case study Private Practice Implements Safeguards for Waiting .pdf
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case study Private Practice Implements Safeguards for Waiting Rooms Covered Entity: Private Practice Issue: Safeguards; Impermissible Uses and Disclosures A staff member of a medical practice discussed HIV testing procedures with a patient in the waiting room, thereby disclosing PHI to several other individuals. Also, computer screens displaying patient information were easily visible to patients. Among other corrective actions to resolve the specific issues in the case, OCR required the provider to develop and implement policies and procedures regarding appropriate administrative and physical safeguards related to the communication of PHI. The practice trained all staff on the newly developed policies and procedures. In addition, OCR required the practice to reposition its computer monitors to prevent patients from viewing information on the screens, and the practice installed computer monitor privacy screens to prevent impermissible disclosures. Recommendations 1. Determine and discuss specific strategies for preventing such HIPAA violations in the future. 2. What should be done and who should do it to make sure that such violations do not recur?.
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HIPAA Case Examples
© 2015 by Jones & Bartlett Learning, LLC, an Ascend Learning Company. All rights reserved.
www.jblearning.com
This handout is a reprint of several HIPAA case examples published by the U.S. Department of
Health and Human Services (http://www.hhs.gov).
Source: http://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/allcases.html
URL Last Verified: 2014-05-16
HIPAA Case Examples
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Chapter 15: Risk Management in Ambulatory Care Settings
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Ambulatory settings differ from inpatient in that they do not have the same mix of specially trained professionals managing patient care 24 hours a day including detailed documentation, observation, decision support teams
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Caso de empresa
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En 1948, Harry y Esther Snyder abrieron la primera hamburguesa In-N-Out en Baldwin Park,
California.
Era una configuracin simple de doble servicio de autoservicio con la cocina entre dos carriles de
servicio, un acceso sin ascensor
ventana y asientos al aire libre. El men consista en hamburguesas, batidos, refrescos y papas
fritas. Este
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un
estimada en 625 millones de dlares al ao. Con base en los resultados, parecera que McDonald's
ha
sali el claro vencedor.
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cuando se trata de la satisfaccin del cliente, In-N-Out le gana a McDonald's. Publica
regularmente la
puntajes ms altos de satisfaccin del cliente de cualquier restaurante de comida rpida en sus reas
de mercado. En comparacin con
A los clientes de McDonald's, los clientes de In-N-Out realmente les "encanta". Casi cualquier
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estado en un In-N-Out cree que es la mejor hamburguesa que han probado. No es ninguna
sorpresa, entonces,
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promedio industrial.
Rompiendo todas las reglas
Segn Stacy Perman, autora de un libro definitivo sobre In-N-Out, la empresa ha logrado
xito inequvoco al romper todas las reglas. Por reglas, la Sra. Perman se refiere a la norma
prcticas comerciales para la industria de comida rpida e incluso para el comercio minorista en
general. In-N-Out ha mantenido
un enfoque tenaz en el bienestar del cliente, pero lo ha hecho haciendo lo impensable: no
cambiando. La filosofa original de la compaa sigue vigente hoy en da y es la que mejor ilustra la
base
por romper las reglas de la compaa: Ofrezca a los clientes los alimentos ms frescos y de la ms
alta calidad que pueda comprar
y brindarles un servicio amable en un ambiente limpio y reluciente. Los grandes gigantes de las
hamburguesas
podra objetar la idea de que no estn brindando el mismo enfoque en el cliente. pero vamos
eche un vistazo ms de cerca a lo que significan estas cosas para In-N-Out.
Para empezar, en In-N-Out, comida de calidad significa comida fresca. Las hamburguesas estn
hechas de 100
% de carne de res pura, sin aditivos, rellenos ni conservantes. In-N-Out posee y opera su propio
comisarios que hacen hamburguesas, asegurndose de que cada hamburguesa sea fresca y nunca
congelada. Las verduras son
loncheados y troceados a mano en todos los restaurantes. Las papas fritas incluso se hacen con
.
CASO 6.2 Algunos ciudadanos preocupados hicieron una cita para reu.pdf
CASO 6.2
Algunos ciudadanos preocupados hicieron una cita para reunirse con el jefe de polica en
Anytown, EE. UU. Les preocupa la productividad del departamento de polica de su ciudad.
Tambin les preocupa la falta de coordinacin entre los residentes de la ciudad y el departamento
de polica.
El Sr. Smith es un residente que mencion en la reunin que hay algunos lugares, conocidos como
puntos crticos de delincuencia, que son la mayor preocupacin para los residentes. Todos los
siguientes se consideran focos potenciales de delincuencia, excepto:
Barras.
Depsitos de autobuses.
centros comerciales
Escuelas.
Barras.
Depsitos de autobuses.
centros comerciales
Escuelas..
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HIPAA Case Examples
© 2015 by Jones & Bartlett Learning, LLC, an Ascend Learning Company. All rights reserved.
www.jblearning.com
This handout is a reprint of several HIPAA case examples published by the U.S. Department of
Health and Human Services (http://www.hhs.gov).
Source: http://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/allcases.html
URL Last Verified: 2014-05-16
HIPAA Case Examples
Hospital Implements New Polices for Telephone Messages
Covered Entity: General Hospital
Issue: Minimum Necessary; Confidential Communications
A hospital employee did not observe minimum necessary requirements when she left a telephone
message with the daughter of a patient that detailed both her medical condition and treatment plan. An
OCR investigation also indicated that the confidential communications requirements were not followed, as
the employee left the message at the patient’s home telephone number, despite the patient’s instructions
to contact her through her work number. To resolve the issues in this case, the hospital developed and
implemented several new procedures. One addressed the issue of minimum necessary information in
telephone message content. Employees were trained to provide only the minimum necessary information
in messages, and were given specific direction as to what information could be left in a message.
Employees also were trained to review registration information for patient contact directives regarding
leaving messages. The new procedures were incorporated into the standard staff privacy training, both
as part of a refresher series and mandatory yearly compliance training.
HMO Revises Process to Obtain Valid Authorizations
Covered Entity: Health Plans / HMOs
Issue: Impermissible Uses and Disclosures; Authorizations
A complaint alleged that an HMO impermissibly disclosed a member’s PHI, when it sent her entire
medical record to a disability insurance company without her authorization. An OCR investigation
indicated that the form the HMO relied on to make the disclosure was not a valid authorization under the
Privacy Rule. Among other corrective actions to resolve the specific issues in the case, the HMO created
a new HIPAA-compliant authorization form and implemented a new policy that directs staff to obtain
patient signatures on these forms before responding to any disclosure requests, even if patients bring in
their own “authorization” form. The new authorization specifies what records a.
Computerized physician order entry (CPOE)
This document provides an overview of computerized physician order entry (CPOE) systems. It defines CPOE and describes its key features and functions, including ordering, decision support, safety checks, and improved documentation. The document discusses common CPOE hardware and software and examines legal/ethical issues. It outlines both the advantages of CPOE in reducing errors and costs and the disadvantages such as high implementation costs. The document also reviews studies on CPOE's impact on patient safety and productivity issues during implementation.
