The event that has change my life span Research Paper

The event that has change my life span - Research Paper Example Prior to the birth of my son I took my job for granted. The birth of my son was the greatest day in my life. Being a parent has matured me a lot. I now have a greater focus in life. I plan on studying for a career at a local university. Education can help humans develop their skills and capabilities in order to succeed in the workplace. In the United States approximately 33% of the population has a college degree (Abel). I want to study in order to become more educated so I can help my kid with his school work as he continues to grow. I want to be the best parent I can for my kid. My parents were always there for me and I want to do the same for my kid. â€Å"In order to fully enjoy effective parenting you will have to follow your rectified heart† (Yuan). Work Cited Page Abel, D. 17 May 2000. â€Å"Going Backwards: US Falls Behind in College Graduate Rate† 22 March 2011. Census.gov. 23 March 2011. â€Å"U.S. and World Population Clock.† U.S. Census Bureau. 23 Mar ch 2011. Tradingeconomics.com. 2011. â€Å"United States Unemployment Rate† 22 March 2011. Yuen, S. 2011. â€Å"The Three Virtues of Effective Parenting.† 22 March 2011.

PERT and CPM Essay Example | Topics and Well Written Essays - 1250 words

PERT and CPM - Essay Example If negative, it indicates the amount of time that must be saved so that the project finish date is not delayed. By default and by definition, a task with 0 slack is considered a critical task. If a critical task is delayed, the project finish date is also delayed." However, there is little distinction between the two; this difference comes from their way of treating the activity time. In PERT, activity time is considered as a random variable, contrary to CPM where each activity requires a single deterministic time value. Furthermore, PERT focuses exclusively on the time variable whereas CPM includes the analysis of the time/cost trade-off. The task starts from A which requires 7 weeks for completion. Following A, there are two tasks, B and D, which can be carried out simultaneously and they, respectively, require 3 weeks and 8 weeks for completion. Task C immediately follows task B which at least requires 10 weeks (Sum of weeks required by task A and task B) to begin and will take 1 week to finish. Task C is followed by task E which needs both task C and task D to be completed before its start. Since, task C requires 11 weeks and task D requires 15 weeks to finish, therefore, it is logically understood that task E cannot be started before elapse of 15 weeks time-period. Keeping the above explanation in focus, the earliest start time for each task can be summarized as shown in below table: Code of task Earliest Start time A 0 B 7 C 10 D 7 E 15 F 15 G 15 H 16 I 19 J 21 It can be concluded from above analysis that the project will require minimum 22 weeks to complete; in other words, the longest path from start stage till finish stage is minimum duration of the project. This path, called critical path, has been already highlighted with the thickest and darkest line in above figure. If any task that lies in critical path is delayed, then ultimately the project gets delayed. However, the tasks outside the critical path can be deferred by certain amount of time. For example, task E is not part of critical path, therefore, if it is delayed by 4 weeks, even then so task J will be started as per its earliest start time, as calculated in above table, because task J can only be started once task I, which lies in critical path and requires 21 weeks to finish, is completed. CPM Representation: The above so-far discussion can be summarized in terms of CPM as follows: Critical Path Method (CPM): = A, D, F, H, I, J = 7, 8, 1, 3, 2, 1 = 22 weeks Through CPM, the critical path time can be reduced by carrying out task differently. For example, the time for sanitary and electrical installation (Task D) is 8

Operation management Essay Example | Topics and Well Written Essays - 4000 words - 1

Operation management - Essay Example conomic crunch has made customers to shrink their budgets thereby preferring airlines that charge relatively less than others one of them being Southwest Airlines. This airline is an example to many the world over due to its consistent profitability streak since its establishment. Southwest Airlines is one of the most profitable and respected airlines in the world. It is a no-frills airline having been established in 1971 as a low cost choice for Americans. It has its base in Dallas, Texas and it serves more than 85 million passengers annually (Southwest 2011). Its net income is well over 100 million dollars a year which it uses for expansion and other strategies. During its establishment the airline had only 3 aircrafts but it currently has a fleet of over 500. All these aircrafts are from Boeing and they help the airline to traverse the US skies while serving more than 70 cities (Southwest 2011). Due to its point-to-point strategy it records one of the highest numbers of flights at 3,100 per day. For it to support these services it has employed 35,000 people many of whom are able to multitask in various departments which makes them some of the most highly paid in the American airline industry. Considering the huge customer base and the demand for its servic es, the airline has done pretty well as it currently stands to be the best in customer service in the US airline market. The company management has for decades managed to stick to the low cost initiative by minimising operational costs and improving on efficiency. Unlike its rivals Regional Airlines and AMR, it has all along charged low fares and offered simplicity in its service range. The above information is summed up by the airline’s mission statement which partly states; The Chief Executive Officer Gary Kelly who is also the President is following his predecessors by ensuring that customers receive the best service and utmost attention from the company staff. This has been possible throughout the years

Consumer Behavior In The Fashion Industry Essay Example for Free

Consumer Behavior In The Fashion Industry Essay Introduction This study is aimed at analyzing the consumer behavior towards the fashion industry especially in consideration young and mature women in London. Fashions are concerned with the production of fashion clothing. Most consumers in the world today are concerned with the features of the product as they form most important factor in determining the consumer behaviors. Take for example of products of fashion show for young and mature women. The industry is involved in the manufacture clothing. Due to increase and growth of consumerism, the clothing should come up with clothes that make women move with times thus increasing consumption and production. Consumer behavior in the automotive industry especially in consideration to general motors is influenced by culture factors, social factors, Personal factors and Psychological factors. Look more:  the consumer buying process begins when essay RESEARCH OBJECTIVES   The answers to this question will enhance my professional knowledge and competence in many ways.   As a professional I will understand factors influencing consumption in the industry and will enable me make recommendations on improving the fashions market share.The answers to this question also will assist me as a professional by motivating me to ensure that that I work improves their products. 1)To review literature on fashion behaviour and the factors influencing 2)To compare and contrast the buying behaviour of mature and young woman in London regarding buying of fashion clothing 3)To identified the key factors influencing the buying process of fashion clothing in young and mature woman in London 4)To provide recommendation to manufacture of fashion clothing and fashion retailer. Scope of the study The scoop of the study follows literature review of factors influencing. The researcher manages the entire gamut of processes from initial stage of identifying the problem to final stage of report writing. The capabilities required by the researcher in this research in managing the entire project and providing real time for information sharing, decision synchronization and research optimization to all stake holders. What are necessary attribute required by a researcher to manage the dynamics of marketing based on the requirements by industry. However, this study assumes that other factors like family background financial, stability of the family place of birth, race, have no impact on the consumer behaviors. The proposed study will be used as a supplementary framework to focus entirely on the competence of the research. The objects of the study will include; Experimental Correlation Survey Grounded theory Ethnography Narrative Mixed method Action research. This study will be based on a process based on experiment using practical’s as a platform to develop method which will be used as evaluation criteria for the research and researcher in this research question and future researchers The critical review Literature review Consumer behavior in the consumption of any product any where in the world is influenced by culture factors, social factors, Personal factors and Psychological factors. Culture factors In world today culture is one of the most fundamental determinants for one when deciding the product to consume. This is because of a wide range of products and services.   Most of the people due to their cultural influence have started preferring certain products.   Children growing up will learn the culture of parents or peers thus preferring specific values that are crucial to a determining consumption. One of the values they like most is comfort.   These values common in children remain in them even if they grow up. From the culture, somebody may develop certain spending patterns is not something strange.   A child growing up in specific culture is exposed to achievement, success, beliefs and other cultural factors that influence behavior towards consumption. Cultural factors real influence a consumer behavior. Where people believe in values like efficiency and practicality it will influence their consumption is such a situation products that are known to be very efficient in their operations will be preferred. Each culture consists of smaller subcultures that provide more specific identifications.   To its some people consist of racial groups such as the Africans, Americans, Europeans and Asian each have good distinct cultural styles.   They are known to prefer products for example consumption of pork may be rare in middle east because culture and religion. Social factor   Another factors consumer behavior is greatly influenced by social factors like statuses, family and reference groups.   When once goes to the market to purchase a product he will take consideration to his membership groups, social class and family.   These are groups having direct influence to once buying decisions.   These are the groups one associates with most of his time. We have some groups like the upper class prefer buying some products which are not preferred by lower class.   Since companies produces many types of products that fulfill needs this groups and attracts many people.   The influence of a family is very great.   These families using specifics brands greatly encourage their family members to also consume similar products. Co-worker also influence one’s buying decision.   If a boss buys a given commodity the juniors will also try to buy the same. People are also influenced by reference groups in three ways.   Reference groups usually expose a person to a new behavior and lifestyle.   