Definition Of Change Management As An Organizational Capability Management Essay

Definition Of Change Management As An Organizational Capability Management Essay Able and How, an international management consultancy firm, specialises in helping clients solve their communications, change and people issues. The project saw the light when the group was working on a growth strategy for Rio Tinto . It was then that the group made a recommendation that said that the massive organization needs to have a capability to manage change and adapt itself to the volatile business environments in order to grow by 100% in the next 3 years!!! Problem Definition The tinkering over the recommendations lead the group to question, whether they can create a definition of change management as an organizational capability? If yes, whether there are any reliable and credible ways of assessing and benchmarking the same? The long term goal of the group is to create a sort of ranking system that would rate organizations on their ability to manage change or adapt itself successfully to the changing environments. Search for the Solution It was the combination of challenge, vagueness of the idea and the knowledge of the expertise at Cass, which lead to Able and How coming to Cass and specifically to Veronica Hope Hailey to help with project. Literature Review: The rapid changes in the business ecosystem create pressure on organizations to implement change initiatives to meet the demands of the stakeholders. Of late, the frequency and magnitude of change has increased. If anything one was to look at as a indicator of this, it would be the Fortune 1000 list of companies. The list shows that between 1973 and 1983, 35% of the companies in the top 20 were new, and this has increased to 60% when we compare the figures for years between 1993 and 2003. This indicates that increasingly more businesses are dealing with / managing changes in their organizations to stay ahead. At this point, one pertinent question that comes to our mind is what is change management? Change management, as defined in the Business and Management dictionary, is the coordination of a structured period of transition from situation A to situation B in order to achieve lasting change within an organization. Change management can be of varying scope, from continuous improvement, which involves small ongoing changes to existing processes, to radical and substantial change involving organizational strategy. Change management can be reactive or proactive. It can be instigated in reaction to something in an organizations external environment, for example, in the realms of economics, politics, legislation, or competition, or in reaction to something within the structures, processes, people, and events of the organizations internal environment. As a proactive measure, an organization might undergo change in anticipation of say, unfavourable economic conditions in the future. (Bloomsbury Business Library Business Management Dictionary 2007) Change management is a well-known and respected means to deal with budget cuts, volatile requirements, and other non stationary core reasons for project failures. The definition of change management includes at least four basic aspects: (1) the task of managing change, (2) an area of professional practice, (3) a body of knowledge, and (4) a control mechanism. Change can either be programmatic and planned or can be emergent, driven by unforeseen external events (Carl and et al, 2010). Boomer suggests that both academics and practitioners see change management capability as a strategic advantage and view change as a control mechanism, which typically results from standards, policies and processes. He goes further to define that as a body of knowledge, change management consists of methods, tools and techniques (Boomer 2008) to successfully manage the transition from one state to another. A lot of research work has taken place in this area, especially in the academic world. If one were to search for change management, in the past 20 years, in the business source complete, one could find that there are 2515 results in the category of academic journals out of a total of 4309. Moreover, the importance of the industry can be highlighted by the presence of the number of consulting firms with sophisticated tools and techniques to help clients manage change. However, even recent studies show that approximately 70% of all planned organizational change initiatives fail (Eaton, 2010). This leaves us wondering why The study done by Beer and Eisenstat in 2000, does talk about the top 6 silent killers of a change initaitive. They are Top-down or laissez-faire senior management style Unclear strategy and conflicting priorities An ineffective senior management team Poor vertical communication Poor coordination across functions, businesses or borders Inadequate down-the-line leadership skills and development (Beer and Eisenstat, 2000). A lot has been talked about in the academic literature and in practioners world of the prescriptive way to overcome these issues, however, not much has been done to identify the causal effect of these and the failures of change initiatives thereafter. As identified by Pellettiere, one of the main causes for these failures is the lack of a thorough diagnostic investigation in an organizations readiness and risk for a planned change. By a thorough diagnostic investigation, he intends to include both an external as well as an internal analysis using some form of an assessment to determine the need to change as well as an organizations readiness and risk involved in a planned change. He did identify that organizations have a tendency not to conduct a thorough internal analysis but rather have a propensity to initiate quick-fix solutions, sometimes ignoring the context, when implementing a change initiative (Pellettiere, 2006). As such, there have been numerous efforts to develop a scale to assess an enterprises managerial or organizational capabilities to change. Before we go an talk about a metric, let us try to define an organizations capacity for change. Organizations Capacity to Change When an organization undergoes a change, new organizational solutions have to be decided upon; product programs must be modified; positions must be reallocated; routines and policies must be revised; employees training programs need to be planned and implemented; and so on (Meyer Stensaker 2006). This requires a lot of effort. As such, as highlighted by Meyer and Stensaker (2006), organizations that have a capacity for creating multiple change processes in order to create sustainable change must not only have the ability (resources and capabilities) to change the organization successfully, they must also have capability to maintain daily operations and implement subsequent change processes. They defined change capacity as the allocation and development of change and operational capabilities that sustains long term performance (Meyer Stensaker 2006). An organizations capability in managing change should ensure that change should happen without destroying the well-functioning aspects in an organization or adversely affecting subsequent changes. This requires both capabilities to change in the short and long term as well as capabilities to maintain daily operations (Meyer Stensaker 2006). Gtaetz and Smith define it as a firms ability in initiating, managing and implementing critical changes in organizational structures and development processes (Graetz and Smith, 2005; Self