National Health Service (NHS): An Overview
The NHS was established in 1948 with the aim of providing health care for all people, based on the requirements and not the capability to pay. It is comprised of a wide variety of healthcare professionals, support human resources and organizations.
The NHS is financed by the taxpayers and is as a consequence answerable to the British Parliament. It is run by the Department of Health. The health department delineates the comprehensive health care policy in Britain, and is the headquarters for the NHS and is answerable to apply healthcare policies into practice. It also establishes targets for the NHS and monitors performance by means of its several directors of health and social care.
Just about one million people are employed in the NHS and it invokes a cost of over Pound50 billion annually to function. Regional assemblies manage healthcare services in Scotland, Wales and Northern Ireland. The aim of NHS is to produce the highest level of physical and mental health care for all people, within the stipulated resources by:
* Promoting health and the prevention of ill-health
* Diagnosing and treating injury and disease
* Supporting those with a critical illness and disability
At the time of its creation, the NHS had a budget of Pound437million. In 2008-9 it was allocated over 10 times that amount. This was equal to an average increase in expenditure over the full 60-year time period of about 4% annually when inflation has been considered. Nevertheless, of late investment levels have been doubled to finance a major modernization program.
Just about 60% of the NHS budget is utilized to pay staff. An additional 20% is allocated for drugs and other medical supplies, with the rest 20% is divided amongst buildings and fixtures, equipment and training expenses on the one hand and medical equipments, catering and cleaning on the other. About 80% of the total budget of NHS is distributed by local trusts in proportion to the specific healthcare preferences in their domains. The money to finance the NHS comes directly from taxes. In accordance to independent agencies for example the King`s Fund, this continues to be the “cheapest and fairest” manner of sponsoring health care in contrast to other systems. The 2008-9 budgets approximately similar to a donation of Pound1,980 for each person in the United Kingdom.
Its Organizational Structure
The Department of Health supervises the NHS. The secretary of state for health is the head of the Department of Health and reports to the prime minister. The Department of Health manages UK`s Strategic Health Authorities (SHAs), which control all NHS activities in the UK. As a consequent, each SHA controls all the NHS trusts in its field. The decentralized management of Scotland, Wales and Northern Ireland operate their local NHS services. The NHS is altering the way it is functional to ensure that patients are preferred. The diagram below shows the NHS organizational structure.
Department of Health
This department assists the government to enhance the health care and the welfare of the population. The Department of Health has of late initiated a program of change, aimed to ensure they offer leadership to the NHS and social care. The Department is answerable to:
* Creation of an overall direction and leading changes of the NHS and social care
* Creation of national standards to enhance the quality of services
* Protection of resources and making investment decisions to make sure that the NHS is able to offer services
* Collaborating with key associates to ensure quality of services, for example: Strategic Health Authorities, who would become the local headquarters of the NHS
This is the care offered to the individuals who would generally see their first health problem. This may relate a visit to a physician. NHS Walk-in Centers, and the telephone line NHS Direct, are also sections of primary health care. All the people offering primary health care are now run by new local health organizations known as Primary Care Trusts (PCTs).
Primary Care Trusts
PCTs are new local health organizations given the management of health care services. They collaborate with local authorities and with other departments that offer health and social care locally to ensure the community`s requirements are being fulfilled.
PCTs are now at the forefront of the NHS and would obtain 75% of the NHS funds. As they are local organizations, they are in the best place to identify the requirements of their community, so they can ensure that the organization providing health and social care centers is working efficiently. They are also given the responsibility for making health and social care systems working for the welfare of the patients.
Higher Education & the Work Environment Leadership & Management: An Introduction
The NHS Plan and a healthcare service for all the talents give emphasis to those immensely large human resources trained to work in very diverse manners would be needed to build a `modernized` healthcare service. Providers of healthcare and social care education would have to espouse various challenges.
There are also a lot of difficulties experienced usually all over higher education in reaction to the effects of new technologies, improved participation occurrences, modified legislations, the effects of research and teaching evaluations and coping successfully with diversity in the organizations. Accomplishments would be conditional significantly on efficient leadership and management by a rather few senior health and social care education leaders spread all over many organizations.
