Understanding IEP Meetings Essay Example | Topics and Well Written Essays - 500 words

Understanding IEP Meetings - Essay ExampleThe circumscribed information instructor is very instrumental in addressing the exceptional and individualized needs of the learner. The special education teacher provides recommendations on how the special learner can succeed in the learning process for example, giving seem row seat to the learner with short vision. The local school district representative ensures that the school administrating and teachers efficaciously implement the conditions set in the IDEA 2004. Example includes, providing appropriate individualized education to the assimilator requiring special learning attention (Friend, 2012). The school psychologist is also another IEP team member. His/her role entails addressing the psychosocial needs of the student for example, ensuring that the student is in a fit mental state so as to enhance learning. The student is the almost important member in the team. The student is required to explain the challenges that he/she ex periences in the learning process. The secret therapist caters for the emotional, social and psychological interests of the student. Example entails, guiding the students on the most appropriate approach of relating and communication with fellow students and teachers, so as to improve learning process (Kamens, 2014). The care provider has the key office of positively guiding the student in all learning activities. The family friend is also critical in socially guiding the student towards adopting positive learning activities. The final member of the IEP team is the reading or behavior expert. The expert is expected to provide professional opinion, in regards to approaches of improving education and related activities of the special student (Patterson, 2013).The chapter 5 video illustrates the IEP team members who took part in the meeting. The required members were present in the meeting. The student, Dominic, was adequately accompanied by his parent. The dad is

MCA DENVER Essay Example | Topics and Well Written Essays - 500 words

MCA DENVER - Essay Example3). Several events ar hosted in the museum, and it provides an ample opportunity for amateurs as well as professionals to develop an appreciation for contemporary art. This radical briefly describes three images that form an integral part of the prestigious MCA Denver museum. Image 1 Schuttbild (6-Day Play) The paintings by famous Austrian painter, Hermann Nitsch, are on display in the MCA Denver museum of contemporary art in the series entitled, Bloodlines Paintings by Hermann Nitsch, which represents Abstract Expressionism (Bloodlines Paintings by Hermann Nitsch, par. 1). The image Schuttbild (6-Day Play) is a brilliant depiction of the emotions of an artist who has spilled agony, frustration, and impuissance on canvas. The use of a blend of pigments and blood on the canvas also portrays the enigma of philistinism and sacrificial practices of the Catholic Church (Bloodlines Paintings by Hermann Nitsch, par. 1). It is interesting to note the use of fresh red pretext with an almost invisible backdrop of brown color. The bright red color shows new and vibrant emotions, plot of ground the brown color shows old and faded emotions.

Discussion Forum #1 - Becoming Human Movie Review

Discussion Forum 1 - Becoming Human - Movie Review ExampleThe skull, sahelanthropus tchadensis was determined at a particle accelerator in France which was restructured using 3d images and reproduced in some cast of characters of 3d plastic printer. From the data results as well as the spine and it was argued that it walked upright thus adequate the oldest bipedal organism (The Antonio Kuilan Project p.12). It is paramount to note that the video described the finding stating that S. tchadensis becomes a comparatively good candidate. The video brought indicated that Ardipithecus ramidus, S. tchadensis, Kenyathropas platyops and Orrorin tugensis exhibited chimp sizingd brains and bipedalism. Scientists try to debate and explain that one primary musical note is the length of the childhood between gentleman and apes. The development of apes according to the documentary takes three years whereas humans take more than two decades to develop fully. For instance, at three years of age t he chimps brain is 90% formed but Selam showed that the brain of humans developed slowly. To find the correlation of this, the fossa tools are analyzed. The way in which the stones were broken reflects primitive thinking. The Homo habilis hominin showed a larger brain size ranging from 400cc to 700cc indicating a major change in the brains structure. Scientists claim that changes in climate boosted the brain to grow. Some purify problem solvers including Homo habilis survived, but A. afarensis died. Indeed, our ancestors adapted to the noted changes, thus propelling us to where we are

The Continuum from Legitimacy to Fraud Research Paper

The Continuum from authenticity to Fraud - Research Paper ExampleThus, the framework volition only be used to the outcome of four components of hire anxiety namely paper earnings perplexity (PEM), real earnings concern (REM), paper earnings fraud (PEF), and real earnings fraud (REF). PEM and REM relate to earnings management practices that comply with accounting standards and corporate laws in place while REF and PEF are earnings management practices that violate the standards and laws in place. Earnings Management Measurement The type of data used in this study shall be secondary data collected from the DataStream database. Such data is usually found from the financial statements of listed companies and consequently deemed reliable. Therefore, the issues of data reliability and validity for the symbolise study shall not arise as no tools shall be developed for the collection of primary data. A number of nuzzlees have been used by researchers to measure earnings management (Prior, Surroca and Tribo, 2007). According to McNicols (2000), three approaches have been commonly used. These are specific accruals, distribution of earnings, and total accruals. The present study will employ the total accruals approach which consists of both discretionary accruals and non-discretionary accruals (Dechow et al. 1995). Prior studies presented two approaches for step totals accruals. For instance, Kothari (2005) uses the balance sheet method while Jaggi et al. (2009) use the cash meld approach. Following Jones (1991) and Dechow et al. (1995), the current or total accruals can be defined using the balance sheet method as tact = ?CAt - ? funds-?CLT + ?DCL DEPt Where?CAt = This denotes change in current assets in year t ? coin = This is a change in cash and cash equivalents in year t?CLT = This is a change in current liabilities in year t?DCL = This means a change in debt included in current liabilities in year t. DEPt = This is depreciation and amortization expense in year t collins and Hriber (2002) notable that the cash flow approach was a superior method than the balance sheet approach especially for companies experiencing mergers and acquisitions. Sun and Rath (2009) argued that the discretionary accrual approach is potentially ill-specified. This study therefore uses the cash flow estimation approach. Under the cash flow method, total accruals are estimated as follows TAC t = Income t Cash Flow t Where Income = Earnings before extraordinary and abnormal items in year t Cash Flow t = Operating cash flow in year t Prior et al., (2007) noted that earnings management is estimated through discretionary accruals (DA) which are computed by detracting the expected or non-discretionary accruals (NDA) from the total accruals (TA) (p. 34). The DA and NDA can be estimated using the Kothari et al (2005) model. The model is different from the modified Jones model proposed by Dechow et al. (1995), and includes a non-deflated term that captures perfor mance (ROA). Consistent with most empirical studies in earnings management, the present study will adopt the modified Jones model. The line for the adoption of this model is best described by Alghamdi (2012) as follows The argument of this study is that management may engage in earnings management via discretionary revenues by quantify the recording of these revenues, such as recording them at the year-end when the cash has not yet been collected.

Third World and Climate Change Research Paper Example | Topics and Well Written Essays - 1250 words

Third World and Climate Change - Research Paper instanceThe principal way in which humans are understood to be affecting the climate is done the release of heat-trapping greenhouse gases into the air (What is Climate Change, 2010).As the environment is mostly affected by climate change, agriculture is facing an unknown future due to the increased rivalry for land, water, and labor from non-agricultural sectors and withal increasing climatic unpredictability. The latter is connected with global warming and will result in evidentiary seasonal/annual unpredictability in food production. All agricultural products are susceptible to droughts, floods, equatorial cyclones, heavy precipitation events, and heat waves. These are known to have an impact on agricultural products and farmers reenforcements. Kumar et al. (2011) bank It has been projected by the recent report of the International Panel on Climate Change (IPCC) and a few new(prenominal) global studies that unless we adopt, t here is a probability of 1040% loss in crop production in India by 20802100 due to global warming, despite beneficial aspects of increased carbonic acid gas.Agriculture and grazing currently occupy 40 percent of the earths land surface. Mendelsohn and dinar (2009 544) make the argument that agriculture is responsible for six percent of the worlds GDP. In many developing countries, agriculture is the most important sector of the economy and is the prime source of livelihood for about 70 percent of rural residents. Climate change has an effect on farmers all everywhere the world because it affects both crops and farm animals in different ways, either directly or indirectly. On the other hand, there are adequate facts to expect that climate change will affect agricultural productivity. Mendelsohn and dinar (2009 546) further assert

Christians should take more interest in ethics Assignment

Christians should take more stakes in ethics - Assignment ExampleAccording to Brit Hume, the recent financial crisis was a ensue of unethical behavior that was conducted with regard to the functioning of the financial markets, government, lending banks and lastly the public. It becomes imperative to be tell in this regard that the proper pursuance of the commandments in discussion by the Christians would have checked much(prenominal) an occurrence. It has been stated by Exodus 2015 under the eighth commandment that one should non steal. This implies that one should not earn by stealing from others or in an unethical way (Long, Christian Ethics A Very Short Introduction). According to the laws stated under the deuteronomic code, 2513-16 set down the need of ordering just weights as well as measures. This implies that there needs to live on an honest and ethical relationship between the trader and the customers focusing on a fair constitution of pricing (Hall, Deuteronomy). It has also been stated by Luke 191 in this regard that salvation is deserve by all the individuals even in grammatical case of unethical conducts as all individuals are considered to be equal in the eyes of god (Alexander, Christianity and Ethics).The above teachings as stated in the bible evidently focus on the aspect of ethics and the way it should guide and direct the behavior of the individuals. Therefore, the radiation diagram of the teachings of Jesus or the Christian ethics is believed to ensure the practice of ethics even in case of economic activities which would further prevent the occurrences of such financial crises in the

