What Is Music Therapy And Its Benifits General Studies Essay

What Is Music Therapy And Its Benifits General Studies Essay Introduction When substances are used excessively for pleasure in society, or an individual uses a substance for reasons that challenge normal behaviour, they are in danger as being labelled a Deviant: junkies, addicts, alcoholics, abusers. There is debate about the causes of such behaviour that can be condensed to the question ‘are we born a deviant, or is it influence from our peers, and from other situational factors around us that make us a deviant? `. American sociologist Robert K Merton proposes that deviancy is caused by society and peers and not the body chemistry. (Robert K Merton) However, this is a question that has long caused argument and differentiation among medical and behavioural psychologists, the former believing that we are born that way, and the latter that we are shaped by life experiences. In order to explore this question I feel it is important to be subjective, as well as objective, and will therefore for this paragraph alone draw on my own personal experiences. Personally I agree with Mertons theory, due to my own self-analysis and actions that I have observed in myself, from underage drinking aged 15 in the pub, and leading on to smoking from peer pressure, which I have continued to do to this day. Playing sport, Rugby, did at the time change my attitude to smoking and drinking as I peered with different people. Changing friends in the 1990s influenced a change in my person leading to the rave scene and recreational drugs use, through own choice and experiments. As an individual I understood the risks and was conscious of my limitations. Using drinking as an example, I understood that when I was drinking, it was part of a social pattern within a social network, if I exceeded that limitation and drank in excess away from the social network, I would have a possible a ddiction. Many substances that are used for pleasure can have an effect on our perspective of time. When we lose a sense of timing we can lose our sense of coherence. Episodes that take us away from coherence of life can threaten isolation (Reith 1999); this is when addiction becomes debilitating. When we lose the timing in life and lose the sense of timing of others around us as human beings, we need something to bring us back to the normal senses and bring us back into the community of other individuals whom we live our lives with. A medium based on performance which can assist with this is the live performance of music. Music therapists provide a solution were we can go into an environment and work with other individuals whom have also extreme deviances. Working on the timing of music can improve our coherent self, leading to a balance in our sense of timing. When focusing on music, an individual can clear their mind of all other problems, therefore allowing themselves a means of escape. Why use music therapy? Music offers a non-symbolic contact with reality, it can be classed a holistic. Performing music with other people is a way of achieving a connection at a fundamental level; we become entrained with other individuals when performing by attachment and emotional expression. However on the reverse side, a Music therapist could potentially face the problem that the songs and music they are using with their clients may resemble memories. An example of this could be drug memories if that particular piece of music was part of the setting when using the drugs. If this happens it could trigger a craving. So can music therapy be a good alternative for the cure of addiction? In a comprehensive study of various books, online journals, videos, documentaries, and case studies there is a significant amount of supporting evidence to be found. This essay will aim to explore the various evidence found and reach a comprehensive conclusion as to the strengths and weaknesses of music used as a therapy for drug addicts, and whether it can effectively help to bring an individual out of an addition. The following chapter will focus on what Music Therapy is and how it can assist in the cure of Drug (drug being alcohol, smoking and illegal substances) addiction, outline the effects of the addiction and explain how music therapy can act as a holistic therapy to the addiction. Chapter 1 What is Music Therapy? Music Therapy can be classed as clinical approach to cure symptoms of addiction. Experiments have had proved results on an individual`s relaxation, the relaxing of the mind, reduction of pain and symptoms with addiction withdrawal and the normalisation and reduction of respiration rate and breathing. Research has found that music therapy has also been successful with the treatment of cancer, brain injuries, and acute pain. Doctors have started to prescribe the use of music therapy by playing their patients different styles of music while undergoing surgery (vid1 linkography). This has proven effects of a supportive measure when altering key hormone levels in patients to speed up recovery, reduce blood pressure, and heart rate. With coordinated preparation of music therapy, clients can experience; Stress and Anxiety reduction. Positive, balancing moods and emotional states. Positive feelings towards themselves, self-confidence and feeling of high self-esteem. Intimacy enhancement of feelings and emotions towards family members and friends. Learning music skills gives the client the patience and abilities to cope with possible situations that may occur in other aspects of their lives. Music therapy has had proven results with the development and learning skills with children, adults and the elderly whom have mental health needs and learning disabilities. Music therapy is recommended for age related diseases aged related diseases such as Alzheimers. Music therapists work from private practices, rehabilitative facilities, hospitals, nursing homes and hospices. Music therapists consult with clients and they assess their condition, physical health, social functioning, and cognitive skills. The Music therapist will construct music sessions for individuals or groups of clients. A wide range of treatment is available from lyric discussion, song writing to live performances and receptive music listening. Experiments by Music therapists have found evidence that their clients have shown remarkable changes in their behaviour of recovering from drug addiction.

