Root Cause Analysis, Change Theory, FMEA, And Nursing Root...

Root Cause Analysis, Change Theory, FMEA, and Nursing Root...
RUNNING HEAD: RTT1 TASK 2 1 RTT1 Task 2: Root Cause Analysis, Change Theory, FMEA, and Nursing Western Governors University RTT1
TASK 2 2 RTT1 Task 2: Root Cause Analysis, Change Theory, FMEA, and Nursing Root Cause Analysis (RCA) A root cause analysis (RCA) is an
essential tool that can be used to examine and understand the ways in which systems fail as well as discuss those specific failures that led to a specific
adverse event and potentially implement steps or behaviors to prevent that event from happening in the future (Ogrinc & Huber, 2013). In the case
study presented, a number of system failures may have contributed to the patient outcome. As such, an RCA of the case study would help determine
those specific... Show more content on Helpwriting.net ...
A flow chart in this step of the process should be utilized as well in order to aid in the visualization of the ideal behaviors. This process may also
RTT1 TASK 2 4 help point out additional behaviors or improvements in the system otherwise overlooked in the verbal or written analysis phase.
After careful analysis of what had happened and what should have happened takes place, the RCA team should ideally focus on why the adverse
events happened. In this step, the goal is pinpoint the direct causes and contributory factors (Ogrinc & Huber, 2013). By doing this, the root cause
of an event can be identified. One suggestion made by the Institute of Healthcare Improvement in the root cause analysis process is to ask "Why?"
five times (Ogrinc & Huber, 2013). 1. Why did this happen? a. The LPN silenced the alarm notifying the staff about the Mr. B's O2 saturation of
85%. 2. Why was it silenced? a. The LPN was engaged in caring for the emergency transport patient along with the RN and was also in the process
of discharging the other two patients. 3. Why did the LPN not notify the RN of the alarm and reading? a. With the information provided, it appears
that the LPN was distracted as well as did not follow her scope of practice. 4. Why was the LPN distracted? a. Additional or backup staff that was
available per the information provided was not present or available to assist with discharges and the care of the acute respiratory distress patient. 5.
Why was
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The Importance Of Error Analysis And Failure Mode Effects...
Introduction
In every work environment, there are various continuous quality initiatives in place to improve organization's product or service quality. For
instance, in the United States, many patients have been losing lives due to serious and avoidable medical errors or safety events (Muething et al.,
2012). For this reason, it is crucial to understand how these avertable medical errors or safety events can be prevented or eliminated. There are
factors involved in the process of analyzing particular errors in an organization. This paper focuses on two processes of error analysis (Root Cause
Analysis (RCA) and Failure Mode Effects Analysis (FMEA)) to address unnecessary medical errors (Serious Safety Events (SSE)). SSE in a healthcare
... Show more content on Helpwriting.net ...
These encounters make it cumbersome to classify alleviate primary causes of harm. Therefore, it affects the ability of the society to identify and prove
the efficacy of patient safety risk management solutions that decrease medical errors and preventable serious safety events.
Measures push for improvement, inform patients and effect payment. Both public and private payers apply measures to make a decision on the health
providers they should contract and to enhance improvements in healthcare. Hence, describing, categorizing and emphasizing on harm prevention is
critical for any practical risk management program.
To prevent or eliminate numerous deaths related medical errors. American Society for Healthcare Risk Management has come up with Getting to Zero.
Getting to Zero is a Serious Safety Events initiative, which emphasizes on event investigation stages. The core part of the investigation process is to
establish harm–score. This always prompts an organizational response and risk management. Therefore, without proper and accurate harm–score
examination, the chances for applying operational response may be wanting.
American Society for Healthcare Risk Management developed Harm Classification Tool to help risk managers and health care leaders to group an
event when deviation happens. Additionally, the tool aids them to ascertain what actions are suitable for a particular event. The tool supports the
American Society

Benefits Of Using Recycled Concrete Aggregate
A specific subset of recycled aggregates is recycled concrete aggregates (RCA) where the masonry content is limited to not more than five per cent.
The performance characteristics of RCA are better than RA and consequently there are fewer restrictions on the use of RCA in concrete (BS 8500–2)
According to a 2004 FHWA study, 38 states recycleconcrete as an aggregate base; 11 recycle it into new Portland cement concrete. The states that do
use recycled concrete aggregate (RCA) in new concrete report that concrete with RCA performs equal to concrete with natural aggregates
It is now predominantly accepted that there is a significant potential for reclaiming and recycling demolished debris for use in value added applications
to increase economic and environmental benefits. As a direct result of this, recycling industries in many part of the world, including South Africa, at
present converts low–value waste into secondary construction materials such as a variety of aggregate grades, road materials and aggregate fines.
Mostly these materials are used in as road construction, backfill for retaining walls, low–grade concrete production, drainage and brickwork and block
work for low–cost housing (M C Limbachiya et all,2004).
The recycled pavement has been designed for a traffic loading of 35 million standard axles (msa), which exceeds what was previously seen as a limit
for this recycling technique (30 msa). However, due to the development of recycling technology and the reducing

Patient Safety And The Medical Errors
In today's fast paced healthcare environment, patient safety as well as healthcare quality has become a major priority. A growing focus on patient
safety and the increasing medical errors has made various healthcare management teams more proactive in identifying and preventing potential risks
for patients. While a great deal of progress has been made in recognizing most medical errors, it is also important to note that in a healthcare
environment there are a number of factors involved, therefore the strategies used to reduce them vary as well. So, despite a healthcare provider's
overall reputation, experience, skills or knowledge in the healthcare field, there is always a slight possibility for a medical error to take place, similar
to our case of Mrs. Jonesky and Samantha Jones. Root–Cause Analysis Definition According to Dattilo and Constantino (2006), "The most
fundamental reason for the failure or inefficiency of a process, in any work setting even the healthcare environment, is referred to as a root cause".
Root cause analysis (RCA) is the tedious process under which the healthcare providers take a step back and analyze their potential mistakes, adverse
events, or sentinel events in the operating room and all areas of healthcare (Croteau, 2003). The primary goal of RCA is to overcome their mistakes,
in order to prevent future risks or damages caused to their patients. According to The Joint Commission, most RCA is expected to take place within a
45 days limit, after

