Properly Training a Call Center Operator

Companies are always looking for ways to grow their business without investing much money. One great way to do this is to hire telephone answering services. By exploring this option, a company frees up more time for employees to focus on other vital tasks like advertising and new customer acquisition. Outsourcing to answering services at one point only included the ability to answer calls and take messages. However, due to the growth of call center software and telecom technology, outsourcing now includes appointment setting, order entry, customer service assistance, CRM integration and more. With all of these “other” things an answering service can do, there is more room for error. Things were simpler when outsourcing was just answering calls. Today’s call centers need to make sure their operators are always at the top of their game.

Outsourcing takes place when a company uses a third party to handle some specific business need. This third party usually specializes in a particular field ensuring they will provide a professional service with lower cost & higher quality versus performing the same service in house. In a call center, you rely on the operator to represent your business, and the operator is responsible for representing the business in the best way possible. The operators are the most important part of the outsourcing model.

It is crucial that call center operators are ready to handle any inbound customer request. No one wants to hear someone fumbling for answers. It makes the business they are representing look unprofessional and will surely inhibit the growth of the call center itself. Because proper customer representation is so important, call center managers need to employ the most effective training techniques. First, your operators need to be schooled in proper communication, customer retention, and avoiding mistakes.

Since call centers are constantly advancing in terms of technology, operators must also be trained on the platform upgrades. During any training process, it is important for management to examine the strengths and weaknesses of each individual employee. By doing this, they will be able to determine what types of jobs this employee will be able to handle and can estimate what to expect out of this operator. No operator is 100% perfect and the training process can help you identify strengths and weakness and allocate the employees properly within your structure. This analysis + allocation process makes even the weakest CSR’s productive.

Another great training technique is observation. Having the operator observe a current employee will help them to learn first-hand how to handle different situations. If your call center uses overseas operators as failsafe rollover employees or as your main operator pool, it is important they are proficient English speakers. If you notice any weak spots with an employee’s pronunciation or meter of speech, you can hold speaking classes or mock calls to help improve on their accents.

Any call center employee needs to understand their job is as much about customer service as efficiency. Call handling training will help CSR’s get to the root of a customers problem quickly. Operators need to understand that any situation, especially emergencies, can be resolved quicker using the right techniques.

An operator must go through many different training programs after being hired as a CSR. And, the most successful telephone answering services engage their operators in ongoing training to stay professional. Just answering calls is not enough of a training process. There needs to be methods to assess faults and weaknesses and fix them before they hurt your reputation, or worse yet, the reputation of your customers

Nexstar offers online training that supports our classroom training and the ideology of Nexstar’s Call Center Excellence coaches. Managers have access to tools that can streamline call center processes and training that can help unify teams and get employees focused on goals, Training for call center managers

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Increase Your Business With Local Search Engine Optimization

There is an increasing awareness about Local Search Engine Optimization particularly by those having local sales outlets. Companies that were marketing certain products or services nationally or globally were understandably unconcerned about local search engine optimization. With local search engine optimization gaining in importance, a new area has been added to search engine marketing.

However, ever since local search engine optimization came to be accepted as part of industry norms, webmasters and local business owners started ways to explore this new opportunity. For web masters specializing in search engine optimization like SEO and SEM, optimizing sites for localized search queries – added another dimension to their work profile.

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Local search is developing into a massive, multibillion dollar market. The yellow pages had hitherto dominated the local market ads, but search engines are now eating off their market share. Small businesses obviously have small marketing budgets and spend a sizable amount annually in Yellow Page advertisement. Market insiders predict that yellow pages will see a steady decline due to the aggressive thrust by local by search engines.

Please know that there are four different types of sites that online users may visit to gather local information:

1. Primary Web Search Engines, such as Google, Yahoo!, and MSN.

2. Top Local Search Engines, such as Google Maps, Yahoo Local, and MSN Live Local.

3. Top online Yellow Pages, such as Superpages.com, Yellowpages.com and Switchboard.com

4. Other sites with local components.

Check out for all local news sites

With users going haywire to such a wide array of sites to obtain local info, it can be baffling to figure out where to focus efforts for gaining maximum customer attention.

It is indeed a good idea to check out the local newspaper sites of your area. It is a fact that more and more people have switched from reading print newspapers to online sources, and the newspapers readership for ads is dwindling. Some local news sites include guides or yellow pages of businesses on their site, so make sure you are seen there as well.

