Compagnie du Froid Analysis Essay

Memorandum Campagnie Du Froid is a summer ice-cream business founded in 1985 by the father of Jacques Truman. In 2007, after the passing of his father, Jacques Truman took over the business and emphasized an aggressive growth strategy. By 2009, Campagnie Du Froid was a market leader in the eastern part of France, northeastern coast of Spain, and northern Italy. Each region had its own manager and the main headquarters was located in Paris. Jacques believed decentralizing the decision making as much as possible. Each region had its own manufacturing, marketing, distribution and sales organization. The central office took care of accounting, developing of new products, and sharing of learning experiences across the regions. Each year Jacques met with the regional managers to discuss a profit plan for each region. The profit plans laid out regional goals for the upcoming year and were used as a tool to monitor performance. During the summer months, a profit statement every two weeks was generated and sent to Jacques in order to detect any major problems. The France region is run by Jean Pinoux and had performed exceptionally well in 2009 with profits above budget and sales increasing by 20% from the previous year. Jean had stumbled across a new source of revenue in which he helped deliver packaged food for regional producers using the company’s refrigerated trucks. The incremental cost to provide the service was very low and was seen by Jean as a simple way to increase revenue. Jacques was surprised by Jean’s new initiative, but acknowledged the profit potential in the distribution business. Pierre Giraux is the manager of the Italian region. The 2009 sales goals were met and Pierre had expanded business into most of the western Italian coast, but suffered from higher wages and lower efficiency than expected, which hindered performance of the region. Andres Molas is the manager of the Spanish region and his performance had been outstanding up until 2009. There had been many problems that sprung up in 2009 causing the performance of the Spanish region to decline. The first  problem was the new machines weren’t working correctly until late August which caused them to run out of capacity several times. The Spanish division had to import product from the French division at a transfer price of full cost plus 5% profit for the manufacturer. On top of that, the Spanish division had to absorb expenses of people traveling to France to fit the Spanish packaging to the French production line. Lastly, there were unseasonably cold temperatures that had driven down tourism and demand. As a result, Andres had to cut prices in order to stimulate demand and keep with competition. Traditionally, each manager was given the same bonus of 2% of corporate profits, but the results in 2009 challenged the fairness of this evaluation system. The Spanish region performed extremely poor and had driven down company’s profits to the lowest it’s been in ten years. Jacques thought it was unfair for the French and Italian managers to pay for the problems of the Spanish region but wasn’t sure Andres Molas was to blame for the poor results. Jacques Truman needs to make many decisions regarding the evaluation and performance of each region. In order to properly evaluate the difference between the expected profit versus the actual profit in the Italian region, a causal analysis was conducted on the Italian region. The causal analysis in Exhibit 1 allowed us to better understand the Italian business. First, we evaluated the impact of the change in sales volume. The sales volume variance (Flexible budget in Euros – Static Budget in Euros) produced a sales variance of â‚ ¬119 for Ice Cream sales and â‚ ¬34 for Specialty sales; this represented a profit variance of â‚ ¬58. While the sales volume variance is important, it is also important to understand the amount of sales growth that is attributed to the temperature change versus actual performance of the business. There was â‚ ¬19 worth of growth strictly from the change in temperature between both ice cream sales and specialty sales. The profit side of the causal analysis resulted in a â‚ ¬8 variance attributed to the temperature change and a â‚ ¬5 0 variance related to performance which resulted in a total volume for profit increase of â‚ ¬58. The change in prices also had an impact on the Italian region’s expected and actual profit because the â‚ ¬7 total sales variance  represented an increase of â‚ ¬7 profit for the actual profit. The â‚ ¬7 variance was calculated by the favorable â‚ ¬20 variance for ice cream sales and an unfavorable variance of â‚ ¬13 for specialty sales (â‚ ¬20-â‚ ¬13=â‚ ¬7). This proves that the Italian region can charge slightly more for their ice cream sales given the increase in demand, while the increase in demand of the specialty product could be more attributed to the decrease in price. Overall, the change in pricing came out to make a positive impact on the Italian region’s profit. The cost of raw materials impacted the actual profit through the price variance and the quantity variance of the direct materials. Using the level 3 analysis, it was determined that the price variance was favorable â‚ ¬46 and the quantity variance was unfavorable â‚ ¬17 which represented a flexible budget variance of favorable â‚ ¬29. This impacts the profit because the Italian region was very efficient with their costs of direct materials, but the Italian region came up short in their manufacturing efficiencies as they experienced an unfavorable quantity variance of â‚ ¬17. An overall favorable flexible budget variance of â‚ ¬29 represents a positive impact on the profit for direct materials. The cost of labor impacted the actual profit through the rate variance and the efficiency variance of the direct labor. Using the level 3 analysis, it was calculated that there was an unfavorable rate variance of â‚ ¬2 and an unfavorable efficiency variance of â‚ ¬11. This impacts the profit because the Italian region paid more for their labor than expected, which turned into an unfavorable variance of â‚ ¬2; this variance is related to the changes in the prices of labor. Also, the Italian region was not as efficient with their labor forces which showed in the unfavorable efficiency variance of â‚ ¬11; this is related to the labor efficiency of the workforce. Overall, the impact of the direct labor was negative to the profit as the Italian region was both inefficient and paid more per labor hour than estimated. The fixed costs impacted the actual profit by having an unfavorable variance of â‚ ¬20. This shows that the Italian region was slightly less cost conscious with some of their fixed costs and this negatively impacted the profit. After considering all of the different components of the profit of the Italian region through a causal analysis, the Italian region experienced a favorable variance of â‚ ¬58 on their overall profit. The manager of the Italian region should be evaluated relative to multiple criteria to gain a holistic view of his region’s performance. In order to compare the three regions together, causal analyses were performed for each region, see Exhibits 1-3. The first crucial measure should be sales growth, and this goes for all regions, not just the Italian region. Sales growth year-over-year is crucial to any business because businesses become more expensive to run as time goes on due to inflation. It is best to look at sales quantities relative to changes in price because if you were to just look at changes in quantity sold, the manager could steeply decrease the price just to make his or her performance look stronger. The next crucial measure should be price and quantity variance. Price variance shows how strong of a negotiator a manager is with suppliers, which can result in huge cost savings. Quantity variance shows how efficient workers are in producing products. A favorable qu antity variance evidences workers are not creating much scrap, and therefore are saving money. Another key indicator of manager performance is labor efficiency variance because it shows how productive workers are when producing product. A strong labor efficiency variance shows that the manager is staying on top of workers and demanding consistently strong performance from them. We do not believe that much weight should be put on labor rate variance because the manager often has little control due to unionization and government regulations within the area of operation. The above measurements of effectiveness of the Italian region and more specifically, the Italian manager can be found in Exhibit 1 which breaks down the relevant variances in determining the appropriate evaluation of the Italian manager. The more specific-scope variances mentioned are shown in Exhibit 6. All of the above tie into the bigger picture variances, which are the flexible-budget variance and the sales-volumes variance, which are shown in Exhibit 5 for Italy in 2009. These then roll into the static-budge t, which determines if a manager met the profit plan for the region, which is shown in Exhibit 4 for Italy in 2009. This gives a rather vague view, and can sometimes distort how a manager truly performed unless the variances that roll into it are investigated further. Both the manager of the French region and Spanish region should be judged on  similar criteria as the Italian region manager besides a few small nuances that France and Spain have in their operations. All of the measurements mentioned above in analyzing the Italian region manager’s performance should be used for France and Spain, as these measurements provide the same value no matter the region. A causal analysis for both France and Spain were conducted and can be found in Exhibits 2 and 3, respectively. For France, the more specific scope variances, flexible-budget and sales-volume variances, and the static-budget variance are shown in Exhibits 9, 8 and 7, respectively. For Spain, the more specific scope variances, flexible-budget and sales-volume variances, and the static-budget variance are shown in Exhibits 12, 11 and 10, respectively. France’s revenue from distribution should be taken out of all variance analyses it is considered in because the other regions do n ot have this service in place, and it would distort the view of relative performance. Also, France’s revenue should not include the 5% markup for transferring product to Spain because this is an intercompany sale and is not based on France’s customer demand but instead is based on Spain’s. We believe it is therefore necessary to remove the 5% markup from the purchase price for Spain because this will cause a heavily unfavorable price variance for direct materials. We feel that it is best to instead take this as a qualitative judgment in the manager’s performance in the sense that sales are outpacing inventory. It can also be noted that competitors have generally shown to steeply decrease market prices when demand weakens, but we feel this is best to account for qualitatively instead of through what seems to be an arbitrary measure of change in sales relative to temperature. It should be the regional manager’s job to address the decrease in the demand instead of have it be excused due to temperature change. In evaluating performance, it can be noted that the conditions did not allow for demand as strong as in other regions, but should not allow for a manager’s performance to be comparable to a region with widely stronger sales. Please note the standards used for Compagnie du Froid are listed in Exhibit 13. Based on our analysis of each of the regions’ performance for the year of 2009 and other important information, we believe that Italy’s regional manager did the best job. First and foremost, the region exceeded profit  expectations are set forth in the profit plan, as shown in Exhibit 6. Italy also earned favorable variances relative to both the flexible-budget variance and the sales-volume variance. The more specific-scope variances were strong as well with the only major weakness being in the quantity variance for ice-cream, but the strength of the other variances outweighs this one significant weakness that can easily be improved through training or overall experience. The direct labor efficiency variance is the only relatively weak variance, however Mr. Trumen noted that new machines were causing labor efficiency issues. It was mentioned that this was included in the profit plan already, however it can be expected that this variance will fluctuate until the equipment begins running normally. Revenue growth also exceeded expectations, which as mentioned earlier, is key to growing any business and maintaining positive cash flows. There are three main problems that Jacques Truman appears to be facing. The first problem involves whether or not to change how much each manager receives as a bonus. Each manager’s bonus is currently calculated at a fixed 2% of corporate profits but after the poor performance of the Spanish division during 2009 has Jacques considering new ways to evaluate each manger’s bonus. Jacques is considering whether to link each manager’s bonus to a performance measure such as a profit plan, revenue growth, or some overall economic measure of results. A second problem is how to calculate transfer pricing from one division to another. The Spanish division was charged full cost plus a 5% profit margin from the French division. Andres Molas believed this was way too much for a transfer price and in turn made his division look bad. Jacques needs to decide for current and future purposes on how to handle transfer pricing in case of a similar event happening again. The third problem involves whether or not to allow Jean Pinoux of the French division to continue providing the distributing services to regional food producers. Jean claims the distributing services add extra revenue with very little incremental cost. Jacques needs to decide whether Jean’s claims of the distributing services are true. After careful analysis of all three problems, we’ve developed some recommendations for Jacques Truman to consider. Our first recommendation involves implementing a new way to calculate the performance bonuses managers receive at the end of  each year. We don’t believe that every manager should simply receive 2% of corporate profits. Each manager’s performances can be measured by a variety growth metrics and budget variances while also taking qualitative factors into consideration. The growth metrics that should be considered are things like sales growth year-to-year and sales quantities relative to changes in price. Varian ces that should be considered are: price variance, quantity variance, and labor efficiency variance. Qualitative factors such as unseasonal temperature changes and intercompany transfer of product should also be taken into consideration. For reasons discussed earlier, we believe considering these metrics will give the most accurate view of each manager’s performance. Using these benchmarks will allow Campagnie Du Froid to calculate a more appropriate performance bonus for each manager. The second recommendation involves how transfer prices should be calculated between divisions. Assuming there are no capacity constraints at the French division because of the two new machines it just bought, transfer pricing should be set at the variable cost per litre of â‚ ¬2.76. When the French division has excess capacity, there is no opportunity cost to be lost and it should be indifferent for them to make these extra units for the Spanish division. Fixed costs don’t need to be added to the transfer price because they will be incurred regardless and the 5% profit margin is unnec essary because all profits eventually go to corporate. This will cut transfer costs for the Spanish division by â‚ ¬0.77per litre and â‚ ¬459,000 total. This type of transfer pricing will be beneficial to the buying division in the future and allow it to spend less when it runs into these types problems. The third recommendation involves the new distribution arrangements that Jean Pinoux wants to engage in the French division. In 2009, revenues from distribution were â‚ ¬79,000. The incremental costs for delivery expenses were â‚ ¬47,000 and â‚ ¬3,000 for depreciation of the trucks. The revenues from distribution outweigh the incremental costs by â‚ ¬29,000; therefore we recommend the French division continues with the new distribution arrangements. We believe these recommendations will help Campagnie Du Froid become a more efficient and profitable company.

