Effectiveness of Guidelines in Improving Patient Care

Effectiveness of Guidelines in Improving Patient Care This brief considers the empirical literature on the use of clinical guidelines in patient care. It is argued that negative guideline characteristics and justified concerns amongst doctors negate satisfactory adherence. Clinical guidelines have been part of the UK landscape for many decades, as a means of improving health care for patients (Woolf et al, 1999). Research evidence suggests that a significant proportion of physicians do not adhere to clinical guidelines in patient care (e.g. Grol et al, 1998; Forsythe et al, 1999; Sherr et al, 2001; White, 2001; Thomas et al, 2003). Sherr et al (2001) investigated adherence of Obstetric Units in the UK and Eire to antenatal HIV testing policies. The Department of Health and Royal College of Obstetricians have both issued specified guidelines, which require that antenatal HIV testing be offered to all pregnant women, and adherence to these benchmarks has generated some debate. Data from 89% of antenatal units was analysed. Only 10% of units offered testing to all presenting women, and these units were concentrated in areas of high HIV prevalence (i.e. London). Other units operated selective screening policies (offering antenatal testing to some women, identified on the basis of clinical criteria) or ‘on request’ screening. Forsythe et al (1999) studied adherence of senior NHS staff (consultants, general practitioners) towards BMA guidelines on the ethical responsibilities doctors have towards themselves and their families. The Academy of Royal Medical Colleges, and the General Medical Council both endorse these guidelines, which generally require that doctors do not assume responsibility for their own personal (or family’s) health care. Questionnaire data was collected from four randomly chosen NHS Trusts and three local medical communities in the London (South Thames) area. Personal use of health services was the outcome measure. Results showed that although most doctors (96%) were registered with a GP, the majority (63% of GPs and 59% of consultants) had not consulted their GP in the past year. Almost a quarter (24%) of consultants stated they would never see a GP before obtaining consultant advice. The majority (71% of GPs and 76% of consultants) self-prescribed drugs ‘usually’ or ‘sometimes’. Forsythe et al (1999) concluded â€Å"senior doctors are not following the BMA guidelines on looking after their own and their families health† (p.608). Clinical guidelines are thought to have significant benefits for patient care (Woolf et al, 1999). However, research findings on the impact of guidelines are mixed (Morrison et al, 2001; Bennewith et al, 2002; Bousquet et al, 2003). Bousquet et al (2003) conducted a randomised controlled trial assessing the value of guidelines of the International Consensus on Rhinitis (ICR) in caring for patients with seasonal allergic rhinitis. GPs were randomised into two groups: one group followed ICR guidelines (patients received an oral anti-histamine, a topical corticosteroid, and/or a topical ocular cromone) while the other group were free to choose appropriate treatment for patients. Outcome measures were degree of impairment[1] and symptom medication scores. Patients treated by the guidelines strategy GPs generated lower symptom scores over a three-week period compared with patients assigned to free-choice GPs. Furthermore, patients in the guideline group reported greater reductions in their degree of impairment compared to the free choice group. This trial clearly demonstrated the benefits for patients of implementing clinical guidelines. Diggory et al (2003) reviewed the results of five audits relating to cardiovascular-pulmonary resuscitation (CPR) at the Mayday University Hospital. At least one audit focused on doctors’ adherence to elderly care policy and guidelines recommended by the Royal College of Physicians. Documentation of a CPR decision, review of all patients, and documentation of any changes to the CPR decision became policy in the emergency department. CPR decisions were documented by both trainee doctors and consultants for >91% of cases. Consultants reviewed 93% of patients within 24hours, and documented a CPR decision in 81% of cases. Benefits for patients seemed to present in a reduction in DNAR[2] orders. Other research suggests that the benefits of guideline adherence for patients may be more limited. Morrison et al (2001; Bennewith et al, 2002) assessed the impact of clinical guidelines for the management of infertility, in both primary and secondary care settings. . Figure 1 Clinical investigations completed for intervention and control practices (Morrison et al, 2001) Over 200 general practices and NHS hospitals accepting referrals for infertility in Greater Glasgow were randomised to a control or intervention condition. The intervention group received clinical guidelines. No group differences were found in referral rates, albeit referrals from intervention practices were more complete, incorporating all essential clinical investigations (e.g. semen analysis, rubella immunity) (see Figure 1). No group differences emerged in the percentage of referrals in which a management plan was achieved within one year, in the mean duration between first appointment and date of management plan, and costs of referrals. On the whole, this study demonstrates a differential effect of guideline adherence across different criteria of patient care. Despite the (modest) increase in the number of recommended clinical investigations performed prior to referral, clinical guidelines were no more cost effective than having no guidelines. Overall, research findings are mixed regarding the benefits of guideline adherence for patient. Nevertheless, improvements in some aspects of care have been demonstrated. What guideline characteristics are pertinent to adherence? Michie et al (2004) assessed the reasons why GPs do not always conform to guidelines. The focus was on guidelines set by the UKs National Service Framework (NSF) for Coronary Heart Disease (CHD). London based GPs, who were classified as either ‘high implementers’ (adhered to five or more of 6 CHD standards) or ‘low implementers’ (adhered to 1 or 2 guidelines), were interviewed on their beliefs, self-reported behaviours, and organisational context. Several issues differentiated the two groups: views about evidence based practice; control over clinical practice; and the repercussions of adhering to guidelines. Low implementers were more sceptical about evidence-based practice, more worried about the lack of control over the development and implementation of guidelines, and their own professional duties as doctors, and adverse consequences for GPs/patients that outweigh any benefits. This study highlights the importance of GP attitudes towards guideline adherence. Irani et al (2003) emphasised the methodological characteristics of the guidelines themselves. They assessed the quality of national clinical practice guidelines (CPGs) on benign prostatic hyperplasia, and lower urinary tract symptoms. Two independent assessors appraised methodological quality of the CPGs using the St.Georges Hospital Medical School Health Care Evaluation Unit Appraisal Instrument. This tool incorporates items gauging three criteria: rigour of development (e.g. ‘Is there a description of the sources of information used to select the evidence on which the recommendations are based?’), context and content (e.g. ‘Is there a satisfactory description of the patients to