Physical therapy management to reduce post operative CABG

Physical therapy management to reduce post operative CABG Coronary Artery Bypass Graft surgery (CABG) is a medical procedure used in the treatment of coronary artery disease (CAD). CAD is a disease that causes narrowing of the coronary arteries (the blood vessels that supply oxygen and nutrients to the heart muscle) due to the accumulation of fatty deposits called plaques within the walls of the arteries. Investigations such as electrocardiogram, stress tests, cardiac catheterization, imaging tests such as chest x- rays, echocardiography, or computed tomography (CT), and blood tests to measure blood cholesterol, triglycerides, and other substances are used to diagnose CAD. The accretion of plaques over the years causes symptoms such as chest pain, fatigue, palpitations, and shortness of breath. Some patients with CAD may be symptom free in the early stages; the disease will progress until sufficient artery blockage exists to cause symptoms and discomfort. Blockage of the coronary arteries will cause the heart muscle to weaken due to inadequ ate blood supply, leading to a condition called ischemia. If the blood flow is not restored to the particular area of the heart muscle, the tissue dies, leading to myocardial infarction or heart attack. In order to restore blood supply and treat the narrowing of the arteries, the blocked portion of the artery is bypassed or rerouted with another piece of vessel, this is called CABG surgery1. Despite the many advances and development in anesthesia, surgical techniques, and postoperative care for CABG surgery, postoperative pulmonary complications (PPCs) retain a high postoperative morbidity and mortality rate 1. The risk of PPC has increased in CABG procedure due to two factors: intra-operative and external. The intra-operative factors are factors that are associated with the surgical procedure such as general anesthesia, surgical incision, type of graft, topical cooling for myocardial protection, and cardiopulmonary bypass2. General anesthesia increases the risk of PPC when the anesthetic component is administered to the patient while lying in supine position; it results in respiratory depression leading to a Ventilation-Perfusion (VQ) mismatch. In the surgical approach, the incision site in the upper thoracic area, which is a standard 20cm incision, decreases the preservation of pulmonary function. The type of graft used such as IMA increases the risk of attaining PPC. Topical cooling also used in CABG increases the incidence of phrenic nerve injury. Cardiopulmonary bypass which is unique to this surgery causes additional lung injury and longer pulmonary recovery, which occurs due to the acute systemic and pulmonary inflammatory response which is known as à ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€¦Ã¢â‚¬Å"pump lung or à ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€¦Ã¢â‚¬Å"post pump syndrome 2. External factors that could increase the risk of acquiring PPC are aging, the prevalence of surgical delay, increased sickness and complex health problems. The diagnosis of PPC, requires symptomatic pulmonary dysfunction symptoms such as increased work of breathing, shallow respiration, ineffective cough, and hypoxemia 2; in addition to clinical findings such as atelectasis, pleural effusion, pneumonia etc. The most frequent types of PPC associated with CABG are atelectasis which ranges from16.6% to 88%, phrenic nerve paralysis (30 % to 75%), and pleural effusion (27%-95%) 2. Acquiring PPC leads to the increased use of medical supplies and other health care expenses. Numerous interventions have been used to treat PPC but, due to variance in opinions, no resolution has been reached to which is the most effective and efficient intervention in treating PPC. To prevent postoperative complications such as PPC, less invasive techniques are applied by physical therapists. Physical therapists are responsible for the management and rehabilitation of the patient, which includes treating and educating the patient and helping them to attain the maximum function, and satisfying level of independence; this is achieved by decreasing the level of limitation and impairment. Physical therapy treatments include mobilization and airway clearance techniques, positioning, breathing exercises, coughing maneuvers, mobility and functional exercises. Physical therapy has been known to intervene in surgical procedures such as CABG, but most of the intervention used in patients reha bilitation is performed postoperatively. Recent studies have confirmed that post-operative patients, especially in CABG can improve as much as 50% 3 by introducing pre-operative physical therapy management. The preoperative management targets patients pre-surgically and directs its rehabilitating techniques towards the reduction of a possible PPC pre-operatively. Preoperative physical therapy management includes appropriate patient selection, preoperative PT assessment, patient education, and pre-operative physical therapy treatment (PPTT). These management protocols further enhance post-operative results by training patients on post-operative techniques. Thus pre- and post- operative physical therapy management is performed to reduce post-operative CABG pulmonary complications. Literature review Pre-operative Physical Therapy Treatment Preoperative management is an early involvement of physical therapy prior to surgery. It is a method used in prevention of patient deterioration by directing its efforts towards the patients respiratory and physical condition. Preoperative physical therapy management ensures that the patient is in the best respiratory and physical condition prior to surgery, to be able to have a rapid recovery. Preoperative management mainly focuses on appropriate patient selection, patient education, pre-operative assessment, and preoperative treatment. Appropriate patient selection Patients undergoing surgery have certain characteristics which can increase or alter the risk of any surgical complications especially in CABG. These characteristics affect the outcome of surgery, therefore leading to post operative complications. Suitable patient selection in preoperative rehab is important. This allows the physical therapists to categorize patients. Patients can either be classified as low risk or high risk patients. Classifying patients in such order ensures that each patient will obtain a tailored preoperative management program according to their condition and will receive maximum benefits from the program 4. The characteristics that alter the patients risks are pre-existing respiratory problems, obesity, age, smoking, patient motivation, and nutritional status 4. Pre-existing respiratory problems is of three factors infection, restrictive defects, and obstructive defects. Infection may affect both upper and lower respiratory tracts. If the upper respiratory tract is infected, it will cause increased mucus production. And if it infects the lower respiratory tract it may initiate impaired gas exchange leading to hypoxia secondary to pneumonia, resulting in exacerbation of infection. Restrictive defects include lung fibrosis, pulmonary oedema, and pleural effusion. The restrictive may reduce lung volume, resulting in an increase of airway resistance and closing of airways following anesthesia. Obstructive defects are also known as Chronic Obstructive Pulmonary Diseases (COPD). The occurrence of COPD in patients undergoing surgery will lead to an increase in the anesthesia dose due to bronchial hyperactivity. Obesity is another characteristic that can upgrade a patient into the higher risk group. Obesity is usually detected by using the Body Mass Index (BMI). According to Selsby and Jones 1993, increase in body mass may lead to reduced lung compliance by approximately one third; this is due to the additional weight on the chest wall. As a person ages the lung loses its elasticity in recoiling and the lung volume is reduced. During aging, respiration is reduced by weakening of the respiratory muscles and stiffening of the rib cage. Smoking is the major cause of greater ventilation/perfusion (V/Q) shunt, and impaired oxygenation during anesthesia. This is because smoking results in narrowing of the airways, excessive mucus secretion and decreased mucus clearance, and irritable airways. Patient motivation is the current mental or cognitive, and emotional state of the patient. Any disturbance in such states may result in decrease patient compliance and increases the duration of the patients recovery. Preoperative PT assessment Pre-operative assessment is a technique used to establish an outline of the patients current status, and form a baseline to assess the patients progress. The pre-operative assessment includes subjective and objective assessments. Subjective assessment is an interrogation procedure used by the physical therapist to obtain information to help with the preoperative treatment program. During the subjective assessment, open-ended questions 4 are used, which allows the patient to discuss their current problems. There are five main points that need to be clarified during this type of assessment; dyspnea, cough, secretion (sputum and haemoptysis), wheeze, and chest pain. During the objective assessment, the physical therapists use their own skill in examining the patient. The physical therapists examines by observation, palpation, percussion, and auscultation. Further details may be obtained by the use of tests such as spirometry arterial blood gases (ABGs), and chest radiographs 4. When assessment is completed, the physical therapist analyzes