OBJECTIVES
As a person with sufficient knowledge in accounting and finance, the author has always brought up to his superiors the viability of strategy formation regarding the use of accounting and financial statements in making informed business decisions and at times fail to understand the reasons or logic behind certain strategic implementations imposed on.
By delving into this project paper, the author intends to impart insights as to how the use of accounting and financial statements help in making informed business decisions. The author hopes to have an in-depth understanding regarding basic accounting theories, assumptions, and principles as well as analyze the relationship between the balance sheet and the income statement.
In order to reinforce the learning objectives, two key focal issues were focused upon, i.e. innovation and diversity. Innovation was discussed with regard to accounting and finance where both are renowned for their developmental capabilities to constantly innovate. Diversity came under strategic thinking and formation as the use of accounting and financial statements must consider the diverse culture, political climate, economic surroundings, social environment, technological settings, government policies and legal systems in order to make informed business decisions.
REVIEW OF RELATED LITERATURE
A. Accounting & Finance
Accounting can be defined as the process of recording, classification, analysis and interpretation of financial information which in turn is reported to the concerned stakeholders through the financial statements (Ashton, 1974). It requires a record for each and every transaction the business enters into. Accounting has five (5) basic categories. The categories are (1) Assets; (2) Liabilities; (3) Equity; (4) Revenue; and (5) Expense.
Finance, on the other hand, is the study of the methods and means in which individuals and organizations allocate and use their financial resources over time, while at the same time taking into consideration the risks involved in their projects (Dyckman et al. 1978). It consists of three (3) interrelated areas, (1) money and capital markets which pertain to topics regarding macro economics; (2) investments, which pertains to the decisions made by individuals and financial institutions as they select the appropriate securities for their investments portfolios; and (3) managerial finance which pertains to the actual management of the business organization. In general the three areas are interrelated.
B. Balance Sheet & Income Statement
Income Statement pertains to the output of the Accounting System. It informs the various stakeholders involved of the following critical information: (1) Where the business stands in a specified period of time; (2) How the business performed for a specific period of time; (3) How the management's stakes in the business changed for a specified period of time; and (4) Where and how the business organization's financial resources was used in the operation and management of the business for a specified period of time. Balance sheet, on the other hand, pertains to a financial statement indicating the financial position of a business entity at a certain point in time. Users of balance sheets interpret financial position as the status of the business entity financially in a given point in time (Gibbins, 1984).
The primary objectives of both the balance sheet and income statement are to provide information that is reliable and can help in making investment and credit decisions; in making evaluations regarding the amount and uncertainty of future cash flows; and in learning about the business entity's economic resources and changes regarding claims to resources. Some of the most significant characteristics of both the balance sheet and income statement include being a means to an end, being historical in nature, and being based on a general-purpose assumption. The balance sheet and income statement are both useful to the business entity with regards to achieving its objectives and corporate mission; evaluation of past performance and future plans; and assessment and rewarding decision-making performance.
C. Using Accounting and Financial Statements
Accounting is the method by which information regarding a business organization is communicated. This is the reason why it is more often referred to as the language of business. Many different stakeholders have the need for accounting information in order to make informed business decisions. These stakeholders include investors, creditors, governmental agencies and others. Because the main objective of accounting and financial information is the provision of reliable data and information for decision-making purposes, it is more commonly referred to as a means to an end, with the end pertaining to the decision that is supported by the presence of accurate and reliable accounting data and information.
COMPANY OVERVIEW 1
A. Palm, Incorporated
Palm, Inc. aims for sustainable growth as a broad market leader in mobile computing as well as for segment leadership. In both cases, the Palm, Inc. brands will play a crucial part. Palm, Inc. is able to establish its broad leadership usually by acquiring other strong mobile computing companies and their products, which are then combined into a new, larger company. Offering training to its employees, improving the company operations, and the introduction of new technologies then reinforces the positions of the various Palm products. This practically results in economies of scale that is able to create a distribution network for both the local and international Palm products. If a market is already in the control of other mobile computing companies, Palm, Inc. devotes its attention towards the development of a premium segment with its various Palm products.
The mission of Palm, Inc. is to secure the growth of the business in a sustainable manner, while at the same time constantly improving the company's profitability. The strategy to achieve this involves four elements:
1. Striving in order to reach a leading position in attractive markets
2. Focusing on securing a competitive share of the mobile computing market segments.
3. Working in order to improve the company's efficiency and cut costs in operations.
4. Continuous growth through selective acquisitions for as long as they are able to create shareholder value.
B. Financial Statements
To be useful and helpful to the various stakeholders involved, accounting and financial statements of Palm, Inc. are:
* Relevant: relevant accounting and financial statements of Palm, Inc. make a significant impact and difference in its decision-making. It also helps the various stakeholders of Palm, Inc. involved to make predictions regarding the past, present and future events. Relevant accounting and financial information also helps the stakeholders confirm prior expectations. It is also must be ready before decisions are made.
* Reliable: reliable accounting and financial statements of Palm, Inc. have been proven and verified, neutral, and presents only truthful information.
C. Accounting principles in consideration
* The historical cost principle makes it imperative for Palm, Inc. to perform their accounting and reporting measures based on the acquisition costs rather than fair market value for the majority of assets and liabilities. This principle guides Palm, Inc to relate data and financial statements that are accurate, thereby removing the opportunity of providing biased market values, but not very relevant. Therefore, there involves a trend of utilizing prudent values. Most debts are now being reported at their actual market values.
* The revenue recognition principle makes it imperative for Palm, Inc. to perform recording only when revenue can be (1) realized or realizable and (2) earned, not when cash is received. This method of accounting is commonly termed as accrual basis accounting.
D. Assumptions in consideration
* Economic Entity Assumption pertains to Palm, Inc.'s assumption that its business per se must be separated from its owners or other businesses. Revenues and expenses must have a distinction from personal expenses. This is applicable even for partnerships and sole proprietorships. The entity concept does not automatically pertain to a legal entity.
* Going Concern Assumption pertains to Palm, Inc.'s assumption that its business will remain strong and functional for a long period of time. This validates the terms asset capitalization and amortization. Only when liquidation is sure to happen will this assumption become null.
E. Resulting competitive advantage
Among the competitive advantages enjoyed by Palm, Inc. because of their efficient accounting system are:
· Economies of Scale and Scope in manufacturing and research and development arising from its numerous facilities situated in the United States and other countries worldwide.
· Unique Quality Technology owing to heavy emphasis on research
Palm, Inc.'s commitment to research & development activities has always been one of its top strategies to remain competitive in the market.
· Differentiated Products
Through the production and marketing of differentiated products originating from their research and development activities, Palm, Inc. is able to create its own firm-specific advantages. The continuous pursuit of research and development processes enables Palm, Inc. to produce a steady stream of originally differentiated products which makes it difficult for competitors to find substitutes. Because of this differentiated approach, Palm, Inc. is able to market their products worldwide, which enables them in turn to maximize the returns on research and development expenditures.
COMPANY OVERVIEW 2
A. Heineken
Heineken is one of the world's leading brewing companies in terms of profit and sales volume. The company has also the widest presence among all international brewing companies. This is made possible through a positioning strategy of global networking of breweries and distributors.
In terms of volume, Heineken is the largest beverage and brewer distributor in Europe. The company also balances stable and profitable markets in Europe and North America. In recent years, Heineken has initiated efforts to solidify its presence in the Asia Pacific Region through the acquisitions of beer markets in China and Russia.
The Heineken brand is one of the world's most valuable international premium beer brand. Heineken uses the name of both the company and its mainstream beer label, and this strategy has allowed the company to pursue an integrated marketing approach directly related to the company name.
Heineken, as a leader in their industry, has implemented various strategies to fully adapt to the need to go global. However, it is more important for Heineken to implement a more sober approach to maintain consumer loyalty with their local brands. This is primarily due to the consolidation and globalization that are taking place across most industries, including the brewing industry.
B. Financial Statements
To be useful and helpful to the various stakeholders involved, accounting and financial statements of Heineken are:
* Comparable: accounting and financial statements of Heineken are comparable. This is done by reporting the results in the same manner for different business organizations.
* Consistent: consistent accounting methods of Heineken can be applied from period to period, and all alterations done in the methods must be justified.
C. Accounting principles in consideration
* The matching principle means that expenses within Heineken need to be matched with revenues for as long as it is reasonable to do so. Expenses within Heineken cannot be recognized whenever the task is done, or whenever a product or service is produced, but only when the task or the product has been proven to steadily contribute to the revenue. If there is no connection that can be made with revenue, then that's the time that costs can be charged as expenses to the present period. Therefore, this principle allows greater assessment of actual financial gains and performance of Heineken (Libby, 1978).
* The full disclosure principle means that the amount and types of financial data and information within Heineken that will be revealed must be decided on the basis of trade-off analysis. This is because bigger amounts of information cost a lot more for the preparations and utilization. Financial data and information within Heineken that will be revealed should be enough to make prudent decisions while keeping costs justifiable. Accurate information must be presented either in the main body of financial statements or as supplementary information.
D. Assumptions in consideration
* Monetary Unit Assumption pertains to Heineken's assumption that a stabilized currency is going to be the unit of record. The FASB recognizes the nominal value of the US Dollar as the standard monetary unit of record.
* Periodicity Assumption pertains to Heineken's assumption that its business operations can be monitored and separated into months, quarters and years. This is a must to enable comparison between present and past performance (Goennedes et al. 1974).
CONCLUSION
The results of the analysis carried out on the managerial accounting and financial reporting of Palm, Inc. and Heineken indicated very significant effects, even amidst the threats of unrest. Therefore, we could conclude that the managerial accounting and financial reporting of Palm, Inc. and Heineken could still be expected to improve faster than average.
The review of Palm, Inc. and Heineken's the managerial accounting and financial reporting capabilities and resources revealed very little inconsistencies regarding their strategies. This is coherent with their traditional inside-out approach. However, the need to reconcile both the inside-out and outside-in approaches becomes imperative now for both companies.
The analysis among the environment as well as the managerial accounting and financial reporting capabilities of Palm, Inc. and Heineken revealed certain gaps, most of which are biased towards the environment. However, these gaps paved the way towards determining a number of recommended strategic options to secure the competitiveness of both companies.
Also, both Palm, Inc. and Heineken have to find a balance between adherence to internal forces within the management and to the changing forces of the environment in order to implement such strategic options.
APPENDICES
Measuring Palm, Inc.'s Performance
a. Financial Analysis
In the fiscal year of 2003, Palm, Inc. was able to experience a significant progress in several key metrics. The inventory was reduced from $55 million to $23 million and inventory turns rose from 12 to 26. The cost of revenues, excluding the benefit from previous special charges and the applicable portion of the amortization of intangible assets, decreased from 72.3% of revenues to 67.8% of revenues. The combination of sales and marketing, research and development, and general and administrative expenses was reduced from $ 435 million to $339 million, while at the same time improving on the pace of innovation. Palm, Inc.'s total revenue has approximately grown from $1 million in fiscal year 1995 to $ 871. 9 million in fiscal year 2003.
b. Marketing
The retailers in the United States represent Palm, Inc.'s largest sales and marketing channel which encompass national and regional office supply stores and mass merchants. Distributors represent Palm, Inc.'s second largest United States channel and generally sell to both traditional and Internet resellers and retailers. In Europe and Asia, Palm, Inc.'s market share is still relatively high. Palm, Inc. has more than 100 international distributors located worldwide.
The company uses the Palm.com store as a venue to sell its products. This is accomplished through the use of e-marketing campaigns and product bundles. The company is able to build awareness of its products and brands through mass media advertising, public relations efforts and branded Internet properties. The company also makes it a point to receive feedback from its customers through market research. The company then uses these feedbacks to refine its product development efforts and marketing strategies.
c. Operations
Palm, Inc. out-sources all of its manufacturing and hardware designs of its products to third party manufacturers. This outsourcing extends from prototyping to volume manufacturing and includes activities such as material procurement, quality control and delivery to distribution centers. The company is assured that there is an adequate supply of components to manufacture its products. The majority of the company's products are assembled in China and Mexico. Distribution centers are operated on an outsourced basis in Tennessee, Ireland, and Hong Kong.
d. Human Resources
Palm, Inc. knows that its future depends on the company's ability to attract new personnel and retain existing personnel in key areas including engineering and sales. None of the company's employees is subject to a collective bargaining agreement. The company considers its relationship to its employees to be good. As of June 30, 2003, Palm, Inc. has a total of 982 employees operating within a company organization structure. Ed Colligan is the current President and CEO of Palm, Inc., while Jeff Hawkins is the current Chief Technology Officer.
Palm, Inc. Key Ratios
Key Ratios
Valuation Ratios
P/E
23.23
Price to Cash Flow Ratio
17.05
Price To Sales (TTM)
1.25
Price To Book
2.55
Per Share Ratios
Book Value Per Share
0.00
EPS Fully Diluted
1.29
Revenue Per Share
24.77
Profit Margins
Operating Margin
6.32
Net Profit Margin
5.23
Gross Profit Margin
30.00
Growth (%)
5 Year Annual Growth
7.66
Revenue - 5 Year Growth
3.73
EPS - 5 Year Growth
0.00
Financial Strength
Quick Ratio
1.58
Current Ratio
1.72
LT Debt to Equity
6.02
Total Debt to Equity
6.02
Return on Equity (ROE) Per Share
0.00
Return on Assets (ROA)
8.81
Return on Invested Capital (ROIC)
0.00
Assets
Asset Turnover
1.39
Inventory Turnover
34.85
Heineken bases its pricing strategies on several key trends that continuously shape the global marketplace of brewing. One particular trend is labeled as "premium-tization". This phenomenon causes the polarization of different markets. This would then trigger the consumers to demand and pay much higher prices for perceived quality. However, discounting in prices is also simultaneously taking place, therefore squeezing out the middle range. More often than not, supermarkets undergo internationalization which leads to a tighter squeeze for shelf space. This will in turn leave Heineken as a winner. It is for this reason why Heineken values the "premise sector" so much because this would allow consumers can to try their brands at low risk and price.
In terms of market segments, premium lagers and specialty brands of Heineken with higher alcohol content have a disproportionate share of volume growth at an estimated 4-5% per year, as against the 2-3% overall growth rate. These rates come up as a result of both the rise in GDP among developing markets and consumer demands for higher value propositions, which is obviously dominated by international brands. Therefore, Heineken has to increase its portfolio and operate globally to overcome the home market. Heineken practically operates on a relatively fragmented market, with the top four brewing companies accounting for 22% of global beer volume five years ago and only about 28% today.
Showing posts with label Management Essays. Show all posts
Showing posts with label Management Essays. Show all posts
Thursday, March 19, 2009
Management Paper Sample on Balance Sheet and Income Statement
OBJECTIVES
As a person with sufficient knowledge in accounting and finance, the author has always brought up to his superiors the viability of strategy formation regarding the use of accounting and financial statements in making informed business decisions and at times fail to understand the reasons or logic behind certain strategic implementations imposed on.
By delving into this project paper, the author intends to impart insights as to how the use of accounting and financial statements help in making informed business decisions. The author hopes to have an in-depth understanding regarding basic accounting theories, assumptions, and principles as well as analyze the relationship between the balance sheet and the income statement.
