Title               :            HOW COLOR IN INTERIOR DESIGN AFFECTS PEOPLE’S MOOD

 

 

Table of Contents

Abstract……………………………………………………………………………………………3

1.0 Introduction……………………………………………………………………………………4

2.0 Connection between Color and Mood…………………………………………………………4

3.0 Analysis of Specific Colors used in Interior Design…………………………………………..4

3.1 Bright Colors…………………………………………………………………………………..4

3.2 Lighting Effect…………………………………………………………………………………5

3.3 Analysis of Warm and Cool Colors……………………………………………………………5

4.0 Emotional Impact of Color on Culture, Personality…………………………………………..6

5.0 The Utilization of color in Interior Design……………………………………………………7

6.0 Limitations of the Effect of Color…………………………………………………………….7

7.0 Conclusion…………………………………………………………………………………….8

 

 

Abstract

This paper based on research and practical experience demonstrates that color is an essential part of interior design. This demands that each and every interior designer needs to reasonably use color in order to bring out a desirable mood for every season. In addition, the essay gives an account of instances to investigate different effects produced by different color such as brighter color, cold and warm color. It was found that colors on the red side of the chromatography spectrum include colors, for instance, red, yellow and orange commonly known to be associated with hostility, anger, warmth and comfort whereas colors on the blue side of the spectrum are often connected with calmness and this includes green, purple, and blue. Finally, this essay point to the reminder that color in interior design affects people’s mood therefore every point should be taken to analyze a color while associating it with a desirable mood. It further emphasizes the need for the establishment of the context in which a certain color is suitable because the interpretation of color is affected by how a person was socialized, personal judgment, and culture.

 How Color in Interior Design Affects People’s Mood

1. Introduction

Interior design is a subject of study widely known for its aesthetic value. Even though it also deals with the creation of building designs, color becomes an essential item in the completion of a building or any other construction work. This is because color provides the ultimate decoration that makes an object memorable, desirable not to mention quality and beauty that has long been associated with color (Bleicher, 2005). Artistically, psychologists proved that eyes are more attracted to colors especially the bright colors making it evident that decorations have an impact on people’s moods. Firstly, this paper illustrates the connection between color and mood and then outlines the different effects of color in interior design by using examples and empirical evidences. Finally, concludes with a discussion of the utilization and limitations of the impacts of color. It will attempt to demonstrate that color in interior design definitely affects people’s mood to some extent.

2. Connection between Color and Mood

It is believe that there are millions of colors with each having a distinct wavelength which is important in influencing the human mood. So far, findings made on color psychology are majorly practical observations devoid of scientifically proven statistics. In spite of this realization, interior decorations and its impact on people’s mood has been a hotly contested topic in arts, design and marketing which have taken the center stage in the use of colors. Whitfield & Wiltshire, (2010) support that basing on research and expert opinion; several helpful discoveries have been made with concern to human moods, feelings, emotions and color. Consequently, theories regarding color psychology have shown a connection between interior decorations, mood, feeling and behavior among human beings.

3. Analysis of Specific Colors Used in Interior Decorations
   • Bright colors

Bright colors are commonly used in interior decoration. James (2007) noted that based on interior designs and room decorations, interior designers assumed that yellow color causes anxiety while blue creates a relaxed and calm mood. From the realization that decoration is a powerful tool for communicating feelings and emotions, interior designers have embraced the use of decorations to create psychological reactions. Whereas some colors have been associated change in mood, other colors have been known to increase metabolism, blood pressure and strain in the eyes. In answering the question on the effects of interior decorations on the human moods, interior designers have begun to appreciate the brighter color have the general effect of brightening the mood and that is one reason pink and purple have predominantly been used during parties while black is mainly used to represent a sad mood. Even though there is no scientific evidence to prove how certain colors included in decorative interior designs individually affect the environment and the mood, the conditions created in the human mind as a result of color use makes it worth appreciating the color which is the main ingredient for interior decorations affects both human and animal moods (James, 2007, pp. 45-67).

• Lighting effect

The color of lighting plays a vital role in affecting people’s mood greatly in their lives. Looking at lighting in general, some light colors have been associated with serenity, loyalty or a romantic mood. Bottomley & Doyle (2006) reiterate that when the dinner tables are set for a romantic date the dominant color associated with love is red. Therefore the human mood has unconsciously been made to believe that red decorations create the perfect mood for romance. In addition, taking a closer look at the Valentine’s Day celebrations, most couples in love believe that wearing red is a symbol of their engagement of a fulfilling relationship and partnership. With such a feeling the moods are bound to change and become jovial.

Entertainment venues have cashed in lots of monies owing to the fact that they set a celebration mood in the people. Looking at the lighting system in the clubs and hangout venues, it is noticeable that the interior decorations are varied from one spot to the other but there are certain things that stand out. The loudest of them being lighting. Dimly lit rooms with disco lights create a perfect mood for partying and entertainment. Evidently, people tend to be active in the dark (Whitfield & Wiltshire, 2010). The same principle applies in the night clubs where people’s faces are hidden behind the façade of poor lighting caused by the lighting effect.

3.3 Analysis of warm and cool colors

Colors on the blue side of the spectrum are often connected with calmness and this includes green, purple, and blue (Kemmer, 2006). They are known to cause moods relating to sadness or indifference (De Craen, Roos & Vries, 2006). In another instance, temperature of the color affects the mood in the sense that people in the warm hemispheres have a preference for interior decorations while those in the cold hemisphere prefer warm colors. This is factual because warm colors create the mood for warmth which is psychologically fulfilling. The color red has been associated with poor moods in examination performance among students because students exposed to red interior decorations before exams were identified with negative performance in their examinations.

Based on the theoretic and case analysis, it indicates that different colors contain strong influences on people’s spirit and mind in different ways. Therefore, choosing proper colors for a certain environment is important in establishing visual illusions of the emotions and moods. At the same time, specialists in the field of design may acknowledge the power of colors in changing the mood and attitude of individuals.

• Emotional Impact of color on culture, personality

However, the topic on interior design and their impact on people’s mood have been elusive because not much study has been done to ascertain the functionality of the colors. Maier and Andrew stated that so far there is very little documented empirical and theoretical work ascertaining claims that decorations influence psychological functioning thus determining mood (Elliot & Maier, 2007). This could be attributed to the realization that interior decorations and color preferences are personal and at times rooted in culture or our personality. Citing evidence is the use of white color which is adored by Western countries for representing innocence and purity whereas the same color symbolizes loss and mourning in the Eastern countries.

As people grow up, they constantly associate with some colors more than others and this makes them reserved when selecting colors for interior designs. Whereas some people remember decorations with nostalgia and past memories, cloth designers have often matched and paired some colors for special events and this creates the mood for the attendants to social gatherings. In the long run, the events are made memorable in the minds of the people simply because of the decorations that set in the mood for the big event. According to the director of the color association of the United States, Mr. Leslie Harrington, emphasizes that people interact differently with colors and decorations depending on their past experiences, personal encounter with the color and this is measured with our cultural believes as well as our social lives.

In order to further the belief that interior decorations have an impact on people’s moods at times depends on the personality. A specific example of this is that historical palaces have been famed for being coated with golden artifacts and paintings. Other households used gold to symbolize loyalty therefore its becomes rife that the golden decorations set the mood for superiority among the leaders while creating the sense of servitude in the other people who were made to believe that golden colors set the mood for respect or fear.

5. The utilization of color in interior design

The utilization of color in organizing and improving interior design is a way of motivating the occupants in feeling pleasure while in the place. From week to week, people increasingly are made better use of them. This is because the use of color has been known to recreate places and make them attractive and appealing to the eyes (Shevell & Kingdom, 2008, p. 17). Consequently, the human brain gets used to some decorations and designs to the extent that it becomes hard for some kind of mood to be rekindled in the same setting yet a change of color is appreciated. When the human brain becomes adapted to a certain environment or setting, it becomes increasingly hard to change the mood which slowly reverts to normal or gloomy. It is said that successful architects have embraced the ideals of proper designing planning and construction of buildings basing on natural lighting, general landscape and the interior furnishing of a room are largely dependent on the requirements of the building (Dutton, 2003, p.26). Furthermore, in a statement made by Jeannie Mai, a television host for the Style Network, modern day ladies have embraced the use of decorative therapies that help them in curing mood disorders (O’Connor, 2011).

6. Limitation of effects of color

With the widely utilization of color in interior design, more skeptical account has been emerged. Modern research has identified that color therapies used in mood treatment only last for a short period of time. This means that the color theory only provides a short lived effect on the human mood. The research findings are true but it seems that even though the effect of decorations on a person’s mood might be short lived, it is acknowledgeable that there is a connection between color choice and change in mood (The Seattle Times, 2008). In fact, the limitation of effects of color serves as a marginal important part so that there is no need to be considered it.

7. Conclusion

To sum up, this essay has discussed the fact that color elicits people’s moods, physical feelings and emotions. Reflecting back on psychologists indicate that the human eye perceives colors differently which further influences the person’s mood and it is evident that there is a relationship between colors used in interior design and a person’s mood. As a result, color has proved to play a major role in interior design and it is evident that interior designs have profound effects on human moods but the effects are at times dependent on the situation, personal judgment and culture. Owing to these impacts, it therefore becomes necessary for designers to choose colors that may bring out the desired effect to the immediate occupants or dwellers of the place.

Bibliography

Aslam, M 2006. Are you selling the right color? A cross cultural review of color as a marketing cue. Journal of marketing communications.

Bleicher, S 2005. Contemporary color theory and use. New York: Delmar

Bottomley, P & Doyle, J 2006. The interactive effects of color and products on perceptions of brand logo appropriateness. Marketing Theories.

De Craen, A., Roos, P. &  Leonard De Vries, A 2006. Effect of color of drugs: systematic review of perceived effect of drugs and of their effectiveness. BMJ: clinical research

Diana, W. & Robert, A 2011. Evolutionary perspectives on sport and competition. Applied Evolutionary psychology. Oxford University Press.

Dutton, D 2003. Aesthetics and evolutionary psychology. The Oxford handbook for aesthetics. Oxford University Press.

Elliot, A. & Maier, M 2007. Color and psychological functioning. Current directions in psychological science.

James, S 2007. The mood change Casebook: A Notre Dame Collection. Edition2. Cengage.  United States

Kemmer, S 2006. A rose by any other name. Color naming influences on decision making. Psychology and Marketing Journal

O’Connor, Z 2011. Color psychology and color therapy: Caveat emptor. Color Research and Application.

Shevell, S & Kingdom, F 2008. Color in complex scenes. Annual review of psychology.

Singh, S 2006. Impact of color on marketing. Management decision

The Seattle Times 2008. Blue streetlights believed to prevent suicides, street crime.

Whitfield, T. & Wiltshire, T 2010. Color psychology: A critical review. Genetic, social and general psychology monographs.

Effectiveness of cognitive behavior therapy (CBT) in treating posttraumatic stress disorder (PTSD) diagnosed in adults

 

Abstract

Cognitive behavioral therapy is the most relied upon psychotherapy approach used to treat PTSD.  This literature review’s aim is to analyze the effectiveness of cognitive behavior therapy in treatment of PTSD diagnosed in adults. To achieve this, various studies views about its effectiveness are incorporated.  The review incorporates different research articles in arriving at its conclusion on effectiveness of the therapy and its recommendation to those people with posttraumatic stress disorder.

            Keywords: Cognitive behavior therapy, posttraumatic stress disorder (PTSD), diagnosis

 

Effectiveness of cognitive behavior therapy (CBT) in treating posttraumatic stress disorder (PTSD) diagnosed in adults

Introduction  

Post-traumatic stress disorder (PTSD) is a disorder which normally develops after exposure to a terrifying event or something that possess physical harm or threat (Deise, 2008).  It is not necessary that a person who is harmed develops this trauma. It also affects other people such as loved ones and witnesses that experienced a harm event happen to their beloved ones. PTSD was first brought to the public limelight in the relations to the war veterans.  These veterans experienced horrifying situations in the battlefield and these impacted their life after retiring. Other traumatic situations that cause post traumatic stress disorder includes rape, mugging, being kidnapped, torture, child abuse,  being held captive , car accidents, bombings, train wrecks, natural disasters such as earthquakes and floods among others (Kindt et al (2007).

