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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Facilities Staffing Requirements for the Veterans Health Administration–Resource Planning and Methodology for the Future. Washington, DC: The National Academies Press. doi: 10.17226/25454.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Facilities Staffing Requirements for the Veterans Health Administration–Resource Planning and Methodology for the Future. Washington, DC: The National Academies Press. doi: 10.17226/25454.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Facilities Staffing Requirements for the Veterans Health Administration–Resource Planning and Methodology for the Future. Washington, DC: The National Academies Press. doi: 10.17226/25454.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Facilities Staffing Requirements for the Veterans Health Administration–Resource Planning and Methodology for the Future. Washington, DC: The National Academies Press. doi: 10.17226/25454.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Facilities Staffing Requirements for the Veterans Health Administration–Resource Planning and Methodology for the Future. Washington, DC: The National Academies Press. doi: 10.17226/25454.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Facilities Staffing Requirements for the Veterans Health Administration–Resource Planning and Methodology for the Future. Washington, DC: The National Academies Press. doi: 10.17226/25454.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Facilities Staffing Requirements for the Veterans Health Administration–Resource Planning and Methodology for the Future. Washington, DC: The National Academies Press. doi: 10.17226/25454.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Facilities Staffing Requirements for the Veterans Health Administration–Resource Planning and Methodology for the Future. Washington, DC: The National Academies Press. doi: 10.17226/25454.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Facilities Staffing Requirements for the Veterans Health Administration–Resource Planning and Methodology for the Future. Washington, DC: The National Academies Press. doi: 10.17226/25454.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Facilities Staffing Requirements for the Veterans Health Administration–Resource Planning and Methodology for the Future. Washington, DC: The National Academies Press. doi: 10.17226/25454.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Facilities Staffing Requirements for the Veterans Health Administration–Resource Planning and Methodology for the Future. Washington, DC: The National Academies Press. doi: 10.17226/25454.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Facilities Staffing Requirements for the Veterans Health Administration–Resource Planning and Methodology for the Future. Washington, DC: The National Academies Press. doi: 10.17226/25454.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Facilities Staffing Requirements for the Veterans Health Administration–Resource Planning and Methodology for the Future. Washington, DC: The National Academies Press. doi: 10.17226/25454.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Facilities Staffing Requirements for the Veterans Health Administration–Resource Planning and Methodology for the Future. Washington, DC: The National Academies Press. doi: 10.17226/25454.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Prepublication Copy – Subject to Further Editorial Correction Facilities Staffing Requirements for the Veterans Health Administration—Resource Planning and Methodology for the Future Committee on Facilities Staffing Requirements for Veterans Health Administration Board on Infrastructure and the Constructed Environment Division on Engineering and Physical Sciences Board on Human-Systems Integration Division of Behavioral and Social Sciences and Education A Consensus Study Report of

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by contracts between the National Academy of Sciences and the U.S. Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/25454 Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2019 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Facilities Staffing Requirements for the Veterans Health Administration—Resource Planning and Methodology for the Future. Washington, DC: The National Academies Press. https://doi.org/10.17226/25454. PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION

COMMITTEE ON FACILITIES STAFFING REQUIREMENTS FOR VETERANS HEALTH ADMINISTRATION COLIN G. DRURY, University at Buffalo (Emeritus), Co-Chair JAMES B. SMITH, U.S. Ambassador (Retired), Co-Chair ROBERT ANSELMI, Engineering Department, Veterans Hospital Administration (Retired) ALBERTO J. GALUÉ, Talent Acquisition and Development, Dallas/Fort Worth International Airport ROBERT GOODMAN, The Innova Group, Austin, Texas WESLEY L. HARRIS, NAE, 1 Department of Aeronautics and Astronautics, Massachusetts Institute of Technology GENE HUBBARD, Human Capital Division, RiVidium, Inc., Manassas, Virginia WILLIAM S. MARRAS, NAE, Department of Integrated Systems Engineering and Spine Research Institute, Ohio State University KIMBERLY O’KEEFE, Office of the Assistant Chief of Staff for Installation Management, Department of the Army (Retired) CHERYL PAULLIN, Talent Management and Analytics Division, Human Resources Research Organization, Alexandria, Virginia FRED S. SWITZER III, College of Behavioral, Social, and Health Sciences, Clemson University BRIAN YOLITZ, Associate Vice Chancellor for Facilities, Minnesota State College and University System Staff CAMERON C. OSKVIG, Director DANIEL TALMAGE, Program Officer KELLY ARRINGTON, Senior Program Assistant HEATHER KREIDLER, Associate Program Officer 1 Member, National Academy of Engineering. PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION v

