Explain the Rationale for the Existence of Supplier Induced Demand in Health Care

EXPLAIN THE RATIONALE FOR THE EXISTENCE OF SUPPLIER INDUCED DEMAND IN HEALTH CARE AND EXPLORE THE EXTENT TO WHICH EMPIRICAL WORK HAS BEEN ABLE TO ESTABLISH ITS EXISTENCE Introduction: In the traditional market, consumers decide how much to consume and suppliers decide how much to supply and prices coordinate the decisions. For perfect competition it is assumed inter alia that there is: perfect information so that individuals are fully informed about prices, qualities etc; a lot of buyers and sellers; no single buyer or seller that has influence on the price. But health care market falls short of the perfect market paradigm as it is dogged by many phenomena that cause it to fail (Arrow 1963). One such phenomenon is supplier-induced demand (SID), whereby health care providers, usually physicians, exploit their information advantage over patients in order to induce patients to utilize more healthcare services than they would if they were accurately informed. The phenomenon of SID tends to take an important place within social debates because it has an impact on health care expenditures, health status and the allocation of income between patients and physicians (Labelle et al 1994). Therefore, it has attracted considerable attention in the health economics literature since Roemer (1961), who observed a positive correlation between the number of hospital beds available and their use leading to the observation, ‘a bed built is a bed filled’, sometimes referred to as Roemer’s Law. Although a variety of empirical tests of SID have been reported in literature, researchers disagree on the definition of and tests for SID. The validity of the results from the tests is controversial. Therefore there is no consensus on the development and implementation of public policy based on these results (Labelle et al 1994, p349). Indeed, Doessel (1995, p. 58) observed that this area of research can be described as a theoretical and empirical quagmire. After defining the terms, this essay is going to explore and explain the theoretical rationale, the empirical evidence and policy implications for the existence of SID. The argument will be summed up in the conclusion. Health Care Market and SID A market is a shorthand expression for the process by which households’ decisions about consumption of alternative goods, firms’ decisions about what and how to produce, and workers’ decisions about how much and for whom to work are all reconciled by adjustment of prices. Health care comprises services of health care professionals, which are addressed at health promotion, prevention of illnesses and injury, monitoring of health, maintenance of health, and treatment of disease, disorders, and injuries in order to obtain cure or, failing that, optimum comfort and function (quality of life) (Worldbank website). In health care market there is: a few buyers and sellers; asymmetry of information therefore violation of consumer sovereignty; allocation of resources by physicians and not price mechanism etc. Therefore patients face a dilemma in translating their desire for good health into a demand for medical care. This requires both information and medical knowledge, which they usually do not have. There is no definitive and widely accepted definition of SID. In literature, the definitions range from positive and value free (Fuchs 1978) to normative with negative connotations (Folland et al 2001, p. 04). McGuire (2000, p504) says that SID ‘exists when the physician influences a patient’s demand for care against the physician’s interpretation of the best interest of the patient’. Labelle et al (1994, p. 363) point out the need to incorporate in the definition of SID both the effectiveness of the agency relationship and the effectiveness of the induced services. This me ans that inducement can give rise to ‘good’ or ‘bad’ outcomes for patients depending on its clinical effectiveness, e. g. f a doctor persuades a patient to undertake more treatment where the patient would otherwise have opted for a less than clinically effective package of care. Rationale for the existence of SID: The theoretical analysis of SID is based upon the assumption that doctors maximise their utility subject to income and inducement. Dranove (1988, p 281) argues that under certain conditions the physician will have an incentive to recommend treatments whose costs outweigh their medical benefits. SID involves a shift of the demand curve, such that as supply ncreases, demand also increases (Fig. 1). In practice the exact demand curves themselves cannot be measured. Only the equilibrium points (A, B, C and D) of the overall market can be observed. If the supply of doctors increases from Q1 to Q2 (Fig. 1a), then the fee payable decreases from P1 to P2. But if SID exists (Fig. 1b), as the number of doctors increases from Q1 to Q2 the doctor would keep shifting the demand curve from D through to D3 in order to maintain or increase income. Fig. 1: Graphical representation of competing hypotheses The potential for SID to arise is shaped but not guaranteed by a number of characteristics of the health care market including: information gaps and asymmetries which encourage patients to seek medical advice and delegate decision-making to doctors; potential weaknesses in the agency relationship and the impact of clinical uncertainty on the decision making processes of doctors. Systems for financing, organising and paying for medical services also influence doctor and patient behaviour. The asymmetry of information between user and provider is the most fundamental peculiarity of health care, and the source of the most serious failures of market processes during resource allocation. Informational asymmetries may also invalidate the assumption of â€Å"consumer sovereignty† which underlies evaluative policy assessment in much of economics. Patients will often be relatively poorly informed compared with their doctor about their condition, treatment options, expected outcomes and likely costs. Unlike other professional services, information asymmetry is most pronounced in health care markets. Many researchers have tested the hypothesis that more knowledgeable patients should be resistant to SID and that they should therefore make less use of medical care. Surprisingly these studies have consistently found that knowledgeable patients frequently use more care [Bunker and Brown (1974); Hay and Leahy (1982) and Kenkel (1990)]. The institutional responses to information asymmetry are professionalisation, self-regulation, and the development of an agency relation between individual transactors and between the professions and society collectively. Agency relationship is formed whenever a principal (patient) delegates decision-making authority to another party, the agent (doctor). Ill-informed consumers are protected, by provider advice, from consumption of unnecessary or harmful services (inappropriate or poor quality) and also from failure to consume needed services. If this agency relationship were perfect, doctor would take on entirely the patient’s point of view and act as if he/she were the patient. All consumption choices made for the patient by the provider would be made so as to maximize the patient’s (and ultimately society’s) utility function. Health care providers do not always act as perfect agents for their patients. Their recommendations are sometimes influenced by self-interest, or the interest of the organization for which they work. This imperfect agency arises because the doctor (agent) performs a dual role — the same person who provides advice about a treatment usually provides and receives payment for that treatment. Hence, demand is no longer independent of supply; the agent can shift the demand curve to any position (Fig. 1b). The demand curve (Figure 1a), assumes that independent consumers of care are not directly influenced by suppliers in their decisions to use care, or alternatively that if such direct influence exists, its level is determined external to the market process itself. On the other hand, it has been shown that in spite of the presumed physician influence over the patient, the physician cannot predict the level of patient compliance (Goldberg et al 1998). Therefore it is doubtful how much influence the physician wields over the patient when it comes to SID. Traditionally doctors’ behaviour is controlled by a professional code- â€Å"Hippocratic oath†. Financial self-interest on the part of the physicians is only one of the causes of imperfect agency. Another very important cause is the failure of physicians to understand or accept patients’ preferences regarding the impact of health status on utility and provide this information to the patient (Labelle et al 1994). The target income theory posits that as the number of physicians has increased, they have induced additional demand to get a particular income, e. g. y increasing the volume and variety of tests and procedures. This is in contrast with conventional economics where increasing supply lowers the price for the consumer. The target income is determined by the local income distribution (Rizzo and Blumenthal, 1996). A professional service like Health care is inherently heterogeneous and nonretradable. A monopolistic competitor selling a nonretradable service set s a quantity to maximize profit and unless there is some cost to inducement, a physician or dental practitioner pursuing net income would induce demand to an infinite extent (Gaynor 1994). However, physicians prefer not to induce demand and only do so if they are compensated by adequate gains in income. The utility maximisation of physicians is limited by disutility of discretion, i. e. either the physician’s internal conscience (Evans 1974; Mcguire and Pauly 1991) or as a result of a reputation process by which doctors who excessively induce demand are punished through future reductions in true patient demand (Dranove 1988). SID can arise when clinical uncertainty causes provision of ‘unnecessary’ or ‘wasteful’ medical services even if doctors act in the perceived interests of their patients. If a doctor inadvertently underestimates a patient’s ability to pay for the cost of medical procedures, the level of care recommended might exceed that which the patient would have nominated. However, some analysts maintain that doctors’ responses to clinical uncertainty can give rise to SID fully consistent with the patient’s interests rather than self-interest (Richardson and Peacock 1999, p. 9) e. g. use of diagnostics in excess of ‘standard’ levels in the event of diagnostic uncertainty. Institutional and regulatory arrangements influence how medical markets work. They create incentives or disincentives for doctors (and patients) to behave in ways that could engender SID. For example, the cost-bearing and financing aspects of the doctor’s service are largely borne by third parties (i. e. governments and private insurers). As a consequence, typically neither the consumer nor the provider carefully considers the price or cost of the service supplied. This can influence the extent and form of SID. Other arrangements that can promote SID include: the system of payment for doctors (i. e. ee-for-service, capitation or salaried); the effect of medical indemnity arrangements on the adoption of ‘defensive medical practices’ by doctors; and the form of monitoring of doctor treatment practices. The link between physicians and pharmaceutical companies can also promote SID. Big pharmaceutical companies approach physicians and â€Å"ask† them to prescribe specific drugs to patients in exchange for a reward, such as free holidays. For example, in 2002 drug firms spent nearly $9. 4 billion on marketing to American doctors (The Economist 15th Feb. 2003). As a result, physicians are illing to prescribe extra medicines that are unnecessary and provide no benefit to the patient. Moreover, these drugs favoured by the physicians and produced by big companies might be more expensive than others with equivalent effectiveness However, one major criticism of the SID model is that it focuses on only one price– the nominal fee level–while ignoring access costs. If increased supply reduces travel time and office waits, the total cost of care has fallen even if fees remain constant. Secondly, the SID theory carries an implicit assumption that the extra services are unnecessary. An alternative view is that few situations in medicine are clear-cut and a broad range of indications is consistent with generally acceptable practice. Empirical evidence of SID Several indirect hypotheses and empirical tests have been carried out but due to the lack of a rigorous theoretical model and the presence of econometric and measurement problems, results concerning the existence of SID still remain controversial and inconclusive. SID is not easy to measure and interpret because of the difficulty of separating out induced from un-induced demand, supply changes from demand changes and SID from other factors influencing demand (e. . income, insurance coverage, health status). However, there is clear evidence that physicians who are paid on fee-for-service basis can adjust the number of services in response to limitations on the levels of fees (Rice, 1983), but such responses are not automatic and health economists don't have a good understanding of what contextual factors are i mportant in predicting such responses. Nevertheless, the potential for such responses means that inducement is an important factor to consider in policy development. To test for SID early studies looked at changes in utilisation compared to increases in physician/population ratio. The hypothesis underlying the tests is that, in response to an increase in the doctor/population ratio (i. e. competition), doctors will seek to induce demand or raise their fees so as to maintain their incomes. Cromwell and Mitchell (1986) demonstrated a significant demand inducement for surgical procedures with overall rates of surgery increase by about 0. 