Gods Gods And Goddesses

The term gods and goddesses can be best explained and understood under four sediment cultural predispositions. First is the monotheistic culture of uneven attitude towards gods and goddesses when God is said to serve as the supreme being of the universe, the one who there are no others, in contrast to the observation Of the Greek philosopher Thales that † the world is full of gods†, the central of Islam begins, â€Å"there is no other God but Allah† and the warning â€Å"you shall have no other gods before† which heads the lists of the ten commandment given to Moses in the biblical world.Secondly, the demystification of the universe comes from the Scientific rationalism that Gods are fiction, a mere projection of natural realities. Thirdly approach is the deistic conceptuality with a general ideas as a metaphysical hypothesis designating ultimate order in the universe, something to be argued about and not something to be sacrificed to. Fourth is the Universa lism one that the main gods of the world religions are all versions of the same affable divine reality such as Allah, God, Brahmas, Buddha and Tao from various transcendent mystery.Like myth and rituals, a god is a form of religion that can have any content, which could be demonic or benign, male or female, limited or unlimited in power. It can represent the power of vengeance, kingship, love, ancestry, luck, territory, wisdom, fertility and consciousness. The word god is used generically here to mean any superior being that humans religiously engage; either being visible, invisible, inhabiting past, present or future can function as a god.Buddha and bodhisattva function as gods in many ways, even though they are a very different genre of being than gods of theism. God, odds and goddesses are not fantasy symbols but beings whose realms cannot be violated with impunity and also correlates with the critical points of a world where humans are most open to the power of the others, from political order to ritual purity. Traditionally, Ancestors, Elders and emperors receiving the same reverence as gods appearing as messiah, redeemers and inner guides delivering them of illness and supplications.Hindus acknowledge that, at the most fundamental level, God is the One without a second -? the absolute, formless, and only Reality known as Brahmas, the Supreme, universal Soul. Brahmas is the universe and everything in It. Brahmas has no form and no limits; it is Reality and Truth. Thus Hinduism is a pantheistic religion: It equates God with the universe. Yet Hindu religion is also polytheistic: populated with myriad gods and goddesses who personify aspects of the one true God, allowing individuals an infinite number of ways to worship based on family tradition, community and regional practices, and other considerations.The Your treat their ancestors with great respect, as might be expected in a culture with only oral records of the past, but anthropologist's debate as to w hether the rituals dealing with ancestry are religious in nature, or simply respectful. At least a few groups believe that ancestors, after death, become demigods, but only once they have assumed the personal of a true deity. This resembles another facet of the Your faith, the phenomenon of possession, in which mediums take on the characteristics of one or another of the gods.The characteristics of each god are so well stereotyped that mediums as far off as Haiti loll back their heads and cross their legs in the same way when possessed by the lightning god (Idiot, 1963). In traditional Roman Catholicism the polytheistic outlook Was carried on to some degree in the veneration of multitude of saints. Forty different saints were invoked in the French Vogues as â€Å"guardians of livestock and protectors from all kind of sickness such as gout, toothache and burns (SST.Augustine for instance protected one from warts), as protectors in the storms and against fleas. In Asian, there is a s imilar assimilation of native spirits of Buddhist saints. The name of invocation could change but the domain (childbirth, small pox etc) of the god or saint remained the same. Some gods are patrons of specific communities of people. In traditional cultures every significant collectivity would have a sacred group spirit of some kind. In many societies domestic spirits or ancestors rule the household circle.The Japanese sun goddesses, Amateurs, is the ancestress of all the gods, the imperial family, and ultimately the Japanese people. Maltreat was the god of tire, Moloch of cartage, Estate of Blush, Maraud of Babylon, Jupiter of Rome and Heehaw of Jerusalem. Christians profess Jesus as their personal Lord and Savior, leaning his presence in the heart and a desire that they are not alone. Mahayana Buddhist tradition speaks of every one being â€Å"the Buddha† â€Å"Islamic mysticism takes its cue from the Guarani phrase that Allah is closer to us than our very jugular veins.The faiths of the Hardbound peoples of Western Nigeria vary significantly from one part of the region to another; the same deity may be male in one village and female in the next, or the characteristics of two gods may be embodied in a single deity in a neighboring region; in the city of Ill Fife in Nigeria alone the trickster god is worshipped under three different names. These variations inevitably arose as the myths were passed by word of mouth; add to them the incorporation into the Your faith of facets of outside religions, particularly Christianity and Islam, and understanding the faith becomes difficult indeed.The religions, however, share a similar structure, â€Å"diffused monotheism†; a single omnipotent creator-god rules over the universe, along with several hundred lower gods, each with a specific domain of rule. Shannon, the god Wool Saying refers to in his poem â€Å"aunt of he Stone†, occupies a major position in the pantheon of the Your, although he holds a less important position in neighboring ethnic groups. Shannon (also spelled Gangs and Sago) creates thunder and lightning by casting â€Å"thunderstorms† down to earth; wherever lightning strikes, priests search the surrounding area for the thrown stone.The Your believe these stones have special powers, and they enshrine the stones in temples to the god. The Your people do not consider him the most powerful or even the most important god; rather, his popularity may have resulted from attempts to radar off the frequent tornadoes that strike western Africa. Curiously, the Your never actively worship their all-powerful god, variously known as Loran (â€Å"the owner Of the sky†) or Lodestar (roughly translates as â€Å"the almighty†), among many other names.Unlike Shannon, who has dozens of shrines erected to him, Loran has not a single shrine; the Your never make sacrifices to him, and he has no priests. He plays much the same role as do the Jude-Christian and Is lamic gods– he is â€Å"the creator of all things, the almighty and all-knowing, the giver of life and breath, and the final judge of mankind†, and yet the Your apparently ignore him in their day-to-day lives.A theory explains that perhaps Loran developed through the influence of early Islamic or Christian missionaries, as a simulacrum of the gods of those religions. This finds support in the argument that the Your find the concept of an almighty God so overwhelming and remote that they cannot relate Loran to their reality. Some Your legends have a pair of gods, Originals (Bobtail, Arise-anal) and his wife Audio, as supreme creating deities, either independent of almighty Loran or preceding him.

