Unit 5 Discussion Domestic Violence Research Paper

Unit 5 Discussion Domestic Violence - Research Paper Example arning theory which states that contextual and situational factors such as stress, individual-couple characteristics, aggressive gait and family violence aid family violence. Biopsychological theory ties together biological factors such as alcoholism and testosterone levels and psychosocial factors such as stress to understand family violence. There is also the feminist theory which asserts that family violence is a culmination and manifestation of the degradation of women. The chosen topic is important in the course because it helps organisations and those in the human resources management (HRM) to regard comprehensively, the magnitude of family violence. The same will also help organisations and HRM to appreciate the limits which they must keep to as they attempt to mitigate the effects of family violence at the workplace. Just as Gosselin (2009) observes, when an organisation fails to determine boundaries in its quest to alleviate the effects of domestic violence as a way of promoting employee welfare, it oversteps its mandate and runs the risk of unduly heightening its operational

Debate on a GP Fee Policy

Debate on a GP Fee Policy Essay Question: What do you think about the prospect of a $5 fee to see a GP? The topic of a $5 patient co-payment for GP visits is an ongoing debate that is currently being argued from individuals to health care providers. Under this proposal, pensioners and concession card holders are exempted, and families are allowed 12 bulk billed visits before co-payment applies. So, why would the government slug patients with a $5 co-payment for GP visits? The Australian Centre for Health Research (ACHR, 2013) claims that by implementing this proposal, the government would save an approximate $750 million over 4 years and that the co-payment proposal would: Reduce avoidable demand for GP services Reduce incentives for GPs to over-service Remind people GPs are not free Reduce moral hazard risk by making people consider visiting a GP for minor ailments Remind people that maintaining good health is an individual’s responsibility However in order to take a stance, it is important to first understand Health. Should Health be a right, or is it a privilege? If Health is a privilege, health insurance would only support emergencies and not day-to-day healthcare maintenance, which would be detrimental to those in financial hardship (J L. Marshall, 2011). Hence, Health should be a right, a right â€Å"based on need and not the ability to pay†, where everyone can have equal accessibility and treatment to health care, which is why the $5 co-payment should not proceed (Public Health Association Australia, 2011). Expenditures and efficiency So why does the government intend to cut expenses from the health sector through a co-payment? Are we spending too much? According to the Australian Institute of Health and Welfare AIHW (2013), total health care expenditure in 2011-2012 amounted to $140.2 billion, which is 7.6% higher compared to the previous year (AIHW, 2013). Since GP visits are covered by Medicare, which is funded by the Government and through a levy, GP visits would be included in this $140.2 billion. However, it was reported that the total Medicare expenditure was $16.3 billion in 2010-2011, â€Å"total† meaning that it included GP visit along with various services covered by Medicare Benefits Schedule – MBS (Australian Government – Department of Human Resources, 2011). Thus, it is reasonable to consider that Medicare is only a small portion of the total expenditure. According to The Organisation for Economic Co-operation and Development (OECD), Australia’s health expenditure stands at $3800 per person, which is 8.9% of the Gross Domestic Product – GDP. In comparison, USA’s health expenditure per capita was $8508 per person, or 17.7% of GDP. Does this perhaps mean that life expectancy in USA is better due to the extra cost to health care? This does not seem to be the case, but rather statistics demonstrates that the highly privatised health care system is inefficient as shown in Figure 1. From Figure 1, by comparing USA to Australia or Canada, it shows that USA has a slightly lower life expectancy, but the health spending is almost double the figures of Australia and Canada’s. It should be noted that both Australia and Canada have universal health care systems in contrast to the privatised health care in USA. Given that a privatised system is evidently less efficient but yet costs more for individuals, would it then be wise to implement the co-payment, a move seen by many as a means to slowly â€Å"dismantle† Medicare (C King, 2014)? According to Catherine King (2014), the government would reduce expenditure for healthcare by means testing Medicare, but Australians will have to carry the tab. Means testing access to primary healthcare will lead to greater privatisation, which