A company’s culture is often buried so deeply inside rituals, assumptions, attitudes, and values that it becomes transparent to an organization’s members only when, for some reason it changes.
—Rob Goffee
Culture is embedded within every organization. Yet, because culture is woven throughout the everyday interactions and atmosphere of an organization, it can be difficult to assess and explain how the culture influences the inner workings of the organization.
As a nurse leader-manager, developing a sound understanding of an organization’s culture can help you to achieve quality improvement initiatives and identify strategies for enacting sustainable change.
For this Discussion, you analyze the culture of an organization and consider how this relates to achieving goals related to quality improvement. You may wish to focus on the same organization that you have selected for your Course Project.
To prepare:
Review the information on organizational culture in this week’s Learning Resources.
Reflect on the culture of an organization with which you are familiar. Consider the following:
What elements of the organization’s culture seem most prominent or significant to you?
What beliefs, dispositions, and/or actions seem to be most valued? Why do you think so?
What do you notice about the expectations, assumptions, and more demonstrated among people within the organization?
What artifacts provide clues about the culture?
How do these cultural elements contribute to or detract from the organization’s ability to meet prominent goals and objectives?
Consider how you, as a nurse leader-manager, could apply your knowledge of this culture to facilitate quality improvement initiatives within this organization. How would you leverage the strengths of the culture, and address limitations or obstacles that may arise within it?
Post an analysis of the culture of the organization that you selected. Explain how you think this particular culture contributes to or detracts from the organization’s ability to meet goals. Explain how you, as a nurse leader-manager, could utilize your knowledge of this culture to facilitate quality improvement initiatives within this organization.
Read a selection of your colleagues’ responses.
Respond to at least two of your colleagues on two different days using one or more of the following approaches:
Analyze similarities and differences between your colleague’s organizational culture and the organization that you selected.
Ask a probing question, substantiated with additional background information or research.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Suggest leadership strategies that your colleague could use to overcome obstacles in the organization’s culture to facilitate quality improvement initiatives.
Required Readings
Hickey, J. V., & Brosnan, C. A. (2017). Evaluation of health care quality in for DNPs (2nd ed.). New York, NY: Springer Publishing Company.
Chapter 10, “Evaluation of Patient Care Standards, Guidelines, and Protocols” (pp. 207-226)
Chapter 12, “Evaluating Populations and Population Health” (pp. 265-280)
Chapter 10 reviews methods for using national, local, and organizational standards to evaluate the quality of health care practices. Chapter 12 examines strategies for identifying quality issues through the evaluation of populations.
Sadeghi, S., Barzi, A., Mikhail, O., & Shabot, M. M. (2013). Integrating quality and strategy in health care organizations, Burlington, MA: Jones & Bartlett Publishers.
Chapter 3, “General Concepts in Quality” (pp. 45–82)
See the six aims for quality proposed by the Institute of Medicine (IOM).
Bellot, J. (2011). Defining and assessing organizational culture. Nursing Forum, 46(1), 29–37.
Retrieved from the Walden Library databases.
Bellot reviews the definition of organizational culture, methods for evaluating organizational culture, and the application of Schein’s framework to defining the culture of health care organizations.
Dixon, M. A., & Dougherty, D. S. (2010). Managing the multiple meanings of organizational culture in interdisciplinary collaboration and consulting. Journal of Business Communication, 47(1), 3–19.
Retrieved from the Walden Library databases.
This article demonstrates the importance of not only understanding the culture of an organization, but also how these dynamics affect workplace performance and retention of employees.
Dorgham, S. R. (2012). Relationship between organization work climate & staff nurses organizational commitment. Nature and Science, 10(5), 80–91. Retrieved from http://www.sciencepub.net/nature/ns1005/009_9000ns1005_80_91.pdf
The correlation between organizational climate and commitment and its effect on an organization is evaluated in this study.
Hartnell, C. A., Ou, A. Y., & Kinicki, A. (2011). Organizational culture and organizational effectiveness: A meta-analytic investigation of the competing values framework’s theoretical suppositions. Journal of Applied Psychology, 96(4), 677–694.
Retrieved from the Walden Library databases.
This article presents a study on the relationship between culture types and organizational effectiveness. The authors apply specific values frameworks to determine the relationships while also assessing the competing values framework.
Schein, E. H. (1996). Three cultures of management: The key to organizational learning. Sloan Management Review, 38(1), 9–20.
Retrieved from the Walden Library databases.
In this seminal article, Schein identifies three subcultures found within an organization and the effects of these competing cultures on an organization’s effectiveness.
Wait, S. T., & Dayman, M. A. (2012, July/August). Company culture drives business value. Value Examiner, 30–31.
Retrieved from the Walden Library databases.
The authors connect company culture to innovation and success.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Retrieved from https://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf
This report briefly outlines the six aims of the IOM to improve the quality of health care.
Schein, E. H. (1997). Organizational culture & leadership. Retrieved from http://www.tnellen.com/ted/tc/schein.html
Edgar Schein is one of the early writers on organizational culture. In this foundational article, Schein outlines various dimensions of organizational culture, and how leaders create, transmit, and embed organizational culture.
Required Media
Laureate Education (Producer). (2013e). Organizational culture. Retrieved from https://class.waldenu.edu
Note: The approximate length of this media piece is 3 minutes.
Dr. Carol Huston discusses the influence of organizational culture on the delivery of quality care
Accessible player
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In your experience, what is the best teaching method you use during a patient stay and/or at discharge? How do you assess your patient understands the information? Again, this is a teaching / learning session for each of us.
I NEED YOU TO ANSWER THIS QUESTION, 150 WORDS NEEDED AND A REFERENCE PLEASE
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Case Study: Imagine that you are the privacy officer for a small town hospital. You receive a report that there is a breach of privacy. You are informed that a 15-year-old girl is received at the emergency with an emergency labor. The baby is delivered in the emergency room as there is no time to move the patient to the obstetrics (OB) department. In addition to the emergency delivery, the baby is born with multiple medical problems. Once the mother and baby are moved to obstetrics and neonate, care is given to both.
The OB nurse who took care of the mother and baby completes her shift, and she goes home to her own daughter to have a talk with her. She sits her daughter down and pleads with the girl to tell her if she ever has any problems, especially when it comes to pregnancy. The nurse tells her daughter the story about the young patient who delivered that evening, and she accidentally mentions the patient’s name. The patient’s name is one of those odd names that immediately triggers the nurse’s daughter to relay that she knows the patient. The mother/nurse, realizing that she made a big mistake by mentioning the patient’s name, pleads with her daughter not to say anything. Needless to say, word shoots through the four high schools in the town the next day.