The key thing to remember is that there are a variety of online sites from which users are obtaining local information. There is also the fact that many consumers are keen to know with whom they are talking business online. They would certainly be happy to visit the local business outlet or at least feel satisfied that the business place is accessible locally. Even though we are in the midst of free market economy, people are psychologically at ease when having their business dealings with the local merchants.

Achieving local Search Engine Optimization

The question arises – how does one achieve local search engine optimization? Just like any SEO process creating relevant and compelling content is absolutely crucial. Well-written text aimed at drawing the attention of the local buyers and proper local keyword density are the necessary factors for good local search engine optimization. It is only to be expected that the majority of users trying to locate local information will be going to the traditional web search engines first, as a matter of habit.

When a user begins a search for local info through the regular web search engine, there is a possibility that they may find your web site if you have imaginative content which matches their keyword search. So, your first step is producing the right content of your site in order to stand a chance to match these keyword searches. Your business website must contain text that would match the locality parameters. Assuming you are a small business owner, have your full business address clearly displayed on your site’s homepage, in the HTML text. If you happen to be a company with national presence, there should be a page for each of your local outlets and each outlet’s full address should be clearly displayed in the HTML text.

One important aspect in keyword research is to bear in mind there are many local colloquialisms across the country. Different people might be searching for the same thing, but entering two totally different search words. Localized keyword research is much tougher than what it may appear to be.

Inbound linking are indeed crucial – for instance, if you are a member of a Chamber of Commerce or any similar local business association, you can have them link to your site at a nominal or no cost. Inbound links like these can be an assured gateway to increased targeted traffic. This should be done without prejudice to traditional link building. Being a member of the local chamber can provide you with a bit more promotion sometimes, and you should be found in the chamber’s directory

Over the years, people have resorted to all types of methods – both ethical and unethical -to achieve high local search results. Earlier, the Meta Keywords tags were working fine till spam adult and gambling sites began competing. Besides, search engines were also capable of easy manipulation.

After studying various trends, Google introduced a geographic box at the top of its search results, tying it into its mapping feature. When it was first introduced, the engine would display three results at the top of its search results whenever somebody entered a geographic modifier into the search box. After the initial trial, Google found that its users appreciate this feature. The engine has now been further developed to display ten local search results, provided you have a geographic modifier attached.

There are of course many resources on the Internet if you are looking for local search engine optimization. But the question is – do many companies that cater to a national or international clientele really benefit from local search optimization? The answer strangely is in the affirmative.

It is evident many customers prefer to deal local contacts, even if their business is national or even global. There is no denying that it feels more comfortable to have a personal meeting than dialing an 800 number. Again, if you are a business owner with multiple locations spread across many cities and each serving a different function, you can certainly benefit from local search engine optimization.

As a final comment, make sure your business information is available in the online directories, remember to put your address info on your website for the search engine bots, and see you are listed with the secondary local info sites. These simple steps will guarantee that you have done your bit for local SEO.

Are you hiding from your potential customers online without even knowing it? Even a beautifully designed website can be unsuccessful and difficult to find if it is not accurately optimized. The visual appeal of your website is important, but it is equally essential to make sure that your clients and prospects can locate your website easily. We strategically optimize your web content to keep your brand top-of-mind to your clients and increase your ranking in the search engines. search engine optimization minneapolis, search engine optimization minnesota,  SEO minnesota ,

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What Is Orthopedics? What Is Orthopedic Surgery?

As the medical fields continue to promote the benefits of exercise and healthy eating habits, both the young and old are becoming more active. Because of this, overuse and injuries to the bones, joints and muscles occurs, especially in baby boomers. Some of the most common conditions that require eventual treatment are those caused by degenerative joint disease, osteoarthritis, and arthritis and these problems are studied by the medical specialty field of Best orthopaedic shoulder surgeon manchester

Orthopedics has become one of the most sought after medical field by people who want a better quality of life..

What is Orthopedics or Orthopaedics? It is the study of the musculoskeletal system which involves the bones, joints, ligaments and tendons, muscles and nerves. Orthopedic doctors (also known as Orthopedists or Orthopeds) specialize in the diagnosis and treatment of musculoskeletal system problems under the associated medical fields of Orthopedics or Orthopaedics.

