Other Conditions That May Bea Focus of Clinical AttentionThis .docx

Other Conditions That May Be
a Focus of Clinical Attention
This discussion covers other conditions and problems that may
be a focus of clinical
attention or that may otherwise affect the diagnosis, course,
prognosis, or treatment of
a patient’s mental disorder. These conditions are presented with
their corresponding
codes from ICD-9-CM (usually V codes) and ICD-10-CM
(usually Z codes). A condition
or problem in this chapter may be coded if it is a reason for the
current visit or helps to
explain the need for a test, procedure, or treatment. Conditions
and problems in this chapter
may also be included in the medical record as useful
information on circumstances that
may affect the patient’s care, regardless of their relevance to
the current visit.
The conditions and problems listed in this chapter are not
mental disorders. Their inclusion
in DSM-5 is meant to draw attention to the scope of additional
issues that may be
encountered in routine clinical practice and to provide a
systematic listing that may be
useful to clinicians in documenting these issues.
Relational Problems
Key relationships, especially intimate adult partner
relationships and parent/caregiverchild
relationships, have a significant impact on the health of the
individuals in these relationships.
These relationships can be health promoting and protective,
neutral, or detrimental
to health outcomes. In the extreme, these close relationships can

be associated with
maltreatment or neglect, which has significant medical and
psychological consequences
for the affected individual. A relational problem may come to
clinical attention either as
the reason that the individual seeks health care or as a problem
that affects the course,
prognosis, or treatment of the individual’s mental or other
medical disorder.
Problems Related to Family Upbringing
V61.20 (Z62.820) Parent-Child Relational Problem
For this category, the term parent is used to refer to one of the
child’s primary caregivers,
who may be a biological, adoptive, or foster parent or may be
another relative (such as a
grandparent) who fulfills a parental role for the child. This
category should be used when
the main focus of clinical attention is to address the quality of
the parent-child relationship
or when the quality of the parent-child relationship is affecting
the course, prognosis, or
treatment of a mental or other medical disorder. Typically, the
parent-child relational
problem is associated with impaired functioning in behavioral,
cognitive, or affective domains.
Examples of behavioral problems include inadequate parental
control, supervision,
and involvement with the child; parental overprotection;
excessive parental pressure; arguments
that escalate to threats of physical violence; and avoidance
without resolution of
problems. Cognitive problems may include negative attributions
of the other’s intentions,
hostility toward or scapegoating of the other, and unwarranted
feelings of estrangement.

Affective problems may include feelings of sadness, apathy, or
anger about the other individual
in the relationship. Clinicians should take into account the
developmental needs
of the child and the cultural context.
V61.8 (Z62.891) Sibling Relational Problem
This category should be used when the focus of clinical
attention is a pattern of interaction
among siblings that is associated with significant impairment in
individual or family functioning
or with development of symptoms in one or more of the
siblings, or when a sibling relational
problem is affecting the course, prognosis, or treatment of a
sibling’s mental or other medical
disorder. This category can be used for either children or adults
if the focus is on the sibling relationship.
Siblings in this context include full, half-, step-, foster, and
adopted siblings.
V61.8 (Z62.29) Upbringing Away From Parents
This category should be used when the main focus of clinical
attention pertains to issues
regarding a child being raised away from the parents or when
this separate upbringing affects
the course, prognosis, or treatment of a mental or other medical
disorder. The child
could be one who is under state custody and placed in kin care
or foster care. The child
could also be one who is living in a nonparental relative’s
home, or with friends, but whose
out-of-home placement is not mandated or sanctioned by the
courts. Problems related to a
child living in a group home or orphanage are also included.
This category excludes issues
related to V60.6 (Z59.3) children in boarding schools.
V61.29 (Z62.898) Child Affected by Parental Relationship

Distress
This category should be used when the focus of clinical
attention is the negative effects of
parental relationship discord (e.g., high levels of conflict,
distress, or disparagement) on a
child in the family, including effects on the child’s mental or
other medical disorders.
Other Problems Related to Primary Support Group
V61.10 (Z63.0) Relationship Distress With Spouse or Intimate
Partner
This category should be used when the major focus of the
clinical contact is to address the
quality of the intimate (spouse or partner) relationship or when
the quality of that relationship
is affecting the course, prognosis, or treatment of a mental or
other medical disorder.
Partners can be of the same or different genders. Typically, the
relationship distress
is associated with impaired functioning in behavioral, cognitive,
or affective domains. Examples
of behavioral problems include conflict resolution difficulty,
withdrawal, and
overinvolvement. Cognitive problems can manifest as chronic
negative attributions of the
other’s intentions or dismissals of the partner’s positive
behaviors. Affective problems
would include chronic sadness, apathy, and/or anger about the
other partner.
Note: This category excludes clinical encounters for V61.1x
(Z69.1x) mental health services
for spousal or partner abuse problems and V65.49 (Z70.9) sex
counseling.
V61.03 (Z63.5) Disruption of Family by Separation or Divorce
This category should be used when partners in an intimate adult
couple are living apart

due to relationship problems or are in the process of divorce.
V61.8 (Z63.8) High Expressed Emotion Level Within Family
Expressed emotion is a construct used as a qualitative measure
of the “amount” of emotion—
in particular, hostility, emotional overinvolvement, and
criticism directed toward a
family member who is an identified patient—displayed in the
family environment. This
category should be used when a family’s high level of expressed
emotion is the focus of
clinical attention or is affecting the course, prognosis, or
treatment of a family member’s
mental or other medical disorder.
V62.82 (Z63.4) Uncomplicated Bereavement
This category can be used when the focus of clinical attention is
a normal reaction to the
death of a loved one. As part of their reaction to such a loss,
some grieving individuals
present with symptoms characteristic of a major depressive
episode—for example, feelings of sadness and associated
symptoms such as insomnia, poor appetite, and weight
loss. The bereaved individual typically regards the depressed
mood as “normal,” although
the individual may seek professional help for relief of
associated symptoms such
as insomnia or anorexia. The duration and expression of
“normal” bereavement vary considerably
among different cultural groups. Further guidance in
distinguishing grief from
a major depressive episode is provided in the criteria for major
depressive episode.
Abuse and Neglect
Maltreatment by a family member (e.g., caregiver, intimate
adult partner) or by a nonrelative
can be the area of current clinical focus, or such maltreatment

can be an important
factor in the assessment and treatment of patients with mental
or other medical disorders.
Because of the legal implications of abuse and neglect, care
should be used in assessing
these conditions and assigning these codes. Having a past
history of abuse or neglect can
influence diagnosis and treatment response in a number of
mental disorders, and may also
be noted along with the diagnosis.
For the following categories, in addition to listings of the
confirmed or suspected event
of abuse or neglect, other codes are provided for use if the
current clinical encounter is to
provide mental health services to either the victim or the
perpetrator of the abuse or neglect.
A separate code is also provided for designating a past history
of abuse or neglect.
Coding Note for ICD-10-CM Abuse and Neglect Conditions
For T codes only, the 7th character should be coded as follows:
A (initial encounter)—Use while the patient is receiving active
treatment for
the condition (e.g., surgical treatment, emergency department
encounter, evaluation
and treatment by a new clinician); or
D (subsequent encounter)—Use for encounters after the patient
has received
active treatment for the condition and when he or she is
receiving routine care
for the condition during the healing or recovery phase (e.g., cast
change or removal,
removal of external or internal fixation device, medication
adjustment,
other aftercare and follow-up visits).
Child Maltreatment and Neglect Problems

Child Physical Abuse
Child physical abuse is nonaccidental physical injury to a
child—ranging from minor bruises
to severe fractures or death—occurring as a result of punching,
beating, kicking, biting,
shaking, throwing, stabbing, choking, hitting (with a hand,
stick, strap, or other object),
burning, or any other method that is inflicted by a parent,
caregiver, or other individual who
has responsibility for the child. Such injury is considered abuse
regardless of whether the
caregiver intended to hurt the child. Physical discipline, such as
spanking or paddling, is not
considered abuse as long as it is reasonable and causes no
bodily injury to the child.
Child Physical Abuse, Confirmed
995.54 (T74.12XA) Initial encounter
995.54 (T74.12XD) Subsequent encounter
Child Physical Abuse, Suspected
Other Circumstances Related to Child Physical Abuse
V61.21 (Z69.010) Encounter for mental health services for
victim of child abuse by parent
victim of nonparental child
abuse
V15.41 (Z62.810) Personal history (past history) of physical
abuse in childhood
perpetrator of parental child
abuse
perpetrator of nonparental
child abuse

Child Sexual Abuse
Child sexual abuse encompasses any sexual act involving a
child that is intended to provide
sexual gratification to a parent, caregiver, or other individual
who has responsibility
for the child. Sexual abuse includes activities such as fondling a
child’s genitals, penetration,
incest, rape, sodomy, and indecent exposure. Sexual abuse also
includes noncontact
exploitation of a child by a parent or caregiver—for example,
forcing, tricking, enticing,
threatening, or pressuring a child to participate in acts for the
sexual gratification of others,
without direct physical contact between child and abuser.
Child Sexual Abuse, Confirmed
Child Sexual Abuse, Suspected
Other Circumstances Related to Child Sexual Abuse
victim of child sexual abuse
by parent
sexual abuse
V15.41 (Z62.810) Personal history (past history) of sexual
abuse in childhood
sexual abuse
child sexual abuse