which the guidelines are meant to apply?’), and clinical application (‘Does the guideline document suggest possible methods for dissemination and implementation?’). Analysis revealed substantial variability in quality across CPGs. Grol et al (1998) found an association between guideline characteristics and adherence. An observation design was used to study 47 specific recommendations from 10 clinical guidelines in relation to 12 different guideline characteristics. For example, evidence base, clinical experience, concerned with daily practice, and ambiguity. Regression analysis revealed three key characteristics that predicted most of the variance in compliance rate: ‘the recommendation is vague and not precisely defined’, ‘the recommendation demands change of fixed routines’, and ‘the recommendation is controversial and not compatible with current values’. Figure 2 Rates of compliance across guideline attributes (present or absent) (Grol et al, 1998) Figure 2 illustrates differentials in adherence rates as a function of the presence or absence of different guideline attributes. In general practitioners were more likely to comply in the presence of an evidence base, capacity to solve clinical problems, precisely described, and media publicity. Compliance was also more probable in the absence of capacity to provoke patients, requiring change to clinical routines, significant consequences for management, demanding new skills/training, controversy, complexity, and ambiguity. Clinical guidelines in the UK have historically been prescribed by a multiplicity of agencies, notably the Department of Health, and profession-specific bodies, such as the Royal College or Surgeons, Royal College of Nursing, and British Medical Association. The National Centre for Clinical Excellence (NICE) currently sets clinical guidelines. This body continually publishes benchmarks for most areas of clinical practice. The Department of Health has also established Essence of Care standards, which have a more generic focus (DOH, 2003). Guidelines are purportedly based on empirical evidence, notably randomised control trials, hence satisfying the requirement for evidence-based practice. However, reservations amongst GPs about the notion of evidence-based guidelines, which often fall outside their clinical experience, has been identified as one reason for low adherence amongst doctors (The BRIDGE Study Group, 2002; Michie et al, 2004). GP scepticism is partly justified. Morice and Parry-Billings (2006) discuss the validity of such ‘evidence’, identifying several important important issues. Firstly, NICE, the DOH, and other relevant prescribing bodies rely on clinical trials, many of which select patient groups â€Å"to give the trial treatment maximum scope to show an effect†. Then there is publication bias –studies showing positive or dramatic effects are more likely to be published than studies showing no difference/effect. Guidelines are often linked to meta-analyses, which by definition will be ‘infected’ by the research biases already mentioned. What is worrying is that many national guidelines are adapted locally, in the form of hospital policy (e.g. Sherr et al, 2001; Diggory et al, 2003), and these adaptations may have an even weaker evidence base than the national benchmarks set by NICE, DOH, and other prescribers. None of this is likely to improve GPs attitudes towards guideline adherence. Do doctors need guidelines? In a discussion of heart disease regulations in the UK, Petch (2002) argued that the specification of treatment criteria has not been very successful in the USA and other countries. Adherence to guidelines is criticised on three grounds. Firstly, guidelines imply universal health care, an ideal most nations cannot afford, least of all the UK, which relies on rationing (i.e. waiting) due to limited health resources. Attempting to implement similar standards for every single patient is expensive. Secondly, recommended treatments can often have complications/side effects, so that certain treatments may be inappropriate for certain patients, but yet be a mandatory therapy, which the doctor is compelled to follow regardless. Thirdly, administering the same treatment to all patients is not cost-effective. The treatment may not benefit every patient. It is usually not clear â€Å"which patients will benefit from which drugs and hence the victim of a heart attack will be recommended to take aspirin, a statin, a ÃŽ ² blocker, and an angiotensin converting inhibitor, in addition to other drugs†¦Ã¢â‚¬  (p.474). Nevertheless, guidelines remain an integral element of patient care. This raises an important question: what kind of support do GPs require in order to adhere to guidelines? Marshall et al (2001) investigated factors that facilitate guideline acceptance in health professionals. Representatives from general practices in the NHS Northern and Yorkshire region were interviewed. Thematic analysis highlighted several issues including the need for training (staff often lacked the requisite clinical expertise to implement some guidelines), a conflict between responsibility and control (nurses/doctors are responsible for implementing criteria, but have no say over resource allocation), the and ‘cul-de-sac’ of patient non-compliance (e.g. little can be done if patients refuse treatment, and this is interpreted as failure of staff to adhere to guidelines). CONCLUSION Several key issues have emerged from this review. Firstly, research findings are mixed regarding the benefits of clinical guidelines for patient care. There is clearly a need for more randomised controlled trials. The benefits for patients probably vary across disease types, clinical setting, and doctor and patient characteristics. Doctors have serious concerns about the use of guidelines in patient care, and these reservations are mostly justified. Perhaps the most defensible concerns relate to questionable evidence base, the need to account for differences in how individual patients respond to treatment, and poor guideline characteristics, such as ambiguity. Unsatisfactory guideline implementation by doctors will probably persist until these problems are fully addressed by NICE and the Department of Health. BIBLIOGRAPHY Bennewith, O., Stocks, N., Gunnell, D., Peters, T.J., Evans, M.O. Sharp, D.J. (2002) General practice based intervention to prevent repeat episodes of deliberate self harm: cluster randomised controlled trial. British Medical  Journal, 324, p.1254. Bousquet, J., Lund, V.J., van Cauwenberge, P., Bremard-Oury, C., Mounedi, N., Stevens, M.T. El-Akkad, T. (2003) Implementation of guidelines for seasonal allergic rhinitis: a randomised controlled trial. Allergy, 58, pp.733-741. Diggory, P., Cauchi, L., Griffith, D., Jones, V., Lawrence, E., Mehta, A., O’Mahony, P. Vigus, J. (2003) The influence of new guidelines on cardiopulmonary resuscitation (CPR) decisions. Five cycles of audit of a clerk proforma which included a resuscitation decision. Resuscitation, 56, pp.159-165. Forsythe, M., Calnan, M. Wall, B. (1999) Doctors as patients: postal survey examining consultants and general practitioners adherence to guidelines.  British Medical Journal, 319, pp.605-608. Grol, R., Dalhuijsen, J., Thomas, S., Veld, C.I., Rutten, G. Mokkink, H. (1998) Attributes of clinical guidelines that influence use of guidelines in general practice: observational study. British Medical Journal, 317, pp.858-861. Irani, J., Brown, C.T., van der Meulen, J. Emberton, M. (2003) A review of guidelines on benign prostatic hyperplasia and lower urinary tract symptoms: are all guidelines the same? British Journal of Urology, 92, pp.937-942. Marshall, J.L., Mead, P., Jones, K., Kaba, E. Roberts, A.P. (2001) The implementation of venous leg ulcer guidelines: process analysis of the intervention used in a multi-centre, pragmatic, randomised, controlled trial.  