interested in how their culture of origin shaped their perceptions of challenges, but rather in the fact that they perceived there to be a challenge. Other than having participants from a variety of cultures, we were not concerned with participants’ cultures as an explanation for why they perceived a challenge. Our focus was on the challenges participants experienced and the strategies used to manage the challenges.We recruited participants through their association with international business coursework during their M.B.A. program. We used an online survey to prescreen participants for experience in multicultural teams. The team tasks that participants reported on included corporate (such as banking-finance or marketing, 44 percent); special projects (20 percent); technical (15 percent); consulting (13 percent); and military (8 percent).Prior to the interview, participants received an overview of the study, the interview protocol, and a consent form. The interviewer asked for verbal consent to participate and reminded the participants that the interview would be recorded and that no names should be used. All participants were entered into a lottery for one of four $150 prizes. Each author conducted about one-third of the interviews. All interviews were transcribed.Data AnalysisThere were three stages of data analysis: (1) identifying responses on the transcripts that represented specific challenges; (2) creating units of analysis; and (3) analyzing the data with the concept mapping method (Jackson and Trochim, 2002).Identifying Challenges and Creating Units of Analysis. Each researcher independently reviewed each transcript, marking passages that described a challenge and any corresponding passage about the management of that challenge. The rate of consistency between the three researchers in identifying the same passages was 77 percent. Passages were excluded from further analysis for one or the other of the following reasons—either the passage represented the same idea as another unanimously identified passage (repeated again in the transcript) or it did not really describe a challenge (it was more of a description of the team). This culling resulted in 160 passages.Next, two of the researchers read all the passages independently, looking for redundancy. Working together they deleted or merged twenty-two passages. They merged passages when there was complete redundancy with another passage from the same interview, and they deleted passages that did not describe a challenge (for example, when the interviewee talked about culture in general). These two researchers then lightly edited passages for clarity and simplicity (spelling was corrected, extraneous words were deleted, dropped words were put in brackets, and so on). The result was 138 statements about challenges faced by multicultural teams, an average of three to four statements per interview. These statements became our units of analysis.Statements were typically one to four sentences long and represented one idea about a challenge experienced by a multicultural team. For example, “In South America . . . when we go into a meeting, we don’t eat and drink. . . . here is different ([people from the] U.S. eat and drink during brainstorming meetings). . . . I think that at some point maybe the internationals look at each other like, ‘Hey these guys are not taking this as seriously as I am . . . or what’s wrong with this guy coming here with a sandwich and eating over the computer and having a conversation at the [same] time he eats?’â€Here is another statement example: “The level of commitment and your word meaning something was different. So in the U.S. I don’t think our words are a promise. When I say ‘Yeah, I’ll get it to you on Friday,’ and perhaps it’s a week late, there is no penalty. However in Japan, if they say, ‘Yes, I will place the P.O. in six months,’ they mean it. You can take it to the bank. It’s going to be there, and if it wasn’t they would lose face. Every time I would go back, or our president would go back, and ask for the P.O., they would say, ‘We told you it would be six months, don’t you believe us?’ In effect, we were being rude to them by continuing to ask.â€Concept Mapping and Clustering Challenges. The next step in the analysis was concept mapping or “participatory content analysis†(Jackson and Trochim, 2002). It is a hybrid of traditional content analysis and semantic mapping analysis. We chose this method because our research objective was to identify the different types of challenges faced by multicultural teams and then associate those challenges with the strategies used to address them. We judged that forcing responses to fit an a priori category scheme (such as with traditional content analysis) would introduce an unacceptable level of researcher bias.Concept mapping as applied to qualitative data analysis (Jackson and Trochim, 2002) combines exploratory statistical analysis (multidimensional scaling and cluster analysis) with the judgments of those doing the concept mapping to produce clusters of similar thematic categories. The analysis is a five-step process: (1) determining units of analysis, (2) sorting units, (3) multidimensional scaling analysis, (4) cluster analysis, and (5) cluster labeling.1. Determining Units of Analysis. We described this step earlier. Each unit (each statement of a challenge) was given a random number and placed on an index card.2. Sorting Units. To avoid introducing researcher bias into the analysis, we did not do this sorting ourselves. Instead, we used twenty M.B.A. students as sorters—excluding any who had been interview participants, in order to protect their privacy (Jackson and Trochim, 2002)—because they were reasonable proxies for the original participants in terms of their work experience and coursework. We chose M.B.A. students who had completed coursework related to understanding cultural issues.We instructed them to sort the 138 index cards into piles based on their judgment of the similarity between statements. We did not limit the number of piles sorters could create (they created piles ranging in number from five to thirty-one). The only limitation was that they could not create a miscellaneous pile. If a statement did not fit with any other, sorters were instructed to leave the statement in its own pile. We also asked sorters to name each pile.3. Multidimensional Scaling Analysis. Next we ran a multidimensional scaling analysis (MDS) on the sorted data to create a visual display or map of conceptual similarity among the statements based on the aggregated similarity judgments of the sorters. We constructed a 138 x 138 binary square matrix (rows and columns represent statements) for each sorter. Cell values represented whether the sorter placed a pair of statements into the same pile (1) or not (0). The sorters’ twenty individual matrices were aggregated to serve as the matrix input into MDS. The MDS solution generated coordinate estimates for each statement and a two-dimensional map of distances between the statements. The final stress value was .33 after nine iterations, indicating a reasonable fit of the map to the similarity matrix that came directly from the sorters for a two-dimensional solution (Davidson, 1982). We chose a two-dimensional solution because it provides the most useful foundation for the next step in this type of tex

