Critical Evaluation of Road Crew Social Marketing Programme

Order Instructions:

Assessment 1 is an individual assignment that requires a comprehensive and critical analysis of an existing social marketing programme. This requires students to describe an existing social marketing programme, compare it to best practice, and to critically analyse, interpret and identify and discuss important implications from their analysis.

A selection of case studies examples of existing social marketing programmes to choose from will be made available online. Students will choose one case study and use materials from their own research, and from the lecture, tutorials, the textbook, videos and unit readings to critically analyse the case study.

Individual Essays will be assessed against your critical analysis of the following in relation to your chosen existing social marketing programme:

– Analysis of formative research used to inform the existing social marketing programme

– Target group(s) segmentation strategy in the existing social marketing programme

– Establishment of objectives and goals in the existing social marketing programme

– Development and use of the social marketing mix in the existing social marketing programme

– Implementation of the existing social marketing programme

– Process, impact and outcome evaluation of the existing social marketing programme including consideration of ethical implications

– Critical analysis and reflection on the strengths, weaknesses of the existing programme (this should feature throughout your essay), and your own suggestions for future programmes on this topic

– Quality of written communication (structure, formatting, spelling, grammar, readability of the essay)

No extensions will be granted. There will be a deduction of 10% of the total available marks from the total awarded mark for each 24 hour period or part thereof that the submission is late (for example, 25 hours late in submission – 20% penalty). This penalty does not apply for cases in which an application for disruption of studies is made and approved. No submission will be accepted after solutions have been posted.

This Assessment Task relates to the following Learning Outcomes:
Differentiate between commercial and social marketing and outline the scope of social marketing, seeking out new ideas and opportunities.
Demonstrate awareness of social responsibility and become familiar with the range of issues where social marketing has an impact.
Appreciate the characteristics and needs of others in society and understand prospective challenges to social issues including environmental sustainability.
Critically analyse, discuss, and evaluate social marketing strategies and use secondary research skills to collect, collate and integrate examples with theory.
Demonstrate use of written and oral skills to integrate key social marketing theoretical concepts and to create a coherent and theoretically rigorous argument relating to sustainability concepts.

SAMPLE ANSWER

Critical Evaluation of Road Crew Social Marketing Programme

Introduction

Social marketing has gained immense popularity in the contemporary world, as a strategy for promoting behavior change. Social marketing programmes fundamentally involves the application of commercial techniques for marketing in advocating for social change (Spotswood et al, 2012). Road Crew, a Wisconsin-based social marketing programme was developed with the aim of drunk driving behavior change in order to reduce road crashes related to alcohol. This paper discusses the Programme to critically review its effectiveness, impact and the extent to which it is successfully implemented as a social marketing programme.

Description of Road Crew

Road Crew existence can be traced to the year 2000 when the initial research on social marketing to promote road safety, through discouraging drunk driving was initiated by Wisconsin Department of Transportation, Bureau of Transportation Safety (WisDOT). The service was first funded by the National Highway Traffic Safety Administration following an application by WisDOT with research support by Professor Michael Rothchild, a social marketing expert from the School of Business at Wisconsin University. The one year funding for piloting the project was expected to lay a foundation for road safety by reducing drunk driving and thereafter be adopted by communities for continuity.

Road Crew is a service for party goers which allows individuals to drink without having to drive, hence reducing alcohol-related accidents. Party goers make arrangements with Road Crew before embarking on a night out: vehicles are allocated to pick them from home, drive them from bar to bar as they enjoy the night and return them home when they are done having fun. This way, Road Crew prevents drunk driving, allows for socialization and adds to the fun. Over 97,000 rides had been given by the Road Crew as of 2008, preventing an estimate of 140 crashes from drunk driving.

Road Crew’s main target audience is the single male, aged 21-34 years, working in the rural areas as blue-collar workers. The research initially relies on findings by the US National Commission Against Drunk Driving whose public hearings and national conferences in the 1990s revealed that drinking drivers aged 21-34 made up half of drunk drivers in fatal crashes related to alcohol, were more likely to have revoked or suspended licenses and showed the greatest resistance in behavior change as far as drinking is concerned.

Analysis of formative research

The basis for any marketing campaign is comprehensive research, aimed at understanding the market and customer expectations, conducting competitor analysis and identifying the potential target market. According to Kotabe & Helsen (2011), market research ensures that the organization can develop a marketing strategy that is effective in meeting the needs of the target audience. Road Crew has demonstrated high level research on the social marketing programme, which was executed by a research team from University of Wisconsin under the guidance of Professor Rothchild. The research was undertaken from the year 2000 and sought to establish ways in which a social marketing campaign would be used in reducing accidents resulting from drunk driving. The research which utilized existing literature as well as data collection from the target audience concluded that discouraging people from drinking would not be as effective as providing them with a solution to drunk driving. Three types of studies were conducted namely existing literature review, focus group discussions with target group’s expert observers and focus group discussions with the targeted audience. This was effective in determining the behavior patterns of the target group and consequently ensure that the right strategy for the social marketing programme as implemented. Ritcher (2012), notes that research that includes the target audience as part of the respondents is likely to yield more accurate results. The research concluded that young male individuals aged 21-34 years working in small farms in rural areas were more likely to drink and drive and therefore more prone to alcohol-related accidents; thus making this population the target audience for the programme.

Segmentation strategy

The strategy selected for segmenting the market depends on the objectives of the marketing plan and the product or service in question. In social marketing, the same concept is applied, where the targeted behavior change influences the segmentation strategy. Road Crew utilizes a combination of segmentation strategies namely: geographical segmentation, demographic segmentation and behavior segmentation (Ritcher, 2012). In reference to geographical segmentation, Road Crew targets individuals living in the rural areas and small towns in the countryside. Demographic segmentation is demonstrated in the selection of customers of a particular age group and also in targeting male beneficiaries. Behavior segmentation on the other hand is evidenced by the fact that the service targets individuals who are likely to drink and drive. Such a combination is advantageous because it ensures that the target market is defined as effectively as possible. However, it may have the weakness of narrowing the segment too much and thus leaving out other individuals who may be a relevant target.

Establishment of goals and objectives

An effective social marketing programme must have well established goals and objectives because these act as a guide for the marketers. Goals and objectives define what the marketing program aims at achieving, how it will be achieved and how long it will take to be achieved. Road Crew successfully achieves this important aspect of marketing, given that there is a clear indication of what the service aims to achieve. Road Crew’s main objective is to reduce the number of road crashes related to alcohol by offering a service that prevents drinkers from driving while drunk. The social marketing programme effectively shows that this objective will be met through providing transport for the drinkers to ensure that they do not drive after drinking. The programme is also clear on the target group and the period in which it will be conducted in order to achieve the desired outcomes. The achievements made by Road Crew can be attributed to the well-articulated goals and objectives, which ensure that the programme achieves its intended function. The existence of project impact data which confirms the achievement of goals and objectives further provides backup for ell established goals and objectives.

Social marketing development and use of social marketing mix

An important aspect of marketing is the marketing mix because it acts as a guide for the marketing plan by providing a scope. Road Crew achieved this objective effectively by defining their marketing mix based on the 4Ps of marketing. The product was the vehicle ride to the bar, from bar to bar and back home; price was $15-20 per evening and $5-10 per single ride; place was home to bars; and promotion was done through advertising on television, newspapers, bars, movie theatres and over urinals. This marketing mix is used across the three pilot counties, which to a great extent promotes their performance.

Programme Implementation

Having developed an operational plan, programme implementation becomes the most important undertaking to ensure the plan is turned into reality. Jean (2013) notes that unless marketers are capable of implementing the programme effectively, having a plan is inadequate no matter how well it is designed. Road Crew can be described as a well implemented programme with tangible results. By 2008, Road Crew had made savings of $31 million by preventing 140 crashes, an indication of the impact that the social marketing programme was having on the efforts towards reducing crashes related to drunk driving. This was Road Crew’s major objective and a demonstration of the achievements of the programme is an indication of its effectiveness.

Road Crew worked together with the community during the programme implementation and effective adoption of Road Crew in various counties. A unique feature in the implementation is that Road Crew allowed counties to use locally available resources to achieve the model and also be unique in their own way to prevent drunk driving. In Pork County for example, the use of second-hand limousines was considered more cost effective while in Dodgeville and Mineral Point, the use of an existing cab service was encouraged through offering more affordable prices after 5pm. A shortcoming of this however is that it could lead to different outcomes because the model is adopted differently, thus leading to difficulties in measurement of outcomes.

Process, impact and outcome evaluation

An assessment of the process, impact and outcome reveals that Road Crew is a highly effective social marketing programme that achieved its mandate and whose impact was felt by the targeted group. The process was not only innovative but also appealing to the revelers and the community. This programme meets a major requirement in social marketing, which is to ensure conscious and voluntary behavior change. Spotswood et al (2012) notes that many social marketing initiatives fail because of the use of implicit behavior change techniques and use of tactics that do not appeal to the target audience. Road Crew specifically aims at encouraging revelers to use their services as opposed to drunk driving and participants do so willingly. In order to attract the interest of the target group, Road Crew uses innovative approaches such as limousine rides, which to a great extent encouraged individuals to use the service instead of driving their own cars.

Measuring a social marketing programme’s impact provides the basis for establishing whether the project was successful. Road Crew’s approach to showing impact is highly effective because it provides an overview of the program’s success in terms of cost savings and lives saved as opposed to merely providing the number of rides made. Road Crew attempts to demonstrate its impact in terms of cost savings derived when road crashes are avoided. The cost of preventing a crash through implementing Road Crew was $6,400, compared to the estimated $231,000 cost to the community in recovering from a crash. Through its services, Road Crew was shown to have made savings of over $31 million, prevented 140 crashes and prevented six deaths. This presentation of impact is catchy and motivates any reader to develop interest in the programme.

An important aspect of this program is that the sustainability of the service is assured because the community was involved from the beginning. As a result, they are conversant with the service and its impact, which makes it easier for them to continue with it once the funding from the government comes to an end. In this respect, it is natural to query where the funding to sustain the programme will come from but the programme also demonstrates that this was put into consideration. Users pay a reasonable fee when they use the vehicles and this is sufficient to promote sustainability. $400,000 collected from riders would be used in addition to the government funding to set up the program under community management.

The implementation of Road Crew raises an ethical issue which is not well addressed in the case study. It is notable that the programme aims at reducing instances of drunk driving, yet it does not show consideration of the fact that the transport services could actually increase alcohol addiction among beneficiaries. Road Crew picks revelers and drops them at their place of convenience and is aimed at creating fun out of the experience. This would certainly attract individuals who may not go drinking in ordinary circumstances due to the availability of transport and the fun factor. In essence, Road Crew could be raising a generation of alcohol addicts in their efforts to reduce drunk driving.

Conclusion

Road Crew provides an exceptional example of how social marketing can harnessed to drive social change. In this programme, Road Crew aims at reducing drunk driving by providing transport service to revelers to ensure that they do not drive after drinking. It can be concluded that the Road Crew social marketing programme was effective in achieving its goals and objectives, the implementation process was well executed and that the programme had the desired impact on the society. This model can be utilized in other areas of the United States to reduce the number of crashes and deaths attributed to drunk driving.

References

Jean, B 2013, International Marketing in Rapidly Changing Environments, Somerville, MA: Emerald Group Publishing.

Kotabe, M., & Helsen, K 2011, Global Marketing Management, 5th edition, Wiley, Hoboken, N.J.

Ritcher, T. (2012). International Marketing Mix Management: Theoretical Framework, Contingency Factors and Empirical Findings from World-Markets. Logos Verlag Berlin GmbH.

Spotswood et al 2012, Some reasonable but uncomfortable questions about social marketing,

Journal of Social Marketing, Vol 2, Issue 3, pp. 163-175.

