REVIEW THIESIS Essay Example | Topics and Well Written Essays - 3250 words

REVIEW THIESIS - Essay Example Additionally, the study also discusses past research findings pertaining to the connection between education and creativity, particularly on how it contributed to success in business education. Moreover, the study will discuss the role of creativity in real life situations and the challenges of incorporating creativity within education with special emphasis on the business sector (Fasko, 2001, p.321). The twenty-first century is an age of globalization, telecommunication and digitalization of various forms of technologies. Therefore, this rapidly changing world demands people to multi-task and have the relevant skills in order to adapt. People need to have the ability to be flexible and process information quickly and efficiently. To succeed in the twenty-first century workforce, it is important for an individual to have certain skills: for example, problems, solving, goal setting and creative thinking skills. According to Jeffrey and Woods (2003, p. 122), an education system can develop these skills by raising and encouraging creativity among students. Education can encourage flexibility, innovation and positive creative thinking among students. Unfortunately, the education system in most institutions also contributes to avoidance of creativity among students. Despite the importance of formal education in the lives of people, most educational systems are failing to recognize the importance of developing creativity among the students. As Shaheen and Robinson (2010) argue, the education system is limiting the extent to which students can discover their creative potential. This is because creativity is not the main objective of the learning and assessment process in education. Most educational systems put more emphasis on the importance of meeting the objectives and goals of the school program but fail to address the importance of creativity among the

Literacy Essay Example | Topics and Well Written Essays - 1250 words

Literacy - Essay Example Through learning of vowels a kid is able to learn the different sounds and later how to make a syllable. Syllables are the basic units of words which are further joined with helping words to make a meaningful word or a sentence. Every literate person learned how to write or read through some formal or informal education. Informal institutions like the kindergartens and baby cares play a big part in the society regarding this matter (Holbek 7). At this period am proud to say my parents played a major role in what I am today. In class I never understood how to pronounce some vowels, finish my homework and majorly how to write my name. The latter, on many occasions made me skip writing my name on writing books or the quizzes we were frequently given. Pronunciation was a big burden in my kindergarten life, especially words that had two or three syllables (Kozol 194). Each day after school, my parents used to teach me these problems countless times before I slept, which was kind of a torture for me at some point. At times when I was stubborn, I was occasionally punished through spanking and some grounding. Through the frequent teachings and memorizations, I learned how to write my name and even learned some pronunciations beyond my level. Pronunciations and writing of my name is one practice that I believe would never end any time soon, because I still use them up to now (Kozol 199). Apart from the basic learning of writing and pronunciations, the kids are also given time to play.