Discussion

According to Deise (2008), PTSD is an anxiety disorder caused by exposure to traumatic events.  After exposure to such events, a patient relives the traumatic event by always avoiding situations associated with trauma and hypersarousal.  It is estimated that PTSD affects 5% of men and 10% of women in United Sates with a lifetime prevalence of 7.8% (Deise, 2008). Most of the people faced with trauma and commonly associated with PTSD are military combats and females abused by sexual abuse. Cognitive behavioral therapy (CBT) is the major psychotherapy approach used to manage PTSD (Deise, 2008).  This approaches are subdivided into various groups which includes; cognitive techniques such as cognitive restructuring, behavioral approaches or techniques used include prolonged exposure therapy. Others include those based on Lang’s emotional processing and systematic desensitization.  Other modalities include psychodynamic psychotherapy, group CBTT, eye movement desentization, reprocessing and social skills training, and relaxation techniques (Brown-Bowers et al., 2012). In cognitive restructuring, techniques, it involves identifying and modifying distorted interpretations and beliefs in relation to a traumatic events exposed and the reduction of future traumatic symptoms. On the other hand, exposure techniques evoke traumatic memories by real exposures or imagery by triggering fear to reduce symptoms through habituation processing and emotional affective information (Brown-Bowers et al., 2012).

Even though these modalities are effective, CBT, exposure therapy and cognitive therapy are effective compared to supportive techniques when it comes to treatment of PTSD. Furthermore, when it comes to promoting diagnostic remission CBT is more effective compared to EMDR (Deise, 2008).

One of the causes of trauma is the terrorists’ attacks. The bombing that happened in London on July 7, 2005 affected many of the victims (Naomi et al., 2012).   Trauma focused cognitive behavioral therapy was provided to the survivors that had developed posttraumatic stress disorder. This therapy is important to help the survivors to come to the senses of what happened. They have to approach the experience in a positive way and accept that life was not going to be the same again (Naomi et al., 2012). Therefore, this therapy was important in encouraging and changing their cognitive or thoughts about the perpetrators and how their lives had changed. Such incidences cause trauma and stress.  For instance, in this study screening and treatment was done on 18 patients that directly experienced the attack and they indicated that it impacted on their lives on the day following the bombing (Naomi et al., 2012). They experienced shock, horror, disorientation, reorientation and reconnecting with the outside world and suffered posttraumatic stress and depression. Consequently, this therapy helped to identify how the patients felt and provide ways to recover from PTSD. The participants felt isolated from those who were not affected by the bombing. This was therefore a burden they were carrying in their hearts.

According to Kindt et al (2007), the prognosis on trauma victims varies in intensity and type of trauma. Different people exposed to these traumas usually develop PTSD. Most of people report PTSD shortly after the experience of the trauma and few of the victims show persistent experience that develops to chronic. Nevertheless, people deal with these symptoms in a different way. Kindt et al. (2007) conquer that indeed cognitive behavioral treatment is highly effective psychotherapy in treating PTSD.  However, they hold the view that mechanisms of change have not fully been understood and this deters its effectiveness. Trauma before and after CBT for PTSD can be treated by imaginal exposure combined with re scripting. This approach requires inductiont of new perspectives on the related occurrences or happenings by experiencing new emotions and views. Therefore, in ensuring effectiveness of this psychotherapy treatment method, changes in or increase in process and conceptual processing helps to predict treatment outcome. In treatment of PTSD, imaginal reliving during CBT is not effective in reducing symptoms but helps in promoting conceptual processing which helps in the prediction of better treatment outcomes (Naomi et al., 2012).

Posttraumatic stress disorder is debilitating mental health condition that is associated with psychiatric co morbidity and diminished quality of life and afterwards a chronic and lifelong course (Britt et al 2009).  In a study carried out on patients through online, there was a significant reduction in PTSD among various patients involved in the study. These findings therefore indicate that indeed this is an effective and reliable method. According to Britt et al (2009), enough evidence is available to show that cognitive behaviour therapy is a safe and effective treatment for PTSD. The therapy has further been found to be efficacious across a wide range of trauma groups in treatment of PTSD.  CBT involves psycho education, cognitive and exposure therapy, anxiety management and elapse prevention. Treatment of these disorders ranges between 9 to 12 weeks, which takes around 60 to 90 minutes every week and is normally conducted face to face (Harvey et al., 2003).

Most of the problems that are experienced in the treatment of these mental problems in rural and regional areas are lack of accessibility as there are no enough professionals to provide good care to such individuals (Britt et al., 2009). Another challenge is cost. Many of the victims may not be in a position to access to these services and therefore, they cannot be able to get assistance to recover from their conditions. The cost is usually higher if the services are to be provided face to face.  Furthermore, a large number of people fail to seek for medical attention because of stigma associated with mental illness. This therefore, makes it hard to apply CBT to help them cope up or recover from their PTSD. Therefore, to ensure that such patients are able to access to these therapies without feeling stigmatized or due to accessibility and costs, using internet is the best alternative to ensure that they are able to be assisted to manage their health situations.

According to Katherine et al. (2011), intimate partner violence (IPV) is one of the serious and most public health problems that face most of women in the United States. Women who develop symptoms of PTSD and depression are at higher risks of causing intimate partner violence victimization. This   problem can be effectively managed through cognitive behavioral therapy. According to Katherine et al. (2011), CBT is effective in reducing future IPV symptoms but there is limited researches that have been conducted in this area. In their findings, they established that it is appropriate to treat PTSD and depressive symptoms and interpersonal traumas survivors to reduce the risk of future intimate partner violence.

Pre-treatment intimate relationships are important in managing PTSD. Most veterans with PTSD can be treated using CBT to help them recover from their traumatic conditions. According to Candice, Rodgriguez & Warner (2011), interpersonal relationships are important in the development, maintenance and possibly amelioration of PTSD. In predicting the development of PTSD, social support has been very instrumental hence; enough prove of its effective in helping patients with PTSD. Most of the people that have been found to suffer from PTSD suffer from myriad of intimate relationships problems, are likely to engage in divorce, and experience diminished relationship and intimacy satisfaction, even though, there has been insufficient investigation of how they are associated with PTSD treatment outcomes (Candice, Rodgriguez & Warner, 2011). The only method or approach established as highly efficacious in treating PTSD is cognitive behavioral therapy. When compared to drug treatments and other   control conditions, CBT has been established to be the treatment choice.  The treatment interventions of Class of CBT are categorized into various interventions, that are trauma focused such as cognitive processing therapy and prolonged exposure.  Adoption of these techniques in treatment of various cases resulting to PTSD such has sexual and non sexual assault, civilians with mixed trauma and combat veterans has shown reduction in PTSD symptoms. Hence, this demonstrates effectiveness of the techniques. However, some studies that have compared CBT with other forms have found noticeable differences in the outcomes indicating that indeed some techniques are more effective than others are.

Some of the authors have expressed concerns about generalability of results from efficacy studies and therefore recommend implementation of cognitive behavioral therapies interventions with trauma survivors in real world practice (Candice, Rodgriguez & Warner, 2011). Some have therefore questioned the tolerability and safety of trauma focused CBT to some patients as some have possibility of resulting to negative outcomes such as symptom worsening, drop –outs and substance abuse, self-medication with alcohol and substance abuse and behaviour dysfunction among many others. Such findings should be taken with the seriousness it deserves and measures put in place to ensure further studies on CBT with PTSD cover a wider scope and focus on patient characteristics associated with treatment outcome. This will help in enhancing the level of effectiveness and efficiency when using cognitive behavioral therapies.

According to Khoo, Dent & Tian (2011), the cases of PTSD in Australia have been higher in relations to the military deployment in Iraq, Afghanistan, East Timor, Egypt, Solomon Islands, Middle East and Sudan. Furthermore, many of the people in Australia are still recovering from the trauma caused to them through devastating bush fires, cyclones, flooding, and earthquakes. These incidences affect the mental component of people causing them to suffer from PTSD.  In their study, Khoo, Dent & Tian (2011), established improvement in the PTSD among the participants. The study indicated that indeed CBT concepts established by efficient research could be used in clinical settings to help in the treatment of these disorders. Using CBT produced positive results as it enhanced the quality of life and caused improvement in the life of an individual. For instance, in this study, it was revealed that CBT impacted greatly on symptom as   positive changes occurred within the first 3 months of therapy. Furthermore, it was found out that 60% of the patients were able to respond positively in a clinically significant way.  Therefore this information is enough to illustrate and support the effectiveness of using Cognitive behavioral therapies in helping to treat PTSD.

According to Vanessa, Deborah & Sue (2011) reliving even though is an integral part  of trauma focused cognitive behavioral therapy and  recommended treatment for post traumatic stress disorder (PTSD) with evidence base supporting its use, most of the clinicians are reluctant to employ it in their therapy . There are various reason advanced that make many of them reluctant to use this kind of therapy such as instilling fear. In relieving, patients are required to relieve their thoughts in their minds including feelings, thoughts, and images as they describe their experiences in the present tense (Vanessa, Deborah & Sue, 2011). Relieving is aimed to serve three major purposes which include facilitating recovery for PTSD through elaboration and contextualizing of the trauma memory, identification and discussion of hotspots to access any appraisals made and to test beliefs of what might happen when thinking about trauma (Vanessa, Deborah & Sue, 2011).

Most of the participants even though experience ambivalence and fear in expressing or remembering their experiences, at the end they found it helpful. They express that it gives them hope and revive their lives and would therefore recommend other people to the same (Vanessa, Deborah & Sue, 2011).  They found it necessary and more appropriate in reducing their PTSD. This finding were consistent with the findings treatments trial for trauma focused CBT. To ensure that this become effective participating need to trust the therapists to ensure that the process becomes effective (Vanessa, Deborah & Sue, 2011). It is therefore important for the therapists to help patients to overcome their fear of relieving by demonstrating confidence in the communication process to show that clinicians own concerns about relieving could hinder the engagement.  Therefore, there is supposed to be openness, honesty, genuineness, in the therapeutic relationships.

Cognitive behaviour therapies are mostly used in the treatment of PTSD among veterans.  Cognitive behavioral therapies have also been found to have a cost benefits compared to other   methods of treating PTSD (Meyers et al., 2013).  In a study at Midwestern VA medical center it was established that utilization of services and costs data to review revealed that there was decreased individual and group psychotherapy.  The direct costs associated with provision of health care were found to have decreased by 39.4% (Meyers et al., 2013).  This therefore shows that this technique apart from its effectiveness is also affordable and can be adopted in various facilities to help promote positive living.

CBT has also been found effective is helping to treat patients with insomnia and PTSD. Insomnia is one of the commonest symptoms that PTSD patients exhibit. This condition is found in around 70% of individuals suffering for PTSD (Baddeley & Gros, 2013). After successful evidence based treatment of PTSD, insomnia still poses a challenge in around half of the cases. It is therefore poses a challenge if it is not well handled. When dealing with patients affected  by  Insomnia and at the same time PTSD cognitive behavioral therapy for insomnia is usually used as a first step treatment. It helps to provide insomnia symptom relief, as psycho education and self-monitoring of PTSD Symptoms allows the client to proceed to exposure therapy.  Studies have found out that CBT is effective and essential in reducing such symptoms such as insomnia and PTSD while at the same time facilitating entry to exposure therapy for PTSD.

Counselors can play cognitive behavioral therapy to provide treatments to patients with PTSD (Makinson & Young, 2012).  CBT treatment strategies incorporate the use of higher order thought process as it directs the attention of a client in a deliberate manner. This technique aims to correct problematic thought patterns and behaviors of the clients. CBT techniques are effective in ameliorating neurological challenges in PTSD. This technique is effective in helping re-wire the brain and help individuals manage their PTSD (Makinson & Young, 2012).  The moment symptoms of PTSD become apparent, neurons in the amygdale forms strong interconnections function in such a way that facilitates evoking of memories that trigger stimuli (Makinson & Young, 2012). The moment the connections are made, they are permanent and have the capacity to last for life long. This therefore allows or promotes diminished expression of learned fear helping in the recovery of a client. However, for this technique to be effective, it is recommended that the counselor know when and how much to stimulate their clients during any treatment plans.  Stimulation is important because it build resilience about future life stressors and promotes recovery from various illness related to psychiatric.

According to Brown-Bowers et al (2012), cognitive behavioral can be used as conjoint therapy for posttraumatic stress disorder in improving PTSD symptom and in enhancing the intimate relationship adjustment. In order to ensure that the therapy functions and results to positive results, there are various stages or rather phases required to be followed. Phase 1 includes psycho education on the reciprocal influences of PTSD symptoms and relationship functioning, conflict management skills, and exercises to promote positive effect and behaviour.  In the second phase, these behavioral methods address avoidance and emotional numbing and in increasing relationship satisfaction.  Consequently, it allows people and even couples in this situation to approach various issues without fear. It is therefore, important in ensuring that this disorders or trauma is approached positively aiding in their resolution. The third phase focuses on specific trauma appraisals and on cognitions of PTSD and relationship problems.

Conclusion

In conclusion, cognitive behavioral therapy is one of the effective therapies that used to provide solutions to clients with PTSD. There are various approaches to these techniques, which help to reduce PTSD symptoms and studies have found out their level of effectiveness in reducing these symptoms. One of the reasons that demonstrate its effectiveness is that it have helped many persons especially veterans military personnel to recover from their PTSD and lead positive lives. The traumatic events these officer are exposed to affect them mentally and therefore, through these techniques, many of them have managed to deal with the disorders in a positive way. Its effectiveness has also been experienced in other traumatic cases such as rape, natural disasters victims among many others.