Rational Approach of Organizational Change Essay

Committee unanimously approved a financial fair play concept for the game’s well-being in September 2009 and on 27 May 2010 approved the UEFA Club Licensing and Financial Fair Play Regulations Edition 2010, in the presence and with the full support of the European Club Association chairman, Karl-Heinz Rummenigge. The concept, which has been supported by everyone around football, looks at the long as well as short-term health of club football and individual clubs. In particular, the objectives aim to introduce more discipline within club finances and encourage responsible spending and investment. Financial fair play is a key point in the 11 values of the UEFA president presented at the UEFA Congress in Copenhagen in March 2009. Despite a background of huge and increasing public and commercial interest in European club football over the last decade, many clubs across Europe are in poor financial health, struggling to meet their financial responsibilities and commitments, and reporting repeated financial losses. UEFA has a duty to consider the systemic environment of European club football in which individual clubs compete, in particular, the wider inflationary impact of clubs’ spending on salaries and player transfer fees and increasing levels of indebtedness across European club football, as the Club Licensing Benchmarking Report shows. Therefore, as requested by and in consultation with the football family, UEFA has aimed to develop sensible and achievable club monitoring requirements to supplement the existing club licensing criteria, in order to safeguard the sustainability of European club football. To supplement and complement the former UEFA Club Licensing Regulations, the UEFA Club Licensing and Financial Fair Play Regulations, comprising both club licensing criteria and club monitoring requirements derived from the financial fair play concept, entered into force on 1 June 2010, with the various financial fair play requirements being phased in over a number of seasons. The consistent application of the club licensing criteria by licensors and the monitoring of clubs are overseen by the independent Club Financial Control Panel, which was created in 2009. If a criterion or requirement of the regulations is not fulfilled, appropriate measures will be taken against the club by UEFA’s independent disciplinary bodies. Potential disciplinary sanctions are the remit of the competent disciplinary bodies that have a palette of sanctions at their disposal including ultimately the exclusion from future UEFA club competitions. Since its creation, the Club Financial Control Panel has referred numerous clubs to UEFA’s disciplinary bodies for both club licensing and club monitoring breaches. Of course many people also believe that the dream of Michel Platini for competitive but healthy football for all the 660 football teams under UEFA’s jurisdiction will fail. But taking into consideration the fact that if the FFP fails the credibility of Michel Platini will be harmed the UEFA Club Financial Control Panel are determined to help the president of UEFA achieve its dream. The tasks of the independent Club Financial Control Panel to achieve Platini’s dream are to ensure that the UEFA club licensing system is applied correctly across all 53 UEFA member associations and that clubs have fulfilled the criteria defined in the UEFA Club Licensing and Financial Fair Play Regulations. As well as conducting and deciding on licensing compliance audits to check the awarding of licenses by the national decision-making bodies and checking that club competition integrity rules have been observed, the Club Financial Control Panel governs the ongoing club monitoring process (financial fair play) after the awarding of licenses. It was introduced at the start of the 2004/05 season with the goal of encouraging European club football to look beyond the short term and consider underlying longer-term objectives essential for the game’s continued good health. It is based on a series of defined quality standards, which each club must accomplish to gain entry to UEFA’s club competitions, and on the key principles of transparency, integrity, credibility and capability. The 36 specific criteria of the licensing system can be broken down into five main categories: 1) sporting 2) infrastructure 3) personnel 4) legal 5) financial These criteria – developed in cooperation with the national associations – have helped to improve the credibility of club operations and led to better transparency and governance by clubs and national associations. A license granted to a club by its national association proves that it has achieved a certain quality level.

