Race, Tribalism, and Genocide in the Sudan - 648 Words

Jpz777 03/11/2013 Order # 2087938 1.) How were tribes in the Sudan formed differently from the way races were constructed in the United States? As is the case with the vast majority of nations which were conquered and colonized by the British during their reign of global imperialism, the Sudanese people of Africa experienced a rapid restructuring of its age old cultural identity system. Located in the Cradle of Civilization, a region straddling both the African continent and the Arab-speaking Middle East, Sudan has long been home to a diverse population that is representative of its many cultural influences, with Arab adherents of Islam living in relative stability alongside tribal bands of native peoples. Upon being co-opted as a British colony in the early 20th century to fuel a flailing textile industry, the fertile lands of Sudan were transformed into cotton plantations, thus beginning the insidious process of subjugating the Sudanese people through division and demarcation. The modern colonial scholar Mahmood Mamdani has observed that British colonial governance was about identity formation †¦ (because) the colonial political objective involved more than just redefining the relationship between colonial power and subject; it involved reshaping the very self-consciousness of the colonized, how they thought of themselves, their self-identity (Mamdani, 2009), and this concept of ensuring obedience through the removal and reshaping of identity lies at theShow MoreRelatedCritical Analysis of the Challenges Faced by Au in Achieving Continental Unity2727 Words   |  11 Pagesphysically, and economically, going beyond the material and affecting the lives of thousands of women, children, and men. AU therefore, came at a time when it was most desired. The African continent needed a powerful organ that cans unit different regions, races, tribes and people from different religious background and creed. AU has become the best hope that the African continent i s hanging its hopes on. There are a number of challenges that are facing the AU. One of the challenges facing the AU’s, is itsRead MoreOne Significant Change That Has Occurred in the World Between 1900 and 2005. Explain the Impact This Change Has Made on Our Lives and Why It Is an Important Change.163893 Words   |  656 Pagesgenerations to be among the processes that distinguish that era, not only from those proceeding it but from the rest of human history altogether. The essay by Gabrielle Hecht and Paul Edwards provides a nuanced interweaving of analyses of the nuclear arms race, debates over nuclear power as a major energy source, and the communications revolution made possible by computer technologies that did so much to shape the cold war standoff between the Soviet and American superpowers and the transition to a new

Evolution Of Lincoln s Policy On Slavery Essay - 1573 Words

Evolution of Lincoln’s policy on slavery in the United States. Abraham Lincoln was the great man of his generation just as well as he is considered a great man in history today. He made a huge difference that impacts us greatly today still. He is one of the main reasons to why we do not have slavery around anymore, along with some help of other people back then that supported him. Even though, racism still exist today it is not as horrifying and sickening as to how it was before back in the 1800s. Considering the fact that Abraham Lincoln ended slavery, in order to have achieve this he created many policies to permanently put slavery to a final end. Some of these policies were: The Gettysburg Address, the Thirteenth Amendment, Emancipation Proclamation, and so on. Slavery was a serious problem that needed a solution and he just so happened to be the type of man that never quit to achieve what he wanted or thought what was right until he achieved his goal. This is a great quality that he had and some of the reasons to why this man was and is gre atly respected and appreciated before and today. He detested how unequal African Americans’ were being treated by the people that supported slavery and thought it was the right thing because African Americans’ were only three-fifths of a person. He did not like how the people of the black race did not have all the rights as of the white race, which is why he created the thirteenth amendment. Abraham Lincoln would make speeches andShow MoreRelatedThe Struggle Of The Civil War1684 Words   |  7 Pagespublished in 1996. Mcpherson decided to split Battle Cry Of Freedom into five different parts and each of those parts tying back to his five themes established in the preface of the book. Those themes being slavery being a polarizing issue that split the country and brought the war, evolution of a conflict from limited war for restoration of the old Union to a total war for a new birth of freedom, role of blacks in the war, political and military leadership, the enduring i mpact of the war on consciousnessRead MoreRole Of The Clergy During The Civil War1193 Words   |  5 Pages1863. In this manner, the use of Christian ideology was also a major factor in the combination of governmental and cultural propaganda that utilized religion as a form of cultural cohesion during the war. More so, this also occurred in the Union Army s as way to justify the religious motivations for a â€Å"just war† as defined in lee’s army, as well as in the North: A â€Å"Great Revival† occurred among Robert E. Lee’s forces in the fall of 1863 and winter of 1864. Some 7,000 soldiers were converted. RevivalsRead MoreThe Evolution Of Democracy In The Early Republic. The Evolution1206 Words   |  5 PagesThe Evolution of Democracy in the Early Republic The evolution of democracy from the time of President Thomas Jefferson to President Andrew Jackson can be depicted as a minimal change in conceptually agrarian viewpoints and strong supporters of equality for the common man. While the two men essentially shared many of the same beliefs and ideas, there was a noticeable difference to how they acted on them