Wrinkle in Time Essay Example for Free

Wrinkle in Time Essay In A Wrinkle in Time by Madeleine L’Engle (1962), 14-year-old Margaret (Meg) Murry finds herself in trouble and miserable. Her beloved father has disappeared, her five-year-old brother, Charles Wallace, is the object of ridicule, and she’s having enormous problems at school. Then, one dark and stormy night, she meets a â€Å"woman† with the odd name of Mrs. Whatsit, who seems to know more than she lets on and who leads Meg, Charles Wallace, and a popular boy from Meg’s school, Calvin, 14, on a quest to find Meg’s father. This quest takes them to other planets and into great danger as they pass behind an evil presence called the Black Thing. The children and their extraterrestrial helpers, Mrs. Whatsit, Mrs. Who, and Mrs. Which, manage to rescue Mr. Murry from a prison planet, but leave Charles Wallace behind during the attempt. Mr. Murry uses a technique called a â€Å"tesseract† in order to jump from one planet to another to make their escape once the children free him from his prison cell. But because Mr. Murry is greatly inexperienced at tessering, which is how he ended up on a prison planet in the first place, Meg is almost killed. Once she recovers, she understands that only she can return to the prison planet by herself to rescue Charles Wallace because the two of them are very close. In the end, Meg is successful and the family is reunited back on Earth. I decided to select this book for my fictional character review because I remember no other book from my childhood enchanting me the way A Wrinkle in Time (L’Engle, 1962) did when my sixth grade teacher read it aloud to us. The opportunity to look at Meg from a different point of view intrigued me. Is she gifted? Does she have some kind of disorder? Perhaps she has dysthymic disorder, a kind of low-grade, long-term depression? Does she meet the criteria to be diagnosed with Oppositional Defiant Disorder (ODD)? Looking at the story from this point of view opens up a whole new way of seeing this character, and the task of analyzing what Meg is experiencing and what her mother and teachers could have done differently to support her is what I hope to accomplish. One thing that the staff at Meg’s school and even Meg’s mother have failed to deal with is Meg’s grief over the loss of her father. Mr. Murry was a physicist who disappeared while doing top secret experiments for the government. He’s been gone for a year, and the government will provide no information about where he is or when, or even if, he will ever return. Meg’s mother lives in a kind of denial, expecting him back at any time, and so Meg has nowhere to turn to express her grief. She tries to hide her feelings like her mother does, but they just back up on her as she turns them inward. Perhaps because of this, I feel that Meg fits the criteria for a diagnosis of dysthymic disorder. For a child or a teen, two or three criteria must be met for a period of at least a year in order to qualify (Diagnostic and Statistics Manual of Mental Disorders, 2000, p. 311). I believe that Meg meets five of these criteria. Meg certainly suffers from low self-esteem and feelings of inadequacy. She calls herself a monster and a delinquent. She thinks that her 10-year-old twin brothers, Sandy and Dennys, are the only normal ones in the family. She feels her plainness acutely, with her mousy hair, her thick glasses, and her braces, and she compares herself unfavorably to her mother, who is a great beauty. Her teachers also compare her unfavorably to her brilliant parents right to her face. Meg feels that she is â€Å"doing everything wrong. † (L’Engle, 1962, p. 7) Another criterion of dysthymia is feelings of pessimism and despair and a kind of hopelessness. Meg has been dropped to the lowest section in her class, and her teachers chastise her frequently for not trying and not being smart enough. She is grieving the loss of her father and his loving support. She is also subjected to nasty town gossip, such as once overhearing a townsperson say, â€Å"I’ve heard that clever people often have subnormal children,† and that the â€Å"unattractive girl† was not â€Å"all there† (L’Engle, 1962, p. 13). All of these things have culminated in despair and hopelessness for Meg. She also suffers from â€Å"subjective feelings of irritability or excessive anger† (DSM, 2000, p 775). She talks back to and even shouts at her teachers and her principal, Mr. Jenkins, when they criticize her or bring up her father’s absence. In addition, when a boy a year older and 25 lbs. heavier than she is called Charles Wallace her â€Å"dumb baby brother,† she beat him up so badly that his mother called to complain (L’Engle, 1962, p. 8). Another symptom of dysthymic disorder is Meg’s inability to concentrate on her school work. She faithfully does her homework every night, but when she gets to class, she can no longer remember what she read. I also feel that Meg meets the criteria established for Oppositional Defiant Disorder, although it is very hard to know exactly how much of an impact her dysthymic disorder has had on her ODD behavior since there is often some relationship between the two diagnoses and there are some areas that overlap. With Oppositional Defiant Disorder, there is a pattern of negative, hostile, defiant or disobedient behavior towards adults and/or authority figures that lasts for six months or longer (DSM, 2000, p. 100). I feel that Meg’s ODD manifests in six different ways. The first three criteria suggest that she suffers from ODD because she frequently loses her temper, is quite touchy or easily annoyed, and she argues with adults who are in authority. At school, as I mentioned before, she talks back to her teachers and to the principal, she gets angry and shouts at them, and there was also the incident on the way home from school in which she beat up an older boy. She also has a pattern of actively refusing to comply with the rules of adults. In this case, Meg’s mother believes that Meg has set up a mental block about math. For most of her life, Meg’s parents tested her IQ and played a lot of math games with her. They know that she is gifted, and they taught her a lot of short cuts in math, so that Meg can actually do math that is two grades above her. However, in 9th grade, the grade that Meg is in, the math teacher wants Meg to show her work; she wants Meg to do the math the long way so that the teacher can see that Meg knows how she arrived at the result. This annoys Meg to no end as she thinks it is a total waste of her time, so Meg refuses to do it. Another criterion of ODD that Meg meets is doing things on purpose to aggravate other people. For example, when Meg is called into the principal’s office, Mr. Jenkins starts asking her questions about her missing father. Meg starts shouting at him and when he asks her to keep her voice down, she refuses and just shouts all the louder. Lastly, Meg blames others for her misbehavior. It’s the teacher’s fault, or the principal’s fault, or the fault of the boy who taunted her. She does not take responsibility for her own actions. It’s unfortunate that Meg has not received the mental health treatment that she needs. But it’s important to remember that the setting is 1962, and that the guidelines for these mental health disorders had not yet been established. School officials and teachers were often working in the dark and had no idea how to handle â€Å"problem children† like Meg. Her teachers berate her for not trying and the principal tells her that she must face facts about her father’s absence. Meg’s mother is doing her best to hold her family together in the face of humiliating rumors and the loss of the man she loves. Because of her own grief, it no doubt never occurred to her that Meg could use some professional help. In conclusion, one would hope that these days, Meg’s grief, her dysthymia, and her ODD would be identified by her teachers or her mother, and addressed by the school social worker. She should definitely be receiving help from a mental health professional. If the topic of the loss of her father is too sensitive for Meg to discuss with anyone at school, such as a school psychologist, then she should be offered the chance to talk to someone from another town. As it is, her main confidant and her emotional rock is her five-year-old brother, Charles Wallace, and although he is smart and mature for his age, he can’t bear that burden for her. References American Psychiatric Association. (2000). Diagnostic and statistics manual of mental disorders (4th ed. , Text revision). Washington, D. C. : American Psychiatric Association. L’Engle, M. (1962). A wrinkle in time. New York: Farrar, Straus, Giroux.

