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Work related stress in healthcare Setting

Work related stress in healthcare Setting

Work related stress in healthcare Setting

Stress may be defined as the physical and emotional response to excessive levels of mental or emotional pressure, which may arise from issues in both the working and personal life. Stress may cause emotional symptoms such as anxiety, depression, irritability or low self-esteem, or even manifest as physical symptoms including insomnia, headaches, loss of appetite and difficulties concentrating. Individuals experiencing high levels of stress may experience difficulty in controlling emotions such as anger, and may be more likely to experience illness or consume increased quantities of alcohol (NHS Choices, 2015). In the UK a survey undertaken by the Health and Safety Executive (HSE) has estimated that in the year 2013-2014, 487,000 of work related illnesses (39%) could be attributed to work-related stress, anxiety or depression (HSE, 2014). Additionally the survey found that as many as 11.3 million working days were lost in the year 2013-2014 as the direct result of work-related stress (HSE, 2014).

Work related stress in healthcare SettingStudies have shown that healthcare professionals, particularly nurses and paramedics, are at an increased risk of work-related stress compared with other professionals (Sharma et al., 2014). This is likely to be due to the innate long hours and high pressure of maintaining quality care standards in the job, as well as pressures caused by staff shortages, high levels of patient demand, a lack of adequate managerial support as well as the risk of aggression or violence towards nurses from patients, relatives or even other staff (Royal College of Nursing (RCN), 2009). Indeed, a 2014 survey of nursing staff by the RCN showed that up to 71% of staff surveyed worked up to 4 hours more than their contracted hours a week, 80% felt that work-related stress lowered morale, and that 72% reported that understaffing occurred frequently in their workplace. As a result of these issues, 66% of respondents in the survey considered leaving the NHS or the nursing profession altogether (RCN, 2014b). A separate report by the RCN suggested that over 30% of absence due to illness was due to stress, which was estimated to cost the NHS up to £400 million every year (RCN, 2014a).

In addition to the physical and emotional symptoms of stress previously discussed, studies in this area have shown that nurses experiencing high levels of work-related stress were more likely to be obese and have low levels of physical exercise, factors which increased the likelihood of non-communicable diseases and co-morbidities such as hypertension and type 2 diabetes (Phiri et al., 2014).

Stress and staff absence

Chronic stress has been linked to “burnout”(Khamisa et al., 2015; Dalmolin et al., 2014), or a state of emotional exhaustion under extreme stress related to reduced professional fulfilment (Dalmolin et al., 2014) and “compassion fatigue”, where staff have experienced so many upsetting situations that they find it difficult to continue empathising with their patients (Wilkinson, 2014). As previously discussed, reducing staffing levels contribute to stress in nursing staff, and in this way chronic stress within the workplace launches a self-perpetuating cycle of understaffing; increased stress leads to increased illness, more staff absence and increased understaffing. In turn, these negative emotions also reduce job satisfaction and prompt many staff to consider leaving the nursing profession, further reducing staffing availability for services (Fitzpatrick and Wallace, 2011).

Studies amongst nursing staff have also reported stress occurring as the result of poor and unsupportive management, poor communication skills amongst team members, institutional and organisational issues (e.g. outdated or restrictive hospital policies) or bullying and harassment (RCN, 2009). Even seemingly minor issues have been reported as exacerbating stress amongst nursing staff, for example a lack of common areas to take breaks in, changing shift patterns, and even difficulty and expense of car parking (Happell et al., 2013).

Work related stress can particularly affect student or newly qualified nurses, who often report higher expectations of job satisfaction from working in the profession, they have worked hard and aspired to join, and are therefore particularly prone to experiencing disappointment on discovering that they do not experience the job satisfaction that they presumed they would do whilst training. Student and newly qualified nurses may also have clear ideas from their recent training on how healthcare organisations should be run and how teams should be managed, and may then be disillusioned when they discover that the reality is that many departments could in fact benefit from improvements and further training for more experienced staff in these areas (Wojtowicz et al., 2014; Stanley and Matchett, 2014). Nursing staff are also likely to, on occasion, find themselves in a clinical situation that they feel unprepared for, or do not have the necessary knowledge to provide the best possible care for patients, and this may cause stress and anxiety (RCN, 2009). They may also be exposed to upsetting and traumatic situations, particularly in fields such as emergency or intensive care medicine (Wilkinson, 2014).

Work related stressMoral distress can also cause strong feelings of stress amongst healthcare professionals. This psychological state occurs when a discrepancy occurs between the action that an individual takes, and the action that an individual feels they should have taken (Fitzpatrick and Wallace, 2011). This may occur if a nurse feels that a patient should receive an intervention in order to experience best possible care, but is unable to deliver it, for example due to organisational policy constraints, or a lack of support from other members of staff (Wojtowicz et al., 2014). For example, a nurse may be providing end of life care to a patient who has recently had an unplanned admission onto a general ward but is expected to die shortly. The nurse may feel that this patient would benefit from having a member of staff sitting with them until they died. However, due to a lack of available staffing this does not happen as the nurse must attend to other patients in urgent need of care. If the patient dies without someone with them, the nurse may experiences stress, anger, guilt and unhappiness over the situation as they made the moral judgement that the dying patient “should” have had a member of staff with them, but were unable to provide this without risking compromising the safety of other patients on the ward (Stanley and Matchett, 2014). One large scale questionnaire based study in the USA on moral distress amongst healthcare professionals has shown that moral distress is more common amongst nurses than other staff such as physicians or healthcare assistants. The authors suggested that this may be due to a discrepancy between the level of autonomy that a nurse has in making care decisions, (especially following disagreement with a doctor, who has a high level of autonomy), while experiencing a higher sense of responsibility for patient wellbeing than healthcare assistants, who were more likely to consider themselves to be following the instructions of the nurses than personally responsible for patient outcomes (Whitehead et al., 2015).

It is acknowledged that many individuals find that being asked to perform tasks that they have not been adequately trained or prepared for can be very stressful. As such management teams should also try to ensure as far as possible that individuals are only assigned roles for which they have adequate training and abilities, and support employees with training to improve skills where necessary (RCN, 2009).

Surveys have frequently reported that organisational issues such as a lack of intuitive work patterns, overloading of workloads and an unpleasant working environment can all contribute to work related stress. Organisations can reduce the impact of these by developing programmes of working hours with working staff and adhering to them, making any necessary improvements to the environment (e.g. ensuring that malfunctioning air conditioning is fixed), and that incidents of understaffing are reduced as much as possible (RCN, 2009). Issues such as insomnia and difficulty in adapting to changing shift patterns can also be assisted by occupational health, for example by encouraging healthy eating and exercise (Blau, 2011; RCN, 2005). For example, in 2005 the RCN published an information booklet for nursing staff explaining the symptoms of stress, ways in which it can be managed e.g. relaxation through exercise or alternative therapies, and when help for dealing with stress should be sought (RCN, 2005). More recently, internet based resources are available from the NHS to help staff identify if they need assistance, and how and why it is important to access it (NHS Employers, 2015).

Witnessing or experiencing traumatic or upsetting events is an unavoidable aspect of nursing, and can even result in post-traumatic stress disorder (PTSD). However, there are ways in which staff can be encouraged by their management teams and organisations to deal with the emotions that these circumstances produce, limiting the negative and stressful consequences of these events. This may include measures such as counselling or even peer support programmes through the occupational health departments (Wilkinson, 2014). Staff should also be encouraged to use personal support networks e.g. family, as this can be an important and effective source of support, however studies have shown that support within the work place is most beneficial, particularly if this can be combined with a culture where healthcare professionals are encouraged to express their feelings (Lowery and Stokes, 2005).

One commonly cited reason for work related stress amongst nurses is the incompetence or unethical behaviours of colleagues, and a lack of opportunity to report dangerous or unethical practice without fear of reprisal. Therefore it is important that institutions and management teams ensure that there is an adequate care quality monitoring programme in place, and a culture where concerns can be reported for further investigation without fear of reprisal, particularly with respect to senior staff or doctors (Stanley and Matchett, 2014).

It has been reported that in the year 2012-2013, 1,458 assaults were reported against NHS staff (NHS Business Service Authority, 2013). Violence and abusive behaviour towards nursing staff is an acknowledged cause of stress and even PTSD, and staff have a right to provide care without fear (Nursing Standard News, 2015; Itzhaki et al., 2015). Institutions therefore have a responsibility towards their staff to provide security measures such as security staff, workplace design (e.g. locations of automatically locking doors) and policies for the treatment of potentially violent patients e.g. those with a history of violence or substance abuse issues (Gillespie et al., 2013).

