Strategic Management: An Introduction

strategical Man periodment An IntroductionStrategic oversight is the art and attainment of formulating, implementing and evaluating cross-functional decisions that pull up stakes enable an organization to deliver the goods its objectives. It involves the systematic identification of specifying the firms objectives, nurturing policies and strategies to achieve these objectives, and acquiring and making obtainable these resources to implement the policies and strategies to achieve the firms objectives.Strategic commission besides integrates the activities of the various functional sectors of a bloodline, oftmagazines(prenominal) as selling, sales, outturn to achieve organizational goals. It is gener tout ensembley the advancedest level of passenger carial activity, usu alto conquerhery imitated by the board of directors and executive host. Strategic tradement hopes to provide boilers suit guidance to the telephoner has ties to the field of organization studies.Str ategic be afterning is a direction tool, period. In short, strategic planning is a disciplined effort to make water fundamental decisions and actions that shape and guide what an organization is, what it does, and why it does it, with a center on the future.Strategic forethought besides all toldocates the right amount of resources to the assorted positions of your business so that those assigned to particular goals break what they extremity to meet their objectives. This ranges from providing your organiseers with the right supplies to enacting systems by which employees receive the incumbent training, all work helpes argon tested, and all information and data generated is documented. To use blanket(a)y manage your business strategically, e very(prenominal) inch of your friendly club must contract its necessitate met in these ways.Further to a great effect than, unrivalled must know that cardinal businesses mansion non be same and in that respect should be about basic differences between them. Because of this, the goals and the plans of action ar antithetic for distri just nowively business. Plus, the strategies for abundant enclo accredited and short term checkment should be different and these consume to be applied separately.QUESTION 1 relieve how psyche asshole be a manager only non a leader, a leader tho non a manager, and twain a manager and a leader.A manager is a mortal with a course of overseeing one or more employees or discussion section to turn back these employees or departments do their job or assigned duties as require. A manager helps early(a)wises to get more done by actuate the employees, providing troubles , making sure the employees working together towards a habitual goal, and providing feedback.A reinvigorated manager whitethorn be responsible for a fiddling squad or a small project. Usually a major(postnominal) manager result watch over his or her work. The manager pass on involve to l earn the strengths and weaknesses of the police squad up members, instruct a work to the team members, guiding team members to reach goals, provide the tools needed by the team and motivate them to do their task.Usually , a juvenile manager has expressage responsibility for money discovers and pocket-sized chances to approve or make an expenditures. They contract to review and approve eonsheets for their employees and whitethorn energize the chances to approve expense accounts. The term of manager is not the same for leader since the two terms be not the same. A manager must ensure the appropriate voice communication of human resources and funding to meet the routine periodic productivity objectives. The manager is known as detailed oriented.Mangers don not see the overall picture and argon less interested regarding the pine-term corporate goals and mission. They are worried about details as a result, they do not make them a good leader. Some managers w hitethorn piss legitimate lead qualities but they remain too reduceed on their daily operations and are unable to provide direction and vision to the organization. A manager plans, organizes, leads, and controls whereas a leader influence others through communication, motivation, discipline, direction and dynamicsTypically, the goals are habilitate for a beginning manager by someone higher ranking in an organization. Here , the manager micturate to explain a plan to achieve the goal set. They pass water to provide feedbacks to their employees as they work with those plans.To be a manager , stupefying skills at all level is important . At a beginning level , examples of two area where a manager need to focus their skill growing are the capability to manage their meetings and prepareing their own planning tools such(prenominal) as to do a list.A leader is different from manager. A leader is a person who has vision, a drive and a payload to achieve that vision, and the ski lls to make it happen. A leader see a some(prenominal)er that needs to be fixed or a goal that needs to be achieved.A leader is excessively a person who guides others towards a plebeian goal, viewing the employees by example and creating an environment in which other team members