Showing papers on "Workforce published in 1997"

How to Compete: The Impact of Workplace Practices and Information Technology on Productivity

Abstract: Using data from a unique nationally representative sample of businesses, the Educational Quality of the Workforce National Employers Survey (EQW-NES), matched with the Bureau of the Census' Longitudinal Research Database (LRD), we examine the impact of workplace practices, information technology and human capital investments on productivity. We estimate an augmented Cobb Douglas production function with both cross section and panel data covering the period of 1987-1993 using both within and GMM estimators. We find that what is associated with higher productivity is not so much whether or not an employer adopts a particular work practice but rather how that work practice is actually implemented within the establishment. We also find that those unionized establishments that have adopted what have been called new or transformed' industrial relations practices that promote joint decision making coupled with incentive based compensation have higher productivity than other similar non-union plants maintain more traditional labor management relations have lower productivity. We also find that the higher the average educational level of production workers or the greater the proportion of non-managerial workers who use computers, the higher is plant productivity.

A Brain Gain with a Brain Drain

Abstract: We study human capital depletion and formation in an economy open to out-migration, as opposed to an economy which is closed. Under the natural assumption of asymmetric information, the enlarged opportunities and the associated different structure of incentives can give rise to a brain gain in conjunction with a brain drain. Migration by high-skill members of its workforce notwithstanding, the home country can end up with a higher average level of human capital per worker.

Training and Innovation in an Imperfect Labour Market

Abstract: This paper shows that in a frictional labour market part of the productivity gains from general training will be captured by future employers. As a result, investments in general skills will be suboptimally low, and contrary to the standard theory, part of the costs may be borne by the employers. The paper also demonstrates that the interaction between innovation and training leads to an amplification of this inefficiency and to a multiplicity of equilibria. Workers are more willing to invest in their skills by accepting lower wages today if they expect more firms to innovate and pay them higher wages in the future. Similarly, firms are more willing to innovate when they expect the quality of the future workforce to be higher, thus when workers invest more in their skills. In modern economies, a large portion of human capital investments takes place within firms in the form of training. Most economic analyses of training are based on the paradigm introduced by Becker (1964) which suggests that a worker should pay for any general training which allows him/her to use the new skills when employed by other firms. Inefficiency occurs mainly because workers may be unable to pay for their training, and also unable to commit to not quitting their firm after employer sponsored training. Yet this source of inefficiency does not seem particularly relevant for many instances of training

High-involvement innovation through continuous improvement

Abstract: Continuous improvement (CI) in all aspects of the business is essential for meeting the challenge of today’s turbulent environments One increasingly popular strategy for enabling continuous improvement is through mobilising a high level of involvement of the workforce in sustained incremental problem-solving Although the potential benefits of such high involvement innovation are considerable, implementing programmes of this kind is not easy This paper reports on a five year research programme exploring implementation issues in CI and presents a framework model for the development of CI which draws upon extensive case study work In particular, it identifies a series of levels of CI performance and the blocks and enablers associated with them