Exercise 7.2. Identifying Effective Strategies for Multicultural TeamsKristin Behfar, Mary Kern, and

Exercise 7.2. Identifying Effective Strategies for Multicultural TeamsKristin Behfar, Mary Kern, and Jeanne M. Brett(Reprinted by permission of the authors)Directions: To begin this exercise read “Part 1. Four Types of Strategy for Multicultural Teams.†You may want to print out the definitions of these strategies, because in Part 2 you will need to choose a management strategy to handle each of eighteen real multicultural team challenges. Following the challenges is Part 3, a description of our research methods, which involved an analytical technique called concept mapping. You can read the research methods section before or after completing the problems.Your instructor can give you further information about what the team(s) actually did in the face of these challenges.Part 1. Four Types of Strategy for Multicultural TeamsPlease read the definitions of the strategies for intervention.Structural Intervention. Structural interventions are deliberate reorganizations or reassignments of roles or group members in order to reduce interpersonal friction or remove a source of conflict or of advantage or disadvantage for one or more subgroups. These interventions can be initiated by either team members or managers.Adaptation. Adaptation refers to team member actions that find alternative working arrangements or address challenges without the intervention of a manager. That is, the team finds a way to either change or work with or around the challenge. This can include adapting work practices or attitudes but not making changes to the group membership or role assignments.Managerial Intervention. Managerial intervention refers to arbitration or resolution of a problem by a manager or leader. For example, the leader may break a stalemate, make a final decision, or choose a solution for the team to perform. In essence, the manager creates the solution and the team follows. Managerial interventions are typically one-time interventions and are not negotiated by the team.Exit. Exit means that one or more team members leave the team or organization. This represents a lack of resolution or lack of a strategy to effectively address the challenge.Part 2. The ProblemsFor each problem, study the “Challenge†and consider the pros and cons of each of the four management strategies for intervening in the challenge.Problem Cluster 1: Thought You Had an AgreementProblem 7.1. Communication Gaps.Project. “My job as engineer was to do a checkout of the refinery I was working at in China. And they had a lot of problems and safety hazards. So we would do a punch list to document the problems and then try to get them to fix everything that was a problem.â€Team. “In addition to myself, there were three people who worked around the clock doing shift work and a chief process adviser who was like the head representative at site. We also had some other technical people that came and went over the course of the job. On the Chinese side were lower-level people that operated the plant, and the maintenance people. It was actually very easy to deal with them other than the technical barrier and the language barrier. The upper management was more difficult. I’m not sure if it was a political issue or if they just felt a higher level of arrogance or ego, but they were the ones that gave us the problems.â€Challenge. “So even though we were trying to help them, it turned into a political issue where it was more important for them to save face for their own nationality or their own company rather than actually submit and fix the problems. [It was] a clash of egos, and we were trying to do due diligence, whereas they were more concerned about saving face.â€Your Answer?Problem 7.2. “Meant to Tell You It Can’t Be Done.â€Project. “We were launching a gift card. In order to hit the peak season, we needed to have that product out [by the] end of November.â€Team. “I’m a [bank] product manager and I also manage projects. One [team member was a] gentleman whose dominant culture was Colombian and was one level above me. He was responsible for all of our advertising and marketing design and production. There was a female from Puerto Rico, also a manager, one level above me, working in the balance and control department. The third member of the team was a gentleman who grew up in Puerto Rico. He was my level; we worked in the same department, and he had experience with the issue that was at hand. So our manager brought him onto the project as a guide. [The fourth and last team member] was a gentleman whose dominant culture was Indian. He was a manager one level above me with the technology group. He was a liaison with our outsource vendor. So it was his responsibility to make sure all of the programming was done so that the reporting that we needed was transmitted at the right time. We were all onsite in the U.S.â€Challenge. “If somebody says something is finished, I consider it finished—it doesn’t have to be completely overhauled or have another week or two weeks’ worth of meetings to address some sort of an issue. A lot of times they would test something, it didn’t work, and then they would stop but never let me know.â€Your Answer?Problem Cluster 2: Direct Versus Indirect ConfrontationProblem 7.3. Delivering Bad News.Project. “We had a program going on in the U.S., a new product that we were trying to launch. The project was to interface with the India team and to get a major component actually designed and manufactured in India. Goals were getting a cost reduction for the overall product itself [and] transferring expertise and knowledge to the India team—getting them up to speed on what the whole thing was about.â€Team. “The lead was a U.S. manager in [the] U.S. The interviewee was also in the U.S., of Indian background, and felt the India team treated him as an American. [Team members in India included] four from India and one from France.