Carolyn B
Week 7 Discussion 1 "Peer Review"
My Abstract: The leadership position has been in development for centuries for the purpose of shaping and molding others in hopes that they will perform through the examples that a leader portrait. While the effective and ineffectiveness of leadership has been researched there is not a specific time listed as to the history of it, but it “has been going on for quite some time.” There is no specific date as to when ineffective leadership started, but the traits were characterized and based on the traits that were different from an effective leadership.
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Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
The History OF HOSPITALS AND WARDS
Gormley, Tom
Healthcare Design; Mar 2010; 10, 3; ProQuest Central
pg. 50
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Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Do No Harm: Adaptive reuse in healthcare construction
Oliver, Scot. The Idaho Business Review; Boise (Oct 17, 2016)
Buildings that are designed and built well can be valuable long after their original intended use is over. More than just a collection of wood, stone, steel and glass, a good building has an intention of exceeding a basic utilitarian purpose. It aspires to make a design statement, to be of service, to be an active participant in the community. Good buildings exhibit a lot of pride--in the developer's mission, or business, or himself. This extends to the pride of design and craftsmanship that makes a building valuable long after the source of the pride is gone.
Some of our favorite buildings have been adapted from other uses.
The old Ada County Courthouse, once slated for demolition, housed the state Legislature for a few years and now serves magnificently as the Idaho Law Center. Railroad warehouses became the cool, eclectic shops and offices in 8th Street Marketplace, and attracted the BoDo development around it. Old hotels got new life as office, residential and retail uses in the Owyhee, Hoff and Idanha buildings. Downtown department stores have been converted, like the Alaska Building offices and Athlos Academy's headquarters. The office where I write this was an opera house in the late 19th century; three blocks away a warehouse from that era now houses the opera.
Even some older industrial buildings were built to last. Often, these buildings don't survive redevelopment, but their high-q.
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CASE STUDY 2.1 W. L. Gore and AssociatesHe was ready for anythi.docxdewhirstichabod
CASE STUDY 2.1: W. L. Gore and Associates
He was ready for anything—or so he thought. Dressed in his finest and armed with an MBA degree fresh off the press, Jack Dougherty walked in for his first day of work at Newark, Delaware–based W. L. Gore and Associates, the global fluoropolymer technology and manufacturing giant that is best known as the maker of Gore-Tex.
But it turned out he wasn’t ready for this: “Why don’t you look around and find something you’d like to do,” founder and CEO Bill Gore said to him after a quick introduction. Although many things have changed over the course of W. L. Gore and Associates’ 50+ years in business, the late Gore stuck to his principles regarding organizational structure (or lack thereof), a legacy he passed down to subsequent generations of management. Gore wasn’t fond of thick layers of formal management, which he believed smothered individual creativity. According to Gore, “A lattice (flat) organization is one that involves direct transactions, self-commitment, natural leadership, and lacks assigned or assumed authority.”
In the 1930s, Gore received a bachelor’s degree in chemical engineering and a master’s degree in physical chemistry. During his career, he worked on a team to develop applications for polytetraflurothylene (PTFE), commonly known as Teflon. Through this experience, Gore discovered a sense of excited commitment, personal fulfillment, and self-direction, which he yearned to share with others. Spending nights tinkering in his own workshop, he did what he had previously thought to be impossible: he created a PTFE-coated ribbon cable. It occurred to Gore that he might be able to start his own business producing his invention, so he left his stable career of 17 years, borrowed money, and drained his savings. Though his friends advised him against taking such a risk, W. L. Gore and Associates was born in January 1958. The basement of the Gore home was the company’s first facility.
Although no longer operating from a family basement (Gore boasts more than $3 billion in annual sales and 9,000 employees in more than 45 facilities worldwide), the sense of informality has stuck. “It absolutely is less efficient upfront,” said Terri Kelly, chief executive of W. L. Gore. (Her title is one of the few at the company.) “[But] once you have the organization behind it . . . the buy-in and the execution happens quickly,” she added.
Structure and Management of Unstructure and Unmanagement
Even as Gore started to grow, the company continued to resist titles and hierarchy. It had no mission statement, no ethics statement, and no conventional structures typical of companies of the same size. The only formal titles were “chief executive” and “secretary-treasurer”—those required by law for corporations. There were also no rules that business units within the company couldn’t create such structures, and so some of them did create their own mission statements and such. Many called Gore’s management style “unmanag.
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How To Write A Narrative Essay Outline.pdfNatasha Smith
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What is a Narrative Essay — Examples, Format & Techniques. How to Write an Outstanding Narrative Essay (and Get an A+). A Comprehensive Guide to Writing a Narrative Essay. Narrative Essay: Narrative paragraph outline. Free Narrative Essay Examples - Samples & Format - Example of a good .... Writing a Narrative Essay: ( Outline form + Sample short essay ) - ESL .... narrative essay format - Neuro Gastronomy. How To Write A Personal Narrative Essay For College : The Personal .... Writing a Foolproof Narrative Essay Outline. sample narrative outline | Essays | Narrative. 30+ Essay Outline Templates - (Free Samples, Examples and Formats). FREE 8+ Essay Outline Samples in PDF | MS Word. Narrative Essay Outline Template For Your Needs. Pin by Quick Help Students on Narrative Essay | Essay outline, Essay .... 37 Outstanding Essay Outline Templates (Argumentative, Narrative .... Writing a Compelling Personal Narrative Essay: Tips and Examples .... FREE 9+ Essay Outline Samples in MS Word | PDF. Sample Narrative Essay. Narrative Writing Template. How to Write the Perfect Essay Outline by Bid 4 Papers | The Burgundy Zine. Step-by-Step Guide How to Write Narrative Essay (2023 Update). Essay Outline | UDL Strategies. Personal Narrative Essay Sample | Templates at allbusinesstemplates.com. 25+ Essay Outline Templates - PDF, DOC | Free & Premium Templates.
Similar to Carolyn BWeek 7 Discussion 1 Peer ReviewMy Abstract The lea.docx (20)
CASE STUDY 2.1 W. L. Gore and AssociatesHe was ready for anythi.docxdewhirstichabod
CASE STUDY 2.1: W. L. Gore and Associates
He was ready for anything—or so he thought. Dressed in his finest and armed with an MBA degree fresh off the press, Jack Dougherty walked in for his first day of work at Newark, Delaware–based W. L. Gore and Associates, the global fluoropolymer technology and manufacturing giant that is best known as the maker of Gore-Tex.
But it turned out he wasn’t ready for this: “Why don’t you look around and find something you’d like to do,” founder and CEO Bill Gore said to him after a quick introduction. Although many things have changed over the course of W. L. Gore and Associates’ 50+ years in business, the late Gore stuck to his principles regarding organizational structure (or lack thereof), a legacy he passed down to subsequent generations of management. Gore wasn’t fond of thick layers of formal management, which he believed smothered individual creativity. According to Gore, “A lattice (flat) organization is one that involves direct transactions, self-commitment, natural leadership, and lacks assigned or assumed authority.”
In the 1930s, Gore received a bachelor’s degree in chemical engineering and a master’s degree in physical chemistry. During his career, he worked on a team to develop applications for polytetraflurothylene (PTFE), commonly known as Teflon. Through this experience, Gore discovered a sense of excited commitment, personal fulfillment, and self-direction, which he yearned to share with others. Spending nights tinkering in his own workshop, he did what he had previously thought to be impossible: he created a PTFE-coated ribbon cable. It occurred to Gore that he might be able to start his own business producing his invention, so he left his stable career of 17 years, borrowed money, and drained his savings. Though his friends advised him against taking such a risk, W. L. Gore and Associates was born in January 1958. The basement of the Gore home was the company’s first facility.
Although no longer operating from a family basement (Gore boasts more than $3 billion in annual sales and 9,000 employees in more than 45 facilities worldwide), the sense of informality has stuck. “It absolutely is less efficient upfront,” said Terri Kelly, chief executive of W. L. Gore. (Her title is one of the few at the company.) “[But] once you have the organization behind it . . . the buy-in and the execution happens quickly,” she added.
Structure and Management of Unstructure and Unmanagement
Even as Gore started to grow, the company continued to resist titles and hierarchy. It had no mission statement, no ethics statement, and no conventional structures typical of companies of the same size. The only formal titles were “chief executive” and “secretary-treasurer”—those required by law for corporations. There were also no rules that business units within the company couldn’t create such structures, and so some of them did create their own mission statements and such. Many called Gore’s management style “unmanag.
Case study 1Client ProfileMrs. Harriet is a 68-year-old .docxdewhirstichabod
Case study 1
Client Profile
Mrs. Harriet is a 68-year-old woman who is alert and oriented. Allergies are Erythromycin. She presents to the emergency department with complaints of chest tightness, shortness of breath, cough, and congestion. She states, "I have been having these symptoms for three days now. I have been taking Maximum Strength Robitussin for my cough but it has not helped very much. When I woke up this morning. I felt very weak so I came in to be checked out." Her vital signs are blood pressure 110/70, pulse 94, respiratory rate of 28, and temperature of 102.7 F. Her oxygen saturation on room air is 92%. She is placed on 2 liters (L) of oxygen by nasal cannula. The HCP prescribes a 12-lead electrocardiogram (ECG, EKG) and chest X-ray (CXR). Laboratory tests prescribed include complete blood count (CBC), basic metabolic panel (BMP), brain natriuretic peptide (B-type natriuretic peptide assay or BNP), total creatine kinase (CK, CPK), creatine kinase-MB (CPK-MB), and troponin. The HCP will also assess blood cultures x 2, AGs on room air, sputum culture and sensitivity (C &S), and asks that the client have a Mantoux (tuberculin, purified protein derivative, or PPD) test.
