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

Research Methodology In Management Decisions Management Essay

Research Methodology In Management Decisions Management Essay Abstract Inline with planning and development, the quality and content of the supporting research is of great importance. It is therefore very necessary to design and adhere to an appropriate research methodology. The research methodology differs from one problem to another, but the basic approach remains the same. The objective of this assignment is to familiarize the art of using different research methods and techniques. This outline will assist in the accomplishment of exploratory, as well as result-oriented research studies. The following are the considerations which will be covered within the preview of research methodology. Objective of Business Research, Types of Research, and Types of Research Approach, Benefits, Business Research Requirements and Problems, Contents of a Research Plan, Features of a Business Research Report. Introduction and Needs: Introduction to Business Research In the present fast track business environment marked by cutthroat competition, many organizations rely on business research to gain a competitive advantage and greater market share. Business Research will be the pursuit of the truth with the observation of study, an comparison and experiment. The knowledge can be searched through objectives and systematic methods of finding solution to the entire problem. Discover answers to questions through the application of scientific procedures. To gain familiarity with a phenomenon. Research comprises the following: Defining and redefining problems. An art of formal training which enables one to understand the new developments in ones field in a better way. Search for knowledge, scientific and systematic search for pertinent information on a specific topic, an art of scientific investigation. Careful investigation or inquiry especially through search for new facts in any branch of knowledge. Systematized effort to gain new knowledge. An original contribution to the existing stock of knowledge making for its advancement. The Business Research Problem 1. The lack of a scientific training in the methodology of research 2. Most of the business units do not have the confidenceThat the material supplied by them to researchers will not be misused. They are often reluctant in supplying the needed information to researchers. The concept of secrecy seems to be sacrosanct to business organizations. 3. Research to many researchers is mostly a scissor and paste job without any insight shed on the collated materials. Due to this the research results, quite often, do not reflect the reality or realities. My Idea There is a need for generating the confidence that the information/data obtained from a business unit will not be misused. Good research is structured systematically with specified steps and sequence to be taken in accordance with the well defined set of all rules. Care should be taken that the systematic characteristic of the research work does not rule out our creative thinking but it certainly does not reject the use of guessing intuition in arriving at conclusions. Good research is empirical as it is related to basically one or more aspects of the real situation and deals with concrete data that provides a basis for all external validity to have a research results. Good research is replicable as it allows research results to be verified by expert in replicating the study for building a sound basis for decision. 1. Objective of Business Research To determine the frequency with which something occurs or with which it is associated with something else and to test a hypothesis of a causal relationship between variables. To understand the market trends, or find the optimal marketing mix, devise effective HR Policies, or find the best investment options. 2. Types of Research 2.1 Application of Descriptive Research For descriptive studied in which the researcher seeks to measure items such as, frequency of shopping, preferences of people etc. Method of research utilized are, Survey methods of all kinds, Comparative methods and Co-relational methods 2.2 Analytical Research The researcher has to use facts of information already available. The researcher has to analyze facts to make a critical evaluation of the material. 2.3 Applied Research Its main purpose is to find a solution for an immediate problem facing by a society or an industrial business organisation and to discover a solution for some pressing practical problems. For example, Research studied concerning human behavior must be carried on with a view to make generalizations about human behavior. Research aimed at certain conclusions facing a concrete social or business problem. 2.4 Fundamental Research It concerned with generalization and with the formulation of a theory. For example, Research concerning some natural phenomenon, Research relating to pure mathematics. 2.5 Quantitative Research Based on the measurement of quantity or amount. It is applicable to phenomena that can be expressed in terms of quantity. It concerned with qualitative phenomenon and phenomena relating to or involving quality or kind. 2.6 Attitude or opinion research It is a qualitative research designed to find out how people feel or what they think about a particular subject or institution 2.7 Qualitative Research It has importance in the behavioral sciences. Its aim is to discover the underlying motives of human behavior. It analyzes the various factors which motivate people to behave in a particular manner or which make people like or dislike a particular thing. 3. Types of Research Approach 3.1 Quantitative Approach It involves the generation of data in quantitative form, which can be subjected to rigorous quantitative analysis in a formal and rigid fashion. 3.2 Experimental approach Greater control over the research environment and some variables are manipulated to observe their effect on to other variables. 3.3 Qualitative Approach It is concerned with subjective assessment of attitudes, opinions and behavior. Techniques used are Focus group interviews, Projective techniques and Depth interviews. 4. Benefits of Business Research 4.1 Benefits in business and Industry Research provides the basis for nearly all government policies in our economic system the plight of cultivators, the problems of distribution, size and nature of defense services etc. It collects information on the economic and social structure of the nation; which indicates what is happening in the economy and what changes are taking place. Research has its special significance in solving various operational and planning problems of business and industry. 4.2 Benefits for professions, philosophers and thinkers Its responsibility as a science is to develop a body of principles that make possible the understanding and prediction of the whole range of human interactions. Because of its social orientation, it is increasingly being looked to for practical guidance in solving immediate problems of human relations. 