The nurse returns to work the following evening, and she contacts you to hand in her badge and keys, stating that she knows she made a mistake by breaching the young patient’s privacy and she knows she is going to be fired. In addition to the breach of the obstetrics nurse, you learn that the patient hid her pregnancy from her family, and to make matters worse, her aunt and mother are both nurses at the hospital. You know both of these nurses on a professional and personal level.
U.S. Department of Health and Human Services. (2002). Standards for privacy of individually identifiable health information; Final Rule. Federal Register, 67(157), 53182-53273. Retrieved from http://www.hhs.gov/ocr/privacy/hipaa/administrative/privacyrule/privrulepd.pdf
Then, perform additional research regarding the HIPAA Privacy Rule and prepare your Final Paper by analyzing the issues through these questions in regards to the above scenario:
Analyze the specific requirements needed to perform this investigation.
Identify whether this incident was an actual breach of privacy according to the HIPAA law.
Examine the differences and similarities between the hospital’s stance and HIPAA as to whether the nurse should be fired from her job.
Explain why you would fire or not fire the nurse immediately or whether you would put her on administrative leave awaiting the details of the investigation.
Final Paper
The final assignment for this course is a Final Paper. The purpose of the Final Paper is for you to culminate the learning achieved in the course by applying your knowledge in the field of health care ethics and medical law through the analysis of an actual case regarding an ethical dilemma.
Focus of the Final Paper
Review the three scenarios below. Choose one of them and address the questions asked within your selected scenario in the form of a written analysis.
Scenario No. 1: HIPAA Privacy Rule
Case Study: Imagine that you are the privacy officer for a small town hospital. You receive a report that there is a breach of privacy. You are informed that a 15-year-old girl is received at the emergency with an emergency labor. The baby is delivered in the emergency room as there is no time to move the patient to the obstetrics (OB) department. In addition to the emergency delivery, the baby is born with multiple medical problems. Once the mother and baby are moved to obstetrics and neonate, care is given to both.
The OB nurse who took care of the mother and baby completes her shift, and she goes home to her own daughter to have a talk with her. She sits her daughter down and pleads with the girl to tell her if she ever has any problems, especially when it comes to pregnancy. The nurse tells her daughter the story about the young patient who delivered that evening, and she accidentally mentions the patient’s name. The patient’s name is one of those odd names that immediately triggers the nurse’s daughter to relay that she knows the patient. The mother/nurse, realizing that she made a big mistake by mentioning the patient’s name, pleads with her daughter not to say anything. Needless to say, word shoots through the four high schools in the town the next day.
The nurse returns to work the following evening, and she contacts you to hand in her badge and keys, stating that she knows she made a mistake by breaching the young patient’s privacy and she knows she is going to be fired. In addition to the breach of the obstetrics nurse, you learn that the patient hid her pregnancy from her family, and to make matters worse, her aunt and mother are both nurses at the hospital. You know both of these nurses on a professional and personal level.
U.S. Department of Health and Human Services. (2002). Standards for privacy of individually identifiable health information; Final Rule. Federal Register, 67(157), 53182-53273. Retrieved from http://www.hhs.gov/ocr/privacy/hipaa/administrative/privacyrule/privrulepd.pdf
Then, perform additional research regarding the HIPAA Privacy Rule and prepare your Final Paper by analyzing the issues through these questions in regards to the above scenario:
Analyze the specific requirements needed to perform this investigation.
Identify whether this incident was an actual breach of privacy according to the HIPAA law.
Examine the differences and similarities between the hospital’s stance and HIPAA as to whether the nurse should be fired from her job.
Explain why you would fire or not fire the nurse immediately or whether you would put her on administrative leave awaiting the details of the investigation.
Scenario No. 2: DNR
Project Assignment: Review your State Government’s website and search for its official Do Not Resuscitate (DNR) Form. Along with the form will be information and instructions regarding the form. In addition, research three area hospitals to determine if they provide separate DNR forms. Then, perform additional research regarding DNR and prepare your Final Paper by analyzing the issues through these steps:
Analyze the requirements of your State Government’s DNR.
Identify the requirements of the three hospital’s DNRs.
Examine the differences and similarities between the state’s and the three hospital’s DNR requirements, and address the following questions:
What are they?
Which one should you follow?
Explain how a DNR is applied if a patient is under hospice care and EMTs are called.
Scenario No. 3: Institutional Code of Ethics
Project Assignment: Codes of ethics are standards that outline how individuals or groups of people are to act. The healthcare/medical community has its own code of ethics, which is outlined in the American Medical Association’s Code of Medical Ethics. Review the following:
AMA’s Code of Medical Ethics here:
American Medical Association. (2013). AMA’s code of medical ethics. Retrieved from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page.
Three local or regional hospitals’ codes of ethics.
Various scholarly research on healthcare codes of ethics (at least seven additional sources).
Then, prepare your Final Paper by analyzing the issues through these steps:
Analyze the specific requirements of a code of ethics.
Identify three critical elements of the AMA’s code that you believe are most important.
Examine the differences and similarities between the AMA’s Code of Medical Ethics requirements and the code requirements of the three hospitals that you researched.
Explain why certain individuals and/or groups (please name these) should follow a hospital’s code of ethics.
Writing the Final Paper
The Final Paper:
Must be eight to ten double-spaced pages in length, excluding title and reference pates, and formatted according to APA style as outlined in the Ashford Writing Center.
Must include a title page with the following:
Title of paper
Student’s name
Course name and number
Instructor’s name
Date submitted
Must begin with an introductory paragraph that has a succinct thesis statement.
Must address the topic of the paper with critical thought.
Must end with a conclusion that reaffirms your thesis.
Must use at least eight scholarly sources that were published within the past five years, including a minimum of four from academic journals found in the Ashford University Library.
Must document all sources in APA style, as outlined in the Ashford Writing Center.
Must include a separate reference page, formatted according to APA style as outlined in the Ashford Writing Center.
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I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT. BETWEEN 250-300 WORDS
Teenage years can be the some of the hardest years. Kids at this age are cruel and strive to fit in. Teenagers experience strong feelings of stress, confusion, self-doubt, pressure to succeed, financial uncertainty, and other fears while growing up (Teen Suicide). Also teens going through a divorce can cause a lot of stress. Some teenagers believe that suicide is the only way out.
