Saturday, August 24, 2019

Consumer Relationship Essay Example | Topics and Well Written Essays - 2500 words

Consumer Relationship - Essay Example Consumer relationship management is one area of organizations that calls for proper intelligence and understanding to achieve. Most organizations look into satisfying the needs of their customers without first understanding themselves. By giving so much focus to consumer satisfaction and ignoring the organization itself, in the long run even the customers themselves hardly get satisfied (Liveris 2011, p. 17). This paper critically analyzes the contribution of organizational/product- consumer relationship trends in the global beer industry by taking into consideration the demands of consumer relationships, theories around consumer relationships and the techniques that have been employed by organizations so as to achieve customer relationships. In purchasing goods and services, consumers are always faced with dilemmas before arriving at the decision to buy some specific products or services. In the beer industry, one may ask such question as, why do I need to buy â€Å"Heineken† but not â€Å"castle lager† for instance. Well, depending with the individual, different factors such as price, quality and satisfaction will start ringing in their minds. To others, however, the producer of the product matters a lot. It is common that people tend to choose products from well established organizations as opposed to the upcoming organizations. Described below is the process that most consumers undergo before arriving at the decision to purchase certain products: What triggers the mind of any individual to buy a certain product is the need to solve a certain need or problem that such a consumer may be facing. Here, the consumer tends to believe that by purchasing specific products, their problems will be solved. Most organizations start influencing the customer decision making from this point. Companies try to put to customers that those customers actually have problems and those problems can only be  solved with products from such organizations. A good example is alcohol consumption.  

Friday, August 23, 2019

Position Paper - Topic - Inside the Minds of Google Essay

Position Paper - Topic - Inside the Minds of Google - Essay Example Instead, different entities that cater for the youth should support them both financially and socially in order to realize their ambitions. Additionally, IT experts and creative minds are stimulated by the success stories of the Google team in terms of working together to attain a common goal (Genzlinger 1). This implies that the aspect of Ms. Bartiromo to address the privacy issue is quite illuminating considering that complaints have been raised how Google handles such information. Therefore, it is imperative to note that security of internet users’ should not contravened because this is a violation of one’s private life. For example, there regular deletion of information contained in most databases of IT companies that are interconnected globally. This is why Google and security items have generated a fuss across different sectors of the nation. In other words, complaints of most modern innovations of technology being used to snoop into the private lives of citizens have even elicited fierce debate in the Congress. Therefore, suggestions have proposed the passing of legislation that monitors how IT comp anies handle the information of its clients and the legal action one is entitled to incase of a violation. In other words, this means that one of the most innovative and a successful company in the world is worried on how it is perceived by its more than one billion clients around the world. Similarly, from the video there is the chief executive of Google, Eric Schmidt explaining how the gigantic IT Company nurtures its workers by fostering a creative environment. This teaches IT managers and other leaders of other companies on the need to cater for its workers in order to attain results desired by the clients on time (Genzlinger 1). However, management should at times adopt its position depending on the existing environment of its workers and the expected goals and objectives. On that perspective, motivation of workers is

Thursday, August 22, 2019

Are patents good or bad for Economics Term Paper

Are patents good or bad for Economics - Term Paper Example ‘Patent’ is the rights approved by the government that is bestowed to the inventor or patentee for special use of the invention for a restricted time period in the country or region, subjected to the prevailing law of that country or region. The duration for protection is generally 14 to 20 years including possible extension of 7 years (Bardowell, â€Å"Patent System†). The policy of patenting is an important part of the economy as it helps in the process of innovation and invention to the country. The paper aims to substantiate the importance of patents for an economy. For the society, the benefits are achieved when the invention moves into the public realm after a certain period of time after the invention. Also the invention is revealed to the society with the expectation that there will be improvement in the invention. The patentee holds no such intention of keeping it as a trade secret. The granting of patent may sometimes become risky for the government. The term for which duration of patents are restricted (20 years) is very elongated. For such approach, innovation or improvement on the invention might get hold for a long period of time. But granting patents always keep the government on the safe side with because they can control the innovation and invention, be it good or bad. The historical data shows that patents have always produced good results for the economy. In this section of the paper, an article from the magazine â€Å"The Economist† has been cited and analyzed. The article named ‘The good, the bad and the ugly’ has explained the traits of urge towards innovation in Britain. The objective of the article was to rate Britain as a knowledge based powerhouse among the world countries. The article establishes that for upgrading the economic growth, governments provide good reason to promote innovation. As patent is the heart of invention through innovation in the field of R&D, governments take initiatives in

