Frankenstein and How to Read Literature Essay

The pursuit of knowledge is the very heart of Frankenstein. Mary Shelley depicts how the very pursuit, thirst for knowledge ruined one man’s life. Victor’s life is consumed by a want for more knowledge and Mary Shelley shows the before and after effects of that relentless pursuit. Robert Walton life could also be ruined by an endless need for more knowledge. The ruthless pursuit of knowledge, of reaching for a distant light proves dangerous to both Victor and Robert. The monster, Victor’s act of creation, eventually results in the destruction of everyone dear to him and Robert’s expedition is dangerously encased sheets of ice. It is here that the two characters pursuit of knowledge diverges. Victor’s telling of his story shows the dark path his need for knowledge led him down and ultimately his obsessive hatred of the monster, his creation, leads to his death. It is the telling of Victor’s story that pulls Robert back from his single minded mission and shows him the destruction that can lead from a blinded need for knowledge. Although the monster’s learning experiences and knowledge are not as advanced as Victor and Robert’s it is significant in this book. The monster’s thirst for knowledge was driven by a need for acceptance and understanding of his creation and ultimate rejection. Chapter 10: It’s More Than Just Rain or Snow Mary Shelley uses the weather as a metaphor throughout Frankenstein. It is coupled with Victor’s sickness as a foreshadowing of coming events. The storm that occurred on the night of William’s murder is an example, a foreshadowing, of the misery caused by the monster that night. Another example of seasons and the effects of them on this story is seen when both Victor and the monster feel the lifting of their spirits during warm weather. The Alps show a spiritual awakening and self-reflection, whereas, the cold and stormy weather of the north arctic or the rain of Victor’s wedding night show depression and thoughts of death. Both examples underscore the desperation of Victor and the monster’s circumstances and remind them of their own coming doom. It is clear that the weather directly corresponds to the attitudes and feelings of the characters. Chapter 11†¦More Than It’s Going to Hurt You: Concerning Violence The use of gloomy imagery reveals the creature’s feelings of abandonment and how much his pain was greater than that of Victor’s. The creature goes through a great deal of hatred brought on by his feelings of suffering and abandonment. As the book develops Shelley uncovers levels of sadness in the creature. An observation discovered through Mary Shelley’s writing style is how she uncovers the sense of sadness in the creature. His feeling of abandonment is seen when he talks of his emotions to Victor stating, â€Å"Be calm! I entreat you to hear me, before you give vent to your hatred on my devoted head. Have I not suffered enough that you seek to increase my misery? Life, although it may only be an accumulation of anguish, is dear to me, and I will defend it† (68-69). The theme of no one listening to the monster, thereby excluding him from society, is scene throughout the book. During this passage between the creature and Victor, he explains his feelings throughout his journeys using dark imagery in his attempt to make Victor understand what he felt inside. An attempt to show Victor that his pain was greater and would hurt him more than any pain he inflicted upon Victor. The creature says that even though his life is an â€Å"accumulation of anguish†, he will continue to live because he cares about his life even though no one else does. Chapter 12: Is That a Symbol? Touches of violent imagery are given to the reader throughout the book. The violent side of the creature is unleashed and shown to the reader as he tries to find a moment of acceptance by the human community. An excellent example of this is the portion of the monster’s story where he is sharing the cottage with the Delacy family. After being rejected by society, the monster took refuge in a little barn adjacent to a small, humble cottage. Through a gap between the barn and the cottage the monster observed their behavior. He was amazed that despite their poor circumstances the Delacy family still maintained a loving relationship. The creature remarks, â€Å"When I slept, or was absent, the forms of the venerable blind father, the gentle Agatha, and the excellent Felix flitted before me. I looked upon them as superior beings, who would be the arbiters of my future destiny. I formed in my imagination a thousand pictures of presenting myself to them, and their reception of me. I imagined that they would be disgusted, until, by my gentle demeanor and conciliating words, I should first win their favor, and afterwards their love† (72). Chapter 19: Geography Matters†¦ In a person’s life social geography plays a huge role. Included in social geography are segregation, economics, class, and race. All which play a part in how a person lives and how they are treated by society. In addition to the fore mentioned factors, a person’s looks play a part in how they are looked upon by society. Deformities, monstrosity, can directly affect where a person lives and even their class. In Frankenstein, Shelley used the monster’s looks to single him out in society. The origins of his looks were the unnatural manner of his creations, and it was this origin of his looks that made everyone want to get out of his path, to cross the street to avoid contact. The monster was immediately abandoned by Victor without any direction and left to deal with preconceived prejudices people had based on his looks and no personal knowledge of his situation. The monster’s lack of knowledge as how to handle these reactions from society pushed him to commit crimes. The monster said, â€Å"I, the miserable and the abandoned, am an abortion, to be spurned at, and kicked, and trampled on† (Shelley 19). This eruption of self-pity by the monster in questioning the injustice of his treatment by society and his creator displays his inner life, giving Walton and the reader a look into the monster’s suffering and his motivation behind his crimes. Chapter 20†¦So Does Season The changes in Victor’s physical and mental state seem to mirror the changes of the seasons, or maybe these states are simply affected by the change of the seasons. An example of this would be the period in which Clerval nursed Victor back to health. During this period the season changed to spring and could be seen as signs of new beginnings. Clerval helps Victor regain his physical health and re-discover his love for the natural world he lost during his quest for creating new life. Shelley’s use of the excerpt that â€Å"Winter, Spring, and Summer passed away† during Victor’s work, does more than just inform the reader of the passing of time buts reminds the reader of the imagery relating to each of the seasons. In addition, the phrase â€Å"passed away† indicates that time Victor could have spent enjoying nature â€Å"died† while he was closed off in his laboratory. Furthermore, the excerpt describes that â€Å"The leaves of that year withered before my work drew near to a close†¦Ã¢â‚¬  The use of the word â€Å"withered† hints to Victor’s body becoming frail and unhealthy during that time. The imagery showed that Victor was in an unhealthy state of body and mind. Chapter 25: Don’t Read With Your Eyes Mary Shelley’s Frankenstein, as many other works of its time, have been taken apart and studied repeatedly for underlying meaning by the author. Scholars look for an understanding of what they believe Shelley’s views and what message she was trying to give to the reader. So many have taken apart this novel, analyzing it over and over again, from many different angles, yet her work still remains a puzzle to solve. Could this perhaps be the result of over-analysis? Are scholars looking too carefully and too deeply for a meaning more elaborate than a story told by a teenager? Mary Shelley was eighteen at the time she wrote Frankenstein. Taking into account her age, is it more likely that Shelley was not commenting on social aspects but expressing feelings felt by all teenagers. Almost all of us can relate to a time when we were young and misunderstood by our parents. A time when feelings of isolation, separation and being misunderstood, were common experiences. These feelings being attributed to the monster could be nothing more than the feelings that Shelley was herself feeling at the time. Works Cited Foster, Thomas C. How to Read Literature Like a Professor: A Lively and Entertaining Guide to Reading between the Lines. New York: Quill, 2003. Print. Shelley, Mary Wollstonecraft. Frankenstein or, The Modern Prometheus. Berkeley and Los Angeles: University of California Press, 1984.