As previously discussed, nurses are more likely than other healthcare professionals to experience moral distress as the result of a discrepancy between the actions they believe are correct and the actions they are able to perform (Whitehead et al., 2015). However there are policies that can be introduced into healthcare organisations to reduce its occurrence, and the severity with which it can affect nursing staff. Studies have shown that nurses who were encouraged to acknowledge and explore feelings of moral distress were able to process and overcome these in a less damaging manner than those who did not (Matzo and Sherman, 2009; Deady and McCarthy, 2010). Additionally, it is thought that moral distress is less frequent in institutions and teams that encourage staff to discuss ethical issues with a positive attitude (Whitehead et al., 2015). For example, institutions could employ a designated contact person for staff to discuss stressful ethical issues with, or set up the facility for informal and anonymous group discussion, for example on a restricted access internet-based discussion board (Matzo and Sherman, 2009)

Conclusion

Work related stress is responsible for significant costs to the NHS in terms of staffing availability and financial loss from staff absence from stress itself or co-morbidities that can be exacerbated by stress (RCN, 2009), for example hypertension and diabetes (Phiri et al., 2014; RCN, 2009, 2014a). The loss of valuable and qualified staff from the profession is also a significant cost to health services, and of course exacerbates the situation by increasing understaffing further, which in turn increases stress for the remaining staff (Hyrkas and Morton, 2013). It can also exert a significant cost to healthcare professionals who experience it, in terms of their ability to work, their personal health, effects on personal relationships (Augusto Landa et al., 2008) and job satisfaction (Fitzpatrick and Wallace, 2011). However, organisations can implement recommendations to reduce work related stress, for example by encouraging a positive and supportive culture for staff by offering interventions such as counselling (Wilkinson, 2014; RCN, 2005). Furthermore, interventions such as encouraging the reporting of unsafe or unethical practice – a commonly cited source of stress amongst nurses (RCN, 2009; Stanley and Matchett, 2014) – may also contribute to improving the quality of patient care.

References

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Dalmolin, G. de L., Lunardi, V. L., Lunardi, G. L., Barlem, E. L. D. and da Silveira, R. S. (2014). Moral distress and Burnout syndrome: are there relationships between these phenomena in nursing workers? Revista Latino-Americana de Enfermagem, 22 (1), p.35–42. [Online]. Available at: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692014000100035

Deady, R. and McCarthy, J. (2010). A Study of the Situations, Features, and Coping Mechanisms Experienced by Irish Psychiatric Nurses Experiencing Moral Distress. Perspectives in Psychiatric Care, 46 (3), p.209–220. [Online]. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20591128

Fitzpatrick, J. J. and Wallace, M. (2011). Encyclopedia of Nursing Research. 3rd ed. New York: Springer Publishing Company.

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RCN. (2009). Work-related stress. Royal College of Nursing. [Online]. Available at: https://www.rcn.org.uk/__data/assets/pdf_file/0009/274473/003531.pdf

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Critical Analysis Nursing Care for the Older Adult

Older-Adult-Care2_0Dementia is an umbrella term to describe a collection of symptoms that develop in association with a progressive disorder of the brain of which dementia of the Alzheimer’s type is the most common. Other forms of dementia include Lewy body dementia, Pick’s disease and (MID) multi-infarct dementia (Ramsay et al, 2005). The main features of dementia are a decline in memory, ability to learn and understand in a continuing progression. There are often changes in social behaviour, general motivation and the client’s ability to control their own emotions (Burgess, 2005). These changes vary from a gradual to more sudden onset that varies from individual to individual. In the early stages of dementia memory problems are often the most obvious sign (DH, 2009).

Mental health practitioners find that memory problems and other needs are only the beginning of the process in making a diagnosis. The doctor is required to check in what ways an individual is not functioning as they would expect. Assessments may be carried out at home in order to gain a clearer image of how the client is managing (Ramsay et al, 2005). The doctor will also need to know the client’s medical history including any physical illness and current medication. The doctor will also want to rule out depression as a cause of the memory problems. If the memory problems are attributed to depression, then treatment using an antidepressant could help substantially (Ramsay et al, 2005). Diagnosis is a scientific tool. Beyond that the carer requires an understanding of the client’s experience of having a problem or disorder, health and social care needs to be values based as well as evidence based. To translate this philosophy into practice requires that the assessment process be driven by the principles of partnership, holism and personalisation (Atkins et al, 2004). Assessment is a valid and integral part of any nursing intervention and must be performed in partnership with the client (RCN, 2004).

Following this, the next step is to consider involvement of various investigations, often carried out in hospital or in a clinic, including the use of blood testing, X-ray and if necessary, brain scanning to discover the cause of the symptoms (Ramsay et al, 2005).

To carry out a full assessment of the client’s problems, other practitioners are likely to play a part in the assessment as part of a multi-disciplinary team (MDT). Members of the team may include nurses, occupational therapists, psychologists, physiotherapists, social workers and doctors. Making a diagnosis is important as diagnosis affects the type of treatment used (Ramsay et al, 2005)

Difficulties that can occur in practice when attempting to engage with clients in an effective manner include; making all of the information that is being exchanged comprehensible to the client, finding methods to reduce frequency of forgetting that can occur, finding methods to encourage clients to feedback information – positive or negative to overcome any difficulties that many people can feel in clinical settings (Ley, 1997).

The reflective account outlines the importance of communication skills in practice where the nurse can be delivering care to individuals with very specific needs that must be attended to with privacy, comfort and dignity for the health and wellbeing of the patient. In the account it is clear that clients with dementia can find communication, mobility, and physical health problems difficult and in managing the care of clients with dementia although challenging, may be overcome through empathic understanding and best practice including evidence based care delivery. In relation to communication, the most suitable approach is the use of selective questioning, providing information, respecting personal dignity and being clear so that the client understands (Zimmermann, 1998).

Patient centred methods of care place demands on nurses because such a method involves responding to the cues from clients in which feelings and emotions are expressed. Nurses are required to develop the expertise to respond in an appropriate manner to the client’s feelings and emotions (Stewart et al, 1989). In order to provide high quality person centred care, the needs of each patient must be assessed individually to ascertain additional requirements that the client may have. Conversely, some clients will require less assistance than initially considered by the team. It is equally important to understand these needs in order to respect each client’s need for independence (Stewart et al, 1989). Best care can be defined by the underlying principles that communication should always be person centred (Oberg, 2003). Therefore the client should be provided with a quality standard of care that allows a sense of control over the treatment that is being provided. It is vital that the client is involved in their own care and treatment, not only does this maintain the comfort and dignity of the person, but prevents errors and miscommunication leading to an effective client/nurse relationship. In one study findings concluded that actively involving the patient in aspects of care and treatment often leads to earlier recovery and an improved quality of life (Stewart et al, 1989).

Overview of Care Practice – Reflection in Action

ageism 2In practice, a male client was confused as a result of his dementia. The client was an older adult who used a wheelchair and required assistance with mobility because of a leg amputation. Sometimes the client would try to leave his wheelchair which resulted in him falling to the floor. The client was unable to find the lavatory and was becoming increasingly frustrated by his inability to identify specific places. In addition the client became agitated and at times had difficulty with speaking. On one occasion the client called a nurse who responded to the patient, approaching him slowly from the front and greeted him, and asked “How can I help? Is everything ok?” The patient responded to the question with an answer “I need… I need to go to the…” The client repeated this statement several times with increasing sense of urgency but was unable to find the correct word to finish the sentence due to his level of confusion. The client experienced memory problems and episodes of agitation. Managing the client’s ability to be continent was another important consideration in the care of the individual as he used an attachment (catheter) and was occasionally incontinent of faeces (Johns, 2000; Schön, 1983; 1987).

The assessment phase of the nursing process is fundamental at this stage of the interaction so that the nurse was able to ascertain if the client required the use of the toilet (Kozier, 2004). The nurse asked the client if he needed to use the toilet. The client responded by nodding his head and saying “yes”. The planning phase of the nursing process is equally important at this stage. The nurse informed the client that he would show him the way and escorted the client to the toilet. When speaking to the client the nurse was careful to maintain eye-contact and speak slowly and calmly to ensure that the client would understand. Whilst being escorted the client explained that he had been incontinent of faeces. The client began apologising but the nurse reassured him and explained that he would get him some fresh clothes (Johns, 2000; Schön, 1983; 1987).

