Response Journal for “Boys and Girls” by Alice Munro Essay

Alice Munro’s â€Å"Boys and Girls† tries to view a young girl’s rite of passage into womanhood, through a limited feminist perspective. The narrator battles with conformity on a 1940’s Canadian Fox Farm. As this time period was still centred on male dominance, her desire to become a powerful woman wastes away when she finally submits to the rules that society has imposed on her. The story is written in first person narration and is seen through the eyes of a young and free-spirited girl. The themes of this story are self-discovery, stereotypes, and rebellion. To portray these themes, literary devices such as allusion, similes and situational irony were used. Allusion is present in the line â€Å"his favourite book in the world was Robinson Crusoe,† as the author attempts to portray the father’s inventive nature by relating it to a well-known novel. Similes can be seen in the narrator’s descriptions of her environment as she states that the â€Å"snowdrifts curled around the house like sleeping whales,† to bring to attention the howling of the winds. Situational irony is evident throughout the story because the narrator despises her mother for being a woman and working in the house, but in the end, she too develops into a woman and takes on the roles of the title. This story of inequality between the sexes appropriately opens with a detailed account of the narrator’s father. The narrator describes every aspect of her father’s life, including his occupation, and even his friends. Throughout this first part of the story, the narrator’s mother is virtually inexistent, outside her disapproval of her husband’s pelting business. The reader is left uncertain about the mother’s whereabouts, but is aware that the father figure is somewhat of an idol in the narrator’s mind. As a young girl, the narrator, holding on to her carefree spirit and strong sense of individualism, is unaware of the constraints of her gender. Although she is the main character, the narrator is not given a name. This seems to enhance her lack of purpose in society, and stresses that the attitude of the narrator is not that of just one woman, but women in general. Munro’s decision to allow the narrator to remain nameless assists in the progress and significance of the character. The narrator’s brother, however, is given the name of Laird. Synonymous with â€Å"lord,† the boy’s name plays an important role in outlining the rules society has forced upon the narrator. This name symbolizes society’s favouritism towards men, and how the male child was superior in the eyes of the parents. The fact that the narrator remained anonymous, whilst her brother was given the name of Lord, signifies the difference between the sexes at the time. It is quite odd that Munro used the girl to portray the feelings of female stereotyping of this story. Munro captures the attention of her audience through the lines, â€Å"It was an odd thing to see my mother down at the barn. She did not often come out of the house unless it was to do something- hang out the wash or dig potatoes in the garden.† These lines are full of sexism and serve only to relay the common roles that women were forced into. Although aware that the girl would much rather spend time with her father, the family constantly attempts to encourage her to act as a proper girl should. The fact that the narrator idolizes her father, just provides further proof of her strive to gain equality. As the girl grows older, the pressure from her family becomes more intense. The narrator’s grandmother comes off as the perfect example of the how women were thought of at the time. Having been raised in a time where the rules imposed on women were even stricter, the grandmother best voices what the attitude of a girl should be. The narrator, however, refuses to listen to the advice offered to her, and responds with defiance. The girl still seems to believe that if she does not conform to society’s rules, she can hold on to her freedom and will somehow be able to escape with her individuality. It is only through the killing of the horse, Flora, that the narrator finally assumes her appropriate gender roles and enters her rite of passage. To help Flora escape her inevitable fate, the narrator leaves the gate open. It seems as though the narrator believed that it was the gate that held Flora back from the freedom she was entitled to. Flora, however, could never escape her fate and was eventually caught and killed. Through Flora’s death,  the narrator comes to realize that her acts of disobedience will always be in vain because her fate is unavoidable. The gate symbolizes the girl’s hope of liberation outside of the farm. The war against society could not be won, so she gives up and proceeds to help her mother with dinner. By assuming the roles of a woman, she completes her rite of passage into womanhood. The killing of Flora also leads to Laird’s rite of passage, though in his case this is the cause of different reasoning. Whereas the narrator learns that she cannot escape her fate, Laird visualizes a new life for himself. He reaches maturity by priding himself in his kill, symbolized by the horse’s blood. He boasts to his mother about the blood on his arm, and feels as though he is finally man enough to stand beside his dad. This is part of the symbolism behind the name â€Å"Boys and Girls,† as the contrasting natures of the two children are portrayed. In order to advance her feminist viewpoint, Munro touches upon only the minor aspects of the female stereotypes. She focuses on the girl’s newfound interest for fashion, beauty and decor to portray her femininity, rather than the harsher traits that were frequently placed on women. The author uses this limited feminism to stress the fact that this protest and change were the actions of a mere child that had not yet seen the full effects of prejudice. When taking into consideration the time period and setting, it can be clearly understood why the narrator and her brother both conformed to their gender-specific roles. As the world entered into the Second World War, women replaced their husbands in the workforce and started gaining recognition. However, because this story takes place in the rural side of Canada, the war’s social impact does not seem to have yet reached this area. The narrator’s mother being just a simple housewife causes the narrator to have a negative bias towards her, illustrating how women are looked down upon by society. Through her ultimate disapproval of her father’s inhumane occupation, the narrator reveals a side that is driven by emotion. Her concern for the helpless animal’s well-being displays her affectionate and loving character. Alice Munro’s story of â€Å"Boys and Girls† is an enlightening tale of the struggle that each child undergoes in discovering their own identity. The author insists throughout the story that the narrator’s acceptance of her place in society is influenced by her family and setting. Her resistance is useless because she has no choice but to conform into a proper woman. She is forced to hide her yearning for individualism in order to be socially acceptable. Current literature uses the feminist approach to convey the views of oppressed women, but Munro’s use of the limited amount of feminism allows the reader to make up their own opinion on the matter.

How Would You Define the Word “Democracy” Give Full Reasons for Your Answer?

