MANAJEMEN

OPERASIONAL
RUMAH SAKIT

SESI 5-6 :
ANALISIS SISTEM PELAYANAN RS
ASPEK MUTU DAN KESELAMATAN PASIEN

Dr. dr. Sandra Dewi, MARS

2019
The study of an activity or procedure to determine the desired end and the
most efficient method of obtaining this end.

Systems analysis is defined as looking at a process with an eye

towards understanding and improvement.

This requires interviewing users and management to gather insight

of the process and discern how it fits into the organization's mission
and operational needs.

After this comes re-engineering and change.

And all the while customers want to be involved with alternatives

and decisions.
A systems analysis approach acts as a bridge between the clinical, economic, patient-
centered and organizational domains to incorporate the clinical pathway with the
organization and delivery of care.

Additionally, it acts as a mechanism to integrate interests and information from

multiple levels of the healthcare system
(Figure 1): micro (evidence based clinical practice), meso (institutional rules), and
macro (government policies).

In the evaluation of healthcare provision, emphasis is placed on the clinical (e.g.

effectiveness and safety), economic (e.g. costs and resource utilization) and patient-
centered (e.g. quality of life and patient preferences) domains while the organization
of services is often left to administration.
Roles and responsibilities: Analysis of the roles of health care professionals, their activity profiles, their
responsibilities, and the organizational hierarchies and decision structures. Weaknesses that may be found
during systems analysis include unclear responsibilities, or conflicting roles.

Information processing and information processing tools: Representation of the information processing functions,
such as registering, storing and archiving information, as well as the used information processing tools (paper or
computer-based). Weaknesses that may be found include redundant documentation, insufficient number of
information processing tools, or violation of data integration.

Communication between health care professionals: Representation of the communication processes taking place
between the various roles, both indirect and direct information exchange, including meetings, briefings, postings,
etc. Weaknesses that may be found include redundant communication or communication breaches.

Business processes: Representation of the logical and temporal sequences of activities. Weaknesses that may be
found include redundant work routines, unclear process definitions, waiting times, or missing feedback of
process results.

Team structure and cooperation within the teams: Representation of the structures of the multi-professional
health care team, description of the cooperation between team members, and teams.Weaknesses that may be
found include a high effort for cooperation, insufficient definition of team aims, and an unclear team structure
for a particular patient.
In general, a system analysis yields an understanding of how a system works and
how different elements in a system interact.
This facilitates system design and system redesign, and aims to improve the
interface between components of a system in order to enhance the functioning of
each individual component in the overall system.
System analysis has much to contribute to patient safety, specifically through its
study of organizational and work systems.

Adopting a systems approach to error reduction requires a shift from blaming

individuals for errors to analyzing systems to uncover design flaws, thus moving
from addressing problems reactively (i.e., after problems occur) to proactively
preventing accidents through system analysis and design.

The basic reliability concept is defined as the probability that the system will perform
its intended function during a period of running time without any failure. A fault is an
erroneous state of the system.

Although the definitions of fault are different for different systems and in different
situations, a fault is always an existing part in the system and it can be removed by
correcting the erroneous part of the
system.
System analysis can help manage and reduce risks by identifying hazards so they
can be controlled through good design. That is, in order to improve safety, quality,
performance, and comfort, a good place to start is by analyzing the involved
systems so they can be improved.

The key to improving safety and reducing risk is through good system design, which
can only be achieved though a complete understanding of the system.

To understand the system, it is essential to know how to analyze it.

Industrial and human factors engineering work system analysis methods provide a
set of tools that can be used to analyze health care systems.

Chapanis states that human factors engineering “discovers and applies

information about human behavior, abilities, limitations, and other
characteristics to the design of tools, machines, systems, tasks, jobs, and
environments for productive, safe, comfortable, and effective human use.”
 Overall Organizational Staff
Level View Role Task
Organization Unit Member

Role dan
Responsibilities

Information
processing and tools

Communication

Bussiness processes

Team structure and

cooperation
Key systems terms

System element:

A system element is anything that is part of a particular system.

Elements can include people, technologies, policies,
lighting, furniture, and jobs.

System attribute:

System attributes are the perceived characteristics of the system.

System boundary:

System boundaries are zones between one system and another. These
zones can be in time, space, process, or hierarchy
Temporal boundary:

A temporal boundary separates systems in time.

