Johnson Beverage Inc Essay

As president and primary owner of Johnson Beverage, Inc. (JBI), Jack Johnson was beginning to realize that retaining long-term customers was becoming a challenge. During a delivery run yesterday, driver Joe Stevens had noticed a competitor’s sales manager talking with the general manager of Saver Superstore, one of JBI’s largest customers. Then, that morning, Johnson’s sales manager, Marsha Ketchum, had mentioned that, during her visit with the same general manager on Wednesday, he was starting to make some noises about wanting to negotiate a lower price. This could cause a dilemma because this customer had been one of the company’s largest and most loyal customers for years. Johnson leaned back in his chair. These things always seemed to come up on Friday— just in time to monopolize his thoughts over what otherwise would have been a restful weekend. Deciding to address the situation head on, he scheduled a meeting with Stevens, Ketchum, and several others for later that afternoon. Company Background JBI distributed beverages to retail customers. The company had been in business for two decades and had become a preferred distributor among several retail outlets in the local area. JBI primarily distributed bottled sports drinks made by small specialty beverage companies, and its business had grown steadily with the popularity of sports drinks over the past 10 to  20 years. Last year, JBI’s revenues totaled $12 million. The company serviced about 20 customers whose beverage purchases totaled anywhere from about $100,000 to over $1 million annually. The undiscounted list price on the sports drinks that JBI distributed was $15.20 per case of 24 bottles. The full cost (excluding customer service costs) of the bottled drinks was $13.10 per case. The company offered discounts to some of its customers, which varied by customer based on a number of factors, including the volume of drinks the customer purchased, the future potential of the customer, and the negotiating success of the company’s sales representative, among others. This case was prepared by Associate Professor Luann J. Lynch. It was written as a basis for class discussion rather than to illustrate effective or ineffective handling of an administrative situation. Copyright ïÆ' £ 2009 by the University of Virginia Darden School Foundation, Charlottesville, VA. All rights reserved. To order copies, send an e-mail to sales@dardenbusinesspublishing.com. No part of this publication may be reproduced, stored in a retrieval system, used in a spreadsheet, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without the permission of the Darden School Foundation. Rev. 6/09. This document is authorized for use only by madelene manu at Douglas College. Please do not copy or redistribute. Contact permissions@dardenbusinesspublishing.com for questions or additional permissions. The Meeting Johnson opened the meeting by summarizing what he had heard from Stevens and Ketchum over the past couple of days. â€Å"It looks like we’ve got some competition for one of our best customers: Saver Superstore. I guess I’m not too surprised. They’re a big customer.† â€Å"This isn’t the first time this has happened,† added Ketchum. â€Å"You might remember that this same competitor has approached Saver Superstore before. But that time, we were able to keep the business by offering a bit more of a discount. I think we’ll have to do more of that this time, or I’m afraid we’ll lose the customer.† Johnson responded quickly. â€Å"We can’t get into a price war on this. I know this is a big customer, and a loyal one too, but it’s certainly not one of our most profitable. I had Jim pull some numbers together on several of our accounts. Saver Superstore is one of our lowest-margin customers. Take a look.† Jim Thomas in accounting, who was also in the meeting, had prepared a report (Exhibit 1), which Johnson laid on the table for the others to look at. Thomas explained how the accounting group compiled the numbers: For each customer, we just pull the revenues right out of the accounting system. We know what they ordered and what we shipped, and we know what price we charge each customer, so that part is pretty easy. And we know that the cost per case, excluding our customer service costs, is $13.10. So we can multiply $13.10 per case by the number of cases we shipped to get our cost of goods. Then, we subtract our cost of goods from revenues for each customer and get a gross margin. Now, you may remember that we’ve talked about how hard it is to trace our customer service costs to any particular customer. Our customer service costs run about $1.2 million a year, roughly 10% of revenues. To make things easy, we allocate those to each customer based on its share of the company’s total revenues. So if a customer accounts for 5% of our revenues, we allocate it 5% of our customer service costs. Then, we calculate a customer margin for each customer. Johnson looked at the numbers and said: I don’t think we can lower our price to Saver Superstore much more and make any money on this one. And just think, if we offer a larger discount to them, then we’ll have our other customers wanting the same thing—especially the other big ones. I can see it now: Marsha is going to walk in here next  month and tell us that Oscar’s OddLots has heard about the deal we struck with Saver Superstore, has been talking with that competitor, and they want the same thing. This document is authorized for use only by madelene manu at Douglas College. Please do not copy or redistribute. Contact permissions@dardenbusinesspublishing.com for questions or additional permissions. Oscar’s OddLots, a large local retailer on the edge of town, was another of JBI’s large customers. Jason Rodgers, the operations manager for JBI, was listening carefully. This was the first he had heard of the situation, but to a careful observer, his nod would have revealed what he was thinking. He said: You know, I’m not a bit surprised to hear all this. Saver Superstore is a great customer. They buy lots of beverages, and they’re easy to deal with. They place their orders on a regular basis and almost never ask for anything special. I don’t remember the last time we had to run around in the warehouse pulling together a rush order from them. Who wouldn’t want that business? Stevens agreed, â€Å"You’re right. I almost never have to change my delivery schedule because they’ve asked for quick delivery. And they’re right around the corner, so they’re easy for us to get to.† Rodgers continued: I think about some of our other customers. They seem to never be able to  anticipate that they’ll be out of stock. Then they call us and make it our problem to deal with. It seems like we have some customers that we work on all day every day. Why can’t that competitor go after those customers? It’s hard for me to believe that some of those customers are more profitable than Saver Superstore. Maybe we ought to add what we guys in the warehouse call a â€Å"pain factor† onto those other customers and then see who is most profitable for us. As Johnson listened, he realized Rodgers might be onto something. â€Å"Jim, what types of costs are included in those customer service costs?† Thomas replied, â€Å"Well, that number includes several things.† He continued: It includes anything related to handling the beverages, like picking the beverages from the warehouse shelves according to the order instructions, moving the beverages over to the dock, and loading them on the delivery truck. It includes any costs related to taking, coordinating, and administering the orders, like what we pay the people in the sales office who take phone orders from customers, the supervisory costs to administer the order, and similar things. It includes anything related to delivering the beverages to the customer’s location, like the cost of the delivery trucks, truck maintenance, and what we pay Joe and people like him to drive the trucks. It includes anything related to all those rush orders you’re talking about, like overtime, extra scheduling, and stuff like that. And it includes what we pay Marsha for what she does, like visiting the customers to check in on them. So there’s quite a bit of stuff in there. Johnson thought about this. â€Å"So you’re telling me that there are some customers that you are spending a lot more time on than others? And it’s not Saver Superstore?† This document is authorized for use only by madelene manu at Douglas College. Please do not copy or redistribute. Contact permissions@dardenbusinesspublishing.com for questions or additional permissions. â€Å"That’s right,† Rodgers replied. Johnson continued, â€Å"But since our accounting system is allocating these customer service costs based on revenues, and since Saver Superstore is one of our biggest customers, it’s allocating a large share of those costs to Saver Superstore.† â€Å"Exactly,† Thomas said. Let me do this: Let me spend a couple of days collecting some information. I’ll need some help from each of you because I want to try to find out how much of your time you are spending on each of our customers. Maybe it’s time to get more sophisticated about how we look at these customer service costs. It may be worth the effort. Stevens, Ketchum, and Rodgers all agreed to spend some time with Thomas so he could summarize the amount of activity they devoted to each customer. They would meet again the following Friday. Thomas promised to compile an analysis that might help them determine how profitable each of their customers really was. Activity Analysis Before he left for the weekend, Thomas decided to pull together some information about the customer service costs he had described in the meeting: handling the product, taking the orders, delivering the product, expediting rush orders, and visiting the customer. He searched through the accounting system and determined how much of the annual $1.2 million in customer service costs was associated with each of those categories (Table 1). Table 1. Customer service costs during the prior year by area of activity. Area of activity Total $ Product handling Taking orders from customers Delivering the product Expediting deliveries (other than automobile) Sales visits to customers Total $ 672,000 100,000 140,000 198,000 90,000 $ 1,200,000 This document is authorized for use only by madelene manu at Douglas College. Please do not copy or redistribute. Contact permissions@dardenbusinesspublishing.com for questions or additional permissions. Then, on Monday, Thomas met individually with Stevens, Ketchum, and Rodgers. With their help, he determined what he thought to be the primary driver of the costs in each of those customer service categories (Table 2). Table 2. Cost drivers by area of activity. Area of activity Cost driver Product handling Taking orders from customers Delivering the product Expediting deliveries (other than automobile) Sales visits to customers Number of cases sold Number of purchase orders Number of miles traveled Number of expedited deliveries Number of sales visits Thomas determined from the company’s accounting records that the company sold 800,000 cases of beverages and processed 500 purchase orders the previous year. Stevens checked the mileage records for the delivery vehicles and determined that the vehicles had traveled a total of 44,800 miles. Rodgers was able to determine that the company made 4,480 deliveries, 2,500 of which were expedited deliveries. And finally, Ketchum checked her daily travel log to determine she had made a total of 360 sales visits to the company’s customers. Thomas’s next step was to determine how much of these cost drivers were attributable to each customer. Again, he was able to obtain some of that information (e.g., number of cases) relatively easily from the company’s records. Then his colleagues helped him determine customer numbers for the rest of the activities. Exhibit 2 presents this data for the four customers included in Thomas’s first report (Exhibit 1). Exhibit 1 JOHNSON BEVERAGE, INC. Report of Customer Profitability during the Previous Year for Four Customers Prepared by Jim Thomas Net revenues Cost of goods Gross margin Customer service costs Customer profit Customer profit (% of net revenues) Saver Superstore $ 1,168,000 1,048,000 $ 120,000 116,800 $ 3,200 0.3% Oscar’s OddLots $ 1,192,000 1,048,000 $ 144,000 119,200 $ 24,800 2.1% Midwellen Supermarket $ 121,520 104,800 $ 16,720 12,152 $ 4,568 3.8% Downtown Retail $ 454,500 393,000 $ 61,500 45,450 $ 16,050 3.5% Total for JBI $12,000,000 10,480,000 $ 1,520,000 1,200,000 $ 320,000 2.7% Exhibit 2 JOHNSON BEVERAGE, INC. Additional Information from Prior Year for Four Customers Price per case Number of cases Number of orders Number of deliveries1 Miles traveled per delivery Number of expedited deliveries Number of sales visits 1 Saver Superstore $14.60 80,000 16 110 5 10 12 Includes both expedited and regular deliveries. Oscar’s OddLots $14.90 80,000 40 400 19 250 25 Midwellen Supermarket $15.19 8,000 20 200 11 130 18 Downtown Retail $15.15 30,000 30 230 4 90 9 Total for JBI $15.00 800,000 500 4,480 10 2,500 360

