1 INTERPERSONAL RELATIONS 2 1: Aggression and Violence Aggression is, “an act or behavior that intentionally hurts another person, either physically or psychologically” (Matsumoto & Juang, 2008, p. 389).  While some expressions of aggression are universal, cross-cultural differences exist in the type and level of aggression that are considered to be legally or socially sanctioned. There have been multiple reasons proposed by theorists to explain these cultural differences in the type (verbal, physical, etc.) and level of aggression expressed across cultures.  For this Discussion,review this week’s Learning Resources. Select a culture and consider how this culture expresses aggression.  With these thoughts in mind:  a brief description of the culture you selected. Provide an example of a behavior that may be perceived as aggressive by culture you selected and explain why. Then, provide an example of a behavior that may be perceived as aggressive across most cultures and explain why. Finally explain how socially sanctioned violence is acceptable within certain cultures. Support your responses using the Learning Resources and the current literature. . Reference: Matsumoto, D., & Juang, L. (2008). Culture and psychology (4th ed.). Belmont, CA: Thomson Wadsworth. 2: Attribution “Not only do people bolster beliefs in their ability to control in response to successful control of an event but also they hold an unwarranted belief that they can control chance events,” states Yamaguchi (Matsumoto (Ed.), 2001, pp. 226–227) in the course text. While members of all cultures have the goal of protecting self-image following failures, differences exist among cultures in terms of the attributions made for the failure and success of a task. Thus, while the self-serving bias is universally applied, the specific attributions made differ cross-culturally. In some cultures, it is assumed that failure is attributable to situational factors while others assume dispositional factors.   Differences also exist in how the failure or success of another individual is attributed. Consider the relevance of attributions for success and failure for the scholar-practitioner working in a multicultural environment or in a global company. How would knowledge of how individuals’ attribute their own or others failure impact a team, classroom, or organization?   For this Discussion, imagine that a group of business people from two different cultures (one from a collectivistic culture and another from an individualistic culture) work together on a business project, and at the end, the project fails. Consider how people from individualistic and collectivistic cultures respond to failure and the factors to which they would most likely attribute their failures. With these thoughts in mind:  a brief comparison of the similarities and differences of attribution styles in individualistic and collectivistic cultures. Then provide an example of a group situation in which a proj ...

1. 1
INTERPERSONAL RELATIONS
2
1: Aggression and Violence
Aggression is, “an act or behavior that intentionally hurts
another person, either physically or psychologically”
(Matsumoto & Juang, 2008, p. 389). While some expressions of
aggression are universal, cross-cultural differences exist in the
type and level of aggression that are considered to be legally or
socially sanctioned. There have been multiple reasons proposed
by theorists to explain these cultural differences in the type
(verbal, physical, etc.) and level of aggression expressed across
cultures.
For this Discussion,review this week’s Learning Resources.
Select a culture and consider how this culture expresses
aggression.
With these thoughts in mind:
a brief description of the culture you selected. Provide an
example of a behavior that may be perceived as aggressive by
culture you selected and explain why. Then, provide an example
of a behavior that may be perceived as aggressive across most
cultures and explain why. Finally explain how socially
sanctioned violence is acceptable within certain cultures.
Support your responses using the Learning Resources and the
current literature.
.

2. Reference:
Matsumoto, D., & Juang, L. (2008). Culture and
psychology (4th ed.). Belmont, CA: Thomson Wadsworth.
2: Attribution
“Not only do people bolster beliefs in their ability to control in
response to successful control of an event but also they hold an
unwarranted belief that they can control chance events,” states
Yamaguchi (Matsumoto (Ed.), 2001, pp. 226–227) in the course
text. While members of all cultures have the goal of protecting
self-image following failures, differences exist among cultures
in terms of the attributions made for the failure and success of a
task. Thus, while the self-serving bias is universally applied,
the specific attributions made differ cross-culturally. In some
cultures, it is assumed that failure is attributable to situational
factors while others assume dispositional factors.
Differences also exist in how the failure or success of another
individual is attributed. Consider the relevance of attributions
for success and failure for the scholar-practitioner working in a
multicultural environment or in a global company. How would
knowledge of how individuals’ attribute their own or others
failure impact a team, classroom, or organization?
For this Discussion, imagine that a group of business people
from two different cultures (one from a collectivistic culture
and another from an individualistic culture) work together on a
business project, and at the end, the project fails. Consider how
people from individualistic and collectivistic cultures respond
to failure and the factors to which they would most likely
attribute their failures.
With these thoughts in mind:

3. a brief comparison of the similarities and differences of
attribution styles in individualistic and collectivistic cultures.
Then provide an example of a group situation in which a project
failed or a goal was not reached. Finally, explain how someone
from each culture might explain the failure and why. Support
your responses using the Learning Resources and the current
literature.
Reference:
Yamaguchi, S. (2001). Culture and control orientations. In D.
Matsumoto (Ed.), The handbook of culture and psychology (pp.
223–243). New York, NY: Oxford University Press.
Current and Emerging Trends in Healthcare
Topic Research/Selection and Literature Review
Bettina Casimir
Colorado Technical University
Dr. Mountasser Kadrie
Part 1: Topic Research and Selection
There are a number of things that health cares are doing in order
to increase profitability. What most organizations have found to
be effective is the introduction of quality improvement program.
Organizations have succeeded in improving their performance
through the use of effective quality improvement program.
Organizations are seen with clinical and service quality
improvement activities due to this program.
Having quality improvement program with all the basic
elements work properly in assisting organization attain its
goals, such as those directed towards increasing profitability
and reducing costs. Below are the basic elements of quality
improvement program:
· Description of organizational objectives, program goals, and
mission
· Definition and explanation of major quality concepts and

4. terms
· Explanation of how quality improvement program is selected,
managed, monitored
· Explanation regarding training as well as support for people
who will take part in the quality improvement process
· Explanation of quality methodology, (such as Six Sigma) and
quality techniques that will be utilized
· Description of communication plan that will be employed and
the manner in which updates will be communicated.
· Explanation of measurement as well as analysis, and how the
analysis will assist in defining future quality improvement
activities.
Part 2: Literature Review
According to Swensen and colleagues, quality improvement
program is very important since it is tightly coupled and
intrinsically interlocked with cost, quality, trust, speed, and
value. Quality improvement program has not yet spread so much
throughout medical centers and hospital. The reason behind this
is because it is not very clear to many hospitals and health care
centers how quality improvement program directly benefits the
financial status of the institutions far beyond the needs of
society and that of patients. Most health care institutions have
not embraced the idea and concept of quality improvement
program. The management of most health care institutions has
not realized that there is a relation between the business
management strategy for fiscal well-being and achievement of
optimal quality and improved patient outcomes (Swensen,
Dilling, Mc Carty, Bolton, & Harper Jr, 2016). The major
source of financial benefit or return seen by an organization
will come from disciplined removal of waste with advanced
techniques, such as systems engineering techniques. There are
three major types of provider-related health-care waste. These
are preventable harm, overuse, and inefficiencies. A lot of
health care dollar spent by health care organizations is wasted.
This is estimated to be about 40 percent. It is possible to design