Before I Came To The Rca And To London, I Worked As A Textile
Before I came to the RCA and to London, I worked as a textile designer specialising in the design of men's ties in Seoul, South Korea. My business
was relatively small and I enjoyed making bespoke textiles for my customers. Over time, I got to know my customers well, and tried to base my
designs on this personal knowledge. I wanted the ties to be more than just mere physical objects; instead I wanted to imbue them with an emotional
attachment that reflected the relationship between me and my customers and my knowledge of their lives and personalities. I began talking to my
customers and noticed that – unconsciously – my designs were becoming more dialogical2, a graphical representation of the conversations and stories
we shared.
This ... Show more content on Helpwriting.net ...
The new research raises the question of ethical silk, made without the destruction of the moth within the cocoon, and the ethics of employment
practices within the silk manufacturing industry today.
The majority of mass production generates pollution, which causes climate change.
In an era of fast–fashion, mass–produced textile waste has continued to grow4.
According to the report Valuing our Clothes , extending the average life of clothes by only three months of active use would lead to a five to ten per
cent reduction in each of the carbon, water and waste footprints; around 350,000 tonnes of used clothing ends up in landfill in the UK every year5.
Waste is not just a UK problem. Dongdaemoon market is the biggest fashion and textiles market in South Korea. Many young designers work there but
follow fashion trends rather than creating their own unique designs. About 20 tonnes of fabric waste is generated per day. Seoul city authorities
estimate that it collects about 5,000 tonnes of waste resources, such as fabric and banners, per year from the
Dongdaemoon market.6
The challenge of designing environmentally friendly textiles within existing economic systems without

Acute Inferior Wall Myocardial Infarction
We present an 85 year old non–diabetic and non–hypertensive patient admitted with acute inferior wall myocardial infarction. After successful coronary
angioplasty patient had no reflow phenomenon which was treated with adenosine, nikorandil and nitroglycerine with TIMI 3 flow achieved at the end.
This case report revisits one of the dreaded complications in cath–lab and its successful management
Keywords: No–reflow, coronary angioplasty.
Case Report:
A 85 year old male patient, non–diabetic and non–hypertensive, was admitted with acute inferior wall myocardial infarction. Angiography showed
osteal RCA 80 % lesion and mid RCA 90 % lesion (Figure 1). Patient underwent angioplasty to RCA with 2 stents from the ostia to the mid RCA
covering both lesions. However, post–stenting patient had significant no ... Show more content on Helpwriting.net ...
This may lead to inadequate healing of the cardiac scar and development of collaterals. Treating no reflow increases the delivery of blood and nutrients
to the ischemic tissues, speeds healing and reduce the presence of infarct expansion and left ventricular remodelling.2
Widely used medication in the management of no reflow is adenosine (24 to 48 ugm), a potassium channel opener.3 A direct ATP potassium channel
opener, nicorandil (2 mg), also used in treating the no–reflow phenomenon. 4 However, nitroglycerine (200 to 1000 ugm) and verapamil (10 ugm/ml)
are also very widely used to treat no reflow.1
Keypoints
No reflow can be sometimes life threatening event
Intra–coronary nitro–glycerine, nicorandil and adenosine remain the mainstay of

Example Of A Critical Application Of Root Cause Analysis...
A personal conflict that I have recently encountered was among one of my roommates and the rest of our household. Currently I live with four
other individuals. We all have our own bedrooms and our own space so it is possible that we have our own places to go when our living situation
tends to be a little too much around the house. Now our schedules are all different, so we are not all home at the same time, which can be both a
positive thing and a negative thing. Now, one of our favorite restaurants to venture to is a local traditional sushi and hibachi restaurant in the area. One
of our roommates, Travis, he is especially fond of this restaurant. The specific conflict that we have recently encountered can be best summed up as the
four of... Show more content on Helpwriting.net ...
There was a sequence of events that happened earlier in the afternoon that led to Travis ultimately being upset with us. Earlier that day he received a
phone call from his cousins, in which they told him they would not be waiting for him to get off work in order to celebrate what they call, "cousins
day." This was extremely important to Travis, so to feel already rejected by hisfamily, he then felt even more so rejected by his friends at home.
Another one of our roommates was already aware of the "bad day" Travis was experiencing. So he thought that maybe it would have been given more
consideration, because someone was aware of his unfortunate situation with his family members. In consummation, Travis felt abandoned by the
most influential people in his life. While it may appear to not be exceptionally important and frivolous, it had true significance to Travis. By
searching for other clues as to why this problem occurred, we were able to work backwards from a puzzle, if you will. We had a matter of
contention and in order to find resolutions we had to dig a little deeper. The fourth step in understanding why there was a conflict of interest between
our roommates and Travis is identifying the root issue at hand. What really caused Travis to be upset with everyone. And ultimately the answer is that
Travis felt as if his feelings were neglected and dismissed. While this may seem as

Essay on Television in the Fifties
Technology in the 1950s started with many great innovations that shape the way we live now. Probably the most important innovation of television
was the introduction of cable T.V., television broadcasting, sitcoms and talk shows. Television went though many changes in its younger years. The
way T.V. Developed in the early years is the foundation for what we watched now days. Transitory radios became very popular in the fact that Music
could be heard in any location because it was now portable. Still T.V. Innovations were what the 1950s were all about from a technology and the birth
of the T.V. show. In 1950, the use of a single
–channel "strip–amp" amplifier permitted the extension of cable systems to homes located ... Show more
content on Helpwriting.net ...
Also, on Sept. 4, 1951 the first transcontinental TV broadcast was a speech featuring President Harry S. Truman. The legendary sitcom I Love
Lucy premieres on CBS in October of 1951. In 1952 KTLA makes the first telecast of an atomic bomb detonation. The Today show premieres on
NBC in 1952. In 1953 50% of Americans now have a television set in there homes, which is approximately 25,233,000 homes. On Apr. 3, 1953 the
first issue of TV Guide is published, with 10 editions and a circulation of 1,562,000 copies. On Aug. 30, 1953 NBC's Kukla, Fran, and Ollie Show is
broadcast in color, the first announced network broadcast in color. In March of 1954 Edward R. Murrow denounces Sen. Joseph R. McCarthy on See
It Now. On January 1st the first national coast–to–coast colorcast takes place, with the broadcast of the "Tournament of Roses Parade" from Pasadena,
California to 21 network stations. There were only 200 RCA electronic color television sets able to view the show. This is acknowledged as the first
day American television officially changed from black–and–white to color. In March there are 370 TV Stations in operation, with another 202 about to
come on–line and the first color commercial airs by Pall Mall cigarettes. In April RCA Launches COLOR Television at $1,000 a copy with the price so
high less than 5,000 sell the first year. The First World Series game was broadcast in color, on Sept. 28, 1955. On June 7th The $64,000

Commitment-Rca Student Athletes
Commitment–RMCA student athletes are expected to perform all activities required of other students, regardless of evening practices or game
commitments. If modifications need to be made, the student should speak with the instructor, and gain approval before any event or accommodations
are required.
Scholastic eligibility– Athletes will be monitored for academic progress. Weekly cumulative grade checks will be done. Students having two or more
D's or one or more F's will be ineligible for one week. If a student is determined to be ineligible or at risk of becoming ineligible, the athletics
department routinely holds study hall before and after school and an athlete may be required to attend one or more sessions for part of or in place of
practices

