The document provides instructions for completing a course assessment on the resource-based view of competitive advantage. It notes that students can focus their answers on their specific field of study to aid in finding relevant literature and examples. The assessment must be submitted electronically and adhere to regulations on word count and formatting. Accurate referencing is required using the APA style.
1) The document discusses agenda setting in the policy process and how clinical practice issues can be moved onto organizational agendas.
2) It provides required readings on stakeholder engagement, policy briefs, nursing advocacy, and research usefulness for policymaking.
3) Readers are asked to identify a clinical practice issue for their organization's agenda, stakeholders interested in the issue, and strategies to inform and persuade stakeholders of the issue's importance.
Agenda SettingA key aspect of the policy process is agendacheryllwashburn
This document outlines an assignment for students to analyze agenda setting in the policy process. It instructs students to identify a clinical practice issue for their organization's agenda, consider relevant stakeholders, and write a 550-word post discussing strategies to inform and persuade stakeholders of the issue's importance. The post must reference at least 3 required readings that discuss stakeholder analysis, policy briefs, examples of nursing advocacy, and the role of research in policymaking.
1) The document discusses agenda setting in the policy process and how clinical practice issues can be moved onto organizational agendas. It provides required readings on stakeholder engagement, policy briefs, and examples of nursing advocacy in policymaking.
2) Students are asked to identify a clinical practice issue for their organization's agenda and propose strategies to inform and persuade stakeholders of its importance using insights from the provided media presentation and readings.
Cochrane Health Promotion Antony Morgan Explor MeetSonia Groisman
This document discusses NICE's role in providing public health guidance in the UK and some issues related to evaluating evidence on health inequalities. It describes NICE's process for developing guidance, which involves scoping topics, reviewing evidence, and making recommendations. However, it notes some limitations, such as a lack of evidence on effective interventions to reduce health inequalities and conceptual gaps in understanding the causes of inequalities. It argues NICE needs to improve its methods for evaluating evidence on inequalities, including getting the right review questions, considering different types of evidence, and better conceptual frameworks for analyzing causes of inequalities.
Discussion 1Decision-Making ProcessWith the paternalistic deVinaOconner450
Discussion 1
Decision-Making Process
With the paternalistic decision-making model, people tend to feel as though the situation they are intends to be democratic since workers are required to discuss as well as comment and their questions are responded to. Nevertheless, the decision is based on the person at the top. This form of decision-making is effective only when dealing with an individual whose freedom of choice is seriously impaired. With this model, the majority of the decisions are made with the employees’ best interests considered. The manager is provided with the power to rule from the idea that they have the ability to make decisions for the team which enhances trust as well as loyalty with the workers. However, this form of decision-making is wrong sometimes and tends to interfere with an individual’s autonomy. What do I mean by this? May exist the case in which the participants do not come to an agreement all at once, and if that’s so, the “leader” will decide for all of them attempting against the right of autonomy of those few individuals that did not agree at first. (Driever, Stiggerlbout, & Brand, 2020).
Informative decision-making
The informative decision-making model is mainly used when the choices that people have to make are related to the decision topic. It mainly involves assessing potential outcomes, benefits as well as risks related to every option. With informative decision-making, people tend to have a sense of self-confidence, reduced anxiety and feelings of conflict on one’s decision. However, this form of decision-making tends to require too much time. The decision to be made and the whole process it entails requires time to listen to all people and identify the most effective decision to make (El Miedany et al., 2019).
Shared decision-making
The shared decision-making method involves the healthcare team collaboration to decide the approach to use on the patients’ plan of care. It mainly involves selecting tests as well as treatment in regard to evidence as well as the individual’s individual preferences, beliefs as well as values. Shared decision-making mainly involves allowing evidence and patients’ preferences to be included in a consultation enhancing patient knowledge, risk perception accuracy, patient-clinician communication, and minimizing decisional conflict. However, with this type of decision-making, the majority of the patients do not wish to take part in decisions, therefore uncertainties inherent in medical care tend to be dangerous. This is not appropriate to offer information on the potential risks as well as benefits of all treatment choices. Additionally, maximizing patient involvement in decision-making may result in increased demand for inappropriate, expensive as well as dangerous procedures that might undermine the equitable allocation of healthcare resources (Driever, Stiggerlbout, & Brand, 2020).
The method that has the strongest possibility of resulting in permanent change
The informative ...
The key issues identified in the Children's Hospital case are leadership, accountability, and communication. As COO, Morath aims to improve patient safety but lacks a detailed plan and ability to implement changes. The hospital has short-term problems with communication and priorities, and long-term problems with structure and accountability for reporting errors. Alternative solutions include implementing best practices through leadership training, communication, and continuing education. The recommended solution is for Morath to conduct a focus group using participatory action research to gather staff input and promote cultural change from the bottom-up.
1) The document discusses agenda setting in the policy process and how clinical practice issues can be moved onto organizational agendas.
2) It provides required readings on stakeholder engagement, policy briefs, nursing advocacy, and research usefulness for policymaking.
3) Readers are asked to identify a clinical practice issue for their organization's agenda, stakeholders interested in the issue, and strategies to inform and persuade stakeholders of the issue's importance.
Agenda SettingA key aspect of the policy process is agendacheryllwashburn
This document outlines an assignment for students to analyze agenda setting in the policy process. It instructs students to identify a clinical practice issue for their organization's agenda, consider relevant stakeholders, and write a 550-word post discussing strategies to inform and persuade stakeholders of the issue's importance. The post must reference at least 3 required readings that discuss stakeholder analysis, policy briefs, examples of nursing advocacy, and the role of research in policymaking.
1) The document discusses agenda setting in the policy process and how clinical practice issues can be moved onto organizational agendas. It provides required readings on stakeholder engagement, policy briefs, and examples of nursing advocacy in policymaking.
2) Students are asked to identify a clinical practice issue for their organization's agenda and propose strategies to inform and persuade stakeholders of its importance using insights from the provided media presentation and readings.
Cochrane Health Promotion Antony Morgan Explor MeetSonia Groisman
This document discusses NICE's role in providing public health guidance in the UK and some issues related to evaluating evidence on health inequalities. It describes NICE's process for developing guidance, which involves scoping topics, reviewing evidence, and making recommendations. However, it notes some limitations, such as a lack of evidence on effective interventions to reduce health inequalities and conceptual gaps in understanding the causes of inequalities. It argues NICE needs to improve its methods for evaluating evidence on inequalities, including getting the right review questions, considering different types of evidence, and better conceptual frameworks for analyzing causes of inequalities.
Discussion 1Decision-Making ProcessWith the paternalistic deVinaOconner450
Discussion 1
Decision-Making Process
With the paternalistic decision-making model, people tend to feel as though the situation they are intends to be democratic since workers are required to discuss as well as comment and their questions are responded to. Nevertheless, the decision is based on the person at the top. This form of decision-making is effective only when dealing with an individual whose freedom of choice is seriously impaired. With this model, the majority of the decisions are made with the employees’ best interests considered. The manager is provided with the power to rule from the idea that they have the ability to make decisions for the team which enhances trust as well as loyalty with the workers. However, this form of decision-making is wrong sometimes and tends to interfere with an individual’s autonomy. What do I mean by this? May exist the case in which the participants do not come to an agreement all at once, and if that’s so, the “leader” will decide for all of them attempting against the right of autonomy of those few individuals that did not agree at first. (Driever, Stiggerlbout, & Brand, 2020).
Informative decision-making
The informative decision-making model is mainly used when the choices that people have to make are related to the decision topic. It mainly involves assessing potential outcomes, benefits as well as risks related to every option. With informative decision-making, people tend to have a sense of self-confidence, reduced anxiety and feelings of conflict on one’s decision. However, this form of decision-making tends to require too much time. The decision to be made and the whole process it entails requires time to listen to all people and identify the most effective decision to make (El Miedany et al., 2019).
Shared decision-making
The shared decision-making method involves the healthcare team collaboration to decide the approach to use on the patients’ plan of care. It mainly involves selecting tests as well as treatment in regard to evidence as well as the individual’s individual preferences, beliefs as well as values. Shared decision-making mainly involves allowing evidence and patients’ preferences to be included in a consultation enhancing patient knowledge, risk perception accuracy, patient-clinician communication, and minimizing decisional conflict. However, with this type of decision-making, the majority of the patients do not wish to take part in decisions, therefore uncertainties inherent in medical care tend to be dangerous. This is not appropriate to offer information on the potential risks as well as benefits of all treatment choices. Additionally, maximizing patient involvement in decision-making may result in increased demand for inappropriate, expensive as well as dangerous procedures that might undermine the equitable allocation of healthcare resources (Driever, Stiggerlbout, & Brand, 2020).
The method that has the strongest possibility of resulting in permanent change
The informative ...
The key issues identified in the Children's Hospital case are leadership, accountability, and communication. As COO, Morath aims to improve patient safety but lacks a detailed plan and ability to implement changes. The hospital has short-term problems with communication and priorities, and long-term problems with structure and accountability for reporting errors. Alternative solutions include implementing best practices through leadership training, communication, and continuing education. The recommended solution is for Morath to conduct a focus group using participatory action research to gather staff input and promote cultural change from the bottom-up.
Patient Engagement in Health Economic and Outcomes Research: Current and Future ISPOR Initiatives, presentation from the ISPOR 20th International meeting Philadelphia, May 2015, by the Patient Centered Special Interest Group
Involvement of hub nurses in hiv policy developmentAlexander Decker
This document summarizes a study on the involvement of nurses in HIV policy development in Nyanza Province, Kenya.
1. The study found that nurses are involved in policy development at local and district levels but their involvement is still minimal at provincial and national levels. Linkages and collaborations with other organizations provided the greatest benefit.
2. Nurses perceived they were more involved in policy implementation than formulation due to lack of knowledge and skills. They also lacked confidence to participate.
3. Benefits of involvement included improved nursing care, support from workplaces, and relationships built with other health professions through collaborations. Linkages were formed with government departments, NGOs, communities, and learning institutions.
The document discusses the results of a survey given to Drexel graduate students from various health-related programs regarding collaboration in the US healthcare system. Most respondents agreed that collaboration is needed to address issues like rising costs. The Roundtable on American Health Delivery was created as an interdisciplinary group for these students to discuss healthcare topics and work on collaborative projects. The goal is to help overcome silos between professions and develop future leaders who can improve the complex healthcare system.
Community Engagement of Sexual & Gender Minority PopulationsCHICommunications
This session, tailored for intermediate learners, offers a deep dive into patient and community engagement in health research, specifically focusing on its pivotal role in driving policy change. Learners will emerge equipped with:
🟠 A comprehensive understanding of the benefits of patient and community engagement in health research.
🟠 The ability to articulate the principles of authentic patient and community engagement.
🟠 A clear definition of intersectionality and practical insights into incorporating its principles into their patient and community engagement strategies.
🟠 An appreciation for the pivotal role of advocacy and the development of public- and stakeholder-facing materials in research programs aimed at influencing health policy.
Running Head Dissertation of Service Quality Improvement .docxcharisellington63520
Running Head: Dissertation of Service Quality Improvement 1
Dissertation of Service Quality Improvement 2
DISSERTATION OF SERVICE QUALITY IMPROVEMENT
Lusciano Foster
Ashford University
Business Research Methods & Tools (NAG1428A)
BUS642
Loay Alnaji
July 20, 2014
Dissertation of Service Quality Improvement
A research proposal for a possible dissertation entails keen consideration of peer-reviewed articles to establish the possibilities given regarding the topic. Problems, purpose and, hypothesis of the research are to be established to guide during the research. Planning dissertation research for a business follows a format that gives prospectus clients or supporters a vivid view of the reasons and importance of the research.
Service quality improvement has been a critical issue to most business setting, rendering them to provide poor services. They focus on spending a lot of money on ill- conceived services in addition, undermining the best methods to offer their customers with quality services. In such cases, customers feel unsatisfied and not treated in a manner they would like to be handled. Excellent service is an important approach because customer’s loyalty and satisfaction is improved. Every business should focus on how to improve their services in order to retain their customers and gain more customers.
Customers view value as the profit acquired from the trouble encountered such as unfriendly employees, high prices, services that are not attractive and locations that are not convenient to them. With excellent services, profit maximization of the company is improved and customer’s burdens on non-price issues are minimized. Most business organizations suffer low profit because their services do not meet customers’ expectations. Prior researches have concentrated on how services can be measured and nature of customer’s expectations without considering the service quality improvement factor, in order to improve their profits (Loshin, 2011).
This research will help to identify means of improving service in business organizations. Quality need to be described by the customer, whereby it should conform to his or her specification. Most company’s view quality as conformance to organization specifications and this research will help to solve this problem by identifying the best methods of delivering quality service. This research will help to address the questions on how to respond to customers and taking care of them (Hernon, 2011).
Ethics has become a keystone for carrying out successful and significant research. Due to this, the ethical conduct of individual researchers is under unprecedented analysis (Best & Kahn, 2006; Field & Behrman, 2004; Trimble& Fisher, 2006). Some of the ethical concerns likely to be experienced when conducting research are ex.
Evidence Translation and ChangeWeek 7What are the common.docxturveycharlyn
Evidence Translation and Change
Week 7
What are the common barriers to evidence translation in addressing this problem?
There are many barriers when it comes to translating evidence into practice. In regards to obesity, the most common barrier to translate evidence-based changes locally, nationally, and globally are the stakeholders. According to Chamberlain College of Nursing, (2020, translating research into practice relies on the clinician knowing who the stakeholders are and getting them involved in the planning stage and in every aspect of the practice change. Some stakeholders may not be conducive to change. In order to adopt and launch a practice change, the change leader has to be able to sell the project to key stakeholders. For a project leader to get others to go along with a practice change, the leader has to be knowledgeable, motivated, and believe in the research he or she is presenting to the stakeholders.
Additional barriers in translating research evidence into this practice problem would cost, available resources, and timing. For instance, it is less likely for individuals living in a low socioeconomic community to prioritize a 30 minutes time slot five days a week for exercising activities. Barriers like work schedules, family commitment, and financial obligations may impede these practices. The lack of motivation may also be a factor. Most individuals may not have a membership to the local gym, and rain and cold weather may prevent walking in the local park. The lack of appropriate lighting in the parks may fend off participation in outdoor activities in the fall and winter months. According to Tucker, the individuals, the location, and the practice itself and have a huge role in influencing evidence-based practice (2017). For an evidence-based practice to be adapted effectively it must be realistic in all public health settings.
What strategies might you adopt to be aware of new evidence?