Interactive Teaching Coursework Example | Topics and Well Written Essays - 9750 words

Interactive Teaching - Coursework Example It also provide with the literature review of great historical leaders who contributed a great deal towards improving and introducing new techniques of teaching in elementary schools. It also sheds light on the most effective method of teaching, practical approach. Introduction Interactive Teaching techniques have been existed worldwide as the foundation of formal educational system. It establishes the base for future education. It prepares students in fundamental skills and awareness and can be defined as prior to formal education that comes after that. Most important characteristic of interactive teaching strategy is getting affiliated with peers and creating an identification of children with society and nation. For decades, classroom management has been an issue and many effective teaching lessons have gone array due to student disruption. This critical review of the literature analyzes the elements that can be identified in a successful and effective classroom teaching techniques. Research consistently has shown that traditional lecture methods, in which professors talk and students listen, dominate college and university classrooms. It is therefore important to know the nature of active learning, the empirical research on its use, the common obstacles and barriers that give rise to faculty members' resistance to interactive instructional techniques, and how faculty, faculty developers, administrators, and educational researchers can make real the promise of active learning. Background During science, social studies, and writing time, in my first year of teaching, it has been noticed many students getting off task. They sometimes appeared bored, as if they were not really interested in doing their assignment.... As the report declares most important characteristic of interactive teaching strategy is getting affiliated with peers and creating an identification of children with society and nation. For decades, classroom management has been an issue and many effective teaching lessons have gone array due to student disruption. This critical review of the literature analyzes the elements that can be identified in a successful and effective classroom teaching techniques. According to the paper findings during science, social studies, and writing time, in my first year of teaching, it has been noticed many students getting off task. They sometimes appeared bored, as if they were not really interested in doing their assignment. Some students found any excuse to get up from their desk, go to the bathroom, get a drink, sharpen their pencil, or just roam about; anything other than doing their work. Other students were consistently blurting out, made rude comments to classmates, exhibited disrespect and showed inappropriate behavior. A few students created severe disruptions including tantrums in class. This created management issues and students produced minimal work of low quality. In today’s dynamic and diverse school environment, engagement and creating interest of students is an issue. For students to achieve success academically and in life, they must have access to the opportunity to receive a quality education in a school environment conduct ive and creative to learning.

Who is liable under a Shipment or Destination Contract Assignment

Who is liable under a Shipment or Destination Contract - Assignment Example As it is with most contracts involving the transportation of goods, contracts are presumed to be shipment contracts unless stated (McNett, 2005). In the scenario provided; therefore, the contract involved is a shipment contract. Shipment contract is a type of business contract whereby the tender of performance is reached at the time when goods are surrendered to the carrier, which is then responsible for delivery of the goods to the owner. However, the buyer remains responsible for the goods as the owner immediately the seller surrenders the goods to the carrier. Under the  destination contacts, the seller of the goods tenders the  goods  to the carrier, who is then  responsible for the delivery the goods to the buyer.  However, the buyer is neither responsible for any damage or loss of goods nor the owner of the goods until the carrier directly delivers the goods to the buyer (Beatty, Bredeson and Samuelson, 2013). In  the situation  therefore, it is  identified  that  the  person responsible for the loss of the computer in the scenario  is me the buyer  and not Dell Computers, Inc., as the charge that had been taken from my credit card only included the purchase of the computer and not shipment costs as the contract could have stated that so. In order to answer to the question accurately, one requires more information pertaining to the terms in the contract between Dell Computers, Inc. and I. Since such information is not available, the conclusion remains that Dell Computers, Inc. was only responsible for the loss of the computer until it rendered them to the carrier for the delivery to me. I would, therefore, remain fully responsible for the goods from the time Dell Computers, Inc. delivered the computer to the carrier. Additionally, information pertaining to the agreement between the types of contract involved is also essential in determining the person

Preservation of Organs for Transplant Research Paper - 1

Preservation of Organs for Transplant - Research Paper Example Sodiumpump regulates and reduces intracellular sodium under normothermic conditions, however, when the pump speed falls during hypothermia, the intracellular sodium rises, thus pulling water into the cell leading to lethal cell swelling (Toledo-Pereyra, 42). Methods With the modern technologies, some organs such as the liver can be stored for a longer periodthrough flushing the tissues or applying organ preservation fluids and preserving the tissues at (0–5Â ° C) hypothermic temperatures. This method is efficient as it uses various impairmentagents such as lactobionic acid, raffinose, hydroxyethyl glucose that prevent swelling of the cells during storage, and because the solution contains glutathione and adenosine agents that trigger normal metabolism function upon reperfusion by triggering generation high-energy phosphate (adenosine) upon reperfusion. Since the development of the UW solution, other preservation solutions have been discovered, which include Histidine-Tryptoph ane-Ketoglutarate (HTK) and Celsior. However, some Percentages of organs such as livers, kidneys and intrathoracic organs fail upon transplant hence need for improved methods for preservation.Bottom of Form Dynamic preservation methods require some dynamic fluid or gas movement to allow preservation. In the 20th century, Hypothermic machine perfusion was invented for organ preservation to extend both preservation time and quality. Alexis Carrel coined the term organ culture referring to an analogous technique for whole organs that would be developed by using vascular perfusion with support of Charles Lindbergh who helped with the engineering in which he developed a glass perfusion pump that could support kidneys by maintaining oxygen delivery through perfusion. Hypothermic... This paper stresses that in many years following the first successful transplantation of organs, preservation of tissues and organs has attained incredible successes in enhancing and improving preservation and function of organs, and irrespective of these improvements, a huge disparity still exists among the number of people on the waiting list and the available organs donors. The main organ preservation challenge will be how to enhance the marginal donor organs recovery and resuscitation mainly the donation after cardiac organ death; therefore, given the success of static organ preservation methods, the dynamic preservation methods, oxygen persufflation methods and other methods, there is a crucial advances in improving the donor problems. The author of the paper talks that dynamic preservation methods require some dynamic fluid or gas movement to allow preservation. In the 20th century, Hypothermic machine perfusion was invented for organ preservation to extend both preservation ti me and quality. This report makes a conclusion that hypothermic machine perfusion allows organs oxidation for ATP creation through fluid perfusion for oxygen transportation. The cold tissues oxygen requirements are low thus the oxygen demand is also low and this allows for slow flow rates during hypothermia and the relatively low oxygen carrying capacity of most crystalloid perforates are adequate at low temperatures.

Globalisation and Ford Motor Company. The golden age of the company Essay

Globalisation and Ford Motor Company. The golden age of the company - Essay Example Globalisation is chosen as topic for this assignment since the significance of this concept is being widely questioned these days. Referring to the adverse impacts of 2009 global financial crisis, it is argued that the globalisation has not led to a rapid growth or economic convergence in the world. On the other hand, many economists hold that this process greatly slowed down economic growth, diverged income levels, and widened the gap between industrialised and developing countries. Therefore, it is reasonable to analyse the effects of globalisation in the context of a specific international company to identify the degree of its effectiveness and flaws. I have selected Ford Motor Company for this assignment as it is the US’ second largest and world’s fifth largest automaker in terms of annual vehicle sales. The company has subsidiaries across the globe and its UK subsidiary is operated under the name Ford of Britain. While analysing the history of the Ford Motor Compan y, it is evident that the mid to late 1990s was the golden age of the company. During this period, the company sold large number of vehicles by taking maximum advantages of a booming American economy with quickly developing stock market and relatively low fuel prices. The situation extremely changed with the dawn of the 21st century. As a result of mounting fuel prices, legacy healthcare costs, and an unstable economy, the company experienced a considerable fall in its sales volume, market shares, and ultimately in profit margins in the beginning of the new century. By 2005, the company’s bonds were downgraded by corporate bond rating agencies, citing to the threatening market condition of the firm. Ford reduced its profit margins even on luxury models since the company was forced to spend higher costs to offset declining demand. The company substantially increased its borrowing capacity to $25 million in order to meet its mounting financial requirements. The skyrocketing lab our costs also hurt the profitability of the company to a great extent. The company’s 2006 annual financial statements reported the biggest loss ($12.7 billion) in the history of Ford and the company management team identified that the firm might take long time to return to its profitability track. The company remained unprofitable in the next two consecutive years. The 2008 global financial crisis worsened the growth rate of the organisation as its all policy responses went in vain due to the negative impacts of this crisis. Although the company returned to profitability in the fiscal year 2009, it is still striving to improve or even stabilise its profit margins. The Ford is also affected by environmental issues as its production processes alleged to have threatened the sustainability of the environment. To illustrate, as Miller (2008) reports, the company was fined for violating state air pollution polices in Brook Park. ` Theoretical framework Conceptually, Globalisation refers to a process through which national economies and cultures are integrated into an international economy so as to enhance international trade, direct foreign investment, migration, and technology sharing. According to the concept, globalisation greatly contributes to effective and rapid circulation of ideas, languages, and cultural ideologies. Obviously, globalisation divided the history into two; age of manual labour and age of technical labour. This concept influences nations to liberalise cross border trade regulations by pointing to the significance of foreign investment and cross-border trade for international business expansion. The theoretical framework of globalisation envisages that this process would contribute to the

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A first draft of the story - Essay Example Despite her circumstances, Constance brought her children up with the strong determination to make them get better lives. The children in turn worked hard. Being used to difficulties, they were able to help their mother as they went to school. They helped her until they were able to find their wings. Now, they are all successful. Her first daughter became a doctor and married a British doctor and they decided to raise their family in Europe. Another went to California to be raise her own family and the last son chose the easy and lazy life. she knows that her son is just around the corner but she seldom sees him. Her strength is drained. Her feet cannot carry her anymore to places she would want to go in search of her son. All she can do now is drag herself to the welfare building when winter arrives so that she would be sure to have something to eat. A lot of things changed in her seventy years of existence but she thinks nothing has changed at