and spoke out about them. As the nation s third president, Jefferson organized the national governmentRead MoreSummary : Does Freedom Ring? 1802 Words   |  8 PagesFreedom Ring? Mrs. Levin Belleville West Outline Intro Past issues Slavery Women Rights LGBT Minorities Unborn Conclusion Does Freedom Ring? America is known as â€Å"the land of the free and the home of the brave,† yet some people can object to this statement and say, ‘America is not free for me’! Our country’s history shows that freedom may not be free for all of us. With issues in our past, such as slavery, women s rights, and present-day controversies, i.e. the fight for equal rightsRead MorePolitical Parties And The Democratic Party2072 Words   |  9 Pagesrestore what is established and traditional, and to minimize change. This means that Republicans want a free market capitalism, limited government, strong national defense, opposing regulation and labor unions, and they support socially conservative’s policies. On the other hand, the Democratic Party was created in 1828 and is considered the oldest political party in the United States of America. The donkey symbolizes that Democratic people are smart and brave. The Democrats believe in social liberalismRead More The Reconst ruction of the Union After the Civil War Essay2103 Words   |  9 PagesUnion began under President Lincoln before the end of the war, and carried on by President Johnson after the assassination of President Lincoln. After Lincoln’s death, the leadership of the nation bestowed upon Andrew Johnson of Tennessee. According to A. Brinkley (pg. 375), Johnson revealed his plan for reconstruction or â€Å"Restoration†, as he preferred to call it, soon after he took office and implemented it during the summer of 1865 when Congress was in recess. Like Lincoln, he offered some form ofRead MoreHow African American Woman Is Working Essay1322 Words   |  6 Pagessociety in the 1880s and years beyond that. Being African American woman who is demanding to profitable to Nursing profession is a story of colored women fighting to overcome racial, social and economic injustice. In 1879s there was institutions, policy that only one African American students and one Jewish students could be enrolled in each training class at a time. Nevertheless, beforehand in general African American weren’t supposed to be educated to become anything not only men but particularlyRead MoreThe Importance of the Thirteenth, Fourteenth, and Fifthteenth Amendendments1493 Words   |  6 Pagesof slavery and inequality during the time periods in which these Amendments were ratified. These amendments changed the way America operated as a country from politics to human rights and equality by granting freedom to sformer slaves and the prevention of discrimination from all citizens of the United States. The Thirteenth Amendment to United States Constitution was passed by congress on January 31, 1865 and was ratified by the states on December 6, 1865 it declared that â€Å"Neither slavery norRead MoreThe Potential Misuse of Genetic Engineering and Cloning556 Words   |  2 PagesHuman’s wisdom has not yet caught up to their capability in science and technology. Genetics are being experimented which could alter human evolution. This technology, genetic alteration, is close to being used by the public. Cloning is a form of genetic alteration and experimentation. More legislation should be passed to further restrict genetic experimentation due to the possible misuses of the technology. There are many different forms of cloning. There is cloning in nature which helps with farmingRead MoreThe Constitutional And Modern Roles Of The Potus Insures Domestic Tranquility2389 Words   |  10 Pages grants reprieves and pardons, issues Executive Orders, and coordinates the efforts of over 150 departments and agencies. He does not do all of it, he has help form his Cabinet of 13 department heads and the White House Executive Office Staff. Lincoln s -Civil War- Gettysburg speech Keeping the peace between the North and the South George Bush’s Speech after 9/11 Explains unity Highlights What they are doing to fix it example: President Obama held a Cabinet Meeting in January of 2014 to discuss

Outsourcing Trends Health Services Professionals Free Essays

string(108) " quality and bring the programs under local control to align the program with their own mission and values\." [pic] MGT 6220 – Health Care Human Resource Management Outsourcing Trends – Health Services Professionals Fall 2012 Research Paper Anthony Edens Thomas Grumley Outsourcing Trends – Health Services Professionals In today’s healthcare environment, hospitals are facing increasing pressure to reduce costs, increase efficiency and improve the quality of patient care. Although some of the details of the impending changes may not be perfectly defined, the industry is certain that changes are inevitable. Going forward, there will be an increased focus on quality; penalties for re-admissions, medical errors and hospital acquired infections (Buser, 2010). We will write a custom essay sample on Outsourcing Trends: Health Services Professionals or any similar topic only for you Order Now Several factors, such as aging populations, new treatments, low patient financial responsibility and misalignment of incentives have forced the Government to reconsider current Medicare reimbursement arrangements (Kaplan, Porter, 2011). For example, fee for service, which reimburses providers and hospitals based on the procedure performed, are not based on the desired outcome which should be good patient health. Therefore, the incentive for the provider could be to perform more of the higher reimbursement procedures and not to focus on decreasing the costs of business. Unfortunately, this has lead to a cycle of increasing costs for the government and payers, who are now looking for ways to decrease reimbursement and align incentives with quality while reducing re-admissions. Decreasing reimbursement will force hospitals that are not currently focused on cost control to rethink the existing strategies. In light of this, hospitals will need to concentrate on expense control, staffing productivity and service line efficiency. Crucially, hospitals will need to focus on effective alignment with physician practices and hospitalists. One consideration that continues to arise is whether to outsource certain functions from an employment model to one involving outsourcing, and one which will be discussed at length in the following pages. The current climate is signaling a clear increase in the trend to outsource a multitude of functions, for both large and small hospitals. In Modern Healthcare’s 33rd Annual Outsourcing Survey, 42 firms reported a 14% increase in the number of healthcare clients from 2009 to 2010. The following year’s survey, reported that among the top 20 outsourcing firms there was a reported 13. 