CULTURAL VARIATION ACROSS INTERNATIONAL ORGANIZATIONS Essay

CULTURAL translation ACROSS INTERNATIONAL ORGANIZATIONS - Essay ExampleThe encouraging movement of IM&As has been recognised especially in developing countries which has facilitated in providing scope for maximizing and reshaping the financial structure of the global boundaries. With this concern, it fecal matter be find that the Mergers and Acquisitions (M&As) be frequently not able to ascertain the overall financial benefits of M&As due to not keeping abreast with the recent trends (Chapman, 2003). The paper takes into consideration a competitive analysis of increase amount of FDI through the IM&As and its impact on the culture of the United Kingdom and China. The paper excessively intends to focus on the various cultural differences and their impacts on the aspect of IM&As. Key Components of Culture Values and Beliefs persons cling tos and beliefs are the fundamental aspects of cultural deviation deep down a community. The notion of value can be defined as the various evo lving aspects that affect a person while acquiring decisions or doing any activity in relation to development of the social culture. The dissimilar national cultures entangled within the cross boarder M&As endorse increased opportunities along with augmenting the amount of risks within the enterprises (Comminicaid, n.d.). It has been ascertained that the process of M&As defecate certain difficulties for the merging enterprise to be interconnected due to its double layered of socialization norms where, the organisations need to fiddle not only with a divers(prenominal) national culture but also the values and the traditions of the firms of another country. With this concern, the higher individualistic characteristic within the UK employees enables to ascertain the development of individual performances with their creativity and innovative ideas. However, the values within Chinese culture are frequently observed as a significant aspect in terms of establishing the culture in mana gerial and organisational practices. The strong importance upon the dimension of collectivism and correlative group behaviours are highly observed within the business culture of Chinese organisations (Cheng & Seeger, 2012). Communication Styles The communication style of the business organisations is an important fibre to negotiate and perform various operational as well as organisational practices. The communication style enables to create a sophisticated relationship between two different organisations having diverse cultural norms. Moreover, communication can be considered as a major aspect that impacts on the business culture in suit of clothes of M&As. With this concern, the European communication styles play considerably an eminent part in terms of maintaining a positive and comprehensive communication within the various organisational practices. The communication style of the organisations in the UK and China should be adequate to perform an idealistic approach of IM&As (St ahl & Voigt, 2006). Negotiation Styles Negotiation can be considered as a feasible strategy for an organisation to achieve the height of success in global business. The plurality of the organisa

Critical review on non-traditional method of requirement gathering Literature

life-sustaining on non-traditional method of requirement gathering - Literature review ExampleWhile the authors did non reprize previous research, they illustrate the importance of this concept via the issuance of a case study that explores multiple methods that tummy be utilised when promoting enterprise system development (Shen 2004). This is a critical concept to understand as it is essential to select the correct resources and tools before any given organisation begins the process developing a worry model that tush be useful to their operations moving forward. To illustrate this, the authors do a highly effective job of discussing each of the significant modelling methods and techniques that the modern day business has to aim from in this regard today. Through the analysis of the case study, this paper further demonstrates that enterprise information systems should not be viewed as a stagnant, but rather as a constantly evolving process that can greatly be impacted by toda ys increasingly technological and global business landscape. When this is taken account, the study does demonstrate that such business modelling methods can provide a square(p) base to build upon in terms of meeting the requirements of further enhancing existing enterprise

Research propsal Essay Example | Topics and Well Written Essays - 3000 words

Research propsal - Essay ExampleDiabetes Mellitus is an incurable chronic disease and is a debilitating health problem which is increasing worldwide. Extreme outcomes can leave the soul disabled causing further strain on healthcare costs due to a highschool incidence of amputations requiring rehabilitation programs (Dunning, 2005)The purpose of this research proposal is to investigate the attitudes and experiences of the diabetic client and to establish which factors counteract useful foot care and compliance. Thus, enhancing the nurses understanding of the patients perceptions of the disease and what influences their lifestyles in order to meet compliance or non-compliance toward a holistically devised treatment plan as well as establishing client autonomy to implement effective foot care are the goals of this project(Greenwood, 2000).Patients with diabetes are vulnerable to damage to their feet, and minor problems can deteriorate cursorily (Clapham, 1997, p. 851). The successf ul management of diabetes requires the adherence of a patient to a prescribed self-care plan. This often presents a challenge to health care professionals in order to ensure that the plan of care is implemented. The framework for this literature retrospect is multilevel, moving from the global aspect of diabetic complications, to the more specific aspects of patients attitudes and experiences in analogy to education and compliance, focusing on the foot care problems experienced by the diabetic client.As the report of diabetes and lifestyle is reviewed, it is impossible to discuss the complications and implementation of foot care without including the major intervention of patient education. Gallichan (1997, p. 100) states, diabetic foot problems are usually preventable, through education, early intervention and treatment. On review of the articles it

Organizational Diagnosis of Palm Essay Example | Topics and Well Written Essays - 1250 words

Organizational Diagnosis of Palm - Essay ExampleThe name 7S describes the cardinal elements of an approach to make-upal design and review all starting with the letter S strategy, structure, systems, staff, skills, style and sh atomic number 18 values (Daniell, 2004). The strengths of the 7S model rest upon the variables included in it, which ar generally deemed important for any organization and that the inter-relationship between the elements is considered in the model. However, its weakness lies in the absence of an external environment and variables relating to performance (Burke & Litwin, 2009). It should not, therefore, come as a surprise that the 7s model has been singled out as the culprit in many unsuccessful bids at strategizing in the higher level (Daniell, 2004). Congruence Model The Congruence Model was formulated by Nadler and Tushman in 1977 based on their assumption that an organization is as open system. As such, an organization is affected by its environment in t he same way, although not in the same extent that the organization molds its environment. As explained by Nadler and Tushman, it is not enough that inputs, outputs and components are listed and described. The Congruence Model depicts the organization as a dynamic entity and uses the termination fit to measure the equivalence between two pairs of inputs, particularly between the elements of the transformation process (Burke, 2011). The important issues against the congruence model include the equal weight addicted to each of the organizational dimension, which does not judge the reality that in different organizations, one or more of the dimensions are weightier than the others and the fact that no recommendations were given to aid in determining whether or not congruence is in place. Burke-Litwin Model The Burke-Litwin Model operates on the belief that organizational change is brought about primarily by environmental factors. Various organizational factors are viewed as a collec tion of interdependent components which all operate on a common environment. The interdependencies pose in the organization such as mission, strategies, leadership, and culture help effect organizational transformation and deal improvements in individual and organizational performance (Noolan, 2006). Six-Box Model Weisbord called his framework the sixsome-box model to represent the six interacting variables, namely purpose, structure, relationships, rewards, helpful mechanisms and leadership. Preziosi (1972) added a seventh box into the six-box schemeal model when he prepared the diagnostic questionnaire to provide inputs on readiness for change among the members of organisation. The six-box model offers a method of examining the structure of an organisation and how the organisation functions in straddle to determine how a planned change effort can happen within such organisation (Shapiro, 2011). Ironically, Burke (2011) maintained that the strength of the six-box model also co ntributed to its weakness. Particularly, Burke (2011) noted that the simplicity offered by the six boxes in understanding organizations suffers from the pitfall of complications arising from the six boxes under-representing the other variables involved in the diagnosis of an organization. However, its other strenghts are significant the prominent position of leadership stresses its coordinating function, and its usefulness for fast and simple diagnostic

Innovation and Sustainability Essay Example | Topics and Well Written Essays - 500 words - 2

Innovation and Sustainability - Essay ExampleThis activity involves cutting, burning and bulldozing trees down to clear land or gain access to more land. It harms the earth when the carbon monoxide seeps into the soil and floats off into the atmosphere. The consumption point of this fulfill is having land cleared to build an industry or commercial business. It allows public to produce products and consume currency. industrial enterprise is as well as a major human production economic consumption. It involves processing of raw material, could be natural resources from the earth, into done for(p) products. Agriculture supports industrialization in the food sector and food systems sustenance (Likens, Driscoll & Buso 1996, p.120). This particular production habit has been greatly influenced by the technological changes and the scarce resources. These two factors hold resulted to a lot of innovation and higher(prenominal) utilization of the available resource.Consumption is the dir ect utilization of material resources. Transportation is one office that humans consume. The number of vehicles has increased gradually and the fuel we use to run them is very harmful to the atmosphere. In this way we consume the efficiency of mobility by producing vehicles to ferry us to our destinations. In the larger picture production is also a part of consumption especially in transportation since in the process of production materials have to be moved from one site to another.The concept of sustainable consumption and production is comprehensive and takes a holistic approach to the systems of production and consumption. Humans have to seek ways to ultimately reverse or reduce the negative social and ecological impacts. This calls for a means of aligning economic systems to meet the call for of current and future generations within the ecological carrying capacity of the Earth.Policy instruments and tools that affect change and shift in production and consumption patterns are efforts that need to be considered in sustenance of the global population.

WALMART-international corporation Research Paper

WALMART-international corporation - look Paper ExampleThe political party has worked very hard to get into this position by pursuing chasten strategies in both national and international regions. The organization thrives as an efficient merchandiser with effective processes and systems. These strategies stir contributed to the boilersuit buying power, superior growth and leadership in various systems such as logistics and append chain. The company is headquartered at Bentonville, Arkansas, United States. The company has established more than eighty-five thousands stores across the globe. Product portfolio of the company includes, app atomic number 18l, footwear specialty, supercenter, discount store, warehouse club, cash & carry, superstore, hypermarket and supermarket. The strategies of corporate management include make outing products of high persona and high brand name and it lowest prices (David 293-298). The low prices are kept by reducing the overall operational costs th rough the use of advanced and unique electronic technology and unmatched warehousing. trade deals are negotiated directly from the manufacturers which eliminate the work of middle men and save a lot of costs. The confederacy outreach of Wal-Mart is focused on various goals such as involvement with local community services, customer satisfaction, providing scholarships for higher(prenominal) studies etc. The major emphasis of the company is on environmental and child issues. Mission and Goals Mission and goals are the building blocks of an organization. They guide the actions of an organization and define the goals and objectives. Whether an organization is big or small, to have a delegating is the first step for setting up a business. The mission and purpose of Wal-Mart is to save the money of its customers so that they can have a better life. Apart from that, the purpose of the company is derived from the philosophy of the companys founder. The motto of the retail giant is to wo rk together and lower the living cost for everyone (Ahmed 23-30). This will depart an opportunity for the world in terms of saving money and enjoying a better life. Core Competencies agonistic advantage for Wal-Mart lies in its ability of cost differentiation and strong distribution channel across the globe. salute leadership and distribution strategy of Wal-Mart has created barrier for competitors to copy the strategy of Wal-Mart (Gagnon 130-135).Expanded distribution channel of the company has helped them to sell products to large base of customers and increase market saturation for competitors. Wal-Mart follows a low cost leadership strategy. macroscopical view of Wal-Marts competitive strategy shows that the company uses a resource based model in order to develop a value chain proposition which cant be matched by competitors. With the help of the resource based view (RBV) model, it can be summarized that Wal-Mart has three major resources which are tangible, impalpable and human resources, in order to create and maintain strategic capabilities. Resource capabilities of Wal-Mart can be explained in the following manner. Access to both tangible and intangible resources has helped Wal-Mart to achieve the capabilities which has established the departmental chain as a global market leader.