Some signs that your teenager is going though suicidal feelings is: A change in eating or sleeping habits, withdrawal from family and friends, violent behavior, loss of interest of what they liked to do and a decline in school work. If your teenagers say things like you would be better off without me or you won’t see me again, take it seriously and seek immediate help.
If one or more of these signs occurs, parents need to talk to their child about their concerns and seek professional help from a physician or a qualified mental health professional. With support from family and appropriate treatment, children and teenagers who are suicidal can heal and return to a more healthy path of development (Teen Suicide).
Reference:
Teen Suicide. (n.d.). Retrieved from American Academy of Child and Adolescent Psychiarty: http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Teen-Suicide-010.aspx
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i have an assignment that needs 5 more page do a annotated bibliography also need the assignment gone through and put in MLA format. willing to pay 100 dollars need it in 4 hours or less can you do it. Check for errors and where highlighted need more information. The last part is an interview and the information can be made up paying 100 dollars need to be done withing the next 4 hours do not i repeat do not bid if you can not have this done in the next 4 hours. has to be put in proper MLA format please reply saying you understand not just the standard i can do your assignment
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1. Which disorder is characterized by the formation of abnormal new bone at an accelerated rate beginning with excessive resorption of spongy bone?
Osteomalacia
Paget disease
Osteoporosis
Osteosarcoma
Question 2. Considering the pathophysiology of osteoporosis, what are the effects of extracellular signal regulated kinases (ERKs) and receptor activator of RANKL on osteoblasts and osteoclasts?
ERKs increase the life span of osteoclasts and RANKL decreases the life span of osteoblasts.
ERKs and RANKL increase the life span of osteoclasts and decrease the life span of osteoblasts.
ERKs and RANKL increase the life span of osteoblasts and decrease the life span of osteoclasts.
ERKs increase the life span of osteoblasts and RANKL decreases the life span of osteoclasts.
Question 3. _____ is the temporary displacement of two bones in which the bone surfaces partially lose contact.
Dislocation
Subluxation
Malunion
Nonunion
Question 4. What is the diagnosis of a person who has tennis elbow characterized by tissue degeneration or irritation of the extensor carpi brevis tendon?
Lateral epicondylitis
Medial tendinitis
Bursitis
Lateral tendinitis
Question 5. Which type of osteoporosis would a person develop after having the left leg in a cast for 8 weeks to treat a compound displaced fracture of the tibia and fibula?
Iatrogenic
Regional
Idiopathic
Osteoblastic
Question 6. Bone death as a result of osteomyelitis is because of
formation of immune complexes at the site of infection.
localized ischemia.
TNF-? and IL-1.
impaired nerve innervation at the site of infection.
Question 7. By the time osteoporosis is visible on x-ray, up to ____% of bone has been lost.
30
40
50
60
Question 8. Osteochondrosis is caused by a(n)
imbalance between calcitonin and parathyroid hormone.
nutritional deficiency of calcium and phosphorus.
bacterial infection of the bone.
vascular impairment and trauma to bone.
Question 9. Ewing sarcoma arises from
bone marrow.
bone-producing mesenchymal cells.
metadiaphysis of long bones.
embryonal osteocytes.
Question 10. An insufficient dietary intake of vitamin _____ can lead to rickets in children.
C
B12
B6
D
Question 11. Which protein, absent in muscle cells of Duchenne muscular dystrophy, mediates the anchoring of skeletal muscles fibers to the basement membrane?
Syntrophin
Laminin
Dystrophin
Troponin
Question 12. Which serum laboratory test is elevated in all forms of osteogenesis imperfecta?
Phosphorus
Calcium
Alkaline phosphatase
Total protein
Question 13. Cerebral palsy is usually a result of
brain ischemia during birth.
prematurity.
congenital defects.
genetic defect.
Question 14. What diagnosis is given when the infant’s hip maintains contact with the acetabulum, but is not well seated within the hip joint?
Dislocatable hip
Subluxated hip
Dislocated hip
Subluxable hip
Question 15. The total mass of muscle in the body can be estimated from which serum laboratory test value?
Albumin
Blood urea nitrogen
Creatinine
Creatine
Question 16. Which malignancy is characterized by slow-growing lesions that usually have depressed centers and rolled borders and are frequently located on the face and neck?
Squamous cell carcinoma
Kaposi sarcoma
Malignant melanoma
Basal cell carcinoma
Question 17. Which cell is thought to be the progenitor cell of Kaposi sarcoma?
Endothelial
Keratinocyte
Melanocyte
Exothelial
Question 18. Cutaneous vasculitis develops from the deposit of _____ in small blood vessels as a toxic response allergen.
immune complexes
IgE
complement
T lymphocytes
Question 19. Which type of psoriasis is characterized by lesions on the elbows and knees that are well demarcated, thick, silvery, scaly, and erythematous?
Plaque
Inverse
Guttate
Erythrodermic
Question 20. An older adult man states he has a sore above his lip that has not healed and is getting bigger. The nurse observes a red scaly patch with an ulcerated center and sharp margins. The nurse recognizes these features as commonly associated with Bowen disease, a form of
Kaposi sarcoma.
malignant melanoma.
basal cell carcinoma.
squamous cell carcinoma.
Question 21. What is a common source of tinea corporis?
Mites
Kittens
Fleas
Ticks
Question 22. Which skin disorder has as its hallmark clinical manifestation skin lesions that rupture, creating a thin, flat, honey-colored crust?
Rubella
Tinea capitis
Atopic dermatitis
Vesicular impetigo
Question 23. Bullous impetigo is caused by a strain of _____ that produces an exfoliative toxin, resulting in a disruption in cellular adhesion.
Staphylococcus aureus
Streptococcus pyogenes
Escherichia coli
Candida albicans
Question 24. Which immunoglobulin is elevated in atopic dermatitis?
IgA
IgM
IgE
IgG
Question 25. Which clinical manifestation is considered the hallmark of atopic dermatitis?
Papular rash
High fever
Vesicles that burst and form crusts
Itching
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I would like to know if you can revise this paper and provided 3 references. This Paper is on Gemba Walk
Lean Thinking in Aircraft Repair and Maintenance Takes Wing at FedEx Express
LAX aircraft maintenance facility reaps big returns in short time By Doug Bartholomew If ever there were a testimony to the flexibility of lean practices, it’s the FedEx Express Aircraft Maintenance facility at Los Angeles International Airport (LAX).