will restrict access to GPs for most Australians, more so on older people, the vulnerable ones in our population and families with children (C King, 2014). King (2014) states that â€Å"GPs are the cheapest within health systems, experts at diagnosis and able to detect potential health issues in their infancy†. Thus, if GPs are restricted, people would end up in hospitals, the expensive side of the health care system, increasing the expenditure rather than saving. Reduce avoidable demand for GP services Besides the intention of cutting costs for health care, one of the reasons provided by the ACHR for the co-payment proposal was to reduce avoidable demand (over usage) of GP services. However, the solution to this issue would not be to introduce a $5 co-payment for GP visits, as there are concerns that the co-payment would â€Å"jeopardise equitable access to clinically appropriate healthcare† (J Swan, 2013). This can be explained with a few questions by considering the targeted audience and the effects of the solution: According to J Swan’s article â€Å"John Glover voices fears GP fee will make poor suffer† (2013), Professor Glover, who led Australias most detailed analysis on the relationship between a persons wealth and their willingness to visit a doctor, states that there is â€Å"very strong† evidence that poorer people are already under using healthcare in proportion to their level of illness. Through his analysis, it is shown that only 5% of residents who lives among Sydney’s wealthiest neighbourhoods – Mosman, Woollahra and Hunters Hill, claimed they had delayed medical consultation due to financial issues. In contrast to less wealthy areas, Penrith had 13.5%; Nambour 23.4% and Ballarat had 17.9% residents claiming they would delay visiting doctors due to cost. From these statistics, it is clear that the poor would be most affected. John Glover, director of the public health information development unit at the University of Adelaide describes that the $5 co-payment for doctor visits would â€Å"discourage the wrong group of people from visiting the doctor while doing nothing to dissuade those who are already over using GP services† (J Swan, 2013). The co-payment would cause those likely to get seriously ill to unreasonably avoid preventative care which is a step towards reducing what we have as a universal healthcare system privatisiation (J Swan, 2013). Disadvantage to certain group of people (delay seeking medical help) Would the $5 co-payment disadvantage certain groups of people? The co-payment would have dangerous consequences for the poorest and sickest This then comes down to the issue of cost and equity. Health Program director of Grattan Institute, Stephen Duckett states that â€Å"In the healthcare system theres a trade-off between costs and equity, the government might save money in the short-term at the cost of equity, but Emergency departments would soon fill up with patients delaying to visit GPs† (J Swan, 2013). Clogging up ED (caused by delay in seeking aid from primary health care) Potentially preventable hospitalisations (PPH) have been defined as those hospitalisations which could have been avoided with access to quality primary care and preventative care. Rates of PPH for selected conditions, such as chronic conditions and vaccine preventable conditions are being used nationally and internationally as an indirect measure of problems with access to care and effective primary care. In contrast it is well established that hospital admissions can be prevented by primary care. Australian data show that there are around 33 hospitalisations per 1000 people per year or 10% of hospitalisations could be prevented by effective primary care5. These primary care preventable hospital admissions are increasing in recent years. The ACHR report suggests that the introduction of a co-payment will reduce all GP attendances, both those regarded as necessary, and those that are perceived as unnecessary1. There are inadequate data to know how this will affect hospital admissions. However, the co-payment may increase rather than reduce overall government health expenditure. I support the reasoning provided by ACHR for the introduction of co-payment to remind people that maintaining good health is an individual’s responsibility, which requires investments in comprehensive primary health care (Public Health Association Australia (2011). I also support the overall aim that health care expenditures must be properly managed, to ensure an accessible, equitable, safe, effective and efficient health service provision (Public Health Association Australia, 2011). However, introducing co-payments for GP visits is just one of many solutions available to reduce Health expenditures. Is it a good solution for the reasons provided by ACHR? In my opinion, I do not think it is a good solution. The co-payment would disadvantage the poor, ill and families with children greatly. It is an inefficient method not only to increase