Is The Humane Society International Gave For Animal Testing

One of my childhood best friends is Shadow. Shadow is my 7 year old Black Lab; I don’t know what I would do without his friendly greetings when walking through the door. With having such a good relationship with Shadow, it makes me wonder how people can be so cruel to animals. I have taken a recent interest in learning more about animal testing and let me tell you I am completely against it. I am against it because the way they treat the animals is inhumane, the acts they created are not helping, and because some of the experiments are not beneficial to human life. The definition that the Humane Society International gave for animal testing is performing procedures on living animals for further research in biology, diseases, effectiveness in new medicines and house held products. There are varies animals that can be used for these tests such as; mice, rats, dogs, non-human primates, and rabbits. Every year 100 million animals die from being a victim of animal testing. To me t hat is an absurd amount of animals dying. Some of the known testing labs animals could be sent to are Covance, Shin Nippon Biomedical Laboratory, and Charles River. These three labs are known to have the most painful experiments, they are also known for having primates flown into their labs. A few acts that were created were the Animal Welfare Act (AWA) and The Animal and Plant Health Inspection Service (APHIS). The Animal Welfare Act was created to help regulate testing animals, and to setShow MoreRelatedThe Negatives of Animal Testing1027 Words   |  5 Pageshave been tested on animals; from lipstick and shampoo to dish soap and foot powder. Even the white ink on an MM has been tested on animals. To some, this statement may be alarming and even disturbing – to others it may not mean much at all. Either way, the debate over animal testing has gained much popularity in recent decades. Animal testing has been done since at least 500 BC; even Aristotle experimented on animals for scientific reasoning. Around 200 AD, dissecting animals in public was actuallyRead MoreCruel Methods Of Animal Testing2812 Words   |  12 PagesWhy do U.S companies still use cruel methods of animal testing despite The Animal Welfare Act of 1966? Millions of animals are used in painful experimentation yearly. Animals such as rabbits, dogs, cats, guinea pigs and monkeys are used in extreme testing for drugs, cosmetic and household products.(http://www.animalresearchcures.org) In the United States, no matter how cruel, pointless or painful an experiment is, it is always legal. The usage of animals in research goes way back to the early 1900’sRead More Animal Rights Essay2196 Words   |  9 Pagesrelationship with animals is the use of animals in laboratory sciences. Some manufactures of cosmetics and household products still conduct painful and useless tests on live animals, even th ough no law requires them to do so. Some people, called anti-vivisectionists, are at one extreme in their concern. They want an abolition of all experiments on live animals. At the other extreme there are those who say that it is quite all right for us to do whatever we like to animals. They say that God gave us such aRead MorePersuasive Speech On Killer Whales1673 Words   |  7 Pageswhales is endangering their survival in the ecosystem, which should not be the case (BioExpedition 1). Our interaction with the ecosystem should not pose a threat to the existence of other organisms. According to the 1960 Prevention of Cruelty To Animals Act, it is unconstitutional to inflict unnecessary suffering, stress and pain through restricting an organism of its rights. We should let the orca find his way back to his natural habitat, because keeping orcas in captivity has detrimental effectsRead MoreAnimal Testing Is A Significant Controversy Across The Nation Essay2191 Words   |  9 PagesA nimal testing is a substantial controversy across the nation. According to Rush, Catherine M. et al. â€Å"Animal Models to Investigate the Pathogenesis of Rheumatic Heart Disease.† Frontiers in Pediatrics 2 (2014): 116. PMC. Web. 27 Oct. 2016., animal testing has been around for quite some time. Her article states that â€Å"Animals have been used repeatedly throughout the history of biomedical research. Early Greek physician-scientists, such as Aristotle, (384 – 322 BC) and Erasistratus, (304 – 258 BC)Read MoreThe Importance Of Animal Testing1883 Words   |  8 PagesAnimal Testing is Essential On the other had, some individuals deem animal testing necessary for the furthering of the medical field. There have been illnesses and diseases that have been eradicated due to animal experimenting. One such disease a vaccine that was resulted by successful experimentation on animals to combat it is the poliomyelitis vaccine Continuing, one essential aspect to consider when evaluating the similarities between humans and animals is the amount shared genes. According toRead MoreAnnotated Bibliography : Animal Testing5436 Words   |  22 PagesAnnotated Bibliography Aziz, T., Stein, J. (2011). Animal testing: TV or not TV? Two views on whether scientists who believe that animal experimentation is necessary should become public advocates, or work quietly behind the scenes. Nature, (7335), 457. The authors are Tipu Aziz and John Stein.   These authors source of authorities are that they are writers for a publishing group.   You can tell these two writers are prepared to write about this topic because they are using actual events that haveRead MoreThe Body Shop, Corporate Social Responsibility Essay6824 Words   |  28 PagesAssignment Corporate Social Responsibility Analysis of The Body Shop Date 29 January 2010 Word Count 5477 Grade 75% Table of Contents Preamble 1 Introduction 1 Corporate Social Responsibility 2 Opposition to Animal Testing 3 Support for Community Trade 6 Environmental Protection 9 Evaluation 11 Conclusion 13 References 16 Appendix 1 20 Preamble The objective of this piece of work is to undertake a critical analysis of the cosmetics companyRead MoreThe Ethics Of Stem Cells2828 Words   |  12 Pagesresearch experiments that call out the moral issues about science. People are concerned about the honesty about science of how research will be shown to society and how scientists will perform their research without being corrupt. Most of the research that scientists do is to fully understand the fundamental questions of biology and also help society progress such as with cures for once thought incurable diseases. One of the many researches that is being looked at is stem cells. Stem cells were firstRead MoreThe Use Of Non Human Tests Subjects For Experimentation And Research Studies3837 Words   |  16 PagesDefinition Animal testing, also known as animal experimentation, is the use of non-human test subjects for experimentation and research studies (2). This definition is very broad because it is used in numerous fields such as drug testing, brain functionality, effects of food additives, pesticides, DNA modification, xenotransplantation, cosmetic testing, cancer research, AIDs research and many more. Overall, animal testing is a professional conflict, but it can also be considered as a personal conflict

Multilingualism in Nigeria. a Blessing or a Curse

TITLE PAGE MULTILINGUALISM IN NIGERIA: A BLESSING OR A CURSE? PREFACE Multilingualism is an issue that has become a subject of discussion in a variety of language related disciplines. Some researchers discuss multilingualism as a sociolinguistic concept through which issues of language contact and the status of the mother tongue can be interrogated. Others see multilingualism as a political matter, that is, an issue which requires solutions to language problems from the policy makers who are political authorities in a multilingual nation, and as an economic problem, because, as Jahr (1998) states, chaotic language differences are determinants of economic disadvantage whereas well planned language differences are considered to be†¦show more content†¦Ã¢â‚¬Å"Multilingualism† is easily distinguished from â€Å"monolingualism† (the use of a single language) and â€Å"bilingualism† (the use of two languages). Though many developed nations flaunt their national languages in the face of the under-developed ones and thereby give th e false impression that they are monolingual, monolingual nations are actually rare. Many a country that is known by its national language comprises a multiplicity of ethnic groups, indigenous and non-indigenous. Such a nation pretends to be monolingual because it has a dominant ethnic group whose ethnic language has assumed the role of a national language. In France, for example, the national language is French, but there are such minority languages as Breton, Basque, Catalan, Dutch, and German (Trugdill 1983:143). In like manner, Great Britain has English as its national language in addition to Welsh and Gaelic, which are minority languages. There are also other immigrant languages still used as mother tongues within the country. We, therefore, regard societal multilingualism as the rule rather than an exception, not only in the under-developed countries like Nigeria but also in developed ones like Great Britain and France. 1.1 DEFINITION OF THE KEY WORD â€Å"MULTILINGUALISM† The question of how to define multilingualism appears to have split scholars into two groups – those who favour narrow definition and those in favour of a broad definition. For the narrow group,

Mental Illness And Mental Health - 1222 Words

