question
The Role of Human Informatics in Chronic Disease Management:
Explain how human informatics can be used to improve chronic disease management.
Focus on how data collection, analysis, and visualization can contribute to better care coordination.
Utilizing patient-generated data (PGD) from wearable devices to track health metrics and identify potential issues.
Applying data analytics to personalize treatment plans and predict potential complications.
Using data visualization tools to create comprehensive patient profiles for informed decision-making.
Discuss the ethical considerations involved in using patient data for chronic disease management.

Answer
1. Introduction
Today, chronic diseases represent a major global health burden. The WHO has estimated that 60% of all deaths worldwide will be the result of chronic diseases by 2020. The treatment of such diseases is increasingly dependent upon the active involvement of the patient, with patient-centered healthcare and a focus on prevention being at the core of modern-day healthcare practice. Patient-centered healthcare is an approach to planning and delivering healthcare that is grounded on mutually beneficial relationships among patients, families, and healthcare practitioners. This represents an attempt to shift the general focus of healthcare practice from the traditional approach towards an approach where the patient is an informed and empowered decision-maker in their care. This is particularly relevant to developmental disorders such as Down’s syndrome and cerebral palsy, where medical interventions cannot increase functioning, and preventive management is critical. A great example of the focus on prevention is the American Down’s Syndrome Preventive Healthcare Guidelines. This is an incredibly detailed guideline that is aimed at preventing further decline of function resulting from complications of associated health problems, such as hypothyroidism or leukemia. This guideline assumes that regular monitoring and treatment of associated conditions will prevent decline in function. An informed patient or, in the case of childhood disorders, the informed parents, can regularly monitor these conditions, and so it can be said that current and future methods of chronic disease management will rely on the availability of health information to the informed patient.
1.1. Overview of chronic disease management
Summary Chronic diseases are currently the dominant form of health problem in the world. A non-communicable condition is defined as lasting for 3 months or more and generally cannot be prevented by a vaccine or rapidly cured. Chronic diseases can have a major impact on an individual by not only being a major cause of premature death but by affecting the person’s quality of life as they can be disabling, which can result in an inability to perform an activity, thus affecting the quality of life. Activity limitation can be common for people with chronic diseases and can have potential effects on the participation of work and, in some cases, be a reason for cessation of work. The level of severity of a chronic disease can vary from mild to severe and generally people spend a lot of time attempting to manage the disease. The management of chronic diseases will often involve attempts to prevent the condition from worsening, potentially resulting in complications which can lead to an urgent need for medical care. Symptoms or the condition itself can be the cause of a bio-psychosocial state that can be distressing for affected individuals (Murray and Lopez et al, 1996). This ongoing management of the chronic conditions is what would be classified as a complex continuing care case, where an individual would have a health issue that is non-curable and would require long-term assistance. This can vary from attempting to repair an activity limitation state to preventing major complications of the diseases. Often, the more complex cases will require an interprofessional team and can involve monitoring and changes to a person’s health regimen to determine what is the most effective form of long-term management of the condition, in turn attempting to prevent further progression of the disease. This may involve the person changing various aspects of their life in an attempt to find an approach to improve their health (Adams et al, 963). This approach to the assessment of the effectiveness of self-management of chronic diseases is known as the clinical assessment phase. This process must be done in a safe manner with minimum harm to the patient. All of the phases of continually attempting to improve a person’s health status with chronic disease are what is attempted to change the natural history of a disease into a more favorable outcome. This type of care is what is attempting to perform improvement illness care on the illness level, as opposed to acute care which generally aims to perform a cure or prevention of a disease.
