Psychology For Social Care Practice Essay

This essay will demonstrate my understanding of developments which occur at each stage of an individual’s life cycle. I will relate these developments to two relevant psychological theories and discuss how an individual’s needs must be met to enable them to develop. The human life cycle can be broken down into 5 basic stages (Bingham et al. 2009); Infancy – 0-2 years Childhood – 2-12 years Adolescence – 12-21 years Adulthood – 21-65 years Older Adulthood – 65+ years During each stage of the life cycle, different physical, emotional, cognitive, social and cultural developments occur; In infancy, physical changes include learning to sit up, crawl and walk independently. At this stage, the infant will begin to look for attention from others and seek affection and love. Infants are able to interact with others by smiling/laughing and crying, and begin to form attachments to main care givers such as family members from around 6 months. Fine motor skills and communication skills (understanding and formation of words) develop rapidly in infancy and individuals will become used to the routines and norms of those around them. In childhood, physical development extends to skills in balance and control over the body. Emotionally, the child will continue to strengthen bonds with primary care givers and social development will move on to interactive play and forming friendships. Language and expression develop further and the child shows a capacity to learn new information and skills as well as learning about and conforming to social and cultural â€Å"norms†. The body begins to change significantly in adolescence; the individual will go through puberty. An adolescent will be more self aware than in childhood and will become detached from primary care givers, instead preferring to form closer relationships with friends and peers. The individual will form stronger affiliations to certain cultural and sub-cultural norms and will express these through personal appearance, partaking in activities and choosing certain peer groups. In early adulthood, the individual will reach a peak of physical fitness which they will thereafter have to â€Å"work at† to maintain. More physical demands are made on the body such as childbearing, work and aging. Emotionally, a person  in adulthood will have established a â€Å"role† possibly in their place of work, or at home as a parent- how effectively they fill their â€Å"role† can effect self esteem. Social development can become limited to those with similar careers or interests and c an be hindered by other responsibilities such as work and family commitments. Older adults may experience a decline in physical fitness – eyesight may deteriorate and the body may become weaker. Some individuals may remain fairly fit well into older adulthood and some may find that physical fitness can deteriorate rapidly. Older adulthood can be isolating and one’s self image can be altered through changing of roles eg. retirement. Socially, some find a sense of freedom in being able to leave work behind and â€Å"live†, others lose a sense of purpose and find that their world may become smaller and more family focused. Older adults will have a well established perception of themselves and what they find acceptable as part of their culture. For this essay I have used Mrs. Oswald as a case study. Mrs. Oswald is a resident at Thorneycroft residential care home for older people. She has been a resident at Thorneycroft for six months and at ninety-five years old, is in the final stage of development as detailed in the life cycle breakdown above. Mrs. Oswald is relatively able bodied, she is able to bathe herself but requires help getting in and out of the bath. She is able to move around independently, she does have a tripod to help her with this but she doesn’t tend to use it. She is prone to falling over and has fallen fifteen times since moving to Thorneycroft, this is not helped by her insomnia which leaves her restless at night so she ends up wandering around unattended. Mrs. Oswald is hard of hearing and requires a hearing aid but her eyesight is good when wearing her glasses. She has a good level of personal hygiene and takes pride in her appearance. Before coming to Thorneycroft she had home help who assisted her with household tasks such as cooking and housework and helped her with medication for her cellulitis. Mrs. Oswald was a midwife for fifty years, she is well educated and enjoys sharing her knowledge and talking about her career. She keeps her mind active by reading the newspaper, doing crossword puzzles and playing dominoes when she goes to the day centre but it is possible that these activities are not stimulating e nough for her. She is a little confused at times about her roles; she behaves as though Thorneycroft staff are her employees and adopts a matron-like attitude with them, which probably  crosses over from her role in her career as a midwife. She can be forgetful but does not have dementia and before moving to Thorneycroft was quite vulnerable as she sees the best in people and was being exploited by people doing odd jobs and coming in and out of her home. Mrs. Oswald appears to be content on the surface, she has started to accept death and talks about it openly. Her remaining family all live some distance away in England but she looks forward to a phonecall from her cousin each evening and seems to take comfort in speaking to him, appearing more settled after their conversations. She has outlived her close family – husband and daughters and appears lonely. Mrs. Oswald doesn’t talk much about her husband an daughters the way she does about her career, it is possible that talking about them makes her feel sad. As before, Mrs. Oswald has not made friends with other residents of Thorneycroft, though she has made a few friends at the daycentre. She likes to talk and could be encouraged to mix more which would he lp with her feelings of loneliness, she never had friends or visitors at home before she came to Thorneycroft as her family all live far away and only visit to attend review meetings every six months. She has not formed close relationships with staff at Thorneycroft, instead, as mentioned before she treats them as her employees. Mrs. Oswald is an articulate and well spoken individual who has come from a middle class background. She appears to be well educated and has had a successful career as a midwife spanning fifty years. She had her daughters when she was young and out of wedlock, as a result they were brought up by her mother and Mrs. Oswald left at sixteen to begin her training as a midwife. Her career was important to her and she concentrated on this, not having any more children and marrying late in life. Her middle class upbringing has followed her through life, and she still takes pride in her appearance and has a strong sense of what she believes to be â€Å"proper†. Her husband and her enjoyed going on cruises and she is well- travelled. She does not attend church services or appear to be religious at all. In order for them to progress successfully through each stage in the life cycle, an individual’s needs at each stage must be met. For example, our most basic physical needs are shelter and nourishment, if these needs are not met in the infant stage, potential for development and progression into childhood will be threatened. For each aspect of development, certain needs must be met; Physical – The body must be kept fit and healthy through nourishment, shelter from the elements and the cold, excercise and rest. Emotional – The need to be loved and to feel love for others. Good self esteem can be established from feeling loved and wanted by others. Social – Being able to interact and build relationships with people around you. Cognitive – The need for opportunities to learn and develop knowledge and keep the mind active. Cultural – Having your values, religion, diet, language etc.(norms) as part of your daily life. In order for me to understand the needs of Mrs. Oswald and to what extent her needs have been met throughout her life, I examined Erik Erikson’s theory of eight â€Å"psychosocial† stages. Erikson believed that humans develop through eight predetermined stages (a detailed table of these can be found in appendix 1) and in order to progress successfully through life, we must â€Å"successfully negotiate ea ch stage† and that failure to do so results in â€Å"mental deficiencies such as lack of trust, which will remain with us throughout life† (Collin et al., p. 273). Each stage has one positive outcome and one negative outcome, and individuals progress through each life stage with a mixture of both, the differences between positive and negative being a result of the environment the individual is developing in. Mrs. Oswald, as an adolescent, would have experienced role confusion. She was from a middle class background but fell pregnant at a young age, resulting in her being hidden away and her mother raising her children as her own. It would have gone against Mrs. Oswald’s role as a respectable young girl to have children at such a young age. She went off to train as a midwife at sixteen and left her family and her daughters behind. She concentrated on her career and appeared not to have any intimacy throughout young adulthood. This was resolved in mature adulthood when Mrs. Oswald got married and enjoyed the intimacy which she had missed out on in young adulthood. She never had any more children but her husband nd her appeared to have a ha ppy life and they enjoyed travelling together. Mrs. Oswald is now in maturity and has begun to talk about death in an accepting way. Her needs may not have been met in the early stages of her life where she did not conform to her role in society and her life lacked intimacy, but later in life she had a successful and satisfying career and a happy marriage. I have used Abraham Maslow’s Hierarchy of Needs (see appendix 2) to assess how  Mrs. Oswald’s needs are being met now. â€Å"Maslow’s Hierarchy of Needs starts at the basic physiological needs we need just to stay alive. Once these are made we have a need for safety, then we want love and affection. Within our group we want to have self esteem. Finally we have a need of satisfying our full potential that Maslow calls Self Actualization† (Deeper Mind). Maslow believed that one’s needs had to be met at each stage of the hierarchy before the needs at the next stage could be attended to. The first category in Maslow’s hierarchy refers to physiological needs. I believe that most of Mrs. Oswald’s needs are being met a t this level. She has plenty to eat and drink and since she is mobile she has some level of excercise. She can have fresh air and she has warmth and shelter. However, Mrs. Oswald’s need for sleep is not being met at Thorneycroft. She suffers from insomnia which is not helped by the fact that her bed is too small and therefore uncomfortable for her to sleep in. This has resulted in her being reluctant to settle in bed at night at all, so she is losing out on sleep. As a result of all her physiological needs not being met, all of Mrs. Oswald’s safety needs are not being met either. Although she has shelter and security at Thorneycroft, the fact that she does not sleep has compromised her safety as she has a tendency to wander around at night time and is prone to falling as her mobility is not great. Mrs. Oswald appears sad that she has outlived her close family and her husband and doesn’t speak about them much. She does have some distant family whom she speaks with on the phone every night which brings her some comfort, but she remains distant with others and reluctant to form close relationships with staff or fellow residents. Her need for love and belonging has not been satisfied. In order for Mrs. Oswald to progress and reach self actualisation the care staff at Thorneycroft must work on the needs which are not being met. Getting her a bed which is comfortable for her to sleep in may help her to settle at night and reduce the risk of a fall. She could be encouraged to mix more with fellow residents and form closer relationships with them as well as staff. This will help with Mrs. Oswald’s sense of love and belonging and boost her self-esteem which will help her to reach self actualisation. References BBC (2014) BBC News Magazine. [Online] Available from: http://www.bbc.co.uk/news/magazine-23902918 [Accessed 13/11/2014] BINGHAM, E. et al (2009) HNC Social Care for Scotland. 12th Ed. Essex: Heinemann. COLLIN, C. et al (2012) The Psychology Book. London: DK London. MACLEOD, S. (2011) Simply Psychology. [Online] Available form :http://www.simplypsychology.org/Erik-Erikson.html [Accessed 11/11/2014]. NORWOOD, G. (2014) Deeper Mind. [Online] Available from: http://www.deepermind.com/20maslow.htm [Accessed 11/11/2014]