Aviation Geography - Tourism in Asia-Pacific has had its challenges Essay

Aviation Geography - Tourism in Asia-Pacific has had its challenges but the ingathering has been large in the past 15-20 years - Essay ExampleThe country shows high recovery potential from the 2008 even out brought by the great recession. Receiving 6.8 one million million million international arrivals in 2012 up from 4.8 million received in 2008, the country has opted for diversification to ensure that it taps the Asian touristry potential better. Looking into the 2007 gross domestic product, touristry contributed 4.5 % of the bestow GDP. The country has thus focused more of the foreign direct coronations on the tourism sector with an investment of over $94.2billion on tourism-related infrastructure.Inbound tourism in Vietnam registered a significant growth in 2013 compared to 2012. The growth has been attributed to the constant efforts by the government of Vietnam towards the administration of tourism. Through these efforts, the government seeks to make Vietnam the preferre d tourism terminal for international travellers. The Government through this programme undertook an initiative and organized the Da Nang International Fireworks Competition in Da Nang Province. The event was held on a five-day holiday for the country promoting both domestic and international tourism. The rising levels of disposable income among the Vietnamese people and the improving living standards have been credited as a major(ip) boost for local tourism in the country. Further, travelling has become more affordable owed to the increased tourism infrastructure, fostering both local and international tourism alike. According to the UNWTO (2015), the country was able to serve 9.6 million local tourists in the 3months. The country also targets to receive 10-10.5 million visitors from across the globe and places its local tourism expectations to about 47-48million by the year 2020. The revenues from both are also expected to rise to about $18million or $19billion.The Vietnamese peo ple have a rich history and several tourist destination

DERIVATIVES MARKETS Assignment Example | Topics and Well Written Essays - 1750 words

DERIVATIVES MARKETS - Assignment ExampleSince the securities ar listed and traded in the stock exchange, the indirect commercialize is as well called the stock market. In primary market, companies move with investors directly while in the secondary market investors interact with themselves. In both cases, the capital market intermediaries play an important role .The secondary market, based on all available information, determines the value and risk of the issued securities, it provides useful signals to both listed companies and investors to act in the primary markets. The secondary market may also include the everywhere the counter market and the differentials market. In the stock market share prices are determined by the demand and supply forces. On the other hand, in the over the counter market prices are negotiated between the buyer and the seller. The derivatives market deals in futures and options. In the derivatives markets, securities or portfolios of securities are t raded for future delivery. In case of options, the future delivery is conditional as the buyer has a honorable to exercise or not to exercise the option. The derivatives market and my proposed derivative product The emergence of new markets for derivatives much(prenominal) as forwards and futures can be traced back to the willingness of risk adverse economic agents to protect themselves against uncertainties occurring from price fluctuations in sundry(a) asset categories. Naturally, financial markets are very volatile. Through derivative products, however, it is possible to amply or partially transfer price risks by locking in prices of assets. By doing so derivative products reduce the impact of fluctuations in prices of assets on the cash flow and profitability situation of risk loath investors (Morrison and Winston 34). The derivative instruments are in use by all business sections, for instance, corporates, SMEs, financial institutions, banks and retail investors. My stri ke for this derivative is the ability to trade while conserving the environment through the hampering of the big problem of global calefacient which is getting worse as firms continue to produce. The duty is also focused on trading coulomb credits with the aim of controlling or reducing pollutants produced from business activities of firms. Therefore, the central driver of atomic number 6 emissions trading would be the impact on the climate and the degradation of the environment as a result of emissions of various gases. The immaturity of this market of derivatives also gives hope that in that respect is a growth potential for this business. Currently there are smaller numbers of firms that offer such certificates. An appropriate pricing model for derivatives on the coke emission certificates is certainly the first step in coming up with the derivative there is need to investigate the price dynamics. Product Design and Specifications The proposed derivative is a futures contra ct. Via the American Climate Exchange (ACX) carbon derivatives will be based upon 3 types of carbon related units. The following table gives an overview of my product in terms of price, quantity, unit of underlying asset, maturity date, delivery policy, margin requirement and daily settlement and achievement costs. Type Carbon Emission Derivation futures contract Trading Units 1000 carbon dioxide EUA valuation accounts, with each allowance allowing 1 tonne of carbon dioxide equivalent gas tokenish trading 1 lot chastise Price Intervals Quotation US dollar per metric tonne Minimum Tick $ 0.01 per tonne Minimum price flux $0.01

New product in Qatari market ( Recorder pen ) Essay

New harvest-time in Qatari grocery store ( Recorder frame ) - Essay ExampleThe fourth section comprises of SWOT analysis of the business and product being offered. ordinal section provides a detailed discussion about segmentation, targeting and promotion strategy of the company. Sixth section provides a detailed marketing mix for the product, and the last section discusses the ethical dilemma of the product.The company, Qatar Deja Vu, is a newly set up Qatari based company which is focusing on providing state of the art electronic products with smart and amaze use of technology. However, during this short history of 15 years, the company aims at learning and adjusting itself in line with the societal and cultural values of the country, while ensuring that technological advancements run smoothly. Qatar Deja Vu will operate in the consumer electronic labor in Qatar and deal in the manufacturing of smart devices which are specifically made for young generation. The upcoming prod uct of the company is named as Smart Pen, which is also being developed for people falling in the young age group.This mission statement is a depiction of the comprehensive vision and long confines strategy being followed by the company. As the company aims at targeting young generation, therefore the element of callowness is everywhere in its vision, strategies and products. The plan to introduce a Smart Pen in Qatari market is also a part of its long-term strategy to remain committed to serve the Qatari youthfulness with innovative products.The marketing query carried out and presented in this report has been based on information cool through secondary sources of information. In fact, there has been no primary information source or research instrument has been used in the research. The major sources of secondary information, used in this report, have come from online sources, such as websites, market reports, analysts opinions and forecasts, news, journals, books, magazines, etc. All information obtained from these

Impact of Illegal Immigrant Workers on the US Economy Essay Example for Free

Impact of Illegal Immigrant Workers on the US Economy EssayIllegal immigration is tightly woven into the fabric of the US economy. Its prevalence shams either corners of the financial world, but affects the greatest impact on educational funding, healthcare expenditures and taxes. Illegal immigration tends to be viewed from extreme viewpoints in our country much influenced more by personal biases and political opinions than statistical facts. In reality, the positive and negative effects closely neutralize each other and it has become a delicate balancing act for politicians to create and fend for a system that drills to please both sides and retain economic stability. Illegal immigrants are be as anyone who is not a US citizen and who is in the country in violation of our immigration laws this could believe anyone who has entered the country undocumented or falsely documented, those with expired visas or any permanent resident who commits a crime after entry and remains after deportation orders. It is virtually impossible to report incisively how many illegal immigrants reside in the country since they deal with fears of deportation they dont pronto identify themselves, but the INS, Census Bureau, and US General Accounting office estimates put the number someplace between 2 and 12 million.There is also likely fluctuation based on m of year depending on availability of agricultural work. Most of the illegal immigration debate over the at long last two decades has focused on Mexican immigrants and California has been used as a model for influencing regulations crossways the country. This is due to the fact that in the US those of Mexican origin account for over 54% of all illegal immigrants and that California houses over 40% of the illegal immigrant population.This is important to recognize because many of the arguments and proposed or passed laws with regards to this payoff stem from the Mexican immigration dilemma in California. (Here is wh at I could recover- I can get it through by Sunday on the school computers if it will make your due date- I am so sorry again. . . I have been freaking out cause of my computer and then I was stuck at work and couldnt get to any computer all day yesterday.)

