Describe a process with which you are familiar. List some factors that contribute to common cause variation. Cite some examples of special causes of variations.

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1. Identify (6) of Deming’s 14 Points for Management (pp. 28-32) that you believe are demonstrated in the organizational practices and employee behaviors of Bronson Methodist Hospital (BMH) [pp. 3-5]. For each Deming Point chosen, write at least one sentence describing the point in your own words and at least one additional sentence regarding how that point is demonstrated. State SPECIFIC CASE FACTS — not generalizations – to support your thoughts & maximize earning full point credit. (see attachments)
2. Describe a process with which you are familiar. List some factors that contribute to common cause variation. Cite some examples of special causes of variations.
3. Read Gerber Case (see attachment) Answer question: For each of the (6) TQ principles discussed in Chapter 1 (pp. 36-48), write at least one sentence regarding how that principle is demonstrated in the organizational practices and employee behaviors of Gerber. Use SPECIFIC CASE FACTS — not generalizations — to support your thoughts & maximize earning full point credit.
4. Answer question- What philosophical changes might be required to implement a Six sigma process in a hospital, government agency, or not-for-profit organization? Are they likely to be easy or difficult?
5.Read Case : Can Six Sigma Work in Health care?” (see attachment) answer questions A. What would be your agenda for this meeting? B.What questions would you need answered before proposing a Six Sigma implementation plan? C.How would you designan infrastructure to support Six Sigma at SLRMC?
6. How does DryMcDermott Petroleum Operations meet the expectations of its only customer, the Department of Energy? How does it exceed expectations?
7. Identify a customer-supplier relationship in which you are involved. How does it compare to the principles and practices of TQ relationships? In what specific ways could adopting some of the principles and practices discussed in this chapter improve this relationship?

Whose interests are really being served when mentally ill patients are legally obligated to take prescribed medications, despite the risks?

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Question 1:
Though policies vary province to province, in Canada, physicians have the legal right to enforce what are known as Community Treatment Orders (CTOs) if they feel that a patient, who has been diagnosed with a mental illness, must be legally held responsible to follow a prescribed course of treatment while living in the community. This often includes some type of prescription medicine as well as regular doctor visits (Strohschein and Weitz, 2014, pp.169). When this legal right is used, it is a clear exercise of the power of physicians. Yet it is also a reflection of our culture and societal standards.

Answer the following questions:
1. There are well documented risks and side effects to many antipsychotic medicines. Should people be forced into compliance?
2. Who has the power to define what mental illness is in the first place? How do these definitions serve to reinforce societal norms?
3. Whose interests are really being served when mentally ill patients are legally obligated to take prescribed medications, despite the risks?

Question 2:
In this discussion, you will consider and debate some of the barriers to cultural safety by answering the following questions:
a. According to traditional nursing thought, all people should be treated the same, regardless of their differences. Explain why this can be problematic.
b. There are time pressures in the workplace. Certain tasks must be completed at certain times and within certain routines that the institution has set. However, developing relationships with clients takes time. Discuss how this issue could be addressed. (Hint: Remember that often taking time initially to understand someone’s needs can actually reduce the time needed in future encounters).
c. What other barriers to cultural safety can you think of? How might those barriers be overcome? Can they be overcome?

Question 3:
Something to Think About
“…although descriptions of cultural characteristics and practices can be useful to health care practitioners and researchers, they can also reinforce stereotypes and simplistic views of particular ethnocultural groups as outsiders, as different, and as ‘other’” (Aboriginal Nurses Association of Canada et al., 2010, pp. 18).

“Cultural safety takes us beyond cultural awareness and the acknowledgement of difference. It surpasses cultural sensitivity, which recognizes the importance of respecting difference. Cultural safety helps us to understand the limitations of cultural competence, which focuses on the skills, knowledge, and attitudes of practitioners. Cultural safety is predicated on understanding power differentials inherent in health service delivery and redressing these inequities through educational processes (Spence, 2001)” (Aboriginal Nurses Association of Canada et al., 2009, pp.2)

“While cultural competence is an important concept, it can sometimes overlook systemic barriers, which makes it inadequate to fully address health care inequalities. Cultural safety, however, promotes greater equality in health and health care…[as it addresses the] root causes of health inequalities” (Canadian Nurses Association, 2013, pp.3).
Instructions
1. For this Discussion, answer the following questions:
a. Explain why cultural competence could be a step backwards.
b. How could having in-depth knowledge about an ethnic group actually be a bad thing when trying to practice culturally safe nursing?