The Culture Of Cambodia Cultural Studies Essay

The Culture Of Cambodia Cultural Studies Essay There is a different work hours between government and private offices. For government offices, the routine work hours is on Monday- Saturday since 7.30am until 4.30pm with breaking for the lunch time while private offices normally have no break by use working on ones shift instead to keep longer hours for example; shops, supermarket, etc. Cambodian have customs and tradition to have long and suitable relationships in any business. They trust having proper behavior is more important than work performance for example; if you are honest, responsible for your tasks, polite and respect to the superiors or the higher powers, etc. The higher power will concern and give some rewards to the good employees such as money or power. To give and opinion, Cambodian employees prefer to follow the superiors opinion than against them. Cambodians prefer to improve their English skills to enhance themselves to the internationally therefore, the English books, magazines or language tapes are popular to be the gifts for any business. Shoes and socks are unsuitable for the gifts because cultures they believe that the foot is the lowest of their body according to Buddhist cultures. Cambodia has a long history of culture and civilization which mainly influenced by Indian country. Notice from the Cambodians life involve with the religions of Buddhism and also Hinduism. Cambodia population around 95 percent is Theravada Buddhist according to relies on reasonableness, personal experience, and critical analysis. This is the main Buddhist in Southeast Asia including Cambodia which affected Cambodians culture and etiquette in nowadays and the other are Islam, atheism, or animism respectively. For example; the conceptual ideas about karma, collectivism, and saving face plays and important roles in the daily life of Cambodians. For karma, this idea involves with the rationality and law of action. If you do something, something will be happened follow things that you did. For collectivism, Cambodians prefer give priority to family, group, and society rather than the individual. This idea also concerns about saving face which tries to avoid losing someones face in any transactions. Losing face can be occurred when someone is criticized or is given compliments in the public. Therefore, if you want to do business with Cambodia, you should be aware of this action to assure that you are not misunderstanding this concept. The followings are the tips for saving Face; Normally the monks in Cambodia always highly respect in the society because they are faithful and admirable. They have similar ways to Thailand for example; they dressed in the color robes, women must avoid touching or handing to the monks even though she is a monks mother. To have a conversation with the monks, you should press the hands together at the chest  level for showing respect to the monks. For the daily routine of monks, they are allowed to eat only to times per days which are in the morning and lunch. Normally, when the Cambodians greet, they usually bow their head to show respect with press the hands together at chest level which is quite similar to Thailand. This gesture is known as Som Pas. However, when they greet with the foreigners, they usually adapt the greeting of western style by shaking hands. Typically, it is improper for the men to shake hands with Khmer women and to hug, kiss, or touch the body of a Khmer woman are not allowed and unsuitable in this society. To address the name of Cambodians, they use Lok instead of Mr. for the man and Lok Srey instead of Ms. or Mrs. for the woman before the first name and surname. Proper dress is an important for Cambodians for both men and women. It can show their position in the society for example, shorts are considered as the proper dress only for school children and it is not proper for both men and women if they want to go inside the official places or temples. Doing business in Cambodia also consider about the proper dress. Generally, to do business or working in Cambodia men wear collared shirts and long pants. For women, they wear dress or blouse instead short skirts and should not show their shoulders. It is a typically in Cambodian society to bring the gift for the host if you are invited to have lunch or dinner at someones home. Normally they give flowers, fruit, cookies, etc. Knives or sharp things are not popular to be the gifts. Moreover, gifts are preferred to wrap with colorful paper rather than the white because it means the sadness or mourning. Moreover, when you want to give the gifts, you should use both hands for showing care and gifts are not opened when you received. Cambodians emphasis on the formal dress when they are doing business for both domestic and international transactions, contact with the government sectors or enter to the official places. Moreover, having proper and formal dress show the respect to the people who are doing business with or the places that you will go there. Normally, both men and women wear a lightweight tropical suit in formal situations. Shorts and skirts are not suitable in the public. For less formal occasions, it is enough to wear casual shirts and blouses with collars. Cambodians culture in communication is very indirect and non-verbal behavior therefore, the person who want to do business in Cambodia should understand about this culture and be aware of it for example; they prefer silent when they disagree instead of complain in front of others, smiling in Cambodia has many meanings not only in the positive ways but also in the negative ways, etc. Time is also important in doing business here. If you arrive late, it means you ignore and do not respect to the person who you are doing business with. Business Cards Presenting the card in doing business is general in Cambodia and it should be exchanged at the beginning of introduction. For the business card, it is better if one side is translated into Khmer. When you present your card or receive the card, remember to use the right hand or both hands. Meeting and Greeting The followings are some guides for meeting and greeting in Cambodia; For Group meeting you should introduce people in order to rank. Handshakes are general however you should be careful not to be too tight which can be considered as aggressive. It is the tradition that if the man is doing business with the woman, they should keep distance to avoid misinterpret from the others because Cambodians has a strongly traditional in sexuality for example eye contact should be kept to a minimum. Cambodians address them with the title Lok for a man and Lok Srey for a woman with the first name only or both the first and the last name. CULTURAL DIMENSIONS Nowadays the world is separated in different countries and culture and many people still dont know much about their international business partners and how to deal with them in the right way. Therefore business people should need to know how they can cope with the foreign partners. This part is emphasized on the cultural dimensions and communication in South East Asia including Lao and Cambodia. It is an important to know about the fundamental facts of these countries if you want to do successful business in SE Asia. Cultural Dimensions from Hofstede High power distance Societies have significant gaps between the higher power and the weak. There is related distinguished to unfairness between the rich and the poor. High level of uncertainty avoidance The cultures in SE Asia tend to reduce risk and ensure financial securities, many written rules, less risk taking by managers, lower labor turnover and less ambitious employees. Collectivism People are very interested in long lasting relationships and give priority to a group, family or society. They care each other in change for loyalty and tend to show less individual. High feminity (low masculinity index) Care each other and quality of life for both men and women. Managers give their employees more credit if they have high responsibility for their tasks and allow them more freedom.

