University of Southern Califo

Earlier in the course, you were asked to informally evaluate your leadership skills and qualities (see attached for the initial summary of self-assesment). In this Final Project, you use formal assessment tools to identify your areas of strength and areas in which you need further development.

In this Final Project, you use formal assessment tools
to identify your areas of strength and areas in which you need further
development. You may use the results of this self-assessment to develop a plan
to gain the skills and experiences that will help you move toward achieving
your short- and long-term professional goals and objectives.

Using the assessment tools provided in Introduction to Leadership: Concepts
and Practice (see attached)
, conduct a self-assessment
of your own leadership characteristics, style, and skills. Complete at least four assessment tools for this self-assessment. In
addition, select one tool to give to a colleague or supervisor so he or she
can assess your leadership skills.

After you complete the 4 assessments, you
must score them so you can analyze the results (the actual scores or summaries
of your actual scores) to add to your paper. In addition, select one assessment to give to a colleague so s/he can
assess your leadership skills. Upon completion, score that survey as well and analyze the
findings, this too should be
added to your paper.

Part of the analysis will require you to compare and
contrast the results of the assessments. Be sure to provide the actual numbers/scores and/or
summaries (of the numbers/scores) from your assessments
as part of your analysis in a well-written
paper. The main objective of this assignment is your observations related to
the findings of each of the instruments and how these contribute to your
understanding of yourself as a leader -both your strengths and areas to be
strengthened.

Final Project (2–4 pages in APA
format)

Evaluate your current leadership characteristics,
style, and skills based on the assessment tools you and your
colleague/supervisor completed. Be sure to:

  • Include actual results or
    summaries of the results you collected using these tools
  • Identify personal leadership
    strengths as well as areas for improvement
  • Include U.S.-based references (including the course text) for leadership concepts covered in this course and relevant issues related to
    ethics, diversity, and power in the organizational setting

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To complete this assignment, you will do the following:

1. In order to complete this assignment, you will apply the 3 prong test from our lecture in class Monday night. In order to get started, you won’t need the podcast I promised you which will reiterate Prong #3 “Salary Basis,” as well as providing you with a reiteration of each of the prongs of the entire test.

2. Review the attached PDF job description for the Front Desk Manager and then review the scenario below.

SCENARIO: One of your employees believes the company owes her unpaid overtime. As a front desk manager, she thinks the company misclassified her position as exempt. She has a degree, but the position does not require one. Finally, she earns $40,000.00/year.

3. For your assignment submissions, discuss the process you will use (the steps you will take) to determine if she should be receiving overtime as she claims. You are applying the 3 prong test. Be sure to draw a conclusion about whether or not she is Exempt or Non-Exempt.

As you prepare your submission, you may find yourself needing more information to determine the answer to one of the prongs. Please state the question you need answered or what information you don’t have and then presume both sides. Here’s a cooking example: you must cook a dish and explain the process in writing. Your recipe requires oil, but you don’t know if you have oil available, so you would say something like: “….this recipe requires oil and we don’t know if we have any oil. If we have oil, then we need 1/4 cup. If we do not have oil, then we could use 1/2 half cup applesauce as a substitute.”

You will do something similar here. In your response if you need more information in order to answer, you will answer both sides of the issue (e.g, “oil is available” or “oil is not available and we used applesauce as a substitute.”). I can’t say too much here on point with the 3 prong test because I might give something away. I think when you sit down and start working through it, this will make sense. If it doesn’t, PLEASE reach out and we’ll get your question answered.

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Airline tickets are a price-driven market for most customers. Many will trade off non-stop flights, preferred travel times, and choice of airline to get the lowest possible price. Therefore, airlines offer advance purchase discounts to make sure they fill as many seats as possible. Demand tends to be very elastic, as evidenced by the heavy reservation activity that takes place during fare wars. Notable exceptions include first-class travelers and business travelers. First-class travelers are easily segmented–they get a better seat, but business travelers often sit in coach. Ever wonder why you get a cheaper fare when you have a Saturday night stay? It’s because the business traveler is willing to pay a premium to fly out and return home in the same workweek. Vacation travelers, by contrast, are willing to spend Saturday night. In this exercise, we are going to plan a flight online in order to observe the price elasticity in this industry.

Use Expedia to price a round-trip flight from New York (any airport) to Paris (any airport) traveling coach class, departing tomorrow, and returning one day after you arrive. Record Expedia’s response in the table below. Then search again and vary the criteria to complete the rest of the table:

The date you completed the table:

Class

Departing

Returning After

Airline & Departure Flight

Price

Coach

Tomorrow

1 day

Coach

Tomorrow

1 week

Coach

Next Month

1 day

Coach

Next Month

1 week

First

Tomorrow

1 day

First

Tomorrow

1 week

First

Next Month

1 day

First

Next Month

1 week

Questions:

1. What can you conclude from this example about the elasticity of demand for coach fares? For first-class fares?

2. Do you think the higher price for a first-class seat is justified by higher costs to the airline?

3. How do the prices differ for one day versus one-week trips? How can you explain this?

4. For the first class, do the prices differ for trips departing tomorrow versus next month? Why or why not?

5. What pricing approach(es) mentioned in the chapter might the airlines be using based on your research?


Submit the completed table and your answers to the questions. The write-up should be 500-600 words (excluding the table).

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Web Page Critique

The Las Vegas Convention and Visitors Authority (LVCVA) is the official destination marketing organization (DMO) of Las Vegas for business and leisure travelers. Internet marketing and website design are critical for DMOs.

Visit www.lvcva.com (Links to an external site.) (business) and www.visitlasvegas.com (Links to an external site.) (consumer).

1) Discuss possible market segments targeted by the business and pleasure visitors sites and 2) evaluate/critique the website effectiveness according to guidelines provided here and in Chapter 16: Direct, Online. Social Media, and Mobile Marketing.

Your write-up should be 500-750 words.
7 Cs of Effective Website Design:

Context: The site’s layout and design. A website’s layout and overall visual design need to be uncluttered, easy to read and navigate, the color scheme needs to be appropriate for the marketing design. Having some white space will also aid in the overall design and readability.

Commerce: The site’s capabilities to enable commercial transactions. If the website is intended for commercial transactions, then it has to be safe and the fact that it has been made safe must be communicated to the customer, most websites use a “lock” symbol in the corner to indicate that it has been encrypted.

Connection: The degree that the site is linked to other sites. Any links that lead the customer away from the website.

Communication: The ways the site enables site-to-user, user-to-site, or two-way communication. How the company talks to its customers; this can be done through signing up for special offers, email newsletters, contests, surveys, live chat with company representatives, and company contact information.

Content: The text, graphics, animation, sound, music, and/or videos that are presented.

Community: The way the site enables user-to-user communication. The website may allow interaction between customers through message boards and live chat.

Customization: The site’s ability to tailor itself to different users or to allow users to personalize the site. Companies can allow customers to personalize aspects of the website or it may tailor themselves to different users, for example having different colors and graphics for people who speak different languages.

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Once you have chosen the issue for your project, examine the associated study (or the Riverbend City multimedia scenario) thoroughly. Conduct research that addresses or relates to your chosen human services issue, including its history and previous work that has been conducted on it in the field. Apply theoretical frameworks and systems thinking to your chosen study (refer to your Unit 1 readings).

Write a paper in which you provide a detailed profile on the issue and the study from your chosen organization. Include the following components:

Introduction
  • Briefly describe the human services organization and the program being examined.
  • Explain the focus of your chosen study.
  • State what the study is attempting to learn and understand about the issue.
  • List the specific research questions of this study. (Note: You will outline them further in the next section of the paper.)
  • Identify your overall goals for the issue, program, and organization. (Note: You will define them further in the next section.)
Background for the Study
  • Discuss research that addresses or relates to your chosen human services issue, including the following:
    • Explain what you have learned about the research.
    • State the history of the issue and how the history is relevant to the current state of the issue.
    • Describe the previous work that has been done on this issue.
    • Analyze how other research relates to this issue.
  • Analyze the background of your chosen study.
    • Address the population, governance structure, and leadership models.
    • Outline the specific research questions of this study.
  • Examine your chosen study using theoretical frameworks and systems thinking.
    • Investigate how this issue relates to other problems within the organization.
    • Examine research that discusses this issue and related problems, using theoretical frameworks and systems thinking.
    • Define your overall goals for the issue, program, and organization.
  • Provide a references page, including at least two resources used in your paper.

Please note that it is expected that your responses to the above will change as you refocus and refine your action research project.

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Please write a discussion and respond to this 2 peers’ Discussion Prompts

Discussion:

  • State the research question you have chosen for your signature assignment and discuss it in terms of qualitative and quantitative research.
    • Provide examples of quantitative and qualitative research you have found in the text or your own research.
    • What are the pros and cons of each type of research?
  • Respond to at least two of your classmates’ or instructor’s posts. Provide input on your classmates’ research questions. Which type of research do you think would be most appropriate to answer the question?
  • ALL citations and references needs to be APA 7th edition format. THANK YOU

My signature assignment is a Research Study Question about Epilepsy.

Epileptic individuals are in many cases linked to having seizures and convulsions that affect their well-being. What are the social effects that the situation brings to an individual living with epilepsy?





Peer# 1

My research question is: Is there a correlation between increased BMI and increased intake of artificially sweetened beverages in night shift nurses?

In the research that I have conducted, most of the information I have found tends to be quantitative research where there were detailed studies performed to obtain their data. Specific groups of people are sought out to obtain data, and very specific data is obtained to be able to answer the hypothesis (Jacobsen, 2017). This is a method that I will be using to obtain information to answer my research question. My population is very specific in working with night shift nurses. I will be using a source population that is well defined subset (night shift workers) from a larger population (nurses) (Jacobsen, 2017). One such study that I found was titled “Association of Rotating Night Shift Work with BMI and Abdominal Obesity among Nurses and Midwives” (Peploneska, et al., 2015. In this article they also used the same population as I will be using. They took detailed measurements of the body to obtain BMI starting information. From this point, they chronicled their nurses BMI over the course of 4 years. Throughout the process, they made continual measurements including BMI, “waist to hip ratio (WHR) and waist to height ratio (WHR)” (Peploneska, et al., 2015). Over the course of the 4-year period, they sought to see if there was a positive or negative correlation between increase in BMI in the nurses that worked only night shifts for those 4 years. The pro of using this type of research, is that I can get specific data, similar to what I will be collecting. It will also allow me to compare my research data to other’s data collected, to see if we are getting similar data, or if my research is an outlier.

As most of the research that I have found is qualitative, I was able to find one study that was qualitative. In this study, the focus was not on the specific data, but more lenient in data collection (Jacobsen, 2017). In this study titled, “Sugar-Sweetened beverages and Genetic Risk of Obesity”, the researchers utilized subjective data in the form of questionnaires for the participants. Instead of actually monitoring the specific amount of sugar consumed, as a qualitative study would do, this study just asked participants to disclose their average amount of sugary beverage consumed. In the terms of what my question asks, this type of research would be good for background data and also for weeding out individuals from outside my population requirements. Unfortunately, when looking at things like quantities of sugary beverages consumed, and BMI stats, this type of research would be quite a limitation for me.

Peer# 2


Research Question: What are the social determining factors that influence an individual’s decision to resist vaccines?

This topic is well suited for a combination of both quantitative and qualitative research, or mixed methods.

Quantitative research is used to demonstrate generalizable facts like – people are hesitant to get vaccinated. Quantitative research answers questions such as: Who is vaccine hesitant? Where do they live? When did they become vaccine hesitant? I will most likely use surveys with close-ended questions and recruit using online tools and social media platforms.

Qualitative research is used to better understand the individual experiences and thoughts of participants. Why are they vaccine hesitant? What experiences or information has led them to make this decision? I could gather this information either through individual interviews, focus groups or by doing a literature review. Individuals who participate in the initial quantitative study can be recruited as participants for more in-depth interviews or focus groups.

I have come across a lot of information that has been gathered through both quantitative and qualitative methods. In their clinical review, Shen & Dubey (2019), both physicians, did an in-depth literature review related to vaccine hesitancy in order to develop guidance for primary care physicians in addressing vaccine hesitation among parents (pp. 175-176).

Pros and Cons: Qualitative research can be relatively inexpensive but the data is more difficult to analyze, therefore the conclusions can be less definitive. Quantitative data is easier analyze, but the development and design of a quantitative study can be time consuming (developing survey questions, recruiting participants and analyzing results). You can also include a larger sample size in a quantitative study compared to a qualitative study (West Coast University, n.d.). The fact that the sample size can be larger makes the survey results more generalizable.

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Please write a discussion and respond to this 2 peers’ Discussion Prompts

Discussion:

  • Read about both managed care and fee-for-service health plans. In a short paragraph, discuss the similarities and differences between these plans. Next, respond to the following question: Does managed care give greater accountability for quality of care than fee-for-service? Why or why not? Use at least one specific example in your post.
  • Respond to at least two of your classmates’ or instructor’s posts. Give your classmates input on the secondary data sources they have chosen. Are there any other funding sources they might consider?
  • ALL citations and references needs to be APA 7th edition format. THANK YOU

Peers# 1

The term managed care is used to describe a type of health care focused on helping to reduce costs while increasing the quality of healthcare (Cigna,2021). The primary purpose of managed care is to better serve plan members by focusing on prevention and care management, which helps produce better patient outcomes and healthier lives (Fleming,2015). In managed-care plans, the insurance companies contract with groups of providers to offer plan members reduced rates on care and services. These networks can include doctors, specialists, hospitals, labs, and other health care facilities. In managed care, the members are requested to see only those physicians affiliated with the plan. They would need the members to refer from their respective primary care doctors to visit the specialists.

Whereas, Under the fee-for-service method, doctors and hospitals get paid for each service they perform. There were no limits on their treatment decisions; doctors or hospitals could order as many tests as they felt necessary (Healthcare.gov, 2021). This method rewards the providers for the volume and quantity of services provided, regardless of the outcome. In this, patients are not benefitted because their insurance companies would often only pay a percentage of the charged fees. The members choose the doctor they want to see and do not need any referral for specialists to visit unless requested by the provider.

Over the past few years, the fee for services has changed to value-based payments that reward medical providers based on efficiency and patient outcomes rather than the volume of services provided. Fee for service payment model does not necessarily promote quality (Texas Human and Health Services, 2016). For example, In Managed Care Plan, a periodic check-up by a primary-care physician is paid for by the plan. It may be accompanied by reminders to get regular preventive screening tests, whereas, in fee-for-service, periodic check-ups do not include cancer screening tests like mammograms. Compared to Fee for Service Plans, managed care allows for greater accountability for outcomes and can better support systematic efforts to measure report, and monitor performance, access, and quality. Managed care programs also allow improved care management and care coordination, thereby increasing the quality of care.

Peers# 2

It is important to note that there is a stark difference in managed care and fee-for-service health care. Additionally, one needs to note that many insurance companies are utilizing a managed cost plan now.

A managed care plan is expansive in scope and truly is built to benefit the patient and to ensure that they are receiving proper care (Sekhri, 2000). It is important to note that managed care focuses on the entire healthcare process for the patient. It monitors the patients progression from the PCP to speciality services or hospital services. There is a massive press on health education and preventative medicine. There is a press for the patient to use urgent cares over hospitals whenever possible. Finally, there are incentives offered too providers to ensure that proper, effective, quality care is being delivered (Sekhri, 2000). Finally, managed care functions off of a capitation model. This means that a “fixed amount, on a per-member-per-month” is paid to the healthcare entity (Fleming, 2015). The goal of the healthcare entity is then to ensure that the care rendered for that patient does not exceed the allotted amount, but to also ensure that the patient is receiving quality care.

A fee-for-service model is a little different from managed care. Under the fee-for-service scope a provider is paid a Relative Value based unit (RvU) for the care that they render. Essentially, the more RvU’s the provider charges, the more the provider is paid. The quality of care and patient outcomes are not considered in this model. The model allows the providers to manipulate it in a manner that allows greater personal gain.

When comparing the two models, a managed care plan holds a higher level of accountability to the provider and the care that is rendered. This is due to the acceptance of risk that the organization has to accept in order to participate. Most of the models are setup in a manner that allow an organization to keep any of the allotted money that is not spent on the patient care. However, if the organization overspends on the patient care, then the organization is responsible for the additional cost and cannot shift the cost to the insurance or patient. This presses the organizations to ensure that they are pressing preventive health medicine and only ordering testing that is truly necessary. Additionally, the organization will need to use high value providers for any services that they refer out in order to continue to contain costs.

An example of managed care providing better quality care would be if a patient presented to the hospital with chest pain, dizziness, fever and a plethora of other symptoms. The provider treating the patient would only order the testing necessary to achieve the diagnosis and be able to help the patient. The multi-million dollar work up with extensive imaging would be avoided until it was truly indicated. Once the patient is treated, the organization would assist with ensuring that patient has proper follow-up with any needed specialities and their primary care provider. These extra steps would help to ensure that the patient is not readmitted to the hospital. This is important because hospitals have to maintain a certain re-admittance rate. By performing only necessary testing and care, coordinating the patient’s follow-up and preventing re-admission to the hospital an additional layer of quality and oversight has been added by managed care.

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PLEASE USE A JAZZ CONCERT

There are many full-length concerts now available on YouTube and other streaming video services. Be sure that the concert you view is a concert of popular music – including at least two musicians performing together in the same band, and is at least 60 minutes in length. Then follow the guidelines for the concert report.

Please address the following points:

  • Date and venue of the performance.
  • Names of performers (the name of the band and/or the names of individual performers for small ensembles)
  • Ensemble type and/or instruments being played (list each instrument for small ensembles of 6 musicians or less)
  • Briefly describe the ambiance and/or decor of the venue.
  • Briefly describe the audience.
  • Identify the style of popular music performed.
  • Identify the titles of the pieces/songs that you discuss (including composer’s names only if possible/relevant).
  • Describe in detail, four of the songs/pieces performed, with a paragraph of around 150 words for each song. This is the most important part of your concert report, and it should comprise at least 600 words. Be specific as possible, utilizing vocabulary and musical terms from the course if possible. Make observations on:
  • the general character of each song – melody, rhythm, texture, and timbre (melody, rhythm, tempo, texture, emotional content, etc., in your own words as it seems appropriate).
  • how the song/piece unfolds from beginning to end – this can include notable moments or shifts in mood and character, and interesting musical exchanges and dialogues between musicians.
  • In conclusion, sum up your experience. Did the music communicate to you on a deeper emotional or psychological level? Why, or why not? Was there a particular performer (or performers) who you really connected with – why? Did the information you learned in class impact your experience?
  • Your essay will be graded based on depth of analysis, the degree to which you address all of the bullet points above, the use of detailed descriptions, and on spelling and grammar. One of the course learning outcomes is to become an “ active” listener, so your observations should reflect a developing awareness of this skill. If you quote or paraphrase an author, website, or other sources, you must cite your references using parenthetical citations (author last name, page number) or footnotes.

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    Hi, I have a short policy analysis first draft I need help with. I am a current intern at a site called Doctor Lifestyle in Orange County, CA and I have to research a problem within my site. The problem is in the pdf attached (Policy Analysis Matrix). I have filled out and attached the Policy analysis matrix, but there are a few comments from my professor that need to be addressed for the first draft I am writing. The comments are also attached with screenshots what part of the matrix needed to be resolved.

    I have included the rubric, a sample paper, and the lecture slides that will help you complete this first draft.

    ***I will need an outline in Harvard format before the first draft.***

    As for the actual first draft the criteria is as follows:

    The first draft will include:

    • Cover page
      • Must have: Title, your name, your practicum site, and the specific audience for the analysis.
      • The title must reference both the problem and the criteria for analysis.
        • Examples are here.
    • The body of the analysis (750-900 words) with the following subtitles:
      1. Background (subtitle)
        • Description of the broad problem
        • Description of current and previous efforts to address the problem
      2. Scope (subtitle)
        • Assessment of previous policy efforts
        • Significance of the problem
        • Why the need for analysis
      3. Problem Statement (subtitle)
        • Specific definition of the problem that will be analyzed in the paper
        • Describe the major stakeholders (Primary, Secondary, and Key)
        • Objectives and goals of solutions
        • Criteria to be used for recommendation
      4. Analysis of Alternatives (subtitle)
        • Description of three potential solutions
        • Compare possible outcomes, constraints, and feasibility of each
      5. Policy Recommendations (subtitle)
        • Choose one of the three options.
        • Describe why the chosen alternative is preferred based on the specific criteria from Problem Statement
        • Discuss potential implementation challenges or possible unwanted outcomes
      6. References (subtitle, separate page)
        • At least six sources, at least three must be academic. No sources older than 10 years.
        • Academic, journalistic, and original data collection are all possible
        • Must be in APA 7 format!

