Change is part of the game. Leaders both set vision and navigate the, sometimes, murky waters of change. Effective leadership requires you to harness both the minds and hearts of employees to enable change to occur and take root in the company’s culture. For this assignment, you will identify one change management need within your company or from a company you previously worked for and plan a change initiative. Business Brief (2-3 pages) Identify a needed organizational change and utilize Kotter’s eight-stage framework. This should be written in a professional format (font size 10-12, one-inch margins double spaced, and use of headings and subheadings). Remember to include a cover page that has all appropriate course, assignment, date, and name information. 1. Provide a brief background of the company, industry, and culture. 2. Identify the problem you want to address and why it is important. 3. Describe your change initiative according to Kotter’s eight stage framework.  What is your change vision and why is it important?  How will you create a sense of urgency?  How will you create a guiding coalition?  How will you communicate the change vision?  How will you empower employee action?  How will you enable and create short-term wins?  How will you consolidate gains and produce more change?  How will you anchor the new approach in the company culture? Company profile below. Use this company to answer the questions above. Operation Management of ERMI Inc. Introduction ERMI Inc. is a leading medical device company in USA with specialization in treating patients falling under outlier category (Papotto, & Mills, 2012). These kinds of patients have severe motion loss thus the company partners with physicians, physical and occupational therapists and other healthcare professionals to provide medical services to such patients (Papotto, & Mills, 2012). ERMI Inc. does research, develop, manufacture and market its healthcare services to patients across the United States. The operations of the company are tallied with its need to help patients get back to their normal way of life as before occurrences of injuries or surgeries (Papotto, & Mills, 2012). Such target complies with the company’s mission that focuses purely on patient’s improvement. ERMI Inc. greatly serves people with severe motion loss and those who have failed conventional therapy by enabling them to get back to their motion (Papotto, & Mills, 2012). ERMI Inc. Company as known in the medical sector remains consistent and cost-effective care in delivery of medical services to people (Branch, 2013). It as well ensures high quality services accompanied with challenging healthcare situations to physicians for rewarding career opportunities (Branch, 2013). The success of the company does originate from its dedicated physicians, offering of services in an extensive manner and international academic medical center backing. The organization of ERMI Inc. management ...

1. Change is part of the game. Leaders both set vision and
navigate the, sometimes, murky waters of change. Effective
leadership requires you to harness both the minds and hearts of
employees to enable change to occur and take root in the
company’s culture.
For this assignment, you will identify one change management
need within your company or from a company you previously
worked for and plan a change initiative.
Business Brief (2-3 pages) Identify a needed organizational
change and utilize Kotter’s eight-stage framework. This should
be written in a professional format (font size 10-12, one-inch
margins double spaced, and use of headings and subheadings).
Remember to include a cover page that has all appropriate
course, assignment, date, and name information.
1. Provide a brief background of the company, industry, and
culture.
2. Identify the problem you want to address and why it is
important.
3. Describe your change initiative according to Kotter’s eight
stage framework.
sion and why is it important?
-term wins?
culture?
Company profile below. Use this company to answer the
questions above.

2. Operation Management of ERMI Inc.
Introduction
ERMI Inc. is a leading medical device company in USA with
specialization in treating patients falling under outlier category
(Papotto, & Mills, 2012). These kinds of patients have severe
motion loss thus the company partners with physicians, physical
and occupational therapists and other healthcare professionals
to provide medical services to such patients (Papotto, & Mills,
2012). ERMI Inc. does research, develop, manufacture and
market its healthcare services to patients across the United
States.
The operations of the company are tallied with its need to help
patients get back to their normal way of life as before
occurrences of injuries or surgeries (Papotto, & Mills, 2012).
Such target complies with the company’s mission that focuses
purely on patient’s improvement. ERMI Inc. greatly serves
people with severe motion loss and those who have failed
conventional therapy by enabling them to get back to their
motion (Papotto, & Mills, 2012).
ERMI Inc. Company as known in the medical sector remains
consistent and cost-effective care in delivery of medical
services to people (Branch, 2013). It as well ensures high
quality services accompanied with challenging healthcare
situations to physicians for rewarding career opportunities
(Branch, 2013). The success of the company does originate from
its dedicated physicians, offering of services in an extensive
manner and international academic medical center backing.
The organization of ERMI Inc. management
ERMI Inc. Company has a competent administrative and
medical staff that offers objective and all round leadership to its
operation. The leadership of ERMI Inc. has indicated steadfast
and adaptive system realistic to patients’ demands with a larger
percentage of motion retention.
ERMI Inc. has a defined leadership with potential leaders with
vast leadership experience in medical sector from the president
of the company to executive administrator (Branch, 2013). The