1% growth from 2010 to 2011. The top 5 services which are currently outsourced are laundry, housekeeping, clinical/diagnostic equipment maintenance, hospital based emergency departments and food services (Kutscher, 2012). Additionally, the outsourcing of back office functions continues to increase. For example, firms providing accounts receivable functions reported a 21% increase in 2010 and firms providing medical record services reported a 6% increase in 2010 and an 8% increase in 2011 (Kutscher, 2012; Daly, 2011). Also related to the back office functions is effective revenue cycle management. When considering the tightening of the current and future reimbursement environment, the ability for a hospital to successfully collect monies owed and to reduce bad debt will be crucial. For example, in May of 2011, Conifer, a subsidiary of for-profit hospital chain Tenet Healthcare Corp. , Dallas announced that it closed on a deal to provide revenue management services to 56 hospitals (Kutscher, 2012). Another area of explosive growth is in the IT sector. Part of the reason is that there is a federal mandate which requires hospitals and physician practices to show â€Å"meaningful use† of electronic records. Not only are there financial incentives for implementing electronic health records early, there are financial penalties for those that have not implemented a system over the next few years. Robust growth can also be seen among the firms that provide diagnostic equipment maintenance. In Modern Healthcare’s 33rd Annual Outsourcing Survey, these firms saw 12. 6% growth from 2009 to 2010 and the following year’s survey showed a 16. % increase. This is due to the fact the medical equipment is growing increasingly more complex and that specialized firms are able to adhere to strict maintenance schedules, provide detailed documentation and track repair costs. One of the largest areas of growth is in the outsourcing of anesthesia services. From 2009 to 2010, the growth among survey respondents was 147% to a total of 2 22 contracts. One of the reasons for this is that anesthesia services can operate as a self contained unit within a hospital. This works more efficiently than if each physician would bring in their own team by providing both consistency and cost effectiveness. However, there are concerns regarding outsourcing hospital services. Reasons for hesitation among hospital executives can be corporate culture, patient privacy and regulatory compliance. There are definite security and compliance concerns related to the outsourcing of electronic medical records. For instance, while Indian insurance and pharmaceutical companies have had success, gaining market share from U. S hospitals may prove to be difficult. As soon as it leaves the confines of the U. S. , it’s not subject to the same rigorous laws as we are,† says George Conklin, chief information officer of Christus Health (Sharma, 2010). Here, we are going to focus on outsourcing the hospitalist and revenue cycle functions and show some of the advantages and limitations of each. The number of hospitals that have hospitalist programs continues to gro w, and today 2/3rd of all hospitals use a hospitalist program. Additionally, the demand for these providers currently outweighs the supply with a total of 31,000 covering the country’s demand of 40,000 (Buser, 2010). One of the reasons for this increasing demand is it allows those physicians with busy outpatient practices to concentrate on those practices and for the providers in the hospitalists programs to concentrate on the inpatients. Additionally, hospitalists can focus their attention to the details of inpatient management due to their more consistent practice patterns and expertise which all helps to reduce average length of stay and increase patient health and satisfaction. Hospitals can choose from either employing and managing the group of hospitalists directly or using a 3rd party vendor such as TeamHealth or EmCare to outsource the service. For instance, a hospital may choose to employ a group of hospitalists directly if it’s looking to ensure quality and bring the programs under local control to align the program with their own mission and values. You read "Outsourcing Trends: Health Services Professionals" in category "Papers" However, crucial to the success of this is effective leadership and expertise. In some instances, employing hospitalists directly may require abundant investment in IT systems and other tools which will require large amounts of capital dollars that some smaller hospitals may not have access to. In these instances a hospital may choose to outsource this function to take advantage of the large economies of scale and expertise a large vendor may be able to offer. For instance, in the article â€Å"Hospital Medicine’s Management Shuffle† by Bonnie Darves, Martin Buser, MPH, who is the co-founder of the hospitalist consulting firm Hospitalist Management Resources LLC, attributes the decisions to outsource to rapid growth of programs in which the hospital did not have the proper infrastructure and financial support to carry on with the program. Additionally, by outsourcing the practice the hospital reduces its regulatory risks as well