Proactive Document Management for Device Manufacturers – Part 2

Part 1 of this article discussed the importance of documents in designing and manufacturing products and how the existence of or lack of drawings, plans, and other records has hurt manufacturers, as well as how documents have helped manufacturers in their defense.

Part 2 will discuss document management systems, legal requirements to create documents, and ways in which employees can affirmatively create helpful documents—and not create unnecessarily harmful documents.

What follows are some guidelines that should be helpful to manufacturers in establishing an effective document management system. Document management includes the development of guidelines and procedures for determining what documents to create, what documents not to create, what words to use and not to use, how long to keep documents, when to destroy and how to destroy them, and in what form documents should be retained.

The pervasiveness of electronic records has made developing such a system considerably more difficult. The document management programs of many manufacturers only address when to discard or delete documents. Such a narrow program is inadequate; there are many other elements of a management program that, if not handled properly, can lead to liability. Any manufacturer concerned about the use of documents in future litigation should implement a comprehensive document management program as part of an overall product liability prevention program.

It is helpful for each manufacturing entity within a corporation to establish a document management policy and guidelines. This policy should confirm that employees are encouraged to bring to management’s attention, orally and/or in writing, all good and bad information about the design and manufacturing process of which they are aware. In other words, within the company, employees should be discouraged from hiding potentially damaging information, and instead encouraged to bring such information to the attention of supervisors.

The policy should also contain guidance on the kinds of documents to be created and guidelines on how they are to be written. It should contain schedules detailing retention periods for all documents including electronic records. The policy should be written in clear, unambiguous language so that all affected employees will be able to comply.

In addition to writing and distributing the policy internally, a periodic audit of compliance with the policy should be performed, for the dual purpose of demonstrating that management is serious about compliance and identifying and correcting problem areas. In some companies, activities that don’t help get products out the door may be ignored if management does not emphasize their importance and establish a specific audit requirement to confirm compliance.

Another essential part of managing the document program is educating employees about the policy and how to comply. The training must clearly show that the company is interested in learning about all good and bad information concerning its products, and that its documents should reflect the concern it has for selling safe products that comply with all applicable laws, regulations, and standards.

There are probably thousands of federal and state legal requirements for the creation and retention of documents. The federal requirements have been gathered by CCH in its Guide to Record Keeping Requirements (in the Code of Federal Regulations as of January 2006). The state and federal requirements are also gathered by the Information Requirements Clearinghouse (http://www.irch.com/).

Of course, many of the documents created in pre-market applications to the FDA must be kept, as well as documents evidencing compliance with quality, safety and labeling requirements as well as post-market requirements.

Any manufacturer doing business in the United States must be acquainted with the safety and quality-related document creation and retention requirements imposed by federal and state statutes and regulations. In addition, mandatory and voluntary standards or certifications in the United States and elsewhere must also be considered.

Documentary evidence of compliance with such standards may strengthen the defense’s case in any product liability lawsuit. Such evidence can be used to confirm that the manufacturer took steps to ensure that its products were reasonably safe and complied with all applicable laws, regulations and standards. In other words, both the legally required and voluntary documents reflect that the manufacturer considered safety during the design and creation of the product.

A comprehensive program should result in the creation of a file containing a history of the life of the product, from creation through destruction. Such a core history, to be assembled after the development of each product or product line, will allow the manufacturer to prove that it complied with all safety and other requirements on a routine basis. The project manager could gather all documents from all sources within the company pertaining to the project, and organize them into a comprehensive, coherent file that tells the history of the product. Drafts and duplicates of documents should be destroyed so that there is no uncertainty as to which are the correct or final versions of core documents.

Developing this product history file does not mean that potentially harmful documents, such as an internal memo that questions whether the company should continue developing a particular product, should be destroyed. Juries and judges understand that there may be internal differences of opinion during the development of a product. All the manufacturer will need to explain is how this dissenting opinion was handled—that it was fully considered, and then accepted or rejected. Disclosure of dissension within a company can actually be beneficial; it confirms that the manufacturer encourages varying opinions and does not try to hide bad or potentially damaging information. Of course, it can also be harmful if the jury believes that the rejected opinion was correct.

There are no specific or universal guidelines on how long such documents should be kept. The company does need to comply with certain legal requirements. Otherwise, documents that are necessary to explain a product's design should be kept as long as they might be needed to defend the manufacturer. Decisions on retention time must be made on a case-by-case basis; considerations include the life expectancy of the product, applicable statutes of repose, and a prediction of the period of time after the product’s life is over that claims or lawsuits might be anticipated.

Some documents should be kept forever even if they represent an old design. Subsequent designs and redesigns are often based on the earlier design. Products evolve over time, and therefore the earliest product development documents may be needed to explain later designs.

As a result, it is possible that the product history file, if developed, should be kept permanently. Assuming that this file is organized and duplicates and drafts are discarded, the quantity of documents may not be so large that permanent retention becomes a problem. And they can be converted into electronic records so that files subject to future discovery can be easily found.

In the FDA’s Quality System regulations, there is a similar concept called Device Master Record. The FDA describes it as follows:

Device master record (DMR) is the term used in the Quality System (QS) regulation for all of the routine documentation required to manufacture devices that will consistently meet company requirements. Section 820.3(j) of the QS regulation defines device master record as a compilation of records containing the procedures and specifications for a finished device. (See relevant Device Advice on the FDA website here.)

Documents relevant to product safety and liability generally fall into seven categories:

product design and development, including labels and instructions;

manufacturing and quality control;

merchandising and sales;

service and installation;

post-sale including complaints and incidents;

personnel; and

management and coordination.

Documents detailing a manufacturer’s activities in the above categories will present a comprehensive history of the life cycle of the product including manufacturing, design, sales and post-sale.

Each of these documents should be prepared in such a way as to not unnecessarily increase potential liability in the event of claims or lawsuits. This is usually called “defensive writing.” Writing defensively does not mean that the manufacturer is trying to hide bad information or evidence or shading the truth. On the contrary, a company's policy and educational programs must stress to employees that they should raise all issues, good or bad, during the development of the product.

The documents must portray correctly and accurately the manufacturer’s rationale for designing and making its product. A record of this rationale is necessary for designing future similar products and for good historical corporate recordkeeping. In addition, if the content of some documents challenge or discuss safety, they must be written in a way so as not to create a misleading impression or written in a way that they can be quoted out of context and unfairly used against the manufacturer in litigation.

