STALIN Essays (766 words) - Communism, Political Philosophy

STALIN Stalin Essay Much like Adolf Hitler, Joseph Stalin was one of the most ruthless and diabolical people in the history of the world. Hitler once said of Stalin, He is a beast, but he's a beast on a grand scale who must command our unconditional respect. In his own way, he is a hell of a fellow! (Stalin Breaker of Nations, p.xvi) What Hitler said of Stalin is only his opinion, and it is not a valid one at that. For you must consider the source, it takes a beast like Adolf Hitler to know a beast and Stalin was a horrible beast. He was also a murderer. Stalin abused his people when he starved them to death, and systematically murdered them. Stalin also abused his country by halting Russia's progress and economic growth. Stalin was a breaker of nations. Stalin first enter the Russian political system in the early nineteen teens. With the help form Lenin, Stalin proposed an answer to the National Question, which was self determination. Stalin's ruthlessness is first discovered by Lenin, whe n Stalin is sent to Georgia to convince the Georgia leader not to practice self determination. When the leader does not agree with what Stalin has to say, Stalin punches the man out and threaten to kill them all. Years after that incident Lenin end up dying and Stalin takes over as the leader of Russia. Because Trotsky was hated by many of the influential political figures in Russia, Stalin becomes the leader of Russia even after Lenin's dying last wishes. 1929 was the first of many years in which Stalin stunted Russia's growth. In that year the Engineer Trials were held. During these trials the Russian elite was brought forth by Stalin on the account of treason. Confessions by the elite which consisted of engineers, doctors, lawyers, teachers and clergy were extracted by many means including torture. After these trials were through thousands of the Russian elite were murdered, with their blood on Stalin's hands. These trails had a horrific effect on the progress of Russia, there wa s now nobody left to lead Russian into the future, and the few elite's that still remained in Russia lived in constant fear of their lives. Around 1932, Stalin had put his plan into action that was later called the Terror Famine. In the Terror Famine, Stalin started to order grain requisitions from the lower class in the Ukraine. Stalin used his army to retrieve the grain from the people, following the orders by Stalin, the army takes too much grain and causes a famine among the lower class. Stalin justified the taking of the grain by saying that it was just a way for the state to regulate the price of grain. By doing this Stalin ended up breaking the back of the Georgians and the Ukrainians. Knowingly, Stalin eliminated millions upon millions of Russian, between 30 and 50 million, in his attempt at an absolute totalitarian rule in Russia. By killing so many of the Russian's who were the ones which the economy was supported on, Stalin has broken the nation of the Ukraine. From aroun d 1936 through 1938 Stalin extracted his Great Terror. The Great Terror consisted of many events including the Purge Trials and the Katyn Massacre. During the purge trials, Stalin once again haltered Russian progress. The Purge Trials eliminated many military officers and engineers. The numbers are not exact, but between 250,000 to 500,000 Russians died because of Stalin's orders. These trials caused mass paranoia of the elite's, afraid to make a difference, for if they did then they would ultimately end up dead. Stalin not only haltered the growth of his own country, but he haltered the growth of neighboring counties, on being Poland. In Poland during the Great Terror, Stalin ordered the Katyn Massacre to occur. The top 15,000 officers in the Polish army were rounded up and killed in the forests of Belarus. This was a deep wound, the stunted the Polish progress, since now there were would be no more experienced leaders in Poland's future, since Stalin killed most of their military elite. Once again Stalin had broken another nation. During all this time, Stalin was also

Micro financing your content strategy

Micro financing your content strategy Blogs are proliferating at the astounding rate of over 100,000 per day. They reflect both the both urge to communicate and the changing face of marketing. Funding a blog can be challenging, especially when you are starting out. However, micro-financing web content promotion is possible – so micro that it could be free!Advertising We will write a custom article sample on Micro financing your content strategy specifically for you for only $16.05 $11/page Learn More You may be blogging for the sheer joy of sharing your ideas, or to mobilize action on a favorite cause. Alternatively, you could be blogging for pay, promoting something you or someone else sells. Commercial blog is a growing category. These days, almost any product, service, or cause should probably have an associated website and blog to let prospective customers or supporters know about it. Such commercial blogging’s growth reflects drastic changes in marketing. Many traditional chan nels for promotion such as network (and even cable) television, print periodicals, and broadcast radio, are giving way to online alternatives. Even print Yellow Pages effectiveness has fallen prey to the switch away from landlines (up to 75% of some demographic groups). These factors pose a challenge for you as a blogger. You face a challenge in alerting your target audience that your expertise exists. Your audience also needs to be able to find you from any and all devices. This, then, is where promoting your website content (as differentiated from promoting your product, idea, service, or cause, which the blog itself accomplishes) becomes crucial. How can you promote your website content cheaply? Some tools cost quite a bit, but others, happily, require no expenditure except of your time, energy, good writing, and marketing acumen. The most fashionable buzzword in web content promotion right now is ‘native advertising’. No less an eminence than the New York Times has announced native advertising for their online edition. A separate writing and production studio will ensure that only high quality â€Å"continuously scrolling multimedia storytelling pagesâ€Å" will accompany hard news, and look like them too, while promoting the advertiser.Advertising Looking for article on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More This disturbingly parallels science fiction’s dystopian vision of future ads irritatingly tailored to a reader’s idiosyncratic preferences. Native advertising, however, while definitely cutting edge, still seems a bit high end, and you probably don’t possess a fully equipped studio like the Grey Lady of journalism! Now, can you accomplish something similar for little or no money? Yes, and here are several rules of thumb to keep your own website busily promoting itself. You need to generate content that is worth reading: If your blog pro motes without cessation, it will be decidedly unappealing. The challenge is to find new ways – consistently to discuss topics related to your website content in ways that are useful to your readers. Solve problems, illuminate unanswered questions, untangle unresolved mysteries, amuse, instruct, and point your reader in new and hopeful, helpful directions. A really useful web page, like Thomas the Tank’s ‘really useful engine’, will be a happy place to which a reader will wish to return frequently. You need to learn what content your readers want so you can promote it better: This involves using social media to the maximum to connect with your readers. You can talk about your blog on Facebook, LinkedIn, and let your readers talk about it too. Just be careful not to impose on your contacts. This sort of interaction with your audience is termed SMO, or Social Media Optimization. You need to make yourself findable via SEO The web’s spider bots need you r help to find you. Use best SEO techniques to give them ample signals of your presence. Exploit all potential spots in your website to cleverly slide in keywords. Keyword choice is its own science, and it requires that you know what your readers are seeking (see above regarding reader interaction).Advertising We will write a custom article sample on Micro financing your content strategy specifically for you for only $16.05 $11/page Learn More Opportunities to feature your keywords pop up in a variety of places. These could include: Title tag The META description tag – in the first 150 characters META keywords tag In headers and sub headers within the body of the text Content itself, with a density of no more than 3-5% keywords, with a ratio of one page of content for one keyword. 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Essential Element Facts in Chemistry