as administrative and recruiting burdens. For example, in 2007 Hospital Specialists of Georgia, turned over management services to Cogent, a prominent and large vendor of hospitalist programs. At the time the group was handling a third of the medical center’s admissions and could not increase that without support. Without available capital, the company was not able to meet the growing demands of IT, especially as quality and performance measurement started to become more prevalent. (Darves, 2007). Using a 3rd party vendor whose expertise lies in focus and efficiency, and especially when combined with firms who bundle ED and hospitalist services, hospitals can reduce patient wait times and reduce the number of patients who leave the ER prior to triage or treatment. Ultimately this acts to increase the overall volumes of the hospital. Additionally, for 2012, CMS (Centers for Medicare and Medicaid Services) created two new critical measurements which measure, in minutes, the time from ED arrival to ED departure for patients admitted from the ED to the facility and from the admit decision time to the time of departure from the ED for patients admitted to inpatient status. Improving these times has a multitude of positive effects on the facility. For example, this can reduce the ED length of stay, increase the ED capacity, improve the admission process and ultimately improve the patient outcome. Conversely, some may argue that quality and alignment with the hospital are better achieved when providers are employed directly. For example, Kadlec Medical Center of Richland Washington decided that in 2006 it would discontinue its arrangement with a large vendor and bring its program in-house. The hospital wanted more control over the number of hospitalists as well as the scope and quality of services (Darves, 2007). However, the data suggests that quality does not suffer when outsourcing a hospitalist program. This is why we recommend outsourcing in the case of a hospitalist program. In a 2009 survey released by the Medical Group Management Association, the data shows that a hospitalist from a large vendor sees, on average, more than 19% more patients per day than a hospitalist employed by the hospital. Patrick Hays FACHE and C. Thomas Smith explain in their article â€Å"Why the Independent Hospitalist Practice is here to Stay,† that this does not imply an adverse effect on the quality of the healthcare, and is instead the result of a focused effort where other hospital assignments are not competing for attention. An increase in focus and expertise can lead to early detection and better diagnosis of disease which ultimately leads to less expensive and less complex treatments, and importantly, to fewer re-admissions. Outsourcing the hospitalist practice is also cost effective. A 3rd party hospitalist vendor can usually integrate its existing software with the hospitals and reduce training and orientation costs that could come with having to learn a new EMR system. In addition to IT and recruiting costs, there can also be costs associated with billing, accounting, legal, regulatory, marketing and quality control. Should a hospital choose to employ the physicians and experience rapid growth without the proper infrastructure, these costs can quickly deteriorate the earnings of the group. Regulatory and legal costs can be especially problematic. For instance, Stark and Anti-Kickback Laws limit what a hospital can pay to an employed physician and require that each contract be put under scrutiny to ensure fair market value scrutiny to guarantee there are no conflicts of interest between the physician, hospital and patient. To make certain a hospital is not violating these serious and complex laws, it would need to employ and increase its legal department’s infrastructure to include a department specifically designated to physician contracts, a cost many small hospitals may not be able to afford. With so many reasons for a hospital to use a 3rd party vendor, hospitals may become increasingly interested in avoiding the employment model. John Donahue, CEO of Cogent HMG expects a â€Å"dramatic ramp up of hospitalist consolidation† in the coming years because of the new quality requirements the government is demanding the hospitals meet. The large hospitalist companies already have effective ways to measure this as well as reduce length of stay and complications resulting from hospital stays (Robeznieks, 2012). Another step firms are taking to convince hospital executives that outsourcing is the right choice is using local contractors and simultaneously offering a national support model. For example, Radisphere, an Ohio based radiology outsourcing firm, uses local radiologists who work with a network of offsite subspecialists offering continuous access to consultations. In summary, outsourcing hospitalist services can provide hospitals, large and small, a cost effective and efficient means to provide quality patient care. With an ever increasing focus on quality, using a group focused physicians with hospital expertise who do not have competing private practices can increase patient satisfaction, increase hospital capacity and volumes all while helping the hospital achieve its goals while creating and maintaining a good quality reputation in the community. Let us not forget, however, that the presence of Human Resources should be critical in this decision. The head of Human Resources needs to understand the dynamics of the business and the challenges that lay ahead should the company choose to outsource an existing function or in-source a function currently delegated to a 3rd party firm. For instance, if a decision is made to outsource an existing department there will need to be a roadmap for the existing employees. Ask questions such as, â€Å"Will there be a severance package or can these employees be transitioned or transferred to open positions in other areas of the company? Furthermore, there needs to be discussions regarding the reliability of the outsourcing firm and a contingency plan should