08% for each 1% increase in surgeon supply. Rice’s (1984) found that 10% decline in physician reimbursement led to a 6. 1% increase in intensity of medical services and a 2. 7% increase in intensity in surgical services. However, a similar study found mixed responses to fee changes across procedures (Labelle et al 1990). Another technique used for testing SID is to examine the effect of changes in doctor supply on doctor compared with patient initiated visits. Assumption here is that if SID exists, increases in doctor numbers would lead to an increase in doctor-initiated visits (that is, an income maintenance response test). Tussing and Wojtowycz (1986), using this technique, found that areas with more GPs were associated with much larger proportion of return visits arranged by doctor, i. e. a strong relationship to support SID. On the other hand, doing a similar experiment, Rossiter and Wilensky (1983) found only very small inducement effect. This approach to investigating the presence of SID effects (increasing physicians and increasing utilisation) fell somewhat out of favour when Dranove and Wehner (1994) found that, according to the standard methodology among SID theorists, an increase in the number of physicians resulted in an increase in childbirths. Recent studies have looked at physician behaviour in response to fee reduction, e. g. Yip (1998) found that physicians compensate for income losses due to public price reduction by increasing volume. Medicare fee cuts lead to increased amounts of heart surgery enabling physicians to recoup 70% of lost revenue. Gruber and Owings (1996) found that a 13% reduction in fertility rate in the US in 1970-1982 led to an increase in caesarean sections and reduction in the less profitable vaginal births. Between 1971-1981, the number of GPs per capita in Winnipeg, Canada increased by 56%. Remarkably, however, real gross income per physician remained virtually unchanged during the period. GPs simply increased the number of contacts with existing patients – so much so that their average revenue actually increased (Roch et al 1985). On the other hand, in Norway, Grytten and Sorensen (2001) compared a salaried group of physicians with another one that was compensated by fee for service. Neither of the two groups of physicians increased their output as a response to an increase in physician density. In UK, dentists are paid on a fixed fee-for-service basis. Supplier income can only be increased by increasing utilisation. Therefore, testing for the existence of SID in dentistry has involved looking for a positive correlation between dentist density and utilisation of dental care. Birch (1988) concluded that a positive correlation between the number of dentists per capita and the treatment content per visit provides sufficient (but not necessary) evidence for the existence of SID, in a fee-regulated market environment. Other researchers [Manning and Phelps (1979); Grytten et al (1990)]  found similar correlations. Sintonen and Maljanen (1995) found that individual and general inducement appeared to have considerable effect on utilisation, but no systematic connection with supply conditions (dentist/population ratio). This was interpreted to indicate that some dentists, regardless of the market situation, have adopted individual inducement. However, there are alternative explanations for a positive correlation between dentist density and the utilisation of medical services: permanent access demand on the market for medical services due to price regulation; demand decisions by rational patients (the opening of new practices, particularly in rural areas, reduces the average time and transport costs, and the average time spent in the waiting room also falls); reversed causality where physicians set up shop in high demand regions (Zweifel 1981 p216). Policy Implications of SID: SID is of great importance to the policy maker because it threatens the basic market paradigm and severely undermines economic recommendations about market policy. There are differing interpretations of policy significance of SID. According to Carlsen and Grytten (2000), policy makers can compute the socially optimal density of physicians without knowledge of SID. Yet most analysts look at SID from the perspective of manpower and reimbursement policy for purposes of cost containment. They do not consider its contribution to the health status of patients. The impact of SID on equity, distributional issues and the net social benefits is usually ignored (Labelle et al 1994). The issue of SID raises another major controversy of whether adequate control over resource allocation to and within healthcare is best achieved through the demand side or through regulatory controls on the supply side (Reinhardt 1989, p. 339). Indeed, due to problems with moral hazard and SID, insurers use demand-side incentives (e. g. co-insurance and deductibles), as well as supply-side incentives aimed at providers (e. g. aying physicians through salary or capitation). An example of policy implications of SID to manpower planning is when a government wishes to attract physicians to rural areas, and it does so by paying rural doctors more than those in urban areas. This could precipitate SID within urban practices, hence nullifying the government’s intention. Direct regulation of the supply of physicians—by mandating that all new graduates spend a c ertain number of years in rural communities, for example —might have some advantages, although this may well affect the number and quality of medical students. For facility planning purposes, Roemer’s Law has the fundamental implication that there is no external â€Å"demand† standard, based on observed utilisation, from which â€Å"needed† levels can be inferred. Providers will themselves determine use on the basis of available capacity inter alia. SID means increased demand by patients, which raises costs of care. If it exists, then the policy maker may wish to provide for control of supplier behaviour by mandating evidence-based medicine: cost-effectiveness evaluation of new interventions, medical audits etc, all of which encroach on clinical freedom. Use of provider payment mechanisms like salaries for doctors, global budgets, and case payments could help. However, Ferguson (2002) argues that overall, demand curve for medical care slopes downward, and that supplier-induced demand is overrated as a policy concern. Conclusion: This essay has explained the rationale for the existence of SID and has explored its policy implications and empirical evidence of its existence. There is arguably sufficient evidence to accept that SID can occur. Even Hippocrates himself realised that as in all things mercenary (in health care it is â€Å"fee-for-service†) there is no such thing as pure altruism. Indeed, the Hippocratic oath is an admission to the potential for pecuniary self-interest and abuse of sacred trust. Imperfect agency and clinical uncertainty are the main causes of SID. If SID is pervasive, there could be a variety of economy-wide impacts, e. g. it could increase health expenditure without a commensurate improvement in health outcomes. Therefore, it has important implications for the health policy process. Strong support for SID hypothesis was found in the UK dentistry. Otherwise, there is no robust evidence on the likely magnitude of SID. Although inconclusive, most studies suggest that where SID arises, it is small both in absolute terms and relative to other influences. However, it is still worth considering SID-attenuating arrangements say in the case of physician reimbursement policy. As there are a number of fundamental and seemingly irresolvable methodological and data problems associated with trying to assess SID, definitive evidence of its existence most likely will remain illusive. References: 1. Arrow, K. J. (1963). Uncertainty and the Welfare Economics of Medical Care. American Economic Review 53: 941-973. 2. Birch, S. (1988). The identification of supplier-inducement in a fixed price system of health care provision: The case of dentistry in the United Kingdom. Journal of Health Economics. 7:129–150. 3. Bunker, J. P. and Brown, B. W. (1974). The physician patient as an informed consumer of surgical services. New England Journal of Medicine 290: 1051-1055 4. Carlsen, F. and Grytten, J. (2000). Consumer satisfaction and supplier induced demand. Journal of Health Economics 19:731-753 5. Cromwell, J. and Mitchell J. (1986). Physician-Induced Demand for Surgery. Journal of Health Economics 5: 293-313. 6. Doessel, D. P. (1995). Commentary. In Harris, A. (ed), Economics and Health: 1994, Proceedings of the Sixteenth Australian Conference of Health Economists, School of Health Services Management, University of New South Wales, NSW. 7. Dranove, D. (1988). Demand inducement and the physician/patient relationship. Economic Inquiry 26:281-298 8. Dranove, D. and P. Wehner (1994): Physician-induced demand for childbirths Journal of Health Economics 13:61-73 9. Evans, R. G. (1974). Supplier induced demand; some empirical evidence & implications. In Perlman, M. (ed). The economics of health & medical care. London: Macmillan 10. Ferguson, B. S. (2002). Issues in the demand for medical care: can consumers and doctors be trusted to make the right choices? AIMS Health Care Reform Background Paper #5. Halifax: AIMS http://www. aims. ca/Publications/Demand/demand. pdf (accessed: 26th April 2004). 11. Folland, S. , Goodman, A. and Stano, M. (2001). The Economics of Health and Health Care. 3rd ed, Upper Saddle River, New Jersey. Prentice Hall 12. Fuchs, V. (1978). The supply of surgeons and the demand for operations. Journal of Human Resources, 13(supplement): 35–56. 13. Gaynor, M. (1994). Issues in the Industrial Organization of the Market for Physician Services. The Journal of Economics and Management Strategy 3(1): 211-255. 14. Goldberg, A. I. Cohen, G. and Rubin, A-H E. (1998). Physician Assessments of Patient Compliance with Medical Treatment. Social Science and Medicine 47(11): 1873-6) 15. Gruber, J. and Owings, M. (1996). Physician financial incentives and caesarean section delivery, RAND Journal of Economics 27(1): 99-123. 6. Grytten, J. and Sorensen, R. (2001). Type of contract and supplier-induced demand for primary physicians in Norway. Journal of Health Economics 20: 379-393. 17. Grytten, J. , Holst, D. and Laakf, P. (1990). Supplier Inducement: Its Effect on Dental Services in Norway; Journal of Health Economics 9: 483-491 18. Hay, J. and Leahy, M. (1982): Physician-induced demand: An empirical analysis of the consumer info rmation gap. Journal of Health Economics 1: 231-244. 19. Kenkel, D. (1990): Consumer health information and the demand for medical care. Review of Economics and Statistics 52: 587-595 20. Labelle, R. , Hurley, J. and Rice, T. (1990). Financial Incentives and Medical Practice: Evidence from Ontario on the Effect of Changes in Physician Fees on Medical Care Utilisation, Working Paper 90-4 Centre for Health Economics and Policy Analysis, MacMaster University, Hamilton, Ontario 21. Labelle, R. , Stoddart, G. and Rice, T. (1994), A Re-examination of the Meaning and Importance of Supplier-Induced Demand. Journal of Health Economics 13(3): 347-368. 22. Manning, W. G. , Jr. and Phelps, C. E. (1979). The demand for dental care. Bell Journal of Economics 10(2): 503–525. 23. McGuire, T. (2000 chapter 9). Physician agency. In Culyer, A. J. and Newhouse, J. P. (eds). Handbook of Health Economics, 1A, Elsevier: North Holland. 24. McGuire, T. G. , and Pauly, M. V. (1991). Physician Response to Fee Changes with Multiple Payers. Journal of Health Economics 10: 385-410. 25. Reinhardt, U. (1989). Economists in health care: saviours, or elephants in a porcelain shop? American Economic Review 79: 337-342. 26. Rice, T. (1983). The Impact of Changing Medicare Reimbursement Rates on Physician-induced Demand. Medical Care. 21(8): 803-815. 27. Rice, T. (1984). Physician-induced demand: New evidence from the Medicare program. Advances in Health Economics and Health Services Research 6:129-160 28. Richardson, J. and Peacock, S. (1999). Supplier-induced demand reconsidered. Working Paper 81, CHPE, Monash University. http://chpe. buseco. monash. edu. au/pubs/wp81. pdf (accessed: 27th April 2004). 29. Rizzo, J. A. and Blumenthal, D. A. (1996). Is the Target-Income Hypothesis an Economic Heresy? Medical Care Research and Review 53(3): 243–266. 30. Roch, D. Evans, R. G. and Pascoe, D. (1985). Manitoba and Medicare: 1971 to Present. Winnipeg, Manitoba: Manitoba Health. 31. Roemer, M. I. (1961). Bed supply and hospital utilisation: A national experiment, Hospitals. Journal of American Health Affairs 35:988–993 32. Rossiter, L. and Wilensky, G. , (1983). The Relative Importance of Physician-Induced Demand for Medical Care. Milbank Memorial Fund Quarterly 61(2): 252-277. 33. Sintonen, H . and Maljanen, T. (1995). Explaining the Utilisation of Dental Care: Experiences from the Finnish Dental Market. Health Economics 4(6): 453-466. 34. Tussing, A. D. and Wojtowycz, M. (1986). Physician-induced Demand by Irish General Practitioners’. Economic and Social Review 14(3): 225-247 35. Worldbank website: http://www1. worldbank. org/hnp/hsd/HEGlossary. asp (accessed: 27th April 2004). 36. Yip, W. (1998). Physician Responses to Medical Fee Reductions: Changes in the Volume and Intensity of Supply of Coronary, Artery Bypass Graft (CABG) Surgeries in the Medicare and Private Sectors, Journal of Health Economics 17(6): 675-699 37. Zweifel, P. (1981 p245-267). Supplier Induced Demand in a Model of Physician Behaviour. In van der Gaag, J. and Perlman, M. (eds), Health, Economics and Health Economics. Amsterdam: North-Holland ———————– P- fees for ServiceQ- supply of doctors S- supply curve of servicesD- demand curve for services P2 P1 Q1 Q2 D C A S1 S P3 P1 P2 Q1 Q2 Q3 Q4 D D2 D1 D3 S1 S B (a) No SID(b) With SID D

