Six Sigma for Pizza

Hong Kong Baptist University Professional Diploma in Quality Management Six Sigma and Quality Tools Group Assignment Report of Six Sigma Project For Yum Yum Pizza Group Group Members: CHIU Chi Cheong, Ricky CHOI Kam Tong, Danny CHUNG King, Carmen FONG Luk Chi, Brian LEE Lai Fun, Fanny Wong Ming Chung, Victor DQM03I2-004 DQM03I3-004 DQM03I3-021 DQM03I3-008 DQM03I3-022 DQM03I3-018 Report of SiX Sigma Project, Yum Yum Pizza Group Page 1 of 23 Contents 1. Introduction 2. Define Phase 3. Measure Phase 4. Analysis Phase 5. Improve Phase 6. Control Phase 7. Conclusion Report of SiX Sigma Project, Yum Yum Pizza Group Page 2 of 23 Introduction Yum Yum Pizza group comprises of 10 pizza shops scattering in different areas in Hong Kong Island, Kowloon and New Territory as shown on the map below. Staff in each shop are basically organized with order receptionist, baker and delivery worker. On top of these 10 pizza shops, the leadership and management works are responsible by a management team. The core business is to produce pizza of various styles and deliver to their customers according to address of the order by phone. Of course, there are also self-pick up pizza available to the customers. However, this is merely involved about 10% of the overall business. Pizza Group Shops Location P P P P P P P P P P P : Shop Location Starting from early 2003, there were occasional customer feedbacks and complaints which were mainly involved unpunctual delivery of pizza. Since 90% of the business required our pizza delivery, the management began to pay attention on these feedbacks. During the half year review in June 2003, it was discovered about 3% loss of customers and about 5% drop in pizza sales in the same period. We immediately communicated the finding with the Management. Subsequently, a project team was set up to investigate the causes and seek for improvement on the situation. After the first Report of SiX Sigma Project, Yum Yum Pizza Group Page 3 of 23 project team meeting, it was agreed that the team would adopt Six Sigma strategy to determine the cause of the problem and implement the solution. Purpose of this report is to present the results of the pizza group’s problem-solving process and explain the solution adopted. As Six Sigma problem-solving includes statistical and measurement methods, by using the stools , we focused the efforts on understanding the variations in the business process and the defects that results: Customer satisfaction Revenue Quality Impact to employees Growth of business Competitive advantages. This report also presents a detailed explanation of steps on how we used the six sigma problem-solving strategy ( i. e define, measure analysis, improve and control ) to determine the cause of losing customer , decreasing of pizza sales and to establish method in rectifying the faulty steps in our operation process. Lastly, with implementation of the fine-tuned process, reoccurrence of the defects can be minimized in order to maintain and enhance a sound pizza business operation. Define Phase To the current practice, the time required for delivery of a pizza to customer was one hour on average. With concern on the customer complaints on unpunctual delivery, sales decreasing and number of customers was found reducing in the 6-months financial review in June 2003, undoubtedly, the pizza group had to take action to rectify the situation. At the beginning, we did not know what particular problem being existed in the business. A project team was therefore set up, by using six sigma strategy to tackle and rectify the problem. After the first project team meeting, a project team charter was formulated based on the management concern and displayed as below: Report of SiX Sigma Project, Yum Yum Pizza Group Page 4 of 23 Project Team Charter – Delivery performance of pizza Business Case Opportunity Statement Current average delivery time is one hour for each We currently have an average delivery of pizza / pizzas to customer. Management delivery cycle of one hour. requires the pizza to be delivered within one hours as declared by same scales competitors in this trade of Our customers expect the business. pizza can be delivered Yum Yum Pizza group have been losing 3% of punctually within +/- 5 min. customers base per month within the past 6 months variation review, the sales have dropped in 5% (HKD135K per month) for the same period. By improving the accurate delivery time we anticipate loss of customer would be merely 1% drop and the sale would also be return to about 2% drop. With continuous implementation, the pizza sales would have 3% to 5% further increase monthly (i. e. $81K/month – $135K/month increase ) in the coming one or two years. Goal Statement -To deliver pizza from order to customer within one hour punctually – To achieve pizza delivery time within +/- 5 min. – Since this is the first six sigma project in Yum Yum Pizza Group, the current sigma process level is unknown which have to be identified and improved as the target of the project team. Activity Define Measure Analyze Improve Control Track Benefit Project Plan Start End 6/1 6/14 6/10 6/30 7/4 8/1 9/12 10/13 10/13 11/13 11/14 12/15 Project Scope Main objective – to review and improve order processing – Start – Order received from customers – End – Pizza in customer’s hand Team Selection Bob Black Belt Charles Group Manager Apple Order Receptionist Donald Baker Edward Deliveryman The project team charter submitted to management and was approved in mid May 2003. Right immediately, a brainstorming session conducted to review the business Report of SiX Sigma Project, Yum Yum Pizza Group Page 5 of 23 rocess on a high level steps. SIPOC diagram was also established with identification on Supplier, Inputs, Process, Outputs Customers for showing the current situation of the business process and is now as below : Report of SiX Sigma Project, Yum Yum Pizza Group Page 6 of 23 SIPOC Diagram – Pizza Delivery Company Supplier Inputs Process Outputs Customers Requirements †¢ Ingredients for Pizza †¢ Packaging material supplier †¢ †¢ Supplier for motorcycle †¢ Printing Company Process †¢ Ingredients †¢ Packaging materials †¢ Staff †¢ Motor cycles †¢ Order form See below †¢ †¢ Pizza Office customers Household customers Delicious †¢ Good taste †¢ †¢ †¢ †¢ †¢ †¢ Punctual delivery Step 1 Receive Order (by phone) Step 2 Production & Packaging Step 3 Motorcycle Delivery Step 4 Park & arrive delivery point Step 5 Hand in pizza to Customer & receive money Report of SiX Sigma Project, Yum Yum Pizza Group Page 7 of 23 Besides, customer surveys was also conducted to collect the impression and feedback from customers. With these â€Å"Voice Of Customers† (VOC ), we firstly developed a list of key customer issues. On the further steps, we also formulated a list of critical customer requirement as listed on the table: Voice of Customer to Critical Customer Requirement ( VOC to CCR ) Critical Customer Requirement maintain pizza at temperature 40 degree C when passing to customer inform arrival time and price in advance Key Customer Issue pizza delivered to customer should be at reasonable temperature on time delivery packing arrangement concern on price Voice of Customer Cool pizza, tasted no good Late delivery Long deliver lead time Poor packaging outlook Poor packaging spoil pizza unexpected high price impolite delivery manner ragged deliver worker – – – keep arrival time variation less than 5 min. tandard pizza package standard greeting and manner delivery worker in uniform need polite manner when passing pizza to customer reasonable worker outlook – Measure Phase To investigate and realize further improvement for fulfilling the most important requirement from customers, it was anticipated operational definition would be essential to clearly point out the criteria to our operational performance. Based on the current operation process and the established operational definition, we conducted surveys and interviews with our customer and staff to collect data on how we performed currently. Below is the table showing our data measurement plan which was designed to collect the feedbacks and opinions. As indicated, the data were collected from various sources, that included the direct feedback from customer, and we anticipated the right moment to collect these data should be right after the telephone order from customers, which was the most simple and direct method to collect the first hand information.. Report of SiX Sigma Project, Yum Yum Pizza Group Page 9 of 23 Data Measurement Plan Performance Measure Operational Definition Data Source and Location -measure the failure rate in maintaining pizza temperature not less than 40 degree -maintain pizza in standard cartoon Sample Size Who will collect the Data When will data be collected? How will data be selected? Other data that should be collected at the same time? -feedback from customer,-feedback from delivery worker, 15% of delivered pizza 1June to 30 June Randomly Pizza quality,, Bob, Black Belt -telephone ,survey / questionnaire ox with thermal indicator and ensure the temperature is not less than 40 degree C on the indicator -estimate delivery time and price of pizza, then inform customer on the arrival time right after telephone order -ride motorcycle for pizza delivery and arrive on time -packaging pizza with standard cartoon box -greeting to customer with wording -delivery worker must be wearing clean and tidy uniform standard C when passing to customer -measure the failure rate in informing arrival time an d price in advance to customer -measure the failure rate in keeping arrival time variation less than 5 min. measure the failure rate in packaging pizza in standard package -measure the failure rate of delivery worker greeting to customer by saying standard greeting and manner -measure the failure rate of delivery worker wearing uniform selected Weather situation, Traffic situation Report of SiX Sigma Project, Yum Yum Pizza Group Page 10 of 23 Pizza Ordering Sequence ( By Phone ) Customer Order Receptionist Baker Deliver Order by phone standard greeting, listen customer's order details produce and bake pizza as ordered confirm order details and customer address lan delivery route confirm delivery time, payment package pizza in delivery box collect packaged pizza, or other food items plan for production schedule put pizza and other items into delivery box of motorcycle drive to customer address get to the door of the address, ring the bell and say standard greeting check acceptance an d pay confirm delivery of pizza and other food items receive payment and customer signature on receipt, say standard goodbye and leave business case completed Report of SiX Sigma Project, Yum Yum Pizza Group Page 11 of 23 According to the established operation definition and sequence above, survey forms and questionnaires were formulated. It was also decided to perform the 500 surveys to customers randomly starting from 1 June. 2003, that involved about 15% of the pizza business during the moment. In addition to the questions devised from operation definitions, some general questions liked â€Å"Do you think choice of the pizzas is sufficient to you â€Å" and â€Å"Can you find your favorite taste among the existing available choice of pizzas â€Å" were also included in the questionnaires and survey questions to customers. Below is the table summarizing the survey results: Summary of operation defects as identified in June 2003 survey Satisfactory Defect item Operation description level Frequency not acceptable 1 maintain pizza not less than 40 degree C not acceptable 2 advise pizza arrival time not acceptable 3 variation of pizza arrival time within 5 min. cceptable 4 acceptable pizza package acceptable 5 delivery worker wearing uniform 6 acceptable greeting words fromdelivery worker acceptable 7 Do you think choice of the pizzas is sufficient to yougood Can you find your favor us taste among the existing 8 available choice of pizzas very good good 9 waiting time during telephone order for pizza 10 clear telephone communication with order receptionivery good 11 overall impression during making telephone order good %in Overall Defect 21 21. 88 18 18. 75 45 46. 88 6 6. 25 3 3. 13 3 3. 13 N. A. N. A. N. A. N. A. N. A. ( Satisfactory Level : very good; good; acceptable; not acceptable; poor ) Report of SiX Sigma Project, Yum Yum Pizza Group Page 12 of 23 Before tackling the results, we also formulated the data in Pareto Chart and calculated the process sigma for more understanding on the business situation of the pizza group. Operation Defect Rates in Pareto Chart O cc u ran n a ce F req u e n cy 100 90 80 70 60 50 40 30 20 10 P a re to C h a rt – O p e ra tio n D e fe c t a s id e n tifie d in J u n e 2 0 0 3 % in O v e ra ll D e fe c t 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% s a y i n g st a n d a r d g r e e ti n g k e e p a rri v al ti m e v a riati o n i n f o r m a rri v a l ti m e a n d sta n d ard p a c k a g e aintain te m p erature p a c kin g piz z a in w it h p o lit e m a n n e r p ric e in a d v a n c e w e arin g u nif o r m at 4 0 d e g re e C Calculated Sigma Value of the overall process ( as in June 2003 ) less th a n 5 m in. O p e r a tio nD e fe c ts 1 2 3 4 5 6 O v e ra ll Y e ild = 21 18 45 6 3 3 = U n its 500 500 500 500 500 500 DPU 0 . 0 4 2 0 . 0 3 6 0 . 0 9 0 . 0 1 2 0 . 0 0 6 0 . 0 0 6 T h r o u g h tp u C u m . Y ie ld t Y ie ld 0 . 9 5 9 0 . 9 5 9 0 . 9 6 5 0 . 9 2 5 0 . 9 1 4 0 . 