Child Neglect
Child neglect is defined as any confirmed or suspected
egregious act or omission by a
child’s parent or other caregiver that deprives the child of basic
age-appropriate needs and
thereby results, or has reasonable potential to result, in physical
or psychological harm to
the child. Child neglect encompasses abandonment; lack of
appropriate supervision; failure
to attend to necessary emotional or psychological needs; and
failure to provide necessary
education, medical care, nourishment, shelter, and/or clothing.
Child Neglect, Confirmed
Child Neglect, Suspected
Other Circumstances Related to Child Neglect
victim of child neglect by
parent
neglect
V15.42 (Z62.812) Personal history (past history) of neglect in
childhood
neglect
child neglect
Child Psychological Abuse

Child psychological abuse is nonaccidental verbal or symbolic
acts by a child’s parent or
caregiver that result, or have reasonable potential to result, in
significant psychological
harm to the child. (Physical and sexual abusive acts are not
included in this category.) Examples
of psychological abuse of a child include berating, disparaging,
or humiliating
the child; threatening the child; harming/abandoning—or
indicating that the alleged
offender will harm/abandon—people or things that the child
cares about; confining the
child (as by tying a child’s arms or legs together or binding a
child to furniture or another
object, or confining a child to a small enclosed area [e.g., a
closet]); egregious scapegoating
of the child; coercing the child to inflict pain on himself or
herself; and disciplining the
child excessively (i.e., at an extremely high frequency or
duration, even if not at a level of
physical abuse) through physical or nonphysical means.
Child Psychological Abuse, Confirmed
Child Psychological Abuse, Suspected
Other Circumstances Related to Child Psychological Abuse
victim of child psychological
abuse by parent
psychological abuse
V15.42 (Z62.811) Personal history (past history) of
psychological abuse in childhood

psychological abuse
child psychological abuse
Adult Maltreatment and Neglect Problems
Spouse or Partner Violence, Physical
This category should be used when nonaccidental acts of
physical force that result, or have
reasonable potential to result, in physical harm to an intimate
partner or that evoke significant
fear in the partner have occurred during the past year.
Nonaccidental acts of physical
force include shoving, slapping, hair pulling, pinching,
restraining, shaking, throwing,
biting, kicking, hitting with the fist or an object, burning,
poisoning, applying force to the
throat, cutting off the air supply, holding the head under water,
and using a weapon. Acts
for the purpose of physically protecting oneself or one’s partner
are excluded.
Spouse or Partner Violence, Physical, Confirmed
Spouse or Partner Violence, Physical, Suspected
Other Circumstances Related to Spouse or Partner Violence,
Physical
V61.11 (Z69.11) Encounter for mental health services for victim
of spouse or partner
violence, physical
V15.41 (Z91.410) Personal history (past history) of spouse or
partner violence, physical

perpetrator of spouse or
partner violence, physical
Spouse or Partner Violence, Sexual
This category should be used when forced or coerced sexual
acts with an intimate partner
have occurred during the past year. Sexual violence may involve
the use of physical force
or psychological coercion to compel the partner to engage in a
sexual act against his or her
will, whether or not the act is completed. Also included in this
category are sexual acts
with an intimate partner who is unable to consent.
Spouse or Partner Violence, Sexual, Confirmed
Spouse or Partner Violence, Sexual, Suspected
Other Circumstances Related to Spouse or Partner Violence,
Sexual
violence, sexual
partner violence, sexual
partner violence, sexual
Spouse or Partner Neglect
Partner neglect is any egregious act or omission in the past year
by one partner that deprives
a dependent partner of basic needs and thereby results, or has
reasonable potential
to result, in physical or psychological harm to the dependent
partner. This category is used

in the context of relationships in which one partner is extremely
dependent on the other
partner for care or for assistance in navigating ordinary daily
activities—for example, a
partner who is incapable of self-care owing to substantial
physical, psychological/intellectual,
or cultural limitations (e.g., inability to communicate with
others and manage everyday
activities due to living in a foreign culture).
Spouse or Partner Neglect, Confirmed
Spouse or Partner Neglect, Suspected
Other Circumstances Related to Spouse or Partner Neglect
neglect
partner neglect
partner neglect
Spouse or Partner Abuse, Psychological
Partner psychological abuse encompasses nonaccidental verbal
or symbolic acts by one
partner that result, or have reasonable potential to result, in
significant harm to the other
partner. This category should be used when such psychological
abuse has occurred during
the past year. Acts of psychological abuse include berating or
humiliating the victim; interrogating
the victim; restricting the victim’s ability to come and go
freely; obstructing the victim’s
access to assistance (e.g., law enforcement; legal, protective, or

medical resources);
threatening the victim with physical harm or sexual assault;
harming, or threatening to
harm, people or things that the victim cares about; unwarranted
restriction of the victim’s access
to or use of economic resources; isolating the victim from
family, friends, or social support
resources; stalking the victim; and trying to make the victim
think that he or she is crazy.
Spouse or Partner Abuse, Psychological, Confirmed
Spouse or Partner Abuse, Psychological, Suspected
Other Circumstances Related to Spouse or Partner Abuse,
Psychological
psychological abuse
partner psychological abuse
perpetrator of spouse or partner
psychological abuse
Adult Abuse by Nonspouse or Nonpartner
These categories should be used when an adult has been abused
by another adult who is
not an intimate partner. Such maltreatment may involve acts of
physical, sexual, or emotional
abuse. Examples of adult abuse include nonaccidental acts of
physical force (e.g.,
pushing/shoving, scratching, slapping, throwing something that
could hurt, punching,
biting) that have resulted—or have reasonable potential to

result—in physical harm or
have caused significant fear; forced or coerced sexual acts; and
verbal or symbolic acts
with the potential to cause psychological harm (e.g., berating or
humiliating the person;
interrogating the person; restricting the person’s ability to come
and go freely; obstructing
the person’s access to assistance; threatening the person;
harming or threatening to harm
people or things that the person cares about; restricting the
person’s access to or use of economic
resources; isolating the person from family, friends, or social
support resources;
stalking the person; trying to make the person think that he or
she is crazy). Acts for the
purpose of physically protecting oneself or the other person are
excluded.
Adult Physical Abuse by Nonspouse or Nonpartner, Confirmed
Adult Physical Abuse by Nonspouse or Nonpartner, Suspected
Adult Sexual Abuse by Nonspouse or Nonpartner, Confirmed
Adult Sexual Abuse by Nonspouse or Nonpartner, Suspected
Adult Psychological Abuse by Nonspouse or Nonpartner,
Confirmed
Adult Psychological Abuse by Nonspouse or Nonpartner,
Suspected

Other Circumstances Related to Adult Abuse by Nonspouse or
Nonpartner
of nonspousal or nonpartner
adult abuse
perpetrator of nonspousal or
nonpartner adult abuse
Educational and Occupational
Problems
Educational Problems
V62.3 (Z55.9) Academic or Educational Problem
This category should be used when an academic or educational
problem is the focus of
clinical attention or has an impact on the individual’s diagnosis,
treatment, or prognosis.
Problems to be considered include illiteracy or low-level
literacy; lack of access to schooling
owing to unavailability or unattainability; problems with
academic performance (e.g.,
failing school examinations, receiving failing marks or grades)
or underachievement (below
what would be expected given the individual’s intellectual
capacity); discord with
teachers, school staff, or other students; and any other problems
related to education and/
or literacy.
Occupational Problems
V62.21 (Z56.82) Problem Related to Current Military
Deployment Status
This category should be used when an occupational problem
directly related to an individual’s

military deployment status is the focus of clinical attention or
has an impact on the
individual’s diagnosis, treatment, or prognosis. Psychological
reactions to deployment are
not included in this category; such reactions would be better
captured as an adjustment
disorder or another mental disorder.
V62.29 (Z56.9) Other Problem Related to Employment
This category should be used when an occupational problem is
the focus of clinical attention
or has an impact on the individual’s treatment or prognosis.
Areas to be considered
include problems with employment or in the work environment,
including unemployment;
recent change of job; threat of job loss; job dissatisfaction;
stressful work schedule;
uncertainty about career choices; sexual harassment on the job;
other discord with boss,
supervisor, co-workers, or others in the work environment;
uncongenial or hostile work
environments; other psychosocial stressors related to work; and
any other problems related
to employment and/or occupation.
Housing and Economic Problems
Housing Problems
V60.0 (Z59.0) Homelessness
This category should be used when lack of a regular dwelling or
living quarters has an impact
on an individual’s treatment or prognosis. An individual is
considered to be homeless
if his or her primary nighttime residence is a homeless shelter, a
warming shelter, a domestic
violence shelter, a public space (e.g., tunnel, transportation
station, mall), a building