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    Please respond to this 4 peers’ Discussion Prompts

    ALL citations and references needs to be APA 7th edition format. (200-250 words each)

    • you must also post substantive responses to at least two of your classmates’ or instructor’s posts in this thread. Your response should include elements such as follow-up questions, further exploration of topics from the initial post, or requests for further clarification or explanation on some points made by your classmates.

    Peer# 1

    According to Joe Tye’s 2015 video, having employees take the Florence Challenge can help them be emotionally positive, self-powered, and fully engaged; these make a great workplace and also creates high employee satisfaction. Tye’s 2015 has a photo of the Florence Challenge, named after nurse Florence Nightingale, which is composed of the following requirements:

    • Turning complaints into constructive suggestions, which is meant to improve emotional positivity.
    • Taking the 7 Promises of self-empowerment: responsibility, accountability, determination, contribution, resilience, perspective, and faith.
    • Fully engaging by being committed, engaged, passionate, effective with resources, fostering belonging and fellowship, as well as taking pride in oneself, one’s work, profession, and organization.

    All of these parts of the challenge involve ethics because in order to have ownership, one must have excellent ethics. Tye mentions that trust is huge in healthcare, because no matter what, patients will trust their providers to perform procedures on them without even knowing what they are doing (2015). Tye strongly believes a leader can use transformational leadership as well as ownership to help employees look at themselves as if they are their best selves; this can also help them stay emotionally positive (2015). Tye states that children have a vision of greatness in their self-perception of their future selves; leaders can help re-spark these dreams and self-perceptions of greatness that employees are currently missing (2015). As for engagement, Tye mentions that ownership happens when employees are motivated because they are proud of their organization and the job they do; he mentions how a high life satisfaction can come from being happy at work (2015).

    Peer# 2

    • How would a leader ensure that leaders and followers were emotionally positive, self-empowered, and fully engaged?

    A leader will use the transformational leadership style to elevate his/her followers to a higher level. Ensuring the followers take accountability for their work or action and most importantly getting rid of baggage or pickle suckers as Joe Tye calls them. A good leader will get rid of the negative culture within their organization.

    A good leader set the tone for the employees, especially for the employees who are not engaged. The good leader should recognize what or who is preventing the organization from being the best. Changing the employee’s mindset of the disengaged employees to a positive culture helps promote excellence, accountability, ownership and builds trust amongst staff. “It is the leader responsibility to create a workplace environment where toxic emotional negativity is not tolerated.” (Tye)

    • Why and how does ethics fit into a culture of ownership?

    Ethics fit into a culture of ownership because it is about having respect for others. Using the ethics principles to guide you, you can learn about cultures other than your own. It allows understanding and diversity within an organization.

    Peer# 3

    Hi everyone!

    To be successful, a project manager must be able to handle unplanned scope changes. Larson and Gray (2014) point out that changes during the life cycle of projects are inevitable, but some changes can be very beneficial to project outcomes. The changes that have negative impacts on the outcomes are the ones that wish to be avoided and monitored. Even with the best planning, it is inevitable that changes will occur during the duration of a project and the scope with be altered.

    As a project manager, no matter the project I was working on, I would plan for a change instead of reacting to unforeseen changes. Making sure that I have a thorough change management process in place is crucial. The key to managing scope creep is change management (Larson & Gray, 2014). All changes, especially unplanned ones, should be documented effectively so that they can be communicated to the team. As part of the change management process, the change should be evaluated to understand the overall impact on the scope, schedule, and budget (How to Deal with Last-Minute Scope Changes, 2021).

    Project managers should monitor any scope changes very carefully (Larson & Gray, 2014). At the start of the project, the baseline must be well defined and agreed upon with the project customer (Larson & Gray, 2014). If I was the project manager and the scope of the project began to change in the middle of the project, I would document the change and compare the effects of the change to the baseline. This would include evaluating the impact of the change on the cost, time, dependencies, specifications, or responsibilities of the project (Larson & Gray, 2014).

    The only constant is change and a project manager must be able to adapt to changes, whether big or small, during a project. Though it is impossible to plan for every change that may occur, the best practice is to have a change management process in place so when an unforeseen change occurs, it can be handled effectively and efficiently.

    Peer# 4

    When managing a project, “changes during the life cycle…are inevitable” (Larson & Gray, 2014, pg. 500). Even though we cannot avoid the scope’s change, there are ways to help mitigate scope creep. The main one is to have a very well-defined scope statement before the project begins. The clearer the scope statement, the less room there is for change of scope when the project begins.

    If I were managing a project and started to notice change, the next observation to make is if the change is positive (like a shorter timeline) or negative (like late schedules or even loss of control of the project). If the change is good for the project (positive), then we endorse the change on the scope and get the project customer to approve and sign off on it (Larson & Gray, 2014). If the change alters the scope negatively, then we reassess the project’s data, timeline, scheduling, communication, accountability, etc. (Larson & Gray, 2014). In either case, it’s paramount to share the scope creep with stakeholders.


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    Q1 In Capstone Part 2, what are the three most significant limitations you had faced?

    Q2 Review your business case and share your outline with the professor.

    Rubric

    Research Paper Rubric (1)

    Research Paper Rubric (1)

    Criteria Ratings Pts

    This criterion is linked to a Learning OutcomeResponsiveness and RelevanceCompletely responsive and relevant to assignment, instructions, stated requirements. Includes all required sections.

    20 pts

    This criterion is linked to a Learning OutcomeThesis/PurposeIdentifies a relevant research topic and a clear thesis that provides direction for the paper. Thesis clearly and concisely states the position, premise, or hypothesis and is consistently the focal point throughout the paper. Concepts and terminology are clearly understood and used appropriately.

    20 pts

    This criterion is linked to a Learning OutcomeAnalysisDemonstrates clear understanding and careful analysis of the research topic, thesis, and content of the research. Displays critical thinking by comparing and contrasting perspectives, considering counter arguments or opposing positions, and drawing original and thoughtful conclusions. Reasoning and logic are sound.

    20 pts

    This criterion is linked to a Learning OutcomeResearchProvides compelling, accurate, and substantive evidence to support in-depth the central position beyond assignment requirements. Depth and breadth of research is strong. Research sources are highly relevant, accurate, and reliable and add to the strength of the paper. Appropriately and correctly cites sources.

    20 pts

    This criterion is linked to a Learning OutcomeClear and Well-organized WritingEach paragraph has a central idea; ideas are connected and paragraphs are developed with details; paper is easy to read and flows naturally in an organized way. Ideas are clearly connected and make sense.

    10 pts

    This criterion is linked to a Learning OutcomeGrammar/Syntax/Formatting MechanicsWell constructed using standard English, characterized by elements of strong mechanics and basically free from grammar, syntax, punctuation, usage, and spelling errors.

    10 pts

    Total Points: 100

    Textbook
    See sections in the textbook on leadership.
    General Resources
    Haefner, C. (2018). Sofia University writing & style handbook download[PDF file].
    Labaree, R. V. (2019). Organizing your social sciences research paper: 11. Citing sources. Retrieved from https://libguides.usc.edu/writingguide/citingsourc… (Links to an external site.)
    Labaree, R. V. (2019). Organizing your social sciences research paper: 2. Preparing to write. Retrieved from https://libguides.usc.edu/writingguide/preparingto… (Links to an external site.)
    Labaree, R. V. (2019). Organizing your social sciences research paper: 10. Proofreading your paper. Retrieved from https://libguides.usc.edu/writingguide/proofreadin… (Links to an external site.)
    Lieberg, C., Patterson, J., Schwartz, A., Marks, J., & Frisoli, S. (2017). Chapter 12 Writing and Language: Standard English Conventions download. The Official SAT Study Gem (pp. 121–130). New York: The College Board.
    NC State University Libraries. (n.d.). Videos and interactive guides. Retrieved from https://www.lib.ncsu.edu/tutorials/ (Links to an external site.)
    Purdue Online Writing Lab. (n.d.). APA style. Retrieved from https://owl.purdue.edu/owl/research_and_citation/a… (Links to an external site.)
    Purdue Online Writing Lab. (n.d.). ESL students introduction. Retrieved from https://owl.purdue.edu/owl/english_as_a_second_lan… (Links to an external site.)

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    Please respond to this 4 peers’ Discussion Prompts

    ALL citations and references needs to be APA 7th edition format. (200-250 words each

    • you must also post substantive responses to at least two of your classmates’ or instructor’s posts in this thread. Your response should include elements such as follow-up questions, further exploration of topics from the initial post, or requests for further clarification or explanation on some points made by your classmates.

    Peer# 1

    Hi everyone.

    I chose the Situational Leadership Questionnaire because I was very curious to see which leadership style I would fall under. I had an idea of my strengths and weaknesses in all four styles – directing, coaching, supporting, delegating. I also have a pretty clear grasp of the developmental level (or degree of competence and commitment) of the staff I supervise.

    Coaching and supporting were my two highest scores. I scored a zero on delegation. Reviewing information from the video presentation, this makes perfect sense. Especially in my current position as a Supervising Registered Nurse in the California prison system. The staff I supervise include RNs (some with advanced degrees some with A.A.s), Licensed Vocational Nurses, Medical Assistants, and schedulers (Office Technicians). I also interact and troubleshoot patient care and operational issues with our primary care physicians and medical leadership. So, they all have different levels of competence and many have relatively low commitment to accomplish activities and specific goals.

    According to the West Coast University video presentation (n.d.), coaching leadership style is suited for followers with some competence and low commitment. Supporting leadership style is best suited for followers with high competence and low commitment (Slide 4, Development). I acknowledge that I could delegate more than I do. But I tend to be a bit of a perfectionist, with high expectations of myself and others. Sometimes it just seems easier for me to take on a project myself. I need to work on that. It’s important for me to give people the opportunity to take on tasks and activities that will enhance their professional skills and knowledge base. Even when things are crazy busy and it needs to be done quickly.

    As side note, just because a person has an advanced degree, it doesn’t mean they are automatically more committed or competent in their job duties.

    Peer# 2

    Hello Everyone,

    I chose to do the Path-Goal Leadership Questionnaire because in my new role, I felt this was more appropriate, I recently took an instructor role teaching medical radiography for some background. The path-goal theory is meant to explain how leaders work to move their followers, in my case students, in moving along the path needed to reach their goals. In my case, I am leading my students along their associate program to be able to complete their program and pass the national registry. With path-goal theory, I need to be able to use my behaviors to lead my students to success and satisfaction with the passing of their registry and getting into the field of radiography (Northouse, 2018).

    I learned that I have a more directive leadership style with a score of 34, which I expected from answering these questions from the role of an instructor, but was happy to see that I scored a 30 on the other three styles as well (WCU, 2021). Directive leadership fit into the teaching structure I now work in, as explained in the text. With the syllabus, I give my students clear instructions on the tasks they must complete, the expectations required of them, what timeline items need to be completed in, and how they are to turn in and maintain high grades in my classes. “A directive leader sets clear standard of performance and make the rules and regulations clear to followers (Northouse, pp. 134, 2018).

    Scoring high in the other aspects also assists with my new role though. Supportive behaviors can make my classroom a nice place to build confidence in their abilities. Participative behaviors gives my students the ability to share ideas and opinions on how to best remember information, we work together to make different monikers and abbreviations to memorize information. And achievement-oriented behaviors is necessary to get my students to achieve the highest levels possible, which in turn will help them pass their registry the first time (Northouse, 2018). Understanding how to adapt and use all four of these path-goal oriented leadership behaviors, with that clear expectation from directive leadership, can set my students and myself up for success in getting them to their ultimate goals of being medical radiographers.

    What are your thoughts? I look forward to your feedback.

    Peer# 3

    Hi everyone!

    Managers recognize time, cost, and resource estimates must be accurate if project planning, scheduling, and controlling are to be effective (Larson & Gray, 2014). Accurate estimates are critical to effective project management because studies show that poor estimates are a major contributor to failure. Accurate estimates are needed to support good decisions, schedule the work that needs to get done, determine the project time frame or whether it is worth doing. Accurate estimates also allow for the development of cash flow needs and budgets for the project. Larson & Gray (2014) point out that without solid estimates, the credibility of the project plan is eroded because deadlines become meaningless, budgets become rubbery, and accountability becomes problematic.

    Accurately estimating costs is particularly important during project management in healthcare organizations. As healthcare care costs continue to rise and the Affordable Care Act continues to have a presence in the marketplace, the industry is experiencing increased competition (Laudolff, 2016). Because of this, healthcare organizations are becoming more budget conscious and must ensure that funds for design and construction are spent in the most optimal way (Laudolff, 2016). Accurately estimating costs for healthcare projects is crucial because the projects tend to be very high-end, high-tech spaces that must accommodate multiple functions. Healthcare facilities are specialized spaces different from other facilities, meaning costs must be estimated beyond the typical needs. For example, every building needs to estimate costs for drywall, flooring, and lighting, but healthcare facilities must make allowances for medical gas systems, specialized lighting, etc. Accurately estimating costs also prevents healthcare projects from becoming mega projects that tend to go way over budget and fall behind schedule (Larson & Gray, 2014).

    -Sabrina


    Peer# 4

    According to the textbook, “estimating is the process of forecasting or approximating the time and cost of completing the project deliverables” (Larson & Gray, 2014, pg.135). It’s important that in this sense, the word is being used to combine the scope of the timeline and the cost cohesively. Also per the textbook, there are six main reasons estimating is important:

    1. Supporting good decisions
    2. Scheduling work
    3. Determining project timeline and cost
    4. Whether the project is worth doing
    5. Developing cash flow needs
    6. Determining progress of the project

    The factors above serve as a great starting point for analyzing any project. Though estimates cannot be 100% accurate, it’s good to strive for 100% accuracy. “Accurate” estimates are critical to effective project management because simply because the outcome of any project has an impact on the future of the respective organization (and even industry as a whole). Applying this to projects in healthcare organizations, it is even more detrimental that projects be completed as close to the estimate as possible. The biggest reason being health outcomes are always affected by projects, regardless of the size or time of the project. Everyone’s health is on the line in the healthcare industry. Tampering with the system that is already in place—even for improvement—is still a risk for the patients. For example, let’s say a proposal is made to renovate all the main waiting rooms in a hospital. Looking at the reasoning above, the project might not be worth the time and the cost simply to provide more space in the waiting room; this would be relatively expensive and cost a lot of money for workers. Not to mention the logistics for all patients—would the hospital close parts of the hospital for renovating the waiting rooms and then “switch sides”? An even bigger question: shouldn’t the hospital focus more on the patients waiting less time in the waiting room instead of making the waiting room more comfortable?

    Reference

    Larson, E., & Gray, C. (2014). Project management: The managerial process. (6th ed.). New York, NY: McGraw-Hill.

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    Please respond to this 2 peers’ Discussion Prompts

    • Respond to at least two (2) of your classmates’ or your instructor’s posts. Your responses should include elements such as follow-up questions, a further exploration of topics from the initial post, or requests for further clarification or explanation on some points made.

    ALL citations and references needs to be APA 7th edition format. (200-250 words each

    Peer# 1

    The balanced scorecard (BSC) allows managers to look at the business from four important perspectives: (1) Financial perspective, (2) Customer perspective, (3) Internal business perspective and lastly (4) Innovation and learning perspective. BSC essentially is a set of measures that gives top managers a fast but comprehensive view of the business and its flow and direction (Harvard Business Review, 2019). 3 challenges in implementing the BSC is management, leadership and reliance on only one perspective. The organization must be on board in trying to up keep the organization’s business flow. Management needs to realize that things within the organization are not abiding to what projections should be and BSC is a good way in seeing where everything is at. Leadership, the managers must be competent at navigating multiple tasks. For example, the Harvard Business Review compared the BSC as “dials” and “indicators” in an airplane cockpit. For the complex task of navigating and flying an airplane, pilots need detailed information about many aspects of the flight. Information like fuel, altitude, air speed, destination and bearing and other indicators are all information that the pilot needs that can summarize the current and predicted environment (Harvard Business Review, 2019). For the third challenge, is the manager is reliant on only one perspective, in this example, if reliance is only on one instrument in the cockpit, it can be fatal. “Similarly, the complexity of managing an organization today requires that managers be able to view performances in several areas simultaneously” (Harvard Business Review, 2019).

    Reference:

    Harvard Business Review. (2019). The Balanced Scorecard- Measures that Drive Performance. https://hbr.org/1992/01/the-balanced-scorecard-mea…

    Peer# 2

    Hi everyone!

    The balanced scorecard (BSC) is another took for focusing on implementation as strategy (Ginter et al., 2013). The primary benefit of the BSC approach is to focus the health care organization on those aspects of its operations that most directly impact the accomplishment of its strategies (Ginter et al., 2013). As simple a concept as BSCs are, organizations still have difficult implementing them effectively (Regan, 2012).

    One challenge to implementing a BSC is that the organization has too few measures per perspective. A good BSC should have no more than five but no less than three measures per perspective (Regan, 2012). When an organization utilizes too few measures in each perspective, it fails to obtain a balance between performance drivers and outcomes. Without this balance between performance drivers and outcomes, it can be difficult to implement the BSC.

    Another challenge to implementing a BSC is that the measures selected for the scorecard do not reflect the organization’s overall strategy. When the organization tries to apply all their key performance indicators into each perspective without screening for measures that are linked to its strategy, the strategy is not translated into action and the organization does not obtain any benefit from the BSC. Although the fundamental purpose of a BSC is to increase the organization’s focus on execution and results by measuring those things that truly matter to the organization, some BSCs become so crammed with data that they lose all meaning (Regan, 2012).

    A third challenge to the implementation of BSCs is the lack of buy-in from leadership. If the organization’s leadership is not convinced with the BSC and the learning curve of the new system, the BSC will not be useful. Without senior leadership involvement, there is not the shared commitment that is needed to align the organization with its objectives, measures, and targets. For the BSC system to be fully effective, it must be implemented from the bottom all the way to the top of the organization (Balanced Scorecard in 2020: Advantages and Disadvantages, 2020).


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    Project Action Plan

    Your readings for this unit emphasize how to reflect on the findings of a case study in order to take action. Consider the results of the data collection and analysis you completed on your chosen study for the Unit 5 assignment. Based on your findings, you will now develop the action plan for your Action Research Project, following the steps outlined below.

    The 1–2 page action plan you complete for this discussion will become the basis for the Action Plan section of your final project assignment. Review the course project overview and the Unit 9 instructions for the final project assignment, focusing on the Action Plan section, for further context on this required project component.

    You will attach your action plan to this discussion as a Word document, in order to exchange it for peer review. Then, in your initial discussion post, you will briefly reflect on your action plan. You will provide feedback on two of your peers’ action plans in your response posts. Once you have completed this discussion, you will incorporate the peer feedback you have received into your action plan, as applicable. You will then add your action plan as a component to your final Action Research Project Report.

    Creating Your Action Plan

    Create a 1–2 page action plan for your Action Research Project, using a Word document. Use the data you have analyzed from the case study as a roadmap for the solution to your chosen issue. Incorporate the following in your action plan:

    1. Formulate a solution to the issue from your study, based on your findings.
      • Identify the theoretical framework used in the study.
      • Explain what is not working in the program and what the data tells you about why.
      • Make your recommendations on how to improve the issue.
    2. Develop your action plan for getting to your solution.
      • Briefly outline the sequence of steps to be followed in your action plan.
      • State who would address the steps.
      • Explain how the people involved will act and what activities will occur.
    3. Explain how your plan will continue past its initial implementation and be reassessed as part of the action research cycle.
      • Explain how the plan will be monitored and supported.
      • State who is responsible to complete these activities, and when.

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    1.Purpose of a Budget- 250 words

    Budgeting for organizations is not very different from budgeting for a single organization, though the scale may be different.