Comparative Advantage And Competitiveness Essay
This paper is going to summarize the article Revealed Comparative Advantage and Competitiveness: A Case Study for Turkey towards the EU written
by Vildan Serin and Abdulkadir Civan. The study based on the theory of comparative advantage established by the British economist Ricardo in the
early of the 19th century. The Ricardian model assumes that productivity of labor is different from country to country and the country exports the
goods in which it has a comparative advantage.The study attempts to examine the comparative advantage of Turkey in the tomato, olive oil and fruit
juice industries over Italy, Greece and Spain and how its comparative advantage changes over the period of 1995 to 2005. Besides, the authors
hypothesize that the prices ... Show more content on Helpwriting.net ...
Firstly, to increase the persuasiveness and coherence of the study about the effect of the EU new membership on trade, the author can replace the data
of Portugal for the data of Italy. Secondly, it would be more comprehensive than if the author mentioned the formula of the regression analysis model.
Conclusion
The study illustrates that Turkey has comparative advantage in olive oil and fruit juice products, but not in the tomato product over Greece, Spain and
Italy in the EU market during the period of 1995–2004. The study also finds out that the competitive advantage of Turkey has been declining since
2000 due to the result of accession of new members in EU, which also export those products more importantly, the regulations from both Turkey and
the EU. Besides, the regression analysis also implies that change in price of Turkish product significantly sharps the export of Greek, Spanish and
Italian products to the EU market. In conclusion, the paper provides some important empirical findings in competitiveness of Turkey in tomato, olive
oil and fruit juice over its rival;however, the authors still can improve the plausibility of the article by over come the mentioned

My Role Model In My Life
Most life changing events happen with someone whom you truly trust. It is easy to ignore people, withdraw, and not form relationships built on love
and reliance. I have truly grown closer to my role model in my life. Matt Harp, my role model, is a man of truth, integrity, love, selflessness, and
compassion. Many different times he surprised me with how he acted, spoke and thought. I clearly saw the Lord lead his life, and his actions revealed
as much. I wanted to follow his example. He led me through junior high, what was definitely the toughest part of my life. Looking back, I can only
imagine what would have happened in my life if I had not grown to trust this honorable man. There are many different times where Matt taught me
a life lesson, but these three are the most prominent. He taught me how to be unique, be yourself, always be willing to share, and to never give up,
even when you are tired. As a groovy guy, my small group leader always wore what the coolest clothes. I loved to talk to him about it. I said "I love
your style. Where do you buy your clothes?" Many different times, I wore similar clothes to him. I started wearing unique socks, colored jeans, and
many other things. He took more notice than I realized. One day he took me aside and said "You don't have to live exactly like someone else, you
just need to be you." He insisted, saying "don't just copy me because you like the way that I dress, find your own groove." I took these small
statements to heart.

Rapid Critical Appraisal
Was it really "rapid" or was it more of a laborious process? In my opinion, the rapid critical appraisal (RCA) process was not rapid. It was a process
requiring considerable effort and time. Though tedious, the RCA process helped me to stay focused, analyze in depth information about the studies,
and select most relevant articles that would be beneficial in answering the PICOT question and appropriate for my evidence based practice(EBP)
proposal. According to Melnyk & Fineout–Overholt (2015), RCA is one of the key components to the evidence–based practice process. It helps to
evaluate the validity, reliability, and applicability of aresearch article. Did reading the abstract help you make quick decisions about including or
excluding the study? Reading the abstract was absolutely a helpful strategy in sifting through the articles. It helped me to make quick decisions about
including or excluding the study. Abstract is the reflection of the article as it provides an idea about what to expect in a research article. It provides an
overall summary of the components of the article and outlines the ... Show more content on Helpwriting.net ...
The utilization of the MESH terms like chemotherapy, patient education, and patient anxiety within various databases, especially ProQuest and
Cochrane library increased my findings. I downloaded the evaluation table and exemplar on my computer, which helped me to concentrate on what
was needed from within the article. I always saved all research articles in a folder in my computer first and later eliminated or included them using
the RCA process and reading abstract. What didn't work well for me was when I tried to read through an article and then try to fill out the evaluation
table from recollection of what I just read. Filling it out in 'real–time' helped me to stay focused and timely with this

Failure Modes And Effects Analysis
Some key differences concerning the failure modes and effects analysis (FMEA) and a root cause analysis (RCA) are clarified. Failure mode and
effects analysis is conducted prior to any event. FMEA is a preventive action used to help prevent a failure. The FMEA committee consists of about
three to four members who all are experts in the designated subject. Through FMEA the committee helps develop action plans to reduce the risk of
failure (Quality–One, 2011). RCA is an investigation that occurs after a sentinel event that is unexpected. Through the RCA you are looking to find out
why did an event occur or not occur, how the event happened, and how to prevent additional events for occurring (VA National Center for Patient
Safety, 2015).

History of Television Essays
History of Television
Television has become a major industry all over the world, especially in the industrialized nations, and a major medium of communication and source
of home entertainment. Television is used in many industries. A few examples are for surveillance in places inaccessible to or dangerous for human
beings, in science for tissue microscopy, and in education. Today you can find a television in almost every home. This is why I decided to research the
history of the television.
The first television devices were based on an 1884 invention called the scanning disk, patented by Paul Nipkow. This device was a large disk with
holes on it, which spun in front of an object while a photoelectric cell recorded ... Show more content on Helpwriting.net ...
An anode finger was a pencil–sized tube with a small aperture at the top. Magnetic coils sprayed the electrons emitted from the electrical image left to
right and line–by–line onto the aperture, where they became electric current. Both Zworykin's and Farnsworth's devices then transmitted the current to
a cathode–ray tube, which recreated the image by scanning it onto a fluorescent surface.
Farnsworth applied for a patent for his image dissector in 1927. The development of the television system was plagued by lack of money and by
challenges Farnsworth's patent from the giant Radio Corporation of America (RCA). In 1934, the British communications company, British Gaumont,
bought a license from Farnsworth to make systems based on his designs. In 1939, the American company RCA did the same. Both companies had
been developing television systems of their own and recognized Farnsworth as a competitor. World War II interrupted the development of the
television. When television broadcasts became a regular occurrence after the war in 1945, Farnsworth was not involved. Instead he decided to devote
his time to trying to perfect the devices he had designed.
David Sarnoff, Vice President of the Radio Corporation of America, later hired Vladimir Zworykin to ensure that RCA would control television
technology. Farnsworth's business manager ended up selling