Bmw Swot Analysis Essay Example for Free

Bmw Swot Analysis Essay Logo-BMW’s white-and-blue logo is recognizable worldwide, and recalls the company’s start as an aircraft engine manufacturer. It symbolizes a pilot’s view through a propeller as alternating white and blue segments. †¢Most successful multi-brand premium car manufacturer-BMW has three brands, BMW, MINI, and Rolls-Royce. They delivered 141,952 BMW, MINI and Rolls-Royce automobiles in 2007 and sales increased by 7. 4% from the previous year. †¢Super luxury Rolls Royce car-The Rolls-Royce phantom holds the number one position in the super-luxury car segment. The Phantom was launched in 1993, and the final assembly, as well as all-wood and leatherwork are custom made for each customers individual specifications. The plant where they are produced, the Goodwood plant in England, contains only two robots to paint the space frame body; all other work is done by hand, in keeping with the Rolls-Royce tradition. †¢Spends one of the highest revenues on R;D-BMW Group employs about 8,000 people worldwide within the research ; development (R;D) network and has invested millions of dollars over the years. They employ engineers, designers, model builders, computer experts, and scientists of various disciplines FIZ co-ordinates and optimize research activities across the group to create the BMW cars of the future. †¢Brand-BMW ranked in the top 20 most recognized global brands. BMW is now the only multi-brand automaker that utilizes a pure, premium brand strategy. The objective behind this strategy is to generate higher income per vehicle on the basis of products with a high intrinsic value and a strong brand image. Their brand ranked number 15 in 2006. Longevity-Bavarian Motor Works (BMW) was formed in 1916 after two small aircraft engine manufacturers merged. In 1923, BMW began to build motorcycles, then its first car in 1928. †¢Driving School-Many manufacturers have associations with driving schools; BMW runs its own. The BMW Performance Center, adjacent to the BMW Manufacturing facility in Spartanburg, attracts owners and prospects from around the country for an ultimate br and experience. †¢Sales-BMW is one among the leading players in the premium cars segment. It achieved a record sales volume of 1,373,970 units in 2006. BMW is ranked among the ten largest car producers globally. Awards/Recognition-Reflecting BMWs commitment to developing quality and innovative products, the company has been honored with several awards in the past. For example, BMW was presented with the Design Award of the Federal Republic of Germany in February 2006 for the BMW 6 Series Coupe and Convertible models. Presented by the German Design Council, the award was the highest official German design award. Following this, the MINI model of the company won the Golden Steering Wheel 2006 award in seven out of 15 categories, ten days ahead of its official market launch in November 2006. Formula 1-BMW won its first Formula 1 championship in 1983 using a four cylinder, 1. 5-liter production based engine. Of course it was turbocharged and could develop well over 1,000 horsepower, some say over 1,500 for short periods of time. BMW continues to field a Formula 1 team because it provides the ultimate in competition and thus the ultimate in learning for BMW. †¢Excellence through quality innovation-BMW Group’s success is its strategic focus on developing customer-friendly innovations, coupled with an approach to innovations management that is unique within the motor industry Customize your own car-BMW has the option of seeing a sample of the car you’d like by selecting different options such as the color of interior design and exterior design, the wheels, the model etc. †¢Intelligent processes-the COSP(Customer oriented sales and production process) bases production on the customer’s customized version and not by company standards. They employ 70,000 workers in 23 different locations to build the customized cars. A customer can change or alter the options and style of the car right before it goes into production. †¢Environment-friendly-BMW considers environmental and recycling requirements. They use recycled products to build cars. They have environmental standards for all the plants throughout the world. They build cars that lower the amount of fuel consumption. †¢Superior technology and development of new products BMW is doing this is by developing a hybrid engine as part of a global alliance. The aim of this development is known as a â€Å"two-mode† hybrid vehicle, combining a combustion engine with two electronic engines. This design is aimed towards improving the performance, fuel consumption, emissions and range of conventional hybrid vehicles. The primary goal of modern hybrid systems is to save fuel. †¢Commitment to customers BMWs’ main goal is to focus on getting the product to the customer as quickly as possible. BMW has a program known as the â€Å"Customer oriented sales and production process. † This way, the customer is able to make any last minute changes to the equipment and accessories they’ve ordered shortly before the vehicle goes to assembly-without delaying the date of delivery. †¢Design Work design process of building vehicles is done by California Innovation Triangle. This state of the art firm uses computers to help aid the process of design. The highlight of this facility is what the industry has begun to call â€Å"the model plate. † The model plate is a measurement system that transfers the contours of the object being scanned to computers where a 3D model is produced. The designers can then go in and make changes to the object through the computer in order to make the part as suitable for its intended use as possible. What makes this machine so rare is the size of object that can be scanned. The model plate can scan very large object, up to the size of an omnibus. With the use of this technology BMW and California Innovation Triangle are able to layout and design entire vehicles piece by piece. †¢Involvement in community South Africa serves as good example of BMW’s social commitment. BMW works to bring change from within by enacting equality in the workface, and investing not only in the business, but also in education, healthcare and recreational facilities for employees. The factory at Rosslyn, near Pretoria, evolved from a CKD facility to serve the old South Africa, into a sophisticated facility that is now part of BMW’s international production-distribution network. This risk BMW took provided South Africa the ability to export. And in 2002, the South African factory captured the J. D. Power and Associates gold award for initial production quality. †¢Environmental commitment BMW factories meet the demanding ISO 14001 environmental standards worldwide. This is not only true for the oldest BMW factory in the city of Munich and at 10 year old American plant in Spartanburg, South Carolina, but also with new factories in emerging and less regulated markets like Thailand and Russia. Excellence through quality innovation-BMW Group’s success is its strategic focus on developing customer-friendly innovations, coupled with an approach to innovations management that is unique within the motor industry. From features like the twin-flat motorcycle engine, V-shaped overhead valves, and hemispherical combustion chambers introduced on the classics of the 1920s and 30s, to modern technology including ABS brakes, Xenon lights, smart airbags, the head protection system, Valvetronic and iDrive, BMW constantly reinforces its credibility as a premium manufacturer Management-Chief executive, Norbert Reithofer, who took office on September 1, will be seeking to build on the Bavarians’ global momentum. Reithofer has a brilliant track record as head of production, such as combining lean manufacturing and Japanese-like continual improvement with benchmark flexibility for a premium automaker which gives BMW a big cost advantage over leading competition and making it tough for competitors like Mercedes to gain any ground. †¢Young customer base-With the Mini and series 3, BMW has a significant dvantage of gaining younger and first time purchasers over other luxury brands. The youth market is critically important because if a young buyer chooses a particular brand for a first car, he or she is more than likely to buy others with the same name plate as they mature and move up in the market. Even though buyers in the 16-35 age category only accounted for a small percentage of overall sales it is important to gain there sales because as the old marketing principle goes it is easier to keep a customer than to gain new ones. WEAKNESSES †¢New Models-Is it really worth developing new models? It entails expenses along with shipping prices. Each day BMW is striving to produce and develop new cars to satisfy the customers. In the long run, who actually knows if these cars are going to be a big hit. The company might actually be wasting their time and money in producing a model that will not be worthwhile. When developing and producing cars it is important to decipher whether or not the car will become one that is popular on the market. †¢BMW’s heavy cost German base. -More and more