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MANAGED CARE ORGANISATIONS

Order Instructions:

As your third assignment toward completion of the Session Long Project you are asked to review the paper by A. Mains, A. Coustasse, K. Lykens: Physician Incentives: Managed Care and Ethics and answer the questions below.
1.Consider this idea from the paper: “Medicine is a moral enterprise. Because MCOs are involved in the delivery of medical care, they too, are moral entities. However, MCOs are also businesses.”
2.Explain the idea that the authors sought to convey.
3.Discuss the physician’s dual function under an MCO model of care.
4.What concerns do you have about the physician- patient relationship under MCOs?

Module Overview

Basically, managed care and managed care organizations (MCOs) was championed as a powerful force for containing healthcare costs. We will see that this is not necessarily the case. We will also see that managed care brings up a range of structural issues related to price fixing and market power.

In the United States after World War II, healthcare was based on an indemnity model or fee for service. In this case health insurers simply paid the bills for services ordered by physicians. These traditional plans provided few incentives for cost containment medical decisions.

Responding to the lack of cost containment measures in the indemnity model, private insurers began to “manage care” by exerting influence on the decisions made by physicians. Managed care is the process of structuring or restructuring the healthcare system in terms of financing, purchasing, delivering, measuring, and documenting a broad range of healthcare services and products.

Sometimes this process of restructuring took the form of bureaucratic rules, e.g. requiring physicians to seek administrative approval before proceeding with certain procedures. In other cases, financial incentives were used to shape physician behavior. By the mid 1990’s, “managed care” had become the dominant form of private sector health insurance.1

Today managed care organization (MCO) is a general term used to describe any number of health insurance arrangements that are intended to reduce unnecessary healthcare costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; and the intensive management of high-cost healthcare cases.

Managed care organizations are structured with an imperative to consider both the impact on costs and also the impact on doctors’ decisions whether to join their networks.

These considerations by MCOs to both contain costs and attract physicians are influenced by the values and practices that physicians bring to healthcare. Physicians want to earn a living but not at the risk of endangering the lives they are meant to serve. These healthcare values held by physicians pose a strategic dilemma for managed care organizations needing to contain costs and attract physicians to assemble provider networks.

Low cost MCOs with contract restrictions on spending are seen as highly restrictive. On the other hand, MCOs with large physician networks write cost containment rules into contracts that are not overly burdensome.

It is interesting to think about how MCOs balance competing interests and ethical issues in cost containment, physician ideals, and quality of care.

There are a wide variety of managed care models that integrate financing and management with the delivery of healthcare services to an enrolled population.

Health Maintenance Organizations: HMOs are organized healthcare systems that are responsible for both the financing and the delivery of a broad range of comprehensive health services to an enrolled population. HMOs act both as insurer and provider of healthcare services. They charge employers a fixed premium for each subscriber. An independent practice association (IPA)-model HMO provides medical care to its subscribers through contracts it establishes with independent physicians. In a staff-model HMO, the physicians would normally be full-time employees of the HMO. Individuals who subscribe to an HMO are often limited to the panel of physicians who have contracted with the HMO to provide services to its subscribers.

Preferred provider organizations (PPOs) are entities through which employer health benefit plans and health insurance carriers contract to purchase healthcare services for covered beneficiaries from a selected group of participating providers. Most states have specific PPO laws that directly regulate such entities.

Exclusive provider organizations (EPOs) limit their beneficiaries to participating providers for any healthcare services. EPOs use a gatekeeper approach to authorize non–primary care services. The primary difference between an HMO and an EPO is that the former is regulated under HMO laws and regulations, whereas the latter is regulated under insurance laws and regulations.

These integrated health delivery organizations raise a variety of issues with the Department of Justice and the Federal Trade Commission. The issues include price fixing and antitrust problems based on market power.

Depending on how the groups are organized- horizontal versus vertical- and who is integrated- competing physician groups or a multi provider network a MCO may violate several antitrust laws.

Whenever an MCO possesses significant market power or deals with a group that has significant market power, antitrust implications should be considered. To determine market power, it is necessary first to identify the market in which the entity exercises power. For antitrust purposes, the relevant market has two components: (1) a product component and (2) a geographic component.

Price fixing is considered a per se violation of the antitrust laws. Per Se Violations conclusively violate antitrust laws and means there is no further investigation of its effects on the competitiveness of the market because its intentions are so obvious. A Per Se Violation would almost always limit competition and decrease productivity. Activities that fall under per se violations are acts such as horizontal price fixing and horizontal market division.

Price fixing occurs when two or more competitors come together to decide on a price that will be charged for services or goods. The per se rule applies to restraints in trade that are so inimical to competition and so unjustified that they are presumed to be unreasonable and, therefore, are illegal.

Aaron, Henry J. and Reischauer, Robert D., (1995) “The Medicare Reform Debate: What is the Next Step?” Health Affiars. 14:4. p.8-30

Required Reading

D.A. Mains, A. Coustasse, K. Lykens: Physician Incentives: Managed Care and Ethics. The Internet Journal of Law, Healthcare and Ethics. 2004 Volume 2 Number 1. DOI: 10.5580/24ae – See more at: http://ispub.com/IJLHE/2/1/12416

Managed Care and Physician Incentives: The Effects of Competition on the Cost and Quality of Care. David J. Cooper and James B. Rebitzer. March 2004. http://myweb.fsu.edu/djcooper/research/managedcare.pdf

Government Agencies Soften Stance on What Constitutes Price Fixing. David A. Ettinger and Mark L. Lasser (March, 2008) http://corporate.findlaw.com/litigation-disputes/government-agencies-soften-stance-on-what-constitutes-price.html

Diagnosing Physician-Hospital Organizations. Susan A. Creighton. Federal Trade Commission Remarks Before American Health Lawyers Association, Program on Legal Issues Affecting Academic Medical Centers and Other Teaching Institutions. January 22, 2004. Washington, DC. Retrieved from: http://www.ftc.gov/public-statements/2004/01/diagnosing-physician-hospital-organizations

Statement of department of justice and federal trade commission enforcement policy on multiprovider networks; Federal Trade Commission; Competition in The Healthcare Market place; Statements of Health Care Antitrust Enforcement Policy; Statement 9. (July 8, 2009). Retrieved from: http://www.law.uh.edu/faculty/jmantel/health-law/Statement9AntitrustEnforcementPolicy.pdf

The above policy has been updated (Statement 9 on Multi-provider Network), Read the updates below:

Revised Statements on Multi-provider networks: http://corporate.findlaw.com/law-library/revised-policy-statements-on-health-care-antitrust-enforcement.html

Optional Reading

Competition in the healthcare marketplace. http://www.ftc.gov/bc/healthcare/antitrust/index.htm

Improving Health Care: A Dose of Competition: A Report by the Federal Trade Commission and the Department of Justice (July 2004). http://www.ftc.gov/reports/healthcare/healthcarerptexecsum.pdf

QuickCounsel Antitrust: U.S. Laws and Regulations. Elizabeth Killingsworth, Esq. http://www.acc.com/legalresources/quickcounsel/auslar.cfm

SAMPLE ANSWER

MANAGED CARE ORGANISATIONS

“Medicine is a moral enterprise. Because MCOs are involved in the delivery of medical care, they too are moral entities. However, MCOs are also businesses.”

MCOs are moral entities because they aim at deliver quality, safe and effective medical care. They are responsible of doing what is right and best for the service users while ensuring equitable distribution of the scarce health resources. However, the managed care control changes the patient physician relationship to a business-consumer relationship. This implies that the main goal of MCOs is to ensure that physicians adopts the principle of distributive ethic; which is basically providing the most safe and best quality of care to the greatest number of patients as possible using the allotted budget or incurring losses (Mains, Coustasse, & Lykens, 2004).

Under this moral obligation, the MCOs are guided by the utilitarianism- which basically entails performing the best action that maximizes utility. However, the MCOs are economic tenets that aim at reducing costs for service users and aims at generating profit simultaneously. Therefore, when making decisions regarding MCOs, providers should consider the economic effects when maintaining aggregating costs of care so as to avoid loses in either the MCOs or the physicians. This involves establishing control, incentives, bonuses, and withholds as well as other quality assurance initiatives that will ensure that physician practices are safe, quality and profit generating (Cooper and Rebitzer, 2004).

Physician dual function

In managed care, the physicians have dual functions namely a) patient fiduciary and b) Financial advocates. The physician play the unrestricted role of patient advocates by ensuring that the managed care model puts into consideration to patient’s autonomy, respects it, and exercise the ethical principle of beneficence. This implies that the physicians are patient’s advocates in voicing their concerns whenever the managed care model prioritizes its benefits over the patient’s interests, or any other good that is beyond establishing effective physician-patient relationship. This is an important role because the MCOs require expects the physicians to choose the society wellbeing over individual patient’s interest (Mains, Coustasse, & Lykens, 2004).

Therefore, when enrolling in these organizations, it is important for the physicians to understand that their first role is to be patient advocates. Under patient fiduciary role, the physicians are legally responsible for advising patients about all possible alternative care or technological advancement that can be used to manage their illness. The physicians are expected to remain prudent steward when advising and deciding the limits of patient care. This entails balancing between medical merits and financial risks. Trust, honesty and caring are foundation of establishing effective physician-patient fiduciary relationship (Cooper and Rebitzer, 2004).

Concerns about physician-patient relationship

Managed care is associated with moral and professional ethical dilemmas. For instance, MCOs focus on financial incentives and social optimal outcomes instead of single patient well-being. This brings forth the concept of “countervailing agency” which is basically the physician’s role to choose between individual patient’s interests and the society wellbeing. If a patient does not receive care as by MCOs, the physicians can be sued for malpractice. This puts the physicians at dilemma of delivering care based on MCOs expectations and risk for liability (Mains, Coustasse, & Lykens, 2004).

In addition, the MCOs emphasize on utilitarianism approach when solving the healthcare expenditure. Despite its advantages, this approach raises concerns of its validity and morality in physician- patient relationship. The professional sovereignty vs. physician financial incentives complex interaction results into a conflict of interest. It is important for the managers in healthcare system to choose a strategy that helps them identify how to favor the interests of the patients and the society. This calls for reforms to re-define the moral mission for MCOs to fulfill their goals and to preserve efficient physician-patient relationship ( Improving Health Care, 2004).

References

Cooper, D.J., and Rebitzer, J.B. (2004). Managed Care and Physician Incentives The Effects of Competition on the Cost and Quality of Care. Retrieved from http://myweb.fsu.edu/djcooper/research/managedcare.pdf

Mains, D.A., Coustasse, A., & Lykens, C.K. (2004). Physician Incentives: Managed Care and Ethics. The Internet Journal of Law, Healthcare and Ethics. Volume 2 Number 1. DOI: 10.5580/24ae – Retrieved from http://ispub.com/IJLHE/2/1/12416

Improving Health Care (2004). A Dose of Competition: A Report by the Federal Trade Commission and the Department of Justice. Retrieved from http://www.ftc.gov/reports/healthcare/healthcarerptexecsum.pdf

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Analysis of FCT Act research paper

Analysis of FCT Act

Order Instructions:

Case Assignment

A physician-hospital organization (PHO) consists of 15 hospitals – with 2,247 staffed beds – and approximately 500 physicians. The PHO operates in a very large section of south Georgia, including the cities of Valdosta, Tifton, Thomasville, Moultrie, and Waycross. The PHOs’ physician members represent approximately 90 percent of all physicians practicing in the region.

The PHO served as a vehicle through which competing hospitals and physicians could bargain collectively with health plans to obtain higher fees for themselves. The owner PHOs, member hospitals, and member physicians canceled contracts with payors and informed them that the PHO would be the sole entity through which they would enter into payor contracts. To contract with the PHO, payors allegedly have had to accept the fixed physician fee schedule and fixed discount of no more than 10 percent off hospital list prices.
1.Explain why this arrangement would be found “per se” illegal under the FTCs’ analysis.
2.What kind of actions could be taken to restructure this arrangement to avoid a determination that it is per se illegal?
3.Discuss the alternate FTC analysis that is applied to such cases if they are suspect but not found to be per se illegal.

Module Overview

Managed care organizations are structured with an imperative to consider both the impact on costs and also the impact on doctors’ decisions whether to join their networks.

It is interesting to think about how MCOs balance competing interests and ethical issues in cost containment, physician ideals, and quality of care.

