week 4


After reading the journal article entitled The Effect of Mobile Marketing Design on Consumer Mobile Shopping, provide an overview and answer to the following discussion prompt:
1) Based on the article, what do you believe is the essential element of how mobile design influences consumer shopping?
2) Pick a mobile retail app of your choice as an example and relate it to the article. What of this mobile app design do you think this retailer does well to engage consumer shopping well? What could they do better?


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Hanlon_Digital Marketing_AW.indd 4 12/10/2018 12:55

Sara Miller McCune founded SAGE Publishing in 1965 to support
the dissemination of usable knowledge and educate a global
community. SAGE publishes more than 1000 journals and over
800 new books each year, spanning a wide range of subject areas.
Our growing selection of library products includes archives, data,
case studies and video. SAGE remains majority owned by our
founder and after her lifetime will become owned by a charitable
trust that secures the companys continued independence.

Los Angeles | London | New Delhi | Singapore | Washington DC | Melbourne

Annmarie Hanlon


Hanlon_Digital Marketing_AW.indd 5 12/10/2018 12:55

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Annmarie Hanlon 2019

First published 2019

Apart from any fair dealing for the purposes of research or private
study, or criticism or review, as permitted under the Copyright,
Designs and Patents Act, 1988, this publication may be reproduced,
stored or transmitted in any form, or by any means, only with the prior
permission in writing of the publishers, or in the case of reprographic
reproduction, in accordance with the terms of licences issued by
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outside those terms should be sent to the publishers.

Library of Congress Control Number: 2018966917

British Library Cataloguing in Publication data

A catalogue record for this book is available from
the British Library

ISBN 978-1-5264-2666-6
ISBN 978-1-5264-2667-3 (pbk)

At SAGE we take sustainability seriously. Most of our products are printed in the UK using responsibly sourced papers and
boards. When we print overseas we ensure sustainable papers are used as measured by the PREPS grading system. We
undertake an annual audit to monitor our sustainability.

This book is dedicated to Nick, who positively makes all things possible.

To my parents, who were there at the start but left before the ink was dry, Ar dheis
D go raibh a n-anam.

List of Figures viii

List of Tables xi

About the Author xiii

Acknowledgements xiv

Preface xv

Online Resources xvi

Part 1 Digital Marketing Essentials 1

1 The Digital Marketing Landscape 3

2 The Digital Consumer 24

Part 2 Digital Marketing Tools 49

3 The Digital Marketing Toolbox 51

4 Content Marketing 95

5 Online Communities 125

6 Mobile Marketing 151

7 Augmented, Virtual and Mixed Reality 181

Part 3 Digital Marketing Strategy and Planning 203

8 Audit Frameworks 205

9 Strategy and Objectives 225

10 Building the Digital Marketing Plan 249

11 Social Media Management 270

12 Managing Resources 294

13 Digital Marketing Metrics, Analytics and Reporting 309

14 Integrating, Improving and Transforming Digital Marketing 339

References 361

Index 386

1.1 A framework for analysing the pace of technology substitution 5
1.2 Application of digital disruption across industry sectors 13
1.3 Consumer-centric IoT business models 15

2.1 The scope of consumer behaviour 27
2.2 Technology Acceptance Model (TAM) 29
2.3 Typology of consumer communication (C2B/C2C) in the

digital age 32
2.4 Online customer service experience (OCSE) conceptual model 41

3.1 Digital marketing toolbox 54
3.2 Example of email marketing 56
3.3 Why email works model 58
3.4 Tweet from AdAge 69
3.5 ASOS off-page SEO 74
3.6 Model of blog success 81
3.7 The honeycomb model 84
3.8 Investing in social media 90

4.1 From keyword to long-tail keyword 98
4.2 The Furrow Russian edition 100
4.3 The Content Marketing Pyramid 105
4.4 Strategic content building blocks for awareness 106
4.5 Example of image used for brand awareness 107
4.6 Strategic content building blocks for conversion 108
4.7 Strategic content building blocks for retention 109
4.8 Paid, owned, shared, earned (POSE) media model 113
4.9 The TripAdvisor content gate 119
4.10 Example of targeted content by Superdry 120
4.11 Content themes and content promotion framework 121
4.12 The Content Maximiser 122
4.13 Examples on the vividness to interactivity scale 123