Office of Inspector General Study on OCR's HIPAA audit program
Office of Inspector General: OCR should strengthen its oversight of covered entities' compliance with the HIPAA privacy standards.
OIG has recently completed a study of OCR's HIPAA audit program and published the following recommendations:
(1) OCR should fully implement a permanent audit program
(2) OCR should maintain complete documentation of corrective action
(3) OCR should develop an efficient method in its case-tracking system to search for and track covered entities
(4) OCR should develop a policy requiring OCR staff to check whether covered entities have been previously investigated
(5) OCR should continue to expand outreach and education efforts to covered entities. OCR concurred with all five recommendations and described its activities to address them.
OCR's chief Jocelyn Samuels has concurred with all the recommendations of OIG.
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Overview
Practitioners in health information management and healthcare informatics are expected to be keenly aware of new and upcoming technologies that might
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medicine at their institution. When faced with new technologies, leaders in health information management must evaluate the state of the organization and
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the course to scaffold learning and ensure quality final submissions. These milestones will be submitted in Modules Three, Five and Seven. The final product will
be submitted in Module Nine.
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Determine standard technology systems and their uses in modern healthcare institutions through analysis of current and historical technology use in
health information management and healthcare informatics
Analyze the interrelationship between various professional roles within healthcare institutions and their use of technology systems for informing
recommendations regarding health information technology systems
Determine the potential impact of violating health regulations and laws regarding health information technology systems on healthcare organizations
Develop health information technology recommendations for healthcare institutions that are compliant with health regulations and laws and ensure
ethical management of health information
Determine effective investment of resources in health information technology for healthcare institutions based on the needs of the healthcare
institution
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Imagine you have been contracted to consult on the recent developments at the Featherfall Medical Center. Featherfall has been struggling of late; it has had a
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Ghost Posting in the OR
Discussion Question
1. What are the main facts of this case?
The main facts in this case show that a register nurse in the OR discovered how Dr. Neuer’s is using techniques that are so detrimental for the hospital just because he wants to protect his block time. In addition, others surgeons who are part of the organization have noted that although the OR is usually empty, they have to go to others institutions to perform their surgeries. Furthermore, Dr. Neuer uses imaginary patients to fill in the time and availability for the schedule days in which he has to post certain surgical cases. The RN communicates all this matter to the administrator in charge of the OR. After further investigations, it is concluded that Dr. Neuer does not want anybody to know how is performing his job with inefficiency. While Dr. Neuer continues doing this practice, the hospital will be financially affected.
2. Which theory or theories do you believe best explain Dr. Neuer’s behavior?
Bureaucratic theory can be used to describe Dr. Neur’s behavior in some ways. Despite all the matters going on with him, there was not flexibility for others staff members to use the OR. Another social factor that influence Dr. Neuer’ behavior might be his knowledge on how the organization does not have a clear understanding on what “constitutes adequate patient information to post a surgical case.”
3. What are the three potential obstacles to changing Dr. Neuer’s behavior? Should action (s) be taken against Dr. Neuer?
The first and most important obstacle in this case is the lack of organizational skill from the managers and supervisors in charge of the OR. First of all when management an organization there should be a clear understanding on what and how services are practice or delivery. Therefore, not being able to identify the rules established for the department would constitute a barrier to change Dr. Neur’s behavior.
Using imaginary patients could be another problem to change Dr. Neur’s behavior because it is hard to identify whether he is lying or not.
Another potential factor that can be identified in this case is the lack of human and conceptual skills from Dr. Neur’s that disallow him to care for the organization’s goal. Actions must be taken against Dr. Neur. To start with, if nothing is done regarding this matter, the organization is not going to be able to success at longer term; since both production and finance are affected.
4. What are some ways that block time can be allocated to ensure the OR is used as efficiently as possible? Who should be in charge of this process? How can the process prevent ghost posting?
One way that should improve the block time allocation is set up a carefully plan from top managers that would allow them to deliver and revise all the activities that each surgeon performs. In addition, having a clear understanding on what “constitutes adequate patient information” also will be an excellent tool that wou ...
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Chapter 15: Risk Management in Ambulatory Care Settings
Ambulatory Settings
There has been a steady flow of clinical services out of hospital settings into more cost-effective outpatient settings
Risk management is as important in the outpatient setting as it is in the inpatient, especially as outpatient settings are not subject to accreditation
Of all paid malpractice claims, a greater number are coming from the ambulatory setting than from inpatient alone
Why the increased risk?
Ambulatory settings differ from inpatient in that they do not have the same mix of specially trained professionals managing patient care 24 hours a day including detailed documentation, observation, decision support teams
Ambulatory setting provides infrequent care spread over time and patients are generally seen by personnel with a lower level of training performing tasks in multiple areas
Assessment of the Practice Setting
Risk Managers need to assess the risks inherent to the specific site
Management of risk in the ambulatory setting sites on 3 core principles:
A culture of safety
Good employment practices
Ethical business practices
Culture of Safety
It is important to recognize that human errors are inevitable and leads to ways to strengthen the system of care rather than punishment
4 Key Features
Psychological safety
Active leadership
Transparency
Fairness
Good Employment Practices
Under the principle of vicarious liability, the facility owner is legally responsible for the actions of their employees
Potential risks:
Non-physician employee exceeding their legally authorized duties
Inappropriate actions of employees
Fair employment practice issues
Ethical Business Practices
The risk manager must guard the practice against fraud and abuse by ensuring
Appropriate billing practices
Compliance with Stark Law
No inappropriate upcoding of claims
High Risk Areas
Missed diagnoses
Medication risks
Infectious risks
Communication
Documentation
Office Management
Clear and regularly updated policies and procedures will help maintain high standards of patient care and lower the risk of lawsuits
The Policy and Procedure Manual should be available to all employees and follow the mission, vision and values of the practice setting.
Policy Manual Section –
Administration
Describes the organization of the practice setting
Hours of operation
Holidays
Emergency contact after hours
HIPAA
Patient Rights (including children)
Patient responsibilities
Missed appointment policy
Patient complaint procedure
Transfer of care to another provider
Consent forms (including treatment of minors)
Advance directives
Clarifies HR issues
Hiring - Application process, forms and reference checks
Verification of credentials and identity
Verification of Immunization and TB testing
Compliance with employment laws
Job descriptions
Various employee policies
Employee grievance policy
Workplace violence policy
Disciplinary procedures
Employee training
Dress code
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Caso de empresa
Hamburguesa In-N-Out: el valor del cliente a la antigua usanza
En 1948, Harry y Esther Snyder abrieron la primera hamburguesa In-N-Out en Baldwin Park,
California.
Era una configuracin simple de doble servicio de autoservicio con la cocina entre dos carriles de
servicio, un acceso sin ascensor
ventana y asientos al aire libre. El men consista en hamburguesas, batidos, refrescos y papas
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El formato era comn para el perodo de tiempo. De hecho, otra hamburguesera que se ajusta a
este mismo
description abri el mismo ao a solo 45 minutos de la primera In-N-Out Burger. l
se llamaba McDonald's. Hoy, McDonald's cuenta con ms de 34,000 tiendas en todo el mundo
que traen
ms de $ 88 mil millones cada ao. In-N-Out tiene solo 281 tiendas en cinco estados, bueno para
un
estimada en 625 millones de dlares al ao. Con base en los resultados, parecera que McDonald's
ha
sali el claro vencedor.
