Case study Example | Topics and Well Written Essays - 750 words - 22

Case Study Example Ellen can consider having trademarks that would help her to stop anybody from using the marks she chooses for her products (Rustad & Cyrus 6). Design rights will help protect the form of Ellen’s products. The things that Ellen can protect using design rights include computer icons, software fonts, on screen displays and trading name. Ellen’s databases of educational materials, social bookmarking tools, digital stories, and collection of audio recordings should be protected using database right. This right extends to metadata that compilers create to encourage the addition or subtraction of files and datasets relating to the structure and arrangement of data in a given database (Rustad & Cyrus 7). Children between age four and six lack a mastery of ethical thinking and needs web operators like Ellen to protect them from unethical use of the internet. Ellen has to be cognizant of the children’s temptation of viewing obscene content in the internet. Obscene content in the internet includes sexually suggestive content sent or received through the internet. This is what has come to be popularly known as sexting. Pornography and sexually explicit materials is another ethical issue with young internet users. Exposure to violent media has been found to be an important correlate of aggressive behavior among children. Privacy issue has gained prominence as an ethical issue among young internet users. Children are tricked into disclosing personal information such as those required to allow access into certain internet content. This information can be used to cause harm to the child or their families (Rustad & Cyrus 8). The Children Online Privacy Protection Act requires web operators to include privacy policies. The act also requires operators to provide ways of seeking verifiable consent from parents and specifies an operator’s responsibilities in protecting

CHANGE MANAGEMENT (CASE STUDY) Case Study Example | Topics and Well Written Essays - 2750 words

CHANGE MANAGEMENT ( ) - Case Study Example Organizations can be transformed by creating a new system in a new place with new personnel, or by renewing the old system in the same place with the same personnel. Critics admit that when change is conducted by taking the "renewal" alternative, it usually entails the positioning of a new top manager or top managerial team. In business organizations, Ford, like many other firms, created separate plants to develop new technology and new products. In total institutions, the creation of a radical new vision that really rehabilitates is possible by starting out with a new strategy, guards carefully chosen to be rehabilitators, and a new, dedicated staff. Ford is one of the oldest automakers in the world. The history of the company goes back to 1903 when the first converted factory was opened. Today, Ford is the second largest automaker with 17.5% market share. Historically, Ford sought to compete against the industry's leader, General Motors (GM), by increasing its presence in foreign markets. Ford's International Automotive Operations co-ordinates activities in twenty-six countries grouped in three principal regions (Europe, Latin America, and Asia Pacific). In the late 1970s, Ford produced outside the United States half of its worldwide vehicle production - compared with GM's one-fourth. The Ford Motor Co. has also been a leader in introducing or rapidly adopting technological innovations in the industry (Lessons In Change From Ford Motor Company n.d.). Henry Ford, the founder and president of the company, is considered the father of mass production. In the difficult decade of the 1980s, Ford showed its capability to rapidly adopt the Japanese system of production and to move faster than any other auto maker in seeking the integration of its operations on a global basis. The company was also a pioneer in the internationalization of production, as it was the first to open an assembly plant in Canada (1904), in Mexico (1925), and in many other countries. Historically, the company has had a leading role in developing an automotive capability in those countries, and its strategies have been characterized by its responsiveness to local government demands and its relatively high levels of export activity (Lessons In Change From Ford Motor Company n.d.; Ford Home Page 2007). The change process within the company is influenced by the industry requirements and competition. In order to survive and maximize profits, auto makers like Ford must comply with structural rules. Structural rules are derived from production technologies (hard and soft technologies) that are successful in producing cars efficiently. An automobile is a complex product, which consists of over 10,000 parts and requires multiple and complex processes for its manufacture. Mass production proved successful in efficiently producing automobiles, which explains that for almost seven decades, it determined the structural rules for the automobile industry. It is a complex system that needs to be understood in order to comprehend Ford's strategies. Where they existed, differences in strategy or goals between the US Big Three (Ford, GM and Daimler Chrysler) stemmed basically from each firm's ability to conform to the rules of competition and from its relative power position in the industry. Durin g 1990s, Ford had little room for designing

Managerial accounting Essay Example | Topics and Well Written Essays - 1250 words

Managerial accounting - Essay Example Following which it will be discussed how the company has implemented this strategy in the day – to – day working. As mentioned earlier JIT was firstly introduced by Henry Ford and was clearly described in his book ‘My Life and Work’ in 1923. It was then that Henry Ford had realised that inventory stocking was a waste of investments in terms of the amount locked up in forms of inventory as well as storage and transportation costs. The JIT process is simple and defines stocking of goods to be a waste. Companies using this method follow the thumb rule of ordering for stocks whenever it is required by the company. This process exposes the hidden costs that the company incurs for storing and transporting of the inventories. The process might seem simple however when it comes to incorporating it into the daily business, the companies face a number of issues as it would mean completely changing the process flow of the company. There are a number of different disciplines that are followed to ensure the correct timing for ordering the goods to fit in correctly into the process flow of the company. This process involves aspects of statistics, behavioural science, production management and industrial engineering. In simple terms JIT is a process ensures that the inventories of a company are available at the right time, at the right place, the right amounts and finally the right materials (Sandras, 1989). Toyota is one of biggest motor company in the world. The company has been existent from times before the first ever air conditioner, colour television and even the first ever cheese burger was invented. It was started way back in 1934, where the first engine was produced by the company. It was later in 1935 that the first car was produced. In 1937 the company was split off. The company’s production was very limited between the years of 1936 -1945. The company however picked up motion in 1945 and the production was seen to grow rapidly since then.