One of three large aircraft maintenance facilities in the Aircraft Operations Division of FedEx Express, the LAX hangar differs from a traditional manufacturing plant in one significant way: rather than assembling products, the facility performs both routine maintenance and safety checks as well as unscheduled repairs, both major and minor. Despite this variability, FedEx LAX has applied lean principles with impressive results.
Although FedEx Express operates about 170 aircraft maintenance facilities worldwide, including about 100 in the U.S. that perform routine maintenance that generally takes a day or less, it’s in this sprawling 950,000-square-foot facility — staffed with 550 employees — that the company performs much of its major service, repairs, overhauls, and equipment upgrades. “We do a lot of unscheduled work,” says Hector Chavez Jr., aircraft maintenance manager and a leader of the hangar’s lean initiative. In other words, the FedEx Express LAX staff must be prepared to replace or repair everything from a cracked engine nacelle to a faulty hydraulic line on any of the corporation’s 360 large cargo transport aircraft.
FedEx Express LAX’s lean initiative, which has been under way since December 2007, dovetails nicely with the corporation’s current emphasis on finding ways to reduce costs and boost revenues during the global economic downturn. To that end, the LAX facility has accelerated the aircraft upgrade programs it already had under way that are designed to reduce maintenance costs by increasing capacity with the same equipment and staff. “Here we have found opportunities where we can create capacity by using lean,” says Phillip Coley, managing director of aircraft maintenance at FedEx Express, who is in charge of the LAX maintenance facility as well as one in Indianapolis.
Fighting the Recession
To be sure, lean is paying off for FedEx Express at its LAX hangar. For example, take the facility’s bread and butter maintenance and repair exercise, the labor-intensive operation it calls a C-check — a series of deep maintenance inspections and repairs on an aircraft that typically took six weeks or so. Two years ago, with the same size staff, equipment, and floor space, the facility performed 14 C-checks. This year (April 2009) LAX has already done the equivalent of the current fiscal year’s as well as next fiscal year’s C-checks. This year the facility plans to complete 30. The C-check improvement alone is especially critical to the company, because FedEx Express’ Los Angeles Airport operation is the only maintenance site handling this major maintenance regimen. Any overflow of C-checks FedEx LAX can’t handle are outsourced at an average cost of about $2 million excluding parts. “Lean has enabled us to optimize our resources,” Coley says. In other words, any work that can be brought back in-house yields immediate and significant savings. FedEx Express delivers about 3.4 million packages and 11 million pounds of freight each day worldwide. The largest operating company in the $38 billion FedEx enterprise, FedEx Express brings in the lion’s share of the revenue– $24.4 billion in fiscal 2008. While saving a million dollars here and a million there may not seem like a lot, Coley says every bit of savings counts dearly during the downturn, which has resulted in a decline in FedEx’s package delivery and cargo business. The company’s domestic package volume when measured year-to-year was down 7.7 percent as of the second quarter of its fiscal year ended last November 30, and international priority package volume was off 6.7 percent over the same period year-to-year. Ground volume (-0.9 percent) and freight shipments (-2.0 percent) were down as well. To reduce costs, FedEx Express plans to park some airplanes that are not being fully utilized for possible use later at a site near Victorville, CA. In the near term, other aircraft, including nine aging 727-200s, are being permanently retired. Ten leased A310-200s also are being returned.
“C” Check Savings
Despite the business slowdown, the FedEx Express LAX staff of lean-trained aircraft maintenance technicians is digging in for the long haul, finding ways to save money for the company until better times return. A key piece of the strategy is to continue the hunt for lean opportunities to remove waste and refine maintenance operations for greater efficiency. In fact, a radically redesigned approach to the way the LAX facility handles the all-important, labor-and-parts-intensive C-check of a jet aircraft has already yielded FedEx some big dividends. By reducing the typical time it takes to do a C-check from 32,715 man-hours six months ago to 21,535 man-hours today, the facility is able to handle more work (see chart below). That translates into a savings of $2 million, excluding parts, per C-check that otherwise would have had to be performed by a paid third-party aircraft maintenance firm.
Some typical C-check activities the mechanics perform include overhauling the aircraft’s cargo loading system, overhauling the cockpit seats in some planes, and overhauling the aircraft’s large flaps, the adjustable rear portion of the main wings that is critical for creating lift on takeoff and drag on landing. FedEx LAX has already done initial kaizen on the cargo loading system maintenance, reducing the time that process requires from about 30 days two years ago to about 18 to 20 days now. Additional C-check refinements include further improving the flap overhaul/replacement process, and improving the kitting system to speed the cargo loading maintenance process even more. Through these more efficient C-checks, as well as a critical landing gear modification and other lean initiatives, FedEx LAX and its sister facilities in Memphis and Indianapolis, are expected to save the company an estimated $18 million during the current fiscal year.
Maintenance facilities at Memphis and Indianapolis handle the “B”-check maintenance procedures that typically require about 400 man hours or more. Lean is paying off considerably for these facilities as well. As an example, Indianapolis has cut the time it takes an out-of-service aircraft to receive a B-check service from 60 elapsed hours to 30 hours, with a June 2009 goal of further reducing the B-check time to 24 hours. Reducing the elapsed hours by half on a B-check allows more hangar capacity, which allows the facilities to handle more special visits and aircraft modifications. In Memphis, for instance, increased capacity has been used to handle extra work such as installation of fire suppression systems and HUD (Head Up Display, which allows pilots to see cockpit data without looking down, similar to the system military fighters use). In the past, these modifications would have been sent to outside contractors. By performing them in-house, FedEx Express is able to save on external spend.
Value-Stream MappingColey points out that FedEx Express’ use of the C- and B- checks to designate certain levels of maintenance programs and inspections are not standard industrywide, generic terms, rather they are customized FedEx terms only. “A C-check might be anything at a different airline, depending on the approved maintenance program and operational pull,” he explains.
Excluding unexpected major repairs, most C-check maintenance operations are fairly predictable, requiring certain new parts and specific tools the aircraft mechanic technicians need to install them. Using Value-Stream Mapping, the lean teams analyzed all the standard work involved in a series of prototype “vanilla” C-check. They came up with 68 milestones, or key aspects of the overall process.