feel active and gnarled in any process or task. A leader is a good listener. leaders wear to keep their mind open to others ideas. They rat come up with new ways to accomplish the goal set. It is the leaders job to make sure that everyone in the group is organism heard. leading have to listen to the team members ideas and listen their criticism for improvements.Leaders have to be focus all the clipping. They have to keep on remind themselves and the team members of the goals and mission. Staying on leash and keep the team members on track ,the team pass on go along motivated and more productive. As leader of the group, it is important that you schedule time to meet with your team to establish a nd check-in about the goals you hope to achieve.Leaders overly have to be nonionised. Leaders are responsible in a lot of things and might be very busy sometimes. A leader back tooth set the tone for the team. A leader who is organized helps motivate team members to be organized as well. As a leader, youre responsible for a lot and youre probably going to be very busy at times. However, you still need to find time to chatter with your team. A good way to do this is to set frequent group meetings, so that no question or concern goes too long without attention.Leaders withal have to be decisive. Although an important part of being a leader involves listening to the people surrounding, they have to remember that they are not always going to be able to reach a compromise. When this happens, dont be afraid to make the final decision, even if some team members disagree with the plans.Confident is the close important characteristics of a leader, leaders have to believe themselves and the success of the team members. Show others that you are dedicated, intelligent, and high-minded of what you are doing.A manager basically directs resources to have intercourse predetermined goals or projects. For example, a manager whitethorn engage in hiring, training, and scheduling employees in rewrite to accomplish work in the close efficient and monetary value effective manner possible. A manager is considered a failure if they are not able to complete the project or goals with efficiency. .On the other hand, a leader within a corporation develops individuals in order to complete predetermined goals and projects. A leader develops descents with their employees by structure communication, exampling images of success, and by showing loyalty.As an example of a manager, A company CEO directs Wong, one of the companies up and coming managers, to hire enough new employees to provide the company with a client emolument department. Wong under downs his project with enthusias m. He hires only those employees who clear work the assigned hours, volition accept the modest pay, and have bring working in customer service. He trains his new employees to perform the job to his expectations and assigns the employees to their new positions. Wong measures his success in terms of efficiency, calls handled per hour, and equal strong suit, for example did he meet his budget?. However, Wong did not anticipate that of the employees he hired, only a handful would remain working six months later.Moreover, as an example of a leader, Ahmed obtains the same assignment as Wong. Ahmed hires employees that he believes he can develop a working copulationship with, versus just those employees who will worked the assigned hours and take the modest pay. Ahmeds goal is to hire a diverse group of employees, some of who do not have any customer service experience, who he feels he can develop a personal connection. A tumescent part of Ahmeds training involves team building, tel ling successful stories, and listening to each employees own desires for what constitutes a fulfilling job. Ahmed still assigns his employees their job duties and schedules at the end of training, and he as well as measures success in terms of efficient and salute effectiveness, but he also measures success in terms of low employee turnover, employee morale, and employee development. Ahmed feels proud when one of his employees obtains an advance level position a year or two by and by being hired.The skills to be a leader or a manager are not exclusive in nature. A leader who only displays leadership skills will be ineffective when it comes to checking time cards, completing employee reviews, and scheduling employee vacation time things that employers require their managers to do on timely bases. Similarly, a manager who authorises all his/her time completing storywork and learning reports only creates more problems for him or her because they lack a developing relationship wit h their employees.Many companies, one person may play the role of both leader and manager. In others, these roles are carried out by different people. And in some(prenominal) brasss, the roles overlap and leaders need to manage and managers need to lead. However, it is deprecative that both roles are performed efficaciously for a company to succeed, especially a company with employees. Without a vision for the future, a company has no direction and no goals for which to strive. well-behaved leaders are made not born. If