The nurse was able to provide comfort and maintain the dignity of the client as well as the client’s confidence in the nurse’s abilities. The client was reassured and an explanation of the procedure was provided to the person in a step-by-step process, asked if he understood and if he was agreeable. The client confirmed he was agreeable and began to converse with the nurse and appeared much more relaxed. The client responded with additional banter and appeared more content. The client was able to carry out more intimate aspects of his personal cleansing so that further consideration to preserving his dignity and independence was maximised. The nurse recommended that the client’s catheter bag was emptied on a more regular basis to aid comfort and reduce distress (Johns, 2000; Schön, 1983; 1987). The NMC (2008) guidelines stipulate that nurses maintain the respect, dignity and comfort of clients. After being washed the client was assisted with putting on clothing, explaining each step slowly, the client responded y following each step and no longer appeared agitated and was returned to the lounge in a wheelchair. The student reported the information to the rest of the team and discussed regular catheter care for the client.

Reflection on Action

elderly_careDuring the reflection in action (Johns, 2000; Schön, 1983; 1987) the nurse was able to quickly and effectively clean and change the client with comfort and dignity through implementation of the nursing process and incorporating the ideas of assessment, diagnosis and planning phases of care. The reflection on action (Schön, 1983; 1987) highlights what the nurse was trying to achieve and provides opportunity to consider alternatives for future practice. Care was delivered to the client using the Care Programme Approach (CPA) and the procedure implemented to offer a framework to complement policy documents and therefore allow the process to be followed. The approach allows mental health practitioners to provide a structured pattern of care throughout the process, assess client’s need, plan ways to meet the needs and check that the needs are being met (DH, 2007).

Those who experience dementia may find some tasks increasingly difficult such as everyday tasks of living, including washing and dressing without assistance or with finding the right words when talking. Interaction for the person can become increasingly difficult and distressing for the client in their relationship with others (Ramsay et al, 2005). Dementia care practice provides opportunities to mental health nurses on how to engage effectively with clients.

During the initial contact stages of any nurse and client interaction it is important that the nurse keeps the environment simplified and to eliminate noise that can distract the client (Zimmermann, 1998). It is useful if the nursing team minimises activity occurring in a shift change because a confused client may misunderstand nurses saying goodbye to each another and may wish to leave. Approaching the client slowly and making eye contact can reduce any risk of alarming the client (Zimmermann, 1998). Also the nurse should speak slowly and calmly with pauses so that the client responds to the content of the communication and not the mannerisms of the nurse (Zimmermann, 1998). These skills may help to reduce the client’s anxiety and confusion.

The National Service Framework (NSF) for older people sets out national standards and service models of health/social care that older people using mental health services can expect to receive, whether they are living at home, in care or are in hospital (DH, 2001; WAG, 2006). Older people are generally referred to as anyone aged sixty and over and the national ten year initiative is to ensure better health and social care services for people meeting the criteria. It includes older people with dementia, carers and ethnic minority groups. In addition, age discrimination and patient-centred care have been identified as two key areas. Including the NSF, there have been a number of campaigns to promote dignity in the care of older people, recognising that standards of care in some cases are poor and inadequate (DH, 2006a).

Unfortunately, there has been a lack of clarity associated with the notion of dignity and the appropriate minimum standards and/or recommendations that should be applied. For example, in an attempt to address the concerns of dignity the Department of Health published an online public survey around the views of dignity and care provision (DH, 2006a). Results of the survey reported that a many aspects of care were identified by older people as vital in maintaining dignity, such as respecting the person and communicating effectively.

The Lets Make It Happen NSF (2002) outlines eight standards of care that address issues such as age discrimination, person centred care, mental health and the promotion of health and active life in old age. The success of the NSF for Older People depends on how well it is being implemented. Lets Make It Happen follows the NSF for Older People in 2001 and focuses on examples of research and good practice through evidence based care provision, which demonstrates how implementing good practice can improve people’s quality of life and should also help to develop ideas for how the NSF might be implemented (Alzheimer’s Society, 2002).

In 2006, the Department of Health released a report: ‘A New Ambition for Old Age’, in an attempt to move the requirements outlined in the National Service Framework forward, and offers details of the next stage of healthcare reforms for older people. This documentation places older peoples’ needs as integral to care planning and delivery, with ‘respect’ and the maintenance of ‘dignity’ by recognising the existing issues around health related age discrimination (Department of Health 2006b). Furthermore, the Department of Health have established a set of benchmarking tools to ‘root out age discrimination’ and to ‘advance person-centred care’ (Department of Health 2007a). This is to be achieved, in the first place, by actively ‘listening to the views of users and carers about the services they need and want’ (Department of Health 2007a).

Within Wales the Care Programme Approach (CPA) is highly regarded as the cornerstone of the Government’s mental health policy and procedures. The framework was introduced in 2004 for the care of people with mental health issues who are accepted as clients by mental health services in an inpatient or community setting. All NHS Trusts in Wales participated in a review and all had processes in place to deliver CPA to clients (Elias & Singer, 2009). Although the review sample was small, findings were consistent across all the organisations, and demonstrated that CPA had not been implemented as effectively as it should. If this randomly selected sample is representative of all mental health services in Wales, there is a risk that services are failing clients and carers due to a lack of adequate risk management processes, a lack of focus on the outcome of patient interventions, and a lack of service planning and service models to safely and adequately meet client’s needs. Greater focus is needed on the assessment and management of risk (Elias & Singer, 2009).

Practitioners must be prepared and fully trained to fulfil the role of care co-ordinator. Information systems need to meet client needs rather than organisational priorities. The current system is very complex and bureaucratic particularly where CPA and the Unified Assessment (UA) have been integrated into a single process. A record management system needs to be developed that supports CPA and UA whilst also providing the least administrative burden for clinicians and practitioners (Elias & Singer, 2009).

A significant amount of evidence exists suggesting that providing care for a person with dementia is not only stressful, but can also have a negative impact on the carer’s mental health (Cooper et al, 1995). Recently, government policy has expressed the importance of offering support to carers. This has been highlighted by the Audit Commission report examining mental health services for older people (2000).

Research suggests that carer’s needs are multifaceted, and that support is needed at times of transition, for example diagnosis, admission of the person they are caring for to residential care and the death of the person with dementia. (Aneshensel et al, 1995). The need for more advanced training in the field of dementia care has been recognised for quite some time (Keady et al, 2003). NICE and the Social Care Institute for Excellence (SCIE) recently developed guidelines for supporting people with dementia and their carers (NICE & SCIE, 2007). The guidelines identified the main therapeutic interventions and when and why they should be used. The principal focus of care should involve maximising independent living skills and enhancing client function. This will involve assisting client’s to adapt and develop their skills to minimise the need for support (NICE & SCIE, 2007).

This should start in the early stages of the condition, and could involve a number of services and the client’s carers. Providing care in ways that promote independence is liable to take time, but it is the core intervention for people with dementia on a therapeutic basis. The NICE and SCIE (2006) guideline identified key interventions that should be utilized for maximising function. Care plans are vitally important and should include the activities that are important for maintaining independence. Care plans should take account of the individual’s type of dementia, their needs, interests, preferences and life histories (NICE & SCIE, 2006). Obtaining advice about client’s independent toilet skills is important. If the client experiences episodes of incontinence, any possible causes should be assessed and then treatment options tried before the team concludes that incontinence is permanent. Physical exercise should be encouraged when possible and facilitated in a safe environment, with assessment advice from a physiotherapist when required. As exercise is thought to help improve continence problems, loss of mobility and improve endurance, physical strength and balance in falls prevention (NICE, 2004) physical exercise should be promoted by all staff.

Therapeutic interventions for the cognitive symptoms of dementia are comprised of psychological and pharmacological treatments. However, providing supportive levels of care that encourage clients to maintain as much of their independent functions as possible is equally as important as any specific interventions for the cognitive symptoms of dementia (NICE, 2007; Moniz-Cook & Manthorpe, 2009).

Much has been written about medical and social models of dementia, some of which has implied that there are a number of different ways of looking at dementia, one as a disease model and one as a disability. Some of these differences are described in Tom Kitwood’s Dementia Reconsidered (Kitwood, 1999). Kitwood described the medical model as the ‘standard paradigm’, and argues eloquently that it is the wrong model to use. Dementia is an illness that causes a progressive decline in cognitive abilities and there are demonstrable changes to the brain. It is, however very important to remember that we are treating a person with dementia. How the condition presents depends on the clients’ personality, their relationships with others, and who they are as a person (Kitwood, 1999).