Outsourcing Trends: Health Services Professionals

[pic] MGT 6220 – Health Care Human Resource Management Outsourcing Trends – Health Services Professionals Fall 2012 Research Paper Anthony Edens Thomas Grumley Outsourcing Trends – Health Services Professionals In today’s healthcare environment, hospitals are facing increasing pressure to reduce costs, increase efficiency and improve the quality of patient care. Although some of the details of the impending changes may not be perfectly defined, the industry is certain that changes are inevitable.Going forward, there will be an increased focus on quality; penalties for re-admissions, medical errors and hospital acquired infections (Buser, 2010). Several factors, such as aging populations, new treatments, low patient financial responsibility and misalignment of incentives have forced the Government to reconsider current Medicare reimbursement arrangements (Kaplan, Porter, 2011). For example, fee for service, which reimburses providers and hospitals based on the procedure performed, are not based on the desired outcome which should be good patient health.Therefore, the incentive for the provider could be to perform more of the higher reimbursement procedures and not to focus on decreasing the costs of business. Unfortunately, this has lead to a cycle of increasing costs for the government and payers, who are now looking for ways to decrease reimbursement and align incentives with quality while reducing re-admissions. Decreasing reimbursement will force hospitals that are not currently focused on cost control to rethink the existing strategies. In light of this, hospitals will need to concentrate on expense control, staffing productivity and service line efficiency.Crucially, hospitals will need to focus on effective alignment with physician practices and hospitalists. One consideration that continues to arise is whether to outsource certain functions from an employment model to one involving outsourcing, and one which will be discussed at length in the following pages. The current climate is signaling a clear increase in the trend to outsource a multitude of functions, for both large and small hospitals. In Modern Healthcare’s 33rd Annual Outsourcing Survey, 42 firms reported a 14% increase in the number of healthcare clients from 2009 to 2010.The following year’s survey, reported that among the top 20 outsourcing firms there was a reported 13. 1% growth from 2010 to 2011. The top 5 services which are currently outsourced are laundry, housekeeping, clinical/diagnostic equipment maintenance, hospital based emergency departments and food services (Kutscher, 2012). Additionally, the outsourcing of back office functions continues to increase. For example, firms providing accounts receivable functions reported a 21% increase in 2010 and firms providing medical record services reported a 6% increase in 2010 and an 8% increase in 2011 (Kutscher, 2012; Daly, 2011).Also related to the back office functions is effective revenue cycle management. When considering the tightening of the current and future reimbursement environment, the ability for a hospital to successfully collect monies owed and to reduce bad debt will be crucial. For example, in May of 2011, Conifer, a subsidiary of for-profit hospital chain Tenet Healthcare Corp. , Dallas announced that it closed on a deal to provide revenue management services to 56 hospitals (Kutscher, 2012). Another area of explosive growth is in the IT sector.Part of the reason is that there is a federal mandate which requires hospitals and physician practices to show â€Å"meaningful use† of electronic records. Not only are there financial incentives for implementing electronic health records early, there are financial penalties for those that have not implemented a system over the next few years. Robust growth can also be seen among the firms that provide diagnostic equipment maintenance. In Modern Healthcare’s 33rd Annual Outsourcin g Survey, these firms saw 12. 6% growth from 2009 to 2010 and the following year’s survey showed a 16. % increase. This is due to the fact the medical equipment is growing increasingly more complex and that specialized firms are able to adhere to strict maintenance schedules, provide detailed documentation and track repair costs. One of the largest areas of growth is in the outsourcing of anesthesia services. From 2009 to 2010, the growth among survey respondents was 147% to a total of 222 contracts. One of the reasons for this is that anesthesia services can operate as a self contained unit within a hospital.This works more efficiently than if each physician would bring in their own team by providing both consistency and cost effectiveness. However, there are concerns regarding outsourcing hospital services. Reasons for hesitation among hospital executives can be corporate culture, patient privacy and regulatory compliance. There are definite security and compliance concerns related to the outsourcing of electronic medical records. For instance, while Indian insurance and pharmaceutical companies have had success, gaining market share from U. S hospitals may prove to be difficult. As soon as it leaves the confines of the U. S. , it's not subject to the same rigorous laws as we are,† says George Conklin, chief information officer of Christus Health (Sharma, 2010). Here, we are going to focus on outsourcing the hospitalist and revenue cycle functions and show some of the advantages and limitations of each. The number of hospitals that have hospitalist programs continues to grow, and today 2/3rd of all hospitals use a hospitalist program. Additionally, the demand for these providers currently outweighs the supply with a total of 31,000 covering the country’s demand of 40,000 (Buser, 2010).One of the reasons for this increasing demand is it allows those physicians with busy outpatient practices to concentrate on those practices and for the pro viders in the hospitalists programs to concentrate on the inpatients. Additionally, hospitalists can focus their attention to the details of inpatient management due to their more consistent practice patterns and expertise which all helps to reduce average length of stay and increase patient health