Demand vs Supply Essay

The two main driving forces of the economy are supply and demand. Understanding the basic concepts of supply and demand can help an organization focus on the bottom line. According to Gretzen (2007), demand is the relationship between price and quantity. Supply refers to the amount of a good or service available at any particular price. The principle of supply and demand describes a balance that develops between the supply of an item or service and the demand for it (Kleinman, 2009). Economics plays a major role in the health care industry. As a resource, the health care workforce is a determinant of the balance between supply and demand. The health care workforce consists of nurses, physicians, and other ancillary health care workers such as certified nurses’ aides (CNA’s) and patient care associates (PCA’s). The supply of health care workers directly impacts the demand of quality care rendered to patients. SERVICE OR PRODUCT Health care organizations have specific stated missions and visions to map out their fundamental way of operation. In health care, the workforce is instrumental in assisting with the organizational delivery of services to consumers (patients). The primary issue for all health care workforce personnel is that of inadequate staffing. This paper focuses on the staffing effectiveness of supplemental staffing of health care personnel within the inpatient setting. IMPACT Nursing managers formulate staffing patterns on a daily basis. The staffing of inpatient units requires a knowledge of unit census (total bed capacity),  consideration of patient acuity (level of care required for the patient), and skill mix (nursing hours per patient per day and nurse patient ratio) (U. S. Department of Health and Human Services, 2002). Often times, inadequate staffing is due to a high rate of call outs of sickness or other emergencies. Inadequate staffing directly impacts patient safety and quality of care. All health care titles render supplemental staffing coverage in one of two ways, overtime and through per-diem agencies. Overtime employment provides regular full time employees with monies set at a rate of time and half for any extra work completed over the prescribed 40 hours a week. Per-diem agencies are outside contractors capable of providing their own qualified titled personnel to fill vacancies with monies defined at a set rate. Patients are admitted to inpatient setting with varied co-morbidities may or may not indirectly increase the necessity of staff. Patients are often admitted for diagnoses of altered mental status, agitation / combativeness, risk for falls, suicidal ideation, and alcohol or drug intoxication. Many patients require a higher level of skilled care, such as turning and repositioning, and assistance with activities of daily living such as toileting and eating. It requires a higher staff to patient ratio to provide safe, effective quality care. PERSPECTIVE AND RATIONALE According to published reports there are key factors affecting the adequacy of the health care workforce. Some key factors include an aging workforce of where 40 percent of practicing physicians are older than 55, and one-third of the nursing workforce is over 50 with a majority of both professionals seeking to retire within the next 10 years (Alliance for Health Reform, 2011). The largest groups of health professionals in the United States are composed of Registered Nurses. Statistically, there is a huge decline in the numbers of nurses within all regions of the U.S. An estimated 118,000 FTE RNs will exit the workforce within the next five years (Staiger, Auerbac, & Buerhaus, 2012). This potentially leaves a major void in terms of numbers of bodies needed to fill vacated positions. Low staffing levels are associated with higher rates of adverse outcomes that are directly sensitive to nursing attention, such as urinary tract infections, pneumonia, pressure ulcers, and falls (American Federation of Teachers, 2012). Unintended additional costs  associated with the development of complications in patients are greater than labor savings when units are understaffed. Acquiring pressure ulcers are estimated to cost the health care industry $8.5 billion per year (Kleinman, 2009) Overtime costs and per-diem agency costs can’t stand alone to solve the issues of staffing shortage. Their combined usage enables institutions to deliver optimal health care services to consumers/ patients. The supply of overtime and per-diem staff meets the increased demands of patients. It also assists in the delivery of quality care through services rendered. In terms of patient safety, the potentiality of the risk of injury to patients via falls, medication errors, and or sentinel events decreases. CONCLUSION The United States is a great consumer demand for health care services. The supply of such services is affected by varied factors. These factors directly influence the financial stability of health care organizations. Recessional times cause delays in career and retirement plans for health care professionals. In recessional times, there are noted changes in the supply and demand of the health care workforce. The shortage of registered nurses and providers in the workforce may inadvertently lead to a reduction in health care access for consumers. Inadequate staffing levels place heavy burdens on the nursing staff. Adverse events such as falls, hospital acquired infections and medication errors are potentially painful and life threatening events. Adverse events can result in considerable costs to be paid by the understaffed institution. For this reason alone, supplemental staffing via agency and overtime personnel provides a measure of increased patient safety. The future is trending towards the assistance in the recovery of the health care workforce shortage. It will rely heavily on the provisions made by the Affordable Care Act of 2010 (Alliance for health reform, 2011). Recruitment and reinvestment in health care professions especially nurses and physicians will assure sufficient supply of workforce personnel to meet the increased demands of health care economy and its’ consumers( Kaiser Foundation (2012). The Joint Commission bolsters workforce infrastructure through in-service and continuing education, supporting nursing education, and the adoption of set staffing levels based on  competency and skill mix relative to patient mix and acuity (Stanton, 2012). It also supports the establishment of financial incentives for health care organizations investing in nursing and workforce services. REFERENCES Alliance for Health Reform. (April, 2011). Health care workforce: Future Supply vs. Demand. Retrieved from http://www.allhealth.org/publications/medicare / health_care_workforce. American Federation of Teachers. (2012). Issues: Healthcare Staffing. Retrieved from http://www.aft.org/issues/healthcare/staffing/index.cfm Changes in Health Care Financing & Organization. (August, 2009). Issue brief: Impact of the economy on health care. Retrieved from http://www.academyhealth.org /files/hvfo/findings0809.pdf Getzen, T.E. (2007). Health economics and financing. (3rd ed.). John Wiley and Sons, Inc., Hoboken, NJ. Kleinman, C. (2009). Health care supply & demand. Retrieved from http://www.community.advanceweb.com Staiger, D. O., Auerbach, D. I., & Buerhaus, P. I. (2012, April). Registered nurse labor supply and the recession- Are we in a bubble? New England Journal of Medicine, (366), 1463-1465. Stanton, M. (2012). Hospital nurse staffing and quality of care. Retrieved from http://www.ahrq.gov/research/nursestaffing/nursestaff.htm U.S. Department of Health and Human Services. (July, 2002). Projected supply, demand, and shortages of registered nurses: 2000- 2020. Retrieved from http://hrsa.gov. The Kaiser Foundation. (2012). Nursing workforce: Background brief. Retrieved from http://www.kaiseredu.org/Issues-Modules