3. president and Chief medical officer has experience and skills in
emergency medicine residency, board certification in emergency
medicine and has performed under such similar healthcare for a
long period. Dr. Richard Wadas also serves as the Associate
Regional Medical Director for Emergency Medical Services
Institute.
Next in the rank is the Assistance Medical Officer who also
performs as the Compliance Officer. Dr. Richard Hearth has
information and knowledge on emergency medical services and
has completed his study on internal medical residency (Branch,
2013). The Chief of Hospitalist service for ERMI Inc. serves
also as the Co-Medical Director of the Hospitalist Program at
another hospital.
The Chief of urgent Care Service and Executive Director
conceal the top most leadership of the ERMI Inc. Company
(Branch, 2013). The executive director is responsible in
providing harmonized and collective leadership qualities to all
stakeholders to ensure track maintenance while providing
services to patients.
The services offered at ERMI Inc.
ERMI Inc. provides services to patients in a cost effective
manner with appropriate staffing physicians (Branch, 2013). It
keeps operation and overhead costs low as well as offering more
resources to physician thus improved patient care. The
management strategies applied by the company improve the
quality of care, reduce costs and ensure optimization of
revenue.
Staffing of physicians
ERMI Inc. recruits qualified physicians with high quality
background on healthcare services. Its recruiting and retention
program is comprehensive and leads to a recognized
improvements in staffing and service delivery to patients
(Branch, 2013). ERMI Inc. commits significant resources on
physician recruitment that covers advertisements on journals,
internet, and displays at national emergency medicine and
medicine meetings as well as substantial databases (Branch,

4. 2013). Also the company provides floater physicians to offer
high quality services on short notices to fill unexpected
vacancies in the organization depending on the demand rise.
Floater physicians have required experiences and knowledge of
ERMI philosophy that motivate provision of high quality
solution in situations of staffing challenges contributed by
physician disabilities, relocation or retirement (Branch, 2013).
To successfully attain the market demand, ERMI put mechanism
that ensures balanced physician workloads and maintain a low
patient to physician ratio.
The success of ERMI Inc. originates contributively from both
the medical directors and physicians who are committed to
serve in various committees such as medical executive, risk
management, patient safety, disaster management, critical care
and education.
Satisfaction of patient
Patient satisfaction forms the basis of ERMI Inc. operation and
it works closely with partner hospitals to provide improvement
on patient satisfaction (Wilson, & Kelly, 2015). Improved
patient satisfaction becomes realistic through educative,
monitoring and feedback reliance programs. ERMI Inc. medical
directors ensure a maximum review on patients’ complaints and
coordinate with partner hospitals to solve such complaints in a
quicker reaction. ERMI Inc. has annual education conferences
that offer physicians with patient satisfaction education.
Quality improvement initiatives
For the past periods, ERMI Inc. has remained a leader in the
Physician Quality Reporting System. Every physician working
in ERMI gets updated on the quality reports monthly in
reference to individual performance throughout the period of
report. The physician quality report makes part of a physician
incentive plan.
To effectively attain the standards, ERMI Inc. works in close
relationship with partner hospitals to ensure increment of its
core measure scores initiatives as well as pay-for-performance
initiatives (Wilson, & Kelly, 2015). In addition, medical