Nurses and GPs have cited inadequate professional training as one of the main factors influencing their ability to provide an optimal service to people with dementia (Iliffe & Drennan, 2001; Alzheimer’s Society, 1995). However, it is not known what method of training would equip them with the right range of knowledge and skills. Around 700,000 people in the UK have dementia, and this number is predicted to double to 1.4 million over the next 30 years (DH, 2009).

Conclusion

In summary, dementia is a debilitating disorder that is having a massive impact on mental health services. The introduction of numerous frameworks for the care of the older adult and other policy documents have set the standards expected of mental health professionals and backs up evidence based care with a high standard of principals and values (RCN, 2004; DH, 2009,). The number of people being diagnosed with a dementia is increasing, and although difficult to manage, through continued research, development and training of staff and practicing with empathy, treating clients with dignity and respect and upholding the core values of the nursing profession (NMC, 2008) dementia care services and service providers may transcend the potential difficulties that lay ahead. In these uncertain times it is comforting that the care of the older adult has not been forgotten.

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HW1: EVALUATION OF A PEER-REVIEWED ARTICLE

RESEARCH METHODS

HW1: EVALUATION OF A PEER-REVIEWED ARTICLE

PURPOSE: The purpose of exercise is to conduct a detailed, critical evaluation of the research design, methods and analysis of a study written up and published in a peer-reviewed journal.   Students will be using Wolfer’s (2007) critical questions for evaluating written research to evaluate an article; these questions are provided below. Tips on Finding a Peer Reviewed Journal Article may be found under Lessons>Course Materials>Resources.

Article selection tips:

  • select an article from a peer-reviewed Sociology Journal
  • the article should clearly be written about a study the author conducted
    • a meta-analysis of multiple studies is not appropriate for this assignment
    • secondary data analysis of an existing national data set is OK, but be sure you understand what you are reading

Requirements:

Your evaluation should include

  • ALL sections 1-5,
  • 1 section from 6-10 (based on design in your article), and
  • 1 section from 11-12 (based on analysis in your article).

APA formatting should be used throughout. Any time your paraphrase or directly quote a source (such as your article), in-text citations should be used. A full APA-formatted reference should be included at the beginning or end of assignment. See Course Materials>Resources for APA Tips.

1.Title (3 pts)

  • Is the title specific enough to differentiate it from other related topics?
  • Do subtitles, if present, provide important information regarding the research?
  • Are the main variables expressed in the title?
  • Are the terms in the title easily understood by most people?
  • Does the title avoid any reference to the study’s results?
  • Overall, is this a good title? Why or why not?
  1. Ethical Evaluation (2.5 pts)
  • Are the steps the researcher took to honor ethical responsibilities to individuals clear? Are they appropriate? Are they enough?
  • If there were any findings (based on your readings of tables or other means of data presentation) that refuted the researcher’s hypothesis, did he address these findings?
  • If any results were unexpected, did the researcher discuss any explanations for the unexpected effects?
  • Did the researcher adequately acknowledge the limitations of the research?
  • Overall, has the researcher adequately fulfilled his ethical obligations?
  1. Literature Review (4 pts)
  • Is the material presented in the literature review relevant to your research interests?
  • Is the special problem area identified in the first paragraph or two of the report?
  • Does the researcher establish the importance of the research problem?
  • Has the researcher been appropriately selective in deciding what studies to include in the literature review?
  • Is the research cited recent?
  • Is the literature review critical?
  • Is the researcher clear as to what is research, theory and opinion?
  • Overall, do you think this is an adequate literature review? Why or why not?
  1. Operationalization and Measurement (5.5 pts)
  • Is the conceptualization suitably specific?
  • Are the definitions productive?
  • How many different dimensions are being measured at once?
  • Are the various dimensions sufficient?
  • Are the actual questions (or a sample of them) provided?
  • Is the response format clear, or, when not already clear, does the researcher provide information on the response format? Is there any information on restrictions in respondents’ responses?
  • If the researcher is using a published instrument, does he or she cite sources where additional information can be found?
  • Has the researcher avoided overstating the preciseness of the measurement?
  • Does the researcher provide some measure of reliability? What type of reliability is established? Do the measures indicate adequate reliability for your purposes?
  • Does the research provide some measure of validity? What measures of validity are presented and are they adequate for your purposes?
  • Overall, is the measurement appropriate and adequate given the research purpose?
  1. Sample Strategy (3 pts)
  • Does the research goal lend itself to generalization? Is the broad sampling method appropriate for the research goal?
  • Does the researcher provide information regarding the study population? The sample?
  • Is the exact sampling method (e.g. simple random, purposive) specified? Remember, it is not sufficient for a researcher to simply state that a sample was selected ‘randomly.’
  • Is the sample size sufficient, given the research goals, the degree of accuracy the researcher desires, and the nature of the population studied? Given the nature of the research, is the sample size sufficient?
  • If the researcher uses a probability sample, does he or she generalize the findings to the appropriate population? If the researcher uses a non-probability sample, does he or she refrain from generalizing to a wider population?
  • Overall, is the sampling appropriate?

Your evaluation should include ONE of the following sections (6-10) (4 pts):

  1. Experiments
  • Can you identify a treatment variable that indicates that an experiment is the method of observation?
  • How many groups were studied?
    1. If there were two or more groups, did the researcher use random assignments
    2. If the researcher did not use random assignment, did the researcher present evidence that the groups were similar regarding key variables at the beginning of the study?
  • Is the treatment and any pre- or posttests described in sufficient detail that facilitates replication?
  • Is deception necessary?
    1. If so, is the deception within the parameters of the research topic?
    2. Have the participants been debriefed so they know the true nature of the study (and can enact their right to privacy by declining to participate after the fact?)
  • Based on the description of treatment and experimental procedure, do you see any red flags regarding ethical issues?
  • Did the researcher use assistants?
    1. If so, did the researcher state that they were properly trained?
    2. If so, did the researcher specify any special measures to make sure that the assistants administered the treatment properly?
  • Is the setting natural or artificial (in a laboratory)?
    1. If it’s in a laboratory, does the researcher recognize that external validity may be weak?
    2. If it’s in a natural setting, does the researcher recognize that there may be some differences in the environments of the various groups?
    3. Overall, do you think the experimental design is sound?
  1. Survey
  • Is the research topic worded appropriately for survey research?
  • Did the researcher specifically state which type of survey method was used?
  • Do the survey questions adequately address the topic?
  • Are the survey questions constructed correctly?
  • Did the researcher provide any information about the response rate? Did the researcher provide any information about follow-up mailings or other ways of increasing response rate? What are the implications of the response rate?
  • Did the researcher explain how he or she guaranteed anonymity or confidentiality?
  • Overall, is the survey methodology effective and appropriate?
  1. Field Research
  • Does the research describe the selected site? Does the research provide some explanation as to how that site was chosen?
  • Did the researchers explain how they addressed gatekeepers?
  • Did the researcher address how he developed field relations? If conflict arose, did the researcher make any comment about how personal or research problems in the field were addressed?
  • Did the researcher adequately protect the identity of the respondents? Did the researcher address other ethical considerations?
  • Did the researcher describe, at least in passing, his method of note taking? Does the method seem adequate?
  • In the analysis, does the researcher present general patterns of behavior and support those patterns with data such as quoted comments? Does the researcher use quotes selectively?
  • Does the researcher make any mention of issues of validity and/or reliability?
  • Overall, is the research adequate?
  1. Unobtrusive Measures
  • What is the researcher’s research purpose or hypothesis? Is content analysis an appropriate method of observation?
  • What are the researcher’s units of analysis? What are the units of observation (if they are different than the units of analysis)?
  • Is the researcher studying a population or a sample of these units? If the researcher is studying a sample, is it a probability sample? If so, was it correctly drawn? If the researcher is not studying a population or a probability sample, is he or she appropriately cautious about the nature of any conclusions?
  • Does the researcher identify the characteristics and level of content being analyzed? Does the researcher explain how material is coded, especially for issues of latent content?
  • Did the researcher do any type of pretest with other coders to test for reliability? Where they any tests for validity?
  • Are the conclusions consistent with the units of analysis?
  • Are the results clearly presented and the conclusions appropriate?
  • Generally, is the method of observation done appropriately?
  1. Evaluation Research
  • What is the purpose of the evaluation presented?
  • Is the nature of the program described in detail?
  • Are the goals presented and can the goals that the author presents be evaluated?
  • What type of observation method is used? Is it appropriate, given the real-life restrictions of evaluation research?
  • Is a control group used? If so, how has the researcher tried to show that it is equivalent to the experimental group? If not, does the researcher adequately explain its omission?
  • How are people selected for program participation? Does this affect the interpretation of findings, and, if so, does the researcher discuss this?
  • Are the results clearly explained?
  • How does the article address the other areas of evaluation discussed in earlier chapters?