Then they were able to sit down and plan each C-check, breaking it down into four-hour increments. By understanding each four-hour block of mechanics’ time, Coley explains, “They learned how to pass the baton without dropping it, so that one mechanic can pick up on a task exactly where his predecessor on the last shift left off.” The end result was that they were able to carve plenty of wasted time and movement from the various processes that make up the typical activities in a C-check. For example, a couple of big bottlenecks were eliminated by finding ways to place pallets of special tools and airplane parts right on the hangar floor where the airplane maintenance technicians (AMTs) are working. Before the lean initiative, mechanics typically queued up in front of the parts stock room, often waiting for 15 minutes or longer, just to get batch of screws or a particular component. With some of the best-paid airplane mechanics in the industry on staff, that waiting time can be costly.
Both the parts staff and the AMTs participated in figuring out which parts were most likely to be needed during the C-check operations. They also decide the best way for the highest-use parts to be displayed on a “roto-bin,” a cart with a parts rack, and brought to the location closest to where they’re needed, thus eliminating unnecessary walking for mechanics. They even found a way to place a “quick parts” box on a level with the cockpit/nose of the aircraft for mechanics working on that part of the plane. “The difference in the way the AMTs work now has been easily 180 degrees,” Chavez says. Instead of taking up to four hours for setup, it now takes two hours or less. “Now our mechanics have the parts they need just 10 feet away. They need air, a ladder, electrical — it’s all just 10 feet away.” For less commonly needed parts, the facility has located four terminals on the floor where mechanics can look up the specific parts they need. Similarly, when the AMTs found they needed a special tool, such as a four-foot-long torque wrench, they had to go to the tool crib and — you guessed it — line up once more. Again, FedEx LAX engaged both the parts staff and the airplane mechanics in the kaizen to figure out the best sets of tools the AMTs needed close at hand for each particular repair or maintenance operation in the C-check. “We have a toolkit assigned to each mechanic’s task so we don’t have skilled people standing in line,” Coley says. “We realized that our internal customer is our mechanic.”
Speaking of tools, each airplane mechanic has his own full-size, multiple-drawer toolbox on wheels similar to those used by automotive mechanics. Before the LAX facility performed a 5Soperation to clean up the workplace, these large wheeled toolboxes were scattered around on the floor, making it difficult for the mechanics to find their own boxes, let alone walk among them. Today, the boxes are lined up in neat rows, each parked in its own assigned location, allowing easy access for the AMTs to walk between them.
See examples of 5S improvements by FedEx LAX employees:
Among the most significant cost-saving measures the FedEx LAX facility has pursued aggressively during the downturn is its accelerated schedule for converting old steel brakes on aircraft to carbon brakes, which are more durable and require less frequent replacement.
Based on the FedEx LAX facility’s repair records on brake replacement, steel brakes last at most 337 cycles — with most aircraft flying two cycles, or round trips, daily — or about six months. By contrast, the carbon brakes provide 2,200 cycles of service, or about three years. With 8 to 10 brakes per airplane, the savings add up fast. The brake modifications save the company about $1 million per year in fewer parts and reduced labor cost per aircraft. The task of swapping out the old steel brakes for new carbon ones — a more complicated process than simply changing a pair of brake shoes as one would on a car — was so important that Coley and his team performed a kaizen exercise to find and implement ways to improve and speed the changeover. The result was that FedEx LAX got the time it took to do a brake modification down from about 15 days to 7 days. Another kaizen on replacing landing gear — there are four per aircraft — yielded a time reduction from 11 to 12 days down to about 5.5 days, Coley says.
Motivating Employees
Of course, getting airplane mechanical technicians, parts specialists, and other staff on the hangar floor to think lean wasn’t easy, Coley admits. “We invested a lot of lean training in our employees, because we believe that, ultimately, everybody should get to be a change agent.” Coley, who successfully re-energized a lean initiative at United Airlines in San Francisco, where he was director of airframe maintenance, knows that any lean program can be only as good as the workers who participate in it and believe in its success. To that end, he devotes a big chunk of his time to motivating employees and finding ways to bolster their commitment to the lean efforts. “It’s a major cultural change, to get people to do things because they want to do them,” he says. Chavez agrees, pointing out that when the lean program was launched, people were somewhat skeptical. “At first it was an uphill battle,” he says. “There was an attitude, ‘We’ve seen many of these programs before.’ It took about four months for people here to really understand this was going to be a complete change in the way business would be conducted. Now, it has really taken off.”
Coley likes to use visual tools to help motivate workers. He shows employees videos that demonstrate how lean works and show how it can pay off. He even takes groups bowling, assigning them to teams that compete with one another to see which is best at “balancing the workload” — i.e., finding the best combination of bowlers to achieve the highest score within certain parameters. “They actually start to collaborate to try to get the highest team score,” Coley says. “At the end, we do some lean training, and you can see they understand the concepts and how it works.” (The company also developed a group exercise program to cut injuries. Use this link to see pictures of the warm-up routine.) Besides using videos, he has lined the hallways of the office area of the hangar building with large color blow-up photographs of outstanding employees on the job. “I’m a believer that recognition for employees is effective,” Coley says. What’s different in this case, though, is that each month the workers are asked to choose an employee-of-the-month, instead of management (Coley or a manager) making the selection.
The LAX hangar received close to 1,000 suggestions in the past year. If a mechanic has an idea to improve a process, he can present it as a suggestion to the lean committee. “If it’s only something that takes an hour or two to do, we tell them they should just do it,” Coley says. Having the airplane mechanics and other hangar staff consider each suggestion and work out their own solutions to the way work is handled goes a long way toward making the lean program at FedEx LAX a success, Chavez believes. “The very way you present it to people is key to getting their buy-in,” he says. “We actually have the personnel who are part of the process help figure out the solution.” Adds lead mechanic Monte Petry, “One of the things we’ve learned here is that you’ve got to take everybody’s opinion into account before making a decision.” As a former airplane mechanic himself, Coley doesn’t put much stock in formalities. When he took the job a year ago, one of the first things he did was get rid of the personalized parking space for the director. In a similar vein, he spends a minimum of five hours a week roaming the workareas, including the hanger floor, the parts warehouse, and the tool storage area. “The mechanics know I’m out there on the floor to help them, do an independent audit, and that I have a check list,” he says. “I look to see if the leaders and technicians are active. Are the manager and lead mechanic touring the work area? My goal is to be on the floor three times a week.”
