Organizational Assessment: The Multicultural Foodservice and Hospitality Alliance

The Multicultural Foodservice & Hospitality Alliance (MFHA) is an educational non-profit organization that delivers multicultural solutions and services to its members and customers. Through their work, they aim to build cultural intelligence which maximizes business opportunities in the workplace and marketplace. MFHA’s mission is to bring the economic benefits of diversity and inclusion to the food and hospitality industry by building bridges and delivering solutions. Their commitment is to deliver more connections and opportunities to build its members’ cultural intelligence to effectively engage multicultural employees, customers, and communities. MFHA is a small organization with a diverse team and they pride themselves as living the multicultural experience every day and using their first-hand knowledge and experience, as people of color, to provide the most relevant insights to power cultural intelligence content.

As a small organization, their goal is to help their members and customers to:

• Develop culturally intelligent leaders which are critical for innovation and long-term business success.
• Providing solutions and services that are specific to the challenges of the restaurant, foodservice and lodging industries that will help the industry continue its leadership in multicultural awareness achievement.
• Offering innovative programs that strategically position organizations to maximize the multicultural opportunities for today and the future.

Their end result is to:

• Raise the Topline – sell, market and serve multicultural markets.
• Improve the Bottom-line -attract, engage and develop multicultural talent.
• Add value to the Brand – build “cultural authenticity” into the brand.

MFHA makes sure that they work with members that are dedicated to build cultural intelligence within their organizations in order to ensure that they provide the best services and establish themselves as a leaders in their industry.

Our team evaluated the progress, success, and faults of the organization. We used the SWOT analysis which is a strategic planning tool used to evaluate the strengths, weaknesses, opportunities and threats of the organization. This model helped the team to identify the internal and external drivers that MFHA would need to improve and continue their success for future growth.

STRENGTHS

MFHA Recruiting Process

Gerry Fernandez, CEO and Founder of  MFHA says that his selection of a team is what makes the organization successful. He believes in hiring intelligent,  hardworking individuals who believe in doing the right thing. MFHA has a streamline recruiting process that defines the roles, responsibilities and  requirements for their positions in their job description and interviewing process. This educates  the candidates on the expectations of the role and culture of MFHA should they apply. An important piece of the MFHA recruiting process is that everyone is on team interviews with potential candidates and not just the CEO.  He believes that including his team input on hiring someone for the team builds an collaborative environment. He also believes that by stressing the importance of selection and identifying the right employees  has saved the organization time and retained his employees. It has helped him to clearly see the type of person that will be successful in the organization, . All of this has resulted in a better selection  and teamwork, which has led to improved company performance and customer retention.

Work Life Balance

Gerry said, if the employees feel that MFHA is instilling a culture where work-life balance is important, then MFHA is going to be rewarded with employees who are loyal, attentive and committed to their work.  Work-life balance is “creating and maintaining supportive and healthy work environments, which will enable him to have a balance between work and personal responsibilities and thus strengthen employee loyalty and productivity (Johnson, 2015) ).” Gerry said that this approach helped him to create a team which is committed to the company and low turnover of employees. The focus on work-life balance has also contributed  to the productivity of the staff at MFHA. Many firms face unethical issues such as employees coming in late or  calling in sick for personal matters. However, these issues are minimal at MFHA because of the priority of work-life balance. MFHA ensures its employees can balance work and life responsibilities such as  child care and elderly parent care  to ensure employees remain actively engaged.

Team Collaboration

MFHA is a small organization with only seven employees. This gives them the advantage of getting to know each other personally and professionally. Gerry said that a small team is easier to get a real sense of what the business model is and how each employee impacts the work. He also mentioned that in small teams there is less bureaucracy involved and decisions can be made quickly. This has assisted MFHA employees to understand each other’s role and collaborate on projects to produce great work which has made their members and customers continue to do business with them.

Workplace culture

Many organizations pride themselves on having a strong workplace culture and values. But those things are never followed through in their day to day activities. That is one thing that MFHA has been able to establish and follow through each day. Their culture has been a powerful draw for new employees and has kept current employees at the organization long after their contracts have expired. Small businesses have the advantage to promote a culture that aligns or aspires to align with the best corporate culture because the communication is much easier with a few people and the closeness helps to get people together and talk more often. This has helped MFHA employees  have an open dialogue with each other and issues can be resolved quickly. Small business owners should develop and promote their workplace cultures as assets, whether the culture is a supportive family atmosphere, or one with an emphasis on creativity and innovation, or something else.

WEAKNESS

 Expense Policy and Guidelines

MFHA has many strengths as an organization but is also susceptible to weakness as well. For example, they do not have a clear expense guideline policy that outlines the per diem for business travel. MFHA does  not have a functional expense reporting system. Gerry mentioned that in the past they had an issue with individuals using their corporate card for personal charges that were not work-related. Moreover,  he also mentioned that due to their size sometimes, expenses were not submitted on time. This leaves the company vulnerable to auditing issues from the IRS and any other governing bodies. Due to the lack of policy, the organization does not have a process for corrective action. In the example of the individuals using their corporate card for personal use, Gerry mentioned that when it was discovered that this unethical behavior was happening they were sat down and told not to do it again.  However, the issue  as the company grows. a  certain action must be in place rather than a   simple conversation…

Onboarding Process

Although MFHA has a great selection process they still have an opportunity to the onboarding of new employees. Gerry stressed doing the right thing in the interviewing process. however, new employees do not receive an handbook because it is outdated Doing the right thing is a great mantra to live by. However if it is not clearly defined it can mean different things to different people. Without a clear definition the onboarding process becomes  a liability which could lead to turnover. In addition, since their employee handbook is not recent and not used during the onboarding process, it can be an issue to set an expectation around how to  behave when it comes to workplace conduct. Although MFHA, has these vulnerabilities they can take these and turn them into opportunities.

OPPORTUNITIES

Establishing Expense and Guideline Policy

One of the ways MFHA can address the expense policy issues is to establish policy around travel for work. Since they are a small business, it could be difficult to have funding for resources. However, there are many programs that are low cost to help out such as Certify Travel and Expense Management. This program has receipt capture and has an automated expense report creation, which means as employees are on business travel, they can ensure to upload all of their receipts to ensure it is timely record keeping. In addition, they will have to create a policy that is simple and addresses meals, travel, entertainment, and telephone usage. In each of these categories, especially travel, they need to  have set per diem that each employee will adhere to. This process will set the foundation and guarantee that future employees know exactly what the process and policy are for expenses.

 Succession Planning

Since MFHA is focused on the future they also need to focus on their pipeline. Gerry, the CEO and Founder has been in place since its inception, however, there is no plan of succession should he step down. This is another opportunity that the organization should identifying the hiring process. Gerry mentions that they have found a lot of people through Craigslist and have even built a culture that when people leave they give him more than enough notice. However, they should deploy other methods of finding qualified individuals because they plan to build out their sales department. Since they have such a huge network, they should use referrals as an additional recruiting strategy. Through the use of referrals, they will not only receive candidates who are passionate about the brand but the referrals will  also  serve as  marketing tools

Marketing Services

One of the most critical aspects of MHFA being successful is the marketing of their services. Most of their services are advertised through word of mouth and their website lays out the different levels a company can engage. As their organization grows and they bring in more experience people to generate revenue, they should focus on other small companies that could use their services and diversify their portfolio. Their strategy could be working with large, mid-size and smaller companies and then diversify their services based on the size of the company instead of having many services that could benefit everyone. Overall, if MFHA starts to understand what vulnerabilities they have as an organization, then it will aid them in any growth they will have in the future.

THREATS

Ethical Hiring Practices  

As mentioned above the recruitment and selection process in MFHA is collaborative effort between the CEO and his team members. Although they have opportunities to use other methods of finding people, as they grow as a company it can still greatly impact their organization. Gerry has mentioned in the past the hiring of families and friends into the organization. Although

“a team made up of several different compatible personalities that complement one another can be more productive than a team made up of those who are so similar they cannot work productively together(McFarlin, N/A).”  The practice of hiring friends and family can be frowned upon not only with current employees but nepotism can encourage unfriendly feelings of inequality in the workplace. Also, this can lead to an impact on the continued revenue of the company. If nepotism is seen as a way that business is conducted at MFHA, it could also lead to un-renewed contracts which in turn would lead to a loss in revenue.

            Code of Ethics

It is vital for every company to have a written Code of Ethics. Even though MFHA has a mission statement they are missing a written Code of Ethics.  Due to their lack of a Code of Ethics it poses a threat to their primary and secondary stakeholders. Without a defined Code of Ethics “the main threat is that when employees fail to behave ethically, the company acts swiftly to corral the bad behavior. If not, the inappropriate behavior might spread throughout your business, causing further problems(Mack, N/A).” For example, when it was found that MFHA’s employees were not filling out expense reports, the CEO of the company just warned them not to do it again. Unintentionally, the CEO created a precedent of impunity. The impunity always encourages other individuals to act unethically. The reason is simple-they believe that other unethical behaviors will not be punished either. So MFHA’s foremost threat is that without defined Code of Ethics there is a possibility that other unethical behaviors will happen. If, this is not established the organization could be sued for discrimination and also their culture may  not thrive with new employees. In addition, a Code of Ethics will help develop policies to protect whistleblowers and ensure the company is protected and other employees are as well if issues arise.