Manti TeO Case Essay Example for Free

Manti TeO Case Essay By having read the comprising articles and the reader comments on the college football player Manti Te’o, this issue has many different meanings to many different readers. And as Gail Collins stated, â€Å"All I can say is, the story tells you a lot†, this open ended story clearly does give off a large amount of information and arouses a series of questions that anyone would hope to have answered for a better understanding. To me, this issue comes off as confusing, disturbing, and at the same time wretched. Even though Te’o had explained that he was hoaxed, I still am confused to what I believe. For some reason, I feel as though he has something to do with the person that has been hoaxing him all this time to make him not look completely foolish. In order for someone to accept to be in an online relationship, they must be absolutely desperate or grasping for a lot of attention. Especially because this is becoming a problem with someone like Manti Te’o is just puzzling. From someone who is a senior at Notre Dame College, and more than likely having dealt with a wide variety of different situations, anyone would think he would have had more common sense to go along with something like this. That is why most individuals, including me, can give a long explanation to why we are confused. After reading these articles, a different question popped up in my head after every sentence and this situation would be a lot more understandable if they were answered. To make a fake profile, and to use it as a way to make another individual feel sorrow for you is just alarming. It is incredible that today’s society has people that stimulate and have to deal with situations like this one. The fact that you can be in an extremely serious relationship over the internet, without ever meeting face to face, and knowing that Manti Te’o is one of the very many makes this society even more provoking. You hear about these types of issues more and more as time progresses. This issue is wretched because it is what today’s society is evolving to and society makes it okay for issues like this to occur. Television shows, social networking sites, magazines, and movies are putting ideas in people’s head and allowing them to think these types of occurrences are okay to perform. It is just absolutely terrible because issues like this are going to continue to occur because no one is attempting to put an end to it and people seem to be just falling into these types of pits more frequently. Consequently, if this situation was to teach anything, it was that our society has a lot ahead of us. Anyone can be a phony, everything in a way can be unreliable, and people need to realize this is become a truly large struggle. Gail Collins statement â€Å"All I can say is, the story tells you a lot† is an understatement. This story tells you much more than a lot and it tells you exa ctly what our future is beginning to become.

Leadership And Change Management At Mcdonalds Business Essay

Leadership And Change Management At Mcdonalds Business Essay McDonalds started his business in 1940 with 1st restaurant opened in San Bernardino, California by Richard. It was the result of the thoughts of two young brothers, Mac McDonalds and Dick who introduced a new revolutionary restaurant Speedee Service System in 1948 which was established on principles of the modern  fast-food restaurant. Speedee completely replaced with  Ronald McDonalds  by 1967. McDonalds as Trade Mark is time used on May 4, 1961, with the description of Drive In Restaurant Services and still continues until end of June, 2010. The logo M with double arched overlapping as trademark was introduced in Sep 13 1961. The double overlapped as trade mark symbol M as logo temporarily disfavoured by September 6, 1962. The modern double arched M symbol started in November 18, 1968. (McDonalds, 25 August, 2010, http://www.mcdonalds.co.uk ) Big Mac started in 1968, Egg McMuffin started in 1973, Happy Meal for children started in 1979 and Chicken McNuggets started in 1983 .At the present time, McDonalds have more than 31,000 restaurants in 119 different countries of the world of which a lot are franchised. (www.mcdonals.com.uk) McDonalds vision is to become worlds best and quick service experience restaurant for this purpose McDonalds delivering outstanding quality, service, cleanliness, and value, so that we make every customer in every restaurant smile. In mission statements includes best employer or our people in each community around the world, excellent operational for delivery to customers and enduring profitable growth by expanding the brand and leveraging strength of McDonalds through innovation and technology McDonald Corporation ,2010) Change and Resistance to Change: According to Rev Sharon Patterson that which people want to changes are babies who have wet diapers. We can be explained that change is the pain full processes in the place of work towards real physically changes are consists exciting incentives. (Bernerth, 2004) Change Process Model Though we all know and believe that success is change so every one want and need success because everyone want earning profit and want to hold this success but on the other hand we dont forget that every change have some resistances and resistance only in the response of change. (Duck, 1993) According to Duck (1993) bluntly he pointed out that Changes are strongly personal. According to Petersen (2002) many people consider that change basically factor of Fear and uncertainly and some Doubts. (Peterson, 2002) As change broadly accepted all over the world as usual from top management to down management and its also brings high management and those people who are in the capacity of manage by any management they always show resistances against the change before application of change or before forward change its duty of manager to make a such type framework which should be overcome over all resistance before implementation. (Peterson, 2002) Resistance to change can be defined as its an apparent attitude of organization employees or members who are declined to admit any change within organization. (Cheng and Petro Vic Lazar Vic, 2004). James Hunt says Resistance isnt an indication that something is wrong with what you are trying to change. It is an indication that something is happening. Ansoff defined Resistance as its only cause of creation unexpected delays and different types of costs or losses which create instabilities into the process of costs and instabilities into the process of planned change (Ansoff, 1988) Resistance is any employee behaviour trying to stop or delay in any change. (Bemmels and Reshef 1991) Real example of the change process and its implementation. British Airways. Past in 1981, British Airways hired on board of Directors a new chairperson.  When this chairperson joined, he noticed that the company was very unproductive and was wasting a lot of valuable resources in useless activities.  To make the organization efficient and increasing the profit ratio he decided to restructure the entire organization.  He realized that Change Methodology Management Plan is the best way to serve that purpose. (Jean Scheid, 2010) Systematically, the British airways started reducing workforce.  But, before started this, through his change management leadership, the chairman gave the all reasons for the restructuring and privatization of the company in order to prepare them for the future change.  He directed his company through a hard time that could have been terrible without  effective change management resistance communication just only through his Leadership Communication (Jean Scheid, 2010) Scope of the Change at McDonalds. Every organisation has different departments with their own value and importance. These departments have their own specific objective. Marketing is one of them department which is most important part of and company and organisation. So in McDonalds integrated market campaign has played vital role in development of business. This campaign has important goal is adopting latest rules and regulation of health and safety. That is latest styled of awareness about health and safety for the children by focusing the market. Through this IMC, McDonalds has launched new low fat healthy meal deal menu for children and try to give answer of awful advertising of the McDonalds. Moreover, McDonalds have basic aim to make customer happy and proving good healthy diet which is beneficial for the childrens and parent as well. McDonalds have offered new meal deal for childrens which are McKids deal especially for the healthy food of kids. In addition, for progress of business, McDonald has started new integrated marketing communications which has helped out in the advertisement and for convey the message to the customer. This new system has attracted the Childers more than parents. For adopting and accepting the responsibilities McDonalds has make team which will be handle the change as well. This type of strategies will bring change not only in marketing mix and will increase in sale and advertisement as well which will help to achieve their gaols, objective and success. McDonalds has faced many bad responses in the menu of children which is mostly issues were related to nutrition. So IMC has turned the McDonalds status in eyes of the customers. IMC is a developed way to focus on the aim and in progress of company. IMC has helped to promote the advertisement level. Basically purpose or scope of change in