One can belong to a group whose lifestyle believes at consuming a certain product.   If a company produces high quality brands it stands at a better chance of making more sales to such reference group. Reference groups also influence one’s attitudes because their desires fit in these groups. People may prefer some products from a certain company, hence once could like to join his friend or family member towards belonging to the same social class by buying a that product. Also reference groups influence similarity and conformity that may make a person to alive at a specific decision.   So doing one will eventually buy a product similar to that of his friend. People who are in the same social class share similar values, interests, and behavior.   For example there is upper class people who are social elite with a good family background. Personal factors Age and life cycle stage greatly influence consumer buying behavior of almost all products from all industries. Most Bachelors tend to prefer specific brands associated by most youths. But those who are newly married, young and better of financially prefer buying consume different products. In making the final decision of buying a product one’s personal characteristics like his age and life-cycle stage, lifestyle, occupation, economic circumstances and personality will influence his choice. Companies take much consideration to personal characteristics of various groups of people before coming up with a product in order to meet the needs and demand of its people. A child growing up and exposed to some values like material comfort, external comfort and achievement and success will be influenced by those characteristics to consume. For example in America people like buying products that gives them external comfort. People in various professions like occupation managers, school heads, senior government officers, mayors, engineers, lawyers and physicians usually buy some products with the most recent technology. Economic circumstances also influence once buying pattern.   Most people especially those who are highly paid with good saving and with good personnel incomes buy expensive products. The lifestyle of a person influences his or her buying pattern.   People may belong to the same occupation, social class and subculture but leading different lifestyles usually prefer products that feed that group. Personality and self-concept: Personality and self confidence also influence consumers buying behavior products and services. For example expensive car, which are electronically controlled and having four wheel drive systems are associated with people who have high Self-confidence Psychological factors Motivation: some people get satisfied when they buy specific products.   people feel that they have satisfied specific needs by buying certain goods and services. Perception: once a person has been motivated he is willing and ready to act.   Most people to be motivated in order to act will depend mostly on their perceptions of the situation. Two people in the same motivated state may act differently depending on how they perceive the situation. A product may appeal to the perception of a specific customer.   For example various colors that cars are attractive giving customers a good picture of the real quality of this car. Beliefs and attitudes: most people follow some set of belief when making a decision on the type of product to consumer. A belief about a certain product will also influence consumption.   These beliefs make up brand images and most people have been proved to act on these images. People always have good attitude towards specific products and if this product meets the performance according to the needs, desire and attitudes consumption will be influenced. METHODOLOGY: The purpose of the study is to find out factors that influence fashion consumption in UK. The phenomenological research design that will be used will involve a study of the consumer behaviors and consumption in fashion industry. This particular study will be done in two phases where the first phase will involve completion of a questionnaire which is commonly known as a questionnaire survey by individuals. This questionnaire survey will be done on a sample of twenty fashion show owners within London . And the second phase will involve the use of some interview which will be in some way semi structured. Each given phase in this design will address the different research questions and their concerns. At some point within the first phase, there will be cases of the first qualitative phase relying on the some quantitative phases that might have been in use in the design. The interviews that will be used in the design will be carried out in a sample of twenty fashion show owners. The interviews will serve to give out information concerning buying behaviors’ among women. These surveys will therefore give some contextual information about the consumption of a specific fashion. Some studies will be conducted using single stage designs and others like this one will be conducted using the two-stage design. When using the two stage design, the contextualization that will be given in the first stage will be very much helpful (Jasper, 1994). The survey will provide a specific frame for which sampling will be done from for the semi structured interviews that will be done on the fashion operators and buyers. And gaining access to the twenty fashion owners will be very essential to getting the right information concerning the consumption of fashion among young and mature women from the sampled group of a given part of city which will be a representation of the whole population of the young and mature. The given questionnaires will have the contacts so that the used sample can be contacted incase more information will be needed. The quantitative data that will be gotten from the phase of questionnaire survey will now be used to get through to the qualitative sample. The questionnaire surveys have always been made with the above additional purpose in mind. In the cases where one researcher will have to make attachments of qualitative sub samples to samples that will be statistically derived will lead to another mixed method of designs in qualitative research methods (George, 2000). Such mixed methods of designs will most of the time benefit the qualitative researchers in that they give them the chance to have a selection of the specific cases from which they will be able to draw upon information that will be contextual that will also enable them to put their hypothesis under test on a large samples that will be statistically be represented. Therefore in most cases, the researcher will have to be decided on which research design he will use in his project. Some researchers do use multiple designs while others will use single designs. This purely depends on the project that one is doing and which research design the researcher will be most comfortable with. There are three major components in a research design model and they are; determination of the limits of the people to be investigated and also what will be investigated, the collection of data and the last component is the analysis of the collected data in a phenomenological manner. In the first component, the researcher will have to know to what limits the participants in the survey will get in trying to give him the required information. Here the researcher will have to put in mind the limits of the twenty fashion owners in trying to give him information as far as matters of fashion consumption. In addition, the researcher will have to have specific issues which he would want to research on (Joan, 2004). At this point in time, the researcher will have to carry out his project purely on the safety of the crane operators. In trying to get information, the phenomenologist will have to engage himself in an in-depth probing so that quality information may be found. After identifying the sample group that will help in giving the required information, the following step will now involve identifying the most efficient data collection methods. The following methods will be the most preferred methods for this particular survey; the in-depth semi structured interviews that will have to be tape recorded and later on be transcribed. The second data collection method will be the use of a documentary study from which the writings of the subject matter will have to be reviewed so that their meanings can be properly derived from them. This second method will be used hand in hand with the first method (Johnson, 2000). The third and the last data collection method will be the technique of the participant observation. This particular technique will lead to a generation of some kind of an interview. It will be worth noting that in phenomenological research tape recording is important because the tapes will later be transcribed. Sampling designs strategies in qualitative research. There are many different qualitative sampling designs that will be used at the different stages of the research or still they will be used for the different purposes of the research. There are those questions that the researchers should constantly be asking themselves which will serve to give relevant information on the sampling strategy design that the researcher would have chosen to use. It will be very crucial for the researcher to give a clear definition of the objectives of the research. The time that will be spent making clarification with the client will be a time that will be well spent (Kendy, 19976). Most of the times, in qualitative research, the objectives of the project might be refined as the research will keep on progressing. Sometimes the available resources will try to undermine the progress of a researcher’s project. This should be prevented to happen by considering the available human resources to the project at hand and also the nature of the method of data collection. The length of interview that is the qualitative interview will have a great impact on the qualitative sampling design strategy and the final decision of the given sample size. For instance longer interviews will provide detailed data than shorter interviews. With this in mind a decision may be taken on whether to carry out longer or shorter interviews.The sampling size should also be put in mind. This will basically depend on the homogeneous or the heterogeneous nature of the population to be sampled and the requirements of the methods of the data collection that will be employed in this research. Data analysis After the researcher will collect the data, she/he will tabulate the data into tables and analyze it using frequencies descriptive and percentages. The processing of the survey results. The processing of the survey results need not to wait until has been completed, but can begin as soon as the first questionnaires are received. The main steps are; Coding. Nowadays the computer is used widely to process information. For that reason it is often advisable to code the information or even use a preceded questionnaire to facilitate the necessary processing and calculations. Punching. Subsequently the information can be punched for computer purposes. Data tabulation. With the aid of a computer, raw tables may be compiled. These tales are often only preliminary and may serve as guidelines for further analyses and condensed into possibly more meaningful tables. Statistical processing. With the previous step as a basis the information can be processed further until it yields objectives and clear answers to the problem or opportunity which is being investigated. REFERENCES Aaker, D.A., Keller, K.L. (2000), Consumer evaluations of brand extensions, Journal of Marketing, Vol. 54 pp.27-41.    