Journal of Clinical Nursing, 10, pp.758-766. Michie, S., Hendy, J., Smith, J. Adshead, F. (2004) Evidence into practice: a theory based study of achieving national health targets in primary care. Journal of  Evaluation in Clinical Practice, 10, pp.447-456. Morice, A.H. Parry-Billings, M. (2006) Evidence based guidelines – a step too far?  Pulmonary Pharmacology and Therapeutics, 19, pp.230-232. Morrison, J., Carroll, L., Twaddle, S., Cameron, I., Grimshaw, J., Leyland, A., Baillie, H. Watt, G. (2001) Pragmatic randomised controlled trial to evaluate guidelines for the management of infertility across the primary care-secondary care interface. British Medical Journal, 322, pp.1-5. Petch, M.C. (2002) Heart disease guidelines, regulations, and the law. Heart, 87, pp.472-479. Sherr, L., Bergenstrom, A., Bell, E., McCann, E. Hudson, C.N. (2001) Adherence to policy guidelines – a review of HIV ante-natal screening policies in the UK and Eire. Psychology, Health and Medicine, 6, pp.463-471. The BRIDGE Study Group (2002) Responses of primary health care professionals to UK national guidelines on the management and referral of women with breast conditions. Journal of Evaluation in Clinical Practice, 8, pp.319-325. Thomas, A.N., Pilkington, C.E. Greer, R. (2003) Critical incident reporting in UK intensive care units: a postal survey. Journal of Evaluation in Clinical Practice, 9, pp.59-68. White, S.M. (2001) An audit of audit and continued educational and professional development. Anaesthesia, 56, pp.1003-1004. Woolf, S.H., Grol, R., Hutchinson, A., Eccles, M. Grimshaw, J. (1999) Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines.  British Medical Journal, 318, pp.527-530. Footnotes [1] Using the Standardised Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). [2] ‘Do not attempt resuscitation’

Ideal Women :: essays research papers

The American women of today can never be too thin or too pretty. In most cases thin equates beauty, so the present ideal is a thin, fit, radiantly healthy, young woman. In magazines stuffed with models and advertisements, billboards on the highway, and actresses on TV, the message of what women should look like is everywhere. The inescapable presence of these images in effect shapes the image of women today. It is very unfortunate that the media influences American society to the point that it defines the "ideal woman." According to Naomi Wolf, author of the bestselling book, <a href="http://click.linksynergy.com/fs-bin/stat?id=pcZ8g7DjAzA&offerid=6424&type=2&subid=0&url=http%253A//search.borders.com/fcgi-bin/db2www/search/search.d2w/Details%253F%2526mediaType%253DBook%2526prodID%253D2647098" >The Beauty Myth: How Images of Beauty are Used Against Women<IMG border=0 alt=icon width=1 height=1 src="http://ad.linksynergy.com/fs-bin/show?id=pcZ8g7DjAzA&bids=6424&type=2&subid=0" >, one reason media is so influential is "advertising is a 130 billion dollar a year industry. The average American watches 30 hours of TV a week and spends 110 hours a year reading magazines. That adds up to exposure to 1500 ads daily" (45). Advertising is a powerful educational force in our culture due to the simple fact of exposure. Eco nomics is also a significant factor in the development of the ideal image. There is a wealth of businesses that depend upon the American desire for thinness to survive. Exercise and diet companies are an example. In order to create a market for their product, they attempt to make women feel inadequate about their own bodies through advertisement. According to Wolf, "the diet industry has tripled its income in the past 10 years from a $10 billion industry to a $33.3 billion industry" (47). Other companies that cater to the current "large" population sell beauty, tactfully. As William Lutz points out in his article, "With these Words I can Sell You Anything," girdles are called body shapers or control garments (158), and in Diane White's article, "Euphemisms for the Fat of the Land," extra-extra large is changed to queen size (176). Either way, it is their diet, exercise, or control product that will get women on the way to the thinner, and better, more popular, sexy ideal. Advertisers manipulate women into thinking their value is dependent on their physical appearance. They appeal to that basic human desire to be wanted, accepted, and sexually attractive, as Charles O'Neill points out in his article, "The Language of Advertising"(163). One reason this "ideal" has manipulated the American society in particular, is that it appeals to some basic American values. Ideal Women :: essays research papers The American women of today can never be too thin or too pretty. In most cases thin equates beauty, so the present ideal is a thin, fit, radiantly healthy, young woman. In magazines stuffed with models and advertisements, billboards on the highway, and actresses on TV, the message of what women should look like is everywhere. The inescapable presence of these images in effect shapes the image of women today. It is very unfortunate that the media influences American society to the point that it defines the "ideal woman." According to Naomi Wolf, author of the bestselling book, <a href="http://click.linksynergy.com/fs-bin/stat?id=pcZ8g7DjAzA&offerid=6424&type=2&subid=0&url=http%253A//search.borders.com/fcgi-bin/db2www/search/search.d2w/Details%253F%2526mediaType%253DBook%2526prodID%253D2647098" >The Beauty Myth: How Images of Beauty are Used Against Women<IMG border=0 alt=icon width=1 height=1 src="http://ad.linksynergy.com/fs-bin/show?id=pcZ8g7DjAzA&bids=6424&type=2&subid=0" >, one reason media is so influential is "advertising is a 130 billion dollar a year industry. The average American watches 30 hours of TV a week and spends 110 hours a year reading magazines. That adds up to exposure to 1500 ads daily" (45). Advertising is a powerful educational force in our culture due to the simple fact of exposure. Eco nomics is also a significant factor in the development of the ideal image. There is a wealth of businesses that depend upon the American desire for thinness to survive. Exercise and diet companies are an example. In order to create a market for their product, they attempt to make women feel inadequate about their own bodies through advertisement. According to Wolf, "the diet industry has tripled its income in the past 10 years from a $10 billion industry to a $33.3 billion industry" (47). Other companies that cater to the current "large" population sell beauty, tactfully. As William Lutz points out in his article, "With these Words I can Sell You Anything," girdles are called body shapers or control garments (158), and in Diane White's article, "Euphemisms for the Fat of the Land," extra-extra large is changed to queen size (176). Either way, it is their diet, exercise, or control product that will get women on the way to the thinner, and better, more popular, sexy ideal. Advertisers manipulate women into thinking their value is dependent on their physical appearance. They appeal to that basic human desire to be wanted, accepted, and sexually attractive, as Charles O'Neill points out in his article, "The Language of Advertising"(163). One reason this "ideal" has manipulated the American society in particular, is that it appeals to some basic American values.