Pero In-N-Out nunca quiso ser otro McDonald's. Y a pesar de su tamao ms pequeoo
tal vez por eso: a los clientes de In-N-Out les gusta la cadena regional tal como es. Cuando
cuando se trata de la satisfaccin del cliente, In-N-Out le gana a McDonald's. Publica
regularmente la
puntajes ms altos de satisfaccin del cliente de cualquier restaurante de comida rpida en sus reas
de mercado. En comparacin con
A los clientes de McDonald's, los clientes de In-N-Out realmente les "encanta". Casi cualquier
persona que tenga
estado en un In-N-Out cree que es la mejor hamburguesa que han probado. No es ninguna
sorpresa, entonces,
que las ventas promedio por tienda de In-N-Out eclipsan las de McDonald's y son el doble de las
promedio industrial.
Rompiendo todas las reglas
Segn Stacy Perman, autora de un libro definitivo sobre In-N-Out, la empresa ha logrado
xito inequvoco al romper todas las reglas. Por reglas, la Sra. Perman se refiere a la norma
prcticas comerciales para la industria de comida rpida e incluso para el comercio minorista en
general. In-N-Out ha mantenido
un enfoque tenaz en el bienestar del cliente, pero lo ha hecho haciendo lo impensable: no
cambiando. La filosofa original de la compaa sigue vigente hoy en da y es la que mejor ilustra la
base
por romper las reglas de la compaa: Ofrezca a los clientes los alimentos ms frescos y de la ms
alta calidad que pueda comprar
y brindarles un servicio amable en un ambiente limpio y reluciente. Los grandes gigantes de las
hamburguesas
podra objetar la idea de que no estn brindando el mismo enfoque en el cliente. pero vamos
eche un vistazo ms de cerca a lo que significan estas cosas para In-N-Out.
Para empezar, en In-N-Out, comida de calidad significa comida fresca. Las hamburguesas estn
hechas de 100
% de carne de res pura, sin aditivos, rellenos ni conservantes. In-N-Out posee y opera su propio
comisarios que hacen hamburguesas, asegurndose de que cada hamburguesa sea fresca y nunca
congelada. Las verduras son
loncheados y troceados a mano en todos los restaurantes. Las papas fritas incluso se hacen con
.
CASO 6.2 Algunos ciudadanos preocupados hicieron una cita para reu.pdf
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Algunos ciudadanos preocupados hicieron una cita para reunirse con el jefe de polica en
Anytown, EE. UU. Les preocupa la productividad del departamento de polica de su ciudad.
Tambin les preocupa la falta de coordinacin entre los residentes de la ciudad y el departamento
de polica.
El Sr. Smith es un residente que mencion en la reunin que hay algunos lugares, conocidos como
puntos crticos de delincuencia, que son la mayor preocupacin para los residentes. Todos los
siguientes se consideran focos potenciales de delincuencia, excepto:
Barras.
Depsitos de autobuses.
centros comerciales
Escuelas.
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centros comerciales
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Caso de Estudio:Liderazgo y Gestin
Laura es directora asociada de una agencia sin fines de lucro que brinda asistencia a nios y
familias. Ella es la jefa de un departamento que se enfoca en evaluar los programas de desarrollo
de habilidades que la agencia brinda a las familias. Ella reporta directamente al liderazgo de la
agencia. En general, la agencia ha sido cautelosa al contratar este ao debido a la mayor
competencia por la financiacin de subvenciones federales. Sin embargo, tambin han sufrido una
alta rotacin de personal. Se han ido dos directores, as como tres miembros clave del personal de
investigacin y un miembro del personal del departamento de finanzas.
Laura tiene un horario exigente que requiere viajes frecuentes; sin embargo, supervisa a dos
gerentes que a su vez son responsables de cinco miembros del personal cada uno. Ambos
gerentes han sido designados en los ltimos seis meses.
Gerente 2:Linda tiene una slida formacin en investigacin y evaluacin de ciencias sociales. Ella
gestiona el personal que trabaja en diferentes proyectos dentro de la agencia. Se la conoce como
una solucionadora de problemas y brinda un gran apoyo a su personal. Es muy organizada y
tiene mucha experiencia en la evaluacin de servicios familiares. Linda es muy capaz y, a veces,
puede asumir demasiado.
Los gerentes estn sintiendo que el personal est sobrecargado de trabajo a medida que todos
asumen mayores responsabilidades debido a la alta rotacin de personal. El personal tambin ha
mencionado que el estilo de conversacin de "vaso medio vaco" de Laura los deja sintindose
abatidos. Adems, Laura no ha compartido los presupuestos con sus gerentes, por lo que tienen
dificultades para asignar adecuadamente el trabajo al personal. Laura dijo que no ha recibido
suficiente informacin del departamento de finanzas para completar los presupuestos. El
departamento de finanzas dijo que le han enviado toda la informacin que tienen disponible.
A medida que el personal se angustia, los gerentes se frustran. Sienten que no pueden defender a
su personal o resolver problemas sininformacin clave comoelpresupuesto del departamento.
Preguntasdel caso: -
1.Cmo puede Laura utilizar de manera ms eficaz tanto las habilidades de gestin como de
liderazgo en su papel como directora asociada? Qu combinacin de los dos crees que funcionara
mejor en este entorno?
3.Qu consejo le dara a Laura para mejorar sus habilidades de liderazgo ya los gerentes para
mejorar sus habilidades de gestin?
4. Qu estilo de liderazgo cree que necesitara un lder para ser eficaz en esta situacin?.
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Mercados emergentes: Red Alliance de Etihad Airways
Fundada en 2003 y con sede en Abu Dhabi, Etihad Airways est inspirada en Emirates Airlines y
es un competidor directo de Emirates, que tiene su sede en Dubi, otro emirato de los Emiratos
rabes Unidos (EAU). Etihad, que significa unin en rabe, se ha convertido rpidamente en la
aerolnea de ms rpido crecimiento en la historia de la aviacin comercial. Ahora con 101 aviones,
Etihad atiende a 11 millones de pasajeros a casi 100 destinos en todo el mundo. Ahora, la cuarta
aerolnea ms grande del mundo, Emirates es un mamut que tiene 220 aviones y transporta 40
millones de pasajeros a ms de 100 ciudades.
Etihad imita al exitoso Emirates al (1) equiparse con aviones modernos de larga distancia (como
el Airbus A380 y el Boeing 777 Extended Range [ER]) y (2) aprovechar la envidiable ubicacin
del Aeropuerto Internacional de Abu Dhabi, que se encuentra a solo a una hora en coche del
histrico aeropuerto de Dubi. Dada la pequea poblacin local (tres millones en Abu Dhabi frente a
cuatro millones en Dubi), Etihad, como Emirates, solo puede crecer siendo una aerolnea de
"superconexin". En otras palabras, la mayora de los pasajeros no viajan ni desde ni hacia Abu
Dhabi. Bendecida por su ubicacin en Oriente Medio, Abu Dhabi, al igual que Dubi, es un punto
de parada ideal para el trfico areo entre Europa y Australasia y entre Asia y frica.