Business Continuity Plan as a Part of Risk Management

Celem niniejszej pracy jest zaprezentowanie roli i znaczenia Planu Ciaglosci Funkcjonowania Przedsiebiorstwa w calosciowym procesie zarzadzania ryzykiem w firmie oraz przedstawienie przykladowej tresci takiego planu.Rozdzial pierwszy zawiera ogolne wprowadzenie do zagadnienia zarzadzania ryzykiem. Przedstawia on definicje ryzyka w sensie, w jakim jest ono rozumiane w niniejszej pracy. Ponadto, znajduje sie w nim opis wielorakich zagroSen, ktore sa zwiazane z funkcjonowaniem przedsiebiorstwa, a takSe lista metod sluSacych do pomiaru ryzyka oraz opis przykladowych postaw, jakie sa przybierane wobec zagroSen. W rozdziale drugim zaprezentowano pojecie Zarzadzania Ciagloscia Funkcjonowania Przedsiebiorstwa. Znajduje sie tu charakterystyka ewolucji tego zagadnienia oraz wyjasnienie, dlaczego Plan Ciaglosci FunkcjonowaniaPrzedsiebiorstwa jest dokumentem o ogromnym znaczeniu dla firmy i jej interesariuszy. Ponadto, w rozdziale tym poddano dyskusji pewne szeroko rozpowszechnione mity dotyczac e Zarzadzania Ciagloscia Fukncjonowania Przedsiebiorstwa. Ta czesc pracy konczy sie opisem Analizy Wplywu na Przedsiebiorstwo jako glownego narzedzia, ktorym posluguje sie opisywany typ zarzadzania. W rozdziale trzecim przedstawiono rezultaty dokonanej przez autorke analizy roSnych Planow Ciaglosci Funkcjonowania Przedsiebiorstwa i ich szablonow.To studium bylo podstawa do zaprezentowania przykladowej struktury Planu oraz opisu najczesciej spotykanych w nim bledow. Ostatni rozdzial zawiera takSe charakterystyke faz wprowadzania i testowania Planu, ktore sa rownie waSne jak etap jego przygotowania. Wspolczesne przedsiebiorstwa nie moga sobie pozwolic na postawe reaktywna wobec realnych zagroSen, gdyS wydarzenia bedace w stanie zaklocic ich funkcjonowanie sa liczne i moga zaistniec zarowno w wewnetrznym, jak i zawnetrznym srodowisku firmy. Profesjonalnie przygotowany i skrupulatnie 5 aktualniany Plan Ciaglosci Funkcjonowania Przedsiebiorstwa cechuje postawe proaktywna. Jest nie tylko ogromnie pomocny w przezwycieSaniu trudnosci, ale dla interesariuszy firmy stanowi takSe dowod jej wiarygodnosci. MoSna wiec oczekiwac, Se coraz wiecej przedsiebiorstw bedzie sie staralo zdobyc ten nieoceniony atut. 6 ABSTRACT The aim of this thesis is to present the role and significance of a Business Continuity Plan (BCP) in the holistic process of a company’s Risk Management, and to provide a characteristic of exemplary BCP contents. The first chapter contains a general introduction into Risk Management.It delivers the definition of risk as it is understood in the context of the present thesis. Moreover, there is a description of multiple risks which are relevant to a company’s activity, as well as a list of the risk measurement methods and an account of exemplary attitudes towards threats. The second chapter presents the question of Business Continuity Management (BCM). It characterizes the evolution of this concept and explains the reasons why the BCP is a documen t of utmost importance to the company and its stakeholders. What is more, certain wide-spread myths concerning BCM are also disputed there.This part of the thesis ends with a description of Business Impact Analysis as the main tool of Business Continuity Management. The third chapter provides the results of the author’s analysis of various Business Continuity Plans and their templates. That study has been the basis for the presentation of an exemplary structure of a Business Continuity Plan, as well as for the description of the most frequent mistakes which occur in BCPs. The last chapter also contains a characterization of implementation and testing phases which are as significant as the preparation of a Business Continuity Plan.Modern companies cannot afford a reactive stance towards possible threats as the dangers which may disrupt their functioning are multiple and come both from the inner and outer environment. A professionally prepared and carefully updated Business Con tinuity Plan characterizes a proactive attitude. Not only does it significantly help to overcome difficulties, but it is also a convincing proof of the firm’s reliability to all its stakeholders. Therefore, it may be expected that more and more companies will attempt to acquire this invaluable asset. 7 INTRODUCTIONThe present thesis is the result of the author’s interest in various aspects of Risk Management, especially in the procedures which are applied by companies in case their functioning is faced with a serious threat. The most effective method used by business units is called Business Continuity Management (BCM) and focuses on the preparation and implementation of a Business Continuity Plan (BCP). The aim of this thesis is to present the role and significance of a Business Continuity Plan in the holistic process of a company’s Risk Management, and to characterize the contents of an exemplary Plan.The first chapter contains a general introduction into Risk Management and includes, inter alia, a description of multiple threats which are relevant to the company’s activity and a list of risk measurement methods. The second chapter discusses the concept of Business Continuity Management, explains the importance of Business Continuity Plan and characterizes the steps which lead to the development and implementation of this document. In the third chapter, there is a description of the contents which should be included in a Business Continuity Plan.That presentation is based on the author’s analysis of various BCPs and their templates. The exemplary materials enclosed in appendices have been provided by Punk, Ziegel & Company, Business Link, London Borough and Wallsal Council. All the translations which are enclosed in the present thesis have been made by the author. The references have been edited in accordance with the traditional Footnote/Endnote System. 8 CHAPTER 1 RISK MANAGEMENT This chapter contains an introduction into the nature and types of risk, as well as a description of the methods by which risk is assessed and managed.All these issues are inseparably connected with the concept of Business Continuity Plan, which aims at making provisions for the whole spectrum of present and future threats that may put a company's proper activity into danger. When a company decides to prepare and implement such a plan, it has to carry out a complex and accurate analysis of all the factors which may influence its operation, so that even the least expected dangers are taken into consideration. The first phase of drafting a BCP requires the recognition of existing and prospective risks, evaluation of their possible impacts and assumption of particular attitudes towards them.These vital steps are covered by Risk Management, which helps to organize the findings and solutions in a logical way. The proactive nature and principles of this comprehensive process will be presented and explained in the following chapte r. 1. 1. The Definition of Risk Risk and uncertainty are inseparable parts of every aspect of life. As Jan Mikolaj writes, â€Å"risk is connected with human activity, while uncertainty applies to the environment. †1 When these terms are used in the scientific context, they must be precisely defined.Some of the authors of economic and financial literature do not stress the difference between them. For example, Allan Willet states that â€Å"risk is objective uncertainty of the occurrence of an undesirable event. †2 In his opinion, â€Å"risk changes in accordance with uncertainty, not with probability level. †3 Similarly, Joseph Sinkey defines risk as â€Å"uncertainty connected with some occurrence or profit 1 2 Jan Mikolaj, Risk Management, (RVS FSI ZU, Zilina 2001), p. 17. Allan Willet, The Economic Theory of Risk Insurance, (Philadelphia 1951), p. . 9 in the future. †4 Frank Reilly thinks that â€Å"risk is the uncertainty that the investment may not bring the expected return. †5 However, the prevailing trend in modern professional literature is to differentiate between them. According to the Dictionary of Economic and Financial Terminology by Bernard and Colli, risk is â€Å"the probability of incurring losses by a business unit as a consequence of making a certain economic decision by this unit. The probability results from the uncertainty of the future. 6 The same source states further that â€Å"the concept of uncertainty is used in the situation when calculus of probability cannot be applied, whereas the term risk concerns recurrent events which possibility of occurrence can be calculated using the calculus of possibility. †7 Similar classification is introduced by Frank Knight. In his opinion, risk is a â€Å"measurable uncertainty,†8 while â€Å"immeasurable uncertainty†9 is uncertainty sense stricto. According to Irving Pfeffer, â€Å"risk is the combination of hazard and is measurable by pr obability mathematics, whereas uncertainty is measured by the level of confidence.Risk is a state of the world while uncertainty is a state of mind. †10 To summarize, risk means â€Å"a condition in which there exists a possibility of deviation from an outcome that is expected or hoped for. †11 Risk â€Å"can be expressed as a probability, ranging from 0 to 100 percent. †12 What is important, although not often mentioned in professional literature, there is not only the negative aspect of risk, but also the positive one. Thus, it is a possibility of loss as well as gain. 3 4 ibid. Joseph Sinkey, Commercial Bank Financial Management, (New York: Macmillan Publishing Co. 1992), p. 391. 5 Frank Reilly, Investments, The Dryden Press, (London: Intenational Edition, Collins, 1988), p. 463 6 Bernard and Colli, Slownik ekonomiczny i finansowy, (Wydawnictwo â€Å"KsiaSnica†, 1995), p. 156. 7 ibid. , p. 157. 8 Frank Knight, Risk, Uncertainty and Profit, (Boston: Univ ersity of Boston Press, 1921), p. 233. 9 ibid. 10 Irving Pfeffer, Insurance and Economic Theory, (Illinois: Irvin Inc. Homewood, 1956), p. 42. 11 Reto Gallati, Risk Management and Capital Adequacy, (New York: Mc Graw Hill, 2003), p. 7. 12 ibid. , p. 8. 10 1. 