Responsibilities of Management Essay Example | Topics and Well Written Essays - 3500 words - 1

Responsibilities of Management - Essay Example The organizations should recognize the importance of equality in workplace, which motivates the employees to improve their performance. Management is the art of getting things done by the people for achieving the desired objectives. What a manager does is also called management. It is the process of planning, organizing, directing, staffing, co-coordinating, reporting and budgeting. The levels of management are of three types. They are top level management, middle level management and lower level management. The main responsibility of a manager is to control the entire organization. The important responsibilities are encouraging employees, making sure that employees achieve the organizational objectives, controlling the activities and looking after the employees, making sure that resources are used in the best possible manner. That means usages of resources in most productive way, minimizing waste, and making sure of efficient use of time. The human resources manager plays a very important role in organizational hierarchy in between top level management to bottom level management. The important responsibilities of h uman resource manager are as follows. The human resource manager controls the employees and he is responsible for monitoring, guiding, and encouraging them in the best possible manner. He provides very good support to the selection of staff who meets the organizational standard. To sustain the competitive advantages the following factors should be maintained. They are performance management, providing training, reward, and recognition to staff, retention of employees, implementation and supervision of human resource policies and making sure of availability of human resources to accomplish the organizational objectives. â€Å"Stress is the emotional and physical strain caused by our response to pressure from the outside world. Common stress reactions include tension, irritability, inability to

North American Compensation Essay Example | Topics and Well Written Essays - 500 words

North American Compensation - Essay Example This company has also its own strategies and services considerably unique with the other companies. Mercer.com is more on the point of view regarding new leadership that developed with the business in Harvard as well as Oliver Wyman. The organizations which were considered to be around the world may be able to recognize the payback including the competitive advantage in order to develop the human capital's rights that include the outsourcing that is related and strategies of investment. More clients were able to get the right in the passion of Mercer. Mercer.com has its core strengths in the areas of consulting, investing and at the same time outsourcing coming from the advice to solutions that creates the unique position of Mercer. The capabilities are said to be highlighted in recent launched of campaign in terms of advertising viewed as cited below. as well as financial products helping the companies with the management of liabilities' benefit and in order to enhance the value of shareholder. This made Clark Consulting Services unique in terms of the strategies and their services.

Anne Boykin and Savina O. Schoenhofer's Nursing as Caring Theory Assignment

Anne Boykin and Savina O. Schoenhofer's Nursing as Caring Theory - Assignment Example The authors specifically state that nursing is not only a profession but also a discipline. Boykin and Schoenhofer (2010) claim that the Nursing as Caring Theory is a better framework to improve an individual’s understanding of caring as it particularly emphasizes the need of nursing knowledge to increase the care quality and patient safety (p.371). Since this knowledge comes from situations, the Anne Boykin and Savina O. Schoenhofer consider nursing situation as a key concept of the theory. In actual practice, this theory makes significant contributions to nursing practice, nursing administration, nursing education, and nursing research and development. The Nursing as Caring theory enhances nurses’ knowledge about caring their clients in creative and individualized ways in a situation-specific environment. In addition, as Purnell (2013) purports, this framework assists nursing administrators to develop and implement policies within the organization in order to improve operational efficiency and thereby to achieve higher degree of patient safety (p.371). Evid ently, a clear understanding of personhood contributes notably to nursing knowledge and education. This theoretical framework can be better used by researchers to explore the patterns of caring personality and improve the quality of the care delivered. Since Nursing as Caring is a grand theory, it can be applied to real life situations in collaboration with other nursing theories like Watsons theory of nursing or Orems theory of nursing. Today the growing number of clinical errors becomes a great threat to the medical field, and in most cases the issue is caused by the negligence of caring staff. Here the theory of Nursing as Caring can be applied to improve the situation because this theory greatly emphasizes the virtue of humanness in a caring environment. When humanness is valued greatly and considerable importance is given to care

Financial Report Essay Example | Topics and Well Written Essays - 2750 words

Financial Report - Essay Example The bench mark companies in this industry include DP world limited, Global point investment and finally Hangar & plc. Review of U.K and global economy U.Ks economy is in a strong position. It has been stable and its growth rate has been consistent for the last two decades. The economy boosts of the highest employment rate among the G7 nations. The main challenge facing United Kingdom currently is finding ways to build it further in order to become more competitive in the globe. Currently UK has almost 30million people employed. Global economy has been changing at a very high rate. This is contributed to from different emerging economies that include china and India. This is illustrated in China’s growth that was at over 11% in 2005. With this trend it is likely to be the third biggest economy by 2016. Review of the target company sector The major players in this industry are small and medium sized enterprises. In this sector a person will notice that less than 1% of these comp anies do employ 300 people and above and on the other side sole traders make up 37%. In respect to education, 16% will account for people who have graduated. There are various forms of transport in this industry namely, land transport, water, warehousing, postal, courier and air transport (TAMARI, 1978). The key issues in this industry include attitude that people have especially the young graduates who are not interested to join this sector Company information The target company was incorporated in the year 2011 and does conduct its business through its subsidiary Fujian Xingtai Company limited. The company was founded by Mr. Shufang and Mrs Meijin. The main business undertaken by this corporation is providing logistic services. The corporation has a market share of about 60 manufacturers based. Swot analysis Strength Risk management system Company market position Business model Weakness Poor performance Management team Opportunities Assessment of the company’s sources of in puts and finance Threats Strong franchise value Expansion potential Strength of the company The company also has a strong market segment in Europe that it serves best. The company top 20 client’s account for 45% of the total revenue. In management of its risks, the company uses what we call a proactive approach. This approach ensures that both the employee and the customer are safely protected (FINE, 2009). The business model of this company forms the strength of the company. This is because it is loyal to its customer, the services are offered at affordable prices which create economic value hence sound business model. Opportunities for the company Sources of inputs and finance for the company are available and obtainable at a reasonable cost. A larger percentage of the company source of finance is through the owners’ contribution. The company also get loans from the leading financial institutions in the United Kingdom. Besides these, the company also raise part of th eir capital through issue of shares which are sold to the public at a given price (FINE, 2009). Threats Potentiality to expand its business activities is limited because of its competitors in Europe. The company get stiff competition from multinationals companies in the transport industry and this has led to reduced revenues in the company (WIEHLE. 2007). Weakness The Company has a poor management team which has resulted to poor

Fashion of America in the 1906's Essay Example | Topics and Well Written Essays - 750 words

Fashion of America in the 1906's - Essay Example The essay "Fashion of America in the 1906's" talks about the fashion and trends in America during 1906. This inspired me to study the fashion events for understanding trends and comparing the old trends with the new ones. American first fashion design program was founded in the 1906. Persons established the Seventh Avenue of New York City as the home of American fashion. Seventh Avenue is respected being the first fashion-designing centre in New York. Parsons offers a bachelor degree in fine arts, fashion designing, and fashion marketing. Seventh Avenue is playing its role as an international fashion centre to educate the American youth on fashion aspects. Many artists appeared on the art horizon in the early 20th century with some exceptional work in the field. That period of the century is also known as the period of making and breaking. Eakins, Winslow home and Charles Russell displayed talent in painting and landscaping. Alfred showed mastery and soon became the famous photograph er of America. Newspaper changed from two columns to four-column tabloid style paper in the first decade of the 20th century. Newspaper â€Å"the Christian science monitor’ was found in 1908 in America. Fiction stories gained fame in women as women go the material of their interest in fiction books. Mary Jonson’s â€Å"to have and to hold† and â€Å"the Virginian† are the masterpieces that still entertain the people in America and outer world. These books and newspapers have gone through continuous updating with the passage of time. and are still liked by many Americans (Druesedow & Mitchell 34). The decade brought progressive education in all the fields of fashion life of American people. After the persons, other educational schools were opened for girls in 1900s (Thomas 2011). Men fashion also started getting touch of romance at the start of new century. Men in America used to wear long trousers with half sleeve shirts. Youths were crazy of motoring in smart dress. Use of goggles and hats increased amongst the youngsters especially for motoring and biking (Wilcox 48). Broad shoulder dressing was commonly used in 1906s. Cotton knit lightweight shirts got fame as beach and sportswear. Smart and slim women wore straight corset with long hips in order to give a small look to their waist. Automobile advancement also had long lasting effects on dressing of the people in 1906s. Women started wearing smaller skirts as for ease of travelling in the new model automobiles (Scheips 129). Hobble skirts were particularly used for walking and jogging. High button shoe that we still see some Hollywood stars wearing them, were first introduced in the first decade of the century (Thomas 2011). Americans adopted bobbed hairstyle after its first appearance in 1908. Hats got a lot of fame in 1906s and both the genders used hats extensively in the normal life. Different designs of hats were introduced catering for modern dressing. Large and small hats of different cloth and colour were very famous in 1900s (Wilcox 52). Advancement of technology brought about many changes in human life in that decade. Teddy Bear became a famous cartoon and his fashion spread fast in 1905. Job opportunities for railway, ships and different business opportunities changed the human lifestyle in that part of the world (Hall 58). Wright brothers made first human journey in 1903. This was a remarkable achievement of human mind in field of aviation. Cadillac and Ford introduced cheap cars for common Americans in the same decade (Scheips 125). Sunday

