UK DMS Military Amputee Rehabilitation Strategy

UK DMS Military Amputee Rehabilitation Strategy Introduction The previous chapter provided information regarding the context and background to the study, the research aim and objectives, the statement of the problem, the scope and limitations of the study, and the study structure. Globally, the availability of rehabilitative staff and for that matter health workers in general has become a cause for concern. WHO (2006) commented that the world faces a shortage of 4.2 million health workers. Experts have warned that the number of health workers being trained domestically in many countries is threatened by the strain on public finances inflicted by the ongoing economic crisis. The EU could face a shortage of 1 million health professionals by 2020 or 2 million if long-term care and auxiliary professions are also taken into account (Jensen, 2013). To combat these shortages, the UK and USA recruit staff on an industrial and international scale (Eckenwiler, 2009). This chapter will review the UK DMS military amputee rehabilitation strategy. Comparing the UK with US, it will review the global rehabilitation situation, discussing a number of issues affecting service provision, and rehabilitation staff availability. Additionally, the chapter will review some of the current evidence supporting the impact relocation has on the retention of civilian rehabilitation staff, and review perspectives underlying staffs willingness to stay with health organisations. UK Military Rehabilitation Strategy The principal aim of the UK DMS Rehabilitation Strategy (the Defence Military Rehabilitation Programme) is to return service personnel to operational levels of fitness as soon as possible the fitter quicker principle. Where this is not achievable e.g. military amputee patients the aim is to attain the maximal level of physical, psychological and social health possible (MOD, 2010, p.1). The Defence Military Rehabilitation Strategy (the Defence Medical Rehabilitation Programme) currently encompasses two distinct capabilities; the DMRC (Defence Medical Rehabilitation Centre) and the DMRS (Defence Medical Rehabilitation Service). The DMRC is the foremost Defence rehabilitation centre where service personnel can receive rehabilitation for neurological, complex trauma (polytrauma) or force generation musculoskeletal conditions. The DMRS (MOD, 2016) is provided through a tiered network of rehabilitation facilities including 152 Primary Care Rehabilitation Facilities (PCRF) and 15 Regional Rehabilitation Units (RRU) across the UK and Germany. The PCRFs are Unit/Station based rehabilitation departments offering physiotherapy and exercise therapy on an outpatient basis. Patients with injuries that cannot be resolved at this level are referred to RRUs who provide rapid access to imaging services, podiatry and residential rehabilitation. The Defence Military Rehabilitation Programme is also supported by PRCs (Personnel Recovery Centres). They are residential facilities situated in or near garrisons and are available to all members of the Armed Forces during their recovery from sickness or injury. They aim to assist personnel back to either military service or a second career in a civilian occupation. US Military Rehabilitation Strategy United States Military Rehabilitation Strategy recognised the need for an overhaul of rehabilitation services during the War in Afghanistan. Seven years after US troops entered the Afghanistan conflict, Congress passed the Defence Authorization Act of 2008, which reflected legal and healthcare workers concerns about the quality and availability of medical care services (Lister, Panangala, and Scott, 2008). Accordingly, todays casualties receive an effective and expansive set of rehabilitative services that are akin to those seen in the in the United Kingdom. US rehabilitative care is provided by Tricare (a health care program of the United States Department of Defense Military Health System) and the Veterans Association (VA)2. Global Rehabilitation Issues Amputee Services Amputee rehabilitation services in high income countries are usually centrally funded and provide effective support. Amputee rehabilitation in low and middle income countries depends on their nations stage of development. In areas beset by war (for example Cambodia, Vietnam, Angola, Mozambique and Uganda), the greatest number of amputations (Staats, 1996) results from conflict and landmine explosions. As war drags on, the number of amputees increases and becomes an economic burden. In some countries the number of amputees is so great it is considered an ecological as well as economic disaster; this is the amputee volume imperative. In these regions amputee rehabilitation in any form is a luxury, if it is available at all. Global Rehabilitation Issues Population Effects When delivered at its best, rehabilitation provides people with the tools they need to attain maximal health, function, independence and self-determination (WHO, 2002). The World Health Organization (WHO) and the World Bank estimate that people with disabilities constitute at least 15% of the worlds population, with the majority in low and middle-income countries (WHO, 2011; Pryor and Boggs, 2012). Despite the continued increase in rehabilitation cases worldwide, prioritizing and monitoring of progress to improve health services for people with disabilities remains inadequate (Tomlinson et al., 2009). International evidence shows that people with disabilities have many unmet health and rehabilitation needs, face barriers in accessing mainstream health-care services, and consequently have poor health. With an ever-increasing incidence and prevalence of chronic disabling non-communicable diseases (Boutayeb and Boutayeb, 2005) and a global health refocus on reducing mortality, the world is experiencing a growing demand for rehabilitation services. Generally however, physical and functional rehabilitation is not emphasized in global health discourse (Pryor and Boggs, 2012), despite many recent documents, including various national and international policy instruments and the World Report on Disability (2011) that stressed that physical rehabilitation services are a necessary element of a comprehensive system. The WHO Global Disability Action Plan 2014-2021 (2015) includes the strengthening of rehabilitation services as a key objective. To achieve this objective, it provides capacity building actions (to meet this objective) for member states, national and international partners. Currently however, rehabilitation services, particularly in low and middle-income countries, do not have t he capacity to adequately address the needs of their populations. Global Rehabilitation Issues Finance and Resources UK and US military rehabilitation strategies are able to provide tiered and specialist services as they are centrally funded. Specialised amputee services in high income countries can also attract charitable donations in order to achieve the best care solution. Where rehabilitation is adequately financed, national rehabilitation strategies (NRH, 2009) dictate that care should be delivered from 3 perspectives: general rehabilitation; specialist rehabilitation; and a complex specialised rehabilitation service (C-SRS). In high income countries (UK, US, Australia, New Zealand, Norway, Sweden) rehabilitation is integrated in health care and financed under the national health system (Lilja et al., 2009; WHO, 2004). In other countries responsibilities are divided between different ministries. This stymies rehabilitation services at regional and local level; they are often poorly coordinated and not integrated into the overall system (OECD, 2008). The cost of rehabilitation can be a barrier for people with disabilities in high-income as well as low-income countries. Rehabilitation is problematic even where central funding from government, insurers, or NGOs is available, as it may not cover enough of the costs to make it affordable (Bijelow et al., 2004). Deficits in the New Zealand rehabilitation infrastructure and workforce already severely compromise access to and provision of rehabilitation services (New Zealand Rehabilitation Association, 2014). Australia (the sixth largest country in the world) is a high-income country, ranked 19th in terms of per capita GDP. The development of health services in Australia has mainly been focused on metropolitan and regional areas, with both on-site and outreach locations. A review of 30 years of development in rehabilitation, clinical services, and education reforms in Victoria (Pryor and Boggs, 2012), indicates that progress has been indifferent with mistakes, dead ends and successes al ong the way. Financing strategies can improve the provision, access, and coverage of rehabilitation services, particularly in low-income and middle-income countries. Whilst it can be assumed that any new strategy should be carefully evaluated for its applicability and cost-effectiveness before being implemented, the reality is that rapid implementation negates strategic review. In low and middle income countries, physical and functional rehabilitation is particularly challenging, given human resource shortages and inadequate funding of health care. In these situations, rehabilitation services have evolved in unique ways. They are often strongly linked to humanitarian responses and wider disability actions, and are less connected with mainstream health care than in other settings. Aid agencies from Australia, Germany, Italy, Japan, New Zealand, Norway, Sweden, the United Kingdom, and the United States have supported such activities (Dolea, 2010). The rehabilitation sector is frequently disconnected from the health sector and is closely linked with poverty reduction strategies. Limited resources and health infrastructure in developing countries, and in rural and remote communities in developed countries, can reduce access to rehabilitation and quality of services (World Bank, 2009). In a survey of the reasons for not using health facilities in two Indian states, 52.3% of respondents indicated that no healthcare facility in the area was available (World Bank, 2009). Other countries lack rehabilitation services that have proven effective at reducing long-term costs, such as early intervention for children under the age of five (Stucki et al., 2005; Rimmer, 2006; Storbeck and Pittman, 2008). A study of users of community-based rehabilitation (CBR) in Ghana, Guyana, and Nepal showed limited impact on physical well-being because CBR workers had difficulties providing physical rehabilitation (Stucki et al., 2005). A 2005 global surv ey (SNCDD, 2006) of the implementation of the nonbinding, United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities found that: in 48 of 114 (42%) countries that responded to the survey, rehabilitation policies were not adopted; in 57 (50%) countries legislation on rehabilitation for people with disabilities was not passed; in 46 (40%) countries rehabilitation programmes were not established. Spending on rehabilitation services is difficult to determine because it generally is not disaggregated from other health care expenditure. Many countries particularly low and middle income countries struggle to finance rehabilitation, but rehabilitation is a good investment because it builds human capital (Haig et al., 2009). Health care funding often provides selective coverage for rehabilitation services, for example, by restricting the number or type of assistive devices, the number of therapy visits over a specific time, or the maximum cost (Dejong, Palsbo, and Beatty, 2002), in order to control cost. Governments in 41 of 114 countries did not provide funding for assistive devices in 2005 (SNCDD, 2006). In Haiti, before the 2010 earthquake, an estimated three quarters of amputees received prosthetic management due to the lack of availability of services (Bijelow et al., 2004). Poor access to prosthetic services that were available was attributed partially to users being unable to pay (Bijelow et al., 2004). Rehabilitation national survey in India, found two thirds of the assistive