Case Study
Mrs. Harriet's ECG shows normal sinus rhythm (NSR) with a heart rate of 98 beats per minute. The CXR reveals a right lower lobe(RLL) infiltrate. Laboratory tests include the following results: white blood cell cot (WBC) 12,2000 cells/mm3, 72& seg neutrophils with a left shift of 11% bands, and a BNP of 50.9 pg/mL. ABGs on room air is pH 7.44, partial pressure of carbon dioxide (PaCO2) 39 mmHg, bicarbonate (HCO3) 26.9 mEq/L, partial pressures of oxygen (PaO2) 58 mmHg, and oxygen saturation (SaO2) of 92%. Results of the sputum culture show Streptococcus pneumoniae. The CPK, CPK-MB, and troponin are all within normal limits. Mrs. Harriet is five feet three inches tall and weighs 224 pounds (101.8 kg). On assessment, the nurse hears expiratory wheezes and rhonchi bilaterally with diminished lung sounds in the right base. Her thoracic (chest) expansion is equal but slightly decreased on inspiration. Accessory muscle retraction is not noted, and she does exhibit central cyanosis. The capillary refill of the client's nail beds is four seconds.
Mrs. Harrier is admitted with acute bronchitis and pneumonia. The HCP prescribes oxygen via nasal cannula to keep the client's saturations greater or equal to 95%, Ceftriaxone sodium, Erythromycin, Albuterol, Acetaminophen every four to six hours as needed, bed rest, an 1800 calorie diet, increased oral (PO) fluid intake to 2 to 4 liters per day, coughing and deep breathing exercises and use of the incentive spirometer (IS).
1. Discuss additional assessment data that would help gain a more thorough understanding or Mrs. Harriet's symptoms?
2. Discuss the causes, pathophysiology, and symptoms of acute bronchitis?
3. Discuss the pathophysiology and causes of pneumonia in general?
4. Compare the defining characteri.
Case Study 11.1 Why the Circus No Longer Comes to TownFor 146 y.docxdewhirstichabod
Case Study 11.1: Why the Circus No Longer Comes to Town
For 146 years, the Ringling Brothers and Barnum & Bailey Circus traveled the United States by train, putting on shows featuring acrobats, trapeze artists, clowns, and exotic animals. In 2017, the circus held its last performances after a significant decline in attendance and revenue due to changing public tastes. Shorter attention spans also contributed to its demise. The final blow to the circus came from its decision to eliminate elephant acts. According to a press release from Feld Entertainment, the company that owned the circus, this move led to a “greater than could have been anticipated” decline in ticket sales.1
For decades the American Humane Society, PETA (People for the Ethical Treatment of Animals), and other animal rights groups tried to ban elephant acts in Ringling Brothers performances. Protesters regularly picketed the circus, and for 14 years animal rights groups fought Ringling Brothers in court. Activists claimed that elephant acts were cruel and pointed out that these highly intelligent animals were chained up much of their lives. In 2011, Feld Entertainment was fined $270,000 for violations of the Animal Welfare Act. However, Feld Entertainment successfully fended off the lawsuits, winning a $24 million judgment against the animal rights groups in 2014. Nonetheless, Ringling Brothers agreed to retire all traveling elephants to its Center for Elephant Conservation in Florida that same year. (During this same period, Los Angeles, Oakland, and Asheville, North Carolina, restricted animal acts.)
Animal rights groups cheered the closing of the circus. According to PETA’s president, “PETA heralds the end of what has been the saddest show on earth for wild animals, and asks all other animal circuses to follow suit, as this is a sign of changing times.”2 The CEO of the United States Humane Society said, “I applaud their decision to move away from an institution grounded on inherently inhumane wild animal acts.”3 CEO Kenneth Feld acknowledged that the negative publicity generated by the lawsuits took its toll: “We prevailed in court 100% [but] obviously, in the court of public opinion we didn’t win.”4
Ringling Brothers/Feld Entertainment isn’t the only company that has had to deal with changing societal attitudes toward animals. For decades killer whales were the major attraction at SeaWorld parks in San Diego, Orlando, and San Antonio. However, the death of trainer Dawn Brancheau, who was dragged into the water and drowned by Sea World’s largest breeding male, Tilikum (“Tilly”), galvanized opposition to captive orca programs. The film Blackfish documented the death of Brancheau and whale mistreatment. Matt Damon, Harry Styles, Willie Nelson, and other celebrities joined the protest. Animal activists noted that orcas (which are really large dolphins) never kill humans in the wild. In captivity, young killer whales are separated from their families and are forced to live thei.
Case Study 10.3 Regulating Love at the OfficeThe office has bec.docxdewhirstichabod
Case Study 10.3: Regulating Love at the Office
The office has become a hotbed of romance. In one survey, 60% of employees surveyed reported that they had participated in an office romance during their careers and 64% said they would do so again. And the percentage of workplace romances is likely to climb as younger workers (ages 25 to 34) put in more hours at work. As one human resource writer notes:
Traditional places like church, family events, and leisure time don’t present the same pool of candidates as they did in earlier times. The workplace provides a preselected pool of people who share at least one important area of common ground. People who work together also tend to live within a reasonable dating distance, and they see each other on a daily basis.1
Office romances can pose a number of problems, including a loss of productivity, public displays of affection, gossip, damage to the professional image of the organization, charges of favoritism, and affairs in cases where romantic partners already have spouses or significant others. Serious issues arise when superiors and subordinates date and then break up. The subordinate (often a young female assistant) may claim that she was sexually harassed because she was pressured into having sex to keep her job or that her supervisor (often an older male executive) retaliated when the relationship ended.
The nation was reminded of the dangers of superior–subordinate relationships when former late-night talk show host David Letterman admitted that he’d had a series of sexual relationships with female writers and staffers at his production company. Letterman went public with his affairs after a CBS producer who dated his long-term girlfriend, Stephanie Birkett, tried to extort money from the entertainer in return for keeping silent about his sexual activities. While Letterman’s relationships were consensual, it appeared as if the women he dated received special benefits. For example, Birkitt was featured in broadcast segments even though she did not seem to be particularly talented.
Human resource departments are taking note of the dangers of office romances. The number of companies developing written policies to address office romances rose from 20% to 42% over an eight-year period, according to the Society of Human Resource Management. And the policies grew stricter. Almost all the firms surveyed by SHRM forbid romantic relationships between superiors and subordinates; one-third forbid relationships between those reporting to the same supervisor or with a client or customer; 10% don’t allow romances between their employees and employees of competitors. Punishments range from minimal (relationship counseling and department transfers) to severe (suspension and termination). Executives at the American Red Cross, the World Bank, Walmart, Boeing, and the Harvard Business Review lost their jobs for having relationships with subordinates.
Not everyone is convinced that restrictions on dating are just.
Case Study 1 Is Business Ready for Wearable ComputersWearable .docxdewhirstichabod
Case Study 1: Is Business Ready for Wearable Computers?
Wearable computing is starting to take off. Smartwatches, smart glasses, smart ID badges, and activity trackers promise to change how we go about each day and the way we do our jobs. According to Gartner Inc., sales of wearables will increase from 275 million units in 2016 to 477 million units by 2020. Although smartwatches such as the Apple Watch and fitness trackers have been successful consumer products, business uses for wearables appear to be advancing more rapidly. A report from research firm Tractica projects that worldwide sales for enterprise wearables will increase exponentially to 66.4 million units by 2021.
Doctors and nurses are using smart eyewear for hands-free access to patients’ medical records. Oil rig workers sport smart helmets to connect with land-based experts, who can view their work remotely and communicate instructions. Warehouse managers are able to capture real-time performance data using a smartwatch to better manage distribution and fulfillment operations. Wearable computing devices improve productivity by delivering information to workers without requiring them to interrupt their tasks, which in turn empowers employees to make more-informed decisions more quickly.
Wearable devices are helping businesses learn more about employees and the everyday workplace than ever before. New insights and information can be uncovered as IoT sensor data is correlated to actual human behavior. Information on task duration and the proximity of one device or employee to another, when combined with demographic data, can shed light on previously unidentified workflow inefficiencies. Technologically sophisticated firms will understand things they never could before about workers and customers; what they do every day, how healthy they are, where they go, and even how well they feel. This obviously has implications for protecting individual privacy, raising potential employee (and customer) fears that businesses are collecting sensitive data about them. Businesses will need to tread carefully.
Global logistics company DHL worked with Ricoh, the imaging and electronics company, and Ubimax, a wearable computing services and solutions company, to implement “vision picking” in its warehouse operations. Location graphics are displayed on smart glasses guiding staffers through the warehouse to both speed the process of finding items and reduce errors. The company says the technology delivered a 25 percent increase in efficiency. Vision picking gives workers locational information about the items they need to retrieve and allows them to automatically scan retrieved items. Future enhancements will enable the system to plot optimal routes through the warehouse, provide pictures of items to be retrieved (a key aid in case an item has been misplaced on the warehouse shelves), and instruct workers on loading carts and pallets more efficiently.
Google has developed Glass Enterprise Edition smar.
Case Study 1 Headaches Neurological system and continue practicing .docxdewhirstichabod
Case Study 1 Headaches: Neurological system and continue practicing documentation of a focused/episodic SOAP note for Assignment
A 20-year-old male complains of experiencing intermittent headaches. The headaches diffuse all over the head, but the greatest intensity and pressure occurs above the eyes and spreads through the nose, cheekbones, and jaw.
Episodic/Focused SOAP Note Template
Patient Information:
Initials, Age, Sex, Race
S.
CC
(chief complaint) a BRIEF statement identifying why the patient is here - in the patient’s own words - for instance, "headache", NOT "bad headache for 3 days”.
HPI
: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form, not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:
Location: head
Onset: 3 days ago
Character: pounding, pressure around the eyes and temples
Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia
Timing: after being on the computer all day at work
Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better
Severity: 7/10 pain scale
Current Medications
: include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products.
Allergies:
include medication, food, and environmental allergies separately (a description of what the allergy is ie angioedema, anaphylaxis, etc. This will help determine a true reaction vs intolerance).
PMHx
: include immunization status (note date of
last tetanus
for all adults), past major illnesses and surgeries. Depending on the CC, more info is sometimes needed
Soc Hx
: include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here - such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.