Spatial boundary:

A spatial boundary separates systems in space

Process boundary:

A process boundary separates systems into adjacent

component processes, also known as subprocesses

Hierarchical boundary:

A hierarchical boundary separates systems by their

location in a hierarchy of systems
System input:

A system input is anything necessary to energize the system.

Transformation:

Transformations are processes that turn inputs into outputs; they

are actions in the system.

Outputs:

Outputs are the results of transformations.

Unit operation:

A unit operation is a simple input-transformation output process that

does not contain any other input- transformation output processes.
System analysis methodologies include :

• the macro ergonomic analysis and design (MEAD),

• fault tree analysis,

• root cause analysis,

• failure modes and effects analysis (FMEA),

• health care failure modes and effects analysis (HFMEA),and

• probabilistic risk assessment (PRA).

 Guidance Stage in RCA Investigation Process Tools Templates

Being Open Framework RCA Investigation Process Maps *RCA Report Writing Templates
Three Levels of RCA Getting Started Triggers for RCA Investigation
HC Risk Assessment Made Easy RCA Investigation Glossary

Aggregate & Multi-incident RCAs *Detection Factors List *Tabular Timeline

Investigative Interview Guidance Gathering and Mapping Information Time Person Grid

*Incident Decision Tree Change Analysis Lessons Learned Log

Identifying Care & Service Delivery Problems
Nominal Group Technique

Contributory Factors Contributory Factors grid

Classification
Identifying Contributory Factors & Root Causes *Fish Bone Diagram
Five Whys

Barrier Analysis
Generating Solutions and Recommendations
*Types of Preventative Actions

Option Appraisal & Impact

Implementing Solutions Analysis *Action Plan

*Investigation Report Writing *RCA Report Writing Templates

Guide Report Writing
Example Concise RCAs Cause and Effect Charting
There can be a quick and effective questioning tool applied in several environments --
specifically in an information system process.

THE PROBLEM

Why? Why do we need this application/process/procedure?

Why do we need this method?

Why is this a problem?

What? What need does this application/step satisfy?

Where? Where is this application utilized?

Who? Who uses this application?

When? When is it done? When does it have to be done?

How? How is it accomplished?

ELIMINATE, COMBINE, CHANGE AND SIMPLIFY

Eliminate Can this node, process or need be eliminated?

Change Can this node, process or need be changed?

Combine Can this node, process or need be combined

Simplify Can this node, process or need be simplified?

WHAT DO YOU RECOMMEND?

Asking for a recommendation turns out to be a very powerful and insightful

question. Often the answers are in front of us -- just ask those closest to the
process.

For some strange reason systems analysts frequently believe "they" are
expected to solve the problem.

This conception is far from the truth. They are expected to find a solution.
By asking users and those ultimately responsible for the process for their
thoughts and recommendations, we are able to compile a list of alternatives.
They have now been included in the solution process by having their ideas
solicited and considered. Therefore, if the users ideas are accepted, the
user has accountability.
DATA GATHERING TECHNIQUES

Interviews: Interviewing all persons associated with the system and asking the above
questions will assist in seeing the problem or need from a variety of
perspectives. It allows the opportunity to ask, "What do you recommend?"

Observation: Observing a process in the users own environment, or getting a

demonstration of the process or problem, combined with asking the
aforementioned questions, provides insights to define the need or problem.
Visit the user area and experience what the user sees and feels.
"Walk in the Sometimes it is possible for the analyst to perform the function. This will give
users shoes”: a sense of user experiences.

Surveys: Surveys can reveal problems, needs and opportunities not discovered with
other techniques. A person completing a brief survey (less than five
minutes) may disclose problems, issues, processes, or solutions not seen
through other data gathering techniques.
Formal Many times formal reports and user documentation reveal needs or
problems.

Reports: This requires the writer to understand the problem - before they can write
about it.

Professional Articles on subject areas provides others’ positions. Diverse opinions

Journals: Offer new insights.

Peer Groups: Attending professional peer group meetings can provide one-on-one
roundtable dialogue, and perspectives to a problem or need.