et al., 2007). These refer to a firms ability to launch and implement large scale changes to develop organisational capabilities for rapid adaptation, flexibility and innovation (Graetz and Smith, 2005; Yanni Yan, Ding Mak 2009). This definition of change capability does give us an impression that the capability is a static advantage. It can be set in place by having the right processes and structures. If it is so prescriptive then why does it happen that there are organizations that are better off at changing because of some unknown factors. The answer to this was found in the extension of the RBV and the intersection of the same with change management capability. Savory (2006) attempted at extending the RBV concept and distinguished the terms resource, competence and capability. He defined resources as factors that are owned and controlled by the organization or available through alliances and other external relationships whereas competence is the ability to use the resources to an acceptable level of performance towards a desirable purpose. Further, he defined capabilities as the ability to operate a specific configuration of an organizations set of resources and dynamic capabilities as the ability to reconfigure both the use and coordination of a specific configuration and the development of new configurations of resources, according to changes in the organizations environment and strategic direction (Butler, 2009). Dynamic Capability We know the key ingredients of a successful planned change comprise of leadership, visioning, teamwork and communication, but in dynamic environments on the other hand, change can hardly be planned ex ante in a detailed and distinct manner. The most severe disadvantages of planned change can be seen by large losses in the short-term, a high probability of a relapse, issues coming up as an result of limited foresight, unadjusted takeover of best practice from a different context, ignorance of key contingencies, a possible implementation lag that makes change already outdated before completion and a lack of suitability for large-scale change matters (Weick, 2000; Burnes, 2004). One especially severe drawback for hypercompetitive environments is that planned change represses innovative behaviour and, thus, rejects the important innovators, innovations and adaptive processes for this context (Weick, 2000; Biedenbach SÃ ¶derholm 2008). These drawbacks have encouraged us to think of the proactive, emergent change. Such an approach supports experimentation, is sensitive to local contingencies, open to shortened and tightened feedback loops from results to action, is comprehensible and managable. However, also within emergent change there are some drawbacks such as due to its incremental nature the speed of change which is slow, outcomes might be too small and, thus, more appropriate for exploiting opportunities than countering threats. Weick (2000) suggests that such an emergent change, in general, is most suited for operational level change than a major strategic change, which however can be built up incrementally through smaller emerging changes. Moreover it is because of the diffuse and less focused character of emergent change that it is less likely to deliver a transformational shift (Weick, 2000; Biedenbach SÃ ¶derholm 2008). When we talk about organizational change capacity, it cannot be an activity performed in order to improve operations or products once the change has been implemented. Instead, it is an inherent and continuous ingredient of the firms activities that need to be incorporated as a capacity of regular operations. Organizational change is thus upgraded from being a one-off and unique activity, to a strategic capability of the successful companies in hypercompetitive or turbulent environments (Nadler and Tushman, 1999; Meyer and Stensaker, 2006; Biedenbach SÃ ¶derholm 2008). Flexibility and creativity, as per rhe Mckinsey Quarterly (april 2009), are very important for a successful organizational change. These all lead us to think that there exists some kind of dynamic capabilities in an organization that would enable it to proactively change to the external environment. Teece et al. (1997) define dynamic capabilities as firms ability to integrate, build, and reconfigure internal and external competences to address rapidly changing environments. In other words, independent of the line of business, technology applied or markets served, dynamic capabilities point to the ability to constantly change in order to respond to environmental changes, to overtake competitors and to maintain competitive advantages (Biedenbach SÃ ¶derholm 2008). The dynamic capability is an extension of the static resource based view, which fails to explain firms competitive advantage in changing environments (e.g., Priem Butler, 2001). As a result, Teece and colleagues proposed the dynamic capabilities framework to fill that gap. Teece et al. (1997). It seems that the concept dynamic capabilities was the one most suited for developing a theory on organizational capacity to change because of the focus of the theory on the organizational processes that enable growth and adaptation in changing environments (Eisenhardt and Martin, 2000; Teece et al., 1997). Moreover, such capabilities are grounded in organizational learning and managerial capabilities, the former, because organizational learning both leads to dynamic capabilities and is a dynamic capability (Zollo and Winter, 2002) and the latter as managers play crucial roles in developing organizational capabilities (Teece et al., 1997). The dynamic capabilities have actually taken up a strategic stage and subjugated the operational capabilities as zerolevel capabilities, being the how we earn a living now capabilities (Winter, 2003; Dixon, Meyer Day, 2010). Organization Capability for Change When we talk of a construct that would enable us to measure an organizations capacity to proactively change, one is lured to think of 3 antecedents, viz. organizational ambidexterity, environmental uncertainty and relative performance. Ambidexterity, which means doing 2 things at the same time, when extended to an organizational context, refers to the ability of organizations to achieve alignment in their current operations while also adapting effectively to changing environmental demands (Gibson and Birkinshaw, 2004). As conceptualized by Ghoshal and Bartlett (1994) ambidexterity builds on the 4 interdependent attributes, which are discipline, stretch, support, and trust. Discipline encourages individuals to voluntarily strive to meet all expectations generated by their explicit or implicit commitments. Stretch tempts members to voluntarily strive for more, rather than less, ambitious objectives. Support refers to the collective action of members to lend assistance and countenance to others. Finally, trust induces members to rely on the commitments of each other (Gibson and Birkinshaw, 2004). They argued that an organization needs to foster discipline and stretch to encourage individuals to push for ambitious goals, but it also needs support and trust to ensure that this happens within a cooperative environment. In terms of the yin and yang of continuous self-renewal (Ghoshal Bartlett, 1997): a balance between a pair of hard elements (discipline and stretch) and a pair of soft elements (support and trust) (Gibson and Birkinshaw, 2004). To understand the meaning of environmental uncertainty, another antecedent to the change capability, we need take each word at a