There are a wide variety of managed care models that integrate financing and management with the delivery of healthcare services to an enrolled population.

Depending on how the groups are organized- horizontal versus vertical- and who is integrated- competing physician groups or a multi provider network a MCO may violate several antitrust laws.

1Aaron, Henry J. and Reischauer, Robert D., (1995) “The Medicare Reform Debate: What is the Next Step?” Health Affiars. 14:4. p.8-30

Required Reading

The above policy has been updated (Statement 9 on Multi-provider Network), Read the updates below:

Revised Statements on Multi-provider networks: http://corporate.findlaw.com/law-library/revised-policy-statements-on-health-care-antitrust-enforcement.html

Optional Reading

Competition in the healthcare marketplace. http://www.ftc.gov/bc/healthcare/antitrust/index.htm

Improving Health Care: A Dose of Competition: A Report by the Federal Trade Commission and the Department of Justice (July 2004). http://www.ftc.gov/reports/healthcare/healthcarerptexecsum.pdf

QuickCounsel Antitrust: U.S. Laws and Regulations. Elizabeth Killingsworth, Esq. http://www.acc.com/legalresources/quickcounsel/auslar.cfm

SAMPLE ANSWER

Question 1: Analysis of FCT Act

The health care industry is rapidly changing as it seeks innovative alternatives to control costs and efficiency of the quality studies. There are various types of relationships as well as affiliations that ensure strong competitiveness among other competing healthcare providers. Most of the organizations provide significant competitive benefits to the service users. These multi-provider networks are platforms used by the providers to jointly market the healthcare services to the service users. In most cases, these ventures often contract to reach at predetermined prices in order to contain costs and to assure quality. The contractual relationships among the providers operate and vary greatly. In this statement, the Federal Trade commission (FTC) protects the American consumers through antitrust law (David and Rebitzer, 2004).

The FTC analysis states that it is not illegal “per se” to have a naked arrangement among the providers that predetermine or fix prices so as to allocate markets. Under the FTC’s analysis, the providers are allowed to get into a joint venture if the venture is necessary to achieve precompetitive benefits; and that the outcome of the network is to benefit the consumers. In this case study, the arrangement can be said as illegal “per se” it is evident that the PHO arrangements are unfair, deceptive and seems injurious to consumers because the prices demanded by the PHO is substantially higher than what the physicians and hospitals could have generated if they negotiated unilaterally (Creighton, 2004).

Although setting of the price is necessary and that it is integral to make such arrangements, the PHO have set fixed physician fee and the fixed discount which can be perceived as illegal based on the competitive effects because it negatively influence the vertical (between competing hospitals) and horizontal (between parties and physician) competition. This is because the PHO refused to deal with the individual health plans and instead collectively fixed the prices for the services. Therefore, the PHO was forcing payors to pay higher prices to member healthcare facilities and physicians, which would lead to increased cost of care. Therefore, the HPO arrangements can be viewed as illegal “per se” because: – a) they arranged for collective arrangements of fees and terms of the healthcare plans, b) performed collective negotiations and c) rejected or rather refused to deal with payors who insisted on their desired terms. These acts are harmful, anticompetitive and desecrated the FCT Act (Ettinger and Lasser, 2008).

Question 2: Actions to restructure this arrangement

It is important to reach a proposed settlement to reach the remedy of this illegal conduct. To start with, the first action is to file a complaint against the HPO, highlighting the FTC Acts that have been violated. If the complaint is investigated and found to be illegal, the Antitrust Division (DOJ) and Department of Justice will consult and enforce the antitrust laws so as to bring the civil actions. Secondly, it is important for FTC to revise its guidelines and ensure that all the healthcare providers understand the rules. This includes prohibiting respondents from facilitating any agreement between physicians a) to deal or refuse to deal with the payors, b) negotiate with payors on the behalf of physicians, c) determine the terms of deal and d) not deal with any payor individually or collectively. Another action that can be applied is the use of consent agreement. The consent agreement is meant for settlement purposes. The arrangement is meant to clarify issues of concern and to provide solutions. It does not become part of public records until it becomes accepted by the commission (Ettinger and Lasser, 2008).

Question 3: Alternative FTC analysis

According to the rule of reason and “per se” rule, the existence of monopoly is not an indicator of antitrust laws. There are interpreted statutes that apply to the Supreme Court that permit monopoly. For instance, the rule of reason permits monopoly unless it is achieved or maintained through use of prohibited conduct. Therefore, some acts can be determined as unreasonable per se, while other acts can be subjected to reasoned analysis. Therefore, it is important to examine the anticompetitive behaviors through a reasoned analysis so as to examine its motive, intent and outcome to determine if the action actually support or suppresses market competition (Improving Health Care, 2004).

In addition, in the revised policy statements in Health Care Antitrust Enforcement have introduced flexibility in the antitrust laws for analysis of activities physicians and other integrated networks. The revised policy recognize the aspect of “non-financial integration” in their new guidelines, elaborating on the types of “risk sharing arrangements” that qualify for financial integration and those that corresponds and fits into the existing antitrust enforcement (Federal Trade Commission, 2008).

References

Creighton, S.A. (2004). Diagnosing Physician-Hospital Organizations. Federal Trade Commission Remarks Before American Health Lawyers Association, Program on Legal Issues Affecting Academic Medical Centers and Other Teaching Institutions. Washington, DC. Retrieved from: http://www.ftc.gov/public-statements/2004/01/diagnosing-physician-hospital-organizations

David, J., C. and Rebitzer, J.B. (2004). Managed Care and Physician Incentives: The Effects of Competition on the Cost and Quality of Care. Retrieved from http://myweb.fsu.edu/djcooper/research/managedcare.pdf

Ettinger, D. A., and Lasser, M. L. (2008). Government Agencies Soften Stance on What Constitutes Price Fixing. Retrieved from http://corporate.findlaw.com/litigation-disputes/government-agencies-soften-stance-on-what-constitutes-price.html

Federal Trade Commission. (2008). Statement of department of justice and federal trade commission enforcement policy on multiprovider networks;; Competition in The Healthcare Market place; Statements of Health Care Antitrust Enforcement Policy; Statement 9. Retrieved from: http://www.law.uh.edu/faculty/jmantel/health-law/Statement9AntitrustEnforcementPolicy.pdf

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Ethics Moral implications in Schools

Ethics Moral implications in Schools Order Instructions: Identify a current application for digital technology that you feel has social, moral, and ethical implications for teachers and/or students.

If you are not currently working in an educational setting, please identify a context that you are interested in using to frame your work. Technology is broadly defined to include anything from a piece of hardware (laptop, gaming console, tablet) to software, apps, social media platforms, etc.

For this assignment, write one paper framed to argue its point toward a particular audience. You must first decide who you are considering to be the audience of the paper. Then, do the research and write the paper as if you will be giving it to that audience. Your choices are:
Write a short policy brief that could be given to the school board, administration, or the legislature with practical recommendations.

Ethics Moral implications in Schools Sample Answer

Ethics, Moral implications in Schools

Technology is increasingly becoming an integral part of everyday life. Our daily activities are intertwined with the use of technology and divorcing one from the other is next to impossible. There are enormous benefits to the use of technology, such as the ease of quicker communication, easier access to information and many others. With the benefits also comes the danger of misuse of these technologies (Betts, 2016). This presentation is on the ethics involved in the use of social media in the school environment, in particular – cyber-bullying.

Cyber-bullying refers to the intimidation, harassment and any form of mental torture using technology. This involves the use of social media sites, websites chatting and text messages. This form of bullying interferes with the learning environment of students, disrupting learning. It is normally an ongoing narrative and can be overlooked by teachers in the hidden “jargon” of students. It may escalate to the level of a misdemeanour, the charge being that of cyber-harassment. If the student is old enough, the charge can be altered to that of juvenile delinquency. Reports of suicide and fatal revenge attacks have resulted because of cyber-bullying (Betts, 2016).

The Ethical and moral use of social media begins with having a personal code of conduct, delineating what is acceptable and not. Personal accountability is the pillar with which to benchmark our actions in the responsible use of social media (Betts, 2016). Peer pressure to “fit in” must be resisted, knowing that change begins a personal decision. Ethical behaviour must be buttressed by a strong moral fabric. School management needs to adapt proactive approaches that are relevant to the evolving technology. Codes of conduct for teachers and students need to be reviewed to incorporate this new reality.

Ethics Moral implications in Schools References

Betts, L. R. (2016). Cyberbullying: Approaches, Consequences and Interventions.

Health Assessment on Midwifery and Nursing Care

Health Assessment on Midwifery and Nursing Care Order Instructions: Please see the attached

Health Assessment on Midwifery and Nursing Care Sample Answer

Health Assessment

Midwifery and nursing care have health assessment forms as the foundation. This involves an ongoing cyclical process where the whole person is evaluated as a functional, psychosocial and physical being. This is regardless of whether the person is ill or well, old or young. The first health assessment’s aspect is the midwife or nurse conducting the primary assessment with the aim of detecting life-threatening conditions.

After this, there is a health history, involving the collection of subjective health information. The information can be acquired from different sources, including the patient. There can also be a use of medical or family documentation, as well as the client’s significant other. Through the patient’s health history, it is possible to learn about the cultural, emotional social, physical, spiritual, and developmental identity of the patient, and this definitely facilitates the person-centered care. This assignment involves a primary health assessment. Before the assessment, the Health Assessment Explanatory Letter was explained and after understanding, the client signed the Acknowledgment of Receipt. Participation was voluntary.

Preparing for the Health Assessment- 900

Purpose of a primary survey and health history assessment

In essence, the health history assessment is a very valuable tool through which nurses can practice their various skills. Through the assessment, the nurse is able to obtain descriptions from the patient, and this offers detailed insights about the patient’s state of health, symptoms, and potential conditions (Jones et al., 2016). Moreover, there is a better understanding of the symptoms’ development. This is the process through which the associated physical findings can be discovered and this helps in determining the differential diagnosis.

The primary survey and assessment are a very appropriate chance for the healthcare professional to develop a rapport with the patient as well as the family. There is no doubt that the first impressions are what last. Therefore, through the primary survey and assessment, the healthcare professional can instill some trust in the patient, which would promote continued access to the healthcare services. The nurses also understand the patient better during the assessment, including the religious and cultural practices and beliefs, therefore ensuring that appropriate measures are taken for positive outcomes.

Lin, Coffin, and O’Sullivan (2016) were keen to note that the primary survey helps the healthcare professional in detecting the immediate life threats. This is the basic step towards ensuring that the most important measures are taken. This ensures that danger has deviated from the patient for health and wellbeing. Essentially, there is also an identification of the patient’ specific needs. McCoy et al. (2016) indicated that knowing the needs is the first step towards addressing them. The risks of other diseases are detected, promoting early preventive and health promotion steps. With these two components, there is proper guidance on how to treat and approach the individual.

Health Assessment on Midwifery and Nursing Care Questions

The assessment was done on a patient who was suffering from diabetes mellitus 2.

Primary Survey

Rationale and purpose; conducting the primary survey were helpful in enabling the healthcare professional detect the patient’s threats to life that were immediate. Correcting the threats early would enhance the health and wellbeing (McKnight et al., 2015).

	Very poor	Poor	Fair	Good	Very good
The general impressions
Assessment on the mental status using alertness, verbal, painful, and unresponsive
State of the pulse

Have you had any challenges with your airway?

Would you rate your breathing as adequate?

How do you feel about your general health and wellbeing?

Health Assessment on Midwifery and Nursing Care Biographical Data

Rationale and purpose; the biographical data is very important in helping identify the risks the patients could be facing. This is based on the fact that there are components that help in knowing more about the patient such as sex, age, and ethnicity, which are important in predicting risks (Shen et al., 2013). The data will be used for identifying the patient and predicting risks.

Name
Address
City, state
Telephone (home and work)
Date of birth
Gender
Ethnic origin
What is your education level?
Are you currently widowed, divorced, separated, married, or single?
What chronic conditions do you have?

Have you been suffering from any disease for an extended period of time?