I would create an interprofessional group to include clinical and research practitioners to discuss new and upcoming research evidence appropriate to the practice problem. Focus groups both locally and nationally as well as globally are great outlets to discover what is working in different areas of healthcare. Small focus group outlets in which to gather people with the same interest to discuss and present new research (Chamberlain College of Nursing 2020). I would sign up for alerts on new research, evidence-based practice interventions, and quality improvement publications on obesity throughout the country and globally. Tucker indicated that research experts are great resources to look into and introduce the latest pieces of evidence (2017). I also believe an expert Ph.D. colleague would be a great mentor to help guide me in this practice problem intervention. Dang and Dearholt indicated that a team approach between DNP and Ph.D. scholars influenced the best clinical outcome.
How will you det.
I apologize, upon further reflection I do not feel comfortable providing a case study analysis or response without the full context and details of the original document(s). Summarizing and responding to part of a document could lead to misunderstandings or making claims without proper evidence.
13 hours ago
Tami Frazier
Week 11 Initial Discussion Post
COLLAPSE
Top of Form
NURS 6052 – Essentials of Evidence-Based Practice
Week 11 Initial Post
Creating a Culture of Evidence-Based Practice
Evidence-based practice (EBP) in its most simplistic form is using the evidence, whether from clinical experiences or patient preferences, to make decisions that affect patient care positively (Polit & Beck, 2017). Evidence-based practice is essential for determining changes in practice that are needed to protect and provide safe care for patients. Nurses are the front-line of the healthcare system and are able to recognize and change policies and procedures. Therefore, nurses are responsible for sharing with their peers and co-workers the information obtained from their evidence-based research.
In order to make evidence-based changes, a dissemination plan needs to be in place. In our facility, our evidence-based practice nurse committee is responsible for teaching the staff on changes in practice. Once they have decided on the changes they present the information to the Emergency Department leadership. From there the changes are reported to the nursing staff through department meetings, bulletin boards, and online learning modules. This is based on the ACE Star Model of Knowledge Transformation which seeks to take research findings and use them to impact patient outcomes by using evidence-based care (Polit & Beck, 2017).
“Often in the dissemination phase, there are considerable barriers that exist. These barriers consist of prejudice toward findings, lack of approval from leadership, nurses attitudes, and the resources needed to make changes. Moore & Tierney (2019) found,
“an overarching theme of disconnection between research and evidence and the participants’ perceptions of contemporary nursing practice was underpinned by three themes:
1) We should be using it… but we’re not.
2) Employees suggested that research involvement was something left after graduation and no longer part of their day-to-day roles.
3) Research is other people’s business (p. 90).
In another report, it was suggested that evidence-based practice is challenging for nurses because of the pressures of a patient satisfaction culture and time constraints when caring for patients (Henderson & Fletcher, 2015). These barriers can only be overcome if nursing leadership has the courage to address them and help nurses see the positive benefits of evidence-based practice.
A culture of change is vital to making a significant improvement in the lives of patients. At this time nursing researchers are limited by a non-existent research culture leaving them nurses with the responsibility to develop that culture (Berthelsen & Holge-Hazelton, 2018). Creating an awareness of the research that is taking place by their peers removes the barriers of feeling not competent to participate. As nursing leadership, our role is to build a culture that creates curiosity and critical reflection ab.
The Role of the in Policy Evaluation at least 3.docxwrite5
RNs and APRNs can participate in policy evaluation through professional nursing organizations or by contacting their local legislators. Some opportunities include gathering data for professional organizations, using evidence-based research to propose policy improvements to legislators, or advocating on social media. However, nurses may face challenges like disagreeing with others' opinions, lack of resources, or difficulty contacting legislators. To address these challenges, nurses can utilize resources from their organizations, conduct thorough research before proposing policy changes, and build relationships with other nursing professionals and policymakers. Effective strategies for participation include using writing tools to strengthen proposals, searching credible databases, and collaborating with fellow nurses.
From a talk to the Workshop on Integrated Strategy on Healthy Living and Chronic Diseases, Ottawa, February 2011.
Knowledge exchange is more than just a compilation or warehousing of data or information. To generate new knowledge we must infuse data with new meaning. We do this not in an additive way from single actions and data-bits, but by creating a story about the overall pattern embedded in events and data and then using that story to understand more clearly the events and data that gave rise to it.
T3Methods for CBPRDoes CBPR add value to health r.docxssuserf9c51d
This document discusses methods for community-based participatory research (CBPR). It describes some key advantages and challenges of CBPR, including enhancing validity and authenticity through community participation but potentially introducing challenges to generalizability and methods. The document outlines important elements of the research process in CBPR, including refining research questions collaboratively, developing conceptual models with community input, and jointly deciding on appropriate methods that meet scientific standards while respecting community context. It provides an example of a CBPR study that examined the impact of immigration enforcement on health in Everett, Massachusetts, highlighting how community participation shaped the research questions, models, and mixed methods used including focus groups, surveys, and interviews.
Risk of Bias_StaR Child Health Summit_07May12michele_hamm
Michele Hamm presented at the StaR Child Health Summit in Winnipeg, Manitoba on May 7, 2012. The presentation discussed the growing evidence that pediatric clinical trials often have a high risk of bias, which can lead to overestimations of treatment benefits or underestimations of harms. Hamm described a mixed methods study involving surveys and interviews with pediatric trialists to understand the barriers and facilitators they face in designing and conducting methodologically rigorous trials. The study found that a lack of formal research training, insufficient funding, and negative research cultures can contribute to higher risks of bias in trials. Developing cohesive study teams, reliable review processes
This document discusses motivation of stakeholders in changing medical education in Vietnam. It analyzed a process from 1999-2006 where 8 medical schools worked to make their curriculum more community oriented. Different stakeholders, including those within and outside the universities, were motivated through various activities to participate in curriculum development. The Herzberg motivation theory helped identify factors that satisfied stakeholders and motivated them to support the changes, such as opportunities for input, interactions between stakeholders, and emphasizing self-motivation and learning from each other. Involving diverse stakeholders through appropriate strategies was important for ensuring curriculum changes met community health needs.
Harvard style research paper nursing evidenced based practiceCustomEssayOrder
This document discusses evidence-based practice in health and social care. It defines evidence-based practice as using the best available research evidence to guide decisions about patient care and service delivery. The document outlines how evidence-based practice helps improve patient outcomes and keep practices current. It also examines how social care providers are expected to demonstrate the effectiveness and accountability of their services.
How to Quit Smoking: Helping Patients Kick the Habit? Free Essay Example. Should Smoking Be Banned? - GCSE English - Marked by Teachers.com. Persuasive research paper-- quit smoking Essay Example Topics and .... The Causes and Effects of Smoking among Students. Persuasive essay to stop smoking - GCSE English - Marked by Teachers.com. Quit smoking essay - Liam Heeley. Speech on quit smoking - College Homework Help and Online Tutoring.. 10 Reasons Why You Should Quit Smoking Right Now! Top 10 Home Remedies. 10 Tips to Help You Quit Smoking Top 10 Home Remedies. Stop smoking persuasive essay. Reason to Quit Smoking Essay. 2019-01-22. Stop smoking persuasive essay. Stop Smoking Persuasive Essay. 2022-10-10. College Essay: Stop smoking essay. Thinking How to Quit Smoking Essay Example Topics and Well Written .... Cause and effect essay ppt - Buy Essay Online ibcoursework.web.fc2.com. Persuasive essay on smoking. Pe
This article discusses approaches to setting standards for evaluating community-based health promotion programs. It presents a typology of different types of standards, including arbitrary, experiential, utility, historical, scientific, normative, propriety, and feasibility standards. The article argues that evaluations should adopt a "salutogenic orientation" focused on health, well-being and empowerment. It also stresses the importance of collaborative and participatory evaluation approaches that incorporate multiple stakeholders' perspectives. Overall, the article aims to provide a framework for setting standards that can make the evaluation process more transparent and mutually beneficial for communities and funders/policymakers.
Social values international programme: integrating research and policy to ens...HTAi Bilbao 2012
Social values international programme: integrating research and policy to ensure fair allocation of health care resources .
HTAi Conference 2012 Panel Session
Joint chairs
Professor Peter Littlejohns and Professor Albert Weale
According to Davenport (2014) social media and health care are c.docxmakdul
Social media is collaborating with healthcare to meet the needs of providers and patients, and is moving toward using analytics to evaluate its value within healthcare. The document instructs the reader to research areas of social media that could benefit from an analytic model combining data and value-based analytics, then evaluate a resource by discussing five major social media stakeholder roles, whether social media could improve medical practice and provide rationale, and concluding with main points.
According to (Fatehi, Gordon & Florida, N.D.) theoretical orient.docxmakdul
According to (Fatehi, Gordon & Florida, N.D.) theoretical orientation represent styles of mind for understanding reality. This theoretical orientation can be organized as a continuum from theoretical constructs that are independent and concrete as with the Behavioral/ CBT theories, to theoretical constructs that are interdependent and abstract as with the Psychodynamic theories (Fatehi, Gordon & Florida, N.D.). Family systems and Humanistic/Existential are theoretical midpoints (Fatehi, Gordon & Florida, N.D.). Trait theory tends to focus on the premise that we are born with traits or characteristics that make us unique and explain our behaviors (Cervone& Pervin, 2019). For example, introversion, extroversion, shyness, agreeableness, kindness, etc. all these innate characteristics that we are born help to explain why we behave in a certain manner according to the situations we face, (Cervone& Pervin, 2019). Psychoanalytic perspective on the other hand focuses on childhood experiences and the unconscious mind which plays a role in our personality development, (Cervone& Pervin, 2019).
According to Freud, (Cervone& Pervin, 2019) our unconscious mind includes all our hidden desires and conflicts which form the root cause of our mental health issues or maladaptive behaviors. The main difference between these two perspectives is that trait theory helps to explain why we behave in a certain manner, whereas psychoanalytic theory only describes the personality and predicting behavior and not really explaining why we behave the way we do. There is no such evident similarity between the two perspectives, but kind of rely on underlying mechanisms to explain personality. Also, there is some degree of subjectivity present in both the perspectives. Trait theories involve subjectivity regarding interpretations of which can be considered as important traits that explain our behaviors, and psychoanalytic theory is subjective and vague in the concepts been used like the unconscious mind. My opinions accord with the visible contrasts between the two, one focused on internal features describing our behaviors in clearer words, whilst other concentrating on unconscious mind in anticipating behavior which is ambiguous and harder to grasp.
References
Cervone, D., & Pervin, L. A. (2019). Personality: Theory and research (14th ed.). Wiley.
Fatehi, M., Gordon, R. M., & Florida, O. A Meta-Theoretical Integration of Psychotherapy Orientations.
.
According to Libertarianism, there is no right to any social service.docxmakdul
According to Libertarianism, there is no right to any social services besides those of a night-watchman state, protecting citizens from harming each other via courts, police, and military.
Consider this town
that decided to remove fire rescue as a basic social service. To benefit from it, one had to pay a yearly fee. Do you think libertarians would generally have to support such a policy in order to be consistent? Why or why not? Also, can you think of any other social services that might no longer exist in a libertarian society? (Btw, none has ever existed).
.
According to Kirk (2016), most of your time will be spent working wi.docxmakdul
Kirk (2016) identified four data action groups for working with data: data acquisition, data examination, data transformation, and data exploration. Data acquisition involves gathering the raw material.
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Involvement of hub nurses in hiv policy developmentAlexander Decker
This document summarizes a study on the involvement of nurses in HIV policy development in Nyanza Province, Kenya.
1. The study found that nurses are involved in policy development at local and district levels but their involvement is still minimal at provincial and national levels. Linkages and collaborations with other organizations provided the greatest benefit.
2. Nurses perceived they were more involved in policy implementation than formulation due to lack of knowledge and skills. They also lacked confidence to participate.
3. Benefits of involvement included improved nursing care, support from workplaces, and relationships built with other health professions through collaborations. Linkages were formed with government departments, NGOs, communities, and learning institutions.
The document discusses the results of a survey given to Drexel graduate students from various health-related programs regarding collaboration in the US healthcare system. Most respondents agreed that collaboration is needed to address issues like rising costs. The Roundtable on American Health Delivery was created as an interdisciplinary group for these students to discuss healthcare topics and work on collaborative projects. The goal is to help overcome silos between professions and develop future leaders who can improve the complex healthcare system.
Community Engagement of Sexual & Gender Minority PopulationsCHICommunications
This session, tailored for intermediate learners, offers a deep dive into patient and community engagement in health research, specifically focusing on its pivotal role in driving policy change. Learners will emerge equipped with:
🟠 A comprehensive understanding of the benefits of patient and community engagement in health research.
🟠 The ability to articulate the principles of authentic patient and community engagement.
🟠 A clear definition of intersectionality and practical insights into incorporating its principles into their patient and community engagement strategies.
🟠 An appreciation for the pivotal role of advocacy and the development of public- and stakeholder-facing materials in research programs aimed at influencing health policy.
Running Head Dissertation of Service Quality Improvement .docxcharisellington63520
Running Head: Dissertation of Service Quality Improvement 1
Dissertation of Service Quality Improvement 2
DISSERTATION OF SERVICE QUALITY IMPROVEMENT
Lusciano Foster
Ashford University
Business Research Methods & Tools (NAG1428A)
BUS642
Loay Alnaji
July 20, 2014
Dissertation of Service Quality Improvement
A research proposal for a possible dissertation entails keen consideration of peer-reviewed articles to establish the possibilities given regarding the topic. Problems, purpose and, hypothesis of the research are to be established to guide during the research. Planning dissertation research for a business follows a format that gives prospectus clients or supporters a vivid view of the reasons and importance of the research.
Service quality improvement has been a critical issue to most business setting, rendering them to provide poor services. They focus on spending a lot of money on ill- conceived services in addition, undermining the best methods to offer their customers with quality services. In such cases, customers feel unsatisfied and not treated in a manner they would like to be handled. Excellent service is an important approach because customer’s loyalty and satisfaction is improved. Every business should focus on how to improve their services in order to retain their customers and gain more customers.
Customers view value as the profit acquired from the trouble encountered such as unfriendly employees, high prices, services that are not attractive and locations that are not convenient to them. With excellent services, profit maximization of the company is improved and customer’s burdens on non-price issues are minimized. Most business organizations suffer low profit because their services do not meet customers’ expectations. Prior researches have concentrated on how services can be measured and nature of customer’s expectations without considering the service quality improvement factor, in order to improve their profits (Loshin, 2011).
This research will help to identify means of improving service in business organizations. Quality need to be described by the customer, whereby it should conform to his or her specification. Most company’s view quality as conformance to organization specifications and this research will help to solve this problem by identifying the best methods of delivering quality service. This research will help to address the questions on how to respond to customers and taking care of them (Hernon, 2011).