Box Score for Aircraft Maintenance C-Checks at FedEx LAX Before Lean Improvements:
Actual wrench time varied greatly depending on the task
Airplane maintenance technicians (AMTs) spent between 1.3 and 2.4 hours a day walking to get parts, tools, etc.
AMTs made 106 trips (five trips per mechanic) in pursuit of expendables and consumables
After Lean Improvements:
Wrench time improved and moved toward a standard that the Lead Mechanic could predict
AMTs spent between .47 and 1.3 hours each day walking to get things other than consumables and expendables
AMTs made approximately 25 trips to obtain items for tasks during observations (carbon brake mod, outside kitting, and point-of-use scope)
For More Information
FedEx Express — Founded in 1971 as Federal Express Corporation, FedEx Express is the world’s largest express transportation company, providing service to every U.S.
address and to more than 220 countries and territories. The company uses a global air-and-ground network to speed delivery of time-sensitive shipments, usually in one to two business days.
Leadership Behavior and Actions to Sustain Lean From the CEO to unit leaders to plant managers and supervisors, business leaders at all levels play a critical role in sustaining a lean program. Here are some of the specific tactics, practices, and behaviors that they can deploy to keep employees and teams motivated, and the organization moving forward.
1. COMMUNICATE THE VISION Company leaders need to provide regular and consistent communication with employees about the specific returns that the company is gaining from its lean initiative, and what’s in it for them. Employees need to understand how lean impacts the company’s overall competitiveness, financial performance and, ultimately, job security.
2. ALWAYS UPDATE STANDARD WORK Standardized work reinforced with visual work instructions based on the kaizen-improved processes can help ensure employees adhere to the correct work procedures. Such standards guard against back-sliding to the old ways of working. Of course leadership must also communicate that standard work processes are always open to modification during future kaizen events.
3. GO ON GEMBA WALKS Going to the gemba, walking around the plant and asking employees, “What did you do this week to make continuous improvement happen?” That’s one of the most powerful questions a leader can ask. When business leaders keep asking such questions, employees soon learn what’s important and what they need to be working on. It’s important, though, to differentiate between gemba walks and plant walks, or “board” walks. Board walks involve reviewing the plant’s performance (SQDC) boards to ensure that each area is meeting targets, and providing support for corrections when needed. A gemba walk typically involves an executive or other top-level manager observing select processes and functions, such as material flow, with the goal of helping plant leaders and other continuous-improvement personnel see potential and high-priority areas for improvement.
4. BUILD A CONTINUOUS IMPROVEMENT CULTURE True lean leadership encourages continuous improvement even when the improvement ideas don’t meet expectations. By making it acceptable to try something even if it fails, leaders empower workers to assume responsibility for solving their own problems. It’s important to demonstrate that observing processes, challenging current practices, and engaging in improvement activities are all part of a comprehensive problem-solving approach that will improve the business.
5. FOSTER A RESPECTFUL, TEAM-DRIVEN ORGANIZATION Teamwork is an essential element of any lean initiative because it requires employees from different departments to work together to improve processes that almost always cross functional boundaries. Encouraging groups to contribute their ideas and responding to their suggestions is one way that teamwork demonstrates respect. Engendering respect and mutual trust is a critical element of any lean initiative. Yet leaders often overlook it because they focus all attention on process improvement. In a lean business, one way to demonstrate such respect is by actively encouraging every employee to be deeply engaged in the work that he or she does for customers and the company.
6. CONTINUE TO MOTIVATE EMPLOYEES: Employee enthusiasm for any initiative naturally will wane over time. Full participation in a continuous-improvement program goes far beyond normal job descriptions and the scope of most employee compensation programs. This is where leaders personally participating in the continuous-improvement process can demonstrate the organization’s commitment. They can participate in kaizen events and be part of the problem-solving process. Leaders can motivate individuals by increasing their autonomy and encouraging them to find ways to permanently improve their work. At the FedEx Express Aircraft Maintenance facility at Los Angeles International Airport, the plant’s managing director takes employees bowling, assigning them to teams that compete with each other to get the highest score within a defined set of parameters. Employees quickly figure out that they must collaborate to get the highest team score. After the bowling session the plant’s managing director holds a lean training session to reinforce how teamwork improves outcomes. How One FedEx Facility Encourages Teamwork
7. MAINTAIN REGULAR TRAINING Another way to sustain lean is through non-stop training of all employees, including supervisors, in the redesigned and improved work processes. Cross-training employees is also critical. Employees who have been trained in all the primary work processes tend to exhibit a more proprietary attitude toward improving their own work processes and offering ideas to improve other processes as well. For instance, Menlo Worldwide Logistics in San Mateo, Calif., a large warehouse and distribution firm, rotates its kaizen teams to examine the work flows in other departments. Groups of employees visit other work areas, inspect the process, and then discuss their ideas and findings to the area’s supervisor.
8. REINFORCE PERFORMANCE AND PROGRESS WITH METRICS AND VISUAL-MANAGEMENT TOOLS Another way to show employees how their efforts are advancing the company’s lean efforts is through the use of visual-management tools and constantly updated metrics. Tracking and reporting performance metrics help sustain the organization’s commitment to the lean at both the leadership level and on the plant floor. For example, measuring takt time is one way to ensure employees are following procedures and standard work. Supervisors and work cells should report takt time hourly, and post hour-by-hour charts for employees to see how performance is measuring up against goals. If performance is off, the team can see it and figure out what needs to be done to get back on track.
9. POST CONTINUOUS-IMPROVEMENT SCORECARDS Tracking progress on a month-to-month basis reinforces accountability and gives leadership an opportunity to check on results. At Menlo Worldwide, for example, each warehouse is evaluated based on projects completed that month and planned projects in the coming month. Each facility posts a monthly “continuous-improvement roadmap,” known within Menlo as a “30-30” form. The April/May 30-30 may contain a half-dozen or more initiatives completed in April, along with a similar number of projects scheduled for May. These forms report project status and detail the time trimmed from each process and the annual savings.
Whether it’s a week-long kaizen event or a six-month project, too many companies make improvements that produce significant early results, and then they walk away to work on the next thing. To use a medical metaphor, just because the operation is a success doesn’t mean the treatment is complete. The doctor still needs to monitor the patient through a post-operative recovery and follow up with physical therapy.
Long-term success with lean works much the same way. Business improvement leaders need to follow up to make sure new behavior patterns are consistent with the new methodology. This includes a commitment by executives to remain engaged in the lean process by going to the gemba and participating in kaizen events.