Fam Hx
: illnesses with possible genetic predisposition, contagious or chronic illnesses. The reason for the death of any deceased first degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.
ROS
: cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows:
General:
Head
:
EENT
: etc. You should list these in bullet format and document the systems in order from head to toe.
Example of Complete ROS:
GENERAL: No weight loss, fever, chills, weakness or fatigue.
HEENT: Eyes: No visu.
CASE STUDY 1 HeadachesA 20-year-old male complains of exper.docxdewhirstichabod
CASE STUDY 1: Headaches
A 20-year-old male complains of experiencing intermittent headaches. The headaches diffuse all over the head, but the greatest intensity and pressure occurs above the eyes and spreads through the nose, cheekbones, and jaw.
Evaluate abnormal neurological symptoms
Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for cognition and the neurologic system
Assess health conditions based on a head-to-toe physical examination
USE THE ATTACHED EPISODIC SOAP NOTE
.
Case Study - Stambovsky v. Ackley and Ellis Realty Supreme C.docxdewhirstichabod
Case Study -
Stambovsky v. Ackley and Ellis Realty
Supreme Court, Appellate Division, State of New York 169 A.D.2d 254 (1991)
he assignment should consist of a Word Document, 2 pages in length double spaced, 12-point font, 1-inch margins not including the title page and reference page. (Short papers will lose significant points!!). All cases will automatically be submitted to Turnitin. Your paper should follow the case format (below) and include a summary of the relevant facts, the law, judicial opinion, etc.
Research the case using the case citation in the Library under databases (select - HeinOnline), FindLaw.com, and other legal sources. Research the parties and circumstances of the case itself.
Utilize the case format found in the Case Analysis Module.
Submit your assignment as a Microsoft Word document.
.
CASE STUDY - THE SOCIAL NETWORKThe growing use of social network.docxdewhirstichabod
CASE STUDY - THE SOCIAL NETWORK
The growing use of social network sites (such as Facebook) and online communities (such as
for instance the Apple Computer community, the community of Harley-Davidson riders,
and the community of Starbucks customers) provides exciting opportunities for
organizations. Online brand communities allow organizations to engage and interact with
customers, obtain market information, sell and advertise products, rapidly disseminate
information, develop long-term relationships with the community, and eventually to
influence consumers’ preferences and behavior (Dholakia and Bagozzi, 2001, Dholakia,
Bagozzi, and Pearo, 2004, Franke and Shah, 2003, Muniz and Schau, 2005, Tedjamulia, Olsen,
Dean, and Albrecht, 2005). “Brand community” is a term that is used to describe likeminded
consumers who identify with a particular brand and share significant traits, such as
for instance “a shared consciousness, rituals, traditions, and a sense of moral responsibility”
(Muniz and O’Guinn, 2001, p. 412). Online brand communities are based on their core value
- the brand- and grow by building relationships with and among members interested in the
brand (Jang et al. 2008).
There are several possible categorizations of online brand communities, but they are
generally grouped into two categories based on who initiates and manages the community;
(1) company-initiated communities, built by the company that owns the brand and (2) userinitiated
communities, voluntarily built by their members (that is, the consumer) (e.g.,
Armstrong and Hagel 1996; Kozinets 1999). These two types of brand communities provide
different opportunities for marketers. For instance, a brand community on a company
website is one of the key determinants of attracting consumers to and retaining customers
on the website (Nysveen and Pedersen, 2004). Consumer-initiated online brand
communities may provide consumers with useful information about other consumers’
experiences with the product or service and the strengths and weaknesses of products or
services (Jang et al. 2008).
The success of online brand communities is heavily dependent on consumer participation in
the online brand community. To determine why consumers participate in online brand
communities business student Jesse Eisenberg has developed a model based on extant
service marketing literature. The main idea in this literature is that perceived value and
satisfaction are antecedents of the intention to use a product or service (Anderson, Fornell,
and Lehmann 1994; Bolton and Drew 1991; Grönroos 1990; Hocutt 1998; Kang, Lee, and Choi
2007; Ravald and Grönroos 1996). Jesse wants to apply this idea to consumer participation in
online brand communities. According to Jesse, “members will probably be satisfied with an
online brand community and have the intention to participate in the community when they
derive value from the community. Therefore it is important to know which values.
Case Study #1 Probation or PrisonWrite a 12 to one page (.docxdewhirstichabod
Case Study #1: Probation or Prison?
Write a 1/2 to one page (150–275 words) response in which you answer the three questions that follow the case study below:
You could have been in the same situation yourself. Instead, it is Mary Lee Smith, one of your probationers, who is about to stand before the judge in a probation revocation hearing.
When you and your husband split 10 years ago, you had two children and eventually had to declare bankruptcy and accept food stamps to be able to pay the rent. After seven years working as a secretary at the nearby state juvenile corrections center, receiving constant encouragement from Mrs. Jones, the superintendent, and taking advantage of a criminal justice scholarship program, you finished a degree in administration of justice and qualified for an entry-level position with the community resources division of the state department of corrections. You advanced as the system grew, and now, three years later, you are a probation supervisor in Judge Longworth's court.
In a way, Mary Lee is as much a victim as she is an offender. Married at seventeen, she quit high school and moved west with her husband who was in the army. By the time she was twenty, she had two children and was divorced. With babysitters to pay and skills that would command no more than minimum wage, Mary Lee turned to such income supplements as shoplifting, bad check writing, and occasionally prostitution. Her check-passing skills developed rapidly, and it was not long before she had amassed a series of convictions, not to mention several lesser offenses for petty larceny that were disposed of by the prosecutor's declaration of
nolle prosequi
. To date, Mary Lee has not served a day in prison. Judge Longworth has used admonition, restitution, suspended sentence, and probation to rehabilitate Mary Lee. However, Mary Lee's criminal conduct has persisted, as has her inability to stretch her food stamps, welfare payments, and part-time minimum-wage employment into a satisfactory existence for herself and her children. To complicate the matter, the welfare safety net that had helped keep Mary Lee and her children afloat would cease to exist for her within 24 months.
Judge Longworth has called you into his chambers before the hearing. He read your violation report with interest. You pointed out Mary Lee's family obligations and the imminent possibility that the children would have to be placed in foster homes if she were confined. You also pointed out that she has been faithful in making restitution and that she maintains a steady church relationship and a good home environment for her children. Although your report is fair and accurate, you realize that the judge has sensed your misgivings and uncertainty concerning Mary Lee.
Judge Longworth looks up from your report and comes directly to the point. "Do you really believe this woman deserves to go back into the community? You certainly seem to have found some redeeming features in her cond.
Case Studies of Data Warehousing FailuresFour studies of data .docxdewhirstichabod
Case Studies of Data Warehousing Failures
Four studies of data warehousing failures are presented. They were written based on interviews with people who were associated with the projects. The extent of the failure varies with the organization, but in all cases, the project was at least a disappointment.
Read the cases and prepare a report that provides a substantive discussion on each of the following:
1. What’s the scope of what can be considered a data warehousing failure?
2. What do you find most interesting in the failure stories?
3. Do they provide any insights about how a failure might be avoided?
Your discussion should be at least 2 pages in length with 1.5” spacing & 1” margins.
Case Study 1: Auto Guys
Auto Guys initiated a data warehousing project four years ago but it never achieved full usage. After initial support for the project eroded, management revisited their motives for the warehouse and decided to restart the project with a few changes. One reason for the restructuring, according to the project manager, was the complexity of the model initially employed by Auto Guys.
At first, the planner for the data warehouse wanted to use a dimensional model for tabular information. But political pressure forced the system’s early use. Consequently, mainframe data was largely replicated and these tables did not work well with the managed query environment tools that were acquired. The number of tables and joins, and subsequent catalog growth, prevented Auto Guys from using data as it was intended in a concise and coherent business format.
The project manager also indicated that the larger the data warehouse, the greater the need for high-level management support – something Auto Guys lacked on their first attempt at setting up the warehouse. Another problem mentioned by the project manager was that the technology Auto Guys chose for the project was relatively new at the time, so it was not accepted and did not garner the confidence that a project using proven technology would have received. This is a risk inherent in any “cutting edge” technology adoption. The initial abandonment of the project was undoubtedly hastened by both corporate discomfort with this new technology and the lack of top management support.
A short time after dropping the project, top management felt pressure to reestablish it. Because Auto Guys initially planned an enterprise-wide warehouse, they had considerable computer capacity. It was put to use on a much smaller project that focused exclusively on a single subject area. Other subject areas were due to be added once the initial subject area project was completed. Auto Guys expects to grow the warehouse to two terebytes within a year or two and eventually expand to their projected enterprise-wide data warehouse. The biggest difference between pre- and post-resurrection will be that the project will evolve incrementally.
Given his experience with the warehouse, the project manager made the following summary .
Case Studies GuidelinesWhat is a Case StudyCase studies.docxdewhirstichabod
Case Studies Guidelines
What is a Case Study:
Case studies are stories. They are formatted in such a way that at a glance one could easily determine the “issue” about to be discussed. We look to clearly address the who, what, where, when, why and how to ensure that we have covered the story in its entirety. If you miss one of these factors, you leave the reader guessing and questioning your report. In public policy & administration our case studies/stories are required to be fact based. Make sure your research is based on credible information. Verify, verify, verify. Make a mistake and/or be challenged on one of your “facts”, could create a host of issues. If you are found to be incorrect, the entire report is incorrect and your credibility is suspect. Cite your research appropriately.
We call it an issue rather than a “problem” because a problem presents a negative image/connotation. Issues are not necessarily negative and provides the policy analyst with an opportunity to evaluate each issue based on its own merits without taking a position of negative or positive.
What Does a Case Study Look Like:
A case study should set up similar to story-telling.
Do not write this as you would a thesis.