The New Angle On How to Write in College Just Released

The New Angle On How to Write in College Just Released The How to Write in College Game The notion that we're able to train someone for a work today that will stay the exact same for that individual's life is nonsense. The truth is you are better off taking the time that it requires for using keywords correctly to pull visitors with a larger focus on what you're blogging about! If you think that you're able to write an essay that will enhance your probability of being accepted, by all means, go ahead. Although writing a winning college study essay may appear like an intimidating task, it truly needs some preparation for caution, originality, and plenty of patience. Dr. Metri can always figure out who's saying the truth and who's writing for the interest of writing. While you don't need to be a writing expert, you will need to write from the heart to receive your message across. Utilizing somebody else's subject (or his essay for this matter) is not a fantastic idea. Get copies of the sort of writing you're looking forward to and learn to write from such examples. How to Write in College - What Is It? Leadership Skills Regardless of the part in question, every employer wishes to employ a leader. Actually, there are a lot of attributes applicants should have to be able to even be considered! People looking for the sort of information you've written about will locate it in their search success! The majority of the colleges utilize the typical application essay prompts. Top Choices of How to Write in College To compose a successful press release, you must think as a journalist. It is very important to realize that you're able to manage some sort of writing. You're able to come before beginning writing, as you are drafting, and as you're making final edits. Don't begin with the toughest type of writing. Now you're ready to start writing a college essay. When it is their very first job, learn why THEY think they are qualified. There are rather many academic writing services readily available on the internet to help students who require help in writing their work. It's easy to discover students not understanding how to write college application essays. As an example, writing a report to your English professor is extremely different than writing a letter to your very best friend, which means style has to be different. Creating a distinctive voice'' is among the most challenging facets of writing for anyone, even experienced writers. Everyone will specialize to be the greatest in their various fields. Moreover, there are online businesses that trap students by claiming to present inexpensive college application essay writing service. The quantity of reading is just one of the starkest differences between the 2 experiences which demands a specific strategy toward reading. Thus, you'll need to receive your writing out there so that it is possible to hone your craft. The net has made research so much easier, particularly the way it's possible to discover photos from almost any local, in addition to numerous articles and books on the internet. The Chronicles of How to Write in College Among the tasks every student is going to have to face is understanding how to write a college resume. In the 21st century, college interviews are lost on the best way to the VCR, in other words, they are normally employed. When you compose a college resume, make the most of phrasing job descriptions by focusing on skills and not only the experience. College is a great deal of walking, and walkin g is excellent thinking time. Inside my case, it's career-wise, and you may be stranded in your love life, you may be lost in deciding whether to move out of your family house, or maybe you think that your college major is a huge mistake and that you'd probably never graduate. Whether there are any significant accomplishments you've done while employed as a team, be certain to bring this up. Many MBA programs request that you explain a mistake you've made or talk about a challenge you overcame. Being a real student of your craft is critical if you wish to attain quality in your art.

Ethical Dilemmas Of The Home Work For Chemistry At 8 Essay

1. Ethical Egoism This Monday morning my study group meet to go over the home work for chemistry at 8:30 am. I have had a long weekend so I wanted more sleep. I then continued to hit the sleep button on my alarm. I did not make it to the study groups until 9:50. This was ethical egoism thinking on my behave. I had homework due soon for a class. I tried to complete the assignment, but my boyfriend had other plans. He played his video games and metal music as I tried to do my homework. I cannot focus when there is loud sounds and distractions in the room. I asked him to turn it off but he continued to play. He turned the sound down because he wanted me to stay, but it still didn t help. I had to go to a different room. This was ethical egoism thinking on my boyfriends side. My mom did not want me to get my ears pierced. I on the other hand did. I kept asking her and asking her but the answer was always no. One day when no one was home I pierced my own ears. I hid it from my parents for quite sometime, until I wore my hair up exposing the piercing. My mom then made me take them out and make them close up. This was ethical egoism thinking on my side. 2. Moral/Cultural Relativism When I was mad at my boyfriend, I went out and got my nose pierced. I kept it for awhile just to spite him. One day we were going to meet his parents. I knew that his mom thought girls with nose piercings where trashy so I took my piercing out and let it heal up, because I did not want his motherShow MoreRelatedOrion Shield Project Case Essay3268 Words   |  14 PagesAllison, is in operating as leader. Specifically, the paper focuses on what technical, ethical, legal, contractual, and other managerial issues plague the success of The Orion Shield Project. The paper attempts to analyze these issues by first introducing the reader to background about the project, and then moving into a deeper discussion of every one of the previously mentioned issues. 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The Personal Dilemmas Of Creon Vs. Antigone - 920 Words