1.2. Importance of human informatics
Another reason human informatics is vital to chronic disease management is because of the patient centered care and disease management philosophy of today’s health care organizations. Patient centered care is care designed to involve the patient in the process of medical treatment. It is a highly individualized care system with the goal of changing the patient’s health behavior. This is consistent with the coping process described earlier and is something that is best guided by information. The sinew of patient centered care is the frequent interaction between provider and patient aimed at making the best health decision for the patient. This is an interaction rich in information and the failure to provide the correct information at the right time can lead to a decrease in functional health for the patient and/or wasted time and money for the health care provider. Disease management is a more recent philosophy within the healthcare system. It is less a scheme or a distinct program and more an approach to how health care should be delivered to persons with chronic health issues. The aim of disease management is to increase the general health of those with chronic disease so as to avoid any decline in health and functional ability. This is to be attained through treatment and various health interventions. The first step is to understand the nature of the specific disease and what are the best interventions to improve health. Disease management is highly dependent on clinical research and it is there where evidence based medicine is often cited as a tool for making the best health decisions. Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.
The importance of human informatics can be pegged to the basic need of a chronic disease sufferer to cope with their disease. Coping is an interactive process involving the person and their environment. Information helps the person modify their environment and/or their interaction with that environment in a manner that better suits their needs. In the case of the chronic disease sufferer, they are seeking to cope with their disease in a manner that allows them to attain their level of desired function whilst minimizing the effects of the disease. Usually they are needing to adapt to a new set of bodily limitations and/or changes to their social and physical environment. This kind of coping process is highly dependent on information and a lack of appropriate information can lead to self-mismanagement and a decline in health. An acute care patient is seeking a fast and effective cure to their ailment. The treatment decision process for acute care is less dependent on information. Fast forward to today’s world of an exploding chronic disease population where 1 in 3 people in the US are dealing with one or more chronic health issues. The decisions chronic disease sufferers make regarding their health and treatment are more complex and involve weighing the costs and benefits of various outcomes over an extended time period.
There are tremendous human and financial costs that result from the mismanagement of chronic diseases. In the past twenty years, the information age has presented us with a variety of tools that can be employed to better manage chronic disease. These “information age” tools are varied and highly sophisticated ranging from telecommunications and the internet to an array of new diagnostics using DNA/RNA and advanced imaging. The common thread with all of these tools is that they are information based. The rise of these information age tools in many ways mirrors the rise of human informatics. Essentially, human informatics is the science of how best to use information to improve human health.
2. Data Collection in Chronic Disease Management
2.1. Utilizing patient-generated data (PGD)
2.2. Wearable devices for health metric tracking
2.3. Identifying potential issues through data collection
3. Data Analysis in Chronic Disease Management
3.1. Data analytics for personalized treatment plans
3.2. Predicting potential complications through analysis
3.3. Benefits of data-driven decision-making
4. Data Visualization in Chronic Disease Management
4.1. Importance of data visualization tools
4.2. Creating comprehensive patient profiles
4.3. Enhancing care coordination through visualization
5. Ethical Considerations in Chronic Disease Management
5.1. Privacy and security of patient data
5.2. Informed consent for data usage
5.3. Ensuring data confidentiality and integrity
6. Conclusion

Question
Based on the religion you selected in Module 1, and the articles you selected in Module 2, write a 3-4 page paper about the practices and beliefs of of that religion that are related to health. 
Provide examples of differences in verbal and nonverbal communication methods within this religion. Explain some beginning and end-of-life decisions related to this worldview and culture.
Provide examples of how religion shapes health behaviors and the rationale behind them.
Explain issues that health care professionals should take into consideration related to beginning and end-of-life transitions.

Answer
Practices and Beliefs Related to Health in a Selected Religion
1. Introduction
It has been said that health is wealth. And indeed, the belief that health is the most important aspect of life is a common one. Thus, it is not surprising to find that religion, which is an all-encompassing way of life, has much to say about the subject. In fact, to various religious groups, health is the most important thing to ask from God; it is health of body and mind that is viewed as the precondition to performing good deeds and meriting entry into paradise. For some, to have to ask for anything in the way of physical or mental well-being is a reflection of a lack of faith; God, who is the ultimate purveyor of healing, can heal all ills without exception. Therefore, the group which has to ask is in some way failing to fulfill the requirements set by God. But God is viewed as merciful, and it is written that if man shows thankfulness for what he has, he will be given more. And so it is that with prayer and dedication to religious duties, many believers strive to attain good health as a sign of God’s favor.