You don’t want to put in a lot of “fluff & stuff”. Think of the reader as a high level administrator whose in-box is full of documents that require review. To catch this administrator’s attention, consider what he/she would be concerned with. The “issue” clearly delineated, then the people involved “stakeholders”, the positions (where one stands depends upon where one sits), of these people/perspectives” of the stakeholders and then a fact based well thought out “recommendation”. Use the first paragraph or two to set the tone for the issue under consideration. Once you have the reader’s attention then you are prepared to move onto your 4-step policy analyses.
Why a 4-Step Policy Analysis:
We use the four-step policy analysis because of its simplicity and its thoroughness. There are plenty of other models, some with seven-steps and others with ten-steps. It is not the number of steps that makes a case study. It is the report itself that stands on merit.
Do not change the language of the 4-steps or add other language, as new headings could change the report and its intent. It is vital that you understand this foundation as it will be used throughout your baccalaureate curriculum. Learning to use this in both your professional and personal lives will help you with your decision making in a variety of ways.
How Do I Begin:
Case studies are complex and may contain a myriad of issues, stakeholders, etc. It is your job to select one issue and then to stay on course as you work through your critical thinking and 4-step policy analysis. Do not say there are “many” issues as this may confuse the reader of leave him/her questioning why you chose one issue over another. Chose one….
How Should the Final Case Study Paper Set Up:
Use APA format when c.
Case Project 8-2 Detecting Unauthorized ApplicationsIn conducti.docxdewhirstichabod
Case Project 8-2: Detecting Unauthorized Applications
In conducting a review of the Oss running on the Alexander Rocco network, you detect a program that appears to be unauthorized. No one in the department knows how this program got on the Linux computer. The department manager thinks the program was installed before his start date three years ago. When you review the program’s source code, you discover that it contains a buffer overflow vulnerability. Based on this information, write a report to the IT manager stating what course of action should be taken and listing recommendations for management.
Your essay should be a minimum of 350 words and include the steps you took to discover file.
Use reference:
Simpson, M. T., Backman, K., & Corley, J. (2011).
Hands-on ethical hacking and network defense
. Cengage Learning.
Add any other recent references
.
Case Number 7Student’s NameInstitution Affiliation.docxdewhirstichabod
Case Number 7
Student’s Name
Institution Affiliation
Case Number 7. The case of physician do not heal thyself
Questions
1. Have you recently engaged in risky behaviors such as binge eating, unsafe sex, gambling, drug and substance abuse, or risky driving?
1. How would you describe your relationships with people such as your spouse, friends, neighbors, colleagues, and strangers while considering aspects of anger, irritability, and violence?
1. Do you have a recurring problem of variant moods that result to interpersonal stress, feeling of emptiness, and other challenges that are stress-related and they push you towards suicidal thoughts?
People to speak to
It is crucial to identify the right people to provide essential details for the assessment of the patient. Some of the most important people include the spouses, siblings, family friends, personal friends, and neighbors. Furthermore, the patient’s colleagues can provide important information regarding the behaviors of the patient and help in identifying issues that the patient could be hiding. Speaking to the people to whom the patient exercises authority is important in attaining the true image of the person.
Physical exam and diagnostic test
The disorder is mental, but it can be assessed through physical exams that indicate how the brain is working in relation to actions ( Stahl 2013). Fixing a puzzle would be an effective way of testing the patient and how stable they can be. The other approach is engaging the patient in a physical exercise and observing their participation. Physical exams provide a diagnostic insight to test how the patient relates with others.
Diagnoses
Personality Disorder
Mood Disorder
Depression with psychotic features
Pharmacological agents
Application of antidepressants
Use of antipsychotics
Administering mood-stabilizing drugs
Contradictions or Alterations
It is a complex situation to treat a complex and long-term unstable disorder of mood because the patients experience different emotions even during therapy (Yasuda & Huang 2008). It becomes difficult to separate mood disorder from personality disorder especially for difficult patient like in this case. Furthermore, there are no specific drugs that can be used for treatment without additional therapy since this patient is able to adjust or play with their own treatment as a physician. The mental condition observed in the patient requires a careful approach due to the delicate situations involving suicidal thoughts and aggression.
Lessons Learned
In the case study “The case of physician do not heal thyself,” the lessons include the importance of conducting a complete assessment of the patient and including other people who interact with the patient. It would be more effective to treat such conditions if the patients had stable emotions, but strategic approaches can help to streamline the treatment process ( Stahl 2014b).
References
Stahl, S. M. (2013). Stahl’s essential psychopharmacol.
Case number #10 OVERVIEWAbstract In this case, a local chapt.docxdewhirstichabod
Case number #10
OVERVIEW
Abstract In this case, a local chapter of a national nonprofit organization continuously struggles with funding and must, therefore, be proactive in seeking out additional revenue sources. The local coordinator encounters a situation involving a potential donor that forces her to weigh the pros and cons of breaking the rules and the best way to communicate her concerns to her superiors and the donor. A chance meeting on a flight leads to a potential conflict-of-interest situation for the local coordinator.
Main Topics Decision making, Ethics
Secondary Topic Communication, Intergovernmental affairs*
Teaching Purpose To discuss the complexities involved in balancing personal and organizational responsibilities within the framework of a nonprofit organization.
The Organization ReadNow is a nonprofit program that promotes early literacy by giving new books to children and advice to parents about the importance of reading aloud in pediatric exam rooms across the nation.
* Main Characters: • Michael Vaughn, Executive Vice President of Johnson Hospital • Dr. Lea Nelson, Head of National ReadNow • Patricia Clay, Local ReadNow Coordinator • Molly Carter, Tillingast Foundation employee • Dr. Katie Nelson, ReadNow Local Director
BACKGROUND
In 1962, a group of doctors at a hospital in Phoenix, Arizona, were brain-storming ways to increase early childhood literacy and parent– parent– child interactions among their patients. One doctor had the idea of distributing children's books to their patients during checkups, accompanied by advice to the parents about the importance of reading aloud to their children. From this modest beginning, ReadNow developed into a national, nonprofit organization that distributes books and early literacy guidance to more than 2.5 million children and their families. ReadNow has offices all over the United States and is currently supported in part through a grant from the U.S. Department of Education. ReadNow opened a branch in Crown City, Michigan, in August with a partnership between the National ReadNow and the Johnson Children's Medical Center. One of the founders, Dr. Mark Jeffries, still active within ReadNow, approached Dr. Katie Nelson, a pediatrician at Johnson Hospital with the opportunity to bring ReadNow to Crown City. Dr. Nelson soon had more than thirty pediatric clinics participating in the program and hired a coordinator, Patricia Clay, to manage the day-to-day operations of the Crown City chapter.
As a result of its affiliation with the Johnson Children's Medical Center, ReadNow was fortunate to have its rent, computers, telephones, and office supplies provided by the hospital. Johnson Children's Medical Center agreed to support the office environment of ReadNow, as well as to guarantee the coordinator a stipend of $ 50,000 each year. However, part of Patricia Clay's duties included raising funds to purchase books to distribute in clinics across the metropolitan area and t.
Case GE’s Two-Decade Transformation Jack Welch’s Leadership.docxdewhirstichabod
Case: GE’s Two-Decade Transformation: Jack Welch’s Leadership
Thoroughly: -Identifies core problem of the case with applicable rationale and evidence. -Discusses the severity of the core problem. Provides supporting rationale. -Discusses implications of the core problem. How and to what extent may the core problem affect the stakeholders/those being led? Provides supporting rationale.
.
CASE BRIEF 7.2 Tiffany and Company v. Andrew 2012 W.docxdewhirstichabod
CASE BRIEF 7.2
Tiffany and Company v. Andrew
2012 WL 5451259 (S.D.N.Y.)
FACTS: Tiffany (plaintiffs) allege that Andrew and others (defendants) sold counterfeit Tiffany
products through several websites hosted in the United States. Andrew accepted payment in U.S.
dollars, used PayPal, Inc. to process customers' credit card transactions, then transferred the sales
proceeds to accounts held by the Bank of China (“BOC”), Industrial and Commercial Bank of
China (“ICBC”), and China Merchants Bank (“CMB”) (“Banks”).
Andrew defaulted on the suit, and Tiffany sought discovery from the Banks by serving subpoenas
seeking the identities of the holders of the accounts into which the proceeds of the counterfeit sales
were transferred and the subsequent disposition of those proceeds. The Banks involved all
maintained branch offices in the Southern District of New York, and the subpoenas were served
on those branch offices.
The Banks responded to the subpoenas by explaining that the information sought was all
maintained in China and that the New York branches of the Banks lacked the ability to access the
requested information. China's internal laws prohibited the disclosure of the information except
under certain conditions. The Banks proposed that the plaintiffs pursue the requested discovery
pursuant to the Hague Convention.
The court concluded that Tiffany should pursue discovery through the Hague Convention. Tiffany
submitted its Hague Convention application to China's Central Authority in November 2010, and
on August 7, 2011, the Ministry of Justice of the People's Republic of China (“MOJ”) responded
by producing some of the documents requested. For each of the Banks, the MOJ produced account
opening documents (including the government identification card of the account holder), written
confirmation of certain transfers into the accounts and a list of transfers out of the accounts. With
respect to CMB, the records indicate that all funds in the account were withdrawn through cash
transactions at either an ATM or through a teller. BOC and CMB each produced documents
concerning a single account; ICBC produced documents for three accounts.
In its cover letter, the MOJ noted that it was not producing all documents requested. Specifically,
the letter stated, “Concerning your request for taking of evidence for the Tiffany case, the Chinese
competent authority holds that some evidence required lacks direct and close connections with the
litigation. As the Chinese government has declared at its accession to the Hague Evidence
Convention that for the request issued for the purpose of the pre-trial discovery of documents only
the request for obtaining discovery of the documents clearly enumerated in the Letters of Request
and of direct and close connection with the subject matter of the litigation will be executed, the
Chinese competent authority has partly executed the requests which it d.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Carolyn BWeek 7 Discussion 1 Peer ReviewMy Abstract The lea.docx
1. Carolyn B
Week 7 Discussion 1 "Peer Review"
My Abstract: The leadership position has been in development
for centuries for the purpose of shaping and molding others in
hopes that they will perform through the examples that a leader
portrait. While the effective and ineffectiveness of leadership
has been researched there is not a specific time listed as to the
history of it, but it “has been going on for quite some time.”