References

Baddeley, J., & Gros, D. (2013).  Cognitive Behavioral Therapy for Insomnia as a Preparatory      Treatment for Exposure Therapy for Posttraumatic Stress Disorder, American Journal of Psychotherapy, 67(2): 203-214.

Britt, K et al. (2009). A Therapist-Assisted Internet-Based CBT Intervention for Posttraumatic    Stress Disorder: Preliminary Results, Cognitive Behaviour Therapy,  38,(2): 121–131.

Brown-Bowers, A. et al. (2012). Cognitive-Behavioral Conjoint Therapy for Posttraumatic Stress             Disorder: Application to a Couple’s Shared Traumatic Experience, Journal of Clinical            Psychology, 68(5): 536-547

Candice, M., Rodgriguez, B., & Warner, R. (2011). Cognitive-Behavioral Therapy for PTSD in    the Real World: Do Interpersonal Relationships Make a Real Difference?, Journal of           clinical psychology, 61(6): 751-761.

Deise, D et al. (2008). A systematic review on the effectiveness of cognitive behavioral therapy    for posttraumatic stress disorder, Baywood Publishing Co., Inc.

Harvey, A., Bryant, R., & Tarrier, N. (2003). CBT for PTSD. Clinical Psychology Review, 23,     501–522.

Makinson, R., & Young, J. (2012). Cognitive Behavioral Therapy and the Treatment of     Posttraumatic Stress Disorder: Where Counseling and Neuroscience Meet, Journal of      Counseling & Development, 9(9):131-140

Meyers, L. et al. (2013). Service Utilization Following Participation in Cognitive Processing          Therapy or Prolonged Exposure Therapy for Post-Traumatic Stress Disorder,  Military Medicine, 178(1): 95-99

Katherine, M et al. (2011). Cognitive–Behavioral Therapy for PTSD and Depression Symptoms   Reduces Risk for Future Intimate Partner Violence Among Interpersonal Trauma       Survivors Journal of Consulting and Clinical Psychology, 79(2): 193–202

Khoo,  A., Dent, M., & Tian, P. (2011). Group cognitive behaviour therapy for military service-    related post-traumatic stress disorder: effectiveness, sustainability and repeatability,      Australian and New Zealand Journal of Psychiatry, 45:663 –672

Kindt, M. et al.  (2007). Perceptual and conceptual processing as predictors of treatment outcome            in PTSD, J. Behav. Ther. & Exp. Psychiat. 38 (2007) 491–506

Naomi, W. et al.  (2012). Survivors of the London Bombings With PTSD: A Qualitative Study of            Their Accounts During CBT Treatment Traumatolgy, 18:1-11.

Vanessa, S., Deborah, L., & Sue, C. (011). How do clients experience reliving as part of trauma-  focused cognitive behavioural therapy for posttraumatic stress disorder?, Psychology and       Psychotherapy: Theory, Research and Practice, 84, 458–472.

 

Healthcare Costs: Healthcare Insurance in the United States

Three Main Parts of Health Insurance in the U.S and the Solvency and Longevity of each

Health insurance plays a core role in the US healthcare system and determines the ability of consumers to access care. Three main parts of healthcare insurance are public insurance (Medicaid, Medicare and other public), employment-based, and private Non-group plans (Kumar, Ghildayal, & Shah, 2011). Employers may either self-insure their employees or offer insurance plans to employees through a contracted insurance company. According to an analysis of a 2009 Current Population Survey, Austin and Hungerford (2009) reported that employment-based insurance covers most of the US population aged below 65 years, whereas public (Medicare option) covers the majority of those aged 65+ years (p. 16). Private non-group plays a minor role in the under 65 population (5.1 % for under 19 and 6.3 % for under 65; both below the uninsured in both populations), but a comparatively larger role in the 65+ population (above the uninsured in this population) (Austin & Hungerford, 2009, p. 16). The employer-based option offers various advantages over other forms, for example allowing negotiation for better prices from providers, or insurance intermediaries, and offering tax benefits for covered employers (Austin & Hungerford, 2009). Further, the ability of employers to pass-on the insurance burden to employees through a reduced compensation (Austin & Hungerford, 2009, p. 16), offers employers a motivation to support such insurance arrangement. Such a structure makes this form the most solvent type of insurance due to the incentives that promote continued payment of premiums. However, findings that employers avail such insurance only to long-term core employees but not to peripheral, short-term employees (Farber & Levy, 1998; SHADAC & Robert Wood Johnson Foundation, 2013) threatens the longevity of such insurance plans as jobs become defined on short-term contract periods in contemporary world. Unlike the employer-sponsored structure, public sponsored insurance has benefit of the backing by public finances, but a disadvantage in that expenditures towards the insurance plans are determined by the political regime (Kumar, Ghildayal, & Shah, 2011). As such, change in ruling government may affect the longevity of such insurance plans. The disadvantages of the private non-group insurance include limited ability to negotiate better prices from providers or insurance intermediaries and low population coverage (Austin & Hungerford, 2009). Such disadvantages challenge the solvency and longevity of such plans, since, in the case of individuals, they depend only on high-income individuals, necessitating the private companies to enter into contractual arrangements with employers, unions or groups to enhance their profits.

Does Private Health Insurance Violate Standard Principles of Insurance?

Private health insurance, in its current state, violates the standard principles of insurance. Insurance principles demand that premiums be pegged to assessment of individual risk and adoption of strategies that dissuade the prevalence of moral hazard. In such a model, the insurance premise is that individuals have a free choice and their taking of insurance is determined by ability to pay. The basis of private health insurance was on such a premise where healthcare access was argued to be based on ability to pay and free choice (Dror, 2000). In such a way, market forces and consideration of inherent risk, which would demand insurance providers to adjust their rates according to the risk structure, would dictate the premium amounts paid for insurance providers to remain competitive. Subsequently, however, private insurance has departed from such a premise, where, for example, legislation brought about by adoption of and attempts to maintain a four-party model (Kroncke & White, 2009), have prevented a voluntary enrollment to the private insurance. For instance, government mandates for employers to pay insurance for employees, and employees demand for quality care than offered via government’s social insurance programs (Kroncke & White, 2009), has implied that private healthcare insurance has deviated from a free-choice model. Such legislation and other initiatives that encourage employers and groups to sign up to healthcare insurance has also diverted the private insurance from the “ability to pay” model (Kroncke & White, 2009). As a consequence, the private healthcare insurance industry has become integrated into a model that, instead of encouraging variance of healthcare costs in line with income trends, has led to the astronomical increment in the provision of healthcare in the US.

Evolution of the Promotion of Health and Disease Prevention in the U.S

The evolution of health care promotion in the US is traced to the development of the hospitals, initially as charitable organizations that were based on the moral responsibility of physicians as envisaged in Hippocratic Oath.  Not until well into the twentieth century, hospitals were regarded as institutions of last resort; members of the family were the principal caregivers to their ill loved ones then (Kroncke & White, 2009). However, spurred by urbanization and increase in scientific medicine, in the 1920s, hospital care became a high-demanded service in society (Kroncke & White, 2009). However, it was with the advent of Blue Cross policies shortly afterwards, that a great impact in the healthcare system started. The Blue Cross policies provided an assurance for healthcare providers to get paid for services rendered, irrespective of achievement of cure or financial status of the client (Kroncke & White, 2009). As such, the providers had the incentive to promote healthcare services. Subsequently, the morphing of such Blue Cross policies into successful non-profit insurance entities attracted commercial insurers to the healthcare industry. The entry of for-profit entities proved another turning point of the health industry where complex relationships among the patient, employers, providers of care and payers (e.g. employers) arose (Kroncke & White, 2009). Such multiple players have occasioned the increase in the cost of health care, and reversed the mode of provision of care in a way that has proved difficult to change.

 

References

Dror, D. M. (2000). Reforming health insurance: A question of principles? International Social Security Review, 53(2), 75-99.

Farber, H.S., & Levy, H. (1998). Recent trends in employer-sponsored health insurance coverage: Are bad jobs getting worse? NBER Working Paper Series, no. 6709. Retrieved from http://www.nber.org/papers/w6709

Kroncke, C., & White, R. F. (2009). The modern health care maze: Development and effects of the four-party system. Independent Review, 14(1), 45-70.

Kumar, S., Ghildayal, N. S., & Shah, R. N. (2011). Examining quality and efficiency of the US healthcare system. International Journal of Healthcare Quality Assurance, 24(5), 366-388. DOI:10.1108/09526861111139197

State Health Access Data Assistance Center (SHADAC) & Robert Wood Johnson Foundation. (2013). State-level trends in employer-sponsored health insurance: A state-by-state analysis. ESI Report April 2013, Retrieved from http://www.rwjf.org/content/dam/farm/reports/reports/2013/rwjf405434

Leadership

Introduction

British Petroleum (BP) has experienced several accidents in history including the recent Gulf of Mexico oil spill. Findings from a series of internal investigations reveal that the company has continuously disregarded safety and environmental rules, posing a serious risk to increased accidents in the future. Issues that dwell in BP include disregarded safety and emergency procedures, falsifying of safety and inspection reports, inadequate maintenance and inspection programs to save on production costs, intimidating workers who are concerned about occupational safety standards, and few workers and insufficient storage devices encouraging spills. Despite the continuous reassurance by BP’s management that actions are being undertaken place to curb the safety issues at the company, there seems to be little commitment at correcting the underlying causes. Certainly, these problems stem from the leadership and organizational culture of BP.

This paper gives a critical reflection of leadership issues at BP basing on the account of the company’s Gulf of Mexico Oil Spill which resulted from failure of safety/ emergency systems and ultimate explosion of the Deepwater Horizon rig, killing 11 workers, destroying the plant, and the incessant environmental impact. First, moral accountability from the perspectives of various stakeholders of BP are given. Second; a highlight of major leadership issues of vital importance for BP’s future. Third; a coach’s critical assessment of leadership and how senior BP managers can change practices to respond to public critiques of their actions in the Gulf Spill.

Moral accountability issues

A BP rig operator on a platform other than that which exploded will have concerns about his safety at work, work security especially if rigs keep exploding and more workers get laid off to reduce costs, or intimidate them from speaking about low system inspection and waning technical standards at BP.  The Deepwater Horizon rig exploded because the emergency systems put in place to prevent accidents failed to work (Boxell & Crooks 2010: 1).  This is demoralizing and will impact his decision on whether to continue working at BP. The moral implication is that organizations have to protect their workers by ensuring that they work in a safe environment.

Concerns for a 25-year-old postgraduate university student from a township on the Gulf of Mexico that majored in chemical engineering are whether BP is the right company for him to develop his career in regards to getting better training and career development, a competitive remuneration package, and job security. The postgraduate would also be concerned about working for an oil company with a high company profile and rank globally, and which shows social responsibility by protecting the environment in which it operates. One of the moral accountability issues facing BP is that the company placed fairly inexperienced workers in a high-risk operation as no one in the engineering team had been on the job for more than six months when the Deepwater Horizon rig exploded (Brady 2012: Para 6). The reason was mostly to cut on the high costs required for training recruited in-house workers or outsourcing the operation (Boxell & Crooks 2010: 2). BP’s profile is tarnished in relation to its history of accidents and poor public relations to restore the image of the company. With various catastrophes that have occurred at BP, it seems reasonable to the company to reduce costs in various areas including salary packages offered to its skilled workers (Boxell & Crooks 2010: 2) which is definitely unattractive to the chemical engineering postgraduate student. The postgraduate may also not wish to work for a firm that is destroying his township as BP has persistently been attacked for its role in environmental degradation in the Gulf of Mexico (Chief Counsel 2011).

A UK based retiree with a major income stream from BP shares will have concerns about his financial and social security especially from the plummeting values of shares and options following the unending catastrophes. After all, the employees at BP reinforce their low remuneration with investments in the company’s shares (Boxell & Crooks 2010: 2). The low value of shares will directly lead to low-value retirement earnings as BP’s deteriorating profile leads to a fall of value in its shares, as well as cost-cutting procedures being put in place with the money used in recovering from catastrophes and settling lawsuits.

Leadership issues

There are various leadership issues of vital importance for BP to consider in the future.

First, the issue of dysfunctional corporate culture stands out at BP. Past leadership based on values of ambition and a vision which targeted saving dollars at the expense of safety and technical competence have been blamed for past events (Boxell & Crooks 2010: 3). The new leadership under Hayward promised detail and operational excellence with a focus on safety through introducing the Operating Management System but history repeated itself, with yet another spill. Hayward reverted to a focus on financial performance by slashing costs, proving that the influence of past corporate culture persists (Blackden 2013). BP needs to attract hire and retain the best human resource team that aligns with its culture by establishing great staff morale through organizational learning, training and development, and coordinating with schools to start early career programs for trainees to get acquainted with company’s culture and fit their roles effectively.