health care funding, but ineffective mechanism for reducing demand. The introduction of a co-payment for GP visits is a regressive move toward s a privatised system. Given that a privatised system has been shown to be inefficient, â€Å"means testing and privatisation would only spell the end of Medicare and it’s not how the government should manage health expenditure† (C King, 2014). It is my belief that this proposal has been inadequately investigated and more research would reveal better options to constrain health expenditure while encouraging individual responsibility for health. If further investigation are to be carried out, I would strongly recommend the government look into the management of successful countries with universal health care system such as Canada; or they could make slight adjustments to the Medicare levy, which would help increase health funding as well. References: Jonathan Swan (2013, December 31). â€Å"John Glover voices fears GP fee will make poor suffer†. Retrieved 13 March 2014, from http://www.smh.com.au/federal-politics/political-news/john-glover-voices-fears-gp-fee-will-make-poor-suffer-20131231-304go.html#ixzz2p8w8aZ3vAs Australian Centre for Health Research (2013, October 18). â€Å"A PROPOSAL FOR AFFORDABLE COST SHARING FOR GP SERVICES FUNDED BY MEDICARE† Retrieved March 18, 2014, from http://www.cormorant.net.au/images/18%20oct%202013%20achr%20gp%20copayment%20paper%20final.pdf Sue Dunlevy (2013, December 29). â€Å"Health groups fear $5 GP will hit hospital emergency departments†. News Corp Australia Network. Retrieved 18 March 2014, from http://www.news.com.au/lifestyle/health/health-groups-fear-5-gp-fee-will-hit-hospital-emergency-departments/story-fneuz9ev-1226791543887 John L. Marshall (2011, February 3). â€Å"Is Healthcare a Right or a Privilege?†. Retrieved 20 March 2014, from http://www.medscape.com/viewarticle/736705 Public Health Association Australia (2011, September). â€Å"Policy-at-a-glance – Primary Health Care Policy†. Retrieved 20 March 2014, from http://www.phaa.net.au/policyStatementsInterim.php#p Australian Institute of Health and Welfare (AIHW, 2013). â€Å"Health expenditure Australia 2011–12†. Health and welfare expenditure series no. 50. Cat. no. HWE 59. Canberra: AIHW. Australian Government – Department of Human Resources (2011, July 8). â€Å"Medicare Australia Annual Report 2010-11†. Retrieved 25 March 2014, from http://www.humanservices.gov.au/spw/corporate/publications-and-resources/annual-report/resources/1011/medicare-australia-annual-report-2010-11-full-report.pdf OECD (2013). â€Å"Health at a Glance 2013: OECD Indicators†. OECD Publishing. Retrieved 5 April 2014, from http://dx.doi.org/10.1787/health_glance-2013-en Catherine King (2014, February 24). â€Å"GP co-payment would man the end of Medicare†. Retrieved 7 April 2014, from http://www.alp.org.au/gp_co_payment_would_mean_the_end_of_medicare What are the equity arguments against the proposal? Unfair to poor and frequently ill people What are the literatures from overseas on this topic? Supporting evidence: University of Adelaide expert on health inequality Professor John Glover Report: The cost of care One in seven Australians has delayed seeking medical help because of cost, with Queenslanders more than twice as likely to find cost a barrier than people in NSW. Increased Ambulatory Care Copayments and Hospitalizations among the Elderly Amal N. Trivedi (M.D., M.P.H) increasing the patients share of the cost for ambulatory care may not reduce (or may even increase) total health care spending and may result in worse health outcomes. Elderly patients may be particularly sensitive to cost sharing because they have lower incomes, are more likely to be in poor health, and have greater out-of-pocket spending on health care than nonelderly populations In conclusion, increasing copayments for ambulatory care reduced the use of outpatient care among elderly enrollees in managed-care plans, but this decline was offset by an increase in hospitalizations, particularly among enrollees with low socioeconomic status and those with chronic disease. Increasing copayments for ambulatory care among elderly patients may have adverse health consequences and may increase spending for health care. http://www.nejm.org/doi/full/10.1056/nejmsa0904533#t=articleTop accessed date 13/3/2014 intro (250) para 1 (650) para 2 (650) para 3 (650) conclu (350) (2550)

Isocrates The Educated Man versus Atticus Finch in To Kill a Mockingbird :: To Kill a Mockingbird Essays

