Knowledge Management Essay

It involves applying the collective knowledge and abilities of the entire workforce to achieve specific organizational objectives. State agencies should feel free to adapt and use information and tools on the following pages as necessary within their organization. It is provided to be a starting point for sharing knowledge and experience, allowing those who remain with the organization to continue providing quality service. Capturing and sharing critical knowledge and expertise should be occurring continuously among employees. In many cases, however, it is not and this need becomes pressing when a valued employee is preparing to retire or change positions. When an organization is considering implementing a knowledge transfer plan it is important to answer several questions: 1. Is the organization going to fill the vacant position or reassign the duties? 2. Are all the duties of the position still important to the mission of the organization? 3. Is there a need to update the position description? 4. Will the position change, remain as is, or be eliminated once the employee leaves? What is knowledge transfer? David DeLong’s book â€Å"Lost Knowledge† describes knowledge as the â€Å"capacity for effective actions or decision-making in the context of organizational activity†. Accordingly, lost knowledge would decrease this vital capacity and help undermine organizational effectiveness and performance. The goal of transferring knowledge to others [known as Knowledge Transfer] is to: 1. Identify key positions and people where potential knowledge loss is most imminent. 2. Assess how critical the knowledge loss will be. Develop a plan of action to ensure the capture of that critical knowledge and a plan of action to transfer it. Why is knowledge transfer important? A significant percentage of the state’s workforce is nearing retirement age over the next ten years. These employees have acquired a tremendous amount of knowledge about how things work, how to get things done and who to go to when problems arise. Losing their expertise and experience could significantly reduce efficiency, resulting in costly mistakes, unexpected quality problems, or significant disruptions in services and/or performance. In addition, faster turnover among younger employees and more competitive recruiting and compensation packages add significantly to the mounting concern about the state’s ability to sustain acceptable levels of performance. What are the benefits of a knowledge transfer program? Knowledge transfer [KT] programs prevent critical knowledge loss by focusing on key areas. Some of the immediate benefits of KT programs are: 1. They provide reusable documentation of the knowledge required in certain positions or job roles. 2. They result in immediate learning and knowledge transfer when carried out by individuals who can either use the transferred knowledge themselves or have responsibility for hiring, training, mentoring, coaching or managing people within an organizational unit. 3. They reduce the impact of employee departure. 4. They integrate staffing, training, job and organization redesign, process improvements and other responses. 5. They aid in succession planning. 6. They prevent the loss of knowledge held only in employees’ heads when they leave the organization or retire. They enhance career development. Generally Accepted Definitions for Knowledge Management and Transfer Knowledge Management (KM) refers to practices used by organizations to find, create, and distribute knowledge for reuse, awareness, and learning across the organization. Knowledge Management programs are typically tied to organizational objectives and are intended to lead to the achievement of specific outcomes such as shared intelligence, improved performance, or higher levels of innovation. Knowledge Transfer (an aspect of Knowledge Management) has always existed in one form or another through on-the-job discussions with peers, apprenticeship, and maintenance of agency libraries, professional training and mentoring programs. Since the late twentieth century, technology has played a vital role in Knowledge Transfer through the creation of knowledge bases, expert systems, and other knowledge repositories. To understand knowledge management and knowledge transfer, it is helpful to examine the differences between data, information, and knowledge. Data is discrete, objective facts. Data is the raw material for creating information. By itself, data carries no judgment, interpretation or meaning. Information is data that is organized, patterned and/or categorized. It has been sorted, analyzed and displayed, and is communicated through various means. Information changes the way a person perceives something, thus, affecting judgment or behavior. Knowledge is what is known. It is richer and more meaningful than information. Knowledge is gained through experience, reasoning, intuition, and learning. Because knowledge is intuitive, it is difficult to structure, can be hard to capture on machines, and is a challenge to transfer. We often speak of a â€Å"knowledgeable person,† and by that we mean someone who is well informed, and thoroughly versed in a given area. We expand our knowledge when others share theirs with us. We create new knowledge when we pool our knowledge together.

Improving Communication for People with Learning Disabilitie

learning zone CONTINUING PROFESSIONAL DEVELOPMENT Page 58 Improving communication for people with learning disabilities Page 66 Learning disabilities multiple choice questionnaire Page 67 Read Annette Martyn’s practice profile on type 2 diabetes Page 68 Guidelines on how to write a practice profile Improving communication for people with learning disabilities NS336 Godsell M, Scarborough K (2006) Improving communication for people with learning disabilities. Nursing Standard. 20, 30, 58-65. Date of acceptance: February 6 2006. Summary Patients with learning disabilities have higher healthcare risks than the general population. Similar essay: Collate Information About an Individual's Communication and the Support ProvidedHealth professionals need to develop skills that enable them to communicate effectively with this patient group. Identifying barriers to communication is the first step to reducing or removing them. Suggested strategies to improve healthcare access for patients with learning disabilities include: developing individualised health action plans, simplifying communication styles and providing accessible facilities and tailored resources. learning activities you should be able to: Understand the impact of communication on interaction between healthcare providers and patients with learning disabilities.Describe the relationship between communication and the health inequalities experienced by people with learning disabilities. Identify strategies to improve communication between health providers and patients with learning disabilities. Authors Matthew Godsell and Kim Scarborough are senior lecture rs, Faculty of Health and Social Care, University of the West of England, Bristol. Email: Matthew. [email  protected] ac. uk Introduction Learning disability is not a diagnosis but a term used to describe people with a wide range of strengths and needs.Eighty per cent of children and 60 per cent of adults with learning disabilities live with their families (Gravestock and Bouras 1997), and many people with learning disabilities exceed the expectations of families and professionals in their capacity to learn new skills and develop their talents (NHS Executive 1999). The term ‘learning disability’ says little about an individual’s strengths and needs but it does incorporate three elements that appear in most definitions (Box 1). Emerson et al (2001) state that the number of people with learning disabilities in the UK has not been determined.They estimate that in the UK there could be as many as 350,000 people with severe learning disabilities (intelligence quotie nt (IQ) 50). This means that 2 per cent of patients are likely to have a learning disability (NHS Executive 1999). The ways in which people with learning disabilities are described have changed. Terminology and related facts are listed in Box 2. NURSING STANDARD Keywords Communication; Learning disabilities nursing: attitudes These keywords are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review.For related articles and author guidelines visit our online archive at www. nursing-standard. co. uk and search using the keywords. Aims and intended learning outcomes The aim of this article is to explore the impact of communication on health care for people with learning disabilities. The article discusses how cognition and communication influence interactions between healthcare providers and patients. It also examines how poor communication can contribute to health inequalities that separate people with learning disabilities f rom the rest of the population.The article explores communication strategies that can overcome or reduce barriers to effective health care. After reading this article and completing the 58 april 5 :: vol 20 no 30 :: 2006 Time out 1 Based on a figure of 2 per cent of patients having learning disabilities, it is likely that 40 per 2,000 patients registered with GP services are likely to have learning disabilities. How many patients with learning disabilities are you aware of in your practice area? List some of the reasons that might prevent people with learning disabilities from accessing local health services. Health inequalitiesAlthough people with learning disabilities are living longer, the gap that separates the health status of people with learning disabilities and the general population has increased. Cohen (2001) asserted that gross inequalities in health are politically, socially and economically unacceptable. An investigation into health inequalities by the Disability Rights