the information obtained and integrates it with their knowledge, resulting in a problem list. According to the problem list the physical therapists addresses these problems by setting specific, measurable, achievable, realistic, and time specific goals according to the problems obtained from examination. A well designed treatment plan is set to help resolve these problems. Patient Education Patient education plays an important role in rehabilitation. The patient is educated by the staff, which includes the surgeon, physical therapists and nurses. The patient is educated on preoperative and postoperative programs or protocols. During patient education, verbal and written information is given to patients. The role of the physiotherapist in patient education is to highlight and clarify the main points of the CABG procedure, allowing the patient to become familiar with the surgery. The physical therapist also explains the main effects of surgery on the respiratory function, location of the wound, and wires and monitors attached. The instructions given before the surgery puts the patient at ease and postoperatively accelerates the functional recovery of the patient. To reinforce the verbal information, leaflets and brochures are given to help the patient. Pre-operative Physical Therapy Treatment (PPTT) PPTT is directed towards maximizing pulmonary function 4 by the reduction of PPC and the use of non-invasive PT interventions. Since PPTT is a newly emerged, few studies are found that discuss the preoperative treatment of patients undergoing CABG procedures. Therefore no precise treatment techniques or protocols are followed during PPTT. Studies have suggested that the most common types of PPC that occur following CABG surgery are atelectasis, and pneumonia. Atelectasis which is an abnormal respiratory condition causes lung collapse, therefore leading to deprivation of gas exchange. It is caused by an obstruction of major airways and bronchioles. It is a complication that is frequently seen in post-operative period and is found in the basilar region in post CABG. To treat and prevent such condition deep breathing techniques and incentive Spirometry is used 5. Pneumonia is an infection or inflammation of the lungs. It can be caused by microorganisms such as bacteria, viruses, or fungi or by a potential complication such as pleural effusion. Pneumonia is treated by pharmaceutical agents, coughing techniques, and breathing exercises 5. It was found that both PPCs are caused by the patients inability to expectorate sputum and due to insufficient diaphragmatic breathing. Therefore the most appropriate way to treat such conditions is to rehabilitate patients preoperatively. PPTT treatments are of a large variety and no precise treatment has been advised solely for treatment. During my investigation I have came upon many techniques used. The most common treatment used within the PPTT is breathing exercises (BE), respiratory muscle devices, and sputum expectoration techniques. BE are several techniques used to help increase the muscle strength and increase air entry. It is performed by inflating and deflating the lungs. There are many types of BE some are pursed lip breathing (PLB), paced breathing, diaphragmatic breathing, segmental breathing, sustained maximal inspiration (SMI), and global lung expansion. Respiratory muscle devices are instruments used to help strengthen the surrounding breathing muscle by the use of resistance as shown with the inspiratory muscle trainers (IMT) and aids the patient in air entry by visual aid, as shown with the incentive spirometer (IS). The sputum expectoration techniques are tactics used to expel secretions from the lung. One of the most common techniques used nowadays is the secretion removal technique, this is a method used to remove mucus from the lung and helps in expectorating the sputum, it is known as postural drainage. This method can be applied according to area of secretion and can be modified according to the patients condition. Other supporting or assisting techniques is coughing and the Forced Expiratory technique. Coughing is used to help the patient to expectorate sputum. The PT can teach the patient the correct method and may support the patient incision or wound when coughing if needed, or assists the patient by applying force on the abdomen, increasing the abdominal pressure therefore giving extra force. FET is less forceful technique, it is similar to coughing, and the patient huffs instead of coughing. This method brings the mucus to the upper airways and is usually followed by coughing to expel sputum. An observational follow up study was performed by Isabel Yanez-Barage. The purpose of the study was to examine the use of preoperative respiratory physiotherapy, on the incidence of pulmonary complications in CABG surgery. Two groups of patients were involved in the study. The first group was the intervention group, whom received PPTT and the second group was the control group, who had no PPTT. The apparatuses used within the study included Incentive IS and, BE. Prior to their use, uses and importance of the apparatus was explained to the patients. The techniques that was used during the study, were ten deep BE, diaphragmatic breathing, thirty long expansion maneuvers, tactile stimulation, three stages of Sustained Maximum Inspiration (SMI), ten global lung expansion, secretion removal techniques, supported or assisted coughing. The above techniques were put in a program, and all exercises were performed in two sessions per day, while the SMI was performed six times per day, five set s with 30-60 seconds rest between each set. The results of the study showed that the presence of atelectasis occurred 48hours after surgery. The PPTT group had a 17.3% of atelectasis, while the non PPT group had 36.3%. The study also showed that a relationship existed between atelectasis and patient gender, and that 21.8% was found in females while 37.5% in males 3. Another study performed by Erik H. J. Hulzebos, focused on two primary outcomes. One was post operative complications, which is pneumonia. The second outcome measure is the post-operative pulmonary complications (PPC), which include the influences of morbidity and mortality rate, the length or duration of stay at hospital, and the overall resource utilization. The interventions used in this study included such as IMT and IS, while the techniques included are patient education in active cycle of breathing techniques and Forced Expiratory Techniques (FET). The program followed within the study was the use of FET and performing it on daily basis seven times per week for duration of two weeks before surgery, and the IMT was done for twenty minutes, six times per week without supervision and once per week with PT supervision. The result of the primary outcome measure is that18% (25 of 139) of the patients from the IMT group developed PPC, while patient 35% (48 of 137) of usual care group developed PPC. The incidence of pneumonia was less in the IMT group whom had 6.5% (9 of 139). While on the other hand the usual care group had a higher incidence which was 16.1% (22 of 137).The usual care group had also another complication, where 3 of the 22 patients developed respiratory failure and died after surgery as a result of cardiac failure, while none of the IMT patients died. The study concluded that preoperative physical therapy reduced PPC by 50%. The study suggests that no a single PT techniques or intervention is better than the other in preventing PPC. Pre-operative PT has increased inspiratory force, decreased the incidence of PPC and hospitalization, and reduced morbidity 1. . Post-operative Physical Therapy Management Post operative complications are common in patients undergoing cardiothoracic surgeries. According to Agnieszka Piwoda et al, the fundamentals to a properly designed and conducted cardiac surgery, is physical therapy management 6. To minimize postoperative complications, physical therapy management is introduced. Postoperative physical therapy (POPPT) starts the instant the patient is transferred from the operating room to the intensive care unit (ICU), which lasts 1 to 2 days and is continued in the ward from 2nd day till the date of discharge which is the 7th day 6. During the patients stay at the ICU postoperative, physical therapy rehab is aimed towards the reduction of airway obstruction, increasing and enhancing ventilation-perfusion matching, which is also known as gas exchange (VQ matching), restoring normal gasometrical values which when by doing so, the patient is prevented from re-intubation 6, decreasing ventilatory failure where the patient becomes dependent to the mechanical ventilator 3, and preventing thrombo-embolitic changes altogether leading to a decrease in ICU stay. The ward rehab starts when the patient gains early extubation; this allows the patient to regain contact with reality. During this period the physical therapist is able to eradicate secretion accumulation, and rapidly mobilize or ambulate the patient 6. Maintenance of permanent and intensive mobilization will improve cardiopulmonary tolerance, leading to an increase in physical endurance and patient independence, therefore reducing hospital stay 7. Most of the studies involving a majority of patients undergoing CABG are focused on reducing basilar atelectasis and pneumonia and hypoxemia 7 by applying specific post operative physical therapy objectives such as recruiting lung tissue from shunt to zone of low ventilation in relation to perfusion 8, increasing lung capacities especially FVC and FEV8, decreasing respiratory muscle dysfunction 3, increasing