Leadership And Service Improvement Management Essay

Leadership And Service Improvement Management Essay The study of leaders and leadership has led to many competing theories which attempt to distill the essence of great leadership into its component parts, to allow others to acquire some of these attributes, and become more effective leaders. The very earliest theories on leadership tended to assume that leaders were born, and that leadership was not a skill, or set of skills that could be acquired. The overall impression was that Great Men had inherited leadership qualities from their ancestors, which would make them effective leaders when placed in positions of authority (Kirkpatrick and Locke 1991). This is not a very helpful way to look at leadership, and does nothing to assist students of leadership in their efforts to become better leaders themselves. It is not, though a great leap from identifying natural leaders to identifying which parts of their character or personality mark them out from others. This underpins the Trait theories of leadership. Trait theory was studied extensively in the mid part of the 20th Century, and had a wide range of results. Kirkpatrick and Locke (1991) explain that trait theory made no assumptions as to the origins of the traits studied, but simply highlighted the differences between leaders and non-leaders. In 1974, Stodgill published the results of his studies of leadership theory, and identified 22 traits and skills which are present to varying degrees in the individuals studied. This did not show how individuals could become better leaders, but, the identification of leadership as a skill has been vital in the subsequent development of leadership training. He himself ultimately concluded that A person does not become a leader by virtue of the possession of some combination of traits. (Stodgill 1948 cited in Levine 2008) McGregor (2005) looked at leadership behaviours as relating to underlying traits or world views. They examined the ways in which managers and leaders approached a task, and tried to understand the motivating factors. McGregror (1960) felt there were two major theories of human motivation which lay behind the actions of the leaders he studied. His theories were labelled X and Y. Theory X assumes that the average human being inherently dislikes work, and therefore must be coerced to perform at the required level. The motivating factors here are extrinsic. Theory Y assumes that work is a natural part of life, as much as is play or rest, and intrinsic motivation is key. This intrinsic motivation can be viewed as an expression of the Hierarchy of Needs (Maslow 1943) The work of McGregor informed the production of methods to map leadership behaviours. Blake and Mouton (1964) plotted concern for production against concern for people. This produces a helpful framework for mapping behaviours, but it is rather passive in form, and seems mainly useful for reflection or critique, to inform future endeavours. It does not necessarily inform leaders of what behaviour is best suited to the group they are working with at a particular time. Action centred leadership was proposed as a leadership model by Adair (1973). His time in the Army and work as a trainer at the Royal Military Academy at Sandhurst led him to develop a model that considers three domains; Task, Team and Individual. He argues that each domain requires the attention of a leader, but the relative importance of each will vary. The relationship of these domains is represented by a venn diagram: Task needs Team maintenance needs Individual needs This model then details the areas a leader should address in each domain: Task: Practical managerial concerns, for example creating a plan, monitoring performance Team: Facilitating group working by agreeing standards of behaviour, resolving group conflicts etc. Individual: Ensuring individuals are performing as well as possible by supporting through challenges, allocating work according to strengths etc. There is considerable overlap and interaction between each of these domains, and it is argued that attention to each domain is required for a balanced team. The key feature of this model which made such an impact was providing a practical framework which allowed leaders to combine some of the softer skills of leadership with more managerial traits of time management and task focus. Situational / Contingency Theories of Leadership The studies of leadership discussed above have all looked at leaders and leadership behaviour and described them, allowing leaders to analyse their behaviour. The theories above, over time have been developed to include a degree of dynamism, but were initially descriptive exercises. It was the recognition that there was not necessarily on right way of leading that prompted thinking about the possibility of adaptive styles of leadership (Schermerhorn 1997). The study of leadership in different situations and settings, and the observation that the most effective style of leadership changed with respect to situational variables led to situational leadership models. The earliest described was the Contingency Model (Fiedler 1964). This model relies on a self-rated scale to determine a preferred leadership style. Fiedler then studied working conditions, and described them through three variables: Leader-member relations how willing team members trust and will follow a leader Task structure: how well defined a task is, or if it follows a standard procedure Position Power: the extent of the rewards and punishments a leader has available. Through his studies, Fiedler constructed a visual guide to represent his findings about which type of leader was most effective given the situational variables. The model states that leaders with high LPC scores should work with teams where the situation is moderately favourable. The more task focused leaders will be more effective in situations which are either very favourable or unfavourable to the the leader. This model has been studied extensively and has received both criticism (Ashour 1973) support (Strube and Garcia 1981). A major source of controversy in this model is the LPC. One important point to note is that Fiedler felt leaders would find their behaviour difficult to alter, and organisations should therefore pick the correct leader for a given team. This is in contrast to other models which suggest leaders should be adaptable. The Hersey-Blanchard (1969) model of situational leadership looks at a different variable in the team context; the maturity of followers. The underlying assumption is that a leader should adopt a style of leadership which reflects the needs of the team. This is in direct contrast to Fiedlers (1964) assertion that organisations should pick leaders given the favourability of the situation. In this model, a two by two grid which is very similar to the Blake Mouton (1964) Managerial Grid, is used to describe four leadership styles: S1: Telling (low relationship, high task) S2: Selling (high relationship, high task) S3: Participating (high relationship, low task) S4: Delegating (low relationship, low task) There is an accompanying scale which rates the team a leader is concerned with: M1: Low competence, and low commitment M2: Low competence, and high commitment M3: High competence with low/variable commitment M4: High competence and high commitment The M score for maturity of the team members was developed over time, and was later divided to reflect job and psychological maturity (Hersey and Blanchard 1982). Job maturity is the ability or capacity to perform the task in hand. Psychological maturity indicates motivation. The model has received criticism from a theoretical standpoint, and from empirical research. Graeff (1983) claims that the maturity scale is invalid, as it classifies workers who have skill