competitors are shifting product development activities to lower cost countries. BMW could be forced to negotiate a way to maintain cost competitiveness and its reputation for German engineering excellence made in different countries. †¢Price-Another weakness of the BMW industry is getting the customers to buy these cars. Yes, the hybrid vehicle will save you fuel, but it will be so expensive that it might be hard trying to find customers to buy them at such a high price. Another reason the price of the vehicle is so high is because they are shipped across the United States and also come from a factory in Germany. The expenses of the vehicles and the shipping rate are two key weaknesses that many companies must work with. †¢Motorcycle Sales-The European market accounts for more than 60% of BMWs motorcycle sales on an average. The group is heavily dependent on this region with Germany being one of the largest markets for its motorcycles business. With the demand in Germany being highly inconsistent in the past six years, this high dependence on a particular region can have an adverse effect on the companys sales, during periods of demand stagnation in the region. For example, BMWs motorcycle sales in Germany declined by 9. % to 24,064 units in 2005, which further declined to 23,617 units in 2006. †¢Corporate image-too serious ad tradition-bound. †¢Hybrid Prices-These types of cars will save you a lot of money on fuel, but the problem BMW is having trouble with is pricing the hybrids. It would be hard for BMW to find customers that would buy the hybrids at a high cost. †¢Ship ment Cost-Most of the cars are shipped from Germany to the United States. The shipping cost would affect the price of the car. This is one the expenses that the BMW company’s would have to deal with in pricing their vehicles for the customers satisfaction. Online Strategies-BMW is not winning the â€Å"information war† in the market place about its own customers, their attitudes, complaints, wishes, etc. BMW is not operating in a manner, which acts to â€Å"include† its customers including their meeting and information sharing sources. Existing online efforts do not meet consumer needs. There is a lack of â€Å"human intelligence† and an over-reliance on visual marketing in BMW’s on-line strategies. †¢Dealer Networks-BMW’s dealer network is in the midst of great change. Overall basic product margins are down while business infrastructure requirements are up. Many dealers do not feel that the field reps are there to help them build their business but rather just to comment arbitrarily and deliver business change requirements from BMW headquarters. There is a problem with two way information flow in the distributor-dealer relationship. Dealers feel that they are not being listened to and are also not being serviced in critical areas of their business by BMWNA staff. †¢Management-Dealers want to be able to discuss key elements of their business given their limited capital resources. Given the size and nature of he motorcycle market many dealers feel that BMW’s current policies are overly restrictive to the healthy development of their business and that BMWNA should operate in a more flexible manner which could be seen as co-development of a dealer’s franchise not just top-down management by memo. †¢Changing Consumer Environments-Also, as it appears that BMW’s dealer strategy is to move to larger centralized â €˜corporate style’ stores, many of the smaller ‘mom and pop’ dealerships that historically or currently serve a key segment of the BMW owners/riders are being alienated and/or eliminated. By following this policy of upgrade or be eliminated BMW is removing both the habitat in which the consumers live as well as the knowledge base and support structure from which they engage in BMW oriented motorcycle commerce. OPPORTUNITIES †¢India-The Company has been launching several new initiatives and has been widening its product base since 2001. The company expects ample growth opportunities in India, and it is keen on expanding its bases in these countries. †¢The expansion of the euro. -In May 2004 more countries adopted the euro making it the world’s biggest trading block. This offers ample opportunities for BMW to leverage its strong European position in the premium car segment to gather more market share across new and expanding markets. †¢A Chinese luxury car market-Rigorous attempt to get into the Chinese luxury car market signifies an increase in the earnings of the company over the coming years. China already ranks as the third largest market for BMW’s 7 Series luxury limousines. BMW predicts that vigorous growth will place China among the company’s seven largest markets in a few more years. †¢Diesel Power-BMW foresees an immense opportunity in the diesel-powered cars segment. Tourism-the Zentrum building is located in South Carolina. This gives tourists the opportunity to take a look at the history of BMW, also at the cars, the speed and innovation free of charge. It is the only BMW museum in the United States. It is also located next to the only BMW manufacturing plant in the United States. BMW should take a look into bu ilding more museums throughout the world. †¢Expansion-although BMW is very successful they should think about expanding their manufacturing plants throughout the United States and other countries. They only have one location in the United States which is in South Carolina. †¢Have the best and most current technology-It is important for BMW to have the best research and development staff where they can keep the company up-to-date with technology. With the latest technology and supplies, BMW can create the best cars the fastest and most efficient way possible. †¢Broaden information sharing -BMW should broaden information sharing amongst their dealers, distributors, and factory. This will improve product repair knowledge resulting in improved customer service and satisfaction. Improve and run their business based on their business plan-Improving the capabilities of dealers to sell more BMW products in the marketplace through refinement of their business plan †¢Utilize the Internet more-Multiply the value of the ‘human capital’ in the BMW network by â€Å"e-knowledge† and â€Å"e-training. † †¢Better training of their salespeople-Deve lopment and implementation of business practices that harness the best of each individual dealer and make their unique market position/skills a valuable part of the entire network. Partnering with Sirius Radio-In 2005, BMW partnered with Sirius Satellite Radio to promote its new 3-serious car for 44 days. BMW used Sirius to promote its new car because the radio station had 1. 24 million subscribers and still growing. On the final day of promotion it broadcasted a live concert with various artists. †¢Acquiring Volvo-The chairman of BMW, Dr. Norbert Reithofer, is plan on expanding the business with a fourth brand name, Volvo. Although sales of Volvo has been slow in the North American and Europe, its brand name focuses mainly on safety and its fashion appeal is not attractive to the eye. BMW could help out by acquiring the company to make it a more global brand, also in the Asian Market. †¢Apple iPhone-The new Apple iPhone is one of the next best things of phones. It is a touch screen phone with a built in iPod. This would give BMW the opportunity to integrate the iPhone into their cars. †¢China market-An opportunity for BMW is the increase in the luxury automobile market in china. The most significant growth of the luxury market can be attributed to Jiangsu province which has created an 84 percent increase. Next to Jiangsu is Guangdong, making 79 percent recorded growth in the market. On the other hand, Zhejiang province also bagged a 54 percent increase. THREATS †¢Demand Patterns-BMW operates in an industry that is prone to cyclical demand patterns due to consumer wants and needs. †¢Currency-Any unfavorable trend in Euro valuation against major currencies can hurt BMWs performance. †¢Fuel Efficiency-While BMW continues to work on high performance, clean and efficient gasoline engines, the company is also committed to a green-house-gas- free hydrogen powered vehicle as a long-term strategy. At this time we have an active development program that will enable us still to bring to market a full size automobile, propelled with hydrogen, before the end of the decade. †¢The continuing decline of the dollar against the euro-This threatens to undercut BMW’s top-line thereby tempering its profitability. The euro to one-dollar ratio has dropped from 0. 702626 euros to 0. 690376 euros from October to November. †¢The rising price of raw materials -Materials such as steel threaten to offset the company’s earnings. BMW continues to face the rising cost of raw materials as the key challenge to maintain and improve their growth performance. The annual average market price of aluminum, copper and plastic rose by 34%, 76% and 13%, respectively, in 2006. Likewise, the price of industrial raw materials also increased by more than 30% in 2006. †¢Rising gas prices – with a weak U. S. market, steadily rising gas prices and gaining popularity in non-luxury vehicles there is the temptation to move down market.

