Comets Essay -- Astronomy Essays Space Outer

Comets   Ã‚  Ã‚  Ã‚  Ã‚  Have you ever looked up in the sky and seen a little ball creeping by? If so, did you wonder what it was? That little ball is called a comet. Comets are small, fragile, and irregularly shaped. Most are composed of frozen gas. However, some are composed of frozen gas and non-volatile grains. They usually follow very strict paths around the sun. Comets become most visible when they cross the sun. This also applies to people who view comets with telescopes. When a comet gets near the sun it becomes very visible because the sun's radiation starts to sublime its volatile gases, which, in turn, blow away small bits of the little solid material the comet has.   Ã‚  Ã‚  Ã‚  Ã‚  Another feature of a comet is a long tail. This is caused by materials breaking off and expanding. They expand into an enormous escaping atmosphere called the coma. This becomes at least the size of our planet. With the comet going so fast, these materials are forced behind the comet, forming a long tail of dust and gas.   Ã‚  Ã‚  Ã‚  Ã‚  Comets are cold bodies. We see them only because the gases they are composed of glow in the sunlight. All comets are regular family members of the solar system family. They are bound by gravity to a strict path around the solar system. Scientists believe that all comets were formed of material, originally in the outer part of the solar system, which did not become incorporated into planets. This material is from when the planets just started forming. This makes comets an extremely interesting topic to scientists who are studying the history of the solar system.   Ã‚  Ã‚  Ã‚  Ã‚  In comparison to planets, comets are very small. They can be anywhere from 750 meters (or less) to 20 kilometers in diameter. However, lately, scientists have been finding proof that there are comets 300 kilometers in diameter or greater.   Ã‚  Ã‚  Ã‚  Ã‚  Comets are still compared to the planets, though. Planets usually follow the shape of a sphere. Most planets are fat at the equator. Comets come in all different shapes and sizes. Most evidence that science has revealed says that comets are extremely fragile. A comet is so poorly structured that it is like a loose snowball--it can be pulled apart with one's own bare hands.   Ã‚  Ã‚  Ã‚  Ã‚  Comets have very awkward rotation periods. They are very oblong. When comets reach their aphelion they are usually near Jupiter or even sometimes Ne... ... is expected to reach its closed point to the sun. At this time it will also be most visible because the sun reflects off the tail of the comet.   Ã‚  Ã‚  Ã‚  Ã‚  It will come .914 astronomical units from the sun. This is not all that close to the sun considering the fact that some comets have run into the sun and others have skimmed the surface of it.   Ã‚  Ã‚  Ã‚  Ã‚  Although the comet will be closest to the sun on April 1, it will be closest to the earth on March 23, 1997. Some people have been saying that the comet will hit earth and cause human extinction, just like the dinosaurs. The fact is, however, THE COMET WILL NOT HIT EARTH. The closest it will come is 120 million miles away from the earth.   Ã‚  Ã‚  Ã‚  Ã‚  Some people are saying that the comet is going to Be huge, and others say it will be small. We will never know though because we can not see the nucleus of a comet. The part of the comet we see is the tail. The tail of a comet can be over 10,000 kilometers long.   Ã‚  Ã‚  Ã‚  Ã‚  In all, comets, the history of comets, and comets waiting to be discovered is very interesting. I think that one day we will get to see the nucleus of a comet, and be able to watch comets form in the Oort Cloud.

Thomas Jefferson report card

The Barbara Pirates are a great example as to how Jefferson dealt with problems with foreign people. The pirates would take crew members from ships and demand payment on behalf of America, after making the decision to put an end to the payments to the pirates Jefferson sent a naval to punish them; although semi contradicting his devotion to peace and economy. Later on after in 181 5 Stephen Decatur was sent to the Mediterranean to where a treaty renouncing both raids and tribute were signed.Although It wasn't something totally eliminating the racketeers from being wicked it still was a success on behalf of Jefferson; he was able to lead the world toward a path of free seas and peace for all nations. Jefferson so far was able to fulfill his promises to keep peace and friendship with other nations. The relations between the new United States and European nations were pleasant and the Barbara Pirates had compelled admiration for the American flag. Intense admiration should be given to J efferson for he was able to handle the impressments of American seaman In an appropriate manner.He was able to keep calm and not go to war with Britain even though there was a vast amount of anger In the United States towards the situation. Instead of going Into something more drastic such as war, Jefferson simply demanded the British to stay out of the U. G's waters and for an apology. Lastly In relation to foreign relations, In 1803 war between France and Britain was renewed. As a war tactic each nation attempted to affect their opponent's trade using neutral nations such as the United States.Jefferson saw this and In an attempt to keep peace between the United States and other nations, there was the Embargo Act which cut off the United States trade In hopes of getting Britain and Napoleon Into terms. (Embargo Act of 1802) Jefferson was unsuccessful when It came to the Embargo act; neither the French nor Britain needed the American trade as much as American trade needed them there fore not making a difference when It came to scaring the nations. What this would have done Instead of scaring Napoleon and Britain out of their conflict was, demolish theAmerican commerce which was what It was trying to protect. Jefferson as a president managed to fulfill a lot of his promises made In his Inaugural address regarding keeping peace and honest friendships with other nations. He was very successful and although he had a failure with the Embargo Act he still attempted to make a change therefore his grade of a B Is accurate due to his successful attempts and failure of the Embargo Act. Thomas Jefferson report card By watermelon United States at peace with nations in Europe during his first term, as wealth and tooth raids and tribute were signed.Although it wasn't something totally eliminating impressments of American seaman in an appropriate manner. He was able to keep calm and not go to war with Britain even though there was a vast amount of anger in the United States t owards the situation. Instead of going into something more waters and for an apology. Lastly in relation to foreign relations, in 1803 war Jefferson saw this and in an attempt to keep peace between the United States and other nations, there was the Embargo Act which cut off the United States trade in popes of getting Britain and Napoleon into terms. Embargo Act of 1802).