Those employees who draft the manuals, plans, specifications, and other documents—the “writers”—should be encouraged to avoid legal terms that describe theories that may be presented to a jury in a product liability lawsuit. These terms include “defect, negligence, misrepresentation, and reckless.” Use of these and related legal terms by internal writers may lead a jury to decide that the company has admitted that its product is defective or unreasonably dangerous or in some other way legally deficient.

While the writer will have a chance to tell the jury why the word "defect" did not really mean defect in a product safety sense, the presence of such a loaded word in, for instance, a report on the development of a new product, gives the plaintiff an advantage in presenting her case to the jury.

Additional phrases and words in documents that can cause problems for the defense include overstated expressions, characterizations, or opinions. For example, phrases such as “occurs often” or “occurs frequently” should not be used when the engineer has only noticed two or three occurrences. The word “catastrophic” should not be used in connection with a product failure unless it was truly catastrophic; this may be a commonly understood term among engineers but may be misunderstood when heard by a jury.

Another term to avoid is “crisis.” Writers trying to get the attention of their supervisors may want to call every problem a crisis. This is an unnecessary overstatement; it suggests that the company is having huge problems all the time. Similar terms are “smoking gun,” “ticking time bomb,” and “sitting on a powder keg.” They are inflammatory and unnecessary.

In addition to being careful about the choice of words and phraseology, companies must organize their flow of documents to ensure that bad reports or criticisms written by lower-level employees are read, analyzed, and responded to. This is called “closing the loop.” Suppose a supervisor, such as an engineering manager, receives a memo from one of his employees that expresses concerns about the safety or quality of the product. The supervisor must analyze the problem and respond in writing to the employee. Then, the original letter and the response must be attached or stored together so that if these documents are obtained later in litigation, the original criticism and the response will be considered together. Otherwise, the criticism—without the response—might be discovered, giving the plaintiff the opportunity to portray the manufacturer as willfully disregarding safety by not considering or responding to concerns or criticism.

In summary, writers of company documents should consider the following guidelines when creating documents:

Assume that what you write will exist forever.

Assume that your document will be read on national television.

Avoid unnecessary documents; provide copies to the minimum number of people necessary.

Avoid documents that blame someone else in the company or describe internal disputes.

Always close the loop.

Do not discuss liability issues except when requested by the company’s lawyer.

Do not speculate, exaggerate, or editorialize.

Do not make unsupported statements, conclusions, or opinions.

Use data or facts to support conclusions.

Do not be funny or humorous.

Avoid drawing “funny pictures” or making handwritten notes in the margins.

Be careful when discussing product safety issues in financial terms.

Do not write documents outside your area of expertise or responsibility.

Avoid using words or expressions (including legal terminology) that are ambiguous or could be misinterpreted (perhaps intentionally) by the plaintiff.

Following these guidelines will not necessarily prevent the creation of potentially harmful documents. That is not the goal. The goal is to not create documents that unnecessarily and incorrectly create an impression that the manufacturer did not sufficiently care about safety.

Documents that describe a manufacturer’s concern for and incorporation of safety into the design of its products are of little litigation value if they are not retained long enough to be introduced in a future lawsuit. In fact, the lack of documents might be used against the manufacturer by raising a presumption that the documents were incriminating and that is why they were destroyed.

Suppose, for instance, that during the design phase the engineers considered three alternative designs, each with differing levels of cost and safety. In selecting the final design, the company recognized that one of the other two may have been a reasonable alternative design, but it was nevertheless considered and rejected on other grounds.

When the final design is selected, the manufacturer must document and justify why that design was selected and why the resulting product was reasonably safe. The fact that there were safer alternative designs that were rejected does not necessarily mean that the manufacturer is going to be liable in a subsequent lawsuit. The question is whether it is necessary or useful to keep documents on all three designs.

Some defense lawyers would prefer that their clients destroy any such reports shortly after product launch to prevent a plaintiff’s expert from arguing that one of the rejected alternative designs should have been adopted. However, with no documents on which to rely, the company witness will have to describe from memory what alternative designs were considered and rejected, what safety tests were performed during the design of the product, and how the company decided to incorporate safety into the final product. Moreover, the company’s liability may well rest on the company witness’s credibility in front of a jury rather than on the actual facts of the design process.

Unfortunately, a jury may not believe that the company cared about safety if no documents are retained that prove that such matters were considered. The jury might believe that if safety were so important, the manufacturer should be able to present written proof that safety was considered. In addition, a judge may even tell the jury that it can infer from the lack of certain documents that they would have been harmful to the manufacturer’s case.

Establishing an effective, rational, practical and comprehensive document retention system is not easy. It is impossible to propose a program that can be used by any specific company. In fact, each company must set up a customized schedule that is practical and effective for the amount of documents it creates, the places where they are kept, and the legal and technical requirements for retaining documents.

There are many sources for samples of document retention programs such as the records management association, ARMA International (www.arma.org) and Information Requirements Clearinghouse (http://www.irch.com/). These samples can be very helpful to the manufacturer that has not yet established its program. The samples contain extensive lists of the types of documents that are kept by a company, where these documents are to be stored, how long they are to be kept in the company’s offices, and how long they are to be retained after they are moved to storage. The documents can also be classified as to their importance, and a description made as to the form in which they can be stored. ARMA and IRCH also publish best practices on all aspects of the organization, maintenance and retention of electronic records.

Each manufacturer must establish its own system and schedules in accordance with its peculiar needs. One schedule may indicate the method of destruction for certain kinds of documents. Some may need to be shredded if they could contain trade secrets or other business confidential information. Others may need to be burned, and some can merely be thrown out in the trash. Of course, it is particularly difficult to destroy electronic records. Therefore, the schedules need to address when to delete certain files on the computer, what documents to back up, and what electronic documents to keep forever.

The document retention program should include procedures for the periodic moving of documents from the company's offices to a storage site or to a backup tape. It should indicate the individual with responsibility for approving the moving of documents to storage and approving their eventual destruction. A record of what happened to certain documents, when they were destroyed, and who approved the destruction should be kept.

In the history of product liability litigation, documents have proven to be both helpful and harmful to plaintiffs and defendants. Unfortunately, one does not know whether what they are writing today will be helpful or harmful later. To curb that uncertainty, manufacturers can and should proactively establish document management systems that ensure compliance with FDA’s legal requirements and will result in creation of a story of the development of the product. The system must also include procedures that will minimize the creation of misleading and unnecessarily harmful documents.