Bloom P.N. and   Greyser S. A. (1981);   ‘The Maturity of Consumerism’ Harvad Business Review, Nov-Dec. 1981 pp 130-139) Charles, K. (1990). Methods used in Research. Social Science, 29(10), 1160-1178. Cole Gerald ‘2004; management theory and practice; 6th Edition, TJ International, Pad stow, Cornwall. Creswell, J. (1998). Guidelines to choosing the best research design. Phenomenology, 34, 234-245. Dacin, P.A., Smith, D.C. (2004), The effect of brÐ °nd portfolio characteristics on consumer evaluations of brÐ °nd extensions, Journal of Marketing Research, Vol. 31 pp.197-207. George, H.   (2000). Qualitative research design illustrated.   Journal of Qualitative Methods, 34, 246-257. Jasper, A.  Ã‚   (1994). Phenomenological issues for project researchers.   Phenomenological research method, 4 , 409-414. Johnson, K. (2000). Commonly used research methods. Boston: St. Martin’s Keller, K.L. (2003), Conceptualizing, measuring, and managing customer-based brand equity, Journal of Marketing, Vol. 57 pp.1-22. Keller, K.L., Aaker, D.A. (2002), ThÐ µ effects of sequential introduction of brÐ °nd extensions, Journal of Marketing Research, Vol. 29 pp.35-50. Klein, A. (2003). What is phenomenology?   New York: SUNY Press. Kotler P., 1989, marketing management; Analysis, planning, implementation and control, 6th Edition; Prentice-hall, India (NewDelhi) Loken, B., John, D.R. (2003), Diluting brand beliefs: when do brand extensions have a negative impact?, Journal of Marketing, Vol. 57 pp.71-84. Nakamoto, K., MacInnis, D.J., Jung, H-S. (2003), Advertising claims and evidence as bases for brÐ °nd equity and consumer evaluations of brÐ °nd extensions, in Aaker, D.A., Biel, A. (Eds),BrÐ °nd Equity Advertising: Advertising’s Role in Building Strong BrÐ °nds, Erlbaum, Hillsdale, NJ, pp.281-97. Park, C.W., Jaworski, B.J., MacInnis, D.J. (2006), Strategic brand concept image management, Journal of Marketing, Vol. 50 pp.135-45. Park, C.W., Milberg, S., Lawson, R. (2001), Evaluation of brÐ °nd extensions: thÐ µ role of product feature similarity and brÐ °nd concept consistency, Journal of Consumer Research, Vol. 18 pp.185-93. Richard, S. (2002). Methods used in social research. Oxford: OUP. Ries, A., Trout, J. (2006), Positioning: ThÐ µ Battle for Your Mind, McGraw-Hill Inc., New York, NY., . Robson, C. (2000). The Handbook of Research Methodology. Oxford: Blackwell. Romeo, J.B. (2001), ThÐ µ effect of negative information on thÐ µ evaluations of brÐ °nd extensions and thÐ µ family brÐ °nd, in Holman, R.H., Solomon, M.R. (Eds),Advances in Consumer Research, Vol. 18.   Rowe, D., Bartleman, D., Khirallah, M. Smydra, M., Keith, G., and Ponder, M. (1999), .Reduce cynicism and apathy and create positive change agents: Essential and missing components of our educational curricula. Tauber, E.M. (2003), Fit and leverage in brÐ °nd extensions, in Aaker, D.A., Biel, A. (Eds),BrÐ °nd Equity Advertising: Advertising’s Role in Building Strong BrÐ °nds, Erlbaum, Hillsdale, NJ, pp.313-18. Wright, T., (2001), .A review of definitions and frameworks for sustainability in higher education draft, Assessing Progress Toward Sustainability in Higher Education consultation presentation paper, Washington, D.C.

Healthcare Reforms in England Issues of Efficiency

Healthcare Reforms in England Issues of Efficiency The healthcare service in England attempts to improve the overall healthcare service have been ongoing through some of the most radical reforms since its inception as a comprehensive public service since 1948. The noticeable need of a free healthcare service was essential after the state of the country due to the world war. Once the NHS was established it saw many reforms led by diverse types of governments at different times. Despite the scale of the reforms they have preserved their core principle of A free service at the point of delivery 1 till this very day. Even though they have adopted the core principle they still face huge challenges; as demands and costs are still rising, the entirety of the service is increasingly being looked at. This paper looks at the reforms the NHS has been through and analyses each reform in the light of Efficiency: the capability of the NHS, whether the reform made the NHS more competent, Equity: bringing fairness and equal right for the patients as well as the staff, Quality: whether adapting the reforms improved the patients ability to acquire different types of healthcare services without any predicament and obtain high-quality healthcare services. Methodology This paper was conjured up by the use of reports published by NHS Publications website. Journals and studies on NHS reform via the scientific database PubMed were also utilized. To gain info on the theories the NHS was formed on, management theory books by Max Weber, Henri Fayol and Frederic Winslow Taylor were used. Results/Discussion Each reform improvised the NHS in many ways, in relation to Efficiency the NHS since its inception has seen major investments and new hospitals built, employment of up to date technology allowing more patients to be seen within an applicable time and budgets been controlled efficiently with the aim to reduce costs each year allowing the NHS to run efficiently. In terms of Equity after the publication of the Black report, the NHS has improved on giving equal opportunities to its minor ethnic groups of staff. Also the equal treatment of patients regardless of their social class has been improved since the Blair era. The NHS in terms of quality has become one of the world leading healthcare providers. Measuring their services against standards set by the NHS ensured that they are meeting the set standards. The major investment in staff in 2000 saw a number of lives saved in the past 10 years. The NHS has met quality standards that are accepted by its patients and valued as a first class service. Conclusion Overall the NHS has seen many reforms which have lead to the NHS becoming a world class service. Since the reforms in the 1960s to the latest plans of the new coalition government the NHS has improved immensely in terms of efficiency, equity and quality and the future also looks bright for the NHS. Introduction: Healthcare service in England was launched in 1948 with an aim to provide universal healthcare to its citizens which is free at the point of use and available to everyone based on need, not ability to pay 1. The NHS was established after World War II where the country needed a stable healthcare service 2. The initial idea was that no-one should be deterred from seeking health services by a lack of resources and the founder Aneurin Bevan: Minster of Health stated A free service at the point of delivery 3. Till this day they have been providing free healthcare service to the citizens of England. In 1948 Sir William Beveridge, a British Economist and a Social Reformer conferred details of his radical plans for economic and social reform in post-war Britain. Sir William proposed major healthcare service changes on the basis that the country needed the abolition of want before the enjoyment of comfort and suggested a scheme where every kind of medical treatment would be available for everybody. 1,3 Pre NHS There has been some form of state-funded provision of health and social care in England prior to the NHS for 400 years.4 Prior to a health system being formed, attaining healthcare service in Britain in the 1930s and 1940s was difficult. Life expectancy was very low and thousands of people died of infectious diseases like pneumonia, meningitis, tuberculosis, diphtheria, and polio each year.4 The poor never had access to medical treatment and they relied instead on dubious and sometimes dangerous home remedies. Either that or they relied on doctors who gave their services free to the poor patients. The Hospitals charged for treatment and although the poor were reimbursed and before they received treatment they had to pay.4 Figure 1 shows the life expectancy that has changed since the NHS was introduced. Figure 1.Life expectancy changes since 1840 5 The need for free healthcare was widely recognised, but it was impossible to achieve without the support or resources of the government. A study showed that experts believed and have written extensively on the reasons of why a health service was needed.6 These included: The appearance of a view that health care was essential, not something just imparted erratically by charity The drastic effects of the war that made it possible to have a massive change of the healthcare service being provided, rather than just an incremental alteration As younger members of the country were becoming increasingly educated in the medical profession they had a view of things could be handle in a more efficient way. The hospitals having financial problems, funds not sufficing.6 Having looked at the reasons to why a health service was needed the government made plans and core principles were established: 6 Regardless of persons status they were eligible for health care, even people temporarily residing or visiting the country.ÂÂ   People could be referred to any hospital. The healthcare service was financed almost 100% from central taxationÂÂ   Care was entirely free at the point of use6 The main achievement was that the poor who in the past went without medical treatment now had access to free healthcare.6 NHS today and NHS employment NHS is one of the largest organisations in the world with an annual budget of around ÂÂ £80 billion employing more than 1.7 million people and treating over one million people every 36 hours.7 In general, healthcare service being provided within England to every single citizen is a difficult commission to undertake and consequently the system needs efficient health personnels to help run the system economically. Today the view of the healthcare service in England is that the NHS is a world leader and provides first class service that other countries envy. Countries all over the world seek to learn from the comprehensive system of general practice, and its role as the medical home for patients, providing continuity of care and coordination.8 Other countries look at English NHS system and use them as a guideline to run their healthcare system. NHS Structure The healthcare service in England has been run in a structural way with the Secretary of state and Department of Health controlling the overall NHS in England. The secretary of state for health has the responsibility of reporting to the prime minister. There are10 Strategic Health Authorities (SHAs) in England which are controlled by the Department of Health, they oversee all the activities within the NHS and the SHAs supervise all the NHS trusts in its area. Primary care plays a major role in community healthcare and is central to the NHS. Services under NHS trust (Secondary Care) include Hospitals, Mental Health services, Learning disability services and Ambulances. The overall structure of the NHS is shown below in Figure 2. 