Business Task 2 on reflection Essay Example for Free

Business Task 2 on reflection EssayUAE otherwise known as join Arab Emirates is amalgamation of 7 Emirates namely Umm Al, Quwain, Ras Al Khaimah, Ajman, Sharjah, Dubai, Abu Dhabi, and Fujairah. UAE is the second biggest Arabian Middle East economy. The united Arab Emirates is the number 3 biggest in this region in crude anoint exporting, following Iran and Saudi Arabia. It possesses the number 6 biggest recognized fusty crude oil reverse and the 5th biggest natural gas reserves. The swift growth in contain of water and electricity has generated the necessity to appraise unconventional power generation sources. In the year 2008, the join Arabs Emirates produced strength white paper on study of energy that con sloppeded that nuclear power to be purlieually friendly and safe alternative which would increment the prevailing plants of power in accomplishing increasing energy requirements.2.1 Objective of this study accomplishment The objective of this study of examining whether self-command structure matters for the murder of firms in United Arabs Emirates was achieved. Empirical evidence suggests that in camera held firms tend to be more efficient and more profitable than in public held firms. This shows that will power structure matters. The inquiry now is how does it affect firm cognitive operation? This question is very beta because it is based on a research agenda that has been strongly promoted by La Porta et al. (1998 1999 2000). fit to these studies, failure of the legislative manakin to provide sufficient protection for external investors, entrepreneurs and founding investors of a gild tend will fight down large positions in their firms thus resulting in a concentrated possession structure. This paper aimed at looking at whether possession structure has an impact on firm carrying out in UAE. This region has witnessed significant economic growth over the last few decades. The region is overly facing turbulent times with respect to corporate presidency practices, resulting in poor firm death penalty. bodied governance issues are not limited to the Gulf region. From a global point of view, corporate governance has witnessed significant transformations over the last decade (Gomez and Korine, 2005). The data that is used in this study includes 362 non-financial listed firms during the period of 2006-2011 from Thomson mavin banker, Thomson.com, DataStream and annual report. Panel data is used to analyse the impact of ownership structure on firm performance number of independent directors on the board are controlled for. The different types of ownership structure that are included in the study are managerial ownership, family ownership, government ownership, institution ownership, extraneous ownership and concentrated ownership.Evidence personalised learning and development1.0 Effects of structure on firm performance It is incontestible, managerial ownership, Chairman own share, institutio nal investors, corporate total own, institutional owner domestic and corporate foreign all deport positive effects on firm performance. The evidence is also consistent with supposititious and empirical arguments. On the contrary, When Return on Assets (ROA) is used as a measure of performance the evidence shows that government ownership has negative effects on firm performance in United Arab of Emirates oil firms. Therefore, performance of United Arab of Emirates oil companies is affected by government ownership. The relationship between performance and ownership structure also differs for firm specific variables such as leverage, GDP growth and firm surface. When the Tobins Q is used, the relationship is negative for leverage, GDP growth and firm size. The negative and significant impact of firm size on firm performance when Tobins Q is used can be attributed to the fact that large firms have limited investment opportunities, which limit their potential to grow and make prof it. Surprisingly, the impact of GDP growth is importantly negative. However, when ROA is used, we did not find any significant relationship with firm performance in United Arab of Emirates oil firms. This study also shows that there may be a necessity to motivate policy makers of United Arab of Emirates oil firms to ensure that banks practice the mechanisms of corporate governance effectively. This practice should be compatible for the business environment of United Arab of Emirates oil firms, whereas adopting the same governance standards in order to ensure unification of disclosure level among the banks. It is expected that the best practice of the corporate governance characteristics will contribute to improve efficiency, effectiveness and observe in the Islamic banks of UAE. Therefore, this can only be applied by developing the regulatory and have frameworks. In the last 4 decades, researchers have believed that there is a connection between the firm performance and t he ownership structure. In this regards, there has been publications of many studies on different markets to inspect this relationship. This connection between performance and ownership structure dates back to empirical study of Mean and Berle in the year 1932 that got that the weakness of shareholding in a negative way influence the performance of affirm via an inverse relationship. Generally, the number of well-developed policies and the present well-grounded systems are poorly developed in the markets that are emerging. These new markets, according to most analysis studies, lose protection for their creditors and shareholders (La Porta, 1999).2.0 Ownership structure in relation to firm performance The issue as to whether ownership structure matters for the performance of firms has been an important subject of debate in the finance literature. Empirical evidence suggests that privately held firms tend to be more efficient and more profitable than publicly held firms. This sh ows that ownership structure matters. The question now is how does it affect firm performance? This question is very important because it is based on a research agenda that has been strongly promoted by most researchers in economics. According to these studies, failure of the legislative framework to provide sufficient protection for external investors, entrepreneurs and founding investors of a company tend will maintain large positions in their firms thus resulting in a concentrated ownership structure.This finding is interesting because it implies that ownership structure can affect the performance of the firm in one way or the other. It is indisputable the lack of regulations in corporate governance gives managers who intend to mishandle the flow of cash for their own personal interest a low control level. The empirical results from the past studies of impacts of ownership structure on performance of corporate have been inconclusive and mixed up.ReferencesGomez, P.Y. Korine, H. 2005, Democracy and the Evolution of corporate Governance. Corporate Governance, 13, 739-752.La Porta, R., L. et al. 1999, Corporate ownership around the world. The Journal of Finance, 54(2), 471517.Source document

Work, Culture, and Society In Industrializing America 1815- 1919 Essay Example for Free

locomote, Culture, and Society In Industrializing the States 1815- 1919 EssayIt is historian Herbert G. Gutmans thesis that the conflicts amongst the ricking clear up and the non working class resulted in a departure from its values and principles. The working class did not want this departure to happen it was only the inevitable result of the growing industrialization. The conflicts between the ease of bon ton and the working class resulted in the disappearance of its principles. During the beginning of the 19th century, the United States had remained a pre-industrial society and in that location were few workers and factories because at the magazine, it was dominated by a farming, skilled workers, and agricultural socialisation. However, after 1843, the diligence developed radically through the civil war and was followed by a virgin nature industrial society that appeared in 1893. During this development, both skilled women and men were forced to modernize. Just as Sid ney Pollard had described, a society of peasants, craftsmen, and versatile labourers became a society of modern industrial workers. This process was difficult because it required a task of industrializing whole cultures. Nevertheless, the process was achieved as the nation gathered and worked to transform themselves and new groups from the pre- industry to the new.This progression was continually altered by immigration, social conflicts, and through various other elements. These women and men sold their labor to an employer to kernel this new changing factory working condition. Work habits in comparison remained the same from the native culture and to the immigrants. Also, the working pattern also parallels one of that of the European patterns in pre-modern development. There were also tensions between culture, work, and society. Work habits of men and women in the new factory and labor life attributed to the diverse pre-modern cultures.During the early 19th century, many American s were newly introduced to a more efficient process of production called the factory. At this period of time, most work was done by man, not machines. Conversely, as time developed, more and more factories, beginning with textiles and cotton industry used unskilled labor to work in mass producing products. Drinking was common in this time even while working, it caused unproductive labor and often be inclined to have more accidents and deaths. repair movements began and to solve this there was a temperance movement although it was short lived it served its process.Also, man hop onrs began to fine and deduct from wages if there was unproductiveness, for instance, drinking liquor. And at places where unskilled factory workers could easily be replaced, they took this as an advantage and often discharged those who did become drunk. The effect was better working habits to society. These work habits were not just common to pre modern America but also later generations of factory workers. And by 1920, two thirds of workers in the twenty-one major digging and manufacturing industries came from either Southern or Eastern Europe or were American blacks.Many of these cultures and factory workers had legion(predicate) of the pre-industrial work habits. Assorted patterns of working class behavior accompanied the industrialization of the United States. Forms of protest occurred end-to-end the periods and development of industrialization in America. This followed the ever changing behavior and diversity of the cultures that were in the working class. other form of culture was included in street gangs that were believed to hold artisan and lower class workers and were organized by ethnicity. Others, people often had food riots against the monopolies and the rising food prices.Similar behaviors in riots even decades away for instance, the 1837 food riot wasnt much different from one from 1902. For instance, women became organized and were led by a char butcher and these people protested the rising price of kosher meat and a disloyalty among the members in not boycotting it. bid the previous disorders and riots, these women battered shops and carried the meat like flags although they did not steal at all. The development of the industrial age was a process where many progressed and left their previous values behind, although there was some resistance to this new modernization.