Wednesday, August 21, 2019

Strategic Leadership In An Organizational Change Process Management Essay

Strategic Leadership In An Organizational Change Process Management Essay The following essay will critically discuss the role of strategic leadership in an organizational change process using relevant theories and example. The objective of this paper is to come up with a solution of the many challenges that occur in the process of organizational change through implementing proper leadership. Organizational change refers to a situation whereby an organization adopts a new strategy in the way it carries out its activities and management for better or removes a major section or an operational department (McNamara, 2011). Strategic leadership on the other hand refers to the implementation of strategies in the management of workers in any organization. Organizations always go through change, at times gradual and other times drastic throughout their normal life cycle whereby organizational leaders may create change driving forces within the organization. For example, radical changes may take place in an organization leading to structural transformation through which organizations attempt to revitalize business orientations through changing the reporting structure. Other changes, for instance, merger and acquisition, transforming the top management of an organization, reorganization and restructuring of the company may affect the organization culture and processes. Most of these transformations in organization are mainly meant to down size the size of the organization (Pryor et al, 2008). However, organizational change is not always embraced positively by the employees and the stakeholders thus it is a very challenging process (Appelbaum, St-Pierre Glavas, 2000, Pg 293). Most people are either afraid or unwilling to try out something new and they may go ahead convincing their counterparts otherwise. In other instances, organizational change is viewed like a threat by those who have been used to the old system (Pryor et al, 2008).. For instance, when a certain unproductive department may be scrapped from the company by the management, the employees feel threatened to loose their jobs thus resisting this change. This may lead to demonstration and if the leadership is not very careful, they may end up frustrated and may even fail to achieve their objectives and goals. This is where leaders ought to undertake proper change management in order to accommodate the views of each party and to make proper decision which wont affect the overall performance of the organization ( Thompsons, 2008, p5). When an organization is going through change, proper change management is vital in order to take the company through proper and successful transition. This is a time when the leaders and the managers need to exercise their leadership fully. Leaders should be the role models and the best examples to the rest of the employees in the implementation of change to show the positive attitude and that change is possible. Apart from action, they should explain the need for change to the employees, displaying the benefit and the importance of change in order to create a positive attitude even as they work towards the change. Once the employees find the attitude that their leaders have towards the change, they will be willing to learn more about the change and they will be motivated to participate more in implementing the change (Pryor et al, 2008). Several theories will be discussed in the essay pertaining the organization change and change management. We will also look at the economic importance of strategic leadership in change management. This will be in relation to the Arabic nature of the organization culture. Strategic leadership Strategic leadership involves use of strategy to manage workers in an organization (Cyprus, 2010, Para1). Strategy refers to a long-term plan of action that has been laid down by a company in order to achieve competitive advantage, by meeting the market needs and the stakeholders competition, through proper combination of resources (Johnson Scholes, 2011). The basic strategy that managers employ in organizations is motivation of workers in order for them to be productive at the end of the day. For strategic leadership to be successful, the managers ought to be critical thinkers and to apply the theories of strategic planning. Leaders are the most important assets of the company since their mode of leadership determines the future of the company and the productivity of the workers. Their input to the company and to the employees inspires them to take the appropriate action thus laying the foundation for the future of the company (Cyprus, 2010, Para1). Strategic leadership works handy with strategic planning, competitive advantage and comparative advantage. Competitive advantage refers to an advantage an individual or a company has over his competitors by offering goods and services to the market at a lower opportunity cost (Annon, 2011). It is a theory that tries to address some of the criticisms of comparative advantage which refers to the ability of a firm to produce goods and services at a lower opportunity cost as compared to its rivals. Since competitors can easily learn any strategic position, it has become so challenging for leaders to maintain competitive advantage over their rivals. Also, there has been acute and drastic global competition and technological changes that require the leaders to be updated and we set with the current affairs in order to protect the future of their organizations. Strategic leaders are therefore always focused and looking ahead as well as analyzing the present to prepare the business for what may be ahead (Cyprus, 2010, Para1). The major aspect in strategic leaders is awareness of the market, current as well as possible future occurrences, critical thinking out of action, adaptability as well as growth oriented. They implement their leadership roles by training the employees to get things done by combining resources in order to come up with the best results for the company (Cyprus, 2010, Para1) . Organizational Change Organizational change refers to a situation whereby an organization adopts a new strategy in the way it carries out its activities and management for better or removes a major section or an operational department (McNamara, 2011). Organizational change may also occur when the organization evolves through growth with time from what was established to something else after input of resources. This is the development that an organization gains as it grows and it is a major and very significant process of organization change. Since no organization remains static or the way it was established, the topic of organization change has become a very common and widespread topic among business people as well as scholars (McNamara, 2011). Strategic leadership is very core in the process of organizational change in order to embrace this change in a positive and rewarding way as well as preventing negative impact of change to the company. Leaders and managers are faced with a challenging task to accomplish successful and significant change whereby some achieve beyond our expectations whereas others struggle a lot and fail. Reasons for organizational Change Organizational change is brought about by different reason, some of which are from the management whereas others are out of human control. Natural disaster and acts of terrorism are some of the major reasons that may bring about organizational change. The Arabic community has been facing many of these kinds of hazards in their continents directly or indirectly which has made it important to embrace the culture of organization change in their organizations. For instance, the long time war in Afghanistan and Iraq has affected many organizations leading to implementation of new strategies and dynamics. This is because the terrorist attacks may at times target an organization in such a manner that it is not possible to continue with its ordinary culture. Also, major disasters in the United States have been associated with the terrorist groups in the Arabic community making it very hard for the two parties to do business together thus need for organizational transformation to accommodate these changes. Change management theories An organization must be in a position to understand the changes itmight be going through for it to manage it successfully, otherwise, any change is doomed to serious problem and failure. Some of the change management tactics include accepting the brief, diagnosing the change through investigation to be able to understand the change, managing the stakeholders carefully, planning for change by creating a bullet proof plan, managing change project by making it happen in practice, investing in means of turning the plans in to reality, designing the organization in such a manner that it will accommodate the changes and successfully move from the old organization in to a new organization, employing change techniques that will instill personal change among the parties involved in the organization to make it easy in to reality and adopting the 4D change project framework that is good at managing organizational change projects (Annon, 2002-2011, Chapman, 2005-2010). Scholars have come up with various theories that explains change management some of which include the action research theory, Lewins three step modal, Scheins Extension of Lewins Change Model, The Lippit, Watson and Westley model of planned change which expanded Lewins Three-Step Model to a Five-Phase Model, Kotters Strategic Eight-Step Model, Mento, Jones and Dirmdofer.s Twelve-Step Model, Jicks Ten-Step Model and Shields five-step model (Pryor et al, 2008 Kritsonis, 2005). Let us look at some of the change management theories in details. Action Research Model Action Research Model or Theory involves several and diversified tactic of implementing change. It involves a combination of changing the attitudes and behaviors as well as crosschecking and testing the change technique to be employed. Changing of attitude and behavior mostly involves the leadership and the employee (Pryor et al, 2008). This is the very important stage whereby the leaders and the managers ought to exercise their leadership and help their juniors in to the change process. This involves training the employees concerning the change process that may be required as well as giving them a good example by acting as their role models. At this stage, the management should take their time to let the employees and the stakeholders the importance, reasons and benefits of change process that needs to be undertaken in order to create a positive attitude in them and to give them morale towards wanting to learn more concerning the new change in the organization. This part of changing the actions and behaviors of the parties involved in the organization is action oriented because the ultimate goal is to make change happen. The other part that is covered in the action research theory involves testing the change method being utilized. In this part, the leaders revolve around trying different frameworks in a real situation as a means of testing or confirming whether the theories can yield their objectives. They may also apply different theories in different situations they have identified in the organization that require change. The basic requirement in this part is to understand the change itself in order to avoid repeated try and error but to identify the matching theory easily. There are three major steps that lead to the implementation of the change through strategic leadership. It requires first to diagnose the need for change in an organization probably due to global and technological changes or any other reason. After identifying the need to do organizational change, it is followed by introducing an intervention and finally evaluation and stabilizing change. The above three steps of change are cons istent with the three steps to be discussed in the Lewins Model (Pryor et al, 2008) Lewins Model/ Theory Lewins model is characterized by three major steps of implementing change which include 1) Unfreezing the present- This involves diagnosing the need for change in an organization. 2) The second step involves moving from the present by introducing intervention. This is where the parties involved stop using the old and the ordinary methods in running the organization and starts using the new changed techniques. 