Your evaluation should include ONE of the following sections (3 pts):

  1. Qualitative Analysis
  • Is the results section a cohesive?
  • Does the researcher connect the results to any general research questions or goals?
  • Is the perspective of the results presentation appropriate? Does it match the research technique?
  • Has the writer presented enough examples to support the conclusions? Do the examples make the readers ‘believe’ the researcher’s points?
  • Do you have reason to believe that the presence of the researcher influenced the actions or statements of other group members? If this is possible, has the researcher addressed it in the research?
  • Especially in field research (although this may be an issue to a lesser degree in other forms of qualitative data gathering), does the researcher discuss how he or she interacted with subjects in the field, what problems arose, and how the researcher addressed them?
  1. Quantitative Analysis
  • Is the results section a cohesive with the important findings highlighted?
  •  does the researcher tie the results to the research hypotheses or goals stated in the introduction?
  • If there are tables or graphs, are they clearly presented?
  • Does the researcher present any descriptive statistics?
  • Are the statistics appropriate for the level of measurement?
  • Are the conclusions the researcher draws appropriate for the statistical information?
  • In the discussion section, does the researcher briefly summarize the research purposes, methodologies, and key findings (in a non-statistical manner)?
  • Does the researcher acknowledge any methodological or statistical weaknesses?
  • Are the implications of the research or suggestions for future research discussed?
  • Overall, is the results section adequate?
  • Overall, is the discussion section adequate?
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Henry Ford And John Gray

Henry Ford and John Gray founded Ford Motor Company in 1903 with the intent of making automobiles affordable to the average American family. In 1908, Ford was credited with producing one of the “most popular cars in the world,” the Model T (NPR, 2006). The company was highly profitable in its early stages, operating on a model of Taylorism and pioneering the use of assembly line in automobile production. The company has since moved to a more Holistic approach, creating a diverse and motivated workplace culture. Through Corporate Social Responsibility (CSR), innovative technologies, international presence, and strong leadership practices the Ford Motor Company has established themselves as a worldwide leader in the automotive industry. Their place has been determined by a few significant operational and design decisions, such as maintaining affordability and high safety standards, but continued success is reliant upon maintaining successful innovation to meet evolving customer expectations.

This analysis does not include Lincoln, the luxury brand of automobiles produced by Ford Motor Company.

Output Analysis

The Output Analysis will focus on the organizational effectiveness of Ford Motor Company. To assess its effectiveness, Ford’s outputs will be analyzed with respect to several output factors and how they compare to other American automobile manufacturers. The output factors this analysis will focus on are customer results in the automobiles produced, business and financial indicators, employee engagement in the output measures, company innovation, and Ford’s global/societal responsibility.

Customers

This analysis will focus on two primary customer satisfaction factors in 2012 vehicle models: Dependability and safety.

For dependability, or reliability, Ford has performed very well. J.D. Power & Associates 2012 US Vehicle Dependability Study shown below shows Ford well above average in problems per 100 vehicles. While Toyota received the most awards with eight, Ford Motor Company did receive three awards for vehicle dependability (J.D. Power & Associates).

Figure . J.D. Power and Associates – 2012 Dependability Study

(Power and Assocates 2012)

For safety, Ford has a very good history of good safety performance highlighted by their #1 ranking in 2010. (Insurance Institute For Highway Safety, 2009) Ford’s exceptional safety record continues but has fallen slightly behind competitors in 2012 where it received 12 top safety awards from the Insurance Institute for Highway Safety (Insurance Institute For Highway Safety, 2011) compared to Toyota/Lexus/Scion at 15 winners, General Motors with 14, and Volkswagen/Audi with 13. Ford’s Top Safety Picks for 2012 include the following vehicles:

Fiesta (Mini Car)

Focus (Small Car)

Fusion (Midsize Car)

Taurus (Large Car)

Edge (Midsize SUV)

Explorer (Midsize SUV)

F-150 (Large Pickup)

Overall, the results indicate a steady safety performance for Ford vehicles. However, the results also show a significant increase in competitor safety performance and Ford is no longer the industry vehicle safety leader as it was a few years ago.

Employee Engagement

Employee engagement can mean many things but perhaps the best definition of it that engagement “is a positive work-related psychological state” and “a motivational state reflected in a genuine willingness to invest focused effort toward organizational goals and success”. (Albrecht, 2010) How much, or how well, the employees buy-in to the company’s strategic goals and success can greatly affect the company’s performance. One could reasonably assume that an employee who really cares and is invested in the success of his or her employer would be more productive and more likely to recommend improvements and seek to improve quality and performance of the products.

While employee engagement is something companies strive for and want to foster, gaining it, maintaining it, and measuring it is another thing entirely. Employee engagement is something that will likely be varied individually and over time, fluctuating constantly depending on many variables. With that in mind, perhaps the best way to look at employee engagement is to look at company practices that are intended to foster employee engagement positively.

On Ford Motor Company’s employee web page (Ford Motor Company, 2012), the company lists many of the things they do to foster engagement in their employees, including town hall meetings, intranet surveys and chats, joint labor/management committees and diversity councils. Ford also conducts employee “Drive Events” to give employees the opportunity to test drive new vehicles before they are released. This provides customer perspective to the employee and helps promote the vehicles to the public.

Ford also uses employees in beta testing of new applications and equipment to provide real-world feedback during product development. This gives the employees a sense of contribution and ownership in the development process they may not otherwise have.

Innovation

Two key sources of innovation within Ford are electric vehicles and connectivity within vehicles.

Electric vehicle technology has come to the forefront of clean energy initiatives for automotive manufacturers and Ford has created a goal to reduce carbon dioxide emissions in U.S. and European vehicles by 30% by 2020 with a global electrification strategy. (Hughes-Cromwich, 2011) The strategy is a long-term strategy that starts with hybrid electric vehicles (HEVs) in the short term and full battery electric vehicles (BEVs) in the long term.

The strategy is to create a high level of sustainability for its vehicles in the future. However, Ford is not unique in this innovation and may even be a little behind the technology curve. Nissan, GM, Toyota, and others are currently producing multiple electric vehicles. There are also several other smaller start-up manufacturers producing electric vehicles such as Tesla and Fisker. Ford, on the other hand, is taking a much more deliberate approach to their electric vehicle plan, the electrification strategy, that will result in an across the board electrification of their entire vehicle fleet. (Herron, 2012)

The success of Ford’s deliberate approach will not be known for several years as their strategy plays out, but they are clearly not being as aggressive as other manufacturers in the field of electric vehicle production. This year have they produced new Ford Focus Electric, which will soon be followed by four others including the Ford Fusion Electric.

Vehicle connectivity is another key factor in vehicle innovation as the world in general becomes more connected and technology application based. What started out several years ago with installed global positioning satellite (GPS) systems and Bluetooth connection is now evolving to constant Internet connection with in-vehicle mobile services that include streaming audio/video.

Ford’s Sync system is a factory installed hands-free communication and entertainment system that enables drivers to use voice activation to perform numerous digital functions while driving. These functions include phone calls, radio controls, mapping functions, and vehicle climate control. The system is programmed for operator voice recognition and customizable for operator needs. (Ford Motor Company, 2012)

Other manufacturers also have similar technology such as GMs OnStar, Toyota’s Entune, and Chrysler’s Uconnect systems. OnStar was the industry leader for in-vehicle communications for several years after starting in 1996 (Borgia, 2009) but other manufacturers are catching up. Comparing the systems to each other is an extremely quirky and personal endeavor with different people rating each one differently depending on their personal needs and uses.

In summary, Ford’s SYNC system has reached the forefront of in-vehicle connectivity technology in five short years and competes with the technology of the other manufacturers. The system is continuing to evolve as technology increases.

Societal

Corporate Societal Responsibility has integrated into Ford Motor Company intrinsically through their ONE Ford Mission and Vision, as shown in Figure below.