Essential Element Facts in Chemistry What Is an Element? A chemical element is  the simplest form of matter that cannot be broken down using any chemical means. Any substance made up of one type of atom is an example of that element. All atoms of an element contain the same number of protons. For example, helium is an element all helium atoms have 2 protons. Other examples of elements include hydrogen, oxygen, iron, and uranium. Here are some essential facts to know about elements: Essential Element Facts While every atom of an element has the same number of protons, the number of electrons and neutrons can vary. Changing the number of electrons forms ions, while changing the number of neutrons forms isotopes of an element.The same elements occur everywhere in the universe. Matter on Mars or in the Andromeda Galaxy consists of the same elements found on Earth.The elements were formed by nuclear reactions inside stars. Initially, scientists thought only 92 elements occurred in nature, but now we know many of the shorts of allotropes of carbon include diamond, graphite, buckminsterfullerene, and amorphous carbon. Although they all consists of carbon atoms, these allotropes have different properties from each other.Elements are listed in order of increasing atomic number (number of protons) on the periodic table. The periodic table arranged elements according to periodic properties or recurring trends in the characteristics of the elements. The only two liquid elements at room temperature and pressure are mercury and bromine.The periodic table lists 118 elements, but when this article was written (August 2015), the existence of only 114 of these elements had been verified. There are new elements yet to be discovered.Many elements occur naturally, but some are man-made or synthetic. The first man-made element was technetium.Over three-quarters of the known elements are metals. There are also a small number of nonmetals and elements with properties in between those of metals and nonmetals, known as metalloids or semimetals.The most common element in the universe is hydrogen. The second most abundant element is helium. Although helium is found throughout the universe, it is very rare on Earth because it does not form chemical compounds and its atoms are light enough to escape Earths gravity and bleed out into space. Your body contains more hydrogen atoms than atoms of any other element, but the most common element, by mass , is oxygen. Ancient man was exposed to several pure elements that occur in nature, including carbon, gold, and copper, but people did not recognize these substances as elements. The earliest elements were considered to be earth, air, fire, and water substances we now know consist of multiple elements.While some elements exist in pure form, most bond together with other elements to form compounds. In a chemical bond, atoms of one element share electrons with atoms of another element. If its a relatively equal sharing, the atoms have a covalent bond. If one atom basically donates electrons to an atom of another element, the atoms have an ionic bond. Organization of Elements in the Periodic Table The modern periodic table is similar to the periodic table developed by Mendeleev, but his table ordered elements by increasing atomic weight. The modern table lists the elements in order by increasing atomic number (not Mendeleevs fault, since he did not know about protons back then). Like Mendeleevs table, the modern table groups elements according to common properties. Element groups are the columns in the periodic table. They include alkali metals, alkaline earths, transition metals, basic metals, metalloids, halogens, and noble gases. The two rows of elements located below the main body of the periodic table are a special group of transition metals called the rare earth elements. The lanthanides are the elements in the top row of the rare earths. The actinides are elements in the bottom row.

What is a principle Scholarship Essay Example | Topics and Well Written Essays - 500 words

What is a principle - Scholarship Essay Example Other than these two examples, we can also observe the system of the whole world running on a defined set of principles. Principles hold a key value in my life. To me, principles act as foundations for every personal and professional success. I never overlook my principles while dealing with any matter of life. Whatever the situation is, I always take every step following my principles. Some of my core qualities include honesty, truth, moral courage, hard work, and sincerity. I have based all of my principles on these characteristics. I always try to be sincere to others, speak truth in any situation, defend the disadvantaged, raise my voice over in any unlawful situation, work hard for my better future, and avoid backbiting. These are my principles of life which I follow in all situations that occur in my life. I abide by my principles because they are the real gems of my life. They always keep me on the right track. They make my inner clean and fulfilled. They also guide me when I am in some trouble. On many occasions of my life, my principles have made me satisfied and pleased. Whenever I help a disadvantaged person, I feel extremely satisfied and relieved. Similarly, when I speak truth in a situation where it can cause problems for me, I feel that I have done something admirable. I love to follow all of my principles because they are as precious for me as any other asset. I believe that principles are assets that produce a number of considerable benefits for a person. Although we cannot touch these assets the way we touch and feel tangible assets, but the benefits associated with these assets are not less in worth than tangible assets. I would say that principles are such assets that guide us to acquire a number of tangible and intangible assets. I believe that a person can never achieve success in his/her life without following some key success principles. The reason is that principles give us direction while enlightening the way to

Case Study Essay Example | Topics and Well Written Essays - 500 words - 19

Case Study - Essay Example The changes to the completion were mainly from Amazon which entered the market for online auctions and the entry of other smaller players who cloned eBay’s business model. These in turn made eBay look towards more innovation and building brand loyalty among its consumers as well as providing remote customer support to its users. Q2) eBay took a series of steps to ensure that it responds to the competition by going after newer products and platforms. In its quest to remain the number one online auction site, eBay pioneered a set of changes in its business model. For instance, it adopted the paradigm of going global and acting local. What this meant was that eBay expanded into international markets and retained the local flavor in each of these markets by adopting practices that were commensurate with the market in which they operated. The business model that eBay implemented relied on trust, loyalty and building brands that saw its business grow in size. To respond to the competition, eBay also introduced a wide range of products as well as invested in computing infrastructure that was needed for its aggressive forays into newer ranges of products and services. There were changes to the trading platform as well that were introduced by eBay and which culminated in the metamorphosis of eBay into a world class online auction site. Q3) The opportunities for eBay are many and some of them include newer forms of auction formats that allow innovative pricing models for its products and greater participation of the customers in the online auction site. The other opportunities arise from the expansion of eBay into Asia and other regions that are bound to get volumes of customers who would be a source of loyal customer base for the company. The most significant opportunity for eBay would arise from targeting the youth and the teenagers who form a

Fundamentals of Management Essay Example for Free

Fundamentals of Management Essay How does being decisive help, or hurt, conflict resolution? Should every decision be solely made by the manager? How should a manager handle criticism of his/her decisions by followers? There is nothing more annoying than a manager who can’t make a decision. If you don’t like making decisions or you feel you aren’t any good at it, you will disappoint a lot of people. On the other hand, it is preventable. Being decisive isn’t about making the right decision, it’s about making a decision. It’s about putting yourself in the driver’s seat of the car, you may decide to turn a different way later, but for now, you control the wheel and you choose where the car goes. Developing real conflict resolution skill sets are a crucial part of a building a maintainable business model. Unsettled conflict frequently results in a loss of production, represses creativeness, and creates obstacles to teamwork, most importantly for leaders, good conflict resolution skills equals’ good employee retention. Leaders who don’t deal with conflict will eventually watch their good talent walk out the door in search of a healthier and safer work environment. Decisions should be made solely or primarily by considering ones duties and the rights of others? The principle of management is making decisions. Managers are always required to evaluate alternatives and make decisions concerning a wide range of matters. Just as there are different managerial styles, there are different decision-making styles. Decision making involves confidence and threats. Decision makers have variable degrees of risk. Decision making also involves qualitative and measureable analyses, and some decision makers choose one form of analysis over the other. Decision making can be affected not only by rational judgment, but also by non-rational factors such as the personality of the decision maker, peer pressure, the organizational situation, and others. When it comes to criticism, it’s important to first understand that half of the stuff people say about you is true. So just take inventory, suck it up and change. And the other half they say about you is not, they are just revealing issues in their own lives. If you know yourself, you will know what you are good at and what you are not. Criticism will never stop, and it have a negative effect in your life. And that’s a big lesson I had to learn that has helped me as a person. â€Å"If you’re getting kicked in the rear, it means you’re out front. †

The Anaconda Plan Essay example -- essays research papers

The Anaconda Plan At the onset of the Civil War, President Abraham Lincoln met with his generals to devise a strategy by which the rebellious states of the Confederacy could be brought back into the Union. General Winfield Scott, commanding general of the Union army, proposed a plan of battle that became known as the Anaconda Plan. General Winfield Scott, commanding general of the Union Army From the Collections of The Mariners' Museum General Scott, a native Virginian, believed that the majority of Southerners desired a complete union with the United States. In order to restore the Union with as little bloodshed as possible, he favored a relatively nonaggressive policy. The primary strategy of Scott's plan was to create a complete naval blockade of the Southern states. Named for the South American snake that kills its prey by strangulation, Scott's plan was to strangle the South into submission by cutting its supply lines to the outside world. The plan was sound, but ambitious. For the plan to succeed, it would be necessary to blockade more than 3,500 miles of coast from Virginia to Mexico and up the Mississippi from New Orleans to New Madrid Bend. And the Anaconda Plan could only succeed over time: the South would not starve overnight, so patience was an essential part of Scott's strategy. Gideon Welles, Secretary of the Navy, USA From the Collections of The Mariners' Museum By adopting the Anaconda Plan, Lincoln ran the risk of committing diplomatic suicide. Sin...