the firm go out of business or discontinue the relationship. Are there alternative companies that could provide similar services if this situation were to arise? Will the chosen firm be able to meet the projected volume needs to the hospital? Additionally, even if the hospitalist function is outsourced, communication from management and H R will remain important so that those in these new positions still feel supported and motivated. HR needs to work closely with the firm providing the services so that boundaries, objectives and targets are clear. In a situation where an outsourced function is brought in-house, HR needs to ensure that the current management infrastructure can accommodate the new positions. Especially in the case of employing hospitalists, contracts as well as compensation and benefit packages need to be created. Another example of where opportunities lie for outsourcing departments is in office functions such as revenue cycle management. In recent years, hospitals have steadily warmed to the idea of outsourcing functions which were previously kept in-house, such as business processes and information technology. However, a host of factors–including the passage of the Patient Protection and Affordable Care Act, the faltering economy and the increasing emphasis on quality and performance improvement–have pushed that trend into overdrive (McKinney, 2010). In order to remain competitive and stay afloat, hospitals and other healthcare organizations are desperately looking deeper into business functions to determine the areas that may be better off outside the walls. Faced with a potential flood of new patients and lean budgets, hospitals are carefully considering each department to determine which functions can be turned over to contractors, and more areas are fair game than ever before†, says Reggie Hill, a partner at Waller Lansden Dortch Davis, Nashville (McKinney, 2010). Although housekeeping, food services, and diagnostic equipment maintenance are among the most common outsourced services, revenue cycle management is becoming increasingly popular. Because of the perception that there will continue to be cuts in reimbursement and new reimbursement models, hospitals are looking for ways to cut expenses and maximize revenue,† Hill says. â€Å"If an outsourcing agreement looks like it will accomplish those goals, it’s going to be something a hospital will want to take advantage of. † In particular, there has been continued growth in the number of organizations that are seeking out revenue-cycle management services, Hill says. â€Å"There are vendors that have shown they can add value, and more hospitals are giving it a try† (McKinney, 2010). Although more organizations are looking into the use of a vendor, it is important to consider all variables before determining the best option. Outsourcing the revenue cycle function does not fit all business models. Factors such as practice size, legal compliance, training ability, cost savings, quality, and efficiency should be studied carefully in order to realize the maximum return on investment. Companies that fit the outsourcing model and execute the transition properly can realize the greatest rewards. Conversely, outsourcing may be the downfall of an organization if these factors are not considered. When a company commits to outsourcing, cost savings tend to dominate and labor rates are a large contributing factor. In search of satisfaction, many companies are looking to offshore vendors. Offshore outsourcing companies might save hospitals even more money in labor costs because employees in countries such as India often work for much less money than U. S. staffers (Mantone, 2003). Managing a department outside of the organization’s walls has its other cost saving advantages. Having fewer internal employees reduces the need for back office space which will generate savings in rent. With a billing service, billing and collection activities occur off-site and therefore it may be possible for a hospital to reduce its current overhead costs or convert existing office space to a revenue generation, patient services area (Schechter, 2000). Furthermore, cost savings with outsourcing may also be realized in more subtle ways such as an adaptation of superior processes. The demand for standardization in revenue cycle management is on the rise. Despite growth in the industry, the floundering economy has made some providers skittish about first-time outsourcing deals†, Zambuto says. Another motivating factor that is convincing many to take the plunge is the need for standardization, he says. Outsourcing to a vendor can help ensure processes are done the same way each time at every location, which reduces the probability of errors, he says (McKinney, 2010). With this standardization comes an increased revenue flow. Many companies are careless with collections and spend unnecessary time, money, and resources on correcting mistakes. Re-billing and managing overpayments can become costly due to the increased hours of operation and additional wages paid to employees working these claims. If the billing can be done quickly and accurately the first time, these costs will not have to be wasted in order to generate the same amount of revenue. For example, Marshall McHenry, MD, a Cincinnati internist, chose to outsource billing when he started his own private practice. â€Å"He pays an outside billing service 6% of collections or about $20,000 to $22,000 annually, he said. In contrast, an in-house biller would have cost $30,000, including benefits, and a billing system would have cost several thousand, if not tens of thousands of dollars, Dr. McHenry estimates. Also, had he hired a biller, he would have had to factor in training and vacation time, and figure out how to avoid down time that could have seriously hurt his practice† (Chin, 2003). Additionally, this higher level of quality requires ongoing employee training which may become not only time consuming, but expensive. The billing service is responsible for hiring, training and supervising