5.1 Example of London Northwestern Railway Trains use
of Twitter as a customer service channel 141

5.2 Key factors in online community management 141
5.3 Community lifestages model 144
5.4 Example of customer complaining behaviour directness 146
5.5 The place of social media in the customer complaining process 147
5.6 Example of double deviation by an organisation 149

6.1 The structure of an m-payment ecosystem 158
6.2 The elaboration likelihood model of persuasion 162


6.3 Mobile advertising effectiveness framework 164
6.4 How ad networks work to manage publishers,

applications and advertisers with an
advertisement library 166

7.1 Simplified representation of a
virtuality continuum 183

7.2 Technology Readiness Scale 186
7.3 Technological variables influencing telepresence 188
7.4 Lockheed Martin Mars Experience Bus 191
7.5 Typology of experiential value 194
7.6 IKEA VR kitchen app 195
7.7 Gatwick Airport augmented reality wayfinding

app using beacons 197
7.8 Conceptual model for an adoption framework for mobile

augmented reality games 199

8.1 Digital marketing audit in context 207
8.2 Ten Cs of marketing for the modern economy 209
8.3 Forresters 5Is 220

9.1 The TOWS matrix 230
9.2 The social media strategy framework 234
9.3 The acquisition, conversion, retention framework 236
9.4 The McKinsey consumer decision journey 238
9.5 Hierarchy of objectives 242
9.6 Business goals adapted into digital marketing objectives 243

10.1 The 9Ms of resource planning 258
10.2 Social media campaign planning process 262
10.3 Framework for digital marketing campaign objectives 263
10.4 Impact and effort matrix 268

11.1 Increasing levels of media richness 275
11.2 Classification of social media by social presence/media

richness and self-presentation/self-disclosure 276
11.3 Stage model of social media adoption 280

12.1 Line messaging system 296
12.2 The T-shaped web marketing skill set 297
12.3 The T-shaped web marketer 298
12.4 The Suitability, Acceptability, Feasibility (SAF) framework 304

13.1 Weak, acceptable and strong metrics 315
13.2 Flowchart of customer search loop 320
13.3 Example of web address using UTMs 325
13.4 When Facebook users are on site for a business to business

organisation 326


13.5 Strategic dashboard 334
13.6 Framework for the adoption and success of dashboards 336

14.1 Vanish Tip Exchange example 342
14.2 Communication goals 344
14.3 IMC conceptual framework 345
14.4 Example heatmap 350
14.5 Actual customer journey 352
14.6 Path to superior firm performance 359

1.1 Adopter categories and general characteristics 7
1.2 The move from traditional to digital marketing tools 10
1.3 Generational cohorts 11

2.1 Differences in customer acquisition for
traditional and digital consumers 28

2.2 Initial scale items for Perceived Usefulness and
for Perceived Ease of Use 30

2.3 Customer experience management 38
2.4 What we know about customer experience 38
2.5 Service blueprinting with examples 42
2.6 Aligning the customer journey and business strategy 43

3.1 Development of the digital marketing toolbox 53
3.2 Website purpose and function 61
3.3 Examples of HTML code 73
3.4 Personal data available via social media pages 84
3.5 The utility of social media for business 88

4.1 Content Marketing Strategy Framework 101
4.2 Content purpose blueprint 102
4.3 Digital persona elements 103
4.4 Storybox Selection 104
4.5 Content purpose blueprint and metrics 112

5.1 Timeline of online communities 128
5.2 Demographic features within online communities 134
5.3 Rules of engagement examples 142
5.4 How to manage different types of online complaints 148

6.1 Mobile marketing implications 152
6.2 Use of wearables for marketing 160
6.3 Mobile advertising options 163
6.4 Benefits and downside of programmatic advertising 168

7.1 Virtual and augmented reality timeline 184
7.2 Six dimensions of interactivity 189
7.3 Experiential value applied to retail examples of

virtual and augmented reality 194
7.4 Industry bodies 200


8.1 Customisation techniques 214
8.2 Reasons why customers make contact with organisations 216
8.3 Evaluation of British Airways current digital marketing methods 221
8.4 Digital PESTLE used as an evaluation of opportunities and threats 222