respiratory muscle function diaphragm 6, restoring thoracic breathing manoeuvres by strengthening postural and respiratory muscles, and endorsing effective breathing patterns by reducing the work of breathing 7. To achieve optimum results and regain the inclusive functional independency, POPPT management should include airway clearance techniques, early mobilization, bed mobility and positioning, breathing exercises (BE), and patient education. Specific post operative physical therapy techniques such as the use of intensive deep breathing exercises and devices such as IS, and IMT should be emphasized when rehabilitating post CABG patients. Prior to POPPT, an extensive patient evaluation similar to the preoperative assessment should be performed. When assessing the patient problems, goals should be set and are treated accordingly. Airway clearance techniques A manual or mechanical procedure that assists in clearance of secretion from the airways is known as Airway Clearance Techniques (ACT) 9. ACT is indicated for impaired mucociliary transport or an ineffective and unproductive cough. When choosing an ACT the patients pathophysiology, symptoms and medical status should be taken in consideration. The techniques included in ACT are Postural Drainage (PD), manual chest clearance, and coughing. PD is a technique that drains secretion by gravity assistance, and the use of more than one body position. There are 12 positions used during PD 9, in each position the segmental bronchus is drained perpendicular to the floor. These positions can be modified according to the patients medical status. The most affected segment should be prioritized. The patient is positioned using an adjustable bed, pillows or blanket rolls, and enough personnel to assist in moving the patient safely. PD is used for approximately 5-10 minutes solely and longer if tolerated 9. Manual chest clearance technique is the application of manual supplementary techniques such as vibration, percussion, and shaking to postural drainage positions 10. Coughing technique is a forceful airstream method used to remove secretions out through the trachea and to the mouth. Coughing technique is performed in four stages, and may be applied before, during and after PD and manual chest clearance techniques. In CABG patients, the coughing technique is supported using splinting. This is done is applying pressure to the incision site either by using a pillow or a belt. This techniques helps with decreasing the pain associated with the surgery. Early mobilization Early mobilization or ambulation is the method used to set patients in motion postoperatively by using the assistance of PT. The patient mobilization process is performed gradually and according to the patients tolerance. Mobilization starts by sitting the patient from supine to a long sitting position. Then when further stability is regained the patient is positioned on the edge of the bed. The patient is then progressed to standing, and later when the patient regains more stability, walking is initiated. Positioning Positioning is a therapeutic and ventilatory movement that is used to assist the patient in regular changing of position while in bed. It is essential in the patient early stages of recovery. Positioning allows the patient to progress from dependence to independence. The technique involves the selection of certain positions to assist the patient with efficient and diaphragmatic breathing patterns. The technique is indicated for patients with diaphragmatic weakness, patients unable to correctly use the diaphragm for efficient inspiration, or who have inhibition of diaphragm muscle due to pain 9. The training usually commences in the ICU. An example used by Sadowsky et al on positioning is the performance of ROM exercise with breathing. The exercise is performed by the patient inspiring air and accompanying it with shoulder flexion, abduction, external rotation, and eyes in an upward gaze. Then the patient exhales with shoulder extension, adduction, internal rotation and downward gaze. In addition to the exercise the patient is asked to tilt the pelvis posteriorly. This allows diaphragmatic breathing pattern and optimizes the length-tension relationship of the diaphragm 9. This technique progression should be applied to transfer, ambulation, and stair climbing. This technique is highly recommended for patient patients that underwent CABG since they are likely to have 90.7% of diaphragmatic elevation 11. Breathing exercises Breathing exercises are maneuvers used for patients with signs and symptoms of decreased strength or endurance of the diaphragm and intercostal muscles 9. There are many breathing exercises one of them is known as the Active Cycle of Breathing Technique (ACBT) 10. ACBT includes a group of breathing techniques such as breathing control, thoracic expansion exercises, and forced expiration technique. Other methods that assist BE are respiratory devices such as Inspiratory Muscle Trainers (IMT) and Incentive Spirometry (IS). Respiratory devices are mechanical equipments used in attempt to reduce postoperative pulmonary complications particularly atelectasis and pneumonia. BE and respiratory devices are suggested for patients at high risk of having atelectasis such as CABG patients, whom are for 24.7% of postoperative atelectasis 9, 11. A study performed by Elizabeth Westerdahl investigated the effect if deep breathing exercise on pulmonary function, atelectasis, and Arterial Blood Gases (ABGs) after CABG. The study was performed on two groups, the first group was the deep breathing group and the second was the control group. Both groups were approached similarly in assessment, positioning, and mobility once or twice daily during the first 4 postoperative days. Chest PT was done twice in the first 4 post-op days, the therapy includes early mobilization, instructions in coughing techniques, and daily active exercises of the shoulder girdle, upper back, and assistance to turn form side to side and get out of bed. The deep BE group received an extra program, performing breathing exercises every hour during the day for four postoperative days. The exercise used is, 30 slow deep breaths with PEP blow bottle device, a 50cm plastic tube in a bottle containing 10 cm of water. The exercise was performed sitting; it is 3 sets of 10 deep breathing exercises with 30-60 seconds pause between each set. If needed, patient coughs during the pause to mobilize secretion. The result of the study illustrate that atelectasis was found in large areas at basal level close to the diaphragm and minor at the upper level near the apex. There was a significant decrease in atelectasis in deep breathing group by one half compared to the control group, and the correlation between PaO2 and atelectasis was weak. Recruited lung tissue is most likely converted from shunt regions to zones with low ventilation in relation to perfusion. In conclusion, Patients who performed deep-breathing exercises had a significant smaller atelectasis, and less reduction in FVC and FEV on the 4th post-op day. 8 Patient education Patient education which is an integral part of the post-operative physical therapy management is applied similarly to the preoperative patient education program. When educating a patient in the post-operative period, the instructions given should highlight the thought of improving quality of life by emphasizing on points such as having healthy eating habits, ceasing smoking, achieving independence, and accentuating the benefits of rehab, and returning back to ADL. Patients should also improve their physical education by participating in other therapies that have been introduced such as tai chi, PNF, NDT Bobath and music therapy 6. Conclusion As PPC has been of great concern to health professionals, the reduction of complications that accompany major surgeries such as CABG is of an important development. The main objective in physical therapy with regard to CABG is to reduce PPC by intervening with less invasive protocols. The combination of both pre-operative and post-operative physical therapy management has had effective results in managing CABG patients. The reduction of PPC by the use of preoperative physical therapy management has led to many advantages. Some of them are significant reduction in mechanical ventilators duration therefore reducing the duration of ICU stay, reduced hospitalization, decreased morbidity and mortality rate, enhanced early functional recovery, improved lung function and gas exchange. Such accomplishments are significant, but more studies have to be performed to develop PPTT programs and provide a certain protocol The reduction of PPC by the use of postoperative physical therapy has lead to the best outcome of treatment. It has decreased complications associated with surgery and reduces PPC, allowing the patient to regain maximum physical condition, reducing ICU and hospital stay by achieving physical and functional independence therefore assisting the patient in regaining better-quality of life 5. The patient can further continue physical therapy at the cardiac facility to promote additional cardiopulmonary conditioning. In Kuwait, post-operative PT management is more widely-used than preoperative. During my investigation I found out that the chest hospital is aware of the preoperative management and is applying it, but in an informal way. I would like to call attention to the use of post-operative PT management in association with pre-operative physical therapy management to help the patient have a better surgical outcome, regain maximal independence and improve the quality of their life.

