What are three aspects of the case that consider new information or that offered deeper context.

What are two aspects of the case that can apply in practice healthcare field now or in the future.

What is one aspect of the case that found confusing, created question for further consideration, or which would to learning more.

This case focuses on the interaction of a physician and three families. As you read, pay attention to how Dr. Williams’ interactions with each family differ and how these different interactions could affect the health outcomes of each child. Dr. Brent Williams is having a terrible day. Medical school prepared him for the hectic pace and difficult, needy patients. And most of them don’t even have health insurance! Does nobody work anymore? Medicaid reimbursement is hardly worth the clinic’s time. It won’t be long before his blond hair will be streaked with gray. After a day in Sleep Clinic, he feels as if he has been around the world in 80 hours. Maybe he should rethink this job. But he likes practicing in Minneapolis, near his family and his buddies from residency. It's hard to believe its been a year since they completed their program. To Dr. Williams’ relief, his first afternoon patient is Johnny Reese. Today, as he enters the room, Becki Reese has four year old Johnny on her lap and is reading to him while Johnny pulls on his mother’s blond pony tail. Dr. Williams chats with Becki for a few minutes about horses, a shared interest. He then regretfully confirms that according to the sleep study Johnny’s obstructive sleep apnea (OSA) has not improved, despite having had his tonsils and adenoids out. In fact, he adds that the second sleep study was worse than the first and Johnny will need to use CPAP. Becki nods sadly, “I was afraid of that”. She listens carefully as he explains that Rita, the nurse will order the CPAP machine and mask from Pedi-delight Homecare and it will be delivered in the next few days. “It is very important that Johnny wear the mask every night”. After a few more comments, he leaves the room. Later, he is discussing the homecare equipment with Rita. Rita says that Becki mentioned she has been really stressed recently as she has three children under the age of five and bedtime is often chaotic. Rita wonders whether Becki will realistically be able to get Johnny to use CPAP on a consistent basis. “I wouldn’t worry about that, they are a nice family,” Dr. Williams replies. “It should not be a problem.” “Still,” Rita says, “I’d feel better if we saw them in a one month follow-up just to make sure.” “Well, okay,” says Dr. Williams, “they have good insurance, we can do that.”

     

As Dr. Williams enters the second room, he groans under his breath.   Another African American family. This probably means Medicaid and low adherence. No matter how long he spends with these families, they usually don’t do what he says anyway. He glances down at the chart to get the parents’ names, Fahari and Mendi Waleed. It is a new eight month old patient and her name is Breshay. “Where do they get these names?!” he wonders. He wonders why Mr. Waleed is not at work. “They are probably on welfare. I wonder how many other kids they have.” Dr. Williams figures that he might as well plunge in and asks what brought them to clinic today. He is surprised when Mr. Waleed speaks with an accent. “He’s probably from Haiti,” Dr. Williams thinks. Mr. Waleed goes on to explain that his daughter seems to stop breathing at night. She seems very quiet during sleep and doesn’t seem to be breathing very hard. He has noticed that her lips look dark at times. His wife believes someone has cast the evil eye on Breshay. “The church members wanted us to come to the clinic, but it is expensive and we thought we could fix on our own.” Mr. Waleed explained that the family consulted an oracle who conducted a ceremony in which a white chicken was sacrificed. Dr. Williams thinks to himself, “Good Heavens, those Caribbean countries are really superstitious.” He takes an inadvertent step backward. He wonders what kind of church they are involved with. After examining Breshay, Dr. Williams wants to rule out the possibility that she has central hypoventilation syndrome. “I would like her to have a sleep study” he says. Mr. Waleed looks confused and asks if this will cost money. “Don’t you have Medicaid?” Dr. Williams asks. Mr. Waleed explains that they came from the Sudan six months ago and do not have their green cards yet. Dr. Williams tries to remember where the Sudan is located. He decides not to refer Breshay for a sleep study, but tells the family if she becomes symptomatic, they can go to the emergency room. Telling Rita about it later, he says, “With no insurance, there is really nothing that we can do. They didn’t really want healthcare anyway.”

Bao, Chi, and Duong Phan are sitting quietly in the examining room when Dr. Williams rushes in. “Oh geez”, he thinks to himself, “I have to get to Seminar by 5:30 PM and I’m already running an hour behind. I’d better make this quick.” He turns to Chi Phan and says hurriedly, “So, Mom, we have the results of the sleep study. As we thought, it is OSA. His AHI was 120 increased in REM to 250. He had long periods of hypoxemia and hypercarbia. He is at risk for pulmonary hypertension with these results. I doubt that an adenotonsillectomy will adequately treat his problem. The most rapid and effective treatment at this time is CPAP with a Cflex of 3. He may need to tolerate a nasal interface, but if he develops a significant leak we will change him to a Quattro full face mask.)   Chi looks at Bao, who says tentatively, “face? A mask?” “Oh shoot”, Dr. Williams thinks, “here we go again, this is going to take forever.” He figures the mother must be a little slow – she isn’t saying anything. Or maybe she doesn’t care about her son. Dr. Williams responds loudly, “It - will – help - your - child – keep - breathing”.   Frustrated, he decides to proceed with some more questions before trying to explain anymore. When he asks about any medication that six year old Doung is taking, Bao replies that he is not on anything right now. Bao says that their pediatrician had prescribed Ritalin but his wife tried it before giving it to Duong. It made her feel funny, so she decided not to give it to him. Dr. Williams resumes trying to explain OSA and CPAP to the Phan family. He explains it as clearly as he can, but cannot understand why they are not saying anything. “It must be that they do not want to do this,” he thinks. Agitated, he puts his hands in his pockets and starts pacing. Finally he sits down again and says in exasperation, “Well, if you don’t use CPAP, you’ll have to get a trach”. As he says this, he points to neck and demonstrates a hole. He asks, “Do you understand?” Bao and Chi nod politely. “OK, so we’ll order the CPAP and you can do that,” Dr. Williams finishes. He tells the family that the nurse Rita will arrange to have to equipment delivered. As he leaves, Dr. Williams, one hand still in his pocket, hands the checkout sheet to the family. He finds Rita and says, “I want you to call the social worker and see about a referral to child protective services. This Mom is clearly not involved and her tasting the medication is truly bizarre. On their way out of the clinic, Bao tells Chi that he will consult with his mother and father over Duong’s medical problems and will talk to the Buddhist Temple performing a ceremony before considering any medical procedures. “I think we should ask our friends for the name of another doctor, I do not want to come back to this rude place.”

Following clinic, Rita walks to the parking lot with the receptionist, Mary. “I’m really worried about Brent’s approach. There’s so much that he doesn’t know about different cultures let alone dealing with children. He makes such assumptions.   By assuming that the Waleeds are African American, he overlooked the stresses they may have had in emigrating from the Sudan. When he found out they didn’t have insurance, he just blew off the issue of a sleep study. He could have asked the sleep lab to at least do a daytime nap study monitoring sats and CO2. Some times the sleep lab will do that for free, but he didn’t even check. And he never asks for an interpreter. He uses such technical medical terms and doesn’t worry at all about the families’ health literacy.

When we had that cancellation at 4:30, I looked on the internet to learn more about Vietnamese culture. You won’t believe what I learned! Brent really blew it. In Vietnamese families, like the Phan’s, it is impolite to seem loud or in a rush. Also, in their culture, one always addresses the man, not the woman, and its not at all unusual for mother’s to test their children’s medicines. In some parts of Asia, there is inadequate regulation of medicines, or none at all, so mothers do this precisely because they want to protect their children. Worst of all, in Vietnamese culture it is considered downright rude to put your hands in your pockets or hand a form to someone with just one hand. I wish he would look on the internet, or ask families, or use a culture broker.”

Rita sighs, “I’m just so worried that many of the families we see are not getting good care and won’t do well, through no fault of their own. Mary agrees, “As an African-American woman, I think I’d have problems with him. There are so many ways his approach would just get us off on the wrong foot.” Rita decides to talk to Dr. Williams the next day. When she calls to see if there would be a time they could talk, she is pleased to hear him at least say, “Boy, you know, I really thought a lot about my day today on the way home. This can’t be the best way to do things.”

After reading the message below please provide your personal opinion in detail of what you learned.

I was sitting in one of those fluorescent corporate cafeterias eavesdropping on the women at the next lunch table. One had vacationed in Thailand. The other had returned from a group tour of Vietnam.

"Over there, it was nothing to see two generations of family crammed into a house no bigger than my living room," said the Vietnam traveler. "Makes you appreciate what we have here, in America."

I will probably never see that American woman’s living room. But I'm willing to bet that it's larger—and certainly more weather-proof—than my childhood home in Ireland. And as for that multi-generational-living thing? Yup, we managed to cram two parents, five kids, two grandparents, and the family dog into a thatch-roof house with three tiny bedrooms.

But, sitting there in that air-conditioned cafeteria, did I interrupt my lunch neighbors to say: “Whoa! Wait. You have no clue how it really is. You have no clue about what I learned from my live-in grandparents, or that poverty and cultural exotica are a lot more than the sum of our non-commodities, of what we don’t possess?"

Nope. I just kept munching on my salad. Ten minutes earlier, I had ordered and paid for that salad in my best expat-American patois.

These days (I have since switched jobs), I work as the communications director for a nonprofit. In my own office, among my own colleagues, I say nothing about my rural, hardscrabble beginnings. Equally, I don’t stand at the office photocopier belting out a Gaelic-language song, just as I don’t brag about how, once, I used to design and knit fisherman-knit sweaters. You'll never see me pulling up a boardroom chair to re-tell one of my live-in grandfather’s fireside stories, like that one about how, as a little boy, his mother (my great-grandmother) took him to town where he saw a huge ship sitting way, way out in the harbor. His mother said that the ship was on a stopover between England and America. It was called the Titanic.

So as an expatriate in America, am I in a perpetual state of what my late mother called “putting dogs on windows” (a.k.a., pretending or trying to be someone I’m not)?

Today In: Leadership

No. And yes.

In my private, non-working life, among my American friends, everything is fair game. Actually, I’m often the one quizzing them about their childhoods. But in the workplace, I’m quite content to “pass” as American.

PROMOTED

I was 24 years old when I landed from Ireland at JFK Airport. It was a freezing December afternoon. I had an overstuffed backpack and a borrowed $200 and a set of directions for how and where to catch a Trailways bus.

In my early American years, I worked as a waitress in an Irish-American pub in a jazzy college town. This was the swingin’ ’80s, and that cash ’n’ carry restaurant life was one eye-popping culture shock. Also, in any country or culture, waiting tables is a safari of human behavior: the good, the bad, and the downright weird (especially after midnight).

In that Irish-American pub, for the first time in my life, I had to become—well, Irish. I discovered this “all-Irish” meal called corned beef (yuck) and cabbage. My bar customers ordered this “Irish” beer drink called a Black and Tan. By the way, if you had ever offered my history-buff father any food or beverage of that name, he would have laughed in your face or spat at your feet. (The “black and tans” were a band of temporary British constabularies sent to fight the IRA during the Irish War of Independence. Mostly comprised of World War I vets, the “tans” were famous for their civilian attacks.)

The first week on the job, I learned that the way I spoke was called a “brogue.” And my “brogue” brought a string of questions: Oh, what brought you here? Don’t you miss your family? Aren’t all you Irish chicks named “Colleen?”

Of course, I was grateful for this job and this all-American chance to reinvent myself from my heretofore life as a parochial school teacher in a rural Irish village. So, bit by bit, I began to assume this packaged, offshore brand of Irishness.

Three years after arrival day, I quit that pub gig to start an evening graduate-school program and to work a string of day jobs, most of them in offices. I’m not proud to admit this, but as I interviewed for and started each new job, I wasn’t above laying on the brogue and the Maureen O’Hara charm.

What I didn’t yet know was this: Playing to a set of Hollywood stereotypes, to a set of broad-brush cultural assumptions, is “putting dogs on windows." And worse, it will deplete our sense of self and self-esteem.

I finished that graduate degree and landed better-paid jobs, including my first gig in business writing and communications.

In one position, I had to deliver a short, monthly overview of the organization's public information policies as part of the new-hire orientation. As an ex-teacher, preparing content and delivering a short, lively presentation was a snap. So I assumed that my participant evaluations would be glowing.

They were.

Then I scrolled down to those add-on, narrative comments: “I liked the communications woman’s accent.” “Love that accent!” “She’s really cute!”

Gulp. What about my carefully prepared content?

Outside of work, I was also building a career as a creative writer. My publications and bylines landed me on some book-discussion panels and public presentations.

More than once, an audience member would approach the podium to say: “Heck, with that accent, you could stand there and read the phone book, and I’d sit here and listen.”

But here’s the thing: I didn't want to read any phone books. I didn't want to have crossed an ocean and navigated a whole new country just to achieve “cute.”

Then came our 21st-century recession. And with it came a lot less room, a much narrower tolerance, for blather or swagger. In a 2008, 8-10% unemployment America, in an America where both the communications and the publishing industries were changing and dipping faster than the NASDAQ, it took real, hard-core skills to snag a new job. And, in a perpetually merging and downsized workplace, keeping that job means being trained, ready, and willing to produce the goods.