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Therefore, to form a â€Å"change† culture can make changing organisational culture easier. However, it is also difficult to establish an organisational culture. It is need to experience a long time and face lots of difficult and challenges. According to levels of cultural analysis (Wood 2004), it shows how difficult to form the organisational culture, especially the deepest level of cultural analysis: common assumption. Common assumptions are to collect truths that organisational employees shares as a result of their common experiences and that direct beliefs and behaviours. It is extremely hard to isolate these modes, but it is interpret why culture is full of organisational life. It is hard to shape common assumptions if members of the organisation do not experience same ups and downs or cooperate long time. As Ferrara-Love (1997) stated that organizational culture does not appear in a night. On the contrary, organisational culture evolves during the time, and is the collective beliefs of individuals who worked together. Therefore, it is hard to establish organisational culture, to say nothing of changing organisational culture. At the same time, it is debatable to recruit plenty employees when the company want to change organisational culture. The new power is unstable to the company. It is hard for managers to control the new employees and it still need to cost much time. To conclude, it is difficult to change organisational culture. Organisational culture plays an ineradicable role to different kinds of organisational behaviours and members within organisations. Thus, it is always failure if certain problems of organisational culture were not being considered. Moreover, if managers want to change organisational culture which focuses on shared values or beliefs, it will be more difficult; because on the deepest of organisational culture, it formed invisible and omnipresent old guard or power which makes organisational change failure. As Locus and Kline (2008) stated that organizations always appear â€Å"learning disability† and â€Å"defensive routines† which obstruct the learning and organizational change. It shows the strong of conservative power. When managers try to change the organizational culture, they always face opposition. What was worse, the conservative power always important to the organisation. They make huge contribution to the company, which used to promote the development of company. Therefore, they play an important role to organisation. It is difficult for managers to challenge their authority. Moreover, the reason people do not want to change is the nature of people. People are easy to be used to do one thing and do not want to accept new thing. They are afraid of the unknown thing after change. As Ferrara-Love (1997) stated that people are comfortable with exist ways to finish the work. In their opinion, change is just the threat to their peaceful. Thus, they do not want to change organisational culture and dispute to change. It is obvious that changing organisational culture is so difficult. Leadership is the key to change organisational culture. The achievements of an organisation mostly depend on the leadership of managers. As Fishman and Kavanaugh (1989) stated that the culture of an organization and how employees want to change was formed substantially by leader. For example, if managers uphold to change organisational culture steady and have enough ability to direct staff, it will achieve maximum results with little effort to change organisational culture. Thus, managers are the guidance of the company; they are main factor to change organisational culture. Clement (1994) also expounded that management leadership is basic factor in a major organisational change effort. From this, it can be seen that the importance of leadership in change organisational culture. However, it is hard to change managers. If managers are not satisfied with their employees, employees can be changed, but managers will not changed unless the company go bankrupt. Thus, the most difficult to change organisational culture is to change the mind of managers. For instance, if managers make no attempt to make progress and milk-toast, it will be the most resistance to change organisational change. For this reason, the best way to change is from up to bottom. At the same time, change the mind and ability of leader is the difficult demand for changing organisational culture. To change organisational culture, managers have lot of things to do it. The role of managers is very important through up down system. As Ott (1989) suggested that the leader can do lots of things included staff selection, socialization, removal of deviating members, cultural communication and role model to guide behaviour. For example, managers can choose employees who will support to change organisational culture. Although it will not change the situation directly, they can be the power push the step of changing organisational culture. In the same way, managers can fire part of staff who opposes to change. It is not only reducing resistance to change organisational culture, but also overawe the opponent to change their minds. Furthermore, managers need to be the role model to change organisational culture. The behaviour of managers can be the maximum power to guide behaviour of managers. For example, when managers try to change organisational culture but not to do anything to change it, employees will not follow managers with any anxiety. To sum up, it is important to be the role model of changing organisational culture for managers. Furthermore, communication is an important tool for managers to change organisational culture. According to Fry (2003), he examined that leadership as motivation to change; managers need to communicate with employees about their feelings. In other words, managers should get in touch with employees and let them know core values of changing organisational culture and the need of changing organisational culture. The employees may understand the determination of managers and why to change organisational culture. Then, they can have their decision about changing organisational culture. In this way, it can reduce the distance between managers and employees, and let employees think they are also the participants to change organisational culture, they are not insignificant. When employees think they are the part of changing organisational culture, they will follow managers and try their best to help managers. At the same time, managers communicate with employees also can understand what employees think about and then do well about interactive. In addition, it can reduce the fear of employees about unknown future. As Kanter, Stein and Jick (1992) stated that communication is basic tool within any change process and failure to change always because of the feeling uncertain and anxious about their future. Thus, communication is very significant for managers to change organizational culture. In addition, to help employees to change organisational culture, managers need to teach them related skills and knowledge to work differently. As Ke and Wei (2007) suggested that employees thought to learn skills and knowledge as their main responsibility. Thus, employees may accept skills and knowledge easier than accept directly new culture. When they understand how to do, it may easy for them to accept to change organisational culture. At the same time, it is also the good way to remove their fear to uncertain future. When they master relevant skills and knowledge, they will be confident to deal with change of organisational culture. In this way, they will not fight against to change organisational culture as before. Then they can be the power help to change organisational culture. The most important things to change organisational culture are to change origin perception and beliefs. According to the definition of organisational culture, if managers want to change organisational culture, they must change shared values. The same as Whitely (1995) said that, managers need to be able to help employees to remove the past values which are not consistent with current shared vision of future organizational arrangements. The shared values and beliefs are keys of the organisational culture. Thus, managers need to change origin values of employees to change organisational culture. For example, managers can change new uniform to show the new the new appearance of company. According to Wood (2006), managers can create processes, systems and ways of working that enable to put the new values into practice. The new values can take place of the past one. In addition, managers can recruit and select new employees to help change origin values. As Harris and Metallinos (2002) stated that new employees were outside the company who did not affect by origin organizational culture, thus they were easy to accept new culture. That is why managers to select new employees to enlarge the power to change organizational culture. The new values and beliefs can be brought into the company in this way. In the same way, managers can retrain employees and engraft new rules to them, although it will not have better effect than new employees, it also can help to change organizational culture. In a word, managers need to create new values and beliefs to substitute origin one. Technology change also can promote to change organisational change. Although Weick (1990) thought technology change may make people anxiety about the values of new technology to their work, the new technology is the progress to organisational culture. There is no doubt technology change may improve work efficiency which may improve organisational culture. As Harris and Metallinos (2002) suggested that the application of new technology and subsequent development of system would promote standardization. The implementation of new technology can make employees understand new things which break routine. It also can be the sally port to open the mind of employees, let them know advantages of changing. When they can accept technology change, it is easy for them to support to change organisational change. Thus, managers can first bring in advanced technology to improve organisational change. Then teaching them to learn about it and establish new values in this process. This essay introduces what are the organisational culture and two main parts of organisational culture, the reason why changing organisational culture is difficult and how managers do to change it. This essay support to change organisational culture is so difficult because of the fear of unknown and difficult process to form organisational culture.