5. Contents of Research Plan 5.1 Layout of the Report Anybody, who is reading the research report, must necessarily be conveyed enough information about the study so that he or she can place it in its general scientific context; judge the adequacy of its methods and thus form an opinion of how seriously the findings are to be taken. Following are some suggestions, though styles may differ. 5.2 Preliminary Pages In its preliminary pages the report should carry a title and date, and put acknowledgements at the end in the form of Preface or Foreword. Then, a table of contents, list of tables and illustrations so that anybody can easily locate the required information in the report. 5.3 Main Text This provides the complete and detailed outline of the research report. The title of the research study is repeated at the top of the first page of the main text and then follows the other details on pages numbered consecutively, beginning with the second page. The main texts have the following sections. a. Introduction findings b. The result c. The implications drawn from the result and d. The summary. The main body of the report should be presented in logical sequence and broken-down into readily identifiable sections. The key findings are concisely presented in the executive summary running into 100-200 words or a maximum of two pages. The major thrust should be on highlighting the objectives, salient features, and analysis of the results including the recommendations 5.3.1 Introduction It includes Clear statement of the objectives of research. A brief summary of other relevant research so that the present study can be seen in that context. The hypotheses of study Definitions of concepts The methodology adopted The statistical analysis adopted The scope of the study and The various limitations should be mentioned. 5.3.2 Results It includes a. The main body of the report b. Statistical summaries All relevant results must find a place in the report and must be presented in logical sequence and split into readily identifiable sections. 5.3.3 Implications of the results It includes a. A statement of the inferences drawn from the present study which may be expected to apply in similar circumstances. b. The condition of the present study which may limit the extent of legitimate generalizations of the inferences drawn from the study. c. The relevant questions that still remain unanswered or new questions raised by the study along with suggestion for the kind of research that would provide answers for them. 5.3.4 Summary It has become customary to conclude the research report with a brief summary, describing in brief the research problem, the methodology, the findings and conclusions drawn from the research results. 5.4 End Matter At the end, appendices should be enlisted such as questionnaires, sample information, mathematical derivations etc in respect of all technical data . Bibliography of sources consulted should be given and index should invariably be given at the end of the report. The value of index is the fact that lies in the works as a guide to the reader for the contents of all the report. 6. Criteria of Good Business Research 1. Purpose should be clearly defined and common concepts be used. Statements should be short and direct. 2. Underlining relevant parts for better emphasis 3. Pictures and graphs accompanying tables. 4. Graphics and animations accompanying the presentation of the report. 5. Procedure should be described in sufficient detail to permit another researcher to repeat the research for further advancement, keeping the continuity of what has already been attained. 7. Features of a Business Research Report 7.1 Problem Definition A problem is any situation which requires further investigations. Decisions made on the judgments may not always turn out to be correct, but the problem may not be important enough to justify substantial time, money and effort to be spent on solving. It is correctly said that a problem well defined is half solved. Clear, precise, to the point statement of the problem itself provides clues for the solution .On the other hand a vague, general, or inaccurate statement of the problem only confuses the researcher and can lead to wrong problem being researched and useless results generated. 7.2 Research Objectives Address the purpose of the project. The basic purpose of research is to facilitate the decision making process. Every research follows a set of well-planned objectives. The general and specific objectives should be stated. These can be adjusted for sequencing without changing their basic nature. The research objectives can take the form of questions and statements. 7.3 Background Material à ¢Ã¢â€š ¬Ã‚ ¢ Include a review of the previous research or descriptions of conditions that caused the project to be authorized. à ¢Ã¢â€š ¬Ã‚ ¢ It may entail preliminary results from an experience survey or secondary data from various sources. à ¢Ã¢â€š ¬Ã‚ ¢ The references from secondary data, definitions and assumptions are included. 7.4 Methodology 1. Sampling Design 2. Research Design 3. Data Collection 4. Data analysis 5. Limitations 6. Findings 7. Conclusions 8. Recommendations 9. Appendices 10. Bibliography 7.4.1 Sampling Design Here Researcher defines the target population and the sampling methods put to use. It contains other necessary information such as: 1. Types of sampling (probability or non-probability) used 2. Types of probability sampling (Simple random or complex random) or non-probability sampling (quota sampling or snowball sampling) used. 3. The factors influenced the determination of sample size and selection of the sampling elements. 4. The levels of confidence and the margin of acceptable error. 7.4.2 Research Design Should be carefully planned to yield results that are as objective as possible. It should contain information on: Nature of research design Design of questionnaires Questionnaire development and pre-testing Data that was gathered Sources (both primary and secondary) from which data was collected Scales and instruments used Designs of sampling, coding and method of data input. Strength and weaknesses Copies of materials used and the technical details could be placed in the appendix. 7.4.3 Data Collection The collection of primary data for business research is of paramount importance to assist management in making decision. Generally, information regarding a large number of characteristics is necessary to analyze any problem pertaining to management. The collection of primary data requires a great deal of deliberation and expertise. 7.4.4 Data Analysis Provides information on the different methods used to analyze the data. It should justify the choice of the methods based on assumptions. It should be sufficiently adequate to reveal its significance and the methods of analysis used should be appropriate. The validity and reliability of the data should be checked carefully. It provides details on: a) Data handling b) Groundwork analysis, c) Rational statistical test and analysis. 