Commission (Nocon 2004) found that people with learning disabilities have: An increased risk of early death compared with the rest of the population; mortality rates are particularly high for those with more severe impairments.A greater variety of healthcare needs. Many needs that are not met. High rates of unrecognised or poorly managed medical conditions including: hypertension, obesity, heart disease, abdominal pain, respiratory disease, cancer, gastrointestinal disorders, diabetes, chronic urinary tract infections, oral disease, musculoskeletal conditions, osteoporosis, thyroid disease, and visual and hearing impairments.A briefing paper produced by the NHS Service Delivery and Organisation (SDO) Research and Development Programme (NHS SDO 2004) identified barriers to appropriate and timely BOX 1 Definition of a learning disability A person with learning disabilities has: Significant reduction in the ability to understand new or complex information. Reduced ability to cope inde pendently. Impairment starting in childhood that will have a lasting effect on development. (DH 2001) access to health care within and outside services.Many people with learning disabilities find that identifying their healthcare needs is a major challenge. Proactive strategies are required to encourage people to access the full range of services that are available. Some people with learning disabilities have said that negative and unhelpful attitudes from healthcare workers have prevented them from seeking medical help (Bristol and District People First 2003). Support and encouragement are required by carers, allies and friends before people with these concerns are ready to engage with services again.People are more likely to trust service providers when they are convinced that services and practitioners have responded to their needs by improving communication skills and producing information in an accessible format. People with learning disabilities have the same right to access m ainstream services as the rest of the population (Department of Health (DH) 2001). However, mainstream services have been slow to develop the capacity and skills to meet their needs.In the document Valuing People (DH 2001) it was acknowledged that the wider NHS had failed to consider the needs of people with learning disabilities and that overcoming this source of inequality was the most important issue for the NHS to address for this patient BOX 2 Terminology and facts related to learning disabilities ‘Mental handicap’ was a term used to describe people with learning disabilities. It is no longer used in the UK. ‘Mental retardation’ is a term used internationally, however, it is not an accepted term in the UK and some may find this term offensive. Learning difficulty’ is the term used in education to define individuals who have specific learning needs, for example, dyslexia. Some people who are identified as having learning difficulty by education s ervices may also be considered to have a learning disability, but this is not necessarily the case. ‘Mild’, ‘moderate’, ‘severe’ and ‘profound’ are terms to describe different degrees of disability (Figure 1). A person with mild learning disabilities might communicate effectively, learn, live and work with little support.However, a person with profound learning disabilities will require support with activities of daily living, for example, communication, dressing, feeding, washing and mobility. A diagnosis of ‘mental illness’ is not the same as having a learning disability, but people with learning disabilities may have mental health issues as well. Not everyone with learning disabilities requires a social worker or a community nurse. People with learning disabilities may have multiple diagnoses resulting in complex health needs. People with the most profound physical or sensory impairments do not always have the most profound cognitive impairments.NURSING STANDARD april 5 :: vol 20 no 30 :: 2006 59 learning zone nursing attitudes group. The briefing paper produced by the NHS SDO (2004) provided key action points for removing barriers and improving access to health care, which included: Using specialist learning disability teams to aid adaptation of mainstream services to meet the needs of patients with learning disabilities. Developing strategies for health education and health checks for people with learning disabilities that promote timely access to health care.Families and paid carers have an important role in helping people with learning disabilities to access health care. Some people will need assistance to recognise mental health problems and to identify gradual changes in health. Time out 2 Make a list of the ways that you communicate with patients about their health, for example, through appointments and telephone calls. Take three examples from your list and consider reasons why communi cation with a person with learning disabilities might be difficult.Give an example of effective communication between a practitioner and a person with learning disabilities. Policies should address the use of technology to support communication, and the development and dissemination of accessible information. Jones (2003) suggests that managers and commissioners of services should liaise with health, social care and education agencies to ensure consistency in communication policies throughout the lives of people with learning disabilities. Communication can be broadly defined as the exchange of information between a sender and a receiver (Figure 2).Where a person has learning disabilities they may be communicating with an intention to attract a communication partner and commence a two-way dialogue. However, for some people with profound learning disabilities sending a message might be a response to their body and feelings. Their level of cognition might be such that they are unaware of possible communication partners and of how to take the communication further. This is called pre-intentional communication, in which the individual says or does things without intending to affect those around them.It is important to remember that everyone communicates and that the role of communicator and communication partner swaps from one person to the other so that a conversation can develop. The challenge for health professionals is to develop skills that enable them to interpret the messages they receive and make the messages they send understandable. Communication is not only about verbal communication; it is also about nonverbal communication, for example, the use of body language, words and pictures. CommunicationRecommendations have been made to improve communication and access to health services for people with learning disabilities. Jones (2003) states that services supporting people from birth to older age should develop communication policies. FIGURE 1 Estimated pe rcentage of people with learning disabilities according to level of severity Mild Moderate 12% Severe Profound 80% 7% 1% Augmentative and alternative communication systems Systems of communication, such as sign language, symbols and eye pointing, are known as augmentative and alternative communication systems (AACs).AACs can be used to enhance or replace customary pathways, such as speech or writing. The use of photographs of everyday objects, picture boards, line drawing and real objects are good ways to enhance communication with people with learning disabilities (American Speech-Language-Hearing Association (ASHA) 2005). You do not need to attend specialist training to be able to use AACs such as these. More formal AACs, such as Makaton (a form of sign language for people who have learning disabilities that uses keywords to enhance understanding), require preparation but learning a basic vocabulary does not require extensive training.Cognition and communication (Winterhalder 1997 ) Understanding complex information People with learning disabilities have a reduced ability to NURSING STANDARD 60 april 5 :: vol 20 no 30 :: 2006 understand new or complex information (DH 2001), and those who experience difficulties when processing information may find it hard to learn new skills. Intelligence can be quantified as a figure related to an individual’s IQ. However, it might be more useful to think about intelligence in relation to cognitive processes.Smith and Mackie (2000) describe cognitive processes as: ‘†¦the way in which our memories, perceptions, thoughts, emotions and motives guide our understanding of the world and our actions. ’ Intelligence exerts a powerful influence over the ability to process information, the capacity to learn new skills and to adapt knowledge to different situations. Intelligence is an attribute that can guide our understanding of the world, but it is not fixed or static. Teaching and learning strategies can be used to stimulate cognitive processes so that people can approach information, or potentially confusing situations, with more confidence.Similarly, complicated tasks and information can be broken down into small, simple steps so that people can approach them in stages. Attempting to understand another person’s cognitive processes can help practitioners to develop a more empathetic and person-centred approach to care, and can provide an incentive to develop the teaching and learning strategies that are best suited to the individual needs of patients. Coping independently People with learning disabilities may have a reduced ability to cope independently (DH 2001). Independence is defined according to levels of social functioning.Assessment of a patient’s strengths and needs in social functioning is a fundamental stage in developing planned care that is familiar to practitioners from all branches of nursing. Making an accurate assessment of social functioning provides val uable information about the range of activities that a person can undertake on his or her own as well as those activities where a