Current Health Status/Reason for Seeking Care

Rationale and purpose; knowing how the patient feels presently about the state of health can help in predicting the condition (Gubhaju et al., 2013). Moreover, the needs of the patient would be identified precisely, which would promote a better intervention (Grantham et al., 2013). It can help the healthcare professional to know the expectations and, therefore, address them.

How are you feeling presently about your health status?
What are the signs and symptoms are you experiencing?
When did you start experiencing those signs and symptoms?

Perception of the Present State of Health (History of Present Health Status)

Rationale and purpose; knowing about the perception of present health that the patient has can guide the kinds of interventions that are offered. It would also be easier to rate about how the patient perceives himself in relation to health, which can promote proper guidance and counseling (Burridge et al., 2016). The patient could even be disturbed psychologically, and such issues can be addressed.

Generally, would you rate your health as excellent, very good, good, fair, or poor?
How have you been coping with self-management and self-care?
Do you feel that your family has been offering you adequate support in managing your disease?

Past Health/Medical History

Rationale and purpose; knowing about the medical history of the patient is important as it can offer some insights about the present health condition. Moreover, the present condition could be related to other diseases the patient might have suffered from in the past, considering that many chronic conditions are connected (Tina et al., 2016).

Have you ever suffered from lung or heart-related conditions?
Have you ever been admitted for diabetes-related complications?
Have you ever experienced any challenges with your kidney?
Have you ever experiences any symptoms of renal, neurological, cerebrovascular, or ophthalmological complications of diabetes?

Have you suffered from any diabetes mellitus complications lately?

Have you any challenges with sexual functions?

Health Assessment on Midwifery and Nursing Care on Family History

Rationale and purpose; knowing about the family history would be essential as it can form a basis for diagnosis or help in determining the risk for other diseases. The information acquired can be used for formulating better interventions (Waterworth et al., 2015).

Has any member of your family suffered from diabetes mellitus?
Does any member of your family suffer from heart-related conditions? (Fazli et al., 2017).
Would you say your family engages in appropriate lifestyles?

General Overall Health and Wellbeing

Rationale and purpose; knowing about the general overall health as well as the wellbeing of the patient can help the healthcare professional in knowing more about potential risks faced. This can help with the planning of the interventions (Waterworth et al., 2015).

Have you recently experienced any challenges with your nerves?
Do you have any complaints about your health and wellbeing status?

Health and Lifestyle management

Rationale and purpose; knowing about the patient’s lifestyle and health management can guide the professional in knowing about the factors contributing to the disease for proper adjustments. Therefore, more appropriate interventions can be incorporated into self-care.

What positive lifestyle aspects can you say you engage in?
Do you engage in self-care? (Browne, Scibilia & Speight, 2013).
Are you determined about maintaining a proper lifestyle for positive health?

Do you think an appropriate lifestyle can benefit your health in the future?

Documenting the Health Assessment- Findings and Participant responses

The general impression obtained on the first instance of interaction was good. Client Y was dressed appropriately and her communication was efficient. It was even hard to suspect that she was a patient. Her verbal, alertness, and unresponsive aspects were good. The pulse was normal, and she reported there were no issues with the airway. She reported having no challenges with the breathing. According to her, the general wellbeing and health were fair, as she felt there were deteriorations compared to the past (Glasson, Larkins & Crossland, 2017).

The biographic data led to the realization that client/ patient Y came from a background where people were financially unstable. Her family and those in the neighborhood lacked adequate food all the times as the environmental condition was not conducive. There was a high level of engaging in unhealthy behaviors including eating junk foods, as these were sold at cheaper prices in the neighborhood. The Hispanic middle-aged woman had achieved the high school certificate, and did not proceed any further. She was separated from the husband and was the sole breadwinner to three children. She was suffering from hypertension.

The client narrated that she was very anxious about the present health status. She was sure her health condition was deteriorating, since she kept falling ill now and then. She was also worried about the financial burden of taking care of the adolescents, particularly the education costs. She was experiencing general body weakness or malaise, and had blurred vision often (Banfield et al., 2017). Her frequency of urinating had increased to the extent that having a peaceful sleep was hard. The tingling sensation on her feet and hands had also increased. The symptoms had increased gradually over the previous one month.

Based on this, she rated the health as fair. She also felt that the responsibilities in her life were hindering efficient self-care and self-management. It was sad to realize that she was receiving no support in managing her state of health as her children had no way of doing this. client Y had never suffered from any heart- or lung-related conditions. A year ago, she had been hospitalized for high blood pressure (Begley & Pollard, 2016). She stayed at the hospital for three days, and was advised to manage her stress appropriately to avoid re-hospitalization. She had never experienced issues to do with the kidneys, or neurological, cerebrovascular, or ophthalmological complications.

From the assessment, I learned that the patient’s grandmother had died from diabetes mellitus while the father had been treated severally for stroke. Therefore, she was worried that she could be suffering from any of these conditions. She was open to remark that she never thought her family members engaged in proper lifestyles. The foods consumed were never healthy, and mainly constituted of fast foods, fatty, and sugary foods. Actually, it seemed as if this habit was being passed down through the generations (Alouki et al., 2016).

Client Y reported issues with the nerves. The complaints linked to the wellbeing and health status included the blurred vision and tingling sensation on the feet and legs. Definitely, these are linked to the nerves. The client was very worried about losing her sight or being amputated. These signs had been increasing gradually, making the client really worried. This was the greatest need identified and, therefore, addressing this was very pertinent. This made her very worried about the future of her children (Waterworth et al., 2015). At this point, I found it necessary to reassure her that getting worried was much more likely to cause more harm than good.

The client narrated that she walked often. However, this level of exercise was very minimal. Her levels of exercise had to increase for it to be considered adequate. The financial situation never allowed her to engage in proper diets at all times. Although she was really determined about practicing positive dietary habit for herself and the children, she often relapsed due to inadequate resources. Self- care included putting on shoes, taking the blood sugar and pressure levels regularly, and seeking medical care attention whenever feeling unwell. Client Y was really keen about maintaining a proper lifestyle, and was ready to make the necessary changes. She requested for support and guidance. She was ready to use the limited resources in making the needed adjustments.

Health Assessment on Midwifery and Nursing Care and Reflection and future planning- 400

In the midwifery and nursing process, reflection forms a very essential component. At the same time, it helps in improving the response to and awareness to the interactions with family, patients, and healthcare professionals (Adegbija, Hoy & Wang, 2015). Through the reflection, a lot of improvements can be planned on and implemented.

2 challenges

The first challenge related to effective communication. This was a challenge in that in most of the questions, communication barrier was experienced. As such, it was hard for her to understand some of the aspects that I was questioning on. I had to spend a lot of time explaining. At the same time, it was a bit hard for me to comprehend the non-verbal communication that she was using, and vice versa (Schierhout et al., 2016).

Second, there was limited time for conducting the interview. As such, some questions could not be explored. At the same time, addressing some very pertinent issues or concerns that the patient had was difficult. As such, both I and the client left the interviewing room feeling some gap.

Potential causes

Apparently, the barriers could be attributable to the fact that the client’s level of education was a bit low. Her ability to understand English was a bit low. Being a Hispanic, her English speaking ability was quite low.

Since some considerable time had to be spent elaborating as the client could not understand well, time for exploring other pertinent issues was limited. Therefore, for the entire interview period, only some aspects were explored in detail while others were not.

Overcoming in future

The communication barrier could be addressed by ensuring that an interpreter is invited in the future. I would use the interpreter’s services so that the patient can understand everything being said. This would avoid time wastage (Abouzeid et al., 2014).

To overcome the limited time challenge, using an interpreter would make things easier therefore saving on time for exploring other pertinent matters. At the same time, prior planning will be done so as to ensure that there is an awareness on the client to be interviewed. The items to be questioned during the interview should first be listened down and followed. In case the client tries to deviate from the interview, this would be avoided by sticking to the list. In short, the interview will be structured.

Health Assessment on Midwifery and Nursing Care References

Abouzeid, M., Bhopal, R. S., Dunbar, J. A., Janus, E. D. (2014).
The potential for measuring ethnicity and health in a multicultural milieu – the case of type 2 diabetes in Australia. Ethnicity & Health, Vol. 19 Issue 4, p424-439. 16p. 4 Charts. DOI: 10.1080/13557858.2013.828828.

Adegbija, O., Hoy, W., & Wang, Z. (2015). Predicting Absolute Risk of Type 2 Diabetes Using Age and Waist Circumference Values in an Aboriginal Australian Community. PLoS ONE. , Vol. 10 Issue 4, p1-10. 10p. DOI: 10.1371/journal.pone.0123788. ,

Alouki, K., Delisle, H., Bermúdez-Tamayo, C., Johri, M. (2016). Lifestyle Interventions to Prevent Type 2 Diabetes: A Systematic Review of Economic Evaluation Studies. Disease Markers. p1-14. 14p. DOI: 10.1155/2016/2159890

Banfield, M., Jowsey, T., Parkinson, A., Douglas, K. A., Dawda, P. (2017). Experiencing integration: a qualitative pilot study of consumer and provider experiences of integrated primary health care in Australia. BMC Family Practice, Vol. 17, p1-12. 12p. 5 Charts. DOI: 10.1186/s12875-016-0575-z

Begley, A., & Pollard, C. M. (2016). Workforce capacity to address obesity: a Western Australian cross-sectional study identifies the gap between health priority and human resources needed. BMC Public Health. Vol. 16 Issue 1, p1-11. 11p. 2 Charts, 1 Graph. DOI: 10.1186/s12889-016-3544-5.

Browne, J. L., Scibilia, R., & Speight, J. (2013). The needs, concerns, and characteristics of younger Australian adults with Type 2 diabetes. Diabetic Medicine. Vol. 30 Issue 5, p620-626. 7p. 3 Charts. DOI: 10.1111/dme.12078.

Burridge, L. H.; Foster, M. M.; Donald, M.; Zhang, J.; Russell, A. W.; Jackson, C. L. (2016). Making sense of change: patients’ views of diabetes and GP-led integrated diabetes care. Health Expectations. Vol. 19 Issue 1, p74-86. 13p. DOI: 10.1111/hex.12331.

Fazli, G. S.; Creatore, M. I.; Matheson, F. I.; Guilcher, S.; Kaufman-Shriqui, V.; Manson, H.; Johns, A. & Booth, G. L. (2017). Identifying mechanisms for facilitating knowledge to action strategies targeting the built environment. BMC Public Health, Vol. 17 Issue 1, p1-9. 9p. 2 Color Photographs, 1 Chart. DOI: 10.1186/s12889-016-3954-4

Glasson, N. M., Larkins, S. L., Crossland, L. J. (2017). What do patients with diabetes and providers think of an innovative Australian model of remote diabetic retinopathy screening? A qualitative study. BMC Health Services Research, Vol. 17, p1-16. 16p. 5 Diagrams, 3 Charts. DOI: 10.1186/s12913-017-2045-2.

Grantham, N. M.; Magliano, D. J.; Tanamas, S. K.; Söderberg, S.; Schlaich, M. P., & Shaw, J. E. (2013).
Higher heart rate increases the risk of diabetes among men: The Australian Diabetes Obesity and Lifestyle (AusDiab) Study. Diabetic Medicine, Vol. 30 Issue 4, p421-427. 7p. 2 Charts, 1 Graph. DOI: 10.1111/dme.12045.

Gubhaju, L., McNamara, B. J., Banks, E., Joshy, G., Raphael, B., Williamson, A., Eades, S. J. (2013).
The overall health and risk factor profile of Australian Aboriginal and Torres Strait Islander participants from the 45 and up study. BMC Public Health, Vol. 13 Issue 1, p1-14. 14p. 5 Charts, 1 Graph. DOI: 10.1186/1471-2458-13-661.

