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How process enterprises really work.

Many companies have succeeded in reengineering their core processes, combining related activities from different departments and cutting out ones that don't add value. Few, though, have aligned their organizations with their processes. The result is a form of cognitive dissonance as the new, integrated processes pull people in one direction and the old, fragmented management structures pull them in another. That's not the way it has to be. In recent years, forward-thinking companies like IBM, Texas Instruments, and Duke Power have begun to make the leap from process redesign to process management. They've appointed some of their best managers to be process owners, giving them real authority over work and budgets. They've shifted the focus of their measurement and compensation systems from unit goals to process goals. They've changed the way they assign and train employees, emphasizing whole processes rather than narrow tasks. They've thought carefully about the strategic trade-offs between adopting uniform processes and allowing different units to do things their own way. And they've made subtle but fundamental cultural changes, stressing teamwork and customers over turf and hierarchy. These companies are emerging from all those changes as true process enterprises--businesses whose management structures are in harmony, rather than at war, with their core processes. And their organizations are becoming much more flexible, adaptive, and responsive as a result.

Evaluation Studies as Topic↗

The ongoing challenge of defining quality.

Home care professionals want to provide high-quality care, and their rate of financial reimbursement is one of the variables that substantially affects their ability to do so. How will the advent of prospective payment, and the accompanying incentive to limit care, influence the quality of care? Clearly, agencies find themselves in a difficult position. Unless home health agencies are willing to stipulate that they had been previously providing unnecessary care, they would be disingenuous to suggest that quality will not be affected. Furthermore, for an agency to believe that quality has not been compromised in the face of evidence to the contrary could be seen as an institutional form of cognitive dissonance.

Home Care Services↗

[What messages did the Norwegian tobacco industry communicate to consumers in its advertising?].

BACKGROUND: A Norwegian official report, NOU 2000: 16, Tort liability for the Norwegian tobacco industry, concludes that Norwegian law and judicial practice allows lawsuits against the tobacco industry for damages. A crucial claim in such suits would be that the industry withheld information on health risks and addiction and instead used advertising messages that undermined the information campaigns initiated after the reports on smoking and health from the U.S. Surgeon-General and the Norwegian Board of Health in 1964. This article reports a study of differences in tobacco advertising in Norway before and after 1964. MATERIAL AND METHODS: A total of 1,945 photographs of advertisements in two popular weekly family magazines over the 1955 to 1975 period were stored in a database along with information on date of publication, size, copy and message, presumed target group, and characteristics of persons and situations shown. RESULT: Up until 1964, advertisement space per year in these magazines totalled 100 dm2 (11 sq. feet). The amount of advertising space then increased up until 1973, to 2,033 dm2 (219 sq. feet). The share featuring women went up from 33 in the 1955-64 period to 62% in 1965-75, when 51% of advertisements showed women smoking while 31% showed men smoking. Pre-1964 advertisements primarily contained information to smokers on price, type of tobacco, packaging and country of origin; after 1964 the advertisements developed a more universal appeal associating smoking with various social situations marked by style, well-being and comfort. The tobacco was said to be pure, fresh, mild and natural, and the filter was claimed to have protective properties. INTERPRETATION: It is probable that the cognitive dissonance created by more health information on smoking after 1964, i.e. the necessary motivation to quit, was reduced as a result of strategic changes in the amount and content of advertising.

Advertising↗

[Effects of exercise on anxiety, depression and mood].

This article reviews the studies on the effects of physical activity on the emotional states--anxiety, depression and mood. The meta-analyses of correlational and experimental studies reveal positive effects of exercise, in healthy people and in clinical populations (also in patients with emotional disorders) regardless of gender and age. The benefits are significant especially in subjects with an elevated level of anxiety and depression because of more room for possible change. The most improvements are caused by rhythmic, aerobic exercises, using of large muscle groups (jogging, swimming, cycling, walking), of moderate and low intensity. They should be conducted for 15 to 30 minutes and performed a minimum of three times a week in programs of 10-weeks or longer. The results confirm the acute effect of exercise i.e. the reductions in anxiety and depression after single sessions of exercise. The changes in anxiety, depression and mood states after exercise are explained most frequently by the endorphin and monoamine hypotheses. Exercise may also increase body temperature, blood circulation in the brain and impact on hypothalamic-pituitary-adrenal axis and physiological reactivity to stress. The possible psychological mechanisms include improvement of self-efficacy, distraction and cognitive dissonance.