technology users reported having paid for their devices themselves (World Bank, 2009). Whilst global strategy recognised the need for appropriate resourcing, very few countries recognised the impact of disability on income. People with disabilities have lower incomes and are often unemployed, so are less likely to be covered by employer-sponsored health plans or private voluntary health insurance. If they have limited finances and inadequate public health coverage, access to rehabilitation may also be limited, compromising activity and participation in society (Crowley, 2003). Global Rehabilitation Issues Availability of Services and Staff National rehabilitation strategies require competent professional staff in great numbers; the global availability however of qualified /experienced rehabilitation professionals is on the decline (Chen, 2006). Not only do the settings for rehabilitation vary greatly from country to country, the availability of rehabilitation services in different settings varies within and across nations and regions (WHO, 2004; Haig, 2007; Tinney et al., 2007; Buntin, 2007; Ottenbacher and Graham, 2007). Haig et al (2009) flippantly concluded that the chance of a person with a disability in sub-Saharan Africa meeting a physician with specialist skills is about the same as that for an Antarctic penguin. Continuous WHO research has revealed wide cross-national disparities in the supply of rehabilitation health professionals. Lower income countries tend to have the lowest densities with less than 0.5 workers per 10,000 inhabitants in many countries of sub-Saharan Africa but also in several across Asia (Bangladesh, Nepal, Pakistan, Myanmar, India) and the Eastern Mediterranean (Iran, Yemen). Many high income countries including Finland, Japan, the United States, the United Kingdom and Canada have workforce densities several times higher (De Savigny and Adam, 2009). This finding is not surprising: large differences across countries and critical shortages of highly skilled professionals in low-income countries have been well documented (Chen, 2006). Building a cadre of trained amputee rehabilitation personnel is a goal of many organisations and governments. Dunleavy (2007) suggests that the quality of the rehabilitation workforce in low-income countries is both disturbing and dangerous. A recent comprehensive survey of rehabilitation in Ghana identified no rehabilitation doctor or occupational therapist in the country, resulting in very limited access to therapy and assistive technologies (Tinney, 2007). An extensive survey of rehabilitation doctors in sub-Saharan Africa identified only six, all in South Africa, for more than 780 million people, while Europe has more than 10 000 and the United States more than 7000 (Haig et al., 2009). Discrepancies are also large for other rehabilitation professions (Saxena et al., 2007). Many developing countries do not have educational programmes for rehabilitation professionals. According to the 2005 global survey, 37 countries had not taken action to train rehabilitation personnel and 56 had not updated medical knowledge of health-care providers on disability (SNCDD, 2006). Despite a huge need for rehabilitation services in both urban and rural Cambodia, for example, hospitals could not afford to hire rehabilitation professionals (Dunleavy, 2007). Global Rehabilitation Issues Communication and Strategy Inadequate health information systems and communication strategies can contribute to low rates of participation in rehabilitation. Barriers to rehabilitation include poor communication across the health care sector and between providers (notably between primary and secondary care), inconsistent and insufficient data collection processes, multiple clinical information systems, and incompatible technologies (DiGiacomo, 2010). Poor communication can result in ineffective coordination of responsibilities among providers (Kroll and Neri, 2003). Complex referral systems can limit access. Where access to rehabilitation services is controlled by doctors (Dejong, Palsbo, and Beatty, 2002), medical rules or attitudes of primary physicians can obstruct individuals with disabilities from obtaining services (Hilberink, 2007). People are sometimes not referred, or inappropriately referred, or unnecessary medical consultations may increase their costs (Eldar, 2000; Holdsworth et al., 2006). The 200 5 global survey (SNCDD, 2006) of 114 countries, revealed 57 did not consult with families of persons with disabilities about design, implementation, and evaluation of rehabilitation programmes. This directly challenged McColl and Boyces supposition (2003) that the development, implementation, and monitoring of strategy and policy should always include users. A study of rehabilitation medicine related to physical impairments in five central and eastern European countries suggested that the lack of strategic planning for services had resulted in an uneven distribution of service capacity and infrastructure (Eldar et al., 2008). Strategy and planning needs to be based on analysis of the current situation, and consider the main aspects of rehabilitation provision leadership, financing, information, service delivery, products and technologies, and the rehabilitation workforce (De Savigny and Adam, 2009), defining priorities based on local need. Many countries have good legislation and related policies on rehabilitation, but the implementation of these policies, and the development and delivery of regional and local rehabilitation services, have lagged. Retention of Rehabilitation Staff Like other health staff, retaining rehabilitation professionals is affected by poor working conditions, safety concerns, poor management, conflict, inadequate training, lack of career development and continuing education opportunities (Crouch 2001; Tinney, 2007; Lehmann, Dieleman, and Martineau, 2008; Tran et al., 2008; Dolea, 2010). High income countries do not suffer from this scarcity, as their economies regularly attract healthcare workers from low-income countries (Landry, Rickets, and Verrier, 2007; Mock et al., 2007; Lehmann, Dieleman, and Martineau, 2008; Willis-Shattuck, 2008; Magnusson and Ramstrand, 2009). Retaining professional workers is especially important as professional workers may have stronger professional than organisational identification reasons for staying (Robertson and Hammersley, 2000). Retention can prove difficult however as turnover tends to be growing rapidly across many industries (Si, Wei and Li, 2008). More importantly, when employees leave they take their know-how with them and thus an organisation risks a potential loss of experience and expertise (Walker, 2001; Frank, Finnegan and Taylor, 2004). Employers invest a lot in recruiting and selecting employees and then invest even more in training and developing them over time. The development of these assets is an important task for human-resource managers (Sutherland, Torricelli, Karg, 2002). Moncarz, Zhao and Kay (2009) found that professional growth is an important retention factor and that in organisations where employees receive the proper training needed to assume greater responsibilities, turnover rates are generally lower (p. 441). Why Staff Stay With Organisations The learning and development of employees is an important retention-supporting strategy (Horwitz, Heng, and Quazi, 2003; Kyndt et al., 2009). Tymon, Stumpf and Smith (2011) note how retaining the best professional talent is of great practical significance to organisations as it eliminates the recruiting, selection and on-boarding costs of their replacement, maintains continuity in their areas of expertise, and supports a culture in which merit can be rewarded (p. 293). Advancement opportunities appear to motivate high-performer retention more so than other employees (Hausknecht, Rodda, and Howard, 2009). The role of management as a key factor in the retention of professional workers has been cited by several studies. Andrews and Wan (2009) link improved nurse retention to manager behaviour (p. 342) and Snyder and Lopez (2002) emphasize the role of leaders in an organisation in encouraging the talent of the organisation to stay. Research has shown that as long as employees feel that they are learning and growing, they will be less inclined to leave. On the other hand, once employees feel they are no longer growing, they begin to look externally for new job opportunities (Rodriguez, 2008). Factors influencing retention appear to be the existence of challenging and meaningful work, opportunities for advancement, positive relationships with colleagues, empowerment, responsibility, recognition of capabilities and performance contributions, rewards, good work-life balance, good communication within the organisation, managerial integrity and quality, and new opportunities/challenges (Arnold 2005; Herman 2005; Pitts, Marvel, and Fernandez, 2011; Allen and Shanock, 2013). The role of management as a key factor in the retention of professional workers has been cited by several studies. Andrews and Wan (2009) link improved nurse retention to manager behaviour (p. 342) and Snyder and Lopez (2002) emphasize the role of leaders in an organisation in encouraging the talent of the organisation to stay. There appears to be two aspects of management that are particularly important in retention these being the adoption of an appropriate style of leadership (Spence Laschinger et al., 2009) and perceived management support (Paillà ©, 2013). Since learning and development opportunities appear crucial for the retention of talented employees (Arnold, 2005; Echols, 2007; Rodriguez, 2008; Kroon and Freese, 2013) an organisation must establish a supportive learning and working climate. This makes development and learning critical for attracting and retaining employees, because talented people are inclined to leave if they feel they are not growing and stretching (Michaels, Handfield-Jones, and Axelrod, 2001, p. 14). Relocation and Strategy Relocation is among one of the most radical strategic decisions a firm can make (Isabella 1990). Relocation is essentially a form of organisational change, which, in its simplest form, can be defined as a difference between new and old settings (Weber and Manning, 2001, p. 229). Even when completed within the same vicinity, it is a complex and unsystematic process involving several stakeholders, phases and decisions (OMara, 1999). Whilst relocation can be perceptualised as a golden opportunity, with organisations using change as a catalyst to introduce elements of organisational change (Inalhan, 2009), it can have a significant impact on real estate costs, productivity, efficiency, workforce satisfaction, and meeting the overall business objectives (Morgan and Anthony, 2008; Christersson and Rothe, 2013). For employees, the combination of workplace redesign and relocation can be challenging. Not only are they facing a change in their workspace, they also lose the organisational patte rns and roles that were a part of the old premises (Milligan, 2003). Additionally, the way the change is delivered can also impact on how the change is received (Bull and Brown, 2011; Vischer, 2011). At an organisational level, many positive effects of relocation have been identified; positive changes in employee behaviour: enhanced employee satisfaction and productivity: improved decision-making, collaboration and cross-selling: improved retention and recruitment: reduced churn costs: and positive client feedback (Morgan and Anthony, 2008). On the other hand, relocation can also be risk-laden (Rasila and Nenonen, 2008). People form emotional links to physical environments, called place attachment (Milligan, 2003; Inalhan, 2009), and a relocation inevitably causes a disruption in this relationship to the old premises with some employees experiencing loss and grieving (Inalhan, 2009) or even a form of organisational death (Milligan, 2003). Early employee involvement and empowerment to participate in decision-making should be a part of projects where workplace change is significant and a part of a cultural transformation. Effective managerial