staff. They also are responsible for coverage when any of their employees are out of the office. And they are responsible for acquiring and maintaining all necessary computer software and hardware as well as addressing other technology-related issues (Schechter, 2000). The relief of these burdens will allow management to focus more on its core competencies. Typically, a revenue-cycle outsourcing firm takes over some or all of a hospital’s business office functions, which can include everything from patient registration, accounts receivable, billing and coding. They consolidate those functions into larger offices that serve many providers. The end result, outsourcing companies say, is a more efficient model that leaves more operating revenue for hospitals. Those types of business arrangements will likely continue as cash-strapped hospitals see the potential for big savings, says Dean William Harvey, a partner at the law firm Vinson Elkins in Dallas (McKinney, 2010). Richard Garnick, chairman and CEO of Anthelio Healthcare Solutions, credits the â€Å"incredible† cost pressures on hospitals for the growth in his company’s revenue-cycle management services. In the case of federal healthcare programs, Garnick has seen his client hospitals grow increasingly concerned that possible across-the-board cuts to Medicare and Medicaid could push them into the red. Those concerns have led some of Garnick’s core clients at community hospitals to replace their in-house back office staff with his employees to reduce the cost of those functions by 30% to 35%. â€Å"That gap will potentially allow that hospital to survive,† he says about one recent client (Daly, 2011). Success with outsourcing has also been achieved by Marc D. Grobman, DO, a solo internist at Internal Medicine and Primary Care in Wilmington, DE when he chose to use Health Care Practice Management Inc. as a billing service. He says he is getting 98% of money due compared with 75% when he was part of the hospital network. â€Å"At first using a billing service was a virtual necessity. Now I see no reason to bring it in-house because it’s working out so well,† Dr. Grobman says. He also thinks he gets more expert billers through outsourcing, which in turn means he leaves less money on the table. Dr. McHenry contends that he gets about 10% more — $35,000 to $40,000 a year — than he would have had he hired someone to handle billing. Because it’s a specialized skill, it can be hard to find good billers in the local labor pool, he added (Stevens, 2007). On the contrary, outsourcing does have its drawbacks, and most notably, a reduced sense of control is inevitable. Outsourcing firms are responsible for these functions which prevents the hospital from easily maintaining close management of operations. â€Å"The downside is you can lose control,† said Louis Korman, MD, one of Dr. Weinstein’s partners. â€Å"You can be taken. There are a lot of people who think that doctors’ practices are just money mills they can take advantage of† (Chin, 2003). Additionally, an absence of direct management may result in poor customer service. Third party billing firms may be required to deal with patients directly and it is difficult for the hospital or physician practice to monitor this interaction closely. Many physicians believe that they are able to maintain better relationships with patients when billing functions are kept in-house. Without this strong patient – provider relationship, a healthcare organization may not be able to survive. Moreover, a third party revenue cycle management firm may not hold the same work ethics as the healthcare entity which may result in subpar performance. A vital piece to the success of any billing department is legal compliance and these performance standards must be met. But revenue management outsourcing has its share of pitfalls, most notably legal compliance, he adds. Providers need to be confident in a contractor’s ability to manage the billing requirements of Medicare and other programs, while successfully complying with the Health Insurance Portability and Accountability Act of 1996 (McKinney, 2010). Dissatisfaction with an outsourcer’s performance led Detroit Medical Center in February to sue to dissolve a 10-year, $300 million contract with Provider HealthNet Services, Dallas. Detroit Medical said the outsourced operation failed to achieve timely completion of medical records and had not delivered on a plan to train employees and organize the department for computerized records. Provider HealthNet said uncooperative and obstructive action by Detroit Medical officials caused the performance problems (Morrissey, 2003). A company’s decision whether or not to outsource a department will inevitably require the presence of Human Resources. One advantage of outsourcing the revenue cycle management team is the distance that it creates between management and the frontline employees. In some cases, this disconnect is desired by the hospital because it relieves the duty of having to deal with employee issues. If an employee of a hospital is not performing, the management team will have to carefully follow HR policies and document progression of failing performance before termination may occur. This can not only be time consuming, but it can hinder productivity until the change may be made. Utilizing a vendor will allow the hospital to simply request that a replacement be made for a certain employee without having to follow any HR policies. â€Å"While the net cost of farming out billing is unknowable, Dr. Schwartz does believe that whatever it is, it’s worth the peace of mind it gives him. † An outsource service insulates us from the kinds of problems that could get us into financial trouble,† he says. There are some advantages† to not having him on staff, Dr. Weinstein said. â€Å"The biggest one is that if he’s not doing a good job, I don’t have to worry about firing him. I just have to say to the company, ‘Hey, this guy is not doing a good job. I want somebody else. ‘ They have to worry about firing him, and firing high-level people