â€Å"Only enemies speak the truth; friends and lovers lie endlessly, caught in the web of duty.† - Stephen King (brainyquotes.com). In Sophocles’ Antigone as well as Anouilh’s version of the play duty versus personal motives is a very significant theme that heavily contributes to the outcome of the character’s actions. The two protagonists, in both plays, Creon and Antigone are aware of the negative consequences of their actions. Creon and Antigone both believe that they are correct within their arguments, regardless of their knowledge of the repercussions. Looking at Creon and Antigone’s actions in both Sophocles’ and Anouilh’s versions of the play, they prove that duty to the law is much more important than anything else. Making decisions†¦show more content†¦Her hubris results to Creon to continue with what he has to do as king, what he has to do for the duty to the law. He must kill Antigone even though he doesn’t want to in order to insure safety of Thebes. This shows that Creon even thinks that the duty to the law is much more important than anything, even if it is related to family. That is seen what he makes the decision to have her killed. Creon’s character traits of being a much more sentimental and caring man is seen here as well. When he says â€Å"And I don’t want to†, it is easy to recognize that regardless of how he feels and what his character traits are he must sacrifice that for his duty to the law. Similarly, Antigone still makes very irrational decisions based on her own personal motives that go against Creon’s duty of law. Antigone is speaking to Ismene about her plans to bury Polynices, as well as knowing the negative repercussions that will occur from following through with the plans. Nevertheless, she later continues in the book to follow through with it even without the support of Ismene. While talking about her plan to her sister, Antigone says, â€Å"O Ismene, What do you think? Our dear brothers †¦ Creon has given funeral honours to one, And not to the other ; nothing but shame and ignominy. ... ...the order Says he is not to be buried, not to be mourned ; To be left unburied, unwept, a feast of flesh For Keen-eyed carrion birds. ...Show MoreRelatedAntigone Moral Dilemma1253 Words   |  6 PagesAntigone’s Moral Dilemma Margaret Walsh South University Online Antigone’s Moral Dilemma Perhaps the most pronounced question in the play Antigone by Sophocles is the value of human law vs. divine law. In this tragic play a newly appointed king Creon declares to his people that treason was committed during battle, and

Positive Feedbacks in the Economy Free Essays

Positive Feedbacks in the Economy A new economic theory elucidates mechanisms whereby small chance events early in the history of an industry or technology can tilt the competitive balance by W. Brian Arthur onventional economic theory is built on the assumption of diminishing renrrns. Economic actions engender a negative feedback that leads to a predictable equilibrium for prices and market shares. We will write a custom essay sample on Positive Feedbacks in the Economy or any similar topic only for you Order Now Such feedback tends to stabilize the economy because any major changes will be offset by the very reactions they generate. The high oil prices of the 1970’s ncouraged energy conservation and increased oil exploration, precipitat- ing a predictable drop in prices by the early 1980’s. According to conventional theory the equilibrium marks the ‘best† outcome possible under the cir- natives will be the â€Å"best† one. Furthermore, once random economic events select a particular path the choice may become locked-in regardless of the advantages of the alternatives. If one product or nationin a competitive marke@lace gets ahead by â€Å"chance,† it tends to stay ahead and even increase its lead. hedictable, shared markets are no longer guaranteed. During the past few years I and other economic theorists at Stanford University, the Santa Fe Insurute in New Mexico and elsewhere have been developing a view of the economy based Such a market is initially unstable. Both systems were introduced at about the same time and so began with roughly equal market shares; those shares fluctuated early on because of external circumstance, â€Å"luclC’ and corporate maneuvering. Increasing returns on early gains eventually tilted the competition toward VHS: it accumulated enough of an advantage to take vhrually the entire VCR market. Yet it would have been impossible at the outset of the competition to say which system would win, which of the two possible equilibria would be se- Such an agreeable picture often on positive feedback. Increasing-returns economics has roots that go back 70 years or more, but its application to the economy as a whole is does violence to reality. In many parts largely new. The theory has strong lected. Furthermore, if the claim that Beta was technically superior is true, then the market’s choice did not represent the best economic outcome. Conventional economic theory of- stabilizing forces arallels with modern nonlinear physics (instead of the pre-ZOth-century physical models that underlie conventional economics), it requires new and challenging mathematical techniques between