The training for orthopedists is intense with undergraduate, medical school, residency, subspecialty work and often research. During their careers, orthopedists often work in an even more specialized practice or in a more defined area within the field of Best orthopaedic shoulder surgeon CHESHIREor Orthopaedics, such as the following areas:

Hand surgery

Shoulder and elbow surgery

Total joint reconstruction (arthroplasty)

Pediatric orthopedics

Foot and ankle surgery

Spine surgery

Musculoskeletal oncology

Surgical sports medicine

Orthopedic trauma

What is an Orthopedists?

Orthopedists often have a choice with the way in which they treat conditions. They can either opt for surgical or non-surgical remedies with there patients. Orthopedists who specialize in non-surgical musculoskeletal remedies include physiotherapists, chiropractors, occupational therapists, podiatrists and kinesiologists.

Those orthopedists who use medicine or surgery to remedy musculoskeletal conditions include Orthopedic surgeons. Orthopedics, orthopaedic surgery and orthopaedics are effectively describing the same branch of orthopaedic shoulder surgeon manchester, depending upon the part of the world in which the orthopedist trains and lives. They use medicine and surgery to remedy conditions regarding the musculoskeletal system such as the following:

Hand, Foot and Spinal Surgery

Physical Therapy

Prosthetics

Joint Replacements

Joint replacement (hips, knees, shoulders) is one of the most common types of orthopedic surgeries administered in hospital around the world. Patients often determine whether or not they need to talk with a doctor when their affected joint hurts for one or more days during a week or if the pain is consistent or interferes with sleep. Orthopedic surgeons recommend that it is time to consider joint replacement when pain makes it increasingly difficult to perform and enjoy everyday activities or if pain medications are no longer effective.

What is Orthopedic Surgery?

Reconstructive Surgery – According to many research groups, reconstructive joint implants is the field of orthopedics

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that is most popular. Large joint replacements such as knee replacements, hip replacement and implants for smaller joints such as the elbows, ankles, wrists and fingers are also increasingly getting popular.

Arthroscopic Surgery – Because several diseases and injuries can damage bones, cartilage, ligaments, tendons and muscles, orthopedic surgeons may use arthroscopic surgery. Some common occurring conditions would include inflammation, acute or chronic injury, rotator cuff tears and dislocations, knee damage and carpal tunnel syndrome.

Arthroscopic surgery is a procedure that orthopedic surgeons use to visualize, diagnose and treat ongoing issues within a joint itself. There are six joints most frequently examined using this type of arthroscopic procedure: ankle, elbow, hip, knee, shoulder and wrist. By making a small incision into the skin and inserting a pencil-size instrument inside the joint, the surgeon is able to see the image on the screen, thus making a final diagnosis and in some cases repair. In the end, this is a much more accurate process, allowing for a less invasion surgery and or treatment.

Orthopedic surgeons can use both surgical and nonsurgical methods to treat their patients with the following conditions: sports injuries, infections, tumors, degenerative diseases (neurodegenerative disease affecting tissues or organs such as cancer, diabetes and Alzheimer’s disease), congenital disorders (a condition that occurs before birth or within the first months of life such as down syndrome) and musculoskeletal trauma. It is the job of the orthopedic doctor to get their patients up and moving again, enjoying pain-free activity and a higher quality of life.

So, What is Orthopedics? and What is Orthopedic Surgery? It is a very specialized area of medicine and is better defined by a certified Physician that has a defined specialty in the area of your concern.

Mayweather vs McGregor

Mayweather said last Wednesday he’d battle McGregor in Moscow.

“Firstly we have to concur a battle and after that after we can concede to a place,” he said in a meeting with Russian state-possessed media arrange RT. Mayweather vs Mcgregor Fight “On the off chance that some way or another it turns out the battle will be in Moscow, then I have no issue. On the off chance that I needed to pick now then I would pick Moscow.”

Accepting Mayweather vs McGregor can clear every one of the obstacles important to complete the arrangement, Moscow would be a far-fetched setting for their occasion.

Mayweather’s last 14 battles going back to his win over Zab Judah in April 2006 have happened in the Las Vegas metropolitan territory, and not even once has he battled professionally outside the United States. For him to battle McGregor in the Russian capital would be a noteworthy amazement.

