Team Activity and Principles of Team Management

Group Activity and Principles of Team Management Presentation It has been seen that the way of life of an association that is worked around groups is strikingly not quite the same as an association worked in a customary progressive fashion.Advertising We will compose a custom paper test on Team Activity and Principles of Team Management explicitly for you for just $16.05 $11/page Learn More Some of the distinctions lie in responsibility to objectives, portrayal/familiarity with key plans predictable nearness of occupation execution markers, representatives isolating errands and taking responsibility for and setting/meeting of new degrees of execution are regular to associations worked around groups (Dew 3). Anyway it is likewise essential to know when it is critical to frame groups as groups are known to function admirably where the assignments included are mind boggling and can be divided. The assignment of choosing when to frame groups is an administration job and the correspondence and initiative of the group must be coordinated from the organization (Dew 5). In this report the conversation introduced will give data in a group movement and reasons dependent on standards of group the board on the side of the action just as territories that could have been improved. The Team Activity The action included was the association of a social night appear by a gathering of understudies from my nation of origin. When the date was set the gathering plunked down and had a gathering to choose a pioneer. In the determination of a pioneer the gathering felt it was essential to choose a person with solid administration characteristics. Among the characteristics wanted included; a capacity to retain genuine beliefs to permit different individuals have a state, great listening capacity, capacity to coordinate a conversation without partiality, draw out assessments all things considered and capacity to fabricate accord rather compelling choices on individuals (Kriel, Singh, de Beer, Louw, Muton, Roussouw, Berning and du Toit 42). Following this underlying conversation a vote was led and a pioneer was chosen. When the group head was set up the conversation proceeded and chose the different authorities that would be required to finish the assignment effectively. Subsequent to framing a total group of pioneers the council shaped set about setting up a plan and request of assignments to be finished. Notwithstanding this it was likewise referenced that arbitrary gatherings could be called among chosen people to conceptualize and finish the different undertakings. The occasion was in the long run finished effectively however not without some unforeseen issues. Among the issues that were distinguished was the situation that a portion of the individuals were given a bigger number of assignments than they could deal with in the allotted time.Advertising Looking for article on business financial aspects? We should check whether we can support you! Get your first paper with 15% OFF Learn More Owing to this there w ere various postpones which could have been maintained a strategic distance from had there been exceptional correspondence and extra help for the authorities (Kriel et al. 41). One of the qualities of cooperation is the capacity to use on the help of different individuals and this is one territory where the group neglected to completely grasp. Another difficult that was knowledgeable about the group was poor peace promotion. Regardless of the way that the pioneer chosen was useful for the activity the group comprised of a few individuals all with various thoughts and sentiments. The outcome was that during conceptualizing practices there was an excessive amount of time squandered on attempting to push different feelings home. It created the impression that the group did not have a bound together objective and this prompted wastage of time. It is accounted for that poor correspondence can keep a group from accomplishing its objective and undermine its endurance (Kriel et al. 38). Thi s point was generally clear in the underlying arranging gatherings held by the gathering. Then again probably the best result of the occasion was the expanded compatibility that emerged between individuals as the days advanced. Attributable to the capacity of the pioneer to keep the individuals engaged just as help colleagues to remember the objective of the panel it was a lot simpler to defeat obstacles brought about by various suppositions. It was through the steadiness of the gathering chief that individuals were continually helped to remember singular responsibility and gathering duty (Kriel et al. 41). The social night wound up a fruitful occasion and the gathering figured out how to create a sensible measure of income from different sources. Reference index Dew, John Robert. Overseeing in a Team Environment. Westport: Quorum Books, 1998. Kriel, G., D. Singh, A. de Beer, H, Louw, J. Mouton, D. Rossouw, J. Berning and D. du Toit. Concentrate on Management Principles: A Generic A pproach. South Africa: Paarl print.Advertising We will compose a custom article test on Team Activity and Principles of Team Management explicitly for you for just $16.05 $11/page Learn More

How to Write Essays That Will Attract and Convert Your Target Audience

How to Write Essays That Will Attract and Convert Your Target AudienceIf you have the desire to write essays for the website that writing essays for you, there are a number of ways that you can go about it. The idea is to learn how to do this and not to put forth too much effort. Once you find out how to do this, then you can be ready to start learning about writing and editing.The first thing you need to learn is the basics of grammar and sentence structure. This is one of the most important things to learn, especially if you want to work with people in your target audience. You will also want to master how to proofread for yourself, but it is okay to ask for someone else to do this. Keep practicing as you begin to learn the basics of writing for your target audience.After you know how to write, you need to find out how to read and what your readers are looking for. For instance, if you are writing for an academic website, you may want to consider making it more interesting for your readers by including multimedia or audio content. This can help you get an edge over your competitors, as well as give you a chance to wow your readers.After you have figured out how to write essays for you, you will need to continue to research as much as possible to make sure that you are using the most powerful manner of presenting your information. Research can be very powerful if you know what you are doing. In addition, it can allow you to start generating sales and making money from your own research.Talking to experts in your field is an excellent way to begin doing this. When you talk to people that have knowledge in your field, you will find that they are eager to help you. You will learn as they share their knowledge and then you can pass this knowledge along to your readers.Nowadays, many online websites and online businesses offer service packages where you can find individuals who are willing to help you. These services may include proofreading, editing, and other ser vices that you may be interested in. You may be able to work with the individual who offers these services or you may want to find another writer.The next step in the process is learning how to write the essay that will be used on your website. You will need to look at what you want to convey to your readers and then find the proper words that will make this happen. This process can be difficult, but with the right support and direction, you will be able to succeed.Once you have learned how to write essays for you, then you will need to market your services to the best of your ability. You should continue to market and promote the best you can. Write articles, write reviews, and write blogs. The ideas are endless.

How to Write the William and Mary Supplement 2019-2020 TKG

How to Write the William and Mary Supplement 2019-2020 The College of William and Mary in Williamsburg, Virginia, is frequently referred to as a “public Ivy.” It might not be an official title, but it does say a lot. William and Mary is highly respected, provides an educational experience of an Ivy caliber, but with the benefit of being more accessible. If you live in Virginia, you even get the added benefit of in-state tuition. The 6,400 undergraduate student body is big enough to offer something for nearly anyone while small enough to provide a community that is known for being close-knit and supportive. William and Mary’s emphasis on undergraduate research is also a huge selling point. The overall acceptance rate for William and Mary is 37%, but that can be a little misleading. There is about a 15% difference between in-state acceptance rate and out-of-state acceptance rate. If you are from outside of Virginia, the acceptance rate is closer to 30%. If you live in Virginia, you’re in luck. You have a 45% chance of attaining a w ell-respected Ivy-level education at a seriously discounted cost.   William and Mary lists their supplement as “optional.” However, if you’ve been reading our posts for a while, you already know how we feel about “optional.” There is no such thing. Everything is mandatory, even if they say it is not. When you only have so much space to make a case for yourself, deciding not to do a supplement is not an option.  Beyond your impressive academic credentials and extracurricular accomplishments, what else makes you unique and colorful? We know nobody fits neatly into 500 words or less, but you can provide us with some suggestion of the type of person you are. Anything goes! Inspire us, impress us, or just make us laugh. Think of this optional opportunity as show and tell by proxy and with an attitude. We love this question, but we also know that it can be very overwhelming for students who are going through the college application process without a guiding hand. First, let’s look at the very first sentence. In it, they set the limitations for the question. You can write about nearly anything, but they do not want to hear about something academic or that is in your activities section (aka extracurricular). By giving you a place to share what you do in the time you have outside of scheduled activities, they are trying to learn who you really are.   But who are you? That’s an intimidating question. We ask our students to come up with a list of five (or more) characteristics/adjectives that they feel encapsulate who they are. It’s not an easy task, and sometimes it helps to ask friends. Maybe you are analytical, or perhaps your friends most appreciate your empathy. You might be inquisitive or identify as an artist. Before starting your applications, you should pull together five characteristics. Here you won’t hit on all five though. Instead, you will pick one or two. It can be tempting to try to hit all five at once but resist the urge! Focus is a g ood thing. Once you’ve picked the characteristic you’d like to focus on, it’s time to tell a story. Telling a story as a way of illustrating who you are will keep you on track and carry the reader on a journey alongside you. The story should be small, precise, and allow for lots of colorful detail. If you are someone who continually cracks jokes, telling a humorous story may make sense. If you aren’t so sure of your comedy chops, it’s always better to be earnest than to fail at being funny. An example of a potential story that we love comes from one of our very own team members. When she was in elementary school, she convinced her parents to let her buy a science classroom kit and breed praying mantises. For some reason they let her do it. The praying mantises hatched in the middle of the school day, and her mom had to pull her out of class to welcome them into the world. She even had to breed fruit flies to feed them. Once they were large enough, she released them into he r garden. This launched a passion for animals that were misunderstood and resulted in more than ten years of unexpected pets including, clawed African frogs, geckos, a snake, and even a cockroach.  If she were to write this supplement, she wouldn’t talk about all of these experiences, but about seeing a praying mantis in the garden years after releasing the ones she had hatched. She would write about curiosity, and about an insatiable desire to understand how the world works.  When you’re writing your supplement, remember that they set a strict 500-word limit. Usually, sticking to a word ceiling isn’t too hard in the Common App. If you try to go over, it cuts you off. In this supplement, the limit in the prompt is 500 words, but the dialogue box (where you input your response) allows for up to 650 words. This is not an invitation to go over â€" even by a single word. The number one rule of supplements is to follow directions. If you cannot follow a simple direction like a wo rd count, you are telling the school that you either a) don’t listen or b) thing that what you have to say is more important than their guidelines. Neither reflects well on you and going over certainly doesn’t reflect who you are in a positive way.  Fitting a story into just 500 words can be tough. If you allow yourself to be vulnerable, focus on a precise experience, and highlight only one or two personal characteristics, you’ve got this.  Sometimes a question that asks you to be vulnerable can be overwhelming. If you need help, let us know.