Management Information Systems in Process-Oriented Healthcare Organisations

Linkoping Studies in Science and Technology Thesis No. 1015 Management Information Systems in Process-oriented Healthcare Organisations by Anna Andersson Submitted to the School of Engineering at Linkoping University in partial fulfilment of the requirements for the degree of Licentiate of Philosophy Department of Computer and Information Science Linkopings universitet SE-581 83 Linkoping, Sweden Linkoping 2003 Management Information Systems in Process-oriented Healthcare Organisations by Anna Andersson Maj 2003 ISBN 91-7373-654-6 Linkopings Studies in Science and Technology Thesis No. 015 ISSN 0280-7971 LiU-Tek-Lic-2003:14 ABSTRACT The aim of this thesis work was to develop a management information system model for process-oriented healthcare organisations. The study explores two questions: â€Å"What kinds of requirements do healthcare managers place on information systems? † and â€Å"How can the work and information systems of healthcare managers and care providers be inc orporated into process-oriented healthcare organisations? † The background to the study was the process orientation of Swedish healthcare organisations. The study was conducted at the paediatric clinic of a county hospital in southern Sweden. Organisational process was defined as â€Å"a sequence of work procedures that jointly constitute complete healthcare services†, while a functional unit was the organisational venue responsible for a certain set of work activities. A qualitative research method, based on a developmental circle, was used. The data was collected from archives, interviews, observations, diaries and focus groups. The material was subsequently analysed in order to categorise, model and develop small-scale theories about information systems. The study suggested that computer-based management information systems in processoriented healthcare organisations should: (1) support medical work; (2) integrate clinical and administrative tools; (3) facilitate the ability of the organisation to measure inputs and outcomes. The research effort concluded that various healthcare managers need the same type of primary data, though presented in different ways. Professional evelopers and researchers have paid little attention to the manner in which integrated administrative, financial and clinical systems should be configured in order to ensure optimal support for process-oriented healthcare organisations. Thus, it is important to identify the multiple roles that information plays in such an organisation. Department of Computer and Information Science Linkopings universitet SE-581 83 Linkoping, Sweden Co n te n ts 1. Introduction †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 1 1. . 1. 2. Organisational and work process models in medical informatics †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 2 Aims of the study†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 3 2. Research methods†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 4 2. 1. The setting of the case study†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 4 2. 2. The data collection†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 2. 2. 1. Archival data †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 2. 2. 2. Interviewing †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 6 2. 2. 3. Diary method †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 2. 2. 4. Observation†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 7 2. 2. 5. Focus groups †¦Ã¢ € ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 7 2. . 6. Feedback loops †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 8 2. 3. Analyses†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 8 2. 4. Modelling†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 9 3. Results†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 9 3. 1. 3. 2. 3. 3. The requirements of healthcare managers for an HIS†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. Interpretation of organisational and work processes in relation to HIS†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 10 A management information system model for process-oriented healthcare†¦. 12 4. Discussion †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 14 5. Conclusions †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã ¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 15 6. Future work †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 15 7. References †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 7 Management Information Systems in Process-oriented Healthcare Organisations 1. Introduction Swedish healthcare organisations are required by law to maintain a holistic view of their processes (Prop. 1999/2000:149). Thus, such organisations need to have an overview of the entire scope of health service delivery. As a result, system thinking is vital (Senge, 1990). An organisation must be able to collect data from its operational processes and furnish health service management with data concerning the way in which th ey have utilised their resources (Kaplan & Norton, 1996). As a response to this imperative, many healthcare providers have begun to introduce process-oriented structures recently. There are a number of theories about how to design such structures. One theory is based on Business Process Reengineering (BPR), the purpose of which is to identify and redesign organisational processes (Davenport, 1993). Another approach is to analyse a healthcare organisation as a Complex Adaptive System (CAS), an interdisciplinary method that focuses on the self-organisation of systems and patterns, as well as the way in which outcomes emerge. The purpose of a CAS analysis is to resolve issues associated with adaptable systems (Zimmerman, Lindberg & Plsek, 2001). Regardless of whether a BPR or CAS approach is employed, process-oriented organisational structures face difficulties stemming from the fact that healthcare organisations operate on multiple levels, including county councils, hospital management, clinical management, and care providers, each with its own information requirements (Andersson, Vimarlund & Timpka, 2002). Each level struggles to survive under difficult economic constraints, limited growth and the constant threat of regulation (Luce & Elixhauser, 1990). Healthcare organisations need an integrated structure in order to quickly disseminate information among managers and care providers (Van de Velde, 2000). The first challenge is to structure information systems such that they support the workflow in a healthcare environment (Strauss et al. , 1985). Thus, it is not surprising that healthcare managers are increasingly seeking help from health information systems (HIS). Their objective is to minimise the overall costs of healthcare delivery, to improve the quality of their services (Greenes & Lorenzi 1998; Clayton & van Mullingen, 1996) and to correlate costs with resources consumed (Stead & Lorenzi, 1999). One option for gathering data in an 1 Management Information Systems in Process-oriented Healthcare Organisations HIS is to use censors and other devices that continuously furnish the healthcare organisation with data about its finances, quality, competence and level of satisfaction. However, before an HIS can be designed, both managers and developers need to be familiar with work routines, information requirements, and other key parameters at the clinical level, given that medical information is linked to the environment in which it is generated (Berg & Goorman, 1999). Thus, the organisation must outline its information requirements and work procedures. The HIS that ultimately emerges will be embedded in the organisation’s processes and must satisfy the care provider’s information needs (Berg, 1999). To sum up, in order to design an HIS in process-oriented healthcare organisations, attention must be paid to issues such as patient focus, cost effectiveness, service quality, adaptability to the constraints of the organisation, and integrated use of information at both the hospital and clinic level (Ovretveit, 1992; Flarey, 1995). Moreover, a holistic overview based on system thinking is vital, including the gathering of data from multiple sources in order to correlate costs with the utilisation of resources. The challenge is to define models that can support the design of an HIS. 1. 1. 1. Organisational and work process models in medical informatics The main purpose of reengineering was to focus on the processes rather than the functions or an organisation (Hammer, 1990). Further organisational enhancement could be achieved with quality methods such as Total Quality Management (TQM), which included process-oriented models. Another approach is to modify the business culture such that it becomes a learning organisation (Senge, 1990). In the financial area, Balanced Scorecard has been used to translate mission and strategy statements into operational objectives and measurement variables (Kaplan & Norton, 1996). When it comes to medical informatics, attempts have been made to design various kinds of organisational models, such as socio-technical modelling (Berg et al. ,1998). The rationale for introducing these models is to gain a greater understanding of the ways in which an HIS will affect the allocation and content of work tasks. Changes in work activities require modification of information management (Berg, 2001). The validity of a technology rests not only on the fulfilment of functional specifications, but also on the interaction of the technical system with its 2 Management Information Systems in Process-oriented Healthcare Organisations organisational environment (Brender, 1998). The resulting conclusion that has been drawn today is that social, organisational, cultural and contextual issues should be taken into consideration at an early stage of the development process (Kaplan, 2001). Moreover, approaches such as cultural-historical activity theory have been used to perform contextual analyses of clinical cognition and activity. Culturalhistorical activity theory argues that studying the present healthcare setting is insufficient – a researcher must also become acquainted with the history of the setting, given that clinical cognition is embedded in broader institutional structures and longstanding evolution (Engestrom, 1995). One method was to highlight patient data on the presumption that the objective of any healthcare organisation is to improve the health of individuals (Engestrom, 1999). Other researchers argue for a framework that allows for a constant interplay of different models, theories and perspectives (Maij et al. , 2002). The advantages of integrated frameworks are that methods and models can be optimised during the development process, while methods with specific weaknesses can be reinforced by others (Timpka, 1995). Finally, there are approaches for exploring the ways in which healthcare providers tend to reason in clinical contexts – such as situated action, an emerging perspective for studying human cognition and behaviour in order to design intelligent systems (Patel, Kaufman & Arocha, 1995). Such models address the clinical tasks that are to be performed within specific guidelines and define criteria for selecting appropriate options when there is a set of potentials (Wang et al. , 2002). 