person requires support. Some people with learning disabilities may require assistance with tasks such as washing and dressing, and many need help to have their mode of communication understood.Learning disability and development Learning disability starts before adulthood, affects people of all ages and has a lasting effect on development (DH 2001). A majority of younger people with learning disabilities are living in the community with their parents or carers. Older people with learning disabilities also live in the community but they may have periods of institutional care. Some people will have frequent contact with health services and others have irregular contact. People with learning disabilities are not a homogeneous group. Their perceptions of nurses, NURSING STANDARDFIGURE 2 A model for communication Person communicating: we take turns in this ro le of sender of information. Depending on the person’s cognitive ability, this may be intentional or pre-intentional communication Communication barriers: can be present in the environment as well as being caused by the communicator and communication partner Communication partner: we take turns in this role of the person who receives the information sent, makes sense of it and responds appropriately doctors, health centres, clinics and hospitals will have been shaped by their formative experiences with staff and services.Providing encouragement for people with learning disabilities to attend health checks and to make use of healthcare services can involve changing their perceptions of health professionals. Some people with learning disabilities have not received the treatment they need because they are reluctant to engage with services where they have had bad experiences in the past. To encourage people with learning disabilities to make effective use of healthcare services t hroughout their lives, practitioners need to use their communication skills to initiate and maintain positive relationships. Time out 3Think about the last time you communicated with a person with learning disabilities, or someone who has communication difficulties. Refer to the list you made in Time out 2 about the communication systems you use in your workplace. What are the main barriers to communicating about health with a person who has learning disabilities? How do you remove or reduce barriers to communication? Which environmental factors impede communication? Identify any barriers that you had not previously considered. april 5 :: vol 20 no 30 :: 2006 61 learning zone nursing attitudes Barriers to communicationThere are barriers to communication which can be identified in relation to the person with learning disabilities, the health professional and the environment (Box 3). When barriers have been identified, health professionals can start to think about ways of reducing or removing them. Health professionals exchange information by using terminology that reflects their specialised knowledge. Patients and other people who are not involved in the day-to-day delivery of health care BOX 3 Barriers to communication The person with learning disabilities may: Have limited understanding.Have limited vocabulary or difficulty speaking. Have sensory impairments that limit ability to hear requests or instructions. Have poor understanding of health and healthy living. Be scared of people in uniforms. Be stressed because of illness. Not like new places. Have difficulty waiting and may not understand the concept of time or queuing. Have limited literacy and numeracy skills to read health advice and information, for example, instructions, letters, dosages. Expect contact with nurses to be unpleasant because of previous experiences. The nurse may: Be rushed because of heavy workload.Have biases and assumptions about people with learning disabilities. Have poor listeni ng and attending skills. Be unable to understand augmentative and alternative communication systems. Have limited knowledge of the individual. Have insufficient time to develop a good relationship with the individual or carer. Not use visual aids to support understanding. Use technical jargon and/or long words. Provide written information without thinking of the patient’s ability to read it. Provide information about the next appointment in a way the patient will not understand or remember.The environment may: Be crowded. Busy. Uncomfortable. Have strange smells and noises. Bring back bad memories. Have limited physical access, for example, no hoists. Include unhelpful people. Have poor signage, relying on literacy skills and good sensory abilities. Have no area to sit quietly with limited sensory stimulation while waiting. Be filled with machines and instruments that a person with learning disabilities may not understand. may find it difficult to comprehend the terms and ide as they encounter in healthcare settings. They can find it hard to follow advice or instructions.This could result in patients making inappropriate decisions or exposing themselves to unnecessary risks. For example, patients with learning disabilities who take their own medication may be at risk of overdosing or taking an ineffectual dose, particularly if the route and dosage of a newly prescribed medicine has not been explained clearly and/or recorded in an accessible format. Time out 4 Consider the list of potential barriers to communication and categorise them according to: Barriers that have been addressed for patients with learning disabilities using the services you work in.Barriers that can be remedied quickly. Barriers that need planning to be reduced or removed. Barriers that require financial investment to be reduced or overcome. Discuss this list with your colleagues. Identify strategies for removing barriers and improving communication. Good practice in communication In South Warwickshire, health passports have been developed for people with learning disabilities (Leamington Spa Today 2005). These provide detailed information about an individual’s health, strengths and needs so that practitioners can provide patient-centred care.They are used to improve communication across a range of healthcare providers. Having an alert system incorporated into patient notes which provides individual communication needs could be beneficial, especially where staff do not know individual patients. Health practitioners may use and be involved in developing health action plans. These are plans specific to individuals and are developed to meet their access needs. Health action plans are a way of overcoming some of the barriers to high quality health care (DH 2001).Plans are produced by a group of people including the patient. They encourage the development of a shared understanding about an individual’s health needs. Where training in health action plann ing has been provided for GP surgeries, improvements have been shown in the health of patients with learning disabilities (Smith et al 2004). There are benefits to having a lead person to deal with learning disability issues. In primary healthcare services, a lead person takes an interest in learning disability issues, collates information, NURSING STANDARD 62 april 5 :: vol 20 no 30 :: 2006 ives support and advice to health staff and develops links with specialist services for people with learning disabilities and other agencies (NHS Executive 1999). Time out 5 Does your organisation have a lead person who is involved in initiatives such as joint communication policies and the development and sharing of accessible health information? If yes, find out how he or she is supporting your team to develop skills in communicating with people who have learning disabilities. If no, how might developing this role benefit your team and improve access to health care for patients with learning d isabilities?To improve communication with people with learning disabilities, more time should be allocated to appointments so that there is more time for them to express themselves and understand any information they have received (DH 1999). This is particularly the case if AACs are being used. Reception staff are often aware of people who have difficulties using services. Supporting these key staff to develop effective communication skills and flexibility can improve access to health services (NHS Executive 1999).For example, if staff in reception are aware that someone finds it difficult to wait in a queue, they may offer that person the first appointment. Several resources have been developed by trusts to improve communication. Some examples of these include: Hambleton and Richmondshire Primary Care Trust (PCT), in partnership with Mencap, has developed an accessible ‘Choose and Book’ guide for hospital appointments that uses a combination of pictures and words to ex plain how patients can make choices about hospitals and appointments.Bristol South West PCT, as part of its ‘Expert Patient Programme’, has developed plans that help prepare people with learning disabilities for a visit to the doctor. The Health Facilitation Team at Gloucestershire Partnership NHS Trust (2004) has produced a ‘traffic light assessment’ that conveys information about individuals on admission to hospital. This ensures that important information is clearly communicated to health professionals. Camden PCT (2005) has used this work to develop an online resource. Although people may appear to have limited communication skills, they should not be ignored.These patients should be addressed directly and NURSING STANDARD the information they receive should be provided in a simple way without being patronising. Effective communication often depends on how the information is delivered. Practitioners may have to talk to carers, but they should not forget to address the person with learning disabilities. Practitioners should examine their beliefs about people with learning disabilities and avoid making assumptions about an individual’s