not intended for residential use (e.g., abandoned structure,
unused factory), a
cardboard box or cave, or some other ad hoc housing situation.
V60.1 (Z59.1) Inadequate Housing
This category should be used when lack of adequate housing has
an impact on an individual’s
treatment or prognosis. Examples of inadequate housing
conditions include lack of
heat (in cold temperatures) or electricity, infestation by insects
or rodents, inadequate
plumbing and toilet facilities, overcrowding, lack of adequate
sleeping space, and excessive
noise. It is important to consider cultural norms before
assigning this category.
V60.89 (Z59.2) Discord With Neighbor, Lodger, or Landlord
This category should be used when discord with neighbors,
lodgers, or a landlord is a focus
of clinical attention or has an impact on the individual’s
treatment or prognosis.
V60.6 (Z59.3) Problem Related to Living in a Residential
Institution
This category should be used when a problem (or problems)
related to living in a residential
institution is a focus of clinical attention or has an impact on
the individual’s treatment
or prognosis. Psychological reactions to a change in living
situation are not included in this
category; such reactions would be better captured as an
adjustment disorder.
Economic Problems
V60.2 (Z59.4) Lack of Adequate Food or Safe Drinking Water
V60.2 (Z59.5) Extreme Poverty
V60.2 (Z59.6) Low Income
V60.2 (Z59.7) Insufficient Social Insurance or Welfare Support
This category should be used for individuals who meet

eligibility criteria for social or welfare
support but are not receiving such support, who receive support
that is insufficient to
address their needs, or who otherwise lack access to needed
insurance or support programs.
Examples include inability to qualify for welfare support owing
to lack of proper
documentation or evidence of address, inability to obtain
adequate health insurance because
of age or a preexisting condition, and denial of support owing to
excessively stringent
income or other requirements.
V60.9 (Z59.9) Unspecified Housing or Economic Problem
This category should be used when there is a problem related to
housing or economic circumstances
other than as specified above.
Other Problems Related to the Social Environment
V62.89 (Z60.0) Phase of Life Problem
This category should be used when a problem adjusting to a
life-cycle transition (a particular
developmental phase) is the focus of clinical attention or has an
impact on the individual’s
treatment or prognosis. Examples of such transitions include
entering or
completing school, leaving parental control, getting married,
starting a new career, becoming
a parent, adjusting to an “empty nest” after children leave
home, and retiring.
V60.3 (Z60.2) Problem Related to Living Alone
This category should be used when a problem associated with
living alone is the focus of
clinical attention or has an impact on the individual’s treatment
or prognosis. Examples of
such problems include chronic feelings of loneliness, isolation,
and lack of structure in carrying

out activities of daily living (e.g., irregular meal and sleep
schedules, inconsistent
performance of home maintenance chores).
V62.4 (Z60.3) Acculturation Difficulty
This category should be used when difficulty in adjusting to a
new culture (e.g., following
migration) is the focus of clinical attention or has an impact on
the individual’s treatment
or prognosis.
V62.4 (Z60.4) Social Exclusion or Rejection
This category should be used when there is an imbalance of
social power such that there is
recurrent social exclusion or rejection by others. Examples of
social rejection include bullying,
teasing, and intimidation by others; being targeted by others for
verbal abuse and
humiliation; and being purposefully excluded from the activities
of peers, workmates, or
others in one’s social environment.
V62.4 (Z60.5) Target of (Perceived) Adverse Discrimination or
Persecution
This category should be used when there is perceived or
experienced discrimination
against or persecution of the individual based on his or her
membership (or perceived membership) in a specific category.
Typically, such categories include gender or gender
identity, race, ethnicity, religion, sexual orientation, country of
origin, political beliefs, disability
status, caste, social status, weight, and physical appearance.
V62.9 (Z60.9) Unspecified Problem Related to Social
Environment
This category should be used when there is a problem related to
the individual’s social environment
other than as specified above.
Problems Related to Crime or Interaction

With the Legal System
V62.89 (Z65.4) Victim of Crime
V62.5 (Z65.0) Conviction in Civil or Criminal Proceedings
Without Imprisonment
V62.5 (Z65.1) Imprisonment or Other Incarceration
V62.5 (Z65.2) Problems Related to Release From Prison
V62.5 (Z65.3) Problems Related to Other Legal Circumstances
Other Health Service Encounters for
Counseling and Medical Advice
V65.49 (Z70.9) Sex Counseling
This category should be used when the individual seeks
counseling related to sex education,
sexual behavior, sexual orientation, sexual attitudes
(embarrassment, timidity), others’
sexual behavior or orientation (e.g., spouse, partner, child),
sexual enjoyment, or any
other sex-related issue.
V65.40 (Z71.9) Other Counseling or Consultation
This category should be used when counseling is provided or
advice/consultation is
sought for a problem that is not specified above or elsewhere in
this chapter. Examples include
spiritual or religious counseling, dietary counseling, and
counseling on nicotine use.
Problems Related to Other Psychosocial, Personal,
and Environmental Circumstances
V62.89 (Z65.8) Religious or Spiritual Problem
a religious or spiritual
problem. Examples include distressing experiences that involve
loss or questioning of
faith, problems associated with conversion to a new faith, or
questioning of spiritual values
that may not necessarily be related to an organized church or

religious institution.
V61.7 (Z64.0) Problems Related to Unwanted Pregnancy
V61.5 (Z64.1) Problems Related to Multiparity
V62.89 (Z64.4) Discord With Social Service Provider, Including
Probation Officer,
Case Manager, or Social Services Worker
V62.89 (Z65.4) Victim of Terrorism or Torture
V62.22 (Z65.5) Exposure to Disaster, War, or Other Hostilities
V62.89 (Z65.8) Other Problem Related to Psychosocial
Circumstances
V62.9 (Z65.9) Unspecified Problem Related to Unspecified
Psychosocial Circumstances
Other Circumstances of Personal History
V15.49 (Z91.49) Other Personal History of Psychological
Trauma
V15.59 (Z91.5) Personal History of Self-Harm
V62.22 (Z91.82) Personal History of Military Deployment
V15.89 (Z91.89) Other Personal Risk Factors
V69.9 (Z72.9) Problem Related to Lifestyle
This category should be used when a lifestyle problem is a
specific focus of treatment or directly
affects the course, prognosis, or treatment of a mental or other
medical disorder. Examples
of lifestyle problems include lack of physical exercise,
inappropriate diet, high-risk
sexual behavior, and poor sleep hygiene. A problem that is
attributable to a symptom of a
mental disorder should not be coded unless that problem is a
specific focus of treatment or
directly affects the course, prognosis, or treatment of the
individual. In such cases, both the
mental disorder and the lifestyle problem should be coded.
V71.01 (Z72.811) Adult Antisocial Behavior
adult antisocial behavior
that is not due to a mental disorder (e.g., conduct disorder,

antisocial personality disorder).
Examples include the behavior of some professional thieves,
racketeers, or dealers in
illegal substances.
V71.02 (Z72.810) Child or Adolescent Antisocial Behavior
antisocial behavior in a
child or adolescent that is not due to a mental disorder (e.g.,
intermittent explosive disorder,
conduct disorder). Examples include isolated antisocial acts by
children or adolescents
(not a pattern of antisocial behavior).
Problems Related to Access to Medical
and Other Health Care
V63.9 (Z75.3) Unavailability or Inaccessibility of Health Care
Facilities
V63.8 (Z75.4) Unavailability or Inaccessibility of Other
Helping Agencies
Nonadherence to Medical Treatment
V15.81 (Z91.19) Nonadherence to Medical Treatment
nonadherence to an important
aspect of treatment for a mental disorder or another medical
condition. Reasons
for such nonadherence may include discomfort resulting from
treatment (e.g., medication
side effects), expense of treatment, personal value judgments or
religious or cultural beliefs
about the proposed treatment, age-related debility, and the
presence of a mental disorder
(e.g., schizophrenia, personality disorder). This category should
be used only when
the problem is sufficiently severe to warrant independent
clinical attention and does not

meet diagnostic criteria for psychological factors affecting other
medical conditions.
278.00 (E66.9) Overweight or Obesity
This category may be used when overweight or obesity is a
focus of clinical attention.
V65.2 (Z76.5) Malingering
The essential feature of malingering is the intentional
production of false or grossly exaggerated
physical or psychological symptoms, motivated by external
incentives such as
avoiding military duty, avoiding work, obtaining financial
compensation, evading criminal
prosecution, or obtaining drugs. Under some circumstances,
malingering may represent adaptive behavior—for example,
feigning illness while a captive of the enemy during
wartime. Malingering should be strongly suspected if any
combination of the following is
noted:
1. Medicolegal context of presentation (e.g., the individual is
referred by an attorney to
the clinician for examination, or the individual self-refers while
litigation or criminal
charges are pending).
2. Marked discrepancy between the individual’s claimed stress
or disability and the objective
findings and observations.
3. Lack of cooperation during the diagnostic evaluation and in
complying with the prescribed
treatment regimen.
4. The presence of antisocial personality disorder.
Malingering differs from factitious disorder in that the
motivation for the symptom
production in malingering is an external incentive, whereas in
factitious disorder external
incentives are absent. Malingering is differentiated from
conversion disorder and somatic