The RCA Balassa Index: A Comparative Advantage In...
To estimate a country's comparative advantage or comparative disadvantage in commodities, industries or sectors many researchers uses standard
approach or methodology for RCA index. Theoretically, we can measure comparative advantage in requisites of relative prices, when there is no trade.
In accordance with Ricardian theory, comparative advantage happens due to technological dissimilarities across nations, whereas the H–O theory
considers cost dissimilarities occurs due to differences in factor prices across countries, assuming constant technology. Hence, we summarize thattrade
theories in the classical framework are based on pre–trade relative price differentiations across countries. Although measuring comparative advantage
through H–O ... Show more content on Helpwriting.net ...
Balassa (1965) considered a comprehensive measure that is widely accepted in literature. The RCA Balassa index is expressed as following.
RCA2 (Balassa Index) = (Xij / Xin) / (Xwj / Xwn)
Where Xij is the export of country i, for, j commodity and n is a set of all exported commodities of country i, while Xwj represents the export of
world for same commodity j and Xwn is a world export of all n commodities. According to the results of this index if RCA2 >1 then a country has a
comparative advantage, if RCA2<1 then a country has a comparative disadvantage in that commodity or industry.
Another RCA by Balassa explains Net Export Ratio (NER) takes into account the possibility of imports and exports simultaneously but it checks trade
performance its own not with any reference country or rest of the world. This index is shown as following.
RCA3 (NER) = (Xij / Mij) / (Xij / Mij)
This index ranges from –1 to +1 and in the case of Xij = 0 there will be revealed comparative disadvantage but if Mij = 0 there will comparative
advantage. However, zero value creates ambiguity (Greenaway and Milner, 1993). Another version derived from the Balassa index captures the effect
of imports and this index can be written as

Root Cause Analysis Paper
Define a root cause analysis and when it is used.Root Cause Analysis (RCA) is a controlled method used to analyze serious adverse events.
Originally developed to analyze industrial accidents, RCA is now commonly organized as an error investigation tool in health care. A principal theory
of RCA is to identify fundamental problems that increase the probability of errors while avoiding the trap of focusing on mistakes by individuals. RCA
thus uses the systems approach to identify both active errors: errors occurring at the point of interface between humans and a complex system and
dormant errors: the hidden problems within health care systems that contribute to adverse events. It is one of the most widely used methods for
detecting safety... Show more content on Helpwriting.net ...
RCAs are one of the most used methods to improving patient safety. However, much of the problem lies in how RCAs are understood rather than
in how they perform, since there is no agreement on how hospitals should follow up on RCA data. This limits the usefulness of RCAs as a quality
improvement tool. Another issue is that few devices exist for analysis of multiple RCAs across institutions. As an individual case study of a specific
error, analysis of multiple RCAs performed at different institutions may help identify patterns of error and point the way toward many solutions
(Ewen & Bucher, 2013; Root Cause Analysis, 2014; Utah Department of Administrative Services, 2013). This tool is easy to use and requires little or
no training. It identifies the underlying causes of problems. However, it also assumes that systems and events are interrelated, which may not always
be the case (Root Cause Analysis, 2015). Outline the steps to conduct a root cause analysis. To determine the cause of an error certain steps must be
followed in order to produce positive

A Root Cause Analysis ( Rca )
A.
Root Cause Analysis
A root cause analysis (RCA) must be conducted when a sentinel event occurs in order to identify where the systems and pro cesses involved failed
and how these systems may be improved to eliminate or reduce the risk for a reoccurring event of this type
(Cherry
, 2011
)
.
The
first step in conducting a root cause analysis is to form a committee of individuals that are from different levels of t he organization to review the
failures of the system and processes that are associated to the event. This allows the committee to implement appropriate changes if necessary to the
system and process to reduce the risk of a future ev ent of this nature havi ng .
Based on the scenario provided
Mr. B arrived at the hospital with a ... Show more content on Helpwriting.net ...
ORGANIZATIONAL SYSTE
MS & QUALITY LEADERS
HIP
3
A1. Errors or Hazards
In the scenario provided the following are errors that led to the un fortunate outcome.
T
h e l ack of proper staffing and a radiology study to confirm that Mr. B did not have any fractures prior to the reduction procedure may have
contributed to his death
.
A s Mr. B could have had internal bleeding from a fractured pelvis or femur that w ent undetected
.
The ED physician's medication dosages were unsafe and the re

–
administration times increase d the risk of harm to the Mr. B.
The lack of knowledge or communication betwee n Nurse J and the ED physician in regard to the medication dosages and re
–
administration times led to the over sedation of Mr. B
.
The scenario d oes not confirm that
Nurse J or th e
ED
physician had successfully completed the training module for conscious sedation required by the hospital where they worked
.
Regardless,
Nurse J and the ED physician failed to follo w the policy in regard to a dministeri ng c onscious sedation to Mr. B
.
Nurse J and the LPN failed to call for a respiratory therapist to be present d uring a conscious s edation procedure.
; n or did anyone in the emergency

Personal Narrative: An Interview With Nurse Helen
My bare feet slap against the smooth, cold floor as I graze my hand across the fractures of the dark gray walls. Patients walk around me with nurses
scolding them like monstrous mothers. Compared to all the psychos in here, I seem to be an angel. I never talk back, I always listen, I do what they
say. Nurse Helen even said I may be released in a month's time. The workers don't understand why I was sent here, and neither do I for that matter. I
can ignore his voice, I can reject his advances on my mind, I... "Listen to me!" I scream as we trot down the hallway, her heavy step masking the
sounds of the other patients. I look through her emerald eyes, seeing everything she sees. She never seems to answer and I don't know why. I only want
what's ... Show more content on Helpwriting.net ...
I knew I could do it. All it took was a few months of persistence, and a little manipulation on my part. She did the rest all on her own. The nurses are
starting to catch on, but that doesn't really matter too much. They don't know I'm here. They'll never catch me. I have everything right where I
want it. She'll never realize what is actually happening here, She's too far gone. It's almost done. How should I truly feel? His argument has started
to make sense. These people will never learn and this place will never overcome it's madness. This rain of torture inflicted on my sanity must end. I
may not agree with everything he says, but if letting him run free will get him to let go of me completely, I'll submit. There comes a time in
everyone's life where they can't bare the weight on their shoulders, and if the doctors won't help me, I'll have to help myself. This is the only way. I
will relinquish my power to the wretched

Coke Test Lab Report
Introduction The purpose of this experiment is to show how an acid (Coke) can react together with potassium to create a charger for an iPhone.
Potassium and acid formed together makes bubbles. With both potassium and acid working together, they will give off energy to the iPhone. Why
Coke? Every liquid will be either acidic or basic traits. An acid–base reaction is a chemical reaction that happens between an acid and a base. There are
multiple definitions when considering the reaction mechanism when solving problems. Regardless of what the problem is, it's always a known fact
that when using liquid or gaseous reactions, they become less apparent. You want to use Coke because its pH is the acidity of the substance. For an
acidity to be... Show more content on Helpwriting.net ...
The banana was used as the main source in this experiment because the main objective was to find out if a fruit could charge an iPhone without
being plugged into an actual outlet. In this lab, the Coke acts as an acid and the banana is potassium. The RCA cables were used as connectors to
stick one side into the banana and the other side in the Coke itself. The Coke can is used to basically start the chemical reaction by the RCA cables
that are put inside it which in return is still connected to the banana. Just like plugging the cables into a television, the red cable is usually used for
right analog audio (the red goes in at the top end of the banana which is to the right) and the white cable is usually used for mono analog audio (the
white goes in at the end of the fruit which is to the left.) The team used an iPhone because something electronic had to be used in this particular
experiment to get the results that we were looking for so an iPhone was the chosen item. The iPhone charger is used to put into the Coke can while it is
plugged into the actual iPhone to see if we get results or not; this determined whether or not the iPhone can be charged by a fruit. If the iPhone comes
on, this indicates that it is charging through the chemical reaction and if it doesn't, this could possibly mean the chemical reaction wasn't strong
enough, something went wrong during the procedure of the actual lab, and/or an