Mental Illness. Lots of times when we hear these words people assume that there is something critically wrong with that person. Sometimes there is but most people who struggle with a mental illness or disorder are everyday people that you pass on the street. Just because they have a mental Issue does not necessarily mean that they are much different than you or me. In fact if an individual is being treated for his or her mental illness it can be difficult to recognize that they even have one. There are many different types of treatments for the many different types of illnesses and disorders and each person has their own type of treatment that works for them. Although medication can help manage mental health there are so many other ways to†¦show more content†¦Sometimes though the patient can remain at home and does not need to be hospitalized. These patients are usually medicated. Medication is most often used when any individual is diagnosed with a mental illness. Medicati on does not cure the mental illness it just helps manage it. Antidepressants are used to treat depression and anxiety. Anxiety is managed with anti-anxiety medications. Mood stabilizing medications are mostly used for bipolar disorder or used with an antidepressant to manage depression. Schizophrenia, bipolar disorder and many other mental illnesses are also treated with antipsychotic medications. Case managment plans are coordinated services for a certain individual with a case manager. A case manager is a trained professional to help guide you through your plan to a healthy recovery. A case manager helps assess, plan and implement a number of strategies to help you recover. If you have a case manager you have to be willing to compromise and work with him or her. This takes a certain level of stability and maturity to be able to do so. A case manager is not helpful to every person. The plan that he or she is making for you is designed specifically for your unique problem, no two pe ople will have the same exact recovery plan. Case management helps you participate in your own care. You and your manager are workingShow MoreRelatedMental Illness : Mental Health Illness2108 Words   |  9 PagesMerriam-Webster, mental health illness is described as a broad range of medical conditions (such as major depression, schizophrenia, obsessive compulsive disorder, or panic disorder) that are marked primarily by sufficient disorganization of personality, mind, or emotions to impair normal psychological functioning and cause noticeable grief or disability and that are usually related with a disruption in standard judgement, feeling, mood, behavior, interpersonal interactions, or daily functioning. Mental healthRead MoreMental Health : Mental Illness1604 Words   |  7 PagesMENTAL HEALTH REPORT 1.Prevalence is the number of cases of disease in a given population and is defined with epidemiological data. Mental health is a person’s psychological well-being. Associated diseases have become increasingly prevalent in Australia over the past decade, with a recent advertisement by the ABC highlighting that 50% of Australians will experience a mental illness. Mental illness is responsible for the third largest burden of disease in Australia, making it a priority. †¢ MorbidityRead MoreMental Illness And Mental Health1460 Words   |  6 Pageshaving mental health problems when actually they should be referred to as having a mental illness. Mental health is â€Å"a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community† (Mental health basics). Mental health is something a normal, healthy functioning human being has when everything in their head is in order. A mental illness is theRead MoreMental Health And Mental Illness1702 Words   |  7 Pagesbetween mental health and mental illness? Although the terms are often used interchangeably, mental health and mental illness are not the same thing. According to the World Health Organization (WHO), mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. However, mental illness is a recognized, medically diagnosable illness that resultsRead MoreMental Illness : Mental Health Illness1986 Words   |  8 PagesMerriam-Webster, mental health illness is described as a broad range of medical conditions (such as major depression, schizophrenia, obsessive compulsive disorder, or panic disorder) that are marked primarily by sufficient disorganization of personality, mind, or emotions to impair normal psychological functioning and cause noticeable grief or disability and that are usually related with a disruption in standard judgement, feeling, mood, behavior, interpersonal interactions, or daily functioning. Mental healthRead MoreMental Health : Mental Illness1604 Words   |  7 PagesMENTAL HEALTH REPORT 1.Prevalence is the number of cases of disease in a given population* and is defined with epidemiological data. Mental health is a person’s psychological well-being. Associated diseases have become increasingly prevalent in Australia over the past decade, with a recent advertisement by the ABC highlighting that 50% of Australians will experience a mental illness. Mental illness is responsible for the third largest burden of disease in Australia, making it a priority. †¢ MorbidityRead MoreMental Illness And Mental Health1284 Words   |  6 PagesMental Illness Mental illness has been the most overlooked issue in society today let alone within prisons. Researcher Lurigio (2001) explored studies from the 1970’s through to the 2000’s on the deinstitutionalization and restructuring of mental health laws that basically channeled the mentally ill into the corrections system. Often mentally ill offenders are released into community care. Lurigio emphasized that community based care â€Å"compartmentalizes† mentally ill offenders and creates limitationsRead MoreMental Illness And Mental Health1724 Words   |  7 PagesVISUALISATION Mental illness is one of the major illnesses, some people face in everyday of their life, which can trigger them in one or the other as well prevent them to do things effectively as it use to be. According to Mental Health Foundation (2015), about a quarter of the population will experience some kind of mental health problem in the course of a year, this can happen either by anxiety and depression which is the most common mental disorder in Britain. Women are consideredRead MoreMental Health And Mental Illness1314 Words   |  6 PagesUnderstanding mental health is a very complex concept. The antiquity of mental illness and madness tells two common and defective definitions of mental health. The first, that mental health is the absence of mental illness, while the second that mental health is a state of well-being (Tudor, 1995). The fact that both definitions are reductive and the same word mental health is used to mean mental illness added more confusion to such term. However, i t is important to know what really is mental health and mentalRead MoreMental Illness And Mental Health893 Words   |  4 Pagesreasons I wanted to write about mental health is because I do not think is discussed enough and more importantly I do not think it is given the importance it deserves. Mental Health is something you heard now and then, but it’s never actually discussed and it should. When I asked about this topic some people were uncomfortable, others were more open to discussion, but both of these people had something in common: they did not actually had an idea of what is a mental illness or disorder, the people who

Impacts Of The Economic Downturn On Health Economics Essay Free Essays

string(43) " impacts of the recession are dissociated\." Undertaking ) â€Å" Identify and explicate how the economic downswing may impact straight and indirectly on the wellness of people in the UK. Discuss with mention to identify positions on wellness inequalities and socioeconomic position † â€Å" Those who do n’t cognize history are destined to reiterate it. † Edmund Burke ( 1729-1797 ) 1. We will write a custom essay sample on Impacts Of The Economic Downturn On Health Economics Essay or any similar topic only for you Order Now 0 Introduction 1.1 Poor wellness affects the lower-classes more significantly and disproportionately than the upper-classes ( Chadwick, 1843 ) . Somewhat before his clip Chadwick concluded the unequal impact of hapless wellness on lower socio-economic groups is evitable. Indeed, Chadwick claimed that he could cut the decease rate in London by a 3rd by bettering the conditions of the lower-classes ( Chadwick, 1843 ) . Figure: Scanned infusion from the original study by Edwin Chadwick on the healthful conditions of the laboring population of Great Britain ( 1843 ) . 1.2 Chadwick ‘s belief in miasma, as the instrument of decease, was incorrect but his decision that the impact of ill-health and mortality on the lower-classes was greater than that of â€Å" upper-classes † was anything but incorrect. In 1844 Engles claimed the disparity was due to the chase of wealth by the upper-classes, the middle class, at the disbursal of the wellness of the lower-classes, the labor, and referred to the phenomenon as â€Å" societal slaying † ( Engles, 1844 ) . 1.3 Since Chadwicks ‘ study in 1843 many others, most notably, the Black Report ( DHSS, 1980 ) , the Whitehead Report ( Whitehead, 1988 ) , the Atchison Report ( 1997 ) and the Marmot Review ( 2010 ) , conclude that those in lower-classes or lower socio-economic groups are more likely to be affected by hapless wellness, and as a effect the labor will see higher mortality which is unjust and wholly evitable ( Bradby, 2009 ) . The purpose of this paper is to place and explicate how the 08/09 economic downswing may impact the wellness of people in the UK with specific mention to social-class and wellness inequalities. 