In order to reinforce the learning objectives, two key focal issues were focused upon, i.e. innovation and diversity. Innovation was discussed with regard to accounting and finance where both are renowned for their developmental capabilities to constantly innovate. Diversity came under strategic thinking and formation as the use of accounting and financial statements must consider the diverse culture, political climate, economic surroundings, social environment, technological settings, government policies and legal systems in order to make informed business decisions.
REVIEW OF RELATED LITERATURE
A. Accounting & Finance
Accounting can be defined as the process of recording, classification, analysis and interpretation of financial information which in turn is reported to the concerned stakeholders through the financial statements (Ashton, 1974). It requires a record for each and every transaction the business enters into. Accounting has five (5) basic categories. The categories are (1) Assets; (2) Liabilities; (3) Equity; (4) Revenue; and (5) Expense.
Finance, on the other hand, is the study of the methods and means in which individuals and organizations allocate and use their financial resources over time, while at the same time taking into consideration the risks involved in their projects (Dyckman et al. 1978). It consists of three (3) interrelated areas, (1) money and capital markets which pertain to topics regarding macro economics; (2) investments, which pertains to the decisions made by individuals and financial institutions as they select the appropriate securities for their investments portfolios; and (3) managerial finance which pertains to the actual management of the business organization. In general the three areas are interrelated.
B. Balance Sheet & Income Statement
Income Statement pertains to the output of the Accounting System. It informs the various stakeholders involved of the following critical information: (1) Where the business stands in a specified period of time; (2) How the business performed for a specific period of time; (3) How the management's stakes in the business changed for a specified period of time; and (4) Where and how the business organization's financial resources was used in the operation and management of the business for a specified period of time. Balance sheet, on the other hand, pertains to a financial statement indicating the financial position of a business entity at a certain point in time. Users of balance sheets interpret financial position as the status of the business entity financially in a given point in time (Gibbins, 1984).
The primary objectives of both the balance sheet and income statement are to provide information that is reliable and can help in making investment and credit decisions; in making evaluations regarding the amount and uncertainty of future cash flows; and in learning about the business entity's economic resources and changes regarding claims to resources. Some of the most significant characteristics of both the balance sheet and income statement include being a means to an end, being historical in nature, and being based on a general-purpose assumption. The balance sheet and income statement are both useful to the business entity with regards to achieving its objectives and corporate mission; evaluation of past performance and future plans; and assessment and rewarding decision-making performance.
C. Using Accounting and Financial Statements
Accounting is the method by which information regarding a business organization is communicated. This is the reason why it is more often referred to as the language of business. Many different stakeholders have the need for accounting information in order to make informed business decisions. These stakeholders include investors, creditors, governmental agencies and others. Because the main objective of accounting and financial information is the provision of reliable data and information for decision-making purposes, it is more commonly referred to as a means to an end, with the end pertaining to the decision that is supported by the presence of accurate and reliable accounting data and information.
COMPANY OVERVIEW 1
A. Palm, Incorporated
Palm, Inc. aims for sustainable growth as a broad market leader in mobile computing as well as for segment leadership. In both cases, the Palm, Inc. brands will play a crucial part. Palm, Inc. is able to establish its broad leadership usually by acquiring other strong mobile computing companies and their products, which are then combined into a new, larger company. Offering training to its employees, improving the company operations, and the introduction of new technologies then reinforces the positions of the various Palm products. This practically results in economies of scale that is able to create a distribution network for both the local and international Palm products. If a market is already in the control of other mobile computing companies, Palm, Inc. devotes its attention towards the development of a premium segment with its various Palm products.
The mission of Palm, Inc. is to secure the growth of the business in a sustainable manner, while at the same time constantly improving the company's profitability. The strategy to achieve this involves four elements:
1. Striving in order to reach a leading position in attractive markets
2. Focusing on securing a competitive share of the mobile computing market segments.
3. Working in order to improve the company's efficiency and cut costs in operations.
4. Continuous growth through selective acquisitions for as long as they are able to create shareholder value.
B. Financial Statements
To be useful and helpful to the various stakeholders involved, accounting and financial statements of Palm, Inc. are:
* Relevant: relevant accounting and financial statements of Palm, Inc. make a significant impact and difference in its decision-making. It also helps the various stakeholders of Palm, Inc. involved to make predictions regarding the past, present and future events. Relevant accounting and financial information also helps the stakeholders confirm prior expectations. It is also must be ready before decisions are made.
* Reliable: reliable accounting and financial statements of Palm, Inc. have been proven and verified, neutral, and presents only truthful information.
C. Accounting principles in consideration
* The historical cost principle makes it imperative for Palm, Inc. to perform their accounting and reporting measures based on the acquisition costs rather than fair market value for the majority of assets and liabilities. This principle guides Palm, Inc to relate data and financial statements that are accurate, thereby removing the opportunity of providing biased market values, but not very relevant. Therefore, there involves a trend of utilizing prudent values. Most debts are now being reported at their actual market values.
* The revenue recognition principle makes it imperative for Palm, Inc. to perform recording only when revenue can be (1) realized or realizable and (2) earned, not when cash is received. This method of accounting is commonly termed as accrual basis accounting.
D. Assumptions in consideration
* Economic Entity Assumption pertains to Palm, Inc.'s assumption that its business per se must be separated from its owners or other businesses. Revenues and expenses must have a distinction from personal expenses. This is applicable even for partnerships and sole proprietorships. The entity concept does not automatically pertain to a legal entity.
* Going Concern Assumption pertains to Palm, Inc.'s assumption that its business will remain strong and functional for a long period of time. This validates the terms asset capitalization and amortization. Only when liquidation is sure to happen will this assumption become null.
E. Resulting competitive advantage
Among the competitive advantages enjoyed by Palm, Inc. because of their efficient accounting system are:
· Economies of Scale and Scope in manufacturing and research and development arising from its numerous facilities situated in the United States and other countries worldwide.
· Unique Quality Technology owing to heavy emphasis on research
Palm, Inc.'s commitment to research & development activities has always been one of its top strategies to remain competitive in the market.
· Differentiated Products
Through the production and marketing of differentiated products originating from their research and development activities, Palm, Inc. is able to create its own firm-specific advantages. The continuous pursuit of research and development processes enables Palm, Inc. to produce a steady stream of originally differentiated products which makes it difficult for competitors to find substitutes. Because of this differentiated approach, Palm, Inc. is able to market their products worldwide, which enables them in turn to maximize the returns on research and development expenditures.
COMPANY OVERVIEW 2
A. Heineken
Heineken is one of the world's leading brewing companies in terms of profit and sales volume. The company has also the widest presence among all international brewing companies. This is made possible through a positioning strategy of global networking of breweries and distributors.
In terms of volume, Heineken is the largest beverage and brewer distributor in Europe. The company also balances stable and profitable markets in Europe and North America. In recent years, Heineken has initiated efforts to solidify its presence in the Asia Pacific Region through the acquisitions of beer markets in China and Russia.
The Heineken brand is one of the world's most valuable international premium beer brand. Heineken uses the name of both the company and its mainstream beer label, and this strategy has allowed the company to pursue an integrated marketing approach directly related to the company name.
Heineken, as a leader in their industry, has implemented various strategies to fully adapt to the need to go global. However, it is more important for Heineken to implement a more sober approach to maintain consumer loyalty with their local brands. This is primarily due to the consolidation and globalization that are taking place across most industries, including the brewing industry.
B. Financial Statements
To be useful and helpful to the various stakeholders involved, accounting and financial statements of Heineken are:
* Comparable: accounting and financial statements of Heineken are comparable. This is done by reporting the results in the same manner for different business organizations.
* Consistent: consistent accounting methods of Heineken can be applied from period to period, and all alterations done in the methods must be justified.
C. Accounting principles in consideration
* The matching principle means that expenses within Heineken need to be matched with revenues for as long as it is reasonable to do so. Expenses within Heineken cannot be recognized whenever the task is done, or whenever a product or service is produced, but only when the task or the product has been proven to steadily contribute to the revenue. If there is no connection that can be made with revenue, then that's the time that costs can be charged as expenses to the present period. Therefore, this principle allows greater assessment of actual financial gains and performance of Heineken (Libby, 1978).
* The full disclosure principle means that the amount and types of financial data and information within Heineken that will be revealed must be decided on the basis of trade-off analysis. This is because bigger amounts of information cost a lot more for the preparations and utilization. Financial data and information within Heineken that will be revealed should be enough to make prudent decisions while keeping costs justifiable. Accurate information must be presented either in the main body of financial statements or as supplementary information.
D. Assumptions in consideration
* Monetary Unit Assumption pertains to Heineken's assumption that a stabilized currency is going to be the unit of record. The FASB recognizes the nominal value of the US Dollar as the standard monetary unit of record.
* Periodicity Assumption pertains to Heineken's assumption that its business operations can be monitored and separated into months, quarters and years. This is a must to enable comparison between present and past performance (Goennedes et al. 1974).
CONCLUSION
The results of the analysis carried out on the managerial accounting and financial reporting of Palm, Inc. and Heineken indicated very significant effects, even amidst the threats of unrest. Therefore, we could conclude that the managerial accounting and financial reporting of Palm, Inc. and Heineken could still be expected to improve faster than average.
The review of Palm, Inc. and Heineken's the managerial accounting and financial reporting capabilities and resources revealed very little inconsistencies regarding their strategies. This is coherent with their traditional inside-out approach. However, the need to reconcile both the inside-out and outside-in approaches becomes imperative now for both companies.
The analysis among the environment as well as the managerial accounting and financial reporting capabilities of Palm, Inc. and Heineken revealed certain gaps, most of which are biased towards the environment. However, these gaps paved the way towards determining a number of recommended strategic options to secure the competitiveness of both companies.
Also, both Palm, Inc. and Heineken have to find a balance between adherence to internal forces within the management and to the changing forces of the environment in order to implement such strategic options.
APPENDICES
Measuring Palm, Inc.'s Performance
a. Financial Analysis
In the fiscal year of 2003, Palm, Inc. was able to experience a significant progress in several key metrics. The inventory was reduced from $55 million to $23 million and inventory turns rose from 12 to 26. The cost of revenues, excluding the benefit from previous special charges and the applicable portion of the amortization of intangible assets, decreased from 72.3% of revenues to 67.8% of revenues. The combination of sales and marketing, research and development, and general and administrative expenses was reduced from $ 435 million to $339 million, while at the same time improving on the pace of innovation. Palm, Inc.'s total revenue has approximately grown from $1 million in fiscal year 1995 to $ 871. 9 million in fiscal year 2003.
b. Marketing
The retailers in the United States represent Palm, Inc.'s largest sales and marketing channel which encompass national and regional office supply stores and mass merchants. Distributors represent Palm, Inc.'s second largest United States channel and generally sell to both traditional and Internet resellers and retailers. In Europe and Asia, Palm, Inc.'s market share is still relatively high. Palm, Inc. has more than 100 international distributors located worldwide.
The company uses the Palm.com store as a venue to sell its products. This is accomplished through the use of e-marketing campaigns and product bundles. The company is able to build awareness of its products and brands through mass media advertising, public relations efforts and branded Internet properties. The company also makes it a point to receive feedback from its customers through market research. The company then uses these feedbacks to refine its product development efforts and marketing strategies.
c. Operations
Palm, Inc. out-sources all of its manufacturing and hardware designs of its products to third party manufacturers. This outsourcing extends from prototyping to volume manufacturing and includes activities such as material procurement, quality control and delivery to distribution centers. The company is assured that there is an adequate supply of components to manufacture its products. The majority of the company's products are assembled in China and Mexico. Distribution centers are operated on an outsourced basis in Tennessee, Ireland, and Hong Kong.
d. Human Resources
Palm, Inc. knows that its future depends on the company's ability to attract new personnel and retain existing personnel in key areas including engineering and sales. None of the company's employees is subject to a collective bargaining agreement. The company considers its relationship to its employees to be good. As of June 30, 2003, Palm, Inc. has a total of 982 employees operating within a company organization structure. Ed Colligan is the current President and CEO of Palm, Inc., while Jeff Hawkins is the current Chief Technology Officer.
Palm, Inc. Key Ratios
Key Ratios
Valuation Ratios
P/E
23.23
Price to Cash Flow Ratio
17.05
Price To Sales (TTM)
1.25
Price To Book
2.55
Per Share Ratios
Book Value Per Share
0.00
EPS Fully Diluted
1.29
Revenue Per Share
24.77
Profit Margins
Operating Margin
6.32
Net Profit Margin
5.23
Gross Profit Margin
30.00
Growth (%)
5 Year Annual Growth
7.66
Revenue - 5 Year Growth
3.73
EPS - 5 Year Growth
0.00
Financial Strength
Quick Ratio
1.58
Current Ratio
1.72
LT Debt to Equity
6.02
Total Debt to Equity
6.02
Return on Equity (ROE) Per Share
0.00
Return on Assets (ROA)
8.81
Return on Invested Capital (ROIC)
0.00
Assets
Asset Turnover
1.39
Inventory Turnover
34.85
Heineken bases its pricing strategies on several key trends that continuously shape the global marketplace of brewing. One particular trend is labeled as "premium-tization". This phenomenon causes the polarization of different markets. This would then trigger the consumers to demand and pay much higher prices for perceived quality. However, discounting in prices is also simultaneously taking place, therefore squeezing out the middle range. More often than not, supermarkets undergo internationalization which leads to a tighter squeeze for shelf space. This will in turn leave Heineken as a winner. It is for this reason why Heineken values the "premise sector" so much because this would allow consumers can to try their brands at low risk and price.
In terms of market segments, premium lagers and specialty brands of Heineken with higher alcohol content have a disproportionate share of volume growth at an estimated 4-5% per year, as against the 2-3% overall growth rate. These rates come up as a result of both the rise in GDP among developing markets and consumer demands for higher value propositions, which is obviously dominated by international brands. Therefore, Heineken has to increase its portfolio and operate globally to overcome the home market. Heineken practically operates on a relatively fragmented market, with the top four brewing companies accounting for 22% of global beer volume five years ago and only about 28% today.
As a person with sufficient knowledge in accounting and finance, the author has always brought up to his superiors the viability of strategy formation regarding the use of accounting and financial statements in making informed business decisions and at times fail to understand the reasons or logic behind certain strategic implementations imposed on.
By delving into this project paper, the author intends to impart insights as to how the use of accounting and financial statements help in making informed business decisions. The author hopes to have an in-depth understanding regarding basic accounting theories, assumptions, and principles as well as analyze the relationship between the balance sheet and the income statement.
In order to reinforce the learning objectives, two key focal issues were focused upon, i.e. innovation and diversity. Innovation was discussed with regard to accounting and finance where both are renowned for their developmental capabilities to constantly innovate. Diversity came under strategic thinking and formation as the use of accounting and financial statements must consider the diverse culture, political climate, economic surroundings, social environment, technological settings, government policies and legal systems in order to make informed business decisions.
REVIEW OF RELATED LITERATURE
A. Accounting & Finance
Accounting can be defined as the process of recording, classification, analysis and interpretation of financial information which in turn is reported to the concerned stakeholders through the financial statements (Ashton, 1974). It requires a record for each and every transaction the business enters into. Accounting has five (5) basic categories. The categories are (1) Assets; (2) Liabilities; (3) Equity; (4) Revenue; and (5) Expense.
