Creating an Emergnecy Service Delivery Operation Essay

Creating an Emergnecy Service Delivery Operation - Essay Example The company will enjoy a contingent team of experience team to fill in any gap occasioned anytime. The volunteer aspect will also serve as the company’s corporate social responsibility where it connects to the people of the surrounding where its domain is felt (Thomas, & Voss, 2009). The company strategic goals and objectives will be to enhance capacity and provide extensive support in alleviating human suffering during cases of emergencies that require swift responses. The organization envisages conducting a survey regarding certain crucial information that will make the management have useful information at hand that will make them make informed choices on how to roll operation. This is in terms of routes, population density, and the area morphology. The organization also plans to increase their service two folds higher compared to the current level (Sene, 2008). In the case of fire which is the most destructive in terms of devastation and time, our organization will need tw o fire fighting vehicles fully loaded with at least 20 trained and experienced personnel in fire mitigation. In the flood rescue, it will need chopper plane, a number of life jackets, and at least 5 trained personnel in such calamities. In the case of the mass casualty incident to say road accident, the organization will need at least three ambulances with trained medical team-this may be a road accident or something of similar magnitude. In the case of a urban fire interface, the organization may need up to 100 personnel and a fleet of 10 fire fighting vehicles with functional system. In the organization, the day-to-day duties will be organized as if there is already signs that there will be a disaster at specific time. This is to avoid any delay in cases of the emergencies. The operation manager will confirm that at least five fire-fighting vehicles are ready with full load of system to respond to any emergency without any delay. The human resource manger will also confirm that th e minimum number of the personnel area available anytime any day for maximum preparation to any emergency. The toll free call has to be examined every day and their functionality noted, the recipient to the call must always be at the desk to attend to any cal on time (Blyth, 2008). This is seen as a good strategy and preparation that will ensure immediate response to the emergencies. The organization will depend on the government assistance during annual budgeting though this is not always enough to manage emergencies throughout the year. The organization is thus linking with other firms and corporate bodies to contribute in the running of the daily affairs as part of giving back to the society (Thompson, 2004). Well-wishers and philanthropist are also being courted to help the organization meet their objectives. We will also be working on getting grants from other bodies. We have to emphasize that resources are the lifeline of this organization and in the case of shortage; it can h ardly achieve its objectives as stipulated. The regional state response partners will be the city governor. We find this the best alternative since the city also has a parallel system that can supplement this. It is therefore easy to execute operation intended with them. We face several changes; this includes narrow roads and poor traffic adherence by other motorist, this always delays our operation in the cases of emergencies. The construction of the building

Finance International Expansion Essay Example | Topics and Well Written Essays - 1000 words

Finance International Expansion - Essay Example Major differences exist in the economic, political, socio-cultural, technology, competitive and financial environments of different countries. These need to be taken into account in planning the overseas expansion. Expansion decision has to be made after proper consideration of all strategic and operational issues arising from within international milleu. Decisions need to be made concerning a wider range of both Strategic and Operational Issues. Key Strategic Issues that need to be addressed include assessing our company's readiness to internationalise which includes the suitability of your product or service for overseas markets and the extent of local adaptation required; choosing the most attractive foreign market(s) and the best entry strategy to adopt; international pricing, distribution and promotion strategies; organising and controlling our overseas activities. Operational issues include export paperwork and documentation; legal and financial issues; finding and managing overseas partners and so on and are ultimately transferrable into financial and legal consultancy fees and travel expenses. Whether the company intend operating through agents/distributors or establish its own overseas sales subsidiary, the burden of control-related activities and costs is heavier than at home making it much more difficult to monitor and control overseas activities. There are significant financial risks associated with doing business abroad, including the risk of higher indebtness, risk of not getting paid at all and currency fluctuations-related risks. Further, when going international we will need to be sensitive and empathetic to the local political and cultural environments of different countries. That entails higher management and consultancy costs and will unltimately produce to elevation of cross-cultural and political analysis to the level of decision making tool. The competitive environment may be quite different from what we are used to at home. In whole, as a consequence of the above, international marketing is more costly and time consuming than domestic marketing and you will need to take a long-term view to achieve sustained profitability. The Barriers US Computer Systems companies, especially medium sized enterprises, face a number of barriers or obstacles when going international. These may include: Psychological Barriers including lack of international/global orientation; short-termism; product or technology rather than customer led 'mindset'; lack of commitment to international markets; exporting seen as 'too risky', 'not for us' or 'too much trouble'; the 'fear factor'. Organisational Barriers including limited resources (financial and managerial); lack of knowledge of foreign markets; lack of international experience; lack of formal training in international marketing; problems in finding suitable overseas partners; ability to compete away from home. Operational Barriers relating to export documentation and paperwork; language problems; payment delays and risks etc. Product/Market Barriers in the sense of overseas market demand particularities, i.e. that product or service may not be suitable for overseas markets without major and costly adaptation; the product or service may not have a unique competitive advantage abroad; further, problems in