5. directors and physicians in ERMI Inc. have enough experience
dealing towards performance improvement projects that involve
a wide range of initiatives. The initiatives such as LEAN and
patient throughout helps the hospital to improve employment
opportunities as well as tailoring a custom approach related to
individual hospitals.
Medical and legal services
To deal with medical and legal issues equally without a
discriminative sense that can lag behind the ERMI Inc.
performance, it has a comprehensive risk management
programs. The program covers all aspects of emergency and
hospital medicine (Branch, 2013). ERMI as well provides its
physicians with high quality occurrence malpractice insurance
cover. Due to its size and composition, ERMI Inc. has enjoyed a
low insurance cover costs that helps in facilitating patient care
(Uhl, & Jacobs, 2012). The existence of expertise in EMTALA,
HIPAA, compliance and other significant areas have ensured
that the highest quality patient care is realized.
Documentation services
ERMI has established a comprehensive system for
documentation for efficient optimization and compliance
(Wilson, & Kelly, 2015). Such documentation enables
physicians to receive monthly feedbacks on their performances
as well as indication of individual performance metrics.
The billing and coding areas also have expertise helping in
optimal collections. ERMI economy of scale provides billing
and coding costs at a lower cost that leaves more resources
unused directed to direct patient care (Wilson, & Kelly, 2015).
In addition, ERMI works closely with partner hospitals to attain
proper documentation thus facility optimality at collections or
coding.
Facility planning
ERMI Inc. helps other hospitals to design new and appropriate
emergency departments as well as renovate new existing
emergency departments. The company uses its collective
expertise to help partner hospital design emergency departments

6. to promote patient flow, ergonomic efficiency and improved
patient care.
Operations and processes provided at ERMI Inc.
In ERMI Inc. healthcare center, patients suffering from motion
loss get treatment and operations through various devices
relevant to prevent and treat joint stiffness, and contractures
including physical therapy, serial casting, and continuous
passive motions and stretching devices (Wilson, & Kelly, 2015).
Mechanical stretching devices
Low load prolonged duration stretch devices (LLPS) allow for
resisted active and passive motion at a limited range (Wilson, &
Kelly, 2015). These devices maintain a prescribed level of
tension through incorporation of springs. Under low-load,
prolonged duration stretch, ERMI Inc. has Dynasplint system,
Ultra flex, Pro-glide dynamic ROM devices as well as Advance
Dynamic devices.
Static progressive devices also falls under stretch devices that
hold the joint in a set position while permits for manual
modification of the angle of a joint and as well can allow the
active motion with no resistance (Wilson, & Kelly, 2015).
While using the device, it does no exert stress on tissue and
allows for a limited range of passive and active motion;
however, the motion does not provide an elastic traction due to
its freeness. Within the Static progressive devices ERMI Inc.
has the following devices; Joint Active System, Static
Progressive Stretch devices and Joint Active System pronation
device.
The other devices found in ERMI Inc. are the Patient- actuated
stretch (PASS) devices. These devices provide a low to high
level load to the joint using pneumatic systems adjustable by a
patient. Pneumatic systems are both extensionators and
flexionators in nature (Branch et al., 2014). PASS devices
include; ERMI Knee Extensionator, ERMI Knee/Ankle
Flexionator, ERMI Shoulder Flexionator and ERMI Elbow
Extensionator.
Devices for knees, ankles, elbows and shoulders