    • Government organizations prepare budget requests to a legislative body. Ultimately, the budget is set by the decision of that body.
    • Similarly, executives in for-profit organizations offer a budget that projects incoming revenues against expenses and desired profit to a corporate or business finance board.
    • Nonprofits also develop budgets at the executive level, but in consultation with board members and key program personnel, projecting possible funding levels from grants, contracts, and services. Then, they project the expenses for carrying out the mission and the programs.
    • Mixed (hybrid) organizations perform virtually the same process as organizations in the other sectors, but the budget reflects legislative or board mandates if the organization is a government/nonprofit partnership. If it is a for-profit/nonprofit partnership, then the revenue streams used to set the budget are defined by each of the partners, and then configured as a single budget.
    • Please use the planning a budget section in the Community Toolbox link to assist you in answering the discussion question.
    • https://ctb.ku.edu/en/table-of-contents/finances/managing-finances/annual-budget/main

    Developing a Budget for the Organization Logic Models-250 words

    The budget is the heart of a program. Without a budget, the program cannot function. In a strategic plan, the budget evolves from an understanding of the organizational mission, the available resources, voluntary or non-cost supports, potential activities, the benefits resulting from the activities, and, ultimately, objectives.

    These are the key parts of a logic model that form the foundation of your budget process. The Kellogg Foundation defines a logic model as “a systematic and visual way to present and share your understanding of the relationships among the resources you have to operate your program, the activities you plan, and the changes or results you hope to achieve” (W. K. Kellogg Foundation, 2006).

    Review the “Use Logic Models in Evaluation” Evaluation Toolkit Web page from The Pell Institute and Pathways to College Network, which describes logic models. Then, discuss how you would use a logic model to explain how and why your chosen program or organization will work with possible budgetary resources.

    http://toolkit.pellinstitute.org/evaluation-guide/plan-budget/using-a-logic-model/

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    Please write a discussion and respond to this 2 peers’ Discussion Prompts

    Discussion:

    You’ve been asked to create a sales presentation about a chemical dependency program to the employee assistance professional of a large company.

    • What might the presentation look like if you use the stimulus-response approach?
    • Respond to at least two (2) of your classmates’ or instructor’s posts
    • ALL citations and references needs to be APA 7th edition format. THANK YOU!

    Peer# 1

    Let’s start with what the stimulus-response approach is. Basically, it’s a manipulative way to get the prospective consumer to buy your product by asking questions that provoke a specific answer. This is done through what is called a “canned presentation” (Berkowitz, 2010). This approach is highly effective “where the decision issues are relatively simple and similar” (Berkowitz, 2010).

    Applying this approach to the chemical dependency scenario, I would first of all be in charge of the presentation, showing a lot of confidence and “dominant energy.” My presentation would definitely include a lot of statistics about drug and alcohol statistics—the percentage of “users” in the world, then those in the healthcare industry, and finally those in “larger medical facilities.” This would create the prospect to wonder how many of the employees in their facility use/abuse drugs and alcohol. Then, I would explain my program and how it targets larger facilities. I think that is the key here; making sure the prospect understands that because this company is so big, it is imperative that there be a program that confronts this topic of discussion. It might be helpful to provoke a thought that the prospect is responsible for the employees going down this path as well. Then I might mention that it can’t be helped and that it’s not their fault (though they will feel responsible at this point) and the only sensible option is to create an assistance program to help these closeted employees with their struggles—particularly, the one I am selling to them. Closing the presentation would include “the necessity” of this program in their company, circling back to making the prospect feel accountable and, in a way, guilty if the program isn’t developed within the company’s borders. I would show the prospect how easy it is to start the program here, and also showcase some positive feedback and statistical results that I have received through other companies that have gone through the program as well.

    Peer# 2

    Good Afternoon Everyone,

    Berkowitz (2010) defined the stimulus-response sales approach as saying the right thing (stimulus), in order to get a favorable reaction from the consumer/buyer (response). This could be through a persuasive presentation that makes the audience want the product. For example, you can be at a festival where there are multiple people outside dancing. It is 100 degrees outside and the promoter starts describing the ice-cold beverage they had earlier. Explaining the taste and feel of the cup and multiple people might go stand in line for the product now. Since the drink is the stimuli while the response is overcrowded people going to get the beverage. To obtain this, one has to know their target audience and how to manipulate the situation.

    If I was giving the chance to create a sales presentation about a chemical dependency program to the employee assistance professional of a large company using a stimulus-response approach this is what I would do.

    To open my presentation, I will showcase a testimony of a past client (HIPAA protection). This will appeal to the companies emotion. I will have the client discuss what led them to the facility, then discuss how the treatment benefited them. I will then present facts and figures to the company regarding the dependency usages of employees in big corporations. The figures will list statistics of chemical dependency programs and how they benefit workers and helped the company. I will then go into an interactive session, by asking common questions. The first question will be an ice breaker to make the executives comfortable. When I see the executives are comfortable, I will ask if the company likes their employees? When they respond yes I will say so don’t you think you should add a chemical dependency program to the employee assistance program? (Giving them a guilty feeling). I will follow by going over the chemical dependency program I am offering and how “easy” It is to show employees you care about them. Closing with facts and figures regarding the program and “name dropping” competitors that utilize the services.

    Overall, I believe this strategy is a bit manipulative and tries to appeal to emotions to gain a response. To market, I will research the company and use what is found to appeal to emotion to get the stimuli to gain my desired response.


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    Please write a discussion and respond to this 2 peers’ Discussion Prompts

    Discussion:

    Health care organizations will need to make changes to comply with the new healthcare reform legislation.

    • Describe the financial impact the Affordable Care Act (ACA) will have on HCOs, as well as proactive ways HCOs can mitigate these financial impacts.
    • Respond to at least two (2) of your classmates’ or your instructor’s posts. Your responses should include elements such as follow-up questions, a further exploration of topics from the initial post, or requests for further clarification or explanation on some points made.
    • ALL citations and references needs to be APA 7th edition format. THANK YOU!

    Peers# 1

    In March of 2010, President Obama signed into law the Affordable Care Act, ACA (Nowicki, 2015). This act was designed to provide insurance coverage to an additional 32 million Americans, increasing the health insurance coverage to 94% of the population (Nowicki, 2015). According to LaPointe (2016), the ACA has significantly changed the health care revenue cycle management landscape since its passage. After the ACA, care transitioned to value-based and there was a rise in patient consumerism. The ACA set out to provide health insurance coverage to more Americans, but this also caused a rise in patient consumerism (LaPointe, 2016). LaPointe (2016) states that of the 12.7 million consumers, 90% of them enrolled in high-deductible health plans in 2016. Because of this, providers are finding it difficult to collect full payments from patients. Patients gained a sense of empowerment and they began choosing providers based on their expectations and needs (LaPointe, 2016). Providers had to improve their patient satisfaction scores to attract and retain patients (LaPointe, 2016).

    The ACA also changed the payments that providers received, so providers had to reshape their care to receive the full incentive under the value-based care model (LaPointe, 2016). Providers reported that lower reimbursement rates for increasing patient volumes was a top concern after the implementation of the ACA (LaPointe, 2016). Some Medicare and Medicaid reimbursement rates declined under the ACA as a way to transition HCO’s away from the fee-for-service model. HCOs were rewarded for high-quality, affordable care rather than volume. To avoid declining reimbursement payments, HCOs should look to monitor quality improvements, more robust population healthcare management techniques, and upfront patient billing strategies as a way to mitigate the financial impacts of the ACA (LaPointe, 2016).

    Peers# 2

    The Affordable Care Act has helped millions of Americans obtaining healthcare coverage. Millions of lives, been saved because of this, and strengthened the health care system. “The Affordable Care Act codified protections for people with preexisting conditions and eliminated patient cost sharing for high-value preventive services.” Centers for American Progress (2020, October 6).

    Some of the ways that Affordable Care Act been impacting the HCOs are with the increase of the number of Americans with healthcare insurance. Another point is the accessibility of people with preexisting conditions are being able to receive the proper medical care without feel discriminated. No healthcare provider can deny care for this patient and with it, they healthcare provided been having an increment on revenues at their side. One of the ways that is it possible is because of the Medicaid expansion, allowing more people been able to qualify for medical insurance. “Some of the Medicaid benefits expansions are the capability of diagnosis and treatment of health ailments, including cancer, mental illness, and substance use disorder”. Centers for American Progress (2020, October 6).

    A proactive way of mitigating the impact of the Affordable Care Act in the Health Care Organizations is providing better training and more mechanisms to their medical staff and increment the productivity. Increasing the productivity and the customer service at the HCOs will be ending in the volume incrementation of patients and less distress for the staff. This include the implementation of new software’s and the implementation of Telehealth, allowing the clinic to increment services and minimize errors.



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    Please write a discussion and respond to this 2 peers’ Discussion Prompts

    Discussion:

    • Describe two secondary data sources that you might consider using for your signature assignment.
    • Identify and discuss a funding source that might be appropriate for this type of research topic.
    • Respond to at least two of your classmates’ or instructor’s posts. Give your classmates input on the secondary data sources they have chosen. Are there any other funding sources they might consider?
    • ALL citations and references needs to be APA 7th edition format. THANK YOU

    My signature assignment is a Research Study Question about Epilepsy.

    Epileptic individuals are in many cases linked to having seizures and convulsions that affect their well-being. What are the social effects that the situation brings to an individual living with epilepsy?

    Peers# 1

    The two secondary data sources I might consider using for my signature assignment include: Publicly Available Data Sets: those allowed by governmental agencies to anonymized data sets (also called deidentified data sets) that have had all potentially identifying information removed from the files (Jacobsen, 2017) for instance, data from CDC regarding obesity in children The other option is using clinical records from the school, for that I would apply to gain access to patient records for research purposes (Jacobsen, 2019).

    A funding source I think might be appropriate for this type of research is self-financing. I think that as people do some savings to pay for their college, travelling abroad or buying a car, same can happen with a study. Likewise, using platforms such as Kickstarter of GoFundMe is a great to obtain funds for your study without getting into the bureaucratic paperwork (Renwick & Mossialos,2017).

    Self-financing your study gives you independence, although it is true that funds may be more restricted; it gives you more control over research directions, since, often times those who fund the study have different interests and can influence on the direction you want to give to your study.

    Peers# 2

    The topic I chose for my signature assignment is “Antibiotic Resistance a Public Health Issue”. For my project I would like to develop these points: 1) Surveillance systems of antibiotics use and resistance. 2) How human use antibiotics? 3) How they deal with antibiotic-resistance in healthcare settings? 4) is antibiotic-resistance in the food chain. Therefore, my first secondary website will be; www.ncbi.nlm.nih.gov (Links to an external site.) which is a website of National Center for Biotechnology Information that “advances science and health by providing access to biomedical and genomic information” (NCBI – NIH, ). Further, this data source was created on November 4, 1988, their basic research is a national resource for molecular biology information, and they are able to to develop new information technologies in order to understand the fundamental of molecular and genetic processes that control health and disease. Additionally, they “conduct research on fundamental biomedical problems, they maintain collaborations with several NIH institutes, academia, industry, and other governmental agencies. They foster scientific communication, they support training, they engage members, they develop, distribute, support, and coordinate access to a variety of databases and software for the scientific and medical communities. Lastly, they develop and promote standards for databases” (NCBI – NIH, 1988).

    Moreover, antibiotic resistance is a public health concern around the world, thus I chose this other data source to work on my signature assignment; www.canada.ca/en/services/health.html. This is a Canadian government data source that focus on health science and research activities, opportunities for funding “I might refer to them to funding my research”, and professional development, partnerships and investments in research. In addition, they monitor surveillance reports, databases, programs on food, drugs, radiation, diseases and infections.

    Nevertheless, the funding source I might use for research topic would be; Research Affairs: Grants & contracts /Houston Methodist https://www.houstonmethodist.org (Links to an external site.). At Houston Methodist, they practice Leading Medicine through integrity, compassion, accountability, respect and a commitment to excellence. They make the research innovations that grow from the partnerships of their clinicians and researchers accessible to patients, as quickly and safely as possible. They invite you to be part of their transformation and interdisciplinary research team.

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    Please respond to this 4 peers’ Discussion Prompts

    • Respond to your classmates’ or instructor’s posts. Provide examples of concepts (such as a confidence interval) and practical skills you have learned that could be used to explain the information to healthcare leaders who might not have an MHA or training in healthcare research. 

    Peer# 1

    Hospital administrators are supposed to be the key to maintaining a balance between the facility’s budget and the accommodations for the patients and the healthcare professionals. From my understanding, most facilities struggle to maintain this balance, as they usually do not have the funds to properly run their programs. Mixing this with dissecting statistical data and the time they are given to make difficult decisions, I do not think they have adequate time to interpret vital information given to them when making these difficult decisions.

    When I think of statistical data being given to hospital administrators, I think of a lot of numbers and graphs that are up to the administrator to interpret as they see fit. However, administrators do not always have the extensive background in data analytics that health researchers have. Health researchers have a deep understanding of how to organize data. Rightfully so, as some studies evolve with many variables. If that is the case, then hospital administrators—who, granted, should have experience interpreting data—may not have the same extensive background required to completely understand the information being presented. Again, mixing this with the other factors administrators are responsible for, I can see why they could make decisions that aren’t as educated. Or rather, administrators make decisions based on their minimal understanding of the data.  

    I suppose an argument for this question is that it is not always the administrator who needs to have the experience understanding the different statistical data; this information should be delegated to the researchers who are comfortable translating this information. Administrators would be more effective if they were told what the hospital needs instead of being given information that is hard to comprehend.  

    Peer# 2

    Professor and classmates

    The way in which statistics is applied in the field of health, and in particular in nursing, is by providing knowledge and understanding of information about the etiology and prognosis of diseases, in order to advise patients on how to avoid disease or limit its effects (Charekishvili, 2016).

    I think so many hospital administrator tend to face substantive challenges or difficulties in the course of understanding the statistical method used in healthcare research because,  to interpret and understanding results of statistical methods, it is necesary for the healthcare administrator to engage in application or integration of the most suitable as well as the powerful statistical tests; something which most of them lack off, usually because they also lack of interest to learn (Groth, 2020).

    On the other hand there’s  a lack of the suitable and power test have been critical in forcing administrator from conclusion from subscribe subsequent studies, which might enjoy insufficient support from the data (Aggarwal, 2018). For instance, concepts like confidence interval can be explained in layman’s language, like; it is an educated guess about a certain characteristic feature in a population. It’s a range of values around that stat that has a probability of true value of that particular stat. Such concepts can be further supplemented with relatable examples like weight of one candy in a box of candy, to make it more interesting to the people who do not have any formal training.

    Peer# 3

    During the Covid-19 pandemic outbreak lawmakers had to execute new pieces of legislation in efforts to support the American people and the economy. One of the laws that was passed during the pandemic was The CARES Act. Under The CARES Act various industries were represented – small businesses, education, and most importantly health care. Under the health care segment, the bill provided funding for the prevention, diagnosis, and treatment of Covid-19. Under the bill limits for liability for volunteer health care professions were also placed as well as the prioritization for the review of certain drugs for the Food and Drug Administration (FDA). The bill allowed emergency use of certain diagnostic tests that are not approved by the FDA and expanded health-insurance coverage for diagnostic tested and requires coverage for preventative services and vaccines. Under the bill there were also revisions for other comestibles including those regarding the medical supply chain, the national stockpile, the health care workforce, the Healthy Start program, tele-health services, nutrition services, Medicare, and Medicaid (116th Congress, 2019 – 2020). The passage of this legislation experienced some setbacks in regard to cost. It was referred back to the Committee on Finance various times. These delays may have occurred in effort to find reasonable funding within each industry. Industries were impacted tremendously during the Covid-19 outbreak, causing a scarce of resources. Thus, placing pressure on lawmakers to ensure everyone was represented and covered.

    Peer# 4

    ACA is a comprehensive health care reform law signed by then-president Obama in March 2010. This law has three main goals which were, to make affordable health insurance available for more people, to expand the Medicaid program to cover all adults below the 138% of the Federal poverty levels and to support innovative medical care delivery methods designed to lower the costs of health care generally (healthcare.gov, 2021). The act also established the American Health Benefits Exchange, where citizens can review and compare insurance plans.

    While the Affordable Care Act has started to help alleviate healthcare disparities among US citizens, the state and federal insurance exchanges have not made payers very happy. Younger adults and healthier patients have been more likely to take on the individual mandate’s tax penalty than to purchase coverage on the health insurance exchanges due to high prices, which has left payers with a pool of older and sicker populations.

    Implementation of the ACA has been marked by controversy and unexpected twists and turns, including court challenges and delays in crucial provisions. States first implemented many ACA provisions in their efforts to expand access to care and improve overall health system performance (NCSL, 2011). Then, in 2012, a supreme court ruling further complicated the landscape by allowing states to choose whether or not to expand their Medicaid coverage to insure more low-income individuals. At present, nineteen states have still not expanded their Medicaid programs, causing disparities in healthcare access and leaving millions of patients with few coverage options.

    The ACA is the most significant and comprehensive health care reform enacted since Medicare. Although however, we cannot say with certainty that Obamacare has led to lower premiums, we can say that it has provided coverage for millions of previously uninsured Americans.

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    University of Southern Califo

    Please write a discussion

    Discussion prompt:

    • Prompt : In the healthcare industry, everything is measured. From drip rates to dosages, it seems as though numbers are everywhere. But how does this reflect the care given to the patients? After reviewing chapter 5, reflect on the following:
      • Which type of data (qualitative or quantitative) do you think yields the most information? Why?
      • Which type of data (qualitative or quantitative) is most effective for forecasting future trends? Why?
      • Which practices can a healthcare manager use to ensure that the data used for forecasting trends is accurate?
      • Provide examples of data evaluation in different types of facilities.
      • Provide examples of data evaluation for different types of issues, such as billing or loss of revenue.
    • ALL citations and references needs to be APA 7th edition format. THANK YOU
    • textbook may be used as a reference. The APA format for your text is as follows:
    • Langabeer, J. R., & Helton, J. (2016). Health care operations management: A systems perspective (2nd ed.). Burlington, MA: Jones & Bartlett Learning

    CHAPTER

    5

    Please write a discussion

    Discussion prompt:Operations Research Methods

    GOALS OF THIS CHAPTER

    1. Describe the application of operations research methods in health care.

    2. Understand how to identify and eliminate bottlenecks.

    3. Use forecasting methods to estimate patient volumes and demand.

    4. Understand the concept of capacity and its relationship to demand.

    5. Explain why tracking systems can improve process flows.

    6. Describe bar codes and radio frequency identification and their roles in operations management.

    Health care facilities are busy places with hundreds of people constantly coming and going. To maintain efficient operations, organizations must optimize patient and other process flows. This entails:

  • Understanding patient demand.
  • Aligning capacity and resources with demand.
  • Using de-bottlenecking approaches to improve throughput.
  • Managing patient and asset flows through tracking systems.
  • The use of tools and techniques such as operations research help to incorporate quantitative methods that can improve decision making. Techniques such as wait time minimization models and forecasting algorithms help to support improvements in process and patient flows. To make informed decisions about changing processes, decisions must rely on data, not just subjective gut feel. This chapter discusses these concepts in detail.

    OPERATIONS RESEARCH

    Throughout the years, operations research (OR) has been defined in many ways, often using different terms to describe the same body of knowledge and methods. In England and Europe, operations research is commonly called operational research, although the terms are synonymous. Similarly, the term management science (MS) has become popular in some schools of business, though usage is mixed. Operations research is still used primarily in industrial engineering departments and other schools outside of business, but for the purposes of this research, all of these terms (i.e., operational research, management science, and operations research) are considered identical and interchangeable.

    The simplest definition is what the Institute for Operations Research and the Management Sciences (INFORMS, 2014b) uses today: “a discipline that deals with the application of advanced analytical methods to help make better decisions.”

    Generally, the operations management and management sciences can be combined using the term “OR/MS” and describe using a scientific view and quantitative methods to support managerial decision making (Hillier & Hillier, 2008; Anderson, Sweeney, Williams, & Loucks, 1999). The Operational Research Society (n.d.) defines OR as “the discipline of applying advanced analytical methods to help make better decisions”; it posits that “by using techniques such as problem structuring methods … and mathematical modelling [sic] to analyse [sic] complex situations, operational research gives executives power to make effective decisions and build more productive systems.”