General Electric Company Presentation Essay
Purpose: After hearing this presentation. The prospective investor will have to proper knowledge and information to purchase stocks in the corporation.
* Thesis: General Electric is the world leader in research and development, manufacturing, and international cooperation.
Introduction
General Electric has been the cornerstone of innovation for over a century. Employing over 36,000 technologists around the world.
The manufacturing and development branch has played a huge part in creating imports and exports to spur the U.S. economy.
GE's corporation has branches in almost every continent to allocate ideas and build vital infrastructure to improve the standard of living throughout the
world. * Transition: All these functions of ... Show more content on Helpwriting.net ...
Values
GE's spirit reflects the values used to represent the companies solid foundation to lead change as business evolves
These values ask every GE employee to recommit to a common set of beliefs about the work in the world
Passion, curiosity, resourceful, accountable, teamwork, commitment, open and energizing
Always with unyielding curiosity
Transition: Wherever General Electric applies itself it succeeds while making the world a better place to live
Conclusion
GE is ranked by Forbes, Fortune 500, and many other companies as one of the most admired companies in

Root Cause Analysis And Rca
A. Root Cause Analysis or RCA Root Cause analysis is an effective tool used both reactively, to investigate an adverse event that already has
occurred, and proactively, to analyze and improve processes and systems before they break down. Roost cause analysis helps dissolve the
problem, not just the symptoms. In health care, it is important to analyze the root cause because: (1) deficiencies and weaknesses in the system can
lead to human errors (2) evidence shows that in organizations with high trust the systematic errors can reveal the deficient system flaws (3) need
to learn from incidents and errors that have occurred in the past (4) events and adverse occurrences are the symptoms of a pathological disasters in
organization (5) disease in the organization can affect the various working system (6) accurate analysis of much critical incident or an error is a
very useful analysis than many precipitous accident or error (Abdollahi, 2015). B. Failure Mode, Effect, and Critically Analysis or FMECA Failure
Mode Effects Analysis (FMEA) is a systematic, proactive method for evaluating a process to identify where and how it might fail, and to assess the
impact of those failures, in order to identify the parts of a process that are most in need of change or improvement. The basic steps for performing an
FMEA are: (1) select the process to evaluate (2) recruit a multidisciplinary team, including those involved at any point in the selected process (3) have
the team meet and

Rca ( Radio Corporation Of America
RCA Records
"One of the largest and most influential electronics companies during the 20th century was the Radio Corporation of America, or RCA. At one time,
the breadth of its operations included everything from making vinyl records to building and manufacturing communications satellites." (Engineering
and Technology History Wiki: RCA (Radio Corporation of America)). Today, RCA stands as of the most popular and successful record labels in the
music industry, and it serves more purposes now than ever before. Over the years, RCA has taken on responsibilities such as searching for talent,
signing talent, developing the artists (sometimes), recording and producing their artists, promoting and marketing their artists, and exploiting their ...
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For all these amazingly talented artists, there have to be people who make sure these people are set and they also makes sure the company is getting
paid. There are different departments and jobs for the many employees in a record label, and I shall explain how the structure and success of the
organization is determined by this.
Much like other labels, RCA has the legal affairs department, the business affairs department, A&R, art, promotion, media, publicity, marketing and
artist development departments all playing key roles in the label's success. Specific people are picked and assigned to work in their respective
department to be better relate and benefit to not only the artists but their consumers, listeners and business partners. One would place a lawyer in the
A&R (Artists & Repertoire) department. Nor would they send a person who is great at fashion and creating image to handle the label's finances. It just
would not make sense, and it would not help neither the company or the artists. To break down the importances of these departments even more, the are
even teams within each department to handle certain aspects as well.
For instance, the artist development department is structured to build the artists up in regards to their clothing, their social networking, their fan base,
and how they are marketed. This job is important because one an artist is signed, someone has

Evaluation And Implementation Of Abc Hospital
ABC hospital has/had been having numerous issues within the hospital along with the issues related to the hospitals' processes. Some of the hospitals
situations included: excessive wait times, excessive delays in care, elopements, patient falls, excessive costs, decrease patient satisfaction, and not being
able to prioritize their patients appropriately nor accessing the situation effectively for the patients needing services (Nash, Grandon, Grandon, &
Goldfarb, 2006). After ABC'shospital executives evaluated the situations that the organization has been facing, they embarked on a nine month
journey; in order to investigate completely all the situations that arose as well as developed action plans and changes in the hospital to alleviate these
situations. The following report will include detailed information regarding the solutions and plans the hospital initiated within the organization to
resolve these problems. The report will also include information related to three types of quality or risk management techniques or tools the hospital
could have used during their evaluation and implementation phases during the project. An organization has the availability to utilize various tools,
concepts, benchmarking measures, reporting measures, etc... in order to improve the overall sustainability of the organization and improve the effects
of their actions to increase quality and efficiencies. No tool has been designed to be the only tool as the best approach when addressing

Corporate Television Research Paper
Corporate Television: Who Owns The Networks?
HOWARD BEALE: "We are no longer an industrialized society; we aren't even a post
–industrial or technological society. We are now a corporate
society, a corporate world, a corporate universe. This world is a vast cosmology of small corporations orbiting around larger corporations who, in turn,
revolve around giant corporations, and this whole endless, eternal, ultimate cosmology is expressly designed for the production and consumption of
useless things . . . "
NARRATOR: "By the end of June,The Howard Beale Show was down eleven points, a catastrophic condition."
––from the 1976 movie Network, written by Paddy Chayefsky
NBC
East Coast, 30 Rockefeller Plaza, New York, NY 10112
West Coast, 3000 W.... Show more content on Helpwriting.net ...
In 1932, GE and Westinghouse withdrew and sold their ownership shares of the network to RCA, who then acquired sole ownership of NBC. The buy
out was done to avoid prosecution by the U.S. Justice Department because of antitrust concerns.
Then in 1985, RCA, including NBC, was bought by the General Electric Corporation for $6.3 billion.
NBC Cable Services operate the Consumer News & Business Channel (CNBC, 2200 Fletcher Ave., Fort Lee, NJ 07024), the Prime SportsChannel
Network, and the NBC Super Channel which broadcasts English speaking programs in Europe, Asia and Mexico.
The General Electric Corporation manufactures military and commercial aircraft jet engines. It also produces appliances such as refrigerators, electric
stoves, microwave ovens, washers and dryers, air conditioners, and (of course) televisions. Its products are sold under the GE, Monogram, Profile,
RCA and Hotpoint brand names. GE also manufactures a vast array of electrical equipment, medical technologies such as x–ray machines and
ultrasound equipment, AC and DC electric motors, plastics, silicones, superabrasives, train engines, and steam turbine equipment for nuclear power