Employee Empowerment Essay

The empowered employee is said to respond more quickly to customer service requests, act to rectify complaints and be more engaged in service encounters. A more reflective approach suggests there are different managerial perceptions of empowerment, resulting in empowerment being introduced in different service organisations in different ways, and presenting different benefits to managers and working experiences for the empowered. This paper suggests that a framework of analysis needs to be developed which goes beyond the more simplistic claims which tend to discuss empowerment as that which is labelled empowerment. The success or failure of an initiative which claims to be empowering will be determined by the experience of being empowered. Employee empowerment in services 169 Introduction Employee empowerment has been hailed as a management technique which can be applied universally across all organisations as a means of dealing with the needs of modern global business (Barry, 1993: Johnson, 1993; Foy, 1994), and across all industrial sectors. However, the service sector is said to involve a unique cluster of tension which managers, employees and customers have to address (Heskett et al. 1990), and the empowerment of employees is an approach which has been advocated for service sector management (Sternberg, 1992; Lockwood, 1996). Investigation of the use of empowerment in service sector organisations reveals a number of different forms of empowerment being applied in practice. These different approaches evidence a range of managerial meanings being applied which are based on different perceptions of business problems, motives for introducing empowerment and perceived benefits to be gained from empowerment. The fact that empowerment can be used as a term to describe different initiatives provides a convenient rhetoric which suggests that empowerment is â€Å"in principle a good thing† and produces a â€Å"win-win† situation for employees and managers. In part these different perceptions of the service need and the appropriate match with the management of employees, is a consequence of the different service offers being made to customers. Some service offers require employees to exercise discretion in detecting and delivering customer service needs. In other cases, the service offer is highly standardised and require employees to practise service delivery in â€Å"the one best Personnel Review, Vol. 28 No. 3, 1999, pp. 169-191. # MCB University Press, 0048-3486 Personnel Review 28,3 170 way†. Reflection on both the specific applications entitled â€Å"empowerment† and on variations in the characteristics of the service offer, question the somewhat simplistic claims for the universality of empowerment, and the supposed benefits which ensue. This paper is based on a cluster of research projects which have investigated different approaches to empowerment in similar service businesses: Harvester Restaurants, TGI Fridays and McDonald’s Restaurants Limited operate branded restaurant chains. All are to some extent â€Å"McDonaldized† (Ritzer, 1993), they use highly standardised menus, â€Å"one best way† production techniques which assist in the delivery of consistency and predictability to customers. That said, these organisations differ in the service offer to customers, particularly in the extent that employees exercise discretion to meet customer service needs. The approach outlined in the paper is informed by these cases studies, though the key concern of the paper is to establish a framework for understanding empowerment in the service sector which questions the universalistic and evangelical claims of some of the advocates of empowerment. This framework of analysis suggests that there is a need to approach the study of empowerment in a systematic manner which goes beyond the label. According to Conger and Kanungo (1988) empowerment describes working arrangements which engage the empowered at an emotional level. They istinguish between concepts of empowerment which are relational and motivational. As a relational concept empowerment is concerned with issues to do with management style and employee participation. As a motivational construct empowerment is individual and personal, it is about discretion, autonomy, power and control. This motivational aspect to empowerment becomes the defining feature of the initiative. The empowered must feel a sense of personal worth, with the ability to effect outcomes and having the power to make a difference (van Oudtshoorn and Thomas, 1993; Johnson, 1993). Advocates of empowerment claim that employee empowerment helps firms to enthuse and enable employees to take responsibility for the service encounter (Barbee and Bott, 1991). The paper identifies four different types, or managerial intentions, for empowering employees, which in turn impact on the precise form the arrangements take. Following from this, and so as to better understand the detailed changes in working arrangements which claim to be empowering, the paper provides a five dimensional framework of analysis. By contrasting and comparing the detail of the changes to what the newly empowered employee can now do, it is possible to establish the boundaries and limits which are placed on empowerment in any particular context. Given the need to engage employees at an emotional level and to generate the appropriate feelings about the service encounter, the impact of each initiative on the employee is a crucial ingredient in meeting the objectives set. This paper suggests that there are likely to be a number of factors which generate positive or negative feelings about a particular initiative. At root this will be concerned with the empowered employee’s perception of the state rather Employee than the form of empowerment. Investigation into empowerment must, empowerment in therefore, incorporate an analysis of how individuals feel about the result of services being empowered. Finally this paper suggests that beneath the rhetoric of empowerment, service firms are in different positions in relation to their customers and markets, and 171 this will impact on how managers perceive and interpret empowerment. Factors such as the degree of customisation/standardisation and the relative importance of tangibles/intangibles in customer satisfaction are likely to be influential in determining the locus of control of employee performance. Empowerment in the service sector Interest in employee empowerment in service industry firms has been associated with many of the key issues related to employment practices in general, namely in gaining competitive advantage through improved service quality. Paradoxically, however, attempts to gain competitive advantage through service quality can present some major problems for service operators. In the first instance, there are difficulties in defining the successful service encounter, particularly in the intangible sources of customer satisfaction. Customers vary considerably in their expectations of service quality (Rust and Oliver, 1994). Indeed individual customers may define and re-define their needs from service deliverers as their circumstances, experiences and expectations change. In turn, customer evaluation of a successful service encounter, and thereby repeat visits, will be a product of the extent to which their experience matches their expectations (Foulkes, 1994). Whilst there are these difficulties in defining successful encounters, many writers agree that â€Å"front line staff† (Johnston, 1989; Horovirz and Cudenne-Poon, 1990; Barbee and Bott, 1991) play a crucial role in the service encounter. There are in fact, some base level customer expectations of employee performance, positive interpersonal contacts, service deliverer attitudes, courtesy and helpfulness that are all closely related to customer evaluations of service quality (Adelmann et al. 1994). Hence human resources management and the strategies needed to engage employees emotionally in the objective of customer service take on a new and urgent meaning. This leads to the second difficulty for service deliverers. Unlike other resources used within an organisation there is a problem in predicting the levels of output, efficiency and general effectiveness which will be the outcome of a given level of labour employed. Human resources can be uniquely unstable. Under certain circumstances they physically leave the organisation, they may collectively resist management instructions or individually just not give â€Å"a fair days work for a fair days pay†. Clearly, these are problems shared by all employers but given the pivotal role of service delivery employees these issues are of particular concern to service sector employers. The response of many employers in the sector has been to look to manufacturing industry for models of control which minimised the significance Personnel Review 28,3 172 of individual idiosyncrasies. What Levitt called the â€Å"production-line approach to service† (1972) or the â€Å"industrialisation of service† (1976). Based on essentially Taylorist (1947) views of job design, they establish standardised procedures and one best way of doing each task. In many cases this extended to scripting the interaction with clients and left little to the discretion of the individual service deliverers. The consequence of this has been the rapid growth of organisations specialising in high volume, mass produced, standardised services which minimised the significance of labour inputs (Bowen and Lawler, 1992) in the delivery of predictable tangible and intangible product attributes to customers. Ritzer’s (1993) somewhat overblown comments about the â€Å"McDonaldization of Society† are little more than observations about the application of manufacturing techniques to the production of mass services, which are themselves but one of a number of service offers (Wood, 1997). Whilst this strategy was tremendously successful over the two decades preceding 1990, many of these operators now see the limits of standardisation and control. A point largely ignored by Ritzer. Apart from high labour turnover which has been endemic in many of these firms, any attempt to compete on service quality cuts across the rigidities of the production line approach. Firstly, even the most standardised operation encounters occasions when customer service needs are difficult to predict and a quick response is needed at the point of the service encounter. A small child in a family group at a McDonald’s is getting restive and the quick intervention of a crew member with a balloon or a hat calms the child. A customer knocks over his coffee in a Welcome Break and the service operative replaces it without charge. Whilst these responses may well be prescribed in operational manuals, they still require employees to act with initiative and discretion. The intangible element of the service encounter requires some form employee of participation, even in highly standardised and Tayloristic situations. The second problem is in the quality of the service encounter itself. Hochschild’s (1983) work with air stewardesses reveals much in common with â€Å"the commercialisation of feelings† across the service sector in general. She makes the point that seeming to love the job becomes part of the job; and managing the appropriate feelings of enjoyment of the customer helps the worker in this effort. Fineman (1993) also comments on the interplay between feelings and performance in service interactions. Enabling employees to sense their own power and the significance of their role in the service drama may help employees manage the emotions required of their performance. It is here that empowerment of employees seems to offer the prize of generating feelings of commitment to the service encounter (Barbee and Bott, 1991) with the appropriate amount of power and the freedom to use that power (van Oudtshoorn and Thomas, 1993) to meet customer needs as they arise. The extract below is from a series of advertisements by Marriott Hotels which make play of the benefits of empowered employees. It highlights the aspirations for empowerment. Here the night porter’s feelings of commitment to â€Å"delighting the customer† perfectly match the organisation’s commitment to its clients. The Employee advertisement also confirms that empowerment, service quality and empowerment in organisational attempts to gain competitive advantage through improved services service quality are entwined in some operations. It was more than considerate of the Marriott night porter to trace my lost wallet  ± it meant he had to re-trace my entire journey through Vienna. All I could remember was that I’d been travelling on a Southern District streetcar. Miraculously, from this tiny piece of information, the night porter from the Marriott hotel managed to trace the route I’d travelled, the particular streetcar I was on, and my wallet. I was astonished that he went out of his way so much to help me. But, as I now know, everyone at Marriott works this way. personally assuming responsibility for the needs of every guest. It’s called Empowerment. And thankfully, they never seem to find anything too much trouble. (Always in the Right Place at the Right Time, Marriott). 173 For the advocates of empowerment, empowered employees willingly take responsibility for the service encounter, they respond more quickly to customer needs, complaints and changes in customer tastes (Barbee and Bott, 1991). The organisation will experience lower labour turnover (Cook, 1994), there will be high staff morale and employees will take responsibility for their own performance and its improvement (Barry, 1993). Employees’ inherent skills and talents will be put to work for the organisation (Ripley and Ripley, 1993) so as to produce more satisfied customers (Johns, 1993) and greater profits (Plunkett and Fournier, 1991). Research methods The observations reflected in this paper are based on case studies of three organisations who make different service offers to their customers, and who manage their employees in different ways. Each is attempting to empower employees to take responsibility for the service encounter, though each expects employees to exercise discretion in different ways. The case studies provide a valuable context through which to explore employment practice in context (Hartley, 1994), though these are published in detail in other publications (Lashley, 1995; Ashness and Lashley, 1995; Lashley, 1997). This paper reflects on the findings from the case studies to build the framework for analysing empowerment. In each case, the study involved semi-structured interviews with senior managers to explore their perceptions of empowerment, intentions for the initiative and the perceived benefits ensuing from the changes. Interviews were also conducted with the immediate line managers of the empowered. Again the intention was to explore the detail of the changes on the ground, and most importantly the practical responses from both middle managers and those line managers whose role might have been changed by the introduction of empowerment. Finally, semi-structured interviews were conducted with the â€Å"empowered†, that is the subjects of the initiative. In particular, the study explored their perceptions of the changes, the boundaries in which they had to operate and the extent to which employees developed a sense of personal efficacy. Personnel Review 28,3 174 The semi-structured interviews identified key themes which needed to be explored with each respondent. For managers and those responsible for introducing and managing the initiative (the empowering), the questioning explored the background to the change in the way the organisation was to be managed  ± perceived problems and views as to what contribution empowerment ould make to overcoming the problems. Having established the managerial intentions for empowerment, interviewees were asked to describe the form of empowerment and the changes in working arrangements which ensued. They were then asked to comment on the success and weakness of the changes, and comment on any plans for the future development of the approach. For the supposedly empowered, questioning followed similar broad themes but from their perspective. In other words, to what extent did they share managerial views of problems and benefits of empowerment? They were asked to comment on how the nature of their work had changed and how they felt about it. Fundamentally did they feel empowered? Flowing from this, the interviews explored changes in work behaviour and their perceptions of the benefits and limitations of the initiative. Table I shows the total number of interviews in each of the three case study organisations. The table indicates the number of interviews that were conducted with â€Å"empowering† and the â€Å"empowered† in each organisation. The case studies which inform this paper were founded on an approach which suggests that empowerment needs to be based on the systematic exploration of each aspect of empowerment. The more evangelical claims suggest that empowerment of employees will result in an almost automatic improvement in organisational performance (Foy, 1994; Stewart, 1994). These models are simplistic and do not take into account, different managerial intentions, different forms introduced, differences in what employees can now do, different needs of employees to feel empowered and different impacts on the resulting performance exercised by employees. It is more likely that a multistage model is needed to analyse initiatives and outcomes. Figure 1 suggests a model for studying empowerment which assumes that the organisational benefits will not be a simple and direct trade-off. Managerial perceptions of what empowerment is and the benefits it is supposed to deliver will shape the form that is introduced (quality circles, autonomous groups, etc. ), which in turn will shape what employees can now do that they did not do before the change. This in turn has an impact on the feelings of those empowered, do they Number of interviews with â€Å"empowering† 11 8 11 Number of interviews with â€Å"empowered† 28 38 25 Organisation Table I. Numbers of interviews in three case study organisations Harvester Restaurants McDonald’s Restaurants TGI Friday Restaurants Managerial intentions Forms of empowerment Change in working arrangements The state of empowerment Change in work behaviour Organisation objectives: – improved service quality – increased service productivity – reduced labour turnover Employee empowerment in services 175 Figure 1. The form, state and outcomes of empowerment experience the state of empowerment, and if they do, does the state of empowerment result in improved work performance which then results in the desired organisational objective? Managerial intentions for empowerment Once we move away from the generalised claims for empowerment it is possible to see that the term itself is being used to describe a wide variety of practice in service delivery. In the Accor group of hotels, for example, empowerment has been used to describe the use of quality circles (Barbee and Bott, 1991); in McDonald’s Restaurants, suggestion schemes (Bowen and Lawler, 1992); â€Å"Whatever it Takes† employee training