McDonalds is application of the integrated Integrated Communication (IMC) as essential part of the strategy of the marketing in McDonalds. In this way of change, very important area where we should attention is the advertisement and promotional activities of the McDonalds. Mostly promotional activities and advertisement campaign concerned with offering new services or any new products through any mode of communication. For this purpose there is lot of sources which are used to for this type advertisement or campaign by company. Basic purpose of this new change to concentrate on sales activities and promotional activities and try to increase sale of the company and this change give the important of Integration Marketing system as important part of the marketing strategy of the company. (McDonalds Corporation 2009) According to Forgeson and Green Basically there are three major categories of change resistances are organizational, group and individual. The following are resistance or conflicts faced by McDonalds during implementation of this change: McDonalds workers, customers, culture and behaviour. (Mabin, Forgeson Green, 2001) Resistances and Conflicts to change at McDonalds:   1st resistances due to reactions of the McDonalds staff and customers of the company, some employees are in favour of this new change and some are against this new change mean using the Integrated Marketing communication. Managers and some employees only against this change due to fear, they think might be this change instead of resolving problem it will increase the problems of the company. There are not only employees have negative reaction towards this change but also customers are not showing positive reaction towards this campaign so it lead o another conflict in the shape of not positive attitude of customers towards this new change in this way McDonalds cant achieve benefit from this change as whole of the company.   One more resistance against this new change of the company the shortage of qualified personnel in company who assigned the maintaining these tasks to maintaining crew and application of this new marketing change but they are not much professional so this is the conflict in the way of new change. The fear of stakeholders of McDonalds for insufficient budget and ineffective use of different mass communication for this new change and chance of failure of this new change is also conflict and resistance in the way of this new change. The difference in culture between the different employees of the organization is another inner conflict. Due to difference in cultures in McDonald in different members of the company so in this way they unable to do work in pleasant environment and in good way and also this cultural leads to create difficulties in the way of implementation of new change in organization. According to Wilkins Dyer the management of the McDonalds and main administration of the McDonald must point out empowerment of the culture of the organization mean the empowerment culture of the McDonalds and should also identify the relation between the empowerment of the culture and planed system of the McDonalds and also relation between both empowerment and culture (Wilkins Dyer, 1988). Recommendation: In restaurant industry managers play vital role in any change so in this way what McDonalds managers pay specific attention at the time of implementation and initiating change towards reducing possible resistances and achieve better organization performance. Manager is the person who initiating and start the change and employees have to accept and adopt it. Through Effective communication, awareness of manager actions, employees attitude and harmonious working situation can be overcome resistances to change and also play important role in attaining better organizational performance. Process for change implementation in Restaurant Industry Effective communication is the most important components in restaurant industry and played a vital role in the success of organizational operations. Effective communication is very important among the managers and employees and among the employees to employees. Good listening skills are the essential for a successful manager of any organization especially in fast growing fast food industry. Before, after and during the change process managers should carefully listen to the employees opinion and should modify the new change according to the opinion of the employee. For implementation of successful change in organization it is compulsory for manager he should always alert regarding employees reaction towards change. McDonalds Managers should realize that if employees against that change and dont want to cooperate with them so in this way customer service delivery will get worse. Conflict may arise amongst colleagues and managers when employees resist change. In this way employees may not perform well which directly effecting reputation of restaurant and might be it will also become cause of resignation of employees. So before implementation of new change McDonalds managers listen very carefully arguments of employees and change the situation according the time need and should avoid the create bad environment in which employees proved poor environment for work and end all go for resignation. Not only this but also they should encourage the employees for better service and development of performance of the company as well as the employees. There should be a proper action of plane for development of or improvement of different customer services and development in working environment within the organization. This strategy or procedure will always encourage to managers as well employees to sure things are well done. We should understand that improvement is with only change. If there is no improvement, it means no change in this way restaurant become sluggish due to not improvement and any other reason like occurring unforeseen and unexpected circumstances in the restaurant and this way it will very difficult to maintain that position in market and compete the competitors. Managers should also provide a pleasant environment to employee for keeping happy to workers and happy workers are great part of high performance and great motivation. Well motivated staff is in this position to do work in good manners and in good pleasant way and strong relations with their colleagues. Its duty of managers to provide and keep very good and pleasant environment for work and we well know a good pleasant environment always get good result and a poor and boring environment always get a poor result and this the negative impact on the repute of the restaurant (A Paton, R. and Maccalman, J. ,2008) Further more, the success of the new change is still under process and difficult to convert the children attitude towards healthy fast food meals. But at the other hand, there are very strong chance for this success due to strong campaign and promotion activates for prompting the characteristics of the this new change. Furthermore, McDonalds should assure the message has been reached to every child in 119 countries where McDonalds is serving for this purpose help from every type media is the best strategy. There should be a new theme for new advertisement I love it even more! and hopefully this new theme and way of advertisement will inspire the parents and also encourage the childrens towards healthy food. This campaign should be long lasting, strong concerned on healthy characteristics of this new change and should be in friendly way like kiddie-friendly way. If McDonalds carefully make plan and use best strategy and good and effective method for implementation of this new change so there are bright chance of the success of this new change and in this way company can achieve very easily mission and objectives of the company. The most concerned of this company to give image of health conscious which is good match with the latest trend of health conscious measures for this world and also for the future world. Conclusion: According to Beverage the management change leaders must be willing to keep their fingers on the pulse of the organization, by monitoring what is working and what is not working and in the change process.   It is duty of managers to reassure, support and take commitment before application of this new change and for getting positively and good result of this new change. The managers should make a strong strategy and should make strong plans of actions regarding this change before implementation of this change and for making this successful. (Beverage (2003) Therefore, we can be concluded now that changes of management is not bad until they enhance the competitiveness and power of an industry. If any change implicated through proper planning and investigation so it will be very effective and will also increase the performance of the organization. So organizations should impose the any change at the right time when studies proved that no time of change. Because we dons forget the change management system not only critical and complex but also very sensitive so only one wrong decision of any company in any change might be it push company to in under clouds and prove harmful for organization profit and inspite giving development instead company feel difficult to survive in perfect market. This is strongly recommendation for McDonalds that must see and again and again ensure that future changes are well very planned there implication is very carefully because these changes will be cause of the success /or failure of any company.

