Business-Technology Alignment - Smart Custom Writing Samples

Business-Technology Alignment - Smart Custom Writing Innovative processThe innovative process is important for companies that want to realize their objective in the competitive and consumer driven market. Hassell (2003) says that the systems used in the innovative process are the most complex both in technical and social terms. Hassell (2003) says that the most commonly used model of the innovation process is the liner model. The four phases include research, development, evaluation or demonstration, and deployment phases. The first phase is known as the research phase. Starbuck will embark on researching on the problem and inventing a solution conceptually and not physically. Shapiro (2002) says that the purpose of this step is to learn how to use data more flexibly and it will help the team at Starbuck to create and find new perspectives on everyday facts and figures as far as their products are concerned.   During this phase the team involved in the innovation process will explore relationships and patterns between the existing products in order to open the door to truly revolutionary insights. Schwartz (2006) says that despite how the innovation is started the problem needs a proper description. Starbuck as a company should involve more people in order to come up with detailed and explicit representation of the problem. The second phase will involve development of a viable prototype of a solution or product protype. During this step Hassell (2003) says that once an invention is found in the first phase through research and brain-storming, it is refined and perfected through the development process. The team at Starbuck will develop a small scale or prototype product that provides a proof of concept that the innovation is technologically sound. In addition, Shapiro (2002) argues that â€Å"during the development phase the company will definitely figure out what is possible and not what would be the right solution† (30). In addition Schwartz (2006) says that during this phase a conceptual model for the implementation is developed which describes its planned solution on a conceptual level. The team at Starbuck will take into consideration the description, the problem and the idea as input. The third phase of the innovative process is the demonstration phase. Hassell (2003) says that â€Å"this phase involves coming up with a full scale prototype to prove not only the innovation’s technical viability but also that it meets the required safety standards, it is appealing to the consumer and can be produced at a reasonable cost† (p. 12). The company (Starbuck) will use this step to carry out an evaluation through independent evaluation and testing organizations which test the product to certify that it is safe and effective. According to Schwartz (2006) the evaluation phase tests the results produced during the innovation process. During this phase Starbuck will undertake a careful planning of the experimental design and analysis to make sure that there is a representative and valid results for the new product. The fourth phase of the innovative process entails deployment of the product. Hassell (2003) says that sometimes this phase is known as diffusion, commercialization, or marketing stage. Hassell indicated that during this phase Starbuck will work towards increasing the production or manufacture of the innovation and making it commercially available (2003). It is important to note that the outcome and success of this phase depends heavily on consumer demand, the cost of the product, regulatory acceptance, marketing efforts, and the cost and performance of competing products among other considerations (Hassell, 2003). Starbuck will in last phase take the newly developed product and will try to market it as profitable as possible or a new process is implemented and integrated into the operational workflow for its improvement and to obtain more cost effective performance (Schwartz, 2006). The company will also explore the technological domain in which it can effectively facilitate new insights and methodologies to be disseminated to the company’s areas of interest as well as the public at large. In conclusion, the above four phases will help Starbuck to go through the innovative process and come up with the required product. The innovative process will determine how the company edges its competitors in the domain of technological advancement and the development of new products that meet the customer needs. The research phase should involve brainstorming sessions as well as intensive research so as to determine what the market demands. After the development phase Starbuck should then carry out a thorough evaluation and then deployment to ensure that the product meets the required standards and demands of the consumers.    References Hassell, S. (2003). Building better homes: government strategies for promoting innovation in housing. Santa Monica, CA: Rand Corporation. Shapiro, S. M. (2002). 24/7 innovation: a blueprint for surviving and thriving in an age of change. New York, NY: McGraw-Hill Professional. Schwartz, D. G. (2006). Encyclopedia of knowledge management. Hershey, PA: Idea Group Inc (IGI).

