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sales growth small business ctp process improvement lack of cash flow increased competition higher wages wages going up across us widening digital divide decreasing marketing effectiveness fighting clutter increasing marketing costs healthcare employee health care dangerous trends in business hiring hr human resources recruiting accounts payable improvement order quality improvement order entry improvement mafia offer supply chain supply chain optimization middle market business recovery trough recession decline peak ±ð³æ±è²¹²Ô²õ¾±Ã³²Ô strategy business model cirm cpim production and inventory management productivity improvement retail distribution cash flow ceo operations coo corporate renewal certified turnaround professional tma turnaround management association business failure operational improvements