1.1. Background of the Selected Religion
Hinduism is the third largest world religion with about 900 million Hindus worldwide. In 1999, there were about 1 million Hindus living in the U.S. and they are concentrated mainly in two states, New York and New Jersey. Hinduism is not a religion of the book, and has no common scripture, Church, or doctrine. The term “Hinduism” is an exonym, and while it is a convenient label for the complex of traditions and peoples it describes, it also implies a measure of homogeneity that does not exist. During the ancient times of invasions and other historical events the Indian religion started evolving and taking shape. That is why the religion is so diverse and has different ways of practice and belief. A Hindu seeking spiritual knowledge can choose from yoga, jnana, bhakti, karma, and other paths, and can study anything from astrology to the holy scriptures. The main texts that provide the basis for Hinduism are the Vedas; this comes from the word “vid” meaning to be knowledgeable. During the invasions of the Muslim, the Muslims could not pronounce the word so said “Hindu”. This was given to the people who lived in this land. This was actually a geographical term and did not refer to the religion or the people living there. This went on to become the world’s third largest religion. Due to the many diverse ways of life, there are four castes in Hinduism based on occupation: Brahmins (priests), Kshatriyas (warriors), Vaisyas (farmers and merchants), and lastly Sudras (servants). In around 1000 B.C., the caste system was beginning to take shape with the addition of a group called the untouchables. The beliefs of the Hindu religion began to take shape with the incorporation of two great epics, the Mahabharata and the Ramayana, and the Bhagavad Gita (which is contained in part of the Mahabharata). These writings were an attempt to captivate the people so that they may learn from them and understand the true meanings of life in many different forms. This is why there were numerous stories and characters involved. The Gita is a conversation between Lord Krishna and Arjuna and aspires to reveal the duties of human beings and the unity between the universal and the personal. It makes this apparent through the paths of knowledge, devotion, and action which were explained earlier.
1.2. Importance of Health in the Selected Religion
In India, sages did a lot of research on medicine, which shifted attention from salvation to prevention of disease. This is evident in the philosophies found in the Atharva Veda, one of the four holy texts of the Hindu religion. Chapter 30, verses 25-35 of the Atharva Veda, contains the following dialogue, which illustrates the importance of health and the prevention of disease in the Hindu religion: “What has hurt you? In a state of disease, I ask, do you verily say that you are in health? How can one that is not afflicted with a malady, one that is afflicted and one that has rid himself of it be alike? O physician, thus should you ask the sick man and discern it all, if you are to recognize the nature of his malady. Any gentle remedy that harms not, does not affect or malady, is not a remedy at all.” This shows the importance of health and well-being, in that not having an affliction is comparative to the need of no remedy. This philosophy of preventing an illness so that there is no need for a remedy is deeply rooted and is still a common aim of physicians today. In this way, health is perceived as being extremely important, as it is seen as the maintenance of a diseaseless state and prevention of mental, physical, and spiritual agony.
