Health Care

There are hundreds of different medically related careers. Some of the jobs involve close contact with patients whereas others are to do with organisation and management or with providing essential support services. There are opportunities for people with all levels of qualifications from none at all, to post graduates and degrees. So don’t think that you have to be VERY brainy to work in medicine because there is a job for everyone, as you will see from this presentation.

To Work in Medicine

Basically, to work in health and medicine, you need:

• Good communication and team work skills. A lot of the work you do will be as part of a team so you need to know how to behave and cooperate with other people.
• To be reliable and conscientious. Your patients need to feel they can rely on you and come to you for any help.
• Sensitivity, tact and understanding. (For those in patient contact)
• An interest in science and technology. So don’t just choose medicine because of your family, or because of the amount of money you get paid, that’s just ridiculous. You need to have a genuine interest in science and technology.

People with 5 GCSEs at Grades A – C

• Dental technicians make dental appliances such as dentures, crowns and braces as well as fittings for people with facial injuries. It is mainly a workshop job and most dental technicians work in commercial dental laboratories.
• You need to be good with your hands and be interested in science and technology.
• Dental Nurses work with dentists in hospitals, community clinics and private practices. They prepare fillings and dressing, pass instruments to the dentist, attend to the patients and sometimes act like receptionists too. Therefore you need to be calm and have a pleasant manner.
• Medical technology covers the area of clinical physiology and medical physics. Concerned with measuring how well various parts of the body function and it involves working with sophisticated electronic machinery such as scanners or working in nuclear medicine. The technicians assist the professionally qualified staff in diagnosing and treating patients.
• Biomedical scientists work mainly in hospital labs, carrying out tests on bodily tissues and fluids. There are opportunities for those without any formal qualifications to work as medical laboratory assistants and assist those that are professionally qualified.
• Pharmacy technicians make up prescriptions and prepare medicines, supervised by a pharmacist. Accuracy is essential when you are working with drugs, as mistakes can be highly dangerous. It’s largely behind-the-scenes job in a hospital or in a retail chemist’s shop.
• Dispensing opticians supply and fit glasses and contact lenses, working from the optometrists prescription. They are not qualified to do eye tests themselves. You need to be good with people and also enjoy selling.

For People With A-Levels or Equivalent, or With Higher Qualifications

• Doctors diagnose and treat illness, but they also have a role in preventing disease. Qualified doctors can specialise in general practice, surgery, psychiatry, obstetrics, orthopaedics, paediatrics, ophthalmology, oncology and many other areas. Three very good A-levels are needed, including Chemistry and often two other sciences.
• Dentists treat damaged and diseased teeth and gums, and also carry out preventative and corrective treatments. Dentists must be skilled with their hands and good at dealing with people under stress.
• Dental therapists and hygienists advise people on how to look after their teeth and gums. They clean and scale teeth, and carry out other treatments prescribed by dental surgeons. Therapists are trained to do fillings and extractions on children.
• Medical illustrator, pharmacist & optometrist
• Medical Photographers record operations, postmortem examinations, laboratory specimens and injuries at various stages of recovery. Medical photographs are used for patient’s records, to help in diagnosis and to record patients’ progress.
• Medical illustrators make illustrations, diagrams, visual aids and displays. Their work is mainly used for teaching, health education, medical journals, textbooks and for presentations.
• Pharmacists supply drugs, medicines, preparations and appliances prescribed by doctors, either in hospital pharmacies or over the counter in a retail chemist’s shop. They have to know a great deal about medicine and their effect on the body.
• Optometrists test eyesight to detect and measure faulty vision, and prescribe lenses to correct it. They must also spot any diseases, which can show up as eye conditions and know when to refer patients to a doctor. Most optometrists work in private practice, but some work in the NHS.
• Clinical psychologists treat people who have behavioural problems, learning difficulties, and conditions like anxiety and depression through a mixture of counselling and psychotherapy. After a psychology degree, comes postgraduate training.
• Health Promotion is an area where experienced health professionals can enter. It raises our awareness of how to live a healthy lifestyle. The work involves organising campaigns, providing advice and support to other health professionals and health service managers.
• Podiatrists treat all kinds of foot problems from verrucas to ulcers. They also try to stop such problems arising in the first place.
• Dieticians advise patients about special diets to follow to control a medical condition or as part of their general recovery plan. They also advise hospital catering staff on nutrition. They may also work in health and fitness clubs.
• Orthoptists work with patients, often children who have defective vision, abnormal eye movements or other correctable eye conditions. They prescribe eye exercises and check on their progress.
• Radiographers can specialise in one of two areas. In diagnostic radiography, they help doctors to diagnose broken bones and other conditions using x-rays, ultrasound and other techniques. In therapeutic radiography or radiotherapy, small doses of radiation are used to treat patients with conditions such as cancer.
• There are many different therapists. Physiotherapists help sick and injured people, and those with disabilities, to be as physically independent as possible. They use exercises, massage, heat and electrical treatment, hydrotherapy etc.
• Occupational therapists help clients to be more independent through everyday activities, which will get their minds, muscles and joints working properly. Patients may need help because psychiatric problems or accidents.
• Speech and language therapists work with clients who have speech and communication problems, which they may have been born with, or which has risen due o illness, injury, or as a result of psychological problems. Therapists need to be patient, resourceful and have good communication skills.
• Art, music and drama therapists help patients on general psychiatric hospital units, clinics, special schools etc. dance therapists have a similar role.

Chapter 1 – Health Care Delivery Systems There are many interesting and important points in this chapter. Some of them include: Pennsylvania Hospital founded by Ben Franklin was the 1st US hospital University of PA was the US first medical school The AMA was founded in Philadelphia in 1847. The Flexner Report was published in 1910 and impacted the status of medical school education. Hill-Burton Act of 1948 provided federal monies to update hospitals JCAH which is now JCAHO was created in 1951. JCAHO is an independent accreditation agency for health care facilities (all types).

Medicare and Medicaid were enacted by Congress in 1965 Privacy Act of 1974 – protect the privacy of information systems in federal health care facilities HCFA (now called CMS) was created in 1977 TEFRA in 1982 established the first Medicare prospective payment system EMTALA of 1985 protected patients against “dumping” HIPAA was passed in 1996 with components on standardization, simplication, privacy, and security SCHIP was established in 1997 to provide health insurance to infants and children not covered under Medicaid Notice all of the abbreviations used in chapter 1!

The use of abbreviations and acronyms is very prevalent in the health care and HIM field. Important Concepts in Chapter 1 Continuum of Care – primary care, secondary care, and tertiary care. Most of us are familiar with primary care, care sought by a patient with medical professionals for current problem or maintenance of a problem. Secondary care is seeing a specialist, dermatologist, neurologist, etc. for a problem, often referred by your primary care or family doctor. Tertiary care is often provided in specialty hospitals.

This can include specialty radiograph (PET scan, MRI), burn treatment, cancer treatment centers, etc. Health care facility ownership, there are three kinds of facility ownership in general; government, for profit, and not-for-profit non government (Faith-based hospitals for example). Hospitals are organized with a governing body at the top, sometimes referred to as a board of trustees. Within the hospital and most larger health care facilities (rehab, clinics) there will be an Health Information Management (HIM) or Medical Records Department.

However, Medical Records is an older term. Typical functions of an HIM department include, coding, chart abstraction, record processing, record storage and retrieval, medical transcription, release of information (ROI), cancer registry, and index complying and retrieving. The size of the HIM department staff will vary and is usually based on the bed size of the facility and/or annual visits processed (discharged, ED, Outpatient surgery etc. ). One of the most visible components of a health care facility and an HIM department is the coding function.

Coding is also seen in outpatient area for physician office and other types of non-hospital based healthcare. This is based partially on the fact the coding is tied to reimbursement and funding for the facility/provider. In the US there are two main coding systems used; ICD-9-CM and HCPCS. HCPCS contains CPT codes which are often thought of as a separate system but CPT is part of HCPCS. CPT codes are used to report physician services regardless of the place of service (hospital, office, ED, clinic, etc. ).