Flexible Working in Europe: A Review of the Evidence

Abstract: Introduction(1) The concept of flexible working practices(2), the extent of such practices and the implications for practitioners and policy makers in the area, have been much discussed. These are critical issues for employers, trade unions and governments. Recent opinions from the European Court of Justice have raised the political profile of the subject and the European Commission is committed to further action on this issue in 1997. This paper addresses these issues in a comparative European context. The paper presents evidence on developments in flexible working from organisations across Europe. Flexible working here covers only working time and contractual variations (temporary contracts, outsourcing etc.).(3) The paper summarise the debates on the topic; briefly outlines the research that was done; shows the extent and growth of flexibility; explores the reasons for the massive growth in flexible working in Europe and considers whether this is evidence of convergence of European labour markets. This is followed by a wide-ranging examination of the implications of the findings. Theories of Labour Flexibility The concept of "labour flexibility" remains, both in theoretical and practical terms, highly problematic. Despite the huge volume of literature devoted to the so-called "flexibility debate" (see bibliography in Brewster et al. 1996a), relatively little progress has been made in resolving many of the problems associated with the concept. In the literature, the term "flexibility" is applied to a series of quite distinct (if related) theories. There are those which have been labelled "post-Fordist": a category which covers a range of variants, but is characterised by the work of Piore and Sabel (1984), Mathews (1989a, 1989b, 1990, 1992), Lash and Urry (1987), Katz (1985), Kern and Schumann (1987), Tolliday and Zeitlin (1986), and Streeck (1987). For these writers, who generally concentrate on manufacturing industry, new technology is the key to a more flexible form of production, more responsive to increasingly rapid changes in the market. Whilst such developments may depend for their success upon a more skilled, motivated, and flexible workforce, the focus of this stream of writing is on production systems rather than employment. A more critical, "neo-Marxian" (Clegg 1990) or "neo-Fordist" (Wood 1989b, p. 21) group of writers is also concerned with flexible production, though taking a more negative view of its likely effect on individuals and including discussion of the impact on labour markets (Bramble 1988; Bramble/Fieldes 1989, 1992; Harvey 1989, 1991). An alternative conception of flexibility is provided by researchers in the operational management area. There is also an important set of literature labelled by some as "managerialist" (Bagguley 1991, p. 164) or "neomanagerialist" (Clegg 1990, p. 210) and typified by the work of Atkinson (1984, 1985a, 1985b, 1986, 1987; Atkinson/Gregory 1986; Atkinson/Meager 1986). His work has been subjected to critiques which have attempted to demonstrate the limited utility and lack of theoretical robustness of his work or even, in the early debates, to deny that the labour market had changed substantially, rather than attempting to build upon the insights which it provides or to develop a more comprehensive theoretical framework based on it (see for example: Pollert 1988a, 1988b). Nonetheless, Atkinson's work has been extremely influential. His vision of flexibility has influenced policy debates internationally (OECD 1986a, 1989). These changes and the development of a more flexible labour market have been controversial. They are seen by some to have taken our societies back towards the early years of the industrial revolution, with the creation of a significant underclass of underprivileged and "vulnerable" workers. They are seen by others as evidence of an uncaring and irresponsible approach to employees by employers -- sometimes associated with a desire to "de-unionise" the workforce. …

Workforce 2020: Work and Workers in the 21st Century

Abstract: The authors of this text set out to set the record straight on the demographic makeup of the work force in the years 2000 to 2020.

The Education-Jobs Gap: Underemployment or Economic Democracy

Abstract: According to Ivar Berg's performance criteria, over half of the U.S. workforce is now underemployed. Using analysis based on U.S. and Canadian surveys of work and learning experiences and other documental data, author David Livingstone exposes the myth of the "learning enterprise" and argues that the major problem in education-work relations is not education but the mismatch between work and worker.

Islamic revival in Asia and human resource management

Abstract: Discusses some of the implications of Islamic values for management of the workforce in organizations in Muslim countries in the light of the rise of Islamist movements in many of these countries. Discussion is placed within the context of the debate about the influences of national culture on organizations in general and employee‐management relationships in particular. Argues that there are differing manifestations of Islamic values in the countries concerned, which could lead to differing implications for human resource management (HRM). Highlights difficulties in trying to isolate the influences of Islam on organizations from those of other institutions, such as the economy, politics and business imperatives. As a result, and also given the limited available comparative studies into the issue, it would be unwise to suggest an Islamic HRM model. However, Islam, as an all‐encompassing religion, is bound to have implications for certain aspects of organizations, especially in those countries which are organized and run in accordance with an Islamic ideal. Attempts to explore, therefore, the likely relationship between Islamic values and certain HRM features in Muslim countries.

Does the Labour Market Explain Lower Female Schooling in India

Abstract: Labour market discrimination against women and parental discrimination against daughters are two of the most commonly cited explanations of the gender gap in education in developing countries. This study empirically tests the labour market explanation for India using household survey data collected in urban Uttar Pradesh in 1995. It estimates workforce participation functions and selectivity-corrected earnings fluctuations, and calculates the rates of return to education for the two sexes. Using the Blinder-Oaxaca method, the gross gender difference in earnings is decomposed into the part that is explained by men and women's differential characteristics and the part that is due to labour market discrimination. The results reveal that there is substantial omitted family background bias in the estimates of returns and that, contrary to received wisdom, the rates of returns to education rise by education level. The analysis suggests that, as well as overall labour girls face significantly lower economic rates of returns to education than boys.