9 Although this is the current NHS structure with the new government in power, changes are to follow. Figure.2 overall structure of the Healthcare system in England 5 NHS Reforms Since its inception in 1948 the NHS has seen many reforms in terms of managing the way they provide healthcare service. The DoH has a lot of control and influence the major decisions taken in the reforms. The overall expectations of Healthcare service in England are of a high calibre, which requisites high-quality management capacity.10 In the 1980s and early 1990s prominence was on recuperating management. The recent focal point has been on development of leadership within NHS. With the new government, new ideas and plans will be imposed to see improvements in quality of healthcare being provided, cut down on costs making it more efficient and in terms of equity provide equal service to everyone. Table 1 briefly enlists the reforms that have taken place since its inception in 1948. Table.1 Reforms in the NHS: 1948-2010 Period the reforms were in place Reform and theory of Management 1948- 1960 Managers as diplomats 1960s Scientific Management and the Salmon report 1970s Classical Management, Systems Approaches and the 1974 Reorganization 1980s The Griffiths report and Managerialism 1990s Working for Patients and the Internal Market 2000 The NHS Plan (DOH 2000) and the Third Way. 2010 NHS White Paper 2010: Equity and excellence: Liberating the NHS Healthcare service and Reforms in other Developed Countries Healthcare reforms within developed countries can be analyzed in order to compare whether the healthcare services in England have been successful in its bid to ensure efficiency, equity and quality. Attempts to handle reforms of the healthcare system in the European countries have been an ongoing process for 30 years. Although the reforms have taken throughout the 30 years in different ways, their main emphasis has been on improving the cost-effectiveness of the healthcare service. In the early 1980s the EU countries were looking at cost containment. The feature in the 1990s was to endorse efficiency in terms of introducing competition and markets in the healthcare system. Since 2000 the focus has switched to effectiveness; promoting various notions of healthcare in terms of quality.11 Over the course of the 20th century the countries of Europe have established significant success in improving the healthcare service for their citizens. However they still face challenges in the form of restraining costs, improving quality and providing universal healthcare access, these have put the European healthcare services under immense pressure.11 Looking at another OECD: USA, A report on A review of health care reform in the United States assessed whether the USA have been successful in providing healthcare. The findings showed that United States spent more per capita on health care than any other OECD country, yet its health outcomes lagged behind other countries.12 This shows they are struggling with efficiency issues and are still countering challenges in providing quality healthcare service that is expected from the citizens of the USA. Especially in the last few years Healthcare reform has been a major activity of the federal government, in order to revolutionize and develop the service overall. The 3 goals of optimizing cost, access and quality still remain a challenge within the healthcare society in the U.S.12 They concluded that USA still faced many challenges in running the national healthcare service, a key challenge they face is the utter complexity of the system, with its numerous public and private providers.12 Another OECD country reviewed in terms of healthcare service being provided and the reforms that have taken place is China. A report from on From a national, centrally planned health system to a system based on the market: lessons from China concluded: China is the country that has undergone the highest number of health care reforms. Since 1978, China saw many reforms and they also followed the way as the EU countries, with the healthcare system starting from governmental, centrally planned and a collective system to ending up as a heavily market influenced system. Now, thirty years later, the Chinese government openly concede that the reforms were unsuccessful and seek innovative and fresh directions.13 This illustrates that China is also in a healthcare crisis and looking to implement different strategies in order to gain control of Chinas Healthcare system. Having reviewed the healthcare service being endowed in these developed countries, it demonstrates that they are all on an identical level as the healthcare service being provided in England and all face similar challenges. All these developed countries are looking to develop the countries overall healthcare service in terms of efficiency, equity and quality. NHS Plan 2000 and the future of NHS Since the last reform: The NHS plan 2000 14, a lot has transformed in terms of funding and operating the healthcare system in England. Especially with the new coalition governments idea of cutting budgets it is a difficult time the NHS is going through and will necessitate a lot of expertise and world class management to get through todays financial and economical predicament. An additional indication that will be taken into deliberation is the election of the new plans set out in the NHS White Paper 2010. As the new coalition government has come into authority there have been huge changes to overall budgets for the public services and this possibly will have a consequence on the way the NHS operates in England. 15 The reforms have encompassed a significant impact on the organisation and deliverance of health care service in England. Wide array of transformations have been pioneered in an attempt to ensure the NHS is managed more resourcefully and effectively. This report will examine whether these reforms have on the whole improved the healthcare system in England in terms of efficiency, equity and quality and if the publics requirements have been convened. Aims: To examine the healthcare reforms in England since its inception and to assess whether these reforms have improved factors of efficiency, equity and quality in providing healthcare. Objectives: To review the reforms in the NHS since its inception in 1948 To examine whether these reforms improved efficiency, equity and quality of healthcare To assess the key features of healthcare reforms proposed by the current government and their implications on the NHS To put forward plans for the future of the NHS Methodology: A number of sources were consulted to conjure up this paper and examine the healthcare reforms in the NHS. Scientific search engines and databases such as PubMed, Google Scholar and Science Direct (Date accessed 20/10/10) were used to gain literature reviews but results from Google Scholar and Science Direct were dismissed as they were too vague and irrelevant to this topic. With PubMed following keywords were inserted Healthcare, Reforms and England. The data was also set from 1948 to 2010 when searching for reports as this would set the inclusion criteria. The reports and journals since 1948, when the NHS was established were used. Even though history before 1948 was looked at for study purposes, reports before NHS establishment; these were regarded as the exclusion criteria as reports werent looked at prior to 1948. Healthcare service within Britain was looked at in general but for the results of this report, the inclusion criteria was healthcare service in England as it just look ed at the healthcare service being provided within England. The exclusion criterion was healthcare service in Scotland, Wales and Northern Ireland. For the first part of the report, the introduction: where the report looked at the history of the NHS. The resources used included looking at general management books looking at management theories. The classical theories of Max Weber, Frederic Taylor and Henri Fayol were the backbone of the NHS and that is why these were used. Another source to produce this paper was the Department of health (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/index.htm) where the publications and reports about the NHS in general were looked at. This paper used a lot of publications produced by the Department of health and the NHS publications as these sources are reliable; these were seen as good foundation to work from. One of the main publications used was The NHS white paper: Equity and excellence: Liberating the NHS presented to Parliament by the Secretary of State for Health, this was a key entity in writing up this paper. As the paper didnt contract with experiments and clinical trials, it didnt look at a lot of statistics; the majority of its content was obtained from qualitative data. Results/ Discussion Having carried out the required literature searches and reading journals, reports and Department of Health Publications, results were gathered and have been shown below with the discussion of the key topics. The results look at each reform taken place in the NHS and then goes onto analyse the plans set by the new government. Having looked at the reforms and the new plans the paper than talks about efficiency, equity and quality related to each reform. Reforms in the healthcare service in England The healthcare service in the UK has undergone a number of reforms since its inception in 1948. Prior to 1948, healthcare service was provided in England but due to the increasing pressures for efficiency and quality in health services it lead to these developments and reforms in healthcare being provided. A more overtly management-oriented approach to the healthcare service delivery was adopted based on classical management theories to gain more control of the healthcare service in England. 16,17 Classical theories and Scientific Management: 1960s The NHS was based on the classical theories of Frederic Winslow Taylor, Henri Fayol and Max Weber. 16-19 Table 1: Frederic Winslow Taylors four main scientific management principles. Replacing rule-of-work thumb methods with methods based on a scientific of the tasks Scientifically train each individual rather than leave them to train themselves Cooperate with each worker to ensure that the scientific method is being followed Divide workload equally between managers and staff Table 2: Henri Fayols Modern Operational Management approach. Division of work- Specialization for efficiency Authority Responsibility- Both are related, the latter arising from the former. Discipline-Requires good superiors at all levels Unity of Command- Employee should receive orders from one superior only Unity of Direction- Each group of activities with the same objective must have one head and one plan Subordination of individual to general interest- When the two are found to differ, management must reconcile them Remuneration-Should be fair and satisfactory Centralization-Extent to which authority is concentrated or dispersed Scalar chain/line of authority-Needs to be sensible, clear and understood Order : Right thing/person in the right place Equity- Equal opportunity for everyone Stability of tenure- Unnecessary turnover is both the cause and effect of bad management Initiative- Thinking out and execution of a plan Thinking out and execution of a plan Table 3. Max Webers Bureaucratic approach. Power-Ability to get things done, often by the use of threats or sanctions Authority- Ability to get things done because of the position that justified someone in terms of legitimacy Formal approach Hierarchical authority Extensive roles and procedures- Uniformity of decisions and actions Job description- Clear-cut division of labour and High level of specialization Discipline These classical theories contributed a lot to the healthcare service in England and still do to this day.16-19 The classical writers thought of the NHS in terms of purpose and formal structure. They created a formal structure on which the NHS could run on. They also looked at job design, scientific selection and development of workers. The classical theories generally serve as a backbone to the present day NHS management. Although the classical theories made a big contribution to the healthcare service in England it had its limitations and wasnt the most effective way. One drawback was that it wasnt evidence based; it didnt look at the way staff did their tasks and didnt look at the well being of staff, the human and social aspects of work. It just treated them like machines. The theories didnt look at motivating the staff and developing them in their own interests, had they done this staffs work quality wouldve enhanced thus providing an efficient service to patients and overall improve the quality of healthcare service in England. Overall the classical theories were too concrete and fully based on rules and procedures. In terms of efficiency the theories bought a set way of running the healthcare service in England. Once the NHS was established it introduced equity as well as healthcare service was now available to anyone. The NHS was just established and with these set in place in the 1960s the qua lity of service would improve from now with further reforms to come. Salmon Report: 1960s One of the first reforms took place since the NHS was established was in the 1960s. The Salmon Report bought findings and changes which included that workload should be equally distributed between managers and practitioners.20 The NHS would also get rid of matrons and replace them with a hierarchy of nurse managers. The introduction of several additional layers to the management hierarchy; in order to improve efficiency in operating the NHS. This lead to responsibility being equally distributed and the service met its aims and objectives more efficiently. Another change was that nurse managers would contribute to the overall management of the service through the medium of consensus management teams and thus improve efficiency and quality within the NHS. Having nurse managers lead to them taking control of set responsibilities and helped in general running of tasks at ward level leading to an improvement in general quality in the healthcare service being provided. 