    The three key terms used or implied in most definitions are structured, decision making, and improvements. Structured implies that techniques will focus on using rigor and sophistication. Many times this also requires a reliance on data and a mathematical or quantitative basis, although this is not always the case. Traditional methods can be classified as “hard” (i.e., relatively mathematically intense) and “soft” (i.e., rigorous but qualitative, which stresses structured problem solving for complex and messy problems that cannot be solved by traditional math models). Advanced quantitative methods, such as simulations, optimization, and mathematical models incorporating probabilities and other variables, are often tools used in this scientific process.

    The focus of OR relies on improving the outcomes of decision makers through use of better methods and techniques that comprehensively and systematically produce options, scenarios, and better results (Trick, 2003). Exploring data in new ways, using new techniques, or building models that can help determine the effects of decisions so that managers and other decision makers can improve the quality of their decisions is a fundamental goal of OR.

    Finally, OR is about making improvements in performance (Ackoff & Sasieni, 1968). Scientific rigor and better quality decisions should result in improved operating, financial, or strategic performance. OR is not supposed to be arbitrary or exploratory for its own sake; the results need to be better through the OR if the discipline is to grow and thrive. Thus, the new slogan for INFORMS and other OR organizations is the “science of better,” focused on improving outcomes and results.

    Based on its focus and intent, it is important to evaluate the scope of OR for the health care industry, both currently and its future potential.

    MANAGEMENT DECISION MAKING

    In a completely rational model explaining how managers “do” (descriptive models) or “should” (normative models) behave in organizations, the emphasis is placed on maximizing outcomes of the decision process. Management of any organization would identify the goals of a specific problem or situation, generate alternatives, and select the one that is optimal. In this environment, OR methods would appear to be highly complementary. OR techniques allow managers to seek alternatives; evaluate these choices using probabilities, risks, and other variables as key criteria; and then model potential outcomes. Unfortunately, managers in organizations do not always behave rationally, which has opened the decision sciences field to a much less rational approach to decision making. Due to behaviors, politics, and other potential influences, the rational model is not the norm.

    OR methods play a vital role in the management decision-making process. For these purposes, decisions are defined as a choice between two or more alternatives, and management decision making is the process in an organization by which decisions are made.

    Because managerial decision making occurs at higher levels of an organization and typically involves major commitments of resources or changes in strategic direction, this research seeks to understand how decision processes work in health care organizations. Understanding the unique aspects of this industry is important because they have been described as service intensive and goal ambiguous in many respects. Management theorists, such as Harrison (1987), have suggested that as the organization’s environment becomes more complex, there is a higher use of “judgment” in decision making and less procedural computation, as in a rational model of decision making. Better understanding of the health care industry’s organizational environment and the specifics of the decision-making process can offer greater insight into how decisions are made, which criteria are used, how the search for alternatives occurs, and the role analytical or quantitative methods can play in the evaluation of alternatives in decision making.

    A BRIEF HISTORY OF OPERATIONS RESEARCH

    OR seeks to apply structured analytical techniques to improve decisions made by managers. These can come in the form of qualitative (i.e., soft) techniques or the more commonly cited quantitative techniques. For this reason, it is typically described today by management theorists as being its own “school” but as a derivative of the scientific or classical school of management thought (George, 1968; Salveson, 2003), which evolved from the work of Frank and Lillian Gilbreth, Frederick Taylor, and others.

    Based on most accounts, the OR discipline can be traced back to the pre–World War II 1930s and 1940s. The British government brought together several interdisciplinary teams to apply science to investigate military tactics. OR groups were used to develop the first radar system around 1941 to help the British military track and identify aircraft. This led to the use of OR for improving other communication systems, and it became instrumental in the Royal Air Force, Army, and Navy (McCloskey & Trefethen, 1954). It was due to these efforts to incorporate scientific and mathematical information into military activities that OR found its niche. Subsequently, operations researchers were deployed to numerous projects throughout all of the British armed forces. With success in England, OR began to move into U.S. military operations during the early 1940s.

    During the latter part of that decade, the Massachusetts Institute of Technology developed courses in OR, and in the early 1950s a complete curriculum was developed in OR/MS by Columbia University, Case Western Reserve University, and others. Many universities in England followed suit and developed OR short courses during this time frame as well. The Operational Research Society of the UK (previously the OR Club) was formed in 1950 and is considered to be the world’s oldest OR society (Symonds, 1962). The Operational Research Quarterly began publication in 1950, and the journal Management Science was launched in the United States in 1952, both providing avenues for OR in which to publish and expand. Annual conferences soon began uniting academic researchers worldwide, and since this time the OR discipline has continued to thrive (Schrady, 2001).

    Based on its military beginnings, OR quickly became known for incorporating scientific processes into decision making, and it is sometimes called a systems approach (Ackoff, 1971; Riggs & Inoue, 1975). A systems approach refers to how OR attempts to study the underlying behavior and structure of the systems—or interrelated set of processes, events, and activities—that define most problems and decision realms.

    This systems approach recognizes that forces and relationships exist between the environment and the internal processes, and that they can be analyzed closely, modeled, and then used for predicting or simulating results. Systems can be defined formally as the “collection of activities that share in their transformation to achieve a defined purpose” (Riggs & Inoue, 1975, p. 70). When systems are modeled, they then can be manipulated in various ways to estimate the effects of changing policies or decisions. Therefore, when applied to management, OR has shown that through a variety of methods (e.g., linear programming, optimization) better or improved results can be identified.

    OPERATIONS RESEARCH APPLIED TO HEALTH CARE

    OR was applied to health care as early as the 1950s, with one of the first OR articles related to medicine published in the Operational Research Quarterly (Bailey, 1952). This early work was sponsored by a trust of the British National Health Service and led to a small collection of articles. Around the same time in the United States, the Johns Hopkins Hospital assigned a contract position (joint with the Army Operations Research) for a full-time director to assist in hospital management decisions (Flagle, 2002). From the 1960s through the early 1970s, there appeared to be a growing interest in OR, with the field gaining significant momentum around 1970.

    It was then that the Operations Research Society of America (now part of INFORMS) held its first symposium on health services delivery (Young, 1969). The Health Applications Section of INFORMS was created in the early 1970s and currently has more than 500 members (INFORMS, 2014b). Subsequently, in 1975, the European Working Group on Operational Research Applied to Health Services was formed and now claims 242 members in more than 30 countries (Operational Research Applied to Health Services, 2014). The result of these societies is a much broader, global effort to apply OR to health care delivery processes. Both of these groups have conducted annual meetings and conferences to continue to encourage innovation in and research on OR topics in health care. In addition, in the late 1970s, the Society for Medical Decision Making was formed to help introduce more quantitative and sophisticated methods into health care decision processes.

    Prior to this time, there were several articles published on decision methods and quantitative techniques in health care administration, but they were less focused on the unifying themes, which center on building quantitative models of systems that are stochastic in nature and ultimately patient focused.

    Since this time OR has developed some momentum, although not as much as might be expected considering the size and complexity of the health delivery system. Carter (2002) described the lack of OR focus in health care when he stated in his research that only two members of the entire INFORMS membership community were professionals working in hospitals or health organizations and that fewer than 2% of the entire membership body was involved in the Health Applications Section. Figure 5–1 shows a brief time line of the significant early events in health care OR.

    About 15 books have been written that focus exclusively on health care and OR. The most significant include Operational Research Applied to Health Services (Boldy, 1981), Application of Operations Research to Health Care Delivery Systems (Fries, 1981), and Operations Research in Health Care (Shuman, Speas, & Young, 1975). More recently, the edited collection from Brandeau, Sainfort, and Pierskalla (2004), Operations Research and Health Care, provides detailed application of OR methods to health operations and clinical processes. Health Operations Management, edited by Vissers and Beech (2005), focuses on using OR and operations management to improve patient flows and logistics in health care organizations. It was the first book to concentrate specifically on this area and discusses basic concepts and frameworks for classifying processes in health, provides methods for analyzing supply and value chains, and offers multiple case studies on outpatient clinic scheduling, master planning, and admissions planning, among others. Other works include Blumenfield (1985), Kessler (1981), and Koza (1973). Nearly all of these books include a summary of key applications and methods used in health care, and most have focused on either clinical decisions or patient logistics.

    img

    FIGURE 5–1 Time Line of Significant OR Events

    Pierskalla and Brailer (1994) developed a bibliographic survey of OR applications in health care and describe numerous applications for OR methods. Carter (2002) maintains a database of OR research articles focused on health care, and there were more than 800 in 2002. A simple Google search shows about two million hits for the combination of “operations research” and “health care,” although most of these are likely related to clinical or patient care uses of OR. It does appear, however, that OR has started to penetrate at least part of the health care field in certain areas.

    OPERATIONS RESEARCH APPLICATIONS

    Given the political and community concerns about health care access and costs, it is critical to use more sophisticated tools for solving problems involving variability, uncertainty, and risk. One of the key areas where OR methods can contribute is in the modeling of patient volumes and flow through organizations and health systems. Patient flow means the movement of patients from initial point of entry or service to the point when the patient exits the system. This entails understanding the key processes and transactions that patients must experience in multiple departments (such as admissions, triage, treatment room, laboratory, pharmacy, and finance) and through the network of providers. This process perspective in health care management modeling is extremely important.

    Linear programming has been somewhat widely used to minimize labor costs in health care settings. Linear programming is a mathematical technique designed to make decisions that optimize the trade-offs necessary for resource allocation. Linear programming problems focus on maximizing (usually revenue) or minimizing (usually costs). This represents the objective function of the problem. Constraints are the restrictions that are inherent in the problem that limit the degree of change. For example, if a hospital chooses to minimize nurse labor costs but must ensure that at least one nurse is on shift at all times, this represents a constraint.

    Simulation models have also been applied to labor staffing problems. A simulation model is a computer application that predicts the behavior or performance of a process or how something may perform in the real world. Discrete event simulation models allow for changes in resources and inputs. For instance, a model of the emergency department can show patient flow and movement if resources are changed, tasks are modified or realigned, or variability in demand occurs. Commercial software for simulation is widely available.

    Revenue Cycle Management

    Given today’s reimbursement models, operations management in the United States is largely focused on maximizing revenues (and not just minimizing resources or expenses). Financial decisions arise from a contracting perspective with third-party payers and insurers, and it is necessary to ensure that the reimbursement from payers exceeds the operational cost in each service line. This process is called revenue management, or revenue cycle management. Revenue cycle management is the process of managing claims processing, setting payment practices, and generating revenue. It should be an analytical method for determining prices to achieve specific objectives, such as greater demand, higher utilization, or maximizing margins. Price (payer reimbursement) optimization models can be built that minimize risk (the variance in net profitability of a payer contract), which results in a formula such as:

    img

    where pj is equal to the price of an input or patient service j, dj is the demand, and cj is the cost for service j. Several constraints are used (such as an equation to define minimal net margin requirements) as well as a variety of other parameters.

    Risk and Financial Simulation Models

    Financial simulation models were described in the early 1970s as potential OR tools for improving planning outcomes. Many large Fortune 500 corporations constructed formal models that used mathematical programming to dynamically explore changing financial policies, debt leverage, or changes in operational conditions. In essence, these tools help to create pro forma financial statements given certain assumptions and historical relationships. The models range from simple, deterministic, and top down to more complex stochastic, multivariable simulation models. Simulation models allow managers to play “what if” using many different assumptions and scenarios.

    Most simulations in health care utilize Monte Carlo simulation analysis, which combines probability theory with random number generation and defined distribution patterns to iteratively simulate outcomes. Monte Carlo methods have been incorporated into spreadsheet solution solvers and programs such as @RISK, RiskAMP, and Crystal Ball. Software tools that incorporate Monte Carlo’s statistical powers allow managers to simulate budgets and plans.

    DE-BOTTLENECKING

    Assume that a hospital admissions department has two full-time employees who admit patients into the hospital during the 8-hour day shift. Each employee has a computer and monitor with access to the admission system, which takes approximately 30 minutes to complete for an average new patient admission. Therefore, the maximum capacity of this process is 32 new patient admissions daily (2 employees × 8 hours × 2 patients per hour). This 400-bed hospital has a 72% occupancy rate and frees up approximately 40 rooms daily. The challenge for this hospital has always been to get more patients into the process earlier.

    As described in this example, only 32 patients can be admitted based on current capacity at the entry point of the process, even though 40 is the actual demand or theoretical capacity further downstream in the process. Therefore, if more than 32 patients arrive, a bottleneck would exist (Demand > Capacity). A bottleneck is a choke point, or a point in a process where demand exceeds available capacity. In other words, a bottleneck can occur at any point where capacity is insufficient to meet demand due to physical or logical constraints. A bottleneck can also be a person, role, or any other barrier or obstacle to cooperation and work performance among departments.

    One of the keys to increasing throughput or capacity is to remove these obstacles or bottlenecks, which is called de-bottlenecking. In the preceding example, potential solutions for reducing the bottleneck might be to add labor (recruit additional employees), reduce the process time below 30 minutes (invest in systems and procedures that allow for faster processing), or remove forms or tasks that are redundant. All of these should be considered. Figure 5–2 provides an example of a bottleneck, shown visually as a funnel. In a funnel, the neck of the funnel limits volume throughput. In other words, the narrowest part of the funnel determines how quickly volume can be moved through the process, thus creating a bottleneck.

    img

    FIGURE 5–2 Process De-Bottlenecking

    The key to being able to de-bottleneck is to thoroughly analyze both demand and capacity to determine where the bottleneck exists. To be successful in improving processes, it is important to determine if the bottleneck is the result of an inability to handle demand at all times, or just at a specific point in time, as well as to discover if other barriers to throughput exist.

    Bottlenecks can occur at any point in the process: where a patient enters the hospital, at registration, during transition time of equipment, and at time of discharge. The earlier the bottleneck exists in the process, the fewer the number of patients (or throughput) that can be pushed through the system. Alternatively, a bottleneck at the end of the process typically results in wait times and inefficiency that can eventually affect the entire system. Eliminating a bottleneck at the beginning, only to discover that more exist in the middle or end of the system, will not help increase throughput. That is why it is important to study all processes systematically and to identify those obstacles that really limit capacity.

    FORECASTING PATIENT DEMAND AND VOLUMES

    Forecasting patient demand is the first step to thoroughly understanding changes in activity levels over time. Comprehensively defining patient logistic flow involves tracking volumes intraday, as well as throughout the week, using time-series data. If a hospital does not exhaustively know patient volumes and traffic levels, it cannot project volumes for individual departments and services throughout the day. Without understanding demand, it is nearly impossible to align resources and capacity with demand.

    Forecasting is a collaborative process that estimates the volume of patients who will be served over a specific time period. More precisely, it is a projection of demand that will occur along three dimensions: service type, location, and time dimensions. Service type includes the specific procedures performed or the staff involved in the effort. Location includes the specific department, unit, floor, or other geographical location that performs the service types. Time refers to the hour, day, week, and month that the demand was met. Forecasts are based on time-series data. Time series refers to a set of values or observations at successive points in time.

    Forecasting, by definition, is the practice of making a prediction or estimation about the future (Makridakis, 1996). It involves modeling the past to define the future. Demand forecasting, then, is the practice of predicting future demand to accomplish specific business goals, such as more accurately planning how many beds or clinics are needed or how much staff to hire. Performing forecasting really well allows managers to minimize unproductive wait time, maximize customer service, and in general improve operational efficiencies—the goal of operations management.

    There are two major types of forecasts: qualitative and quantitative (Armstrong, 2001). Qualitative methods include mainly market research, executive opinion, or Delphi methods to make subjective or judgmental decisions about the future without relating demand to historical performance quantitatively. Qualitative methods for demand forecasting may be useful for gauging potential demand of entirely new products that have no relationship with other products and cannot be reasonably estimated statistically. Qualitative forecasts of new products that a surgeon or specialty area requires may be the best use of these types of forecasts.

    In health care, forecasting should primarily be based on quantitative methods. Quantitative forecasts can be broken down into two major types: univariate and multivariate methods. Univariate can be defined as dependence on a single variable; univariate methods attempt to forecast demand by exploring historical data relative to a single variable, such as number of patients, procedures, or items. In standard hospital environments, all of the transactional details for patient volume are captured in the clinical scheduling or information system, such as the number of admissions or the number of surgeries. In addition to this, clinical systems also capture the date patients are admitted and discharged, which procedures were given, the drugs and supplies administered, and prices charged. Reliance on any one of these transactional data elements is a univariate method, which reflects the single variable that will be analyzed to assess historical usage levels and then, based on this analysis, used to make a projection about future values.

    With univariate forecasting, there are several different statistical models that are often called on to assess patterns in the data. These include such methods as Box-Jenkins, linear trend analysis, exponential smoothing, moving averages, least squares, and many others. These models all have specific advantages and disadvantages that make them useful for single-variable forecasts. Some of these methods will be discussed in the rest of this section.

    Moving Average Forecast

    A moving average calculates an average historical figure for a specific time period, such as the last 3 rolling months, and then extrapolates this average forward. This is a very imprecise type of forecast because it actually lags the relevant time period. In a constantly growing environment, moving average can be too conservative, and it is underbiased in its predictions. The mathematical calculation of a moving average forecast is:

    img

    The term moving indicates that as a new data point becomes available, the oldest data value drops off and is replaced. In other words, if you were calculating a 3-month moving average, the calculation would sum the last 3 months’ actual historical data values and divide the total by 3. For example, if historical data values were 10, 20, and 30, the moving average forecast would be 20, calculated as follows:

    img

    Trend Forecasting

    Another type of forecasting algorithm is based on simple trend analysis. Trend analysis looks for linear upward or downward movements in data and then extrapolates them going forward. Trend models are effective when demand for a product exhibits fairly consistent demand over time. The basic formula for calculating trend forecasts uses the initial starting point or intercept and adjusts for slope (or angle of the trend) over time. This is often called rise over run, and it is mathematically calculated as follows, where y is the forecasted value, a is the y-axis intercept, b is the slope of the regression line, and x is the independent variable.

    img

    Other Methods

    Smoothing methods in demand forecasting are useful because they use a factor to weight the most recent demand observations more than in previous periods, and they help account for errors in previous periods. Smoothing, whether it is exponential (i.e., discounts previous periods with a higher magnitude as the observations age), double exponential, or third order, focuses on improving forecast accuracy by giving more weight to the most relevant historical periods.

    Box-Jenkins is a slightly more complex model that uses regression or curve-fitting techniques at predefined time intervals for the single variable being analyzed. It combines single-variable linear regression with a moving average technique to achieve good results from univariate methods.

    A much more comprehensive set of forecasting methods falls within the category called multivariate. Multivariate methods attempt to use more than one variable to help better explain or model the past to make more accurate forward projections about the future. Although factors such as seasonality and cyclicality (i.e., business cycles that repeat similar patterns over time) can be detected and modeled using advanced univariate methods, they are much more common in multivariate methods. Using multiple variables to help make predictions about the item being forecasted allows seasons and cycles to be combined with other causal factors (e.g., pricing, promotions, events) to model relationships with other variables and improve forecast accuracy.

    The most common form of multivariate demand forecasting in large-scale causal forecasting is multiple regression. Multiple regressions use other contributing factors to help better explain the past and predict the future. For example, when forecasting demand for a downstream department (e.g., radiology), we might find a causal relationship with number of admissions, number of square feet in the hospital, patient acuity levels, case mix index, or other variables.

    Excel and other spreadsheet packages can be used to create both univariate and multivariate forecasts. The Excel functions—trend, forecast, growth—and many others allow users to create forecasts with time-series data for linear trends, exponential curves, and moving averages. They are fairly simple and straightforward. The transactional data can be organized to show the time dimension, or periods, and the corresponding item usage. Then use of Excel’s “=forecast” or similar function can be implemented to point to the known dependent and independent variables, which will then plot the forecasted value. This can be shown in spreadsheet or graphical views, as Figure 5–3 illustrates.