Summary The Health Care Quality Book Essay Example for Free

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

Security Threats In Cloud Computing

Security Threats In Cloud Computing What is cloud computing? To explain Cloud computing in simple words, lets just say it is Internet computing, if we observe closely the internet is basically the collection of cloud; thus, the cloud computing word can be elaborated as using the internet, to its full potential, to provide organization and people, technology enabled oriented services. Cloud computing let consumers access, by the help of the internet, resources online from any corner of the world without the need to worry about physical/technical maintenance and management issues of the real original resources. What is cloud computing security? To keep it in simple words, cloud security actually points out to a broad set of rules/regulation or policies, maybe set of technologies, or controls deployed solely for the sake of, to protect application data, and the linked infrastructure of cloud computing from the malicious intruder. If all seems good how come security threat became an issue? The cloud computing technology is on the verge of peak. Its really a wonderful news for enterprises and organization who want to get things done with more quickness and easiness as compared to past times but one need to keep their vision open to the possibility of data hijack. The famous Company IBM lies on top of companies providing cloud security with many options in hand to reduce risk. The 9 biggest threats right now according to a report that was released, on 29 February, from the Cloud Security Alliance are: Security Breach in terms of data The companies providing cloud environment face more commonly the same threat i.e. traditional corporate, yet due to the huge amount of data stored on their private servers, they are more vulnerable to the eyes of hackers or intruders. The information being leaked from their servers or exposed becomes headline showing the drawback of the security area. Disaster occur when information such as trade secret, health information or intellectual property data are breached If such event occurs in which hacker or intruder outrun the security checks of cloud environment and data breach occur, then the organization providing the facility may end being washed up on the shore just like a broken ship because they may be filed or sued by the potential customers. To protect their environment, normally cloud owners, deploy security protocols in their services field but in the cloud organizations are responsible for protecting their own data Broken authentication Compromised credentials The most common reasons for data breach are weak passwords, poor key lax authentication or certificate management. Companies often strive with identity management, as they try to give or deny permissions as defined to the users job role. More important, keeping in view, they sometimes dont or forget to remove access of user when a job function changes or when a user leaves the environment of organization. The ways of multifactor authentication systems such as phone-based authentication, one-time passwords smartcards tends to protect cloud services because this make it quite harder for attackers, hacker to log or go in to access with stolen passwords. Many developers dont realize the danger of embedding credentials in source code and make such mistake and upload the source code on famous site where source code is easily accessible such as GitHub and bit bucket. APIs Hacked interfaces Normally every cloud application and service now gives APIs access to its users. IT teams use APIs and interfaces to organize and connect with cloud pool, including those that offer cloud management, provisioning, monitoring, and orchestration. The availability and security of cloud services from authentication to encryption and access control and activity monitoring depend on the security level of that particular API. Risk level increases with commonly third parties that tends to rely on APIs and build an infrastructure on these interfaces, as organizations may feel the need to expose or portray more credentials or service, the CSA warned. Weak APIs and interfaces expose company to security concerns related to integrity, confidentiality, accountability, and availability. APIs and interfaces are the most exposed and weak part of a system because theyre usually accessible and easily gained access from the open Internet. Misuse system vulnerabilities Exploitable bugs, or system vulnerabilities in application and programs, are not new, but theyve become rapidly a huge problem with the inclusion of multitenancy in cloud computing services. Organizations handshake databases, memory and other resources in close range to one another, giving chance to new possible attack surfaces. Hijacking of Account Software exploits, fraud and phishing are still the most successful way for intruders for back door gain access. Above all that, cloud services add a whole new level of dimension to the possibilities of threat because hackers can eavesdrop on various activities, modify data and manipulate transactions. Not only that, hackers may also use cloud application for their advantage to launch various other attacks. Cloud service provider should prohibit user from sharing of account security credentials between services and users Malicious insiders The threat from inside has many faces: a former or current employee, a contractor, system administrator, business partner or a contractor. In a cloud system scenario, a malicious insider can destroy or burn the whole infrastructures to ground or manipulate system data. Systems that solely depend on the various cloud service provider for security implementation, such as data or key encryption, are at huge risk. The parasite Advantage persistent threat (APT) APTs normally and blend in normal traffic move through the network, so it becomes difficult to detect. The major cloud service providers make sure to apply advanced encryption techniques to prevent threat such as APTs from infiltrating or entering their building infrastructure. Common points of entering in the system include direct attacks, spear phishing, USB or pen drives loaded with malware injection, and third-party compromised software networks. Totally Permanent loss of data With the day to day enhancement and cloud services of getting matured, reports of permanent loss of data due to error from provider have vanished into thin air. But intruders or malicious hackers are famous to white wash cloud data just to harm businesses and bring the service provider to ground, and cloud data provider centers are at risk to natural disasters as any common facility. Cloud service providers advice or recommend their user to distribute their data and applications across various multiple layers of zones for much more added protection. Abuse of cloud service power The disaster that can occur from the misuse of cloud service power can never be mapped of any graph scale. It has the tendency to supportÂÂ   various criminal activities such as using the resources of cloud technology to break in to gain encryption key in order to launch various attack such as sending phishing email, messages or filling mailbox with spam mails, launching famous DDoS attack to shut down server or hosting malicious content.