and satisfaction. Hospitals can choose from either employing and managing the group of hospitalists directly or using a 3rd party vendor such as TeamHealth or EmCare to outsource the service.For instance, a hospital may choose to employ a group of hospitalists directly if it’s looking to ensure quality and bring the programs under local control to align the program with their own mission and values. However, crucial to the success of this is effective leadership and expertise. In some instances, employing hospitalists directly may require abundant investment in IT systems and other tools which will require large amounts of capital dollars that some smaller hospitals may not have ac cess to.In these instances a hospital may choose to outsource this function to take advantage of the large economies of scale and expertise a large vendor may be able to offer. For instance, in the article â€Å"Hospital Medicine’s Management Shuffle† by Bonnie Darves, Martin Buser, MPH, who is the co-founder of the hospitalist consulting firm Hospitalist Management Resources LLC, attributes the decisions to outsource to rapid growth of programs in which the hospital did not have the proper infrastructure and financial support to carry on with the program.Additionally, by outsourcing the practice the hospital reduces its regulatory risks as well as administrative and recruiting burdens. For example, in 2007 Hospital Specialists of Georgia, turned over management services to Cogent, a prominent and large vendor of hospitalist programs. At the time the group was handling a third of the medical center’s admissions and could not increase that without support.Without available capital, the company was not able to meet the growing demands of IT, especially as quality and performance measurement started to become more prevalent. (Darves, 2007). Using a 3rd party vendor whose expertise lies in focus and efficiency, and especially when combined with firms who bundle ED and hospitalist services, hospitals can reduce patient wait times and reduce the number of patients who leave the ER prior to triage or treatment. Ultimately this acts to increase the overall volumes of the hospital.Additionally, for 2012, CMS (Centers for Medicare and Medicaid Services) created two new critical measurements which measure, in minutes, the time from ED arrival to ED departure for patients admitted from the ED to the facility and from the admit decision time to the time of departure from the ED for patients admitted to inpatient status. Improving these times has a multitude of positive effects on the facility. For example, this can reduce the ED length of stay, increas e the ED capacity, improve the admission process and ultimately improve the patient outcome.Conversely, some may argue that quality and alignment with the hospital are better achieved when providers are employed directly. For example, Kadlec Medical Center of Richland Washington decided that in 2006 it would discontinue its arrangement with a large vendor and bring its program in-house. The hospital wanted more control over the number of hospitalists as well as the scope and quality of services (Darves, 2007). However, the data suggests that quality does not suffer when outsourcing a hospitalist program. This is why we recommend outsourcing in the case of a hospitalist program.In a 2009 survey released by the Medical Group Management Association, the data shows that a hospitalist from a large vendor sees, on average, more than 19% more patients per day than a hospitalist employed by the hospital. Patrick Hays FACHE and C. Thomas Smith explain in their article â€Å"Why the Independ ent Hospitalist Practice is here to Stay,† that this does not imply an adverse effect on the quality of the healthcare, and is instead the result of a focused effort where other hospital assignments are not competing for attention.An increase in focus and expertise can lead to early detection and better diagnosis of disease which ultimately leads to less expensive and less complex treatments, and importantly, to fewer re-admissions. Outsourcing the hospitalist practice is also cost effective. A 3rd party hospitalist vendor can usually integrate its existing software with the hospitals and reduce training and orientation costs that could come with having to learn a new EMR system. In addition to IT and recruiting costs, there can also be costs associated with billing, accounting, legal, regulatory, marketing and quality control.Should a hospital choose to employ the physicians and experience rapid growth without the proper infrastructure, these costs can quickly deteriorate the earnings of the group. Regulatory and legal costs can be especially problematic. For instance, Stark and Anti-Kickback Laws limit what a hospital can pay to an employed physician and require that each contract be put under scrutiny to ensure fair market value scrutiny to guarantee there are no conflicts of interest between the physician, hospital and patient.To make certain a hospital is not violating these serious and complex laws, it would need to employ and increase its legal department’s infrastructure to include a department specifically designated to physician contracts, a cost many small hospitals may not be able to afford. With so many reasons for a hospital to use a 3rd party vendor, hospitals may become increasingly interested in avoiding the employment model. John Donahue, CEO of Cogent HMG expects a â€Å"dramatic ramp up of hospitalist consolidation† in the coming years because of the new quality requirements the government is demanding the hospitals meet .The large hospitalist companies already have effective ways to measure this as well as reduce length of stay and complications resulting from hospital stays (Robeznieks, 2012). Another step firms are taking to convince hospital executives that outsourcing is the right choice is using local contractors and simultaneously offering a national support model. For example, Radisphere, an Ohio based radiology outsourcing firm, uses local radiologists who work with a network of offsite subspecialists offering continuous access to consultations.In summary, outsourcing hospitalist services can provide hospitals, large and small, a