â€Challenge. “In the U.S., even though it’s bad news, people are more open to saying [something like], ‘This part of the program has a lot of risks, and just today I found a few more issues and that are going to delay the program by so many weeks.’ [In the United States], I think people are a lot more open to saying that [in India].â€Your answer?Problem 7.4. Passive-Aggressive Team Member Behavior.Project. Sales team.Team. Manager and interviewee, Mexican-American; other members South African, Romanian, African American, and Filipino-Thai.Challenge. “One guy who is half Filipino and half Thai, he even said that he tends to be a little more passive-aggressive at times. He equated that to his Filipino culture and his Filipino upbringing that they tend to be a little more passive-aggressive, he kind of expected you to understand that. And a lot of the times we don’t understand how he’s feeling so it gets to almost like a tipping point to where he’s kind of had enough and it’ll escalate almost into an argument at times. He has a hard time verbalizing.â€Your answer?Problem Cluster 3: Norms for Problem Solving and Decision MakingProblem 7.5. Explicit Directions.Project. “I had to make sure that we had technical infrastructure (servers, software, interfacing to other systems, and so on) in place for the project that we worked on. Onshore resources in Japan were responsible for all of the master data that needed to be loaded into the system for, say, customer ship-tos and bill-tos and anything [involved in] the order-to-cash process.â€Team. “Myself [U.S. female] and three Japanese members [male] [with whom I worked]. I know there were more people on this project, but they don’t let you have access to people directly. They’ll interface for you.â€Challenge. “The need to follow the direction from the top is explicit in Japan. If the president or leader of the company mandates an action, process, procedure, or policy, it is considered ‘law.’ The protocol is strict. Hierarchical structure shall not be deviated from. Whatever way the leader says, goes. No one bucks the system, even if it causes hardship. If hardship occurs, employees are expected to endure the hardship.â€Your answer?Problem 7.6. No Initial Agreement.Project. “It was Bosnia 1996. A peacekeeping effort to do the first mass grave exhumation in Bosnia.â€Team. “Really a challenge because none of the four countries had really worked closely together in peacekeeping operations. And the first time that four large countries like that had taken a step together in Bosnia to put a team together and do something jointly as opposed to the U.S. doing something or the Russians doing something. I think the U.S. had been there at that point probably about four months, and we were forming a team with the U.S., Germany, Turkey, and Russia.â€Challenge. “We didn’t initially have agreement on where we were going. We would sit down and kind of talk about the pros and cons of the situations. There were some heated moments.â€Your answer?Problem Cluster 4: Time, Urgency, and PaceProblem 7.7. Timeline.Project. “The project was relatively high-dollar, lots of people, lots of visibility. We were looking for commonalities of process; for opportunities for us to consolidate things that happen to be done differently in different places.â€Team. “The team was three people: one from the U.S., one from Germany, one from India. People lived in their respective countries and were flown in to work on the project.â€Challenge. “We did not come up with a timeline. . . . [Higher-ups] would say for us to accomplish fourteen to fifteen [units], and we figured a year and a half. The U.S. guy would say, ‘Well, it’s probably four to five months. It’s not a big deal. It’ll be simple.’ There was never really an agreement on that.â€Your answer?Problem 7.8. Pressure to Make Something Happen.Project. “As an international marketing manager I cover the Asia Pacific region from North America. One of my recent jobs was to negotiate a custom software feature package for our customer in Japan.â€Team. “Members of the team were myself and a salesman who was part of my company, but located in Tokyo, and the customer, our contact at the customer’s end, whom I also consider part of the team. And we also had executives who were pretty much riding each of us. So we had three workers and three executives. One executive was in Japan, one was in Singapore, and one was in [the] U.S. We were trying to negotiate price and contents of the custom work for this customer.â€Challenge. “My boss was just frustrated. He didn’t understand the situation, didn’t have patience for it. So he put a lot of pressure on me to make something materialize that couldn’t possibly materialize. We had an ongoing relationship [with the Japanese]. You can’t just pressure somebody, no matter who they are, into doing something before they are ready. It’s like a marriage, and he [the boss] was pretty short term. I think basically Japan, all of Asia really, has a long-term view of things, and the U.S. is very quarterly–based, especially in the last couple of years.â€Your answer?Problem Cluster 5: Differences in Work Norms and BehaviorsProblem 7.9. Outlining a Business Concept.Project. “The team was to outline what the business concept would be to take our existing business to Japan. And that involved an eight-month-long project. Four months living in Japan and using experts and associates and senior consultants from this consulting firm based in Tokyo and then also some of their retail experts throughout the world. And we would do everything from consumer research to competitive analysis to considering mergers and acquisitions.