9.1 Themes and metaphors in marketing 227
9.2 Strategy models 228
9.3 Digital marketing strategy models 232
9.4 Application of the McKinsey consumer decision

journey to strategy 239
9.5 Business goals based on organisation type 242

10.1 Digital application of the 7Ps to ASOS and Boohoo 252
10.2 Strategy, digital marketing objectives and tactics 253
10.3 One-page digital marketing plan 254
10.4 Building the action plan 256
10.5 Digital media plan example 267

11.1 Overview of main social media platforms 271
11.2 Prominent features of the four social media tools 276
11.3 Summary of the 5C categorisation 278
11.4 Risk evaluation for an #AMA event 283
11.5 Social media monitoring and management tools 288
11.6 Midlands Air Ambulance Charity aligning the digital

marketing and social media strategy 292

12.1 The RASCI and RACI models 301
12.2 RACI roles and responsibilities example 302
12.3 Key considerations in the SAF framework 305
12.4 SAF framework scoring example applied to PetBnb 306

13.1 Twitter data 311
13.2 Metrics from traditional to digital 312
13.3 Financial KPIs 314
13.4 Metrics and how to apply them 316
13.5 Web analytic data elements 321
13.6 Social media analytics terminology 325
13.7 Email analytics data available 328
13.8 Management and dashboard systems 337

14.1 Message appeals applied to digital marketing 341
14.2 The 7Cs of integration 343
14.3 The 4Cs of cross-platform integration 348
14.4 Companies failing to adopt digital business 353

Annmarie Hanlon is a Senior Lecturer in Digital Marketing at the University of
Derby and a practitioner who works on digital marketing strategy and social media
projects with charities, household names and service businesses.

Originally a graduate in French and Linguistics, Annmarie subsequently gained a
Masters in Business Administration, focusing on marketing planning. She studied
for the Chartered Institute of Marketing Diploma for which she won the Worshipful
Company of Marketors award for the best worldwide results.

As an early adopter, working in online marketing since 1990, she is a Senior Examiner
in digital strategy, a Fellow of the Chartered Institute of Marketing, a Member of the
Marketing Institute Ireland and a Liveryman of the Worshipful Company of Marketors.
Annmarie is past winner of the Mais Scholarship and her research interests include
the strategic use of social media in organisations, differences in practice between
generations and the technology that makes it happen.

Follow her updates on Twitter @AnnmarieHanlon

Writing a textbook on digital marketing is achieved with a supporting cast of prac-
titioners and academics. As a hybrid part-academic and part-practitioner I am in a
wonderful and unique space with access to students as well as organisations of all
shapes. Whilst I would like to list everyone who has helped, this would be like the
never-ending speech at the awards ceremony! May I thank you all, you know who
you are #RoundOfApplause.

Special thanks are due to: Karen Jones at Aston University, who provided constant
motivation and helped with the content marketing and online communities chapters;
Adam Civval at Greendog Digital, David Peck at the University of Derby and Peter
Rees, an examiner in digital marketing, who all provided inspiration and ideas for
mobile marketing; Karl Weaver, the CEO of Isobar, who shared insights into program-
matic advertising; Richard Shambler, a long-established examiner in digital marketing
and an expert in the SAF framework; some of my former digital marketing students
now working in agencies and in-house: Joe Alder, Imogen Baumber and Jade Walden.

Thanks to those behind the scenes, including: Jonathan Saipe and Tracey Stern, who
deliver digital training at Emarketeers, Brian OKane at Oak Tree Press in Cork, who
inspired me to write my earlier practitioner books, Dave Chaffey, who encouraged
me to write a textbook, plus the plethora of anonymous reviewers who provided
fantastic feedback.

Translating the book from an idea to reality was made possible by the detailed
and dedicated SAGE team, ably managed by Matthew Waters, Delia Alfonso and
Jasleen Kaur.