The Greek philosopher Isocrates describes the characteristics of an ideal citizen in his essay, â€Å"The Educated Man†. From his point of view an educated man is not one who has pursued higher education but one who has good character and contributes to his society. In Harper Lee’s To Kill a Mockingbird, Atticus Finch is portrayed as an educated man because he has excellent morals and knows how to conduct himself. Atticus and the â€Å"educated man† are both the ideal and perfect members of a community and family. They are strong-minded, charismatic, and honorable – traits that most people strive for. The diction that Harper Lee uses when describing Atticus Finch helps create the image of the perfect and educated man. Isocrates addresses the fact that an educated man has self-restraint and is always in control of his actions. An educated man never lets temperament, selfishness, or weakness overcome himself. One’s ability to carry himself in a honorable fashion is imperative for being a true educated man. Isocrates established a school of rhetoric is 392 B.C. that taught the art of persuasion to orators. From Isocrates’ perspective, an educated man is â€Å"not duly overcome by [his] misfortunes, bearing up under them bravely†. (line 9-10) By persuading others, an educated man can win arguments, or judicial trials in Atticus’ case, without having to be ill-mannered. When Atticus loses Tom Robinson’s case he doesn’t blame the jury for being prejudice or even Bob and Mayella Ewell for lying. Atticus stays calm under pressure and during stressful times. Later, when Atticus discuses Tom's death with Aunt Alexandria, he tells her that: â€Å"I told him what I thought, but I couldn’t in truth say that we had more than a good chance. I guess Tom was tired of taking white man’s chances and preferred to take his own.† (p. 235-236) Atticus knows that killing Tom Robinson was unnecessary and that they would have had a good chance with a better jury. However, he does not lose his temper and continues to think clearly. Even with all the things that he and his family have had to endure, he understands that violence or revenge will not solve any of his problems. It is in this way that he is an educated man. Another characteristic of an educated man is that he is able to endure things he feels is distasteful.

Can a Criminal Be Rehabilitated Back Into Society

The purpose of this paper is to research the whole subject of criminals and their rehabilitation. This is a discussion of what society’s responsibility in this matter is and how to approach whether it is reform or punishing those who commit the crime. Should a criminal who claims insanity be rehabilitated into society? This is a common argument that many people find themselves wondering if such thing is possible when a heinous crime has been committed. It is stated that juries find for only about 20 percent of the defendants who plead insanity. Sixty to 70 percent of insanity pleas are for crimes other than murder. They range from assault to shoplifting. There are some opponents that attack the insanity defense for confusing psychiatric and legal concepts, in the process undermining the moral integrity of the law. During the 150 years or so the insanity defense has been and still is an issue in the U. S. within our criminal law and the medical psychology that have gone through many tireless changes in the criminal responsibility and the mental illness relationship. Ignoring this issue we may have steered away from an important source in our struggle with this type of defense. The United States Federal law states that insanity is a fair defense if at the time of the commission of the acts constituting the offense, the defendant as a result of a severe mental disease or defect, was unable to appreciate the nature and quality of the wrongfulness of his or her acts. When invoking insanity as a defense, a defendant is required to notify the prosecution. In some states, sanity is determined by the judge or jury in a separate proceeding following the determination of guilt or innocence at trial. In other states, the defense is either accepted or rejected in the verdict of the judge or jury. Even if evidence of insanity does not win a verdict of not guilty, the sentencing court may consider it as a mitigating factor. The criminal justice system under which all men and women are tried holds a concept called mens rea, a Latin phrase that means â€Å"state of mind†. According to this concept, criminals committed who commit their crimes are oblivious of the wrongfulness of their actions. A mentally challenged person, including one with mental retardation, who cannot distinguish between right and wrong is protected and exempted by the court of law from being unfairly punished for his/her crime. Insanity, what does that word mean? I don’t have a clear cut definition for it but for most of us when we think of that word we think of someone mentally ill or just plain crazy. Does insanity makes us loose the thought of moral value and or our justification from right from wrong? It is stated that most socially recognized authorities such as psychiatrists, medical doctors, and lawyers agree that it is a brain disease. Let say it is a brain disease should we link insanity with other brain diseases like strokes and Parkinsonism? Unlike these two diseases, whose causes can be medically accounted for through a behavioral deficit such as paralysis, and