3) Refreezing- This is the final stage of action as seen in the Lewins Model and it involves final evaluation and stabilizing of the change process. This is where the organization community is now convinced that the direction the leadership took is the best and the results may even be felt (Pryor et al, 2008). For the Lewins model to be significant and permanent it is important to carefully follow the above mentioned steps, otherwise, the impacts will be short lived. It is important to move from the present without giving room to the possibility of moving back. It is a planned change whose speed has drastically increased in the present day. However, the Lewins model can be applied in unplanned changes in a situation where there is a high probability that change will occur. For instance, in the cases of natural disaster like hurricanes, earthquakes and floods, the probability of change taking place is very high whereby, these occurrences happen unplanned. It is therefore possible to apply this model on preparation of a disaster to take place in some unknown time. In most cases, the public may not be willing the changes proposed by their leaders whereby the three stages are not carefully followed and this results in damages when the public is caught unawares (Pryor et al, 2008). Scheins Model This theory is an extension of Lewins Model which describes how the three stages of action should be implemented. It describes on the best methods of unfreezing, moving from the present and freezing. Schein describes that for unfreezing to work, or diagnosing the need for change in an organization, in order for people to embrace the change, they must first see the need for change, whereby they are not satisfied with the prevailing status quo. This is where people start seeing the difference between the existing state and the expected state. Once people realize the gap between what is prevailing and what is expected, they are motivated to work towards change in order to bridge the gap and achieve their goals. In order to achieve or accomplish the desired goal, people must be assured that taking the action of change wont humiliate or frustrate them in any way (Pryor et al, 2008). The second stage of organizational change involves moving or changing from the present to the future or the expected goal. Schein identifies this stage with cognitive restructuring which helps people adopt a different view of event from the present to the future. He describes that for cognitive restructuring to be effective, people must identify with new role models as well as acquiring new and relevant information pertaining the new changes to help them move forward (Pryor et al, 2008). The third stage of organizational change according to the Lewins model of change management is the freezing stage. This stage is involved in stabilizing the change making it permanent and ensuring that it is not short-lived. In his description over this stage, Schein has divided this stage in to self and relation with others. He describes that for the change to be stable and permanent, people must personally adopt the changed way of doing things and make it comfortable and usual to work out things using that method. In relation with others, they must ensure that their attitude and behavior are aligned towards the new system permanently (Pryor et al, 2008, p9). Lippitt, Watson and Westleys Expansion of Lewins Change Model This model expands and changes the Lewins model by making the steps of change five instead of three. The five stages of the expanded model include unfreezing, establishing a change relationship, moving, refreezing and finally achieving a terminal relationship (Pryor et al, 2008, p10) Kotters Model Kotters model of change management is an eight phase theory whereby each step lasts a certain period and mistakes in one phase can affect the success of the whole plan. This model is best suit in strategic leadership and strategic management whereby through changing the vision of an organization, it is possible to change the vision of the organization. The eight phases of Kotters model include 1) Creating a sense of urgency 2) Proper handling of the resistant groups 3) Creating a plan of action 4) Proper communication of change to the organization 5) Doing the necessary training pertaining the new idea 6) Short terms rewards to those who have embraced change 7) Process evaluation and implementing the necessary changes 9) demonstrating the relationship between new behaviors and organizational success change to reinforce making the change permanent (Pryor et al, 2008, p10) . Role of Strategic Leadership in Organization Change Strategic leadership involves the application of strategy in the management of an organization. In this case, leaders are very instrumental in ensuring that organizational change establishes and is permanent. There are different types of leaders some of which cannot be able to see through a process of change while others are very good at it However, due to specialization, the two kinds of leaders to discussed briefly below are necessary in an organization setting in the process of change (Centre for Creative Leadership, 2005, p1). The charismatic leader- This kind of a leader has personal quality and ability to mobilize and sustains a n activity in an organization. During the process of change, a charismatic leader, through personal action and perceived personal characteristics, is able to mobilize the employees and sustain an efficient adoption towards the new dynamics. A charismatic leader can easily change an individuals values, goals, needs and aspirations. Though he is the popular kind of a leader, his leadership is observable and definable since his behavioral characteristics are very clear. A charismatic leader has three major components: envisioning, energizing and enabling which are very key in the process of organizational change (Schneier, 2011, Pg 281). Instrumental leader- This kind of a leader ensures that every person in the management team as well as all the employees follow the proposed line of change to ensure that the process is consistent and permanent. He invests in building of competent teams, clarifying the line of action to his team, both leaders and the employees, building in measurements and administration of rewards and punishment depending on how individuals handle the process. An instrumental leader ensures that the established process of change is not short lived but lasts permanently (Schneier, 2011, Pg 281). Effective organizational transformation requires both charismatic and instrumental leaders. A charismatic leader is good at generating energy, creating commitment and directing individuals towards the new approach of the organization. An instrumental leader eurs consistency in the adoption of te new organizational approach. Let us look at some of the roles of strategic leadership in organizational change management (Ireland Hitt, 2006, p63). As mentioned earlier, organization change is not always embraced positively in an organization. In this case, strategic leadership should be capable of introducing the news about change in a very professional and conducive way to ensure that the parties involved receive them positively (Heller Bonno, 2006). This includes proper prior training, workshops and acting as role models to the rest such that the rest of the people are motivated and are eager to learn more and adopt the change. It is necessary to introduce the process of change in piecemeal to reduce chances of resistance (Appelbaum, St-Pierre Glavas, 2000, pg 294). Once the organization is aware of the intended change and the means and dynamics of implementing change, it is the role of leaders to ensure that the procedures are carefully followed. This involves consistent monitoring and evaluation of the employees, rewarding those who do well to motivate them whereas those who entertain laxity are faced with the appropriate repercussion. If the leadership is consistent with monitoring and evaluation processes, adoption of the new leadership techniques may take root very easily and the employees will forget the old system and get used to the new one (Schneier, 2011, Pg 281). The effectiveness of the management affects the success of change management a great deal. During the initial stages of a change process, a leader ought to be envisioning such that he is able to create a picture of the future which people can identify with and work towards its achievement. People are more likely to be committed when working towards a common goal (Schneier, 2011, Pg 281). Another role o a strategic leader is generation of energy and motivation of workers in the organization to motivate them to work towards the set goal. The common method a leader may use in energizing the employees is through demonstration of personal excitement through personal contact with the organization employees. Once employees identify the confidence in their leaders, they may not hesitate to be involved in the process of change (Schneier, 2011, Pg 282). Furthermore, strategic leadership is responsible of helping people psychologically to be able to perform when faced with challenges. After everything has been done for the employees and is set to do the work, it is important to give them emotional support in times of need. A good leader should be able to listen to his employees, understand their problem and participate in coming up with a solution. Employees tend to have more confidence in that kind of a leader whereby a charismatic leader is better suit for this position (Schneier, 2011, Pg 282). Economic importance of strategic leadership and change management Strategic leadership in change management has got its own benefits in the overall community of the organization. Some of its benefits towards the organization include, providing the staff with direction and focus, Forming the basis for objectives and strategies, Inspiring positive emotions about the organization, Ensuring unanimity of purpose and Helping resolve divergent views among employees. It is the basic core of an organization that determines success or frustrations in it (Bondenm, 2009). However, strategic leadership may at times be biased and fail to provide the benefits thats meant to bring in an organization. For instance, the strategic vision to be effected by the leaders may only be favoring the interests of the leaders while failing to consider the interests of the subordinate and ordinary employees. Also, senior executives use failureà ¢Ã¢â€š ¬Ã‚ prone practices, may engage in or condone unethical conduct, may pay little or no attention to productivity, quality, and innovation, may allocate time and money unwisely and may apply too much intuition and too little rational analysis (Bondenm, 2009). Conclusion Strategic leadership and change management are two very close areas which are very interdependent. Change management can be very frustrating and at times disappointing if it is accompanied by poor leadership. To have proper and effective organization change, it is necessary to employ good management whose source is from the leaders. This is why it is important as the essay pertains, to learn the relationship between the two, including the theories describing them, their economic importance as well as the role of strategic leadership in change management. Every organization has its culture and in this particular case, the organization change must be in line with the Arabic culture. This is because each community has its own beliefs which are different from the rest in the whole globe. However, since diversified kinds of people are likely to work within the organization who may not be necessarily Arabs, it is important to have policies and changes within the organization that are open to the global and technological changes. Organizations always go through transformation throughout their life cycle. This is because an organization starts when it is small and as people continues investing in it , it continues growing and there may be need for change in one area or another. Also, the prevailing global and technological changes have got so much impact on the well being of an organization. For instance, introduction of the internet has reduced the world in to a cyberspace whereby most of organization needs to adopt these changes. Technology has also reduced the need of so much manpower since most of the work can now be done using the machine. This has led to drastic organizational changes whose goals I mainly to downsize the companies. This results to laying off of staff whose solution has been brought about by the introduction of 24 hour working shift that ensures that work is done all the time. Organization change may either be planned or unplanned. H planned change s mainly mean to improve the conditions of the organization while the unplanned depends on its nature. For example, natural unnatural disasters r not planned and the change enforced by them may not be positive whereas technological and global effects impacts organizations positively and they are not planned. Strategic leadership is very important in managing both of these changes to ensure that their results ar always positive. Several theories have been laid down to show the relationship between strategic leadership in change management. When learnt keenly, it is clear that change involves stages which leaders should overlook carefully since a mistake in one stage of change may affect the overall results of the change process. It is also clear that the leaders should be in the front line in the implementation of the change process. Firstly, they should be the role models to the rest of the organization; they should make proper communication to the people and should ensure that the employees stick to the set plan to ensure consistency. Though strategic leadership has got many benefits, it does not lack a few challenges that affect the effectiveness of the change process. For example, there may lack proper leadership to implement the change process or the change may be biased. Also, the community may resist change making it hard for them to achieve their goals. Through proper leadership and proper prior preparation, It is possible to prevent negative results in a change process.