Student evaluation form Essay Example | Topics and Well Written Essays - 250 words

Student evaluation form - Essay Example Specific examples of such acts of professional behavior can be given in regards to how the student keep data and information confidential and monitors patients to ensure that patients stick precisely to prescription even if patients begin to record substantial degrees of recovery. The student shows positive inter-personal relationship with patients in terms of attending to their needs in the consulting room and in the office. Such inter-personal relationship is exhibited through the patience with which the trainee has in listening to the problems of patients and the patience taken to give out reasons and explanations as to why patients experience certain conditions. There however exists some little amount of limitation when it comes to rapport with staff. Specifically, the trainee often wants to work independently and is therefore not very comfortable with team work. As far as motivation is concerned, it can be said that the student has a very high level of intrinsic motivation that urges him to give off his best at work even when not asked to attend to certain tasks. This motivation is translated into regularity and punctuality to work (Ameyaw,

Horse Slaughter Essay Example for Free

Horse Slaughter Essay The topic of horse slaughter doesn’t usually come up very often in everyday conversation. Horse slaughter is more of an implicit subject, which your everyday person doesn’t know much about. Because it is highly controversial, it has gone through the cycle of being banded and then reinstated twice in the last 5 years. With being involved in the horse industry my entire life, I have witnessed the effects first hand. Some people see it as killing pets, animal cruelty, and morally wrong. However, I see it as a source of income, a way to stop the starvation and abuse of horses, an export industry for the United States, as well as a quality meal for in times of despair. The history of people eating horse meat dates back to the early 1800’s when the French were at war with Russia. Emperor Napoleon advised his starving soldiers to eat the dead battlefield horses. Because horse meat is sweet, lean, protein-rich, and finely textured, it sufficed as a quality meal. Due to the high cost of living in France, in 1866, the French government legalized the consumption of horse meat because it could be bought at a lower price than pork or beef. (Sherman) Countries like France, Belgium, Germany, Chili, Japan and many others still consume horse meat today. The history of horse meat for human consumption in the United States has a similar story. â€Å"No longer will the will the worn-out horse wend his way to the boneyard; instead he will be fattened up in order to give the thrifty another source of food supply. This new meat is to be put upon the city’s platter under the protection and encouragement of the Board of Health. The Board at its meeting yesterday made several radical changes in the Sanitary Code, and one of them was to revoke the present section that forbids the sale in this city of horse flesh as food. † (Allow Horse Meat for Food in City) This is a segment from an article by the New York Times, published in 1915. Also in the article, Health Commissioner Haven Emerson discussed that the houses that slaughter horses are to follow the same protocol and inspections as any other slaughter house does. During the 1930’s low supply and high cost of pork and beef made horse meat rise in popularity. Again during World War II, people were again in the same predicament. Inflation during the early 1970’s raised the cost of traditional meats; Time Magazine reported from Carlson’s, a butcher shop in Westbrook, CT, that they were selling over 6,000 pounds of horse meat a day. (Weil) In 2006, the House of Representatives voted to end horse slaughter; the bill passed to make the killing and selling American horses for human consumption an illegal practice in the United States. Today in the US, people do not consume horse meat on a whole sale basis. But because many other counties do, the exporting of horse meat is a huge industry. When the ban was in place, US horses were being transported to Canada and Mexico to be slaughtered instead. From 2006 to 2010 the increase in horses being exported to Canada and Mexico was 148 and 660 percent. They are loaded up on trailers and shipped across the boarders, often times going days without food or water until they reach their destination. The regulations, or lack thereof, are different than in the US. Shesgreen) Valley Meat Co. owner Rick De Los Santos brings up valid points in his interview with NBC News last week. The majority of people, who are against slaughter, are getting caught up on the â€Å"ick† factor of killing our â€Å"pets†. However, the process is the exact same for cows and pigs. The horse is struck in the forehead with a tool known as a captive gun. The captive gun an air pressured gun which launches a metal bolt against the horses head rendering it unconscious before it is exsanguinated, â€Å"bled out. Meat plants are inspected regularly, expected to follow code, and are fined heavily if found otherwise. He also makes mention that he is sending horse carcasses to Mexico instead of live horses. If the horses are killed in the US they are still under regulation. (NM Meat Plant Owner Defends Horse Slaughter Plan) I often hear the statement â€Å"Dead horses don’t help the economy! † But before it was banned; the export industry in the US was nearly $65 million dollars a year. That is $65 million dollars that could be coming into the US, but isn’t. Shesgreen) Mr. De Los Santos mentioned in his interview that due to the closing of his plant, he laid off over 160 workers at his small scale plant. With our economy in its current state, I believe we should not be cutting corners with people losing jobs or missing out on opportunities to make money. On the contrary, â€Å"Horses were never raised or bread specifically as a source of food because they have a much lower grain and grass efficiency rate then cows do. They take a lot more food and time to fatten up. Their immune systems are also not as strong s cows and they have the tendency to get sick easier; which can cause weight loss,† explained veterinarian Kathy Ott, owner and senior vet of Clearly Lake Equine Hospital. I did an interview with Dr. Ott knowing that I would receive a perspective of the opposing argument. She referenced that because horses are not specifically raised to be consumed; the vaccines, medications, injections and feed that they receive have not all been certified or regulated by the FDA. (Ott) Humane Society says; owner responsibility is the answer. It is a matter of personal responsibility when someone takes on a horse as a companion or work animal. If an owner can no longer care for a horse, that person has a responsibility to seek out other options for placing the horse or to have it humanely euthanized, rather than simply try to profit by selling it to slaughter. This is a valid point; however, in the state and federal legislation passed thus far in the US, the right to kill horses humanely has never been challenged, with the exception of those falling under the Bureau of Land Management (BLM), National Wild Horse and Burro Adoption Program. In the USA, horses remain property and anyone can â€Å"humanely† kill his or her own horse without fear of sanction including euthanasia or gunshot. How are do we know everyone one out there kills there horse on the first try? They could have possibly miss the vein or miss the shot. PETA is not against horse slaughter! PETA is disgusted by the idea of transporting of horses to foreign destinations, which increases their stress, probability of sickness and injury. They believe that the previous congressional action that ended the slaughter of horses in the U. S. was terribly inadequate solution, and had only made matters worse for the problem of unwanted and abandoned horses. The organization is a major advocate of local euthanasia or gunshot. They are constantly looking to find a better solution to unwanted and abandoned horse problem. Slaughtering is at the bottom of their list; however, right now it is necessary to prevent more suffering and starvation of the unwanted horse. (PETA) On November 11th, 2012, President Obama signed the ban to abolish the ban on horse slaughter. Horse meat, for the past 100 years, has had an influential effect on America. It has helped us in times of need, as well has been a huge amount of income for the US. With it still being so controversial on an ethical basis, I am sure it will continue to go through the cycle of being banned and reopened.