Essay about Chrysanthemums, A Review
"The Chrysanthemums" introduces us to Elisa Allen, a woman who knows she has a gift for things, but can't make more use of it than to grow her
chrysanthemums. She is trapped in the Salinas Valley, where winter's fog sits "like a lid...and [makes] the great valley a closed pot." Her human
nature has made her complacent in ordinary life, but the short glimmers of hope offered by her flowers and a passing stranger reveal that there is
more to Elisa than her garden. Her environment may be keeping her inside her small garden, but inside her heart there is a longing for more.
When we are first introduced to Elisa, she seems to look more like a man from afar than a woman who is gardening. She wears a man's hat, and her
flower ... Show more content on Helpwriting.net ...
She is no longer hiding behind her man's hat, but rather tears it off to reveal her pretty hair and asks him to step inside the garden. When she gives
the man a pot with a chrysanthemum inside to carry with him, she begins to tell him of her "planter's hands." Elisa becomes very excited, as she
begins to think this man has something to offer her; he is a traveling man and can help her understand what freedom feels like. While she is speaking
to him, she begins to get overly excited and almost grabs a hold of him. Unfortunately, he is not the man who can help her out, and draws the
conversation away by mentioning dinner. As soon as he does so, Elisa becomes ashamed at her own excitement, the same excitement she showed when
she was working with her flowers.
Elisa's glimmer of hope is gone now, and her character begins to reveal how she is trapped inside that valley, much like the valley is trapped from
the rest of the world by the overwhelming fog. She becomes defensive against the stranger once more, and wants to prove to him that even a woman
can do what he is doing. Even a woman can travel and fix things for people, especially one who has such a gift with her hands. The man's discomfort
with the situation brings him to leave Elisa alone, alone to the sounds of her own voice whispering goodbye. Here is where human nature gets the best
of Elisa, as she creeps back into her habitual

Rca and Fmea
Root Cause Analysis:
Root cause analysis (RCA) is used in different fields to conduct a systematic search to find the causes of a specific sentinel event (Jacob, 2010).
The main goal for conducting a RCA is to prevent similar adverse events from happening in the future (Jacob, 2010). In this paper, I will use the
scenario provided in the task to create a complete RCA report as well as improvement plans that will prevent similar incidents from happening again.
RCA is best done as soon as an adverse event has happened (Jacob, 2010). The first step in the RCA is to identify what had happened (Jacob, 2010).
In the scenario, Mr. B was admitted to the Emergency Room (ER) after a fall. During the treatment, Mr. B was given... Show more content on
Helpwriting.net ...
To do so, I am going to use the fishbone diagram to categorize the causative factors (Potter & Perry, 2008). For patient characteristics, Mr. B was a
67 year old patient with routine use of oxycodone to treat chronic pain. Because of his routine use of oxycodone, he may need a different dose to get
to a sedated level than other people who are not on any medication. Next is the task factors, the hospital had a policy which requires that anyone who
are treated with moderate sedation or analgesia have to be put on continuous blood pressure, ECG, and pulse oximeter monitoring until the procedure is
done and patient is in stable condition. Mr. B was not being monitored accordingly during the sedation process. Another task factors is that all staffs
must first complete a training module on sedation before performing the task. Individual staff is a factor too, Nurse J had completed the training module
on sedation, he had an ACLS certification as well as experience working as a critical care nurse. Team factors include communication between staffs;
an example would be the LPN not informing Nurse J or Dr. T when the alarm went off the first time, it showed that Mr. B had low oxygen saturation.
Work environment factors included the staffing in the ER, the equipments they had, and the level of experience of the staffs. According to the scenario,
additional staffs were available for back up support and all the equipment needed

RCA Essay
Improvements for RCA Make Regent Christian Academy great again. A generous high school graduate from Regent, has blessed the school with a
large financial gift. The donated money should be focused towards the improvement of the P.E department, Fine arts department, and the school
campus. The physical education department is one of the sections that the money should be used for. First, the school needs more P.E equipment, as well
as an upgrade of the current equipment. For example, the badminton nets that are being used right now are not the proper nets for a game. Because of
the temporary nets, RCA is unable to host badminton games and tournaments. Another example, would be the badminton racquets and the lacrosse
sticks, many of them ... Show more content on Helpwriting.net ...
Rather than just having basic elective classes expanding their selection gives them the freedom to try new things, and see what they like and
dislike. Secondly, similar to the P.E department there is also a lack of equipment in the Fine arts department. An example for this would be drama
costumes, there is a lack of funds for the drama department to buy costumes and scripts. Therefore, it becomes quite challenging for the drama
teachers and students to pick a production that they can actually produce. Putting in more funds toward Fine arts equipment will allow students to
do more activities . Lastly, there should be more field trips for the fine arts department. For example, a field trip for the choir class could be going
to an opera, while the drama class could go to a play or musical and the art class could go to a museum. All of these additions in the fine arts
department will be money well spent, because it will allow the students of RCA to explore their God given talents, and it will inspire them to be
more creative and work harder. A major portion of the financial gift should go towards renovations for the school campus. First, the school building
needs to be enlarged, because there is not enough space for everyone to be in the same building. This has been a challenge for many students, because
they have classes in portables

Root Cause Analysis In Healthcare Organization
A root cause analysis (RCA), an organized protocol or procedure, institutes a means of analyzing a sentinel or adverse event that occurs within a
healthcare facility, ultimately uncovering causes of problems or errors. U.S. hospitals are required to keep confidential records within the facility of
adverse reactions, yet RCAs are mandated to accompany a reported sentinel event to the accreditation organization, the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO) and other organizations (AHRQ 2014). Various members from all aspects of thehospital form a
multidisciplinary team to analyze, evaluate, and resolve errors with the goal of prevention of future adverse, sentinel events. A RCA allows for
concentration on events and underlying problems that contributed to the incident rather than focusing on individual actions and behaviors (AHRQ
2012).
Case Study ... Show more content on Helpwriting.net ...
The medication error occurred as the vasoactive drug Vasopressin infused at 0.4 units per hour instead of the correct dose of 0.04 units per hour.
Unfortunately, the gentleman experienced a myocardial infarction yet favorably, the patient recovered without incident. While the patient outcome was
not affected in this particular incident, the facts that this error was not discovered for sixteen hours and through multiple levels employees, pharmacy,
computerized order entry, nursing, physicians, is alarming for this and future mistakes. For prevention of future medication or order errors this problem
should be investigated by means of a root cause analysis, establishing causes and