Tuesday, August 20, 2019

Nurses Benefits On Quality Improvement Teams Nursing Essay

Nurses Benefits On Quality Improvement Teams Nursing Essay As part of a randomized control trial to improve the delivery of preventive services, the authors studied the effect on clinic nurses in the roles of team leaders or facilitators of multidisciplinary, continuous quality improvement (CQI) teams. Our goal was to learn how these nurses felt about their experience with this project, specifically their satisfaction with process improvement, acquired knowledge and skills, and the impact on their nursing role. Overall, the nurses involved in this study reported significant gains in all three areas. This study suggests that CQI can be a valuable vehicle for improving and expanding the nursing role for clinic nurses. QUALITY improvement (QI), also referred to as Continuous QI (CQI), Total Quality Management (TQM), and other terms, has undergone an explosive growth in health care over the last 10 years.1,2 This growth has been accompanied by the publication of a steadily increasing number of articles. However, review of these articles would lead one to believe that nearly all of this QI activity has occurred in hospitals and large medical organizations and, until recently, most has involved administrative processes rather than clinical ones.3-6 Very few articles have addressed smaller ambulatory care settings and almost none have described the QI role of clinic nurses or the impact of these activities on nurses. Is involvement on QI teams helpful to nurses and do the changes in care processes produced by these teams improve the ability of nurses to provide better patient care? What is the potential for QI to affect the often-restricted role of nurses in ambulatory care? Our involvement in a large scientific trial of QI as a way to create more systematic delivery of preventive services in private medical clinics has provided us with an opportunity to begin answering these questions. This involvement brought us into frequent contact with all types of clinic personnel, but particularly with the nurses who often served in leadership roles on the clinics QI teams. As we provided training or consulting with these nurses, we noted that many of them seemed to enjoy the opportunity and reported anecdotes about how it had expanded their abilities. We conducted a systematic series of interviews and a survey with the clinic nurses who were involved in the trial as leaders or facilitators of the QI teams established in these clinics for preventive services. This studys goal was to learn how these nurses felt about their experience in three areas: 1. satisfaction with the process and its results for them 2. acquisition of specific knowledge and skills 3. impact on the nursing role Back to Top BACKGROUND The trial was called IMPROVE (IMproving PRevention through Organization, Vision, and Empowerment) and it was funded by the Agency for Health Care Policy and Research as a randomized controlled trial.7,8 Sponsored by two normally competing managed care plans (Blue Plus and HealthPartners), it was designed to test the hypothesis that such plans could improve the delivery of specific adult preventive services in contracted clinics by using CQI methods to develop prevention systems. Forty-four individual primary care medical clinics in the Twin Cities region of Minnesota were recruited for the trial from 33 of the 71 medical groups eligible to participate by reason of a contract with one or both plans and location within 50 miles. No financial incentives were provided to the clinics to participate other than reimbursement for the research evaluation efforts (eg, pulling charts for audits, providing patient appointment lists for sampling, etc.). The clinics ranged in size from 2 to 15 primary care clinicians (except for one residency-training clinic with 28), with an average of 8. At the time of recruitment, only an average of 19 percent of their patients were members of the two sponsoring plans. Thus, they were fairly typical of this regions clinics except perhaps in having a particularly strong interest in working on improvement of their preventive services and in learning how to use CQI. At the start of the trial in September 1994 each of the 22 clinics randomized to the intervention arm was asked to form a multidisciplinary QI team with a management sponsor and a leader and facilitator for the team. We suggested that they name a physician as leader and a nurse as facilitator but in this, as in all aspects of the trial, all decisions were up to the clinic. The IMPROVE team provided just-in-time group training to the leaders and facilitators in six sessions over seven months for a total of 26 hours. The training was focused on the specific knowledge and skills needed to use a seven-step CQI process to improve preventive services. During and after the training, IMPROVE project nurses provided periodic telephone and on-site consultation. After an 11-month training period, additional periodic opportunities were provided to network with other clinic leaders and facilitators and to obtain additional group consultations about areas of particular concern. Back to Top METHODS In June of 1996 (22 months after starting the intervention), two of the authors obtained written surveys and conducted individual interviews with each of the nurses who had served as leader or facilitator for one of the clinic teams. One nurse practitioner and two nurses who became facilitators after the completion of the training were excluded in order to provide a more homogeneous group and experience. This left 13 nurses to participate in the study, 9 of whom had served as facilitators and 4 as leaders for their teams. All agreed and signed consents, although one nurse could not find time for the interview and only completed the questionnaire. Other nurses participated as members of some teams, but we felt that the views of those with more project training and experience were especially valuable. The questionnaire was designed to assess the respondents attitudes and beliefs in each of the areas of focus for this study as well as to obtain relevant demographic information. It contained 55 close-ended questions that were developed from learning objectives for the training and a literature review of previous research on the nursing role in ambulatory care settings.9-12 Questions about skills and activities asked for a six-point Likert-scale response from none to very much choices and those asking about satisfaction and nursing roles asked for a five-point scale response from strongly agree to strongly disagree. After pretesting and revision, the questionnaire was mailed to the nurses to complete before the interview. The questionnaire is included in the Appendix. The interviews were structured to obtain qualitative data to expand on the questions in the survey. Eleven interviews were conducted in person at the clinical site and one was conducted over the telephone. Each was tape-recorded and transcribed later. Survey responses were simply summarized and reported directly for the small numbers involved. Questions that were stated negatively in order to improve response validity have been reworded for ease of comparing the answers. The interviews were analyzed for themes and for examples to illustrate questionnaire responses. Back to Top RESULTS Most of the nurses studied had already been involved in some degree of management in their clinics prior to the study. Only four were clinic nurses while two each were clinic manager, patient care manager, and nursing coordinator. The other three nurses were vice president of information services, medical services director, and health educator. Eight held positions that involved supervision of others, and an overlapping eight worked in direct patient care at least part time. As might be expected from such a group, 12 had been nurses more than 10 years and 10 had worked at their present clinics for at least 5 years. Educationally, seven nurses were registered nurses (RNs) (2 with bachelors of science in nursing, two with diplomas, and three with associate degrees) and six were licensed practical nurses (LPNs). All were female. Only four nurses reported that they had received previous formal training in CQI, although another four reported informal on-the-job training as part of a process improvement team. However, only the latter four and one additional other reported previous participation in QI. Three of these had been team leaders, one had been a facilitator, and one was a member of a team. Back to Top Satisfaction with the IMPROVE process improvement experience Table 1 suggests that, even after working on this process for 22 months, most nurses reported high levels of satisfaction associated with this experience of process improvement. That is particularly true for questions about obtaining personal value and improving patient care. Positive recognition from their clinics and greater job security are much less strongly supported. Table 1 From the interviews, several comments reinforced the written survey results concerning the opportunity to learn and grow: I was looking for the experience of a CQI project. I had done some reading on Dr. Deming on my own. I knew he was very successful and I didnt know how. This was just very fascinating to me. Learning something new was probably one of the greatest things that attracted me to this. My mind is just constantly going all the time and I really like getting involved in new things. The nurses also reported high scores in task significance. Questions included, The time spent on this process improvement has been worth it, I feel like what I am doing with my team is worthwhile, and I believe that our process improvement activities have resulted in our patients receiving better care. Comments around task significance centered largely on the perceived benefit to their clinics patients. One nurse responded to the question, What are the three most positive benefits of your involvement in process improvement? by answering: Number one is that we actually focused on those eight preventive services and that when you take a look at them they are actually going to improve somebodys life. And thats going to continue here even after were formally finished. Another repeated theme focused on participation-the opportunity provided to interact in a positive way, not only within each clinic site, but with other clinics involved in the project: Youre not in this alone, youre working with a lot of good people, and not just health professionals. We have good people like _____ who is not a health professional. She works in the business part, but I cant imagine doing this without her because they have the skills of getting the word out when youre busy with patients. So we need each other. It has been fun to be involved with other people. This has given me an awareness of not only my own clinic site, but awareness of the broader picture of health care within the Twin Cities. Back to Top Acquisition of specific knowledge and skills Overall, these nurses reported increasing a wide variety of knowledge and skills relevant to process improvement and working with people as a result of this experience. Table 2 summarizes these reported changes between self-perceived skills before and after the 22-month project. The largest improvements involved learning how to make use of data, managing change, and managing meetings. Even the eight respondents with previous training in QI reported gains, even though they had rated their previous overall QI knowledge and skills as average (3 nurses) to above average (5 nurses). Table 2 From the interviews, several themes emerged as to what the nurses perceived as skills gained from participating in process improvement. The most frequently mentioned skill was the ability to apply a model for problem solving (the seven-step model): I think really learning how to problem solve was very beneficial because we had tried to solve some situational process problems in our clinic before and it gets to a certain point where everyone complains about something and they decide to do something about it and we would set up some basic rules or policies and three or four months later no one was doing it anymore because it didnt work. There never was a lot of follow through, so I think this really gave us a good role model on how to go about problem solving in the clinic. Another frequently cited skill was the ability to effectively conduct meetings: One of the major things I learned was how to run a meeting. It is so effective and we use it so much in other meetings now. People come out of those meetings and say, This is a great way to do a meeting we get out of here on time and we get something done. Other themes cited were around skills gained in interpersonal relationships, specifically the ability to directly deal with coworkers or others on solving problems: I now am being more direct and am looking at things more from a process point of view rather than a personal point of view. Another nurse reported: Overall, now if someone is not following the standard, I approach them now by going over what the protocol is or what the process is, rather than honing in on the fact that the person may not be a good nurse. Back to Top Impact on