Finance, on the other hand, is the study of the methods and means in which individuals and organizations allocate and use their financial resources over time, while at the same time taking into consideration the risks involved in their projects (Dyckman et al. 1978). It consists of three (3) interrelated areas, (1) money and capital markets which pertain to topics regarding macro economics; (2) investments, which pertains to the decisions made by individuals and financial institutions as they select the appropriate securities for their investments portfolios; and (3) managerial finance which pertains to the actual management of the business organization. In general the three areas are interrelated.
B. Balance Sheet & Income Statement
Income Statement pertains to the output of the Accounting System. It informs the various stakeholders involved of the following critical information: (1) Where the business stands in a specified period of time; (2) How the business performed for a specific period of time; (3) How the management's stakes in the business changed for a specified period of time; and (4) Where and how the business organization's financial resources was used in the operation and management of the business for a specified period of time. Balance sheet, on the other hand, pertains to a financial statement indicating the financial position of a business entity at a certain point in time. Users of balance sheets interpret financial position as the status of the business entity financially in a given point in time (Gibbins, 1984).
The primary objectives of both the balance sheet and income statement are to provide information that is reliable and can help in making investment and credit decisions; in making evaluations regarding the amount and uncertainty of future cash flows; and in learning about the business entity's economic resources and changes regarding claims to resources. Some of the most significant characteristics of both the balance sheet and income statement include being a means to an end, being historical in nature, and being based on a general-purpose assumption. The balance sheet and income statement are both useful to the business entity with regards to achieving its objectives and corporate mission; evaluation of past performance and future plans; and assessment and rewarding decision-making performance.
C. Using Accounting and Financial Statements
Accounting is the method by which information regarding a business organization is communicated. This is the reason why it is more often referred to as the language of business. Many different stakeholders have the need for accounting information in order to make informed business decisions. These stakeholders include investors, creditors, governmental agencies and others. Because the main objective of accounting and financial information is the provision of reliable data and information for decision-making purposes, it is more commonly referred to as a means to an end, with the end pertaining to the decision that is supported by the presence of accurate and reliable accounting data and information.
COMPANY OVERVIEW 1
A. Palm, Incorporated
Palm, Inc. aims for sustainable growth as a broad market leader in mobile computing as well as for segment leadership. In both cases, the Palm, Inc. brands will play a crucial part. Palm, Inc. is able to establish its broad leadership usually by acquiring other strong mobile computing companies and their products, which are then combined into a new, larger company. Offering training to its employees, improving the company operations, and the introduction of new technologies then reinforces the positions of the various Palm products. This practically results in economies of scale that is able to create a distribution network for both the local and international Palm products. If a market is already in the control of other mobile computing companies, Palm, Inc. devotes its attention towards the development of a premium segment with its various Palm products.
The mission of Palm, Inc. is to secure the growth of the business in a sustainable manner, while at the same time constantly improving the company's profitability. The strategy to achieve this involves four elements:
1. Striving in order to reach a leading position in attractive markets
2. Focusing on securing a competitive share of the mobile computing market segments.
3. Working in order to improve the company's efficiency and cut costs in operations.
4. Continuous growth through selective acquisitions for as long as they are able to create shareholder value.
B. Financial Statements
To be useful and helpful to the various stakeholders involved, accounting and financial statements of Palm, Inc. are:
* Relevant: relevant accounting and financial statements of Palm, Inc. make a significant impact and difference in its decision-making. It also helps the various stakeholders of Palm, Inc. involved to make predictions regarding the past, present and future events. Relevant accounting and financial information also helps the stakeholders confirm prior expectations. It is also must be ready before decisions are made.
* Reliable: reliable accounting and financial statements of Palm, Inc. have been proven and verified, neutral, and presents only truthful information.
C. Accounting principles in consideration
* The historical cost principle makes it imperative for Palm, Inc. to perform their accounting and reporting measures based on the acquisition costs rather than fair market value for the majority of assets and liabilities. This principle guides Palm, Inc to relate data and financial statements that are accurate, thereby removing the opportunity of providing biased market values, but not very relevant. Therefore, there involves a trend of utilizing prudent values. Most debts are now being reported at their actual market values.
* The revenue recognition principle makes it imperative for Palm, Inc. to perform recording only when revenue can be (1) realized or realizable and (2) earned, not when cash is received. This method of accounting is commonly termed as accrual basis accounting.
D. Assumptions in consideration
* Economic Entity Assumption pertains to Palm, Inc.'s assumption that its business per se must be separated from its owners or other businesses. Revenues and expenses must have a distinction from personal expenses. This is applicable even for partnerships and sole proprietorships. The entity concept does not automatically pertain to a legal entity.
* Going Concern Assumption pertains to Palm, Inc.'s assumption that its business will remain strong and functional for a long period of time. This validates the terms asset capitalization and amortization. Only when liquidation is sure to happen will this assumption become null.
E. Resulting competitive advantage
Among the competitive advantages enjoyed by Palm, Inc. because of their efficient accounting system are:
· Economies of Scale and Scope in manufacturing and research and development arising from its numerous facilities situated in the United States and other countries worldwide.
· Unique Quality Technology owing to heavy emphasis on research
Palm, Inc.'s commitment to research & development activities has always been one of its top strategies to remain competitive in the market.
· Differentiated Products
Through the production and marketing of differentiated products originating from their research and development activities, Palm, Inc. is able to create its own firm-specific advantages. The continuous pursuit of research and development processes enables Palm, Inc. to produce a steady stream of originally differentiated products which makes it difficult for competitors to find substitutes. Because of this differentiated approach, Palm, Inc. is able to market their products worldwide, which enables them in turn to maximize the returns on research and development expenditures.
COMPANY OVERVIEW 2
A. Heineken
Heineken is one of the world's leading brewing companies in terms of profit and sales volume. The company has also the widest presence among all international brewing companies. This is made possible through a positioning strategy of global networking of breweries and distributors.
In terms of volume, Heineken is the largest beverage and brewer distributor in Europe. The company also balances stable and profitable markets in Europe and North America. In recent years, Heineken has initiated efforts to solidify its presence in the Asia Pacific Region through the acquisitions of beer markets in China and Russia.
The Heineken brand is one of the world's most valuable international premium beer brand. Heineken uses the name of both the company and its mainstream beer label, and this strategy has allowed the company to pursue an integrated marketing approach directly related to the company name.
Heineken, as a leader in their industry, has implemented various strategies to fully adapt to the need to go global. However, it is more important for Heineken to implement a more sober approach to maintain consumer loyalty with their local brands. This is primarily due to the consolidation and globalization that are taking place across most industries, including the brewing industry.
B. Financial Statements
To be useful and helpful to the various stakeholders involved, accounting and financial statements of Heineken are:
* Comparable: accounting and financial statements of Heineken are comparable. This is done by reporting the results in the same manner for different business organizations.
* Consistent: consistent accounting methods of Heineken can be applied from period to period, and all alterations done in the methods must be justified.
C. Accounting principles in consideration
* The matching principle means that expenses within Heineken need to be matched with revenues for as long as it is reasonable to do so. Expenses within Heineken cannot be recognized whenever the task is done, or whenever a product or service is produced, but only when the task or the product has been proven to steadily contribute to the revenue. If there is no connection that can be made with revenue, then that's the time that costs can be charged as expenses to the present period. Therefore, this principle allows greater assessment of actual financial gains and performance of Heineken (Libby, 1978).
* The full disclosure principle means that the amount and types of financial data and information within Heineken that will be revealed must be decided on the basis of trade-off analysis. This is because bigger amounts of information cost a lot more for the preparations and utilization. Financial data and information within Heineken that will be revealed should be enough to make prudent decisions while keeping costs justifiable. Accurate information must be presented either in the main body of financial statements or as supplementary information.
D. Assumptions in consideration
* Monetary Unit Assumption pertains to Heineken's assumption that a stabilized currency is going to be the unit of record. The FASB recognizes the nominal value of the US Dollar as the standard monetary unit of record.
* Periodicity Assumption pertains to Heineken's assumption that its business operations can be monitored and separated into months, quarters and years. This is a must to enable comparison between present and past performance (Goennedes et al. 1974).
CONCLUSION
The results of the analysis carried out on the managerial accounting and financial reporting of Palm, Inc. and Heineken indicated very significant effects, even amidst the threats of unrest. Therefore, we could conclude that the managerial accounting and financial reporting of Palm, Inc. and Heineken could still be expected to improve faster than average.
The review of Palm, Inc. and Heineken's the managerial accounting and financial reporting capabilities and resources revealed very little inconsistencies regarding their strategies. This is coherent with their traditional inside-out approach. However, the need to reconcile both the inside-out and outside-in approaches becomes imperative now for both companies.
The analysis among the environment as well as the managerial accounting and financial reporting capabilities of Palm, Inc. and Heineken revealed certain gaps, most of which are biased towards the environment. However, these gaps paved the way towards determining a number of recommended strategic options to secure the competitiveness of both companies.
Also, both Palm, Inc. and Heineken have to find a balance between adherence to internal forces within the management and to the changing forces of the environment in order to implement such strategic options.
APPENDICES
Measuring Palm, Inc.'s Performance
a. Financial Analysis
In the fiscal year of 2003, Palm, Inc. was able to experience a significant progress in several key metrics. The inventory was reduced from $55 million to $23 million and inventory turns rose from 12 to 26. The cost of revenues, excluding the benefit from previous special charges and the applicable portion of the amortization of intangible assets, decreased from 72.3% of revenues to 67.8% of revenues. The combination of sales and marketing, research and development, and general and administrative expenses was reduced from $ 435 million to $339 million, while at the same time improving on the pace of innovation. Palm, Inc.'s total revenue has approximately grown from $1 million in fiscal year 1995 to $ 871. 9 million in fiscal year 2003.
b. Marketing
The retailers in the United States represent Palm, Inc.'s largest sales and marketing channel which encompass national and regional office supply stores and mass merchants. Distributors represent Palm, Inc.'s second largest United States channel and generally sell to both traditional and Internet resellers and retailers. In Europe and Asia, Palm, Inc.'s market share is still relatively high. Palm, Inc. has more than 100 international distributors located worldwide.
The company uses the Palm.com store as a venue to sell its products. This is accomplished through the use of e-marketing campaigns and product bundles. The company is able to build awareness of its products and brands through mass media advertising, public relations efforts and branded Internet properties. The company also makes it a point to receive feedback from its customers through market research. The company then uses these feedbacks to refine its product development efforts and marketing strategies.
c. Operations
Palm, Inc. out-sources all of its manufacturing and hardware designs of its products to third party manufacturers. This outsourcing extends from prototyping to volume manufacturing and includes activities such as material procurement, quality control and delivery to distribution centers. The company is assured that there is an adequate supply of components to manufacture its products. The majority of the company's products are assembled in China and Mexico. Distribution centers are operated on an outsourced basis in Tennessee, Ireland, and Hong Kong.
d. Human Resources
Palm, Inc. knows that its future depends on the company's ability to attract new personnel and retain existing personnel in key areas including engineering and sales. None of the company's employees is subject to a collective bargaining agreement. The company considers its relationship to its employees to be good. As of June 30, 2003, Palm, Inc. has a total of 982 employees operating within a company organization structure. Ed Colligan is the current President and CEO of Palm, Inc., while Jeff Hawkins is the current Chief Technology Officer.
Palm, Inc. Key Ratios
Key Ratios
Valuation Ratios
P/E
23.23
Price to Cash Flow Ratio
17.05
Price To Sales (TTM)
1.25
Price To Book
2.55
Per Share Ratios
Book Value Per Share
0.00
EPS Fully Diluted
1.29
Revenue Per Share
24.77
Profit Margins
Operating Margin
6.32
Net Profit Margin
5.23
Gross Profit Margin
30.00
Growth (%)
5 Year Annual Growth
7.66
Revenue - 5 Year Growth
3.73
EPS - 5 Year Growth
0.00
Financial Strength
Quick Ratio
1.58
Current Ratio
1.72
LT Debt to Equity
6.02
Total Debt to Equity
6.02
Return on Equity (ROE) Per Share
0.00
Return on Assets (ROA)
8.81
Return on Invested Capital (ROIC)
0.00
Assets
Asset Turnover
1.39
Inventory Turnover
34.85
Heineken bases its pricing strategies on several key trends that continuously shape the global marketplace of brewing. One particular trend is labeled as "premium-tization". This phenomenon causes the polarization of different markets. This would then trigger the consumers to demand and pay much higher prices for perceived quality. However, discounting in prices is also simultaneously taking place, therefore squeezing out the middle range. More often than not, supermarkets undergo internationalization which leads to a tighter squeeze for shelf space. This will in turn leave Heineken as a winner. It is for this reason why Heineken values the "premise sector" so much because this would allow consumers can to try their brands at low risk and price.
In terms of market segments, premium lagers and specialty brands of Heineken with higher alcohol content have a disproportionate share of volume growth at an estimated 4-5% per year, as against the 2-3% overall growth rate. These rates come up as a result of both the rise in GDP among developing markets and consumer demands for higher value propositions, which is obviously dominated by international brands. Therefore, Heineken has to increase its portfolio and operate globally to overcome the home market. Heineken practically operates on a relatively fragmented market, with the top four brewing companies accounting for 22% of global beer volume five years ago and only about 28% today.
Saturday, March 7, 2009
Kerala Tourism
Introduction
India is the seventh largest country in South Asia and ranked second in terms of the population. The country is composed of 28 states, one of which is Kerala. This Indian state is now starting to build its name regarding the prevailing promotion of medical tourism in less developed countries. Recently, Kerala was recognized by the UNICEF and the World Health Organization as the world's first "baby-friendly state". The state's international recognition just help them to be more motivated regarding their health care system that they have been engaging with in the past few years.
Several opinions have been implied regarding this matter. Mostly, people would ask, how such an obscure state from a not so developed country acquire such recognition from international organization. The industry of medical tourism continuously invades under dog regions within the globe. A lot of opportunities have knock on their doors that gives them the chance to prove something despite of the massive global competition.
What make Kerala distinct from others who have been in the same business is that the state promotes their traditional way of health care system. The Ayurvedic treatment is now capturing the attention of the people, especially in the western country where such practice is every unusual.
All about Kerala
The "land of coconut tress", this is what the name Kerala actually means. Aside from being considered as the pioneering health and medical tourism in India, this state also kept some alluring secrets behind it that will truly captivate the heart of many tourists. Kerala is one of the exotic destinations of the world and over the recent years its popularity has also increases. In fact, the National Geographic travel magazine considered the state among the fifty must see locations in the entire world. With this, the Tourism Department of the state launched various promotions of Kerala's natural beauty, breathtaking landscape and tropical beaches. They even come up with the slogan "God's Own Country" which results to a significant reflux of tourist and foreign visitors.
Kerala is such a paradise for individuals who have been there for whatever reason. It may be for some sort of exploration with its nature or may be for its health care system. Although the state is located in a third world country, the state of Kerala manages to reinvent itself and provide the most appropriate needs that they can render.
It was during the 50's when the state has a State Hospitality Department which usually tends to run a guest house and other arrangements among the VIPs. Also still at that time, they weren't enough facilities such as hotels to accommodate foreign visitors that is why the guest houses where used for their lodging. After a decade, they have started to encounter a large traffic of tourist. This event gave them the idea that there are a lot of opportunity on the hotel sector that why the government since then implemented a separate department on it.