weakness, how can one explain the behavior of crimes done by such criminals? Doctor’s and psychiatrists describe what they say insanity is a neurological illness explaining it to a jury a person's or in this case a criminal’s reason and behavior. It rarely excuses it. Insanity is now considered a legal concept not a medical diagnosis. The most widely known rule in the insanity defense refers to the M'Naghten rule which arose in 1983 during the trial of Daniel M'Naghten who pleaded that he was not responsible for his murders because he suffered from delusions at the time of that he committed the crime. The rule states that a criminal defendant may be excused from criminal responsibility if at the time of the crime, the person accused was laboring under such a defect of reason, from a mental illness, as not to know the nature and the quality of the act he or she was doing. The biggest problem I feel is that with the insanity defense is either examined from a legal angle or a psychoanalytical one which involves talking to people and taking many tests. These tests so far show no proof of confirming the causal relationship between mental illness and the criminal behavior based on a deeper neurological working of the brain sciences. Many doctors and or professionals seemed to find themselves in a double bind where with no clear medical definition of mental illness, he/she must answer questions of legal insanity- beliefs of human rationality, and free will instead of basing it on more concrete scientific facts. For example, let us use a case study to elaborate the argument that law in this country continues to regard insanity as a moral and legal matter rather than ones based on scientific analysis. Remember the insanity case of Andrea Yates which occurred in Houston, Texas in 2002. In March 2002, a panel of Texas jurors debated her fate. A devoted mother with a history of postpartum psychosis, hallucinations, and two suicide attempts, Yates admitted to drowning her five children in a bathtub. Prosecutors conceded that Yates was mentally ill but knew right from wrong and so was not legally insane at the time of the murders. Under the law, jurors could not be told that Yates would be hospitalized if she were found NGRI. The jury rejected her claim of mental illness, found her guilty, spared her the death penalty but sentenced her to life in prison. At least there Yates would be kept in protective custody because of her ongoing mental problems and possible threats from other inmates and unless she needed intensive psychiatric care she would eventually mingle with the general population at the prison known for housing some of the toughest, meanest women in Texas. Yates's symptoms are controlled by medication. How about rehabilitating the insane, is it possible or how are we the society should deal with this issue? Rehabilitation is based on the idea that the criminal violation resulted from inadequate socialization of the offender; it represents an effort to provide some counseling and practical training that can aid an offender and therefore weaken or remove the stimuli that led him or her to committing the crime. Can we just say that the person with the mental illness is not capable of being normal or distinguishing right from wrong so we should just lock them up and throw the key away? One might wonder if criminals use the insanity defense to escape punishment. After all a crime had been committed and therefore they too should be punished maybe not as a normal criminal but with the proper medical assistance needed for their behavior can be controlled. Some of these individuals can in fact be rehabilitated back into society by properly giving them the right medication and not just sending them to jail where they get no help. If in fact the insanity defense is successful the offender then is placed in psychiatric hospital or the psychiatric ward of a state prison which are secured facilities. Many offenders who plead insanity are nonviolent offenders, and most if not all will stay at the hospital longer than they would if they were going to prison if had been convicted of the crime that they were accused of. Again the insanity does not always bring freedom but indeterminate detention. The defense by which defendant argue that they should not be held criminally liable for breaking the law due to being legally insane when at the time the crime occurred. The defendants who attempt such defense will undergo mental examinations beforehand. There are four various insanity defense standards. The first is the M’Nagthen rule which the standard is whether or not he or she did not know what he or she was doing or didn’t know it was wrong. The burden of proof varies, from proof by a balance of probabilities on the defense to proof a beyond a reasonable doubt on the prosecutor and or depending on the state jurisdiction. The second is the irresistible impulse test which legal standard is if he or she could not control his