8 4 5 0 . 9 8 8 0 . 8 3 5 0 . 9 9 4 0 . 8 3 0 0 . 9 9 4 0 . 8 2 5 ( Y (1 ) x Y (2 ) x Y (3 ) x Y (4 ) x Y (5 ) x Y (6 ) 0 . 8 2 5 a ro u n d 0 . 0 6 sig m a ) Report of SiX Sigma Project, Yum Yum Pizza Group Page 13 of 23 Analysis Phase In analysis phase, we had studied why all the pizza delivery to customer could not be achieved steadily within one hour. The failure rates is the highest of 46. 88% among all defects identified and it happened 45 times during the survey period with sample size of 500 survey. With further investigation on the finding, we found the traffic condition, weather condition, and the familiarity of the delivery worker to the customer address would highly affected the overall delivery time and therefore giving an â€Å" Not Punctual Impression† to customer. In addition, such delay would also caused the pizza temperature dropped below the designed 40 degree C. As the result, the number of customer decreased and pizza sales dropped. Below was the Cause-and-Effect diagram utilized for analyzing causes leading to delayed delivery. Cause-and-effect Diagram – Pizza Delivery People poor communication Machines Telephone Traffic Condition Traffic Jam Pizza Oven deliver not familar with customer's address Road excavation Motorcycle Operation process Not Punctual Pizza Delivery Typhoon kill of baking by Pizza Oven Driving Skill on Motorcycle Raining delivery box on motorcycle Cartoon box for packing pizza Methods Weather Materials For the pizza temperature, we investigated the delivery box on motorcycles and cartoon boxes currently used in packaging pizzas for delivery. No major problem was found in keeping pizza exist oven temperature. Actually, the material for keeping warm, that included delivery boxes on motorcycles and cartoon boxes, all these equipment and facilities were at an acceptable quality standard and in a sound condition. Report of SiX Sigma Project, Yum Yum Pizza Group Page 14 of 23 Cause-and-effect Diagram – Pizza Temperature People poor communication Machines Telephone Pizza Oven deliver not familar with customer's address Motorcycle kill of baking by Pizza Oven driving skill of Motorcycle delivery box on motorcycle Cartoon box for packing pizza Pizza Temperature below 40 degree C Methods Materials Analysis on other issues were also conducted, which mainly carried out with reference on the operation process, starting from customer order to the payment received from customer. Report of SiX Sigma Project, Yum Yum Pizza Group Page 15 of 23 In addition to the analysis on the collected data, FMEA was also a tool to study on recommended improvement action. The project team had also formulated a FMEA table below for showing the analyzed risk priority and recommended action. Ite m a n d F u n c tio n p la n d e liv e ry ro u te P o te n ia l F a ilu re M ode p la n b a s e d w ro n g o r o n w ro n g d e la y in fo r m a tio n d e liv e ry P o te n ia l E ffe c t(s ) of F a ilu re F M E A P ro c e ss P o te n tia l C a u se(s) o f F a ilu re A c tio n re s u lts C u rre n t C o n tro ls R e c o m m e n d e d R e s p o n s ib ility A c tio a n d T a rg e t A c tio n n c o m p le tio n D a te Severity e Occurrenc Detection RPN Severity e Detection Occurrenc RPN T aken o lle c t a n d p u t p iz z a in d e liv e ry box of m o to rc y c le d riv e to th e c u s to m e r ad d ress g e t to th e ad d ress an d rin g d o o r b e ll p iz z a d ro p p e d d u rin g c o lle c tio n need re p la c e m e n t, lo s e o f p iz z a 7 w ro n g in fo rm a tio n fro m o rd e r re c e p tio n is t o r w ro n g p la n n in g o f 9 c a re le s s o f d e liv e r 2 p la n b a s e d 5 on m ap and e x p e rie n c e 3 1 ta k e c a re in p u ttin g th e p iz z a 7 0 a s th e re a re to ta lly 1 0 s h o p s , s u g g e s t to s e rv e th e c u s to m e rs based on s p e c ific a re a o f 2 7 ta k e c a re in d e liv e ry o n tin u . b y o rd e r re c e ip tio n is ts , N ov. 03 e ffe c tiv e b y d e liv e ry w o rk e rs, N o v . 0 3 e ffe c tiv e b y d e liv e ry w o rk e rs, N o v . 0 3 e ffe c tiv e b y d e liv e ry w o rk e rs, N o v . 0 3 e ffe c tiv e b y d e liv e ry w o rk e rs, N o v . 0 3 e ffe c tiv e c o n tin u . 4 2 3 24 9 1 3 27 f a ilu re o f d e la y in m o to rc y c le , d e liv e ry tra ffic ja m d e la y d e liv e ry d e liv e r n o t f a m ilia r w ith th e p la c e o f a d d re ss c o n f irm d ro p th e d e liv e ry p iz z a w h ile a n d re c e iv e p a s s in g to paym ent c u s to m e r u n p re d ic te d tra ffic o r w e a th e r s itu a tio n 6 n o t fa m ilia r w ith th e a r e a o f c u s to m e r ad d ress 8 c a re le s s o f b o th c u s to m e r a n d d e liv e r 4 n o s p e c ific c o n tro l 6 1 6 8 lis te n to ro a d re p o rt fro m ra d io 1 0 8 a rra n g e e x p e rie n c e d e liv e r fo r s e rv in g th e a re a 3 2 b e c a re fu ll in h a n d lin g p iz z a c o n tin u . 4 3 4 48 3 n e e d m o re 6 c o n tin u . 2 2 4 16 need re p la c e m e n t, lo s e o f p iz z a tim e to p re p a re d e liv e ry p la n 1 b e c a re fu ll in h a n d lin g p iz z a c o n tin u . 8 1 4 32 T o ta l R is k P rio rity N u m b e r R e s u ltin g R is k P rio rity N u m b e r Report of SiX Sigma Project, Yum Yum Pizza Group Page 16 of 23 After analyzing the survey data and cause of operation defects, we had also analysed the relationship of the customer requirement against our group available technical and internal resources , that included analysis on communication tools, listening skill, baking skill, packaging devices, delivery equipment and even the manner of delivery workers etc. The purpose was to had a thorough understanding on the internal strength and weakness of Yum Yum Pizza Group. Below was the quality function deployment matrix utilized for the analysis. As indicated on the diagram, the highest score of 27 was found on â€Å" Keep arrival time variation less than 5 minutes â€Å". That meant it should be the first issue to be resolved for improving the pizza business Quality Function deployment Matrix VS : Very strong relationship w w Thermal sensing tape w w Good knowledge of road condition and driving skill S : Strong relationship W : Weak relationship VS Well equipped pizza bakery Communication tools Manner training Cartoon pizza box Good baking skill Technical requirement Good conditioned motorcycle Accurate watch Tidy uniform CCR Pizza at temperature 40 degree to customer Inform arrival time & price in advance Keep arrival time variation less than 5 minutes Standard pizza package Standard greeting and polite manner Proper dressed delivery worker Low pizza price Delicious Score 24 18 9 9 9 9 9 9 9 3 3 27 10 9 9 9 9 1 9 1 1 1 3 1 1 9 1 9 5 22 Report of SiX Sigma Project, Yum Yum Pizza Group Page 18 of 23 Improve Phase Based on the analyzed information, the project team understood that the methodology, facilities and including the operation behavior of staff are at acceptable level. The most serious and uncontrollable factor is the traffic or road condition and weather situation, which was mostly serious item affecting the arrival time of pizza to customer. To minimize this factor, the Project Team recommended the entire services areas of the Pizza Group to be separated into 10 services zones. And each shop would response to serve the pizza customers’ within the defined zone. Should there was any order outside the their responsible zone, the order receptionist had to refer the orders to the responsible shop to produce and deliver the pizza by their own resources. However, whenever there was any order outside all the 10 service zone as shown on the map of responsible zone, the receptionist had to estimate the delivery time and immediately explain to the customer for the estimated time required. Even the delivery time would exceed the pre-designed one hour delivery period, with this clarification the customer would understand the situation without wrong expectation on the pizza delivery. As such, complaint on unpunctual pizza delivery should be kept to the minimal. Below were the modified operation process chart with the changes marked in brown and the map showing the responsible service zones of the 10 pizza shop for reference. Responsible Zones of Pizza Shops P Hou se Hou se P P Hou se P Hou se P Hou se P Hou se P Hou se P Hou se P Hou se P Hou se P Responsible Service Zone Report of SiX Sigma Project, Yum Yum Pizza Group Page 19 of 23 Pizza Ordering Sequence, after process restructuring ( By Phone ) Customer Order Receptionist Order Receptionist of responsible area Baker Deliver Order by phone standard greeting, listen customer's order details confirm order details and customer address confirm delivery time, payment Plan for production schedule produce and bake pizza as ordered plan delivery route pack pizza in delivery box collect packed pizza, or other food items Review for production area put pizza and other items into delivery box of motorcycle continue pizza production locally drive to customer address get to the door of the address, ring the bell and say standard greeting check acceptance and pay confirm delivery of pizza and other food items receive payment and customer signature on receipt, say standard goodbye and leave business case completed Report of SiX Sigma Project, Yum Yum Pizza Group Page 20 of 23 Control Phase For monitoring operation performance, control chart was utilized to collect operation data. The chart could distinguish the process variation resulting from common causes or special causes. It was aware that variation in the pizza operation was unavoidable. Number of factors including material, machines, methods, environment and operators were the major elements causing variation. For easily reflecting and controlling the overall performance of the pizza delivery, X-bar & R chart was selected for the monitoring and controlling purpose. Measures Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Day 10 No. ( min. ) ( min. ) ( min. ) ( min. ) ( min. ) ( min. ) ( min. ) ( min. ) ( min. ) ( min. 1 56 57 58 55 55 60 54 58 54 59 2 59 49 53 52 59 57 52 57 58 56 3 58 57 54 52 49 55 52 54 55 53 4 50 52 49 54 53 68 63 51 56 59 5 52 53 52 52 49 56 52 53 47 52 6 52 54 53 54 59 64 63 53 56 53 7 58 57 48 57 59 57 64 59 51 53 8 56 54 57 59 52 52 55 54 52 59 9 57 51 63 51 51 59 51 59 51 53 10 53 50 50 57 63 53 54 56 54 59 11 49 56 52 53 64 62 48 54 48 54 12 59 49 59 53 56 57 52 58 52 57 13 59 57 62 59 64 52 70 52 53 52 14 52 52 55 54 52 59 54 53 54 53 15 51 59 51 49 51 53 57 57 57 58 16 55 53 54 55 54 60 47 55 54 57 17 57 54 49 56 52 53 47 52 59 57 18 52 49 59 49 49 53 56 53 52 52 19 53 52 59 57 49 59 51 54 53 59 20 54 53 52 52 55 54 52 57 55 53 21 57 57 51 59 51 70 51 52 60 56 22 64 52 64 53 54 69 54 53 53 52 23 65 53 62 54 49 56 52 53 62 53 24 63 54 52 49 59 69 59 53 56 49 25 59 53 50 54 53 54 53 55 57 55 Average Range == X == R __ UCL X __ LCL X 56 16 53. 48 10 54. 72 16 53. 96 10 54. 44 15 58. 44 18 54. 52 23 54. 6 8 54. 36 15 54. 92 10 = 54. 944 ( min. ) = = = 14. 1 ( min. ) 57. 1013 ( min. ) 52. 7867 ( min. ) __ UCLR __ LCLR = = 21. 7281 6. 4719 Report of SiX Sigma Project, Yum Yum Pizza Group Page 21 of 23 Average 63 62 61 60 59 58 57 56 55 54 53 52 51 50 1 2 3 4 5 Day 6 7 Performance Requirement Min. __ UCLX __ X __ LCLX 8 9 10 Range 40 35 30 25 20 15 10 5 0 1 2 3 4 5 Day 6 7 8 __ R UCL __ R Min. __ LCLR 9 10 Report of SiX Sigma Project, Yum Yum Pizza Group Page 22 of 23 The above data was collected within 10 operation days from mid Oct. o mid Nov. It was obvious that the operation on a heavy rainy, day 6 was the worst. There were totally 4 deliveries required more than 65 minutes to complete, which exceeded the operation definition. This was still out of our control. With comparison with the performance before the project improvement, it was found that the defect rate was great ly improved as summarized below : Summary of Operation Defects Comparsion between June 2003 / Dec. 2003 June 2003 Dec. 2003 Frequenc % in Overall Frequenc % in Overall y Defect y Defect 21 21. 88 7 20. 59 18 18. 75 5 14. 71 45 46. 88 10 29. 41 6 6. 25 6 17. 65 3 3. 13 3 8. 82 3 3. 13 3 8. 82 item 1 2 3 4 5 6 Operation description maintain pizza not less than 40 degree C advise pizza arrival time variation of pizza arrival time within 5 min. acceptable pizza package delivery worker wearing uniform acceptable greeting words from delivery worker Conclusion Even though it was not 100% rectified all the operation defects, with the great improvement on the pizza delivery, the defect rate on pizza temperature was also improved. The sigma value on the overall pizza delivery of the group was greatly improved to 1. 5 sigma and the pizza sales as reviewed in end Dec. 2003, 5% increased was identified in comparing with the sales figure six months before. Sigma level after implement of new operation process: OperationDefects Units DPU Throughtpu Cum. Yield t Yield 1 7 500 0. 014 0. 986 0. 986 2 5 500 0. 01 0. 990 0. 976 3 10 500 0. 02 0. 980 0. 957 4 6 500 0. 012 0. 988 0. 946 5 3 500 0. 006 0. 994 0. 940 6 3 500 0. 006 0. 994 0. 934 Overall Yeild = = Y(1) x Y(2) x Y(3) x Y(4) x Y(5) x Y(6) 0. 934 ( around 1. 502 sigma ) It was concluded, implementation of the improved operation process was essential to the business. With the continuation implementation of the improved process and current good taste of pizza with variety choice to customer, the pizza sales was expected gradually increased with number of customer increased as well. Report of SiX Sigma Project, Yum Yum Pizza Group Page 23 of 23