2. Risk in Business ActivityThe volume and diversity of risk obviously depend on a company’s type and branch of economy, but risk as such is a phenomenon which accompanies in its versatile forms any kind and field of business activity. It may come from the external environment of a company as well as from the internal one. For some entrepreneurs, risk is a necessary evil, whereas for others it is an additional motivation, if not the main one. Whatever the point of view is, if a given business activity is to succeed, it is essential to recognize what are the kinds of possible risk, asses their possible impact and acknowledge ways of reacting towards them.Such identification will considerably help in developing a suitable a ttitude, which allows minimizing a potential loss and maximizing a gain. 1. 2. 1. Types of Risk Types of risk which threaten a company’s activity are complex and numerous. Classifications of risk provided by professional literature differ with regard to the assumed criteria. The following comprehensive categorization is based mainly on the division presented in the book Risk Management in Emerging Markets.How to Survive and Prosper by Carl Olsson13: †¢ business risk (also called strategic risk) concerns potential results of inappropriate strategies, inadequate allocation of resources and changes in economic or competitive environment; †¢ market risk is associated with potential results of changes in market prices. It can be divided into: – interest rate risk, –foreign exchange risk, – commodity price risk, Carl Olsson, Risk Management in Emerging Markets. How to Survive and Prosper, (London, Pearson Education United, 2002), pp. 35-36. 13 11 shar es price risk; †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ credit risk means that a debtor may not pay in due time; industry risk regards operating in a particular industry; liquidity risk applies to inability to pay debts because of the lack of available funds; operational risk means potential results of actions by people, processes, and infrastructure; accounting risk concerns a possibility of financial accounts not being in accordance with the reality; reputation risk regards the results of changes in a company’s reputation; country risk is associated with effects which the mother ountry’s and foreign countries’ economic policies may have over the company; sovereign risk applies to lending money to the government or a party guaranteed by the government; political risk means results of changes in political environment; legal/regulatory risk is associated with the consequences of non-compliance with legal or regulatory requirements; environmental/ecological risk applies to the changes in natural environment which affect a company; systemic risk concerns small events which may produce much larges results than expected; technological risk is associated with the consequences of bringing new technology products to the market and introducing new IT systems; natural risk concerns natural and space disasters. All these risks usually appear simultaneously and their effects are synergic. Therefore, none of them should be ignored when considering the company’s situation. After realizing the large number and complex nature of different types of risk involved in all aspects of business activity, a logical step is to try to estimate their potential impact and results. 12 1. 2. 2. Methods of Risk Evaluation An assessment of a particular risk, both internally- and externally-driven, allows taking an appropriate attitude towards it.As Andrzej Stanislaw Barczak writes, such a measu rement involves both subjective and objective elements. 14 The subjective component consists in assuming a priori particular stipulations of a given evaluation tactic, as well as interpreting obtained results in a specific way. The objective constituent derives from the common agreement of the business circle on the methods widely applied to the assessment of risk. Two main types of risk measurement tactics are quantitative risk assessment and qualitative risk assessment. 1. 2. 2. 1. Quantitative Risk Assessment The main conception of quantitative risk assessment is to determine the cost of a given unwelcome occurrence, i. e. o calculate how big the loss would be if an adverse event happened. As it is pointed out in The Security Risk Management Guide, â€Å"it is important to quantify the real possibility of a risk and how much damage, in monetary terms, the threat may cause in order to be able to know how much can be spent to protect against the potential consequence of the threat . †15 This method involves: †¢ evaluation of assets (determining the overall value of a company’s assets, the immediate financial impact of losing the asset and the indirect value of losing the asset); †¢ measurement of the Single Loss Expectancy (SLE), which means â€Å"the total amount of revenue that is lost from a single occurrence of the risk. 16 It is calculated by â€Å"multiplying the asset value by the exposure factor (EF). The 14 Andrzej Stanislaw Barczak, Ryzyko – kategoria obiektywna czy subiektywna? , (Poznan: WSB, 2000), s. 30. 15 Microsoft, The Security Risk Management Guide, (Microsoft Corporation, 2004), p. 19. 16 ibid. , p. 18. 13 exposure factor represents the percentage of loss that a realized threat could have on a certain asset. †17 †¢ assessment of the Annual Rate of Occurrence (ARO), which is â€Å"the number of times that one can reasonably expect the risk to occur during one year. †18 This step is very diffi cult; it bases on historical data and previous experiences, and requires consultation with experts. calculation of the Annual Loss Expectancy (ALE), which stands for â€Å"the total amount of money that an organization will lose in one year if nothing is done to mitigate the risk. †19 This figure is established by multiplying the SLE and the ARO. †¢ valuation of the Cost of Controls (ROSI), i. e. establishing â€Å"accurate estimates on how much acquiring, testing, deploying, operating, and maintaining each control would cost. â€Å"20 It is estimated by using the following equation: (ALE before control) – (ALE after control) – (annual cost of control) = ROSI Although quantitative risk analysis provides clearly defined goals and results, all of the involved calculations are based on subjective estimates, which may prove inaccurate. Moreover, the whole process can be long and costly. 1. 2. 2. 2. Qualitative Risk AssessmentIn opposition to the quantitative method, qualitative risk assessment does not â€Å"assign hard financial values to assets, expected losses, and cost of controls†21 but instead, 17 18 ibid. , p. 19. ibid. , p. 19. 19 ibid. , p. 19. 20 ibid. , p. 19. 21 ibid. , p. 20. 14 â€Å"calculates relative values. †22 It involves distribution of questionnaires among people in the company who have relevant skills and knowledge, and workshops. The questionnaires are designed to discover what assets and controls are already deployed, and the information gathered can be very helpful during the workshops that follow. In the workshops participants identify assets and estimate their relative values.Next they try to figure out what threats each asset may be facing, and then they try to imagine what types of vulnerabilities those threats might exploit in the future. The information security experts and the system administrators typically come up with controls to mitigate the risks for the group to consider and the approx imate cost of each control. Finally, the results are presented to management for consideration during a cost-benefit analysis. 23 This tactic does not require a lot of time and it is not a big burden for the people involved. What is more, the results of the implemented solutions are quickly visible. However, the estimated figures are often perceived as too vague.These two presented approaches are often used together in order to obtain the most comprehensive information about a potential threat. Although scientific methods of risk assessment are helpful in estimating the possible impact which particular occurrences may have on the company’s activity, it is essential to remember that none of the methods can be perceived as 100% trustworthy and absolutely infallible. However, even if it is impossible to predict all threats and provide for all undesirable events, the significance of risk evaluation tactics combined with human knowledge, experience, imagination and intuition canno t be questioned. 1. 3. Risk Management in Business ActivityThe fact that the phenomenon called risk is measurable and its occurrence may be predicted means that it is also possible to take preventive measures and proactive attitude towards it. As Reto Gallati stresses, â€Å"the term Risk Management is a recent creation, but the actual practice of risk management is as old as civilization itself. †24 In everyday life, people face risk in a varying degree all the time and they manage it in a natural way so as to minimize undesired impact and render possible profits. 22 23 ibid. , p. 20. ibid. , p. 20. 15 Certain individuals even enjoy plunging into extraordinarily dangerous situations in order to check how they will cope in difficult moments.However, Andrew Holmes notices that â€Å"at the individual level, if a person takes a risk and fails to manage it properly, the damage is limited to him, and maybe his near relatives,†25 while â€Å"the management of risk for orga nizations is not as simple. †26 As it was presented in the part 1. 2. 1, the company is a subject to various and multiple threats. Holmes stresses that â€Å"ultimately, all risks have a financial impact. †27 The complexity of the required actions aimed at coping with the risk means that â€Å"within the modern corporation, risk management must encapsulate managing strategic, business, operational, and technical risks, rather than those associated with pure finance such as credit, interest rate, and currency risk. †28 Nowadays, Risk Management is not an extra feature added to a company’s basic activity, but â€Å"an essential skill of all modern corporations. †29 All usiness units should realize its great importance, because it is essential not only for their success but simply survival. According to Holmes, a company’s attitude towards the risk depends on its risk sophistication, which can be divided into five stages30: †¢ at the lowest level of sophistication (reactive stance), risks are dealt with only when they turn into live issues or when crisis strikes. There is no effort to recognize and measure possible risks in advance. †¢ At a slightly more sophisticated stage, a company understands the importance of risk management and takes the trouble to identify and manage threats more actively. It tends to seek out the best practice and views adverse events in a wide context. At the next level, there are organizations which acknowledge the need to manage risks throughout the organization and usually develop some form of 24 25 Reto Gallati, Risk Management and Capital Adequacy, (New York: McGraw Hill, 2003), p 11. Andrew Holmes, Risk Management (Oxford: Capstone Publishing, 2002), p. 2. 26 ibid. 27 ibid. 28 ibid. 29 ibid. 30 ibid. , p. 8. 