ICD-9-CM classification contains diagnoses codes which are used by all providers for coding. ICD-9-CM volume 3 is only used to report inpatient or acute care hospital procedures. Note: CPT does not have any diagnoses codes in it. If a physician uses CPT to code/bill for procedures, ICD-9-CM must also be used. A complete picture must be captured with the procedure and the diagnosis(ies) of the patient for coding/billing to be correct! Licensure and accreditation – your textbook makes a distinction between these wo. Licensure is often governed by state and can be for an individual or a facility. Licensure is most often required for a health care provider or facility to operate in that specific state. Accreditation is for a facility and is most often voluntary. JCAHO is one accreditation body, others include; AAAHC, AOA, CARF, NCQA, NCCHC. New Developments: When the implementation of more digital technology in the area of health care and specifically in the HIM area.

Electronic health records (EHR) are being discussed and used more and more in the US. With this type of record gathering and storage, methods of authentication have been updated for the digital age. These include electronic signature. Security measures have also been updated which include smart cards and biometrics. Your textbook also includes some excellent websites for concepts in this chapter. You may also want to refer to this list when you are looking for journal articles to complete lab assignment 2-5 which will be due next week.

Project: Leading Strategies change at DaVita: The Integration of the Gambro Acquisition Course: MGT 215 Submitted: 7thDecember, 2011 Acknowledgement ………………………………………………7 Introduction……………………………………………………….. 8 Synopsis…………………………………………………………9-20 Conclusion…………………………………………………………… 23 Bibliography…………………………………………………………. 24 Acknowledgement I would like to thank God for the strength he gave me to do this course. It was a challenge but through it all he brought me to the end of twelve weeks of studies.

I would like to thank Mr. Veron Johnson for the patience and time he took to impart his knowledge to me. Thanks to everyone who assisted in any way. Introduction DaVita Inc. , a FORTUNE 500 company, is a leading provider of kidney care in the United States, delivering dialysis services to patients with chronic kidney failure and end stage renal disease. DaVita strives to improve patients’ quality of life innovating clinical care, and by offering integrated treatment plans, personalized care teams and convenient health-management services.

As of September 30, 2011, DaVita operated or provided administrative services at 1,777 dialysis facilities, serving approximately 138,000 patients. DaVita supports numerous programs dedicated to creating positive, sustainable change in communities around the world. DaVita Medical Mission Statement: “To be the Provider, Partner and Employer of Choice We are becoming the greatest dialysis company the world has ever seen through our commitment DaVita Medical Mission Statement: “To be the Provider, Partner and Employer of Choice We are becoming the greatest dialysis company the world has ever seen through ur commitment to upholding our Mission and Values every day, in everything we our Mission and Values every day, in DaVita Medical Mission Statement: “To be the Provider, Partner and Employer of Choice We are becoming the greatest dialysis company the world has ever seen through our commitment to upholding our Mission and Values every day, in everything we wed” Synopsis Total Renal Care (TRC) a company founded by Victor Chatiel in 1994, offered renal services. One of his strategies was to apply strict business principles and reap rewards upon entering the traditionally non-profit domain of Kidney Dialysis centers.

He focused on growth through acquisition through the 1990’s. Unfortunately, chatiel and his team failed to integrate their acquisition leading to some operational incoherence. Firstly, there was no uniformity to a critical patient data form used to record and monitor patient care during dialysis. Secondly, there was little standardization in reporting work methods across centers, this absence made routine management activities, such as transferring personnel and patient across, much more difficult if not impossible.

Thirdly, cash flow issues created serious problems like operational weakness in insurance reimbursements – a critical problem for a company whose revenue was entirely dependent on it. Insurers and government would frequently question charges and demand additional documentation. They would occasionally unilaterally reduce the reimbursement amount and delay payment until they received answers to queries and requested documentation.

Finally, senior’s executives paid very little attention to the dialysis centers themselves, which were seen more as an avenue of corporate growth where patient and caregivers were economic units in a bigger financial structure. This headquarters- centric, financially oriented operating culture did not win friends among the health care practioners who worked hard in the field to deliver quality care. In 1999 Total Renal Care (TRC) ran into severe financial difficulties. The board of directors turned to Kent Thiry, who worked at another dialysis center in 1997.

Kent Thiry is a Harvard MBA graduate and an ex-brain consultant. Before accepting the job offer he reached out to a set of people who had been with him in his previous dialysis venture, people whom he trusted, liked and respected. He recruited Harlan clever, to be the chief technology officer, David Barry to be COO (chief operating officer) and Doug Vlchek to lead the organizational change and culture building efforts. When he came to lead the company October of 1999, the organization was in a mess. It had financial operational regulatory and moral difficulties. They were technically bankrupt, and being investigated by SEC, they were sued by shareholders, had turnovers at twice our current level, was almost out of cash and in general, wasn’t the happiest of place. ”(Thiry) Thiry and his colleagues begin assessing the talent in the company, moving people who could not perform and hiring people who could “get stuff done” (GSD remained a popular acronym in the company; being considered “good at GSD” was the highest compliment a teammate could receive) persons were sent to the billing office, to work on collections and to fix the cash flow problem.

In May 2000 more than 400 clinic managers, plus people from corporate headquarters assembled in Phoenix Arizona, for the first of what has become an annual ,corporate-wide meeting. At this first meeting suggestions for a new name for the company were presented. The company’s teammates, the board of directors and senior management collectively voted to chose the new name “DaVita” which in Italian phrase which means “to give life or he/she gives life. ” At this meeting groups discussed, debated and voted on proposal for the core values and a mission statement was presented.

A few persons were sent to Tacoma’s billing office to work on billing and collections and to fix cash flow problems. The situation became severe when the government stopped paying DaVita for laboratory tests because of records and document issues. The company had to decide what to do with the patients whose lab tests were not being reimbursed, however the company decided to continue performing tests that it felt were essential in delivery of care and to appeal the decision to an administrative law judge to attempt to obtain the denied funds. Four (4) years later after winning successive judgments, the government paid them over $90 million.

The issue of outstanding debt was dealt with under much constraint. The banks wanted the company to sell parts of the business to honor debts. The management group did not buckle, and after long and difficult discussions, the loans were restructured and financial penalties for default were discontinued. Eventually the company sold the dialysis centers that were outside the United States to direct it focused in a geographically area. In the area of technology, the chief information officer introduced an automated patient registration and to incorporate all the clinical records and activities, an electric file cabinet was also created.

It was the first step to standardize the paper-based system used to keep track of patient care in the various centers. Continuous improvement and teammate education was critical at this point, so a change process was initiated using continuous quality improvement (CQI). Each center manager attended these training sessions and was expected to train their own staff at the various centers in quality improvement techniques. They were on the road to a new philosophy where patients care was delivered and where most DaVita teammates work were important to the company’s success.

To emphasize the importance of the centers, Thiry and his senior manager “adopt” a center and drop by occasionally. They later replaced the adopt-a-center program with the practice of having everyone hired in or promoted to the vice president level or above go through “Reality 101”, which entailed spending a week in a center helping to do the day-to- day-work. DaVita’s strategy was characterized by their attention to detail; they took painstaking attention to operational details and compliance with government regulations.

Also managing financial outcomes rested largely on small but important behaviors and decisions. One such activity was carefully using supplies to avoid waste and maintaining appropriate stock levels so that inventory costs were unnecessarily high, yet avoiding emergency ordering. Another was achieving good clinical outcomes, it was important to take care while putting the patient on the machine, monitoring the treatment as it was occurring and taking the patient off the machine at the end of the session.

The final strategy which was used was employees attraction and retention, this was important because turnovers was costly, entailing finding replacement people and possibly paying overtime labor rate if a center was temporarily short- staff. There strategy can be characterized in organization development and change as leading and managing change where after they diagnosed the causes of the problem, management took a leading role in implementing the change. They created a vision, develop a political support, manage the transition and sustained the momentum. With the increased focus and attention to perational detail, the commitment of the company’s teammates and the bank negotiation behind it, DaVita embarked on a remarkable transformation in its performance. Achieving great financial result and was consistent over the years in improvements in clinical outcomes and reduction in turnover. The organizational culture at DaVita was a result of what Thiry call “purposeful action” that “articulated and demonstrated” what a company could be. His approach took the form of a clear concise mission- that was quickly turned into a song. He then got his colleagues to come to consensus on core values, he also use benchmark questions.