Lightest football Essay Example for Free

Lightest football Essay I have chosen to focus on just one of the sports manufacturers Nike, for two reasons. 1. Nike is arguably the fore runner in the technological developments of most sports football being one. 2. There is little deviation between the finished products and their properties regardless of the manufacturer and with Nike being the largest of all the sports brands, it seems logical to focus on them. Shirt Nike cool motion shirt (image 1)   Two layers lighter than one   Inner shirt wicks moisture. Outer shirt has vents and water resistant properties   Luminous colouring makes visibility improved under floodlights Boots Nike vapour boots (image 2)   Lightest football boot around built for speed Soft ground 194 g Firm ground 202 g   Sprint spike stud configuration   Ultra thin synthetic for `feel` of the ball Ball Nike mercurial vapour ball (image 3). Synthetically made strength and durability in all conditions   Low water retention keeps shape and weight  Ã‚  2% more deviation in flight leading to harder shots, therefore more spectacular goals   Special small sided games version in metallic silver higher visibility Protection Nike vapour guards (image 4) Lightweight again built for speed   Anatomically shaped providing optimum fit   Wicking inner layer Nike Kracken gloves (image 5) 4mm thick grip durability and shock absorption in all conditions   curved grip for easier catching of the ball   wicking inner layer Headers` padded head band (image 6). reduces shock to the brain   reduces risk of concussions   reduces risk of onset of post game illnesses directly associated with brain trauma (i. e. Parkinsons) Stadia After the Hillsborough disaster of 1989 and a series of other crowd related tragedies (Heysel 1985, Bradford fires) there was a need to drastically improve the stadia across the world. The Taylor report deemed that all top division clubs must have all seater stadiums, with restrictions placed on those without. Similar guidelines were introduced and applied with lower league clubs, where although all-seater stadiums were not compulsory, the safety of each stadium must pass stringent checks. There have been cases especially highlighted in the conference league where upon a club has been promoted, only to be demoted back to the same league immediately because their ground or stadium did not meet safety regulations. The recent world cup in Japan/Korea highlighted the new breed of `super stadia`, where spectators can rely upon space age technology to enjoy watching in safety and comfort. (Image 7) Television Due to the ever increasing demand to watch football, and sometimes the increasing price to do so, the needs of the spectator, whether at home or at the stadium remain almost the same. Television, has pumped money into many clubs, and very nearly ruined many others. (the collapse of ITV digital bankrupted some smaller clubs)   Television runs football date and times of kick off are directly effected by television companies The majority of money involved is directly to do with television TV rights, pay-per-view   Some clubs cannot survive without TV. money. Football and television have become co-dependent Conclusion   advancements are geared towards providing more of a spectacle   speed of the game has increased more end to end action   balls/boots are benefiting the scoring of spectacular goals again more spectacle   Spectators watch games in more comfort at a price, some match tickets are no longer affordable.   Sport is run now like a business high risk for high rewards, and the rewards are getting that much greater Money essentially now runs the game.

Bullwhip Effect In Healthcare Sector

Bullwhip Effect In Healthcare Sector In Supply Chain management, Bullwhip effect has attracted some considerable importance in the FMCG sector in the last 20 years. The phenomenon Bullwhip Effect shows how small changes at the customers end have tremendous impact on the operations back there in the chain. The cause behind this effect is mainly attributed to the increasing demand variability in the supply chain. We consider the number of companies taking part in a single supply chain. Each of the company gets the order from its immediate downstream company to be fulfilled. In Bullwhip effect the orders to the suppliers tend to have a larger variance than sales to the buyer. This demand distortion then gets amplified while propagating upstream. The paper mainly focuses on how the Bullwhip effect the matching of the demand and supply and the main causes leading to this. It also focuses on the PG case study to understand the Bullwhip effect and the steps taken to dampen the bullwhip effect. Further it aims at quantifying the bullwhip effect and reducing its impact on the supply chain. Acknowledgement I am thankful to Mukesh Patel School of Technology Management and Engineering (MPSTME) for giving me this opportunity to understand the Bullwhip Effect and the major causes and the PG case. Furthermore helping us understand the various techniques and procedures for writing a research project. I would also like to express my sincere gratitude to my college mentor Prof. Jinu Kurian for her continuous guidance and support and being available at all times whenever the need may arise. I would also like to thank Prof. Prasad Chakrabarty for his help and support in the project. Table of Contents Introduction The bullwhip effect occurs when the demand order variability in the supply chain is amplified as they moved upstream in a supply chain. Distorted information from single end of a supply chain to the other may lead to tremendous inefficiencies. Companies can effectively deal with the bullwhip effect by thoroughly understanding its underlying causes. Organizational leaders are implementing various innovative strategies that pose new challenges: integrating new information systems defining new organizational inter relationships implementing new incentive and measurement systems. At macroscopic level, Bullwhip Effect generates inefficiencies in production scheduling, sourcing, capacity utilization, distribution and the profit generation. While if we take a look at the operating level it induces additional inventory which is placed inappropriately to maintain the service levels. It also reduces the performance level by decreasing the incoming cash and the potential revenue. It can even dilute any companys competitive strategies. 