After acquiring a separate Tourism Department, the state soon realizes that there is a huge market for health tourism. The good thing about Kerala's concept in health tourism is that they remained faithful regarding their culture and beliefs. They have been incorporated their own techniques in medication without sacrificing the true essence of providing proper health care. Part of their general notion is to implement the Ayurveda or the Ayurvedic Medicine. This is an ancient Hindu system of health care that is native to the Indian Subcontinent. The word Ayurveda was roughly translated as the "knowledge of a long life". The Ayurveda is merely concerned with the measures to protect life, which includes healthy living among the therapeutic measures that relate to physical, mental, social and spiritual harmony. This is also considered one among the few traditional systems of medicine to contain a sophisticated system of surgery which they called "salya-chikitsa". By incorporating the method of Ayurveda, they still manage to provide every foreign visitor a taste of their culture.
According to Suman, the director of the tourism department in Kerala, it was about a decade ago when the state starts promoting the method of Ayurveda in a large scale. Since then, it was globally acknowledge and he even emphasized that they don't even need to market Ayurveda from scratch for it becomes a global term.
Aside from being known for Ayurveda, the state is also considered as the first baby-friendly state in the world. This becomes possible because Kerala have maintained their central focus on primary education and healths care which very unusual among the states in India. It is also the only state in the country wherein the sub-replacement fertility is implemented. This means that Kerala is now being associated with the developed countries such as Canada, Japan, Russia, United States of America and United Kingdom wherein the sub-replacement fertility rate is approximately below 2.1 children per woman's life time.
Conclusion
Kerala have been giving their health tourism a boost. The eye-catching sceneries and traditional health care system really becomes a perfect combination to lead their state at the top of the fierce competition in medical tourism. They were lucky enough to be blessed with such natural wonders that become very much advantageous to them in the promotion of tourism.
It would be very much adequate if they manage to continue such practices among the entire state and also within the entire country of India. Their highly develop health care system really enables them to attract foreign patients from abroad.
Moreover, the government of the State of Kerala is noticeably very responsible enough to come up with activities that would be beneficial not only for the state but as well as the inhabitants of the state. They become capable of eliminating poverty, unemployment and suicide rates within their area. Hence, if one is capable of providing such changes that will result to good outcome to the welfare of the state and the people, then this should be considered as a change among other states in India and even the other nation within the globe.
India is the seventh largest country in South Asia and ranked second in terms of the population. The country is composed of 28 states, one of which is Kerala. This Indian state is now starting to build its name regarding the prevailing promotion of medical tourism in less developed countries. Recently, Kerala was recognized by the UNICEF and the World Health Organization as the world's first "baby-friendly state". The state's international recognition just help them to be more motivated regarding their health care system that they have been engaging with in the past few years.
Several opinions have been implied regarding this matter. Mostly, people would ask, how such an obscure state from a not so developed country acquire such recognition from international organization. The industry of medical tourism continuously invades under dog regions within the globe. A lot of opportunities have knock on their doors that gives them the chance to prove something despite of the massive global competition.
What make Kerala distinct from others who have been in the same business is that the state promotes their traditional way of health care system. The Ayurvedic treatment is now capturing the attention of the people, especially in the western country where such practice is every unusual.
All about Kerala
The "land of coconut tress", this is what the name Kerala actually means. Aside from being considered as the pioneering health and medical tourism in India, this state also kept some alluring secrets behind it that will truly captivate the heart of many tourists. Kerala is one of the exotic destinations of the world and over the recent years its popularity has also increases. In fact, the National Geographic travel magazine considered the state among the fifty must see locations in the entire world. With this, the Tourism Department of the state launched various promotions of Kerala's natural beauty, breathtaking landscape and tropical beaches. They even come up with the slogan "God's Own Country" which results to a significant reflux of tourist and foreign visitors.
Kerala is such a paradise for individuals who have been there for whatever reason. It may be for some sort of exploration with its nature or may be for its health care system. Although the state is located in a third world country, the state of Kerala manages to reinvent itself and provide the most appropriate needs that they can render.
It was during the 50's when the state has a State Hospitality Department which usually tends to run a guest house and other arrangements among the VIPs. Also still at that time, they weren't enough facilities such as hotels to accommodate foreign visitors that is why the guest houses where used for their lodging. After a decade, they have started to encounter a large traffic of tourist. This event gave them the idea that there are a lot of opportunity on the hotel sector that why the government since then implemented a separate department on it.
After acquiring a separate Tourism Department, the state soon realizes that there is a huge market for health tourism. The good thing about Kerala's concept in health tourism is that they remained faithful regarding their culture and beliefs. They have been incorporated their own techniques in medication without sacrificing the true essence of providing proper health care. Part of their general notion is to implement the Ayurveda or the Ayurvedic Medicine. This is an ancient Hindu system of health care that is native to the Indian Subcontinent. The word Ayurveda was roughly translated as the "knowledge of a long life". The Ayurveda is merely concerned with the measures to protect life, which includes healthy living among the therapeutic measures that relate to physical, mental, social and spiritual harmony. This is also considered one among the few traditional systems of medicine to contain a sophisticated system of surgery which they called "salya-chikitsa". By incorporating the method of Ayurveda, they still manage to provide every foreign visitor a taste of their culture.
According to Suman, the director of the tourism department in Kerala, it was about a decade ago when the state starts promoting the method of Ayurveda in a large scale. Since then, it was globally acknowledge and he even emphasized that they don't even need to market Ayurveda from scratch for it becomes a global term.
Aside from being known for Ayurveda, the state is also considered as the first baby-friendly state in the world. This becomes possible because Kerala have maintained their central focus on primary education and healths care which very unusual among the states in India. It is also the only state in the country wherein the sub-replacement fertility is implemented. This means that Kerala is now being associated with the developed countries such as Canada, Japan, Russia, United States of America and United Kingdom wherein the sub-replacement fertility rate is approximately below 2.1 children per woman's life time.
Conclusion
Kerala have been giving their health tourism a boost. The eye-catching sceneries and traditional health care system really becomes a perfect combination to lead their state at the top of the fierce competition in medical tourism. They were lucky enough to be blessed with such natural wonders that become very much advantageous to them in the promotion of tourism.
It would be very much adequate if they manage to continue such practices among the entire state and also within the entire country of India. Their highly develop health care system really enables them to attract foreign patients from abroad.
Moreover, the government of the State of Kerala is noticeably very responsible enough to come up with activities that would be beneficial not only for the state but as well as the inhabitants of the state. They become capable of eliminating poverty, unemployment and suicide rates within their area. Hence, if one is capable of providing such changes that will result to good outcome to the welfare of the state and the people, then this should be considered as a change among other states in India and even the other nation within the globe.
Kerala Tourism
Introduction
India is the seventh largest country in South Asia and ranked second in terms of the population. The country is composed of 28 states, one of which is Kerala. This Indian state is now starting to build its name regarding the prevailing promotion of medical tourism in less developed countries. Recently, Kerala was recognized by the UNICEF and the World Health Organization as the world's first "baby-friendly state". The state's international recognition just help them to be more motivated regarding their health care system that they have been engaging with in the past few years.
Several opinions have been implied regarding this matter. Mostly, people would ask, how such an obscure state from a not so developed country acquire such recognition from international organization. The industry of medical tourism continuously invades under dog regions within the globe. A lot of opportunities have knock on their doors that gives them the chance to prove something despite of the massive global competition.
What make Kerala distinct from others who have been in the same business is that the state promotes their traditional way of health care system. The Ayurvedic treatment is now capturing the attention of the people, especially in the western country where such practice is every unusual.
All about Kerala
The "land of coconut tress", this is what the name Kerala actually means. Aside from being considered as the pioneering health and medical tourism in India, this state also kept some alluring secrets behind it that will truly captivate the heart of many tourists. Kerala is one of the exotic destinations of the world and over the recent years its popularity has also increases. In fact, the National Geographic travel magazine considered the state among the fifty must see locations in the entire world. With this, the Tourism Department of the state launched various promotions of Kerala's natural beauty, breathtaking landscape and tropical beaches. They even come up with the slogan "God's Own Country" which results to a significant reflux of tourist and foreign visitors.
Kerala is such a paradise for individuals who have been there for whatever reason. It may be for some sort of exploration with its nature or may be for its health care system. Although the state is located in a third world country, the state of Kerala manages to reinvent itself and provide the most appropriate needs that they can render.
It was during the 50's when the state has a State Hospitality Department which usually tends to run a guest house and other arrangements among the VIPs. Also still at that time, they weren't enough facilities such as hotels to accommodate foreign visitors that is why the guest houses where used for their lodging. After a decade, they have started to encounter a large traffic of tourist. This event gave them the idea that there are a lot of opportunity on the hotel sector that why the government since then implemented a separate department on it.
After acquiring a separate Tourism Department, the state soon realizes that there is a huge market for health tourism. The good thing about Kerala's concept in health tourism is that they remained faithful regarding their culture and beliefs. They have been incorporated their own techniques in medication without sacrificing the true essence of providing proper health care. Part of their general notion is to implement the Ayurveda or the Ayurvedic Medicine. This is an ancient Hindu system of health care that is native to the Indian Subcontinent. The word Ayurveda was roughly translated as the "knowledge of a long life". The Ayurveda is merely concerned with the measures to protect life, which includes healthy living among the therapeutic measures that relate to physical, mental, social and spiritual harmony. This is also considered one among the few traditional systems of medicine to contain a sophisticated system of surgery which they called "salya-chikitsa". By incorporating the method of Ayurveda, they still manage to provide every foreign visitor a taste of their culture.
According to Suman, the director of the tourism department in Kerala, it was about a decade ago when the state starts promoting the method of Ayurveda in a large scale. Since then, it was globally acknowledge and he even emphasized that they don't even need to market Ayurveda from scratch for it becomes a global term.
Aside from being known for Ayurveda, the state is also considered as the first baby-friendly state in the world. This becomes possible because Kerala have maintained their central focus on primary education and healths care which very unusual among the states in India. It is also the only state in the country wherein the sub-replacement fertility is implemented. This means that Kerala is now being associated with the developed countries such as Canada, Japan, Russia, United States of America and United Kingdom wherein the sub-replacement fertility rate is approximately below 2.1 children per woman's life time.
Conclusion
Kerala have been giving their health tourism a boost. The eye-catching sceneries and traditional health care system really becomes a perfect combination to lead their state at the top of the fierce competition in medical tourism. They were lucky enough to be blessed with such natural wonders that become very much advantageous to them in the promotion of tourism.
It would be very much adequate if they manage to continue such practices among the entire state and also within the entire country of India. Their highly develop health care system really enables them to attract foreign patients from abroad.
Moreover, the government of the State of Kerala is noticeably very responsible enough to come up with activities that would be beneficial not only for the state but as well as the inhabitants of the state. They become capable of eliminating poverty, unemployment and suicide rates within their area. Hence, if one is capable of providing such changes that will result to good outcome to the welfare of the state and the people, then this should be considered as a change among other states in India and even the other nation within the globe.
India is the seventh largest country in South Asia and ranked second in terms of the population. The country is composed of 28 states, one of which is Kerala. This Indian state is now starting to build its name regarding the prevailing promotion of medical tourism in less developed countries. Recently, Kerala was recognized by the UNICEF and the World Health Organization as the world's first "baby-friendly state". The state's international recognition just help them to be more motivated regarding their health care system that they have been engaging with in the past few years.
Several opinions have been implied regarding this matter. Mostly, people would ask, how such an obscure state from a not so developed country acquire such recognition from international organization. The industry of medical tourism continuously invades under dog regions within the globe. A lot of opportunities have knock on their doors that gives them the chance to prove something despite of the massive global competition.
What make Kerala distinct from others who have been in the same business is that the state promotes their traditional way of health care system. The Ayurvedic treatment is now capturing the attention of the people, especially in the western country where such practice is every unusual.
All about Kerala
The "land of coconut tress", this is what the name Kerala actually means. Aside from being considered as the pioneering health and medical tourism in India, this state also kept some alluring secrets behind it that will truly captivate the heart of many tourists. Kerala is one of the exotic destinations of the world and over the recent years its popularity has also increases. In fact, the National Geographic travel magazine considered the state among the fifty must see locations in the entire world. With this, the Tourism Department of the state launched various promotions of Kerala's natural beauty, breathtaking landscape and tropical beaches. They even come up with the slogan "God's Own Country" which results to a significant reflux of tourist and foreign visitors.
Kerala is such a paradise for individuals who have been there for whatever reason. It may be for some sort of exploration with its nature or may be for its health care system. Although the state is located in a third world country, the state of Kerala manages to reinvent itself and provide the most appropriate needs that they can render.
It was during the 50's when the state has a State Hospitality Department which usually tends to run a guest house and other arrangements among the VIPs. Also still at that time, they weren't enough facilities such as hotels to accommodate foreign visitors that is why the guest houses where used for their lodging. After a decade, they have started to encounter a large traffic of tourist. This event gave them the idea that there are a lot of opportunity on the hotel sector that why the government since then implemented a separate department on it.
After acquiring a separate Tourism Department, the state soon realizes that there is a huge market for health tourism. The good thing about Kerala's concept in health tourism is that they remained faithful regarding their culture and beliefs. They have been incorporated their own techniques in medication without sacrificing the true essence of providing proper health care. Part of their general notion is to implement the Ayurveda or the Ayurvedic Medicine. This is an ancient Hindu system of health care that is native to the Indian Subcontinent. The word Ayurveda was roughly translated as the "knowledge of a long life". The Ayurveda is merely concerned with the measures to protect life, which includes healthy living among the therapeutic measures that relate to physical, mental, social and spiritual harmony. This is also considered one among the few traditional systems of medicine to contain a sophisticated system of surgery which they called "salya-chikitsa". By incorporating the method of Ayurveda, they still manage to provide every foreign visitor a taste of their culture.
According to Suman, the director of the tourism department in Kerala, it was about a decade ago when the state starts promoting the method of Ayurveda in a large scale. Since then, it was globally acknowledge and he even emphasized that they don't even need to market Ayurveda from scratch for it becomes a global term.
Aside from being known for Ayurveda, the state is also considered as the first baby-friendly state in the world. This becomes possible because Kerala have maintained their central focus on primary education and healths care which very unusual among the states in India. It is also the only state in the country wherein the sub-replacement fertility is implemented. This means that Kerala is now being associated with the developed countries such as Canada, Japan, Russia, United States of America and United Kingdom wherein the sub-replacement fertility rate is approximately below 2.1 children per woman's life time.
Conclusion
Kerala have been giving their health tourism a boost. The eye-catching sceneries and traditional health care system really becomes a perfect combination to lead their state at the top of the fierce competition in medical tourism. They were lucky enough to be blessed with such natural wonders that become very much advantageous to them in the promotion of tourism.
It would be very much adequate if they manage to continue such practices among the entire state and also within the entire country of India. Their highly develop health care system really enables them to attract foreign patients from abroad.
Moreover, the government of the State of Kerala is noticeably very responsible enough to come up with activities that would be beneficial not only for the state but as well as the inhabitants of the state. They become capable of eliminating poverty, unemployment and suicide rates within their area. Hence, if one is capable of providing such changes that will result to good outcome to the welfare of the state and the people, then this should be considered as a change among other states in India and even the other nation within the globe.