Un rea en la que Etihad se ha desviado decisivamente de su modelo a seguir, Emirates, es el
inters en tejer una red de alianzas. Aparte de una sola alianza con Qantas, Emirates ha sido muy
tmido o no se preocupa por la colaboracin. En una industria con tres redes principales de mltiples
socios: One World, Sky Team y Star Alliance, las aerolneas no son ajenas a las alianzas. Pero las
alianzas de Etihad no son lo que piensas. Sus conversaciones para unirse a estas tres mega redes
no llegaron a ningn lado, porque ninguna de ellas estaba interesada en admitir a un nuevo
miembro ambicioso decidido a comer su almuerzo. En cambio, Etihad ha construido su propia
red de alianzas que consta de ocho aerolneas ms pequeas. En 2011, Etihad adquiri una
participacin del 29 % en Air Berlin, la sexta aerolnea ms grande de Europa. Desde entonces, a
travs de una serie de inversiones estratgicas basadas en acciones, Etihad adquiri participaciones
en Aer Lingus, con sede en Dubln, Irlanda (4% de acciones); Alitalia, con sede en Roma, Italia
(49 %), la aerolnea ms grande de Italia; Air Serbia, con sede en Belgrado, Serbia (49%), la
aerolnea ms grande de Serbia, anteriormente conocida como Jat Airways; Air Seychelles, con
sede en Mahe, Seychelles (40%); Darwin Airline, con sede en Lugano, Suiza (34 %),
recientemente renombrada como Etihad Regional; Jet Airways, con sede en Mumbai, India
(24%); y Virgin Australia, con sede en Brisbane, Australia (20%).
El director ejecutivo de Etihad, James Hogan, que es australiano, es visto com.
CASO DE ESTUDIO La cl�nica Mayo es uno de los nombres m�s respetad.pdf
CASO DE ESTUDIO
La clnica Mayo es uno de los nombres ms respetados en el mundo de la medicina. Fundada en la
dcada de 1880 en Rochester, Minnesota, la clnica Mayo abraz la innovacin desde el principio. Se
cree que es la primera prctica grupal integrada de Estados Unidos, ya que emple el concepto de
atencin especializada coordinada y busc la mejor experiencia.
En el ncleo de la cultura de Mayo, desde sus inicios hasta el da de hoy, se encuentra un enfoque
de equipo y una toma de decisiones mdica arraigada en la responsabilidad compartida y la
creacin de consenso. Mayo tiene una slida tradicin de ser una organizacin dirigida por mdicos
que defiende la atencin al paciente excepcional y la investigacin mdica. Es reconocida
mundialmente por su calidad de atencin.
Hoy, la clnica Mayo est decidida a establecer un nuevo estndar en el cuidado de la salud al
eliminar el desperdicio y mejorar la eficacia. Ya ha logrado brindar una atencin ms segura que
cuesta significativamente menos que el promedio de EE. UU. A medida que la organizacin creci
y la sociedad cambi, una combinacin personalizada de herramientas y enfoques de calidad ayud a
lograr una transformacin en todo el sistema, posicionando a Mayo para lograr su objetivo de
brindar la mejor atencin mdica, sin excepcin.
A medida que la atencin mdica cambi en la dcada de 1990, Mayo comenz a abordar la calidad
con un rigor cada vez mayor, midiendo ms a fondo los resultados de sus esfuerzos con la ayuda
del instituto Juran, Mayo lanz un programa completo de mejora de la calidad. Varios lderes
siguieron la capacitacin Six Sigma y compartieron su experiencia con la organizacin. Estos
esfuerzos trajeron algunas mejoras y ayudaron a desarrollar futuros lderes clave. Pero un
conflicto entre la eficiencia y la eficacia sentido por muchas organizaciones se desarroll en
Mayo: el costo percibido de la mejora de la calidad choc con la mejora de los resultados, ya sea
necesaria o no. el programa fue descartado.
Se prob la ventaja estratgica de Mayo de ser lo mejor de lo mejor. En 1999, el instituto de
medicina emiti un informe fundamental, construyendo un sistema de salud ms seguro. Que desafi
a los proveedores de atencin mdica a reducir los errores mdicos prevenibles en un 50 por ciento
durante los siguientes cinco aos. Cruzando el abismo de la calidad: un nuevo sistema de salud
para el siglo XXI y varios otros informes influyentes siguieron.
Los informes del IOM fueron un catalizador para que Mayo aprendiera cmo estaba a la altura de
la seguridad y la atencin del paciente. Alrededor de este tiempo, el personal de la clnica reconoci
que ocurrieron algunos errores prevenibles que pusieron un rostro humano en los datos del
informe y ayudaron al liderazgo de Mato a darse cuenta de que todas las organizaciones, ya sean
buenas o malas, necesitan mejorar.
Mayo tambin enfrent el desafo de ser un proveedor de destino, ya que la mayora de los pacientes
viajaban largas distancias y esperaban completar su atencin en cuatro o.
CASO DE ESTUDIO La �pera de Sydney es uno de los edificios ic�nico.pdf
CASO DE ESTUDIO
La pera de Sydney es uno de los edificios icnicos ms conocidos, reconocido en todo el mundo
como un smbolo mundial de Australia. El arquitecto dans Jrn Utzon gan el concurso de
arquitectura establecido por el gobierno de Nueva Gales del Sur para el nuevo edificio en 1957, y
la construccin comenz en 1959. El proyecto estaba originalmente programado para cuatro aos,
con un presupuesto de 7 millones de dlares australianos. Termin tardando 14 aos en completarse
y cost AUS $ 102 millones. La pera de Sdney probablemente podra verse como uno de los
proyectos de construccin ms desastrosos de la historia, no solo desde el punto de vista financiero
sino tambin desde el punto de vista de la gestin en su conjunto. Analicemos las principales
razones que llevaron a ello. En primer lugar, al comienzo de cualquier proyecto, el cliente debe
definir claramente las metas y los objetivos para proporcionar una gua de lo que debe completar
el proyecto. Hay tres factores principales: tiempo, costo y calidad. En el caso de la pera de
Sdney, este ltimo fue el ms importante, ya que era un objetivo casi irrestricto del proyecto y el
motivo por el cual se puso en marcha. Tampoco se proporcionaron indicaciones sobre los lmites
de tiempo o costo para la competencia. As, a los arquitectos se les permiti total libertad en sus
diseos. Despus de que Utzon fuera seleccionado, present su "Libro rojo" en marzo de 1958, que
consista en el informe de la pera Nacional de Sydney. Comprendi algunas indicaciones como
planos, secciones, informes de consultores, etc. Los fondos provinieron casi en su totalidad de
una lotera dedicada, por lo que el proyecto no fue una carga financiera para el gobierno. En
cuanto a la planificacin del tiempo, la meta era completar la construccin a fines de 1962 y tener
la gran inauguracin a principios de 1963. El proyecto debera haber durado cuatro aos. La
principal parte interesada era el arquitecto, pero Utzon estaba mucho ms preocupado por el
aspecto del diseo que por los objetivos de tiempo y costos, lo que result ser problemtico. Durante
el proyecto, Utzon colabor con Ove Arup, quien estuvo a cargo de la estructura y la ingeniera.