Figure . Ford Motor Company business strategy: ONE Ford

http://corporate.ford.com/doc/one_ford.pdf

Ford maintains an in-depth sustainability strategy with the ONE Ford business strategy with the goal to create three primary outputs: Great Products, Strong Business, and a Better World. (Ford Motor Company, 2011) Within the primary company output of a Better World, Ford has built a sustainability strategy to “create value consistent with the long-term preservation and enhancement of environmental, social and financial capital.”

Ford, as part of its sustainability strategy, maintains seven primary focus areas to achieve sustainability: Fuel Economy, Vehicle Safety, Income, Employee Satisfaction, Supply Chain, CO2 Emissions and Water Use. Nearly all of these are societal in nature as they deal with environmental, education, safety, and energy.

There are also numerous examples of Ford’s commitment to society that includes working and building partnerships with communities. These include Operation Goodwill, Ford Mobile Food Pantry Program, Pride and Honor Flight, The Ford College Community Challenge (Ford C3), Ford Community Corps, Ford Blue Oval Scholarships, and the Ford Volunteer Corps just the name a few. (Ford Motor Company, 2011)

External Business Environment Analysis

Ford, like all American auto manufacturers, experienced a significant downturn in the auto industry during the recent economic recession. What separates the successful companies is how they deal with a volatile economy and how they are able to exploit the business environment during the economic recovery. Ford has not only weathered the recession rather well, but also expanded into Asia where the economy remained strong and established long-term production capability. This section will look at several characteristics of the external business environment as it relates to Ford and will discuss Ford’s environmental initiatives.

Business and Economic Characteristics

The automotive industry has struggled over the past several years while working through a tumultuous economy in the United States and Europe. However, the significant drop in production in 2008 and 2009, and the slow recovery since, has been offset dramatically by sales in China where “production grew a staggering 32.4% in 2010, led by the country’s rising income, expanding urbanization and growing population.” (IBIS World Industry Report, 2012)

The production growth in China and other emerging markets is expected to continue along with the economic recovery in the U.S. and Europe, which IBIS expects to produce a 2012 growth of 5.2% in total industry revenue worth an estimated $2.2 trillion. However, despite this projected growth the longer-term outlook to 2017 is more conservative. There is potential growth of less than 5%, as the U.S. and European economies will likely remain sluggish as they deal increasing debt.

Forces Driving Change in the Industry

Several forces drive change in the auto industry. This analysis will focus on three: gas prices, industry structure, and emerging markets.

Gas Prices

A significant increase in fuel prices over the past several years has caused a shift in automobile production away from larger vehicles with high fuel consumption in favor of smaller fuel efficient vehicles. Figure shows regular gas prices have doubled over the past 7 years. This has driven auto manufacturers to be much more competitive in fuel economy in their vehicles.

Figure . 96 Month Average Retail Gas Price Chart

(GasBuddy.com, 2012)

Industry Structure

Another example of external forces affecting the auto industry is the increase in steel prices. Significant growth in developing countries, primarily China, has led to increased raw material prices industry wide. For example, the price of iron ore increased from $60 a ton in 2009 to $180 a ton in April 2010. (International Trade Administration, 2011) Similar increases were experiences for thermoplastics, which increased 16% in 2010.

Dramatic price increases in raw materials put the manufacturers in a tough position. Steel suppliers seek shorter term contracts with auto manufacturers to protect themselves from the rising price of ore and while the auto manufacturers want to stabilize the steel costs to better manage car costs and profits. The results is an extremely competitive environment where the demand for cheaper and more fuel efficient vehicles must be balanced with higher material costs.

Emerging Markets

The BRICs (China, Russia, India, and Brazil) represent emerging economies with a rapidly expanding industrial capacity. While their industrial capacity increases, so does their demand and middle class families emerge and are able to purchase cars. (IBIS World Industry Report, 2012) This affects U.S. manufacturers such as Ford in a couple of different ways, both positive and negative. First, the growing economy in the emerging markets has created demand for U.S. cars and helped grow sales in a tough U.S. economy. However, U.S. automakers have been getting a lot of their raw materials, iron ore in particular, from China in recent years and China’s own increased industrial manufacturing has affected both price and availability. (International Trade Administration, 2011)

Competitive Forces in the Industry

Auto manufacturing is an increasingly competitive industry. The primary competitive force in play is market share concentration. In Ford’s case, market share concentration is relatively low with the four largest automakers accounting for 33.7% of industry revenue in 2012 (IBIS World Industry Report, 2012) and will continue to drop as new companies emerge and large companies split into smaller divisions as Chrysler did in 2007.

However, as the market share concentration drops, competition increases as smaller automakers hone in on niche cars that meet the demand for cheap, economic transportation. While many of these smaller manufacturers are not a real competitive threat at this time, they are quickly gaining ground.

Major Threats and Opportunities

Perhaps the best example of an up and coming automaker threatening big automakers like Ford is Tata Motors in Mumbai, India. While Tata Motors has been manufacturing cars in India since 1954, the last decade has seen an incredible expansion to other parts of the world. Tata began a big push by acquiring Daewoo truck manufacturing in 2004 and culminated in purchasing Jaguar Land Rover from Ford in 2008 for $2.3 billion in the middle of the U.S. financial crisis. (Fitzwater, 2012) Now, Jaguar Land Rover is producing substantial profits for Tata Motors with sales of $15.4 billion in 2011, a 48% increase from 2010.

Tata Motors is a company on the rise. While Ford and other U.S. and European automakers were trying to survive and recover for a recession from 2008 to 2011, Asian companies like Tata are charging full speed ahead taking advantage of a growing market in China. Figure below shows Tata Motors’ growth since 2002.

Figure . Tata Motors Growth

(Fitzwater, 2012)

In 2009, Tata Motors introduced a car called the Nano, which sells for approximately $2100 and is currently working on a car that will run on compressed air. (Fitzwater, 2012) This is simply a price point that companies like Ford cannot compete with. Companies such as Tata may not be an immediate threat to U.S. markets due to stringent safety and environmental requirement laws, but they cut into sales in the BRICs. Also, with Tata’s quick rise, it should be assumed they are targeting U.S. and European markets in the near future.

Keys to Competitive Success

Given Tata Motors’ history, a key to Ford’s success may lie in Asia. Fortunately, Ford has not been blind to the emerging markets in the BRICs. Ford has already built a new assembly plant in Chongqing, China and plans to build three more assembly plants in Asia-Pacific in the near future, highlighted by a $1 billion facility investment in Sanand, Gujarat in India. (Ford Motor Company, 2011)

Another key to Ford’s success is in vehicle profitability. Ultimately, as in any business, Ford’s success depends on how profitable it is. However, profitability varies greatly depending on the line of vehicle. Large, expensive SUV’s that are popular in America carry a large profit margin and smaller, less expensive cars have a much smaller profit. Given the global demand for affordable and efficient cars, Ford is exploiting that segment of the market by increasing production efficiency and sales of smaller vehicles. With the increases production capacity of four new assembly plants in Asia, Ford will be able to increase their profit contributions from smaller vehicle through greatly increased sales in the BRICs.

Inputs and Internal Business Environment Analysis

The internal business environment within the Ford Motor Company has as much to do with its success or failure, as do any external factors. The Ford Motor Company has been able to weather bad economic conditions in the automotive industry and come out ahead, internal business organizational and process changes, and external pressures that could have forced the company to collapse. The internal environment of the Ford Motor Company has been changed significantly over the past decade for the better. If it were not for the current Chief Executive Officer (CEO), the company might not be alive today. Ford is divided into two separate companies, Ford Motor Company and Ford Motor Credit Company, that can provide a full spectrum of automobile selling, lending, and buying (MarketLine, 2012).

Alan Mulally took over as the CEO of Ford in 2006. Before him, under the leadership of Bill Ford Jr., the Ford Motor Company was divided between each of its separate geographic regions and the regions acted independently, without cooperation. The geographic regions could be described as different factions that are in conflict with each other. There existed no sharing of information, ideas, technology, or designs between each of the regions before Mulally took over as CEO (The Associated Press, 2012). Ford has historically operated separately in each of its four main geographic regions, North America, South America, Europe, and Asia. These regions also have their own distinct and duplicative processes (Ford Motor Company, 2008). In addition, before 2006, Ford factories around the world produced too many varieties of vehicles and vehicles themselves; Ford dealerships had to even offer discounts in order to sell all of the vehicles (The Associated Press, 2012). Initially this operation made sense for the Ford Motor Company because of sparse communication and transportation infrastructure. As technology has increased, this led to inefficiencies, duplication of effort, and waste of resources, talent, and money (Ford Motor Company, 2008).