and are unmotivated (M3) as more mature than those who lack skill but are dedicated to a task(M2). He also argues that the additive nature of job and psychological maturity in the model is invalid. He supports this view by suggesting that in tasks where skill requirements are low, motivation has a much greater importance. One study into the model concluded that, because high follower maturity did not obviate the need for supervision, their results lent very little support to the model (Cairns et al 1998). This study though had methodological flaws, a skewed population, and did describe some support for aspect of the SLT model. The practical application of this model relies on the ability of the leader to determine the maturity of their followers, and reflect this in their leadership style. Perhaps the most important aspect of the model is the recognition that leadership styles are not fixed, and leaders can change their approach to suit a given team or individual. In modern healthcare settings, there has been a change in the nature of teams. There is no longer a stable, small, hierarchical team. Instead, teams form and disperse on an almost shift-by-shift basis. To lead effectively in this environment, it is necessary to be adaptable, and be able to support team members to realise their potential. The models described above illustrate that there is no one best way to lead a team. Instead, by appreciating the different situations, individuals and tasks involved, leaders stand a better chance of forming teams which can cope with the varying demands of the modern NHS. Perhaps Goleman (2000, p.4) has argued this most eloquently through his work which revealed that the most effective leaders do not rely on only one leadership style; they use them seamlessly and in different measure depending on the business situation. Service Improvement Methods: The literature describes a large number of service improvement methods which have been applied in some form to healthcare settings. Most service improvement methodologies that have been implemented in healthcare have been adopted from industry, where the driving force is to maximise profits for shareholders. The adoption of industrial techniques for service and quality improvement has often met with a degree of resistance from the medical profession (Moss and Garside 1995) and from the health sector as a whole. This has been attributed to the professional nature of healthcare, which involves large numbers of autonomous, independent practitioners who often place independence of clinical decision making at the heart of their operating values. (Degeling et al 2003) Recently though, there has been a recognition within the medical profession of the need to drive up standards in healthcare, and to focus on overall quality of care, rather than just direct clinical activity. Included in most definitions of quality is efficiency of healthcare delivery. This focus on efficiency is built on the growing recognition that publicly funded healthcare systems need to be accountable for the expenditure they make. (Donabedian 1988) It is in the context of increased demands for efficiency, increasing burden of chronic disease, and ever increasing expectations from the users of the health services that service improvement tools have started to be implemented on a wider scale than ever before. Systematic approaches to service improvement have been in existence for a long time. Taylor published his Principles of Scientific Management in 1911 after many years of employing what are now known as time and motion studies to various industrial processes. His approach was much criticised for giving too much power to managers, and its use was even banned by the American Senate in defence establishments for relying too heavily on command and control leadership (Mullins 2005a). However, his methods produced great improvements in efficiency, and he made an argument about systems which is still valid today: The remedy for this inefficiency lies in systematic management rather than in searching for some unusual or extraordinary man.(Taylor 1911) Total Quality Management This approach to systematic improvement was developed by Deming during his work with Japanese manufacturers in the aftermath of World War II. He was initially concerned with teaching statistical control methods to Japanese manufacturers to improve efficiency. However, he adjusted his teaching to focus on the process, rather than individual performance, and emphasised the need for good management and a collective push for optimisation. He published his recommendations for industry, government and education, which set out his 14 points for management in the seminal work Out of the Crisis (Deming 1986). TQM is more than a technique or set of tools for improvement, and can be described as a way of life for an organisation as a whole, committed to total customer satisfaction through a continuous process of improvement and involvement of people. (Mullins 2005b) TQM has been utilised in healthcare since the early 1990s, and aspects of it are increasingly being employed today. It is often the tools associated with the approach which are used, rather than the wholesale systems change originally described, and this lack of clarity regarding the true nature of what is called TQM has contributed to a lack of clear evidence of benefit. (Øvretveit and Gustafson 2002) Where the whole package of TQM has been implemented, results have been mixed, but there are numerous examples of where certain elements have shown benefit. The most commonly employed techniques derived from TQM are statistical control methods, and the PDSA cycle. Plan Do Study Act (PDSA) Alongside his work on TQM, Deming is credited as being one of the key proponents of the PDSA (or PDCA) cycle. This cycle of learning, implemented as a quality improvement tool had been taught by Shehwart (1939) whilst Deming was working with him. Deming took this knowledge to Japan and it formed part of his work on TQM (Hossain 2008). The cycle reflects Kolbs learning cycle (1973), and is a tool for testing changes, and reacting to the results. It can be seen as either a standalone tool for change, as part of a larger system of change, or as a key part of a philosophy for wide-scale change across an organisation.(Cleghorn and Headrick 1996) The PDSA cycle consists of four parts: Plan: The objective of the test must be defined, and a method of data collection must be incorporated. Do: The planned change to a process is carried out, with concurrent data collection Study: The data is analysed, compared with predicted outcomes, and a summary of learning is produced. Act: The conclusions from the data are utilised, and used to inform the next plan. The underlying rationale for the PDSA cycle lies in systems theory. Systems theory implies that small scale changes within a system can create large results. The PDSA cycle is useful for testing small changes, and reflecting on the effects before either applying them across a whole system, or making further changes (Berwick 1998). When linked together, PDSA cycles can be used to drive up quality. This approach of multiple linked cycles and this approach of multiple linked PDSA cycles is used in the Model for Improvement, the rapid cycle model of change, and the collaborative approach (Langley et al 2009, 1992; Institute for Healthcare Improvement 2003). In contrast with small PDSA schemes within a team or organisation, the collaborative approach uses multiple PDSA cycles within separate organisations, whilst aiming for improvement in a shared area of care: The PDSA model, when used within the model for improvement, or as a chain of cycles within a single team is a clear, simply understood, but powerful tool for implementing change, and improving quality. Its strength lies in its ability to be applied