Body Image Essay example -- Psychology

Laurie was a size fourteen at age eleven and weighed one-hundred fifty-five pounds. She went through elementary school being the kid that everyone called fat and never felt love from any of her peers. Even a counselor at her after-school YMCA program made an example of her to the other children. The teacher told all the children that she used to be as big as Laurie. Putting aside all the criticism from her fellow peers and teachers she found the courage and strength to lose weight. She began doing sit-ups and eating â€Å"healthier†. In all reality, she was eating less and less every day. She went from a size fourteen to a nine and then from a nine to a five. This all happened to her between summer and Christmas. By the following summer Laurie was a size double zero. During the following school year, she was called to the nurse’s office to be weighed and the scale read ninety-seven pounds. Laurie had become anorexic from the mentally abusing childhood she experienced f rom her peers. Every culture has a â€Å"perfect body image† that everyone compares their own bodies to. Girls especially have the mental thinking that they have to live up to the models on TV and magazines. In the United States the skinnier the girls, the more perfect their image is perceived. The â€Å"perfect body image† has an intriguing background, health and psychological problems, and currently few solutions. Background The history of having an â€Å"ideal body† type goes all the way back to the colonial times. Jennifer L. Derenne and Eugene V. Beresin have researched the â€Å"ideal body† from the colonial times up until now. During the colonial times, women were valued who were fertile, physically strong, and able women. This was because women during this time helped tend to t... ... (Ed.), Nutrition and Well-Being A to Z (Vol. 1, pp. 69-71). New York: Macmillan Reference USA. Retrieved from http://go.galegroup.com Drugs (Illegal). (2006). In J. Merriman & J. Winter (Eds.), Europe Since 1914: Encyclopedia of the Age of War and Reconstruction (Vol. 2, pp. 886-891). Detroit: Charles Scribner’s Sons. Retrieved from http://go.galgroup.com Franco, K.N., Alishahie, M., & Bronson, D. L. (2004). Body Image. In S. Loue & M. Sajatovic (Eds.), Encyclopedia of Women’s Health (pp.110-112). New York: Kluwer Academic Publishers. Retrieved from http://go.galegroup.com Gleason, W. (2006). Leisure. In J. Gabler-Hover & R. Sattelmeyer (Eds.), American History Through Literature 1820-1870 (Vol. 2, pp. 639-644). Detriot: Charles Scribner’s Sons. Retrieved from http://go.galegroup.com http://www.eating.ucdavis.edu/speaking/told/anorexia/a42laurie.html

Sentrong Sigla

â€Å"All the evidence that we have, indicates that it is reasonable to assume in practically every human being, and with certainly in almost every newborn baby, that there is an active will toward health, an impulse toward growth, or towards the actualization. † -Abraham Maslow Introduction Department of Health or the Kagawaran ng Kalusugan is the principal health agency here in the Philippines. The department is responsible for ensuring access to basic public health services to all Filipinos through the provision of quality health care and the regulation of providers of health goods and services.DOH has three major roles in the health sector: (1) leadership in health, (2) enabler and capacity builder, and (3) administrator or specific services. The DOH’s vision is to be the leader of health for all in the Philippines, and its mission is to guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, and to lead the quest for excellence i n health. While pursuing its vision, DOH adheres to the highest value of work such as: integrity, excellence, compassion and respect for human dignity, commitment, professionalism, teamwork and stewardship of the health of the people.Because of the department’s dedication in guaranteeing equitable, accessible, sustainable and quality health services for all Filipinos, especially the vulnerable group, the department has formulated different programs to ensure quality health services and one of them is the Sentrong Sigla Program. Sentrong Sigla The Department of Health’s (DOH) Quality in Health (QIH) Program seeks to institutionalize Continuous Quality Improvement or CQI in health care in order to create health impact in terms of health promotion and disease prevention control.Sentrong Sigla Certification has been identified as one of the components and strategies of this program. The quality standards cover total systems quality for outpatient care and public services g raduated into three levels. This quality standards list (QSL) covers the basic certification level or Level 1. The next higher levels of specialty award and award for excellence, Levels 2 and 3 respectively have their own standards lists. Aside from the QSL, other tools available for use of the health facility staff are the Supervisory Forms (SF) and the Facility Certification Form (FCF).The Birth of Sentrong Sigla Quality Assurance Program (QAP) Goal: To make DOH and LGUs active partners in providing quality health services. Key Strategies: 1. Certification / Recognition Program (CRP) 2. Continuous Quality Improvement (CQI) In 1999, QAP was renamed the Sentrong Sigla (â€Å"Center of Vitality†) Movement (SSM). Sentrong Sigla Movement Goal: Quality health – quality health care, services and facilities. Objectives: Better and more effective collaboration between DOH and LGUs.Where DOH: serves as a provider of technical and financial assistance package for health care. L GU: serves as prime developers of health systems and direct implementers of health programs. Specific Objectives: * Institutionalization of quality assurance * SS certification targeting 50 % of health facilities in 2003 and 60% in 2004. Pillars: * Quality assurance * Grants and technical assistance * Awards * Health promotions Phases: Phase| Period| Standards| I| 1998 – 2000| Input Quality | II| 2001 – 2004| Process Quality|III| 2005 – 2010| Outcome or Impact Quality| Guiding Principles for Sentrong Sigla Movement To ensure that Sentrong Sigla remains focused on its quality goals and objectives, the following guiding principles are hereby adopted: * Recognition for achieving good quality shall be the main incentive in SS certification. Advocacy and social mobilization activities should be used to enhance the value of prestige and recognition. Other incentives shall not be overemphasized and should only be secondary to recognition. * Quality improvement is an un ending process.SS certification should promote the continuing drive for ever – improving quality by providing multi – tiered and progressively higher quality standards. * SS certification shall focus on core public health programs that have been proven to be most cost – beneficial to the people such as child health, maternal care and family planning, prevention and control of infectious diseases and promotion of healthy lifestyle. Public health programs are best integrated, synergized and synchronized to achieve maximum health impact. Quality improvement is a partnership that empowers all stakeholders. In SS, communication between the DOH and the health facilities to be certified shall be open and shall be based on mutual trust and transparency. All quality standards and the methods by which these shall be assessed shall be openly shared and discussed to ensure clear understanding and strong commitment by all concerned. * In the same spirit, roles, responsibilit ies and contributions shall promote appropriate counterpart and reciprocity. To ensure even distribution of quality health services, DOH assistance shall be purposive, targeting to achieve quality improvement in health facilities that have been