â€Team. “The team consisted of myself, a female and one of the youngest members on the team, by twenty years. Three older gentlemen from my company and then our counterparts on the consulting side consisted of an engagement manager who was from Germany, but fluent in English and had been living in the United States for three years, a Canadian consultant who was based out of Ontario, then two Japanese consultants, as well as all the experts in Japan that we would interact with.â€Challenge. “Japanese associates would definitely not participate when the group got bigger than a few. [They] would not speak on topics that weren’t their responsibility.â€Your answer?Problem 7.10. Attention to the Process.Project. “It was a consulting project supporting our client, which was a French-Dutch merger. We were supporting both sides.â€Team. “The team was working a few days a week in the Netherlands and a few days in France with a French leader and another French consultant, and myself (Dutch).â€Challenge. “What I saw in France was that the people were really paying a lot of attention to the process. I think the way we work with clients in Holland is more direct. We really believe that [we wouldn’t do] something if it would not make sense to do it. We couldn’t go that route. I saw in France that the way they work with their clients is much more like doing whatever they say for the sake of process and making sure that they comfort the client in any case.â€Your answer?Problem Cluster 6: Violations of Respect and HierarchyProblem 7.11. Low Level Over High Level.Project. An audit project in Panama.Team. Asian, Latin American, and U.S. nationals.Challenge. “Because it was an American project, there were times when Latin American people who were higher in the hierarchy in their office would be working for people who were lower in the hierarchy in the American company. For people of American culture, this was not so bad because they said, ‘Well we’re in a different country.’ I think for Latin American people it was sort of a double-edged sword.â€Your answer?Problem 7.12. Contacting Top Management.Project. “Due diligence for the acquisition of a Korean company by an American company.â€Team. “Korean investment bankers (interviewee was Korean), representing the Korean seller. Also on the team were Americans from a U.S. bank representing the U.S. buyer.â€Challenge. “U.S. people tried to contact the top management [of the Korean firm] directly. That really didn’t turn out well. The top management in the Korean firm, they’re really high-level managers, and there is a certain amount of respect, certain processes that they expect people to go through before they actually get contacted and work on the issue. But the U.S. company circumvented the bankers and the working-level people on the due diligence team. The high-level Korean management was pissed because they’d got a call (from the Americans) saying this is not working out, what’s happening. And that was somewhat of an affront to them. The working-level people (at the Korean bank) were also very concerned because they were in a very hierarchical structure. Just the fact that something like that (this is not working out) was communicated to higher management of the client firm was a blow to their (the Korean bankers) credibility.â€Your answer?Problem Cluster 7: Intergroup PrejudicesProblem 7.13. Peacekeeping Operations.Project. “It was Bosnia 1996. A peacekeeping effort to do the first mass grave exhumation in Bosnia.â€Team. “Really a challenge because none of the four countries had really worked closely together in peacekeeping operations. And the first time that four large countries like that had taken a step together in Bosnia to put a team together and do something jointly as opposed to the U.S. doing something or the Russians doing something. I think the U.S. had been there at that point probably about four months, and we were forming a team with the U.S., Germany, Turkey, and Russia.â€Challenge. “Everyone kind of viewed the Turks as a second-class military. The Germans and the Russians didn’t really hit it off too well. And we [Americans] were viewed with kind of different levels of trust or skepticism by everybody else.â€Your answer?Problem 7.14. Too Many Contracts?Project. An investment banking team representing a Korean seller to a Chinese buyer.Team. “[The] interviewee was Korean, working for a Korean bank representing the Korean seller. Also on the team were Chinese from a Chinese bank representing the Chinese buyer.â€Challenge. “There was an incredible amount of distress between [the two companies]. Even though they wanted the deal, and it should happen for the good of both, they had a hard time. There were lots of contracts, and the Chinese company was like, ‘If you had trust in us, you would not ask us for these kind of contracts or these continuous contracts to be signed or certain deposits to be made. If you want this deal to go through and you don’t trust us, how can we work with you?’ The Korean company is, ‘Well, we had a bad experience before and this is just so that you guarantee that you go through with your agreement. I don’t understand why you won’t be able to do this.â€Your answer?Problem Cluster 8: Lack of Common GroundProblem 7.15. Crude Language.Project. To develop and implement systems for customers in the field.Team. Software engineers from Ireland, India, Bulgaria, Taiwan, and the United States. All were hired for their technical competency, not their English-language skills.Challenge. “[One] person’s language was crude and direct and at times offended other people in the team, making inappropriate jokes [about cultural differences].â€Your answer?Problem 7.16. Dealing with Perception.Project. “The team was to outline what the business concept would be to take our existing business to Japan. And that involved an eight-month-long project. Four months living in Japan and using experts and associates and senior consultants from this consulting firm based in Tokyo and then also some of their retail experts throughout the world. And we would do everything from consumer research to competitive analysis to considering mergers and acquisitions.