Quality and Risk Scenario Essay Example for Free

Quality and Risk Scenario Essay The HIM professional can have a direct impact on the quality or compliance of specific operations or employees within a healthcare institution. Healthcare institutions, such as hospitals, can be huge institutions made up of hundreds or even thousands of treatment or operation specific areas operation. This can include anything from the surgeon who performs coronary artery bypass to the neonatal intensive care nurse who directly cares for struggling newborns to the physical plant worker who makes sure all the lights in the building stay on and the operating room is maintained at a certain temperature. As an overall institution the thought of identifying risk and liability within the organization can be quite overwhelming and daunting. The best way to approach this is to break things down into specific issues or areas and focus on one thing at a time, with the overall goal to be improving quality and reducing risk to the institution. This paper will focus on three specific scenarios that represent an area of risk and liability for the institution. These three scenarios will include the safety of blood transfusions within a hospital, dealing with power failure risks within a hospital and using operational checklists to improve employee efficiency, consistency and reducing the human factor of making mistakes. Scenario one is to be specific to a scenario involving patient care and safety. The specific discussion here will be the use of blood transfusions within the hospital setting. This is a procedure that has been done for dozens of years even as medical science has made tremendous progress. The reality is that science just hasn’t found a synthetic way to carry oxygen through the blood stream and blood infusions still remain today the best way to do just that. While the best procedure out there for this, blood infusions don’t come without their risks and financial impacts. A study by the University Healthcare Consortium analyzed over 29,000 blood transfusions over a 7 year period from 2003-2009 (Williams, 2011). These transfusions ranged anywhere from scheduled routine outpatient surgeries to unexpected traumatic injuries brought in through the emergency room. The analysis identified many risks associated with blood transfusions, including poorly trained staff, lack of trained staff, minor hemolytic allergic reactions all the way up to severe anaphylactic reactions. The study was even able to identify that the time of day that the transfusion was performed could positively or negatively affect the patient outcome. So, while this can be a lifesaving procedure a blood transfusion should not be taken lightly. Another study published in the April, 2012 issue of the professional journal Anesthesiology was conducted by Johns Hopkins Hospital analyzing the outcomes of over 3000 patients who received blood transfusions. This study reveals that measuring the hemoglobin level in patients can be an accurate indicator of when a patient should receive a blood transfusion. This is a significant study because it could have a positive effect on both patient outcome and the financial costs involved in giving a blood transfusion. The Johns Hopkins study revealed that patients were being given blood transfusions when they really didn’t need it. A normal hemoglobin level ranges between 12-14 and the study reveals that a level as low as 7 or 8 is safe. Prior to this study the leading specialty societies, including the FOCUS research group (Functional Outcomes in Cardivascular patients Undergoing Surgury), set parameters that transfusions were definitely needed if the hemoglobin was below 7 and probably did not need a transfusion if the hemoglobin was 10 or above. But nobody ever set any parameters on what to do if the hemoglobin ranged between 7 and 10. This left the physician to decide when to start a blood transfusion. The Johns Hopkins study revealed that because of this most physicians always erred in the side of â€Å"safety† by ordering a transfusion any time the hemoglobin was at or below 10. But the Hopkins study has now determined that a hemoglobin of 7 or 8 can be considered safe. Giving blood to patients who have a hemoglobin above 7 shows no real benefit and truth is that the risk due to side effects may actually be increased. Remember that this procedure has been in place for decades and this new research was a game changer. The benefits to a hospital from the Hopkins study are tremendous. The study revealed that the costs to the hospital for one unit (300ml) of blood can cost as much as $1,100. While the donor gives the blood for free it must be analyzed for toxic diseases including Hepatitis and HIV (IMVS 2012). The blood is then separated into red blood cells, platelets and plasma, to be distributed specifically where needed. Include the storage and transportation costs and you can start to understand why blood is so expensive. Only giving blood when truly indicated has been shown to reduce the use of blood by up to 66% per institution with no change in outcomes to the patient including â€Å"length of stay, heart attack, stroke, death, and even the ability to walk† (Clark, 2012). This is where the HIM professional can come into play. The HIM can take research articles like this or even acquire their own research and then do training to educate the hospital staff. The Hopkins tudy indicated that when the HIM spoke directly with the surgeons and showed them the research there was a tendency to accept the new mindset and start delaying blood transfusions until the patient hemoglobin dropped below 7. This resulted