identified using carefully selected health priorities and health needs. These should include health facilities in far – flung and underserved areas, in congested urban centers or in marginalized communities. * To ensure objectivity and broad, varying perspectives, SS assessment shall involve partners in health from non – DOH units such as other government and non – government units agencies.They shall be encouraged to actively advocate for and give support to SS. Sentrong Sigla Certification Phase I Phase I of the certification component started in mid – 1999 and extended until 2002. Sentrong Sigla seals were given to health facilities that met at least 80% of the standards. By mid – 2002, 44% of health cent ers, 13 % of district and provincial hospitals, and 1 % of BHS have been certified Sentrong Sigla. Additional national awards were given to several health facilities, the prize for which included P 1 Million for health centers, P 3 Million for district hospitals and P 5 Million for provincial hospitals.More than 135 Million pesos have been awarded to these facilities. The Sentrong Sigla certification during the first phase was successful in terms of promoting interests and participation of local government units in raising the quality of health care in public health facilities and in generating additional support from local chief executives for health and channelling local resources to fund basic equipment, amenities and supplies of local health facilities.The strategy also confirmed that a mechanism that recognizes good quality health services is a powerful tool to maintain DOH leadership in health, with high potential for eventually creating health impact through more effective an d better quality public health programs. Valuable Lessons during Phase I * The realization of the need for total systems quality standards that combine simple yet basic input process and output standards. While the health facilities met input – only standards in Phase I, SSM itself had to be positioned as a total quality movement.Thus, consumers will equate SS with total quality. â€Å"Input only† certified health facilities would raise doubts on the SS seal as a certification of genuine total quality. Changing the standards over the years, as originally planned, was difficult to implement. Besides, The LGUs preferred a stable core of total system quality standards. * The importance of careful selection of incentives. While it is important that incentives be attractive, these should also be appropriate, sensible and sustainable.During SS Phase I, monetary rewards were too much focused. This generated unprecedented interest but distracted the LGUs away from the real qua lity objectives of SS. The quest for the million peso prize led them to skip the capability – building step which was really the most important step in the process. * The need for changing procedures to provide adequate time for crucial processes like the internalization of the quality standards by the Local Chief Executive and is local health staff, the provision of supportive technical assistance by the DOH and other quality improvement activities prior to formal assessment. There was also need to provide multiple, progressing quality standards to drive continuing quality improvement. Formulation of the Philippine Quality in Health Program and the Transition into SS Phase II In 2001, with the change of DOH administration, the effort to raise quality of health services was intensified, leading to the expansion of concern for quality beyond the DOH – LGU interaction level into the entire health sector.Other instruments and interventions that can drive quality higher, s uch as mandatory licensing and the accreditations and payment scheme of the Philippine Health Insurance Corporation (PHIC) were included. Other efforts of professional societies were also acknowledged and incorporated, resulting in the more integrated Philippine Quality in Health Program AO No. 17 – B s. 2003, replacing the Sentrong Sigla Movement. The certification strategy of the â€Å"movement† – The Sentrong Sigla Certification – remained an important strategy in the accreditation approach of the broader Philippine QIH Program.To harness the full potential of the SS Certification in achieving its quality goals and objectives, basic modifications were adopted for SS Phase II (2003 – 2007) in terms of revised quality standards, procedures and incentives scheme. Goals: As one of the accreditation strategies in the QIH Program, Sentrong Sigla Certification has the same long term and intermediate goals as the Philippine QIH Program: Long – Te rm Goals:To institutionalize within the health sector the leadership processes, knowledge, attitudes, skills, and organizations that will generate Continuous Quality Improvement in health care thus creating health impact in terms of health promotion and disease prevention and control. This goal is a process and systems goal, fully recognizing that the quest for better quality health care and services is a continuing or unending process. This is also an expanded goal, aimed to cover the entire health sector, not only the public health or government sections of the sector. Intermediate (5 – year) Goal (2003 – 2007)To improve the quality of health care in outpatient health facilities, hospitals, and the public health services in the communities. In specific terms, this goal will be carried out by establishing specific quality criteria and by targeting (a) to raise the average quality of out – patient care, hospital care and community / public health care; and (b) t o reduce the variation around the average quality of care among these different categories of providers and services. Specific Goal: To improve the quality of outpatient health care (public and private) and of public health services in communities.For 2003 – 2007, SS will put emphasis on improving the quality of services in local government health facilities and of public health services in communities. Objectives for 2003 – 2007, Phase II Sentrong Sigla Certification has the following objectives for 2003 – 2007, Phase II: By 2007, 1. To establish an efficient systems of providing technical and other forms of assistance to outpatient health facilities, of assessing health services against established criteria, and of monitoring key indicators in the Ss certification process. 2.To progressively raise the average quality of public health services through recognition of successful attainment of quality standards: * At least 50% of health centers in the country succ essfully meet the revised SS Phase II Basic Certification (Level I) standards. * At least 20% of Level I certified health centers successfully meet SS Phase II Specialty Award (Level 2) standards for all four core public health programs (child care, maternal care / family planning, prevention and control of infectious diseases, and promotion of healthy lifestyle. 