Capital Punishment and Complainants Essay Example for Free

Capital Punishment and Complainants EssayThis paper go forth comment on the significant decisiveness of the Honble Supreme Court in Vikas Deshpande v cease Council of India,1 dismissing the greet by an advocate who was banned from pr constituteicing and fined by the Bar Council of India for gross master copy muck up. The comment will take a look at the facts that constitute the bungle and the possible reasons behind the Supreme Courts decision. Case Comment Facts in BriefIn this case, an call sight was filed by Vikas Deshpande, advocate, hereinafter referred to as the appellate, downstairs Section 38 of the Advocates Act, 1961 for short the Act against the final rove passed by the disciplinary charge of the Bar Council of India. By the impugned order the Bar Council of India permanently debarred the plaintiff in error from practising as an advocate for the commission of a grave professional misconduct and also imposed the cost of Rs. 25,000.Ramrao Chandoba Jadh av, Vidyadhar Ramrao Jadhav, and Chandrakant Ramdeo Jadhav (all deceased), hereinafter referred to as the complainants, were prosecuted for committing murder of six persons on 16th December, 1990. As they were extremely poor, they asked the Court to appoint a lawyer to represend them free of cost as amicus curiae. Sessions Court after trial ready the complainants conscience-smitten of the offence charged with and awarded them death penalty by an order dated 30th August, 1991. On the homogeneous date the appellate contacted the complainants in Yervada Central Prison where they were lodged.Appellant took the copies of the judgment from the complainants and obtained their thumb impression and signatures on the Vakalatnama to prefer an appeal in the High Court of Bombay at Aurangabad Bench. Appellant told the complainants that he would non be charging any fee as he was doing this to make a name for himself. On 10th October, 1991 plaintiff in error visited the Yervada Central Priso n again and obtained their signatures on some stamp papers. The deed was non read everywhere to the complainants nor were the contents made known to them. Complainants signed and put their thumb impression on the documents in candid faith.In January, 1992 the High Court dismissed the appeal of the complainants and confirmed the death sentence and subsequently complainants were hanged to death. On 16th February, 1992, appellant met the complainants in Yervada Central Prison again and told them that he had sold their reason on the basis of power of attorney executed in his favour by them authorising him to sell the land. That he had attachd the funds received by him towards his fees. Further the appellant asked the complainants to authorise him to prefer an appeal to the Supreme Court which they declined.thereafter the complainants filed a complaint with the Chairman, State Bar Council to the effect that the appellant who was practising as an advocate at Nanded, Maharashtra atta ched an act which amounted to professional misconduct within the meaning of Section 35 of the Advocates Act and for the said act disciplinary action be taken. They had requested for the appointment of an advocate as amicus curiae to defend them to leave their seat for the surviving members of the family in case the complainants were sentenced to death.They stated that they had never authorised the appellant to sell their land. That the appellant had play fraud on them and sold the property on the basis of the alleged power of attorney obtained by him through misre usher ination. Appreciating the seriousness of the complaint made by the complainants, State Bar Council took suo motu cognizance and issued nonice to the appellant who filed his reply. He described himself to be an expert criminal lawyer as he had conducted many sessions trials and appeals.It was pleaded by him that he had also engaged some other lawyers as well and he was trying his top hat to pay the fees of the sai d advocates by interchange the land of the complainants. It was further stated that on the request of the complainants on 30th August, 1991 he accepted the vakalatnama on behalf of the complainants on an oral agreement that the complainants would pay Rs. 50,000 to the appellant for conducting the checkout case and the appeal before the High Court, for which they authorised him to dispose of their land to recover and appropriate the currency received.That out of 16 acres of land owned by the complainants the appellant had sold only 6 acres and 30 gunthas of land to meet the expenses. Another fact which needs to be mentioned is that the government military rating of the land was 1,35,000 but the appellant had settled the final consideration at Rs. 75,000 out of which Rs. 30,000 was paid at the time of the agreement to sell and the remaining amount was to be paid before 1st March, 1992. later(prenominal) on a sum of Rs. 17,000 was paid to the appellant. The remaining amount of Rs.2 8,000 could not be obtained by the appellant as the power of attorney executed in his favour was cancelled by the complainants. The complaint was taken cognizance of and the matter was referred to the disciplinary Committee of the State Bar Council. Vidhyadhar, complainant no. 2, was examined on oath. He, in his deposition, reiterated the what had been stated by him in his complaint. He specifically stated that he and his two other associated had not executed any power of attorney in favour of the appellant authorising him to sell their land and appropriate the bargain consideration towards his fees.That their signatures had been obtained on blank papers. That the power of attorney had been obtained by misrepresenting the facts in order to hook them. This witness was cross-examined but nothing of substance could be brought out from his cross-examination. As the State Bar Council could not complete the proceedings within a period of one year, the complaint was transferred to the B ar Council of India under dent 36B of the Act. The matter was entrusted for further action to the Disciplinary Committee of the Bar Council of India.In spite of repeated notices sent to the appellant which were duly served on him (four times) the appellant did not put in appearance. The proceedings were continued ex-parte. The Disciplinary Committee of the Bar Council of India found the appellant guilty of soliciting brief from the complainants and obtaining their signatures and thumb impressions on certain documents on the basis of which power of attorney was executed in his favour authorising him to sell the land of the complainants.It was found that the appellant had failed to kindle that the complainants had executed the power of attorney in his favour to sell the land. It was also held that the appellant had failed to judge that his fees at the relevant time to conduct the criminal appeal was settled at Rs. 50,000. That he has failed to prove that he was entitled to and just ified in recovering the fees by selling the land belonging to the complainants. The Disciplinary Committee found the appellant guilty of gross professionalmisconduct as defined under Section 35 of the Advocates Act and directed the State Bar Council of Maharashtra and Goa to remove the name of the appellant from the bowl of the Bar Council of Maharashtra and Goa under section 35(3d) of the Act. Cost of Rs. 25,000 were imposed and made payable to the heirs of the complainants because by that time the complainants had already been put to death in execution of the sentence imposed on them. A lien was created on the property of the appellant for the recovery of costs. Decision of the Honble Supreme CourtThe judgement of the division bench of the heyday Court, consisting of justices VN Khare and A Bhan, was to dismiss the appeal without costs The judges saw no merit in the appeal for the following reasons 1. There was no substance in the submission made by the appellant that he could n ot be proceeded ex-parte. It was evident to the judges from the perusal of the indicate that there were four acknowledgements on the participate which showed that the appellant had been duly served four times and in spite of the notices having been served on the appellant he did not choose to appear before the Disciplinary Committee at any point of time.The Disciplinary Committee had no other option but to hear the matter. 2. The Secretary of the State Bar Council, who was appointed as a prosecutor, also did not lead any evidence because in the meantime all the tercet complainants were hanged in execution of the sentence imposed on them. The only evidence which remained and which had come on the record is the statement of Vidhyadhar, complainant. Vidhyadhars testimony fully launch the charge of professional misconduct against the appellant. 3. The Court agreed with the relegateings enter in the impugned order.The appellant failed to lead any evidence to displace the testimony of Vidhyadhar to the effect that the appellant had solicited a brief for himself from them and they had not executed any power of attorney in his favour for the purpose of the sale of their land. He had obtained signatures and thumb impressions of the complainants on some documents. Without informing complainants a power of attorney was got executed in favour of the appellant to sell of the land. 4. The power of attorney was obtained by the appellant on misrepresentation.In following of the alleged power of attorney in his favour the appellant sold the land of the complainants fraudulently. 5. It was also established that fees of the appellant had not been settled at Rs. 50,000. He was neither entitled nor justified in selling the land of the complainants on the basis of the alleged power of attorney for the recovery of his fees. Had the intention of the complainants been to sell the land then they would not have requested for appointment of an amicus curiae to defend them before t he Sessions Court.Thus, in the Honble Apex Courts opinion, the appellant took advantage of the situation that the complainants facing death sentence and obtained the power of attorney on misrepresentation in his favour and sold the property of the complainants. Further, the appellant fraudulently appropriated the sale proceeds for his gain. He has committed a grave professional misconduct. SUMMARISE WHAT HAVE TO SAY Professional Misconduct Blacks Law dictionary defines misconduct as transgression of some established and definite rule of action, a forbidden act, a dereliction of duty, an unlawful behaviour, improper or wrong behaviour etcetera.2 Justice Darling defined professional misconduct in the following words, If it is shown that an advocate in the pursuit of his profession has done something with regard to it which would be reasonably regarded as disgraceful or dishonourable The Advocates Act, 1981, also does not lay down the translation of misconduct. In a 2004 case, the Ap ex Court further clarified that it would be difficult to lay down exhaustively what would constitute misconduct and indiscipline. 3 However, that decision had not been passed at the time of deciding of the present case, and the judges had to rely on their discretion as best they could.In order to do so, they relied on their common sense. An advocate ought not to act in an unlawful manner with respect to his or her client. peculiarly in criminal matters, the life and death of the accused might depend on the skill and will of the advocate. If the advocate decides to deliberately fight the case in a languid fashion, he can considerably ensure that his clients die. In the present case, the advocate stood to gain much from the death of his clients, as they would be inefficient to deny the fact that they had agreed to let him sell their property and appropriate the proceeds as his fee.Their legal heirs would be unable to oppose this fact and he would easily get the money they were ent itled to. low such suspicious circumstances, the advocates selling of the clients property without their consent or knowledge certainly amounts to professional misconduct. discourse PREVIOUS LEGAL ETHICS CASES DISCUSS EVIDENCE POSSIBLE REASONS FOR COURTS DECISION QUOTE FINAL space-reflection symmetry IN INDIRECT FORM Conclusion The Court was right in not reversing the decision of the Bar Council of India in the appeal. The relationship between an advocate and his client is of trust and therefore sacred.Such acts of professional misconduct and the frequency with which such acts are coming to light distresses as well have to be curbed. saving of the mutual trust between the advocate and the client is a must otherwise the prevalent juridical system in the country would collapse and fail. Such acts do not only affect the lawyers found guilty of such acts but erode the confidence of the general public in the prevalent discriminatory system. It is more so, because today recruitment to the Bench is from the Bar starting from the subordinate judiciary to the higher judiciary.You cannot find honest and hard working judges unless you find honest and hard working lawyers in their chambers. To summon the judges themselves, Time has come when the Society in general, respective Bar Council of the States and the Judges should take greenback of the warning bells and take remedial steps and nip the evil or the curse, if we may say so, in the bud. 4 Thus, this case was a fitting reminder of the long reach of the law, from which even advocates are not exempt, regardless of what they might believe to the contrary.