FloCombat’s Duane Finley announced March 12 the T-Mobile Arena in Las Vegas has put aside June 10 as the date of Mayweather and McGregor’s planned session. Mayweather vs Mcgregor Boxing In a meeting with FightHype.com, Mayweather said he needs McGregor this mid year.

“I would prefer not to hear no more reasons about the cash, about the UFC,” he said (h/t USA Today’s Mike Coppinger). “Sign the paper with the UFC so you can battle me in June. Basic and plain, we should battle in June.”

Be that as it may, McGregor told the Los Angeles Times’ Lance Pugmire he’s looking toward September to perhaps go up against Mayweather.

 

Mayweather vs McGregor live

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HVAC Improvements For Existing Buildings

One way to identify tenant needs in existing buildings is to note what architects and designers are trying to create for clients in new buildings. The objective for a new building is to provide the ideal office space. Tenants are often looking for space that can address such issues as flexibility, modular space planning, environmental considerations and individual temperature comfort. A particular hot spot for many national tenants is to gain the highest level of productivity from their employees. This usually means the building will need plenty of HVAC zones, flexible office hours and point-of-use supplemental systems. These factors point to a flexible and often programmable HVAC system that can meet tenants’ needs.

Architectural trends can also create new loads and requirements for an HVAC system in an existing facility. More natural light can increase heat loads; atrium designs can obstruct air distribution; additional zones can increase the overall volume of ventilated air needed, the quantity of heat to be rejected and the amount of outdoor air required. If a building doesn’t have a flexible HVAC plant, then modifications or upgrades to the HVAC system will be necessary to compete with new building design and technology.

One factor that must be considered in any analysis of a possible retrofit is that an HVAC upgrade usually means that the building has to be brought into compliance with current codes. Some codes are based on prescriptive regulations; however, the trend to create a safer and healthier indoor environment can also bring new performance requirements. For example, over time, the percentage of outdoor air has gradually been increased, and current requirements may call for more outdoor air than many buildings have the capacity to condition. Bringing the building up to code may require a significant investment in upgrades beyond those originally planned.

Making Retrofit Decisions

HVAC systems are major energy users, and new HVAC technology is far more efficient than 15 to 20-year-old systems in place in buildings. In some cases, the energy savings alone are so substantial that they justify the upgrade investment. But in many commercial office buildings it can be difficult to justify an HVAC upgrade. Perhaps some upgrades have been performed over the years, reducing the energy savings now available. Or perhaps the owner has a too short a payback-period requirement for energy upgrades.

When energy savings alone do not clearly justify an upgrade, how does the facility executive responsible for a commercial office building determine whether and how to upgrade the HVAC system? It is best to start with the building profile. A relatively small or mid-sized building (less than 200,000 square feet) may present marketing opportunities not available to larger facilities. For instance, instead of converting a constant-volume system to variable-air-volume (VAV), it might be possible to make each floor a separate zone. The marketing plan could then be changed to focus on larger, whole-floor users with large bullpen work areas that do not require multi-zone improvements.

In a medium or large-sized building, upgrade options will depend more on the type of system already in place. If the base building system is a constant volume system, with the main fans delivering varied air temperatures to large sectors of the building, there isn’t much choice. To serve the varied needs of today’s tenants, the facility executive will need, at a minimum, to increase the zoning abilities. How this is accomplished depends on the building’s design and business plan.

For example, new speculative office buildings sometimes install heat pumps, which can deliver heating or cooling to small or large zones, are easily programmable, and operate at about 50 cents a ton per hour. But is the first cost for installing heat pumps a good value for retrofits? Probably not if the building was configured as a constant-volume or multi-zone system. Using heat pumps would require running condenser piping throughout the building and changing the fresh air distribution; what’s more, the actual conversion could not run parallel to the old system if this retrofit was attempted in the summer because the cooling tower would be reused.

In this case, options for conversion should be limited to a VAV conversion or to individual zone diffusing that does not reduce energy costs but does create comfort zones similar to VAV systems. VAV systems provide a constant temperature to the space, but the air volume varies with the comfort setting. If the building was constructed after 1975, it probably has some type of VAV system installed. The earlier systems did provide easy zone creation; however, after-hour and flexible operation were usually not part of the operating system.