Good Research Topic Essay Example for Free

Good Research Topic Essay Many at times choosing an appropriate topic seem like a herculean task as a lot of problem areas may come to mind at the time of choosing the topic. What is more frustrating is being able to settle on a brilliant topic. Choosing the research topic is one of the most critical steps in conducting a successful by all standards. The truth is, the search for a good research topic is a daunting task, especially when researchers are often expected to know how to identify or figure out a good research question by themselves. It also is important for us to keep in mind that an initial topic that we come up with may not be the exact topic which we end up writing about. Research topics are often fluid and dictated more by the students ongoing research rather than by the original chosen topic. Such fluidity is common in research, and should be embraced as one of its many characteristics. The ability to identify and develop a good research topic depends on a number of factors. Fortunately, with every problem, there is always a place at which we can use as a starting point that will hopefully lead us to a desirable solution. The first important factor to consider when selecting or choosing a good research topic is to choose a topic that is of interest to them. The researcher should be able to ask themselves and identify where their interest lies, after all every individual will have at least an interest in one area or another. The fact that students approach their supervisors/ advisors with questions if they are faced with any confusion when conducting their research, the importance of the research advisor also having an interest in the chosen topic cannot be over emphasised. Research supervisors or advisors to a large extent, has a duty to coach, and give critical comments and reviews to the chosen topic. Uri Alon, a theoretical physics major turned systems biology expert (who is now one of the most renowned scientists in his field), per his own experience gave this piece of advice; â€Å"listen to your inner voice. † As he indicated, interest in a research problem is a subjective experience. In most instances, one’s actual interest clashes with the public interest and makes it impossible for the researcher to identify what their actual interest lies in. This however does not mean that pursuing a research of public interest is not a good option; in any case, a good research should be able to benefit the general population as a whole. We must be able to distinguish what we are interest in from other people’s opinion. This is what will inspire us and enable us stay focused throughout our research journey. For instance we can search within our hearts and minds problems in our various communities, industries or even continents which we are passionate about and would wish for these problems to be solved. This will help sieve out the many options from external sources such as the media, and focus on what we are interested in. In effect, if we have a research problem that has been bugging us for quite some time, chances are we have found our true interest to conduct our research on. Another attribute that makes a chosen topic a good one is whether the researcher has the requisite knowledge in their area of interest. It should be noted that doing a literature review enables us to have more insights in our area of interest, narrows down our research focus and directs us to ask more specific questions. In addition, knowing how much knowledge base is available on our chosen field will help us figure out what strategy to adopt in finding data. We can also read some other publications other than the text books and famous business journals available online as well as in print versions to be abreast with our chosen problem area. No matter how much potential our research question has, if we do not have the needed time to conduct our study, it can easily be a wasted effort and disappointment. A researcher can work on a time-feasible research project without having to sacrifice their interest, by breaking down the research problem into several smaller, manageable and more specific questions. It all depends how early they start their research activity. The main point here is for us as researchers to be more realistic about the time available and identify our research question accordingly. In order to ascertain whether an identified problem area must be researched on, it must satisfy primarily three (3) main conditions: i. There should be a perceived difference between what the current situation in the problem area is and what it should have been, all things being equal ii. The reason or reasons for this difference should be ambiguous. If the reason is readily known, then there is no point researching this problem area iii. There should be more that one (1) possible solution to the problem identified. It is very important and of a high significance that one chooses a research topic which is of significance to the current scenario in the society and one’s field of study. One therefore has to select research topics pertaining to business and management practices. Relevance is the key word in this regard. A clear understanding of the assignment will allow the student to focus on other aspects of the process, such as choosing a brilliant topic, which is, identifying the problem area and identifying their target audience. If a possible research topic is not addressing a priority problem, it is not worthwhile researching into it. To avoid duplication, care must be taken to ensure that the chosen topic has not been researched on. If one can find answers to the identified problem in already available, published or unpublished information, or just by using their common sense, then it will not be worthwhile conducting the research on the selected topic. Where it has been established that the problem area has already been researched into, the researcher must investigate whether the most important aspects of the problem area(s) still require some answers or the answers gathered by the predecessor researcher does not address the problem in its entirety. In this case, the same topic could be chosen otherwise the topic should be dropped. One of the most common difficulties in selecting a research topic is focusing on appropriate questions. Initially it might appear that the most exciting, interesting and relevant questions require a 10 year research programme, a team of research assistants and a multi-million research budget! But that isnt actually the case. The question here is, â€Å"how can you make sure that the research project is feasible, manageable and do-able within the normal constraints that he/ she will find themselves in? There are several practical considerations that almost always need to be considered when deciding on the feasibility of a research project. First, the researcher has to think about how long the research will take to accomplish. In addition, the researcher has to question whether there are important ethical constraints that need consideration. Also, one needs to establish whether they can achieve the needed cooperation to take the research project to its successful conclusion. Last and most importantly, the researcher should consider how significant the costs of conducting the research will be. Failure to consider any of these factors can be disastrous to the whole exercise. In general it is advisable for the one conducting the research to choose a topic that has the interest and support of the relevant authorities. This will increase the chance that the results of the study will be implemented. Topics that do not have the support or backing of the decision makers should be avoided as chances are they might never be implemented. In choosing a good research topic, the researcher must also consider the urgency in the needed research results for making a decision or developing interventions. Consideration must be given to which research should be done first and which could be done later. In effect, if the research cannot be done in a timely manner, then it better left not looking into. Topics or problem area that has been identified should be ethically acceptable. The researcher must be mindful of the possibility of their chosen area causing harm to others. We should consider whether there are any relevant ethical issues associated with our chosen area. If we happen to think our research isn’t ethical, we must drop the topic. In relation to the second part of the question which requires us to give five (5) examples of a good research topic and justify why we have chose them are as follow: Why doesn’t the average Ghanaian feel the effect of low inflation in their pockets? There have been impressive stories about declining inflation rates in Ghana in the past few months. The Ghana Statistical Services recently reported that inflation rate has decreased from 15. 2% in December 2003 to 8. 8% in January 2013. But while officials are painting a rather rosy picture of the economy, the average Ghanaian feels very ambivalent about these reported rates for the simple fact that they can hardly see the impact on their everyday cost of living. Economists have debated the seriousness of inflation since time immemorial, yet its economic cost remains ambiguous. It seems no matter the real economic cost of inflation, it does not show a real picture in the cost of living of the average Ghanaian. The confusion surrounding inflation rates in Ghana has to do with measurement problems. There are about three (3) ways of measuring inflation, that is, by the consumer Price Index (CPI), Producer Price Index (PPI) and the Gross National Product (GNP) deflator. The most commonly used index in Ghana is the CPI. Conducting a research on this problem area will inform us whether the CPI way of calculating the inflation rates reflects the actual state of the economy. In addition, we will figure out whether the various consumer products included are realist. The pricing structure of housing units in Ghana, how can it ever be regulated? Compared with other advanced countries, Ghana’s housing industry is at a rudimentary stage. High property prices particularly in the urban centres fuelled by a rapidly growing middle class and an uncontrollable urbanization have turned the housing industry into one of the critical developmental issues facing policy makers. It has been argued that the boom in the housing sector is largely driven by the surge to remittances. Others are of the opinions that the sector has experienced growth mainly because non-resident Ghanaians who have access to low-interest global funds are increasingly investing in the housing sector. If this is the case, then how come houses in Ghana are not affordable? A study into this area to a large extent will reveal the factors driving the pricing of housing units and alternative ways to make houses affordable to the middle class. Women in the corporate management, are they really improving performance? The impact of gender diversity and corporate leadership is not a new phenomenon. Gender diversity within senior management teams has become an increasingly topical issue for three related reasons. First, although the proportion of women at board level generally remains very low, it is changing across the world. Second, government intervention in this area has increased. About seven (7) countries have passed legislation mandating female board representatives to address the issue of fairness and equity. The third and most interesting of the debate around this topic has shifted from an issue equity and fairness to a question of superior performance over their male counterparts. If gender diversity on an entity’s board implies greater profitability then it would make sense to have more women in senior management regardless of government directive. This topic is of interest to a large number of people and as such has a lot literature available on it. It will make a brilliant research topic for these reasons. Are auditors really independent as they are perceived to be? Auditor independence has been termed the cornerstone of the auditing profession, since it is the foundation for the public’s trust in the attest function. However, auditors are faced with pressure to compete among themselves and the likelihood of them not being completely independent has increased overtime that is, staying in business over conforming to ethical requirements. A research in this area will inform us on the actual or perceived independence of auditors and how the business and ethical aspects can be managed. There will be a great literature review on this subject as are result of the Eron scandal in 2011, plus it is of interest to the corporate world. The social network phenomenon, Is it doing more harm than good to our relationships? It is a known fact there are many positives to social media and like everything, there is always a negative to balance the source. As social networks like facebook, twitter, myspace, instagram etc have left positive tracks within our lives; it has also affected us by turning us against one another. Social media whether we like it or not affects our relationships from family, both nuclear and extended, friends, schoolmates, work colleagues, marriages, dating partners, the list goes on and on. The question here is whether the positive effects outweighs the negatives and vice versa. A study in this area will help conclude if social media is worth it after all, on our various relationships. The importance of choosing a good research topic is the primary key to unlocking a successful research exercise. Getting the research question right is an essential, although not always a straightforward step in any research project. Settling on a research question is often difficult to do in isolation, therefore obtaining advice from experts and colleagues, collecting information from the literature and developing an awareness of the context in which the research is likely to be undertaken will all contribute to a successful outcome.