time. Uncertainty, which is defined as an individuals perceived inability to predict something accurately because he/she perceives himself/herself to be lacking sufficient information to predict accurately or because he/she feels unable to discriminate between relevant data and irrelevant data (Gifford, Bobbitt, Slocum, 1979). The word environmental when attached to the term uncertainty, suggests that the source of the uncertainty is the organizations external environment. This uncertainty stems from the components of the environment (e,g, suppliers, competitors, government, distributors, consumers, etc) in which a company operates. Milliken (1987) said that the decision makers need to not only understand the particular source of environmental uncertainty, but also understand the type of environmental uncertainty. While specifying the source of uncertainty he refers to the domain of the environment which the decision maker is uncertain about (eg. competitors or suppliers). The type of uncertainty focuses on delineating the nature of the uncertainty being experienced. This could of 3 types, State uncertainty, Effect Uncertainty and Response uncertainty. State uncertainty refers to the inability in understanding how components of the environment might be changing. Effect uncertainty is defined as an inability to predict the nature of the impact of a future state of the environment on the organization. Response uncertaintys definition acknowledges the lack of knowledge of response options and/or the inability to predict the likely consequences of a response choice (Milliken, 1987). One of the reasons to construct a scale to measure an organizations capacity to change is to help the firm gain a competitive edge. This would mean superior performance. A firms performance depends on its strategy, but as per Bourgeois, (1980) the lack of consensus on means is more troublesome than disagreement on ends (final strategy). Also, a firms performance is affected by its organizational structures (centralised or decentralised), adaptive entities and decision problems (decomposable or non -decomposable) (Siggelkow and Levinthal, 2003). Based on the aforementioned 3 concepts, a new dynamic capability called organizational capacity for change (hereinafter referred to as OCC) was developed by Judge and Elenkov (2005). They conceptualize OCC as a dynamic organizational capability that allows the enterprise to adapt old capabilities to new threats and opportunities, as well as create new capabilities. More specifically, it is defined as the dynamic resource bundle comprised of effective human capital at varying levels of a business unit, with cultural predispositions toward innovation and accountability, and organizational systems that facilitate organizational change and transformation (Judge et al., 2009). OCC is defined as a meta-capability that enables an enterprise to regain or remain competitive with other enterprises through effective leadership, adaptive cultures, resilient employees, and an organizational infrastructure conducive to change. As suggested, it is different from Cohen and Leventhals (1990) absorptive capacity. Absorptive capacity focuses exclusively on organizational routines and processes while OCC focuses not only on the organizational routines and processes but also takes into account leadership talent and employee attitudes (Zahra and George 2002; Judge et al., 2009). Another construct that comes close to the OCC is the organizational readiness for change (Armenakis, Harris and Mossholder 1993),as both constructs deal with the organizations receptivity to change and organizational resilience. However, organizational readiness for change is focused exclusively on employee attitudes toward change, while OCC examines employee attitudes, leadership capabilities, and organizational infrastructure for bringing about change. In essence, OCC presents a comprehensive and as such, OCC is a bigger and more encompassing concept than absorptive capacity or organizational readiness for change (Judge et al., 2009). Having defined the Organization Capacity for Change, lets see how this has been developed as a construct in the organizational sciences that can be used by executives to prepare for and enhance their organizational change process, or for scholars to study the organizational change process. Building Blocks of the OCC Construct The construct was developed by an inductive process of assessing the works of several academics and practitioners in the area of organizational change over a period of 20 years. The construct has defined eight distinct but inter-related dimensions relating to the issues of human capabilities, formal organizational systems/processes and informal organizational culture (Judge and Douglas, 2009)*. [An earlier version of this paper was accepted for the 2006 Academy of Management Best Paper Proceedings for the Organization Development and Change Division.] [Insert the pic here] Sl. No. Dimension of OCC What does it mean? Referred Work 1 Trustworthy leadership Ability of senior executives to earn the trust of the rest of the organization and to show organizational members the way to meet its collective goals (Barney and Hansen, 1994) 2 Trusting followers Ability of the non-executive employees to constructively dissent with and/or willingly follow a new path advocated by its senior executives (Kelley, 1992) 3 Capable champions An ability of an organization to attract, retain, and empower change leaders to evolve and emerge (Kanter, 1983) 4 Involved mid-management The ability of middle managers to effectively link senior executives with the rest of the organization (Floyd and Wooldridge, 1996) 5 Innovative culture The ability of the organization to establish norms of innovation and encourage innovative activity (Kotter and Heskett, 1992) 6 Accountable culture Ability of the organization to carefully steward resources and successfully meet pre-determined deadlines (Ulrich et al., 1999) 7 Effective communication The ability of the organization to communicate vertically, horizontally, and with customers (Oshry, 1996) 8 Systems thinking The ability of the organization to focus on root causes and recognize the interdependencies within and outside the organizational boundaries (Kilmann, 1991) Not only have Judge and Douglas (2009) designed the construct, interestingly they have found significantly positive relationship between OCC and financial performance of companies. This co-relation lends support to the contention that OCC is a strategically important organizational capability, and that it may be a source of competitive advantage. This capability assumes all the more importance when the perceived environment uncertainty is high (Judge and Douglas, 2009). Judge and Douglas (2009) have attempted to make OCC construct as robust and relevant as possible by refining it while surveying 3,725 employees within 161 organizational units in a wide variety of industries during the period of 1999-2005. While they do intend to help leaders in one of the most difficult aspects of leading organizational change initiatives, which is the ability to diagnose and develop the organizations capacity for change (Bossidy and Charan, 2002), their study is not void of shortcomings. Neither does it take into account the size of the change nor does it measure the effects of the specific nature of the environment changes. The study is not free of regional bias, as all the findings are validated in a North American context. Moreover the construct