16 risk management framework to ensure consistency of approach. †¢ At the following stage, a company understands the link between risk and reward. It is aware that for eve ry risk there is an associated opportunity which can be exploited. Such a business unit is often a market leader and is willing to take risks to achieve its strategic objectives. At the ultimate level of risk sophistication, there are organizations which integrate risk management with the goal of enhancing shareholder value. Thus, they shift the responsibility for risk management away from the traditional areas of audit and compliance to everyone within the organization. Of course, the active process of Risk Management requires commitment and focus as it means following a deliberate set of actions which are designed to identify, quantify, manage and then monitor the events or actions that could lead to financial loss. Often, there is too little data about a given risk, and therefore, this kind of management may involve a large degree of judgment and assumptions concerning the future. 1 Yet, all the effort is worthwhile as â€Å"successful organizations tend to be excellent risk man agers, not only because they understand the risks they face, but also because of how they manage them. Conversely, those organizations that are poor at risk management spend no time scanning the risk horizon, instead leaving their futures to fate. This invariably means shocks, falling market share, takeovers and missed opportunities. †32 As Holmes reflects, â€Å"risk management is both an art and a science, and being successful depends on how well the two are kept in balance. †33 1. 3. 1. Methods of Risk Management John Holliwell, the managing director of Smith Williamson Consultancy, once said, â€Å"There is nothing wrong with risk.It is the lifeblood of business and the test of entrepreneurs and managers. What matters is how you handle risk and the culture in 31 32 ibid. ibid. 17 which you operate. ’’34 A similar thought is expressed by Clifford Tijok, â€Å"Entrepreneurial behaviour demonstrated in real life entails, i. a. , the ability to enter int o calculated risk, so that return-driven opportunities can be pursued and the ability to identify the relevant risks associated with these opportunities and the decision on appropriate behaviour to address these risks. †35 When a company decides on its risk management techniques, it usually analyses the following features: Table 1. Factors influencing the type of risk management framework required by the organization36ors the type of risk managementframework required by an organizatio FACTORS INFLUENCING RISK MANAGEMENT REQUIREMENT DIMENSIONS TO CONSIDER Strategy risk appetite of owners/risk managers industry geographical coverage aggressive or conservative risk taking or risk averse sunrise or sunset industry; primary, manufacturing, service sector local, national, regional or global is the company critically dependent on critical success factors one or two factors which require close management? volatility is the environment likely to change significantly or unpredictability ? monopoly, few or limited number of osition in industry players, or free market with many players and no barriers to entry is the area of operations highly controlled by regulatory environment legislation and/or regulatory bodies? are regulators intrusive or hands off? 33 34 ibid. ibid. , p. 2. 35 Clifford Tijok, Risk Management in Finance, (Lehrverangstaltung, 2005), p. 8. 36 Carl Olsson, Risk Management in Emerging Markets†¦ pp. 110-111. 18 is deregulation occurring or the level of regulation increasing? management style centralized or decentralized adequate or inadequate people and resources technology resources, financial position – adequate funds available, highly or lowly geared. tatus/ownership Organizational culture Public or privately owned Is the culture strong or weak? are they simple and predictable or nature of risks faced complex/ unpredictable? is the size of risks manageable or is catastrophic risk a cause for concern? Such an analysis leads to adopting one of the main risk management techniques, as presented by Cliff Tijok37: †¢ †¢ †¢ risk limitation – a company establishes its range of tolerance towards a given risk and constantly monitors whether the limits are not breached; risk avoidance – a company chooses the least risky option or none of them; risk transfer – a company reduces or completely transfers specific risks by hedging against a risk (i. e. , obtaining insurance) or diversification.Whatever the approach is, managing risks â€Å"takes a degree of courage and requires the organization to take responsibility for its actions. †38 It is a continuous process, which is â€Å"based on a distinct philosophy and follows a well-defined sequence of steps. †39 After the application of the methods and rules provided by risk management, the obtained data are organized in a clear and logical way. This is the basis which allows the company to go one level up and prepare action schedul es that will be used in case a recognized danger occurs. An essential part of such planning is encompassed by Business Continuity Management and will be discussed in the next chapter. 37 38 Cliff Tijok, Risk Management†¦ pp. 12-13. Andrew Holmes, Risk Management†¦ p. 2. 39 Reto Gallati, Risk Management†¦ p. 11. 19 CHAPTER 2 BUSINESS CONTINUITY MANAGEMENT This chapter provides information on what is Business Continuity Management, when it appeared in the history of management, what purposes it serves and how it should be organized and introduced into a company’s activity. Moreover, it contains a description of the steps which lead to the preparation of a Business Continuity Plan and of the implementation process that follows. Business Continuity Management forms an integral part of Risk Management. It met with particularly deep interest in the 1990s as the result of the frenzy which concerned the year 2000.At that time, there were many anticipated business conti nuity problems, implicated by the date change in computer systems. Business Continuity Management became even a bigger focus of attention in 2001, after the terrorist attack in New York. As Michael Gallagher observes, that huge calamity â€Å"increased awareness of business interruption issues, resulted in a better understanding of critical processes and vulnerabilities and improved co-operation and collaboration between public and private sectors on emergency management questions. †40 Lyndon Bird adds that â€Å"‘business today has far more economic interdependency between regions than ever before. There are often global consequences when risk becomes reality. 41 Yet, at the same time â€Å"there is a growing awareness of what business continuity really is about and why it is so important to both businesses and individuals. †42 8 2. 1. The Concept of Business Continuity Management Business Continuity Management (also called BCM) is defined by the Business Conti nuity Institute as â€Å"a holistic management process which identifies potential Michael Gallagher, Business Continuity Management, (Edinburgh: Pearson Education Limited, 2003), p. 7 41 Lyndon Byrd, â€Å"Business Continuity Management in a shrinking world,† Business Continuity & Risk Management (a supplement distributed in The Times), July 26 2006, p. 2 40 20 mpacts that threaten an organization and provides a framework for building resilience and the capability for an effective response that safeguards the interests of its key stakeholders, reputation, brand and value creating activities. † Its main purpose is to enable the company’s regular functioning, even though everyday operations are disrupted. As Lorraine Lane observes, â€Å"organizations must be capable of withstanding the shocks that can so easily distract management from their primary purpose of meeting and beating their ‘normal’ operational goals. †43 BCM appears as the solutio n that is exactly needed to guarantee such stability to the business. Obviously, BCM looks different in various companies as each organization is a unique system of multiple factors and interdependencies.Dr David Smith explains that â€Å"because of its all-embracing nature, the way BCM is carried out will inevitably be dependent upon, and must reflect, the nature, scale and complexity of an organization’s risk profile, risk appetite and the environment in which it operates. †44 Gallagher supports this view by stating that â€Å"the plan must fit comfortably with the culture and management style of the organization. For example, the type of plan that suits a financial institution would be totally inappropriate in a radio or television broadcasting organization. †45 It is also very important to acknowledge that the company’s BCM must be continuously revised and tested, in order to stay valid and fulfill its tasks. As Dr Smith emphasizes, â€Å"BCM is, by necessity, a dynamic, proactive and ongoing process. It must be kept up-to-date and fit-for-purpose to be effective. 46 Maintaining the validity of proper plans and policies is actually more difficult than establishing them, but this is what constitutes the point of developing BCM by a business. On the following page, there is an approximate structure of steps involved in Business Continuity Management, which is focused on planning. 42 43 ibid. â€Å"Corporate resilience: the new regime,† Business Continuity & Risk Management,†¦, p. 11 44 David Smith, â€Å"Business continuity and crisis management,† Management Quarterly, July 2003, p. 27 45 Michael Gallagher, Business Continuity Management,†¦, p. 43 46 ibid. 21 Scheme 2. 1. Procedures involved in Business Continuity Management47 INPUTS 1. 2. 3. 4. 5. 6. scope definition desired objectives policies and standards inventory – information, technology, people management commitment financeANALYSIS ASSET ASS ESSMENT BUSINESS IMPACT ANALYSIS TECHNICAL REQUIREMENTS 1. analyze BIA and Asset Assessment 2. list technical strategies based on the analysis of each asset and business process in scope 3. document drawbacks and advantages of each listed strategy 1. identify and quantify asset needs 2. document ownership 3. assign weight based on importance 4. assess exposure 5. identify access control and other preventive measures 1. rate processes based on criticality 2. identify dependencies 3. identify custodian 4. identify threats and consequences 5. identify safeguards needed/possible 6. list critical resource requirement 7. quantify acceptable owntime and and losses DEVELOPMENT 1. 2. 3. define continuity goals and chosen strategy in the form of a plan acquire resources needed for preparing and implementing the continuity plan test the plan RESULTS 1. 2. 3. 4. preventive control Business Continuity Plan continuity team training plan for team 47 Padmavathy Ramesh, Business Continuity Planning, (Tata Consultancy services, 2002), p. 28 22 2. 1. 1 The Evolution of BCM As Halls observes, â€Å"Business Continuity Management is a relatively modern idea. Its first mentions can be found in the 1980s, although it was only in the very late 1990s that it became a more widespread as a business discipline. 