BOARD ON INFRASTRUCTURE AND THE CONSTRUCTED ENVIRONMENT JAMES P. WHITTAKER, Facility Engineering Associates, P.C., Fairfax, Chair WAYNE ARNY, Wayne Arny & Associates, Virginia Beach, Virginia PATRICIA GALLOWAY, Pegasus Global Holdings, Inc., McLean, Virginia SANJIV GOKHALE, School of Engineering, Vanderbilt University CHRIS T. HENDRICKSON, NAE, Carnegie Mellon University, CHRIS POLAND, Chris D. Poland Consulting Engineer, Canyon Lake, California Staff CAMERON C. OSKVIG, Director PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION vi

BOARD ON HUMAN-SYSTEMS INTEGRATION PASCALE CARAYON, College of Engineering, University of Wisconsin, Madison, Chair JAMES BAGIAN, NAE/NAM, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor DIANA BURLEY, Graduate School of Education and Human Development, George Washington University BARBARA DOSHER, NAS, School of Social Sciences, University of California, Irvine MICA ENDSLEY, SA Technologies, Mesa, Arizona EDMOND ISRAELSKI, AbbVie, North Chicago, Illinois NAJMEDIN MESHKATI, Viterbi School of Engineering, University of Southern California FREDERICK OSWALD, Department of Psychology, Rice University EMILIE ROTH, Roth Cognitive Engineering, Stanford, California WILLIAM J. STRICKLAND, Human Resources Research Organization, Alexandria, Virginia MATTHEW WEINGER, Vanderbilt University Medical Center Staff TOBY M. WARDEN, Director PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION vii

Preface This report by the Committee on Facilities Staffing Requirements for Veterans Health Administration is the next piece of the project to prepare a comprehensive resource planning and staffing methodology guidebook for the Facility Management (Engineering) Programs of the Veterans Health Administration (VHA). The committee has held five committee meetings and five workshops so far, and one more feedback workshop is planned after the release of this report. From these activities, the committee has developed both a deep appreciation of the complexities associated with VHA Facilities Management and an understanding of its current methods of staff modeling and planning. The wide-ranging expertise brought to bear on the study challenge through the varying committee investigations has allowed the committee to evaluate existing models from potential analogues of the VHA Facility Management’s situation. An Interim Report has already been written and released to the sponsor and public. As the committee’s target organization knowledge and modeling examples converged, it has developed findings and recommendations to meet the statement of task. We wish to express our deep appreciation to the members of the committee for their diligent and dedicated contributions to developing and participating in the multiple workshops and meetings. The diverse expertise and experience offered by the members of the committee were indispensable to the formulation of the individual sessions. We also wish to thank, on behalf of the entire committee, the staff of the National Academies of Science, Engineering, and Medicine, whose expertise and skill was absolutely essential to our meeting the charge from our sponsor. Colin G. Drury and James B. Smith, Co-Chairs Committee on Facilities Staffing Requirements for Veterans Health Administration PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION ix

Acknowledgment of Reviewers This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: Joseph G. Crance, Consultant, Chris Hendrickson, NAE, Carnegie Mellon University, Paul F. Hogan, The Lewin Group, Fairfax, Virginia, Russell Manning, Kaiser Permanente, Brian Norman, Compass Manpower Experts, LLC, Julie C.H. Ryan, Wyndrose Technical Group, William Seed, Jackson Health System, Gene Siegal, University of Alabama, Birmingham, and Philip Smith, Ohio State University. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by Rear Admiral David J. Nash of Dave Nash & Associates, LLC. He was responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content of the report rests entirely with the authoring committee and the National Academies. PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION xi