Conclusion

In conclusion, MFHA is in a pivotal moment in their organization . They have many positive attributes such as focus work-life balance, great employee selection and a collaborative team. However, the organization needs to grow in their onboarding process and establishing systems for expenses.  Yet, through the assessment of the organization it is clear they need more foundational aspects in place before growing their business. If, Gerry continues to focus on his ability to identify talent with the balance for onboarding and ultimately the creation of the Code of ethics, it can lead to more opportunity for the company.

References

Brookins, M. (2018, June). „Ways to Prevent Unethical Behavior in the Workplace“. Small

business chron.

Hamlett, C.(2018, May) “Nepotism in the Workplace With Friends.” Small business chron.

Jonson, S. (2015, March). “Importance Of Work-life Balance in the Workplace”. LinkedIn.

McFarlin, K.  (N/A). “Importance of Different Personalities in a Workplace

Tracy, T (2018, February). “5 Unconscious Biases That Every Recruiter Needs to Recognize “.

Recruiting daily.

Mary Rowlandson’s Captivity Narrative as Environmental Literature with a Window into the Puritan Belief System about the Wilderness

Mary Rowlandson’s village was raided by Natives in 1676 during King Philip’s War (Anderson 602-606). The Native’s captured Rowlandson and her daughter and took the pair with them when they moved through the forest to camping spots where they could hide out from the English. Rowlandson wrote and published her narrative about six years after her husband ransomed her from the Natives for 20 pounds in silver. The narrative overtly had a mission of telling other Puritans how God saved her from the “heathens” in the wilderness. She was to witness to other Puritans just how God worked, using the Natives in fact, to bring her back home. Many historians and other academics used Rowlandson to show how women acted in history, how Natives acted in history, and how Puritans acted in history. However, few academics chose to examine the narrative as a piece of environmental literature. It is very full of environmental descriptions that have her Puritan connotations attached to them. The main belief system that Puritans held onto was that the wilderness was evil and in need of taming. Once the wilderness and all of its inhabitants were tamed, the devil could no longer reside there.

Sezgin Toska opined that nature was a feature of American literature from the onset (424). Toska reported that the Puritans “saw nature as God’s unfinished creation, thus, nature needed to be completed through conquest” (425). Puritans got their view of wilderness from their interpretation of the Bible. One of the scriptures describes Jesus going out into the wilderness for 40 days and nights. While there, the Devil says to Jesus that if Jesus would just do one act of worship to the Devil, he would give all the world to Jesus. Jesus turned him down. Moses also had the Jews wandering the desert for 40 years and they encountered all sorts of trials. What happened to believers in the wilderness was not good. Puritans believed superstitiously that the Devil resided in the wilderness. Some Natives made their homes in the forest, therefore, they were Devils. Over and over, Rowlandson refered to the Natives as heathens. She does not fully trust “praying Indians” either even though they are her brothers in faith (Rowlandson 3).

Andrew Light illuminates more on the word wilderness. He said that there are two different meanings and the type of wilderness Puritans dealt with has the classical meaning rather than the romantic description. He relayed the meaning Puritans attached to the word is the “wilderness is a place that is always marked as the realm of the savage who is . . . thought to be cognitively, or mentally, distinct from the civilized human. The savage is always marked as the thing . . . outside of the classical wilderness, we civilized people, are not” (Light 17). In other words, by thinking Natives are savage, it makes the Puritans believe they are a better class of people. The word divides the civilized from the uncivilized, the Godly from the ungodly. Light goes on to relate that the Natives use the romantic description of the wilderness. They would not think it a place of evil but a place that sustains life and gives shelter. Examining the word wilderness proves just how far apart the Puritans and Natives were from each other. The Natives disliked the Puritans’ encroachment on to their land. At the same time the Puritans wanted to tame the wilderness and the people who lived in it.

Rowlandson had to prove she was untainted by the wilderness when she returned home. Her narrative showed how she did not “become native” but she upheld her Christian beliefs during some of the most trying times. Some other women who the Natives captured decided to stay with the group who kidnapped them. Rowlandson seemed to have Bible verses pop into her head when she needed them so that she could keep focused on surviving and returning to her husband. Since she had spent time in the wilderness, she did have to be purified to enter the congregation again. In the end, Puritans would win the war of 1675-1676. King Philip would die and more Native land taken and tamed. Over time, Natives lost a lot of land and were treated more savagely by Anglos than Natives treated the English.

Works Cited

Anderson, Virginia DeJohn. “King Philip’s Herds:  Indians, Colonists, and the Problem of

Livestock in Early New England.” JSTOR.

Light, Andrew. “The Metaphorical Drift of Classical Wilderness.”

Rowlandson, Mary. “A Narrative of the Captivity and Restoration of Mrs. Mary Rowlandson.”

Provided by client.

Toska, Sezgin. “From ‘Howling Wilderness’ to ‘Holy Wilderness.’” Humanitas, 2017.

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Introducing a New Product to the Market

Company Overview

The product selected for introduction to the market is a reading map kit. Included within the package will be a world map that includes demarcation of countries and states within the U.S., 100 pushpins in red, 100 pushpins in blue, 50 feet of yellow twine, a pair of hand scissors, and instructions. The proposed product is unlike anything currently available on the market, and the book merchandise market is in its growth stages, with new products entering the market and being consumed daily. The unique nature of this proposed product and the physical representation of reading books will appeal to many readers, allowing for identification of literary travels in a non-digital format and creating a work of art and a conversation piece at the same time.

Objectives and Goals

To make an international product used by inexperienced traveler, to the most advanced world destination seekers.  The goal is produce a kit simple enough to use to for daily use. As well as a product that is sustainable and durable for daily or weekly uses.  In addition, adding new inventory to the initial product as time progresses to keep the product viable and fresh.

Situational Analysis

To ultimately make this a global product, research needs to be conducted to see as to which products are more favorable among the consumers as well as where the product should be purchased.  Conducting research over the course of 6 months in two test fields, one in books stores and the other at hobby stores, such as crafting to determine, where the market will favor more.

Segmentation

When exploring the characteristics of the book reading population in the U.S. based on age ranges, between the years of 2011 and 2016, seventy-two to seventy-nine percent of polled individuals stated that they had read at least one book within the past twelve months (Statista, 2018). Of those who indicated book consumption, between 81 – 86% of participants stated that they had a college degree, and results showed that women read more than men, with 77% of the females polled reporting that they read at least one book within the past twelve months, as compared to 68% of male respondents (Statista, 2018). Using this information, the market segment considered should be females with college degrees aged 18 or older.

Targeting

This target market is particularly attractive due to the rise in book and book themed or book related products that have entered the market in recent years. The increased drive for book specific products, book-themed products, and book-related products, all hereafter referred to collectively as book merchandise, has become so great that publishing houses are recommending new authors use book merchandise as a means of increasing sales and generating a wider audience

Positioning

While there are scratch off posters that allow readers to scrape off the gold or silver coating over a book cover to indicate which books they have read, and while there are travel maps that would enable the traveler to scratch off the gold or silver coating over a country to indicate which countries they have traveled to, there is no product currently available that allows the reader to mark off or highlight his or her literary travels, in spite of the fact that a large quantity of book merchandise incorporates quotes referring to the trips of the reader or the lifetimes the reader has experienced through the pages of a book.

Marketing Mix

Product: The World is Your Oyster.

Price: Initial Map Kit $25.00 various add ons ranging $10-$15.

Promotion: Advertising in book and crafts stores.

Place: Physical locations with future to add Apps on smart devices.

Reference

Statista. (2018). Book readers in the U.S. by age 2018.

Garment Industry in Bangladesh.

The dynamic changes in technology specifically the social media has largely affected the garment industry in Bangladesh. This was greatly seen after the Rana Plaza incident where thousands of workers lost their lives as a result of the factory owners not taking health and safety measures in the factory into consideration. This horrific and traumatizing act was greatly publicized via the social media (Habib, 2016). This led to a negative perception of the industry and some of the country’s major markets pulled out and some were threating to pull out to discourage such treatments.

Due to this, the country decided that it was time to effect change in the working environment and working culture in the industry. The change started by the victims of the accident being compensated and all factories had to follow and adhere to proper measure to ensure employee safety like installation of fire extinguishers and ensure that the buildings were safe to accommodate their staff and workers (Habib, 2016).

The Bangladesh Government also improved the country’s minimum wage by 77% resulting to the new minimum wage being sixty dollars per month for all the ready garments workers (Mostafa and Klepper, 2017). The membership organization for garment Workers like the Bangladesh Centre for Workers Solidarity, an organization that stood up for the rights of the workers in the country, which was previously targeted and under the close watch of the government was allowed to operate freely the country.