programmes in Scott’s Hotels (Hubrecht and Teare, 1993); employee involvement in devising departmental service standards in Hilton International Hotels (Hirst, 1991); autonomous work groups and removal of levels of management in Harvester Restaurants (Pickard, 1993); and the delegation of greater authority to service managers in British Telecom (Foy, 1994). Investigation of these specific initiatives reveals that there is considerable overlap between employee empowerment, employee participation, employee involvement and even employee commitment. Often these terms are used interchangeably (Collins, 1994; Cotton, 1993; Denton, 1994; Plunkett and Fournier, 1991). Thus quality circles, autonomous work groups, suggestion schemes and various employee share ownership programmes are frequently discussed under these different headings without defining the boundaries between them. Clearly, these initiatives do have similar antecedents in that they aim to meet, in varying ways, the individual employee’s psychological needs (Watson, 1986). In addition there is similarity in the intended outcomes. Marchington et al. (1992) say that employee involvement is used to describe initiatives which are largely designed and initiated by management and intended to improve communication with employees, generate greater commitment and enhance employee contributions to the organisation. This Personnel Review 28,3 176 might equally be said of the intentions for employee empowerment (Sewell and Wilkinson, 1992). Indeed empowerment is an integral feature of the â€Å"soft† version of human resource management (Legge, 1995). Watson (1986) suggests that employment strategy tends to wax and wane between managerial concern for control over employee performance and concern for employee commitment. Whilst this is a useful metaphor which does indeed suggest that employment strategy is both dynamic and political, it does suggest that a shift towards employee commitment results in less organisational control. A view frequently expressed by line mangers is that empowerment of subordinates will result in a loss of control. In reality empowerment as an employment strategy is concerned with both commitment and control of employees. It is more a shift in the locus of control (Friedman, 1977). Figure 2 provides a model which suggests that different employment strategies might shift the locus of control along a continuum between externally imposed control of the individual to internally generated self control. In effect employee empowerment, â€Å"increases [top management’s] control whilst creating the impression of lessening it† (Robbins, 1983, p. 67). Under this model, production line approaches to service delivery rely largely on imposed external controls in which employee commitment is less significant for effective performance, it is typical of Edwards’ (1979) â€Å"technological control†. Employee empowerment, in its more participative form, is more reliant on internalised self-control, where the employee works to the desired standard and controls their own performance accordingly (Salaman, 1979). Personal commitment to these standards then becomes a crucial ingredient. The empowered employee has much in common with Friedman’s (1977) employee with â€Å"responsible autonomy†. Having said that, it is possible to detect variations in the locus of control implied within different definitions of empowerment. Bowen and Lawler (1991), suggest that empowerment is defined as â€Å"management strategies for sharing decision making power† (p. 49). Others (Barbee and Bott, 1991) define empowerment as being â€Å"the act of vesting substantial responsibility in the people nearest the problem† (p. 28). These two different phrases reflect more than mere semantic differences. They reflect different assumptions about the nature of empowerment and the power of the empowered. The first implies a shift in authority whilst the second is concerned with a shift in responsibility. Traditional Technological Social Self Organisation Structure and Procedures Technology Leadership/ Management Style Work Groups Empowerment Professionalism Figure 2. Employment strategies and the locus of control External Control Internal Control My own investigation in the hospitality sector suggests that there are probably Employee four distinct but overlapping managerial intentions for empowerment (Lashley, empowerment in 1994). These are summarised in Table II. In principle they reflect the variations services in the assumptions discussed above, but there do appear a range of managerial intentions which have their roots in other initiatives mentioned earlier. For this reason the four categories are labelled with terms which reflect their 177 antecedents. There are three types of managerial intentions for empowerment of operatives. Empowering through participation is closely related to the Bowen and Lawler definition because they are chiefly concerned with empowering employees with decision making authority in some aspect of the work which had been formerly the domain of management. Harvester Restaurant’s use of semi-autonomous work teams (Ashness and Lashley, 1995) provides a good example. Employees not only dealt with and rectified customer complaints, they also were involved in receiving goods, securing the building and â€Å"cashing up the tills†. Empowerment through involvement is chiefly concerned with gaining from the experiences and expertise of service deliverers through consultation and joint problem solving. Managers continue to make the decision but with inputs from employees. The study of TGI Fridays (Lashley, 1997), confirms that pre-service team briefing sessions are used to both provide employees with immediate information about the operation and company objectives, but are also used to test out ideas with employees and gain suggestions. Employees have little authority to make decisions, even complaint handling is the responsibility of managers. Attempts at empowerment through commitment overlap and interrelate with both these other categories because it is hoped that improved employee commitment will result from the changed arrangements. However, some initiatives are distinctly aimed at winning Managerial meaning Empowerment through participation Initiatives used Autonomous work groups â€Å"Whatever it takes† training Job enrichment Works councils Employee directors Quality circles Team briefings Suggestion schemes Employee share ownership Profit-sharing and bonus schemes Quality of working life programmes (job rotation, job enlargement) Job redesign Re-training Autonomous work groups Job enrichment Profit-sharing and bonus schemes Empowerment through involvement Empowerment through commitment Empowerment through delayering Table II. Managerial meanings of empowerment Personnel Review 28,3 178 greater commitment to organisational service quality objectives. As with Barbee and Bott’s definition, these initiatives are ultimately about employees taking more responsibility for the service encounter through a variety of training programmes and appeals to both extrinsic and intrinsic sources of job satisfaction. McDonald’s crew training includes a customer care programme which aims to sensitise employees to customer service objectives. Crew are encouraged to intervene in the service situation, as in the example given above. They can give away some low cost gifts to children. The limits and boundaries of what they are empowered to do are narrow and restricted. Whilst the three foregoing intentions are typically concerned with employees, particularly front line personnel, some initiatives empower managers within the management hierarchy. These I have called empowerment through delayering. The restructuring of the McDonald’s MCOPCO organisation (Lashley, 1995), and the removal of layers of management in the external management of Harvester Restaurants (Pickard, 1993), or empowerment of hotel managers (Jones and Davies, 1991) are examples. Here the intention is greater managerial focus on the source of organisational profits  ± the units, greater responsiveness to customer needs, reduced management costs and the encouragement of entrepreneurialism. In the McDonald’s case, two levels of management were removed and the unit managers were â€Å"empowered†. In reality it meant that they were allowed to operate with reduced contact with their Area Supervisors. In this case, empowerment of the unit managers meant they were not as closely supervised by their superordinates and were â€Å"left to get on with it†. In suggesting these four features of managerial intentions I do not wish to imply that these are mutually exclusive. Whilst managers in some organisations may well be more concerned with one meaning more than others, it is more likely that managerial actions will be driven by a mixture of motives, and hence will encompass more than one, or all, of these. However, it is useful to suggest that managerial intentions are different and there are different managerial perceptions about empowerment and the benefits it will deliver. The form of empowerment Whatever the intentions of managers, initiatives which claim to be empowering will be translated into concrete practical arrangements which set the limits and boundaries within which the empowered operate (Ripley and Ripley, 1993; Potter, 1994). Somewhere, these arrangements will clarify just what the empowered have the authority to do and for what they will be responsible. It is here within the practical objective limits set by management that tensions between the perceptions and needs of management are likely to be set against the perceptions and needs