two technologies or products performing the same function. An example is the competition between water and coal to generate electricity. As cumstances: the most efficient use and allocation of resources. of the economy, appear not to operate. Instead positive feedback magnifies the effects of small economic shifts; the economic models that describe such effects differ vastly from the conventional ones. Diminishing returns imply a single equilibrium point for the economy, but positive feedback-increasing returns-makes for many possible equilibrium points. There is no guarantee that the particular economic outcome selected from among the many alterW. BRIANARTHUR is Morrison hofes- sor of Population Studies and Economics at Stanford University. He obtained his Ph. D. from the University of California, Berkeley, in 1973 and holds graduate degtees in operations research, economics and mathematics. Until recently Arthur was on leave at the Santa Fe Institute, a research insdrute dedicated o the srudy of complex systems. There he directed a team of economists, physicists, biologists and others investigating behavior of the economy as an evolving, complex system. and it appears lTth† history of the videocassette I recorder furnishes a simple exI ample of positive feedbaik. the vcR market started out with two competing formats selling at about the same price: VIIS and Beta. Ehch forma t could realize increasing rerurns as its market share increased: large numbers of VHS recorders would encourage video outlets to stock more prerecorded tapes in VHS format, thereby enhancing the value of owning a WIS ecorder and leading more people to buy one. (The same would, of course, be true for Beta-format players. ) Ir this way, a small gain in market share would improve the competitive position of one system and help it further increase its lead. 92 Scrrmrrc AMERTcAN to be the appropri- ate theory for understanding modern high-technology economies. February 1990 fers a different view of competition hydroelectric plants take more of the market, engineers must exploit more costly dam sites, thereby increasing the chance that a coal-fired plant will be cheaper. As coal plants take more f the market, they bid up the price of coal (or trigger the imposition of costly pollution controls) and so tip the balance toward hydropower. The two technologies end up sharing the market in a predictable proportion that best e’qploits the potentials of each, in contrast to what happened to the two video-recorder systems. The evolution of the VCR market would not have surprised the great Victorian economist Alfred Marshall, one of the founders of today’s conventional economics. In his 1890 Pr’nciples of Economics, he noted that if firms’ production costs fall as their arket shares increase, a firm that simply by good fortune gained a high proportion of the market early on would be able to best its rivals; ‘uhatever firm first gets a good start† would corner the market. Marshall did not follow up this observatior however, and theoretical economics has until recently largely ignored it. Marshall did not believe that increasing returns applied everywhere; agriculture and mining-the mainstays of the economies of his timewere subject to diminishing returns caused by limited amounts of fertile land or high-quality ore deposits. Manufacturing, on the other hand, eqioyed increasing returns because large plants allowed improved organization Modern economists do not see economies of scale as a reliable source of increasing returns. Sometimes large plants have proved more economical; often they have not. would update Marshall’s insight by observing that the parts of the economy that are resource-based (agficulI ture, bulk-goods production, mining) are still for the most part subject to diminishing returns. Here conventional economics rightly holds sway. The parts of the economy that are knowledge-based, on the other hand, are largely subject to increasing retums. Products such as computers, pharmaceuticals, missiles, aircraft, automobiles, software, telecommunications equipment or fiber optics are complicated to design and to manufacture. They require large initial investments in research, development and tooling, but once sales begin, incremental production is relatively cheap. A new airframe or aircraft engine, for example, typically costs between $2 and $3 billion to design, develop, certify and put into production. Each copy thereafter costs perhaps $50 to $100 million. As more units are built, unit costs continue to fall and profits increase. Increased production brings additional benefits: producing more units means gaining more experience in the uct so as to be able to exchange information with those using it already. manufacturing process and achieving greater understanding of how to produce additional units even more mechanisms that did not involve technology. Orthodox economists avoided increasing returns for deeper reasons. cheaply. Moreover, er How to cite Positive Feedbacks in the Economy, Papers

Multi-Skilling “Jack of All Trades Master of None” free essay sample