The ready garment industry in Bangladesh mainly employs women. Women were mainly perceived to household workers and were bound to household chores while the men were the breadwinners of the family. The fact that the industry mainly employed and gave jobs to women was seen as a form of women empowerment in the country as they would become independent and generally raise their standards of living. The fact that women are employed in these factories at an early age has led to the decline of early childbirth and early marriages in the country (Habib, 2016).

Women mostly the sewing jobs in the industry and the supervisory jobs are left to men. This has brought up the issue of gender equality in this industry. The entrepreneurs who decide to invest in skills improvement and training in women have generally seen a difference in their output. Since the industry has decided to promote their workers on the merit of skills and job competence, women are now able to take up supervisory roles in the factories which were previously reserved for men (Mostafa and Klepper, 2017). This has surprisingly seen women performing better than their male colleagues.

The financial constraint in the garment industry has disrupted the industry from reaching its full potential and attaining the set objectives and goals. This has resulted in the industry and the country in general seeking funds to ease its day to day operations. Foreign Direct Investment (FDI) form the International Monetary Fund has contributed to the industry initiating major projects like energy, power as well as infrastructure improvement in order to increase its production. This will not only benefit the garment industry but also will help the country diversify its products for exports like agricultural processing industry, shipbuilding industries as well as the pharmaceutical industry (Habib, 2016).

Investments models have been developed and invented in order to upgrade the factories in Bangladesh to ensure the safety of their workers and staff. In addition to this, the government has established programs for technical training so that employees whether male or female can get proper skills to be efficient in the factory jobs despite the level of work that they perform (Mostafa and Klepper, 2017). Investing in skilled labor has seen to improve profits and increase productivity. The action to empower women in the country has seen that most households improve their living standards as both spouses are able to financially stable.

The Bangladesh government should strive to address the issues affecting the garment industry and help improve them as this is a major contributor to the country’s GDP. The fact that the industry is able to retrace its steps and become better even after facing so many challenges shows its potential to become even better in future. Both the industry and the government have major roles to ensure the success of the industry in general.

References

Habib, M. R. I. (2016). Backward Linkages in the Ready Made Garment Industry of Bangladesh:

Appraisal and Policy Implications. The South East Asian Journal of Management, 129-146.

Mostafa, R., & Klepper, S. (2017). Industrial development through tacit knowledge seeding:

Evidence from the Bangladesh garment industry. Management Science.

The Other Pay-offs of Biking

I’d never been what one might call an athletic person. My folks let me give youth football a try when I was maybe 13, but it wasn’t anything that really stuck. Besides, I had been feeling moderately healthy since I changed my eating habits, going to strict vegetarianism, and losing a substantial amount of weight a few years ago. But at a visit to my doctor one day, he looked at the blood test results, and told me that my cholesterol had gotten pretty high; I wasn’t at a dangerous level, but my doctor gave me two options: take a pill or start exercising at least 30 minutes per day, 5 days per week. I decided to go with the latter option, and resolved to get on my bicycle every day. It took me a while to realize it, but in addition to improved health, there were a number of other benefits that I discovered.

Thinking about where to start was a bit intimidating. There are people who have really expensive bikes, made from super-light alloy metals, and special shoes that clip in to costly pedals, and really tightly designed outfits they wear while they ride all over the place; it seemed like a level of dedication I wasn’t sure I could afford. But that doesn’t mean I was out of luck. I’d purchased a low-end dark grey city commuter bike a year or two before, mostly to get from my apartment to a place to eat in my neighborhood, or to events like a festival in the park or a street fair. I live in a city with some serious parking shortages, and the bike was to avoid having to circle block after block in my car, or have to shell out $5 for parking, or even more for a cab or ride share (the bus fits my economy, but doesn’t run as often as I need it). I just wanted to casually ride up to my location, lock up, and go have fun. It’s also a city with some serious hills, and my city bike had a pretty versatile combination of three gears in the front, and seven on the back cassette. It isn’t the kind of road racer major enthusiasts ride, but my little Raleigh bike seemed like a great bike to start off with. But getting started required some preparation beyond the bicycle.

Because the doctor told me that I had to get my heart-rate up (and keep it up) for a certain amount of time, it seemed reasonable to measure just how fast or slow I was riding. I plotted out a route going about 8 blocks east in my neighborhood, looping south, then back west, coming back down a different stretch of road, which took me about 7 minutes so I thought that If I did that 4 times I’d be giving my body what it needs. But I quickly discovered that doing the same route 4 times in a row can get terribly boring, so I had to change it up. I started experimenting, and found a really good route, going through my neighborhood twice, taking slightly different roads in each loop. Not only does it keep me pedaling for at least 30 minutes, but I discovered that when biking around these streets and avenues, I got to know my neighborhood better.

As I got out on my bike for the daily ride, I started seeing people from my community, like the guy who owns a television repair place on Adams Ave., and an old coworker who also happens to jog every morning around the same time. On one morning, I saw an older woman take a spill on the sidewalk, and stopped to help her up and make sure her Chihuahua didn’t run off; the next time I saw her walking, she flagged me down and gave me a thank you card, and told me she owns our local music shop, and welcomed me in to get a few records. On any given morning, there are so many different people I run into—the group walking their retrievers, the woman in curlers with coffee and the paper on her Spanish style porch, the pair of scooter riders putting down 35^th side by side on a schedule I can set my watch by, and the monks who live on the cliff and toll a bell at 6 and 7am, then shuffle out through the blocks of craftsman style homes under the banana and palm trees.  I later learned (from a report by Roxana Popescu) that my neighborhood is unusual in that it has racial and ethnic demographics that reflect the whole city, and it’s really interesting I’m part of that microcosm of diversity.

Not only was I getting to know some of the people in my neighborhood a bit better, but on these rides I also started to learn more about the structure of my city, and some areas of destruction. Each road where my tires spun taught which streets were smoother, and which ones really need repair. According to a study done by researchers at the University of British Columbia, “trips by bicycle face higher risk of fatality and injury per trip and per distance travelled than trips by car,” so I was concerned about the conditions of the roads I was using to ride (Teschke, Reynolds, Ries, Gouge & Winters, 2012, p. 7). Reading about those risks (and also benefits in the article) helped me think more deeply about road safety concerns. After I’d been riding for a few months, I got to speak to my City Council member at an event he was having at a local coffee shop. When he asked what I’d like to see in the neighborhood, I told him that we need some new roads, and was able to mention specific blocks that were exceptionally bad. He gave me the number for his office and told me about the phone app the city has, and since then I’ve reported broken water pipes, leaking gas lines, garbage cans that have been knocked over, and graffiti on some of our wonderful murals. When people say, “Somebody should do something about this,” I think that maybe those somebodies are the people who are out and about, and paying attention, and trying to make things better. My daily exercise makes me that somebody!

Another thing I noticed about my neighborhood was all the efforts to build community. During my ride I passed signs, banners, and marquees that gave notice about neighborhood sports teams at the Rec Center, movies in the park every weekend in the summer, and public meetings about things like businesses, the school board, and other city groups. Biking around and seeing these things, I became aware of ways I can get involved in my local community. Though I normally bike as the sun is rising at dawn, sometimes I head out in the evening for a Community Planning Group meeting, or to a gathering of one of the local cycling/environmental groups, who are thinking about how biking is a major part of my city’s Climate Action Plan, with a mission that includes, “Promoting active transportation,” which I’m dedicated to as well (City of San Diego, 2015, p. 4).

Another benefit I discovered from biking was that it brought me closer to my family. When I first began, I’d get out of bed around 6:30, and whisper to my partner that I was going for a ride. But after a few months, they decided that they wanted to go too, and we started biking together. It’s difficult to have a conversation while biking with someone, as we didn’t want to ride side by side because of fears that cars might not share the road. Still, even though we couldn’t speak to each other, just sharing the experience of being out and active early in the morning made the time together special; it’s like we have a date every morning, but instead of some fancy restaurant, we have the whole town!

My biking habit also really impressed my father in-law, who once biked from Long Beach all the way up to Santa Barbara on a folding bike (which has really small wheels compared to a regular road bicycle). Sharing a hobby gave us a common ground. When we spend time together now, we usually compare rides, and every so often, we sign up for a long bike ride together. Just a few months ago, we did the Bike the Bay event, where almost four thousand riders signed up and biked from the San Diego Convention Center, over the Coronado Bridge, through Coronado, down the Silver Strand, to Imperial Beach, then back up along the east side of the San Diego Bay. While he and I were out, my mother in-law and partner hung out, and prepared a little picnic we all enjoyed together when we got home. Sometimes it can be difficult to connect with people in the family from the older generations, but this biking routine has really helped build these relationships.