in extra blood supply for those patients who truly need it and a significant reduced operating cost to the institution. It’s the HIM’s job to establish or change procedures that reflect changing and beneficial modalities and to get the information out to the hospital physicians and staff so they can help reduce institutional costs and ultimately benefit their own livelihood. This process can be done for hundreds or even thousands of processes currently in place within a hospital institution. Now we move on from our blood transfusion scenario to one involving the infrastructure of the hospital. The specific example to be used here is the hospital power supply. Hurricane Sandy revealed for many healthcare institutions in the north eastern United States that they were not as prepared as they thought. Some of these hospitals did have emergency generators in place, but they did no good for providing electricity when they were located in the basement of the building submerged in water from the flood. Sometimes it takes a real catastrophe for us to truly see how prepared we really are and how to improve. It’s crucial that a hospital be able to maintain electricity at all times. Almost every part of the building depends on electricity for staff to function and take care of their patients. Without electricity the lights won’t work, the furnace and air conditioners won’t work, the pumps won’t pump water through the pipes, ventilators will stop working and elevators won’t even be able to transfer sick patients between floors. These are some examples, but surely you can find many more failures if you look hard enough. For this reason, it is important that a hospital evaluate and have a plan in place to reduce the possibility of losing electricity and also have a plan in place if all safe guards fail. The concerns can truly be specific to a geographic area. For example, a hospital in the Midwest may not have to worry much about being hit by a hurricane, but it could be hit by a tornado. I spoke with hospital administrator Robyn Mazzolini at Advocate Lutheran General Hospital in Park Ridge, Illinois regarding how their hospital has addressed the issue of maintaining electricity to the facility. Robyn indicated that there were three specific issues of highest concern. They included the loss of power from the local utility company, flooding of the existing generators in the basement of the main hospital and damage from tornados. Robyn indicated that about ten years ago the hospital installed a generator in the basement of the main building that is capable of providing power to the entire ten story hospital, including all lights and HVAC. The problem was that the unit was very large and heavy and, as a result, had to be installed in the basement. A second generator was installed right next to the first to act as a backup generator should they lose power from the power company. These generators are also designed to operate on both natural gas or stored gasoline in the event the gas lines become compromised. This seemed to solve 90% of the scenarios that could come up. Then the neighboring community experienced a flood that shut down utilities for days and a few weeks in some areas. The hospital was concerned that they would be shut down in the event of a flood in their generator rooms in the basement. So, they added a third generator inside a remote area on the south perimeter of the hospital. This generator is located inside a concrete structure three floors above ground level. This is a smaller generator that will run specific areas in order for the hospital to stay functional. For example, this generator only supplies certain lights so that there is always enough visibility to operate. It also is designed to operate all electronics in the operating rooms, emergency room and critical care areas so there is no compromise to patient care. On the remaining medical floors there is one or two red colored electric outlets that operate off this third generator. In addition, this generator is not connected in any way to the basement level so that it can power the upper floors of the hospital even if the ground level is buried under 20 feet of water. The third generator is also enclosed in walls of reinforced concrete with the thought that it could withstand a tornado. It was the HIM and the HIT who were involved in the process to help determine the essential power needs of the hospital. The HIM evaluated the staff and the various facilities to determine that they could function treating most patients as long as there was one dedicated outlet within each patient room. The HIT also identified that the operating rooms, critical care areas and emergency room pretty much needed full power capabilities no matter what. The HIM and facilities managers both have a critical role in communicating the needs of the patients, staff and hospital to the engineers, administrators and building designers. And while Lutheran General Hospital was able to spend millions to prepare for a power disruption and pretty much covered every scenario, they still need to be ready to operate should all power to the facility cease. It is the HIM who can evaluate the various areas of the hospital based on resources, staffing and needs to determine the most critical issues to address first in the event of a total power failure. This takes a lot of time and energy and is probably an evolving process as conditions and resources change. But, in the end, it is the HIM professional who is able to connect all the dots to help bring the best solution for the organization. The third and final scenario presented here is related to staffing and