2 factors have changed the landscape of supply chain management in the last few years significantly. Availability and use of the technology and software applications to allow capture and sharing of information across a supply chain mostly through extranets Increasing indulgence of members of the supply chain in order to move towards to put aside the traditional arms-length relationships amongst each other and in its place move towards closer, partnership-type arrangements. Again, the networks over which these collaborations take place must include the necessary levels of performance, scalability, security and reliability to realise these benefits to their maximum potential. Problem Statement To analyse the Bullwhip Effect in healthcare sector and to find out its causes, consequences and cures. Significance Global competition in the world market today contains many challenges to achieve a degree of predictability in the supply chain and remove the impact of Bullwhip Effect. Researchers have examined the bullwhip effect and some models to reduce it, however a very few research has been done on analysing the Bullwhip Effect in healthcare sector and to find out its causes, consequences and cures quantifying the effect of bullwhip and its Measurement still remains an exigent research path. Research Methods A case-study based approach was employed to conduct the research. Data were gathered primarily through interviews, observations and archival sources. At the hospitals, Interviews were conducted, in person, with doctors, nurses, administrators, and other hospital staff. At the diagnostic laboratory, personal interviews were conducted with the CEO, pathologists and other lab technicians. As far as data gathering is concerned, we decided to employ an informal, minimally structured, non-directive interview approach, enabling to minimize the influence of the assumptions. . Literature Review Fluctuations in demand have a varying graph when we compare from industry to industry. Driven by seasonal demand and business cycles, apparel industry faces major demand adjustments, while the diaper market is subjected to constant demand in the market arena. Due to misjudgement of demands, the big players in the retail market can be subjected to inventory shortages or surpluses. But given the consistency of demand in the diaper market the diaper supply chain should be more efficient and accurate. But it isnt the case. The diaper market even with the reliable demand patterns isnt able to match the demand-production matching. The major cause to this supply chain inefficiency can be subjected to Bullwhip Effect. The term was coined by Procter Gamble who noticed amplification in the information distortion as the information of the order travelled upstream in the supply chain. Bullwhip effect or Whiplash effect can be majorly seen in the forecast driven distribution channels. It indicates a lack of synchronization among the members across the supply chain. Even if there is a small fluctuation in the customer sales, it reflected upstream in an amplified form. Because of this supply patterns does not match the demand patterns resulting in inventory surplus at various stages of the supply chain.C:UsersIndiaDesktopblwhp.jpg As the customer demand would be rarely perfectly stable, businesses should forecast demand in order to match the demands with the production and managing their inventory levels. Some of the major reasons behind bullwhip effect are:- Forecast Errors Overreaction to backlogs Lead time variability No communication and no coordination along the supply chain members Delay in information and material flow Price fluctuations Product promotions Order batching raw material orders from ProcterGamble to its suppliers fluctuated over time. On further noticing it was found that farther down the chain, when sales at retail stores were studied, it was found that the fluctuation which was present, were small. It is reasonable to assume that the consumers of the diapers at the last stage of the supply chain used them at a steady rate. Although consumption at the end product was stable, orders for raw material were highly variable, increasing costs and making it difficult for supply to match demands. Lack of coordination between supply chain members also results if information distortion occurs within the supply chain. Considering the Bullwhip effect PG observed in the diaper supply chain. As a result of the bullwhip effect, orders PG receives from its distributors are much more variable than the demand for the diapers at retailers. The lack of the supply chain coordination between members has an adverse effect on manufacturing cost. It increases the manufacturing cost in the supply chain. PG and its suppliers must satisfy a stream of orders that is even more variable than customer demand. ProcterGamble responded to the increased change by either building excess capacity or by holding excess inventory, both of which increase the manufacturing cost per unit produced. It even increases the replenishment lead time in the supply chain. The increased variability due to bullwhip effect makes scheduling at PG and supplier plants much more difficult as compared to a situation with level demand. There are times when the capacity which is available and inventory cannot supply the orders coming in. This results in higher replenishment lead times in the supply chain from both PG and its suppliers. It even hurts the level of product availability and results in more stock outs in the supply chain. Very high fluctuations in orders make it difficult for PG to supply all distributor and retailer orders on time. This increases the likelihood that retailers will run out of stock, resulting in lost sales for the supply chain. It also leads to an increase in the inventory costs. To handle the increased variability in demand PG has to carry a higher level of inventory than would be required if the supply chain was coordinated. As a result, inventory costs in the supply chain increase. The high levels of inventory also increase the warehousing space required and thus the warehousing cost incurred. It impacts the transportation cost in the supply chain. The transportation requirements over time at PG and its suppliers fluctuate with the orders being filled. As a result of bullwhip effect, transportation requirements fluctuate significantly over time. This raises transportation cost because surplus transportation capacity needs to be maintained to cover high demand periods. It also leads to the increase in labour costs associated with shipping and receiving in the supply chain. Labour requirements for shipping at PG and its suppliers fluctuate with orders. A similar fluctuation occurs for the labour requirements for receiving at distributors and retailers. The various stages have the option of carrying excess labour capacity in response to the fluctuation in orders. Either option increases total labour cost. PG estimated that due to the manual interventions required in their process of ordering, billing and shipment systems, each deal to its customers cost between $35 to $75 to process. Sharing point-of-sale (POS) data across