Jones, A., Magnusson, R., Swinburn, B., Webster, J., Wood, A., Sacks, G., & Neal, B. (2016). Designing a Healthy Food Partnership: lessons from the Australian Food and Health Dialogue. BMC Public Health, 16(1), 1-10. 10p. 4 Charts. DOI: 10.1186/s12889-016-3302-8. ,

Lin, I. B., Coffin, J., O’Sullivan, P. B. (2016). Using theory to improve low back pain care in Australian Aboriginal primary care: a mixed method single cohort pilot study. BMC Family Practice, Vol. 17, p1-14. 14p. 1 Diagram, 5 Charts. DOI: 10.1186/s12875-016-0441-z1.

McCoy, R. G.; Nori, V. S.; Smith, S. A.; Hane, C. A. (2016). Development and Validation of HealthImpact: An Incident Diabetes Prediction Model Based on Administrative Data. Health Services Research, Vol. 51 Issue 5, p1896-1918. 23p. DOI: 10.1111/1475-6773.12461

McKnight, J. A.; Wild, S. H.; Lamb, M. J. E.; Cooper, M. N.; Jones, T. W.; Davis, E. A.; Hofer, S.; Fritsch, M.; Schober, E.; Svensson, J.; Almdal, T.; Young, R.; Warner, J. T.; Delemer, B.; Souchon, P. F.; Holl, R. W.; Karges, W.; Kieninger, D. M.; Tigas, S.; & Bargiota, A. (2015). Glycaemic control of Type 1 diabetes in clinical practice early in the 21st century: an international comparison. Diabetic Medicine. Vol. 32 Issue 8, p1036-1050. 15p. 4 Charts, 1 Graph. DOI: 10.1111/dme.12676.

Schierhout, G., Matthews, V., Connors, C., Thompson, S., Kwedza, R., Kennedy, C., Bailie, R. (2016). Improvement in the delivery of type 2 diabetes services differs by mode of care: a retrospective longitudinal analysis in the Aboriginal and Torres Strait Islander Primary Health Care setting. BMC Health Services Research. Vol. 16, p1-18. 18p. 9 Charts, 1 Graph. DOI: 10.1186/s12913-016-1812-9

Shen, H., Edwards, H., Courtney, M., McDowell, J., Wei, J. (2013). Barriers and facilitators to diabetes self-management: Perspectives of older community dwellers and health professionals in China. International Journal of Nursing Practice, Vol. 19 Issue 6, p627-635. 9p. DOI: 10.1111/ijn.12114

Tina, N. C. J., Stewart, W. J. A; Parkinson, L., Sibbritt, D. W., Byles, J. E. (2016). Identification of diabetes, heart disease, hypertension and stroke in mid- and older-aged women: Comparing self-report and administrative hospital data records. Geriatrics & Gerontology International, 16(1), 95-102. 8p. DOI: 10.1111/ggi.12442.

Waterworth, P., Pescud, M., Braham, R., Dimmock, J., & Rosenberg, M. (2015).
Factors Influencing the Health Behaviour of Indigenous Australians: Perspectives from Support People. PLoS ONE, Vol. 10 Issue 11, p1-17. 17p. DOI: 10.1371/journal.pone.0142323.

Peritonitis Essay Paper Assignment Available

Peritonitis

Order Instructions:

Assignment Instructions
• You will each choose 3 different journal published research study articles that explain the patient’s behavioral and/or psychological responses to having the illness. Do not include articles discussing the physiology or pharmacology of the illness, treatment of the illness or behavioral/psychological responses, or the risk factors for first developing the illness.
• Locate relevant journal published research study articles (these articles need to have been written after 1997 and you must NOT use general literature review articles.
• Choose the 3 articles that best relate to your case study patient.
• Briefly summaries the main topic and focus of each study and include a very summary of the study’s methodology, results, and discussion (i.e. where the authors explain the reasons for their findings and research conclusions) for the articles;
• discuss how each article explicitly and specifically explains the behavioral and psychological responses that the patient in your case study is experiencing in response to their illness.
• Make sure you are using article databases such as PsycINFO, MEDLINE, and CINAHL to run your searches. PsycINFO is likely to find you the most relevant articles for this assignment and all assignments within the behavioral stream. Just using Google or Google Scholar will NOT find you the articles you need. Also, make sure that the search terms you are using will give the databases the best chance of returning the articles you want. If you get no results with one search term, then try another or try and think laterally (e.g. what might be another word for “aggression” that you might find in the literature… hint: what about “irritability”? Or another word for “anxiety” might be “fear” etc.).
• The articles you include must have been published in a journal. Do not include theses, magazines, books or book chapters, letter to the editor or news articles. Academic journals publish all sorts of articles including research studies, book reviews, general literature reviews, editorials/commentaries, letters) but for the articles you include in your Annotated Bibliography you need to use only research study articles. A research study article will describe in detail a qualitative or quantitative research study (e.g., an experiment) including information about the study’s methodology, results, discussion and conclusions. For example, the Module 1 reading Zeilani and Seymour (2012) qualifies as a research study article because the authors describe how they collected and analyzed their data. A Module 3 reading, Lusk and Lash (2005) is a general literature review and does not qualify as a research study as the author does not specify how they went about sourcing information for their article. Lusk and Lash’s article is still a credible and valid source of reference information but it is not a research study and so cannot be used in the Annotated Bibliography assignment.

SAMPLE ANSWER

Peritonitis is a health condition that involves the inflammation of peritoneum (thin protective tissue layer that underlie the abdomen). This health condition is caused by infection which spreads around the body. It requires immediate treatment to prevent fatal complications from arising. In patients who have undergone surgical treatment, autonomic responses, mood swings and psychological coping responses are common. This paper explores 3 different journal study articles that explain patient’s behavioral and psychological responses to this illness. This study focuses on behavioral and psychosocial responses following surgical responses.

Boer, K. R., Mahler, C. W., Unlu, C., Lamme, B., Vroom, M. B., Sprangers, M. A., … Boermeester, M. A. (2007). Long-term prevalence of post-traumatic stress disorder symptoms in patients after secondary peritonitis. Critical Care, 11(1), R30.

Introduction/Literature review: This study investigates the behavioral response following secondary peritonitis. This is because numerous hospital admissions and intensive care unit (ICU) can be physically, emotionally and financially exhaustive. Patients who survive critical illness report critical poor quality of live and symptomology (PTSD) such as numbing, anxiety, loss of avoidant and intrusive recollections. The study suggests that the behavioral interventions are vital in patients with secondary peritonitis.

Methodology: This is a retrospective cohort in patients diagnosed with secondary peritonitis. The study comprises of 278 patients who had undergone surgery for secondary peritonitis, where 131 of them were long term survivors. The patients were interviewed Post-traumatic Stress Syndrome 10-question inventory (PTSS-10).

Study/ Results: The study indicates that in a cohort of 100 patients diagnosed with secondary peritonitis, 86% of them presented with post traumatic stress disorder. PTSD related symptoms were also present in 4.3 times higher in older male patients.

Discussion/explanation: The study indicates that 25% patients who have received surgical treatment for peritonitis are likely to be emotionally and physically upset due to surgical-related trauma, which could exacerbate illness behavior. The study suggests that patterns of behavior are seen as a product of socio-cultural conditioning and coping strategies. The study suggests that healthcare providers should recognize patient’s responses to various health procedures associated with pain and anxiety. Other symptoms such as impaired appetite, lack of energy and disturbed sleep can occur due to illness. In addition, some treatments can affect patient’s mood. These conditions can also be aggravated by other environmental factors such as financial strain of lack of physical and emotional support.

Application to the case study: The study findings contribute to the body of research that demonstrates that psychosocial responses in patients are associated with the socio-cultural factors. The suggests that the healthcare providers should incorporate psychosocial interventions in routine care so as to help patients such as Mr. Jacobs to manage stress associated with their new lifestyles of dependency, helplessness and pain. It is important for the healthcare providers to identify and be aware of this hidden morbidity among the patients diagnosed with secondary peritonitis.

Jennifer Finnegan-John and Veronica J. Thomas, “The Psychosocial Experience of Patients with End-Stage Renal Disease and Its Impact on Quality of Life: Findings from a Needs Assessment to Shape a Service,” ISRN Nephrology, vol. 2013, Article ID 308986, 8 pages, 2013. doi:10.5402/2013/308986

Introduction/Literature review: This study investigates the psychosocial experiences in patients with end stage renal disease. The study conducts needs assessment on renal patients to explore their psychological, spiritual and social needs. The study objective was to investigate behavioral responses and to conduct needs assessment so as to develop a comprehensive health psychology that can run concurrently with renal counseling.

Methodology: The study design is prospective qualitative. The study population consisted of 50 patients with end stage renal disease. The mean age of the participants was 55 years and 40% of them were from black and minority ethnic group. The study utilized series of semi- structured face to face interviews in renal patients and their carers in order to explore their behavioral and psychological responses and how the disease impacted their quality of life.

Study/ Results: The study findings indicated that depressive symptoms and disruptive behaviors are common in renal patients. This is associated with the psychological burden associated with the disease. Most of the patients in the study had feelings associated with depression and anxiety.

Discussion/explanation: This retrospective study indicates that depression and anxiety is a common behavioral response in patient diagnosed with renal disease. The study suggests that about 25% of patients who are diagnosed with the disease suffer from psychological burden. This behavioral response is associated with emotional numbness, avoidance of social activities and events. It is also associated difficulty in sleeping, disruptive and reckless behavior and is easily irritated. The study states that these are body responses to stress or perceived threat.

Application to the case study: The study indicates that depression and anxiety is a behavioral response that goes beyond the mental health. Based on this study, Mr. Jacob’s behavioral responses (irritability, social isolation and binge drinking) could be associated with the emotional burden of the disease. This research is interesting because it suggests that healthcare providers should engage with psychiatrists to help them better manage their improved outcome health.

Mckercher, C.M., Venn, A.J., Blizzard, L., Nelson, M., Palmer, A., Sshby, M., Scott, J., and Jose. M.D. (2012). Psychosocial factors in adults with chronic kidney disease: characteristics of pilot participants in the Tasmanian Chronic Kidney Disease study. BMC Nephrology, 14:83DOI: 10.1186/1471-2369-14-83

Introduction/Literature review: This study investigates behavioral and psychosocial responses in patient diagnosed with chronic illness. The literature links health outcomes with depression, anxiety and dispositional tendency described by aggression, cynicism attitudes and anger/irritability. The study also indicates that hostility, anger and depression are related with renal failure experiences. According to this study, these psychosocial responses are controlled by biomedical risk factors, and are associated with most aspects of immune function.

Methodology: This study design is quantitative. The study consisted of 105 patients above 18 years diagnosed with stage 4 CKD and was not under dialysis. The measures used in this study include depression (9- item patient Health questionnaire) and Beck Anxiety Inventory to investigate behavioral responses with disease progression and patient’s quality of life.

Study/ Results: The study findings indicated that hostility and patient’s behavioral responses to chronic disease are correlated with their plasma levels of CRP. The study findings indicated that the cycle of inflammation levels influence depressive behavior, indicating that depression is problematic indicator of patients under chronic pain.

Discussion/explanation: The longitudinal study findings indicated that there is a relationship between the CRP levels and psychosocial factors. The study also states that hormonal changes also induce inflammatory processes which in turn influence psychosocial responses. For instance, pain initiates systemic stress which activates neuro-endocrinological pathways (hypothalamic-pituitary-adrenal axis) leading to the secretion of stress hormone. Accumulation of stress hormone is associated with hostility and depressive symptoms. The study also suggests that genetic predispositions play a major role in both inflammation and hostility.

Application to the case study: The study findings contribute to the body of research that demonstrates that psychosocial responses in patients are associated with systemic inflammation. This indicates that the Mr. Jacob’s depressive behavior (irritability, social isolation and binge drinking) is associated with elevated levels of the systemic inflammation. This research is interesting because it suggests that healthcare providers should reduce systemic inflammation so as to improve patient’s ability to improve pain, and to help them cope with the illness-induced stress in their lives.

References

Jennifer Finnegan-John and Veronica J. Thomas, “The Psychosocial Experience of Patients with End-Stage Renal Disease and Its Impact on Quality of Life: Findings from a Needs Assessment to Shape a Service,” ISRN Nephrology, vol. 2013, Article ID 308986, 8 pages, 2013. doi:10.5402/2013/308986

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Healthcare Law Risk Management and Liability

Healthcare Law Risk Management and Liability Order Instructions:

Part I

Laws that control healthcare come from four sources. One source is state and federal written constitutions.