Second implementation of occupational standards and safety programs is required. Workers are losing lives in the accidents by working in high risk environments where some mandatory safety procedure are skipped,  to save on costs, or having dysfunctional systems that fail to respond to emergency situations. To retain its reputation and choice of working environment, BP would benefit from a leadership that implements policies concerning work safety.

Third, BP needs to extend leadership in social responsibility and engage in effective public relations and communication in order to have a valued corporate image in the future and also to eliminate any perceived fears of work security.  A lot of anger was directed at the management for not handling the Gulf Spill appropriately. The media continuously reported of negligence by the leaders to put up safety measures (Blackden 2013). Yet inside BP, workers feel that there is discrepancy in communication with the public and media, and what is really happening as the technical team is putting a lot of effort to make things right.

Leadership Theories

As a coach to senior BP managers, there are a lot of changes to be made on their practices in order to demonstrate a sense of moral accountability as leaders and be in a better position to handle public critiques of their actions in the Gulf Spill. According to Yukl (2010: 96) the nature of managerial work revolves around four primary processes namely decision-making, exchanging information, influencing, and developing and maintaining relationships. Mintzberg (1973: 94) describes the managerial role as one on a leader, figurehead, spokesperson, liaison, disseminator, and monitor, all of which are necessary for BP managers in handling public critiques after crises similar to that of the Gulf Spill. Managers’ leadership styles and behaviors can directly and indirectly impact on operations at the organization. As a liaison, the leader is able to maintain a self-developed outsider network that provide favors and information which can be used to the advantage of the interpersonal and organizational relations (Yukl 2010: 84). In the situation of the Gulf Spill, a manager who is a liaison would have adequate information that will help him or her shape his information in response to public critique to their favor.

Regarding the incident of the Gulf Spill that occurred, some personality traits that could be cultivated to respond well to the issue include conscientiousness, agreeableness, adjustment, and intellectance (Yukl 2010: 61). These together with surgency have been described as the big five personality traits that can be used as approaches to leadership (Yukl 2010: 61). Through conscientiousness, senior managers need to have inherent or acquired qualities of personal integrity and dependability, such that people can see that the spill was not as a result of a moral implication issue, and that the leader can be depended upon to fix the problem. Agreeableness enables the leader to offer nurturance and instead of distancing himself from the problem, he can offer a sympathetic/helpful hand, for example, to families, and friends of the demised 11 workers. Adjustment is needed to give the perception of emotional stability, self-esteem, and self-control, especially during the catastrophic incident that crushed the spirits of many people. If a leader appears emotionally misplaced, he will not be in position to encourage other people that things will be alright. Intellectance, from the Gulf Spill is necessary as a way to having a learning orientation. Many accidents have occurred in BP of which all of them are based on almost similar causes. An appropriate leader should develop an inquisitive mind as to why this is so, and help his organization learn what needs to be done in order to bring about a change (Yukl 2010: 61).

BP deals with oil and a key concern for such companies is safety, which can be integrated through leadership behaviors.  One ideal integrative approach to leadership for safety is transformational leadership. Transformational leadership focuses on leadership with aspects such as inspiring, acting as a role model, and motivating employees to work safely (Barling et al, 2002: 489). Transformational leadership can promote a number of safety outcomes such as cultivate perceptions of a positive safe climate, while enhancing higher levels of employee participation in safety activities, and compliance with general safety citizenship behaviors.  The BP managers need to use proactive influence tactics (Yukl 2010: 202) to showcase a visible commitment to safety, for example, by prioritizing safety and allocating required resources, as well as actively becoming involved in health and safety activities in the company. Transformational leadership also involves encouraging the workers to have a voice and asking them to voice their safety concerns, or give suggestions to improve safety in the workplace (Barling et al, 2002: 489). A transformational leader does not intimidate the employees through threats of sacking or other forms of punishment when they air out concerns about safety.

Transformational leadership is also possible when a manager has a source of personal power referred to as charismatic power (Yukl 2010: 202). By a person’s own qualities, he or she is able to control social relations in a way that others will agree to decisions or take actions in their favor. This is a great quality that can be used in BP, for example, in re-instilling confidence among the employees that issues will be solved soon. If used well, for example, through impression management tactics, the charismatic quality can dispel unfounded fears and help the employees strive for a good company image together rather than fight against the organization and its leaders in the press.

Another needed integrative approach to leadership at BP is ethical leadership theory.  BP and other companies in the oil industry always face myriad environmental concerns from the public due to the nature of their operations. Oil companies face environmental, health and safety, liability risks which ultimately leads to reputational risk which is basic to the organization’s long-term success (Spence 2011:59). The public is often ambivalent to the day-to-day operations and the environment in which the oil companies operate in. Managers need to demonstrate that they understand the ethical implications of the nature of their work and are incorporating policies to deal with the issue. Through ethical leadership, the managers can take personal risks to advocate for moral solutions to problems which should go hand-in-hand with opposing unethical practices (Yukl, 2010: 351). Various employees have been transferred, sacked, or intimidated into silence when they tried to raise concerns about safety issues at BP. Managers, who wish to stand out as authentic should take a chance to correct this culture by providing assistance to such workers opposed to unethical decisions and/or practices.

Current leadership needs to extend beyond the work station context and provide an outreach to the entire community (Smith 1988: 89). This is especially true for BP which is a global organization in the oil industry and headquartered in the UK. Its leadership should draw power from cultural, political, economic, and personal sources. When the leadership fails to integrate the sources of cultural power, a lot of misunderstandings may occur leading to harsher judgment (Alon &Higgins 2005: 503), as is the case with the Gulf of Mexico spill. The public can perceive it as a way of foreigners coming to destroy their land and mistreat their people. However, this does not have to be so, as through recruitment of managers and workers from different backgrounds, cultural relations through exchange of ideas, sharing common values among others can be controlled in a way to work in favor of the organization.

In summary, this has been a critical reflection of leadership issues at BP basing on the account of the Gulf of Mexico oil spill. BP has continually been attacked harshly for the seemingly negligence in implementing safety procedures at the organization. The series of accidents over the years and the poor handling of public relations have led to negative perceptions concerning the moral accountability by BPs manager. Drawing from theories of leadership, the paper has given various approaches that the senior managers can use to handle public critique appropriately for the benefit of the organization.

List of References:

Alon, I.  &Higgins, J., M. 2005. Global  leadership  success  through emotional and cultural intelligences,” Business Horizons, vol. 48, no.6, pp.501-512.

Barling, J., Loughlin, C, and Kelloway, E. K. 2002. Development and test of a model linking safety- specific transformational leadership and occupational safety.  Journal of Applied Psychology, vol. 87, pp. 488 – 496.

Blackden, R. (2013, February 26). Gulf of Mexico disaster caused by ‘classic failure of leadership at BP. The Telegraph, Retrieved August 17, 2013 from http://www.telegraph.co.uk/finance/newsbysector/energy/oilandgas/9896230/Gulf-of-Mexico-disaster-caused-by-classic-failure-of-leadership-at-BP.html

Boxell, J. & Crooks, E. 2010. Inside BP: A giant wounded. Financial Times,

Brady, J. 2010. As workers age, oil industry braces for skills gap. National Public Radio. Retrieved August 17, 2013 from http://www.npr.org/2012/04/20/150871935/as-workers-age-oil-industry-braces-for-skills-gap.

Chief Counsel (2011). National Commission on the BP Deepwater Horizon Oil  Spill  and Offshore  Drilling: Macondo  the  Gulf  Oil  Disaster. Accessed from http://www.oilspillcommission.gov.

Mintzberg, H. 1973. The nature of managerial work. New York: Harper & Row.

Smith, H. 1988. The power game. New York: Ballantine Books.

Spence, D. 2011. Corporate social responsibility in the oil and gas industry: The importance of reputational risk. Chicago-Kent Law Review, vol. 86, no.1, pp. 59-85.

Yukl, G. 2010. Leadership in organizations. Upper Saddle River, NJ: Prentice Hall.

 

Management and Organizations: How managers can manage by monitoring of external factors

Introduction

It is important for managers to be able to measure business outcomes. However, it is also important to understand how managers measure performance in order to identify ways in which managers can evaluate or measure performance in a way that contributes to effective management. In understanding how management in an organization functions, it is important to analyze the supra, macro and micro activities of particular organizations functioning in either national or international situations. This is because organizations utilize both external and internal resources to accomplish objectives. The organization draws external resources through its interaction with society.

Managers ought to manage not only based on employees performance, but they also require to consider other factors such as how the organization interacts with external factors to contribute to performance. Such external factors may include societal culture in international markets, competitors and competitive advantage, laws and regulations, technological and political factors. The internal factors on the other hand focus mainly on human resource. It is unproductive for managers to only focus on measuring human resource’s performance and neglect other external factors. Managers require assessing how external factors affect businesses to inform better management. Human resources or employees are not the only factors affecting business performance and thus managers require undertaking a holistic approach in measuring performance. Organizations are part of society and managers ought to factor in the social dynamics that support the existence of the organizations. Managerial decisions influence how organization interacts with the society and the society determines its profitability or collapse. This indicates that performance in an organization is not pegged on employees’ output only but also on external or societal interaction with the organization.

Employees’ output is measurable but external factors may not be measurable because they are dynamic and not static. Even when measurement of performance is crucial to management, it is not always possible to measure external factors. This is because managers may not always be able to predict or measure the extent of how certain external factors may affect the organization. This would call for managers to seek ways of adapting the organization instead of taking a rigid stance about management purely based on performance evaluation. In this case, instead of managers, relying solely on measuring performance they would have to seek ways of adapting the business to the prevailing external circumstances.

Measuring performance is vital to an organization’s profitability or effectiveness but sometimes managers would have to focus on how to adapt the organization to the business environment for it to remain competitive. Measuring performance is an internal function which is necessary for an organization’s success. However, external factors also determine an organization’s success. Thus managers require being diverse to manage the organization by adapting the organization to the external factors as well as implementing changes drawn from performance evaluation. When conducting performance evaluation on employees, managers also require making reference to how external factors influence individual employee performance. This is because it is not only based on the employee’s effort but is affected by external factors such as other individuals in the team and competition from other organizations in the same industry.

Literature review on why managers measure performance

Performance measurement or evaluation focuses on specific activities and their outcomes and it is anchored on practice theory. Practice theory’s empirical approach recognizes the importance of peoples’ actions to organizational outcomes. The theory informs manager’s motivation to focus on employees’ everyday activity. The theoretical approach of practice theory backs managers’ performance evaluation because it requires specific explanation for employees’ activities. It is concerned with evaluating how activities are produced, reinforced and changed for the intended results. The philosophical approach of the theory underscores the reason why evaluating performance is important to a manager. This is because it views activities as the building blocks that culminate in success of the organization (Feldman & Orlikowski, 2011).

Managers use performance units or evaluate the extent to which organization goals are attained say in dollars for a business or in the number of patients receiving quality care in a hospital (Klaas & Donaldson, 2009). They perceive any decline in the number of performance unit as reduced performance. Managers believe that giving evaluations to all employees is important because it sets the stage for success in the business or organization (Randall, 2013). Managers view performance review as the perfect means to translate the high-level company goals into employee’s personal goals and activities required of each of the employees (Barrier, 2008).

Managers use performance evaluations to assist employees to make the connection between their performance and the necessary improvement needed to achieve the high-level goals of the company (Eccles & Serafeim, 2013). Managers emphasize on making the connection because it is necessary in helping the employee to understand how it will be measured. Managers view performance evaluations as ways in which they can strengthen the organization and to help each employee to reach their highest level of capability (Hurst, 2004). Managers require providing the employees with the necessary support because employees who are encouraged to grow are more capable, flexible and open to change that drives organizational success. It is also essential that managers review each employee’s progress, identify and remove roadblocks to success. (Randall, 2013)

Implications: does it benefit employees or not?

Performance reviews inflict pain on employees and managers sometimes offer soft peddled criticisms. This can be fatal particularly when an employee is subsequently terminated for unsatisfactory performance and it can bring suit for wrongful discharge. Additionally, when employees get negative reviews they may blame managers for some forbidden motive such as discrimination and this may cause managers to fail to give the deserved feedback (Torres, 2008). This makes management through measuring performance a somewhat weak. Managers may be put in the midst of constant lawsuits, which divert organization’s resources from productive activities. However, managers can adopt more acceptable means of performance evaluation such as by creating a when a culture of continuous feedback through open communication.