Balanced Scorecard for Hospital Performance Productivity - Free Essay Example

Sample details Pages: 15 Words: 4432 Downloads: 3 Date added: 2017/09/20 Category Management Essay Type Argumentative essay Tags: Hospital Essay Did you like this example? The Balanced Scorecard for Hospital Performance and Productivity ABSTRACT The purpose of this paper is to provide an overview of the usefulness of the Balanced Scorecard in improving a hospitals management and delivery of health care at reduced cost without loss of quality. This paper describes an approach to designing and implementing a balanced scorecard system for measuring performance and productivity in a hospital setting. Specific measures of performance criteria are suggested as well as interpreted. Guidelines for measuring productivity are also suggested and interpreted. How these measures may be used by a hospital to improve its administration of health care while reducing costs and maintaining quality are described. This paper is a useful resource for hospital managers looking to improve their performance and productivity. The balanced scorecard is a management tool that is widely used in the manufacturing industry. This paper fulfills a need by healthcare provid ers to obtain information on implementing a balanced scorecard system that specifically addresses issues unique to hospitals. This paper also addresses how to measure productivity within a balanced scorecard system. Keywords:Hospital Performance, Balanced Scorecard, Hospital Productivity 1. INTRODUCTION Performance measurement and productivity in health care are important issues to individuals and at a national level. Medical costs continue to rise and consume an increasing proportion of GNP worldwide. Cost pressures are producing dramatic changes in the health care environment. The government continues to search for ways to control spiraling costs, principally through caps on reimbursement rates, and at the same time the public seeks coverage for more services. Competition among health care providers is intense as alternative delivery systems grow and compete with public health facilities forcing all health care organizations to lower their costs, downsize, or close facilitie s (Gumbus et al. 2003). Increasingly health care providers are cutting services to, or refusing to treat, Medicare and Medicaid patients because of inadequate reimbursement rates. One result of cost pressures faced by individuals, employers, insurance companies, and the government is to shift health care provider performance priorities in several areas. Previously, a primary objective of health care provider organizations was to attract more patients (a revenue focused strategy). Now, they are concerned with reducing costs to meet patient demand. In the past, hospitals wanted simply to attract leading doctors trained in the latest procedures and technologies (a high-cost strategy). Now, the emphasis is on improved service quality to meet the demands of payers and regulators. Historically, hospitals wished to bill more care to more patients (another revenue enhancing strategy). Now, they seek to balance cost versus patient outcomes resulting in shorter stays, less expensive tre atments, and fewer tests. Traditionally, hospitals allowed doctors free reign in treatment plans, which increased demand for hospital services (and costs). Now, hospitals seek to attract patients from managed-care plans and balance the goal of maintaining physician loyalty with limits (i. e. , lower costs) on the use of the latest, and more expensive, medical technologies. Finally, hospitals encouraged only limited innovation in delivery of core services and administration. Now, high rates of innovation in both areas are necessary to achieve cost effective and efficient health care. Key to achieving cost controls in health care is adopting new approaches to performance and performance measurement (Adler et al. 2003). Hospitals have been slow to develop and implement formal performance and productivity measurement systems (Voelker et al. 2001). The primary problems that have inhibited hospitals from making greater progress in this area are culture, organization, and managerial pra ctices that are inconsistent with competitive business, including operating practices that are not cost driven. Some specific reasons why hospitals have not been active in this area include the following: many hospital boards are composed of members lacking experience in competitive environments, lack of employee participation, particularly among doctors, and because many individuals regard hospital services as intangible and impossible to measure. Medical staff relations and quality of care are important attributes of hospital performance that can be difficult to measure, interpret, and compare with other health care organizations (Zelman et al. 2003). The balanced scorecard (BSC) is fundamentally a customized performance measurement system that looks beyond traditional financial measures and is based on organization strategy. This paper discusses fundamental concepts in developing performance metrics, provides an overview of issues in developing balanced scorecard measures, and gives numerous illustrations of performance measures. As shown later, the BSC is an active area of research within the medical community. However, previous research does not report on the fundamental linkages between hospital inputs, outputs, and the creation of performance metrics. In addition, these articles provide few specific examples of balanced scorecard measures and illustrations of how the balanced scorecard translates action into improved performance. 2. PERFORMANCE MEASUREMENT AND THE BALANCED SCORECARD IN HEALTHCARE Emphasis on financial measures of performance in response to cost pressures may be a dangerous impediment to creating future economic value (Weber 2001). Hospitals can benefit by using a balanced scorecard (BSC) to measure performance and productivity. The BSC consists of an integrated set of performance measures that are derived from the hospitals management strategy. The BSC is designed to translate managements strategy into performance measures t hat employees can understand and implement. Using a balanced scorecard can provide a hospital with the following benefits: * It aligns the hospital around a more patient-focused strategy, * It facilitates, monitors, and assesses the implementation of the overall strategy, * It provides a communication and collaboration mechanism, It assigns accountability for performance at all levels of the hospital, and * It provides continual feedback on the strategy and promotes adjustments to changing market and regulatory factors. The BSC was originally developed by Kaplan and Norton (1992; 1993) from the notion that reliance on financial measures of performance alone is insufficient for managing complex organizations, especially as those organizations become more customer focused and want to benefit from their knowledge-based human capital. The BSC has evolved into a strategic management system that uses a framework and core principles to translate an organizations mission and strategy int o a comprehensive set of performance measures (Kaplan 1996). Kaplan and Norton suggest measuring an organizations performance around four perspectives: (1) financial, (2) customer, (3) internal processes, and (4) learning and growth. This framework provides a balance between short- and long-term objectives, financial and non-financial measures, and external and internal performance indicators. The scorecard also balances the results the organization wants to achieve (typically the financial and customer perspectives) with the drivers of those results (typically the internal processes and the learning and growth perspectives) (Inamdar and Kaplan 2002). Zelman et al. (2003) establish the relevance of the balanced scorecard to health care, but with modifications to recognize unique characteristics of the industry and organizational characteristics. Numerous articles exist concerning the balanced scorecard and healthcare. One area of research on this topic is concerned with the in ternal process of developing the balanced scorecard in a generic sense (see Voelker et al. 2001; Pink et al. 2001; Inamdar and Kaplan 2002; Sioncke 2005). Another group is concerned with developing measures at specific organizations or within defined patient populations (see Kershaw and Kershaw 2001; Gumbus et al. 2002; Gumbus et al. 2003; Sugarman and Watkins 2004; Woodward et al. 2004; Wells and Weiner 2005). Fundamentally, measuring performance gives health care providers more control over their services. Performance measures are designed to answer the following questions; * Are the service objectives appropriate? * Are the services meeting their objectives? * Are the services meeting the desired standards in terms of quality, effectiveness, access, and efficiency? Measures are based on inputs (e. g. , staff, services, supplies, equipment, facilities), outputs (services rendered, e. g. , acute and elective services, professional advice, training), and outcomes (results of inpu ts and outputs, e. g. , health status, disability, continuing care). Examples of hospital services, outputs, and outcomes are shown in Table I. Efficiency measures are ratios of inputs to outputs and it relates to achievement of specific objectives. The effectiveness of a department is a measure of how well the outcomes are achieving desired outcomes. The cost effectiveness of a service is the resources required to achieve the outcome, for example the total cost of achieving mobility and/or pain relief. Table I: Examples of Hospital Services, Outputs, and Outcomes Service Output Outcome Obstetrics Live birth Healthy child and mother Pathology Diagnostic test results Correct diagnosis, effective treatment Engineering Preventive maintenance Decreased machine downtime, reduced operating costs Financial services Financial reports Effective financial management Faced with increasing cost pressures, extensive government regulation, high expectations by the public, and increasing criticism health service providers must be able to not only do many things well but communicate their achievements in a clear and concise manner. Hospitals can benefit by applying the BSC approach to answer the following questions about performance: * Has financial performance improved? * Do patients recognize that we are delivering more value? * Have we improved key services and processes so that we can deliver more value to patients? * Are we maintaining our ability to learn and improve? . ESTABLISHING AND INTERPRETING PERFORMANCE CRITERIA There are some simple principles to follow when using a BSC approach to establishing performance indices and monitoring performance in hospitals. First, major health goals for the hospital must be established. Second, these goals will serve as a roadmap for service managers of major segments of the organization to establish related goals and supporting objectives. Third, a series of indicator measures should be developed to assess service delive ry and effectiveness, operational performance, and the organizations response to the environment. All measures of performance/productivity are interpreted in light of the hospitals goals. Table II provides a high-level view of indicator measures, how they should link with hospital goals, objectives, and environmental concerns. Indicators are consistent with the perspectives outlined for application of the balanced scorecard, i. e. , they may be financial, patient focused, operational, and/or learning/growth oriented. Table II: Role of Indicator Measures in a Hospital Relate To Monitored By Timescale Service Goals Departmental Probably Effectiveness managers annually Indicators Service Objectives Departmental/ Monthly or Delivery cost center weekly Indicators managers Operational/ Detailed Cost center Monthly Organizational objectives/ managers Indicators action plans Environmental Assumptions, Corporate and Ad hoc, but Indicators goals, and departmental preferably objectives m anagers annually Following are brief descriptions and examples of performance measures for a public hospital using the perspectives of the BSC. 3. 1. FINANCIAL PERSPECTIVE The financial perspective garners the greatest amount of attention when cost control is paramount. However, it is difficult for most hospital managers to follow direct costs through to the general ledger and then relate them to the activities they manage. Health care organizations need to be able to accumulate this information in a concise and understandable way. Categories of financial measures might include financial health, capital, human resources, and efficiency. Financial Health. Measures such as the percent by which revenues exceed expenses, return on assets, liquidity measures (e. g. , current ratio, working capital ratio) will certainly be used. Capital. In an era of ever expensive medical technology, the percentage of total expenses accounted for by capital equipment is important to monitor. Human Resources. The costs of direct care staff are another important, and rising, health care cost component. Nurses, for example, are in short supply and hospitals regularly bid up the costs for their services. Measures such as nursing care hours as a percentage of total inpatient/outpatient nursing hours indicate the percentage of all inpatient/outpatient nursing hours for staff who are available to carry out the activities that contribute directly to care of in/outpatients. Efficiency. A measure of unit cost performance is the percent by which planned cost per weighted case differs from actual. Hospitals should monitor the cost of administrative services as a percentage of total expenses. Day in inventory is a useful measure of the efficiency of inventory usage. 3. 2. CUSTOMER PERSPECTIVE Patient service must include developing a positive perception of care delivery and an ability by the organization to quickly correct patient service problems (Kershaw and Kershaw 2001; Gumbus e t al. 2003). Several categories of customer/patient measures may be important. These include measures of patient satisfaction, patient involvement, and waiting time. Patient satisfaction. The number of complaints provides an indication of satisfaction. The results should be interpreted in light of the number of patient advocates, how well their presence is publicized, and if a centralized complaints system exists. The pattern of complaints should be monitored. Patient surveys should be conducted. Patient involvement. Indicators for patient involvement in treatment choices includes the number of sources from which treatment information is available, the proportion of treatment services for which protocols exist, and the proportion of consumers offered treatment choices. Monitoring of consumer involvement in the broader decision making process is difficult, with a possible measure being the number of consumers on service development groups. Waiting lists. Waiting lists for servi ces should be monitored separately. If the notional days required to clear either of these waiting lists is high, the percent change in patients on the list should be examined. In addition, the average length of time that patients have to wait for specialists should be surveyed because this may impact on the demand for public hospital services. 