how the HIM can help reduce risk and liability when it comes to the behavior of hospital staff. Hospital employees by their human nature are susceptible to making mistakes or forgetting to do certain things in the course of their patient care. Every health care institution, and any other business for that matter, strives to find ways to provide the best service possible to its customers. The challenge in improving service and reducing liability is finding a process that actually works. Ohio State University Medical Center found a way to improve the quality and consistency of patient care from its medical professionals. Ohio State did created a system of check lists to be used by hospital staff in their particular department and area of responsibility. So, there were many different checklists, but each employee only had one checklist that they were specifically responsible for. The University compared the outcome of over 3000 patients both before the check lists were used and then an additional 3000 plus patients after the checklists were used. The results were staggering. The study showed, for example, that the surgical death rate of patients decreased 47% when check lists were used compared to none used. Surgical infection rates were found to have decreased by 45%. These are dramatic results that clearly show a huge improvement in patient care and reduction of risk and liability. A possible cause for such improvement is that using checklists prevented medical staff from skipping a stop that could have caused a serious complication or infection. The aviation industry has proven that checklists work. When a pilot has a sudden engine failure there is plenty of room for panic and impulsive missed steps. This is why pilots are trained to immediately pull out their check lists, even if they have them memorized, and go systematically down the list to make sure that all steps are completed as indicated. This following of check lists has proven to significantly improve survivability of the aircraft during an emergency. The use of check lists seems to hold true for the health care industry, too, as the data clearly shows. The HIM plays a critical role in the development and rollout of these check lists to the various departments. The HIM must involve the hospital staff, managers and physicians in the process of developing a check list that easily and safely covers the needs of both the patient and the hospital. Once developed the HIM must develop and take the time to train the staff so that they understand the intent of the check lists as well as the individual steps and why they are to be completed. This training will ensure that the employees buy into the use of the check lists and choose to use them consistently with every patient. Theoretically, this should provide the same process and the same desired outcomes each time. Besides implementing the checklist program through training the HIM also plays an important role in developing a policy that says how the plan is to be implemented. Employees appreciate it when everything is clearly spelled out of what is expected of them. The HIM is in a position to deal with both the hospital administrator and the front line nurse who is physically caring for patients. This allows the HIM to obtain feedback and recommendations from all involved in the process and create or modify the plan as it is determined that changes need to take place. The HIM is possibly also in the best position to analyze the data to present the findings of the continued analysis to administrators to determine if the check list process is working or not. An example of a checklist that Ohio State University Medical Center used was the Pre-Op holding RN checklist that ends with transfer to the operating room RN checklist. Each nurse has specific duties to complete with their patient as they prepare them for their surgical procedure. The Pre-Op nurse can follow the check list to ensure that all required actions have indeed taken place. When transferring care to the operating room nurse the pre-op nurse passes on her check list to verify to the next nurse that everything has been completed properly. Each nurse is also required to ask the next receiving nurse if they have any questions. As you can see, this process really does maintain a high quality of continuity of care for the patients as they move throughout the various areas in the hospital during their stay. Cutting corners and skipping steps in the patient care process is significantly reduced if not completely eliminated and the HIM or HIT professional is involved all along in helping to create and improve the process within that hospital. This paper only discussed three scenarios in the process of seeking to maintain quality while reducing financial liability within a hospital environment. These processes can be used and applied towards the thousands of specific areas of responsibility that exist within a large health care facility like a hospital. The HIM professional really does play a crucial role in connecting the various departments and providers within a small or large healthcare institution. The HIM is in a position to know the pulse of the front line operations as well as the upper office administration’s intended direction going forward. The HIM professional can pull everyone together to compile data and make recommendations or changes that benefit the patient, the physicians and nurses, the facilities operators and even the top level administrators. There are few other individuals who are in such a good position to create such positive change. Quality HIM professionals will be in demand for many years to come.