Digital marketing is a journey that can take an organisation towards new markets,
discover new opportunities and protect the current landscape. In the digital marketing
journey you can choose to be a navigator or a passenger. As a navigator you explore
options, set the course and lead the way. As a passenger you can sit back and take
in the scenery or you can lean forward and advise the navigator.

Whilst digital marketing was established 20 years ago and is one of the fastest moving
and most exciting aspects of marketing today, there are fewer universities and colleges
providing digital marketing education. As a result there is still a lack of understanding
and fewer established frameworks to make it easier to adapt business practices and
adopt new ways of working. This book aims to provide that understanding and share
the latest concepts to apply in organisations, whether you are a student working on
a case study, or heading into your placement year, or juggling a part-time vocational
marketing module with work.

Students can think of this textbook as a digital marketing roadmap, a blueprint for
your digital journey, to enable you to become navigators rather than passengers.

The book contains three key parts. Depending on your knowledge you may start at
Part 1 or jump straight into Parts 2 or 3.

Part 1, Digital Marketing Essentials, equips you with a useful context to the digital
landscape. Discover the key concepts to understand how we arrived in this new world
and comprehend more about the changing digital consumer.

Part 2, Digital Marketing Tools, provides a rich source of the key components. It
starts with an overarching toolbox that explores all possible digital marketing tactics,
followed by more detail with dedicated chapters on content marketing, online com-
munities, mobile marketing and augmented, virtual and mixed reality. It is critical to
understand the tools available before embarking on a digital strategy.

Once you have comprehended the digital marketing tools, this is a good time to
explore Part 3, Digital Marketing Strategy and Planning. This part investigates digital
audit frameworks to ensure you are ready to develop the strategy and objectives,
before building the digital marketing plan. Newer issues, including social media
management, managing resources, digital marketing metrics, analytics and report-
ing, are included. The part concludes with methods of integrating, improving and
transforming digital marketing, enabling you to apply the knowledge and tools gained
though the chapters.

Enjoy the journey and lets start the campaign to create more digital navigators!


Head online to access a wealth of online resources that will aid study and support

teaching, available at: https://study.sagepub.com/Hanlon. Digital Marketing:

Strategic Planning & Integration is accompanied by:

Editable PowerPoint slides will allow you to easily integrate each chapter into

your lessons and provide access to figures from the book

Kahoot! quizzes will help you test students knowledge and understanding
of the materials

Instructor manuals for each chapter will provide further support when teach-
ing each chapter and encourage discussion in sessions

A digital marketing strategy and plan template can be used to help students
get their project off the ground

Downloadable templates can be added to course resources or printed out
for use in class

Follow the links to SAGE journal articles selected by the authors to help you

supplement your reading and deepen your understanding of the key topics
outlined in each chapter

Access links to helpful websites with lots of extra information to reference
in your assignments




1 The Digital Marketing Landscape 3
2 The Digital Consumer 24



When you have read this chapter, you will be able to:

Understand key issues in the digital landscape

Apply communications theories to a digital environment

Analyse technology change

Evaluate blockchain potential

Create a plan to become an opinion leader

When you have worked through this chapter, you should be able to:

Manage online reputation using third-party tools

Apply the search engines EU privacy removal process for unwanted content


The fast-changing digital landscape provides many opportunities for marketers. It is
important to understand key concepts such as ubiquitous computing and how the
pace of technology has changed. This chapter explains how traditional marketing
models like Diffusion of Innovation are still valid and apply to online opinion lead-
ers, as well as differences between generations.

We explore the meaning and impact of digital disruption and the Internet of Things,
with new business models emerging to understand how this applies to consum-
ers. In a world where your personal information has value, you can discover more
about big data and privacy issues that affect marketing plans. The last part of this
chapter considers bitcoin and blockchain and how this might influence the future of
data management.

The growth of digital marketing has changed the relationship between businesses
and customers. Scholars and practitioners agree that organisations are keen to use
digital marketing to engage with their customers and we have moved into a new era
where things look different.

The term ubiquitous computing was originally coined by Mark Weiser, who was head of the
Computer Science Laboratory at the Xerox Palo Alto Research Center (PARC) when writing in
Scientific American in 1991 (Weiser, 1991). At that time Weiser commented that in the future
there would be computers everywhere and we would not notice their presence; they would
just be there.