    Similarly, analysts can use Excel to simulate multiple regressions, using the data analysis add-in package. These regressions are slightly more sophisticated than simply using linear trends because regressions attempt to fit or model the historical transaction data to predict more probable future estimates.

    img

    FIGURE 5–3 Forecasting Volumes in Excel

    The Forecasting Process

    The process of forecasting demand involves four key steps:

    img

    These steps are typically performed in a wide range of time intervals, from short range (next day or week), intermediate (next month), or long term (next year or two). For demand forecasting as it relates to patient volumes in health care, forecasting is typically done in short and intermediate time intervals. Longer-term forecasting is usually done for strategic planning purposes, such as for adding bed capacity or capital investment in new space or equipment.

    The process starts with an analyst, operations manager, or planner identifying or isolating what is to be forecast; patient admissions, appointments, visits, clinic registrations, research protocols, supply usage, and pharmaceutical sales are common forecasting applications. Typically, forecasting is used to make specific business decisions, such as how many of each type of pharmaceutical to order next week or how many outpatients to expect next month. Most health care forecasts tend to focus on univariate methods, where time-series data are forecasted.

    Once identified, the planner must gather all historical data for this variable. Data collection may come from a variety of systems, depending on the time-series data selected. For example:

  • Appointment data reside in the organization’s scheduling system.
  • Admissions data come from the admission discharge transfer system.
  • Pharmaceutical or supply information is stored in an enterprise resource planning or other purchasing system.
  • Once the system has been selected, either an interface or a download of historical data will have to be requested from the information systems group, unless the data are available for export directly. A choice of any attribute or other characteristic that describes the data values might also be collected. Time-series data, which represent values over time, are necessary for most mathematical forecasts to predict the future.

    Once these data are in place, they should be incorporated into either a spreadsheet solution (for simple forecasts) or a sophisticated forecasting package. There are many excellent software solutions that can inexpensively and simply model and analyze the historical demand patterns to help understand the past and make accurate projections for the future.

    The planner then needs to analyze the data to make sense of the forecast and ensure that the results seem appropriate. Closely examining the forecast and history will ensure that there were no issues with the data and that the forecast is reasonable. Finally, the analyst must continually monitor and adapt the forecast to ensure that forecast accuracy increases over time (or, alternatively, that the error rate decreases). This can be accomplished using tracking signals or by monitoring forecast errors such as mean absolute percent error. Error rates should be used in the monitoring process to adapt or refine the model to obtain better projections the next time.

    It is important to focus on the data variation, whether it is random or predictable. One of the goals of demand forecasting is to reduce the uncertainty or variability that inherently exists. Ways to do this include looking at the source of the data, examining the frequency of the process, searching for patterns in volumes or demand behaviors (e.g., spikes due to purchasing increases to draw down operating budgets at year end by departments), and identifying the best level at which to forecast.

    BASIC PRINCIPLES OF FORECASTING

    There are some principles of forecasting that should be kept in mind to improve results. First, forecasts are always inaccurate. There is no process that will repeatedly match forecast to actual. That is why it is important to quantify the error and use it to adapt the forecasts for the future. Forecasts made at high levels (e.g., total number of inpatients weekly) are always more accurate than at the lowest levels (e.g., outpatient appointments in a specific location at a certain time). The more granular the forecast, the less precise it will be, but that is typically where the value of forecasting really can be found. Creating forecasts at the lowest levels and then grouping them accordingly for planning purposes is vital to a healthy process. Finally, it must be remembered that forecasts are only the starting point for the planning process—forecasts help provide a basis for further refinements and the selection of a most likely scenario for the future. Here are some additional guidelines and principles.

    Level of Hierarchy

    Decide on the level at which you wish to forecast. Forecasting at the lowest levels (typically, a patient procedure at an individual location in the hospital) provides significant levels of detail, but if this detail is not necessary it should not be used. Aggregation of the data allows for more strategic viewing, but some of the richness of the underlying data is lost. Thus, a trade-off exists between the details gained and the additional level of effort required. Forecasting attributes allow a different perspective, which may be useful during negotiations with suppliers. As much as practical, use downstream transactional data. The best source of demand is actual customer requisitions or items that have been directly issued or charged to patients, not warehouse orders or inventory movements.

    Decompose the Forecast

    Understand the real demand-forecasting problem first; then break it down into smaller, less complex parts. This is the principle of decomposition, which uses a general approach to drill down into more specific, narrower areas.

    Time Horizon

    Decide on a realistic forecasting horizon. Although the business process should dictate the forecasting horizon, shorter time horizons provide more reliable results. For most demand forecasts, forecasting out more than 3 to 6 months is not optimal.

    Apply Quantitative Techniques

    Utilize a mathematical or statistical forecasting application if at all possible, preferably one that is integrated with the hospital’s existing information systems. More advanced tools can help to automatically isolate the effects from seasonality, pricing, operating cycles, or other causal factors and apply appropriate algorithms without significant manual intervention. Also, use combination approaches if possible. Weighting of specific statistical models based on their historical standard errors, such as the Bayesian approach, tends to generate significantly better forecasts than single-forecast methods. Some excellent solutions that are widely used in various industries include Forecast Pro (www.forecastpro.com), SAS (www.sas.com), and Logility (www.logility.com).

    Simplicity First

    Try forecasting in the simplest fashion possible, and add complexity only if necessary. If multiple demand patterns generate poor forecasts due to complexity or scale, look for causal relationships and better statistical models to build a more robust solution. Be careful to not “overfit” the forecasting models. In many cases, too many variables are used in multivariant forecasting. Adding this complexity does not always result in improved forecasting accuracy, so be mindful of challenging the concept that more is always better by validating each variable used in the model.

    Reliable Data Sources

    Utilize reliable data sources. Data coming from hospital resource planning or other clinical systems tend to be the most accurate. It is important not to use any systems or data points that are incomplete or have errors or missing data. Look for alternative sources of data that can reliably feed the demand forecasting system to generate the most valid, reliable results.

    Cleanse the Data

    Cleanse or scrub the data using business rules. Data coming from most hospital systems or business warehouses today tend to be inaccurate in some manner. Cleansing or scrubbing the data by applying logic and business rules (such as “do not import any history that has negative values”) results in higher-quality forecasts.

    Causal Relationships

    Avoid making predictions on predictions. Causal relationships that are highly judgmental about the future (e.g., expected changes in interest rates or weather) tend to serve as poor causal factors because their forecast is usually inaccurate and unpredictable. Basing your product’s demand forecast on these forecasts often yields unreliable results.

    Exception Reporting

    Make use of exception reporting to flag problem areas. Specific forecast combinations that may be problematic should be flagged based on specific business rules (e.g., where forecast error is greater than 15%).

    Graphical Analysis of Trends

    View forecasts graphically—visual representation of data allows users to better interpret results and identify inconsistencies. Graphical analyses allow patterns to emerge more readily than in straight tabular forms.

    Apply Insight and Intuition

    Never use statistical results without applying business intelligence. We know that forecasts are always wrong, so it is important to apply human business intelligence to ensure validity within the current context. For example, a statistical forecast might generate specific values, but if the models applied did not know that a clinic is closed on Mondays, the demand will be overstated.

    Use Unconstrained Data

    Do not forecast based on constraints. For example, if historical patient visits were down last month because of a major snowstorm that limited patient volumes, this constrained or reduced demand is artificial and biases the forecasts. Forecasting based on these artificially low figures should be explained through a causal event, by adding “pseudo” sales to account for an unrealistic month or by eliminating that period as an outlier.

    Measure Errors and Accuracy Levels

    Measure forecast accuracy in multiple ways. Use multiple measures of forecast accuracy or error to help remove the distortion that occurs when firms become fixated on a single measure. Use the forecasting error to improve the next forecast so that the errors generated in the last forecast are fed back into the next one to improve the quality of the forecast. Typical forecasting software or spreadsheet solutions will provide at least the mean square error rates, which is a simple statistical calculation that squares the difference between the forecast and the actual values. Another similar calculation is the mean absolute deviation (MAD), which is the sum of the absolute difference between the average of the actual values and the forecast, divided by the number of observations. Mathematically, this is calculated as follows:

    img

    For example, if the time-series forecasted values were 10 in August and 8 in September, and actual values observed for those months, respectively, were 9 and 7, the MAD would be 1. The first step is to calculate the mean value of the actual data, which would be 8 in this case ([9 + 7] ÷ 2). Second, subtract the mean from the forecast value for each observation. Third, take the absolute value (the value regardless of the positive or negative sign) of the difference. In this case, that is 2. Fourth, divide this by the number of observations (2). Therefore, the MAD is 1.0, calculated as follows:

    img

    Tracking the mean absolute deviation or the mean square error allows forecasters to compare how accurate their forecasts are over time to continue to refine and improve the calculations and methodologies.

    CAPACITY ANALYSIS

    Once demand is known, it is extremely important to understand how much capacity exists. Capacity refers to the amount of resources or assets that exist to serve the demand. In health care, capacity can be measured in terms of multiple resources, including:

  • The number of available beds, treatment or examination rooms, and clinics.
  • Labor availability of physicians, nurses, and other providers.
  • Availability of key medical technologies and equipment (e.g., diagnostic imaging, x-ray).
  • Supplies and other resources.
  • Elevators, hallways, and other facility space.
  • Cafeteria, parking, and other support services.
  • Capacity analysis requires detailed understanding of the organization’s resources, including labor, technology, and facilities. Documentation of this capacity should be done using time-series data, similar to how demand-series data were treated, to track capacity changes over time.

    For example, if a hospital has a magnetic resonance imaging (MRI) machine, the assumption may be that it could operate 24 hours per day, 7 days per week. This is called the design capacity, which is the maximum stated or theoretical output for a resource. However, when closely analyzing the equipment over a period of time, it would be discovered that there is necessary downtime for maintenance or repairs or other reductions to stated capacity. Therefore, the more important capacity term is effective capacity. Effective capacity adjusts the design capacity with average expected utilization rates. For example, if average operating efficiency or utilization is 75% on the MRI machine, then the effective capacity is 18 hours, calculated using the following equation, where Ce is effective capacity, Cd is design capacity, and U represents utilization rates:

    img

    Consider this example. A hospital clinic has two treatment rooms and offers services that typically require 30-minute appointments. Therefore, approximately two patients can be seen each hour in each room. The daily design capacity of this system, based on an 8-hour day, is therefore 32 (2 × 8 × 2). This is the design capacity given “average” procedure types for the clinic and standard cycle times (the process for calculating normal times will be discussed later in this chapter as part of time and motion studies). However, these averages do not take into account any deviations, such as scheduling problems, patient delays, or transition times in between patients. Historically, the average clinic room utilization is 72%. Therefore, the effective capacity is really only 23 patients per day.

    CAPACITY PLANNING: ALIGNING CAPACITY WITH DEMAND

    Capacity planning refers to the planning process for aligning capacity with demand, analyzing whether resource constraints (shortages) or surplus (excess) exist at all points in time. If 100 hours per week of physician labor is available to a specific clinic, yet demand forecasts suggest 1,400 procedures and 120 hours of potential patient demand, there is a mismatch or lack of alignment between capacity and demand. This is very common in health care, where either demand or capacity is limited (or both). Creating a strategy for effectively dealing with this takes five key steps:

    1. Forecast patient demand at detailed levels (by hour, location, etc.).

    2. Using productivity estimates, translate this demand into capacity requirements (where patient flow exists; which resources will be used).

    3. Analyze current level of capacity in terms of hours of labor or equipment available or numbers of other resources. Translating capacity into a per-hour basis is the most common measurement (e.g., 11 hours of equipment time available on an MRI daily, or 362 hours of nursing labor).

    4. Estimate the delta (or change) between capacity and demand on a per-hour or other basis.

    5. Develop a strategy for aligning capacity with demand.

    Typically, this involves mapping supply and demand over time, graphically analyzing the data, and then developing plans for adding or removing capacity. The most common strategies for dealing with capacity constraints are as follows:

    1. Increase capacity, where capital or operational dollars allow. Adding capacity suggests purchasing new capital equipment that could allow the facility to perform more procedures or operate longer hours. Organizations also add capacity by hiring more labor, adding swing beds, or increasing total square footage for new clinics or rooms. Other options include contracting with other facilities to provide additional capacity or subcontracting certain service lines. The use of return on investment models should be utilized to ensure that the benefits of adding capacity are greater than the marginal costs to invest in the capacity expansions.

    2. De-bottleneck, which may free capacity. The use of process engineering tools can identify bottlenecks, and targeted improvement methods can eliminate them.

    3. Reduce demand, where possible and profitable. This may include reducing the services or procedures provided or redirecting patients to other competitor or partner facilities.

    4. Transfer capacity from other areas (i.e., sometimes capacity exists in certain areas or departments that is often not needed, which can be used to fund capacity expansions in other areas). For example, if facilities or space is the issue, square footage can be reduced in one department and provided to another.

    MINIMIZING WAIT TIMES

    Typically, one of the biggest bottlenecks in health care involves the issue of wait times. Wait time is defined as the time interval during which there is a temporary cessation of service. Alternatively, it is the amount of time that has elapsed or has been delayed from the start point until some action occurs or until service is provided. Most of us experience wait times everywhere in our daily lives, even if they are brief—at a gas station, restaurant, convenience store, or coffee shop.

    In health care, wait times are frequently a source of poor patient satisfaction and process inefficiency. In emergency rooms, for example, wait times of up to several hours are common. Some waits are more acceptable than others. Another common example of wait time is when patients arrive at a clinic but spend time waiting to get registered or checked in.

    Wait lines occur in all areas of the hospital—such as patient admissions, financial services, physicians’ lobbies—and are generally considered to be routine and a part of everyday business in health care. This is inaccurate. Understanding wait times is a required step to modeling process and staffing changes to improve service. Wait times are generally one of the most controllable and significant variables driving waste and inefficiency.

    Wait lines form because people are seeking service faster than they can be served. There are several situations where queues typically form in health care:

    1. Point of admission (entry).

    2. Financial services.

    3. Point of discharge (exit).

    4. In the front lobby.

    5. Treatment or exam rooms.

    6. High-volume departments, such as emergency departments or operating rooms.

    7. Point-of-use for key clinical technologies (e.g., MRI, computed tomography, position emission tomography).

    8. In common clinical ancillary services (laboratory, pharmacy, blood bank).

    9. Elevators, hallways, or other common spaces.

    10. In the individual physician’s office.

    11. At supporting services (cafeteria, gift shops, social work).

    Wait lines can be minimized using advanced quantitative tools. They can be modeled to improve service, align staffing with projected volumes, and control the service levels (or minutes spent in a queue). Wait line simulation models can be built around all aspects of an organization to improve service and process efficiency.

    There are three key components of wait line simulation models: arrival rate, service rate, and queue structure. The speed at which patients arrive is called the arrival rate. Arrival rate is represented by the Greek letter lambda (l) and is always defined as X per unit of measure (e.g., 12 patients per hour). The speed at which employees can serve them is called the service rate. Service rate is represented in most equations by the Greek letter mu (m). The queue structure is defined by a few subvariables, including number of simultaneous servers or channels, which represent the employees who offer assistance to the guest or patient represented by the symbol (c), and the number of phases in the process (p). Most health care wait lines are considered to be a finite problem. Therefore, finite wait time minimization models can be defined generically as:

    img

    There is a lot of complexity that can be built around queuing models, but for purposes of this text one primary model is discussed—that of multiple channels (or multiple servers) providing service through a single-phase process. For instance, at a clinic waiting room, there are two employees at the front desk who check in patients, register them, ensure that updated medical insurance is on file, and confirm that all other forms for registration are completed. This is represented in Figure 5–4.

    In the example in Figure 5–4, there are currently three servers, or channels, who can provide service to the customers. All three of them are on the phone, and only one person is currently providing service to one of the waiting guests. There is a buildup of four customers in the waiting line. There is only one phase, in that the next step after receiving service is to visit the physician. In many processes, however, there are multiple waiting rooms, or phases.

    img

    FIGURE 5–4 Wait Time Simulation Models

    A key indicator for managing customer service is the number of minutes that a patient has to wait in the queue. This can be modeled using the following equation, where W = wait time, L = the number of customers in the system or queue, and l represents the arrival rate, or the speed at which new patients arrive in the clinics:

    img

    For example, assume that there are currently 5 people in the system, and they arrive every 2 minutes (or 30 per hour). The average wait time would be 10 minutes, solved as follows:

    img

    However, in practice, the number of people in the system is a complex calculation and solving for L requires several calculations that are best done in a spreadsheet solution. The formula that follows shows how to solve for L when it is not given as an assumption. In this calculation, L = total number of customers in the system, Po = the probability that no customers are in the system, and all other variables are as defined earlier (Anderson, Sweeney, & Williams, 1997).

    img

    To calculate Po, the mathematical calculation is also quite complicated:

    img

    Average number of customers waiting in line is calculated as:

    img

    Finally, another important calculation is to define how long it takes for a patient to wait in line versus the total time spent in the system (Wq; both receiving service and waiting in the queue). This can be calculated as follows, which basically subtracts the inverse of the service rate from the total waiting time:

    img

    Wait Time Example

    A patient arrives at the Solder County Hospital emergency department (ED) and finds a waiting line that is currently 60 patients long. Several negative comments are passed on to the front desk employees, which are then communicated to the ED director. When she looks out in the waiting area, she too becomes annoyed with this situation, and she makes up her mind that something must be done to help improve the situation. She decides to engage the hospital’s management engineering department to study the situation and recommend possible solutions. The director wants to comprehensively understand current waiting times and determine if staffing levels are appropriate to meet these stated service levels or analyze what changes might be made.

    The process has only one phase—patients are registered and then transferred back to a primary treatment or exam room (this is a simplification of course, for illustrative purposes only). The potential population or number of patients is finite and, most important, there are three employees at the front desk to handle all admissions and registration, so it is considered multichannel. The ED director has defined a service-level policy of 45 minutes, suggesting that each patient should have to wait no more than this time prior to being moved to an exam room before being seen by a triage nurse or other provider, although admittedly total cycle time or wait time has never been comprehensively monitored.

    After careful analysis over a 1-week period, the management engineer assigned to the project conducted several detailed cycle time studies. He discovered that on average during the morning shift there are approximately 50 patients arriving every hour and that the front desk personnel can register a patient in approximately 3.5 minutes, or 17 patients per hour.

    Using the formulas provided earlier, the probability that there are patients in the system is very high, and the Po (or probability of the waiting queues being completely cleared) is less than one-tenth of 1% (0.004). Therefore L (average number of customers in the system) is around 51, which is similar to the 60 that the ED director found on the day this project began. The total wait in the system is found to be a little more than 1 hour (61 minutes). Because registration time is only 3.5 minutes, the total time spent waiting in line is nearly 58 minutes (i.e., 61 – 3.5). This is significantly higher than the 45-minute service level that the director expected.

    How can this situation be improved? There are some key options:

    1. Streamline, or reduce, the number of checks or steps that the front-desk personnel are required to perform to increase throughput and shorten the registration time to fewer than 3.5 minutes. For example, if the process can be shortened by just 5% (to have a service rate of 18 patients per hour, or 3.33 minutes per check in), the total waiting time would fall to just 13 minutes in line!

    2. Add another employee (additional capacity). Recruiting one more employee (or channel) would cause the total waiting time in the line to fall to just 2 minutes. Of course, the costs of that additional employee must be evaluated relative to the benefits of reducing the queue.

    Wait Time Decision Making

    Depending on the system, it may be necessary to use different optimization algorithms. The algorithms are different for each of the four types of systems:

    1. Single channel, single phase.

    2. Single channel, multiple phase.

    3. Multiple channels, single phase.

    4. Multiple channels, multiple phases.

    This text covered only the third type of system. For a more comprehensive discussion of the optimization models for all four systems, consult Introduction to Queuing Theory (Cooper, 1981).

    Wait times create poor service levels and are bottlenecks for system throughput. As much as possible, and as long as total benefits exceed costs, they should be minimized. In reality, however, there is no such thing as an optimal solution with wait lines. They can be minimized, but the total cost of adding new channels must be carefully weighed against those gains. Similarly, if a bottleneck in registration is eliminated, it may just move that bottleneck to the physician’s or nurse’s treatment rooms. Moving a choke point back one step in the process does not create any system benefits, so it is important that the total system wait times and process be analyzed carefully.