This essay will argue that there is no single definition of democracy, due to the fact that there are many models of democracy, which in turn have their own opinions on what the term means. For example direct democracy can be seen as government by the people. In contrast representative democracy can be seen as government for the people. Also depending if one agrees with political equality will alter your definition for example if a person has high level of social significance they would believe that democracy is the rule of the elite and political equality does not exist this is the view point of Marxists.However on the other hand liberal- democracies do believe it and therefore their opinion on â€Å"democracy† is political equality. As Bernard Crick 1993 stated, â€Å" democracy is the most promiscuous word in public affairs† (Andrew Heywood politics third edition chapter four page 73) meaning the word democracy can mean anything. The word democracy comes from the Gre ek word demo meaning people and kratos meaning power.So the classical term for democracy is rule by the people. However this term is very vague, who is the people in ancient Greece in order to participate in politics you had to be male over the age of twenty, excluding women slaves and foreigners. In contemporary times there is restricted political participation usually the ages from 21 to 15, to vote. This in turn shows that not everyone is able to participate in controlling his or her own government due to age.The fact that voting is based on majority shows that voting only represents the majority. So people who voted against the majority will not get their say â€Å"the tyranny of the majority† (Andrew Heywood politics third edition chapter four page 73) explains that the term people is not everyone living in the state but the majority. Therefore depending on how old you are and who you voted for will depend if you believe the word democracy is rule by the people.The most significant point of democracy is liberal democrat view of political equality â€Å"one person one vote one value† this is very true most western democratic regimes are based on voting everyone get a vote and it is equal however in contrast Marxists believe that actually this is not true. The more level of significance of social equality such as control of mass communication and economic resources as well as voting is more likely to have your point of view taken into account by the government.An example is in the 2000 presidential election between George W Bush and Al Gore, Florida was the sate that could tip the balance between who would win, many news stations counted that Al gore won. The fact that George W Bush brother Jeb Bush was senator of Florida and that his other brother was in charge of publishing the votes on Fox News meant. The fact that votes was casted on fox news earlier than most stations meant many voters changed their minds and voted Bush as he was supposed ly most likely to win.The fact is George W Bush had the backing from the mass media such as Fox media and people in power such as Jeb meant he came in to power. (George W Bush had mass media control, the average voter voice was not heard, and as Al gore was whom the majority voted for) (Film Fahrenheit 9-11 Michael Moore) This is an example of pluralist democracy in which the elite are in control of society, the capacity of organised groups to articulate government responsiveness.In countries that has capitalism as its backbone economy, the elite tend to be the ones who own or control big corporate business, you only need to look at â€Å"America political system and see that people funding political candidates are buying influence and accesses to lobby groups† (www. news. bbc. co. uk/world/america), that is why in 2000 191 million dollars was raised by oil companies and united defence for Bush. Of course through the course of history we know that theses business benefited a lot from the wars in Iraq and Afghanistan.This shows that corporatist pluralism is a threat to society as a threat to society because political equality does not take place, if you are considered an insider group you will benefit such as united defence and if you are an outsider the chances of you influencing government other than voting is almost nil. As Lenin said liberal democracies are seen as bourgeois democracies that are†¦ by the ruling class (Andrew Heywood politics third edition page 86). However the view that only the elite benefit from â€Å"democracy† and that political equality does not exist which is the major point of democracy in that it should exist, is not always true.Peak associations benefit the state rather than major economic associations and the elite; theses are groups that want the best interest for the workers. So you could argue that in some cases political equality does exist. An example is Obama and his democratic party in which they believe in supporting the people not the business, the creation of Medi-care is an example. The creation of the Gettysburg Address delivered in 1864 by Abraham Lincoln â€Å"government of the people by the people for the people â€Å" (www. showcase. et/ creative Lincoln speech) made defining democracy a lot more difficult, due to the fact two models of democracy have cropped up direct democracy (by the people) through systems of referendum and representative democracy (for the people) system of electing someone on your behalf. Direct democracy may be seen by citizens of countries such as Switzerland as the real form of democracy due to the fact the people are in- charge of ruling them selves all the government do is facilitate the decision and make sure it is carried through.This is most similar to the ancient Greek idea of democracy. The way it is done is through referendums’ that can only be passed if majority of cantons agree as well as a small minority of cantons. An example o f referendums in Switzerland in which the people have voted for and taken action is the Swiss people have rejected the law that state funded layers can protect animals in 2010. (www. bbc. co. uk). However the main problem with referendums’ is governments can reject them going against the principal of rule by the people.An example occurred in the state of Rhode Island in 2002, when the governor placed such a referendum on the ballot asking citizens if they wanted to change the state constitution to make the three branches of the state government co-equal. The citizens voted in favor of the measure, but the result was not binding, and the governor and the legislature were not required to take action. (www. elearnportal. com/courses/political-science).The other point is direct democracy would only work in areas with small population such as Greek city states and Switzerland otherwise a population like the UK with over 60 million people would mean any decision would take a huge a mount of time. Therefore the representative democracy exits, the argument for representative democracy is people may not have the education or background to make logical decisions for the rest of the population; therefore you vote for your constituency who on your behalf represented you.Who in turn in parliamentary democracies would vote who would head your party. This may seem democratic in the view that your MP is only interested in your constituency. However party politics play a part and some politicians may seem greedy for power and not really care or represent you. Also even though this creates accountability on MPs behalf you may only do something about it every time an election is held. We only have an input every four years (undergrounddemocracy. com).This is means if politicians go against their mandate or do something the majority of people don’t like example the student cuts you cant do something about it until the next election. Also depending on who you are in t he political system will depend on what you think is a democratic system, for example totalitarian regimes such as Hitler and the Nazi party may claim they where democratic due to the fact they represented the peoples best interest, however the German people who where not involved in politics or people in general who live under a dictatorship may not agree that they are living democratically.In conclusion the language of democracy is used as political propaganda â€Å" it is a political weapon it is shaped and honed to covey political intent† (Andrew Heywood political theory page 2) what Andrew meant is similar to what Bernard Crick in that there is no clear definition of democracy. It all depends on who is the person or group that is defining the word democracy.If you are living in a representative democracy under a totalitarian regime and you are the head of that party in power then of course you would say you are democratic working in the best interest of the people despit e the fact they could be living in the gutter starving. Or if you are the prime-minster of the Britain despite the fact you where not directly elected by the people to be prime-minster but you are non-the less creating a government for the people you would say you are democratic, in contrast to people who did not vote for you or your policy.If you are considered a Marxist then your opinion on liberal democracy is that it is false due to the fact political equality does not exist and that the elite and corporatists have more power to influence the government for them and not always the majority of people, however if you are the elite you would say it is democratic as we live in competitive capitalist environment and through peek associations we benefit the economy because we have the know how, and the majority would want that.Direct democracy is another definition of democracy stating that the citizens should have complete control however due to political restrictions such as age and the ability to reject referendums proves that rule by the people can t be fully accomplished.My opinion is that again depending on who is defining democracy will depend on what they want it to mean due to the popularity of being democratic however, complete democracy will never be achieved as there will always be people who appose an opinion causing rule by the majority. But the ability to vote enables that citizens do have some control over their society and that in most western democracies people in power are trying to do what is best for the interest of the people, even if political equality may not exist.

A Life Changing Experience

On the first day of my life, my stomach is already closed and my hair does not seem to be able to do anything. I packed all the pen, paper, notebook and other miscellaneous goods in my brand new blue bag. My mother watched the world wake up while drinking morning tea on the terrace. I put a quick light on my new shoes and checked my hair about three times each time I found a new mistake. My mother shouted at me from the stairs. You miss the bus! Bus. Good Life Change Experience Kim Kelly Manuel American InterContinental University Change Life 2 Abstract This article is an important part of my life, which means the world to me. So I would like to share the experience of marriage and marriage. I will provide information on how I got married today and what I learned from my previous mistakes in my life. And I will also tell us the love for everyone. About a year ago I changed my life, I went to a small town called Kelly in the suburbs of Dublin, Ireland. This is the most beautiful place I have ever seen. This beautiful existence will help me see life from a different perspective. I just want to be happy, thank you for what I have, do not open my thoughts, do not consider it a matter of course, and I would like to love everyone. - Change life's experience to death. For people, this means that many different things may not be considered by some people until it approaches them. I know that I have never thought about this before my father passed away. It made me feel very sad when I heard that my father died for the first time. I am 10 to 11 years old. It is not enough to understand why someone wants their own life. I crashed when it happened. I think that it makes sense to change the viewpoint of a person who has experienced similar things when returning from my experience of changing my life. A new perspective is this: When you change, when you are affected by new places and people, the person you leave home is growing and new as you go out. When you raise your eyes from yourself and your needs, you can see the beauty and differences of the people you love clearly, and you can join a larger story that has been moving around you I can. There is nothing to change this reality, but you need to decide whether you believe this or not, it will play a central role in the way you experience daily life. Military life is a very challenging experience of changing life. This is very challenging for me and changes my life. This is the awakening of my life as my grandparents raised them and they did everything for me. Since I am not an independent person, I have doubts about future changes. However, other studies have shown that partners showing long-term survival (no signs of relapse) of breast, prostate, and colon cancer are found to be in similar health status reported by the general population in the UK Anxiety and depression (Edwards and Clark, 2004). This indicates that psychological distress experienced by a caregiver decreases over time as a close r elative is diagnosed with cancer.

Analysis of the Strategic Situation of HTC, the Mobile Phone Handset Essay

Analysis of the Strategic Situation of HTC, the Mobile Phone Handset Firm - Essay Example The main objective of the paper is to undergo strategic situational analysis of HTC which is a mobile phone handset firm. It will attempt at preparing a SWOT analysis of the company. The study will also focus upon Porter’s five forces model as well as industry life cycle analysis. In order to comprehend the resources held with the company, the study will make use of the value chain analysis. PESTEL analysis will be conducted in order to comprehend the macro environmental factors affecting the products and the services of the company. Porter’s Five Forces Model In order to recognise the competitive scenario of the smartphone industry in which HTC operates, the Porter’s five forces analysis can be quite applicable. Entry Barriers There are several barriers that prevent companies from entering into the smartphone industry. A few of the barriers that may work in favour of HTC need to be determined. High fixed cost, which is required for research and development, is c onsidered to be one of the biggest barriers to entry into the industry. High brand recognition of the established companies is considered to be other barrier to entry for the new firms since people prefer to purchase goods from those companies that they trust (Scribd, 2012). Bargaining Power of Buyer It has been observed that the bargaining power of the buyers of smartphone is quite high. There are innumerable substitutes available in the smartphone industry. The product differentiation is quite low in comparison to the competitors. The demand for smartphones is generally elastic because of the fact that they are not indispensable products (Scribd, 2012). Threat of Substitutes Products There are various substitutes available for smartphones which are generally utilised for mobile phone’s admittance to information. There are a few substitute products available in the market, which include laptops, cell phones, pagers and organisers. The cellular phones as well as laptops offer the services that are needed by most of the customers in terms of access to information for the consumers. The different complements that the consumers can use for the smartphones are e-mails along with maps, internet applications as well as software that are available over the phones (Scribd, 2012). Rivalry There is high competition in the smartphone industry and even though there are few strong competitors, the industry does not endorse numerous organisations. This is because of differentiation. Although there is greater differentiation between the casual as well as the professional users for smartphones there is limited capability to differentiate it. There is negligible scalability in order to generate more number of software by not directing the market to a small number of firms (Scribd, 2012). When customers purchase a regularly utilised product, they tend to put greater emphasis upon quality instead of price. There is minimum differentiation for price and the companies with recognized low quality as well as fewer budgets for research and development will face difficulties in competing within the market. Bargaining Power of the Suppliers The phones are normally assembled making use of the components from numerous suppliers. Original Equipment Manufacturer (OEM) has

Patient Safety and Medical Errors Essay Example | Topics and Well Written Essays - 3250 words

Patient Safety and Medical Errors - Essay Example Failure by this group to follow due process or any negligent behavior increases the risks of the patients and compromises their safety. Patient safety is considered as a wide area that has grown out of the current use of technology and the development of different medical approaches in healthcare. According to the global nursing association, patient safety has no financial needs as it involves the commitment of the healthcare professionals and the provision of quality services to the patients (Stern, 2008). Medical errors do occur in a hospital setting as a result of professional negligence or omission which could have been avoided thus affecting the healing process of the patient. In medical history, the medical errors and their impacts on patients recovery has been documented beginning from the time of Socrates. However, most professional healthcare workers lack information on the impacts of the errors they commit and these results into misreporting or lack of reporting altogether, an event that has led to the death and chronic injury of patients (Leape and Berwick, 2005). A number of studies have indicated the prevalence of medical errors in the health system across the globe, affecting developed and developing countries alike. In Australia, the medical errors documented in one year caused more than 18,000 deaths that could have been avoided and prevented. In the United States, the number was high, standing at over 44,000 in one particular year. The number of injuries remains high though their accuracy is doubtable due to lack of documented information on the same at any particular time (Nieva and Sorra, 2003). The cost of medical errors on patients can be categorized into human and economic costs and this provides a description of human life lost or the number of adverse effects caused on the health of the patient.  