Some decades later, we have computers at home and with us at university; they are embed-
ded in our mobiles, wearables, in cars, in outdoor billboards everywhere. We have reached
Weisers vision that computers are integrated seamlessly into the world at large (p. 94).

One of the reasons for these trends and the change in the digital landscape is due to
the acceleration in the adoption of new technologies. It took more than 50 years for
over 50% of US households to adopt telephones (imagine life with no phone!), nearly
20 years to adopt home computers, yet it took less than 10 years for the same group
to adopt smartphones.

In a pre-digital age, you booked a holiday by visiting the travel agents on the high
street. It was only on arrival at your holiday destination that you saw what the hotel
really looked like. Today you will go online, read reviews, see traveller photos or
holiday snaps others have shared and ask questions of people who have actually
visited the destination IRL (= in real life).


Writing in the Harvard Business Review, Ron Adner and Rahul Kapoor (2016) explored
the pace of technology substitution and suggested that the speed of replacement was
based on ecosystems. Old technology ecosystems may find product extension oppor-
tunities whereas the new technology ecosystems need to counter these challenges.
Within their framework there are four quadrants, as shown in Figure 1.1, which can
be described as:

Creative destruction, where there are few challenges to the new tech and few
opportunities for the old tech, resulting in fast substitution.

Robust coexistence, where the old tech fights back and brings out alternatives
and a gradual substitution takes place.

Illusion of resilience, where the new tech moves in with few challenges.

Robust resilience, where old tech fights back and new tech challenges, bringing
about a gradual substitution.












































IN THE 1990S






Figure 1.1 A framework for analysing the pace of technology substitution

Source: Adner and Kapoor, 2016, p. 66


It could be argued that there are limitations to this framework as the research was
based on a five-year study in the semiconductor manufacturing industry and adop-
tion of new products is not always based on product desire, but also availability.
In some countries it is harder to get a landline phone than a mobile. The landline
requires wires and major investment whereas a mobile network is simpler to deploy.
At the same time, growth in landline telephone ownership is declining sharply, espe-
cially in the G12 industrially advanced nations. Explore the latest statistics on the
Telecommunication Development Sector (ITU-D, 2017).

Activity 1.1 Analyse Technology Change
1. Working in groups, use Figure 1.1, the framework for analysing the pace of technology substi-

tution, to analyse the types of technology changes that you have witnessed in your lifetime.

2. What were the greatest changes?

3. Why was this?

4. Are there any difficulties ensuring all four quadrants in the framework are included?

How do we learn about new products or what influences our judgement to adopt new
technology? In 1944 sociologists and behavioural scientists Paul Lazarsfeld, Bernard
Berelson and Hazel Gaudet conducted a study to see how mass media affected voters
in the US election campaign for President Franklin Roosevelt (Lazarsfeld et al., 1944).
The surprising result of their research was that it was influencers, or opinion leaders,
not the media, that had the greatest impact. Influencers, who received the messages
from what at that time were mainly traditional newspapers and radio, shared this
with their followers.

The research was further developed by Paul Lazarsfeld and Elihu Katz who named this

the two-step flow theory of communications (Lazarsfeld and Katz, 1955) where the

media communication was received by the influencer and then passed to other


There were limitations to the two-step flow theory of communications. It was based on
one piece of research, which meant that it was not necessarily generalisable to other
situations. It may be that this was a set of exceptional circumstances that could not be
repeated. Another issue is that it was a simplistic binary model which assumed that this
is how mass media worked. As a result of these limitations, the model was extended
from two to multiple steps (the multi-step flow), which was developed by John Robinson
(Robinson, 1976) and was used as a basis for other communications theories.


A key aspect of the digital environment is that we have moved from two-step or
multi-step to a totally different understanding of communications with newer models
emerging, such as media richness (see Chapter 11, Social Media Management) and
uses and gratifications theory (see Chapter 13, Digital Marketing Metrics, Analytics
and Reporting), although at the same time some much older theories, such as diffu-
sion of innovations, have remained valid.

In 1962 Everett Rogers published a book entitled Diffusion of Innovations, which was based on
the two-step flow of communications and explored the conditions that increased or decreased
the likelihood of product adoption.