1974 Reorganization: 1970s The aim of this reform was to attain greater integration of the healthcare service in order to provide more stability and increase efficiency. The reorganisation also introduced more central control in order to: 21 ensure policies were implemented improve accountability encourage delegation develop democratic decision-making process These changes lead to a more structured way for managers to follow and enhance the quality of the healthcare service. By the mid 1970s quality was improving but there were still concerns of equity in the NHS. There were still clear differences of health sufferers in terms of social class; figures showed that people in lower social classes more likely suffered from diseases. There were several possible explanations for these inequalities. Natural and social selection. This would depend on the view that people who are fittest are most likely to succeed in society, and classes reflect this degree of selection. Poverty leads to ill health, through nutrition, housing and environment. Cultural and behavioural explanations. There are differences in the diet and fitness of different social classes, and in certain habits like smoking. 22,23 Overall in the 1970s the quality of healthcare service was still improving, equity issues were still a concern and in terms of efficiency they were recuperating the NHS. The Griffiths Report: 1980s This reform was a major point in NHS history, the Griffiths Report identified problems such as the healthcare service was institutionally inactive and that the local health authorities were filled with directives without being given any clear procedures to follow.24 The Griffiths report stated that changes were difficult to achieve but gave recommendations to improve the NHS. It introduced a more formal and modern way of management. It gave increased participation for managers in setting and controlling budgets. The report also gave greater emphasis on cost awareness in order to improve efficiency. A Clear and quick decision-making process was introduced to improve quality of service provided to patients. The managers in local authorities were given a more clearly defined direction and the overall staffs were better informed.24 The Internal Market Working For Patients: 1990s Another reform in the 1990s took place, this bought a new dimension to the NHS; large publicly-owned hospitals could opt to become self-managed trusts. This meant that health services could be bought by private investors i.e. patients themselves thus allowing them to take control of the way they want the service. Even large GPs could become fund holders and be both purchasers and providers of care.25 This reform lead to introduction of greater flexibility thus allowing more effective matching of patients needs and care. Money followed the patients through the system of purchasing and providing of healthcare service, this led to equity being improved as patients had more selection of services. This reform led to higher competition in providing quality healthcare service, the costs decreased and the general quality increased. The NHS Plan 2000 The NHS Plan 2000 made key findings : the NHS is a 1940s system operating in the 21st century and that it lacked of national standards. It also said that there were barriers between staff and providing services. There were a lack of clear guidelines and the NHS structure has over-centralization.14 Plans to diminish problems and propose new plans such as introducing Modern Matrons to improve the management of services, a strong leader with clinical experience and with clear authority at ward level, improve efficiency by setting standards and controlling resources these were there aims.14,26 The figure below shows the comparison of the 1948 and the new NHS model outlining the key differences. Figure.4 the key difference between the 1948 model and The NHS Plan 2000 model 14 The NHS Plan 2000: Achievements This reform set out specific targets which were achieved in order to improve efficiency, equity and quality of healthcare service in England: Over 100 new hospitals by 2010 and 500 new one-stop primary care centres Clean wards and better hospital food 7,000 extra beds in hospitals Over 3,000 GP premises modernized Modern IT systems in every hospital and GP surgery 7,500 more consultants and 2,000 more GPs 20,000 extra nurses and 6,500 extra therapists Childcare support for NHS staff with 100 on-site nurseries.26 These targets were achieved in 2008 and it led to the improvement of efficiency as the number of GPs and consultants employed were increased. The modernisation of technology and IT systems led to quality of service being improved as high investment in high quality equipment made the NHS one of the worlds top quality service. Since 2000 NHS has improved the overall service and met its objectives. NHS Implications: Equity and excellence: Liberating the NHS With the new coalition government coming into election another set of reforms have been proposed as they hope to improve the overall healthcare service in England. The main aims and objectives to improve the healthcare service are varied and very detailed but to summarise it these are the points covered:15 Increase health spending in real terms in each year of this Parliament 15and also that there goal is an NHS which achieves results that are amongst the best in the world 15. However the government will uphold the foundation that the NHS was formed on; a comprehensive service, available to all, free at the point of use and based on clinical need, not the ability to pay 15. The government than goes into detail of what they arrange to initiate to make an efficient healthcare service: acknowledge the fact that patients come first and therefore will give them greater choice and control. An example of this is that a patient will be able to choose any GP practice, consultant, and choice of treatment consequently improving equity of the service. The government endeavours to develop the healthcare outcomes: set objectives such as reduce mortality and morbidity, increase safety, and improve patient experience and outcomes for all 15. By doing this they are ensuring they are driving efficiency and improving the service. In order to achieve the objectives that the government sets, the ability for service providers to have more autonomy, responsibility and accountability will be a means to achieving efficient results. A big change will be the establishment of a NHS Commissioning Board. The board will be accountable for making sure health outcomes are achieved, allocate resources and have the lead on quality improvement and to tackle inequalities that exist in the NHS. Overall the reforms in the NHS Paper 2010 will provide the NHS with greater incentives to increase efficiency, equity and quality. Efficiency The healthcare system in England has on the whole perceived a huge improvement in terms of efficiency since its inception in 1948. A system has been established where it endows with one of the best services in the world but there are still room for improvements. An analysis of the services gives evidence such as the NHS building 100 new hospitals since 2000, therefore improving the efficiency and allowing better access for patients. 27 Even though there continue to be a lack of quality and accessibility to services across the country. The patients havent been able to impose enough pressure to force improvements. The NHS need to give patients more control over the health services they have access to improve efficiency. In 2008 investment in the NHS as a whole rose from ÂÂ £43.9bn per year in 2000, when the NHS Plan was launched, to ÂÂ £92.6bn. another measurement of efficiency is looking at numbers of early deaths from cancer, coronary heart disease and suicide; they continue to fall as services improve; over 98% of patients at Accident and Emergency (AE) Departments are seen within 4 hours; and hospital waiting lists are lower than ever, with half a million fewer patients waiting since lists were at their peak.28 One key way to achieve the set objectives is to cut down NHS managements costs by 45% over the next four years enabling them to free up investment for further improvements.28 Much has been achieved during the last five years of investment and reforms. For example, the significant investment in NHS staff, along with more flexible working, is facilitating healthcare professionals to take advantage of the freedom thus improving their commitment to the NHS. NHS staff working flexibly and using improved technology are better able to respond to patients needs and changing expectations and are achieving improvements in quality and productivity across the system.27 Since 1948, the NHS budget on average has risen over 4% in real terms each year; this is something they hope to resolve as the NHS will face a sustained and substantial financial constraint if it continues. They hope to avoid the financial crisis that happened in the NHS in the 1970s. The NHS hopes to release up to ÂÂ £20 billion of efficiency savings by 2014, which will be reinvested to suppor Healthcare Reforms in England Issues of Efficiency Healthcare Reforms in England Issues of Efficiency The healthcare service in England attempts to improve the overall healthcare service have been ongoing through some of the most radical reforms since its inception as a comprehensive public service since 1948. The noticeable need of a free healthcare service was essential after the state of the country due to the world war. Once the NHS was established it saw many reforms led by diverse types of governments at different times. Despite the scale of the reforms they have preserved their core principle of A free service at the point of delivery 1 till this very day. Even though they have adopted the core principle they still face huge challenges; as demands and costs are still rising, the entirety of the service is increasingly being looked at. This paper looks at the reforms the NHS has been through and analyses each reform in the light of Efficiency: the capability of the NHS, whether the reform made the NHS more competent, Equity: bringing fairness and equal right for the patients as well as the staff, Quality: whether