Commencement Speech for UH-Windward Class of 2023 Essay

Commencement Speech for UH-Windward Class of 2023 - Essay Example Hope that a bright future, filled with vast opportunities lies ahead. Fear that I might be entangled in the web of conflicting and confusing intricacies of professional and personal goals that none might end up accomplished. Anxious of achieving all my dreams and aspirations at once. Grateful for all the people who have, in one way or another, gave support and understanding during my incessant quest to gain more knowledge in preparation for my dream career. And relieved that my academic nightmares have finally ended. I stand here, for you today, not so much as a professional forensic photographer, but more so as a professional traveler in life who fought to delve into a career which I loved against all odds. And is it all worth it? I have absolutely no intentions to bore you to death and make you all samples of my forensic expertise. My career as a forensic photographer was all what I imagined it would be when I first dreamed of it more than twenty years ago. As you can see, the most challenging hindrance then, was my physical disability. But this seemingly detrimental barrier became my most redeeming factor which catapulted me to succeed. Impossible? Dreams and aspirations come from one’s mind and heart. When one is utterly determined to reach one’s goals, no barrier or hindrance can stand in the way. First lesson: know your goal and pursue it with valor. I am sure you all have different dreams and endeavors. Most of you have already made plans to go into careers of your choice. Some might still be ambivalent as to the specific directions. But, I am sure you have encountered people, situations, factors that block your path for success. I have encountered a lot. The Vocal Rehabilitation Officer at the US Department of Veterans Affairs, Mr. Les Sakuma, (God bless his soul – although he still shares earthly pleasures with us), advised me to pursue a degree in Business Management or Computer Science, of which I have already had

A key historical development such as the development of the tripartite Essay

A key historical development such as the development of the tripartite system or the introduction of comprehensive education - Essay Example The British transition provides an excellent way for the study of the effect of a comprehensive system as compared to selective schooling system on the student's achievement. In the traditional British school system, scholars would attend an academically selective grammar college at age 11, or they would attend a secondary modern school, which used to be academically less hard. The tripartite system had its disadvantages and also its advantages but the criticisms made it necessary to development of comprehensive education, which was friendlier to the students and all the scholars involved. Starting within the Nineteen Fifties, there was once dissatisfaction with choices on the local level, and a few native authorities began to experiment with comprehensive colleges. In 1965, the local authorities requested the Local Education Authorities (LEAs) to make plans to convert to a comprehensive education system. The implementation went on slowly, with sooner growing, more Labour leaning LEA s moving to comprehensive colleges more quickly while Conservative leaning Authorities implemented the amendment extra slowly. Presently there are still few conservatives offering grammar schools as an option INTRODUCTION National school programs range extensively within the quantity of skill tracking of scholars they provide in secondary school. Some education systems are based on comprehensive systems, where students of all abilities go to similar schools, although there is typically some tracking within the schools. Other systems channel students at an early age into different school types based on academic standards (tripartite system). The British idea is appealing since it involved a significant and a well defined change in terms of the ability of secondary school scholars, thus offering a potential way to assess the importance of comprehensive education system on student achievement. Comprehensive education is an education system where selection is not based on academic found ation or competency. A tripartite education system was created by the 1944 Education act and provided the basis of a state funded secondary school sector. The structure was to have three schools, which were grammar school, secondary technical school and secondary modern school (Education Act 1944). In the essay, we are going to discuss why Britain switched to the comprehensive system from tripartite system and the setbacks and advantages of the comprehensive system. We are also going to look at the key areas in the development of the comprehensive education system and the factors which lead to its implementation. Comprehensive education can be looked at as an improvement of the tripartite system, but it also has its own disadvantages. Historical development of Comprehensive Education from the Tripartite System in Britain The 1944 Education Act or the Butler Act brought about the tripartite education system which was found on the belief that at eleven years of age it was possible to measure intelligence of a child, the basis of this is to make a choice on the  activity, or career the child  might be suited to. Children sat the 11+ exam which was made up of English, Math and IQ tests. Those who passed were deemed to be more academic and would then proceed to secondary grammar school while the other would go to lower level grammar school. By the early 1960s, many LEAs were devising and reorganizing plans to end the traditional

City Road Essay Example for Free

City Road Essay Another would be that pedestrians seem to be favoured more so than motorists. For instance the islands in the middle of the road, they are there to make crossing City Road safer and more convenient to those who travel by foot. The island isn’t just the concrete mound in the middle of the road, it also includes the paint on the ground around it which cars are not allowed to drive over. Again, the bollards that were erected along the pavements are there to favour pedestrians. The reason why they were put there is to stop vehicles parking on the curbs, which was a problem before the bollards were put in place as the cars and lorries would park right over the pavements making it difficult for people to walk past and leaving less space for people with prams or wheelchairs to go round. Some things favour different groups because they appeal to different groups. Take for example the Taste Buds Cafe; one thing that struck me straight away was that the majority of the customers in there were predominantly female and mostly the older generation. They like to go in there because it appeals to them, it appeals to them because; The price is reasonable- a lot of the customers will be drawing a pension so keeping costs down is important to them, They feel safe- because there are regulars who go there and they get familiar with one another and that gives the customers a sense of safety because they know what to expect and Mr Suarez the cafe owner aids in the feeling of safety through being consistent in the way in which he runs his business. Also the menu is all home cooked and this is important to his customers. Because of all these factors, Mr Suarez’s cafe is geared more towards the older generation than the younger ones so in a sense it is favouring, although that isn’t altogether a bad thing. Lastly I would mention the security cameras. They are positioned all over City Road and they are there for a number of reasons, one reason is that a crime is less likely to be committed in an area which has CCTV (which deters people from offending) and also it makes people in the area feel safer knowing that these things are in place to not only aid in the catching of the people who commit the crimes but also that it is part of crime prevention too. CCTV is important on City Road because it does make the residence feel that little bit safer, a lot of them feel that the road is a bit â€Å"rough† and not the sort of place you would like to walk down at night, even though the local policeman denies that there is a problem with crime in the area. People just perceive it to be a crime hotspot, despite having little to no experience of any serious crimes having taken place on the road. Most of the material things on City Road favour one group over another but some inadvertently and some deliberately, the issue with the busses for example is inadvertent. They are not purposely designed to be inconvenient to a certain