strengths and needs. This will help to make health assessments more accurate (DH 1999).It is useful to invite a speaker with learning disabilities to talk to healthcare staff about living with a learning disability and his or her experiences of accessing health services. Time out 6 What beliefs and values do you think society holds about people with learning disabilities? Some examples of negative beliefs and values are that people with learning disabilities: Have a poor quality of life. Have higher pain thresholds. Are dangerous and promiscuous. Will not understand anything. Should not get married or have children. Cannot care for their children. Need institutional care. Cannot work.Are like children not adults. What are your feelings about these statements? How might the presence of any or al l of these beliefs influence the care given to a person with learning disabilities? People with learning disabilities can have additional physical or sensory impairments that should be considered. They are also more likely to have more mental health needs than the general population (DH 2001). Where a patient has additional impairments or health issues these need to be considered during communication. The healthcare environment should be adapted to accommodate people with physical or sensory impairments.Time out 7 In your work place: Do you have a private area to talk to a person who has a large wheelchair? Do you have rooms where glare is controlled and the environment is suitable for people with limited vision? Do you consider the needs of interpreters/ carers and ensure they fully understand information before they pass it on? april 5 :: vol 20 no 30 :: 2006 63 learning zone nursing attitudes Accessible information Accessible information comes in many forms, such as videos, CDs, DVDs and audiotapes. Pamphlets can be produced with accessible information about the services offered.Written information needs to be in plain language, with short sentences and one subject per sentence. Photographs, drawings, symbols and other visual information can be used to support written information. It is important to keep pages uncluttered on plain backgrounds so that text does not detract from graphics. Letters should be large, 16-18 point type size, and fonts that do not have serifs, such as Arial and Comic Sans, should be used. Graphic text, underlining and italics should be kept to a minimum because they can impede readability. Many trusts are now producing resources to enhance accessibility.Some of these include: The United Bristol Healthcare NHS Trust has produced a leaflet called ‘You are coming to the Bristol Royal Infirmary about your heart’, TABLE 1 Using terminology that is easy to understand Health issue Common words that are used Epilepsy Investigat ions EEG (electroencephalogram) Strategies or words that improve understanding Find out more about This word would have to be used, but a photograph of someone having an EEG may help understanding Medicine tablets to help control your epilepsy Having two or more seizures straight after each other or whatever describes status for the individual Taking your medication as we have agreed Things that might make you have a seizure Not being able to have a poo for three days Things you feel in your head and body that make you think you will have a seizure Having a fit or turn, whichever word the person uses which uses pictures and words to introduce some of the staff and explain what happens when patients are admitted to the cardiology department.The Learning Disability Partnership Board in Surrey has developed ‘The Hospital Communication Book’ that combines words, pictures, signs and symbols. Trafford North and South PCTs have produced a toolkit for people with learning disab ilities called ‘Cancer and You’ (Provan 2004). Contact your local Community Learning Disability Team or People First organisation for information about local resources. Simplifying conversation When talking to people with learning disabilities, use approaches similar to those used for written text. Plain language, the use of keywords, short sentences and one subject per sentence should be used. Give people time to process what is being said and to formulate a reply.Use openended questions to assess a person’s understanding and rephrase the question if necessary, as repeating the same question rarely improves understanding. When information is presented during a consultation it is important to check that the person with learning disabilities has understood it. If there is insufficient time during the initial consultation, it may be necessary to make a further appointment to check what the person has understood and retained. For an individual who processes informat ion slowly this might be essential to ensure an accurate assessment and the effective implementation of a treatment plan. Examples of terms that are easier to understand are presented in Table 1.Such terms are only beneficial if the person understands them so, for example, ‘constipation’ could be described as ‘not being able to have a poo’, but the health practitioner needs to know whether the person uses this term to describe defecation. Anti-epileptic drugs Status epilepticus Drug compliance Triggers Constipation Aura Time out 8 Think of four common illnesses that are likely to make a person visit your service. Write these in the first column of a table (see Table 1). Identify the language you use when discussing these illnesses and record these words or phrases in column two. These might be medical terms, health terms or long words. Now spend some time identifying words that are easier to understand and record them in the third column. NURSING STANDARD S eizure 64 april 5 :: vol 20 no 30 :: 2006 ConclusionPeople with learning disabilities may have communication difficulties that have restricted their access to health care and prevented them from receiving the information required to maintain their health. In addition to learning disability, they are more likely to have complex healthcare needs leading to multiple diagnoses. Steps towards better health for people with learning disabilities can be made by providing encouragement and support to attend regular health screening and reviews, and by developing a range of strategies to improve communication between practitioners and individuals with learning disabilities NS RECOMMENDED RESOURCES British Institute of Learning Disabilities (2001) Factsheet No. 005 Communication. www. bild. org. uk/pdf/factsheets/communication. pdf (Last accessed: March 10 2006. British Institute of Learning Disabilities (2005) Your Good Health (a set of 12 illustrated booklets). www. bild. org. uk/publication s/your_very_good_health_details. htm (Last accessed: March 10 2006. ) Communication Matters (updates 2005) What is AAC? www. communicationmatters. org. uk (Last accessed: March 10 2006. ) Communication Matters (updated 2005) How to be a good listener. www. communicationmatters. org. uk (Last accessed: March 10 2006. ) Department of Health. www. dh. gov. uk (Last accessed: March 10 2006. ) Foundation for People with Learning Disabilities (2004) Communication and people with learning disabilities. www. learningdisabilities. org. uk/page. cfm? agecode=ISSICMMT (Last accessed: March 10 2006. ) Foundation for People with Learning Disabilities (2005) Patients with learning disabilities in South Warwickshire have been given a new type of passport to help with their medical appointments. www. learningdisabilities. org. uk/profilenews. cfm? pagecode=ISSICOLN&are acode=ld_communication_news&id=7231 (Last accessed: March 10 2006. ) MENCAP (2003) You and your health: a basic guide to being heal thy. www. mencap. org. uk/download/you_and_your_health. pdf (Last accessed: March 10 2006. ) Plymouth Hospitals NHS Trust (2005) Living with cancer. www. learningdisabilitycancer. nhs. uk/ (Last accessed: March 10 2006. ) Time out 9Complete a SWOT analysis (strengths, weaknesses, opportunities and threats) of your skills and knowledge when communicating with and supporting access to health care for people with learning disabilities. Time out 10 Now that you have completed this article, you might like to consider writing a practice profile. Guidelines are on page 68. References American Speech-LanguageHearing Association (2005) Introduction to Augmentative and Alternative Communication. www. asha. org/public/ speech/disorders/acc_primer. htm (Last accessed: March 9 2006. ) Bristol and District People First (2003) We are People First. (Film) People First, Bristol. Camden PCT (2005) What You Need to Know About Me in Hospital. www. camden. gov. k/ (Last accessed: March 17 2006. ) Cohen J (2001) Countries’ health performance. The Lancet. 