adapting the reforms improved the patients ability to acquire different types of healthcare services without any predicament and obtain high-quality healthcare services. Methodology This paper was conjured up by the use of reports published by NHS Publications website. Journals and studies on NHS reform via the scientific database PubMed were also utilized. To gain info on the theories the NHS was formed on, management theory books by Max Weber, Henri Fayol and Frederic Winslow Taylor were used. Results/Discussion Each reform improvised the NHS in many ways, in relation to Efficiency the NHS since its inception has seen major investments and new hospitals built, employment of up to date technology allowing more patients to be seen within an applicable time and budgets been controlled efficiently with the aim to reduce costs each year allowing the NHS to run efficiently. In terms of Equity after the publication of the Black report, the NHS has improved on giving equal opportunities to its minor ethnic groups of staff. Also the equal treatment of patients regardless of their social class has been improved since the Blair era. The NHS in terms of quality has become one of the world leading healthcare providers. Measuring their services against standards set by the NHS ensured that they are meeting the set standards. The major investment in staff in 2000 saw a number of lives saved in the past 10 years. The NHS has met quality standards that are accepted by its patients and valued as a first class service. Conclusion Overall the NHS has seen many reforms which have lead to the NHS becoming a world class service. Since the reforms in the 1960s to the latest plans of the new coalition government the NHS has improved immensely in terms of efficiency, equity and quality and the future also looks bright for the NHS. Introduction: Healthcare service in England was launched in 1948 with an aim to provide universal healthcare to its citizens which is free at the point of use and available to everyone based on need, not ability to pay 1. The NHS was established after World War II where the country needed a stable healthcare service 2. The initial idea was that no-one should be deterred from seeking health services by a lack of resources and the founder Aneurin Bevan: Minster of Health stated A free service at the point of delivery 3. Till this day they have been providing free healthcare service to the citizens of England. In 1948 Sir William Beveridge, a British Economist and a Social Reformer conferred details of his radical plans for economic and social reform in post-war Britain. Sir William proposed major healthcare service changes on the basis that the country needed the abolition of want before the enjoyment of comfort and suggested a scheme where every kind of medical treatment would be available for everybody. 1,3 Pre NHS There has been some form of state-funded provision of health and social care in England prior to the NHS for 400 years.4 Prior to a health system being formed, attaining healthcare service in Britain in the 1930s and 1940s was difficult. Life expectancy was very low and thousands of people died of infectious diseases like pneumonia, meningitis, tuberculosis, diphtheria, and polio each year.4 The poor never had access to medical treatment and they relied instead on dubious and sometimes dangerous home remedies. Either that or they relied on doctors who gave their services free to the poor patients. The Hospitals charged for treatment and although the poor were reimbursed and before they received treatment they had to pay.4 Figure 1 shows the life expectancy that has changed since the NHS was introduced. Figure 1.Life expectancy changes since 1840 5 The need for free healthcare was widely recognised, but it was impossible to achieve without the support or resources of the government. A study showed that experts believed and have written extensively on the reasons of why a health service was needed.6 These included: The appearance of a view that health care was essential, not something just imparted erratically by charity The drastic effects of the war that made it possible to have a massive change of the healthcare service being provided, rather than just an incremental alteration As younger members of the country were becoming increasingly educated in the medical profession they had a view of things could be handle in a more efficient way. The hospitals having financial problems, funds not sufficing.6 Having looked at the reasons to why a health service was needed the government made plans and core principles were established: 6 Regardless of persons status they were eligible for health care, even people temporarily residing or visiting the country.ÂÂ   People could be referred to any hospital. The healthcare service was financed almost 100% from central taxationÂÂ   Care was entirely free at the point of use6 The main achievement was that the poor who in the past went without medical treatment now had access to free healthcare.6 NHS today and NHS employment NHS is one of the largest organisations in the world with an annual budget of around ÂÂ £80 billion employing more than 1.7 million people and treating over one million people every 36 hours.7 In general, healthcare service being provided within England to every single citizen is a difficult commission to undertake and consequently the system needs efficient health personnels to help run the system economically. Today the view of the healthcare service in England is that the NHS is a world leader and provides first class service that other countries envy. Countries all over the world seek to learn from the comprehensive system of general practice, and its role as the medical home for patients, providing continuity of care and coordination.8 Other countries look at English NHS system and use them as a guideline to run their healthcare system. NHS Structure The healthcare service in England has been run in a structural way with the Secretary of state and Department of Health controlling the overall NHS in England. The secretary of state for health has the responsibility of reporting to the prime minister. There are10 Strategic Health Authorities (SHAs) in England which are controlled by the Department of Health, they oversee all the activities within the NHS and the SHAs supervise all the NHS trusts in its area. Primary care plays a major role in community healthcare and is central to the NHS. Services under NHS trust (Secondary Care) include Hospitals, Mental Health services, Learning disability services and Ambulances. The overall structure of the NHS is shown below in Figure 2. 9 Although this is the current NHS structure with the new government in power, changes are to follow. Figure.2 overall structure of the Healthcare system in England 5 NHS Reforms Since its inception in 1948 the NHS has seen many reforms in terms of managing the way they provide healthcare service. The DoH has a lot of control and influence the major decisions taken in the reforms. The overall expectations of Healthcare service in England are of a high calibre, which requisites high-quality management capacity.10 In the 1980s and early 1990s prominence was on recuperating management. The recent focal point has been on development of leadership within NHS. With the new government, new ideas and plans will be imposed to see improvements in quality of healthcare being provided, cut down on costs making it more efficient and in terms of equity provide equal service to everyone. Table 1 briefly enlists the reforms that have taken place since its inception in 1948. Table.1 Reforms in the NHS: 1948-2010 Period the reforms were in place Reform and theory of Management 1948- 1960 Managers as diplomats 1960s Scientific Management and the Salmon report 1970s Classical Management, Systems Approaches and the 1974 Reorganization 1980s The Griffiths report and Managerialism 1990s Working for Patients and the Internal Market 2000 The NHS Plan (DOH 2000) and the Third Way. 2010 NHS White Paper 2010: Equity and excellence: Liberating the NHS Healthcare service and Reforms in other Developed Countries Healthcare reforms within developed countries can be analyzed in order to compare whether the healthcare services in England have been successful in its bid to ensure efficiency, equity and quality. Attempts to handle reforms of the healthcare system in the European countries have been an ongoing process for 30 years. Although the reforms have taken throughout the 30 years in different ways, their main emphasis has been on improving the cost-effectiveness of the healthcare service. In the early 1980s the EU countries were looking at cost containment. The feature in the 1990s was to endorse efficiency in terms of introducing competition and markets in the healthcare system. Since 2000 the focus has switched to effectiveness; promoting various notions of healthcare in terms of quality.11 Over the course of the 20th century the countries of Europe have established significant success in improving the healthcare service for their citizens. However they still face challenges in the form of restraining costs, improving quality and providing universal healthcare access, these have put the European healthcare services under immense pressure.11 Looking at another OECD: USA, A report on A review of health care reform in the United States assessed whether the USA have been successful in providing healthcare. The findings showed that United States spent more per capita on health care than any other OECD country, yet its health outcomes lagged behind other countries.12 This shows they are struggling with efficiency issues and are still countering challenges in providing quality healthcare service that is expected from the citizens of the USA. Especially in the last few years Healthcare reform has been a major activity of the federal government, in order to revolutionize and develop the service overall. The 3 goals of optimizing cost, access and quality still remain a challenge within the healthcare society in the U.S.12 They concluded that USA still faced many challenges in running the national healthcare service, a key challenge they face is the utter complexity of the system, with its numerous public and private providers.12 Another OECD country reviewed in terms of healthcare service being provided and the reforms that have taken place is China. A report from on From a national, centrally planned health system to a system based on the market: lessons from China concluded: China is the country that has undergone the highest number of health care reforms. Since 1978, China saw many reforms and they also followed the way as the EU countries, with the healthcare system starting from governmental, centrally planned and a collective system to ending up as a heavily market influenced system. Now, thirty years later, the Chinese government openly concede that the reforms were unsuccessful and seek innovative and fresh directions.13 This illustrates that China is also in a healthcare crisis and looking to implement different strategies in order to gain control of Chinas Healthcare system. Having reviewed the healthcare service being endowed in these developed countries, it demonstrates that they are all on an identical level as the healthcare service being provided in England and all face similar challenges. All these developed countries are looking to develop the countries overall healthcare service in terms of efficiency, equity and quality. NHS Plan 2000 and the future of NHS Since the last reform: The NHS plan 2000 14, a lot has transformed in terms of funding and operating the healthcare system in England. Especially with the new coalition governments idea of cutting budgets it is a difficult time the NHS is going through and will necessitate a lot of expertise and world class management to get through todays financial and economical predicament. An additional indication that will be taken into deliberation is the election of the new plans set out in the NHS White Paper 2010. As the new coalition government has come into authority there have been huge changes to overall budgets for the public services and this possibly will have a consequence on the way the NHS operates in England. 