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BBC Inquiry Blames Rigid Management for Mishandling Sex Abuse Scandal

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The 200-page report by Nick Pollard, a former head of the Sky News channel who began his broadcast career as a BBC reporter, traced in detail what it described as “a chain of events that was to prove disastrous for the BBC.” Among other things, Mr. Pollard blamed a “rigid management system” that had “proved completely incapable of dealing with” the crisis that followed the program’s cancellation.

While much of the report centered on the interplay between journalists and their superiors as the allegations against Mr. Savile were investigated, its central conclusion appeared to be that confusion and mismanagement, not a cover-up, lay at the heart of the decision to drop the Savile program. Mr. Savile died at 84 in October 2011, weeks before the “Newsnight” program was scheduled to be broadcast.

“The efforts to get to the truth behind the Savile story proved beyond the combined efforts of the senior management, legal department, corporate communications team and anyone else for well over a month” after the crisis broke, precipitated by a program earlier this year on ITV, Britain’s leading commercial broadcaster, the report said. “Leadership and organization seemed to be in short supply.”

Mr. Pollard dismissed one theory that was widely circulated in recent months, that BBC News executives or their superiors, reluctant to have the BBC reveal a dark passage in its past, pressured the “Newsnight” team to cancel the Savile segment. Critics who took this views have played down the reason Peter Rippon, the program’s editor, cited to his staff. Mr. Rippon said he considered the team’s conclusions about Mr. Savile had not been adequately substantiated.

“While there clearly were discussions about the Savile story between Mr. Rippon and his managers,” Mr. Pollard said, he did not believe that they had exerted “undue pressure on him.”

The report was strongly critical of several news executives who were directly involved in the decision to cancel the Savile exposé, including Mr. Rippon and the two top executives in the BBC’s news division to whom he reported, Helen Boaden and Stephen Mitchell, all three of whom were suspended from their posts during the nine-week Pollard inquiry.

But it adopted a largely sparing tone in its review of the role played by the broadcaster’s former director general, Mark Thompson, who stepped down after eight years in the job in September and became president and chief executive of The New York Times Company last month.

The report’s criticism appeared to be aimed mainly at the broadcaster’s complex management systems, not on the actions — or absence of them — by Mr. Thompson and other top executives who presided over the BBC, its $6 billion annual budget and its 23,000 employees.

Mr. Thompson has said that he was not briefed about the “Newsnight” investigation before its cancellation, was not involved in canceling it, and did not know about the allegations of sexual abuse against Mr. Savile until the report about the cancellation appeared on ITV, a commercial competitor of the BBC.

The report does not dispute Mr. Thompson’s public statements that he did not know about the Savile investigation until it had been killed.

It cited, without criticism, Mr. Thompson’s account of an episode when he was asked about the “Newsnight” cancellation by a BBC reporter at a social gathering. The report quoted Mr. Thompson as having testified that he subsequently asked BBC News executives about the matter and “received reassurances” that the program had been killed for “editorial or journalistic reasons.” After that, Mr. Thompson said, according to the report, he “crossed it off my list and went off to worry about something else.”

While the scuttled program became the subject of media stories in London beginning in January — some of which, BBC officials have said, were included in press summaries prepared for Mr. Thompson — Mr. Pollard concluded: “Mr. Thompson told me that the various press stories which followed passed him by. I have no reason to doubt what he told me.”

Matthew Purdy contributed reporting from New York.

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Shift work and the assessment and management of shift work disorder (SWD)

Available online 2 May 2012

In Press, Corrected Proof — Note to users

a Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado at Boulder, 1725 Pleasant Street, Boulder, CO 80309, USAb SleepMed Incorporated, SleepMed of South Carolina, 700 Gervais Street, Suite #200, Columbia, SC 29201, USAc School of Medicine, University of South Carolina, USAd Sleep Disorders Service and Research Center, Rush University Medical Center, Johnston R. Bowman Health Center, 710 S. Paulina Street, 6 South JRB, Chicago, IL 60612, USAReceived 5 July 2011. Revised 10 February 2012. Accepted 13 February 2012. Available online 2 May 2012.View full text Nearly 20% of the labor force worldwide, work shifts that include work hours outside 07:00 h to 18:00 h. Shift work is common in many occupations that directly affect the health and safety of others (e.g., protective services, transportation, healthcare), whereas quality of life, health, and safety during shift work and the commute home can affect workers in any field.

Increasing evidence indicates that shift-work schedules negatively influence worker physiology, health, and safety. Shift work disrupts circadian sleep and alerting cycles, resulting in disturbed daytime sleep and excessive sleepiness during the work shift. Moreover, shift workers are at risk for shift work disorder (SWD). This review focuses on shift work and the assessment and management of sleepiness and sleep disruption associated with shift work schedules and SWD. Management strategies include approaches to promote sleep, wakefulness, and adaptation of the circadian clock to the imposed work schedule. Additional studies are needed to further our understanding of the mechanisms underlying the health risks of shift work, understanding which shift workers are at most risk of SWD, to investigate treatment options that address the health and safety burdens associated with shift work and SWD, and to further develop and assess the comparative effectiveness of countermeasures and treatment options.

prs.rt("abs_end");Shift work; Shift work disorder; Circadian rhythm; Circadian adaptation; Circadian misalignment; Homeostatic sleep drive; Good sleep behavior; Sleep duration; Caffeine; Naps; Melatonin; Hypnotics; Armodafinil; Modafinil

Figures and tables from this article:

Fig. 1. Occupations with a large proportion of shift workers (>20%).8

View Within ArticleFig. 2. Characterization of brain arousal across the 24-h day in a typical day worker and a night shift worker. Wakefulness and sleep are dependent upon the interplay between the circadian alerting signal and the homeostatic sleep drive in day- and night-shift workers. In a typical day worker (A), the sleep and circadian systems interact in such a way that alert wakefulness is promoted during the day and sleep is promoted at night. A circadian arousal signal increases across the day to counteract the buildup of sleep pressure that occurs with time awake. In a non-adapted night-shift worker (B), the circadian arousal signal increases across the day when the shift worker is attempting to sleep, resulting in short sleep duration. During the night shift, the circadian system and sleep pressure promote sleep, leading to excessive sleepiness during the work shift. Modified from Drake, 2010.128