Biking has also helped me exchange some of my old negative habits to more positive ones. For example, I really get sucked into video games, and it’s difficult to do the exercise my doctor recommends with a controller in my hand. I think about how when we play games, and do something in the digital world, we might get a “trophy” or an “achievement,” and how that feels good. In a study about these kinds of motivations, Kwon, Halavais, and Havener (2015) write, “Badges have traditionally been used by various institutions to recognize and incentivize performance, providing a marker of accomplishment visible to the community and to the wider public” (p. 93).  This made sense to me! I loved it when I’d get a badge in a game, so I figured, Why not try that with biking? I was able to download an app on my phone (there are a whole bunch of them), that tracks my biking speed, route, and could track my heart beat if I wore some kind of monitor. When I ride faster than usual, or farther than normal, or for a longer amount of time, I get a little trophy that appears on my phone. Though the article talks about public acknowledgement, I don’t share the results of my ride with the public, but just the private knowledge motivates me to keep riding, and trying to beat myself in this new game I associate with my bike ride. I even hide it from myself, keeping the phone in my pocket until the ride is over; I’d hate to get distracted while I’m riding, after all.

That leads to one more benefit that seems really important: in the 30 to 45 minutes I’m biking every morning, I’m getting valuable time to myself. In that time, I’m thinking about how my body feels while I’m riding, and looking around my neighborhood, but I’m also mentally preparing for my day. I’m talking myself through problems I’m trying to solve, conflicts I experience in my daily life, and plans I know I have to sit down and make later. The quiet time on my bike, and the motion through the cool morning air goes a long way to prepare me for the long day ahead. In the 18 months or so I’ve been doing this, I’ve been more productive at work, more awake during the day, and I find the food I eat is often healthier too, and I don’t want huge meals or heavy drinks at night, because I want to be able to wake up in the morning and ride.

It hasn’t taken much to become a “cyclist.” I didn’t need a bunch of fancy gear and an expensive bike. With a simple 10 speed bike, an old t-shirt, shorts, and sneakers, I’ve discovered so much. Not only have I been able to get my body a bit healthier, I’ve also been able to get more involved in my community, get closer to my family, and find new little ways to enjoy the day, and to face the challenges of life with a clearer mind. After about a year and a half of being on the bike every morning, I’m even starting to wonder: could I make the ride up to Santa Barbara? Maybe with a little more pedaling, I can start to expand out the neighborhood, eventually.

References

City of San Diego. (2015). City of San Diego climate action plan. San Diego, CA.

Kwon, K. H., Halavais, A., & Havener, S. (2015). Tweeting Badges: User Motivations for Displaying

Achievement in Publicly Networked Environments. Cyberpsychology, Behavior & Social               Networking, 18(2), 93.

Popescu, R. (2017) Normal Heights diversity. Union Tribune.

Teschke, K., Reynolds, C. O., Ries, F. J., Gouge, B., & Winters, M. (2012). Bicycling: Health Risk or

Benefit?. UBC Medical Journal, 3(2), 6-11

Abstract

Good leadership is essential for the success of a business organization. Modern business has been diversified and new practices have been introduced. Even the most effective leadership techniques can end up being obsolete as far as new business models are concerned. Leaders should be flexible. They should strategize their leadership models in such a way that they can quickly adopt to change soon as the need arises. In order for business leaders to remain relevant as time goes by, they should be able to outline their main areas of organizational leadership that they intend to put their major focus on. This study will focus on three elements of leadership; team leadership, innovation and people development. These three were chosen based on the realization that they bring together all the other elements of organizational leadership. A discussion of how the three should be employed by business leaders will form the bulk of this study.

Leadership Competency Improvement Focus Proposal

Introduction

In my life, I have always believed in the power of transformational leadership as the key to success in business. There are different scales of business that exist today. In my case, I consider a business that employs many people as being more viable than a sole proprietorship. This is based on my belief on the essence of profit maximization, customer satisfaction and creating employment opportunities. In order to bring the significance of the above mentioned objectives into practice, realized that effective transformational leadership is a component that will have to be embedded in my life for as long as I wish to practice business. Transformational leadership is not just applicable in the business sector. It is applicable in my everyday life as well. My interactions with friends and family are made more efficient whenever I apply the ideologies of transformational leadership, values and ethics.  Personally, this trait has garnered me a large amount of success and I intend to continue holding on to it.

Leadership Competencies

Innovation, team leadership and people development are the leadership competencies that will be addressed in this study. People development involves coming up with strategies to enhance the quality of employee output. Identifying the best people development strategies is one of the greatest challenges facing business leaders. Learning and development programs is one way by which leaders can practice people development. Many business organizations spend a lot of money on these programs.

Innovation constitutes coming up with new ways of doing things. Anyone can innovate. Employees have for a long time now been embedded in the misconception that business innovation is something that should be left to the executives. This is not the case. One way in which this mindset can be reversed is by implementing people development programs. Innovation brings numerous advantages to a business organization. For instance, it gives a firm the competitive advantage of growing and adapting the firm’s business in the marketplace. Organizations that employ innovation are likely to save time and money in their operations.

The success or failure of a business team is determined by the effectiveness of the team leaders’ strategies. A good leader will lead his or her team to success while a bad one will lead his or her team to failure. Team leadership is characterized by the size of the organization one is dealing with. Being the manager of a small company is not the same as heading a large organization. The two bring diverse challenges on the table. As such, it is advisable to view the two in the context of leadership in general.

Effective team leadership depends on the characteristics of the leaders. A good team leader is supposed to be flexible. The modern business environment keeps changing from time to time. An effective leader should be able to quickly adopt to these changes and unite the team around new and reversed goals. By so doing the leader ensures that the team does not get glued to old practices in a changing business environment. A team leader is tasked with the responsibility of developing the organization’s operational strategies. A good leader should not take on this responsibility independently. He or she should take advice from the organization’s funders, trustees, staff, service users and partner agencies.

Innovation, team leadership and people development are some of the main factors that define an organization’s success or failure. The success of a business is dependent on a number of factors. The core competencies of a firm are based on its leadership model. Innovation, team leadership and people development are three most crucial components of a leadership model. They encompass all the other factors that lead to organizational success. An organization that is able to come up with an effective strategy that will include these three is guaranteed to succeed even in the most unfavorable business environment. This formed the rationale for choosing these three.

Leadership competencies proposal

People development can be done in different ways. Managers play a crucial role in influencing employees. One way in which people development can be executed is by igniting the managers’ passion to coach their employees. Managers pass important skills, insights and knowledge to the employees through coaching and mentoring. Modern business has been globalized and as such, it has become more competitive and complex (Tipu, Ryan and Fantazy, 2012). This has led to managers being overburdened by new responsibilities. This has made it difficult for them to handle what they were originally tasked to do let alone offer coaching and mentoring.

The business world is changing. Knowledge and skills can be become obsolete in just a few months. Leaders should ensure that managers and their employees learn rapidly and regularly. Currently in most organizations, learning and people development is a once in a while occasion. This should be transformed to be a more continuous, ongoing campaign. Adopting new strategies of conducting people development can consequentially lead to information overload. This can be risky to an organization.

Enacting leadership strategies that will ensure that tech employees own their own career development is good way of performing people development. The organization cannot control the learning futures of the employees. It is the responsibility of every individual to own, self-direct and control his or her learning futures (Freeborough, 2012). Individual’s talent development is crucial for overall productivity. It is not only essential for the general organizational success but it is also important for self-development and one’s ability to innovate.

Most employees do not have trust in the leadership systems that guide them in their respective organizations. This study suggests building trust in organizational leadership as a people development strategy. Employees crave transparency, honesty and openness from their leaders. Research conducted by the American Psychological Association postulates that only half of the employees in the U.S. are certain that their leaders are being upfront and open with them (Green, Miller and Aarons, 2015). Leaders are supposed to share their ongoing learning journeys with their employees. They should conform to the old adage, “lead by example.”

Through research and planning, an organizational can be able to identify the respective areas that need innovation. One way in which this can be done is through conducting a market study.  Business market environment keeps changing. New trends keep coming up with the wake of every new working day. In order to stay up to date with these trends, an organization should be able to analyze these new trends and relate them to customers’ wants and needs and those of the competitors. Doing so will enable the firm to stay ahead of its competitors or at least stay in the same level.

Leaders should be open to new ideas. They should be adoptive to change. In order for them to do this, they should be able to seek advice. A good organization should have advisors, grants and assistance. These are essential in driving innovation. Learning everything there is to know about local and international collaboration can help the leaders head their employees through efficient and reliable innovative techniques. There is need to protect the organization’s ideas (Salem, 2015). Seeking Intellectual Property protection can aid the organization in commercializing its ideas.

Team leadership is the foundation on which innovation and people development are practiced. In this case, what matters is the characteristics that make an individual a good leader. A good leader should be confident, respectful, fair, influential, delegate, should have integrity, and should be a facilitator and a negotiator.

References

Freeborough, R. E. (2012). Exploring the affect of transformational leadership on nonprofit

leader engagement and commitment (Order No. 3498733). Available from ABI/INFORM Collection. (928140246).