the supply chain can help reduce the bullwhip effect. A primary cause for information distortion is the fact that each level of the supply chain uses orders to forecast the future demand. Given that orders received by different levels vary, forecasts at different levels also vary. If retailers share POS data with other supply chain stages, all supply chain stages can forecast future demand based on customer demand. Sharing of POS data helps reduce information distortion because all stages now respond to the same change in the customer demand. Sharing aggregate Point Of Sale data is sufficient to reduceinformation distortion. PG has convinced many retailers to share demand data. PG in turn shares the data with its suppliers, improving coordination in the supply chain. In a continuous replenishment programs (CRS), the wholesaler or the manufacturer replenishes the inventorey regularly based on Point of sale data. In its simplest form, CRS seeks to allow more accurate production planning of inventories and also matching of supply and demand. Success with continuous replenishment programs is achieved when production planning has become demand-driven on an end-to-end basis throughout the supply chain. . Vendor-managed inventory (VMI) is a family of business models in which the buyer of a product provides certain information to a supplier of that product and the supplier takes full responsibility for maintaining an agreed inventory of the material, usually at the buyers consumption location (usually a store). A third-party logistics provider can also be involved to make sure that the buyer has the required level of inventory by adjusting the demand and supply gaps. PG now employs vendor-managed inventory (VMI) in its supply chain, starting with its supplier, 3M, and its customer, Wal-Mart In VMI, packaged-goods behemoth Procter Gamble (PG) initiated a value pricing scheme for sales to retailers. Value pricing was PG label for everyday low pricing (EDLP), a pricing strategy under which retailers are charged a consistent price rather than a high baseline price punctuated by sporadic, deep discounts. PG had many reasons for converting to EDLP. Its sales force had grown to rely on discounting to drive sales and the use of deep discounts had spiralled out of control, cutting into earnings. Background SMS Hospital, operating in Jaipur, is one of the largest government healthcare providers in Rajasthan. It consists of more than 500 beds and offers healthcare services ranging from a 24 hour accident and emergency service, to acute medical and surgical care, operating theatre suites, intensive care, ocus on cardiac and orthopedics areas and head injury and orthopaedic related trauma and community care. The hospital services more than 40,000 patient admissions and an average length of stay of 3.62 days for all patients. There are10 operating rooms (OR) with state of the art equipment, in-patients have hospital wards, acute cases beyond normal post-operative hospital care have rehabilitation unit for recovery and related ancillary services in the hospital facilities. These rooms are being used for major inpatient procedures. On an average of about 27,000 operations are performed in these rooms in a year. Specialty and staffed with suitably qualified nurses and technicians organizes 500+ beds in the hospital. The Operating Room Management Department (ORMD) is the central division, which faces daily challenges of managing and allocating the staff and equipment so that surgeries can be performed in an efficient, cost effective, and safe manner. The equipment that is owned by the hospital may either be dedicated to a theatre or be shared across theatres. The Operating Room staff is comprised of registered nurses, nursing assistants, scrub technicians and unit secretaries and an Operating Room nurse super vises all these. Equipment to be used for Operating Rooms may either be owned by the hospital or be procured from outside on a loan/hire basis. The Operating Room Management Department is responsible for assignment of theatre suitable for the scheduled surgery and ensuring the availability of staff and equipment when needed. Quality and cost of patient care implications are on overstaffed, undermanned, and unbalanced nursing teams. The hospital has adopted a hybrid strategy to meet its nurse requirements in both wards and Operating Rooms. The hospital has employed a group of permanent, full time nurse staff, which is also, complemented by a bank of casual, part time nurses which are available at short notice. Also, the hospital also has made some arrangements with several private agencies, which are known for providing qualified nurses for short periods to hospitals, on a temporary basis. Fifty % of the hospitals requirements) in the terms of nurse requirements are usually been met by permanent staff, thirty% by part time nurses and twenty% from agency staff. The hospital havent employ any specialist/surgeon, but only has a small group of physicians for overall supervision of the wards. Instead, it has arrangement with a large group of consultant surgeons who hold privileges to avail of the hospital facilities for treatment of their patients. The hospital derives its revenues from the fees charged for the use of its facilities ORs, hospital beds and other services from the patients. In most cases hospital charges are borne by patients medical insurance providers and the hospitals revenue is based on negotiated rates with these firms. Value Chain Figure 1 illustrates a schematic description of SMSs service value chain. As shown in the figure, the multi-stage process begins with the patients consultation with his or her primary care physician. Upon receiving a referral from the general practitioner to visit a medical specialist, the patient will then be assessed by a specialist. This stage does not involve the hospital and may consist of several visits to the doctors office and diagnostic laboratories, deals with the assessment of patients condition and treatment options. A determination of the need for surgery results in the addition of the patient to the doctors list of patients requiring surgery/hospitalization. Typically, specialist doctors have privileges at several hospitals in the area, and the choice of hospital for surgery is determined by a number of factors that include cost, patient preference, case complexity, wait involved, facilities and other services provided by the hospital. Following the choice of hospital, the patient is scheduled for surgery by assigning a slot in one of the doctors theatre sessions at the hospital. It is not uncommon for elective surgeries to be scheduled several weeks to a few months in advance. The schedule for each session along with patient and surgery details is expected to be communicated by the doctors office to the hospital well in advance to enable