Relevance of Psychology in Primary Health Care Delivery

Relevance of Psychology in Primary Health Care Delivery Critically discuss how an understanding of psychology can enhance the delivery of primary health care. (District Nursing) Essay The concept of psychology as relevant to district nursing and the primary healthcare team can be examined on a number of different levels. An understanding of psychology is clearly important to the nurse when she interprets a patient’s reaction to events in their personal illness trajectory. (Yura H et al. 1998). It is equally important as she considers her professional approach to the patient and the understanding of how a patient will react to the delivery and impact of healthcare, particularly in her considerations of how to achieve maximum patient compliance in any given therapeutic regimen. (Dean A. 2002).There are other, arguably less immediately obvious, ramifications of the impact of psychological implications in the delivery of primary health care when one considers the interactions and dynamics of the primary healthcare team and the interplay between various members of the team. In this essay we shall consider all of these implications. We start with the general plan that the topic of psychology in this context is potentially vast and for this reason we shall consider individual illustrative episodes in some detail in order to demonstrate an overall understanding of the area. The perception of any given situation and indeed, the evaluation of the probabilities that arise from it, are generally dependent on its presentation. This in turn gives rise to differences and variations in the number and scope of the possible outcomes from that situation. This is the so called Theory of Rational Choice (De Martino B et al. 2006). The perception of a situation is dependent on its â€Å"framing†. It therefore follows that the outcome is also dependent on the same concept of framing of the presentation. This has great relevance to our question, as the District Nurse can make decisions that are influenced by the â€Å"framing† of the presentation by the patient, but more significantly, she can seek to modify the decisions that a patient ultimately makes by framing her presentation of the situation in a number of different ways. There is a substantial evidence base in the literature which cites examples of how decisions can be changed or even reversed if t hey are presented with different emphasis on different factors in the presentation (van Osch S M C et al. 2006). A full consideration of the implications of this statement will suggest that these psychological concepts will have a direct bearing on other professional considerations such as autonomy and other ethical issues. (Hendrick, J. 2000). How can a patient be considered to be making a truly autonomous decision if that decision is being influenced by the abilities of a nurse to â€Å"frame† the presentation of the relevant factors in order to suggest that one outcome is better than another? (Green J et al. 1998). How can a patient be considered to be â€Å"empowered and educated† about a course of treatment if the nurse has been selective in the way that treatment has been explained to the patient? (Sugarman J Sulmasy 2001). We do not presume to suggest that such concepts are necessarily wrong. It may be entirely reasonable for a nurse to use her professional skill and judgement to suggest to a patient that one particular course of action is preferable to another by framing the presentation in such a way that the patient is guided towards a certain decision. In a commonly experienced clinical situation such as a frightened patient with an extensive skin wound to the leg which clearly requires suturing and who is saying that they don‘t want anything to be done, we could probably all agree that it would be quite appropriate for a nurse to suggest that the procedure of suturing is not very painful and will give a good cosmetic result whereas to leave the wound open will give rise to infection and other difficulties. From an analytical viewpoint, this approach could be viewed as detracting from the patient’s autonomy and ability to make their own valid consent. (Gillon. R. 1997). A pragmatist mi ght equally suggest that the nurse is employing valid psychological principles in her professional desire to achieve what is probably the best outcome for the patient (Coulter A. 2002) One of the major areas that we shall consider in this appreciation of the significance of psychology in the delivery of healthcare, is that of attitude of those delivering the particular intervention to the patients concerned. This area is examined in commendable detail by the paper by Johansson (K et al. 2002) which specifically considered the effectiveness of the delivery of alcohol awareness programmes in a group of problem drinkers. The reason that we have selected this paper for an initial consideration is that, unusually for a research paper, it does not simply consider the efficacy of a particular healthcare package, but it reviews and critically analyses the attitudes of the healthcare professionals on the overall outcomes with specific focus on their readiness to participate in such a venture. This is seminal to the major thrust of this essay and therefore merits a detailed examination. In essence, the entry cohort to this study was a collection of about 150 primary healthcare team workers who could potentially be involved in the delivery of an alcohol awareness programme. Each was asked to fill in a questionnaire which was designed to evaluate a personal profile of the respondent and covered areas such as: experiences with patients with alcohol-related health problems, knowledge and perceived capacity concerning early identification and intervention, attitudes towards the role of primary care staff in early identification and intervention and current intervention methods in use at the health centre. The results are interesting insofar as there was general agreement that the likelihood of a patient generating or triggering an enquiry into their alcohol usage was most likely to be when issues relating to the alcohol-related health-risks were perceived by the healthcare professionals. The relevance of the psychological aspects of such an enquiry became clear when it was found that nurses were more likely to enquire than the doctors in the sample and that on average, nurses tended to drink less alcohol than doctors. (Dihn-Zarr, T et al. 1999) Those who drank the least were more likely to be concerned about the health risks than those who drank more. Clearly the effects of alcohol in any individual patient are specific, but the willingness of a healthcare professional to instigate healthcare measures to minimise the health-related effects of alcohol appears to be dependent on their own attitudes towards alcohol and this may be reflected in their own levels of consumption. There is an old adage that the definition of an alcoholic is a patient who drinks more than their doctor. (Fleming, M et al. 1999). In the light of this study, this comment may not be as flippant as it initially appears. In alcohol-related problems, there is frequently an element of denial, both in terms of alcohol intake and its effects. (Herbert, C et al. 1997). If the healthcare professional involved has a degree of denial of their own intake, clearly this will have repercussions on their presentation of the problem to the patient and their subsequent evaluation and willingness to invoke therapeutic or interventional measures for that patient. (Kaner, E. F. S et al. 1999) Other significant factors that contributed to the likelihood of a healthcare professional instigating therapeutic measures were found to be their individual perception of their own degree of knowledge on the subject, both in terms of the effects of alcohol on the body and also in terms of the interventions that were available. (Aalto, M. et al. 2001) Many nurses expressed the fact that they were concerned that patients might react negatively to such enquiries and that this would affect the degree of patient empathy. Doctors appeared to be generally more confident about handling the possibility of a negative reaction. The same study pointed to the fact that it appears that such fears were unfounded in reality, as