There is no specific date as to when ineffective leadership
started, but the traits were characterized and based on the traits
that were different from an effective leadership.
Reproduced with permission of the copyright owner. Further
reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further
reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further
reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further
reproduction prohibited without permission.
2. The History OF HOSPITALS AND WARDS
Gormley, Tom
Healthcare Design; Mar 2010; 10, 3; ProQuest Central
pg. 50
Reproduced with permission of the copyright owner. Further
reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further
reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further
reproduction prohibited without permission.
Do No Harm: Adaptive reuse in healthcare construction
Oliver, Scot. The Idaho Business Review; Boise (Oct 17, 2016)
Buildings that are designed and built well can be valuable long
after their original intended use is over. More than just a
collection of wood, stone, steel and glass, a good building has
an intention of exceeding a basic utilitarian purpose. It aspires
to make a design statement, to be of service, to be an active
participant in the community. Good buildings exhibit a lot of
pride--in the developer's mission, or business, or himself. This
extends to the pride of design and craftsmanship that makes a
building valuable long after the source of the pride is gone.
Some of our favorite buildings have been adapted from other
uses.
The old Ada County Courthouse, once slated for demolition,
housed the state Legislature for a few years and now serves
3. magnificently as the Idaho Law Center. Railroad warehouses
became the cool, eclectic shops and offices in 8th Street
Marketplace, and attracted the BoDo development around it.
Old hotels got new life as office, residential and retail
uses in the Owyhee, Hoff and Idanha buildings. Downtown
department stores have been converted, like the Alaska Building
offices and Athlos Academy's headquarters. The office where I
write this was an opera house in the late 19th century; three
blocks away a warehouse from that era now houses the opera.
Even some older industrial buildings were built to last. Often,
these buildings don't survive redevelopment, but their high-
quality construction and design can lead to interesting reuse--
local examples from the early 1900s include the Biomark
office/manufacturing building, built as a coal-gasification plant;
the Linen Building and Powerhouse event centers; and the
Armory, undergoing rehabilitation for a new use.
Increasingly, however, commercial and industrial buildings are
victims of the national trend toward disposability and quick
profit. There's a sameness in design, and construction methods
and materials are quick and cheap. The owners expect a
relatively short business life in that location and build
accordingly. There's no motivation to think about the
neighborhood context and how the building will fit in it over
time. Owners of big-box stores or factories don't live in the
neighborhood and usually don't have the sense of pride or long-
term vision to create lasting buildings that enrich their context.
Health care is a rapidly growing industry that needs new
facilities as it grows. The single largest private
employer in Idaho is the St. Luke's Health System; three of
Idaho's 10 largest private employers are healthcare systems.
Nationally, healthcare workers are projected to be the largest
workforce by 2020.
Yet the way health care is delivered is constantly changing. Not
that long ago, healthcare delivery often meant doctors making
house calls. This was followed by a rapid increase in hospital
treatment, with a corresponding proliferation of large auto-
4. oriented factory-like hospitals. Trends are shifting again.
Patients, payers and the courts are deciding that too much
growth and consolidation in the healthcare industry is not
healthy. Today, U.S. hospitals have one million beds with an
average daily occupancy rate of 70 percent, a decline of nearly
39 percent since the 1980s. Inpatient use declined by 16.1
percent from 1999 to 2012. This is due in part to the push by
payers for evidence-based outcomes rather than more
procedures and hospitalization. Demand is changing, too, as
people look for care in ambulatory centers in their communities,
or opt for direct care in their homes. Home healthcare jobs are
the nation's fastest growing sector, expected to increase 70
percent between 2010 and 2020.
Facility design is changing as well. Patients and their families
are showing a preference for care in small, friendly, personal
spaces with access to daylight and the outdoors. This mirrors
their residential and business preferences: places that are
walkable and have a lively mix of uses. As patients develop a
more retail-oriented approach to healthcare choices, providers
are adaptively reusing retail and commercial spaces to be closer
to the market. There are many instances of large systems like
St. Luke's and Saint Alphonsus as well as smaller "docs-in-a-
box" taking advantage of this trend.
Kaiser Permanente, one of the nation's
largest healthcare systems, has been promoting green, smart-
growth healthcare facility design for years. Recently they held
the international Small Hospital, Big Ideas design competition
to encourage new thinking about hospitals that provide patient-
centered healing with a small environmental footprint and also
reduce costs and improve community health. The winning
concepts propose places that inspire human connection and
collaboration, blur the boundaries between the community and
the traditional hospital setting, provide direct access to daylight
and nature and go beyond carbon neutrality to restore
ecosystems and biodiversity.
We can't predict what's next in healthcare demand and delivery,
5. but we can expect the trend away from large centralized
facilities to continue. Healthcare providers will be challenged to
repurpose outdated buildings; if they fail the community
ultimately will be left with the task. If we're lucky, we'll have
good designs to work with. One excellent example is Fort Boise,
the first large development in the area. Fort Boise
started in 1863 as a U.S. Army cavalry fort and operated for
many years before it was adaptively repurposed as
a healthcare complex for the Veterans Administration. It's a
great example of how good design and construction can be a
lasting community asset.
Scot Oliver is executive director of Idaho Smart Growth, a
statewide nonprofit that promotes community choices in land
use, transportation and community development issues.
(c) 2016 Dolan Media Newswires. All Rights Reserved.
Credit: Scot Oliver
Word count: 917
(Copyright 2016 Dolan Media Newswires. All Rights Reserved)
Do No Harm: Adaptive reuse in healthcare
construction
Oliver, Scot
.
The Idaho Business Review
; Boise
(Oct 17, 2016)
Buildings that are designed and built well can be valuable long
after their original intended use
is
over. More than just a collection of wood, stone, steel and
6. glass, a good building has an intention
of exceeding a basic utilitarian purpose. It aspires to make a
design statement, to be of service, to
be an active participant
in
the community. Good bui
ldings exhibit a lot of pride
--
in
the
developer's mission, or business, or himself. This extends to the
pride of design and
craftsmanship that makes a building valuable long after the
source of the pride is gone.
Some of our favorite buildings have been ad
apted from other uses.
The old Ada County Courthouse, once slated for demolition,
housed the state Legislature for a
few years and now serves magnificently as the Idaho Law
Center. Railroad warehouses became
the cool, eclectic shops and offices
in
8th Stre
et Marketplace, and attracted the BoDo
development around it. Old hotels got new life as office,
residential and retail uses
in
7. the
Owyhee, Hoff and Idanha buildings. Downtown department
stores have been converted, like the
Alaska Building offices and Athl
os Academy's headquarters. The office where I write this was
an opera house
in
the late 19th century; three blocks away a warehouse from that
era now houses
the opera.
Even some older industrial buildings were built to last. Often,
these buildings don't su
rvive
redevelopment, but their high
-
quality
construction
and design can lead to interesting
reuse
--
local
examples from the early 1900s include the Biomark
office/manufacturing building, built as a
coal
-
gasification plant; the Linen Building and Powerhouse event
centers; and the Armory,
undergoing rehabilitation for a new use.
Increasingly, however, co
8. mmercial and industrial buildings are victims of the national
trend
toward disposability and quick profit. There's a sameness
in
design, and
construction
methods
and materials are quick and cheap. The owners expect a
relatively short business life
in
that
location and build accordingly. There's
no
motivation to think about the neighborhood context
and how the building will fit
in
it over time. Owners of big
-
box stores or factories don't
live
in
the neighborhood and usually don't have the sense of pride or l
ong
-
9. term vision to create
lasting buildings that enrich their context.
Do No Harm: Adaptive reuse in healthcare
construction
Oliver, Scot. The Idaho Business Review; Boise (Oct 17, 2016)
Buildings that are designed and built well can be valuable long
after their original intended use is
over. More than just a collection of wood, stone, steel and
glass, a good building has an intention
of exceeding a basic utilitarian purpose. It aspires to make a
design statement, to be of service, to
be an active participant in the community. Good buildings
exhibit a lot of pride--in the
developer's mission, or business, or himself. This extends to the
pride of design and
craftsmanship that makes a building valuable long after the
source of the pride is gone.
Some of our favorite buildings have been adapted from other
uses.
The old Ada County Courthouse, once slated for demolition,
housed the state Legislature for a
few years and now serves magnificently as the Idaho Law
Center. Railroad warehouses became
the cool, eclectic shops and offices in 8th Street Marketplace,
and attracted the BoDo
development around it. Old hotels got new life as office,
residential and retail uses in the
Owyhee, Hoff and Idanha buildings. Downtown department
stores have been converted, like the
Alaska Building offices and Athlos Academy's headquarters.
The office where I write this was
an opera house in the late 19th century; three blocks away a
warehouse from that era now houses
the opera.
10. Even some older industrial buildings were built to last. Often,
these buildings don't survive
redevelopment, but their high-quality construction and design
can lead to interesting reuse--local
examples from the early 1900s include the Biomark
office/manufacturing building, built as a
coal-gasification plant; the Linen Building and Powerhouse
event centers; and the Armory,
undergoing rehabilitation for a new use.
Increasingly, however, commercial and industrial buildings are
victims of the national trend
toward disposability and quick profit. There's a sameness in
design, and construction methods
and materials are quick and cheap. The owners expect a
relatively short business life in that
location and build accordingly. There's no motivation to think
about the neighborhood context
and how the building will fit in it over time. Owners of big-box
stores or factories don't
live in the neighborhood and usually don't have the sense of
pride or long-term vision to create
lasting buildings that enrich their context.