How to Compete: The Impact of Workplace Practices and Information Technology on Productivity

Abstract: Using data from a unique nationally representative sample of businesses, the Educational Quality of the Workforce National Employers Survey (EQW-NES), matched with the Bureau of the Census' Longitudinal Research Database (LRD), we examine the impact of workplace practices, information technology, and human capital investments on productivity. We estimate an augmented Cobb Douglas production function with both cross section and panel data covering the period of 1987-1993 using both within and GMM estimators. We find that what is associated with higher productivity is not so much whether or not an employer adopts a particular work practice but rather how that work practice is actually implemented within the establishment. We also find that those unionized establishments that have adopted what have been called new or "transformed" industrial relations practices that promote joint decision making coupled with incentive based compensation have higher productivty than other similar non-union plants, while those businesses that are unionized but maintain more traditional labor management relations have lower productivity. We also find that the higher the average educational level of production workers or the greater the proportion of non-managerial workers who use computers, the higher is plant productivity.

Workforce Education: The Basics

Abstract: The book begins with the premise that workforce education is a profession. The product is always instruction; the goal to promote learning that leads to individual labour market advantage or solving human performance problems. It is this common product and goal that joins all workforce education into a common professional bond.

Middle management downsizing: an empirical investigation of the impact of information technology

Abstract: Nearly all Fortune 1000 firms claim to have downsized since the early eighties, and it is argued that information technology IT is responsible for this massive downsizing. However, earlier research has indicated that IT increases middle management. Even though the impact of IT on the middle management workforce has been studied for the last thirty years, research has failed to clearly explain this phenomenon. Quite the opposite, research has fueled controversy and has provided inconsistent findings. This article addresses the state of inconsistent findings across multiple studies by examining the impact of information technology on the number of middle managers using two additional variables: the degree of centralization of organizational decision authority and the degree of centralization of computing decision authority. One hundred and fifty-five city governments were surveyed. Information technology was found to be both positively and negatively associated with the size of the middle management workforce. The impact of information technology was fundamentally determined by who controlled computing decisions and what interests were being served, and by the roles of middle managers. Information technology was associated with a decrease in the size of the middle management workforce in organizations with centralized decision authority and with an increase in the number of middle managers in organizations where decision authority was decentralized.

The Evolution of U.K. Self‐Employment: A Study of Government Policy and the Role of the Macroeconomy

Abstract: This paper reports the findings of a time series analysis exploring the fundamental determinants of the substantial rise in U.K. self-employment over the period 1972–92. The key findings are that the self-employed/wage-employed income differential has a high and positive effect upon the proportion of the workforce in self-employment, supporting alternative wage theories of labour market status, as does housing wealth, supporting credit-rationing theories. Perhaps the most interesting feature concerns the relationship between unemployment and self-employment. On this we find that it is the duration structure of unemployment that matters, not simply the stock of unemployed people. This evidence may imply that self-employment is a last resort for certain individuals marginalized in the employed sector and facing lengthy spells of unemployment.

Managing Knowledge: Experts, Agencies and Organisations

Abstract: From the Publisher: This book explores the growing phenomenon of atypical work manifested in workforce flexibility, mobility, the feminization of professional employment, and technological changes. Albert and Bradley focus upon an influential group of knowledge-based employees - experts - and show the way in which they are ushering in changes in the work environment by resorting to atypical employment arrangements which are enhanced by an agency system. Case studies are developed from companies including AT&T, The Hollywood film industry, London accounting firms, and specialised agencies such as Labforce and Knowledge Net.

Do Employers Need the Skills They Want? Evidence from technical work

Abstract: Changes in the modern workplace, brought about by technology and management innovations and by increased global competition, raise many concerns about the adequacy of workforce skills. In the US and elsewhere, these concerns have led to new ideas about skills, in particular the need for ‘generic skills’ like problem solving, teamwork, and communications. Many employers and policymakers in the US believe that these skills are necessary for work across most jobs and support school reforms to teach them. This article presents empirical evidence from a study in technical work which challenges conventional wisdom about skills and skill requirements and has broad implications for school reform.