7.4.5 Limitations Certain researchers tend to avoid this section but this is not a sign of professionalism. There should be a tactful combination of reference and explanation of the various methodologies and their limitations of implementation problems. The limitations need not be explained in detail. Details of limitation do not detract from the research. They help the reader in acknowledging its honesty and validity. 7.4.6 Findings It is better to report one finding per page and support it with quantitative data It presents all the relevant data but makes no attempt to draw any inferences The section attempts to bring to the fore any pattern in the industry Charts, graphs, and tables are generally used to present quantitative data 7.4.7 Conclusions Conclusions are inferences drawn from the findings. It should be directly related to the research objectives or hypotheses. Researcher should always present the conclusions as he has first hand knowledge of the research study. It is wrong to leave the inference of the conclusions on the reader. It should be confined to those justified by the data of the research and limited to those for which the data provide an adequate basis. Towards the end of the main text, researcher should again put down the results of his research clearly and precisely. In fact, it is the final summing up. 7.4.8 Recommendations Recommendations are a few corrective actions presented by the researcher. Highlight the actions the report calls for as per the researcher. It should be in line with the results of the report. It should be explicit. They may even contain plans of how future research for the same can proceed. Recommendation should be given if the client wants them else should be avoided because some decision-makers do not want their thought process to be limited to the recommendations given. In such a case, the report should not carry any recommendations. 7.4.9 Appendices Appendices are optional. It includes Raw data Calculations, Graphs Copies of forms and questionnaires Complex tables Instructions to field workers Quantitative material that would look inappropriate in the main text. The reader can refer to them if required. Care should be taken that they do not exist in isolation and reference to each appendix is given in the text. 7.4.10 Bibliography There is a list of citations and references of books and periodical articles on the particular topics, journals etc., consulted should also be given in the end. 7.4.11 Index Index is given specially in a published research report. It contains all the works consulted in the preparation of the report, not just those referred to in the text. A consistent reference format should be used all through the section Conclusions à ¢Ã¢â€š ¬Ã‚ ¢ Research will require the collection of new data through surveys and/or the use of existing data such as is often the case in the application of econometrics. These approaches are often associated with survey statisticians and economists, respectively. à ¢Ã¢â€š ¬Ã‚ ¢ Report should be written in a concise and objective style in simple language avoiding vague expressions such as it seems, there may be, and the like. à ¢Ã¢â€š ¬Ã‚ ¢ Charts and illustrations in the main report should be used only if they present the information more clearly and forcibly.

Financial performance of ABC Ltd

Financial performance of ABC Ltd Introduction Accounting is concerned with collecting, analyzing, and communicate accounting information. The accounting information is helpful to those people who make plans about business and in making important decisions related to the business The aim of this paper is to evaluate the financial position of the company and the importance of credit manager to achieve credit sales targeted and importance of actual figures when estimating the budget. This paper consists of two main sections. In the first part, evaluation of the financial position of ABC Ltd uses gross profit margin and net profit margin. The second part concentrates on things need to consider when preparing the budget in order to prevent from biased budget. Part A A) Evaluate the financial performance of ABC Ltd. Over the four year period. Financial ratio examines the financial health of the business. It helps to identify the financial strengths and weakness of the business. By calculating the ratio, it is possible to provide a good picture of the financial position and performance of a business. Financial ration can be represented in numerous ways. For example, as percentage, as fraction and as proportion. Financial ratio can be classified into profitability, efficiency, liquidity, gearing and investment. ABC Ltd company’s financial performance is evaluated by using profitability ration of gross profit margin and net profit margin. Gross profit is the difference between the sales and cost of sales. And the ratio is a measure of profitability in buying ad selling goods and service before any other expenses are taken into account. For example: Gross Profit Margin = Gross Profit x100 Sales = 119800/296700 x 100 = 40% Gross profit for the year one is 40%. The most appropriate measure of operational performance for comparison purposes is the Net profit margin ratio. The factors which influence the net profit margin of a business are the degree of competition, type of customer, economic climate and industry characteristics. For example: Net Profit Margin = Net profit before interest and taxation x 100 Sales = 22500/296700 x 100 = 8% Net Profit Margin for the Year one is 8% Gross profit margin of ABC Ltd company has fallen down from 40% to 33%. And again increased to 38% and fall down to 36%. The decrease of the gross profit margin of ABC Ltd was a result of high production cost of the company. The raw material used to produce goods and services has increased. As a result the company is experiencing less gross profit margins. Nonetheless, the Net profit margin of ABC Ltd has been maintained for the last two years, Year 3 and Year 4. Whereas in Year 1 company had a high net profit margin and it gradually decreased and company experience loss of (2) % of Net profit margin. This may be because the company’s Gross profit margin decreased from 40 to 33 and affected the company’s net profit margin. Moreover, it may be the reason that, the company has high expense such as high selling and distribution expense, Administration and other general expenses. After experiencing a loss in Year 2, company gain 7% of net profit margin in Year 3 and year 4 also. This shows company has minimized their expenses and cost of sales and increase their revenue by generating more sales. Below show graphical demonstration of ABC Ltd financial performance. According to the above table, all the accounts except the financial expense of ABC Ltd, all others have increased. Total sales increased. Meaning that number of goods and services sold by ABC Ltd have increased and generated