Management and leadership in exercise and sport Essay

Management and leadership in exercise and sport - Essay Example Hence management can be described as the art of getting things done or getting resources being used through people. This paper will look at the above mentioned functions of management and how they are employed in management. (Higgings 1994, p. 34) There are four basic functions of management. First management is involved in planning the resources for the organization. In this regard, management performs the work of determining resources that are to be used in the organization and how they are to be used. Management also carries out the work of leading the organization. In this function management works to direct resources in the organization on how they are to be used. This calls for application of leadership skills in order to direct others on how the resources are to be used. Management also functions to coordinate the operations of the organization in order to ensure that resources are used in the most appropriate manner. In this regard the management coordinates the functions of different departments in the organization so that they can function as one system. Management also functions to control the resources in the organization. ... Planning should act as the base under which all other functions of management are to be carried out. It forms the core operation of management function since there can be no management if there is not efficient planning of how resources are to be used in the operation of an organization. Planning involves the assessment of the needs of the organization and consequently coming up with ways on how those needs are to be fulfilled. Assessment helps the management to understand how all other functions are to be integrated in order to achieve the set goals. Basically planning involves setting goals and objectives that has to be achieved. (Purcell 2006, p. 5) Planning can simply be termed as an unending course of actions. It involves coming up with set of problems to be addressed and strategies that will be used to address the problems. Planning is therefore the way in which management assess the needs of the organization and consequently comes up with strategies aimed at addressing the specific needs. Strategies can be termed as a systematic way of addressing external and internal factors that helps an organization to achieve its objectives. Depending on the conditions and the needs to be addressed, the management may have to come up with different strategies or change its course of action in fulfilling its goals. This is function of management is called strategic planning. In this regard the management must take time to analyze internal and external factors that may affect the strategies of an organization to achieve the set goals. It invokes studying strengths and weakness, opportunities and threats of the organization in its pursuit o f achieving the set goals. This requires practical and

Stories Assignment Example | Topics and Well Written Essays - 1000 words

Stories - Assignment Example I learned that supporting characters are important to the plot. They lend intrigue to the main characters. The conflict is not always what it seems through supporting characters. These essays have made me want to develop my fiction essays through rich supporting characters. 2. The original story is very different from the film version. In the movie version of Tarzan, the brute force and violence is emphasized more. Tarzan is a super human that saves a weak woman in the jungle. However, in the story Tarzan is not only strong, but intelligent as well. â€Å"For a moment he scrutinized the ground below and the trees above until the ape that was in him by virtue of training and environment, combined with the intelligence that was his by right of birth† (Burroughs 47). I think the reason for the conflict is the nature versus nurture debate. Burroughs used the nature for Tarzan’s intelligence and nurture for his strength. However, in today’s society everybody is into t he nurture theory. Thus Tarzan’s strengths are put forth in the movies instead of his intelligence. I have already read the book. 3. Emily poisoned Homer. She went to the druggist and stated â€Å"I want poison† (Faulkner 60). Since she lived to be an old woman, the poison must have been used for Homer. â€Å"Thus she passed from generation to generation† (Faulkner 61). ... 4. My feelings about â€Å"Saving Sourdi† were sympathetic to the little sister, Nea. She wanted to save her sister from an arranged marriage. Mr. Chhay is a good husband. â€Å"Slowly the room came into focus. It was a mess. Baby toys on the carpet, shoes in a pile by the door, old newspapers scattered on an end table anchored by a bowl of peanut shells† (Chai 83). If he was a bad husband, the house would have been spotless. After Duke hit him â€Å"Mr. Chhay kept repeating, ‘No problem, don’t worry’† (Chai 83). If he had a bad temper, Mr. Chhay would have thrown both Nea and Duke out. He would have beaten Duke up. Mr. Chhay was a good husband. Nea’s relationship to her sister was one of protector. Nea tried to protect Sourdi even if she did not need protection. I would have done the same thing for any of my siblings. 5. 5. The family in â€Å"A Good Man is Hard to Find† is a typical American family. The Grandmother lives with a n only son and his family. This situation is a conflict itself. The Grandmother wants to do things her way, but the family goes about their life with little interest in what the Grandmother wants. â€Å"The grandmother didn't want to go to Florida. She wanted to visit some of her connections in east Tennessee and she was seizing at every chance to change Bailey's mind. Bailey was the son she lived with, her only boy† (O’Connor 261). The Grandmother gives advice throughout the trip, but Bailey did not listen. This is familiar. Many younger people do not take their elders’ advice. The title suggests that people should not trust each other because good men are hard to find. Older people have learned that lesson, but younger people feel invincible. The theme is younger people should

Prospects and Practices in Educational Tourism Essay

Prospects and Practices in Educational Tourism - Essay Example The researcher states that Singapore receives thousands of visitors on educational tours from a wide variety of nations and cultures. It has several places of attractions for the educational tourists. Singapore has meaningful and beneficial tie-ups with countries such as Abu Dhabi and China which demonstrates that the future of education tourism in Singapore is promising. While the majority of the educational visitors are teenagers, there is ample scope for Singapore to attract adults and businessmen. Hence, proper segmentation and promotion has to be looked into. However, as in every trade and sector, corruption, misuse and competition has entered the educational tourism market also. Both education and tourism have grown as industries in the recent decades and this is the reason that both these sectors are important from the social as well as the economic perspective. Education and tourism promote international exchange and learning and these are the two sectors on which would rest the success, growth and economic prosperity of nations. Changes in both these industries have taken place which has seen a convergence of these two industries. Education facilitates mobility and learning and this has become an important part of the tourist experience. However, despite both these industries growing independently, very little theoretical writing is available on the convergence – educational tourism. Educational tourism is â€Å"tourist activity undertaken by those who are undertaking an overnight vacation and those who are undertaking an excursion for whom education and learning is a primary or secondary part of their trip†. Educational tourism is a novel method of acquiring knowledge which involves traveling to a foreign location and enrolling short term courses in a specified field or subject. In the process, the individual also learns about the history and culture of the country, including its lifestyle and architecture.

Marketing management- next Essay Example | Topics and Well Written Essays - 2000 words

Marketing management- next - Essay Example The target market for Next Direct in India mainly includes young age group of people from urban areas with higher middle income. In India, the domestic as well as some foreign apparel retailers are dominating and they are also offering online retailing services. Hence, it needs to reposition itself by offering comparatively lower priced brand products. The price is a key factor in Indian market and Next Direct must offer better discounts, offers though loyalty cards schemes. Moreover, Next Direct also needs to incorporate ethical marketing concepts for its Indian market by focusing on better consumer satisfaction level. Table of Contents EXECUTIVE SUMMARY 2 INTRODUCTION 4 PLC STAGE 5 TARGET MARKET 7 PRODUCT REPOSITIONING 10 PRICING STRATEGIES 12 ETHICS 13 CONCLUSION 14 RECOMMENDATION 15 REFERENCE 16 BIBLIOGRAPHY 17 INTRODUCTION Next Plc is a UK-based retail chain and it also present in the multiple countries like India, China, European countries, U.S.A. etc. It is primarily engaged i n the retailing business of the apparels, accessories, home products and other electrical consumer durable products. In its domestic country, UK and in Eire it has nearly 500 stores. Besides, in International markets, it is operating with more than 180 stores (Next Plc-a, 2011). Recently, the retailer faced a steep fall in its sales revenue during financial crisis of 2007-2008. However, with the recovering economy, Next Plc’s financial statements are recovering with an increase in the sales comparing to the previous financial year. With recovering economy, the competition in the market is expected to intensify as its competitors will try to the recover their losses due to financial crisis during 2008 to 2009 (Clark, 2011). In such situation, Next Plc must try to reposition itself in the competitive market by gaining effective sustainable completive advantages. However, the recovering growth rate of UK (as per GDP real growth rate 1.6%) is much slower in comparison to other de veloping countries like China and India (CIA, 2011). Therefore, opportunities in these developing countries are far better than other recovering developing countries like UK and U.S.A. Next Plc can try to reposition its apparels in the Indian retail market as Indian economy is growing at a faster rate i.e. 8.3% (CIA-b, 2011). Next Plc can focus on its apparel product segments to reposition itself in Indian market. With enhancing disposable income of the Indian consumers demand for clothes and related accessories are rising (Mirdha, 2011). PLC STAGE Kasse has explained that a PLC â€Å"is the period of time, consisting of phases that begins when a product is conceived and ends when the product in no longer available for use† (Kasse, 2008, p.56). The clothes and apparels are generally belongs to the fashionable consumer products and fashion industry keeps changing its trends by introducing multiple product developments as per current trends. Generally, clothes can be categorize d into three types i.e. fashion, fad and basic products and hence, as per three types of apparel categories, the PLC is given below. Figure 1: PLC for Apparels and Clothes (Source: Cornell University, 2006) The basic clothes and apparels are already in its declining phase and fashionable clothes are in correct trend. However, the fad clothes have the minimum life cycle as its popularity changes frequently among the youngsters. BCG matrix is a model to