How Learned Helplessness Can Impact Patient Satisfaction Nursing Essay

How Learned Helplessness Can Impact Patient Satisfaction Nursing Essay Ever since To Err is Human did patients really start to care about the quality of care they received from their physicians, hospitals, and healthcare organizations. However, healthcare organizations had already recognized the importance of patient satisfaction several years earlier. Many organizations started measuring patient satisfaction as a way to judge the perceptions of how their patients viewed their experiences while under their care. There are many facets to measuring patient satisfaction but to date the concept of learned helplessness has not been incorporated into the mix. Learned helplessness is a phenomenon occurring in many places in our society. It affects how we work, interact with others, conduct our business, and employ our thoughts and views on healthcare. When experience with uncontrollable events leads to the expectation that future events will also be uncontrollable, disruption in motivation, emotion, and learning may occur. That phenomenon has been called learn ed helplessness (Cemalcilar 2003). Armed with a better understanding with how learned helplessness plays a role in patient satisfaction healthcare settings will be better able to alleviate this discomforting phenomenon and thus should raise patient satisfaction scores. This paper serves as a vehicle to investigate the concept of learned helplessness combined with a review of patient satisfaction and provide guidance for research to further our understanding of the relationship between the two. Literature review: Learned helplessness came about by accident in 1965 by Martin Seligman and his team while studying the relationship between fear and learning. Seligman observed an unexpected behavior while investigating Pavlovs theory on stimulus and response. Seligman didnt pair the bell with food but rewarded the dog with a small shock while restraining the dog to keep it from running away. The researcher thought that the dog would experience fear after hearing the bell and would try to run away or display some other type of behavior. After this the dog was placed into a box with two compartments divided by a low enough fence that the dog could see the other side and escape if the dog so desired. To their amazement, after the bell was sounded the dog didnt try to run away but instead just laid or sat on the one side of the box. The researchers repeated the test but instead of sounding the bell they gave the dog a small shock. As was the case with the bell the dog decided to stay on its initial sid e of the box. The test was repeated with a dog that had never been subject to any of the previous experiments and when given the shock the dog took flight and jumped over the small fence to escape. What was decided was that the first dog, while being restrained, learned that trying to get away from the shock was pointless and the dog had no control over its destiny and was therefore helpless. Some researchers have contended that the dog just thought he was being punished for some act of wrongdoing or that the end of the pain from the shock was indeed the reward. However, this behavior has been used in a variety of situations which will be explained here in an effort to learn more about this phenomenon. Learned helplessness has detrimental effects on children. They develop a lack of self-confidence in challenging tasks which result in deterioration of performances (Dweck, Davidson, Nelson, Enna, 1978). These children do not develop good problem solving strategies and can suffer from lack of attention and think that all of their efforts are fruitless. Children like this are often held back a grade in an effort to bolster their social and academic skills. In the end, they get a message that they are worthless and hopeless (Berger, 1983). These children may be inadequately prepared to take on new learnings and perform out of the ordinary tasks. Failure become synonymous in these childrens vocabulary and repeated efforts may do little to change their outlook. In Eriksons view, he suggests that children with few successes will become inferior which leads them to have a low self-esteem (Berger, 1983). Most learned helpless students give up trying to gain respect through their academic pe rformance so they turn to other means for recognition. They may become the class clown, bully or tease. When they begin adolescent years they try to gain respect through antisocial behaviors (Berger, 1983). With learned helpless children, competence is almost entirely destroyed. They lose confidence within themselves because they experience failures, leading them to believe they are failures. They might feel competent about something at first but if they fail in that activity they wont bother to try it again for fear of failure. Autonomy is also faint in a learned helpless students life. They feel as though they have no control over their environment because no matter how hard they tried in the past, they never succeeded. As for relatedness, learned helpless students feel as though they dont belong because they believe that they dont relate to the environment. This is why they become the class clown, bully or tease in order to get their recognition. These results may include becomin g an antisocial individual during their adolescent years or earlier. These three factors are all detrimental to an individuals growth and development in our social world today. There have been a few scales conducted and measured trying to use this construct in a variety of situations. The majority of these studies utilized learned helplessness as a secondary construct in explaining either complaint behavior (Lee and Soberon-Ferrer 1999) and measuring the relationship between empowerment and learned helplessness (Campbell and Martinko 1998). The study showed that there were many differences between empowerment and learned helplessness. Another study was conducted in a hospital setting with a reported reliability of 0.85. It had a positive relationship with Becks hopelessness scale (r=.252) and a negative correlation with Rosenbergs Self-Esteem scale (r=-.622) (Quinless 1988). Another way it can affect people is through different emotions such as pessimism, futility, risk aversion, depression, and self-esteem. It has been defined in people as a state of which the consumer cannot control their destiny or outcomes and therefore relinquish control over a certain situation. What research to date has been conducted to study patient behavior with learned helplessness? Raps et. al (1982) found that the longer a patients length of stay was the worse the patient performed on cognitive tasks that index learned helplessness. First, they determined this because of a perceived loss of control by the patient. Second, increased hospitalization resulted not only in increased deficits but also in increased vulnerability to identical deficits produced by minimal amounts of uncontrollable noise, suggesting that the process underlying the deficits in the no-noise conditions is learned helplessness produced by hospitalization. Third, increased hospitalization disrupted performance at the problem-solving tasks, but not at the verbal intelligence test-replicating the previous results from laboratory studies of learned helplessness and suggesting that the deficits of our subjects were not a general deterioration but instead a more specific difficulty with new learning (Rap s et al. 1982). Fourth, increased hospitalization produced increased depressive symptoms that covaried with poor performance both across and within conditions. This pattern suggests again that perceptions of helplessness caused the observed deficits, since depression involves a diminished sense of efficacy (Raps et al. 1982). Faulkner (2001) set out to investigate the relevance of learned helplessness and learned mastery theories in the respective development of dependence and independence in older hospitalized people. Faulkners experiment shows how an exposure to uncontrollable or disempowering circumstances potentially places patients at risk of developing learned helplessness. This condition has the potential to retard self-care performance in the absence of supervision, direction, or active personal assistance thus rendering patients dependent (Faulkner 2001). Moreover, this dependence may not remain specific to the task within which LH was induced, but may generalize to affect patient performance in other activities. To date the accepted scale to use when measuring learned helplessness is the LHS scale developed by Quinless and McDermott-Nelson. A conceptual definition is necessary in order to further explore this phenomenon. Learned helpless can be defined by a state in which a person thinks that they cannot control their own destiny and the life experiences which happen to them. This definition incorporates the key elements found throughout the research: loss of control, depression, low self-esteem, pessimism, and defeat. Learned helplessness can have the potential for explaining some variation in patient satisfaction scores. In order to further explore how the two are interrelated, an investigation into patient satisfaction must be employed. Patient satisfaction: With the effectiveness of medical care being increasingly measured according to economic as well as clinical criteria, the inclusion of patients opinions in assessments of services has gained greater prominence over the past 25 years (Sitzia Wood 1997). As health care budgets come under scrutiny, so consumers in the West have become more critical of the health care provided, organizing and claiming rights as active participants in the planning and evaluation of health services (Sitzia Wood 1997). An increase in interpersonal relationship interest sparked the development for a need to understand the patient-physician relationship which gave rise to patient satisfaction measurement. Consumer advocate groups such as the National Consumer Council produced Patients rights, which influenced the rise of consumerism in healthcare. The term patients rights became the rallying cry for Patients to have more control and say about the care that was extended to them. What then determines what pa tient satisfaction is? Linder-Pelz (1982) approached a definition of patient satisfaction through five social-psychological variables proposed as probable determinants of patient satisfaction with health care. These are outlined as: Occurrences-the event which actually takes place, and perhaps more importantly, the individuals perception of what occurred; valueevaluation, in terms of good or bad, of an attribute or an aspect of a health care encounter; expectationsbeliefs about the probability of certain attributes being associated with an event or object, and the perceived probable outcome of that association; interpersonal comparisonsan individuals rating of the health care encounter by comparing it with all such encounters known to or experienced by him or her; and entitlementan individuals belief that s/he has proper, accepted grounds for seeking or claiming a particular outcome. Ware et al. (1983) gives a more definitive taxonomy with eight dimensions: interpersonal mannerfeatu res of the way in which providers interact personally with patients (e.g. respect, concern, friendliness, courtesy); technical quality of carecompetence of providers and adherence to high standards of diagnosis and treatment (e.g. thoroughness, accuracy, unnecessary risks, making mistakes); accessibility/conveniencefactors involved in arranging to receive medical care (e.g. waiting times, ease of reaching provider); financesfactors involved in paying for medical services; efficacy/outcomes of carethe results of services provided (e.g. improvements in or maintenance of health); continuity of careconstancy in provider or location of care; physical environmentfeatures of setting in which care is delivered (e.g. clarity of signs and directions, orderly facilities and equipment, pleasantness of atmosphere); and availabilitypresence of medical care resources (e.g. enough medical facilities and providers). CMS has mandated the HCAHPS measures of patient perception of quality of care