Rca Fruits
Because it is so close to the equator, Costa Rica has a year round climate giving access to to a selection of exotic Costa Rican fruits. Costa Rica also
has rich volcanic soil which is great for growing things like pineapples,bananas and other native fruits that are unknown to foreigners. The many
fruits in Costa Rica are not just used for eating, that are used in the beverages frescos, refrescos, or jugos naturales where the fruits are blended with
sugar, and a choice of water or milk. They are similar to the smoothies we drink. For this project I made a fruit salad using differents fruits that are eaten
or popular in Costa Rica. The following fruits were used: mango, pineapple(piГ±a), starfruit(carambola), papaya, and strawberries(fresas). ... Show
more content on Helpwriting.net ...
Papaya is Native to southern Mexico and Central America, depending on how ripe or unripe your papaya is affects the taste of it. These fruits are
commonly seen in Central America. One of the more commonly eaten fruits mango is one of the most popular fruit in the world and are generally
sweet and are served on a stick with the skin peeled back in Latin America countries. Pineapple(piГ±a) is a delicious tropical fruit that is surrounded
by thorny spikes and topped with hard waxy leaves. Hawaii had the largest production of pineapples, but they are now in large quantities in Brazil, the
Philippines, and Costa Rica. Theses fruits all have their unique tastes so, I combined them into a fruit salad making it where you get a little taste of

National Broadcasting Company Research Paper
The National Broadcasting Company (NBC) is an American commercial broadcast television and radio network that is the flagship property of
NBCUniversal, a subsidiary of Comcast. The network is headquartered in the Comcast Building (formerly known as the GE Building) at Rockefeller
Center in New York City, with additional major offices near Los Angeles (at Universal City Plaza) and in Chicago (at theNBC Tower). NBC is
sometimes referred to as the "Peacock Network", in reference to its stylized peacock logo, which was originally created in 1956 for its then–new color
broadcasts and became the network's official emblem in 1979.
Founded in 1926 by the Radio Corporation of America (RCA), NBC is the oldest major broadcast network in the United States.

Redeemer Urc Analysis
I was born and raised attending Redeemer United Reformed Church (URC) here in Orange City, Iowa. Redeemer URC is a member of the United
Reformed Churches in North America. The official page of the URCNA makes no statements concerning gun control, immigration, or national debt and
spending. However, speaking from personal experience within the URC, the relationship between citizen and government does arise. For example,
Romans 13:1 says "Let every person be subject to the governing authorities. For there is no authority except from God, and those that exist have been
instituted by God." Aside from general respect and submission to authority, the most oft repeated sentiment I have heard towards authority is one of
support. Our leaders carry an enormous amount of responsibility, and therefore they deserve our sincere prayers of support...whether we agree with them
... Show more content on Helpwriting.net ...
The two largest being gun control and refugees. The first, gun control, was taken up at the 1977 General Synod they "spoke out in favor of gun
control. It [General Synod] adopted three resolutions" (RCA). The most blatant resolution was the first: a request to Congress to ban the manufacturing
and sales of handguns for civilian ownership (MSG 1977: 200–201). The second topic, refugees and immigrants, was splashed across the running
banner of the website #refugeeswelcome. Along with various tags on how to get involved in the global and national refugee crisis, the RCA has taken
an updated official stance. The 2007 General Synod stated, "may the scriptural witness of the RCA and its members continue to consistently advocate
for the rights of the poor and oppressed" (MGS 2007: 252–253). The RCA has taken an official position on many modern issues that face the church.
The denomination believes that it should take an active and vocal position in faith and

Comparing The Failure Modes And Effects Analysis And The...
The Failure Modes and Effects Analysis (FMEA) and the Root Cause Analysis (RCA) are both used to prevent adverse events from happening.
However, they are used at different time periods. Understanding how they are used helps one to understand when to use them. The FMEA is a
process that is used before an error has occurred. It is recommended by the Institute for Healthcare Improvement (IHI) to use the FMEA as a
proactive way in which to assess for not only the risk of failure but also to protect the patient from harm (Sorrentino, 2016). In a study it was
described as "a risk analysis technique designed to identify and analyze failure modes, causes, and effects in a system or process before actual sentinel
events or near misses occur" (Nielsen,

Music Row History
Until the late 40s, most country and western artists on a major record label would record in New York, Los Angeles or Chicago as they were where
the label offices and studios were located. 1945 saw the first independent recording studio built in Nashville, titled 'The Castle Recording company'
and was created by a pair of enterprising radio engineers from WSM in Nashville, (Levy 2000, 22–23). In 1954, Nashville Producer Owen Bradley
constructed a studio away from downtown in the famed Quonset hut and was soon followed by a rush of producers, publishers and performers in
the late 50s to early 60s converting old houses into studios and offices. This central hub of music industry development in downtown Nashville would
form what would come to be known as 'Music Row' (Hill 2011, 294). This rush of interest would see session musician and producer Chet Atkins
persuade label RCA Victor to construct a studio in 1957, later known as "Studio B". (Studio B, n.d.)... Show more content on Helpwriting.net ...
This was also defined by a use of mellow strings, and backing vocal choruses, and would help make the music more accessible to a wider audience.
An example of the 'Nashville Sound' is 'The End of The World' by Skeeter Davis, which was recorded in RCA Studio B and produced by Chet
Atkins. [Play song] This refined style of music would help expand Nashville recorded music presence on a national stage, and lock in its place on an
international music

The Importance Of Using Mixed Methods Used For Data...
This section outlines the methodology approach, which covered the research and the techniques used in gathering the information as well as the
limitations of the research methods employed. This study identifies the importance of using mixed methods (qualitative and quantitative methods) as
the research strategies. After the introductory section, the second section indicate the methods used for data collection, following with the sampling for
data collection and how contestants were enlisted. The fourth section includes the interviewer experience following with the last section of ethical
approval in conducting a research.
3.1.2 Statement of research aim
The aim of this research as discussed previously in chapter one is to investigate the use of recycled concrete aggregates in the building construction
projects and relate it to the structural performance requirements, which will give a better understanding on the concrete made by using recycled
concrete aggregates. 3.1.3 Research Methods Employed
This chapter will start by reviewing various approaches to data collection and justify the difference between quantitative and qualitative research, then
finally this chapter will explain about the selected method for this research and reasons why.
Deciding on which type of research strategy to follow according to Naom (1998), depends on the purpose of the study and the type and availability of
the information which is required. However, Saunders et al. (2007) indicated that

The Root Cause Analysis Of Rca Essay
The root cause analysis, RCA is used in the health care profession to find flaws and opportunities for improvement in the nursing environment. It is a
structured analysis method for serious adverse health care events. Moreover, by conducting a RCA, health care practitioners determine the underlying
problems that intensify the likelihood of errors with avoidance of focus on individuals' mistakes. A systems approach is used to detect and eliminate
active and latent errors to prevent future harm. As a result, RCAs follow a pre–specified protocol starting with collection of data, record reviewing and
participant interviews to reconstruct the event in question (Franklin, Shebl & Barber, 2012). Health care workers are obligated to protect their clients
through full understanding of nursing–sensitive indicators for aversion of any possible cases of hospital–associated injury or death. If a patient is in
more danger than they arrived at the hospital, then a RCA is useful to determine the way forward. A 67–year old male patient presented to the
emergency department moaning and complaining of severe pain to his left leg and hip after a fall. The patient's vital signs are recorded as blood
pressure 120/80, heart rate 88, body temperature 98.60F, and respiration 32 and weights of 175 pounds. The pain is severe at 10/10. On assessment it
is revealed that the patient is in moderate distress and the left leg seems shortened with calf edema, ecchymosis and has a limited range of motion.