1. 2. Aims of the study The aim of this thesis is to develop a management information system model for process-oriented healthcare organisations, based on two questions: â€Å"What kinds of requirements do healthcare managers place on information systems? † and â€Å"How can the work and information systems of healthcare managers and care providers be incorporated into process-oriented healthcare organisations? The work is based on a circular process, during which models are developed by collecting and categorising data, as well as by designing small-scale theories about information systems. Organisational process is defined as â€Å"a sequence of work procedures that jointly constitute complete healthcare services†. A work 3 Management Information Systems in Process-orie nted Healthcare Organisations activity is defined as a set of work procedures that are closely related by virtue of their purpose and means of performance. A functional unit is the organisational venue responsible for a certain set of work activities. Healthcare Information Systems (HIS), Management Information Systems (MIS) and Information and Communication Technology (ICT) all define computer-based information systems. 2. Research methods A qualitative research strategy, based on an idiographic case study, was employed. Qualitative research, which has evolved within several disciplines, consists of a set of interpretive practices. It does not accord priority to any single methodology for data collection and analysis, nor does it have a theory or paradigm that is distinctly its own (Denzin & Lincoln, 1998). Qualitative research is best suited for understanding the processes inherent to a situation, along with the beliefs and perceptions of the people involved. Nevertheless, qualitative researchers can make their findings more widely applicable (Firestone, 1993). Furthermore, a case study is both a process of inquiry and the product of that inquiry (Stake, 2000). The researcher needs a wide array of information about the case in order to provide an in-depth assessment (Creswell, 1998). A primary distinction is between single-case and multiple–case designs of such studies (Yin, 1994). A case study whose primary mode of research is hermeneutic is idiographic in a natural setting – its main type of data is qualitative and its fundamental level of analysis is holistic (Fishman 1999). Interpretive studies are well served by a considerable degree of openness to field data, along with willingness to re-examine initial assumptions and theories. The result is an iterative process of data collection and analysis during which initial theories are expanded upon, revised or abandoned altogether (Walsham, 1995). 2. 1. The setting of the case study The setting of the study was a paediatric clinic at a county hospital in Sweden. In 1996, the county council adopted a wide-ranging quality program based on TQM and a Plan-Do-Check-Act (PDCA) cycle. In 2000, the county council started using Balanced Scorecard to measure the healthcare organisation’s outcomes. At the time of the study, the county’s development and change program for 4 Management Information Systems in Process-oriented Healthcare Organisations organisational quality was based on a CAS strategy. Furthermore, a processoriented healthcare information system was being designed. With some 30 clinics and 3,200 employees, the hospital had identified its main organisational objectives as the delivery of emergency and specialist healthcare, as well as county-wide rehabilitation and habilitation services. The purpose of habilitation is to enable someone with a congenital impairment, whereas rehabilitation focuses on recovering lost ability. Above and beyond the responsibilities of healthcare managers in accordance with the functional structure, all clinics at the hospital (including paediatrics) had developed work processes for specific groups of patients. These Patient Need Group Processes (PNGPs) centred on the healthcare needs of individual patients. The main objective of the PNGPs was to cultivate and maintain a high level of knowledge about medical care at the paediatric clinic. The scope of the processes varied considerably. However, a PNGP unit always comprised at least a doctor, nurse and secretary. If necessary, several clinics, hospitals and county councils could collaborate on the same process. In order to improve nursing care, development teams, staffed by practitioners interested in development work, were set up. Specific development areas included palliative care and the use of technical equipment. The teams produced documents concerning their specific areas that could prove of value for their co-workers. New work routines were developed for nursing care and for activities that are indirectly related to the patient care process, such as meal delivery, ordering medication and play therapy. The teams had contact people at each ward who were prepared to step in whenever nursing care problems arose. The team members normally attended meetings during their free time – or overlapping time when two shifts were on duty simultaneously. The paediatric clinic also cooperated with maternity wards and a total of 13 Child Health Centres (CHCs) throughout the county. The clinic was part of a network of specialist clinics in southern Sweden that focused on the exchange of knowledge and experience. At the time of the study, the paediatric clinic employed 12 senior physicians, 21 physicians, 91 nurses, 77 paediatric nurses (specialist nurse’s aides) and 13 secretaries. The management team consisted of six senior physicians, seven nurses and one secretary from the clinic. During the period of the study, the paediatric clinic supplied approximately 16,000 bed-days to inpatients, performed 5,000 scheduled surgical interventions and handled 5 Management Information Systems in Process-oriented Healthcare Organisations 6,000 emergency room visits by children. The paediatric clinic comprised one surgical unit and three wards, each with a physician responsible for medical matters and a nurse as manager. The ward for neonatal patients had eight beds for intensive care and ten for prenatal care. The ward for contagious patients had 16 isolation rooms for newborn babies and contagious children. The institutional care ward for children older than a year had 18 beds. The clinic used 15 PNGPs. 2. 2. The data collection The collection of data was conducted throughout documents, archives, interviews, observations, diaries, focus groups and feedback loops. 2. 2. 1. Archival data Archival data was used to place the research into context before, during and after the studies at the clinical site (Drury, 2002). An obvious danger posed by fixed data is that it can easily become outdated unbeknownst to the researcher. In these studies, archival data was related to: 1) annual reports by the clinic; 2) the county council’s quality pronouncements; 3) the government’s bill for the healthcare organisation; 4) the physical and mental health survey of hospital employees; 5) reports concerning the county council’s development plans for an HIS. 2. 2. 2. Interviewing A common interviewing technique is to meet face to face (Fontana & Frey, 1998). The interview may be structured, semi-structured or unstructured. The scope of an interview can range from five minutes to the lifetime of the subject (Fontana & Frey, 2000). This study involved semi-structured interviews with four doctors and four nurses. A series of open-ended questions addressed daily work routines and communication patterns. 2. 2. 3. Diary method The holistic perspective of this approach identifies connections among the individual, societal and organisational levels. One of the techniques that have evolved is the diary method, which proceeds from subjective assessments of time utilisation. The various steps require a practitioner to enter time, activity, Management Information Systems in Process-oriented Healthcare Organisations location, the names of co-workers with whom they interact and other comments during a specified period (Ellegard, Nordell & Westermark, 1999). In this study, a ward nurse kept a diary during one workweek. She entered the nature of her work tasks, the times that she performed them and the names of the co -workers with whom she interacted. 2. 2. 4. Observation Observation involves gathering impressions of the surrounding world. Qualitative observational research is fundamentally naturalistic (Adler & Adler, 1998). There is â€Å"descriptive observation†, in which the researcher assumes that he or she knows nothing about what is going on and takes nothing for granted. He or she employs â€Å"focused observation†, ignoring that which is defined as irrelevant. Finally there is â€Å"selective observation†, the most systematic approach, during which the researcher concentrates on the attributes of various activities (Angrosino & Mays de Perez, 2000). This type of observation requires a notebook, a storage location for the data that is collected during the process (Ely, 1993). The researcher observes and interacts with care providers at the paediatric wards before and after their rounds. Alongside the observations, the clinical staffs were interviewed again about what they were doing, why they were doing it, what they hoped to gain from an HIS and what benefits they expected. Field notes were entered into a log during the observation study. 2. 2. 5. Focus groups A focus group’s planning process should begin as soon as it is set up. The process includes the following steps: establish research objectives, appoint a moderator, develop moderator guidelines and draw up procedures. The moderator plays an important role during the group session. He or she conducts the interviews. It is important that the moderator not be the same person that put together the moderator guidelines and questions. In this study, a focus group session was held with seven nurses and three paediatric nurses, all of whom were women selected by a ward nurse. The participants had various duties at the paediatric clinic, where they had been employed for anywhere from 9? to 32 years. Five nurses were ward managers and two also managed development teams. They all had experience at each ward, as well as the paediatric surgery. The researcher had furnished the group moderator with 7 Management Information Systems in Process-oriented Healthcare Organisations guidelines and questions (Greenbaum, 1993). The questions were based on the clinic’s profile of itself: administrative activities, care provision and development work. Questions also dealt with work activities and the exchange of information with other units. Some questions focused in on a patient’s relations with the care providers, as well as the time and place for the performance of care activities. The entire focus group session was videotaped and transcribed. . 2. 6. Feedback loops Feedback loops throughout the research project permitted the generation of reports for evaluating data collection. A total of four reports were sent to the practitioners as a result of the case study. In addition, four seminars were held with the practitioners, the purpose of which was to discuss the research findings. The practitioners discussed and critiqu ed the results. 