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)

• 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)

• 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.

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.

The analysis on the external and internal environment of Primark retailing industry

Introduction
The omnipresence of global trends and innovations debunk the idea of business monopoly and empire states. Today, the trends are set to maximize the potential of human powers by trivializing simple phenomena in order to fashion complex and subtle effects. In the minds of prominent sociologists and philosophers these trivialization of occurrences brought about by man's deepest desire of uncovering the truth and meaning of life. However, our correspondence and connection with the truth is indirect and diluted which can only be accessible via representations and constructs. Hence, the necessity, though, not necessarily is, of excavating the truth embedded on phenomena became an ordinary human laborious pursuit.

Moreover, due to rapid changes on various aspects of human life our reactions vary depending on the way we perceive it, while forming effective and efficient mechanisms become a mechanical elocutionary act. This fact is paralleled with the nature and condition of business operations wherein technology dictates in setting the trends and innovations. Moreover, such despotic nature of technology invigorates the force and power of globalization to deeply penetrate all human spheres of interaction.

Technology, Market, and Trends
The incorrigibility of technological advancement obviously shoves business operations and economic modes to be flexible. Here, business movers, analysts, strategists, theorists, scholars, and other personalities with significant role in business management and economic functions should be shrewd enough to incline their attention to the unexpected events and surprises which charily crafted by setters of global trends and innovations. Therefore, in business operations incessant assessment, evaluation, and revision of organization's strategies, programs, standards, objectives and goals are imperative. So much so, that such relentless observation should have mixed with collective effort and work of all representatives and members of the giving organizational body.

Hence, the evolution of marketing processes and modes of producing goods and services was not only invented during the recent centuries but, was already present when the first civilization came to existence. Although, no proper and serious study made at those times, recent discoveries and theoretical principles were, I believe, are products of the precedents civilizations. Meanwhile, not until Frederick Taylor's revolutionary theory which led to crumble the traditional management process and replaced it with a scientific-based management process stupefied managers, capitalists, and movers of his time.

Hence, the evolution of marketing processes and modes of producing goods and services was not only invented during the recent centuries but, was already present when the first civilization came to existence. Although, no proper and serious study made at those times, recent discoveries and theoretical principles were, I believe, are products of the precedents civilizations. Meanwhile, not until Frederick Taylor's revolutionary theory which led to crumble the traditional management process and replaced it with a scientific-based management process stupefied managers, capitalists, and movers of his time.

Significance of business market
The ascension of skyscrapers, business towers and trade centers in different places all over the world signify the dominance and control of business sector compared to other social fields. We can argue then that business operations become instrumental in human living without which the height of survival maybe reduced to a lesser amount. In contrast, business as a mode of survival for human beings inexorably becomes an exploitative and dominative domain wherein human resources and manual labor are alienated from the true value of human dignity and worth.

Despite this reality, human resistance is tempered by the need to survive and to further acquire material possessions. Likewise, as man's social and material needs increases, new business production and services schemes are emerging in response to these increasing demands.

It is in this context, which many business types are emerging due to human needs. On this account, technology, human needs, and business inseparably affect each other's domains, more so, tends to cross each other's boundaries to penetrate each others' systems. The chain of reaction cannot be dissolve easily. This idea under capitalist's viewpoint, the plethora of ever-increasing needs is the façade of one fundamental need: the pressing need for money. Now what dictates business firms and increasing expenses on research to track down recent trends is because of such need.

Primark: An Overview
Primark Stores Limited is an Irish clothing retailer. Its stores are located in various regions like United Kingdom, Ireland, and Spain. Within this area of responsibility, Primark stores outnumbered other clothing retailer business, with one hundred sixty one stores overall distributed in three major regions: one hundred twenty-five in the United Kingdom, thirty-four in Ireland and eight in Spain. The company positions itself as marketing fashionable at cutthroat prices.

The original clothing store was established by Arthur Ryan and his collaborator Micaela Mitchell in Dublin Ireland in 1969. After various success in clothing business, great profits and gross income led them to open stores in local and regional areas. It acquired various premises in different business centers within its local and regional areas which eventually generate more profits and income.

Primark is known for selling clothes at the budget end of the market. Its success is based on sourcing supply, making clothes with simple designs and fabrics and targets young, fashion-conscious individuals ages 35 below, offering them simple yet high quality clothes and apparels.

Hence, these successes brought significant changes on Primark's retail business. The relevance of global trends and consumers' demands on lifestyle made Primark Store Limited reinvent its business scheme and management structure.