Multi-skilling â€Å"Jack of all trades master of none? † Gerald R. Snider June 14, 2010 Wayland Baptist University David Gomez Abstract In today’s Health Care arena where economics is failing and healthcare workers are looking for a reason to stay in the business, it is important to look at every tool available to make that happen. Multi-skilling is a unique tool available that if used correctly could combine technical and administrative duties normally held by several different employees into one job. This paper explores the multi-skill lifecycle model used, associated elements, stages and criteria needed to properly implement this process. It also explores recent challenges that are specific to the medical field when this model is used and how the healthcare industry can implement this process to help it with downsizing and reorganization issues. My research found few studies that explicitly or specifically considered the affects of multi-skilling on the healthcare industry and its affects on patient care. Consequently, general management literature was reviewed with the aim of identifying the model used; generic issues and lessons learned that can be applied across the field of resource management. The literature considers issues relating to the efficacy and success of multi-skilling which could impinge on the integrity of healthcare and patient safety in the workplace. The review considers general effects of multi-skilling with the aim of identifying the problems which may have in impact on healthcare and patient safety and considers the drivers of multi-skilling as it influences the approach and required focus of controls. Because this term applies to a broad range of industries there can be many definitions and applications to this process. The medical industry has defined it as such: Persons cross-trained to provide more than one function, often in more than one discipline. These combined functions can be found in a broad spectrum of health-related jobs ranging in complexity from the non-professional to the professional level, including both clinical and management functions. The additional functions (skills) added to the original health care worker’s job may be of a higher, lower, or parallel level. (Jacobson and Johnson,1998,p. 79) Other industries describe multi-skilling as a way of working where the traditional divisions between work areas and separate disciplines are removed, and individuals are given the responsibility for a range of different types of task. Vertical Multi-skilling – This is where support personnel have learned enough supervisory and administrative tasks and move up into a supervisor role. This can be either considered a form of empowerment or if this process occurs due to downsizin g, often we see individuals that lack the ability to lead or have not been trained properly. Horizontal Multi-skilling This is learning skills from another discipline or function within an organization. For example an electrician learns some mechanical tasks or a process operator learning some maintenance skills. Horizontal Multi-skilling can be considered as two main types: †¢ Skill broadening – where minor elements and tasks are learned on top of the predominant activity (major task). So expertise is maintained in the major task with elements added to increase efficiency. For example, a mechanical engineer may learn how to isolate and disconnect a motor to avoid the use of an electrician. Cross skilling/dual skilling – where another major activity is learned in addition to the main craft and a person is considered competent to carry out any activity in these two main disciplines. For example, multi-skilled craftsmen considered competent to carry out both mechanical and electrical tasks. Typically some limits will be placed on the types of safety critica l work that can be carried out. (Horbury Wright,2001,p. 3) Depth multi-skilling – This is where more in-depth, complex and specific skills are trained on the same skill set. These skills can either be acquired as part of an individual effort to support a team or be incorporated into multi skill set teams. Multi Skill Set Teams (Skill Mix) – This should not be confused with multi-skilling although it does encompass some of the same processes but does not have the same dynamics involved with multi skilling. Multi skill set teams try and align job specific personnel in order to stream line a certain process or to make time and room for more people to be served or more products to be produced. This of course involves multiple team members with all different skill sets where the strengths and specialties are combined and then are managed by an individual in that group. Because multi-skilling can be used in various industries there are numerous models and stages that each industry applies to their application of multi-skilling. For the purposes of this literature we will look at what appears to be the predominant model used in most settings. I. Initial conception – There are usually a number of reasons why organizations choose to multi-skill these primarily fall under four main areas: Organizational flexibility – companies are starting to go away from the worker that can only perform at one job task. This hinders the company’s ability to work efficiently and stay competitive. Now organizations are looking for employees that can function across several levels of job tasks and experiences and are reducing the functional demarcations previously instituted so they remain flexible. Reduce labor costs – Multi-skilling is often a reaction to a reduction in personnel rather than a deliberate strategy. The direct labor costs were found to be reduced by between 20 and 25% following organizations implementation of multi-skilling. Further benefits were a reduction in overtime and a decrease in personnel needed to perform the tasks (Horbury Wright,2001). Reduced downtime/Streamlined jobs – It is often found when multi-skilling tasks to different workers and after eliminating excess workers you can streamline the process for specific tasks or related jobs into a more efficient and less time consuming procedure. Human resource issues – numerous human resource issues can lead to multi-skilling, weakening the power of trade unions, enhancing skill sets, ersonnel development, and empowerment initiatives, enhancing skills and increasing job security. II. Imagining change Once a