2. Verbal and Nonverbal Communication Methods
2.1. Differences in Verbal Communication
2.1.1. Use of Sacred Texts and Prayers
2.1.2. Ritualistic Chants and Incantations
2.2. Differences in Nonverbal Communication
2.2.1. Symbolic Gestures and Body Movements
2.2.2. Ritualistic Clothing and Adornments
3. Beginning and End-of-Life Decisions
3.1. Views on Birth and Pregnancy
3.1.1. Rituals and Practices during Pregnancy
3.1.2. Naming Ceremonies and Blessings
3.2. Views on Death and Dying
3.2.1. Funeral and Burial Practices
3.2.2. Mourning and Grieving Rituals
4. Religion’s Influence on Health Behaviors
4.1. Dietary Practices and Restrictions
4.1.1. Fasting and Ritualistic Diets
4.1.2. Prohibited Foods and Beverages
4.2. Rituals and Practices for Physical Well-being
4.2.1. Meditation and Mindfulness Techniques
4.2.2. Sacred Baths and Cleansing Rituals
5. Considerations for Health Care Professionals
5.1. Cultural Sensitivity and Respect
5.1.1. Understanding Religious Beliefs and Practices
5.1.2. Avoiding Cultural Assumptions and Biases
5.2. Ethical Dilemmas in Beginning and End-of-Life Care
5.2.1. Balancing Religious Beliefs and Medical Interventions
5.2.2. Supporting Patients’ Spiritual and Emotional Needs

Questions
 Psychological principles are theories and beliefs about major areas of our lives, like cognitions, intelligence, social groups, habit,  
Answer
1. Introduction
Psychological principles are the basis of understanding human emotions, relationships, and motivation. They are building blocks to comprehend the complexities of human behavior. Psychological principles are a set of factors that help the psychologist explain the varieties of psychological behavior from the elements of those principles. Now let’s discuss the definition of psychological principles by differentiating both terms. Psychology is the scientific study of the behavior of the organism and the behavior to be understood must be observable and recordable. Therefore, psychology is the science which is more interested in the overt behavior rather than personality, where personality is the general pattern of the behavior and behavior changes between one situation to another and another person to another person. There must be some set of factors which will help us predict and control the behavior. Those factors are called psychological principles (Brewer and Treyens, 1981). According to different scholars, there are multiple definitions of principles but all revolve around the meaning that a principle is a set of interrelated variables which can predict behavior. So psychological principles are the guidelines for understanding behavior. These are comprised of higher-level abstractions to understand complex behavior (Eckensberger and Zimba, 1985). These are universal and cognitive concepts by which causal relations and predictions about behavior occurring in an organism can be identified (Craig, 1996). These principles involve constant relations between a situation, the behavior under that situation, and the consequences of that behavior. To understand these principles, psychologists have formulated different theories. So the one definition that sums up all the explanations on psychological principles is given by Charles E. Osgood: “Psychological principles are hypotheses that specify relations between two or more variables in the form of if…then.”
1.1. Definition of Psychological Principles
Psychological principles are statements explaining the behavior of people and the influence of behavior on the environment. These principles are built on scientific method, which is another way of saying the strength of the explanation and predictions of behavior. If the predictions are accurate ones, the probability of the acceptance of the explanation is high. If not, the opposite is true. The explanations of behavior that are to become principles are first tested through research, usually of an empirical nature. If the results provide evidence supportive of the explanation, the persuasion of other scientists will eventually test the similar explanation in their own setting. If each of these attempts to confirm the original explanation is successful, the explanation can be said to be a principle on the basis that it has strong predictability and has withstood a variety of conditions and circumstances. It is this high level of predictability and testing that distinguishes psychological principles from common sense or lay opinion about behavior. Common sense knowledge is usually vague, general, and not invalidatable. For example, it is often said that a lazy person will find the easiest way of doing something. This is not always the case; there are times, because of the individual’s intentions or the complexity of the task, that the easiest way just cannot be found. An example of an idea that is generally acceptable as true without significant evidence is that the reason people get aggressive after drinking alcohol is because it’s the alcohol “bringing out the badness inside”. This belief has been the justification for many unproductive treatments of aggression, while there is in fact little evidence to support it. In both cases, the lay opinion statement does not satisfy the strict criteria of a psychological principle.
1.2. Importance of Understanding Human Behavior
In the study of psychology, understanding why people behave the way they do is an area of great interest. It is important to have knowledge of human behavior because it is so vital to many aspects of our lives such as health. There have been so many advances in the field of health from past research in which the main focus was how to change unhealthy behaviors. In order to change a behavior one must first understand why a person is behaving in such a way. This is giving rise to a new field known as health psychology. Professionals in this field are trying to understand the various behaviors that are detrimental to one’s health such as drug use, overeating and unsafe sexual activity. A study from the Centers for Disease Control and Prevention identified the most common types of unhealthy behaviors that contribute to the leading cause of illness and death and by doing so have estimated that these deaths are preventable. This is just one example of how understanding human behavior is a crucial element to many important issues one might come across.