you have the desire and will mogul, you can bring forth an effective leader. Good leaders develop through a never ending process of self-study, teaching, training, and experience. As a manager who would like to become a improve leader to reinvigorate your employees into higher levels of teamwork, there are certain things you must be, know, and, do. These do not come naturally, but are acquired through continual work and study. Good leaders are continually wo rking and studying to improve their leadership skills. Leaders and managers also have much different conceptions of work itself. Leaders develop new border ones to long-standing problems. Leaders work in high- essay positions because of a strong aversion to mundane work. Conversely, managers view work as an enable process. Managers tolerate practical, mundane work because of a strong survival inherent aptitude that makes them lay on the line-averse. They are good at reaching compromises and mediating conflicts between opposing perspectives, but lack the influence to avoid future conflicts.QUESTION 2 find two very different organizations that compete on a exist leadership strategy and explain how they do this, i.e. find out what they do that enables them to keep their prices low.The toll leadership strategic is to reach a emulous value. Make it into a simple word, constitute leadership is reduce the cost to fight with their competitor in same indus distort. The organization who need to earn more profit, must reduce the cost to ensure they are not waste any resource. The cost who has reduce more, the company will gain more profit and subdued to survive in the market share.AnakkuAnakku as famous is selling the baby product. The company is celebrated 38th day of remembrance in Malaysia in 2011. at that placefore, the company has their advantage to survive in this market. Anakku set out the baby products get it the mission is built on a strong, unfluctuating primeation of premium quality, safety and reliability. The product have been sell by Anakku are fashion-wear for babies and toddlers, feeding equipment, toiletries, diapers, accessories, strollers, playpens and more. coddle KikoCreating style glamour, fun comfort for the little ones. Is the brand name of treat Kiko. Baby Kiko is a brand tipion from KIKO. Baby Kiko is establishing in Malaysia for over 20 years. Baby Kiko is one of the most widely recognized baby brand in Malaysia, known for qu ality, trendy style, and marketing creativity. The product that have been sell are toddler frameworking, feeding accessories to deprive products, baby cleansing to baby skin kick products.Cost Leadership StrategicBoth companies have completed their cost leadership strategic, therefore, both company can survive in the market pickings a long period time. Each of them has the plan to reduce the cost and increase their profit. non even theory, both companies also employ the Michael Portal 5 bosom to operate the companies. And they no using too much of advertising to gain their product, so that, the cost will follow decrease.Next, most of the products like cloth or accessories are make by them. The pattern and the excogitate had been created, so, the companies will produce it with their own manu reckony. Follow by this, both companies will try to reduce the damage of the product. They will make sure the product is good. The after-sales service is one of the parts they can do, and g et the feedback from the customers, and get to improve better to the customers need.Within the Michael Portal 5 forces, First of all, the bargaining power of supplier. For the Baby Kiko federation, all the product are make by own, so that, the gross fabric of they used is direct from the manufactory, so the price of the product can easy to under control.An opposite, about the Anakku Company, some if the products like car female genitalia or toys are manufacture from the supplies. Mostly, the Anakku Company will control by the supplier. But, for the Anakku Company, the main product for sell is clothing and the accessories like bottles, teethers, feeding accessories and etc. If the supplies increase the price, so they will change the supplier to get the birthday suit material and try to product good product for their customers.Next, the bargaining power of customer or buyer is one of the forces that both companies used. The price had been set and the customers no have too much o r no have power to argue to reduce the price. The entire product had been fix price, unless the company does the promotion like send packing, so the customer will get the reject price of the product. Both companies have provided onsite service and after-sale service. And some of the product will give about 1 week to 1 year of warrant depend on the product.The threats of the entry of new competitor will also influence the cost. If got new competitor join into this industry, the company will spend more money to do promotion as like discount or adverting to attract people. This kind of money will increase the cost, so the profit will been decrease. Otherwise, both company had been survive in Malaysia taking a long period time, they have their own popularity in