a huge amount of revenue. However, the cost of sales also has increased. But compared to sales achieved, cost of sales is less than the sales generated. Meaning that the money generated by sales by the company was spent to make the sales, such as raw material, Equipements, machineries cost. Therefore the company gross profit has increased. The expenses spent to generate the revenue are selling and distribution expenses, administration and other general expenses and financial expenses. All expenses have increased except financial expenses. This may be due to each years increase in sales of the company. As demand for the goods and service increases, more number of good and services are produced. And to deliver the products to customers, costs incurred will be high such as delivery cost, transportation cost and other administrative cost related to the delivery of goods and services. Financing expenses have decreased such as rent paid, electricity, fixtures and fitting etc. As a result Net profit of ABC Ltd increased by $10,845. Part B A) Why credit manager is to blame for poor credit collection There are certain causes why credit manager is to blame for the deterioration in the credit collection period which are beyond the credit manager. Downturn in the economy When the budget was formulated, during that time economy may have been in a very good condition like in a boom. Businesses earn profits and their ability to pay the suppliers would be strong. And based on credit worthiness, ABC company Ltd has released goods on credit facility during that time. After two months of time, the economy turned into recession. During recession, companies reluctant to spend money and have difficulties in paying to debtors, lenders and suppliers. Henceforth customers, who have bought goods from ABC Ltd under the credit facility, would not able to pay as agreed terms and conditions. Liberalize credit policy The next reason which credit manager cannot be blamed, is a formulation of credit policy terms and conditions and implementation of the policy. When developing a credit policy there are certain conditions which should take into account. For example, buyer’s strength in the market, available net profit margin, size and type of buyers, buyer’s creditworthiness and many more. Any credit policy should include the range of payment, terms, prepayment terms, installments, penalty interest, conditions of sales, methods of assessing customer, explaining credit rating and risk codes, legal actions, follow up methods, staff responsibility and authority, relationship with another and arbitration process. If these clauses are incorporated into the policy, and customers are aware before getting into any sales and customer agreed by signing the terms, then the customer will be binding to it. As a result the credit manager would able to claim for the payment accordingly to the agreement, if a customer is disobeying the agreed terms and conditions. Therefore, it is a responsibility of policy makers of the company and senior management to come up with a strong policy and implementing it. And this could be done in coordination with a credit manager. Another reason could be that, even if the company has a strong policy, without acting upon it, we cannot achieve what we want. For example, if the sales persons or sales manager, or senior management, issue goods without checking the credit worthiness of customer with their friends or close customers and they make own payment paying term their way without consent of credit manager. Increased competition among suppliers The business environment is very volatile. Competition among business increases steadily. Being proactive would be the best solution for the success of the company. During the tough competition, it is essential to revise the credit policy terms as accordingly to customer needs and affordability. Otherwise competitors would be offering more attractive conditions and they are likely to get all customers resulting gain the market share in the business sector. And ABC Ltd would not able to get enough customers to achieve the credit targets allocated in the budget. Quality of goods and services If the quality of the products offered by ABC Ltd is very low, then the customer will refuse to buy the products. Even if they buy the product if the quality is below their expected level, then the payment will be held for some time. And it’s a responsibility of the production department to produce the goods with good quality according to customer needs. The goods Delaying in delivering If the company is unable to deliver the goods at the agreed time, then the customer would not able to depend on the company. In other words, failure to deliver the promises will lead to loss of customer and low dependability. Therefore, it is important for production department to provide raw materials and other necessary material to produce goods and it’s their responsibility to deliver the goods to customers on time. If the company fails to provide this, then the customers would prefer other competitors and faces low market share and generate low profit. Relationship with sales and credit department The relationship between sales staffs (or sales manager) and credit manager is very important. The credit manager responsibility is that to provide further guidance to achieve sales to the sales staffs. Why manager might submit a budget estimate that is biased. And ways to Company guard against it. According to the CIMA definition of budget, it is a plan quantified in monetary terms, prepared and approved prior to a defined period of time, usually showing planned income to be generated and/or expenditure to be incurred during that period and the capital to be employed to attain a given objective. There are types of budget, managers use when preparing the budget. One of the methods is incremental budget. The budget is prepared using the previous year budget as a basis with incremental amount is added to the new budget. Resources are allocated based on previous years resource allocations. The main advantage of this type of budget is that it is easy to understand and implement and also save time. This could be one of the reasons why budget estimates are based. The main reason is that incremental budget does not take environment changing factor into considerations. Due to changing is economy, budget need to be revised basically periodically and necessary amendments need to be done. Another problem is that, incremental budget does not have incentives to innovative ideas and to reduce cost. Another type of budget could be fixed budget. In fixed budgets, figures are fixed at the beginning of budgetary period. Any change in circumstance, these cannot be changed. For example, due to high inflation, raw material costs (others as well, such as machinery cost, about cost, rent, electricity) increase more that which is estimated in the budget. In fixed budget this cannot be changed. Therefore, actual expenditure exceeds than the estimated