conduct. The third is the substantial capacity test. The legal standard is if he or she lacks the substantial capacity to appreciate the wrongfulness of his conduct or to control it and the burden of proof is beyond reasonable doubt and rests on the prosecutor. The fourth test is the Present federal law which indicates if he or she lacks the capacity to appreciate the wrongfulness of his or her conduct. The burden of proof is clear and convincing evidence and rests on the defense. The insanity defense shouldn’t be confused with incompetency. Individuals who are incompetent to stand trial are held in a mental institution until they are considered capable of participating in the proceedings. The insanity defense should also be kept separate from issues concerning the mental retardation. In the case in 2002 Atkins v. Virginia the U. S. Supreme Court ruled that the execution of the mentally retarded criminals constituted the cruel and unusual punishment and it was prohibited by the 8th Amendment. If a criminal is acquitted by reason of insanity then execution was not an option. The insanity defense has contributed to making the law more humane. The criminal justice system seeks to protect the public, with the main goal of the mental health system in treating and rehabilitating individuals with some sort of mental illness. Another issue is what critics contend that the insanity defense undermines the functioning of the criminal justice system. Wealthy defendants are able to hire experts and have the advantage over the indigent. The defense may be exploited by perfectly sane defendants who have the resources to conclude a credible defense. The wealthy defendant who pleads insanity usually hires his or her own medical team to be evaluated. This often leads to corruption in a rich man's trial, because the wealthy can afford to buy their doctor's verdicts. This is very unfair in that, the wealthy can afford to hire expensive doctors and defenses and are more likely to get off with a non-guilty verdict whereas the poor man or middle class man has less of a chance even if they are actually insane. This presents a violation of the very basic concept that all people, regardless of their wealth or social status, should be given the equal treatment they deserve when in a court of law, but that is not always the case. Some studies have shown that as many as 70 percent of NGRI defendants withdrew their plea when a state-appointed expert found them to be legally sane. Individuals in this type social status are using the insanity plea as a way to get away with their crime and not have to be punished. If a person is truly insane and cannot be counted on to know the difference between right and wrong, this should be seen beforehand by medical doctors, declared insane and then taken out of society's reach for the safety of the innocent. Those who are harmful to the public should be kept away, not as a measure of cruelty but for the one with mental illness they should get the proper care in a secure facility and once they are sane than be transferred to a prison facility. The law states that we have the same rights no matter what our social status is so therefore should get the same treatment. That is not always the case though. It is difficult even for doctor’s to really determine if the defendant really was insane when the crime was being committed. To really understand the nature of the insanity defense one must go back and look at where and how it started. In today's insanity cases, mental health experts, doctors, and scientists have important roles to play. They can inform the jury of the nature of the defendant's mental illness, the likeliness that the crime might be repeated, and whether the defendant may bring harm upon himself/herself. However, like any court case, there will always be divided opinions amongst the mental experts regarding the outcome of the case depending on whether they testify for or against the defendant. Dangerous mentally ill offenders should be confined appropriately to proper treatment facilities while receiving care. Mentally ill offenders I believe would be less of a financial burden to society since they would be able to return to society as productive members following their required treatment. Many mentally ill offenders would no longer be sentenced as if they had the mens rea required for committing the crime. Instead, mentally ill offenders would receive a constitutionally valid sentence that is proportional to their degree of culpability, thus accurately reflecting the criminal justice system’s notion of criminal culpability. References: Anniken Davenport (2009), Basic Criminal Law: The Constitution, Procedure, and Crimes, 2nd Edition, Upper Saddle River, NJ: Prentice Hall. Paul B. Weston & Kenneth M. Wells & Marlene Hertoghe (1995), Criminal Evidence for Police, 4th edition, Upper Saddle River, NJ: Prentice Hall. Larry J. Siegel (2004), Criminology: Theories, Patterns, & Typologies, 8th