Change Management In Healthcare Environment Policies

Change Management In Healthcare Environment Policies Question 2: Develop policies and systems for involving others in the process of change Describe how you would involve stakeholders in the introduction of this change into the healthcare organisation viz. Mercer Medical Centers. Analyze and evaluate the effectiveness of systems in promoting change in Mercer Medical Centers. (Word Count :1500 words) Question 3: Implement models for ensuring change in which risks are managed 3.1 Develop models for change that take account of risks in the context of case study 3.2 Plan the implementation of the model of change developed for Mercer Medical Centers 3.3 Evaluate the outcome of change in Mercer Medical Centers (Word Count :1500 words) Question 1: Explore the background to change affecting the healthcare organisation in the case study viz. Mercer Medical Centers Assess the background to change that faces Mercer Medical Centers. . At first change is awkward but it is something that presses us out of our comfort zone. Changing from one state to the next upsets our control over outcomes and is uncomfortable. Change changes the speed of time. Time is so slow for the reluctant, and yet it is a whirlwind for those who embrace it. Change doesnt look for a resting-place; just the next launching point. For those who dont learn from it they perceived it only as a waste, Institute of Industrial Engineers (IIE, 2010). Change management is all about people and processes that work for people. It is about how you take an organisation from Position A to Position B, in the fulfilment or implementation of a vision and a strategy and the whole art is to how to carry your people with you, so that the envisaged benefits of the vision and strategy are actually realised (Warrilow, 2010). Organisational Change Management seeks to understand the sentiments of the target population and work with them to promote efficient delivery of the change and enthusiastic support for its results (Wallace, 2007). Pressures that triggered for the need of change in Mercer Medical Centre can be seen. Competition in the market is the primary motive. The pressure has been relentless to constantly update expensive systems and equipment in order to be on the top of the business. Managed care penetration is increasing, and Mercer has bought up small private clinics as well as having its own managed care insurance plan. In order to stay competitive in the market, contracts from high technology firms such as Syntel, the company which manufactures computer chips whose function is to apply the Physician Order Entry (POE) system was sought after by Mercer Medical Centre. Plans from other competitors to implement same physician order entry (POE) system pushed Mercer to implement its system earlier than what has been planned (Ash et al, 2000). Second reason is the public relations. The latest lawsuit has a negative impact to the corporation and could damage its reputation in the market and its managed care contracts. As stated by Anderson, having a state of the art POE system will be a good promotional tool in negotiation of contracts (Ash et al, 2000). Resistance to change is normal. Lack of communication, minimal top management involvement and forced change processes are among barriers to change. Initially, the target population sees the change as a bad or threatening thing. The Project Manager should expect to encounter it and deal with it. The worst time to encounter resistance is during the cutover to the new solution. Transition is usually a busy, critical, high-risk period when the last thing you need is a lack of co-operation from the target population. A significant project will require a cascade of sponsorship, such that all affected parts of the organisation hear strong support from their leadership. If the message is delivered from the top and reinforced by the immediate management, staffs are far more likely to believe in the case for change and to act in support of the changes (Wallace, 2007). 1.2 Evaluate the strengths and weaknesses of bureaucratic health organizations Bureaucracy is a form of structure in many large scale organisations. It is based on specialisation of tasks, hierarchy of authority and decision making, systems of rules and regulations and an impersonal orientation from officials (Mullins, 2007). Bureaucracy is the division of labour applied to administration. Bureau, is a French word meaning desk, or by extension, an office; thus, Bureaucracy is rule through a desk or office, that is, a form of organization built on the preparation and dispatch of written documents. In contrast to the commonly held view of bureaucracies, they do not rule in their own right but are the means by which a monarchy, aristocracy, democracy, or other form of authority, rules (VectorStudy, 2008). Moreover, bureaucracies provide a safe haven where managers can hide from responsibility and avoid being held accountable for errors of judgement or problems they crated or failed to solve. In return, managers are able to use bureaucratic rules to stifle self-management and compel employees to follow their direction (Mullins, 2007). According to Weber, bureaucracy is a particular type of administrative structure developed through rational-legal authority. Bureaucratic structures evolved from traditional structures with the following changes In addition, the ideal bureaucracy was characterized by impersonality, efficiency and rationality. The key feature of the organization was that the authority of officials was subject to published rules and codes of practice; all rules, decisions and actions were recorded in writing. The structure of the organization is a continuous hierarchy where each level is subject to control by the level above it. Each position in the hierarchy exists in its own right and job holders have no rights to a particular position. Responsibilities within each level are clearly delineated and each level has its own sphere of competence. An appointment to an office, and the levels of authority that go with it, are based solely on the grounds of technical competence (VectorStudy, 2008). The term red tape is often used by customer to call an organisation when it has rigid policies and procedures. In addition, an organisation is described as bureaucratic when it seems to be inflexible and unresponsive to a customers individual situation. Top managers are dangerously ill-informed and insulated from what is happening on the front lines or in the field. Decisions are made based on the perceived desires of superiors, rather than concern for mission achievement. Bureaucratic management promises control and consistency, an up-focused mission promised that governmental agencies would serve the stockholders, represented by the board of directors, rather than the people within the organisation. Moreover, Bureaucracy as defined by customers and employees is an array of negative forces, attitudes or actions that are damaging to customer and employee satisfaction. It is damaging to organizational effectiveness. It weakens employee morale and commitment. It divides people within the organization against each other, and misdirects their energy into conflict or competition with each other instead of mission achievement (Visionary Publications, 2010). Compare and contrast different forms of organisational development. Organisational development (OD) can play a vital part in harnessing the collective talent of an organisation, bringing about change and improving performance. It involves taking planned steps to create an environment that will enable staff to understand and deliver organisations objectives, People Development Team (PDT), 2010. These steps include developing appropriate skills, behaviours and attitudes, culture and a style of leadership that will enable the organisation to achieve optimum performance. A clear sense of direction, strong leadership and a focus on people management issues including the management of performance and the promotion of learning, development, creativity and innovation are essential (PDT, 2010). A team building could be a group of people who improve their individual and collective performances through a process designed to bring this about. The definition needs to further state that the group of people need to have shared or common goals, which are usually the goals of the company they work for and it starts with good leadership, Team Building Online (TBO), 2010. Four stages of team building had been identified. First is the forming stage wherein people tend to be polite, cautious, trying to get organized and sense of belongingness in a group is being asked. Second is the storming stage wherein issues, irritations, and problems surface, infighting develops. Third is the norming stage wherein issues and problems are discussed openly to set new ground rules, processes and procedures to resolve them. Last is the performing stage wherein members of the organization are working together to meet the high standards of performance Some of the team building tips are valuing each member of your team, be the kind of company that a team member wants to be part of, give team members a reason to feel motivated to achieving the company goals, a strong leader committed to his or her work and make certain that there is always good communication between members and their management. While coaching is typically applied to one-on-one situations or to teams, most effective leaders are in truth coaches for their entire organisations. Coaching at its core about enabling others to succeed; toward that end coaches converse, cajole, confront and sometimes challenge individuals to do their best and then support them in that effort. Just as when you coach one on one, communications is all the more critical when coaching across an entire organisation. It can only be successful if it is based upon trust. One way you build trust is to listen to your people (Baldoni, 2005). Organisational coaching spreads the leaders message throughout the rank and file and in return it gives them ownership in the enterprise. It communicates that you care about individuals and you want them to succeed. It also gives them a voice in the process because listening to their ideas is essential. From the listening comes the learning so together leader and followers enrich a culture of sharing that builds a sense of pride as well as a more determined effort to succeed (Baldoni, 2005). A strategy is an overall approach and plan. So, strategic planning is the overall planning that facilitates the good management of a process. Strategic planning takes you outside the day-to-day activities of your organisation or project. It provides you with the big picture of what you are doing and where you are going. Strategic planning gives you clarity about what you actually want to achieve and how to go about achieving it, rather than a plan of action for day-to-day operations (Shapiro, n.d.). Word count = 1584 words Question 2: Develop policies and systems for involving others in the process of change 2.1 Describe how you would involve stakeholders in the introduction of this change into the healthcare organisation viz. Mercer Medical Centers Stakeholder is any individual, group or business with interest (a stake) in the success of an organisation. They typically concerned with an organization delivering intended results and meeting its financial objectives. A stakeholder may contribute directly or indirectly to an organizations business activities. Other than traditional business, a stakeholder may also be concerned with the outcome of a specific project, effort or activity, such as a community development project or the delivery of local health services. A stakeholder usually stands to gain or lose depending on the decisions taken or policies implemented (Investor Glossary, 2010). There are two important reasons in involving stakeholders in all phases of a project. Firstly, their involvement in a project significantly increases your chances of success by building in a self-correcting feedback loop; secondly, their involvement in a project builds confidence in a product and will greatly ease its acceptance in your target audience. Different types of stakeholders should be handled differently (Alexandrou, 2010) In approaching any businesses that require change clarity in all areas should be specified. A constant two-way communication that explains clearly the reason what and why there is a need for change. Active communications is important and demonstrate to people that you have thought the impacts of change on them, and that you are prepared to work with them to achieve their support and commitment to the change by making it work for them. Be consistent in leading the change. Constantly pay attention to the management of the tasks, activities, projects and initiatives that are delivering the capabilities into organisations that will deliver the benefits that you are seeking. Ensuring that your people have the full resources and capabilities they need to support them thro the change (Warrilow, 2010). The reason is so important is because people are stressed, tired and generally fed up with change initiatives. They need careful and detailed explanation of what are change management why the proposed change is necessary, and the direct effects on them and the benefits to them. They need help and practical support (Warrilow, 2010). There are two types of stakeholders in a company. First is the internal stakeholder that includes employees, managers and owners. Second is the external stakeholder that includes the suppliers, society, government, creditors, shareholders and customers. Mapping of stakeholders in change can be a useful tool to understand the support and opposition you will get for a planned change. Construct the map by first analyzing your stakeholders and then plotting them in the map below, writing their names in the relevant box. In doing this in a team one should write the names down of the stakeholders on Post-It Notes and stick them up on a chart on the wall. Opposition Support Stakeholder Power High Active opponents Passive opponents Fence-sitters Passive supporters Active supporters Medium Low Stakeholders all have authority, whether it is the formal power invested or it is social power of being able to persuade others to support or oppose the change. Those with higher power are likely to be your most useful supporters or most dangerous opponents thus power analysis helps you prioritize your focus on stakeholders. Some people will actively support the change, putting their necks on the line and working long hours to help it be successful. Others will work the other way, determinedly seeking to ruin your efforts (Straker, 2010). These active people are where much focus often happens. However, there is often a silent majority who are more difficult to classify. These may be in gatekeeper positions, where rather than taking positive action, they can subtly support or oppose the change by allowing things to happen or quietly blocking and hindering progress (Straker, 2010). A Stakeholder Analysis and Map is a useful and necessary process for identifying and planning the necessary communications process for a programme. It lists each of the stakeholders against their particular interest area in the programme. It also lists known or anticipated issues associated with any person or group (Warrilow, 2010). Each of these people and groups will have a specific interest area, such as financial, technical, regulatory etc so when you are identifying them it is important to recognise their specific interest areas in order to ensure that their expectations can be managed effectively. There clearly will be individuals or groups who will be worse off as a result of the programme and who are therefore potential blockers to the progress of the programme. Both the positive and negative viewpoints should be considered as part of stakeholder management (Warrilow, 2010). Moreover, the Pre Programme Review and Planning will have identified issues associated with these individuals or groups and determined potential solutions and strategies for resolving the issues. Information dissemination and two-way communications are critical for managing expectations effectively (Warrilow, 2010). 