MEMORANDUM DATE: TO: Tundra Medical System Surgeon and Anesthesia Champions FROM: Name, Director of Strategic Initiatives SUBJECT: Improving the Surgical Quality Journey with an ERAS Program Surgeons, anesthesiologists, and health care systems strive for excellence in surgical care. This is a time when the Surgical Quality Journey needs to collaborate and implement the most current evidence-based surgical quality initiatives. There is overwhelming literature to support that the use of an Enhanced Recovery After Surgery (ERAS) program significantly improves outcomes, reducing morbidity and decreasing costs. This memo requests that Tundra Medical System Surgeon and Anesthesia Champions support the use of the ERAS program to improve the surgical care and recovery care of patients. Current Surgical Care Model Observation of the process for surgical preparedness in the offices of 15 surgeons of varying specialties was completed for 6 months. In short, it was observed that patients receive limited examination and discussion with surgeons preoperatively. There was no program that addressed patient education, optimization, and assessment for surgical readiness. Patients were not provided with information of what to expect before, during, and after surgery regarding their pain management, mobility expectations, nutritional requirements to optimize healing and other measures they could engage in to prevent complications. Anesthesia care in the medical center was similarly observed. Like the surgeons, the time spent preparing a patient for anesthesia and review of what to expect before, during and after procedure was very limited. Outdated processes such as patient fasting for six to eight hours prior to procedure and heavy intra-operative use of intravenous fluids to maintain perfusion was noted. Pain management included early and often use of narcotics and opioids to manage surgical pain. Changes in care are driven by objective matrix that are measured over time and represent quality of care outcomes. In review of these matrix, data such as length of stay, surgical site infections, length of time for return of bowel function, narcotic and opioid pain medication usage, and overall patient satisfaction have had little movement in the last 3 years. Enhanced Recovery After Surgery (ERAS) Model Enhanced Recovery After Surgery is not a new idea. Melnyk, Megan, et alia found that ERAS has been around since the 1990s and was developed to change the way patients physiologically respond to the stressors of surgical procedures (Melnyk, Megan, et al. 343). It has since been Commented [MP1]: Purpose of memo is clear Commented [MP2]: While the current situation is presented here, it must be cited. The student is referencing data in this whole section and it must be cited. Commented [MP3]: The research is cited effectively with an attributive tag to start and closes with a parenthetical reference, but we, as readers don’t know who the authors are and why we should.

1. MEMORANDUM DATE: TO: Tundra Medical System Surgeon and Anesthesia Champions
FROM: Name, Director of Strategic Initiatives SUBJECT: Improving the Surgical Quality
Journey with an ERAS Program Surgeons, anesthesiologists, and health care systems strive for
excellence in surgical care. This is a time when the Surgical Quality Journey needs to collaborate
and implement the most current evidence-based surgical quality initiatives. There is
overwhelming literature to support that the use of an Enhanced Recovery After Surgery (ERAS)
program significantly improves outcomes, reducing morbidity and decreasing costs. This memo
requests that Tundra Medical System Surgeon and Anesthesia Champions support the use of the
ERAS program to improve the surgical care and recovery care of patients. Current Surgical Care
Model Observation of the process for surgical preparedness in the offices of 15 surgeons of
varying specialties was completed for 6 months. In short, it was observed that patients receive
limited examination and discussion with surgeons preoperatively. There was no program that
addressed patient education, optimization, and assessment for surgical readiness. Patients were
not provided with information of what to expect before, during, and after surgery regarding their
pain management, mobility expectations, nutritional requirements to optimize healing and other
measures they could engage in to prevent complications. Anesthesia care in the medical center
was similarly observed. Like the surgeons, the time spent preparing a patient for anesthesia and
review of what to expect before, during and after procedure was very limited. Outdated processes
such as patient fasting for six to eight hours prior to procedure and heavy intra-operative use of
intravenous fluids to maintain perfusion was noted. Pain management included early and often
use of narcotics and opioids to manage surgical pain. Changes in care are driven by objective
matrix that are measured over time and represent quality of care outcomes. In review of these
matrix, data such as length of stay, surgical site infections, length of time for return of bowel
function, narcotic and opioid pain medication usage, and overall patient satisfaction have had
little movement in the last 3 years. Enhanced Recovery After Surgery (ERAS) Model Enhanced
Recovery After Surgery is not a new idea. Melnyk, Megan, et alia found that ERAS has been
around since the 1990s and was developed to change the way patients physiologically respond to
the stressors of surgical procedures (Melnyk, Megan, et al. 343). It has since been
Commented [MP1]: Purpose of memo is clear
Commented [MP2]: While the current situation is presented here, it must be cited. The student is
referencing data in this whole section and it must be cited.