2.0 Social-class and wellness inequalities 2.1 The Registrar General ‘s categorization of social-class, conceived in 1911, was based on business with specific mention to the implied societal position of that business ( Bartley and Blane, 2009 ) . This method of categorization, limited by its stiff contemplation of a structured-hierarchal-unchanging-society, was superseded in 2001 by the National Statistics Socio-economic Classification ( NS-SEC ) , an internationally recognized categorization that takes history of position, income, chances, security, instruction, and liberty and control ( Denny and Early, 2005 ) . 2.2 In using NS-SEC, Marmot ( 2010 ) showed the sum of societal inequality persons experience is comparative to the sum of wealth and power wielded by those single ; the less wealth, power and influence and accordingly the lower social-class the greater the inequality. Graham ( 2007 ) , identified the beginnings of economic and societal inequality are hapless instruction, deficiency of occupation chance, and accordingly hapless income chances, and demonstrated a generational geographic temperament to ill-health and disablement. 2.3 The eventual societal place, money, power, and material wealth acquired in life are non relative to their wellness hazards, ( Marmot, 2010 ) . Jointly the determiners of wellness are rooted in the societal, geographical, environmental, political, and material universe ; which affect the mental and physical wellbeing of persons unevenly. Dahlgren and Whitehead ( 1991 ) clearly describe the determiners of wellness as a multifactorial-socio-economic phenomenon of which the bulk is under the control of those with greater power, see Figure: The chief determiners of wellness ( Beginning: Dahlgren and Whitehead, 1991 ) . below: Figure: The chief determiners of wellness ( Beginning: Dahlgren and Whitehead, 1991 ) . 2.4 The societal inequalities in wellness are described by Bartley et al.. ( 2004 ) as 4 theoretical accounts: 2.4.1 The behavioral theoretical account which advocates the single chooses to damage their ego through their ain hapless picks such as intoxicant maltreatment, drug usage, smoke, and hapless diet doing fleshiness ( Bartley et al.. 2004 ) . 2.4.2 The materialist theoretical account which suggest the quality of your material universe such as your house, the location you live in, and handiness of quality merchandises has an impact on your wellness ( Bartley et al.. 2004 ) . 2.4.3 The psyco-social theoretical account analyses the relationship between the physiological effects of perceived societal unfairness on the human organic structure. High emphasis, deficiency of support, emotional withdrawal, relationships, can consequence harmful biological alterations which manifest in unwellnesss ( Bartley et al.. 2004 ) . 2.4.4 The life class theoretical account, which combines strands from the behavioral, materialist, and psychosocial theoretical account. If you are of a lower social-class, societal mobility is improbable and your material universe is improbable to alter for the better, nor are you behaviours or stressors, all of which have negative cumulative effects that damage wellness but can-not be mitigated by societal capital, ( Bartley et al.. 2004 ) . 2.5 Locker ( 2008 ) describes the incorporate nature of these theoretical accounts as the â€Å" web of causing † . Suggestive of the proposition that no individual theoretical account histories for all causes of ill-health but without uncertainty wellness inequalities manifest in more long-run unwellness for lower-classes, and higher infant mortality rates, non to advert a greater opportunity of coronary bosom diseases, shot, lung malignant neoplastic diseases, self-destructions, and respiratory disease ( Marmot, 2010 ) . 3.0 Recession and Downturns 3.1 The definition of a â€Å" Recession † is widely accepted as two-or-more back-to-back quarters of negative growing. The ONS has recorded eight recessions over the past 55 old ages ; on norm of 1 every 6.8 old ages, Table: Eight recessions between 1956-2009, associated figure of negative growing periods and cumulative impact on GDP. ( Beginning: ONS, 2011 ) refers ( ONS, 2011 ) . Table: Eight recessions between 1956-2009, associated figure of negative growing periods and cumulative impact on GDP. ( Beginning: ONS, 2011 ) . 3.2 Literature suggests the lower socioeconomic category suffer more well in times of recession, although Elliott et Al. ( 2009 ) suggest the longer-term agony and in some respects, the greatest consequence on lower social-classes is from the downswing. The 08/09 recession started in Q2/08 and ended in Q3/09, stand foring six quarters of negative growing and has the greatest cumulative decrease in GDP ( ONS, 2011 ) . Elliott et Al. ( 2009 ) province the length of recession and longer-term impacts of the recession are dissociated. You read "Impacts Of The Economic Downturn On Health Economics Essay" in category "Essay examples" The writers attempt at a graphical representation of Elliott et Al. ‘s premise are seen in below: Figure: Writers graphical representation of Elliott et Al. ‘s premise that the recession and downswing are dissociated 3.4 This representation may propose the consequence of rebalancing is more likely to impact lower social-classes than the recession its ego, given that market forces manipulated by higher social-classes create the environment for a recession, which is rebalanced by cardinal authorities at the disbursal of the lower-classes in the signifier of decreased public disbursement and accordingly a decrease in employment and societal services. 4.0 Social-class and the economic downswing 4.1 Harmonizing to Marmot and Bell ( 2009 ) recessions have greater impact on those of a lower socio-economic place due to their inability to endure a recession. Although, Gerdtham and Ruhm ( 2006 ) , based on an analysis of OECD informations, claimed mortalities rates decline during recessions an analysis of informations obtained from the ONS demonstrates that morality rates as a % of population did non worsen universally over the period of 1956 – 2009 against the mean mortality rate for that period. Harmonizing the the ONS information for the first 5 recessions the mortality rate was higher than norm when considered as a % of population. During the 90/91 recession the mortality rates as a per centum of population was close norm and so declined significantly during the latest recession, which concur with Rhum ( 2005 ) findings, Figure: Mortality rates as a % of population during recession old ages. ( Beginning: ONS 2011 ) refers. Figure: Mortality rates as a % of population during recession old ages. ( Beginning: ONS 2011 ) 4.2 Interestingly the unemployment rate as a per centum of the population when considered against the mean unemployment for the period 1973-2009, was significantly lower in the 73/74 recession and merely reached para at the beginning of the 90/91 recession, Figure: Unemployment rates as a per centum of population during recession old ages refers. Martikainen et Al. ( 2007 ) identified in their survey, mortality rates do non needfully increase during recession old ages, and in fact, grounds suggests the antonym. Specifically, during the last recession mortality rates appear to be above the norm during periods of high unemployment, Figure: Mortality rates as a % of population during recession old ages. ( Beginning: ONS 2011 ) and Figure: Unemployment rates as a per centum of population during recession old ages refer. Figure: Unemployment rates as a per centum of population during recession old ages, ( Beginning: ONS, 2011 ) 4.3 Marmot ( 2010 ) , Elliott et Al. ( 2010 ) , Kondo et Al. ( 2008 ) , conclude the impact on wellness is straight related to social-class, which is important when you consider latest recession. Evidence shows that unemployment by and large rises and with that rise there is besides a rise in the mortality rates ( as a per centum of population ) with the exclusion of the latest recession ( ONS, 2011 ) . 4.4 A quick and soiled statistical reappraisal for the period 1973-2009 of % decrease in GDP, against the % unemployed suggests a tendency for social-class effected during recession see.Table: England and Wales – Population Total, Deaths, Mortality Rates, Unemployment Rates, against recession old ages. below. Table: England and Wales – Population Total, Deaths, Mortality Rates, Unemployment Rates, against recession old ages. 4.5 Using the 73/74 and 75 recessions as a benchmark and presuming the social-class affected by the recession contributed to the loss of GDP, it is apparent that the undermentioned recessions affected different social-classes accepting mean net incomes applies to social-class. 4.6 The 80/81 recession saw more people unemployed but less of an impact on GDP, which implies those unemployed contributed otherwise to GDP coevals proposing lower paid workers, lending less to the coevals of GDP were unemployed, this tendency is more apparent in the 90/91 recession. However, the 08/09 recession appears different the ratio of unemployed to the decrease in GPD is similar to that of the 73/74 and 75 recessions. 4.7 Vaitilingam ( 2009 ) suggested the 08/09 recession would impact the in-between category and given the important addition in loss of GDP in relation to the figure of unemployed is implicative of a more flush worker going unemployed. 4.8 In kernel the information suggest the greater the decrease in GDP relation to the rate of unemployment the different category affected by the recession. Therefore, in every instance other than the 08/09 recession the per centum of unemployed has been greater than the decrease in GDP. This suggests that lower category are proportionately more instantly affected by the Recession than higher categories. In the instance of the 08/09 recession, the decrease in GDP is greater than the rate of unemployment proposing a high socio economic category will be instantly affected by the recession, which is really unusual for the UK. How that manifest down the societal strata is yet to be observed. 