I find this delightful. I find it really freeing. Without the cultural distractions, I’m just another middle-aged woman with a skill base that's continually challenged and updated. I'm a woman valued for what I know and what I can do, not for where I came from.

Still, since that day in the lunchtime cafeteria, I have imagined myself turning to those women and regaling them with enough hardscrabble childhood stories to put them off their sandwiches. Like how I remember reaching for the family sugar bowl to sweeten my morning porridge only to discover that the mice had (again) decided to deposit their—ahem—food additives in there. Or how, without indoor plumbing or central heating, a kid needs both skill and stamina to snag herself a Saturday-night bath. Or how infuriating it was to finish all my third-grade homework only to get up in the morning and find it (again) stained with brown rain leaked through the thatch roof.

We weren't a poor family. Thanks to my father’s double life as a weekday truck driver and a weekend farmer, we were actually quite well off—at least by 1970s rural Ireland standards, and at least by how we viewed ourselves or, indeed, where we ranked in our village's socio-economic pyramid. Based on what I overhead at that lunchtime table, our set-up probably didn't match how those women grew up, but in our village primary school, most of my classmates had live-in grandparents. The lucky among us had a pair of good shoes just for Sunday, plus a warm winter coat. If it had once been a sister’s or a cousin’s coat, what difference?

But in that imaginary lunch speech, the glossary becomes longer than the actual content. There are more cultural footnotes, more lost-in-translation asides than any of us would have time for.

And anyway, from our company dress codes to our bullet-pointed, buzzwordy chatter, today’s workplaces breed a certain homogenization. We assume that most or all of us watched after-school TV and used the microwave on the kitchen shelf and went to U.S. colleges where Dad delivered us for freshman orientation and Mom kitted out our dormitory with a mini-fridge.

There are those of us who didn’t. There are those of us who get up in the morning and stand under the shower belting out a foreign-language song. We go home at night to dream in another language. But in our fluorescent, white-walled workplaces, we abandon all that in the downstairs lobby. Why? Because, as I learned the hard way, the socio-economic dissonance and the cultural quirks can eclipse what’s really there, what we can really do.

I can improve America. There. For 20-plus years now, I’ve been longing to just come out and say that. In my own small way, in my creative and working life, I believe that I can be the softly spoken (ha!) but persistent voice for better healthcare, better education, and fairer public policies—the kinds of policies that let kids go to bed at night with full bellies and go to school in the morning without a bullet-proof backpack.

But tell me: How can a woman improve a country, how can she write or fight for anything—anything worthwhile, anyway—if all she’s considered by the people around her is “cute?”

Apple’s profile

Apple Inc. (hereafter Apple) was established in 1977 and is registered on the NASDAQ Global Select Market exchange. According to its Form 10-K ‘Apple designs, manufactures and markets mobile communications, media devices, personal computers and portable digital music players, and sells a variety of related software, services, peripherals, networking solutions, and third-party digital content and applications’. Its products are sold through Apple’s retail stores, online stores and third parties

Apple is a world leader in producing innovative electronic goods and technology. In 2011 Apple’s net sales were estimated at $108.2 million. Its net sales in 2011 increased by 60% compared to 2010. Apple worldwide employs 60,400 full-time people and 2,900 temporary employees and contractors. The company utilizes outsourcing through the manufacturing of its products overseas; most of the factories are located in Asia          

Apple’s CSR policies and reporting

As required by the Security Exchange Commission (SEC), Apple has made the Form 10-K annual report available on its website. The Form 10-K contains – amongst other things – information on Apple’s business strategy and organization, the company’s risk factors, legal proceedings and financial data. It also includes the business conduct policy of Apple: ‘Apple conducts business ethically, honestly and in full compliance with all laws and regulations. This applies to every business decision in every area of the company worldwide’. Furthermore, the business conducts deals with corporate governance, information disclosure, non-corruption and bribery, environmental health and safety

Apple has considered the GRI G3.1 indices relating to the economy, the environment, human rights, society and labour for its publication on Governance, Product Environmental Reports, Recycling and Facilities Environmental Report and Supplier Responsibility. For Supplier Responsibility, Apple, for example, has taken into account the indicator which reports on measures it has taken to contribute to the elimination of child labour. About Product Environmental Reports, Apple has used the EN26 performance indicator and sets out initiatives to lessen the environmental impact of its products. Apple designs its products with the aim of being as energy efficient as possible, and it is the only company that can claim all electronic goods are Energy Star qualified. Apple’s products have become more powerful while, at the same time, fewer materials are used and fewer carbon emissions are generated.

Almost all of Apple’s products are outsourced for manufacturing overseas. On its Supplier Responsibility website, Apple states: ‘Apple is committed to the highest standards of social responsibility across our worldwide supply chain. We insist that all of our suppliers provide safe working conditions, treat workers with dignity and respect, and use environmentally responsible manufacturing processes. Our actions – from thorough site audits to industry-leading training programs – demonstrate this commitment

The Supplier Code of Conduct (Supplier Code) outlines Apple’s expectations for the suppliers it does business with. As a condition for doing business with Apple, suppliers have to commit to the Supplier Code. For the Supplier Code, Apple has adopted the Electronics Industry Code of Conduct (EICC), the guidelines and standards for the electronics sector. Through onsite audits, Apple ensures that suppliers comply with the Supplier Code. The final assembly manufactures are audited every year and the components suppliers are audited arbitrarily. Apple obliges its suppliers to respect the human rights of its workers, to inform the workers of their rights, and to treat them with dignity and respect. Apple requires from its suppliers that they prevent discrimination, involuntary and underage labour, excessive working hours and that they pay workers with wages and benefits in accordance with the applicable laws and regulations.

Apple’s conflicts

The limited transparency of Apple’s supplier sustainability policy has often been criticized in the media. In February 2010 Apple also turned down two shareholders’ sustainability proposals to establish a sustainability report on Apple’s environmental policies and the impact that climate change has on the company. The other proposal was to establish a board of directors’ sustainability committee

Labor and human rights

A well-known conflict involving Apple’s suppliers is the suicides at Foxconn. It is the largest contracted electronics manufacturer in the world, with dealings involving Dell and Sony. Foxconn is the manufacturer of iPhones and iPads and employs over 900,000 workers, of whom 420,000 employees work at the Foxconn Shenzhen plant. This plant covers 15 factories, including dormitories, a hospital, a bank, a grocery stores and restaurants. The workers live and work inside the complex

In 2006 the Chinese local press reported on the excessively long working hours and the discrimination of mainland Chinese workers by Taiwanese superiors. In May 2010 several media sources reported several cases of suicide at Foxconn. From 2009 to 2010 a total of 13 workers had committed suicide. The first worker, Sun Danyang, committed suicide after he had been interrogated on the loss of an iPhone 4 prototype that he had in his possession. When the former CEO Steve Jobs was asked about the suicides at Foxconn, he responded: ‘Foxconn is not a sweatshop

During an undercover investigation, it was discovered that the reason for the multiple suicides was related to internal management. ‘The facilities of Foxconn are fine, but the management is poor,’ revealed Zhu Guangbing, who organised the investigation. According to Audrey Tsui, a professor at the National University of Singapore Business School, Foxconn maintains a military-style management approach. The workers were not allowed to interact with each other. Workers who violated the rule were penalized with a fine or were held to be in contempt by the manager

The weekly working hours of workers were up to 70 hours, ten hours above the maximum hours set by Apple’s Supplier Code. The Foxconn factory has good facilities. The workers have access to swimming pools and tennis courts. Foxconn organises activities such as chess clubs, mountain climbing or fishing expeditions. But with a 70-hour workweek, employees did not have any time to enjoy these facilities

However, interviews with several Foxconn workers by Dreamworks China revealed that not all the employees were dissatisfied. Some believed that the working conditions at smaller factories are worse. One of Foxconn’s workers stated that employees at Foxconn thought the media had exaggerated the suicides regarding their connection to Foxconn and that possibly some suicides had a sentimental or romantic cause.

In February 2011, the media reported the child labour issues had worsened at the suppliers for computers, iPods and iPhones. Apple’s Supplier Responsibility Report 2011 revealed 91 underage workers at the suppliers

Workers’ health and safety

Concerning workers’ health and safety conditions at the suppliers, in May 2010 two workers were killed and sixteen employees were injured during an explosion at Foxconn. An Apple spokesperson stated: ‘We are deeply saddened by the tragedy at Foxconn’s plant in Chengdu, and our hearts go out to the victims and their families. We are working closely with Foxconn to understand what caused this terrible event’. In the same month, The Guardian reported that workers from Wintek had been poisoned by n-hexane, a toxic chemical used to clean the touch screens of iPhones. The employees complained that the compensation Wintek offered for the health damage was not sufficient. The workers who did receive compensation were asked to resign from their jobs.

Apple’s CSR policy post-conflict

Apple makes sure that suppliers comply with the Supplier Code by conducting audits. The audits cover working and living conditions, health and safety but also environmental practices at the facilities. According to Apple’s Supplier Responsibility Report 2010, Apple conducted 102 audits in 2009. In 2011 Apple conducted 229 audits, an increase of 80% compared to 2010. An audit is conducted by an Apple auditor and supported by local third-party auditors

In the Supplier Responsibility Report 2010, published in February 2011, Apple included a paragraph responding to the suicides at Foxconn

In the Supplier Responsibility Report 2011, Apple reports that during inspections Apple discovered ten facilities with underage labour violations. One of the facilities had a large number of underage workers. Because the management did not want to address the problem, Apple terminated businesses with this facility. Where underage labour has been discovered, suppliers are required to pay educational expenses, living stipends and lost wages for six months or until the worker reaches the age of sixteen

In November 2010, Apple set up a training programme to prevent the future hiring of underage workers. The human resources managers are trained in Chinese labour law. Training human resources managers, however, will not solve child labour issues. When the costs of labour, energy and raw materials rise and there is a shortage of labour, factory owners are forced to cut costs or to find cheaper labour. Child labour can easily be hidden by providing fake wages and work schedule data. Also, it is difficult to prevent child labour when underage workers want to work to provide for their families. The Supplier Responsibility Report of 2012 states that suppliers are obliged to return underage workers to school and finance their education through Apple’s Child Labour Remediation Program. Regarding abolishing underage labour, Tim Cook, the CEO of Apple, stated: ‘We would like to totally eliminate every case of underage employment. We have done that in all of our final assemblies. As we go deeper into the supply chain, we found that the age verification system isn’t sophisticated enough. This is something we feel very strongly about and we want to eliminate’

In the Supplier Responsibility Progress Report of 2011 Apple addressed the issue of the use of n-hexane. Apple obliged Wintek to stop using n-hexane and required Wintek to repair its ventilation system and to work with a consultant to improve its environmental health and safety systems

To take action, companies need to be transparent about their supply chain. In February 2012 Apple announced it would be the first technology company to join the Fair Labor Association (FLA) as a participating company.

------------------------quation-------------

1. At Shenzhen plant, many employees have committed suicide due to the following reason. (1 Mark)
   1. Discrimination among the employees
   2. Bad management
   3. Poor facilities
   4. Due to the explosion at the plant

Justify your choice: (50 words minimum/ 1Mark)

Q4: Based on the case study, explain how satellites have contributed to bringing about change in the global world. Provide specific examples.

THIS IS THE CASE STUDY

Satellite Instructional Television Experiment

The use of modern technologies for development purposes was pioneered by the Indian Government when, in 1975, it launched the Satellite Instructional Television Experiment (SITE). The programme, supported by UNESCO, aimed to use satellite technology to assist development by transmitting daily programmes on health, agriculture and education to rural communities.

India’s Department of Atomic Energy negotiated a deal with the US

National Aeronautics and Space Administration (NASA) which loaned India one of its satellites, Applications Technology Satellite-6 (ATS-6), for a year to make these broadcasts in exchange for sharing the knowledge from the project (Krige, Callahan and Maharaj,2013).

The SITE programmes lasted from 1 August 1975 to 31 July 1976, and the estimated cost to India of the world’s largest techno-social experiment was about $6.6 million. The government chose 2,400 villages, selected from twenty districts of some of the poorest regions of six contiguous provinces – Orissa and Bihar in the east, Madhya Pradesh in central India, Rajasthan in the west and two southern states, Andhra Pradesh and Karnataka. Most of these villages had little existing communication infrastructure (Agrawal,1978).

In each village, a direct-reception system (DRS) television, a 25-inch, black-and-white set, was installed in a public place for community viewing. Signals were beamed from Ahmedabad and Delhi earth stations to ATS-6, which had a capacity of two audio and one video transmission signals. The use of direct reception systems eliminated the need for costly microwave relay towers. In addition, conventional television sets in 2,500 villages and towns received the programmes through terrestrial transmitters.

Members of government institutions, such as the Indian Space Research Organisation (ISRO), teamed up with other experts from the areas of health, education, agriculture and development and the Satellite Television Wing of All India Radio, to produce the daily four-hour programming at three base production units located in Delhi, Cuttack and Hyderabad. The science-education programmes for schools were produced by Space Applications Centre’s Ahmedabad and Bombay studios. Several international experts, including Wilbur Schramm, were also involved in theproject.