â€Team. “The team consisted of myself, a female and one of the youngest members on the team, by twenty years. Three older gentlemen from my company and then our counterparts on the consulting side consisted of an engagement manager who was from Germany, but fluent in English and had been living in the United States for three years, a Canadian consultant who was based out of Ontario, then two Japanese consultants, as well as all the experts in Japan that we would interact with.â€Challenge. “So it was a struggle. Because you are dealing with subtlety. You are dealing with perception. You know there’s knowledge that she (the Japanese consultant) has, but because she’s in the culture, she has preconceived ideas of what she should find. And because we’re coming from another culture, we have preconceived ideas of what we should find. And so sometimes it was difficult when interpreting the data about what it (the data) really meant or what was the most important issue.â€Your answer?Problem Cluster 9: Fluency, Accents, and VocabularyProblem 7.17. Outsourced Calling.Project. “The team was making phone calls to customers to collect delinquent bills.â€Team. “I was the accounts receivable manager for my business. I had twenty-six people in India working for me. I never met them. They actually didn’t work for my company but for an outsourcing company.â€Challenge. “We certainly had issues with having them call our customers. I don’t care if you say you’re Sue from Indiana, they know you’re not. And our customers are—I’m in the rail business and our customers are very old boy. I got a lot of negative feedback. Most of it was, ‘we don’t understand what they’re saying’ because of the accent, especially over the phone. If you’re with someone, you can see them and you can understand better what they’re saying. But over the phone, especially over the phone lines to India, you’ve got an accent, you’ve got static, you’ve got ten thousand miles of fiberoptics.â€Your answer?Problem 7.18. I Know I Have an Accent.Project. To develop systems to sell and implement for customers in the field.Team. Software engineers from Ireland, India, Bulgaria, Taiwan, and the United States, all hired for their technical competency, not their English-language skills.Challenge. “There were people on the team who were not as used to dealing with foreigners, complaining about language issues, and saying that it is difficult.â€Your answer?Part 3. Research MethodsThe preceding challenge statements were drawn from a set of data that was gathered, analyzed, and finally clustered, using a method of qualitative data analysis known as concept mapping. Following an explanation of this process, we also describe how we arrived at the four types of strategy.Samples and ParticipantsWe conducted and recorded telephone interviews in English with forty members or managers of multicultural teams. We asked each interviewee to describe one or more challenging multicultural team experiences, saying that team members could be citizens of different countries (for example, the United States, India, or Japan) or citizens of the same country (for example, the United Kingdom) but with very different cultural backgrounds (for example, U.K.-Indian, U.K.-Russian, U.K.-American, and so on). We looked for teams that did at least part of their work face-to-face and did not interact exclusively via technology. The interviewer probed for details about the challenge, who was involved, what the cultural issues were, and what the team or team members did about the challenge.Interviewees came from multicultural teams in military, legal, high-tech, and business settings. They described challenges within their teams, challenges stemming from the need to coordinate between the team and other parts of the organization, and challenges stemming from the need to interact with clients, customers, or counterparts from other cultures.Most of the forty interviewees were employed full time; all were completing their M.B.A. degrees. The average age was twenty-nine; the average work experience was seven years. They had worked in a variety of countries on all continents except Antarctica. Culturally, 47 percent were American or Canadian, 15 percent were Latin American, 15 percent were Asian (including Indian and Turkish), and 23 percent were European.In selecting participants, we were not interested in how their culture of origin shaped their perceptions of challenges, but rather in the fact that they perceived there to be a challenge. Other than having participants from a variety of cultures, we were not concerned with participants’ cultures as an explanation for why they perceived a challenge. Our focus was on the challenges participants experienced and the strategies used to manage the challenges.We recruited participants through their association with international business coursework during their M.B.A. program. We used an online survey to prescreen participants for experience in multicultural teams. The team tasks that participants reported on included corporate (such as banking-finance or marketing, 44 percent); special projects (20 percent); technical (15 percent); consulting (13 percent); and military (8 percent).Prior to the interview, participants received an overview of the study, the interview protocol, and a consent form. The interviewer asked for verbal consent to participate and reminded the participants that the interview would be recorded and that no names should be used. All participants were entered into a lottery for one of four $150 prizes. Each author conducted about one-third of the interviews. All interviews were transcribed.Data AnalysisThere were three stages of data analysis: (1) identifying responses on the transcripts that represented specific challenges; (2) creating units of analysis; and (3) analyzing