Commented [MP3]: The research is cited effectively with an attributive tag to start and closes
with a parenthetical reference, but we, as readers don’t know who the authors are and why
we should trust them.
found to have the added benefits including reduced complications, decrease in hospital stay, and
improvement in cardiovascular and bowel function as well as a quicker return to baseline status
(Melnyk, Megan, et al. 343). The modern approach to ERAS encompasses many aspects of the
three stages of surgical care: pre, intra, and post procedure. Preoperatively, ideas such as
comprehensive education, patient optimization including evaluation of baseline nutritional status
and prior pain management routines, carbohydrate loading, and bowel preparation are addressed.
Intraoperatively, care that includes restrictive use of intravenous fluids, maintenance of
normothermia, and use of regional anesthesia versus general anesthesia is done. Postoperatively,

2. care including prophylactic management of nausea and vomiting with early alimentation, early
mobility, restricted use of narcotics in favor of NSAIDS, and early removal of catheters and
drains is employed (Melnyk, Megan, et al., par. 343). The Impact of the Changes The ERAS
processes are a paradigm shift in the way elective surgical patients are prepared and cared for.
Fitzgerald, in referencing the thoracic surgery program at University of Virginia Health System
(UVA), wrote that the challenge was to get the buy-in of the clinicians (Fitzgerald, par. 10).
These professionals were very invested in the care they provided to their patients and truly
believed they were doing very well (Fitzgerald, par. 10). Per Melnyk, Megan, et alia, even minor
changes that are simple to implement, represented what was thought to be fundamental care and
thus was difficult to achieve (Melnyk, Megan, et al. 348). Joliat, Gaetan-Romain et alia, also
noted that to start to change the way care is delivered, there had to be some challenging to the
usual care surgical care trends (Joliat, Gaëtan-Romain, et al., par. 1). They go on the further
say that the success of improving care and embracing new challenges and way of thinking
depended of the leadership of the clinicians and their willingness to apply evidence-based
interventions (Joliat, Gaëtan-Romain, et al., par. 1). Data Analysis At Tundra Medical Center,
once there is commitment to embrace the literature and embark upon changes, data collection
and assessment will drive sustainability. Fitzgerald noted that at UVA, ERAS resulted in better
educated patients both before and after surgery, which in turn proved to result in decreased pain
and shorter lengths of stay (Fitzgerald, par. 7). The ERAS program at UVA diminished the use
of morphine related medications by 74% in one group and 59% in another, shortened length of
stay by two days and saved over $1.3 million for a group of 139 patients (Fitzgerald, par. 22).
Joliat, Gaetan-Romain et alia state that ERAS and associated pathways do two things: improve
patient outcomes and decrease costs (Joliat, Gaëtan-Romain, et al., par. 4). In review of several
studies, there was a 40% reduction in morbidity for colorectal cases and for liver specific
procedures, surgery complications were reduced by 30-50% (Joliat, Gaëtan-Romain, et al., par.
4). In those same studies, there was a cost savings realized of $1 million for 198 cases (Joliat,
Gaëtan-Romain, et al., par. 5).
Commented [MP4]: It’s not enough to cite at the end of a para—the research must be
presented in a meaningful way.
Commented [MP5]: We need to know the author’s title in order to be able to trust what
he/she is saying
Commented [MP6]: Excellent job of using support in this section, but it must be presented in a
meaningful way.
Commented [MP7]: What data? Headings should be specific, they’re like a summary to the
text that follows.
The Road to Change and Success There are many examples of successful programs in the
volumes of evidence-based literature. Available to help Tundra Medical Center is Improving
Surgical Care and Recovery (ISCR). Wick, Elizabeth, et alia reports ISCR is a program
partnership of well-respected organizations including with the American College of Surgeons
(ACS), Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality as well as the
Agency for Healthcare Research and Quality (AHRQ) Safety Program (Wick, Elizabeth, et al.,

3. par. 1). ISCR is an effective program, offering support of the ERAS process that starts from the
initial roll out including coaching calls, webinars and a nurse consultant with vast experience in
establishing ERAS programs (Wick, Elizabeth, et al., par. 6-7). ISCR program is free, funded by
AHRQ and is comprehensive, providing evidence-based literature with the pathways to model
helping organizations implement their own unique ERAS programs. Please consider partnering
the Executive Team and the Office of Strategic Initiatives to implement an ERAS program to
improve the surgical care and recovery care of patients. Your support and engagement in this
initiative is appreciated. Please let me know if you have any questions and or if I can help in
implementing this change. I look forward to improving the care we provide to our patients.
Works Cited
Fitzgerald, Andrea. "Enhanced Recovery Program Reduces Opioid Use and Costs, Benefits
Patients at UVA." A Press Ganey Publication, August 2018. INDUSTRY EDGE,
https://www.pressganey.com/docs/default-source/default-document-library/enhanced- recovery-
program-reduces-opioid-use-and-costs-benefits-patients-at-uva.pdf.