Slavery in the English Colonies Essay - 837 Words

Although, Slavery had existed for centuries as a lowest social status in different parts of the world like Africa, Roman Empire, Middle East and etc., in English colonies slavery gained an importance, because of increasing demand for labor force and becoming relationship legitimated by law. Therefore, Englishmen were the reason of slavery in the colonies and its consequences. In the beginning of 17 century a group of merchants established first permanent English colonies in North America at Jamestown, Virginia. Englishmen expected to find gold. Moreover, Virginia Company offered 50 acres of land everyone who journeying to Virginia. They wanted to attract many people to expand their possessions in colony. Determinant factor in the†¦show more content†¦Third, Bacon’s Rebellion, involving rebellious former seeking land, led white planters force a looking more flexible force .Moreover it was more profitable to purchase Negro man. Their price was a little expensive, but th ey worked for whole life. According to labor owned by a Virginia planter, 1648 the cost white slave for instance, Thomas Groves was 1300(in lbs tobacco) for 4 years of service, however a cost of Negro man for instance, Mingo was 2000(in lbs tobacco) for whole life. This is another reason of increasing population and demand for black skin slaves. The rapid increase in the slave population led to strict control, cruelty and justification to brutality. Englishman called slave the† strength and the sinews of this western world . The slave trade horrors were inconceivable. Oladah Equiano, a slave from Nigeria described some horrors of slavery the â€Å"Middle passage†. Equiano and his youngest sister were seized by raiders. They passed from one trader to another. Majority of their slave group died, because of exhaustion or hunger. They were gathered in the merchant’s yard, like so many sheep in fold, without taking into account the sex or age. After signal given, the buyers rushed into the yard and choose for the best one. Furthermore, without scruple, relations and friends separated. In the vessel where Equiano was, there were two brothers which were sold in different slots. This is obvious example of new refinement in cruelty, which adds horrors toShow MoreRelatedThe Differences Of Slavery And The English Colonies1233 Words   |  5 PagesDifferences of Slavery in Africa, the Spanish Colonies, and the English Colonies During the 16th and 19th centuries, slavery was widespread throughout the world. It was practiced by African and European countries to facilitate labor in their colonies abroad. These cultures, who were economically dependent upon the slave trade, also utilized slaves to fill vacancies wherever the citizenry failed to meet the needs of labor. The areas that are experienced in the primary sources are the English colonies of NorthRead MoreSlavery And Religion : The English Colonies867 Words   |  4 PagesSlavery and Religion in the English Colonies Many English immigrants came to America to seek religious freedom and some to improve their economic conditions. The concept of how slavery, thought by many colonists to be an economic necessity, was shaped and came to be rationalized and justified through Christian religious beliefs, is very interesting. The first English colonists settled in the Massachusetts colonies for religious reasons; to escape religious persecution in England as in the caseRead MoreEssay about Slavery by Another Name1282 Words   |  6 PagesThroughout the book, The Origins of Slavery, the author, Betty Woods, depicts how religion and race along with social, economic, and political factors were the key factors in determining the exact timing that the colonist’s labor bases of indentured Europeans would change to involuntary West African servitude. These religion and racial differences along with the economic demand for more labor played the key roles in the formation of slavery in the English colonies. When the Europeans first arrivedRead Morechapter 3 and 41055 Words   |  5 Pagesthought out. Chapter 3 â€Å"Introduction† â€Å"Global Competition and the Expansion of England’s Empire† â€Å"Origins of American Slavery† â€Å"Colonies in Crisis†- Choose only one sub-topic â€Å"The Growth of Colonial America† â€Å"Social Classes in the Colonies†- Choose only one sub-topic 1. How did the mercantilist system work? Explain how the â€Å"mother country† benefited from having colonies. a. The government was in charge of all economic activity the way to promote power. They establish special boundaries.Read MoreEssay about Racism and Slavery Hand in Hand1304 Words   |  6 PagesAmerican colonies were established with the idea of freedom and liberty to all. This goal, however, is darkened by a contradictory event: racism. Racism against African Americans (Negroes) in America was a by-product of permanent and inhumane enslavement of the black population. This type slavery was built upon the need for the American colonies to achieve economic prosperity and social stability. The slavery prior to these social and economic problems was equal to that of white slavery. Black andRead MoreThe Regions of Colonial America Essay864 Words   |  4 PagesBy the 1700’s, New England, the Chesapeake region and the Southern Colonies developed into three distinct societies, despite coming from the same mother country, England. The regions of Colonial America each had a distin ctive culture and economy entirely different from the other regions. Religion and religious tolerance was completely different in each region, running from being free to complete persecution. Ethnicity and racial composition ranged from almost complete British descent to a wide rangeRead Morewhen did slavery start in america742 Words   |  3 PagesHistory Essay #1 9/20/13 When did slavery start in america. Once Slavery was introduced into the new colonies it changed the direction that the colonies were heading in. there are many theory’s and ideas linked with the importation of africans to america. Although some may consider racism a major role of the african enslavement, the need for Labor, Low Cost Price ,and Availability played a major role on the enslavement of africans in the new colonies. When the start of the colonizationRead MoreDifferences Between Latin And North America1279 Words   |  6 PagesThe differences between Latin America and North America are primarily due to the disparity between Spanish and English culture. Both Latin and North America are different, due to the Spanish and English ideals implemented in each area. The way of life in both regions are very different. Additionally, the trading and methods of making a stable economy, are substantially diverse. If the English had conquered Mexico and Peru instead of North America, their way of trade would be different. Furthermore,Read MoreColonization and Conflict in the South, 1600-1750 Essay1441 Words   |  6 Pagesbecoming havens for the English poor and unemployed, or models of interracial harmony, the southern colonies of seventeenth-century North America were weakened by disease, wracked by recurring conflicts with Native Americans, and disrupted by profit-hungry planters’ exploitation of poor whites and blacks alike. Many of the tragedies of Spanish colonization and England’s conquest of Ireland were repeated in the American South and the British Caribbean. Just as the English established their first outpostRead MoreRace Relations During The Early Colonization Of America1608 Words   |  7 PagesAmerica till now. American race relations started in early 1600’s when the English settlers arrived. We see the English arrive in North America where they attempt to establish themselves. Unfortunately the continent was already inhabited by native americans they called â€Å"Indians† because they believed at the time they were in the Indies. Moving forward in the 17th century the colonist and Indians are facing turmoil, the English sought peace with the Indians in an attempt to be different than the Spanish

Analysis Of The Movie The All American Movie Experience

Two American cities Tulsa and Miami competed in the All-American City (AAC) Contest set by the famous director Steven Spielberg for the purpose of shooting his movie â€Å"The All-American Movie Experience† in one of these cities. Through this competition, each city committee tried to present that their city reflects the American culture more than other. Throughout my essay I will argue that Tulsa should be chosen to be the All-American city rather than Miami. This will be demonstrated by contrasting the differences between the two cities in the following aspects population diversity, special events, and history. Like any other city in the U.S, Miami and Tulsa have population diversity. In contrast, Tulsa is more diverse. As an illustration, the ethnic variety of the 391,906 residents of Tulsa survey made by the United States Census (USC) showed slight, but noticeable difference with 62.6% of white American and 37.4% of African American, Hispanic, other ethnicities, two or mor e ethnicities, Native American, Asian American, and Native Hawaiian and Other Pacific Islander (Demographics of Tulsa, 2010). Moreover, the same organization USC reported another survey illustrating a percentage of a various races speaking another language besides English at home of 76.7% of all Asian or Pacific Islander, 68.9% of Hispanic, 5.6% of Indians, 3.6% black, and 2.6% Non-Hispanic White (Brandon University, the Heller School for Social policy and Management, 2010). Miami, on the other hand, hasShow MoreRelatedCrash1243 Words   |  5 PagesCrash Movie Analysis Anjelica McCartney HUM/150 January 18, 2016 Victor Armenta Crash Movie Analysis Discrimination, racism, classism, prejudice and more plague today’s society. These horrible issues do not affect one race, sexes, class, ethnicity, or age group; these issues affect all races, both genders, all ethnicities, and all age groups. For this film analysis, I have chosen to discuss the racism portrayed throughout a three-time Oscar award winning movie called Crash. Summary PaulRead MoreFilm Theater : A Movie Theater1524 Words   |  7 PagesThis is the main point for any Movie Theatre. The profit for a Movie Theatre is not coming only from tickets but also from all the sales of food and drinks. Nowadays a Movie Theater has a 3 to 4 floors building with different types of restaurants and entertainments for kids so basically there are a lot of different sources of profits for Movie Theater. A Movie Theater has to attract people not only with movies but also with all the fun that people can have in Movie Theater. Technological factorsRead MoreArt in Raw Form1434 Words   |  6 PagesArt in Raw Form The movie industry is for entertainment purposes. For many people, going to the movies is an escape; time to sit back and become someone else. However, once in a rare moment then a movie comes out that is not just foe entertainment and dares to address a controversial issue. â€Å"The Blind Side† and â€Å"Precious† are two movies that I was very surprised at my reaction to them. My reasons for wanting to see both movies were as different as night and day. I went to see the â€Å"BlindRead MoreThe Hobbit : The Battle Of The Five Armies1333 Words   |  6 PagesIt is estimated that one in five Americans suffer from a mental health disorder. (Www.mentalhealth.gov) Hundreds of different types of psychological concepts are known and classified to date. These classifications and diagnosis are developed by the American Psychiatric Association and are published in the Diagnostic and Statistical Manual of Mental Disorders, which is now in its fifth edition, abbreviated DSM-5 The DSM-5 is used by healthcare providers to help give their patients an accurate andRead MoreThe Help Film Analysis Essay1686 Words   |  7 PagesHannah Struzynski Film/Documentary Analysis Paper: The Help ERS 100 Section 8 For my film/documentary analysis paper, I chose the movie The Help. This movie was actually originally a book written by Kathryn Stockett, but then in 2011, a screenplay was written and directed by Tate Taylor. I selected this film because it directly relates to some of the topics we talk about in class. Some of them being segregation and discrimination. In society today, segregation and discrimination play a huge roleRead MoreAnalysis Of Arthur Miller s The Crucible 961 Words   |  4 Pages Movie paper analysis of The crucible The circumstance brought upon a person can change them greatly. The Crucible edited and rewritten by Arthur Miller, is a movie which takes place in Salem, Massachusetts in 1692. The leading actors are Daniel Day-Lewis as Proctor, Winona Ryder as Abigail, Paul Scofield as Judge Danforth, Joan Allen as Elizabeth, Bruce Davison as Parris, and Rob Campbell as Hale. It was directed by Nicholas Hytner and was Based on the witch hunt which surrounded MassachusettsRead MoreEmily Liddick. Mrs. Campbell. English 2. 23 April 2017.1203 Words   |  5 Pages2017 Gatsby Analysis Essay Cinematic techniques are methods that authors use to convey specific pieces of information in a narrative. Some examples of this would be the angle shots, flashbacks, themes, symbols, etc. In both the movie and the novel of The Great Gatsby, F. Scott Fitzgerald portrays multiple instances of these techniques. This not only enhances the effect that it has on the audience, but it also constructs similarities and differences between both the novel and the movie. For instanceRead MoreScarface Analysis Essay1065 Words   |  5 PagesScarface Analysis Essay The gangster movie genre is one of the most popular among the modern movies and some of the best film directors have produced some very excellent gangster movies. For my first film analysis, I decided to analyze my favorite gangster movie of all time. The movie that I analyzed is called â€Å"Scarface† and is directed by Brian De Palma. It was released in 1983 and is still a super hit movie today. Let me go through a short summary of the movie. The movie is focusedRead MorePrecious Based on the Novel Push by Saphire Analysis1368 Words   |  6 PagesProfessor Brook Film Analysis on 2009’s â€Å"Precious† Analyzing a dynamic film like the 2009 â€Å"Precious† is difficult. The movie got a lot of praise for the acting and the story that was portrayed but it also got a lot of heat from the race that was portrayed in the movie. African Americans nationwide said the movie made their African American ghettos into a sexually incest ridden, classless society and didn’t properly show any of the positive attributes that come from the African American ghettos. In ourRead MoreAnalysis Of The Movie American History X 858 Words   |  4 Pagespersonal/familial level, or the institutional level. The film,American History X, tells the story of two brothers who are both involved with a Neo-Nazi gang in Venice Beach. The movie starts with the older brother Derrick getting out of jail for the murder of two black gang members. At the same time his brother is getting out of jail, the younger brother Danny is forced to write a paper about his brother s influence on him. The movie then unfolds as part of the paper that Danny is writing. It