as a c ondition of Medicare participation (Griffith White 2007). CMS (Medicare) states the supplier shall conduct beneficiary satisfaction surveys and make the results available upon request and/or listed on their Internet website (if applicable). The supplier shall document and review on a quarterly basis a percentage of beneficiaries satisfied with services. These surveys include questions that are divided into five groups: Your care from nurses, Your care from Doctors, The hospital environment, Your experiences in the Hospital, When you left the Hospital, Overall rating of the Hospital, and Demographic questions. These questions must be incorporated into commercial patient satisfaction surveys and publicly reported. In some cases referring physicians may act as agents for their patients and are concerned with clinical outcomes, patient satisfaction and cost. This is important because if they are not satisfied with their patients responses, they may divert their patients elsewhere. However there are some concerns for those that dont buy into patient satisfaction scores. These fall into the category of social-psychological artifacts. LeVois et al. (1981) states that Social desirability response bias argues that patients may report greater satisfaction than they actually feel because they believe positive comments are more acceptable to survey administrators. Similarly, ingratiating response bias occurs when patients use the satisfaction survey to ingratiate themselves with researchers or medical staff, especially if there are any reservations over the anonymity of respondents (Sitzia Wood 1997). Why then study patient satisfaction? Typically patient satisfaction surveys are after the services have been rendered and the patient has left the hospital or physicians office. Most of the surveys use a 5 point Likert scale with 5 indicating excellent or highly satisfied and 1 being poor or highly dissatisfied. Most managers think that getting an average of 4s is very good or good enough and trying to achieve a 5 rating is too costly or time consuming. This is not the case. Many managers also think that they should focus on unsatisfied customers but research has shown that no matter how much time, effort, and money they invest, there will always be a small percentage of patients that are dissatisfied. Managers should then focus on moving those four ratings to fives. When it comes to customer loyalty, excellent has a different meaning from the other rating categories (Otani et al. 2009). Highly satisfied customers are the ones that are loyal and return for their next encounter or recommend others to the same physician o r facility. This usually comprises of about 75% of the physicians business so it is imperative that they keep this group happy and highly satisfied. In an emerging competitive market such as healthcare, managers should focus on achieving excellent ratings to distinguish their organization from others (Otani et al. 2009). Patients that are merely satisfied will seek care elsewhere and look for other providers. Even though the cost of switching hospitals is quite high, patients have more choices now than they did in previous eras. What are some other reasons to highly satisfy these patients? Satisfied patients tend to comply with prescribed medical treatments (Ford, Bach Fottler 1997). Due to an increase in chronic conditions, it is more imperative that patients follow the treatment process prescribed. This can reduce length of stays and lower readmission rates thus reducing costs. Also, it decreases switching. When a patient changes physicians, he or she may be required to retake te sts, which increases the patients costs and may hurt the patient (Otani et al 2009). Another factor is patient satisfaction is now considered a key part of the healthcare quality improvement initiative (Shortell and Kaluzny 2000). Many managed care organizations use patient satisfaction data to determine reimbursement rates to healthcare providers, and many leading companies will not contract with health plans that do not require a patient satisfaction survey. Providers with positive patient satisfaction survey results may receive more financial incentives than providers with poor patient satisfaction survey results (Kongstvedt 2001). In addition a 1 standard deviation point increase in the quality of pt/physician interaction equals a 35% lower chance of a patient complaint for the primary care physician, and a 50% lower chance of a patient complaint for a specialist (Saxton et al. 2008). Saxton (2008) also reports that a one standard deviation decrease in patient satisfaction equal s a five percent increase in the physicians risk management. Compared to physicians in top satisfaction scores: Physicians in middle 1/3 of scores had malpractice lawsuit rates 26% higher while Physicians in bottom 1/3 of scores had malpractice lawsuit rates of 110% higher. According to Saxton (2008) the top five patient priorities are: Response to concerns/complaints during stay, Degree to which hospital staff addressed patients emotional needs, Staff effort to include patient in decisions about their treatment, How well the nurses kept the patient informed, and Promptness in responding to the call button by the patient. One issue not investigated thoroughly is the billing activities of the hospital or caregiver. Richard Clarke, HFMA CEO and President has stated the best care, and great customer service provided during the patients hospital encounter can be destroyed quickly by confusing, complicated, or incorrect billing afterwards (Swayne et al. 2008). According to Swayne (2008, the top five hospital bill features that irritate customers the most are: confusion about what the patients insurance company has paid, confusion about the balance the patient owes the hospital once the insurance company pays its share, use of medical terminology that the patient does not understand, sending a bill to the patient before the insurance company has processed the patients claims, and inability to determine exactly what services the hospital has provided and what the patient is being charged for the service. Follow-on activities are also another area that the physician or caregiver can alter patient satisfaction scores. Many providers think that once the patient is out the door the experience ends there. After a patient has been seen by a physician or is leaving the hospital after surgery, there is a likely need for further services: a child with an ear infection has to return in 10 days for another check-up to make sure the infection is no longer present; after hip surg ery a patient may need to be relocated to a rehabilitation facility to learn to walk again (Swayne 2008). All of these additional services are value adding service activities. All of these factors play a role in learned helplessness as the patient may become frustrated by not having an excellent experience throughout the visit or after the visit. Proposed study: This paper shall utilize the current learned helplessness scale (LHS) and apply it to see how it moderates patient satisfaction scores. Method of study: The proposed model for this study is: Patient Satisfaction Scores Internal State of patient Patient Experience Learned helplessness Learned helplessness This research was consistent with the often used S-O-R paradigm. This paradigm assumes that environments contain stimuli (Ss) that cause changes to peoples internal or organismic states (Os), which in turn cause approach or avoidance responses (Rs) (Mehrabian and Russell 1974). It is anticipated that higher levels of learned helplessness will negatively impact patient satisfaction scores. The area most anticipated are those consistent with loss of control in fulfilling the needs of the patient, like care from the nurses, care from the physician especially in information sharing, and billing issues from either the hospital or the insurance company. The construct will be viewed as a moderator. In general terms, a moderator is a qualitative (e.g., sex, race, class) or quantitative (e.g., level of reward) variable that affects the direction and/or strength of the relation between an independent or predictor variable and a dependent or criterion variable. Specifically within a correlation al analysis framework, a moderator is a third variable that affects the zero-order correlation between two other variables. In the more familiar analysis of variance (ANOVA) terms, a basic moderator effect can be represented as an interaction between a focal independent variable and a factor that specifies the appropriate conditions for its operation. (Baron Kenny 1986). Data collection: Data collection shall be the most challenging facet of this study. It is important to gather rich data that will either support or disprove the theory that learned helplessness lowers patient satisfaction scores. A large enough sample is to be gathered in order to fully demonstrate this phenomenons capability. The LHS will be distributed along with the chosen hospitals patient satisfaction survey and patients will be asked to complete them. It may be necessary to delay the distribution of the survey so the patient has ample time to be contacted or experience learned helplessness form billing issues that may arise. After a sufficient number of surveys have been returned to the author, statistical regression methods will be employed to assess statistical significance as it relates to learned helplessness and patient satisfaction scores. Different factors can be cross-tabulated to see if there are any generalized effects on the scores like age, race, financial, and educational positions . Model fit could be assessed using SEM or other methods to ensure proper allocation and model assessment. Limitations As stated before data collection shall be difficult in performing this study. Hospitals may be reluctant to allow a researcher, independent of the organization, access to their patients and their satisfaction data. This reluctance could be over a variety of factors including patient privacy, fear of inappropriate scores released to the public, and a general distrust for academic research. It may be necessary to conduct this study as a joint venture so the hospital may learn from this study as well as the researcher. Another limitation is patient recall. This is always a factor since consumer recall plays a role in remembering perceptions, actions, and behaviors that occurred in the hospital or caregivers office. Since billing is an issue with learned helplessness, the delay in presenting the surveys may affect memory recall. The last limitation may be that of the construct being studied itself. Since there is little research on learned helplessness as it relates to patient satisfacti on or patient experience it may be difficult to determine how strong a score on the LHS scale must be to fully realize an effect on patient satisfaction. Conclusion: This paper has outlined the construct of learned helplessness and how it potentially could interact with patient satisfaction scores. Patient satisfaction scores are of the upmost importance to hospitals and caregivers as it affects their quality ratings, their allocation from CMS, and their reputation in general. While this project is a major undertaking, the author feels that it is worthy of such time and effort as patients and caregivers seek to further understand the patient experience in healthcare settings. This paper has outlined a course of action and while this project needs to be further investigated, it lays the necessary framework for a study worthy of journal submission. Future research could fully implicate different ways that learned helplessness is formed in different healthcare settings allowing for richer analysis into how patients react to different perceived outcomes. Hospitals and caregivers should be able to use information from this study to redesign their pati ent satisfaction surveys to allow them to gather richer data and use this to improve satisfaction scores which ultimately affect the bottom line. In this new age of healthcare reform, it is imperative that healthcare organization strive in every effort to raise the bar of patient outcomes, not only physical outcomes but mental outcomes as well.