Primark's management and business structure
As a famous clothing retail store, recently, Primark embarks in different retail products not only restricted on manufacturing clothes but also other related products such as apparels and accessories available to all human sizes.

Primark employs simple managerial operation on its stores structure. Each store has its own manager responsible in overseeing the status and business operations. With managers' inherent authority, they are given the power and control to manage the store within his/her point of responsibility. Moreover, in smaller or larger branches, assistant and deputy managers are assigned to control and manage the store. Within the store, there are different subdivided departments in which a manager is assigned like senior department managers and junior department managers who are in charge for individual departments.

Moreover, under management, there are supervisors in charge of staff on a sales floor, on different departments like stock room staff, customer service staff, customer service desk, cashiers who work on the tills, cash office staff and staff responsible to look after fitting rooms.

This management and business structure posits a simple way of managing human labor force, however, simple it may seem, yet inevitably creates serious problems and issues if and when proper assessment of the structure will be undervalued.

Analysis on the internal and external environment of Primark retail industry
The Primark clothing retail industry is a member of Ethical Trading Initiative, a collaborative forum bringing together businesses to work on labor rights issues in their supply chains. In fact, Primark developed ethical strategy in order to promote labor rights issues within its organization. Certain guidelines and code of conduct must be defined in relation to the ethical implications of work to human labor rights. Primark, initiated and defined its ethical trade strategy in 2006, focusing on assessment of employees working conditions, factories operations' concerns and addressed necessary improvement. Primark's annual report of activity should be passed to the Ethical Trading Initiative Board.

Moreover, Primark stands to a principle that shared learning and collaboration is one of the most successful ways to achieve sustained positive progression with its supplier's factories. However, climate change within and outside Primark's environment changes as it faces the challenges posed by the global business market. Using PESTLE and SWOT analysis, let us examine the ins and outs environment of Primark's retail clothing industry.

The PESTLE analysis allows us to examine the external factors affecting the environment of an organization while SWOT analysis aids us to assess organization's internal strengths and weaknesses and further identify threats and opportunities external to its environment.

Hence, these methods are helpful for us to understand and underline positive and negative factors affecting the external and internal environment of an organization like Primark.

In assessing the political, social, and economic factors external to the environment of Primark, we must consider different issues. Primark's business operations are subject to government policies and regulations. The business firm should conform to the set of policies and regulations stipulated and enforced by the government and policy making body while conforming to the set of regulations and policies, the firm should assume social responsibility as demanded by the global consciousness. Nowadays, business sectors no longer busied themselves to produce bonds of profits and income but deeply involved in social programs to promote social awareness and equality. Cultural and social behaviors of different consumers are important to consider when establishing or venturing business in the global landscape.

Furthermore, economic, environment, laws, and technology are inseparable entities in which influence the business operations. The economic stability of certain region can contribute allot to the business condition of certain firm, like Primark. Technology on the other hand, brought a tremendous effect to the status and development of business operations and marketing programs. It generates new trends in a rapid movement, which if organizations are unaware will impede growth and development.

Hence, Primark's must constantly assess its strategy with consideration to its PESTLE as external factors that in one way or the other affects its internal and business operations.

Assessing the strengths, weaknesses, opportunities, and threats of Primark, we go back to its established management or business structure. The need for re-tracking the management or business structure is important in analyzing its SWOT. As to my knowledge upon my encounter with Primark's business operations, its strengths are gained in its simple, systematic and organized business structure, having assigned proper authorities to proper positions. Moreover, its recognition for valuing high quality of products and quality services with its customers garnered more strength to attract more people. On the other hand, Primark's weaknesses can be found in its way of managing people. Although, Primark is a member of Ethical Trade Initiative, study shows given different negative issues concerning its business operations and transactions like child labor, purports less value on ethical matters. Different issues were attacking Primark concerning exploitation and abuse on labor force, other environmental concerns, poor working conditions, and disvaluing workers' rights. Primark in different surveys was labeled as a fashion industry with oppressive regime. The primacy of autocratic and rigidity on standard structures can be a weakness as well as threats to the life of the company.

Since, it goes globally, opportunities are in wide array not only on the part of venturing into regions with much income and profit to gain but also an opportunity to share and provide quality products to fashion-conscious people with vogue to fashion lifestyle.

Conclusion
Given this analysis we come to realize that each organization has its own external and internal problems to handle. The process in which we enable to identify and analyze such problems is by using proper management method of analysis like SWOT and PESTLE. The importance of these methods is squared to the importance of the business itself.