Ethical Philosophies of Machiavelli and Subramanian Essay

One of the greatest comparisons of all time is to contrast Niccolo Machiavelli’s â€Å"The Prince† with V. K. Subramanian’s â€Å"The Chanakya: Kautilya. † Critically, a look can be taken into several different elements of each author’s work to best compare and contrast them. To that end, a look will be taken at the political, social, and ethical philosophies of Machiavelli and Subramanian to determine how they differ and in which ways the philosophies are similar. Niccolo Machiavelli’s The Prince† in the early 1500’s as a way of adding his insight from what he had seen of politics and hereditary principality—even though â€Å"it was plagiarized during Machiavelli’s lifetime†¦[and] was never published by him†¦[making] the text [itself as] still disputable† (Machiavelli 11). While current versions of â€Å"The Prince† are attributed to him, this fact of plagiarism and publishing fraud make the work even more intriguing, given the subject matter itself. Of the work itself, Machiavelli said that â€Å"I pour myself out as fully as I can in meditation on the subject, discussing what a principality is, what kinds there are, how they can be acquired, how they can be kept, why they are lost; and if any of the fancies ever pleased you, this ought not to displease you; and to a prince, especially to a new one, it should be welcome† (Machiavelli 11). Machiavelli dedicated the work itself to Lorenzo de’ Medici, even after he was put to torture by the family for treachery. Machiavelli’s methods are one of unique significance as he is writing, having been there, in the thick of things. Essentially, â€Å"The Prince† is meant as a guidebook on how to rule in all princely matters for Lorenzo de’ Medici. Machiavelli wrote about how hereditary principalities worked, how to keep that inheritance, and even how a prince could gain a new principality, and how a prince should rule his people and act, as a prince, and politically. While Machiavelli essentially confined his writings to obtaining fortune, keeping and obtaining power, and virtue as a leader, a look can be taken into his writings to discover the philosophies beneath his ideas. In comparison, V. K. Subramanian’s â€Å"The Chanakya: Kautilya† was published in 1980 about and are translated from are translated from three works known as the â€Å"Chankyasutras,† the â€Å"Chankyanitidarpan† and the â€Å"Arthshastra† and are based upon the time in history around 300 BC. The intro of Subramanian’s work notes that â€Å"Chanakya, also known as Kautilya and Vishnugupta was the famous Indian Machiavelli who was responsible for the overthrow of the last ruler of the Nada Dynasty and the enthronement of Chandragupta Maurya†¦there is an interesting story about Chanakya’s first encounter with Chandragupta, which ultimately ended in their collaboration and capture of power† (Subramanian 1). Subramanian’s work, then, is a direct reflection of Machiavelli’s own. What makes them similar, however, despite the men within the tales, is the philosophies shared between the two. Machiavelli’s political philosophy is perhaps the easiest to pinpoint as the very purpose of his work revolved around the necessity of a prince to reign successfully. Machiavelli, actually, mainly focused on the political aspects of maintaining and gaining principalities. He notes that â€Å"let any one now consider with what little difficulty the king could have maintained his position in Italy had he observed the rules above laid down, and kept all his friends secure and protected; for although they were numerous they were both weak and timid, some afraid of the Church†¦and thus they would always have been forced to stand in with him, and by their means he could easily have made himself secure against those who remained powerful† (30). Machiavelli is urging his prince to take note of the past and understand that had the king protected his weaker neighbors, he would have not only gained them as allies—but also could have gained them as part of his reign. And, at all costs, he should protect his allies as he would protect his own lands. Politically, being a stronger power, he would have been made into the â€Å"leader,† who they would be indebted to and would follow with more loyalty than any money could purchase. And, to Machiavelli, the art of gaining allies and principalities, even de facto ones, was the art to be achieved. Even more so, Subramanian’s fourth maxim entitled â€Å"Advisors, Aides, Counselors, Ministers,† notes that â€Å"after equipping oneself fully, one should seek an ally (aide), one without an advisor has no certainty of counsel, one wheel does not move (the vehicle), the true aide serves alike in prosperity and adversity, a self respecting ruler should appoint as counselor, one who is inferior to him, and respects him†¦deflection to the enemy takes place due to negligence† (22-25). In this, Subramanian agrees wholeheartedly with Machiavelli’s statements. To be a successful ruler, allies must be taken and protected, first and foremost, before true rule can begin. The reason being, that with allies, a force become much stronger, incrementally, with each ally added. Furthermore, each ally must be protected and cared for to ensure their cooperation—but with that cooperation comes an extended kingdom. Indeed, Machiavelli’s social philosophy can be found within his writings on obtaining fortune. Machiavelli writes that â€Å"principalities are either hereditary, in which the family has been long established; or they are new†¦. such dominions thus acquired are either accustomed to live under a prince, or to live in freedom; and are acquired either by the arms of the prince himself, or of others, or else by fortune or by ability† (21). Machiavelli is commenting, simply, that the way in which a prince gains land is two-fold: either he inherits it or he fights for it. The manner in which the prince gains and obtains his land, however, is what makes the prince either beloved by his people or hated. For Machiavelli, gaining the most principalities possible by virtuous means was the ideal result. And, as he instructed his prince, it was best to be good, socially, if any hopes of maintaining that principality are held. In fact, Machiavelli comments that, for example, â€Å"Louis the Twelfth, King of France, quickly occupied Milan, and as quickly lost it; and to turn him out the first time it only needed Lodovico’s own forces; because those who had opened the gates to him, finding themselves deceived in their hopes of future benefit, would not endure the ill-treatment of the new prince† (23). Moreover, â€Å"it is very true that, after acquiring rebellious provinces a second time, they are not so lightly lost afterwards, because the prince, with little reluctance, takes the opportunity of the rebellion to punish the delinquents, to clear out the suspects, and to strengthen himself in the weakest places† (24). Thus, not only is it important for a prince to be clear in his occupation in a land, to become most beloved, he must first get rid of the troublemakers—thus leaving the peaceable, and willing to be occupied. If a prince does not take this step, he is left in hostile territory with people willing to stage an overthrow. On contrast, Subramanian writes out a few of the maxims of Chanakya, citing that â€Å"economic prosperity creates prosperity for the people, if the people are prosperous, even a leaderless state can be governed, people’s fury is the greatest of furies†¦[and] to be without a master is better than having an arrogant master† (22). In this, the two authors cannot be more different from the other. Machiavelli believes that the first step of any prince should be to take a firm grasp upon his principalities, to conquer new ones, and to rout the dissenters by force before they can rally for an overthrow. Machiavelli believes that by getting rid of the rebellious people before they can act, a leader can sustain and mark his position within his land, taking charge before the people even really know that it has happened. Then, once all the rebellion has been stamped out, a leader can begin to make his land prosperous. However, Subramanian cites a very different kind of social philosophy, making note that a leader might as well not exist if he intends to be a tyrant to the people, that a people have more respect for a man intent on prosperity, first, and rebellion last. Because, in an attempt to rout the dissenters, a leader would make a dent on the value the people hold for him—and thus their fury would remain. To really be a true leader and be beloved by his land, a leader must intend on affluence and prosperity as his bottom line. Finally, Machiavelli’s ethical and moral philosophy requires the most interpretation to highlight significantly. As Machiavelli writes about virtue in a leader, instructing a prince on how to act and behave, an ethical philosophy is formed. On contrast, Subramanian’s ethical philosophy stems from his ethical roots maxim that states â€Å"righteousness is the root of happiness, wealth is the root of righteousness, the state of the root is wealth, victory over senses is the root of the state, humility is the root of sense control, worship of elders is the root of humility, wisdom results from the worship of elders, with wisdom one can prosper, the prosperous one becomes the victorious one†¦[and] the victorious one obtains all the riches† (21-22). Despite it’s cryptic fortune-cookie nature, Subramanian’s writings do indeed have a fine message on ethical philosophy, here. In explicating the words, Subramanian is saying that to be a good leader, on must first be righteous, but to be righteous, one must first have wealth, to have wealth, one must first have victory, to have victory, one must first have humility, to have humility, one must listen to their elders to obtain wisdom, and with that wisdom a leader can prosper and be victorious in all they seek to achieve. The value here, is that Subramanian notes the significance of wisdom in all things. Without wisdom and following and heeding the elders who have come before, a leader stands no chance of being successful. Morally, a leader is obligated to his people to be triumphant so that the land can prosper, but without wisdom, a leader is nothing to his people but a tyrant. Subramanian says what Machiavelli does not. To Machiavelli, leading a people, by first disposing of the bad ones, is the best way for a prince to prosper in his lands. While he encourages his prince to be sound and wise, he first sends out the encouragement that the prince must always guard his assets, for fear of being overthrown or taken down by a greater force. To Machiavelli, obtaining land and prospering was, essentially, about war. To win that war, a prince had to be wise, and indeed, listen to his elders as well, but not in the ethical sense. Machiavelli meant for the prince to watch out for himself, first and foremost, and then, once the land became prosperous, Machiavelli encouraged the prince to be good to his people so that they would love him and understand that they were prosperous because of him. To Machiavelli, the ethical philosophy came last, after conquering and protecting one’s principalities. Overall, one of the greatest comparisons of all time is to contrast Niccolo Machiavelli’s â€Å"The Prince† with V. K. Subramanian’s â€Å"The Chanakya: Kautilya. † Taking a look at several different elements of each author’s work critically revealed a great level of significance as to their philosophies on politics, socially, and even ethically. Politically, Machiavelli and Subramanian follow the same philosophy, which intends a leader to find and protect allies first and foremost. As to social philosophy, however, the two authors cannot be more different. Machiavelli intends his prince to take charge and stamp out rebellion, while Subramanian cites that prosperity and kindness should be shown towards the new land. And finally, ethically, the two authors also differ. Machiavelli is intent on a prince who focuses on war and conquering new lands, and in this way a leader can gain wisdom and insight—however, to Subramanian, wisdom only comes by following one’s elders. Morally, a leader is obligated to his people to be triumphant so that the land can prosper, but without wisdom, a leader is nothing to his people but a tyrant. Works Cited. Machiavelli, Niccolo. The Prince. Trns. W. K. Marriott. New York: Plain Label Books, 1910. Subramanian, V. K. Maxims of Chanakya: Kautilya. India: Abhinav Publications, 1980.