48 In fact, Business Continuity Management is â€Å"the outcome of a process that started in the early 1970s as computer Disaster Recovery Planning (DRP) and then moved through an era where the emphasis was on business continuity planning rather than on management. †49 In that time, computer managers were responsible for DRP. Soon, they realized that â€Å"the concentration of systems and data in itself created new risks; computer operations management introduced formal procedures governing issues such as backup and recovery, access restrictions, physical security, resilience measures such as alternative power supply, and change control. †50 In 1970s, if a big probl em appeared, the tolerated downtime was not measured in hours, but days. Therefore, â€Å"the cost of back-up computers sitting idle in an alternative location waiting for a disaster to happen was prohibitive. However, for some companies, data safety was a priority; no matter at what cost it would be obtained. As Gallagher points out, â€Å"organizations such as banks were in a more vulnerable position and invested considerable resources in installing and testing computers at alternative sites. Back-up tapes or disks were increasingly stored at protected locations well away from the computer centre. †51 Later, in the 1980s, commercial recovery sites offering services started to appear, often on a shared basis. â€Å"This was the start of the sophisticated recovery centers that operate today,†52 notes Gallagher. However, they all concerned mainly IT: â€Å"The disaster recovery plans documented the actions required to safeguard and restore computer operations.These co vered computer processing, computer applications, telecommunications services and data after a disruptive event. The objectives were to 48 49 Michael Halls, â€Å"What is Business Continuity Management? † †¦ Michael Gallagher, Business Continuity Management,†¦, p. 6 50 ibid. 51 ibid. 52 ibid. 23 prevent or at least minimize the impact that such an event would have on the business. †53 Such plans were far from being perfect as â€Å"they were more concerned with, for example, restoring a company’s financial systems to an operational state than with worrying about whether there would be accommodation available to allow the staff of the finance department actually to use the systems. 54 Not much attention was paid to implementing BCL into every aspect of the company’s activity. In 1990s, a significant change in the IT environment took place and the movement from DRP to Business Continuity Planning became considerably quicker. Gallagher confirms tha t â€Å"throughout this decade, and into the 2000s, there were significant changes in the IT approach to DRP/BCP and in what constituted acceptable downtime. The emphasis moved from being mainly on IT to an approach that considered all aspects of an organization’s business and relationships. †55 It is only then that â€Å"BCP has become BCM with the emphasis on management – not just planning.This encompasses the emphasis on risk management and the measures to be taken to reduce risk. BCM is no longer regarded as a project – it is now a program, emphasizing that it is a continuous process rather than a task with a defined enddate. †56 The next step is to make managers of all companies aware of the importance of BCM as â€Å"the increased recognition of BCM means that a greater budget allocation may be available to it. More significantly, the message preached by business continuity practitioners for years that business continuity principles should b e an integrated part of the business planning process may be heard. † 57 2. 1. 2 The Significance of BCMThanks to proper Business Continuity Management, a company has a professional plan which allows acting as quickly and efficiently as possible in case a dangerous 53 54 ibid. ibid. 55 ibid. 56 ibid. 57 ibid. 24 event happens, because â€Å"BCM not only aims to provide continuity in customer service at a minimum acceptable level, it also aims to limit the impact on the financial position of an organization by ensuring that its critical functions continue to operate during a crisis and that the remainder are recovered in a controlled manner. †58 Therefore, when a BCP is applied, there are no chaotic, haphazard attempts to minimize the losses as clear and logical procedures have been devised earlier and communicated to the staff.As Mel Gosling notices, â€Å"decisions made in the first few hours of an event that causes serious disruption to an organization’s opera tions are critical, and actions undertaken in the first few days will have a significant financial impact†59 and â€Å"a company that has an effective and well-tested Business Continuity Plan is more likely to take the right decisions in the first few hours and to subsequently undertake the best actions to limit the impact on its financial position. It has a better chance of incurring significantly less additional expenditure at the time of a disruption. †60 Moreover, â€Å"one of the benefits that implementing business continuity management brings to a firm, which is not immediately apparent, is an understanding of what the business does and what is important to it. †61 In this way, a company can analyze its allocation of resources and improve it, as well as â€Å"find out what is critical and of value, and what can be outsourced or left undone. †62 Besides, certain companies, e. g. , financial institutions, are legally obliged to develop BCM and maintain an effective business continuity plan.It is also becoming increasingly common that businesses require from their suppliers to be presented with their BCM plans. This facilitates the process of assessing the supplier’s infallibility and constitutes an element of developing a sound business relationship. Mel Gosling, â€Å"Why invest in business continuity,† 1 February 2007, . 59 ibid. 60 ibid. 61 ibid. 62 ibid. 62 ibid. 58 25 The investment into Business Continuity Management is beneficial not only in the matter of a business being prepared for multiple diverse crises. It also adds significantly to the company’s reputation and brand image by â€Å"demonstrating effective and efficient governance to the media, markets and stakeholders. 63 Moreover, it enhances the competitive advantage of the business, because to some investors and customers it may be a vital factor in deciding to which company they should entrust their capital. Osborne explains it as follows, à ¢â‚¬Å"To a firm’s shareholders it’s part of investor relations – you are showing your commitment to keeping their investment safe. To a firm’s staff it is labour relations – you are showing your willingness to protect the livelihood of your staff. †64 Furthermore, he stresses that â€Å"it’s customer relations too – you’re demonstrating your commitment to providing a service for them even in the most extreme of circumstances. †65 Last but not least, devising professional plans and keeping them updated increases the company’s credibility in the eyes of nsurers and auditors because they are becoming increasingly aware of the importance of BCM. As Osborne observes, â€Å"Five years ago, auditors simply would have said to their clients, do you have a plan in place? A couple of years ago, they would have wanted to inspect it, to see if every contingency was covered and how practical it appeared to be. Nowadays, they will ask how it worked in practice. When it was last tested and what were the results? †66 What is more, â€Å"insurers like to see evidence that all reasonable steps have been taken to understand the past accident record and that actions have been put in place to prevent them from happening again. 67 This is confirmed by Gosling, who states that â€Å"insurance companies themselves are now starting to realize the opportunities that business continuity provides for loss reduction, and it is becoming increasingly common for a condition of insurance cover to be the existence of a business 63 64 David Smith, â€Å"Business continuity and crisis management,† †¦ p. 27 Ask the panel of business continuity experts,† †¦ 65 ibid. 66 ibid. 67 â€Å"Pro-active Risk Management: Avoiding catastrophe. † Business Continuity & Risk Management,†¦, p. 14 26 continuity plan. †68 All in all, devising and implementing an effective BCM plans brings ve rsatile advantages to a company, while the failure to do so â€Å"means taking an unnecessary risk with an organization’s future and profitability. †69 2. 1. 4 Continuity Culture in a Company A vital step in forming Business Continuity Management in a company is to instill a proper attitude in the staff.Michael Gallagher believes that â€Å"it is about creating a continuity culture in the organization. This can be at least as important as producing the actual plans. †70 He also states that â€Å"for BCM to work, it must be driven from the top. â€Å"71 Therefore, senior managers must understand that BCM is â€Å"not just another expense but also a significant resource,’ 72 as Mike Osborne assures. However, the amount of data that has to be taken into consideration while developing preventive measures is overwhelming. Lane points out that â€Å"while responsibility for corporate resilience sits firmly with the executive board, the skills and experience required to combat the growing list of disruptive threats exists throughout the organization. 73 Thus, in large companies, it is a wise move to appoint a full-time Business Continuity Manager, whose tasks are to accumulate the relevant knowledge from all departments and co-ordinate proper procedures, as well as devise professional plans and keep them updated. Smaller businesses may use the services offered by consulting companies. The staff’s awareness of specific procedures ready to be applied in case of any foreseeable disaster enhances their efficiency and identification with the company. Instructing them of the specific plans encourages them to pay bigger attention to the safety issues, which significantly contributes to the BCM process. 68 69Mel Gosling, â€Å"Why invest in business continuity,† †¦ ibid. 70 Michael Gallagher, Business Continuity Management,†¦, p. XI 71 ibid. 72 â€Å"Ask the panel of business continuity experts,† Business Continu ity & Risk Management,†¦, p. 12 73 David Smith, â€Å"Business continuity and crisis management† †¦ p. 27 27 Gallagher explains that â€Å"if the business continuity culture is sufficiently developed, the continuity considerations will be a natural part of the development of the plans. †74 2. 2 BCM and the Company’s Size For the definite majority of large corporations, BCM is a regular part of their activity but, as Gallagher states, â€Å"there is a feeling that it is not a matter of concern to the smaller business. 75 This happens because â€Å"a lot of the emphasis in the business continuity press, and in business continuity material generally, relates to large organizations and to the financial services industry. †76 While â€Å"for the largest corporations and those with enormous sums of money at stake, the complexity of planning is breathtaking,†77 â€Å"small and medium-sized enterprises tend to get ignored when talking about bus iness continuity planning. The planning is more prosaic. The challenges are fewer. And most importantly, their budgets are smaller. †78 Another problem is the fact that â€Å"smaller companies are typically less aware of the correct procedures than larger firms where systems have been developed. 