The analysis on the external and internal environment of Primark retailing industry

Introduction
The omnipresence of global trends and innovations debunk the idea of business monopoly and empire states. Today, the trends are set to maximize the potential of human powers by trivializing simple phenomena in order to fashion complex and subtle effects. In the minds of prominent sociologists and philosophers these trivialization of occurrences brought about by man's deepest desire of uncovering the truth and meaning of life. However, our correspondence and connection with the truth is indirect and diluted which can only be accessible via representations and constructs. Hence, the necessity, though, not necessarily is, of excavating the truth embedded on phenomena became an ordinary human laborious pursuit.

Moreover, due to rapid changes on various aspects of human life our reactions vary depending on the way we perceive it, while forming effective and efficient mechanisms become a mechanical elocutionary act. This fact is paralleled with the nature and condition of business operations wherein technology dictates in setting the trends and innovations. Moreover, such despotic nature of technology invigorates the force and power of globalization to deeply penetrate all human spheres of interaction.

Technology, Market, and Trends
The incorrigibility of technological advancement obviously shoves business operations and economic modes to be flexible. Here, business movers, analysts, strategists, theorists, scholars, and other personalities with significant role in business management and economic functions should be shrewd enough to incline their attention to the unexpected events and surprises which charily crafted by setters of global trends and innovations. Therefore, in business operations incessant assessment, evaluation, and revision of organization's strategies, programs, standards, objectives and goals are imperative. So much so, that such relentless observation should have mixed with collective effort and work of all representatives and members of the giving organizational body.

Hence, the evolution of marketing processes and modes of producing goods and services was not only invented during the recent centuries but, was already present when the first civilization came to existence. Although, no proper and serious study made at those times, recent discoveries and theoretical principles were, I believe, are products of the precedents civilizations. Meanwhile, not until Frederick Taylor's revolutionary theory which led to crumble the traditional management process and replaced it with a scientific-based management process stupefied managers, capitalists, and movers of his time.

Hence, the evolution of marketing processes and modes of producing goods and services was not only invented during the recent centuries but, was already present when the first civilization came to existence. Although, no proper and serious study made at those times, recent discoveries and theoretical principles were, I believe, are products of the precedents civilizations. Meanwhile, not until Frederick Taylor's revolutionary theory which led to crumble the traditional management process and replaced it with a scientific-based management process stupefied managers, capitalists, and movers of his time.

Significance of business market
The ascension of skyscrapers, business towers and trade centers in different places all over the world signify the dominance and control of business sector compared to other social fields. We can argue then that business operations become instrumental in human living without which the height of survival maybe reduced to a lesser amount. In contrast, business as a mode of survival for human beings inexorably becomes an exploitative and dominative domain wherein human resources and manual labor are alienated from the true value of human dignity and worth.

Despite this reality, human resistance is tempered by the need to survive and to further acquire material possessions. Likewise, as man's social and material needs increases, new business production and services schemes are emerging in response to these increasing demands.

It is in this context, which many business types are emerging due to human needs. On this account, technology, human needs, and business inseparably affect each other's domains, more so, tends to cross each other's boundaries to penetrate each others' systems. The chain of reaction cannot be dissolve easily. This idea under capitalist's viewpoint, the plethora of ever-increasing needs is the façade of one fundamental need: the pressing need for money. Now what dictates business firms and increasing expenses on research to track down recent trends is because of such need.

Primark: An Overview
Primark Stores Limited is an Irish clothing retailer. Its stores are located in various regions like United Kingdom, Ireland, and Spain. Within this area of responsibility, Primark stores outnumbered other clothing retailer business, with one hundred sixty one stores overall distributed in three major regions: one hundred twenty-five in the United Kingdom, thirty-four in Ireland and eight in Spain. The company positions itself as marketing fashionable at cutthroat prices.

The original clothing store was established by Arthur Ryan and his collaborator Micaela Mitchell in Dublin Ireland in 1969. After various success in clothing business, great profits and gross income led them to open stores in local and regional areas. It acquired various premises in different business centers within its local and regional areas which eventually generate more profits and income.

Primark is known for selling clothes at the budget end of the market. Its success is based on sourcing supply, making clothes with simple designs and fabrics and targets young, fashion-conscious individuals ages 35 below, offering them simple yet high quality clothes and apparels.

Hence, these successes brought significant changes on Primark's retail business. The relevance of global trends and consumers' demands on lifestyle made Primark Store Limited reinvent its business scheme and management structure.