The management report Essay Example | Topics and Well Written Essays - 2500 words

The management report - Essay Example They must have the greatest leverage on both time and costs and for the case study; the report explores the manner in which Zara appreciates both of these to their success. The report explores the ways in which Zara utilizes these three pillars of its operations to a resounding success; (Tolga 2010, p.63, Peters 2011, p.8) posit that short lead time, lower quantities and a greater variety. The short lead time philosophy adopted by the company has aided the firm to churn out more fashionable clothes. Lower quantities of production often leads to more supply while greater variety of styles leads to more choice and more frequency of determining customer needs. The report will finally consider company A, an apparels company which does not manufacture, but operating in the high end of the city’s prime located district. The report will offer the management of the store a variety of recommendations which are in tandem with the reports results from the analysis of Zara Company. Zaraâ €™s Critical Success factors According to Barnes and Lea-greenwood (2006) flexibility in both design and production ultimately determines the success of a company especially in the fast paced fashion world. This report has identified and explored critical success factors relating to the organizational, technological and managerial impetus that have contributed to the effectiveness and success of the firm within the confines of the case study given. The company employed a number of strategies that catapulted it to success, enabling it to overtake other firms to be the leading apparels maker in the world, although under the banner of the parent company. Organizational Factors Zara operates on strategic organization; the company has enhanced communication flow from production to retail. The designers receive feedback from those operating the stores regarding customer tastes and preferences regarding clothes, the colors and etc. Zara focuses in its internal market having control in nearly every stages of the product flow, management theorist refer to such behaviour as internalization theory. When they expanded into foreign market, Zara still maintain its internal aspect and does not follow the typical trend of other competitors. Zara’s in-house business model enables overcoming the market imperfection better (Vrijhoef 2011, p.196).   Zara protects all know-how within the firm from design to ready item since it keeps all production in-house. From the case study one can gather that the business structure adopted by Zara tends to be more closely controlled, and that the firm pays keen attention by having the various business elements in close proximity to each other, around its head quarters in La Coruna, Spain. Unlike the competitors, Zara does not outsource for production from overseas countries that offer cheap labor, where majority of its competitors have pitched camp to take advantage of the low costs. The company closely controls most of its operat ions from the head office in Spain, including production and retail. For example, Zara procures most of its dyes from one of the subsidiaries of the parent company. This is a vertically integrated business s structure; through town his structure, the company has been able to offer their customers products at affordable prices and control

Multinational company Research Paper Example | Topics and Well Written Essays - 3000 words

Multinational company - Research Paper Example In order to find out reasons for divergence in work attitude of Japanese and German employees, the study has also assessed professional orientation of employees from mentioned countries. In the final section, on the basis of theoretical and empirical research findings, a relativistic overtime payment model has been proposed. Implementation of the recommended model has also been discussed in the report. Concept of statistical performance management has been used to formulate the proposed recommendation. Almost 30 years ago, Hofstede (1980) had developed the concept of cultural dimensions in order to understand ways in which cultural and personal orientation of people differs with change in geographic locations. In such context, Dong and Liu (2010) argued that organizational leaders not only need to manage cultural diversity, but also have to deal with diversity of expectations of employees nourished in different cultural dimensions. Consideration of research works of Jamal (2005) reveals the fact that, multi-national enterprises (MNEs) face three levels of problems in managing cultural diversity such as, cross-cultural knowledge sharing, development of team collaboration among cross-cultural employee pool and standard reward system for all employees. It is evident from the theoretical argument that MNEs face range of difficulties while managing different perspectives of cross-cultural diversity within organizational environment. In such a backdrop, a new leader of an organization h as approached the researcher, who is working as a consultant, to develop a report by evaluating reasons for the employees in Japan and Germany to have different attitudes towards work. From previous study, it has been found that Japanese employees are happy to work additional hours without pay, while German employees expect to be paid for every extra hour of work. As part of the report, the study will use the concept of cultural dimensions in order to understand

Gambling in Cyberspace the Ethical Dilemma Essay

Gambling in Cyberspace the Ethical Dilemma - Essay Example With the technological advancements, it has become increasingly important to understand ethics related to this phenomenon such as concerning privacy and security issues (Lim, 2007). Online gambling has emerged as one of the most debated issues when the ethics of information technology is discussed. This can be attributed to the fact that gaming industry has started to sweep across the American nation, and as such, a flood of ethical issues has been in tandem with it (Ho?rnle and Zammit, 2010). This paper will discuss the ethical dilemma of gambling in cyberspace. Introduction Online gambling is officially considered to have started on 18 August 1995 when Internet Casinos Inc. put the first virtual casino upon the internet. This site offered 18 different online gambling games. The online gambling industry gained prominence and in less than four years, it had exploded. It is estimated that in 1996 alone, about $1.2 million had been wagered online. It was estimated that this amount had increased to $10 billion annually by 2000 (Dunnington, 2003). Online gambling has grown over the years to have an effect on many people and spheres of the American society. For example, a number of states in recent years have taken it upon themselves in implementing commercial casinos in order to generate takes, as well as provide monetary relief for state governments facing budget deficits. It has however been observed that gambling has led to addiction thus raising ethical issues in the society (Spapens, Littler and Fijnaut, 2008). It is argued that it has led to increase in crime, as well as social and psychological problems associated directly with losing. Nonetheless, from an economic point of view, online gambling help to create jobs and generate taxes for state governments. It is estimated that gambling industry influences about one million are directly or indirectly. As such, while it presents some ethical issues, there are economic benefits to justify it. It is because of t his reason that there has been ethical dilemma regarding gambling, and more particularly about online gaming (Gainsbury, 2012). Primarily, there are two main standpoints for the ethical dilemma of gambling in cyberspace: the arguments against online gambling and arguments made for online gambling. The opponents of online gaming argue that it further confuses the legality issue, as it blurs the line between illegal and legal gambling. Different states have varying position on gambling and therefore confusion reigns from one state to another on varying extent (Ho?rnle and Zammit, 2010). According to available data, 48 states have certain forms of legalized gambling such as casino games, racetracks, and lotteries. However, they lack or have little consistency in gambling laws. Some states have outlawed casino gambling but have made them legal based on reservations. The critics of online gambling further argue that it breeds addiction. In some cases, online gaming has been criticized of giving access to millions of people who would otherwise not have access to such amount of money. Therefore, it has led the society to have more gamblers and so more addicts of gambling (Harrison, 2000). The consequence of this has been that some people have even sacrificed their homes and jobs over the need of paying off gambling debts. This has caused depression and stress on the affected individuals

Editorial Overview Essay Example | Topics and Well Written Essays - 250 words

Editorial Overview - Essay Example Likewise, there is a need to check on sentences that were too long and which necessitate the use of appropriate punctuation marks. As such, the author is recommended to go through the manuscript in greater detail to make the necessary proofreading and corrections, as deemed necessary, prior to final submission and publication. In addition, the content needs to be revised in terms of reliability and accuracy of the information that were presented. For instance, in the prologue, as Detective Inspector Richard Moore was noted to remove the dead man’s possession, one of the items mentioned was â€Å"a thick silver wrist wetch (check spelling, should be watch), a birthday present from his wife† (Attached Fiction Essay par. 1). The author should add more details to explain how he knew that the watch was a present from the dead man’s wife (for instance, viewing from the inscriptions at the back of the watch). Overall, the manuscript was well-written and could be considered for publication after addressing the points and issues that were above

Paradise lost Essay Example | Topics and Well Written Essays - 500 words

Paradise lost - Essay Example Knowledge is compared to food and needs no less (Milton, 1905, p. 45). Wisdom to folly, as nourishment to wind. The influence of wind by tossing or creating turbulence in mind is a metaphor used to direct state the mind. The use of virginity to illustrate originality and innocence is revealed in the several lines of the poem. The use of â€Å"her Virgin Fancies pouring forth more sweet (v 291-97). Though Eve is revealed as a Matron latter on, the original status calls her a virgin because she does not know evil and she is an innocent nature spirit. In modern language, literary use is occasional, with the main approach being on the use of metaphor. Several issues in the society are addressed by the use of metaphor such as pass away to illustrate death. The current literature books address almost all the literary devices that can be used to evaluate the different contemporary literature (Milton, 1905, p. 67). Compared to paradise lost, the current literature such as water for elephant employs the use of metaphor in defining the life of the young man Jacob Jankowski. The young man’s life is depicted clearly through the use of metaphor and the other stylistic devices such as irony (Gruen, 2011, p. 34). Suspense and metaphor use in the book illustrates the power of literary devices. The use of styles that facilitate the development of interest to read the book. The exposition of Jacobs’s depression illustrates the beauty of the story with continued use of illustrative language and the development of understanding of t he overall plot of the novel. The behavior of the characters is explained by use of metaphor and epic similes making modern literature similar to the traditional literature such as paradise lost. In response to the different plots, the use of literary device is changed, by the authors, to suit the style of writing. The novel Paradise Lost has employed the use of metaphor significantly, with the statements being used,

Benefits For Company Of Upgrading To Microsoft Office 2010 Essay

Benefits For Company Of Upgrading To Microsoft Office 2010 - Essay Example In the details, it talks about the essential features of the MS Office 2010. And the last part of the report tells about the summary and the action that will be made. The purpose of this report is to change the software package the Encoder Power Plus Company (EPPC) is using and introduce the newest software package to help the workers work more productive and more effective. Encoder Power Plus Company is one of the famous encoder companies that accepts encoding and grammar checking jobs of different paper works. Most of their customers are students and workers. One of the major technologies the workers are using is the computer and one of the major software packages they are using is the Microsoft Office 2007. Recently, orders were rapidly increasing. Despite the fact that 200 workers are in the company, some orders are still not completed in time. It has been discovered from the personal interviews done and from the general discussion between the workers and the employers that due to the incomplete features of the MS Office 2007, these lead the workers to do some orders manually. The reason behind this is that some important features that are very useful and important to the encoding jobs aren’t included and are limited in the software package MS Office 2007. Due to these problems that have been discovered, it is essential to change the current MS Office 2007 to the newest one that will have the answers to the problems encountered, the MS Office 2010. The MS Office 2010 has the following features that will best help the workers: Basing from the information gathered, in order to change the currently used MS office, we need to upgrade the supported operating system. I used the internet and the Microsoft Corporation to gather the information about the cost of the product and the other essential features of the recommended package. The estimation of the cost of the product and the upgrading of the OS is about $50,000.