Green, A. E., Miller, E. A., & Aarons, G. A. (2013). Transformational leadership moderates the

relationship between emotional exhaustion and turnover intention among community mental health providers. Community Mental Health Journal, 49(4), 373-9.

Salem, I. E. (2015). Transformational leadership: Relationship to job stress and job burnout in

five-star hotels. Tourism and Hospitality Research, 15(4), 240-253.

Tipu, S. A. A., Ryan, J. C., & Fantazy, K. A. (2012). Transformational leadership in pakistan:

An examination of the relationship of transformational leadership to organizational culture and innovation propensity. Journal of Management and Organization, 18(4), 461-480.

Decreasing CNA Turnover Rates

Abstract

The primary rationale for the selection of this project is the need to reduce the turnover rates of Certified Nursing Assistants in my home health agency. The turnover rates of CNAs remain a long-term care issue affecting the delivery of quality care. The current turnover rates range from 56% to 75% for the CNA’s. This research study seeks to probe whether CNA’s empowerment procedures are associated with the retention of CNAs. In an effort to gather an evidence-based knowledge for this study, data from nursing homes and home health agencies will be used.  After an adjustment for the covariates, an efficient staff empowerment initiative score was established to be positively associated with the higher levels of retention. In comparison with the low empowerment section, nursing institutions with scores that were perceived to be medium had a 45% chance of having higher CNA retention rate; while those with higher empowerment scores were considered to have a 65% likelihood of having a higher CNA retention rate. Greater opportunities for nursing institutions in regard to CNA empowerment are therefore associated with long-term CNA retention. This research reveals that staffing empowerment measures are worthwhile from a CNA staffing retention point of view.

Decreasing CNA turnover rates

The U.S. will have over 88.5 million people aged over 65 years by 2050, double the 2010’s 40.2 million estimates (Hummel, 2017), with an estimated increase in the demand for CNAs in the range of 5.7-6.5 million (Meyer, Raffle & Ware 2014). The need for nursing homes is also expected to rise. Such postulates, compounded by the cost of training a CNA, and beliefs that CNA stability positively impacts the quality of care afforded to nursing home residents have ignited long-standing interest in CNAs turnover and retention in long-term care facilities (Institute of Medicine, 2008; Squillace et al., 2008). As Bowers and Nolet, (2011) note, the correlation between CNA staff stability and care quality is premised on the idea notions that staff staying for more extended periods at a facility establish a relationship with both colleagues and residents thus are familiar with the residents’ needs (Donoghue, 2010). Importantly then, appraising whether CNA’s empowerment procedures result in this correlation cannot be overstated.

Systematic Problem Identification

Adequately skilled CNAs are highly required to meet the increasing demands of the aging population in long-term nursing homes that are unable to provide basic geriatric services (Lerner et al., 2014; Ammons & Kelly, 2015). CNAs account for 66% of the total healthcare workforce segment in long-term health care (Hummel, 2017). CNAs who characteristically spend 6-8hours in contact with residents, function in one of the most core and influential capacities in nursing homes (Hummel, 2017)

By 2020, the need for CNAs will increase by 20% and 39% by 2024 (Hummel, 2017). Such amplification in demand for these staff and the facilities in which they operate is paired with the opposing realities of them having one of the highest turnover rates for any long-term care work-related position (Ammons & Kelly, 2015). This is compounded by the cost of recruiting, orienting and training a new CNA into a nursing facility, which is estimated to be $30,000 (Squillace et al., 2008). Such facts are a recipe for crisis and prerequisites for approaches for nursing facilities to retain their CNAs, including staff empowerment measures.

Assessment of Researching the Existing Knowledge-Base

The stability of staff in literature is measured as staff turnover (the % of quitting staff in specified periods (usually a year)) and staff retentions (the % of remnant staff within the same period) (Bowers & Nolet, 2011; Donoghue, 2010). As Hummel, (2017) reports, the estimated annual CNAs turnover rates range between 23.8% to 74.5%; in 2012, the turnover rate was 52%, with 47,000 vacant positions for skilled labor being reported in nursing facilities. In Castle and Engberg’s (2005) research in four states, a yearly 85.8% turnover rate was realized in 354 facilities while the 2010 CNA turnover rates as reported by AHCA (2014) was 42.6%. National CNA retention rates as estimated by Donoghue (2010) were 62.5%.

Employment practices that are empowerment focused have been proposed as one of the means of enhancing CNA job stability and satisfaction (Hummel, 2017). The approaches have been linked to staying intent, higher job satisfaction, and lower turnover rates. These include developing more supportive facility culture and the development of greater CNA opportunities (Bowers & Nolet, 2011). Best exemplifying this includes offering educational and training opportunities, practice implementation reflecting staff valuing, staff involvement in the planning of care and participation of staff in day to day and managerial decision making (Koren 2010).

Probst, Baek, and Laditka, (2010) research postulate positive associations between organizational climate, sufficient time for tasks, good hourly earnings, good supervisor behavior and staff valuation with job satisfaction. Approaches implementing team empowerment gave CNAs authority to make decisions on their work, leading to modest positive effects on CNA job satisfaction, performance, improved procedures, cooperation, coordination and better resident care (Yeatts & Cready, 2007). The study also revealed a minimal likelihood of CNAs exposed to empowerment for getting fired or quitting.

The clinical significance of CNAs is enormous. CNAs are considered paraprofessional performing multiple tasks with and for residents. Most of the work of CNAs is associated with the physical care of residents (Squillace et al., 2008). CNAs are also trained to provide non-physical support, including the ability to recognize changes in behavior and social interaction decrements among residents (Hummel, 2017). Additionally, they also offer support to resident family members, making their retention in a nursing home important.

Adaptation of Existing Practice

In practice, the implementation of cultural changes within organizations is one of the leading fronts changing staff empowerment (Banaszak-Holl et al., 2013). Movements advocating for cultural change are expansive and mainly focus on the improvement care and life quality for residents in nursing facilities (Zimmerman, Shier & Saliba, 2014). CNA empowerment presents residents with a homelike atmosphere, direction, close contact, decision making based on collaboration and processes aimed at improving quality of care (Koren, 2010). Implementation of the principles of staff empowerment follows the postulates of being organized to support the empowerment of all staff responding to the needs and desires of residents (Hummel, 2017).

Conduct a Clinical Trial and Evaluation

Evaluation of the effectiveness of this approaches will employ the postulates of (Berridge, Tyler & Miller, 2018) and (Banaszak-Holl et al., 2013).  A culture change survey of nursing home directors and administrators at similar nursing homes will be conducted via mail, phone and online at a sample of nursing homes implementing the approach. The survey will use a stratified sampling design. The survey will examine two culture change domains: staff empowerment practices (choices and decisions) and the physical environment. Survey questions will be designed to be on the area of interest, that is, the domains of staff empowerment practices and retention rates. Analysis of data obtained will follow the postulates of Tyler et al., (2013).

That, as Berridge, Tyler & Miller, (2018) postulates, nursing homes which identify themselves as adopters of change implemented strategies such as the cross-training of staff, provided leadership training opportunities, and engaged nurse assistants in decision making on assignment residents. Then for the sample of facilities implementing staff empowerment practices, the evaluation will be based on CNA tracking information as provided by participating facilities, pre and post job satisfaction surveys and CNA exit interviews. Qualitative measures will be undertaken through valuations; observations made on project variables will be detailed.

Decision: Adoption, Modification, Rejection

Relationships between organizational cultural changes and the stability and satisfaction of CNAs is complex (Bowers & Nolet, 2011). Implementations of changes may be hard in the face of more permanent staff with long institutional relationships and memory as they tend to be attached to a familiar, different model (Donoghue, 2010). An uphill task would be the achievement of staff buy-ins (Tyler et al., 2013). Strategies (below) to involve CNAs and assure buy-ins require extensive training and strong communication (Hummel, 2017). Modification: going beyond the federally recommended staff-residence rations in the face of looming large workload issues, residence dissatisfaction, and CNA turnover. More realistic ratios have to be established in the face of growing CNA pools due to improved wages and better training.

Plan for Diffusion of Innovation to Other Areas

Findings from the research will be diffused to training institutions to offer adequate training (Hummel, 2017). The development of highly specific and meaningful training programs for CNAs can help address turnover problems. Such training has to be imperatively accompanied by between hourly pay. The acquisition of better trained CNAs only reasonably requires more than minimum wage to guarantee long-term stay. Financially constrained nursing facilities can strongly argue their case for additional resources for wages (Hagerty & Buelow, 2017).

Maintenance Mechanisms

Strategies to overcome resistance to change in part will entail the use of change agents with characteristics similar to the targets of change which has been postulated to improve the reception of change (Berridge, Tyler & Miller, 2018). A second option involves the use of dramatic symbols and ceremonies signaling disengagement from the past (Parkin, 2009). Organizations have been known to burn old policies and tear down buildings to demonstrate their disengagement from the past and the embracement of the future. The approach best works when fundamentally supported by widespread communication about the change and ensuring that staff and administrators understand the rationale (Hagerty & Buelow, 2017).