3. 3. INTERNAL PROCESSES PERSPECTIVE Hospitals need to identify the internal processes (service development, service delivery, service evaluation) that have the greatest impact on what patients (customers) value. Excellence in these areas is determined by measures that capture time to market, delivery time, cost, and process quality (Kershaw and Kershaw 2001). Ultimately, balanced scorecard measures such as patient satisfaction (from surveys), retention, and safety, establishment of minimally invasive surgery programs, accreditation, and patient referral rates will determine the outcome of internal process initiatives. Patient flow (timely discharge of patients) suggests another important area to measure. Following are some areas of concern for internal processes that may lead to well-functioning processes. Staffing. The ratio of staff to the area population and the staff workload should be monitored in aggregate and for specific work groups such as medical practitioners and nurses. An indication of the hospitals commitment to equal employment opportunity (EEO) could be gauged by examining the workforce by ethnicity and gender mix. Efficiency. If the average cost per inpatient or outpatient case by treatment is high, then the key determinants of cost, namely average length-of-stay and staff costs should be examined. Staff costs should be analyzed to identify whether costs are high because of the base cost of staff, the workload per staff member, or because of high overtime costs. Additionally, utilization rates such as occupancy rates, throughput rates, and outpatient clinic time utilized should be examined in assessing how efficiently services are provided. Facility utilization. The overall proportion of specialized treatment facilities or equipment time allocated to a medical service should be monitored as well as this time in relation to specialty treatment beds and patient population in the hospital. It is also important to analyze how facilities or equipment time is used. Equity of access. The balance between use of inpatient, outpatient, and community services should be monitored as well as the balance between provision of services in the public and private facilities. Other factors affecting access that should be monitored include staffing levels, average travel time, and the availability of facilities to accommodate families. Activity rates should be monitored in aggregate and by age, sex, ethnicity, and domicile. Mortality rates. Overall mortality rates for procedures should be examined and related back to the morbidity rates included in equity of access. 3. 4. Learning and Growth Perspective Measures from the learning and growth perspective attempt to identify the skills and tools needed to improve important internal processes. Key areas of concern include the skill levels of employees, availability of training, and employee satisfaction. Patient loads and training hours per caregiver are important BSC measures. Other concerns and measures in this area include. 4. CONTINUING PROFESSIONAL EDUCATION, TRAINING, AND EMPLOYEE SATISFACTION. Most medical practitioners are subject to continuing professional education requirements. Measures that encourage employees to remain current in their fields and enhance their credentials should be part of a balanced scorecard system. In addition, learning and growth measures should be present to encourage innovation in delivering medical services. Examples of measures include budgets and expenditures to support cutting edge procedures, number of experimental treatments attempted, and the number of test projects fund ed to improve service delivery. A service department must establish its own performance standards. It is not particularly helpful to monitor the activity levels, incident rates, etc. if there is no standard or budget for comparison. For example, expected throughput for surgical services should be specified on a month-by-month basis, and a standard should be set for post-operative infection rates (it may be appropriate to set a target level together with an acceptable or minimum standard). The deviation from these standards is the key management information that should be monitored. Comparative information should be used carefully. In addition to measuring the difference in actual performance from planned, it is often useful to compare current performance with historical and similar departments in other organizations. When comparing performance with outside departments or standards, differences in objectives and standards, measurement practices, information systems, environment al factors, and resource constraints should be considered. Careful study and comparisons of other organizations criteria and standards should be undertaken (e. . , admission rates, length of stay, environmental standards). Despite these difficulties, there are many examples where careful use of simple comparative information has helped improve the quality and productivity of service delivery. 5. PRODUCTIVITY: A PARTICULARLY USEFUL TYPE OF OPERATIONAL AND ORGANIZATIONAL MEASURE Increasingly, techniques borrowed from production organizations are being utilized to measure productivity and performance and to balance staff resources for greater flexibility in meeting patient demand. Productivity measures are very useful in hospitals if they are constructed with a clear purpose in mind and have the support of employees. Productivity measures are used for two purposes. First, they report information not previously known by asking the questions; * Is an activity on schedule? * What is th e cost of an activity or service? * How productive is a department? Second, they are used to control activities that need to be monitored or limited in some fashion. To be successful, productivity measures must affect employee behavior through a change in the relationship between performance nd rewards and generate commitment by employees to productivity improvement. Hospital department staffs are being asked to do more with less. Where hospital departments historically staffed according to peak loads, they now staff to meet the average load. This demands much greater flexibility in staffing, the greatest productivity challenge to hospitals because of the tremendous fluctuations in demand for hospital services. However, staffing flexibility impacts on service quality in periods when staffing is low and service demand is high. As a result, efforts to improve productivity need to be balanced with quality of care, effectiveness, and social equity. Productivity is easier to measure t han these