15 The reforms have encompassed a significant impact on the organisation and deliverance of health care service in England. Wide array of transformations have been pioneered in an attempt to ensure the NHS is managed more resourcefully and effectively. This report will examine whether these reforms have on the whole improved the healthcare system in England in terms of efficiency, equity and quality and if the publics requirements have been convened. Aims: To examine the healthcare reforms in England since its inception and to assess whether these reforms have improved factors of efficiency, equity and quality in providing healthcare. Objectives: To review the reforms in the NHS since its inception in 1948 To examine whether these reforms improved efficiency, equity and quality of healthcare To assess the key features of healthcare reforms proposed by the current government and their implications on the NHS To put forward plans for the future of the NHS Methodology: A number of sources were consulted to conjure up this paper and examine the healthcare reforms in the NHS. Scientific search engines and databases such as PubMed, Google Scholar and Science Direct (Date accessed 20/10/10) were used to gain literature reviews but results from Google Scholar and Science Direct were dismissed as they were too vague and irrelevant to this topic. With PubMed following keywords were inserted Healthcare, Reforms and England. The data was also set from 1948 to 2010 when searching for reports as this would set the inclusion criteria. The reports and journals since 1948, when the NHS was established were used. Even though history before 1948 was looked at for study purposes, reports before NHS establishment; these were regarded as the exclusion criteria as reports werent looked at prior to 1948. Healthcare service within Britain was looked at in general but for the results of this report, the inclusion criteria was healthcare service in England as it just look ed at the healthcare service being provided within England. The exclusion criterion was healthcare service in Scotland, Wales and Northern Ireland. For the first part of the report, the introduction: where the report looked at the history of the NHS. The resources used included looking at general management books looking at management theories. The classical theories of Max Weber, Frederic Taylor and Henri Fayol were the backbone of the NHS and that is why these were used. Another source to produce this paper was the Department of health (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/index.htm) where the publications and reports about the NHS in general were looked at. This paper used a lot of publications produced by the Department of health and the NHS publications as these sources are reliable; these were seen as good foundation to work from. One of the main publications used was The NHS white paper: Equity and excellence: Liberating the NHS presented to Parliament by the Secretary of State for Health, this was a key entity in writing up this paper. As the paper didnt contract with experiments and clinical trials, it didnt look at a lot of statistics; the majority of its content was obtained from qualitative data. Results/ Discussion Having carried out the required literature searches and reading journals, reports and Department of Health Publications, results were gathered and have been shown below with the discussion of the key topics. The results look at each reform taken place in the NHS and then goes onto analyse the plans set by the new government. Having looked at the reforms and the new plans the paper than talks about efficiency, equity and quality related to each reform. Reforms in the healthcare service in England The healthcare service in the UK has undergone a number of reforms since its inception in 1948. Prior to 1948, healthcare service was provided in England but due to the increasing pressures for efficiency and quality in health services it lead to these developments and reforms in healthcare being provided. A more overtly management-oriented approach to the healthcare service delivery was adopted based on classical management theories to gain more control of the healthcare service in England. 16,17 Classical theories and Scientific Management: 1960s The NHS was based on the classical theories of Frederic Winslow Taylor, Henri Fayol and Max Weber. 16-19 Table 1: Frederic Winslow Taylors four main scientific management principles. Replacing rule-of-work thumb methods with methods based on a scientific of the tasks Scientifically train each individual rather than leave them to train themselves Cooperate with each worker to ensure that the scientific method is being followed Divide workload equally between managers and staff Table 2: Henri Fayols Modern Operational Management approach. Division of work- Specialization for efficiency Authority Responsibility- Both are related, the latter arising from the former. Discipline-Requires good superiors at all levels Unity of Command- Employee should receive orders from one superior only Unity of Direction- Each group of activities with the same objective must have one head and one plan Subordination of individual to general interest- When the two are found to differ, management must reconcile them Remuneration-Should be fair and satisfactory Centralization-Extent to which authority is concentrated or dispersed Scalar chain/line of authority-Needs to be sensible, clear and understood Order : Right thing/person in the right place Equity- Equal opportunity for everyone Stability of tenure- Unnecessary turnover is both the cause and effect of bad management Initiative- Thinking out and execution of a plan Thinking out and execution of a plan Table 3. Max Webers Bureaucratic approach. Power-Ability to get things done, often by the use of threats or sanctions Authority- Ability to get things done because of the position that justified someone in terms of legitimacy Formal approach Hierarchical authority Extensive roles and procedures- Uniformity of decisions and actions Job description- Clear-cut division of labour and High level of specialization Discipline These classical theories contributed a lot to the healthcare service in England and still do to this day.16-19 The classical writers thought of the NHS in terms of purpose and formal structure. They created a formal structure on which the NHS could run on. They also looked at job design, scientific selection and development of workers. The classical theories generally serve as a backbone to the present day NHS management. Although the classical theories made a big contribution to the healthcare service in England it had its limitations and wasnt the most effective way. One drawback was that it wasnt evidence based; it didnt look at the way staff did their tasks and didnt look at the well being of staff, the human and social aspects of work. It just treated them like machines. The theories didnt look at motivating the staff and developing them in their own interests, had they done this staffs work quality wouldve enhanced thus providing an efficient service to patients and overall improve the quality of healthcare service in England. Overall the classical theories were too concrete and fully based on rules and procedures. In terms of efficiency the theories bought a set way of running the healthcare service in England. Once the NHS was established it introduced equity as well as healthcare service was now available to anyone. The NHS was just established and with these set in place in the 1960s the qua lity of service would improve from now with further reforms to come. Salmon Report: 1960s One of the first reforms took place since the NHS was established was in the 1960s. The Salmon Report bought findings and changes which included that workload should be equally distributed between managers and practitioners.20 The NHS would also get rid of matrons and replace them with a hierarchy of nurse managers. The introduction of several additional layers to the management hierarchy; in order to improve efficiency in operating the NHS. This lead to responsibility being equally distributed and the service met its aims and objectives more efficiently. Another change was that nurse managers would contribute to the overall management of the service through the medium of consensus management teams and thus improve efficiency and quality within the NHS. Having nurse managers lead to them taking control of set responsibilities and helped in general running of tasks at ward level leading to an improvement in general quality in the healthcare service being provided. 1974 Reorganization: 1970s The aim of this reform was to attain greater integration of the healthcare service in order to provide more stability and increase efficiency. The reorganisation also introduced more central control in order to: 21 ensure policies were implemented improve accountability encourage delegation develop democratic decision-making process These changes lead to a more structured way for managers to follow and enhance the quality of the healthcare service. By the mid 1970s quality was improving but there were still concerns of equity in the NHS. There were still clear differences of health sufferers in terms of social class; figures showed that people in lower social classes more likely suffered from diseases. There were several possible explanations for these inequalities. Natural and social selection. This would depend on the view that people who are fittest are most likely to succeed in society, and classes reflect this degree of selection. Poverty leads to ill health, through nutrition, housing and environment. Cultural and behavioural explanations. There are differences in the diet and fitness of different social classes, and in certain habits like smoking. 