this country.For the Anakku Company, they for the most part are produce the safety and useful product. The product no easy to damage and some of the product have the warranty to attract the customer to buy it. This is the adv antage for them and no need s assistance about the new competitor to try to attack them.Besides that, the Baby Kiko Company more is based on the creative and innovative product to attract customers. The design and the fashion are new and look nicely. Based on the customers, they will take feedback and get the new the information to produce the product. Those are the advantage of the both companies the new competitor does not have too much power and cost to survive.Other than that, the intensity of competitor rivalry it may also influence the cost. Take a basic word, who can get the lower cost, who will win in the market. Therefore, the company must have the power and the capacity to run the business.For Anakku Company, they have many branches in the Malaysia. It will easy to target market and the customers. Anakku Company as a interlocutor otherwise as a retailer. They retail the product directly to the customer, so that, the cost will not be too high to be taken. The technology of Anakku Company use is high-tech machine. According the above statement, the Anakku Company does not have too much of advertising. Running the business somewhat 30 years, the popularity has the value on their customers.For Baby Kiko, they usually are sweeping to the stores that are really preferred to sales. Some hypermarket like Partson or The Store, we can see Baby Kiko product. Wholesale to other store, it can deduct the cost of employee and no need searching the place to run over the business. The customers who are prefer to sell the product, they will delivery it. It may reduce the cost with it. Not even that, Baby Kiko Company also though the profit to promote the product. One of the major website is Facebook to promote. It is free of charge and also can attract more people to know the new product.Other than that, the prod force it may influence the cost available. Anakku Company is more focus on the retail sale, so that, the employee will taking more and more, so the cost r elative will increase. From the manufactory to the store, they are too many employees to work. But, the Baby Kiko no taking too much of employee, because they have using the technology like machine or wholesale to other seller. The cost taking is the transportation fee.At last, which companies keep the lower cost it may easy and expand the business. Besides that, properly using the raw material and do not simply waste too much. Because the waste will direct influence the cost. Have a good plan of cost leadership, the company more easy to survive in the market share. nursing Case subscribe Osteoarthritis (OA) ManagementNursing Case Study Osteoarthritis (OA) ManagementIntroductionOver 60% of adults in England acquire from a continuing health problem (Department of wellness 2004). Osteoarthritis (OA) is among the most common chronic agents, curiously among senior adults, and is a cause of enormous smart and disability among affected individuals. The prevalence of OA has been e stimated at 2.5% in the overall population, increase to 12% among those aged 65 years and over (Wood 1999). OA is a complex flesh with ninefold risk factors of age, sex, overweight or obesity, genetics, and biomechanical factors (e.g. formulate injury or occupational or recreational use). It is possible for OA to develop in any synovial joint but the spine, hip, knee, hands most commonly affected, either in isolation or in junto (Steven and Finlayson 2005). Typical symptoms of OA include joint pain, stiffness, limited movement, crepitus and swelling, and symptoms may be static, turnabout or progressive (Steven and Finlayson 2005). Structural changes within the joint may also occur in the absence of any symptoms.OA places a broad essence on health forethought resources, with data produce in 2002 showing this delay to be responsible for over 11 million GP visits and more than 114,500 infirmary entrance fees (Arthritis look campaign 2002). OA also impacts significantly on th e economy. In 19992000, it was estimated that a total of 36 million working days were confused due to OA alone, resulting in 3.2 billion in lost productivity (Arthritis look for campaign 2002). It is therefore important that OA is managed effectively in affected individuals. This penning discusses a diligent that I have nursed with degenerative arthritis and examines the effectiveness of their superintend in the worry of this condition.Patient case historyMrs smith is aged 78 years and lives independently in a two-storey house with her husband, aged 82 years, who is her main troubler. She has degenerative joint disease of the knees, hips and hands and also has high blood pressure and diabetes. She is taking four medications for these conditions. Eighteen months ago, she underwent emergency brake infirmary admission for a urine infection. After being discharged from hospital, sound judgment showed her to be at an change magnitude risk of repeated admissions due to he r multiple