A Person With Various Mental Health Needs - 2233 Words

This paper will examine a person with various mental health needs. This will be followed by a discussion on the range of health needs and possible services to be accessed. It will also identify other professionals likely to be involved in the person’s care. The piece of work will look at the impact these health conditions have on the patient, carer(s), as well as neighbors and family. In meeting identified needs of the patient, a framework of care will be explored to offer a holistic person-centered care that includes psychological, emotional, physical, and social needs. There will be a further discussion on the model of care that will be suitable and convenient for the patient in order to promote effective communication and a good partnership approach that will guarantee the patient’s value, dignity and respect at all time through evaluation, plannification, and assessment of the patient mental illness, taking into consideration that all have an equal right and opportu nity to high standard health care facility. Department of Health. (DH) (2012c). The scenario in hand tells of a patient with mental health problems. It will be wise and prudent for us to understand what the concept of mental health is all about, and identifying the various needs associated with it. World Health Organization (WHO) (2001) cited in Pryjmachuk(2011,p.4) defines mental health as ’a state of well-being in which the individual realizes his or her abilities, and can cope with the normal stresses ofShow MoreRelatedChronological Record of Various Acts that were Implemented for Persons with Mental Illness954 Words   |  4 Pagesthe government and its various branches. The treatment of persons with mental illness has been documented in the ancient Ayurvedic texts, but introduction of a separate institution for the sole purpose of the care of the mentally ill is a British introduction. This assignment will provide a chronological record of the various Acts and provisions that were implemented for persons with mental illness. 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World Health Organization explains that integrated careRead MoreInadequacy Of The United States Mental Health Care System1104 Words   |  5 PagesStates Mental Health Care System: Barriers to Care According to the World Health Organization, mental illness will affect approximately 25% of people at some point in their life (â€Å"WHO Qualityrights†, n.d.). Despite that, the current mental health care system in the United States is inadequate. Many aspects of the system need improving, especially the barriers to service. In fact, approximately 20% of individuals are left without necessary treatment for their mental health disorder (â€Å"Mental Health†Read MoreLearning Mental Health During Undergraduate Education1657 Words   |  7 PagesLearning mental health during undergraduate education can be challenging as it is a broad and complex sector of health care. Like complicated physical illnesses, there are also various problems, frameworks, and theories associated with a person’s mental aspect which can be hard to learn and explain if without further studies or exposures (Simon, 2014). Therefore, utilising other types of learning such as the continuing p rofessional development (CPD) online or face-to-face activities are importantRead MoreIntellectual Ethics And Mental Health1019 Words   |  5 PagesIntellectual health is as essential as bodily fitness. Still, millions of usa citizens suffer with various types of intellectual contamination and mental health troubles, consisting of social tension, obsessive compulsive disorder, addiction to capsules and alcohol, and persona issues. Intellectual contamination and psychological issues have correct treatment options with medicines, psychotherapy, or different remedies. Intellectual fitness issues all of us. It impacts our ability to addressRead MoreCounseling: Helping Clients Find Solutions Essay1345 Words   |  6 Pagesproblem and needs assistance, while the counselor is experienced and possesses unconditional positive regard to the client (Colin J. S Graham U. 1994).Therefore, counseling may also be regarded as a helping profession because it aims at helping the clients deal with the problems they face. The counselor is the person who offers services of counseling and is a professional who has undergone training to acquire the skills and competency to do the job. The client or counselee is the person faced withRead MoreMental Illness Is A Social Problem1501 Words   |  7 PagesMental illness is a health condition that affects an individual’s moods and thinking in a way that changes how that person relates to other people in society. The functioning of the affected person is also altered and usually results in the person failing to perform some of the daily activities that the person has previously engaged in. Mental illness can be considered a combination of both social and health complications, affecting the social life of the people who fall victim in many ways (ElliottRead MoreProtection Is High On Social Work Agenda964 Words   |  4 Pageseffects of abuse significantly damages overall health. Abuse can be experienced by anyone as it occurs in various forms, either s eparately or in conjunction with others, including verbal, physical, mental, emotional or financial. Yet abuse tends to be against those most vulnerable within society as their dependency makes them powerless to prevent ill-treatment. Due to frailty elder abuse is prevalent, however the actual numbers are unknown as, for various reasons, cases go unreported, for instance anRead MoreFactors Affecting Health Care Workers1492 Words   |  6 PagesAs seen above, although there is an overall imbalance between the supply and demand of mental health care throughout the country, rural areas are most affected. Various factors influence health care workers’ decision to avoid the rural localities, one of which is the unfavorable living conditions in these areas. Many of the rural areas do not offer the luxury or prestige that most of the health workers desire in the modern age. For example, the housing facilities may not match those that they canRead MoreHealthcare : A Great Deal789 W ords   |  4 Pagesin treating infection, the ascent of incredible organizations of medicinal preparing and mending, and the approach of restorative protection. As of 2015 the healthcare spending was around 320 billion which is about 10,000 per person, hence per capita spending on each person is very high. Even though the spending is high, Universal coverage has not been achieved and there is increase in personal debt and economic failure because of medical expenses. Now about 44 million population is benefiting which

Protozoa Infections Pictures Example For Students

Protozoa Infections Pictures entamoeba histolytica entamoeba histolytica (intestinal ulcer) entamoeba histolytica (flask shaped ulcer) entamoeba histolytica (trophozoa with ingested RBCs) entamoeba histolytica (black hole liver abscess) entamoeba histolytica (+cytotoxic assay) entamoeba histolytica (cyst) naegleria fowleri (meningoencephalitis) naegleria fowleri (acanthamoeba) acanthamoeba (keratitis) naegleria fowleri (trophs in sterile fluid) giardia lamblia (adhesive disks) giardia lamblia (showers of cysts and trophs) giardia lamblia (trophs) with pinworm infection dientamoeba fragilis trichomonas vaginalis (troph) trichomonas vaginalis (troph) trichomonas vaginalis (troph in discharge sample) leishmania donovani (visceral leishmaniasis/kala azar) leishmania donovani (amastigotes) leishmania tropica (cutaneous leishmaniasis/oriental sore or delhi boil) leishmania braziliensis (mucocutaneous leishmaniasis) leishmania tropica (cutaneous leishmaniasis/oriental sore or delhi boil) trypanosoma gambiense or rhodesiense (african trypanosomiasis/sleeping sickness-winterbottoms sign) trypanosoma cruzi (chronic chagas disease-cardiomegaly) trypanosoma cruzi (chagas disease) trypanosoma cruzi (chronic chagas disease-cardiomegaly) balantidium coli balantidium coli (troph) plasmodium (malaria- blackwater fever) plasmodium (thick and thin smear) plasmodium (schizont-prior to lysis) plasmodium (ring stage) plasmodium ovale (gametocyte) plasmodium falciparum (gametocyte) toxoplasma gondii (cyst in muscle) toxoplasma gondii (tachyzoites) toxoplasma gondii (hydroencephalus) toxoplasma gondii (hydroencephalus/suture opening) toxoplasma gondii (macular lesion of retina) cryptosporidium parvum (intestinal lining) cryptosporidium parvum (acid-fast stain) cryptosporidium giardia (IFA) isospora belli (oocyst)

Born In Boston In 1809, Edgar Poe Was Destined To Lead A Rather Somber

Born in Boston in 1809, Edgar Poe was destined to lead a rather somber and brief life, most of it a struggle against poverty. His mother died when Edgar was only two, his father already long disappeared. He was raised as a foster child in Virginia by Frances Allen and her husband John, a Richmond tobacco merchant. Poe later lived in Baltimore with his aunt, Maria Clemm and her daughter Virginia, whom he eventually married. The trio formed a household which moved to New York and then to Philadelphia, where they lived for about six years -- apparently the happiest, most productive years of his life. Of Poe's several Philadelphia homes, only this one survives. In 1844 they moved to New York, where Poe briefly owned his own journal. Tuberculosis took Virginia's life in 1847, drawing it from her slowly after the fashion of this cruel affliction. Poe's subsequent decline was as tragic as it was rapid. In 1849 Edgar Allen Poe died in delirium of "acute congestion of the brain." There is a very bright side to Poe's life, however, that the rest of us have enjoyed, if not the man himself. His prose and poetry have forever changed the course of storytelling, setting standards that many authors have striven to meet and still do. Poe is widely recognized as the inventor of the modern mystery with his "Murders in the Rue Morgue" (written in Philadelphia). Here detective Cesar A. Dupin solved crimes through a process of rational thinking Poe called ratiocination. Dupin was the predecessor of Arthur Conan Doyle's Sherlock Holmes and Agatha Christie's Hercule Poirot. Edgar Allen Poe is probably most famous for his macabre tales such as "The Raven", "The Tell-Tale Heart" and "The Fall of the House of Usher" (the latter two written in Philadelphia, along with other famous stories and poems). A Dream Within a Dream Take this kiss upon the brow! And, in parting from you now, Thus much let me avow - You are not wrong, who deem That my days have been a dream; Yet if hope has flown away In a night, or in a day, In a vision, or in none, Is it therefore the less gone? All that we see or seem Is but a dream within a dream. I stand amid the roar Of a surf-tormented shore, And I hold within my hand Grains of golden sand - How few! yet how they creep Through my fingers to the deep, While I weep - while I weep! O God! can I not grasp Them with a tighter clasp? O God! can I not save one from the pitiless wave? Is all that we see or seem But a dream within a dream? by Edgar Allen Poe Carl August Sandburg was born the son of Swedish immigrants August and Clara Anderson Sandburg. The elder Sandburg, a blacksmith's helper for the nearby Chicago, Burlington and Quincy Railroad, purchased the cottage in 1873. Carl, called "Charlie" by the family, was born the second of seven children in 1878. A year later the Sandburgs sold the small cottage in favor of a larger house in Galesburg. Carl Sandburg worked from the time he was a young boy. He quit school following his graduation from eighth grade in 1891 and spent a decade working a variety of jobs. He delivered milk, harvested ice, laid bricks, threshed wheat in Kansas, and shined shoes in Galesburg's Union Hotel before traveling as a hobo in 1897. His experiences working and traveling greatly influenced his writing and political views. As a hobo he learned a number of folk songs, which he later performed at speaking engagements. He saw first-hand the sharp contrast between rich and poor, a dichotomy that instilled in him a distrust of capitalism. When the Spanish-American War broke out in 1898 Sandburg volunteered for service, and at the age of twenty was ordered to Puerto Rico, where he spent days battling only heat and mosquitoes. Upon his return to his hometown later that year, he entered Lombard College, supporting himself as a call fireman. Sandburg's college years shaped his literary talents and political views. While at Lombard, Sandburg joined the Poor Writers' Club, an informal literary organization whose members met to read and criticize poetry. Poor Writers' founder, Lombard professor Phillip Green Wright, a talented scholar and political liberal, encouraged the talented young Sandburg. Writer, Political Organizer, Reporter Sandburg honed his writing skills and adopted the socialist views

Functions of Corrections essays

Functions of Corrections essays When we hear the word corrections the first thing that most people will think of is jail or prison; some custodial institution. Many people dont realize that the same term also applies to non-custodial alternatives such as parole or probation, programs and/or facilities specifically designed for juvenile offenders and halfway houses. It is popularly believed the function of corrections is merely to lock criminals up. While this is not entirely untrue, it is also only a very small portion of the role that corrections plays in our society. The functions of corrections are to provide control, custody and care to any person convicted of a criminal offense. Providing control for correctional clients is twofold. The first thing that needs to be addressed is the correctional employee. These employees work in any governmental jurisdiction in the country. They sport various titles such as Correction Guard, Warden, Social worker, Doctor, Lawyer, Cook, Grounds Keeper, and Secretary among others. Each of these various professions plays a vital role in keeping our many correctional institutions operational. The second component of control lies in classifying a correctional client. All clients that are in a custodial institution require that they be housed in an environment which will provide them security as well one in which their individual medical andor program needs will be met. Custodial clients are classified to either a maximum, medium, or minimum security facility. Once there, they are assigned to a unit or mod. At this point the correctional client is also assigned a Unit Manager, a Case Manager, a Correctional Counselor as well as some one from the Education, Psychology and Work departments. Correctional clients meet on a regular basis with their Unit Team to develop, review and discuss programs they should be involved in as well as to address any other concerns or needs they may have...