Chenee W
Abstract
Technology changed the way the industry professionals
approach healthcare. Despite the positivity that exists with
technology adoption in the healthcare industry, when a new
technology emerges, there are persons who adopt from the onset
and even earlier, while there are those who adopt in the late
majority and those that resist change. The reasons for the
different technology adoption rates among the professionals are
related to costs, mistrust in new technology and some prefers
the traditional way of doing things (Unknown 2018). With these
concerns comes challenges that need to be recognized and
11. avoided in order to facilitate quality and effective patient care
and treatment. Chapter 1 of this Capstone Project will analyze
the specific problems in technology adoption that needs to be
addressed, how the challenges may affect patient outcomes, the
problem’s history to include when it appeared, who it affects
and the current scope of the problem. The issue of the
Coronavirus pandemic and its role in redefining healthcare will
be briefly address. All information will be based on publicly
available healthcare data and other open data resources.
Reference
Unknown (2018). Technology in healthcare: Adoption,
challenges and progress. GHX. Retrieved
from https://www.ghx.com/the-healthcare-
hub/2018/technology-in-healthcare-adoption-challenges-and-
progress/
Healthcare Administration Capstone – Week #7 Lecture 1
Submission of Abstract and Revisions/Additions
Almost finished! In this week (no later than Thursday – Day 2),
you will submit the abstract you wrote last week to the Week 7
discussion forum for peer review and feedback. Before most
articles are published, they undergo a peer review similar to
what you will be doing. This step is completed because it is
easy to become so engaged in your project that you fail to see
the proverbial forest for the trees. As you read the abstracts of
your fellow students, ask yourself what holes may exist in the
plan. Odds are that they are more than likely addressed,
however, a fresh set of eyes can make a world of difference.
Another reason to read the work of others is that it provides a
great break from your own research project. Returning to your
own work may reveal some errors that were simply not caught
beforehand. As you reread your own material, be sure to review
it from a “says who?” perspective. As a reminder, anytime that
12. you move beyond what is referred to as “common knowledge”
you will need a citation.
What is “common knowledge”? For practical purposes, it is the
information and knowledge that one would expect the average
8th grader to have acquired. As an example, most everyone
knows that the sun is a star. However, not too many individuals
know that the sun is classified as a G2V star or yellow dwarf.
Such information would indeed require a citation. Additionally,
anytime that you use statistics you will need to support this
with a citation. As an example, if you mentioned that the sun is
93 million miles from the earth, you will need to provide your
source.
A word of caution is in order. Due to the number of healthcare
related courses that you have taken, you may find yourself very
comfortable with the healthcare related jargon. However,
remember that you are reading this from a “says who?”
perspective. The average 8th grader will more than likely not be
familiar with some of the terms and concepts; thus requiring
citations.
Your instructor and your peers will provide you with great
feedback. If you have any questions about any of the feedback
received, ask. Lastly, Microsoft Word provides excellent tools
to assist with editing and polishing your project. Be sure to use
the Spelling and Grammar tool frequently. Also, it is highly
recommended that you utilize the Readability Statistics.
Unfortunately, it is not normally enabled. To enable this
feature, while in Microsoft Word, follow these instructions:
· Click on the File tab
· Click on “Options”
· Click “Proofing”
· Under “When correcting spelling and grammar in Word”,
make sure the “Check grammar with spelling” check box is
selected.
· Select “Show readability statistics”
· Re-run the Spelling and Grammar tool
At the conclusion of the Spelling and Grammar tool, your
13. project’s “counts”, “averages”, and “readability” will be
displayed. A Master’s level Capstone Project should rate in the
“collegiate” level. The following table will help you decipher
readability:
Scores between 90 and 100 are easily understood by a 5th
grader. Scores between 60 and 70 are understood by an 8th
grader, and those scores below 30 are understood by a college
graduate. It is recommended that your score not exceed 55. The
following website can assist you in better understanding
the Flesch reading ease:
http://www.readabilityformulas.com/flesch-reading-ease-
readability-formula.php
As always, if you have any questions, please be sure to post
them in the “Project Questions” discussion forum.
The following resource is available to assist you in
proofreading:
https://owl.english.purdue.edu/owl/resource/561/01/
*Reminder: You will need to submit your Abstract to the
discussion forum no later than Day 2 (Thursday) to ensure that
your peers will have plenty of opportunity to review and reply.
CHAPTER 13
Improving Performance and Controlling the Critical Cycle
CHAPTER OBJECTIVES
• Define the management functions of quality improvement and
controlling.
• Introduce the concept of the search for excellence and
examine its relationship to the function of controlling.
• Relate controlling to directing in an essential cycle that
affords ongoing attention to follow-up and correction.
• Introduce the concept of benchmarking and describe its place
in the management process.
• Describe selected techniques for improving quality.
• Enumerate the essential characteristics of adequate controls,
14. and introduce some commonly used tools of control.
QUALITY, EXCELLENCE, AND CONTINUOUS
PERFORMANCE IMPROVEMENT
Headlines and key phrases that reflect a deeper organizational
commitment to quality include the following:
• Committed to Excellence
• Your Safety Comes First
• The 30-Minutes-or-Less ER Service Pledge
• Memorial Nursing Care Facility Granted 5-Star Rating
These are a sign of the continuing search for excellence and the
striving for perfection, creating a climate of continuous
improvement. Also, these phrases and similar ones reflect the
overall theme of performance improvement initiatives
associated with the management functions of quality
improvement and controlling. The search for excellence flows
from the healthcare organization’s fundamental vision and
purpose: the timely and thorough care of the patient. Its values
of stewardship and integrity further infuse the organization with
energy directed toward continuous quality improvement (CQI).
Effective managers engage in this pervasive process of
continuous performance improvement.
What other factors occasion the emphasis on quality? There are
several—some positive, some challenging. The fundamental
commitment to excellence includes full compliance with the
applicable laws, regulations, and standards. Thus, any area with
less-than-full compliance receives review and corrective action
to achieve that basic goal. The response to major legislation or
regulation (e.g., Health Insurance Portability and Accountability
Act [HIPAA], Affordable Care Act, electronic health record
[EHR] mandates, Recovery Audit Contractor [RAC] programs,
Program Effectiveness Review) brings renewed attention to the
systems and functions affected by these mandates. When
management chooses to make a major systems change (e.g.,
complete automation of information system, adoption of
advanced technology), new concerns arise; in these examples,
the related issues of identity theft, date security, and
15. antihacking measures become the focus of quality review.
During any major changeover in a system (e.g., migration from
hard copy to EHRs; a shift from one coding system to a newly
required one), the manager must attend to the issues associated
with phasing out legacy systems.
Topics relating to patient care studies reflect new concerns and
therefore special studies about these topics. By way of example,
note the increased attention paid to sports-related injuries (e.g.,
concussions, hand or knee injuries) in professional and high
school athletes. Another aspect of quality improvement studies
relating to patient care is reflected in the emphasis on outcomes
and predictive analysis. Or an external event (e.g., a
superstorm, a pandemic) might result in a review of the disaster
response findings: what went well; what needs upgrading?
Finally, negative publicity about a particular issue (e.g., rising
infection rate, a scandal arising from employee behavior, an
accident resulting in improper disposal of medical records) may
require the management team to prepare a proactive response,
including a renewed commitment to quality.
Just as there is negative publicity from time to time, there is
also the opportunity for sharing positive accomplishments with
the internal and external communities. For example, public
relations releases feature the achievement of a five-star rating,
the (n) number of days without accidents, excellence awards by
specialty groups for certain diagnostic categories (e.g., cancer,
stroke, neonatal care), peer-reviewed score for hospital safety,
and ranking in top 25 hospitals nationally in supply-chain
management. All of these issues reflect managers’ concerns
about maintaining quality in every aspect of organizational life.
This continuing search for excellence has a long and varied
history. A review of this history provides managers with a
framework within which to consider effective approaches to
CQI.
THE SEARCH FOR EXCELLENCE: A LONG AND VARIED
HISTORY
Emerging with a vengeance in the late 1980s, quality became
16. the most fashionable business term of the 1990s, just as the
term excellence had dominated much of the 1980s. The total
quality management (TQM) movement and the earlier
excellence movement had somewhat different origins, but so far
the results of the quality movement have been much the same as
the visible results of the excellence movement, although more
widespread. In each instance, a basically sound, well-
intentioned philosophy has been adopted, promoted, and
implemented with extremely mixed results.
Many of the organizations that attempted to adopt dedication to
excellence as a guiding philosophy ran into the same problem
that has stymied many otherwise effective organizations: how to
instill a philosophy in people so that it will cause them to
behave in the desired manner.
Between the philosophy, which may initially be accepted by a
few members of top management, and the actual practice, which
involves many employees living out the philosophy, lies a
matter of process. There has to be some process available to
successfully transfer the philosophy from the few to the many.
A great many people never see past the process and are thus
unable to truly adopt the philosophy. They simply go through
the motions, appearing to do what they perceive top
management wants them to do. Invariably, when a philosophy is
proceduralized—that is, when a process is superimposed on
something as ethereal as a concept, idea, or belief—something
essential is lost. Those who simply adopt the process as part of
the job without buying into the philosophy will not truly reflect
the philosophy in their behavior.
When a philosophy of management is overproceduralized,
overpromoted, overpublicized, and overpraised, it becomes a
fad. It becomes fashionable for its own sake. It was in this
manner that excellence essentially went down the same path
traveled years earlier by management by objectives. We have
reason to wonder, therefore, whether the quality movement will
prevail or devolve into just another fad, the current “flavor of
the month” destined to go the way of management by
17. objectives, quality circles, excellence, and others.
Quality Control, Quality Assurance, and Quality Management
For years, many of the manufacturing and service industries had
what was referred to as quality control. Quality control
ordinarily concentrated on finding defects, rejecting defective
products, and providing information with which to alter
processes so they would produce fewer defects.
Healthcare organizations had what they called quality
assurance. It consisted largely of record scrutiny during which
errors consisting of departures from some dictated standard
were counted, providing information that subsequently directed
which steps would be taken to reduce the frequency of
recurrence of the same kinds of errors.
In addition to correcting the processes that produced the errors,
both quality control and quality assurance were often
responsible for instituting more frequent quality checkpoints so
that errors might be caught earlier. The most important
similarity between quality control and quality assurance,
however, was that both focused primarily on finding errors after
the fact. Both were, and yet remain, retrospective processes.