the same proportion of patients reacted in a negative way in both groups. >From this brief overview, it can be seen that psychology plays a role at many different levels in what is basically a fairly straightforward healthcare professional / patient interchange, and the attitudes of both patient and healthcare professional can have a profound impact on the eventual outcome of the care package for the individual patient. The paper itself makes the comment that: Nurses appear to be an unexploited resource, in need of training and support. Nurses may need to be convinced that an active role does not interfere with the nurse–patient relationship. Building teams of GPs and nurses in primary care might enhance the dissemination of alcohol prevention into regular practice. A further psychological input that is relevant in this area is the perception of the healthcare professional of just how effective the intervention that is proposed is likely to be. A previous paper on the same subject (Andrà ©asson S et al. 2000), concluded that healthcare professionals were much more likely to recommend a healthcare intervention that they had personally experienced or witnessed as successful, with greater frequency than one which had been shown to have a secure evidence base in published literature. The paper concludes with the suggestion that specific training in the subject needs to be implemented and this training not only needs to address the knowledge gap that has been identified, but also the belief systems and attitudes of the healthcare professionals in the primary healthcare team in order that it can reach its maximum potential. Although this paper was targeted and written in relation to a specific alcohol related intervention, it is reasonable to assume that the selected comments cited in this essay are sufficiently general to apply to most specific health related interventions and we will consider and explore other psychological rationales in specific relation to Health Promotion initiatives together with the inferences that can be drawn in relation to team building issues at greater length later in this essay. One of the major areas where psychology is relevant to the success (or otherwise) of a particular treatment is encapsulated in the concept of empowerment and education. (Howe and Anderson 2003). The patient who is both empowered and educated by the nurse will approach their illness trajectory in a completely different psychological frame of mind than one who is not. Time spent in explanation to a patient of the parameters and reasons for their treatment is rarely wasted. (Holzemer W et al. 1994). Marinker’s concept of the differentiation of compliance and concordance. (Marinker M.1997) is particularly useful in this respect. Although his original paper was written with specific regard to the taking of medication, the principles that it expounds are sufficiently general that they are now commonly extrapolated to cover most aspects of the interaction between the healthcare professionals and the patient. The patient who understands why he is being asked to undergo a particular th erapeutic regimen is far more likely to complete is successfully than one who is simply told what to do. This can be encapsulated in the professional advice on the subject from the RCN Patients are as fully involved as practicable in the formulation and delivery of their care (e.g. through the use of self-care plans) Where appropriate, patients are offered treatments other than medication Treatment plans are individually tailored for each patient Patients are involved, unless impracticable, in any decisions about referral Where practicable, patients are informed of the reasons for referral to specialists or other professionals (cited in CSAG 1999) This element of compliance is frequently cited in many of the tools of quality indication that are used in formal studies in this area. The degree to which a patient complies (or concords) with instructions can be viewed as a measure of success of the presentation of that treatment directly to the patient. (Campbell S M et al. 2000) As we have intimated in the introduction, the title of this essay can be interpreted at several different levels. In this segment we shall consider the impact of formal psychology services in primary health care. The rationale for our consideration of this topic specifically lies in the fact that an understanding of basic psychological principles is fundamental in allowing the nurse to appreciate the elements of treatment commonly undertaken in a psychology clinic. The excellent and informative article by Sobel (A B et al. 2001) provides a good starting point for this consideration. In practical terms, the average attendance at a psychology clinic is about five outpatient attendances. (Arndorfer, R. E et al. 1999). This means that the contact of a patient with the primary healthcare team is likely to outnumber the attendances at the clinic over a period of time. To give a specific example, it is clearly important for the nurse, who may come into contact with (for example) an anorexic adolescent, to understand the issues revolving around body dysmorphia, self-image enhancement and self-esteem (Lavigne, J. V. et al. 1999) if they have been undergoing treatment, if the nurse is to consider giving any degree of holistic consideration to whatever problems are being presented to her at the time. It is clearly of little value, if requested to give advice on the subject of weight loss (which is a common enquiry at nurse-run clinics), (Hogston, R et al. 2002) . to attempt to give such advice without a background knowledge of the psychological principles that have been employed in trying to restore the patient’s eating habits to a more normal pattern. (La Greca, A. M. 1997). Equally the parents of a child who is undergoing treatment for enuresis may have questions that they have not felt able to ask at a busy clinic and these may be presented to the practice nurse. A background knowledge of current treatment (both interventional and behavioural) is clearly vital t o being able to answer the questions with a degree of professional confidence. Another area where the nurse’s knowledge of psychological issues may be important is that, given the fact that a comparatively high number of patients default from follow up before being formally discharged, the nurse should know that psychological treatment is rarely successful if the â€Å"less than optimum† course of treatment is completed. (Sobel, A. B et al. 2001). Encouragement to return to complete the full course may be a useful remit for the nurse confronted by a patient in this situation. It follows that a sensitive exploration of the reasons for default my also be helpful and a knowledge of the subject is clearly helpful here as well. The patient who has defaulted from follow up through apathy needs completely different handling from the patient who has defaulted because of a resurgence of painful or difficult memories during a course of cognitive behavioural therapy. (Street, L. L.et al. 2000). In the latter case, empathetic handling is of great importance a s the issues involved may have a deep significance for the patient and completion of the course may be fundamental to a complete resolution of the issues involved. (Mitchell M C et al. 2004). When dealing with the patient who has specific emotional or psychological issues, the professional nurse would commonly have to employ a degree of psychological understanding which may be deeper than in many other cases for both of the reasons set out above. Let us now consider a different aspect of psychology and its relevance to nursing practice in primary care. A large proportion of the work of the district nurses can be taken up with the care of the dying patient. The dying, or terminally ill patient typically has a psychological profile that is quite different to the â€Å"average† patient. This was explored in the fascinating and very well written paper by The (The et al. 2000) who considered the elements of denial and cognitive distortion exhibited by a patient when being given news that they do not want to hear. The diversity of psychology shown by these patients is virtually unique to this group and a firm grasp of the essential elements is vital if the district nurse is