In 2006, everything for Ford began changing. Alan Mulally took over the company from William C. “Bill” Ford Jr., a direct descendent of Henry Ford, realized that the way his company was headed was going to devastate the company. Bill stepped down as CEO but continued to remain on as Chairman of the Board of Directors. Alan Mulally, after realizing how separated each of the operating regions had become, instituted a completely new management, manufacturing, and design plan across the board. To fix and improve the broken manufacturing process, Mulally introduced what is called a Direct Labor Management System (DLMS) to assist in the production and planning of vehicles. The DLMS improves the assembly process by standardizing everything. Also, the DLMS was implemented to help provide a generic manufacturing process across many different vehicles types. For instance, vehicle structure and frames were standardized across trucks so that one type of frame could be used in multiple vehicle models. The DLMS provides consistent and accurate estimates of product (technical) and non-product (clerical) labor times. By using the DLMS, Ford was able to remove all non-product tasks from engineers, allowing them to focus more time on product processes (John O’Brien, 1989).

In addition to the new DLMS, Mulally’s new management style was implemented and executives completed training on procedures and processes. Any executives not onboard with the changes were let go. First, Mulally implemented a new procedure to match production to demand and were able to demand higher vehicle prices. This strategy prepared Ford to better weather the impending harsh economic environment. Ford executives across the company changed the way they conducted business. Executives established weekly business review meetings in which employees voiced concerns and opinions, called Mutual Growth Forums (MGF). This way, direct change is implemented more often. These meetings have become so successful that they trickled down to lower level managers and are considered a staple of the company’s management at all levels. In addition to managers and executives working together, engineers and designers are also encouraged to collaborate to make better products through MGF (The Associated Press, 2012).

Alan Mulally remarkably transformed the way the Ford Motor Company operates. Ford still operates internationally, but is more successful and informed in the way it markets, manufactures, designs, sells, and buys vehicles. Ford still has an extensive, strong, and diversified operational network of manufacturing, assembly, distribution, warehouse, sales, administrative, and engineering centers. As a result, the company is better able to manage the way it operates now than it has been in the past. Ford is made up of 69 manufacturing plants, 41 distribution centers and warehouses, 56 research and development and engineering centers, 11,790 dealerships, and 110 sales offices after Mulally condensed operations (MarketLine, 2012). In conjunction with shaking up the organizational structure and physical footprint of the company, Mulally also substantially changed the products that Ford produces.

Over the past several decades, Ford has relied mostly on the sales of trucks and sport utility vehicles (SUVs). Ford also manufactured vehicles under the Ford, Mercury, Volvo, and Lincoln brands (Chakraborty, 2012). Before the economic and auto crisis hit in 2008, Ford had begun to restructure its brands and image. Ford shifted to creating additional types of cars including electric and hybrid cars and staking more of its revenue on selling more cars than trucks with the ability to shift production based on demand (MarketLine, 2012). The shift that Mulally instilled in the Ford Motor Company allowed it to survive the 2008 economic downturn where other American car manufacturers could not. Ford is now has a net income which is approximately $6.56 billion higher than its main competitors. Another contribution to a hefty increase in net income was Ford’s investment in alternative fuel technologies to improve fuel efficiency (Chakraborty, 2012).

An inhibitor to Ford’s restructuring efforts can be partly attributed to its contract with the United Auto Workers (UAW) Union. The impact of the closure of unneeded manufacturing plants which would result in the layoff of workers cannot be fully seen immediately. Any hourly employees that are members of the UAW must still get paid at a rate of 90% with full benefits until the end of the contract. This pattern bargaining plan, accepted by Ford in 1990, prevents auto companies from easily laying off hourly employees.

Mulally’s restructuring efforts will only be fully realized in the future (Maynard, 2006). The change that Mulally has implemented in the Ford Motor Company will be hard pressed to keep up when he is scheduled to retire within the next couple of years. The man that will take over the helm of Ford, Mark Fields, is the current director of North, South, and Central American operations and actually wrote the restructuring plan that Mulally implemented (The Associated Press, 2012). It is yet to be seen of the new organizational changes will survive this change in leadership.

Transformation/Execution Systems

Reward System

Motivation is generally linked to reward, and it is accepted that maintaining a healthy reward system is central to the regulation of employment. Reward systems vary between organizations, including: monetary or non-monetary, tangible or intangible, and physical or psychological. Rewards are offered to the employees as compensation for the productive work they execute. (Reward System in Organizations, 2009)

Ford Motor Company incorporated an effective reward system exemplified by the restructuring of its operations and its organizational chain of command. The company incorporates a team-based methodology in its manufacturing process to give employees more control over their responsibilities (2006).  Instead of simply following the instructions of managers, workers can directly contact suppliers to talk about quality of equipment or fix the product defects. At Ford, employee’s decisions are valued by their organization; they can exercise personal judgment to increase their productivity. Â

Ford is one of the numerous organizations in the United States that use the Internet to run incentive programs for employee motivation, recognition, award selection, and award fulfilment. Online-oriented employee motivation poses various benefits that are advantageous for employees and the organization itself. For instance, promotional events are posted online, reducing the use of paper. These materials can be immediately and efficiently managed.  Hence, online incentive programs save time, money, and even permit greater control for the organization and employees.

Ford also acknowledges corporate social responsibility (CSR) to benefit employees, consumers, dealers, suppliers and community. Hence, Ford is able to provide a quality life to its employees and their families (Reward System in Organizations, 2009)

Other forms of compensation for Ford employees are programs for Employee Involvement (EI).  Some of the EI programs are Mutual Growth Forums (MGF), as discussed previously, and the Employee Assistance Plan (EAP).

Through MGF the relationship between employees and administration is developed through two-way communication. To do this, the concerned parties conduct regular meetings to discuss matters of mutual interest, such as product plans, competition, economics, holiday schedules and work conditions.

The EI program is completely voluntary and takes care of workers who have health problems, drug dependency, or other immediate concerns. The program also includes a referral technique for professional counselling, assessment, and treatment, as well as wellness activities for health risk evaluations, stress management, hypertension monitoring, and so on. These compensations benefits to Ford with enhanced employee creativity, lessened absenteeism, better quality of products, and improved relations between employees and the administration.

Team design

Ford incorporated the Ford Production System (FPS) in the mid-1990s, an initiative to restructure its manufacturing process to enhance flexibility and efficiency in its automobile production systems. Under FPS, factory employees form teams called “work groups.” (Liker & Morgan, 2011). With this new format, managers of the workgroups are given the authority to make independent work decisions, which eventually result in time savings.

In 2000, Ford concentrated its product development teams into three centers of competence. Small cars developed at co-centers in Cologne, Germany and Dunton, U.K., and large-car and truck teams are in Dearborn, Michigan. (Wernle, 2000)

Product Design Team

Product design team has a parallel approach, improving on the linear process. These teams are task-focused and the level of communication and decision-making is high. The project team design begins with the empowering and staffing the team, the team members are chosen according to the company history and breakdown of the task. Then, the design engineers, responsible for the development of the product are selected. (Therese, 1990)

Leadership/decision making

Bill Ford is the chairman of Ford Motor Company and most of the decisions in the company are taken care by CEO, Alan Mulally, and a board of directors. The CEO makes the majority of the executive decisions. The role of the board is to select and evaluate the CEO and other top-level executives. (Ford Motor Company 2011 Annual Report, 2011) The board of directors has 17 members.

Through Ford Production System (FPS) work groups were formed which gave powers to the managers of the work groups to make their own decisions. Employees were significantly involved in the decision-making process as they could directly contact the suppliers and discuss the quality of the products. (Liker & Morgan, 2011)

Human Resource System

When CEO Alan Mulally came to Ford in 2006, he developed the “One Ford” plan. Under One Ford, all Ford workers are integrated into a system where employee opinions are valued. (White, 2011). Since 2009, Ford has been encouraging social networks in order to enable easy communication among employees so that employees can more easily engage customers. (Khan & Khan, 2011)

Cross-cultural Human Resource Management at Ford

Ford is putting efforts to reach diverse communities by targeting universities with higher percentage of women and minority groups (Reward System in Organizations, 2009). Ford launched its global diversity initiative in 1994 to improve diversity and work life throughout the company. Of its 157,000 U.S. employees, 12.8% of Officials and managers are minorities. African Americans represent 8.7% of all top management posts and 17.3% of the workforce overall (Reward System in Organizations, 2009). Ford has also launched some programs and processes for managing diversity. This has been a key-contributing factor to Ford Motor Company’s goal of global markets and corporate efficiency.