Additionally, performance reviews are inherently destructive and inaccurate because individual performance is heavily influenced by other factors such as other individuals’ performance. Constant communication is more effective than formal review systems. Small organizations are at a unique advantage to avoid performance reviews. Scrapping off performance management is does not mean that it is not important rather, it is more effective when done continually. This is a form of performance management in a way the makes more sense for the company. Employees would advocate for managers to alter the way in which they manage performance from a formal periodic review to a continuous system of constant communication. This way, employees get the chance to express their concerns about other factors that could be affecting their performance in a timely and supportive way (Barrier, 2008).

Practice relevance:  argument on how external factors influence employee performance

Practice theory indicates that organizational action takes place in a social world. It is a practical theory and it is invaluable in influencing organizational change. It emphasizes the micro dynamics of everyday activities and that activities of all participants are important in producing organizational outcomes (Feldman & Orlikowski, 2011). Advocating for management based on assessment of unpredictable and dynamic external factors such as technology or competition, which is uncertain, relies on organizational design’s contingency or organic theory (Klaas & Donaldson, 2009).

Apart from other individuals within an organization affecting employee performance, other external or environmental factors contribute to organizational success. Managers also require exploring into which certain external factors necessitate organizational action. They require assessing how political changes say in government and the resultant policy changes affect the success of the organization. They should also explore economic factors such as interest’s rates, exchange rates and the business climate for investment in certain areas would affect the entire business. They also require evaluating how social changes that for instance affect buying habits affect the organization (Evans & Richardson, 2008).

Managers also need to address how technology such as new products and services would affect the operations of the organization and its success. They also require adapting the organization to new legislations relevant to the organization such as minimum wage policy. Managers of business firms also require paying ample attention to competition dynamics including the current and the potential competitors. This then informs the manager’s response in determining the organization’s core competencies and strategies before evaluating likely actions or strategies (Evans & Richardson, 2008).

These factors influence organizations performance and subsequently the employees’ performance. It is important to for managers to evaluate employees’ achievement of set goals in light of the evaluations of the industry and the competition. Managers are decision makers and they should be able to accurately perceive environmental issues and formulate management strategies (Oswald, Mossholder, & Harris, 2007). Managers can manage organizations better by allowing their perceptions of the external environment and the organizations competitive strengths to inform strategic considerations.

These strategic considerations are informed by dynamic factors, which are unpredictable indicating that managers can manage without measuring. For instance, managers may not necessarily require measuring the actual magnitude of the competition to put in place a marketing plan. Rather, managers adapt the organization to the prevailing competitive environment and recommend certain forms of marketing strategies, product innovation for competitive advantage (Chow, Wu, & Chan, 2009). This is because effective management requires that managers tailor the decision making process to fit the demands of the environment (Payne, 2010). Managers must then in their managerial work devote resources and energy in collecting environmentally relevant information.

Managers require knowledge to make certain decisions within the organization. Obtaining external environment information or knowledge is important because it enable s managers to make perceptual judgments of positive consequence to the organization. They take more ownership of strategy development and share this information with employees. They assist employees to adjust their objectives in line with the organizational goals and they also structure ways in which to support the employees to achieve them. This way, managers are aware of the factors that affect their employees’ performance and are able to adapt their management to support the employees to achieve their targets (Crumpton, 2013).

A manager that not only focuses on the internal environment that is measurable but also the external environment is invaluable to an organization. This type of manager extends the scope of management to external factors and is otherwise referred to as a strategist. A manager who functions based on just the measurable internal factors such as employee performance limits his effectiveness as well as the effectiveness of his organization (Pryor, Taneja, Toombs, & White, 2008).

A manager who is a strategist confronts complex situations emanating from the employees and as well as those emanating from external factors. They use integrative thinking to arrive at solutions that would otherwise not be evident. They are passionate about understanding the present and using it as a foundation for inventing the future (Klarner & Raisch, 2013). They simultaneously develop and execute plans that focus on the short-term success and long-term viability of the organization. They understand that strategic execution is important to both long term and short-term success of the organization (Pryor, Taneja, Toombs, & White, 2008). Measuring performance is a narrow viewed management approach, which focuses on internal predictable and static factors. A strategist approach on the other hand covers a wider scope of activities within the organization. A manager with a wider view is thus more effective than one that takes management purely focused on measuring performance.

Conclusion: ways in which managers can manage through evaluating external factors

Evidently, when managers rely too heavily on internal factors and neglect the external factors that inform organizations strategic direction organizations become ineffective. Managers require a wider view to effectively manage organizations without which an organization is likely to plunge into performance misfit. Organizations do not function in isolation but in a social world with competitors, legal structures, political influences, economic influences, technological advancements or innovations and changing regulations. Managers ought to adapt the organization to these factors accordingly.

One of the ways in which managers can adapt to these external factors in their management is through coordinating activities with other managers in different areas within the organization (Philip, 2011). For instance, a manager in a sales and marketing team coordinates with the research and development manager to conduct surveys on consumer behavior trends. This way the managers understand their competition and tailor their products to better clinch the market. The finance managers coordinate with product development managers to determine which financial factors would affect manufacturing expenditure of certain products. This integrative thinking is a strategic approach seeking to integrate the organization’s competencies with its human resource to attain or retain competitive advantage.

Another way in which managers can adopt a holistic and strategic approach is through involvement in formal strategic planning processes within the organization (Gluck, Kaufman, & Wallack, 2008). Formal strategic planning process gathers together all the top-level managers, the organization’s top executives and employees in a single forum. They air their views about how to achieve the organization goals and consultants are also involved in strategic decision-making. Managers of different sectors within the organization get the chance to understand how different external and internal factors play out to attain the goals of the organization. It is also an important platform to understand employees’ point of view regarding areas that may require improvement within the organization. This is because all participants have a level field to air their views in a professionally, impartial and well-coordinated process. It is an important platform because all the views and suggestions are properly documented and acted upon either as matter of further debate or inclusion into the strategic plan.

Performance reviews conducted in an informal way that involves continuous communication with employees is the most effective way to manage employees. This is particularly effective when the manager includes a strategist approach to management because he is able to offer accurate support to the employees. When managers are armed with information about external factors and internal factors that contribute to organizational success, they include strategic management styles to their previous narrow performance oriented approaches of management. They are empowered to make information that is more accurate because they have a wide understanding of different aspects affecting business or organizational performance. They are also able to assist employees to make better personal and professional development goals because they understand the strategic direction of the organization.

Overall, a manager with a strategist approach to management makes better management decisions than one taking a rigid performance approach. This indicates that employees are better served by a strategist manager who not only focuses on continuous communication to offer feedback on progress but also when such a manager is well informed about the organization’s position in the respective industry or sector. This is because such a manager makes informed decisions is less involved in conflict with employees over inaccurate judgments in appraisals.

References

Barrier, M., 2008. Reviewing the Annual Review. Nation’s Business, 86(9), 1-5.

Chow, w. S., Wu, J. P. and Chan, A. K., 2009. The Effects of Environmental Factors on teh Behavor of Chineses Managers in the Information Age in China. Journal of Business Ethics, 89, 629-639.

Crumpton, L. L., 2013. The Measure of Success. Industrial Management, 27-30.

Eccles, R. G. and  Serafeim, G., 2013, May 1. The Performance Frontier. Harvard Business Review, 50-60.

Evans, C., and Richardson, M., 2008, October 1. Strategy in Action: Assessing the Environment. Manager: British Journal of Administrative Management, 1-3.

Feldman, M. S. and  Orlikowski, W. J., 2011. Theorizing Practice and Practicing Theory. Organization Science, 22, 1240-1253.

Gluck, F. W., Kaufman, S. P., and Wallack, A. S., 2008. Strategic MAnagemnet For Competitive Advantage. McKinsey Quarterly, 2.

Hurst, J., 2004, July 1. Performance Reviews Benchmarking Growth. Supply House Times, 158.

Klaas, P. and Donaldson, L., 2009. Underfits Versus Overfits in the Contigency Theory of Organization Design: Assymmetric Effects of Misfits on Performance. In A. B. al (Ed.), New Approaches to Organizational Design, Information and Organization Design Series (pp. 147-168). Aarhus, denmark.

Klarner, P. and Raisch, S., 2013. Move to The Beat-Rhythms of Change and Firm Performannce. Academy of Management Journal, 56(1), 160-184.

Oswald, S. L., Mossholder, K., and Harris, S. G., 2007. Relations Between Strategic Involvement and Managers’ Perceptions of Environment and Competitive Strenght. Group and Organization Management, 22(3), 343-365.

Payne, M.-L., 2010. A Comparative Study of HR Managers’ Competencies in Strategic Roles. International Management Review, 6(2), 5-12.

Philip, M., 2011. Factors Affecting Business Success of Small and Medium Enterprise (SMEs). Amity Global Business Review, 118-136.

Pryor, M. G., Taneja, S., Toombs, L. A. and White, J. C., 2008. The Impact of Ostrich Managers on Strategic Managemnt. Proceedings of teh Academy of Strategic Management, 7(2), 9-13.

Randall, R., 2013, January 13. Employee Performance Evaluations Important to Company Success. Central Penn Business Journal, 13.

Torres, A. C., 2008, July 28. Emotional Mismanagement. Business Week, 84.

 

 

 

TEMPLATE ASSESSMENT ITEM 1

 

ASSESSMENT ITEM 1: Stakeholder Reflection exercise

 

 PART A Summary Templates

UNIT 1 : Sustainable business development
Media Article/ Report  Reference (Author, Date, Title of Article/ Report, Source): Coop Bank of United kingdom, accessedAugust15, 2013, http://www.iisd.org/business/viewcasestudy.aspx?id=118
DESCRIPTION: What is the main point of the media article or report? The main point is to elucidate how a corporate can focus on making the life of its client better and preserve the environment while at the same time making profit.	RELEVANCE: How does this relate to the class materials? This article is relevant to the class material in that it focuses on one of the areas of making a corporate sustainable by its involvement in the green campaign to preserve environment and maintain a good image to the public.			REFLECTION: What are my thoughts and opinions regarding this article or report? In my opinion, i think this article is enlightening on how we can focus on the business stakeholders and eventually end up with profits and the future of the company is assured since it is closely linked to its support system
UNIT 3: Compliance and sustainability
Media Article/ Report  Reference (Author, Date, Title of Article/ Report, Source): Cuong Tat, August 8, 2013, Document management: ensuring safety and compliance in the oil and gas industry, Accessed August 15, 1013, http://digitalbusiness.blogs.xerox.com/
DESCRIPTION: What is the main point of the media article/ report? The foremost thing highlighted in this article is the effect compliance can have in an organisation. compliance to the regulations can reduce the costs associated with non compliance		RELEVANCE: How does this relate to the class materials? This article is appropriate for class material because it focuses on the importance of compliance as a means to achieve sustainability of the business.			REFLECTION: What are my thoughts and opinions regarding this article/ report? I understand that non compliance can be sometimes so costly to a business. To comply with HSSE regulations can save the business a lot of losses which could have been incurred in compensation and restorations.
UNIT 4: Sustainable Efficiencies Media Article/ Report  Reference (Author, Date, Title of Article/ Report, Source): Pilita Clark, August 8, 2013, Renewables; A Rising Power.  Accessed August 15, 1013, http://www.ft.com/intl/cms/s/0/a41d86b4-ff9c-11e2-a244-00144feab7de.html#axzz2c2VGM7vT
DESCRIPTION: What is the main point of the media article/ report? This article concentrates on the benefits of efficiency to a corporate. A business that creates efficiency will be more profitable and more sustainable.			RELEVANCE: How does this relate to class materials? This relates to the class work in that use of solar power which is renewable is less costly and can help a business in reducing its powering costs and increase its profitability and ultimately its sustainability.			REFLECTION: What are my thoughts and opinions regarding this article/ report? I think efficiency can aid in improving profitability of the company by reducing cost of production or by increasing the output of the organisation without adding to its cost.

 

Characteristics of Health Policy

A health policy is an instrument that a government or an organisation needs to expedite health care goals and objectives. Health policymakers will take into consideration the strategies and actions that will ensure that these goals have been realised within a specific period of time. For this to be a reality, the following are some of the characteristics that must be taken into consideration in developing a health policy.

Access

It is important to note that a country may have a terrific health care policy but fail the test of accessibility. It is argued that the United States is one of the nations that enjoy the best healthcare system but it is not accessible to all her citizens (McDonough, 1999). This could be a major drawback in the realisation of goals. It is therefore important to put checks and balance that are aimed at helping the process to be effective. One of these measures is evaluation. Evaluation will always keep the system in check and constantly looking for ways in which healthcare services can be made universal, meaning that everybody can access healthcare at any given time. The policy must therefore show how evaluation will be conducted in assessing the policy.