Affect↗

Clinical, radiographic, and histologic perspectives on success and failure in endodontics.

There is a tremendous impact of multiple variables on the decision-making process in determining success or failure. The best approach to quality outcomes is to minimize the variables that can affect case adversity. Therefore, it behooves the clinician, who chooses to do endodontic therapy, to fully understand the level of treatment that is necessary to achieve success and to attain that level on a consistent basis. Additionally, the wise and prudent clinician should be able to assess completed treatment, with the proper integration of clinical and radiographic factors, in an environment that minimizes the shackles of bias and the dictates of cognitive dissonance.

Decision Making↗

Persistent traditional Yemenite ways of dealing with stress in Israel.

Using her own clinical-field case material, the author, an anthropologist working in ethnopsychiatry, analyzes and illustrates the contemporary Israeli-Yemenite cultural concepts and therapeutic approaches to mental illness. The sources and content of the traditional Yemenite health system are historically traced with particular emphasis on Judaism as the moral matrix. Despite the continuing identification and involvement with the traditional bases of health beliefs, it is pointed out that this folk conservatism has been no bar to the acceptance and utilization of scientific medicine. The Yemenite has been able to integrate, without apparent cognitive dissonance, both the traditional healers and the modern physicians. The moral approach of the Yemenite traditional healer in dealing with interpersonal, functional disorders, is reflected in the diagnostic and therapeutic behavioral and ritual prescriptions of Jewish religion and Islamic influences. In this connection, there is no incongruity perceived between the existence of the evil eye, devils and spirits possessing a person and the teachings of the Talmud.

Adult↗

[Suicide attempts in old age - a follow-up study (author's transl)].

48 patients above the age of 55 years were seen in a follow-up study 8 1/2 months after having been admitted to an emergency ward following a suicide attempt. Somewhat more frequent than in young persons the suicide attempts were caused by depressive or schizophrenic psychosis. Nevertheless, with the elderly the most frequent diagnosis was depressive reaction and neurosis. Physical illness was overrepresented in our group, but only in some cases fear of being ill was justified by the real physical status. Such cognitive dissonances were also found to concern the subjective valuation of the social situation. Some of the patients were satisfied with their living conditions though they were actually isolated. On the other hand patients with a high rate of social contacts sometimes complained of loneliness. A real social isolation of old people having attempted suicide seemed to be more rare than expected. Finally we found that the elderly chose different ways to seeking help from social and medical services in comparison to younger people. The personal tie to the doctor was of great importance for this group. - During the time of investigation only one patient had attempted suicide once more. But many of the patients were continuously reconsidering committing suicide.

Aged↗

Ethnically sensitive messengers: an exploration of racial attitudes of health-care workers and organ procurement officers.

This study examined attitudes of organ procurement employees toward black and Hispanic clients. Participants completed the Situational Attitude Scale (SAS). Findings showed that participants favored the person of color over the neutral, race-unspecified person when the person of color was in a subservient role. While the SAS items were not specific to organ donation scenarios, some inferences may be can be made. White organ procurement employees, dealing with white people significant to the donor, may experience little anxiety when placed in the role of service provider. However, when dealing with donors of color, white procurement employees may experience some cognitive dissonance. White employees may be comfortable being served by people of color, but uncomfortable serving people of color. This feeling, coupled with a lack of cross-cultural understanding, may create a communication barrier between procurement and donor communities.

Black or African American↗

Munchausen-by-proxy syndrome: countertransference as a diagnostic tool.

The authors report on an unusual reaction in clinicians interviewing known perpetrators of Munchausen-by-proxy syndrome (MBPS): an uncanny, ego-dystonic, and cognitively dissonant sense that the parent could not be the perpetrator, despite all clinical/forensic evidence. The authors suggest that this reaction can have various sources: One may be "as-if" character pathology in the parent, with the capacity to evoke, unconsciously, disbelief in the clinician. Given the poor treatment outcome reported in MBPS perpetrators, the authors suggest that, if confirmed, this finding will lead to more accurate psychiatric diagnosis of the parent, and more informed treatment of this potentially harmful or lethal syndrome.

Adult↗

Conception, commitment, and health behavior practices in medically high-risk pregnant women.