Problems In Policy Implementation Policy And Education Education Essay

Problems In Policy Implementation Policy And Education Education Essay In a growing economy like UAE, there is a vital need for numerous numbers of policies to regulate this growth and cope with it. The direct effect of this growth is increase in the number of expatriates compared to nationals; those expatriates are from diverse cultural backgrounds that have their impact on the educational system in UAE and the increase in demand for new educational policies to deal the problem of cultural diversities in schools. Education policy refers to the collection of laws, rules, and regulations that run the operation of education systems. Education occurs in many forms for many purposes through many institutions (early childhood education, kindergarten through to 12th grade, two and four year colleges or universities, graduate and professional education, adult education and job training). Education policy can directly affect the education people engage in at all ages, it includes school size, class size, school choice, school privatization, tracking, teacher ed ucation and certification, teacher pay, teaching methods, curricular content, diversity in class, graduation requirements, school infrastructure investment, values that schools are expected to uphold and model, globalization challenges . The goals of new educational policies are to provide all children with an equal educational opportunity under the increasing pressure of diversities within classrooms. The ideal policy in general must include the responsibility are required changes in our methods of thinking and approaching education in such a way that all people are respected. More intercultural understanding and an awareness of social and global knowledge will need to be actively incorporated into our educational curriculums. Not only is knowledge of other cultures required but also creative and critical thinking will be developed to create new policies involving equalities in multicultural education (Bennett, 2010). In UAE, we cant say that there is one single policy to deal with the problem of increasing in diversities at schools in UAE, and each school has its own policy to deal with this problem. The need for policy Tharp (1994) states that The increasing diversity of cultural and ethnic groups in schools has led to a parallel increase in concern for the implications of this demographic shift for education .Most of the schools in UAE are focusing on culture in their policies; they are discussing how to create suitable educational culture in the classrooms and friendly atmosphere outside the classrooms to increase levels of interactions between the students. Cultural diversity is considered a major concern for many schools and it differs from school to another based on the types of students they have, and from what cultural backgrounds they come. Cultural diversity and Multicultural education is an idea, an approach to school reform, and a movement for equity between students, social justice, and diverse cultural recognition that is needed in order to adapt with the globalization movement. Specialists within diverse cultural education emphasize different components and cultural groups. However, a significant degree of consensus exists within the field regarding its major principles, concepts, and goals. A major goal of multicultural education is to restructure schools so that all students acquire the knowledge, attitudes, and skills needed to function in an ethnically and racially diverse nation and world (Multicultural Education, 2010). Good and idealistic policy will increase the focus on cultural diversity will help schools in maintaining educational equity for members of diverse racial, ethnic, cultural, and socioeconomic groups, and to facilitate their participation as critical and reflective citizens in an inclusive national civic culture, but is there an existence of such policies at schools in UAE? The awareness of cultural diversity concept in education tries to provide students with educational experiences that enable them to maintain commitments to their community cultures as well as acquire the knowledge, skills, and cultural capital needed to function in the na tional civic culture and community. Policies at private schools in Dubai There are many policies related to cultural diversities at private schools in Dubai, but the focus will be on the policy at DIS that is dealing with the issue of cultural diversity in and outside the classrooms. Social development culminates in its expansion to a global magnitude, where students place themselves and their culture in an international perspective, understands and accepts cultural specifics and differences, and assume the individual and national responsibilities towards international cooperation (DIS, 2010). This quotation is an example of how private schools in Dubai are referring to cultural awareness in their policies, but questions on the factors interfering in policy formation, like rules and believes of the surrounding environment, implementation and the relevant instruments rise immediately into discussion. This quotation is the policy of how to deal with cultural diversity at DIS, but it is considered short to express everything related to its values, too genera l, it lacks of implementation techniques, and it is considered implicit. Who put the policy and who will implement it, are considered major issue for the success of the policy; I will represent a sample of Institutional perspective on educational policy and practice ( figure 1, Scott and Meyer 1994), and what are the major parties involved is any policy from settings, implementation, monitoring and responsible for giving feedback. Institutional theory offers a more nuanced lens for examining the organizational and institutional conditions that mediate these reforms, and how they do or do not make their ways into classrooms. Namely, as represented in Figure 1, institutional theory draws attention to the broader cultural forces that help define the major parties involved in every policy (Patricia Burch, 2007). The major concern here is that the schools which refer to cultural diversity and awareness in their policies are not aware of it, and if they are aware; there is no clear method s of implementations and evaluating. Each policy is affected by the surroundings (stakeholders), that may interfere directly or indirectly in setting the policy, schools in Dubai are facing a problem of cultural diversity, but what are the solutions of going over this problem. Mentioning it in the policy is a part and solving is another part (words vs. action), and it is allowed for single school to take it own action in solving the problem without governmental interference. The policy is set by people in charge who may interact by either involving others in implementing it, or force others to implement it. Those people in charge are responsible for any change in the policy. Figure 1 How does the Policy view Culture? You can feel it within minutes of entering a school: the behavior of the students, the attitude of the teachers, the care for the physical plant, the artifacts of discovery, learning, curiosity, community, expression and intellection that adorn the walls of the place, it is obvious that this is a place where young people and teachers learn (Bill Schubart 2010). Good policy must include the characteristics of good and learning culture that is aware to students from diverse culture and give them equal chances of learning, and increase their sense of awareness towards each others. Good educational and learning culture is not driven by high property taxes, escalating school budgets, federal or state legislation, national testing, good buildings, nice classes or teachers unions. It is a modeled behavior set by leadership in the school, followed by a critical mass of the teaching body, all of whom are accountable for the culture and spread it by their own example and experience, their comm itment to a community of learning, removing cultural diversities and barriers between students, their respect for one another and for their students (Schubart, 2008). What is the teachers role in implementing and adopting the policy? The diversity in classrooms presents unique opportunities and significant challenges for teaching. Students in UAE schools are with a wide variety of skills, abilities, and interests and with varying potentials in various areas. The wider the variation of the student population in each classroom, the more complex the teachers role becomes in, teaching, organizing, motivating and controlling students to ensure that each student has access to high-quality learning . The ultimate goal of any teacher is to find suitable approach to every student in the classroom, and try to motivate him in a way to get the best from him. To reach that goal, teachers need assistance, training and well designed curriculum that must fit the needs of all students. Many schools have prepared their teachers to deal with diversity cases in their classrooms and leave it for the teacher to evaluate the situation and find the suitable solution to eliminate those diversities in order to get the best from students, and increase their sense of belonging. The policy at DIS doesnt mention any point related to the teacher role in the implementation of the policy, how it will be applied, what other parties to be involved (supervisors and parents), and the changes in curriculums to facilitate the implementation process. This implicit policy is considered too short to discuss every single aspect related to the problem and put pressure on teachers to figure out personal solutions to deal with diversities in their classrooms. Those solutions are not standard; they vary from teacher to teacher and from class to class. Good policy doesnt give margin for such variations; it must have clear values, well articulated, the action required from this policy must be stated, and the methods of implementation must has to included in the policy. Where are the errors of implementation? (Implementation Gap) The policies in general are clear, written in a good professional language, and they are considered part of schools mission. The problems are not in the policy or its values only, but in the implementation of those policies, and the lack of communication between various parts responsible for applying the policy. There could be implementation gap as a result of many factors, which could arise from the policy itself, the policy maker, or the environment in which the policy has been made. Implementation