communication in an organisation helps to connect with employees, build positive relationships and frame attitudes and behaviours of employees in the workplace and numerous studies state that communication plays an important role in the change process (Elving, 2005; Hayes, 2007) and some even claim that employee communication can mean its success or failure (Barrett, 2002). Communication of the reason and impact of the workplace change is significant in influencing the participants to accept change, and it is suggested to be even more important than the frequency or amount of information supplied (Bull and Brown, 2011). Despite this, employee experiences of the relocation process have not been widely addressed, with the exception of needs and experiences of employees in long-distan ce relocations, where organisations move to a new geographical area and the employees will have to move to a new home to stay with the company (Rabianski, 2007). Studies conducted within a relocated setting, often focus on comparing employees experiences of the old office with the new one (Brennan, Chugh, and Kline, 2002; Brown et al., 2010), but do not give attention to how employees experience the change in location. Conclusion The current economic situation has severely impacted global rehabilitation services. In low and middle income countries, inadequate resourcing combined with an ineffectual health infrastructure and consistent neglect of rehabilitation services, leaves patients facing lifelong disability. Some countries are barely able to provide a single rehabilitation practitioner. Beset by the net effects of an ever increasing population, the increasing health burden will continue to destabilize and overwhelm the most basic rehabilitation services. Even affluent countries (UK and USA) struggle to retain or recruit personnel, depending on industrial-scale immigration of qualified rehabilitation staff from countries who can barely afford their release. Nations (and naturally organisations, the DMS and MOD) recognise the qualities an experienced workforce can deliver. With the prospect of relocation, retaining these workforces can be difficult. Thus, the availability and maintenance of personal and professional development are key retention strategies. Relocation however, can have diverse results. On the one hand it can result in positive changes in employee behaviour, enhanced employee satisfaction and productivity; on the other it can result in a significant impact on the workforce, leading to the loss of staff with a resulting shortfall in experience and expertise. Though there are a number of researchers that have investigated healthcare workers perspectives of relocation and retention, this literature review has revealed a lack of any available UK military associated research of its military or civilian staff. The next chapter will attempt to address the DMRC civilian rehabilitation workforces retention and relocation perspectives through a research methodology that will encompass a qualitative focus group and cross-sectional quantitative investigation.

Types of Exercise in Sports

Types of Exercise in Sports Sport was known as part of exercise where most people used to stay in healthy lifestyle. Exercise is the bodys physical exertion. The main function of exercise is to achieve a higher level of fitness and health, for both physically and mentally. Sport is an competitive,organized, skillful, and entertaining physical activity. To be the winner, the player requiring commitment, strategy, and fair play that can be defined by objective means. Sport was divided into few categories where it divided into different categories age and gender. This arrangement usually helps them in order to give a comfortable exercise to certain people. There will be not a old man are doing heavy exercise like going gym. Of course only to those who young want who they are full energetic. Human being will destroys the good condition for lack of activity, to save it and preserve it do some movement and methodical physical exercise. Sport exercise gives so many health advantages to people who take advantage from i t. Participating one on physical activities can add further years into yourself, and the more you will exercise, the more benefits that you get. You will also get to avoid health diseases and also delay our death when you regularly engage yourself upon physical activities as well as sport exercise. Light sport also known as simple exercise, were usually use by most people when they are having little time to exercise and have a problem of doing heavy exercise. It commonly practices by elder people, pregnant woman, patience and young children. This is the opposite of when a person is having an active lifestyle and exercising.  Ã‚   This study focused on the important of doing somethings to breaks throughout the day to stand up and move around. Step out from the environment you are, take quick walk outside, and walk up and down the stairs few times around the building. A light exercise involves small movement, time and energy to perform. Light exercise is a kind of exercise that usually causes less energy and stamina. It is also make the person less sweat and dehydrate too. Although to some people who is in this range feel that it make cause less tiredness, but it work within long term effect rather than do nothing. This exercise actually creates a light movement between the ank le, muscle joined and heartbeat. The moment when they do a walk, it takes a 3 combination and less energy to perform. The longer the person walks, the more tired they will be. This is because the effect of doing light type exercise in a long term. It also giving another long term effect is they will slowly overcome the matter of leg pain for long walk exercise. This exercise usually did not require any special attention and can be perform at any time as they wish. From home to office, from young to old doesnt give any problem. But it recommended for the person who listed earlier to perform for their capability over to stay in health. Here is some few example of light exercise which is categories of light exercise. They are walking, stretching body, Chinese Tai-chi, gardening, cycling, dumb bell and much more. The second type of exercise is so called medium exercise are usually perform for moderate person at different age. It doesnt care any of the gender arrangement or requirement. This medium exercise usually performs in small amount in time and to those loves to save time. This medium exercise requires an amount of concentration, energy or stamina, time and place. It also can be perform by a group of people and solo. It train a lot of body part and cause performer to sweat a lot dehydrate even much more compare to the light exercise. It might be also need some specified skill to perform on the right way because once they perform it on the wrong way, it may cause muscle cramp. For the short term effect, it may reduce smoker to smoke. This is because they might exhaust but only exercise reduces the chances of taking any nicotine and tar in their body. This will make the smoker not to take any cigarette as their throat is drying and if let say they smoke, this person might be in very high chance for getting throat cancer. In the long term effect of this medium exercise, it may bring a healthy lifestyle and physical attitude as well. The long term effect usually takes time to as to the person especially in their daily mood. The person who less exercise, their face is pale or looks tired but if compare with the person who do exercise, they have more energetic and confident looks. This effect also will bring close relationship and build up strong neighborhood if they done it together. But to some people who are disable, they also can perform sport as the part of their exercise. They perform in sport like track sport, field sport like futsal and more according to their convenience. It is proven where the is special sports day were introduce just for them. There are few example of medium type of exercise that practice by most people. They are cycling, walking uphill, jogging, Tae Kwan Do, swimming, running, and much more. This some part is actually providing sufficient li festyle to avoid any of negative impact or disease. Hard or professional type exercise is another kind of exercise where this involves to active people and to people loves diet. This type usually takes a lot of concentrations as to prevent any side causes or muscle injured too. Plus this exercise requires all of energy and full stamina. It also have to be assisted by professional incase of not clear or not sure about it. This exercise performs by athlete and to all active people. It takes all the energy and power to perform while it also takes a full concentration to play the sport. If suddenly the player lost concentration, it may cause a major injury and might be cause paralyze too. The physical activity involves the movement of people, animals and/or a variety of objects such as balls and machines or equipment. This professional exercise, usually require a place that suit to the sport like stadium, or gym center. It also can be perform on the game court too as to a game like basketball or tennis. This game gives everyone a chance t o practice on how to work with team and think a strategy to win the game. Like basketball, from what we see is a 3 versus 3 games. But in the three people they need teamwork so that they can pass the ball and score. Besides that, they also need to think a strategy on breaking through opponent defenses and score without playing fault. In gym, they will train in specified machine to help them in body building. This training in gym is especially in abdomen and shoulder where they are 85% chances in use of the body part. They also have a chance on meeting new people to train human skill and share their experience together. Whenever you indulge yourself into sports, you were even meeting new people. Apart from being an exciting and joyful activity, sports give a lot of various advantages to our character. It can serve as a good source of pleasure. Sport is a fantastic physical activity, and this may also develop a better physical image than these persons who do not do it. Training is als o give a chance to provide them more time to be control the stage of games too. With a fully all strategy, teamwork, training, concentration and full energy, there is no way for other to any change to stop them from growing. Plus physical activities can significantly help from the decline of ones depressive symptoms. Persistent health problems are usually preventable with routine exercise. When you make this a habit to workout daily, you will be able to avoid unsafe health problems from any kind of cause. Exercise forms is resistance for the body, also it functions on strengthening your muscles. Sports, one of the most active activities compare to other where it cause the heartbeat and sweat part of the entire body toxin out. Plus it reduces chances of getting sick or even flu. In every minute the heartbeat, the body pulse is double than usual where it give chance to human to breath twice as fast to capture the oxygen the blood cell. Every human pulse requires a full concentration where it helps to keep on line of the body blood cycle. If let say they over the limit of one minute heartbeat, they might get faint as also heart shock and body cramp. This are often happen to some of the athlete where they push up the maximum limited of their body level. There are also can possibility cause of easily broken bones if they did not train. This effect actually related to calcium consumption and exercise training. In research of health central, there will be long and short term effect. In the short term effect, it increases the flexibility of the bones and strengthens the bones and joint especially when playing an outdoor sport. But in long term of sport, this will reduce the chances of broken bones, delaying muscle loss, and reduce risk of loosen the bones and joint. Therefore, sport does play an important role in humans life as they bring a healthy life to even live longer.