79 The managers of small and medium-sized businesses simply tend to think that their company’s size is a kind of safeguard against a disaster, or that potential recovery will be quick and simple, so â€Å"the process of developing a plan is perceived as too complicated, involving excessive costs and management time. †80 However, Mike Osborne emphasizes that â€Å"the issue for small to medium sized businesses is that they often do not have the inherent resilience that say, a UK multinational has. †81 He warns the managers against an illusive safety feeling as â€Å"smaller firms often trade from a single location and do not benefit from vast armies of support sta ff and Michael Gallagher, Business Continuity Management,†¦, p. 88 Michael Gallagher, Business Continuity Management,†¦, p. 28 76 ibid. 7 Michael Halls, â€Å"What is Business Continuity Management? † Business Continuity & Risk Management,†¦, p. 3 78 Michael Halls, â€Å"Small is still beautiful (but riskier too),† Business Continuity & Risk Management,†¦, p. 10 79 ibid. 80 â€Å"It’s never too late to plan for the future,† Business Continuity & Risk Management,†¦, p. 15 75 74 28 specialists who can react to and recover from an incident. If they are hit by a disaster, the impact is greater then it would be the case in a larger organization. †82 This view is supported by Gallagher, who states, â€Å"Small businesses should remember that their biggest threats do not come from high profile incidents such as earthquakes or terrorist bombs.It is the dozens of relatively minor issues such as prolonged power outages or computer ne twork failures that may cause the problems. The vast majority of problems are caused by people or process failures. †83 He points out that â€Å"this is where the effort and investment should be concentrated. Because of size, the process is simpler and the cost will be proportionally less than for larger organizations. The consequences of not having a plan are, however, likely to be disastrous. †84 Therefore, as Michael Halls stresses, â€Å"Business Continuity Management is a must for companies of all sizes. A small firm that loses its data will go out of business just as surely as a larger one. †85 2. 3 BCM in Relation to InsuranceSome managers wonder why they should engage themselves into Business Continuity Management while their company is insured. To them, devising a BCM plan seems to be an unnecessary waste of time and money, because they think that risks are looked after by the insurers and thus, there is no need to worry. But these are absolutely false c onclusions. As Mark Baylis emphasizes, â€Å"insuring the risk is not the answer, because it is better for the business that the problem does not happen at all. † 86 This view is supported by Gallagher, who states that â€Å"insurance is simply a necessary part of the total business protection and recovery plan – but it is only a part. 87 Although it is true that insurance provides financial aid in case a disaster strikes, the money may 81 82 ibid. ibid. 83 Michael Gallagher, Business Continuity Management,†¦, p. 28 84 ibid. 85 Michael Halls, â€Å"Small is still beautiful (but riskier too),† †¦ 86 Mark Baylis, â€Å"Weak links in the supply chain,† Business Continuity & Risk Management,†¦, p. 11 87 Michael Gallagher, Business Continuity Management,†¦, p. 33 29 arrive after quite a long period. Moreover, â€Å"insurance for loss of profits, or for increased cost of working, will cover only a defined period – which in practice may prove to be inadequate. †88 Besides, â€Å"proving loss of profits can be very difficult.The outcome may be based on historical performance and may not take account of recent market developments. †89 It is also very important to notice that insurance will not â€Å"keep customers supplied or guarantee that market share will be recovered,†90 nor will it â€Å"protect the organization’s reputation and image. †91 Last but not least, as it was mentioned in the previous paragraph, there may be a situation when the insurer refuses to provide a cover unless the company devises a BCM, because nowadays businesses are required to act more actively in protecting themselves from various possible risks. Therefore, it is vital for a firm to have efficient Business Continuity Management in order to obtain insurance on favourable terms.To sum up, managers must remember that â€Å"insurance is reactive – while it has its place, the whole protection proce ss must be more proactive and BCM is the key. †92 2. 4 Business Impact Analysis Business Impact Analysis (also known as BIA) is the most important tool of Business Continuity Management. Gallagher defines it as â€Å"a management-level analysis that identifies the impacts of losing company resources. It measures the effect of resource loss and escalating losses over time in order to provide senior management with reliable data upon which to base decisions on risk mitigation and continuity planning. †93 The BIA process â€Å"identifies and ranks the business processes, 88 89 ibid. , p. 34 ibid. 90 ibid. 91 ibid. 92 ibid. 93 ibid. , p. 146 30 criticalities and dependencies. 94 It is closely related to risk analysis, which was discussed in the previous chapter, therefore, it may base on the materials that have already been gathered during the general Risk Management process in the company. The method by which BIA is carried out â€Å"depends on the nature of the organiza tion – size, structure, local or international, etc. †95 Generally, in order to maximize the efficiency of a BIA processes, standardized questionnaires should be used. They should contain questions which are formed in such a way as to provide information that concerns the following issues: †¢ †¢ the nature of given problems; the impact of the problems, which should be presented from different perspectives, e. g. the company’s reputation, costs involved, loss of future business, etc. †¢ †¢ †¢ the influence that may be caused by the problems at different times of the day, week, month and year; the kind of resilience that may be currently provided in a quick and easy way; the recovery from the addressed problems (time needed for recovery, priorities for resumption, duration of backlog, additional costs, insurance cover); †¢ †¢ the available workarounds and the way they operate; the continuity and recovery requirements, e. g. , acco mmodation, computer systems, etc. 96 After the questionnaires have been filled in, the Business Continuity Manager prepares a comprehensive report which presents the company’s Business Impact Analysis. The report is composed of the following parts: 1. Introduction 2. Executive Summary 3. Background to Study 94 95 ibd. , p. 47 ibid. 96 cf. Michael Gallagher, Business Continuity Management,†¦, p. 57 31 4. Current State Assessment 5. Threats and Vulnerabilities 6. Critical Business Functions/Operations 7. Business Impacts – Operational and Financial 8. Potential Strategies 9. Recommendations 10. Conclusion 11.Appendices97 Thanks to the logical and substantial structure, the report fully represents the current standing of the company, clearly indicates its weak points and realistically describes possible procedures. Business Continuity Management is an extremely important process, which not only enables the assumption of proper attitudes towards multiple threats that endanger a firm’s functioning, but it also significantly deepens the understanding of the business and improves the staff’s morale. Proper implementation of BCM in a company leads to the creation of a Business Continuity Plan, which will be discussed in detail in the following chapter. 32 CHAPTER 3BUSINESS CONTINUITY PLAN In the previous chapters, the importance of Business Continuity Management was explained and it was stated that devising a Business Continuity Plan is one of the main tasks of this type of management. This chapter provides information on how to construct, implement and test a Business Continuity Plan. Moreover, it contains a description of the most frequent mistakes that appear while drafting a BCP and advises how to avoid them. The exemplary plans and templates on which the analysis is based are attached as Appendices B, C, D, E and F at the end of the present thesis. 3. 1 The Structure of an Exemplary Business Continuity PlanBusiness Continuity Plan s vary in length and are divided into different parts, which mostly depends on the size and type of a company. However, certain sections are vital and thus common for all the plans. They should be organized in such a way as to enable quick access to the required information. These crucial parts will be successively discussed herein. 3. 1. 1 Front Page and Introduction On the front page of a Business Continuity Plan, there should be written the name of the company, the issue date and a distinct lettering stating BUSINESS CONTINUITY PLAN. Moreover, if the Plan is confidential, it should be indicated on the front page as well. Optional elements inserted here may include contact details for feedback, references, the revision date, etc.These components are followed by an introduction, which consists of a distribution list (copy number, name and location) and a table of contents. 97 cf. Michael Gallagher, Business Continuity Management,†¦, p. 57 33 3. 1. 2 Aim This section should con tain the description of the purpose for which the Plan has been created. It usually gives examples of possible disasters and explains the objectives which the plan is intended to meet in case of a calamity. What is more, a company which wishes to convey an especially powerful message concerning its reliability may include in this part a summary of the extensive works and professional researches which have been involved in the development of the Plan. 3. 1. 3 Critical Functions ChecklistCritical Functions are these activities without which the company would not be able to perform. In order to prepare a Critical Functions Checklist, the following steps should be completed: †¢ †¢ †¢ †¢ †¢ the identification of Critical Functions, e. g. , sales and distribution; the description of the Functions in terms of the impact which may be caused by their interruption in the first 24 h, 48 h, one week and two weeks; the prioritization of the Functions; the ascription of a reasonable timeframe within which the recovery is possible; the determination of resources which will be necessary in the recovery process, such as: a) the staff – the required number of people, their knowledge and skills; b) alternative location – e. g. the staff working at home or provisional premises; together with necessary equipment like computers, cars; c) data – information and documents, e. g. , insurance certificate, service, customers and suppliers details; d) communications – all ways in which customers, suppliers, the staff and media can be contacted in case of disaster. 34 Such a Checklist allows ensuring that â€Å"critical tasks are completed on time and according to a pre-agreed priority schedule. It may also be used to provide a handover document between different shifts in the recovery process. †98 3. 1. 4 Risk Analysis Table This part should contain a table comprising a list of dangers which may interrupt and threaten the activi ty of the company.The matrix presented below may be used to ascribe values to the particular risks with regard to the likelihood of their occurrence and their potential impact. Table 3. 1. 4 Risk Matrix LIKELIHOOD NEGLIGIBLE CATASTROPHIC RARE UNLIKELY POSSIBLE PROBABLE M M M L L H H M L L VH VH H M L VH VH H M L VH VH H M L IMPACT SIGNIFICANT MODERATE MINOR INSIGNIFICANT Legend: L – low, M- medium, H – high, VH – very high Moreover, there may be also attached a list of possible losses, endangered people and equipment, as well as the actions which had to be taken in case a particular risk occurs. 98 Appendix D, p. 77. 35 3. 1. 