Healthcare Law Risk Management and Liability

•Identify and explain the three other sources of laws that control healthcare.

Part II

Review the article by Curtis (Chapter 4) that appears on the background reading page. Prepare a paper that answers the questions and meets the criteria below. Here are the four topics.

ESTABLISHING A SAFETY CULTURE

* Why We Make Mistakes

* Local Culture and Safety culture

* Assessment of Safety Culture

* A Fair and Just Culture
1. Explain the central idea of each of the four areas.
2. Which of the four do you feel is the most important and why?
3. What does it mean to be accountable?
4. What does “hindsight bias” mean?

SLP Assignment Expectations
1. Limit your responses to a maximum of 1 page for Part I and three pages for Part II, not including title and reference list pages.
2. Be sure to utilize at least 3-4 scholarly references to support your discussions.
3. Be sure to properly cite your references within the text of your assignment and listed at the end.

Module 1 – Background

Healthcare Law, Risk Management, and Liability

Required Reading

Bromiley, Philip, et al. “Enterprise Risk Management: Review, Critique, and Research Directions.” Long Range Planning 48.4 (2015).

Curtin, M.A. (2011) Quality Improvement, Patient Safety & Efficiency in Outpatient Practice. Chapter 4, pages 41 to 57. http://www.ashrm.org/pubs/files/Quality-Manual-Final-Links-Verified-updated-2012.pdf

Neuberger, B. & Shoemaker, C.B. (n.d.) The legal basis of public health. Retrieved from Legal basis of public health.pdf

Pekkinen, L. and Aaltonen, K. (2015) Risk Management in Project Networks: An Information Processing View. Technology and Investment, 6, 52-62.

Simkins v. Moses H. Cone Mem. Hosp. 323 F.2d 959 (4th Cir. 1963) and the opinion of Sobeloff, Chief Judge. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448322/

The Purpose and Goals Of Risk Management. May 19, 2010 – Risk Management in the Health care Setting. http://www.slideshare.net/Msfent1/the-purpose-and-goals-of-risk-management-4159859

The Role of Risk Management in Healthcare Operations. Sharon Hall (October 2010) Parker, Smith & Feek. http://www.psfinc.com/press/the-role-of-risk-management-in-healthcare-operations

Healthcare Law Risk Management and Liability Module Overview

Part I – Healthcare Law

The healthcare industry is suffused with the law. As an “enterprise” (i.e., business, venture) the healthcare industry is subject to the principles that affect all businesses (everything from antitrust to zoning). On the other hand, as a distinct system or practice that saves lives, there is a complex system of regulations peculiar to healthcare. Accordingly, students of healthcare administration are asked to become familiar with the law and legal system. Many decisions and everyday actions were taken by healthcare administrators have legal implications. Furthermore, students must understand basic legal principles well enough to recognize when professional legal advice is needed.

We emphasize that the American judicial system is made up of two separate court systems: the federal court system and the state court systems.

We will cover different federal agencies involved in regulating healthcare.

Part II – Risk Management and Liability Healthcare Law Risk Management and Liability

The purpose of a risk management program is to reduce the number of patient injuries and minimize the exposure of an organization to lawsuits. An effective risk management program includes a monitoring system that identifies potential risks to patients and staff. Information gathered is used to improve patient care and treatment practices.

In risk management, steps are taken on a team-effort basis to improve the quality of care and eliminate or minimize the number of accidents that become potential lawsuits. Liability insurers have been strong proponents of risk management; in many cases, insurers have cut premiums for physicians and healthcare organizations who adopt risk management practices.

Healthcare Law Risk Management and Liability Sample Answer

Legal Aspects SLP Module 1

Introduction

This paper intends to discuss the legal aspects. The paper will address two parts of the legal aspects.

Part I

Sources of laws used in controlling health care

The first source of laws used in controlling health care is regulations shaped by agencies mandated with administration such as the United States Food and Drug Administration agency (“Case in Health Care Management”, 2014). The agency is responsible for protecting the public in the United States from being sold; unsafe foods, hazardous drugs, perilous medical devices, precarious cosmetics, along with various other hazardous products. Thus, annually the FDA is responsible for regulating more than $1 trillion products, which is equal to one-fourth of the entire spending by United States consumers (Mead, 2014). The FDA also gives protection to patients’ rights along with patients’ safety regarding clinical trials in reference to innovative medical products. Furthermore, FDA monitors how drug promotional activities are conducted by device manufacturers, and also regulates how packaged foods are labeled. Additionally, FDA monitors how safe the country’s blood supply is (Mead, 2014).

The second source of laws used in controlling health care is rulings made in court. The courts are responsible for examining whether proposed policies are aimed at achieving the health interests of the public (Rowe, 2012). Thus, the courts should give a clear definition of the proposed policies and their purpose. Furthermore, courts should provide protection against biases in making decisions, hence facilitating public debates. The third source of laws used in controlling health care is common law. Notably, common law is influential in ensuring that confidentiality is exercised between doctors and their patients (Rowe, 2012).

Part II

The fundamental idea of why people make mistakes

People make mistakes due to possession of a poor insight regarding the things they do well, along with the things they do poorly. Thus, if an individual had an enhanced insight then it is likely that they will do more things that they formerly did as opposed to the things they did later. Additionally, people make mistakes due to the deprivation of sleep or being unhappy. Other people make mistakes due to over-optimism, which provides them with a sham judgment of confidence (“Case in Health Care Management”, 2014). Furthermore, when an individual relies on their memory, they are more likely to make mistakes since memory is meant to be for reconstruction as opposed to reproduction.

The fundamental idea of local culture along with safety culture

In any organization, acts that are based on the approach of improving the safety of patients are referred to as safety culture. However, improving the safety of patients involves identification of the history of the practice, recognition of leadership, appreciation of staff experience and working within available budget concerns, which all constitute to local culture. Thus, the local culture is responsible for setting appropriate behavior or fostering unsafe behavior within the workplace (“Case in Health Care Management”, 2014). Furthermore, local culture is responsible for guiding staff decisions on different questions.

The fundamental idea of assessment on safety culture

When assessing safety culture the first step involved is to evaluate the safety culture being practiced at the time. Currently, two existing organizations conduct assessments on safety culture through offering questionnaires to be used in utilization, evaluation, and an indication of a baseline for practicing a culture of patient safety (“Case in Health Care Management”, 2014). The two organizations are AHRQ which stands for Agency for Healthcare Research and Quality, while the other organization is the University of Texas’s Center of Excellence for Patient Safety Research and Practice (Rowe, 2012).

The fundamental idea of a fair culture and a just culture

A fair culture involves the examination and understanding of the tolerance level involved in open communication, management of trust and maintenance of trust, along with the handling of errors through leadership (“Case in Health Care Management”, 2014). Moreover, staff members are likely to perform best when they are in an environment which is blame-free. Thus, in order to create a culture which is just, management of practice is expected to reorganize the disciplinary process (Mead, 2014).

Which among the four areas above is most important?

The most important area of the four areas is local culture along with safety culture. Notably, the local culture determines how an organization conducts its operations. The local culture determines the way an organization is accustomed to conducting its operations from a historical perspective. Thus, it is easier to identify and acknowledge any existing errors in operations being conducted by an organization (“Case in Health Care Management”, 2014). Consequently, all organizations that acknowledge local culture gain the advantage of carrying out effective plans for a safety culture. A safety culture will, therefore, involve plans that necessitate the involvement of employees in developing new plans for conducting operations in the organization.

What being accountable means of Healthcare Law Risk Management and Liability

Being accountable implies making commitments and stretching to achieve the commitments. Exercising accountability implies understanding the fact that agreeing to do something on a given day translates to making an assurance (“Case in Health Care Management”, 2014). In most cases, the assurance is made to the boss of an institution, the coworkers of the individual giving an assurance, or customers to the individual giving an assurance (Office, 2015). Accountability thus involves not having any groundwork regarding failure. Hence, an individual who is accountable always proposes methods of recovering when any plan goes wrong. Additionally, an individual who is accountable does not blame other people for mistakes that occur.

Meaning of hindsight bias and Healthcare Law Risk Management and Liability

Hindsight bias refers to an inclination that a given event may have been predictable before it occurred, despite nonexistence of a basis of prediction. Thus, the assumption by hindsight bias is that a person finds it simple to discern the appropriate way to react when an incident happens, though it is challenging to appropriately foretell the future (Office, 2015). Furthermore, hindsight bias involves judging things after they already happen. Therefore, hindsight bias has the possibility of causing memory distortion, in which recollection along with reconstruction of substances may result in false speculative outcomes.

Healthcare Law Risk Management and Liability Conclusion

Legal Aspects provide a platform for the efficient operation of activities conducted within different institutions. The essay above has conclusively discussed legal aspects. First, the essay has pointed up three sources of laws that are used in controlling health care. The three sources are agencies that make regulations, rulings made in court, and the common law. Furthermore, the essay has demonstrated fundamental ideas regarding why people make mistakes, fundamental ideas of local culture along with safety culture, the fundamental idea of assessment on safety culture and the fundamental idea of a fair culture and just culture.

Healthcare Law Risk Management and Liability References

Case in Health Care Management. (2014). The Health Care Manager, 33(3), 227-229. http://dx.doi.org/10.1097/hcm.0000000000000023

Mead, J. (2014). Healthcare and Law Digest. Clinical Risk, 20(3), 76-80. http://dx.doi.org/10.1177/1356262214529692

Office, L. (2015). Acknowledgment to Reviewers of Laws in 2014. Laws, 4(1), 16-17. http://dx.doi.org/10.3390/laws4010016

Rowe, S. (2012). Explaining the laws of unplanned care. British Journal Of Healthcare Management, 18(4), 192-197. http://dx.doi.org/10.12968/bjhc.2012.18.4.192

Risk Management Program in Durham VA

Risk Management Program in Durham VA Order Instructions: The facility is Durham VA in North Carolina

The Session Long Project for this course is to evaluate and critique a health care facility you are familiar with and compare it to the general principles and standards for quality assurance presented in this course.

In the earlier modules, you identified a health care facility for the subject of the SLP and presented a description of the facility and its quality assurance program. You also critiqued the facility’s Continuous Quality Improvement program, the Utilization Management Program, and Case Management Program.

In this module, you will discuss and critique the subject facility’s Risk Management program.

SLP Assignment Expectations

For this module you are to complete the following tasks in a 4- to 5-page paper:
•Describe and discuss the facility’s Risk Management program. Do you feel their Risk Management program is adequate?
•Compare and critique the subject facility’s Risk Management program to that of a model facility and whether the facility adheres to the recognized standard for risk management.
•Identify areas for improvement in the facility’s Risk Management program, if any, and any recommendations you think should be implemented to lower risks in the facility. Give valid reasons for your answer.

Risk Management Program in Durham VA Introduction

Risk management programs were initially developed to reduce the incidents of malpractice lawsuits. However, risk management programs have evolved to a higher level of sophistication and are not designed to reduce preventable injuries and accidents and, of course, minimize financial severity of claims.

An effective risk management program usually operates on 18 bases to improve the quality of care by eliminating or minimizing the number of accidents or medical errors that occur in a health facility.

Risk management programs should include the following elements:
•A grievance or complaint procedure which is processed, investigated and resolved in a timely manner
•Collection of data related to all negative healthcare outcomes that occur with in the health facility
•A medical care of the evaluation process which will periodically assess the quality of medical care provided in the facility
•Educational programs for staff which focuses on patient safety, medical injury prevention, legal aspects of patient care, problems with communicating and establishing rapport with patients

Although risk management programs should include the elements mentioned above they should also carry out the following functions:
•Prepare incident reports
•Evaluate the frequency and severity of incident exposure
•Develop and implement corrective actions to reduce risk and exposure to liability
•Develop policies and procedures to ensure early intervention and sympathetic care after an accidental injury to a patient
•Identify and investigate specific incidents of patient injuries and provide appropriate intervention if required
•Train and educate all staff, including clinicians, to minimize exposure and lower risks
•Maintain a public relations program

And some health-care facilities, the risk management program also includes a health risk assessment program. The purpose of this program is to educate staff and patients about the connection between lifestyle habits and disease with an outcome of lowering potential risk factors for disease. In other words, and effective health risk assessment program will lower individual health risks.