Summary The Health Care Quality Book Essay Example for Free

Summary The Health Care Quality Book Essay Chapter 1: science and knowledge foundation Two notable contributions to the industry from the Journal of American Medical Association: 1. Assessment of the state of quality ïÆ'   serious and widespread quality problems 2. Categorization of three defects: a. Underuse: many scientifically sound practices are not used as often as they should be b. Overuse: can be seen in areas such as imaging studies for diagnosis in acute asymptomatic low back pain or prescription of antibiotics when not indicated for infections. c. Misuse: when the proper clinical care process is not executed appropriately, such as giving the wrong drug to a patients. To Err Is Human: publication that shows the severity of the quality problems in a way that captured the attention of all key stakeholders for the first time ïÆ'   this report spoke about the negative, not how it should be improved. Crossing the quality chasm: provided a blueprint for the future that classified and unified the components of quality through six aims for improvement, chain of effect and simple rules for redesign of health care. Six dimensions of quality (Berwick): Outcome measures and goals (IOM) = Institute of Medicine’s Safe Percentage of overall mortality rates/patients experiencing adverse events or harm Effective: science and evidence should be applied and serve as the standard for delivery of care. How well are evidence based practices followed? Percentage of time diabetic patients receive all recommended care at each doctor visit.. Efficient: Care and service should be cost effective, and waste should be removed. Analyzing the costs of care by patient, organization, provider or community Timely: no waits or delays in receiving care Measured by waits and delays in receiving needed care, service, and test results. Patient centered: system should revolve around the patient, respect its preferences and put the patient in control Patient or family satisfaction with care and service Equitable: Disparities should be eradicated. Examining differences in quality measures by race, gender, income or other factors. The underlying framework for achieving these aims depicts the health care system in four levels: Level A: what happens with the patient Level B: the micro system where care is delivered by small provider teams Level C: organizational level: the macro system or aggregation of the Microsystems and supporting functions. Level D: external environment where payment mechanisms, policy and regulatory factors reside (verblijven) Chapter 2: Basic concepts of health care quality The following attributes relevant to the definition of quality of care are important: Technical performance ïÆ'   refers to how well current scientific medical knowledge and technology are applied in a given situation (it is usually assessed in terms of timeliness and accuracy of the diagnosis, appropriateness in of therapy) Management of the interpersonal relationship ïÆ'   refers to how well the clinician relates to the patient on a human level. The quality of this relationship is important because: By establishing a good relationship with the patient the clinician is able to fully address the patient’s concerns, reassure the patient and relieve the patient’s suffering It can affect technical performance: the clinician is better able to elicit from that patient are more complete and accurate medical history, which can result in a better diagnosis Amenities (voorzieningen) ïÆ'   refers to the characteristics of the setting in which the encounter between patient and clinician takes place, such as comfort, convenience and privacy. Amenities are valued both in their own right and for their effect on the technical and interpersonal aspects of care. Amenities can yield (opleveren) benefits that are more indirect. Access ïÆ'   refers to the degree to which individuals and groups are able to obtain needed services. Responsiveness to patient preferences ïÆ'   respect for patients’ values, preferences and expressed needs affects quality of care as a factor in its own right. Equity ïÆ'   the amount, type or quality of health care provided can be related systematically to an individual’s characteristics, particularly race and ethnicity, rather than to the individual’s need for care or healthcare preferences, have heightened concern about equity in health care. Medicine does not fulfill its function adequately until the same perfection is within the reach of all individuals. Efficiency ïÆ'   refers to how well resources are used in achieving a given result. Cost-effectiveness ïÆ'   how much benefit, typically measured in terms of improvement in health status, the intervention yields for a particular level of expenditure. For each stakeholder in health care, quality can be differently defined: page 30 + 31. These definitions have a great deal in common: Each definition emphasizes different aspects of care Definitions conflict only in relation to cost-effectiveness All evaluations of quality of care can be classified in terms of one of the three aspects of caregiving they measure: Structure: when quality is measured in terms of structure, the focus is on the relatively static characteristics of the individuals who provide care and of the settings where the care is delivered. These characteristics include the education, training and certification of professionals. Process: refers to what takes place during the delivery of care, also can be the basis for evaluating quality of care. Outcomes: Outcome measures, which capture whether healthcare goals were achieved, are another way of assessment of quality of care. Outcome measures have to include the costs of care as well as patients’ satisfaction with care. Which one is better to use? ïÆ'   none of them, all depends on the circumstances. To assess quality using structure, process or outcome measures, we need to know what constitutes good structure, good process and good outcomes. We need criteria and standards we can apply to those measures of care: Criteria = specific attributes that are the basis for assessing quality Standards = express quantitatively what level the attributes must reach to satisfy preexisting expectations about quality. For example ïÆ'   type of measure: structure and focus on primary care group practice: Criterion: percentage of board-certified physicians in internal or family medicine – Standard: 100% of physicians in the practice must be board certified in internal or family medicine. Optimal standards: denote the level of quality that can be reached under the best conditions, typically conditions similar to those under which efficacy is determined ïÆ'   useful as reference point. Structural measures are well suited to detecting lack of capacity to deliver care of acceptable quality. They are also only as good and useful as strength of their relation to desired processes and outcomes. To evaluate structure, process and outcome measures criteria and standards are essential. Whereas the formulation of criteria is expected to be evidence driven (efficacy). The setting of standards is not similarly tied to scientific literature. The decision to set standards at a minimal, ideal or achievable level is most meaningful if driven by the goals behind the specific quality of care evaluation for which the standards are to be used. Chapter 3: Variation in medical practice and implications for quality Variation ïÆ'   the difference between an observed event and a standard or norm. Without this standard, or best practice, measurement of variation offers little beyond (biedt niet meer dan) a description of the observations. Random variation = physical attribute of the event or process, adheres to the laws of probability and cannot be traced to a root cause. (houdt zich aan de wetten van waarschijnlijkheid en kan niet worden herleid tot een oorzaak). It is not worth to study it in detail. Assignable variation = arises from a single or small set of causes that are not part of the event or process and therefore can be traced, identified, and implemented and eliminated ïÆ'   subject to potential misunderstanding because of complexity of design and interpretation. 1. Process variation = the difference in procedure throughout an organization (use of various screening methods for colorectal cancer) Technique ïÆ'   multitude of ways in which a procedure can be performed within the realm of acceptable medical practice. 2. Outcome variation = difference in the result of a single process (mostly focus on this measure) the process yielding optimal results ïÆ'   outcomes research 3. Performance variation = the difference between any given result and the optimal ideal result. This threshold or best practice is the standard against which all other measurements of variation are compared. Performance variation tells us where we are and how far we are from where we want to be, and suggests ways to achieve the desired goal. Variation can be desirable? ïÆ'   a successful procedure that differs from other, less successful procedures is by definition variation. The objective then for quality improvement is not simply to identify variation but to determine its value. How can the variation be eliminated or reduced in the ways that focus on the variation rather than on the people involved? So, understanding the implications for quality of variation in medical practice is not simply learning how eliminate variation but learning how to improve performance by identifying and accommodating good or suboptimal variation from a predefined best practice. Variability plays a role in identifying, measuring and reporting quality indicators (effective, efficient, equitable..) and process-of-care improvements. Some hospitals are reluctant to use quality improvement measures (they perceive them as biased towards academic medical research centers or large health care organization) ïÆ'   untrue! Quality improvements efforts can be and have been successfully applied to small organization and practices. The size of an organization also effects the ability to disseminate (verspreiden) best practices. Large organization tend to have rigid frameworks or bureaucracies; change is slow and requires perseverance (doorzettingsvermogen) and the ability to make clear to skeptics and enthusiasts the value of the new procedure in their group and across the system. An organization ‘s commitment to paying for quality improvement studies and implementation is equally affected by its size and infrastructure, but there are some minimum standard levels of quality and linked reimbursement schemes to achieving goals established by the Joint Commission, CMS and Medicare ïÆ'   all organizations obligated to meet these standards. Quality improvement effort must consider organizational mind-set, administrative and physician worldviews, and patient knowledge and expectations. Physician buy-in is critical to reducing undesired variation or creating new and succesfull preventive systems of clinical care, therefore: training physician champions and inciting (aanzetten) them to serve as models, mentors and motivators and it reduces the risk of alienating (vervreemden) the key participants in quality improvement efforts. Patient education in quality of care is equally subject to variation; patients are aware of the status of health care providers in terms of national rankings, public news of quality successes and so on. Educating patients about a health care organization and its commitment to quality makes variation and process-of-care measures available to the public. Organizational mind set ïÆ'   organizational infrastructure is an essential component in minimizing variation, disseminating best practices and supporting a research agenda associated with quality improvements. Economic incentives may be effective in addressing variation in health care by awarding financial bonuses to physicians and administrators who meet quality targets or withholding bonuses from those who do not. Goals of incentives: to help people understand that their organization is serious about implementing quality changes and minimizing unwanted variation to ensure alignment with national standards an directions in quality of care and to encourage them to use the resources of the organization to achieve this alignment . Chapter 4: Quality improvement: the foundation, processes, tools and knowledge transfer techniques Different leaders of quality improvement systems: page 63 – 67 Quality improvement approaches (derivatives and models of the ideas and theories developed by thought leaders): PDCA/PDSA, Associates for Process Improvement’s Model for Improvement, FOCUS PDCA, Baldrige criteria, ISO 9000, Lean, Six Sigma. PDCA/PDSA cycle Basis for planning and directing performance improvement efforts. 