gap can arise from the policy itself when such a policy emanates from government rather than from the target groups. By this, it means that planning is top-down. And, by implication, the target beneficiaries are not allowed to contribute to the formulation of the policies that affect their lives, the target groups could be the teachers, students, and families (Makinde, 2005). Another cause of implementation gap is the failure of the policy makers to take into consideration the social, po litical, economic and administrative variables when analyzing for policy formulation, as I referred in the beginning of this paper there is gap between private and public schools polices concerning cultural policies, public schools that are only attained by nationals with unified curriculum all over the country, put less pressures on those schools to realize cultural diversities between their students. Conclusion Schools in UAE are considered melting pot of students from diverse cultural backgrounds that need a suitable polices to achieve equal educational opportunities that will help them to realize other cultures, and increase students openness to diverse cultures. Polices alone without the suitable instruments of implementation is considered useless, good implementation is considered key success for any policy that put policy in action. Considering targeted group in setting the policy and involving them will increase its credibility and make the implantation easier to a certain extent. The policies must be clear, written in a good professional language, and they are considered part of schools mission. The problems are not in the policy or its values only, but in the formulation and implementation of those policies, and the lack of communication between various parts responsible for implementing the policy.

San Gabriel River and its drainage problems :: essays research papers fc

In 1938, the San Gabriel Mountains (Los Angeles, USA) experienced heavy amounts of rain. This then led to mass movement, such as mudslides, and flash flooding, which flushed through downtown LA, damaging buildings, homes and vehicles. After these events, a flood committee was formed, and networks of hard defences were set up along the long profile of the San Gabriel River. The aim: decrease the hydrograph, and reduce the risk of flooding. In the upper course of the San Gabriel River, the San Gabriel Dam was built. This is a filtering dam, and uses sluice gates to prevent large boulders from progressing down river. By doing this, the amount of sediment in the river decreases, which reduces the possibility of flooding from high sediment yield, and in the case of a flood, there will be no harmfully large sediment. Problems, however, are that the velocity of the river increased as there is less load to carry, which makes the erosion process scarce, as attrition and corrasion cannot take place. Also the riverbed and slip-off slopes of the river are very weak and can erode easily from hydraulic action. Then there are open dam systems, like Santa Fe and Maddock, where the river is stored and filtered of its sediment. This shares the same benefits of the sluice gates, however, it means no natural levees can form on the riverbanks. Further downstream, there are large control dams and artificial diversion-zone river basins, like the Wittier Narrows. When the river begins to flood, the control dams close, and form a barrier. This completely prevents the river from flowing downstream. The water is then detoured into the artificial basins, like the Wittier Narrows where it is stored until the river returns to its normal level. Then the control dams gradually re-release the stored water into the stream flow. This is effective as it prevents the flooding entering the downtown area. It also allows for things like hydroelectric power and water supply to be easily obtainable, without affecting the main river flow itself for too long. This problem is that this can lead to the starvation of habitats living alongside the river, as there is no water flow.

The Madina Collection of Islamic Art at the LACMA Essay example -- ess

The Madina Collection of Islamic Art at the LACMA Introduction   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  The Los Angeles County Museum of Art (LACMA) announced recently that it had acquired â€Å"the remarkable Madina Collection of Islamic art. The collection contains works of various media dating from the late 7th through 19th centuries from the vast areas that comprise the Islamic world, from Southern Spain to Central Asia† (Los Angeles County Museum of Art, 2005). While the museum already had quite an extensive collection of Islamic art, this particular exhibit truly adds the collections as a whole. The Madina Collection of Islamic Art   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  The first item to be examined is a bowl from the 14th century, from either Egypt or Syria (Los Angeles County Museum of Art, 2005). It is ceramic, fritware and is underglazed-painted (Los Angeles County Museum of Art, 2005). It is 10 and  ¾ inches in diameter. The design is very symmetrical and incredibly colorful in its green and cream along with black lines. Without knowing what the design symbolizes one could imagine that it is very much an Islamic design, and appears to be religious or spiritual in content. There is a Mandela presence to the design, with very strong lines and striking elements. http://collectionsonline.lacma.org/mwebcgi/mweb.exe?request=record&key=8533   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  The next piece to be examined is cup from the 13th century, from Greater Iran. This cup is â€Å"Silver, gilded, chased and punched† and measures â€Å"3 7/8 x 4 5/8 in. (9.84 x 11.75 c...

Journal of Service Quality and Customer Satisfaction in Transportation Essay

International Journal for Quality research UDK- 656.025.2:658.56 Short Scientific Paper (1.03) SERVICE QUALITY AND CUSTOMER SATISFACTION IN PUBLIC TRANSPORTS Filipa Fonseca1) Sofia Pinto1) Carlos Brito2) 1) Faculty of Economics and Management, Catholic University of Portugal, Portugal 2) Faculty of Economics, University of Porto, Portugal Abstract: The objective of the paper is to identify the determinants of service quality as well as its impact on the satisfaction of public transport commuters. The paper explores the relationship between service quality and customer satisfaction in a public transport service taking into account both internal and external perspectives. In order to analyse this relationship, the concepts of service quality, consumer satisfaction and dissatisfaction are assessed. A model of analysis is developed aiming at explaining this relationship and guiding the empirical study. This is based on an exploratory case study of a metro company in Europe. The results of the study put in evidence two key findings. The first is related to the level of service quality in its main dimensions. We conclude that reliability, security, speed, comfort and punctuality are quality dimensions of greater importance for the public transport services. Secondly, the study explores satisfaction and their determinants. Despite literature stipulates the existence of a distinction between the constructs of quality and satisfaction, this study found that the transport company, non-customers and customers clearly do not make such a distinction. Keywords: service quality, satisfaction, dissatisfaction, public transport 1. INTRODUCTION Marketing researchers have, for a long time, recognized the importance of service quality as well as consumer satisfaction. Significant investigation has been conducted in both fields, particularly in services (cf. Andreassen, 1995; Edvardsson, 1998; Friman e Garling, 2001; Higgs et al., 2005). However, few studies have explored the both sides of the service process: operations (the internal side) and customer (the external side) perspectives of quality and satisfaction. In the public sector this is likely to be of particular interest. Public services, such as public transportation, have to meet the needs of the customers playing, at the same  time, a role in economic and urban sustainability. They challenge operations to deliver quality to serve customers and non-customers while making the best use of company resources. Read more:  Investigation Into Customer Service The objective of this article is to identify the determinants of service quality and its impact on the satisfaction of public transport commuters. It is divided into five sections beyond this introductory section. It begins with a review of the literature that synthesizes and discusses some concepts considered relevant for the research. Then it addresses the methodology used in the study, as well as a number of considerations about the quality of the research design. The next section presents the findings, which are followed by a discussion of possible implications. Finally, the paper ends with the main conclusions, managerial implications and some suggestions for further research. 2. THEORETICAL BACKGROUND The theoretical background is developed around three major issues: quality, satisfaction and dissatisfaction. In the management context, the word quality can be used to refer to different things: accordance with the specifications (Levitt, 1972; Juran and Gryna, 1991); excellence (Garvin, 1984); accordance with the requirements, adequacy of use, prevention of losses, or how to answer to or to exceed consumer expectations (Grà ¶nroos, 1984, Parasuraman, Zeithaml and Berry, 1985, 1988). Through such a variety of concepts, the common point of most of the definitions, exception for the first one, is that of targeting the consumer. In this research, quality is presented in the perspective of perceived quality because it is the most commonly used in the services area. Moreover, the research led to a better understanding of the existence or the non-existence of differences between quality and satisfaction. These arguments were enriched by the literature review of each theme, particularly satisfaction which is presented next. Literature about satisfaction has to be adapted to the context which is to be studied. Customer satisfaction is seen as an answer to completion and fulfilment of needs (Oliver, 1996); a psychological state (Howard and Sheth, 1969) and as an assessment of overall evaluation (Westbrook, 1987). Moreover, consumer satisfaction is seen as a cognitive response (Bolton and Drew, 1991; Tse and Wilton, 1988), an emotional answer (Cadotte and Turgeon, 1988; Halstead, Hartman and Schmit, 1994; Westbrook and Reilly, 1983) and as a result of a Vol.4, No. 