Critical questions Research Paper Example | Topics and Well Written Essays - 500 words

Critical questions - Research Paper Example Firstly, the development of the oil drilling plant in the water leads to congestion in the marine life, in turn, making them migrate to spacious areas. Oil spillage to the water caused by the drilling can lead to the release of toxins. Subsequently, when marine life encounters the toxins, they get genetic disorders and even death. The machines used to drill the oil are operated by humans and use fuel to do a lot of things. These machines usually need cooling occasionally, and the cooling usually takes place in the water. This leads to the transmission of the heat and ends up heating the surrounding water thus cause temperature imbalance1. In turn, this imbalance causes the marine organisms that live the surroundings to migrate to favorable environments. Concurrently, the heat may also lead to the death of the marine life around due to exposure to extreme temperatures. Lastly, offshore drilling leads to pollution in the water by damping wastes such as mud and other rock particles onto the surface of the water. The quest for making the mode of transport more efficient has been there over an exceedingly long period in history. We have evolved from animal transport, to carriage carts and now to cars and more sophisticated modes of transport. Nevertheless, this evolution has come with a cost. Cars have made our day-to-day lives easier making the movement from one place to another fast. The use of cars has led to the environmental degradation through the constant emission of fumes and gasses to the air. These fumes and gasses, when inhaled by human beings and animals, can cause respiratory problems. For example in human beings, apart from the respiratory problems, these fumes with toxins can cause serious diseases like lung cancer. The infiltrations of the harmful fumes have also led to global warming because of allowing the penetration of harmful rays to the ecosystem. This is because of global warming. The extraction of fuel from the earth has also

Current Market Conditions Competitive Analysis Essay

Current Market Conditions Competitive Analysis - Essay Example For that reason, this paper shall undertake a thorough analysis of the history, products, market, and target price of McDonald’s. Further, this shall also touch on various issues related to competition in the national and international food industry, especially on subjects concerning price target, financial conditions, and market shares. Current Market Conditions and Competitive Market Analysis History of McDonalds McDonalds is the largest hamburger fast food chain restaurant in the world today. It currently serves 119 countries with at least 68 million customers every day (Yahoo Finance, 2012). McDonald was born in 1940, with its first branch opened to public by Richard and Maurice McDonald in California. It was in 1948 that the restaurant adopted and advanced the standards of contemporary "fast-food" restaurant, which has already been adopted by White Castle hamburger within the past 20 years. Despite the initial soaring success and growing public patronage, the restaurant w as provisionally closed in 1948 in order to revamp its services (Juan Pollo, 2011). Three months later, the company re-opened with its newly adopted production line standards, which include the drive-in service (Ivanova, 2011). In 1955, a food mixer, businessman, and salesman, Ray Kroc, joined the company as a chartered agent. He later acquired the restaurant from the McDonald brothers and managed its wide-ranging, international expansion (Ivanova, 2011). Kroc recognized that if he takes advantage of the opportunity to become a franchising agent, it would expand the company worldwide, and would bring so much promise to his future. Still in 1955, another McDonald restaurant was launched in Des Plaines, Illinois. Also, Fred Turner, who would later become the restaurant’s chairman, was signed up as a â€Å"counter man† (Ivanova, 2011). In 1963, the business started to proliferate at a much faster rate. It already had 500 restaurants (Ivanova, 2011). The restaurant had its initial stock sharing price of 22.50 dollars per share by 1965. Two years later, the company would expand internationally, beginning to open in US neighbors and borders like Canada and Puerto Rico until today when it has reached countries worldwide. The company had big modifications on its service system, which include the first-ever Drive-thru. The first drive-thru was employed in a branch in Arizona. The Drive-thru system had become one of the most victorious enactments that the company had carried out. Not long after, the company began to flourish so rapidly. It had invaded Europe with countries like Spain and Denmark, as well as some parts of Asia, which include the Philippines. By the closing of 1983, it had an astonishing 7,778 restaurants in only 32 countries internationally (Ivanova, 2011). Today, the company is heavily regarded as the largest fast food chain the world, with at least 32 thousand branches in 119 countries worldwide (Yahoo Finance, 2012). The concept and rule of this growth is to provide "high quality, standardized products to all customers" (Ivanova, 2011). Each McDonald restaurant is being managed autonomously through the company's franchising system. McDonalds Products McDonald’s products are basically classified into several categories: hamburgers, salads, desserts, chicken, pork and/or fish sandwiches, fries, soft drinks,

Private labels and their effect in the market Essay Example for Free

Private labels and their effect in the market Essay Introduction   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The intense competition in retail markets has driven retailers to offer their own products that have somewhat similar quality at affordable price. The so-called â€Å"private label† becomes an attractive solution for customers that cannot afford to buy branded products.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   According to global survey on private labeling, performed by AC Nielsen in 2005, they found that consumers in 38 markets continue accepting private labeling as good alternatives especially in markets where private labeling has existed for a long time. On average, in the Europe like Pacific regions, private labeling is perceived to be preferred choice by 78% of their consumers, followed by North America (77%), and Asia (51%). In terms of individual country, private labeling becomes the most preferred choices in Netherlands (91%), followed by Portugal (89%), and Germany (88%) (Shelf Impact, 2005).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The situation suggests that private labeling now becomes the savior for consumers and serious threat for branded producers. Since the private labeling has been adapted in many countries worldwide, this paper will discuss about private labeling of Welch Foods in United Arab Emirates (UAE). Company Background   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Welch Foods is a well-known producer of juices, jams, and jellies made from Concord and Niagara grapes. Since the company only produces particular type of grapes that only grows in the United States and some parts of Canada, it becomes the Welch’s competitive advantages.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   However, as globalization and open market policies are adopted by several countries to ensure fair competition, Welch Foods face serious threats as giant retailers start aggressively their private labeling strategy on variety of products including juice products. Private Labels and Its Impacts on market   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   By definition, private labeling refers to products or services that produced or manufactured by one company to offer under another company’s brands. Usually, retailers’ name appears on the packaging of the products and offer customers much lower price than other branded products.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In case of Welch Foods that face intense competition from other branded juice products and private label in the UAE, the company must deal with private labeling strategies that retailers or supermarkets performs. Therefore, in order to cope with pricing strategies that retailers perform to undermine branded products, Welch Foods have two options.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   First is to form an agreement with retailers to produce store brands for the retailers. This private labeling of Welch has following benefits: It prevents competitors (juice producers) to take opportunity of private labeling with retailers/supermarkets Reduce promotion costs since it is such a joint promotion program Obtaining more shelf space in retailers’ outlets   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The second option is to produce second layer products if the retailers have conducted private labeling with Welch’s competitors. By delivering second layer products, the company can match the retailers’ private label products. Case of Welch Foods in United Arab Emirate (UAE)   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The fast growing of private label industry also exist in the United Arab Emirates (UAE). During the Private Label Middle East (PLME) – Dubai 2007, the number of foreign companies that are interested in entering UAE through private label strategy is increasing (AME Info, 2007).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The situation suggests that Dubai becomes one target market of private label industry. AME Info refers Dubai as the gateway to private label industry ion the Middle East in which in the exhibition there are about 100 exhibitors from more than 20 countries want to enter UAE through private labeling.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   According to AC Nielsen survey, 84% of UAE consumers know at least one private label. This is much better than United Kingdom of Saudi Arabia (only 67%). Due to the intense competition in retail industry, Welch Foods must provide counter strategy to compete with already-in-market private labels.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In simple ways, Welch Foods must perform marketing plan that consist of the following activities: Identification and Choosing Market Segments   Ã‚  Ã‚  Ã‚  Ã‚   For most products, there are always a number of different markets into which the product can be sold. Furthermore, within each market there are also a number of market segments that will also need special attentions. These segments are based on age, sex, tastes and preferences, religious beliefs, demography, income, etc. The importance of identifying and choosing between these different segments lies in several requirements. First, identifying between market segments is required to tailor the product quality characteristics. Second, it is important for designing promotional efforts. Third, it is important to design distribution and sales strategies. Designing the Marketing Mix   Ã‚  Ã‚  Ã‚  Ã‚   The marketing mix design (product, place, promotion and price) is derived from the identification of market segments performed earlier. It is the answer to some of these questions: who will be our customers?, where are our customers?, what are the average income level of our intended customers?, who are our competitors?, what are their apparent strengths and weaknesses?, how will our product be better?, how will our product be distributed?, etc. Enhance Packaging and Building Brand Image   Ã‚  Ã‚  Ã‚  Ã‚   The first impression obtained by consumers about any product comes from its brand image and packaging. A simple attraction toward product label or packaging could lead to a lifetime of product loyalty. Thus, the design of a label, design of a package and the quality of materials used for packaging is a critical factor that has considerable influence in determining sales number.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   (‘Marketing’. n.d; Lake, 2005) Reference: AME Info. (2007). Private label industry on growth path across the Middle East. Retrieved November 15, 2007 from http://www.ameinfo.com/135804.html Gordon, I.H. (1999). Relationship Marketing: New Strategies, Techniques, and Technologies to Win the Customers You Want and Keep Them Forever. John Wiley and Sons John Stanley About.com. (2007). Brands versus Private Labels. Retrieved November 07 from http://retailindustry.about.com/library/uc/02/uc_stanley2.htm Kotler, Philip. (2000). Marketing Management. New Jersey: Prentice Hall Lake, Laura. (2005). How To Develop a Marketing Strategy in 5 Easy Steps. Retrieved November 14, 2007 from http://marketing.about.com/cs/advertising/ht/5steps2strategy.htm SBA. (2003). Target Market. Retrieved November 14, 2007 from Available at: http://www.sba.gov/starting_business/marketing/research.html Shelf Impact. (2005). Consumers: Private label ‘good alternative’ to other brands. Retrieved November 14, 2007 from http://www.shelfimpact.com/archives/2005/09/consumers_private_label_good_a.php