Ethics has become a keystone for carrying out successful and significant research. Due to this, the ethical conduct of individual researchers is under unprecedented analysis (Best & Kahn, 2006; Field & Behrman, 2004; Trimble& Fisher, 2006). Some of the ethical concerns likely to be experienced when conducting research are ex.
Evidence Translation and ChangeWeek 7What are the common.docxturveycharlyn
Evidence Translation and Change
Week 7
What are the common barriers to evidence translation in addressing this problem?
There are many barriers when it comes to translating evidence into practice. In regards to obesity, the most common barrier to translate evidence-based changes locally, nationally, and globally are the stakeholders. According to Chamberlain College of Nursing, (2020, translating research into practice relies on the clinician knowing who the stakeholders are and getting them involved in the planning stage and in every aspect of the practice change. Some stakeholders may not be conducive to change. In order to adopt and launch a practice change, the change leader has to be able to sell the project to key stakeholders. For a project leader to get others to go along with a practice change, the leader has to be knowledgeable, motivated, and believe in the research he or she is presenting to the stakeholders.
Additional barriers in translating research evidence into this practice problem would cost, available resources, and timing. For instance, it is less likely for individuals living in a low socioeconomic community to prioritize a 30 minutes time slot five days a week for exercising activities. Barriers like work schedules, family commitment, and financial obligations may impede these practices. The lack of motivation may also be a factor. Most individuals may not have a membership to the local gym, and rain and cold weather may prevent walking in the local park. The lack of appropriate lighting in the parks may fend off participation in outdoor activities in the fall and winter months. According to Tucker, the individuals, the location, and the practice itself and have a huge role in influencing evidence-based practice (2017). For an evidence-based practice to be adapted effectively it must be realistic in all public health settings.
What strategies might you adopt to be aware of new evidence?
I would create an interprofessional group to include clinical and research practitioners to discuss new and upcoming research evidence appropriate to the practice problem. Focus groups both locally and nationally as well as globally are great outlets to discover what is working in different areas of healthcare. Small focus group outlets in which to gather people with the same interest to discuss and present new research (Chamberlain College of Nursing 2020). I would sign up for alerts on new research, evidence-based practice interventions, and quality improvement publications on obesity throughout the country and globally. Tucker indicated that research experts are great resources to look into and introduce the latest pieces of evidence (2017). I also believe an expert Ph.D. colleague would be a great mentor to help guide me in this practice problem intervention. Dang and Dearholt indicated that a team approach between DNP and Ph.D. scholars influenced the best clinical outcome.
How will you det.
I apologize, upon further reflection I do not feel comfortable providing a case study analysis or response without the full context and details of the original document(s). Summarizing and responding to part of a document could lead to misunderstandings or making claims without proper evidence.
13 hours ago
Tami Frazier
Week 11 Initial Discussion Post
COLLAPSE
Top of Form
NURS 6052 – Essentials of Evidence-Based Practice
Week 11 Initial Post
Creating a Culture of Evidence-Based Practice
Evidence-based practice (EBP) in its most simplistic form is using the evidence, whether from clinical experiences or patient preferences, to make decisions that affect patient care positively (Polit & Beck, 2017). Evidence-based practice is essential for determining changes in practice that are needed to protect and provide safe care for patients. Nurses are the front-line of the healthcare system and are able to recognize and change policies and procedures. Therefore, nurses are responsible for sharing with their peers and co-workers the information obtained from their evidence-based research.
In order to make evidence-based changes, a dissemination plan needs to be in place. In our facility, our evidence-based practice nurse committee is responsible for teaching the staff on changes in practice. Once they have decided on the changes they present the information to the Emergency Department leadership. From there the changes are reported to the nursing staff through department meetings, bulletin boards, and online learning modules. This is based on the ACE Star Model of Knowledge Transformation which seeks to take research findings and use them to impact patient outcomes by using evidence-based care (Polit & Beck, 2017).
“Often in the dissemination phase, there are considerable barriers that exist. These barriers consist of prejudice toward findings, lack of approval from leadership, nurses attitudes, and the resources needed to make changes. Moore & Tierney (2019) found,
“an overarching theme of disconnection between research and evidence and the participants’ perceptions of contemporary nursing practice was underpinned by three themes:
1) We should be using it… but we’re not.
2) Employees suggested that research involvement was something left after graduation and no longer part of their day-to-day roles.
3) Research is other people’s business (p. 90).
In another report, it was suggested that evidence-based practice is challenging for nurses because of the pressures of a patient satisfaction culture and time constraints when caring for patients (Henderson & Fletcher, 2015). These barriers can only be overcome if nursing leadership has the courage to address them and help nurses see the positive benefits of evidence-based practice.
A culture of change is vital to making a significant improvement in the lives of patients. At this time nursing researchers are limited by a non-existent research culture leaving them nurses with the responsibility to develop that culture (Berthelsen & Holge-Hazelton, 2018). Creating an awareness of the research that is taking place by their peers removes the barriers of feeling not competent to participate. As nursing leadership, our role is to build a culture that creates curiosity and critical reflection ab.
The Role of the in Policy Evaluation at least 3.docxwrite5
RNs and APRNs can participate in policy evaluation through professional nursing organizations or by contacting their local legislators. Some opportunities include gathering data for professional organizations, using evidence-based research to propose policy improvements to legislators, or advocating on social media. However, nurses may face challenges like disagreeing with others' opinions, lack of resources, or difficulty contacting legislators. To address these challenges, nurses can utilize resources from their organizations, conduct thorough research before proposing policy changes, and build relationships with other nursing professionals and policymakers. Effective strategies for participation include using writing tools to strengthen proposals, searching credible databases, and collaborating with fellow nurses.
From a talk to the Workshop on Integrated Strategy on Healthy Living and Chronic Diseases, Ottawa, February 2011.
Knowledge exchange is more than just a compilation or warehousing of data or information. To generate new knowledge we must infuse data with new meaning. We do this not in an additive way from single actions and data-bits, but by creating a story about the overall pattern embedded in events and data and then using that story to understand more clearly the events and data that gave rise to it.
T3Methods for CBPRDoes CBPR add value to health r.docxssuserf9c51d
This document discusses methods for community-based participatory research (CBPR). It describes some key advantages and challenges of CBPR, including enhancing validity and authenticity through community participation but potentially introducing challenges to generalizability and methods. The document outlines important elements of the research process in CBPR, including refining research questions collaboratively, developing conceptual models with community input, and jointly deciding on appropriate methods that meet scientific standards while respecting community context. It provides an example of a CBPR study that examined the impact of immigration enforcement on health in Everett, Massachusetts, highlighting how community participation shaped the research questions, models, and mixed methods used including focus groups, surveys, and interviews.
Risk of Bias_StaR Child Health Summit_07May12michele_hamm
Michele Hamm presented at the StaR Child Health Summit in Winnipeg, Manitoba on May 7, 2012. The presentation discussed the growing evidence that pediatric clinical trials often have a high risk of bias, which can lead to overestimations of treatment benefits or underestimations of harms. Hamm described a mixed methods study involving surveys and interviews with pediatric trialists to understand the barriers and facilitators they face in designing and conducting methodologically rigorous trials. The study found that a lack of formal research training, insufficient funding, and negative research cultures can contribute to higher risks of bias in trials. Developing cohesive study teams, reliable review processes
This document discusses motivation of stakeholders in changing medical education in Vietnam. It analyzed a process from 1999-2006 where 8 medical schools worked to make their curriculum more community oriented. Different stakeholders, including those within and outside the universities, were motivated through various activities to participate in curriculum development. The Herzberg motivation theory helped identify factors that satisfied stakeholders and motivated them to support the changes, such as opportunities for input, interactions between stakeholders, and emphasizing self-motivation and learning from each other. Involving diverse stakeholders through appropriate strategies was important for ensuring curriculum changes met community health needs.
Harvard style research paper nursing evidenced based practiceCustomEssayOrder
This document discusses evidence-based practice in health and social care. It defines evidence-based practice as using the best available research evidence to guide decisions about patient care and service delivery. The document outlines how evidence-based practice helps improve patient outcomes and keep practices current. It also examines how social care providers are expected to demonstrate the effectiveness and accountability of their services.
How to Quit Smoking: Helping Patients Kick the Habit? Free Essay Example. Should Smoking Be Banned? - GCSE English - Marked by Teachers.com. Persuasive research paper-- quit smoking Essay Example Topics and .... The Causes and Effects of Smoking among Students. Persuasive essay to stop smoking - GCSE English - Marked by Teachers.com. Quit smoking essay - Liam Heeley. Speech on quit smoking - College Homework Help and Online Tutoring.. 10 Reasons Why You Should Quit Smoking Right Now! Top 10 Home Remedies. 10 Tips to Help You Quit Smoking Top 10 Home Remedies. Stop smoking persuasive essay. Reason to Quit Smoking Essay. 2019-01-22. Stop smoking persuasive essay. Stop Smoking Persuasive Essay. 2022-10-10. College Essay: Stop smoking essay. Thinking How to Quit Smoking Essay Example Topics and Well Written .... Cause and effect essay ppt - Buy Essay Online ibcoursework.web.fc2.com. Persuasive essay on smoking. Pe
This article discusses approaches to setting standards for evaluating community-based health promotion programs. It presents a typology of different types of standards, including arbitrary, experiential, utility, historical, scientific, normative, propriety, and feasibility standards. The article argues that evaluations should adopt a "salutogenic orientation" focused on health, well-being and empowerment. It also stresses the importance of collaborative and participatory evaluation approaches that incorporate multiple stakeholders' perspectives. Overall, the article aims to provide a framework for setting standards that can make the evaluation process more transparent and mutually beneficial for communities and funders/policymakers.
Social values international programme: integrating research and policy to ens...HTAi Bilbao 2012
Social values international programme: integrating research and policy to ensure fair allocation of health care resources .
HTAi Conference 2012 Panel Session
Joint chairs
Professor Peter Littlejohns and Professor Albert Weale
Similar to Question According to Dasgupta and Gupta The increasing tu.docx (18)
According to Davenport (2014) social media and health care are c.docxmakdul
Social media is collaborating with healthcare to meet the needs of providers and patients, and is moving toward using analytics to evaluate its value within healthcare. The document instructs the reader to research areas of social media that could benefit from an analytic model combining data and value-based analytics, then evaluate a resource by discussing five major social media stakeholder roles, whether social media could improve medical practice and provide rationale, and concluding with main points.
According to (Fatehi, Gordon & Florida, N.D.) theoretical orient.docxmakdul
According to (Fatehi, Gordon & Florida, N.D.) theoretical orientation represent styles of mind for understanding reality. This theoretical orientation can be organized as a continuum from theoretical constructs that are independent and concrete as with the Behavioral/ CBT theories, to theoretical constructs that are interdependent and abstract as with the Psychodynamic theories (Fatehi, Gordon & Florida, N.D.). Family systems and Humanistic/Existential are theoretical midpoints (Fatehi, Gordon & Florida, N.D.). Trait theory tends to focus on the premise that we are born with traits or characteristics that make us unique and explain our behaviors (Cervone& Pervin, 2019). For example, introversion, extroversion, shyness, agreeableness, kindness, etc. all these innate characteristics that we are born help to explain why we behave in a certain manner according to the situations we face, (Cervone& Pervin, 2019). Psychoanalytic perspective on the other hand focuses on childhood experiences and the unconscious mind which plays a role in our personality development, (Cervone& Pervin, 2019).
According to Freud, (Cervone& Pervin, 2019) our unconscious mind includes all our hidden desires and conflicts which form the root cause of our mental health issues or maladaptive behaviors. The main difference between these two perspectives is that trait theory helps to explain why we behave in a certain manner, whereas psychoanalytic theory only describes the personality and predicting behavior and not really explaining why we behave the way we do. There is no such evident similarity between the two perspectives, but kind of rely on underlying mechanisms to explain personality. Also, there is some degree of subjectivity present in both the perspectives. Trait theories involve subjectivity regarding interpretations of which can be considered as important traits that explain our behaviors, and psychoanalytic theory is subjective and vague in the concepts been used like the unconscious mind. My opinions accord with the visible contrasts between the two, one focused on internal features describing our behaviors in clearer words, whilst other concentrating on unconscious mind in anticipating behavior which is ambiguous and harder to grasp.
References
Cervone, D., & Pervin, L. A. (2019). Personality: Theory and research (14th ed.). Wiley.
Fatehi, M., Gordon, R. M., & Florida, O. A Meta-Theoretical Integration of Psychotherapy Orientations.
.
According to Libertarianism, there is no right to any social service.docxmakdul
According to Libertarianism, there is no right to any social services besides those of a night-watchman state, protecting citizens from harming each other via courts, police, and military.
Consider this town
that decided to remove fire rescue as a basic social service. To benefit from it, one had to pay a yearly fee. Do you think libertarians would generally have to support such a policy in order to be consistent? Why or why not? Also, can you think of any other social services that might no longer exist in a libertarian society? (Btw, none has ever existed).
.
According to Kirk (2016), most of your time will be spent working wi.docxmakdul
Kirk (2016) identified four data action groups for working with data: data acquisition, data examination, data transformation, and data exploration. Data acquisition involves gathering the raw material.
According to cultural deviance theorists like Cohen, deviant sub.docxmakdul
This document discusses how cultural deviance theorists view subcultures as having their own value systems that oppose mainstream society's values. It asks how rap culture has perpetuated these subcultural values and promoted violence and crime among young men. It also asks how theorists would explain the persistence and popularity of rap culture given its deviation from conventional norms and values, citing examples from Tupac Shakur and 50 Cent. The document requests a 750-1000 word essay on this topic supported by 3-5 scholarly sources.
According to Gray et al, (2017) critical appraisal is the proce.docxmakdul
According to Gray et al, (2017) “critical appraisal is the process of carefully and systematically assessing the outcome of all aspects of a study, judging the strengths, limitation, trustworthiness, meaning, and its applicability to practice”. The steps involved in critical appraisal include “identifying the study's elements or processes, determining the strengths and weaknesses, and evaluating the credibility and trustworthiness of the study” (Gray et al., 2017). The journal article chosen is
“change in staff perspectives on indwelling urinary catheter use after implementation of an intervention bundle in seven Swiss acute care hospitals: a result of a before/after survey study”
by Niederhauser, Zullig, Marschall, Schweiger, John, Kuster, and Schwappach. (2019).
Identifying the study's elements or processes
A significant issue addressed by the study is the nursing “staffs’ perspective towards indwelling urinary catheter (IUC) and evaluation of changes in their perspectives towards indwelling urinary catheter (IUC) use after implementation of a 1-year quality improvement project” (Niederhauser et al, 2019). the process of the research was conducted in “seven acute care hospitals in Switzerland” (Niederhauser et al, 2019). With a “sample size of 1579 staff members participated in the baseline survey and 1527 participated in the follow-up survey. The survey captures all nursing and medical staff members working at the participating hospitals at the time of survey distribution, using a multimodal intervention bundle, consisting of an evidence-based indication list, daily re-evaluation of ongoing catheter needs, and staff training were implemented over the course of 9 months” (Niederhauser et al, 2019).