Contents SUMMARY 1 1. THE NEED FOR A STAFFING METHODOLOGY FOR THE VETERANS HEALTH ADMINISTRATION 11 Study Origin, 12 Charge to the Committee, 12 Committee Approach, 13 Interim Report, 16 Rationale for Modeling, 17 Report Structure and Summary, 18 2. FACILITIES MANAGEMENT DEPARTMENTS 19 Introduction, 19 Capital Projects, 20 Planning and Programming, 20 Project Management and Delivery, 21 Operations and Maintenance (O&M), 23 Engineering Administration, 25 Other FM Functions, 28 Additional Considerations and Factors, 29 Federal Facilities Considerations, 29 Medical and Healthcare Facilities, 29 Summary, 30 3. MODELS APPLIED TO STAFFING 33 Models, 33 Desirable Model Characteristics, 36 Critical Characteristics of Input Data, 40 Models Applied to Staffing, 41 Context, 41 Model Complexity, 42 Staffing Model Inputs, 43 Staffing Model Outputs, 45 Risk, Benchmarks, and a Caution About Metrics, 45 Modeling Techniques, 47 Summary, 52 4. VHA FACILITIES MANAGEMENT (ENGINEERING) STAFFING METHODOLOGY 53 Linking VHA Facilities Management (Engineering) Staffing with Target Levels of Performance, 54 Defining Target Performance Levels for VHA Facilities Management PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION xiii

(Engineering), 54 Defining Key Performance Indicators that Reflect Target Levels of VHA Facilities Management (Engineering) Performance, 57 Analyzing Links between VHA Facilities Management (Engineering) Staffing and Performance, 59 Staffing Methodology, 60 Facilities Management (Engineering) Functions Included in the Staffing Methodology, 60 Levels at Which the Staffing Methodology Should Be Built and Applied, 60 Establishing Baseline Facility Management (Engineering) Staffing Requirements, 61 Incorporating Infrastructure Complexity Parameters into a Baseline Staffing Model, 62 Parameters That Could Be Considered in the VHA Engineering Staffing Model, 63 Number of Infrastucture Complexity Parameters to Include in the VHA Facilities Managmeent (Engineering) Staffing Model, 67 Notional Applications of the VHA Facilities Management (Engineering) Staffing Methadology, 68 Estimating the Number of Facilities Management (Engineering) FTEs Needed at the VAMC Level, 68 Estimating a Staffing Budget Request at the VAMC Level, 71 Summary, 72 5. DESIGN, IMPLEMENTATION, AND SUSTAINABILITY OF THE VHA FACILITIES MANAGEMENT (ENGINEERING) STAFFING MODEL 73 Introduction, 73 Key Staff Element Roles, 73 Sponsorship and Oversight, 73 Leadership Champion, 74 Permanent Chief Engineer Facility Advisory Council, 74 Subject Matter Expert (SME) Task Force (TF), 76 Design Process and Timeline, 77 Overview, 77 Phase 1: Design of “Initial Model” (12 Months), 77 Phase 2: Coordinated Review of Initial Model (6 Months), 79 Phase 3: Coordinated Working Model Independent Entity Verification (12 Months), 80 Implementation Process and Sustainment Cycle, 81 Organizational Support and Leadership Commitment, 81 Synchronizing Implementation and Sustainment with the Budget Cycle, 81 Resources, 82 VHA Facilities Management (Engineering) Staff Investment, 82 Annual Review, 84 VHA Leadership and Key Staff, 85 Change Management, 85 VHA Key Staff, 86 Human Resource Support, 86 Labor Relations—Union Considerations, 86 Areas for Further Study, 86 Infrastructure Investment, 86 Data Collection, Accuracy, and Analytics, 87 Staffing Approaches, 87 Integration in Strategic and Interdisciplinary Planning, 88 Leveraging Big Data, Machine Learning, and Artificial Intelligence, 88 Summary, 89 REFERENCES 91 PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION xiv