Con algunos otros subcontratistas, el equipo estuvo a cargo de la mecnica, electricidad,
calefaccin y ventilacin, iluminacin y acstica. No haba un director de proyecto real, sino ms bien
una colaboracin entre Utzon y Arup.
El otro actor principal era el cliente, el estado de Nueva Gales del Sur. Esto abarc al gobierno
australiano, que lanz el concurso para el proyecto, y especialmente al primer ministro laborista,
Joe Cahill. Se cre un comit ejecutivo a tiempo parcial para supervisar el proyecto, pero los
miembros no tenan habilidades tcnicas reales. El gobierno finalmente se convirti en un obstculo
para el equipo del proyecto al inhibir los cambios durante el progreso de las operaciones y, por lo
tanto, contribuy a sobrecostos y demoras. Finalmente, el pblico era un actor indirecto porque
estaba preocupado .
Caso de estudio Despu�s de luchar con la deuda y la fuerte compete.pdf
Caso de estudio
Despus de luchar con la deuda y la fuerte competencia de Netflix y Redbox, Blockbuster, Inc. se
declar en bancarrota en septiembre de 2010. Este fue un final triste para una empresa que haba
dominado el negocio de alquiler de pelculas en la dcada de 1990. Blockbuster Inc. fue fundada
por David Cook en 1985 con su primera tienda de alquiler en Dallas. Cook plane aprovechar un
mercado de alquiler de videos altamente fragmentado, en el que la mayora de las tiendas eran
operaciones familiares relativamente modestas que vendan una pequea seleccin de pelculas de
gran xito, principalmente debido al alto costo que cobran los distribuidores (alrededor de $ 65).
por cinta). Con 8000 cintas que cubran 6500 ttulos, Blockbuster tena un inventario mucho ms
amplio y profundo en comparacin con el de su competidor ms cercano. Las operaciones de la
tienda tambin se agilizaron en gran medida gracias a un sistema computarizado de control de
inventario y caja. La tienda fue un gran xito, lo que provoc la adicin de tres ubicaciones ms a
mediados de 1986. En 1986, debido a problemas de liquidez, Cook se vio obligado a entregar
toda la empresa a un grupo de inversores liderado por Wayne Huizenga. Entre 1987 y 1993,
Huizenga convirti a Blockbuster en un enorme xito. Durante este perodo, Blockbuster abri
tiendas en todo el mundo a razn de una cada 24 horas. En 1993, Blockbuster era el principal
proveedor mundial de entretenimiento de juegos y pelculas para el hogar, con ms de 3400 tiendas
en Amrica, Europa, Asia y Australia. Las tiendas de gran xito eran una caracterstica
omnipresente del vecindario que permaneca abierta los 365 das del ao, generalmente desde las
10 am hasta la medianoche. La seleccin, la cantidad y los formatos de la mercanca se
personalizaron a nivel de tienda para satisfacer las necesidades y preferencias de los clientes
locales. Sin embargo, a principios de la dcada de 2000, Blockbuster comenz a ver una
competencia real del floreciente mercado de alquiler en lnea a medida que los DVD comenzaron
a reemplazar las cintas. Su principal competidor era Netflix, lanzado en 1997. Adems de ser ms
baratos de comprar que las cintas, los DVD eran adecuados para el envo por correo porque eran
menos costosos de enviar y menos frgiles que las cintas. Netflix desafi a Blockbuster en dos
dimensiones clave: variedad y cargos por pagos atrasados. Mientras que las tiendas Blockbuster
generalmente vendan alrededor de 3000 ttulos, Netflix inicialmente ofreca ms de diez veces esa
cantidad. Adems, Netflix no cobr los "cargos por pagos atrasados" que tanto disgustaban a
Blockbuster, sino que permiti a los clientes conservar los ttulos todo el tiempo que quisieran. El
plan de suscripcin mensual de Netflix ofreca alquileres ilimitados por correo por $9, el costo de
dos alquileres en una tienda Blockbuster. Mientras tanto, Redbox, una unidad de Coinstar Inc.,
operaba mquinas expendedoras que alquilaban DVD por tan solo $1 por noche. A pesar de sus
mejores esf.
Caso cl�nicoSDRAPregunta 1.Dados sus s�ntomas de fatiga, disne.pdf
Caso clnicoSDRA
Pregunta 1.Dados sus sntomas de fatiga, disnea, tos y fiebre, mencione 3 diagnsticos
diferenciales (incluya definiciones y caractersticas importantes de la enfermedad).
1.
2.
3..
Caso 21-3 Orden de prueba de deterioro Five Star Hotel Corporati.pdf
Caso 21-3
Orden de prueba de deterioro
Five Star Hotel Corporation (Five Star) opera dos propiedades tursticas exclusivas que operan
bajo diferentes marcas, una ubicada en los Estados Unidos y la otra en las Bermudas. Se ha
determinado que cada resort es un grupo de activos para evaluar el deterioro de los activos de
larga duracin y una unidad de informes para evaluar el deterioro de la plusvala. Five Star fue
adquirida por una compaa de inversin hace varios aos, lo que result en la inclusin de un activo
intangible de marca y un fondo de comercio en cada grupo de activos/unidad de informes.
Ambos activos intangibles de marca estn determinados a tener una vida til indefinida. En
resumen, cada grupo de activos de resort/unidad de informes tiene los siguientes tipos de activos:
Cuentas por cobrar
Inventario
Activos intangibles relacionados con el cliente (de vida finita)
Activos intangibles de marca (de vida indefinida)
Propiedad, planta y equipo
Buena voluntad
Durante el perodo de informe actual, Five Star ha determinado que ocurri un evento
desencadenante en relacin con el resort en los Estados Unidos, lo que requiere que el grupo de
activos sea probado por deterioro sobre la base de retencin y uso. Adems, durante el perodo de
informe actual, Five Star inici un proceso para disponer del resort en las Bermudas a travs de una
venta y ha determinado que se cumplen los criterios para la clasificacin como mantenido para la
venta.
Requerido:
Cul es el orden de las pruebas de deterioro para los activos en el grupo de activos de resort de
EE. UU. de Five Star cuando el grupo de activos se clasifica como mantenido y utilizado?
Cul es el orden de las pruebas de deterioro para los activos del grupo de enajenacin de
complejos tursticos de Five Star en Bermudas cuando el grupo de enajenacin se clasifica como
mantenido para la venta?.