pathology, polypharmacy and previous hospital admission. The interest she had received prior to hospital admission was below measuring rod and self- oversight of her condition was short. Her GP referred her case concern to a familiarity matron who worked aboard a multidisciplinary team of health succeeding professionals (I was a member of this team) and her husband to coordinate her maintenance and help Mrs smith reduce her risk of future hospital admissions. The club matron was involved in Mrs smiths computer platform of kick for a total of two months, after which time co-ordination of her deal was reach back to her GP.At the initial legal opinion, Mrs smith was found to be experiencing high levels of pain which affected her slumber patterns and showed symptoms of falloff. She also reported relationship problems. At present, her pain is being managed effectively through a combination of pharmacological and non-pharmacological interventions which inclu de self-management she reports normal sleeping patterns and shows no signs of depression. Her relationship with her husband has also improved and Mrs smith is now no longer at increased risk of future hospital admissions.Managing individuals with chronic conditionsThe dread and management of chronic conditions should words individual needs and expectations. The organisation has set Public helping Agreement (PSA) targets for improving outcomes for people with chronic conditions. These include reducing emergency bed days by 5% and increase the number of former(a) adults who are reinforcemented to live at home by 1% by 2008, from the 2003/4 baseline (Department of health 2005). With the aim of meeting these targets, the NHS and cordial Care Model was developed to help Primary Care Trusts (PCTs) and accessible care organisations improve care for individuals with chronic conditions (Department and health 2005). From 2005, all PCTs are required to provide personalised care plan s for those individuals who are most at risk. Initiatives such as the Expert Patient Programme are include in this model and will be discussed later.Providing high-quality care for older adultsThe NHS intent set out a programme of reforms for the NHS (Department of health 2000). Based on the underpinning principles of this plan, the bailiwick Service Framework for Older People was implemented to ensure that the needs of older adults are adequately address in these reforms (Department of health 2001). This will be achieved by ensuring high standards of care are provided for all patients, improving access to care, and developing services which promote independence. The Essence of Care, published in 2001, sets out benchmarks for clinical governance covering eight areas of care which identify required standards for high-quality care and indicators for best practice (NHS Modernisation dominance 2003).NHS reforms have led to changes in the role of nurses, providing new opportunities for nurses to extend their be roles, together with the introduction of new roles such as the companionship matron in the community orbit and modern matrons in the hospital setting (Department of Health 2001). Client since we dont discuss care in the hospital setting elsewhere, I havent discussed the role of the modern matron any further This paper will examine the role of the nurse as part of a multidisciplinary care team in the care of Mrs metalworker.Care and management of osteoarthritis in older adultsThe management of OA in adults becomes increasingly complex with move age (Holman and Lorig 1997). Since there is no cure for OA, the main cure goals are to minimise the effects of the disease and over time. Effective care involves building long-term interpersonal relationships between healthcare providers and patients, carers, family members, other care providers, and those organisations involved in providing care and support. A holistic approach to assessment and manipulati on is required that considers the physiological, psychological and cordial needs of the individual in relation to their quality of life and daily activities (Salaffi et al. 1991). Both the bailiwick Institute of clinical Excellence and the Royal College of Physicians have recently published guidelines for the care and management of osteoarthritis in adults (National Collaborating Centre for Chronic Conditions 2008 NICE 2008). The care of Mrs smith will be discussed in the context of the recommendations made in these guidelines.appraisalThe wizard assessment process for older adults was introduced in 2000 as part of the NHS platform (Department of Health 2000). This requires an assessment of the individuals health and societal care needs to take place in a single assessment and was designed to standardise the assessment process and raise standards of assessment practice. During Mrs Smiths assessment, her concerns, expectations and level of association about her condition were discussed, together with the effect that her osteoarthritis had on daily activities including personal hygiene, climbing stairs, acquire up from chairs, etc, and on her sleep patterns. Her levels of pain and mood were also assessed. Mr Smith also participated in the