to small scale changes, but achieve significant results. From an organisational point of view, the relatively small amount of resource which is required to test each hypothesis makes this model very attractive. Processes can be studied with little disruption of everyday activity, and if the results are not favourable, learning can continue without significant loss to the organisation. In clinical processes, the PDSA cycle is an excellent tool for testing hypotheses, especially where evidence may be lacking and inaction seems inappropriate, but action without reflection sees un-wise (Berwick 1998) The smaller, more local focus of PDSA cycles, and small resource requirements make this model particularly accessible to staff of all levels, and as the engagement of frontline staff, and in particular doctors has been shown to be a key factor in the success of change in the healthcare setting, this is a major strength. (Greenhalgh et al 2004 and Øvretveit 2005) The incorporation of the PDSA cycle into wider schemes of change management brings additional complexity, and also invites additional problems. There have been varied results in the implementation of the collaborative approach within healthcare as a service improvement tool. Some studies report great success (Monteleoni and Clark 2004; Schonlau et al 2005) while others (Newton et al 2007) found that there were difficulties using the same model. The major difficulties identified were lack of adequate resources, the conceptual difficulties associated with the model, and poor leadership. A recent review concluded that there is currently no evidence about the long term results or cost effectiveness of collaboratives compared with other models. (Øvretveit 2002). Toyota Production System (TPS) / Lean One approach to service improvement which is being applied with growing enthusiasm within the NHS is Lean. Lean thinking and theory emerged from studies of the manufacturing processes at Toyota. The term was first used in the late 1980s and the approach grew in stature after the publication of The Machine that Changed the World (Womack et al 1990). Lean was not originally a single tool or approach, but instead was a philosophy to which all members of an organisation aligned themselves. This whole systems approach is probably now better recognised at the Toyota Production System (Liker 2003). The success of Lean/TPS has led to a proliferation of schemes which fall under the umbrella of Lean thinking but do not necessarily hold to the original principles. The TPS was developed in the 1950s in Japan, and was first published in English in 1977 by Sugimori et al. The system has been studied extensively, but many organisations, despite implementing the principles behind the TPS, have not achieved the efficiencies and quality that Toyota exhibit. (Spear and Bowen 1999). There have been many attempts to reduce the TPS to a method which can be applied in many settings, but as Sutherland and Bennett (2007) state, such a complex process cannot be adequately documented. They suggest that instead, to understand the system, one must learn from mentors, much like a child learns and forms habits from their parents. Liker (2003) sets out 14 principles of the TPS, but for the purposes of this assignment, three will be examined: 1. The thorough elimination of waste (muda) 2. Jidoka or the primacy of quality 3. Kaizen continuous incremental improvement Ohno (1988) identifies 7 wastes (muda) which should be eliminated from any system. These are: Overproduction production of more than is required for immediate use Delay / Waiting any delay between the end of one process, and the start of another. Unnecessary transportation of materials Overprocessing using more energy than required for a given process, or exceeding the agreed specification Excess inventory any raw materials or work in progress in excess of customer requirements. Motion any unnecessary movement of workers, eg. reaching / stretching. Defects any process or work that results in unacceptable goods These wastes have immediate equivalents in most healthcare settings, and underpin a lot of the efforts in healthcare which are labelled as Lean. From these definitions many techniques for identifying waste have been developed. The NHS Institute for Innovation and Improvement (NHSIII) has developed a series of products known as the Productive Series which use the elimination of waste to improve healthcare. The tools used in the productive series are often taken directly from industry (NHSIII 2007), and include some elements which date back as far as the Scientific Methods described by Taylor (1911). Jidoka is defined by Toyota (2010) as automation with a human touch. When applied to a manufacturing context, this emerges as the principle that a process should continue unless a defect is noted. Once that defect has been detected, work should stop until the problem is solved. This principle ensures in manufacturing that if a machine or worker detects a problem, or a process issue, the line is stopped, a solution introduced and, vitally, incorporated into the standard workflow. In this way, the defect should not arise again. The early detection of defects on a production line, and the empowerment of workers to raise the alarm if defects occur also reduces waste. It is unfortunate that, although many principles of the TPS/Lean system are implemented in healthcare, it is often this concern for detecting problems and creating solutions which are incorporated into standard work which fails to be introduced. One reason cited for this area failing to be implemented is that clinical care c annot stop, in in this respect, clinicians feel methods for producing widgets cannot be applied to the art of healing (Wilson et al 2001). There are examples of where this concept has been introduced, into the healthcare environment, with clear evidence of improvements (Ballà © and Rà ©gnier 2007), but a recent paper argues that more could be done (Grout and Toussaint 2010) Kaizen is the culture of continuous, incremental improvements to a system (Imai 1986). This cultural philosophy of scientific experimentation, conducted at the lowest possible level in the organisation, is held up by Spear and Bowen (1999) as one of the key elements of the success of the TPS, and as a key stumbling block for others who seem unable to replicate Toyotas success. This philosophy, combined with other unwritten rules combine to create a community of scientists, who engage in experimentation to solve problems. These problems are often on a small scale, and the process closely follows the PDSA cycle. When this principle of widespread, incremental change is adopted across an organisation, with recognition of the value of tacit knowledge, it is possible for a learning organisation to emerge (Howells 1996). In conclusion, there are many approaches to leadership and service improvement which are being used in the healthcare setting today. Use of an adaptive model, which allows a leader to change management style depending on the team they are leading, and the task in hand, is most appropriate for leaders of modern medical teams, in a large part due to the very flexible nature of the teams involved. The application of industrial quality improvement techniques to healthcare has great potential, and successful trials have been conducted. However, a common feature discussed in analyses of obstacles to implementation is the engagement of medical professionals. Through the use of effective leadership, and engagement of these key stakeholders, it is possible to lay the foundations for a learning organisation. A learning culture which is open to the possibilities of change through quality improvement strategies will ultimately be the most fertile environment in which to implement change for a be tter quality of care.