5.0 Decision 5.1 It is widely accepted that hapless wellness affects lower social-classes more significantly and disproportionally and that it is evitable, ( Marmot, 2010 ; Bradby 2009 ) . Occupation entirely, as step of social-class in out dated and does non take history of the diverse societal stratification seen in modern society where position, income, chances, security, instruction, and liberty and control, vary well throughout occupational sets ( Bartley and Blane, 2009 ; Denny and Early, 2005 ) . 5.2 Marmot ( 2010 ) and Graham ( 2007 ) showed the less wealth, power and influence and the lower social-class the greater wellness inequality. This wellness in equality Graham ( 2007 ) , and Dahlgren and Whitehead ( 1991 ) claim is associated with hapless instruction, deficiency of occupation chance and hapless income chances. The behavioral, stuff, psychosocial and life class theoretical accounts, discussed by Bartley et al.. ( 2004 ) and Lockers ( 2008 ) â€Å" web of causing † by definition place the determiners of wellness are rooted in the societal, geographical, environmental, political, and material universe. 5.3 The clear premise by Elliott et Al ( 2009 ) and Marmot and Bell ( 2009 ) that recessions doing greater and more well longer enduring to those of lower socio-economic category is mostly without challenge. The effects of economic rebalancing on lower social-classes is less good understood, nor are the longer term effects of the downswing in the signifier of decreased public disbursement and accordingly a decrease in employment and societal services that are to a great extent relied upon. Does policy alteration better conditions for lower social-classes or does it amplify the effects of an already unequal system. 5.4 Gerdtham and Ruhm ( 2006 ) show there is grounds of displacements in mortality rates around recessions although the overall consequence of recession and unemployment on longer term mortality rates is less clear. If, as Marmot ( 2010 ) , Elliott et Al. ( 2010 ) , and Kondo et Al. ( 2008 ) , claim the impact on wellness is straight related to social-class, and if one can pull the decision that different social-classes suffer otherwise during recessions so Vaitilingam ( 2009 ) 08/09 middle-class recession should uncover, as the longer term effects of the downswing come to an terminal, that there is no noticeable addition in preventable unwellnesss and deceases amongst the most vulnerable. The consequence on the lower social-classes may non be as apparent this clip unit of ammunition albeit strictly by opportunity. How proud would Chadwick be of our advancement? Mentions ‘The Acheson Report ‘ ( 1998 ) Independent Inquiry into Inequalities in Health, HMSO. Bartley M and Blane D. 2008. ‘Inequality and social-class ‘ in Scambler, G. ( erectile dysfunction ) Sociology as Applied to Medicine ( 6th Edition ) London: Saunders pp 115-132. Bartley, M. Blane, D. Davey-Smith, G. 2004. The Sociology of Health Inequalities, Oxford: Basil Blackwell. Bradby, H. 2009. Medical sociology: an debut. London: Sage. Chadwick, E. 1843. Report on the healthful status of the laboring population of great Britain. London: Clowes and Sons. Black. D. 2008. Inequalities in wellness: study of a research working group. London: DHSS. Dahlgren, G. and Whitehead, M. 1991. Policies and Schemes to Promote Social Equity in Health. Stockholm: Institute for Futures Studies Engles, F. 1844. The status of the working category in England in 1844. Germany: publishing house terra incognita. Elliott E, Harrop E, Rothwell H, Shepherd M and Williams GH ( 2010 ) Working Paper 134: The Impact of the Economic Downturn on Health in Wales: A Review and Case Study, Cardiff School of Social Sciences, November ( 2010 ) . Denny, E. A ; Earle, S. 2005. Sociology for nurses. Cambridge: Polity Press. Graham, H. ( 2007 ) Unequal Lives: Health and Socio-economic Inequalities, Buckingham: Open University Press. Gerdtham, U. G. and Ruhm, C. J. 2006. Deaths rise in good economic times: grounds from the OECD. Economics A ; Human Biology 4 ( 3 ) , pp. 298aˆ?316. Kondo, N. Subramanian, S. Kawachi, I. Takeda, Y. and Yamagata, Z. ( 2008 ) Economic recession and wellness inequalities in Japan: analysis with a national sample, 1986aˆ?2001, Journal of Epidemiology and Community Health, 62, 869aˆ?875. Locker, ( 2008 ) ‘Inequality and social-class ‘ in Scambler, G. ( erectile dysfunction ) Sociology as Applied to Medicine ( 6th Edition ) London: Saunders pp 18-55. Marmot, M. and Bell, R. 2009. ‘How will the fiscal crisis affect wellness? ‘ British Medical Journal ; 338: b1314 Marmot M ( Chairman ) . Fair society, healthy lives – strategic reappraisal of wellness inequalities in England station 2010. London: The Marmot Review, 2010. Martikainen, P, Maki N A ; Jantti M. ( 2007 ) The effects of unemployment on mortality following workplace retrenchment and workplace closing: a registeraˆ?based followaˆ?up survey of Finnish work forces and adult females during economic roar and recession. American Journal of Epidemiology 165 ( 9 ) , pp. 1070aˆ?1075. ONS, 2011. Statbase [ online ] . Available at: hypertext transfer protocol: //www.statistics.gov.uk/CCI/nscl.asp? ID=7433. Accessed: 31 March 2011. Ruhm, C. ( 2005 ) Comment: Mortality additions during economic upturns. International Journal of Epidemiology 34:1206aˆ?1211 Vaitilingam, R ( 2009 ) . Recession Britain: Findingss from Economic and Social Research. Economic and Social Research Council. Whitehead M. ( 1988 ) The wellness divide. In: Townsend P, Davidson N, Whitehead M, eds. Inequalities in wellness: the Black study and the wellness divide. Harmondsworth, UK: Penguin, 1988: pp215-356. How to cite Impacts Of The Economic Downturn On Health Economics Essay, Essay examples

Dionysus

Dionysus- some ideas Essay February 5, 2001Within all the text in the Dionysus section the universal theme I found is that the characters were punished by fate for no apparent reason. In one pivotal moment in each story, the innocent character loses free will and henceforth is steered by merciless fate. In the myth of Diana and Actaeon, Actaeon has committed no crime but is punished as if he had. His seeing Diana bathing was the work of fate. As a matter of fact, Hughes reinforces this belief in the first paragraph of the story when he states, Destiny, not guilt, was enough for Actaeon. It is no crime to lose your way in the dark wood (Hughes 97). It is perfectly clear that it was purely fate guiding this story. Actaeon was Steered by pitiless fate- whose nudgings he felt only as surges of curiosity (Hughes 99). At this point one can see that Actaeon has completely lost his free will. It is no longer his decision whether to not go further in the cave. From here on, fate takes control of his life. The only character that has gained a form of justice from this encounter is Diana. By disposing of Actaeon, she won back her purity- the essence of her virginity. This purity she had lost when Actaeon saw her exposed. Her only means of regaining her chastity is by ridding herself of Actaeon . In comparison, there is no justice in this tale for Actaeon. He was simply a victim of fate, which put him in the wrong place at wrong time. The strongest moral of the myth of Diana and Actaeon is that fate carries no preferences. Actaeon committed no crime; he did nothing to anger the gods. Fate catches up to all people regardless of the manner in which they chose to live their lives. Ovid could have used this myth as a basis for explaining to his people why even the innocents suffer in life. However, I found that the morals of this myth are as beauty is to the eyes of a beholder. For example, another one of the possible morals I came up with is that the hunter became the hunted. Diana, being the goddess of the hunt had the power to show Actaeon what it was like to be the hunted. This is brutally demonstrated when Actaeons own dogs, which were so peculiarly described (practically all of page 101 is dedicated to the description of these dogs), hunt Actaeon down and ravenously tear him to pieces. This idea of Actaeons own hunting tools helping to hunt him down is further emphasized when Actaeons friends and fellow hunters take part in the hunt. Actaeon found himself wishing to be at the other end of the rope. And he wished he were as far off as they thought him. He wished he were among them not suffering his death but observing (Hughes 103). There is another aspect of the readings that I just noticed and found interesting anough to mention. It is constant theme of physical transformations that are present in each story. In the tale of Europa, Zeus transforms himself into a bull, in Cadmus; Minerva transforms the soil and Dragons teeth into men, in Actaeon; he himself is transformed into a stag, in Semele; Juno transforms herself into an old woman, and finally Tiresias transforms himself into a woman and then back to a man. Most of these transformations involve gods and most serve to teach the characters a lesson. I found these interesting enough to note because transformations can be thought of as being used to conquer foes and to escape difficult situations; they are a means of expressing power. People fear change and the metamorphosis of the characters in these stories represents this change. Perhaps showing these transformations in myths (thereby showing the powerfulness of the gods) were a way of scaring the public i nto fearing and never doubting or disobeying the gods?