edition, Belmont, Ca. Wadsworth/Thompson Kenneth J Peak (2003), Policing in America: Methods, Issues, Challenges, 4th edition, Upper Saddle River, NJ: Prentice Hall. References: Anniken Davenport (2009), Basic Criminal Law: The Constitution, Procedure, and Crimes, 2nd Edition, Upper Saddle River, NJ: Prentice Hall. Paul B. Weston & Kenneth M. Wells & Marlene Hertoghe (1995), Criminal Evidence for Police, 4th edition, Upper Saddle River, NJ: Prentice Hall. Larry J. Siegel (2004), Criminology: Theories, Patterns, & Typologies, 8th edition, Belmont, Ca. :Wadsworth/Thompson Kenneth J Peak (2003), Policing in America: Methods, Issues, Challenges, 4th edition, Upper Saddle River, NJ: Prentice Hall. Todd R. Clear & George F. Cole (2003), American Corrections, 6th edition, Belmont, Ca. Wadsworth/Thompson Frank Schmalleger (2002), Criminal Justice: A brief imtroduction, 4th edition, Upper Saddle River, NJ: Prentice Hall. Todd R. Clear & George F. Cole (2003), American Corrections, 6th edition, Belmont, Ca. Wadsworth/Thompson Frank Schmalleger (2002), Criminal Justice: A brief imtroduction, 4th edition, Upper Saddle River, NJ: Prentice Hall.

Organizational Structure and Culture Essay

Authority structure within organizations is important for the oversight of delegated processes and expected outcomes. Without structure, chaos would impede support, communications, and vision development. Organizational designs vary according to the need of the organization to operate efficiently, to achieve goals, and to support the associates within the organization. The organizational structure style design helps lead the organization in successful endeavors (Sullivan & Decker, 2009). Organizational History The history of an organization contributes to the design of the formal organizational structure.  The medical center has a tumultuous history. A new modern building was constructed in 2000 to replace an older structure. The local physicians had no input into the decision or design of the new facility. The organizational structure during that time was a strict parallel design. The physicians reported to the chief medical officer and the Board of Trustees. The physicians jointly decided not to support the new local hospital; the organization began to collapse. The medical center eventually fell into bankruptcy because of the lack of physician support, poor financial management, and unscrupulous use of organizational monies. The court system retained a reconstruction organization in an attempt to rebuild the local hospital. During the time of bankruptcy the parallel organizational structure remained in place, but with less authority of the medical governance branch. The main focus of the organizational structure was financial survival of the organization. An immediate change was needed for the improvement of the dangerously low morale of the health care associates The once country owned, bankrupted not-for-profit-hospital was bought and sold twice before stabilization began to be a possibility. A corporation purchased the hospital and changed it to a for-profit organization. There was very little resistance to the change because the organization had been surviving in chaos. According to Kurt Lewin’s three stage theory of change, the first phase, the unfreezing phase, is an important phase of change. Change is getting ready to happen during this phase. The health care associates of the medical center had been getting ready for change for a few years. The unfreezing phase requires the development of motivation. Motivation was the chance to prosper in a successful business venture while delivering quality care to the community (â€Å"Kurt Lewin,† 2012). Generational Culture The generational culture of the organization had a positive effect on the change. There was a common goal developed, the success of the organization. The generational similarities outnumber the generational differences. According Anick (2008), â€Å"The top reason for happiness in the workplace is the sense of feeling valued† (Table 2. Elements on which members of each generation are mostly similar). The traditional, baby boomers, generation X, and generation Y became involved in the decision making as the new organization structure formed. They shared ideas and offered suggestions for patient care improvement. Informal leaders began to emerge. During the refreezing phase, the stabilization became the norm. The differences in the generational culture became more apparent. More processes, greater accountability, and new required use of technology caused a feeling of less worth for the older generation of health care providers. The younger nurses seemed to adapt more quickly to new systems and techniques. Older nurses began to believe they were less important to the process. The informal leader roles changed. A new information system was installed and education was initiated. This led to more attention on the differences of the generational cultures. Much of the