1 Plan: Objective: what are you trying to accomplish? What is the goal? Questions and predictions: What do you think will happen? Plan to carry out the cycle: Who? What? When? Where? 2 Do Educate and train staff Carry out the plan (try out the change on a small scale) Document the problems and unexpected observations? Begin analysis of the data 3 Study/Check Assess the effect of the change and determine the level of success as compared to the goal/objective Compare results to predictions Determine what changes need to be made and what actions will be taken next 4 Act Act on what you have learned Determine whether the plan should be repeated with modifications or a new plan should be created Perform necessary changes Identify remaining gaps in process or performance Carry out additional PDCA/PDSA cycles until the agreed-upon goal or objective is met API improvement model Simple model for improvement based on Deming’s PDSA cycle. The model contains three fundamental questions that form the basis of improvement: What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will results in improvement? FOCUS/PDCA model Building on de PDCA cycle the FOCUS PDCA model is created: more specific and defined approach to process improvement. The key feature of this model is the preexistence of a process that needs improvement. The intent of this model is to maximize the performance of a preexisting process, although the inclusion of PDCA provides the option of using this model for new or redesign process. F: FIND a process to improve O: ORGANIZE a team that knows the process C: CLARIFY current knowledge of the existing or redesigned process U: UNDERSTAND the variables and causes of process variation within the chosen process S: SELECT the process improvement and identify the potential action for improvement Baldrige criteria The criteria can be used to assess performance on a wide range of key indicators: health care outcomes; patient satisfaction; and operational, staff and financial indicators. The Baldrige healthcare criteria are built on the following set of interrelated core values and concepts (page 70). The criteria are organized into seven interdependent categories: Leadership Strategic planning Focus on patients, other customers, and markets Measurement, analysis and knowledge management Staff focus Process management Organizational performance results Baldrige’s scoring system is based on a 1000 point scale. Each of the seven criteria is assigned a maximum value ranging from 85 to 450 maximum points. The most heavily weighted criterion is the results category (450). The weight of this category is based on an emphasis Baldrige places on results and an organization’s ability to demonstrate performance and improvement in the following areas: Product and service outcomes, customer-focused outcomes, financial and market outcomes, workforce-focused outcomes, process effectiveness outcomes, leadership outcomes. ISO 9000 The international Organization for Standardization (ISO) issued the original 9000 series of voluntary technical standards in 1987 to facilitate the development and maintenance of quality control programs in the manufacturing industry. In 2000, ISO made major changes to the standards to make them more relevant to service and health care settings. Focused more on quality management systems, process approach, and the role of top management, the most recent standards include eight common quality management principles: Customer-focused organization Leadership Involvement of people Process approach System approach to management Continual improvement Factual approach to decision making Mutually beneficial supplier relationships Lean thinking Lean ïÆ'   to describe production methods and product development that, when compared to traditional mass production processes, produce more products, with fewer defects, in a shorter time. The focus of Lean methodology is a ‘back to basics’ approach that places the needs of the customer first through the following five steps: 1. Define value as determined by the customer, identified by the provider’s ability to deliver the right product or service at an appropriate price. 2. Identify the value stream: the set of specific actions required to bring a specific product or service from concept to completion 3. Make value added steps flow from beginning to end 4. Let the customer pull the product from the supplier, rather than push products 5. Pursue perfection of the process Six sigma The aim of six sigma is to reduce variation (eliminate defects) in key business processes. By using a set of statistical tools to understand the fluctuation of a process, management can predict the expected outcome of that process. Six sigma incluses five steps, commonly known as DMAIC: Define: Identify the customers and their problems. Determine the key characteristics important to the customer along with the processes that support those key characteristics. Identify existing output conditions along with process elements. Measure: Categorize key characteristics, verify measurement systems and collect data Analyze: Convert raw data into information that provides insights into the process. These insights include identify the fundamental and most important causes of the defects or problems. Improve: Develop solutions to the problem, and make changes to the process. Measure process changes and judge whether the changes are beneficial or another set of changes is necessary. Control: If the process is performing at a desired and predictable level, monitor the process to ensure that no unexpected changes occur. The primary tool of six sigma is that focus on variation reduction will lead to more uniform process output. Secondary effects include less waste, less throughput time and less inventory. Quality tools: three categories (also six categories distinguishing on page 74) Basic quality tools Control chart: upper and lower control boundaries that define the limits of common cause variation. It is used to monitor and analyze variation from a process to determine whether that process is stable and predictable or unstable and not predictable Histogram Cause-and-Effect/Fishbone diagram: the problem is stated on the right side of the cart, and likely causes are listed around major headings that lead to the effect. It can help organize the causes contributing to a complex problem. Pareto chart: 80% of the variation of any characteristic is caused by only 20% of the possible variables. Management and planning tools (75) Affinity diagram: a list of ideas is created, and then individual ideas are written on small note cards. Team members study the cards and group the ideas into common categories. The affinity diagram is a way to create order of a brainstorm session. Matrix diagram: helps us to answer two important questions when sets of data are compared: Are the data related? How strong is the relationship? Priorities matrix: uses a series of planning tools built around the matrix chart. Other quality tools Benchmarking: compares the processes and successes of you competitor of similar top-performing organizations to your current processes to define, through gap analysis, process variation and organizational opportunities for improvement. Benchmarking defines not only organizations that perform better but also how they perform better. Failure mode and effect analysis: examines potential problems and their causes and predicts undesired results. FMEA normally is used to predict product failure form past part failure, but it also can be used to analyze future system failures ïÆ'   both in patient safety toolbox. 5S: is a systematic program that helps workers take control of their workspace so that is actually works for them instead of being a neutral or, as is quite common, competing factor. Sort: means to keep only necessary items Straighten: means to arrange and identify items so they can be easily retrieved when needed. Shine: means to keep items and workspaces clean and in working order Standardize: means to use best practices consistently Sustain: means to maintain the gains and make a commitment to continue the first four S. Theory of Transfer of Learning ïÆ'   page 77 Rapid cycle testing/improvement Developed by IHI, rapid cycle testing/improvement was designed to create various small tests involving small sample sizes and using multiple PDSA cycles that build on the lessons learned in short period while gaining buy-in from staff involved in the change. It is designed to reduce the cycle time of new process implementation from months to days. Read 78/79/80/81 Chapter 5: Milestones in the quality measurement journey Many health care providers struggle to address the measurement mandate proactively, which leads organizations to assume a defensive posture when external organizations release the data. In such cases, the provider usually responds in one of the following ways: data are old, data are not stratified and do not represent appropriate comparisons, our patients are sicker than those in other hospitals. A more proactive posture would be to develop an organization-wide approach to quality measurement that meets both internal and external demands. This approach is not a task, but a journey that has many potential pitfalls and detours. Key milestones exist that mark your progress and chart your direction. Milestone 1: Develop a measurement philosophy (strategic step): What is/should be the role of performance measurement in the organization? Should it be done periodically or a day-to-day function? The first step toward this milestone should be the creation of an organizational statement on the role of measurement. Three simply questions should be explored when developing a measurement philosophy: 1. Do we know our data better than anyone else does? 2. Do we have a balanced set of measures that encompasses clinical, operational, customer service and resource allocations? 