cost effective and efficient means to provide quality patient care. With an ever increasing focus on quality, using a group focused physicians with hospital expertise who do not have competing private practices can increase patient satisfaction, increase hospital capacity and volumes all while helping the hospital achieve its goals while creating and maintaining a good quality reputation in the community. Let us not forget, however, that the presence of Human Resources should be critical in this decision.The head of Human Resources needs to understand the dynamics of the business and the challenges that lay ahead should the company choose to outsource an existing function or in-source a function currently delegated to a 3rd party firm. For instance, if a decision is made to outsource an existing department there will need to be a roadmap for the existing employees. Ask questions such as, â€Å"Will there be a severance package or can these employees be transitioned or transferred to open positions in other areas of the company? Furthermore, there needs to be discussions regarding the reliability of the outsourcing firm and a contingency plan should the firm go out of business or discontinue the relationship. Are there alternative companies that could provide similar services if this situation were to arise? Will the chosen firm be able to me et the projected volume needs to the hospital? Additionally, even if the hospitalist function is outsourced, communication from management and HR will remain important so that those in these new positions still feel supported and motivated.HR needs to work closely with the firm providing the services so that boundaries, objectives and targets are clear. In a situation where an outsourced function is brought in-house, HR needs to ensure that the current management infrastructure can accommodate the new positions. Especially in the case of employing hospitalists, contracts as well as compensation and benefit packages need to be created. Another example of where opportunities lie for outsourcing departments is in office functions such as revenue cycle management.In recent years, hospitals have steadily warmed to the idea of outsourcing functions which were previously kept in-house, such as business processes and information technology. However, a host of factors–including the pa ssage of the Patient Protection and Affordable Care Act, the faltering economy and the increasing emphasis on quality and performance improvement–have pushed that trend into overdrive (McKinney, 2010). In order to remain competitive and stay afloat, hospitals and other healthcare organizations are desperately looking deeper into business functions to determine the areas that may be better off outside the walls. Faced with a potential flood of new patients and lean budgets, hospitals are carefully considering each department to determine which functions can be turned over to contractors, and more areas are fair game than ever before†, says Reggie Hill, a partner at Waller Lansden Dortch & Davis, Nashville (McKinney, 2010). Although housekeeping, food services, and diagnostic equipment maintenance are among the most common outsourced services, revenue cycle management is becoming increasingly popular. Because of the perception that there will continue to be cuts in reimbu rsement and new reimbursement models, hospitals are looking for ways to cut expenses and maximize revenue,† Hill says. â€Å"If an outsourcing agreement looks like it will accomplish those goals, it's going to be something a hospital will want to take advantage of. † In particular, there has been continued growth in the number of organizations that are seeking out revenue-cycle management services, Hill says. â€Å"There are vendors that have shown they can add value, and more hospitals are giving it a try† (McKinney, 2010).Although more organizations are looking into the use of a vendor, it is important to consider all variables before determining the best option. Outsourcing the revenue cycle function does not fit all business models. Factors such as practice size, legal compliance, training ability, cost savings, quality, and efficiency should be studied carefully in order to realize the maximum return on investment. Companies that fit the outsourcing model an d execute the transition properly can realize the greatest rewards.Conversely, outsourcing may be the downfall of an organization if these factors are not considered. When a company commits to outsourcing, cost savings tend to dominate and labor rates are a large contributing factor. In search of satisfaction, many companies are looking to offshore vendors. Offshore outsourcing companies might save hospitals even more money in labor costs because employees in countries such as India often work for much less money than U. S. staffers (Mantone, 2003). Managing a department outside of the organization’s walls has its other cost saving advantages.Having fewer internal employees reduces the need for back office space which will generate savings in rent. With a billing service, billing and collection activities occur off-site and therefore it may be possible for a hospital to reduce its current overhead costs or convert existing office space to a revenue generation, patient service s area (Schechter, 2000). Furthermore, cost savings with outsourcing may also be realized in more subtle ways such as an adaptation of superior processes. The demand for standardization in revenue cycle management is on the rise. Despite growth in the industry, the floundering economy has made some providers skittish about first-time outsourcing deals†, Zambuto says. Another motivating factor that is convincing many to take the plunge is the need for standardization, he says. Outsourcing to a vendor can help ensure processes are done the same way each time at every location, which reduces the probability of errors, he says (McKinney, 2010). With this standardization comes an increased revenue flow. Many companies are careless with collections and spend unnecessary time, money, and resources on correcting mistakes.Re-billing and managing overpayments can become costly due to the increased hours of operation and additional wages paid to employees