Employees became teammates and if they “cross the bridge” of believing the company could be special, they become “citizen of the village” (not the company) with Thiry as “mayor. ”A general synergy of teammates and executives brought the organizational change concept to life. A closer look at DaVita’s culture and leadership showed that the management team’s focus had been on creating a strong and positive value-based organization where levels of the organization had an emotional commitment to its success. The foundation was Mission and Values, created at the first meeting in 2000 and now widely practiced throughout the company.

To the management team, the company’s rebirth strategy was based on the belief that they had to create something larger than themselves in order to be successful. DaVita offered a comprehensive benefit and pay package that was somewhat unusual for a company that had a reasonably large number of relatively low-paid, hourly employees. Pay was pegged against competitive benchmarks. There was a broad- based profit-sharing program that covered virtually all team members, based on the idea of sharing the village’s good times and success with all citizens.

There were also benefits that provided people an opportunity to invest in professional and personal growth. Health and welfare benefits included a comprehensive package of medical, dental and vision benefits, extended illness leave, both short-term and long-term disability insurance, life insurance and flexible spending account to set aside pre-tax dollars for health or childcare expenses, and an employee assistance program Another incentive offered by DaVita to encourage the teammates to be fully involved in their work and to be present in the company, not just physically but also emotionally was “we are here awards. This was a $1000 in vacation expenses given to a randomly selected non-exempt teammate who had perfect attendance during a 90 – day period. There was also the “shining star award,” for people who not only perform their job with exceptional proficiency but who also exemplified the DaVita’s values and who contributed to the well-being of the team. DaVita have many training program within the organization to assist teammates in their development.

DaVita University started within a year of Thiry arrival in the company and offers program in continuous quality improvement (a two day program required for newly hired facility administrators, managers and vice presidents that had not taken the class previously) presentation skills, leadership development, team skills and programs for vice presidents. There are also numerous courses on clinical subjects. Two of the most important programs that reach the people directly or indirectly were the DaVita Academy (more recently called Academy 11) and a program called F.

A. S. T (Facility Training Administrator Survival Training) Academy11 was a newer program attended by all teammates from a specific region, designed to “take facility performance to the next level by fostering mutual accountability amongst the team. ” By emphasizing how to hold difficult and honest conversations among the teams to resolve interpersonal issues, the course fostered better and more productive interaction. It also contained numerous team building activities and joint planning for operational improvement at the facilities. F. A. S.

T (Facility Training Administrator Survival Training) is a five day program taken by all new clinic managers. The program consist of training in managerial skills such as time management, communication, providing coaching and feedback to team members, and interviewing, as well as material on DaVita culture ( DaVita Way and One for All). The company integrated programs to give back to the community; they introduced a program “one for all, all for one. ” This program the DaVita village Network is where teammates make contributions and the company matched this with its profit.

These funds were used to assist persons in the communities where centers are located who use their services and have difficulties in meeting their financial obligations. In 2005, Thiry and his senior executive team met to discuss the next step the company should take to continue its organizational development and strategies evolution. Their special focused was how to manage several looming challenges because they were just in the process of completing a $3. 1 billion purchase of Gambro, a large competitor. The acquisition would nearly double its size from 700 to more than 1200 dialysis centers and from 13, 000 to 25,000 people.

As such it would cement its position as the second largest Kidney Dialysis centers in the United States. Their task immediately entailed integrating Gambro into the DaVita’s way of managing and its culture. Gambro was significantly more hierarchical and formal than DaVita, and did not have a strong people- oriented culture. Gambro had purchased Vivara in 1997 , a small publicly traded dialysis company led and transformed by Thiry during the 1990’s, now as leader of the combined organization, his goal is to be respectful of Gambro, its people and its capabilities, while maintaining DaVita’s unique culture and way of management.

Gambro is a global medical technology company and a leader in developing, manufacturing and supplying products and therapies for Kidney and Liver dialysis, Myeloma Kidney Therapy, and other extracorporeal therapies for Chronic and Acute patients. Kidney (renal) dialysis was the world’s first extracorporeal therapy (i. e. a therapy that treats organ failure outside the body). Dialysis saves the lives of a growing number of patients every year, and innovation in the field is essential.

The only current alternative to renal dialysis – kidney transplantation – is not an available option for most patients, due to a shortage of donor organs. Dialysis technology is now being developed for new applications such as liver dialysis and an emerging field of other extracorporeal therapies, to remove different fluids and toxins from chronically and acutely ill patients. For decades, Gambro has been first to market many groundbreaking innovations. By designing and delivering solutions to dialysis clinics and intensive care units, they offer not just improved treatment quality, but also improved efficiency.

Gambro was founded in 1964, and had 8 000 employees, production facilities in 9 countries, and sales in more than 100 countries. Their purpose and culture unified as a company and remind us as individuals of how we can make a difference for patients and their families. Customer focus was always strived to exceed customer expectations and they keep patient safety and quality as a key priority. They hold themselves accountable to their customers, team members and partners by delivering on their commitments. People are the biggest asset of the company and teamwork is important for success.

They conducted business in an ethical manner with courage to do the right thing and continuously seek ways to improve their business. The Gambro Healthcare acquisition is the largest acquisition we have made to date. There is a risk that, due to the size of the acquisition, we will be unable to integrate Gambro Healthcare into our operations as effectively as we have with prior acquisitions, which would result in fewer benefits to us from the acquisition than currently anticipated as well as increased costs.

The integration of the Gambro Healthcare operations will require implementation of appropriate operations, management and financial reporting systems and controls as well as integration of the clinical policies and procedures of both companies, all of which could have a material adverse impact on our revenues and operating results. In addition, it requires the focused attention of our management team, including a significant commitment of their time and resources. The need for management to focus on integration matters could have a material and adverse impact on our revenues and operating results.

I would advice Thiry to design a team to lead in managing the integration. This team should include the (COO) the chief operational officer, the chief technology officer and the structure design manager. I would share the effective change management program with him, which include four phases. The first is to motivating change this includes creating the readiness for change among organization members and helping to address the resistance to change. The second would be creating a vision in providing a purpose and reason for change and describe the desired state.

The third would be developing a political support for change where there can be powerful individuals and groups that can either block or promote change, they you need to gain their support. The fourth would be managing the transition from the current state to the desired future state and finally you should sustain the momentum for change so that it will be carried to completion. The team should relate to individuals, interpersonal relations and group dynamics. The individual approach should be aimed at coaching and training.

Coaching attempts to improve one’s ability to set and meet goals and improve interpersonal relations. Training and development aimed at transferring knowledge and skills to individuals. Interpersonal and group process approach includes process consultation, third party intervention and team building. Process consultation help group members understand, diagnose and improve behavior, the third party intervention focus directly on dysfunctional interpersonal conflict and team building is aimed at doth helping teams perform its tasks better and at satisfying ndividual needs. The first 100 days action plan should include recommendation for the organizational structure the organization should implement. The new structure and action plan need to be communicated to the organization. The design team will conduct its initial activities in a relatively easy manner and follow it by implementing a monitoring, correcting and evaluation process. As the plan is implemented new information, changes in the environment and other issues will arise that required adaptation and adjustment.

The team is charged with the monitoring implementation by collecting implementation feedback to find out if the plan is working. The data collected would be analyzed and if they are feasible would be implemented. To preserve the DaVita’s culture I would suggest training in the various program areas such of team building, communication skills and clinical areas. DaVita has Academy11 for all teammates to improve team building amongst workers. It hast F. A. S.

T a program for 5 days in the various management skills and also DaVita University for quality improvement for newly hired managers DaVita’s culture and leadership showed that the management team’s focus had been on creating a strong and positive value-based organization where levels of the organization had an emotional commitment to its success. Their mission “to be the provider, partner and employer of choice” had made an impact on the organization and the core value had kept them in second place in the dialysis industry.

Their financial position has been exceptional over the years Mission Statement Kent Thiry Conclusion I have learned a lot about Kidney Dialysis and the time and patience that caregivers give to save a life on a daily basis. DaVita’s team led by Kent Thiry made the organization a village community rather than a company and in doing so working became a part of their life style. I realized that an organization with a strong culture can be a leading company. Bibliography Organizational Development and change 8th Edition by Cummings & Worley The internet

1. Prepare an industry analysis using Porter’s 5 Forces model. What are the key determinants of Vershire’s aluminium can profitability? Explain. (20%) * Barriers to entry I would suggest that the barriers to entry are relatively high in this industry. Although there would not be huge capital requirement to enter into the aluminum cans producing business and customer-switching costs are considered to be low, the fact is that the competition in this industry is very intense. There are already many aluminium cans manufacturers exist in the market, with some large packaging manufacturers dominating the market shares.