has references to studies that are out-dated, the oldest one done in 1983. A lot of research has been taken place in each of the dimensions in the recent years. It will be worth exploring / expanding the ideas of the construct in the light of latest works. New findings Trustworthy Leadership: The construct talks about trustworthy leadership, but it will be worth understanding what attributes make leadership trustworthy. Ingenhoff and Sommer (2010) identified the 4 different dimensions that influence the degree of overall of trust, namely ability, integrity, benevolence, and information quality. They also identified trust as being significantly important for a companys ongoing success, as it strengthens the long-term relationship between stakeholders and the company (Ingenhoff and Sommer, 2010). Trust, which is correlated with greater information sharing, has been identified to reduce transaction costs. It is unique as a governance mechanism and also creates value in the exchange relationship (Dyer and Chu, 2003). Croonen, 2010, through his studies strengthened the findings of Brockner and Siegel, 1996; Krishnan et al. 2006; Mishra and Spreitzer, 1998 who have considered fairness as an important element of trust and says that it should be shown more often. Trusting followers: When subordinates trust their managers, they are willing to provide benefits in the form of extra effort toward job performance and OCB and should have more favourable attitudes toward the exchange relationship and be more willing to maintain it (Dirks Ferrin, 2002; Konovsky Pugh, 1994; Mayer Gavin, 2005). Every leaders top priority should be to establish trusting relationships in order to drive productive working environments, as a study by the Institute for Organizational Performance has revealed that trust alone predicts 46% of the difference between low and high performers (Mercurio, 2005). For this, it is not only sufficient for senior managers to be able to demonstrate that they are trustworthy, but also they have to trust their subordinates. Such trust-building practices involve exchange of information and the empowerment of employees (Cummings, 1983; Deluga, 1994; Folger Konovsky, 1989; Whitener, 1997). This does puts the manager in a more vulnerable position and organizations should help managers learn to use these procedures wisely (Brower et.al, 2009). It has been identified that effective followers play significant roles in fostering leadership and organizational effectiveness. Trusting followers leads to very effective employees, but requires the leaders put forth leadership over their specific area of work and requires honest upward communication. Such followers need to be dependent, loyal and co-operative (Agho, 2009). Capable Champions When we talk of capable champions, what skills and abilities are we referring to? In his book, The Change of Champions Field guide: Strategies and Tools for Leading Change in the New Era, Ulrich says that the winners in turbulent times will be the ones who are good at understanding the environmental and technological contingencies and leveraging them to the advantage of the organizational performance and excellence. It has been found that good change managers are very good at envisioning. They can see the future they want to create, the short and long-term wins they want to achieve. They are completely aware of the dynamics involved in developing adaptability, team-learning and responsiveness within the organization to achieve the desired win (Khan, 2006). We all know that change in an organization takes in 3 phases and each phase requires specialized skills. The table below gives a summary of same and has been adapted from the study done by Warrick, 2009 and the book Exploring Strategic Change by Veronica Hope Hailey and Julia Balogun (2008). [Refer to book by Veronica .. ] Stage of Change Role played by the Change Champion Skills Needed Mobilise Initiating Developing a change mindset Providing visionary leadership Involving key stakeholders and building commitment Well informed and cognizant of the issues and opportunities and knows how to get things done Move Facilitating Working with teams Working with people Networking and getting the right people together Sustain Implementing Planning and managing the change process Making things happen Motivating people Developing feedback mechanism to evaluate and monitor progress Persevering until the change succeeds (Warrick, 2009) For a successful change, change champions are required to create a creative culture, manage diversity, empower employees, maintaining organizational integrity, establish a just and fair reward system, create an environment of trust and inclusion that will really empower leaders and proponents of change to deal with any change process. Some additional skills are the use of appreciative enquiry, intuition and creativity (Khan, 2006; Warrick 2009). Involved Mid Management When we talk about line managers, researchers say that they can be of 2 types, the realists and the humanists. Realists are goal orientated and focus on getting things done, which includes things like developing a plan and a budget for the work and ensuring that the deadlines will be hit. On the other hand humanists, as the name suggests, focus on the people aspects-for example, making sure everybody understands and is committed to the plan, and figuring out how to handle any resistance to the plan (Axelrod, 2007). Axelrod (2007) further suggests that to get things done in an organization, one needs to bring together both the perspectives in his / her thought process and make it an all encompassing approach by moving beyond the usual suspects to include people who care about or stand to be affected by the initiative, people with relevant knowledge and expertise, and people whose authority is touched by the work. All change efforts need some element of fresh thinking and ways to overcome resistance. It has been found that innovative solutions can be obtained by including people with diverse points of view. Also, by bringing resisters, detractors, and other troublemakers onboard, one can reduce the resistance as it reduces the chance of stirring up trouble and distrust from the outside and might even convert the detractor to an instrumental team member (Axelrod, 2007). Axelrod has suggested some steps, for an involved middle management in a change effort. They are Keep the vision for the project front and center. Remind people whats going to be different as a result of your collective efforts. Give them regular progress reports about whats been achieved so far. Listen and value to the subordinates inputs. Communicate and celebrate the closure is very important too. (Axelrod, 2007). Innovative Culture Change is intended, amongst other reasons, to foster innovation and as suggested by Judge et.al. (2009), it also is one of the pillars that supports and organizations capacity to change. How do we foster innovation in an organization? The answer lay in leaders ability in fostering and developing innovation among their followers by having a vision and mission that encourage ideas from their workforce and actively seeks input from all departments and across all levels. It means giving followers the freedom to make decisions. This act enables employees to try out new ideas in a conducive environment and challenge themselves with a new way of thinking. With the ability to add to the work process, employees will begin interacting in a way that supports innovative ideas and influences the future of the business. It has been prescribed that with proper leadership training, accountability, and daily communication about leaderships responsibilities to foster creativity and trust, mid-level managers can rise to the standards necessary to inspire innovation and grow the next generation of innovative leaders (Agin and Gibson, 2010). When we talk about a culture, what would attributes would define an innovative culture? Daniels, 2010, discovered that innovative workplaces share six cultural characteristics. They are Dimension Meaning Context rich Information feed innovation. It would lead to a culture which ensures free-flowing communication so that innovators can draw on a rich background and perspective. Customer close Key to innovation lies at