King Leopolds Ghost Essay -- Essays Papers

King Leopolds Ghost King Leopold's Ghost tells a story of the Belgian King Leopold II and his misrule of an African colony, named (at the time) the Congo Free State. It is a wild and unpleasant story of a man's capacity for evil and the peculiar manifestation of it. In telling this story, Hochschild does a wonderful job of giving detailed descriptions, especially of the colorful individuals involved, both good and bad. His analysis of the situation is very solid, starting with the movement when the Congolese hero (Morel) finds out a very terrible fact and moving on through his (Morel) analysis and actions, all the while telling the story of a treacherous monster. Set in the palaces and boardrooms of Europe and in the villages of central Africa, it tells the story of the tragedy that took place during Leopold's so called rule, a tragedy that is so familiar to African-Americans, being told of our African brothers residing in the homeland. This "horror" story is just in fact that, a horror story, giving and revealing the utter most secrets of the respected King Leopold. Allow me to take you on a journey, pointing out the King's determination and, reasoning for what he'd done and the scars he left deep within the heart of the Congo. In the introduction I stated that Morel was the character that I considered to be the hero of this story, now the main question behind that would be, why? Along with, Who is Morel? His complete name was Edmund Dene Morel; he was a young clerk who worked for a Liverpool based firm where his duties were to supervise the unloading and reloading of the ships arriving in Antwerp, Belgium. As Morel watched the shipments arrive he noticed something, a great amount of ivory and rubber were being transported into Belgium but nothing was being taken out, as the book states: "There is no trade going on here. Little or nothing is being exchanged for the rubber and ivory†¦with almost no goods being sent to Africa to pay for them, he realizes that there can be only one explanation for their source: slave labor." (p.2) With his newfound revelation at hand Morel does not sit still. Demonstrating that he refused to turn a blind eye to what fortune had allowed him to see, he soon becomes active with his newfound knowledge. Soon afterward Morel devoted his life to stopping slavery in the Congo. From the early 1900's until afte... ... their own, getting educated, and even going to the lengths of forming Greek organizations, that their fellow brother in Africa were being brutally mutilated and stripped of their humanity. Hochschild has done an exemplary job of writing this book by gathering details and evidence not to mention the wonderful writing skills that he's displayed throughout the entire book. In my opinion, the account of shocking and brutal nature of Belgian colonial rule, is worth reading on it's own, if only to remind us of the horror of the colonialism from which the US has recently escaped. And anyone with an interest in the way we car for or mistreat other humanbeings may find a great deal of food for thought here as well. ABOUT THE AUTHOR Hochschild, a renowned journalist has taken on Stalin and Russian psyche in previous books. He has been criticized the almost exclusive focus of the CRA movement on Belgium, citing comparable brutality by the US in the Philippines, the British in Australia, the Germans in what is now Namibia. Bibliography: Hochschild, Adam "King Leopold's Ghost:a story of greed, terror, and heroism in colonial Africa. First Mariner Books 1998. New York

Comparison of German and French Soldiers Experiences :: World War I History

Comparison of German and French Soldiers' Experiences The First World War was a horrible experience for all sides involved. No one was immune to the effects of this global conflict and each country was affected in various ways. However, one area of relative comparison can be noted in the experiences of the French and German soldiers. In gaining a better understanding of the French experience, Wilfred Owen's Dulce et Decorum Est was particularly useful. Regarding the German soldier's experience, various selections from Erice Maria Remarque's All Quiet on the Western Front proved to be a valuable source of insight. A analysis of the above mentioned sources, one can note various similarities between the German and French armies during World War I in the areas of trench warfare, ill-fated troops, and military technology. Trench warfare was totally unbiased. The trench did not discriminate between cultures. This "new warfare" was unlike anything the world had seen before, millions of people died during a war that was supposed to be over in time for the holidays. Each side entrenched themselves in makeshift bunkers that attempted to provide protection from the incoming shells and brave soldiers. After receiving an order to overtake the enemies bunker, soldiers trounced their way through the land between the opposing armies that was referred to as "no man's land." The direness of the war was exemplified in a quotation taken from Remarque's All Quiet on the Western Front, "Attacks alternate with counter-attacks and slowly the dead pile up in the field of craters between the trenches. We are able to bring in most of the wounded that do not lie too far off. But many have long to wait and we listen to them dying." (382) After years of this trench warfare, corpses of both German and French soldiers began to pile up and soldiers and civilians began to realize the futility of trench warfare. However, it was many years before any major thrusts were made along the Western front. As soldiers past away, recruits were ushered to the front to replenish the dead and crippled. These recruits were typically not well prepared for the rigors of war and were very often mowed down due to their stupidity. Both the French and Germans were guilty of sending ill-prepared youths to the front under the guise that "It is sweet and fitting to die for one's country." (380) Owen's Dulce et Decorum Est is a prime example of this "false optimism" created by the military machine in France to recruit eager new troops to die a hero's death on the front lines.

Essay on Camus’ The Stranger (The Outsider): Parallels Within

Parallels Within The Stranger (The Outsider) The Stranger by Albert Camus is a story of a sequence of events in one man's life that cause him to question the nature of the universe and his position in it. The book is written in two parts and each part seems to reflect in large degree the actions occurring in the other. There are curious parallels throughout the two parts that seem to indicate the emotional state of Meursault, the protagonist, and his view of the world. Meursault is a fairly average individual who is distinctive more in his apathy and passive pessimism than in anything else. He rarely talks because he generally has nothing to say, and he does what is requested of him because he feels that resisting commands is more of a bother than it is worth. Meursault never did anything notable or distinctive in his life: a fact which makes the events of the book all the more intriguing. Part I of The Stranger begins with Meursault's attendance at his mother's funeral. It ends with Meursault on the beach at Algiers killing a man. Part II is concerned with Meursault's trial for that same murder, his ultimate sentencing to death and the mental anguish that he experiences as a result of this sentence. Several curious parallels emerge here, especially with regard to Meursault's perception of the world. In Part I, Meursault is spending the night next to his mother's coffin at a sort of pre-funeral vigil. With him are several old people who were friends of his mother at the home in which she had been living at the time of her death. Meursault has the strange feeling that he can see all of their faces really clearly, that he can observe every detail of their clothing and that they will be indelibly impr... ...r has not done makes no essential difference at the end. The nurse at the funeral tells him, "if you walk too slowly, you'll get heat exhaustion, but if you walk too fast, then the cool air in church will give you a chill.† As he kills the Arab, he thinks, "Whether I fire or don't fire is irrelevant; the ending will be the same.† And at the trial, Meursault tells the prosecutor, "I have lived my life thus and did x, but if I had done y or z instead, it wouldn't have mattered.† And, ultimately, Meursault turns out to be correct; he discovers that when death approaches, all men are equal, no matter what their ages or previous lives. Meursault views death as an escape: you can't escape from it, but you can escape into it, and he prepares himself to do so, bit by bit. Each parellel incident is just one more winding round of the rope that will bind him completely.