going to handle the situation both professionally and well. The concept of â€Å"a good death† (Seale C et al. 2003) is one that is frequently cited in the modern literature and a fundamental prerequisite to a good death is that the patient is surr ounded and treated by healthcare professionals who have broad understanding of the psychological issues that are relevant to this spectrum of patient. (Wilkerson, S. A et al. 1996) There are many patients who confront the inevitability of death with a stoical inevitability that makes their management a relatively straightforward matter (Wadensten et al. 2003). The patients that we shall specifically consider in this segment however, are those who have a positive diagnosis of a life threatening condition but employ a number of coping mechanisms so that they do not have to directly confront the possibility of imminent death. These mechanisms can range from false optimism right through to frank and abject denial (Weeks et al 1998). We have already considered some of the ethical implications of autonomy and consent earlier in this essay, but they also are of great relevance in this section. It follows that if a patient is to have any degree of meaningful input into their treatment plans and consideration of the various options that are open to them, they must be both fully aware of, and quite prepared to confront, the implications of the situation that they find themselves in. If they chose to distort some or any of the relevant facts of the case, it equally follows that they cannot make a reasoned and rational decision about the options and choices that they have in front of them. Once again we return to the issue and concept of framing the presentation, the only difference here is that it is generally the patient who deliberately distorts the frame rather than it being distorted or manipulated by the healthcare professionals. This specifically is the issue that The and his colleagues considered in their paper (The et al. 2000). We should start a consideration of this issue however, with a reference to an earlier paper by Jennings (1997) who described the â€Å"emotional roller coaster† experienced by patients who deal with a malignant diagnosis and that this â€Å"evolution of emotional landscapes† can be predicted with a degree of certainty. This can be best examined with a verbatim extract from the The paper which refers to patients with small cell carcinoma of the lung: â€Å"False optimism about recovery is usually developed during the (first) course of chemotherapy and was most prevalent when the cancer could no longer be seen in the x ray pictures. This optimism tended to vanish when the tumour recurred, but it could develop again, though to a lesser extent, during further courses of chemotherapy. Patients gradually found out the facts about their poor prognosis, partly because of physical deterioration and partly through contact with fellow patients who were in a more advanced stage of the illness and were dying. False optimism about recovery was the result an association between doctors activism and patients adherence to the treatment calendar and to the recovery plot, which allowed them not to acknowledge explicitly what they should and could know. The doctor did and did not want to pronounce a death sentence and the patient did and did not want to hear it. Clearly an understanding of the psychology of what colours the patient’s reactions is vital to the district nurse if she is to handle this type of situation both professionally and empathetically. If we take a completely detached and dispassionate consideration of this situation the healthcare professional can say with almost complete certainty, that the patient with a positive diagnosis of small cell carcinoma of the lung is going to die. Statistically we know that over 90% of patients are dead within two years of diagnosis and the overall five year survival figures are nil. (Seale C et al. 2003) The practicality of the situation is therefore that it clearly makes sense to discuss options in terms of treatment, palliation and support as soon as a positive diagnosis is made. In real terms, this is rarely done because healthcare professionals frequently find it difficult to effectively pronounce a â€Å"death sentence† on patients. In this respect the psychology of the situation is as much a reflection of the attitudes and feelings of the healthcare professionals as it is of the patient. On a fictional level one can cite the classic literary example of A J Cronin’s Dr Findlay (Cronin A J 1934) who disagreed with his partner Dr Cameron. Dr Findlay felt strongly that the eponymous Mrs McIver should be told of her hopeless prognosis on the grounds of being completely truthful with the patient and this was against the advice of the older, more experienced partner, Dr Cameron who had been hitherto managing the situation by keeping the lady’s spirits high by telling her how well she was looking at each occasion he had contact with her. Dr Findlay confronts the situation by telling Mrs McIver the truth and within a few days she has died. The relevance of the story is seen at the end where Dr Findlay is depicted talking to the dead lady’s husband and Dr Findlay expresses his shock at the speed at which the old lady died and the husband concludes the episode by observing that: â€Å"She was doing really well until you took away from her the one thing that she had left – and that was hope†. In short, this episode highlights some of the difficulties and dilemmas that are frequently faced by healthcare professionals in general and district nurses in particular. The practicality of the situation could have been handled better with a more thorough understanding of the thought processes and psychological mechanisms employed by Mrs McIver in her last few weeks. One can see the point of view of Dr Findlay who took the view that the lady would not have been in any realistic position to make appropriate arrangements to confront her own death if she had never faced the possibility in the management plan that Dr Cameron had adopted. Dr Findlay’s approach could be argued to have allowed her to consider a number of timely treatment options if the truth was confronted. The fact of the matter was that she chose to actively collude with the optimistic approach of Dr Cameron and she derived strength and the ability to cope from the transparent belief (a cognitive distortion) that her prognosis was not hopeless. Dr Cameron was clearly of the opinion that this was of greater benefit to her than confronting her imminent death. What the story does not tell us (and we can only surmise) is that Dr Cameron, in common with many other real healthcare professionals, also has psychological difficulties in dealing with the subject himself. A number of different mechanisms may be active in this situation. It is possible that, by telling a patient that they are soon to die, it may challenge the notion that medical science can cure everything and that healthcare professionals are infallible (sadly, a still all to common belief). Equally it could be that the healthcare professionals involved do not like to be vicariously reminded of their own mortality and therefore collude willingly with the patient’s false optimism. Others again may take a rational view that â€Å"if the patient wants to know the truth then they will ask, if they don’t want to know then they won’t ask† and thereby actively avoid confronting the situation (Curtis J R. 2000) The The paper examines this issue in considerable depth with a commendable degree of scientific scrutiny. In the words of the paper, the authors suggest that: The problem of patient / doctor collusion does actually require an â€Å"active, patient orientated approach from the doctor†. A practical and novel solution to this problem is suggested in the form of the use of a â€Å"treatment broker† who is defined as: â€Å"a person who is trusted by both patient and doctor and who can help both parties to clarify and communicate their (otherwise implicit) assumptions and expectations†. The’s analysis suggested that the majority of patients in the study did actively want to know if the illness that they had was terminal with over 85% stating that they would wish to be told the truth rather than be given false optimism in an unrealistic fashion. This is contrasted with the finding that, in the study, when a patient was given a terminal diagnosis, the next question was almost invariably a variation of â€Å"what are the chances of a cure?