Organizational Theory and Design

Question: Write an analysis on the strategic role of human resources in creating and then sustaining an environment in which your organization will thrive. Answer: Introduction The human resource department is a crucial department, which is responsible for the conceptualization, development and sustenance of an optimum work environment and high degree of productivity. The leaders of the organization should strive for optimum utilization of the organizational resources and striving for continuous development (Epstein Buhovac, 2014). The aim of the organizational leaders should be to push the organization to the topmost position in the global market. The organization- Coca Cola is selected for the purpose of this study. This paper would perform a detailed analysis of the strategic role of the human resources personnel in the process of creating and maintaining excellent work standards. Discussion The human resource department in Coca Cola helps the organization in the implementation of sustainable business practices (Karnani, 2013). There are several critical success factors for every organization, which drive the sustainable business dynamics of the organization. The human resource department plays a critical role in the improvement of the critical success factors (Rummler Brache, 2012). This is described below- Development of a sustainable vision and mission of the company Development of a suitable leadership pipeline Creation of an appropriate organizational structure and implementation of appropriate governance mechanisms that drive the sustainability Development of important functional HR capabilities so that there is creation of sustainable HR processes and systems. Ability of motivation and engagement of the employees. Alignment of the employees with the organizational goals Building agile workplace, which is able to adapt to changes in the internal and external environment (Rummler Brache, 2012). Coca Cola have diverse employees working in the organization for fulfilling the common goals of the organization (Ulrich, 2013). The human resource department should be aware of the individual citizenship behaviors. The individual behaviors of the employees, which influences the overall functioning of a particular organization is known as organizational citizenship behavior (OCB) (Borman Motowidlo, 2014). The individual behavior is neither explicitly mentioned in the job description nor it is specified in the employment contract. The individual behavior is a personal choice and it depends upon the individual to behave in a particular fashion. The OCB is considered to be beneficial for the organization as it enhances the efficiency, ability to attract as well as retain talented employees and the ability for organizational transformation (Arthaud-Day, Rode Turnley, 2012). The human resource managers should identify OCB and strive for the maximum utilization of the same. There are a lot of domains in which the HR plays strategic roles in Coca Cola. The various issues and domains of the organization are discussed below along with the role of HR in each of these domains- Issues of diversity, culture, retention and engagement- There is a need for decreasing the attrition rate of the organizations (Mowday, Porter Steers, 2013). The organizational culture of Coca Cola should be improved and there should be proper management of employees coming from diverse domains (Mowday, Porter Steers, 2013). The employee engagement activities should be focused upon, which increases the satisfaction level of employees (Bal, Kooij De Jong, 2013). The satisfied employees would stick to the organization for a longer time. Redesigning of the performance management- The focus should be made on the development of the skills of the workforce. There is a need to improve peer to peer relationships and focus should be done on the coaching and development (Epstein Buhovac, 2014). The numeric scales, formal evaluations, rankings and others are used to evaluate the performance of the employees (Kehoe Wright, 2013). There is a need of providing positive feedback to the employees based on their performance standards. Ensuring satisfaction of the employees- The modern day organizations are looking for the creation of open workspaces; alter their work locations, open policies like work from home and others (Brooke et al., 2013). The flexibility of the workplace practices and better work-life balance fascinates the employees and there is increased employee satisfaction. The productivity levels of the satisfied employees are more, which contributes to organizational success (Mowday, Porter Steers, 2013). The satisfaction of the employees is also increased by excellent financial and non financial benefits. More emphasis on corporate learning- There is a need for increased specialization of skills of the employees so that they can contribute more to the organizational productivity. There is a need to implement face to face learning and development opportunities (Kolb, 2014). The Coca Cola Company should strive to bring the global workforce together to promote an innovative environment for learning. The traditional methods of e-learning are not appropriate for the modern day organizations (Rummler Brache, 2012). There is a need to introduce an integrated experience of digital learning (Ulrich, 2013). Coca Cola should strive to incorporate an enriching learning culture, increasing employees collaboration and focusing on digital learning tools, like online videos, tutorials and others. The HR manager should incorporate the enhancement of capability development (Rummler Brache, 2012). Redesign of talent acquisition Coca Cola should strive for innovative methods for recruitment and selection of the human resources of the organization. The company should utilize the network recruiting, which implies that the contacts of the employees, contractors, corporate alumni and others should be utilized (Datta Roumani, 2015). The candidates should also be sourced from global networks. The HR personnel should develop a strong candidate pool, leverage external as well as internal networks, train the hiring manager and formulate a suitable strategy for talent acquisition (Ulrich, 2013). Emphasis on career management strategies and talent mobility- The attrition rate of a company poses serious threats to the organization. The organization incurs a great expenditure when hiring a new person. The different costs include cost of hiring, loss of productivity and the reduction in the learning curve of the new hire (Ulrich, 2013). Coca Cola should engage in facilitated talent mobility, which means that the employees should be allowed to move into new suitable job roles (Kehoe Wright, 2013). The employees should be constantly challenged and developed so that they can contribute more to organizational productivity. The company should invest in new recruit orientation, on boarding, offer incentives and others (Rummler Brache, 2012). The company should also develop career coaches to determine the patterns of the movement (Ulrich, 2013). The employees should be promoted as per their level of experience and not just the functional expertise. Adopt innovative tools in HR technology- The talent management process should engage in human resource management systems. The major job functions of human resource involves performance management, payroll, learning, recruiting, succession planning and others, which are best addressed by enterprise resource planning (ERP) solutions (Ulrich, 2013). There is a need to hunt for the cost effective vendors who provide the best ERP solutions and human resource information system at the most cost effective way (Rummler Brache, 2012). The organization Coca Cola, should strive for quick adaptation to the changing internal and external environment. The leaders should identify the requirement for change, define the change, develop a suitable action plan, deliver the change process and sustain the change (Rummler Brache, 2012). The HR should devise monitoring mechanisms that reviews the implemented changes (Ulrich, 2013). It is also important to document the various knowledge management systems and make sure that the information is accessible to the new employees as well as existing employees. The leaders should ensure maximum workplace productivity so that the end objectives of the organization are met (Rummler Brache, 2012). The HR leaders should invest in workforce planning and talent analytics (Ulrich, 2013). The talent analytics comprises of the collaboration of the analytics and reporting teams in the compensation, recruitment, leadership and learning job roles. The leaders should engage in efficient planning of the work environment and the formulation of suitable HR strategies (Rummler Brache, 2012). HR The HR personnel of Coca Cola should engage in the process of change management in the organization (Rummler Brache, 2012). The existing processes should be revamped and remodeled so that it meets the organizational objectives. The policies should be formulated in such a way that Coca Cola remains ahead of the competition in the global market. The changes should be rapid and should satisfy the critical success factors of the organization. Conclusion The human resource job roles are not an annual process and should be done once in every year. It is one of the dynamic job roles that need to be addressed by the human resource managers. The human resource plays an important role in creating a professional environment. The rules and policies of the organization should be formulated in such a way that it satisfies the interest of both the organization and the individual employees. The organization should strive to be the most popular and should possess excellent brand image in the market. The organization should strive to be one of the global leaders and this is possible only through the betterment of the human resource policies. References Arthaud-Day, M. L., Rode, J. C., Turnley, W. H. (2012). Direct and contextual effects of individual values on organizational citizenship behavior in teams.Journal of Applied Psychology,97(4), 792. Bal, P. M., Kooij, D. T., De Jong, S. B. (2013). How do developmental and accommodative HRM enhance employee engagement and commitment? The role of psychological contract and SOC strategies.Journal of Management Studies,50(4), 545-572. Borman, W. C., Motowidlo, S. J. (2014).Organizational citizenship behavior and contextual performance: A special issue of human performance. Psychology Press. Brooke, E., Taylor, P., McLoughlin, C., Di Biase, T. (2013). Managing the working body: active ageing and limits to the flexiblefirm.Ageing and Society,33(08), 1295-1314. Datta, P., Roumani, Y. (2015). Knowledge-acquisitions and post-acquisition innovation performance: a comparative hazards model.European Journal of Information Systems,24(2), 202-226. Epstein, M. J., Buhovac, A. R. (2014).Making sustainability work: Best practices in managing and measuring corporate social, environmental, and economic impacts. Berrett-Koehler Publishers. Karnani, A. G. (2013). Corporate Social Responsibility Does Not Avert the Tragedy of the Commons--Case Study: Coca-Cola India.Ross School of Business Paper, (1210). Kehoe, R. R., Wright, P. M. (2013). The impact of high-performance human resource practices on employees attitudes and behaviors.Journal of Management,39(2), 366-391. Kolb, D. A. (2014).Experiential learning: Experience as the source of learning and development. FT press. Mowday, R. T., Porter, L. W., Steers, R. M. (2013).Employeeorganization linkages: The psychology of commitment, absenteeism, and turnover. Academic Press. Rummler, G. A., Brache, A. P. (2012).Improving performance: How to manage the white space on the organization chart. John Wiley Sons. Ulrich, D. (2013).Human resource champions: The next agenda for adding value and delivering results. Harvard Business Press.