Essay --

Amanda Korah P.1/Gwizdala February 26th, 2013 A Long Way Gone In Class Essay A Long Way Gone by Ishmael Beah is a memoir of a young, emotionally distraught child soldier who takes his audience through his mental and physical journey to his eventual escape of the Civil War in Sierra Leone. For the past few days, our World Literature class have been trying to figure out/argue what category A Long Way Gone falls under. In Tim O'Brien's book, The Things They Carried, he distinguishes between two types of stories: (1) stories that need to be real and (2) stories that rely on the emotional truth. To me, A Long Way Gone is a novel that relies on the emotional truth and should be read as such; it relies on the emotions of human beings for the story to be understood as it was written by a boy like one of us. Initially I was not sure what the emotional truth was, so I googled the definition and got that, â€Å"an emotional truth is writing in such a way that readers not only learn the facts of an event, but can feel the joy, sorrow, anger, envy, love, hate, poigna ncy that the participant feels.† And I believe that a story that relies on the emotional truth is not any less significant than stories that strictly state the truth. A story told using emotional truth/validity is a story that, in my opinion, offers more of the real picture than that of a story that doesn’t tug on the emotions of a reader and just blatantly state the true happenings of an event. I’ve come to terms that there is a possibility of a stretch in truth in A Long Way Gone. Listening to the arguments made throughout the discussion, there is evidence out there to counter some of the statements made by Ishmael Beah in his memoir (i.e. Being a child soldier in 1995 ... ...ay because we are emotionally vulnerable beings who respond more to emotions rather than the real situation. We believe everything is ok when someone expresses happiness, and we think things are going bad if someone expresses sorrow. We acknowledge situations, and we react to the emotions felt about a particular situations, which is why Ishmael Beah’s A Long Way Gone is categorized as a story of emotional truth, it relies on our emotions to bring awareness to not only his life experiences but problems that went on in the world, and problems that still may be going on in the world. We must view this emotional truth story as valid as one that tells us a straight up truth, the reason why this book was made an emotional truth is so that we have a better understanding (and we understand better) about our surroundings, in a way that we would understand to the fullest.

Individual Management and Leadership Plan

Introduction This brief is aimed at investigating and reporting my own individual management and leadership plan. It covers identifying and owning my individual leadership development requirements using a range of appropriate diagnostic tools. Alongside with this is the planning of the development of these skills, supporting such plan with appropriate use of academic and leaning theories. Such plans are placed in an organisational or industry context, in which clear links to organisational strategies are created. Appropriate professional reflection at relevant intervals is incorporated. According to Gallos (2008), leadership is a complex social process that is grounded on the values, knowledge, and skills of leaders and followers. Adaptive change is always involved in the concept of leadership. Leaders are able to see new opportunities and facilitate a multifaceted interactive process that reinforces individual and collective growth. Ladkin (2010) states that understanding leadership as a lived experience requires studying it within the specific context in which it operates. It is important for leaders to relate to followers where they must work together within a specific context and work towards a clear purpose. Kezar (2009) has articulated that leadership is a property of whole systems rather than of individuals, which means that effectiveness in leadership is a result of those associations or relationships amongst parts rather than of any one part of such system (i.e. the leader). This will be illustrated in the devised plan and placing such plan in an industry context. Identifying and Owning my Individual Leadership Development Requirements This part of the paper effectively identifies my own individual leadership development requirements through the use of a range of appropriate diagnostic tools such as Belbin Test, Four Temperaments Personality Test, and Myers Briggs Assessment. These individual leadership development requirements consist of what one knows about himself, what he does not know about himself, and how to find it out. The reason why one must identify and own his/her individual leadership development requirements is because of the need to examine where his skills, behaviour, and attitudes are placed within leadership and collaborative continuum and how he/she helps in building leadership in the organisation. It is also important to link personality and character with leadership because personality and character determine how one leads a group or organisation (Adair, 2007). According to Kezar (2009), team and collaborative leadership models highlight the significance of focusing on organisational relationships, processes, and structures that foster collaboration, instead of emphasis on identifying and cultivating individual leadership skills. The Myers Briggs Assessment tends to yield accurate type results through the use of administered and scored questionnaire (Quenk, 2009). (Since this test is not available online, it is only cited here as one of the assessment tools that assesses personality/behaviour and is not utilised in actual assessment.) The Belbin Test, on the other hand, measures the behavioral contribution of an individual through Belbin team role theory, making this test a behavioural test rather than a personality test. Team role preferences are identified in Belbin reports to enable the individual to know and appreciate the extent of their strengths and the behaviour that must be developed for the benefit of the team (Riding and Rayner, 2001). From the Team Roles Test, which is part of the Belbin Test that I have taken, my strengths are identified as the ability to effectively resolve conflict with teammates and ability to plan and coordinate with teammates. The potential strengths, on the other hand, are satisfactory interpersonal skills, ability to communicate with others with relative ease, and ability to manage various tasks and other aspects of teamwork. The limitations I exhibit, which require further improvements for my team role performance, are lack of team-based problem-solving ability, setting only few goals for team projects, and preference for individual work instead of team work (Psych Tests, 2014). The Belbin Test clearly shows the strengths, potential strengths (which can turn into real strengths in the future, given one’s increased maturity), and limitations (which can also turn into