One of the difficulties in the medical education field is that a lot of leaders are about to retire, and succession planning is limited. There are no especially customized programs to create new educational leaders who are capable to work at the improved interface between higher education and fast changing healthcare and social services in the organizations. The project was intended to deal with this vital need. Current health and social care leaders are quite familiar to change management in the organizations. Medical institutes have planned and executed new curricula in the institutions.
Some global programs support the improvement of management and leadership skills. For example, Harvard Medical School operates, with Harvard Business School, the `Harvard Macy` program for leaders in healthcare education, which were attended by the medical leaders.
In the NHS there is at present great stress is laid on the growth of leadership skills, for instance with the creation of the clinical leadership center and programs. An outline for lifelong learning for the NHS gives stress to how good leadership and management are considered critical to improve all features of health care. The same is valid of health and social care education where the advantages of efficient leadership distributed primarily to the students and then to their potential customers.
The project consequently puts much stress on the development of leaders who can efficiently run educational institutes that include the interface between higher education, the health and social care fields. This would necessitate an understanding of the particular outline together with a receptive and flexible method to the dual requirements of higher education and health & social care. This project links to the priorities in subjects related to medicine, for human resources, in medicine for setting up of systems for managing & quality control, and in nursing for management of practice learning.
Incorporating the project into the higher education
One of the key objectives of the project is to set up a leadership development program for prospective leaders that fulfills the requirements of health and social care education and that is sustainable in the medical field in the long term. NHS has been dynamic in working closely with various national organizations to promote the program and explore methods in which the program. One of the methods being discussed is that the final version of the program would be presented and applied to institutional staff development programs and to assist institutes in succession planning for leaders in health and social care education.
Many leaders in healthcare education and professionals in management and leadership have been engaged in this program as a result of involvement in the residential and one day events. NHS involved in with those people who are at present professionals in educational leadership in addition to specialists in different features of leadership and management to provide detailed knowledge and help to create a discussion forum for participants. NHS plans over the final stages of the project to engage other individuals, especially those offering social care programs in addition to medical and healthcare education.
Leadership & management issues in NHS
There is a constant and fast reformation in British health and social care that has been undertaken by many professionals in the field for new and challenging roles. A number of these analysts are not trained or experience in coping and dealing with these changeovers and it is consequently vital that ample and devoted education be offered in this field. In the NHS, medical staff is growingly being needed to carry out managerial tasks, the responsibilities of which are not essentially part of their fundamental training (Empey, Peskett & Lees 2002). Moreover, clinical leaders generally have problems in dealing with dual roles as they can be easily unfocused as a result of operational requirements and contradictory preferences.
Different basic and applied prospects for management training are accessible via formal educational institutes, internal activities and private companies. On the other hand, a handful of formal and devoted leadership training prospects does exist.
Leadership development in the NHS has always been unplanned and irrational with fewer clinicians in leadership roles and too few prospects for ordinary members to create leadership competencies. That would now likely to change (NHS 2000).
Management and leadership are two different roles, at times contradictory to the objectives and functions. Simpson and Calman (2000) suggest that there are three ways for learning to be a leader as a result of test and trial, creation of relationships, and education.
Formal leadership education needs to begin medical school. `Tomorrow`s doctors must be fully equipped to take on leadership roles with enthusiasm and confidence` (Simpson & Calman 2000, p. 211).
A number of writers doubt whether leadership can be `taught` in any way (Washburn 1998 Zaleznik 1977). `There is no known way to train great leaders` (Zaleznik 1977, p. 68). Irrespective of this debate, the principles of management training cannot evidently relate to leadership education. If leadership education is to appear as recognized developmental activities, significant focus is given to the disparities between management and leadership and the role and challenges experiencing the leaders.
Following paragraphs would deal with concepts of leadership and would explore different leadership concepts in medical fields.
Definition of leadership
Yukl (2002) describes that leadership is generally mistaken with the concepts for example power, authority, management, administration, control and supervision. Nevertheless, the quintessence of the leadership role and procedure is to motivate, develop and give power to followers.
`Leadership is the process of influencing others to understand and agree about what needs to be done and how it can be done effectively, and the process of facilitating individual and collective efforts to accomplish the shared objectives` (Yukl 2002, p. 7).
Vroom and Jago (2007) defined leadership as a `process of motivating people to work together collaboratively to accomplish great things` (p. 18).