Programmes were broadcast mornings and evening in four languages – Hindi, Kannada, Oriya and Telugu. A thirty-minute national programme in Hindi (partly live) was broadcast from Delhi for all villages, while the remaining three-and-a-half hours were broadcast in region-specific

languages. More than 80 per cent of the reception systems were functioning at any given time in the villages. The availability of visuals and sound generated much interest among the viewers, with a large numbers watching the first programmes but gradually audience size stabilized to about 100 for the evening broadcast.

Inspired by the dominant paradigm of modernization theories of communication for development (Lerner, 1958; Schramm, 1964; see also Chapter 2, p.42), the project aimed to bring about behavioural changes among the rural communities and help them reject traditional social attitudes, which were seen as antithetical to the goals of modernization, but it also reflected current domestic political concerns. Among the primary objectives was to use television for population control – ‘family planning’ was a major priority for the then government of Prime Minister Indira Gandhi.

Modernizing agricultural practices by using high-yielding seeds and pesticides and fertilisers – all part of the ongoing ‘Green Revolution’ – was another key plank of the programme. Attempts to improve school education, contribute to teacher training and improve health and hygiene were other main objectives of SITE. It is, however, ironical that this innovative project was in operation at a time when Indira Gandhi had imposed an Emergency, muzzling the press and arresting opposition leaders.

Of the four hours of programming, one and a half hours were targeted at children aged between five and twelve years of age, to be watched in schools as supplements to the regular school curriculum. The objective was to make learning more interesting through audiovisual teaching tools, hitherto unknown in most villages, and to reduce the drop-out rate, as well as to improve the children’s basic skills and instil in them a sense of hygiene (Agrawal,1978).

Another major objective of the SITE programmes was the development of agriculture, a key sector in a predominantly rural country. The aim was to disseminate relevant information, give demonstrations and provide advice on such matters as improved farming methods,pest

control, crops management and poultry and animal husbandry. The programmes were also supposed to provide information about the district- level government organizations responsible for the supply of seeds, fertilizers and agricultural implements. In addition, programmes also advised on crop marketing and commodity prices, agricultural credit schemes and had regular reports on weather forecasts. The agricultural programming constituted thirty minutes each day, for each linguistic group.

The third priority area was healthcare and birth control. Advice was given on nutrition and hygiene, as well as on pregnancy and postnatal care, a vital topic, given that thousands of women died in childbirth in India every year, especially in rural areas.

The programmes were more varied and imaginatively made than the standard fare on Indian television, and many organizations were involved in their preparation. Some programmes used techniques borrowed from traditional folk theatre to make their message accessible to the rural audience, while children’s programming used puppets.

Despite such worthy objectives, the results were not very encouraging. A major two-volume report by ISRO evaluating the impact of the programmes recorded only ‘modest gains’ in the sphere of education, while there was no evidence that the introduction of television in the classrooms had affected drop-out rates. SITE villages showed only a 2–4 per cent higher adoption of birth control, although a year is not long enough to judge any tangible change in traditional attitudes towards ‘family planning’. Also, given the community viewing patterns where gender mixing was unavoidable, women in the age of 15–24 were discouraged from watching.

There was also little evidence that television viewing had made any significant increase in farmers’ knowledge about agricultural practices or a change in attitude towards crop patterns. Anthropological findings, however, indicated that there were subtle social and cultural changes, based on gender, caste and class in the rural setting (Agrawal, 1977).

The advice on crop patterns, the use of pesticides and high-yield seeds

was mostly of use to rich farmers with the money to buy new seeds and other agricultural implements. In a country where land distribution is highly skewed in favour of rich farmers, such advice was of little consequence to the poor majority, whose condition could hardly be improved without wider structural changes in the social system. In such desperately poor rural communities, where the majority of inhabitants are landless farmers, school enrolment and drop-out rates, and awareness about health and hygiene, depend primarily on economic factors. Even today, in rural India, many children have to work on the farms, rather than attend school, to supplement their families’ meagreincomes.

The government’s view was that television would be a key instrument to disseminate development-oriented information and generate public participation and support for social and economic modernization. However, SITE showed that TV played only a limited role in changing behaviour among the audience and instead resulted in indifference towards the medium as well as the message itself. In the absence of relevant and effective complementary support in the lives of the viewers, innovative communication and the use of satellite technology were merely information inputs, which, in rural India, remained little more than a high-sounding idea. Despite its top-down approach to communication and the dissemination of information, the tendency to privilege rural elites and insensitivity to the needs of the rural poor, SITE did create awareness about social problems and brought the experience of audiovisual media to ruralcommunities.

The experiment came to an end when NASA withdrew its satellite, reflecting the dependence of the South on Northern technology. However, this spurred the Indian government to sanction the development of an indigenous satellite technology, with India becoming one of the first Southern countries to invest heavily in satellite communication. India’s first communication satellite, Indian National Satellite (INSAT-1A), was launched in 1982, providing Doordarshan with transponders for networking. The more advanced INSAT satellites increased the capacity to transmit satellite-based programmes for school children across the

country, though their viewership remained very low.

With the gradual commercialization of television in India since the 1980s development-oriented programming became a low-priority area, even for state-run broadcasters. For private television companies, both domestic and international, driven by advertising demand, the rural poor are not demographically desirable viewers, and health, education and rural development do not make profitable television. By 2017, India had one of the most sophisticated satellite networks in the developing world but it was being used more to promote entertainment than to address the development agenda. Yet, SITE remains one of the most important early examples of using modern technologies for developmentalpurposes.

The American Red Cross seemed in its true element following September 11, 2001. It was flooded with donations to do its highly needed and regarded work. Most of those donations went to its Liberty Fund. But shortly after it started to disperse the funds, the media began asking questions. And the American Red Cross soon wore a patina of tarnish. Learn about the research that evaluated Americans’ perception of the Red Cross and how research by Wirthlin Worldwide helped craft a new and highly effective donation solicitation process. www.wirthlin.com; www.redcross.org >Abstract

>The Scenario

Whether it’s a landslide in California, a flood in Puerto Rico, fires in Colorado, hurricanes in Florida, or tornadoes in Texas, the Red Cross can be depended on to help not only the victims but also those involved in rescue and relief services. But each local independent chapter of the American Red Cross also responds to thousands of smaller events that disrupt peoples lives yet aren’t as likely to be splashed across headlines or lead the evening news, such as a fire in a single-family house fire or a family that loses its breadwinner when the father’s military reserve unit is activated to serve in the war in Iraq. While the magnitude of the disaster affects the visibility of the Red Cross’s relief efforts, the skilled professionals and volunteers who constitute the American Red Cross pride themselves on being where they are needed as quickly as possible, providing the services that are needed by those both directly and indirectly affected. In a single year the American Red Cross affiliated chapters respond to approximately 70,000 such disasters, both small and catastrophic, by providing disaster relief services, family emergency services, domestic preparedness for bioterrorism, critical lifesaving services, and 24-hour military assistance. The American Red Cross provides these services 24 hours per day, every day. And it provides them for free. A totally independent philanthropy, one receiving no government financial support, the American Red Cross relies on the generosity of U.S. citizens for the operating capital to fund its services. For decades it has followed a policy of raising funds by soliciting donations via advertising during the high-visibility period surrounding a disaster that has captured media attention. As its Web site details, “One of the best ways to help disaster victims, people in need where you live, and people around the world right now is through a financial donation.” Donors primarily are encouraged to give to (1) the Disaster Relief Fund, which “enables the Red Cross to provide shelter, food, counseling and other assistance to those in need across the country,” (2) their local Red Cross chapter, which “assists people in need” within a donor’s community, or (3) the International Response Fund, which “allows the American Red Cross to respond to people’s needs around the globe.” Its stellar reputation for speedy, quality assistance generates millions of dollars in donations each year. September 11, 2001, changed many people’s lives and it also dramatically changed the way the American Red Cross solicits donations. The sheer number of people affected was beyond the scope of any other domestic disaster addressed, including Oklahoma City, the San Francisco earthquake, and hurricanes Camilla or Hugo. Typically, the Red Cross develops a disaster plan by determining what will be needed in terms of resources—financial, services, and manpower—to respond to those in need. It is able to use its extensive disaster experience to estimate the amount of money necessary to address the needs, and it does this quickly, often within three to seven days. But it would take three Can Research Rescue the Red Cross? 2 weeks to estimate the dollars required to address the needs created by the acts of September 11. And services couldn’t and didn’t wait. Contrary to the perceptions of many U.S. citizens at that time, the Red Cross doesn’t maintain a huge pool of dollars, just waiting for the next disaster to happen. When a need occurs, the local chapter draws on its own local disaster fund, generated by its own fundraising efforts. Depending on the size and resources of the chapter, it might not have sufficient reserves to address a major disaster and so turns to the national organization. The chapter can gain assistance with advertising to solicit additional donations, as well as dip into the national Disaster Relief Fund, which contains dollars that poured in from donors after previous disasters but were not needed to provide services to those disasters’ victims or relief workers. The local chapter must replace funds taken from the national Disaster Relief Fund. Following September 11, advertising soliciting for donations began immediately, right along with disaster relief services. Using its prior experience, the Red Cross typically plans the advertising flight and stops advertising when it reaches a certain percentage of its monetary those funds needed by the families for disaster services and hold in reserve for “future disasters” those dollars it deemed unnecessary to expend. Then the media criticized the Red Cross for not distributing donations as fast as they were coming in. The Red Cross was caught between an angry tirade of accusations by the media demanding change and total involvement in providing disaster services, both to the victims and to the disaster relief workers who were operating under increasing stress and strain. On November 8, 2001, Daniel Borochoff, president of the American Institute of Philanthropy, testified to a congressional subcommittee of the Committee on Ways and Means investigating charity response to the September 11 terrorist attacks. “The Red Cross could have avoided a lot of donor confusion had it used the Liberty Fund exclusively to raise money for immediate disaster relief and direct victim aid and then cut off fundraising after that need had been met at about $250 million.” Explaining that the Red Cross’s Liberty Fund and the United Way’s September 11 Fund accounted for about 75 percent of all funds raised related to September 11, Borochoff claimed that rather than earning the organization the Nobel Prize, the Red Cross’s actions “have tarnished its high public standing and brought distrust and skepticism to the entire nonprofit field.” During this period of continuing attack, on the pages of newspapers and magazines and on newscasts, not a single donor requested his or her money back. But neither did a single supporter come forward to defend the long-standing Red Cross fund-raising policy of using the sympathy generated by a current disaster to raise money for “this and other disasters.” In this instance, the donations following September 11 were separated and deposited in the Liberty Fund. Borochoff testified that he believed the “Red Cross in its zeal to fundraise while the iron was hot raised more money than it needed for what it would ordinarily do in a disaster and behaved opportunistically by using this crisis to raise money for programs that were not a major part of its advertising—such as upgrading its phones…building a strategic blood reserve…[and providing funds for] physiological trauma counseling nationwide.” Behind the scenes, some officials within the Red Cross were second-guessing whether the Liberty Fund should have been established. Others were asking an even more important question: “If something ever happens like this again, what should we do differently.” Officers of the Red Cross began to suspect from the anecdotal evidence reported in the news that donors responding to the ads either didn’t read or hear the ads fully or didn’t perceive that donations not needed to address issues related to a specific disaster, one then in the media spotlight, would be used to respond to future disasters. The same officials questioned whether the problem went beyond donors responding to the September 11 ad campaign. Did donors simply not understand how the Red Cross raised money? Did it not understand how the Red Cross spent donor contributions? By November 14, the media dialogue became so intense that Red Cross CEO Harold Decker, appointed following Healy’s resignation, stated, “We deeply regret that our activities over the past eight weeks have not been as sharply focused as America wants, nor as focused as the victims of this tragedy deserve. The people affected by this terrible tragedy have been our first priority, and beginning today, they will be the only priority of the Liberty Fund.” More than 25,000 families were then in the database of those receiving direct payouts from the Liberty Fund. In that same press release, David McLaughlin, chairman of the American Red Cross Board of Governors, stated, “The people of this country have given the Red Cross their hard-earned dollars, their trust, and very clear direction for our September 11 relief efforts. Regrettably, it took too long to hear their message. Now we must change course to restore the faith of our donors and the trust of Americans, and, most importantly, to devote 100 percent of our energy and resources to helping the victims of the terrorist attacks.”

1. If you had been McLaughlin or Decker, what research would you want done?

2. Create the management-research question hierarchy for the research you think might help the Red Cross make decisions related to public relations efforts and future advertising soliciting donations.

3. What considerations should influence sampling decisions in any research the Red Cross would do on this issue?

PROGRAM INSTRUCTIONS:

1. Code an application that asks the customer for a log-in and password. 2. The real log-in is "Buffet2011" and the real password is "Rank1Bill2008". 3. Allow the customer two (2) attempts to type either.

a. Each time the customer enters an invalid log-in or password issue an error message.

b. If the customer fails all two (2) log-in attempts, issue another error message and exit the program.

c. If the log-in is successful, the customer can calculate the cost of multiple trades, so there can be a combination of online and broker assisted trades.