the nursing role As illustrated in Table 3, these nurses reported that they believe QI is important for nurses and that nurses have a crucial contribution to make to QI. With a few exceptions, they believe that QI will improve the ability of nurses to control their work and many of them feel that their work on process improvement has helped them to be better nurses. However, when asked about each of nine specific areas of nursing activities (room preparation, technical activities, nursing process, telephone communications, patient advocacy, patient education, care coordination, expert practice, and quality improvement), only in QI did more than 3 of the 13 nurses report that they had experienced a significant change in the frequency with which they performed that type of activity after working on this project. Table 3 During the interviews, the nurses were asked whether they saw a role for process improvement in the nursing profession. The majority of the responses revolved around the value they perceived in being able to approach problems in a systematic way: I dont think nurses training ever gave us the skills to deliberately study something and improve it. Yet we get out and we become head nurses. It has helped the role of the nursing supervisors in dealing with their staff. It has helped them work through problems and problem solve rather than just coming to me for an answer. Many of the nurses reported that their environment was changing and that their role had changed. Because of this changing environment, they reported needing new skills and a new way of thinking: Everything is changing. We need to improve for our patients. I think the scope of nursing has changed and that the nurses need to look at the whole system, you know what goes on with the patient besides just with the hands-on things. I think it (process improvement) is a blend of how you clinically take care of somebody, but I think it kind of helps you to critically look at other things. Youre dealing with so many systems with the patient and how they move through these systems. We were never trained to deal with the system, we were only trained to deal with each patient. In the clinic setting, we need to be aware of what we are doing and why we are doing it. There is a lot of time and wasted effort. Back to Top DISCUSSION Although the sample is small, this study helps to document the generally positive feelings of ambulatory practice nurses involved in leading or facilitating their local clinic QI effort to improve the process of providing preventive services. Both their questionnaire responses and their interview comments and anecdotes suggest that they feel they benefited from their involvement with this project, despite the fact that it required a great deal of time and energy from them. Overall, they report that they were very satisfied with the experience and that it provided them with increased knowledge and skills as well as enhancements for their nursing role. In light of the reported knowledge, skill, and role enhancements, it is not surprising that these nurses would feel satisfied with their experience. Even though most of these nurses were already working at higher-level positions, nursing in ambulatory practice has traditionally been viewed as less prestigious and challenging than hospital nursing, both by nurses and by the public generally. Hackbarths study showed that ambulatory nurses reported more frequent performance of lower-level work dimensions and less frequent performance of dimensions requiring disciplinary knowledge and critical thinking, despite the growing complexity of care in ambulatory settings.12 Capell and Leggats comment that the traditional view of the nurse as one only involved in the accomplishment of tasks prescribed by others is no longer fitting in todays health care environment, does not mean that traditional role is disappearing.13(p39) Thus, anything that promises improvement in the nursing role is likely to find appeal. Counte has shown that in the hospital setting, personal participation in a TQM program was associated with higher job satisfaction.14 McLaughlin and Kaluzny feel that the new set of decision-making skills required by TQM includes not only technical skills like data management and statistical analysis, but also the ability to work well in multidisciplinary teams.15 Despite previous QI training and/or experience, all of the nurses in this project reported gains in skills, and most of these skills were gained in the areas noted above, along with change management. Another aspect of the current health care environment that lends both importance and urgency to acquiring new skills is the extreme degree of turmoil in health care, especially in the Twin Cities. As Magnan has documented for these clinics involved in the IMPROVE trial, enormous change is going on.16 Within a one-year time period during the process improvement efforts described here, 64 percent of the clinics were purchased, merged, or underwent a major shift in affiliations; 77 percent of the clinics changed at least one major internal system; and 45 percent of the clinics changed their medical director and/or their clinic manager. This turmoil may explain why so few respondents reported that the experience provided them with more job security in their current clinic (question 12 in Table 1), even though it gave them more job opportunities for the future (question 9). Clearly QI is very important to health care improvement and reform. Phoon et al.17 believe that the success of health care delivery depends on the successful integration and coexistence of QI and managed care. Moreover, they believe that nurses play a key role in this integration, although they tend to emphasize primarily nurse managers and practitioners. Spoon et al., on the other hand, use their experience with 45 CQI process improvement teams in a community hospital to highlight the potential for this experience to empower typical hospital nurses.18 They also point out the many ways nurses are essential to most of the steps in the improvement process. Corbett and Pennypacker go on to describe a process improvement effort that took place entirely within a hospital nursing department,19 although that is not particularly consistent with the interdisciplinary needs for most QI efforts. It is worth highlighting that the training in this project was very action oriented. It focused not on theory, but on the application of process improvement and team skills. For example, the trainees learned to flow chart their own clinics prevention process and to collect and analyze their own data in order to learn the root causes for the problems with that process. Role plays of meeting management skills and audits of dummy charts prepared them for applying those skills with their own clinic teams. A basic assumption governing the intervention with these trainees and their teams was that they could act their way into a new way of thinking by applying specific skills in a structured way. These new ways of thinking derive from a real understanding of work as process and include recognizing that problems are generally due to systems deficiencies rather than to individual workers. In other words, we were teaching systems thinking-what Peter Senge describes in The Fifth Discipline as the discipline for seeing wholes.20(p68) We believe that we saw this type of fundamental change in thinking in these nurses and others involved in this improvement process. Over time, the language of the group began to change and to include terms and statements that reflected systems thinking. For example, one rather taciturn physician remarked after the third training session that I never realized how many people were involved in getting the patient ready to be seen by me Aside from the knowledge and skills acquired from the training and the task, it was clear that most of these participants highly valued the opportunity to talk with others in similar environments. They liked to share frustrations as well as to learn from the efforts of peers in other situations. Most clinic personnel are surprisingly isolated, with few opportunities to attend broadening learning experiences, much less to learn first-hand how their way of doing things compares with that of others. We believe that this study and our experience with providing training and consulting for 60 clinics show that there is a great deal about the concepts and techniques of QI that appeals to nurses and other health care professionals. It appeals to both their scientific orientation and their desire to help improve things, in particular their customers-each patient. The acquisition and the application of these concepts and techniques appear to be both satisfying and broadens their views of how they can contribute to health care. Finally, it is worth noting that besides enhancing the skills and satisfaction of nurses, the QI projects in which they work are often likely to lead to role enhancements for nurses, especially those in ambulatory care settings. QI teams interested in improving prevention or other clinical areas of focus, like those we had the privilege to work with, will find that they cannot do this without expanding the role of nurses. McCarthy et al.,21 among others, have demonstrated the power of empowering clinic nurses to offer and arrange for mammography as patients are seen. The Oxford Project in England has carried this even further by creating a new profession for facilitators to help primary care practices improve their prevention activities by training practice nurses to fill an expanded role in performing health checks and facilitating practice system changes.22 Most of these external facilitators are also nurses and it is recommended that all of them have that background.23 Astrops des cription of the facilitators activities within a practice sound very similar to those of the nurses involved in this project and paper. Both this project and the literature suggest that QI concepts and techniques can be important vehicles for improvements in both patient care and in the skills, roles, and job satisfaction of nurses. This can be stimulated and assisted by managed care plans and others external to individual practice settings, but ultimately its success will depend on individual nurses, like those in this study, using their creativity and energy to make it happen. Back to Top REFERENCES 1. Berwick, D.M. Continuous Improvement as an Ideal in Health Care. New England Journal of Medicine 320, no. 1 (1989): 53-56. UvaLinker Bibliographic Links [Context Link] 2. Laffel, G., and Blumenthal, D. The Case for Using Industrial Quality Management Science in Health Care Organizations. Journal of the American Medical Association 262, no. 20 (1989): 2869-2873. [Context Link] 3. Barsness, Z.I., Shortell, S.M., and Gillies, R.R. National Survey of Hospital Quality Improvement Activities. Hospitals and Health Networks 67, no. 23 (1993): 52-55. UvaLinker [Context Link] 4. Shortell, S.M., OBrien, J.L., Carman, J.M., et al. 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Managed Care and Total Quality Management: A Necessary Integration. Journal of Nursing Care Quality 10, no. 2 (1998): 25-32. Ovid Full Text UvaLinker Request Permissions Bibliographic Links [Context Link] 18. Spoon, B.D., Reimels, E., Johnson, C.C., and Sale, W. The CQI Paradigm: A Pathway to Nurse Empowerment in a Community Hospital. Health Care Supervisor 14, no. 2 (1995): 11-18. Ovid Full Text UvaLinker Request Permissions Bibliographic Links [Context Link] 19. Corbett, C., and Pennypacker, B. Using a Quality Improvement Team to Reduce Patient Falls. Journal of Healthcare Quality 14, no. 5 (1992): 38-54. [Context Link] 20. Senge, P.M. The Fifth Discipline: The Art and Practice of the Learning Organization, New York: Doubleday, 1990. [Context Link] 21. McCarthy, B.D., Yood, M.U., Bolton, M.B., et al. Redesigning Primary Care Processes to Improve the Offering of Mammography. The Use of Clinic Protocols by Nonphysicians. Journal of General Internal Medicine 12, no. 6 (1997): 357-363. [Context Link] 22. Fullard, E., Fowler, G., and Gray, M. Promoting Prevention in Primary Care: Controlled Trial of Low Technology, Low Cost Approach. British Medical Journal 294, no. 6579 (1987): 1080-2. UvaLinker Bibliographic Links [Context Link] 23. Astrop, P. Facilitator-The Birth of a New Profession. Health Visitor 61, no. 10 (1988): 311-312. [Context Link] The authors would like to thank the 46 clinics that participated in the IMPROVE project. These included the two demonstration clinic sites; Kasson Mayo Family Practice Clinic and HealthPartners St. Paul Clinic. Intervention Clinics Apple Valley Medical Center Aspen Medical Group, W. St. Paul Aspen Medical Group, W. Suburban Chanhassen Medical Center Chisago Medical Center Creekside Family Practice Douglas Drive Family Physicians Eagle Medical Fridley Medical Center Hastings Family Practice Hopkins Family Practice Interstate Medical Center Metropolitan Internists Mork Clinic, Anoka North St. Paul Medical Center Ramsey Clinic, Amery Ramsey Clinic, Baldwin River Valley Clinic, Farmington River Valley Clinic, Northfield Southdale Family Practice Stillwater Clinic United Family Medical Center Comparative Clinics Aspen Medical Group, Bloomington East Main Physicians