2. 3. Analyses There was no theory at the beginning as to how the material should be analysed. The first step was to break down healthcare management into the hospital, clinical and care process levels. Statements from the various management levels were interpreted on the basis of information requirement, i. e. main objectives, system functions, expected benefits and risks to be avoided. The second step was the analysis of three main work activities, each with three work procedures, at the clinic level. The third step involved the design of a management information system model. All empirical data was categorised. Various themes were identified and classified. After the categories had been cross-compared and clustered, abstract new categories were defined (Strauss & Corbin, 1990). The final analysis started with a category-by-category comparison, which enabled the identification of core categories that were sent to the paediatric clinic as a preliminary report for comment and critique (Glaser, 1978). Finally, the categories were modified in response to the comments. The focus was to come up with a context-based, process-oriented description and explanation of the phenomena (Orlikowski, 1993). The categories were incorporated into two small-scale theories. The first theory interpreted the information requirements of three management levels. The second theory interpreted the work processes employed by institutional care. 8 Management Information Systems in Process-oriented Healthcare Organisations 2. 4. Modelling In order to conduct the final analysis, the two small-scale theories were applied to the modelling of a management information system. Various possible approaches included data modelling (Connolly, Begg & Strachan, 1996), function modelling and object-oriented modelling (Booch, Rumbaugh & Jacobson, 1999). To handle such approaches, various modelling languages have been developed, including the object-oriented Unified Modelling Language (UML) (Fowler & Kendall 1999). The symbols and notations of the various languages can be difficult for the uninitiated to grasp (Sommerville & Sawyer, 2000). Furthermore, the notation and logic for modelling a system must work in tandem with the people involved in the development process. Thus, it is useful to visualise the information flow by means of a modelling approach, using notation and logic that have been established by consensus. As a result, the management information system models were designed in dialog with the practitioners in the case study. The notation was taken from Eriksson & Penker’s (2000) business processes but modified on the basis of the discussions. 3. Results The results are presented in accordance with the three sub-analyses. The first sub-analysis focused on the requirements of healthcare managers for an HIS. The second sub-analysis focused on interpreting organisational and work processes in relation to the HIS. The third sub-analysis focused on designing a management information system model for process-oriented healthcare. 3. 1. The requirements1 of healthcare managers for an HIS Hospital management expressed its intention to use an HIS to empower patients while maintaining control of resource utilisation. Thus, the planned HIS was expected to encourage a greater overall awareness of cost effectiveness with respect to the services provided by various units of the hospital. The biggest risk noted was that of a mismatch between the system and the existing organisational culture, in which it was easy to identify and reward employees who handled 1 Requirements and demands are used as synonym in this chapter and in article 1. 9 Management Information Systems in Process-oriented Healthcare Organisations mergencies. As a result, some of the staff appeared to resist a new way of transmitting information throughout the various levels of the organisation. The goals of the functional units (i. e. clinic management) focused on patients and the introduction of leadership based on co-determination. While management accepted patient empowerment and cost effectiveness as the their main objectives, they thought it was important that employees be allowed to make their own organisational decisions. Management wanted to see a new approach to measuring the activities of their organisational unit. In order to achieve these goals, they sought a way to define the data that is essential to making a reliable estimate. In managing the healthcare process, the objectives of an HIS centred on developing and maintaining specific clinical competence by enhancing support for decision-making and co-operation on the part of care providers. While all the process managers agreed that sharing information and knowledge was important to improving the decision-making process, they were unaware of resource competition issues. However, the withholding of information was not always intentional. Due to limited resources and full schedules, process managers were often unable to share their knowledge with other employees. 3. 2. Interpretation of organisational and work processes in relation to HIS Work activities included: (1) co-ordination of information exchange management; (2) care, including documentation of the care provided and the practice that had evolved at the clinic; (3) supply, including patient assistance and psychosocial support. The work procedures of the various activities were often related to and dependent on each other. Co-ordination activities were oriented toward management of the wards and the clinic. The activities focused on co-ordinating various types of information in order to support the care effort. External co-ordination is related to the exchange of information between the paediatric clinic and other care units. This coordination continued after the patients had been discharged from the clinic. Thus, the coordination of external resources and inter-organisational collaboration was important to the management of the clinic. Patient co-ordination started before a patient was admitted to institutional care. There were two 10 Management Information Systems in Process-oriented Healthcare Organisations easons for such approaches. First, the amount of time that patients stayed at the wards proved expensive for the healthcare organisation. Thus, such approaches saved money. Second, these approaches enhanced the relationship between care providers and caretakers, assuming that patients and their families were kept well informed. Internal co-ordination was related to management and planning activities at the clinic and the wards. Such activities were linked to external and patient co-ordination, given that providers needed to cooperate with other units and patients in order to manage ward care. Care activities were underpinned by what had been agreed upon during the coordination of work activities and the information that was to be used by various co-ordination procedures. Care provision involved medical and nursing care performed by physicians, nurses and paediatric nurses. Care activities were broken down among the various professions. But care was regarded as teamwork from the point of view of the patients. Thus, the work tasks of the various professions cumulatively became what are referred to as the outcome of care provision. Practice development took in both medical and nursing care issues. The knowledge and information cultivated was incorporated into the ordinary work routines of the paediatric clinic. Care documentation activities were linked to care work and development efforts. Documentation provides protection for both care providers and patients. Care documentation served as a means of communication among care providers. Supply activities were indirectly related to care activities. Among employees who performed supply activities were nurses, paediatric nurses, kitchen staff, cleaning staff, play therapists and teachers. Material provision furnished care activities with pharmaceuticals, equipment and materials. Based on the resources that material provision furnished to care activities on a daily basis, estimates were prepared concerning the resources the activities would require over time. Bandages, diapers, syringes, etc. were also a part of material provision. Material provision also included equipment and supplies for play and school activities, such as games, videotapes and textbooks, as well as kitchen and cleaning supplies. Psychosocial support activities called for an information system that could offer emotional support, such as administrative tasks associated with permitting patients to have their own personal phones. Thus, psychosocial support depended on the ability of patient co-ordination efforts to proceed smoothly, assuming that both patients and their families could be kept well 11 Management Information Systems in Process-oriented Healthcare Organisations informed. The main purpose of Patient assistance, which included both material provision and psychosocial activities, was to assist care activities. Such activities were related to supporting the physical and mental well-being of patients while undergoing medical and nursing care. 3. 3. A management information system model for process-oriented healthcare The county council formally required that hospital management monitor and report on service production with regard to quality and cost. As a result, hospital management needed data about resource utilisation and healthcare quality from the hospital organisation, along with information systems that could support methods such as Total Quality Management (TQM) and Balanced Scorecard. To monitor costs and quality, hospital management needed data from the functional units after determining what needed to be collected. The focus of process management was developing and maintaining a high level of quality in the medical and nursing care processes. The process unit was responsible for documentation and quality control operations. Process management needed directives from the functional management unit about both data collection templates and quality for medical and nursing care. Process management generated information about medical and nursing quality data for functional unit management. Best practice guidelines and decision support protocols for clinical practitioners were involved in the clinical process. The HIS application required by process management was a service quality control system that could extract data from and support decision making for medical and nursing care. Functional unit management comprised managers at both the clinic and ward levels. Clinic management organised the monitoring of the clinic’s resources, while ward managers co-coordinated the exchange of information at the wards. Functional unit management requested information about resource allocation specifications and templates for expenditure reports, as well as for patient satisfaction and staff work satisfaction data, from hospital management. Functional unit management needed data concerning the perceptions of patients and staff with regard to the services provided by the unit. Management was also looking for a way to relate its expenditures to resources utilised. In other words, its primary needs were in the areas of data collection, storage and access tools. 