Brain Swelling in Pediatric Cerebral Malaria

Brain Swelling in Pediatric Cerebral Malaria 1.5T MRI to Investigate Potential Etiologies of Brain Swelling in Pediatric Cerebral Malaria Abbreviations: Red Blood Cell (RBC) Parts per billion (ppb) Cerebral malaria (CM) Blood brain barrier (BBB) Abstract Objective: Cerebral malaria (CM) remains a common cause of death in African children. The pathologic hallmark of pediatric CM is sequestration of parasitized red blood cells in the cerebral microvasculature. Recent Malawi-based research utilizing a 0.35T MRI has established that severe brain swelling is associated with fatal CM, but the etiology of brain swelling remains unclear. Autopsy and clinical studies suggest several potential etiologies, but technical limitations of 0.35T MRI precluded optimal investigations into swelling pathophysiology. A 1.5T MRI in Zambia allowed for further investigations including susceptibility weighted imaging (SWI). SWI is an ideal sequence for identifying regions of sequestration and microhemorrhages given the ferromagnetic properties of hemozoin and blood. Methods: Using 1.5T MRI, Zambian children with retinopathy-confirmed CM underwent imaging with SWI, T2, T1 pre- and post-gadolinium, DWI with ADC and T2/FLAIR sequences. Results: Sixteen children including two with moderate/severe edema were imaged. All survived. Gadolinium extravasation was not seen. Cerebral perfusion was intact with DWI abnormalities sparing the gray matter. SWI findings consistent with microhemorrhages and parasite sequestration co-occurred in white matter regions where DWI changes consistent with vascular congestion were seen. Findings consistent with posterior reversible encephalopathy syndrome as a cause of swelling were also present. Interpretations: High field MRI findings indicate that vascular congestion associated with parasite sequestration, local inflammation from microhemorrhages and autoregulatory dysfunction contribute to brain swelling in CM. Keywords: sequestration; venous congestion; hemozoin Introduction: Pediatric cerebral malaria (CM), defined as P. falciparum peripheral parasitemia and unarousable coma with no other coma etiology evident, primarily affects children in sub-Saharan Africa [1]. Although antimalarial agents provide rapid parasite clearance, mortality rates remain high (8-25%) [2, 3]. The pathological hallmark of pediatric CM at autopsy is intravascular sequestration in which parasitized red blood cells (RBCs) adhere to the endothelium of cerebral microvessels. Although malaria causes almost a million deaths per year, neuroimaging capacity is typically limited in malaria-endemic regions. Only one large MRI case series from Malawi using a 0.35T MRI has provided insights into the in vivo structural abnormalities associated with pediatric CM [4]and CM mortality [5]. Other studies and case reports using higher field MRIs have been performed on adults [6, 7], but adult CM appears to represent a different disease syndrome [8]. In adult CM, coma onset largely occurs some days after illness onset in the setting of multisystem organ failure often including hepatic dysfunction, renal failure and gross electrolyte abnormalities. As such, the coma of adult CM is clinically dominated by the effects of a toxic, metabolic encephalopathy. In contrast, in pediatric CM coma onset occurs very early in the malaria illness, often as one of the first signs of the illness, with very limited hepatic or renal involvement and no evident systemic cause for coma. MRI insights gained from imaging pediatric CM to date have been limited to low field MRI technology. The recent pediatric CM MRI study used 0.35T technology to establish that increased intracranial pressure due to increased brain volume is the cause of death in CM [9], but the low field MRI technology was unable to further evaluated the potential etiologies of brain swelling in pediatric CM, so the underlying cause(s) of cerebral edema in CM remains unclear. Further study delineating the underlying cause(s) of swelling is needed to develop appropriate interventions. Potential etiologies suggested by autopsy and clinical studies include any/all of the following: (a) blood brain barrier (BBB) breakdown with resultant vasogenic edema [10, 11]; (b) impaired perfusion resulting in cell death with cytotoxic edema [12]; (c) vascular congestion due to occlusion at the post-capillary venules [13]; (d) hyperemia with auto-regulatory dysfunction due to endothelial injury and CM-associated seizures, anemia and hyperpyrexia [14, 15], [16]; and (e) diffuse cerebral microhemorrhages (i.e. ring hem orrhages) [11]. Hemozoin is an iron-rich breakdown product of the parasites metabolism of hemoglobin [5]. Hemozoin is present primarily in mature, sequestered parasites. Thus, susceptibility weighted imaging (SWI) [17], which is extremely sensitive to the magnetic field inhomogeneity caused by ferromagnetic substances, is an ideal imaging sequence for identifying regions of parasite sequestration. SWI also offers the ability to identify small hemorrhages on the order of several  µg of blood per gram of tissue [18],[19]. We hypothesized that imaging retinopathy-confirmed pediatric CM with a 1.5T MRI including DWI, SWI and gadolinium enhanced sequences would identify pathophysiological mechanisms underlying cerebral edema in pediatric CM and undertook an imaging study of CM in Zambia where 1.5T MRI is available specifically seeking evidence of blood brain barrier breakdown, impaired perfusion, parasite sequestration, autoregulatory dysfunction and microhemorrhages. Material and Methods: Subjects and Recruitment During the malaria seasons (Jan-June) in 2012-2014, comatose children with retinopathy-confirmed [20] CM underwent brain MRI on the 1.5T MRI scanner (Siemens Magnetom Essenza using Syngo MR 200 4A version software, Germany) at the Cancer Diseases Hospital in Lusaka, Zambia within 24 hours of admission. Inclusion criteria were: (1) admission to the pediatric high care unit of the University Teaching Hospital, (2) a Blantyre Coma Score of à ¢Ã¢â‚¬ °Ã‚ ¤ 2 [21], (3) P. falciparum infection as determined by a Paracheck Rapid Diagnostic Test (RDT), (4) the presence of malarial retinopathy, and (5) no other evident etiology for coma. A thick peripheral blood smear to identify parasitemia was also obtained prior to recruitment, but was not immediately available and was not required for inclusion. All children received standard antimalarial treatment, anticonvulsants, antipyretics, antibiotics and blood transfusions, as clinically indicated and in accordance with national treatment guidelin es. As per present treatment standards, no steroids were given. Children with comorbid meningitis as determined by cerebrospinal fluid analysis were excluded from enrollment. Written consent was obtained from the childs parent or guardian. Children with impaired renal function (creatinine à ¢Ã¢â‚¬ °Ã‚ ¥2.0) did not receive gadolinium. This study was approved by the Institutional Review Boards at the University of Zambia, Michigan State University and the University of Rochester. Imaging Gadolinium (Magnevist) doses were determined by individual patient weight and administered intravenously (0.2 mL/kg, 0.1 mmol/kg) by hand injection. The scanning protocol is provided in an appendix. Apparent diffusion coefficient (ADC) calculations were provided by the standard Siemens software algorithms [22]. SWI phase images were collected unfiltered and post-processed with a 6464 high pass filter then viewed using SPIN (signal processing in nMR) software. SWI was also collected with a shorter echo time (15ms) for some subjects to avoid potential aliasing [17]. Interpretation Images were reviewed independently by two radiologists (MJP; neuroradiologist, and SDK; MRI fellowship trained radiologist) and data were managed using NeuroInterp, a web-based program that allows radiographic findings to be entered into a searchable and quantified database [23]. Reader discrepancies, determined in advance of the analysis, were reevaluated by the two radiologists to develop a consensus interpretation. Increased brain volume, the imaging finding associated with fatal cerebral malaria, was rated on a scale from 1-8 with 3 being no edema, 1 and 2 indicating atrophy. An edema score of 4-5 indicated minimal-mild edema, with no loss of sulcal markings. Grade 6 (moderate edema) was defined as loss of some sulcal markings. An edema score of 7 represented moderate/severe edema with diffuse sulcal and cisternal effacement universally evident but without herniation present, and the severe edema score of 8 required sulcal and cisternal effacement with evidence of herniation. MRI findings coded within the NeuroInterp database that could plausibly be associated with the five potential pathogenic mechanisms of brain swelling in CM were then reviewed. Specifically, (a) to evaluate diffuse BBB breakdown causing vasogenic edema, we looked for evidence of gadolinium enhancement [24], (b) to assess for impaired perfusion and subsequent cytotoxic edema we looked for gray matter diffusion weighted imaging (DWI) abnormalities [25], (c) evidence for vascular congestion or venous micro-occlusion was sought by looking for white matter DWI abnormalities [26], (d) autoregulatory dysfunction was evaluated by looking for focal regions of symmetric hemispheric edema of varying confluence in regions susceptible to autoregulatory vulnerabilities [9, 27], and (e) SWI abnormalities were assessed clinically and quantitatively based upon effective voxel susceptibility with the anticipation that these would be located in the same anatomical regions as ring hemorrhages and sequest ration have been identified in prior autopsy studies [28]. Given the small anticipated sample size ( Results: Patient Characteristics and Data Acquisition Twenty three children met study inclusion criteria during the enrollment period. Parents declined participation for 2 children and 5 children were deemed too ill to transfer for imaging or died before imaging could be performed, so 16 subjects were imaged5 (31%) were male and the mean age was 6.4 years (range 1-15). Table 1 provides demographic data and admission clinical characteristics from the 16 subjects who were imaged. Of the 5 consented children who were not imaged, 3 died. Among the 16 subjects imaged, the scans for one patient was non-diagnostic on the SWI sequence due to movement artifact. Renal function could not be ascertained on two children, so these subjects did not receive gadolinium. There were no fatalities among the imaged study subjects and none had clinical sequelae evident at discharge. Table 2 provides the frequencies of the 1.5T MRI findings identified and captured in NeuroInterp. MRI Findings Increased brain volume: None of the subjects had severe (grade 8) edema. Moderate/severe (grade 7) edema was present in 2/16 (13%); moderate (grade 6) edema in 4/16 (25%); minimal/mild (grade 4 5) edema in 7/16 (44%) and no edema in 3/16 (19%). T2 signal changes: The total number of cases exhibiting white matter increased T2 signal was 12/16 (75%), and two distinct patterns were observed: primarily subcortical (10/12, or 83%) and primarily periventricular/peritrigoneal (2/12, 17%) (Figure 1). These generally occurred in isolation; only 2 cases had both findings. Gadolinium enhancement: The expected normal physiological intravascular and circumventricular organ enhancement was evident in all subjects on the post-contrast images (Figure 2). A small region of subtle focal cortical enhancement was seen in one subject with positive SWI signal and no associated T2 abnormalities consistent with a capillary telangiectasia. There was no evidence of gadolinium extravasation in the other 13 patients who received contrast. Cortical findings: Cortical swelling and increased T2 signal was seen in 10/16 (63%), but these signal abnormalities were relatively mild in extent, confluent, and without associated cortical DWI findings. Increased cortical T2 signal was generally diffuse, with only 2/16 (13%) having a posterior predominant pattern [4]. DWI showed restricted water diffusion in the subcortical white matter in 10/16 (63%) which was confirmed by accompanying ADC maps. Basal Ganglia and Thalamus Abnormalities: The structures in the basal ganglia had different levels of involvement. T2/FLAIR signal abnormalities were present in the globus pallidus and putamen in 10/16 (63%), and the caudate in 9/16 (56%). While frequently involved simultaneously, there was generally a region of predominance (Figure 3). Regional differences were also illustrated in the DWI images. Fifty six percent of subjects had DWI abnormalities in the globus pallidus, 13% in the putamen and none in the caudate. Pontine and Brainstem Signal Abnormalities: This was assessed at two levels, within the pons at the level of the middle cerebellar peduncle and within the brainstem at the level of the substantia nigra. Pontine involvement was seen in 9/16 (56%) and brainstem in 11/16 (69%). Abnormalities were usually diffuse, and consisted of generalized increase in T2 signal. However, focal areas of involvement were also seen. Corpus callosum: Showed increased T2 signal and thickening in 10/16 (63%) with 6/10 having associated positive DWI findings as confirmed by ADC maps. The splenium was the primary site of involvement in 