value in the budget. A good way to mitigate the budget that is based is that having shorter review periods. For example, if estimated budget is for one year. Then managers can review the budget after three month period or on quarter basis. The second way to guard the company from base budget is that to approach zero based budgeting. Budget starts from zero and items included in the budget should be justifiable to the budget holder. All expenses allocated for the whole project, should justify each activity separately and develop a questioning attitude. This helps to minimize the over spendinging and inefficient. Therefore company cannot spend more that what it is estimated and from the estimated expenditure, expected profits will be generated. Conclusion From above discussion, we can conclude that, increase in company gross profit would have a direct impact on net profit. Generating more sales will increase the gross profits and by minimizing the company expenses, the companies net profit would increase. And the profitability can be compared against the previous years by using ratios and trend analysis. Secondly, businesses normally prepare the budgets annually and quarterly. Regular evaluation of budgets prevents from overspending and adjust the budgets, according to changing the environment. And also in order to achieve high credit facility a budgeted, not only the credit manager should work on it. Other department staffs like sales and senior management should play an important role in doing so. References Atrill, McLaney, Harvey Jenner 2012, Accounting an introduction, 5th edn, Pearson Australia. FICM, GB 1986, Â © 2004 FECMA , viewed 1 December 2014, http://www.fecma.eu/Documents/FECMA%20Credit%20Policy%20chapt%20%201.pdf>. McLaney, E Atrill, P 2010, Accounting An Introduction, 5th edn, Pearson Education Limited. Riley, Jim 2012, Tutor2u Limited, viewed 1 December 2014, http://www.tutor2u.net/business/accounts/incremental-budgeting.htm>. Schaeffer, MS 2012, Essentials of Credit, Collections, and Accounts Receivable, John Wiley Sons, Inc., Hoboken, New Jersey, USA. Page 1 of 14

Serial Killers Essay -- Essays Papers

Serial Killers Serial killers kill because of three patterns we see develop throughout their lives. These patterns are the development of youthful characteristics and habits, abusing events in their lives, and the final push. To be qualified as a serial killer one must murder more than three victims, one at a time, in a relatively short time period. The most common serial killers are white, heterosexual, sexually frustrated, young adult males with low self-esteem. Lester Ballard, the main character in Child of God, by Cormac McCarthy, displays these patterns as I have found it described in texts on serial killers. The earliest warning signs of serial killers can be traced back to their childhood. It is believed that the mind of a murderer is charged with a turbulence of emotions stored from early childhood (Abrahamsen 18). When these often repressed emotions are activated, the mind, particularly when aroused or frustrated, becomes violent, and so it is that a person who may appear quite normal and well adjusted on the surface, becomes possessed by a mind that murders (Abrahamsen 18). The study of 36 incarcerated killers by Robert Ressler, Ann Burgess, and John Douglas, which can be found in their book Sexual Homicide Patterns and Motives, found many common behavior indicators in their childhoods. These behaviors include daydreaming, compulsive masturbation, isolation, chronic lying, bed wetting, rebelliousness, nightmares, destroying property, fire setting stealing, cruelty to children, poor body image, temper tantrums, sleep problems, display assault toward adults, phobias, ru nning away, cruelty to animals, accident prone, headaches, destroying possessions, eating problems, convulsions, and... ...nd. New York: Harper and Row, 1973. Bardsley, Marilyn. Jeffrey Dahmer. Dark Horse Multimedia, 2000. Bell, Rachel. The Crime Library: Everything You Need to Know About Ted Bundy. Dark Horse Multimedia Inc, 2001. Mendoza, Antonio. Internet Crime Archives. 2000. McCarthy, Cormac. Child of God. New York: Vintage Books, 1973. Newton, Michael. Encyclopedia of Serial Killers. New York: Facts on File, 2000. Serial Killers Exposed. Serial Killers Info Polls. 2000. Winn, Steven. Ted Bundy, The Killer Next Door. New York: Buntam Books, 1979.

The Waging of War :: War Violence History of Sexuality Essays

The Waging of War â€Å"Wars are no longer waged in the name of a sovereign who must be defended; they are waged on behalf of the existence of everyone; entire populations are mobilized for the purpose of wholesale slaughter in the name of life necessity: massacres have become vital.†[1] In Foucault’s pithy explanation of a new form of warfare, in its justification, causes, and even execution, several units of logic enter a rationality of massacre. In the context of the sentence, amid a discussion of bio-politics as a population-level version of bio-power, the facet he takes issue with seems primarily to be this justification for war. He understands its logic as part and parcel of the movement of thinking that declares â€Å"we are repressed†, that liberation is the alternative, and that the truth will set you free - a romantic positivism. His move makes the slogan of sexual liberation, â€Å"make love not war†, something between naà ¯ve and cunningly sinister - perhaps the latter for the very reason of the former. However close his politics here seem to sophisticatedly anti-war, the comment is not a thesis statement or a way to collect together all political sentiment for one clear and explicit goal to which all philosophical moves can be i nstrumentalized and all other political objectives subordinated. That bio-political power has become dominant, and has not always been so (a genealogical reminder kept in the preface to the political statement), is instead an important consideration in discussions of which discourses and what rationalities are more or less politically appreciable, almost separately of their philosophical merits. In his juxtaposition of different ages’ wars, Foucault suggests some changes in political rationality: more clearly the name of the survival of the population as a kind of substitute for the name of the sovereign, and less obviously a shift in understanding of death. Yet, the contrast is not so simple as wars having once been waged for the sovereign and now for the population. First, and most pressingly in this context of discussion of the population, the sovereign and the population are not necessarily characters of a similar kind. Indeed, Foucault writes early in The History of Sexuality: Volume One that One of the great innovations in the techniques of power in the eighteenth century was the emergence of â€Å"population† as an economic and political problem: population as wealth, population as manpower or labor capacity, population balanced between its own growth and the resources it commanded.