symptom–related mental disorders by the intentional production
of symptoms and by the
obvious external incentives associated with it. Definite evidence
of feigning (such as clear
evidence that loss of function is present during the examination
but not at home) would
suggest a diagnosis of factitious disorder if the individual’s
apparent aim is to assume the
sick role, or malingering if it is to obtain an incentive, such as
money.
V40.31 (Z91.83) Wandering Associated With a Mental Disorder
This category is used for individuals with a mental disorder
whose desire to walk about
leads to significant clinical management or safety concerns. For
example, individuals with
major neurocognitive or neurodevelopmental disorders may
experience a restless urge to
wander that places them at risk for falls and causes them to
leave supervised settings without
needed accompaniment. This category excludes individuals
whose intent is to escape
an unwanted housing situation (e.g., children who are running
away from home, patients
who no longer wish to remain in the hospital) or those who walk
or pace as a result of medication-
induced akathisia.
Coding note: First code associated mental disorder (e.g., major
neurocognitive disorder,
autism spectrum disorder), then code V40.31 (Z91.83)
wandering associated with
[specific mental disorder].
V62.89 (R41.83) Borderline Intellectual Functioning
This category can be used when an individual’s borderline
intellectual functioning is the focus
of clinical attention or has an impact on the individual’s
treatment or prognosis. Differentiating

borderline intellectual functioning and mild intellectual
disability (intellectual
developmental disorder) requires careful assessment of
intellectual and adaptive functions
and their discrepancies, particularly in the presence of co-
occurring mental disorders that
may affect patient compliance with standardized testing
procedures (e.g., schizophrenia or
attention-deficit/hyperactivity disorder with severe
impulsivity).
"Hard" Measures that Support the Business Case
for Diversity: A Balanced Scorecard Approach
Stephen B. Knouse, PhD, and James B. Stewart, PhD
The Diversity Factor © 2003
ISSN 1545-2808
Fall 2003
Overcoming Barriers to Opportunity
Volume 11, Number 4
Employee diversity is touted by consultants and university
experts as an
important factor in the organizational mix. Not only is diversity
ethically
and legally (EEOC and Affirmative Action compliance) the
right thing to
do, it is considered good for business.1 Many measures of
diversity's
effectiveness in organizations have been self-reports —
perceptions of
personal satisfaction and organizational climate taken from
organizational

surveys. Such "soft" measures of effectiveness have been
downplayed by
managers who want "hard" data on how diversity is working.
They want
to see an increase in market share, improvement in quality,
fewer errors,
decrease in costs and, most importantly, better performance on
the
"bottom line" of financial reports. In this article we focus on the
"hard"
measures that support and reinforce the business case for
diversity, and
we examine the innovative measures of several well-known
companies.
The Business Case for Diversity
In recent years ample theoretical work has emerged about why
diversity
should work. Taylor Cox nicely encapsulates this work in five
basic
arguments for the business case:
organizations want to attract
and retain the best available
talent; diversity helps by
creating a larger talent pool,
which makes firms more
competitive.
diversity enhances marketing
efforts; a diverse workforce
better serves a diverse customer
base, offers better insights into
customer needs and markets
can be segmented along
diversity group lines.
better creativity in organizational

processes: a diverse workforce
possesses more innovative ideas, creative
approaches and diverse strategies for dealing
with organizational issues.
the need for improved problem solving: a diverse workforce
offers new solutions,
expanded critical analysis and higher quality decisions.
the need for a diverse workforce creates organizational
flexibility; less tradition-bound
and more divergent thinking (looking at problems from different
angles). Moreover,
accommodating diversity makes the organization more
adaptable to other organizational
issues.2
These arguments sound convincing; they make sense. But again
where is the hard evidence
Stephen B. Knouse is
the Alvin & Patricia
Smith Professor and
Head of the
Department of
Management at the B.
I. Moody III College
of Business
Administration at the
University of Louisiana
at Lafayette.
James B. Stewart is
Professor of Labor

Studies and Industrial
Relations, and of
African and African
American Studies, at
The Pennsylvania
State University.
"Many of the measures of
the effectiveness of
diversity in organizations
have been self-reports —
perceptions of personal
satisfaction and
organizational climate
taken from organizational
surveys. Such "soft"
measures of effectiveness
have been downplayed by
managers who want "hard"
data on how diversity is
working."
5
that diversity works? We present here several examples of such
"hard data" by using a
Balanced Scorecard framework.
Measures of Effectiveness with the Balanced Scorecard
Approach
The Balanced Scorecard offers a means of categorizing various
organizational performance
indicators. Four basic categories of performance form the basis

of the Scorecard:
Financial performance shows bottom-line activity —
profitability, return on
investment, economic value added and sales growth.
The customer includes measures of the organization’s effect on
its customers —
customer satisfaction, customer retention, acquisition of new
customers and market
share of targeted market segments.
Internal business process covers quality, response time, cost and
new product
development.
Learning and growth examines long-term growth and
improvement through
employee self-improvement and technological advancement.
Beyond merely a means of categorizing measures of
organizational effectiveness, the Balanced Scorecard
links organizational structure, processes and results
through strategy.3 By setting basic business goals
which drive the creation of business structures and
processes to meet these goals, the Scorecard sets
performance measures that track how well the goals
are being met.
Originally, the Business Scorecard was created to link
strategy and performance. As a strategy-based framework, it is
readily adaptable to diversity
management. Indeed, recent research shows that the
effectiveness of diversity programs
depends on the strategic approach of the organization.4
Diversity can enhance proactive
strategies, such as growth and innovation, by using creative
problem solving.5

Table 1 summarizes a number of hard measures of diversity
effectiveness using a Balanced
Scorecard approach. Within the first Scorecard category of
Financial is return on diversity.
Basically, this is an indicator of how the costs of diversity (the
amounts invested in diversity
initiatives) relate to increases in revenue due to these
initiatives. Ford Motor Company has a
unique variation on return on diversity. During an economic
downturn, Ford wanted to increase
sales by using its diversity connections. As do many companies,
Ford has a large employee
resource network composed of 11 employee resource groups.
These groups support the effort
by calling upon their external connections in the community
who can influence the purchasing
of Ford products. In this case, the incentive was an invoice
rebate they could use with the Ford
dealer. In the African American group alone sales increased $50
million.6
The Customer category focuses upon diversity market segments.
Olive Garden wanted to
increase its presence in Latino markets by changing its
advertising slogan from "When you’re
here, you’re family" to "Aquí estas en casa" ("Here you are at
home") in the Spanish language
media. The original family slogan was judged to be too personal
for many Latinos with strong
extended family ties. Tests of the ad showed an increase of
brand recognition and favorability
of 15-20% among Latinos. These ads will be directed to Latino
markets in Dallas, Houston,
Phoenix, Los Angeles, Orlando and Chicago.7
Another section of the Customer category involves market share

of customer market segments.
As part of its strategy, Xerox uses its employee resource groups
to cultivate new business
through adapting current products and creating new products to
serve its diversity market
segments. Xerox tracks how its share of diversity markets
grows.8
"Beyond merely a means of
categorizing measures of
organizational
effectiveness, the Balanced
Scorecard links
organizational structure,
processes and results
through strategy."
6
TABLE 1
A Balanced Scorecard Framework of Hard Measures of
Diversity Effectiveness
Scorecard
Category
Hard Measure of
Diversity
Effectiveness
Examples of the Measure
Companies Using
Each Measure

Financial Return on diversity
Increase in sales due to diversity/
investment in diversity initiative
Ford
Customer
Brand Favorability
Increase in rated brand favorability
due to advertising focused on
diversity group
Olive Garden
Diversity of
Customer Base
Percent of diversity groups in
customer base
Xerox
Internal
Business
Process
Benchmarked as
Best Business
Practice
Number of other companies that
benchmark a process like
mentoring as a best practice
DuPont

Representation of
Diversity
- Percentage of diversity groups
hired
- Percentage of diversity groups in
different career tracks
- Percentage of diversity groups in
levels of the organizational
hierarchy
- Percentage of promotions to
diversity group members
- Turnover rate of diversity groups
- Numbers of diversity members in
middle management
Xerox
Citigroup
Targeted Recruiting
- Percentage of minority hires from
targeted recruiting programs
- Expenditures to targeted schools
IBM
Motorola
Workforce
Competency
Training and development
costs/diversity group members
Proctor & Gamble

Hours of developmental planning
per employee
Eastman Kodak
Diversity Training
Percentage of employees
participating in diversity training
programs
Pricewaterhouse
Coopers
Work Life Programs
Percentage of participation of
diversity groups
IBM
Alternative Dispute
Resolution Programs
Reduction in discrimination and
harassment complaints and
litigation
IBM
Supplier Diversity
- Total spent on diversity suppliers
- Percentage of total procurement
spent on diversity suppliers
- Number of 2nd tier diversity
suppliers