decision has been made to take the next step in the multi-skilling process the organization can approach the implementation in several different manners. â€Å"Wait and See†, this approach is fundamentally reactive and was found that companies which operated off this premise often lacked the focus on proper training of e mployees on relevant skills, was unwilling to invest the proper resources and were more in a trouble shooting mood. Learn as you Go†, this approach involves a good practice of feedback strategies and requires constant communication at all levels. Management needs to look at the overall cultural view towards change and there should be a widespread sense of ownership. A positive aspect of this approach is the limited start up costs for implementing this system. â€Å"Predict and Preempt†, this approach involves changes in the implementation and content stage. The organization places a series facilitating measures that cover staffing, education, training, and salary issues. Key decisions that should be discussed include, what is the vision the company wants to achieve during this time frame? What kind of risks is the company willing to accept? What can the company do to show it wants to be part of the change process and how can the workforce be persuaded? Finally, the company needs to recognize that it may need to persevere possibly over a number of years and a concerted effort will be required. III. Planning and Enrolling support – This is considered the detail planning stage. This is where you need to consider the wider context of all issues that multi-skilling will affect. Issues such as, human resource agreements, culture of the organization, proper communication of multi-skilling aims and the importance of buy-in by the stakeholders and whether or not the current technical and social system that are in place are consistent with the proposed multi-skilling plan. Enrolling support is about convincing workers within the organization to work together and involve themselves in the proposed changes. Other elements to consider are identification of tasks that are both routine and non routine. Try and optimize the technical and social systems that are already in place. Define the specific knowledge and skills required for multi-skilling. We could go in depth here about task specific items and resource specific ideas but there are far too many to list here. More specifically in the medical field it is felt that the technical specialists are those that should be targeted for cross-training. IV. Implementation and Operation – One of the biggest tasks to complete here is the training and competence step. One of the first steps is to train up staff with the requisite activities and then ensure the training has equipped the staff with the necessary skills and knowledge to competently and safely carry out the tasks at hand. This can be accomplished through defining skill sets to be cross trained, have outside learning provided by third parties, use log books in work area to record daily duties and best practices used reassessment of job skills taught and periodic refresher training. Ongoing management of this process is necessary for multi-skilling to be successful. Following the training that was coordinated and a check on competence to ensure training was successful the review should that organizations with the most success had programs in place to ensure that new and old skills were being used and there was no stagnation taking place. Supervisors and trainers were aware of all the skills necessary to perform job specific tasks by attending some training courses provided to the workers as well. Different organizations then used different means to access the effectiveness of the multi-skilling process and used control measures to try and measure its affects. Some of these performance measures included: job satisfaction, motivation, performance, turnover, health and safety and financial performance. Although we have reviewed the stages that a multi-skilling process should follow the literature also reviewed a model that companies should try and pursue to implement the multi-skilling format. Although it follows the stages very closely in word and format they look a little closer into the lifecycle process used. According to Horbury and Wright (2001), the steps are defined by key management objectives and issues: 1) Starting out – recognize the need for multi-skilling, identify and asses the risks associated with this event, use SOP’s and MOI’s to ensure understanding and compliance, define safety criteria. 2) Planning and assessment – what individuals will be used, what tasks will be used, how will they be trained and supervised, ensure you take into account the workload and competence when making decisions, ensure changes are developed in a planned and systematic manner. ) Implementation – detailed planning is turned into operational reality, ensure proper resources are allocated to change, ensure flexibility is built into the model to allow for change and growth. 4) Implementation check – ensure planned training, supervision, etc has been carried out, achieved required performance objectives, modify implementation if necessary, consider feedback a nd issues that might arise. 