4 Emergency Response Checklist Such a Checklist greatly facilitates the performance of people involved in fighting a potential adverse event.It also acts a concise register of actions that were taken after the disaster happened. It should be later analyzed, developed and improved. It is preferable that tasks to be completed are organized in the form of a table, together with a column in which the date of termination will be written down. The actions may be listed as follows: †¢ during the first 24 h a) to establish the Actions and Expenses Log, which is a more detailed and comprehensive version of the Emergency Response Checklist; b) to contact emergency services; c) to identify and approximately assess the damage which has been incurred by the staff, equipment, buildings, data, etc. d) to determine the critical functions which have been interrupted; e) to decide on the steps that need to be taken within the recovery process, which is based on the Critical Function Checklist; f) to contact the staff, customers, suppliers, insurers, relevant authorities and other stakeholders in order to assure them that the situation is under control; g) to issue a special PR statement to the media. †¢ daily within the recovery period a) to update the Actions and Expenses Log; b) to provide valid information to the staff, cu stomers, suppliers, insurers, relevant authorities and other stakeholders, as well as the media; †¢ after the recovery period a) to interview the staff with respect to their welfare needs; b) to analyze the Emergency Response Checklist and Actions and Expenses Log in order to introduce possible improvements into the Business Continuity Plan. 36As it can be seen, the response to the crisis should focus on its effects, not on the causes. The reasons of the adverse event should be identified as quickly as possible, but a comprehensive analysis of them must not be performed before the main steps of the recovery process have been taken. 3. 1. 5 Roles and Responsibilities This section should contain information and contact details regarding the people who are responsible for the shape and content of the Business Continuity Plan (e. g. , Business Continuity Manager, the BCM Team). Moreover, there may be included a list of duties which are ascribed to the particular staff members in ca se an adverse event happens.Last but not least, it is necessary to indicate the names and contact details of the co-ordinators of the recovery process, help-line numbers (possibly, with pre-recorded messages) and location of meeting rooms and the Business Recovery Command Centre, together with maps. 3. 1. 6 Contact List In this part, there should be listed the following contact details: †¢ staff members (divided in respect to the departments) and their next of kin a) name, b) address, c) work telephone number, d) home telephone number, e) mobile telephone number, f) e-mail address; †¢ key suppliers a) name, b) provided goods, c) address, d) telephone/fax number, 37 e) e-mail address; †¢ key customers a) name, b) service/good used, c) address, d) telephone/fax number, e) e-mail address; †¢ mergency services (ambulance, fire service, flood line, hospitals, police) a) address, b) telephone number; †¢ utilities (water, telecommunication, gas and electricity comp anies) a) name, b) telephone number, c) e-mail address; †¢ insurers and banks a) name, b) address, c) telephone/fax number, d) e-mail address; †¢ authorities a) name b) address c) telephone/fax number; †¢ media a) name, b

Human resources development Coursework Example | Topics and Well Written Essays - 1000 words

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Health and Safety Report Essay Example | Topics and Well Written Essays - 2000 words

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Genetics, environment, general biology, evolution, plants, etc. and Article

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Current Issues in Parent-Child Relationships Research Paper

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Kubler Ross Essay Example for Free

Kubler Ross Essay After reading Kubler-Ross’s On Life after Death, I must say, it’s definitely opened my eyes to a new perspective, and made me realize, that I too, will leave this earth one day. Kubler-Ross was the first in her playing field to open up the subject matter of death. She was able to bring about her ways of ideas through her seminars on what life, death, and transition is. In her counseling of and research on dying patients, Kubler-Ross brings about five stages of dying that an individual experiences when they leave their cocoon. These five stages are denial/isolation, anger, bargaining, depression, and acceptance. I think many different individuals can benefit from reading this book, no matter who you are and no matter what your profession is. 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But she would never let my grandma see her upset; she’d wait until she got home before she cried. Kubler-Ross mentions that it is usually a temporary guard and will eventually be able to reach the stage of acceptance (p. 21). Kubler-Ross points out that when you are angry, it can’t really be sugar coated. And when you have an upset or angry individual in a family, it will make its rounds and the mood will just linger amongst those that are there. During this time it’s important to be very liberal to the way others feel. The process of being open-minded to others will aid in expressing the wishes of the dying patient. I now understand that in more cases than not, the rationale for dying is connected with bargaining for more time. Bargaining, which is one of Kubler-Ross’s (5) stages, is when the individual thinks that if they would have done something differently, God would have given him/her more time to live. I feel we can learn a lot from this section in our day-to-day lives. We all ask ourselves if only and if we are struck with an illness, would we fight for the time we have and try to make it worthwhile. If we did not live with such suffering, like my grandmother had, we may lead different lives. The ways each person individually lives him/her life may be focused on materialistic values or it can be of faith in who we are and faith in God. I do believe that when any individual comes into contact with going through someone passing, it’s ok to be upset, and it’s expected for one to suffer from a heightened state of depression. As human beings, we can make a decision to let that depression take charge of us, or we can choose to accept death. To resolve most conflicts in our lives when we are dying is when we are able to accept the unavoidable events that transpire. It’s very important to be able to come to some terms of agreement with events that happen in our lives not just when death occurs, but also in our day to day lives in this world. 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Febrile Neutropenia Case Study

Febrile Neutropenia Case Study Consent: The patient consented for the use of the details of the illness in this report. 2.1 Patient History 2.1.1 History of disease Mr DW is a 50yr old male who was admitted to hospital on the 12th of February after suffering from nausea, vomiting and diarrhoea the previous day. He reported vomiting about 3-4 times during the day but only very small amounts of vomitus as he felt too unwell to eat anything but very small amounts of food. This was on a background of a 5-month history of multiple myeloma (MM), as well as chemotherapy induced pancytopenia. He received a Melphalan peripheral blood stem cell transplant on the 8th of February 4 days prior to his current admission His symptoms were managed by medication, but on the 15th of February he had a spike in temperature overnight. His mucous membranes became mildly erythematous on the 14th of February. He has experienced no other symptoms and overall his symptoms have gradually improved during his stay. 2.1.2 Past Medical History Relevant past medical history includes multiple myeloma which was diagnosed on the 9th of September 2016 which he has been undergoing chemotherapy for. He also received an autologous stem cell transplant on the 8th of February 2017. At the time of the diagnoses, Mr DW presented with vertebral fractures and symptomatic anaemia. Mr DW also has pancytopenia which is a consequence of his chemotherapy. Aside from hospital admissions related to the aforementioned conditions, Mr DW has never been to hospital and has no other relevant past medical history. 2.1.3 Medications       Drug Name Dose Indication Aztreonam 2g, IV, 8 hourly Antibacterial Prophylaxis Fentanyl 25mcg/hr (transdermal modified release patch) 1 patch, every 3 days Pain Fluconazole 200mg, 1 capsule, Oral, Daily Antifungal prophylaxis Metoclopramide 10mg, 2mL, IV, 8 hourly Nausea, vomiting Nystatin 1 tab, Oral, BD (twice a week) Antifungal prophylaxis Ondansetron 4-8mg, IV, 8 hourly Nausea, vomiting Pantoprazole 40mg, Oral, night Ulceration of oesophagus valaciclovir 10mg, Oral, bedtime Herpes Prophylaxis 2.1.4 Drug Allergies Penicillin Leaves the patient with a full body erythematous rash 2.1.5 Family History The patient had no family history of any conditions 2.1.6 Psychosocial History and Functional Status Mr DW is currently employed as a cinematographer and regularly has to travel around and to different states due to his line of work. He is a non-smoker, drinks approximately 1 or 2 standards in a fortnight and denies recreational drug use. He lives with his wife and 2 of his 5 children at his house and describes himself as feeling very well supported by his family. The diagnosis of multiple myeloma was a big shock for him and his family and he is quite concerned about his current prognosis. He stated that he has accepted it and is trying to stay positive and to continue living life as normally as possible. 2.2 Physical Examination Observation revealed a middle-aged man who was very bright, alert and sitting upright in a chair. Within the room there was a lot of flowers and cards. His vitals were normal (RR 18, SPO2 98% on RA, BP 115/75, HR 80, afrebile 37.4oC) On general inspection there was no visible bruising, scars, masses or other abnormalities except for some slight erythema around a PICC line on his right arm. His hands had no nicotine stains, nail changes or palmar erythema but there was palmar crease pallor. There was good dentition, mucous membranes were moist. 2.2.1 Cardiovascular Exam Pulse was palpable bilaterally and of normal rate and rhythm.Carotid pulse was strong in character. JVP was not elevated.Heart sounds dual no murmur.No audible bruits nor palpable thrills or heaves.No signs of peripheral oedema. 2.2.2 Respiratory Exam Trachea was midline.Chest expansion symmetrical and not reduced.Clear lung sounds throughout as well as normal percussion and vocal resonance.No signs of peripheral or central cyanosis. 2.2.3 Gastrointestinal Exam Abdomen was soft and non-tender.Spleen and kidneys not palpable.Liver of normal span (10cm)Bowel sounds were present. 2.3 Investigations X-ray Skeletal Survey Lungs and pleural spaces clear. Mediastinal contour and heart size are normal. Mild multi-level degenerative disc disease at the thoracic level. Normal everywhere else. Multiple small lytic lesions involving calvarium, proximal humeri and proximal femora bilaterally in keeping with MM Blood Cultures Results had not yet returned. Blood Test: Haematology WCC: 0.93*109/L (Low) Hb: 98 g/L (Low) PLT: 84*109/L (Low) HCT: 0.276 L/L (Low) MCV: 85.2 fL (Normal) RCC: 3.24*1012/L (Low) MCH: 29.9pg (Normal) MCHC: 351 g/L (Normal) Neutrophils: 0.89*109/L (Low) Lymphocytes: 0.03*109/L (Low) Monocytes: 0.00*109/L (Low) Eosinophils: 0.01*109/L (Low) *Non-listed results were within normal ranges 2.4 Diagnoses Based on his initial presentation and considering his recent stem cell transplant his treating team suspected his symptoms were likely to be due to side effects of his treatment as opposed to infection. Following the spike in temperature he was considered to have febrile neutropenia and was treated according to the guidelines (with a slight modification that shall be discussed later in report) and based on his symptoms as well as the mildly erythematous mouth Mr DW was considered to have mucositis. He is currently being managed with anti-emetics as well as prophylactic treatment considering his vulnerable state. They are also awaiting the results of blood cultures to ensure that he does not have any severe opportunistic infections. 