Electronic Health Records Essay Example for Free

Electronic Health Records Essay interpolationElectronic closelyness records (also known as e-notes) affirm commonly replaced the conventional makeup records used in medical facilities. This discussion describes how electronic wellness records have provided a solution to a range of health c are procedures, have offered cost savings and benefits, and still have greater potential for improvement done future efforts. Overall, this discussion documents the progress and demands for further convenience in regards to electronic health records, presenting concepts, statistics, and recent analyses print by authorities on the topic. Through this, it is perspicuous that electronic health notes still have shortcomings that are commonly noted and targeted, but as they have solved some(prenominal) more problems inherent in previous systems, they are the ideal path for ripening and improvement in this area.Electronic Health RecordsSince the training of electronic health records, healt h carefulness coifrs have been able to reach numerous solutions to previous problems in their systems this has include improved capacities to record and store the clinical and demographic information patients, the capacity to observe or manage the results of laboratory tests, the capacity to give prescriptions, improved ease of managing billing data, and improved facilitation of analysis for clinical ends. These improvements find the character of challenges and demands relevant to operations using the previous form of records ( write up), with electronic health records being well more organized, convenient, and manageable. According to Al-Ubaydli (70), the use of paper records had several implications.On the one hand, writing on paper fast and easy, so it fits well with clinical workflow. On the other hand, notes are only useful to the somebody who reads them, no to the one who writes them. When writing, speed and brevity are essential as there are endlessly more patients to vi sit and care for. But for the reader, speed mode illegible handwriting and brevity operator in pick out notes. This leads clinicians to ask patients questions to which the answers already exist in the notes (Al-Ubaydli 70). Moreover, as the author pointed out, paper is more catchy to transfer or copy, leading to it ultimately becoming easiest to keep the records confined to one central place. With this, they cannot crusade as easily as the patient, and the chore of copying tended to result in the patients being without a complete set of easily accessible records. Meanwhile, there are substantial space and cost requirements associated with storing paper records.The development of computer hardware, software package, and improved data storage techniques eventually led to the development of efficient and effective software capable of storing patient data in secure databases, further allowing all data to be stored in a size-efficient manner that could also be easily communicate. With the development of the internet, patient files could even be stored and transmitted online, providing an ideal backup for databases while improving the capacity for patients to have complete record sets sent to a range of facilities.The general motivation for creating these electronic health records was to address the problems inherent in the paper records, with the just about convenient aspect being the cost-effective nature of storage and transmission the nature of this being a virtually free cost and nearly instantaneous transmission made the desire and changes especially significant. Moreover, electronic health records would allow users to improve the capacity for users to index, sort, and search by dint of records faster than the time demanded to sort through the paper files manually (Al-Ubaydli 70). An additional benefit is the reduced potential for illegible notes, as the nature of the systems means that all data is entered in using clear computerized text characters.A s mentioned, alike(p) to the nature of demands and problems evident in the paper records, there are now demands for improving aspects of the electronic records. However, these problems can be intercommunicate through improved organization, software, and other means that does not demand a drastic change in mediums, as was required to address the problems of the paper records. Al-Ubaydli (71) reported that electronic health records must include checks and balances to canvass and control access.Second, the user interfaces for adding to the records must move around easier to that they fit better into clinical workflow and allow clinicians to do more in less time. Speech recognition continues to improve, and the designers of templates continue to innovate. The author further points out that similar to the improved search engines of the internet (first challenging and then drastically improved with developments like Google), electronic health records can be similarly improved without restructuring comparable to restructuring paper records.Other researchers have analyzed the nature of electronic health records, further elaborating on the nature of solutions and remaining demands. DeVoe et al. (351) pointed out that the clear and detailed recording of all received and recommended services should be considered the most vital aspect of health records, which is most effectively addressed through electronic records rather than paper records. This further assists with insurance aspects, as the detailed and right aspects of recording services can improve coordination with claims and related demands. DeVoe et al. (352) further asserted that electronic health records have the potential to assist researchers and policy makers with overcoming prior restrictions in examining services provided in CHCs.Meanwhile, Hoffman and Podgurski (425) reported on the emergence of health care and pharmaceutical costs, frequency of unnecessary medical procedures, evoked healthcare refo rms, and critical roles of records in all of these processes. With this, comparative effectiveness research (conditioned emotional response) has commonly been coupled with electronic health records to show that many expensive procedures have had less desirable outcomes for comparable conditions that less expensive ones, pointing out the nature of some health care facilities and physicians. Meanwhile, however, some have argued that CER is likely to lead to limited patient choices, amiss(p) rationing of health care, homogenized care, and potentially refusal of needed treatments (Hoffman and Podgurski 425).Congress allocated $1.1 billion to CER through the American Reinvestment and Recovery Act, which included other aspects of improving and restructuring facilities. Soon it became evident that a unique application of CER could allow physicians to improve their decisions regarding treatment, as when coupled with electronic health records, physicians could conduct computer inquiries acr oss a large database of patient records. Naturally, this would provide a valuable supplement to the patients history and literature. Hoffman and Podgurski (425) recommended that software be designed to summarize findings of queries by presenting the most relevant outcomes of patients with the most comparable conditions, while records be developed and stored in a manner which facilitates this. Thus, personalized comparison of treatment effectiveness or PCTE could become a phrase more common than CER in the future.ConclusionElectronic health care records have solved many of the problems that could not be effectively addressed through developments in the paper systems, with major improvements in the capacity to copy and transfer records, cost of storage, and clarity of information. Although this has led to implications for security and profuse copying, databases have been developed to improve the concerns in these areas. Moreover, researchers have proposed additional improvements in d evelopment as well as use, with records having the potential to serve as an informal accessible databank, thereby improving understanding and decision making.Works CitedAl-Ubaydli, Mohammad. Personal Health Records A Guide for Clinicians. John Wiley Sons New York, NY, 2011.DeVoe, Jennifer, Rachel Gold, Patti McIntire, Jon Puro, and Susan Chauvie. Electronic Health Records vs Medicaid Claims Completeness of Diabetes stay trade Data in Community Health Centers. Annals of Family care for 9.4 (2011) 351-358.Hoffman, Sharona and Andy Podgurski. Improving Health Care Outcomes through Personalized Comparisons of Treatment Effectiveness Based on Electronic Health Records. Journal of Law, Medicine Ethics 39.3 (2011) 425-436.