strengths, given their realisation through the test) for one’s undertaking of the team roles. On the other hand, the Four Temperaments Personality Test yields for me a 75-per cent score for each of the Sanguine, Choleric, and Melancholic aspect, whilst 58 per cent for the Phlegmatic aspect. This would mean that I am a people-person who likes socialising and exhibits optimism, enthusiasm, compassion, impulsiveness, and self-indulgence. Being choleric, the results show that I am extroverted, task-oriented, and seek competition and success at all cost, with strong leadership skills and passion for work. Being melancholic, I am respectful, compassionate, and possess intuitive traits. My phlegmatic traits, which are underplayed by the three other traits -sanguine, choleric, and melancholic- are passive aggressiveness and calmness (How Much Do I, 2014). These traits play an influential stance on how I approach leadership and teamwork. My sanguine, choleric, and melancholic traits can be used in how I undertake leadership and team roles in my work towards achieving set goals. My kno wledge of both these dominant and negligible traits based on the four temperaments supports my knowledge of my skills based on the Belbin Test. Planning the Development of Mentioned Skills This part of the paper includes planning for the development of the skills mentioned above. These skills are the potential skills and limitations identified in the Belbin Test. The Four Temperaments Personality Test shows one’s personality based on temperaments, which greatly aids in my understanding of my inclination to developing the potential skills and cited limitations. The plan includes the following: Improving my interpersonal skills from satisfactory level to above-average level Increasing my ability to communicate with others with relative ease Improving team-based problem-solving ability setting several goals for team projects instead of only a few ones Increasing my preference for team work over individual work in accomplishing goals Improving my interpersonal skills from satisfactory level to above-average level The importance of increasing my interpersonal skills from satisfactory level to above-average level is seen in the fact that effective leadership necessitates not only analytical and decision-making skills but also interpersonal skills (Grant, Rothstein, and Burke, 2010). Such importance is evidenced by leader-member exchange theory, which focuses on the low-exchange and high-exchange dyadic relationships between the leader and the followers (Rainey, 2009), and transformational leadership theory, which states that leaders must inspire followers towards more accomplishment by focusing on the value of the followers and helping them align these values with those of the organisation (Givens, 2008; Nohria and Khurana). Additionally, Robinson (2011) underlines the importance of interpersonal skills by linking them to goal setting, such that the quality of goal setting is always connected to the quality of (interpersonal) relationships. Goal setting will remain empty unless leaders are a ble to motivate the people who are required to achieve them. Grant and colleagues (2010) note the dichotomy between analytical and decision-making skills on one hand, and interpersonal skills on the other. It is important to delineate what constitutes interpersonal skills in order to place the significance of this skill to the wider leadership context. According to Grant et al. (2010), interpersonal skills development for leaders and managers refer to complex abilities of conflict management and negotiation skills, rater than just plainly focusing on engaging people in quality interactions, speaking and listening effectively, and providing positive feedback. As for improving my interpersonal skills, this will be done by attending a skills training seminar focused on interpersonal skills for effective leadership (e.g. Grant et al., 2010). Increasing my ability to communicate with others with relative ease The importance of communication to leadership is that it is the process used for setting and communicating clear goals (Robinson, 2011). Improving this skill is through constant practice; meaning, talking to people more often. This is however not a difficult stance to undertake since as my score in the Four Temperaments Personality Test shows, I have dominant extrovert behaviour shown by my sanguine and choleric tendencies, which indicate an interest to communicate with people (e.g. Ricketts and Ricketts, 2011). Management theory’s human relations movement highlights the importance of people motivation (Banhegyi, 2007), which is indirectly linked to communicating with them to foster smooth relationships. Improving team-based problem-solving ability In my plan to develop my management of various tasks and other aspects of teamwork, an important point to consider is that a leader cannot rely on teamwork to develop automatically without exerting some conscious effort on his/her part. Without the leader’s influence, it is still possible for teamwork to develop to some extent, but this setting is unlikely for the work group to develop member satisfaction and maximum task performance (Butterfield, 2011). In order to develop my team-based problem solving ability, my course of action is to read books on the subject. Applying into practice what I have learned conceptually and theoretically about it will yield positive outcomes, leading to desired improvements in my management of various tasks and other aspects of teamwork. Theodore Newcomb’s Balance Theory explains why people tend to be attracted towards group formation, and this is because of the similarity in attitudes in their pursuit for a common goal. Such similarity allows them to share ideas with one another and function as a team. Lack of similar attitudes leads to loss of balance, resulting in a team not being formed (Kandula, 2006). An important thing to consider is that team-based learning is a result of good team-based decision making and problem-solving ability (Michealsen, Sweet, and Parmelee, 2008). Setting several goals for team projects instead of only a few ones Goal-setting involves identifying the goals to be established, gaining the commitment of people who are tasked to achieve them, and communicating these goals to people who have interest in their achievement (Robinson, 2011). Having this renewed realisation that setting many goals rather than just a few ones is more preferable to effective leadership and goal attainment, the plan is focused on taking a conscious effort on enumerating several goals every time goal-setting is being undertaken, and suggesting to the group a more increased identification of goals each time the group tends to identify only a few ones. The point is consciously putting into practice this knowledge. The relevance of setting several goals instead of only a few ones is apparent; a team that identifies more goals is able to achieve more goals, compared to a team that identifies only a few goals, which becomes delimited to