Technology

In 1933, Henry Ford had outlined on what makes a great product when he said, “It is the type of engine and it’s reliability; the structure of chassis and body, durability; preference should be given to safety factors; a steady development in comfort, convenience of driving and economy of the vehicle and these factors make the car.” These basic principles as envisioned by Henry Ford are very closely monitored as the Four Pillars, which are the main areas of focus for Ford today. (Armbruster, 2011)

The four pillars are: Drive smart, Drive safe, Drive quality, and Drive green.

Drive Smart

Ford is committed to deliver industry-leading technology that enhances driving experience at a value to the customer. Ford’s history of technological innovation goes way back from 1906 with the unitary engine and transmission and also the 1908 Model T which had the standard interchangeable parts. In 1936, for its Lincoln Zephyr, Ford came up with new alligator type hood, which made it way easier for consumers to access and service the engine. Ford introduced many new technologies to their customers in 1980s such as electronic message centers (1980), keyless entry systems (1980), heated front seats (1984) and insta-clear windshields (1986) which are amongst the few. Ford added more to their technology list in 1990s with auto-glide front seats (1993) which gave more comfort to the drivers of their vehicles, the seat and mirror positions had memory recall function (1994), voice activated cell phones (1995) and reverse activated rearview mirrors (1995). It’s true that some of these technologies mentioned above are no longer in use today, but they surely demonstrate the innovative atmosphere that still Ford has maintained. (Armbruster, 2011)

Their latest technology as part of drive smart include

Sync- This is an award winning communication and entertainment system developed by ford and Microsoft. Sync integrates most Bluetooth enabled mobile phones and digital media players. Sync Wi-Fi mobile hotspot makes the vehicle a rolling Wi-Fi hotspot which allows all passengers to access the internet.

MyFord touch- An LCD touch screen is mounted on the dashboard which has multiple features like App links, voice command system, 911 assist etc…

Blind spot Information System with cross traffic alert system.

Rear view camera system

Parking assistant and Electric power assisted steering (Technology fact sheet, 2012)

Drive Safe

Ford has been continuously thriving hard to introduce new designs to keep customers safe in its vehicles. Beginning in 1909, Ford gave an option to use acetylene headlamps which would provide more safety during low light conditions. In 1927, Henry and Edsel Ford came up with an idea of installing laminated safety glass in the windshields of the Model A which would reduce the injuries from flying glass in the event of an accident. After few years of research, Ford introduced many other features in their model line in 1956 such as steering wheel which could absorb energy, door latches with impact resistance, padded instrument panels, seat belts for driver and passengers. They also introduced airbag systems in the 1980s which made Ford’s customers of all ages feel much safer. (Armbruster, 2011)

Latest technology as part of Drive safe:

Roll stability control- Sensors are placed intelligently to detect vehicle roll motion and automatically engage measures to maintain control of the vehicle.

Curve control technology- Helps driver to maintain control over the vehicle while making a quick curve. The technology rapidly reduces the torque and also applies brakes to slow down the vehicle.

Lane keeping technology

Forward collision warning with brake support

Next generation air bags for extra protection to the driver and passengers. (Technology fact sheet, 2012)

Drive Quality

Ford offers world-class quality which challenges the best in the industry. As Henry Ford’s vision, he always wanted to give people most reliable transportation at lowest possible cost. This focus on quality has been the biggest weapon in Ford’s business. Henry Ford II even launched a new campaign called “Quality and Demand Go Hand in Hand” (Armbruster, 2011). The aim of this campaign was to improve quality in Ford products from the very first step of production. Henry Ford II believed that quality would be the determining factor for Ford to lead the market in the tough competition. Ford In 1981,launched the “Quality is Job 1” program which showed Ford’s dedication towards maintaining the quality.

Seventy-nine percent of Ford customers who purchased 2011 model year cars and trucks were satisfied with the quality of their vehicles, according to the 2011 full-year GQRS study. (Armbruster, 2011)

Latest technology:

Error proof manufacturing- Error proof systems are incorporated to ensure critical-to-quality assembly process which allows constant monitoring during the build.

The new technologies include an environment friendly anti-corrosion system that reduces the use of water to half.

A 3-wet paint technology that reduces CO2 emission by 15%.

Electrical systems of the vehicles are thoroughly checked to ensure electrically driven features operate properly. (Technology fact sheet, 2012)

Drive Green

As early as 1913, Henry Ford had started to design and experiment batteries which would be an alternative power source for Ford vehicles (Armbruster, 2011). He also promoted experiments on botanical sources of ethanol in search for an inexpensive, renewable fuel. During the late 1960s and early 1970s, fuel economy was a major deciding factor in purchasing a car for a common man because of emissions and safety legislation, and also the oil crisis at that time. Ford Motor Company responded to this crisis quickly by launching more fuel-efficient vehicles and also educated people about optimum driving techniques to attain better fuel efficiency. (Armbruster, 2011)

Latest Technology:

Eco boost, ford’s latest technology smaller displacement turbocharged gas engines reduces fuel consumption by 20% and also reduces CO2 emission by 15%.

Ford is planning to advance transmissions to six-speed gearbox, which improves fuel efficiency.

Ford’s hybrid vehicle C-MAX energi is expected to deliver greater fuel efficiency than Toyota Prius

Ford’s first all-electric vehicle is rated by U.S environmental protection agency as America’s most fuel-efficient vehicle. (Technology fact sheet, 2012)

Problem Statement

Ford Motor Company continues to lead the automobile industry on an international level, but will face many challenges as the marketplace evolves. In order to remain competitive, it is recommended that Form motor company improve its investment in the electric car market, facilitate a smooth CEO leadership transition, and evolve CSR programs with customer and environmental demand.

Electric Car Market

Ford has taken a very deliberate approach to developing electric vehicles. While Ford plans to develop and market electric vehicles rather slowly, 25%-30% of the fleet electric by 2020, other manufacturers are leading the way. Tesla Motors’ Model S is a fully electric vehicle that was selected as Motor Trend’s Car of the Year for 2013 (Motor Trend, 2013), representing the arrival of a truly impactful electric car. The Model S was also selected as Car of the Year for multiple other publications including Automobile Magazine. Other manufacturers are introducing electric cars already or in the near term.

The recommendation is that Ford monitors the electric vehicle market very closely and look for ways to expedite production of fully electric vehicles if the market demands it. Technology is increasing at a rapid rate with manufacturers like Tesla taking full advantage of the availability of it while claiming over 250 patents related electric car production. Ford should not stand by and let companies like Tesla set the pace in the electric car market.

This is not to say that Ford should abandon its current strategy for full electric competition, but simply that Ford needs to stay engaged to be able to respond shifts in electric car technology and market demand. The market for electric vehicles is still emerging, nobody knows the long-term demand, but it is recommended that Ford be at the forefront of that emerging market, in terms of both technology and availability.

Leadership

The Ford Motor Company has been transformed significantly since Alan Mulally took over the helm of the company from Bill Ford Jr. Ford improved under Mulally’s leadership because of his proactive approach to decision making and his stringent plan for leadership and executive reform. A new Direct Labor Management System (DLMS) was implemented under Mulally’s leadership that allows Ford employees to utilize common practices, equipment, and automobile parts.

Ford might have some challenge in maintaining its current level of efficiency and its positive revenue flow when Mark Fields takes over as CEO. Even though Fields created the restructuring plan that was implemented by Mulally, Mulally held most of the executives responsible for Ford’s previous decline.

It is recommended for Fields to expand upon Mulally’s leadership shakeup and continue to replace executives that have previously contributed to the decline of Ford. Bringing in new management could also introduce a revitalizing spark for the future of Ford.

Corporate Social Responsibility

A study by Sun Mi Ha on Ford Motor Company and CSR shows that Ford’s consumers prefer the company’s product based on its reputation for social and environmental responsibility (Ha, 2008).

Ford produces electric automobiles, efficient gasoline and diesel powered cars, and is working on reducing the carbon impact on the world (Ford & Mullaly, 2012). Through these initiatives, Ford has excelled; however, CSR is more about reacting to the present scenarios quickly and addressing the demands and needs of the customers.

It is recommended that Ford focus more on environmental impact in the future. These requirements continuously evolve and may again in the future as impact of carbon on the environment and water in the manufacturing plants are further quantified. Implementing a minimum CSR requirement will not help Ford compete in future expansion. In these ways, they must be proactive. Top management should manage their environmental and societal impact to ensure a constructive influence.

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