Two Recent Merger and Acquisition Cases Research Paper

Two Recent Merger and Acquisition Cases - Research Paper Example Verizon shareholders were the winners in the deal in that the new wireless unit was expected to have an annual income of 21.8 billion as operations income, a major boost to Verizon wireless coffers. The implication would be that Verizon wireless would have huge capital for investment in its wireless network infrastructure to take over competition wars to new levels. The deal was particularly of much importance to Vodafone shareholders as the company was not in a position to control operations and dividends in the U.S market. As such, the deal liberated Vodafone to focus more on reinventing and improving its operations in the European market where they have total control of their operations. Concentrating on the European market would improve the value of the company to its shareholders. In other words, the company made efforts to concentrate in smaller market segment hence improved performance and obtaining a competitive edge. The move to sell Vodafone U.S to Verizon was a response to the dwindling fortunes in the European market, which was badly affected by the debt crises. As such the buyout would leave Vodafone in improved financial status for boosting its network in the European market, which would be a win to Vodafone shareholders after several years of misfortune. The lucrativeness of the deal was evident by the fact that Verizon had agreed to sell its 23% stake in Vodafone Italy back to Vodafone at a cost of $3.5 billion. The amount is a fraction of what Verizon churned out for Vodafone US. On the other hand, the deal was a major boost to Verizon shares in the market. Verizon was expecting at least 10% gain per share since the buyout, a major surprise in the U.S communication market. However, the deal was not without a cost to Verizon. The company faced a major downgrade risk from S & P due to its high debt, with its credit rating being downgraded by one level and risking sinking deeper towards

Immigration Essay Example | Topics and Well Written Essays - 1250 words - 5

Immigration - Essay Example Despite the fact that the force to search for better fortunes across the borders is too powerful to resist, it is not always gratifying since problems also exist in the US for the immigrants. To illustrate this, Nazario (12) reckons that Enrique decides to travel to the US since his mother’s expectations of changing their life are foiled with time, to an extent that she even stops calling home. Life in third world countries around the world, particularly those in South America, Central America and neighboring Mexico is difficult due to underdevelopment. The difficult conditions at home for the immigrants make the case for immigration powerful such that not even immigration laws can stand in the quest for a better life across the border. Lack of proper services in home countries of the immigrating population when or poor service delivery when compared to the US triggers survival interests for instance when involving food and medical services. As an illustration, child protection services are poor or inexistent such that children struggle to look for their parents who leave them behind. â€Å"What kind of desperation, I wondered, pushes children as young as seven year old to set out, alone through such a hostile landscape†¦Ã¢â‚¬  (Nazario xiii) Other services such as safety and security as well as justice are not as advanced in the third world setting, which compel movement in search of delivery of such in the US (Brick and Rosenblun 5). Several immigrants seek to reunite with their family members such as children in search of their parents who leave them and immigrate to the US never to return home. Under the circumstances of family reunion reasons, blood ties form a very strong force propelling immigrants to cross over the borders despite strict legal regulations. The seriousness of some of the above risks to living a normal life as a

The Five Management Functions Essay Example for Free

The Five Management Functions Essay The subject of this reflective paper is regarding the most critical organizational management functions. Critical management functions sit at the core of any organization and steer its leaders, managers, and employees toward success by utilizing the people and resources in the most effective manner. My intent is for the reader to be enlightened of how I helped manage a Heating, Ventilation, and Air Conditioning (HVAC) company by implementing some of the same leadership and management methods from our Management 330 college course. Though many of the Theories from the text book are very valuable, I believe some the information is very vague and somewhat common sense in nature. In my opinion, I don’t believe Mark Zuckerburg, Bill Gates, Lee Iacocca, Mark Cuban, or Donald Trump used these EXACT theories of management to become successful owners of businesses and organizations. Think of how the main points and sub-headings pertain to your current job or another job you have held in the past. My personal examples provide a simplistic version that proves with the right planning, organizing, staffing, leading, and controlling, a tiny HVAC company could become an even larger success than what the owner had initially hoped for. Enjoy! The Planning Function Upon retirement from the USAF and a short term of employment at Sandia National Laboratories, I was hired to manage a heating, ventilation, and air conditioning (HVAC) company. I was not very familiar with HVAC systems, but as a home owner I knew enough about them that I was comfortable in that type of environment. The owner of the company seldom communicated with the HVAC technicians because he wanted them out of the shop and either on their way to the job site or at the job site no later than 8:00 a. m. The company had seven HVAC technicians, an accountant and me, the company manager. A few of my daily tasks were to maintain the weekly service call, maintenance, and installation schedules. This required extensive planning and communication with the technicians. As the manager, I was responsible for enforcing the owner’s company goals then motivate the employees to reach those goals via several courses of action. I used a variety of planning activities to include bi-weekly staff meetings, reviewing internal and external factors such as employee’s scheduled vacations, budget statuses, job site locations, and the weekly weather forecast. I also had to take into consideration the strengths and weaknesses of our employees. Some technicians had more experience and education than others, so I had to match jobs with installers or service technicians. There were some jobs our company was not qualified to do, such as electrical installation and hook up. None of our technicians were licensed electricians, which was a handicap for the organization. If a job required electrical installation or upgrade, I would coordinate with one of our electrical sub-contractors to ensure they could be on the job site when the equipment was ready for electrical hook up and start up. Our accountant was responsible for all aspects of receiving and distributing monetary resources to complete the company’s goals. One of the many challenges we faced was keeping informed of the government incentives for households to install more efficient heating and cooling systems. We were in constant communication with our system vendors to get the latest and greatest government rebates and installation incentives and deadlines. Economic and technological changes were another challenge because we had to stay abreast of new and emerging heating and cooling systems to stay competitive in the HVAC industry. Planning for an organization occurs with some degree of uncertainty because the end result is somewhat unknown. As the manager, I sometimes had to take certain risks with company resources to succeed in a job completion strategy. The Five Functions of Effective Management; Introduction to Management: Achieving Form through Function, Chapter 1, Page 15). Even though this company was relatively small with less than 10 employees, the same planning fundamentals applied to that of a major employer or organization. The Organizing Function When the owner of the company had new tasks or company goals, I was always his go-to person to ensure the visions and processes he demanded were successful. Our task and authority relationship (The Five Functions of Effective Management; Introduction to Management: Achieving Form through Function, Chapter 1, Page 15). as always very professional because we worked together to achieve the organization’s goals. Another important responsibility I was delegated was to decide the best way to organize the company’s resources. The owner usually determined the actual job requirements, what specifically needed to be done, and who he wanted doing the job(s). My role was to inform him of each employee’s status, who was available, who was qualified, etc. , The Staffing Function As an Information Technology geek by trade, my experience with the human resources and staffing functions was limited. During my Air Force career, I was not able to choose who I wanted in my work center. It was my decision as to who would supervise who, but the hiring/firing and interviewing functions were pretty much non-existent in the military; you get who is allocated toward a specific vacancy, get the person trained, press on with the mission, and mold your troops to become leaders in their own right. If they mess up along the way, you reprimand them and hope they learn from their mistakes. As the HVAC company manager, staffing was also delegated to me. Even with my lack of human resource experience, the owner wanted his manager to do the recruiting, selecting, evaluating, and hiring of employees. (The Five Functions of Effective Management; Introduction to Management: Achieving Form through Function, Chapter 1, Page 16). The Leading Function I was taught that to become a truly effective leader you must first be an effective follower and subordinate. I have been on both sides of the leading/following roles and know what it is like to be the low person on the totem pole or the â€Å"boss† making the tough decisions. A key element when trying to motivate individuals to accomplish goals is to present clear tasks to those completing the organizations actual goals. The owner and I would constantly encourage our technicians to be great at what they do, not just be good at what they do, and that if they needed anything from us we were always available for support and mentoring. My boss had a tendency to get a bit excited and raise his voice when something didn’t go as planned. Once he calmed down, he and I were able to sit at the conference table to sort out the events that led to an unsatisfied customer or a derogatory employee internal issue. I would open up the conversation with an open mind and allow the employee(s) to take their time to explain what went wrong or why a customer was dissatisfied. After listening to what had actually occurred, the situation was discussed thoroughly, and a plan of action to remedy the issue was agreed upon by all parties, I could always sense an increase of personal commitment to the organization. The Control Function After a few weeks as manager of the company, I noticed the technicians did not provide customer satisfaction/feedback forms to our customers. I asked the boss about how he receives feedback from our customers and he told me that if there is a problem someone will call you and then you can report the problem to me. I asked how he received positive feedback from a job well done or when an employee goes above and beyond the norm to satisfy a customer. He told me that the employee would just tell him that their customers were very pleased with their service. That didn’t seem like a very accurate customer service measuring tool so I suggested we implement an easy, effective, and yet â€Å"voluntary† customer feedback system. My idea was the next time we needed to order our company invoices, to have the printing contractor add a portion to the customer’s copy where the customer could fill in the survey/feedback form and mail it, fax it or e-mail their comments to me and the owner. Then, we would hold a monthly drawing from our customer feedback file, and one of our customers would receive free merchandise, such as a pocket knife with our company name and logo, a free HVAC inspection, free furnace filters, or a free spring or fall start-up of heating or cooling services. After 30 days, the feedback forms, e-mails, and phone calls increased our customer relations by over 80 percent and business increased by over 25%! Within a matter of 90 days we had established an excellent customer service standard, and an employee performance metric that was created by external factors, not biased internal performance ratings. The owner was impressed with the new system and began to reward employees with free lunches, new tools, use of company vehicles (which helped with advertising), paid time off, and other tokens of his appreciation for a job well done.

Against Louis Riels Execution :: essays research papers

Louis Riel should not have been hung because he represented those who couldn't represent themselves. Louis Riel was disappointed with the way the MÃ ©tis were, so he took it upon himself to represent the MÃ ©tis and their rights. Even though the actions that followed, such as keeping the new governor out the colony, was illegal and very wrong. Riel risked it for the rights of the MÃ ©tis. As for Thomas Scott, Riel has absolutely no legal right to have him shot, but Riel himself never touched a gun for that purpose. He had a firing squad shoot Scott. Although, Riel may have ordered the squad to shoot, but the men could have backed down, no matter how powerful Riel seemed. After the rebellion, he was elected by Manitoba to sit in the House of Commons. Riel went to Ottawa but was not allowed to sit as a member in the House, for he was threatened by many to be shot if he appeared in the House. This was the mistake of the government. They should have sopped the nonsense and threats. For Riel was a man of ideas. He was a man who was knowledged in the government. It was obvious since he formed his own government. Riel would have been an asset to the Canadian government. In 1884, Gabriel Dumont rode to Montana and asked Riel to defend the MÃ ©tis once again. Riel returned to help the natives once more. Riel was risking capture when he returned. This was a very noble act on his part. Instead of staying nice and safe in Montana, Riel gave up his safety for the MÃ ©tis. Riel decided to try an unviolent approach this time instead of starting an all out rebellion. Riel and the MÃ ©tis drew up a petition and presented it to the government. The petition, which demanded more food and money for the natives, was looked over but not acted upon. The petition was fair in all parts but the government turned it down. It only demanded that what belonged to the natives be returned. In early 1885, Riel formed another provisional government, and started another rebellion. His followers killed many army troops, but once again it was not the hand of Riel that killed so many. It was of people who had their own thoughts and intuitions. They could have easily said no to Riel instead of shooting. In which case Riel was

