The Sales Process Practice of Food and Drink SMEs - A Holistic Conceptual Framework: Steps, dimensions, barriers and enablers.

Purpose –The research examines the sales process practised by SMEs, and barriers and enablers that hinder and support effective selling practices from the selling organisation’s perspective in Scottish-based Food and Drink firms. Design/methodology approach - – The paper adopts an interpretivist perspective with qualitative data gathered through face-to-face semi-structured interviews. 20 people involved in selling activities were interviewed from 15 SMEs across Scotland. Thematic analysis established key findings regarding the sales process practice. Findings – Five themes emerged that affect the operationalisation of the selling process: the owner manager has considerable involvement in the sales process, SMEs with some degree of sales knowledge take a more systematic approach, SMEs lack awareness of how CRM technology can assist them, power is tipped in favour of the buyer and, the geographic location of the SME places constraints on how SMEs conduct business Research limitation/implication – Thematic analysis was chosen over other more traditional methods due to the lack of relevant quantitative data. The phenomenon of the research and research methodology means that it will not be possible to repeat this study and replicate its findings. However, the process that has been adopted does provide a basis for future research. Originality/value - The paper identifies areas where future research is required in the field alongside suggestions where policy makers and government business agencies might focus intervention to assist SMEs improve delivery of the sales process and selling effectiveness

Development of process control methodology for tracking the quality and safety of pain, agitation and sedation management in critical care units

Objective: To develop sedation, pain, and agitation quality measures using process control methodology and evaluate their properties in clinical practice. Design: A Sedation Quality Assessment Tool was developed and validated to capture data for 12-hour periods of nursing care. Domains included pain/discomfort and sedation-agitation behaviors; sedative, analgesic, and neuromuscular blocking drug administration; ventilation status; and conditions potentially justifying deep sedation. Predefined sedation-related adverse events were recorded daily. Using an iterative process, algorithms were developed to describe the proportion of care periods with poor limb relaxation, poor ventilator synchronization, unnecessary deep sedation, agitation, and an overall optimum sedation metric. Proportion charts described processes over time (2 monthly intervals) for each ICU. The numbers of patients treated between sedation-related adverse events were described with G charts. Automated algorithms generated charts for 12 months of sequential data. Mean values for each process were calculated, and variation within and between ICUs explored qualitatively. Setting: Eight Scottish ICUs over a 12-month period. Patients: Mechanically ventilated patients. Interventions: None. Measurements and Main Results: The Sedation Quality Assessment Tool agitation-sedation domains correlated with the Richmond Sedation Agitation Scale score (Spearman [rho] = 0.75) and were reliable in clinician-clinician (weighted kappa; [kappa] = 0.66) and clinician-researcher ([kappa] = 0.82) comparisons. The limb movement domain had fair correlation with Behavioral Pain Scale ([rho] = 0.24) and was reliable in clinician-clinician ([kappa] = 0.58) and clinician-researcher ([kappa] = 0.45) comparisons. Ventilator synchronization correlated with Behavioral Pain Scale ([rho] = 0.54), and reliability in clinician-clinician ([kappa] = 0.29) and clinician-researcher ([kappa] = 0.42) comparisons was fair-moderate. Eight hundred twenty-five patients were enrolled (range, 59-235 across ICUs), providing 12,385 care periods for evaluation (range 655-3,481 across ICUs). The mean proportion of care periods with each quality metric varied between ICUs: excessive sedation 12-38%; agitation 4-17%; poor relaxation 13-21%; poor ventilator synchronization 8-17%; and overall optimum sedation 45-70%. Mean adverse event intervals ranged from 1.5 to 10.3 patients treated. The quality measures appeared relatively stable during the observation period. Conclusions: Process control methodology can be used to simultaneously monitor multiple aspects of pain-sedation-agitation management within ICUs. Variation within and between ICUs could be used as triggers to explore practice variation, improve quality, and monitor this over time