Monday, August 19, 2019

Finding Freedom in Kate Chopins The Awakening :: Chopin Awakening Essays

Finding Freedom in The Awakening  Ã‚  Ã‚   The Awakening was shocking to readers in 1899, and would be today if it were published in â€Å"Ladies Home Journal†. Even today, women are expected to sacrifice themselves, if not to their husbands, then definitely to their children. I find it interesting that Grand Isle is the setting for the beginning and end of the novel. The story is built around a circle and represents the whirling force that is the energy of Edna’s life. The circle reminds me of Yeats’ â€Å"The Second Coming† : â€Å"Turning and turning in the widening gyre/things fall apart/the center cannot hold.†   So often I wanted Edna to act and she didn’t, I suppose that it is Chopin’s purpose to not let us into Edna’s thoughts, or make us omniscient of her actions. This was hard for me while reading. I wanted Edna’s point of view, so I could EASILY figure out what she was going to do, and that’s what was most difficult about this novel, and the reason it is not an easy read. I guess this is Chopin’s purpose. An example is when Edna cannot pinpoint why she is crying - the reader is left just as confused as Edna about the emotions. The sleep motif is very enlightening, in that key moments of Edna’s awakening are preceded by sleep. Sleep, especially for those who are depressed, is used as a way of escape, but in this novel sleep is used mystically as a way for Chopin to show that many things happen while Edna is sleeping that leads to awakening. In this way, the reader can only guess what occurs during sleep. I found I related to Harding Davis’ work more in that I can relate to Hugh and Deb’s oppression (politically, economically, class structurally). One thing the two works have in common is that both main characters (Hugh and Edna) actually hold the key to their own oppression, yet Edna’s social condition doesn’t require much sympathy from the reader. Also, if a reader cannot step into that world with Chopin, it is difficult to comprehend that kind of oppression. Perhaps it’s not correct to use the term oppression when writing about Edna, as it seems she only lives a life of obligations. She breaks free of these, however, and realizes: â€Å"Every step which she took toward relieving herself from obligations added to her strength and expansion as an individual.