Gerschenkron Model

ECONOMIC HISTORY Answers Reading I 1. In the case of England, the agricultural sector played a key role in industrialization. This is mainly because, the increase in productivity in the sector led to an increase in the workers income, and this increase made possible for them to save more. The increase in savings led to an increase in investment in the industrial sector. When we are talking about a backward country, the process cannot be imitated.Backward countries had a traditional agriculture, and there was not an increase of productivity, so the agricultural sector could not finance the imports of capital needed. Also it was much easier to borrow money from institutions than being dependent of the agriculture. 2. Although Rostow thought that countries followed a stage-like pattern of development, Gerschenkron firmly disagreed with this assumption: Rostow implied that all countries repeat the same process of industrialization; this could be seen as a â€Å"inescapable law of econom ic development.The process of industrialization of the advance countries was not the same as of the backward countries. For example, England did not have any institution to finance its industrialization, in contrast to the late-comers, who had a whole international financing system built. This advantage of backwardness is what the Gerschenkron model is about. Each country had its own process of industrialization and it did not have to follow certain stages. 3. In order to industrialize, backward countries need to import large amounts of capital.The technology imported will come from the advance countries, and will help the relative backward countries to become advanced. The process of industrialization of these countries will take, in fact, much less time compared to the advanced countries, because the technology imported is far more efficient than those used in first place by the advanced countries when they were in the middle of the process. Since they have access to this new tech nology that the advanced countries did not have, these countries have an advantage for being backward economies. However, hese advantages do not come naturally to the country, but it is the government that needs to use the advantage in their favor in order to achieve a modern economy in less time. 4. a) Big Spurt: In the text Gerschenkron refers uses the term to describe the moment when the industrialization in a backward country begins, and there is a rapid economic growth. It is closely related to Rostow’s â€Å"take-off† but the big spurt focuses on the manufacturing and mining sector b) Missed opportunity: This term it is used to describe the failure of applying the proper substitutions in a given economy in order to obtain a big spurt.Like the case of Bulgaria when there was a failure to make the proper substitutions and there was not a big spurt. 5. The prerequisites for industrial growth are: a) Abolition of an archaic framework in agricultural organization: In order to increase the productivity of Land and of Labor, so there can be an increase of supply to face the increase of demand (due to the increase of population).This will increase the worker’s income, allowing them to save more, and therefore invest in the industry sector. b) Creation of a modern elite that seek economic growth: In Europe, the Noble class had no interest in changing their way of life (serfdom), so in order to access industrialization there is a need to create a group of influential entrepreneurs that seek a modern economy that is more productive and efficient. ) Provision of a social over-head capital in physical form: In the backward countries, there is a need of capital in order to industrialize. The government must seek this capital by borrowing it from financial institutions. Getting the capital by themselves was not an option, since there was not enough savings and it would have took much longer than just borrowing the capital.

Public Sector Innovation And National Highway Development Project Economics Essay

India had its rendezvous with fate on 15 August 1947 when it got independency after about 200 old ages under British regulation. India started its procedure to construct up the state so by following the policies of socialism, be aftering committees. However it was marked by ruddy tapes, controls, bureaucratism hurdlings, and authorities intercession. For about 40 old ages India grew at a slow gait of 3.5 % which is now called Hindu rate of growing. In 1993 India dwelled into a new way to growing. The markets were opened ; liberalization and globalisation were the words of the twenty-four hours. However India could ne'er go the success narrative which it became without revamping its decennaries old transit substructure. India was now turning at a modest gait and to do certain that the growing degrees are increased and maintained it became imperative that the logistic substructure be improved. Acknowledging these endangering jobs India under the regulation of NDA ( National Democratic Alliance with the BJP as biggest party in the confederation ) with the auspices of the so premier curate Atal Bihari Vajpayee announced a monolithic undertaking to revamp its substructure. It was called â€Å" National Highway Development Project † which paved the way for a new epoch of growing.IntroductionNational Highway Development Project was implemented in 1998. It planned to widen, reconstruct the national main roads of the state which accounted for less than 2 % of the entire route web in India but carried about 40 % of the route traffic. Road denseness in India is among the lowest at 2.75km per 1000 people and 770 kilometers per 1000 sq kilometer compared to 6.7 and 841 resp. ( TCA Anant, 2008 ) The stage I of the undertaking was called the Golden Quadrilateral ( GQ ) Project. Subsequently seven more stages have been launched and the undertaking has been extended to cover all the of import hubs, ports to this national main road grid.The UndertakingThe bureau responsible for execution of NHDP was National Highway Authority of India ( NHAI ) . It is a nodal bureau under the Ministry of Road Transport and Highways, Government of India. The stage I and phase II of the undertaking aimed at building and up step of 13,146 kilometers of national main roads into 4 to 6 lanes. The aureate quadrangle undertaking and the north South and east West corridors were portion of these stages. Golden four-sided undertaking aimed at bettering route connectivity between the four metropolitan metropoliss of India viz. , New Delhi, Mumbai, Chennai and Kolkata. Other major towns like Ahmedabad, Surat, Vishakhapatnam, Pune, Bangaluru were besides supposed to be a