12 Management Information Systems in Process-oriented Healthcare Organisations Thus, functional unit management required data from clinical activities, but not at an individual or contextual level. The systems it was seeking were to supply data for use at a composite level, including the volume of financial and human resources that specified care activities necessitated. To monitor service delivery, management units in process-oriented healthcare organisations need data in three distinct areas: (1) medical and nursing care, (2) patient flows and (3) the utilisation of human and material resources. Although the management units may have access to a common data warehouse, requirements for data analysis and presentation vary considerably. Similarly, data collected from the healthcare organisation during daily work routines can be shared, but the primary data must be converted into a format that is usable by healthcare managers. The data that is collected should ideally be located where it can be made available to ordinary healthcare activities. For instance, networked devices can be used to monitor pharmaceutical use. Intelligent devices can also be connected to equipment in order to track their use, and material storage and use (diapers, sheets, etc. ) can be traced by bar-code systems. Furthermore, patients and healthcare staff can be registered with smart cards as they come and go. However, computerised patient records (CPRs) are the most logical central resource for data collection in the clinical setting. The data that is documented in the records can be used to monitor the clinical activities that have been performed. CPRs can also furnish data about work activities at the healthcare organisation. Such data is of little value as long as it is limited to individual patients. What is useful is to analyse cumulative data, such as the number of radiology examinations that have been conducted on leukaemia patients. The purpose of the data warehouse is to store what has been collected from various sources. The application and its interface are the parts of the HIS with which healthcare managers interact and with which users most readily identify. Thus, the application must help healthcare managers use information and must supply the right information to the right healthcare managers. Moreover, the application must support the specific analysis methods, tools and data formats required by current organisational analysis procedures, such as Balanced Scorecard and quality assurance methods. 13 Management Information Systems in Process-oriented Healthcare Organisations 4. Discussion The aim of this thesis was to develop a management information system model for process-oriented healthcare organisations. The research effort employed qualitative methods such as archival data analyses, interviews, observations, diary analyses and focus group analyses. Constant feedback loops among the participants in an idiographic case study helped establish a balanced interpretation. Meanwhile, categorising and modelling formed the pattern of interpretation for the management information system model. The main findings of the study are that an HIS in a process-oriented organisation must support the medical work, integrate clinical and administrative tools, and furnish information that allows for the measurement of organisational inputs and outcomes. As a result, it is important to identify the multiple roles that information plays in a process-oriented healthcare organisation. Most of the organisational development methods that healthcare currently takes advantage of, such as reengineering and quality management, include process definitions. However, the interaction between various groups of processes has seldom been analysed. Several recent organisational methods, such as Balanced Scorecard (Kaplan & Norton, 1996), address the problem of relating costs to resources. The areas in which information systems are expected to enhance care delivery range from access to medical knowledge bases, patient and clinician communication, and the minimisation of medical errors. Nevertheless, little attention has been paid to how integrated administrative, financial and clinical systems should be configured in order to support process-oriented healthcare organisations in an optimal manner. Internal co-ordination is informed by and dependent on documentation of care activities, particularly by monitoring the way in which human resources are harnessed to take care of patients. Furthermore, such co-ordination relies on information about the utilisation of material resources, i. e. durable equipment and disposables. Thus, internal coordination must obtain information from care activities in order to synchronise the work of the clinic, as well as to track costs associated with care and supply activities. The various processes monitor costs and allocate resources, relating them to the kinds of care activities that have been provided. 4 Management Information Systems in Process-oriented Healthcare Organisations The third sub-analysis discovered that the various management levels in process-oriented healthcare organisations need the same type of primary data, though in differing formats. An HIS for healthcare management in a processoriented healthcare setting can adhere to its structure and practice activities. Moreover, CPRs and other tools can be used to directly collect management data where and when the activities take place. But the data is useful only if healthcare management has the opportunity to examine it with its own analysis tools. For instance, while computerised ordering systems are regarded as important, the fit between organisational and information system models is not identified as a success factor. Clearly, there is a need for systems that optimise clinical workflow, as well as those that support the maintenance of equipment and supplies. However, systems provide optimal organisational value only if they support an integrated organisational model and business plan. 5. Conclusions This thesis points out that healthcare managers at different levels in an organisation all need the same primary data. The differences among the various management levels all concern the ways in which they compile the data that they need for their work. One problem when developing management information systems for healthcare organisations has been a lack of interest in integrating administrative, financial and clinical systems. In process-oriented healthcare organisations, integration is essential to obtaining the full benefits of such a structure. System thinking must also pervade the development of healthcare management information systems. As a result, the multiple roles played by information in process-oriented healthcare organisations must be identified. 6. Future work Identifying the multiple roles played by information in a process-oriented healthcare setting requires additional research about the process of designing an HIS. In the complex environment that healthcare organisations represent, various practitioners are required to pinpoint data sources and information 15 Management Information Systems in Process-oriented Healthcare Organisations requirements, as well as to advocate for the process of change in the organisational and information structure. Healthcare managers have differing preferences when it comes to information requirements, organisational processes and work activities. Thus, the development process relies on tools that can incorporate those divergent needs into system thinking. As a result, primary data is refined into information differently at the various levels of a processoriented healthcare organisation. More research is required concerning information system models and their notation. Though various groups (system analysts, designers, programmers and healthcare managers) can employ models and modelling activities during a development process, their objectives differ. Healthcare managers need to visualise their work environment and organisational processes, system analysts are interested in developing information systems in collaboration with designers, and programmers are looking for coding specifications. They may share a vision in terms of designing a healthcare information system, but their perspectives vary. Thus, the modelling effort should be based on at least two dimensions: (1) furnishing models with notations and objectives oriented towards specific groups; (2) ensuring that the models visualise the same system but address varying interpretations. Arguments based on the cognitive and practice perspective have identified prototyping as a fruitful approach to the development process (Houde &Hill, 1997). Prototyping is often used when the design calls for a high degree of involvement on the part of practitioners and end-users (Bodker & Gronb? k, 1991). Modelling, on the other hand, is linked to an organisational perspective and is frequently employed by system analysis methods. Thus, there is an opportunity to combine these two perspectives during the development process. Modelling is useful as part of a design theory with a high degree of practitioner involvement alongside of system analysts, designers and programmers. The process can subsequently be analysed based on the representations in the models that emerge from the requirements of the various groups. Additional research should examine what the groups need when it comes to the substance of the models, how the models are to be visualised and the ways in which they can interact with the differing requirements of the groups in order to ensure a fruitful development process. 16 Management Information Systems in Process-oriented Healthcare Organisations 7. References Adler P. A. , Adler P. , (1998), Observational Techniques, in Denzin N. K. , Lincoln Y. S. , (eds), Collecting and Interpreting Qualitative Material, Thousand Oaks, Sage Publication. 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N. , (eds), Evaluation of Human Work – A practical ergonomics methodology, second edition, London, Taylor & Francis Ltd. Ellegard K. , Nordell K. , Westermark A. , (1999), Att ta kontroll over vardagsliv kvalitativ dagboksmetod for reflektiv emancipation, In Linden J. , Westlander G. , Karlsson G. , (red), Kvalitativa metoder i arbetsvetenskapen, Uppsala, TK i Uppsala AB. Ely M. , (1993), Kvalitativ forskningsmetodik i praktiken – cirklar om cirklar, Lund, Studentlitteratur. Engestrom Y. (1995), Objects, contradictions and collaboration in medical cognition: an activity-theoretical perspective, Artificial Intelligence in Medicine, Vol 7 395-412. 18 Management Information Systems in Process-oriented Healthcare Organisations Engestrom Y. , (1999), Expansive visibilization of work: An activity-Theoretical Perspective, Computer Supported Cooperative Work, vol. 8, pp. 63-93, Kluwer Academic Publishe r, Netherlands. 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Overtime vs Hiring: A Case Study Essay