9/10 (90%) of cases. SWI Findings: Decreased signal is defined as a positive SWI finding as it localizes to areas of magnetic field inhomogeneity caused by the presence of a ferromagnetic substance (Figure 4). SWI findings were noted along the regions of the venules of both the superficial and deep venous systems corresponding to areas of parasite sequestration and ring hemorrhages. SWI resolution did not allow distinction between gray and white matter involvement in the cerebellum. One SWI dataset was not interpretable due to severe motion artifact. In the remaining cases, 7/15 (47%) showed abnormal paramagnetic signal within the following regions of the parenchyma: corpus callosum (7/15, 47%), sub-cortical white matter (6/15, 40%), cerebellum (5/15, 33%), lenticulae striate (5/15, 33%), and periventricular white matter (2/15, 13%). In two subjects, both the internal capsule and optic radiation had abnormal paramagnetic signal. The susceptibility of heavily infected red blood cells is ~1880 parts per billion (ppb) relative to water [18]. The effective voxel susceptibilities in the corpus callosum and junction of the cortical gray and white matter was 50 ppb relative to water in SWIM. As distributed within the voxel, this represents a 1/38th decrease in susceptibility. Given the voxel size of 0.5 x 0.5 x 2.0 mm3, this represents 1/78th  µL. Assuming the capillary volume is ~5% (or 1/20th of the pixel) [29], this indicates that ~half of the capillaries are filled with hemozoin. The combination of moderate to severe symmetrical cortical swelling (edema score of 6 or 7), with corresponding underlying subcortical white matter changes with associated DWI and ADC findings was evident in 4/16 (25%) of cases (Figure 5) with two of the four showing a predominantly posterior distribution. Table 3 summarizes the MRI findings seen using 1.5T in 16 Zambian children with CM in the context of the proposed mechanisms for brain swelling in CM and the 1.5T MRI findings anticipated for each mechanism. Discussion: MRI findings using a 0.35T MRI have shown that death from pediatric CM occurs due to increased brain volume [9] but low field MRI was unable to further delineate the etiology for the brain swelling. Interventions studies aimed at reducing or preventing cerebral edema in CM would ideally target the underlying mechanism of swelling. Existing clinical and autopsy data suggest at least five potential etiologies for brain swelling in CM. In this study, we describe what the MRI findings associated with each of these potential etiologies would be and then used 1.5T MRI in children with retinopathy-confirmed CM to identify the presence or absence of findings consistent with each of the five proposed etiologies. As such, the results of this study can be subdivided into evidence both for and against these specific potential origins of brain swelling in pediatric CM. Decreased SWI signal was evident on the brain MRIs of children with CM and furthermore these changes were seen in regions where autopsy studies have shown microhemorrhages (Figure 6) as well as in the regions where sequestration is common. Since the SWI signal effectively identifies blood and hemozoin, both sequestration and ring hemorrhages were likely identified. Marked T2/DWI abnormalities were evident in the subcortical brain regions most sensitive to venous outflow obstruction. If perfusion is obstructed in regions with SWI signal changes, then blood flow to the tissue would decrease by ~50% which is consistent with what is seen in an animal model of malaria where blood flow was found to be reduced to 53% +/- 12% [29]. In the setting of the sequestration-associated SWI abnormalities and intact large venous drainage systems (i.e. no venous thrombosis), the T2/DWI findings are strongly suggestive of a venous obstruction phenomenon in the capillary bed system. Much of what is known about pediatric cerebral malaria has been learned from autopsy studies, so it is reassuring to see that the distribution of microhemorrhages and parasite sequestration found in prior autopsy studies are very similar in distribution to the microhemorrhages and parasite sequestration identified in living children who survived CM. Vasogenic edema was demonstrated by increased T2 signal in the white matter. Cytotoxic edema has a similar appearance, but is accompanied by restricted water motion identified by increased DWI signal. Both were evident in this cohort, with cytotoxic being more common. This tended to be significant and diffuse. None of these children died and there were no clinical sequelae at discharge, suggesting that the process is reversible, and may represent early cytotoxic edema rather than tissue infarction. MRI findings of symmetrical cortical swelling with underlying white matter changes were seen, consistent with posterior reversible encephalopathy syndrome (PRES) and suggestive of autoregulatory dysfunction. Pediatric CM is congruent with many other clinical conditions associated with PRES. Specifically, pediatric CM generally involves a rapid neurologic deterioration, usually in the setting of seizure, followed by relativity prompt full recovery in most patients. Radiographically, brain swelling with underlying vasogenic edema associated with positive DWI findings is the hallmark of both CM and PRES [4, 16]. Autoregulatory dysfunction as a result of the primarily endothelial process associated with parasite sequestration in CM may result in vasoconstriction coupled with hypoperfusion causing vasogenic edema and associated brain swelling. This is the favored theory for the etiology of the radiographic findings seen in PRES [27]. We found no evidence of cortical cytotoxic edema and there was no radiographic evidence of gadolinium enhancement although gadolinium was clearly seen within the vessels and in circumventricular organs. Gadolinium, as a contrast agent, is chelated by a range of very small molecules (Magnevist 0.54kDa)[30]. These agents are all hydrophobic, so they do not cross the intact BBB. At autopsy in CM, areas of sequestration show fibrinogen (340kDa)[24] leakage and ring hemorrhages which require sufficient BBB breakdown to allow a deformable, non-parasitized blood cells (7  µM) to escape. The SWI imaging in this study identified ring hemorrhages so some BBB breakdown associated with their presence must have occurred, but if there was associated gadolinium extravasation, the quantity and concentration of gadolinium was insufficient to be visually evident on MRI. Gross BBB breakdown indicative of severe vasogenic edema was not evident in this small series of non-fatal pediatric CM. This study is limited by the small sample size, less severe disease spectrum, and lack of a comparison group. In Zambia, children felt to be at risk of imminent death were not imaged since transport for imaging there requires ambulance transportation to an adjacent facility. The small number of subjects prevented meaningful quantitative analyses despite the use of NeuroInterp. Although no a prior analyses were planned, we did conducted a post-hoc comparison to determine if the edema score or the presence of SWI, DWI, or focal cortical abnormalities was associated with age, coma duration prior to admission or the seizures prior to admission. No associations were found (all ps >0.05). The absence of subjects with severe brain swelling or fatal disease may have impacted our findings, as florid BBB breakdown might not occur to a significant degree in less severe CM. Normal MRIs on a similar aged comparison group were not available. In the Zambian setting, most imaging is obtained on adva nced disease with normal images being uncommon. Acquisition of imaging in an age-comparable group of healthy children was not feasible given the risk of sedation, particularly in this environment. Finally, more quantitative MRI analyses would have allowed more optimal assessments, but the power injections equipment required to obtain perfusion studies and/or dynamic contrast enhanced studies, which could detect contrast influx too small to be visually evident, is prohibitively expensive and was not available in this resource limited setting. Conclusions: Pediatric CM brain MRI findings in non-fatal cases using 1.5T technology suggest that vascular congestion, autoregulatory dysfunction, and microhemorrhages likely contribute to brain swelling pathogenesis. References [1] WHO, World Malaria Report, 2011. http://www.who.int/malaria/publications/world-malaria-report-2016/report/en/ [2] A.M. Dondorp, C.I. Fanello, I.C. Hendriksen, E. Gomes, A. Seni, K.D. Chhaganlal, K. Bojang, R. Olaosebikan, N. Anunobi, K. Maitland, E. Kivaya, T. Agbenyega, S.B. Nguah, J. Evans, S. Gesase, C. Kahabuka, G. Mtove, B. Nadjm, J. Deen, J. Mwanga-Amumpaire, M. Nansumba, C. Karema, N. Umulisa, A. Uwimana, O.A. Mokuolu, O.T. Adedoyin, W.B. Johnson, A.K. Tshefu, M.A. Onyamboko, T. Sakulthaew, W.P. Ngum, K. Silamut, K. Stepniewska, C.J. Woodrow, D. Bethell, B. Wills, M. Oneko, T.E. Peto, L. von Seidlein, N.P. Day, N.J. White, Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial, Lancet 376(9753) (2011) 1647-57. [3] M.E. Molyneux, T.E. Taylor, J.J. Wirima, A. Borgstein, Clinical features and prognostic indicators in paediatric cerebral malaria: a study of 131 comatose Malawian children [see comments], Q J Med 71(265) (1989) 441-59. [4] M.J. Potchen, S.D. Kampondeni, K.B. Seydel, G.L. Birbeck, C.A. Hammond, W.G. Bradley, J.K. DeMarco, S.J. Glover, J.O. Ugorji, M.T. Latourette, J.E. Siebert, M.E. Molyneux, T.E. Taylor, Acute brain MRI findings in 120 Malawian children with cerebral malaria: new insights into an ancient disease, AJNR Am J Neuroradiol 33(9) (2012) 1740-6. [5] F. Paul, S. Roath, D. Melville, D.C. Warhurst, J.O. Osisanya, Separation of malaria-infected erythrocytes from whole blood: use of a selective high-gradient magnetic separation technique, Lancet 2(8237) (1981) 70-1. [6] D.D. Rasalkar, B.K. Paunipagar, D. Sanghvi, B.D. Sonawane, P. Loniker, Magnetic resonance imaging in cerebral malaria: a report of four cases, The British journal of radiology 84(1000) (2011) 380-5. [7] S. Vyas, V. Gupta, A. Hondappanavar, V. Sakhuja, N. Bhardwaj, P. Singh, N. Khandelwal, Magnetic resonance imaging of cerebral malaria, The Journal of emergency medicine 42(5) (2012) e117-9. [8] R.J. Maude, F. Barkhof, M.U. Hassan, A. Ghose, A. Hossain, M. Abul Faiz, E. Choudhury, R. Rashid, A. Abu Sayeed, P. Charunwatthana, K. Plewes, H. Kingston, R.R. Maude, K. Silamut, N.P. Day, N.J. White, A.M. Dondorp, Magnetic resonance imaging of the brain in adults with severe falciparum malaria, Malaria journal 13 (2014) 177. [9] K.B. Seydel, S.D. Kampondeni, C. Valim, M.J. Potchen, D.A. Milner, F.W. Muwalo, G.L. Birbeck, W.G. Bradley, L.L. Fox, S.J. Glover, C.A. Hammond, R.S. Heyderman, C.A. Chilingulo, M.E. Molyneux, T.E. Taylor, Brain swelling and death in children with cerebral malaria, N Engl J Med 372(12) (2015) 1126-37. [10] H. Brown, S. Rogerson, T. Taylor, M. Tembo, J. Mwenechanya, M. Molyneux, G. Turner, Blood-brain barrier function in cerebral malaria in Malawian children, Am J Trop Med Hyg 64(3-4) (2001) 207-13. [11] K. Dorovini-Zis, K. Schmidt, H. Huynh, W. Fu, R.O. Whitten, D. Milner, S. Kamiza, M. Molyneux, T.E. Taylor, The neuropathology of fatal cerebral malaria in malawian children, The American journal of pathology 178(5) (2011) 2146-58. [12] N.A. Beare, S.P. Harding, T.E. Taylor, S. Lewallen, M.E. Molyneux, Perfusion abnormalities in children with cerebral malaria and malarial retinopathy, J Infect Dis 199(2) (2009) 263-71. [13] M.J. Ponsford, I.M. Medana, P. Prapansilp, T.T. Hien, S.J. Lee, A.M. Dondorp, M.M. Esiri, N.P. Day, N.J. White, G.D. Turner, Sequestration and microvascular congestion are associated with coma in human cerebral malaria, J Infect Dis 205(4) (2012) 663-71. [14] P. Brodersen, O.B. Paulson, T.G. Bolwig, Z.E. Rogon, O.J. Rafaelsen, N.A. Lassen, Cerebral hyperemia in electrically induced epileptic seizures, Arch Neurol 28(5) (1973) 334-8. [15] I. Prohovnik, S.G. Pavlakis, S. Piomelli, J. Bello, J.P. Mohr, S. Hilal, D.C. De Vivo, Cerebral hyperemia, stroke, and transfusion in sickle cell disease, Neurology 39(3) (1989) 344-8. [16] W.S. Bartynski, Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features, AJNR Am J Neuroradiol 29(6) (2008) 1036-42. [17] E.M. Haacke, Y. Xu, Y.C. Cheng, J.R. Reichenbach, Susceptibility weighted imaging (SWI), Magn Reson Med 52(3) (2004) 612-8. [18] S. Hackett, J. Hamzah, T.M. Davis, T.G. St Pierre, Magnetic susceptibility of iron in malaria-infected red blood cells, Biochim Biophys Acta 1792(2) (2009) 93-9. [19] T. Bosemani, S.I. Verschuuren, A. Poretti, T.A. Huisman, Pitfalls in Susceptibility-Weighted Imaging of the Pediatric Brain, J Neuroimaging (2013). [20] N.A. Beare, T.E. Taylor, S.P. Harding, S. Lewallen, M.E. Molyneux, Malarial retinopathy: a newly established diagnostic sign in severe malaria, Am J Trop Med Hyg 75(5) (2006) 790-7. [21] M.E. Molyneux, T.E. Taylor, J.J. Wirima, A. Borgstein, Clinical features and prognostic indicators in paediatric cerebral malaria: a study of 131 comatose Malawian children, Q J Med 71(265) (1989) 441-59. [22] Siemens, MRI Protocols 2010. http://www.healthcare.siemens.com/magnetic-resonance-imaging/magnetom-world/clinical-corner/protocols. [23] M.J. Potchen, S.D. Kampondeni, K. Ibrahim, J. Bonner, K.B. Sey