Some large beverage processors even manufacture cans themselves (one large beverage company produced one-third of its own container requirement and ranked one of the top five beverage producers in the industry). Also, three of the global aluminum supplier companies also themselves manufacture aluminum containers. Although there would be high demand in the industry (from both small and large breweries and soft drink bottlers), there are too many competitors that could keep new entrants out of the market. * Power of suppliers There are four global companies supplied aluminum to can producers: UC Rusal, Alcoa, Alcan, Chalco (as shown below).

There are many buyers (can producers) in the market while there are only few major suppliers. In addition, aluminum is a highly differentiated product. Resources of bauxites, the raw material for aluminum, are not widespread throughout the world. The main deposit of high-quality bauxites are already dived by those main players. Therefore, whoever owns the resources ‘wins the game’. Today the ‘Big Ten’ aluminium manufacturers are: Although it can be argued that steel is one of the substitutes, aluminum has many advantages over steel: it is easier to shape and allowing more attractive packaging; it reduces the problems of flavouring and it educes the transportation costs because of its lighter weight. Therefore, there would be constant demand for aluminum because of its beneficial nature. According to the above, I would say that the power of supplier is extremely high in the aluminum can manufacture industry. * Buyer (customer) power Buyer power is relatively high in the aluminum can manufacturing industry. Their buyers are primarily the soft drink bottlers, which are small independent franchisees of Coca-Cola and Pepsi Cola. Most of these customers maintained at least two or more suppliers and spread purchases among those suppliers.

Thus, in order to retain customers, division must meet customer’s cost and quality specification or its standards for delivery and service, otherwise customer would turn to another supplier. * Threat of substitutes As I have mentioned above, one of the substitutes of aluminum can is steel can. Yet there are a lot of advantages of aluminum over steel. A ton of scrap aluminum has almost three times the value of a ton of scrap steel. Other substitutes for breweries and soft drink bottlers would be plastic or glass bottle.

An study conducted by the metal can industry leader, Silgan Containers, revealed that 81 percent of shoppers prefer metal cans compared to 9 percent for plastic and 6 percent for glass. In addition, Aluminum is a more attractive recycling material compare to steel, plastic or glass. A US record also showed that 56 billion aluminum cans were recycled in 2010. Aluminum never wear out, it can be recycled forever. Therefore, aluminum is still considered to be the most attractive material for the can manufacturing business. * Rivalry amongst competitors

Competition is high in this industry in term of supplier power, customer power and number of competitors as mentioned above. Conclusion As Vershire is one of the largest manufacturers of aluminum cans in the industry, it is assumed that it has access to sufficient raw material to produce aluminum cans. They would also have large number of loyal customers but just the matters of maintaining their high level of products and on-time delivery. I would argue that the key determinants of Vershire’s aluminium can profitability would be the costs of the production. A lower costs while maintaining its quality can attract new customers.

Thus, the relationship with suppliers could become critical. Vershire could renegotiate prices and develop long-term relationship with one or two suppliers. Cutting costs in purchasing can be a big saving for the company. Vershire could also improve its production efficiency to eliminate unnecessary production costs. 2. Which of Porter’s generic strategies is Vershire following? (10%) Porter claims that there are two ways of responding to the opportunities in the external environment and developing a competitive advantage, there are: cost leadership and differentiator.

Veshire would most likely be a cost leader. Aluminum can itself is not a highly differentiated product. Every metal can manufacturer produces the same kind of product. In addition, most of the customers maintain two or more suppliers. In other word, if a manufacturer failed to meet the customer’s cost and quality specification, it is very likely that the manufacturer would lose the customers. Therefore, being a cost leader is essential in this industry and it is the strategy adopted in Vershire.

Back land

From the last few decennaries the rate of cesarean subdivision is go oning to lift in many parts of the universe, particularly in industrial states. Ratess of hundred -sections have been increased in Norway as in the remainder of the western universe since 1970. Although C-section is a safer option to a hard vaginal bringing where there is a clear medical account for its usage, there is still possibility of long term wellness hazards to the female parent and kid due to its unneeded usage ( MacDorman, et al. , ( 2008 ) . Maternal complications due to cesarean subdivision include, complications due to anaesthesia and surgery, and longer term generative morbidity and mortality in following gestations. Babies born by cesarean subdivision are more prone to hold respiratory hurt, less breast-feeding and likely more atopic diseases ( Tollanes, ( 2009 ) ; Van den Berg A, ( 2001 ) and MacDorman, et al. , 2006.Ramachandrappa, 2008.

By taking into history the economic facets of the bringing method, it has been observed that cesarean bringings are more dearly-won than vaginal bringings. Harmonizing to an audit committee study published in 2002 in the UK, a cesarean bringing costs hospitals an norm of & A ; lb ; 1,701 as compared to a vaginal bringing which costs an norm of & A ; lb ; 749. Therefore a one per centum rise in CS rates costs the NHS an excess & A ; lb ; 5million per twelvemonth ( station note 2002, p. ) .

In add-on, adult females who have a cesarean subdivision are more likely to remain longer in the infirmary and sometimes hold to be re-admitted in the infirmaries due to injure infections and other complications. It may besides be of import to believe about long term wellness attention costs due to the services used by adult females themselves and their babies following a cesarean birth ( Wendy Sword, et al. , 2009 ) . In consideration of that first cesarean delivery subdivisions about guarantee that following gestations outcome will be Cesarean bringings. It can be a fiscal load for society and the national wellness system ( Sword, et al. , 2009 ) .

World- broad high rates of cesarean bringings are a affair of concern to international public wellness due to its effects on maternal and child wellness and the associated socio-economic effects on society.

Literature reappraisal shows, high rates of cesarean delivers among all female parents irrespective of age, ethnicity, gestational age and medical position ( Menacker, et al. , ( 2006 ) and MacDorman, et al. , ( 2008 ) . None the less concerns have been raised over the high cesarean birth rates that go beyond the World Health Organization ‘s ( WHO ) suggested rate of 15 % and its possible hazards to the maternal and antenatal wellness ( Wendy Sword, et Al ; 2009 ) .

In order to halt this progressive rise in rate of operative bringings, a elaborate analysis of the factors lending to this addition is required. Many epidemiological surveies have been conducted in assorted states to find the factors responsible for the planetary rise in Cesarean subdivisions. Datas analysis from different surveies found a figure of medical and non-medical factors that are responsible for the addition of cesarean bringings both in developed and developing states. Medical factors accountable are raise in maternal age, high organic structure mass index ( BMI ) and alterations in medical pattern as explained by Tollanes ( 2009 ) . Tollanes ( 2009 ) identified maternal penchants ; improper pregnancy attention and fright of legal action among accoucheurs are major not medical ground for high prevalence of cesarean subdivisions.

However, supervising the overall rate may non be helpful in cut downing unneeded cesarean subdivisions. It may be more utile to descry and take at subgroups of adult females in whom undue cesarean subdivisions could be avoided. To categorise subgroups of adult females who could be observed for possible hazard of cesarean bringings, a figure of surveies have been conducted in many states. An analytical survey was carried out in Latin America by, World Health Organization ( WHO, 2004-2005 ) ( Betran, et al. , 2009 ) . In this analysis two subgroups of female parents were identified to lend high rates of operative bringings that need to be monitored more closely. These subgroups include adult females with a individual full term cephalic gestation: ( a ) with a history of old cesarean delivery and ; ( B ) those female parents who had c-deliveries after initiation of labor or who had elected cesarean deliveries ( Villar, et al. , 2006 ) .

Numerous surveies have focused on familial heritage of medical factors responsible for complications of gestation and its results ( Rolv T, 2007 ) . A argus-eyed survey of non- medical hazard factors may let us to place grounds for the increasing rates of unneeded Caesarean bringings which are conformable to alter. In order to measure these non- medical hazard factors and their familial heritage within the coevalss and across the coevalss quite a few surveies have been conducted ( Vernal, et al. , 1996 and berg-Lekas, et al. , 1997 ) .