In this model, based on how a product gains momentum and spreads or diffuses through
a group, Rogers proposed five adopter categories (1) innovators; (2) early adopters; (3) early
majority; (4) late majority; (5) laggards which considered the time at which an individual
adopted an innovation.

The five adopter categories were ideal types fabricated to make comparisons, and Rogers
recognised these generalisations. There was criticism of the terminology no one wanted to be
considered as a laggard, which was perceived as being a negative label. Table 1.1 shows some
of the general characteristics identified, which I have adapted to apply to digital marketing.

The one notable category is that early majority were seen as opinion leaders, an idea
which was identified in the two-step flow theory of communications and which reverberates
within digital marketing as organisations strive to seek those to influence product adoption.

Table 1.1 Adopter categories and general characteristics

Adopter category General characteristics % adopters of innovation

(1) Innovators Active information seekers, often
buying the latest gadget who
in class has a pair of Snapchat


(2) Early Adopters Opinion leaders who are happy
adopting new products, seeking
information before others whose
opinion do you seek in class when
buying gadgets?


(3) Early Majority Deliberate before adopting
active blog readers who like to
gather evidence before deciding.


(4) Late Majority Sceptical and nearly the last
to adopt they may still own a
feature phone.


(5) Laggards Suspicious of inventions and only
adopt when no choice perhaps
the one remaining lecturer with no
mobile phone!



Rogers generalised that opinion leaders (see Key Term) were more cosmopolitan
than their followers. One prescient observation from Rogers was that opinion leaders
needed access to mass media and had to be accessible. Think about those opinion
leaders with mass followers on YouTube and Twitter they meet these conditions.

Opinion formers are formal experts. They work in this area, may be qualified or professionally
trained and have significant specialist knowledge about the subject.

Opinion leaders are informal experts who carry out research and whose knowledge is
valued amongst family, friends and followers.

As Lazarsfeld, Berelson, Gaudet, Katz and Rogers observed, the opinion leaders, or
influencers, are key to spreading the word about new products and services. These
influencers are generating an income from their online following and, according to
Forbes.com (OConnor, 2017), a paid-for social media post can be very lucrative, with
fees of $25,000 paid to a top yoga teacher (e.g. Rachel Brathen) for their endorsement
or $3000 to $5000 paid to a recognised fitness instructor.

The fees can be higher for specific social media platforms where they have greater
numbers of followers and fans, for example:

$300,000 for a YouTuber with 7 million subscribers or more

$200,000 for Facebook

$150,000 for Instagram

In our digital age, as celebrities charge more and more to promote brands, brands
are turning to alternatives. We have seen the development of a new type of opinion
leader, the micro-influencer. Forbes.com suggested that an Instagram user with
100,000 followers can command $5,000 for a post made in partnership with a com-
pany or brand (OConnor, 2017, p. 1).

Carol Scott, whilst director of marketing at a specialist influencer company, described micro-
influencers as everyday individuals with small, dedicated followings online (Scott, 2016, p. 1).

Writing in Adweek, Emma Bazilian provided a profile of a female millennial micro-
influencer: typically aged between 18 and 34 with 2000 to 25,000 Instagram followers,
attracting an engagement rate of 3% and higher. Their key topics were fashion,


beauty, travel or fitness (Bazilian, 2017). Bazilian added that the brand marketers
could employ these micro-influencers to promote and increase product and brand
awareness and specifically to:

Seed products

Promote sample products

Share unbox videos

Create how to videos

Develop day in the life of

Share trending content

Attend events

Promote discount codes

Host product competitions

Smartphone Sixty Seconds
Evaluate Your Influencers
On your mobile phone search for your favourite influencers. You might follow them on Instagram but
they may have additional social media profiles too.

Find all their online profiles.
Add up the number of followers on each.
Find a sponsored post and share with classmates.
Try to figure out what they were paid for the post and what impact you think it had.

Case Example 1.1 Eltoria Influencer
Eltoria is the alter ego of Simone Partner and, as an influencer, Simone is not an IT girl or someone
who has a famous dad. She had a very different starting point and is a law graduate from the Uni-
versity of Reading, where she gained a 2:1 degree.