Cost

The economic inflation in most of the world economies has caused the rise in prices of medical equipments and drugs, and this has also led to the rise in medical bills or charges. For the policy to be effective, it must show how this challenge will be addressed and the means by which these changes will be kept constant so that both the government and healthcare stakeholders are able to arrive at a consensus on its sustainability. The other factor to consider is that the policy must outline the priorities in terms of provision of healthcare. For instance, the policy must be able to show the distinctiveness between private, public and organisational policies. In addition, it must show how emergencies are going to be dealt with and its cost implication (Feldbaum, 2009). Finally, it must indicate how technological advancement will be integrated in healthcare provision and its cost implications, as well as a proposal of how these changes will be achieved.

Quality

Another important characteristic of a healthcare policy is to ensure quality services are delivered and maintained in healthcare profession. It is important to show how quality will be controlled and the measures that will be taken to ensure consistency, from the training of medics up to delivery of the same in health centres. The policy ought, therefore, to elaborate how the vision of providing quality care will be achieved and how this achievement will be sustained and how communication will be done in every level (Niessen et al, 2012).

Effects of policy characteristics on decision making

The above mentioned characteristics can be summed up into three main objectives of healthcare, namely, provision of unbiased healthcare to all, cost effective healthcare and quality healthcare services (Dudley & Luft, 1999). Therefore, this knowledge will affect the authority to make decisions that rotate around the three objectives. For instance, one of the decisions that can be made in line with quality is to ensure that the trainees access the best education in college; and in line with accessibility, the policymakers may make a decision to subsidise medical bills for a certain group of people who may not afford to get medical covers. In other words, the characteristics of healthcare policy will influence the policymakers to choose the right course of action.

 

References

Dudley, A. & Luft, H. (1999). Goals, Target, and Tactics: Making Cealth Care Policy Decisions Explicit. Journal of Health Care Politics, Policy and Law , 705-713.

Feldbaum, H. (2009). A report of the CSIS Global Health Policy Centre. Washington D.C.: Centre for Strategic & International Studies.

McDonough, J. (1999). Healthcare Policy: The Basics. Boston: The Access Project.

Niessen, L. et al. (2012). Assesing the Impact of Economic Evidence on Policymakers in Healthcare – A Systematic Review. Baltimore: AHRQ publication.

 

 

How Mass Entertainment Media Can Respond to the Millennial Audience

Currently, many studies have identified that the mobile segment controls the digital activity. This observation has been noted even in countries like the U.S, where the usage of the internet is ubiquitous. The observation covers all the age groups such as the Boomers and the Gen Xers. However, the Millennials take the leading position among all the age groups. Companies that are responsible for mass entertainment media face many problems in relation to this generation. Studies have shown that the adoption of a mobile content is a crucial tool for the millennial audience (Ferri, 2010). The mobile content acts a significant mechanism of engaging and satisfying this audience since it has unique preferences, and the high quality presentation of contents can be achieved via the mobile. Such a presentation has a blend of interactivity, localization, visual stimuli and call for input. Entertainment industry faces tough challenges in coping up with the trends of the millennial age group. Thus, researchers have made efforts to unveil issues that can help entertainment companies understand this age group. This paper champions the thesis that mass media entertainment is significantly affected by the forces within its own industry, especially the difficulty of entertainment companies to capture the attention of the millennial audience.

Millenials can be referred to as the Generation Y. This is the largest generation of all and comprises internet pioneers. It is made of individuals who were born between the late 20th century and the early years of the 21st century. The range includes those who were born in the period between 1980 and 2005. In the United States, studies have shown that this age group comprise of 150 million people (Ferri, 2010). Thus, there exist several people from the millennial age group. The Millenials are characterized by the use of smart phones and mobiles in servicing their mode of choice. This implies that the entertainment companies need to direct their contents towards mechanism that are accessible to these devices.

In relation to the information obtained from the examination of mobile utilization, researchers pointed out the demographics that have a high penetration. The focus was on the Millenials who take online operations by means of mobiles. The data indicated that 92.3% of this age group used mobile phones in the year 2012. Besides, the research established that 63.2% of this population employed the mobile web for their activities, whereas a small number used smart phones (Ling, 2013). Millenials often have a high penetration of the social media sites such as Facebook and twitter. Lately, they constitute half the number of twitter users despite the old generation being the first to use this service. Moreover, researchers have projected that the number of Millennials who use the social networks will continue to rise in the coming years. Statistical data regarding digital video consumers indicate that the millennial age group account for 40% of the consumption level. This is because video, mobile, and social networks play a crucial role in their lifestyle. The survey conducted by Harris indicates that Americans, who are aged between 18 and 34, have a high potential to consume a wide range of entertainment. For instance, among the listeners of music, those aged between 18 and 34 have a higher chance of listening to recent music than those who are over 55 years (Rinallo, 2013). Many teens have also been associated with the consumption of online videos. This implies that marketers should focus on the recent issues of entertainment so that they can manage to meet the expectations of the millennial generation.

There are huge implications that are linked to the marketers who target creation, management, and marketing based on the cross-platform content. Understanding the mindset of the millennial audience has always been a significant challenge to many marketers. Entertainment companies need to ensure that they understand the mindset of their audience given that they are Millenials. It is crucial to note that the mindset of the millennial generation is often focused on the social media. This often includes liking, sharing and tweeting in relation to the current entertainment issues. Social media acts as a platform on which members of this generation exchange their views regarding matters of entertainment (Ferri, 2010). This implies that marketers should explore such sites in order to enable them obtain vital information on entertainment preferences for the Millenials. The tendency of entertainment companies to advertise or display their contents on television is being faced out gradually by the use of Web. Sharing, liking and tweeting issues can be achieved efficiently by means of mobile. The millennial generation often opts to seek information related to the entertainment contents from mobile devices and smart phones. Thus, entertainment companies should ensure that they are involved in developing, executing, and optimizing contents in a manner that compliments the mobile environment. This will enable them satisfy and engage the millennial audience. The millennial generation tends to spend more time on the mobile phones than on the desktop. On the contrary, most of the entertainment companies display their content on such devices. This leads to mismatch between the expectations of such companies, and that of the target audience (Ferri, 2010). Many companies have lost their revenues because they spend many resources in displaying contents on wrong channels. The main threat that is associated with the continuation of this trend is the collapse of many entertainment companies. Success of entertainment companies is linked to the ability of their contents to trigger brand authority, audience engagement, and brand depth. These goals can be accomplished effectively when companies have a paralleled and robust mobile experience. This implies that mass entertainment media companies need to focus on the issue of mobile. They should inquire on the considerations and appearances of mobile devices, as well. This can be achieved by focusing on the engagement, stimuli, localization, personalization, and input on content. All these elements need to be considered in relation to the available mobile experience.

Studies have proved that the millennial generation depends on both video and social channels for engagement in the mobile environment. Thus, both their connections and considerations are done through the mobile. Engagement within the mobile environment can be accomplished when Smart marketers adopt content solutions and video advertisements as opposed to desktops. For instance, both the vine and the Instagram brands that are driven visually are designed for the hand-held environment. Furthermore, the two have been identified to compete for the millennial market. The Instagram have a shorter time content of 15 seconds than the twitter’s vine, and this makes it to match the millennial attention span. The two brands compete for the mindshare of the Millenials in several ways. Their main target elements are creative flexibility and content as they exploit new target horizons.

Millenials are different from other audience because they cannot manage to stay on the television attentively. This also applies to their attention when they browse on the internet. The millennial generation is often associated with operating in spurts through the mobiles. Thus, marketers can manage to accomplish their goals through the utilization of this opportunity. Consumers have been identified to employ their internet ready-devices to conduct research on the latest events in the entertainment industry. Both Bing and Google are the main applications that the millennial generation uses to accomplish their goals. These applications offer several opportunities such as the top placed movies, songs and other entertainment issues (Lucas, 2013). Thus, most teens can search the entertainment modes of their choice, and watch through other site such as Youtube. In the developing countries where many youths are not accessible to smart phones, watching movies and songs via You Tube has been a problem. This forces many of them to move to the cyber cafés where they can access these services. Millenials always use their mobile phones to check on the prices of entertainment commodities. The marketers, therefore, face challenges when marketing the entertainment products such as movies and songs via other means, which are not linked to the internet. Marketers who can manage to reach Millenials at the stage of mobile to shop can benefit extremely. This is because they can drive the traffic associated with brick-and-mortar. This does not imply that marketers should engage in the development of shopping applications for the millennial generation. Many brands such Axe have been noted to be successful when integrated with mobile games and applications for the Millennials. The beautiful game is also one of the successful executions in relation to this generation. This brings the concepts of localization and personalization of the mobile contents, and their effectiveness in the promotion of mass media entertainment activities (Ewing, 2013). These two concepts have been identified as being significant in the driving engagement, interaction, and desired traffics.

Millenials are always more tolerant than other generations when it comes to one-way brand communication. They often want to have both direct participation and input. Studies have indicated that Millenials desire to contribute content themselves. In relation to the concept of personalization, this age group often wants to their entertainment experience with others through creating and sharing their contents. (Jiyuong, 2013) The question that entertainment marketers need to ask themselves is how to incorporate this aspect into their mobile experience. Teenagers always want to associate themselves with celebrity actors from the movies that rated highly. In most occasions, they attempt to dress, talk and act like these individuals. This, therefore, provides a suitable ground for marketers to gather information on what should be included in the movies, songs and other entertainment activities. This idea is not limited to the markets only, but also to the developers of mass entertainment media activities. Information that relates to what the millennial generation desires can be obtained from the social sites. Communication of ideas should be based on the current issues, which are appealing to their lifestyles. This can act as suitable mechanism of reaching them alongside satisfying their desires and expectations. Marketers and developers of entertainment activities should ensure that all their operations match the interests of the Millennials. These should comprise soliciting opinions, spurring social connectivity, and soliciting feedback. Uploading of photos and language choices are some of the mechanisms of achieving a successful personalization process, in relation to entertainment activities. Integration of mobile, social and video in the promotion of mass entertainment media products is critical for their success.

Both marketers and mass media entertainment developers, who spend adequate time to understand their audience, have a significant head start in relation to the development of digital channels. This is because these individuals gain adequate knowledge regarding the behaviors, preferences, lifestyle, and modes of the target audience (Coffey, 2013). The unique preferences that the millennial generation has in terms of mobile, social, and video intersection present adequate opportunity in playing to that environment. Engagement and driving interaction imply that those who target them possess powerful choices at their disposal.

In conclusion, the issue of responding to the needs of the Millennials has been a challenge in the mass entertainment media industry. The millennial generation is known to be focused on the current lifestyle issues. This makes them have dynamic needs that can be identified through a continuous research process. Studies have shown that the millennial generation often spends much time focusing on the use of mobile and smart phone devices to access entertainment activities. This implies that devices such as desktops cannot be the best channels of displaying the mass entertainment media contents. Marketers and developers of mass entertainment activities, therefore, need to ensure that they develop operations that match the mobile environment. Such operations need to be designed in a manner that suits the emerging trends in order to meet the expectations of the millennial generation. This will enable them access adequate information concerning the interest and preferences of this generation, in relation to mass entertainment media activities.

 

References

Coffey, A. (2013). Understanding the Invisibility of the Asian American Television Audience: Why Marketers Often Overlook an Audience of “Model Consumers”. Journal of Advertising Research, 53(1) 101-118

Ewing, T. (2013). The Good News About Television: Attitudes Aren’t Getting Worse: Tracking Public Attitudes Toward TV Advertising. Journal of Advertising Research, 53(1) 81 89

Ferri, A. (2010). The Emergence of the entertainment Age. Society, 47(5) 403-409

Hill, P; Moran, N. (2011). Social Marketing Meets Interactive Media. International Journal of Advertising, 30(5) 825-838

Jiyoung, C. (2013). Do Online Video Platforms Cannibalize Television?: How Viewers Are Moving from Old Screens to New Ones. Journal of Advertising Research, 53(1) 71-82

Karniouchina, V; Uslay, C. (2011). Do Marketing Media have Life Cycles The Case of Product Placement in Movies. Journal of Marketing, 75(3) 27-48

Ling, P; Geng, C; Chunyu, L. (2013). The Comparative Impact of Critics and Consumers. International Journal of Market Research, 55(3) 413-436

Lucas, J; Henry, C; Eric, K. (2013). Impact of Research on Transformational Information Technology: An Opportunity to Inform New Audiences. MIS Quarterly, 37(2) 371-382

Pierce, M; Tang, T. (2012). Refashioning Television: Business Opportunities and Challenges of Webisodes. International Journal of Business & Social Science, 3(13) 163-171

Rinallo, D;  Suman, W; Jeon, H. (2013). The Media and Their Advertisers: Exploring Ethical Dilemmas in Product Coverage Decisions. Journal of Business Ethics, 114(3) 425-441

 

Financing Healthcare Services within the State of Georgia

Appropriate funding of healthcare services affects not only accessibility but also quality of services rendered. This report provides recommendations for funding ambulatory services, continuum of long-term care services, and mental and behavioral services in the state of Georgia

Funding Ambulatory Services

Increasing use of ambulatory services has resulted from challenges in financing healthcare that have necessitated a shift from in-patient to outpatient management of illness.  However, as Morris (2012) observes, having patients pay significant amounts for their outpatient visit from out-pocket arrangement may lead to significant dropout from treatment. As Decker (2009) also reports, reduction in the level of funding to ambulatory services by Medicaid leads to the shift towards more utilization of inpatient services, which bears higher cost implications. As such, and as observed by a MedPac (1999) report to the congress, public insurance options have a significant role in ensuring a shift to ambulatory care, which, eventually leads to long-term cost savings when compared to inpatient care.