Advertising Stereotype Essay

Media stereotypes are inevitable, especially in the advertising, entertainment and news industries, which need as wide an audience as possible to quickly understand information. Stereotypes act like codes that give audiences a quick, common understanding of a person or group of people—usually relating to their class, ethnicity or race, gender, sexual orientation, social role or occupation. But stereotypes can be problematic. They can: reduce a wide range of differences in people to simplistic categorizations transform assumptions about particular groups of people into â€Å"realities† be used to justify the position of those in power perpetuate social prejudice and inequality More often than not, the groups being stereotyped have little to say about how they are represented. Anyone who examines North American entertainment and news media will notice that members of ethnic and visible minorities are inadequately represented in entertainment and news media, and that portrayals of minorities are often stereotypical and demeaning. This tendency is particularly problematic in a multicultural country, where some of the population is immigrants and some is visible minorities, along with larger urban centers. Visual representation of reality is influential in shaping people’s views of the world, where everyday realities are articulated mostly by what we see in the media. The role of advertising in this interpretation of reality is crucial. The target audience’s self-identification with the images being a basic prerequisite for an advertisement’s effectiveness, makes advertising one of the most important factors in the building of behavior models and values systems. The way a certain notion is managed at a visual level determines how people will perceive this notion and whether they will identify with it or not. Meaning is encoded in the structure of the images, which thus become potent cultural symbols for human behavior. The framing and composition of the image, the setting, the symbolic attributes and every other element in its structure, all are engaged in the effective presentation of the underlying notion. Gender Stereotypes in Advertising Dominant discourses surrounding gender encourage us to accept that the human race is ‘naturally’ divided in to male and female, each gender realistically identifiable by a set of immutable characteristics. In Foucault’s terms, relations of difference are social constructs belonging to social orders that contain hierarchies of power, defined, named and delimited by institutional discourses, to produce social practices. â€Å"Gender differences are symbolic categories† (Saco, 1992:25). These categories are used to ascribe certain characteristics to men and women. The representation of those characteristics determines how men and women are presented in cultural forms, and really whether an individual is identified as ‘masculine’ or ‘feminine’. It is important to understand the big role that media, in general, and specifically advertisement plays in maintaining an ingrained gender hierarchy. The closer study of men’s and women’s images as presented in advertising should result in uncovering the messages about their identity and role in society. Until recently, masculinity in the media was not considered problematic since there was the notion that masculinity is not constructed. â€Å"Masculinity remains the untouched and untouchable against which femininity figures as the repressed and/or unspoken† (Holmlund, 1993:214). The role advertisements play in the development and perpetuation of gender-role stereotypes may include: Women Stereotypes in Advertising Advertising is an over 100 billion dollar a year industry and affects all of us throughout our lives. We are each exposed to over 2000 ads a day, constituting perhaps the most powerful educational force in society. The average American will spend one and one-half years of his or her life watching television commercials. The ads sell a great deal more than products. They sell values, images, and concepts of success and worth, love and sexuality, popularity and normalcy. They tell us who we are and who we should be. Sometimes they sell addictions. Advertising is the foundation and economic lifeblood of the mass media. The primary purpose of the mass media is to deliver an audience to advertisers, just as the primary purpose of television programs is to deliver an audience for commercials. Adolescents are particularly vulnerable because they are new and inexperienced consumers and are the prime targets of many advertisements. They are in the process of learning their values and roles and developing their self-concepts. Most teenagers are sensitive to peer pressure and find it difficult to resist or even question the dominant cultural messages perpetuated and reinforced by the media. Mass communication has made possible a kind of national peer pressure that erodes private and individual values and standards. But what do people, especially teenagers, learn from the advertising messages? On the most obvious level they learn the stereotypes. Advertising creates a mythical, mostly white world in which people are rarely ugly, overweight, poor, struggling or disabled, either physically or mentally (unless you count the housewives who talk to little men in toilet bowls). In this world, people talk only about products. The aspect of advertising most in need of analysis and change is the portrayal of women. Scientific studies and the most casual viewing yield the same conclusion: women are shown almost exclusively as housewives or sex objects. The housewife, pathologically obsessed by cleanliness, debates the virtues of cleaning products with herself and worries about â€Å"ring around the collar† (but no one ever asks why he doesn’t wash his neck). She feels guilt for not being more beautiful, for not being a better wife and mother. Very unrealistic goals for ideal body shapes, which lead to high rates of anorexia nervosa and bulimia Make women believe they are valued based on their body, therefore their self-esteem is also based on how their body looks compared to others. Give messages to women that changing their appearance, they will have a better life *Men* Stereotypes in Advertising It is interesting to see that now, when things have admittedly changed for women, we still see much of the same themes in modern men’s advertisements. In the ads from â€Å"Men’s Journal,† we generally see a handsome, strong, successful and somewhat rugged man. The camera angles are almost invariably from the bottom up, giving us a view of the man as though we, the viewer are below him, looking up at him. All of them are young, but none are teen-aged looking. All but one have, or show remnants of facial hair. None of these ads show the man in the work place, but their depiction of leisure is that of mature success, not youthful excess. Because of the camera angles, the strong stances, the rugged good looks, and the depictions of success, these ads reinforce the stereotypes of men as strong, powerful, aggressive providers. An ad for Tommy Hilfiger shows the man with his arm around a girl who is leaning into his chest. This ad depicts a man as protector and as a heterosexual. The one ad that stands out from the group in this collection of ads from Men’s Journal is the one from ESPN’s Sport’s Center. This ad shows a man finishing up a piece of cake at a diner and watching Sport’s center from across the bar. This is a different depiction of leisure which seems directly related to the product it is selling. The rest of the ads are selling some form of apparel. They are designed to show clothes as comfortable and stylish and show that a man who wears those clothes can be the aggressive, dominant male. The Sport’s Center ad is selling a product that isn’t consumed as part of public image, but of private pleasure. The clothes worn by the models are assertively masculine, and often emphasize a broad shouldered and solid body shape. The models display a highly masculine independence and assurance, as well as the coding of narcissistic self-absorption. The choice of lighting and film stock emphasizes the surface qualities of skin, hair, eyes and the texture of clothing. Finally the cropping of the images works to produce intensity in many of the images. This stereotyped presentation of a gender role, certainly tells us that there is still a part of society that believes that men should be naturally related to power, aggression and authority. In recent years however, other aspects of masculinity have become acceptable in ads. This can be seen in the difference between the ads in Men’s Journal and those in Maxim. The ads from Maxim are similar to those from Men’s Journal but definitely appeal to a younger audience. It is therefore interesting to look at what advertisers feel is more appealing to younger men. There is one ad for Ralph Lauren Cologne that shows a young successful looking man in a shirt and tie looking over the top of the head of the women cuddling in his chest. She is looking into the camera seductively and he looks as though his mind is elsewhere. He is dominant, even arrogant in this position and once again appears successful and confident. Another ad from Maxim is for a DVD special edition of â€Å"Rocky. † The ad shows rocky beaten and worn but continuing to fight. The copy reads â€Å"at least David had a slingshot. † This ad depicts the ultimate American sports hero, appealing men, both young and old. In-short, disadvantages with Men Stereotyping, are: Show ideal for body type, also which can be unrealistic Show men as aggressive and in control of things, including women Women’s problems are â€Å"fixable†, you either fit the part of the masculine ideal or you do not Negative Stereotypes in Advertising Aunt Jemima, Darkie toothpaste, Uncle Ben and the infamous â€Å"Waaaaaz up† crew from the people at Budweiser are some blatantly stereotypical roles that have had many conscious blacks frustrated during the past century. Darkie toothpaste may be unfamiliar to many Americans today because it was marketed in Hong Kong until March 1990. The toothpaste package featured a minstrel character with a wide smile. The character appeared to have placed black soot on his well-rounded face and red lipstick around his mouth while smiling large with gleaming white teeth. To make the character completely minstrel-like, the character added a large brimmed top hat to grace his head. According to Jamieson and Campbell, the authors of â€Å"News, Advertising, Politics and the Mass Media: the Interplay of Influence,† Darkie toothpaste was removed because of its negative connotation of the word â€Å"Darkie† and not so much the image on the box. The regional commercial director for Hawley and Hazel (the makers of Darkie toothpaste) said, â€Å"We want the name of our toothpaste to be internationally acceptable. However, some people consider the word ‘Darkie’ racially offensive, particularly in America. † It’s not that the name is not offensive, but the image was not even discussed. Associating the name with such an offensive image makes the toothpastes image just a bit more offensive. If Darkie toothpaste were associated with an image of dark yellow teeth with a contradictory image of a bright smile shown next to the crude picture, it would have shown a whole new connotation to the brand name. The frightening thing about this image is it was only removed from circulation 13 years ago, well after the Civil Rights Movement. Aunt Jemima has been a character that has shown a dramatic change throughout the years. Aunt Jemima wore a red and white scarf over her head. Now Aunt Jemima has a well-groomed coif and a slimmer face that graces the boxes of pancake, waffle and syrup bottles across the world. The changing images of Aunt Jemima and Uncle Ben are representative of the changes in American culture today. Although we do not see blacks as cooks, maids and servants anymore, we may see a new stereotype arising. The â€Å"Waaaz up† crew from the recent Budweiser commercials is an example of this theory. This campaign was very effective and catchy. It had people – black, white and every race in between – making it a staple in our ever-changing language. Budweiser did not only stereotype blacks in America but also other often-stereotyped groups. The Italian mobsters constantly repeating â€Å"How you doin? † and the â€Å"yuppie† stereotype stating, â€Å"How are yooooooou doing. † The only people that spoke proper English in these advertisements were the upper class white men. The images of blacks have increased by number but not by quality. According to the Journal of Advertising, blacks spend more than $279 billion a year on consumer goods, yet the advertisers are only spending approximately $865 million a year to reach them. This disproportionate figure reveals why many advertisements misrepresent blacks across America. Only a small percentage of the black population is professional athletes, yet they are the majority of endorsers for black products. Blacks, Hispanics, Asians and women must demand a wider variety of roles in advertisements for it may negatively affect the children of tomorrow. If we are only being shown in narrow roles, our future generation may not aspire to be anything but rappers and athletes, instead of politicians, doctors or lawyers. Ask the advertisers, â€Å"Waaaz up wit dat? † Research supports that mass stereotyping groups of people does not work in the development and marketing of business ideas. Although many corporations still try to capitalize on stereotypes, this line of thinking simply does not work as effectively as the old â€Å"mom and pop country store† approach to business: Getting to know your customers as intimately as possible. If grouping populations like cattle into marketing niches worked, why would major corporations still continue to invest so heavily into studying consumer habits and demographics? If this type of marketing philosophy worked well then anyone with a great business idea could make it simply by targeting. Obviously, this is not so. *Stereotypin*g Myths For example, stereotype marketing ideologies might focus too much on one group and ignore another equally, or even more important. For example, target only kids for (non-PC) video games and lose access to millions of customers. Nearly a quarter of all video games are purchased by consumers aged 40 and older, and 38% of all video game sales are made by women. Another case in point: Senior citizens have become the fastest-growing population in the United States. ; however, mass marketing to seniors has remained somewhat elusive. Several pioneers in the senior marketing industry note that age alone has little to do with the interests of senior consumers. Those who have attempted to cash in on the senior population, simply lumping retirees together by age, have failed, and miserably so. When it comes to advertising, â€Å"marketing† studies that offer only cold statistics may play less of a role than you think in developing successful marketing strategies and advertising campaigns. Customers can be your best or worst source of advertising. Word of mouth referrals, especially in the age of the Internet, should not be undervalued. And, since consumers are more likely to complain than to compliment, it pays to have customer-friendly and trustworthy complaint resolution practices in place. It pays to see your customers as individuals, with common needs, but not as groups who, because of stereotype images, have lemming-like behaviors when it comes to making purchases.