other factors so there is a tendency to focus on productivity measures to the detriment of other important factors in health care, although improvements in productivity may help improve throughput, accessibility to services, and quality of services. A few simple guidelines are useful for building and sustaining a good productivity measurement system. The measures should be developed participatively. A participative approach lessens resistance to measurement and has motivational benefits. The measures should reflect where the hospital wants to be. If the strategic direction changes, then so should the measures. Productivity is a long-term process. Patience is required concerning expected results. Regarding the specific measures used, choose a mix of individual and group performance measures. Clearly, the performance of a hospital depends on a combination of individual and team efforts. Clinical employees often view their work as a set of technical activities that they perform independently. They fail to connect their work to that of individuals and departments preceding and following them. Develop measures that consider the customers point of view. Frequently productivity measures neglect to consider that a hospital exits to satisfy patient needs. Develop a family of measures for each department that encompasses productivity, performance, quality, and other relevant measures. Rarely does a single measure adequately describe performance. Broad indices such as nursing hours paid per admission are unlikely to be helpful in identifying the factors behind the performance index or helping managers decide what action needs to be taken. Specific measures may be developed by analyzing the chain of factors between the initial decision to treat a patient and the actual expenses incurred. By looking at each link in the chain, it is possible to identify the factors that generate nursing costs. It is also possible to consider the interrelationship between these measures. For example, a relatively high index for admissions/population may be linked with low average patient activity. 6. COMMUNICATING PERFORMANCE INFORMATION Performance should be communicated to three groups; * Staff * Management * External groups contributing to your objectives. Health managers can only change service delivery through changing the behavior of their staff employees. Therefore, it is necessary to communicate performance information that is credible and meaningful to those personnel. A brief outline of a process for constructing performance measures, feeding back the information, and facilitating staff involvement in performance and productivity improvement may include; * Identifying the key issues relating to both quality and productivity, * Developing a few selected indicators that are useful for that particular work setting, * Establishing the monitoring system and baseline standards/targets, * Facilitating employee involvement in interpreting inf ormation, solving problems, and changing behavior, and * Rewarding performance. This degree of participation may not be appropriate to all units but it is imperative that this process start top-down to demonstrate managements commitment and ensure consistency in application. Regardless of the degree of staff participation, the performance indices must be credible, the performance information must be communicated simply and frequently, and the information must be used for action to identify and solve problems, encourage improvements, and reward good behavior. Traditionally, management reporting has been on the basis of inputs, primarily deviations from budget (e. g. , bed and staff numbers), outputs and activity levels (e. g. , numbers of admissions, operations, tests conducted, inspections, etc. ), and progress in implementing plans. Communication with external groups requires information that is simple and credible. The objective of the communication should be very clear. If behavioral change is desired, then the communication will need to be reinforced with discussions and develop mutually acceptable action plans. . LEVELS OF MONITORING AND REPORTING Individuals throughout the organization will be interested in different performance levels of throughput. For example, the manager of surgical services for a multi-location facility might be concerned with total throughput in each surgical specialty (broken into acute and elective), quality as measured by post-operative morbidity, cost as measured by variance from budget, and accessibility as measured by average waiting time. The manager of surgical services at one location might be concerned with far greater detail. Finally, the manager of operating rooms might monitor; * availability of time for elective work (against an agreed upon standard), * availability of workers for acute work (against an agreed upon standard), * quality as measured by anesthetic related complications, * costs broken down into nursing, senior medical, junior medical, technical, etc. , * staff costs associated with scheduled and unscheduled sessions, * costs of OR and anesthetic supplies, * average cost per hour, and * unproductive time due to non-availability of staff. The managers of the surgical departments might also monitor a number of factors relating to their own specialties such as quality as measured by surgical related complications, use of allocated time, unproductive time due to non-availability of surgeons, delays in access to operating rooms for acute operations, and surgeon productivity. 8. CONCLUSION Concern by hospital management for performance and productivity measurement has grown in proportion to cutbacks in government funding for health services, pressure from businesses and insurance companies, and public concerns about the rising costs of health care. These factors have produced heightened competition in the health services industry. Many hospitals are responding by adopting t he performance/productivity measurement techniques more commonly found in manufacturing businesses, such as the balanced scorecard. Although scorecards may appear as a fad in the healthcare field, they have in fact earned a permanent place in strategic planning (Pieper 2005). A successful performance/productivity measurement system should follow a few important principles and take account of the unique characteristics of health care. Application of these measurement methods along with some creativity, initiative, and cooperation among hospital employees, customers, and consumers can improve the management and delivery of health care at reduced cost and without loss of quality. REFERENCES Adler, P. S. , P. Riley, S. Kwon, J. Signer, B. Lee R. Satrasala (2003). Performance improvement capability: Keys to accelerating performance improvement in hospitals. California Management Review 45(2), 12-33. Cleverly, W. O. Cleverly (2005). Scorecards and dashboards using financial metrics t o improve performance. Healthcare Financial Management 59(7), 64-69. Gumbus, A. , B. Lyons D. E. Bellhouse (2002). Journey to destination 2005: How Bridgeport Hospital is using the balanced scorecard to map its course. Strategic Finance 84(2), 46-50. Gumbus, W. , D. E. Bellhouse B. Lyons (2003). A three-year journey to organizational and financial health using the balanced scorecard: A case study at a Yale New Haven health