Strengths and Weaknesses of Crime Statistics and Victimisation Surveys

Strengths and Weaknesses of Crime Statistics and Victimisation Surveys Rates of crime are recorded using two key sources; Police Recorded Crime (PRC) and Victimisation Surveys. Both will be explored and examined to see how they can, effectively assist policy makers in targeting areas for change. In addition the advantages and disadvantages of each method will be discussed along with their similarities and differences. To understand why it is important to record crime levels, three key notions must be clarified. Firstly, crime is legally defined as any act or omission outlawed by the criminal law and thus punishable (Odgers,1911). Secondly, the purpose of the judicial system is to enforce the law and protect victims of crime. Thirdly, criminal guilt relates to premeditated intention. Universal law is non-existent; therefore each country or locality has its own legal system. The shared aim is to hold person/s accountable for their behaviour. Substructures of the judiciary may focus on specific areas of interest. These may include the courts, and penal system and constabulary. The role of the courts and penal system is specific. It is in place to serve and protect the innocent, to pass judgement on the guilt or innocence of persons presented and to serve a proportionate punishment in response to the criminal act committed. Any form of justice served must remember the civil liberties of all concerned, including the offender. Crime prevention and law enforcement are a separate division provided by the constabulary. The term criminal guilt stems from two fundamental Latin principles. These are actus reus which translates as bad act and mens rea guilty mind. The accused must be found to have committed actus reus with the willing intention to perpetrate the act and/or to have assessed the risk i.e. accident or fear may be experienced as a direct result of the action (Dubber, Markus D. (2002). Few exceptions to being found guilty of one of these alone exist, these concern whether a person can be fully answerable for their actions. Examples of mens rea without actus reus can relate to crimes, where although the action is deemed illegal, the act may not have the deliberate intention to harm another. Examples of this could involve driving at excessive speed, an act of accidental manslaughter or self-defence. (law.jrank.org) Two comparable sources are used to measure crime rates within the UK. Police recorded crime measures the volume of notifiable offences committed over a fixed period, within the jurisdiction that the constabulary serves. Crime-related statistics are obtained at request of the British Home Office, where they are collated, analysed, and published throughout the year. The figures provide the government and the public with a summarised account of the information obtained. They aim to reveal and compare crime rates within specific localities. They are also used to demonstrate the effectiveness of policing. This information can be used to suggest areas for improvement and assist in the constant struggle to prevent crime occurring. The second method that is utilised, verifies the extent to which crime is perpetrated and is a valuable tool when combatting crime. Victimisation surveys; primarily recognised as the British Crime Survey (BCS) is a form of crime-related statistical research that was established in 1982. It was introduced in response for an alternative complementary system to exist alongside using police records alone. It aimed to gather intelligence on the public attitudes towards crime and their opinions relating to the judicial system. Although operationally independent from any government body, the BCS is still conducted for the British Home Office (First BCS report, Hough and Mayhew, 1983). The survey confidentially canvasses in the region of forty to fifty thousand individuals (Office for National Statistics, 2005) to uncover various information relating to crime-related experiences, including anti-social behaviour and police interaction and response to criminal activity. The people questioned span various demographics and aim to be representative of society. They are interviewed anonymously via door to door visits or telecommunications. Police recorded crime statistics are easy to conduct and provide a good measure of criminal cases both regionally and nationally. Because the statistics are compiled from police reports readily available, the only additional cost incurred involves the information being sent, analysed and evaluated. Over time re-occurring inclines and declines in illegal behaviour can be identified and used when analysing patterns of crime, in particular to risk assess, highlight and tackle crime hotspots. Crime statistics can also indicate the workload and performance level of police forces throughout the country.  [1]   An indication of a reduction in crime related incidents could boost public morale. If necessary the findings could influence change surrounding governing policy. For example, the allocation or re-allocation of specific resources within a police department could lead to a more efficient service. Identifying the need to place patrol officers where the greatest street crime occurs would be one way to maximise effectiveness of the police service. Unless a crime has been reported to the police and they have classified it as criminal it will not be included. This means that all minor misdemeanours that would be trialled as summary offences in court such as, crimes relating to anti social behaviour, assault, disorderly conduct and criminal trespass, along with most either-way offences for example theft and drug offences are excluded from being recorded  [2]  . This highlights one of the main failings of this form of data collection as it leads to discrepancies when analysing the results, especially when comparing between PRC and victimisation surveys. Data collection and recording of PRC statistics are affected by the regulations implemented by the current governing body  [3]  . The results uncovered may point to a rise in criminal acts being committed. This could have a negative impact on society. As a result the published findings could become biased and used as propaganda to mislead people into believing that crime rates are more favourable than factual. In some situations the volume of crime could be falsely recorded to meet performance and administrative targets (Chambliss, 2001). This is in direct contradiction of providing a good service to the public. British crime surveys are independent from government reports and not affected by changes in how crime is reported and documented. They play an important role in serving the public interest and governing change and policy. They provide a better indication relating to long-term trends of crime within society  [4]  , in particular highlighting crimes which affect different sociological groups. For example, crimes against women and those which affect minority groups such as the vulnerable, mentally ill, the disadvantaged and ethnic minorities. The BCS provides statistics which demonstrate the extent to which crime occurs. It accounts for minor offences, antisocial behaviour and victimless crime such as fraud. It also includes household and personal crime which may not be otherwise reported or deemed a criminal act  [5]  . The BCS is constantly changing to adapt to new concerns affecting society  [6]  . Recent expansion has seen the inclusion of acts committed against minors such as gadget theft which has seen a vast increase as technology advances; however this is only in the testing stage and is yet to be fully implemented. It has also seen the inclusion of crimes relating to identity theft  [7]  . The confidential method of surveying is flexible and can reach a wide proportion of people. Interviews conducted may take place at home, by visiting door to door or over the telephone. This can motivate people to openly speak their mind about their experiences and concerns. It may also lead to the discussion of topics of a sensitive nature for example, being the victim of racially incited or homophobic hate crimes, which they may not have wanted to report. This may be due to shame, embarrassment, a fear of repercussions or not being believed or taken seriously by the police service  [8]  . Over all the BCS appears to paint a broader picture of how a variety of crime-related issues really affect a range of varied people. Perhaps this is because they take the initiative and seek to learn more. Shortcomings surrounding this form of canvassing is that it is very costly to conduct, not only in man power but also time and resources. The effectiveness is questionable as the results gathered rely on a persons honesty and personal insight in to how they have been affected which may provide exaggerated responses or false information. The BCS also excludes the recording of commercial crimes and heinous crime such as murder. However, the Commercial Victimisation Survey and the Offending Crime and Justice Survey are both in place to ensure that crimes outside the boundaries of the BCS are still accounted for  [9]  . In summary, I have explored both methods used to research crime statistics and outlined the strengths and weaknesses of each. For example, The BCS relies on the respondents personal view of the effect of crime. PRC assumes that crime is always reported. Both methods are dependent on the classification of crime. Victimisation surveys fail to provide an accurate depiction of society. This is because surveys of this form assume that people interviewed can and will provide a reliable version of events. An effective source of information can not solely rely on the integrity and factual representation of those it surveys. Individual perception can vary hugely, and factors such as differences between living in a rural versus urban location and coming from differing socio-economic backgrounds can lead to ambiguous results. For example, certain groups of people may be targeted more or less than indicated. If these variables are not taken in to account then the measure of crime rates could be distorted and the overall findings in relation to the sample population unfounded. Overall it can be seen that both the BCS and PRC are adequate methods for collecting information. When trying to measure crime the most effective method is to examine BCS and PRC together as the results combined provide a more com prehensive picture of how crime really affects society.