Quality and Care Governance
INTRODUCTION
The healthcare professions all involve life and death situations. In these situations, quality is crucial and quantity is irrelevant. In my place of employment, there is an increasing incidence of chest infection associated with the use of tracheostomy tubes. The blame is placed on the apparent lack of knowledge of the nursing staff regarding tracheostomy care. It is time to seriously rethink, redesign, redevelop and reinvigorate the way governance is practiced in my current place of employment. There is a need for better quality and care governance.
Clinical governance provides a framework for a coherent, local program of quality improvement and an opportunity to share best practice. For nurses, clinical governance will be about building upon and linking together many of the activities that they are already involved in, which help to promote and improve standards of patient care (Metcalfe, 2002).
This paper presents the problems of increasing incidence of chest infection in my current place of employment and how this problem can be solved by providing solutions designed for the apparent cause of the problem. These solutions will focus on quality and clinical governance. The tools to be used to explore the issue will include SWOT analysis and ___. Theories to be used to resolve the issue will include shared governance and total quality management.
A personal analysis on the presented problem will also be presented and as well as recommendations on how the quality of care can be improved in my place of employment regarding the particular problem.
CONTEXT
Tracheostomy refers to an opening into the trachea where an artificial airway (the tracheostomy tube) is inserted. This is usually performed to protect the patient from accidentally inhaling food, fluid or saliva. Such an airway may be necessary for patients when prolonged ventilation is required, or when an extended coma is anticipated. It may also be placed surgically to maintain the structure of the trachea--when threatened by cancer, infection or trauma, Placement of a tracheostomy is mainly used during the acute phase of an illness and later removed (Wright, 2005).
A client may have a tracheostomy to bypass an upper airway obstruction, prevent aspiration, manage tracheobronchial secretions, or allow for prolonged mechanical ventilation. Whatever the reason for tracheostomy, the client should be provided standardized care in tracheostomy management. Lately, the rising incidence of chest infections in patients undergoing tracheostomy in my place of employment had been largely blamed on the part of the nurses. Such poor quality of practice is a no-no in the healthcare field. If nurses are not aware of the recommended and safe procedure, then the lives of clients are in jeopardy.
Quality in healthcare service and practice provision is very important. The method of quality measurement used by health economists is the QALY. QALY stands for Quality Adjusted Life Year. It is a term developed by health economists for an approach that is concerned with evaluating both effectiveness of treatments and their cost-effectiveness. The outcomes are measured according to a generic scale whereby if a client's treatment is felt to be effective and long-lasting as well as cost-effective, then the patient can increase his/her score on the quality-of-life measure. This technique supports treatments that show improved quality-of-life over a long time and for the least cost (Antony & Preece, 2002).
Since the late 1980s, the topics of quality and performance measurement have become important reporting areas for governance. Various "report card" "scorecard," or "dashboard" measurement sets have been developed for routine reporting to governance on selected important performance areas. These balanced reporting sets may cover, for example, key clinical performance measures, financial performance summaries, satisfaction surveys, and measures related to human resources (such as turnover, time to fill vacancies). Progressive organizations also make the summary level information available for their employees and release the information to the community (Genovich-Richards, et al, 2000).
Clinical governance involves the development of a culture and ways of working that continually improve quality, allowing good practice to be shared, lessons to be learnt from mistakes, and encouraging patient participation. For many nurses, clinical governance will afford the opportunity to formally link together and enhance existing quality improvement activities such as implementing evidence-based practice and care pathway development (Metcalfe, 2002).
Clinical governance can be divided into four key components: clinical effectiveness, human resources, professional self-regulation and risk management (Metcalfe, 2002).
Clinical effectiveness is about doing the right thing at the right time for the right patient. It enables nurses to reflect on why they do what they do for patients and to systematically find and implement better ways of providing care. The activities involved in clinical effectiveness include finding out what is best known practice, appraising the available evidence, changing practice if necessary, and confirming through clinical audit that actual practice is consistent with best practice (Metcalfe, 2002).
The human resources component of the clinical governance framework is about ensuring that healthcare professionals have the right education, adequate training and development, skills and competencies to provide quality patient care. It is also about workforce planning and lifelong learning (Metcalfe, 2002).
Professional self-regulation protects the public as it requires registered practitioners to practice within a code of conduct and is supported by the promotion of good practice, prevention of poor practice, and intervention when practice is poor. Professional self-regulation supports the clinical governance framework by setting professional standards and guidelines that contribute to the creation of an environment in which clinical excellence will flourish (Metcalfe, 2002). In practice, many nurses have experienced real and substantial problems with regulation.
Risk management is about identifying, measuring and controlling those risks that threaten quality or performance in the delivery of patient care (Metcalfe, 2002). Every day, nurses help patients through education, empowerment and expertise to avoid the recognized complications associated with tracheostomy care. They give practical advice and support to people with who underwent tracheostomy to manage risky situations such as an episode of chest infections, encouraging the patient and the family to learn from the event and employ tactics to prevent recurrence. This is a proactive risk management strategy that involves the recognition and identification of things that can go wrong as part of a systematic approach to patient care. Patients are empowered to respond appropriately in a risky situation.
Implementation of shared governance initiatives or other structures that promote autonomy, control of practice, and empowerment of nurses have been identified as key strategies to continue to improve the work environment of nurses (Batson, 2004). This could in turn improve how the nurse delivers care to the clients.
In a shared governance model, each person has an obligation to ensure that his or her skills and knowledge make a positive contribution and to work efficiently and effectively (Batson, 2004). Shared governance is a collaborative team process in which team members share key leadership roles (Storey, 2004). Shared leadership is empowering employees to act autonomously, be decisive at the point-of-service, and create a shared vision aligned with organizational goals. Shared leadership development and autonomously practicing nurses appear to be the equation for success in delivering quality patient outcomes in today's organized health care delivery systems.
For a shared governance model to work, the nursing leaders must develop skills that go beyond facilitating team and group decision making and assume a transformational role of disrupting the status quo, particularly in situations where evidence-based practice clearly points to a need for rapid change and improvement. Nursing leaders must translate the demand for change into a clear, understandable plan, as well as help staff members handle the chaos and uncertainty that accompany rapid change (Batson, 2004).
ANALYSIS
Strengths (internal)
Weaknesses (internal)
Opportunities (external)
Threats (external)
The SWOT analysis shows that although the hospital is equipped with competent staff, there is still an increase in chest infection in tracheostomy care since majority of the nursing staff are unaware of the recommended practice regarding tracheostomy care resulting to unsafe practice. Good clinical facilities for the tracheostomy procedure are also present in my place of employment.
Coming up with recommendations and implementing them at the place of employment is the most logical thing to do. An improvement for tracheostomy care and a decrease in chest infection incidence is expected as health authorities and the staff supports the programs that are designed for improvement of nursing services and quality of patient care.
Hong Kong's healthcare profession is challenged by the shortage of healthcare professionals. This presents a threat to many areas of nursing practice. Not only that, this is a threat to patient care. If there is a decrease in the number of nursing staff that are competent enough to handle tracheostomy care, the problem regarding the increase in chest infection associated with tracheostomy would not be solved.
It seems that there is also an apparent poor quality of management and leadership in this case resulting to the poor quality of service. To improve quality, organizations have to apply 'Total Quality Management' (TQM) to their organizations to help them plan their efforts. The promise of superior performance through continuous quality improvement has attracted a wide spectrum of business to TQM, with applications reported in many domains including healthcare (Antony & Preece, 2002).
RECOMMENDATIONS
Since the problem in itself roots on the apparent lack of knowledge on the part of the nursing professionals regarding the recommended practice of tracheostomy care, solutions must be also directed on them. The proper ways of performing tracheostomy care as well as the rationale behind each step are found in various medical literatures which can be provided to the nursing staff through educational programs.
In order for each and every staff to be educated and aware of this proper procedure, training or educational programs must be made available. Every nurse must be required to attend such educational training program. It will be an objective for the hospital for all nurses to attend a workshop on providing quality tracheostomy care as well as governance by the end of June 2006.
Once all the nursing staff are thoroughly educated and properly equipped with the knowledge of the recommended practice regarding tracheostomy care, their performance has to be monitored every now and then. They will be assessed on how they perform such care and evaluated if there is a change on how they perform it. It is not enough that after the initial educating sessions they will then be left to do the procedure. Monitoring has to be done in order to ensure that there is a demonstration of safe and proper practice of tracheostomy care.
From these educational programs designed to improve the quality of nursing care that is being offered, it is expected that standards for tracheostomy care will improve by reducing the incidence of chest infections following tracheostomy by the end of 2006.
As already presented in the analysis, there is an all-out support for this endeavor on the part of healthcare authorities and staff. That in itself would help make this project a success. Since they support the project of decreasing the incidence of chest infection, it follows that they would also support this plan of educating the nurses on how to properly perform tracheostomy care.
A one month time frame for properly educating the nursing staff on tracheostomy care is recommended. Granting that the nurses have their hearts in the education process, they will easily learn the recommended practice for tracheostomy care. Standards and objectives have also to be set as this is very important.
The period of monitoring would be the longer period in my recommended strategy. I propose a six-month to one year monitoring period. This would include assessing how each nurse performs the tracheostomy care and also observations on the incidence of client's admission to intensive care unit because of chest infections.
To effectively carry out all of these, strategic planning has to be developed. Strategic planning is crucial in the management of healthcare organizations, even when the characteristics of the healthcare systems vary (Geisler, et al, 2003).
Shared governance should be used as the nursing practice model for this. Shared governance is a dynamic process that promotes collaboration, shared decision making, and accountability for practice through workforce empowerment (Batson, 2004). Although the principles of shared governance are universal, structure and process generally follow the needs of an organization based on its core values, mission, vision, and philosophy.
In moving to a shared governance model in my place of employment, ownership becomes both individual and team ownership because optimal outcomes cannot be achieved without integrated team effort. This transition requires new knowledge and behaviors at each level and results in a paradox as team members have to perform efficiently while practicing new skills that are unfamiliar and uncomfortable (Batson, 2004).
Nursing leaders are needed to guide the nursing staff in the education or training process. They must be able to translate the demand for change in the particular field of tracheostomy care into a clear, understandable plan, as well as help nursing staff members handle the chaos and uncertainty that accompany the rapid change.
In achieving what is needed to be able to provide quality of care to the clients, the nursing staff should also act as a team. If a nurse learns something that is proven to be beneficial in the client's care, then it is encouraged that they will share this with the other members of the nursing staff or if applicable, to the whole healthcare profession with the area of employment.
Management also plays an integral part in all of these. The quality of care delivered after the education and monitoring period could be measured using QALY. Evaluations can be done after the proposed strategies have been implemented.
Applying the four key components of clinical governance to the problem is helpful. The activities involved in clinical effectiveness will include finding out what is the best known practice regarding tracheostomy care, appraising the available evidence, changing the practice by educating the nursing staff, and confirming through monitoring or clinical audit that actual practice is consistent with best practice.
The human resources component of the clinical governance framework would aim to ensure that the nursing staff has the right education, adequate training and development, skills and competencies to provide quality tracheostomy care to patients.
There will be an all-out support for the promotion of good practice, prevention of poor practice, and intervention when practice is poor in tracheostomy care. Professional standards and guidelines that contribute to the creation of an environment where there will be less incidence of chest infections after tracheostomy will be set.
To further improve quality care, nurses must help patients through education, empowerment and expertise to avoid the complications associated with tracheostomy care. The nurses must be able to recognize and identify the things that can go wrong as part of a systematic approach to patient care.
The expected outcome of the recommendations should be a decrease in the incidence of tracheostomy clients developing chest infections within a period of at least six months from the time the educational programs are offered to the nurses. As already pointed out in the first few paragraphs of this paper, the reason why there is an increase in the incidence of clients developing chest infections is because of improper tracheostomy management on the part of the nurses. Therefore, the recommendations are more aimed at the nursing staff with emphasis on quality and care governance.
CONCLUSION
In my place of employment, there is a growing problem regarding the development of infection in tracheostomy patients. It has been found out that the reason for this is the apparent lack of knowledge of the majority of our nursing staff regarding the recommended and safe practice for tracheostomy care.
As part of the large whole of the healthcare organization, and as nurses who are in the frontline of delivering care to clients, it is our duty and responsibility to provide the best quality of care to our clients. But this has not been the case in my place of employment.
To summarize, I have recommended a training or education program for the nursing staff.
This program will educate the nurses on the recommended practice of tracheostomy care. Every procedure that is involved will be taught and the rationale behind the procedure will also be given. After the initial education program, the staff will be periodically monitored. The incidence of chest infection will likewise be monitored and observed if there is a significant decrease since implanting the recommended strategy. Monitoring the implementation of health policy and evaluating the impact of the outcome has to be well developed.
To effectively carry out the recommendations and in the process improve the quality of care in tracheostomy patients, there should be a collaboration and support of healthcare professionals within my place of employment. Strategic planning should also be employed. Effective teamwork and good communication are essential to the success of quality and care governance. Change can result if there is unity within the organization. Clinical governance is about linking together many activities that affect the delivery of patient care.
The healthcare professions all involve life and death situations. In these situations, quality is crucial and quantity is irrelevant. In my place of employment, there is an increasing incidence of chest infection associated with the use of tracheostomy tubes. The blame is placed on the apparent lack of knowledge of the nursing staff regarding tracheostomy care. It is time to seriously rethink, redesign, redevelop and reinvigorate the way governance is practiced in my current place of employment. There is a need for better quality and care governance.
Clinical governance provides a framework for a coherent, local program of quality improvement and an opportunity to share best practice. For nurses, clinical governance will be about building upon and linking together many of the activities that they are already involved in, which help to promote and improve standards of patient care (Metcalfe, 2002).
This paper presents the problems of increasing incidence of chest infection in my current place of employment and how this problem can be solved by providing solutions designed for the apparent cause of the problem. These solutions will focus on quality and clinical governance. The tools to be used to explore the issue will include SWOT analysis and ___. Theories to be used to resolve the issue will include shared governance and total quality management.
A personal analysis on the presented problem will also be presented and as well as recommendations on how the quality of care can be improved in my place of employment regarding the particular problem.
CONTEXT
Tracheostomy refers to an opening into the trachea where an artificial airway (the tracheostomy tube) is inserted. This is usually performed to protect the patient from accidentally inhaling food, fluid or saliva. Such an airway may be necessary for patients when prolonged ventilation is required, or when an extended coma is anticipated. It may also be placed surgically to maintain the structure of the trachea--when threatened by cancer, infection or trauma, Placement of a tracheostomy is mainly used during the acute phase of an illness and later removed (Wright, 2005).
A client may have a tracheostomy to bypass an upper airway obstruction, prevent aspiration, manage tracheobronchial secretions, or allow for prolonged mechanical ventilation. Whatever the reason for tracheostomy, the client should be provided standardized care in tracheostomy management. Lately, the rising incidence of chest infections in patients undergoing tracheostomy in my place of employment had been largely blamed on the part of the nurses. Such poor quality of practice is a no-no in the healthcare field. If nurses are not aware of the recommended and safe procedure, then the lives of clients are in jeopardy.