system hospital. Journal of Business Economic Studies 9(2), 54-64. Inamdar, N. Kaplan, R. S. (1992) Applying the balanced scorecard in healthcare provider organizations. Journal of Healthcare Management 47(3), 179-195. Kaplan, R. S. D. P. Norton (1992). The balanced scorecard: Measures that drive performance. Harvard Business Review 70(1), 71-79. Kaplan, R. S. D. P. Norton. (1993). Putting the balanced scorecard to work. Harvard Business Review 71(5), 134-140. Kaplan, R. S. D. P. Norton. (1996). Using the balanced scorecard as a strategic management s ystem. Harvard Business Review 74(1), 75-86. Kershaw, R. S. Kershaw (2001). Developing a balanced scorecard to implement strategy at St. Elsewhere hospital. Management Accounting Quarterly 2(2), 28-35. Pieper, S. (2005). Reading the right signals: How to strategically manage with scorecards. Healthcare Executive 20(3), 8-14. Pink, G. H. , I. McKillop, E. G. Schraa, C. Preyra, C. Montgomery G. R. Baker (2001). Creating a balanced scorecard for a hospital system. Journal of Health Care Finance 27(3), 1-20. Sioncke, G. (2005). Implementation of a balanced scorecard in a care home for the elderly: Useful or not? Total Quality Management 16(8-9), 1023-1029. Sugarman, P. A. and J. Watkins (2004). Balancing the scorecard: Key performance indicators in a complex healthcare setting. Clinician in Management 12, 129-132. Voelker, K. , R. Rakich G. French (2001). The balanced scorecard in healthcare organizations: A performance measurement and strategic planning methodology. Hospital T opics 79(3), 13-24. Weber, D. O. (2001). A better gauge of corporate performance. Health Forum Journal May/June, 20-24. Wells, R. B. Weiner (2005). Using the balanced scorecard to characterize benefits of integration in the safety net. Health Services Management Research 18, 109-123. Woodward, G. , D. Manuel V. Goel (2004). Developing a balanced scorecard for public health. ICES (Institute for Clinical Evaluation Sciences), Toronto. Zelman, W. N. , G. H. Pink C. B. Matthias (2003). Use of the balanced scorecard in health care. Journal of Health Care Finance 29(4), 1-16. Don’t waste time! Our writers will create an original "Balanced Scorecard for Hospital Performance Productivity" essay for you Create order

Homosexual Culture in America and China - 992 Words

Homosexuality is considered as sub-culture in modem society. However, nowadays, it is freely discussed and widely analyzed among the world. The sharply increasing amount of homosexuals and the heated argument raised by people has drawn more and more eyes. This paper is centered on homosexual culture especially in America and China. General concepts on homosexual Homosexual used to be the abominable crime not to be mentioned. in America. After the word â€Å"gay† emerged for years, a vast majority of American start to change their attitude. Now they retain a deep loathing toward homosexuals, but there is a growing mixture of tolerance, empathy or apathy. While the situation in China is almost the same. Subjected to conservative traditional†¦show more content†¦The number of homosexuals in the United States is about 100 million concentrating densely in metropolitan area. On June 28, San Francisco will hold an annual gay parade, attracting homosexuals around the world. Therefore, considering the gay community as a significant voter base, politicians have to deal cautiously with the issue of homosexuality. Actually it is supportive and helpful for the gay rights movement. In contrast, on this certain aspect, China still has a long way to go. It also reflects the Chinese citizens’ immaturity of the Awareness of rights protection Hot issues about homosexual culture Homosexuality is a unique cultural behavior, which is not widely accepted by the community and alienated from the mainstream culture. People who are against it require the legal prohibition, and who support it request for setting laws to recognize its legitimacy. Thus, would homosexuality be given legal protection has become the focus. America and China are no exception. In 1993, Hawaii first put forward the legal possibility of same-sex marriage, but was rejected. Since then, the U.S. 30 states and the federal government have passed legislation to ban recognition of same-sex marriage. March 16, a law allowing gay’s marriage passed by House of Representatives in Vermont with 76 votes to 69 votes. After the vote, they criedShow MoreRelatedGender, Gender And Sex Matters904 Words   |  4 Pagesmarriage in China, and although it does not touch the law, but it will cause a lot of problems in everyday life, it even leads you to death sadly. Five years ago, homosexual people in China were really active, they wants to get their right to happiness in China too, just like here in America and those countries support gay marriage. They start all kinds of activities, they want something like homophile movement (Allen, 2011, p123), which happened in the 1950s, middle- class homosexuals formed groupsRead MoreHa Jin – The Bridegroom Essay1161 Words à ‚  |  5 PagesHa Jin – The Bridegroom Described as utopian in nature, the Chinese culture is often in pursuit for the perfect individual, a harmonious and structured society where the citizens as a whole create the ideal culture. In a collection of short stories entitled The Bridegroom, author Ha Jin documents this aspect of reality in homeland China. Primarily for the purposes of instruction and satirical verse, Ha Jin, shows how people are trying to find themselves in a society that focuses on the ‘whole’Read MoreHuman Behavior Is More Influenced By Things Outside Of Us Than Inside929 Words   |  4 Pagesspace. Western cultures and eastern cultures have a different perception of personal space. Personal space in America is large while compared to the Chinese culture. Due to the difference in levels of personal space, there is also a difference in the level of discomfort between western and eastern cultures. One of the important reasons for the difference in personal space between the different cultures may have been due to their environment. With a population of 1.3 billion, China has a small livingRead MoreQueer Musicology Means Gender And Sexuality1974 Words   |  8 Pagesorientation to persons of the same sex. Homosexuality is not usually talked in public, especially in China. American is quite open, while China is more conservative. Homosexual literature has never been accepted by the mainstream society. Homosexual culture is a sensitive topic to them. When people talk about this subject, most of them choose to be silent. Homosexuality has a history of thousands years in China. However, our country emphasizes men and women to reconcile and fertility. Therefore, gaysRead MoreHow Does The Views Of Lgbtiq Change Over Time Across The Globe?1229 Words   |  5 Pagesit is not a choice but rather a biological and unchangeable feature from birth.[1] The irrational fear of, aversion to, or discrimination against homosexuality or homosexuals is the definition of homophobia according to the Merriam-Webster Dictionary. 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As millions sit gluedRead MoreThe Controversy Of Homosexuality Sparks Controversy1773 Words   |  8 PagesIntroduction: In every corner of the world, the topic of homosexuality sparks controversy from both supporters and opponents of the sexual orientation. Merriam Webster’s dictionary defines a homosexual as â€Å"being sexually attracted to people of the same sex.