Abstract This report aims to address the debate over whether it is more beneficial to hire new employees when faced with shortages, or cover the shifts with overtime. The issue is examined from the viewpoint of Columbia University’s Department of Public Safety, and takes into account factors and costs as found therein. This report includes a graphical comparison of the costs associated with each option, and analyses and discusses the greater expense of hiring. One of the most debated topics in management is whether it is more beneficial to hire new employees or pay overtime to increase production or coverage. Many factors go into this decision, including benefits, duration of the period of extra work needed, and even type of work involved. In Columbia University’s Department of Public Safety, this issue gets more attention than at most places of business. Minimal staffing levels, union regulations, and round-the-clock posts – among other factors – conspire to make this decision one that is faced often. When all factors are considered, is it better for the department to hire new officers when coverage is lacking, or to utilize overtime to staff positions as needed? Executive Summary In almost all instances, it is more cost-efficient to fill gaps in coverage with overtime rather than hiring new officers in this department. This report will examine the factors involved, analyze the financial implications, and discuss exceptions to the findings. Explicit and implicit costs to the department will be discussed, along with their relevance to the decision-making process. This report will also compare the costs of new hires and overtime to find an equilibrium point beyond which the decision should change, and introduce the concept of diminishing returns. Finally, it will summarize the process and discuss application. Definition In Columbia University’s Department of Public Safety, there is a minimum level of on-duty staffing required at all times. Department employees are licensed, uniformed personnel belonging to the Transit Workers’ Union, Local 241. Management is required to ensure sufficient coverage on a daily basis, while conforming to the guidelines of the collective bargaining agreement. Sick time, vacation time, requests for guard services or special details, and emergencies such as natural disasters can create shortages in coverage that need to be addressed. Failure to cover these openings is not an option, and so management is left with two choices: hire additional full-time personnel to cover the openings, or pay overtime – at the rate of one-and-one-half times normal salary. Spending large amounts on overtime raises concerns in multiple areas, such as yearly budget reviews and union negotiations. This report aims to examine the issue in depth, and decide which option is mor e fiscally appropriate in a given situation. Factors and Costs As previously mentioned, there are numerous factors that influence this decision. The following are the most critical points that must be considered: * Department employees are unionized. Due to contractual agreements, the department must maintain all currently occupied positions. Any vacated position must be filled, somewhere in the department; for example, if an officer resigns, the department must fill that vacancy, whether in the same position or laterally, or be found in violation of the collective bargaining agreement. * Note that this is regardless of shortages, and only applies to permanently vacated positions. If the department has three extra officers on a given tour, and one resigns, the department may not continue to operate with two extras; rather, it is necessary to hire a new third extra. If an officer goes out on extended disability, however, it is not contractually necessary to fill that opening. In these cases, the department can cover the shortages, if any, through other means. Hiring remains an option, but the mandate to retain positions applies to newly created positions as well. In effect, if a new officer is hired in this situation, and the disabled officer returns to duty, the department is now obligated to keep both positions filled permanently and has a new minimum level of staffing. * New hires are paid at a rate of 80% salary for the first two years, then 82.5% the third year, 85% the fourth year, then 100% from year five on. * Overtime is paid at one-and-one-half times salary for any work done beyond 40 hours in a week. If an employee works a shift during all 7 days of the pay period, work done on the 7th day is paid at twice salary. * Any mandatory overtime performed without at least one hour of advance notice is paid at double time. This is relevant because when electing to not cover openings with additional personnel, any emergency shortages could lead to mandatory overtime without notice. * Most posts on campus require continuous coverage 24 hours a day, 365 days a year. This means there are three distinct tours with their own unique dynamics for coverage. The 8Ãâ€"4 tour, for example, has the highest concentration of senior officers, meaning they accrue more vacation time than junior officers. The summer months are obviously prime time for vacation picks, and two officers are allowed out at a time during summer. This means that summer vacation time is booked solid on the 8Ãâ€"4, so the tour is perennially short two officers all summer. Also, as a medical research facility in addition to a university campus, there are more posts open during the 8Ãâ€"4 tour than any other. As a result, it makes a difference where the shortage occurs. * Shortages on the night tours are easier to absorb, because there are fewer posts, but there is also night differential to consider: any officer working between 4pm and 8am makes an extra stipend of $1.80 per hour for night differentia l. As a fixed bonus separate from salary, however, night differential has no impact on this decision, as shown later. * New employees must be trained for a minimum period of one month before being able to assume post unsupervised and unassisted. This not only reduces the utility of a new hire for the first month, but also reduces the utility of the officers assigned to train him or her. * The department provides, as a service, officers for hire on campus for special events. The department charges $50 hourly for this service per officer assigned. If there is extra coverage on the tour during which the guard service is requested, an officer may be reassigned from a non-mandatory post, at a significant savings to the department. By using already assigned personnel as opposed to paying overtime for another officer in addition to the scheduled non-mandatory officer, the department can significantly reduce the overtime budget. For the purposes of this report, it will be assumed that no overtime is covered in this way, to preserve an empirical comparison of salary costs. * Officers are paid hourly, and thus are a variable labor cost. If the amount of time worked during a pay period changes, the officer’s salary for that period will change accordingly. For the purposes of this report, it will be assumed that labor costs are fixed. All officers not assigned to overtime always work exactly 40 hours per week, and those assigned to overtime always work in increments of exactly 8 hours per additional shift. Docking pay for tardiness will be disregarded. * The department pays an amount equal to 37.7% of each officer’s salary for his or her benefits package. This payment remains in effect so long as the officer is on the University’s payroll, whether or not he or she actually works or is paid. Officers on vacation, sick leave, or disability still incur this cost. While the cost of benefits itself is highly relevant, and will be used extensively in analysis, the fact that disabled officers still incur this cost even when not being paid by the department is not relevant to this discussion. Measurement In trying to determine how best to fill coverage, the most obvious comparison is between costs of a new hire and overtime. As previously stated, overtime is equal to one-and-one-half times salary (S). Cost of overtime can therefore be represented by the equation COT=h(1.5S), where h represents hours worked. New hires, who incur a cost of 37.7% of their salary, have a cost of CNH=h(1.377S). New hires always have a starting salary of 80% of full pay, while officers working longer than two years have a gradually increasing pay scale. One eight hour shift of salary at the rookie wage scale is equal to $149.20. For a third-year officer, that rises to $153.84, then $158.56 for a fourth-year employee. Finally, upon completion of four years of employment, the wage scale tops out at $186.48. A new hire will always work 5 shifts a week, leading to CNH=5(1.377)(149.2), or CNH=1027.24. COT, on the other hand, varies based on how many shifts of overtime are required that week, and the seniority of the officer performing the overtime. Plotting those equations against each other leaves us with the first graph below, labeled Weekly Salaries, New Hires vs Overtime at Each Level of Seniority. As expected, officers receiving full pay cost significantly more to cover with overtime than any other officer, but even at that escalated rate, there would need to be shortages in excess of 3 positions per week to justify hiring a new officer. For all other levels of seniority, 4 shifts of overtime could be covered per week at a lower cost than one new hire. In order to simplify the situation, this report will henceforth take an average of the salary levels and assume that all officers working overtime earn that rate of pay. Weekly Salaries, New Hires vs Overtime at Each Level of Seniority After applying this assumption, full pay is removed as an outlier, and it becomes always less expensive to fill four shifts of overtime than to hire one new officer. Weekly Salaries, New Hires vs Average Overtime Rate for Day Shift As seen in these graphs, the presence of night differential increases cost equally across the board, and therefore has no impact on this decision. Weekly Salaries, New Hires vs Average Overtime Rate for Night Shifts Analysis The graphs provide striking evidence that new hires are significantly more costly for small to reasonable shortages, seemingly four or fewer per week. However, due to the nature of the department, this is an underestimation. Since all three tours need to be covered, and officers must contractually be assigned to a stable tour, each tour must have its own graph. It is clear in every graph above that if there are five or more shifts of overtime per week, it is always less costly to hire a new officer; this is not completely accurate. During a given stretch, if there were expected to be 6 shifts of overtime that need to be filled each week, but the shifts are distributed evenly, with two shortages per tour per week, hiring one new officer will not account for five tours of overtime, but two. As presented by Bob Thomas (2006, p.13), â€Å"adding officers does not automatically reduce an equivalent number of overtime hours by the amount of the actual hours worked.† Thomas explains that while adding officers reduces overtime, it also raises costs disproportionately in an example of diminishing returns, an effect found mirrored in the previous graphs in this report. In essence, hiring additional officers beyond a certain point will produce reduced utility with each new hire. Hiring additional officers will add utility, but at a much higher cost per unit of utility, creating an inefficient Summary The measurements set forth in this report clearly show that only the most extreme of shortages justifies hiring an additional employee from a cost-effectiveness standpoint, but this is not the only factor to consider. Most important among these is the contractual obligation of the department to hire a new officer each time a position is vacated. Fatigue is a concern that is often raised regarding the use of overtime to fill gaps in coverage. Steve Earley’s report for the Riverside Fire Department (2001, p.14) cited studies finding a correlation between the number of hours worked and work-related injuries. The department has already taken steps to mitigate this, as employees are prohibited from working longer than 16 consecutive hours, and are strongly dissuaded from working 7-day weeks. Overtime is also distributed in a rotation, by seniority, so that no one officer has significantly more overtime opportunities than any other. In conclusion, the data is so compelling that whenever possible, shortages should be covered with overtime rather than hiring. Works Cited Earley, S. (2001). An Analysis of the Utilization of Overtime Versus Hiring Additional Personnel. Riverside, CA. Thomas, B. (2006). Corrections Overtime Planning Study. Olympia, WA.