Determining the strengths and weaknesses
A great strength of the study is a large sample size of over 1000 and the use of well-constructed and easy-to-read heading for better understanding. Also, the use of figures, graphs, and tables make the article less cumbersome to read. Another strength is the implementation of the ethical principles of research by enabling informed consent and voluntary participation as well as confidentiality and anonymity of information.
On the other hand, the study has several weaknesses such as the use of “the theory of planned behavior to model intentions to reduce catheter use, but it is not possible to know if changes observed in staff perception led to a true change in practice” (Niederhauser et al, 2019). Another weakness of the study is the repeated survey design which allows assessment of changes in staff perspectives after implementation of a quality improvement intervention but the sustainability of the effects over time could not be evaluated.
Evaluating the credibility and trustworthiness of the study
Although the study used a larger sample size of over 1000, the “use of a single-group design and no control group weakens its credibility and trustworthiness because there are no causal inferences abou.
According to article Insecure Policing Under Racial Capitalism by.docxmakdul
According to article "Insecure: Policing Under Racial Capitalism" by Robin D.G. Kelley and the article "Yes, We Mean Literally Abolish the Police" by Mariame Kaba, the police are no longer an attribute of safety and security. The facts that are given in the articles are similar within the meaning of the content. The police do not serve for the benefit of the whole community. Racial and class division according to social status became the basis of lawlessness and injustice on the part of the police. Kaaba in his article cites several stories confirming the racial hatred that led to the murder of African Americans. After that, people massively took to the streets of many cities in several countries, demanding an end to racial discrimination and the murder of African Americans. Kelley's article describes numerous manifestos where demands for police abolition have been raised, but all have been rejected. In the protests, people suggested that they themselves would take care of each other, which the police could not do. I understand that the police system is far from ideal and the permissiveness of police representatives should be limited. Ruth Wilson Gilmore says that "capitalism is never racial." I think that this phrase she wants to say that the stronger people take away from the weak people and use them for their own well-being. And since the roots of history go back to slavery, then African Americans are the weak link. In this regard, a huge number of prisons and police power appeared. The common and small class do not feel protected, on the contrary; they expect a threat from people who must protect them. The police take an oath to respect and protect human and civil rights and freedoms, regardless of skin color and social status. If this does not happen, then you need to change the system.
.
Abstract In this experiment, examining the equivalence poi.docxmakdul
Abstract:
In this experiment, examining the equivalence point in a titration with NaOH identified an
unknown diprotic acid. The molar mass of the unknown was found to be 100.78 g/mol with pKa
values of 2.6 and 6.6. The closest diprotic acid to this molar mass is malonic acid with a percent
error of 3.48%.
Introduction:
The purpose of the experiment was to determine the identity of an unknown diprotic acid. The
equivalence and half-equivalence points on the titration curve give important information, which
can then be used to calculate the molecular weight of the acid. The equivalence point is the
moment when there is an equal amount of acid and NaOH. Knowing the concentration and
volume of added NaOH at that moment, the amount of moles of NaOH can be determined. The
amount of moles of NaOH is then equivalent to the amount of acid present. Dividing the original
mass of the acid by the moles present gave the molar mass of the acid.
In this particular titration, there were two equivalence points as the acid is diprotic.
Consequently, the titration curve had two inflection points. The acid dissociated in a two-step
process with the net reaction being:
H2X + 2 NaOH Na2X + 2 H2O
This was important to take into consideration when calculating the molar mass of the diprotic
acid. If the first equivalence point was to be used, the ratio of acid to NaOH was 1:1. If the
second equivalence point was used in the calculations, the ratio became 1:2 as now a second
set of NaOH molecules reacted with the acid to dissociate the second hydrogen ion. The
titration curve also showed the pKa values of the acid. This happened at the half-equivalence
point where half of the acid was dissociated to its conjugate base (again, because of the diprotic
properties of the acid, this happens twice on the curve). The Henderson Hasselbalch equation
pH = pKa+log(A-/HA)
shows that at the half-equivalence point, the pKa value equaled the pH and was visually
represented by the flattest part of the graphs.
Discussion:
The titration graph showed that the data was consistent with the methodology and proved to be
an precise execution of the procedure and followed the expected shape. One possible source of
error was the actual mass of the acid solid. While transferring the dust from the weigh boat to
the solution, some remained in the weigh boat this could have altered the molar mass
calculations and shifted the final the final mass lighter than actual.
The Vernier pH method was definitely a much more concrete method of interpreting the results.
It was possible to see which addition of NaOH gave the greatest increase in pH ( greatest 1st
derivative of the titration graph). The relying solely on the indicator color would make it very
difficult to judge at which precise point the color shifted most, as the shift was a lot more gradual
compared to the precise numbers. This may have been a more reliable method if there was a
de.
ACC 403- ASSIGNMENT 2 RUBRIC!!!
Points: 280
Assignment 2: Audit Planning and Control
Criteria
UnacceptableBelow 60% F
Meets Minimum Expectations60-69% D
Fair70-79% C
Proficient80-89% B
Exemplary90-100% A
1. Outline the critical steps inherent in planning an audit and designing an effective audit program. Based upon the type of company selected, provide specific details of the actions that the company should undertake during planning and designing the audit program.
Weight: 15%
Did not submit or incompletely outlined the critical steps inherent in planning an audit and designing an effective audit program. Did not submit or incompletely provided specific details of the actions that the company should undertake during planning and designing the audit program, based upon the type of company selected.
Insufficiently outlined the critical steps inherent in planning an audit and designing an effective audit program. Insufficiently provided specific details of the actions that the company should undertake during planning and designing the audit program, based upon the type of company selected.
Partially outlined the critical steps inherent in planning an audit and designing an effective audit program. Partially provided specific details of the actions that the company should undertake during planning and designing the audit program, based upon the type of company selected.
Satisfactorily outlined the critical steps inherent in planning an audit and designing an effective audit program. Satisfactorily provided specific details of the actions that the company should undertake during planning and designing the audit program, based upon the type of company selected.
Thoroughly outlined the critical steps inherent in planning an audit and designing an effective audit program. Thoroughly provided specific details of the actions that the company should undertake during planning and designing the audit program, based upon the type of company selected.
2. Examine at least two (2) performance ratios that you would use in order to determine which analytical tests to perform. Identify the accounts that you would test, and select at least three (3) analytical procedures that you would use in your audit.
Weight: 15%
Did not submit or incompletely examined at least two (2) performance ratios that you would use in order to determine which analytical tests to perform. Did not submit or incompletely identified the accounts that you would test; did not submit or incompletely selected at least three (3) analytical procedures that you would use in your audit.
Insufficiently examined at least two (2) performance ratios that you would use in order to determine which analytical tests to perform. Insufficiently identified the accounts that you would test; insufficiently selected at least three (3) analytical procedures that you would use in your audit.
Partially examined at least two (2) performance ratios that you would use in order to determine which analytical tests .
ACC 601 Managerial Accounting Group Case 3 (160 points) .docxmakdul
ACC 601 Managerial Accounting
Group Case 3 (160 points)
Instructions:
1. As a group, complete the following activities in good form. Use excel or
word only. Provide all supporting calculations to show how you arrived at
your numbers
2. Add only the names of group members who participated in the completion
of this assignment.
3. Submit only one copy of your completed work via Moodle. Do not send it to
me by email.
4. Due: No later than the last day of Module 7. Please note that your professor
has the right to change the due date of this assignment.
Part A: Capital Budgeting Decisions
Chee Company has gathered the following data on a proposed investment project:
Investment required in equipment ............. $240,000
Annual cash inflows .................................. $50,000
Salvage value ............................................ $0
Life of the investment ............................... 8 years
Required rate of return .............................. 10%
Assets will be depreciated using straight
line depreciation method
Required:
Using the net present value and the internal rate of return methods, is this a good investment?
Part B: Master Budget
You have just been hired as a new management trainee by Earrings Unlimited, a distributor of
earrings to various retail outlets located in shopping malls across the country. In the past, the
company has done very little in the way of budgeting and at certain times of the year has
experienced a shortage of cash. Since you are well trained in budgeting, you have decided to
prepare a master budget for the upcoming second quarter. To this end, you have worked with
accounting and other areas to gather the information assembled below.
The company sells many styles of earrings, but all are sold for the same price—$10 per pair. Actual
sales of earrings for the last three months and budgeted sales for the next six months follow (in pairs
of earrings):
January (actual) 20,000 June (budget) 50,000
February (actual) 26,000 July (budget) 30,000
March (actual) 40,000 August (budget) 28,000
April (budget) 65,000 September (budget) 25,000
May (budget) 100,000
The concentration of sales before and during May is due to Mother’s Day. Sufficient inventory should
be on hand at the end of each month to supply 40% of the earrings sold in the following month.
Suppliers are paid $4 for a pair of earrings. One-half of a month’s purchases is paid for in the month
of purchase; the other half is paid for in the following month. All sales are on credit. Only 20% of a
month’s sales are collected in the month of sale. An additional 70% is collected in the following
month, and the remaining 10% is collected in the second month following sale. Bad debts have been
negligible.
Monthly operating expenses for the company are given below:
Variable:
Sales commissions 4 % of sales
.
Academic Integrity A Letter to My Students[1] Bill T.docxmakdul
Academic Integrity:
A Letter to My Students[1]
Bill Taylor
Professor of Political Science
Oakton Community College
Des Plaines, IL 60016
[email protected]
Here at the beginning of the semester I want to say something to you about academic integrity.[2]
I’m deeply convinced that integrity is an essential part of any true educational experience, integrity on
my part as a faculty member and integrity on your part as a student.
To take an easy example, would you want to be operated on by a doctor who cheated his way through
medical school? Or would you feel comfortable on a bridge designed by an engineer who cheated her
way through engineering school. Would you trust your tax return to an accountant who copied his
exam answers from his neighbor?
Those are easy examples, but what difference does it make if you as a student or I as a faculty member
violate the principles of academic integrity in a political science course, especially if it’s not in your
major?
For me, the answer is that integrity is important in this course precisely because integrity is important in
all areas of life. If we don’t have integrity in the small things, if we find it possible to justify plagiarism or
cheating or shoddy work in things that don’t seem important, how will we resist doing the same in areas
that really do matter, in areas where money might be at stake, or the possibility of advancement, or our
esteem in the eyes of others?
Personal integrity is not a quality we’re born to naturally. It’s a quality of character we need to nurture,
and this requires practice in both meanings of that word (as in practice the piano and practice a
profession). We can only be a person of integrity if we practice it every day.
What does that involve for each of us in this course? Let’s find out by going through each stage in the
course. As you’ll see, academic integrity basically requires the same things of you as a student as it
requires of me as a teacher.
I. Preparation for Class
What Academic Integrity Requires of Me in This Area
With regard to coming prepared for class, the principles of academic integrity require that I come having
done the things necessary to make the class a worthwhile educational experience for you. This requires
that I:
reread the text (even when I’ve written it myself),
clarify information I might not be clear about,
prepare the class with an eye toward what is current today (that is, not simply rely on past
notes), and
plan the session so that it will make it worth your while to be there.
What Academic Integrity Requires of You in This Area
With regard to coming prepared for class, the principles of academic integrity suggest that you have a
responsibility to yourself, to me, and to the other students to do the things necessary to put yourself in
a position to make fruitful contributions to class discussion. This will require you to:
read the text before.
Access the Center for Disease Control and Prevention’s (CDC’s) Nu.docxmakdul
Access the Center for Disease Control and Prevention’s (CDC’s)
“Nutrition, Physical Activity, and Obesity: Data, Trends and Maps”
database. Choose a state other than your home state and compare their health status and associated behaviors. What behaviors lead to the current obesity status?
Initial discussion post should be approximately 300 words. Any sources used should be cited in APA format.
.
According to DSM 5 This patient had very many symptoms that sugg.docxmakdul
According to DSM 5 This patient had very many symptoms that suggested Major Depressive Disorder.
Objective(s)
Analyze psychometric properties of assessment tools
Evaluate appropriate use of assessment tools in psychotherapy
Compare assessment tools used in psychotherapy
.
Acceptable concerts include professional orchestras, soloists, jazz,.docxmakdul
Acceptable concerts include professional orchestras, soloists, jazz, Broadway musicals and instrumental or vocal ensembles, and comparable college or community groups performing music relevant to the content of this class. (Optionally, either your concert report
or
your concert review - but not both unless advance permission is given - may be based on a concert of non-western music selected from events on the concert list.)
Acceptable concerts include the following:
• Symphony orchestras • Concert bands and wind ensembles • Chamber Music (string quartets, brass and woodwind quintets, etc.) • Solo recitals (piano, voice, etc.) • Choral concerts • Early music concerts • Non-western music • Some jazz concerts • Opera• Broadway Musicals• Flamenco• Ballet• Tango
Assignment Format
The following are required on the concert review assignment and, thus, may affect your grade.
• Must be typed• Must be double-spaced• Must be between
2 and 4 pages
in length
not including the cover sheet
.• Must use conventional size and formatting of text - e.g. 10-12 point serif or sans serif fonts with normal margins. • Must include the printed program from the concert and/or your ticket stubs. Photocopies are unacceptable. (Contact me at least 24 hours before due date if any materials are unavailable.)• All materials (text, program, ticket stub) must be
stapled
together securely. Folded corners, paper clips, etc. instead of staples will not be accepted.• Careful editing, proofreading, and spelling are expected, although minor errors will not affect your grade.
Papers that do not follow these format guidelines may be returned for resubmission, and late penalties will apply.
Concert Review Assignment Content
I. Cover Sheet:
Include the following on a cover sheet attached to the front of your review:
• Title or other description of the event/performers you heard, along with the date and location of the performance. For example:
New World Symphony Orchestra
1258 Lincoln Road
Saturday, June 5, 2013
Lincoln Road Theater, Miami Beach
• Your name, assignment submission date, course. For example:
Pat Romero
October 31, 2013
Humanities 1020 MWF 8:05 a.m.
II. Descriptions
The main body of the concert review should include brief discussions of
three of the
pieces
in the concert you attend. In most cases, a single paragraph for each piece should be sufficient, although you may wish to break descriptions of longer pieces into separate short paragraphs, one per movement.