† (Meredith et al 1996). It is also the case that other studies on the psychology of this type of situation have shown that when patients ask about their condition (and this applies not specifically to terminal conditions) they do not want to hear anything other than good news (Costain et al 1999). This argument is extrapolated even further in a study by Leydon and his co-workers (Leydon et al 2000) who provide an excellent qualitative study into patient’s reactions and they cite examples of patients who were interviewed directly after a recorded conversation with a healthcare professional and who overtly denied that they had been given a terminal diagnosis even though this was demonstrably not true. An interesting twist in these discussions of the psychology of the situation is provided by Dean (Dean 2002), who offers a specific insight into the way patients perceive the differences between nurses and other healthcare professionals. He takes the arguments of false optimism and overt denial and examines them further. Again, this paper is specifically concerned with the patient with a terminal diagnosis, and it looked at the differences in the content and tone of the conversations that patients had with both doctors and nurses. A significant finding from this paper was that a patient may choose to overtly collude with the doctor during discussions of â€Å"a cure† but within a very short space of time may choose to talk in a much more open way with a nurse when pretences of a cure are actively dropped. Dean suggests that â€Å"such a dichotomy of approach is not unusual†. He suggests that: Patients may well feel a need for a theatrical faà §ade to bolster their own psychological states as well as to collude with the doctor and indicate that they are remaining positive and confident in the doctor’s ability to try to achieve a cure. And this suggestion is echoed and expanded in the Curtis paper (Curtis 2000) with the observation that, in their more candid moments patients may well wish to get a more â€Å"down to earthâ€Å" response, which they perceive that they will get from the nurse, who they think may not require a faà §ade or even indulge in the sophisticated game play of the doctor. Lynn (Lynn 2001) adds a counter-intuitive note of caution for the nurse with the thought that this situation requires a great deal of careful handling by the nurse, as the psychological mechanism that underlies the nursing approach is that the patient may actually be looking for reassurance and (possibly unexpected) reinforcement of their own false optimism. This is an exemplification of the constant calls in the literature for a holistic and patient centred approach to patient care rather than a blanket approach to this type of clinical problem. The rest of The’s paper is concerned with the psychological theory behind the explanations of just why it is that patients do adopt these defensive positions and just why it is that healthcare professionals frequently collude with them on this issue. It is not particularly relevant to explore this in any further detail as the point is clearly made that a basic understanding of the mechanisms by which patients cope with their adversity and the psychological constructs that are frequently presented in these circumstances is of great importance to the nurse who has to deal with, interpret and empathise with the patient’s particular needs at any given time in their illness trajectory. Nurses are often involved, both overtly and in their everyday work, in the business of Health Promotion. Psychology plays a very important part in the overall success and implementation of health promotion strategies on a both a population and an individual level. The theoretical basis of much recent work in the field of Health Promotion is in the concept of the Attitude-Behaviour theory (A-B theory) (Rise J 2000). This theory suggests that the optimum change in behaviour patterns (at least in the field of health and self-interest) is achieved with the optimum change in attitude (or â€Å"realignment† in the jargon). We opened this essay with a reference to the Theory of Rational Choice. An offshoot of this theory (the Theory of Reasoned Action) modifies the A-B Theory to the extent that it provides a model framework by which one can assess the many divergent processes by which attitudes guide behaviour. The hypothesis states that if people can become highly motivated to make a correct decision and are in a position (because they have been given relevant information), then they are likely to spontaneously engage in a â€Å"deliberate and thoughtful process in deciding how to behave† (Rise J 2000). In the context of Health Education (which was the field that the theories were originally developed in) the theory suggests that if people are given sufficient and persuasive information in relation to their health, then a significant proportion will spontaneously indulge in lifestyle changing activity which can be consistent with healthier living. The significance of these theories is that, if t he nurse has a remit to promote a healthier lifestyle (which is arguably part of a professional remit), she is most likely to have the greatest success in providing significant amounts of information to patients rather than simply dictating to them how they should alter their lifestyle without any significant explanation. This comment effectively brings us full circle to the concept of compliance and conformance as postulated by Marinker. Another issue that has deep seated psychological implications, is the current trend towards teambuilding in primary health care. The ramifications of this concept are huge, and therefore we intend to only discuss the issue by considering a number of the most relevant points. To a large extent, team building overlaps with the concept of multidisciplinary team working. This move has required a redistribution of both power and authority (and thereby a redistribution of responsibility) within the team. (Shortell S M et al. 1998).The psychological implications of this are that if one considers the NHS of more than about twenty years ago its structure was more isolationist and based on individual practice (DHSS 1988). Individual speciality teams and individuals worked in a degree of comparative isolation and this also implied a greater degree of individual responsibility than they have at present. This change has brought about a number of major changes in areas such as ethics and work prac tices which are not particularly relevant to our topic in this essay (and therefore will not be discussed further), and also the psychology of working, which clearly is. The first consideration is the psychology behind the concept of leadership. Leadership is clearly important if one is to have an effective team. In psychological terms styles of leadership can be divided into several categories. The two most prominent being congruent leadership and transformational leadership. A full discus

Bruce Dawe Essay -- Australian Poets Poetry Poems Essays

Bruce Dawe Bruce Dawe is a prominent Australian poet born in 1930, in Geelong. His experiences as a laborer, postman, gardener, and in particular his 9 years as a sergeant in the Royal Australian Air Force, have enabled him to recollect and articulate his memories into a renowned compendium, Sometimes Gladness, which has been described as â€Å"perhaps the most successful book of verse by a contemporary Australian poet†. His anthology contains a variety of poems. The three I will be discussing include The Day that They Shot Santa Claus, The Wholly Innocent, and Homo Suburbiensis, all of which focus on life (or the lack of it) and its ups and downs. The Day That They Shot Santa Claus tells a story through the eyes of a bystander; obviously in central Melbourne (the reference to Bourke St). It elaborates not the death of Santa Claus, but rather the consequences of the event. It tells of extreme sadness after the death of the highly prominent symbol of innocence, happiness and festive spirit, key themes of this verse. The speaker is portrayed very sadly, (yet in a way...