Lifestyle Incongruence :: Economy, Minorities, Poverty

The situation that places African-Americans along with other minorities at an economic disadvantage because blacks tend to earn less than whites which often force blacks to pick between paying rent or providing food to make it daily. The hierarchy of needs are not being meet psychologically is a stressor that can produce health related illness that can effect a community as a whole if no intervention are made. (16) In exploring the impact that cultural model on the African-American community, William Dressler and James Bindon case study entitled, â€Å"The Health consequence of cultural consonance; cultural dimension of lifestyle, social support and arterial blood pressure in an African American community. â€Å" In the case study, Dressler and Bindon focus on the areas of society, culture and individual health; cultural models, cultural consonance and cultural consonance; and blood pressure in the African American community. The first goal of this research involves determining if there are shared models of lifestyle and social support in the community. Two, determine what the separate associations of cultural consonance in lifestyle and cultural consonance in social support are with blood pressure. Lastly, determine if there is a synergism between cultural consonance in social support in relations to stress (blood pressure). In society, culture and individual health, Dressler and Bindon noted that, socioeconomic status refers to the position of the individual in a system of ranked status based on criteria that include occupation, income and education. (9). Social integration refers to the degree to which individuals report social connections based on marital status, membership in voluntary associations, and interaction with friends and relative. (10) In return, a lower ranking on socioeconomic status is associated with an increase risk of disease. Higher levels of social integration are associated with a reduced risk of disease. (11) Furthermore, being lower in the status hierarchy, or being socially, isolated, could conceivably be associated with a wide variety of factors from not getting a sufficient amount of exercise to perceptions of stress on a daily basis. (12) Perspective epidemiological research designs are fairly efficient at ruling out alternative explanations by taking into account (or controlling for) exposure to other kinds of risks. (13) Thus, numerous studies have shown that the risk of disease associated with status role positions remains unaffected by controlling for pre-existing health problems, obesity access to medical care, dietary patterns, smoking; drinking and similar sorts of factors known to have effects on health.

Dengue in Malaysia Essay -- Health, Diseases

Dengue has now emerged as one of the major public health problems in Malaysia. It was first reported in 1901 in Penang and since then the disease has become endemic concentrating mostly in urban areas. The objectives of this study were to utilize the temporal-spatial model to determine high risk areas for the dengue outbreak. This study examined a total of 25000 confirmed dengue fever cases, geo-coded by address in the city of Subang Jaya between Jan 2006 and December 2009, were included in the study. The results were drawn from a measurement of the three temporal risk characteristics (Frequency, duration and intensity) in order to determine the severity and magnitude of outbreak transmission.The values of the three indices were considered high in a spatial unit when their standard values were positive. Measurement of the three temporal risk indices found that there were areas with significant high value for each of the temporal indices. This suggested that areas within Subang Jaya M unicipality had different temporal characteristics for dengue occurrence. The utilization of three risk measures enabled to identify higher-risk areas for the occurrence of dengue fever, concentrated in the city’s northern region. The correlation coefficient for all the three types of relationship was above 0.7. The value indicated that there was a strong correlation between each temporal risk indices. Even though case notification data are subject to bias, this information is available in the health services and can lead to important conclusions, recommendations and hypotheses. As a recommendation, the temporal risk indices can be utilized by public health officials to characterize dengue rather than relying on the traditional case incidence data. ... ...rrupted cases. This index gives an idea of the persistence of transmission and represents the average duration, in weeks, of epidemic waves that occurred in the given period. †¢ Intensity index (ÃŽ ³), characterized as the mean incidence of cumulative dengue cases occurring in consecutive weeks per epidemic wave that had persisted for more than two week. It can be expressed as: ÃŽ ³ = TI / OE where TI is the incidence rate during the given period and OE is described above. It assesses the severity of transmission, and is based on sequences of weeks with the occurrence of uninterrupted cases. High values mean time-concentrated transmission. The dengue cases were provided by MPSJ where dengue cases were summarized according to the housing area, on a weekly basis. Therefore, this study used a week as a temporal unit for better comparison on different indices.