Study design

This survey aimed to place not medical hazard factors for elected cesarean subdivisions and their biological heritage within households. Using informations from Norway is valuable if an apprehension is to be developed of the increasing operative bringing rates, specifically within this state but potentially in other contexts as good.

In this design a population-based information from the Medical Birth Registry of Norway ( MBRN ) was used and a retrospective- cohort of singleton unrecorded borne full term gestations was established with the aid of national designation figure. A cohort of 440236 grandmother-parent units and 275001 same sex full siblings units were constructed from singleton birth registered in the MBRN during 1967-2005. Out of 440236 grandmas -parent units, 261156 were being identified with a female neonate and 179080 with a male new born, who became female parent and male parent subsequently in life. For the same sex full sibling unit 153085 braces of full sisters and 121916 braces of full brothers out of 275001 with their first birth were compared. In instance of grandma -parent units merely the first birth of each female parent and male parent was observed but female parents and male parents themselves were allowed to be of any birth order. To look into the familial heritage to non- medical factors, units with high hazard factors for cesarean subdivision were ruled out and low hazard subgroups of grandmas -parents units and full sibling units of sisters and brothers were constructed. Log – binomial arrested development theoretical accounts were used for statistical analysis in this survey to mensurate the comparative hazards. In instance – parents units the exposure was grandmother presenting parents by cesarean and result was cesarean bringing for parents ‘ first kid. While in instance of full siblings unit the exposure was upwind older siblings first babe was born by cesarean bringing and result was measured by cesarean bringing in younger siblings ‘ first kid.

In this survey at that place has been a clear addition in primary cesarean bringing without a medical or obstetrical indicant. While confusing has been minimized as a consequence of the full accommodation of all aetiological factors at every phase of analysis, there may however be residuary confounding.

Present work involved two separate analyses. First analysis compared manner of birth of first kid in all female parents and male parents borne by c- bringings to the all female parents and male parents borne by vaginal bringings in both high hazard and low hazard parents. Consequences of this survey showed female parents borne by cesarean subdivisions due to complications of gestation and labor had 55 % higher hazard of cesarean bringings than female parents borne by vaginal bringings. A 95 % assurance interval ( 1.48-1.62 ) seems to be rather important and demonstrated strong statistical grounds of associations with the relevant result.

In instance of female parents borne by cesarean delivery after a low hazard gestation consequences showed twice the hazard of giving birth by cesarean subdivision. A wider spread in assurance interval minimizes the value of comparative results and its cooperation in wider population.

Strengths of the survey

One of the chief strength of the survey is the proviso of a big sample, which means that there is satisfactory possible to observe little but clinically critical associations. Another advantage of this survey is usage of a cohort design as compared to a series of cross-sectional surveies that would necessitate to take on new members for each survey. Cohort survey is quicker and cheaper as less proficient staff is required to roll up informations. There is no demand to follow persons over clip because all the information is already available so there is less opportunity of loss of contact and lose valuable information.

In these analyses the exposure and outcome step is likely to be accurate since the accoucheuse and medical staff involved in the bringing is responsible for entering this information informations instantly after the birth.

More confidence can be found in the truth of the collected informations because participants were non required to remember events for long periods of clip. These theoretical accounts are simple in design but let the geographic expedition of the hazard factors which may impact the whole community. These are called incident surveies.

Restrictions of the survey

Although this analysis is typical by analyzing a countrywide information of pregnant adult females and their comparative results, it has several restrictions. First, the truth of the collected information is hard to measure for all factors. It is more likely, that clinical pattern may hold altered or new factors may hold emerged, that influence manner of bringing. Several features of single adult females ( such as para, maternal age, and weight addition during gestation ) have been quoted in the literature as being associated with Caesarean subdivision. Joseph, et al. , ( 2003 ) investigated that alterations in maternal features and obstetrical pattern may lend to recent addition in c- subdivision prevalence. If these factors can be identified it may bespeak cardinal countries that could be targeted to command Cesarean subdivision rates. However, the variables identified in these theoretical accounts are every bit applicable to current clinical pattern.

Data recorded over a long period of clip may besides be apt to alterations in definitions and coding systems.

Second the quality and completeness of recorded information is important for a cohort survey design. Particularly in a retrospective cohort study the research worker goes back in clip to specify exposed and unexposed groups and re-evaluate medical records to follow participants for outcomes. As everyday information systems are planned to function as surveillance, and non a research survey, some informations may be losing or inaccurate.

Another disadvantage of everyday informations may non be able to supply all the necessary information on other of import hazard factors under probe which, if unaccounted for may take to bias.

Northam and Knapp, ( 2006 )

Comparison with other surveies

This research adds to old work on tendencies and an aetiological factor associated with C- subdivision and on the whole has similar findings. In all analyses, maternal and fetal hazard factors ( such as, maternal age, placenta previa, gestational diabetes, eclampsia and pre-eclampsia, macrosomia and many more ) were found to be independently associated with increased rates of Cesarean subdivision. These have the possibility of maternal and fetal heritage, which is in maintaining with other surveies. ( Lie RT, 2007 ; Plunkett J, 2008 ; Onsrud L ; Onsrud M, 1996 ) .

There are several socio-cultural and environmental factors acknowledged in the literature related with C- subdivision has non been confirmed by this research. For case, many surveies have found societal category, nature of employment, and educational attainment, to be associated with Caesarean subdivision, none of which were observed to hold independent associations with manner of bringing in these analyses. This position has been supported by the work of Tollan, et al. , ( 2007 ) , who described the association between cesarean subdivisions and maternal societal background. Consequences of the survey showed that degree of instruction is reciprocally related to the hazard of cesarean bringings. Similar findings have been observed by Torun, et al. , ( 2006 ) sing socio-economic position of adult females and related hazards to the gestation outcomes. Giulia, et al. , ( 2008 ) explored the function of societal category and consequence of educational grade on cesarean bringings in Italy. This research besides concluded female parents from lower societal category and with lower educational accomplishment are more likely to present by cesarean subdivisions than female parents with higher educational degrees.

On the other manus some surveies found a direct association between high cesarean subdivision rates and high socio economic place. Found C -deliveries are more common among those low hazard nulliparous female parents, who are good educated, belong to high socio economic category and have better surplus to prenatal attention. In UK, NHS obstetrician identified that 1.5 % of all C -sections are recognizing to maternal life style and picks in the absence of any clear medical indicant. This has been suggested due to the tendencies in several famous person adult females to give birth by elected cesarean delivery as these female parents are ” excessively classy to force ‘ ( Postnote, 2002, p.2 ) . Lei, et al. , ( 2003 ) stated adult females ‘s medical insurance, societal position and penchants, are implicative for a considerable addition in rates of elected Caesarean bringings in China.

The continuously high rates of elected Cesarean subdivision ( ECS ) performed at a adult female ‘s petition in the absence of a recognized obstetrical indicant, is going progressively common in the most developed states. ( Gamble and Creedy, 2000 ) . McCourt, et al. , ( 2007 ) reviewed published literature refering maternal petition for elected cesarean delivery and observed a really little figure of adult females bespeaking for cesarean bringings. The research worker evident a scope of non-medical grounds, such as the adult female ‘s fright of kid birth, her desire to give birth on a lucky day of the month or clip, or her apprehension that an operative bringing would salvage the babe ‘s encephalon from injury or injury. Weaver, et al. , ( 2007 ) observed similar association between psychosocial factors and maternal petition for cesarean bringings in UK.

However, these surveies contain no clear information whether these cesarean deliveries were the consequence of maternal petition or because of physician recommendation. More research is needed to find the factors associated with maternal penchants, obstetrician pattern form, and institutional civilization, personal and societal grounds that affect the determination to hold a cesarean bringing.

In the instance of ethnicity and race, the survey country has no cognition of cultural minorities and this may hold underpowered this portion of the analyses. Evaluation from different surveies showed linkage between cultural and racial subgroups and maternal and neonatal results. This position has been supported in the work of Johnson, et al. , ( 2005 ) . Vangen, et al. , ( 2000 ) found a significant fluctuation in cesarean delivery rates among different cultural communities in Norway. Similar consequences have been described by Robertson, et al. , ( 2005 ) sing hazard of non vaginal bringings and female parent ‘s state of birth. This could be explained by fluctuations in proviso and usage of wellness services by people of different socio cultural beginning as described by Berkin ( 1990 ) . NY, et al. , ( 2007 ) observed tantamount findings in the usage of wellness services by people of different cultural background in Sweden.