Ford
Awards for Diversity
- Awards from local and national
diversity associations
- Media ranks on diversity efforts
- Diversity awards transmitted over
internal media
Xerox
Motorola
7
In the Internal Business Process category, companies can
measure progress in many ways,
from benchmarking to representation to supplier diversity.
DuPont, for example, keeps a count
of how many companies (over 200 to date) benchmark its best
practices of mentoring for
women and minorities (DuPont has over 30 different mentoring
programs).9 Many companies
have as a strategic goal that the diversity of their workforce
mirrors the diversity of their
customer base. There are several direct measures of meeting
this goal: percentage of women
and minorities hired; percentage of these groups in different
career tracks; percentage of these
groups in all levels of the organizational hierarchy (from janitor
to the board of directors); and
promotion and turnover rates of these groups. Xerox has a
Management Resources Planning
Program where the number of women and minorities in middle-

level management throughout
the company is tallied and recommendations are made for their
next career move.10
IBM maintains Project View, a diversity recruiting program that
includes networking, a career
fair and interviews. This program provides 55 percent of
minority hires at IBM. Motorola
actively recruits minority engineers at Hampton University. To
emphasize its presence, it
supplies money, equipment, faculty training and faculty summer
work with the company.11
Proctor & Gamble tracks its training and development
costs by diversity group, while Eastman Kodak
requires that each employee receive at least 40 hours
per year in career developmental planning. A policy
committee monitors this time.
PricewaterhouseCoopers looks at the percentage of
all employees participating in its diversity training
programs: Improving Communications and
Relationship-building, Gender Awareness and Valuing
Diversity. IBM gathers data on the percentage of
participation of diversity groups in its Work Life
Programs, such as child care and elder care resource
referral, flexible working schedules and personal
choice holidays. In addition, IBM emphasizes
alternative dispute resolution programs in order to reduce the
number of discrimination and
harassment complaints and the lengthy and costly litigation that
can accrue from unresolved
problems. Specifically, IBM has a Panel Review Program
consisting of three employees and two
managers who decide appeals on company policies and
procedures. The Speak Up Program
allows an employee to anonymously bring up concerns or report

seemingly unlawful
activities.12
Many companies also have a diversity supplier program, where
vendors with at least 51
percent ownership by women or minorities are encouraged to
bid for company business. These
companies track the total amount spent on diversity suppliers,
as well as the percentage of the
total procurement budget that is spent on diversity suppliers.
For example, in 2002, Ford spent
over $3 billion on procurement from diversity suppliers. In
addition, it helped start-up diversity
suppliers to meet their specific needs.13
Learning and
Growth
Partnering with
Diversity Groups
- Number of partnerships with
community diversity groups
- Number of partnerships with
national diversity professional
organizations
Pricewaterhouse
Coopers
Survey Feedback
Surveys on results of diversity
determine percentage of
managers’ performance evaluation
American Express

Tuition Aid
Expenditures/diversity group
members
AOL Time Warner
"As part of its strategy,
Xerox uses its employee
resource groups to
cultivate new business
through adapting current
products and creating new
products to serve its
diversity market segments.
Xerox tracks how its share
of diversity markets
grows."
8
The final Scorecard category is Learning and Growth. One
indicator of how diversity affects the
growth of the organization is measured by its ability to attract
talented, diverse employees.
Many companies pursue the public relations value of winning
diversity awards, which are
handed out by local and national diversity group organizations.
In addition, several diversity-
oriented magazines rank companies on their diversity
initiatives. For example, Xerox is rated in
the top ten companies for diversity hiring by Fortune, Forbes,
Working Mother, Latino Style and
Enable Magazines.14 Motorola touts its diversity, EEO and AA

awards to employees through
company print media and videos.15
Many firms also partner with local and national diversity group
professional organizations. They
use these relationships both to maintain visibility and to recruit
professional specialists from
these groups. PricewaterhouseCoopers strengthens its link to
minority accountants by
partnering with minority professional organizations, such as the
National Association of Black
Accountants and the Association of Latino Professionals in
Finance and Accounting.16
With regard to Learning, some "soft" measures suddenly
become significant when used as a
measure of performance in a performance appraisal. For
example, at American Express 12.5
percent of managers’ performance evaluation is based on
diversity results from its annual
employee survey.17 This feedback offers important lessons for
managerial improvement.
Other companies, such as AOL Time Warner, measure more
formal learning. AOL Time Warner
provides up to 100 percent tuition reimbursement to all
employees wishing to pursue formal
education and tracks the tuition expenditures for diversity group
members.18
Conclusion
A number of companies are using a wide range of finance,
customer, process and employee
measures that yield hard data on the effectiveness of their
diversity initiatives. Indeed, these
companies must be experiencing direct payoffs from their

investments in diversity, because
during the recent economic downturn many diversity programs
remained intact or even saw an
increase in funding, while many other company programs were
cut.19
The Balanced Scorecard approach offers a number of
important variables, measures and examples of hard
data that can prove the value of diversity programs
and initiatives. More categories and measures can
and should be developed. In the Financial area, sales
growth for new diversity group customers could be
measured. In the Customer category, the number of
new customers from diversity groups and the number
of diversity group customers who stay with a product
(a variation on brand loyalty) could also yield
valuable data. Internal Business Processes could
include the number of new products and services
developed for diversity group customers. In addition,
a measure of Internal Process could be the number
of problems resolved, the number of ideas for
improvement and the number of ideas for cost containment, all
submitted by teams with
diverse members. Finally, in the Learning and Growth area, new
measures could involve the
self-improvement efforts of members of diversity groups — the
number of new skills acquired
by diversity group employees, the number of internal courses
and workshops completed by
diversity group employees, and the number of external courses,
specialist certificates and even
college degrees completed by diversity group employees.
The business case for diversity proposes that employee diversity
improves business
performance. To prove this, companies need to go beyond soft

self-report indicators and focus
on the hard, performance-related measures. A number of
companies are already using such
measures, however, we must continue to look for new measures
that quantify the value of
"With regard to Learning,
some "soft" measures
suddenly become
significant when used as a
measure of performance in
a performance appraisal.
For example, at American
Express 12.5 percent of
managers’ performance
evaluation is based on
diversity results from its
annual employee survey."
9
diversity initiatives.
Endnotes
1. F. Crosby and A. Konrad, "Affirmative Action in
Employment," The Diversity Factor, Vol. 10, No. 2 (Winter
2002), pp. 5-9.
2. T. Cox, Diversity in Organizations: Theory, Research,
Practice (San Francisco: Berret-Koehler, 1994).
3. R. S. Kaplan and D. P. Norton, The Balanced Scorecard:
Translating Strategy into Action, Boston: Harvard Business
School
Press.
4. O. Richard, "Racial Diversity, Business Strategy, and Firm

Performance: A Resource-based View," Academy of
Management
Journal, Vol. 43 (2000), pp. 164-177; O. Richard, A. McMillan,
K. Chadwick, and S. Dwyer, "Employing an Innovation Strategy
in Racially Diverse Workforces: Effects on Firm Performance,"
Group and Organization Management, Vol. 28 (2003), pp. 107-
126.
5. T. Cox (1994).
6. Y. Cole, "Top Companies for Diversity," DiversityInc, Vol.
2, No. 3 (2003a), pp. 30-65.
7. Ibid
8. Xerox. Diversity: Making all the Difference. Retrieved June
4, 2003 from http://www.xerox.com.
9. DuPont. People Diversity. Retrieved June 4, 2003 from
http://www.peoplediveristy.dupont.com.
10. EEOC. Best Practices of Private Sector Employers.
Retrieved July 8, 2003 from www.eeoc.gov/task/practice.html
11. Ibid
12. Ibid
13. Ford Motor Company. Model D: At Ford Motor Company,
Diversity is the Model Way to Grow). Retrieved June 4, 2003
from http://www.dd.ford.com.
14. Xerox (2003).
15. EEOC.
16. Y. Cole (2003a).
17. W. Conklin, "Conversations with Diversity Executives," The
Diversity Factor, Vol. 10, No. 1 (2001), pp. 5-14.
18. EEOC.
19. Y. Cole, "The Winning Strategies: Why Diversity Initiatives
Thrive in a Downturn," DiversityInc, Vol. 2, No. 1 (2003b), pp.
35-50.
Published by Elsie Y. Cross & Associates, Inc.
Developed by Rutgers University - Division of Continuous
Education and Outreach
© 2003 The Diversity Factor.