Hospital Restructuring in the United States, Canada, and Western Europe An Outcomes Research Agenda

Abstract: OBJECTIVES. This article describes the extent and nature of hospital restructuring across the United States, Canada, and Western Europe, countries with differently organized and financed health-care systems, and assesses the feasibility of international research on the outcomes of hospital restructuring. METHODS. The conceptual background, context, and focus for the Bellagio conference on Hospital Restructuring in North America and Western Europe held in November 1996 is provided, illustrating key issues on hospital and workforce trends using the US data with international comparisons. RESULTS. Hospital systems internationally are undertaking very similar restructuring interventions, particularly ones aimed at reducing labor expenses through work redesign. Nursing has been a prime target for work redesign, resulting in changes in numbers and skill mix of nursing staff as well as fundamental reorganizing of clinical care at the inpatient unit level. Yet little is known about the outcomes of such organizational interventions and there are few efforts in place to critically evaluate these actions. CONCLUSIONS. Restructuring of the hospital workforce and redesign of work in inpatient settings is widespread and markedly similar across North American and Europe, and warrants systematic study. Cross-national studies of the impact of restructuring inpatient care on patient outcomes would yield valuable lessons about the cost-quality tradeoffs in hospital redesign and reengineering, as well as inform national planning about the numbers and types of nurses needed in the coming decades.

A national agenda for geriatric education : white papers

Abstract: In this volume, experts from nursing, social work, medicine, and related fields critique the current state of geriatric health education and make recommendations for its future. Derived from the Geriatrics Future Health Education Project of the US Health Resources and Services Administration, the book is designed to help educators prepare a health workforce to meet the demands of an aging nation. It takes a continuous quality improvement approach.

Right Tracks--Wrong Rails: The Development of Generic Skills in Higher Education.

Abstract: Higher education is being encouraged to provide the graduates needed by commerce and industry in order to ensure economic development and enhance competitiveness. Throughout Europe and America, recent findings indicate that employers show a preference for teamwork, communication, and self-skilIs above knowledge, degree classification, intelligence, and reputation of the institution the graduate attended. Progressively less emphasis on traditional degrees and more on the validation of competence is clearly discernible. But the question persists: Are our higher education institutions meeting the challenge? Employing a large-scale extensive questionnaire, this study explores student and academic staff views within a higher education institution in the U.K. Results indicate that while staff and students ascribe equal importance to key generic skills, they differ in their views of the extent to which a number of such skills are currently being developed through course content. It is time for higher education to address explicitly the issue of the place of transferable skis in the curriculum. This problem is not unique to Europe. Indeed, the need for a concerted effort by teachers and policymakers in higher education to help rebuild American workforce competence has been repeatedly highlighted. Development work in this area should be a priority.

Receptivity to volunteering in the immediate postretirement period

Abstract: Higher rates of volunteering might be expected of elders in the period immediately after retirement because they tend to be in relatively good health and have fewer competing obliga tions. Data from the Commonwealth Productive Aging Survey, a telephone survey of a repre sentative national sample of 2,999 people 55 years of age and older, confirmed findings of previous research that retirement is not associated with higher rates of volunteering. However, in the first and second years following termination of employment, nonvolunteers show a heightened receptivity to volunteering; that is, they indicate more willingness to take on volunteer assignments and an ability to do so than do elders who are employed or who have been out of the workforce for longer periods. The findings suggest that volunteer coordinators should focus volunteer recruiting efforts on elders who are about to leave jobs or who have recently left jobs.

The Transformation of the Japanese Employment System: Nature, Depth, and Origins

Abstract: The 1990s have witnessed significant change in the Japanese employment system and in the work organization of Japanese firms. This article gives a broad overview of the changes taking place in Japanese employment and compensation practice, recruiting and promotion, and corporate organization. More than in previous postwar downturns, Japanese firms are going to great and creative lengths to reduce workforce size and costs without resorting to formal layoffs. Yet the restructurings and adjustments designed to provide this flexibility often prove under scrutiny to be less substantial than media accounts or public corporate pronouncements suggest. Frequently the changes seem in large part symbolic—signaling to the workforce the need for change in the corporate culture and for diminished expectations in a more severe economic environment.

Workforce Readiness : Competencies and Assessment

Abstract: Given the changes in the workplace over the last decade due in large part to the increase in technology and the rise of globalisation, the author suggests that there is a potential skill gap for the high-skill, high-wage, high-productivity jobs This book explores the specification of both individual and team competencies and skills and their assessment for students entering the world of work from both high school and college It focuses on contexts in training as well as education and on entry level positions

Are U.S. Multinationals Exporting U.S. Jobs

Abstract: Many allege multinationals are exporting' U.S. jobs when they expand operations abroad. This paper investigates the extent to which expansion of offshore production by U.S. multinationals reduces labor demand at home and at other offshore locations, using a panel on U.S. multinationals and their foreign affiliates between 1983 and 1992. The results suggest that foreign affiliate employment substitutes modestly at the margins for U.S. parent employment. There is much stronger substitution between workers at affiliates in alternative low wage locations. In contrast, activities performed by affiliates at locations with different workforce skill levels in the same region appear to be complements. The results suggest a vertical division of activities among countries with different workforce skill levels, where workers in developing countries compete with each other to perform the activities most sensitive to labor costs. When wages in developing countries, such as Mexico, fall 10 percent, U.S. parent employment falls 0.17 percent, while affiliates in other developing countries, such as Malaysia, lay off 1.6 percent of their workforce.