    TIME AND MOTION STUDIES

    One of the best ways to minimize wait time is to increase speed o

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    • Please respond to this 4 peers’ Discussion Prompts
    • Respond to at least two (2) of your classmates’ or your instructor’s posts. Your responses should include elements such as follow-up questions, a further exploration of topics from the initial post, or requests for further clarification or explanation on some points made.

    peer# 1

    Social determinants of health, SDOH, are the conditions in the environments where people are born, live, learn, and age that affect a wide range of health and quality-of-life outcomes and risks (CDC, 2021). SDOH can be grouped into five domains: economic stability, education access and quality, healthcare access and quality, neighborhood environment, and social context (CDC, 2021).

        My hypothetical female patient is an African American living in a low income, urban community. Her background and social determinants of health will have a negative impact on her management of diabetes and the state of her health. 1 in 5 African American people are living below the federal poverty level, meaning that many of them cannot afford the nutritious food, safe exercise opportunities, and healthcare needed to manage diabetes (Kenney et al., 2021). According to Kenney et al. (2021), people of color in America are also more likely to be unemployed. Unemployment can affect a person’s access to health insurance, and with the high cost of healthcare, a lack of health insurance can mean lack of preventative healthcare. Even for people who have insurance, the costs of diabetes care and diabetes-friendly nutrition plan can be challenging for people with low incomes (Kenney et al., 2021).

       Segmenting patients with common health conditions can improve their care management. If care is to be truly centered on the patient, the patient’s specific care needs and other characteristics must be addressed (Vuik et al., 2016). Though it is practically impossible to develop care models for each individual, programs can be created for groups of patients with largely similar characteristics (Vuik et al., 2016). By segmenting patients with common health conditions, their healthcare needs can be optimally met and care is more patient centered. When a population is segmented into groups with similar patterns of healthcare needs, policymakers may better understand a heterogeneous population, thus facilitating the planning of healthcare resources and interventions (Chong et al., 2019).

    peer# 2

    Background I have chosen for this female patient with type II diabetes is Hispanic that lives in an urban community and has a faith of Christianity. There are many social determinants that have impacted this female’s diagnoses. U.S. adults already have a 40% chance of developing type II diabetes, however, if you’re Hispanic, that chance increases to 50% more likely to develop diabetes and also at a younger age (CDC, 2020). Some sociocultural factors that increase Hispanics for type II diabetes are genetics, food, weight/activity, decreased access to education and healthcare and lower income.

    According to the NIH, genes play a major role as a determinant in that genetic susceptibility to obesity and higher insulin resistance is at a higher rate in Hispanics than other races, increasing their chances of developing type II diabetes (Aguayo, et al, 2019). The foods Hispanics eat as part of their lifestyle and culture include foods that are high in fat and calories. Hispanics also tend to be less physically active than other races that increases their chance of diabetes as well (CDC, 2020). 

    Segmenting patients with others who have diabetes can positively help influence their day to day care and lifestyle overall. Different prevention strategies based on certain medications, lifestyle modifications and educational programs can help with group sessions (Aguayo, et al, 2019). Also, patient teaching and educating on diabetes self-management education (DSME) is a crucial element for people who have diabetes and is considered to greatly improve patient outcome. 

    peer# 3

    Yes, healthcare professionals should always be prioritizing quality of care. And yes, quality must be a hard task to deliver at times, making consistent solutions even harder. But that should still always be at the forefront. As a future healthcare administrator, I do believe I can affect the quality of care a patient receives. Honestly, I think this is done simply by doing their job as honest and true as possible with the patient in mind. For example, part of the duties of the administration team is productivity. This refers to the overall efficiency and cost-effectiveness of the hospital (Langabeer &Helton, 2016). Assuming that the three factors of this concept (labor, capital, and management) meet an excellent standard, I don’t see why quality of care would be insufficient. Obviously, meeting these three factors at such a level of quality is very hard. And thus, we have different levels of satisfaction for all of these, bleeding into the satisfactory data of care.

    I also believe KPI’s effect and ultimately improve outcomes for patients. Examples of KPIs include the three variables of productivity above: labor, capital, and management. These KPIs are able to steer the organization in the right direction and using the five principles of productivity management can help to keep the variables as high as possible. Assuming this is all in place, then I’m not sure I would see a reason for quality of care to be significantly low.

    peer# 4

    I do believe that a healthcare administrator can affect the quality of care a patient receives by how they have the capability to change patients’ lives with the use of informatics. With the use of informatics, it could help to improve clinicians’ ability to diagnose a patient (Doyle, 2019). Healthcare administrators also use technology aids to foster a healthy living habit, and the implementation of programs to help support patient’s personalized medicine (Doyle, 2019). In addition, healthcare administrators look for opportunities for sustainability in an organization which could lead to benefiting the overall quality-of-care patients receive (Doyle, 2019). This helps by increasing efficiency in an organization and saving on costs which then lead to help lower overall operational costs and allow a hospital to fund more money into their patient care (“Do Patient’s Think”, 2019). As for key performance indicators (KPI) I believe they help to improve outcomes for patients by helping to provide essential navigational tools for hospitals (Pourmohammadi et al., 2018). With the use of KPIs, hospital managers are able to identify the strengths and weaknesses and improve managerial performance in order to help better the overall outcomes of patients (Pourmohammadi et al., 2018). KPIs are helpful to an organization by helping them reach the specific goals they are trying to obtain through the observation and overall health of their business.

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    Protecting human research participants is of utmost importance.

    It is essential that all healthcare professionals, whether or not they are currently involved in research studies, remain aware of regulatory policies and updates such as the Federal Policy for the Protection of Human Subjects, or Common Rule, that will take effect January 2019.

    Review the Frequently Asked Questions on Requirements for Education at the National Institutes of Health (NIH) link here:

    https://humansubjects.nih.gov/requirement-education (Links to an external site.)

    Download the PDF documents Attached below. Read the detailed document by the NIH and then take the self-check quiz to check your understanding before completing this week’s assignment.

    If you would like to review more information, you can go to the following link to view 12 recorded webinars related to Human Research Protection on the U.S. Department of Health and Human Services YouTube channel:

    https://www.youtube.com/watch?v=9r8cpgWs7j4&list=PL5965CB14C2506914 (Links to an external site.)

    Assignment Instructions: This week, reflect on what you learned from the NIH materials about protecting the rights of human research participants.

    Discuss at least three of the following in your paper:

    • Describe the circumstances that influenced the need for a policy to protect human research subjects. Give examples of specific ways human research subjects can be harmed by researchers.
    • Identify three vulnerable populations and the special restrictions associated with human research among these groups. Evaluate the requirements and restrictions. Do you think they are adequate? Why or why not?
    • The Belmont Report summarizes the ethical principles and guidelines for research involving human subjects. Three core principles are identified: respect for persons, beneficence, and justice. Even though these principles are considered equal, prioritize them in order of importance to you. Explain your decisions.
    • Although you are not implementing a change project at this time, and you may not be directly involved in research as part of your professional responsibilities, explain the reasons why it is important for you to know about these rights and protections.

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    • Respond to at your classmates’ or your instructor’s posts. Your responses should include elements such as follow-up questions, a further exploration of topics from the initial post, or requests for further clarification or explanation on some points made.

    Peers # 1

    The Triple Aim is a framework developed by the Institute for Healthcare Improvement back in 2007 with the intention to assist healthcare systems in optimizing performance, reducing costs, and improving patient care through a variety of interventions and metrics (Norman, 2020). According to Norman (2020), achieving the Triple Aim is crucial to the success of healthcare organizations that are moving toward value-based payment systems.

               One of the primary goals of the Triple Aim is to improve the experience patients have when they are interacting with the healthcare system (Norman, 2020). Before a healthcare system can improve patient experience, they must assess the overall health of the communities they serve, identify any existing concerns, and assess overall mortality (Norman, 2020). One example of how healthcare systems are improving patient experience is with the adoption of electronic health records (EHRs). EHRs lead to increased patient satisfaction because they reduce wait times, decreased unnecessary tests and immunizations, improve communication with patients, encourage patients to take ownership of their health, and provide patients with quick, easy access to their health information (HealthIT, 2019).

               Another goal of the Triple Aim is reducing cost. The United States has the most expensive healthcare system in the world, and while the cost of healthcare services is rising, the quality of those services is not (Norman, 2020). This component of the Triple Aim encourages healthcare organizations to find ways to reduce the cost of care while increasing quality, as well as identifying at-risk populations and addressing concerns of the community (Norman, 2020). One example of how healthcare systems can reduce cost is by leveraging technology (Tomlin, 2020). The use of technology can bring efficiencies to scheduling and increase patient compliance that ultimately leads to lower costs. One study found that hospitals using perioperative mobile apps can save up to $300 per procedure through a 40 percent reduction in same-day cancellations (Tomlin, 2020).

               The third goal of the Triple Aim is improving population health. Understanding what the most likely reasons would be for members of a specific population to engage with the healthcare system can help organizations preemptively develop strategies to offset costs and provide improved, patient centered, and coordinated care (Norman, 2020). An example of how healthcare systems are improving population health is through community-based partnerships. Bringing healthcare providers, educators, business leaders, social service providers, community organizations, and clergy together to promote health behavior, improve access to primary and preventative care, and reduce health disparities have been proven to increase population health (Hostetter & Klein, n.d.). In South Carolina, there is a program that relies on volunteers to implement screening programs for blood pressure and diabetes, provide peer-to-peer health coaching, and build community gardens where vegetables are in short supply (Hostetter & Klein, n.d.).

    Peers # 2

    The Triple Aim framework was developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance (IHI, 2020). The three different aims all cater to their own mission. Respectively, they all focus on bettering the health care system overall and the patient care as well.  Aim #1, improve the patient experience of care is tremendously important. An example for this aim would be doing surveys for patient satisfaction and seeing where the levels are at and improving on that. If patients are saying wait times are too long, then creating a plan to decrease wait times will help patient satisfaction. Aim #2, the health of populations, tending to different groups of individuals and being more accessible, will create a wider network of patients. Researching where certain populations are lowerAim #3, reduce the per capital cost of health care, involves many different aspects. When it comes to financials of a hospital, costs and budgets are the priority. If saving can be done within a hospital, the organization will try to find the most appropriate solution. For example, if there is no cardiology department or speciality, then referrals to that hospital wouldn’t tend to certain cardiac tests or procedures and certain cardiac equipment would not be necessary for the budget.

    Reference:

    IHI. (2020). Triple Aim Initiative. http://www.ihi.org/Engage/Initiatives/TripleAim/Pa…

    Peers # 3

    I think the most effective action to control healthcare costs is to consolidate freight across manufacturers. This entails combining shipments from multiple manufacturers which are bound for the same destination.  Most truckloads only run at 65% capacity.  Converting those trucks to full truck loads increases the amount of supplies delivered in one trip and cuts down on the product going through multiple changes which also results in less damage and losses.  (Doone, 2014).

    As an administrator one can have influence to implement consolidating freight across manufacturers.  Presenting data on the potential cost savings that can occur as a result of consolidating the freight can build a case to implement the action.  Not only do organizations need to stay competitive, but also the manufacturers.  Administrators presenting the benefits of a freight consolidation program will demonstrate that it will cut costs down not only for the organization, but also for the manufacturers shipping products.

    I think having a low inventory may cause issues in the long run which may impact patient care.  I think there needs to be a balance between having enough inventory, but also not too much or too little.  I think back to when the pandemic started and there were shortages in PPE such as facemasks, N95s, and gowns.  I think it is important to be in a position to respond to a sudden change, but also not be overstocked where supplies will be wasted.  In addition, I think there needs to be a manner to monitor stock and rotate the stock so the oldest supplies are utilized first.

    I think an alternative manner that could be effective in decreasing spending in the supply chain is to automate manual processes.  Human errors can contribute to increased spending in the supply chain.  Inaccurate ordering or data collection can lead to ordering excess supplies or too little supplies.  Organizations need to have a manner to accurate capture data related to the supply chain.  (Wilson, 2021).

    Peers # 4 

    Quality patient care provided efficiently in healthcare organization is important to achieve positive outcome, but it comes with a cost. Having the sufficient amount of supplies to treat patient is an ongoing problem in healthcare industry. The most effective way to improve healthcare costs is to eliminate excess inventory (Doone, 2014). Having too much inventory in the shelves can cost a lot of money instead of allocating the budget in taking care of the patient (Doone,2014). Maintaining excess inventory is rampant in the healthcare settings to prevent lack of supply when it is backordered or not available. If the staff in-charge of keeping supply will do research on how many of a certain supply is needed for a certain amount of time will prevent hoarding and having excessive supply that will expire at certain time. Keeping a track of usage of a certain product from one end of supply chain to another can help to reduce the cost and prevent excess inventory (Doone, 2014).

               One way of preventing excess supply is to have a warehouse supply that will deliver the supply requested within 1 to 2 days after request or orders have been submitted. If the request or orders will be delivered within few days, it will prevent hoarding of supply. I am in charge of ordering supplies in the Operating Room and the supplies gets used daily  for certain supply and I will order extra for that particular item to prevent shortage and not able to perform the surgery. Keeping inventory of frequently used items and seldom used will keep supplies being used and prevent them from being expired. We also do borrow supplies from other facilities and return them when our order arrives and same token when they ran out of a certain supply. Having a person in charge of ordering will prevent having excess supply in the shelves. As a healthcare administrator, I will implement the same plan to prevent hoarding or having excess supplies in the shelves. Having a shelves that is glass covered to see the number of supplies inside the shelves and prevent over ordering supplies and save money. Practice the first-in, first-out idea to prevent waste by having expired product which will cost a lot of money. Regular checking of expired item or keeping track of expiration dates. Keeping a par level and order if below the par level will also help having over supply in the shelves.

                Supply chain and medical devices are so costly, so it is better to have better alignment to meet the growing challenges in healthcare and having a flexible design or solutions to be more cost-effective (Doone, 2014). Implementing cost effective strategies will be challenging but it is possible to achieve and have success in the new fast -changing world of technology in healthcare organizations. Operation planning to target initiatives and projects to help improve processes on how to best use the facility resources (Langabeer & Helton, 2016). Having a short-term and long-term plan will ultimately drive improved financial productivity and result of operation to help in cost-effective projects.

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    Discussion: 

    When conducting a study, patients occasionally “crossover” to other portions of the study. List one intervention that may impact the patient after this crossover, how it might affect the results of the study, and which (if any) precautions need to be considered when finding crossover data. Additionally, explain what a cohort study is and which types of disease are best to study using a cohort.  (250-300 words)

    Peer# 1

    Crossover study on Oncology

    This study intervention on oncology trials crossover, which allows patients to crossover from the control group to switch to the intervention arm and receive the investigational product after a pre-established study occurrence, for example, either after disease progression or after demonstration of clinical superiority of the investigational medicine, Nonetheless, implementing crossover in a trial will reduce the treatment differences between the randomized arms for long-term trial endpoints, such as overall survival (OS). Results from a simulation study indicate that a crossover rate of more than 50% dramatically decreases the probability of detecting differences in OS by up to 90% (Barrett, D,2019). 

    Cohort studies are a type of longitudinal study—an approach that follows research participants over a period of time (often many years). Specifically, cohort studies recruit and follow participants who share a common characteristic, such as a particular occupation or demographic similarity. Some of the cohorts will be exposed to a specific risk factor or characteristic; by measuring outcomes over a period of time, it is then possible to explore the impact of this variable (eg, identifying the association between smoking and lung cancer (Barrett, D,2019). Cohort studies are, vital in some ways in public health and epidemiology, helping to build an understanding of what factors increase or decrease the probability of developing the disease. A cohort study can also be utilized to measure the level to which a particular risk factor, such as obesity, increases the risk of disease.

    (200-250 words)

    Peer# 2

    During crossover studies, patients are randomly assigned to either the experimental or control group and will be switched off to the other group meaning, both groups will be given the treatment/intervention. An intervention that can impact the patient after the crossover and can affect the results of the study is surgical interventions. For example, if a crossover study aims to determine if a surgical procedure produces better results in individuals with coronary artery disease than medication (such as beta blockers). The experimental group will first receive the surgical procedure while the control group will receive the beta blockers. After the crossover, they will receive the opposite intervention. Since the experimental group already received surgery (which cannot be undone), it affects the results for this group because the surgery is now a factor that can impact the effectiveness of the beta blockers whereas the control group has reported their results of the beta blockers first before receiving an intervention that cannot be undone (the surgical procedure. When finding cross over data, it is important to take into consideration the possible effects the intervention may bring to both groups. In this case, since the surgery can not be undone, the group to receive the surgery first will generate different results than the other group.

    A cohort study is considered a longitudinal study where participants are followed over time. Cohort studies can either be retrospective or prospective. In prospective cohort studies, exposed groups are chosen in the present whereas retrospective, they are chosen in the past. Diseases that are best to study using cohort are cardiovascular disease, diabetes, obesity, etc. These diseases have many risk factors that can be observed and followed over time making them perfect for cohort studies.

    (200-250 words)

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    1. What Is Meant by Strategy?

    The modern idea of strategy connected to planning originated in United States military planning. The focus was on strategy, and then organizing an action plan to implement the strategy (refer to the UNESCO reading). Their approach was later adopted by corporations in the 1960s, and then nonprofit organizations in the 1980s and 1990s.

    Drawing on your readings of Bryson and UNESCO (linked in Resources), discuss the basic purpose of employing a strategy, and assess the significance of applying this purpose to the chosen organization for which you have decided to develop a plan for your course project.

    Your post must:

    • Be at least 250 words.
    • Contain a minimum of one reference with citation in APA style.
    • Follow APA style guidelines.

    2.Also please provide a response (150 WORDS) to the following disscussion concerning his or her assessment of employing a strategy related to his or her chosen organization:

    The basic purpose of utilizing a strategy is to construct an alignment of three important tenets of an organization: achieving the mission, generating and accomplishing directives, and engendering public valuation (Bryson, 2018). The most important responsibilities of a nonprofit’s executive, in establishing and integrating a strategic plan, is directing financial activities, recruitment, and retention, and progressing the mission of the nonprofit through strategic advocacy. Strategic advocacy for nonprofit organizations (NPOs) is very important for the continuance of the organization’s mission in a competitive financial pool. Strategies organized into a cohesive plan allows NPOs like Bay Area Homeless Services (BAHS) to control their human, physical, and capital resources to influence a specific population that can benefit the most from BAHS’s services (Bryson, 2018). It is imperative to keep the lines of communication open between the director and their staff as well as the service population, so they all know what each other is doing (BAHS, 2021). Transparency is an optimal part of business today and to engender trust and loyalty towards their vision, a nonprofit must show through deeds that they are moral and ethical partners who practice what they expect their organization to put into action (UNESCO, 2010).

    Financial resource development strategies are important internal controls governed by the organization’s mission and public value. It should be used when in pursuit of donations through fundraising (Bay Area Homeless Services, 2021). Internal controls do several things: they set up safeguards for assets, monitor cash flow management, reconciles bank accounts, and outlines the parameters for the separation of duties. Hiring developmental staff to oversee fundraising is not recommended because it is a control that an executive member should monitor. This is why BAHS only has one person in charge of finances; the Bookkeeper (Bay Area Homeless Services, 2021). Having this alignment as the basic purpose of a strategy allows the nonprofit to strive to build a great team by emphasizing the commitment to the organization’s goal to make a difference in someone’s life. The mission of the organization satisfies the shareholders’ needs by building a bond of trust, supporting their ideas, and advocating their push to make more connections to other service-learning opportunities for their service population (Bryson, 2018).

    References

    Bay Area Homeless Services. (2021). Home. http://www.bahs-shelter.org/

    Bryson, J. M. (2018). Strategic planning for public and nonprofit organizations: A guide to strengthening and sustaining organizational achievement (5th ed.). Wiley.

    UNESCO. (2010). Strategic planning: Concept and rationale. International Institute for Educational Planning. Available from http://unesdoc.unesco.org/images/0018/001897/189757e.pdf

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    Peer# 1

    Directional strategies, or mission, vision, values, and strategic goals, guide strategists in making key organizational decisions (Ginter, 2013). The organization’s distinctive purpose is captured in its mission, while the vision provides an image of what the organization will achieve when accomplishing the mission (Ginter, 2013). Values are the guiding principles that employees follow when achieving the mission and vision without comprise (Ginter, 2013). An organization’s mission, vision, and values together set the foundation for the strategic direction of the company. The mission provides the basis for judging the success of an organization and its programs, making sure that everyone is on the right track working towards the right goals (Ahmed, 2019). Since the organization’s vision highlights where the organization wants to be in the future, it gives employees a goal to work toward. Mission and vision statements help businesses to outline performance standards and metrics based on the goals they want to achieve. They also provide employees with a specific goal to attain, promoting efficiency and productivity (Ahmed, 2019).