10
Copyright of Diversity Factor is the property of Diversity
Factor and its content may not be copied or emailed
to multiple sites or posted to a listserv without the copyright
holder's express written permission. However,
users may print, download, or email articles for individual use.
Marketing and Management of Innovations ISSN 2227-6718
(on-line)
Issue 1, 2020 ISSN 2218-4511 (print)
Cite as: Elmortada, A., Mokhlis, C.-E., Mokhlis, A. & Elfezazi,
S. (2020). Innovations in HR Management: a Content
Analysis Approach. Marketing and Management of Innovations,
1, 182-191.
http://doi.org/10.21272/mmi.2020.1-14
182

http://doi.org/10.21272/mmi.2020.1-14 JEL Classification:
J24, J53, M10, M12
Asmaa Elmortada,
Ph.D., Cadi Ayad University, Morocco
Chams-Eddoha Mokhlis,
Ph.D., Professor, Hassan II University, Morocco
Ahmed Mokhlis,
Ph.D., Professor, Cadi Ayad University Morocco
Said Elfezazi,
Ph.D., Professor, Cadi Ayad University, Morocco
INNOVATIONS IN HR MANAGEMENT: A CONTENT
ANALYSIS APPROACH
Abstract. One of the objectives of human resource management
(HRM) is to promote the satisfaction of both
managers and employees regarding HRM practices. Since
promoting satisfaction begins by assessing its current
level, this study aims to analyse the challenges faced by
industrial companies' managers within developing countries
– such as Morocco- in terms of implementing human resource
(HR) function practices. This paper presents then a
practice-oriented study conducted using a qualitative method
based on the content analysis approach. Thus, data
collection was based mainly on semi-structured interviews to
which 30 managers had participated. Indeed, this study
aims to measure managers' satisfaction regarding the HR

function while highlighting, at the same time, the practices
used in motivation, documentation process, etc., and in terms of
locating weaknesses and obstacles to better HRM .
The validity of inquiry was tested and proven by two validation
strategies: member checking and external audits
strategies. The results found, revealed genuinely remarkable
weaknesses. Indeed, it turned out to be a lack consistent
in terms of the proper structuring of the HR function. In
addition to the poor mastery and application of basic HRM
practices, namely the primitivity of documentation processes,
and the job-person inadequacy, especially in the scarcity
of adoption of developed management methods such as the
implementation of provisional management of jobs and
skills, the establishment of an occupational health system, and
maturity in terms of carrying out the tasks of the control
system, or even as regards the weaknesses linked to the lack of
active communication, to the clarity of the objectives
targeted for all the members, and to the sharing of private
information, in addition to those arising from the irrelevance
of the training received by the staff. As for proposing solutions,
the integration of IT tools could improve the
performance of HR management processes. Indeed, information
systems promote active communication, different
storage data that develop the quality of the decision. They also
facilitate managing administrative issues,
communicating and applying procedures, programming relevant
training and motivating employees. The study has
important implications for HR professionals and strategic
leaders that are especially interested in developing countries.
Keywords: human resources management, HR function, content
analysis, industrial companies, Morocco, job
satisfaction, the performance of HR function, IT tools
integration, information systems, knowledge-based systems,
human-computer interaction.

Introduction. Since old times; for spiritual, materialistic,
philosophical or purely scientific reasons.
Satisfaction has been the goal sought by everyone. Today, in the
middle of an economic environment
increasingly complex and competitive, satisfaction is a concept
even more related to the discipline of
human resource management (HRM), particularly within
industrial enterprises. Indeed, people (managers,
employees, or State officials) always talk about staff
satisfaction effect on a company's performance and
thus on the country's prosperity. This belief stems from the
growing demand for work quality in today
developed world, especially with researches and studies
confirming the close link between the
psychological side and one's performance (Wang et al., 2014).
When an employee looks for satisfaction
in terms of working conditions, salary, leadership. HR manager
seeks both, minimizing problems that
negatively affect business activity such as absenteeism,
training, turnover and creating a likely
environment to promote employees profitability because «an
essential element of the organizations is
based on the willingness of people to contribute their efforts in
a cooperative system ...» Chester
Barnard (1938). Convinced that any work, including HRM,
cannot lead to best results without the
http://doi.org/10.21272/mmi.2020.1-14
http://doi.org/10.21272/mmi.2020.1-11
A. Elmortada, C.-E. Mokhlis, A. Mokhlis, S. Elfezazi.
Innovations in HR Management: a Content Analysis Approach

Marketing and Management of Innovations, 2020, Issue 1 183
http://mmi.fem.sumdu.edu.ua/en
integration of all its stakeholders, it is better to deal the current
situation by starting with practitioner’s
opinion because this «may help HR departments to be even
more effective in their business!» as stated
Louarn & Wils (2001). Consequently, this research is a
practice-oriented study that aims to reveal
challenges faced by HR managers within developing countries
through studying the Moroccan context. In
order to address managers' satisfaction in-depth, a qualitative
research method (Content analysis method)
was used because it allows better «understanding the meaning
of decisions and behaviours (Usunier,
1993). It is contextual, powerful and robust (Wacheux, 1996)».
Literature Review. Inspired by the concept of «internal
customer» developed by Berry (1981),
managers and decision-makers have also been considered as
internal customers that the company must
take care to satisfy so that they can deliver better service.
(Heskett et al., 1994), primarily that the
performance of the target company through employee
satisfaction can only be evaluated by revealing the
judgment of managers before it is reflected as a quantified
economic return.
Within the framework of this ultimate vision, several
researchers were interested in the satisfaction of
decision-makers regarding management control. Laitinen
(2004), for example, stated that the quality of
management control must be strictly linked to the satisfaction of
managers. Thus, meeting the information

needs of managers influences positively the relevance of their
decisions. The relational side between
managers and employees was, of course, also developed. In the
context of this, Purcell et al. (2003)
reported that managers’ behaviour strongly influences employee
attitudes: «it is also one of the most
important factors in developing organizational commitment».
Interested in the same theme, Mellahi &
Wood (2003) insisted on respecting some ethics within the
company that promote employee satisfaction,
his performance (Edmans, 2011), his efficiency within his teams
(Derue et al., 2010), or his influence on
the team itself (Hackman, 2012). So in this philosophy, « HRM
in the structure/systems perspective
promotes employee participation and informed choice by staff,
with open channels of communication to
management aimed at building employee trust and commitment»
as «[it will] help line managers carry out
their HR/people management and development activities
effectively, and support line managers in getting
the most out of the people resources» (Farnham, 2010).
Whether for managers or employees, in the last decade, the
concept of «job satisfaction» has started
to take a multidimensional approach. Indeed, Mignonac et al.
(2004) are convinced that job satisfaction is
a construct based on an affective component (which takes into
account the subject motivations), a conative
component (linked to the subject's behaviour, it reveals his
passage to action) and a cognitive component
(relating to the mechanisms of thought, beliefs and knowledge
of the subject). Based on the latter's work,
Meyssonnier and Roger (2006) believe that job satisfaction can
be treated according to three approaches:
as a dynamic, as an assessment, and as an emotional state.
Within the framework of this, the thoughts of

Meyssonnier and Roger come in perfect adequacy with Igalens
(1999) when he defines job satisfaction
as being a positive emotional response resulting from the
evaluation of work or work experience.
Satisfaction is a dynamic concept. It is an unstable perception
which evolves according to experiences but
also according to the expectations of the employee, which can
change throughout his life. (Igalens, 1999)
This definition remains close to that given by IGLESIAS et al.,
(2010) who also took over the work of
Mignonac (2004). Patterson et al. (2010) have a similar idea.
Indeed, they consider job satisfaction as an
interaction between cognition and affect (or reflection and
feelings), which can be studied concerning
several dimensions, namely pay, co-workers, hierarchy and
depending on the job itself. Iglesias et al.,
(2010) also underlined the existence of links that the job
satisfaction can have with other concepts of HRM,
in particular with organizational involvement, where the
employee is subject to the effect of the
organizational commitment (his level of loyalty to the entire
organization) instead of being affected only by
his positive feeling (satisfaction) towards his job (Price, 2001).
Although it has been the subject of more
than 10,000 studies carried out since the 1930s (IGLESIAS et
al., 2010), job satisfaction remains a source
of much research and discussion. Indeed, nowadays, one
distinguishes more its relation with the
184 Marketing and Management of Innovations, 2020, Issue 1

performance of the employee Edmans (2011), the effectiveness
of this one within the team (Derue et al.,
2010), or still its influence on the efficiency of the entire team
(Hackman, 2012).
Methodology and Research Methods. According to Dul and Hak
(2007), studies can be classified
into two categories: Theory-oriented studies that aim to
contribute to theory development, and practice-
oriented studies that aim to develop knowledge about the
improvement of practices. Descriptive practice-
oriented research is conducted when it is not necessary to find
and test a hypothesis. However, if the
practitioner needs knowledge, hypothesis-building practice-
oriented research should be performed while
hypothesis-testing practice-oriented research is carried out
when a hypothesis is available, but it should
be tested. This study is a practice-oriented study that aims to
present useful information that can be applied
to improvement projects. Since this research undertakes to
describe and interpret managers' opinions
regarding HR function, it is a descriptive study. As
recommended by Creswell (2007) to build validity in
qualitative researches, there were adopted two of his
recommended validation strategies: member
checking and external audits strategies. In the member checking
strategy, the researcher solicits
participants to give their opinions regarding the credibility of
research findings and interpretations. This
technique is considered as being the essential method to ensure
research validity. It was adopted by a
large number of researchers (Ely et al., 1991; Glesne et al.,
1992; Lincoln et al., 1985; Sharan, 1998; Miles