3. Do we have a plan for using the data to make improvements? Milestone 2: Identify the concepts to be measured (types and categories of measures) (strategic and operational step) The second milestone consists of deciding which concepts the organization wishes to monitor. There are three basic categories of measures: structure (s): represents the physical and organizational aspects of the organization processes (p): every activity, every job, is part of a process. outcomes (o): structure combine with processes to produce outcomes. The relationship between these categories usually is shown as follows: s + p = o Another categorization that can be made is (more specific) according to the six aims for improvement: 1 Safe, 2 Effective, 3 Patient centered, 4 Timely, 5 Efficient, 6 Equitable Regardless of the method used, an organization must decide which concepts, types, or categories of measures it wishes to track. Milestone 3: Select specific measures What aspect of (patient safety) do we want to measure? What specific measures could we track? Choose a specific indicator In this step you need to specifying what aspect of for example patient safety you intend to measure and the actual measures. Within the patient safety, you could focus on medication errors, patient falls, wrong site surgeries etc. Within the medication error you can measure different things: number of medication orders that had an error, total number of errors caught each day, percentage of orders with an error etc. Milestone 4: Develop operational definitions for each measure An operational definition is a description, in quantifiable terms, of what to measure and the specific steps needed to measure it consistently. A good operational definition: Gives communicable meaning to a concept or an idea Is clear and unambiguous Specifies the measurement method, procedures and equipment Provides decision-making criteria when necessary and Enables consistency in data collection The problem created by poor operational definitions should be obvious: if you do not use the same operational definition each time you record and plot data on a chart, you will either miss a true change in the data or think a change has occurred when in fact one has not. Using the same operational definition becomes even more critical if you are trying to compare several hospitals or clinics in a system. Milestone 5: Develop a data collection plan and gather data (giving special consideration to stratification and sampling) Direct start with data collection may cause teams to collect the wrong data in the wrong amounts. The data collection phase consists of two parts: Planning for data collection: what process will be monitored? What specific measures will be collected? What are the operational definitions of measures?.. The actual data gathering: how will you collect the data? Will you conduct a pilot study? Who will collect the data? (page 94) Once you have resolved these issues, the data collection should go smoothly. Sometimes improvement teams do not spend enough time on data collection plans. This can lead to the following problems: (1) collect too much, or too little data (2) collect the wrong data (3) become frustrated with the entire measurement journey. Consequences can be: the team tends to (1) distort (verdraaien) the data (2) distort the process that is produced the data or (3) kill the messenger. Two key data collection skills – stratification and sampling enhance any data collection effort. Stratification = the separation and classification of data into reasonably homogeneous categories. The objective of stratification is to create strata, or categories, within the data that are mutually exclusive and facilitate discovery of patterns that would not be observed if the data were aggregated. Stratification allows understanding of differences in the data caused by different factors (page 95). If you do not think about how these factors could influence your data you run the risk of making incorrect conclusions and having to filter out the stratification effect manually after you have collected the data. Sampling (steekproef) ïÆ'   the most important thing you can do to reduce the amount of time and resources spent on data collection. There are four conditions for developing a sampling plan: accuracy, reliability, speed and economy. Sampling consists of a series of comprom ises and trade-offs. The basic purpose of sampling is to be able to draw a limited number of observations and be reasonably confident that they represent the larger population from which they were drawn. There are two basic approach to sampling: Probability sampling techniques: based on statistical probability (systematic sampling, simple random sampling, stratified random sampling, stratified proportional random sampling) Non-probability sampling techniques: should be used when estimating the reliability of the selected sample or generally applying the results of the sample to larger population is not the principal concern. The basic objective is of this type of sampling is to select a sample that the researchers believe is typical of the larger population. (convenience sampling, quota sampling and judgement sampling) 99-102 Milestone 6: Analyze the data using statistical process control methods (especially run and control charts) Translate data into information. Milestone 7: Use the analytic results to take action (implement cycles of change, test theories and make improvements) Chapter 6: Data collection Quality measurements can be grouped into four categories: Clinical quality Financial performance Patient satisfaction Functional status To report on each of these categories, several spate data sources may be required. The challenge is to collect as much data as possible from the fewest sources with the objectives of consistency and continuity in mind. Retro prospective data collection: involves identification and selection of a patient’s medical record or group of records after the patient has been discharged. Prospective data collection: relies on medical record review, but it is completed during a patient’s hospitalization or visit rather than retrospectively. Disadvantage: time consuming and can distract nurse from their direct patient care responsibilities, expensive method, mostly full time data analyst needed. Source for data for quality improvements: Administrative databases: are information collected, processed and stored in automated information systems. Excellent source of data for reporting on clinical quality, financial performance, and certain patient outcomes. Advantages: less expensive source of data, they incorporate transaction systems, moest of the code sets embedded are standardized, the database are staffed by individuals who are skilled, the volume is great, data reporting tools are available.. Disadvantages: some argue that these data is less reliable than data gathered by chart review. Patient surveys: especially when teams are interested in the perceptions of patients, either in terms of the quality of care or the quality of service provided. A team can design the survey itself, hire an expert to design a survey, or purchase an existing survey/survey service. Functional status surveys: usually measured before and at several points following the treatment or procedure. (for example a baseline before the knee procedure and then assessments are made at regular intervals after the surgery) Health plan databases: excellent source of data for quality improvement projects, particularly projects that have a population health management f ocus. These databases are valuable because they contain detailed information on all care received by health plan members. It provides a comprehensive record of patient activity and can be used to identify and select patients for enrollment in disease management programs. Used properly: rich source of data for population management, disease management and quality improvement projects. Health plan databases limitations: considerations include accuracy, detail and timeliness. Recoding may make some data inaccurate, they do not contain detailed information on outcomes of care . Patient registries: powerful source of quality improvement data. Advantages: rich source of information because they are customized, can collect all the data that the physician or health system determines are most important, can be used for quality improvements, they are not subject to the shortcomings of administrative or health plan databases, collection techniques can be combined to provide a complete picture of the patient experience. They are versatile and flexible. Example case study in clinical reporting: page 123-127 Conclusion: there are many sources and data collection approaches from which to choose. Rarely does one method serve purposes, so it is important to understand the advantages and disadvantages of all methods. A combination is also possible. Knowledge of different sources and techniques will help you to use data more effectively and efficiently in your clinical improvement effort. Chapter 7: Statistical tools for quality improvement Three fundamental purposes for performance measurement: Assessment of current performance: identify strengths and weaknesses of current processes Demonstration and verification of performance improvement And control of performance Performance measurement benefits organizations in several ways: provides factual evidence of performance, promotes ongoing organization self-evaluation and improvement, illustrates improvement, facilitates cost-benefit analysis, helps to meet external requirements and demands for performance evaluation, may facilitate the establishment of long-term relationships with various external stakeholders. May differentiate the organization from competitors, may contribute to the awarding of business contacts and fosters organizational survival. .. Chapter 13: Leadership for quality Leadership = working with people and systems to produce needed change. Individual leadership = this set of leadership is about what people must be and what they must know how to do, if they are to influence others to bring about needed changes. Both being and doing are needed, especially when the changes required for quality improvement involve reframing core value or remaking professional teams. Many improvements in health care will require these kinds of deep changes in values. These changes are sometimes labeled as transformational changes to distinguish them from transactional changes, which do not require changes in values and patterns of behavior. Organizational leadership = about creating a supportive organizational environment in which hundreds of capable individual leaders’ work can thrive (groeien). One way to view this level (system-of-leadership level) is as a complex set of interrelated activities in five broad categories: Set direction: every organization has a sense of direction, a future self-image. A leader should set that direction. Establish the foundation: leaders must prepare themselves and their leadership teams with the knowledge and skills necessary to improve systems and lead change (and reframe values) Build will: to initiate and sustain change takes will, which seem to be highly sensitive to discord and often grind to a halt because of one loud voice opposing change ïÆ'   therefore making logical and quantitative links should be made between improvement and key business goals. Generate ideas: quality challenges require innovation. Page 313 Implementing quality as the core organizational strategy Implementing a culture that has quality improvement at its core is an important goal for providers who want to serve patients better, gain the support of healthcare providers, stay ahead of government regulation, meet consumer’s demand for transparent information on quality and costs, an gain a competitive advantage in the marketplace. Recent history: many efforts have not resulted in the sustainable quality improvements that the leaders hoped to see. Quality improvement strategy should start with leadership from the board of trustees, the CEO and the executive team, but it is a challenge for health care organizations because of the many internal competing agendas, the rapidly changing environment, employees and so on. First step: to establish an organizational culture that will support the hospital on their journey to quality ïÆ'   starting point: leadership! Kaplan Norton: Balanced Scorecard ïÆ'   this approach includes the perspective of the patient and family, internal processes such as clinical pathways, learning and growth opportunities that focus on employees and financial performance. Role of leadership: leaders ask financial questions about market share, margins and quality implications. They raise questions related to the satisfaction of their internal and external customers and the way in which business processes must change to improve and sustain quality. Primary focus on creating a culture of quality. Baldrige National Quality Program Creating the change towards quality starts with leadership. Road map for change Eight stage change process, modified form Kotter’s seminal work (Leading Change 1996) serves as a realistic and viable framework to guide leaders who are managing a change to quality: 1. Unfreezing the old culture This is the most difficult step because of culture’s influence on employee behavior and some employee’s to desire to resist change and impede progress. 2. Forming a powerful guiding coalition 3. Developing a vision and strategy 4. Communicating a vision and strategy 5. Empowering employees to act on the vision and strategy 6. Generating short-term wins 7. Consolidating gains and producing more change 8. Refreezing new approaches in the culture View as multi-pages