the data with the concept mapping method (Jackson and Trochim, 2002).Identifying Challenges and Creating Units of Analysis. Each researcher independently reviewed each transcript, marking passages that described a challenge and any corresponding passage about the management of that challenge. The rate of consistency between the three researchers in identifying the same passages was 77 percent. Passages were excluded from further analysis for one or the other of the following reasons—either the passage represented the same idea as another unanimously identified passage (repeated again in the transcript) or it did not really describe a challenge (it was more of a description of the team). This culling resulted in 160 passages.Next, two of the researchers read all the passages independently, looking for redundancy. Working together they deleted or merged twenty-two passages. They merged passages when there was complete redundancy with another passage from the same interview, and they deleted passages that did not describe a challenge (for example, when the interviewee talked about culture in general). These two researchers then lightly edited passages for clarity and simplicity (spelling was corrected, extraneous words were deleted, dropped words were put in brackets, and so on). The result was 138 statements about challenges faced by multicultural teams, an average of three to four statements per interview. These statements became our units of analysis.Statements were typically one to four sentences long and represented one idea about a challenge experienced by a multicultural team. For example, “In South America . . . when we go into a meeting, we don’t eat and drink. . . . here is different ([people from the] U.S. eat and drink during brainstorming meetings). . . . I think that at some point maybe the internationals look at each other like, ‘Hey these guys are not taking this as seriously as I am . . . or what’s wrong with this guy coming here with a sandwich and eating over the computer and having a conversation at the [same] time he eats?’â€Here is another statement example: “The level of commitment and your word meaning something was different. So in the U.S. I don’t think our words are a promise. When I say ‘Yeah, I’ll get it to you on Friday,’ and perhaps it’s a week late, there is no penalty. However in Japan, if they say, ‘Yes, I will place the P.O. in six months,’ they mean it. You can take it to the bank. It’s going to be there, and if it wasn’t they would lose face. Every time I would go back, or our president would go back, and ask for the P.O., they would say, ‘We told you it would be six months, don’t you believe us?’ In effect, we were being rude to them by continuing to ask.â€Concept Mapping and Clustering Challenges. The next step in the analysis was concept mapping or “participatory content analysis†(Jackson and Trochim, 2002). It is a hybrid of traditional content analysis and semantic mapping analysis. We chose this method because our research objective was to identify the different types of challenges faced by multicultural teams and then associate those challenges with the strategies used to address them. We judged that forcing responses to fit an a priori category scheme (such as with traditional content analysis) would introduce an unacceptable level of researcher bias.Concept mapping as applied to qualitative data analysis (Jackson and Trochim, 2002) combines exploratory statistical analysis (multidimensional scaling and cluster analysis) with the judgments of those doing the concept mapping to produce clusters of similar thematic categories. The analysis is a five-step process: (1) determining units of analysis, (2) sorting units, (3) multidimensional scaling analysis, (4) cluster analysis, and (5) cluster labeling.1. Determining Units of Analysis. We described this step earlier. Each unit (each statement of a challenge) was given a random number and placed on an index card.2. Sorting Units. To avoid introducing researcher bias into the analysis, we did not do this sorting ourselves. Instead, we used twenty M.B.A. students as sorters—excluding any who had been interview participants, in order to protect their privacy (Jackson and Trochim, 2002)—because they were reasonable proxies for the original participants in terms of their work experience and coursework. We chose M.B.A. students who had completed coursework related to understanding cultural issues.We instructed them to sort the 138 index cards into piles based on their judgment of the similarity between statements. We did not limit the number of piles sorters could create (they created piles ranging in number from five to thirty-one). The only limitation was that they could not create a miscellaneous pile. If a statement did not fit with any other, sorters were instructed to leave the statement in its own pile. We also asked sorters to name each pile.3. Multidimensional Scaling Analysis. Next we ran a multidimensional scaling analysis (MDS) on the sorted data to create a visual display or map of conceptual similarity among the statements based on the aggregated similarity judgments of the sorters. We constructed a 138 x 138 binary square matrix (rows and columns represent statements) for each sorter. Cell values represented whether the sorter placed a pair of statements into the same pile (1) or not (0). The sorters’ twenty individual matrices were aggregated to serve as the matrix input into MDS. The MDS solution generated coordinate estimates for each statement and a two-dimensional map of distances between the statements. The final stress value was .33 after nine iterations, indicating a reasonable fit of the map to the similarity matrix that came directly from the sorters for a two-dimensional solution (Davidson, 1982). We chose a two-dimensional solution because it provides the most useful foundation for the next step in this type of tex