View Within ArticleFig. 3. Baseline untreated. In the modafinil study (n = 182) (data on file)69 and armodafinil study (n = 216) (data on file, Cephalon),70 mean nighttime sleep latencies at baseline in untreated patients with shift work disorder (SWD) decreased over the course of a laboratory night shift. Sleep latency data from healthy control groups in three relatively small (n = 15–30), simulated, night-shift studies are also depicted (Study 1: Walsh et al., 1988; Study 2: Walsh et al., 1991; Study 3: Muehlbach and Walsh, 1995 [74], [75] and [76]) showing that healthy controls are more alert than patients with shift work disorder (A). A worsening of subjective sleepiness, as measured by the Karolinska sleepiness scale (KSS), also was seen in the modafinil and armodafinil studies in patients with SWD (B). Modafinil study: At the final visit of the modafinil study (n = 182), multiple sleep latency test (MSLT) scores for the modafinil group had significantly improved from baseline, compared with MSLT scores for the placebo group, at 02:00 h and 04:00 h but not at 06:00 h or 08:00 h (C). KSS scores in the modafinil group were also significantly improved at each time point from midnight to 05:00 h and also at 07:00 h, compared with scores in the placebo group (D).69 Panel C adapted with permission from Czeisler et al., 2005.69 Armodafinil study: At the final visit of the armodafinil study (n = 216), MSLT scores for the armodafinil group were significantly improved, compared with MSLT scores for the placebo group, at all time points measured (E). KSS scores also were significantly improved at each time point from 23:55 h to 05:55 h in the armodafinil group (F).70 Panels E and F reprinted with permission from Czeisler et al., 2009.70*p < 0.001; †p < 0.05, change from baseline vs. placebo. Higher KSS scores indicate greater sleepiness.

View Within ArticleTable 1. Diagnostic and supportive criteria for shift work disorder.13

View Within ArticleTable 2. Clinical guidelines for assessment and management of shift work disorder (SWD).73

ESS, Epworth sleepiness scale; SWD, shift work disorder; KSS, Karolinska sleepiness scale. Modified with permission from Drake and Wright.73

View Within ArticleCopyright © 2012 Elsevier Ltd. All rights reserved.

prs.rt('data_end');

View the original article here

Shift work and the assessment and management of shift work disorder (SWD)

Available online 2 May 2012

In Press, Corrected Proof — Note to users

a Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado at Boulder, 1725 Pleasant Street, Boulder, CO 80309, USAb SleepMed Incorporated, SleepMed of South Carolina, 700 Gervais Street, Suite #200, Columbia, SC 29201, USAc School of Medicine, University of South Carolina, USAd Sleep Disorders Service and Research Center, Rush University Medical Center, Johnston R. Bowman Health Center, 710 S. Paulina Street, 6 South JRB, Chicago, IL 60612, USAReceived 5 July 2011. Revised 10 February 2012. Accepted 13 February 2012. Available online 2 May 2012.View full text Nearly 20% of the labor force worldwide, work shifts that include work hours outside 07:00 h to 18:00 h. Shift work is common in many occupations that directly affect the health and safety of others (e.g., protective services, transportation, healthcare), whereas quality of life, health, and safety during shift work and the commute home can affect workers in any field.

Increasing evidence indicates that shift-work schedules negatively influence worker physiology, health, and safety. Shift work disrupts circadian sleep and alerting cycles, resulting in disturbed daytime sleep and excessive sleepiness during the work shift. Moreover, shift workers are at risk for shift work disorder (SWD). This review focuses on shift work and the assessment and management of sleepiness and sleep disruption associated with shift work schedules and SWD. Management strategies include approaches to promote sleep, wakefulness, and adaptation of the circadian clock to the imposed work schedule. Additional studies are needed to further our understanding of the mechanisms underlying the health risks of shift work, understanding which shift workers are at most risk of SWD, to investigate treatment options that address the health and safety burdens associated with shift work and SWD, and to further develop and assess the comparative effectiveness of countermeasures and treatment options.

prs.rt("abs_end");Shift work; Shift work disorder; Circadian rhythm; Circadian adaptation; Circadian misalignment; Homeostatic sleep drive; Good sleep behavior; Sleep duration; Caffeine; Naps; Melatonin; Hypnotics; Armodafinil; Modafinil

Figures and tables from this article:

Fig. 1. Occupations with a large proportion of shift workers (>20%).8

View Within ArticleFig. 2. Characterization of brain arousal across the 24-h day in a typical day worker and a night shift worker. Wakefulness and sleep are dependent upon the interplay between the circadian alerting signal and the homeostatic sleep drive in day- and night-shift workers. In a typical day worker (A), the sleep and circadian systems interact in such a way that alert wakefulness is promoted during the day and sleep is promoted at night. A circadian arousal signal increases across the day to counteract the buildup of sleep pressure that occurs with time awake. In a non-adapted night-shift worker (B), the circadian arousal signal increases across the day when the shift worker is attempting to sleep, resulting in short sleep duration. During the night shift, the circadian system and sleep pressure promote sleep, leading to excessive sleepiness during the work shift. Modified from Drake, 2010.128

View Within ArticleFig. 3. Baseline untreated. In the modafinil study (n = 182) (data on file)69 and armodafinil study (n = 216) (data on file, Cephalon),70 mean nighttime sleep latencies at baseline in untreated patients with shift work disorder (SWD) decreased over the course of a laboratory night shift. Sleep latency data from healthy control groups in three relatively small (n = 15–30), simulated, night-shift studies are also depicted (Study 1: Walsh et al., 1988; Study 2: Walsh et al., 1991; Study 3: Muehlbach and Walsh, 1995 [74], [75] and [76]) showing that healthy controls are more alert than patients with shift work disorder (A). A worsening of subjective sleepiness, as measured by the Karolinska sleepiness scale (KSS), also was seen in the modafinil and armodafinil studies in patients with SWD (B). Modafinil study: At the final visit of the modafinil study (n = 182), multiple sleep latency test (MSLT) scores for the modafinil group had significantly improved from baseline, compared with MSLT scores for the placebo group, at 02:00 h and 04:00 h but not at 06:00 h or 08:00 h (C). KSS scores in the modafinil group were also significantly improved at each time point from midnight to 05:00 h and also at 07:00 h, compared with scores in the placebo group (D).69 Panel C adapted with permission from Czeisler et al., 2005.69 Armodafinil study: At the final visit of the armodafinil study (n = 216), MSLT scores for the armodafinil group were significantly improved, compared with MSLT scores for the placebo group, at all time points measured (E). KSS scores also were significantly improved at each time point from 23:55 h to 05:55 h in the armodafinil group (F).70 Panels E and F reprinted with permission from Czeisler et al., 2009.70*p < 0.001; †p < 0.05, change from baseline vs. placebo. Higher KSS scores indicate greater sleepiness.