The Past, Present and Future

Throughout the last 50 years, humanity has witnessed many changes that have attired and changed our lives in many ways. The emergence of technology in our lives, for example, has caused life to become simpler by making connections easier between people. Changes such as these have caused many differences between each generation. Whilst comparing the life of our generation and our parent's generation we can see that various aspects have changed Like technology, education and life style.Through the last two decades we've witnessed a rise In aspects that we laden know of before. Technology Is an Issue that our generation was greatly Influenced and affected by. Through the Internet new ways of connections, were brought to the table making life easier for our generation. In the olden days one had to go through uphill efforts In order to simply contact another person, however nowadays due to social media, connections between people are Just one click away. The swift and easy going interacti ons that social media Imposed on us changed the way of life between the two generations completely.Likewise: education is one of the aspects that blossomed in our modern days causing dissimilarities between this generation and the past generation. Due to the common awareness that we have been exposed to regarding the importance of education in life, education has become more easily accessible for people of different classes of the society. Numbers of educated people in our generation has increased tremendously comparing to our parent's generation. Educational institutions have now new and more technological ways of teaching.On the contrary education in the past generation was limited to the local institutions; international schools and universities were few and too expensive. Also, the education method in the past generation differs from the methods we're using now; our parents' educational system mainly depended on spoon-feeding. In these days we are taught to think more critically , deeper, and outside the box. Another aspect that changed between the two generations is their lifestyles. Due to media and the globalization of media our perspective and opinions about various issues have changed.For example, because of open portrait of sex, alcohol and drugs in movies, our generation view these somehow controversial topics as mediocre, In our generation these issues are being practiced more abundantly while in the past these issues were viewed as immorally. Also you can clearly see differences In the smallest details of our life like music. For Instance; the past generation's taste In music was more appropriate, inspirational, motivational and positive storytelling than this generation's.Songs like â€Å"Man In the Mirror† had a positive meaning behind their lyrics â€Å"I'm starting with the man In the mirror. I'm asking him to change his ways. And no message could have been any clearer. If you want to make the world a better place. Take a look at yourse lf, and then make a change. † Michael Jackson. â€Å"Man in the Mirror. † Race. May 1987. Bad. Michael Jackson, Quince lyrical kinds of music, like Electronic Dance Music. Artists like Michael Jackson, The Battles and Affair aren't as popular as they were before.Also, words like â€Å"Rave† â€Å"PLURAL† and â€Å"#Damselfly† are now being used despite the fact that they weren't known before. To put it in a nutshell, we can easily see the differences of our generation and our parent's generation in many aspects like technology, education and lifestyle. It's natural, and as Jim Morrison said â€Å"Each generation wants new symbols, new people, new names. They want to divorce themselves from their predecessors†. We can easily relate that the next generations will be even more different than our generation.

Public Health Issue Diabetes Mellitus Health And Social Care Essay

This assignment will turn to the public wellness issue of the increasing prevalence of diabetes mellitus ( diabetes ) and explore links with wellness inequalities both nationally and locally. It will discourse the models available which give counsel for criterions of attention for diabetes patients and their influence on diabetes attention. It will so critically discourse the issue of diabetes direction in relation to patient instruction and the ability of patients to self-manage their chronic long-run status, measuring both the function of both healthcare professionals and persons in accomplishing the best possible healthy results. It will so discourse whether all people get the same degree of diabetes attention, in peculiar focussing on people who are non able to go to GP surgeries. Public wellness is defined as â€Å" The scientific discipline and art of promoting and protecting wellness and well-being, forestalling sick wellness and protracting life through the organized attempts of society † ( Faculty of Public Health 2008 ) . Health equality is a cardinal component of societal justness and as such justifies the authorities and other wellness bureaus to work in coaction to develop wellness policies which improve the populace ‘s wellness regardless of societal category, income, gender or ethnicity through advancing healthier life styles and protecting them from infective diseases and environmental jeopardies ( Griffiths & A ; Hunter 2007 ) . Yet many wellness inequalities still exist in the UK, some of which will be discussed in this paper. There are preponderantly two types of diabetes mellitus ( diabetes ) ; type 1 diabetes occurs when the organic structure does non bring forth any insulin and type 2 diabetes occurs when the organic structure does non bring forth adequate insulin to work decently or when the organic structure cells do non respond to insulin. Type 2 diabetes is the most common and histories for around 90 five per cent of people with diabetes. If left untreated both types of diabetes can take to farther complications which include bosom disease, shot, sightlessness, and kidney failure ( Who 2011 ) . Life anticipation is reduced by up to 10 old ages in those with this type of disease ( Whittaker, 2004 ) . In the bulk of instances, type 2 diabetes is treated with lifestyle alterations such as eating healthier, weight loss, and increasing physical exercising ( Diabetes UK, 2007b ) . There are presently 2.6 million people in theA UKA with diabetes, and it is thought up to a farther 1.1 million are undiagnosed. ( DiabetesA UK, 2010 ) .A Other grounds suggests that approx 50 % of people are non cognizant they have the status, populating a normal life with lone mild symptoms ( mention ) . Work force are twice more likely to hold undiagnosed diabetes, than adult females, possible because on norm they tend to see their GP lupus erythematosus ( Nursingtimes.net 2009 ) . Diabetes is one of the most widespread chronic diseases, which is potentially life endangering. It is presently thought to be the taking 4th disease doing decease in most developed states worldwide with estimated prevalence of 285 million people. Most experts agree that more than 4 million people in the UK will hold Type 2 diabetes by 2025 with potentially 5.5 million life with this chronic status by 2030 ( Diabetes UK 2010, and International Diabetes Federation ( IDF ) 2010 ) . These statistics are galvanizing ; type 2 diabetes is one of the biggest challenges confronting the UK today with people frequently treated wholly by the National Health Service ( NHS ) who provide attention for all degrees of diabetes. Diabetess control is considered hapless in Europe with the UK being identified as holding the worst control. The grounds for this are non clearly identified. However what is clear is the possible impact on people in footings of complications and shorter lives ( Liebl et al 2002 ) . Peoples with diabetes who have complications cost the NHS 3.5 times more than people who have no grounds of complications ( IDF 2006 ) . The NHS presently spends about 10 % of its entire resources on diabetes, which equates to ?286 per second. This places a important drain on resources which will potentially lift in line with the turning prevalence of diabetes and associated complications unless alternate ways to cut down the load of the disease can be found Diabetes.co.uk ) . There are many grounds for the turning prevalence of type 2 diabetes in the UK, two of the chief 1s being the modernization of industrialization and urbanization, which has changed people ‘s life styles and eating wonts and caused and escalation in fleshiness ( Helms et al 2003 ) . Diabetes and fleshiness are closely linked ; 80 per centum of patients diagnosed with diabetes are corpulent at the clip of diagnosing ( Diabetes UK, 2006 ) . Kazmi and Taylor ( 2009 ) agree and say type 2 diabetes can be linked to genetic sciences, although increased degrees are more likely to be attributable to obesity ensuing from a lessening in physical exercising and westernised diets. A 2008 study highlighted the UK as holding the highest fleshiness degrees in Europe, presently 24 % of grownups are considered corpulent which tends to increase with age. ( Organisation for Economic Co-operation and Development 2010 ) . However this figure should be treated with cautiousness as England is one of t he few states who uses existent measurings of weight and tallness, other states preferring to utilize ego reported steps. The UK has an increasing aged population which combined with lifting degrees of fleshiness is likely to farther addition type 2 diabetes prevalence ( DH2010 ) . The links between socioeconomic want and sick wellness are good established ( Yamey 1999, Acheson 1998, Chaturvedi 2004 ) . This can be observed within the UK, as type 2 diabetes does non impact all societal groups every bit, it is more prevailing in people over 40, minority cultural groups, and hapless people ( The National Service Framework ( NSF ) for Diabetes ) . Several surveies have established people with type 2 diabetes populating in deprive countries suffer higher morbidity and mortality rates than those in more flush countries. ( Roper et al 2001, Wilde et al 2008, Bachhmann 2003 ) . However globally the links between want and type 2 diabetes are less clear as there is less information available on diabetes and want related results. In struggle with the UK, surveies in Finland, Italy and Ireland found no important fluctuations in different socioeconomic groups ( Gnavi et al 2004, O'Conner 2006 ) . Reasons which may hold negated the impact on socioeconomic want may hold been due to differences such in the population studied, wellness attention bringing or available interventions.Linkss between want and type 2 diabetes appear apparent in the vicinity of Derbyshire. All but three local countries in Derbyshire have a diabetes and fleshiness degrees which are significantly worse than the England norm ( Derbyshire County Primary Care Trust ( PCT ) 2008 ) . In Derbyshire there are clear important fluctuations in degrees of want, High Peak has really small want, and yet Bolsover is in the 20 per cent most disadvantaged countries in England, with 30 two per cent of people populating in poorness and mortality and morbidity degrees significantly worse than the England norm ( Bolsover District Financial Inclusion Strategy 2009 ) . These worrying degrees have triggered the Department of Health to declare Bolsover a Spearhead country for betterment ( DH 2009, Derbyshire PCT 2008 ) . Some stairss have been taken in Bolsover to cut down morbidity and mortality rates by presenting healthy enterprises aimed at bettering people ‘s life manners ( Bolsover 2010 ) . However, although morbidity and mortality rates have reduced over the last 10 old ages they remain significantly higher than the England norm ( Bolsover District Financial Inclusion Strategy 2009 ) . Derbyshire has a turning aged population ( Derbyshire PCT 2008 ) . This together with proved links of degrees of fleshiness lifting with age would propose a future addition in degrees of diabetes.Diabetess is a national precedence and Derbyshire has a higher than England mean prevalence, but the lo cal NHS scheme ( 2008 ) does non stipulate diabetes as a cardinal precedence. This may be a factor why Derbyshire is neglecting to run into its marks to cut downing morbidity and mortality by 10 per cent by 2010 in the poorest countries of Derbyshire ( DH 2009 ) .Models and policies exist to give counsel on criterions of attention, better the quality of life and life anticipation of people with diabetes and decrease the fiscal load on wellness services. ( Reference x2 ) . In response to European influence the NHS program ( 2000 ) set out counsel for modernizing services, raising criterions and traveling towards patient centred attention. Subsequently the NSF for Diabetes ( 2001 ) was published which lineations twelve criterions of attention aimed at presenting improved services and cut downing inequalities over a 10 twelvemonth period with the ultimate vision of people enduring with diabetes having a universe category service in the UK by 2013. This model was followed by the NSF for Diabetes: Delivery Strategy ( 2003 ) which gives counsel on how the NSF for diabetes could be achieved. Models are a utile lineation for action and set out clear ends and marks, but do non turn to the societal, economical and environmental causes of sick wellness or take history of available fiscal and staffing resources ( Reference from book ) . The NSF for Diabetes ( 2001 ) appears to back up this statement ; other than retinal showing, no support was ab initio made available to implement the 12 criterions ( Cavan 2005 ) . The handiness of this support will hold been important in the accomplishment of one hundred per cent of people with diabetes now being offered this service ( English National Screening Programme for Diabetic Retinopathy, 2009 ) . It was n't until 2004 the Quality Outcome Framework offered fiscal wagess to run into other marks within the NSF, for case maintaining practiced based registries of people with diabetes, to enable primary attention suppliers to supply proactive attention ( NHS 2004 ) . Ten old ages on this model is still believable and sets the ‘gold criterion ‘ of attention for patients with diabetes in the UK ( NICE 2000 ) which would look to