The Style Of Quentin Tarantino Film Studies Essay

The Style Of Quentin Tarantino Film Studies Essay   Quentin Tarantino has his own distinctive style that mirrors his quirky vision of the universe. From the early Reservoir Dogs   to the stylish Pulp Fiction, Tarantino has challenged both viewers and the movie industry to look at the medium in a new way. His 2009 effort, the ultra-violent war film Inglorious Basterds, is a solid hit and every bit a Tarantino film. This paper discusses the film in general as well as its cinematography and editing. Discussion            Tarantino is a   director known for his love of film in general. He is knowledgeable about the medium and enjoys paying homage to it by sometimes filming scenes in a way that resembles works by other directors; or by putting a great many pop references in his film. This makes his films very hip, but it can also date them. However, because this film is set in a specific time and place-occupied France in 1944-these are quibbles.            Tarantino is also known for telling several stories simultaneously and bringing the threads together at the last moment to make a coherent whole. This is the structure of Pulp Fiction, in which three separate stories are told out of order: characters that are killed in one story show up later in the film, because that part of their story hasnt been told yet. At times its best to just sit back and let Tarantino do his thing and sort it out later.            Inglourious Basterds is just such a film: there are possibly three stories running simultaneously: the story of the Nazi Colonel Hans Landa and his hunt for Jews (Christoph Waltz); the Basterds themselves, led by Lt. Aldo Raine (Brad Pitt); and the Jewish girl Shoshanna Dreyfuss (Mà ©lanie Laurent), who works in the cinema that will be the setting for the films explosive (literally) climax. Critics are singling out Waltzs diabolical, cruel, witty, charming and perverse Colonel Landa as the best thing in the film; he won the Oscar as Best Supporting Actor for his work, along with almost every other award its possible for an actor to receive. That raises some unpleasant questions: Waltzs character is the representative of possibly the most despicable regime ever to disgrace humanity, so what does that say about audiences who find him attractive and funny? Landa becomes a sort of guilty pleasure, as well as an object lesson in the fact that evil can sometimes wear a very attractive face: There is nothing more disturbing than finding something commendable in a character you want so badly to condemn (Meadows).            The film is simple: Raines group of commandos has been dropped into occupied France with only one object: to kill Nazis. They do so, often with a baseball bat or other suitably unpleasant means, and scalp them (Tarantino). They also have a penchant for carving swastikas into their victims foreheads and their gruesome tactics have unsettled Nazi officers all the way up to Hitler.            The film has surprised   some audiences by its length and others because for a war film, it is surprisingly non-violent; the violence is extreme and gruesome but sparse and contained within a few set pieces. The rest of the film contains a lot of dialogue, which is a hallmark of Tarantinos work. He is in love with dialogue; he likes to explore human relationships and does so by letting his character literally speaks for themselves. People who complain that theres no enough action in the film seem to be missing the point. Berardinelli notes that the long dialogue scenes are merely priming the pump for the action that follows: With every sentence, the tension mounts. Tarantino uses these sequences to prime the audience, teasing them until the suspense is nearly unbearable, then releasing it in one explosive burst. The films editing includes title cards that identify each scene, an old fashioned technique that some critics like while others denigrate. Its the same technique that silent films pioneered, and it has the effect of making the film feel very literary, almost as if the audience has to read it like a book rather than watching it.            The cinematographer on the film is Robert Richardson, who was director of photography for Tarantino on both Kill Bill films; he has also worked on films like The Aviator and A Few Good Men as well as The Horse Whisperer, Casino and Snow Falling on Cedars   (MacGregor). If these films have anything in common, its that they have nothing in common, but in each case Richardson has brought to life their [the directors] most grandiose aspirations in a way that is unrivaled and incomparable (Ebenezer).            In this film, numerous critics have pointed to the scene which introduces Colonel Landa as a perfect example of Richardsons gifted cinematography; he works magic with the lighting and framing here as he does throughout the film (MacGregor). In this scene, Landa is questioning dairy farmer Perrier LaPadite, who is suspected of harboring Jews; as he continues to question the farmer, the camera circles the table moving closer and closer, as if it is tying up the farmer in invisible cords (MacGregor). When Landa orders his men to shoot through the floor, killing the Jews he knows are hidden there, its almost a relief because the tension is so high its unbearable. This is Richardsons skill; and it is on display throughout the film. The structure of the scene of course is Tarantinos; it is his direction. But Richardson has the skill to shoot it the way Tarantino wants it shot, so that it brings his vision to life. Richardsons use of color is extraordinary; for instance, in the scene where Landa comes to the farmhouse, the day is beautiful, clear and sunny; the sky is blue and birds are singing. And into the midst of this idyllic scene comes a monster. The juxtaposition of Landa with the beauty of his surroundings, especially as he then orders the murder of the hidden Jews, is brilliant. It reminds viewers that things are not what they seem, and that the potential for violence is ever-present. It can be argued that the United States today is one of the most violent societies on earth, but the threat of drive-bys, gang wars and shootings cannot compare to the terror of living under the Nazi occupation, where punishment for the slightest infraction was swift and brutal. When Landa pops up in the middle of the idyll ic scene, the day is ruined. Much of the rest of the cinematography is muted, sometimes suggesting old newsreels with washed out colors. This could indicate the age of Europe, or the draining effect of war; it makes Europe, which is beautiful, cold and harsh, in keeping with the mission the Basterds have undertaken. The New York Times also mentions the cinematography, though it is less complimentary than most to the movie overall. Dargis writes that whether or not a viewer likes the film has a lot to do with whether he or she can just groove on Tarantinos cinematic style, which includes his exuberant framing  and staging, his swooping crane shots, postmodern flourishes (Samuel L. Jackson in voice-over explaining the combustibility of nitrate prints) and gorgeously saturated colors, one velvety red in particular (Dargis). With regard to the films much-discussed opening scene in the farmhouse, Dargis calls it a marvel of choreographed camera movement and tightly coordinated performances. When the scene moves ins ide the building, Tarantino provides another homage: à ¢Ã¢â€š ¬Ã‚ ¦the German soldiers outside are positioned within one of the windows, a shot that recalls the framing of an image in Monte Hellmans 1971 cult classic, Two-Lane Blacktop' (Dargis). Tarantino also gives a nod to a great Hollywood character actor of the 1950s, Aldo Ray, by naming his main character Also Raine; Also Rays widow served as a casting director on this film (Dargis). (For a delightful look at Aldo Ray, look at Were No Angels the original starring Ray, Humphrey Bogart and Peter Ustinov as three Devils Island escapees who are neither as tough nor as evil as they pretend to be.) As for the rest of the film, however, Dargis is less enthusiastic. She notes that the film is actually five set pieces, each organized around specific bits of business and conversations that increasingly converge (Dargis). The first chapter introduced Colonel Landa; the second brings in the Basterds while the third brings Shoshanna together with Joseph Gobbels (Dargis). The fourth chapter deals with the plot to kill Hitler and the final chapter is the destruction of the fire and the death of many of the characters (Dargis). While all this works, Dargis has trouble with Tarantinos use of slow dialogue scenes and she is particularly disquieted by Colonel Landa, whom she describes as charming and seductive (Dargis). A man who is the tool of a regime as repellant as National Socialism should have none of these qualities. And yet Landa has no equal in the film; he owns it, and that makes for some uneasy viewing (Dargis). Conclusion            Inglourious Basterds would be uncharacteristic for any other director but for Tarantino its merely the latest in a string of films that glorify brutality and make heroes out of the most unlikely people: hit men and Nazi colonels. Its also full of Tarantino trademarks: long dialogue scenes that lead up to shot, explosive action sequences; homage to other films; and a never-ending river of blood. He has also, as usual, played with film itself, using title cards that hark back to the days of silent films, and (mercifully!) having his German characters speak German, his Italians speak Italian, his Frenchmen speak French and so on. This means he has also subtitled some of the scenes, but again, this is a director who truly seems to love playing with the medium and all its capabilities. Whether a viewer will enjoy the film or not particular when it contains scenes of soldiers being beaten to death with a baseball bat and other horrific violence probably depends on whet her or not he or she is a Tarantino fan. If so, theyll know what to expect; if not, it can be a bit much. But all in all, the film has proven to be a solid success and another hit for a quirky filmmaker who breaks all the rules.

Odysseus is an Epic Hero :: essays research papers

People are heroes in different ways for different reasons. American soldiers are heroes because they fight boldly for their country. Corrie Ten Boom is also a hero because she took risks and saved hundreds of Jews. Abraham Lincoln is another example of a hero because he fought for what he thought was right and helped free all slaves. Similarly, Odysseus, the main character in Homer’s epic poem The Odyssey, possesses all of these characteristics and many more, making him a true epic hero. First of all, Odysseus is brave and courageous, giving him the initiative to fulfill his goals. One example is when Odysseus confronts Skylla. Odysseus purposely â€Å"made [his] way along to the foredeck—thinking to see her first from there† (Homer 217). If he was scared, he would have hidden underneath the deck. But instead, Odysseus goes out to face the beast. Odysseus knows that Skylla is immortal and cannot die, yet he is brave enough to confront her. Next, Odysseus fights the suitors, who are courting Penelope in his palace. The suitors greatly outnumber Odysseus, but Odysseus still chooses to fight even though the odds are against him and he is able to win. He stands up against those who do wrong. Having the courage to fight, Odysseus defeats the suitors and fulfills his goal of regaining his palace. If Odysseus was a coward and did not fight, then the suitors would have eventually won Penelope, resulting in Odysseus losing his palace and his wife. Ma ny people have bravery and courage, but not many use it, as Odysseus does, to achieve their purpose. Secondly, Odysseus has great self-control, which allows him to deeply contemplate his decisions. Moments before Odysseus falls asleep, he spots a â€Å"covey of women laughing as they [slip] out†¦to the suitors’ beds† (Homer 375). Seeing this, Odysseus is angered and wants to kill every one of the suitors right then and there. But Odysseus retains his self-control and does not strike yet. At that moment, if he did strike, he would have lost because he would not have been prepared. He retains all his anger for the final battle with the suitors. In that battle, Odysseus is fully prepared and ready to fight, resulting in all the suitors’ deaths. Next, when Antinoos throws a footstool at Odysseus, â€Å"Odysseus only [shakes] his head, containing thoughts of bloody work† (Homer 326).

