900� British�Journal�of�Nursing,�2013,�Vol�22,�No�15 © �2 01 3� M A �H ea lth ca re �L td T he� challenges� to� the� NHS� over� the�coming�years�to�maintain�and�enhance�public� health� and� wellbeing� are� vast�and� complex.� Lifestyle� choices� and� the� causes� of� ill� health� are� now� more� fully� understood� by� health� professionals� who� have� strategies� at� their� disposal� to� support� people� better� in� making� decisions� and� choices� that� are� positive� for� their� general� health.� In� June� 2013,� to� help� accelerate� this� process,� Public� Health�England�published�Nursing and Midwifery Contribution to Public Health� (Public� Health� England,�2013).�This�new�guidance�document� is� designed� to� illuminate� the� specific� roles� of� specialist� public� health� nurses,� but� also� to� reinforce� the� pivotal� health-promoting� practitioner� role� that� every� registered� nurse� and� midwife� has� in� making� every� patient/ client�contact�count. Background A� report� by� The� King’s� Fund� (2012)� has� shown�that�high�levels�of�admission�to�hospital,� especially� of� elderly� patients,� can� often� be� attributed� to� poor� coordination� between� the� different� elements� of� the� healthcare� system,� in�particular�between�primary� and� secondary� care.� Furthermore,� the� King’s� Fund� believe� that� emergency� admissions� among� people� with� long-term� conditions� that� could� have� been�managed�in�primary�care�cost�the�NHS� £1.42� billion� per� year,� a� figure� that� could� be� significantly� reduced� through� investment� in� primary� and� community-based� services.� Key� to� this� aspiration� is� promoting� the� role� of� nursing� and� midwifery� in� protecting� and� improving� public� health� care,� one� of� the� six� key� action� areas� of� the� national� nursing� midwifery� and� care� strategy,� Compassion in Practice�(DH,�2012). This� strategy� is� designed� to� support� the� delivery� of� the� values� and� behaviours� of� the� ‘6Cs’,� now� the� principal� driver� for� nursing� in� the�wake�of� the�publication�of� the�Francis� Inquiry,�which�revealed�suboptimal�standards�of� care�at�the�Mid�Staffordshire�NHS�Foundation� Trust�(Francis,�2013). To�help�achieve�this,�Public�Health�England�� (PHE)�has�prioritised�five�key�areas�for�action: ■■ Designing� strategies� to� promote� longevity� and� improved� health� outcomes� by� tackling� preventable� deaths� and� ill� health� associated� with� smoking,� hypertension,� obesity,� poor� nutrition,� suboptimal� mental� health,� insufficient�exercise�and�alcohol�abuse ■■ Decreasing� the� personal� suffering� caused� by� disease� and� disability� by� concentrating� resources�on�preventing�and�recovering�from� the�long-term�conditions�that�have�significant� impact�on�lives,�including�dementia,�anxiety,� depression�and�drug�dependency ■■ Safeguarding�the�population�from�infectious� diseases�and�environmental�hazards,�including� antibiotic-resistant� infections.� PHE.

1. 900� British�Journal�of�Nursing,�2013,�Vol�22,�No�15
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T he� challenges� to� the� NHS� over�
the�coming�years�to�maintain�and�enhance�public�
health� and� wellbeing� are� vast�and� complex.�
Lifestyle� choices� and�
the� causes� of� ill� health� are� now� more� fully�
understood� by� health� professionals� who� have�
strategies� at� their� disposal� to� support� people�
better� in� making� decisions� and� choices� that�
are� positive� for� their� general� health.� In� June�
2013,� to� help� accelerate� this� process,� Public�

2. Health�England�published�Nursing and Midwifery
Contribution to Public Health� (Public� Health�
England,�2013).�This�new�guidance�document�
is� designed� to� illuminate� the� specific� roles�
of� specialist� public� health� nurses,� but� also�
to� reinforce� the� pivotal� health-promoting�
practitioner� role� that� every� registered� nurse�
and� midwife� has� in� making� every� patient/
client�contact�count.
Background
A� report� by� The� King’s� Fund� (2012)� has�
shown�that�high�levels�of�admission�to�hospital,�
especially� of� elderly� patients,� can� often� be�
attributed� to� poor� coordination� between� the�
different� elements� of� the� healthcare� system,�
in�particular�between�primary� and� secondary�
care.� Furthermore,� the� King’s� Fund� believe�
that� emergency� admissions� among� people�
with� long-term� conditions� that� could� have�
been�managed�in�primary�care�cost�the�NHS�
£1.42� billion� per� year,� a� figure� that� could�
be� significantly� reduced� through� investment�
in� primary� and� community-based� services.�
Key� to� this� aspiration� is� promoting� the� role�
of� nursing� and� midwifery� in� protecting� and�
improving� public� health� care,� one� of� the�
six� key� action� areas� of� the� national� nursing�
midwifery� and� care� strategy,� Compassion in
Practice�(DH,�2012).
This� strategy� is� designed� to� support� the�
delivery� of� the� values� and� behaviours� of� the�
‘6Cs’,� now� the� principal� driver� for� nursing�
in� the�wake�of� the�publication�of� the�Francis�
Inquiry,�which�revealed�suboptimal�standards�of�

3. care�at�the�Mid�Staffordshire�NHS�Foundation�
Trust�(Francis,�2013).
To�help�achieve�this,�Public�Health�England��
(PHE)�has�prioritised�five�key�areas�for�action:
■■ Designing� strategies� to� promote� longevity�
and� improved� health� outcomes� by� tackling�
preventable� deaths� and� ill� health� associated�
with� smoking,� hypertension,� obesity,�
poor� nutrition,� suboptimal� mental� health,�
insufficient�exercise�and�alcohol�abuse
■■ Decreasing� the� personal� suffering� caused�
by� disease� and� disability� by� concentrating�
resources�on�preventing�and�recovering�from�
the�long-term�conditions�that�have�significant�
impact�on�lives,�including�dementia,�anxiety,�
depression�and�drug�dependency
■■ Safeguarding�the�population�from�infectious�
diseases�and�environmental�hazards,�including�
antibiotic-resistant� infections.� PHE� has�
reported�that�cases�of�measles�in�England�are�
at� their� highest� recorded� levels� since� 1994,�
with�1168�confirmed�cases�between�January�
and�May�2013
■■ Helping�families�to�give�children�and�young�
people� the� best� chances� in� life� through�
working� with� health� visiting� and� school�
nursing,� family� nurse� partnerships� and� the�
Troubled�Families�programme�(Department�
for� Communities� and� Local� Government,�
2013).� Through� this� programme,� the�
government� is�committed� to�working�with�
local� authorities� and� their� partners� to� help�
the� estimated� 120�000� troubled� families� in�
England� to� improve� their� life� trajectories�
radically� by� 2015.� This� is� because� the�

4. government� is� committed� to� ensuring� that�
the� children� in� these� troubled� families� are�
afforded� a� better� life� and� simultaneously�
reducing�the�burden�on�the�Exchequer
■■ Improving� health� in� the� workplace� by�
encouraging� employers� to� support� their�
staff,�and�those�moving�into�and�out�of�the�
workforce,�to�lead�healthier�lives.
To� achieve� these� priorities,� PHE� will�
promote�‘place-based’�public�health�systems.�In�
simple�terms,�‘place-based’�approaches�are�one�
strategy� to� improve� the�health� and�wellbeing�
of� local� communities� where� specific� groups�
of� individuals� can� be� targeted� for� health�
interventions.� The� Tasmanian� Government,�
Australia� (2012),� has� produced� a� detailed�
position� paper� on�‘place-based’� public� health�
systems,� in� which� stakeholders� engage� in�
a� collaborative� process� to� address� health�
issues� within� a� geographic� space,� such� as� a�
neighbourhood� or� specific� community.� This�
system� recognises� that� there� is� a� complex�
relationship�between�people,�place�and�health.�
People� who� live� in� disadvantaged� areas� and�
who� may� be� affected� by� social� exclusion,�
unemployment,� poor� education� and� poor�
physical�environments�may�have�a�greater�risk�
of� poor� health� and� wellbeing� than� those� in�
affluent�areas.�It�is�this�difference�between�the�
health� and� wellbeing� outcomes� of� poor� and�
wealthy�communities�that�can�be�described�as�
‘place-based� health� inequity’.� Given� the� UK�
economic� downturn,� it� is� not� surprising� that�
‘place-based’�public�health�systems�are�seen�as�

5. a�way�of�targeting�precious�health�resources.
Independence, wellbeing and health
The� first� action� area� of� ‘Compassion� in�
Practice’� concentrates� on� helping� people�
to� stay� independent,� maximising� wellbeing�
and� improving� health� outcomes.� It� is� this�
action� area� that� the� nursing� and� midwifery�
contribution�to�public�health�focuses�on.�
Helping all nurses and midwives to
maximise their role in public health
This�aspect�of�the�new�guidance�document�is�
designed� to� illuminate� the� contribution� that�
all�registered�nurses�and�midwives,�irrespective�
of� their� place� of� work,� can� make� to� helping�
people�mange�their�own�health�and�wellbeing�
better.�Nearly� 20� years� ago,�Nutbeam� (1996)�
was� arguing� for� the� necessity� of� accurately�
defining�what� constitutes� evidence�of� success�
in� health� promotion;� the� nursing� profession�
is� now� helping� to� build� this� evidence� base.�
The� government� believes� that� nurses� should�
take� opportunities� at� every� patient� contact�
to� maximise� wellbeing� and� improve� health�
outcomes� and,� where� possible,� reduce�
inequalities.� It� needs� to� be� stressed� that� the�
Professor Alan Glasper discusses the latest Department of
Health initiative to enhance the
public health role of nursing and midwifery in improving health
and wellbeing in society
The nursing and midwifery
contribution to public health

6. British�Journal�of�Nursing,�2013,�Vol�22,�No�15� 901
healthcare policy
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government� itself� has� been� accused�of� empty�
rhetoric� after� it� was� revealed� in� the� popular�
press� that� it� had� shelved� plans� to� make� plain�
packaging� of� cigarettes� compulsory� and�
abandoned� its� much-vaunted� aspiration� to�
introduce�a�minimum�unit�alcohol�price�(Mail�
Online,�2013).�Despite�this,�the�new�guidance�
document� illuminates� how� nurses� can� make�
every� person� contact� count� in� the� vision�
for� improved� public� health,� both� locally� and�
nationally.�Measures�include,�among�others:

7. ■■ Promoting�compassion�in�practice�in�social-
care�settings
■■ Developing� the� nursing� and� midwifery�
contribution� to� the� promotion� of� good�
mental� health� and� the� reduction� of� health�
inequalities� for� people� with� learning�
disabilities
■■ Maximising� the� leadership� role� of� public-
health�nurses�and�developing�a�new�model�to�
promote�the�public-health�role�of�midwives
■■ Enabling�nurses�to�learn�the�skills�of�health�
promotion�to�optimise�every�patient�contact
■■ Enhancing� school� nursing� to� improve� the�
health�and�wellbeing�of�children�and�young�
people
■■ Supporting�nurses� in�better� helping�people�
with�dementia�
■■ Promoting� health� visiting� to� showcase�
its� pivotal� role� in� helping� children� and�
their� families� get� the� best� start� in� life.� It�
is� important� to� direct� efforts� towards� the�
prevention�of�child�abuse�and�neglect�before�
patterns� of� abuse� are� established� within�
families�(MacMilllan�et�al,�2005)��
■■ Ensuring� that� nurses� are� given� access� to�
appropriate� technology� and� highlighting�
the�contribution�of�the�National�Institute�of�
Health�and�Care�Excellence�(NICE)�through�
development�of�an�accessible�evidence�base�
for�public�health�nursing
■■ Promoting�interagency�working.
What can nurses do to maximise
the ‘nursing and midwifery
contribution to public health’?
There�are�a�number�of�actions�that�nurses�and�

8. midwives� can� take� to� make� this� new� vision�
for�public�health�work,�configured�around�the�
individual,�the�community�and�the�population:
■■ Public health and the individual:�The�
vision�for�public�health�seeks�to�make�every�
nursing� contact� count,� with� every� nurse�
being� able� to� offer� up-to-date� advice� to�
patients� and� their� families,� based� on� best�
evidence�pertinent�to�health�and�wellbeing.�
Nursing� advice� that�helps� individuals�make�
lifestyle� choices� to�prevent�health�problems�
should�be�given�at�every�opportunity.�Nurses�
should�be�able�to�signpost�individuals�to�the�
appropriate�people�or�agencies�that�can�best�
help�them.�Additionally,�the�role�of�the�nurse�
is�to�help�patients�identify�and�set�achievable�
health� goals,� and� be� able� to� refer� them� to�
others� within� the� multiprofessional� team�
when�concerns�are�identified
■■ Public health and the community:�
Nurses�working�in�the�community�should�be�
able� to� assess,�plan�and�provide�community�
needs,� especially� within� hard-to-reach�
groups,� such� as� traveller� communities,�who�
fail� to�access�health� services.�As�part�of� this�
new� vision,� community� nurses� need� to� be�
enabled� to� engage� with� communities� and�
those� who� commission� services,� and� to�
plan,� implement� and� subsequently� review�
health� ‘place-based’� projects.� To� achieve�
this,� community� nurses� need� to� develop�
enhanced� communication� strategies� to� be�
more�able� to�articulate� the�health�concerns�
of� their� areas� of� health� jurisdiction,� and� to�
collect� and� use� population-level� data� to�

9. underpin�their�assertions
■■ Public health and the population:
Community�nurses� and�midwives� need� to� be�
more�able�to�influence�and�configure�both�the�
political�and�policy�agendas�directly,�so�that�they�
can�better�represent�their�healthcare�constituents.�
This�will�result�in�maximised�opportunities�for�
improving� population� health� and� addressing�
health� inequalities.� Better� engagement� with�
strategic�partners�and�the�public�is�necessary�to�
identify� health� need,� set� objectives� and� health�
priorities,�and�the�methods�to�measure�success�
accurately.� In� building� sustained� community�
health� capacity,� improvement� of� health� and�
wellbeing,�and�reduction�of�health�inequalities,�
should� be� achievable.�To� bring� this� vision� to�
fruition,�the�nursing�and�midwifery�community�
teams� must� be� enabled� to� develop� the� skill�
toolkit� they� need� to� deliver� the� envisaged�
service�improvements.�
Conclusion
The� Public� Health� Outcomes� Framework,�
launched�in�May�2013,�is�designed�to�improve�
and�protect�the�nation’s�health�and�wellbeing�
with� a� rapid� improvement� in� the� health� of�
the� poorest� members� of� society.� This� new�
guidance� document,� Nursing and Midwifery
Contribution to Public Health,� recognises� that�
nurses� and� midwives� are� pivotal� in� making�
this� vision� for� the� nation’s� health� a� reality.�
The� whole� of� the� nursing� workforce,�
wherever�and�whenever� they�work,�must�be�
enabled� to� contribute� to� improvements� in�
public�health� at� every� level—promoting� the�
health� of� the� individual,� the� community� in�

10. which� they� work� and,� ultimately,� the� entire�
population.��� BJN
Department� for� Communities� and� Local� Government�
(2013)� Helping Troubled Families Turn their Lives Around.�
https://www.gov.uk/government/policies/helping-
troubled-families-turn-their-lives-around� (accessed� 23�
July�2013)
Department� of� Health� (DoH)� (2012)� Compassion in
Practice.� http://www.england.nhs.uk/wp-content/
uploads/2012/12/compassion-in-practice.pdf� (accessed�
23�July�2013)
DoH�(2013)�Public�Health�Outcomes�Framework�2013�t
o�
2016� and� technical� updates.� http://tinyurl.com/d45acrg�
(accesssed�23�July�2013)
Department� of� Health� and� Human� Services,�
Tasmania,�
Australia� (2012)� Place-Based Approaches to Health and
Wellbeing.� http://www.dhhs.tas.gov.au/_data/.../Place-
ased_Issues_Paper_V1.0.pdf�(accessed�23�July�2013)
Francis�R�(2013)�Report of the Mid Staffordshire NHS
Foundation
Trust Public Inquiry.� http://www.midstaffspublicinquiry.�
com/sites/default/files/report/Executive%20summary.�
pdf�(accessed�23�July�2013)
King’s� Fund� (2012)� Data Briefing: Emergency Hospital
Admissions for Ambulatory Care-sensitive Conditions.�http://
www.kingsfund.org.uk/publications/data-briefing-
emergency-hospital-admissions-ambulatory-care-
sensitive-conditions�(accessed�23�July�2013)