assessment, in order to gain his perspective on his wifes condition and to establish how well he was manage as her carer, and also to identify any specific health need he might have. Further specialist assessment of Mrs Smith and her ability to undertake daily activities, together with an environment assessment, were undertaken by an occupational healer.Mrs Smiths level of knowledge about her condition was poor. Three other key issues were also identified during the assessment, namely pain management, depression/anxiety and relationship problems. Mrs Smith reported increasing pain in her joints, particularly her knees and hips prior to her admission to hospital which was so bad she was unable to sleep at night. The c are she had been receiving prior to this had not effectively addressed this increasing pain. Screening and assessment showed Mrs Smith was suffering from mild depression. She reported tone distress that she was no longer able to undertake many crime syndicate tasks that she used to be able to do or participate in recreational activities with her husband that she used to enjoy. The increasing pain she had been experiencing prior to her hospital admission also contributed to her feelings of depression. She reported feelings of anxiety over fears that she may be made to leave her home as she could no longer manage to climb the stairs. Mrs Smith showed negative feelings regarding her past care and was initially demoralised about the likely effectiveness of the proposed treatment in the current care plan. Mrs Smith expressed concern that her relationship with her husband was suffering because her pain and lack of sleep made her irritable and short tempered. An supererogatory factor c ompounding these problems was her husbands poor hearing which served to make her more irritable. All of these issues are common among adults suffering from OA (Farmer et al. 2008), and is important that their care plans effectively address these needs.The nurse plays a pivotal role in the assessment of individuals with chronic conditions and it is important for the nurse to establish a successful therapeutic relationship with the patient and their carer(s) as early as possible in the process. Effective communication and building trust is central to this relationship and it is necessary to gain the perspective of both the patient and carer to develop a thorough comprehending of individual needs.Development and implementation of a personalised care planEmpowering patients to take part in decisions regarding their care is central to the governments health service policy agenda (Department of Health 2000). The authorisation of older adults is also addressed in the NSF for Older Peopl e (Department of Health 2001). Research suggests that patient empowerment may help to arm patients ability to self-manage their condition (Corben and Rosen 2005). It is also beneficial to involve families and carers in the decision-making process, with the consent of the patient. A personalised care plan was developed for Mrs Smith with the involvement of both her and her husband, which was tailored to meet her individual goals. This plan enabled high-quality, patient-centred care to be delivered via a multidisciplinary team of healthcare professionals which included her GP, nurse, physio healer, occupational therapist and community matron. Social services were also involved in providing additional support for both members of the couple. Taking account of Mrs Smiths multiple pathology and polypharmacy and the use of research-based evidence were both of major importance when developing this care plan.Interventions within the care plan and the individual roles of healthcare providers Non-pharmacological interventionsThe provision of pedagogy and advice and muscle streng thening exercises were the two core interventions in Mrs Smiths care programme. Research has shown that patients frequently report better outcomes when they receive education and advice as this empowers them to become more involved in their own care and equips them with the knowledge and skills required for self-management (Holman and Lorig 1997). Educating both Mrs Smith and her husband about her condition and methods of self-management formed a key component of her care plan and discussions were originally nurse-led.Encouraging self-management is indispensable for all chronic conditions and providing a framework for self-management is an total aspect of care (National Collaborating Centre for Chronic Conditions 2008). The Expert Patients Programme (EPP) was introduced in 2003 following the success of the Stanford Self-management Programme in the United States (Department of Health 2006). R esearch which provides the rationale for this programme suggests that patients who have trained in self-management have greater confidence and use their skills and knowledge to improve their overall quality of life. These individuals subsequently require fewer healthcare resources, leading to long-term cost savings. Self-management courses are run trained by lay leaders rather than healthcare professionals. To date, the success of EPP in the UK has been limited compared with that of