Committees: Following a structured meeting process using recorders, leaders, timers

and facilitators can make for effective meetings. Tools such as
brainstorming, nominal group technique, affinity diagrams, Delphi method,
weighed voting, and multivoting can provide committee and team
consensus and priority setting, as well the power of group solutions.
PROMOTE INTERACTION AND DIALOGUE

THE THREE STAGES OF SYSTEMS ANALYSIS QUESTIONS

I. During Interviews 1. II. After Understanding III. With the User and Manager …
ask … 1. ask … ask
1. Why? 1. Eliminate?
2. What? 1. What do You Recommend?
3. Where? 2. Combine?

4. Who?
3. Simplify
5. When?
6. How? 4. Change?
to understand the process to seek alternatives for to have those closest and
solutions accountable take responsibility
(and often solve the problem)
Work System Analysis

Conducting a system analysis

Step 1

Decide what system will be the subject of the analysis. This

determination dictates the direction of the remaining steps.
Step 2

Produce a preliminary work system map. This often-overlooked step is critical to

the success of the entire analysis.

The purpose of this map is to identify inputs and outputs relevant to the system,
which facilitates the identification of people who should be represented on the
analysis team (step 3).

Furthermore, by understanding the inputs and outputs of the system being

studied, the system boundaries can be determined (step 5).
Step 3

Use the preliminary work system map to determine who should be represented on
the team that will carry out the analysis. The importance of good representation
cannot be overestimated. Without representation from all involved stakeholders, it
is likely that the team will lack the expertise necessary to correctly analyze the
system, identify hazards, and control hazards.

Step 4

The assembled team should conduct an initial scan of the system. An initial scan has
two scanning components. First, the team studies the preliminary work system map
and gauges its accuracy.

Step 5

Put boundaries on the system under study. The team needs to determine process,
hierarchical, temporal, and spatial boundaries
Step 6

Performance expectations for each step in the system should now be

determined. Performance expectations are quantitative or qualitative statements
that describe what outcomes should come from each unit operation, component
process, or overall process studied in the system

Step 7

The team should begin formal data collection to revise and update the work system
map, gauge the current performance of the system, and determine baseline
measures that will be used to evaluate the effectiveness of the redesign. Data can
be collected through time studies, administrative databases, maintenance records,
structured observations of the process, and interviews of the involved
stakeholders. Interviews should be used to collect details about the system
elements and attributes, and to reconcile and/or clarify data collected from
observations.
Step 8

The team can begin analyzing the collected data. The purposes of the analysis are to
(a) identify weaknesses, variances, and any series of events that could cause the
system to fail; and (b) prioritize the identified problems for redesign.

This can be executed qualitatively, quantitatively, or using mixed methods,

depending on the system analysis method used (e.g., failure modes and effects
analysis, sociotechnical system analysis, probabilistic risk assessment).
 Step 9

Once hazards (i.e., causes of failure modes or variances) have been identified, control
strategies should be developed. These strategies should be based on the hierarchy of
hazard control, which states that the best hazard controls are those that completely
eliminate the hazard.

Criteria for
Step in the Step in process Who currently Proposed Status of
Cause(s) of the Current control knowing Personnel
Hazard process where hazard first controls the control control
hazard ? activities ? variance is responsible ?
hazards occur ? noticed ? hazard ? activities ? methods ?
controlled ?

1/1/2014 :
Study will be Steering
Nobody is
initiated by the Committee
Sample analysis, responsible at this
Poorly designed Activate the lab director of approved the
Wrong test or possibly not time.Patient or Director of
Diagnostic test order form or ordering module laboratory quality change and study.
ordered by until results come physician is most None Laboratory
order wrong test chosen in the order entry to determine 1/22/2014 : Study
physician back or patient is likely to see the Quality Control
by physician system. change over time design approved.
notified mistake once
in rate of incorrect 2/27/2014 :
results come back
lab tests ordered. Baseline measures
being collected.
Step 10

The final step in a work system analysis is to conduct a system analysis on the redesign
hazard-control ideas that the team develops.

This should be done before redesigns are implemented so the team is confident its
proposed redesign ideas do not unintentionally reduce the effectiveness of the system
nor create new safety problems.
TERIMA KASIH
Contents

1. Comprehensive Model for Diagnosing Organizational Systems

2. Organization-Level Diagnosis : Strategy, Structure, Culture,

People and Technology

3. Group-Level Diagnosis : Group Dynamics and Group

Performance

4. Individual-Level Diagnosis : Employee Satisfaction and

Performance

5. Designing Effective Organization Intervention

 Comprehensive Model for
Diagnosing Organizational Systems
What is Diagnosis?