The critical importance of involving persons affected by the change cannot be overstressed. If CNAs feel involved in the planning and implementation of the change are invited to participate and voice their views in the process, they will be much more likely to commit to the changes and engage colleagues to do the same (Hummel, 2017). Similarly, it is critical to get a person on board who have substantial credibility or leadership in the organization. They are likely to be influential by creating by-ins particularly among CNAs resisting change (Parkin, 2009). Finally, change is likely to be far less successful when an organization fails to commit sufficient resources to see it through. Whether these resources are new training for the new process or finances, failure to invest in what it takes for success readily invites resistance.

Evaluation and Dissemination Plan

A culture change survey of nursing homes implementing the approach will be conducted to examine staff empowerment practices to appraise the post-implementation retention rates, as based on the postulates of Berridge, Tyler, and Miller, (2018). Targeted dissemination and diffusion of research findings will employ multifaceted dissemination strategies, emphasizing on media and channels that are most effective for stakeholders – nursing home administrators and directors, funding organizations, CNAs training institutions and CNAS. Based on the postulates of knowledge uptake, theoretically-informed frameworks will be used to guide research finding dissemination through presentations at conferences, posters, institutional websites, and podcasts.

In conclusion, CNA empowerment practices implemented by new-culture-adopting nursing homes are positively associated with retention cannot be ignored, more so as they are indicative of how they may be used to enhance staff stability. This new and vital knowledge on changing the culture of an organization can confer benefits to both nursing facilities and the care afforded to residents. It is expected that the findings of the research will benefit nursing facilities that seek the achievement of higher retention rates of CNAs.

References

American Health Care Association. (2014). American health care association 2012 staffing report. American Health Care Association Department of Research. Washington, DC. Author.

Ammons, S. K., & Kelly, E. L. (2015). Work and family in the new economy. Bingley, U.K: Emerald.

Banaszak-Holl, J., Castle, N. G., Lin, M., & Spreitzer, G. (2013). An assessment of cultural values and resident-centered culture change in US nursing facilities. Health care management review, 38(4), 295.

Berridge, C., Tyler, D. A., & Miller, S. C. (2018). Staff empowerment practices and CNA retention: findings from a nationally representative nursing home culture change survey. Journal of Applied Gerontology, 37(4), 419-434.

Bowers, B., & Nolet, K. (2011). Empowering direct care workers: lessons learned from the GREENHOUSE Model. Seniors Housing & Care Journal, 19(1), 109-20.

Bowers, B., Roberts, T., Nolet, K., Ryther, B., THRIVE Research Collaborative, Brown, P., Cohen, L., Grabowski, D., Horn, S., Hudak, S. & Reed, D., 2016. Inside the Green House “black box”: Opportunities for high‐quality clinical decision making. Health services research, 51, pp.378-397.

Castle, N. G., & Anderson, R. A. (2011). Caregiver staffing in nursing homes and their influence on the quality of care: Using dynamic panel estimation methods. Medical care, 545-552.

Castle, N. G., & Engberg, J. (2005). Staff turnover and quality of care in nursing homes. Medical care, 616-626.

Donoghue, C. (2010). Nursing home staff turnover and retention: An analysis of national-level data. Journal of Applied Gerontology, 29(1), 89-106.

Hagerty, D., & Buelow, J. R. (2017). Certified Nursing Assistants’ Perceptions and Generational Differences. American Journal of Health Sciences, 8(1), 1-6.

Hummel, R. (2017). CNA Turnover and Retention in nursing homes (Doctoral dissertation, University of Pittsburgh).

Institute of Medicine (U.S.). (2008). Retooling for an aging America: Building the health care workforce. Washington, D.C: National Academies Press.

Koren, M. J. (2010). Person-centered care for nursing home residents: The culture-change movement. Health Affairs, 29(2), 312-317.

Kulik, C. T., Ryan, S., Harper, S., & George, G. (2014). Aging Populations and Management. Academy of Management Journal, 57(4), 929-935.

Lerner, N. B., Johantgen, M., Trinkoff, A. M., Storr, C. L., & Han, K. (2014). Are nursing home survey deficiencies higher in facilities with greater staff turnover? Journal of the American Medical Directors Association, 15(2), 102-107.

Meyer, D., Raffle, H., & Ware, L. J. (2014). The first year: employment patterns and job perceptions of nursing assistants in a rural setting. Journal of nursing management, 22(6), 769-778.

Parkin, P. (2009). Managing change in healthcare: Using action research. Los Angeles: SAGE.

Probst, J. C., Baek, J. D., & Laditka, S. B. (2010). The relationship between workplace environment and job satisfaction among nursing assistants: Findings from a national survey. Journal of the American Medical Directors Association, 11(4), 246-252.

Squillace, M. R., Bercovitz, A., Rosenoff, E., & Remsburg, R. (2008). An exploratory study of certified nursing assistants’ intent to leave. US Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Term Care Policy.

Tyler, D. A., Feng, Z., Leland, N. E., Gozalo, P., Intrator, O., & Mor, V. (2013). Trends in post-acute care and staffing in US nursing homes, 2001–2010. Journal of the American Medical Directors Association, 14(11), 817-820.

Yeatts, D. E., & Cready, C. M. (2007). Consequences of empowered CNA teams in nursing home settings: A longitudinal assessment. The Gerontologist, 47(3), 323-339.

Zimmerman, S., Shier, V., & Saliba, D. (2014). Transforming nursing home culture: Evidence for practice and policy. The Gerontologist, 54(Suppl_1), S1-S5.

Be an Organ Donor

For many people, it can be disconcerting to think about what might happen at the end of their lives. The prospect of death is daunting, and many people prefer not to think about the details. However, an important end-of-life decision to address is whether or not to become an organ donor. Any person over the age of 18 can register to be become an organ donor, and there are a wide range of circumstances under which organs may be donated (US Department of Health and Human Services [HHS], 2018). It is possible for older people to donate their organs, depending on the way they die, or the organs may be donated when a person suffers from an unexpected accident that leaves them brain dead (Girlanda, 2016). When a patient is declared brain dead, it means that there is an “irreversible cessation of brain stem activity” (Girlanda, 2016), but in some cases, they may still have functioning organs and tissues that are suitable for donation (Yousefi, Roshani, & Nazari, 2014). If the person is registered as an organ donor, the useable organs may be removed by medical staff and transplanted into one or more needy patients (HHS, 2018). Aside from brain death, there are also several other types of death that are conducive to organ donation, such as cardiac death, but brain death accounts for between eighty and ninety percent of all organ donations each year (Girlanda, 2016). It is important to distinguish these types of organ donation—that is, donation by a registered donor who has reached the end of their life—and living donation, which is sometimes coerced and goes beyond the scope of this paper. When it comes to the question of whether or not to register to become an organ donor, the issue is limited in scope to end of life circumstances.  There are a wide range of benefits to organ donation at the end of life, more people should make the decision to register to become organ donors.

In the United States, there has long been a high demand for organ donation.  In 2017 alone, a total of 34,770 organ transplants were made as a result of organ donation (HHS, 2018). However, there are still far fewer organ donors than are needed within the healthcare system.  In April 2018, there were over 114,000 people on the national transplant waiting list. Moreover, this number has increased significantly in recent years: in 1991, there were only about 24,000 people on the list (HHS, 2018). While it is true that the number of registered donors has also gone up in the last three decades, the rate of the increase in the number of donors has been outstripped by the increase in the demand. As of 1991, there were about 7000 instances of successful organ donation in the United States, but by 2017, that number only risen to about 16,400 successful instances of organization, which is still far fewer than the number of donations that were needed by patients on the waiting list (HHS, 2018). The discrepancy in the rate of increase between organ donation demand and actual organ donation stems directly from the fact that too few people in the United States are registered organ donors.

Perhaps the most compelling reason why more people should register to become organ donors is that organ donation can have a truly positive impact on the lives of others. A single organ donor has the potential to save the lives of eight different people (HHS, 2018). Moreover, organ donation also positively affects the people who love and support the receiver, including their family, friends, colleagues, and even their casual perspectives (Moritsugu, 2013). Therefore, from an ethical perspective, organ donation is a highly altruistic gesture (Dalal, 2015). When a person chooses to become an organ donor, it is a decision that inherently benefits others, without regard to the self (Dalal, 2015). While the end of a person’s life may be a tragedy—especially if it is cut short by an unexpected accident that leaves them brain dead—organ donation makes it possible for them to improve the world through one last act of kindness toward others. No matter what the cause of a person’s death, registering to become an organ donor ensures that their final act will be to do something that benefits others.