Apollo Hospital Essay Example

Apollo Hospital Essay Example Apollo Hospital Essay Apollo Hospital Essay The ‘‘wow’’ factor in service relies on constant innovation and demands continuous and sensitive focus on all issues that may affect the patient’s stay in a hospital. Every touch point of the hospital needs to be ‘‘alive’’ and the client must be able to feel the warmth offered. The culture of service is imperative in today’s scenario, where the differentiators could just be the manner in which services are offered. All the major players could replicate infrastructure within a short span of time, but not the service culture. Dr. Umapathy Panyala, Chief Executive Officer, Apollo Hospitals, Bangalore (March 2013) Dr. Panyala, CEO, Apollo Hospitals, Bangalore believed that in the future, the hospitality aspect of hospitals- the service provided to patients- would differentiate Apollo Hospitals from a large number of equally competent competitors in the growing Indian healthcare industry. He had set up a quality department at the Apollo Hospital in Bangalore, headed by Dr. Ananth Rao. Apart from being an expert on Metabolic Diseases and Biochemistry, Dr. Rao was also a Lean Six-Sigma black belt from the Indian Statistical Institute, Chennai. You can’t manage what you don’t measure- although this may sound cliched; I am still a firm believer of this philosophy and want to apply this, especially in the hospitality part of hospitals. Clinical benchmarking is a compulsory requirement and is taken care of; however, patients have so many other touch points in their stay at hospitals- the hospitality part. Some of the world-class hotels (such as the Ritz–Carlton) have performed benchmarking to standardise their hospitality offerings; at the same time, its employees are allowed to use their judgment to provide whatever delights the customer in every visit. 1 We want to internalise this in our culture as well. – Dr. Ananth Rao, Head–Quality Department, Apollo Hospital, Bangalore (March 2013) Dr. Rao also believed that the hospitality aspect would differentiate Apollo Hospitals from its competitors. Patient cure and care played very important roles in hospitals. Many patients were generally anxious when in a hospital and the sense of disservice increased their anxiety level very easily. Integrating healthcare and hospitality was essential for creating patient-focused care. Hospitality aspects included a smooth admission procedure, friendly medical and non-medical staff, comfortable furniture, varied choices on the food menu, attractive surroundings, recreational facilities, privacy, clear signposting, adequate provisions for visitors, and so on. 2 Important aspects of hospitality were managed by the nursing staff and other non-medical staff, which meant inherent variability of service owingto human interventions. Dr. Panyala and Dr. Rao wanted to measure the hospitality aspects at Apollo Hospitals and improve hospitality to create a world-class hospital. Dr. Rao and his team collected feedback every day from the patients and received a number of complaints, ranging from not having a TV remote to long response time on the part of nursing staff in attending to requests from patients. For Apollo Hospitals, it was important that the patients’ experience in the hospital was not compromised, since it could have a significant financial impact. Managing the hospitality elements of the hospital was as important as managing the clinical aspects. Apollo Hospitals had a stringent process in place to take care of clinical aspects. Dr. Rao wanted to improve the hospitality at Apollo Hospitals by reducing the 1 Hall, J. M. and Johnson, M. E. , When should a process be art, not science, Harvard Business Review, 2009, 1–9. Hepple, J. ,Kipps, M. and Thomson, J. , The concept of hospitality and an evaluation of its applicability to the experience of hospital patients, International Journal of Hospitality Management, 1990, 9(4),305–318. 2 Suhruta Kulkarni, Kripa Makhija and U Dinesh Kumar, Professor of Quantitative Methods and Information Systems, prepared this case for classroom discussion. V Sandeep assisted in data collection and analysis. This case is not intended to serve as an endorsement or source of primary data, or to show effective or inefficient handling of decision or business processes. Copyright  © 2013 by the Indian Institute of Management Bangalore. No part of the publication may be reproduced or transmitted in any form or by any means – electronic, mechanical, photocopying, recording, or otherwise (including internet) – without the permission of Indian Institute of Management Bangalore. This document is authorized for use only by NIKITA VAIDYA in Nutrition 346 taught by Carol Blindauer, at Dominican University Illinois from January 2015 to May 2015. For the exclusive use of N. VAIDYA, 2015. Apollo Hospitals: Differentiation through Hospitality Page 2 of 20 number of complaints from patients; he also wanted to achieve significant improvement in sigma levels measured through the Six Sigma performance scale. According to Dr. Ananth Rao: The immediate challenge is to understand the patients’ sentiment towards the hospitality provided and to design a process improvement plan that is affordable. Apollo takes feedback from patients every day and the quality department staff interviews many patients every week to understand their needs. Dr. Rao was aware that improving hospitality at Apollo Hospitals was going to be a continuous exercise in improvement; collecting feedback was one way of approaching the process of continuous improvement. He treated every complaint as a â€Å"defect† and planned to use lean Six Sigma concepts to eliminate defects. Implementing Six Sigma in all departments was likely to be a challenge since departments such as housekeeping faced high attrition rates. His immediate objective was to introduce a system where future complaints related to hospitality could be reduced. Also, how much importance should be given to hospitality by Apollo Hospital was one of the dilemmas faced by Dr Rao and he wanted to set a realistic target for Sigma level in hospitality at Apollo. APOLLO HOSPITALS: THE TRENDSETTER Dr. Prathap C. Reddy, founder of Apollo Hospital Enterprises Ltd. (AHEL) had accomplished a successful medical career in the United States. He returned to India in 1972 to contribute to the healthcare system in India. Health infrastructure in India was very poorly developed in the 1970s. In 1971, there were 3,862 hospitals and 12,180 dispensaries with a total of 348,6553 beds for a population of 548,159,6524- a ratio of 6. 36 beds per 10,000 people as against the ratio of 9 beds per 10,000 people in 2011. 5 India’s first National Health Policy was declared in 1983,6 almost 36 years after independence, which was an indication of the neglect faced by the health sector in the country since independence. Dr. Reddy had set up a good medical practice in India and used to send patients outside the country for specific treatments. However, in 1979, a young patient died as he could not arrange the money for treatment in the United States. Dr. Reddy then decided to provide the best of medical treatment from the West to patients in India with an emotional touch, calling it â€Å"High Tech with High Touch. † Apollo was a doctor-promoted enterprise- 10,000 Indian doctors, 4,700 U. S. -based doctors, and 60 doctors from the United Kingdom invested approximately USD 5,000 to start the venture. Dr. Reddy selected the best of the talent available to ensure the best possible service and care. He also ensured that a clear distinction was maintained between business management and clinical management. 7Apollo pioneered world-class healthcare in India, which was later emulated by several other hospitals. Apollo focused on technological excellence and garnered many firsts to its credit in the country. Apollo was the first not only in India but also in South Asia to launch Oncological Robotic Surgery, G4 Cyberknife Robotic Radiosurgery System, 320-slice computed tomography scanner, 64-slice positron emission tomography-computed scan system, full-field digital mammography with tomosynthesis, and many such technologies. 8 According to Dr. Rao, Apollo intended to carry forward technological excellence in hospitality to provide patients with the best cure and care services. Dr Preetha Reddy, Managing Director, Apollo Hospitals Enterprises Limited has been the pioneer and chief architect of the tender loving care –TLC ‘‘mantra’’, a pillar of the Apollo way, which is affectionately applied to every patient at Apollo Hospitals. â€Å"The patients and staff comprehend this language better,† she points out. The concept of TLC integrates service delivery with clinical outcomes resulting in exceptional patient experiences9,10. 3 Background Papers: Financing and Delivery of Healthcare Services in India, National Commission on Macroeconomics and Health, Ministry of Health and Family Welfare Government of India, 2005, p. 47. 4 Source: http://cyberjournalist. org. in/census/cenpop. html, accessed on March11, 2013. 5 Source: globalhealthfacts. org/data/topic/map. aspx? ind=78, accessed on March11, 2013. 6 Health Research Policy, Indian Council of Medical Research, New Delhi, (October 2007). 7 Mitra, M. , The Apollo Mission, Corporate Dossier with The Economic Times, June 1, 2012. 8 Apollo Investor Presentation, www. apollohospitals. com, accessed in January 2013. 9 N Amarnath, and D Ghosh, The Voyage to Excellence: The Ascent of 21 Women Leaders of India Inc. , Pustak Mahal, pp. 80-95. 