2, 2010 125 development process (Oliver and De Sarbo, 1988; Tse and Wilton, 1988; Swan, 1992; Erevelles and Leavitt, 1992). Although literature encompasses diverse meanings for satisfaction, they all share common elements. When examined as a whole, three general components can be identified: (i) consumer satisfaction is a cognitive and emotional reaction; (ii) the reaction belongs to a particular focus, (iii) the reaction occurs in a particular period (after consumption, after choice based on experience and expressed before and after choice, after consumption, after extensive experience of using). From the literature it also seems that there is not a general consensus regarding the nature of this concept. If some authors argue that consumer satisfaction results from a specific transaction that occurs at a given time and by the benefits and value of the transaction, others see consumer satisfaction in terms of cumulative overall satisfaction, based on all contacts and experiences with a company and the client’s experience until a certain moment. Literature on customer satisfaction also clarifies the concept of dissatisfaction. For some researchers, these two concepts are totally different while for others, dissatisfaction is on one end and satisfaction is on the other end of the same continuous line, and it is stated that some of the determinants are primarily a source of satisfaction or dissatisfaction. So, this study also intends to make clear the differences between the two concepts. Dissatisfaction has been the focus of extensive research in the services area (Swan and Combs, 1976; Maddox, 1981; Cadotte and Turgeon, 1988; Johnston, 1995; Edvardsson, 1992, 1998, Liljander, 1999). From the literature, once again, contradictions amongst authors tend to arise. According to some researchers satisfaction and dissatisfaction are two different concepts, that is, the consumer can be satisfied or dissatisfied according to the level of received quality. However, for some other authors, the two concepts are not opposing,  but rather a continuum, in that, some determinants tend to be, firstly a source of satisfaction and others a source of dissatisfaction. A number of studies (cf. Edvardsson, 1998) have focused on how passengers of public transport value quality factors, and the final result provides a measure of the value of different factors and ranks them. Nevertheless, there are not significant studies about satisfaction in public transports, especially in metro services. Another gap in literature is that most studies analise customers, but leave non-customers aside. Furthermore, most studies use an external analisys based on surveyss. Finally, the majority of the literature does not execute further analyses about the correlation between customer satisfaction and insatisfaction. 3. FRAMEWORK FOR ANALYSIS In this research the process of data analysis began before its collection, by developing the research questions and model of analysis. The model of analysis developed would examine how quality relates to satisfaction and how this relationship takes place in a public transport services company. To ensure coherence and reliability of the empirical data, the elements which were under investigation and their respective variables were defined, as outlined and presented in Figure 1. Dissatisfaction (Johnston,1995) (Bo Evardson, 1996) Customer Satisfaction (Tse e Wilton, 1988) (Rust e Oliver, 1994) Zone of Tolerance (Berry e Parasuraman,1991) (Johnston, 1994) Personal Needs Experiencied Quality Technical Functional (Grà ¶nroos, 1982) Perceived Quality (Grà ¶nroos, 1982) Suggest Positioning Expectations (Teas, Boulding, Oliver, 1993) Pass-Word Beliefs Consumer Comunication Quality Dimensions: †¢ Reliability †¢Security †¢ Speed †¢Confort †¢Pontuality (Parasuraman, Berry, Zeithaml, 1885) Past Experience Figure 1 – Framework for Analysis 126 F. Fonseca , S. Pinto , C. Brito According to this diagram, the relationship between quality and satisfaction may be understood through a clarification of how customers evaluate the dimensions of quality. The zone of tolerance appears to be used as a unifying link between expectations, performance and results. Previous service marketing challenges have prompted some research questions about the relationship between quality and satisfaction, specifically:RQ1: In public transportation services, what are the determinants of service quality that influence perceived quality?RQ2: How does the perceived quality influence satisfaction and dissatisfaction of commuters in public services transports?Performance evaluations lead to an overall evaluation of service satisfaction, the results of which can be resumed to either satisfaction or dissatisfaction in general terms. The zone of tolerance emerged as important in the understanding of the relationship between quality and satisfaction. 4. METHODOLOGY The research clarifies the key dimensions of services quality that influence customers’ perceived quality. It also explains how the perceived quality influences customers’ satisfaction and dissatisfaction. In addition, the study explores and expands on findings or current theories about the differences and the relationship between satisfaction and dissatisfaction. Evidence was found that there are two different realities in the market: the customers’ and the non-customers’ complex perceptions. Finally, the research identifies the relevance of the zone of tolerance and its relationship with quality and satisfaction. The use of a case study approach seemed to be appropriate in this research. Within qualitative methodologies, a case study strategy was adopted, based on the interaction between theory and empirical data. Yin (1994) defines case study as an empirical study that investigates a contemporary phenomenon in real life context, especially when the boundaries between the phenomenon and context are not clearly evident. In terms of features associated with the processes under study, it seems  important to focus on contexts in which the phenomena developed. Moreover, this method allows the focus on perception processes more than outcomes, and how the participants interpret their experiences and give them meaning. Exploratory and â€Å"how† questions are being posed, and the researcher is focused on a contemporary phenomenon within its real-life context (Yin, 1994). The research objective was to describe and understand processes and relationships in a consumer services organization. Attention was drawn to the processes, which was the study’s unit of analysis. The focus of analysis of this research was teams, groups and departments.Data was collected by both interviews and focus groups, as well as through documents. The interviews focused on the company’s perspective of quality and customer satisfaction, while the focus groups with customers and non-customers provided the market’s point of view. The interviews included people from different functional areas (operations and marketing) and hierarchical levels (executive vicepresident, director of technical systems, director of marketing and communication, manager of operational safety, lawyer and supervision of securities and marketing manager – processing of complaints and suggestions). In addition to the interviews, focus groups were conducted outside the company with customers and non-customers. The main objectives of the focus groups were to identify the most important determinants of satisfaction and dissatisfaction of both customers and non-customers, and to obtain or draw up a list of the determinants considered most relevant and most often expressed by the participants. Specifically, the analyzed documents consisted of: annual company reports, market research reports on service quality and satisfaction and internal memos. A pilot focus group was carried out to test the discussion guide and the survey. Subsequently, four focus groups were made. There were a total of 26 people involved (men and women). The age range of the participants selected was 13-35 years of age, this because prior studies had indicated that 65 percent of the commuters using the metropolitan were within this age range. The selection criteria used aimed at selecting participants consisting of customers who use the metropolitan, at least once a week and non-customers who had never used this transport service. The focus groups were recorded and handwritten transcription notes were taken for later analysis. The focus sessions were  divided in two distinct parts. Initially, the discussion focused on the reasons that would lead customers to use or not use the metropolitan. Subsequently, the focus was shifted towards the determinants of satisfaction and dissatisfaction and on the characteristics that are most valued in this service. The process of analysis and interpretation of data began with the transcription of the interviews and group focus. All of this met with the objectives of the research, including with comparing and contrasting the different views of stakeholders on issues of the research and allowed for individual analysis and comparisons of the case study. Data was also analyzed and grouped, then codified and reduced employing a systematic approach that complies with that proposed by Miles and Huberman (1994). 