of the empowered (Conger and Kanungo, 1988). Ultimately, the success of a particular initiative will be dependent in the first instance on the empowered being given the authority and freedom to make decisions which they themselves consider to be valuable, significant and important. Whilst this will clearly be subjectively assessed by individuals, who ill differ in their evaluation of these arrangements, it is important to arrive at Employee an objective analysis of the changes which have been introduced. empowerment in Our research has identified a number of dimensions of empowerment which services provide a means of describing, analysing and locating the form of empowerment being introduced in a particular company (Lashley and McGoldrick, 1994). These dimensions are listed in Table III. Essentially they 179 provide a mechanism for identifying the boundaries and contexts set for the form of empowerment being introduced. Consideration of these themes creates a framework for understanding the likely meanings of a particular form of empowerment within a given context. Each of the five dimensions is based on a bi-polar model which assumes a traditional â€Å"production line†, â€Å"top-down† approach at one extreme and a more empowered approach at the other. The task dimension considers the discretion which is allowed to the empowered in performing the task for which they were employed. To what extent are the empowered allowed to interpret the tangible and intangible aspects of the organisation’s services so as to satisfy customers. To what extent are the brand attributes, prices, product sizes, etc. , fixed, or to what extent can they be customised? To what extent does the need to control these issues set limits on the ability of an organisation to empower its members? In the cases we have studied there are frequently limits put on the employee because of the brand attributes being marketed. Hence employees in McDonald’s Restaurants and Harvester Restaurants were not allowed to alter menus or provide dishes off the menu, not even unit managers were allowed to make these decisions. In TGI Fridays employees could get a non-menu item produced if it involved ingredients which were stocked. In most cases, and to varying degrees, employees had some discretion over the service encounter. As stated earlier, McDonald’s had scripted the service in the past, but had dropped this in recent years as part of a strategy to improve service quality. Harvesters and TGI Fridays both relied on training and service values to guide the employee in their interactions with customers. An employee of TGI Fridays reported an incident that seemed typical. A customer had asked for a cigar, the company do Employee involvement in production line organisation (High volume, standardised, short time period, simple technology, theory X organisations) Low discretion Seeks permission Limited to task Calculative Control-oriented Employee involvement in empowered organisation (Personalised service, long time period, complex technology, unpredicatable, theory Y organisations) High discretion Responsible autonomy Influences the direction of policy Moral Trust-oriented Dimensions Task Task allocation Power Commitment Culture Table III. Five dimensions of empowerment Personnel Review 28,3 180 not stock cigars, so the employee went next door to the tobacconist and bought one. The guest was very pleased and wrote a letter to the company congratulating it on its excellent service. The task allocation dimension considers the amount of responsible autonomy an individual employee or group of employees have in carrying out their tasks. To what extent are they directed, or need to ask permission to complete their tasks? To what extent do company policies and procedures lay down what has to be done and then let them get on with it? To what extent are there tensions between responsible utonomy and the objectives for effective performance set by senior managers. In McDonald’s Restaurants, a â€Å"one best way† approach involves a narrow span of control and close supervision of both â€Å"crew† and managers. TGI Fridays, was also tightly controlled in the tangibles, again one best way procedures and close supervision of standards meant that employee performance was directly controlled. However, food and drinks service staff are encouraged to use their initiative in finding ways to customise the service interaction. Having said that, staff are not generally allowed to provide discounts or free meals to customers who complain. In Harvester Restaurants staff exercised more responsible autonomy, they were empowered to deal with complaints, to give free drinks, etc. , without reference to a â€Å"team manager† where they felt it would resolve a situation to the guest’s satisfaction. In some situations staff were able to decide on staffing levels, order stock and decide on how best to meet sales targets without the immediate involvement of the team manager. The power dimension is concerned with the feelings of personal power which individuals experience as the result of being empowered. What is it that the empowered are empowered to do? To what extent is their power limited to tasks? To what extent does it involve issues of policy at a more senior level (Marchington et al. , 1992)? To what extent do management efforts to share power foster feelings of empowerment in employees? What tensions are there between strategic objectives and limits on individual power? In all the cases included in these studies, arrangements were limited to what has been described as being â€Å"task participation† (Geary, 1994). In other words the empowered employee was not able to influence the policies which influence them. Thus at Harvester Restaurants, food service staff were able to decide as a team how best to achieve a sales target which required employees to sell one extra side order per table (Pickard,1993), but had no influence over this as an objective. The commitment dimension explores the assumptions about the source of employee commitment and organisational compliance in a particular form of empowerment. To what extent do they follow patterns in traditional organisations which assume that commitment is calculative and based on material extrinsic rewards (Etzioni, 1961). To what extent does the initiative assume a moral commitment, as the individual takes a personal sense of ownership in their activities and work? To what extent is there recognition that individuals may differ in their attachments and needs from work? How, if at all do the changes address needs for a sense of equity and fairness in the benefits from empowerment? Interviews with employees at Harvester Restaurants Employee revealed that employees working in autonomous work teams liked the empowerment in experience. Many reported that they â€Å"liked the extra responsibility† (Ashness services and Lashley, 1995, p. 27) and some that this was the first time they had been given responsibility. In TGI Fridays, employees reported that they enjoyed the â€Å"atmosphere† and that â€Å"you could have a good laugh†, but many also reported 181 that â€Å"they were working here because the money is good†. Employees are guaranteed a low basic pay, but can substantially add to this through a bonus on food sales and tips. Employees and managers both stated employees could earn over ? 0,000 per annum, some even as much as ? 30,000. The culture dimension examines the extent to which organisational culture fosters feelings of empowerment. To what extent can it be typified as being oriented towards openness, learning, and employee contributions (ChristensenHughes, 1992) and creating a climate of trust (Sternberg, 1992)? To what extent can the culture be described as bureaucratic, role, task or control oriented? To what extent is the initiative to empower a part of a broad organisational culture, or just â€Å"bolted on†? The research with the â€Å"delayered† McDonald’s organisation revealed that â€Å"empowered† General Area Supervisors in the pilot group experienced tensions with senior management because senior managers wanted to retain control over the recruitment of Restaurant Managers, and to get involved when problems occurred (Lashley, 1995). Using this five dimension model it is possible to locate the different forms which empowerment takes in practical organisational arrangements against the managerial intentions and the form empowerment takes  ± quality circles  ± autonomous work groups  ± â€Å"whatever it takes training†, etc. As stated earlier, managerial intentions may not be mono-dimensional, and particular initiatives may be driven by a range of intentions. However, each form of empowerment is likely to represent different sources of satisfaction to employees and represent different benefits to employers. Thus quality circles are usually representative, and may provide intrinsic satisfactions for those immediately involved (Kelly and Kelly, 1990), but they represent a more indirect source of satisfaction for the staff who do not take part. Managers gain suggestions and involvement in problem solving for those closest to the problem, but managers retain the decision making power. Autonomous work groups do give employees more direct involvement, all employees take part. They can provide sources of satisfaction which meet belonging and control needs. They can involve some task dimensions, but in the main, autonomous work groups are about improving work organisation. Frequently they are used in situations where the immediate organisational needs are difficult to predict, but the people directly involved are best placed to respond to changed