Reducing Bullying in the Nursing Environment

Reducing Bullying in the Nursing Environment Introduction Bullying is any repeated and systemic behaviour that expects to victimise, humiliate, undermine or threaten towards others, which can impact on physical and psychological well-being. Bullying has been considered as unaccepted workplace behaviour that affects occupational health and safety, and should not be tolerate in any form (Ref). This paper will provide an analytical discussion of the relevant literature of bulling in nursing environment. Rationale regards to the need of changing management plan will be outlined. The plan will utilise Lewins three steps of change theory as a guide to modify the specific phase of change. In addition, it will address the strategies for evaluating the plan outcomes. Finally, this paper will conclude insightfully highlighting main concerns about decreasing bullying behaviour in nursing environment. Literature review Workplace bullying exists in every professional. Particularly, bullying in healthcare environment has been internationally recognised and researched. 70% of US registered nurses who participant in a survey reported being bullied at work. 87% of Turkish nurses stated being bullied in another nursing survey (Ref-Barbara S. Broome). In addition, UK health care reported that recent evidence showed 85% of nurses have been involved in bullying or witnessed a bullying (Ref-Malcolm A. Lewis) and (Ref-Sharon J. Stagg) found 40% of participants never reported bullying in their study. (Ref-A typology of bullying behaviours) state that due to lack of descriptive standard to identify bullying behaviours, which leads to less of effective interventions for reducing bullying behaviours. In addition, the absence of identification of bullying behaviours, bullying acts may be commonly interpreted as office policies or personality differences. The consequences of bullying acts are seriously impact on many aspects, which include nurses, organizations and patients. According to (Ref-Michelle Cleary), the current working environment in health care setting is oriented to maintain safe practices at the meantime also to achieve effectiveness outcomes in day-to-day patients care management. Therefore, under this pressure, it is more likely to create a blaming environment. Nurses who work in a climate of bullying may lead to job dissatisfaction, which, in a way that nurses may resist come to work or call sick leave to avoid facing bullies, and present low productivity in the wards. The bulling acts may impact on both physical and psychological wellbeing, which the frequent outcomes for bullying are headaches, stress, irritability, anxiety, sleep disturbance, excessive worry, impaired social skills, depression, fatigue, loss of concentration, helplessness, psychosomatic complaints, and post-traumatic stress disorder (Ref-Michelle C leary). In addition, the bullied employees from (Ref-LARS JOHAN HAUGE)s study express that they feel more role ambiguity and conflicts in the working environment, therefore, they have less social contact and communicate with colleagues that leads to poor job control and poor management. (Ref-Terri Townsend) states that up to 70% of bullied nurses leave the job, 60% of new RNs quit their first job in 6 months and a third of new graduate nurses think they choose the wrong career. (Ref-Terri Townsend) also introduce a term survivor syndrome, which means bullied nurses would either to quit the job to find another healthier work environment or adapt to the bullying behaviours as part of the culture and become a bully or bystander. When the nurses leave this professional as a result of bullying, the organization has to spend more money for recruitment and re-orientation for new nurses to replace the position. Furthermore, resulting from frequent nursing staff turnover the customer satisf action will decrease and patients may not get continuous care which may impact on patients safety issues (Ref-Michelle Cleary). (Ref- John S. Murray) expresses that the most common reason of nurses may bully others is the need of being in control of everything in the work environment. (Ref- Barbara S. Broome) also states these bullies are narcissistic. Their personality characterized as controlling and manipulative, which means that they like to dominate in interpersonal relationships. These people are self-centred that indicates low empathy, and they normally do not feel guilt over the time by bullying others. Another point of view from (Ref- Workplace bullying in nursing), they believe the educational system foster a belief that the dominate group (normally are senior staffs) is superior and the oppressed group (normally are new staffs) is inferior, therefore, the inferior has to obtain the demand from the superior. (Ref- John S. Murray) also points out that the organization may connive the bullying behaviours in some cases, due to the bullies are senior managers or staffs. The bullies are protected instead of the victims, which has prompted the bullying behaviours existing in the healthcare environment. Many studies have suggested that the organization has to establish zero tolerance policy and legislation to reduce bullying behaviours in healthcare settings (Ref-John S. Murray, Barbara S. Broome, Workplace bullying in nursing). (Ref- Barbara S. Broome) suggest that education will help nurses to recognize the bullies and bullying behaviours and provide strategies to eliminate bullying, meanwhile, they state that education on bullying should not only be provided in work environment but also be implemented in universities and continuing education program that empower new graduates to identify bullying behaviours. In addition, Hutchinson (2009) states the current approaches to bullying are remedial, corrective, regulatory and restorative. Remedial and corrective strategies are focus on individual aspect, to provide counselling to the victim, to mediate between perpetrator and target, and to educate and modify the perpetrators behaviours. Regulatory and restorative strategies are focus on organizational aspect, to provide prohibitive statements about bullying and to make the perpetrator to make amends (Hutchinson 2009). These strategies are more focus on punishing and blaming the perpetrator which has shown ineffectiveness on reduction of bullying. Hutchinson (2009) proposes another strategy named shared responsibility: a restorative approach to bullying, which will not focus on criticising the perpetrator but make the bullying behaviours at the centre. Ref recommend that two parties and their supporters need to come together to discuss the bullying situation, share the concern, share the solution of what can do to repair the harm and what can be done to prevent bullying behaviours in the future. It is important to learn forgiveness and create a non-blaming and non-judgemental working environment (Hutchinson 2009). Rationale for plan The reason to prompt the change management plan is several complaints from anonymous staffs that they feel being bullied by verbal humiliated, given more workload or hidden information from other staffs, which they have expressed their experience like: My preceptor rolled her eyes and looked at me like I was stupid every time I asked her a question. I finally stopped asking. Doesnt she realize Ive only been a nurse for 3 weeks? (Ref- Terri Townsend) Our new manager didn’t like me from the start. Within a month, she was assigning me more and more extra tasks until I couldn’t get them all done. When I tried to talk to her about my workload, she said I should be able to handle it because I was the one with the master’s degree. Later she fired me, stating I didn’t meet our department’s expectations, even though I had several complimentary letters from patients and other managers. (Ref- Terri Townsend) In addition, in those complaints, some have mentioned that they dont feel comfortable to work with certain people, thus, they called sick leave, which has alerted the management that the level of care has been decreased due to patients dissatisfaction and shortage of nursing staffs in the ward that cannot provide effective nursing care. The nursing co-ordinator from the ward has stated that she has to call more agency nurses to replace the regular staffs, whereas, this ward has almost reached the agency budget. If nurse has resigned from the facility as a result of bullying, this may cause financial burden to the organization. The organization has to pay for recruitment, training sections and orientation for new nurses, which leads approximately $15,000 directly extra cost per nurse (Ref- Reiter). Therefore, the rationale for the change management plan would be decrease the incident of bullying, increase bedside nurses retention and increase job satisfaction, which may indirect to improve customer satisfaction as a result of increased level nursing care, decrease financial burden to the facility and build up a better reputation for this facility in the industry. Change Management Plan The change management plan will be guided by Lewins change management model, which includes three phrases: unfreeze, change and refreeze. Unfreeze Identification of what has to be changed needs to be determining in this phrase (Ref- Mind Tools). As the anonymous complaints have come to my attention, these complaints will be considered as feedbacks regarding bullying behaviours in this organization. An initial survey will be conducted throughout the facility to address staffs awareness of bullying and if they willing to make a change in the work environment. A second anonymous survey will also be conducted to gather personal experiences and attitudes from bedside nurses about work related bullying and how they deal with the bullying behaviours. The surveys allow the management to understand the current perception and interaction of bullying within this organization and also motivate staff to be involved in this changing process. Another key to change is to make the organization to implement the plan, which means we have to motivate the organization to accept the idea of change is necessary for the facility and support the change (Ref- Mind Tools). The feedback from the staffs has indicated that the bullying behaviours have affected the nurses performance in daily nursing care. Bullying has decreased the nursing staffs productivity, which leads the quality of care has decreased. Customer satisfaction has decreased as a result form patients cannot receive adequate level of care, in a way that the organizations reputation would damaged. In addition, the nursing coordinator and the human resource manager expressed that high turnover rate in nursing staff, which has directly made the organization cost extra money for each replacement of nursing position. Therefore, in order to maintain reputation, quality of care and reduce financial burden, the organization has to make a change management plan. Change The transition from unfreeze to change will not happen quickly as staffs and the organization has to take time to adapt and accept the new ways of working. In this phrase, people may have questions about the process, such as what is coming and who will be benefit. Clear explanations and honest approach will help dispel rumours (Ref- Mind Tools). As the nursing coordinator and I will explain the coming events , which will include developing zero tolerance policy and legislation, providing education sessions to address workplace bullying and establishing pathway to report bullying behaviours. Staffs may be afraid of being punished because of bullying. Therefore, shared responsibility: a restorative approach to bullying from Hutchinson (2009) would be a useful theory to learn. It is also important to inform employees that the plan aims at the behaviours, not to criticise or punish people. The outcome of the change management plan would be create a non blaming nursing culture in this fac ility, which the nursing staffs will have a nice working environment and prompt them to stay in the profession. The organization will be benefit from the retention of nursing staffs, which reduces costs as a result from nursing turnover. Empowering the involvement is also important for the changing process. In-services sessions will be held to provide an opportunity for employers and employees to have a face-to-face discussion of identification of bullying and how to deal with bullying, which allow both parties being participate in the process, promote understanding between each party and promote the transition to adapt to the workplace culture smoothly (Ref- Mind Tools). In addition, to establish a pathway of reporting bullying will help the management immediately react to any bulling behaviour that can develop new experiences and attitudes toward dealing with bullying. Refreeze In this phrase, the change has adapted to the nursing culture in this facility and we need to develop ways to maintain the effectiveness of change within the facility. For instant, encouraging the nurses unite managers to take the leadership and support their nursing staffs in each ward, frequently collecting feedback from staffs regarding on bullying experiences and running workshops or simulations to keep staffs knowledge about bullying is up to date. Strategies The aim of auditing is to promote and share best practices in order to provide effective care in daily basis. Developing an auditing is not to criticise poor practices, but by analysing the poor practices will help nurses know and realize what goes wrong and what cloud do better in patients care, in a sense that this will prevent the same incident happen again (Ref- Cummins). Therefore, using auditing is the way to assess the outcomes of the change plan. The short term outcomes of audit may show high rate of bullying, the reason would be the nursing staffs are more able to identify the bullying acts in the work environment. However, we would expect that the incident rate would not go up in the long term period. Feedback from nursing staffs will hopefully provide positive responses regarding to bullying, which can motivate the organization to utilize further education on bullying to improve nursing environment. Survey can also be conducted to collect the objective data, which indicate that how nursers feel the change management plan affects their daily performances. Conclusion Bullying is a widespread issue in workplace, in order to make a change management plan that it has to base on evidence support. When innovate a new management, creating the motivation is the first step has to be contemplated, which means the organization accepts the change and the staffs are willing to involve into the new plan. Open and honest approach needs to use to deliver the change as the effective communication can dispel any question or rumour from staffs. Initial supports from the stockholder will empower people to be involved. The consolidation of the change in the current culture involves ongoing support, monitoring and education programs, which increasing the chance of the change becomes norm. References Reiter, M., Young, A., Adamson, C. (2008). Decrease new graduate nurse orientation costs by using HESI exit exam scores. Journal of Nursing Administration, 37(10), 459-463. http://www.mindtools.com/pages/article/newPPM_94.htm Cummins, F. (2006). Using auditing to enhance and improve practice. Nursing Residential Care, 8(1), 37-39.