5. patient-centered care in a way that it can be provided or
delivered with negligible wasted. Driving waste out of the
organizations will reduce waste, which is possible through the
implementation and use of quality improvement program. It will
be possible to enhance employee engagement and build higher
reputation high reliability performance. The satisfaction of
patients will be increased through higher employee engagement.
This will help drive the financial performance of health care
organizations. Many people believe that quality improvement
expenses and linked with accreditation and regulatory agencies.
Due to this, people view this expense as those with little or no
return on investment. Management of some health care
organization argues that they are costs that have to be incurred
in the process of doing business. They do not know that these
costs can be reduced or avoided so as to make operations of a
health care organization to be profitable.
As per Community Health Group (2016), the implementation of
quality improvement program has enabled the organization
provide quality health to its member for a longer period. Now,
members are able to access quality, fairly priced, and
exceptional services. Authority and accountability is being
practiced throughout different levels of the organization. This
has been through creation of Community Health Group’s (CHG)
Board of Directors (Board) that has played a significant role
when it comes to the designing, implementing, and monitoring
quality improvement program of the Community Health Group.
“The quality improvement program provides a formal process to
objectively and systematically monitor and evaluate the quality,
appropriateness, efficiency, safety, improve returns, and
effectiveness of care and service utilizing a multidimensional
approach” (Community Health Group, 2016, p. 102). Due to all
these, the organization has succeeded in directing attention
towards opportunities that improve its operational processes
together with health outcome to patients and the society. Also,
it has been able to attain satisfaction on practitioners/providers
and members through the use of its quality improvement

6. program. Another thing that is promoted by quality
improvement program is the culture of accountability and
quality to affiliated health personnel and workers to offer
quality care as well as services to members. As per the
managements of Community Health Group, the quality
improvement program used on the organization has incorporated
continuous quality improvement methodology, which directed
attention to specific needs of all stakeholders, that is, health
care provider, members, and community agencies.
Operations and financial performance of organization can be
achieved through having a good work plan created by quality
improvement program (HRSA, 2016). The quality improvement
programs used by most organizations, among them a few health
systems centers have important information relating to the
manner in which the organization will deploy, manage, and
review quality throughout the entire organization. Most quality
programs are created by clinical leadership and executive. This
has to be approved by the governing body of organization,
which is usually composed of a board of directors. Once
created, it has to be updated regularly. Regular update helps to
ensure that the program reflects what an organization is doing
with regards to improving quality and returns. Specific clinical
area will be reflected properly through having an effective
quality improvement plan. Focus area for current and
subsequent calendar years will be reflected by the program.
Management should not rush into creating a quality
improvement plan. One has to establish an understanding of
current status of an organization regarding quality
improvement. This means that assessment of current activities
of an organization have to be performed. The good thing with
carrying out the assessment is that it makes it easy to know the
weaknesses and strength of an organization. Also barriers to
sustaining or maintaining quality improvement program can
become clear (HRSA, 2017). There are some common barriers
when comes to quality improvement projects that have been
identified. Some of these barriers are: lack of enough resources,

7. lack of good quality management organizational structure to
support the process of improvement overtime, lack of proper
communication and feedback to staff and providers, lack of
periodic feedback and monitoring, lack of interest as well as
changing priorities, and changing staff and not integrating
sufficient training to staff that is in existence.
The Ontario’s Health Care Organization has seen better
performance due to its quality improvement plan (Ontario,
2016). This health care organization has directed much attention
on making sure that it provides high quality and integrated care
to all its patients, residents, and clients. This is through making
sure that each and every person working for the organization
and in the organization has shared objective, which is providing
quality care. Provision of quality care will increase the
satisfaction of residents and patients when it comes to the
services of the organization’s services. The organization tries to
act as per the principles that are found in the Excellent Care for
All Act (ECFAA), which are related to the provision of
integrated and quality care. Furthermore, this is shared within
broader system initiative and priorities. Due to the Excellent
Care for All Act (ECFAA), the quality improvement plan for
Ontario’s Health Care Organization has created better
foundation for the health care system when it comes to
commitment in improving the quality of care Ontarians receive,
transparency, accountability, and directing focus to patient-
centered activities. The quality improvement plan for Ontario’s
Health Care Organization is a document that has information
regarding quality commitment that is in line with provincial and
system priorities (Ontario, 2016). The organization makes these
priorities to its patients and the society at large. As a result of
this, improving quality is made easier due to focused actions
and targets. Also, it becomes easier for the government to
monitor plans of various organizations when it comes to
achieving some defined targets through going through quality
improvement plans. Most organizations have quality
improvement plans that are almost similar. Even with similarity,