surfing :: essays research papers

Surfing is the sport of riding a surfboard toward the shore on the crest of a wave. It is an amazing sport to learn and it gives the rider a hell of an adrenaline rush!! There are three major phases of surfing – paddling, push up and the standing position. This report will give you a full understanding of the correct techniques to use while surfing and it also describes the basic structure and function of the muscular-skeletal and cardio-respiratory systems of the human body. It will also describe the many different energy systems and how they change when surfing. Getting Started Before catching the massive waves it’s a good idea to practise getting used to surfing on the white wash. The white wash is where the waves break and it is the easiest wave to catch. Strap your leg rope (or leash) to your ankle, and hold the slack so you don’t trip as you enter the water. The first phase in surfing is paddling. To start off you will need to learn how to successfully catch a wave. It’s a good idea to watch other surfers get into the water, and observe the route they use to paddle out. To paddle, you first lie on your surfboard – to do this body weight needs to be positioned along the centre of the board. Your feet need to be raised slightly off the end of the board. Your body needs to be far enough back to keep the nose of the board about a couple of inches out of the water. If you are too far forward on the board you will notice that the nose of the board keeps dipping underwater making it very difficult to paddle. It will take time to find the most comfortable position. Try to be balanced on the board and paddle at almost the speed of the incoming wave. Raise your head when you paddle with arms bent at the elbow approximately ninety degrees. Reach out with one arm at a time, cupping your hands to make a scoop, stroking your way through the water. You don’t have to dig your arms too deep. Keep the movement of your arms nice and smooth, pulling the board through the water and finish your paddle by flicking your wrist as your arms moves past your hip. Pictures (Above and right): The position of different surfers while paddling

Datril Case Essay

My recommendation to Marvin Koslow is to follow the first approach of pricing Datril at par with Tylenol ($2.85 retail price, $1.69 trade cost), leveraging Bristol-Myers’ brand name, and positioning Datril as an analgesic with similar relief effects to the those of the already successful, aspirin-based Bufferin and Excedin, but more gentle on the stomach, and without the side effects of aspirin. By doing so, Datril will primarily target aspirin users, specifically those from Bufferin’s and Excedin’s current consumer base, who suffer from upset stomach. I explain my rationale below. According to the case, when Datril was introduced to test markets per the strategy I recommended, it failed to achieve the projected sales figures within the first month. Although I have no access to those sales projections, I could argue that the may have been overoptimistic. The reason is that Tylenol was well established (8% market share) in the analgesic market which has traditiona lly been dominated by aspirin-based products. Therefore, directly competing against Tylenol at the same price is unlikely to result in quick market share and monetary gains within a month. Koslow should have allowed more time, say a medium run of 6 months to match duration of the marketing expenses to be committed, before thinking about switching to the other strategy. In addition, it can also be argued that the early success of Datril in the test market with the lower selling price may not be representative of its true performance over the medium to long run. Before defending my recommendation in detail, I would like to highlight the most prominent risk of introducing Datril as a cheaper alternative to Tylenol: not accounting for the competitor’s repositioning or defensive marketing strategies. Those could include the following: o One of the quickest responses that McNeil Labs could come up with is to reduce the price to trade, and subsequently the selling price, of Tylenol to match that of Datril. Doing so could result is public accusations of false advertising, thereby reversing the quick gains that Datril could make, and potentially wasting the $6 million on inaccurate communication of information to the public, which could potentially result in insulted, angry and dissatisfied customers due the feeling that they have been deceived. Bristol-Myers will have to incur the cost of pulling all current advertisements, and an additional cost of having to launch another advertising campaign. o McNeil could also respond by changing its currently conservative advertising approach (i.e. focusing on physicians and trade) by aggressively advertising Tylenol to the public, exploiting the fact that its current advertising expenditure