7. The Low-load prolonged duration stretch devices such as
Dynasplint system and static progressive stretch devices such as
Joint active system are reasonable used for knee, elbow, or
finger (Uhl, & Jacobs, 2012).
EMRI Treatment Protocol
In EMRI devices are engineered and designed with a
consideration similar for mimic of the intensity and duration
balanced by a physical therapist, however, the same intensity is
managed under a patient’s control (Branch et al., 2014). A
patient gets motivated due to a possibility of controlling and
managing the treatment him/herself. The device as well allows
patients to use it at their respective homes as an adjunct to
physical therapy (Wilson, & Kelly, 2015).
The general treatment protocol of ERMI balances the three key
factors that cover the following illustrations;
· A patient has to stretch at a high intensity for 10 minutes, take
a rest for 10 minutes and the stretch again for 10 minutes.
· A patient has to repeat the above instruction for two more
times during the day to attain the target of 60 minutes per day.
· A patient can break it up into smaller time periods if
necessary. For an instance a patient can stretch for 5 minutes,
rest for 5 minutes and the stretch for 5 minutes again. Then
need to repeat the step in the day 5 times to meet the 60 minutes
target requirement in a day.
The treatment protocol however, always depends on a treating
physician and therapist’s guidelines.
Devices used to treat clinicians
ERMI uses mechanical joint stretching devices to treat
clinicians with problems in making expected gains in motion
with conventional treatment therapy. As well clinicians with a
motion failure through exercise, manual therapy or other
conservative treatments can get treatment at ERMI Inc.
Mechanical joint stretching devices includes; Low load
prolonged duration stretch devices (LLPS), Static progressive
devices and Patient- actuated stretch (PASS) devices (Uhl, &
Jacobs, 2012).

8. Solution
s for treatment failure
Patients with treatment failures are taken through devices
developed by an orthopedic physician. Through physical
rehabilitation at their homes patients are provided with
mechanical joint stretching devices for elbows, knees, ankle,
shoulder and great toe joints (Uhl, & Jacobs, 2012). These
devices are meant for outlier cases mostly those patients with 5-
10% severe arthrofibrosis, adhesive capsilities (Branch et al.,
2014).
Such patients are taken through a high intensity stretch under a
sustained interval, more controlled condition, without
traumatizing the patient and with no patient guiding. For
effective work, a physician prescription as well as a physical
therapist recommendation has to be followed by a patient
(Branch et al., 2014).
Proven results for the ERMI Inc.
ERMI Inc. proven clinical results demonstrates a high scores of
motion and patient outcome scores compared to low intensity
devices provided by other hospitals. The ERMI Knee
Flexionater illustrates a significant greater gain to patients with
motion problems (Wilson, & Kelly, 2015).

9. ERMI devices demonstrate range of motion and outcome scores
that have improved significantly on a group of frozen shoulder
patients who got treatment through the high intensity ERMI
Shoulder Flexionater (Wilson, & Kelly, 2015).
Conclusion
The management of ERMI Inc. has performed effectively well
to offer objective and result oriented services to patients with
motion challenges. Development of ERMI devices with high
intensity as compared to other devices provided by other
hospitals illustrates effectiveness of the leadership of ERMI
Inc. The management has delivered high quality, cost effective
services with high patient concerns.
General comment of the processes and operations of the ERMI
The processes underlined by physicians and physician therapists
in regard to improvement from motion problem in ankle,
shoulder, wrist or finger with a target of 60 minutes stretch per
day contribute immensely on the effective concept of the
defined processes (Branch, 2013). The company enjoys well-
coordinated operations that have boosted improvement among
patients on their conditions that require mechanical joint
stretches.
References
Branch, T. P., Sattler, A., Branch, E. K., & Jacobs, C. A.

10. (2014). U.S. Patent No. 8,840,570.
Washington, DC: U.S. Patent and Trademark Office.
Branch, T. P., Sattler, A., Branch, E. K., & Jacobs, C. A.
(2014). U.S. Patent Application No.
14/462,634.
Branch, T. P. (2013). U.S. Patent No. 8,361,002. Washington,
DC: U.S. Patent and Trademark
Office.
Branch, T. P., Stinton, S. K., Madden, T. C., Dittmar, E.,
DeJarnette, N. K., & Shary, T. (2013).
U.S. Patent Application No. 14/029,780.
Branch, T. P. (2013). U.S. Patent Application No. 13/838,308.
Papotto, B. A., & Mills, T. (2012). Treatment of severe flexion
deficits following total knee
arthroplasty: a randomized clinical trial. Orthopaedic Nursing,
31(1), 29-34.
Uhl, T. L., & Jacobs, C. A. (2012). Torque Measures of
Common Therapies for the Treatment of
Loss of Knee Flexion. Sports Health: A Multidisciplinary
Approach, 4(2), 101-106.
Wilson, K., & Kelly, T. L. (2015). U.S. Patent No. 9,119,542.
Washington, DC: U.S. Patent and
Trademark Office.