2. Cognitions
2.1. Cognitive Processes and Mental Functions
2.2. Memory and Learning
2.3. Problem Solving and Decision Making
3. Intelligence
3.1. Theories of Intelligence
3.2. Measuring Intelligence
3.3. Emotional Intelligence
4. Social Groups
4.1. Group Dynamics and Behavior
4.2. Social Influence and Conformity
4.3. Stereotypes and Prejudice
5. Habit
5.1. Formation and Maintenance of Habits
5.2. Breaking Bad Habits
5.3. Habit Loop and Behavior Change
6. Emotions
6.1. Theories of Emotion
6.2. Emotional Intelligence and Emotional Regulation
6.3. Emotional Development across the Lifespan
7. Motivation
7.1. Theories of Motivation
7.2. Intrinsic and Extrinsic Motivation
7.3. Goal Setting and Achievement
8. Personality
8.1. Theories of Personality
8.2. Trait Theories
8.3. Personality Assessment
9. Perception
9.1. Sensation and Perception
9.2. Perceptual Illusions
9.3. Influences on Perception
10. Attitudes and Attitude Change
10.1. Formation and Structure of Attitudes
10.2. Attitude Change Techniques
10.3. Cognitive Dissonance Theory
11. Social Cognition
11.1. Social Thinking and Attribution
11.2. Stereotyping and Prejudice
11.3. Impression Formation and Impression Management
12. Interpersonal Relationships
12.1. Types of Relationships
12.2. Communication and Conflict Resolution
12.3. Attachment Theory
13. Developmental Psychology
13.1. Stages of Development
13.2. Nature vs. Nurture Debate
13.3. Parenting Styles and Child Development
14. Abnormal Psychology
14.1. Mental Disorders and Diagnosis
14.2. Causes and Treatment of Psychological Disorders
14.3. Stigma and Mental Health
15. Applied Psychology
15.1. Industrial and Organizational Psychology
15.2. Health Psychology
15.3. Educational Psychology

questions
General Instructions
Advanced practice nurses apply continuous quality improvement (CQI) processes to improve client-centered outcomes. Select one of the following client-centered care initiatives that you would like to improve in your practice area: client clinical outcomes, client satisfaction, care coordination during care transitions, or specialty consultations for clients.   
Include the following sections:
1. Application?of?Course?Knowledge: Answer all questions/criteria with explanations and detail.
·   
a.  Identify the selected client-centered care initiative and describe its application to your future practice.  
b.  Select one CQI framework that can be applied to the selected initiative. Explain each step of the framework. 
c.  Describe how the framework can improve client-centered care for the selected initiative. 
d.  Describe how you would involve interprofessional team members in the CQI process.  

Answer
1. Introduction
Through the tumultuous climate of the United States health care environment, acute care has emerged as a focus of treatment. Advanced practice nurses (APNs) are progressively introduced into the system equipped with potent skills, sheer competence, and autonomy to provide excellence of service and care for the patients. APNs do not merely attend to the patients’ health illnesses and disease conditions but also investigate and implement plans for the prevention of illness and the promotion of healthier living. They strive to bridge the gap in quality of care available between conventional primary care and specialist services by creating a comprehensive care delivery system centered on the patients. Since the 1960s, patient-centered advanced practice nursing care has been the vision and hallmark of nursing practice today. APNs use their metaparadigm knowledge in application to care for patients and establish comfort and trust within the healer/healee relationship. Despite being trained in pathophysiology and the extant medical model, advanced practice nurses awaken each day with knowledge that the patient is a unique, dynamic individual, the locus of control for the nurse’s actions. Subsequently, plans to improve upon this type of care were investigated through the review of an article titled “Improving Client-Centered Care Initiatives in Advanced Practice Nursing”. This article examines 4 research-informed initiatives that have the potential to improve care outcomes and systems for APN care from the US and globally. That two respondents sought out to examine the advancement and outcomes of care systems truly indicates the spirit of APN initiatives for the betterment of society. Methodology involved examination of care systems in 2 different developed countries, comparing results to determine best efficacious methods and to incorporate ideas of quality care leadership into present and future initiatives. These initiatives are parallel to the moral and inner directive of all APNs and directly reflect how APNs would seek to improve care provided to themselves as clients. As a profession largely consisting of second career adults who are intrinsically motivated and often times highly advanced academically, APNs themselves are a unique client group and an often overlooked one at that. An aggregate systems theory serves to build frameworks and initiatives to improve care delivery for all types of clients, including the providers themselves. With a solid foundation of theoretical frameworks and research infusion, these initiatives serve to improve health, augment nurse and system outcomes, and change the face of nursing as we now know it. In an effort to align with the vision of a global society, the methods in which this research was initiated are undoubtedly impressive. An era of increased nursing professional involvement and participation in national and international policy has seen the development of nursing research and quality care initiatives based on evidence-based practice and utilizing comparative methods. This research is an exemplar and has the potential to shape future care systems both locally and abroad.