is less than $2 million a year and possibly even utilizing the power and expertise of the mother company, Johnson & Johnson. This could potentially solidify the sales and market share of Tylenol, making it an even tougher competition to Datril. Given Tylenol’s market share, the speed of executing either one of the above strategies, or both together, could heavily minimize Datril’s penetration of the market. Furthermore, per Exhibit A, Datril will need to sell 13.3 million bottles (at a trade cost of $1.05) or 60 million (at a trade cost of 70 cents) just to break-even. This is highly inefficient, in terms of both numbers contribution margin, compared to Tylenol. Moreover, given the actual quantities of Tylenol sold in 1974 (around 19.1 million bottles per Exhibit B), Datril’s achievement of break-even quantities seems even more doubtful, given the risks highlighted above. Quality cannot be a differentiation because both products are virtually identical as pain relievers; therefore the best strategy is to combine the well-established reputation of Bristol-Myers, the well-known effectiveness of Bufferin and Excedin, with the value or differentiation being the gentleness of the product on upset stomach. Furthermore, Bristol-Myers possesses a large consumer base for its aspirin-based products, a base that is larger than that of McNeil Labs’ Tylenol users. This is Bristol-Myers’ main competitive advantage; its own consumers who may suffer from the typical side effects of aspirin. Targeting those specific customers and communicating to them the value of eliminated side effects should be Datril’s positioning and differentiating strategy. Cannibalization from Bufferin and Excedin, should it happen, should not necessarily be viewed negatively, since my recommended selling price of $2.85 is double that of these aspirin products. Exhibit A – Break-Even Analysis for Tylenol and the different pricing scenarios for Datril (per bottle of 100 pills) Breakeven Analysis for Product Tylenol Approach 1 – Same price as Tylenol Approach 2a – Cheaper than Tylenol Approach 2b – Cheaper w/lowered trade cost $ $ $ $ Unit Cost (Variable Cost) 0.60 0.60 0.60 0.60 Trade Cost (Selling Price to Retailers) $ 1.69 $ 1.69 $ 1.05 $ 0.70 Fixed Cost (Advertising) 2,000,000 6,000,000 6,000,000 6,000,000 Break-Even Quantity [Fixed Cost/(Trade Cost-Unit Cost)] 1,834,862 5,504,587 13,333,333 60,000,000 Contribution Margin (Unit) 64% 64% 43% 14%

Role Of Authority In George Orwells Shooting An Elephant

If you were being pressured into doing something you didn’t want to do, would you do it? How would you feel being laughed at while holding a position of authority? In George Orwell’s narrative â€Å"Shooting an Elephant† you are walked through a series of events that led to his life changing experience. Britain’s imperialism was hard on many people. Burmese citizens mainly, but also the British officers. While reading this narrative I tried placing my self in the position of George Orwell. Thinking to myself â€Å"How would I react if this were me?† Of course I would do exactly what Orwell did. He didn’t have much of a choice. Holding a position of authority over a mass group of people is hard. It is even harder when they hate you. What makes it†¦show more content†¦He says he was mocked by Burmese men in the football fields, and was sneered at by the Buddhist priest. Orwell feels guilty for what he sees the Burmese going through. Though he is still not able to leave his job. Orwell picked up his ringing phone. â€Å"An elephant is ravaging the bazaar. Would you please come and do something about it?† Said the sub-inspector. Orwell did not know what to do but he wanted to see what was going on. He grabbed his gun which was too small to kill an elephant anyhow. Burmese did not have weapons so they were helpless. Orwell headed down toward the last sighting of the elephant only to be stopped by hundreds of Burmese. Orwell was told the Elephant had destroyed huts, killed a cow, and devoured the stock. As he headed into town he heard a women screaming â€Å"go away child!† He headed around the corner to find the Elephant had killed a coolie in the center of town. Orwell orders for a rifle that will take down the Elephant. Five cartridges and a rifle was handed to Orwell. Yelling and screaming from the excitement of the Burmese is all he could hear. Orwell heads down to the patty field where the Elephant was eating. Thousands of Burmese following triumphantly behind. Orwell stoped once he could see the Elephant. He saw a peaceful Elephant eating harmlessly. He did not want to shoot the Elephant. But he could not be laughed at and made a fool. Orwell contemplated what he should do. He had to make aShow MoreRelatedThe Evil Of Imperialism In George Orwells Shooting An Elephant1023 Words   |  5 PagesShooting An Elephant In George Orwell’s narrative, â€Å"Shooting An Elephant,† Orwell recreates his experience as a