358, 9285, 929. Department of Health (1999) Facing the Facts: Services for People with Learning Disabilities: A Policy Impact Study of Social Care and Health Services. The Stationery Office, London. Department of Health (2001) Valuing People: A New Strategy for Learning Disability for the 21st Century. The Stationery Office, London. Emerson E, Hatton C, Felce D, Murphy G (2001) Learning Disabilities: The Fundamental Facts. Foundation for People with Learning Disabilities, London. Gloucestershire Partnership NHS Trust (2004) Traffic light assessment. Unpublished document.Gloucestershire Partnership NHS Trust, Gloucester. Gravestock S, Bouras N (1997) Emotional disorders. In Holt G, Bouras N (Eds) Mental Health in Learning Disabilities: A Training Pack for Staff Working with People who have a Dual Diagnosis of Mental Health Needs and Learning Disabilities. Second edition. Pavilion Publishing, Brighton, 17-26. Jones J (2003) Th e Communication Gap. www. learningdisabilities. org. uk /page. cfm? pagecode= FBFMCHTP04 (Last accessed: March 10 2006. ) Leamington Spa Today (2005) Patients with learning disabilities in South Warwickshire have been given a new type of passport to help with their medical appointments. Leamington Spa Today. January 19, 2005.NHS Executive (1999) Once a Day One or More People with Learning Disabilities are Likely to be in Contact with Your Primary Healthcare Team. How Can You Help Them? Department of Health, Leeds. NHS Service Delivery and Organisation (SDO) Research and Development Programme (2004) Access to Health Care for People with Learning Disabilities. Briefing paper. NHS SDO, London. Nocon A (2004) Background Evidence for the DRC’s Formal Investigation into Health Inequalities Experienced by People with Learning Disabilities or Mental Health Problems. Disability Rights Commission, Stratford upon Avon. Provan K (2004) Cancer and You: Toolkit for Working with People with Learning Disabilities. www. cancerandyou. info/docs/ FullToolkitNov04. pdf (Last accessed: March 9 2006. Smith ER, Mackie DM (2000) Social Psychology. Second edition. Psychology Press, Hove. Smith C, Giraud-Saunders A, McIntosh B (2004) Healthy Lives: Health Action Planning in a Person Centred Way; Including Health in Person Centred Planning. www. valuingpeople. gov. uk/ HealthHealthyLives. htm (Last accessed March 10 2006. ) Winterhalder R (1997) An overview of learning disabilities. In Holt G, Bouras N (Eds) Mental Health in Learning Disabilities: A Training Pack for Staff Working with People who have a Dual Diagnosis of Mental Health Needs and Learning Disabilities. Second edition. Pavilion Publishing, Brighton, 1-6. NURSING STANDARD april 5 :: vol 20 no 30 :: 2006 65

Medtronic External and Internal Analysis Essay

Medtronic Inc. can easily be compared to le Concorde, a turbojet supersonic passenger airliner first flown in 1976. This jet was more than twice as fast as any other airliner ever created, flying at speeds of up to 1,350 mph. The capability to fly at more than twice the speed of a regular airliner equates to twice the flights and premium prices for this astonishing service. The resulting profitability of le Concorde is what puts this machine at the top of its class. In 1957, Medtronic founder Earl Bakken created Medtronic’s Pacemaker, the first wearable device to treat abnormally slow heart rates. The Pacemaker is now the staple product of Medtronic and can be compared to le Concorde for its innovation, efficacy, and profitability. This is just one example of Medtronic’s ability to use its innovation to transform the treatment of chronic disease worldwide. The firm has been a leader in the Medical Device Manufacturing industry for over two decades, developing and manufacturing innovative medical devices to treat more than seven million patients each year. Its products include pacemakers, defibrillators, heart valves, and stents, among others. Medtronic’s drive for excellence is best summed up by its corporate mission, â€Å"To contribute to human welfare by application of biomedical engineering in the research, design, manufacture, and sale of instruments or appliances that alleviate pain, restore health, and extend life† (Medtronic. com). To achieve its goals and maintain success, Medtronic must constantly monitor and evaluate its external environment and the forces in it that could affect the company. The Medical Device Manufacturing industry is exposed to numerous forces and trends that can generate opportunities for firms to exploit as well as threats for firms to avoid. Of note are the effects of rivalry, buyers, regulation, and globalization trends. The Medical Device Manufacturing industry, as a whole, has grown at an annual rate of 18. 9% since 2005, contributing to a high level of industry attractiveness (ibisworld. com). Medtronic is the clear leader with 17. 2% market share. Its closest rivals, Boston Scientific and St. Jude Medical, have market shares of 2. 8% and 4. 8%, respectively (ibisworld. com). Recently, the industry has seen a dramatic increase in consolidation as larger firms have cquired smaller operations in an effort to diversify their portfolios and gain market share. This shrinkage has resulted in greater industry concentration, increasing the rivalry among these key players. Focusing on a more narrow analysis of the Cardiovascular Device segment reveals a similar, more intensified, environment for rivals. Compared to the overall industry, this specific segment has recently witnessed much lower growth rates because the market is saturated with products that have little differentiation and limited innovation possibilities. For this reason, merger & acquisition activity is especially prominent among top firms seeking to create strategic competitiveness. They have identified the threat of rivals and are looking to gain additional resources and capabilities through diversification. The role of buyers is very unique in this industry. While individual patients are the ultimate consumers of medical devices, firms often focus on healthcare providers when selling products. This is because patients in the market have low brand recognition of the devices they use. Instead, they rely on their hospitals and physicians to recommend products for treatment. It is important for manufacturers to understand this distinction since it is these physicians and other providers that have the greatest brand loyalty. That said, individual patients still drive demand for products, and their satisfaction remains the ultimate goal. One key demographic trend of buyers is the aging U. S. population. As life expectancies continue to rise, and the baby boomer generation ages into their late sixties and seventies, this expanding age group will create a great opportunity for medical device manufacturers. For example, elderly patients experience a higher occurrence of health issues compared to the aggregate market, driving demand for medical devices upward. In fact, 40% of all patients diagnosed with heart disease or arthritis are 65 or older (ibisworld. com). The Medical Device Manufacturing industry is also subject to tight regulations, both domestically and internationally. For example, a new device may require a four-year trial before it appears on the market so that the Food and Drug Administration (FDA) can test its long-term effects. Products in Europe, meanwhile, undergo a different regulatory process; products are often introduced in Europe two to four years before they are available for patients in the U. S. Furthermore, compliance with these regulations requires firms to devote significant additional resources, often detracting from investments such as Research and Development. Along with these initial requirements, devices are constantly monitored for defects, which can result in product recalls that damage brand reputation and hurt profits. Globalization trends will certainly continue to have a strong impact on the industry, creating both opportunities and threats. Research shows that exports account for 21. 6% of industry revenue with an expected 2010 growth rate of 3. 9% (ibisworld. com). By developing these export markets, firms can work to maximize capacity utilization as they expand their distribution channels to reach more customers and generate more revenue. This is especially true of developing economies, in which 80% of chronic-disease-related deaths occur. Large portions of these markets are greatly underserved and demand is not being met. In addition, by diversifying into different geographic markets abroad, firms are able to mitigate the risks associated with being too dependent on the domestic market. The emergence of globalization also introduces several threats that firms must be aware of. For one, the competitive landscape changes as companies establish operations sites in foreign countries. When this happens, the demand in export markets declines since customers can purchase devices locally. Exporting firms must then reevaluate their international strategies and consider establishing similar operations of their own. Another threat globalization brings is that of increased competition. Manufacturers constantly fight to expand their geographic reach and to gain control of underserved markets. Given the effects of strong forces and emerging trends in the Medical Device Manufacturing industry, firms should strive to possess a key group of success factors in order to gain strategic competitiveness. The first factor is employees; they must be highly skilled and knowledgeable since the devices they design and produce are very complex. Second, economies of scale allow firms to improve profitability by reducing variable costs in manufacturing, which, in turn, lowers prices for customers. Third, as previously mentioned, the importance of global positioning cannot be understated. In order to compete in the industry, firms must make a global presence, expanding geographic scope and penetrating underserved markets. Finally, access to the latest innovations is imperative. To acquire new technologies, firms must invest considerable resources into Research and Development. Not only must they develop new technologies, but they must also look for ways to continuously improve existing products through high levels of innovation. This understanding of the industry environment is essential when considering a firm’s internal strategies. At the business-level, Medtronic possesses a number of strengths and competencies that are used to create a competitive advantage and contribute to the overall performance of the company. In particular, its research and development efforts along with its superior human resources drive the firm’s differentiation strategy in the Cardiac Rhythm Disease Management (CRDM) unit (see appendix for more strengths). This sector remains the firm’s most profitable product market, accounting for $5. 268 billion of Medtronic’s $15. 817 billion total net sales in 2010 (Medtronic). As a percentage of those sales, Research and Development expenses equated to 9. 23%, a total of $1. 