Quality in healthcare service and practice provision is very important. The method of quality measurement used by health economists is the QALY. QALY stands for Quality Adjusted Life Year. It is a term developed by health economists for an approach that is concerned with evaluating both effectiveness of treatments and their cost-effectiveness. The outcomes are measured according to a generic scale whereby if a client's treatment is felt to be effective and long-lasting as well as cost-effective, then the patient can increase his/her score on the quality-of-life measure. This technique supports treatments that show improved quality-of-life over a long time and for the least cost (Antony & Preece, 2002).
Since the late 1980s, the topics of quality and performance measurement have become important reporting areas for governance. Various "report card" "scorecard," or "dashboard" measurement sets have been developed for routine reporting to governance on selected important performance areas. These balanced reporting sets may cover, for example, key clinical performance measures, financial performance summaries, satisfaction surveys, and measures related to human resources (such as turnover, time to fill vacancies). Progressive organizations also make the summary level information available for their employees and release the information to the community (Genovich-Richards, et al, 2000).
Clinical governance involves the development of a culture and ways of working that continually improve quality, allowing good practice to be shared, lessons to be learnt from mistakes, and encouraging patient participation. For many nurses, clinical governance will afford the opportunity to formally link together and enhance existing quality improvement activities such as implementing evidence-based practice and care pathway development (Metcalfe, 2002).
Clinical governance can be divided into four key components: clinical effectiveness, human resources, professional self-regulation and risk management (Metcalfe, 2002).
Clinical effectiveness is about doing the right thing at the right time for the right patient. It enables nurses to reflect on why they do what they do for patients and to systematically find and implement better ways of providing care. The activities involved in clinical effectiveness include finding out what is best known practice, appraising the available evidence, changing practice if necessary, and confirming through clinical audit that actual practice is consistent with best practice (Metcalfe, 2002).
The human resources component of the clinical governance framework is about ensuring that healthcare professionals have the right education, adequate training and development, skills and competencies to provide quality patient care. It is also about workforce planning and lifelong learning (Metcalfe, 2002).
Professional self-regulation protects the public as it requires registered practitioners to practice within a code of conduct and is supported by the promotion of good practice, prevention of poor practice, and intervention when practice is poor. Professional self-regulation supports the clinical governance framework by setting professional standards and guidelines that contribute to the creation of an environment in which clinical excellence will flourish (Metcalfe, 2002). In practice, many nurses have experienced real and substantial problems with regulation.
Risk management is about identifying, measuring and controlling those risks that threaten quality or performance in the delivery of patient care (Metcalfe, 2002). Every day, nurses help patients through education, empowerment and expertise to avoid the recognized complications associated with tracheostomy care. They give practical advice and support to people with who underwent tracheostomy to manage risky situations such as an episode of chest infections, encouraging the patient and the family to learn from the event and employ tactics to prevent recurrence. This is a proactive risk management strategy that involves the recognition and identification of things that can go wrong as part of a systematic approach to patient care. Patients are empowered to respond appropriately in a risky situation.
Implementation of shared governance initiatives or other structures that promote autonomy, control of practice, and empowerment of nurses have been identified as key strategies to continue to improve the work environment of nurses (Batson, 2004). This could in turn improve how the nurse delivers care to the clients.
In a shared governance model, each person has an obligation to ensure that his or her skills and knowledge make a positive contribution and to work efficiently and effectively (Batson, 2004). Shared governance is a collaborative team process in which team members share key leadership roles (Storey, 2004). Shared leadership is empowering employees to act autonomously, be decisive at the point-of-service, and create a shared vision aligned with organizational goals. Shared leadership development and autonomously practicing nurses appear to be the equation for success in delivering quality patient outcomes in today's organized health care delivery systems.
For a shared governance model to work, the nursing leaders must develop skills that go beyond facilitating team and group decision making and assume a transformational role of disrupting the status quo, particularly in situations where evidence-based practice clearly points to a need for rapid change and improvement. Nursing leaders must translate the demand for change into a clear, understandable plan, as well as help staff members handle the chaos and uncertainty that accompany rapid change (Batson, 2004).
ANALYSIS
Strengths (internal)
- Competent staff
- Good clinical facilities
Weaknesses (internal)
- Lack of education on tracheostomy care
Opportunities (external)
- Health authority support
- Staff support
Threats (external)
- Shortage of staff
The SWOT analysis shows that although the hospital is equipped with competent staff, there is still an increase in chest infection in tracheostomy care since majority of the nursing staff are unaware of the recommended practice regarding tracheostomy care resulting to unsafe practice. Good clinical facilities for the tracheostomy procedure are also present in my place of employment.
Coming up with recommendations and implementing them at the place of employment is the most logical thing to do. An improvement for tracheostomy care and a decrease in chest infection incidence is expected as health authorities and the staff supports the programs that are designed for improvement of nursing services and quality of patient care.
Hong Kong's healthcare profession is challenged by the shortage of healthcare professionals. This presents a threat to many areas of nursing practice. Not only that, this is a threat to patient care. If there is a decrease in the number of nursing staff that are competent enough to handle tracheostomy care, the problem regarding the increase in chest infection associated with tracheostomy would not be solved.
It seems that there is also an apparent poor quality of management and leadership in this case resulting to the poor quality of service. To improve quality, organizations have to apply 'Total Quality Management' (TQM) to their organizations to help them plan their efforts. The promise of superior performance through continuous quality improvement has attracted a wide spectrum of business to TQM, with applications reported in many domains including healthcare (Antony & Preece, 2002).
RECOMMENDATIONS
Since the problem in itself roots on the apparent lack of knowledge on the part of the nursing professionals regarding the recommended practice of tracheostomy care, solutions must be also directed on them. The proper ways of performing tracheostomy care as well as the rationale behind each step are found in various medical literatures which can be provided to the nursing staff through educational programs.
In order for each and every staff to be educated and aware of this proper procedure, training or educational programs must be made available. Every nurse must be required to attend such educational training program. It will be an objective for the hospital for all nurses to attend a workshop on providing quality tracheostomy care as well as governance by the end of June 2006.
Once all the nursing staff are thoroughly educated and properly equipped with the knowledge of the recommended practice regarding tracheostomy care, their performance has to be monitored every now and then. They will be assessed on how they perform such care and evaluated if there is a change on how they perform it. It is not enough that after the initial educating sessions they will then be left to do the procedure. Monitoring has to be done in order to ensure that there is a demonstration of safe and proper practice of tracheostomy care.
From these educational programs designed to improve the quality of nursing care that is being offered, it is expected that standards for tracheostomy care will improve by reducing the incidence of chest infections following tracheostomy by the end of 2006.
As already presented in the analysis, there is an all-out support for this endeavor on the part of healthcare authorities and staff. That in itself would help make this project a success. Since they support the project of decreasing the incidence of chest infection, it follows that they would also support this plan of educating the nurses on how to properly perform tracheostomy care.
A one month time frame for properly educating the nursing staff on tracheostomy care is recommended. Granting that the nurses have their hearts in the education process, they will easily learn the recommended practice for tracheostomy care. Standards and objectives have also to be set as this is very important.
The period of monitoring would be the longer period in my recommended strategy. I propose a six-month to one year monitoring period. This would include assessing how each nurse performs the tracheostomy care and also observations on the incidence of client's admission to intensive care unit because of chest infections.
To effectively carry out all of these, strategic planning has to be developed. Strategic planning is crucial in the management of healthcare organizations, even when the characteristics of the healthcare systems vary (Geisler, et al, 2003).
Shared governance should be used as the nursing practice model for this. Shared governance is a dynamic process that promotes collaboration, shared decision making, and accountability for practice through workforce empowerment (Batson, 2004). Although the principles of shared governance are universal, structure and process generally follow the needs of an organization based on its core values, mission, vision, and philosophy.
In moving to a shared governance model in my place of employment, ownership becomes both individual and team ownership because optimal outcomes cannot be achieved without integrated team effort. This transition requires new knowledge and behaviors at each level and results in a paradox as team members have to perform efficiently while practicing new skills that are unfamiliar and uncomfortable (Batson, 2004).
Nursing leaders are needed to guide the nursing staff in the education or training process. They must be able to translate the demand for change in the particular field of tracheostomy care into a clear, understandable plan, as well as help nursing staff members handle the chaos and uncertainty that accompany the rapid change.
In achieving what is needed to be able to provide quality of care to the clients, the nursing staff should also act as a team. If a nurse learns something that is proven to be beneficial in the client's care, then it is encouraged that they will share this with the other members of the nursing staff or if applicable, to the whole healthcare profession with the area of employment.
Management also plays an integral part in all of these. The quality of care delivered after the education and monitoring period could be measured using QALY. Evaluations can be done after the proposed strategies have been implemented.
Applying the four key components of clinical governance to the problem is helpful. The activities involved in clinical effectiveness will include finding out what is the best known practice regarding tracheostomy care, appraising the available evidence, changing the practice by educating the nursing staff, and confirming through monitoring or clinical audit that actual practice is consistent with best practice.
The human resources component of the clinical governance framework would aim to ensure that the nursing staff has the right education, adequate training and development, skills and competencies to provide quality tracheostomy care to patients.
There will be an all-out support for the promotion of good practice, prevention of poor practice, and intervention when practice is poor in tracheostomy care. Professional standards and guidelines that contribute to the creation of an environment where there will be less incidence of chest infections after tracheostomy will be set.
To further improve quality care, nurses must help patients through education, empowerment and expertise to avoid the complications associated with tracheostomy care. The nurses must be able to recognize and identify the things that can go wrong as part of a systematic approach to patient care.
The expected outcome of the recommendations should be a decrease in the incidence of tracheostomy clients developing chest infections within a period of at least six months from the time the educational programs are offered to the nurses. As already pointed out in the first few paragraphs of this paper, the reason why there is an increase in the incidence of clients developing chest infections is because of improper tracheostomy management on the part of the nurses. Therefore, the recommendations are more aimed at the nursing staff with emphasis on quality and care governance.
CONCLUSION
In my place of employment, there is a growing problem regarding the development of infection in tracheostomy patients. It has been found out that the reason for this is the apparent lack of knowledge of the majority of our nursing staff regarding the recommended and safe practice for tracheostomy care.
As part of the large whole of the healthcare organization, and as nurses who are in the frontline of delivering care to clients, it is our duty and responsibility to provide the best quality of care to our clients. But this has not been the case in my place of employment.
To summarize, I have recommended a training or education program for the nursing staff.
This program will educate the nurses on the recommended practice of tracheostomy care. Every procedure that is involved will be taught and the rationale behind the procedure will also be given. After the initial education program, the staff will be periodically monitored. The incidence of chest infection will likewise be monitored and observed if there is a significant decrease since implanting the recommended strategy. Monitoring the implementation of health policy and evaluating the impact of the outcome has to be well developed.
To effectively carry out the recommendations and in the process improve the quality of care in tracheostomy patients, there should be a collaboration and support of healthcare professionals within my place of employment. Strategic planning should also be employed. Effective teamwork and good communication are essential to the success of quality and care governance. Change can result if there is unity within the organization. Clinical governance is about linking together many activities that affect the delivery of patient care.
Quality and Care Governance
INTRODUCTION
The healthcare professions all involve life and death situations. In these situations, quality is crucial and quantity is irrelevant. In my place of employment, there is an increasing incidence of chest infection associated with the use of tracheostomy tubes. The blame is placed on the apparent lack of knowledge of the nursing staff regarding tracheostomy care. It is time to seriously rethink, redesign, redevelop and reinvigorate the way governance is practiced in my current place of employment. There is a need for better quality and care governance.
Clinical governance provides a framework for a coherent, local program of quality improvement and an opportunity to share best practice. For nurses, clinical governance will be about building upon and linking together many of the activities that they are already involved in, which help to promote and improve standards of patient care (Metcalfe, 2002).
This paper presents the problems of increasing incidence of chest infection in my current place of employment and how this problem can be solved by providing solutions designed for the apparent cause of the problem. These solutions will focus on quality and clinical governance. The tools to be used to explore the issue will include SWOT analysis and ___. Theories to be used to resolve the issue will include shared governance and total quality management.
A personal analysis on the presented problem will also be presented and as well as recommendations on how the quality of care can be improved in my place of employment regarding the particular problem.
CONTEXT
Tracheostomy refers to an opening into the trachea where an artificial airway (the tracheostomy tube) is inserted. This is usually performed to protect the patient from accidentally inhaling food, fluid or saliva. Such an airway may be necessary for patients when prolonged ventilation is required, or when an extended coma is anticipated. It may also be placed surgically to maintain the structure of the trachea--when threatened by cancer, infection or trauma, Placement of a tracheostomy is mainly used during the acute phase of an illness and later removed (Wright, 2005).
A client may have a tracheostomy to bypass an upper airway obstruction, prevent aspiration, manage tracheobronchial secretions, or allow for prolonged mechanical ventilation. Whatever the reason for tracheostomy, the client should be provided standardized care in tracheostomy management. Lately, the rising incidence of chest infections in patients undergoing tracheostomy in my place of employment had been largely blamed on the part of the nurses. Such poor quality of practice is a no-no in the healthcare field. If nurses are not aware of the recommended and safe procedure, then the lives of clients are in jeopardy.
Quality in healthcare service and practice provision is very important. The method of quality measurement used by health economists is the QALY. QALY stands for Quality Adjusted Life Year. It is a term developed by health economists for an approach that is concerned with evaluating both effectiveness of treatments and their cost-effectiveness. The outcomes are measured according to a generic scale whereby if a client's treatment is felt to be effective and long-lasting as well as cost-effective, then the patient can increase his/her score on the quality-of-life measure. This technique supports treatments that show improved quality-of-life over a long time and for the least cost (Antony & Preece, 2002).
Since the late 1980s, the topics of quality and performance measurement have become important reporting areas for governance. Various "report card" "scorecard," or "dashboard" measurement sets have been developed for routine reporting to governance on selected important performance areas. These balanced reporting sets may cover, for example, key clinical performance measures, financial performance summaries, satisfaction surveys, and measures related to human resources (such as turnover, time to fill vacancies). Progressive organizations also make the summary level information available for their employees and release the information to the community (Genovich-Richards, et al, 2000).
Clinical governance involves the development of a culture and ways of working that continually improve quality, allowing good practice to be shared, lessons to be learnt from mistakes, and encouraging patient participation. For many nurses, clinical governance will afford the opportunity to formally link together and enhance existing quality improvement activities such as implementing evidence-based practice and care pathway development (Metcalfe, 2002).
Clinical governance can be divided into four key components: clinical effectiveness, human resources, professional self-regulation and risk management (Metcalfe, 2002).
Clinical effectiveness is about doing the right thing at the right time for the right patient. It enables nurses to reflect on why they do what they do for patients and to systematically find and implement better ways of providing care. The activities involved in clinical effectiveness include finding out what is best known practice, appraising the available evidence, changing practice if necessary, and confirming through clinical audit that actual practice is consistent with best practice (Metcalfe, 2002).
The human resources component of the clinical governance framework is about ensuring that healthcare professionals have the right education, adequate training and development, skills and competencies to provide quality patient care. It is also about workforce planning and lifelong learning (Metcalfe, 2002).