5. RESULTS AND FINDINGS The study focused on a company created in 1993 to operate a light rail system in the second largest city of a European country. For a matter of confidentiality, it will 127 F. Fonseca , S. Pinto , C. Brito be called Metro Europe. This is a network of electrified railways that goes underground in the city centre, and above the surface in the suburbs. It is divided into five separate lines (with seven services, including an express service) spread over six municipalities in the city metropolitan area. It comprises a total of 68 stations spread over 60 kilometres of commercial lines, with 8 kilometres of underground network. In 2008, this company employed about 120 people and carried 40 million commuters. Metro Iberia is a player in a context of a strong competition and is one of the companies responsible for the operations of public transport in the metropolitan area. The analysis of this mass consumer service follows in the next section. The study results point out two main perspectives. One related to the level of service quality in its main dimensions. It was concluded that reliability, security, speed, comfort and punctuality are the quality dimensions of greater importance for the public transport services company. Secondly, the study explores satisfaction and their determinants. The results showed that the dimensions of satisfaction for the company were exactly the same as  those of dimensions of service quality, in particular, security, reliability, comfort and speed. This analysis shows us that the company does not distinguish quality from satisfaction. Evidently, it seems that the dimensions of quality and the determinants of satisfaction are identical. There appears to be no clear difference between quality and satisfaction, findings that are no surprising. The main objective of this research is to understand the relationship between quality and satisfaction. It was found that the organization under study does not make a distinction between these two concepts. Therefore focus groups with the company’s customers were also conducted and undertaken. The objective would be to determine and discover the main determinants of satisfaction, comparing them with results obtained in the organization. In the focus groups it was found that commuters value exactly the same determinants of satisfaction as those advanced by the company, in particular comfort, punctuality, speed and reliability. One exception is safety, the conclusion being that customers assume from the outset that the metropolitan is safe. This is in line with the Johnston’s (ref?) argument about the hygienic factors having potential for dissatisfaction instead of satisfaction. The results also helped to further understand the views of noncustomers, from which we can conclude that the most mentioned determinants were reliability, comfort and cleanliness, security and punctuality. For these reasons it is concluded that despite the literature’s stipulation of the existence of a distinction between the constructs of quality and satisfaction, this study found that the company, non-customers and customers clearly do not make such a distinction. It seems that business, customers and non-customers all use the dimensions of quality to describe satisfaction. A more careful analysis of the case leads to the conclusion that quality and satisfaction are not entirely distinct and there is also a relationship between the two concepts. The relationship between quality and satisfaction exists when satisfaction is guaranteed. Their ability to meet the needs of the consumer with the service, must take into account the quality of service and its dimensions. Another view shown in this paper was the distinction between satisfaction and dissatisfaction. The study acknowledges that for non-customers satisfaction and dissatisfaction are opposing concepts. Moreover, the determinants of dissatisfaction are exactly the opposite of satisfaction, namely: reliability/failure to comply with schedules; comfort and cleanliness/discomfort and dirt; security/insecurity; punctuality/failure to comply with schedules. An interesting finding is that, these results are in line with literature. For customers there is no such relationship between satisfaction and dissatisfaction; dissatisfaction in this case is commonly associated with the technical aspects of the service. It is therefore not clear to customers that satisfaction is the opposite of dissatisfaction. While for the company, the conclusion is that these concepts are contrary, when referring to cofort/discomfort; security/insecurity at night/delays and robberies. Finally, the results for customers and noncustomers tolerance zones were examined. The paper confirms that customers have a greater tolerance zone towards the service than non-customers. In other words, non-customers are less tolerant to failures than customers. This conclusion is evidenced by the customers when they say that in the event of failures or problems with the service, such as delays, lack of cleanliness and lighting, or lack of seating, these reasons alone would not lead to abandoning the service. It is concluded that in the case of customers there may be some oscillation in the levels of satisfaction (very satisfied, satisfied, unsatisfied) within the zone of tolerance. Non-customers are less tolerant. In these discussion groups’ several situations or scenarios of dissatisfaction emerged that would cause abandoning the service, including failure to comply with the vehicle schedules, frequency of carriages and disabled access to the stations. 6. CONCLUSIONS This study answering RQ1 expands on existing knowledge by identifying that service quality dimensions serve as points of departure for companies to develop action plans and strategies that generate perceptions of quality by customers. Thus, for each type of service there may be a specific set of different dimensions of quality, in that they assume different orders of priority. Additionally there is yet another 128 F. Fonseca , S. Pinto , C. Brito possibility that each organization may have dimensions that are specific to each/its sector. The classification of the service quality dimensions is important because each one brings different approaches, which help the managers of the companies providing services to understand the importance of each dimension and their impact on customer satisfaction. The empirical data of this case indicates that reliability, safety, speed, comfort and punctuality are the dimensions of service quality which the organization believes most influence the perceived quality. This study also clarified and thus contributes to identify the key dimensions of service quality that influence the perceived quality service, in a specific means of public transportation. Furthermore, this study shows that if the dimensions of service quality are assured then the customers achieve a degree of satisfaction and dissatisfaction in accordance with their needs, answering RQ2. The research results also showed that depending on the subway line that is used by a particular customer, he/she usually chooses the same dimension as a priority, according to the satisfaction of his/her needs. The research results showed that a client that uses for example the yellow line gives preference to the quality dimensions of frequency and speed, since the choice of this line indicates the need to get to the city centre quickly. The customers who already choose the red line value the dimension of comfort, because it is a line with a more extensive network, which is important for the customer who wants to get a seat. From this we can conclude that if the principal dimensions of quality for customers are guaranteed, they will be satisfied or dissatisfied. There seem to be sever al implications of this study for service management. The first practical implication seems to be that it is important to reveal that if the managers know which dimensions of quality service their customers most value, (depending on the type of service we are dealing with), the customers may become more satisfied. This will occur because the organization will know specifically which dimensions of service quality will further satisfy the customers. Thus, organizations can focus their efforts on improving and increasing the dimensions of service quality which generate satisfaction. The second managerial implication appears to be the evident need for  clarification of the link between satisfaction and dissatisfaction. In terms of contribution to management, it is important that managers recognize that satisfaction and dissatisfaction are on a continuum, and that knowing of the dissatisfaction factors specifically, these can then be transformed into satisfaction, thus preventing the loss of a customer in a specific service. The third practical implication shows that for the non-customers if the companies and the managers know what quality dimensions this group value most, the company can focus investment on the development of these, including increasing the ability to attract new customers and tailor marketing and communication campaigns with a view to achieving this. The number of contributions presented serve not only to increase knowledge of the relationship between quality and satisfaction, but also encourages reflection on a topic which should be of utmost importance for managers and the vast majority of service companies, who are faced with the need to offer quality of service in its main dimensions and the consequent satisfaction of their customers. It is also expected that the contributions of the study encourage businesses and their managers to connect with their customers and noncustomers. As regards the customers it is important that the company be aware of the quality dimensions that they value most in order to tailor the service to their needs, maximizing satisfaction. This paper has limitations which are expected to be addressed in future studies. The limitations can be divided into three groups, namely: selection of the case and the process, limitations in data collection and finally the limitations of data analysis. One of the limitations is the small number of cases studied in public transport services which determines the strength and spread or validity of the conclusions. The inclusion of other cases corresponding to other paradigms or variations of the paradigms used here, will enrich the knowledge acquired. There were a range of other issues that were not explored which could enrich the research. There were other issues that emerged and seemed interesting but again, given the constraints, were not fully explored. For example, the identification of the factors that influence the formation of consumer expectations. When the interviewees were asked, in an open ended question, what factors influence expectations, the  answer was unanimous: communication with other consumers. Nevertheless, other factors could have been further explored. It would be even more interesting to emphasize the importance of expectations in a pre and post-consumer, or take into account the role of emotions in the construction or development of satisfaction and dissatisfaction of the customer. Replication of this study could be carried out in different public transports, which may be compared with another company in the sector. Furthermore, it would be interesting if the theoretical relationship model proposed had an emotional and experimental element. This study could be performed in different scenarios, particularly in areas of different service industries, such as luxury hotels chains, or telecommunications network providers. In addition to providing other results, these would undoubtedly further enrich the data already available. Vol.4, No. 2, 2010 129 REFERENCES: [1] Andreassen, W. (1995), â€Å"(Di)satisfaction with Public Services: the Case of Public Transportation†, Journal of Service Marketing, Vol. 9, pp. 30-41. 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