Hard‐skills, soft‐skills: undervaluing hospitality’s ‘service with a smile’

Abstract: Hospitality gains profitable value-added from the highly developed social skills of its so-called ‘unskilled’ labour force. Applying terms such as ‘skilled’ and ‘unskilled’ to a post-industrial workforce, especially in services, is not only anachronistic but, in the case of front-line hospitality workers, creates something of a myth that serves to undermine their contribution to bottom line results. This paper examines two key human resource areas. The first concerns categorising workers as either ‘skilled’ and ‘unskilled’, floating a postmodernist idea that perhaps this is something of a social construct, being rooted both in ‘modern’ manpower planning for heavy industries and in the former power of trade unions to control entry into the workplace through lengthy apprenticeships. The second area reviews the quantitative approach to manpower planning. The contextual frame is characterised by a two-sided cross-cultural theme; first, that the male-dominated culture of Fordism and ‘scientific management’ socially constructs skill definitions so as to allow management more control over the workforce. Second, that there is evidence of a culture clash when ideas based on this (i.e. essentially Western industrial culture) are superimposed on Third World countries through the manpower planning component of aid-assisted tourism master plan programmes. © 1997 John Wiley & Sons, Ltd.

Workforce, Economic, and Community Development: The Changing Landscape of the Entrepreneurial Community College

Abstract: Focusing on nontraditional workforce, economic, and community development programs being developed within community colleges, this monograph defines these efforts as "entrepreneurial colleges" within community colleges and reviews characteristics and trends related to these efforts. Following an executive summary and introduction, the first section provides definitions and examples of entrepreneurial community colleges, contrasting them with rcgrlar community colleges, describing difficulties in determining the success of entrepreneurial colleges, and providing data on enrollments in entrepreneurial colleges at seven community colleges. The second section discusses internal and external factors influencing entrepreneurial colleges, including college missions, faculty attitudes and activities, and local pressures, while the third section address the role of state policy in promoting workforce and economic development, focusing on issues related to funding, regulations, and balancing state and local initiatives. This section also highlights emerging concerns of state officials related to entrepreneurial college effectiveness, their coherence in state educational systems, and the effects of welfare reform initiatives. The fourth section examines potential tensions within comprehensive community colleges with the rise of these new programs. The fifth and final section presents conclusions and recommendations for promoting and integrating entrepreneurial colleges, developing new state and federal policies, and conducting further research. Contains 35 references. (BCY) ******************************************************************************** Reproductions supplied by EDRS are the best that can be made from the original document. ******************************************************************************** WORKFORCE, ECONOMIC, AND COMMUNITY DEVELOPMENT THE CHANGING LANDSCAPE OF THE ENTREPRENEURIAL COMMUNITY COLLEGE U.S. DEPARTMENT OF EDUCATION Office of Educational Research and Improvement EDUCATIONAL RESOURCES INFORMATION This (ERIC) is document has been reproduced as ceived from the person or organization originating it. Minor changes have been made to improve reproduction quality. Points of view or opinions stated in this document do not necessarily represent official OERI position or policy. ,i411* '---__ "PERMISSION TO REPRODUCE THIS li' N N `-9 MATERIAL HAS BEEN GRANTED BY D. Doucette W. Norton Grubb Norena Badway Denise Bell The University of California at Berkeley