Professional self-regulation protects the public as it requires registered practitioners to practice within a code of conduct and is supported by the promotion of good practice, prevention of poor practice, and intervention when practice is poor. Professional self-regulation supports the clinical governance framework by setting professional standards and guidelines that contribute to the creation of an environment in which clinical excellence will flourish (Metcalfe, 2002). In practice, many nurses have experienced real and substantial problems with regulation.
Risk management is about identifying, measuring and controlling those risks that threaten quality or performance in the delivery of patient care (Metcalfe, 2002). Every day, nurses help patients through education, empowerment and expertise to avoid the recognized complications associated with tracheostomy care. They give practical advice and support to people with who underwent tracheostomy to manage risky situations such as an episode of chest infections, encouraging the patient and the family to learn from the event and employ tactics to prevent recurrence. This is a proactive risk management strategy that involves the recognition and identification of things that can go wrong as part of a systematic approach to patient care. Patients are empowered to respond appropriately in a risky situation.
Implementation of shared governance initiatives or other structures that promote autonomy, control of practice, and empowerment of nurses have been identified as key strategies to continue to improve the work environment of nurses (Batson, 2004). This could in turn improve how the nurse delivers care to the clients.
In a shared governance model, each person has an obligation to ensure that his or her skills and knowledge make a positive contribution and to work efficiently and effectively (Batson, 2004). Shared governance is a collaborative team process in which team members share key leadership roles (Storey, 2004). Shared leadership is empowering employees to act autonomously, be decisive at the point-of-service, and create a shared vision aligned with organizational goals. Shared leadership development and autonomously practicing nurses appear to be the equation for success in delivering quality patient outcomes in today's organized health care delivery systems.
For a shared governance model to work, the nursing leaders must develop skills that go beyond facilitating team and group decision making and assume a transformational role of disrupting the status quo, particularly in situations where evidence-based practice clearly points to a need for rapid change and improvement. Nursing leaders must translate the demand for change into a clear, understandable plan, as well as help staff members handle the chaos and uncertainty that accompany rapid change (Batson, 2004).
ANALYSIS
Strengths (internal)
Weaknesses (internal)
Opportunities (external)
Threats (external)
The SWOT analysis shows that although the hospital is equipped with competent staff, there is still an increase in chest infection in tracheostomy care since majority of the nursing staff are unaware of the recommended practice regarding tracheostomy care resulting to unsafe practice. Good clinical facilities for the tracheostomy procedure are also present in my place of employment.
Coming up with recommendations and implementing them at the place of employment is the most logical thing to do. An improvement for tracheostomy care and a decrease in chest infection incidence is expected as health authorities and the staff supports the programs that are designed for improvement of nursing services and quality of patient care.
Hong Kong's healthcare profession is challenged by the shortage of healthcare professionals. This presents a threat to many areas of nursing practice. Not only that, this is a threat to patient care. If there is a decrease in the number of nursing staff that are competent enough to handle tracheostomy care, the problem regarding the increase in chest infection associated with tracheostomy would not be solved.
It seems that there is also an apparent poor quality of management and leadership in this case resulting to the poor quality of service. To improve quality, organizations have to apply 'Total Quality Management' (TQM) to their organizations to help them plan their efforts. The promise of superior performance through continuous quality improvement has attracted a wide spectrum of business to TQM, with applications reported in many domains including healthcare (Antony & Preece, 2002).
RECOMMENDATIONS
Since the problem in itself roots on the apparent lack of knowledge on the part of the nursing professionals regarding the recommended practice of tracheostomy care, solutions must be also directed on them. The proper ways of performing tracheostomy care as well as the rationale behind each step are found in various medical literatures which can be provided to the nursing staff through educational programs.
In order for each and every staff to be educated and aware of this proper procedure, training or educational programs must be made available. Every nurse must be required to attend such educational training program. It will be an objective for the hospital for all nurses to attend a workshop on providing quality tracheostomy care as well as governance by the end of June 2006.
Once all the nursing staff are thoroughly educated and properly equipped with the knowledge of the recommended practice regarding tracheostomy care, their performance has to be monitored every now and then. They will be assessed on how they perform such care and evaluated if there is a change on how they perform it. It is not enough that after the initial educating sessions they will then be left to do the procedure. Monitoring has to be done in order to ensure that there is a demonstration of safe and proper practice of tracheostomy care.
From these educational programs designed to improve the quality of nursing care that is being offered, it is expected that standards for tracheostomy care will improve by reducing the incidence of chest infections following tracheostomy by the end of 2006.
As already presented in the analysis, there is an all-out support for this endeavor on the part of healthcare authorities and staff. That in itself would help make this project a success. Since they support the project of decreasing the incidence of chest infection, it follows that they would also support this plan of educating the nurses on how to properly perform tracheostomy care.
A one month time frame for properly educating the nursing staff on tracheostomy care is recommended. Granting that the nurses have their hearts in the education process, they will easily learn the recommended practice for tracheostomy care. Standards and objectives have also to be set as this is very important.
The period of monitoring would be the longer period in my recommended strategy. I propose a six-month to one year monitoring period. This would include assessing how each nurse performs the tracheostomy care and also observations on the incidence of client's admission to intensive care unit because of chest infections.
To effectively carry out all of these, strategic planning has to be developed. Strategic planning is crucial in the management of healthcare organizations, even when the characteristics of the healthcare systems vary (Geisler, et al, 2003).
Shared governance should be used as the nursing practice model for this. Shared governance is a dynamic process that promotes collaboration, shared decision making, and accountability for practice through workforce empowerment (Batson, 2004). Although the principles of shared governance are universal, structure and process generally follow the needs of an organization based on its core values, mission, vision, and philosophy.
In moving to a shared governance model in my place of employment, ownership becomes both individual and team ownership because optimal outcomes cannot be achieved without integrated team effort. This transition requires new knowledge and behaviors at each level and results in a paradox as team members have to perform efficiently while practicing new skills that are unfamiliar and uncomfortable (Batson, 2004).
Nursing leaders are needed to guide the nursing staff in the education or training process. They must be able to translate the demand for change in the particular field of tracheostomy care into a clear, understandable plan, as well as help nursing staff members handle the chaos and uncertainty that accompany the rapid change.
In achieving what is needed to be able to provide quality of care to the clients, the nursing staff should also act as a team. If a nurse learns something that is proven to be beneficial in the client's care, then it is encouraged that they will share this with the other members of the nursing staff or if applicable, to the whole healthcare profession with the area of employment.
Management also plays an integral part in all of these. The quality of care delivered after the education and monitoring period could be measured using QALY. Evaluations can be done after the proposed strategies have been implemented.
Applying the four key components of clinical governance to the problem is helpful. The activities involved in clinical effectiveness will include finding out what is the best known practice regarding tracheostomy care, appraising the available evidence, changing the practice by educating the nursing staff, and confirming through monitoring or clinical audit that actual practice is consistent with best practice.
The human resources component of the clinical governance framework would aim to ensure that the nursing staff has the right education, adequate training and development, skills and competencies to provide quality tracheostomy care to patients.
There will be an all-out support for the promotion of good practice, prevention of poor practice, and intervention when practice is poor in tracheostomy care. Professional standards and guidelines that contribute to the creation of an environment where there will be less incidence of chest infections after tracheostomy will be set.
To further improve quality care, nurses must help patients through education, empowerment and expertise to avoid the complications associated with tracheostomy care. The nurses must be able to recognize and identify the things that can go wrong as part of a systematic approach to patient care.
The expected outcome of the recommendations should be a decrease in the incidence of tracheostomy clients developing chest infections within a period of at least six months from the time the educational programs are offered to the nurses. As already pointed out in the first few paragraphs of this paper, the reason why there is an increase in the incidence of clients developing chest infections is because of improper tracheostomy management on the part of the nurses. Therefore, the recommendations are more aimed at the nursing staff with emphasis on quality and care governance.
CONCLUSION
In my place of employment, there is a growing problem regarding the development of infection in tracheostomy patients. It has been found out that the reason for this is the apparent lack of knowledge of the majority of our nursing staff regarding the recommended and safe practice for tracheostomy care.
As part of the large whole of the healthcare organization, and as nurses who are in the frontline of delivering care to clients, it is our duty and responsibility to provide the best quality of care to our clients. But this has not been the case in my place of employment.
To summarize, I have recommended a training or education program for the nursing staff.
This program will educate the nurses on the recommended practice of tracheostomy care. Every procedure that is involved will be taught and the rationale behind the procedure will also be given. After the initial education program, the staff will be periodically monitored. The incidence of chest infection will likewise be monitored and observed if there is a significant decrease since implanting the recommended strategy. Monitoring the implementation of health policy and evaluating the impact of the outcome has to be well developed.
To effectively carry out the recommendations and in the process improve the quality of care in tracheostomy patients, there should be a collaboration and support of healthcare professionals within my place of employment. Strategic planning should also be employed. Effective teamwork and good communication are essential to the success of quality and care governance. Change can result if there is unity within the organization. Clinical governance is about linking together many activities that affect the delivery of patient care.
The healthcare professions all involve life and death situations. In these situations, quality is crucial and quantity is irrelevant. In my place of employment, there is an increasing incidence of chest infection associated with the use of tracheostomy tubes. The blame is placed on the apparent lack of knowledge of the nursing staff regarding tracheostomy care. It is time to seriously rethink, redesign, redevelop and reinvigorate the way governance is practiced in my current place of employment. There is a need for better quality and care governance.
Clinical governance provides a framework for a coherent, local program of quality improvement and an opportunity to share best practice. For nurses, clinical governance will be about building upon and linking together many of the activities that they are already involved in, which help to promote and improve standards of patient care (Metcalfe, 2002).
This paper presents the problems of increasing incidence of chest infection in my current place of employment and how this problem can be solved by providing solutions designed for the apparent cause of the problem. These solutions will focus on quality and clinical governance. The tools to be used to explore the issue will include SWOT analysis and ___. Theories to be used to resolve the issue will include shared governance and total quality management.
A personal analysis on the presented problem will also be presented and as well as recommendations on how the quality of care can be improved in my place of employment regarding the particular problem.
CONTEXT
Tracheostomy refers to an opening into the trachea where an artificial airway (the tracheostomy tube) is inserted. This is usually performed to protect the patient from accidentally inhaling food, fluid or saliva. Such an airway may be necessary for patients when prolonged ventilation is required, or when an extended coma is anticipated. It may also be placed surgically to maintain the structure of the trachea--when threatened by cancer, infection or trauma, Placement of a tracheostomy is mainly used during the acute phase of an illness and later removed (Wright, 2005).
A client may have a tracheostomy to bypass an upper airway obstruction, prevent aspiration, manage tracheobronchial secretions, or allow for prolonged mechanical ventilation. Whatever the reason for tracheostomy, the client should be provided standardized care in tracheostomy management. Lately, the rising incidence of chest infections in patients undergoing tracheostomy in my place of employment had been largely blamed on the part of the nurses. Such poor quality of practice is a no-no in the healthcare field. If nurses are not aware of the recommended and safe procedure, then the lives of clients are in jeopardy.
Quality in healthcare service and practice provision is very important. The method of quality measurement used by health economists is the QALY. QALY stands for Quality Adjusted Life Year. It is a term developed by health economists for an approach that is concerned with evaluating both effectiveness of treatments and their cost-effectiveness. The outcomes are measured according to a generic scale whereby if a client's treatment is felt to be effective and long-lasting as well as cost-effective, then the patient can increase his/her score on the quality-of-life measure. This technique supports treatments that show improved quality-of-life over a long time and for the least cost (Antony & Preece, 2002).
Since the late 1980s, the topics of quality and performance measurement have become important reporting areas for governance. Various "report card" "scorecard," or "dashboard" measurement sets have been developed for routine reporting to governance on selected important performance areas. These balanced reporting sets may cover, for example, key clinical performance measures, financial performance summaries, satisfaction surveys, and measures related to human resources (such as turnover, time to fill vacancies). Progressive organizations also make the summary level information available for their employees and release the information to the community (Genovich-Richards, et al, 2000).
Clinical governance involves the development of a culture and ways of working that continually improve quality, allowing good practice to be shared, lessons to be learnt from mistakes, and encouraging patient participation. For many nurses, clinical governance will afford the opportunity to formally link together and enhance existing quality improvement activities such as implementing evidence-based practice and care pathway development (Metcalfe, 2002).
Clinical governance can be divided into four key components: clinical effectiveness, human resources, professional self-regulation and risk management (Metcalfe, 2002).
Clinical effectiveness is about doing the right thing at the right time for the right patient. It enables nurses to reflect on why they do what they do for patients and to systematically find and implement better ways of providing care. The activities involved in clinical effectiveness include finding out what is best known practice, appraising the available evidence, changing practice if necessary, and confirming through clinical audit that actual practice is consistent with best practice (Metcalfe, 2002).
The human resources component of the clinical governance framework is about ensuring that healthcare professionals have the right education, adequate training and development, skills and competencies to provide quality patient care. It is also about workforce planning and lifelong learning (Metcalfe, 2002).
Professional self-regulation protects the public as it requires registered practitioners to practice within a code of conduct and is supported by the promotion of good practice, prevention of poor practice, and intervention when practice is poor. Professional self-regulation supports the clinical governance framework by setting professional standards and guidelines that contribute to the creation of an environment in which clinical excellence will flourish (Metcalfe, 2002). In practice, many nurses have experienced real and substantial problems with regulation.
Risk management is about identifying, measuring and controlling those risks that threaten quality or performance in the delivery of patient care (Metcalfe, 2002). Every day, nurses help patients through education, empowerment and expertise to avoid the recognized complications associated with tracheostomy care. They give practical advice and support to people with who underwent tracheostomy to manage risky situations such as an episode of chest infections, encouraging the patient and the family to learn from the event and employ tactics to prevent recurrence. This is a proactive risk management strategy that involves the recognition and identification of things that can go wrong as part of a systematic approach to patient care. Patients are empowered to respond appropriately in a risky situation.
Implementation of shared governance initiatives or other structures that promote autonomy, control of practice, and empowerment of nurses have been identified as key strategies to continue to improve the work environment of nurses (Batson, 2004). This could in turn improve how the nurse delivers care to the clients.
In a shared governance model, each person has an obligation to ensure that his or her skills and knowledge make a positive contribution and to work efficiently and effectively (Batson, 2004). Shared governance is a collaborative team process in which team members share key leadership roles (Storey, 2004). Shared leadership is empowering employees to act autonomously, be decisive at the point-of-service, and create a shared vision aligned with organizational goals. Shared leadership development and autonomously practicing nurses appear to be the equation for success in delivering quality patient outcomes in today's organized health care delivery systems.
For a shared governance model to work, the nursing leaders must develop skills that go beyond facilitating team and group decision making and assume a transformational role of disrupting the status quo, particularly in situations where evidence-based practice clearly points to a need for rapid change and improvement. Nursing leaders must translate the demand for change into a clear, understandable plan, as well as help staff members handle the chaos and uncertainty that accompany rapid change (Batson, 2004).
ANALYSIS
Strengths (internal)
- Competent staff
- Good clinical facilities
Weaknesses (internal)
- Lack of education on tracheostomy care
Opportunities (external)
- Health authority support
- Staff support
Threats (external)
- Shortage of staff
The SWOT analysis shows that although the hospital is equipped with competent staff, there is still an increase in chest infection in tracheostomy care since majority of the nursing staff are unaware of the recommended practice regarding tracheostomy care resulting to unsafe practice. Good clinical facilities for the tracheostomy procedure are also present in my place of employment.