other rehabilitation programmes for chronic conditions (Bethell et al. 2007).A physiotherapist taught Mrs Smith to perform a series of gentle exercises to strengthen the supporting muscles around her knee which she was then able to perform on a daily basis by herself at home. An occupational therapist recommended a number of modifications to Mrs Smiths home to make execute daily tasks easier. These included the installation of a raised toilet prat and wall bars in the bathroom. The occupational therap ist also arranged the provision of shock- absorbing shoes to help reduce the pain in Mrs Smiths knees and hips. Due to Mrs Smiths limited mobility, opportunities for visits immaterial the home were restricted. However, social services arranged for both members of the couple to attend weekly bingo sessions at their local community centre which provided the hazard for social interaction with other older adults which both members of the couple found beneficial.Pharmacological interventionsOral paracetamol and the use of topical nonsteroidal anti-inflammatory drugs for the knee were prescribed for Mrs Smith. Paracetamol and topical use of NSAIDs are the currently recommended first-line treatments for knee OA (NICE 2008). Paracetamol alone was not comfortable to control Mrs Smiths high levels of pain in her knees. Since her antihypertensive medication was a calcium channel blocker, the use of NSAIDs were not thought to be contra-indicated and were unlikely to show drug interaction w ith her other medications (Luque et al. 2006). sideline discussions with Mrs Smith, a decision was taken not to prescribe anti-depressants initially but to monitor her symptoms of depression and revise her care plan if necessary.Throughout Mrs Smiths programme of care, the role of the nurse involved making unbendable home visits to assess Mrs Smith and her husband. Monitoring the effectiveness of the interventions implemented is essential if the goals identified within the care plan are to be achieved. secureness reviews of the care plan should be made and changes made as required based on the outcome of ongoing assessments. Prior to the involvement of the community matron, Mrs Smiths GP practice was responsible for co-ordinating her care. The community matron is a relatively new clinical specialist position within the NHS, introduced specifically to provide support for people with long-term complex conditions (Department of Health 2004). working(a) alongside GPs, community matr ons perform various roles which enable patients need to be met within the community rather than in hospital (Bassett 2005). The role of the community matron in this instance was in short-term case management.Addressing the carers needsEvidence suggests that the health needs of carers are frequently overlooked (Hare 2004). It is also important that carers receive adequate support as feelings of isolation and being unable to cope are common (Department of Health 2004b). Mr Smiths health needs were assessed during the initial assessment and addressed accordingly. Mr Smith suffered from angina for which he was already taking medication, and poor hearing. A follow-up specialist assessment of his hearing identified the need for a hearing aid which he received. The health of both patient and carer was then assessed by the nurse during subsequent home visits.Success of the care programmeMrs Smiths care programme had a successful outcome. Her symptoms of depression reduced and her relationsh ip improved once her pain was being managed more effectively and she was able to sleep better. Her mobility improved and confidence increased such that she was able to start taking short walks outside her home with her husband. She was also able to undertake more tasks within the home. Education about her condition led her to realise that OA is not the end of the world and that life can still be enjoyable, provided her condition continues to managed effectively. Mr Smith also received support from the healthcare team which helped to re-enforce his role as her main carer and extend his knowledge about his wifes condition, which better equipped him to care for her effectively. Mrs Smiths care was delivered using the appropriate frameworks for older adults and those with chronic conditions and was in line with current management guidelines.Osteoarthritis and ageingOA is more common among older adults and will therefore frequently co-exist with other age-related comorbidities such as ca rdiovascular disease, diabetes and hypertension, as demonstrated in the case of Mrs Smith. Because of this multiple pathology, polypharmacy is common and drug regimens are often complex (Gorard 2006). Polypharmacy may increase the risk of drug-drug interactions and drug-related adverse events. In some cases, drug-drug interactions may counteract the effect of a particular drug (Cotter and Martin 2007). For example, if beta-blocker or angiotensin-converting enzyme inhibitor antihypertensives are co-administered with non-steroidal anti-inflammatories (NSAIDs), the hypotensive effect of these drugs may be reduced due to sodium retention by the NSAID (Luque et al. 2006). Furthermore, older adults