4. Ask the customer if it's an online trade, if so charge $5.95 for the trade; otherwise, ask if it's a broker assisted trade, if so then charge a 2% brokerage fee. If not then print an error message, and let the customer try again. Keep track of the number of stocks for which trades are being made.

5. Logical Control Structures from PA1:

a. Use a while loop to process for multiple stock trades in a given transaction. Use a sentinel controlled loop variable.

b. Use if-else, nested if-else and if structures to figure out

i. whether it is an online trade or broker assisted trade;

ii. when to print the error message "INVALID TRADE TYPE!"

iii. when to print the final output with the total calculations for stock cost, online fees, commissions, and overall cost.

c. The customer can calculate for multiple stock purchases as long as the customer has more purchases to calculate. The calculated stock cost is added to a total for stock cost and the overall total (total cost); the online fee is added to a total for online fees and the overall total; and, the commission is added to a total for commissions and the overall total. Use printf() with format specifiers where needed.

d. Don’t forget to insert the exit statement at the end of main().

e. The prompts, the final output specs, and the sample output show you in what order to place your code. To return from these links press Alt then left arrow.

6. Logical Control Structures for PA2: This program is the same as PA1 EXCEPT:

a. There are additional prompts for the login and password.

b. Both the login and password must be correct to proceed.

c. You’ll use a do-while loop to control the number of attempts.

d. Use an if-else to test the attempts left, so the proper message is displayed for more than 2 attempts left, 1 attempt left and no more attempts left. Embed a switch to test for attempts less than or equal to 1.

e. There are 3 new variables.

7. Program Logic: NO plan for this PA.

a. The prompts tell you what input variables you will need.

b. The output will tell you the type of calculations you will need (if any) and whether you will need to declare additional variables.

c. The output will tell you the order of logic for your code.

8. Work and submit this program on your own (no partner). Name your program as YourLastNameFirstInitialYourSectionNoPA2.

9. Commenting Your Program:

a. In your program, YOU MUST insert a program purpose in the first comment box. The content of that first comment box was shown to you in the Anatomy of a Java Program lecture for chapter 1.

b. Use Javadoc comment boxes beginning with /** and ending with */ for your comment boxes.

c. Insert a Javadoc comment box above your methods explaining what is going on in the method that goes for the main() which is a method.

d. Line comment the import statements and the variables declared at the class level and/or in any method [including main()].

10. Formatting Rules: Refer to the Java Style Guide posted on Blackboard in IS 2033. Always test your output to validate that your program is functioning properly with the correct output and spacing (line advances and spacing after punctuation). The %n can function differently when using separate printf statements versus one printf.

PROMPTS: Code the bold from the prompts below in the printf statements that capture data into your program. Once again, the prompts tell you your input variables.

Welcome Message: Prints before prompt for customer name.

YEE-TRADE, INC. - The Wild West of Electronic Trading

Welcome to Yee-Trade's stock purchase calculator.  

1st Prompt:  

What is your name?  

2nd Prompt: Beginning with this prompt, the majority of the code will be nested in the do-while mentioned in 2c above.  

Enter your log-in:  

3rd Prompt: If the entries from the 2nd and 3rd prompts match the real log-in and password proceed to the 4th prompt else print the error message(s).  

Enter your password:  

Error Message When Log-In & Password Incorrect: One of these error messages will be displayed every time the log-in or password is incorrect. The 9 represents the number of attempts left out of two (2). You’ll accommodate in the code for the possibility of more than 2 attempts.

Invalid log-in or password! 9 attempts left. ? Use when >= 2 attempts left Invalid log-in or password! 9 attempt left. ? Use when 1 attempt left

Error Message When No More Attempts Left: This error message will be displayed when there are no more attempts left, and the program will terminate. This is NOT a forced exit. The code should automatically sequence to the exit statement at the end of main().  

No more attempts left! Contact tech nical support at 1-800-111-2222.  

4th Prompt: This prompt will display after the customer enters the correct log-in and password within the allotted 2 attempts. The value captured from this prompt is the loop-control variable for the sentinel-while loop mentioned in 1a of the Program Instructions section above.  

Do you want to calculate your stock purchases? Enter 'Y' or 'N' to exit: If the answer is anything other than ‘Y’, the while loop is by-passed and this message is displayed: Thank you for using Yee-Trade's stock purchase calculator!

5th Prompt: Prompts 5 through 9 will be in a sentinel-controlled while loop.  

How many shares did you purchase?  

6th Prompt:  

What is the price per share?  

7th Prompt: If the answer to this prompt is 'Y' add a 5.95 online trading fee to the stock cost then go to the 9th prompt, else go to the 8th prompt. Also, refer to 1c for additional calculation instructions.

Is this an online trade? Enter 'Y' or 'N':  

8th Prompt: This prompt will display only when the answer to the 7th prompt is 'N'. If the answer to this prompt is 'Y', calculate the commission by assessing a 2% brokerage fee on the stock cost then go to the 9th prompt, else proceed to the error message.  

Is this a broker assisted trade? Enter 'Y' or 'N':

Error Message When Trade is Neither Online or Broker Assisted: If the answer is 'N', print this error message then proceed to the 9th prompt.

"INVALID TRADE TYPE!"  

9th Prompt: If the answer is 'Y' then you'll go back to the 5th prompt. This is the same loop-control variable in prompt 4.

Enter 'Y' to calculate the cost of another stock purchase or ‘N’ to exit:  

If the answer is anything other than ‘Y’, the while loop is exited, the final output is displayed along with this message:

Thank you for using Yee-Trade's stock purchase calculator!

Original Code:

/**
* @(#)004PA1.java
* @author
* version 1.00 2020/09/23
*
* PROGRAM PURPOSE: This program controls whether
* a customer can calculate the cost of
* their stock purchase
*/
import java.util.Scanner;
import java.util.Calendar;

public class 004PA1
{
public static void main(String[] args)
{
Scanner input = new Scanner(System.in);
Calendar dateTime = Calendar.getInstance();
String date = String.format("%1$TB %1$TD, %1$TY", dateTime);
  
String customerName = null;
int shares = 0, noOfStocks = 0;
double sharePrice = 0.0,
stockCost = 0.0,
commission = 0.0,
totalCost = 0.0,
onlineFee = 0.0,
totalStockCost = 0.0,
totalCommissions = 0.0,
totalOnlineFees = 0.0;
char onlineTrade = ' ',
brokerAssisted = ' ',
another = 'N';
  
System.out.printf("%nYEE-TRADE, INC. - The Wild West of Electronic Trading%n"
+ "%nWelcome to Yee-Trade\'s stock purchase calculator. %n");
System.out.printf("%nWhat is your name? ");
customerName = input.nextLine();
System.out.printf("%nDo you want to calculate your stock purchases? "
+ "Enter\'Y\' or \'N\' to exit: ");
another = input.nextLine().charAt(0);
  
while(Character.toUpperCase(another) == 'Y')
{
noOfStocks = noOfStocks + 1;
  
System.out.printf("%nHow many shares did you purchase? ");
shares = input.nextInt();
  
System.out.printf("%nWhat is the price per share? ");
sharePrice = input.nextDouble();
stockCost = shares * sharePrice;
totalStockCost += stockCost;
totalCost += stockCost;
  
input.nextLine();
  
System.out.printf("%nIs this an online trade? "
+ "Enter \'Y\' or \'N\': ");
onlineTrade = input.nextLine().charAt(0);
  
if(Character.toUpperCase(onlineTrade) == 'Y')
{
onlineFee = 5.95;
totalOnlineFees += onlineFee;
totalCost += onlineFee;
}
else
{
System.out.printf("%nIs this a broker assisted trade? "
+ "Enter \'Y\' or \'N\': ");
brokerAssisted = input.nextLine().charAt(0);
  
if(Character.toUpperCase(brokerAssisted) == 'Y')
{
commission = stockCost * .02;
totalCommissions = totalCommissions + commission;
totalCost = totalCost + commission;
}
else
{
System.out.printf("%nINVALID TRADE TYPE!");

noOfStocks = noOfStocks - 1;
totalStockCost = totalStockCost - stockCost;
totalCost = totalCost - stockCost;   
}   
}
System.out.printf("%nEnter 'Y' to calculate the cost of another stock purchase "
+ "or 'N' to exit: ");
another = input.nextLine().charAt(0);
}
if (noOfStocks > 0)
{
System.out.printf("%nYEE-TRADE,INC."
+ "%nTOTAL COST OF STOCK PURCHASES "
+ "%nFOR " + customerName
+ "%nAS OF " + date
+ "%nTotal Stock Cost: $" + totalStockCost
+ "%nTotal Online Fees: $" + totalOnlineFees
+ "%nTotal Commissions: $" +totalCommissions
+ "%nTOTAL COST: $" + totalCost);
}
System.out.printf("%nThank you for using Yee-Trade's stock purchase calculator!");
noOfStocks = 0;
  
System.exit(0);

}
}

Using stakeholder analysis, analyse the power and level of interest of the relevant stakeholders involved in running and regulating the London taxi business.

Uber are often accused of ignoring employee rights and employee welfare. How might Uber management address their employees’ concerns?

Guidance notes:

In Sessions 2 of Block 3 you encountered the concept of stakeholder analysis, as a key part of analysing the political context. In particular, Activity 2.1 and Reading 4 discussed some of the theory supporting stakeholder analysis and gave you the opportunity to undertake a practice exercise. The stakeholder analysis framework shown in Reading 4 Figure 1 may help with your answer.

The second part of Question 1 requires you to look at some of the employee relations issues that are taking place at Uber. Block 3, Session 4, introduced you to the idea of inclusive and participatory employment relations. In particular, Reading 6 discussed the importance of employee ‘voice’ and why voice matters in modern organisations. Block 3, Session 5, discusses the issues of flexible working and employee empowerment. Activity 5.1 looks at the importance of involving employees and suggests ways this might be achieved. Your answer should draw on appropriate concepts and theories from Block 3 together with suitable evidence from the case study to support your arguments.

Case study:

Technological challenges in the taxi industry

Uber is a technology company that offers a free programme, or app, available on a mobile device for those wishing to request a ride. At its core, Uber seeks to match passengers to drivers. The platform is able to track a user’s GPS coordinates, even if the user does not know where they are, and within minutes an Uber driver will arrive. The user is able to track how long until the ride will pick them up and receives a text message confirming when the Uber driver is arriving. The driver is able to hit a button on their own app that says ‘Arriving now’ which sends the text message. No cash is exchanged when using Uber since signing up for an account requires providing credit card information. After the ride, Uber charges the user electronically and immediately emails them a receipt. There is a rating system so that passengers can rate their driver and vice versa (Dong et al, 2014).

According to Uber, the company ‘pushes the limits of the transportation industry to create a simple, more efficient, and more enjoyable car service experience. For drivers, Uber is a revenue stream, allowing professional drivers to make more money by turning downtime into profits.’ (Uber, 2016). Unlike the taxi industry, Uber does not employ or license its drivers, but rather views them as independent contractors. The unique experience provided by Uber has enabled rapid growth and international expansion centred on three main focal points: a commitment to on-demand service, an efficient supply of luxurious rides, and the easy accessibility of its smartphone application.

Uber’s growth over the past five years is an example of a major success in what is known as the ‘sharing economy’. The sharing economy is an economic system where assets or services are shared between private individuals either free or for a fee, typically by means of the internet. However, the success of this new business model is attracting criticism from government and civic leaders concerned that this new ‘collaborative economy’ is simply a means of sidestepping regulations, taxes and other legal obligations. These ‘gig economy’ apps have been criticised for failing to provide traditional employee rights such as paid holidays and in-work insurance.

The size of the UK taxi and private hire market is estimated at £9.4 billion. The industry is mature, with high levels of revenue volatility, technological changes, and high competition with low barriers to entry (Skok & Baker, 2019). In London, Uber’s growing popularity meant that their drivers completed some £115m of business within London (Quinn, 2016). However, Uber London (the taxi app’s UK holding company) recorded only a sales take of £23m and a profit before tax of £1.83m. The sales figure reflects only Uber’s share of fares for trips booked on its app. In addition, Uber London retain 20% of any fare to the driver. Despite this Uber London paid just the small sum of £411,000 in UK tax last year.

Concerns have also been raised over driver working conditions, particularly regarding claims that some drivers are doing excessive and unsafe hours.

Some Uber drivers are working up to 21 hours a day to make ends meet as the company increases its cut of fares and fights a ruling giving them employment rights. Drivers in London interviewed by The Sunday Times told of regularly working hours that Uber itself describes as ‘unsafe’. The newspaper has seen official Uber documentation proving one of the men worked a 91-hour week. The disclosures come as new figures show a dramatic rise in casualties involving taxis and private hire vehicles in London.

In interviews with 12 Uber drivers waiting at Heathrow, three admitted working 16 hours or more a day. Tom, from High Wycombe, said: ‘On average every day [I work] 14 hours, and 16 is top whack. I had a colleague last week who said he had worked 19 hours. I know people who even sleep in the car, and they go crazy … I can start at six o’clock in the morning and finish the following day at maybe two o’clock, three o’clock,’ – a 20 or 21-hour day.