The Sisters summary Essays - The Sisters, Boy, Dubliners

The Sisters summary Essays - The Sisters, Boy, Dubliners The Sisters is a short story from a book called Dubliners. The book was written by James Joyce who is one of the most influential writers in Ireland. The main characters in the story are a young boy and his friend the old Priest also the two sisters who are looking after the Priest. Also the young boy's aunt and uncle and an old Cotter who is a friend of the young boy's family. It is 1895 in Dublin when a nameless boy comes down for supper. Old Cotter is telling the boy's aunt and uncle that the Priest has passed away after a third stroke. The two men discuss this friendship and they think that spending time with priest was unhealthy for the boy and he should playing with young lads of his own age. In bed later, the boy tries to understand why Old Cotter and his uncle would not want him to join with Father Flynn then he imagines about the priest trying to confess something to him. The next day, the boy visits Father Flynn's house and finds a card displayed outside announcing the man's death but he does not knock on the door. He feels less sad than he would have expected and a sense of freedom. In evening, the boy's aunt takes him to see the body of Father Flynn in an open coffin, after which the boy's aunt and the priest's two sisters converse cryptically about the deceased, implying that he was mentally unstable for some time before dying and that he may have been involved in some scandal or other.

Learn the Basics About Rocky, Dusty Planet Mars

Learn the Basics About Rocky, Dusty Planet Mars Mars is one of the most fascinating planets in the solar system. Its the subject of a much exploration, and scientists have sent dozens of spacecraft there. Human missions to this world are currently in planning and might happen in the next decade or so. It may be that the first generation of Mars explorers are already in high school, or perhaps in college. If so, its high time we learn more about this future target! The current missions to Mars include the Mars Curiosity Lander, the Mars Exploration Rover Opportunity, the Mars Express orbiter, the Mars Reconnaissance Orbiter, the Mars Orbiter Mission, and Mars MAVEN, and the ExoMars orbiter.   Basic Information about Mars So, what are the basics about this dusty desert planet?   Its about 2/3 the size of Earth, with a gravitational pull just over a third of Earths. Its day is about 40 minutes longer than ours, and its 687-day-long year is 1.8 times longer than  Earths.   Mars is a rocky, terrestrial-type planet. Its density is about 30 percent less than that of Earth (3.94 g/cm3 vs. 5.52 g/cm3). Its core is probably similar to Earths, mostly iron, with small amounts of nickel, but spacecraft mapping of its gravity field seem to indicate that its iron-rich core and mantle are a smaller portion of its volume than on Earth. Also, its smaller magnetic field than Earth, indicates a solid, rather than liquid core. Mars has evidence of past volcanic activity on its surface, making it a sleeping volcano world. It has the largest volcanic caldera in the solar system, called Olympus Mons.   Mars atmosphere is 95 percent carbon dioxide, nearly 3 percent nitrogen, and nearly 2 percent argon with trace quantities of oxygen, carbon monoxide, water vapor, ozone, and other trace gases. Future explorers will need to bring oxygen along, and then find ways to manufacture it from surface materials.   The average temperature on Mars is about -55 C or -67 F. It can range from -133 C or -207 F at the winter pole to almost 27 C or 80 F on the day side during summer. A Once-wet and Warm World The Mars we know today is largely a desert, with suspected stores of water and carbon dioxide ice under its surface. In the past it may have been a wet, warm planet, with liquid water flowing across its surface. Something happened early in its history, however, and Mars lost most of its water (and atmosphere). What wasnt lost to space froze underground. Evidence of  dried ancient lakebeds  have  been found by the  Mars Curiosity  mission, as well as other missions.  The apparently history of water on ancient Mars gives astrobiologists some idea that life might have gotten a toehold on the Red Planet, but has since died out or is holed up beneath the surface.   The first human missions to Mars will likely occur in the next two decades, depending on how the technology and planning progresses. NASA has a long-range plan to put people on Mars, and other organizations are looking into creating Martian colonies and science outposts as well. Current missions in low-Earth orbit are aimed at learning how humans will live and survive in space and on long-term missions. Mars has two tiny satellites which orbit very close to the surface, Phobos and Deimos. They could well come in for some exploration of their own as people begin their in-situ studies of the Red Planet.   Mars in the Human Mind Mars is named for the Roman god of War. It probably got this name due to its red color. The name of the month March derives from Mars. Known since prehistoric times, Mars has also been seen as a god of fertility, and in science fiction, it is a favorite site for authors to stage stories of the far future.   Edited by Carolyn Collins Petersen.

Kristoff on China Ed Essay Example | Topics and Well Written Essays - 750 words

Kristoff on China Ed - Essay Example In Chinese schools, teachers are much respected, and the most admired kid is often the brain rather than the jock or class clown.† (Kristof) Thus, it is fundamental to realize the major purpose of the author in this article is to establish that there has been a fundamental growth in China’s education system and the passion for learning, and the rest of the world, including the U.S., should model this system of education for the growth of the civilization. According to Kristof, it is essential to elevate education on the list of priorities in the nation and there should be emphasis on creativity and independent thought. Therefore, Nicholas D. Kristof establishes through his article that the U.S. should strive to adopt the model given by China’s education system in order to achieve overall development of the nation. This paper makes a reflective exploration of Kristof’s â€Å"China’s Winning Schools?† in order to find out the author’s maj or concepts and ideologies concerning education system and the role of cultural values in education. ... As Kristof indicates, the Confucian reverence for education, steeped into the culture, has been the greatest strength of the Chinese system of education. The author is explicit that this education system and the passion for learning, and not China’s strategic challenge, offer a real challenge to the Americans. Thus, the most crucial argument of the article is that the Americans should think of the real challenge hoisted by the Chinese, which is in the field of education, rather than worrying about China’s strategic challenge in terms of the new Chinese stealth fighter aircraft, etc. Kristof purports that the â€Å"real challenge is the rise of China’s education system and the passion for learning that underlies it. We’re not going to become Confucians, but we can elevate education on our list of priorities without relinquishing creativity and independent thought.† (Kristof) Secondly, in a reflective analysis of the major purpose of the author in wri ting the article, it becomes lucid that he is mainly focused on the growth in the education system of China which is based on Confucian reverence for education. By listing out the most essential aspects of Chinese system of education, the author attempts to provide a highly useful model of education for the U.S., which is based on reverence for education, quality of teaching, passion for learning, and creativity and independent thought. Therefore, the author not only promotes the successful aspects of Chinese system of education, but also establishes the need for creativity and independent thought which are fundamental to the U.S. system of education. Thirdly, the author has been effective in achieving his main purposes in the article by pointing out the essential components of China’s education system, along with