be an outstanding accomplishment. There have been important betterments in caring for people with diabetes since it was published. However, it could be criticised that some criterions are non enforceable until 2013 ( NSF 2001 ) . Numerous publications have followed the NSF for Diabetes ( 2001 ) in an effort to give counsel for wellness professionals to follow ( Nice 2004, NICE 2008, NICE 2009, RCN, NMC ) . These models are non intended to work in isolation but collaborate with each other at different degrees, whilst trying to bring forth a quality wellness service ( Reference ) . . The chief grounds for the oncoming of diabetes and hazard of farther complications is due to suboptimal wellness relation behavior which include small physical activity, high Calorie consumption and insufficiency to keep good glucose control and it is said persons with diabetes play a cardinal function in finding their ain wellness position ( Clarke 2008 Reference 1 ) . Whittaker ( 2004 ) concurs and says that much of the load relating to care prevarications with persons themselves. Patient instruction is seen as cardinal in the intervention of diabetes to guarantee the best possible healthy results for persons ( Alexander et al, 2006, Brooker & A ; Nicol 2003, Walsh, 2002 ) . Standard 3 of the NSF for Diabetes ( 2001 ) clearly demonstrates a move off from medical attention to promote persons to take duty for their ain wellness but besides places the burden on wellness attention professionals to educate, support and empower people to enable them to efficaciously care for themselves. The recent Public Health Whitepaper ( 2010 ) endorses future health care services should concentrate on health instead than handling disease and supports authorising people to set some attempt into remaining good. It acknowledges health care services merely contribute to one tierce of betterment made to life anticipation saying that a alteration in life style and taking wellness inequalities contribute to the staying two tierces. Giving people the accomplishments, cognition and tools to take control of their ain wellness logical as people with diabetes spend an norm of 3 hours per twelvemonth with their healthcare professional and around 8700 hours pull offing themselves ( Ref N3. For illustration there is much grounds reasoning that keeping blood glucose degrees as near to normal as possible slows down the patterned advance of long term complications and if patients can be empowered to take control of their diabetes, non merely will it increase the persons quality of life but besid es cut down the fiscal load on the NHS. ( Whittaker, 2004 ) . ( Ref: 4.1, 4.2 ) . The Diabetes Year of Care programme ( 2008 ) has been developed to assist health care professionals move off from a paternal attack to care be aftering to a more individualized attack for people with chronic long term conditions. This attack involves both healthcare professionals and patients working together to prioritize single demands. Helmore ( 2009 ) agrees that a individualized attack to care be aftering which should be holistic and include the individual ‘s societal fortunes, will authorise patients to take a cardinal function in their ain health care and suggests that nurses and patients should work together to put ends the patient can work towards which would include self attention and the services they will utilize. For illustration a down patient will non desire to venture outside to exert and soothe feeding may do them to derive weight. The precedence in this instance would be to cover with the patient ‘s depression. The nurse could so intercede with other com munity services and societal attention to decide non medical issues which would enable the patient to pull off their weight and addition activities ( Helmore 2009 ) . Peals ( 2010 ) believes nurses should take a lead function on behalf of the GP pool as they are the 1s best placed to place the attention demands of patients with diabetes, they have experience in patient tracts and are able to organize local and professional services. The Department of Health ( 2010 ) has highlighted attention be aftering as an country for betterment to guarantee one hundred per cent of diabetic patients have single attention programs ( DH 2010 ) . Currently it is thought merely 60 per of people with long-run conditions in England have an single attention program ( www.gp-patient.co.uk ) . Diabetes self-management instruction programmes ( DSME ) have been developed to educate and authorise patients to take control of their ain conditions by bettering their cognition and accomplishments to enable them to do informed picks, self-manage and cut down any hazard of complications. DSME besides aims to assist people to get by with physical and mental of life with diabetes ( Ref 21 P 114. These programmes which should be age appropriate can be delivered to persons or groups. ( 6 and 40 P 119 and 120 ) . . ( mention 7 p119 ) . Programmes available include the Expert Patent Programme ( EPP ) , its derivative X-PERT and Diabetes Education and Self-Management for ongoing and freshly diagnosed ( DESMOND ) which are available in all PCT ‘s in the state. These programmes offer the necessary information and accomplishments to people to enable them to pull off their ain diabetes attention and they offer the chance for people with diabetes to portion jobs and solutions on concerns they may hold with on mundane life ( N9 ) . They encourage people to happen their ain solutions to issues such as diet, weight direction and blood glucose control, enlisting the aid of diabetes professionals if needed ( N9 ) . The literature suggests this will ensue in good educated, motivated and empowered patients and systematically supports patient instruction as important to effectual diabetes attention ( utilize many refs ) . Much research has taken topographic point on the effectivity of DSME. Some of which suggests that patients who have non participated in DSME are four times more likely to meet major diabetes complications compared to patients who have been involved in DSME ( Reference ) .Other grounds suggests that it is non possible to set up whether patient instruction is effectual at advancing self-management in the long term to cut down the effects of diabetes or the oncoming of complications and better the patient ‘s quality of life ( mention ) . From surveies that have taken topographic point, it is apparent that although cognition and accomplishments are necessary they are non sufficient on their ain to guarantee good diabetes control. Peoples require ongoing support to prolong the enable them to prolong self-management and therefore the longer period of clip the class run the more likelihood people will stay sceptered ( Ref ) The bulk of people in the UK are offered some signifier diabetes instruction, the majority of which is offered at the clip of diagnosing. Besides the manner, length, content and construction of DSME vary. Very few instruction programmes have been evaluated ; therefore it is non conclusive which intercession scheme is the most effectual for bettering the control of diabetes. The America Diabetes Association suggest that as people are persons and different methods of instruction suit different people, there is no 1 best programme, but by and large programmes which incorporate both psychosocial and behaviour schemes appear to hold the best results. However the Healthcare committee ( 2006 ) found people in England are non being offered equal information about their