View Within ArticleTable 1. Diagnostic and supportive criteria for shift work disorder.13

View Within ArticleTable 2. Clinical guidelines for assessment and management of shift work disorder (SWD).73

ESS, Epworth sleepiness scale; SWD, shift work disorder; KSS, Karolinska sleepiness scale. Modified with permission from Drake and Wright.73

View Within ArticleCopyright © 2012 Elsevier Ltd. All rights reserved.

prs.rt('data_end');

View the original article here

Mayo Clinic offers supplements, Stress Management, massage and acupuncture in Mall of America

Cleveland Clinic Wellness Institute. In another Boost in the realm of well-being, Mayo Clinic now offers one on one consults with doctors of integrative and complementary medicine on campus and where customers are-right in the Mall of America. See this 3-part video series below:

Dr. Bauer, Dr. a. Brent Bauer is a physician in the Department of general internal medicine and supervisor of complementary and integrative medicine program Research at Mayo Clinic.

Nancy Drackley, a physiotherapist, massage therapist and massage therapy supervisor at Mayo Clinic.

Tony Chon, m.d, a physician in the Department of general internal medicine and a member of the complementary and integrative medicine team at Mayo Clinic, discusses acupuncture.

View the original article here

Mayo Clinic offers supplements, Stress Management, massage and acupuncture in Mall of America

Cleveland Clinic Wellness Institute. In another Boost in the realm of well-being, Mayo Clinic now offers one on one consults with doctors of integrative and complementary medicine on campus and where customers are-right in the Mall of America. See this 3-part video series below:

Dr. Bauer, Dr. a. Brent Bauer is a physician in the Department of general internal medicine and supervisor of complementary and integrative medicine program Research at Mayo Clinic.

Nancy Drackley, a physiotherapist, massage therapist and massage therapy supervisor at Mayo Clinic.

Tony Chon, m.d, a physician in the Department of general internal medicine and a member of the complementary and integrative medicine team at Mayo Clinic, discusses acupuncture.

View the original article here

Mayo Clinic offers supplements, Stress Management, massage and acupuncture in Mall of America

Cleveland Clinic Wellness Institute. In another Boost in the realm of well-being, Mayo Clinic now offers one on one consults with doctors of integrative and complementary medicine on campus and where customers are-right in the Mall of America. See this 3-part video series below:

Dr. Bauer, Dr. a. Brent Bauer is a physician in the Department of general internal medicine and supervisor of complementary and integrative medicine program Research at Mayo Clinic.

Nancy Drackley, a physiotherapist, massage therapist and massage therapy supervisor at Mayo Clinic.

Tony Chon, m.d, a physician in the Department of general internal medicine and a member of the complementary and integrative medicine team at Mayo Clinic, discusses acupuncture.

View the original article here

Strathmore minerals quality control attraction BBC News

March 19, market Outlook, it's a big publicity attracting wrote about the management of the quality of my observation. What mainstream promotion that attracts a broad audience of investors, and the possibility of the company of being occupied improves. When their favorite company to celebrate the "play" is a case in point in the initial investor. Strathmore minerals (TSX: STM; other medicines: STHJF), whose story we have followed for almost two years.

Strathmore President David Miller said Hong Kong last week, the uranium mines on the theme of the International Atomic Energy Agency (IAEA) addressing. In the course of his visit, he was invited to interview with the BBC World News, and so on April 6. World premiere radio network, reaching millions of listeners in one of the BBC, but in this case (United Kingdom Broadcasting Corporation), David Miller, but the guest permissions to help a wider audience before the uranium story. At the end of the one he was lucky, and on the right side you can place at the right time. But in the last few months, David Miller, also interviewed by the Street.com and Dow Jones, and Canada's Rob TV and appeared on the CNN TV. That's serious about a small company to promote!

Miller joined Luis Echavarri, Director/General OECD (Organisation for economic co-operation and development), nuclear energy agency of the Paris-based supply of uranium and the BBC News at the show to talk about the crisis. Miller told the BBC, "the current demand is almost double what is currently in production in the mine in the world. You simply set the number of these mines with the switch. "

Many of these small uranium company "quality names" and their management team continues to build, they will continue to attract the eyes of the mainstream media. And for those interested in the story "the uranium story" and the company would be interested in the entire area outside of the media will accelerate. Itochu-uranium resources (OTC BB: URIX) just utility companies and small cap uranium development company, the first of many more joint ventures between Bali is likely to be.

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Strathmore minerals attracts quality management news BBC

On 19 March market Outlook, I wrote about my impression is the quality management that draws a large publication. Mainstream publications is what attracts a wider audience of investors and increases the likelihood of a company taking steps. Early investors celebrate when their company goes "play favorites." the case for instance is Strathmore minerals (TSX: scans; Other OTC: STHJF), whose story we have followed for years.http://www.today.com
Strathmore President David Miller was in Hong Kong last week, the International Atomic Energy Agency concerning uranium mining vioad. During his visit, he was invited to interviewees BBC World News, did so on April 6. To reach millions of listeners in one of the world's premiere radio networks, the BBC (British Broadcasting Corporation) is not only a privilege for the guest, in this case David Miller, but it helps to bring the uranium story before a wider audience. One may say he is lucky, the right place at the right time. But a few months, David Miller has also been interviewed by Lilian Gilman Street.com, Dow Jones, appeared on CNN-TV, most television Canada. This is a serious publications of company!
Miller was joined by BBC news show with Luis Echavarri, Director, Global Energy Agency is based on the Paris ' of OECD (Organization for economic cooperation and development) to speak even uranium supply. Miller said the BBC, "the current demand is nearly double what the current production is the mines in the world. You just don't run these mines with a switch. "
Like many of these smaller uranium companies continue to build the ?????"????? management teams," they will continue to attract the eye of the mainstream media. And accelerate as more media become interested in "the story of uranium", a story which, it is a matter for the company dealing in. Itochu-uranium resources (OTC BB: URIX) likely to be only the first bunch of more joint ventures between service company and company to develop uranium lowercase letters.
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Current Management Opportunities and Challenges in the Software Industry