8. they have succeeded in attaining better performance due to their
quality improvement plans.
Ogrinc and colleagues (2016) directed much of their attention to
quality improvement program development process in their
research titled “for Quality Improvement Reporting
Excellence.” Many organizations have seen better performance
due to the used of an effective quality improvement program.
The use of a good development process while designing quality
improvement program is very important. There are some
organizations that have not been successful while using their
programs. A number of stakeholders should be involved in the
development process of an effective quality improvement
program. Some of stakeholders to be involved are the board of
directors for an organization, patients/ clients/residents,
clinicians, senior management, and other staff. The senior
management as well as the board of directors should make sure
that the organization is meeting targets that have been set out in
the quality improvement program. The performance
improvement of an organization will be supported by a good
quality improvement program. Due to this, goals of an
organization become very easy to attain, where the major goal
revolves around getting better returns or good profitability. The
development of quality improvement program should be driven
by system-level priorities. To be specific, these are metrics that
direct attention to integrated care across patient care settings
and across sectors. These have to be prioritized so as to come
up with quality improvement program that touches on the
functional integration efforts of the entire health care system
(Ogrinc et al., 2016). The needs of the patients, clients and
residents have to be taken into consideration while creating
quality improvement plan. This is because their health care
experience is what should be the top priority of health care
organization. This should be properly incorporated in the
quality improvement plan of an organization. The management
and other people designing the quality improvement program
should move even further to come up ways through which the

9. needs of customers can be enhanced in a way that the
organization was not performing earlier. It is possible to
achieve this through surveys or directly involving patients,
residents, and clients in the process of developing quality
improvement program. There should be incorporation of other
system priorities. This will be directed towards optimal
alignment across the region.
According to research carried out by Meehan and colleagues,
there certain steps that can be followed so as to develop a good
quality improvement program. The first step is to use
organizational-level data. Doing this will meant to determine
the current performance of an organization or coming up with
baseline for the priority indicators. Organizations that are not
having baseline should ensure that they begin the process of
gathering data deemed necessary in the process. The second
thing to do is to review the priority indicators for the
organization. Once reviewed, those that are relevant should be
determined. Reviewing the current performance of an
organization against theoretical best for all priority indicators
or provincial benchmarks will help support this process. If the
management decides not to include a priority indicator in the
quality improvement program (for instance, due to performance
that is already good, that is, exceeding the theoretical best or
benchmark), they should write down the reason in the comment
section of the quality improvement plan (Meehan, Loose, Bell,
Partridge, Nelson, & Goates, 2016).. Any other indicator that is
important to the quality improvement program of the
organization should be included. The third thing is to use the
guidance that is provided to create a program so as to address
each and every system level priorities that were identified for
improvement. The fourth process in developing quality
improvement program is to complete the Narrative to use to
communicate the priorities that have been created. Another
thing to be completed in this process is the progress report. The
final step is sign-off. Sign-off entails approving of the quality
improvement programs by parties that are involved, among them

10. key senior leadership, the Quality Committee (if applicable),
and the board of directors.
There are a number of benefits that are attributed to quality
improvement programs or plans (Aragona, Ponce-Rios, Garg,
Aquino, Winer, & Schainker, 2016). Effective quality
improvement program positively drives the quality improvement
process and structure, which support continuous quality
improvement, including re-measurement, intervention, analysis,
trending, and measurement. Also, the quality improvement
program plays a significant role in supporting practitioners
when it comes to quality improvement initiative. Governing
regulatory agencies have also seen some benefits due to quality
improvement program. Creating of service and clinical
indicators that show epidemiological and demographic
characteristics have been easy with quality improvement
program. Now, organizations are able to come up with good
benchmarks and design performance goals for periodic or
continuous evaluation and monitoring.
Quality improvement is the process of process management
(Haughom, 2017). The use of quality improvement program
entails incorporating modern quality improvement approach.
Generally, this helps to come up with modern organizations that
have the ability to deal with complex challenges that are
emerging in the market, such as those relating to managing
costs and improving profitability. The approaches involved in
the quality improvement programs are very simple. However,
they have the ability of dealing with extraordinarily powerful
issues. Much of the fact about quality improvement program and
plan is based on process management. Many industries in
different parts of the world have seen drastic changes or
transformation due to quality improvement techniques and
concepts. The use of quality improvement program is now being
embraced in most health care institution after seeing some
resistance for a longer time. Its effectiveness in the health care
industry will make other industries, such education to embrace
it with time. Health care is now very complex. But there is no