Summary The Health Care Quality Book Essay Example for Free

Summary The wellness wish feel Book EssayChapter 1 science and cognition ftTwo nonable contri scarcelyions to the manufacturing from the Journal of Ameri shag Medical Association 1. Assessment of the state of reference serious and widespread persona problems 2. Categorization of tierce defectsa. Underuse m both scientific totallyy sound enforces atomic tally 18 non used as ofttimes as they should be b. Overuse butt be seen in argonas such as imaging studies for diagnosis in acute asymptomatic low back pain or prescription of antibiotics when not indicated for infections. c. maltreat when the proper clinical maintenance act upon is not executed appropriately, such as giving the aggrieve drug to a endurings. To Err Is Human publication that shows the severity of the feeling problems in a bureau that captured the attention of all key stakeholders for the first time this report spoke almost the negative, not how it should be emendd. Crossing the character reference chasm tind a blueprint for the future that classified and unified the components of fibre through sestet points for overture, chain of effect and simple rules for redesign of wellness pity. sextette dimensions of forest (Berwick)Outcome barrooms and goals (IOM) = Institute of euphonys SafePercentage of overall mortality rates/patients experiencing adverse events or harm stiff science and evidence should be applied and serve as the streamer for delivery of explosive charge. How well argon evidence based practices followed? Percentage of time diabetic patients receive all recommended charge at separately doctor visit.. Efficient Care and service should be cost effective, and waste should be removed. Analyzing the costs of veneration by patient, ar get alongment, provider or community Timely no waits or delays in receiving grapple mensural by waits and delays in receiving undeniable care, service, and test results. Patient centered form should revolve aro und the patient, admirationits preferences and put the patient in sway Patient or family satisf live up to with care and service good enough Disparities should be eradicated.Examining discriminations in step preventions by race, gender, income or other factors.The underlying framework for achieving these aims depicts the wellness care establishment in quadruplet levels Level A what happens with the patientLevel B the micro system where care is delivered by petty provider teams Level C organisational level the macro system or aggregation of the Microsystems and houseing functions. Level D external environment where payment mechanisms, policy and regulative factors reside (verblijven)Chapter 2 Basic concepts of health care qualityThe pursuit refers relevant to the translation of quality of care are cardinal Technical execution refers to how well current scientific medical knowledge and technology are applied in a given situation (it is usually assessed in legal injur y of timeliness and accuracy of the diagnosis, appropriateness in of therapy) Management of the social sexual relationship refers to how well the clinician relates to the patient on a human level.The quality of this relationship is important because By establishing a good relationship with the patient the clinician is able to fully address the patients concerns, reassure the patient and relieve the patients suffering It can affect technical executing the clinician is better able to elicit from that patient are more complete and accurate medical history, which can result in a better diagnosis amenities (voorzieningen) refers to the characteristics of the pin downting in which the encounter amidst patient and clinician takes place, such as comfort, convenience and privacy. Amenities are protectd both in their own right and for their effect on the technical and interpersonal aspects of care. Amenities can yield (opleveren) benefits that are more in condition.Access refers to t he degree to which individuals and roots are able to regain needed services. Responsiveness to patient preferences respect for patients values, preferences and expressed needs affects quality of care as a factor in its own right. Equity the amount, fount or quality of health care provided can be think systematically to an individuals characteristics, sparkicularly race and ethnicity, rather than to the individuals need for care or healthcare preferences, commence heightened concern about equity in health care. Medicine does not fulfill its function adequately until the same perfection is within the r to each one of all individuals. Efficiency refers to how well re semens are used in achieving a given result. Cost-effectiveness how much benefit, typically heedful in terms of gain in health shape, the intervention yields for a particular level of expenditure.For each stakeholder in health care, quality can be differently defined page 30 + 31. These commentarys deem a g reat deal in common Each definition emphasizes different aspects of care Definitions struggle however in relation to cost-effectivenessAll evaluations of quality of care can be classified in terms of one of the ternion aspects of caregiving they respect Structure when quality is measured in terms of structure, the reduce is on the relatively static characteristics of the individuals who provide care and of the securetings where the care is delivered. These characteristics include the preparation, training and certification of professionals. bit refers to what takes place during the delivery of care, also can be the basis for evaluating quality of care. Outcomes Outcome measures, which capture whether healthcare goals were achieved, are another way of assessment of quality of care. Outcome measures yield to include the costs of care as well as patients satisfaction with care. Which one is better to use? none of them, all depends on the circumstances.To assess quality using structure, process or outcome measures, we need to know what constitutes good structure, good process and good outcomes. We need criteria and standards we can apply to those measures of care Criteria = specialised attributes that are the basis for assessing quality Standards = express quantitatively what level the attributes must reach to satisfy preexisting expectations about quality. For example type of measurestructure and focus on primary coil care group practice Criterion per centum of board-certified physicians in inner(a) or family medicine Standard 100% of physicians in the practice must be board certified in internal or family medicine.Optimal standards denote the level of quality that can be reached under the outflank conditions, typically conditions similar to those under which efficacy is chinkd useful as reference point.Structural measures are well suited to detecting lack of capacity to deliver care of acceptable quality. They are also only as good and useful as strength of their relation to desired processes and outcomes. To evaluate structure, process and outcome measures criteria and standards are essential. Whereas the formulation of criteria is expected to be evidence dictated (efficacy). The setting of standards is not similarly tied to scientific literature. The decision to set standards at a minimal, saint or achievable level is most meaningful if driven by the goals behind the specific quality of care evaluation for which the standards are to be used.Chapter 3 chromosomal mutation in medical practice and implications for qualityVariation the difference between an observed event and a standard or norm. Without this standard, or crush practice, standard of summercater offers little beyond (biedt niet meer dan) a description of the observations. Random innovation = physical attribute of the event or process, adheres to the laws of probability and cannot be traced to a root cause. (houdt zich aan de wetten van waarschijnlij kheid en kan niet worden herleid tot een oorzaak). It is not worth to study it in detail.Assignable variation = arises from a single or small set of causes that are not part of the event or process and therefore can be traced, identified, and utilize and eliminated subject to potential misunderstanding because of complexity of design and interpretation. 1. affect variation = the difference in purpose throughout an brass section (use of various screening methods for colorectal cancer) Technique multitude of ways in which a procedure can be performed within the realm of acceptable medical practice. 2. Outcome variation = difference in the result of a single process (mostly focus on this measure) the process yielding optimum results outcomes research 3. achievement variation = the difference between any given result and the optimal rarefied result. This threshold or best practice is the standard against which all other measurements of variation are compared. Performance varia tion tells us where we are and how far we are from where we want to be, and suggests ways to achieve the desired goal.Variation can be desirable? a successful procedure that differs from other, less successful procedures is by definition variation. The prey hence for quality improvement is not simply to identify variation but to make up its value. How can the variation be eliminated or reduced in the ways that focus on the variation rather than on the great deal involved? So, understanding the implications for quality of variation in medical practice is not simply learning how eliminate variation but learning how to improve performance by identifying and accommodating good or suboptimal variation from a predefined best practice.Variability plays a role in identifying, measuring and reporting quality indicators (effective, efficient, equitable..) and process-of-care improvements.Some hospitals are reluctant to use quality improvement measures (they behold them as biased towards academic medical research centers or large health care organization) false Quality improvements efforts can be and have been successfully applied to small organization and practices.The size of an organization also effects the ability to disseminate (verspreiden) best practices. Large organization tend to have cockeyed frame workings or bureaucracies transport is slow and requires perseverance (doorzettingsvermogen) and the ability to make clear to skeptics and enthusiasts the value of the newfound procedure in their group and across the system.An organization s commitment to paying for quality improvement studies and death penalty is equally affected by its size and infrastructure, but there are some minimum standard levels of quality and linked reimbursement schemes to achieving goals established by the Joint Com sufferion, CMS and Medicare all organizations obligated to meet these standards.Quality improvement effort must consider organizational mind-set, administrative and physician worldviews, and patient knowledge and expectations. Physician buy-in is particular to reducing undesired variation or creating new and succesfull preventive systems of clinical care, therefore training physician champions and inciting (aanzetten) them to serve as feignings, mentors and motivators and it reduces the risk of alienating (vervreemden) the key participants in quality improvement efforts.Patient education in quality of care is equally subject to variation patients are aware of the status of health care providers in terms of internal rankings, public news of quality successes and so on. Educating patients about a health care organization and its commitment to quality makes variation and process-of-care measures available to the public.Organizational mind set organizational infrastructure is an essential component in minimizing variation, disseminating best practices and validateing a research agendum associated with quality improvements. Economic incentive s may be effective in addressing variation in health care by awarding financial bonuses to physicians and administrators who meet quality targets or withholding bonuses from those who do not. Goals of incentives to divine service people understand that their organization is serious about implementing quality changes and minimizing unwanted variation to ensure alignment with national standards an directions in quality of care and to encourage them to use the re point of references of the organization to achieve this alignment .Chapter 4 Quality improvement the foundation, processes, tools and knowledge transfer techniquesDifferent leaders of quality improvement systems page 63 67Quality improvement salutees (derivatives and models of the estimates and theories conk outed by thought leaders) PDCA/PDSA, Associates for Process Improvements Model for Improvement, concentrate on PDCA, Baldrige criteria, ISO 9000, dispose, Six Sigma.PDCA/PDSA cycleBasis for schemening and directing performance improvement efforts. 1 Plan heading what are you trying to accomplish? What is the goal? Questions and predictions What do you think entrust happen?Plan to sustain out the cycle Who? What? When? Where?2 DoEducate and train staffCarry out the architectural plan (try out the change on a small scale)Document the problems and unexpected observations?Begin compend of the selective development3 Study/CheckAssess the effect of the change and determine the level of success as compared to the goal/objective Compare results to predictionsDetermine what changes need to be make and what actions will be interpreted next 4 ActAct on what you have learnedDetermine whether the plan should be repeated with modifications or a new plan should be created Perform necessary changes come across stay gaps in process or performanceCarry out additional PDCA/PDSA cycles until the agreed-upon goal or objective is metAPI improvement modelSimple model for improvement based on Demings PDSA cycle . The model contains three fundamental questions that form the basis of improvement What are we trying to accomplish?How will we know that a change is an improvement?What change can we make that will results in improvement?FOCUS/PDCA model founding on de PDCA cycle the FOCUS PDCA model is created more specific and defined near to process improvement. The key feature of this model is the preexistence of a process that needs improvement. The intent of this model is to maximize the performance of a preexisting process, although the inclusion of PDCA provides the option of using this model for new or redesign process. F FIND a process to improveO ORGANIZE a team that knows the processC CLARIFY current knowledge of the existing or redesigned process U UNDERSTAND the variables and causes of process variation within the chosen process S SELECT the process improvement and identify the potential action for improvement Baldrige criteriaThe criteria can be used to assess performance on a wide range of key indicators health care outcomes patient satisfaction and operational, staff and financial indicators. The Baldrige healthcare criteria are construct on the pastime set of interrelated core values and concepts (page 70). The criteria are organized into seven mutualist categories LeadershipStrategic planningFocus on patients, other guests, and markets saloonment, analysis and knowledge management module focusProcess managementOrganizational performance resultsBaldriges scoring system is based on a 1000 point scale. Each of the seven criteria is assigned a maximum value ranging from 85 to 450 maximum points. The most heavily weighted criterion is the results category (450). The weight of this category is based on an emphasis Baldrige places on results and an organizations ability to demonstrate performance and improvement in the following areas Product and service outcomes, customer-focused outcomes, financial and market outcomes, workforce-focused outcomes, process ef fectiveness outcomes, leaders outcomes.ISO 9000The international Organization for normalization (ISO) issued the original 9000 serial of voluntary technical standards in 1987 to facilitate the growth and maintenance of quality cover programs in the manufacturing industry. In 2000, ISO made major changes to the standards to make them more relevant to service and health care settings. Focused more on quality management systems, process approach, and the role of top management, the most modern standards include eight common quality management principles Customer-focused organizationLeadershipInvolvement of peopleProcess approachSystem approach to managementContinual improvementFactual approach to decision qualificationMutually beneficial supplier relationshipsLean thinkingLean to describe production methods and product development that, when compared to traditional mass production processes, produce more products, with fewer defects, in a shorter time. The focus of Lean methodolo gy is a back to basics approach that places the needs of the customer first through the following five paces 1. Define value as determined by the customer, identified by the providers ability to deliver the right product or service at an appropriate price. 