2.2 Analyze and evaluate the effectiveness of systems in promoting change in Mercer Medical Centers. A system is an organized collection of parts that are highly integrated in order to accomplish an overall goal. The system has various inputs which are processed to produce certain outputs, which together, accomplish the overall goal desired by the organization. To explain, inputs to the system include resources such as raw materials, money, technologies and people. These inputs go through a process where theyre aligned, moved along and carefully coordinated, ultimately to achieve the goals set for the system. Outputs are tangible results produced by processes in the system, such as products or services for consumers. Another kind of result is outcomes, or benefits for consumers, e.g., jobs for workers, enhanced quality of life for customers, etc. Systems can be the entire organization, or its departments, groups, processes, etc (McNamara, 2010). Decision Conferencing is a proven method of achieving more effective decisions. The process involves groups of people in a transparent decision-making process and is ideally suited to resolving complex issues fast (Catalyze Ltd, 2008). All parties involved in the decision making process are gathered together in a series of workshops where options and issues are identified and discussed. These discussions are typically aided by modelling the problem, a process that documents the discussions and allows the best value options to be identified and different scenarios to be analysed. It is a remarkably powerful communication tool, allowing the group to openly discuss their organisation, values, issues and beliefs. The results are also ideal for educating and informing people not present at the workshops (Catalyze Ltd, 2008). Systems engineering integrates all the disciplines and specialty groups into a team effort forming a structured development process that proceeds from concept to production to operation. Systems engineering considers both the business and the technical needs of all customers with the goal of providing a quality product that meets the user needs (Incose.org, n.d.). Evaluation, in the context of management activities, is carefully collecting information about something in order to make necessary decisions about it. There are a large number and wide variety of evaluations that can occur in businesses, whether for-profit or non-profit. Evaluation is closely related to performance management (whether about organizations, groups, processes or individuals), which includes identifying measures to indicate results. Evaluation often includes collecting information around these measures to conclude the extent of performance, Free Management Library (FMP), 2010. Several systems has been tried to implement in Mercer Medical Centre in order to improve its services to its user. A system called Physician has been attempted to implement two years ago and it failed in great proportions. Opposition from the medical staff was identified from the time they previewed the system. The implementation was carried out without consideration to physicians opinions. It was abandoned after two days of implementation due to technical problems. This was not a successful system because it resulted to great loss of money, the CIO nearly lost his job and the image of the information services department was severely tarnished (Ash, et al., 2000) Another system, CareReviewer was tried to be implemented but end up being unsuccessful because of its unwelcomed technology as perceived by the challenged medical staff. They thought that the system add to their workload rather than making their jobs easier. Being pushed to see more patients in less time and with less compensation, physicians see this as a cause for them to receive less salary and working for the top executives to make more money and they lost their autonomy (Ash, et al., 2000) Recently, the hospital is trying to implement a new system, the Physician Order Entry (POE). Instead of implementing the system for a longer period of time, the top management wants to implement it within nine months time. The change in the time frame was caused by competition by Mercer Medical Centre with the other health care provider around the area and public relations (Ash, et al., 2000) Reed was aware of the existing resistance to the organisation and she is willing to win back the trust of the medical staff by being available to them 24-hour and giving support by visiting them to their home personally in order to build rapport. Involving influential people and making sure that the system provides immediate benefit to the users increases the use of the POE. Fast, easy to use, being accessible anytime, consistent, accurate and reliable and a system that positively affect the patient care is the system that physicians wants. (Ash, et al., 2000). Word count = 1525 words Question 3: Implement models for ensuring change in which risks are managed 3.1 Develop models for change that take account of risks in the context of case study. There are many causes of organisational change such as economic downturns, changes in strategy, government legislation, labour market pressure, technological changes and natural evolvement. It is crucial that organisations manage this change from within and understand and plan for the effects it may have on their employees (Snaith, 2010). Introducing change to an organisation can be difficult and managers need to gain the support and commitment of their colleagues and employees to ensure that change is managed effectively and business continues as usual with as little disruption as possible. Failure to do this can result in a loss of talented employees, a loss of credibility and a loss of the organisation market position (Snaith, 2010). It is usual for organisations to encounter resistance to change. Employees may be concerned for their job, be sensitive to change, dislike the change that is taking place, or dislike the process in which it is taking place. To combat this employer need to ensure that they communicate with their employees on a continuous basis, provide any training that may be required for new roles or changes to current roles, and ensure that the reasons for the change are communicated from the offset (Snaith, 2010). When change is imposed to people they feel little ownership with their decision and it leads them to feel out of control. Some people will go through the process quickly and others slowly (RapidBi, 2008). Kotter listed reasons why change fails, these includes allowing too much complexity, failure to build substantial coalition, understanding the need for a clear vision, failure to communicate and permitting the roadblocks against the vision, not planning and getting short term wins, declaring victory too soon and not anchoring changes in corporate culture (RapidBi, 2008). There are many change management models; the most common is the Kubler Ross transition (Grief) cycle which is well grounded in academic research within clinical environments. Another model is the ADKAR model for individual management which was developed by Prosci. It describes the five required building blocks for change to be realized successfully on an individual level. The building blocks include awareness, desire, knowledge, ability and reinforcement. (RapidBi, 2008). Business process Reengineering aims to increase performance by radically re-designing the organizations structures and processes, including by starting over from the ground up (McNamara, 2010). Kaizen is a model that has incremental self-improvement that has been applied to business and management. Use only for improvement to existing processes. It is not a methodology for introducing new processes or large scale change. It works well where there is a long-term requirement. It focuses on the people aspects of improvement, requiring some discipline and acceptance of change for improvement but can be easier to implement than other business process re-engineering methodologies where more radical changes are required in the short term which can give rise to more resistance and require more robust change management skills (JISC Advance, 2009). People have different perception on change therefore it should not and cannot force on people; instead as a change manager we should encourage people to make a choice or decision. 3.2 Plan the implementation of the model of change developed for Mercer Medical Centers Business Process reengineering is a technology-oriented approach that enables radical change however requires considerable management skills. According to Davenport (1992), business process reengineering has 5 steps approach. First is to develop the business vision and process objectives. Second is to identify the business process to be redesigned. Third is to understand the existing processes. Fourth is to identify the IT levers and last is to design and build a prototype of the new process, The Executive Fast Track, (TEFT), 2010. Change is a fundamental component of continuous quality improvement. Any improvement methodology involves introducing change and measuring its impact. In health care there has been recognition of the need for system change to support the delivery of safe, quality care, Victorian Quality Council (VQC), 2006. It is not enough to provide the tools and strategies with which to improve safety and quality of health care and expect success. There is a need to be aware of what to expect when introducing change, how to engage staff and to make change sustainable. Knowledge or awareness of change processes may assist in ensuring success of a project (VQC, 2006). Successful implementation of system change is essential in the provision of safe, quality care to consumers. Implementation of improvement projects and sustaining the resulting change can be a difficult process. It has been stated all too often that quality improvement projects fail on a regular basis. The individual or the teams introducing change have a challenging task. Change management is one component of a successful project; the need for project planning and the use of quality improvement tools are also critical (VQC, 2006). People are generally the most critical resource, supporter, barrier and risk when managing change. The uncertainty of change can provoke strong emotions, with most people experiencing some sense of grief and loss as they let go of the old and move towards the new (VQC, 2006). Awareness of the range of reactions to change will help the leader of the change process respond appropriately to concerns that are expressed. Understanding why these emotions occur may assist the leader to introduce change in a manner that anticipates, acknowledges and responds to concerns (VQC, 2006). Since improvement depends on the actions of people, ultimately it comes down to winning hearts and minds. Staff will not respond well to just being told to change, nor can the project leader stand over staff to ensure compliance. To be successful, a change management process must include an effective communication strategy. All stakeholders must have opportunities to express their views and attitudes as part of the planning process. A lot of improvement is about changing mindsets. It is about having the tools, techniques and confidence to work with colleagues to try something that is different. It is about understanding the possibilities of thinking differently and aiming to make practical improvements for patients and staff (VQC, 2006). Evaluation is an important component of any change process. As part of the project planning a decision needs to be made about measures that will be used to determine if the planned change leads to an improvement (VQC, 2006). Dissemination of the evaluation is important and consideration of the audience, the method and format of communicating the feedback should be undertaken. Present the final package containing all the planning, data, outcomes and learning to staff and stakeholders. If this evaluation is shared, and the emphasis is on learning in a non-punitive environment, then it can become a benchmark (or standard) for implementing change (VQC, 2006). The key to implementing change and continuous improvement is the effective exchange of information between people and process, a combination of business and human dimensions towards a shared objective (VQC, 2006). 3.3 Evaluate the outcome of change in Mercer Medical Centres Competition and public relations are the wrong driving forces for change mentioned in the case of Mercer Medical Centre. These forces for change lead to resistance by its medical staff. In any successful change initiative 3 broad areas should be included: leadership that directly addresses the transitions and emotional dimension of those impacted by the change, and provides inspirational motivation, a change model and methodology that cover the multiple factors that must be addressed and action management that shows and assists people with the specifics of exactly what is required of them (Warrilow, 2010). Fast implementation of the POE system was pressed to Dr. Reed and she knows that the corporation is not ready for this change. They need time to implement such change and that what she does not have (Ash, et al., 2000). Mercer Medical Centre experiences almost the same environmental influences that put pressures to organisations. Two-way communication is very important thing that has been recommended by different stakeholder groups. They must come together, engage in constructive problem solving, create a common strategy, and actively take charge of the change. There can never be any general formulas for organizational success. Each organization has its own constraints and pressures however there is a large number of theories which can be used as a guide for success. Each theory has its own drawbacks and tends to be situation-specific. Managers and organizations need to treat theories with degree of skepticism. If managers can identify the theories for planning and changing organizations and they can understand it then they are in a position to identify choices and make changes (Brunes, 2004). Sometimes mangers may choose or be required by circumstances to change their organizations radically and quickly; sometimes they may choose to influence the context to promote or reduce the need for such changes. In some instances, change may take place more slowly and over a long period, as both organization and context are shaped and changed. The key factor for this is to make conscious decisions rather than rely on untested assumptions. This will require those who manage and lead organizations to question and challenge their own and other peoples assumptions. This will also require them to gather and be open to a wide variety of information. Learning should be an organization-wide and continuous process, rather than one limited to a few like-minded individuals at one point