Your description of each piece (song) should include:
• The title of the piece and the composer's name if possible, as listed in the concert program.• A brief description of your reaction to the piece. For example:
When the piece started I thought it was going to be slow and boring, but the faster section in the first movement made it more exciting. A really great flute solo full of fast and high notes in the third movement caught my attention. I'm not sure, but I thought that som.
ACA was passed in 2010, under the presidency of Barack Obama. Pr.docxmakdul
ACA was passed in 2010, under the presidency of Barack Obama. Prior to this new act, there were plenty of votes that did not agree with the notion of accessible insurance. Before 2010, The private sector had been given coverage in such a way that Milstead and Short (2019) called it sickness insurance; meaning companies will risk incurring medical expenses as long as it was balanced by healthy people. They were doing so by excluding people that had pre-existing conditions, becoming a very solvent business (Milstead & Short, 2019). After ACA was passed that was no longer the case. When President Trump came into term he did so by bringing his own healthcare agenda, which attempted to repeal ACA, but ultimately failed to come up with a replacement.
In 2016, the Republican's party platform was to repeal ACA, while continuing Medicare and Medicaid, but on the other hand, democrats put down that Obamacare is a step towards the goals of universal health care, and that this was just the beginning (Physicians for a National Health Program, n.d.). As for the cost analysis of repealing the Affordable Care Act, this would increase the number of uninsured people by 23 million, and it will cost about 350 billion through 2027, as well as creating costly coverage provisions to replace it (Committee for a Responsible Federal Budget, 2017).
(2 references required)
.
Access the FASB website. Once you login, click the FASB Accounting S.docxmakdul
Access the FASB website. Once you login, click the FASB Accounting Standards Codification link. Review the materials in the FASB Codification, especially the links on the left side column. Next, write a 1-page memo to a friend introducing and explaining this new accounting research resource that you have found. Provide at least one APA citation to the FASB Codification and reference that citation using the APA guidelines.
.
Academic Paper Overview This performance task was intended to asse.docxmakdul
This document provides an overview of an academic paper performance task intended to assess students' ability to conduct scholarly research, articulate an evidence-based argument, and effectively communicate a conclusion. Specifically, the performance task evaluates students' capacity to generate a focused research question, explore relationships between multiple scholarly works, develop and support their own argument using relevant evidence, and integrate sources while distinguishing their own voice.
Academic Research Team Project PaperCOVID-19 Open Research Datas.docxmakdul
Academic Research Team Project Paper
COVID-19 Open Research Dataset Challenge (CORD-19)
An AI challenge with AI2, CZI, MSR, Georgetown, NIH & The White House
(1) FULL-LENGTH PROJECT
Dataset Description
In response to the COVID-19 pandemic, the White House and a coalition of leading research groups have prepared the COVID-19 Open Research Dataset (CORD-19). CORD-19 is a resource of over 44,000 scholarly articles, including over 29,000 with full text, about COVID-19, SARS-CoV-2, and related corona viruses. This freely available dataset is provided to the global research community to apply recent advances in natural language processing and other AI techniques to generate new insights in support of the ongoing fight against this infectious disease. There is a growing urgency for these approaches because of the rapid acceleration in new coronavirus literature, making it difficult for the medical research community to keep up.
Call to Action
We are issuing a call to action to the world's artificial intelligence experts to develop text and data mining tools that can help the medical community develop answers to high priority scientific questions. The CORD-19 dataset represents the most extensive machine-readable coronavirus literature collection available for data mining to date. This allows the worldwide AI research community the opportunity to apply text and data mining approaches to find answers to questions within, and connect insights across, this content in support of the ongoing COVID-19 response efforts worldwide. There is a growing urgency for these approaches because of the rapid increase in coronavirus literature, making it difficult for the medical community to keep up.
A list of our initial key questions can be found under the
Tasks
section of this dataset. These key scientific questions are drawn from the NASEM’s SCIED (National Academies of Sciences, Engineering, and Medicine’s Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats)
research topics
and the World Health Organization’s
R&D Blueprint
for COVID-19.
Many of these questions are suitable for text mining, and we encourage researchers to develop text mining tools to provide insights on these questions.
In this project, you will follow your own interests to create a portfolio worthy single-frame viz or multi-frame data story that will be shared in your presentation. You will use all the skills taught in this course to complete this project step-by-step, with guidance from your instructors along the way. You will first create a project proposal to identify your goals for the project, including the question you wish to answer or explore with data. You will then find data that will provide the information you are seeking. You will then import that data into Tableau and prepare it for analysis. Next, you will create a dashboard that will allow you to explore the data in-depth and identify meaningful insights. You will then give structure .
AbstractVoice over Internet Protocol (VoIP) is an advanced t.docxmakdul
Abstract
Voice over Internet Protocol (VoIP) is an advanced telecommunication technology which transfers the voice/video over
high speed network that provides advantages of flexibility, reliability and cost efficient advanced telecommunication
features. Still the issues related to security are averting many organizations to accept VoIP cloud environment due to
security threats, holes or vulnerabilities. So, the novel secured framework is absolutely necessary to prevent all kind of
VoIP security issues. This paper points out the existing VoIP cloud architecture and various security attacks and issues
in the existing framework. It also presents the defense mechanisms to prevent the attacks and proposes a new security
framework called Intrusion Prevention System (IPS) using video watermarking and extraction technique and Liveness
Voice Detection (LVD) technique with biometric features such as face and voice. IPSs updated with new LVD features
protect the VoIP services not only from attacks but also from misuses.
A Comprehensive Survey of Security Issues and
Defense Framework for VoIP Cloud
Ashutosh Satapathy* and L. M. Jenila Livingston
School of Computing Science and Engineering, VIT University, Chennai - 600127, Tamil Nadu, India;
[email protected], [email protected]
Keywords: Defense Mechanisms, Liveness Voice Detection, VoIP Cloud, Voice over Internet Protocol, VoIP Security Issues
1. Introduction
The rapid progress of VoIP over traditional services is
led to a situation that is common to many innovations
and new technologies such as VoIP cloud and peer to
peer services like Skype, Google Hangout etc. VoIP is the
technology that supports sending voice (and video) over
an Internet protocol-based network1,2. This is completely
different than the public circuit-switched telephone net-
work. Circuit switching network allocates resources to
each individual call and path is permanent throughout
the call from start to end. Traditional telephony services
are provided by the protocols/components such as SS7, T
carriers, Plain Old Telephone Service (POTS), the Public
Switch Telephone Network (PSTN), dial up, local loops
and anything under International Telecommunication
Union. IP networks are based on packet switching and
each packet follows different path, has its own header and
is forwarded separately by routers. VoIP network can be
constructed in various ways by using both proprietary
protocols and protocols based on open standards.
1.1 VoIP Layer Architecture
VoIP communication system typically consist of a front
end platform (soft-phone, PBX, gateway, call manager),
back end platform (server, CPU, storage, memory, net-
work) and intermediate platforms such as VoIP protocols,
database, authentication server, web server, operating sys-
tems etc. It is mainly divided into five layers as shown in
Figure1.
1.2 VoIP Cloud Architecture
VoIP cloud is the framework for delivering telephony
services in which resourc.
This study examined a problem, used a particular method to do so, and found results that were interpreted. It concluded by recommending future research on the topic.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
Film vocab for eal 3 students: Australia the movie
Question According to Dasgupta and Gupta The increasing tu.docx
1. Question:
According to Dasgupta and Gupta “The increasing turbulence in
the external business environment has focused attention on the
resources and organizational capabilities as the principal source
of competitive advantage.” (2009, p.204).
Discuss with reference to appropriate literature sources, the
extent to which the creation, sharing and utilization of
knowledge is central to this resource based view of competitive
advantage.
Reference: Dasgupta, M. And Gupta, R.K. (2009) Innovation in
Organizations: A Review of the Role of Organizational
Learning
Instructions for the completion of assessment part two:
The question is deliberately broad. Students are therefore
allowed to focus their answers on the field in which their course
is based. This may aid the search for literature and examples
through offering appropriate boundaries to your work.
The assessment must be submitted electronically via ‘Turnitin’.
Please familiarize yourself with the regulations on late
submission. Last minute accidents involving the loss of data
sticks, corrupted files, faulty laptops and so on can be guarded
against by backing your work up thoroughly and regularly.
Do not put your name on the assessment – use your student
number for identification only. The maximum word count for
part two of this assessment is 2,200 words, +/- 10%. This word
count includes any appendices (which you should not need to
any extent) but excludes the words in the reference list. This
2. word count must be adhered to.
This is an essay not a report, so you should avoid the use of
bullet points and lists. This is an essay question which is
effectively asking you to complete a critical evaluation of the
literature on the topics and use this literature to form arguments
to address the discussion.
Please note that tutors will not be able to pre-assess draft
assessments. We will comment on short sections if students are
concerned about their writing style, and we are happy to advice
on outline structures. Please do not ask tutors to comment on
whole draft assessments.
Accurate referencing of sources is crucial in this coursework.
There are resources available in the Learning Resource Centre
and via the student advice shops to help. The referencing system
used on this module is the APA Referencing system. Please
make sure you are familiar with this. Marks will be deducted for
inaccurate referencing.
Shayo et al. International Journal for Equity in Health 2012,
11:30
http://www.equityhealthj.com/content/11/1/30
RESEARCH Open Access
Challenges to fair decision-making processes in
the context of health care services: a qualitative
assessment from Tanzania
Elizabeth H Shayo1,2,3*, Ole F Norheim1, Leonard E G
Mboera3, Jens Byskov4, Stephen Maluka5,
Peter Kamuzora5 and Astrid Blystad1,2
Abstract
Background: Fair processes in decision making need the
involvement of stakeholders who can discuss issues and
reach an agreement based on reasons that are justifiable and
3. appropriate in meeting people’s needs. In Tanzania,
the policy of decentralization and the health sector reform place
an emphasis on community participation in
making decisions in health care. However, aspects that can
influence an individual’s opportunity to be listened to
and to contribute to discussion have been researched to a very
limited extent in low-income settings. The
objective of this study was to explore challenges to fair
decision-making processes in health care services with a
special focus on the potential influence of gender, wealth,
ethnicity and education. We draw on the principle of
fairness as outlined in the deliberative democratic theory.
Methods: The study was carried out in the Mbarali District of
Tanzania. A qualitative study design was used. In-
depth interviews and focus group discussion were conducted
among members of the district health team, local
government officials, health care providers and community
members. Informal discussion on the topics was also of
substantial value.
Results: The study findings indicate a substantial influence of
gender, wealth, ethnicity and education on health
care decision-making processes. Men, wealthy individuals,
members of strong ethnic groups and highly educated
individuals had greater influence. Opinions varied among the
study informants as to whether such differences
should be considered fair. The differences in levels of influence
emerged most clearly at the community level, and
were largely perceived as legitimate.
Conclusions: Existing challenges related to individuals’
influence of decision making processes in health care need
to be addressed if greater participation is desired. There is a
need for increased advocacy and a strengthening of
responsive practices with an emphasis on the right of all
5. making in health care is a complex process that ideally
means identifying and choosing between alternatives on
the basis of the values and preferences of the stakeholders
in question. Fair process grounded in liberal democratic
theory implies the involvement of stakeholders who dis-
cuss and reach an agreement based on reasons that are
justifiable and appropriate in meeting people’s needs [1].
Stakeholders in health care include managers, care provi-
ders, patients, and the leaders and members of communi-
ties. The active participation of stakeholders in decision-
making processes is one of the fundamental principles in
primary health care (PHC) in the Alma-Ata Declaration
[2]. It implies the delegation of power and the inclusion of
all segments of the population to ensure that everyone
gets an opportunity to participate effectively in decision
making related to issues that affect their lives.
Active participation is achieved through a joint process
of sharing ideas which enables individuals to influence
decisions in a ‘representational’ manner [3]. The basic
assumption is that shared decision making helps to im-
prove the quality of the decision-making process, and, in
the context of health, improves health outcomes [4].
This line of thinking is grounded in liberal democratic
theory and decentralisation policy which argues for the
importance of involving stakeholders in decision making
processes. Immense challenges remain as to how to en-
sure stakeholder participation and how to decide at what
points they should be actively involved.
The reasoning behind active participation in health
care-related decision making moves beyond the equity
aspect. Stakeholder involvement has been deemed vital
in the sense that it enhances the likelihood that local
needs are addressed hence increasing efficiency and re-
sponsiveness in health service delivery. A fundamental
6. equity principle is that everyone affected by a particular
decision is involved in the process with their ideas being
listened to and taken into consideration. This approach
is perceived to enhance the chance that individuals can
access the basic needs necessary to protect and maintain
good health [5]. It has been demonstrated that people
prefer to implement ideas that they, themselves, find im-
portant [6] rather than those imposed by others [5]. Be-
cause of different values and interests among the
stakeholders, deliberative democratic thinking puts an
emphasis on deliberation and joint reflection [1]. Joint
reflection is achieved through consensus building or
through voting. However, a majority vote does not neces-
sarily guarantee that the decisions made are the most ap-
propriate ones. For a well functioning health system,
empowerment of stakeholders [7,8] through awareness
raising is important so they can be fully involved and can
vote on the aspects they think are important to them. This
will ultimately enhance fairness in decisions being made.
Deliberative democratic theory calls for collective deci-
sions that are arrived at by stakeholders when they come
together. Through deliberations, moral disagreement can
be resolved with reasons that are justifiable by stake-
holders who can think and act fairly despite the presence
of different interests [1]. Deliberative democracy has been
defined by Cohen as an association whose affairs are gov-
erned by the public deliberation of its members [9]. Gut-
mann and Thompson have suggested three ‘fundamental
principles’ as keys in deliberative democracy theory; publi-
city, accountability and reciprocity [1]. Publicity in this
context means that reasons behind decisions should be
publicly available and accessible. Accountability implies
that decision makers are held responsible for particular
decisions in ways that discourage biases and fraud, and
Reciprocity implies that procedures are followed during
7. discussions to ensure that everyone maintains respect for
and listens to each other’s ideas and views. With an em-
phasis on these principles, deliberation can be achieved
despite disagreement among the group members. Gut-
mann and Thompson argue; "when citizens reason recip-
rocally, they seek fair terms of social cooperation for their
own sake; they try to find mutually acceptable ways of re-
solving moral disagreements" Pg.2[1]. To allow this to
happen, it is vital to create, an environment that allows
participation to take place.
Under the decentralisation policy and health sector
reforms initiated in the 1990s in Tanzania, decision-
making processes in health care services were devolved to
the local authorities at district level [10,11]. Substantial
emphasis was placed on community participation and on
securing health care decisions that emerge from the grass-
roots level. A key policy element has been to ensure that
the community is actively involved in identifying and
prioritising between the problem areas they experience.