The NHS (2002) defines the role of leaders as to:
* Advance patients` care, treatment and experience
* Support a healthier population
* Improve the NHS`s standing as a well-organized and responsible organization
* Inspire and develop the workforce.
Grint (2000) maintains that there would be no leaders without supporters, and the relationship between the two necessitates a feeling of community. Successful leadership qualities necessitate a clear strategic visualization that corresponds with the community. The leaders must be capable to create and sustain confidence amongst the community, however also query the implicit aims and objectives and the procedures (Bennis & Nanus 1997).
Bennis (2007) – an authority in the research on leadership -a critical threat being faced in the contemporary world at present is the need of successful leadership of the organizations. In fact, Lipman Blumen (2006) has drawn focus to the let down of leadership in various health care and financial institutions. Health institutes and medical schools alike other human institutes are in need of capable and successful leaders now specially to tackle the risks and challenges of the contemporary business world (Bisbee 2007 Zaccaro 2007).
Leaders experience many challenges in healthcare and medical education organizations (Taylor et al 2008 Minvielle 1997 Wharton 1987). Educational leaders are under examination to realize increased expectations for advancement in teaching and learning. Leaders are given the task to draw focus to the cultural aspects that obstruct organizational learning, to make sure that the organization can prevent controlling the signs rather than primary causes. Leaders are required to create procedures by which problems can be outlined and ways in which member of the organization can communicate the realities (Berthoin Antal, Lenhardt & Rosenbrock 2001).
Kets de Vries (1980) states that emotions in various organizations are generally subdued, suppressed or eliminated – considered to be sidetracked the `real` business of the company. Nevertheless, `the consequence of this attitude is that ritualistic activities and rationalization of behavior seem to be the norm and have become the most acceptable ways of dealing with the routines of management` (Kets de Vries 1980, p. 2).
The significance of emotions is typified through the evidence of stress-related situations, for example untimely death of leaders, output troubles, worker incompetence, labor revenue, strikes and absence.
There is a need for better identification of the causes and rationales for individual and organizational activities, and computation of the emotional costs of corporate life. This might bring about the notice of the limits of prudence in organizational life. Kets de Vries (1980) claims that everybody in the organization has the capability for this kind of learning – nevertheless, there is a pressure to adhere to past learning behaviors. This creates a disregard of dependence, friendliness, resentment, shame and culpability. Good leadership necessitates correspondence between internal principles and external realities – the greater the differences, the better the need to perform power. Leaders have the prospects to become mistrustful – if this paranoia becomes pathological – as a result of delusions of splendor or fears of harassment – it can be self disparaging to both the individuals and the organizations.
In a later work, Kets de Vries and Miller (1984) suggest that companies can be fearful – obsessed, neurotic or depressive. At times these fears depict the leadership style from the top hierarchy, which affects the whole organization. The fear then risks the health and eventual sustenance of the organization.
Change management is a field where efficient leadership is vital to efficient organizational development. Change requires more effective leadership competencies and many organizations have troubles adjusting to various changes (Kotter 1990). The capability to organize a change is a significant feature of a transformational leader. Transformational leaders must be futurist, practical, resourceful, novel and helpful for various outlooks (Empey, Peskett & Lees 2002).
MacFarlane et al (2002) analyzes a complex change management project, engaging relationship between various North London medical schools to create community-based characteristics of the undergraduate medical curriculum. Amidst several problems like, organizational stress, role boundaries and contradictory objectives, leadership stress was one of the key factors which helped in the success of the change management project. Leaders were mistaken about the objectives of the project, which pervaded in the various organizations. Moreover, administrators were then perplexed concerning the priorities of the project. MacFarlane et al (2002) suggest that at the launching of a change management project, a successful leader is needed – a magnetic personality. The needed skills and capabilities then change in relation to the ensuing development and sustenance of the project. There should be attention to this growth otherwise the objectives of the project can become obscured and disagreements can occur.
Goleman`s (2000) research study implies that leaders, who realize the best outcomes do not depend on one leadership style, however integrate several styles impeccably conditional upon the circumstances at hand. Leaders can realize this by creating a team with members who utilize the styles that the leader is deficient, or by developing one`s own leader style gamut.