Aflac

Table of Contents I. Executive Summary†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 3 II. Company History†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦3-4 III. Company Financials†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 5 IV. Internal Factors & External Industry Analysis. 6-11 V. House of Quality & DMAIC†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 11-19 VI. Tree Diagram & PDPC†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 19-22 VII. Flowchart & Check Sheet†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦22-26 VIII. Consultants Conclusion†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 26 IX. Works Cited†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 27 ? I. Executive Summary AFLAC, incorporated offers all different types of insurance including life, health, and accident insurance as being their top sellers. The insurance industry can often be a competitive one. There are many insurance companies, in the past few years, that have been greatly effected by the current recession in the United States. Some insurance companies needed government intervention to help them through this. AFLAC, just like other big companies out there, have gone through many problems. Building the House of Quality and using Deming’s five points will help this company succeed and train their employees better. Using flow charts, check sheets, and tree diagrams will show the employees the right way to do their work and can continuously improve at their work. Consultants will be overall most satisfied with these types of practices. II. Company History Aflac, also known as American Family Life Assurance Company, was founded in Columbus, Georgia in the year 1955. It was discovered by brothers John, Paul, and William Amos to sell life, health, and accident insurance (â€Å"Aflac Incorporated History). † Competition was very fierce back then and the little company did poorly. In the 1940s and 1950s, there were many cases of polio scares and had spawned insurance coverage written specifically for this disease. It was then that Aflac decided to sell cancer insurance (â€Å"Aflac Incorporated History). † In the year 1958, they introduced the world’s first cancer insurance policy. This wound up being a big hit for this company and had written over a million dollars in premiums and had expanded over state lines. This company grew very quickly. It grew very quickly in the decade of the 1960s. They developed a selling approach that was much clustered. This approach worked as employees were willing to make payroll deduction for premiums (â€Å"Aflac Incorporated History). † By the year 1971, this company was booming in over 42 states. In the 1970s, John Amos then decided to expand his company outside the United States. This started by Amos visiting the World Fair in Osaka and he then decided to market this idea to the Japanese (â€Å"Aflac Incorporated History). † The Japanese healthcare plan left them exposed to considerable expense from cancer treatments. After four years, the company finally got approved to sell health insurance overseas to the Japanese (â€Å"Aflac Incorporated History). † It was basically approved because after research, it would have not threatened existing markets and the Amos’s found notable backers in the insurance and medical industries. Aflac became one of the first insurance companies to enter the Japanese market, and it had an eight year monopoly with the Japanese (â€Å"Aflac Incorporated History). † Aflac has sought to supplement its cancer insurance by introducing new products and improving old ones to encourage the policyholders to add on or trade up (â€Å"Aflac Incorporated History). † The company boosted its name recognition in the United States from two percent to fifty six percent primarily through advertising, including the slots throughout the 1998 Winter Olympic Games and NASCAR races (â€Å"Aflac Incorporated History). Accident and disability premiums surpassed cancer premiums in the United States for the first time in the company’s history in the year 2000. The popular Aflac duck made its first appearance on television in the year 2001 for a commercial for accident insurance (â€Å"Aflac Incorporated History). † III. Company Financials With every company, the financial po rtion of the company will vary from year to year. AFLAC, which is one of the most trusted insurance companies and has the most popular commercials, has been doing very well over the years as an insurance company. This company has annual sales presently at over eighteen million dollars (â€Å"Aflac Financial Reports†). Ten million dollars of the eighteen million dollars in revenues were solely from the sales of the employees that worked for this company. This company is a publicly traded company located on the New York Stock Exchange (NYSE). Over the years, this stock price has gone up and up every single year. It is now priced at fifty five dollars per share, which shows how successful this company has been over the years. Below, is a chart that shows Aflac’s stock price from June of 2009 to April of 2010 (Business Source Complete). It shows that in June of 2009, it was price at thirty three dollars per share. It had a significant setback right before September where it dropped under thirty dollars per share (Aflac’s Financial Reports. )† It has since resurged in the past ten months to be up to fifty five dollars per share. It shows that Aflac has not been affected by the recession, which is ongoing in the United States. IV. Internal Factors & External Industry Analysis The insurance industry is a very competitive industry. AFLAC’s main concern is the customer service problems and that the agents are not trained enough to help out the various customers the company deals with. AFLAC specializes in accident and health insurance mostly, with the option of life insurance as well (Business Wire). The industry as a whole is very successful. The most popular aspect that most people will recognize about this company is their memorable commercials featuring the AFLAC duck (Price 1). The duck’s familiar quack and voiceover by Gilbert Godfrey immediately shows that it provides worker’s compensation to its employees (Price 1). There are definitely way more strengths than weaknesses in this particular company. The strengths of this advertisement are its catchiness and cleverness of the advertisements design rather than its theme. The main theme of the advertisement should have gone in a more interesting way of the necessity of the worker’s compensation as part of one’s health insurance package (Price 1). However, the nature of the duck in AFLAC’s commercials makes the surface theme of the duck recognizable and that’s why AFLAC’s commercials with the duck are so popular and has been a big reason why AFLAC has been a solid company over the years. Moreover, in the strengths of this company, it also has to do with the sole person that the customer is dealing with (Wiki wealth). The main strength of this company is the agents that are hired to work with the various customers. If a customer has a great representative, it has come apparent that they would recommend the company to all their friends and family. Personally, having a good representative will keep the customer more calm and know that their insurance claims will be paid in a more efficient time period. In addition, having an agent that can answer all of the customer’s questions and concerns is a big thing as well. If the agent is intelligent enough to answer all of the inquiries the customer may have, the customer will overall have a great experience and would feel that dealing with a company like this would be overall a great experience for that individual. Many believe that the insurance industry can be a profitable one. The industry in itself can be a very successful one, but also can be risky at times. As many might already know, insurance involves pooling different funds from many uninsured entities in order to pay for relatively uncommon, but severely devastating losses which can occur to these entities (â€Å"Industry Handbook). In the United States, the Gramm-Leach-Bliley Act of 1999 was put into legislation. It stated that banks, brokerages, and insurance firms can come together to offer the customers a range of services (â€Å"Industry Handbook. )† In the insurance industry, this had led to an outrage of â€Å"Merger and Acquisition† activity. In addition, a majority o f liability insurance companies underwritten in the United States has been through big firms, which has been scooping up all different insurance industries (â€Å"Industry Handbook†). Insurance can also have some positive and negative effects on society and the economy as well. These are effects that are important and have to be monitored closely (â€Å"Insurance†). One negative about it is that it can increase fraudulent acts by individuals (â€Å"Insurance†). People will try to use insurance companies to try to get money out of them even if nothing extraordinary happens when they need money. On the other hand, it can help many families and individuals prepare for catastrophes and the effects of this on households and societies (â€Å"Insurance†). As one can see, the risk of insurance companies is that there can be access to fraud by individuals trying to exploit these companies for money. On the other end, this is a great way just in case a catastrophe happens in a family such as a deadly car accident, untimely death, or anything of that circumstance. Other factors need to be considered as well when talking about the internal and external aspects of this industry. Demographics is an important factor that needs to be considered. It can affect the sales for insurance, particularly the life insurance aspect (â€Å"Industry Handbook†). As people become older, they tend to rely more on life insurance products for their retirement. In more recent years, the insurance industry has made great headway in offering investments and savings type insurance products for their benefit (â€Å"Industry Handbook†). The Global Insurance Industry is also an important factor when it comes to insurance companies. The industry has to deal with the many fluctuations of the interest rates established. Global insurance premiums grew by 3. 4% to reach 4. 3 trillion dollars (â€Å"Reuters†). Insurance companies do invest in much of the collected premiums, so the income generated through these premiums is highly dependent on these interest rates (â€Å"Reuters†). For the first time in the past three decades, premium income has declined in inflation adjusted terms, with non life premiums falling by 0. 8% and life premiums falling near 3. 