et al., 1984; Jamshidian et al., 2016). In the external audit
method, an external consultant or auditor is
asked to examine findings, interpretations and conclusions. This
auditor should have no connection to the
study. This method was also widely used by several researchers
(Lincoln et al., 1985; Sharan, 1998; Miles
et al., 1984; Jamshidian et al., 2016). In the present inquiry, a
private HR consultant and two HR experts
admitted the credibility research outcomes. They even
recommend for us to check matching findings in
other researches that some of them were advocated in the
discussion session.
As part of the investigation, the Chamber of Commerce and
Industry was visited, which allowed us to
have a database containing details of several leaders. We also
visited some centres of national unions
and managers' associations, in addition to personal contacts.
Thus, setting appointments was generally
made by phone or by mail, according to the available
coordinates. Respondents were selected using a
reasonable choice sampling (Thietart, 2003), mainly based on
their job title (A Senior Management
Member). These respondents were asked to recommend us to
other respondents according to the
principle of the snowball sampling method. The snowball
sampling involves asking interviewees to propose
us, other people, that fit the profile required for the
investigation, according to the chosen criteria of
selection, and that it would be possible to interview. Despite the
difficulties encountered to reach
interviewees – with specific profiles (General Directors, HR
Directors, ...) – that would accept to participate
in the survey, it was not tried to have as participants as possible
only. However, it has also ensured that
the sample is determined following the principle of theoretical

saturation (Thietart, 2003) where the sample
size is considered optimal when the study stops raising new
elements.
Thus, a total of 30 persons with various backgrounds
participated in this study. Table 1 describes the
characteristics of the participants in this survey. It constitutes a
total of 499 years of vocational experience
of highly educated participants that 63% of them are working in
very large and subsidiaries of multinational
companies. It is a sample of experts and practitioners of HR
management.
Talking about interviewing and data analysis procedure, this
study uses semi-structured interviews. It
is a type of interviews that ensures reliability and high
precision, as it allows a better structuring of the
debate, especially in the presence of several articles to cover.
The interviews lasted 75 minutes on average. Interviews were
passed in different ways. Some of them
took places in the company's offices, quietly, ensuring both the
smooth running of discussions and subject
confidentiality.

Table 1. Sample characteristics
N° Sex Position Education
Experience
(years)
Company
size
Activity
P1 M Engineer Industrial Engineering 10 VLC Agribusiness
P2 M Director Industrial Engineering 22 SMC
Building /
Construction
P3 M Director Master’s degree 35
VSC
(subsidiary)
Mining
P4 M
Personnel department
manager
Bachelor’s degree
(Bac+3)
12 MC
Building /
Construction

P5 F
Administrative
Executive
Bac+4 23 MC Agribusiness
P6 F HR Assistant Manager Master’s degree 15 VLC Energetics
P7 M Logistics Manager Ph.D. 14 VLC Metalurgy
P8 M Production Supervisor Engineer 4 SMC Automotive
P9 M HR Director Ph.D. 20 VLC Textile
P10 F Quality manager Bac+4 12 VLC Agribusiness
P11 F Entrepreneur Bac+2 10 SC Textile
P12 M
Maintenance
Supervisor
Engineer 4 SMC
Building /
Construction
P13 M Sales manager Master’s degree 29 VLC Agribusiness
P14 M Leader Bac+4 32 SMC Mining
P15 M Engineer Engineering 2 SC (subsidiary)
Building /
Construction
P16 M Electrical engineer Engineering 2 VLC Energetics
P17 M Head of production Engineering 1 SMC Sanitary

products
P18 M Entrepreneur Skills training 37 MC Agribusiness
P19 F
Assistant
HR Manager
Bac+4 30 LC Energetics
P20 M technical Manager Engineering 10 SMC
Building /
Construction
P21 M Maintenance Manager Engineering 1 MC Agribusiness
P22 M Entrepreneur Skills training 25 VSC Agribusiness
P23 M HR Manager IBM Master 34 SMC Mining
P24 M HR Director Ph.D. 30 SMC Automotive
P25 M
Head of Power
department
Engineering 30 VLC Mining
P26 M Technical Engineer Engineering 6 VLC
Building /
Construction
P27 M QHSE Manager Master’s degree 3 MC Agribusiness
P28 M HR Manager Master’s degree 27 VLC Mining

P29 F Sales manager Master’s degree 9 LC Automotive
P30 F Assistant HR Manager Master’s degree 10 SMC
Building /
Construction
Note: * VSC: Very small company: 1-10 employees; * SC:
Small company: 10-49 employees; * MC:
Medium company: 50 – 499 employees; * LC: Large company:
500-999 employees; * VLC: Very large
company: more than 1000 employee; * SMC: Subsidiary of a
multinational company
Sources: developed by the author.
Other interviews were conducted based on telephone
conversations or correspondences by e-mail in
case the interviewee was not available to meet. In order to
analyse qualitative data, a content analysis
was adopted, whose purpose is «to provide knowledge and
understanding regarding the phenomenon»
(Downe-Wamboldt, 1992). The content analysis used combines
categorical and evaluative analysis

(Bardin, 1989). Indeed, when the categorical analysis fixes
entities based on the frequency of themes'
appearance, the purpose of the evaluative analysis is to
«measure speaker’s attitudes towards objects
about which he is speaking» (Bardin, 1989). It is to identify
indicators concerning the speaker's attitudes
that are «behind the scattering of verbal manifestations»
(Bardin, 1989). Hence, the logico-semantic
analysis that combined treatment processes used by both
evaluative and categorical analysis methods
were adopted. As a first step, attitudes were identified. Since
interviews are the semi-structured type, the
attitudes play the role of categories which allow us to classify
elements that constitute the message
(Bardin, 1989). In the second step, defined units were counted
based on the frequency of their presence.
Thus, the third step concerned the analysis and interpretation of
the obtained results. Indeed, after-cutting
comments, spotting themes, classifying them into meaningful
units, and counting their occurrence
frequencies, the comments were set into several dimensions.
The term ''theme'' to identify the cohesive
set of answers that aggregates the observed trends in the data.
Results. Five main themes have emerged from data regarding
weaknesses that are related to human
resources management inside of Moroccan industrial companies.
Table 2 provides a simple description
of these themes that will be presented in detail later.
Table 2. Principal themes
Description Comment example
Theme 1 HRF structuration «I cannot speak of an HR function.»

Theme 2 Misapplication of fundamental
Practices
«It should be a specified department just for HR management»
Theme 3 Maturity in terms of management «There is no
Occupational Medicine System»
Theme 4
Staff motivation
«Motivation of the company's executive should also be ensured»
«We recognize employees’ efforts ...»
Theme 5 Irrelevance of training «Generally, recruits do not
have enough solid basic training»
Sources: developed by the author.
Theme 1: HR function structuration. Through the interviews
conducted, several respondents noted the
lack of structuring at the HR function. As one respondent has
mentioned: «In fact, I cannot speak about
an HR function, because as an HR manager, I am just managing
staff in its preliminary sense. In other
words, the job is to check employee's presence, manage payroll
and applications having a relationship
with the staff, display ...». It felt that the awareness concerning
the importance of the HR function
contributes to the overall performance of the company was
generally rare and often insufficient. As a
participant pointed out, «We are rarely interested in assessing
the contribution of the HR function in the
organization’s performance». However, the commitment of the

high direction to provide a well-structured
HR function can be considered as a standard in the other
companies that have a long history in integrating
their human resources in order to achieve their objectives.
Theme 2: misapplication of fundamental practices. The second
theme that emerged is related to some
fundamental misapplication of HRM practices. In this sense, it
was clear that it is hard for some companies
to apply their internal administrative procedures as a participant
bearing witness: «Administrative
procedures often cause cumulated delays», or as another also
specified: «even if the procedures are
generally clear and well structured, but they are often rigid
while being applied….». Rigidity regarding
administrative procedures application is often found in
companies with rigid hierarchical cultures. Among
the fundamental weaknesses of HRM, it was also revealed the
problem of non-adequacy between the job
and the person that is in charge of it. One participant
commented: «We must give more importance to the
adequacy Position / Person». Ensuring the adequacy Position /
Person is one of the main tasks of any
personnel management. Therefore, such weakness is a
significant challenge that blocks companies'

performance.
Theme 3: maturity in terms of management. The third theme
focuses on emerging weaknesses related
to maturity in terms of management practices. In connection
with the occupational medicine which is
considered as a maturity indicator in terms of HRM, one
respondent said: «Occupational medicine system
is manifested through a doctor who comes to visit the corporate
site every Wednesday. So if an employee
has a health problem he can consult the doctor who makes
decisions regarding health care, and who
decides to allow him to take some rest or to recommend that the
employee changes his job inside the firm
if his health case so requires». Another person reported, «we do
not have metrological measures of risks
that an employee may encounter within the company». Similar
comments were frequently found
particularly among small and medium-sized enterprises.
Regarding strategic workforce planning, HR
manager of a medium-sized company said: «The fact that our
company has not yet exceeded the
personnel management stage, so we do not apply strategic
workforce planning because it requires the
prior existence of certain conditions regarding the structuring of
the HR function, management tools ... ».
The testimony of this participant emphasized the existence of
conditions while applying management
methods. Another type of weakness that may negatively affect
the maturity of HRM was related to the use
of technology. In this sense, one interviewee noted: «All
documentation is done by writing on records or
reports, there is no data record using computer tools». Even in
companies where there was a enough
available computers, there was no guarantee that they are used
for audio or video content delivery that