Measurement of Sevice Quality of Apollo Using Servqual

Dissertation Project Report On Measurement of Quality at Apollo Hospitals using Servqual Submitted by Richa Kumari A0102208164 MBA (M&S) 2010 Under the Supervision of Faculty Mentor Prof. (Dr. ) P. K. Bansal Faculty Amity Business School AMITY BUSINESS SCHOOL AMITY UNIVERSITY UTTAR PRADESH SECTOR 125, NOIDA – 201303, UTTAR PRADESH, INDIA 2010 DECLARATION I Richa Kumari, student of Master of Business Administration (Marketing &Sales), Class of 2010from Amity Business School, Amity University, Uttar Pradesh hereby declare that the dissertation done by me on the topic â€Å"Measurement of Quality at Apollo Hospital using Servqual† is true to my knowledge. The information collected by me is authentic & is done through data analysis & interpretation & I have a thorough knowledge of the project. The content of this report is based on the information collected from visiting Indraprastha Apollo hospitals in Delhi. I further declare that the matter embodied in this project report has not been submitted to any other university or institute for the award of any degree or diploma. PLACE: Noida DATE : Richa Kumari Amity Business School Amity University, Uttar Pradesh CERTIFICATE FROM FACULTY GUIDE This is to certify that Richa kumari, student of MBA (M&S), Amity Business School, Amity University; Uttar Pradesh has successfully completed the dissertation project under my guidance. The project report and data submitted by her is authentic and genuine to my knowledge. Prof. Dr. P. K. Bansal Faculty guide Faculty, Amity Business School Amity University, Uttar Pradesh ACKNOWLEDGEMENT It takes immense pleasure for me to express my sincere gratitude to all the helping experience I had during my dissertation. The Project was done by me under the guidelines of my Faculty Guide Prof. Dr. P. K. Bansal was a source of enormous learning for me. I am highly obliged to him for their continuous unconditional support & guidelines. A special word of thanks from me to all the respondents whose cooperation and interaction was a great help. As a student of AMITY BUSINESS SCHOOL, NOIDA I got the golden opportunity to work on the topic â€Å"Measurement of Quality of Apollo Hospital using Servqual†. I also feel highly obliged to my program leader Mrs. Aparna Goel and some of the faculties in ABS who in several ways were my inspiration & helped me to put in the best of my efforts. I am deeply indebted to my parents, family members & friends for their support during the course of my dissertation. Last but not the least; the report was completed successfully because of the grace of God. Richa Kumari Amity Business School EXECUTIVE SUMMARY Service firms like other organizations are realizing the significance of customer-centered philosophies and are turning to quality management approaches to help manage their businesses. This paper starts with the concept of service quality and demonstrates the model of service quality gaps. SERVQUAL as an effective approach has been studied and its role in the analysis of the difference between customer perceptions and expectations has been highlighted with support of measurement of quality at Apollo Hospital. Outcomes of the study outline the fact that although SERQUAL could close one of the important service quality gaps associated with external customer services, it could be extended to close other major gaps and therefore, it could be developed in order to be applied for internal customers, i. e. mployees and service providers. Quality Health Care  is an achievement of optimal physical and mental health through accessible, cost-effective care that is based on best evidence, is responsive to the needs and preferences of patients and populations, and is respectful of patients’ families, personal values and beliefs. The report covers the survey of Apollo Hospital Services, Delhi. It focuses on the dynamics of the the overall service provided, the trends over a period of time, and the key challenges faced by the industry. TABLE OF CONTENTS DECLARATION I * CERTIFICATE FROM FACULTY MENTOR II * ACKNOWLEDGEMENT III * EXECUTIVE SUMMARY IV * CHAPTER 1 INTRODUCTION * CHAPTER 2 LITERATURE REVIEW * CHAPTER 3 METHODOLOGY * SAMPLE DESIGN * RESEARCH DESIGN * DATA COLLECTION METHOD * SAMPLE SIZE CHAPTER 4 DATA INTERPRETATION * DATA ANALYSIS * FINDINGS * LIMITATIONS * CHAPTER 5 CONCLUSION &RECOMMENDATION * APPENDICES V * REFERENCES VI * BIBLIOGRAPHY VII CHAPTER 1 INTRODUCTION Earlier in the medical literature, the quality of service i. e. the  characteristics that shape the experience of care was rarely discussed beyond technical  competence. This research measures and analyzes  some routine encounters in Apollo, a hospital of international standard from a service quality point  of view. The study has led to the following two premises: First, if high-quality service had a greater presence  in practices and institutions, it would improve clinical  outcomes and increased satisfaction of patient and doctors while reducing  cost. It will also create competitive advantage for those who  are expert in its application. Second, many other industries  in the service sector have taken service quality to a high level,  their techniques are readily transferable to health care, and caring for patients can learn from them. Healthcare industry The healthcare industry in India comprising of hospital and allied sectors, is projected to grow at 23 per cent per annum and to touch US$ 77 billion by 2012 from the current estimated size of US$ 35 billion, according to a Yes Bank and ASSOCHAM report. The sector has registered a growth of 9. 3 per cent between 2000-2009, when compared with the growth rate of other emerging economies such as China, Brazil and Mexico. According to the report, the growth in the sector would be driven by healthcare facilities, private and public sector, medical diagnostic and pathlabs and the medical insurance sector. Today Hospital industry is an important component of the value chain in Indian Healthcare industry. It renders services and is recognized as healthcare delivery segment of the healthcare industry. It is growing at an annual rate of 14%. The hospital industry accounts for half the healthcare sector’s revenues and was estimated to be worth USD $25 billion in 2008. The dismal performance by the Indian government in providing healthcare infrastructure has created tremendous opportunities in the private sector. The huge pent up demand for quality healthcare and increase in healthcare spending in the long-term are fundamentally strong drivers in this market. The factors contributing to its bright future is based on increased healthcare  consumption, increasing instances of lifestyle-related diseases, medical tourism, and growing  health  insurance. The key challenges for the industry include significant capital requirements and a shortage of medical professionals. Ensuring high quality of healthcare service is another key issue for service providers. Healthcare spending in India accounts for over 5 per cent of the country’s GDP. Of which the public spending in percentage is around 1 per cent of GDP. The presence of public health care is not only weak but also under-utilized and inefficient. Meanwhile, private sector is quite dominant in the healthcare sector. Around 80 percent of total spending on healthcare in India comes from the private sector. Inadequate public investment in health infrastructure has given an opportunity to private hospitals to capture a larger share of the market. In addition the demand for hospital services has been increasing due to the rise in lifestyle related diseases that accompany prosperity. Hospitals serve an important function in India’s healthcare system. They provide in-patient and out-patient services and also support the training of health workers and research. Indian hospitals can be broadly classified as public hospitals, private and not-for-profit hospitals. Corporate hospital chains that provide tertiary healthcare services in large towns and cities have also been established. However, the number of hospital beds in India is around 1. 1 per thousand people. This is significantly lower when compared to most developed economies. The current outlook for the hospital services is positive. Technological innovations in service delivery, increased affordability, improved service quality and supportive government policy initiatives are some of the factors that are likely to impact growth of the sector. This is a pointer to significant opportunities that exist for service providers. Moreover, the future of healthcare is not restricted to the large domestic market alone. Emerging trend of medical tourism indicates the possibility of Indian healthcare services opening to the whole world. Health Care and Service delivery Health  Service delivery  refers to the way inputs such as finance, staff, treatment, equipment and drugs all deliver a range of health interventions to consumers seeking to access health care. Improving Service delivery  depends on having key resources that are well organized and managed. Health services include personal health services that are preventive, diagnostic, therapeutic or rehabilitative; whilst non-personal services cover areas such as mass health education/ promotion programs, health legislation and the provision of basic sanitation facilities. Incompetence or breakdown in the process of care-giving may be the result of problems in practice, products, procedures or systems. A key issue facing development agencies is the utilization of health services as they are often inaccessible or mistrusted by consumers. Lack of managerial capacity at all levels of the health system is increasingly cited as a binding constraint to scaling up services and achieving the Millennium Development Goals. Apollo Hospitals With over  8065 beds across 46 hospitals in India and overseas, neighborhood diagnostic clinics, an extensive chain of Apollo Pharmacies, medical BPO as well as health insurance services and clinical research divisions working on the cutting edge of medical science, Apollo Hospitals is a healthcare powerhouse one can trust with their life. Apollo Hospitals, India is a union of exceptional clinical success rates and superior technology with centuries-old traditions of Eastern care and warmth, with 16 million patients from 55 countries. Apollo Hospitals Group is at the Forefront of Medical Tourism to make India the Global Healthcare Destination. Its mission is to bring healthcare of international standards within the reach of every individual. They are committed to the achievement and maintenance of excellence in education, research and healthcare for the benefit of humanity. Dr. Prathap C Reddy is the Founder & Chairman, Apollo Hospitals Group. Led by Apollo Hospitals Group, Indian Healthcare today has developed International delivery capabilities and has demonstrated International excellence in all specialties with major cost advantages for people from overseas. Apollo Hospitals has successfully treated over 60000 foreign patients from across the world in last five years and the numbers are looking up every year. By constantly measuring our deliverables, they have succeeded in creating infrastructure that meets the needs of the future that incorporates the latest technology and provides superior healthcare delivery systems. Their immediate agenda includes setting up of healthcare facilities in all major Indian cities, 23-hour hospitals, pharmacies, a pharmaceuticals business and finally, a Health Maintenance Organization that will give millions of people access to all these facilities. The telemedicine technology that has been successfully introduced by Dr. Reddy in India will be a key enabler in transforming the healthcare delivery in India. His blueprint for the nation includes setting up of many rural hospitals. Apollo Hospitals Group is the acknowledged leader in bringing super speciality world-class healthcare to India. It is presently the largest integrated healthcare company in Asia. Apollo Hospital  would mean any of the hospitals owned by  Apollo Hospitals, a  healthcare  corporation that operates 38 hospitals in South Asia. It is the largest healthcare provider in Asia and the third largest in the world and is headquartered in  Chennai, India. Apollo Hospital  Delhi  is the first hospital in India to be accredited by the JCAHO and is affiliated with  Johns Hopkins  international, the  Mayo Clinic, and many major hospitals in the United States and Europe. In addition to hospitals, Apollo operates Nursing and Hospital Management colleges,  pharmacies, diagnostic clinics, medical transcription, third-party administration and telemedicine. Through its wholly owned subsidiary, Apollo Health and Life Science Limited, the Apollo Group has set up a chain of nearly 60 branded day-to-day retail clinics on a franchised basis across India and the  Middle East. This is the first time healthcare delivery has been successfully franchised in India. Indraprastha Apollo Hospitals, the largest healthcare group in Asia. Indraprastha Apollo is one of the largest corporate hospitals in the world. It is the third super specialty tertiary care hospital set by the Apollo Hospitals Group, jointly with the Government of New Delhi, India's capital. It is a 695 bedded hospital, with the provision for expansion to 1000 beds in future. The hospital is at the forefront of medical technology and expertise. It provides a complete range of latest diagnostic, medical and surgical facilities for the care of its patients. The hospital started functioning from July 1996, its mission being Medical Excellence with a Human Touch. Cost of treatment Apollo Hospitals is considered one of the most expensive treatment facilities when compared to their local counterparts. A similar treatment and care in a regular hospital would cost significantly lesser. However, their facilities, infrastructure and quality of medical faculty are far superior to anything else in the country, seemingly justifying this increased cost. Medical Milestones * Employs over 4000 specialists and super-specialists and 3000 medical officers spanning 53 clinical departments in patient care * Achieved a 99. 