Skin Diseases Affect On Peoples Health

Skin Diseases Affect On Peoples Health In modern society, more and more people are attacked by a variety of diseases. In medicine, relevant skin diseases seriously affect peoples health. As one of the common diseases, skin diseases such as leprosy, scabies, fungal disease, bacterial skin infections appear frequently. With the form, structure and functions changing, skin (including hair and armor) is influenced by external and internal factors, which produce the pathological process, and the corresponding produce all sorts of clinical successively performance. This is the cause of skin diseases. They have a high incidence of dermatitis, but relatively the symptoms are not serious, they often do not affect health, but a few heavier are even life-threatening. As a typical kind of skin diseases, photodermatoses are among the most common skin disorders in the world. Some of them acquired a particular importance in some regions because of their high frequency, severity, and also beÂÂ ­cause of their different diagnostic and therapeutic apÂÂ ­proaches. Photo medicine is a rapidly developing subspeÂÂ ­cialty of dermatology concerned with skin diseases caused by radiation in the UV and visible spectra. Initiation or exacerbation of a rash after sun exposure that occurs in typical light-exÂÂ ­posed areas is features that point toward a sunÂÂ ­light-induced condition. The diagnosis of photosenÂÂ ­sitive conditions may be difficult, and the use of investigations such as light, patch, and photopatch testing may be necessary to confirm the diagnosis. [1] Background and history With the development of modern medicine, every Teaching Hospital Department is in treatÂÂ ­ment development dilemmas. For becoming involved in a new therapy, they still need to promise to be at the speculative stage. In the early 1990s, the problem about whether to actively become involved in the development of PDT for skin cancers was discussed by the Photobiology Unit within the Department of Dermatology in Dundee. As a new invest significant reÂÂ ­sources, its so difficult for PDT to have a fairly certain outcome. By 1998, with the position changed and enough good quality data existed, treatment outcomes justiÂÂ ­fied become involved in the development of both PDT and photodiagnosis (PD) for pre-malignant and malignant skin lesions. From a clinical reÂÂ ­search and therapeutic point of view, the skin has two huge advantages. Firstly, it can be easily exÂÂ ­amined with the naked eye, and secondly, it is the most accessible organ for investigation, biopsy an d treatment. Although PDT firmly has its roots at the beginning of the last century, it is only over the last 15 years that it has gained considerate popularity as a topical treatment of great promise for the treatment of skin cancers.[2] In 1900 a German medical student Oscar Raab famously reported the concept of cell-induced death subsequent to light interacting with chemicals. In subsequent experÂÂ ­iments he demonstrated that this effect was greater that with alcidine red alone, light alone or alcidine red exposed to light and then added to the paramecium. He postulated that in vitro toxicity occurred as a result of fluorescence caused by the transfer of energy from the light to the chemÂÂ ­ical. Professor von Tappeiner soon after predicted the future of fluorescent substances in medicine. In 1904 von Tappeiner and Jodlbauer identified that oxyÂÂ ­gen was integral component in photosensitisation reactions and termed the phrase photodynamic action in 1907. Since its incidental discovery in 1900 photodynamic therÂÂ ­apy (PDT) and all aspects relating to it from mechanism of action, differing photosensitisers through to clinically based applications have been studied. Three components are required for PDT to occur; a photosensitiser, oxygen and a light source. [3] The Photobiology Unit (photobiology = the study of tight on living systems) has the purpose in Scotland of diagnosing tight sensitive skin disease (the photodermatoses) and the development of new forms of tight therapy (phototherapy). This Centre, which has been in existence since 1973, has always combined clinical skills (photodermatology) with a strong scientific base (photophysics) and laboratory biology (photobiology). This combination of applied science and clinical service in the same unit has proÂÂ ­vided exciting research opportunities. Applied photo physics, through the Medical Physics Department, has dedicated members of staff whose only rote is optical physics. The necessary expertise in tight de-tivery and measurement is essential for predictable PDT and PD. Basic knowledge of sun and the skin Nm 254 290 320 360 X-rays UVC UVB UVA Visible light Figure 1 the place of ultraviolet radiation in the electromagnetic spectrum Figure 1 illustrates the relationship between ultraviolet radiation and the other types of non-ionizing radiation, such su natural light an infra-red radiation. It will be seen that ultraviolet radiation from the sun is divided into three different wavelengths-UVA, UVB, and UVC. The UVA waves are the longest and the UVC the shortest. At present, UVC is prevented from reaching the earths surface by the ozone layer, and is not therefore a natural hazard. There is, however, concern that the loss of the protective layer of ozone above the earths atmosphere will continue, and that in future more UVB might reach the earth. The main ultraviolet component of travel of natural that does each the earths surface is UVB. This penetrates the epidermis and reaches the more superficial layer of the dermisthe papillary dermis. UVA is also present in sunlight and ,in the early spring, a high proportion of natural sunlight in countries at latitudes 50 degrees or more north of south of the equator is composed of UVA. As the summer develops the proportion of UVA falls. UVA is the main, but not the only, wavelength found in the long tubes in UVA sunbeds. The effects of UVA go deeper into the skin than those of UVB. A very simple rule of thumb is that chronic over-exposure to UVB causes wrinkles, chronic over-exposure UVA causes saggi ng, and chronic over-exposure to both increases the risk of developing skin cancer. One of the important points of difference between UVB and UVA exposure is that acute over-exposure to UVB causes the redness and soreness recognized as sunburn. This is maximal 12-24 hours after the exposure has taken place, and is a useful warning that the skin should be protected for a few days until the redness has disappeared. The chemicals in sun-screens that protect against UVA and UVB can be divided into those that absorb ultraviolet radiation and those that reflect it away. The absorbing chemicals include para-aminobenzoic acid-PAMA- cinnamates, and salicylates, which protect against UVB alone. Benzophenones protect against both UVB and UVA and are also chemical sun-screeners.[4] Photosensitivity The skin is our main defense against light, and in particular against ultraviolet (UV) radiation. Sometimes the skin reacts abnormally to light by becoming inflamed. This is called photosensitivity. There are many causes of photosensitivity. Some of the most important are below: Acute parts like Sunburn Xeroderma pigmentosum, Porphyria, Solar urticaria, Pellagra, and Photosensitivity disorders like Polymorphic light eruption, Juvenile spring eruption, Hydroa vacciniforme, actinic prurigo. Disorders exacerbated by light include Drug reactions, Lupus erythematosus, Rosacea Dariers disease Eczema (including actinic dermatitis and photo contact dermatitis Psoriasis Lichen planus. These reactions are either a direct toxic effect of light, or have an immunological component, either provoked by light alone or in conjunction with something else such as a drug. Diagnosis and treatment of common causes of photosensitivity The acute effects of sun on the skin are all too familiar. They are caused largely by medium wavelength UV radiation (UVB), but the dose required producing sunburn depends on: (1)An individuals skin type (2)The intensity of the radiation (greatest near the equator and around midday) (3)The length of exposure to UVB Mild sunburn causes erythema: more severe damage leads to extensive blistering and epidermal boss. Treatment makes little difference to the acute changes, but symptomatic relief can be obtained with soothing lotions, such as calamine. These include avoiding the midday sun, seeking shade, wearing appropriate clothing and eyewear, and using sunscreens, this is more important for those with skin type I and II than for those with a more radiation skin. There are several special examples which are listed and explained: (1) Porphyria: Some forms of porphyria are associated with photosensitivity. In a European child the most common is erythropoietic protoporphyria, whereas an adult presenting for the first time probably has porphyria cutanea tarda. The latter is often associated with alcoholic liver disease. Screening tests involve blood ,urine and stool samples and are best undertaken in a specialist setting. (2)Solar Urticaria: Rarely, exposure to light leads to urticarial weals. (3)Pellagra: In western societies, nicotinic acid deficiency is seen most commonly in alcoholics. It presents a triad of changes: Diarrhoea Dementia Dermatitis, which is light sensitive. (4)Polymorphic light eruption This is perhaps the most important, and certainly the commonest of the primary photosensitivity disorders. Patients often refer to their skin changes asprickly heat, but true prickly heat (or miliaria rubra)is quite different. Polymorphic light eruption presents a day or two after sun exposure, with changes on light exposed areas, for example the forearms, legs the V of the neck and the face. The lesions are itchy and morphologically variable (hence polymorphic). There may be papules, plaques, and blisters of areas resembling eczema. They increase in intensity over a week or so before subsiding. Treatment with topical steroids provides some relief, but some patients require systemic steroids to control an acute attack. Prevention is a better approach. Unfortunately, sunscreens are often not effective, but pre-season PUVA works well and can last for a whole summer. An alternative is the use of antimalarial medication (notably hydroxychloroquine) taken during sunny periods, or while abroad. A variety of polymorphic light eruption occurs almost exclusively in boys. Clusters of small blisters appear on the topes of the ears, especially in early spring. The condition settles spontaneously with age. Clinics in Photodermatosis Actinic Prurigo Actinic prurigo (AP) is a dermatosis that belongs to the group of idiopathic photodermatoses. Many names have