can be used as traceability tool, or in order to develop
management process that is used. In some cases,
particularly for companies whose HR function is very advanced,
some weaknesses in the management
control system existed too. In this context, an engineer pointed
out: «Even if I am a senior executive, I am
rarely informed concerning the major strategic and direction
policies related to HR function within the
society». Such gaps are usually due to the rigidity in terms of
management control, as they can be related
to the company's internal culture as expressed by one
participant: «I feel a lack of flexibility of the decision-
makers within our business».
Theme 4: staff motivation. Staff motivation was prominent in
the discussions. Thus it was revealed,
through interviews, the existence of a variety of staff
motivation practice such as motivation based on
remuneration as one respondent mentioned, «Among staff
motivation methods used in our business, there
is motivation by premiums: shift premium, the premium for job
quality, and bonuses depending on work
and objectives achieved by each employee». Some companies
motivate their personal through
professional promotion as affirmed by a participant, «There is
also career evolution», or as explained by
another «Internal recruitment also exists, so a member can have
the opportunity to occupy a higher job
position». In line with this, leadership is included: «We
recognize the efforts of people, meetings are
organized to resolve problems which promote team spirit», staff
motivation through the organization social
activities: «as part of creating a good working environment, we
organize trips, outings, sports events
between the staff of different services». The latter practice aims
to create homogeneity among the

company's members. Control and monitoring are also among the
practices not to abandon «And there is
control and supervision».
While seeking to discover the difficulties related to this theme,
it turned out, in some cases that besides
the need to ensure the employees' motivation, but there is the
need to ensure the managers' as well, as
one participant expressed «Staff motivation is strongly
requested... Another thing is to focus more on the
company's Executives motivation...». This idea seemed to be
very important. Indeed, how can we expect
from an unmotivated manager to succeed in motivating his
collaborators? On the other hand, the lack in
terms of commitment and sense of belonging among employees
is another challenge for the
company: «few employees are aware of the company's
objectives, some of them seem interested to know
them». Despite the variety of the process used to motivate and
encourage, the scientists continue to
investigate it. As part of this, a manager said: «Continuing his
academic or professional training returns to
the collaborator himself. In this context, it is not an
encouragement or facilitation from his company to push
him to pursue his studies». The lack of this kind of motivation

is a loss because, in this case, the film
misses the opportunity to benefit from a more skilled
workforce. Other firms do not provide enough
monitoring that is necessary to establish good employees'
proposals: «Our company does not have a
system that ensures monitoring or improving solutions proposed
by some agents'». Such a situation blocks
the development of the company, and therefore it reduces its
profits as it may demotivate and discourage
its staff.
Theme 5: the irrelevance of training. The fifth theme that
emerged through this study is linked to
problems related to the irrelevance of training received by
recruits. As part of this, one participant
expressed: «Generally, recruits do not have enough solid basic
training to perform their duties within the
company. Hence other training are usually needed before they
can perform their jobs independently». In
addition to the non-adequacy of basic knowledge acquired by
the new employee, the problem of non-
relevance of training extends to those provided by the company
itself.
Most training that companies provide in order to upgrade their
employees does not match, in many
cases, with the ambitions of decision-makers. The responsibility
for this situation is shared. For example,
if a company relies on another company to give a training to its
staff, the company in charge does not
provide reliable information in order to increase the
employment chances to work repeatedly with the same
company on the pretext of providing additional training. On the
other hand, in many cases, companies'
managers ensure the organization of training for the benefit of
their employees, but they do not control the

quality of the information provided by the company that is in
charge of these training. Employees, in their
turn, do not claim the irrelevance of training they receive.
Based on the results found through this study, a
set of proposals has been developed to enrich research within
the few revealed HRM's characters used
in the Moroccan context. These proposals have defended or
argued many findings across the literature.
Indeed, similar results were obtained by Kehri et al. (2010)
when they asserted that «the size factor has a
very significant influence on the organizational structure of the
company [...]. In medium-sized companies,
human resources function can only be a simple unit to perform
daily administrative tasks. In large firms,
the function takes a more sophisticated and more structured
form». Trepe et al. (2010) defend the same
idea. Despite dealing with few aspects related to companies
maturity in general, the obtained results are
adequate and accurate to perform the definition given by
management; for example; communication
constitutes a useful tool for accompanying changes within
organizations (Fabi et al., 1999), or because
excellent communication is recognized as an essential process
to set in order to ensure the proper
functioning of a work team (Chiocchio, 2012). Also, it was
recognized that safety in workplaces affects
staff behaviours (Troxel, 1954). Known scholars throughout the
HRM literature have not just defended it,
but it also pushes us to adopt the idea of «satisfaction mirror»
through which Heintzman and Marson
(2005) state links between employee satisfaction and quality of
offered services, as declared McMahan et
al. (1999) by relating developing employees skills to the
increase in terms of organizational performance.
Regarding the increased need to pay more attention to

effectiveness and efficiency within
management systems adopted, Gilbert et al. (2007) rightly recall
that a human resources policy is
evaluated based on its achievements and not on the logic that
would be effective, «A Human Resources
policy is evaluated also based on the image that gives much
importance to perceptions and value
judgments (fairness, trust, modernity, etc.) than the efficiency
logic». The efficiency concept was also
defended through literature by several authors such as Ulrich
(1997) and Boudreau et al. (2006).
The results found through this study confirm that the idea
according to which older people develop a
better adaptation to working conditions as demonstrated by
Strivasta (1982), Lewis (1981) or Alderfer
(1969) still able to argue. Indeed, investigation findings do not
allow us to affirm the relationship between
age and appreciating work's regulations. It cannot either state
that this assessment is depending on the
interviewee’s sex as declared Spector (1997). Therefore, the
results agree with those of Foucher (1980)
when he considered that there is almost no relationship between
age and job satisfaction while believing
that, other intrinsic personal characteristics, or also those

related to one's profession cannot be nuanced.
It seems to be also true due to the rarity regarding systems
interested in assessing their HR contribution
in the organization's performance. Integration of IT tools as a
solution. The solution for improving the
situation of the studied enterprises is a proposition to give more
importance to the integration of IT tools
in the management processes. Indeed, the development of
computer science has changed the practices
of HRM over the world. It even plays a strategic and essential
role in the HRM performance in firms located
in developed countries. Information systems (IS) allow the
storage of data on staff, facilitating the
dissemination of information to authorized and concerned
persons by HRM issues. It frees HR managers
from administrative activities (often decentralized). Mainly,
computerization contributes to: increasing
productivity; improving service; developing the quality of HR
decisions; sharing function between HR
managers and hierarchy; anticipating relevant actions.
Moreno pointed out that according to Peretti (2008), human
resources information systems (HRIS) are
used in: payroll management; administrative management of
staff; HRM through recruitment, training,
payment for training, training report, remuneration, career, staff
and position management, attendance
and absenteeism management, individual social assessment, the
company's social balance sheet,
forward career management, etc.
Computerization plays a significant role in the evolution of
HRM because it contributes to the sharing
of the function, the personalization and the individualization of
the HRM practices. The intranet facilitates
communication and the transmission of information. As an

example, the state of work attendance,
absenteeism, management of leave and training sessions. The
software packages which are proactive
software allowing to record information, to capture it and to
mobilize it in order to provide a result built in
terms of HRM such as payroll or personnel management...
Expert systems: based on data collected and
then supplied to this software, the system develops responses by
simulating the reasoning of an expert.
Based on the above, the integration of information systems can
effectively contribute to structuring the HR
function through facilitating communication. They can also help
to apply the fundamental practices
thoroughly and improve the management methods of different
HR aspects, as they can be used to relevant
and various training while including the e-learning programs. It
will motivate employees who search for
developing their skills and competences.
Conclusions. This content analysis has identified some profound
weaknesses. Indeed, a lack in terms
of structuring HR function was revealed in addition to the non-
adequacy between job requirements and
the competences of the person in charge of this position,
especially with the lack in terms of using
developed managerial methods such as strategic workforce
planning method, or within the absence of
adopting occupational medicine system, or even in terms of
maturity regarding the achievement of control
system tasks, besides the weaknesses related to the absence of
active communication, of clarity of
objectives for all members, and sharing private information,
without forgetting, of course, those resulting
in the irrelevance of training received by staff. The use the
information systems can effectively contribute
to solving the found problems. Indeed, information systems

promote active communication, different
storage data that develop the quality of the decision. They also
facilitate managing administrative issues,
communicating and applying procedures, programming relevant
training and motivating employees.
Author Contribution: Conceptualization, A. E. and C. M.;
methodology, A. E. and C. M.;
software, A. E.; validation, A. E. and C. M.; formal analysis, A.
E.; investigation, A. E.; resources, A. E.;
data curation, A. E.; writing–original draft preparation, A. E.;
writing–review and editing, A. E.;
visualization, A. E.; supervision, A. M.; project administration,
S. E.
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