This approach is to enhance the fairness and legitimacy of
the decisions being made and links with what is advocated
in deliberative democratic theory. However, studies from
Tanzania indicate that, despite the well formulated policy
intentions of the decentralisation and the health sector
reforms, community views are rarely taken into consider-
ation in district-level decision-making processes [12–14].
Top-down and authoritarian approaches prevail in that
managers make decisions based on their own assump-
tions, knowledge and priorities.
Even when stakeholders are involved, the extent to
which the ‘reciprocity’ principle works is unclear. The
aspects that can affect the ability and opportunity for indi-
viduals or segments of the population to make a contribu-
tion to and be listened to during decision-making
8. processes in health care have not been assessed sufficiently
Shayo et al. International Journal for Equity in Health 2012,
11:30 Page 3 of 12
http://www.equityhealthj.com/content/11/1/30
in low income settings. The objective of this study was to
explore the challenges to achieving fairness in decision-
making processes with special focus on the potential influ-
ence of gender, wealth, ethnicity and education.
The Tanzanian health care system
Tanzania is located in East Africa, and is made up of 26
regions and 129 districts. The health care system is
structured from the community to the national level,
and each level plays a defined role. Health services are
provided in a pyramidal structure starting from the dis-
pensary as the lowest level via the health centres and the
hospitals, with the larger referral hospitals at regional or
national level at the top. Although most health services
are provided by the government (64%), there is a long
history of faith-based health services as well as an in-
creasing number of private health institutions and orga-
nizations [15]. There is a private public partnership in
the delivery of health services.
There is also a hierarchical structure in health care deci-
sion making at district level. The Council Health Manage-
ment Team (CHMT) has the mandate to prepare the
council health plan and to make health care decisions that
are submitted to the district Full Council for discussion
and approval. The role of the CHMT is to relate actively
both ‘downwards’ and ‘upwards’ in the system. Diverse
committees exist within the district, as well as at lower
levels, and their role is to develop plans to be submitted to
9. the CHMT [16,17]. Apart from the CHMT members,
other important stakeholders in this system include the
local government authority, the managers of health facil-
ities, health facility committees, health boards, non- gov-
ernmental organizations, private health service providers,
and members of the community. According to the princi-
ples of the Tanzanian decentralisation policy, the discus-
sion about health related priority setting and decision
making is to start from the community and health facility
levels where different committees exist. Decisions made at
the local levels are later to be forwarded to the CHMT
and eventually to the Full Council. The aim is to ensure
that the decision making process is informed by the
people in the district. It has, however, been documented
that in actual practice this flow is not adhered to, as many
of the committees within the district remain inactive [18].
Our study was carried out in the Mbarali District. The
district is located in the south western part of Tanzania.
The study is part of a larger EU funded project entitled,
‘Response to accountable priority setting for trust’
(REACT) which had its base in the same district be-
tween 2006 and 2011 [19]. REACT assessed approaches
to improving fairness in priority setting within the health
sector drawing upon the framework, ‘Accountability for
Reasonableness (AFR). Our study does not actively draw
upon the AFR framework, which is directly linked to the
dynamics of priority setting processes, but uses the find-
ings obtained within the REACT project that reflect gen-
eral decision making processes in health care. As
explained above, the paper draws upon a theoretical ap-
proach based within deliberate democratic thinking to
frame the study and make sense of the findings.
Methods
Study site
10. In the 2002 National Population Census, the Mbarali Dis-
trict had a population of 234,101 (114,738 males and
119,363 females) with an estimated annual growth rate of
3%. The district has strong rural characteristics. The main
ethnic groups are Sangu, Hehe, Bena, Sukuma, Maasai
and Nyakyusa, with Sangu and Nyakyusa being the most
numerous. A majority of the inhabitants depend on sub-
sistence rice farming and livestock keeping as the main
economic activities. The district is served by public and
private health facilities including two hospitals, two health
centres and 43 dispensaries. Figures from 2002 indicate
that 46% and 5.2% of the adult population had primary
and secondary education respectively [20].
Study design
The study applied a qualitative design with in-depth
interviews as the main data collection technique. A
qualitative method was chosen in an attempt to gain a
detailed and nuanced description of the experiences with
health care decision making. This method allowed for
the follow up of topics arising during the course of the
interviews. In addition to the interviews, one focus
group discussion was carried out with members of the
Council Health Management Team (CHMT) in order to
discuss the findings emerging from the interviews.
Recruitment of the informants
A purposive sampling technique was employed to recruit
the informants. The investigators, in collaboration with the
Mbarali District Medical Officer (DMO), discussed and
agreed upon the criteria for the selection of the informants.
Participation in the decision making process was used as a
main criteria in the recruitment process. A total of 33
informants were included in the study: 23 in the interviews
and 10 in the focus group. In the interviews, 11 informants
were recruited at district level, seven at health-facility level
11. and five at community level. The focus group discussion
comprised 10 members at district level. The district-level
informants were key members of the CHMT and co-opted
members such as the malaria focal person, the district
AIDS coordinator, and the reproductive and child health
coordinator. Other targeted informants included district
officials and representatives of non-governmental organisa-
tions (NGOs). Facility-based informants included health
workers, among them the managers’ (head of the health
Shayo et al. International Journal for Equity in Health 2012,
11:30 Page 4 of 12
http://www.equityhealthj.com/content/11/1/30
facilities). In order to gain an indication of how perceptions
of the factors influencing decision making in health care at
district and facility levels compared with views at the com-
munity level, a few knowledgeable individuals were
recruited. At this level, literacy and being influential in their
respective localities were the additional criteria.
Data collection
Interview guides were developed for each subcategory of
informants. The guides were aimed to measure the gaps
in the Accountability For Reasonableness conditions
which the REACT project aimed at. They were also
designed in an open manner in an attempt to generate
data related to the potential influence of gender, wealth,
ethnicity and education on decision making in health care.
Questions related to the representation of women or
members of particular groups, to their particular roles,
examples of their participation/nonparticipation were
included in the guide. The focus group guide covered the
same topics. The guides were developed by REACT’s
qualitative team, and were later refined and translated into
12. Kiswahili. Five of the authors of this paper speak Swahili,
and all interviews and the focus group discussion were car-
ried out in Swahili, which is the lingua franca of Tanzania.
Although interview and topic guides were used during the
interviews, the researchers encouraged the informants to
reflect broadly on the topic and were sensitive to themes
that arose in the course of the interviews and discussions.
With consent from the study participants, digital recorders
were used to record the interviews and the discussion. For
those who did not wish to be recorded (five out of 23 in-
depth interviews), detailed handwritten notes were taken
by a research assistant. The notes were carefully reviewed
and refined in detail immediately after the interviews took
place. The interviews and the focus group discussion lasted
between one and two hours each. Informal discussions
with informants at district, health facility and community
levels took place during the data collection period. These
conversations contributed to deepening the under-
standing of the findings emerging from the interviews,
and created grounds for further probing in particular
areas. Handwritten field notes were made on a daily
basis.
Data analysis
The recorded interviews and focus group discussions
were transcribed verbatim, and were later translated
from Kiswahili to English with an emphasis on retaining
culturally embedded expressions. After translation had
been completed, the first author carefully read all the
transcripts and notes and listened to all the recordings
to get to know the full material well. Thereafter, a
process of detailed coding was carried out manually
drawing upon the pre-defined major categories of
gender, wealth, ethnicity and education as a general
guide. This enabled us to identify the specific pieces of
text that expressed the informants’ experiences and per-
13. ceptions related to the influence of gender, wealth, ethni-
city and education on of decision-making processes in
health care. Brief quotes or summaries of the content
were noted in the margins of the transcripts. Recurring
issues or patterns as well as nuances, ambiguities or con-
tradictions within the emerging topics were systematic-
ally searched for. Information obtained from the
interviews and the focus groups were triangulated in the
analysis process to enhance the confidence of the data.
The information gained during the informal conversa-
tions was also reviewed again at this point to increase
the understanding of the material, but no direct quotes
are drawn from the field notes in the results section. At
each step the investigators discussed the emerging find-
ings to enhance the soundness of the interpretation, with
the first and last author being most active in the process.
Ethics
The study received ethical approval from the Medical Re-
search Coordinating Committee of the National Institute
for Medical Research, Tanzania (NIMR/HQ/R.8a/Vol. 1X/
416). Permission to conduct the study was further obtained
from Mbeya regional and Mbarali district authorities. Per-
mission to use the data was also obtained from the REACT
scientific committee. The objective of the study was clearly
expressed to informants before written informed consent
was sought. The principles of voluntariness, rights of with-
drawal, confidentiality and anonymity were strictly adhered
to throughout the study.
Results
Owing to the targeting of district officials and health work-
ers, the informants were more educated than the average
population. Only five out of the 23 informants in the inter-
views and two in the focus group were women. This gender
bias was related to the fact that the levels from which our
14. informants were recruited were dominated by men. The
age range of the informants was 39–70 years: 40–54 at dis-
trict level, 39–55 at health-facility level and 43–70 at com-
munity level. As explained above, informants at all levels
were asked to reflect broadly on their knowledge and ex-
perience regarding the potential influence or lack of influ-
ence of the dimensions of gender, ethnicity, wealth and
education on health related decision making processes.
Gender
Informants were asked about the level of women’s repre-
sentation in and contribution to decision-making bodies,
the extent to which their views were taken into consider-
ation, how women’s participation was perceived and po-
tential barriers to their participation and influence.
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The initial response of the study informants at all
levels referred to the clear political agenda of Tanzania,
and emphasised the importance placed on gender con-
siderations in decision-making bodies. It was reported
that at governmental level it is spelt out clearly how
many men and women are to be part of various commit-
tees. Decision-making bodies followed these guidelines so
women were well represented. Women were said to be
appointed to central positions, and informants said that
women’s views were listened to and taken into consider-
ation in the same way as those of men. They explained
that what matters in decision-making processes is the
strength of the arguments made and not the gender of the
person raising the concern. The following statement was
common throughout the interviews:
15. “Nowadays the gender issue is considered. Women are
given leadership positions. In this district, the District
Commissioner and Education and Agriculture Officers
are women. We have a woman in the Council Health
Management Team, and she is involved in everything at
the office. If she is not present a meeting is postponed.
Women are given opportunities to contribute and are
listened to like men.” (District informant, male)
It was maintained by most of the informants that the
more women gain confidence and influence, the more
fairness will be achieved.
In the course of the interviews a far more nuanced pic-
ture of women’s actual involvement in decision making
processes emerged. For example, informants explained
that actual voice given to a woman depended on the sec-
tion or committee in which she works. Women were said
to have particular influence in the district meetings where
decisions about maternity issues are discussed. Therefore
the opinions of women were particularly listened to and
valued in these sub-meetings and sub-committees. At the
community level, women were also reported to be given
substantial influence in the Village Health Committees,
as they are the main implementers of health-related
issues at a family level. It emerged that beyond the
women- dominated spheres of maternal health, women’s
attendance in and contribution to health related discus-
sions were far from obvious. The discrepancy between
the ideals of equality in terms of representation in di-
verse committees and the actual practice was also ques-
tioned during the interviews. One informant put it this
way:
“If you think carefully about our district you will find
16. that women make up the majority (of the population),
but they are the minority in the decision-making
bodies. In the district council, we have three women
out of the total of 11 councillors. Now, when voting,
even if they (the female representatives) have an
important issue to bring up, when counting the votes
they lose. I will say that women aren’t sufficiently
represented, and I think this is not solely this district’s
problem but a problem found in the entire country.”
(District informant, male)
Informants held that the fewer of females in the deci-
sion making bodies, the smaller the chance for their
views to be taken on board because, they would be
outvoted.
Many male informants claimed that low levels of edu-
cation were a challenge for women’s involvement in the
decision making bodies. The necessary expertise among
women was often lacking. Informants said that, even
when vacancies were advertised, women would not apply
for the positions because they lacked formal skills, and
they could not be forced to apply. This challenge was
related to a lack of adequate skills, interest and ability.
This scenario was said to make it difficult to implement
the official guidelines of equal representation of men
and women in decision-making bodies at the district
level.
In the course of the interviews, differences emerged
between male and female informants regarding women’s
influence. Male informants emphasised women’s partici-
pation more strongly while female informants brought
up numerous complaints related to women’s actual roles
in decision-making bodies from the community to the
district level. Female informants argued that women’s
17. views were not sufficiently listened to.
“An opinion can be rejected just because it comes
from a female member. . . A woman can argue for the
importance of providing training related to health
service provision in the planning meetings, but the
issue may not be considered, as other suggestions like
constructing buildings (suggested by men) are given
priority.” (District informant, female)
Women were said to end up crying sometimes because
of frustrations resulting from being undermined by men
as revealed in the following quote;
“My opinions are taken into account because of my
confidence and standing. But sometimes women are
even crying in the planning meeting as their views are
not taken into consideration” (District informant,
female)
It was held that, even for the educated women, it was
difficult to get their views through simply because they
came from women. At the community level, the chal-
lenges of women’s involvement in decision making
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emerged as particularly serious with more direct refer-
ence to the female gender per se. One female community
informant explained:
“In the meetings, even when there are knowledgeable
women present, we are not listened to when we present
18. our views. We are always asked, "Who are you?”
Throughout the interviews at all levels it was maintained
that women had not gained sufficient confidence in formu-
lating and presenting ‘strong points’ (hoja za msingi). It was
held that little public exposure and shyness made them lag
behind. Apart from reservations regarding women’s skills
and competence, a scepticism regarding the appropriate-
ness of women’s involvement in decision-making bodies
emerged, particularly at community level. A lack of trust in
women’s abilities to carry out proper assessment and deci-
sion making emerged among some of the informants. They
were very direct in expressing their views about women’s
incompetence as one said:
“There are very few things which women can do
because of their nature. There are things which we
just force them to do, although we know that they
really can’t do them. For example women cannot
supervise the construction of the dispensary, so why
should we listen to their opinions?” (Community
informant, male)
It was concluded by the majority of the informants
that the actual influence of women varies starkly from
one decision-making body to another and from one level
of authority to another, with the community level facing
the greatest challenges in terms of ensuring the inclusion
of women’s views.
Wealth
The potential impact of economic status on decision-
making processes in health care services was also
explored. At the district and health facility levels, a very
limited influence of wealth was recorded from the infor-
mant’s statements. Informants stated that in areas where
19. guidelines were properly followed, the influence of well-
to-do people was minimal. One informant concluded:
“We are not influenced by an individual’s
economic status. If you are well-off, it is relevant
to you and your family but not for the hospital
management team. What matters here is how
strong a person’s arguments are.” (Health facility
informant, male)
Informants also argued that at the community level
the wealth of a person had little impact, particularly if
it was combined with low education. One informant
stated:
“. . . People are after constructive ideas and only that.