portion of these national main roads. East west corridor connected Silchar in E to Porbandar in West. North south corridor connected Srinagar in north to Kanyakumari in South. Phase III plans to incorporate the province capital and major economic hubs with the NHDP I and II and entire 12,109 kilometer of main roads will be upgraded in this stage. In stage IV around 20,000 kilometer of national main roads will be constructed and upgraded. These are majorly the main roads that were non a portion of stage I, II and III. Phase V envisages to upgrade 5000 kilometer of 4 lane roads into 6 lane roads. The authorities still has to make up one's mind which subdivisions of the main roads will be upgraded in this stage. Phase VI plans to build freewaies in India on BOT footing. These freewaies will link major industrial towns of India. Phase VII plans to construct beltwaies, overpasss, pealing roads to increase route web in metropoliss to national main roads.Economic ImpactAs the assorted undertakings were launched there was a ra pid rise in the creative activity of occupations. There was besides a immense employment coevals in both skilled and unskilled sectors. During the stage I about 250000 individuals per twenty-four hours were required or around 40 individuals per km per twenty-four hours. ( www.nhdp.org ) . Assorted sectors like steel, cement industry and equipment makers saw high growing rates during the period. As per figures from imperativeness information agency, Government of India growing rate in cement, steel and commercial vehicles were 8.1 % , 6.8 % and 55 % severally. ( www.nhdp.org ) There was a direct correlativity in the advancement of the undertaking and the GDP growing. By the clip the stage one was approaching completion India was timing a GDP growing of more than 8 % systematically. Harmonizing to World Bank the one-year benefits the one-year benefits were about Rs 8000 crore on the GQ undertaking itself. There were a batch of indirect benefits which were to be realized with the undertaking. These were chiefly a decrease in clip for transit of cargo and riders. There will besides be a decrease in vehicle operating costs, fuel costs, and care costs. As the roads will be made the connectivity of rural parts with the nearby major towns will better thereby impacting the development of the country. It would take to faster motion of the green goods and will profit trade. Most significantly there would be a great decrease in accidents. During the clip another strategy â€Å" Pradhan Manti Grameen Sadak Yojana † was besides envisaged and implemented by the authorities. The strategy vowed to better route substructure in the rural countries. It was decided to construct roads in the small towns and link them to the national main roads. Thus the thought on the portion of the authorities to better basic substructure was truly applaudable. In January 2012 when the authorities announced that the aureate undertaking is complete it was the 5th longest main road in the universe. The undertaking was completed in Rs 32000 crores and was under budget as the authorities had estimated that the undertaking cost would be Rs 60000 crore ( at 1999 monetary values ) . The undertaking was besides a first of its sort when it was completed before agenda which is new for a undertaking of this graduated table. The authorities was really dedicated to finish the undertaking and because of this allowed 100 % FDI in the sector. This was one of the earliest sectors where 100 % FDI was allowed. However, recognizing that it would still non be able to bring forth adequate funding for the undertaking assorted funding theoretical accounts was adopted. Cess on gasoline and Diesel along with external and market adoptions were adopted to raise capital for the undertaking. Private partnership was introduced to raise finance and joint ventures with international contractors were made.Financing of Highway ProjectsHistory Until the creative activity of National Highway Authority of India ( NHAI ) , roads were treated as public goods. The funding for developing and keep these roads came chiefly from revenue enhancements. There was no or really small connexion between cost of developing the roads and the income from the revenue enhancements. There was really small effort at direct route pricing. The Problems Limited Support: Highway development requires big investings but the authorities was already under big financial shortage. Inefficiencies: There were big inefficiencies that led to project over tallies thereby intensifying the undertaking budgets exponentially. Hazard: With full development with authorities, all hazard was concentrated at one point. This strained the funding capableness of the Creation of NHAI NHAI started its operation in 1995, the major motive for an independent organic structure under authorities of India was to increase the rate at which national main roads were been developed. One of the major hinderances in increasing this gait was the limited capital available with the authorities. NHAI realized that to full make full its vision it has to look outside authorities for capital to develop its national main roads. The Financial Innovations To understand the fiscal inventions at NHAI, foremost we have to understand the assorted hazards associated with building of National main roads Pre-development: Environmental clearance, land acquisition and other such demands before the building of roads can be done. Delaies in acquiring clearances cause holds and dearly-won undertaking over tallies. Construction: Changes in designs, conditions and geological conditions, financess inaccessibility, incorrect planning of material handiness and unanticipated labor deficits may take to project over tallies Use: Less than expected route use, users unwillingness to pay higher toll rate, may significantly impact the grosss from the route. Foreign exchange rate: Fluctuations in exchange rate may take to important cost over tallies for abroad developer Act of God: Natural catastrophes like temblor, inundations may take to holds and rework. These will take to important cost impact on the undertaking. Political Hazards: Change of authorities, expiration of the undertaking, undue infliction of high revenue enhancements, may set considerable fiscal hazard on the undertaking. The assorted funding theoretical account implemented by NHAI are EPC ( Engineering procurance and building ) contract: The undertaking is wholly finance by the public financess ( E.g. World bank/ADB ) . Except for building hazard all hazards are borne by NHAI. The advantages that NHAI has achieved through this manner are rapid execution of undertakings, improved