During the 1980s, using philosophical grounding and methods
exported from the United States to Japan decades earlier and
later brought back as “new, revolutionary management
techniques,” the emphasis on quality began to shift from
catching errors before they went out the door to avoiding errors
in the first place. Thus we have the basis of the quality
movement embodied today in labels such as TQM, CQI,
and performance improvement initiatives.
Old Friends in New Clothes?
Many of the tools and techniques included under the
performance improvement umbrella should look familiar to
some people who have been in the workforce for a few years.
Many of the “current” tools and techniques have been around
for a considerable amount of time—some for decades. They
have been resurrected, revitalized (especially through computer
technology), and in some instances renamed. For example, a
18. number of TQM-implementation case histories mention the
acronym TOPS, standing for team-oriented problem solving. As
the name suggests, workers who have concerns with various
aspects of particular problems approach problem solving as a
team, with a common goal and purpose. These problem-solving
teams espoused under TQM look, sound, and function the same
as quality circles promoted during the brief popularity of
“Japanese management.”
Also essentially renaming quality circles are other TOPS look-
alikes such as self-directed work teams and team-oriented
process improvement. These particular labels are but two of
several similar designations that have emerged as representing a
significant part of the path to CQI.
Quality circles were themselves nothing new when they were so
named. In years past, many work organizations used what they
called work simplification project teams, in function and intent
essentially identical to quality circles and the problem-solving
teams of TQM. Written about in the 1950s and earlier, work
simplification teams found their way into hospital methods
improvement work as early as 1956.1
Even many of the specific tools used by today’s performance
improvement problem solvers go back 50, 60, or as far as 70
years. Industrial engineering techniques already existing for
decades scored a number of modest, if not long-lasting,
successes when implemented in hospitals from the second half
of the 1960s to the mid-1970s. Renamed management
engineering—probably because of a general aversion in health
care to anything perceived as “industrial”—they have
nevertheless fallen short of their potential value in health care.
Yet, there is a return to these practices (process flow, control
charts, and cause-and-effect diagrams, for instance) as part of
today’s performance improvement programs.
The Common Driving Force
Regardless of how many previously popular techniques are
returned to the spotlight or how many genuinely new features
are added, there remains one ingredient that is fully as essential
19. to performance improvement as it has been to any other
approach by any other name. That crucial ingredient is top
management commitment. Its importance should come as no
surprise. Top management commitment to new ideas and
approaches has been a prerequisite to complete success for as
long as organized enterprise has existed. Without sufficient top
management commitment, most organized endeavors are
destined to, at best, generate results that fall short of intentions,
or, at worst, fail altogether and cause harmful results or leave
residual damage.
One cannot imagine any rational top manager openly avowing
opposition to the principles of quality improvement. Ask any
top manager whose organization has espoused performance
improvement or TQM initiatives if he or she is truly committed
to it—or, for that matter, ask any top manager at all if quality,
period, is a personal commitment; surely each will state
unwavering commitment. We know that many such endeavors
fail because of insufficient top management commitment, but
because almost all managers will voice commitment there is but
one conclusion to be drawn: top management commitment is a
matter of degree, and the degree of commitment is critical.
None of today’s total quality programs will work as intended
unless top management is actually involved and actively
promoting the concept. Superficial commitment at the top
results in similarly weak commitment at lower organizational
levels. Beware of skyrocket commitment of the top manager
who gets all fired up over performance improvement initiatives;
distributes information to everyone; creates a steering
committee, advisory committee, or other body; and chairs the
first meeting or two or three—but then starts missing meetings
because of “pressing business” and soon transfers the guiding
role to subordinates.
A total quality program also will not work if managers,
especially first-line supervisors, will not let go and truly
delegate to employees. This means not simply giving employees
the responsibility for doing different tasks or determining more
20. efficient methods; it means also giving them the authority to
make the decisions to implement their own findings.
Furthermore, letting go means accepting what employees decide
and living with it.
Letting go as just described is difficult for the majority of
managers. A great many managers, far more than would be able
to see it in themselves, possess a recognizable streak of
authoritarianism. On reflection, the reasons for a fairly strong
presence of residual authoritarianism are understandable.
Modern management—true, open participative management—is
a phenomenon of the past two or three decades. Although the
spread of participative management has been steady, it has
also been gradual; there remain many areas of organized
activity in which employees have yet to experience any
management style other than straightforward “bossism.”
Managers learn about management mostly from other managers,
and especially from those organizational superiors who, for
good or ill, were by virtue of their positions role models for
those persons newer to management. At one time, virtually all
management everywhere was authoritarian; even now,
management that is at least partly authoritarian predominates.
Most management role models thus convey at least a modicum
of authoritarianism. Subtle proof of the existence of the
authoritarian streak can be experienced by the manager who
might ponder his or her reaction to being pushed abruptly into a
fully participative management situation. The manager may feel
that participative management exhibits weakness and that
delegating decision-making authority to subordinates is
somehow abrogating his or her responsibility.
Managers also have trouble letting go and adjusting to a truly
participative environment because, for the most part, TQM runs
contrary to classical organizational theory and old notions about
how a work group is to be managed. Classical theory stresses
structure, lines of authority, and the chain of command, and it
suggests that as far as each level is concerned, someone just
above it is in charge. In classical organizational theory, one
21. works for the manager; in contrast, in a truly participative
environment, one works with the manager.
It remains clear, however, that changes in management style and
approach may have to occur for a quality management program
to be successful. In most instances the manager will need to
shift from being the boss—from planning, telling, and
instructing—to being the leader of a team—to counseling,
teaching, coaching, and facilitating.
Management’s commitment, then, can be seen as a total
commitment not only to participative management and employee
empowerment but also to intradepartmental and
interdepartmental teamwork and improved communication
throughout the organization.
Will Total Quality Management Prevail?
The answer to this question is yes: the focus on quality is a
mandate flowing from the very purpose of the healthcare
organization. However, its forms and approaches will vary from
time to time. TQM has every chance of working where previous
and perhaps partial efforts undertaken under other names have
failed. There is a great deal going on with performance
improvement initiatives. Activity undertaken in the name of
quality improvement has become so widespread that the
impression that “everyone is doing it” places considerable
pressure on the supposed few who have yet to commit to true
quality improvement.
In the healthcare setting, quality improvement has become the
norm. It flows from the organization’s overall vision: quality
patient care, with emphasis on timely, effective care given in a
climate of safety. The Joint Commission as well as state and
federal regulatory bodies mandate performance monitoring and
improvement. Examples include the Centers for Medicare and
Medicaid Services (CMS) quality of care initiatives for
hospitals and other healthcare facilities; the American Recovery
and Reinvestment Act (ARRA)/Health Information Technology
for Economic and Clinical Health Act (HITECH), which gives
additional mandates concerning the protection of patients’
22. privacy; and the Federal Trade Commission and its regulations
concerning medical identity theft prevention. In addition,
Congress passed the Patient Safety and Quality Improvement
Act of 2005 (“Patient Safety Act”). The Joint Commission
reflects this mandate in its standards for patient safety. The
Institute for Healthcare Improvement launched the “100,000
Lives Campaign” concerning patient safety, which has since
been expanded to the “Five Million Lives” campaign. Quality,
excellence, and continuous improvement have become the
permanent underlying themes in the healthcare setting.
Performance Improvement Focus
Studies relating to performance improvement generally fall into
one of seven categories:
1. Mandates resulting from laws, regulations, and standards.
Within these laws and regulations there are specific target areas
requiring attention—for example, the payment-error review
requirements of the CMS, which includes a user’s guide
indicating the type of quality study needed to satisfy the review
of payments. Topics for study include same-day surgery
discharges, septicemia, simple pneumonia, and chronic
obstructive pulmonary disease. Also, any topic reflected in the
Plan of Correction for licensure or accreditation would receive
particular focus. Many of the mandates have been noted in
earlier discussions (see Chapters One, Two, and Five) and in the
opening discussions in this chapter. Recall the guidelines
provided in Chapter 6 under the consultant report that uses a
priority system of action.
2. CQI, focusing on maintaining the quality of standard
operations—for example, the quality of medical transcription,
detection of fraudulent line counting, completeness of
documentation, and spoliation of medical evidence in
documentation. These studies become routine and frequent (e.g.,
monthly).
3. Periodic studies, stemming from external requirements as
well as internal commitment to excellence—for example, an
accrediting agency’s quarterly reports or the state agency’s
23. annual licensure survey.
4. Adoption of a new process or approach, focusing on the
“debugging” of such undertakings and eventually moving it into
routine practice. Examples include “dry runs” using the tracer
methodology advocated by The Joint Commission, following the
course of care and services the patient received during the
course of hospitalization, with real-time review involving
several departments. Quality review protocols would be used in
a major project such as the overhaul of the master patient index,
culling out duplicate numbers, and consolidating the related
medical record documents. Once the solution has been found to
this problem, the topic becomes one of routine focus.
5. Critical areas of interest stemming from internal or external
concerns. From time to time, an issue demands intense review.
Examples include:
a. Patient safety. Although this has been an area of focus of risk
management for many years, fresh impetus has been given to
this topic, as noted earlier. The Patient Safety Act, The Joint
Commission standards, internal malpractice-related reviews,
infection control concerns—all of these have led to renewed
interest in studies such as those focusing on wrong-site surgery,
medication errors, “read back” requirements, and any of the
sentinel events emphasized by The Joint Commission in its
adverse patient occurrences topics. The ECRI Institute
(formerly the Emergency Care Research Institute) continues to
develop patient safety–quality improvement programs to support
risk management activities.
b. The revenue cycle. Efforts in improving both the timeliness
and the accuracy of billing, along with the prevention of fraud,
is a multidepartment effort including the physicians, the
admitting department, the emergency service, the finance office,
and health information management. Studies typically include
such topics as:
○ Tracking the time elapsed from the time of clinical events
through the final payment of a bill.