Free College Essays - The Scarlet Pimpernel :: pimpernel

The Scarlet Pimpernel    It was an adventurous tale of love and courage. In 1792, during the French Revolution, a figure named the Scarlet Pimpernel saved many aristocrats from the French. Using daring plots and disguises he escaped from the French and his archenemy, Chauvlin. The richest man in England, Sir Percy Blakenley was married to the most beautiful woman in France, Lady Marguerite Blankenley. Sir Percy was an important character in The Scarlet Pimpernel. The story took place in both England and France. It started in Paris, France at the scene of the guillotine. Some of the story took place at The Fisherman's Rest in Dover, England. Other parts of the story took place at Sir Percy's house in Richmond, England, The Chat Gris in Calais, France, Lord Greenville's Ball and The Covent Garden Theatre in England. The theme of the story was love and courage. It showed how much Sir Percy cared about and loved Marguerite. Marguerite once loved him, but now took him for granted and thought of him as a fop. It also limned how brave Sir Percy, The Scarlet Pimpernel, was in risking his life for the lives of the aristocrats. The Scarlet Pimpernel and a small band of devoted followers had dedicated their lives and fortunes to saving the innocent aristocrats of the French Revolution and the horror of the guillotine. They risked their lives on numerous occasions and rescued many French noblesse bringing them to the safety and security of England. Sir Percy Blakenley, one of the wealthiest men in England, was married to Lady Marguerite St. Just who was thought to be the most beautiful and smartest woman in Europe. She was perceived as a traitor to the French cause for having betrayed the Marquis de St. Cyr and his whole family to the bloody guillotine. This she was duped into doing because of her brother, Armond, who was almost killed by them for having dared to love the daughter of an aristocrat. Therefore Sir Percy showed no love toward Marguerite and acted the part of a fool. She thought Sir Percy to be a vain, pompous dandy and could not conceive how she ever married him. In spite of this she still had feelings of love for him. Sir Percy loved her deeply, though he also hated and detested her for what she did.

My Trip to the Philippines :: Philippines Vacation Personal Narrative Essays

My Trip to the Philippines In September 1989, when I was 11 year old, I came to Philippines during my short vacation. My father brought the whole family, also my cousin Jimmy. We spent 5 days in the Philippines. During these five days, I realized that there were many differences between Taiwan and the Philippines. The most difference was culture. People's language, behavior and also they are happy go lucky. The first problem I faced was the language problem. Philippine was ruled by Spanish long time ago. Most of Filipino could speak Spanish. I could not speak their language and also English, so what ever they said I just acted like stupid. I still remembered when I went to Cebu, in the hotel, the waiter came in to ask me something about my room. First, I was shock, then I used Chinese to answer her. The waiter was kind too. She started using Spanish, Japanese, French to answer me, but he never used Chinese. If he used Chinese, then that will be the time for me to reply. I run to my father's room, crying, and telling that someone is in my room and I doesn't know why he was there. After my father solved the problem for me. We were all laughing about it. My father said, "In the Philippines, eating with hands are their culture, you will never see this in Taiwan." In Taiwan, everybody use chopsticks to eat. Nobody will use spoon and folk to eat, because that's a kind of hard. Just like my first time used the spoon and folk. I doesn't know either to use my left hand to hold spoon or use my right hand. People have longer weekend than Taiwan. Both Sunday and Saturday are their weekend. In Taiwan, we can only have Sunday and half Saturday. For adults, they even only have Sunday to rest. That's unfair to adults. They should have longer weekend then kids, because they worked so hard. So, adults most be exhausted after hard work. People are happy go lucky. They wouldn't care much money they earn each day. They wanted to have better life than earning more money. Whenever they got a serious problem, like no place to overnight, they were try to find a place to

Dating Your Best Friend Essay

I ask myself sometimes why now and not then, I think this was how it was meant to be the whole time. We met in first grade and became real good friends right from the start. I remember playing a lot together with our friends. We also lived just across the street from each other so imagine, seeing each other at school and after school play even more outside after our homework was done, it was a great way of spending time together. Unfortunately after first grade, we somehow had to go to different schools, but we still got together after school and played together. It wasn’t until after 4th grade that I moved to a new neighborhood and didn’t see him again until 8th grade. We saw each other and recognized one another and again we became inseparable. We had a few classes together and we were always partners whenever we were assigned to grab a partner. Also that same school year, all the rumors started; that we liked each other, we were going to end up going out, we were always together and so on. I did think about it but we were just fourteen year olds who had no age and no intention of dating. We were the best of friends in middle school and kept going strong. Our high school years came real quick as we kept on growing up together and watching each other blossom into young adults. We were still the best friends ever, and the same rumors still kept going around. We somehow managed to have classes together which were very good for the both of us because we never wanted to be apart. We still had no intention of going out, because we didn’t want to break that wonderful friendship we had made and kept for so long. It wasn’t until Valentine’s Day of freshman year when I started feeling a little something for him. He sent me a valentine with the following message â€Å"Happy Valentine’s Day! Thanks for being an awesome friend! † I thought at that moment â€Å"Oh, friend† but I let it slide because I felt it was not a big deal. Sophomore year rolled around, we were still the best friends ever, and the rumors and gossip continued. We had classes together again, nothing special happened until the very end of that school year. We were saying goodbye to each other and we hugged, but we hugged each other for a while. I honestly felt that â€Å"spark† between us. I thought he felt the same (he told me later on that he did). We parted ways and kept in touch a bit in the summer, and didn’t see each other again until next year, junior year. That year I couldn’t hide what I felt for him, I was actually becoming more and more in love with him. I can tell he was also falling for me as well. It’s one of those things a girl can tell without being told anything. We were still the best of friends, and the rumors were still going (I was very surprised, yet a bit amused). This year was different because we’re now sixteen/ seventeen and had grown up more. Yes we were inseparable, but those feelings were becoming more noticeable to everyone except to one another. Yet nothing happened and we were still the best of friends. Senior year was a big year for us; it was the last year that we might be together. My feelings for him were now stronger than ever, I wanted to be more that friends, but for some reason he always seemed to avoid me and not talk at all. I don’t know why, I was hoping for him to say something to me, since I had heard from many that he actually did love me. But nothing happened, so I gave up on him in that aspect of us. I had revealed to one of my good friends that I did love Isaac and wanted more. He revealed to that same person that he loved me too. I found out from her and I went to talk to him, he immediately got upset and denied everything. With that being said I also denied everything because I thought to myself that was his chance and he blew it. We got really mad at each other and said â€Å"we are friends and that is it†. We didn’t stay mad for that long; we got back to talking again. I decided to date a guy that year; it was going well until I saw Isaac. He saw us holding hands, I saw his face turn red with anger, and just walked away upset. I knew it upset him but I had no idea why, we had settled on being best friends. We still enjoyed all the senior activities like prom, boat trip, and finally graduation. We both graduated and saw each other for what could be the last time. He was going off to college and I was staying home. After those four years in high school we proved everyone wrong about going out with each other, or at least that’s what we thought. Time passed and I had broken up with my high school boyfriend and I started dating another guy here at ECC for a few months. I never heard from Isaac once during that time, I was a bit upset but I didn’t pay attention to it. It wasn’t until February 12 that I was on Facebook and I got talking with Isaac again via chat that night. We were talking and asked about my boyfriend, I told him I didn’t have one and that I had given up on guys for the moment. We kept talking and talking and then I asked him â€Å"For April Fool’s we should put as our status that we’re going out†. It took him a few minutes to say â€Å"Why not actually make it a reality? † I was shocked! I swear at that moment I had an instant flashback of our childhood all the way through high school. I had waited for so long for that moment that I said yes, it also took me a while to respond back. At that moment he confessed that he had loved me since the end of sophomore year when we said goodbye to each other. I was so happy that everything went the way it did. Unfortunately he was away at school and I wouldn’t see him until our one month anniversary when he came home. I didn’t mind, I did not wait all that time in high school for us to finally be together as a couple and not have the relationship work. We changed our Facebook status that we were officially a couple. It was an explosion of â€Å"It’s about time! †, â€Å"I knew it! †, and â€Å"I told you it would happen eventually! † We didn’t care though because we were just happy that our dream had finally come true. A month passed and it was our one month anniversary. We went out to dinner and had an amazing time together. That same night he took me to his home and I met his entire family. Since then me and his family have gotten along very well and we are practically like family. We definitely enjoyed that week together but he had to go back and I wouldn’t see him until May. My birthday came along and it happened to fall on a Saturday, which was nice because I planned to have a party. Isaac drove all the way home just for my birthday and surprised me. He called me before and said that he had sent a present. Then at around five in the afternoon he called and said that my gift has arrived and I had to open the door, sure enough it was him with a bouquet of flowers. I cried of joy, no one had ever done something like that for me. It was an awesome way to celebrate my birthday. The relationship has been going very well, and I’m positive that it will continue to stay like that. It just comes to show that that myth about how dating your best friend is bad isn’t always true. It can happen to anyone, and yes it doesn’t work out for some people, but in my case it worked out for the better. As I said before, I don’t think we were meant to be best friends, just something more.