10 apollohospitals. com/apollo_pdf/dr_preetha_reddy_managing_director. pdf This document is authorized for use only by NIKITA VAIDYA in Nutrition 346 taught by Carol Blindauer, at Dominican University Illinois from January 2015 to May 2015. For the exclusive use of N. VAIDYA, 2015. Apollo Hospitals: Differentiation through Hospitality Page 3 of 20. CLINICAL BENCHMARKING Apollo Hospitals had been using a clinical score card called [emailprotected] (Apollo Clinical Excellence), which measured and monitored clinical excellence among the group’s hospitals. [emailprotected] measured 25 clinical parameters (Exhibit 1) every month, which were benchmarked against global standards. [emailprotected] was launched on September18, 2008 and used across 32 hospitals of the group. Clinical benchmarks were published by various institutions and bodies such as Cleveland Clinic, Mayo Clinic, and National Healthcare Safety Network (NHSN), among others. Hospitals were grouped according to their bed strengths, locations, services offered, and so on. Group A hospitals had to report 25 parameters- 23 were common parameters, while two were location-specific. Group B and Group C hospitals had to report 15 and 10 parameters, respectively, out of which two were location-specific. [emailprotected] was an internally developed clinical scorecard, created by drawing upon the wealth of expertise available within Apollo. An audit committee at the corporate level was set up to validate the data, methodology, and definitions followed at each location. According to Sangita Reddy, Executive Director, Apollo Hospitals Group: We needed a yardstick like [emailprotected] that would pit us against international institutes like Cleveland Clinic, Mayo Clinic, and others, and position us on the global healthcare firmament for excellence in clinical quality. This also enables us to assess where we stand and where we need to 11 be, while pursuing excellence in clinical quality. Apart from this internal benchmarking exercise, seven of Apollo’s hospitals were accredited by the Joint Commission International (JCI); and it was the largest group in South Asia to be accredited by the JCI. The JCI was a U. S. -based accreditation body dedicated to improving healthcare quality and safety around the world and recognized as the gold standard for hospitals. Apollo was also accorded the Superbrand status by the Indian Consumer Superbrands Council, which recognised that the best practices were used in the brand. Apollo was the 12 only hospital that was accorded the Superbrand status in India. There were other accreditations that several Apollo hospitals had achieved (Exhibit 2). According to Dr. Panyala, Living the brand should be our focus in every initiative or activity we perform. Apollo Hospitals has been one of the consistent names among the Superbrands. The perceived value of a brand like Apollo Hospitals is set very high in the backdrop of the decades of service and excellence it has offered. Clients need to see and experience that value, and the gap between perceived value and obtained value must be zero at best or at a bare minimum. PATIENTS’ FEEDBACK AND REAL-TIME ACTION On average, a patient spends 80% of the time in hospital for the care part rather than the cure, and we need to focus on care to ensure speedy recovery and maximum satisfaction. Hospitality is critical in healthcare as the patient and his/her attendants are already distraught and highly anxious. Hospitality is driven mainly by human interventions- in nursing, housekeeping, as well as food and beverages. It is very difficult to ensure consistency of quality and hence, we want to benchmark these to ensure we provide the best quality of hospitality all the time. –Dr. Ananth Rao, Head–Quality Department, Apollo Hospital, Bangalore (December 2012) Dr. Rao believed that although clinical services formed the core of Apollo’s services and brand image, hospitality would support the brand, and in the long run, both would merge to form the Apollo brand (as shown in Exhibit 3). All services that did not require core clinical expertise were classified as hospitality services, including services such as billing, dietician service, food beverages, facility, housekeeping, nursing, facility, and overall operations. Each service was executed through a variety of processes. All the processes included in each service were identified and defined with regard to the procedure, timelines, required output, and so on. All the processes were mapped and the quality measures defined; these would be used as Sigma metrics. 11 12 Express Healthcare, (2010), http://healthcare. financialexpress. com/201009/strategy01. shtml Source: http://kolkata. apollohospitals. com/newsroom/271-apollo-hospitals-only-healthcare-super-brand-in-india. html This document is authorized for use only by NIKITA VAIDYA in Nutrition 346 taught by Carol Blindauer, at Dominican University Illinois from January 2015 to May 2015. For the exclusive use of N. VAIDYA, 2015. Apollo Hospitals: Differentiation through Hospitality Page 4 of 20 The Quality Department, established under the leadership of Dr. Rao, comprised two dedicated staff- Soumi Dutta and Nisha Maria- who looked after a variety of quality-related issues. Soumi and Nisha collected feedback from the patients between March 2011 and December 2012using the form presented in Exhibit 4. Patients were asked to rate each department on a scale of 1 to 10. Additionally, open-ended feedback such as patients’ comments, opinions, or suggestions was also collected. A schedule was developed for collecting feedback, which ensured that Soumi and Nisha collected feedback from a cross-section of patients; this also ensured that no biases crept into the feedback. The feedback collection methodology is shown in Exhibit 5. Soumi and Nisha were trained to collect frank, free-flowing feedback from the patients. If they received complaints while collecting feedback, they would immediately inform the department concerned and get the errors rectified, whenever possible; or ensure that the complaints were addressed to the patient’s satisfaction in real time. One of them recollected the following anecdote: A patient had complained that the door was not getting locked properly. I got in touch with the facility personnel and they worked on the door and the lock and fixed the problem- all in a matter of 25 minutes from the moment it was brought to my attention. The patient was satisfied with the immediate solution. However, we did not stop there. We teamed up with the facility team and checked every door of the hospital and repaired them if required. We wanted to ensure that such complaints were not repeated. The feedback collection process served multiple objectives such as collecting open-ended feedback from patients, resolving the issues in real time, and further auditing the actions of the service departments. The real-time escalation flowchart is shown in Exhibit 6. The feedback was saved on an MS Excel spread sheet, and stored on a monthly basis for easy retrieval. The data was then analyzed using various parameters and trends were plotted for each service. At Apollo, each service was related to a department; hence, it was easier to deal with the complaints and determine monthly improvements. FEEDBACK ANALYSIS From March 2011 to December 2012, 1,434 complaints were received from among the 1,38,600 in-patients treated during that period (approximately 1. 03%). A Pareto chart was plotted for these complaints (as shown in Exhibit 7). The housekeeping department received the maximum number of complaints, while the dietary service had the least number of complaints. The department-wise spread of complaints is shown in Exhibit 7. Some of the complaints were genuine concerns while some were related to minor discomfort. A few of the complaints were very specific, while some were generic. All of these were analyzed, which would enable the hospital to work towards reducing the overall number of complaints. Some of the sample complaints from each department are provided in Exhibit 8. According to Dr. Rao, Every complaint is an opportunity to improve. We keep looking for the smallest of the complaints, which will help us in improving our quality by several levels. Sometimes it is difficult to interpret the complaints and it is even more complex to develop strategies that will enable a better patient experience. The complete data set was analyzed to determine the word frequency count in the complaints section. The significant words with their frequencies are shown in Exhibit 9. This analysis was used to focus on specific tasks to ensure reduction in the number of complaints. For example, the most significant word was â€Å"time† and it was associated with delays in response time for the various services. The twenty-fourth most frequent word was â€Å"late,† which is again related to response time. Thus, the word frequency technique helped in focusing on problem areas. Based on the results of the analysis, benchmarks were set in consultation with the respective department for the response time of each service as shown in Exhibit 10. Apart from this quantitative analysis, another approach was used to analyze the feedback and obtain deeper insights for quality improvements. Dr. Rao used the term â€Å"defect-defective† from the Six Sigma methodology- one â€Å"defective† product/service could be caused by one or several â€Å"defects†. According to Dr. Rao, This document is authorized for use only by NIKITA VAIDYA in Nutrition 346 taught by Carol Blindauer, at Dominican University Illinois from January 2015 to May 2015. For the exclusive use of N. VAIDYA, 2015. Apollo Hospitals: Differentiation through Hospitality. Page 5 of 20 Any complaint from a patient is considered as a ‘‘defective’’. For example, consider the complaint: ‘‘Food is not served on time’’. This complaint may arise due to several reasons such as food not being prepared in time, food not being delivered on time, patient changing his/her order, etc. It is essential to identify these defects in order to eliminate the defective. On receiving a complaint from the patient, which was termed as â€Å"defective,† defects that led to the defective (complaint) were identified. Root-cause analysis was performed on all the processes of the identified defects. The processes were re-engineered to eliminate all the defects and a pilot study was conducted using the â€Å"Define Measure Analyse Improve Control† (DMAIC) cycle. Once the process was found acceptable, it was then deployed across locations. This was followed by routine and surprise audits to ensure that the process was being followed as defined to ensure customer satisfaction. The flowchart is shown in Exhibit 11a and b. All feedback related to medical services was escalated to the Medical Director’s office. In addition to this, the Quality Department at Apollo Bangalore developed a methodology called the Daily Point Average © or DPA ©. The ratings provided by patients for different departments were used to calculate the DPA ©. The departments had to improve these ratings over a period of time. The DPA © effectively captured the â€Å"mind of the customers† since the feedback was collected during the patients’ stay and not at the time of discharge. BENCHMARKING OF HOSPITALITY Hospitality required high human involvement and was very specific not only to local cultures but also to each individual. Since a patient had to stay in a hospital to get cured, hospitality automatically came into the picture. Hospitality in various hospitals was very different owing to the surroundings and differences in customer (patient) requirements. Patients did not walk into a hospital out of volition- they came in only because there was some problem. Under such conditions, the patient would be very agitated and any small thing that was out of place would become a big issue. Any kind of delay would be extremely intolerable and all the services had to be perfect all the time. Even in the hotel industry, hospitality was not standardized and benchmarks were not available. The Ritz–Carlton hotels, which are considered the gold standard in the hospitality industry, had used Six Sigma and benchmarking for their hospitality business. 