Based on cognitive dissonance and related theories of commitment, this study tested hypotheses that planning pregnancy and number of months spent trying to conceive would be associated with better prenatal health behaviors and that commitment to pregnancy and motherhood would mediate these associations. Participants (N = 96) were pregnant women at high medical risk for an adverse birth outcome. As predicted, planning pregnancy predicted better prenatal health care practices, and this effect was mediated by commitment level. Among women who planned their pregnancy, longer time to conceive predicted higher commitment but did not influence prenatal health behaviors directly. Women who had given birth previously practiced fewer prenatal health behaviors. Commitment, however, remained the strongest predictor of prenatal health care practices. Results are consistent with theories of commitment and with prominent approaches to the study of health behavior.

Adult↗

Physiological and cognitive effects of expressive dissonance.

Emotional well-being depends in part on affect modulation. The present study extends research on emotion regulation by assessing the physiological and cognitive effects of a novel response-focused regulation strategy, termed 'expressive dissonance.' Expressive dissonance refers to the incongruence between an emotional state (e.g., sadness) and a behavioral expression (e.g., a smile). Fifty-five participants watched a series of sad film clips in which they were asked to either naturally watch or express the opposite of what they were feeling. Results suggest that persons using the expressive dissonant strategies evidenced greater sympathetic arousal and performed worse on subsequent memory tasks than persons in the natural-watch conditions.

Adaptation, Psychological↗

Dissonance thin-ideal and didactic healthy behavior eating disorder prevention programs: results from a controlled trial.

OBJECTIVE: Negative body image, a common problem among college-age women in the United States, strongly correlates with low self-esteem, disturbed eating behavior, and eating disorders. Psychoeducational programs have inconsistently shown improvement in body image, thin-ideal internalization, eating behaviors, psychosocial functioning, and self-esteem. METHOD: In the current study, college women with body image concerns (N = 84) were randomly assigned to a cognitive dissonance-based, thin-ideal internalization, single-session workshop (DTI; n = 26); a psychoeducational, healthy behavior, single-session workshop (HB; n = 24); or a wait-list control (WL; n = 34). RESULTS: Comparing baseline data with 4-week follow-up data, results indicated that both DTI and HB participants reported improvement in body image, thin-ideal internalization, and eating behaviors. DISCUSSION: Results provide evidence that both interventions effectively reduce risk factors for eating pathology.

Adolescent↗

Self-exempting beliefs about smoking and health: differences between smokers and ex-smokers.

OBJECTIVES: The purpose of the present study was to examine the role of self-exempting or cognitive dissonance-reducing beliefs about smoking and health. Such beliefs may hold important implications for the content and targeting of health promotion campaigns. METHODS: A survey of smokers and ex-smokers was conducted in western Sydney, Australia. Six hypotheses were tested. RESULTS: The principal findings were (1) that 27.9% of smokers and 42.1% of ex-smokers agreed that smokers were more likely than non-smokers to get five smoking-related diseases; (2) that for 11 of 14 beliefs tested, more smokers than ex-smokers agreed to a statistically significant degree; (3) that the median number of such beliefs agreed to by smokers was five, compared with three for ex-smokers; (4) that for only 5 of 14 beliefs was agreement expressed by more precontemplative smokers than smokers contemplating or taking action to quit; (5) that more than one in four smokers, despite agreeing that smokers are more likely than non-smokers to get five diseases, nonetheless maintain a set of self-exempting beliefs. CONCLUSIONS: Fewer smokers than ex-smokers accept that smoking causes disease, and smokers also maintain more self-exempting beliefs. Becoming an ex-smoker appears to involve shedding such beliefs in addition to accepting information about the diseases caused by smoking.

Adolescent↗

Cognitive reactions to smoking relapse: the reciprocal relation between dissonance and self-esteem.

Perceptions of health risk associated with smoking, commitment to quitting, and self-concept were assessed among smokers before, during, and after their participation in cessation clinics. Consistent with expectations derived from cognitive dissonance theory, results indicated that relapsers' perception of risk declined after they resumed smoking, although the decline was significant only for relapsers with high self-esteem; high self-esteem relapsers experienced a significantly greater decline in commitment to quitting than did low self-esteem relapsers; and decline in risk perception among relapsers was associated with maintenance of self-esteem. The implications of these results for dissonance theory and the study of smoking relapse and cessation are discussed.

Adult↗