quality of roads, foreign investings organize big multinationals. The inefficiencies involved in development of big substructure undertakings like national main roads have been minimized. Foreign multinationals have set up joint ventures with Indian companies driving up inventions and successful execution of undertakings Annuity Contract: Financing of undertaking is done from the contracted rente. Undertaking is financed through these rente receivables. But the fiscal hazard is borne by NHAI. Here NHAI is responsible merely for financing the undertakings. Advantage for NHAI in this manner of funding is that, it has to pay the contractor every twelvemonth specific sum to construct the route. BOT contract: Build operate and transportation as the name suggest, the company to wins the contract has to construct the roads, maintain it and bring forth grosss so as to acquire back all the money invested and so reassign the main road back to authorities after specific period of clip. These contracts are project fundss, with all the capital coming from the private participants. A particular purpose company is created and all the hazard except for political hazard is borne by it. EPC and Annuity presently dominate majority of the undertakings. Therefore most of the hazard is still with NHAI. For undertaking funding as in instance of BOT contract, the certainty of use of main roads and thereby the toll aggregation is really less. This puts a batch of hazard on the investor and hence really few BOT contracts have been materialized. Is Securitization the solution? National main roads have long gestation periods, with hard currency flows coming really tardily in the entire undertaking continuance. This puts considerable fiscal hazards on the private company to take is such undertakings. To minimise this hazard securitization mechanism can be put in topographic point. Securitization is a manner of finance in which assorted hard currency flows are pooled together and sold to particular purpose vehicle created to implement this undertaking. SPV so issues debt securities which are backed by the hard currency flows. Is the feasible solution to hike main road development in India, should NHAI implement this theoretical account?ChallengesLand Acquisition Act, 1984 When railroad web was being expanded in India in the nineteenth century the British Government so swayers of India faced jobs related to the private land acquisitions. They so enacted and passed the jurisprudence whose first ordinance was passed every bit early as 1824. India adopted the jurisprudence in 1947 to chiefly take attention of land acquisition for public usage. However this was merely a land acquisition jurisprudence and did non had commissariats for rehabilitation. Presently the authorities has to cover with this act along with 16 other Acts of the Apostless for commanding private land acquisitions by the authorities and its organic structures. Harmonizing to the jurisprudence the land has to be valued at monetary values on the day of the month of presentment and the compensation has to be paid consequently. However, this had led to broad spread unfavorable judgment and protests from land proprietors. The authorities has been dragged into a figure of differences refering to set down acquisitions. Presently over 80 NHDP undertakings are acquiring delayed due to differences in land acquisition. It is argued by a subdivision of society that the regulations under the act are Draconian. The compensation paid by the land acquisition officer to the land proprietors is besides less than the market value due to money being siphoned off at many phases due to corrupt functionaries. There are charges that the land is under evaluated by the functionaries and when the compensation is being paid at below market monetary values to the land proprietors there is non much public-service corporation for them. Besides, non much attention is tak en about rehabilitation of the people who are displaced by the undertakings. The authorities had appointed commission to see into all these issues and to come up with new recommendations to better the act. The authorities is be aftering to postpone a new jurisprudence in the parliament nevertheless the bill of exchange has led to fresh concerns by the industries and societal militants likewise. The new jurisprudence will do cost of land acquisitions up to four times the market rate in rural countries and twice the market rate in urban countries. Still the societal militants argue it to be pro-market and one which will increase land differences. The investors and houses argue it to be one which will do investings in undertakings dearly-won. President of Confederation of Indian Industries ( CII ) Adi Godrej said after reading the commission ‘s recommendations â€Å" Rather than turn toing concerns of the industry over the commissariats of compensation and consent required for land acquisition, the recommendations of the commission do non look to be takin g into history the demand of the industry, thereby, go forthing it to fend for itself, † Coordination among ministries In India acquiring blessings for substructure undertakings requires a close coordination between assorted cardinal, province and local municipal degrees. It involves coordination amongst all these parties and leads to detain in acquiring undertaking approved. This finally makes the fiscal viability of the undertaking questionable. ( Wang et al, 2000 ) . Despite authorities confidence of a individual window and fast clearance of substructure undertaking they are still acquiring delayed due clearances involved. Change of authorities and its precedences The undertaking was envisioned during the government of NDA in 1999. However, when the elections were held in 2004 UPA ( United Progressive Alliance ) came in to power and has been in power for the last 8 old ages. There focal point has shifted to other public assistance strategies like MGNREGA ( Mahatma Gandhi National Rural Employment Guarantee Act ) , farm loan release among others. This has shifted the precedences of the authorities to raise fundss for its public assistance strategies and non the NHDP undertakings. Subsequently, the undertakings have been running on holds and many undertakings have delayed because the contracts have still non been handed over.RoadmapGiven the challenges being faced will the authorities now take steps to convey in fresh reforms in the sector so that the marks of NHDP are met? This might affect taking in some tough steps which might be opposed by subdivisions of society. However, will a better sense prevail and a greater good of the society, GDP gr owing ends be achieved.