The most difficult VAV retrofit decisions are the ones where the payback related to energy reduction has already been captured by vortex dampers or by the later addition of variable frequency drives. If the facility will not receive an initial influx of energy savings, HVAC retrofits will have to be justified based on increased flexibility, after-hour operation and supplemental cooling. The facility executive must spend the time necessary to understand the overall value to the asset from a marketing standpoint.

It is important that all values are considered when making the decision. More is involved than just the cost of energy. There will be other gains that are not so obvious. A new cooling tower or new chiller not only operates with less kilowatts per ton, it also has new heat transfer surfaces, better part-load abilities and generally reduces maintenance requirements. The amount of labor and maintenance required to service a temperamental HVAC system can be quite a surprise once it is segregated from general operating costs.

The facility executive must also look at the useful life of the existing system. Will there be parts available next year? Is there a service company that will be willing to support the system? If a decision is made to sell the building will the system be flagged as unserviceable? Can the system still be used when a big block of space comes up in two years? These are all questions to ask when a system is facing obsolescence and when reliability of building systems becomes a factor in the marketplace.

There are other building details that sophisticated tenants are aware of or will become aware of if they enlist a good tenant representative or broker. Consider a broker with a client that is considering an existing building over the brand-new building across the street. The potential tenant is concerned with the condition of the HVAC system and requests the following information:

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• Is the ductwork and distribution system clean? Please offer some verification.
• How is the insulation attached? Is it interior or exterior fiberglass?
• Is sound batting provided?
• What is the zoning per terminal?
• What are the temperature setpoints of the zones? How many zones are in my space?
• What is the noise level of the terminals?
• Can we control the perimeter zones of the offices separately?
• Is there any asbestos on the HVAC system, piping or ceiling?
• How can I operate after hours and what is the cost per hour?
• If I want to add some additional servers, is there a tenant tower for condenser water?
• What are the watts per square foot and the cubic feet per minute of ventilation air?
• What am I guaranteed in the future?
• How will I be billed for use of my after-hour heating and cooling?

In the last few years, tenants increase hvac sales been even more concerned with the office IAQ (Indoor air quality) environment. The more important the staff is to the operation, the more concern for the users’ welfare. Tenants are asking more questions like these:

• What is the outside air ratio?
• Where does the outside air for my area originate and can you achieve 100 percent economizing?
• Do you have a proactive plan for indoor air quality complaints?
• Do you allow smoking?
• Do you have pressurization, smoke tower, stairway pressurization or smoke exhaust system?
• Are there any negative air situations in this building and does any of the air come from infiltration?
• Is there any redundancy to the heating and cooling systems?
• What is the origin, quality and reliability of the electrical service supplying the building HVAC system?

Nexstar members attending one of our Business Planning Workshops review their current online marketing strategy. With their internet marketing coach they cover everything: the website, search engine optimization, pay per click, local search, online reviews and social media. Along with other Nexstar members, attendees work together to find new online lead generation opportunities. business plan workshops, business planning workshops,  hvac business planning, hvac business strategic planning

 

5 Optimization Tips For Your Next Online Marketing Strategy

Expanding the image of your brand, increasing the interest people have in your company and boosting sales and profit is the main objectives of an online marketing strategy. These should be your number one concerns when analyzing the success of your marketing strategy.

But what about the marketing strategy itself. How do you optimize your marketing strategy in order to accomplish these common goals? I would like to share some optimization tips with you that you can use and implement in your next strategy. These tips will help you increase your chances of running a successful strategy, and will help you create a more streamlined strategy.

1. Effective and clear communication

The first thing you need to do to ensure your strategy is adequate is to ensure that your message is clear and effective. Make sure that your readers will easily understand what your message is about, and what you can offer them. The clearer your message, the more targeted your audience.

2. Target your audience

If you don’t know who you’re targeting, then you won’t be able to reach the right audience. Do proper research before launching your marketing campaign. Examine your competition and discover your target audience. By knowing who to target, you will be able to have a much more successful strategy. Your marketing costs will also decrease and you will be able to direct your campaign to the right people.

3. Use all your options

Online marketing can consist of a large variety of options, platforms, mediums and more. You should analyze your competition and determine all options available to you. Use all of the relevant options that can help you boost the success of your marketing campaign.

Your options might include SEO, blogging, social media marketing, link building, press release distribution, etc. Find out what works for your competition and you will know what options will work for you.