Healthy Food Essay

Many ways to define healthy food. Firstly, healthy food consists of all the essential nutrients that your body needs like proteins, carbohydrates, lipids, calcium, vitamins etc. Secondly, it is hygienic & doesn’t contain any germs that can harm your body. Thirdly, it should include all sorts of eatables like veggies, fruits, meat, dairy, sweets etc in right proportion. In a nutshell, healthy food keeps your body fit & at its top. Less junk and more home-made stuff. Health food is food considered to be beneficial to health in ways that go beyond a normal healthy diet required forhuman nutrition. Because there is no precise, authoritative definition from regulatory agencies such as the U.S. Food and Drug Administration, different dietary practices can be considered healthy depending on context. Foods considered â€Å"healthy† may be natural foods, organic foods, whole foods, and sometimes vegetarian or dietary supplements. Such products are sold in health food stores or i n the health/organic sections of supermarkets. Healthy eating means eating a variety of foods that give you the nutrients you need to maintain your health, feel good, and have energy. These nutrients include protein, carbohydrates, fat, water, vitamins, and minerals. Nutrition is important for everyone. When combined with being physically active and maintaining a healthy weight, eating well is an excellent way to help your body stay strong and healthy. If you have a history of breast cancer or are currently undergoing treatment, eating well is especially important for you. What you eat can affect your immune system, your mood, and your energy level. No food or diet can prevent you from getting breast cancer. While researchers are still studying the effects ofeating unhealthy food on breast cancer and recurrence risk, we do know that being overweight is a risk factor for both first-time and recurrent breast cancer. In this section, you can learn how to eat in a way that keeps your body as healthy as it can be. Read on for information about food groups, nutrients, how to create a healthy eating plan, how to figure out portions, and how enjoy your food without overeating. In this section, you can read about: Understanding Food Groups How Your Body Gets Nutrients From Foods What Happens to Food in Your Body? Designing a Healthy Eating Plan Portion Size Enjoying Your Food

Argumentative Essay Assertive Communication - 1354 Words

Assertive Communication: Part A A On August 25 2017, around 3pm I started to ring my associate teacher for arrangement visits. One of the teacher answered. After introducing myself, what institution I came from, I proceeded to talk about my associate teacher, I questioned her and said â€Å"Can I talk to Katrina?† That moment I felt awkward, start to make apology and end the call, when she said there’s no Katrina here. I supposed to say then Catherine. After checking and re-checking the name. I decided to make a call again, she humbly corrected me and said â€Å"I know you want to talk to Catherine but she’s not your associate teacher and she’s not here†. â€Å"Your associate teacher is Wei† she added. Without hesitation I replied â€Å"okay, no†¦show more content†¦Additionally, the power of my words – volume, tone and intensity is normal and fits into the situation. (Bishop, 2013). In conclusion, it’s okay sometimes to be a passive communicator, but always try to be assertive. Listening skills A. On August 18 2017, I had a one on one conversation with my associate teacher regarding what I have done with my first week at the center. I replied honestly â€Å"So far so good and I am enjoying it,†. I listened to her as she speaks. I used facial expression and gestures in what my AT was saying. She also told me all the things I have done better and other things which I need to improve on. That was a short and casual discussion. At the end of the conversation, I observed things that I didn’t recognize in my first few weeks. B. I used listening skills in this situation, but when the time that I will apply those things, I observed that I heard it incorrectly and find my listening skills unsuccessful. C. I learned in communicating with adults, especially in this kind of situation that we need to be humble and honest with ourselves. D. Keep an open mind as well as for respect, don’t interrupt if someone is speaking. Lastly, listen carefully and try to picture what the speaker is trying to say. E. As I reflect on this situation, what I did was, I tried to apply all the things that I heard, but unfortunately, there some things that I heard incorrectly. For example, if someone is talking about rats and you feelShow MoreRelatedInterpersonal Communication Is An Effective Communicator1624 Words   |  7 PagesVerderber, K, Verderber, R and Berryman-Fink, C. (2010), stated that interpersonal communication is, â€Å"The process through which people create and manage their relationships, exercising mutual responsibility in creating meaning.† (p. 5). To be an effective communicator, it is vital that the person possesses and practices effective interpersonal skills. Over this semester, important interpersonal skills have been developed through a series of six workshops and assessed in two pieces of assessmentRead MoreInterpersonal Communication Is An Effective Communicator1574 Words   |  7 PagesVerderber, K, Verderber, R and Berryman-Fink, C. 2010, stated that interpersona l communication is, â€Å"The process through which people create and manage their relationships, exercising mutual responsibility in creating meaning.† (Pg. 5) To be an effective communicator, it is vital that the person possesses and practices effective interpersonal/communicational skills. Over this semester, important interpersonal skills have been developed through a series of six workshops and assessed in two piecesRead MoreAn Individual s Level Of Emotional Intelligence1524 Words   |  7 Pagesemotions and mental strength. Having emotional intelligence is fundamental to producing healthier, happier, superior performing teachers. This essay will firstly illustrate emotional intelligence and examine the traits, behaviours and emotions that define a healthy, competent teacher. The second part will analyse the effect’s interpersonal communications and intrapersonal self-management has on developing strong professional performance. Finally, it will discuss the te acher’s role in overcoming debilitatingRead MoreThe Japanese Traditional Society Essay1715 Words   |  7 PagesCultures can be differentiated on the basis of the relationship between communication in that culture and the interactants’ depending on the context in which it is presented (Adair et al, 2009). This essay will evaluate USA and Japanese business culture and the resulting behaviours. Using the set of bipolar scales by Hofstede (1993) and Trompenaars and Turners (1998) it will observe to varying degrees how business culture is closely tied to national culture using a set of bipolar scales, while HofstedeRead MoreHow Far Do You Agree Cybercrime Is an Ever Increasing Danger2571 Words   |  11 PagesCommunication Skills Comms 1010 Unit 1: Introduction to communication Communication can be defined as the sharing of meanings. In fact, the word communication is derived from the Latin verb communicare, which means: be in connection with. Communication also belongs to the same family of words as community. In communication, there is a sharing of meanings among persons or other entities. Those meanings may be transmitted through: a linguistic form (through a structured language)Read MoreManagement: Social Responsibility and Page Ref19403 Words   |  78 Pagesformal social institutions. Diff: 3 Page Ref: 36-38 AACSB: Analytic Skills Objective: 2.2 17) Cultures with a high assertiveness rating tend to have people who are timid and shy. Answer: Explanation: A high assertive rating is the opposite of being timid and shy. Assertive people are confrontational and not reluctant to demand what they want. Diff: 2 Page Ref: 37 AACSB: Analytic Skills Objective: 2.2 18) Future orientation is a measure of how successful a society is at delayingRead MoreTop 1 Cause for Project Failure65023 Words   |  261 Pagesare the TOP10 causes of Project failure that Mathew can think of (they are not in any kind of order): #1. Lacking Sponsor s Involvement/Ownership #2. Halo Effect (Wrong Man for the Job) #3. Poor HR Management #4. Poor/Inadequate Project Communications #5. Ignoring Project Stakeholders #6. Absence of Risk Management #7. Scope Creep/Unrealistic Expectations ( scope creep: Frequent and uncontrolled changes in the scope or requirements of a project) #8. Lack of Monitoring of Plan #9. AbsenceRead MoreStephen P. Robbins Timothy A. Judge (2011) Organizational Behaviour 15th Edition New Jersey: Prentice Hall393164 Words   |  1573 PagesPersonality and Values 131 Perception and Individual Decision Making 165 Motivation Concepts 201 Motivation: From Concepts to Applications 239 3 The Group 9 10 11 12 13 14 15 Foundations of Group Behavior 271 Understanding Work Teams 307 Communication 335 Leadership 367 Power and Politics 411 Conflict and Negotiation 445 Foundations of Organization Structure 479 v vi BRIEF CONTENTS 4 The Organization System 16 Organizational Culture 511 17 Human Resource Policies and PracticesRead MoreLibrary Management204752 Words   |  820 Pages117 6—Marketing Information Services . . . . . . . . . . . . . . . . . 