11. 1
GUIDANCE FOR WEEK THREE
REAL ESTATE 431: COMMERCIAL REAL ESTATE
INVESTMENT
INSTRUCTOR: TRACY GREEN, M.P.A., B.A.
Readings
1. Read Roos, Chapters 10 thru 12.
Additional Resources
AIR Commercial Real Estate Association
http://www.airea.com/HOME/Home.aspx
CCIM Institute http://www.ccim.com/

12. National Association of Realtors http://www.realtor.org
California Association of Realtors http://www.car.org
The National Bureau of Economic Research
http://www.nyber.org
Weekly Overview
During week 3 you are required to read Chapters 10 thru 12.
These chapters will give
you an overview on finding, analyzing and negotiating real
estate deals. Analyzing
commercial real estate deals includes site analysis and being
knowledgeable about submarkets.
Site analysis involves the compilation of all economic, social,

13. political, legal, and environmental
forces that influence the productivity of a given site, whether
improved or not, and with
consideration to current and/or alternative uses. If this sounds a
little like “highest and best use”
analysis to those of you familiar with appraisal terminology, it
is similar, except that site analysis
http://www.realtor.org/
http://www.car.org/
2
might be more focused. For example, site analysis might
determine the appropriateness or
feasibility of a specific location for the intended use of a
specific business. Site analysis might
involve a comparison of three or more sites for competitive

14. advantages for a specific
development concept or use. Site analysis might involve an
exploration of alternative uses for a
given site at the present time, or be based on likely trends in the
future, that is “a site looking for
a use.”
A submarket is an arbitrary grouping of either the demand side
of a market (buyers or
tenants) or the supply side of a market (the market within which
the subject parcel or property
competes). While it is not necessary to define submarkets in
purely geographical terms, and
certainly cyber-markets could be defined in submarket
groupings without regard to location,
geography tends to be a primary determinant of submarket
definitions for the real estate industry.

15. From the demand side, the submarket is the typical profile
attributes of the potential users of
space for a specific property use. For example, the profile of
potential users for an independent-
living, high-amenity, adult-only apartment complex could be
defined by age, wealth, income
sources, and geographic location from which such a market of
users could be drawn with some
degree of confidence. From the supply side, the submarket is
the based upon the attributes of
those properties that may compete with the proposed or current
use, including geography as one
of the important attributes. For example, a parcel with a
proposed upscale housing development
may compete with properties of a similar price range, similar in
size, similar in amenities, and
within a certain geographic area from which the dominant

16. source of potential buyers come.
Some submarkets may involve a relevant geographic range of
only a few miles in radius, such as
a convenience-oriented “strip” shopping center or single family
housing, while others such as
industrial parts distribution warehouses might involve a
submarket of 300 miles or more.
3
In addition to demand and supply factors, as well as the legal
constraints of
zoning or building codes, the suitability of a given site for the
proposed use is important, which
is where physical analysis comes into play.
Site size, shape, topography, soil type, geology, vegetation,

17. wildlife, surface and
subsurface water, utility access, access and traffic flows, noise,
air pollution, and climate all must
be considered in a systematic site analysis.
One of the important tools for combining physical analyses
with market analysis
is through the use of geographic information systems that
integrate several layers of information.
REFERENCES
Larsen, J. E. (2007). Real Estate: Building Strong Foundations.
New Jersey: Wiley.
Miller, N. G.. and Geltner, D. M. (2005). Real Estate Principles
for the New Economy. Mason,
OH: Cengage.

18. Nemeth, C.P. (2011). Reality of Real Estate (3rd ed.). Boston:
Pearson Prentice Hall.
De Ross, D. (2008). Commercial Real Estate Investing. New
Jersey: Wiley.