Coming up with recommendations and implementing them at the place of employment is the most logical thing to do. An improvement for tracheostomy care and a decrease in chest infection incidence is expected as health authorities and the staff supports the programs that are designed for improvement of nursing services and quality of patient care.
Hong Kong's healthcare profession is challenged by the shortage of healthcare professionals. This presents a threat to many areas of nursing practice. Not only that, this is a threat to patient care. If there is a decrease in the number of nursing staff that are competent enough to handle tracheostomy care, the problem regarding the increase in chest infection associated with tracheostomy would not be solved.
It seems that there is also an apparent poor quality of management and leadership in this case resulting to the poor quality of service. To improve quality, organizations have to apply 'Total Quality Management' (TQM) to their organizations to help them plan their efforts. The promise of superior performance through continuous quality improvement has attracted a wide spectrum of business to TQM, with applications reported in many domains including healthcare (Antony & Preece, 2002).
RECOMMENDATIONS
Since the problem in itself roots on the apparent lack of knowledge on the part of the nursing professionals regarding the recommended practice of tracheostomy care, solutions must be also directed on them. The proper ways of performing tracheostomy care as well as the rationale behind each step are found in various medical literatures which can be provided to the nursing staff through educational programs.
In order for each and every staff to be educated and aware of this proper procedure, training or educational programs must be made available. Every nurse must be required to attend such educational training program. It will be an objective for the hospital for all nurses to attend a workshop on providing quality tracheostomy care as well as governance by the end of June 2006.
Once all the nursing staff are thoroughly educated and properly equipped with the knowledge of the recommended practice regarding tracheostomy care, their performance has to be monitored every now and then. They will be assessed on how they perform such care and evaluated if there is a change on how they perform it. It is not enough that after the initial educating sessions they will then be left to do the procedure. Monitoring has to be done in order to ensure that there is a demonstration of safe and proper practice of tracheostomy care.
From these educational programs designed to improve the quality of nursing care that is being offered, it is expected that standards for tracheostomy care will improve by reducing the incidence of chest infections following tracheostomy by the end of 2006.
As already presented in the analysis, there is an all-out support for this endeavor on the part of healthcare authorities and staff. That in itself would help make this project a success. Since they support the project of decreasing the incidence of chest infection, it follows that they would also support this plan of educating the nurses on how to properly perform tracheostomy care.
A one month time frame for properly educating the nursing staff on tracheostomy care is recommended. Granting that the nurses have their hearts in the education process, they will easily learn the recommended practice for tracheostomy care. Standards and objectives have also to be set as this is very important.
The period of monitoring would be the longer period in my recommended strategy. I propose a six-month to one year monitoring period. This would include assessing how each nurse performs the tracheostomy care and also observations on the incidence of client's admission to intensive care unit because of chest infections.
To effectively carry out all of these, strategic planning has to be developed. Strategic planning is crucial in the management of healthcare organizations, even when the characteristics of the healthcare systems vary (Geisler, et al, 2003).
Shared governance should be used as the nursing practice model for this. Shared governance is a dynamic process that promotes collaboration, shared decision making, and accountability for practice through workforce empowerment (Batson, 2004). Although the principles of shared governance are universal, structure and process generally follow the needs of an organization based on its core values, mission, vision, and philosophy.
In moving to a shared governance model in my place of employment, ownership becomes both individual and team ownership because optimal outcomes cannot be achieved without integrated team effort. This transition requires new knowledge and behaviors at each level and results in a paradox as team members have to perform efficiently while practicing new skills that are unfamiliar and uncomfortable (Batson, 2004).
Nursing leaders are needed to guide the nursing staff in the education or training process. They must be able to translate the demand for change in the particular field of tracheostomy care into a clear, understandable plan, as well as help nursing staff members handle the chaos and uncertainty that accompany the rapid change.
In achieving what is needed to be able to provide quality of care to the clients, the nursing staff should also act as a team. If a nurse learns something that is proven to be beneficial in the client's care, then it is encouraged that they will share this with the other members of the nursing staff or if applicable, to the whole healthcare profession with the area of employment.
Management also plays an integral part in all of these. The quality of care delivered after the education and monitoring period could be measured using QALY. Evaluations can be done after the proposed strategies have been implemented.
Applying the four key components of clinical governance to the problem is helpful. The activities involved in clinical effectiveness will include finding out what is the best known practice regarding tracheostomy care, appraising the available evidence, changing the practice by educating the nursing staff, and confirming through monitoring or clinical audit that actual practice is consistent with best practice.
The human resources component of the clinical governance framework would aim to ensure that the nursing staff has the right education, adequate training and development, skills and competencies to provide quality tracheostomy care to patients.
There will be an all-out support for the promotion of good practice, prevention of poor practice, and intervention when practice is poor in tracheostomy care. Professional standards and guidelines that contribute to the creation of an environment where there will be less incidence of chest infections after tracheostomy will be set.
To further improve quality care, nurses must help patients through education, empowerment and expertise to avoid the complications associated with tracheostomy care. The nurses must be able to recognize and identify the things that can go wrong as part of a systematic approach to patient care.
The expected outcome of the recommendations should be a decrease in the incidence of tracheostomy clients developing chest infections within a period of at least six months from the time the educational programs are offered to the nurses. As already pointed out in the first few paragraphs of this paper, the reason why there is an increase in the incidence of clients developing chest infections is because of improper tracheostomy management on the part of the nurses. Therefore, the recommendations are more aimed at the nursing staff with emphasis on quality and care governance.
CONCLUSION
In my place of employment, there is a growing problem regarding the development of infection in tracheostomy patients. It has been found out that the reason for this is the apparent lack of knowledge of the majority of our nursing staff regarding the recommended and safe practice for tracheostomy care.
As part of the large whole of the healthcare organization, and as nurses who are in the frontline of delivering care to clients, it is our duty and responsibility to provide the best quality of care to our clients. But this has not been the case in my place of employment.
To summarize, I have recommended a training or education program for the nursing staff.
This program will educate the nurses on the recommended practice of tracheostomy care. Every procedure that is involved will be taught and the rationale behind the procedure will also be given. After the initial education program, the staff will be periodically monitored. The incidence of chest infection will likewise be monitored and observed if there is a significant decrease since implanting the recommended strategy. Monitoring the implementation of health policy and evaluating the impact of the outcome has to be well developed.
To effectively carry out the recommendations and in the process improve the quality of care in tracheostomy patients, there should be a collaboration and support of healthcare professionals within my place of employment. Strategic planning should also be employed. Effective teamwork and good communication are essential to the success of quality and care governance. Change can result if there is unity within the organization. Clinical governance is about linking together many activities that affect the delivery of patient care.
SWOT Analysis of British Airways
Introduction
Modernity is the era of production characterized by the rise of industrial capitalism and the hegemony of bourgeoisie. Thus it centered on the production of commodities and products which in the Marxian perspective modernity becomes oriented with production and materialism.
On the other hand, Baudrillard interprets modernity as a process of explosion of commodification, mechanization, technology and market relations and further, characterized by an increasing differentiation of spheres of life. Since modernity characterized by industrial revolution leading to an era of production, capitalism acquired the powerful status in an economic system. Although the remnant of Marxist economy is still preserved in some communist countries, undeniably, the proliferation of capitalism as an economic system made the grounds for globalization of economic, cultural, and political spheres.
This significant condition became fundamental in the global economy wherein every capitalist thrives to advance their business tied in with the pervasive and effective strategic planning in order to adapt with such phenomenal change within the basic spheres of the society. Moreover, this rapidity affected the modernization of the society, wherein it pushes itself to the post modern ideology. Thereby our society today, as most of the scholars and researchers would put it, is on the verge of post-modernity.
In global economy, post-modernity is not new at all. The rapid development in corporate management, organizational culture, and human resource management, are but cryptograms of post-modernity. Moreover, such occurrences in the economic landscape are not intended to intimidate entities which are slow and sluggish in response to the signs of the times, but, a matter of fact in which cannot be blamed to particular someone but to all.
SWOT Analysis on British Airways
British Airways is engaged in air services operations both in international and domestic airfreight. It provides various services ranging in commercial flights service for passengers around the globe, cargo freight and mail services and other auxiliary services. British Airways primarily runs its business in Europe and in United States. Located in Harmondsworth, Middlesex, it employs 42, 755 people in all its departments.
British Airways facilitates flight reservation and booking using the online net services in which customers can easily access. Trying to appear competitive and maintain its integrity as one of the best airlines which emphasizes quality customer services, BA strives to create high-end terminal facilities and other services involving comfortable of customers while onboard. BA reaches out to 570 in about 134 countries. Such magnitude of operations offers customers with variety of destinations with world-class services that cater customers ranging from explorers to executives.
Strengths
British Airways' strengths include the first-rate new fleet of aircrafts purchased to accolade comfortable traveling of passengers. This move was made to counter the wretched state of travel and complaint received by the previous fleet used by British Airways. The magnitude of Airways' operations allows them on pro over their competitors by servicing to a wider variety of customers.
Moreover, on the level of knowledge and skills, BA operational research claimed that analytical skills performed by the members of the company and employees become its strengths. The strong customer focus develops expertise in customer areas while in purchasing high-end software for air services and wide selection of it strengthens the company's business orientation.
Weaknesses
One of the many weaknesses on organization's business and services is the lack of marketing strategy that will help reinforce its competitive standards, more so, to win customers loyalty. Despite the great infrastructure hosted the company, BA needs to carry out better market schemes to attract more customers. Hence, competitive package for customer service must be afforded in order to make the airline more attractive to its clients, prompting an opportunity of earning large revenues. Furthermore, on knowledge and skills management, limited knowledge of simulation software and simulation development, knowledge lost through high level of internal staff moves, teams adopt solution approaches aligned only to their skills, and lack of involvement in choice of software and difficulty to enhance specialist airline software are weaknesses which the company must be aware of.
Threats
The threats are not necessarily be found outside of company's environment but can be an internal. Internal threats as seen in management centralized and bureaucratic system and all poor decision-making. Moreover, the company's focus on national and local problems pose a threat since much more problems which it neglect found in the global scheme. It neglects the global problems instead focusing deeply on the national and local level. The global problems greatly offer tremendous threats if and when companies will ignore such. Moreover, globalization can be an opportunity and strength but can also be a threat if not to be keen and vigilant of its tricks and treachery. Further, rapid changes on technology and customers' behavior can also be a threat if mistakenly interpreted and remedied.
Opportunities
The availability of immense services and products pose an opportunity to utilize them properly. The global changes can be an opportunity to work with while ignoring certain opportunities can be a weakness. In BA, virtual reality could provide a new use for simulation, obtaining network software and share expertise through special interest groups are opportunities which can be utilized and used to further enhance the company's business.
Technological trends provide ample opportunities to various business domains, however, if it will be taken for granted, opportunities can be a threat or weakness. Maximizing the global trends is a great opportunity to hold on to.
Modernity is the era of production characterized by the rise of industrial capitalism and the hegemony of bourgeoisie. Thus it centered on the production of commodities and products which in the Marxian perspective modernity becomes oriented with production and materialism.
On the other hand, Baudrillard interprets modernity as a process of explosion of commodification, mechanization, technology and market relations and further, characterized by an increasing differentiation of spheres of life. Since modernity characterized by industrial revolution leading to an era of production, capitalism acquired the powerful status in an economic system. Although the remnant of Marxist economy is still preserved in some communist countries, undeniably, the proliferation of capitalism as an economic system made the grounds for globalization of economic, cultural, and political spheres.
This significant condition became fundamental in the global economy wherein every capitalist thrives to advance their business tied in with the pervasive and effective strategic planning in order to adapt with such phenomenal change within the basic spheres of the society. Moreover, this rapidity affected the modernization of the society, wherein it pushes itself to the post modern ideology. Thereby our society today, as most of the scholars and researchers would put it, is on the verge of post-modernity.
In global economy, post-modernity is not new at all. The rapid development in corporate management, organizational culture, and human resource management, are but cryptograms of post-modernity. Moreover, such occurrences in the economic landscape are not intended to intimidate entities which are slow and sluggish in response to the signs of the times, but, a matter of fact in which cannot be blamed to particular someone but to all.
SWOT Analysis on British Airways
British Airways is engaged in air services operations both in international and domestic airfreight. It provides various services ranging in commercial flights service for passengers around the globe, cargo freight and mail services and other auxiliary services. British Airways primarily runs its business in Europe and in United States. Located in Harmondsworth, Middlesex, it employs 42, 755 people in all its departments.
British Airways facilitates flight reservation and booking using the online net services in which customers can easily access. Trying to appear competitive and maintain its integrity as one of the best airlines which emphasizes quality customer services, BA strives to create high-end terminal facilities and other services involving comfortable of customers while onboard. BA reaches out to 570 in about 134 countries. Such magnitude of operations offers customers with variety of destinations with world-class services that cater customers ranging from explorers to executives.
Strengths
British Airways' strengths include the first-rate new fleet of aircrafts purchased to accolade comfortable traveling of passengers. This move was made to counter the wretched state of travel and complaint received by the previous fleet used by British Airways. The magnitude of Airways' operations allows them on pro over their competitors by servicing to a wider variety of customers.
Moreover, on the level of knowledge and skills, BA operational research claimed that analytical skills performed by the members of the company and employees become its strengths. The strong customer focus develops expertise in customer areas while in purchasing high-end software for air services and wide selection of it strengthens the company's business orientation.
Weaknesses
One of the many weaknesses on organization's business and services is the lack of marketing strategy that will help reinforce its competitive standards, more so, to win customers loyalty. Despite the great infrastructure hosted the company, BA needs to carry out better market schemes to attract more customers. Hence, competitive package for customer service must be afforded in order to make the airline more attractive to its clients, prompting an opportunity of earning large revenues. Furthermore, on knowledge and skills management, limited knowledge of simulation software and simulation development, knowledge lost through high level of internal staff moves, teams adopt solution approaches aligned only to their skills, and lack of involvement in choice of software and difficulty to enhance specialist airline software are weaknesses which the company must be aware of.
Threats
The threats are not necessarily be found outside of company's environment but can be an internal. Internal threats as seen in management centralized and bureaucratic system and all poor decision-making. Moreover, the company's focus on national and local problems pose a threat since much more problems which it neglect found in the global scheme. It neglects the global problems instead focusing deeply on the national and local level. The global problems greatly offer tremendous threats if and when companies will ignore such. Moreover, globalization can be an opportunity and strength but can also be a threat if not to be keen and vigilant of its tricks and treachery. Further, rapid changes on technology and customers' behavior can also be a threat if mistakenly interpreted and remedied.
Opportunities
The availability of immense services and products pose an opportunity to utilize them properly. The global changes can be an opportunity to work with while ignoring certain opportunities can be a weakness. In BA, virtual reality could provide a new use for simulation, obtaining network software and share expertise through special interest groups are opportunities which can be utilized and used to further enhance the company's business.
Technological trends provide ample opportunities to various business domains, however, if it will be taken for granted, opportunities can be a threat or weakness. Maximizing the global trends is a great opportunity to hold on to.
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