A second driver, Peter, said: ‘Recently, Uber cut rates per mile by 25%. Now I’m having to work longer and longer hours in order to pay my rent. I want people to know how powerless you feel when your income comes from a faceless app and when you open it up one morning, things are just different and you’re earning less money and there’s no boss you can talk to, you weren’t told about it, you just see your income is lower today and you just have to deal with it’. A third Uber driver, Khaled, said ‘We need to speak the truth. I work 70-80 hours a week and weekends it’s 14-16 hours a day. There are plenty of days where, minus petrol, I make less than minimum wage. It’s very, very stressful but I don’t have a choice. I feel like I’m a slave; we work like slaves for this company. I wish I knew what I know now earlier,’ he said. ‘I was blindsided. If I knew about the expenses, just how expensive it is to do this gig, then I wouldn’t have gone into it in the first place’. The legal limit for a bus or lorry driver is 56 hours a week.

Another Uber driver, Razak, said: ‘Once Uber got control of the market, they changed in the worst ways. When I started I made 80% of the fees from my fares with 20% going to Uber. Now they are charging anything they want, sometimes taking as much as 60%. All drivers are asking for is fair pay, and that’s what Uber won’t give to us. They are not willing to be transparent. They are willing to change the logo, they are willing to advertise, to spend millions on lobbying, but they are not willing to pay the drivers fairly. Uber treats drivers as just something they have to deal with until technology for autonomous cars gets to the point where they can eliminate drivers all together. They don’t listen to us’. Three other drivers could not be interviewed because they were asleep in their cars. One had installed curtains in the vehicle.

Figures published in 2016 by the London transport regulator, Transport for London (TfL), show there has been a 26% rise in casualties among taxi and minicab passengers during the previous year. The number of passengers killed or seriously injured rose from 13 to 20, a 54% rise.

However, Uber UK said it had no plans to limit driver hours. In London, for new drivers, it has increased the cut it takes on fares from 20% to 25%, forcing them to drive for longer to earn the same money.

The company suffered a blow in 2017 when an employment tribunal ruled that Uber drivers were not self-employed, and were entitled to holiday pay, pensions and other workers’ rights. In 2018 it appealed against this ruling but lost. The Appeal Court judges found there was a “high degree of fiction” in the wording of the standard agreement between Uber and its drivers. The judgement went on to state that “For Uber to be stating to its statutory regulator that it is operating a private hire vehicle service in London and is a fit and proper person to do so, while at the same time arguing in this litigation that it is merely an affiliate of a Dutch-registered company which licenses tens of thousands of proprietors of small businesses to use its software, contributes to the air of contrivance and artificiality which pervade’s Uber’s case.” (Butler, 2018). Uber is appealing this latest judgement.

Steve Garelick, of the professional drivers’ branch of the GMB union, said: ‘Through the app, Uber knows precisely how long everyone has been available. It and other operators could stop this overnight if they wanted to. They’ve made the effort to limit hours in New York, so what’s wrong with London?’ Tom Elvidge, general manager of Uber London, said that three-quarters of Uber drivers in the capital were logged in to the app for less than 40 hours a week. ‘We regularly advise drivers to take rest breaks’ he said. ‘We take this issue very seriously and are always looking into ways to improve the overall safety of the app.’

Uber London actively resists attempts by TfL or other government agencies to bring in any regulation of its services, or to bring its service into line with the historic business practices of London’s historic black cabs. The European Parliament has approved new minimum rights for workers in ‘gig economy’ jobs, including Uber drivers. Under the European Union (EU) regulations, casualised employees across Europe will have a right to compensation from their bosses for last-minute cancellation of work, mandatory training will have to be provided free of charge, and ‘exclusivity clauses’ that ban workers from taking other jobs will also be banned. The UK could end up following EU rules at this point if the Brexit transition period is extended, meaning the rights could apply to workers in the UK. However, if the UK leaves the EU earlier, employees will not benefit from the rules and will probably be exposed to harsher employment conditions (Stone, 2019).

In 2017, Uber was rocked by a former employee’s devastating assessment of her time working at the company. She detailed several instances of sexual harassment and a culture that did not welcome women. In response, Uber launched an investigation involving more than 100 ‘listening sessions’ across the company. The report concluded that ‘The focus of the company had been on the business and not the employees’ and that the atmosphere at the company had created a ‘cult of the individual’ (Lee, 2017).

London’s taxis are responding to the technological challenges presented by Uber, and TfL announced last year that all black cabs in London would be required to take credit cards and contactless payments from October 2016.

Groups representing taxi drivers said the decision by TfL would benefit both drivers and customers. The move by TfL’s board followed a consultation in which it received support from 86% of respondents.

‘Every black cab taking cards is fantastic news for London. In future, when you hail a cab you can be sure that you can pay the way you like – card, contactless or cash. That is without doubt better for our customers and for drivers who will benefit from extra work,’ said Steve McNamara, general secretary of the Licensed Taxi Drivers Association.

The move towards mandatory card payments in black cabs is part of wider changes by London’s 22,500 cabbies in rising to the challenge from Uber. For example, some black-cab operators are fighting back with smartphone apps of their own, such as Hailo and Gett. Gett offers discounts on metered fares for journeys of six miles or more and those made in off-peak hours. Hailo allows Londoners to get a taxi through their smartphone.

Remo Gerber, chief executive of Gett UK, said: ‘This is another strong sign of how the London black cab trade is embracing the future; not only have cabbies embraced apps, but everyone is behind making card payments universally accepted and by that making all journeys easier for Londoners.’

The firm’s application for a new licence in London was rejected in September 2017 on the basis that the company is not a ‘fit and proper’ private car hire operator. At an appeal, a court decided Uber should be awarded a 15-month probationary licence to operate in London after the ride-hailing service promised improvements. In May 2019, Uber completed the significant landmark of floating on the New York stock exchange at a staggering valuation of $91 billion.

Read the "Establishing Proof" Article below and respond to the following questions: ARTICLE IS IN BOTTOM

1. Why were newborn babies being given supplemental oxygen? What would have happened if they did not get supplemental oxygen?

2. Describe the clinical trial Drs. Hoeck and Patz designed. Was it an example of an experiment or an observational study? How was consent given? How were infants assigned to treatments?

3. Describe the clinical trial conducted by the NIH. Was it an example of an experiment or an observational study? How was consent given? How were infants assigned to treatments?

4. What were the results of the clinical trials? Did lowering supplemental oxygen appear to prevent RLF?

5. What unintended consequence of reducing supplemental oxygen did the two doctors from Johns Hopkins discover?

6. Describe how blindness has impacted the lives of the individuals and families of people with RLF.

7. When (if ever) is it okay for one person to give consent for another to be part of a medical trial?

8. How should doctors and researchers weigh risk and benefit when they are designing a clinical trial?

9. How would you feel if if you lost your sight due to a decision a doctor made when you were an infant? Would it make any difference if you knew the doctor was acting to the best of his or her knowledge? What if it was your child who lost his or her sight? Would you have given consent for your child to participate in the clinical trials described in the article?

10. What part of this story made the greatest impression on you? Is there a lesson from the experiences of the doctors and patients described in the story that you can put into practice in your life? Has your viewpoint about medical research been broadened or changed in some way?

Establishing Proof

Some Fifty Years Ago a Baby-Blinding Epidemic Confounded Experts -- Until a Pioneering Study

Conclusively Tied Cause and Effect, and Enshrined Clinical Trials in Medical Practice

By David Brown

Washington Post Staff Writer

Tuesday, April 19, 2005; Page HE01

Marc Maurer was born on June 3, 1951, in Des Moines, the second child of a traveling salesman

and a housewife. He was two months premature. As is often the case with babies born very

early, his lungs were underdeveloped. He spent two months in the hospital. During the first,

supplemental oxygen was pumped into his incubator continuously.

In the same city three months earlier, Patricia Schaaf was born. Her father was a plumber, her

mother was a school cook. Their first child, Patricia was 3 pounds, 10 ounces at birth and two

months premature. She, too, got oxygen for at least a month.

Today, both Maurer and Schaaf are blind.

Maurer is president of the National Federation of the Blind, and his wife -- the former Patricia

Schaaf -- is its director of community relations. They work in South Baltimore in a refurbished

factory that is the headquarters of the 50,000-member advocacy organization. Marc Maurer, a

lawyer by training, has a spacious corner office overlooking the Patapsco River, which he cannot

see.

The Maurers were part of an epidemic that began in the early 1940s and peaked in 1951, the

year of their birth. They were blinded by high concentrations of oxygen, which was routinely

given to premature infants in the United States during and after World War II. It took 15 years

to discover the link between oxygen and blindness -- 15 years in which a mysterious disease

haunted America's best hospitals.

This tragic outbreak was not the first time a medical treatment thought to be beneficial was

shown to cause harm. Nor would it be the last.

In recent years, hormone replacement therapy taken by millions of women turned out to cause

heart attacks, not prevent them. Vitamin A supplements don't lower the risk of lung cancer, as

many smokers once thought; it may increase it. Antidepressants relieve depression in some

teenagers but appear to drive a small number toward suicide, depression's tragic endpoint.

Three years ago the pain reliever Vioxx was the 15th most commonly prescribed drug in the

United States, with $1.8 billion in annual sales. Today, some experts believe it may have

contributed to as many as 160,000 heart attacks and strokes since its arrival in 1999.

The story of oxygen and blindness is a distant mirror of these therapeutic surprises. But it is

much more as well.

Of all the elements on the periodic table, oxygen is the one that seems most to symbolize life

and health itself. Could extra oxygen be dangerous to tiny babies struggling to survive? It

seemed inconceivable!

But it was true. Two doctors proved it more than a half-century ago in a clinical experiment run

in the wards of a hospital in Washington. The medical world didn't believe them, at least not

enough to change routine practice. So a second, bigger experiment was conducted at more

than a dozen American hospitals.

Fifty years ago this summer, the preliminary results of that trial were published. They changed

medical history. Almost overnight, physicians stopped automatically giving supplemental

oxygen to preemies, ending the epidemic of retrolental fibroplasia (RLF), as the disease was

called then. (It is now known as retinopathy of prematurity.)

But the study's results did something else equally important and historic. They convinced many

American physicians of the usefulness of randomized controlled trials, which had been

"invented" less than 10 years earlier in Britain. Not least, the study taught doctors they couldn't

assume that what seemed like a good idea -- extra oxygen -- would necessarily lead to a good

outcome.

"Doctors have to approach their patients, and what they think they know, with a certain

amount of humility," said Steven Goodman, a physician at Johns Hopkins University's

Bloomberg School of Public Health and editor of the journal Clinical Trials. "This is one of the

trials that taught us humility."

The events that culminated 50 years ago is also a story of self-reliance, doggedness and even

heroism on the part of the blind survivors of RLF and the two doctors who first proved the

disease's cause. Those doctors, as it happens, are still alive.

Arnall Patz went on to become the chairman of ophthalmology at Johns Hopkins University

School of Medicine

.

Now 84 and officially retired, he lives in Baltimore and still works part of

nearly every day on some medical project. Last spring, President Bush awarded him the

Presidential Medal of Freedom for a lifetime of scientific discovery that began with the oxygen

experiment at Gallinger Municipal Hospital, the predecessor of D.C. General. His long-ago

collaborator in that work is Leroy E. Hoeck, a 93-year-old retired pediatrician living in Fort

Washington.

The discovery they made in 1951 and 1952 didn't come in time for Marc or Patricia Maurer. Nor

did it come in time for RLF's most famous victim, Stevie Wonder, born prematurely in Michigan

in 1950 as Steveland Judkins. Nor for 10,000 other babies born here and around the world who

became blind from oxygen. But it did come in time for numberless preemies born in the last 50

years who can still see.

Survivors and Pioneers

Nobody knows the first infant to become blind from retrolental fibroplasia. But the first

recorded in the annals of medicine is James Edgar Pew II.

Pew and his twin sister, Margaretta, were born on July 13, 1940, at the Boston Lying-In

Hospital. They were seven weeks premature. Margaretta died in six hours. Her brother held on,

thanks to oxygen.

"The child was examined at the age of ten minutes, at which time the respirations were gasping

and irregular . . . the baby was immediately given oxygen. After about ten hours, his condition

improved," the pediatrician in charge of the premature nursery, Stewart H. Clifford, wrote in

the hospital chart, according to an account published in the Saturday Evening Post magazine in

1955.

The boy's father, George L. Pew, was extremely wealthy, a direct descendant of Joseph N. Pew,

the founder of Sun Oil Company. (Today, the family name is best known for the foundation four

of Joseph Pew's children endowed, the $4.1 billion Pew Charitable Trusts). Jimmy Pew received

the best medical care money could buy. He spent two months in the hospital and got

supplemental oxygen almost continuously.

When the boy was 7 months old, his parents and some visiting relatives became alarmed when

he failed to track the movement of a cigarette lighter his father held in front of his face. (This

anecdote, and many details of the following narrative, come from the magazine account by

Steven M. Spencer and from a 1980 book, "Retrolental Fibroplasia: A Modern Parable," written

by a pediatrician and historian named William A. Silverman.)

Even though it was a Sunday, the Pews summoned Clifford to their Beacon Hill house. He

examined the child and told the parents he suspected the boy was blind. Curiously, Clifford had

just seen a similar case, the infant daughter of a rabbi. "I was shocked to find my second case

within a week of my first," he later said.