required education was completed on the computer. E-mail is essential for communication within the organization. Some of the traditional generation began to feel left behind. At the end of the first year, many of the health care providers who had survived the previous chaos succumbed to the new advancements and left the organization. Current Organizational Design The current organizational structure of the medical center is a matrix design. The upper administration consists of a chief nursing officer, chief financial officer, and an assistant administrator. This group reports directly to the chief executive officer. The chief executive officer reports to the Board of Trustees. The medical center consists of two distinct campuses, four on-site clinics, and one clinic located off campus. The upper administration is responsible for the organization. The matrix esign is complex and requires good interpersonal skills for dual managers. Each nursing unit has a nurse manager. The nurse managers report to the chief nursing officer regarding any patient care issues. The nurse managers of the behavioral health campus also report to the behavioral health program director for organizational issues. The physicians are under the organizational umbrella for operational regulations but report to the chief medical officer regarding medical patient care. The resource manager has a dual reporting line to the chief nursing officer and the chief financial officer. The matrix requires frequent communication between the dual authorities. Non-management views the frequent meetings as meetings about meetings (Sullivan & Decker, 2009) Formal lines of reporting are evident within the organization. The nurse managers report to the chief nursing officer. Managers of departments involving financial business of the hospital report to the chief financial officer. Ancillary and support services report to the assistant administrator. The compliance officer, the pharmacy director and the behavioral health program director report directly to the chief executive officer. The formal lines of reporting are used for recognition of associates, disciplinary offenses, and arbitration of challenges between departments. Patient-Centered Care Environment The organization is creating an environment for client-centered care by the development of a nursing leadership council consisting of direct care providers. The council membership includes seven registered nurses from nursing units with day and night shift representation. The nursing council interviews associates and patients, observes processes, and reports findings to the council. Changes in nursing processes are approved through the nursing council with final approval by the chief nursing officer. The council members were selected using predetermined criteria. The informal leaders of individual departments were chosen for their job performances and their proven leadership skills. The shared governance gives ownership of patient care to the frontline caregivers (Hess, 2004). Organizational Communication Various communication methods are used within the organization. Formal, time sensitive communications are delivered face-to-face or by technology. E-mail and web conferencing are the most frequent used methods for upper administration. Both methods allow quick responses between the communicators. Upper-level management processes the information and decides the best delivery method to the next lower-level management, depending on the subject matter and the expected time frames. Middle management associates attend leadership meetings every two weeks. Management communicates organizational status through these meetings. Plans for future projects are discussed during the leadership meetings. Middle management has e-mail accounts and receives electronic communications on changes. Middle management holds departmental meetings at least monthly to distribute information to the direct care providers. Upper-level management holds open meetings for the direct care providers each quarter. The meetings focus on current organizational trends and plans. Direct care providers ask questions and make suggestions for improvement during the open meetings. Communication boards are placed in strategic areas through the work areas. Information is placed on the communication boards and updated weekly. Questions frequently come from the information from the boards. Conclusion The organizational structure can be descriptive of the culture of the organization. A ridged authoritarian organizational structure defines an organization that does not allow the frontline workers to participate in decisions that affect the organization. The matrix organizational design requires open communication between the leaders of the organization. Added shared governance from the frontline creates more awareness is put on the quality and delivery of the product. Organizational structures vary and are representative of the leadership within.