13 Although benchmarks for clinical services were well-established, those for hospitality in hospitals were yet to be established. Apollo Bangalore developed benchmarks for several common complaints with three levels of services (as shown in Exhibit 10) by adopting the Kano model, which was developed by Noriaki Kano (Exhibit 12). This model was used across service industries and it helped in understanding customer expectations from any product or service. The threshold or the basic quality was the minimum requirement of the customer, which would be taken for granted even if it were present; however, if it were not there, the customer would complain about its absence. Normal or performance quality was something that the customer would expect because these were stated either by the product/service provider or by the customer as a requirement. This quality was observed by the customer and its absence would cause discomfort and disappointment. Exciting quality of the service or product was something that would not disappoint the customer; the presence of this would delight the customer, since the customer did not expect this quality. With time, the exciting quality would become performance quality and the performance quality would become a basic quality. Hence, the manufacturer or the service provider should always strive to provide new exciting qualities. Accordingly, several metrics were defined for benchmarking. For example, patients were informed that routine hospital-provided meals would be served within 10 to 20 minutes of every mealtime. This became a performance attribute. The threshold requirement of the patient would be that meals should be served within 20 minutes after placing the order. If the meal was served within 10 minutes, the patient would be delighted. However, if this customer (patient) were to come to the hospital again, she/he would expect the meal to be delivered within 10 minutes; this then would become a performance quality for her/him. 13 Source: qfdi. org/newsletters/six_sigma_qfd_hotel_application. html This document is authorized for use only by NIKITA VAIDYA in Nutrition 346 taught by Carol Blindauer, at Dominican University Illinois from January 2015 to May 2015. For the exclusive use of N. VAIDYA, 2015. Apollo Hospitals: Differentiation through Hospitality Page 6 of 20 FINANCIAL IMPLICATIONS The Quality Department required funding for data collection, analysis, and other related activities. These expenses affected the bottom line of the hospital. However, from March 2011 to December 2012, the number of re-visits increased, which implied that customer loyalty had increased. There was a 15% increase in the number of inpatients. Earlier, high discounts had been offered to dissatisfied patients owing to errors in service or poor quality of service. Gradually, there was a reduction in the discounts provided, which was a direct result of better satisfied patients. Additionally, owing to better processes, cost of quality (in terms of re-work and consumable wastage) had reduced, which helped in improving the bottom line. Further, owing to better service and higher levels of satisfaction, the patients acted as brand ambassadors for Apollo and provided word-of-mouth publicity, which improved the top line. Another example of decreased turnaround time and a resultant increase in profitability was seen in the Biochemistry Lab at the Apollo Bangalore Hospital. Dr. Rao headed this lab and he understood the patients’ requirement of receiving diagnostics reports in two hours instead of three. Dr. Rao and his team redesigned the process using 5S and lean concepts and managed to reach a turnaround time of two hours. Profits from the Biochemistry Lab nearly doubled after the decrease in turnaround time; while the cost of consumables increased by only 11%. Even though the Apollo team was trying to improve customer satisfaction, it still faced the question of how much satisfaction could be actually provided to the customer considering the room tariffs that were charged. As seen from Exhibit 13, the charges at the Apollo Bangalore Hospital ranged from USD 25 for a basic room to USD 120 for the Platinum Suite. A Ritz–Carlton basic room would cost USD 799 at Washington, U. S. A. and USD 165 at Kuala Lumpur, Malaysia (per person, per night). 14 The Apollo team might be able to provide high quality hospitality to patients in the Platinum Suites. However, the aspiration to provide the same service to patients in other rooms might not be financially feasible. The team was trying to build high levels of service for the Platinum Suites. However, the volumes in the other rooms were too high to be ignored, especially in the Indian context. Additionally, customer loyalty was extremely important to Apollo; in Dr. Panyala’s words, Customer loyalty and not mere retention is what we need to focus on. It is important to think ahead of the customer to identify issues that may compromise the experience. QUANTIFYING HOSPITALITY ACROSS APOLLO According to Dr. Rao, Once, we develop the benchmarks and the Sigma metrics, we want to replicate the system across all Apollo hospitals in the country. Each hospital will have to devise its own benchmark and Sigma metrics. However, we want to provide a framework for developing these and then measuring the outcomes. All the hospitals would then be compared by equalisation of scores and would benefit from one another’s learning†. After collecting the feedback and attempting to set benchmarks, Dr. Rao knew that he needed to go deeper and analyze each service through the complaints, set up relevant benchmarks, and target certain Sigma levels for each benchmark. He wondered whether they could collect and analyze data in a better manner. He wanted to arrive at the basis for the cost-benefit analysis of this activity. Looking at the complaints and the analysis, Dr. Rao had two major questions on his mind: 1. 2. 14 What strategy should be used to reduce the number of complaints and sustain the culture of excellence at Apollo Hospitals, Bangalore under the leadership of Dr. Panyala? Given the manual intensive processes involved in addressing the hospitality issues, what is a good Sigma level? Could Apollo set a target for Sigma level in hospitality? Source: www. ritzcarlton. com, accessed on April 15, 2013. This document is authorized for use only by NIKITA VAIDYA in Nutrition 346 taught by Carol Blindauer, at Dominican University Illinois from January 2015 to May 2015. For the exclusive use of N. VAIDYA, 2015. Apollo Hospitals: Differentiation through Hospitality Page 7 of 20 Exhibit 1 [emailprotected] parameters Sl. Parameter No. 1 Coronary artery bypass grafting (CABG) mortality rate. 2 Complication rate post coronary intervention(percutaneous transluminal coronary angioplasty; PTCA) 3 Average length of stay (ALOS) post angioplasty 4 Average length of stay (ALOS) post total hip replacement (THR) 5 Average length of stay (ALOS) post total knee replacement (TKR) 6 Complication rate for total knee replacement (TKR) 7 Average length of stay (ALOS) post renal transplant 8 Average turnaround per dialysis chair per day 9 Average length of stay (ALOS) post transurethral resection of the prostate(TURP) 10 Complication rate transurethral resection of the prostate(TURP) 11 Endoscopy complication rate. 12 Patient satisfaction with pain management 13 Door to thrombolysis time in ischemic stroke in emergency room (ER) 14 Percentage conversion of coronary angiographies to coronary artery bypass grafting (CABG) 15 Catheter-related blood stream infection (CR-BSI) 16 Ventilator associated pneumonia (VAP) 17 Catheter-related urinary tract infection (CR-UTI) 18 Average length of stay (ALOS) in hospital 19 Average length of stay (ALOS) in intensive care unit (ICU) 20 Door to CT time in stroke cases in emergency room (ER) 21 Surgical site infection (SSI – Clean wound) 22 Medication errors. 23 Average length of stay (ALOS) post modified radical mastectomy (MRM) 24 Average length of stay (ALOS) post microdisectomy 25 Average urea reduction ratio* 26 Percentage of patients achieving/maintaining haemoglobin level of 11gram or higher after 3 months of dialysis in end stage renal disease (ESRD) *Optional This document is authorized for use only by NIKITA VAIDYA in Nutrition 346 taught by Carol Blindauer, at Dominican University Illinois from January 2015 to May 2015. For the exclusive use of N. VAIDYA, 2015. Apollo Hospitals: Differentiation through Hospitality. Page 8 of 20 Exhibit 2 Accreditation of Apollo Hospitals Accreditation Joint Commission International (JCI) Delhi, Apollo Hospital Location Chennai, Hyderabad, Ludhiana, Bangalore, Kolkata, Dhaka National Accreditation Board for Hospitals Madurai, Chennai Healthcare Providers (NABH) National Accreditation Board for Laboratories (NABL) Chennai ISO 9002 Chennai Source: Apollo Investor Presentation (retrieved from www. apollohospitals. com in January 2013) Exhibit 3 Apollo Brand–Clinical and Hospitality Services Core Clinical Services Hospitality Source: Interview with Dr. Ananth Rao. This document is authorized for use only by NIKITA VAIDYA in Nutrition 346 taught by Carol Blindauer, at Dominican University Illinois from January 2015 to May 2015. For the exclusive use of N. VAIDYA, 2015. Apollo Hospitals: Differentiation through Hospitality Page 9 of 20 Exhibit 4 Feedback Form YOUR FEEDBACK Thank you for choosing Apollo Hospitals for your healthcare needs. As a quality improvement initiative, we are looking for improvements in parameters towards ‘‘Service Excellence’’ of our hospital. Please provide a few minutes of your valuable time for a personal interaction. How satisfied are you with your experience and the services provided by our hospital on a scale of 1 to 10? 1. MEDICAL SERVICES 1 2 3 4 5 6 Poor 2. NURSING SERVICES 1 2 3 7 8 Good 4 5 6 3. OPERATIONS ADMINISTRATION 1 2 3 8 5 6 7 1 2 3 1 2 4 3 5 6 7 1 2 3 10 Excellent 8 9 10 Good 4 5 6 Poor 6. FACILITY MAINTENANCE 9 Good Poor 5. HOUSEKEEPING SERVICES 10 Excellent 8 Poor 4. FOOD BEVERAGES 9 Good 4 7 Excellent 8 9 Good 4 Poor 5 6 10 Excellent 7 Poor 9 7 10 Excellent 8 Good 9 10 Excellent COMMENTS (OVERALL): Patient Name (Optional): UHID: Date of Admission: Room No: Signature: Date: This document is authorized for use only by NIKITA VAIDYA in Nutrition 346 taught by Carol Blindauer, at Dominican University Illinois from January 2015 to May 2015. For the exclusive use of N. VAIDYA, 2015. Apollo Hospitals: Differentiation through Hospitality Page 10 of 20 Exhibit 5 Feedback collection methodology A Typical Process Map: DPA Daily Data Collection Method 1:00pm–2:30pm Data consolidated; DPA Score developed* 11:00am–1:00pm Survey conducted Point of Data Colle ction Score given to IT Dept. disseminated to individual stakeholders via.