○ Analysis of billing rejections along with comprehensive error
24. rate testing as it relates to accuracy in payment.
○ Selection of high-priority coding and billing (e.g., a $200,000
inpatient bill versus a $500 clinic visit). All are important, but
priority effort devoted to rapid, high-revenue return is
sometimes indicated.
○ Comparison of present organizational practices to the planned
reviews announced by the Office of Inspector General and its
efforts at fraud control, with emphasis on the RAC program
requirements (e.g., specific attention to coding regarding
present-on-admission and hospital-acquired conditions).
c. Disaster and emergency preparedness. A major catastrophe
(e.g., hurricane, tornado, blizzard, fire) brings renewed
attention to this aspect of organizational plans. The after-action
reports, with lessons learned noted, provide the management
team with valuable focus points. In addition to overall
preparedness as reflected in the disaster/emergency plan, topics
of study could include:
○ Aspects of the business continuity plan for patient care and
financial records
○ Compliance with the HIPAA/Department of Health and
Human Services (DHHS) guidelines for release of information
about the aged and persons with disabilities during a disaster
event
○ The proper use of the condition modifiers in coding and
billing relating to catastrophic or disaster-related events
d. Patient privacy and medical identity theft. HIPAA, ARRA,
and HITECH legislation mandate a variety of security
compliance assessments, prevention of breach analysis studies,
and development of practices to prevent and mitigate
compromises of patient privacy. The increased use of smart
phones, laptop computers, and other devices that are often used
off site (such as by home care personnel) is an area needing
particular attention when these devices are lost or stolen. When
equipment is leased, or recycled, these items must be securely
“scrubbed” of confidential data. The Federal Trade Commission
has promulgated regulations (the “red flag” rules) focusing on
25. the detection, prevention, and mitigation of the effects of
medical identity theft. Regular auditing of workers’ access
rights and their history of access/attempted access to health
record information is another area of monitoring.
e. Patterns of care. Various federal and state government
initiatives include provisions concerning the reduction of rates
for preventable readmission. The frequency and causes of
readmission are aspects of this mandate. Related topics include
transition from acute to post-acute care and observation unit
utilization. Such initiatives also includes requirements to
monitor and report elder abuse, making this a topic ripe for
fresh scrutiny. Another area of focus deals with evidence-based
evaluation and treatment standards such as those promulgated
by the American College of Surgeons Commission on Cancer or
those included in the federal comparative effectiveness reviews.
6. Patient satisfaction studies. Questionnaires (using a mix of
anonymous and identifiable responses) provide feedback about
the effectiveness of quality initiatives as well as processes in
need of improvement. The incidents may describe seemingly
small concerns, but from the client’s perspective, these are the
tangible effects of practices. The care per se may have been
excellent, but the related processes might cause discomfort,
anger, or confusion. Examples include not being able to easily
access health record information because of HIPAA rules but
being asked over and over to state one’s date of birth within
earshot of other patients, giving an overseas 14-digit telephone
number of the next-of-kin/power-of-attorney (POA) holder to
registration personnel only to be told that phone number field is
limited to 10 digits, difficult-to-read/use computers for self–
check in, and no weekend or holiday campus transportation to
remote parking sites.
7. Employee satisfaction studies. As with patient satisfaction
studies, these questionnaires and interviews provide information
to assist managers in maintaining a culture of excellence.
Topics include general working conditions (noise levels,
temperature, proper equipment in good working order) and
26. related concerns such as safety, parking, lack of flexibility in
working hours, lack of adequate training and therefore
promotion opportunities, and lack of easy-to-contact “help
desk” for computer support. An analysis of grievance issues
provides another source of information about topics of concern.
There are many resources available to the manager for carrying
out performance improvement studies. Examples include
American Health Information Management Association
(AHIMA)’s Information Governance Principles for Healthcare,
National Hospice and Palliative Care performance outcomes and
measures, Medicare’s allowable/nonallowable cost compliance
checklist, and Healthcare Effectiveness Data and Information
Set performance measures and quality improvement core set for
cultural and linguistic services. See also the interpretive
guidelines of federal and state regulations.
Managers of each department develop and carry out such studies
within their immediate organizational jurisdiction; they also
partner with other units in the organization through committees,
teams, and special projects to achieve the goals relating to
organizational excellence. The management function
of controlling is the traditional term associated with these
detailed processes.
THE MANAGEMENT FUNCTION OF CONTROLLING
Controlling is the management function by which performance
is measured and corrective action is taken to ensure the
accomplishment of organizational goals. Performance
improvement, continuous quality efforts, TQM—all of these
initiatives make up the controlling function. It is an oversight
operation in management, although the manager seeks to create
a positive climate so that the process of control is accepted as
part of routine activity. Controlling is also a forward-looking
process in that the manager seeks to anticipate deviation and
prevent it. It is an overarching activity, involving all the
functions of management.
The manager initiates the control function during the planning
phase, when possible deviation is anticipated and policies are
27. developed to help ensure uniformity of practice. Goals and
objectives include quality measures. During the organizing
phase, a manager may consciously introduce the “deadly
parallel” arrangement as a control factor. Job descriptions
include reference to maintaining excellence through
performance of duties. Training and retraining programs are
provided in order to prevent poor performance. Motivation,
reduction of conflict, and the promotion of team effort support
quality initiatives. Two styles of leadership are necessarily
blended in this function:
• Close supervision and a tight leadership style reflect an aspect
of control. Through rewards and positive sanctions, the manager
seeks to motivate workers to conform, thereby limiting the
amount of control that must be imposed. Finally, the manager
develops specific control tools, such as inspections, visible
control charts, work counts, special reports, and audits.
• Participative management/leadership style, with wide
participation in the quality cycle, is the generally accepted
principle in performance improvement initiatives.
Does this comprehensive focus on quality consume all or most
of the manager’s time? No, not necessarily—studies and
oversight processes can be combined, efficiently scheduled, and
carried out by designated individuals, teams, and committees.
For example, when budget preparation is undertaken, a review
of just-in-time inventory practices could be an adjunct activity.
When a project to clean up and consolidate the master patient
index is implemented (including timely and accurate updates of
identifying information), a related study might focus on
registration processes regarding unconscious patients or trauma
and emergency admissions. A comprehensive study of clinic
appointments might include …
Chapter 13
IMPROVING PERFORMANCE AND CONTROLLING THE
28. CRITICAL CYCLE
Objectives (1 of 2)
Define the management functions of quality improvement and
controlling.
Introduce the concept of the search for excellence and examine
its relationship to the function of controlling.
Relate controlling to directing in an essential cycle that affords
ongoing attention to follow-up and correction.
Objectives (2 of 2)
Introduce the concept of benchmarking and describe its place in
the management process.
Describe selected techniques for improving quality.
Enumerate the essential characteristics of adequate controls and
introduce some commonly used tools of control.
The Continuing Search for Excellence
Terms associated with this search:
TQM: Total quality management
Quality control; quality assurance
Quality circles; performance improvement
CQI: Continuous quality improvement
Essential Top Management Commitment
An underlying philosophy
Participative management style
Active promotion of the concept
Truly delegate authority and responsibility
Employee empowerment
29. Intra- and interdepartmental teamwork
Performance Improvement Focus
Continuous quality improvement: focus on standard operations
Routine, periodic studies stemming from external mandates
(e.g., Joint Commission)
“Debug” new processes (e.g., Joint Commission tracer
methodology implementation)
Critical areas of interest (e.g., patient safety, revenue cycle,
disaster preparation)
When an Improvement Fails (1 of 2)
During the early stages of implementation, the manager must:
Remain attentive to feedback
Make necessary adjustments
Provide clients with assistance in adjusting to the change
When an Improvement Fails (2 of 2)
When the data and feedback indicate that the hoped-for
improvement has not occurred, the manager must be willing to
make the necessary change, including withdrawal of the new
process.
Definition of Control
The management function in which performance is measured
and corrective action is taken to ensure the accomplishment of
organizational goals
30. Participants in the Commitment to Excellence (1 of 2)
Governing board: Leadership role; adoption of philosophy of
excellence
Line managers: Continuous process improvement of routine
activities and periodic quality improvement initiatives
Quality improvement teams and committees: Interdepartmental
cooperation (e.g., patient safety studies)
Participants (2 of 2)
Employees: Peer group activities through quality circles and
teams
Clients: Response to invitation to give feedback (e.g., patient
satisfaction surveys)
The Basic Control Process
Establish standards
Measure performance
Correct deviations
Control Mechanisms Should Be:
Timely
Economical
Comprehensive
Specific and appropriate
Objective
Responsible
Understandable
Six Sigma Strategies
Based on statistical analysis of variations in performance
31. measures, Six Sigma is particularly suitable for studies such as:
Risk management reviews
Infection control monitoring
Clinical audit studies
Patient safety analysis
Coding error rates
Accounts receivable delays
The DMAIC Process
D: Define the project goal and customers/clients
M: Measure the process to determine current performance
A: Analyze and determine root cause(s) of the defect
I: Improve the process by eliminating the defect
C: Control future process performance
Benchmarking
Select a standard of practice against which performance will be
measured
Standards may be internal (e.g., a department’s best
performance)
Standards may be obtained from external sources (e.g., a
professional association, federal agencies, accrediting
organizations)
The GANTT Chart
Visible control chart
Scheduling and progress monitoring
Work-time relationships
32. Work accomplished compared to work planned
Interrelationship among the phases of the work
The Flowchart
To develop a procedure (think logically about task linkage)
To illustrate and emphasize key points in a written procedure
To compare present and planned workflow
To audit the workflow, especially about delay points
TQM Display Charts
Run chart: Trends
Histogram: Patterns; rates and frequency
Scattergram: Relationship of variables
Cause-effect: Problem identification
Pareto chart: Determining priorities
The Critical Cycle
The importance of follow-up: Make new decisions, or re-
enforce original decisions in light of the findings of the various
performance studies. Use the findings to adjust work processes
in light of current information.