Caso 6.2 Seguro Mar�timo Cl�usula Inchmaree Un barco pesquero c.pdf
Caso 6.2 Seguro Martimo: Clusula Inchmaree
Un barco pesquero con casco de madera de cuarenta pies sufri una fuga inesperada unos das
despus de salir del puerto. A medida que entraba ms agua en la embarcacin, el motor se inundaba
y finalmente la embarcacin se hunda. La inspeccin de la embarcacin durante la fuga mostr que el
agua provena de debajo de un espacio refrigerado en la parte delantera de la embarcacin. En vista
de su estilo de construccin, la sentina debajo de la embarcacin era inaccesible. El asegurador se
neg a indemnizar al asegurado por la prdida de la embarcacin alegando que este ltimo no haba
actuado con diligencia para poner la embarcacin en condiciones de navegar antes de que se
produjera la fuga (segn lo dispuesto en la Clusula Inchmaree). El propietario/capitn del barco no
tena conocimiento de la fuga antes de que el barco comenzara su viaje.
Preguntas
1. (Caso 6.1) Es esta prdida total real o constructiva? Explica tu respuesta.
2. En el caso 6.2, piensa que la prdida est cubierta por la pliza (ver Perspectiva Internacional
6.3)?
PERSPECTIVA INTERNACIONAL 6.1
Atributos de un Sistema Logstico de Clase Mundial: Dinamarca
Dinamarca ocupa el primer puesto mundial en logstica. Su excelencia en logstica se atribuye a
una serie de factores:
Inversin en infraestructura: El aeropuerto internacional se encuentra a unos treinta minutos de
diez puertos internacionales y zonas francas. Proporciona acceso directo a la red ferroviaria y de
carreteras europea con conexiones directas a muchas ciudades europeas. Cuenta con
transportistas e integradores internacionales con instalaciones de depsito aduanero. Proporciona
una inversin sustancial para el mantenimiento y desarrollo de la infraestructura (puentes,
aeropuerto y puerto martimo). Cuenta con una eficiente instalacin de manejo de carga area. El
despacho de aduana de las mercancas se realiza antes del pago de los derechos, con un mnimo de
trmites burocrticos. La tecnologa de la informacin ayuda a agilizar los procedimientos de
exportacin o importacin y vincula a los transportistas y los consumidores.
Recursos humanos: mano de obra altamente calificada y motivada, operaciones las veinticuatro
horas del da, los siete das de la semana y buenas relaciones entre la gerencia y los trabajadores
(las huelgas o huelgas son prcticamente inexistentes).
Entorno de negocios: Disponibilidad de zonas de libre comercio y depsitos aduaneros, bajas
restricciones comerciales con un entorno econmico/poltico estable.
PERSPECTIVA INTERNACIONAL 6.2
Embalaje de exportaciones de artesanas: puntos importantes
Antes del embalaje: Saque el polvo, limpie, elimine las huellas dactilares y seque los artculos.
Principales problemas a considerar en el empaque: Deslustre, corrosin, manchas, descomposicin,
rotura.
edad, humedad.
Prevencin de la humedad: use un agente secante (gel de slice) para reducir la humedad; reducir
el rea de superficie del paquete; artculos secos; y empaque los materiales en paquetes con un
sello he.
Caso 3.1 Firma de contadores Moss y McAdams Bruce Palmer hab�a t.pdf
Caso 3.1
Firma de contadores Moss y McAdams
Bruce Palmer haba trabajado para Moss and McAdams (M&M) durante seis aos y acababa de
ser ascendido a gerente de cuentas. Su primera asignacin fue dirigir una auditora de Johnsonville
Trucks. Estaba bastante complacido con los cinco contadores que haban sido asignados a su
equipo, especialmente con Zeke Olds. Olds era un veterano del ejrcito que haba regresado a la
escuela para obtener una doble especializacin en contabilidad e informtica. Estaba al tanto de los
ltimos desarrollos en sistemas de informacin financiera y tena la reputacin de encontrar
soluciones innovadoras a los problemas.
M&M era una firma de contabilidad regional bien establecida con 160 empleados ubicados en
seis oficinas en Minnesota y Wisconsin. La oficina principal, donde trabajaba Palmer, estaba en
Green Bay, Wisconsin. De hecho, uno de los miembros fundadores, Seth Moss, jug brevemente
para los Packers de la NFL de su ciudad natal a fines de la dcada de 1950. Los principales
servicios de M&M eran auditoras corporativas y preparacin de impuestos. En los ltimos dos aos,
los socios decidieron incursionar de manera ms agresiva en el negocio de la consultora. M&M
proyect que la consultora representara el 40 por ciento de su crecimiento durante los prximos
cinco aos.
Pgina 98M&M operaba dentro de una estructura matricial. A medida que se reclutaban nuevos
clientes, se asignaba un administrador a la cuenta. Se podra asignar un gerente a varias cuentas,
segn el tamao y el alcance del trabajo. Esto fue especialmente cierto en el caso de los proyectos
de preparacin de impuestos, donde no era raro que un gerente fuera asignado a 8 a 12 clientes.
Asimismo, los contadores principales y de planta fueron asignados a mltiples equipos de cuentas.
Ruby Sands era la gerente de oficina responsable de asignar personal a diferentes cuentas en la
oficina de Green Bay. Hizo todo lo posible para asignar personal a mltiples proyectos bajo el
mismo gerente. Esto no siempre era posible y, a veces, los contadores tenan que trabajar en
proyectos dirigidos por diferentes gerentes.
M&M, como la mayora de las empresas de contabilidad, tena un sistema de promocin por
niveles. Nuevos CPA ingresados como contadores junior o de personal. En dos aos, se revis su
desempeo y se les pidi que se fueran o se les ascendi a contador senior. En algn momento
durante su quinto o sexto ao, se tom la decisin de ascenderlos a gerente de cuentas. Finalmente,
luego de 10 a 12 aos en la firma, el gerente fue considerado para su ascenso a socio. Esta era una
posicin muy competitiva. Durante los ltimos 5 aos, solo el 20 por ciento de los gerentes de
cuentas de M&M haban sido ascendidos a socios. Sin embargo, una vez que eran socios, tenan
prcticamente garantizado el puesto de por vida y disfrutaban de aumentos significativos en
salario, beneficios y prestigio. M&M tena la reputacin de ser una organizacin orientada a los
resultados; las promociones de los socios se basaron en el cu.
Caso 2 (TV de Alta Definici�n La Gran Alianza) (1) Seg�n el caso .pdf
(1) El documento describe la transición a la televisión de alta definición (HDTV) y los esfuerzos de varios países y organizaciones para establecer estándares. (2) Japón desarrolló el estándar Hi-Vision a través de NHK, mientras que Europa lanzó el Proyecto Eureka. (3) En Estados Unidos, las emisoras estaban divididas sobre HDTV, ya que requeriría inversiones pero quizás no aumentaría la audiencia.
Caso 1 (8 puntos) Miguel y Cinthia Leatch viven en Covington, Ten.pdf
Caso 1 (8 puntos):
Miguel y Cinthia Leatch viven en Covington, Tennessee, en una casa que tienen desde 2002.