The Pews insisted an eye doctor be called. With some effort, Clifford reached Theodore L.

Terry, a Harvard professor of ophthalmology. He came and thought the problem might be

congenital cataracts. Within a few days, however, that diagnosis was abandoned. The cause of

the Pew baby's blindness was something else -- and it also appeared to be something new.

Terry wrote the case up for a medical journal, making reference to the rabbi's daughter and

three other blind infants he saw soon afterward at the Massachusetts Eye and Ear Infirmary. All

five babies had been born prematurely. In the American Journal of Ophthalmology in February

1942, he made a prophetic observation: "[S]ome new factor has arisen in extreme prematurity

to produce such a condition."

He also personally notified about 50 specialists of his findings and asked them to look for cases.

Soon, he had more, and with them a fuller picture of what was happening.

By the time blindness could be diagnosed for certain in the babies, their eyes contained a

distinctly abnormal membrane in front of the retina, the eye's back wall, where the visual

receptors lie. Terry believed the condition developed after birth, but somehow involved

embryonic tissue. He tried to reproduce it in laboratory animals, but was unable to. He died in

1948 with 117 cases, and no answer.

Proof that retrolental fibroplasia

was

new, and that babies weren't born with it, came from a

look-back at records at Johns Hopkins Hospital. A husband-and-wife research team, Ella and

William Owens, found no cases from 1935 and 1944, but five in premature infants born after

1945. All had normal eyes at birth.

But what was causing it?

There were dozens of theories. They included high-protein diets, large doses of vitamins, blood

transfusions, hormone therapy and antibiotics -- all treatments given with varying frequency to

premature infants. Too much light was the other main candidate. Some of the theories were

put to the test in small experiments. None panned out.

There seemed to be nothing in common with all the cases except prematurity and, ironically,

good medical care. RLF wasn't a disease of incompetence, poverty or inadequate technology.

Quite the opposite. Throughout the 1940s, reports of the disease trickled, and then began to

flow, from Canada, Western Europe and Australia -- all places with advanced medical care and

high standards of living.

Eventually oxygen made it onto the list of possible causes.

The person who put it there appears to have been an English doctor named Mary Crosse. She

noticed that RLF didn't occur in Birmingham until 1948, when the National Health Service was

created. Then, for the first time, many hospitals could buy American incubators and bottles of

oxygen.

The use of oxygen to treat asphyxiation in a newborn was first tried in 1780. It was studied and

recommended again in 1900. By the early 1940s, supplemental oxygen was standard treatment

for premature infants in the best-equipped hospitals. What seems to have initiated the

epidemic of RLF, however, was the development of incubators that could keep pumped-in

oxygen from leaking out. Molded plastics developed during the war made postwar incubators

increasingly airtight.

Crosse's observation came to the attention of an Australian pediatrician named Kate Campbell,

who worked in three hospitals in Melbourne. One had incubators that could give premature

babies air with two or three times the amount of oxygen in atmospheric air. The second used a

less efficient way of delivering the gas. The third required patients to pay for supplementary

oxygen, so it was "used with more economy," she wrote.

She looked at the records of her patients for the years 1948 through 1950 and saw a

remarkable effect. At the hospital where oxygen was given most intensively, 19 percent of

premature babies developed RLF. At the other two where it was used sparingly, the rate was

only 7 percent. She speculated that the adjustment to the "oxygen-rich" world outside the

womb was a stress that premature infants somehow couldn't adjust to.

It was a hunch that in broadest interpretation would turn out to be correct.

Side Effects

When Marc Maurer was 6 months old, his parents took him to Minneapolis for an eye

operation. He had a second when he was 3. He had a third when he was 6. That's the one he

remembers.

People with RLF often develop glaucoma, a condition in which the internal pressure in the

eyeball rises because of problems in the circulation of fluid. Maurer had glaucoma and the

surgery was intended to relieve it. It did that -- and more.

Until then, Maurer had a small bit of residual vision in his left eye. He could see large objects at

a distance of 20 feet. After the surgery, that was gone. "I lost what I thought of as vision," he

recalled recently, speaking in a flat, nearly emotionless voice. "It was very depressing for a kid

like me."

When he returned home from the hospital, he refused to do anything but sit inside on a couch

for a week. His mother eventually took him outside and forced him to go down a slide in the

yard. With great protest, he did. Then she made him do it again. He got mad and decided to run

away. He refused to go back inside.

It was a crucial lesson, he believes. "It got me out of the theory that blindness would stop me

from doing stuff." Still, he adds, his voice heavy with memory, "I know the discouragement of

becoming blind. I remember it still."

Maurer attended a school for the blind in Iowa for the first five grades. He learned Braille (as

did his mother), and became an avid reader. In the fifth grade, he returned home to the town

of Boone (pop. 12,000) and attended parochial school. He says now that he found no

insuperable obstacles to learning what he wanted to.

In high school, he took extra courses at a junior college. After graduating, he spent a year in a

program for blind students in Iowa. There, he expressed interest in auto mechanics; the state

Commission for the Blind provided the tools for him to overhaul a car engine. Ultimately he

graduated from Notre Dame and got a law degree from the University of Indiana.

Patricia Maurer's parents suspected she couldn't see when at 6 months she failed to start

reaching for things. They took her to the Mayo Clinic in Rochester, Minn. and a doctor there

diagnosed RLF. She also had a small amount of light perception in one eye.

She spent her entire career in public school. She didn't even learn Braille until she was 15, when

she mastered it over the course of a summer with the help of a teacher. She took part in school

activities in what seemed a normal way.

"As a child you really don't understand why things happen the way they do," she recalled. Of

her blindness, she says: "I got to the place where I thought it was the way it was supposed to be

for me. I knew I didn't want to just sit around. I knew I wasn't going to give up."

She met her future husband in the same training program where he rebuilt the car engine. She

graduated from Drake University in Des Moines, where she studied special and elementary

education. The couple married in 1973. They have two children, both sighted.

Jimmy Pew remembers Theodore Terry, the doctor who made him the first recorded case of

RLF, "as a very kind, gentle man." Terry operated on him twice for glaucoma. Pew can see

shadows in both eyes, but has no useful vision.

When Pew was about 7, his family moved to Maine. He lived in a large house outside Portland

with his parents and an older brother, and eventually also with four cousins taken in after their

parents were lost at sea. He learned Braille and as a child was a ham radio operator. He

attended Brooks School, a boarding school north of Boston, where he was the only blind

student. In his senior year, he got a guide dog, the first of six. He, too, is glad he was

mainstreamed.

"My parents wanted me to go to regular schools. I think it was a good decision."

Pew also went to college, majoring in psychology at the University of Maine. He earned a

doctorate from the University of Detroit and is now a clinical psychologist in San Francisco,

where he moved in 1972.

First Suspicions

Arnall Patz grew up in Elberton, Ga., the grandson of Lithuanian Jews who immigrated to

Baltimore. His father was a peddler who eventually put down roots in a town on his southern

route.

One of seven children, Patz attended college and medical school at Emory University, both

under accelerated, wartime schedules. He graduated from medical school in 1945, and after an

internship at a hospital in Baltimore entered the Army. During a posting at Walter Reed Army

Hospital, he decided he wanted to be an ophthalmologist. This was also the time he first heard

about retrolental fibroplasias, a growing epidemic of unknown cause. When he was discharged

in July 1948, he took an ophthalmology residency at Gallinger, the District's public hospital.

It was an unlikely choice for an ambitious young doctor who'd already published a paper (on

several cases of a rare allergic reaction he'd seen as an intern) in the New England Journal of

Medicine. But Gallinger beckoned for one reason. In the unvarnished parlance of medical

training, it had "good pathology" -- an abundant and varied harvest of disease.

Working at the hospital when Patz arrived was a pediatrician, Leroy E. Hoeck. He was seven

years older and in charge of the newborn nursery.

Hoeck grew up in Iowa, graduated from medical school there and practicing briefly before being

called into military service. After discharge in 1946, he took a short post-graduate course in

pediatrics at George Washington University's medical school. He then entered a three-year

training program at Gallinger.

From a distance of more than 50 years, both men remember a signal moment that drew them

irretrievably into the search for an answer to what caused RLF.

Patz's came in the summer of 1948, right after his residency began, when he visited the

newborn nursery to look for babies with RLF. "I noticed in the nursing notes for the first time a

single entry about oxygen. The nurse had recorded that the baby [was] 'receiving oxygen at six

liters flow' [per minute]. My interest in oxygen stemmed, really, from that one nursing note."

Hoeck's also involved a single infant -- the first baby born under 1,000 grams (2.2 pounds) in

Gallinger's history to survive. He was a boy, 997 grams, and Hoeck was his doctor. The baby was

"a save" in medical lingo, and Hoeck was proud of his work.

"The problem was that when I happened to see him in the outpatient clinic four months later,

that particular baby -- " Hoeck stops, unable to go further. He is choked with emotion. After 10

seconds of silence, he resumes. " -- he was completely blind." He takes a breath. "And that was

devastating. I just felt we had to find the cause."

Hoeck began to research the possibilities, which in early 1949 still comprised a long list. He

spent days in the library of the Army Medical Museum, on the mall where the Hirshhorn

Museum now stands, reading articles. Eventually, he found an article from the "Staff Meetings

of the Mayo Clinic" of 1940 by three doctors, one an Army captain. They had examined the

effects of varying concentrations of oxygen (as might be encountered by bomber pilots) on

blood vessels in the eye. They reported that after 30 minutes of breathing pure oxygen, a

person's retinal arteries narrowed markedly -- an observation not previously made "to our

knowledge," they wrote.

With the nudge from that article, Hoeck realized that in addition to prematurity, the one thing

all the babies with RLF had in common was exposure to supplemental oxygen. Of course, they

shared that with lots of babies whose sight was unimpaired, too.

Hoeck shared his suspicions with Patz, who was coming to have his own. Patz noticed that the

retinal blood vessels in a premature baby on oxygen were narrowed and constricted, like the

adults in the Mayo Clinic study. If the exposure to the high concentrations of oxygen was brief,

the vessels returned to normal in 30 minutes or so. But in the babies who'd been in oxygen for

days, the constriction seemed to persist indefinitely.

Patz also looked back into Gallinger's nursery records. Even though they usually didn't record

the exact oxygen flow rate, it was pretty clear that nearly all the babies who went on to develop

RLF had had prolonged exposure to high concentrations of the gas. In fact, over three years it

was 18 out of 21.

"I said, 'Roy, the only thing we can do is a carefully controlled prospective study to test the

oxygen,' " Patz recalled.

(The fact that Patz understood the concept of a controlled trial -- and Hoeck apparently did, too

-- is amazing in itself. The first such study, an English trial that proved the antibiotic

streptomycin could cure tuberculosis, had only been published in October 1948.)

Patz got a $4,000 grant from the newly created National Institutes of Health (NIH) after his

initial application was rejected as unscientific and unethical. He reassured the reviewers that

every premature baby who needed extra oxygen to stay pink and healthy would get it. But all

the premature babies wouldn't get it automatically.

The Trial

On Jan. 1, 1951, they started their experiment. Babies weighing under 3.5 pounds were

alternately assigned, based on time of birth, to get either 80 percent oxygen for at least 28 days

or 40 percent oxygen "only for specific clinical indications." Parents were told about the study

after their child was assigned. But they weren't asked whether they wanted their child included,

and they signed nothing. This lack of "informed consent" in the modern sense was standard for

the time.

"We weren't doing those babies any harm," Hoeck recalled thinking. "In fact, we were doing

what we thought was beneficial in every way."

There

was

a group worried about harm, though. It was the nurses.

Part of the mythology of this trial is that nurses would go around at night turning up the oxygen

taps to the low-oxygen babies in a guerrilla operation to save the infants' lives. That story

heightens the drama, but Patz today says it's mostly wrong.

One or two night nurses did crank up the oxygen to all the incubators when they came on shift,

but that occurred during a dry run for the experiment. Patz says he explained the protocol and

asked them to stop, which they did.

In May 1953, he and Hoeck stopped enrolling babies. This was what they found: 12 out of 60

premature babies assigned to standard care were blind from RLF. In the curtailed-oxygen

group, one out of 60 was. There were also a lot of near-misses. In the high-oxygen group, 21

babies developed early RLF, which eventually regressed to normal. In the low-oxygen group,

nine babies showed those changes.

The young doctors published their first-year results in September 1952 (a year after Kate

Campbell's report from Australia), and the final results two years later. By that time, Patz had

successfully reproduced the disease in newborn mice, rats, kittens and puppies. However, even

before the study was finished, the American Academy of Ophthalmology and Otolaryngology

(AAOO) -- the professional organization of eye, ear, nose and throat doctors -- was making

plans to do its own trial of oxygen use.

As is usually the case in medicine, a single well-conducted trial wasn't enough to convince

doctors to change their practice. The Gallinger study had the additional drawback of being

relatively small (and therefore of greater uncertainty) and the product of two unknown

researchers.

The AAOO proposed a trial in 18 hospitals east of the Mississippi River. It would enroll enough

babies to answer the question beyond any doubt -- provided people could agree how to run it.