the hospital to make adequate arrangements. The surgeons operating list is not frozen and is dynamic with additions possible at a later stage (in some cases a few hours in advance) and the hospital is expected to be responsive and be able to provide the requisite support of staff, equipment and supplies. Surgery represents the third stage of the value chain and Saint Marys hospital is responsible for providing required support services. These include staffing the theatres with qualified nurses and technicians, and making available all equipment and supplies needed. The hospital is also responsible for pre-operative care of the patient and getting the patient ready for surgery and for post-operative care. Insufficient capacity and delays in these phases can result in blockage and starving of theatre resulting in underutilization of ORs with consequent adverse impact on hospital costs and efficiency. Post-operative care in hospital wards and in subsequent rehabilitation areas, if necessary represent the fourth and fifth stages before the patient is discharged and exits the hospital system. Constraints on bed capacity in wards can lead to fewer surgeries being scheduled resulting in lower theatre utilization. This is in contrast to the rehabilitation services, where capacity shortage may only lead to patients being off-loaded to other facilities owned by competitors, thereby resulting in loss of potential revenue. Planning and Scheduling at SMS Hospital Planning and scheduling at Saint Marys hospital is similar to other hospitals in Australia with annual theatre plans forming the basis for hospitals activities. The theatre plan involves assignment of theatre sessions to consultant surgeons and essentially defines the demand for hospitals services. A half-day slot is considered the basic unit for this purpose and thus each theatre has a capacity of 10 sessions per week, based on a five day week. As described earlier, surgeons expect hospitals to provide complete flexibility in organizing the activities within their sessions and hence assignment of a theatre session to a surgeon commits the hospital for providing the necessary staff and equipment for operation and post-operative care, and hence the hospital workload is a direct consequence of the theatre plan. In practice, theatre planning at Saint Marys begins three to four months in advance, in September/October for the following year. The plan is developed in consultation with the surgeons and varies little from year to year, except for changes to accommodate vacation periods of surgeons and other planned absences. The plan can be characterized as cyclic with effort to evenly spread out sessions assigned to individual surgeons. Further, to the extent feasible, weekly schedules are adopted. For example, a surgeon with 50 sessions would be assigned one session per week, usually in the same time slot every week (say, Monday morning). One feature of session plan at Saint Marys Hospital that merits special mention relates to the practice of concentration of sessions assigned to particular specialty. As a result, we find, sessions corresponding to different specialties peaking on different days of the week. Such practices are not unique to Saint Marys and are quite common at other hospitals i n Australia. The annual session plan forms the basis for nurse and technician staffing in the hospital. The labor cost of nurses and technicians is perhaps the most significant controllable operating cost at Saint Marys and directly impacts the hospitals financial viability. Staffing plan for nurses in the OR theatres is prepared for each calendar month on a monthly basis, two weeks in advance to conform to regulatory requirements. The initial plan is developed on the basis of the session plan. The nurse schedule is revised and frozen only a day in advance, at which time the requirements are assessed based on surgery lists available in the hospital. Besides adjustments for providing the required number of qualified nurses, the final schedule takes into account deviations from the initial plan (for example, absence due to sickness, or inability to schedule the nurse due to excess overtime on the previous day etc.) At this stage there is only very limited flexibility in respect of permanent, full t ime staff and the nurse scheduler relies on part time staff, supplemented by supply from external agency to meet the requirements. As mentioned earlier, current practices at Saint Marys hospital result in 20-25% of nursing needs being met with agency sources. In monetary terms, the proportion is higher due to higher rates paid for the temporary staff. Nurse staffing in wards is similar and schedules are frozen only a day in advance. Observations Our interviews with doctors/surgeons indicated that in a majority of specialties there is no discernable pattern in the demand for elective surgeries. This is in contrast to illnesses such as flu, hay fever that exhibit pronounced seasonality. Thus, daily demand for elective surgery end customer demand can be reasonably be described as fairly uniform with no seasonality (day of the week, month etc.) and low to moderate variability. Figure 2 describes the pattern of admissions (which corresponds to demand) for orthopaedic surgeries at Saint Marys hospital by day of the week. The figure is based on data for one year and excludes the holiday period (mid-December to mid-January) in Australia during which most doctors avoid scheduling elective surgeries. The data in Figure 2 shows mild seasonality by month (admissions range from a low of 332 to a peak of 512 with mean of 470) and high variability by day of the week. Excluding the weekends, the average daily admissions range from a low of 58 on Fridays to a peak of 123 on Wednesdays. The pattern is similar for other specialties, except for the location of the peak. While in Figure 2 the peak occurs on Wednesdays and Thursdays, for other specialties it might occur on other days of the week. Taken in conjunction with our premise that end customer demand is fairly constant, Figure 2 suggests strongly presence of phenomena similar to the bullwhip effect. In the remainder of this section we discuss briefly the impact of this pattern on hospital performance operational and financial. First, increased variability in the number of surgeries performed directly impacts the demand for post-operative services in the wards. Consequently, on peak days, shortage of beds makes the wards the bottleneck, thereby restricting the number of surgeries and reducing the theatre utilization and hospital throughput, which in turn leads to lower revenues and lower operating profits. While the hospital is a not-for-profit organization, operating profits represent one of the key funding sources for financing investments in equipment and facilities, and lower levels or absence of operating profit can