In various stages of organization, several types of leadership styles are suitable. In a developed culture, for example the NHS, leaders need to prevail over limiting cultural presumptions. Declining cultures may be found on behaviors which were earlier suitable, however are no more applicable now. Leaders must take into consideration variations in external circumstances, deliberate on them and react positively. In case, if an organization does not adjust to the changing circumstance it will collapse. A leader must be capable to encompass limits, and be cognizant of subsidiary sub-cultures and the dominant cultural framework.
With the aim of developing as a leader, it is significant that there is a learning culture where the resources of the organizations are allotted for the development and learning is appreciated (Yukl 2002). Moreover, leaders in learning cultures must endorse that their own knowledge and skill is limited and therefore support a common responsibility for learning. Therefore, a leader should know a culture prior to trying to alter it, have a clear vision for it and yet be flexible to various viewpoints, embrace disagreements and admit oversights.
Kotter (1996) suggests an 8-stage procedure for leading change:
1. Create a sense of urgency
2. Create a guiding partnership
3. Create a vision and strategy
4. Convey the change vision
5. Authorize workers for broad-based activity
6. Create short-term success
7. Reinforce gains and create more changes
8. Support new methods in the culture
Schein (1985) suggests that organizational leaders generate learning cultures by identifying and compensating suitable behavior by means of managing and controlling uneasiness. As such they must look introvert and analyze their own presumptions. Specifically the dominant cultures may show a leaders` own presumptions, including their fears. Schein believed that leaders must feel easy within their own deficiencies and be flexible to diverse experiences.
`We cannot achieve the cultural humility required to live in a turbulent culturally diverse world unless we see cultural assumptions within ourselves. In the end, cultural understanding and cultural learning start with self-insight` (Schein 1985, p. 392).
Empey et al (2002) states that efficient leadership should include different aspects concerning knowledge, skills and means and distinctive features and outlooks.
Berthoin Antal et al (2001) suggest that personal features are considered as more significant sign of efficient leadership than an actual job depiction. Personality characteristics, for example commitment to specific issues and the capability to create distinct relationships between various outlooks and targets, have significant impact on the efficiency of a leader.
There is an argument that, though personality traits are significant pointers of successful leadership, situational variables have the capability to restrain the correlation between characteristics and efficacy. The individuality of the supporters, the character of the work, the type of organization and the type of the outside environment all affect what would be thought to be the most suitable leadership style (Yukl 2002). Kotter (2001) also suggests that personality is not essentially a sign of successful leadership.
Leadership versus management
Management and leadership have different roles which necessitate distinct characteristics and working. Despite the fact the roles are generally conflicting, they are harmonizing – one cannot operate without the other aspect. Managers of the organization generally support stability whilst leaders support change (Kotter 2001).
Kotter (2001) states that leadership creates a direction as well as a vision for the future. Nevertheless, management is more related with planning which is deductive and methodical, not a process of creating a change. Planning should supplement directed environment. Kotter suggests that the American companies are over-managed.
`One of the most frequent mistakes that over-managed and under led corporations make is to embrace long-term planning as a panacea for their lack of direction and inability to adapt to an increasingly competitive and dynamic business environment (Kotter 2001 p. 87).
Kotter (2001) states that the companies should not wait for leaders to happen however should look for them and create their potential. Hence, formal leadership education and training should be of great significance to contemporary organizations.
Leadership education and training
Yukl (2002) proposed the following rules for successful leadership:
* Express a clear and attractive vision
* Delineate how the stated vision can be realized
* Perform assertively and positively
* Instill assurance in the supporters
* Employ remarkable, symbolic activities to stress core values
* To lead by example
* Authorize people to realize the stated goals.
The mainstream leadership training programs are intended to raise basic skills and outlooks essential for success and growth of the organization. Effective training should comprise of clear learning objectives, clear and evocative content, suitable sequencing of content, suitable mix of training methodologies, prospects for dynamic practice, pertinent and sensible reporting, advancement of learners` self-assurance and appropriate follow-up performance.
A number of leadership training programs apply specific paradigms for example, behavior role modeling, case deliberation, business games and simulation (Yukl 2002). Nevertheless, Yukl (2002) is of the view that the most vital leadership skills have learned from experience, than by means formal training programs. Nevertheless, learning from experience is influenced by the kind of challenge, the range of tasks or undertakings, and the quality of response. Yukl suggests that activity learning and multi-source responses are significant methods of improving the learning from experience procedures.