working these claims. If the bil ling can be done quickly and accurately the first time, these costs will not have to be wasted in order to generate the same amount of revenue. For example, Marshall McHenry, MD, a Cincinnati internist, chose to outsource billing when he started his own private practice. â€Å"He pays an outside billing service 6% of collections or about $20,000 to $22,000 annually, he said.In contrast, an in-house biller would have cost $30,000, including benefits, and a billing system would have cost several thousand, if not tens of thousands of dollars, Dr. McHenry estimates. Also, had he hired a biller, he would have had to factor in training and vacation time, and figure out how to avoid down time that could have seriously hurt his practice† (Chin, 2003). Additionally, this higher level of quality requires ongoing employee training which may become not only time consuming, but expensive. The billing service is responsible for hiring, training and supervising staff.They also are responsib le for coverage when any of their employees are out of the office. And they are responsible for acquiring and maintaining all necessary computer software and hardware as well as addressing other technology-related issues (Schechter, 2000). The relief of these burdens will allow management to focus more on its core competencies. Typically, a revenue-cycle outsourcing firm takes over some or all of a hospital's business office functions, which can include everything from patient registration, accounts receivable, billing and coding.They consolidate those functions into larger offices that serve many providers. The end result, outsourcing companies say, is a more efficient model that leaves more operating revenue for hospitals. Those types of business arrangements will likely continue as cash-strapped hospitals see the potential for big savings, says Dean William Harvey, a partner at the law firm Vinson & Elkins in Dallas (McKinney, 2010). Richard Garnick, chairman and CEO of Anthelio Healthcare Solutions, credits the â€Å"incredible† cost pressures on hospitals for the growth in his company's revenue-cycle management services.In the case of federal healthcare programs, Garnick has seen his client hospitals grow increasingly concerned that possible across-the-board cuts to Medicare and Medicaid could push them into the red. Those concerns have led some of Garnick's core clients at community hospitals to replace their in-house back office staff with his employees to reduce the cost of those functions by 30% to 35%. â€Å"That gap will potentially allow that hospital to survive,† he says about one recent client (Daly, 2011). Success with outsourcing has also been achieved by Marc D.Grobman, DO, a solo internist at Internal Medicine and Primary Care in Wilmington, DE when he chose to use Health Care Practice Management Inc. as a billing service. He says he is getting 98% of money due compared with 75% when he was part of the hospital network. â€Å"A t first using a billing service was a virtual necessity. Now I see no reason to bring it in-house because it's working out so well,† Dr. Grobman says. He also thinks he gets more expert billers through outsourcing, which in turn means he leaves less money on the table. Dr.McHenry contends that he gets about 10% more — $35,000 to $40,000 a year — than he would have had he hired someone to handle billing. Because it's a specialized skill, it can be hard to find good billers in the local labor pool, he added (Stevens, 2007). On the contrary, outsourcing does have its drawbacks, and most notably, a reduced sense of control is inevitable. Outsourcing firms are responsible for these functions which prevents the hospital from easily maintaining close management of operations. â€Å"The downside is you can lose control,† said Louis Korman, MD, one of Dr. Weinstein's partners. â€Å"You can be taken.There are a lot of people who think that doctors' practices are j ust money mills they can take advantage of† (Chin, 2003). Additionally, an absence of direct management may result in poor customer service. Third party billing firms may be required to deal with patients directly and it is difficult for the hospital or physician practice to monitor this interaction closely. Many physicians believe that they are able to maintain better relationships with patients when billing functions are kept in-house. Without this strong patient – provider relationship, a healthcare organization may not be able to survive.Moreover, a third party revenue cycle management firm may not hold the same work ethics as the healthcare entity which may result in subpar performance. A vital piece to the success of any billing department is legal compliance and these performance standards must be met. But revenue management outsourcing has its share of pitfalls, most notably legal compliance, he adds. Providers need to be confident in a contractor's ability to m anage the billing requirements of Medicare and other programs, while successfully complying with the Health Insurance Portability and Accountability Act of 1996 (McKinney, 2010).Dissatisfaction with an outsourcer's performance led Detroit Medical Center in February to sue to dissolve a 10-year, $300 million contract with Provider HealthNet Services, Dallas. Detroit Medical said the outsourced operation failed to achieve timely completion of medical records and had not delivered on a plan to train employees and organize the department for computerized records. Provider HealthNet said uncooperative and obstructive action by Detroit Medical officials caused the performance problems (Morrissey, 2003).A company’s decision whether or not to outsource a department will inevitably require the presence of Human Resources. One advantage of outsourcing the revenue cycle management team is the distance that it creates between management and the frontline employees. In some cases, this di sconnect is desired by the hospital because it relieves the duty of having to deal with employee issues. If an employee of a hospital is not performing, the management team will have to carefully follow HR policies and document progression of failing performance before termination may occur.This can not only be time