In the last year of studying law, Simones course included one non-law module and she opted for
entrepreneurship and for her assessment started the Eltoria UK fashion and lifestyle blog based on
her interests. At the time she was working at the organic skincare firm Lush. She enjoyed the module,
which was evidenced in her results a first-class grade. After university she pursued a career in law
and her first job was in a big commercial firm, which she didnt enjoy, so she tried a smaller legal firm.
However, in both firms she discovered that law was not a career in which she felt she could work for



the rest of her life. Having continued with the blog and subsequently winning many awards, Simone
realised that it could be a career option. The awards allowed Simone to take some time off and focus
on the blog to see if it could work.

Today Simone has generated an impressive following on YouTube, Instagram, Facebook and
Twitter. She is not the average fashion blogger: shes intelligent, her content is well written, with great
depth and analysis. Having been at university, she has had typical student jobs in retail stores and
understands the challenges faced by those who are working and studying. This may be one of the
reasons that she is popular with university students s


Systems Thinking in Long-term Care

Created by Izabela Kanzana, DNP, RN
As an Advanced Practice Registered Nurse in a Long Term Care (LTC) facility you provide care to 10 residents on Unit A. Every time you are on that floor during lunch time the majority of residents are sitting in wheelchairs and eating their lunch at tables in the dining room. You have looked at several research studies that point to inactivity of residents as a major risk factor contributing to disability and the relationship between increased walking activity and higher functional performance and quality of life. You are curious whether those residents have severe physical limitations keeping them from walking. Your facility has a Walk to Dine program, led by the facilitys restorative nurses. How many residents are able to walk? Is it safe for them to walk? When do they walk? Who assists them with walking? How far do they walk? You are motivated to engage in a project as you have identified an important practice problem. Because the evidence is strong that physical activity is the solution, you know that a QI project to implement the evidence into the process on your unit is the right way to go. The Medical director agrees with you that walking has potential benefits even in LTC.

1.Who would be on your QI team? Which members will be the most important to interview?You know that restorative nurses are in charge of Walk to Dine program for residents. You interview restorative nurses and they do not know how many residents are enrolled in Walk to Dine program. They do not know how often residents walk to meals and how far residents walk.
2.What would be helpful baseline data?
3.What might your goals be for your improvement project?

Read the above Case Study: A Case Study Highlighting Systems Leadership and Systems Thinking in LTC, on page 57 in your text, Leadership and systems improvement for the DNP. Armstrong, G., Sables-Baus, S. (2019) Springer Publishing.
Answer the questions (1-3) in an effort to design the QI project.

Searching the Literature
You searched the literature and found strong evidence that walking patients in LTC leads to better outcomes. You also find in the literature search evidence of key implementation strategies that support walking in LTC residents:

Staff education (Galik et al., 2013; Slaughter & Estabrooks, 2013)
Monitoring (Slaughter & Estabrooks, 2013)
Mentoring and motivating (Galik et al., 2013; Taylor et al., 2015)
You contacted your colleague in a different LTC facility and they successfully implemented a walking program designed by the Vanderbilt Center for Quality Aging (Schnelle & Simmons, 2013).
Context for the Improvement:
You assess Unit As readiness for a change using the organizational readiness to change survey. To understand the causes of the low participation in the Walk to Dine program, you collect information from all the stakeholders. The following data surfaces:
Unit A is sometimes understaffed
CNAs turnover is high
There is no clear workflow process of walking a resident from an activity to a meal
There are not enough walkers for residents who can ambulate with a walker
A third manager was hired within last 2 months and is still getting oriented
Family members request wheelchairs for residents to take residents to meals
Many residents have dementia and they tell you they were assisted with walking even though you are told by staff they did not walk
Two restorative nurses are in charge of the Walk to Dine program in the entire facility (230 beds)
CNAs think that it is restorative staff function to provide walking activity to residents
There is no log to track who walks to meals
No one knows which residents are able to ambulate to meals
There is no clear process for identification of residents who want to walk to meals
There is no monitoring in how the residents that ambulate to meals tolerate the ambulation”


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