2. Identify the value stream the set of specific actions required to bring a specific product or service from concept to completion 3. Make value added steps flow from beginning to end4. let the customer pull the product from the supplier, rather than push products 5. Pursue perfection of the processSix sigmaThe aim of six sigma is to reduce variation (eliminate defects) in key business processes. By using a set of statistical tools to understand the fluctuation of a process, management can predict the expected outcome of that process. Six sigma incluses five steps, commonly known as DMAIC Define Identify the customers and their problems. Determine the key characteristics important to the customer along with the processes that su pport those key characteristics. Identify existing output conditions along with process elements. Measure categorise key characteristics, verify measurement systems and hoard up information Analyze Convert raw information into information that provides insights into the process.These insights include identify the fundamental and most important causes of the defects or problems. Improve Develop solutions to the problem, and make changes to the process. Measure process changes and judge whether the changes are beneficial or another set of changes is necessary. Control If the process is execute at a desired and predictable level, monitor the process to ensure that no unexpected changes occur. The primary tool of six sigma is that focus on variation reduction will lead to more akin process output. Secondary effects include less waste, less throughput time and less inventory.Quality tools three categories (also six categories distinguishing on page 74) Basic quality toolsControl c hart upper and lower tone down boundaries that define the limits of common cause variation. It is used to monitor and analyze variation from a process to determine whether that process is stable and predictable or unstable and not predictable HistogramCause-and-Effect/Fishbone diagram the problem is verbalize on the right side of the cart, and likely causes are listed around major headings that lead to the effect. It can help organize the causes contributing to a complex problem. Pareto chart 80% of the variation of any characteristic is caused by only 20% of the possible variables. Management and planning tools (75)Affinity diagram a list of ideas is created, and then individual ideas are written on small note cards. Team members study the cards and group the ideas into common categories. The affinity diagram is a way to create order of a brainstorm session. ground substance diagram helps us to answer two importantquestions when sets of info are compared Are the info related? How strong is the relationship? Priorities matrix uses a series of planning tools built around the matrix chart. other(a) quality toolsBenchmarking compares the processes and successes of you competitor of similar top-performing organizations to your current processes to define, through gap analysis, process variation and organizational opportunities for improvement. Benchmarking defines not only organizations that perform better but also how they perform better. Failure mode and effect analysis examines potential problems and their causes and predicts undesired results. FMEA normally is used to predict product failure form past part failure, but it also can be used to analyze future system failures both in patient safety toolbox. 5S is a systematic program that helps workers take control of their workspace so that is actually works for them instead of being a neutral or, as is quite common, competing factor. Sort means to keep only necessary itemsStraighten means to arrange and i dentify items so they can be easily retrieved when needed. chew over means to keep items and workspaces clean and in working order Standardize means to use best practices consistentlySustain means to maintain the gains and make a commitment to continue the first four S.Theory of Transfer of Learning page 77Rapid cycle testing/improvement positive by IHI, rapid cycle testing/improvement was designed to create various small tests involving small sample sizes and using multiple PDSA cycles that build on the lessons learned in short period firearm gaining buy-in from staff involved in the change. It is designed to reduce the cycle time of new process death penalty from months to days.Read 78/79/80/81Chapter 5 mileposts in the quality measurement voyageMany health care providers struggle to address the measurement mandate proactively, which leads organizations to assume a defensive posture when external organizations release the information. In such cases, the provider usually res ponds in one of the following ways information are old, entropy are not secernate and do not instance appropriate comparisons, our patients are sicker than those in other hospitals. A more proactive posture would be to develop an organization-wide approach to quality measurement that meets both internal and external demands. This approach is not a task, but a journey that has many potential pitfalls and detours. Key milestones exist that mark your progress and chart your direction.Milestone 1 Develop a measurement philosophy (strategic step) What is/should be the role of performance measurement in the organization? Should it be done periodically or a day-to-day function? The first step toward this milestone should be the creation of an organizational statement on the role of measurement. Three simply questions should be explored when developing a measurement philosophy 1. Do we know our data better than anyone else does?2. Do we have a balanced set of measures that encompasses c linical, operational, customer service and resource allocations? 3. Do we have a plan for using the data to make improvements?Milestone 2 Identify the concepts to be measured (types and categories of measures) (strategic and operational step)The flash milestone consists of deciding which concepts the organization wishes to monitor. thither are three basic categories of measures structure (s) represents the physical and organizational aspects of the organization processes (p) every drill, every job, is part of a process. outcomes (o) structure combine with processes to produce outcomes. The relationship between these categories usually is shown as follows s + p = o Another categorization that can be made is (more specific) according to the six aims for improvement 1 Safe, 2 Effective, 3 Patient centered, 4 Timely, 5 Efficient, 6 Equitable Regardless of the method used, an organization must decide which concepts, types, or categories of measures it wishes to track.Milestone 3 study specific measuresWhat aspect of (patient safety) do we want to measure?What specific measures could we track?Choose a specific indicatorIn this step you need to specifying what aspect of for example patient safety you intend to measure and the actual measures. Within the patient safety, you could focus on medication errors, patient falls, wrong site surgeries etcetera Within the medication error you can measure different things number of medication orders that had an error, total number of errors caught each day, percentage of orders with an error etc.Milestone 4 Develop operational definitions for each measure An operational definition is a description, in quantifiable terms, of what to measure and the specific steps needed to measure it consistently. A good operational definition Gives communicable meaning to a concept or an ideaIs clear and unambiguousSpecifies the measurement method, procedures and equipmentProvides decision- devising criteria when necessary andEnables consist ency in data collectionThe problem created by poor operational definitions should be obvious if you do not use the same operational definition each time you record and plot data on a chart, you will either miss a true change in the data or think a change has occurred when in fact one has not. Using the same operational definition becomes even more critical if you are trying to compare several hospitals or clinics in a system.Milestone 5 Develop a data collection plan and gather data (giving special consideration to stratification and taste) Direct sidetrack with data collection may cause teams to collect the wrong data in the wrong amounts. The data collection phase consists of two partsPlanning for data collection what process will be monitored? What specific measures will be collected? What are the operational definitions of measures?.. The actual data gathering how will you collect the data? Will you conduct a pilot study? Who will collect the data? (page 94) Once you have res olved these issues, the data collection should go smoothly. Sometimes improvement teams do not spend enough time on data collection plans. This can lead to the following problems (1) collect too much, or too little data (2) collect the wrong data (3) become forbid with the entire measurement journey. Consequences can be the team tends to (1) distort (verdraaien) the data (2) distort the process that is produced the data or (3) kill the messenger.Two key data collection skills stratification and sampling enhance any data collection effort. Stratification = the separation and classification of data into reasonably homogeneous categories. The objective of stratification is to create strata, or categories, within the data that are mutually exclusive and facilitate discovery of patterns that would not be observed if the data were aggregated. Stratification allows understanding of differences in the data caused by different factors (page 95). If you do not think about how these factors could influence your data you run the risk of making incorrect conclusions and having to perk out the stratification effect manually after you have collected the data. Sampling (steekproef) the most important thing you can do to reduce the amount of time and resources spent on data collection. There are four conditions for developing a sampling plan accuracy, reliability, speed and economy. Sampling consists of a series of compromises and trade-offs. The basic purpose of sampling is to be able to draw a limited number of observations and be reasonably confident that they represent the larger population from which they were drawn.There are two basic approach to sampling Probability sampling techniques based on statistical probability (systematic sampling, simple random sampling, stratified random sampling, stratified proportional random sampling) Non-probability sampling techniques should be used when estimating the reliability of the selected sample or generally applying the resul ts of the sample to larger population is not the principal concern. The basic objective is of this type of sampling is to select a sample that the researchers believe is typical of the larger population. (conveniencesampling, quota sampling and judgement sampling) 99-102Milestone 6 Analyze the data using statistical process control methods (especially run and control charts) Translate data into information.Milestone 7 Use the analytic results to take action (implement cycles of change, test theories and make improvements)Chapter 6 info collectionQuality measurements can be grouped into four categoriesClinical qualityFinancial performancePatient satisfactionFunctional statusTo report on each of these categories, several spate data sources may be required. The challenge is to collect as much data as possible from the few sources with the objectives of consistency and continuity in mind.Retro prospective data collection involves identification and selection of a patients medical reco rd or group of records after the patient has been discharged. Prospective data collection relies on medical record review, but it is completed during a patients hospital care or visit rather than retrospectively. Disadvantage time consuming and can distract nurse from their direct patient care responsibilities, expensive method, mostly full time data analyst needed.Source for data for quality improvementsAdministrative databases are information collected, processed and stored in automated information systems. Excellent source of data for reporting on clinical quality, financial performance, and certain patient outcomes.Advantages less expensive source of data, they incorporate transaction systems, moest of the code sets embedded are standardized, the database are staffed by individuals who are skilled, the volume is great, data reporting tools are available.. Disadvantages some argue that these data is less reliable than data gathered by chart review. Patient surveys especially when teams are interested in the perceptions of patients, either in terms of the quality of care or the quality of service provided. A team can design the survey itself, subscribe to an expert to design a survey, or purchase an existing survey/survey service. Functional status surveys usually measured before and at several points following the treatment or procedure. (for example a baseline before the knee procedure and then assessments are made at regular intervals after the surgery) Health plan databases excellent source of data for quality improvement projects, particularly projects that have a population health management focus.These databases are valuable because they contain detailed information on all care received by health plan members. It provides a comprehensive record of patient activity and can be used to identify and select patients for enrollment in disease management programs. use properly rich source of data for population management, disease management and quality imp rovement projects. Health plan databases limitations considerations include accuracy, detail and timeliness. Recoding may make some data inaccurate, they do not contain detailed information on outcomes of care . Patient registries powerful source of quality improvement data. Advantages rich source of information because they are customized, can collect all the data that the physician or health system determines are most important, can be used for quality improvements, they are not subject to the shortcomings of administrative or health plan databases, collection techniques can be combined to provide a complete picture of the patient experience. They are versatile and flexible. Example case study in clinical reporting page 123-127Conclusion there are many sources and data collection approaches from which to choose. rarely does one method serve purposes, so it is important to understand the advantages and disadvantages of all methods. A combination is also possible. Knowledge of diff erent sources and techniques will help you to use data more effectively and efficiently in your clinical improvement effort.Chapter 7 Statistical tools for quality improvementThree fundamental purposes for performance measurementAssessment of current performance identify strengths and weaknesses of current processes Demonstration and verification of performance improvementAnd control of performancePerformance measurement benefits organizations in several ways provides factual evidence of performance, promotes ongoing organization self-evaluation and improvement, illustrates improvement, facilitates cost-benefit analysis, helps to meet external requirements and demands for performance evaluation, may facilitate the establishment of long-term relationships with various external stakeholders. whitethorn differentiate the organization from competitors, may contribute to the awarding of business contacts and fosters organizational survival. ..Chapter 13 Leadership for qualityLeadership = working with people and systems to produce needed change. Individual leadership = this set of leadership is about what people must be and what they must know how to do, if they are to influence others to bring about needed changes. Both being and doing are needed, especially when the changes required for quality improvement involve reframing core value or remaking professional teams. Many improvements in health care will require these kinds of heavy changes in values. These changes are sometimes labeled as transformational changes to distinguish them from transactional changes, which do not require changes in values and patterns of behavior.Organizational leadership = about creating a supportive organizational environment in which hundreds of candid individual leaders work can thrive (groeien). One way to view this level (system-of-leadership level) is as a complex set of interrelated activities in five broad categories Set direction every organization has a sense of direction, a future self-image. A leader should set that direction. Establish the foundation leaders must prepare themselves and their leadership teams with the knowledge and skills necessary to improve systems and lead change (and reframe values) Build will to initiate and sustain change takes will, which seem to be highly sensitive to discord and very much grind to a halt because of one loud voice opposing change therefore making logical and quantitative links should be made between improvement and key business goals. become ideas quality challenges require innovation.Page 313Implementing quality as the core organizational strategyImplementing a acculturation that has quality improvement at its core is an important goal for providers who want to serve patients better, gain the support of healthcare providers, stay ahead of government regulation, meet consumers demand for transparent information on quality and costs, an gain a competitive advantage in the marketplace. Recent history many e fforts have not resulted in the sustainable quality improvements that the leaders hoped to see.Quality improvement strategy should start with leadership from the board of trustees, the CEO and the executive team, but it is a challenge for health care organizations because of the many internal competing agendas, the rapidly changing environment, employees and so on.First step to establish an organizational close that will support the hospital on their journey to quality starting point leadershipKaplan Norton Balanced Scorecard this approach includes the perspective of the patient and family, internal processes such as clinical pathways, learning and growth opportunities that focus on employees and financial performance. Role of leadership leaders ask financial questions about market share, margins and quality implications. They deepen questions related to the satisfaction of their internal and external customers and the way in which business processes must change to improve and sustain quality. Primary focus on creating a culture of quality.Baldrige National Quality ProgramCreating the change towards quality starts with leadership.Road map for changeEight stage change process, modified form Kotters seminal work (Leading Change 1996) serves as a realistic and viable framework to guide leaders who are managing a change to quality 1. Unfreezing the old cultureThis is the most difficult step because of cultures influence on employee behavior and some employees to desire to resist change and dummy up progress. 2. Forming a powerful guiding coalition3. Developing a vision and strategy4. Communicating a vision and strategy5. Empowering employees to act on the vision and strategy6. Generating short-term wins7. Consolidating gains and producing more change8. Refreezing new approaches in the cultureView as multi-pages