For more practical thinkers, another reason to make the choice to become an organ donor is that organ donors are needed, and potential donors are in a position to fulfill that need. This argument rests on the ethical principle of utilitarianism (Dalal, 2015). Given the long length of the organ donor waiting list, there is no doubt about the need for people to register to become organ donors. Every day, about 20 people on the waiting list die waiting for an organ transplant (HHS, 2018), so organ donation has a clear utility for society as a whole. Unfortunately, only about 3 in 1000 people die in a manner that is conducive to organ donation (HHS, 2018). Comparing these statistics, it is clear that the only way to ensure that the number of available organs can catch up with the number of needed organs is to increase the number of registered donors who have agreed to donate their organs. Utilitarianism necessitates that the people with the available resources—organs that are in functional condition at the time of death—should make those resources available to the others in society who desperately need them.

Another reason to become an organ donor is that it can relieve the burden on a person’s own family in the event of an unexpected accident in which they are rendered brain dead, but their organs are suitable for donation to needy patients.  If a person is not a registered organ donor at the time of the accident, but the doctors determine that the organs are suitable for donation, the decision about organ donation falls to the family. This can be extremely challenging for family members during the initial period of grief. Not only does the family have to deal with the shock of the loss of a loved one, but they are suddenly faced with the question of what the person would have wanted (Yousefi et al., 2014). In addition, families who are making decisions while they are overcome with grief may be less likely to choose organ donation because they hope the patient will recover, even when the doctors have clearly specified that the patient is brain dead (Yousefi et al., 2014). Families may also have trouble understanding the process of organ donation, and there may be conflicting opinions within the family about what the person wanted (Yousefi et al., 2014). Clearly, when a person decides not to register to become an organ donor, they place their family members in a challenging decision-making position at what is likely to be one of the hardest moments of their lives—when they are stricken by grief and trying to recover from an unexpected loss. Out of consideration for their families, more people should take responsibility for their own decisions and register in advance for organ donation.

Finally, more people should register to become organ donors in order to advance the science of organ transplant.  Although improvements in surgical techniques and immunosuppression strategies have reduced the failure rates of organ transplants in recent years, the success of an organ transplant is still far from guaranteed (Girlanda, 2016).  In 2017, over 34,700 organ transplants were attempted, but only about 16,400 succeeded (HHS, 2018). However, every time an organ transplant succeeds, it contributes to clinicians’ understandings of the factors that play into a successful transplant. Therefore, by registering to become an organ donor, a person can contribute to advances in medical science that have long-term implications for improvements in organ donation efficacy in the future.

Critics of the argument point out that organ transplant is cost-inefficient, so it can place an unnecessary financial burden on the healthcare system (Axelrod, 2013). Organ transplant is highly resource-intensive, and for patients receiving organs like kidneys, the costs of long-term dialysis may be lower than the cost of transplantation (Axelrod, 2013). In cases where the transplant fails anyway, the transplant attempt is ultimately nothing but an economic loss. Therefore, opponents may argue that instead of encouraging organ donor registration, it is more important to focus on improving medical technology and finding alternatives to cost-inefficient organ transplant.

While it is true that the process of organ donation and transplant is not cost-efficient, there may be ways to reduce cost inefficiencies in the future, even for high-risk transplants patients (Axelrod, 2013). Also, clinicians can learn from every transplant attempt, ultimately leading to better outcomes for future patients. Therefore, regardless of the resource-intensive nature of the process and the potential strain on the healthcare system, it is worthwhile to encourage more people to register to become organ donors and thereby increase the number of transplant attempts each year.

In conclusion, more people should make the decision to register to become organ donors in the event that their organs are suitable for donation when they die. The ethical support for this argument is underpinned by both altruism and utilitarianism. People should also choose to donate their organs because it means that their family will not have to make the challenging decision for them, and it can contribute to further advancement in the medical field. Although there is a credible economic argument against increasing the number of transplant attempts, the costs of transplantation are outweighed by the potential benefits. Therefore, all US adults who are currently unregistered should take the opportunity to register to become organ donors today.

References

Axelrod, D.A. (2013). Economic and financial outcomes in transplantation: Whose dime is it anyway? Current Opinion in Organ Transplantation, 18(2), 222-8.

Dalal, A.R. (2015). Philosophy of organ donation: Review of ethical facets. World Journal of Transplantation, 54(2), 44-51.

Girlanda, R. (2016). Decreased organ donation for transplantation: Challenges and opportunities. World Journal of Transplantation, 6(3), 451-9.

Moritsugu, K.P. (2013). The power of organ donation to save lives through transplantation. Public Health Reports, 18(2), 245-6.

Organ donation statistics. (2018). US Department of Health and Human Services.

Yousefi, H., Roshani, A., & Nazari, F. (2014). Experiences of the families concerning organ donation of a family member with brain death. Iranian Journal of Nursing and Midwifery Research, 19(3), 323-30.

Taking a Stand

This should be a 4 to 5-page paper. Page count does not include a title page or reference pages. In this paragraph, you will introduce the conceptual frameworks of the constructs of ethics, moral, or legal standards. Use a support to help define it here. Should have a minimum of three to four sentences for this topic. Then you will add the purpose of this paper in the last sentence of this paragraph. Be explicit what you will be discussing.

Ethical, Moral, or Legal Dilemma

Consider an ethical, moral, or legal dilemma that you have encountered in your work environment and describe it. Mentally survey your work environment, or one with which you are familiar, and identify a timely issue/dilemma that requires you to perform the leadership role of moral agent or advocate to improve a situation (e.g., speaking or acting on behalf of a vulnerable patient, the need for appropriate staffing, a colleague being treated unfairly). Then I would expect you to use your APA resources from the Walden Writing Center to correctly cite and reference your work. The Walden Library is an excellent place to find your evidenced-based support.

Analysis of the Moral, Ethical, and Legal Implications of Situation

Discuss the moral, ethical, and legal implications of this situation. Each new topic will have a new paragraph. Support your perspectives with literature to support and cite correctly. What ethical, moral, or legal skills, dispositions, and strategies would help you resolve this dilemma? Define the differences between ethical, moral, and legal leadership.

Role as Moral Agent or Advocate for this Specific Issue

Discuss and describe your role as the moral agent or advocate for this specific problem for the Situation discussed in the previous heading level. Finally, consider the values and principles that guide the nursing profession; the organization’s mission, vision, and values; the leadership and management competencies addressed in this course; and your values and reasons for entering the profession. What motivation do you see for taking a stand on an important issue even when it is hard to do so? Be sure to support your perspectives and view with literature. Use current literature – that is within five years to support your work. Use correctly cited material. Do not use contractions or use too many directly quoted material. Use more paraphrasing here.

Self-Assessment and Leadership Styles

Consider your leadership styles identified by your self-assessment in this section.  Under resources, for week 1 you will find the link to the Keirsey self-assessment. Use the week one Keirsey Temperament Sorter self-assessment results to discuss in this area. Again keep the paragraphs with one topic and not too long. Cite the Keirsey Temperament Sorter (n.d.) like this when sharing the source outside the parenthesis. Then if you cite your results (Keirsey Temperament Sorter, n.d.) like this, when citing within the parenthesis. Be sure to reference correctly also. I included the correct way to reference the Keirsey Sorter in the References.

Also, include if the leadership styles acted as a barrier or facilitation during this dilemma. Describe this here. Cite appropriately. The link to the Keirsey Temperament Sorter is at Keirsey Temperament Sorter (KTS-II). (n.d.).

Conclusion

Wrap the paper up here. Be sure you do not add any new information in the conclusion.

References

Cianci, A. M., Hannah, S. T., Roberts, R. P., & Tsakumis, G. T. (2014). The effects of authentic leadership on followers’ ethical decision-making in the face of temptation: An experimental study. The Leadership Quarterly, 25(3), 581–594.

Keirsey Temperament Sorter (KTS-II). (n.d.).

Laureate Education (Producer). (2012a). Ethical, moral, and legal leadership.Baltimore, MD: Author.

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management in nursing: Theory and application (9^th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins.

Obesity Management in Adult Primary Care

Managing obesity in the primary care setting for patients who are over the age of 18 years requires a serious examination of the key risk factors which contribute to this problem and how it can contribute to multiple comorbidities and reduced quality of life. Primary care providers have a responsibility to be proactive in their efforts to support patients and to provide them with the best possible resources to improve their quality of life and wellbeing through targeted education and other interventions to minimize obesity risks as best as possible.  Primary care providers must share their knowledge and support for interventions which will have the best interests of each patient in mind and recognize motivation and other factors relative to obesity risk. The purpose of the paper is to implement a weight management program to promote weight loss and to reduce health risks in patients, including the development and administration of all available treatments to improve outcomes.

Background Information

Obesity is a serious public health epidemic among children and adults and can contribute to reduced quality of life and an increased cost of healthcare services and treatments for patients due to multiple comorbidities and other complications. Specifically, two-thirds of adults in the United States are considered overweight or obese and are often affected by type 2 diabetes, the emergence of cardiovascular disease, and a greater risk of developing some types of cancer; therefore, it is the responsibility of primary care providers to develop strategies that will be useful in treating patients with obesity and which stimulate weight loss in patients (Fitzpatrick et al., 2016). However, it is known that there are few proven interventions which are applied within healthcare organizations and which have a significant impact on reducing weight and improving quality of life in patients.