Corporation and Profit Retention Essay

Sole Proprietorship: This is by far the most common form of business. It is the most common because it is the easiest to form. In order to create this type of business one simply has to â€Å"hang their shingle out† and let the commerce commence. However with such limited oversight also comes unlimited liability. Liability- Liability exposure with sole proprietorships is a huge draw back.. The owner and the business, legally, are one and the same. This leaves all the owners property ( and the business assets since they are one and the same) at risk. Income Tax- There are no real tax advantages at this level. It is known as a â€Å"pass through† entity. The income that is generated passes through the business to the owner. Taxes are paid at the individual level. Longevity- Unless the owners will provides specific direction in the contrary, the business is directly linked to the owners health. Since the owner and the business are legally indistinguishable from one another when the owner dies the business also dies. Control- Unlimited control is another attractive quality of Sole Proprietorships. Since legally there is no separation you may do with the company as you see fit. From what services are offered to what the logo looks like all decisions are the owners to make. Profit Retention- Since the owners efforts alone are responsible for the amount of profit generated, they keep it all. After the employees ( if any ) are paid what is left is the owner’s. Because they have total control, they may reinvest it in the company or they make take it all out. Location- Since there is no legal paperwork filed with any state agency, moving locations is as simple as driving to another state and setting up shop. That being said if you required state license in the original state, you would need the equivalent in the new location. Convenience/Burden- There are no legal documents that need to be filed with any state agency. Owner and company are indivisible so there is no paper work saying otherwise. At the most you may need to file a Doing Business As (D.B.A. ) with your local tax office to allow you to open a bank in the company’s name. General Partnership: This type of company is usually formed when two or more individuals with different skill sets get together. Each participant brings with them their own experience and skills in order to create a new venture. While the liabilities are not bore alone, the partners are not sheltered from them. Liability- While they are split in a predetermined percentage, the liabilities of a General partnership are unlimited. There is nothing that is off the table including your personal assets. Income Tax- There is no real tax shelter provided at this level. Income that is generated is â€Å"passed through† to the partners. They will pay taxes at the individual level. There are however, various tax forms that need to be filled out. Longevity- When a partner dies the partnership ceases to exist. The partners may not pass on the original partnership agreement to their heirs. There may be a buy/sell clause in the articles of partnership. Control- Complete control is given up to a vote of the general partners. If there is no consensus made, the articles of partnership should dictate how the disagreement is handled. Profit Retention- After the business debts are paid, the partners split the net profit. The articles of partnership will usually dictate the percentages, and if no mention is made it is assumed it is split evenly. Location- The fact that a partnership is not it’s own legal entity makes it relatively easy to move. If there is a market in a new location there is very little that prohibits moving. Convenience/Burden- While no state/federal documents are required, you will need an â€Å"Articles of Partnership† drawn up. This will act as the bylaws/charter for decisions and operations moving forward. There are a few tax forms that need to be completed by the partners at the appropriate time. Limited Partnership: This type of business is used more as an investment vehicle than a job or career. It allows an investment to be made and fostered from a distance. If you are the limited partner though, you may not have a hand in the day-to-day activities or management. Liability- As a limited partner your investment is your only liability. That being said your stake in the partnership is an asset that personal creditors may come after. Tax- As a limited partner your revenue from the company is federally taxed at the personal level. There are various situations to avoid taxation as a corporation. General partners must pay self employment tax. Longevity-A limited partnership is sometimes used as an estate planning tool. Therefore the continuity from generation to generation is very customizable. The limited partner may die and this will have very little impact on the business. Control- As a limited partner you have no say in the management or daily activities of the business. You may not bind the partnership to anything as a limited Partner. A general partner runs the daily operations and makes the management decisions. Profit Retention- If you are a limited partner you are entitled to the agreed upon amount of profit only after the general partner is paid. As a limited partner you have very little influence over the amount of profit generated. Location- Limited partnerships can change locations but it is inconvenient and could be considerably more expensive. Some states mandate the filing of tax forms for limited partnerships, not to mention some states have state income taxes. Convenience/ Burden- Articles of Partnership are needed. There are some states witch require registering limited partnerships, and strict attention should be paid to the activities witch the IRS considers â€Å"corporate.† C Corporations: C Corporations are a legal entity unto themselves. They shield the share holders, board members, and employees from liabilities. They have the ability to raise capital by selling portions of the company, and huge tax loopholes to shelter revenue. With all the loopholes however are huge tax burdens, often over 30% of the net. Liability- A corporation is a legal â€Å"being†. It can be sued, or bring legal action against someone. Therefore it provides a large umbrella for its owners and employee’s alike. When malfeasance occurs it will absorb the effects. Income Tax- Being it’s own legal entity is not cheap. The state that the business is located in could very well impose taxes, as well as the federal corporate tax rate witch is the highest in the world. Couple this with the fact that the employees that work there are then taxed again at the individual level, and you see how quickly things add up. Longevity- Corporations have the potential to last forever. Due to the fact that authority is so decentralized, one person getting ill or leaving the company is no more than a bump in the road. You could pass on your shares or stake in a company through proper estate planning. Control- If you were to incorporate your business it could be set up so that your family always had a seat on the board or always had voting rights at a shareholders meetings. However, especially in a public company, you must act in the best interest of the shareholders. No one person runs a corporation alone, there are shareholders, and usually board members. Authority being so decentralized makes complete autonomy very rare. Profit Retention- As there are many owners there are also many hands in the pot. The fact is that each shareholder is entitled to a portion of the company’s profit in direct relation to how much of the company they own. In closely held corporations this could be 3-4 individuals, but in a multi-national company this could be millions of people. Location- The federal government does not create any corporations. This is done at the state level. For a corporation to go from one state to another they would have to file as a foreign corporation. This can get expensive and legally â€Å"sticky† when deal with different state laws and agencies. Convenience/Burden- To incorporate a business is relatively easy. The challenge and burden comes in keeping it running and staying on the proper side of legal. It must file it’s own tax returns, contend with state and local laws, maintain the strictest accounting practices, conduct