• Diagnosis is the process of understanding how the

organization is currently functioning, and it provides
information necessary to design change interventions.

• It is also a collaborative process between organization

members and the OD (organization development)
consultant to collect pertinent information, analyze it, and
draw conclusions for action planning and intervention.
High Politics Organization:
Common Approach to Business Problems
YES NO
DOES THE THING WORK?

DON’T MESS
DID YOU MESS WITH IT?
WITH IT
NO
YES

NO DOES ANYONE YOU DUMB

KNOW? *#@>!!

HIDE IT YES YES

WILL YOU
CATCH HELL?
YOU POOR
$#@! ~*%$

TRASH IT

CAN YOU BLAME SOMEONE ELSE?

NO
YES

NO PROBLEM
Comprehensive Model for Diagnosing Organization
A. ORGANIZATIONAL LEVEL
Inputs Design Components Outputs
Strategy
- General Organization
Environment Structure Culture
Effectiveness
- Industry
Structure Human Technology
Resources

B. GROUP LEVEL
Inputs Design Components Outputs
Goal Clarity
Team
Task Group Effectiveness
- Organization Structure Functioning
Design e.g., quality of
Group Group work life,
Composition Norms performance

C. INDIVIDUAL LEVEL
Inputs Design Components Outputs
Skill Variety Individual
- Organization Effectiveness
Design Task Identity Autonomy
e.g., job
- Group Design
satisfaction,
- Personal
Characteristics Task Feedback personal
Significance about Results development
Organizational-Level
Diagnosis
 Organizational-Level Diagnosis

Inputs Design Components Outputs

Strategy

General
Environment Structure Culture Organization
Effectiveness
Industry
Structure

Human Technology
Resources
Systems
General Environment

General • The general environment represent the

Environment external elements and forces that can
affect the attainment of organization
objectives.
• It can be described in terms of amount of
uncertainty present in social,
technological, economic, ecological, and
political forces.
Five Forces of Industry Structure

Buyer
Power

Supplier Threats of
Power Substitutes
Industry
Structure
Rivalry
Threats among
of Entry Competitors
Strategy

Strategy • A strategy represent the way an

organization uses its resources to gain
and sustain a competitive advantage.
• It can be described by the organization’s
mission, goals and objectives, strategic
intent, and functional policies.
Strategy Formulation
Analysis of
General
Mission – Environment
Why We and Industry
Exist Structure

Vision – Strategy Map :

What We Strategy :
Translate the
Want to Be Our Game
Strategy into
Plan
Action
Values –
What’s Analysis of
Important Organization’s
to Us Core
Competence
 Strategy Formulation

Strategic
Outcomes
Satisfied
Shareholders

Strategy : Strategy Delighted

Our Game Map : Customers
Plan Translate Excellent
the Strategy Processes
Motivated
Workforce
Structure

Structure • The structural system describes how

attention and resources are focused on
task accomplishment.
• It represents the basic organizing mode
chosen to (1) divide the overall work of
an organization into subunits that can
assign task to individuals and groups
and (2) coordinate these subunits for
completion of the overall work.
Culture

Culture • Organization culture represents the

basic assumptions, values, and norms
shared by organization members.
• It orients employees to company goals
and suggests the kinds of behaviors
necessary for success.
Elements of Corporate Culture Formation

Organization Top Industry

System and Management Characteristics
Policy View

Profile of Organization
Employees Structure

Corporate Culture
Human Resources Systems

Human • Human resources systems include

Resources mechanism for selecting, developing,
Systems appraising and rewarding organization
members.
• HR systems influence the mix of skills,
personalities and behaviors of
organization members.
 Human Resources Systems

Recruitment &
Selection

Training & Performance

Business Development Management Business
Strategy Result

HR
Systems

Reward Career
Management Management
Technology

• Technology is concerned with the way an

Technology
organization converts inputs into
products and services.
• It represents the core of the
transformation function and includes
production methods, work flow and
equipment.
Organizational-Level Diagnosis

• What is the company’s general environment?

• What is the company’s industry structure?

• What is the company’s strategy?