For the other factors, this research has minimized confounding and suggests that they are non independently associated with manner of bringing in the survey population. Maternal tallness and weight are one of the of import hazard factors non verified in this analysis. McEvoy and Visscher, ( 2009 ) both described eighty per centum of human growing is under familial control suggestive of resemblances and fluctuations in tallness and weight between relations.

Many surveies summarise that both familial and environmental factors regulate the human tallness and weight in different populations ( Letter, et al. , 2008 ) . Similarly strong familial association for organic structure mass index and human stature was found by Sammalisto, et al. , ( 2009 ) . Letter ( 2009 ) highlighted the engagement of cistrons in difference in grownup tallness and stature. Work of Hirscohhorn and Letter, ( 2009 ) besides provides valuable information sing biological heritage of human growing and familial fluctuations in tallness within a population.

Several surveies conducted in developed states have found that pre- gestation fleshiness, a turning social tendency, is associated with an increased likeliness of maternal and fetal complications responsible for cesarean subdivisions. Harmonizing to these surveies overweight female parents are more likely to hold preeclampsia, gestational high blood pressure, fetal congenital anomalousnesss, macrosomia, and gestational diabetes, and cervical dystocia, initiation of labor and cesarean bringings. Similar tendencies are described by Bhattacharya, et al. , ( 2007 ) and Crane, et al. , ( 2009 ) . This position is besides supported by Satpathy, et al. , ( 2008 ) who studied the inauspicious consequence of fleshiness related to complications during gestation and labor. Poobalan, et Al. , ( 2009 ) found that hazard of cesarean bringings could be more than double in fleshy adult females as compared to female parents with normal BMI. Young and Woodmansee, ( 2002 ) found increased BMI and weight addition are more likely associated with CPD and failure to come on in nulliparous adult females. Mollar, Lindmark ( 1997 ) evaluated the relationship of maternal tallness to obstructed labor and cesarean bringings. Kara, et al. , ( 2005 ) stated that short maternal stature is associated with an increased incidence of obstructed labors due to cephalopelvic disproportion ( CPD ) .

CPD is still a major obstetric hazard factor for maternal and infant mortality in many parts of the universe where operative bringings are non readily available. Harmonizing to the World Health Organisation ( WHO ) about 529,000 maternal deceases occurs throughout the universe per twelvemonth and obstructed labor is one of the major obstetrical factor responsible for these maternal mortalities ( WHO, 2005 ) . Hoefmeyr ( 2004 ) identified an eight per centum of maternal mortalities are due to obstructed labor. To look into the hazard factors for C-Section due to CPD a survey was conducted by Khunpradit, et al. , ( 2005 ) .Who observed maternal tallness less than 150 centimeter and weight more than 15 kilogram is significantly related to increased hazard of CPD. Scott, et al. , ( 1998 ) found short statured adult females are more likely to hold hazard of C-sections for CPD than the taller female parents.

Variations in maternal pelvic sizes and forms and foetal sizes could be explained by biological heritage in different populations.This is described by Vernal, et al. , ( 1996 ) that female parents who are being borne by cesarean bringings themselves due to cephalopelvic disproportion ( CPD ) are at a greater hazard to hold CPD subsequently in their lives. Berg-Lekas, et al. , ( 1998 ) observed opportunities of operative bringings between coevalss and within coevalss by comparing mother-daughter units, sister units and duplicate sister units and found a important uneven ratio between them. These happening show familial heritage to CPD, perchance through familial effects on female parents ‘ pelvic girdle dimension or foetal weight. Lunde, et al. , ( 2007 ) explained maternal and foetal familial factors responsible for fluctuation in caput perimeter, birth tallness and weight within households. Beaty, ( 2007 ) Heritability of little size maternal pelvic girdles and big size fetus could be another account of familial sensitivity of operative bringings.

Finally, this information did non hold any information about institutional features, as type of infirmary, and type of professionals go toing the births. J, et al. , ( 2009 ) studied the relationship between societal category and type of pregnancy services used by urban occupant in southern Europe and found high rates of cesarean subdivisions among high societal category presenting in private infirmaries. Potter, et al. , ( 2009 ) ( 2001 ) stated that in Brazil, higher rates of c- subdivision were among adult females delivered in private pregnancy units as compared to public infirmaries. Almeida, et al. , ( 2009 ) observed similar findings and suggested that most of the cesarean deliveries were scheduled harmonizing to adult females ‘s or doctors convenience and showed no clear medical justification for the process.

Decisions

Despite the survey design and methods this research reflect that there are increasing cesarean delivery rates in low hazard population. These analyses have verified assorted of import prenatal hazard factors for elected cesarean bringings and highlighted their familial association. In add-on, these findings can be utile for early designation and guidance of high hazard female parents sing their penchants to different bringing methods. These findings can be incorporated into public and private pregnancy attention sectors, medical managers, and decision makers in early hazard appraisal and strategic direction.

More surveies are required to widen the range of possible biological heritage of non medical hazard factors and their correlativity with socio cultural background. Further research is needed sing maternal petitions and penchants about child birth including information about picks and knowledge relation to the usage of intercession and its long term outcomes. An appropriate methodological analysis should be used to detect maternal satisfaction with labor and bringing attention and interactions between patients and attention suppliers. A comprehensive survey of cultural tendencies within obstetrical pattern and methods used for describing cesarean subdivision rates in the state or infirmary which have changed over clip, should be conducted. Surveies associating to funding agreements and policy guidelines of the infirmaries, medical organisations and wellness sections should be observed. In drumhead, greater attending demands to be given to the socio-economic, cultural, medical and political position of pregnancy attention.

In decision, the information in this survey is important for those who intend to cut down Cesarean subdivision rates, as it allows early sensing of adult females at a high hazard for surgical intercession. Finally, these happening can help in the development and execution of better schemes to forestall unneeded c- subdivisions and to cut down the cost of attention in wellness system with readjustment of resource allotment harmonizing to population demands.

The Devil’s Snare: The Salem Witchcraft Crisis of 1692 By Mary Beth Norton In the Devil’s Snare is a book about the Salem Witchcraft Crisis of 1692 in which the towns people accused women and men of using witchcraft to cause unexplained happenings throughout the town. The men and women appeared to be possessed by the devil, nothing else could explain it. In early times people didn’t understand reason. Especially the Puritans who only saw God’s will and the evilness of the devil.

During the Salem witchcraft crisis, Puritans struggled to decipher communal security and find the truth around them. They believed that Satan recruited humans to do his evil and be servants to him, i. e. witches. The witches had a magical power that allowed them to harm others. To protect the community the judges of the town took it upon themselves to hold jury trials and hang the witches as punishment. Many believed the witches were burned at the stake, however that is untrue. The idea of witchcraft seemed to be the only logical answer to the community.

Nothing else could possible explain the fires, flood, windstorms, droughts, livestock disease, and epidemics raging through the town. These issues needed an explanation. Puritans could not conceive the notion that this could simply be misfortune, due to their belief in Gods will. Witchcraft was the only explanation because many members of the community dabble in it here and there to spell curses or fortune tell. Although the belief in witchcraft was widespread the prosecution of the witches was sporadic and only a few towns executed the witches.

Many towns held trials, because they didn’t want to rush to judgment. However it was not easy to prove witchcraft, until 1692 when things turned for the worse and problems increased dramatically. Desparate for an answer the towns people finally started to believe this was the only explanation. The town of Salem was an already troubled when the happenings began. Members of the town often fought over pretty much anything. The first witches were teenager girls who saw hallucinations; the town took this very seriously.

The accusations led to formal charges filed against thirty-eight men and one hundred six women. Prosecutors were able to obtain fifty-four confessions, which was used at evidence to execute twenty people (fourteen women and six men). Mary Beth Norton wrote this book as if she was on a witch hunt herself. She had a one way direction of writing and was not objective to both sides. If she were on the jury of the Salem Witches she would have convicted them herself. I did not like the book because I felt it left me hanging, longing to know the other side of the story.