During the past 30 years the world went through a very dynamic technological transformation. In retrospective, it can be stated without exaggeration that the emergence of electronic devices and the Internet have greatly impacted daily life as well as managerial practice to an unforeseen extent. The computerization of multiple business processes and the creation of large scale databases, among many other radical technological advances, have lead to enormous cost savings and quality improvements over the years. The interconnection of financial markets through electronic means and the worldwide adoption of the Internet have greatly reduced transaction and communication costs and brought nations and cultures closer to one another than ever imaginable. Computers are now fundamental tools in almost all businesses around the world and their application and adaptation to specific business problems in the form of software development is a practice that many companies perform on their own. In the past, such computerization and automation efforts were very costly and therefore only practiced by large corporations. Over the years, however, the software industry emerged to offer off-the-shelf solutions and services to smaller companies. Today, having survived the massive dotcom crash of the year 2000, software development businesses established themselves as strong players in the technology industry.
The emergence of numerous computer standards and technologies has created many challenges and opportunities. One of the main opportunities provided by the software sector is relatively low entry barrier. Since the software business is not capital intensive, successful market entry largely depends on know-how and specific industry domain knowledge. Entrepreneurs with the right skills can relatively easily compete with large corporations and thereby pose a considerable threat to other, much larger organizations. Companies, on the other hand, need to find ways to reduce turnover and protect their intellectual property; hence, the strong knowledge dependence combined with the relatively short lifespan of computer technologies makes knowledge workers very important to the organization. Knowledge workers in this industry therefore enjoy stronger bargaining power and require a different management style and work environment than in other sectors, especially those industries that have higher market entry capital requirements. This relatively strong position of software personnel challenges human resource strategies in organizations and it also raises concerns about the protection of intellectual property.
The relatively young industry is blessed with sheer endless new opportunities, such as the ability of companies to cooperate with other organizations around the globe without interruption and incur practically no communication costs. In addition, no import tariffs exist making the transfer of software across borders very efficient; however, the industry with its craft-like professions suffers from lack of standards and quality problems. The successful management of such dynamic organizations challenges today's managers as well as contemporary management science because traditional management styles, such as Weberian bureaucracies, seem to be unable to cope with unstable environments.
Challenges in the Software Industry
Many studies indicate that present-day software development practices are highly inefficient and wasteful (Flitman, 2003). On average, projects are only 62% efficient, which translates to a waste of 37 %. The typical software development project has the following distribution of work effort: 12% planning, 10% specification, 42% quality control, 17% implementation, and 19% software building (2003). There are many possible interpretations of the nature of this distribution of resources. First, the extraordinarily high share of 42% for quality control purposes can indicate a lack of standards and standardized work practices. This large waste of effort may also be the result of inefficient planning and specification processes. Because the share of 19% for software building is a function of software complexity, hardware, and tools used, there is a chance to reduce it by carefully managing and standardizing internal work processes. The disappointing share of only 17% for implementation, however, should be alarming to business owners, since implementation activities are the main activity that results in revenue. The relatively low productivity level reported by Flitman (2003) seems to be also reflected in the fact that the average U.S. programmer produces approximately 7,700 lines of code per year, which translates to just 33 per workday (Slavova, 2000). Considering that a large software project, such as Microsoft Word, is reported by Microsoft to require 2 to 3 million lines of code, it becomes obvious how costly such projects can become and that productivity and quality management are major concerns to today's software businesses. The challenge for contemporary software managers is to find the root of the productivity problem and a remedy in the form of a management practice.
A plethora of recent studies addresses software development productivity and quality concerns. Elliott, Dawson, and Edwards (2007) conclude that there is a lack of quality skills in current organizations. Furthermore, the researchers put partial blame on prevailing organizational cultures, which can lead to counterproductive work habits. Of the main problems identified, project documentation was found to be lacking because documents are deficient in detail and not updated frequent enough. Quality control in the form of software testing is not practiced as often and there seems to be a lack of quality assurance processes to ensure that software is built with quality in mind from the beginning. Organizational culture was found to be deficient in companies were workers tend to avoid confrontation and therefore avoid product tests altogether (2007).
Since knowledge workers are the main drive in software organizations, creating a fruitful and efficient organizational culture constitutes a main challenge to today's managers. The relationship between organizational culture and quality and productivity in software businesses was recently investigated by Mathew (2007). Software organizations tend to be people-centered and their dependency on knowledge workers is also reflected by the enormous spending remuneration and benefits of more than 50% of revenue. As the industry matures and grows further, the challenge to organizations is that larger number of employees need to be managed which brings culture to the focus of management. Mathew (2007) found that the most important influence on productivity was achieved by creating an environment of mutual trust. Higher levels of trust lead to greater employee autonomy and empowerment, which strengthened the existing management view that trust and organizational effectiveness are highly related. Those companies with higher trust and empowerment levels benefitted from more intensive employee involvement and thereby achieved better quality products (2007).
Product quality, however, depends on other factors as well that reach beyond the discussion of work processes. Relatively high employee turnover was found to have a detrimental effect on product quality and organizational culture (Hamid & Tarek, 1992). Constant turnover and succession increase project completion costs, cause considerable delays, and expose organization to higher risks because their development processes can be severely disrupted. While human resources strategies should help find ways to retain key personnel in the company, organizations need to nevertheless be prepared for turnovers and minimize their risks. One of the greatest risks for people-centered, knowledge worker organizations is the loss of knowledge when employees leave.
Knowledge management has evolved into a relatively new discipline in the last two decades but is mostly practiced by large, global organizations only (Mehta, 2008). As corporations realized the importance of knowledge management activities to mitigate the risk of know-how loss within their organizations, they started employing chief knowledge officers and crews with the goal of collecting and organizing information. By building custom knowledge management platforms, companies can benefit from increased transfer, storage, and availability of critical business information. Such activities can help companies innovate and build knowledge capital over time (2008). The challenge remains, however, to set up such systems and to elicit employee support for knowledge management systems. In addition, these systems leave another critical question open. What happens when top performers take all the knowledge with them when they leave?
Another crucial variable affecting software product and service quality is top management involvement. Projects in the software industry commonly fail due to one or a combination of the following three major causes: poor project planning, a weak business case, and lack of top management support and involvement (Zwikael, 2008). Software projects are similar to projects in other industries by focusing on timely project completion, budget, and compliance to specifications, the industry requires specific support processes from top management to facilitate projects. These processes are summarized in Table 1. Key support processes, such as the appropriate assignment of project managers and the existence of project success measurement, indicate that successful companies demonstrate a higher level of project progress control than others; however, Zwikael acknowledges that top managers rarely focus on these key processes and instead prefer to deal with those processes that are easier for them to work on personally.