5) Ongoing skills maintenance and review – ensure skills are maintained at organizational and individual level, detect any latent problems, always seek opportunities to improve the process. How does the issue of multi-skilling, models, and stages presented fit into the healthcare arena? Most organizations look at the multi-skilling model because of a need for downsizing because of staff limitations or possibly related to financial restraints placed on it by failing economics. Healthcare fits into both of these categories. The U. S. now spends over 16 percent of its Gross Domestic Product for healthcare related services. More money is being spent but less money is being generated. We will soon hit a healthcare crisis as the baby boomers which number in the millions and are on a fixed income, and also on fixed Medicare insurance reach ages of 65-85 which will require numerous medical interventions. It is also well publicized that there is a national nursing shortage that has left many hospitals short on required staff. There is also been a recent problem with staffing some of the technical job skills in certain hospitals and there has always been an issue with how do we get healthcare to those urban settings that lack both physical resources and personnel. So the issue of multi-skilling and cross-training has been forced to the forefront in order to try and deal with some of these issues. Many hospitals had started looking into cross-training/multi-skilling its employees over 20 years ago. Most popular use was training medical personnel in the areas of administrative assistance, such as handling phone calls generating reports and data processing. Now with the looming crisis coming even closer they have to think of more innovative ways to tackle these tough issues. In 1995 Greiner described three primary work-restructuring models that hospitals could use to deal with the above stated problems, patient centered care (PCC), patient-focus care (PFC), and operations improvement (OI). Under a PCC model comprehensive survey data are used to determine what organizational changes make hospitals more humane. Detailed patient reports are used to execute structural reorganizations, redesign work processes, and provide ongoing information for quality improvement processes. Cost savings have not been a focus of this model. The PFC model emphasizes both cost and quality and affects a broad spectrum of occupations through multi-skilling, redeployment of ancillary services and teamwork. OI’s primary focus is reducing the number RN FTE’s and using more nurse Aides, while ancillary services remain more centralized (Grenier Pindus,1997). Many hospitals are now struggling with what approach to take, what skills should be multi-skilled and where do you draw the line with patient safety and proper medical care. Under the PFC model a hospital in Illinois found all kinds of issues related to the multi-skilling model. Job redesign seems to imply to workers that even though they’ve been productive and done a good job, the hospital has decided that their job doesn’t contribute sufficiently to the patients well being. One of the hardest things is helping people understand the answer to the questions, â€Å"Why do I have to change? † It’s one thing to understand it intellectually and another to internalize it emotionally. (Hequet,1994) One of the biggest issues that relates to multi-skilling in a medical environment is the licensing issue. Nurses are usually the lowest worker required to have licensure through the state they are currently working. When a legal battle ensues it usually stops at the nurses’ responsibility level. This makes nurses very wary when new training allocates medical duties to non licensed personnel. Certain states are trying out workers called UAPs (unlicensed assistive personnel). Their purpose would be to bridge the gap with nurses and try to perform direct and indirect patient care under the direction of the registered nurse. Duties would include giving the patient a bath, emptying catheter bags or dressing a wound. Some of these activities seem very menial and unimportant when looked at but or a nurse they are direct interaction with their patient that provides relevant information for medical care. For instance, during a bath their is direct patient contact where nurses can asses skin care related issues or use as an opportunity for teaching the patient about his or her condition, emptying a catheter bag a nurse can look at the color of the urine to see if there is blood present or proper hy dration is taking place, also when doing a dressing change they can look for signs of infection and use proper sterile technique (Cameron, as cited in Backman,2000). Healthcare should learn from the presented model and apply the lessons learned to ensure that there is a smooth transition before they run into a case where these matters become a necessity by force. The literature shows that most models can work unless they are used after an organization has a staff decline and then is forced to use the model. Multi-skilling should play a huge role in the future of the healthcare field. This is a dynamic way to quell some of the personnel shortages as well as the financial hardships that plaque the industry today. The medical industry needs to be proactive both in its legislature and its hospitals to implement these action plans. There have already been numerous battles between the nursing associations because they do not want to lessen their craft or release patient control to other job skills. Certain technical job skills are lobbying in court to keep their multi-skilling status as well. The human resource piece to this puzzle is huge of course because this whole issue is tied around how to use your personnel appropriately and how to engage your employees in a process of change. The literature is full of HR related issues, topics and terminology as it deals with the concept of implementing multi-skilling in different organizations. Finally this literature review has clearly shown that there is a lack of studies and research being conducted in the United States concerning these issues. Most literature was taken from studies and reviews conducted both in Canada and the Untied Kingdom.