Laudans Theory of Scientific Aims Essay -- Laudan Science Utopia Argu

Laudan's Theory of Scientific Aims I criticize Laudan's constraints on cognitive aims as presented in Science and Values. These constraints are axiological consistency and non-utopianism. I argue that (i) Laudan's prescription for non utopian aims is too restrictive because it excludes ideals and characterizes as irrational or non-rational numerous human contingencies. (ii) We aim to ideals because there is no cogent way to specify in advance what degree of deviation from an ideal is acceptable. Thus, one cannot dispense with ideals. (iii) Laudan does not distinguish difficult from impossible goals, making his injunction against utopianism imprecise. It is "semantically utopian" and, furthermore, a prescription for conservatism and mediocrity. (iv) Goals often contradict each other or are at least partially incompatible. Since Laudan does not say how to prioritize incompatible aims, axiological consistency is an utopian desideratum. Thus, his constraints on cognitive aims contradict one another. Finally, (v), Laudan's axiological constraints are too weak and in order to strengthen them, he must invoke without justification some implicit pre-philosophical cognitive aims. This opens the logical possibility of axiological relativism, which Laudan attempted from the beginning to avoid. Laudan's Theory of Aims In Science and Values, Laudan has developed the view that our scientific aims can sometimes be rationally selected by imposing two constraints (1) on them: 1. they should be jointly consistent, 2. a pragmatic constraint of empirical realizability, or non-utopianism. This last requisite follows from Laudan`s means-ends conception of rationality, To adopt a goal with the feature that we can conceive of no actions... ...victory, one obtained by just means, i.e., the means employed should not constitute a greater evil than the evil the war was intended to remedy. (13) Since some axiological inconsistencies can be only pragmatic, it is not always clear whether some collection of ideals is mutually inconsistent. (14) Cf., N. Rescher, The Strife of Systems, chapters 7 & 8. (15) When this happens, our passionate nature will decide what our intellect cannot adequately settle. (16) Laudancs meta-aim of axiological consistency is a goal suspect of being 'demonstrably utopian', because it is not likely that we will ever have a theory of rational value priorizations. So it is not reasonable by Laudan's meta-methodology own standards. If so, Laudan's theory would be suspect of being self-referentially inconsistent. (17) Cf., Laudan, 1996, Beyond Positivism and Relativism, p. 16

Are tall buildings necessary for London to remain a competitive world c

Are tall buildings necessary for London to remain a competitive world city? On February 10, 2004 mayor of London Ken Livingstone introduced the London Plan, the first proactive strategy in over thirty years to deal specifically with the planning and development of London. Since an increase in London's population by 800,000 is expected by the year 2020 , the mayor has suggested the construction of high-rise buildings as the method most likely to enable London to grow in a controlled and steady manner and maintain its status as a world city. A key part of the plan, the mayor's proposal for high-density towers throughout the city, has heightened the debate between urban planners and heritage groups as to whether the construction of tall office and housing complexes is necessary and/or appropriate for London. Based on recent documents, articles and essays and London's need to remain competitive with New York and Tokyo as a world class city, the construction of tall buildings in London is a necessity, especially due to certain factors such as the need to preserve historic views, the lack of available space and London's poor transport system. The ongoing debate over whether tall buildings would best serve London and sustain and enhance its status as a world-class city has dominated the political and metropolitan structural-design arenas during the last ten years. On one side are heritage groups and conservationists claiming that an increase in the number of tall buildings would block strategic views of London's historically significant landmarks. For example, the organization English Heritage has stated that the tall buildings are a cultural issue and their role is first and foremost of image and aesthetics rather than economic,... ...22, 16 February 2004 Government of London, 'London's skyline, views and high buildings,' Planners and Development Economists http://www.london.gov.uk 16 February 2004 Government of London, 'The London Plan.' Ken Livingstone. http://www.london.gov.uk 17 February 2004 Hamnett, 'The transformation of London's occupational structure and the rise of the new middle class,' Unequal City. (Routledge) pp. 70 Livingstone, Ken. 'The only way is up,' The Independent. 2 November 2002. London School of Economics, 'London should grow up says new report on tall buildings' http://www.lse.ac.uk/collections/pressAndInformationOffice/newsAndEvents/ archives/2000-2002/Tall_Buildings.htm 13 February 2004 Newman, P, Thornley, A. 'Fragmentation and centralization: Influencing the urban policy agenda in London' Urban Studies 34. The Editors of Urban Studies: 2997. pp 981