severely restrict the hospitals ability to provide state-of-the-art high quality service. Second, the demand for nursing services both in theatres and wards is directly affected by higher variability and results in higher labor costs. With Saint Marys strategy of meeting the nursing demand with a mix of full time, part time and agency staff, higher variability of demand translates to the need for higher levels of flexibility and larger proportion of casual and agency staff. Higher wage rates for these categories increases operating costs and leads to lower profits. Third, SMSs reliance on flexible (part time and agency) staff affects the hospitals operating performance in more subtle, but significant manner. Higher levels of temporary staff leads to frequent changes in the composition of support staff assigned to each theatre, thereby inhibiting development of cohesive support teams. Consultant surgeons in our interviews mentioned this factor repeatedly as the primary cause of inefficiencies in theatre, requiring more operating time and reduction in efficient use of theatre capacity. The role of cohesive support teams in improving OR efficiencies is well known and has been noted in many other hospital environments. In the absence of such a support team, the surgery list scheduled for each session tends to be shorter (thus reducing hospital revenues). Alternately, with normal list the theatre time will be higher than planned, resulting in overtime and increasing operating costs. In either case, this practice adversely affects hospitals profits. Furthermore, this factor influences the doctors choice of hospital, prompting use of Saint Marys for more complex cases requiring its facilities. For simpler cases, the doctors tend to choose other hospitals with more efficiently organized OR theatres, perhaps with more limited range of services. As the more complex cases typically involve higher costs, this behavior has an adverse impact on Saint Marys finances. Under the Australian system the fees payable (to the hospital and doctor) are based on predetermined rates for each class and do not depend on the case complexity within each class. To summarize, increased variability in the demand for elective surgeries at Saint Marys hospital results in lower efficiencies, higher operating costs and lower revenues leading to lower profits. Thus, the presence of bullwhip effect leads to degradation of performance as in the case of manufactured goods reported in the literature. While this is intuitive and not surprising, it is interesting to note the dynamics are different from those observed in manufacturing higher levels of inventories and shortages. Macintosh HD:Users:vasvigakkhar:Desktop:Screen Shot 2012-12-29 at 2.09.56 AM.png Macintosh HD:Users:vasvigakkhar:Desktop:Screen Shot 2012-12-29 at 2.13.36 AM.png Methods for coping with the Bullwhip Effect The preceding section highlighted the different causes of the bullwhip effect in the healthcare sector and identified strategies to mitigate the detrimental impact of the effect. We briefly summarize the strategies (see Table for a summary): (i) Reducing uncertainty In order to minimize or eliminate bullwhip effect, it is important to reduce uncertainty throughout the service value chain. If information about customer can be centrally managed and if each stage of the service value chain can be provided with latest information in a timely manner, it will help eliminate duplication of effort at different stages and also ensure data consistency across all groups that require that data. It is also critical that dynamic updating of information is performed which will greatly help reduce uncertainty. (ii) Reducing variability There is inherent variability in the customer demand process and any effort that can be taken to minimize this variability will help reduce the overall bullwhip effect. Also, localized practices that lead to increased variability in demand at any of the stages should be eliminated with better coordination. Use of good forecasting methods will also assist the reduction of variability. (iii) Developing strategic partnerships The bullwhip effect can be minimized by developing key strategic partnerships with different links in the service value chain. For example, in case of hospitals, the hospital administration has to forge strategic alliances with medical specialists. These partnerships will change the way in which the information is shared and will help foster better coordination between the two parties. Although this may not fully eliminate bullwhip effect, it will go a long way in reducing the effect. (iv) Realignment of incentives One prime reason for the lack of coordination and meaningful information sharing is that the different entities are evaluated on the basis of different criteria and receive rewards for different activities. The evaluation and reward system should be modified to stress cooperation across stages and so that the planning is performed on system-level objectives and not on division/local level objectives. (v) Improving coordination across stages of service value chain To reduce the bullwhip effect, it is also important to ensure coordination across stages that are facilitated and improved. Summary and Future Research In this paper we have identified and described a phenomenon in healthcare industry that is similar to the bullwhip effect observed in the manufacturing sector which results in amplification of demand variability upstream in the service chain. Not surprisingly, this distortion likewise leads to performance degradation. However, the similarity with the manufacturing sector does not extend much further since the causes and the impact are somewhat different. For example, while bullwhip effect in manufactured goods results in higher levels of inventory and shortages, in hospitals it leads to lower levels of throughput, higher operating costs and longer patient waits. Hence, initiatives and strategies for minimizing the bullwhip effect and its impact require a different approach that addresses directly the root causes. Our study also indicates that the potential for performance improvements is quite significant. While our study focused on hospitals and other allied institutions in the health sector, we conjecture that a similar phenomenon may be present in other service industries. For example, billing practices in consumer utilities (electricity, gas etc) and credit card services with monthly cycles leads to variable unbalanced loads in certain segments. Similarly, scheduling practices in auto repair industry result in some variability amplification. Together this suggests that a more detailed study of the bullwhip phenomenon in services is warranted and may lead to order-of-magnitude performance improvements similar to those realized during the past two decades in the manufactured goods industries.