annual shareholders meetings, all while turning a profit for its shareholders. No small task. S Corporations- S Corporations are a legal entity. They offer a legal umbrella to their employees and owners as well. They have the ability to raise capital by selling off small pieces of themselves as stock. The S corporation has to follow the same strict accounting and reporting procedures as corporations, however their income is not taxed the same. Liability- An S corporation is a legal â€Å"being†. Therefore it provides a large umbrella of protection for its owners and employee’s alike. When malfeasance occurs it will absorb the effects. Income Tax- An S corporation is a specialized tax situation. It has most of the reporting and recording requirements of a C corp. but allows for the â€Å"pass through† of revenue to the individuals. The company The S corp. designation is however for federal purpose’s only, the state the company is in will certainly have it’s own laws. Longevity- S Corporations have the potential to last forever. Due to the fact that authority is so decentralized, one person getting ill or leaving the company is no more than a bump in the road. You could pass on your shares or stake in a company through proper estate planning. You could also have a seat on the board reserved for your family/heirs. Control- The fact is when a S Corporation is formed the corporation has to do what is best for itself. A lot like an autonomous person, it must continue to look out for its own survival. Normally one person does not dictate the course of a Corporation, there are several in charge of this. Profit Retention- Since there is no one individual at the pinnacle the profits are distributed through out. If there is a board of directors, share holders, stock owners, all of these individuals are entitled to a portion of the profits. Location- The federal government does not create any corporations. This is done at the state level. For a corporation to go from one state to another they would have to file as a foreign corporation. This can get expensive and legally â€Å"sticky† when deal with different state laws and agencies. Couple this with the fact that states deal with S corporations wildly different, from treating them like the federal government to not recognizing them at all. Convenience/Burden- To incorporate a business is relatively easy, although the fee’s can add up. S corporations must avoid several pitfalls so as they are not taxed like C corp.’s. This and the fact that the accounting is so stringent, they may not have over 100 share holders that meet once a year, and the laws so wildly differ from state to state make the burden factor high indeed. Limited Liability Company- With the protection of a corporation and the flexibility of a Sole Proprietorship, the LLC has become extremely popular since it’s recent creation. However they are not a vehicle for taking a company public, capital can be difficult to raise because the members will have to guarantee the loans, and the members must take care not to intermingle funds. Liability- The LLC, like a corporation, is it’s own legal â€Å"being†. It provides an umbrella for it’s members to operate under and not fear liability claims against themselves personally. Income Tax- LLC’s are in the unique position of deciding how they want to be taxed on a yearly basis. Most of the time LLC’s can function like other forms of small business. The income will pass through to the members who will then pay at the individual level. It does however have the option of paying at the corporate level so as to lower the tax bracket. (This is because the highest individual tax rate is higher than the corporate tax rate.) Longevity- If a member of an LLC dies or retires action will be determined by the operating agreement. This could include a buy/sell clause for the heirs, a transfer of ownership, or whatever state law dictates. In most cases Control- The fact that an LLC could be run by just one person means that he /she could have just as much control as a sole proprietor. The catch is with the finance’s. The finance’s must be maintained â€Å" at arms length† to maintain the corporate veil of protection. So long as this is done, the majority member/owner of the LLC has complete control. Profit Retention- The profits generated by the business flow to the members. The amount is in direct correlation with the amount of ownership each member holds. Location- All 50 states allow LLC’s now but the law varies wildly. Some states still want an ad run in the paper when a business is formed and others require a single 1 page form. To move from state to state can be done but the local laws might be prohibitive. Convenience/Burden- The LLC doesn’t require anywhere near the amount of accounting as a corporation. The articles of organization needs to be filed to create it and then the operating agreement dictates how it’s run.

Positive N Negative Western Influence Essay

Her strength. For most of the Indian public perception, western culture is just a set of western clothes, discos, parties and other things that are ‘hostile to morality’, but in reality western culture totally embodies another realm as opposed to the popular view. One shouldn’t say it straightaway that bikinis, jeans, pornography is all that western culture offers us before having, at least, a brief study about the western culture that it rightfully deserves with dignity. Actually western culture is based on rationality and respect for the human life. Even Indian culture has its evils. Did anyone even mentioned discrimination on caste while mention ‘greatness of Indian culture’? Isn’t that an inherent problem of Indian Culture? And let us remind that such evils were prevalent in the society in the past in the forms of brutal rituals like sati, child marriage etc that were later abolished by the British. The latter is a clear example of esteem that western society gives to the human life, something that is clearly evident in the statistics of life expectancy in some western countries. Although western culture also has its demerits but it doesn’t makes sense just to make mockery of it saying ‘its polluting our culture’. Culture is certainly not decaying. In India we call adoption of western culture as decay of our own culture. But whatever we are adopting is totally for the convenience of the work we do. Lets take example of women police, she has to be active and fast in her work. Hence shirt-pant is the best uniform which will prove convenient for her. Thus, culture can be best defined as running water i.e. to adopt newer changes and continue its flow. If culture sticks to its place like stagnant water, its obvious that people will run away from the decaying and offensive smelling pond. Thus, our culture is on a right path and its modernization should not be taken as its decay. Culture means way of living, way of loving, way of treating, way of dressing, way of receiving, way of sharing, way of respect towards human values. According to modern life style women are equal as men. Girls kids are considered as the boons. Gandhiji has rightly said that, † keep the doors and windows of your house open to allow the breeze to enter freely but take care that you will not fly away to that wind†. According to the great philosopher ALBERT TOYNBEAN â€Å"IF THE WORLD CIVILIZATION WOULD HAVE TO EXIST THEY WILL HAVE TO LOOK LIKE THE INDIAN WAY†. GOOD EFFECTS are that it has abolished inequality, sati system, dowry system, caste system etc from our society. It has introduced euality in the society because of which nobody is treated as inferior and superior.it has introduced democracy,integrity etc in our society. BAD EFFECTS are that it has changed our dressing style, our food habits and also our young generation no longer respect their elders.It has introduced corruption in our society and many other bad things that haS destroyed our culture. Casteism, dowry, sati system which was predominant in our society since historic times have now been removed upto great extent from modern day society due to influence of western culture. But neither of the things mentioned above was part of our culture. It was the wrong interpretation of our religious texts which paved for these evils. So, the culture which we were violating since historic times we became aware off due to influence of other culture.