5% (â€Å"Reuters†). It has become apparent that this industry (insurance) is exposed to the global economic turndown on the assets side by the decline in return on investments and on the liabilities side by a rise in insurance claims (â€Å"Insurance†). It shows that AIG, a similar insurance company just likes AFLAC, was bailed out in September of 2008 and has had an enormous effect on AFLAC’s business and the insurance industry as a whole. The recession and the financial crisis that has gone on throughout the United States the past few years have shown that the insurance industry is sufficiently capitalized (â€Å"Insurance†). The vast majority of the insurance companies have had enough capital to survive, with only a few insurance companies asking the government for help. AFLAC was one of the companies that did not to have the government intervene into their company. The Five Forces Model, which originated from Michael E. Porter’s book, â€Å"Competitive Strategy: Techniques for Analyzing Industries and Competitors,† has become a frequently used tool for analyzing a company industry structure and corporate strategy (â€Å"Porter’s Five Forces Analysis†). These five aspects include Threat of New Entrants, Power of Suppliers, Power of Buyers, Availability of Substitutes, and Competitive Rivalry. First, the threat of new entrants is the first aspect in Porter’s Five Forces Model. In explaining this, it most nearly means that the easier it is for new companies to enter the industry, the more cutthroat the competition will be (â€Å"Porter’s Five Forces Analysis†). Barriers to entry can limit the threat of new entrants. When it comes to the insurance industry, it is not like any type of person or entrepreneur cannot come along and start an insurance company. The threat of new entrants lies within the insurance industry itself. AFLAC has been fearful in the past of being squeezed out by the big players (â€Å"Industry Handbook†). Another threat for AFLAC may be the other financial services companies entering the market (â€Å"Industry Handbook†). This might cause a direct threat to AFLAC and often hurt them in the long run. If a bank or investment company offered insurance products, it would directly hurt the success of AFLAC. The second aspect of this model is the Power of Suppliers. This most nearly means how much pressure suppliers can place on a business (â€Å"Porters Five Forces Analysis†). In the insurance industry, there can be an immense amount of pressure. The suppliers of capital might not pose a big threat initially, but the threat of suppliers luring away human capital does pose a big threat (â€Å"Industry Handbook†). In AFLAC’s case, they do not want suppliers luring away their human capital because they would lose a lot of business. Also, if this had happened, government intervention might have to happen if they were not doing well financially. For example, if a talented insurance agent is working for a smaller insurance company, there is a legitimate chance that they will be enticed away from the smaller company moving to a larger one. In AFLAC’s case, there have been a few individuals that have gone from smaller insurance companies to the more, popular large ones to move into a particular market that they are comfortable in. The power of suppliers has a huge effect on AFLAC and needs to be monitored closely. The third aspect of this model is the Power of Buyers. This is just the opposite of the Power of Suppliers. In this case, this most nearly means how much pressure customers place on a business (â€Å"Porter’s Five Forces Analysis†). The customer can hold substantial power when it comes to insurance companies such as AFLAC. A regular individual does not pose a threat to AFLAC when it comes to the power of customers. But, what do pose a threat to AFLAC, is the large corporate clients that have more bargaining power than AFLAC (â€Å"Industry Handbook†). Just like airlines and pharmaceutical companies pay lots of money in premiums every year and insurance companies try hard to get high corporate clients (â€Å"Industry Handbook†). AFLAC tries this approach so they can get more for their dollar and be successful in different ways of the insurance industry. The fourth aspect of this model is the availability of substitutes. If someone who uses AFLAC as an insurance possibility and the cost of switching is low, this could cause a potential serious threat to AFLAC (â€Å"Industry Handbook†). This aspect is a pretty straightforward one as there are various substitutes in the insurance industry. Most large insurance companies, such as AFLAC being one of them, offer similar services. Whether it be automobile, life, home, and health insurance, chances are that the competitors can offer similar services. Companies focusing on niche areas usually have a competitive advantage, but this advantage depends on the size and whether there are barriers of entry available (â€Å"Industry Handbook†). AFLAC is one of these companies that do focus on the niche areas of the industry and have the competitive advantage. It seems that they are going to be fine when it comes to other companies offering substitutes. The fifth and final aspect of this model is the competitive rivalry. This is the most important part of the model. This describes the intensity of the various companies in the insurance industry (â€Å"Porter’s Five Forces Analysis†). It is becoming a very highly competitive industry. The difference between one insurance company and another is not all that different (â€Å"Industry Handbook†). As a result, it seems that insurance has become a commodity, which means an area in which the insurance company with a low cost structure, greater efficiency, and good customer service will beat out the competitors (â€Å"Industry Handbook†). AFLAC has the historical characteristics of having a low cost structure and good efficiency, but the customer service is still â€Å"Up in the air. † In the long run, I believe we may see more consolidation in the insurance industry. Other companies may prefer to take over or merge with smaller companies, but AFLAC’s approach is to advertise and market with the AFLAC duck and so far it has been a success over the years these commercials have aired. V. Product or Service for Improvement (House of Quality, DMAIC) There is not one company out there in the world that cannot improve. Even if you are considered a â€Å"perfect company,† there will always be room for some type of improvement on a product or service. In AFLAC’s case, they have been a successful company, but at the same time, they have many concerns within their organization. Within AFLAC, there are multiple changes that could be made to their product or service. The most important thing to fix in their system is that it seems that the company does not pay the customers claims in an efficient amount of time. This can mean a certain wide of things, but more importantly needs to be fixed before this company loses more and more customers. Paying the claims on certain individuals and families have been delayed for as long as two years, which seems to be an unreasonable amount of time. Moreover in this, it seems the customer service is lackluster and needs to be improved as well. Building an improvement plan so this company can get better reviews and even improve financially is important. I believe the first aspect of this is to build what is called a House of Quality. The House of Quality is â€Å"A set of matrices used to relate the voice of the customer to technical features and production planning and control requirements (Evans, 294). The House of Quality relates the attributes of the customer to the technical features. This requires six basic steps needed to be successful. When it comes to AFLAC, building a House of Quality will be reliable in their organization. The first step of this model is to identify the customer attributes. The manager must apply Quality Functional Deployment, which is used to ensure custo mer requirements throughout the product or improvement design process (Evans, 293). It is vastly important to use the notion of â€Å"The voice of the Customer† so it is not misinterpreted by any type of designers or engineers. For AFLAC,I have developed three customer attributes that AFLAC deals with. The first one is the basic attribute, which also can be called the â€Å"Must haves†(â€Å"AFLAC Attributes†). These are expected by the various customers. The second attribute is the â€Å"Linear Satisfiers† (â€Å"AFLAC Attributes†). If this company uses this attribute more effectively, this will increase the customer satisfaction, which at some points, is lacking. The third customer attribute is the â€Å"Energizers† (â€Å"AFLAC Attributes†). This means that it is not expected or required, but creates high customer satisfaction when present and can make the difference in choices for the consumer. For AFLAC, the different type of customers might include single individuals, families, working unions, and government officials (Evans, 295). Therefore, there are many classes that need to be considered. The second step of this model is to identify the technical features that are necessary to meet the requirements of customers (Evans, 295). These technical features expressed the language of the designer and engineer. These are the people that form the basis for design and service activities in an organization. In AFLAC, these must be measurable to track the positive or negative results and the output will be compared to the goals of AFLAC. The roof of the House of Quality (Evans 297) shows the interrelationships between any pair of technical features. These technical features can include the premiums, fees, allocated income, less claims, and less operating expenses. They are classified into either a very strong relationship, strong relationship, and a weak relationship (Evans, 296). The third step of this model is to relate the customer attributes to the technical features. The customer attributes is applied to using Quality Functional Deployment. The customer attributes is to have a better â€Å"experience† than they have had in the past with AFLAC. As set up on the House of Quality chart, the customer attributes are listed down the left hand column with the technical features listed across the top (Evans, 296). Using a relationship matrix is the most effective way to show this. AFLAC’s customer attributes must show whether the final technical features adequately address the customer attributes. These technical features can affect several of the customer attributes. â€Å"The lack of a strong relationship between a customer attribute and any of the technical feature suggests that the attributes are not being addressed and that the final service will have difficulty meeting customer needs (Evans, 296). If the technical feature does not match customer attribute, then the designer might have missed something important. † For instance, in AFLAC the â€Å"Voice of the Customer,† all input is appreciated with expert experience, customer surveys or overviews, or any type of controlled experiments (Evans 296). AFLAC should implement customer surveys and overviews to see what the customers have to say about their experience. Within many companies, especially restaurant establishments, they give out survey cards and rate the service of the waiter and restaurant staff. AFLAC should implement this and read over these surveys so at each AFLAC branch, they can see what they are excelling in and what they are struggling in. This would be beneficial to the company as a whole and to the customers as well. The next step of the House of Quality is evaluating the competitive products or services. This evaluation helps highlight the strengths and weaknesses of the problem. In AFLAC’s instance, the strengths