circumstances. Several employees at Harvester Restaurants reported that when the operation was quiet the team would, â€Å"jointly agree for one member to go home for the rest of the shift, so that the team’s labour costs would be kept under control† (Ashness and Lashley, 1995, p. 27). â€Å"Whatever it takes† is again a direct form of involvement, particularly for service personnel, training is aimed at â€Å"giving Personnel Review 28,3 182 staff confidence to make decisions large or small, that impact on a guest’s stay† (Hubrecht and Teare, 1993). Typically these arrangements are focused at the task and interpreting customer requirements. For employees a sense of ownership, pride in the service encounter and the potential tip are sources of employee satisfaction. For the organisation, employees are encouraged to be responsive to customer needs and a greater level of customer satisfaction is likely to follow. Each of these examples, claim to empower employees, yet the brief discussion above shows that each represents different sources of satisfaction for employees. The arrangements are themselves different and appear to meet varied managerial needs. Certainly it is possible to identify alternative ways of managing and motivating employees which involve different amounts of discretion, autonomy, power, sources of commitment and cultural contexts, all claiming to be empowering. By considering the detail of the changes against the five dimensions it is possible to develop a much closer picture of the form of empowerment, the consistency of the arrangements and the limits placed upon them. My research with hospitality operators provides some useful vehicles for the analysis of forms of empowerment. For example, it is possible to describe Harvester Restaurants as empowering front line personnel through participation. In this case it takes the form of autonomous work groups where employees have virtually no discretion in the tangible aspects of their task, though they have some limited discretion in the intangible elements of the task. There is a high degree of responsible autonomy in task allocation. Power is limited, however, to the task level with little opportunity to influence objectives outside the immediate job. Commitment is in part calculative though, for some individuals, arrangements do meet psychological needs within a culture which is best typified as being control oriented. The state of empowerment The feelings of the empowered are fundamental to understanding the concept of empowerment and variations in form and application. Most definitions of the state rather than the form of empowerment stress the need for the individual to feel in control (Conger, 1989), have a sense of personal power together with the freedom to use that power (van Oudtshoorn and Thomas, 1993) and a sense of personal efficacy and self determination (Alpander, 1991). Similarly, Thomas and Velthouse (1990) suggest a four dimensional model of employee motivation based on a cognitive assessment of the competence, impact, meaningfulness and choice associated with a set of changes. In other words the state of empowerment is likely to be a consequence of the individual’s assessment of their ability to be effective, that they could make a difference, in a task which they feel is worthwhile and they have some degree of freedom to act as they see fit within a given context. Attempts to empower service workers will be tested against the experience of being empowered and the sense of personal efficacy which is created. Empowerment, therefore, involves both the objective facts of what a person is mpowered to do and the subjective feelings which the individual experiences Employee as a result. In these circumstances individual differences, orientations to work empowerment in and needs are likely to be important factors in the way an individual interprets services and responds to a particular change (Alpander, 1991). Managerial initiatives to empower employees are introduced to meet commercial objectives. In the case of service workers, the objectives may be to improve service quality or service 183 worker productivity, or improve job satisfaction and reduce labour turnover. Managerial evaluations of empowerment will therefore turn on the extent that these initiatives result in worker behaviour which meets the desired objectives. Whilst there is some research, on service workers which identifies factors likely to result in outcomes of empowerment as measured by pay satisfaction, promotion satisfaction and intentions to leave (Sparrowe, 1994), few studies draw the links between these feelings of empowerment and increased productivity or improvements in service quality.

Working With Refugees And Displaced Persons - 902 Words

The bulk of my experience working with refugees and displaced persons comes from my time working in the Kachin Statement of Myanmar. As described above, I did various education and community development work in a serious of refugee and internationally displaced camps (IDP) on the border of China and Myanmar. I have also done work with displaced persons in Morocco when I studied abroad in my internship at a local nonprofit that provided courses and basic life necessities for displaced persons. Finally, I have experience working with asylum seekers during my field placement at Bronx Legal Services and in my work as an advisory board member of my undergraduate university’s alternative break program, most notably spending a week in Immokalee, Florida aiding in connecting asylum seekers to community resources. As a social worker and public health student and professional, I am dedicated to a future working with refugee and displaced populations. I have focused much of my coursework in my dual degree program at Mailman School of Public Health on refugee and displaced populations. However, with the exception doing some case management at Bronx Legal Services, much of my work with refugee populations was not in a social work capacity and was not always fully informed by social work practice and techniques that address power, privilege and oppression. I hope to build upon the coursework I have taken relating to refugees and displaced persons in the fields of public affairs, publicShow MoreRelatedThe Refugee Crisis : The Refugee Crisis1286 Words   |  6 Pages According to the European Commission, globally there is â€Å"one displaced person every second† (â€Å"Refugees and Internally Displaced Persons†). Displacement is known as forced removal from a particular area, which cre ates an influx of people seeking safety in neighboring places. These people are known as refugees. 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Dehumanization In 1984 By George Orwell - 1579 Words

George Orwell utilizes his novel 1984 to pass on that individuals, as a species, are greatly vulnerable to dehumanization and abuse in the public arena. Orwell shows how an administrations control of innovation, dialect, media, and history can persecute and debase its subjects. In 1984 the political control of innovation persecutes the general population of Oceania and prompts the defeat of independence and of the qualities that characterize mankind. Telescreens and the Internet are utilized not for diversion purposes but rather to screen individuals lives. For Orwells situation, Pynchon refers to media advancements, for example, intelligent level screen TVs and the Internet as instruments of observation (Deery). The effect of†¦show more content†¦In 1984 government officials intentionally control ideas and thoughts. This incapacitates the human capacity to express sentiments and feelings, which is precisely what the totalitarian government wants. We might pound you down to the point from which there is no returning. Things will transpire from which you couldnt recoup, on the off chance that you carried on a thousand years. Never again will you be equipped for standard human feeling. Everything will be dead inside you. Never again will you be equipped for adoration, or companionship, or delight of living, or chuckling, or interest, or boldness, or trustworthiness. You will be empty. We might press you exhaust, and afterward we should fill you with ourselves (Orwell 148). By controlling dialect the Party replaces singular feeling with Party purposeful publicity. To communicate their dehumanizing purposeful publicity, the legislature in 1984 controls the media and introduction to it. Individuals cant shape their own particular conclusions and subsequently should depend on the media to do as such for them. The general population of Oceania cant think basically, for instance, about open figures. In any case, what was weird was that despite the fact thatShow MoreRelatedOppression and Dehumanization in George Orwells 1984 Essay1621 Words   |  7 PagesMikalaitis English 9 12 April 2012 Oppression and Dehumanization of Society in George Orwell’s 1984: The Manipulation of Technology, Language, Media and History George Orwell uses his novel 1984 to convey that human beings, as a species, are extremely susceptible to dehumanization and oppression in society. Orwell demonstrates how a government’s manipulation of technology, language, media, and history can oppress and degrade its citizens. In 1984 the political manipulation of technology oppressesRead MoreGeorge Orwells 1984: Methods of Suppression in 1984. A study of ways people were oppressed in the book.1532 Words   |  7 PagesMethods of Suppression in 1984 George Orwells anti-utopian novel 1984 paints a picture of a society in which the individual has no freedom, hope, or feeling. 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