soldier trying to end imperialism in the country of Burma by shooting an elephant. George Orwell recreates this experience of imperialism being evil through the use of literary devices. Orwell opens his essay by reflecting upon the evil of British imperialism before shooting the elephant. Orwell’s hatred for imperialism is exemplified when he mentions â€Å"was hated by large numbers of peopleRead MoreAnalysis Of George Orwells Shooting An Elephant1154 Words   |  5 Pagesown beliefs or follow the rule of authority? Are we sheep’s who only do what we are told. Is that the same in Orwell’s case? John F Kennedy once said, â€Å"A man does what he must - in spite of personal consequences, in spite of obstacles and dangers and pressures - and that is the basis of all human morality.† Shooting an Elephant by George Orwell he touches base on morality which makes the reader question their beliefs. In Shooting an Elephant, George Orwell’s works as a sub-divisional police officerRead MoreGeorge Orwells Essay Showing Regret for Shooting an Elephant880 Words   |  4 PagesThis story is a representation of George Orwell’s perception of British imperialism around the world. It is a firsthand account of how imperialism affects both rulers and the oppressed using a short story. 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By going throughRead MoreAnalysis Of George Orwell s Shooting An Elephant 941 Words   |  4 Pages5 February 2015 Analysis Essay   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   George Orwell’s  Ã¢â‚¬Å"Shooting an Elephant† is a story about the experience of the narrator who was asked to shoot a wild elephant. He was a police officer who worked for British imperialists and killing the elephant would help him receive good judgement from the villagers in Burma. Orwell says that imperialism is evil and should be eliminated while others think that it is good for the public. The purpose of Orwell’s story is to show the audience that imperialismRead MoreVictimization : A Postcolonial Reading Of George Orwellsshooting An Elephant 1915 Words   |  8 PagesVictimization: A Postcolonial Reading of George Orwell’s â€Å"Shooting an Elephant† In my short teaching career, I have experienced two paralyzing instances of student tears in class that required my response. One of those such instances was in response to reading George Orwell’s essay â€Å"Shooting an Elephant†: my sensitive student was so sad about the elephant’s fate that she needed to leave class to recover from her grief. Such a reaction is not unreasonable to Orwell’s tragic essay, the story of a BritishRead MoreShooting An Elephant By George Orwell1670 Words   |  7 Pagesmy role in the group eventually caused me to comply. In â€Å"Shooting an Elephant,† by George Orwell, Orwell faced a similar dilemma. â€Å"Shooting an Elephant† is an essay that depicts Orwell’s conflictions about shooting a rampaging elephant while he served as an Imperial policeman in Burma during British colonial rule. In his essay, Orwell describes the difficult decision of whether or not to shoot the elephant and why he made his decision. Although he did not initially want to shoot the elephant, theRead MoreThe Paradox Of Belonging : The Complex Role Of Colonialism1343 Words   |  6 PagesThe Paradox of Belonging: The Complex Role of Colonialism in Finding Identity Adrienne Clarkson the twenty-sixth Governor General of Canada once wrote: â€Å"I was, and am, a child of diaspora. I am someone who, for a while, did not belong anywhere.† For nearly everyone who has ever lived in the wake of colonialism, it can be painstakingly difficult to find a sense of belonging with two distinct cultures being juxtaposed together. This colonization process had devastating effects for those upon whichRead More The Colliding Dynamics of Class Structure Essay1721 Words   |  7 PagesThe rigidity of class structure is the culprit for the vast number of inequities in society. Power is concentrated in the hands of a small sector; leaving a few individuals to have more authority and influence, in comparison to others. The construction of class structure identifies the way groups are divided into social positions. Differences stemming from social position are further exemplified by the accessibility to valuable resources–such as wealth, education, occu pation, and status. Those withRead MoreAltered Self-Image According to Thiongo, Orwell, and Kincaid1211 Words   |  5 PagesThe writer of the essay Decolonising the Mind, Ngugi wa Thiongo, expresses his views that Kenyans had been stripped of their native languages and lost an important way to express themselves. In the essay Shooting an Elephant, George Orwell presents imperialism metaphorically through the use of animals to illustrate the power and instability of imperialism. Jamaica Kincaid focuses her essay, On Seeing England for the First Time, on how her view of England ultimately changes when she visits