is not easy to do† (Stevens, 2007). Although some hospitals may find this Ã¢â‚¬Ë œpeace of mind’ to be worth a potential added cost, there are some disadvantages that an HR department may face with outsourcing a business function. Whenever a hospital chooses to outsource a department or other function, it will unavoidably have to endure a layoff of some magnitude. A layoff or employee termination will most certainly involve a strong HR presence. No matter the level of expertise of the HR department, this process is never easy to manage. In some cases, a layoff may be necessary involving employees who have been part of an organization for years. Relationships have developed between the employees and management team which can make this event even more difficult. However, if the business decision to outsource is made, many times a layoff is most likely unavoidable. Additionally, this will create a loss of jobs in the community. â€Å"Also it can be a â€Å"hard sell† because outsourcing hospitals are â€Å"taking jobs from the local community and putting them elsewhere,† Johnston says. â€Å"It’s not that big of a deal when the office has 10 people,† he says. â€Å"But when there are 100, 200 people in the office it becomes a big deal† (Mantone, 2003). This event can also create a negative image for the hospital which may not be beneficial for its reputation. This challenge must be closely managed by the HR department. In conclusion, outsourcing can be an effective way to increase the efficiency and lower the costs of an organization. In the case of using a 3rd party hospitalist firm, it uses a focused group of physicians who not only help to decrease costs but improve patient care and decrease re-admissions. Also, with improved patient care there comes a decrease in the average length of stay which is obviously great for the patient but also enables the hospital to increase its capacity for additional patient services. It can be advantageous to a hospital to use a 3rd party outsourcing firm so long as the goals and expectations are clearly outlined and defined within the contract terms with the firm providing these services. Another example of an opportunity to take advantage of the focus of a 3rd party firm is in the realm of the revenue cycle function. Advantages such as decreased overhead costs, increased expertise and augmented standardization are ways in which a hospital can improve its overall collections, decrease its net accounts receivable days and lower the amount of money spent to do so. Outsourcing does not necessarily imply going overseas, as mentioned in the hospitalist example above, patient care mostly depends on human interaction in most services and so the local community economy remains intact. In the end, HR needs to be well versed in the goals of the company and be able to contribute to the decision by offering perspective on future labor needs, compensation and benefit costs or savings and strategic alignment with the hospital’s strategies and mission. â€Å"References† Buser, M. , (2010, December). Hospitalist Programs in the Age of Healthcare Reform. Journal of Healthcare Management, 55:6, 378-380. Chin, T. , (2003, August 11). The Doctor is Outsourcing: To Hire or Not to Hire. American Medical News, Retrieved November 15, 2012 from http://www. ama-assn. org/amednews/2003/08/11/bisa0811. htm Daly, R. , (2011, September 5). Under Pressure. Modern Healthcare, Vol. 41 Issue 36, S1-S4. Darves, B. , (2007, May). Hospital Medicine’s Management Shuffle. Today’s Hospitalist. Retrieved November 10, 2012 from http://www. todayshospitalist. com/index. php? b=articles_readcnt=64. html Hays, P. , Smith, C. Thomas. , (2010, October). Why the Independent Hospitalist Practice is here to Stay. Physician Future. Retrieved November 18, 2012 from http://www. physicianfuture. com/news/physician-news/why-the-independent-hospitalist-practice-is-here-to-stay. html Kaplan, R. , Porter, M. , (2011, September). How to Solve the Cost Crisis in Health Care. Harvard Business Review, 48-49. Kutscher, B. , (2012, September 3). Expertise on Call. Modern Healthcare, Vol. 42 Issue 36, 20-27. Mantone, J. , (2003, November 24). Letting Someone Else Do It Better. Modern Healthcare, Vol. 33 Issue 47, S10 McKinney, M. , (2010, September 20). Outsourcing Sees Stimulus Effect: Health Reform, Ailing Economy Prompt a Closer Look at Use of Contractors. Modern Healthcare, Vol. 40 Issue 38, pS1-S5, 5p. Morrissey, J. , (2003, May 12). Not Paying Off: Baylor, EDS Terminate Revenue Management Deal. Modern Healthcare, Vol. 33 Issue 19, p3, 1/2p. Robeznieks, A. , (2012, April 2). Partnering up: As Consolidation Begins to Sweep through Healthcare, Hospitalists Expect to See the Trend Accelerate in their Sector. Modern Healthcare, Vol. 42, Issue 14. Schechter, K. , (2000, July 24). Compare Costs, Benefits of Billing Service vs. In-House. American Medical News, Retrieved from http://www. ama-assn. org/amednews/2000/07/24/bica0724. htm Sharma, A. , Worthen, B. , (2010, November). Qualms Arise Over Outsourcing of Electronic Medical Records. The Wall Street Journal. Retrieved November 29, 2012 from http://online. wsj. com/article/SB10001424052748704865104575588252907738276. html Stevens, L. , (2007, April 16). The Ins and Outs of Billing: Pros and Cons of Outsourcing. American Medical News, Retrieved November 15, 2012 from http://www. ama-assn. org/amednews/2007/04/16/bisa0416. htm How to cite Outsourcing Trends: Health Services Professionals, Papers

Analysis Of Maltese Falcon Essay Research Paper free essay sample

