Establishment of Blood Screening Protocols Literature Review Chapter

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[. . .] " (Fallon, ) However, more recent evidence is stated by Fallon to call this conclusion into question as Hinton et al. In reports a double-blind, placebo-controlled trial, that investigated the effect of iron supplementation in 42 iron-depleted nonanemic women. Findings of the study state that five male athletes were identified in which "screening abnormalities were associated with illness or other factors that explained the abnormalities." ( ) In three cases it is reported that hematological screening did not contribute clinically useful data as the abnormalities would have been expected based on the history and examination." In the other two it is reported that "the case of the asymptomatic slowly developing iron deficiency and of the football player who refused follow-up, hematological and iron-related screening uncovered clinically useful information." ( )

Finally in regards to male athlete screening the study reports "In summary, the screening blood tests carried out on this group of elite male athletes found only 2 sets of abnormalities of clinical significance that could not have been suspected from clinical history and examination. Five athletes with a serum ferritin less than 30 ng/mL satisfied our criteria for iron supplementation. These were the only cases in which a change in athlete management was made based solely on blood test results." ( ) Findings in regards to the female athletes state that six cases were identified "in which screening abnormalities were associated with illness or other factors that explained the abnormalities. In each case, hematological screening would not have been useful as the abnormalities would have been expected based on the history and examination. Two others required further investigation. Twenty-seven athletes were identified as candidates for iron supplementation (ferritin <30 ng/mL). In summary, screening of 174 female athletes led to the detection of 1 clinical disorder and 27 athletes who were placed on iron supplementation. Of these 27, 14 had serum ferritin <20 ng/mL, which may have been impinging on some aspects of performance." ( ) The study reported by Fallon concludes by stating "Screening for hematological and iron-related abnormalities in male athletes has a low yield. Due to the critical nature of the effects of anemia and low serum ferritin on some aspects of performance, it is reasonable to perform a full blood count and a serum ferritin on male athletes entering an elite training program. Further testing should be performed on clinical grounds." ( ) It is reported that in females "the yield is greater. Again, it is reasonable to perform a full blood count and a serum ferritin on female athletes entering an elite training program. In view of their greater risk of iron depletion and to assess the effect of increased training inherent in elite programs, this could be repeated at 6-month intervals, or an isolated measurement of serum ferritin could be performed. Further testing should be performed on clinical grounds." (Fallon, )

One change methodology is that of Leadership that 'leads by example' and it is reported in the work of Nellis ( ) that the leader must know themselves and know their people. In order to compel all actors to buy-in to the change initiative it is important to have knowledge of the staff and moreover to know what motivates each individual and for example knowing what motivates each individual, that individual's needs. There are three other people skills stated to be vital to successful management or leadership which are those of: (1) enacting loyalty; (2) encouragement; and (3) reprimand. ( ) It is related that loyalty is a requirement for successful organizations. Stated as well is that positive opportunities ensure exposure to all facts of athletic training.

Change management is focused on achieving organizational efficiency and has as its bases the work of Kurt Lewin. Kurt Lewin proposed a 'force field analysis model for use in understanding organizational change. Force field analysis proposes that an organization is typically in a state of equilibrium." (Change Management, 2002) There are two forces that maintain organizational stability; driving forces and restraining forces. Driving forces are stated to be those elements of the organization which support a desired organizational change. Keeping the organization in equilibrium are the restraining forces becomes stronger than the other (disequilibrium) Once the change has occurred the organization is reported to revert "to a new state of equilibrium which reflects the desired change." (JPC Training and Consulting, 2002) Lewin's model when followed to a logical conclusion is stated to predict that an intervention which strengthens the driving forces or weakens the restraining forces will result in the desired change. Intervention strategies different from author to author but they contain similar elements. The following are reported to be basic elements of a formula-based organizational change strategy:

(1) Determination of the need to change;

(2) Development of a vision;

(3) Consensus building;

(4) Indentify barriers to implementation;

(5) Walk the talk;

(6) Creating an overall change strategy;

(7) Implementation and evaluation. (JPC Training and Consulting, 2002)

Employee resistance is the primary reason that change programs fail in 70% of organizations. (Gateway Information Services, New York Consulting Firm in: Change Management, 2002) Kurt Lewin's organizational change theory is comprised by two basic concepts: (1) the organization's natural state is static or unchanging; (2) an organization can be successfully divided into two groups, one that seeks change and one that opposes change. (JPC Training and Consulting, 2002) Another theory is that of organizational learning which has as its bases the collective and individual learning within the organization. (Smith, 2001)

Peter Senge (1999) explored the "art and practice of the learning organization" with more than 750,000 copies of The Fifth Discipline were sold in the ten years after it was first published. Three definitions of a learning organization are stated as follows: (1) Learning organizations are those in which people expand their capacity to create the results they want in an ongoing manner and where "new and expansive patterns of thinking are nurtured, when collective aspiration is set free, and where people are continually learning to see the whole together." (Senge 1990: 3 cited in: Smith, 2001)

Learning organizations are: (1) a vision of what might be possible. It is not brought about simply by training individuals; it can only happen as a result of learning at the whole organization level. A Learning Company is an organization that facilitates the learning of all its members and continuously transforms itself. (Pedler et. al. 1991: 1) and (2) Learning organizations are characterized by total employee involvement in a process of collaboratively conducted, collectively accountable change directed towards shared values or principles. (Watkins and Marsick 1992: 118 in: Smith, 2001)

Sandra Kerka holds that the largest majority of conceptualizations of the learning organizations appear to work on the assumption that "learning is valuable, continuous and most effective when shared and that every experience is an opportunity to learn." (Kerka, 1995 cited in: Smith, 2001) Characteristics of the learning organization include those as follows: (1) provides ongoing opportunities for learning; (2) utilizes learning to reach the organizational goals; (3) links performance of individuals with performance of the organization; (4) fosters inquiry and dialogue in an environment that is safe for people to share openly and to take risks; (5) embrace creative tension as a source of energy and renewal; and (6) are aware at all times of their environment and interact actively with that environment. (Kerka, 1995 as cited in: Smith, 2001)

Planning for change involves: (1) gaining consensus; (2) building an excellent team; (3) developing a comprehensive and visible plan; (4) make sure resources are available; (5) have a realistic schedule; (6) do not try to do more than is possible; (7) remember that people count; (8) establish and maintain formal support from managers and stakeholders; (9) be ready to change; (10) keep people informed. (ASTD Learning System, nd) It is reported that designing the performance measures requires knowing what the organization is trying to accomplish? (2) knowing what the organization wants its employees to be able to do better; (3) knowing the baselines for measurement before and after the change initiative; and (4) knowing what employees need to know to fully implement the change. (ASTD Learning System, nd)

Summary and Conclusion

This study has examined Change management specifically in view of the need for blood screening of elite and endurance athletes in the sports program for the purpose of diagnosing non-anemic iron deficiency. This condition is much more common in female athletes than in male athletes. Change management offers the method and process for initiating such change in the organization as shown in the literature reviewed in the present study.

References

Fallon, Kieran E. (2004) Utility of Hematological and Iron-Related Screening in Elite Athletes. 3 May 2004, Retrieved from: http://adalpt.com/2007/Dakar/Artigos/Medicina%20Desportiva/Anemia/Utility%20of%20Hematological%20and%20Iron-Related%20Screening%20in%20Elite%20Athletes.pdfClin J. Sport Med • Volume 14, Number 3, May 2004

Eichner, E. Randy (2001) SSE #81:… [END OF PREVIEW]

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