It has been proposed that the term `training` should not be applied when denoting leadership education. `Training` suggests the idea of getting knowledge whilst a focus on development` or `learning` demonstrates the autonomy of the leadership role (Garrett 2000).
Leadership development programs
Bush (2003) explained the many case examples of leadership and management development in the schools and college domains. To support the schools segment, various universities operate courses in school and college management however these are attached to national programs.
On November 2000, the National College for School Leadership was created and this presently operates leadership development programs. The College operates as a `virtual college`, it performs research operates and has a global outlook. Its activities give stress to the relationship between efficient leadership and excellent education regarding `continuous improvement and major system transformation` (NCSL 2001a). A new body, the Leadership Foundation for Higher Education was created in 2003.
The Leadership Foundation for Higher Education is a groundbreaking global program supported by the British Government and the Standing Conference of Principals (SCOP). Its objective is to hunt talent and leadership in higher education and to become a center of excellence, recognizing best practice and commissioning custom-made training for existing and future higher education leaders.
The lookout for existing educational programs for leadership showed few global prospects particularly for growth in healthcare and, especially, social care education. It is hence appropriate that a formal, recognized leadership program be created in Britain, to help new leaders in health and social care education. One of the key disparities between the Fund for Developing Tomorrow`s Leaders (FDTL) and Social Care Education Program and other existing leadership development programs are the focus on interprofessional learning that would take place in the mixed groups. It is also significant that the program is locked into nationwide initiatives to fulfill government programs in both the higher education and the NHS social care segments. The study of present programs stressed the need for such a program.
Key qualities, attributes and skills of successful leaders in health care education
One of the major challenges for leaders in the health care education is to translate the vision into concrete routine activities. These leaders are required to be capable to be flexible in iterative cycles. It is however recognized that it can be hard to generate a visualization which is suitably well d to motivate others, however not so well established that others think they cannot modify it. Vision concerns with the establishment of big targets which have both individual and organizational objectives, however also about giving the flexibility of this visualization to others and guaranteeing suitable tenure in order that the leader can advance to the next roll when this has taken place.
The leaders who came across at the residential event in May 2003, described some of the major characteristics of leaders as:
* Having vision in a practical framework
* Being able to value the complex association between vision and value
* Being competent to convert vision into shorter term clear goals and to create strategic plans to realize these which are flexible to outside factors.
In organizations, `good leadership concerns about corporate direction and then creating departments and groups that all advance in the right direction for the organization. This remark also concerns with various aspects of strategic management and change management which are essential factors of changing the vision into a practical strategy.
Leaders of the future need to be reasonable, they must have a good explanation of the manner things work, where the power bases are and where the forces for change exist. In making the step from being a clinical expert to assume a leadership or management role in Higher Education, people should be confident of their skills when tackling with other management practitioners. They are accustomed being a healthcare professional and they have a rational idea of the health care service and the various roles in it. They have to learn about what other professionals follow the trades. Yet significant feature of successful leaders is that they have the capability to see the big picture.
Being capable to see the big picture implies how a successful leader can `add value` and translate the vision into strategy to realize the objectives and goals. For instance how he became engaged in national programs in medical fields by having a good counselor and being involved in a network of those working countrywide on the execution of Tomorrow`s Doctors. This would help him to query the quintessence of medical education and look at and comprehend the bigger picture.
For medical and healthcare education, nevertheless, one of the key factors of the educational environment is the relationship higher education has with the NHS: they should show understanding of the Higher Education and NHS interface. It is improper for education leaders to be familiar about their own organizations however they must also be responsive to the key developments in the wider higher education sector and the NHS. Knowledge is relative, the contemporary leaders need to understand the existing processes and procedures and modernization of the NHS.
A viable health care system is founded on having the right workforce with the right skills, so the companies must be trained workforce in various ways if they want to modify the education program and recognize that education is the procedure to effect change – however this requires strong and efficient leadership. The companies must also realize that higher education keeps pace with relative alterations and education leaders require real knowledge and perception of these two fields.
Moreover, there are also individual issues for leaders employed in health care education institutes and successful leaders need to adjust and position themselves suitably within the organization. The human resource in medical education has a tendency to be more adapted to their fields than they are to the organization, showing the `academic tribes and territories` – it is significant to understand that knowledge and information is power, so there is a need to have a good understanding of how the organization functions.