The recommendations for financing ambulatory services in Georgia would thus be to combine public and private insurance options to enhance utilization of ambulatory services as compared to inpatient care. For public insurance, Medicare needs restructuring to enhance co-payment services that may help avoid moral hazard among the beneficiaries and providers. For co-payment to act as a moral hazard deterrent, however, an effective balance between level of co-payment needed to arrest unnecessary visits and level that may deter necessary visits needs to be established.  For instance, although earlier studies conducted in the US (Cherkin, Grothaus, & Wagner, 1990 and Scitovsky & McCall, 1977, as cited in Schreyogg & Grabka, 2010, p.332) showed that per-visit co-payments reduced physician visits, the study by Schreyogg and Grabka (2010) found that a single co-payment within a defined period may not deter visits to the physician.  On the other hand, as Morris (2012) observes, high co-payments may lead to patients not seeking care even when necessary, which would lead to progression of illness to levels that would need more funds to address. As such, a well-structured co-payment approach, which accounts for levels of individual income and health risk, can enhance coverage not only by public sector systems, but also by private insurers (Kumar, Ghildayal, & Shah, 2011). In effect, this would help enhance utilization of ambulatory services compared to inpatient services thus lessening the overall cost of healthcare in the state in the long term.

Funding Long-Term Care Services

Effective funding of long-term care is necessary especially with the changing demographics, not only in Georgia, but also in the US and other developed countries. Aging of the baby boomers population and better healthcare services that have lengthened life expectancy imply that more people will be in need of long-term care services in the near future (Moon, 2011; Wiener, 2011; Roberts, Miller & Hokenstand, 2012). However, traditional public funded programs such as Medicare and Medicaid that fund up to 97% health care needs of the elderly have increasingly faced a threat with the pressure to cut Federal and state expenditures (Moon, 2011, p. 298-299).  Such pressure may imply the need to transfer the funding by Medicare and Medicaid to alternative options, especially with a recent report indicating that Georgia would be among the states whose health care cost would increase significantly on adopting Patient Protection and Affordable Care Act’s (ACA)  recommendation to expand Medicaid coverage (Kaiser Family Foundation, 2012). Nevertheless, funding long-term care via private options is not a feasible alternative since private insurers are likely to agree only to high premiums based on significant risk of illness during old age.

One of the alternatives to supplement Medicaid has been argued to be employer-sponsored plans. In recent years however, employers have increasingly reduced retirement coverage in cost cutting measures and adopting such an approach would leave a lot of the elderly uncovered (Moon, 2011). Similarly, other Medigap insurance options (either employer or individual private insurance arrangements) are reported to lead to a higher financial burden and lower quality of care to the beneficiary compared to Medicare and Medicaid alternatives (Moon, 2011). Although private options organized in the form of Health Maintenance organizations (HMOs) offered better prices than Medigap in their initial stages, subsequent legislation made them unaffordable due to increased premiums and high cost sharing requirements (Moon, 2011).  As such, with lowered incomes during retirement, such plans become unfeasible to cater for long-term care. A recommendation would thus be to have beneficiaries contribute more to the cost of the care within the Medicare plan. For Medicaid, requiring beneficiaries to contribute more may be counterproductive since Medicaid mainly targets low-income, and already requires beneficiaries to devote a substantial amount of their income to institutionalization costs (Moon, 2011). As such, increased revenues for Medicaid to fund increased participation as more population qualifies will likely have to come from taxation, for instance, an income tax component based on individual average risk and years-to-retirement age (Frank, 2013).

Funding Mental and Behavioral Services

Historical stigmatization of mental disorders has prevented advancement in financing alternatives as opposed to financing for physical disorders. As evident in Kroncke and White’s   (2009) argument, the perception that inclusion of mental health disorders in public funded insurance programs has facilitated the increase in health care costs still prevails. Nevertheless, observations that as much as 20 percent of the US population suffers from diagnosable mental disorders, and only 37 percent of these receive treatment (Carpenter, 2005), have necessitated development of better financing approaches.

The recommendation for funding of mental health services for the state of Georgia is to employ managed care approaches.  For example, such an approach would encourage the use of low-cost providers, which would be appropriate for less severe cases (Carpenter, 2005). As Kapphahn, Morreale, Rickert and Walker (2006) observe, private insurance plans and employer-sponsored insurance have often left out mental health services from the health insurance policies they develop. Such a case has led to most people relying on Medicaid and, for children, State Children’s Health Insurance Program (SCHIP) to access mental health services (Kapphahn et al., 2006, p. 322). Such use of managed care would encourage the participation of private insurance players in the provision of mental health insurance (Carpenter, 2005), thus easing the burden on public insurance plans that have faced increased threats with need for federal and state expenditure containment. Although the quality of services under managed care receives a lot of criticism (e.g. Kapphahn et al., 2006), they may be the only feasible approach to expand care to many underserved populations by enhancing affordability.

 

References

Carpenter, C. E. (2005). Financing mental health care. Journal of Financial Service Professionals, 59(6), 32-34.

Decker, S. L. (2009).  Changes in Medicaid physician fees and patterns of ambulatory care. Inquiry, 46, 291-304.

Frank, J. A. (2013). W(h)ither Medicaid. NAELA Journal, 9(1), 67-89. Accession #: 87314054

Kaiser Family Foundation (2012). The cost and coverage implications of the ACA Medicaid expansion:  National and state-by-state analysis. Retrieved from http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8384.pdf

Kumar, S., Ghildayal, N. S., & Shah, R. N. (2011). Examining quality and efficiency of the US healthcare system. International Journal of Healthcare Quality Assurance, 24(5), 366-388. DOI:10.1108/09526861111139197

Kapphahn, C., Morreale, M., Rickert, V. I., & Walker, L. (2006). Financing mental health services for adolescents: A background paper. Journal of Adolescent Health, 39, 318-327. doi:10.1016/j.jadohealth.2006.06.002

Kroncke, C., & White, R. F. (2009). The modern health care maze: Development and effects of the four-party system. Independent Review, 14(1), 45-70.

MedPac (1999). Changing Medicare’s payment systems for ambulatory care services. In  Report to the congress: Medicare payment policy (101-114). Retrieved from http://www.medpac.gov/publications%5Ccongressional_reports%5CMar99%20Ch6.pdf

Moon, M. (2011). Organization and financing of health care. In R. H. Binstock & L. K. George (Eds.), Handbook of Aging and the Social Sciences (Seventh Edition) (295-307). San Diego, CA: Elsevier Inc. DOI:10.1016/B978-0-12-380880-6.00021-6

Morris, R. (2012). Using third-party financing to help today’s patient pay for treatment and care.  Journal of Medical Practice Management, 27(4), 189-191.

Roberts, A. R., Miller, D. B., & Hokenstad, M. C. (2012). Long term care insurance beyond the CLASS program. Journal of Sociology & Social Welfare, 39(3), 85-109.

Schreyogg, J. & Grabka, M. M. (2010). Copayments for ambulatory care in Germany: A natural experiment using a difference-in-difference approach. European Journal of Health Economics, 11, 331-341. DOI:10.1007/s10198-009-0179-9

Wiener, J. M. (2011).  Long-term care financing, service delivery, and quality assurance: The international experience. In R. H. Binstock & L. K. George (Eds.), Handbook of Aging and the Social Sciences (Seventh Edition) (309-322). San Diego, CA: Elsevier Inc. DOI:10.1016/B978-0-12-380880-6.00022-8

 

U.S Healthcare System: Trends in the Pharmaceutical Industry

Various factors have influenced the transformation of the health care industry in the world. In the U.S, aspects such as financing changes and legislation guiding the activities of pharmaceutical companies have influenced developments witnessed in the health care industry.  In addition, pressures imposed on professionals in the industry such as negative effects of managed care arrangement on physician autonomy and clinical freedom have been advanced to compromise physician job satisfaction. Such issues have changed the landscape of the health care industry as highlighted subsequently in a review of factors that have influenced changes in the pharmaceutical industry and career implications of changes in the health care industry.

How Regulations in the U.S. Impact the Claims and Facts Presented in the Video

The video by Tribeca Knowledge (2011) presents a case for the expected change in the pharmaceutical industry following the expiry of various pharma patents in 2012. The video argues that, with an estimated $60 billion loss in patent revenue expected following the expiry of patents in 2012, and the decline in FDA drug approvals from an all-time high in 1996, generics will continue their dominance over the branded drugs for the foreseeable future. Such a change, as presented in the video, is likely to shift the attention of the pharmaceutical companies to emerging economies where the lower prices of the generics are likely to attract higher demand. To survive the changes, the video argues that mergers and acquisitions will prevail, not only as a way to ensure quick penetration in the emerging markets, but also as a means of eliminating duplicates. As noted by GSK CEO in the video, the rise of generics may also open opportunities in underdeveloped world where access to medication is curtailed by the prohibitive pricing of branded medication. The rise in generics accompanied by expiry of patents may however dissuade development of new drug compounds, and, as argued in the video, restrict such development to small venture capital-funded entities.

Legislation that affects the pharmaceutical industry is likely to influence the claims and facts presented in the case in various ways. An example would be in respect to regulations and legislation concerning drug approval process. For example, despite the declining rate of approvals by the Food and Drug Agency (FDA) as noted in the video, various attempts have arisen to expedite the approval process of some categories of medications. Danzon and Keuffel (2013) for instance cite the 1997 FDA Modernization Act that sought to enhance the approval process for novel drugs (p. 12). The Act recognizes the need to designate products that “are intended for the treatment of a serious or life-threatening condition [and which] demonstrate the potential to address unmet medical needs for the condition” (FDA, 2005 (b) as cited in Danzon & Keuffel, 2013, pp. 11 & 12). Similarly, inclusion of various medications under the coverage of Medicare part D reimbursement has been suggested to spur research and development activities to meet the demand that has arisen (Blume-Kohout & Sood, 2013). Such observations have implications for the claim made in the video that R&D activities will mainly be a preserve for venture funded small entities. On the contrary, legislation that provides incentives to develop drugs whose demand is eminent are likely to attract even the larger companies  who may have the resources to realize better economies of scale.

Another issue noted in the video influenced by legislation is the increase in generics following patents expiry. Specifically, as observed by Danzon and Keuffel (2013) the Hatch-Waxman Act has been critical to enhancing entry of generic following expiry of originator’s patents.  State-level legislation has also reinforced the effect of the Hatch-Waxman Act by allowing the use of generics as substitutes to originator medication unless where physicians appends a note that the brand is required to the prescription (Danzon & Keuffel, 2013). With insurance firms becoming core stakeholders in financing healthcare, and clamor for cost containment in health care provision heightening, the rise of generics appears to be in line with the predictions presented in the video.

Where the Biggest Opportunity will be for the Pharmaceutical Companies

The entry to emerging markets will offer an opportunity for the pharmaceutical companies to expand their revenues on a global market. As noted by Danzon and Keufel (2013), companies can utilize price discrimination in such countries to get marginal revenue for funding research and development activities. Even where various countries seek to standardize prices by quoting price references offered in origin countries (Danzon & Keufel, 2013), the huge population in countries such as China, India and Brazil offers pharmaceuticals opportunities for pharmaceutical companies to enhance their revenues. However, as observed in the video, realizing such opportunities will be possible only when entities can use innovation to provide affordable medication in such regions.

Drug Pricing Practice in the US and Belgium

Observations that the US residents as much as two-thirds more than Europeans in per capital biopharmaceutical use has led to the clamor to reduce prices in the US. However, as a RAND report observes, such a status has arisen more out of use of more expensive medications in the US than in Europe, rather than price differences per se (Lakdawalla et al., 2008). To contribute to the evaluations of price differentials in the US and the EU, this section evaluates the pricing practices in the US and Belgium.