consuming, but it can hinder productivity until the change may be made. Utilizing a vendor will allow the hospital to simply request that a replacement be made for a certain employee without having to follow any HR policies. â€Å"While the net cost of farming out billing is unknowable, Dr. Schwartz does believe that whatever it is, it's worth the peace of mind it gives him. † An outsource service insulates us from the kinds of problems that could get us into financial trouble,† he says. There are some advantages† to not having him on staff, Dr. Weinstein said. â€Å"The biggest one is that if he's not doing a good job, I don't have to worry about fir ing him. I just have to say to the company, ‘Hey, this guy is not doing a good job. I want somebody else. ‘ They have to worry about firing him, and firing high-level people is not easy to do† (Stevens, 2007). Although some hospitals may find this ‘peace of mind’ to be worth a potential added cost, there are some disadvantages that an HR department may face with outsourcing a business function.Whenever a hospital chooses to outsource a department or other function, it will unavoidably have to endure a layoff of some magnitude. A layoff or employee termination will most certainly involve a strong HR presence. No matter the level of expertise of the HR department, this process is never easy to manage. In some cases, a layoff may be necessary involving employees who have been part of an organization for years. Relationships have developed between the employees and management team which can make this event even more difficult.However, if the business decis ion to outsource is made, many times a layoff is most likely unavoidable. Additionally, this will create a loss of jobs in the community. â€Å"Also it can be a â€Å"hard sell† because outsourcing hospitals are â€Å"taking jobs from the local community and putting them elsewhere,† Johnston says. â€Å"It's not that big of a deal when the office has 10 people,† he says. â€Å"But when there are 100, 200 people in the office it becomes a big deal† (Mantone, 2003). This event can also create a negative image for the hospital which may not be beneficial for its reputation.This challenge must be closely managed by the HR department. In conclusion, outsourcing can be an effective way to increase the efficiency and lower the costs of an organization. In the case of using a 3rd party hospitalist firm, it uses a focused group of physicians who not only help to decrease costs but improve patient care and decrease re-admissions. Also, with improved patient care t here comes a decrease in the average length of stay which is obviously great for the patient but also enables the hospital to increase its capacity for additional patient services.It can be advantageous to a hospital to use a 3rd party outsourcing firm so long as the goals and expectations are clearly outlined and defined within the contract terms with the firm providing these services. Another example of an opportunity to take advantage of the focus of a 3rd party firm is in the realm of the revenue cycle function. Advantages such as decreased overhead costs, increased expertise and augmented standardization are ways in which a hospital can improve its overall collections, decrease its net accounts receivable days and lower the amount of money spent to do so.Outsourcing does not necessarily imply going overseas, as mentioned in the hospitalist example above, patient care mostly depends on human interaction in most services and so the local community economy remains intact. In the e nd, HR needs to be well versed in the goals of the company and be able to contribute to the decision by offering perspective on future labor needs, compensation and benefit costs or savings and strategic alignment with the hospital’s strategies and mission. â€Å"References† Buser, M. , (2010, December). Hospitalist Programs in the Age of Healthcare Reform.Journal of Healthcare Management, 55:6, 378-380. Chin, T. , (2003, August 11). The Doctor is Outsourcing: To Hire or Not to Hire. American Medical News, Retrieved November 15, 2012 from http://www. ama-assn. org/amednews/2003/08/11/bisa0811. htm Daly, R. , (2011, September 5). Under Pressure. Modern Healthcare, Vol. 41 Issue 36, S1-S4. Darves, B. , (2007, May). Hospital Medicine’s Management Shuffle. Today’s Hospitalist. Retrieved November 10, 2012 from http://www. todayshospitalist. com/index. php? b=articles_read&cnt=64. html Hays, P. , Smith, C. Thomas. , (2010, October).Why the Independent Hospitali st Practice is here to Stay. Physician Future. Retrieved November 18, 2012 from http://www. physicianfuture. com/news/physician-news/why-the-independent-hospitalist-practice-is-here-to-stay. html Kaplan, R. , Porter, M. , (2011, September). How to Solve the Cost Crisis in Health Care. Harvard Business Review, 48-49. Kutscher, B. , (2012, September 3). Expertise on Call. Modern Healthcare, Vol. 42 Issue 36, 20-27. Mantone, J. , (2003, November 24). Letting Someone Else Do It Better. Modern Healthcare, Vol. 33 Issue 47, S10McKinney, M. , (2010, September 20). Outsourcing Sees Stimulus Effect: Health Reform, Ailing Economy Prompt a Closer Look at Use of Contractors. Modern Healthcare, Vol. 40 Issue 38, pS1-S5, 5p. Morrissey, J. , (2003, May 12). Not Paying Off: Baylor, EDS Terminate Revenue Management Deal. Modern Healthcare, Vol. 33 Issue 19, p3, 1/2p. Robeznieks, A. , (2012, April 2). Partnering up: As Consolidation Begins to Sweep through Healthcare, Hospitalists Expect to See the T rend Accelerate in their Sector. Modern Healthcare, Vol. 42, Issue 14. Schechter, K. , (2000, July 24).Compare Costs, Benefits of Billing Service vs. In-House. American Medical News, Retrieved from http://www. ama-assn. org/amednews/2000/07/24/bica0724. htm Sharma, A. , Worthen, B. , (2010, November). Qualms Arise Over Outsourcing of Electronic Medical Records. The Wall Street Journal. Retrieved November 29, 2012 from http://online. wsj. com/article/SB10001424052748704865104575588252907738276. html Stevens, L. , (2007, April 16). The Ins and Outs of Billing: Pros and Cons of Outsourcing. American Medical News, Retrieved November 15, 2012 from http://www. ama-assn. org/amednews/2007/04/16/bisa0416. htm