How does Advertising affect price elasticity?

You will be writing a research paper relating to an economic topic or current economic event in microeconomics. The essay should be between 5-6 pages in length (excluding any cover pages, bibliography, works cited, or endnotes pages), double-spaced, and in APA format.

The purpose of the research paper is for you to employ economic concepts (scarcity, opportunity cost, comparative advantage, supply and demand, price signals, diminishing returns, marginal utility, competition, monopoly, labor markets, income distribution, externalities, public goods, and many others) in a practical way to a business or social issue, bridging the gap between theory and practice. The research paper should clearly incorporate the economic analysis and topics of discussion covered in both the textbook and the workshops (as they pertain to the topic of research). You should attempt to see business and social issues through the lens of economic logic. The conclusions should reflect a deeper economic way of thinking.

Dividing the paper into six specific sections as follows:

  1. Introduction: Topic, statement of problem to be discussed.
  2. Objectives: Thesis statement, what is the goal of the essay?
  3. Method: The research method used: case study, books and newspaper or magazine articles, personal statistical research, or previously conducted statistical surveys.
  4. Findings and Observations: Data, facts ascertained, what did you discover?
  5. Conclusions: Interpretation, analysis of findings, arguments, personal comments and your informed opinions.
  6. Documentation: works cited, reference page.

Sections 1, 2, and 3 (Introduction, Objectives, and Method) should not consume more than one to two pages of the final draft. The bulk of the research and writing should be concentrated in the fourth and fifth sections where discussion should occur, evaluation of theories should be conducted, and conclusions may be drawn.

Instructions

  1. You will be completing a research project for this assignment. Primarily utilize Off Campus Library Services(OCLS) for your research.
    1. OCLS link (https://ocls.indwes.edu/) Let me know if the link doesn’t work. 
  2. Decide on a topic and begin organizing your research paper as soon as possible.
  3. Explore sources of information. Keep in mind that professional, peer reviewed journals are preferred for academic papers.
  4. By the close of this workshop, a good benchmark of your progress will be to have a topic and some preliminary research completed.
  5. You will be submitting an initial draft of parts of your paper 

I need to turn in an initial rough draft on June the 21th, 2020.

PLEASE use simple vocabulary and simple sentences. Thanks

You can  use as many as sources. 

Explain how you might use the strategy and resource/tool to help you overcome the concerns or challenges you described.

A: ExemplaryB: Meets the StandardC: ProgressingF: EmergingPaper or writing Assignment is:

Points Range:42 (33.60%) – 45 (36.00%)

Responsive to and exceeds the requirements given in the instructions. It:

 Responds to the assigned or selected topic;
 Goes beyond what is required in some meaningful way (e.g., ideas contribute a new dimension to what we know about the topic, unearths something unanticipated);
 Is substantive and evidence-based;
 Demonstrates that the student has read, viewed, and considered the Learning Resources in the course and that the Paper topic connects in a meaningful way to the course content; and
 Is submitted by the due date.

Points Range:38 (30.40%) – 41 (32.80%)

Responsive to and meets the requirements given in the instructions. It:

 Responds to the assigned or selected topic;
 Is substantive and evidence-based;
 Demonstrates that the student has read, viewed, and considered the Learning Resources in the course and that the Paper topic connects in a meaningful way to the course content; and
 Is submitted by the due date.

Points Range:32 (25.60%) – 37 (29.60%)

Somewhat responsive to the requirements given in the instructions. It:

 Somewhat misses the point of the assigned or selected topic; and/or
 Lacks in substance, relying more on anecdotal than scholarly evidence; and/or
 Contains little evidence that the student has read, viewed, and considered the Learning Resources in the course and that the Paper topic connects in a meaningful way to the course content; and
 Is submitted by the due date.

Points Range:0 (0.00%) – 36 (28.80%)

Unresponsive to the requirements given in the instructions. It:

 Misses the point of the assigned or selected topic; and/or
 Relies primarily on anecdotal evidence; and/or
 Contains little evidence that the student has read, viewed, and considered the Learning Resources in the course and that the Paper topic connects in a meaningful way to the course content; and/or
 Is submitted past the late deadline.