In the US, various policy alternatives have affected the prices offered on drugs. Such policies may be categorized into those that reduce manufacturers’ revenues while not affecting consumer prices, and those that reduce consumer prices while not affecting manufacturer prices (Lakdawalla et al., 2008). The initial policy alternatives include aggressive negotiations that pressure manufacturers to lower their prices. One example of these has been pressure for pharmaceutical companies to lower the prices of antiretroviral products in the low-income countries, and subsequently in the middle-income countries (Bate & Boateng, 2007), which had implications of US consumers paying for the cost of development of such drugs through a higher discriminated price. The second group of policies, which reduce consumer prices but not manufacturer prices, can be exemplified in changes in legislation to reduce the amount of copayment. Such policies, as an example, have been evident with the enactment of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) that has provided insurance coverage for prescription drugs for beneficiaries of Medicare program (Lakdawalla et al., 2008). However, consensus still lacks as to whether such Medicare initiatives have not had an effect on manufacturer prices by enhancing the market power of private insurers to negotiate for lower costs. However, even if the Medicare change has led to the reduction of manufacturer prices, the subsequent observed reduction in copayments (Lakdawalla et al., 2008) indicates that, at least, the act has had price benefits to consumers.

In Belgium, various determinants also interact in determining pricing policies of pharmaceutical companies. For example, in the Study by Adriaen, De Witte and Simoens, the pricing of originator and generics is a factor of determinants such as regulatory aspects, market competitive forces, manufacturer power, and medication class. An example of the regulatory aspects was noted to be reference price reductions and changes in prescription status of medications. The changes in prescription status have also had a role in drug prescription in the US, which is exemplified by the inclusion of mental health prescriptions for reimbursement in public insurance programs (Carpenter, 2005). In respect to price reference prices, although the US prices are essentially based on a free pricing model, the rise of health maintenance organizations (HMOs) and other Pharmacy Benefit Managers (PBMs) and their policy to encourage a set of drugs that offers a price incentive could have an effect of similar to price references (Atella, Bhattacharya, & Carbonari, 2012).  Price competition in Belgium has occurred in two fronts; among generics and between originator and generic medications. Such diverse nature of determinants of drugs prices implies that no single strategy can determine the direction of drug prices of both originator and generic medication in both countries, but regulation and competition appear to have an effect in both countries. As observed by Lakdawalla et al. (2008) regulation pursued via manufacturers’ price controls seems to have little beneficial effect, whereas that which involves reduction in copayments, without necessarily reducing the manufacturers’ prices has shown potential benefits for cost containment in the US.

Career Trends in Healthcare Related Industries and the Career that will prove to be the Most Economically Rewarding

The health care industry offers various career opportunities including careers for medical personnel and health care executives. With respect to medical personnel, the growth of the aging population as a proportion of the entire US population implies a rise in demand for care professionals. For instance, as per the 2010 census statistics, people aged 65+ years were noted to have increased at a higher rate (15.1 percent) as compared to the rate of increase in the total population (9.7 percent; U.S. Census Bureau, 2011, p.1). Such an increase implies that nursing home and home based care will become a cores service provided for the population in years to come. With Nurse staffing levels in such care environments being shown to have a positive association with the care quality (e.g. Dyck, 2007), and advocacy for appropriate nurse staffing ratios and nurse leadership (Zhang, Unruh, Liu, & Wan, 2006) nursing professionals will continue to have a high demand in the US.

Nevertheless, the clamor for cost containment in various health care aspects makes the career of healthcare executives to be the most economically rewarding in the near future. For instance, as Kapphahn, Morreale, Rickert and Walker (2006) argue, managed healthcare may turn out to be the most feasible way for enhancing access at a relatively affordable cost for various care needs. Similarly, legislation such as the Patient Protection and Affordable Care Act’s (ACA) that, for instance expands Medicaid coverage, implies that healthcare stakeholders will need the services of managers and administrators whose skills can enable the entities to contain costs while enhancing the capacity to enhance their service provision. As such, the services of healthcare executives will continue to be highly demanded especially with the likely increase in healthcare costs arising from provision of care to the aging population. Such rising costs will enhance the pressure to contain costs, which will continue to create a demand for healthcare executives in various healthcare organizations.

Effect of Pressures placed Upon Medical Professionals – Specifically Doctors

The practice of medicine in the recent decades has seen dramatic changes in the physician-patient relationship. One of these changes has been the issue of managed care where physicians provide services based on an arranged care plan. In a study by Stoddard, Hargraves, Reed and Vratil (2001) physicians who received high levels of managed care revenue reported being less satisfied than those receiving low managed care revenues. Similarly, the physicians tied to managed care plans reported having lower clinical freedom as opposed to those whose core practice was not integrated into such plans. Such effects were attributed to lack of professional autonomy and lower incomes for services rendered. However, even after controlling for incomes, Stoddard et al (2001) found out that the lack of professional autonomy under managed care arrangements continued to affect physician satisfaction levels adversely.

On the contrast, other studies have reported mixed findings, for instance reporting increased satisfaction with managed care organization with respect administrative functions. For instance, in a study by Linzer et al. (2000), physicians practicing under HMO settings had higher average satisfaction rates  concerning administrative issues as compared to practice within other service-provision arrangements. However, the HMO physicians reported lower satisfaction rates compared to other settings with respect to resources and interactions with staff and community members. Issues such as time allowed with patients and resources access affected overall satisfaction rates of physicians under HMO. As such, the authors concluded that physician under HMO are generally less satisfied compared to physicians in other practice arrangements.

Such adverse effects of managed care point to the effect of various pressures on the attractiveness of physician careers. For instance, as observed by Linzer et al. (2000) the lower job satisfaction influences physician turnover in such managed care plans. This necessitates the restructuring of patient-physician interactions under the managed care to allow for higher professional autonomy for physicians. One way of doing this would be allowing for longer periods for new patient visits to enhance more quality interactions necessary for quality provision of care. Although such longer periods may reduce the number of patients a physician attends to, it would increase the quality of care that such physicians offer the patients they attend to (Grembowski et al. 2005). Another approach would be for staff training to offer better support to physicians serving under the HMO plans. Such an issue arises since lack of effective support resources is noted to be one of the contributors to job dissatisfaction among physicians working under HMO plans (Linzer et al., 2000; Stoddard et al., 2001).

Role of Health Policies and their Impact on Organizations over the next Decade

Health policy provides a benchmark of the desired health status or the strategies to achieve the desired status in a population. The policies continue to play a critical role of addressing health challenges facing the community. Health policies also allow commitment of public resources to address the challenges they target. For instance, policies concerning access to care for minority groups allow government resources to be used to promote such access. Use of resources may arise through ways such as funding, subsidies, and tax reliefs targeted to organization providing services covered under the health policy.

Some of the health policies are directed towards improving the welfare of society or a section of disadvantaged population. For instance, realizing the health needs of the elderly, public insurance options such as Medicare arose  as health policies initially but later reinforced by legislation (Moon, 2011). Such initiatives have led to increased access to healthcare for the elderly, which has resulted in better lives during the old age (Moon, 2011). Health policies that have arisen out of international efforts, such as the vaccination of small children for various diseases, have led to the elimination of debilitating diseases such as small pox. Similarly, policies supporting the subsidization of medications such as antiretroviral drugs have led to increasing access of such medications to a population that would not otherwise afford the drugs (Bate & Boateng, 2007). As such, health policies have had a central role in addressing health challenges in society.

Going forward, health policies will continue to be of significant effect in the health care industry. Since provision of healthcare is a social responsibility for every government worldwide, health policies will continue to occupy a central role even in the next decade. Various emerging issues such as increasing cost of healthcare might necessitate the use of health policies to enable access to care for groups that cannot afford such care. As such, it would be challenging to leave the private enterprise to control healthcare aspects since the profit motive of such enterprise may avert the provision of essential care to individuals who cannot afford care. In this respect, health policy will continue to be a core instrument through which government maintains regulation of stakeholders in the industry, and upholds its social responsibility to avail healthcare to all its citizens.

Reflection on Learning from the Assignment

The assignment has provided various insights into the intricate nature of relationship among healthcare stakeholders that have influenced the cost of care. In the first instance, the events in the pharmaceutical industry that influence the cost of healthcare have highlighted need for funding of new-drug development initiatives. With expiring patents leading to high competition following entry of generics, originator pharmaceutical companies may find it challenging to invest in R&D activities. The high cost implications of R&D without an assured return on investment even where the product passes the safety and efficacy evaluations indicates that companies may fail to embark on such development, thus crippling the development of novel treatments. On the contrary, failure to allow entry of generics may lead to unaffordable pricing of originator medicines. In such a way, government initiatives need to focus on subsidizing the R&D costs for originator companies, such that the companies can compete effectively with generics without having to price the product out of the reach of the patient.

The predominance of cost as the single most determinant of developments in the healthcare industry has also been reinforced by changing nature of careers in the industry. Whereas the need for medical personnel such as nurses is heighted with an increasing proportion of the aged, a more poignant need for healthcare executives arises with the need to contain costs. Such pursuit of cost containment is evident in the rise of managed healthcare provision models. However, the managed healthcare provision models have brought challenges of lower physician satisfaction, which may influence the intake of physicians in future. To manage such diverse interests of stakeholders, health policy will continue to be a central tool that ensures access of care services to the underprivileged population.

References

Adriaen, M., De Witte, K., & Simoens, S. (2008). Pricing strategies of originator and generic medicines following patent expiry in Belgium. Journal of Generic Medicines, 5(3), 175-187. doi: 10.1057/jgm.2008.8

Atella, V., Bhattacharya, J., & Carbonari, L. (2012). Pharmaceutical price controls and minimum efficacy regulation: Evidence from the United States and Italy. Health Services Research, 47(part 1), 293-308. DOI: 10.1111/j.1475-6773.2011.01333.x

Bate, R., & Boateng, K. (2007) Drug pricing and its discontents: At home and abroad. Health Policy Outlook, 9. Retrieved from http://www.aei.org/files/2007/08/09/20070808_22039HPO09Bate_g.pdf

Blume-Kohout, M. E., & Sood, N. (2013). Market size and innovation: Effects of Medicare part D on pharmaceutical research and development. Journal of Public Economics, 97, 327 -336. http://dx.doi.org/10.1016/j.jpubeco.2012.10.003

Carpenter, C. E. (2005). Financing mental health care. Journal of Financial Service Professionals, 59(6), 32-34.

Danzon, P. M., & Keuffel, E. L. (2013). Regulation of the pharmaceutical-biotechnology industry. In. N.L Rose (Ed.). Economic Regulation and Its Reform: What Have we Learned?  Cambridge, MA: NBER. Retrieved from http://www.nber.org/chapters/c12572.pdf

Dyck, M. J. (2007). Nursing staffing and resident outcomes in nursing homes: Weight loss and dehydration. Journal of Nursing Care Quality, 22(1), 59-65.

Grembowki, D., Paschane, D., Diehr, P., Katon, W., Martin, D., & Patrick, D. L. (2005). Managed care, physician job satisfaction, and the quality of primary care. Journal of General Internal Medicine, 20, 271-277, DOI: 10.1111/j.1525-1497.2005.32127.x

Kapphahn, C., Morreale, M., Rickert, V. I., & Walker, L. (2006). Financing mental health services for adolescents: A background paper. Journal of Adolescent Health, 39, 318-327. doi:10.1016/j.jadohealth.2006.06.002

Lakdawalla, D. N., Goldman, D. P., Michaud, P. C, Sood, N., Lempert, R. Cong, Z., de Vries, H., & Gutierrez, I. (2008). U.S. pharmaceutical policy in a global marketplace. Retrieved from http://www.rand.org/content/dam/rand/pubs/reprints/2009/RAND_RP1380.pdf

Linzer, M., Konrad, T. R., Douglas, J., McMurray, J. E., Pathman, D. E., Williams, E. S., … Rhodes, E. (2000). Managed care, time pressure, and physician job satisfaction: Results from the physician worklife study. Journal of General Internal Medicine, 15, 441-450.

Moon, M. (2011). Organization and financing of health care. In R. H. Binstock & L. K. George (Eds.), Handbook of Aging and the Social Sciences (Seventh Edition) (295-307). San Diego, CA: Elsevier Inc. DOI:10.1016/B978-0-12-380880-6.00021-6

Stoddard, J. J., Hargraves, J. L., Reed, M., & Vratil, A. (2001). Managed care, professional autonomy, and income: Effects on physician career satisfaction. Journal of General Internal Medicine, 16(10), 675-684. DOI: 10.1111/j.1525-1497.2001.01206.x

Tribeca Knowledge (2011). Pharmaceutical industry in transition: Dramatic changes ahead, how will you survive? Retrieved from http://www.youtube.com/watch?v=4-7I-t6JQKA

U.S Census Bureau (2011). The older population: 2010. 2010 Census  Briefs, C200BR-09. Retrieved from http://www.census.gov/prod/cen2010/briefs/c2010br-09.pdf

Zhang, N. J., Unruh, L., Liu, R., & Wan, T. T. H. (2006). Minimum nurse staffing ratios for nursing homes. Nursing Economic$, 24(2), 78-93.