3. To raise public awareness of, public support and demand for, and client participation in SS certification of their health services and facilities. Overall Certification Process The quality standards cover total systems quality for outpatient care and public health services graduated according to the following levels: Level| Category| Description| Level 1| Basic Certification| Minimum input, process and output standards for integrated public health services for 4 core programs, facility systems, regulatory functions and basic curative services. Level 2| Specialty Award| Second level quality standards for selected public h ealth programs (includes other health programs in addition to Level 1 core programs) and facility systems. | Level 3| Award for Excellence| Highest level quality standards for maintaining Level 2 standards for the 4 core public health programs and Level 2 facility systems for at least 3 consecutive years. | All the local health centers and rural health units are qualified to apply for Level I certification. Only those that passed the Level I can go to Level 2; only those that passed the Level 2 can proceed to Level 3.The certification process starts with participatory self – assessment at the local health facility level assisted by the DOH Representative to the area. Then, for a period of about 3 – 6 months, depending on the deficiencies noted, the local health facility will have to improve its systems and services to meet the quality standards for the appropriate level. DOH Representatives and other regional technical staff shall assist the LGU in this transformation process, providing appropriate technical packages and other assistance as needed.Multi – sector Regional SS Assessment Teams that have been trained and certified as assessors shall conduct formal assessments using the appropriate Facility Certification Form. These teams will then recommend the certification of health facilities that successfully meet the standards criteria. Major Steps for SS Certification Step 1: Orientation and invitation. Step 2: Self – assessment by LGU. Step 3: Provision of technical assistance. Step 4: Formal assessment for Level 1, Basic Certification.Step 5: Maintenance of Level 1; working for Level 2 certification. Step 6: Formal assessment for Level 2 certification. Step 7: maintenance of Levels 1 and 2; working for Level 3 certification. Step 8: Formal assessment for Level 3 certification. Step 9: Maintenance of Level 1, 2, and 3 | The above strategy is designed to promote the continuing progression of health facilities towards higher qualit y levels. The pace of progress towards higher levels depends on the motivation of the health facilities.However, should health facilities not actively apply for certification into the next higher levels after 2 years, renewal of their SS certification status would be validated by Regional Assessors every 2 years. The following is the recognition scheme: Level| Recognition| Level 1Basic SS Certificate | SS seal, individual recognition| Level 2Specialty Award| Specialty banner, individual recognition, others| Level 3Award for Excellence| SS trophy, individual recognition, media exposure, others| Levels 1 and 2 recognition shall be conferred by the DOH through its CHDs.Recognition for Level 3 Award of Excellence shall be given at the national level. Matching grants shall be a mechanism to provide assistance to LGUs to achieve basic SS Certification and to continue to attain higher levels of quality. Region – specific procedures to assess needs and motivation shall guide prioriti zation of such grants. Facilities that did not progress into higher level certification after 2 years, but maintained their current certification status based on Regional validation, shall be given stickers confirming the renewal of the validity of their SS status.Validation shall be done every 2 years. There shall be no other incentives for mere renewal of SS status. Grants for technical assistance towards attaining higher level quality, however, may still be granted by the respective CHDs based on thorough assessment of the needs and the commitment of the health facility. The SS Certification Flow Chart Procedures 1. 0. Technical Assistance 2. 1. Self – assessment and planning This process is participatory involving all key staff of the health facility, other units of the local government and the local executive.The DOH Representative to the area is the primary technical assistant of the DOH. He / She shall ensure that the LGU has all the necessary documents and materials n eeded for the certification and that all key LGU staff understands the standards and processes involved. The DOH Rep shall either provide actual technical inputs or tap other regional resource person and technical services to assist his / her LGU. Based on the QSL, The LGU, assisted by their DOH Rep, shall conduct a system and services analysis and shall formulate a plan, synchronized with the DOH Rep‘s assistance plan, to achieve the standards in the QSL. . 2. Designing and providing technical package Based on the improvement plan, the DOH Rep shall provide the technical inputs and packages. 2. 3. Systems improvement Improving the quality of systems, such as logistics and information systems, are better facilitated through field exposure in facilities that demonstrate model systems or by bringing in resource persons knowledgeable in systems analysis and systems improvements. These special arrangements are possible through the DOH Rep and regional TA teams. 2. 0. Assessment 3. 4.Quality Standards for SS Phase II Level 1 (Basic Certification) The 78 SS Phase II Level 1 standards are organized into 4 sections: integrated public health programs, facility systems, regulatory functions, and basic curative services. Integrated Public Health Programs. Only four â€Å"core† public health programs are currently included in Level 1 Basic Certification in order to focus the services on the most crucial public health priorities in child health, maternal health and family planning, prevention and control of infectious diseases especially tuberculosis, and the promotion of healthy lifestyle.Integration is stressed to emphasize the need to combine similar and related interventions, such as child targeted programs like EPI, CDD – ARI, nutrition and others, infection prevention and control interventions, maternal care and family planning, and healthy lifestyle approaches. Integration is achieved by ensuring that facility – based services are reinforc ed by well – planned and well – coordinated, synergistic home – and community – based activities. The synthesized protocols emphasized â€Å"proven† interventions, excluding experimental interventions not yet proven to be cost – beneficial or effective such as the syndromic approach to STD.Note that for Level 1, the program selected is maternal care and family planning, not Women’s Health. This is because there are many developmental and experimental areas in the expanded field. Women’s Health and other programs not in Level 1 Basic Certification are to be included in Level 2 SS. Facility Systems. These standards include systems and services that cut across various programs and support all health facility services. These include planning and budgeting, human resources development, management and health information systems, logistics system, referral system and community systems.Regulatory Functions. Regulatory functions include two aspects: compliance of the health staff with health laws and the performance of the responsibilities of the local health staff in the enforcement of these health laws. Basic Curative Services. The standards refer to routine history – taking, physical and laboratory examination, and systematic assessment of these signs and symptoms. 3. 5. Quality Standards for Level 2 and 3 ideas and direction These standards are still being developed.The concept for Level 2 Specialty certification is to define program – centered higher level quality standards for selected programs. The programs include the four core public health services in Level 1 and other programs that include developmental components, for instance women’s health or reproductive health. Level 2 standards would also include higher quality systems standards. Level 3 standards would be very much like Level 2 standards with emphasis on maintenance of these high quality service levels. 3. 