Gender and leadership style analysis

Gender and leadership style analysis 1. Introduction Leader is the central part of a company. No matter what kind of organization it is, the activity of leading is very important. Leader style is also called manager style, which is concerned with maintaining motivation, balancing interests and implementing tactical plans. An effective leader is someone who motivates a person or a group to accomplish more than they would have otherwise accomplished without that leaders involvement (Gedney R., 1999). As a good leader, he or she should be visionary, innovative, and has strategic and logical thinking. Good leadership style can help a company to build and sustain a high performance structure. When a baby is born, the first question people always ask is is it a boy or a girl? The babys gender determines what kind of characteristics he or she would have to some extent. If the baby is a boy, he is more likely to be competitive, strong and tough in the future. If the baby is a girl, she seems to be more careful, emotional, and patient when she grows up. So according to different characteristics male and female maintain, their leadership styles have many differences. 2. Different Genders Leadership Styles Research presented by Dr. Pat Heim in her video, The Invisible Rules: Men, Women and Teams, indicates that each gender is a culture in itself, raised with invisible rules of conduct instinctively known to all adult members of that gender (Norton D., 1998). Male leader leans towards the traditional command-and-control style. They are more likely to employ a transactional leadership. The transactional leadership style developed by Bass is based on the hypothesis that followers are motivated through a system of rewards and punishment (Transactional leadership, 2007). Leaders using this style view job performance as a series of transactions and they offer rewards for services rendered or punishment for inadequate performance. This means if the followers do something good for the organization, they will be rewarded. On the contrary, if they do something wrong, they will be punished. Followers are putting the wishes of leaders in effect.  In fact, this kind of style may begin to form the very early leader-follower relationship. Male leaders give the ideas to their followers that they can get better raises by following orders. As for female leaders, they also use the transactional leadership style. But the study found women were more likely to use the supporting component the leadership style have. On the other hand, male leaders not always give rewards when their employees perform well. But if the employees do something wrong, he will punish them without doubts. Female leaders are tended to use this kind of interactive leadership style. They not only encourage others participation but also attempted to energize followers by enhancing their sense of self-worth. They inspire and motivate employees while allowing them some initiative and giving them the power to make decisions on their own. Many women leaders believe that people perform best when they feel good about themselves and their work. The leaders are opening access to information to increase opportunities for continuous improvement. But similarities also exist among men and women managers. In order to lead employees, no matter what gender you are, you should follow many similar principles that useful in management. An extensive review of research suggests that similarities in leadership styles tend to outweigh the differences. Because of career self-selection and organization selection, people who choose careers in law enforcement or real estate have a lot in common. So do individuals who choose managerial or supervisory roles (David C., 2006). In retrospect, men are more likely to use the transactional leadership style for rewarding and punishing employees. Men are strong and decisive. Women build bridges of empathy. Men get things done. Women care more about the process(Different leadership styles, 2007). As women always use the transformational leadership style, they are better at negotiating than men. There are many communication strengths for female leaders: they enhance team work, win the trust of the people they work with, and encourage innovation. Male leaders also have many advantages: they are decisive when they face difficult situations, have clear mind to set different responsibilities, and remove unwanted elements without doubts. 3. Male Leaders vs. Female Leaders, Which Make Better Leaders During a long period of time, many people think men have the ability to manage people well and they are suitable to management. However, as more and more women are moving into management in recent years, some questions have arisen: Do women bring a special brand new style of leading into company? The traditional command-and-control style, compared with womens ways of leading, which one is more effective? Which leadership style is better? Which leadership style is better? In 2005, a year-long study identified a number of characteristics that distinguish women leaders from men when it comes to qualities of leadership. The study findings are summarized into four specific statements about womens leadership qualities: Women leaders are more persuasive than their male counterparts. When feeling the sting of rejection, women leaders learn from adversity and carry on with an Ill show you attitude. (Women Leaders study, 2005). Esther Wachs, the author of the book Why the Best Man for the Job is a Woman: The Unique Female Qualities of Leadership, makes research on the careers of fourteen top female executives among them the President and CEO of eBay to find out what makes them so successful. She found women has a willingness to reinvent the rules; an ability to sell their visions; the determination to turn challenges into opportunities; and a focus on high touch in a high tech business world (Lowen L.). Women in both staff and line positions were more likely to be leader-style executives than their male colleagues. During 1990s, there were only small part of women filled in managerial positions and most of them stayed in house looking after babies and doing housework. But just after several years, more and more women become white-collars and get high-leveled jobs. Organizations realize women have better performance than expected. In 2005, the number of women ascent into top management positions in large companies has increased nearly 60 percent over the last decade. In both the UK and Ireland, women represent more than 45 percent of the workforce (Gurdal I., 2005). From the data we can see, the speed which women moved into top positions is very fast. Nowadays, it is common to see female leaders in organization, although they are still the minority. Since technology develops rapidly, what the company concerned most in the future is for people. Interactive management, creative problem handling method, and effective communication skills are more valuable for an organization than other aspects. All these characteristics as important for future development and success are the qualities female leaders have. So to some extents, it seems that female leadership style is more and more suitable for companies. Women have the ability to create brand new corporation culture, which is different from male leaders produced. The structures that women establish seem to be flexible and these structures can help to create more interactive environment for a company. Since women also tend to discuss problems more openly and utilize group-think to seek solutions, such solutions are often more acceptable to teams (Gutià ©rrez M., 2008). According to what mentioned above, female leaders have many advantages outweigh than male leaders. But this does not mean male leaders are not good. There is still much superiority which male leaders have. Many studies show there are not lots of differences between the qualities of men and women leadership styles. Each genders leadership styles have their good points. Since male leaders are more masculine, they are good at solving problems, delegating, and influencing superiors. Female leaders are more feminine, they are more likely to be supporting and rewarding others, building team and consulting. Interestingly, some male leaders are better at networking, which generally is seen as a feminine behavior. Some female leaders are better than males at solving problems, an ability regarded as male leadership style. 4. The Trend of Leadership Style 4.1 Feminine leadership style is growing The general perception of business management before was a structure dominated by males whose leadership style was hierarchical, tough, action-oriented, and even autocratic. In most peoples mind, the ideal leader should be regarded as an independent, tough, individualistic hero. But today a new generation of women is bringing to business a different style often described as more consensus-building, more likely to encourage participation by others, more open and inclusive, and even more caring than that of many males. Now a new wave revolution created by women is coming. Many females begin explore their own way to top management positions. The way is not sitting down under old rules and habits that have proved effective and suitable for males, it derives from womens own experience and their unique understanding of the world.T he World YWCA Secretary General Kanyoro says attitudes toward leadership changing mentioned this: These newly admired leadership qualities of shared leadership; nurturance and doing good for others are today not only sought after but also indeed needed to make a difference in the world.A feminine way of leading includes helping the world to understand and be principled about values that really matter (Kanyoro M., 2006). In modern society, domination is no longer a popular leadership style. Todays work force is better-educated. Nowadays, more and more young professional workers are joining into the organizations. They demand to participate and contribute. In some cases, they have knowledge or talents their bosses dont have. Normally, these kinds of workers are likely to respond more to interactive leaders. They hope their leaders can be flexible, interactive, trust and encouraging rather than rigid, right-wing, serious, and restraining. Todays company requires leaders who not only are risk takers, but also are capable of hearing the ideas of others and really give them the power to use some of the ideas in changing business making them successful. Listening, encouraging and sharing information with people are the keys to success for best leaders. Just like the President of the nearly $500-million-a-year magazine group of Meredith Corp. said: Companies that try to manage in the old top-down, hierarchical, drill-sergeant way is just doomed (Nelton S., 1991). Many experts agree that women are more likely to have the ability to deal with the complicated problems existed in the company. They are more active in building networks, listening, resolving conflict, and getting people to work together. In addition, women can help companies be more competitive because they see business opportunities as a result of their own experience. Many female leaders have the confidence that they can help company grow very well in an international market. Although men still run the world, more and more people realize that it might be in better shape if women were more often in charge. Female leadership characters can help companies solve three major problemsthe need for better customer service, the demand for higher quality, and the need for leadership itself (Nelton S., 1991). Gradually, many male leaders start to use the so-called feminine tools of leadership without embarrassment. Being more male than male is no longer effective for women leaders on controlling a company. Women leaders have more opportunities to use the styles that are more natural to them as individuals, whether soft or tough. As never before, the world is seeking capable women as being the female leader. Its happening most quickly on the entrepreneurial side, as well as on the corporate side. A large growing pool of women will have the chance to show their executive talent. According to the research on Google, in United States, more than 4 million of women have already started at the top by launching their own companies. In order to nurture the development of women leaders, many companies encourage mentoring for women. They create situations that facilitate informal, on-the-job advice for women. Some companies also add women to board of directors. 4.2 Different leaderships blend together Although there are many advantages by using feminine leadership style, smart companies are making room for a diversity of styles, encouraging the development of women leaders along with the men. Male leaders are better at giving orders, while female leaders like to build the bridge between employees and her. They enhance team work more than male leaders and they more focus on the detailed things during the process. On the contrary, male leaders always lead in a macro point of view. Men and women can learn strengths from each other. Many women are combining the best of the traditional styles, such as focus on performance, into their leadership style, while men are adopting the so-called soft management approaches that women use effectively. For the fortunate businesses, these different styles should be complementary rather than confrontational. If two men or two women work together, it may not be more effective than men and women work together. At the top of the company, if different genders work together, they can produce harmony and comfortable environment and develop the companys potential to higher point. For an organization, in order to fully realize its potential, it is vital to meld different leadership styles together. No matter what kind of way the leader uses, the critical thing for the leader is to know the strong and weakness the style they use most frequently. To be effective in the workplace, the leader must also realize that switching between different styles can make his or her company have better performance. Dilemma Faced by Female Leaders in Todays Society: Stereotyping Leadership When we talk about the two types of leadership -one is predominantly masculine and the other is predominantly feminine, we would think about two different kinds of figures: men in the military and on the playing field to train soldiers, and women in the home to manage the house and nurture husbands and children. Since many women have been married and have children, most of them spend higher average hours of housework than men per week. The competitive pressure is growing higher and higher in todays society, women have to strive to balance their professional careers and family roles. Some people think female are not suitable for being leaders because women always consider their family a lot and can not spend all efforts on work. Womens inability of being leaders is not because they lack adequate leadership characteristics; it is because they do not have time and energy. Widely shared gender stereotypes are in effect the genetic code of the gender system, since they constitute the cult ural rules or schemas by which people perceive and enact gender difference and inequality (Carli L., 2001). Male and female management styles are distinct. In many cases, managerial stereotypes fit with gender stereotypes. People stereotype women as being better at encouraging, supporting and taking care; while men are stereotyped as being more direct, kinglike and taking charge. Many people think if the leader is a female, she is more likely to discuss with their employees when making a decision. To the contrary, if the leader is a male, he would decide by himself and influence superiors to follow him. People always consider man can better achieve a solution than women. Today, the number of men in top management positions is still much higher than women. Only a quite small part of women can enter top management field, let alone being CEOs. No matter what leadership style female executives choose, they are more likely to be perceived negatively than men. Female business leaders act consistent with gender stereotypes are considered too soft. But if they go against gender stereotypes, they are considered too tough. To explain these, when a female leader exhibit traditionally valued leadership behaviors such as assertiveness, she tends to be seen as competent but not personable or likable. If she adopts a more stereotypically feminine style, people like it but not see it as having valued leadership skills. So there is a double-bind dilemma for women in leadership: Damned If You Do, Doomed If You Dont (Study, 2007). So todays female leaders are really at a deadlock. Even though they tried very hard to become leaders, they still have limited positional power. Many people do not agree women become leaders because they regard all of women as a whole, and all of them have the same characteristics in other words, womens character flaw. In those peoples mind, since most women are sentimental, they should be tender and shilly-shally; since they are approachable, they do not have the determination to make punishment or criticize; since they are likely to support and encourage others, they do not have the power to influence superiors, etc. Stereotyping is strong and horrible, it gives women more and more pressure when they pursuit higher positions. Although many women have diversity trainings before they enter into executive positions, they still feel powerless to eliminate the stereotypes. The effect of gender stereotyping can be devastating, it block the way they pursuit their career, whittle down their confidence, bury their talents and potential and increase the huge gap in business leadership. One day women will be fully accepted in senior positions, but before this day comes true, women still have much further to go. Many companies have already realized the bad environment and unequal opportunities for women. In order to help women achieve their advancement and argue for their rights, some organizations have already taken active measure to avoid and resist gender stereotyping. Women leaders performance should be shown and supported, especially when they are in the fields dominated by male. Company should also create a gender-sensitive workplace, to give women the same opportunities to take part in the work discussion. Another way is to give managers, executives, and even employees the education about stereotyping. This can give them the idea that it is important to improve gender quality and let women have more confidence to strive for their rights. Furthermore, objective standards must be used when evaluating peoples achievements. It is sure that with equitable and supportive business environment, the organization will have better-educated workforce, enjoy better business performance and become more compatible in the market. 6. Suggestions for Good Leadership Style Regardless of the size of the company, both men and women business leaders have a lot they can teach one another about leadership, as well as the members of their own sex. As they learn from one another, they can bring strengthened leadership abilities to their companies. Here are some suggestions for good leadership styles. 6.1 Listen Carefully For this point, women leaders tend to be better listeners than men. Listening is the key because leaders can learn from the people who work for them by listening. If followers know their leader is open, the leader even hears the downside directly. Listening to others is a kind of way to gather information. It enables leaders to keep making changes to improve the organization. However, listening doesnt always mean agreement. Listening to a person doesnt mean you should decide it in his or her way. Leaders should be good at filtering useful information. Some leaders meet with a different group of 15 or more non-managerial employees for round-table discussions every month. By talking with those employees, leaders can get to know people at levels they might never see. The purpose of the round-table discussion is communication, but a wise leader makes a point of listening more than talking. 6.2 Being Decisive Decisiveness is defined as being characterized by firmness and decision' (Being decisive, 2007). Being decisive doesnt mean having a closed mind or being bullheaded. A good leader should know when to stop building consensus and gathering information to make a decision. Decisiveness is an area that women could probably learn something from men. 6.3 Be Willing to Express Your Emotions In fact, there is always a wrong perception about management. People always think soft management means the leader is sensitive, caring and supportive, and hard management means the leader is tough and draw the lines. But actually, a lot of the tough guy is really cowardly and ineffective management. Managers who take the hard approach sometimes are hiding behind a shell, they are afraid to confront their own emotions and feelings. They scare to show it in public. Dont be afraid to show your feelings to your employees which are important for both male and female leaders. Because it is a way to show your faith and honest, and it is also an opportunity to build the bridge of trust among people. Many leaders find when they stop hiding their emotions, their reputation among employees is higher. Instead of considering being soft, they receive more respects from their employees. Cry doesnt mean you are wimp. Leaders who cry for their employees outstanding performance or regret for their own leading mistakes convey that they take employees performance and achievements seriously. 6.4 Doesnt Let Your Ego Get in the Way No matter you are a man or a woman, you have to learn that there is no place for ego in leadership. Only one person can not make a company successful. Running an organization its a team effort and a team attitude. If something is good, both leader and followers will all take credit. But if it is bad, they all take the blame. Leaders should not be too proud of them and focus on making profit for their own, since it will be found sooner or later and followers will not trust the leaders any more. Dont be egotistical does not mean you can not get to the top if you want to. But what the leader should make it clear is that the more people you try to take along with you, the faster youll get there and the longer youll stay there. 6.5 Be Yourself Dont try to force yourself into a certain style thats not natural to you, even if you think its expected of you. Leaders should aware that different people have different expectations, you can not satisfy everyone. Do not lose yourself. Female leaders are strong professionals, but they can still wear dresses instead of masculine-looking suits. They can also keep a jar of candy in the office, which is regarded as a typically female touch. Believe it or not, such little things can produce an environment of communication and friendliness. You can learn to draw on other leaders styles, however, to enrich your choice of tools. Leader should build on his or her strengths in terms of the personality, and it basically comes down to what works best for him or her. 7. Does only sex determine the leadership style? Most of the male leaders can set legible responsibilities, but that does not mean women leaders can not. So all of these characteristics described for male and female actually do not have clear boundaries and are not the unique ones just aim at one gender. The leadership style is not just influenced by gender, the style also develop out of personalities and life experiences. Each leader has a predominant style, but the other aspects of leadership must also be present as tools to use. If men do not feel embarrassed to show some kinds of feminine ways of leading, they can also use them directly and effectively. In some cases, female leaders are also comfortable to show use some male leadership styles when necessary. In very difficult and dangerous situation, there may be just only one right decision. The leader should use it, no matter what gender the leader is. For many successful male and female leaders, their partners (have different gender) are linked by neither marriage nor romance. Men and women in senior management all work for long hours and are motivated by the achievement they made. Leadership style is also determined by the types of operations executives run. If the leader oversees design and production, he seems to be more low-key than the other one who is responsible for sales, marketing, and finance. The second leader needs to be more intense and aggressive so as to increase the performance of apartments which he or she charges. If leaders responsibilities require more structure, they should be more strict and rigid. On the contrary, if they need to deal with creative people, they should be more fluid, spontaneous, and flexible. From a get-somebodys-attention standpoint, it is beneficial for the leaders to be direct, no nonsense, and get on the table what they want. 8. Conclusion In retrospect, males tended to be more task-oriented; females tended to be more relationship-oriented. Women tend to employ a more democratic, participative style while men tend to take a more autocratic, directive approach. Self-selection and adaptation are factors common to female leadership, while delegation and controlling are factors common to male leadership. Female leaders are more likely to be supporting and rewarding others, building team and consulting. Male leaders are better at solving problems, delegating, and influencing superiors. Human flexibility combined with cultural experiences allows men and women the ability to do more or less what they choose versus being locked into stereotypical behaviors. For example, men are capable, although maybe not comfortable, working within organizations currently identified with womens styles. Also, women can and do adapt to military leadership styles when required. Although there are lots of differences between male and female leaders, they can still successfully work together, to communicate effectively, and contribute equally to the work place. Nowadays, more and more leaders become introspective but decisive, caring yet competent. Companies seem to understand giving the chances to a variety of leaders to grow and shine is good for business. All in all, whether a style is masculine or feminine, the best leadership style depends on the organization. A nontraditional leadership style can be effective in organizations that accept it. The most competitive organizations will take leaders wherever they find them, no matter what sex they are. Thats not only the essence of capitalism, but also the law of survival of the fittest.