What is more, rich people are few in our village.
Others may have many cattle, but they don’t have a
substantial influence owing to their poor education.”
(Community informant, male)
A different picture of the influence of wealth emerged
as we moved closer to the community. Informants
acknowledged that as far back as people could recall the
wealth of a person has influenced decision-making pro-
cesses. A continued impact of rich people emerged
because of their ability to offer assistance in various
matters. Rich individuals used their power to influ-
ence decisions in more direct ways, as this quote
illustrates:
“There are individuals here known as "Burushi". These
people are a mixture of Arabs and Africans, and are
financially well-off. They have plenty of money. In the
meetings, if they want a certain decision to be made,
even if it is of no benefit to the community, it is
20. commonly accepted. Decision makers have no choice
as the "Burushi" make substantial contributions to
health-related issues.” (District informant, male)
A more common phenomenon touched upon by al-
most all the informants was the ability of rich people to
influence decision-making processes more directly
through bribery. Bribery brings wealth to the heart of
decision making, and gives affluent individuals more
power. The asset implied by the well-to-do was linked
with male gender.
It emerged in the interviews that when a wealthy per-
son speaks he is listened to more than others, not only
because he is in a better position because of his
resources, but because of perceptions that wealthier
people are more ‘intelligent’ than the poor. One inform-
ant put it in the following way:
“I must be frank; a poor person’s influence on the
decision-making process is minimal because of his
status. He might have good ideas, but because he is
poor, he has no influence. . . It is the opinions of the
rich person that to a large extent are implemented. I
know myself that when you have a good life you also
have a good ability to think, but if you are poor your
thinking capacity becomes limited as you are thinking
about very small things. While you are thinking about
stiff porridge (ugali) others are thinking of cars.
Therefore, to convince people becomes really hard
because you’re thinking: "How am I going to get my
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lunch today?" while your friend is thinking of cars and
machines.” (Community informant, male)
The manner in which a degree of legitimacy was given
to such scenarios emerged in several of the interviews
and informal talks at community level. Moreover, the in-
fluence of wealth emerged as more pronounced when it
was coupled with high education of an individual.
Ethnicity
As with the other points raised, the immediate response
from the district and health facility informants regarding
the potential influence of ethnic affiliation was that eth-
nicity had a very limited influence in Tanzania. This in-
stant reply was situated within the discourse of the late
Tanzanian President Julius Nyerere, who used his entire
career to advocate against differentiation based on ethnic
criteria. The fact that members of the district decision-
making bodies and facility committees would always be-
long to different ethnic groups was also brought up as a
factor that worked against tribalism. It was maintained
that individuals in such positions were obliged to follow
governmental rules and regulations, which makes it very
difficult to promote decisions that favour particular eth-
nic groups. Emphasis was again placed on an individual’s
knowledge and skills relating to a particular topic. One
informant stated:
“. . . Although you may find that a majority of the
health staff in a certain unit/department originates from
the same ethnic group, when it comes to decision
making in health care services, the person’s capabilities
or skills are considered to a greater extent than their
ethnic affiliation.” (District informant, male)
22. Regarding gender and wealth, a more complex picture
did emerge in the course of the interviews. For example,
informants expressed that a leader at any level will listen
far more attentively to the opinions from individuals who
originate from his/her own ethnic group. District and
health facility informants provided numerous examples of
how ethnic affiliation was made relevant concerning issues
such as staff transfers, payment of allowances, promotions
and training opportunities. The following quote illustrates:
“. . . Here there is a department that is dominated by a
certain ethnic group. When it comes to decision
making, you may reach an agreement in relation to a
particular health issue, but later you find that the
decision has been changed without any official reason.
If you ask yourself who changed the decision, you will
realise that it is the head of the department, who
originates from the same ethnic group as the person
who ends up being favoured. He commonly favours
his "colleagues" (from the same ethnic group) and that
is not a secret here.” (District informant, female)
Informants expressed the view that, in the community,
certain ethnic groups have a strong tendency to domin-
ate or influence others. The largest ethnic group in the
community was said to use their numerical advantage to
exploit or oppress others. This was even more apparent
as this group was also wealthy. Large and strong clans
within particular ethnic groups could also have undue
influence as reflected in the following quote:
“. . . There is a certain clan in this community with a
very strong influence in decision-making meetings. Even
the local government leaders are afraid of them. It is a
very big clan that affects the government of this village.
This is also a rich clan that doesn’t follow government
23. regulations.” (Community informant, female)
Education
Informants perceived educational level as a very import-
ant factor in decision-making processes. Educated indivi-
duals and professionals were strongly depended upon by
their leaders when making decisions. The importance of
education was emphasised strongly to an extent where
local knowledge was devalued. One informant said:
“. . . An educated person first of all is a professional
and the advice he gives has scope. Opinions and
decisions given by non-educated individuals are
doubtful” (Community informant, male)
Two different concerns regarding the representation of
groups with low education emerged: one related to a lack
of influence and the other related to too much influence
in the decision making processes. It was argued that if
individuals with lower level of formal education were bet-
ter represented, common people’s problems would be
more readily identified and addressed. One informant had
this to say:
“We, health facility managers are not involved in the
District Health Committee meetings. As a result we
don’t receive most of the things we are in need of. Let
them invite us to these meetings even once a year,
even if it will be at our own expense. They are afraid
to call us because they fear being asked questions
specifically related to the expenditures.” (Health
facility informant, male)
It was argued that a real challenge was linked to the
fact that when the formal educational level of an individ-
ual is low, a person tends to lack the necessary confi-
24. dence to take an active part in discussions, and will not
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be able to present his/her argument clearly. This view
supported the argument provided by some informants
that the attendance and representation of less educated
individuals often does not lead to the desired results in
terms of a true grass-roots engagement and does not im-
pact on the decision-making processes.
There was a strong focus among the district level
informants on the substantial influence of individuals
with very low levels of education in the decision making
processes. They referred specifically to the Full Council
where the majority of the members are made up by the
Councillors who represent communities. The informants
from district level raised serious concerns that these
councillors are given substantial power to engage in
district-level decision making but often lack the educa-
tion and expertise related to the issues they discuss and
eventually vote on. It was held that as councillors, they
are often not in a position to be well enough informed
and to judge the issue at stake from different positions.
According to the informants, the result are uninformed
decisions;
“Most of the Councillors have little knowledge to
conceptualise what is being discussed. Usually they
attend the meeting just to listen, and when it reaches
the time for voting they just agree and sign in order
to pass the resolution. From my experience I can say
that some of these members do not understand what
25. is being discussed. Most of the health issues are not
understood by non-medical personnel. A resolution
may be passed with the understanding that the
council has reached consensus, but in reality it might
be a decision proposed and enforced by a single
member of the council as the other voters simply
have agreed but may not have understood the issue
being discussed.” (District informant, male)
The informants reported that the impact of grass-
roots representation in actual practice was limited as the
representatives were unable to grasp many of the issues
at stake, and would vote in ways that would not favour
community opinion. However, many informants would
also argue that there are community members who, des-
pite a lack of formal education, have an excellent ability
to provide constructive ideas by drawing upon their var-
ied competence and experience. Thus, a complexity of
views were raised regarding the challenges of ensuring
informed grass-roots engagement and grass-roots im-
pact at a time when formal education and specialised
knowledge is increasingly demanded.
Discussion
This study indicates extensive limitations in terms of fair
participation in the decision- making processes in health
care in the study district in Tanzania. The influence of
gender, wealth, ethnicity and education presents sub-
stantial challenges. At a general level, the tendency was
clearly one of placing more trust and power in men, in
wealthy and formally educated individuals as well as in
individuals from powerful ethnic groups. The influence
was more pronounced at the community level than at
the district and facility levels. At the district level, the in-
fluence, particularly of wealth and ethnicity, was deemed
to be minimal. This was attributed to the fact that mem-
26. bers of decision making bodies would come from differ-
ent ethnic origins and would have different economic
status. For example in the Full Council meetings, these
factors were said to hardly play a role as the members
are obliged to adhere to government rules and regula-
tions that strictly stipulate the procedures to be followed
and it is not easy to deviate from them.
At the onset of the discussion, it is interesting to note
the way the interviewees started their responses by addres-
sing the importance of the principles of fairness in terms
of gender, ethnicity, wealth and education, and the lack of
discrimination on the basis of such characteristics. This
immediate response was seen to become more nuanced
and ambiguous in the course of the discussions. It is im-
portant to comment upon this seemingly ‘politically cor-
rect’ response with a brief reference to Tanzanian history.
In Tanzania, the former president Mwalimu J. K. Nyer-
ere’s political agenda from independence focused on
fighting against a class society based on poverty, disease
and ignorance, which he saw as the main enemies of de-
velopment. He worked on the basis of socialist ideals
and the village became the core of his policy through
the ‘ujamaa na kujitegemea’ (socialism and self reliance).
A prime legacy of Nyerere was to unite all ethnic groups
in the country through a joint language ‘Kiswahili’ [21].
Through this agenda, the battle against tribalism in Tanza-
nia was fought through slogans such as ‘united we stand,
divided we fall’ (‘umoja ni nguvu, utengano ni udhaifu’).
This made Tanzania a showcase for maintaining peace
and unity in a multi-ethnic setting [22]. Nyerere based his
policy on social justice principles where each individual
was to have the right to be respected and be listened to re-
gardless of social status [23]. Despite his good intention,
he did not spell out clearly the manner in which the grass-
27. roots’ level was to be heard in the face of a strong and au-
thoritarian state.
The immediate response of the informants regarding
gender, wealth, ethnicity and education must also be
understood in light of the later health sector reform and
the decentralisation policy in Tanzania which strongly
advocate bottom-up approaches in decision making [24].
Emphasis is placed on community or grass root involve-
ment where every individual is to participate equally in
discussing their problem areas and suggesting solutions.
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The recognition and emphasis of the village or the com-
munity as the focus of or basis for development has
remained central for close to 50 years in Tanzania. In re-
cent years, active engagement of people in debate has
been encouraged [24,25]. This has increased recognition
of the importance of poor and marginalized segments of
society having a right to air their grievances. The funda-
mental assumption is that when diverse stakeholders
from grassroots are involved, decision making improves
as it takes place closer to where the problems are
located. Communities are called upon to take an active
part in and to challenge decisions that affect their health.
These visions have been a central part of Tanzania’s in-
dependent history, and it is within this contextual back-
drop that the immediate response from the informants
must be understood. However, the implementation of
ideas of decentralization policy has largely remained the-
ory [14]. The initial responses are also in line with the
deliberative democratic thinking that in a fair process,
28. there should be reasoning among equal citizens and
shared commitment to the resolution. To achieve this,
in the deliberation, stakeholders should decide on the
agenda, discuss the issue, propose solutions and support
those solutions with reasons [9]. Each stakeholder is to
have equal voice in the decision making since the distri-
bution of power and resources is not supposed to shape
their chances of contributing or playing an authoritative
role in the deliberations.
Beyond the initial response, our study findings indicate
that gender, ethnicity, wealth and education do, in prac-
tice, pose substantial challenges in making fair decisions.
This study cannot, in any substantial manner, quantify
or explain the discrepancy between the levels of ideals
and values on the one hand and the level of practice on
the other. But we can indicate a few aspects of the chal-
lenges that emerged in our study findings, and ways in
which some of these seem to not only appear at the level
of discriminatory practice, but also at the level of ideas
and ideals in a way that may impose serious constraints
on principles of fairness.
Our findings indicate that, despite the strong focus on
gender balance in decision-making bodies, substantial
challenges remain. There is still a lack of women with
the necessary formal competence or skills to occupy cer-
tain positions. Beyond this, women were said to be lis-
tened to less seriously during discussions than their
male counter parts. Informants expressed the view that,
in meetings where educated and active women were
involved, it was often difficult for them to be heard be-
yond the field of maternal and child health. At the com-
munity level, the findings were even more serious as the
fundamental ability of women to make a meaningful
contribution to the discussions was questioned by sev-
29. eral of the male informants, revealing a true distrust
between the genders. This lack of ability was not merely
linked to a lack of experience in voicing their views or to
a lack of formal education or training, but was related to
their nature as women. These findings reflect strong
traces of patriarchal ideology as have been found also in
a number of other studies [26–28].
A similar line of reasoning emerged from the findings
related to wealth and influence. People with higher in-
come were reported to be listened to more than the poor.
This finding emerged as far more apparent at lower levels,
and not least at the community level. Informants at the
community level argued that the rich would be in a better
position not only because of their financial resources, but
because poor individuals were perceived to have lower
thinking capacity; the more affluent were perceived to be
more intelligent than the poorer. The influence of wealth
has been reported in another study where members of de-
cision making bodies were chosen because of their fun-
draising ability [29]. This implies that poor people’s views
will be heard to less extent, although they may be the ones
who may experience a problem more acutely and may be
most affected by the potential decisions. This tendency to
allow the wealthy to have more influence has been pointed
out as reason for caution also in other studies [30] if fair-
ness is to be achieved. Despite the enormous historical
focus on the dangers of tribalism, ethnicity did also emerge
as challenge in our study. The majority ethnic group in the
community was said to be more likely to be respected and
listened to than other groups, not least if its power in
terms of numbers was coupled with wealth. A bias was
noted also in the district departments when a majority of
the staff belonged to a particular ethnic group. Our find-
ings indicate that advantage or disadvantage based on eth-
nic criteria in decision-making contexts needs to be
30. watched carefully also in present day Tanzania.
The influence of education was, not surprisingly, pro-
nounced. People with formal education were said to have
substantial influence owing to their increased knowledge
and competence, while individuals with little education
had less influence. Other studies have found that educated
individuals were thought to have more confidence [31] and
thus feel more comfortable in engaging in complex discus-
sion. In our study, the elected councillors who approve dis-
trict decisions were considered by some informants to lack
the necessary education and understanding to vote in an
informed way in many of the questions addressed. These
councillors have authoritative power, yet at times lack the
necessary knowledge in approving decisions in health care.
This point has been raised also in other studies [29,32–34].
With this in mind, the approaches to ensuring proper
community representation need to be thought out, and the
necessary knowledge and information need to be imparted
to councillors so that they can make informed decisions
for better health outcomes.