APPENDIXES A Committee Meeting and Workshop Agendas A-1 B Committee Biographical Information B-1 C Nature of Veterans Health Administration Facilities Management (Engineering) Tasks and Staffing C-1 PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION xv

Acronyms A/E architects and engineers AHRQ Agency for Healthcare Research and Quality AI artificial intelligence APPA APPA (formerly Association of Physical Plant Administrators) ASHE American Society of Healthcare Engineering ASHRAE American Society of Heating, Refrigerating, and Air-Conditioning Engineers ASI Aviation Safety Inspectors ATSS Airway Transportation Systems Specialists BDA big data analytics BICE Board of Infrastructure and the Constructed Environment BIM building information modeling BV best value CAI Capital Asset Inventory CAPRES Capital Resource Survey CARES Capital Asset Realignment for Enhanced Services CBOC community-based outpatient clinic CD construction document CEFAC Chief Engineer Facility Advisory Council CI condition index CM construction manager CMMS computerized maintenance management systems CMS Centers for Medicare and Medicaid Services CP capital project DD design development DM deferred maintenance DoD Department of Defense DOE Department of Energy EA engineering administration EPA Environmental Protection Agency FAA Federal Aviation Administration FCA Facility Condition Assessment(s) FCI facility condition index FM Facility/ies Management FRPC Federal Real Property Council FTE full-time equivalent PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION xvii

FTEE full-time equivalent employee FY fiscal year GAO Government Accountability Office GMP guaranteed maximum price GSA General Services Administration GSF gross square feet HCFC Health Care Facilities Code HHS Department of Health and Human Services HQ Headquarters HSI human-systems integration HVAC heating, ventilation, and air conditioning ICU intensive care unit IDIQ indefinite-delivery, indefinite-quantity IFB invitation for bid IFMA International Facilities Management Association IG Inspector General IOT Internet of Things IR interim report ISO International Organization for Standardization IWMS integrated workplace management system JOC job order contract KPI key performance indicator KSAO knowledge, skills, abilities, and other characteristics LSC Life Safety Code ML machine learning NASA National Aeronautics and Space Administration NDMS National Disaster Medical System NFPA National Fire Protection Association NIH National Institutes of Health NRM nonrecurring maintenance NTP notice to proceed O&M Operations and Maintenance OACSIM Office of the Assistant Chief of Staff for Installation Management OCAMES Office of Capital Asset Management, Engineering, and Support OI&T Office of Information and Technology OMB Office of Management and Budget OPES Office of Productivity, Efficiency, and Staffing OPM Office of Personnel Management OSHA Occupational Safety and Health Administration PTSD post-traumatic stress syndrome RFB request for bid PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION xviii

RFI requirement for improvement RiTMS Risk Identification, Triage, Mitigation, and Sustainment SCIP Strategic Capital Investment Planning SD schematic design SME subject matter expert TCO total cost of ownership TF task force USAF U.S. Air Force VA Veterans Affairs VAMC Veterans Administration Medical Center VAST VA Site Tracking Database VCP Veterans Choice Program VERA Veteran’s Equitable Resource Allocation Methodology VHA Veterans Health Administration VISN Veterans Integrated Services Network PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION xix

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The Veterans Health Administration (VHA) is America's largest integrated health care system, providing care at 1,243 health care facilities, including 172 medical centers and 1,063 outpatient sites of care of varying complexity, serving 9 million enrolled Veterans each year. In addition, VHA has opened outpatient clinics and established telemedicine and other services to accommodate a diverse veteran population and continues to cultivate ongoing medical research and innovation. Facilities specific to VHA fulfill clinical, operational, research laboratory, and administrative functions. Each site is designed to serve a geographical location with specific health care needs. VHA's building inventory has sites of different ages, and often there is a mix of building size and age at each site or campus.

At the request of the VHA, this study presents a comprehensive resource planning and staffing methodology guidebook for VHA Facility Management Programs by reviewing the tasks of VHA building facilities staff and recommending actions for the VHA to meet the mission goals of delivering patient care, research, and effective operations.

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