1.1. Background and Context
APNs practice has grown significantly over the years. This growth has been stimulated by the continuing shortage of physicians, the growth of managed care, and a clear and consistent, well-documented record of safe and effective practice. Managed care has evolved through models such as health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point of service (POS) plans. APNs are recognized for their ability to provide cost-effective care and are employed in a variety of settings to assist in cost saving measures. As health care reform is once again on the forefront of American politics, it is evident that APNs currently practicing or those that will practice in the future, must be prepared to navigate through and affect change within the complex health care system. This poses a profound challenge to those APNs who have been educated and honed their practice in a context largely removed from today’s health care system. It is a stimulation to define practice and move it closer to the ideals of APN and improve patient outcomes.
The first graduate program for advanced practice nursing (APN) (nurse practitioner, nurse midwifery, nurse anesthesia, clinical nurse specialist) was developed by the University of Colorado in 1965 (Dimeo, 2008). The program was established to prepare nurses in the primary care role to meet the needs of the medically underserved. At that time, the IOM had defined primary care as the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community (IOM, 1996). Primary care should be the first element of a continuing healthcare process and the system of family and community should be a partnership between the patient and the provider working to promote health and prevent disease. Primary care provider should be the coordinator for any specialty care or hospitalizations and the patient should be provided care that is cost-efficient and meets the needs of the patient. Today, APNs are providing primary care in outpatient and community-based settings, and have come closer to achieving these goals of primary care. They are educated to provide a full range of services to meet the needs of their patients.
1.2. Purpose of the Work
This comprehensive work was generated to improve “client” people-centered treatment initiatives within the context of advanced practice nursing. Towards that goal, the methods to improve client-centered treatment within a current APN practice were investigated. These methods are supported through amendments to the current system of care, use of direct and indirect clinical interventions, as well as involving clients in health education and promotion. The foundation for this work comes from research stating that Dimatatis et al. (1999) found that clients diagnosed with chronic conditions tend to be more compliant and satisfied with their treatment when they perceive the medical system to be more aligned with their own values and treatment preferences. This study serves to combine practice wisdom with scientific evidence to these ends.