achieving only these few goals. The Goal Setting Theory explains the importance of goals in motivating people to work, and consequently, in making them behave with a purpose (Lussier, 2012). This would mean that not only is goal-setting beneficial for the organisation but for the people working on these goals as well. Increasing my preference for team work over individual work in accomplishing goals Since leadership is about leading people, individual work is not the paramount aspect of goal achievement, but teamwork. In a team, people work together towards achieving desired goals, have full and sufficient understanding in the importance of these goals, how these goals may be achieved successfully, and what each one and the whole team may contribute to their successful achievement. If the leader and even the team members are more focused on working individually rather than as a team, the essence of teamwork is lost. (Ricketts and Ricketts (2011) indicate that working as a team is more effective than working individually; thus, the motivation to utilise teamwork and the various literature on the importance of this concept (e.g. Dyer, Dyer, and Dyer, 2007; Morgeson, Reider, and Campion, 2005; Valle and Witt, 2001). Since the results of my Four Temperaments Personality Test indicate that I have an extraverted temperament, this temperament would help in my ability to build team wor k. The result of my Four Temperaments Personality Test on the phlegmatic aspect, specifically self-indulgence, is a good point to consider in my current preference for individual work over team work. On the other hand, since my dominant sanguine and choleric propensities show that I am inclined to being extraverted, this preference is likely to be changed with ease, given such initial knowledge for its imperative change. Heneman and Greenberger (2002) state that the facilitation of team work is through the efforts of some extraverted individuals. Placing the Plan in an Organisational or Industry Context/Strategy Having accomplished the plan, the next step would be to place this in an organisational or industry context, creating clear links to organisational strategies. First of all, leadership is an important concept in the success of an organisation, which is why organisations always gear for effective leadership or management in the workplace. Leadership is different from seniority or one’s position in the hierarchy of his or her organisation. It is an influential relationship that takes place between a leader and his/her followers as they pursue certain changes or objectives that mirror shared meanings, purposes, and strategies (Mills, Mills, Forshaw, et al., 2007). The potential skills and limitations, on which the plan has been established, will eventually add up to my series of strengths identified by the Belbin Test. After implementing the plan, the expected outcomes for me would be above-average interpersonal skills, ability to communicate with others with relative ease, improved team-based problem solving ability, setting many goals for team projects, and increased preference for team work over individual work. These skills are useful in an organisational context; specifically in managing people where the leader/manager needs to unify his/her team towards successful goal attainment. By being able to work in a team and foster good communication skills, problem solving ability, and other skills thus cited as my strengths, I and my team would together work on the necessary aspects of several tasks, which we are responsible to accomplish. The retail industry is the specific industry context on which the plan is placed. This industry is characterised by several challenges in attaining competitive advantage because of the presence of new entrants, substitute products, bargaining power of customers and suppliers, and rivalry between existing competitors (Stonehouse, Campbell, Hamill, et al., 2004). These challenges serve as a factor for my pursuit for effective leadership and team roles, on which the plan is established. My ability to effectively resolve conflict with teammates and to plan and coordinate with them plays a significant role in smooth working relationships within the team. This importance is further seen in the claim that conflict and lack of team coordination serve as a barrier to attaining desired goals (e.g. Lencion, 2012; Rout and Omiko, 2007). Moreover, my improved interpersonal skills will enable me to communicate my ideas more effectively across people and departments. It has been noted that interpe rsonal skills refer to analytical and decision-making skills (Grant et al, 2010), which means that my possession of these skills will aid my team and the organisation in addressing the competition that retail companies commonly experience. These – together with my improved ability to communicate with others with relative ease, improved team-based problem-solving ability, setting many goals, and increased preference for team work over individual work – will help the company develop strategies for competitive advantage. Incorporating Appropriate Professional Reflection at Relevant Intervals This research has enabled me to identify my own strengths, limitations, and potential skills in leadership and team roles. Apparently, I had no prior ideas of these skills and limitations on a systematic basis, but the Belbin Test and the Four Temperaments Personality Test enabled me to find out approximately what these skills are. I certainly have an initial knowledge of myself, but these tests confirmed them and even added some more which I was not very aware of, such as my satisfactory level of my interpersonal skills, a need to communicate with others with relative ease, a need to improve my team-based problem-solving ability, and my inclination to set only a few goals instead of many goals for team projects. Some of the skills that I am already aware of are effective conflict resolution and ability to plan and coordinate with teammates. Moreover, the Four Temperaments Personality Test made me understand the ease that the potential skills and limitations may be improved. This is because of my dominant combination of sanguine, choleric, and melancholic temperaments, which have positive traits for leadership abilities (e.g. extraversion, being a people-person, optimism, and enthusiasm, being task-oriented, being competition-focused, and being success-specific and strong leadership skills). A further realisation that I have derived from this exercise is the importance of knowing oneself – strengths, skills, abilities, potentials, and limitations – since such knowledge serves as a prelude to being able to manage teams and the organisation as a whole. By being able to systematically identify my strengths, I have been personally assured of my abilities. By being able to also systematically identify my potentials and limitations, I have found out the areas that need improvement. These limitations and potentials allow me to better focus on what I must take an effort to improve on, whilst seeing