Question 4:
Instructions
For this discussion, answer the following questions:
1. If it is possible to improve the well being of a client by implementing the principles of cultural safety, why would anyone oppose doing so?
2. Culturally safe practices challenge existing power relations in many ways. Describe how.
3. Most of the burden (as well as the opportunities) involved with implementing cultural safety is currently being placed onto the shoulders of individual nurses. Explain why you think this is.
4. Given what you have learned, do you think it is possible to practice cultural safety in nursing at this moment in Canada? Why or why not?

Question 5:
1. Do you believe it fair to say that white culture and white identity are privileged in Canada and that with this social position comes social power? Remember, the argument is also being made that most white Canadians will not recognize their unearned privileges because it is the norm.

2. Answer the same question asked above, but this time imagine you are a member of a different racial group than the one you were born into. Would this change your answer?

3. The norms, the laws and many of the most powerful institutions in the country are formed around white ideals and ideas in such a way that they are usually not questioned. For example, white people are not racially seen or labeled as white. They are ‘just the norm.’ What are some of the possible consequences of this for people who, by no choice of their own, can never fit ‘the norm’? What can be done to change this situation?

Question 6:
1. Acculturation is the process by which immigrants increasingly adopt the lifestyles and habits of their host country. Explain the effect this has on health status. Does this mean that acculturation is a good thing, or a bad thing?

2. The decline in health is not the same for all immigrants. Discuss why.

3. There are noted, subtle differences in the health statuses of different types of immigrants to Canada. The economic immigrant class tends to have the best health upon arrive to Canada, and the refugee class tends to have the worse. Discuss the social consequences of this for immigrants as well as the possible consequences of acculturation.

Opposition to Cultural Safety

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Question 5:
Opposition to Cultural Safety
There are many barriers that health care practitioners face when trying to provide culturally safe care. One of the most powerful barriers is the dominance of bio-medicine. Cultural safety challenges the current power structures within the institution of medicine. It challenges some of the traditional teachings of nursing.

It requires that “culturally safe practitioners…move beyond the critical self-reflective to engage in actions that address the broader sociopolitical and economic determinants…of health and challenge the taken-for-granted processes and practices that continue to marginalize…this demands, therefore, advocacy and the creation of multiple clinical pathways for clients that extend beyond biomedical models” (Smye et al., 2010, pp. 15).

This is not an easy task. Challenging dominant power relations never is.
Instructions
For this discussion, answer the following questions:
1. If it is possible to improve the wellbeing of a client by implementing the principles of cultural safety, why would anyone oppose doing so?
2. Culturally safe practices challenge existing power relations in many ways. Describe how.
3. Most of the burden (as well as the opportunities) involved with implementing cultural safety is currently being placed onto the shoulders of individual nurses. Explain why you think this is.
4. Given what you have learned, do you think it is possible to practice cultural safety in nursing at this moment in Canada? Why or why not?

Explain why this occurs and how culturally safe nursing practices can assist in stopping this from happening.

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Question 4:
Health Care in Practice
According to your textbook, “health care providers commonly associated and anticipated violence with poor and racialized people, despite the fact that they were aware that violence crosses all socioeconomic levels and cultures. Paradoxically, although they were likely to assume abuse as an issue among poor and racialized women, they also tended to view poor and racialized women as less deserving of care and support” (Strohschein/Bolaria, 2014, pp. 364).
Instructions
1. For this discussion exercise, answer the following questions:
a. Do you believe the paradox identified in quote above occurs and persists in health care practices. Remember to consider the power of stereotypes, prejudice and discrimination in Canadian society.
b. “In a disturbing example [of the use of power], nurses reported that a physician refused to call the sexual assault team to examine a First Nations woman who had been drinking, calling her a ‘social derelict’ (Strohschein/Bolaria, 2014, pp. 364). Discuss who had the power in this situation, and why you think the doctor could not call the sexual assault team.
c. Research findings have also shown that “support was often not offered or was withdrawn from women who were perceived as not making decisions that health care providers thought best” (Strohschein/Bolaria, 2014, pp.365). Explain why this occurs and how culturally safe nursing practices can assist in stopping this from happening.