Cuando compraron la casa, haba una cantera de grava al otro lado de la calle. En 2005, el estado
convirti la gravera en un vertedero. Bajo la operacin del estado, el vertedero acept basura
domstica, recortes de csped, estircol, cadveres de animales, contenedores con advertencias de
contenido peligroso, bateras de automviles con fugas, aceite de desecho, entre otras cosas. A
pesar de las leyes ambientales federales que exigen que los depsitos de vertederos se cubran
dentro de las veinticuatro horas posteriores a su vertido, los depsitos de vertederos a menudo se
dejaban descubiertos durante semanas seguidas, atrayendo insectos, ratas y otros carroeros. Se
produjeron incendios, incluido al menos uno iniciado por un intruso que haba ingresado a la
propiedad del vertedero a travs de una puerta abierta.
Los Leatch se quejaron al estado, alegando que el relleno sanitario estaba siendo operado en
violacin de las leyes federales que estn diseadas para minimizar los riesgos de lesiones por
incendios, carroeros, contaminacin del agua subterrnea y otros peligros de contaminacin. El
estado inspeccion el vertedero, pero no se realizaron cambios operativos. Los Leatch presentaron
una demanda contra el estado por la operacin del vertedero.
Caso 1 Pregunta:
Tienen los Leatch legitimacin para demandar en estas circunstancias? Por qu o por qu no?
Explique completamente su anlisis..
Caso 1 Agmmaglobulinemia ligada al X 1. Bill fue testamento duran.pdf
Caso 1: Agmmaglobulinemia ligada al X
1. Bill fue testamento durante los primeros 10 meses de esta vida. como explicas esto
2. Los pacientes con enfermedades de inmunodeficiencia nunca deben recibir vacunas virales
vivas. A varios lactantes varones con agammaglobulineia ligada al cromosoma X se les administr
la vacuna antipoliomieltica oral viva y desarrollaron poliomielitis paraltica. Qu secuencia de
eventos condujo al desarrollo de polio en estos nios?
3. Las infecciones recurrentes de Bills se debieron casi exclusivamente a las especies
Streptococcus y Haemophilus . Estas bacterias tienen una cpsula viscosa compuesta
principalmente por polmeros de polisacridos, que las protegen de todo ataque directo de los
fagocitos. Los seres humanos fabrican anticuerpos IgG2 contra estos polmeros de polisacridos.
Los anticuerpos IgG2 opsonizan a las bacterias fijando el complemento en su superficie, lo que
facilita la rpida captacin de estas bacterias por las clulas fagocticas. Qu otro defecto gentico en el
sistema inmunitario podra imitar clnicamente la agammaglobulinemia ligada al cromosoma X?.
Caso 1 Felipe R�os y Tiffany De Los Rios married filling jointl.pdf
Caso 1 Felipe Ros y Tiffany De Los Rios married filling jointly
Postal direction: URB BEVERLY HILLS A-12 Guaynabo PR 00969
Date of birth Felipe Rios 08/12/1984 Tiffany Rios 12/06/1985
Felipe Rios Seguro Social: 111-21-4521 Tiffany de los Ros 222-54-8489
Telephone: 787-794-4584
Felipe w2 wages 49,844
Tax withholding 3,419
Social security tax 3,090.32
Medicare withheld 722.73
480 7a
Interest paid by borrower 6,808
Property taxes 1,800
Principal balance 212,660
Loan term 180
Tiffany de los ros withholding
Wages 37,513
Refund Expense and fringe benefits 5,778
Tax withheld 2,551
Governmental retirement 4,313
Total wages for social security number 41,860
Social security tax 2,595
Medicare 608
Dependent 1: Patrick Rios De Los Rios Jr. Son
Date of Birth 12/01/2005 Social Security: 151-56-4156
Dependent 2: Maria Rios De Los Rios Daughter
Date of Birth 06/25/2008 Social Security: 165-14-5616
Required: Complete the income tax return for 2022 form 1040 using the information provided
and considering this couple as residents of Puerto Rico. Consider Schedule CO if it suits the
taxpayer..
Case studyData Protect and PrivacyHuman beings value their priva.pdf
Case study
Data Protect and Privacy
Human beings value their privacy and the protection of their personal sphere of life. They value
some control over who knows what about them. They certainly do not want their personal
information to be accessible to just anyone at any time. But recent advances in information
technology threaten privacy and have reduced the amount of control over personal data and open
up the possibility of a range of negative consequences as a result of access to personal data. In
the second half of the 20th century data protection regimes have been put in place as a response
to increasing levels of processing of personal data. The 21st century has become the century of
big data and advanced information technology (e.g. forms of deep learning), the rise of big tech
companies and the platform economy, which comes with the storage and processing of exabytes
of data. The technical capabilities to collect, store and search large quantities of data concerning
telephone conversations, internet searches and electronic payment are now in place and are
routinely used by government agencies and corporate actors alike. The rise of China and the
large scale of use and spread of advanced digital technologies for surveillance and control have
only added to the concern of many. For business firms, personal data about customers and
potential customers are now also a key asset. Source:https://plato.stanford.edu/entries/it-privacy/
As more phishing scams emerge, the more important it is for businesses and individuals to be
protected against these cyber-attacks. Discuss FIVE (5) effective techniques to keep phishing
attacks at bay?.
CASE STUDY [30 Marks] Former Tongaat Hulett bosses in court for frau.pdf
CASE STUDY [30 Marks] Former Tongaat Hulett bosses in court for fraud Just over two years
after charges were laid against them, former Tongaat Hulett Limited chief executive Peter Staude
and six others accused of defrauding the sugar and property giant of R2.5-billion have finally
appeared in court. The group of former executives charged over the fraud includes Deloitte audit
partner Gavin Kruger, who was responsible for auditing Tongaats books; former chief financial
officer Murray Munro; former property division head Michael Deighton, finance section head
Rory Wilkinson; legal executive Kamlasagrie Singh and finance executive Samantha Shukla.
They appeared in the Durban commercial crimes court on Thursday and were granted bail of
R30 000 each. They will appear in court again on 11 April, then the matter will be transferred to
the high court. Straude and his co-accused backdated sale agreements by Tongaats property
division to the value of R2.5-billion between March 2015 and September 2018, when the fraud
was discovered by the new Tongaat board, which appointed a forensic investigation. By inflating
the companys profits, they scored themselves millions of rand in productivity bonuses based on
the fraudulent sales, with Straude alone raking in R94-million by cooking the books. Their greed
cost nearly 8 000 workers in Tongaats sugar division and its milling operations their jobs when
the company moved to sell off assets and reduce its debt, while the firm and its suppliers
sustained huge losses. The company has gone after Staudes assets and those of Munro and
Deighton. It instituted a high court claim against them for R450-million in 2020, seeking
repayment of all the bonuses, salary payments and benefits it had paid them during their tenure.
Tongatt also wants the court to attach the accuseds pensions, which it has withheld pending the
outcome of the civil and criminal matters. According to the charge sheet, the seven had acted
with common purpose in planning to falsify sales figures and defraud the company. The group
also actively associated themselves with the common purpose, and worked together to
misrepresent the true state of the revenue brought about by sales of land by Tongaat Hulett
Development (THD), and to falsify the financial records of THD and or Tongaat Hulett Limited.