Contents Introduction2 Interactive Model of Leadership3 Measure to Analyse Leadership Skills5 Introduction5 Critical Factors5 Identifying Leadership Gaps5 Closing the gaps6 Nature of Motivation, Satisfaction & Performance8 Task Orientation among Teams8 Nature of group & group development8 Leading Virtual teams8 Creating the Virtual Team9 Conclusion9 References10 Introduction The organization chosen for this assignment is Bupa Care Services, Leeds, UK. Founded in 1947, Bupa Care Services have believed in the motto that they should help people live longer, happier & healthier lives with provision of good quality healthcare.

Bupa not being open to shareholders works purely for the benefits of its patients. Their various initiatives in terms of investment are aimed at better healthcare for their patients. The focus of this assignment is on the leadership programme conducted by Bupa in “Caring for elder people” Bupa, through its network of residential hospitals, retirement homes & nursing homes in the UK, Australia, Spain and New Zealand takes care of thousands of elder patients.

Over a period of time with increase in experience they have identified lacunas in their processes and reached a maturity to excel in innovation and development of care facilities for the elderly. With collaborations with researchers, expert partners and academics they aim to find innovative ways to improve their services With the society at large being dominated by ageing individuals, it introduces the healthcare domain with new challenges to address. It is more prevalent in developed countries which have a strong healthcare system to support individuals during their more productive phase in life thus improving their life expectancy.

Globally speaking, it is estimated in the next two decades that there would be about twice the percentage of elders in the UK as compared to today, while individuals who have completed their centenary would be 4 times as compared to today. In Australia, the numbers are expected to increase from the current 0. 2 million to an estimated 0. 5 million in the next two decades. A more similar trend is predicted in New Zealand whereby the current count is estimated to be doubled in the next three decades..

The programme aims at trying to profile care home population, support initiatives to garner funds, target improvement of healthcare aspects and a aim at the greater good for improving the standard of living of the elderly. The programme was conducted under the able leadership of Mark Ellerby, Managing Director, Bupa Care Services and Dr. Clive Bowman, Medical Director, Bupa Care Services. Interactive Model of Leadership Response from people today in a corporate team based culture is largely influenced by the behaviour of their leaders.

People like if their leaders are with them rather then above them, which gives them a feeling on belonging in the team and not a slave to the system. This calls for an innovative and lateral shift in the thinking behaviour on part of the leaders to be effective in their workplace. The interactive leadership development program helps leaders learn to effectively make that shift & excel as team players. The program offers a new lease of life and offers an opportunity for to be leaders to benchmark their skills against the best practises from around the world which is supported and well documented through a world class study of ore than three decades. The intent of the program is to make candidates test their inner skills and coach themselves against external actions. It provokes them to improve upon their competencies and be better leaders to achieve higher performance with results which have a long lasting impression. The research on interactive leadership has been conducted by founder David H. Burnham and Harvard psychologist Dr. David C. McClelland basis which they have observed the way leaders behave and most importantly how they think in the most critical of situations.

The focus of the program is to inculcate a thought process to be able to engage with individuals and groups, improve the emotional intelligence and have a dedicated focus on results. Let’s now focus on applying the model to the leadership programme at Bupa Care Services. The primary premise on which the interactive leadership works is: Thoughts drive Actions to create Outcomes. Participants are given the opportunity to work through simulations, perform exercises and activities in each of the critical areas in order to: Experience and evaluate how their present thinking will help them drive outcomes in future ? Develop and invest in specific goals which would prepare them for any future change ? Identify the key areas that need development and have conscious thought process to achieve them ? Learn the nuances to make the change(s) happen. Measure to Analyse Leadership Skills 1 Introduction Leaders are aware of change and it is obvious to them that they need to adapt to the change as individuals as well as a group and the industry at large.

But considering today’s uncertain and complicated work culture, the importance lies in understanding the importance of leadership skills. The entire healthcare domain for years have been operating in a dynamic world with changes impacting everyone including insurance companies, healthcare providers, device firms and pharmaceutical to a great extent. The industry has been boosted by the advent of technology, newer & improved means of care, a more dynamic business model. Regulatory authority and ethical issues add to the existing woes of the healthcare industry.

With such complexities, organisations find it cumbersome to identify the leadership talent which can help them set direction, gain commitment from employees as well as from partners and drive high quality care for the patients. With a volatile environment, the healthcare sector is looming large on drastic changes ahead in time and at the present moment; it is already amidst a phase of rapid change. This demands high levels of expertise in technology and thorough bred professionals with good leadership skills to be able to swim in the rough waters.

The other problem for the healthcare domain is that it is extremely difficult for them to classify their challenges since these are multi dimensional and of a complex nature. In order to address these challenges, common strategies and processes have to be developed which would enable the organization to achieve high performance. It is the need of the hour and even a need for Bupa Care Services. 2 Critical Factors 1. Improve the ability to lead subordinates and work in groups. Leaders should be able to collaborate and should be capable of creating a culture to influence participation from all members in the group.

It is also important for leaders to be able to deal with problem subordinates. 2. Create strategies to provide current and future leaders broad holistic view. In order to have a holistic view, leaders are expected to have some critical qualities like self awareness, career management and functional know how. A majority of the leaders today have been found wanting in these critical areas. Such limitations are expected to be overcome through continuous training and development, feedback sharing, coaching and succession planning. 3. Leaders possess important strengths.

They are well equipped to handle change and have the ability to achieve the end results. They possess some key additional qualities like cool composure, quick learning capability and clarity in thought process. Such qualities inherited by leaders provide enough proof that the healthcare leaders are a capable bunch of individuals who are assets to the industry. 3 Identifying Leadership Gaps Like in every exercise which involves comparison of two levels of attributes in any individual, there would always be some gaps in the expected level and actual level.

With leadership this disparity can be arrived by the difference in current skills to expected skills. With this understanding, organizations can come up with powerful strategies to build a capable pool of able leaders. The process of identifying gaps leads us to the characterizing certain attributes which are important for leadership skills and certain factors that are termed as derailment factors. Important Factors 1. Resourcefulness. Possesses multiple qualities such as good decision making under pressure, setting up intricate systems, analytical thinking, flexible behaviour and problem solving skills.

Gets along with seniors and has the capability to deal with higher management responsibilities. 2. Result Oriented. Has the capability to get things done by carefully investing in ideas and thrives to overcome hindrances with a dedicated focus. Can stand up and take responsibility to handle tasks individually and at the same time is open to learn from others to accomplish the task. 3. Quick Learner. Has the capability to quickly assimilate business and technical know-how. 4. Decisive. Always looks for prompt and precise solutions to any of the management problems which otherwise would be slow and sluggish. . Leading Subordinates. Strong delegation powers and provides opportunities to budding subordinates to show case their talents. Always on the look out for fresh talent for hiring. Has an unbiased approach towards his subordinates. 6. Handling Problem Subordinates. Tries to understand the problem subordinate and only after proper evaluation decides to act upon a problem employee. Shows enough fairness and is unbiased with problem employees. 7. Encourages participation. Is a good listener and takes everyone’s opinion before arriving at a decision. 8. Handles change.

Is always expecting changes and is ready to adapt. Also, takes efforts to overcome any resistance from his other subordinates with a view that the change has its benefits in the long run. 9. Build relationships. Capable of building and maintain good relations with subordinates and external parties. Masters the skills of negotiation without hurting any of the subordinate sentiments. 10. Compassionate and Sensitive. Genuinely interested in solving others problems and is sensitivity to employees’ needs. 11. Composure. Does not get into blame game over a mistake committed by anyone in the team.

Handles the problem calmly and looks at solving the same quickly. 12. Personal Life. Strikes a balance between his working commitment and personal life. Neither of them is ever side tracked. 13. Self-Awareness. Knows his strengths and weaknesses and has the willingness to improve. 14. Puts people at ease. Displays the right amount of warmth to people and has a good sense of humour. Having a good sense of humour is not at the expense of hurting subordinates sentiments. 15. Manages his career. Remains focussed towards building this career through continuous investing in training, coaching and feedback.