Miltons Satan in Paradise Lost Essay -- John Milton Satan Paradise Lo

Milton's Satan in Paradise Lost After researching Satan and his kingdom, Hell, through the Bible and Paradise Lost to compare and contrast the two characterizations, I realized that Milton must have been a true Bible scholar. Milton’s Satan is described so closely to the Biblical view of Satan that it is often times hard to distinguish the two. Milton changed and elaborated on a few characteristics of his Satan and his Hell in order to create Paradise Lost, but based his characterization and his descriptions on his interpretation of the Bible, using his imagination to form a more vivid picture of how horrible Satan and Hell are in reality. The action of Book One in Paradise Lost begins immediately after God has thrown Satan and his other fallen angels down to Hell from Heaven. The reader then comes to know that Satan was cast into Hell because he became too proud and believed that his power was equal to God’s own power. He wanted to set himself up on a pedestal in Heaven. Milton writes, â€Å"What time his pride had cast him out from Heaven, with all his host of rebel angels, by whose aid aspiring to set himself in glory above his peers, he trusted to have equaled the Most High† (Norton 1819). In the book of Isaiah, the story is relayed very similarly to Milton’s version of how and why Satan fought against God and that he was thrown down into Hell. Milton speaks of Satan as â€Å"O how fallen!† (Isaiah 14:12-15). This phrase comes directly from Isaiah 14:12. Isaiah wrote, â€Å"How you are fallen fro m Heaven, O Lucifer, son of the morning!† (Isaiah 14:12). Isaiah continues in the same fashion as Milton in verse... .... Abrams, M.H. (editor). The Norton Anthology of English Literature. 7th Edition. Volume 1. New York City, NY: W.W. Norton and Co., 2000. pp. 1815-1825. 2. Abrams, M.H. (editor). The Norton Anthology of English Literature. Volume 2. New York City, NY: W.W. Norton and Co., 1968. pp. 704-707. 3. Coleridge, Samuel Taylor. The Statesman’s Manual; or the Bible the best Guide To Political Skill and Foresight: A Lay Sermon, Addressed to the Higher Classes of Society. London: Gale & Fenner, J. M. Richardson, and J. Hatchard, 1816. 4. Extreme Teen Bible: New King James Version. Ed. Bruce Barton, Christopher Hudson, and David Veerman: Thomas Nelson Publishers, 1999 5. Shelley, Percy Bysshe. A Defense of Poetry. Indianapolis: The Bobbs-Merrill Co., 1904 6. The Nelson Study Bible: New King James Version. Ed. Earl Radmacher,Th.D., Thomas Nelson Publishers, 1997

Reflections on the Analytic/Continental Divide Essay -- Research Essay

Reflections on the Analytic/Continental Divide My friends in the English department often ask me to explain the difference I so often talk about between analytic and continental philosophy. For some odd reason they want to relate our discipline with theirs in an effort, maybe, to understand both better. Thus, I welcome the opportunity offered by Schuylkill's general theme this year to give a very general and un-rigorous presentation on Philosophy, intended for the University Community at large. One fine, if annoying, tradition in philosophy is that of hedging our bets. It's the fine art of being slippery. And we actually think it's motivated by a wish to be exacting. Accordingly, I should begin such a paper by saying that neither analytic nor continental philosophy are truly cohesive, unified, groups; much which seems inconsistent flows under their banner, as does much disagreement. However, today, few groups of any merit are cohesive and unified, if they ever were. Even science isn't unified any more. So much for fine print bordering on the platitudinous. This paper has four sections. The first section places analytic and continental philosophy within a historical tradition, specifically in relation to Kant. The second details analytic philosophy, particularly with relation to 'the linguistic turn' and 'ordinary language' philosophy. The third juxtaposes what I take to be a continental response in terms of Heidegger's view of language and Foucault's view of power/knowledge, and shows some of the disrepute in which these are held. The last reviews some recent journal articles on the subject, and delivers a summation and prognosis. I. You all know about the Pre-Socratics, of which I think fondly of Heraclitus, so o... ...of Pure Reason. Trans. Norman Kemp Smith. New York: St. Martins, 1965. Grounding for the Metaphysics of Morals. Trans. James W. Ellington. Indianapolis: Hackett, 1977. Margolis, Joseph. Historied Thought Constructed World. Berkeley: U of California P, 1995. "A Biopsy of Recent Analytic Philosophy." The Philosophical Forum XXVI.3 (1995): 161-188. McDowell, John. Mind and World. Cambridge: Harvard UP, 1994. Norris, Christopher. "Doubting Castle or the Slough of Despond: Davidson and Schiffer on the Limits of Analysis." The Review of Metaphysics 50 (December 1996): 351-82. Quine, Willard Van Orman. "Two Dogmas of Empiricism". The Philosophy of Language. Ed. A.P. Martinich. New York: Oxford UP, 1996. 39-60. Schlick, Morris. "The Turning Point in Philosophy." Logical Positivism. Ed. A. J. Ayer. New York: Free, 1959. qtd. in Follesdal (200).