6. Tools for Measur ing SS Quality StandardsAs in any certification process, accurate measurement of the attainment of the quality standards is difficult. The methods of measurement used in SS include direct observation, records reviewand interview of health staff and clients. Of the total 78 standards in the QSL, 53 shall be measured using the Facility Certification Form (FCF). The rest are measured by suing the Supervisory Form, which in turn is also verified through the FCF. Facility Certification Form. The measurement methods include mostly simple direct observation, short review of records and short interviews with either staff or clients.Supervisory Form. These are taught to the health facility supervisors, mainly the nurses or physicians. The methods included in the SF are the lengthy and more highly technical observations of actual patient care, the more thorough review and analysis of records, and the more detailed interview of staff or clients. The records of the supervisory activities, in tu rn, are those assessed by the SS Assessor. 3. 7. Scoring The scoring system puts more weight on the integrated public health services and facility systems. The â€Å"must have† standards are those listed in the FCF. Nice to have† standards are either in the supervisory form or in the discretionary list for SS assessors. 3. 8. Training and certification of assessors To prevent bias and too wide variation of judgement between assessors, only duly trained assessors will be certified to conduct assessments. Assessor Field Supervisors recruit, train and recommend certification / renewal of certification of assessors in the field teams under them. Advocacy, IEC, and Social Mobilization The table below is the media communication plan for SS listing the basic messages and target groups.National advocacy activities will focus on wide tri – media popularization of the SS seal and its symbol. Regional advocacy will focus on raising the commitments of local executives to SS and the awareness and demand for quality services among the communities. Target Audience| Messages| Scope: Media| General public(including politicians) | What is SS? What is the SS seal? What are the SS standards? What facilities have to meet these standards? What are the general benefits of having SS certified health facilities?What can you do to demand for SS certification or help / support the program? | Nationwide: multi – media| Health staff(LGU, DOH, private health sector)| Reinforce the value of quality in health care. What are the updates on SS? (revisions, etc. )What are the specific benefits of being an SS certified facility? Using the revised SS certification processes, how can the health facility become SS? What are the specific and relevant guidelines for LGU action? | By region & LGU: sales conferences, symposia, meetings, handouts, manuals. | Monitoring, Research and EvaluationThe quality level of each health facility, including the deficiencies of those not ye t SS certified, are monitored to detect the increasing average quality level and the needs for assistance. Research is used to develop improved quality standards program components and training packages and top evaluate the SS achievements. Organization and Functions The National Sentrong Sigla Certification Committee (National SSC Committee) sewrves as the multi – sector body that oversees policy recommendations and coordinates the various activities of SS.This committee also assesses the performance of the various subcommittees and DOH units involved in the implementation of the strategy. The subcommittees of the National SSC Committee with their respective functions are as follows: * Sub – Committee on Standards and Procedures 1. Develops and recommends standards and procedures for Sentrong Sigla certification, as well as basic messages to various stakeholders, through multi – sector consultation and pilot – testing and taking into consideration other quality initiatives and accreditation programs of other agencies in the country. 2.Develops and disseminates guidelines on SS implementation to DOH staff at all levels. 3. Coordinates training of various stakeholders on standards, procedures and basic messages. 4. Performs other functions as relevant to the development and dissemination of standards and procedures in SS. * Sub – Committee on Technical Assistance and Monitoring Assists the DOH Regional Offices / CHDs in the following functions: 1. Dissemination of SS standards, procedures, guidelines, and basic messages to the other members of the health sector such as the local government units (LGUs) and private practitioners, among others. 2.Development of training assistance packages, systems and tools that will facilitate the attainment of SS standards. 3. Coordination of various sectors involved in the SS quality assessment of health facilities. 4. Development of monitoring tools and performance indicators and analysis o f the SS results of the database for all health care facilities (certified and not yet certified). 5. Monitoring of the achievement of identified SS program indicators of performance. 6. Identification and coordination of grants and projects that will facilitate the SS certification of target health facilities and systems in the country. . Other functions necessary to assist the LGUs and other members of the health sector in attaining SS quality standards. * Sub – Committee on Advocacy and Awards 1. Designs and recommends revised, graduated incentives scheme that puts emphasis on excellence rather than monetary incentives. 2. Identifies and mobilizes funds and partners in order to deliver these incentives. 3. Develops projects to facilitate SS certification of target health facilities and systems and performs the necessary processes to get these projects approved and implemented efficiently. 4.Advocates for multi – sector participation in the SS program based on the ba sic messages developed by the Standards and Procedures Sub – Committee with emphasis on the quality improvement benefits to different sectors involved. 5. Performs other functions necessary to make the SS incentives focused on the excellence and to sustain interest and participation in the certification strategy. Functions of the DOH Regional Offices / CHDs in SS Certification In addition to the technical assistance functions mentioned under the Sub – Committee on Technical Assistance and Monitoring, the DOH Regional Offices shall: 1.Organize Regional SS Assessment Teams and SS Technical Assistance Team. 2. Advocate for SS certification within their respective regions. 3. Identify and mobilize resources and partners to help enhance the attractiveness of the SS incentives scheme without putting too much emphasis on monetary or material rewards. 4. Develop regional projects that will promote and facilitate SS certification and active partnership. 5. Perform other functio ns as necessary to implement SS certification and quality improvement activities within the health sector.National Structure for Sentrong Sigla Certification Regional Structure for SS Certification Financing SS activities are funded from multiple sources. The BLHD provides funds for SS national operations, including national advocacy and the activities of the National SSC Committee. Regional Health Offices provide the funds for regional operations including regional advocacy, matching grants and other rewards such as the SS seals, certificates and trophies. BLHD may augment the funds of regions that seek financial assistance.BLHD, in coordination with DOH financing units, monitors selected financial indicators for SS certification such as funds allocated and disbursed at all levels, including counterpart funds from LGUs. Future Directions SS Certification is expected to further develop in many directions. The quality standards are expected to reflect higher levels of quality and oth er changes through the years. Assessors and TAs will have to be retained as these changes are incorporated. New programs and new or revised protocols may be added in the â€Å"core† list. Future standards may be developed to cover other units in the LGU and the community.Within 2007, initiatives shall include preparations for expansion of the coverage of SS certification into private outpatient health facilities and the development of Level 2 and 3 standards. In the future, it is also expected that the Licensing requirements would eventually absorb the â€Å"safety† standards currently in SS. PHIC – developed standards for hospital services are expected to become the SS standards for hospitals. Definition of Terms 1. Quality – degree of excellence or desirability of a product, usually measured in relation to conformity with given standard. 