† The underlying influence from historical, sociological, and health disciplines are just a few reasons such a large gap exists on the spectrum between supporters and opponents of homosexuality. This paper serves as an analysis of the previouslyRead MoreFamily Marriage Dynamics : From Personal Observation1617 Words   |  7 Pageschanging in countries such as United States where people make their own choice on whom to marry. In this paper, I will examine a personal issue I personally observed back in China pertaining to arranged marriage and compare this issue with the current freedom to choose your partner. Personal issue and observation Back in China, I observed a marriage arrangement and courtship process. It was around 2007 when my grandfather decided to make a marriage arrangement for my cousin, Alex Wong (not his realRead MoreNot Protecting the Right of Homosexual Marriage Endangers the Rights of Others1173 Words   |  5 PagesNot Protecting the Right of Homosexual Marriage Endangers the Rights of Others Civil marriage is enjoyed by all people in society; all people that is, excluding the ones that find love in the form of their own gender. These people are being denied the basic right of engaging in legally bound matrimony. Laws, such as this one, have been created time and time again, mostly by ignorant bigots, only to be dissolved when finally seen as immoral and unjust in the eyes of someone without hatred in theirRead MoreThe Iglesia Ni Cristo of the Philippines1193 Words   |  5 Pagesto the formation of the California congregation). The 1970s-1990s were decades of expansion for the Iglesia ni Cristo: establishments were created in North America (US, Canada, Mexico, and Latin America), Europe (England, Germany, Switzerland, Scandinavia, etc.), the Mediterranean (Italy, Israel, Greece, etc.), Africa (Nigeria), and Asia (China, Japan, Thailand, Vietnam, Indonesia, Singapore, and Malaysia). During a recent interview with Joy Villanueva, a member of the Iglesia ni Cristo, she stated

Ratio Analysis The Field Of Management And...

Ratio Analysis What chapter or chapters will I use for my theory? In undertaking this research paper, which will be focusing on the concept of ratio analysis chapter 2 of the book will be used. The chapter focuses on issues to do with financial statement analysis as well as ratio analysis. Hence, the chapter will provide critical information about various concepts associated with ratio analysis, such as profitability ratio, liquidity ratios and other types of ratios. What objectives from course will I be addressing? The main focus of the research will be to explain the concept of ratio analysis and its importance in the field of accounting and management. The research will focus on determining the importance of the various types of ratios, when it comes to the decision making process within a firm. The research will also provide information about how various types of ratios are calculated and interpreted during the financial statement analysis. Therefore, the research will be explaining the role of ratio analysis in the field of management and interpretation of financial reports. What is the research benefit from writing this paper? By writing this research better I will manage to gain a deeper understanding of the concepts of ratio analysis and the way they are beneficial to the organization’s stakeholders, such as investors, employees and management. The study will help me gain deeper understanding of the way in which to interpretShow MoreRelatedAnalysis Of The Textile Industry And Company Analysis1175 Words   |  5 Pages ECONOMY, INDUSTRY AND COMPANY ANALYSIS MUZZAMAL IRFAN MC130202491 VIRTUAL UNIVERSITY OF PAKISTAN 20 November 2014 â€Æ' SCANNED COPY OF JCLâ€Æ' SECTION Iâ€Æ' CHAPTER 1: 1.1. Introduction of the project Mark Andrew Skousen an American Economist states that, â€Å"The reality is that business and investment spending are the true leading indicators of the economy and the stock market. 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Benji by Sun Kil Moon free essay sample

Simplistic but melodic. Tragic but warm. Small-scale stories, grand-scale meta-narratives. These descriptions come to mind when listening to Mark Kozeleks sixth studio LP with Sun Kil Moon, â€Å"Benji.† Folk-rooted, acoustic-driven, and showcasing Kozeleks usual free-styling vocals that give you the impression hes spouting them spontaneously, â€Å"Benji† dares to tackle some of lifes toughest topics, all through the intimate voice that has become Kozeleks niche. To call him a songwriter is an injustice. He is a storyteller. The album has 11 tracks. Each features a tragedy, whether a death in the family, a community-based horror, or a failed relationship. Each song is based on a true story, and is told from Kozeleks perspective. Its as if he is taking a tour of his past, and the people and events that shaped it, and inviting us to join him. In the opening ballad, â€Å"Carissa,† Kozelek relates his struggles to â€Å"find some meaning† in the abrupt and seemingly senseless death of a second cousin he barely knew. We will write a custom essay sample on Benji by Sun Kil Moon or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page â€Å"Carissa was 35, you dont just raise two kids and take out your trash and die,† he sings. In â€Å"Dogs,† he bemoans the predictable and unavoidable demise of an exclusively physical relationship, using examples from his past. â€Å"Pray for Newtown,† a tribute to the victims and families affected by the 2012 Connecticut shooting, describes how we are all greatly impacted by  ­catastrophes, though strangely go on living as though nothing happened. How much you enjoy â€Å"Benji† ultimately comes down to how much you appreciate Kozeleks style and understand where hes coming from. This is not an album meant to stimulate in short bursts – most of the tracks are long and feature similar minimal melodies. The saxophones come out in the closer, â€Å"Bens My Friend,† the albums most upbeat and unpredictable track, but for the most part, â€Å"Benji† has the feel of an album more concerned with its content than with its immediate  ­surroundings. Arguably Sun Kil Moons most intriguing and thought-provoking work to date, â€Å"Benji†s simplistic aesthetic approach and gritty subject matter make for one of the most complete albums this year. F

Teach Your Children Well Essays - Justice, Philosophy Of Law