2. Application of Course Knowledge
2.1. Selected Client-Centered Care Initiative
2.2. Importance of the Initiative in Future Practice
3. Continuous Quality Improvement (CQI) Framework
3.1. Selection of CQI Framework
3.2. Explanation of Each Step in the Framework
4. Improving Client-Centered Care
4.1. Enhancing Client Clinical Outcomes
4.1.1. Point 1: Implementing Evidence-Based Practices
4.1.2. Point 2: Monitoring and Evaluating Treatment Plans
4.2. Increasing Client Satisfaction
4.2.1. Point 1: Enhancing Communication and Education
4.2.2. Point 2: Addressing Client Preferences and Needs
4.2.3. Point 3: Ensuring Timely and Responsive Care
4.3. Coordinating Care Transitions
4.3.1. Point 1: Establishing Effective Communication Channels
4.3.2. Point 2: Collaborating with Interprofessional Teams
4.3.3. Point 3: Implementing Care Transition Protocols
4.4. Facilitating Specialty Consultations
4.4.1. Point 1: Identifying Appropriate Referral Criteria
4.4.2. Point 2: Streamlining Consultation Processes
4.4.3. Point 3: Ensuring Seamless Integration of Specialty Care
5. Involving Interprofessional Team Members
5.1. Importance of Interprofessional Collaboration in CQI
5.2. Roles and Responsibilities of Team Members
5.3. Strategies for Effective Team Engagement
6. Conclusion

QUESTION
How does culture influence cross-border M&A activity? Illustrate this relationship using examples, either real (even anecdotal if you have any) or conceptual. How do similar and dissimilar cultures affect pre- and post-merger performance?
ANSWER
1. Introduction
Organizational culture will not be the main focus of the study since its impact on M&A activity has been studied in depth in management literature. A holistic case study of the merger between the German company Daimler-Benz and US firm Chrysler will be used since this is considered a classic example of clash of national cultures. The inductive methodology used in the Daimler-Chrysler case will be initially used in the attempt to separate national culture from organizational culture and study its direct impact on M&A activity. Any findings and conclusions drawn from this case study will be initially tested against any theory provided in management literature. The aim in the end is to possibly come up with a new model explaining the impact of culture on M&A activity, which will be a useful framework for managers in the future.
In this research paper, the focus will be on studying the importance of culture in M&A activity. The objective of the paper is to separate the impact of national culture from organizational culture on M&A activity. The distinction between the two is important since national culture is considered an unmanageable force a firm encounters when it operates in a foreign environment, while organizational culture is a manageable force the firm can manipulate in order to coordinate and integrate activities when working with a potential partner.
Globalization has led to ever-increasing business activity across national borders. This has fueled the pace of cross-border mergers and acquisitions (M&A) in today’s global economy. Culture has been identified as a critical factor which has a significant impact on the outcome of international business activity. Cross-border M&A is an activity that takes place when a company from one country merges or takes over the assets of a company in another country.
1.1 Importance of Culture in Cross-Border M&A
Despite the prevalence of literature regarding the role culture plays in business, in particular cross-border mergers and acquisitions (M&A), it remains a relatively unexplored and underestimated factor in comparison to other theoretical lenses such as synergy or agency theory. It is widely recognized that national cultural differences are to be found in the differing thoughts, actions, assumptions, and a range of behavioral and material artifacts (Hofstede, 2002); all of which are key components of a society. That said, the fragmented and multidisciplinary nature of cultural theory development to date, it has yet to be fully integrated into M&A research and practice. However, there are various instances within the literature that infer assumptions to the effects of culture on M&A. For example, it is often cited as a reason for failure (Cartwright and Cooper, 1992), a costly barrier to be overcome during post-merger integration (Haspeslagh and Jemison, 1991), or a factor that should be included in the pre-acquisition screening process (Prahalad and Doz, 1987). While these examples bestow importance, it is not sufficient evidence to unequivocally prove it as a critical factor in M&A, and to date there is no defined framework or model that seeks to understand culture with respect to an entire M&A process. This is not to say cultural impact is always negative; a recent study by Stahl and Voigt (2008) identified that high cultural differences between two companies could lead to a lesser likelihood of bidder overpayment in an acquisition deal. However, the context of this result was within financial terms rather than the long-term integration process, and as aforementioned, this is not a widely explored area. With this considered, on the basis that culture is a central aspect of national identity, it can be viewed as a key and relevant aspect to any process involving two differing nations or organizations. This does not necessarily imply that any M&A between two differing national organizations will be heavily influenced by culture, for culture is a very broad and subjective concept, and there are varying levels of cross-border M&A; hence, the theory suggests that cultural impact will vary depending on the circumstance.