46 billion. Moreover, this expense has seen a Compound Annual Growth Rate of 8. % in the last 5 years, indicating Medtronic’s continued confidence in its ability to create value through the investment in research and development. The innovation fostered by research and development in CRDM has allowed Medtronic to create many new products; the complex nature of these products makes them rare and costly to imitate. They often even trump and replace the existing technology in the mar ket, making them highly valuable and unsubstitutable. These key innovations, therefore, give Medtronic a significant competitive advantage in research and development. For example, the CRDM unit recently introduced a new leadless pacemaker. Once implanted into the heart via catheter, the penny-sized device permanently latches into the flesh with tiny claws. Doctors can then wirelessly monitor and control the pacemaker. Medtronic’s demonstration of reduced size and wire elimination will create a new standard for such devices in the industry, making current, bulky pacemakers obsolete, and giving Medtronic a sustainable competitive advantage. Medtronic’s 40,000 employees also play a key role in the success of CRDM and of the company as a whole. They are the source of one of Medtronic’s most valuable intangible assets: knowledge. With a thorough understanding of human physiology and a breadth of technical skills, employees are a driving force behind the company’s groundbreaking innovations. They generate ideas and implement processes that create new or improved products or therapies. These advancements require that employees are well trained and possess a high degree of knowledge about the products or therapies they develop. In addition to the actual production of products, employees extend their knowledge to customers. By educating healthcare providers and users about the devices, employees ensure that patients safely receive the full benefits of Medtronic’s products. One way Medtronic optimizes its human resources is through collaboration blogs and internal grants. The company’s Quest program awards project grants that encourage employees to test their own ideas for product innovation. Nearly 25% of these projects eventually become a product or some part of a therapy. For example, employee Brain Lee had an idea to create an effective diagnostic tool for patients who suffered from unexplained fainting. With funding from the Quest program, Lee modified a pacemaker by adding self-contained electrodes. The device could be implanted just below the skin, recording electrocardiogram (ECG) signals in an endless loop. Much more effective than existing external tools, Lee’s device received additional funding, leading to successful clinical trials, and, eventually, a commercial release. This is just one example of how Medtronic’s strong workforce creates a core competency for the firm, one that is unmatched by its rivals. Furthermore, the innovations developed by employees and through research and development efforts can often be protected with patents, generating competencies that are not only distinctive, but also sustainable. At the corporate level, Medtronic is very well positioned. The firm outperforms its rivals in terms of market share with 17. 2%, compared to Boston Scientific and St. Jude Medical, which hold 2. 8% and 4. 8% market share, respectively. Since 2007, Medtronic has experienced an 8. 75% compound annual growth rate. While lower than St. Jude’s growth rate of 12. 3% in the period, it is noticeably higher than that of Boston Scientific’s, 6. 84% (See appendix for further financial comparisons). Medtronic’s corporate-level strategy defines which businesses it will be in as well as how it will integrate those businesses to grow and deliver value to stakeholders. The firm currently operates in seven business units: CRDM, Spinal, CardioVascular, Neuromodulation, Diab etes, Surgical Technologies, and Physio-Control, all of which are largely related. Because of Medtronic’s strong war chest, it has been able to focus its growth strategy around acquisitions. Since 2009, the firm has purchased nine companies, including ATS Medical Inc. and CoreValv Inc. , requiring a significant cash investment. In fact, Medtronic spent $370 million when it bought heart valve maker ATS Medical. The firm’s acquisition strategy specifically targets two types of purchases: those that will add immediate revenue to existing businesses, and those that add to Medtronic’s technology portfolio by providing expertise the company does not have. Of late, the firm has been focusing on the former, targeting smaller companies that lack the resources to complete clinical trials and gain FDA approval. Chad Cornell, vice president of corporate development at Medtronic, notes, â€Å"Size is obviously a factor, but it’s not what we start with. † Instead the question is â€Å"how can we add value? That’s the key lens† (Lee). Medtronic’s international strategy is best characterized as a global strategy whereby it develops devices in the United States to be distributed across country markets. To support this strategy, it uses a worldwide product divisional structure. Medtronic has recently changed its strategy, implementing a Global Realignment Initiative in 2008. The goal of the initiative is to reorganize the firm’s resources to focus on areas that add the most value and have the most attractive growth opportunities. Prior to 2008, the company had segmented its global market into the United States market and international markets. Under this new strategy, Medtronic will focus around developed markets and emerging markets, using its resources and capabilities to effectively meet each segment’s unique needs. Developed markets include regions such as the United States and Europe where trained healthcare professionals are familiar with current devices, and new, innovative products are readily accepted. Medtronic relies on its strong innovation capabilities and Research and Development investments to meet the demands of this segment. For example, patients with pacemakers are often denied potentially life-saving MRI scans due to possible pacing interference. Medtronic used its superior innovation and product knowledge to address the concern, manufacturing the world’s first pacemaker that is compatible and safe to use with MRI systems. Introduced in Europe in 2008, this innovative device provides a much-needed solution to millions of people who will now be able to receive the full benefit of a safe MRI scan. Emerging markets, meanwhile, include regions such as China, Brazil, Africa, and the Middle East, where access to care is often limited, and physicians may be unfamiliar with certain medical devices and hesitant to accept new products. In this segment, Medtronic depends on its employees and its reliable, high-quality products. Using these strengths, it focuses on training and educating healthcare providers so that products and treatment are much more accessible to underserved patients. At present, Medtronic operates in more than 120 countries, with more than 16,000 employees in communities outside the United States (Medtronic. om). These employees provide immense value to the company by using their extensive knowledge and skills to educate and collaborate with physicians around the world. Currently, 41% of total revenues are realized outside of the United. Medtronic plans to continue its geographic diversity strategy, aiming to become a â€Å"truly boundaryless organization† an d maintain its commitment to â€Å"making a sustained, global impact in the fight against chronic disease† (Medtronic). In order to keep its world-class status, Medtronic executes various tactics at each of its organizational levels in order to protect its strategic competitiveness. For example, the company uses a frontal assault on its biggest competitor, Boston Scientific. By using revenues created from CRDM, they have the capability to invest large investments into research and development in ways that Boston Scientific cannot. In doing so, they maintain continuous development and improvement of innovative products. Another tactic that Medtronic uses is the pre-emptive strike, identifying and evaluating a valuable opportunity and seizing it before a rival does so. This increases sales, differentiates Medtronic from competitors such as Boston Scientific, and helps foster innovation. Based on the analysis of Medtronic’s external environment and internal strategies, it is clear that the firm is a leader in the Medical Device Manufacturing Industry. However, there are also some key problems and issues the firm should address. Medtronic has had litigation issues over the past few years with recalls in various different product offerings as well as patent and licensing disputes. As noted on the 2010 annual report their litigation charges amounted to nets of, $374 million in 2010, $714 million in 2009, and $366 million in 2008 (36-37). This has been an industry wide issue as seen by Boston Scientifics 2009 litigations charges amounting to $2. 022 billion, $334 million in 2008 and $365 million in 2007 (Boston Scientific Annual Report pg. 69). With these industry wide litigation issues, the FDA is currently creating new standard procedures for testing products and time required to introduce them into the market, which creates a separate challenge in dealing with the new health care reform. In a recent interview with Brian Johnson from Massdevice. om, the CEO of Medtronic, Bill Hawkins outlines the challenges ahead with the new health care reform. â€Å"The new medical device tax will cost us $150 to $200 million per year when introduced in 2013. In 2010 we spent $1. 5 billion on R&D and this tax will directly affect that budget for us which hurts our innovation, or possibly investments in emerging markets†. Cleary the health care reform will be one of the toughest challenges ahead for Medtronic and the rest of the medical device industry.