America's competitive secret : women managers

Abstract: The United States has a large number of well educated, experienced professional women ready, willing and able to move into the boardrooms and executive suites of corporate America. Together they represent a great, untapped economic resource, a resource no other country in the world can claim. This is America's competitive secret, argues Judy B. Rosener in this refreshingly pragmatic new book for managers who want to improve their bottom line. A leading expert on women and men at work and a highly sought-after speaker, Rosener argues that not only are men and women different, so are male and female managers. Drawing on in-depth interviews with top-flight executives and middle managers and the latest research on working women and organizational change, she describes the unique contribution of female professionals. Her profiles of top women managers reveal that they cope well with ambiguity, are comfortable sharing power, and they tend to empower others- leadership traits that Rosener contends lead to increased employee productivity, innovation, and profits. As businesses today struggle with corporate reorganization and an increasingly diverse workforce, America's Competive Secret offers compelling evidence that the changes that help organizatiions more fully utilize the talents of women are the same changes that will give them an important edge in today's fast-changing, service oriented, global workplace. Rosener explains why the so-called glass ceiling still prevents many competent women from reaching the upper echelons of management. She analyses why women and men are perceived and evaluated differently at work, and provides new insight into the feelings of men who are asked to interact with women in new roles when there are few new rules. Rosener shows that removing the glass ceiling can no longer be viewed solely in terms of social equity-it is now an economic imperative. Too many American businesses have limited their economic strength by viewing the promotion of women employees only within the context of federally mandated affirmative action laws and policies. America's Competitive Secret redefines the issue for a new era, showing that America's most successful competitive strategy is one that most effectively utilizes all its human resources.

Strategies and measurement for workforce flexibility: an application of functional flexibility in a service setting

Abstract: In situations where a volatile product market meets an unstable labour market, as is often found in customer contact service operations such as the hospitality industry, there is a need for the constant manipulation of labour supply to match labour demand. Functional workforce flexibility, where multiskilled staff are able to move from jobs in one department to jobs in another, presents an opportunity for solving part of the problem. Presents an approach to calculating the need for functional flexibility dependent on the identified discrepancies in labour demand and supply. Having identified the size of the need, a strategy needs to be developed for fulfilling that need. In implementing this strategy, two approaches are identified: planned whole job substitution and boundary loosening. While the planned approach offers the rational course for maintaining quality and productivity levels, there is evidence that an evolving approach may help to stabilize a highly volatile situation by breaking down barriers from within.

Communicating with Cancer Patients in Saudi Arabia

Abstract: UNLABELLED The following factors are relevant to the communication problems that exist in this country: 1. CULTURAL ASPECTS The impression is that patients here cope better with terminal illness at home than do patients elsewhere. The extended family, with its strong ties, and the strong Islamic faith that encourages its members to provide for parents and children in case of need mean that any input by health professionals is magnified by the family in the care of the patient. At first, it was uncertain if foreign health professionals would be accepted into Saudi homes (which are intensely private and protected for the family) for the purpose of caring for patients. This has proved unfounded. Hospitality is a very important part of Saudi society; nurses and doctors are welcomed and respected. Much of this success is due to the use of Saudi men as drivers and translators. These people provide 24-hour service, act as social workers assessing the needs of the family, and are the link between the patient and family, the nurse, and the doctor. 2. "CURE" OR "PALLIATION": The emphasis for cancer patients in Saudi Arabia is still on "curative treatment," even after any realistic hope of a cure is gone. The problem this causes is compounded by many patients being excluded from the decision-making process. Decisions made by the family may not always reflect the patient's wishes. Greater communication is needed to guide treatment decisions. 3. TRUTH-TELLING: Denying information of the patient's illness is probably more a historical than a cultural phenomenon. Similar attitudes prevailed until very recently in practically all other countries. In this very conservative country, people are committed to preserving Islamic culture in the face of Western technology. As medicine continues to demonstrate its effectiveness as well as its limitations, people will come to realize that the right of patients to know and understand their illness allows them to cope much better, and is compatible with the responsibility of the family to care for them. 4. WORK FORCE: The government employs 14,500 doctors, but only 12% are Saudi nationals. Nearly all the 33,000 nursing work force are expatriates. There is a constant turnover of expatriate staff. The commitment to continuing care with proper communication that is required for the whole of medicine is likely to be fully realized only when the majority of the workforce are Saudi nationals. 5. PRIMARY, SECONDARY, AND TERTIARY CARE SERVICES: The Kingdom is well served by a system of 174 public hospitals and numerous private clinics. However, for a patient with a chronic or terminal illness, continuing care, even in the community, tends to be provided by the hospital service; whereas the polyclinics and health centers seem to provide mainly crisis management. The aim should be to develop community care for chronic illness as part of the primary health care system. The impact of Western medicine on Saudi society has been dramatic and sudden, as evidenced by the high growth rate of the population. There is now widespread interest in matching the culture to the technology. Much of the drive to change the attitudes of both patients and health professionals comes from young Western-trained Saudi doctors, who are in the best position to merge the strengths of both cultures in this sensitive area.