3.1 Part A: Physiology Pancytopenia is an important entity encountered in regular clinical practice. It is not a disease but is instead a finding and can have multiple causes most of which primarily involve the bone marrow. Pancytopenia consists of a low haemoglobin count, low white cell count, and platelet count (Gayathri Rao, 2011). In Mr DWs case, his pancytopenia was caused by bone marrow suppression due to his chemotherapy treatment. 3.1.1 Platelet production and Megakaryocytopoiesis Currently the physiology of platelet production from megakaryocytes (MKs) are not perfectly understood. MKs are a type of nucleated bone marrow cells that studies have shown develop into polypoid structure via a process that is known as endomiosis followed by a maturation process before producing platelets in circulation (Machlus Italiano, 2013). Figure 1: Haematopoietic lineage(Deutsch Tomer, 2013) MKs are derived from haematopoietic stem cells (HSCs) which are the precursors to all other blood cells (see Figure 1) and they themselves are derived from haemangioblasts. HSCs progress into becoming common myeloid progenitor cells (CMPs) that mature into either monocytes or granulocytes, or they can continue developing into MK-erythroid progenitor cells (MEPs) which go on to produce MKs (Deutsch Tomer, 2013). Figure 2: Platelet Production Pathway(Machlus Italiano, 2013) In the first phase of maturation MKs undergo nuclear proliferation and enlargement of their cytoplasm which is filled with platelet-specific granules as well as sufficient membrane to complete the platelet production process. The second phase involves MKs remodelling their cytoplasm into proplatelets and then into preplatelets which go on to release platelets through fission events (see Figure 2) (Machlus Italiano, 2013). There are a number of growth factors and interleukins that regulate the development of MKs but the primary and most potent one is thrombopoietin (a glycoprotein produced in the liver). It is crucial in the development and proliferations of HSCs as it stimulates the MKs to undergo hyperplasia and hypertrophy as well as stimulating the formation of the platelet projections from which release platelets into the circulation (Deutsch Tomer, 2013). 3.1.2 Erythropoiesis Erythrocytes are vital to the functioning of the human body as they transport oxygen to the tissues. As such the complex developmental process known as erythropoiesis has to be carefully regulated and managed (Luo et al., 2017). The process mainly occurs within bone marrow and begins with the differentiation of HSCs into burst-forming-unit erythroid (BFU-E) cells which are the earliest erythroid progenitors (see Figure 3). These cells then go onto become the colony-forming-unit erythroid (CFU-E) cells which undergo further differentiation and maturation to become mature erythrocytes (Luo et al., 2017). Figure 3: Overview of Erythropoiesis(Hattangadi, Wong, Zhang, Flygare, Lodish, 2011) Erythropoietin is produced in the kidneys and acts as one of the most important physiological regulators of erythropoiesis. It is produced primarily in response to hypoxic conditions detected by specialised interstitial cells in the outer medulla and inner cortex of the kidneys. Erythropoietin regulates erythrocyte production, prevents apoptosis and controls the rate of release. It also acts on CFU-Es (see Figure 3) which then go on to become proerythroblasts (Hattangadi et al., 2011). These cells undergo maturation to eventually become polychromatic, basophilic, and orthochromatic erythroblasts. The orthochromatic erythroblasts differentiate to reticulocytes and become mature erythrocytes (Luo et al., 2017). Mr DWs pancytopenia is consistent with myelosuppression and is a common side effect of chemotherapy treatment. Normally HSCs from which blood cells develop are capable of self-renewal but chemotherapy affects cells within the bone marrow and greater numbers of HSCs are needed to be activated. Unfortunately, with the diminished capability production of the myeloid cell lines is unable to keep up and leads to low counts which is reflected in Mr DWs blood tests (see investigations) as he has low amounts of white cells, red cells and platelets. Unlike other conditions where there may be infiltration of bone marrow he still makes normal cells but just in a diminished amount, consequently, he has normal mean cell volume, mean platelet volume and mean corpuscular haemoglobin. 3.2 Part B: Health Policies Fever in neutropenic patients occurs frequently early in a course of chemotherapy and in diseases which disrupt the bone marrow. In these cases fever could be considered a medical emergency as it requires immediate evaluation as well as the use empiric broad-spectrum antibiotics (Lyman Rolston, 2010). Patients with febrile neutropenia have mortality rates ranging from 5% 20% and mortality rates can be greater than 50% in patients who develop septic shock or pneumonia even with the use of antibiotic treatment (Kuderer, Dale, Crawford, Cosler, Lyman, 2006). The importance of managing febrile neutropenia swiftly and as effectively as possible cannot be understated and as such the guidelines around this area are extremely important. 3.2.1 Prince of Wales Febrile Neutropenia Guidelines Figure 4: Prince of Wales Initial Management of Febrile Neutropenia Guidelines(Health, 2015) The Prince of Wales hospital where Mr DW presented has a specific guideline for initial management of febrile neutropenia. Since he has a severe penicillin allergy he was treated following the guidelines with Aztreonam but his treating team chose to differ from the guidelines and gave him Vancomycin immediately. Mr DW did not have any of the indicators for the use of vancomycin (see Figure 4) but during a discussion with the treating team it became apparent that they believed it was safer and resulted in overall better outcomes to begin patients on vancomycin immediately. As such they believed that vancomycin should be used immediately in cases with any penicillin allergy and used following the dosing guidelines when theres no penicillin allergy. 3.2.2 Use of Empiric Antimicrobial Therapy In terms of the use of empiric antimicrobial therapy in the initial management of febrile neutropenia the Prince of Wales guidelines essentially perfectly follow the national recommendations. The changes that Mr DWs treating team wished to make to the guidelines is at odds with the current literature and guidelines (Freifeld et al., 2011; Paul, Dickstein, Borok, Vidal, Leibovici, 2014). Based on most studies into this topic, non-selective use of vancomycin reduced relative risk of mortality but was not found to be significant and there also was no significant difference in overall 30-day patient mortality (Lugtenberg, Burgers, Westert, 2009; Paul et al., 2014). 3.2.3 Recommendations The Prince of Wales guidelines closely adhere to the national guidelines and what the current literature deems as the most effective (Freifeld et al., 2011; Paul et al., 2014). Even so, its clear that the treating team for Mr DW felt that the current guidelines were inaccurate. It is difficult to assess which version is more effective specifically for the population they are dealing with at the Prince of Wales hospital but based on current research following the current guidelines (as opposed to modifying them) appears to be the best course of action (Lugtenberg et al., 2009). That being said, in specific cases where the specialists in this area strongly feel that they should act differently it may be best to defer to their experience and expertise. This assignment has been an interesting and thought-provoking experience. The most surprising thing I found was how the views of the treating team differed from the guidelines. I realised I place a lot of value upon their views and thus was very surprised when looking at the literature as it seemed to be contradict what they told me. Its clear that I was biased at the beginning but even after researching this topic Im still unsure if there is a correct view or side. Although, what this whole process has taught me is that more research, consultation, and evaluation in regards to current treatment guidelines and policies still can and should be done. This time around when doing the assignment again I tried to ensure that I took the advice and feedback on my previous assignment seriously. Finding a patient was difficult and I ended up with a patient that had similar aspects to a previous assignment but I tried to explore different aspects and it also allowed me to incorporate things that I did not include previously. There have been issues and difficulties with writing this assignment but I feel that overall, its been quite rewarding and that I hope to maintain a higher level of quality in my work going into the future. References             Deutsch, V. R., Tomer, A. (2013). Advances in megakaryocytopoiesis and thrombopoiesis: from bench to bedside. British Journal of Haematology, 161(6), 778-793. doi:10.1111/bjh.12328 Freifeld, A. G., Bow, E. J., Sepkowitz, K. A., Boeckh, M. J., Ito, J. I., Mullen, C. A., . . . Wingard, J. R. (2011). Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clinical infectious diseases, 52(4), e56-e93. Gayathri, B. N., Rao, K. S. (2011). Pancytopenia: A Clinico Hematological Study. Journal of Laboratory Physicians, 3(1), 15-20. doi:10.4103/0974-2727.78555 Hattangadi, S. M., Wong, P., Zhang, L., Flygare, J., Lodish, H. F. (2011). From stem cell to red cell: regulation of erythropoiesis at multiple levels by multiple proteins, RNAs, and chromatin modifications. Blood, 118(24), 6258. Health, N. (2015). Initial Management of Febrile Neutropenia. Retrieved from Http://www.seslhnweb/powh/policies/default.asp Kuderer, N. M., Dale, D. C., Crawford, J., Cosler, L. E., Lyman, G. H. (2006). Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer, 106(10), 2258-2266. doi:10.1002/cncr.21847 Lugtenberg, M., Burgers, J. S., Westert, G. P. (2009). Effects of evidence-based clinical practice guidelines on quality of care: a systematic review. Quality and Safety in Health Care, 18(5), 385. Luo, S.-T., Zhang, D.-M., Qin, Q., Lu, L., Luo, M., Guo, F.-C., . . . Wei, Y.-Q. (2017). The Promotion of Erythropoiesis via the Regulation of Reactive Oxygen Species by Lactic Acid. Scientific Reports, 7, 38105. doi:10.1038/srep38105 http://www.nature.com/articles/srep38105#supplementary-information Lyman, G. H., Rolston, K. V. I. (2010). How We Treat Febrile Neutropenia in Patients Receiving Cancer Chemotherapy. Journal of Oncology Practice, 6(3), 149-152. doi:10.1200/JOP.091092 Machlus, K. R., Italiano, J. E. (2013). The incredible journey: From megakaryocyte development to platelet formation. The Journal of Cell Biology, 201(6), 785. Paul, M., Dickstein, Y., Borok, S., Vidal, L., Leibovici, L. (2014). Empirical antibiotics targeting Gramà ¢Ã¢â€š ¬Ã‚ positive bacteria for the treatment of febrile neutropenic patients with cancer. The Cochrane Library.