The Movie Crash and Racial Tensions :: Crash Film Movies Racism Race Essays

Tension between the African Americans and Caucasians have been present in America since slavery. In the movie Crash (2004), race and culture are major themes that can be seen in the lives of the characters in the film. One character in particular, Cameron, a prestigious color vision director, displays the friction between two cultures. He belongs to the educated, upper class of the Los Angeles area. He is also an African American, yet he seems to have no ties with that class. He has a light-skinned wife, attends award shows, and it appears that his acquaintances are predominately white. When he and his wife, Christine, get pulled over by a racist cop, he experiences emotions of powerlessness and helplessness that he never knew he would experience due to his upbringing and place in society. Cameron goes through a radical transformation where he comes to grips with his background and how he fits into these two clashing cultures. In the first scene when Cameron is introduced, two white cops get a call about a stolen car. The openly racist cop, Officer Ryan, pulls over Cameron and Christine’s Lincoln Navigator, although it is obvious that their Navigator is not the stolen vehicle. The cop thinks he sees the couple participating in a sexual act while driving. When he approaches the car to ask for registration and license, Cameron and Christine laugh and find the whole situation humorous. Officer Ryan then asks Cameron to step out, and although Cameron obeys, he acts confused. He is obviously not drunk or wanting trouble (in the movie it even states that he is a Buddhist), and he declares that he lives only a block away. When his wife comes out of the car protesting the absurdity of the stop, the officer tells both of them to put their hands on the car so he can check for weapons. The cop then humiliates Christine by feeling her up between her thighs while Cameron is forced to stand by and w atch. In this scene, Cameron does not protest but unbelievingly stares at what is happening to his wife. He is in a vulnerable situation because if he objects, he and his wife could be arrested and his reputation ruined. When the police ask Cameron what he should do with what they did in the car he slowly says, â€Å"Look, we’re sorry and we’d appreciate it if you’d let us go with a warning, please.