2. QualityControl (QC) – set of functions designed to insure quality in manufactured products by relying on pe riodic inspection of finished products, analysis of results of inspection to determine causes of defects and systematic removal of such causes. 3. Quality Assurance (QA) – set of functions designed to insure quality in manufactured products by preventive or pre – emptive removal of potential sources of defects through constant improvement of production technology, engineering design, materials, processes, equipment and workmanship. 4. Quality Management (QM) – the organization – wide pursuit of quality. . Quality Improvement (QI) – the broad all – encompassing generic term for processes involve in the continuing pursuit to improve quality. 6. Performance Improvement – a type of QI focused on the systematic and continuing improvement of organizational performance in order to achieve total quality. 7. Total Quality Management (TQM) – the pursuit of quality that involves not just the production organization but also its clients an d customers, suppliers and sub – contractors, competitors and oversight agencies in the market, and all other stakeholders in the community. 8.Total Quality – the ultimate goal in improvement which involves doing the right thing right the first time and all the time while meeting the needs of internal and external stakeholders and customers. 9. 1998 Quality Assurance Program – refers to DOH quality program formulated in 1998 that is focused on improving the DOH – LGU partnership to provide quality health services. The QAP started the certification and recognition strategy for improving health services in health centers, rural health units and baranggay health stations. The Sentrong Sigla Movement replaced the QAP. 10.Sentrong Sigla Movement – the term used in 1999 to refer to the 1998 QAP. The SSM is essentially the same as the 1998 QAP, with some minor revisions like the inclusion of local hospitals in the certification and the listing of 4 pillar s to support the process. This term was also used to refer to other quality – related concepts such as the quality improvement philosophy, the multi – sector nature of CQI, and the value changes in CQI. The Philippine QIH Program replaced the SSM. 11. QIH Program – refers to the Philippine Quality in Health Program, the current quality improvement program (AO 17 – B s. 003) that replaced the QAP and the SSM. The QIH has expanded the scope of the quality initiatives to involve the entire health sector, not only the DOH and the LGU services, and now includes the licensing and other efforts such as accreditation by PHIC or other professional societies in its strategies. 12. Sentrong Sigla Certification – refers to the strategy of assessing health facilities against established health services criteria and recognizing those that successfully meet the criteria. The certification process is expected to lead to changes in the health facility when they str ive to meet the criteria. 13.SS Quality Standards List (QSL) – the list of basic SS criteria to be met by health facilities. In SS Phase II, the QSL for Level 1 certification includes input, process and output criteria. 14. SS Facility Certification Form (FCF) – the form that is used in the formal assessment of health facilities. The FCF contains standards that will be measured by the SS Assessor and the method by which these will be measured. It also works as the scoring sheet. 15. Supervisory Form (SF) – the form used by the health facility supervisor (the nurse or the physician) in assessing the capability of his / her health staff, usually midwives.This contains the standards that are measured mostly through direct observation of provider – client interactions and in depth review and analysis of records. 16. Inputs – the resources needed to provide care or services such as staff, equipment and supplies. 17. Processes – a series of activi ties or tasks. 18. Outcomes – the result of the processes. Conclusion In 2001, according to the World Bank, â€Å"The quality of service varies between different types of health facilities with the facilities providing better quality of service to be more heavily utilized by the individuals from the higher income groups.Public health facilities such as the rural health units and barangay health stations are generally perceived to provide low quality health services. Few have emphasized the quality of services and most systematic efforts to improve based on findings about the delivery process have been limited to health facilities with adequate resources. † Everybody deserves to receive quality health care. Whether you came from the poorest of the poor or the richest of the rich, there should be a same level of quality care. Sadly, here in the Philippines, the quality of health care services and management system has been widely deficient.With this in mind, quality impr ovement in health system needs to be organized systematically to bring about genuine health systems reform. We should change the general perception that the Philippines have fragmented planning, funding, and management of the quality initiatives. And in order to achieve this – thus achieving quality health care – there should be coordination and collaboration between the government, NGOs, and the community. And it shouldn’t stop there. In order to achieve excellence in health services, it should be remembered that the quest for quality health care is continuous.Honestly, I’m not really aware what Sentrong Sigla Movement is. I don’t know what it is for, how was it being implemented, etc. Because of the limited knowledge I have, and the lack of information and resources, I have decided to visit DOH and ask for information. I have learned that the Sentrong Sigla Movement has been stopped in the year 2007, and only reached the Level 2 where trainings h ave been conducted but there was no implementation. It is stopped because of the PHIC Bench Book, where it is just the same as the Sentrong Sigla Movement, because the DOH also included most of the inputs in the said proposal.Unfortunately, it is still not being implemented, thought it has been revised and just waiting for the sign and review of the Secretary of DOH. I guess, the lack of funds has a major impact why an important program such as Sentrong Sigla was being stopped. But I am sure that there will be always a quest for excellence in providing health care services. I wish that there will come a time that it will not matter if you’re in a public or private hospital for they are providing same quality care.Nevertheless, we should remember that the success of quality initiatives lies in producing change the way people and organization work rather than concentrating standards and measurement alone. Bibliography * Cuevas, F. P. , Reyala, J. , Borja, V. , Serafica, L. , Ma nlangit, C. , Mendoza, M. T. , Ramos, L. , Ruzol, C. , Soliman, R. , Aricheta, J. , Garfin, A. M. C. , Niola, R. , Bocobo, M. , Hipolito, H. (2007). Public Health Nursing in the Philippines 10th Edition. * http://www. doh. gov. ph/sentrong_sigla