Analysis Paper: Zinsser’s Book on Writing Essay

How can I, as a writer, balance writing for myself and for my readers without sacrificing the other? That is the question I was struck with while reading Zinsser’s book On Writing Well, and one he presents. In his book, writers are encouraged to adopt a style that is fitting of themselves, yet capture and maintain the attention of readers. What if my style does not capture readers? What if what captures the attention of readers does not do the same for me as I write? Am I stuck wrestling between this paradox of uncertainty or is there a way out? Note to self: NOT writing is not an option. Luckily, Zinsser, who is a writer, editor and teacher, offers solutions in chapters four, five, and nine that I found very helpful and will serve as a guide in future writing assignments. He advises that I eliminate any unnecessary words and keep my language simple. This won’t take away from my style, but enhance it by removing the â€Å"excess or murkiness [that] has crept into [my] style† and obstructs the message I am trying to convey to readers. Style is something that every writer possesses and makes him/her equally unique. So, the first step in capturing my audience while writing for myself is to relax and be myself. Zinsser states: The reader will notice if you are putting on airs. Readers want the person who is talking to them to sound genuine. Therefore a fundamental rule is: be yourself (19). Before writing, I should relieve myself of any pressure to write in a way that feels unnatural, produce an awesome paper that will rock everyone’s socks off, or meet a certain page length. Just sit down, believe in my own identity and opinions, and write! Aside from being myself, the second step is to determine the audience of my paper. A writers’ audience will first and foremost be him/herself. See more: how to write an analysis of a research paper Zinsser continues to reiterate this point of authenticity by saying, â€Å"Don’t try to visualize the great mass audience. There is no such audience – every reader is a different person†¦You are writing primarily to please yourself, and if you go about it with enjoyment you will also entertain the readers who are worth writing for (24). † Oftentimes, I forget about myself when writing in an effort to complete the assignment and give the teacher what I think he/she may be expecting from someone at my educational level. Those assignments have been the ones I least enjoyed writing and/or have been told was missing my voice. By writing in this manner, I have been performing a huge disservice to my audience by not giving them what they need: me. I apologize! Along with expressing my personality, I should not neglect my craft. There is no excuse, as Zinsser states, for sloppy workmanship. I should respect my audience enough to pay close attention to technical details and ensure that their reading process is one of clarity then artistry. Third and final, I should start and end all of my writing assignments with â€Å"freshness, or novelty, or paradox, or humor, or surprise, or with an unusual idea, or an interesting fact, or a question† that will capture my readers (55). Zinsser says that the most important sentence in any article is the first one. If the reader has not been attracted to my subject through that sentence then there are no chances the reader will want to read further. Along with creatively beginning and ending my writing assignment, the information I present must give the reader a sense of purpose while reading. Readers need to know why I have chosen my topic, why they should read it, and be given enough information that leaves them feeling well-informed. As I continue to hone my writing skills and further develop them in other students, I want to carry Zinsser’s central message of authenticity with me. Writing at its best is unique, informative, and â€Å"an intimate transaction between two people, conducted on paper, and it will go well to the extent that it retains its humanity† (20). I want to urge my students to never forget the most essential piece in their writings: themselves. If that is forgotten, then the â€Å"intimate transaction† that is needed between them and their audience will be distant and ineffective.

The Nursing Process Discipline Theory Dissertation

The Nursing Process Discipline Theory - Dissertation Example As such, nurses need to put in place different reminder systems, as well as the implementation of infection control programs in order to be in the best position to decrease effectively all forms of catheter-associated UTIs (Elphern, 2009). This is despite the challenging aspect of their introduction into the treatment program or the patient care plan. Therefore, in order to achieve all this, the nurses have to rely on the Nursing Process Discipline Theory as suggested by Orlando in order to undertake their respective duties effectively. Orlando’s Nursing Process Discipline Theory states that the role of a nurse is o find out the immediate needs of a patient and help him or her. For instance, the presenting behavior of the patient can be a cry for help. Nevertheless, the assistance that a patient needs might not necessarily be what he exactly wants or desires. As such, this requires nurses to make use of their personal perceptions, their thoughts about these perceptions, as well as their feelings possibly engendered from their thoughts in an exploration of the meaning of each patient’s behavior. This will inevitably assist the nurse to discern the nature of distress of a given patient, thereby being in a better position to provide the patient with the much-needed assistance. According to Elphern (2009), this theory applies to the prevention and management of Catheter-Associated UTIs because it enables nurses to act professionally at all times. This is because they have to prevent an infection from occurring, and as such, have to study the patient at all times and be there at their times of need. The best way to prevent such infections is to avoid any unnecessary catheterization, or removing catheters as soon as possible. Since nurses are well aware of this procedure, they will advise patients appropriately for them to avoid catheterization where possible. In addition, these nurses will also monitor keenly the patients fitted with catheters on a daily basis to determine when is best to remove or change the catheter at the soonest possible

Story Lesson Essay Example | Topics and Well Written Essays - 250 words

Story Lesson - Essay Example This way, the teacher is able to understand the level at which each individual students understand the concepts learnt in class and can thus address these individual problems. The teacher uses several behavioral modification strategies that ensure that the objectives of the lesson are learnt. One is through giving direct instructions which each student is expected to follow. She also uses direct questioning where she mentions the name of a few students and asks them to give answers to her queries. The teacher also reinforces the students who give the correct answers with praises which motivates them to continue participating in the classroom discussion. I was impressed by the manner in which the teacher paced down the class getting close to all the student and not being localized at the front. This reminded me of my teaching where I tend to concentrate more on writing on the board other than connecting with the students. I have also noted that some students in the class are encouraged to type the work on the computer. Using the word processer is a good way of enhancing writing skills in student as it identifies some grammatical errors and this speeds up the level at which the learners polish up their