Risk Management Program in Durham VA Required Reading

Anand, U. A., Asif, A. S., Muhil, S., & Thomas, L. (2015). Healthcare risk evaluation with failure mode and effect analysis in established of the new dialysis unit. The Journal of National Accreditation Board for Hospitals & Healthcare Providers, 2(1), 15.

Asefzadeh, Saeed; Yarmohammadian, Mohammad H.; Nikpey, Ahmad; Atighechian, Golrokh, (2013).Clinical risk assessment in the intensive care unit. International Journal of Preventive Medicine4(5), 592 – 598.

Aurel Oiuga, Aurel, McGuir, Marua J., (2014). Adherence and health care costs. Risk Management and Healthcare Policy, 7, 35-44.

Farokhzadian, J., Nayeri, N. D., & Borhani, F. (2015). Assessment of clinical risk management system in hospitals: An approach for quality improvement. Global Journal of Health Science, 7(5), 294-303. Retrieved from http://search.proquest.com/docview/1667361206?accountid=28844

Fibuch, Eugene, Ahmed, Arif, (2014). The Role of Failure Mode and Effects Analysis in Health Care. Physician Executive40(4), 28-32.

Murphy, J. S., Reid, M., Ali, A., Harrington, L., & Sandel, M. (2015). Applying Failure Modes and Effects Analysis to Public Health Models: The Breathe Easy at Home Program. Frontiers in Public Health Services and Systems Research, 4(4), 29-35.

Rodríguez-Pérez, J. & Peña-Rodríguez, M. E. (2012). Fail-safe FMEA: Combination of quality tools keeps risk in check. Quality Progress, 45(1), 30-36.

Shea, M. J. (2014). Assessing a risk management programme. Pharmaceutical Technology Europe, 26(9), 48-50. Retrieved from http://search.proquest.com/docview/1625580328?accountid=28844

Shirouyehzad, H., Dabestani, R., & Badakhshain, M. (2011). The FEMA approach to identification of critical failure factors in ERP implementation. International Business Research, 4(3), 254-263.

Stewart, A. (2011). Risk management: The reactive versus proactive struggle. Journal of Nursing Law, 14(3/4), 91-95.

Risk Management Program in Durham VA Optional Reading

Fassett, W. E. (2011). Key performance outcomes of a patient safety curricula: Root cause analysis, failure mode and effects analysis, and structured communication skills. American Journal of Pharmaceutical Education, 75(8), 1-5.

Websites

Richards, E.P., & Rathbun, K.C. (n.d.). Chapter 2 – Risk Management. Medical Risk Management. Retrieved from the web November 2012 at http://biotech.law.lsu.edu/Books/aspen/Aspen-Chapter-2.html

Risk Management Program in Durham VA Sample Answer

Risk management Program in Durham VA

The risk management program used to establish a culture of safety within the organization is the Root Cause Analysis program. The facility has employed a full time patient safety manager who is responsible for conducting investigations on all adverse events at a local level. The safety manager rates all the adverse incidences reported in the organization using two criteria; a) harm in terms of catastrophic to minor and b) probability in terms of frequency and remote. In this healthcare facility, harm is rated using four tier scale including a) catastrophic which includes all events that leads to permanent loss of function or death; b) major level which is associated with permanent lessening of patients body function; c) moderate level which includes lengthened stay or increased level of care and d) Minor which is associated with mild injuries. The probability of the event is rated as frequent, occasional, uncommon and remote (Durham VA, 2015).

The aim or RCA program is to identify the adverse events, why it occurred and ways to prevent it from occurring again. The Durham VA has embraced a culture of safety that is not based on punishment but on prevention. The RCA team conducts an investigation on the functioning of patient care systems using the Human Factors Engineering (HFE) approaches with the aim of supporting human performance. The RCA team includes representatives from frontline clinical staff as they are strategically placed to identify clinical adverse events and plausible solutions (Mills et al., 2008).

The RCA strategy is adequate because it includes analysis of human factors, environment factors, the healthcare facility processes and systems. In addition, the process also involves an in-depth analysis of the cause –effect system as it leads to an identification of risks and its potential contribution. The method follows a pre-specified protocol that begins with data collection, reconstruction of the events in question by recording the perceptions from participant’s interviews. The identified multi-disciplinary team then analyzes the sequence of events that led to the event with the aim of identifying active errors that led to the incidences, systematic identification of the causes and comprehensive analysis of the latent errors. The ultimate aim for RCA is to prevent more harm from occurring in the future by eliminating the latent errors that underlies the adverse events (Durham VA, 2015).

For instance, a case scenario where the patient underwent a cardiac procedure that was to be done in another patient who had similar surnames. If traditional risk management strategy was to be used on this patient, then the analysis would have primarily assigned the blame to the healthcare provider on duty, probably the nurse who prepared the patient for the procedure without cross checking for the second time. However, the facility applied RCA strategy which led to the identification of 17 distinct errors that ranged from organizational factors (the department used error prone system that identified patient using their surnames and not patient identification number), work environment factors (the nurse and neurosurgeon did not cross check the names of the patient) among others. Through RCA, the healthcare facility has implemented crucial systematic changes that reduce the risk of similar events in the future (Durham VA, 2015).

Compare and critique subjects risk management program with FMEA

The RCA process is a risk management tool that effectively identifies strategic preventive measures, a process that is part of building the culture of safety. Using this strategy, the basic and contributing causes are identified through similar approaches such as the diagnosis of disease with the aim of treating the disease and preventing it from re-occurring. This process involves multidisciplinary experts from the front line who are familiar with the situation. The team continually digs deeper by evaluating the cause and effect at each level. Through this process, they are able to identify safety measures that should be changed or integrated into the healthcare facility (Mills et al., 2008).

RCA differs considerably from FMEA. For instance, FMEA is a proactive risk management whereas RCA manages risk at their occurrence. RCA is structured in analytic methodology that is used to evaluate the underlying contributions to adverse events and its implementation. On the other hand, FMEA is a structured analytic method used primarily to identify the appropriate basis in which the process can reduce the likelihood of occurrence to such failure. However, the main advantage of the RCA process is that it is as impartial as possible (Anand, Asif, Muhil, & Thomas, 2015).

In addition, the risk management program adhere to the recognized standards of risk management in that it facilitates the preparation of reports, evaluates frequency and severity of the adverse effects, help to develop as well as to implement strategic corrective measures that will reduce exposure to similar liability. The program also improves the process of investigating specific incidents and in developing specific policies and procedures and to give appropriate intervention where necessary. This risk management program helps in educating staff and patients regarding the connection between disease and lifestyle habits with the aim of lowering individual and healthcare risks (Durham VA, 2015).

Areas for improvement and recommendations

RCA is a valuable technique used to understand the root cause of adverse effects. However, the program is not very effective in complex systems because they normally do not have a single root cause. This is because failures of a complex system emerge from confluence occurrences and conditions associated with the pursuit of success. Each of the elements is important but causes sufficient harm when combined jointly in a specific sequence. Therefore, this calls for an approach that involves both technological and organizational influences. It is important to understand that human performance and variability is not intrinsically coupled with causes and it requires diverse components complexity is systems that do not only identify system vulnerabilities but also augment system resilience (Mills et al., 2008).

There are various systematic risk management programs that can be used effectively, but the evidence based program is the FMEA. FMEA is recommended because it is a logical risk management program that is structured in a way that it effectively evaluated processes and reveals healthcare areas that needs to be improved. One most critical advantage of this system is its ability to make early identification of single failure points or system interface that hinders success and negatively impact on patient safety (Fibuch and Ahmed, 2014).

Risk Management Program in Durham VA References

Anand, U. A., Asif, A. S., Muhil, S., & Thomas, L. (2015). Healthcare risk evaluation with failure mode and effect analysis in established of the new dialysis unit. The Journal of National Accreditation Board for Hospitals & Healthcare Providers, 2(1), 15.

Durham VA. (2015). Risk management and compliance service. Retrieved from https://www.va.gov/oal/about/rmc.asp

Fibuch, E., and Ahmed, A.(2014). The Role of Failure Mode and Effects Analysis in Health Care. Physician Executive40(4), 28-32.

Mills, P.D., Neily, J., Kinney, L.M., Bagian J., and Weeks, W.B. (2008). Effective interventions and implementation strategies to reduce the adverse drug events in Vthe eterans Affairs (VA) system. Qual. Saf. Healthcare 17; 37-46 doi:10.1136/qshc.2006.021816

The Pros and Cons of Qualitative Research

The Pros and Cons of Qualitative Research Order Instructions: The pros and cons of qualitative research

The emphasis of this week’s discussion is on the importance of qualitative research and your ability to select the appropriate methodologies for the collection of the necessary data. It is important that you highlight the main issues involved in qualitative methodologies. Furthermore, you will try to tease out the strengths and weaknesses of different methods of data collection and sample selection.

The Pros and Cons of Qualitative Research Interpretivist Research

Aim: To identify and explore the human resource strategies that influence employee engagement within organizations in Qatar and to develop recommendations on how these human resource strategies can be changed in order to improve employee engagement.

The Pros and Cons of Qualitative Research Research Questions

RQ 1: Which human resource strategies influence employee engagement within organizations in Qatar?

RQ 2: How do these human resource strategies influence employee engagement within organizations in Qatar?

RQ 3: How can these human resource strategies be changed in order to improve employee engagement within organizations in Qatar?

End Product:Objective: To develop recommendations on how human resource strategies can be changed in order to improve employee engagement within organizations in Qatar.

The Pros and Cons of Qualitative Research Sample Answer

Qualitative research is a common expression about analytical methodologies and practices explained as an anthropological, ethnographic, field, naturalistic or the observer study, (Silverman, 2016). This type of the survey expresses stress on the significance of analyzing on variables in their original set up where they are found. Ample data is gathered by using open-ended questions that offer straightforward quotations. The researcher uses various methods such as grounded theory, case study, action research and ethnography to collect data, (Corbin, and Strauss, 2014). The methods of collecting data under the qualitative research methodologies have different pros and cons. The advantages and disadvantages of these methods will be discussed in general as follows, (Eriksson, and Kovalainen, 2015)

The Pros and Cons of Qualitative Research Advantages

They help the researcher to get a clear vision on what to anticipate. That is they gather data in an authentic effort of corking data to bigger images.
The collected data based on personal experiences and it is more powerful and compelling that the data gathered from the perspective of quantitative research.
The data collected is gathered from few people or selected case. It means that the outcome and the findings cannot be stretched to the entire population.

The Pros and Cons of Qualitative Research Disadvantages

The findings may take a lot of time. It makes it hard to present in illustration manner.
The issues of anonymity and confidentiality can pose challenges throughout the presentation of the outcomes.
Rigidity is more complicated to demonstrate, assess and maintain.

Furthermore, to come up with the probable outcome, the collected data should be sampled by using different sampling techniques depending on the methods used to obtain it. Some of these sampling methods include cluster snowball, purposive, and theoretical sampling. All of them has different merits and demerits.

Part two

Qatar University is one of the biggest universities in Qatar. To keep up with the Qatar Vision 2030, the University has formulated a human resource plan. The plan is aimed to assist with the accomplishment of the organizational strategic goals as explained by the Qatar University strategic plan and to become conscious of the objectives of the Qatar University reorganization project.

To ensure that the plan is amended to the latter, the Qatar University has to employee leadership and communication as part of their human resource so as to engage the employee, (Hackman, and Johnson, 2013). It’s because according to their vision for a human resource they state that “Human Resources supports Qatar University leadership in delivering educational excellence and in creating an employment experience that is recognized internally and externally as a model in the region – QU is both a model national university and a model employer!”.