them as a way for constructive criticism. In addition, no effective leader can function without self-realising his own strengths, skills, and limitations since only when he/she has fully realised them can they be able to function more effectively. Conclusion This paper has provided an investigation of one’s own individual management and leadership plan, using such diagnostic tools as the Belbin test and the Four Temperaments Personality Test. These tools helped identify and own my individual leadership development requirements. Through the Belbin Test, certain strengths were thus identified along with the potential skills and limitations. The Four Temperaments Personality Test also identified the dominant temperaments that helped in the assessment of one’s leadership propensities and abilities. The plan for development of the skills is centered on improving my interpersonal skills from satisfactory level to above-average level; increasing my ability to communicate with others with relative ease; improving team-based problem-solving ability; setting several goals for team projects instead of only a few ones; and increasing my preference for team work over individual work in accomplishing goals. The retail industry is the specific industry context on which the plan is placed. A professional reflection is conducted, focused on how the entire work is done. References Adair, J. (2007) Develop Your Leadership Skills. London: Kogan Page. Banhegyi, s. (2007) Fresh Perspectives: Management. Cape Town: Pearson Education South Africa (Pty) Ltd. Butterfield, J. (2011) Illustrated Course Guides: Teamwork and Team Building. Mason, OH: Course Technology Cengage Learning. Dyer, W. G., Dyer, W, G., and Dyer, J. H. (2007) Team Building: Proven Strategies for Improving Team Performance. NJ: John Wiley & Sons, Inc. Gallos, J. (2008) Business Leadership: A Jossey-Bass Reader. NJ: John Wiley & Sons, Inc. Givens, R. J. (2008) Transformational Leadership: The Impact on Organizational and Personal Outcomes. Emerging Leadership Journeys, 1 (1), 4-24. Grant, M., Rothstein, G., and Burke, R. (2010) Self-Management and Leadership Development. Glos, UK: Edward Elgar Publishing Limited. Heneman, R. L. and Greenberger, D. B. (2002) Human Resource Management in Virtual Organizations. US: Information Age Publishing Inc. How Much Do I (2014) What Is My Personality TypeFour Temperaments Personality Test. Retrieved on May 10, 2014 from http://www.howmuchdoi.com/personality/What-is-my-personality-type-Four-Temperaments-Personality-Test-70.html Kandula, S. R. (2006) Performance Management: Strategies, Interventions, Drivers. New Delhi: Prentice Hall of India Private Limited. Kezar, A. J. (2009) Rethinking Leadership in a Complex, Multicultural, and Global Environment. Sterling Virginia: Stylus Publishing. LLC. Larkin, D. (2010) Rethinking Leadership† New Look at Old Leadership Questions. Glos, UK: Edward Elgar Publishing Limited. Lencion, P. (2012) The Five Dysfunctions of a Team: Intact Teams Participant Workbook. San Francisco, CA: Pfeiffer. Lussier, R. N. (2012) Management Fundamentals: Concepts, Applications, Skill Development. Mason, OH: South-Western Cengage Learning. Michealsen, L. K., Sweet, M., and Parmelee, D. X. (2008) Team-Based Learning: Small Group Learning’s Next Big Step. New York: Wiley Periodicals, Inc. Mills, J. C., Mills, J. B., Forshaw, C., and Bratton, J. (2007) Organizational Behaviour in a Global Context. Plymouth, UK: NBN International. Morgeson, F. P., Reider, M. H., and Campion, M. A. (2005) Selecting Individuals in Team Settings: The Importance of Social Skills, Personality Characteristics, and Teamwork Knowledge. Personnel Psychology, 58 (3), 583-611. Nohria, N. and Khurana, R. (2010) Handbook of Leadership Theory and Practice: An HBS Centennial Colloquium. US: Harvard Business School Publishing Corporation. Psych Tests (2014) Team Roles Test. Retrieved on May 10, 2014 from http://testyourself.psychtests.com/bin/transfer Quenk, N. L. (2009) Essentials of Myers-Briggs Type Indicator Assessment. NJ: John Wiley & Sons, Inc. Rainey, H. G. (2009) Understanding and Managing Public Organizations. NJ: John Wiley & Sons, Inc. Ricketts, C. and Ricketts, J. (2011) Leadership: Personal Development and Career Success. Mason, OH: DELMAR Cengage Learning. Riding, R. J. and Rayner, S. (2001) Self Perception. Westport: Ablex Publishing. Robinson, V. (2011) Student-Centered Leadership. NJ: John Wiley & Sons, Inc. Rout, E. and Omiko, N. (2007) Corporate Conflict Management: Concepts and Skills. New Delhi: PHI Learning Private Limited. Stonehouse, G., Campbell, D., Hamill, J., and Purdie, T. (2004) Global and Transnational Business: Strategy and Management. Second Edition. NJ: John Wiley & Sons. Valle, M. and Witt, L. A. (2001) The Moderating Effect of Teamwork Perceptions on the Organizational Politics-Job Satisfaction Relationship. The Journal of Social Psychology, 141 (3), 379-388.

Literary Analysis Essay

Painting the Pages with Abstract Words: Creative writing is a tool that can effectively evoke connections with a reader and a piece of writing. Whether these connections are personal, or simply thought provoking, I believe it better helps us become immersed in such writings as â€Å"Tabula Asiae†, by Michael Ondaatje. The use of a sense of place forces one to picture themselves in the story being told. Tabula Asiae uses metaphoric phrases that makes the essay much more interesting to read. the wife of many marriages, courted by invaders who stepped ashore and claimed everything with power of their sword or bible or language† (Ondaatje 99). The sentence used here by Ondaatje creatively elaborates on the historical tale of Ceylon, which describes that â€Å"The island seduced all of Europe† (99). This is where I believe a slice of history makes an appearance in the essay. Although Ondaatje’s essay seems a bit imaginary and dreamy, it definitely does have historical references and occurrences mentioned within its body. When one compares an essay like â€Å"Tabula Asiae† with other nonfiction essays like â€Å"How I Learned to Read and Write† by Frederick Douglass, it becomes abundantly clear that Douglass’ essay is a nonfiction piece focused more on personal experiences as the primary nonfiction form of writing. Once you start reading Douglass’ essay, you instantly become impressed with his cleverness, heart, and strives to become a fluent reader and writer. An example of the personal experience form is used in most of the body of Douglass‘ essay, especially this sentence- â€Å"I was now about twelve years old, and the thought of being ~a slave for life~ began to bear heavily upon my heart. Just about this time, I got hold of a book entitled The Columbian Orator. Every opportunity I got, I used to read this book. † (Douglass 89. ) For me, Douglass immediately establishes a link, which gives me an astonishing need to cheer him on to become the man he wants to become. The two essays mentioned above, proves that different styles of nonfiction writing creates a much different experience for the reader.