Management behavior and actions are part of a successful company’s overall effort to regularly communicate the impact lean has on financial targets and how the employees’ contributions impact them.
At the FedEx Express Aircraft Maintenance facility at Los Angeles International Airport, the plant’s managing director takes employees bowling, assigning them to teams that compete with each other to get the highest score within a defined set of parameters. Employees quickly figure out that they must collaborate to get the highest team score. After the bowling session the plant’s managing director holds a lean training session to reinforce how teamwork improves outcomes.
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As referenced in Week 2, Discussion 2, nurses are perceived as having very high ethical standards (Gallup, 2013). Doctorally prepared nurses should be able to consider ethical issues from multiple viewpoints. In this week’s media presentation, the experts discuss ethical challenges encountered by nurses as they assume leadership positions and as they engage in research.
To prepare:
Reflect on ethical challenges that you have encountered in your nursing practice.
Think about the information the experts shared in this week’s media presentation, focusing on the ethical challenges they have encountered as nurse leaders or scientists, as well as information presented in other Learning Resources.
With this information in mind, consider what new ethical challenges you may face once you obtain your doctoral degree.
By Wednesday 6/28/17, post 550 words essay in APA format with 3 references from the list below, that include the level one headings as numbered below:
Post a cohesive response that addresses the following:
1) Describe two or more significant ethical issues relevant to the DNP- or PhD-prepared nurse.
2) Explain how these issues might compare to the types of issues you have already encountered in your practice.
Required Readings
Campbell-Crofts, S., Field, J., & Fetherstonhaugh, D. (2013). Ethical considerations for nurses undertaking research with a potentially vulnerable population with chronic kidney disease. Renal Society of Australasia Journal, 9(2), 74–79.
Note: You will access this article from the Walden Library databases.
Milton, C. L. (2010). Nursing ethics and power in position. Nursing Science Quarterly, 23(1), 18–21.
Note: You will access this article from the Walden Library databases.
The author discusses what is meant by health care leaders judiciously and transparently addressing ethical challenges.
Suhonen, R., Stolt, M., & Leino-Kilpi, H. (2013). Older people in long-term care settings as research informants: Ethical challenges. Nursing Ethics, 20(5), 551–567.
Note: You will access this article from the Walden Library databases.
Peirce, A. G., & Smith, J. A. (2008). The ethics curriculum for doctor of nursing practice programs. Journal of Professional Nursing, 24(5), 270–274.
Note: You will access this article from the Walden Library databases.
Required Media
Laureate Education (Producer). (2011a). Ethical issues relevant to the DNP [Video file]. Retrieved from https://class.waldenu.edu
Note: The approximate length of this media piece is 5 minutes.
In this media program, Dr. Joan Stanley discusses the importance of considering multiple perspectives when approaching ethical issues as part of a health care team. Dr. Linda Beechinor and Dr. Susan Stefan share ethical challenges they face as nurse leaders.
Optional Resource
Fairchild, R. M. (2010). Practical ethical theory for nurses responding to complexity in care. Nursing Ethics, 17(3), 353–362.
Note: You will access this article from the Walden Library databases.
Grimm, J. (2010). Effective leadership: Making the difference. JEN: Journal of Emergency Nursing, 36(1), 74–77.
Note: You will access this article from the Walden Library databases.
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Research is something we all do in both our personal and our professional lives. We research products we might buy, films or books we might watch or read, restaurants and hotels we might patronize, medical issues and doctors, and much more. At work, we research companies we might want to work for or with, products we might want to use, computer issues we face, and so on.
Think back over the past few months and give at least one example of research you have conducted for yourself and for work. If you cannot think of one from each category, you may give two from the same category.
Tell us whether you were able to find the information that you needed and explain if the information proved to be accurate.
Discuss what types of source materials you are using for your research paper (telehealthcare in nursing homes), and list one of the sources that you plan to use.
Tell your classmates how that source relates to your chosen topic (telehealthcare in nursing homes) and what information you plan to use from that source.
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Prepare a presentation of the policy proposal you developed in Assessment 2 for one of the stakeholder groups identified in your proposal. Inform the group about the future of organizational policy and practices, the current performance shortfalls, and the rationale for why the new policy and practices are needed. In addition, explain how the group will benefit from this change in order to obtain their buy in and support.
Introduction
Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.
Improving quality and outcomes is a key focus for health care organizations. With a focus on quality, the Centers for Medicare and Medicaid Services (CMS) publish publically reported data online and update it quarterly, which allows patients to compare hospitals on a wide range of metrics. These metrics can also be used to inform policy changes at local, state, and federal levels.
It is important that health care leaders be able to clearly articulate policy positions and recommendations and garner buy in and support from stakeholder groups for policy and practice changes in their organizations. Unfortunately, there is often a lack of effective communication. Consequently, it is important for health care leaders, when leading change, to ensure that clear and open communication is ongoing and informative.
An important aspect of change leadership is the ability to address diverse groups of stakeholders and create buy in and support for your ideas and proposals for change. This assessment provides you with an opportunity to demonstrate and hone these skills.
Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 1: Analyze the effects of health care policies, laws, and regulations on organizations, interprofessional teams, and personal practice.
Analyze how proposed institutional policy or practice guidelines related to an existing health care policy or law would impact a stakeholder group.
Competency 3: Lead the development and implementation of ethical and culturally sensitive policies that improve health outcomes for individuals, organizations, and populations.
Propose an institutional policy or practice guidelines related to an existing local, state, or federal health care policy or law.
Advocate for how the proposal would improve quality and outcomes relevant to the stakeholder group.
Competency 4: Evaluate relevant indicators of performance, such as benchmarks, research, and best practices, for health care policies and law for patients, organizations, and populations.
Interpret for stakeholdersthe relevant benchmark metrics that illustrate the need for a policy or practice guidelines.
Competency 5: Develop strategies to work collaboratively with policy makers, stakeholders, and colleagues to address environmental (governmental and regulatory) forces.
Propose strategies for collaborating with a stakeholder group to implement and apply proposed institutional policy or practice guidelines related to a local, state, or federal health care policy or law.
Competency 6: Apply various methods of communicating with policy makers, stakeholders, colleagues, and patients to ensure that communication in a given situation is professional, clear, efficient, and effective.
Apply persuasive and effective communication strategies when presenting to a group of stakeholders.