Joliat, Gaëtan-Romain, et al. "Beyond surgery: clinical and economic impact of Enhanced
Recovery After Surgery programs." BMC Health Services Research, vol. 18, no. 1, 29 December
2018, doi:10.1186/s12913-018-3824-0.
Melnyk, Megan, et al. "Enhanced recovery after surgery (ERAS) protocols: Time to change
practice?" Canadian Urological Association Journal, vol. 5, no. 5, October 2011, p. 342- 348,
doi:10.5489/cuaj.11002.
Wick, Elizabeth C., et al. "AHRQ Safety Program for ISCR expands scope in 2019." Bulletin of
American College of Surgeons, vol. 103, no. 12, 4 December 2018, pp. 16-20,
http://bulletin.facs.org/2018/12/ahrq-safety-program-for-iscr-expands-scope-in-2019/#.
https://www.pressganey.com/docs/default-source/default-document-library/enhanced-recovery-
program-reduces-opioid-use-and-costs-benefits-patients-at-uva.pdf
https://www.pressganey.com/docs/default-source/default-document-library/enhanced-recovery-
program-reduces-opioid-use-and-costs-benefits-patients-at-uva.pdf
http://bulletin.facs.org/2018/12/ahrq-safety-program-for-iscr-expands-scope-in-2019/
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MEMORANDUM
DATE: TO: All Employees FROM: Your Name, Director of Human Resources SUBJECT:
Journey to Excellence Over the course of the year, the Senior Leadership team has performed
various surveys throughout the company to assess the needs of individuals as well as all
departments. These surveys have provided an abundance of information that would benefit our
organization. The purpose of this memo is to bring everyone up to date on current opportunities
for improvement, the introduction of a new style of leadership, and expectations of all
employees. Current Opportunities for Improvement Our Senior Leadership team has discovered
various concerns throughout the company over special treatment or favoritism of certain
employees resulting in unfair advantages for some but not for others. The Senior Leadership
team stands behind discouraging these types of behaviors. After extensive research and
consideration, it’s believed that implementing an alternate leadership approach will be highly

6. beneficial to assist with deterring favoritism and will in turn aid in promoting the future moral
growth of the company. As a result, the Senior Leadership team encourages all employees to
participate in removing this bias towards one another by helping to support the company’s
decision to implement a new leadership style. Our New Leadership Style The best type of
leadership style to address our current opportunities for improvement is the transformative
leadership style. According to the article “Transformational and Transformative Leadership in
a Research-Informed Leadership Preparation Program― written by Hewitt, Davis and Lashley,
transformative leadership “practices and offers the promise not only of greater individual
achievement but of a better life lived in common with others― where leaders are encouraged
to disrupt inequities (229). This article supports the idea that implementing a transformative
leadership style throughout a community or in our case, the company, will be beneficial in
resolving our current opportunities for improvement. This type of leadership doesn’t only
benefit those who suffer from unequal treatment; it also benefits the entire population involved.
Although it seems that this change in leadership style only applies to individuals holding
positions that are typically considered as a leadership role, it is very important for you all to
remember that being a leader does not mean you have to fill the role of CEO, Director or even
Manager. Leaders can be found at all job levels, whether you are an intern or CEO, you can help
support your fellow colleagues in achieving their goals. As we transition into adapting this new
style of leadership, it’s important to remember that this is an improvement that’s meant
to facilitate a more comfortable work environment for all employees within the entire company.
Maheba Pedroso
This is how a memo should be formatted. Please not the alignment and spacing throughout.
Maheba Pedroso
This student does a good job of providing background information and leads into a clear purpose,
which lets the audience know exactly what they can expect from the memo.
Maheba Pedroso
There are headings throughout which guide the audience through the memo. Notice how the
headings are formatted like a title--each major word is capitalized.
Maheba Pedroso
This is how research is presented in a meaningful way. We know where and who the information
came from and why this research/evidence is important and meaningful to the purpose of the
memo.
Expectations of All Employees This journey towards fully adapting a transformative leadership
style may have some difficulties along the way, but throughout this journey, ethical standards
within the company will have a deep influence on all employees and will have outstanding
outcomes according to the journal “Transformative Leadership: Achieving Unparalleled
Excellence― written by Caldwell, Dixson, and Floyd (184). This article demonstrates how
successful transformative leadership will be once all employees aim to become leaders within
their current roles. Hopefully this gives you all some inspiration and motivation to begin this
process as a team and support each other in upholding moral standards. We appreciate your
cooperation with this change as we will all endure some adversities throughout this new journey.