Analysis Of Maltese Falcon Essay, Research Paper I don t remember if Gutman said it in the film about the Falcon being coated by lacquer to obfuscate that it s truly made of gold and gems. I think it was implied that nil is what they truly seem to be. This is what I believe Dashiell Hammett was seeking to pass on through his novel, The Maltese Falcon. In this paper I will compose about why I believe what is Hammett seeking to convey through his dramatis personae of characters. These characters are unlike the image and stereotype dramatis personae upon their functions. Sam Spade International Relations and Security Network T precisely the typical ( stereotyped? ) chief character or instead a detective character ( I think for any chief character. ) By his looks/appearance, He [ Spade ] looked instead cheerily like a blond Satan ( p. 3 ) . Proposing he is non beatific looking like Lashkar-e-Taibas say Humphrey Bogard ( an indicant that the film isn T true to the novel ) . The movie ruined the dry un-charming hero concept the novel have and so make I as one of my first illustration of the things-are-not-what-they-seemed-theory-for-Hammett s message. Spade is indurate, covetous, and portions a similarity with Mike from The House of Games. Why I think Mike and Spade are similar? For one thing Brigid O Shaughnessy gave Spade a talk/speech about him utilizing her reasonably much the same thing Ford asked Mike in the airdrome. Brigid s remark ( p. 211-212 ) You ve been playing with me? Merely feigning you cared-to trap me like this? You didn t-care at all? You didn t-don t-I-love-me? Ford s You used me # 8230 ; address is strikingly similar to Brigid s including the reaction from Mike/Spade. The two work forces both refused to demo sympathy and they did both had sex with their respective victims # 8230 ; er adult females except Mike ends up dead and Brigid ends up in gaol. Ford and Mike and Spade and Brigid portion many similarities from the two adult fe males being used and the work forces victimizing these adult females. We know what Mike did already and Spade used his diabolic appeal to acquire Brigid to work out the instance. He conned her into giving him money, win his trust, and played with her feelings. The comparing between Mike and Spade is to demo that Spade is more of a con work forces than a detective which I hope are ( normally ) depicted as observant, straight-arrow, gentlemen. Spade is a proto-badass character. I think Hammett is seeking to convey that heroes aren t ever good. Brigid O Shaughnessy ( whom I will mention as Brigid because her last name is long ) is a complex character in which that she appears to be a typical damsel-in-distress but say to be a beautiful and unreliable adult female whose truenesss shift at the bead of a dime. ( backcover ) Yet Brigid is demure and gentle throughout the novel. In the film nevertheless she seemed blunt unlike her really diffident fresh opposite number. She was less diffident in the film and she said why she needed Spade and Archer s aid right off wereas in the novel she said Could you- ? I thought-I-that is- quietly. I think due to the adult females s motion that happened late so they decided to do Brigid less diffident. Brigid s character is unlike the usual damsel-in-distress femal e function though she her idiosyncrasy is. Brigid s not damsel-in-distress features are elusive. Brigid s unreliable Acts of the Apostless were mentioned but she was neer shown moving it outright. These Acts of the Apostless were besides obscure that it hardly makes you believe of Brigid any lupus erythematosus. When I read the book I didn t see how Brigid is unreliable. Brigid lied but that doesn T seem unreliable at all possibly because I think it was written in a manner as if she is stating a bantam white prevarication. Her so called perfidy are obfuscated by her demure idiosyncrasy as if to soften them. In the terminal of the novel/film when she revealed that she killed Miles she said it in a manner that it was an guiltless accident and goes on with her You used me†¦ address to do it look like the victim. Brigid s lines were written in a manner they it makes her look exploited and regretful that we are inclined to be sympathetic of what a anguished psyche she is that we can t aid but non recognize that she is a manipulative enchantress! I must state that Brigid is a good written character. Hammettt wrote her in a manner that we the reader think she is what she is: a hapless victimized miss when she is truly subtly pull stringsing our judgement of her, doing us believe she s inexperienced person. That s really unreliable! Casper Gutman is really much like Santa Claus in a manner that he seems reasonably and quiet all the clip. Gutman neer lost his pique one time but even if he did his face ever stayed reasonably. In my sentiment Gutman is the supporter of the novel/film because he is the originator of the whole black bird caper. He has deadly subordinates: Wilmer and ( possibly ) Cairo. Gutman doesn t seem like a bad cat because of the manner he s portrayed as Santa-like. It seems like he is the antonym of spade. Spade is the good cat who looks bad and Gutman is a bad cat who looked nice. I think Hammett neer truly established who s good and bad. Gutman neer threatened Spade with his life to acquire the falcon. Gutman hired Spade and Spade merely didn t agree with them that much. So Gutman is non precisely an adversary. I don t even think there is an adversary who try to do the supporter s life snake pit except possibly Dundy. Dundy nevertheless isn t the bad cat but the cat who doesn T trust a shady character which is typical presents in narratives with a supporter like Spade. In decision, I think Hammett wants us to recognize that everything International Relations and Security Network t black and white, there are sunglassess of grey or so the expression goes. Not all good things are good and non all bad things are bad. Meaning we can t merely based everything with stereotypes and visual aspects for they are lead oning. Through it all it s how good or bad a individual is inside that determines whether they are so good and bad. This nevertheless can non be seen, you ll have to cognize this individual before you can happen out. Spade seemed indurate as I said but he has a devoted trueness to Miles. He didn T show he cared for Miles but he did in the terminal when he put his feelings for Brigid aside to convey his spouse s slayer to justness. Of class Spade besides did this because he doesn T privation to be Brigid s sap but like I said nil is clear.