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Reflective Paper Essay Example for Free

Reflective Paper Essay Introduction   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Organization in the business and industrial setting is like a very interesting organism worthy of effort and time for study. The behavior of people and the environments with which they are in constant interaction is a ceaseless source for curiosity and fascinating research. This is so especially during this particular century when technology sparks the many changes that take place. This generation is in the epoch of organizational reform and innovation. The time is marked with rapid changes in the demography of workforce, changing corporate culture, and changing institutions. In the light of the rapid shift in today’s organizations, the skills required of managers, beginners in the profession and even aspiring students in the discipline, rest on the foundation of knowledge on the whole gamut of organizational development. Corporate America is not without its complications. When the company â€Å"succeeds,† there is with it (the success) a corresponding notion of responsibilities and liabilities. Organizations thrive today because of the policies and guidelines they have managed to fixed firmly in their set-up and translated into their day to day affairs. Big businesses have the competitive edge over others – i.e., over small entrepreneurs, because they have arrived at their positions in the market place by securing certain parameters in the many facets that comprise their organizations. This is especially true on government laws and regulations (McKenna, 2000).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   It is imperative that organizations in industry and business compete with the changing times. To fail to do so may spell substantial loss in both the financial and human capitals; two major components necessary in an organization. Being competitive in today’s business jargon is not as simple as it sounds; it involves a comprehensive and in-depth understanding of the whole gamut of organizational behavior and the complex changes that are dynamic in nature (Mangelsdorff, 2007).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   This paper attempts to express in prà ©cis the various facets of the nature of organization with specific intentions to elaborate on the student researcher’s understanding, insights and learnings regarding how quality management and control systems relate with human motivation. It takes into consideration the importance of how all these concepts are of significance in one’s individual relationships as well as their relevance of the person’s (especially the student researcher’s) professional plans and actual work situations.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Organizational change though oftentimes unpredictable and incomprehensible to many, still goes through a cycle; the nature of which makes it possible for concerned people to study with the hopes and intentions of ultimately, implementing revisions or remodeling. These serve to enhance and improve systems and discover excellent procedures of handling things or procedures and people (Mangelsdorff, 2007). Problem Statements   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   To be specific, the following questions are addressed in this paper: Define what is meant by â€Å"strategic planning.† Distinguish this from long-range planning and other forms of planning. Planning can lead to organizational change. What do the text writers feel are the issues that face the managerwho plans to bring about organizational change? How should a planner go about the process of identifying strengths, weaknesses, and distinctive competencies in an organization? What is the impact of the findings on planning? Discuss the relationship between mission statements, planned change, and unplanned change. Use Discussion Define what is meant by â€Å"strategic planning.† Distinguish this from long-range planning and other forms of planning.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Bruffee, author of Collaborative Learning: Higher Education, Interdependence, and the Authority of Knowledge (1993), explains the need for a more efficient, economical and equitable management of the people in the industry or organization has never been as pronounced as it is today. This need has never been brought about by factors which inevitably affect not only the established structures and ways of doing things within the personnel area but also by the more meaningful and substantial task of managing the organization’s most important asset – the human capital. Among these factors are: stiffer competition in business; rapid changes in technological, competitive and economic environments; the explosion of technical and managerial knowledge; spiraling wage and benefits cost and so many others. These factors have no doubt been responsible for the emergence of the personnel function as a vital area in the implementation of corporate strategy.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Demick and Miller (1993) places in context first what an organization is like and settles how it can affect behavior in general and when that is established, proceeded to explain leadership and management in this context. In organizational behavior which is basic to the management of human resource, it points to the inquiry and application of learning about how people, individuals, and groups perform, operate, and work in organizations. It accomplishes this by means of adopting a system approach. Explicitly, it infers people-organization affairs in terms of the entire person, group totality, complete organization, and total social structure. Its intention is to put up enhance relations by attaining human goals, organizational purposes, and social goals. In such a milieu, the goals to effect change are influenced by several significant factors which are crucial to the overall results. Hence, there are expected leadership behaviors that maintain momentum during the change process.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Effective strategic planning is a process of analyzing an organization’s assets and its needs under changing conditions and developing the activities necessary to satisfy these needs. It is essentially a two-step process. The emphasis is on techniques or systems to be applied. The forecasting of needs allows determining of priorities and allocating of resources to where they can do the most good. Analysis of needs leads to program planning. The planning approach defines human resource needs in relation to the organization’s overall needs and defines a strategy to satisfy them. In this way, individual development, training programs, recruitment, compensation and other activities become integral part of a dynamic process. There are different types of planning aside from strategic type of plan. These include the alignment type, the goal-based type, the self-organizing type, and the scenario-based type (McNamara, 2006). The goal-based type of planning is involved with tailoring the process of improving and enhancing the system of operation of an organization with the focus on the organizations’ goals which may be further specialized according to each of that organization’s departments. The alignment type bases its planning strictly on the organization’s mission and tailors all activities according to that specific aspect of organizational flow. In particular, the scenario type of planning, however, makes use of the critical areas of the organization’s set-up which nay be experiencing problems and issues that may emanate from the external environment such as changing laws and problems outside the firm or establishment which may affect the life, continuity and effective productivity of the organization.   Lastly, self-organizing type of planning is centered on the organization’s core of values and that any or all of the various problems or issues encountered have to be evaluated according to the values of great importance to the members of the organization (McNamara, 2006). -Planning can lead to organizational change. What do the text writers feel are the issues that face the manager who plans to bring about organizational change?   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Organizational behavior is actually a complex and dynamic mechanism. It includes the application and integration of theoretical perspectives from the social and behavioral sciences to shed light on how and why individuals behave in a variety of ways in organizations. Included in the study are the ways the individuals carry out their tasks, the structure, design and operation of human persons in simple and complex organizational set-ups (Mangelsdorff, 2007).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   This is accomplished utilizing the systems approach or systems model. The latter is meant as interpreting people and organizational relationships in reference to the whole individual, â€Å"whole group, whole organization, and whole social system† (Knoster et al., 2000). The objective is developing improved and enhanced relationships by attaining individual aims, organizational goals and social aspirations (Mangelsdorff, 2007).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Specifically, any student who pursues the study of the concepts involved in the matter will examine how individuals work in groups; acquire insights into human strengths and interpersonal relationships. Intertwined in the study is to delve into theories or principles of motivation of personnel, effective leadership with the goal of formulating a sound thinking and values of management and leadership. Moreover, organizational behavior investigates scientific data and utilizes a variety of research traditions to further understand how individuals work and function efficiently in diverse forms of structures (Shortell et al., 2000)   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The concepts that are pursued in organizational behavior include the following: the evolution and organizational and management theories; the rich historical background of management, organizational theories and the development of management thought, are adequately covered in this particular aspect (Robbins,1997).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Organizational behavior, when scrutinized closely, thus far covers a lot of topics. It embraces the understanding of structure, design of the organization itself. It also includes the study of the work design, policies and practices of the human resource, job design, and decision making as an organization. Furthermore, it also examines the organizational culture, its dynamics where change is aimed to be implemented (Revans, 1982) How should a planner go about the process of identifying strengths, weaknesses, and distinctive competencies in an organization? What is the impact of the findings on planning?   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Working relationships are a central portion of a person’s life.   