               An example of a mission and vision statement of an organization that I found particularly powerful is from the Alzheimer’s Association. The mission that guides this organization in their everyday work is “to eliminate Alzheimer’s disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health” (Alzheimer’s Association, n.d.). The future that the organization is working towards is embodied in their vision statement “a world without Alzheimer’s disease” (Alzheimer’s Association, n.d.). The Alzheimer’s Associations holds itself to the following values: integrity, commitment to excellence, inclusiveness, diversity, consumer focus, and accountability (Alzheimer’s Association, n.d.). After reading through these statements and values, I think it is clear to see the strategic direction that is outlined for this organization. The Association is advancing research, enhancing care, and promoting brain health as ways to eliminate Alzheimer’s, while all employees follow the core values in all they do.

    Peer# 2

    A mission statement communicates the organization’s reason for being, and how it aims to serve its key stakeholders. Customers, employees, and investors are the stakeholders most often emphasized, but other stakeholders like government or communities (i.e., in the form of social or environmental impact) can also be discussed. Mission statements are often longer than vision statements. Sometimes mission statements also include a summation of the firm’s values. Values are the beliefs of an individual or group, and in this case the organization, in which they are emotionally invested. In other words, mission statement of an organization represents who they are, what they value. Vision statement represents, what they want to become. Strategy represents, how they will achieve vision and goals and objectives represents what they gauge their degree of success. The organization I work at is a very religious and devotional organization. The mission statement of Loma Linda University health is to continue the teaching and healing ministry of Jesus Christ. We are committed “To make man whole,” in a setting of advancing medical science and providing a stimulating clinical and research environment for the education of physicians, nurses and other health professionals. Vision statement is to, “Transforming lives through education, healthcare and research. This organization brings in a very devotional aspect of patinet care and treat everyone with respect and with the goals of teaching and healing.

    Peer# 3

    I believe the role of the healthcare administrator has evolved because healthcare is so unpredictable and involves caring for people who are sick and at a vulnerable time in their lives. Administrators have to continuously change and adapt to new standards of patient care, infection control, research developments and government regulations. Healthcare administrators need to have a diverse knowledge base that includes the management of clinical services (patient care), accounting, finance, human resources, and so much more. They also need to be up to date on ever changing government regulations and requirements such as the ACA and HIPAA.

    Some current challenges healthcare administrators are faced with include the need change and adapt to a value-based payment model, which ties quality of patient care Medicare and Medicaid payment. They also must adopt and adapt to the use of technology. Not only in direct patient care settings (robotics, telemedicine), but also in electronic health records. With electronic health records comes the need to implement cybersecurity measures and HIPAA laws.

    COVID-19 created new challenges for administrators such as PPE and other supply shortages, loss of revenue due to cancelled elective procedures, higher costs in long-term care for critically ill uninsured or underinsured patients, staffing shortages and sheer lack of physical space to accommodate the influx of sick people.

    Policies and procedures are important in healthcare administration because they provide guidelines and the foundation for providing safe, effective, evidence-based quality care, while ensuring compliance with government regulations and standards of clinical practice. They are a way to hold management and staff accountable. The institution where I work is subject to audits and site visits from state, county, and independent government oversight committees. They inspect every aspect of the medical care provided. From patient access to care, healthcare environment to nursing and provider performance and administrative operations. While the weeks leading up to the visits are nerve wracking, I always learn a lot from the observations, proficiencies and deficiencies that are found. It gives us the opportunity look at how we manage our day-to-day operations, and how we are not always in compliance and what steps we need to take to get there.

     Technology is the driving force behind most of the changes taking place in today’s world. Not only has technology had an impact on the clinical side of healthcare, but it has also significantly changed the field of healthcare management (University of Southern California, 2020). Healthcare administration focuses on creating transparency, reducing risk, innovating healthcare, and cultivating relationships between patients and clinicians (University of Southern California, 2020). Thanks to technology, electronic medical records address all these issues, as well as healthcare cost, value, and access. New software systems have streamlined processes for healthcare administrators, including solutions for compliance, customer service, claims processing, marketing patient retentions, and care management (University of Southern California, 2020). As technology continues to evolve, so will the role of healthcare administrators.

    Peer# 4

    Technology is the driving force behind most of the changes taking place in today’s world. Not only has technology had an impact on the clinical side of healthcare, but it has also significantly changed the field of healthcare management (University of Southern California, 2020). Healthcare administration focuses on creating transparency, reducing risk, innovating healthcare, and cultivating relationships between patients and clinicians (University of Southern California, 2020). Thanks to technology, electronic medical records address all these issues, as well as healthcare cost, value, and access. New software systems have streamlined processes for healthcare administrators, including solutions for compliance, customer service, claims processing, marketing patient retentions, and care management (University of Southern California, 2020). As technology continues to evolve, so will the role of healthcare administrators.

               Policies and procedures are used to drive administrative and clinical decisions within organizations because policies provide board guidelines that are used to create specific procedures (Langabeer & Helton, 2016). The purpose of healthcare policy and procedures is to communicate to employees the desired outcomes of the organizations (Robinson, 2016). In the healthcare environment, policies should set the foundation for the delivery of safe and cost-effective quality care (Robinson, 2016). According to Robinson (2016), hospital policies and procedures establish a high degree of understanding, cooperation, efficiency, and unity among employees at the hospital.

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    HI, I NEED 2-3 PARAGRAPH RESPONSES ANSWERING THE FOLLOWING QUESTIONS PLEASE, THANK YOU IN ADVANCE:

    1. How does dehumanization help turn ordinary people into “killing and torture machines”?
    2. Imagine if you had been a soldier in the 232nd Regiment of the 39th Division from Hiroshima. What would you have done?

    The Rape of Nanking: A Report on Dehumanization

    For Americans, World War II began with the Japanese attack on Pearl Harbor on December 7, 1941. For the Chinese, the war began with the Japanese attack on Manchuria in 1931. One of the most infamous events of the Japanese invasion is recounted by Iris Chang in The Rape of Nanking. The takeover of the city of Nanking, the capital of China, was followed by a 7-week orgy of barbarity, so ferocious and cruel that it horrified even Nazi observers, During these 7 weeks, the soldiers slaughtered about 250,000 people and raped between 20,000 and 80,000 girls and women. They roasted some people alive and hung other by their tongues on iron hooks.

    Who were the men who did these things?

    The answer is that they were ordinary young men. If these men hadn’t been in the war, called by their country to be soldiers, they would have been in college, studying mathematics and sociology, learning to become dentists, doctors, and businessmen. But as soldiers, they had been trained—purposefully and with full intent—to become ruthless, uncaring, and barbarically bloodthirsty. The Japanese military had turned ordinary men into sadistic killers and rapists, thugs who took lives as easily as you and I would snuff out the life of an ant beneath our feet.

    Iris Chang (1977) wrote a remarkable book about these events. She traces how ordinary men learned to dehumanize the Chinese. One of the ways the Japanese military hardened these young men was to make killing a game. This helped to replace their ordinary feelings, creating a new framework for being brutal. An example is the killing contest that the military held as they were on their way to Nanking. Here is how a major newspaper in Japan, the Japan Advertiser, reported the killing contest in an article titled “Sub-Lieutenants in Race to Fell 100 Chinese Running Close Contest.”

    A black-and-white photo shows a Chinese POW kneeling on the ground with hands ties behind his back, and a Japanese officer holding a sword in his hands, about to behead him.

    This photo was taken in 1937 during the Nanking Massacre, also known as the Rape of Nanking. The text explains how killing contests became sporting events.

    Sub-Lieutenant Mukai Toshiaki and Sub-Lieutenant Noda Takeshi, both of the Katagiri unit at Kuyung, in a friendly contest to see which of them will first fell 100 Chinese in individual sword combat before the Japanese forces completely occupy Nanking, are well in the final phase of their race, running almost neck to neck. On Sunday [December 5] … the “score,” according to the Asahi, was: Sub-Lieutenant Mukai, 89, and Sub-Lieutenant Noda, 78.

    You can see how killing had become like a sports contest: Bulls 89, Lakers 78. The Japan Advertiser continued to update the public on this contest. The goal had been to see who could be the first to cut off the heads of 100 Chinese, but somehow the two men lost count, and they decided to up the goal to 150 heads.

    Were these really ordinary men? you might ask. The soldiers who killed and raped didn’t start like this. Chang reports that Japanese officers always found that their recruits to be shocked at the killing and torture of civilians.

    How did the men change?

    One way was telling the recruits that killing as a test of courage. For their Emperor and the Motherland, they had to overcome the feelings that belong to civilians and live up to the test of courage required of Japanese soldiers.

    And they did.

    Japanese officers brought recruits to the detention centers where Chinese prisoners were held. They told the men that these were the raw materials for their coming test of courage. The officers would illustrate the proper way to cut off heads, how to swing a sword so the head would be severed in one blow.

    Then would come the test, when the raw soldiers would be told to put into practice what they had been observing. By now, they had seen head after head separated from its body, and they had mentally and physically practiced the sweeping movement hundreds of times. But now there was a real person before them—but really no longer a person in their minds, for this person had been transformed into raw material for the test of courage.

    And they passed the test. To do less would have brought disgrace before their officers, and before their peers as well. In just one—graceful—swoop of the sword, from the proper angle, the head would become a stranger to its body, a swoop, properly done, that would bring praise and approval from both officers and fellow soldiers. Here is a Japanese solder’s account of “the test of courage”:

    On the final day, we were taken out to the site of our trial. Twenty-four (blindfolded) prisoners were squatting there with their hands tied behind their backs….The regimental commander, the battalion commanders, and the company commanders all took the seats arranged for them. Second Lieutenant Tanaka bowed to the regimental commander and reported, “We shall now begin.”…” Heads should be cut off like this,” he said, unsheathing his army sword. He scooped water from a bucket with a dipper, then poured it over both sides of the blade. Swishing off the water, he raised his sword in a long arc. Standing behind (one of the prisoners), Tanaka steadied himself, legs spread apart, and cut off the man’s head with a shout, “Yo!” The head flew more than a meter away. Blood spurted up in two fountains from the body…

    The lessons were learned well. Many years after the war, an ordinary man said that he saw fellow soldiers toss babies into the air and catch them on their bayonets, throw babies into pots of boiling water, and gang rape twelve-year-olds, killing them when they were no longer useful for sex. He said that he himself had killed more than 200 people. Some he beheaded, others he burned alive, and still others he threw into pits and buried alive.

    An ordinary man? Yes. After the war, he became a responsible citizen, a family man, and a kindly doctor who took good care of his patents.

    This is dehumanization. And it is powerful.

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    Please write a discussion and respond to this 2 peers’ Discussion Prompts

    Discussion:

    • Identify two possible research questions for your final project. Explain why these two questions interest you and why you would like to conduct research on them. Be concise in explaining why you believe there is a need for research to be conducted on the topics you’ve chosen.
    • Respond to at least two of your classmates with feedback on the questions they posted. Advise your classmates on which of the research questions they posted you think would be best for them to use. Explain why you think the question you chose would be best for them to pursue.
      • ALL citations and references needs to be APA 7th edition format. THANK YOU!


      Peers# 1

      The first area of interest that I have is in regards to my career as a mental health nurse. I have been working with adolescent patients in a mental health inpatient setting for the last 3 years. After seeing so many patients come through our doors, I have noticed a significant trend in an increase of transgender youths having active suicidal thoughts. These tend to stem around their transition and family, friends, and society not accepting them as they feel the truly are. I would study a group of trans youths from ages 12-17. I would develop a survey to investigate how often and severe their suicidal thought are/have been. I would also investigate how many of these youth had made suicidal gestures, attempts, etc. and the severity of those attempts. This would give us great insight into the plight that these children are going through and could guide further investigations into the best way to help a child who is not going through puberty and trying to find themselves, but in a culture that is overwhelmingly not supportive of who they feel they truly are.

      Another idea that I had was involving a conversation I had with co-workers the other night. As night shift nurses, we tend to utilize large caffeine intake to get through our long nights. Many of us are not fans of drinking coffee; which is the go to for most nursing staff. Many of us utilize soda as our method of caffeine intake. This lead to a discussion about how drinking so many sugary beverages has been a contributing factor to most of our weight gain in the years following working night shift. The conversation was interesting in that there seemed to be three distinct groups of nurses: 1) those who were health conscious and did not drink sugary or artificially sweetened beverages, 2) those who only consumed sugary beverages (i.e.: regular coke drinkers), and 3) those that consumed artificially sweetened beverages (i.e.: Diet Coke drinkers). I was thinking it would be interesting to do a study on nurses to see if there was a difference in weight (or obesity level) between nurses that consumed sugary beverages over those that consumed artificially sweetened beverages. Data would then be compared between the two groups to see if there is a correlation. This would allow us to help educate staff on better beverage choices to minimize obesity in the nursing world.


        Peers# 2

    Research question #1: Vaccine Hesitancy

    What social/cultural factors influence individual’s resistance to vaccines?

    Vaccine hesitancy refers to a “delay in acceptance or refusal of vaccination despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place and vaccines” (MacDonald, 2015). As a nurse, I have observed an increase in vaccine/immunization hesitancy over the past 15 or so years. Beginning with parents opting out of routine childhood immunizations to the more recent COVID 19 vaccine that is now available – to some, but not everyone (but that is another conversation). It is well known that many preventable diseases, such as measles and small pox, that were in the decline in the U.S. have made a resurgence. The decision to refuse or resist vaccines is a personal, but that decision has consequences throughout communities and the general population. When individuals hesitate or opt-out of vaccinations that prevent the spread of communicable disease, they potentially put the most vulnerable people at risk. I believe it is important to research the cultural, religious, political, etc. beliefs that drive this hesitation to better understand the decision-making process.

    Research question #2: Antibiotic Resistance

    How does the overuse of antibiotics affect public health?

    According to the Centers for Disease Control and Prevention (CDC, 2020), at least 2.8 million people are infected with antibiotic-resistant bacteria or fungi in the U.S. every year, and more than 35,00 people die as a result of those infections (para. 5). Again, as a nurse I am concerned with the what are termed “superbugs”, bacterial or fungal infections that are impossible to treat with antibiotics. Also, because antibiotic resistance is a losing battle, many pharmaceutical companies have abandoned antibiotic research, leaving us more vulnerable. I have personally been involved in the care of people with infections that are resistant to the usual course of antibiotic treatment. Not only does being sick make you feel terrible, multiple rounds of different, powerful IV antibiotics/antifungal medications come with side effects to add to the misery. Antibiotic resistant superbugs have the potential to contribute to a major public health crisis. It is important to research the consequences that antibiotic resistant superbugs have on the future of public health to be able to gain insight and mitigate an impending crisis.

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    •  Peers # 1

    For this week’s discussion, I chose to focus on my current employer, Crystal Run Healthcare. Crystal Run Healthcare was presented with the opportunity to merge with a large health system out of New York City, Monetfiore. This merger would allow Crystal Run Healthcare the opportunity to provide cutting-edge care to their patients that they cannot get locally. Leaders of both health systems stated that the merger is an efficient way for Crystal Run to work with a prestigious research institution to deliver advanced care that is unavailable locally (Axelrod, 2018). Even though the merger was meant to be a great opportunity, it had conflicting effects on Crystal Run Healthcare.

               The merger negatively effected Crystal Run Healthcare because seven doctors filed lawsuits against the organization in regards to the merger. Crystal Run physicians claim that Crystal Run patients seeing Montefiore doctors is one of the deal’s problems (Axelrod, 2018). The merger would require Crystal Run doctors to refer all patients to Montefiore even if the physician does not believe such a referral to be in the patient’s best interest (Axelrod, 2018). Tensions rose between doctors at Crystal Run because the merger also stated that physicians had to provide three years’ notice before leaving the practice. Other health systems weighed in on the merger and stated that the treatment of Crystal Run physicians under the deal was disrespectful and potentially unethical. The merger led to a gray cloud floating over Crystal Run and tensions between physicians, and ultimately the merger did not go through. Instead, Montefiore purchased a 33 percent interest in a Crystal Run holding company (Axelrod, 2018).

               If the merger were to go through, I think many doctors at Crystal Run would be angered at the new regulations that the deal would have put into place. I also think Crystal Run patients would receive lower quality care. The merger would have required Crystal Run physicians to refer all patients to Montefiore health system locations, most of which are outside of the area. Patients would be forced to travel to the referred location even if it was not in the patient’s best interest.

    Peers # 2

    My former employer was Hollywood Presbyterian Medical Center (HPMC) in Los Angeles and it really was a great organization to start my nursing career. I had the opportunity to do a new grad program at HPMC in the Telemetry department and it was quite the learning experience that opened many doors for me. HPMC is teaching hospital and I learned that firsthand during my new grad program. I knew how valuable that new grad program was and I took every learning opportunity I could. Before I was selected into HPMC’s new grad program, I was a nursing student there during my BSN clinicals. Being a nursing student there, I had the privilege to see how the organization worked and how the nurses were treated and the patients. I remember being in awe of how the staff was so supportive of each other and always teaching and giving advice to one another.

    As a nursing student, I had an amazing nurse to shadow and I really made a good connection with the nurse and made an effort to create a good professional relationship. In creating that professional relationship, I had good references in applying to the new grad program after I graduated with my BSN. From the charge nurse to the supervisor, they were all very approachable and always making sure we were helped when needed and very supportive. “Our dedicated team of healthcare professionals works together to plan and coordinate every level of your care. We want to make sure you understand your care plan and feel comfortable, that’s why we ask that you communicate with your nurses, physicians and other members of your care team” (Hollywood Presbyterian Medical Center, 2021). HPMC’s effect on myself and other employees there was proof that it was adding positive value to the organization through its way of treating employees and patients.

    Peers # 3

    According to Langebeer & Helton (2016), it has been suggested that the chance of a complex project surviving and achieving all of the benefits it established early on is around 50%. Successfully managing a project from start to finish requires certain key skills (Joubert, 2020). The two risks that I perceive to be the greatest threat to successful project completion are poor communication and lack of formalized documentation or procedures.

               Poor communication poses a great threat to successful project completion because without everyone being on the same page, no one is working towards the same end goal. Without strong communication skills, project managers would find it incredibly difficult, if not nearly impossible, to effectively manage their teams and coordinate efforts in order to bring about a project’s successful resolution (Joubert, 2020). Think about doing a group project for school. If there is poor communication between the group, parts of the assignment may not get done or parts may be duplicated, and the project would not be successfully completed. This is what would happen in the healthcare industry without proper communication, just on a much larger scale.

               The lack of formalized documentation is also a great threat to the successful completion of a project. Documentation must lay the foundation for quality, traceability, and history for both the individual document and for the complete project documentation (Verma, 2021). Formalized documentation allows for the project to move forward at a speedy pace and ensures that all stakeholders are as informed as possible (Verma, 2021). Having formalized documentation helps all members of the project remember the goals and objectives at all phases of the project. If an issue were to arise during a project, formalized documentation would provide traceable data back to where, who, or how the issue originated.

    Peers # 4

    I have chosen these two risks that I perceive to be the greatest threat to successful project completion: poor communication and lack of financial resources.

    Poor communication: In my opinion, communication is the key to moving forward in any type of relationship. This includes work relationships where the leader is trying to meet a goal with their subordinates. In this case, that could apply to a project manager trying to reach the finish line with the employees involved to complete the project. A way a healthcare administrator could combat this is by creating routine meetings with direct reports. The meetings should be at least weekly and have structure to them, such as an agenda with the expectations of the meeting given beforehand. “Continuous communication also helps to reinforce the concept that the project is important and that there is no hidden motive or purpose” (Langabeer & Helton, 2016).

    Lack of financial resources: I chose this threat as one of the most impactful because if the project isn’t supported with enough money, the project will undoubtedly fail or never finish. Like communication, sufficient funds keep the project moving forward toward completion. To keep the funds secured, a good idea is a sponsorship and promotion. “Projects require sponsorship to secure financing approval and to ensure the commitment of the right people on the project from the outset” (Langabeer & Helton, pg. 182, 2016). Another idea could be to cushion the project with extra funds. Meaning have the project cost less than the budget allotted or reserve more money than the cost of the project. Excellent project managers need to leave room for error, as this will most likely happen.  