118 Marketing—A Strategic Component . . . . . . . . . . Marketing—The Audit . . . . . . . . . . . . . . . . . . . . Marketing—The Value Factor. . . . . . . . . . . . . . . Communication—Promotion as a Basic Element Evaluating—Checks and Balances . . . . . . . . . . . Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 . 122 . 124 . 125 . 127 . 128 SectionRead MoreDeveloping Management Skills404131 Words   |  1617 PagesGaining Power and Influence 279 Motivating Others 323 Managing Conflict 373 PART III GROUP SKILLS 438 8 Empowering and Delegating 439 9 Building Effective Teams and Teamwork 489 10 Leading Positive Change 533 PART IV SPECIFIC COMMUNICATION SKILLS 590 591 Supplement A Making Oral and Written Presentations Supplement B Conducting Interviews 619 Supplement C Conducting Meetings 651 Appendix I Glossary 673 Appendix II References 683 Name Index 705 Subject Index 709 Combined Index

8 Interesting Facts About the Irish American Population

How many facts and figures do you know about the Irish American population? Did you know, for example, that March is Irish-American Heritage Month? If so, you belong to a small group of Americans. Too few people know that there is such a month at all, let alone which month it falls in, according to the American Foundation for Irish Heritage. While a number of events internationally take place in honor of St. Patrick’s Day, celebrating the Irish throughout the month of March has yet to become a routine practice. The American Foundation for Irish Heritage aims to make the cultural heritage month, first celebrated in 1995, as popular as Black History Month or Hispanic Heritage Month. The group even offers tips on how to get the public to take more of an interest in celebrating the month-long observance, such as contacting public radio and television stations, Irish-American organizations and state governors. The foundation already has one agency in its corner; the US Census Bureau. Each year, the bureau acknowledges Irish-American Heritage Month by releasing facts and figures about the Irish population. Irish Ancestry in the US Population Although Oktoberfest is nowhere near as popular as St. Patrick’s Day in the US, more Americans claim to be of German ancestry than any other. Irish is the second most popular ethnicity Americans claim. Nearly 35 million Americans report having Irish heritage, according to the census. That’s seven times the population of Ireland, which is an estimated 4.58 million. Where Irish Americans Live New York is home to the largest percentage of Irish Americans in the country. The state boasts an Irish-American population of 13%. Nationwide, the Irish-American population averages 11.2%. New York City also has the distinction of being host to the first St. Patrick’s Day Parade. It took place on March 17, 1762, and featured Irish soldiers in the English military. In the 5th century, St. Patrick brought Christianity to Ireland, but the day in his honor has now come to be associated with anything Irish-related. Irish Immigrants to America Precisely 144,588 Irish immigrants became naturalized US residents in 2010. Wealth Among Irish Americans Households headed by Irish Americans actually have higher median incomes ($56,363 yearly) than the $50,046 average for US households generally. Not surprisingly, Irish Americans also have lower poverty rates than Americans as a whole. Just 6.9% of households headed by Irish Americans had incomes at the poverty level, while 11.3% of American households generally did. Higher Education Irish Americans are more likely than the US population as a whole to be college graduates. While 33% of Irish Americans 25 or older have at least earned a bachelor’s degree and 92.5 have at least a high school diploma, for Americans generally, the corresponding numbers are only 28.2% and 85.6%, respectively. The Workforce About 41% of Irish Americans work in management, professional and related occupations, the census reports. Next in line are sales and office occupations. Just above 26% of Irish Americans work in that field, followed by 15.7% in service occupations, 9.2% in production, transportation, and material moving occupations, and 7.8% in construction, extraction, maintenance, and repair occupations. Median Age Irish Americans are older than the general US population. According to the 2010 census, the average American is 37.2 years old. The average Irish American is 39.2 years old. The Most Irish President John F. Kennedy broke the glass ceiling in 1961 by becoming the first Irish-American Catholic president. But he wasn’t the president with the most direct ties to Ireland. According to the Christian Science Monitor, Andrew Jackson holds this distinction. Both of his parents were born in Country Antrim, Ireland. They relocated to the United States in 1765, two years before his birth.

The Light Bulb A Luminous Invention - 1341 Words

Light bulbs are an invention that transformed the modern world to what we know it to be today. It was first created by Thomas Edison after countless hours of trial and error. He finally found a combination that worked and lasted for twelve hundred hours. It relied on a bamboo filament and was more efficient after Edison was able to remove more oxygen from the bulb. There are now four main types of light bulbs: incandescent, halogens, fluorescent, and LEDs. Although performing one basic task they all have advantages and disadvantages. Incandescent light bulbs are the oldest and most common type of light bulb. Incandescent bulbs have filament made of Tungsten. Tungsten was chosen to be the filament because it can be made very thin, put under high resistance and has a high melting point. This allows electrons to return to lower energy states and it releases photons that are visible to the human eye. Inside of the light bulb, manufactures have to fill bulb with a combination of nitrogen and argon because they are less reactive than oxygen we breathe (Uva, 2011, p. 1). The light bulb actually works due to electrical current being passed through the filament. The electrons of the filament become excited which causes the filament to get hot and glow creating the light. When the tungsten is heated it sublimates which caused incandescent light bulbs to get darker over time. After being used for a certain amount of time, the tungsten wire becomes thin and breaks. This causes theShow MoreRelatedNick Holonyak And The Invention Of Light Diode ( Led )1384 Words   |  6 PagesNick Holonyak and the Invention of Light Emitting Diode (LED) Introduction Nick Holonyak was born in the United States of America in Zeigler, Illinois on the third of November in 1928. He was the son of the immigrants from the country, which is currently called Ukraine. Holonyak studied electrical engineering at the University of Illinois at Urbana-Champaign, where he attained his Master’s along with his Ph.D. degrees and graduated in 1954 (Holonyak, 1962). He worked at the Bell Telephone LaboratoriesRead MoreThe Effects Of Light Pollution On Humans And The World1307 Words   |  6 Pagesmisdirected, or obtrusive light that is just as large of an issue. This variety of pollution is called light pollution or photo pollution. The effects of light pollution on humans and the world’s various ecosystems are various and need to be realized. Since their initial creation, light bulbs have continuously grown in number and type. Streets are now lined with bright yellow fluorescent, runways are now mapped out with multi-colored bulbs, etc. The utilization of light bulbs has expanded to whereRead MoreEssay about Compact Flourescent Lamp and the Environment3703 Words   |  15 PagesCompact Flourescent Lamp and the Environment Abstract Technological advances have come a long way since the incandescent light bulb. Today, the compact fluorescent lamp (CFL) is the most energy efficient light bulb on the market. In the beginning, consumers had resistance toward the CFL. With governmental support in establishing energy-efficient lighting programs, the CFL have been able to stay in the market and improve throughout the years. Introduction With the advances in technologyRead MoreProsperity and Immigration of United States: Nikola Tesla Essay examples1535 Words   |  7 PagesHis whole life, and the world around him, was about to changed. The young Tesla built and successfully ran a prototype of his induction motor. At first, no one was interested in this invention so he later moved to the New York in 1884, looking for a better chance to show to the world of his groundbreaking invention, and later accepted a job offer from Thomas Edison. While working at Thomas Edison’s headquarters in Manhattan, Tesla amazed and impressed Edison with his inventiveness and thoroughnessRead MoreResearch Paper on Diode2926 Words   |  12 PagesLight Emitting Diodes (LEDs) ELE 432 Assignment # 3 Vijay Kumar Peddinti Light Emitting Diodes Principle Synopsis: To explain the theory and the underlying principle behind the functioning of an LED Brief History: †¢ The first known report of a light-emitting solid-state diode was made in 1907 by the British experimenter H. J. Round. (material.eng.usm.my/stafhome/zainovia/EBB424e/LED1.ppt) †¢ †¢ †¢ †¢ †¢ †¢ In the mid 1920s, Russian Oleg Vladimirovich Losev independently created the first LED, although