Motivation and dedication to any endeavor (e.g. work) and the pleasure from it are collective concerns of the organization and the individual. There are definite factors that generate satisfaction, the so-called â€Å"motivator† factors according to Herzberg. These factors push the worker to the highest levels of accomplishment possible. They are an inherent part of the work itself and consist of the nature of the work, the person’s sense of achievement, level of responsibility, and individual development and improvement. These motivator needs can only be rewarded by stimulating, challenging, and absorbing work. Consequently, the goal of motivation should be to enhance individual growth and advancement, develop sense of accomplishment and liability, and provide recognition (Franken, 1994).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Psychology recognizes different perspectives of motivation. One of these viewpoints pertains to the idea of â€Å"motivational inducements,† otherwise known as incentives. Incentives are referenced from either the vantage point of internal, or that of external motivation. An inducement coming from within the individual is called intrinsic or internal motivation. It is, according to Morris and Maisto, about the â€Å". . . desire to perform a behavior that originates within the individual.† An inducement coming from outside the individual is called external or extrinsic motivation. It is the aspiration to do or achieve a goal in order to acquire a type of incentives or escape or steer clear of punishment (Morris and Maisto, 1999, p.316). People are often induced by the presence of external incentives to perform expected tasks or avoid incurring punishment. For motivation experts, however, a person developing the internal type of motivation will reap more lasting and beneficial effects compared with external motivation (Morris and Maisto, 1999).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   For instance, in taking care of a medical surgical unit and handling newly hired nurses with a few years of experience only, myriads of problems are not remote possibilities. From issues of tardiness during call of duty, in irresponsibility in dispensing of medicines and relational clashes, to grave misconduct within the workplace such as sexual harassment between employees, these are all stark realities that are potential complex problems. Initiating the Herzberg idea can probably be useful. I will groom first the few expert nurses and those who will be directly supervising others that they practice and execute specific agenda for increasing motivation, one of which is Management by Objectives (MBO). It entails having faith in involving the employees in goal-setting and in decision-making. MBO works by integrating goal-setting into individual participation in decision-making in order to establish individual work goals to which the employee feels reasonably committed. At the motivational level, it is theorized that resistance to change is decreased if individuals participate in decisions regarding change and that individuals accept and are more committed to decisions in which they have participated in making. To further encourage and increase involvement, the hospital provides suggestion boxes and hold monthly contests where they give monetary rewards for the best three suggestions. These give the employee a sense of achievement and responsibility for its success. For this workplace in particular, the employees receive incentives in the form of Ladder promotion, general salary increase annually plus performance rating salary increases, CBA – employees can expect a minimum of 15% increase in salary annually within three years; and welfare benefits which include group insurances, medical insurance, accident benefits among others (Baron, 1983). A set-up like this goes to such great lengths at least to assure that it does something for sustaining employees’ morale and motivation. -Discuss the relationship between mission statements, planned change, and unplanned change. Use illustrations.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The elements of organizational behavior lean upon management’s plan and philosophy, vision and objectives. Basing on this foundation springs the organizational culture where the formal and informal types of organization and the social environment are best understood (Knoster et al., 2000).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Every person in direct supervision of employees or workers knows the intricacies of leadership and management of people under his/her care. Whenever possible, it is to the best interest of the organization and employer in general that the workers perform their respective jobs efficiently and on a continuous or consistent manner. This is the aspiration of every owner of a company or those delegated to deliver their/his/her goals. However, this will only work so long as the individuals in their various places or positions know and understand what they want and where they want to go in the context of the overall goals of their organization. Intertwined in this idea is the fact that individuals are motivated to work not only for them but that the vision and mission, goals of the corporate world where they belong must be their own also. Ownership as a motivational factor is critical for the survival and sustainability of both the individual worker and the organization as a whole. Studies reveal that how an organization runs depends upon every human person within the workplace functioning as he/she should be in order that productivity is achieved. This is actually a cyclical picture; both the organization or employer level and the rank and file levels must understand the team and group dynamics that must work to achieve their own objectives. However this seemed to be easy to understand, the applications of which are complex involving multiple disciplines (Mangelsdorff, 2007). Conclusion   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The problem of employee motivation is critical in all kinds of organizations today and is responsible for the shoddy products we buy and the careless service we receive. It was thought that all that was necessary to produce high motivation in workers was to pay them more; this idea may no longer be valid for a large portion of the work force (Adams, 1965). Modern workers demand jobs that satisfy their inner needs for fulfillment, expression, and self-actualization. Traditional values involved loyalty to the company and a strong drive for money, status, promotion and security. The new breed of workers focuses on self-fulfillment and self-actualization and demands jobs that are challenging and that allow participation in decision-making (McClelland, 1976). They have little loyalty to the organization and less concern with money, status and security.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Psychologists have proposed several theories of motivation. The need for achievement by McClelland posits the existence to be the best in whatever they undertake. Studies show that good executives are higher in Ach than poor ones. High in ability and take calculated risks and set moderate achievement goals. These individuals constantly need feedback on their progress (Halonen Santrock, 1996).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   These theories deal with content of motivation, with internal needs that arouse and guide behavior. Process theories of motivation focus on the psychological processes involved in making decisions and choices about work. This is illustrated in the goal-setting theory, which argues that employee motivation is defined by our intention to achieve a particular goal; and equity theory, which deals with our perceived ratio or outcome to input and how equitably that ratio compares with those co-workers (Halonen Santrock, 1996).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The workplace today considers any of the perspectives mentioned in this paper. However, what are more reflective at many organizations are their strategies in enhancing the life of the average worker. The understanding of the needs or drives that motivate people is therefore critical in the choice of what â€Å"motivator variables† that the management may employ to encourage their people to do or sustain an excellent job or an efficient performance.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Mentoring and its application is very much the vogue today in corporate America. It is a strategy employed by companies or institutions to enhance professionalism and the increased transfer of learning and building of skills from the more adept and/or experienced to the junior or neophyte employee. It is also a way of improved retention rate within a company. Reference: Baron, R. 1983. Behavior in Organizations: Understanding and Managing the Human Side of Work, Boston: Allyn and Bacon. Bruffee, Kenneth A. Collaborative Learning: Higher Education, Interdependence, and the Authority of Knowledge. Baltimore: Johns Hopkins Univ. Press, 1993. Demick, J. and Miller, P., Development in the Workplace, Lawrence Erlbaum Associates, Publishers, New Jersey, 1993. Druckman, Daniel, Jerome E. Singer, and Harold Van Cott (Editors) (1997). Enhancing Organizational Performance. National Academy Press: Washington, D.C. (optional) Franken, R.E. 1994, Human Motivation (Belmont, CA, Wadsworth). Halonen, JS and JW Santrock, 1996. Psychology: Contexts of Behavior, Dubuque, IA: Brown    and Benchmark, p.810. Knoster, T., Villa, R., Thousand, J. (2000). A  framework for thinking about systems change. In R. Villa J. Thousand (Eds.), Restructuring for caring and effective education: Piecing the puzzle together (pp. 93-128). Baltimore: Paul H. Brookes Publishing Co. Landy, F.J. 1985. Psychology of Work behavior. 3rd Ed. Dorsey Press. Mangelsdorff, David A.2001. â€Å"Organizational Behavior and Theory. Accessed August 19, 2008 http://users.idworld.net/dmangels/orgbeh.htm McClelland, D. C., Burnham, D. H. 1976. Power is the great motivator. Harvard Business Review, 54(2), 100-110. McKenna, Eugene, 2000. Business Psychology and Organizational Behavior: A Student’s Handbook. 3rd Ed. Psychology press: Taylor and Francis Group. McNamara, Carter. 2006. â€Å"Basic Overview of Various Strategic planning models.† Retrieved August 19, 2008. http://www.managementhelp.org/plan_dec/str_plan/models.htm Morris, Charles G., Maisto, Albert A., 1999. Understanding Psychology.4th ed., Prentice Hall: New Jersey, pp.315-316. Revans, R. W. 1982. The Origin and Growth of Action Learning. Hunt, England: Chatwell-Bratt, Bickley Robbins, Stephen P. 1997. Organizational Behavior: Concepts, Controversies, Applications, Eighth Edition, Prentice Hall. Shortell, Stephen M. and Arnold D. Kaluzny. 2000. Health Care Management: Organization Design and Behavior, Fourth Edition, Delmar Publishers Inc. Revans, R. W. 1982. The Origin and Growth of Action Learning. Hunt, England: Chatwell-Bratt, Bickley Robbins, Stephen P. 1997. Organizational Behavior: Concepts, Controversies, Applications, Eighth Edition, Prentice Hall.