    According to the textbook, there is a problem within hospitals centered around power (Langabeer & Helton, 2016). This is no surprise, as most businesses have similar issues when management comes into play. For example, physicians are an example of a general department that clashes with the administration department. Seeing as physicians are the ones who have “medical expertise and control of the customer,” they often act entitled to influence the decision of the project manager or at least make sure their voice is heard (Langabeer & Helton, 2016). A department well suited for handling issues such as this is the Human Resources department. They are the “lawyers” within the hospital, making sure the employees’ voices are heard as well as their managers without crossing an unprofessional line, or even worse—a harassment line.

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    Peer# 1

    Hi everyone!

    •            Most traditional organizations have not seriously considered entrepreneurship as a desirable path for their employees. Entrepreneurial opportunities are situations in which new goods, services, raw materials, and organizing methods can be introduced and sold at greater than their cost of production (Hisrich et al., 2017). One way that an organization might successfully cultivate an entrepreneurial spirit while continuing to increase efficiency within its routines and structure is to operate on frontiers of technology. The organization must operate on the cutting edge of technology and encourage new ideas instead of discouraging them (Hisrich et al., 2017). While also operating on the frontier of technology, organizations have to have ample time and money if they want to cultivate an entrepreneurial spirit. If the organization does not have enough money, the new idea will not be possible.

              Another way an organization can cultivate an entrepreneurial spirit is to encourage experimentation. According to Hisrich et al. (2017), a company wanting to establish an entrepreneurial spirit has to establish an environment that allows mistakes and failures in developing new ideas and products. A failure is only a failure if you do not learn from it, you have to be able to make a mistake in order to make progress. Going hand and hand, an organization also must remove any obstacles that may stand in the way of creativity in the new product development process (Hisrich et al., 2017). This means that if the organization is encouraging its employees to be entrepreneurs, the organization has to make sure there are no impediments to success.

              According to Hisrich et al. (2017), the process of establishing corporate entrepreneurship within an existing organization also requires the commitment of management, particularly from the top. The organization must carefully choose leaders, develop general guidelines for ventures, and delineate expectations before the entrepreneurial program begins. An organization that wants to successfully cultivate an entrepreneurial spirit while continuing to increase efficiency within its routines and structure needs to encourage new ideas and experimental efforts, eliminate opportunity parameters, make resources available, promote a teamwork approach and voluntary corporate entrepreneurship, and enlist top management’s support.

    Peer# 2

    Hello all.

    It’s difficult to choose one way in which an organization can cultivate an entrepreneurial spirit because it takes a clear decision and commitment from the organization to cultivate that type of environment. So maybe that’s my answer – make a commitment to encourage an entrepreneurial culture. With that comes risks. So the organization will have to be willing to take risks – related to efficiency, routines and structure.

    Hisrich et al. (2017) outline eight distinct differences between organizations that are managed with an entrepreneurial focus and ones with a more tradition focus. One, is the strategic orientation of an organization. Organizations with an entrepreneurial focus are “driven by the perception of opportunity” vs “driven by controlled resources” in more traditionally managed organizations (p. 37). To me, this falls in line with another difference which is growth orientation. Traditionally managed organizations play it safe with slow and steady growth. While entrepreneurial focused organizations understand the risk and rewards of taking risks to achieve growth (Hisrich et al., 2017). An entrepreneurial culture fosters a feeling of opportunity and ownership. The freedom to be creative and take action. I think it creates a more engaging work environment where people have the opportunity to put effort in to and take action towards ideas they have. The freedom to be creative and take risks – or at least be comfortable to communicate the idea.

    Encouraging entrepreneurship in organizations could be considered risky. With risk comes rewards – and failure. Risk-taking is a synonym for entrepreneurship. An organization committed to cultivating the entrepreneurial spirit needs to encourage innovation, creative ideas and embrace the concept of trial-error and failure. Part of the entrepreneurial culture is the organization’s willingness to forego the security of routine and structure. Then reap the rewards of success, or learn from the failure.

    Peer# 3

    Hi all,

    What criteria would you use to evaluate the candidates? What are the strengths and weaknesses of each candidate?

    To develop a criteria to evaluate a candidate for the vacant chief operating officer (COO) position, I must first identify what areas need the most help. It is noted that Wise Medical Center is the largest hospital in the region and holds a stellar reputation. It is also said that its philosophy is one of growth through investing. The two major areas that are identified as needing help are in finances and space constraints. Upon reading of these issues in the hospital, I will lean towards choosing a candidate who is well-versed in all operational areas of the hospital and can work and communicate well with leaders in a functional unit to ensure that the organization is operating well and working towards its strategic goal. In the infographic, we are given 3 options and they are: David O’Brien, Maria Rabin and Sal Sorrentine. The shared strength of all 3 candidates are that they all have experience in their fields given their positions in the department (assistant director, director, division administrator). For David O’Brien, his strength is being the assistant director for the medical center’s finance department. He may have attained that position because of his competence and that is a good strength to have so it should be considered in the interview process because Wise Medical Center is having increased financial pressure. On the other hand, his weaknesses of having an antagonistic personality and having limited experience working with providers would not make him a good communicator. Maria Rabin is a candidate that has the strength of working with a lot of the clinical staff and having a serious work ethic. While this is a good strength, there is a risk of her burning out so that will beg the question of who will replace her for the time she is gone to recover? That is Maria’s weakness but it can be resolved if there is a good enough candidate to cover for her while she is gone to recover. The last candidate is Sal Sorrentine and his strength is being enthusiastic and having the drive to make change quickly. His weakness is that he does not completely explore the implications of his changes and that kind of decision making in a highly volatile field like healthcare may not prove to be beneficial all the time.

    Whom would you recommend as your selection for the position? What evidence did you use in making this recommendation?

    In my opinion, I would strongly recommend Maria Rabin as the next chief operating officer (COO) for Wise Medical Center. I strongly believe her interpersonal communication skill can help her identify where needs are and she can address them quickly. Interacting with the staff on the floor and listening to their input can in turn improve operational efficiency in all of the organization’s aspects. It does not have to be limited to the clinical staff, it can be done to non-clinical staff (finance & facilities) as well to brainstorm and solve the issues identified. Even though she may have the risk of burning herself out, her ability to develop and nurture a different type of company culture where collaboration and communication is encouraged can form a framework that can operate well even when she is away to recover.

    Peer# 4

    Hello Fellow Classmates

    Describe the criteria being used to evaluate the candidates. Would you evaluate them differently?

    I thought that Matthew’s interviews were reasonably generic. Teamwork, willingness to learn, communication skills, self-motivation, and a culture fit. I appreciated reading that they had curiosity and an ability to learn continually, exercise initiative, and complete problem-solving.

    I would evaluate the candidates differently.

    What criteria would you use to evaluate the candidates?

    If the four (4) candidates are currently working and were high performers, any organization will ensure that the employee is retained, motivated, and provided the best opportunities to continue performing. So why would a high performer want to leave the organization?  If the reason is compensation, then the only reason we should be hiring the candidate is that, anyway, tomorrow there will be someone else offering higher. There will be no way to retain such people.

    In your present job description, are there some qualities that made your peers standout performers?  The candidate can identify and acknowledge that there is someone in your path of ambition and they were better in such and such aspects. In one go, I recognize my areas of development and the immediately available benchmarks for myself.  I would also ask how often you reached out to Seniors, Peers, or Juniors for feedback? Feedback is key to fine-tuning. If offered voluntarily by others, it is a gift. But more often, if the person reaches out to seniors and across the team to get feedback, it shows the individual’s openness to transcend one’s ego and focus on performance improvement.  The most qualified is the able candidate, demonstrating they meet or exceed the role requirements, bringing a different cultural perspective or unique expertise to the position and department.

    Which candidate would I choose? 

    I looked at Teamwork, Willingness to Learn, Communication, Self-Motivation, and Culture Fit. I found that Sal Sorrentino was the weakest candidate.  His negative comments in Teamwork, Willingness to learn, communication, self-motivation, and Culture fit found him the least likely candidate. I had a difficult time between Rabin and O’Brien. The red flag that eliminated Rabin was her time questions, looking at another position that does not make my side of the decision move faster. Of the four, I would continue looking further. Rabin and O’Brien are high performers in the organizations, and I find that they should look to step up in their respected organizations. Goldsmith needs someone else to open a door for her; she has no self-motivation. Sorrentino is a lost cause.

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    University of Southern Califo

    In order to complete this paper assignment, students will interview a person of another culture or ethnicity. Ideally the person should be from a cultural or ethnic experience that differs from yours, but in some cases, interviewing an older family member can be illuminating as well. The interview should include the following information on the person interviewed. The idea is to learn new things, and expose yourself to information that you previously did not have experience with. There are two sections to this assignment, your interview and your interpretation of the interview in terms of your experience, in other words data on the person you interviewed, and data on you are the interviewer. Not only should your paper have an Introduction and Conclusion, the Body of your paper should be divided into various subheadings that cover the specific information being discussed for both Section 1 and 2 of your paper.

    You may change the name of the person you are interviewing and use an alias if you wish. Please be sure to explain to the person you are interviewing that this is an exercise in learning more about other peoples cultures and experiences as part of the fulfillment of your Cultural Diversity course.

    Section 1: On the person being Interviewed

    1) Description of ethnic background – Eritrean, Ethiopian, Peruvian, or it may be a mixture, such as African and Spanish, Norwegian and Swedish, German and English.

    2) History of coming to the USA. Historic background of how the people your interviewee has ties with came to be in the United States; when and why they came (were they immigrants or refugees, motivated by dreams of a better life, or running from oppression or poverty); the journey to this country, including any circumstances you consider significant. You may focus on a particular circumstance / event or you may choose to cover and discuss the more general circumstances of others of the ethnic group that the person you are interviewing belongs to. This section of your paper is substantial and should contain citations and sources because you are doing background research on history.

    3) Reception of the members of the ethnicity by other Americans. To what degree were there immigration policies, restrictive or exclusionary policies which affected the opportunities of the newcomers? To what degree did they encounter discrimination or encouragement in their new communities?

    4) Aspects or characteristics of the person’s ethnic background that are salient or important to them and their family; what features, such as the humor, the food, family relations, patterns of communication and childrearing, etc. contribute to the person’s way of thinking and being and those of others of their ethnic background?

    5) Strengths. What strengths can the person trace to their ethnic background? (In some cases, these may be best observed through family values).

    Section 2: Questions for the Interviewer (you the student)

    In addition to the above questions regarding the person you interviewed, please answer the following in regards to your interviewing experience:

    1) What were your feelings/emotions as you put yourself in the situation of interviewing the person for this assignment?

    2) Reflect on how your group membership, race, and/or other factors influenced the ways you interpreted the experience.

    3) Did any common themes about race /ethnicity appear during the course of your completing the assignment? Discuss what you think were the meanings of these themes.

    4) If applicable, what were the aspects of white privilege that you did or did not observe or experience during the interview (this could be anything from a story told by the person who you were interviewing, to how you may have been viewed by the person etc.)? If anything came up, in your opinion, what were reasons why these occurred in those situations?

    5) What did you learn about society/race/minority status, etc. AND yourself as a result of doing this paper?

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    Peer# 1

    • A written business plan is a detailed description of the goals and objectives of a business and how the entrepreneur plans on achieving those goals and objectives. It outlines the internal and external elements that are involved in the venture and integrates plans for many different aspects including marketing, financial, sales, human resources and production plans (Hisrich et al., 2017). In the most fundamental way, business plans are important because banks and investors require them in order to provide loans or funding. A business plan paints the picture and outlines projected costs and potential consequences of business decisions. A business plan should be a living document to be changed and modified as the business grows and changes, or to take the business in a different directed if needed (Hayes, 2021). I think a business plan is also important to keep an entrepreneur focused and realistic. If you are really enthusiastic about a business idea, the enthusiasm may overshadow the reality that perhaps there is no market for the product or service that it is not viable, or marketable.

    If a business plan is written without research or investigation in to an established need for the product or service, an entrepreneur would be moving forward with a venture in which there is no customer demand or perhaps already too much competition. Not a great strategy for success. This is type of market analysis is part of the feasibility study and the information is gathered using national and local trends, local competition, market position and market objectives (Hisrich et al., 2017). Clear goals and objective cannot be made if you don’t understand your customer, your market or your competition.

    Peer# 2

      Planning is an essential and never ending part of any business. Having a written business plan is even more vital in early stages of entrepreneurship. Business plan is an outline of all essential internal and external components and strategies of establishing a new business journey (Hisrich et. al., 2017). It may include such elements as manufacturing, workforce, financials, sales, marketing, among  others. Not only is a business plan important to the entrepreneur, but also his/her investors, teammates, customers, suppliers, etc. Business plan is an important reference piece for all the stakeholders as it describes the mission, goals of a project, helps determine the actuality and reliability of the venture, provides detailed guidance for the entrepreneur, helps to make sound decisions and obtain financing from banks or other lenders (Hisrich et. al., 2017).

             In the absence of a business plan, the venture may not have a structure, direction, guidance, clear priorities, and may face a failure due to insufficient communication among the stakeholders. Business plan includes research on the market, its size, competitors, customer niche and their behavioral specifics, helps determine acceptable pricing. Without all this information, an entrepreneur is simply guessing and hoping for the best, but is not prepared for the real situations of the market being oversaturated or on regression or any other possible roadblocks (Weedmark, 2020). This type of disorganized start may lead to overspending, making rushed decisions, and inadvertently lead to a failure.

    Peer# 3

    Hi everyone!

               Midwest University Medical Center (MUMC) is a highly specialized tertiary referral and trauma center, the main hospital is a 600-bed acute care facility that receives roughly 45,000 patient admissions each year, with more than half coming through the emergency department (Kovner & McAlearney, 2013). Improper handoffs are a huge concern for many organizations, especially MUMC. The handoff signifies the transfer of responsibility for the patient from the emergency department to the inpatient service (Kovner & McAlearney, 2013).

    Multiple factors contributed to the problem in this case. Identify as many distinct factors as you can. Using your list, develop some strategies to reduce the likelihood of a recurrence.

    Some factors that contributed to the problems with handoffs at MUMC include the lack of coordination and communication between various departments, there is no proper tracking of patient records, MUMC lacks standardized approaches, patients in the “boarding” process are out of sight and wait up to six hours to be transported after handoff. The electronic medical record (EMR) system at the hospital is typically not filled out or updated properly, so patient information is often lost in translation between handoffs.

    To avoid recurrence, I would first institute a standardized approach. The first would be to ensure that all staff is completely the patient EMR correctly and updating information within the system. Even if the handoff process was not perfect, the MR would contain all pertinent care information for the physician. A standardized approach needs to be in place to fix the “boarding process”. Patients in boarding should not be waiting out of sight in hallways for up to six hours. These patients need to be waiting in a designated area so that they cannot be forgotten about. MUMC should hold training for staff on interprofessional relationships to address the lack of coordination between departments. All staff should be working together to provide the best possible care for the patients, instead of focusing on personal needs. Positive relationships between the incoming and outgoing nurses have led to higher ratings of handover quality (Raeisi et al., 2019).

    Why do you think hospitals permit handoff problems to continue?

    In my opinion, I do not think hospitals willingly permit handoff problems to continue. I think the root of the problems with handoff is centered around how physicians and nurses interact with one another. Even if a hospital steps in to correct handoff problems, communication between staff can still cause problems to occur. Every hospital has different processes on how handoff is handled, so it can be extremely difficult to control how staff communicates with one another and what information is included during handoff. Lack of communication among the incoming and outgoing nurses in the handover process is one of the main causes of reduced safety and quality of services and patient dissatisfaction (Raeisi et al., 2019).

    Peer# 4

    In the our text this week, we are analyzing case involving patient handoffs. Fortunately, the patient involved did ultimately receive the care that he needed (Kovner & McAlearney, 2013). However, the manner in which the case was handled was unprofessional and disorganized.

    The patient presented to the emergency department (ED) with shortness of breath and an irregular heartbeat. The ED ran traditional tests and determined that the patient needed to be admitted for additional care. However, when the ED provider attempted to hand the patient off to the internal teams, the teams did not want to receive the patient. From there a series of factors came into play that prevented a smooth transition for this patient. Some of the factors were:

    -ED crowding

    -ED staffing

    -ED Transfer process of boarding patients in hallways

    1. -Handoffs being refused or passed to another department

    -Failure to adequately document in the EHR

    -Failed follow through of attending and admitting

    -EMR admitting limitations that request a physician’s name prior to starting the admittance process.

    1. -Verbal orders

    There are several opportunities for scenarios such as these to be improvised. If I were the administrator of the hospital, I would create a focus group with the sole intention of creating policies and procedures surrounding hand offs. It is imperative for the overall safety of the patient that clean communication and accountability for the patient occur (Lee et al., 2016). The team that would come together would write the guidelines to ensure that all providers hold one another accountable. There have to be clean expectations for the hand-offs.

    Additionally, I would work with another group in order to determine how we can safely board patients so that they can still receive the care that they need. The patients cannot be boarded in the hallway while they wait for additional care. However, the ED still needs to be able to see patient’s rapidly and address their volume. One solution can be to look at staff transport team expansions, unit expansion, holding rooms with appropriate staffing / oversight or potentially a new workflow within the ED.

    Finally, I think that as the administrator that a conversation with the physicians involved needs to occur. I believe that there needs to be a transparency with the team that allows for an open conversation. I also would engage these particular providers in the focus group. They have a viable viewpoint that needs to be heard, but they also have a recent exposure with the scenario. They will have a viable and applicable viewpoint that they can bring into the scenario.

    I would also work to ensure that the teams understand the true depth of the complication. That by looking the other way or allowing the poor handoffs, we are compromising patient care. I could readily assume that it is easier to brush these scenarios away than contend with them. The problem can be complex and convoluted. It seems simple on the surface, but there is a mass of complications that come when you start to untangle the process. Some would justify the process by stating that there are not the finances needed to progress accordingly. However, the norm needs to be challenged and changed. The change must occur for the sake of patient care and safety.

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    University of Southern Califo

    Please write a discussion and respond to this 2 peers’ Discussion Prompts

    Discussion:

    State your opinions on the Affordable Care Act and support them with research. Reflect on capitation rates being adjusted to account for risk factors in the population.

    • Respond to at least two of your classmates’ or instructor’s posts. Provide input on your classmates’ research questions. Which type of research do you think would be most appropriate to answer the question?
    • ALL citations and references needs to be APA 7th edition format. THANK YOU

    Peer# 1

    The Affordable Care Act, the ACA or also known as Obamacare The main goals were to make health insurance more affordable, more accessible, and overall fairer for consumers. The fact that Obamacare has been able to touch the lives of children with pre-existing conditions and continue care gives an understanding that this act is more than just an impact. Although there are still snags and postponements of implementation, for the most part, many Americans are now benefiting from the health care law. Adverse selection, on the other hand, occurs if capitated plans attract higher-than-average-risk patients because of the types of services offered, the cost-sharing arrangements, and the delivery network, in terms of choice and location of physicians and facilities (Fleming, 2014). I believe have ACA as the leading healthcare in many Americans has led to it being a success, this is more than just a program for the need but a chance for survival for many. I’ve always been a woman of faith and the believe that this Act came at it’s given time and place.

    Peer# 2

    The Affordable Care Act has 3 primary goals:

    • Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level (FPL). Note: If your income is above 400% FPL, you may still qualify for the premium tax credit in 2021.
    • Expand the Medicaid program to cover all adults with income below 138% of the FPL. (Not all states have expanded their Medicaid programs.)
    • Support innovative medical care delivery methods designed to lower the costs of health care generally. This health care plan has been beneficial to many people during the Pandemic.

    The Affordable Care Act (ACA) made premium tax credits available to people purchasing health coverage on the Marketplaces, but generally only when their incomes fall between 100% and 400% of the federal poverty level. Overall, The ACA is designed to extend health coverage to millions of uninsured Americans. The Act expanded Medicaid eligibility, created a Health Insurance Marketplace, prevented insurance companies from denying coverage due to pre-existing conditions, and required plans to cover a list of essential health benefits.


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