Examples Of Root Cause Analysis
Chapter 2
Literature Review
7
2.1. Root Cause Analysis:
In Root Cause Analysis (RCA) is the process of identifying causal factors using a structured approach with techniques designed to provide a focus for
identifying and resolving problems. Tools that assist groups or individuals in identifying the root causes of problems are known as root cause analysis
tools. Every equipment failure happens for a number of reasons.
There is a definite progression of actions and consequences that lead to a failure. Root Cause
Analysis is a step–by–step method that leads to the discovery of faults or root cause. An RCA investigation traces the cause and effect trail from the
end failure back to the root cause. It is much like a detective solving a crime.
To ... Show more content on Helpwriting.net ...
Like Cox and Spencer (1998), Dettmer
(1997) has also used root cause analysis on management of constraints. He presents one of the earliest studies on the debate of applying Root Cause
Analysis to processes. A proper management decision is necessary to succeed the RCA tools and methods in a particular environment. Lepore and
Cohen (1999), Moran et al. (1990), Robson (1993) and Scheinkopf (1999) move ahead that when change is needed, then think root cause analysing,
identifying and eliminating. The foundations of their studies are pioneering one as they question an accepted practice for root cause analysis and the
results of the example studies are encouraging.
However, the studies are far from being practical one as they include too many parameters and assumptions. Smith (2000) has explained that Root
Cause Tools can resolve conflicting strategies, policies, and measures. The perception is that one tool is as good as another tool. While the literature
was quite complete on each tool as a stand–alone application and their relationship with other problem solving methods. There are very few literatures
available on

The Fire Safety Events And Improve Overall Quality Essay
Introduction. Health care entities across the U.S. manage their own medical mandates, each varying from state to state. States organize a set of
mandates to ensure proper incident reporting. Health care organizations abide by such mandates in order to detect patient safety events and improve
overall quality. The ensuing paper researches incident reporting systems from two separate states. Responsibility. Although not clearly stated, the
responsibility of reporting incidents at both Utah and Minnesota institutions seemingly falls in the hands of every employee or health care professional.
However, each mandate specifies to whom an incident should be reported. In Utah, each facility is obligated to report to the Utah Department of
Administrative Services within seventy–hours of occurrence, and no later than four hours before a root cause analysis (RCA) is administered (UT
Admin Code В§ R380–200–3–(1)). Incidents must be reported to the commissioner of the Department of Health in Minnesota as soon as possible, and
no longer than fifteen working days after the discovery of the event (Minn. Statutes Code В§ 144.7065 Subd. 1). Types of Incidents. For two states that
are nearly 1,300 miles apart, a general similarity rests amongst the types of required reported incidents. Both institutions detail almost identical events in
slightly different formats. Health care facilities in Utah and Minnesota are instructed to report sentinel events relating to surgery, products or devices

General Electric Under Jack Welch
General Electric Under Jack Welch
In 1980 right before Welch took the position as CEO of General Electric, GE 's organizational rigid structure, resistance to change, and bureaucratic
climate made it impossible to perceive important environmental changes. Furthermore, the organizational structure, decision–making process and
information management procedures no longer fit the organization 's needs. In 1981 Jack Welch was not considered a leading contender for GE 's top
job. However, his performance and earnings record ultimately won him the position over six other candidates. When Jack Welch took office as the new
chairman and chief executive officer of General Electric, the company had entered the stage between the maturity ... Show more content on
Helpwriting.net ...
Informality was also standard in company correspondence. Welch faxed handwritten notes to anyone in the company who he felt deserved personal
communication, whether to motivate, correct, or congratulate. Welch also personally reviewed everyone who worked directly for him, handwriting
extensive performance evaluations that sometimes ran several pages. This exercise not only gave specific and ongoing feedback to employees but
was a chance for Welch to reflect on the businesses that each employee was leading. The atmosphere of informality was perhaps most critical among
GE 's top leadership, where the confidence that came from being in familiar company encouraged executives to openly praise or criticize each other.
Welch consistently forced executives to bicker in meetings, the idea being to force management to know their businesses, processes, and issues
thoroughly before engaging in discussion with the boss. Under such conditions Welch could determine a manager 's level of dedication or passion for
a plan or policy by noting the extent to which he was willing to argue. Welch was typically rude and had little patience for half measures and was
equally combative in performance review meetings, in which company leaders would discuss the employees within their respective divisions. Welch
could be quick to make judgments with seemingly limited knowledge, but he wanted to stimulate

Rca's Techniques To Solve Problems In A Team
A problem is an activity that causes upset that disrupts the outcome of the team and needs to solved. there are techniques to help solve problems
within a team. The two main types of problem solving are as followed; Rational problem solving – RCA; RCA looks to recognize why the problem
started. The reason that it started can be seen as the greatest reason why the problem started or didn't start rather than a indicator of the problem. for
example; A service user did not receive their medication, RCA looks to see if there is a under lying problem, Did the staff member know to administer
medication, was it passed on in the handover that the service user required medication. The main problem could be the lack of communication between
staff members... Show more content on Helpwriting.net ...
secondly would be systems and processes, this would high light the handovers and training of staff, Thirdly controls, unclear responsibility and rota
(there is not always a person to handover to) The fishbone Diagram highlights factors that could be changed so stop the problem happening again.
Creative problem solving– The six thinking hats; this technique was made by a man called Edward de Bono, it was to motivate people to think of
different reasons ie 'hats' and from different view points. like the name suggests there are 6 'hats' to think about the first hat is the 'white hat'–
information, What facts are available for example the service user did not receive medication. 'yellow hat' – optimistic perspective, what is good about
this situation? what are the benefits? it has highlighted that there is a problem since the medication was missed, there is no benefits as medication is
needed. 'black hat' – Judgement, what are the likely difficulties or dangers? what might go wrong?, the service users health maybe affected by missing
the medication, the service users next dose of medication maybe administered at the wrong time or not at

Root Cause Analysis, Change Theory, FMEA, And Nursing Root...

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