Interpersonal skills and qualities were recognized by many people as an important aspect to be an efficient leader. One of the most notable of such skill sets is communication skills.
Leadership has much to do with role modeling, regarding being clear in their role and the purpose of that role, about being able to communicate things to people. Communication is an exceptionally strong aspect of leadership, as such there should be better understanding professional and organizational cultures. A lot of characteristics of communication skills were recognized, comprising of `being able to put a positive turn on any changes that are proposed in order that people feel good about them and are ready to affect those changes.
Implications for healthcare education leaders in 21[st] Century Higher Education context
As was noted, leaders employed in health and social care education have a `double burden`. They have looked into issues related to management in a fast shifting global environment, and dynamically lead the organizations in partnership with various NHS associates with potentially conflicting programs. Many healthcare education companies are dealing with change, seeking to cope not only the execution of wider agendas within the higher education sector however also dealing with intra-organizational matters arising from intrinsic strains both within and between various professions.
For instance, many medical schools generally maintain the heritage and traditions of a single staff institute however they may well be part of a large multi-staff university or even part of a health sciences staff. To fulfill the government programs for change and modernization in the higher education and NHS domains is considered as a strong challenge, requiring the capability to recognize and manage power relationships, hierarchies, professional boundaries and educational, training and HR planning matters. Consequently, leaders must apply appropriate strategies, for example those engaged in transformational leadership and running complex systems, with the aim to manage organizational, educational and professional modifications successfully.
Creating the health care leaders of the future who are highly capable professionals, flexible to work within the changeability of professional limits and ability to organize changes both for themselves as individual professionals and for their organization is a significant challenge. Healthcare education leaders have to perform as positive role models themselves. It should be recognized that they would shape and influence within higher education and the NHS. Nevertheless, if the right role models are not accessible for instance as regards profession, sexual category, race or social class then it will be hard to change things at the top hierarchy. There might be for instance, doubt the validity that a successful healthcare professional leader has to be clinically trustworthy or a top flight clinical analyst. It does not essentially follow that since a person is successful in leading an organization in one field that they can change these competencies to another field.
Selection and recruitment policies and practices should therefore be crystal clear, comprehensive and reasonable at all stages and medical schools should dynamically involve inputting succession strategies and leadership growth activities ready, whether individually or on a regional or national basis.
The leadership development program deals with inter-professional concerns and directly removes impediments between professions with the participants in the leadership development program. This is realized by careful option of the content of the program, by ensuring all partners consists of mixed professional groups, by directly and clearly deliberating the inter-professional education outline and by offering each participant a counselor from a different vocation.
Sir Christopher Ball, Chairman of the Talent Foundation wrote about leadership and managing success in Higher Education. His article explained how all companies require to concentrate on people and successful organizations `are typically outward looking, experimenting, trying things out without blaming the experimenter when, as most experiments do, they fail. They are developmental, informal and balanced…the challenges of today and tomorrow are equally important. Function determines structure, responsibility is shared and leadership counts` (2004, p.3). In several manners though, healthcare education organizations have little opportunity for `experimentation`, one of the challenges for leaders is how to assess the need to facilitate forceful `learning` organizations to take risks and challenge accepted view, at the same time also creating a highly qualified and skilled NHS personnel. The `education vs. training` discussion is nowhere more strongly debated than in medical and broader healthcare education. The organization must consequently help individuals to mature as leaders. It must create successive planning and incorporate a means by which leadership potential is recognized and promoted. The organization should vigorously reward various activities, educational and entrepreneurial in addition to the traditional academic pursuits, in order that as varied a cadre of people as possible is inserted into leadership roles. Mentoring and internal and external networking is significant for people`s leadership growth, and thus they should be built into an organization`s business activities.
This report dealt with a wide range of issues and appears to have raised as many questions as it has provided some answers or solutions. However, the report aims to discuss about leadership in modern health and social care education.
As Paul Ramsden (1998) stated though universities have many analogous aspects of other organizations, `the most fundamental difference lies not in academic values and culture, or in whether universities are businesses or not, but in the main product of higher education. The product of universities in change. The business of a university is learning. The job of academic leaders is to help people learn…universities (should) practice, at all levels, the multiple leadership responsibilities of vision, enabling, developing and learning.`
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