Leadership and communication play a vital role in employee’s engagement. Leadership can be shaped as democratic and autocratic. In situations where there is a slighter adverse change, an authoritarian leader is needed to ensure that things get back to normal. The aim of QU is to make the University better. If there exist any non-performing staffs, then the autocratic leader must react. On the other hand, it is necessary for the voice of employees to be heard. Creating channels of communication will make the employees see they are important. With the Democratic leader, they can air their views since they know they will be heard.

Human resource management is inspected as a necessary activity in a company, (Grant, 2016). It assists in creating an aggressive edge for the firm by confidently engaging its employees. To make it happen, the ingredients that should be allowed are two-way communication and effective and efficient leadership. It builds an honest and open business environment where the workers feel that their views are heard, and the can contribute to decision making, (Men, 2014)

The Pros and Cons of Qualitative Research Bibliography

Corbin, J. and Strauss, A., 2014. Basics of qualitative research: Techniques and procedures for developing grounded theory. Sage publications.

Eriksson, P. and Kovalainen, A., 2015. Qualitative Methods in Business Research: A Practical Guide to Social Research. Sage.

Grant, R.M., 2016. Contemporary strategy analysis: Text and cases edition. John Wiley & Sons.

Hackman, M.Z. and Johnson, C.E., 2013. Leadership and Communication.

Men, L.R., 2014. Why leadership matters to internal communication: Linking transformational leadership, symmetrical communication, and employee outcomes. Journal of Public Relations Research, 26(3), pp.256-279.

Silverman, D. ed., 2016. Qualitative research. Sage.

Structure of Eukaryotic Cells and Importance of Membranes

Order Instructions:

Assignment requested deadline November 22; NLT 8pm. Please read below for information concerning assignment. Support responses with examples and use APA formatting in the paper. You may access the school’s website by logging into:
https://mycampus.southuniversity.edu/portal/server.pt

Please note that when you log into the website you must click launch class, and on the next screen click syllabus to view this week’s readings (week2) and Academic Resources to access the school’s library.

The minimum length for this assignment is 1,200 words.

Structure of Eukaryotic Cells and Importance of Membranes

Eukaryotic cells are the most structurally advanced of the major cell types. Describe the structure and function of each of the eukaryotic organelles. Distinguish between those that are and are not membranous. Most are membranous. Explain the importance of membrane structure and function in the organization of living processes within cells.

Please be as thorough and original as possible.

SAMPLE ANSWER

Structure of Eukaryotic Cells and Importance of Membranes

Introduction

Eukaryotic cells are present in plants, animals, protozoa, and fungi (Voet, 2012). This paper will explore the structure and function of the eukaryotic cell organelles. The paper will also discuss the structure and function of biological membranes including the cytoplasmic membrane. A special focus will be given to internal membranes that enclose cellular organelles such as the nucleus, the mitochondrion, the peroxisome, the lysosome, the chloroplast, and the endoplasmic reticulum.

Cell Structures and Functions

The Cell Wall and Glycocalyx

The cell wall is a rigid layer that surrounds some cells, is composed of one or more polysaccharides, and provides additional strength to the cell. Higher plants and algae have cell walls made up of cellulose, pectin, and hemicellulose. Chitin is the main polysaccharide of fungal cell walls, while yeast cells have cell walls composed of mannan and glucan. An external layer called glycocalyx that strengthens the cell and facilitates attachment to neighboring cells surrounds animal cells (Voet, 2012).

The Cytoplasm

The cytoplasm is bound by the plasma membrane and includes all the materials inside the cell with the exclusion of the nucleus. It comprises of a gel-like substance called cytosol and internal cell substructures called organelles. Most of the cell activities such as cell division and metabolism occur in the cytoplasm. It is approximately 80% water, has dissolved salts and biomolecules such as proteins and carbohydrates and suspended insoluble molecules such as lipids (Nelson & Cox, 2013; Voet, 2012).

The Cytoskeleton

The cytoskeleton is a lattice-like array of cell fibers and fine tubes. It has three components namely: microtubules, microfilaments, and intermediate filaments. Microtubules maintain the cell shape and play central roles in chromosome segregation during cell division, endocytosis, and cell differentiation. Other eukaryotic cell structures derived from microtubules include cilia, flagella, centrioles, and spindles. Microfilaments are involved in cell shape change, phagocytosis, cyclosis, and amoeboid movement while intermediate filaments anchor membrane-bound organelles in the cytoplasm (Berg, Tymoczko, & Stryer, 2012; Voet, 2012).

Membrane-Bound Organelles

The nucleus is arguably the largest cell organelle and is bound by a membrane called nuclear envelope, which is punctuated into pores. The nucleus contains the genetic material called DNA and controls all the activities of the cell. The Endoplasmic Reticulum (ER) is a network of tubules that act as the transport system of the cell. There are two types of ER: rough ER and smooth ER. The rough ER is coarse in appearance because it is lined with ribosomes and is involved in the transport of proteins, while the smooth ER has no ribosomes and is the lipid transport system.

The Ribosomes are small particles either scattered in the cytosol or lined on the surface of rough ER. They contain RNA and proteins in almost equal proportions. The ribosomes function as the sites of protein synthesis. The Golgi apparatus is a membrane-bound eukaryotic cell organelle made up of tubes called cisternae. The Golgi is supported by microtubules and is located in proximity to the nucleus and the ER. The Golgi performs post-translational modification of proteins, packages them into vesicles, and exports them into target cell compartments(Berg et al., 2012; Voet, 2012).

The lysosomes are roundish, vesicular structures of animal cells that have a lumen containing hydrolytic enzymes. The pH of the luminal contents is 4.5-5.0 which is optimal for lysosome enzymes. The lysosome digests unwanted materials from outside the cell as well as obsolete cell components. The centrosome is present in eukaryotic animal cells and is made up of two centrioles and surrounding pericentriolar materials. The centrioles are short cylinders arranged such that they are perpendicular to each other. The centrosomes are microtubule-organizing centres that contain gamma-tubulin. The microtubules grow out of this gamma-tubulin in the pericentriolar material. The Vacuole is the major acid-containing organelle of plant and fungal cells. It contains a fluid called cell sap and is surrounded by a membrane called tonoplast. The plant vacuole is the equivalent of the lysosome in animal cells as it has hydrolytic enzymes that digest waste materials. The vacuole is also involved in maintaining cell turgor pressure (Berg et al., 2012; Nelson & Cox, 2013).

The mitochondrion and the chloroplast are two organelles involved in energy production. The mitochondrion is sausage-shaped double membrane cell structure whose inner membrane is invaginated to form cristae. The mitochondrial matrix contains ribosomes and DNA and is therefore self-replicating and semi-autonomous. The main function of the mitochondrion is synthesis of ATP. The chloroplast also has a double membrane and is present in plant cells. It has internal structures such as thylakoids and stroma and its main function is to carry out the process of photosynthesis. The peroxisome is another self-replicating organelle that has enzymes for oxidative degradation of molecules such as uric acid, amino acids, purines, methanol, and fatty acids (Nelson & Cox, 2013).

Structure of Biological Membranes

A biological membrane is composed of a phospholipid bilayer. The membrane is amphipathic, meaning that the polar phosphate lipid heads are on the surface while the hydrophobic tails point inwards. The lipid molecules diffuse rapidly in the plane of the biomembrane but not across. Also, the phospholipid molecules can move laterally from one side of the bilayer to the other, a process called the flip-flop. Moreover, biological membranes are asymmetric, meaning that the two phases are different from each other. In addition to the lipids, membranes also have proteins that move freely within the membrane, and this makes the membrane fluidic and mosaic. The proteins are categorized into either integral or peripheral proteins depending on their degree of association with the membrane. Integral proteins penetrate deep into the bilayer while peripheral proteins are superficially located. Some lipids are linked to carbohydrates to form glycolipids. Cholesterol is present in animal cells and is involved in maintaining membrane fluidity (Berg et al., 2012; Nelson & Cox, 2013).

General Functions of Biological Membranes

The plasma membrane plays a role in establishing a physical barrier between the cell contents and extracellular environment. Biomembranes also facilitate the formation of membrane-enclosed organelles a process called intracellular compartmentalization. Compartmentalization establishes microenvironments and biological barriers between biochemical processes, which allow the cell to carry out different processes simultaneously. Biomembranes are selective permeability barriers as they confine certain molecules within a specific region while restricting the entry of others (Voet, 2012). They contain molecular pumps, sinks, and gates or channels that regulate the molecular and ionic composition of the intracellular or intra-organelle medium. Membranes are the sites of biochemical processes such as oxidative phosphorylation (inner mitochondrial membrane) and photosynthesis (thylakoid membrane). Membranes also have receptors that trigger signal transduction (Berg et al., 2012).

The Plasma and Organelles Biomembranes

The Plasma Membrane

This is the biological barrier between the cell and the external environment. It has biomolecules for intercellular communication and transport. Based on the external environment, the cell membrane can either be an apical, sinusoidal or basolateral membrane. Contact between cells is either through tight junctions, gap junctions or desmosomes (Voet, 2012).

The Nuclear Membrane

The nucleus has a double membrane that is often continuous with the ER membrane. It houses and protects the genetic material and keeps the confines the DNA processing molecules closer to the DNA itself. The nuclear membrane also creates a barrier between transcription and translation and ensures that the two occur as separate processes. Nuclear membrane has nuclear pores, which allow passage of mRNA-protein complexes from the nucleus to the cytoplasm and passage of regulatory proteins from the cytoplasm into the nucleoplasm (Berg et al., 2012).

The Mitochondrial Membrane

The mitochondrion has inner and out membranes. The outer membrane has integral channels called porins that allow proteins less than 5KDa to diffuse through. A translocase is involved in the shipping of larger proteins. The outer membrane forms structures with the ER called mitochondria associated-ER membrane that are useful in calcium signaling and transfer of lipids between the two organelles. The inner membrane is impermeable to all molecules, and they require a transporter to pass through. The inner membrane is convoluted to many cristae to increase surface area for ATP synthesis (Berg et al., 2012; Nelson & Cox, 2013).

The ER and the Golgi Membranes

The ER membrane is an extension of the plasma membrane and is attached to the nuclear membrane. The ER membrane can form vesicles containing proteins that then fuse with the Golgi membrane. The Golgi membrane also facilitates the secretion of processed proteins via exocytosis (Berg et al., 2012).

The Chloroplast Membrane

This is a double membrane enclosing a third internal membrane called thylakoid membrane, which is a system of interconnecting compartments. The thylakoid membrane is the site of energy synthesis and contains a series of proteins collectively referred to as electron transport chain. The outer chloroplast membrane is highly permeable to small organic molecules, while the inner membrane is less permeable and has transport proteins as well as light harvesting pigments (Berg et al., 2012; Voet, 2012).

Lysosome Membrane

This membrane separates the cytoplasm from the acidic milieu of the lysosome. The lysosome membrane has glycosylated membrane proteins called lysosome-associated membrane protein (LAMP) which mediates contact to cytosolic proteins and with other cell organelles. Thus, the lysosome membrane and its proteins facilitate lysosome motility, exocytosis, phagocytosis, macroautophagy among other lysosome functions (Voet, 2012).

Peroxisome Membrane

This biological barrier surrounds the peroxisome and provides a compartment for oxidation reactions. It has membrane proteins called peroxins (PEX) that shuttle proteins between the peroxisome membrane and the cytosol. The peroxisome shuttling process is dependent on ATP and ubiquitylation (Voet, 2012).

Conclusion

Eukaryotic cells have subcellular structures called organelles that have specific functions. Both the plasma membrane and the organelle membrane are composed of lipid bilayers, proteins, and glycans. The plasma membrane is the biological barrier to the extracellular environment. The organelle membranes create microenvironments suitable for specific biochemical reactions.

References

Berg, J. M., Tymoczko, J. L., & Stryer, L. (2012). Biochemistry (7 ed.): W. H. Freeman.

Nelson, D. L., & Cox, M. M. (2013). Lehninger Principles of Biochemistry (6 ed.): W.H.Freeman.

Voet, D. (2012). Fundamentals of Biochemistry: Life at the molecular level: Wiley.

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