Gender Roles Essay

â€Å"We’ve begun to raise daughters more like sons†¦but few have the courage to raise our sons more like our daughters,† (Gloria Steinem, American feminist). Gender roles refer to the set of social and behavioral norms that are considered to be socially appropriate for individuals of a specific sex in the context of a specific culture (Wikipedia). Gender roles are expectations of how an individual should act, dress, talk, walk, etc. based on their sex, which is biological. Gender roles shape the pressures and expectations society places on male and female individuals. For instance in the old American culture men had to be the main source of income in the family, while women were expected to stay home take care of the children and do the domestic housework. In the short story â€Å"Girl† Jamacia Kincaid illustrates the feminine roles her mother taught her growing up and the expectations she needs to meet as a women, a wife, and a mother. In contrast with Kin caid, Michael Kimmel’s essay â€Å"Bros before Hos: The Guy Code† explores the code of masculinity that young men are expected to follow. Traditional gender roles influence many individuals in a positive or negative aspect as they grow and either resist or give in to the expectations within society. Growing up as little girl, my mother would always teach me the social expectations of the feminine roles associated with our tradition. I would always be playing with dolls, dressing in skirts, putting bows in my hair, pretending to be a princess and acting like Dorothy from the Wizard of Oz always clicking my sparkly red shoes. However, the pressures and expectations of the gender roles associated to your sex are more profound as you grow into an adult. As I grew into a young woman the expectations I had and still to this day have to meet are much more demanding and expected. Kincaid states, â€Å"This is how you set a table for dinner; this is how you set a table for dinner with an important guest; this is how you set a table for lunch; this is how to behave in the presence of men who don’t know you very well†¦Ã¢â‚¬  (385). Kincaid explains some of the feminine demands and expectations  her mother would teach her growing up. Similar to Kincaid experience, my mother would also establish the feminine roles and demands that I needed to accept and fulfill from the expectations that have been set forth from generations of women. However, the expectations I needed to meet to fulfill the duties as a wife and mother conflicted with my expectations of not wanting to be a wife or mother at all, but to establish and purse a stable career for myself. The view of femininity in the culture I was raised with compared to old American culture of the 50’s and 60’s. Women were seen as objects, accessories. Femininity was viewed as being fragile and weak, as well as having a â€Å"natural† mother like instinct. Women in my culture are defined as being dependent on a man, stay home do the groceries shopping, clean the kitchen, prepare breakfast, lunch, and dinner, iron their husbands shirt and pants, â€Å"wash every day, even if it’s with their own spit† (Kincaid 385), keep the household in order, and be the perfect wife, mother, and women or at least pretend to be. However, these traditional views of what feminine roles are defined as conflict with the mainstream American culture of today’s feminine expectations. Women in today’s culture are defined as either the main source of income or contribute the equal amount of income with their spouse. Women are seen as independent and many women have established stable careers. In â€Å"Bros before Hos† Kimmel asked a female college student what it means to be a women she stated, â€Å"’Nobody can tell me what it means to be a women anymore’† (462). In modern American society being a woman has no concrete formulated expectation or role that she is expected to fulfill. Although in today’s modern American society views women differently as they once did, my culture still views women in a more traditional aspect. These conflicts or being independent or dependent, pursuing a career or being a domestic house wife and mother affect both expectations I have to meet with my family culture and the culture I was born into. Being one of the youngest girl in my family I would observe my cousins and see them being pressure of the roles and expectations that where concretely defined in my cultures view of femininity. Their decisions of following the domestic housewife role  affected me to resist these pressures, while they did not and gave me the courage to fulfill my and modern American society’s expectations of what being a woman is and not just stay at home and spend all my husbands’ money because I have nothing better to do. Gender roles have always been a social issue that shape the way we think of others. These roles perceive women as fragile and weak, while men are seen as aggressive and show little to no emotion. Gender roles can vary from one culture to another and have different expectations associated with masculine and feminine roles individuals have to obtain. Gender expectation such as women have to stay home and do the domestic housework, while men are the source of the primary income can either conflict or reinstate the expectations of you. These roles can affect an individual either in a positive or negative ways, whether or not they want to override the social norm of what society says is acceptable or give into the pressure of the roles society established for each gender. The gender roles one’s culture establishes or society establishes becomes more overwhelming as we grow older, enforcing these expectations further. Also, your culture’s view of masculinity or femininity may conflict with mainstream American culture and a rise conflicts for an individual. It’s up to them whether they want to endure the pressures or resist the pressures of traditional gender roles or modern American gender roles. Word Count: 1,025 Reference Page Kincaid, Jamaica. Girl. Boston, Mass.: Bedford/St. Martin’s, (2013): 384-386. Print Kimmel, Michael. Bros before Hoes: The Guy Code. Boston, Mass.: Bedford/St. Martin’s, (2013): 461-471. Print.