6% success rate in cardiac bypass surgeries, over 91% of these were beating heart surgeries * Conducted over 55,000 cardiac surgeries First Indian hospital group to introduce new techniques in Coronary Angioplasty, Stereotactic Radiotherapy and Radiosurgery. Performed over 7,50,000 major surgeries and over 10,00,000 minor surgical procedures with exceptional clinical outcomes * Pioneered orthopaedic procedures like hip and knee replacements, the Illizarov procedure and the Birmingham hip re-surfacing technique * Pioneered the concept of preventive healthcare in India * First ho spital group to bring the 64 Slice CT-Angio scan system * First hospital group in South-East Asia to introduce the 16 Slice PET-CT Scan * First to perform liver, multi-organ and cord blood transplants in India * Equipped with the largest and most sophisticated sleep laboratory in the world CHAPTER 2 LITERATURE REVIEW Kotler (1999) points out an unchangeable principle for a successful business are to satisfy the customers’ need. Consumer service is closely related to customer satisfaction and consumer satisfaction has a critical influence on the profits and performance of institutions and organizations (Fornell, 1992; Mittal & Lassar, 1998; Wong, 2000). That is why organizations emphasize the importance of consumer service and satisfaction. Just as the dashboard of a car provides timely feedback on vital performance measures, so should an organization’s dashboards inform decision makers and board members on where the organization is headed and how it is progressing toward its strategic objectives. The consumer service perspective is closely associated with the evolution of the business strategies in the Health Care industry. To manage and improve quality, these successful organizations are coming to the conclusion that quality must be measured. This ensures accurate measurement of customer satisfaction versus that delivered by competitors. Service Quality is a service that is consistent with customer expectations and stated obligation in Customer Care, performance & Value. Quality itself has been defined as fundamentally relational:   ‘Quality is the ongoing process of building and sustaining relationships by assessing, anticipating, and fulfilling stated and implied needs. ‘ One cannot separate the process and the human factor, therefore there is a believe that Quality, when built into a product, generates emotions and feelings within those who have taken part in it's creation. Quality is doing the right things right and is uniquely defined by each individual. Error-free, value-added care and service that meets and/or exceeds both the needs and legitimate expectations of those served as well as those within the Medical Center. Organizations that constantly measure themselves in relation to competitors are able to quickly capitalize on their emerging strengths and address weaknesses before they become problems. Service Quality Quality applies to every product either it is physical product, information product or service product. But when Service Quality is talked about it is all about satisfying the targeted customers through meeting their requirements (Zulfikar Ali). Quality cannot be measured without a clear definition or standard. Likewise, Measuring Quality leads directly to the identification of areas for improvement or enhancement—the first step in Improving Quality. Service Quality models There are a number of models which try to capture and define Service Quality. Each has their strengths, and weaknesses. The core definition of Service Quality is â€Å"Customers thinking they're getting better service than expected†. This is often referred to as the perception gap, i. e. the gap between what the customer expects and what they think they got. It's worth noting that both sides of the gap are in the customers mind. You may actually deliver better Service then your competitors, but if the customer thinks that your Service is worse then that's all that matters. Because the perception gap is based on the difference between what a customer expects to receive from a Service and what they think they received both sides of the gap are â€Å"soft† – they are based on customer impressions rather than a â€Å"hard† definable quality. This means the perception gap is difficult to measure, difficult to manage and is likely to change with time and experience. Nevertheless it's vital to business success. Elements of the model A management model should identify and relate those key elements that require systematic management attention (Brogowicz et al. , 1990). The elements proposed to fit in the model are: * Management’s perceptions of customer expectations and perceptions about the service; * Vision, mission, service strategy and directions to eliminate the gaps; * Service analysis, translation of perceptions into service quality specifications and service design; * Financial and human resources (HR) management; * External communication; * Service delivery system (production, delivery and ‘part-time’ marketing). Some models which are the result of some significant research are: The KANO Model states â€Å"What do customers expect as a minimum standard†, and â€Å"what actually makes a difference if the service provider does it better†. Professor Noriaki Kano (1984, the Japanese quality guru), introduced a two-factor quality model, commonly known as â€Å"Kano's Curve†. The curve illustrates the difference between must-be attractive and linear quality elements. The strength of the Kano model is that it identifies that some aspects of service are simply required to be there whereas others serve to genuinely provide competitive advantage and that there are diminishing returns to be gained from simply focusing on must-be qualities. However Kano does not provide diagnostic tools to identify or measure the different aspects, and suggested the changes with time or environment. The PZB Service Quality Model The service quality model and the role of consumers’ and learners’ satisfaction is an essential part of service quality studies. The â€Å"GAP† model of service quality from Parasuraman et al. (Zithaml & Bitner 1996) offers an integrated view of the consumer-company relationship. It is based on substantial research amongst a number of service providers. According to the PZB model, there are five gaps. The first gap refers to the difference between customers’ expected service and management’s perceptions of customers’ expectations. This gap means that management may not correctly perceive customer expectations. The second gap refers to the difference between management perceptions of customers’ expectations and service quality specifications. This gap means that although the people in management level may perceive the correct expectations of the customers, they may not have suitable and sufficient service quality specifications. The third gap refers to the difference between service quality specifications and the real service delivery. This gap means that although the service providers may have suitable and sufficient service quality specifications, they may not have the satisfactory service delivery in the real situation. That may be because service providers lack well-trained employees to deliver satisfactory service. The fourth gap refers to the difference between the service delivered and external communication about the service with customers. That is, the service providers may not have suitable and sufficient communication with the customers or the service providers may have commitments that exceed what they can do or they may not sufficiently inform the customers of what they have done. The fifth gap is the difference between consumer expectation and their perception of service quality – measured by the difference between what customers expect and what customers perceive about the service. In addition, gap 5 is a function of gap 1, gap 2, gap 3, and gap 4; that is, Gap 5= f (gap1, gap2, gap3, gap4). This means that the service quality is closely related to management perception, marketing, personnel management, communications with customers, service specifications and delivery. Based on theoretical development of the PZB Service Quality Model, the SERVQUAL (SERVice QUALity) instrument was proposed. RATER A complementary analysis of the perception gap is the RATER model also produced by Zeithaml (1990). RATER identifies the 5 key areas which together form the qualities of a service offering from a customer perspective. Where the Gap model describes how the provider can minimize the perception gap. RATER focuses on the dimensions of customers expectations. The RATER factors help provide specific dimensions which can be used to analyse and measure customer expectation. Figure 1: PZB Service Quality Model A Conceptual Model of Service Quality and its Implications for Future Research. Journal of Marketing, 49(4), 41-50. Source: Parasuraman, A. , Zeithaml, V. A. & Berry, L. L. (1985). | RATER dimensions sorted by relative importance (Zeithaml 1990)| Dimension| Description| Relative importance| Reliability| Ability to perform the promised service dependably and accurately| 32%| Responsiveness | Willingness to help customers and provide prompt service| 22%| Assurance | Knowledge and courtesy of employees and their ability to convey trust and confidence| 19%| Empathy| Caring individualised attention the firm provides its customers| 16%| Tangibles | Appearance of physical facilities, equipment, personnel and communication materials| 11%| THE ASSESSMENT INSTRUMENTS-The SERVQUAL and SERVPERF Based on preliminary knowledge about the service quality model and the consumer satisfaction concept, there are two major assessment instruments (SERVQUAL and SERVPERF). The SERVQUAL (SERVice QUALity) instrument was proposed by the Parasuraman et al. (1988). They initially developed a 97-item instrument to measure the service quality attribute. After eliminating the items with low correlation, they extracted five factors (tangibles, reliability, responsiveness, assurance, and empathy) with 22 service quality items, and claimed the generic nature of the five-dimension instrument. Because the disconfirmation-based SERVQUAL instrument has advantages such as better diagnostic power (Jain & Gupta, 2004), and the parsimony of the instrument (Rohini & Mahadevappa, 2006), most researchers in the service quality area tend to prefer the disconfirmation-based SERVQUAL instrument (Abdullah, 2006; Brady, 2001). However, some researchers have been questioning its drawbacks related to the disconfirmation-based model (Redman & Mathews, 1998), process orientation, dimensionality, measuring scale, and the gap scores (Buttle, 1996; Coulthard, 2004; Clewes, 2003; Wetzels, Ruyter, & Lemmink, 2000). To resolve problems related to the disconfirmation-based SERVQUAL instrument, Cronin and Taylor (1992) propose the performance-only SERVPERF (SERVice PERFormance) instrument to measure service quality. Comparing the validity and reliability of the SERVPERF with that of the disconfirmation-based SERVQUAL, they claim that SERVPERF is better than SERVQUAL in overall service quality measurement in empirical tests (Cronin & Taylor, 1992; Brady, Cronin, Brand, 2002; Jain & Gupta, 2004). The debate related to adoption of SERVQUAL or SERVPERF in service quality studies is not yet resolved. SERVPERF has better explanatory power in overall service quality measurement. On the other hand, SERVQUAL has better diagnostic power because of the P-E score measurement. Thus, selection of the service quality instruments will be determined by the intention of the researchers, service providers or decision-makers (Jain & Gupta, 2004). Research Papers â€Å"Provider Competition and Health Care Quality: Challenges and Opportunities for Research†, by HERBERT S. WONG, PEGGY, M NAMARA states that during the last several years, health care quality issues have emerged as important considerations in developing and implementing public policy. This report highlighted health care delivery problems, patient safety concerns, and health disparities issues. Health care quality is difficult to define because different audiences view health care quality from. Clinicians may define quality based on medical outcomes or processes. Economists may define quality based on concepts of social welfare and may include features that consumers happen to care about, but that clinicians do not (e. g. , the appearance and size of hospital rooms). Health plans may further differ and focus on concepts of preventive care or organizational efficiencies. Researchers need to understand what their measures are capturing and should interpret their findings accordingly. Once health care quality has been defined, investigators interested in conducting applied empirical research are confronted with the challenges of creating proxy measures that capture the essence of the health care quality of interest. An initial problem is whether data even exist to create proxy measures for quality. The physician services market was one of the two health care provider groups on which the conference focused. However, the lack of available data about the care administered by physicians has stymied research on physician competition and quality. With literally hundreds of thousands of patient care physicians, current data systems are not structured in a way that makes accessing data and using data for research purposes pragmatic. Even if data were available, researchers must still overcome the challenges of how best to measure physician quality—an area that is currently not well understood. Patient satisfaction measures, which seek to quantify patients’ experiences with healthcare services, represent another dimension of quality still in the developmental stages. The article by Patrick Romano and Ryan Mutter in this supplement documents the studies that examined hospital competition and hospital quality, identifies the variety of hospital quality measures employed, and highlights the challenges of measuring hospital quality. As Romano and Mutter noted, the science of creating hospital quality measures has focused primarily on the clinical definition of quality, and such research is still largely in its infancy. At the heart of the challenges confronting researchers is determining whether observed differences in hospital quality measures are â€Å"true† differences. Confounding factors that may influence their accuracies include severity of illness, underlying patient risk, and the hospital’s overall case mix. Moreover, how well specific data elements are coded varies widely and ultimately affects the accuracy of the corresponding hospital quality measures. Many observers of medical markets believe that hospitals should compete on the basis of health care quality. However historically, hospital merger cases have focused on their effects on prices, costs, and the nature of the competitive environment, largely discounting health care quality issues. Health care markets are unique and extremely complex. While this invitational conference focused only on hospital and physician providers, the research opportunities and challenges outlined here apply to other health care markets as well. Mark Pauly’s article provides some preliminary thoughts on the concepts and the history of the relationship between competition and quality in health care markets. Health care markets are complex. Hospitals compete with one another, physicians compete with one another, and hospitals and physicians interact in many ways. Multiple external factors may influence hospital and physician competitive behavior. Measurement Challenges As mentioned earlier, the science of quality measurement is largely in its infancy and will continue to develop. The main challenges confronting researchers are determining the validity of the current set of measures and improving or developing new measures. The research field involved in inpatient quality measurement appears to be moving in three broad directions. First, researchers are exploring ways to further evaluate and validate the current set of inpatient quality measures. One approach being considered compares existing inpatient quality measures based on administrative data with information from medical records. Organizations such as individual health plans and veterans’ hospitals often have access to a richer source of clinical information, which could be used for this type of assessment. Second, current inpatient quality measures could be improved if the quality of the information collected is better. For example, in their article, Patrick Romano and Ryan Provider Competition And Health Care Quality Mutter mentioned that external-cause-of-injury codes (i. e. , â€Å"E Codes†) are sometimes under reported and vary substantially across the different organizations collecting such data. Many inpatient quality measures rely on accurate coding to identify the relevant observations. Existing measures could be improved if E Codes are collected more consistently. Finally, another broad approach is to supplement current administrative information with additional clinical information that could be used to refine or to create new measures. The availability of this clinical information could be used to improve measures of quality. As the science for better quality measures advances, analysts face a number of important research questions. While some critics argue that existing measures do not capture all clinical