been given to it, such as: solar dermatitis, GuaÂÂ ­temalan cutaneous syndrome, solar prurigo, light-sensitive eruption in American Indians,familial actinic prurigo, polymorphous light eruption, (prurigo type) solar prurigo of high plateaus, and hereditary polyÂÂ ­morphic light eruption of American Indians; howÂÂ ­ever, it is the term actinic prurigo, coined by Lon-dono11 in 1968, which is preferred and used by most authors today. Actinic prurigo is a chronic photodermatosis that has frequently been confused with polymorphic light erupÂÂ ­tion (PLE). However, there are now enough clinical, histologic, epidemiological, and immunogenetic data to suggest that they are two different diseases. AP begins in the first decade of life usually around ages 4 to 5, affects females more than males (ratio 2:1). The lesions are symmetrical in the sun-exposed areas of the face (eyebrows, dorsum of the nose, malar reÂÂ ­gions, upper and lower lips), V-area of the neck, dor-sum of hands and forearms. The primary lesions are erythematous papules although excoriaÂÂ ­tions, crusts, and lichenified plaques are commonly seen. Pruritus is a rule and usually very intense. One of the clinical features which distinguish this disease from PLE is the absence of vesicles as primary lesions in AP. Of course, whenever a secondary dermatosis such as eczema, impetigo, or contact dermatitis ensues, vesiÂÂ ­cles may be seen. Two other differences between AP and PLE are lip and conjunctival affection in AP. CheiÂÂ ­litis of actinic prurigo affects 84% of patients. AlÂÂ ­though lesions are usually seen in both lips, the lower one being more exposed to sun rays is affected first an d more intensely; severe cases show edema, crusts, fisÂÂ ­sures, shallow ulcerations, and hyperpigmentation, while in mild cases only dry lips with scaling may be found. Atopic dermatitis with photosensitivity where the key findings are a familial incidence, an early infancy onset, the presence of xerosis, the sparing of the tip of the nose, and a good response to topical cortico-steroids and emollients. Chronic actinic dermatitis which is quite infrequent, starts much later in life has a reduced UVB minimal erythema dose induction, and/or positive photo-patch testing. Persistent light reactors and actinic reticuloid show histologically dense lymphocytic inÂÂ ­filtrates, which especially in the latter may resemble true lymphomas. [5] Phytophotodermatitis Phytophotodermatitis is a very common skin disease in some countries. It is an acute phototoxic reaction where a substance containing psoralens comes in conÂÂ ­tact with the skin which is then exposed to UVA light. The clinical picture is that of sunburn ranging from mild erythema to severe blistering; it is usually accomÂÂ ­panied by stinging or burning sensations. A residual hyperpigmented macule is the final stage of the disease and usually persists for weeks to months; some dark-skinned individuals (skin types IV to VI) may only present with this hyperpigmentation without any preÂÂ ­vious signs or symptoms of sunburn. The most common phototoxic compounds are the furocoumarins which contained in a wide variety of plants, especially of the Umbelliferae, Rutaceae, and Moracea families. Commonly occurring photosensitizÂÂ ­ing plants include citrus fruits such as limes and orÂÂ ­anges, figs, and many vegetables such as celery, parsÂÂ ­nip, parsley, carrots, and dill32; furocoumarins in lime pulp are 13 to 182 times less concentrated than those in the peel. Treatment is only symptomatic. Topical corticoste-roids help alleviate the burning sensations but do not seem to improve skin healing. Sunscreen use helps the resolution of the hyperpigmentation, and is the most important prophylactic measure for high-risk people. Melasma Melasma (chloasma) is characterized by light or dark brown hyperchromic macules with undefined borders, affecting mainly and symmetrically, the sunlight-exÂÂ ­posed areas of the face. Melasma predominates in women, although it also affects men and has been reÂÂ ­lated to sunlight exposure as well as hormonal, racial, and hereditary factors. Melanocytes are well known to be stimulated by estrogen and other sex-related hormones. Pregnancy and the ingestion of oral contraceptives can produce or exacerbate melasma, with an increase of melanogenesis and the presence of large melanocytes. Facial melano-cytes appear to be especially sensitive to hormonal inÂÂ ­fluences but sunlight is always necessary for melasma to occur. Melasma has been reported to have a greater inciÂÂ ­dence in tan or dark-skinned persons, especially in skin types III, IV, and V, but also depends, as stated before, on sunlight exposure (including UVA and visiÂÂ ­ble light). Piquero-Martin has observed that pigment dispoÂÂ ­sition (as seen with woods light), tends to occur more superficially in lighter skins and deeper in darker skins, the latter being more difficult to treat and eradicate. In some dark-skinned patients with clinically evident melasma, under woods light, the hyperpigmentation disappears. Apparently, this can be related to melanic pigment located deep in the dermis. Differential diagnoses include Rhiel melanosis, Ashy dermatosis, Addison disease, pigmented lichen planus, and postinflammatory hyperpigmentation. Many treatment modalities have been used, such as mercury compounds, vitamin C, tretinoin, topical steÂÂ ­roids, glycolic acid, azelaic acid, and hydroquinone. Pytiriasis Alba Pytiriasis alba is a chronic asymptomatic dermatosis of unknown ethiology, characterized by hypochromic macules, 1 to 5 cm in diameter, covered by a very fine scale, with an ill-defined and occasionally hyperpig-mented border. The macules are mainly located on the sun-exposed areas of the face (malar areas, forehead, around the nasal and moth orifices) and extremities. The cause of this dermatosis is unknown, but many factors have been attributed to it. The main cause is sunlight exposure on a tan or dark skin, and it has been described as a reactive dermatosis to a distant staphy-loccocal or streptoccocal upper respiratory tract infection. The lesions have been attributed to postinflamma-tory hypopigmentation, with a decrease in melanosome number and size, low keratinocyte melanin uptake, and light refraction from a hyperkeratotic and parakeratotic stratum corneum. The histopathology shows an epiÂÂ ­dermis with hyperkeratosis and parakeratosis, acantho-sis, and mild spongiosis. In the papillary dermis, vaso-dilation and mild perivascular inflammatory infiltrate and occasional pigment incontinence can be seen. Sunlight radiation (UVA, UVB, and visible light) in atopic patients with tan or dark skin are the most commonly affected. Treatment of pytiriasis alba must include sunlight protection, sun filters, low potency corticosteroids with a topical antibiotic (mupirocin, vioform). If an upper respiratory tract infection is detected, specific treatment should be given. Pellagra Also named Gaspar Casals disease, pellagra is a nutriÂÂ ­tional disorder due to nicotinic acid deficiency, a B complex vitamin. Niacin is a nonessential vitamin and can be synthesized from the aminoacid tryptophan via the kynurenine pathway. It is mainly expressed on the skin, gastrointestinal and central nervous system. Pellagra is a bilateral and symÂÂ ­metrical dermatosis affecting sun-exposed areas. The avitaminosis can be caused by drugs, such as isoniazid, 6-mercaptopurine, 5-fluouracil, and chloram-fenicol. Phenytoin and sodium valproate51 have also been related to nicotinamide deficiency. Clinical findings in pellagra include dermatitis, diarÂÂ ­rhea, and dementia (the 3Ds). Pellagra is characterized by a intense red, scaly and hyperpigmented plaques on areas exposed to sun, heat, friction, or pressure. The lesions can be edematous with a burning sensation and occasional vesicules and des-quamation. In chronic lesions, the skin is thickened, hyperpig-mented with a dark brown hue. A typical finding is Casals necklace, a scaling collarette around the neck which extends down toward the sternum. Flexural fold may be macerated, and on seborrheic areas, follicular hyperkeratotic plugs are freÂÂ ­quently present. Frequently, angular cheilitis, glossitis with papillary atrophy with a tender beefy red tongue, and esophagitis are seen. Manifestations in adÂÂ ­vanced disease cases are vomiting, diarrhea, and weight loss with secondary anemia or amenorrea. CenÂÂ ­tral nervous system symptoms include irritability, headaches, insomnia, amnesia, and anxiety. Later on, patients develop tremor, movement disorders, numbÂÂ ­ness, encephalopathy, paralysis, and psycosis.[5] PDT in dermatology Photodynamic therapy (PDT) harnesses the power of light and oxygen to enact biologic change. In its infancy, the use of PDT in the treatment of dermatologic disease was limited due to the prolonged and pronounced photosensitivity resulting from systemic photosensitizing agents. HowÂÂ ­ever, in the early 1990s Kennedy and Pottier described the use of topical 5-aminolevulinic acid (ALA) to create endogÂÂ ­enous protoporphyrin IX (PpIX) from which came a limited, localized, photodynamic response. With this development, many of the early limitations of PDT were alleviated, and the treatment became much more convenient. Early application focused primarily on the treatment of dysplastic and neoplastic disease; however, during the past few years, the versatility of PDT has been more fully realized, and it is now also being used to treat a wide variety of inflammatory and infectious processes. The effectiveness of PDT depends on the photosensitizer used, its ability to selectively penetrate diseased tissue, and the duration of application; the activating light source, its ability to penetrate to the desired target, and its duration of exposure; and the type of target cells and their oxygenation status. To be effective, the damage resulting from PDT must surpass cellular repair mechanisms, a feature referred to as the minimum photodynamic dose. [6] Summary According to the lecture the Professor Moseley gave us and the materials I get from relative books and papers. We can know that the photodermatology is a huge branch of skin disease. First I give the introduction and a review of background and history, it can clear explain what is photodermatology especially photodermatosis in clinic use. Next I focus on Photosensitivity, PDT in dermatology and Clinics in Photodermatosis, which explain different parts of the whole photodermatology. In Clinics of photodermatosis, there are many kinds of photodermatosis listed and illustrated, including the principles, treatment and prevention. As new to dermatology, PDT is an effective therapy to cure dermatosis by penetrating diseased tissue.