4. Research and improve

Once you have a strategy in place, you should do some research and improve your strategy in any way that you can.

Planning your initial approach to your strategy takes a lot of time, and can hold errors and issues. This is why you need to go through everything, research all aspects of your strategy and analyze your competition. By doing this, you’ll be able to easily identify problem areas in your online marketing strategy, and fix them before launching your strategy and wasting money.In order to create a successful website for you, we take your entire business into consideration and use fundamental marketing and sales principles throughout the entire proces website development minneapolis, website development minnesota

5. Analyze the results

Once you’ve launched your online marketing strategy, you should closely analyze the results it’s bringing. Draw regular reports and analyze the results your online marketing campaign is bringing you. Once your campaign has been running for a couple of days, you should also look out for any part of your online marketing campaign that’s not performing as expected – try to adjust these parts of the campaign to improve your results We are your one-stop-shop bringing expertise and experience in creative design, web copy writing, responsive website design & development, online search / SEO, social media and project management. website design minneapolis, website design minnesota

Conclusion

Online marketing is a serious task. You need to work hard, do your research and take the time to set up a proper plan for your online marketing campaign. This will help you build a better brand for your business, drive more traffic and land more sales. By utilizing the five tips I mentioned here, you should be able to see an improvement in your online marketing strategy. Founded in 2006, Small Business Mavericks (SBM) is an Online Marketing Agency in Minneapolis, Minnesota that specializes in online strategy, website development, search engine optimization  online marketing strategy minnesota , search engine optimization minneapolis, search engine optimization minnesota,  SEO minnesota ,

Choosing the Right Orthopaedic Office Chair

An orthopaedic office chair gives lower back support, helps promote good posture, and aids in alleviating back pain. Here are some of the features that you should look for before you buy ergonomic office chairs.

Height is important in buying an

shoulder and elbow treatment Cheshirea office chair. This is so because a good office chair should allow you to adjust the height for you to sit comfortably with feet flat on the floor and knees are at 90 degrees parallel to your hips.

Its armrest should support your arms enabling your shoulder to rest at a comfortable position when you are doing your office jobs. Arm rest is a vital feature when your job entails encoding at the computer for many hours. It should also be adjustable in height and position for you to bend and allow different positions depending on your arm and shoulders.

The Backrest of an shoulder and elbow  treatment Manchester office chair should maintain and support the normal curve of your spine. It should give support in your lower back and should be high enough to hold up your shoulder and neck allowing you to bend and move while you are sitting. There are chairs that allow you to recline while sitting. An ergonomic chair should also protect and support your hips. Check its depth and make sure that it is comfortable when you sit on it. When sitting down, you should have at least 2 inches between your back knees Best Shoulder and Elbow injury Surgery Manchester.

Before buying an shoulder injury SURGERY in MANCHESTER, try to assess what you are doing most of the time in the office. Are you answering phone calls most of the time, are you encoding, or do you roam around the office. In this manner, you will be able to list the characteristics of your chair to help you with your choice. After thorough study of your ergonomic office chair needs, you can visit stores to consider the chair’s level of comfort and support. It is also important to choose the style, color and material of your chair. Ergonomic chairs come in different styles and materials; leather, fabric or net chairs. You will be able to choose what color and style you need in order for you to maximize the use of the chair. The right choice of office chairs will help keep your productivity at work high while reducing physical stress. The chair should have a good back and neck support and should be strong enough to be used for a longer period of time in the office.

 

Mr. Narayana Prasad is a Consultant orthopaedic surgeon who specialises in Shoulder and elbow surgery with particular interest in arthroscopy, sports injury, shoulder and elbow replacement and management of fractures. Mr. Prasad works at BMI Alexandra hospital After obtaining his medical degree, Mr. Prasad completed a Masters degree in Trauma and orthopedics. He joined as a clinical research fellow at University hospital of Wales, Cardiff where he developed a keen research interest in shoulder and elbow replacement. Mr. Prasad completed basic and higher surgical training in trauma and orthopaedics under Wales training programme, UK. shoulder injury SURGERY in CHESHIRE, Best orthopaedic shoulder surgeon manchester, Best orthopaedic shoulder surgeon CHESHIRE, SHOULDER AND ELBOW SURGERY MANCHESTER, orthopaedic shoulder surgeon manchester, Best SHOULDER AND ELBOW SURGERY MANCHESTER