Please contact me at 305-222-3333 or [email protected] with questions or concerns regarding
this new approach or throughout this journey to excellence.

7. Maheba Pedroso
There is a clear closing.
Works Cited
Caldwell, Dixon, R. D., Floyd, L. A., Chaudoin, J., Post, J., & Cheokas, G. (2012).
Transformative Leadership: Achieving Unparalleled Excellence. Journal of Business Ethics,
109(2), 175–187. https://doi.org/10.1007/s10551-011-1116-2
Hewitt, K. K., Davis, A. W., & Lashley, C. (2014). Transformational and Transformative
Leadership in a Research-Informed Leadership Preparation Program. Journal of Research on
Leadership Education, 9(3), 225–253. https://doi.org/10.1177/1942775114552329
https://doi.org/10.1007/s10551-011-1116-2
https://doi.org/10.1177/1942775114552329
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Primary language Passed Text language is specified
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Field descriptions Passed All form fields have description
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Associated with
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Other elements
alternate text
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3
Practice Writing 3: Formatting and Designing Workplace Correspondence
Format and design are equally important in professional correspondence as it encourages the
audience to want to read, and it helps the audience navigate the document, helping them scan and
easily locate information.
What is format and design?
Format and design are two aspects of a document you will need to address in every major
assignment you complete in this course. This practice writing will help you better understand
how to accomplish these goals. Every assignment will have a format you must follow such as
memo, letter, email, etc…, and every assignment will need to include design features such as
headings, subheadings, steps, lists, images, etc…
What do I need to do to complete this assignment?
Please look at the text below and put it in memo format. Then include design features for optimal
readability; use what you learned from this week’s readings and videos to help you do this.
For your reference, this text is taken from our course syllabus. While you may look at the
syllabus as an example for format and design, please come up with your own headings and
design features to format and design your memo.
You do not need to rewrite any of the text provided. You only need to add design and formatting
features to make it easier to follow along. The memo is from you, and your audience is students
enrolled in this course.
Submission Guidelines
After you have formatted and designed the text, save the changes, and submit to the assignment
dropbox.
Text to Format and Design

10. This is a fully online course which means that all the course work will be conducted online.
While the expectations for performance in an online course are the same as a traditional face to
face course, an online course requires a degree of self-motivation, self-discipline, and technology
skills that can make them more demanding for some students. You will need intermediate
computer skills and a computer with internet access to be able to engage in this course, and you
must be able to work independently and manage your time with some guidance. This course will
introduce you to the expectations of writing in the professional workplace and help you explore
the ways in which technology and media help shape professional communication. You will
further develop your verbal and written communication skills by learning about how to address
different audiences, using various persuasion strategies to connect with specific audiences,
making ethical workplace decisions, using transformative leadership skills to lead and guide
others to accomplish a common goal in a collaborative work environment, and using reflection to
learn from your leadership experiences. The goal is to become a more effective communicator
while leading and motivating others to use good judgment and make sound decisions that yield
meaningful results. To help you accomplish these goals, you will be introduced to the concept of
transformative leadership, a leadership style which includes the following qualities:
“understanding of what needs to change; the ability to stimulate the intellect; a knack for
encouraging participation, a talent for genuine communication, loyalty — within reason; a
sense of the bigger picture; personal integrity; and an inspiring bearing [presence]―
(www.forbes.com/entrepreneurs), qualities that are critical in the professional arena. You will be
challenged to use creative and critical thinking to analyze the needs of workplace audiences
and to deliver essential information to those audiences in a variety of ways such as instructing,
persuading, and informing; you will also use visuals and page design within various modes of
communication, written and orally, to attain your rhetorical goals. You will be encouraged to
tailor the assignments to the issues and challenges in your major, future career, and or interests.
Methods of instruction: Readings, discussion posts, weekly writing assignments, peer review,
full class workshops. Upon successful completion of this course, you will be able to: Produce
documents in common professional genres. Respond to the needs of multiple audiences,
including international/global audiences. Develop document designs that maximize effectiveness
for the audience and purpose. Develop and deliver effective oral presentations using multi-
media content. Conduct and incorporate primary and secondary research to support rhetorical
goals. Write clearly and concisely with grammar and usage appropriate to the rhetorical
situation. Transformative Leadership Objectives. In addition to developing the learning
objectives, you will also be able to: Define Transformative Leadership, understand the benefits
of this approach, and develop your own philosophy of this leadership role. Engage in
reflection to identify your own leadership qualities and challenge assumptions about leadership.
Explain how a respectful and empathetic collaborative environment where you listen to your
peers’ point of view in an effort to negotiate and make collective decisions may yield a
better work environment. Engage in reflection to analyze how you might recreate your
leadership role to create a better work environment. Describe how Transformative Leadership
enhances workplace communication practices.