Preparation
The policy proposal you developed was well received by senior leadership. As a result, they have asked you to put together a presentation for one of the stakeholder groups that you identified in your proposal.
Your deliverable for this assessment is a slide deck to support your presentation. You may use Microsoft PowerPoint or any other suitable presentation software. Please use the notes section of each slide to develop your talking points and reference your sources, as appropriate.
If you choose to use PowerPoint and need help designing your presentation, you may wish to explore theGuidelines for Effective PowerPoint Presentations [PPTX]andRecord a Slide Show With Narration and Slide Timingsresources.
If you need any additional guidance for recording a presentation in Kaltura, theUsing Kaltura [PDF]resource may be helpful.
TheBuilding Buy In and Communicating With Stakeholders|Transcriptmedia piece may help to provide context for you presentation or refine your communication strategy for specific stakeholders.
The design and organization of your presentation will determine how many slides you need. However, in this instance, senior leaders have suggested that 8–12 slides is a reasonable expectation for this presentation.
Presentation Design Tips
Being able to effectively address any audience is a necessary leadership skill. Remember that you are the speaker, not a projectionist. Your purpose is not to present a slide show. Your audience is there to listen to what you have to say, not read your slides—or worse, listen to you read them. Design your presentation slides to compliment and reinforce your message and engage your listeners.
The following tips will help you create presentation slides that work to your advantage:
Focus on the content of your presentation and the development of your main points. Remember that your purpose is to deliver a message on ethics that is clear, well organized, and engaging.
Consider your intended audience and how best to communicate effectively with them.
Create slides that support your presentation. They should not be your presentation.
Use a professional presentation template, or one used in your organization.
Ensure that your slide background provides sufficient visual contrast for your text and graphics.
Avoid filling your slides with text. Use speaker notes to record the details you want to communicate to your audience.
Be judicious in your use of bulleted lists. Consider a separate slide for each point.
Use images and graphics, when appropriate, to illustrate information and make your points. Presentation slides are a visual medium. Images are more effective than text at capturing viewers’ attention.
Avoid using images that are simply decorative. They can be a visual distraction and do not contribute to your message.
Avoid using flashy slide transitions and animations. They can be both distracting and annoying. Keep your slide transitions consistent throughout the presentation.
Add a slide to the end of your presentation to prompt questions from the audience.
Instructions
Note: The tasks outlined below correspond to grading criteria in the scoring guide.
In your presentation, in an order that makes sense for your presentation, senior leaders have asked that you:
Interpret for stakeholders the relevant benchmark metrics that illustrate the need for a change in organizational policy and practice.
Provide a brief review of the metrics you are trying to improve for this stakeholder group, based on the dashboard benchmark evaluation you completed in Assessment 1.
Be sure to interpret the dashboard metrics in a way that is understandable and meaningful to the stakeholder group to which you are presenting.
Explain your proposedchange inpolicy and practice guidelines and how it relates to applicable local, state, or federal health care laws or policies.
What specific changes are you proposing?
How will these changes help drive performance improvement?
Why are policy and practice guidelines important, from an organizational standpoint?
What is the overall goal of the proposed policy or practice guidelines?
Explain how your proposed change in policy or practice guidelines will affect the tasks and responsibilities of the stakeholder group to which you are presenting.
How might your proposal change what tasks the stakeholder group performs or how they currently perform them?
How might your proposal affect the stakeholder group’s workload?
How might your proposal alter the responsibilities of the stakeholder group?
How might your proposal improve working conditions for the stakeholder group?
Explain how your proposed change in policy or practice guidelines will improve the quality of work and outcomes for the stakeholder group to which you are presenting.
How will your proposed changes improve the group’s quality of work?
How will your proposed change improve outcomes for the group?
How will these improvements enable the stakeholder group to be more successful?
Explain your strategies for collaborating with the stakeholder group to implement your proposed change in policy or practice guidelines.
What role will the stakeholder group play in implementing your proposal?
How could the stakeholder group collaborate with you and others during the implementation of your proposal?
Why is the stakeholder group’s collaboration important to successful implementation of your proposal?
Design your presentation to be persuasive and effective in communicating with the stakeholder group.
Is your presentation logically organized, clear, and professional?
Additional Requirements
Format and length of presentation: A PowerPoint Presentation containing 8–12 slides.
Recorded audio of you presenting your PowerPoint that is targeted at key stakeholders in your audience.
If you have technical difficulties in recording your audio, you may instead include a full script of what you intended to say in the notes section of each slide in place of recording audio.
Number of references: Cite a minimum of 3–5 sources of scholarly, professional, or policy evidence to support your analysis and recommendations.
APA formatting: Resources and citations are formatted according to current APA style.
Submit your PowerPoint presentation and any other necessary documentation or links (if you used other technology) when you turn in this assessment.
Grading Rubric:
1. Propose an institutional policy or practice guidelines related to an existing local, state, or federal health care policy or law.
Passing Grade: Proposes an institutional policy or practice guidelines related to an existing local, state, or federal health care policy or law, and identifies assumptions on which the proposal is based.
2. Interpret for stakeholders the relevant benchmark metrics that illustrate the need for a policy or practice guidelines.
Passing Grade: Interprets for stakeholders the relevant benchmark metrics that illustrate the need for a policy or practice guidelines, including details or perspectives that will be especially relevant for the specific stakeholder group .
3. Analyze how proposed institutional policy or practice guidelines related to an existing health care policy or law would impact a stakeholder group.
Passing Grade: Analyzes how proposed institutional policy or practice guidelines related to an existing health care policy or law would impact a stakeholder group; identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty (where further information could improve the analysis).
4. Advocate for how the proposal would improve quality and outcomes relevant to the stakeholder group.
Passing Grade: Advocates for how the proposed changes would improve quality and outcomes relevant to the stakeholder group, and impartially considers and addresses conflicting data or perspectives.
5. Propose strategies for collaborating with a stakeholder group to implement and apply proposed institutional policy or practice guidelines related to a local, state, or federal health care policy or law.
Passing Grade: Proposes strategies for collaborating with a stakeholder group to implement and apply proposed institutional policy or practice guidelines related to a local, state, or federal health care policy or law; shows insight to stakeholder perspectives by addressing possible objections.
6. Apply persuasive and effective communication when presenting to a group of stakeholders.
Passing Grade: Applies persuasive and effective communication when presenting to a group of stakeholders, and includes details that demonstrate attention to the interests and concerns of the stakeholder audience.
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