The success of a health care institution-as defined by delivering high-quality, high-value care, positive patient outcomes, and financial solvency-is inextricably tied to the culture within that organization. The ability to achieve and sustain alignment between its mission, values, and everyday practices defines a positive organizational culture. An institution that has a diminished organizational culture, reflected in the failure to consistently align management and clinical decisions and practices with its mission and values, will struggle. The presence of misalignment or of ethics gaps affects the quality of care being delivered, the morale of the staff, and the organization's image in the community. Transforming an organizational culture will provide a foundation for success and a framework for daily ethics-grounded operations in any organization. However, building an ethics-grounded organization is a challenging process requiring strong organization leadership and planning. Using a case study, the authors provide a multiyear, continuous step-by-step strategy consisting of identifying ethics culture gaps, establishing an ethics taskforce, clarifying and prioritizing the problems, developing strategy for change, implementing the strategy, and evaluating outcomes. This process will assist organizations in aligning its actions with its mission and values, to find success on all fronts.

Water Systems Council (WSC) is a national, non-profit organization providing education and resources to private household well owners. Since 2003, WSC has provided wellcare®, a toll-free telephone hotline to answer questions from the public regarding well stewardship. In order to identify knowledge gaps regarding well stewardship among private well owners, we obtained data from WSC and reviewed calls made during 2013 to wellcare®. WSC records data from each wellcare® call—including caller information, primary reason for call, main use of well water, and if they were calling about a cistern, private well, shared well, or spring. We searched for calls with key words indicating specific contaminants of interest and reviewed primary reasons for calls. Calls classified as primarily testing-related were further categorized depending on whether the caller asked about how to test well water or how to interpret testing results. During 2013, wellcare® received 1100 calls from private well owners who were residents of 48 states. Among these calls, 87 (8%) mentioned radon, 83 (8%) coliforms, 51 (5%) chemicals related to fracking, 34 (3%) arsenic, and 32 (3%) nitrates key words. Only 38% of private well owners reported conducting any well maintenance activities, such as inspecting, cleaning, repairing the well, or testing well water, during the previous 12 months. The primary reason for calls were related to well water testing (n = 403), general information relating to wells (n = 249), contaminants (n = 229), and well water treatment (n = 97). Among calls related to testing, 319 had questions about how to test their well water, and 33 had questions about how to interpret testing results. Calls from private well owners to the wellcare® Hotline during 2013 identified key knowledge gaps regarding well stewardship; well owners are generally not testing or maintaining their wells, have questions about well water testing treatment, and concerns about well water contaminants.

A model is described whose purpose is to predict the distribution of students in different activities and locations during the course of a typical day, depending on the effective restrictions imposed by the spatial distribution of buildings and sites, and by administrative and social constraints on the timing of activities. The model is of an entropy-maximising type; the data against which it is tested are drawn from time budget surveys made in two universities, using diary methods. A series of exploratory experiments made with the model are reported; these are designed to test the effects of alternative planning and administrative policies on activity patterns and the use of facilities.

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