Table 1
The ten most critical top management support processes in the software sector (Zwikael, 2008). Those processes marked with an asterisk (*) were found to be the most important.
Support Process
Appropriate project manager assignment *
Refreshing project procedures
Involvement of the project manager during initiation stage
Communication between the project manager and the organization *
Existence of project success measurement *
Supportive project organizational structure
Existence of interactive interdepartmental project groups *
Organizational projects resource planning
Project management office involvement
Use of standard project management software *
Opportunities in the Software Industry
The advent of low cost communication via the Internet and the diversification of the software industry into many different branches brought a multitude of new market opportunities. Some of the main opportunities are rooted in the low costs of communication, while others originated from the possibility of geographic diversification and international collaboration.
One major opportunity which especially larger organizations seek to seize is geographic diversification in the form of globally distributed software development. Kotlarsky, Oshri, van Hillegersberg, and Kumar (2007) have researched this source of opportunities that is mainly practiced by multinational companies; however, an increasing number of small companies is also reported to be benefitting from dispersed software development across national boundaries. The study revealed that software companies can achieve significantly higher levels of productivity by creating reusable software components and reducing task interdependencies. By reducing interdependence, the produced modules are more likely to become useful in future projects on their own; furthermore, this reduction of intertwined computer code also has a positive effect on project teams. Teams in companies that globally distribute their developments benefit from increased autonomy and reduced communication requirements. The authors point out, however, that the prerequisites to distributing software development are not only good project planning but also the standardization of tools and development procedures. Without such prearrangements it may become almost impossible to manage and consolidate the various distributed team activities (2007). Especially for teams working across countries away from one another, it may pay off to deploy video or other Internet-based conferencing technologies and exploit huge savings potentials. But are these means of communication effective?
In the last decade a new form of organization has emerged that has taken the most advantage of the Internet. Virtual organizations exist entirely in cyberspace and their team members communicate mostly, if not exclusively, via the Internet using webcams and messaging software. The challenge for managers in virtual organizations is to exploit the new technology but also to find ways to motivate and direct the workforce and work processes. A study by Andres (2002) compared virtual software development teams with face-to-face teams and identified several challenges and opportunities for virtual managers. Managing work from a different time zone can be problematic due to the lack of physical presence. Communication will need to be asynchronous or can only occur at work hours that overlap in both time zones. Virtual teams facilitate this process by using email and voice/text messaging but more importantly by reducing the interdependency of tasks. Andres (2002) suggested that these types of communication have lower "social presence" meaning that humans have a need and ability to feel the presence of others in the group. The problem with many computerized communication channels is that visual clues, utterances, body language clues and clues from the person's voice are missing. When placed on a social presence continuum, the various communication types rank as follows from the lowest to the highest: email, phone, video conferencing, and face-to-face meetings. Andres' comparison between development teams using video-conferencing versus face-to-face meetings revealed that the latter group was far more efficient and productive, even though the video-conferencing team benefitted from reduced travel costs and time.
The study conducted in 2002, however, has several shortcomings. First, it is already seven years old and Internet costs have dropped and speeds have improved significantly since then. Considering the improvements in video quality and availability and computer speeds, this form of communication became more feasible recently. In addition, today's managers are just now starting to learn how to use these means of communication efficiently. For example, even though email technology has been around for two decades now, many managers still find that emails can create a lot of ambiguity. The challenge to future generations of managers will be to change their writing style to match the limitations of email and other text messaging technologies. Another important factor to consider is that written communication may be stored indefinitely and have legal consequences; hence, more often than not, managers may intentionally prefer to avoid such communication channels for political or legal reasons. The study by Andres (2002), however, resulted in a negative view of video conferencing probably because the technology was not yet matured and the team members were not yet comfortable with it.
For video conferencing to work well, all participants need to be knowledgeable of the peculiar characteristics of that technology and adjust their communication style and speech accordingly. Regardless of meeting type, another important factor is preparation. What could be researched in conjunction with Andres' study in the future is the degree of preparation of the group. Do team members invest enough time in preparing questions and answers for their teammates before coming to the meeting? Video conferences may require more preparation than face-to-face meetings in some circumstances.
Another opportunity for software businesses and challenge for managers worldwide is outsourcing. In the year 2007, $70 billion were spent globally for outsourced software development (Scott, 2007). Given the extreme shortage of IT skills in the U.S. and Europe, many companies take advantage of globalization by choosing international suppliers for their software development tasks. Outsourcing, however, requires elaborate coordination between the organization and its many supplier groups. The idea is that in total, coordination costs and problems are less costly than in-house development; however, this goal is not always achieved. While outsourcing, when it is deployed and coordinated correctly, can result in 24 hour development worldwide and thereby provide continuous services to the organization around the clock, it may result in the loss of intellectual property. While mechanic parts are patentable in most countries that support intellectual property rights, software is not patentable in most countries outside North America.
In addition to the challenge of managing outsourcing, software organizations exploit technologies in various ways to save costs, for example by offering remote access, telecommuting, and service-oriented architectures (SOA) (Scott, 2007). Remote access and telecommuting has increased six-fold between 1997 and 2005 and resulted in $300 million annual savings due to a reduction of office space (2007). SOA is a similar concept and involves a software rental for customers. Instead of buying, installing, and maintaining software and servers, customers can rent a service online and reduce the total cost of ownership because these activities are no longer required on the customer side. Gradually the virtualization of the software business opens new horizons and provides further opportunities but it also presents managers with endless challenges.
Some of the strengths and weaknesses of offshore and virtual team development were studied by Slavova (2000). In the year 2000, India and Ireland were the largest offshore software development locations. Offshore companies can offer up to 60% cost reduction, a faster completion of development tasks by distributing them around the globe, and specific domain knowledge which they acquired over the years providing similar services to other customers. The integration of work from external sources, however, constitutes a major hurdle. Furthermore, language and cultural issues can cause serious communication problems that put the project at risk, especially when misunderstandings cause misinterpretations of project specification documents. Slavova (2000) found that the most common remedy and strategy avoiding problems with offshore suppliers is to visit them frequently face-to-face; however, this tactic results in higher travel costs and disruptions of the managers' workflows and hence may offset the benefits gained for outsourcing altogether. Managers in the software business need therefore to balance the risks and opportunity potentials before engaging in outsourcing because for many companies this strategy failed to pay off in the end.