Teach Your Children Well New California law states that it is up to the prosecutors in a case as to whether minors are charged as adults for violent crimes. What should a judge do when eight boys from suburban middle class families, confess to armed robbery and assault and battery of five Hispanic immigrant farm workers? In this case, one must realize what a delicate situation this has come to be. If tried as adults these eight boys could spend their next sixteen years in juvenile detention. They were described as being 'good boys' with no other marks on their records. With only one reason for committing such a crime, these boys need to face their racism while justice is being served, with non-traditional punishment that will teach an unforgettable lesson. As upper-middle class, above-average students, even some athletes, these boys obviously do not know what life is all about. Authorities said that the boys were specifically looking for Hispanic workers to attack, so that shows the boys had some type of motive. In this day and age where Americans have a need to be treated as equal; equal opportunity employers, equal rights for men, women, African-American, Chinese-American, and every other group of people in this country, one would think that somewhere along the line children would get the message that we are all the same. Children should be taught to love, not hate. It is painful to see such a crime committed just for the mere fact that they were different. Didn't hate crimes end in the sixties? Why is it that still parents cannot or will not instill in their children ideals of an equal human race? Black or white, brown or red, rich or poor, aren't we all the same when you turn out the lights? I am not saying that I think this is ent irely the parents' fault, but they do need to take blame. At the age these boys are at, their parents are some of their few role models, and they always will be, but at this age, parents are the most influential people in a child's life, nothing can come close to a mother's scorn, or a fathers praise. In that sense too, children believe in what their parents believe in, not because it is right, but because it is the only way they know. So, parents should watch when they say they hate someone or some group and we should all try to be better people, for the sake of our children. (Gil Garcetti 588-590) In a crime this violent, considering the assailants and their victims, a measure of justice needs to be served. The assailants need to take responsibility for their actions. However, sixteen years in a juvenile detention facility does not seem the best answer. James Twitchell believes that, In recent years the dispensers of the law are finally realizing that shame has a place in punishment. (602) And so, there needs to be a way of measuring how the boys are rehabilitated, and their community needs to be involved, as well as their parents and friends. Justice means fairness. It means righteousness, impartiality, honesty, and integrity. Justice should be measured by the victims themselves, they should get to see their assailants suffer and learn from their mistakes. That is what justice is all about. These boy assailants need to witness justice first hand in order for it to have any affect ct on them. (Garcetti 588-590) A punishment that can validate such a hiesous crime needs to be quite creative. One could just shout An eye for an eye! As Mark Costanzo concedes, even the often misinterpreted 'eye for an eye' passage in the bible was meant to restrain rather than require vengeance. (592) But that is not how our judicial system works, although it would be fair. Still there are others, like Bradley O'Leary who implies that the punishment?should fit the crime, not the age of the violent offender. As a society, we cannot show any sympathy for, or excuses from, the youth thugs?who are destroying our schools and neighborhoods. (590) These boys will be punished, as they should be, but their judge has an opportunity to change their lives forever. If Teach Your Children Well Essays - Justice, Philosophy Of Law Teach Your Children Well New California law states that it is up to the prosecutors in a case as to whether minors are charged as adults for violent crimes. What should a judge do when eight boys from suburban middle class families, confess to armed robbery and assault and battery of five Hispanic immigrant farm workers? In this case, one must realize what a delicate situation this has come to be. If tried as adults these eight boys could spend their next sixteen years in juvenile detention. They were described as being 'good boys' with no other marks on their records. With only one reason for committing such a crime, these boys need to face their racism while justice is being served, with non-traditional punishment that will teach an unforgettable lesson. As upper-middle class, above-average students, even some athletes, these boys obviously do not know what life is all about. Authorities said that the boys were specifically looking for Hispanic workers to attack, so that shows the boys had some type of motive. In this day and age where Americans have a need to be treated as equal; equal opportunity employers, equal rights for men, women, African-American, Chinese-American, and every other group of people in this country, one would think that somewhere along the line children would get the message that we are all the same. Children should be taught to love, not hate. It is painful to see such a crime committed just for the mere fact that they were different. Didn't hate crimes end in the sixties? Why is it that still parents cannot or will not instill in their children ideals of an equal human race? Black or white, brown or red, rich or poor, aren't we all the same when you turn out the lights? I am not saying that I think this is ent irely the parents' fault, but they do need to take blame. At the age these boys are at, their parents are some of their few role models, and they always will be, but at this age, parents are the most influential people in a child's life, nothing can come close to a mother's scorn, or a fathers praise. In that sense too, children believe in what their parents believe in, not because it is right, but because it is the only way they know. So, parents should watch when they say they hate someone or some group and we should all try to be better people, for the sake of our children. (Gil Garcetti 588-590) In a crime this violent, considering the assailants and their victims, a measure of justice needs to be served. The assailants need to take responsibility for their actions. However, sixteen years in a juvenile detention facility does not seem the best answer. James Twitchell believes that, In recent years the dispensers of the law are finally realizing that shame has a place in punishment. (602) And so, there needs to be a way of measuring how the boys are rehabilitated, and their community needs to be involved, as well as their parents and friends. Justice means fairness. It means righteousness, impartiality, honesty, and integrity. Justice should be measured by the victims themselves, they should get to see their assailants suffer and learn from their mistakes. That is what justice is all about. These boy assailants need to witness justice first hand in order for it to have any affect ct on them. (Garcetti 588-590) A punishment that can validate such a hiesous crime needs to be quite creative. One could just shout An eye for an eye! As Mark Costanzo concedes, even the often misinterpreted 'eye for an eye' passage in the bible was meant to restrain rather than require vengeance. (592) But that is not how our judicial system works, although it would be fair. Still there are others, like Bradley O'Leary who implies that the punishment?should fit the crime, not the age of the violent offender. As a society, we cannot show any sympathy for, or excuses from, the youth thugs?who are destroying our schools and neighborhoods. (590) These boys will be punished, as they should be, but their judge has an opportunity to change their lives forever. If