Pillsbury a Tale in Management free essay sample

A Revolutionary Tale In Management Written by: Louis Maatiaha Tangiia Pillsbury: A Revolutionary Tale In Management Assignment: Pillsbury Customer Driven Reengineering Date: 28/04/2013 Student Name: Louis Maatiaha Tangiia Student ID: 4594096 Abstract This report discusses the Pillsbury Companys reasons for changing their strategy and assessment of the new strategy using Value Chain Analysis and Activity Based Costing . A brief history of Pillsbury and its old strategy is outlined initially. The discussion then focuses on their new strategic focus with emphasis on the how and why of this change. The performance of Pillsbury is assessed using Value Chain Analysis with an explanation on how Pillsbury leverages primary and supporting activities to decrease cost and add value across the chain. Activity Based Costing analysis is used to gain insight into the cost structure of Pillsburys supply chain. Finally these insights gained from Activity Based Costing analysis will be explored by assessing Pillsburys ability to influence future decision-making. Table of Contents Abstract 1. 0 Introduction 2. 0 New Strategic Focus 3. 0 Pillsbury Leveraging its Activities 3. 1 Primary activity improvements 3. 2 Supporting activity improvements 4. 0 Activity Based Costing Analysis 4. 1 Cost structure of supply chain 4. 2 Influence on future decision-making 5. 0 Conclusion 6. 0 Reference List 7. 0 Appendicies Appendice 1 New Value chain 1. Introduction Founded in 1869 The Pillsbury Company began as a flour milling firm in Minnesota. This company was then bought by Grand Metropolitan (GrandMet) in 1989, a UK-based consumer goods and retail corporation who sought to become a world leader in branded food and drinks businesses. In 1994 Pillsbury North America sector created 50% of GrandMets 1993 sales of 8 billion dollars due to their 75% market share of refrigerated dough. A choice was made by CEO of Pillsbury Paul S Walsh to focus on core businesses, to consolidate the parts of Pillsbury that add value thus from 1991 to 1993 they sold all their flour mills but retained their procurements with long-term supply agreements. These asset sales were the beginning of many changes to come in their activities as they realised the competitive pressures, technology advances and demanding consumer preferences which were taking its toll on The Pillsbury Company achieving a sustainable profit in the future. 2. 0 New Strategic Focus Pillsburys top level managements realised that changes needed to be made if they were to compete in the current competitive environment. Although a 75% share was held on refrigerated dough products the company as a whole was subpar in relation to its competitors. As a result, the new strategy focus would be to work on improving relationships and activities throughout the customer supply chain rather than relying on their strong brands. Thus looking at Appendix A we can see that there is a priority on Research and Development. This is because original ideas were being researched into product mixes and customer preferences but more importantly costs were being allocated using Activity Based Costing (ABC) in order to single out certain product lines and their profitability. Pillsbury realised a competitive advantage by collaborating with their customers and suppliers. With a collaboration in place between Pillsbury and its customers, shelf space and choices of shelves could be negotiated. Since customers are now basing their choices more upon price and eye-line shelving the choice of shelves and the size of shelves are important factors in the selling of Pillsburys product. Realisation of consumers prioritising on pricing made Pillsbury concentrate on their costs within operations, their suppliers and their customers in that decreases of costs in one part will decrease the cost to the consumer. The management tools, Value Chain Analysis (VCA) which is explained in the following text and ABC thus allowed Pillsbury to realise their new Strategic Focus. 3. 0 Pillsbury Leveraging its Activities VCA is a tool used by many organisations to pinpoint ways of adding value or decreasing costs to their products in order to increase their competitiveness. Leveraging the activities identified is the focus of VCA and an understanding of these activities are directly involved with their organisations purpose and product. These activities are considered the primary costs of Pillsbury: Research and Development, Inbound Logistics, Operations, Outbound Logistics and Marketing and Sales. The other activities are those that support the primary activities and indirectly help in the production of an organisations goods namely: Procurement, IT Management, Service amp; HR and Infrastructure. 3. 1 Primary activity improvements Pillsbury understood that to begin their new strategic focus they had to Research. Improvements were made to this activity when they decided to gain competitive advantage by sharing information with their customers. Information sharing has proven to aid consumer preference. This is helpful because different regions may buy different goods compared to another region, so information sharing systems will for example help delivery times and stock shortages. This consumer demand knowledge could help operations in designating batches and prioritising setup times for certain products, decreasing delivery times to customers and making more efficient purchase choices with suppliers. An important aspect of leverage with information sharing is that the Pillsbury customers see the changes in consumer trends, earlier, which will allow a proactive stance in product differentiation, new products and cake recipes. An example of this is the changes in consumer diets towards healthier choices. As stated above, one activity improvement will produce a domino-effect that improves other activities across the chain. A new information system with the customer will decrease delivery times to customers. Inbound Logistics is a primary activity which focuses on Pillsburys suppliers. This supplier relationship also benefits from the competitive advantage of sharing information. The operations activity benefits as well since the batches could be designated to decrease delivery lead time and setups could be decreased to cut costs. An objective of Pillsbury was to achieve a 100% fill rate. However, this can only be achieved by collaboration. With the realisation that Pillsbury-Customer relationships are a competitive advantage, why cant this relationship extend to Pillsburys suppliers? Historically, Pillsbury exerted price pressures and long-term supply agreements on their suppliers to decrease costs. Although this could only work to a certain extent. Thus Pillsbury realised that having more flexible and better ingredient specification would allow them to find better vendors, and the same collaboration with their customers could be used with their suppliers. If an information system existed with suppliers as well, Pillsbury could decrease stock levels of raw materials, understand and realise new opportunities for different ingredients or use this relationship to garner prioritisation for new products from suppliers. This whole information sharing system will induce cost savings for all parties including the consumers. On the other hand operations could more effectively test their products or find cheaper options for packaging. Testing and packaging could be simultaneously done and outsourced, this would decrease costs and could increase quality of outbound products to customers due to specialisation of the outsourced organisation. In addition an important aspect in Pillsburys case is the utilisation of its assets. For example if the operations sector increased the flexibility of its equipment then set ups could be reduced as one set up would be able to cater to multiple products. Additionally, marketing and sales is the most effective activity for swaying consumer demand for Pillsburys products. Whether it be promotions or advertising, Pillsbury tried to eliminate trade spending inefficiencies with the use of promotions. Pillsbury realised that their most profitable products will allow marketing and sales to target and promote the best products. However promotions must consider consumer preferences as well. 3. 