• What is the company’s culture?
• What are the company’s structure, human
resources systems, and technology?
 Organizational-Level Diagnosis

Inputs Design Components

Strategy
Does the
General
Environment organization
Structure Culture
strategic
Industry orientation fit
Structure
with the
inputs? Technology
Human
Resources
Systems
Organizational-Level Diagnosis

Design Components

Strategy

Do the design
Structure Culture
components
fit with each
other?

Human Technology
Resources
Systems
Group-Level Diagnosis
 Group-Level Diagnosis

Inputs Design Components Outputs

Goal
Clarity

Organization Task Group Team

Structure Functioning
Design Effectiveness

Group Group
Composition Norms
Organization Design

Organization • Organization design is the major input to

Design group design.
• It consists of the design components
characterizing the larger organization
within which the group is embedded :
technology, structure, human resources
systems and organization culture.
 Group Components

Goal Clarity involves how

well the group understand
its objectives

Task Structure is Group Functioning is the

concerned with how the underlying basis of group life
group’s work is designed

Group Composition Group Norms are member

concerns the membership of beliefs about how the group
groups should perform task
Goal Clarity

• Goal Clarity involves how well the group

Goal
understands its objectives.
Clarity
• In general, goals should be moderately
challenging; there should be a method of
measuring, monitoring and feeding back
information about goal achievement.

• The goals should be clearly understood

by all members.
Task Structure

• Task Structure is concerned with how

Task
the group’s work is designed.
Structure
• Task structure can vary along two key
dimensions : coordination of members’
effort and regulation of their task
behavior.
Group Functioning

Group • Group Functioning is the underlying

Functioning basis of group life.

• How members relate to each other is

important in work groups because the
quality of relationship can affect task
performance.
Group Composition

Group • Group composition concerns the

Composition membership of groups.

• Members can differ on a number of

dimensions having relevance to group
behavior.

• Demographic variables such as age

education, and job experience, can
affect how people behave and relate to
each other in groups.
Group Norms

Group • Group Norms are member beliefs about

Norms how the group should perform task

• Norms derive from interaction among

members and serve as guides to group
behavior.
Group-Level Diagnosis

• How clear are the group’s goals?

• What is the group’s task structure?

• What is the composition of the group?

• What are the group’s performance norm?

• What is the nature of team functioning in the

group?
Individual-Level
Diagnosis
 Individual-Level Diagnosis

Inputs Design Components Outputs

Organization Skill
Variety
Design

Group Design Task Task Individual

Identity Significance
Effectiveness
Personal
Characteristics
(skill, knowledge Autonomy Feedback
attitude)
Individual-Level Diagnosis

Organization • Organization design is concerned with

Design the larger organization within which the
individual job is the smallest unit.

Group • Group design concerns the larger group

Design or department containing the individual
job.
• Like organization design, group design is
an essential part of the job context.
 Individual-Level Diagnosis

Personal • Personal characteristics of individuals

Characteristics occupying jobs include their age,
education, experience, and skills and
abilities.
• Personal characteristics can affect job
performance as well as how people react
to job designs.
Individual Jobs Dimensions

Skill Variety

Task Identity Autonomy

Five Key
Dimensions

Task Significance Feedback About Results

 Individual Jobs Dimensions
Skill Variety
The degree to which the job
requires a variety of different
activities

Task Identity Autonomy

The degree to which the job The degree to which a job
requires completion of a provides freedom and discretion
whole and identifiable piece in scheduling the work and
of work determining work methods.

Task Significance Feedback About Results

The degree to which a job has a The degree to which a job provides
significant impact on other employee with direct and clear
people’s lives information about the effectiveness of
task performance
Job Characteristics Model - Hackman/Oldham

Core Job Psychological Personal and

Dimension States Work Outcomes

Skill Variety Experienced

Task Identity meaningfulness of
Task Significance the wok • High internal
work motivation
Experienced • High-quality work
Autonomy responsibility for performance
outcomes of the • High satisfaction
work with the work
• Low turnover
Knowledge of the
Feedback actual results of
the work activities
Individual-Level Diagnosis

• What is the design of the larger organization within

which the individual jobs are embedded?

• What is the design of the group containing the

individual job?

• What are the personal characteristics of

jobholders?
Individual-Level Diagnosis

• How much skill variety is included in the jobs?

• How much task identity do the jobs contain?

• How much task significance is involved in the

jobs?

• How much autonomy is included in the jobs?