22,23 Overall in the 1970s the quality of healthcare service was still improving, equity issues were still a concern and in terms of efficiency they were recuperating the NHS. The Griffiths Report: 1980s This reform was a major point in NHS history, the Griffiths Report identified problems such as the healthcare service was institutionally inactive and that the local health authorities were filled with directives without being given any clear procedures to follow.24 The Griffiths report stated that changes were difficult to achieve but gave recommendations to improve the NHS. It introduced a more formal and modern way of management. It gave increased participation for managers in setting and controlling budgets. The report also gave greater emphasis on cost awareness in order to improve efficiency. A Clear and quick decision-making process was introduced to improve quality of service provided to patients. The managers in local authorities were given a more clearly defined direction and the overall staffs were better informed.24 The Internal Market Working For Patients: 1990s Another reform in the 1990s took place, this bought a new dimension to the NHS; large publicly-owned hospitals could opt to become self-managed trusts. This meant that health services could be bought by private investors i.e. patients themselves thus allowing them to take control of the way they want the service. Even large GPs could become fund holders and be both purchasers and providers of care.25 This reform lead to introduction of greater flexibility thus allowing more effective matching of patients needs and care. Money followed the patients through the system of purchasing and providing of healthcare service, this led to equity being improved as patients had more selection of services. This reform led to higher competition in providing quality healthcare service, the costs decreased and the general quality increased. The NHS Plan 2000 The NHS Plan 2000 made key findings : the NHS is a 1940s system operating in the 21st century and that it lacked of national standards. It also said that there were barriers between staff and providing services. There were a lack of clear guidelines and the NHS structure has over-centralization.14 Plans to diminish problems and propose new plans such as introducing Modern Matrons to improve the management of services, a strong leader with clinical experience and with clear authority at ward level, improve efficiency by setting standards and controlling resources these were there aims.14,26 The figure below shows the comparison of the 1948 and the new NHS model outlining the key differences. Figure.4 the key difference between the 1948 model and The NHS Plan 2000 model 14 The NHS Plan 2000: Achievements This reform set out specific targets which were achieved in order to improve efficiency, equity and quality of healthcare service in England: Over 100 new hospitals by 2010 and 500 new one-stop primary care centres Clean wards and better hospital food 7,000 extra beds in hospitals Over 3,000 GP premises modernized Modern IT systems in every hospital and GP surgery 7,500 more consultants and 2,000 more GPs 20,000 extra nurses and 6,500 extra therapists Childcare support for NHS staff with 100 on-site nurseries.26 These targets were achieved in 2008 and it led to the improvement of efficiency as the number of GPs and consultants employed were increased. The modernisation of technology and IT systems led to quality of service being improved as high investment in high quality equipment made the NHS one of the worlds top quality service. Since 2000 NHS has improved the overall service and met its objectives. NHS Implications: Equity and excellence: Liberating the NHS With the new coalition government coming into election another set of reforms have been proposed as they hope to improve the overall healthcare service in England. The main aims and objectives to improve the healthcare service are varied and very detailed but to summarise it these are the points covered:15 Increase health spending in real terms in each year of this Parliament 15and also that there goal is an NHS which achieves results that are amongst the best in the world 15. However the government will uphold the foundation that the NHS was formed on; a comprehensive service, available to all, free at the point of use and based on clinical need, not the ability to pay 15. The government than goes into detail of what they arrange to initiate to make an efficient healthcare service: acknowledge the fact that patients come first and therefore will give them greater choice and control. An example of this is that a patient will be able to choose any GP practice, consultant, and choice of treatment consequently improving equity of the service. The government endeavours to develop the healthcare outcomes: set objectives such as reduce mortality and morbidity, increase safety, and improve patient experience and outcomes for all 15. By doing this they are ensuring they are driving efficiency and improving the service. In order to achieve the objectives that the government sets, the ability for service providers to have more autonomy, responsibility and accountability will be a means to achieving efficient results. A big change will be the establishment of a NHS Commissioning Board. The board will be accountable for making sure health outcomes are achieved, allocate resources and have the lead on quality improvement and to tackle inequalities that exist in the NHS. Overall the reforms in the NHS Paper 2010 will provide the NHS with greater incentives to increase efficiency, equity and quality. Efficiency The healthcare system in England has on the whole perceived a huge improvement in terms of efficiency since its inception in 1948. A system has been established where it endows with one of the best services in the world but there are still room for improvements. An analysis of the services gives evidence such as the NHS building 100 new hospitals since 2000, therefore improving the efficiency and allowing better access for patients. 27 Even though there continue to be a lack of quality and accessibility to services across the country. The patients havent been able to impose enough pressure to force improvements. The NHS need to give patients more control over the health services they have access to improve efficiency. In 2008 investment in the NHS as a whole rose from ÂÂ £43.9bn per year in 2000, when the NHS Plan was launched, to ÂÂ £92.6bn. another measurement of efficiency is looking at numbers of early deaths from cancer, coronary heart disease and suicide; they continue to fall as services improve; over 98% of patients at Accident and Emergency (AE) Departments are seen within 4 hours; and hospital waiting lists are lower than ever, with half a million fewer patients waiting since lists were at their peak.28 One key way to achieve the set objectives is to cut down NHS managements costs by 45% over the next four years enabling them to free up investment for further improvements.28 Much has been achieved during the last five years of investment and reforms. For example, the significant investment in NHS staff, along with more flexible working, is facilitating healthcare professionals to take advantage of the freedom thus improving their commitment to the NHS. NHS staff working flexibly and using improved technology are better able to respond to patients needs and changing expectations and are achieving improvements in quality and productivity across the system.27 Since 1948, the NHS budget on average has risen over 4% in real terms each year; this is something they hope to resolve as the NHS will face a sustained and substantial financial constraint if it continues. They hope to avoid the financial crisis that happened in the NHS in the 1970s. The NHS hopes to release up to ÂÂ £20 billion of efficiency savings by 2014, which will be reinvested to suppor

Brain-Behavior and Nature-Nurture: Two Interacting Scientific Debates E

Brain-Behavior and Nature-Nurture: Two Interacting Scientific Debates Whether there is more behind human behavior than can be explained solely by neural phenomena has been the subject of much time-worn scientific and philosophical debate. In regards to this question, two primary classes of alternative explanations come to mind: the human soul and the environment. The former of these involves a possible internal, individualistic force guiding behavior beyond the guides provided by the brain; many feel that the topic of the human soul is best left in the realm of the philosophical. Environmental influences on behavior, however, are quite pertinent to scientific investigations into the brain/behavior dichotomy. Whether and to what extent one’s environment effects one’s behavior, personality, even destiny is embodied by the widely publicized and highly politicized nature-nurture debate. Generally, those factors thought to come from nature are those that are inherited, and those thought to be nurture-bred are inculturated. It seems, then, that a discussion of neural control of behavior necessarily involves this nature-nurture question; the interplay between inherited brain structure and inculturated experience offers insight into the roots of behavior. Vitalists and reductionists, empiricists and situationists, geneticists and sociologists all have something different to say about the degree to which the human genome specifies human traits. Many of these traits are behavioral, thus, these people also have much to say about the role of the brain in guiding behavior. It is estimated that sixty percent of human genes are dedicated to neurological development (5). This is an immense amount of genetic material, and, particularly du... ... still be subject to biased interpretations of which we are capable as human-mammals. â€Å"Our concepts of reality will always be shaped by our genetically-inherited mental models† (3). Subjecting myself to biased interpretations, though, I feel that an individual drawing breath each day in the context of many, nestled environments much akin to the Bronfenbrenner ecological systems theory **, behaves ultimately because of the brain and the genes from which it originates. WWW Sources 1) Compton’s Encyclopedia http://comptons2.aol.com/encyclopedia/ARTICLES/03888_html 2) The Eye of the Frog http://www.objana.com/frog/home.html 3) Sociobiology page http://res3.geocities.com/Athens/Acropolis/3976/socio.html 4) Of Mice and Men http://www.informinc.co.uk/LM/LM73/LM73_Futures.html 5)Pro-nurture http://www.michiganinbrief.org/text/issues/issue-23.htm

Racism: Similarities and Differences In Two Essays -- Discrimination,

In the two essays, â€Å"Just Walk on By: A Black Man Ponders His Power to Alter Public Space† by Brent Staples and â€Å"I’m Not Racist But†¦Ã¢â‚¬  by Neil Bissoondath, there are both differences and similarities. The two authors differ in their opinion on the causes of racism and life experiences involving racism, but are similar in regards to the use of stereotypes in the world In Brent Staples’ opinion, causes of racism are derived from fear and the insufficient knowledge that a person might have about another that may cause them to be racist. In his piece, he writes, â€Å"Another time I was on assignment for a local paper and killing time before an interview. I entered a jewellery store on the city’s affluent Near North Side. The proprietor excused herself and returned with an enormous red Doberman pinscher straining at the end of the leash. She stood, the dog extended toward me, silent to my questions, her eyes bulging nearly out of her head. I took a cursory look around, nodded, and bade her good night.† (Staples 227) This quote shows that the woman that owned the jewellery store was afraid that she might get robbed by Staples and therefore acted by protecting herself with her vicious dog, with the intention to scare away the â€Å"robber†, whom she believed to be Brent Staples. She assumed that because she was in an affluent neighbourhood and because Brent Staples was black, he was there with the intention to rob her rather than the true reason, which was to kill some time prior to his next interview. She showed prejudice and racism towards Staples because of she was afraid of his skin colour and did not have true information about him. Neil Bissoondath differs in his definition of racism. He writes that the cause of racism derives fr... ... became afraid and tried to get away from him. (Staples 224) In Neil Bissoondath’s essay, we see an example with the mover complaining about a Chinese driver he encountered. He said, â€Å"I’m not racist, but the Chinese are the worst drivers on the road.† (Bissoondath 271) The accusation that the mover made was a stereotype which exists about the Chinese, in general, because of the shape of their eyes because of their ethnicity. Their eye sight is not impaired in any way because of the shape of their eyes, but because they are different and people are afraid of them, they are made fun of because they are different. In regards to racism, Brent Staples and Neil Bissoondath may have different view points about its causes and by their life experiences involving racism, but they have similar views on the use of stereotypes and how they affect the races they pertain to.