Do you think that Crito is being a good friend to Socrates by trying Research Paper

Do you think that Crito is being a good friend to Socrates by trying to convince him to escapeThe focus on your reflection should be the nature of friendship.What does it mean to be a good friend - Research Paper Example 196). This statement would have us believe that Crito was not really interested in the philosophy of Socrates and thus does not qualify as a friend at all. However, in real life, friends may not understand our attitudes Critics have also pointed out to the role of Crito in the financial affairs of Socrates, which they use as a point to accuse Crito of false friendship. â€Å"Crito suspects that people will say that he had cared more for his money than for his friend†¦most scholars, failing to understand the depth of Crito’s concern, have picked out this argument to dismiss Crito as caring only for appearances† (West 71). Crito’s concern for his friend, has however been proved beyond doubt by his subsequent questions to Socrates. These questions include ones where he enquires of Socrates whether his refusal was because of the risks that he would run; â€Å"justice demands that friends run such risks† (West 73). That the concern that Crito expresses for Socrates is thus that which would be expressed by any true friend is evident from this. From the above analysis, it is fairly evident that the actions of Crito were totally selfless. His inability to completely understand the philosophy of his friend should not be held against him, since such instances are very rare where two friends are of the same intellectual

Personal Statement for MSc Investment & Wealth Management [Imperial

For MSc Investment & Wealth Management [Imperial College London] - Personal Statement Example This company also increased my knowledge in insurance and financial services including wealth or asset management, and at this point, I realized I was in a wrong course. My love and passion for things to do with finance, banking, insurance and asset or wealth management increased. It was until recently when I went back to work again with HSBC under internship program that I then realized that I needed to pursue a career in a field that relates finance and assets as I mostly used to deal with loaning sector when the loan was based majorly on assets and the collateral. After a thorough search and consultation, I landed on the Msc. Program in Investment and Wealth Management to be the best course for me as it encompasses all my recent work experiences. My positions of past responsibilities include being a student trainee at the AIA International Limited. Here, my achievement included learning various insurance products and services as well as taking part in a group project to expose me to being a good team player. I also held the position of a student trainee at the HSBC Commercial Bank where I achieved experience from a day to day operation and the experience of working under an assigned manager. Ive also held the position of a quality control engineer assistant at the KeyStone Electric Wire and Cable Limited. Here, I was responsible for filing, lodging and inputting the cable testing data and documents. I also was responsible for multi-tasking, weight and size calculations of various wires and cables as I also assisted in writing cable specification reports. Lastly, I have also held the position of an assistant technician at Chung Sing Taxi Limited at the maintenance department. Here, my responsibilities included examining and i dentifying problems in the taxis as well as performing maintenance and repairs. All these positions held, and responsibilities have molded me to being one person who is focused, experienced

Rhetorical analysis Essay Example | Topics and Well Written Essays - 1000 words - 1

Rhetorical analysis - Essay Example The article is aimed at discussing the English as the dominate global language and, also acts as a rebuttal to retrospective arguments claiming that that position should be held by languages spoken by many people such as Mandarin. The writers commence the article with the aforementioned though inducing question, and promise in the thesis statement to explain what a global language is and how English became one. This introduction serves to prepare the reader for the ideas of the writer and creates an impression of a well thought out and organized article. The first post thesis paragraph examines and dispels popular preconception about a global language, alluding to Crystal’s book â€Å"English as a second language† wherein he posits that a language does not gain global pertinence based on the scope of words or intrinsic structure, or cultural and literal affiliations. The writers also cites Goh and Liam (Globalization of Language and culture in Asia) who found that the n umber of native speakers is not a determining feature since had this been the case Mandarin and Hindi would be considered global languages. The writer thus builds up their argument by eliminating these perceptions and creates suspense as they finally reveal what criterion determines this. They argue the status of the speakers is the main feature in giving a language global relevance; this is backed up by international recognition of the language and the number of second language speakers in the world. â€Å"The status of the native speakers that play a big role in raising the status of their language† (LCOM) It is notable that the writers of this article have alluded to two academic writers of repute and this way they create credibility for their work by presenting their perspectives. Furthermore, simply by virtue of the fact that they have cited and acknowledged makes it evident to anyone who may have interacted with the prior works that the bloggers have academic integrity by giving credit where it is due. Using these arguments, the writers are able to frame a logical viewpoint as to why English is a global language, take the first position on the status of the people. If one pursues Historical considerations and employs logical thinking, these arguments are largely proved sound. Most African countries speaking English were colonized by the British, and the status of the British as colonial masters necessitated that more natives learn and use English than the English to learn and use the local languages. Even English at some point in history was relegated to obscurity by Latin and French when the two were in their own times used by the Romans and Normans respectively in admiration, legal and religious fields by the conquerors. However, when the English speakers took over power and inevitably status, it naturally followed that the rest of the world would toe the linguistic line. The same case applied to India and Hong Kong where English is widely used despite being a second language. The claim about international recognition is also one that is easily validated logically, the more people recognize a language internationally, and the more likely they are to learn it as a second language. This further clarifies the position the English language since; it is the language, which many speakers speak as a second language. In fact, the number of those who speak English language are only found in a few countries North America,