A huge opportunity that emerged in the last decade is online innovation. The collective innovation effort of many individuals and companies is generally known as open-source on the Internet and it has lead to many advances in the computer technology, such as the free Linux operating system. At first businesses felt threatened by this wave of developments on the market because the businesses perceived that open-source solutions were in competition with their products. In many cases this was and still is in fact true; however, a couple of companies, including IBM, are exploiting this new way of innovation for their own and for a common benefit (Vujovic & Ulhøi, 2008). Because software companies operate in an increasingly instable environment, they struggle to create continuously new and better products. By exposing the computer code to the public on the Internet, companies can benefit from ideas submitted by the public, especially other companies. Furthermore, companies benefit from free bug finding and testing by external users but one of the primary reasons for "going open-source" is the quick adoption and spread of the company's technology at a relatively little or no cost. The spread of IBM's open-source technology, for example, is also free marketing for the company. But how can companies make money by offering something for free?
The closed innovation model (the traditional model of providing software without revealing the software code) can be combined with open-source, so the company can charge for the product. In other cases, the company can reveal the technological platform on the Internet for free and then sell specialized tools which utilize the new platform. The big money savers are obviously the shared development, testing, and maintenance costs since many interested parties work on the same project.
The knowledge-sharing model of open-source is nothing new, however. The philosophy and the benefits of open innovation models have been already realized in the third quarter of the nineteenth century. Back then, open innovation was practiced in the UK iron and
US steel industry. The cooperation of many industry players ended the domination of proprietary technologies for which costly royalties were due (Vujovic & Ulhøi, 2008). Given the dynamic environment of the IT industry and the short lifespan of computer technologies, the adoption of open innovation models gained much more popularity. By analyzing the largest open-source players in the market, Vujovic and Ulhøi put together a list of supportive strategies, which is shown in Table 2. Several of these strategies are quite relevant from a top management perspective as well, such as deploying open-source to block a competitor and using the open model as a gateway for greater market share.
Table 2
Strategies for adopting the open-source approach (Vujovic & Ulhøi, 2008).
Business Strategy
Obtaining higher market share
Obtaining market power
Better adoption of a product and thereby establishing standards
Shifting competitive advantage to another architectural layer
Making the product more ubiquitous
Delivering faster time-to-market
Spurring innovation
Complementing a revenue core stream
Blocking a competitor
Conclusion
Reviewing the rather recent emergence of the IT industry and the software industry in particular, several parallels can be drawn to management history. While Taylor's scientific management was a highlight in the evolution of management science (Wren, 2005), the software industry seems to be lagging behind such great advancement. Due to its high level of complexity, the software development discipline is still plagued with quality problems stemming from a lack of standardization. Similar to Taylor's efforts, managers need to analyze software development processes and develop industry-wide standards and measures. Once such measures and procedures exist, this will help make software projects much more predictable.
Much of today's software industry practices would have been a déjà vu for Taylor, if he was still alive. In addition, the anomie and social disorganization concerns during the social person era apply today more dramatically than in the past. Mayo described in the 1940s how managers overemphasized on technical problems in the hope of raising efficiency ignoring the human social element (p. 296). The same situation is now evident to a larger degree in the computer industry. The rapid technological advances have created many opportunities and changed the work environment drastically. At the same time, however, management was unable to prepare for these dramatic shifts technology would bring to the workplace. At best, managers are simply reacting to technological advances because the consequences are mostly unpredictable given the complexity of human nature. For example, email brought several benefits such as low cost and simple asynchronous communication; however, many email messages are misunderstood because they are not written appropriately. Moreover, IT knowledge workers are struggling to keep up with the vast number of messages received per day as they constitute a severe disruption of the daily workflow.
As knowledge workers are becoming more and more essential to an organization's survival and as organizations in this industry mature and require greater headcounts, the span of control is becoming an issue for managers to handle correctly. As discussed in Wren (2005), as the team size increases, the number of interrelations to be managed rises astronomically (p. 353). Managing larger teams poses a great problem because the sheer number of interrelations makes it also more difficult to develop trust within the team. Motivating large groups of knowledge workers can hence be tricky, especially because creative tasks can require a large degree of collaboration. Work design is hence a major hurdle for future managers to overcome. Much emphasis has been on hygiene factors and not on motivators of the workforce. Flexible hours, telecommuting, empowerment, and increased responsibility may help in the short-term but for the long-term management will need to find new strategies for retaining knowledge workers.
Product quality remains a big issue. Deming's ideas are good but quality assurance in the software world is difficult to implement due to the lack of standards and measures. The open-source innovation model may provide some relief in this respect because the greater involvement of external developers can help improve overall quality. On the other hand, however, open-source projects are hard to manage for the same reason. Since open-source projects are self-directed and not owned by anyone in particular, those projects sometimes suffer from uncontrolled, tumorlike growth.
Several of Deming's deadly sins (Wren, 2005, p. 463) apply directly to the software industry. Most products are made from scratch rather than from components and there is little standardization in software organizations. Since software developers have a tendency to see their job as a craft they defy standards and procedures. In addition, the rather complex environment with its dynamic requirements and the push for meeting deadlines make it easy for practitioners to lose sight of quality improvements through the preparation of organizational standards. High turnover and individual performance measures continue to be industry practice, even though many scientists, such as Deming, have argued for long that such measures are counterproductive.
Future managers need to find ways to compensate for the high turnover, if they cannot find a way to avoid it. The division of labor might work well for the company but it is not well perceived by the workforce which tends to require constant challenge. Top performers disfavor mundane tasks and prefer to walk away with all their knowledge. IBM has successfully deployed job enlargement for some time to combat this phenomenon (Wren, 2005, p.332). Unfortunately, this strategy might not work for every company and it can only be used within certain boundaries of the organization. Given the developments of the last two decades, managers will need to confront the discipline of knowledge worker management and find a workable solution for their organization.
The integration of management science with the advances in psychology and sociology may provide a route towards the solution of the knowledge worker management problem. It is crucial for managers to have an accurate understanding of the motivational drives for this particular group of the workforce. These employees enjoy higher income, greater flexibility and freedom, and greater bargain power. This puts them in a gray zone between the traditional, lower skilled employee and an owner in the company because knowledge workers create intellectual capital in the company. Because most of this capital is lost and remains with the employees when they decide to leave the organization, turnover can be much more damaging than with traditional workers. Managers can therefore not simply apply conventional strategies to this dissimilar group of employees; rather, they need to seek for more creative incentives for motivating and retaining knowledge workers.
References
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