2 Supporting activity improvements Supporting activities can be attributed to one or all primary activities. For instance improvements in HR and Services activity would improve all primary activities. The new strategic focus has forged the way for project teams in Pillsbury. These project teams have effectively initiated Reengineering Programs that are the reason Pillsbury made estimations of $100,000,000 in savings. HR activities increased the value of customer relationships by using teams for their diversity. Multi-skilled, multi-functional teams (finance, marketing operations, logistics) were used to communicate with customers, as this type of team could cater to all contingencies made by customers to attain the best deal. These teams could both increase value and cut costs when contracts are made with customers. 4. 0 Activity Based Costing Analysis Pillsbury originally used traditional costing to assess the costs of production. Initially, traditional costing systems attempt to assign cost directly to products, rather than to activities first and then from the activities to product units. The typical cost report gives information on what is spent, but not why it is spent. This general allocation of costs does not work efficiently since Pillsburys products are different, use different machines and take different times to set up. This is why ABC is used to improve the control of overheads by a cost-cause relationship. The system is flexible enough to relate costs to customers, processes, management responsibility and not just products. 4. 1 Cost structure of supply chain In 1991 Pillsbury launched ABC to examine its high cost structure. By studying 20 Plants in the U. S.  they realised that the costs were drastically different at times when the processes were the same for each plant. Pillsbury also noticed the significant amounts of excess capacity at peak periods immediately after crops were harvested. This was most likely due to decreased costs associated with bulk buys and the use of quick freeze equipment. Referring to exhibits 4 and 5 of the Pillsbury case we can see in both instances large discrepancies that could not be associated to just a smaller volume produced by the respective plants. Exhibit 4 shows the drastic differences in finance costs of London and Dayton plant, and a one sided ANFK plant that only incurred F91 type costs. These outliers show a definite issue that could be resolved by moving operations to other plants which will both maximise asset utilisations and definitively decrease costs. Exhibit 5 remarks on the lowest finance cost producing plant Hoopeston, the array of cost versus production volume for several types of beans. There is a high cost outlier Some. Spec. BBQ product that may need to improve its costing to be profitable. The high cost of the product may also relate to inefficiencies in its production as well which could be due to specialised equipment which would increase setup time. The cost hierarchy used would be batch-level costs since the complexity of the product introduces more cost into every set-up and thus the focus would be on decreasing complexity. Pillsbury used this information to begin the closing down of around 6 plants, by figuring what product lines used what cost drivers. These cost drivers showed surprising results, for instance one cake mix product was unprofitable even though it sold in high volumes due to its complexity (Kaplan, 1995). This instance of complexity is governed by the facility-sustaining costs since Pillsbury effectively decreased the number of plants it needed to sustain output. Exhibits 6 and 7 of the Pillsbury case show significant differences from traditional costing to ABC in relation to cake-mixes. ABC more accurately measures the costs each cake mix make revealing that the Caramel Bundt cake-mix was largely understated cost-wise using the traditional costing method. Batch-level unit costing would have been used to understand these costs since these high cost low volume cake-mixes required extra processes to produce them. Some cake-mix products required a hand-insertion process where special ingredients had to be placed. Exhibit 8 corroborate this with correlation to high volume efficiency versus low volume inefficiency in that the change over costs become significant because the product lines of low volume products arent effectively utilised. Exhibits 9 and 10 of the Pillsbury case relate the amounts of store keeping unit (SKU) to volume to all of Pillsburys products. facility-sustaining costing is used here as complaints are being made by customers because those low volume unit products in the previous exhibits tend to have high SKUs which means that by the time consumers receive their product through Pillsburys customers the product is old. SKU is the amount of inventory held of a product and so high SKU means products arent sold quickly. Inventory then runs the risk of becoming obsolete. 4. 2 Influence on future decision-making All of these estimable improvements due to VCA and ABC sparked several reengineering programs. The VCA helped realise deficiencies in the customer supply chain. Pillsbury improved this by partnering up with their vendors and their customers to improve customer demand and cut costs throughout the whole chain. The use of multi-skilled teams were the lynch-pin in servicing these improvements between customer and supplier. Value-adding activities included specialised services for different customers. Higher costs were placed on customers that wanted services like category management, modular pallets for promotions, direct store delivery and other delivery options to give diversity to our customers which in turn increases relations. Decisions were made based on ABC, including the cutting of certain products due to losses made on those products and the stream lining of its operations by closing down plants. Pillsbury also conducts Reengineering: Phase 2 which focussed on getting customers to include ABC in their own calculations of stock. Pillsbury now has a budget target that seems too easy to accomplish. ABC and VCA analysis has decreased the costs of production considerably and have created new avenues of uncharted territory to investigate and improve. For instance as I said above packaging and testing processes have yet to be improved and outsource capabilities maybe available to consolidate even further Pillsburys change from a flour manufacturing company to a consumer-based company. 5. 0 Conclusion Pillsbury changed its ways. The new strategic focus enabled that. This report showcases the ability for different tools to synergise. The VCA realises what activities are inherent in an organisation and is a spring board for cost savings and value added processes. The ABC tool enables these cost savings and value added processes by pinpointing accurately the function of costs and how they relate to not only products, but customers, processes and management responsibility. Without these tools Pillsbury would neither compete effectively nor reply to consumer demand. This is shown when they increased competitive advantage by collaboration throughout the customer supply chain. However we can also see that ABC works more prominently in the operations activities than anywhere else, which is why the barriers for change to ABC was prominent in the marketing and sales activity. Pillsbury effectively brought down the barrier with the use of multi-functional teams. This enabled Pillsbury to be more proactive in all areas whether from Logistics outbound/inbound to research and development, which definitely promoted sustainable profits for Pillsburys future. 6. 0 Reference List Kaplan, R. S. (1995). Pillsbury: Customer Driven Reengineering. HBS Case No. 9-195-144. 7. 0 Appendix Appendix 1 New Value Chain