They had overstated the company revenue by R2.4-billion, an act which, once discovered,
exposed Tongaat to negative publicity and has been brought into disrepute with shareholders,
lenders, regulatory authorities and the broader public. Their fraudulent conduct cost Tongaat
R44-milion to have its financial statements restated and it was fined a further R7.5million by
local bourse the JSE and R20-million by the Financial Sector Conduct Authority. The seven
knew that material inaccurate accounting records had been compiled and maintained which were
ultimately processed and incorporated into the financial statements, the indictment said, adding:
The financial stateme.
Case Study Liberty and the Elderly Patient Ronald is 71 years old..pdf
Case Study
Liberty and the Elderly Patient Ronald is 71 years old. A widower, he lives alone in an
apartment, but he regularly receives some assistance from a cleaning woman and a friendly
neighbor. Ronald is presently in Metropolitan hospital, because he had a fall and suffered a
broken leg. Now that he has begun to heal, he is ready to be discharged. Ronald also suffers from
arteriosclerosis, a condition that results in his experiencing periods of confusion during which he
sometimes wanders purposelessly around his apartment building and sometimes wandering
around the city. This type of behavior has run some risks for Ronald in the past, and his children
do not want him to return to his apartment. The children believe that he needs the supervised care
provided in a nursing home. Ronald, when not in a confused state, repeatedly expresses his
awareness of the problems he faces stemming from his arteriosclerosis and the resultant risks that
he runs. Nonetheless, he would rather run those risks than be confined to institutional care. The
health care professionals and Ronalds children decide that he cannot be discharged from
Metropolitan hospital until an appropriate nursing home is found. At that time, he will be sent to
the nursing home. When Ronald insists to being discharged from the hospital, the nurses sedate
him to a level sufficient to gain his compliance.
1. If Ronalds adult children decided that he is capable of returning to his apartment with his
neighbor and his cleaning lady assisting him, would the medical professionals and the social
workers at the hospital be able to detain him against Ronalds will and his childrens will? In your
opinion, would this situation similar to a battered child/ spouse scenario where the abused person
is returned to the abuser? _______
2. If Ronald is deemed to be mentally incompetent because of his medical condition, his oldest
daughter will become his legal guardian. In your own words, explain how the removal of
Ronalds self-determination and autonomy in the hospital and the nursing home have made him
more vulnerable and dependent on his children and medical care givers. (will he be better off
/worse off if someone else is making decisions for him _______
3. In your opinion, what is the best possible outcome for Ronald? Please choose 1 (A -Ronald is
allowed to go home to his apartment B- He moves into his daughters house, C - he is sent to the
County Nursing home) Explain why your solution will put Ronald at the lowest risk and Please
indicate if you agree or disagree with what has happened to Ronald so far in our case.
Case Study AMr. P tripped and broke her left hip while attempting.pdf
Case Study A:
Mr. P tripped and broke her left hip while attempting to go to the bathroom in the middle of the
night. Prior to this episode, she has been living alone and spend most of her days watching
television. She last presented 3 months ago after she has had a fall at home. At that time, she had
no serious injuries.
Mrs. P was taken to surgery and underwent an ORIF for her fracture. She did well post-op and
was discharged to a rehab facility. The physician overseeing her rehab started her on alendronate
once a week in addition to calcium with vitamin D.
Youre the discharging nurse and Mrs. P has questions about her new medications. Answer each
question:
Case Study B:
Mrs. Davis presented to the clinic in December of 2010 with some concerns about osteoporosis.
She was becoming more stooped and had already lost 1 in height over the last few years. She
was 20 years postmenopausal and had never taken hormone replacement therapy. She
subsequently received a DEXA scan at that time and was placed on Fosamax 10 mg daily. Over
the next year, this seemed to be working well for her and she did not experience any side effects
from the medication. In the fall of 2011, she sustained a fracture to her 4th metacarpal on her left
hand that she suffered during a fall. She received another DEXA scan in late 2011 with no
change. She seemed fairly stable and was only seen yearly after that time. During a repeat exam
in 2013, DEXA scores continued to show progression and she was subsequently referred to an
endocrinologist to eliminate secondary causes. After a thorough work-up, no cause was found for
her worsening osteoporosis. Thyroid studies were normal as well as serum phosphorus, PTH and
urine calcium. suggestion was made to switch to weekly Fosamax; however, this was not
tolerated well and she remains on Fosamax 10 mg q.d.
1. Identify and discuss at least 6 risk factors in Mrs. Davis history that predispose her to
osteoporosis. (3 points)
2. Which of those risk factors are intrinsic and not amenable to change? Which are extrinsic and
can be modified? (2 points)
3. Evaluate her calcium intake from her diet and supplements; is it adequate for her age and
menopausal status? (1 point)
4. Formulate a recommendation for vitamin and mineral intake for Mrs. Davis, including specific
compounds, doses and directions. (2 points)
5. Evaluate Mrs. Davis level of physical activity and make any recommendations you think
necessary. (2 points).
Case Study - Rescuing a Troubled Project C.A. McCall-Peat Liberty Li.pdf
Case Study - Rescuing a Troubled Project C.A. McCall-Peat Liberty Life, Johannesburg, South
Africa P.O. Box 10499, Johannesburg, 2000, South Africa, telephone +27 11 408-3687, fax +27
11 408-3650, email: c..t@liberty.co.za Summary This case study outlines a troubled project and
the issues faced by the project. The case study attendees are asked to analyze the project
information provided and to recommend courses of action to bring the project back on track.
Attendees are also asked to suggest actions that could be taken on future similar projects to
mitigate encountering similar problems. The key lessons learnt could be applied by other
organizations to avoid common pitfalls which result in projects going off track, as well as
knowing the telltale signs of troubled projects and actions to take to bring them back on track.
This is an interactive session, which utilizes group discussion to facilitate the adult learning
experience. Background A leading financial services company embarked on a new product
development project. The nature of the company's business is that it operates in an extremely
competitive environment that necessitates fast delivery to market so as to prevent competitor
companies from gaining dominant market share with similar competitive products. The key
success factors of the project were, therefore, time to market and quality. Cost of delivery was
not a major concern. Scope The scope of the project was to make a new investment product,
including the systems changes, the policy documents, marketing launch material, and the
administrative user training. The project was divided into sub-projects consisting of: Systems,
Marketing, Training, and Legal. A project manager was appointed, as well as sub-project co-
coordinators. Time Scales The launch date was set as 1 June 2002. The product had to be ready
for launch on this date, as all the marketing material would reflect this date and the launch had to
precede the launch of similar products from competitors. The project start date was 3 December
2001. The tasks that had been completed prior to 3 December were the Business Case
compilation and approval and the project team establishment. Technology The systems
development was to be done using the Java programming language and environment, which was
new to the development team. The developers were sent on Java programming training 2 weeks
prior to the project start. The developers were used to working in a COBOL programming
environment and had not worked with any object-oriented languages before. Case Study
Summary of Events Business Case Development The Product Development Department
developed the Business Case for the proposed new product, including projected cost/benefit
analysis based on previous similar products and current market share. The Business Case was
reviewed by Executive Management and approved. Requirements Definition The Product
Development Department developed the requirements specification for the new product. .
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