Rhetorical Analysis of a Modest Proposal Essay

Swift’s â€Å"A Modest Proposal† written in 1729 was his proposal â€Å"for preventing the children of poor people in Ireland, from being a burden on their parents or country, and for making them beneficial to he publick† (Swift, Title). This proposal included the selling, skinning and buying of babies at the age of one. This proposal that he has come up with is a very inhuman and controversial one when it comes to being socially acceptable. Swift begins his essay by describing walking down a street in Ireland. He describes how you would see, â€Å"beggars of the female sex, followed by three, four, or six children, all in rags, and importuning every passenger for an alms† (Swift, Para. 1). This gives the reader a mental picture of how bad things are for the women he is trying to help. Swift then talks about how there are very many of these poor people in Ireland and how they are not able to be part of the middle or working class. Look more:  how to write satire essay He then proposes his idea that the children could, â€Å"contribute to the feeding, and partly to the cloathing of many thousands† (Swift, Para. 4). In no way, shape, or form is the eating of or the using of children in this manner acceptable. No society would ever find it suitable to eat or make babies into clothes. Dr. Swift has made a proposal that he should know would not work because of the inhumanity that it is asking people in which to participate. Jonathan Swift later tells the reader of how he has, â€Å"computed the charge of nursing a beggar’s child (in which list I reckon all cottagers, labourers, and four-fifths of the farmers) to be about two shillings per annum, rags included; and I believe no gentleman would repine to give ten shillings for the carcass of a good fat child,† (Swift, Para. 14). This is a good thing that Swift does telling how the mother would stand to make money on selling her child to a man for dinner. Except, I do not believe you couldn’t find a willing mother to sell her child knowing that it would be eaten by a human for a meal. Dr. Swift has made a plan for people with no remorse or thought of their children. The only place this plan could be carried out and continue working is a place with robots that have no feeling or conscious. Swift then makes the statement, â€Å"Those who are more thrifty (as I must confess the times require) may flea the carcass; the skin of which, artificially dressed, will make admirable gloves for ladies, and summer boots for fine gentlemen,† (Swift, Para. 15). He thinks that someone would be able to treat a baby’s skin as an animal’s and make it into a glove or boot without objection to what it is. This is another flaw in his plan. There are people who are against making animals into clothing. Therefore, I am sure that there would be people against the making of clothes from baby. Next, Dr. Swift gives 6 reasons of why he thinks the plan is a good one. His second reason states, â€Å"Secondly, The poorer tenants will have something valuable of their own, which by law may be made liable to a distress, and help to pay their landlord’s rent, their corn and cattle being already seized, and money a thing unknown,† (Swift, Para. 22). He thinks that poor tenants with children will be able to give their landlords something valuable by giving them their child. No landlord would take a child as a means of money because it just costs more money to them to have the child then without it. In his fourth reason Swift says, â€Å"Fourthly, The constant breeders, besides the gain of eight shillings sterling per annum by the sale of their children, will be rid of the charge of maintaining them after the first year,† (Swift, Para. 24) If the people who like to â€Å"breed† hear of this then they will just think that they will be able to keep having children and selling them instead of having a job. This would cause more jobless people and after so long the supply of the babies would surpass the demand. There then would be poor children hanging on their mothers again in the street defeating the purpose of the plan in the beginning. Fifthly Dr. Swift says, â€Å"This food would likewise bring great custom to taverns, where the vintners will certainly be so prudent as to procure the best receipts for dressing it to perfection; and consequently have their houses frequented by all the fine gentlemen, who justly value themselves upon their knowledge in good eating; and a skilful cook, who understands how to oblige his guests, will contrive to make it as expensive as they please,† (Swift, Para. 5). Again, I refer back to how people would not be able to eat the carcass of an one year old child, but also I think that if you were to find a cook to make this and a person to eat it that it would be at such an outrageous price that the people could not afford to try the meal of the baby. Finally, the last reason I do not think that this plan would work is what is in the final paragraph of the essay-â€Å"I profess, in the sincerity of my heart, that I have not the least personal interest in endeavouring to promote this necessary work, having no other motive than the publick good of my country, by advancing our trade, providing for infants, relieving the poor, and giving some pleasure to the rich. † (Swift, Para. 33). If the person that is proposing the idea at the end of the idea tells you that he has no interest in promoting his own proposal, I believe that it means he thinks that it also will not work and could not be enacted on a society. I am not the only one that is outraged or appalled with the works of Dr. Swift. Patrick Delany also states â€Å"As I have marked the passages that seemed to me most faulty, and gave me most offence, I beg leave to point them out, as they come in my way: without any further preface, or apology. The picture he draws of the Yahoos, is too offensive to be copied, even in the slightest sketch. † (Kathleen, Pg. 132). Delany and I are both offended and disagree with Swift’s works, but as a satire writer this just shows how effective his writing is on his audience. He tries to use outrageous and controversial subjects in order to grab the attention of his readers and keep them reading his papers. This style works very well and is a great way to get your point across. This style has grabbed the attention of all the readers and will continue to grab the attention of all the future readers of his essay.

Effective Team and Performance Management Essay

Effective Team and Performance Management - Essay Example 6). The team has become more effective, in norming stage. Each individual began to focus on the possible ways to improve their team. Due to this, more group effort and unity has increased within the team. At this stage, the team is focusing on collaboration or cooperation. The task of the group is to interact, and to ensure the flow of data. It is my duty to support the members and group as a whole. â€Å"During the norming stage of team development, team members will begin to solve discrepancy they felt between their individual expectations and the reality of the team experience† (Parcon 2007, p. 33). I have been a part of the best  team, and that worked out very well, for the reason that all of us, as a team loved the work we were doing. So the teams are ready to set aside their differences, and we truly move forward for attainment of team goals. In norming stage, leaders â€Å"help the team take responsibility for progress towards the goal. This is a good time to arrange a social or a team-building event† (Gears off a Leader Seriies (GOALS) 2011, p. 2) team interacted well each other. This means that we worked together efficiently, and are well with conscious of our goals, and the ways to accomplish those goals. There is no teamwork, devoid of regular communication. â€Å"Teamwork accomplishes a task more effectively and efficiently than individual efforts. Every team member should contribute equally toward accomplishing the task† (Gibson et al. 1980, p. 6). The â€Å"individual behavior† (Gupta 2010) is influenced by factors like abilities, gender, race and culture, perception, attributes, and attitude of the individuals. Behavior and Expectation for the Team in Each Area of Norms: Meeting: All team members should be attending at the meeting, so that they can own group norms resulting from the meeting. In the meeting, only one person at a time is supposed to speak. The opinion of each member is to be placed during the meeting t ime itself. If a member is found to be late, the member is not supposed to interrupt in between the meeting. A member, if always comes late for the meeting, should be asked to depart the group. All members are asked to get involved in the meeting, and the silent members are encouraged to speak and place their opinion. Specific time is also alloted for each member to speak. â€Å"Meeting norms  set ground rules or expectations on how people treat each other at a meeting† (Meeting Process Recommendations n.d.). Decisions: Decision is made by the consensus of the team members. Consensus means the voluntary support from the group. It is difficult to obtain complete consent for a team decision, but the members have to support the decisions, whatever it might be. All members are supposed to contribute their views and opinions regarding the issues. If they remain silent in the group means they too support the decisions. This is applicable for those who abstain from the meeting, as their opinions in absentia have no value. Communication and Co-ordination: Every member should participate, speak on one’s burn behalf, and also give chance for others to speak. Each person will be held responsible for their own actions. There are three choices left before every member: to accept the decisions, or to try to work to make it superior, or leave it. But they are not expected to complain about it, if one is not ready to work on it. Communication