11. MacMillan�HL,�et�al�(2005)�Effectiveness�of�home�visi
tation�
by�public-
health�nurses�in�prevention�of�the�recurrence�of�
child�physical�abuse�and�neglect:�a�randomised�controlle
d�
trial.�Lancet�365(9473):�1786–93
Mail� Online� (2013)� Stubbed Out.� 23� July.�
http://tinyurl.
com/kxxtqlg�(accessed�23�July�2013)
Nutbeam�D�(1996)�Health�outcomes�and�health�promotio
n:�
defining�success� in�health�promotion.�Offic J Aust Health
Promot Professionals�6(2):�58–60
Public� Health� England� (2013)� Nursing and Midwifery
Contribution to Public Health.� https://www.gov.uk/
government/publications/nursing-and-midwifery-
contribution-to-public-health�(accessed�23�July�2013)
Key PoInTs
n The challenges to the NHS over the forthcoming years to
maintain and enhance public health
and well-being are vast and complex
n The new guidance document which describes the nursing and
midwifery contribution to public
health is designed to address the challenges to the health and
well-being of people in society.
n Every registered nurse and midwife has a duty to make every
patient /client contact count in

12. promoting public health.
n Place-based approaches are one strategy which can be used by
community nurses and
midwives to improve the health and wellbeing of local
communities.
n The government want to maximise the leadership role of
public health nurses and midwives.
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Week 5-Determining the Change / MICROSOFT VS TESLA
ARE 2 CHOSEN COMPANIES
For an overview of this part of the course project please watch
the following video.
Select a diagnostic model (see Chapter 4) that you and your
team can utilize to review aspects of change activities and
actions that have been taken by the companies chosen. For this
analysis, we are looking at the parts of the companies as well as
their strategies, as surmised by your earlier research. It is
acknowledged that this information will not be complete as you
are looking at these companies as an outsider, but a thoroughly
researched paper will give enough data to allow some well-
defended assumptions on your part.
Here’s what to do.
1. Select one diagnostic model (i.e., 6-box, 7S, congruence, or

13. one of the others) to apply to the two chosen companies. Choose
the model that you and your team feel best identifies and
measures the relevant aspects of the organization's performance.
2. Apply the data obtained in your research through an analysis
of the appropriate chosen model. This will allow you and your
team to create a diagnosis of where each company is today (as
per the criteria of the model).
3. Create a SWOT analysis for each of the two chosen
companies change plans/programs, utilizing information
obtained in the diagnosis (strengths, weaknesses, opportunities,
threats).
4. As a team, compare the two company analyses to each other
and offer your perspective (value judgment) of the effectiveness
of the changes made to date in each case.
5. Identify potential areas of resistance that may occur and at
least one strategy to respond to each. (This will most likely
come from your weaknesses/threats section of your SWOT. If
not, take another look at your SWOT.)
6. Make recommendations for further actions within the
organizations and the rationale chosen for these
recommendations.
7. Write your team paper, including each of the above sections
and analyses.
Grading Rubric
Item
Total points
Provide a comprehensive review of the change diagnostic model
chosen that details the components included as well as some
background about the model itself through research from the
author(s)
25
Include your team's rationale defending why that particular
model was selected. You can utilize a review of
internal/external pressures that have affected the companies
chosen.
25

14. Create a SWOT analysis based on the above. Compare the two
company analyses to each other, and offer your team's
perspective (value judgment) of the effectiveness of the changes
made to date in each case.
20
Address potential areas of resistance that were encountered or
that you anticipate may be encountered and possible actions to
minimize the negative effects of such resistance.
20
Include your team's recommendations for further actions within
the organizations and the rationale chosen for these
recommendations.
20
Use four new references, properly cited.
10
Total points
120