1.2 Objectives of the Study
The primary goal of this project is trying to figure out the impact of national and organisational culture on cross-border mergers and acquisitions, in the hope that better understanding of the influence of culture can help in avoiding some of the obvious pitfalls, and lead to successful integration which is the ultimate mark of a successful M&A activity. As this is an exploratory study, no hypothesis is put forward as it seeks to find new insights and information in the hope of forming a new theory. This has led to much of the research being in a more qualitative manner, although many questions do lend themselves to quantitative analysis. Measures of national culture provide a good base to look at the cultural issues, and matched-pair studies of companies involved in M&A activity can give good indications of the influence of culture on M&A and what actually occurs during the process. By looking at the level and nature of the increased M&A activity in the last 15 years, from the standpoints of both acquiring company and target firms, insights can be gained as to why the increase in M&A activity has led to mixed results, and how culture may be a key factor regarding this. Being an exploratory study, no specific culture dimension or issue is singled out, rather it looks at broad overall influence that culture may have at the national and organisational levels. A literature review is done on the failures and success stories of M&A activity, and there have been many case studies that offer comparisons such as two companies of different nationalities, one which has succeeded in M&A activity and one which has not. This provides much insightful data for the matched-pair studies and goes towards meeting the goals of this research.
1.3 Methodology
Another belief is that the culture of a society can be described by the values and norms present (Tayeb, 2000). Although it is possible to measure culture directly with various means, indirect measurement is probably the most effective, possibly using a society’s political or legal systems as a function of the culture it represents. Due to the breadth of values, norms, and the multi-level nature of culture, measuring the exact effects of culture on M&A activity is problematic and has only been extensively attempted by the very biggest firms in simulated training exercises. This encompasses a number of variables that would be best done by multiple means and at various levels, to provide a comprehensive understanding of the various issues involved. This too is evident throughout the research, as nearly all the micro-level events that created problems during M&A could always be related back to a difference of values or norms.
The research’s underpinning philosophy is the belief that culture affects behavior. This belief was supported by Yalcintas (1981), Guy and Beddow (1983), and Seth (1986). Yalcintas suggested that M&As were of an international nature and therefore present many problems in terms of differences in national policies, mentalities, and ways of doing business. Guy and Beddow and Seth also suggested that the variables of nationality and culture were of major import in M&A activity and provide one of the better frameworks within which to understand M&A behavior (Guy and Beddow, 1983; Seth, 1986 cited in Cartwright and Cooper, 1993). This belief was held throughout the EFA and case study and remained evident in the various responses received during the research, and some of the contradictions and practical problems that were found; each of which was possible to explain by cross-cultural differences. If we consider Schneider and Barsoux’s argument that cultural variation causes different mental programming, which creates ambiguity in cross-cultural encounters (Schneider and Barsoux, 1997), i.e. different behavioral patterns and an expectancy of behavior between parties in the M&A, the importance of effects of national factors and culture in M&A become more transparent.
II. Essay Summary
2. Theoretical Framework
2.1 Definition of Culture
2.2 Cultural Dimensions
2.2.1 Power Distance
2.2.2 Individualism vs. Collectivism
2.2.3 Masculinity vs. Femininity
2.2.4 Uncertainty Avoidance
2.2.5 Long-Term Orientation
3. Cultural Influence on Pre-Merger Performance
3.1 Cultural Due Diligence
3.2 Cultural Compatibility Assessment
3.3 Communication and Integration Challenges
3.4 Leadership and Decision-Making Styles
3.5 Employee Motivation and Engagement
4. Cultural Influence on Post-Merger Performance
4.1 Organizational Culture Alignment
4.2 Change Management Strategies
4.3 Employee Retention and Talent Management
4.4 Knowledge Transfer and Learning
4.5 Performance Measurement and Control Systems
5. Case Studies
5.1 Cross-Border M&A Success Stories
5.2 Cross-Border M&A Failures
5.3 Lessons Learned
6. Conclusion
6.1 Summary of Findings
6.2 Implications for Cross-Border M&A Practitioners
6.3 Recommendations for Future Research