information, proponents argue that if there are no systematic biases across hospitals, precise patient-level information may not be needed. Consequently, is the science of quality measurement â€Å"good enough† for aggregate studies of competition and quality? Are they good enough for individual hospital comparisons? How will new measures with better information compare with existing measures? The Evolving Science of Quality Measurement for Hospitals: Implications for Studies of Competition and Consolidation PATRICK S. ROMANO The literature on hospital quality is young; most studies have focused on few conditions and outcomes. Measures of in-hospital mortality and complications are susceptible to bias from unmeasured severity and transfer/discharge practices. We describe the strengths and limitations of various approaches to quality measurement; summarize how quality has been operationalized in studies of hospital competition. three mechanisms by which competition may affect hospital quality, and propose measures appropriate for testing each mechanism. To evaluate the effects of competition and consolidation in health care markets on quality of care, it is essential to understand the capabilities and limitations of the tools currently available for measuring quality. The number and scope of these tools have grown considerably over the past two decades. These developments have created new opportunities to understand how competition and consolidation affect quality of care, although critics may still challenge the validity of any particular quality measure. The fundamental problem is that quality of care has multiple dimensions, and organizations that perform well on one dimension may not perform well on others. It is all too easy to arrive at the wrong conclusion if one focuses on a single measure, or even on multiple measures of a single dimension. In this paper, a standard definition of health care quality and an associated typology of quality problems is set. It describes the three general approaches to quality measurement, focusing on their strengths and limitations for studies of the impact of hospital competition and consolidation. Next summarizes how these measures have been applied in previous studies, and how the authors of those studies have dealt with concerns about confounding and endogeneity. It describes a conceptual framework that may be helpful in identifying promising measures for future studies in this area. 1. Definitions of Quality and Quality Problems In this paper, they have adopted a clinical perspective on quality of care. Avedis Donabedian (1980), one of the founders of the modern science of health care quality measurement, defined the quality of medical care as â€Å"the management that is expected to achieve the best balance of health benefits and risks (taking) into account the patient’s wishes, expectations, valuations, and means the social distribution of that benefit within the population. † The American Medical Association (1984) defined high-quality care more narrowly as care that â€Å"consistently contributes to the improvement or maintenance of the quality and/or duration of life. Perhaps the most authoritative definition was published by the Institute of Medicine (1990), which defined quality of care as â€Å"the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with curren t professional knowledge. † All of these definitions attempt to distinguish between quality and other non-price aspects of service, which might be classified as â€Å"amenities. † Amenities include aspects of appearance, comfort, and convenience, such as the number of television channels available to hospital patients, the number of menu choices, and the quality of decoration. In making this distinction, they acknowledge that the line between amenities and quality may become blurred, especially with important patient-centered measures such as telephone response time, wait time for appointments, clinic hours, prompt complaint resolution and claims payment, and patient satisfaction. Nonetheless, this distinction is useful because it focuses attention on whether provider organizations expend resources in ways that were likely to improve patient outcomes, or in ways that are designed to give the appearance of quality. this paper, also follow the Institute of Medicine’s (1999) typology of quality problems (Chassin et al. , 1998) as involving inappropriate overuse (i. e. too much care), inappropriate underuse (i. e. , too little care), and misuse. Although this conceptualization may state Pauly’s (2003) definition of quality as â€Å"everything about some good or service relevant to consumers’ well-being that is not measured by quantity,â⠂¬  we prefer to place all provider judgments and recommendations regarding appropriate care in the category of â€Å"quality† rather than â€Å"quantity. † 2. Approaches to Quality Measurement Donabedian (2003) has described the three broad approaches to quality measurement as structure, process, and outcomes. This useful schema has been widely adopted by the health services research and quality improvement communities. Structural measures describe the conditions under which care is provided, and encompass material resources such as facilities and equipment, human resources such as the credentials and experience of health care providers, and organizational characteristics such as patient volume and team nursing. Process measures describe the content of health care, and encompass health care providers’ activities in the realms of screening, diagnosis, pharmacotherapy, surgery, rehabilitation, patient education, and prevention. Finally, outcome measures describe changes attributable to health care, and encompass mortality, morbidity, functional status and pain, as well as patients’ health-related knowledge, behaviors, and satisfaction. Although this schema remains conceptually useful, it is sometimes difficult to apply. For example, the shared features of â€Å"high-reliability organizations† (Reason, 2000) include both the structural conditions under which professionals work and how that work is performed. 3. Integrating Outcome and Process Measures of Quality Given that quality of care is a complex and multidimensional concept, no single measure of either process or outcome is likely to provide an adequate summary of the effects of competition and consolidation. Hospitals that perform well on risk-adjusted outcomes for one condition often perform poorly for unrelated conditions (Rosenthal, 1997; Chassin et al. , 1989), making it useful to consider a spectrum of conditions. Similarly, explicit process measures must be developed and implemented on a condition-specific basis (Ashton et al. , 1994). It may be particularly useful to consider outcome and process measures together, as an integrated approach would offer a more complete assessment of quality and elucidate the pathways by which market forces affect patient outcomes. Observed agreement between process and outcome measures at the provider level would support the construct validity of each measure. Disagreement would suggest: (1) information bias attributable to misclassification on either measure; (2) confounding of outcome measures due to unmeasured severity of illness; (3) selection bias due to selective enrollment or dropout of high-risk patients; or (4) an incorrect conceptual model, based on an assumed process-outcome linkage that does not actually exist Competition in Medical Services and the Quality of Care: Concepts and History MARK V. PAULY Consumers of medical services care about both the price they pay (directly, or indirectly through insurance) for that care and the quality of the care for which they pay. While both an unambiguous measurement of quality and the process by which quality is produced are in many ways unknown, it is surely possible for producers, consumers, and regulators to detect and analyze large (enough) variations in relevant qualitative characteristics. Sometimes, in some places, and with some providers, quality is higher than at other times, places, and providers. To some extent the final level of quality is (from an analyst’s perspective) going to be random; some quality variation is bound to be due to unknown forces and accidents. However, to some extent as well the supplier decisions which affect quality are explicit and rational, and likewise the consumer choices about which provider or which supplier to use depends on perceived quality. Economically Efficient (Optimal) Quality From an economist’s perspective, â€Å"quality† in its most general sense just means anything and everything about some good or service relevant to consumers’ (actual and perceived) well being that is not measured by quantity. Since the definition of quantity is somewhat arbitrary—for hospitalization for example, is it the number of hospital admissions, the number of hospital days, or some amalgam of inpatient services and outpatient services? the definition of quality will depend on how we define quantity. If we define quantity by surgical admissions, then average length of stay would be one dimension of quality, prevalence of wound infections would be another, and patient satisfaction would be a third. Th ere can also be qualities that do not have this ordering—for example, the color of the walls, the temperature of the room, or even the length of stay—but these factors are usually not very important. It is focus on â€Å"ordered† qualities. However, just because people prefer more of some characteristic to less does not necessarily mean (or even usually mean) that the market will or should â€Å"maximize quality† in that dimension. If we think of some unequivocally-ordered characteristic, from an economic viewpoint the optimal level of quality, given some total quantity, is that level at which the marginal benefit from additional quality (measured in money) just equals the marginal cost of adding to quality. The optimal length of stay is not infinite, the optimal amount of space in a patient’s room is not enormous, the optimal number of medical errors is not zero (though it could be much lower than at present). Of course, it is possible, indeed, likely, that optimal quality will be different at different quantities (quality and quantity can be substitutes or complements). It is certain that the optimal level of quality, given quantity, will be different for different people, depending on the value they attach to quality. The â€Å"right† quality depends on the patient as well as on the illness or procedure, and it depends on the patient’s preferences (backed up by ability to pay) as well as on the patient’s physiological state. A more complex question is the optimal variety of quality levels when people have different preferences but it is too costly to produce a different quality level for each person. This definition of optimal quality when applied to medical services certainly includes everything that would be embodied in a clinical definition of quality. However, there are some differences between the economic and what we might call the â€Å"health services research† perspective. One difference is that the economic definition will probably include more features (that consumers happen to care about but clinicians do not). One can think of cases in which consumer preferences about such things as â€Å"travel time,† â€Å"bedside manner,† â€Å"respect,† and â€Å"discomfort† do become important. The other difference is that the economic definition will probably require a more careful consideration of marginal cost relative to marginal benefit than would be embodied in the clinical view of â€Å"ideal quality. † 2. Quality Options with Inefficient Suppliers: A Diagrammatic Analysis Although the foregoing seems fairly basic, there are some aspects of the normative notion of optimal quality that may be controversial in both health policy and health services research, and some aspects of the positive aspects of market supply that are both confusing and contentious. A key issue for much of the literature is that of the existence of tradeoffs. The previous discussion implicitly assumed that higher quality costs more—that cost (which really just represents an index of the sacrifice of all other goods consumers value) and quality trade off. Yet many observers of medical care markets in the United States have the strong opinion that cost and quality don’t usually trade off—that higher quality implies lower cost or that it is at least an open question (Leatherman et al. ,2003). Improving the Service Quality of Distance Education( Rui-Ting Huang,USA / Taiwan) states that the success of a distance learning program is dependent on the quality of supporting services. This research relates to services, gaps in service, business models, continuous quality improvement, and maintaining a competitive edge. Distance Learning has become an important learning option for education systems (Yilmaz, 2005) and training solutions in the Human Resource Development (HRD) area (Felix, 2006). The growth of the distance learning industry has been faster than expected (Huynh, Umesh & Valacich, 2003). Most importantly, in terms of organizational training, an investigation from the Fortune-500 companies indicates that over 80% of companies use distance learning or plan to do so (Hammond, 2001). Through distance learning, organizations have a more convenient, practical and cost-effective way to train the employees (Hammond, 2001; Whitney, 2006; David, 2006). Due to the growth and competition in the distance learning market (Huynh, Umesh & Valacich, 2003), DL research includes the study f consumer aspects such as consumer services and satisfaction (Shaik, 2005; Granitz & Greene, 2003; Huynh, Umesh & Valacich, 2003). Feedback from learner give the instructor important data to determine how well the instr uctional program satisfies individual learner needs (Steyn & Schulze, 2003; Long, Tricker, Rangecroft, Gilroy, 1999). This in turn offers service providers in the marketplace important information to streamline the business process to improve the quality of distance learning services (Granitz & Greene, 2003; Steyn & Schulze, 2003). Quality services and support will help the service providers, institutions and organizations in DL get a competitive advantage in the marketplace (Shaik, 2005). As the distance learning industry has become mature in the educational marketplace (Huynh, Umesh & Valacich, 2003), it is providing learners with convenient and flexible learning alternatives (Alexander, 1999; Tarr, 1998). It is also giving organizations alternative cost-effective and timely training solution to effectively and efficiently implement the human resource development plans (Hammond, 2001; Whitney, 2006; David, 2006). ). The focus on consumer service may offer the service providers new insights (Moisio & Smeds, 2004) to help them streamline the business process, improve the quality of future service in distance learning (Granitz & Greene, 2003; Steyn & Schulze, 2003) and gain long-term competitive advantages (Shaik, 2005). Mary Nugent ( 2002, vice president and general manager of Subscription Services for BMC Software Inc. a leading provider of enterprise management)said that an increasing number of companies are relying on service providers to manage their mission-critic al applications, service providers are realizing that they need an improved method for consistently delivering reliable and highly available service at a competitive cost. Measuring the performance and availability of Web and enterprise applications is inherently difficult. Without accurate and timely measurements it is all but impossible to measure customer satisfaction and Quality of Service (QoS). Due to the cost of developing and implementing such a solution, service providers are finding they need to partner with others in the marketplace to ensure service level agreements (SLAs) are being met and the end-user experience is optimized. A quality end-user experience is what service provider clients require service providers must deliver in order to survive. Online shoppers are not tied by brand loyalty since they can get what they need at many different sites. Companies that want to achieve customer loyalty must deliver value through the customer experience. By outsourcing to service providers for this expertise, companies are entrusting their business and reputation on the solutions they offer. This makes it doubly important that service providers choose solutions that deliver on their SLAs. Principles Of Quality Customer Service 1. Quality Service Standards -Publish a statement that outlines the nature and quality of service which customers can expect, and display it prominently at the point of service delivery. 