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The study findings indicate that deliberative demo-
cratic thinking that advocates fairness and legitimacy in
decision-making processes [1,9] continues to be under-
mined, and that it is not yet adequately practiced or con-
ceptualised in our study district. The objective of
participation in decision making is to make sure that
decisions reached are informed by the people. For this
principle to function, as the reciprocity principle of de-
liberative democratic theory states, each stakeholder
31. needs to have an equal chance to contribute and being
heard regardless of inherent power differences. Our find-
ings bring a serious dilemma. How can one possibly take
on board ideas from all stakeholders in an effort to en-
hance the democratic process and, at the same time be
able to address the needs in an adequate and informed
way as perceived by stakeholders themselves? Our study
indicates that the basis for fair and legitimate decision
making is far from being reached, and that the chal-
lenges need serious and renewed efforts. Despite this,
enhancing fairness and legitimacy through the inclusion
of people beyond powerful individuals is deemed vital,
as shown by Kapiriri and Martin [35].
When informants question women’s or poor people’s
innate ability to take part in informed decision making
constructively, and consider it fair that other individuals
legitimately act or decide on their behalf, we are not
talking merely of discrimination, but of challenges to
human rights-based fairness principles in a more funda-
mental way.
Prevailing biases affect people’s self esteem and sense of
worth, which in turn affect their ability to be open, cre-
ative and vocal. On such grounds Gibson et al. propose
adding ‘empowerment’ to the fairness conditions as pro-
posed by the ethical framework Accountability for Rea-
sonableness [36]. This line of thinking, emphasizes
appropriate training and orientation to enable stake-
holders to contribute substantially [14,33,37–39]. Em-
powerment has been defined as the process and outcome
whereby those without power gain information, skills, and
confidence and thus control over decisions pertaining to
their own lives [40]. Empowerment processes can take
place at the individual, organizational or community
levels. Green argues; “The poor, divorced from centres of
32. decision making dominated by elites with different inter-
ests, must be empowered to participate in the decisions
which affect them” [7]. In a decision-making context, sta-
keholders should be obliged to respect the opinions of
each other. This is the fundamental argument of delibera-
tive theorists who advocate for mechanisms that reduce
the influence of all asymmetric power relations and au-
thoritarian approaches in decision-making processes. De-
liberative democracy advocates for a just society where
decisions are made collectively and become a public good
[9]. Rawls clarifies that power in decision making has to
be located independently of the economic and social pos-
ition of individuals [41]. More consultative and participa-
tory approaches are called for in an attempt to secure the
participation of broader segments of the population [1,6].
The struggle to find ways to include the views of women,
the poor, individuals from every ethnic segment and from
both educated and non-educated parts of the population
has to remain in focus in the years ahead.
Strengths and limitations of the study
The findings of this study are based on a limited number of
informants located at different levels within the district.
There is nonetheless reason to believe that the findings
have relevance beyond the study district as policies, bureau-
cratic structures and multi-ethnic environments are found
in all parts of Tanzania. It is indeed likely that the findings
may have relevance for many other settings in newly devel-
oping democracies where there has been less focus on com-
munity voice and involvement than in Tanzania.
Conclusion
The findings from this study have revealed that fairness
principles in health care decision making processes are
greatly undermined in the present study district in
Tanzania. Women, poor individuals, members of minority
33. ethnic groups and less educated individuals were found to
be discriminated against in decision-making bodies. The
findings were more pronounced at community than at
health facility and district levels. The findings revealed that
such biases were related to perceptions of women, the less
educated and poor individuals as less knowledgeable and
having a lower thinking capacity. These notions imply fun-
damental challenges to the implementation of democratic
and justice theories as spelled out by deliberative demo-
cratic thinking. We argue that such notions pose a very
real threat in health care decision making as they may sys-
tematically undermine the views and experiences of par-
ticular segments of the population. There seems to be a
prevailing lack of knowledge and also a lack of acceptance
of the principles on which the political system is built, in-
cluding the fundamental right of everyone to be heard. In-
tensive advocacy related to fairness principles and to
people’s rights to participation in decision making pro-
cesses should be strongly emphasised in the years to
come. The clear distinctions between the findings at com-
munity levels and at district levels indicate that ensuring
equal opportunities in terms of access to education and
information will, in the long run, lead to a situation where
stakeholders at every level are given a chance to partici-
pate in a fair way and make legitimate decisions in health
care since they will be knowledgeable on the issues at
stake. Only in this way can the true community voice be
secured regardless of gender, wealth, ethnic origin and
educational level.
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Competing interests
34. The authors declare that they have no competing interests.
Authors’ contributions
EHS participated in the development of the tools, collected and
refined the
data, carried out the analysis and drafted the manuscript. AB
was central in
the process of developing the guides, made a follow-up visit to
the field site
during data collection, took part in the analysis process and
revised the draft
manuscripts. PK participated in the development of the tools,
took part in
the data collection process and reviewed the manuscript. OFN,
LEGM and
SM reviewed the manuscript several times. JB conceived the
idea of the
project, developed the methodology and reviewed the
manuscript. All
authors read and approved the final manuscript.
Acknowledgements
Through funding and support from the European Union’s Sixth
Framework
Programme (INCO-2003-A.1.2, contract PL517709) for the
Specific Targeted
Research and Innovation Project REACT - ‘Strengthening of
fairness and
accountability in priority setting for improving equity and
access to quality
health care at district level in Tanzania, Kenya and Zambia’.
We are also
grateful to the Norwegian government through its Quota scheme
for
financial support. We are grateful to Dr. �ystein Evjen Olsen
for conceiving
35. the concept of the project and for jointly with Dr. Paul Bloch
and others
contributing to detailing research methods, tools and guiding
procedures.
We thank Bruno Marchal for the scientific coordination of
permits to access
and publish the project data, the Mbarali district authority and
our
informants for positive collaboration. We are also grateful to
Nils Gunnar
Songstad for providing diverse support when developing this
manuscript.
Special thanks are extended to reviewers for providing
constructive and
informative comments.
Author details
1Department of Public Health and Primary Health Care,
University of Bergen,
P. O. Box 78045020, Bergen, Norway. 2Centre for International
Health,
University of Bergen, P.O. Box 78045020, Bergen, Norway.
3National Institute
for Medical Research, P.O. Box 9653, Dar es Salaam, Tanzania.
4DBL - Centre
for Health Research and Development, Faculty of Life Sciences,
University of
Copenhagen, Thorvaldsensej 57, DK 1871, Frederiksberg,
Denmark. 5Institute
of Development Studies, University of Dar es Salaam, P. O. Box
35169, Dar es
Salaam, Tanzania.
Received: 1 November 2011 Accepted: 15 May 2012
Published: 7 June 2012
36. References
1. Gutmann A, Thompson D: Democracy and Disagreement.
London, England:
The Belknap Press of Harvard University Press; 1996.
2. Sanders D, Schaay N, Mohamed S: Primary Health Care. In
International
Encyclopedia of Public Health. 5th edition. Edited by Kris
Heggenhougen,
Stella Quah. San Diego: Academic; 2008:305–316.
3. Glass JJ: Citizen participation in planning: the relationship
between
objectives and techniques. J Am Plann Assoc 1979, 45(2):180–
189.
4. Gravel K, Légaré F, Graham DI: Barriers and facilitators to
implementing
shared decision-making in clinical practice: a systematic review
of health
professionals' perceptions. Implementation Science 2006, 1(16).
5. Allen GAO: Equity and Health. Rev Panam Salud Publica
2000, 7(1):1–7. ISSN
1020–4989.
6. Harris R: Introduction to decision making; Evaluating
internet research
sources. Retrieved from http://www.virtualsalt.com, 2008
(accessed in
October 2009).
7. Green M: Participatory development and the appropriation of
agency in
Southern Tanzania. Critique of anthropology 2000, 20(67):67–
37. 89.
8. Gibson J, Martin D, Singer P: Priority setting in hospitals:
fairness,
inclusiveness, and the problem of institutional power
differences. Soc Sci
Med 2005, 61(11):2355–2362.
9. Cohen J: Deliberation and Democratic Legitimacy, in
Deliberative
democracy: essays on reasons and politics. In Edited by Bohman
J, Rehg
W. Cambridge, Massachusetts: London: The MIT press; 1997.
10. Ministry of Health: Tanzania Second Health Sector Strategic
Plan (SHSSP),
July 2003 - June 2008. Ministry of Health, 2003.
11. Ministry of Health: National Health Policy. Ministry of
Health, Dar-es-salaam
Tanzania: 2003:32.
12. Mboera LEG, Rumisha SF, Senkoro KP, Mayala BK, Shayo
EH, Kisinza WN:
Knowledge and health information communication in Tanzania.
East Afr J
Public Health 2007, 4(1):33–39.
13. Mlozi MRS, Shayo EH, Senkoro KP, Mayala BK, Rumisha
SF, Mutayoba B,
Senkondo E, Maerere A, Mboera LEG: Participatory
involvement of farming
communities and public sectors in determining malaria control
strategies
in Mvomero District, Tanzania. Tanzan Health Res Bull 2006,
8(3):134–140.
38. 14. Maluka S, Hurtiq A-K, San Sebastian M, Shayo EH, Byskov
J, Kamuzora P:
Decentralization and health care prioritization process in
Tanzania: From
national rhetoric to local reality. Internal Journal of Health
Planning and
Management 2011, 26((e55-e73)):e102–120.
15. MoHSW: Joint External Evaluation of the Health Sector in
Tanzania, 1999-2006.
Dar-es-salaam: Ministry of Health and Social Welfare;
2007:168.
16. Maluka S, Kamuzora P, SanSebastián M, Byskov J, Ndawi
B, Olsen OE, Hurtig A-K:
Implementing accountability for reasonableness framework at
district level
in Tanzania: a realist evaluation. Implementation Science 2011,
6(11):1–15.
17. Venugopal V, Yilmaz S: Decentralization in Tanzania: An
assessment of
local government discretion and accountability Public Admin.
Dev 2010,
30:215–231.
18. Maluka S, Kamuzora P, SanSebastián M, Byskov J, Ndawi
B, Olsen OE, Hurtig
A-K: Decentralized health care priority-setting in Tanzania:
evaluating
against the accountability for reasonableness framework. Soc
Sci Med
2010, 71:751–759.
19. Byskov J, Bloch P, Blystad A, Hurtig AK, Fylkesnes K,
Kamuzora P, Kombe Y,
39. Kvale G, Marchal B, Martin DK, Michelo C, Ndawi B, Ngulube
TJ, Nyamongo
I, Olsen OE, Shayo EH, Silwamba G, Songstad NG, Tuba M:
Accountable
priority setting for trust in health systems - the need for
research into a
new approach for strengthening sustainable health action in
developing
countries. Health Research Policy and Systems 2009, 7(23):1–
10.
20. The United Republic of Tanzania: Tanzania Census 2002:
analytical report, vol
X, National Bureau of Statistics, Ministry of Planning,
Economy and
Empowerment. Dar es Salaam: The National Bureau of
Statistics; 2006.
21. Mazrui AA, Mazrui AM: Swahili state and society: The
political economy of
an African language. East African Educational publishers,
1995:167.
22. Bannon S, Miguel E, Posner DN: Source of ethnic
identification in Africa:a
comperative series of national public attitude survey on
democracy, market
and civil society in Africa, Volume Working paper no 4.
afrobarometer
project; 2004:23.
23. Warrema IJ: Tanzanians to the promised land: after forty
years. In
Tanzanians to the promised land: after forty years. Edited by
Ulimwengu J, EC
H. Tanzanian: Lulu.com; 2006:14.
40. 24. Ministry of Health: Health Sector Reform Plan of Action
1996–1999. Dar es
Salaam-Tanzania: Ministry of Health; 1996.
25. De Savigny D, Kasale H, Mbuya C, Reid G: Fixing Health
Systems. 2nd edition.:
International Development Research Centre; 2008:14.
26. Senarath U, Gunawardena N: Women's autonomy in decision
making for
health care in South Asia. Asia Pac J Public Health 2009,
21(2):137–43.
27. Okoko B, Yamuah L: Household decision-making process
and childhood
cerebral malaria in The Gambia. Arch Med Res 2006, 3:399–
402.
28. Sloan L: Women participation in decision making processes
in Arctic
Fisheries Management. Arctic Council, 2002–2004. Edited by
Kafarowski J,
Heilmann A, Karlsdttir A, 2004.
29. Rebecca A, Bruni BA, Andreas L, Martin DK: Public
engagement in setting
priorities in health care. CMAJ 2008, 179(1):15–18.
30. Baltussen R: Priority setting of public spending in
developing countries:
Do not try to do everything for everybody. Health Policy 2006,
78:149–156.
31. Flynn K, Smith M: Personality and health care decision-
making style. J
41. Gerontol B Psychol Sci Soc Sci 2007, 62(5):P261–P267.
32. Mshana S, Shemhilu H, Ndawi B, Momburi R, Olsen OE,
Byskov J, Martin DK:
What do district health planners in tanzania think about
improving
priority setting using 'accountability for reasonableness'? BMC
Health
Service Research 2007, 7:180.
33. Makundi E, Kapiriri L, Norheim OF: Combining evidence
and values in
priority setting: testing the balance sheet method in a low-
income
country. BMC Health Service Research 2007, 7:152.
34. Martin D, Hollenberg D, MacRae S, Madden H, Singer P:
Priority setting in a
hospital drug formulary: a qualitative case study and evaluation.
Health
Policy 2003, 66:295–303.
Shayo et al. International Journal for Equity in Health 2012,
11:30 Page 12 of 12
http://www.equityhealthj.com/content/11/1/30
35. Kapiriri L, Martin DK: A strategy to improve priority
setting in developing
countries. Health Care Anal 2007, doi:10.1007/s10728-006-
0037-1.
36. Wilkinson A: Empowerment: theory and practice. personnel
review. 1998,
27(1):40–56.
42. 37. Saunders C, Crossing S, Girgis A, Butow P, Penman A:
Operationalising a
model framework for consumer and community participation in
health
and medical research. Australia and New Zealand Health Policy
4 2007, 4(13).
38. Martin D, Singer P: A strategy to improve priority setting
and health care
institutions. Health Care Analysis 2003, 11:59–68.
39. Park A, Jowell R, McPherson S: The future of the national
health service:
results from a deliberative poll, 1998.
40. Rifkin S, Pridmore P: Partners in Planning. London:
Macmillan; 2001.
41. Rawls J: Theory of Justice. Cambridge, Mass: Harvard
University Press; 1971.
doi:10.1186/1475-9276-11-30
Cite this article as: Shayo et al.: Challenges to fair decision-
making
processes in the context of health care services: a qualitative
assessment from Tanzania. International Journal for Equity in
Health 2012
11:30.
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http://dx.doi.org/10.1007/s10728-006-0037-
1AbstractBackgroundMethodsResultsConclusionsBackgroundTh
e Tanzanian health care systemMethodsStudy siteStudy
designRecruitment of the informantsData collectionData
analysisEthicsResultsGenderWealthEthnicityEducationDiscussi
onStrengths and limitations of the studyConclusionCompeting
interestsAcknowledgementsAuthor
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