Paper or writing Assignment demonstrates/provides:

Points Range:38 (30.40%) – 40 (32.00%)

 In-depth understanding and application of concepts and issues presented in the course (e.g., insightful interpretations or analyses; accurate and perceptive parallels, ideas, opinions, and conclusions), showing that the student has absorbed the general principles and ideas presented and makes inferences about the concepts/issues or connects them to other ideas;
 Rich and relevant examples;
 Thought-provoking ideas and interpretations, original thinking, new perspectives;
 Original and critical thinking; and  Mastery and thoughtful/ accurate application of knowledge and skills or strategies presented in the course.

Points Range:34 (27.20%) – 37 (29.60%)

 Understanding and application of the concepts and issues presented in the course, demonstrating that the student has absorbed the general principles and ideas presented;
 Relevant examples;
 Thought-provoking ideas and interpretations, some original thinking, and critical thinking;
 Mastery and application of knowledge and skills or strategies presented in the course.

Points Range:28 (22.40%) – 33 (26.40%)

 Minimal understanding of concepts and issues presented in the course, and, although generally accurate, displays some omissions and/or errors; and/or
 Few and/or irrelevant examples; and/or
 Few if any thought- provoking ideas, little original thinking; and/or
 “Regurgitated” knowledge rather than critical thinking;
 Little mastery of skills and/or numerous errors when using the knowledge, skills, or strategies presented in the course.

Points Range:0 (0.00%) – 37 (29.60%)

 A lack of understanding of the concepts and issues presented in the course, and/or application is inaccurate and contains many omissions and/or errors; and/or
 No examples or irrelevant examples; and/or
 No thought-provoking ideas or original thinking; and/or
 No critical thinking;
 Many critical errors when applying knowledge, skills, or strategies presented in the course.

Writing is:

Points Range:38 (30.40%) – 40 (32.00%)

Scholarly and exceeds graduate-level writing expectations. Paper:

 Uses language that is clear, concise, and appropriate;
 Has few if any errors in spelling, grammar, and syntax;
 Is extremely well organized, logical, clear, and never confuses the reader;
 Uses a preponderance of original language and uses direct quotes only when necessary and/or appropriate;
 Provides information about a source when citing or paraphrasing it;
 Consistently uses correct APA form and style (including citations, references, use of nonbiased language, clear organization, good editorial style, etc.) with very few or no errors.

Points Range:34 (27.20%) – 37 (29.60%)

Scholarly and meets graduate-level writing expectations. Paper:

 Uses language that is clear;
 Has a few errors in spelling, grammar, and syntax;
 Is well organized, logical, and clear;
 Uses original language and uses direct quotes when necessary and/or appropriate;
 Provides information about a source when citing or paraphrasing it;
 Provides correct APA citations about a source when citing or paraphrasing it.

Points Range:28 (22.40%) – 33 (26.40%)

Somewhat below graduate-level writing expectations. Paper:

 Uses language that is unclear and/or inappropriate; and/or
 Has more than occasional errors in spelling, grammar, and syntax and/or lacks correct APA citations; and/or
 Is poorly organized, is at times unclear and confusing, and has some problems with logical flow; and/or
 Reflects an underuse of original language and an overuse of direct quotes and paraphrases; and/or
 Sometimes lacks information about a source when citing or paraphrasing it.

Points Range:0 (0.00%) – 27 (21.60%)

Well below graduate-level writing expectations. Paper:

 Uses unclear and inappropriate language; and/or
 Has many errors in spelling, grammar, and syntax; and/or
 Lacks organization in a way that creates confusion for the reader; and/or
 Contains many direct quotes from original source materials and/or consistently and poorly paraphrases rather than using original language; and/or
 Lacks information about a source when citing or paraphrasing it and/or incorrect use of APA.

ASSIGNMENT…

Write a 2- to 3-page paper that addresses the following:

  • Describe any concerns you have or challenges you might anticipate as an online learner.
  • Identify one strategy and one resource/tool from the Learning Resources that may contribute to a successful online learning experience.
  • Explain how you might use the strategy and resource/tool to help you overcome the concerns or challenges you described.
  • Identify two personal weaknesses or limitations that you might need to improve upon in order to ensure your success in this program, and explain why.

Reference the resources from this week that you will use to address these personal weaknesses or limitations. Provide at least one additional strategy and/or resource (not included in the Learning Resources) to address the personal weakness or limitation you identified.

Reminder: Proper formatting and APA citations are required.

Refer to the Writing Template for Course Papers for additional guidance.

References…

https://academicanswers.waldenu.edu/faq/73209