status to ease effectual self-management. They reported merely eleven per cent of respondents had attended an educational class on how to populate with diabetes and disturbingly 17 per cent of respondents did non even know whether they had type 1 or type 2 diabetes ( Reference 2 P 119 ) . The success of DSME is dependent many discrepancies which include the patient ‘s single features, the context of their societal environment, the extent of the disease, and the patient ‘s interface with the attention and instruction provided. Overall there is a great trade of grounds to propose DSME is the ‘cornerstone ‘ in effectual diabetes attention ( NSF 2001 ) . It is recommended that DSME is delivered by a multi-disciplinary squad together with a comprehensive attention program ( cite 1 ) . Experts agree that effectual direction of diabetes mellitus increases life anticipation and reduces the hazard of complications ( NICE Guidenance for the usage of patient instruction theoretical accounts of diabetes Referece 1 P 119 Changing the wellness related behavior of people with diabetes has been proved to be successful in cut downing or even eliminating the hazard of complications ( mention ) . Many different wellness publicity theoretical accounts of exist which can assist a patient to digest wellness publicity advise and want to alter their wellness related behaviors ( Kawachi 2002 ) . Health publicity theoretical accounts are utile tools to help with this procedure. The Stages of Change wellness publicity is a often used theoretical account for weight direction as it identifies 6 phases of preparedness to alter which helps wellness professionals identify the intercession actions to urge and back up. Standard 3 has besides ensured people with diabetes receive regular attention ( Hicks 2010 ) , although Hillson ( 2009 ) would reason the quality of which is still unfastened to debate. Every individual with diabetes should have the highest criterions of individualized attention, no affair who delivers it or where or when it is delivered. Access to specialist services should be available when required ( Hillson 2009 ) . Diabetes patients receive different criterions of attention depending on whether or non they can go to their physician ‘s surgery ( Knights and Platt 2005 ) . Diabetes patients who are unable to go to the surgery are being overlooked and missed out on testing and reappraisals of their diabetes, accordingly having a lower criterion of attention despite the NSF for Diabetes saying inequalities in proviso of services should be addressed to guarantee a high criterion of attention which meets single patient demands. ( Gadsky 1994, Hall 2005, Harris 2005, ) . Until late the territory nursing squad were some of the few professionals who provided attention in the place for diabetes patients and merely normally had input with diabetes patients when intervention was required for a complication ( Wrobel 2001 ) . District nurses have historically been seen as Renaissance mans and able to supply attention and intervention for patients with a broad scope of conditions and hence do non needfully have specialist disease cognition ( Hale 2004 ) . Sargant ( 2002 ) agree with this and suggests the quality and rede territory nurses give to diabetic patients is questionable as they do n't hold the in-depth degree of cognition in relation to diabetes. In acknowledgment of the incompatibility of attention being provided to patients with chronic unwellnesss in their ain places, the function of Community Matron was introduced in 2004 to guarantee patients with diabetes receive the first category service advocated by the Department of Health ( 1999 ) and the NHS PLAN ( 2000 ) by pull offing their all embracing attention demands and aid patients efficaciously manage their long term conditions which in theory should ensue in cut down hospital admittances. ( NHS Improvement Plan 2004 ) . However a survey conducted by Gravelle et Al ( 2006 ) would propose the Community Matron function has non been effectual in cut downing hospital admittances. Forbes et Al ( 2004 ) concurs that territory nurses, given the clip and with the right preparation could widen their functions and satisfactory undertake appropriate attention for housebound people with diabetes. However Brookes ( 2002 ) suggests preparation and resources are large issues and Harris ( 2005 ) says that territory nurses may non be carry throughing their Professional Code of Conduct by neglecting to care sufficiently for this group of patients ( Nursing and Midwifery Council 2008 ) . The turning prevalence of diabetes and the drain on NHS resources continues to be a concern for the UK, in footings of life quality and life anticipation of patients. Many wellness inequalities exist for people with diabetes ; there are proved links with fleshiness and want ; and diabetes attention provided is non equal for all patients. Patients who are able to go to their GP surgery receive better attention than those who are housebound, although this inequality is being addressed and attention is bettering. The NSF for Diabetes is a utile model for health care professionals to follow when supplying attention for people with diabetes. The quality of diabetes attention has improved since this model has been introduced. However, the execution of some recommendations has been slow and will non be complete until 2013. Patient instruction is paramount to successful diabetes control and there appears no uncertainty that the key to successfully decelerating the oncoming of diabetes and th e recognised associated complications is to prosecute patients in DSME.

Obedience to Authority vs. Personal Conscience Essay

Stanley Milgram, conducted a study focusing on the conflict between obedience to authority and personal conscience. According to the study Migram suggested â€Å"that obedience we naturally show authority figures can transform us into agents of terror† (Migram, 1974/1994, p. 214). Milgram experiment was developed for the justification of the act of genocide in World War II. Many of the accomplices in the Holocaust said they were following in order given by Adolf Eichmann. Obedience to superiors is built onto the history of civilized society, and no culture worthy of the name has existed without stressing the respect that is due to legitimate authority of the duties of those in command. Milgram study provides information that supports that†¦show more content†¦Milgram study shows that 65% of the â€Å"teachers† obeyed the order to the level of 450 volt. Before the experiment Milgram gather prediction of how the teachers would obey to a directive and the major ity of the participants felt that teacher would refuse to obey the experimenter. One participant, the psychiatrist predicted most of teachers would only administer up 150 volt. Both teachers and the learner was aware of the conflicting pain of 45 volt electroshock, each participant was given this amount of voltage before the experiment began. The experiment shows that when we are under an authority order, we will forget our ethical principles. The history of electroshock therapy (ECT), Ugo Cerletti, in 1938 came up with the idea for treat human beings with electroshock therapy. He was observing the barbaric act of slaughterhouse pigs being electrocuted into unconsciousness to make it less difficult for working to slit their throats and thought that is could be applied to the treatment of mental illnesses in human beings. 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