Primark's management and business structure
As a famous clothing retail store, recently, Primark embarks in different retail products not only restricted on manufacturing clothes but also other related products such as apparels and accessories available to all human sizes.

Primark employs simple managerial operation on its stores structure. Each store has its own manager responsible in overseeing the status and business operations. With managers' inherent authority, they are given the power and control to manage the store within his/her point of responsibility. Moreover, in smaller or larger branches, assistant and deputy managers are assigned to control and manage the store. Within the store, there are different subdivided departments in which a manager is assigned like senior department managers and junior department managers who are in charge for individual departments.

Moreover, under management, there are supervisors in charge of staff on a sales floor, on different departments like stock room staff, customer service staff, customer service desk, cashiers who work on the tills, cash office staff and staff responsible to look after fitting rooms.

This management and business structure posits a simple way of managing human labor force, however, simple it may seem, yet inevitably creates serious problems and issues if and when proper assessment of the structure will be undervalued.

Analysis on the internal and external environment of Primark retail industry
The Primark clothing retail industry is a member of Ethical Trading Initiative, a collaborative forum bringing together businesses to work on labor rights issues in their supply chains. In fact, Primark developed ethical strategy in order to promote labor rights issues within its organization. Certain guidelines and code of conduct must be defined in relation to the ethical implications of work to human labor rights. Primark, initiated and defined its ethical trade strategy in 2006, focusing on assessment of employees working conditions, factories operations' concerns and addressed necessary improvement. Primark's annual report of activity should be passed to the Ethical Trading Initiative Board.

Moreover, Primark stands to a principle that shared learning and collaboration is one of the most successful ways to achieve sustained positive progression with its supplier's factories. However, climate change within and outside Primark's environment changes as it faces the challenges posed by the global business market. Using PESTLE and SWOT analysis, let us examine the ins and outs environment of Primark's retail clothing industry.

The PESTLE analysis allows us to examine the external factors affecting the environment of an organization while SWOT analysis aids us to assess organization's internal strengths and weaknesses and further identify threats and opportunities external to its environment.

Hence, these methods are helpful for us to understand and underline positive and negative factors affecting the external and internal environment of an organization like Primark.

In assessing the political, social, and economic factors external to the environment of Primark, we must consider different issues. Primark's business operations are subject to government policies and regulations. The business firm should conform to the set of policies and regulations stipulated and enforced by the government and policy making body while conforming to the set of regulations and policies, the firm should assume social responsibility as demanded by the global consciousness. Nowadays, business sectors no longer busied themselves to produce bonds of profits and income but deeply involved in social programs to promote social awareness and equality. Cultural and social behaviors of different consumers are important to consider when establishing or venturing business in the global landscape.

Furthermore, economic, environment, laws, and technology are inseparable entities in which influence the business operations. The economic stability of certain region can contribute allot to the business condition of certain firm, like Primark. Technology on the other hand, brought a tremendous effect to the status and development of business operations and marketing programs. It generates new trends in a rapid movement, which if organizations are unaware will impede growth and development.

Hence, Primark's must constantly assess its strategy with consideration to its PESTLE as external factors that in one way or the other affects its internal and business operations.

Assessing the strengths, weaknesses, opportunities, and threats of Primark, we go back to its established management or business structure. The need for re-tracking the management or business structure is important in analyzing its SWOT. As to my knowledge upon my encounter with Primark's business operations, its strengths are gained in its simple, systematic and organized business structure, having assigned proper authorities to proper positions. Moreover, its recognition for valuing high quality of products and quality services with its customers garnered more strength to attract more people. On the other hand, Primark's weaknesses can be found in its way of managing people. Although, Primark is a member of Ethical Trade Initiative, study shows given different negative issues concerning its business operations and transactions like child labor, purports less value on ethical matters. Different issues were attacking Primark concerning exploitation and abuse on labor force, other environmental concerns, poor working conditions, and disvaluing workers' rights. Primark in different surveys was labeled as a fashion industry with oppressive regime. The primacy of autocratic and rigidity on standard structures can be a weakness as well as threats to the life of the company.

Since, it goes globally, opportunities are in wide array not only on the part of venturing into regions with much income and profit to gain but also an opportunity to share and provide quality products to fashion-conscious people with vogue to fashion lifestyle.

Conclusion
Given this analysis we come to realize that each organization has its own external and internal problems to handle. The process in which we enable to identify and analyze such problems is by using proper management method of analysis like SWOT and PESTLE. The importance of these methods is squared to the importance of the business itself.