Some doctors felt that because the chief problem of premature babies was respiratory distress,

limiting oxygen to them was likely to cause brain damage or death. Others felt that giving

supplemental oxygen indiscriminately would cause avoidable cases of blindness. Few people

were in the middle -- and certainly not Arnall Patz and Leroy Hoeck. Neither Johns Hopkins

Hospital, where by then Patz had an affiliation, nor Gallinger participated in the study.

"I couldn't take part in it," Hoeck said. "I didn't have to be convinced any more."

At a meeting in the mansion house of NIH's new campus in Bethesda, about 45 scientists met to

draw up plans. They wrangled through an entire night, at one point placing a transatlantic

telephone call to Austin Bradford Hill, the British biostatistician who had designed the

streptomycin-for-TB study. He suggested a Solomonic compromise.

The trial would basically be two studies run sequentially. For three months, premature infants

would be randomly assigned to routine high oxygen, or oxygen only if they needed it, in a 1:2

ratio. That would answer the question whether oxygen caused RLF. Then -- assuming the study

wasn't stopped because of higher mortality in the curtailed-oxygen group -- all babies born in

the following nine months would get oxygen only for clinical need. That would provide an

estimate of the incidence of RLF under oxygen-sparing conditions -- a statistic nobody actually

knew.

Cobbled together with a speed inconceivable today, the 18-hospital study commenced on July

1, 1953. It was run out of a central office at the Kresge Eye Institute in Detroit by a biochemist

named V. Everett Kinsey, who'd been interested in RLF since working with Theodore Terry in

Boston a decade earlier. The study used random numbers, not every-other-baby assignment as

in Washington, to determine which infants would get what treatments. Western Union

provided a teletype machine for free, and seven days a week telegrams came and went from

the 18 hospitals.

"This was at the height of the McCarthy era," recalled William A. Silverman, who was in charge

of enrolling preemies into the trial at Columbia's Babies Hospital in New York. "Some people

from the FBI came up to see me to find out what kind of subversive activity was going on with

all these suspicious telegrams." (Silverman died last December.)

The trial closed on June 30, 1954. Before the summer was over, Kinsey and his collaborators

had answers, which they presented to a meeting of eye doctors in New York that fall.

RLF severe enough to cause blindness occurred in 17 percent of the babies getting routine high

oxygen, but in only 5 percent of the curtailed-oxygen group. The death rate in the two groups

was similar -- 22 versus 25 percent. Oxygen -- and nothing else -- was responsible for the

epidemic of blindness in premature infants. Doctors could safely turn it down.

In fact, not to do so would soon be unforgivable.

The preliminary trial results, published in August 1955, and the final 62-page report of "The

Cooperative Study of Retrolental Fibroplasia and the Use of Oxygen," which appeared in

October 1956, might have been the end of the story. But it wasn't quite.

The rate of RLF started dropping in 1952. By 1956 it was roughly at the level of 1946, the early

period of the epidemic. In 1960, however, two physicians at Johns Hopkins Hospital wondered

if this remarkable decline might have come at an unnoticed price.

They reviewed autopsies of babies who had died in the premature nursery, looking especially

for deaths from respiratory complications. They discovered that the percentage of babies dying

in the first six days of life rose from 8 to 13 between 1948 and 1958. The fraction of autopsies

that found lung immaturity as the cause increased by the same proportion during that time. In

1962, an English physician reported a related and similarly unsettling trend. The longer a

premature infant with breathing problems got oxygen, the higher its risk of blindness -- but the

lower its risk of brain damage and paralysis.

Again, the culprit appeared to be oxygen. Only this time it was too little, not too much. Limiting

supplementary oxygen to premature babies had a cost: death or brain damage, at least in some

of them.

Why hadn't this been recognized in either the Washington study or the 18-hospital study?

Patz and Hoeck, surprisingly, didn't record the number of deaths in their study, although they

wrote that there wasn't a significant difference between the high- and low-oxygen groups. In

the 18-hospital study, however, the reason there appeared to be no mortality cost is now clear

-- it's because the babies weren't enrolled in the trial until they were 48 hours old. Before then,

they could get supplemental oxygen.

Those first two days of life were when the tiny infants, clinging to life, were most likely to die.

Oxygen kept some of them alive. When the oxygen was then turned down, they not only lived,

they escaped blindness. If the study had denied them oxygen in those first two days, a

significant number would never have made it to the point where blindness was the worst

outcome. They would have already died -- which was the fate of some of the preemies cared

for in the post-study years.

Recognition of this led to a half-swing back of the pendulum by the early 1960s. Oxygen use

was liberalized, especially in the first days of life.

Fifty years after the dangers of oxygen were discovered, the safe maximum -- if there is one --

still isn't known. As increasingly premature babies can be saved, the prevalence of oxygen-

induced blindness and damaged vision has ceased falling. The condition is not nearly as

common as it was in the 1950s. But it's still here.

Results

Over the years, a lot was learned about the mechanism of RLF.

It's now clear that with prolonged exposure to supplemental oxygen, the arteries in the eye not

only constrict, they become completely obliterated. That leads to a second growth of vessels,

possibly because of a sensation of oxygen deficiency in the eye. This new crop of vessels grows

wildly. It can destabilize the whole retina, which in severe cases peels back and rolls up into a

useless mass behind the lens -- "retrolentally." Much of this knowledge came from the

laboratories of Arnall Patz, his collaborators and students over the last half-century.

Patz became chairman of the Wilmer Eye Institute, Johns Hopkins's renowned department of

ophthalmology. Long before then, though, his RLF work was recognized with the Lasker Award,

which are sometimes called "America's Nobels." He shared his in 1956 with Everett Kinsey, who

ran the big RLF trial, and Jonas Salk, whose successful testing of a polio vaccine was the other

big medical news of 1955. Helen Keller, the most famous blind person in the world, presented

the award.

Leroy Hoeck stayed at the renamed D.C. General Hospital until 1957. He then entered private

practice in the Maryland suburbs of Washington until retiring in 1987. He was asked recently if

he remembered the name of the 997-gram baby whose blindness still makes him choke back

tears.

"Do I know his name?" he answers with incredulity in his voice. "I know it like my own." But he

won't say what it is. Perhaps the man is still alive. Perhaps he is still in Washington.

Jimmy Pew, the index case of the RLF epidemic, has spent much of his career in clinical

psychology treating the victims of another epidemic -- AIDS. As a man living in San Francisco

since 1972, he witnessed that disease come out of nowhere. He blames no one for his

blindness

,

nor does he find it ironic that the best medical care in America took away his vision.

"It was just something that happened," he says.

This, too, is the view of Marc and Patricia Maurer.

"I'm one of the luckiest people I know," asserts Marc Maurer. Lucky because he's been able to

help a large number of blind people like himself find independence and happiness.

"Now, certain things have changed because of blindness," he says. "There are some things that

are different for us than they are for others. Have I ever seen the face of my own children? No.

But it hasn't prevented me from working with them and loving them."

He continues, in a heavy cadence.

"Some people say to me, 'Aren't you

sorry

?' No, I'm not sorry. What the doctors did was give

me what they knew to keep my alive. And I am grateful to them for that."

Earlier in the conversation, the couple had been told of Hoeck's memory of the baby

unwittingly blinded by his treatment. It was emotional even in the retelling.

Patricia Maurer follows up what her husband has just said with this: "Maybe you can give that

message to the good doctor who was so upset”.

Using the CNA Insurance company Knowledge Management scenario (below), carry out the following knowledge management assignment Questions after reading the scenario/essay:

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For Gordon Larson, telling stories is all in a day's work at his job as chief knowledge officer at CNA, and that's just fine with executives at the Chicago-based insurance giant. Larson owes his job to a shift in corporate direction. Three years ago, under the direction of a new chairman, CNA set off on a new mission. The ultimate goal, says Karen Foley, CNA's executive vice president of corporate development, was "to get out of the distribution business and become a great underwriting company." And in order to do that, the company had to become more informed about the industries and customers it served. But CNA's traditional structure of 35 separate strategic business units made sharing internal information among employees nearly impossible. A single customer seeking answers to different insurance needs might be passed along to a variety of departments.

CNA knew it had to create one uniform face to customers, and that meant it had to reeducate its employees. Branch offices would have to be consolidated to facilitate closer working relationships among staff teams. Most important of all, CNA had to equip its employees—many of whom had focused solely on niche markets—with the much broader knowledge of all the company's products. To do that, CNA set about building a Web-based knowledge network that captures the expertise of its employees. And it's that expertise that Larson uses as the fodder for his "knowledge" stories. In 1999, a team of CNA executives evaluated the feasibility of becoming a "great underwriting company," and what they found wasn't pretty. In North America, 175 branch offices supported CNA's 35 business units. In order to create a single face for customers, the executives decided to reorganize the company's business into three major areas: property casualty, life and group benefits, and reinsurance. By December 2001, the trio of new business units was established. CNA is still consolidating its field operations into 75 offices organized around five geographic regions, and that process is expected to be complete by early next year.

Along with the physical reorganization, the very nature of what employees did had to change as well. "Just by reorganizing, we wouldn't get people to change how they think and work with other people," Larson says. "Moving from a decentralized culture to a collaborative one is a major change-management challenge." As the new "single face" of the company, each employee had to cede narrow product and market expertise to gain general knowledge of the company's entire product portfolio. In the past, a CNA small business customer that wanted additional coverage in the international arena would have to contact another underwriter and complete separate applications. With the new CNA, such customers would get all their needs met through one representative. "We needed to give the frontline underwriter the ability to appear like an expert for a variety of products," Larson says.

But how to make instant experts out of the staff? CNA's offerings include hundreds of products in more than 900 industry segments for both businesses and individuals, and in-depth knowledge was dispersed among 15,000 employees. The company had to figure out how to make the collective expertise of so many employees readily available to anyone, when and where it was needed. And it would have to do so in a way that didn't crimp individual work styles or create undue burdens on employees looking for information. Larson knew the company would have to "make it easy for any individual to have access to people within CNA who had answers and information." Even if that staff was geographically dispersed. Then Larson hit upon the idea of an expert locator system, software that allows employees to post questions and give answers via the Internet or an intranet.

Working with consultants from Cap Gemini Ernst & Young, a team of CNA managers spent the end of 2000 evaluating numerous expert location software products. In late 2000, the team chose AskMe Enterprise software from AskMe Corp. of Seattle. Factors in AskMe's favor included software that was scalable and capable of being integrated with Microsoft Outlook (already used by the company's employees), which meant a quick implementation. In February 2001, Bob James, CNA executive vice president of the technology and operations group, spearheaded a team of consultants from AskMe's professional services group to customize the software and create a small pilot project of 500 employees. The system, which CNA calls the knowledge network, has since been rolled out companywide and is being actively used by 4,000 employees.
Now if a CNA employee needs someone with underwriting experience in the inland marine industry, for example, he can type in a query and other employees are notified via e-mail that a question in their area of expertise has been posted. When employees answer questions, the software automatically adds to the archive, which eliminates the headache of answering the same question over and over again. Employees who have identified themselves as subject experts are known as knowledge sources. "Our knowledge network is a high-tech, geographically neutral watercooler that enables access to thousands of people," says James.

Larson, a 20-year veteran of the insurance industry and CNA employee since 1995, didn't officially join CNA's knowledge management effort until four months after the pilot launch of the expert locator system. Back then, Larson was working with Foley in the corporate development department on efforts to bring together CNA's various products and expertise in professional liability and standard property casualty. "It was hard to bring our internal expertise to our customers because each business unit had separate channels and distribution," Larson says. Given his prior experience in cross-marketing and in getting employees in different units to collaborate, he was very interested in taking a key role in CNA's new strategic direction. In June 2001, Foley formalized a leadership role around knowledge management, and Larson assumed the helm of a four-person team dedicated to promoting KM.

As Larson sees it, implementing KM represented a significant cultural change at CNA, where employees traditionally didn't collaborate with one another. For Foley, creating a KM department under the corporate development umbrella was a nod from management to the importance of knowledge sharing. "Our KM sits in corporate development for a specific reason," she says. "We chose not to put KM under technology because we don't want it viewed as a piece of technology. We chose not to put it in HR because it's not a training program. For us, KM involves brand development, research and employee communication."

Daniel Wright, AskMe's vice president of professional services, who consulted with James on implementing the knowledge network, says that CNA's establishment of a high-profile chief knowledge officer (CKO) role in conjunction with rolling out a KM system is part of an increasing trend. "Having a CKO not only shows commitment from the executive team, but it helps create accountability," he says. "Leaders within an organization have to drive adoption of knowledge-based networks in order for them to be effective."

That's not to say that Larson has had it easy simply because he now wears an official CKO mantle. He is quick to admit that creating an environment receptive to knowledge sharing came at a particularly problematic time. When CNA announced its reorganization plans, the inevitable rumors of layoffs and restructuring that resulted sent nervous vibes throughout the company. "Getting traction for the knowledge network in the second half of last year was difficult," Larson concedes. "We were reorganizing the company into three major business units, there was a great amount of organizational turmoil, and employees were not sure of their roles or where they would fit in the new structure." However, now that the reorganization is complete, organizational roles have been clarified. "There's now a clear understanding of the importance of collaboration and knowledge sharing because the knowledge network is aligned with our corporate strategy," Larson says. For their part, employees are now clearer about their roles, responsibilities and accountabilities, and Larson has seen a groundswell of interest in the knowledge network as a result.