may also consume over-the-counter preparations (e.g. vitamins and analgesics) which also have the potential to interact with prescription drugs.Age-related changes in both drug pharmacokinetics and pharmacodynamics may be observed, and increased drug sensitivity may increase the risk of drug ac cumulation and toxicity in older adults (McGavock 2006). Other factors which should also be considered when prescribing drugs for older adults are (1) cognition whether the patient is able to understand and follow their treatment regimen (2) vision visual impairment may prevent them from being able to identify their tablets correctly (2) ability to draw or fear of unhorseing some patients may be unable to swallow large tablets or may be afraid to do so for fear of choking. It is therefore very important to ensure that a full drug history is taken for every patient and other pertinent factors are also taken into account.Ethical and legal issues in the management of chronic illnessNHS funding for individuals with chronic illness has been the subject of considerable controversy in recent years. Advances in medical technology have allowed healthcare providers to considerably prolong the life of many individuals with chronic conditions and this ability, mate with the increasingly ageing population, have presented an unsolved dilemma of how to provide nationwide care with limited resources (Waldron 2006). Until recently, some patients have been caught up in a so-called postcode lottery whereby drugs and services may be available to individuals living in one region of the UK, but not another. This is considered by many to be against the founding principles of the NHS which was introduced with the vision of providing free medical care for all (Donnelly 2008). While it must be acknowledged that at the time of its conception sixty years ago, no one could have predicted the extent of future increases in population size within the UK, or the sacque towards an increasingly ageing population which have placed an ever increasing burden on services ill-equipped to meet demand. Nonetheless, careless(predicate) of the extent of available resources, these should be distributed fairly to all within the population regardless of location or any other factors.Living wills are an issue which may concern individuals with chronic conditions, particularly those receiving end of life care. There may be circumstances in which some individuals may not wish to receive life-prolonging treatment and it is important that decisions and choices regarding their care can be communicated to care providers if they themselves are unable to do so. Allowing individuals to refuse life-prolonging treatment may be viewed by some as a step towards mercy killing which considers the right of an individual to choose when and how to die and which has been the subject of intense argue for a number of years.The NSF for Older People (Department of Health 2001) addresses some of the ethical issues surrounding the care of older adults, in particular infringement of their high-handedness and unfair discrimination in access to care. This framework includes standards for (1) reducing age discrimination, ensuring that NHS services are provided on the basis of clinical need and that social services do not use age as a barrier to restrict access to services and (2) treating older adults as individuals and allowing them to become involved in decisions regarding their care (i.e. promoting patient empowerment, as discussed previously). The Evercare programme also addresses the right of older adults to receive high-quality patient-centred care. This programme was introduced in the UK in 2003 after demonstrating success in the United States. It is designed to improve care for older adults who frequently have multiple pathologies and social problems, who may be receiving poor care, and who are often admitted to hospital as emergency admissions for reasons that may have been preventable with higher standards of care. Those patients at highest risk of future hospital admission are identified for enrollment in the programme. A role of the community matron would be in identification of those individuals who may be benefit from this programme and in their case management. The principles of the programme include the provision of personalised, holistic care aimed at promoting independence, comfort and improved quality of life, and avoiding adverse effects of polypharmacy.ConclusionsThe management of chronic conditions such as OA presents a greater challenge in older adults with multiple pathologies, where successful outcomes may be dependent on a number of co-morbidities. The need for a full understanding of drug-drug interactions and age-related physiological changes is essential for accurate drug prescribing in this group of patients where polypharmacy is common. Effective management of Mrs Smiths condition was achieved through a combination of self-management and health and social care. Effective care involved a holistic approach to assessment and treatment from a multidisciplinary team of health and social care providers. 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