In accordance with the recommendations made by the Institute of Medicine (IOM) (2012), it is important to consider the following aims as part of a comprehensive strategy to reduce obesity: Increasing the amount of physical activity of each individual and making this process habitual so that it is part of the daily routine; facilitating easier choices regarding the consumption of healthier foods among adult population groups by reducing access to high sugar and high processed foods; and supporting an increased marketing push to promote increased physical activity and proper nutrition throughout the adult population. These steps are critical in addressing some of the most important health challenges within the adult population and in ensuring that all possible options are explored to promote exercise and physical activity and to improve health and quality of life among adult patients who are obese and have numerous health complications or other challenges which impact their long-term health prognoses.

Purpose Statement

The purpose of the project is to implement an evidence based weight management program in the primary care setting which is designed to emphasize physical activity and proper nutrition through enhanced behavioral modifications among patients who are overweight or obese; furthermore, this program is designed to reduce Body Mass Index (BMI), weight, and waist circumference among patients where no current program exists within the primary care practice setting, enabling nurses to provide critical education, guidance, and support to patients to meet their goals and objectives to stimulate weight loss and improved weight management.

Quality Improvement Model

The Quality Improvement Model chosen for this discussion is the Modified 5 As, which is defined as the following parameters to implement counseling among primary care providers for obese patients to stimulate an intervention to improve weight loss outcomes: Ask by using motivational interviewing to ask questions of patients to address their weight concerns; Assess each patient and the information that is available, such as BMI, along with psychosocial factors and root causes related to weight gain; Advise by improving the relationship between provider and patient through open dialogue and guidance in a professional yet sensitive manner; Agree to a treatment plan and allow the patient to clearly understand its specifics and how the plan will be executed; and Assist in carrying out the course of treatment and provide as much support as necessary to accomplish these goals in a timely manner (Vallis, Piccinini-Vallis, Sharma, & Freedhoff, 2013). This model is provided in the Appendix. Orem’s Theory of Self-Care is applicable to this model because it is often difficult for individuals to engage in self-care activities without a structured support system in place which is designed to improve the outcomes of the intervention and to ensure that patients receive the best possible support to accomplish the goals of the intervention (Eke, 2017). It is important to guide patients when an obesity-based intervention is in place because it is very difficult to overcome the challenges of completing the goals of each step of the intervention individually without a solid support system in place (Eke, 2017).

Synthesis/Overview of Evidence

For this discussion, the evidence that was obtained offers a variety of perspectives regarding the use of interventions to stimulate weight loss in overweight or obese adults. For instance, reducing the risk of cardiovascular disease is a primary objective of any intervention method and requires an examination of key guidelines and recommendations set forth to reduce these risks, such as those supported by the American Heart Association and the American College of Cardiology (Jensen et al., 2013). Lifestyle interventions are of critical importance to this process and require individuals to engage in specific behavioral modifications that will contribute to weight loss and improved quality of life (Brauer et al., 2015). Behavioral interventions are discussed at length throughout the literature and include the approval of interventions at the primary care level by the Centers for Medicare and Medicaid Services (CMS) (Wadden, Butryn, Hong, & Tsai, 2014). Furthermore, evidence addresses the use of motivational interviewing as part of a weight loss intervention to improve behavioral outcomes (Barnes & Ivezaj, 2015). However, although there is information regarding the use of behavioral approaches to weight loss, these practices as part of a larger framework to improve weight loss are not supported by policies that are fully integrated into the practice setting (Dietz et al., 2015).

Prior evidence in this area of study is often represented by a systematic review and meta-analysis technique, including interventions which are designed to lead to behavioral changes (Booth, Prevost, Wright, & Gulliford, 2014). Systematic reviews provide a summary of existing evidence through literature searches and determine if an existing intervention or policy is supported by credible evidence. Furthermore, systematic reviews such as the study by Texieira et al. (2014) considers the risk of relapse which is common when lifestyle interventions for obesity prevention are conducted. Therefore, it is necessary to consider this level of evidence as supportive of the risks associated with these interventions and how to best overcome the challenges that many patients and providers face when attempting to implement these interventions among different adult population groups (Texieira et al., 2014). These practices are essential to the discovery of new resources that may be applied to the practice setting that will have lasting benefits for patients and will contribute to effective outcomes over the long term for patients who face obesity and have specific healthcare complications due to this condition.

PICO Question

The following PICO question is considered for this discussion: Population: Adult patients who are 18 years and older. Intervention: A weight management program focuses on diet and exercise behavior modification.  Comparison: Currently, there is no intervention in the practice.  Outcomes: to reduce BMI /weight/waist /circumference and increased physical activity

In the development of the PICO question, the following key terms were search to identify relevant studies: primary care , obesity, weight loss and nutrition, weight loss and exercise, weight management, and behavioral modifications in weight loss.  A number of electronic databases have been selected due to their relevance for this subject. These databases are the Cochrane Collaboration, PubMed, CINAHL and Scopus.

The inclusion and exclusion criteria for this review of the literature was any study published in the last 5 years that followed an experimental, quantitative or qualitative design, which focused on the knowledge of diabetes self-management in the adult population and interventions to improve this knowledge. This date range was selected in order to ensure that the most up to date These key terms are important in addressing some of the most important challenges of the primary care setting and in recognizing the value of organized interventions with the intent to stimulate weight loss among obese adults.

Conclusion

Managing obesity among adults in the primary care setting is of critical importance because obesity is a serious public health issue with numerous consequences for patients. It is important to develop interventions which can have positive benefits for adult patients and to encourage the integration of motivational interviewing, counseling, and behavioral modifications to stimulate weight loss and reduce obesity in patients. When weight loss is achieved, patients will experience fewer complications and comorbidities and improve their quality of life. This is of critical importance in addressing how to improve weight loss outcomes in patients who are obese and for primary care organizations to introduce interventions that will have positive and lasting effects on patients. A proposed intervention involving adult patinets18 years and older will determine if weight loss can be achieved through improved dietary and physical activity among patients who are overweight or obese and who have multiple comorbidities.

References

Barnes, R. D., & Ivezaj, V. (2015). A systematic review of motivational interviewing for weight

loss among adults in primary care. Obesity reviews, 16(4), 304-318.

Booth, H. P., Prevost, T. A., Wright, A. J., & Gulliford, M. C. (2014). Effectiveness of

behavioral weight loss interventions delivered in a primary care setting: a systematic review and meta-analysis. Family practice, 31(6), 643-653.

Brauer, P., Gorber, S. C., Shaw, E., Singh, H., Bell, N., Shane, A. R., … & Canadian Task Force

on Preventive Health Care. (2015). Recommendations for prevention of weight gain and use of behavioral and pharmacologic interventions to manage overweight and obesity in adults in primary care. Canadian Medical Association Journal, 187(3), 184-195.

Canadian Task Force on Preventive Health Care (2004). Definitions of levels of evidence and

grades of recommendations of the Canadian Task Force on Preventive Health Care.

Dietz, W. H., Baur, L. A., Hall, K., Puhl, R. M., Taveras, E. M., Uauy, R., & Kopelman, P.

(2015). Management of obesity: improvement of health-care training and systems for prevention and care. The Lancet, 385(9986), 2521-2533.

Eke, P. (2017). Evaluating the Impact of an Evidence-Based Weight Reduction Program Among

the Obese at a Medical Facility in North Central United States.

Fitzpatrick, S. L., Wischenka, D., Appelhans, B. M., Pbert, L., Wang, M., Wilson, D. K., &

Pagoto, S. L. (2016). An evidence-based guide for obesity treatment in primary care. The

           American journal of medicine, 129(1), 115-e1.

Institute of Medicine (2012). Accelerating progress in obesity prevention: solving the weight of

the nation.

Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., … &

Loria, C. M. (2014). 2013 AHA/ACC/TOS guideline for the management of overweight

and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Journal of the American college of cardiology, 63(25 Part B), 2985-3023.

Teixeira, P. J., Carraça, E. V., Marques, M. M., Rutter, H., Oppert, J. M., De Bourdeaudhuij, I.,

… & Brug, J. (2015). Successful behavior changes in obesity interventions in adults: a systematic review of self-regulation mediators. BMC medicine, 13(1), 84.

Vallis, M., Piccinini-Vallis, H., Sharma, A.M., & Freedhoff, Y. (2013). Modified 5 As: minimal

Intervention for obesity counseling in primary care. Canadian Family Physician, 59: 27-31.

Wadden, T. A., Butryn, M. L., Hong, P. S., & Tsai, A. G. (2014). Behavioral treatment of

obesity in patients encountered in primary care settings: a systematic review. Jama, 312(17), 1779-1791.