11. big difference between it and other industries. This is because
health care has about a thousand interlinked processes that are
interlinked to make it a complex system. It is possible to change
the challenges that are facing health care through directing
attention to these small interlinked processes. “Now, this may
seem like a tall order, but Pareto’s principle tells us that there
are probably 20% of those processes that will get us 80% of the
impact, so the challenge of every organization is to identify that
20%, roll up their sleeves, and begin the important work of
addressing those challenges” (Haughom, 2017, p. 9).
Rosenberg (2016) found quality improvement program to be
effective in insulin pen safety. The program was meant for
health care professionals. There have been reports of safety
concerns of insulin pen. Others have been relating to
commitment to continue insulin pen use as well as optimize
safeguards. This has affected the performance of some health
care when it comes to service provision and satisfaction of the
needs of customers. Through the use of quality improvement
program, staff education on insulin pen preparation together
with injection technique and improvement opportunities in
insulin pen best practices were properly identified and
implemented. The major problem that was identified during the
process is storage of insulin pens for people with contact
isolation precautions. It was easier to devise a practical solution
once the problem was identified. Other things that were carried
out during the quality improvement program were putting into
place of barcode medication administration, scanning of insulin
pens designed for certain patients, and prevention sharing of
pen among patients. Participation in the mentor quality
improvement program made it possible for the health
professions to improve their service delivery.
References
Aragona, E., Ponce-Rios, J., Garg, P., Aquino, J., Winer, J. C.,
& Schainker, E. (2016). A quality

12. Improvement project to increase nurse attendance on pediatric
family centered rounds. Journal of pediatric nursing, 31(1), e3-
e9.
Community Health Group (2016). Quality Improvement
Program Description. Retrieved from
http://www.chgsd.com/documents/QIProgDesc.pdf
Haughom, J. (2017). Five Deming Principles That Help
Healthcare Process Improvement.
Retrieved from https://www.healthcatalyst.com/5-Deming-
Principles-For-Healthcare-Process-Improvement
HRSA. (2016). Developing and Implementing a Quality
Improvement Plan. Retrieved from
https://www.hrsa.gov/quality/toolbox/methodology/developinga
ndimplementingaqiplan/
HRSA. (2017). Quality Improvement. Retrieved from
https://www.hrsa.gov/quality/toolbox/methodology/qualityimpro
vement/
Meehan, A., Loose, C., Bell, J., Partridge, J., Nelson, J., &
Goates, S. (2016). Health system
Quality improvement: impact of prompt nutrition care on patient
outcomes and health care costs. Journal of nursing care
quality, 31(3), 217-223.
Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff,
F., & Stevens, D. (2016).
Standards for Quality Improvement Reporting Excellence 2.0:
revised publication guidelines from a detailed consensus
process. Journal of Surgical Research, 200(2), 676-682.
Ontario (2016). Quality Improvement Plan (QIP). Guidance

13. Document for Ontario’s Health
Care Organizations, 132-237.
http://www.health.gov.on.ca/en/pro/programs/ecfa/legislation/q
ualityimprove/qip_guide.pdf
Rosenberg, A. F. (2016). Participation in a mentored quality-
improvement program for insulin
pen safety: Opportunity to augment internal evaluation and
share with peers. American Journal of Health-System
Pharmacy, 73(19 Supplement 5), S32-S37.
Swensen, S. J., Dilling, J. A., Mc Carty, P. M., Bolton, J. W., &
Harper Jr, C. M. (2016). The
business case for health-care quality improvement. Journal of
patient safety, 9(1), 44-52.