Much of that interest in the knowledge network is attributable to Larson's message and the way he has chosen to deliver it. He has hammered home to employees and CNA's leadership alike the connection between presenting one face to the customer and shared knowledge. Larson has done that by telling stories about how sharing knowledge has helped employees on the job. He highlights individual success stories and publicizes them on CNA's intranet via a newsletter called Inside Scoop that's pushed to employees' desktops. As of April, Larson was in the process of recruiting so-called knowledge champions in about 20 functional areas throughout the company who will be responsible for collecting stories and passing them his way. "Storytelling is a helpful way for people to understand the role of the network," he says. "I highlight some of the ways using the network has helped us land new business or avoid unnecessary costs."

The case of Donald Schwanke is a perfect example. A claims consultant in commercial insurance from Syracuse, N.Y., Schwanke received a claim from Canada in February 2001 that involved a lawsuit relating to alleged abuses that took place between 1953 and 1962. Included with the claim was a policy written through Continental Insurance, which had merged with CNA. Canada would not allow any statute of limitation defense—making this, potentially, CNA's responsibility. However, some of Schwanke's colleagues, former employees of Continental, recalled that all the Canadian policies had been sold following the merger. Schwanke needed to find out if the policy in question was among those sold and if so, which company had purchased it. Schwanke turned to the CNA knowledge network, where he posted his question. His answer came the next day from an executive in a different business line who pointed Schwanke to a Canadian insurance company that had indeed purchased the policy. Schwanke was then able to notify the party who'd sent the claim of the correct insurer. According to Larson, the end result was Schwanke saving hours researching the issue—and CNA was spared settling a potentially very expensive claim.

Larson spent last winter and early spring reorganizing the categories on the knowledge network to better reflect CNA's new strategy and the roles of employees. For example, within the underwriting group, Larson is organizing content into casualty, property and specialty categories to capitalize on internal expertise. In the process, Larson is also recruiting new knowledge sources to populate the categories with information. To get out the word about the new knowledge network, Larson and his KM team took their message on the road this summer by visiting CNA's field offices and offering a hands-on introduction. In addition to gathering feedback from employees about the knowledge network and its relevancy to their job, Larson gathered more stories to share. To demonstrate the value of the knowledge network in the future, Larson wants to incorporate a more formal metrics process through regular employee surveys.

Despite high-level executive support for the knowledge network in particular and knowledge management in general, Foley remains circumspect about KM's ability to completely transform CNA. "We're excited about the [KM] initiative, but we've come to understand that people and paper are still important," she says. James is a bit more enthusiastic. "The idea of using technology to connect people in a knowledge network is a very interesting one for corporations with a lot of intellectual talent geographically dispersed," he says. "Where it's difficult to get to know your colleagues, these networks can really help collaboration efforts." For Larson, the end result is the power of collective knowledge. "With the network," he says, "we have the tremendous capability to deliver the expertise of thousands of people to our customers."

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Using the Essay above to help answer with the Questions:

Conclusions – summarize your findings in the form of an overall description of the current KM situation. (Answer must be at least 2 paragraphs)

Evaluation of this answer will be based on completeness in addressing all key KM dimensions (e.g. BTOPP Framework or KM Maturity Model), ability to analyze and to justify discussion and recommendations made (e.g. level of persuasiveness of your arguments, justifications, and prioritization).

“How I Reengineered a Small Business” by Richard H. Snyder, Strategic Finance (May 1999)

Case Study

REENGINEERING IS NOT JUST FOR LARGE BUSINESSES. IT'S TRUE THAT ONLY
GIANT CORPORATIONS CAN AFFORD TO PAY THE FEES FOR HIGH­POWERED
CONSULTANTS TO COME IN AND TURN THE ORGANIZATION UPSIDE DOWN. BUT
FOR THOSE BRAVE SOULS IN SMALL BUSINESSES WILLING TO THINK THE
UNTHINKABLE, REENGINEERING CAN BE MANAGED WITHOUT HUGE MONEY
OUTLAYS.
The major stumbling block in reengineering a small business is the staff who has worked
at the business for years and tends to develop an ownership in the current process and,
as a result, may be unable or unwilling to consider a revolutionary change in the
process. What is required is knowledge of the system that exists and a willingness to
consider radical new processes that would dramatically improve the system. In such
circumstances an outsider may be necessary in order to produce dramatic change.
Take as an example the case of James Street Fashions dba Latt­Greene, a knitting and
converting operation in Vernon, Calif. I became controller of the company on January 2,
1990, at the request of the owner in order to introduce control into the activities of the
company. I had a prior knowledge of the textile industry, having been in public

accounting for many years and having had some textile companies as clients (not Latt-
Greene). I also had controllership, internal auditing, and cost accounting experience and

had guided businesses though bankruptcy.
Latt­Greene knits textiles for the women's and children's apparel market, dyes and prints
designs on the textiles according to customer instructions, and delivers the product to
the customer ready for cutting and sewing into clothing. The customers of the company
consist of clothing manufacturers who sell to clothing retailers.
In the initial interviews at this family­owned and operated company, I discovered some of
the concerns: severe negative cash flow, a belief that not all sales to customers were
being billed or collected, a paper­heavy system that was being crushed by its own
weight. In my initial walk­through, I was astonished to see that the accountant was still
keeping records on a "one­write" system. There wasn't a single computer to be found on

the premises. I told the owners that if I were hired I would be making some dramatic
changes including introducing data processing.
UNRAVELING THE OLD
The first thing I did upon being hired was to purchase a personal computer. I purchased
one without any networking software because at that moment I had no one to network
with. But I did look forward to that day in the future and purchased a computer with the
capability of being turned into a central server at a future date. The only software that I
installed at that time was a powerful spreadsheet, Quattro Pro. In order to gain insight
and perspective into the problems of the system, I loaded into a spreadsheet all the
invoices billed to customers during the month of November 1989, the most current
period available at that time. I then began filling in columns with dyeing and printing
costs from the subcontracting companies who did this work for Latt­Greene. I also
calculated and added yarn costs and added a knitting cost, a tricky and inaccurate
process because such costs had never been accumulated or calculated. The only
financial records being prepared at this time were the general ledger, cash receipts
journal and customer ledgers, and a cash disbursement journal. As yarn was knitted into
unfinished textiles (called greige goods), sheets were manually prepared showing what
pieces were assigned to what lot and what the lot weighed. But no attempt was made to
cost the greige goods. When the finished goods were delivered to customers, they were
billed as per the purchase order, but again no attempt was made to cost the product. The
owners believed they knew what their knitting costs should be, and so I used that
number as a starting point.
Table 1
YEAR ENDED NET
05/31 SALES ROI
1985 16.5 113%
1986 19.8 (46%)
1987 24.8 (18%)
1988 33.6 33%
1989 39.2 11%
1990 54.8 (6%)
SEVEN MONTHS
ENDED 12/31
1990 31.3 63%
YEAR ENDED
12/31
1991 54 61%
1992 30 7%
1993 32 41%

1994 38 53%
1995 31 28%
1996 30 30%
1997 36 43%
1998 30 24%

As I developed the cost sheet, several problems began to surface. One, I couldn't locate
dyeing and printing invoices that could be matched up against the sales invoices. There
was no controlling order number that followed the job through all its steps before the
finished product was delivered to the customer. The dye house assigned its own number
to the orders, and the print plant did the same. In some cases it was virtually impossible
to determine to which order the costs applied. Two, I found purchase orders for which no
shipment to the customer could be located. Three, I found many orders being delivered
late. The person who placed orders into work kept the orders in an alphabetical file on
her desk and each day rummaged through the file, pulled some orders from it, and told
her assistant to put them into work. Many orders were delivered very late simply
because they didn't get pulled from the file, and there was no control over the orders that
were in process.
As I completed input for the month of November, I began seeing that a large number of
the orders either had a too low gross margin to generate a profit on the sale, or even
incurred a gross loss. I began analyzing these orders, and several problems came to the
surface. First, like a conscientious baker who regularly gives his customers a "baker's
dozen," Latt­Greene was producing textiles that were heavier than required. If an order
called for goods that weighed eight ounces to the running yard, we were filling it with
goods that weighed nine ounces. This extra weight made for a nice finished product, but
it also often meant the difference between a profit and a loss. Second, in many cases,
while the weight was okay, and all other factors in the production were correct, the order
didn't produce a profit. We came to the conclusion that in many cases the product was
simply being sold for too low a price. No wonder the company's sales increased from
$16 million to over $54 million in five short years.
During the time that I was developing this spreadsheet, the solutions to the problems
being uncovered were becoming clearer. I developed a manual costing system whereby
every new order coming in was costed as it progressed through the stages of production.
When it was delivered to the customer we knew immediately whether we made or lost
money and the reasons for an unsatisfactory result. But this manual costing system
required a tremendous amount of time to maintain and keep current.
KNITTING TIlE NEW TOGETHER
While searching for computer software that would take the place of the manual system, I
looked at several programs, but each had some faults or shortcomings that disqualified

them. Finally, I was introduced to a company that had produced a textile conversion
system for a business which was smaller than Latt­Greene, and which did no knitting.
But I liked what I saw because it had many fine features and controls. Talking with the
developer convinced me that the knitting operation could be added to produce a system
that met our needs.
In October 1990, we installed a computer system using my old personal computer as the
central server and added 10 stations using the Novell system. After installation, I had to
train the employees to use the new system. For some who resisted abandoning "the way
we had always done it," I had to warn them to either do it my way or I would get
someone who would. Over several months they learned to become computer operators,
and the old system was forgotten.
As better and better cost data was developed using the new system, we refined our
sales prices. In some cases major customers were lost because we raised our prices.
But most customers were retained because we improved our service to them in several
ways. Delivery schedules were met on a more consistent basis, and product consistency
and quality improved as the employees were able to spend more time on those aspects
of the product and less time on paperwork and trying to track down product location.
The system developer and I were able to develop a system that works very well for us
because we took the time to thoroughly understand the business of Latt­Greene and the
problems that occur in the textile industry. I took the time to talk to everyone involved in
the process of converting yarn into a dyed and printed textile. I looked at every piece of
paper being produced and traced an entire month's orders through to the final invoicing
of the finished product. This thorough analysis uncovered the problems. All that was left
was the development of the systems necessary to fix the problems. I involved as many
of the employees of Latt­Greene as possible in identifying the problems and in
suggesting solutions. Then, when the final system was installed, many of the people who
would be working with it already felt ownership of the system. The few who felt
threatened by it and resisted it subsequently left the company.
How successful were we in turning the company around? The table on page 28 displays
sales and return on owners' investment (ROI) for the years 1985 to 1998.
The big ROI fluctuations up to the year ended May 31, 1990, represent the agonies the
company was experiencing because of its rapid growth without corresponding
improvements in the systems. The marked decline in ROI in 1992 was due to the
upheavals introduced when the recession hit the clothing industry with a vengeance that
year. But the important thing here is that even in the deep recession into which the
clothing industry sank that year, Latt­Greene continued to be profitable. The 1998
numbers reflect the fact that tremendous quantities of Asian textiles were "dumped" in
the United States at prices that we cannot compete against. Several of our clothing
customers closed up because of this situation. Even during this "textile depression,"

however, Latt­Greene continued to be profitable.
The lesson here is that reengineering can have a dramatic impact upon a business.
Huge costs to implement change aren't necessary. The entire cost of our new system
was approximately $150,000. Turnaround was swift and dramatic. Downsizing did not
take place. We have about the same size office staff as we did in 1990 (eight people).
The difference is that now we know what our costs are, we bill all our sales, and collect
all our receivables. We are able to plan and to develop strategy. While marketing
mistakes still occur (for example, when we miss a season because of incorrect designs),
the cost of these mistakes is minimized because we can measure them and identify
exactly what the nature of the mistake was and make corrections before the mistake
becomes a catastrophe.
AN UPDATE
Nine years after inception, the system has changed considerably from the initial setup,
but we have never had to do another reengineering. The staff today is still about the
same size as it was in 1990. All the personnel that I hired in 1990 to assist in
administering the system are still with us. The only office staff to leave were those who
refused to work with the new system and had left by the end of 1990.
Some general principles that I learned from this reengineering and which may be helpful
to others who would like to upgrade their operation:
* Be open with all employees regarding the process.
* Solicit input from all employees.
* Involve everyone in the implementation of the new system.
* Understand the system yourself because this understanding is more important than
bringing in consultants and helps to ensure that costs are kept under control.

Discussion Questions:

Briefly describe the company, its products and customers.

What problems did the author discover when he conducted his initial interviews?

Describe the company’s old financial costing system, and identify its weaknesses as well as business operating and profit consequences cause by its poor costing system.

What are major impacts of the company’s new computerized costing system on its business operations, product prices and quality, and company’s profit?

What are general principles learned by the author for changing or reengineering a company’s costing system?