• How much feedback about results do the jobs

contain?
Designing Effective
Intervention
 Intervention

• A set of sequenced planned actions

or events intended to help an
organization increase its
effectiveness.
Intervention
• Interventions purposely disrupt
status quo; they are deliberate
attempts to change an organization
or subunit toward a different and
more effective state.
Effective Intervention

Two Major 1. The extent to which it fits the needs

of the organization
Criteria to
Define an 2. The extent to which it transfer
Effective change-management competence to
Intervention organization members
 Intervention Success Factors

Readiness Capability of
Key Factors for Change the Change
that can affect Agent
intervention
success Capability Cultural
to Change Context
Types of Intervention

Human Process
Intervention

Structural
Intervention
Types of
Intervention Human Resource
Management Intervention

Strategic
Intervention
 Examples of
Human Process Intervention

Process This intervention focuses on

interpersonal relations and social
Consultation
dynamics occurring in work groups.

Team Building This intervention helps work groups

become more effective in
accomplishing task
 Examples of
Structural Intervention

Structural Design This change process concerns the

organization’s division of labor – how to
specialize task performances.

Downsizing This intervention reduces costs and

bureaucracy by decreasing size of the
organization

Reengineering This intervention radically redesign the

organization’s core work process to
create more responsive performance.
 Examples of
Human Resources
Management Intervention

Performance This intervention is a systematic

process to link between corporate goal
Management
settings and reward systems.

Career Planning & This intervention helps people choose

Development career paths and attain career
objectives.

Reward System This intervention involves the design of

organizational rewards to improve
employee satisfaction and performance.
 Examples of
Strategic Intervention

Merger and This intervention is a systematic

process to integrate two or more
Acquisition
organizations.

Cultural Change This intervention helps organizations

develop cultures appropriate to their
strategies and environment.

Organizational This intervention seeks to enhance an

Learning organization’s capability to acquire and
deploy new knowledge.
Institutionalizing Interventions

Effective
Intervention
Institutionalization
Process

Enhance
Organization
Performance
Factors Affecting Institutionalization Process

Organization
Characteristics:
• Congruence
• Stability
• Unionization Institutionalization
Process
Intervention
Characteristics:
• Goal Specifity
• Programmability
• Level of Change Target
• Internal Support
• Sponsorship
Organization
Characteristics:

This is the degree to which an intervention is

Congruence perceived as being in harmony with the
organization’s strategy, and structure; its
current environment; and other changes
taking place.

Stability of This involves the degree to which the

Environment and organization’s environment and technology
are changing.
Technology
Organization
Characteristics:

Diffusion of interventions may be more

Unionization difficult in unionized settings, especially if the
changes affect unions contract issues, such
as salary and fringe benefit, job design, and
employee flexibility.
Intervention
Characteristics:

This involves the extent to which intervention

Goal Specifity goals are specific rather than broad.

This involves the degree to which the

Programmability
changes can be programmed or the extent to
which the different intervention characteristics
can be specified early in advance to enable
socialization, commitment, and reward
allocation.
Intervention
Characteristics:

This concerns the extent to which the change

Level of
target is the total organization, rather than a
Change Target
department or small work group.

This refers to the degree to which there is an

Internal
internal support system to guide the change
Support
process.
Intervention
Characteristics:

This concerns the presence of a powerful

Sponsorship
sponsor who can initiate, allocate, and
legitimize resources for the intervention.
References/Recommended Further Readings

Thomas Cummings and Christopher Worley, Organization Development

and Change, South Western College Publishing.
You can obtain this excellent book at this link: http://www.amazon.com/Organization-Development-InfoTrac-College-
Printed/dp/0324421389/ref=sr_1_1?ie=UTF8&s=books&qid=1219798794&sr=1-1

Stephen Robbins, Organizational Behavior, Prentice Hall

You can obtain this excellent book at this link: http://www.amazon.com/Organizational-Behavior-12th-Book-CD-
ROM/dp/0131890956/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1219800224&sr=1-1

Marvin Ross Weisbor, Organizational Diagnosis : A Workbook of Theory

and Practice, Perseus Books Group
You can obtain this excellent book at this link: http://www.amazon.com/Organizational-Diagnosis-Workbook-Theory-
Practice/dp/0201083574/ref=sr_1_1?ie=UTF8&s=books&qid=1219800382&sr=1-1
If you find this presentation useful, please consider telling others
about our site (www.exploreHR.org)

End of Material