2. Equality/Diversity -Ensure the rights to equal treatment established by equality legislation, and accommodate diversity, so as to contribute to equality for the groups covered by the equality legislation (under the grounds of gender, marital status, family status, sexual orientation, religious belief, age, disability, race and membership of the Traveller Community). Identify and work to eliminate barriers to access to services for people experiencing poverty and social exclusion, and for those facing geographic barriers to services. 3. Physical Access -Provide clean, accessible public offices that ensure privacy, comply with occupational and safety standards and, as part of this, facilitate access for people with disabilities and others with specific needs. 4. Information -Take a proactive approach in providing information that is clear, timely and accurate, is available at all points of contact, and meets the requirements of people with specific needs. Ensure that the potential offered by Information Technology is fully availed of and that the information available on public service websites follows the guidelines on web publication. Continue the drive for simplification of rules, regulations, forms, information leaflets and procedures. 5. Timeliness and Courtesy -Deliver quality services with courtesy, sensitivity and the minimum delay, fostering a climate of mutual respect between provider and customer. Give contact names in all communications to ensure ease of ongoing transactions. 6. Complaints -Maintain a well-publicised, accessible, transparent and simple-to-use system of dealing with complaints about the quality of service provided. 7. Appeals -Similarly, maintain a formalised, well-publicised, accessible, transparent and simple-to-use system of appeal/review for customers who are dissatisfied with decisions in relation to services. 8. Consultation and Evaluation -Provide a structured approach to meaningful consultation with, and participation by, the customer in relation to the development, delivery and review of services. Ensure meaningful evaluation of service delivery. 9. Choice -Provide choice, where feasible, in service delivery including payment methods, location of contact points, opening hours and delivery times. Use available and emerging technologies to ensure maximum access and choice, and quality of delivery. 10. Internal Customer -Ensure staff are recognised as internal customers and that they are properly supported and consulted with regard to service delivery issues. Performance measurement In Health care, the patients’ satisfaction has been widely used as a critical dependent variable to evaluate success of the service provider. The patient is one of the important stakeholders in the health care arena (Yeung, 2001; Yang & Cornelious, 2004). And it is reasonable that the patients’ perception will be considered as a crucial indicator to evaluate the quality of service(Steyn & Schulze, 2003). In the business area, consumer satisfaction often denotes whether the service provider met the consumers’ need (Steyn, & Schulze, 2003). Anderson, Fornell and Lehman (1994) propose there are at least two viewpoints in the definition of consumer satisfaction. The first viewpoint is a transaction-specific perspective, which refers to the consumers’ post-purchase appraisal or judgment of the products or service based on expectations at the specific purchasing time or location. The second viewpoint is cumulative satisfaction, which refers to consumers’ overall appraisal of purchasing and consuming experience toward the products or service. Therefore, we may regard patients’ satisfaction as the patients’ overall post-use evaluation toward the health care service. Performance measurement is a fundamental building block of TQM and a total quality organisation. Historically, organisations have always measured performance in some way through the financial performance, be this success by profit or failure through liquidation. However, they do not map process performance and improvements seen by the customer. In a successful total quality organisation, performance will be measured by the improvements seen by the customer as well as by the results delivered to other stakeholders, such as the shareholders. A simple performance measurement framework includes more than just measuring, but also defining and understanding metrics, collecting and analysing data, then prioritising and taking improvement actions. It is important to know where the strengths and weaknesses of the organisation lie, and measurement plays a key role in quality and productivity improvement activities. The main reasons it is needed are: to ensure customer requirements have been met, to be able to set sensible objectives and comply with them, to provide standards for establishing comparisons, to provide visibility and a â€Å"scoreboard† for people to monitor their own performance level, to highlight quality problems and determine areas for priority attention,to provide feedback for driving the improvement effort Quality-related activities that will incur costs may be split into prevention costs, appraisal costs and failure costs. Prevention costs are associated with the design, implementation and maintenance of the TQM system. They are planned and incurred before actual operation, and could include: Product or service requirements – setting specifications for incoming materials, processes, finished Products/services;Quality planning – creation of plans for quality, reliability, operational, production, inspection; Quality assurance – creation and maintenance of the quality system; Training – development, preparation and maintenance of programmes. Appraisal costs are associated with the suppliers’ and customers’ evaluation of purchased materials, processes, products and services to ensure they conform to specifications. They could include: Verification – checking of incoming material, process set-up, products against agreed specifications; Quality audits – check that the quality system is functioning correctly; Vendor rating – assessment and approval of suppliers, for products and services. Failure costs can be split into those resulting from internal and external failure. Internal failure costs occur when the results of work fail to reach designed quality standards and are detected before they are transferred to the customer. They could include: Waste – doing unnecessary work or holding stocks as a result of errors, poor organisation or communication; Scrap – defective product or material that cannot be repaired, used or sold; Rework or rectification – the correction of defective material or errors; Failure analysis – activity required to establish the causes of internal product or service failure. External failure costs occur when the products or services fail to reach design quality standards, but are not detected until after transfer to the customer. They could include: Repairs and servicing – of returned products or those in the field; Warranty claims – failed product that are replaced or services re-performed under a guarantee; Complaints – all work and costs associated with handling and servicing customers’ complaints; Returns – handling and investigation of rejected or recalled products, including transport costs Effective quality improvements should result in a future stream of benefits, such as: †¢ Reduced failure costs †¢ Lower appraisal costs †¢ Increased market share †¢ Increased customer base †¢ More productive workforce Service Quality Management (SQM) Service quality can be defined as â€Å"the collective effect of service performances which determine the degree of satisfaction of a user of the service†. In other words, quality is the customer’s perception of a delivered service. Service-quality management, refers to the monitoring and maintenance of end-to-end services for specific customers or classes of customers. As larger varieties of services are offered to customers, the impact of network performance on the quality of service will be more complex. It is vital that service engineers identify network-performance issues that impact customer service. They also must quantify revenue lost due to service degradation. The service-mapping tool comes in next. Performance data is mapped onto service-quality data. Take a customer using Multimedia Messaging Services, or MMS. If a video download is interrupted many times during a session, the customer will lose interest. The operator’s revenue will be lost with it. To avoid this situation, key quality indicators (KQIs) like availability can monitor the QoS offered to customers. From a customer’s point of view, the availability KQI measures how successfully he or she can access and use the MMS service. With the service mapping tool, it’s possible to combine KQIs from multiple key performance indicators (KPIs) across different service resources. KPIs measure a specific aspect of the performance of either a service resource or a group of service resources of the same type. A KPI is restricted to a specific resource type and derived from network measurements. By following this top-down approach, the service-mapping tool provides several benefits. It helps operators manage end-to-end quality of service from a customer’s perspective. It also allows them to reuse key performance indicators and key quality indicators across services and products. Lastly, it helps operators drill down to the service elements that are responsible for quality degradations. Service quality also demands a simple and easy-to-use user interface. With this interface, Network Operations Center (NOC) staff and service managers can monitor service-quality objectives against thresholds. These thresholds may be internal targets for the network operator. Or they could be derived from Service Level Agreement (SLA) definitions. When the service quality falls below the contracted levels, managers could then initiate corrective actions. They could focus on the service degradations that affect the greatest number of customers. A set of standard reports for different user communities should also be available. For new services, marketing and sales may be interested in reports on service usage and service uptake. National regulators may also request historical service quality against given service objectives. CHAPTER 3 METHODOLOGY Cooper and Emory (1995) defined research as a systematic inquiry aimed at providing information to solve problem. This chapter will present a detailed idea about how the research will be conducted. In this chapter research methodology, the sample selection methods, data collection methods & data extraction from the Questionnaire and data analysis will be studied and explained. At the end of this chapter validity and reliability issues will be discussed to follow the quality standards of the research. Research strategy will be a general plan of how researcher will go about answering the research questions that has been set by researcher. It will contain clear objectives, derived from research questions specify the sources from which researcher intend to collect data and consider the constraints that researcher will inevitably have such as access to data, time, location and money, ethical issues. (Thornhill et. al. , 2003) Based on three conditions 1) form of research question 2) requires control over behavioral events and 3) focus on contemporary events Yin (1994) identified five research strategies in social science. These are – experiments, surveys, archival analysis, histories and case studies Most important condition for selecting research strategy is to identify the type of research question being asked. â€Å"Who†, â€Å"What†, â€Å"Where†, â€Å"how† and â€Å"Why† are the categorization scheme for the types of research questions. Two possibilities need to investigate by asking the â€Å"what† question. First, some types of what questions are justifiable for conducting an exploratory study and the goal is to develop pertinent hypotheses and propositions for further inquiry. Any of the five research strategies can be used in that situation- exploratory survey, exploratory experiment, or an exploratory case study. The second type of what question is actually form a â€Å"how many† or â€Å" how much† line of inquiry and the outcomes from a particular situation. The survey or archival analysis is more favorable than other strategies. If the researcher needs to know the â€Å"how† question, the better strategy will be doing history or a case study. (Yin 1994) Research Purpose Research can be classified in terms of their purpose. Accordingly, they are most often classified as exploratory, descriptive or explanatory (Saunders, Lewis & Thornhill 2003). Exploratory research is useful when the research questions are vague or when there is little theory available to guide predictions. At times, researcher may find it impossible to formulate a basic statement of the research problem. Exploratory research is used to develop a better understanding (Hair, Babin, Money & Samouel 2003). Exploratory studies are a valuable means of finding out what is happening, to seek new insight, to ask questions and to assess phenomena in a new light. It is particularly useful if researcher wish to clarify the understanding of a problem. There are three principle ways of conducting exploratory research: a search of the literature, talking to experts in the subject, conducting focus group interviews (Saunders, Lewis & Thornhill 2003). Descriptive research describes some situation. Generally things are described by providing measures of an event or activity. Descriptive research designs are usually structured and specifically designed to measure the characteristics described in a research question. Hypotheses, derived from the theory, usually serve to guide the process and provide a list of what needs to be measured (Hair, Babin, Money & Samouel 2003). The object of descriptive research is to portray an accurate profile of persons, events of situations. It is necessary to have a clear picture of the phenomena on which researcher wish to collect data prior to the collection of the data (Saunders, Lewis & Thornhill 2003). Explanatory Research establishes causal relationships between variables. The emphasis here is on studying a situation or a problem on order to explain the relationship between variables (Saunders, Lewis & Thornhill 2003). Explanatory studies are designed to test whether one event causes another (Hair, Babin, Money & Samouel 2003). The purpose of the research is mainly descriptive and explanatory. It is descriptive because descriptive data has been collected through detailed interviews and it is also explanatory since we will explain the relationship between the service quality variables and customer satisfaction and how these dimensions affect customer satisfaction. It is somewhat exploratory nature since Data Collection Method Data was collected by primary as well as by secondary data c