Derailment Factors 1. Interpersonal Relationships. Finds it difficult to get along with subordinates which indirectly impact his work. 2. Building and Leading a Team. Finds it difficult to build and lead a team. 3. Manage change. He is not able to manage change. Finds it difficult to adapt to change and inherently shows resistance to change. 4. Fails to achieve goals. Finds it difficult to keep up with his commitments and fails to meet business objectives. 5. Narrow thinking. Does not get into details and fails to have a holistic view. 4 Closing the gaps

To close the leadership gap in the areas identified, organizations and individual leaders will need a solid understanding of the skills and behaviours required to be effective in each area. Here, is the starting point for understanding five areas that healthcare leaders and organizations should emphasize: 1. Leading employees. This requires a leader to be self aware and have strong interpersonal skills. They need to invest in creating and building a team. They provide ample opportunities and challenges to their subordinates which is followed up with continuous guidance and coaching. They look at being mentors to future leaders. . Encourage participation. A leader should look at getting his teams involved, build a consensus and have a concurrent decision with everyone’s strong participation. Should be able to communicate well and also be a good listener in order to be able to get the best out of his team members. Looks at multiple perspectives before arriving at a decision. 3. Relationship Management. A leader should look at building relationships with his subordinates and also be fair in handling these relationships. He should be able to relate to all kinds of people and easily gain support and respect of peers, senior management and customers. . Self-Awareness. Be aware of ones strengths and weaknesses. Some one who is aware of his own being will always seek feedback from others and try to improve him continuously. He would be open enough to admit his mistakes and self correct himself. 5. Organizational perspective. A leader should have a broad and holistic organizational view. If the thinking is narrow then it would hurt the team was well as the organization in the long term. Should be capable enough to handle the tactical and technical points required to manage his work. Nature of Motivation, Satisfaction & Performance

Motivation is something that makes people performs better. However, not everyone gets motivated by the same things: Someone who is motivated might be satisfied and would perform better by getting additional responsibilities, whereas someone would gets some flexibility in his working style might get motivated to perform better. It merely means that motivation to every individual might mean differently and his response to it would also differ. The various initiatives take at Bupa Care Services to contribute to the overall success of the leadership programme are listed below 1.

Clinical Leadership: Director of mental and physical disability care, Dr Graham Stokes, is responsible for driving forward the quality and scope of care for people living with mental and physical disability in Bupa’s care homes in the UK, Australia, Spain and New Zealand. 2. Fund Raising: Bupa is continuing their successful partnership with Alzheimer’s Society in England and Wales, and Alzheimer Scotland for the Bupa Great Run Series. They managed to raise close to ? 1 million in 2009, which is evidence of the shared commitment to continue to raise awareness of mental and physical disability.

Bupa has sponsored the Great Run Series for 17 years, making it one of the longest-running sporting partnerships in the UK. 3. Boosting Research: Alzheimer’s Society and the Bupa Foundation have formed a partnership to pioneer and boost research into physical & mental disability and its causes. They jointly launched a ? 1. 5 million fund to support research into the cause, cure, care, and prevention of physical & mental disabilities. Task Orientation among Teams Every organization wants to have a well collaborated team which can provide results effectively.

There are many factors which would define a team’s success but the key factor being a leader’s vision and control over his team. Leaders have to be a mix of task and team orientation. This capability to leverage on both orientations enhances the ability build trust, create stability, and bring effectiveness among the team. The various task orientation initiatives taken at Bupa Care Services are listed below. 1. Pioneering Champions: Alzheimer’s Society and Bupa have joined together to launch the first ever physical & mental disability Champions programme across 190 Bupa specialist care communities in the UK.

The programme aims to develop in-house bred leaders to combat physical & mental disability care in their place of work and has been successfully piloted in Bupa care homes. By changing the culture, the physical & mental disabilities champions aim to further improve quality of care and quality of life for people with physical & mental disability. 2. Supporting careers in their own communities: Bupa’s partnership with the charity for physical & mental disability aims to build capacity by developing new Admiral Nurse Posts in communities not served by this specialist nursing discipline. Physical & mental disability Pioneers’ are appointed to selected areas to spearhead development plans. The work of the Admiral Nurse in helping families and those living with physical & mental disability is well proven. Admiral Nurses have a significant role in helping families cope with the difficulties faced through their journey with physical & mental disability. Nature of group & group development There are four distinct stages that a group passes through as it comes together and starts to operate. The process can be known to all, but an understanding of the stages can help everyone attain effectiveness more quickly. . Forming: Being humans, everyone thrives to be accepted in their groups and also looks to avoid getting into conflicts. Everyone has a part to play in the entire jigsaw puzzle and thus they avoid getting into issues and hurting others feeling. But they have to accomplice their task by being in touch with their sub ordinates in order to achieve the results. 2. Storming: Every group has Individuals with varied natures. Some have a high degree of patience while some just get annoyed at everything. Similarly there is a threshold to everyone’s patience which eventually might lead to minor disputes or confrontations.

These might be related or totally unrelated to work. 3. Norming: As we progress from the storming stage, the group matures and starts understanding their roles and responsibilities. These become more clear and each one agrees to follow the same. They start understanding each other better having gone through the grind during the storming stage. This eventually would lead to forming a cohesive unit which is capable of achieving the desired results. 4. Performing: Reaching this stage for any group is an achievement as not many groups reach this stage.

Having attained this stage signifies that the group is highly collaborative and works as a cohesive unit. The group possesses high morale and has created a identity for itself which reflects through their loyalty for each of the members. Leading Virtual teams The last couple of decades have seen rapid globalisation which has also made an impact on the healthcare domain. Challenges have come up with leaders expected to manage teams which are geographically diverse in terms in distances and time zones and not being co located.

The problems however with managing virtual teams especially in the healthcare domain has not received enough importance the world over. 1 Creating the Virtual Team With the above problem statement, leaders today have an inherent wish to be able to select team members based on their ability to work in virtual teams. However, in the healthcare domain, this is not an option which is readily available since there are very limited options available when it comes to having the right skill sets. The choices are therefore made as far as ossible; collate team members who have experience in virtual teamwork, rest of the parameters remaining same. 1. Discovering Commonalities: It is a difficult task to find commonalities within virtual teams as it is very much possible that the team leader has never met all members face to face and thus does not have enough data points to gauge them on a level scale. Extra efforts have to be taken by the leaders to Identify commonalities between people to actually arrive at trying to group similar minded or similar skilled team members together. . Creating Trust: Trust and respect cannot be commanded, it is almost always earned from the members of a team that trust each other and will go far in working together as a team. It is important to make every member valued and appreciated. Everyone should be given the opportunity to voice their opinion and all opinions need to be heard. 3. Understanding team dynamics: Within virtual teams, there are no visual or physical cues and thus it makes it challenging for the leader to understand the team dynamics.

The likes and dislikes of the team members are also difficult to assimilate since the communication most of the times would be on phone or emails. 4. Team member interaction: An important component of virtual teams else would be difficult to handle such diverse user groups. Working virtually sometimes has its limitations that some of the team members might get missed out in the communications and which would be harmful for the team as a whole. It is sometimes observed than one member gets invited to fewer and fewer meetings and suddenly one is a non-entity on the team.

Now imagine this happening with multiple team members. 5. Communication: With virtual teams, there are various ways in which the communication happens – phone, phone conference, video conference, email, internet, chat rooms and IM. The leaders have to be well conversed with all these medias and should decide on the right channel when communicating with the members of the virtual team. Conclusion Hoping to get immediate results, healthcare organizations cannot be investing in too many leadership programmes especially in the uncertain times.

Therefore, it is important for the team to be conservative when it comes to making such decisions. Yet, it should be noted that leadership talent and technical expertise are necessary to meet the population’s healthcare needs, manage operations and find innovative and effective solutions to complex challenges. Good leadership initiatives, then, are essential for success. To start with, healthcare organizations have the opportunity to re-assess their organizational leadership capabilities and begin focused efforts to develop leaders and create a culture of collaboration.

References Ellerby, Mark and Dr. Bowman, Clive, Bupa Care Services, 2011, “Healthcare leadership in caring for older people” CCL Report Jun, 2010. “Addressing the Leadership Gap in Healthcare” retrieved on 29th September 2012 from “Group Dynamics: Basic Nature of Groups and How They Develop” retrieved on 29th September 2012 from < http://managementhelp. org/groups/dynamics-theories. htm > “Stages of Group Development” retrieved on 29th September 2012 from “InterActive Leadership”, Burnham Rosen Group retrieved on 29th September 2012 from