of this company is that they have a strong financial strength within the company, the coverage it provides, the portability, the cost, and the direct payment (Hartman 1). The weaknesses include delays on paying customer’s claims, poor customer service, and more concerned about processes than progresses (Hartman 1). This step enables the designers to seek the opportunities for improvement. This links Quality Functional Deployment to a company’s strategic vision and allows priorities to be set in the design process (Evans, 297). † Some customer attributes become key selling points and help establish promotional strategies. The next step is the evaluation of the technical features of competitive aspects and development of targets. This step is usually accomplished through internal testing and translated into measurable results (Evans, 297). With AFLA C, these evaluations are compared with the competitive evaluation of customer attributes to find inconsistencies. The inconsistencies with AFLAC is their customer service. Targets for each technical feature are set on the basis of customer importance ratings and the existing products strengths and weaknesses (Evans, 298). The final step in building the House of Quality is selecting the technical features to be deployed in the remainder of the process. This means â€Å"identifying the characteristics that have strong relationships to customer needs, have poor competitive performance, or are strong selling points (Evans, 297). † The cost and direct payments with AFLAC are the proper actions and controls to maintain the voice of the customer. Also, on the negative side, the poor customer service and the delay of paying customer claims are critical as well and do need the attention. The House of Quality shows the six steps and how they are to be evaluated in sequential order. They will either be a very strong relationship, strong relationship, or weak relationship. We have to focus to make sure AFLAC improves its processes. It is important AFLAC improves as a company as a whole or could face the financial crisis as AIG did in September of 2008. They need to improve on what they have been criticized for in the past. Using a six sigma approach would be beneficial to their improvement plan. This is an approach to measuring product and service quality (Evans, 93). â€Å"The late Bill Smith, a reliability engineer at Motorola, is credited with originating the concept during the mid 1980s and selling it to Motorola’s CEO, Robert Galvin (Evans, 94). † He wanted to improve product and service quality in his organization and wanted to achieve six sigma capability by 1992. The key concepts of this was think, focus, emphasize, ensure, provide, Create highly qualified improvement experts, and set stretch objectives for improvement (Evans, 94). Today, Six sigma is used as a quality framework and in service organizations. As part of the improvement plan, AFLAC needs to implement a six sigma approach called DMAIC methodology. â€Å"This is a standard problem solving approach used in Six Sigma (Evans, 264). The DMAIC stands for define, measure, analyze, improve, and control. AFLAC can use this methodology to help solve their problem of not dealing with the insurance claims in an efficient amount of time and the customer service that goes along with it. It is explained that the six sigma project selected is dealing with the insurance claims in a sufficient amount of time without any delays. Therefore, the first step is to define the process that needs to be solved or needs â€Å"help. † The problem must be described in operational terms. As an example for AFLAC, this company has history of poor customer service and not paying the claims in time. Therefore, this six sigma project is to improve customer service reliability. Along with this problem, shows that the various insurance agents that are employed with AFLAC seem to not be motivated enough to satisfy the customer. In most organizations including this one, the main job is to satisfy the customer and make sure he or she got the experience with the company and is walking away happy with the customer service. This drills down to a more specific process which is called project scoping (Evans, 264). The customers must be identified that have the most impact on this negative performance, errors or the customer complaints. This phase also needs to address project management issues. In a more timely effort, these AFLAC agents may need some motivation whether it be more of an incentive or extensive training practices to make sure every customer walks out happy. The next phase is the measuring phase. This phase main focus is on how to measure the internal practices of the problems (Evans, 265). It does require an understanding of relationships between process performance and the value of the customer. In AFLAC, every customer is important. Once this is understood, collecting good data, observation, and careful listening should be implemented (Evans, 265). With AFLAC, the high managers and CEO should be doing this type of aspect of this cycle. They should be doing the observation part of every AFLAC branch. Hiring a team of auditors would most likely be the smartest idea. The careful listening part should be by the various AFLAC agents. The auditors and CEO should be giving the individual feedback and the agents should listen on how they can improve their working practices. The third phase is the analyze phase. A huge flaw that happens in problem solving teams and approaches is a lack of emphasis on the analysis portion (Evans, 266). A lot of the time, companies just want to jump into a solution and miss the step of understanding how serious the problem is and identifying where it is coming from. This phase focuses on why defects and errors occur in the organization. The AFLAC auditors need to conduct experiments to be one hundred percent sure that the scope of the problem is accurate. These experiments generally consist of formulating some type of hypothesis and then collecting data and analyzing it (Evans, 266). AFLAC needs to implement a statistical thinking tool. This tool is a philosophy of learning and action based on three principles. These principles include all work occurring in a system of interconnected processes, variation exists in all processes, and understanding and reducing variations are keys to success (Evans, 323). Analyzing statistical thinking in AFLAC would be an immense of help regarding not paying the claims in a timely manner. Variation must exist in this process and AFLAC does not have variation in this type of process. This is why statistics is an important part of the Six Sigma training. Also, what also needs to be analyzed in AFLAC is to see if their also is a computer problem regarding the claims not going through their system. AFLAC pays all their claims online and doing a computer simulation of all computers in the offices would scope out if there is a possible problem with the computer. Once the cause is determined, the analyst, auditors, and teams needs to generate ideas for removing or resolving the problem and improve the performance measures (Evans, 266). One of the difficulties in this section of the DMAIC phase is the natural instinct to prejudge ideas before thoroughly evaluating them in full detail. â€Å"Effective problem solvers must learn to defer judgment and develop the ability to generate a large number of ideas at this stage of the process, whether they are practical ideas or not (Evans, 266). AFLAC needs to improve their customer service and paying their claims in a timely fashion. One idea that needs to be implemented is to have an online website to file the claims to AFLAC. This would be a big convenience to all AFLAC’s clients. On the website, it should also have a spot where you can track the status of your claim. This would save AFLAC lots of money and it would cause less hassle on the customer service line of all the customers asking if their claim has been paid or not. Switching it to online would be more efficient, save money and also would be easier to keep track of every claim. It is way more efficient being on the computer and being well organized than searching through a person’s file looking for it. Implementing the websites to file claims will make the turnover be lower of the amount of complaints regarding the customer service, but there still needs to be improvements. As for the poor customer service, their needs to be extensive training for the many insurance agents that are employed with AFLAC. It has become apparent that these agents were not trained fully on the job when they were originally hired. Implementing a plan where training must exist upon hiring an agent and it should be done every two years to ensure quality in these individuals. The final phase of DMAIC is the control phase. This focuses on how to maintain the improvements AFLAC has implemented. This means putting tools in place to ensure the key variables remain within the maximum acceptable ranges under the modified process (Evans, 266-267). Controlling these plans are vastly important. AFLAC should hire an individual outside of the organization to solely work and monitor the website where claims are filed and to see the status of the claims that are filed. The company will be paying the individual, but in the end, it will save them money and turnover will have gone down significantly. The individual will control these websites and make sure there are no downturns or technical difficulties in the operation of this website. As for the training process improvement, the individual will be trained by top management on an individual basis once every two years. This might seem to be a lot of training by retraining them every two years. Technology changes from year to year and different programs will most likely be established in the near future and it is very important that the agents learn the new development in technology to help them do their jobs on the computer. Training the individual might seem like a hassle to the co-worker, but in the end they will become a more positive individual because they will know that they are doing their job in the most efficient and successful way possible. VI. Identify Management Planning Tools (Tree Diagram, Process Decision Program Chart) Planning is one of the basic functions of every manager out there. The complexity of the business environment today means that planning is not always the easiest thing to do (Evans, 302). However, many different types of tools have been developed by several Japanese companies over the last half century as part of their planning processes (Evans, 302). These tools can be used to address problems typically faced by managers in an everyday role. There are all different types of management tools that can be used to show the improvement in a chart or just explaining it in words. These help the manager understand what exactly needs to be done to improve the process it is struggling or needs â€Å"help† in. With AFLAC, showing these different management tools to management and the lower level employees will help them understand what AFLAC is trying to do as a company and is finding many ways to improve themselves in the