Lets Keep Some of the Old Verb Forms

Lets Keep Some of the Old Verb Forms Lets Keep Some of the Old Verb Forms Lets Keep Some of the Old Verb Forms By Maeve Maddox When it comes to some irregular verbs, I really hate to see the old past participle forms regularized to the dominant -ed ending. Heres an odd regularization of split: Data is splitted between the protocols HTTP and FTP. To be fair, I found this example on a site belonging to a company based in Germany. Its a logical mistake for a non-native English speaker. Split is one of those rare verbs that never changes its form: Today they split the data. Yesterday they split the data. The data is split between protocols. The data has been split. This next example is from an online chat: the Rabbi of Bardichevalways seeked to judge Jews favorably As far as I can tell, the site is based in the U.S. The person who typed this sentence is well-educated. I have no way of knowing if hes a native English speaker, but Im pretty sure that he is. It may be that seek is undergoing the same change as slay. Ive often expressed my aversion to slayed as the simple past of slay, to kill. I much prefer the forms slay, slew, (have) slain. Ill continue to use the old forms in my own writing, but I realize that many other writers are going with the -ed forms. Unlike slayed, Ive never seen seeked before. I hope this is just a personal aberration. The -ed change has already taken place with seeks cousin, beseech: to beg urgently. Both words derive from Old English secan, visit, inquire, pursue. He beseeched her to change her mind raises no hackles for me, although I might still find a use for besought in my writing. What do readers think? Should all English verbs be regularized to -ed forms? Or do you have old-fashioned favorites youd hate to see make the change? Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Misused Words category, check our popular posts, or choose a related post below:100 Beautiful and Ugly WordsThe Letter "Z" Will Be Removed from the English AlphabetEnglish Grammar 101: Prepositions

Law,Ethicsand globaisation Essay Example | Topics and Well Written Essays - 2500 words - 1

Law,Ethicsand globaisation - Essay Example , Tamanaha submits, â€Å"was the reflection of the divine order consistent with the good that intended to eliminate injustice and prevailed stability within society.† (2004: p 9) The same is applied with the present day legal systems prevailing in various regions of the world that have been articulated for the best interests of general public; fire safety law of the UK is also among such legal frameworks. Fire Safety Order 2005 UK: Fire Safety Law has been introduced for the security of the people from being victim to the breaking of fire, and training them regarding taking up immediate measures in order to avoid the grave consequences of the sudden fire eruption. â€Å"The purpose of the Fire Safety Act is to educate and encourage persons and communities to apply the principles of fire safety so as to prevent fires, preserve human life and avoid unwarranted property loss due to the destructive forces of fire.† (2002, c. 6, s. 2) Fire safety law encompasses commercial and business areas, which does not apply on residential areas of society. Fire Safety Order 2005 applies on the employer of some business premises, self-employed individuals having control of the premises, and organisations responsible for the maintenance of some specific building, area or premises. In addition, the law is also applied on the managers, executives, employees and persons responsible for look after of the premises. Sec 3 (a) and (b) define the responsible persons within a business place accountable for fire fighting and controlling. According to the provisions of law a responsible person means: Hence, the UK law delegates the entire powers to the private entrepreneur and state is somewhat free from fire prevention responsibilities. But it does not mean that the state stands as indifferent from the afflicted area altogether. On the contrary, it is the state that performs its obligations on the basis of assessment made by the responsible person defined in FSO. In addition, Section 4 of

The literature of exile and imaginary homelands in salmon rushdie, Essay

The literature of exile and imaginary homelands in salmon rushdie, bharati mukherjee, and v. s. naipaul - Essay Example es. Salman Rushdie, Bharati Mukherjee, and V.S. Naipaul can all, in different ways, be considered writers in exile. They have all traveled across the sea, all have come to a new, "foreign" land, and each one interacts with the English language as both "a home" for words and an alien tongue. In addition, within these three writers' works, we can see the operations of exile, how the thesethbiographical and linguistic exile of these writers come to be processed and represented, reflected and distorted, and the effect that the concept of exile (that resounds throughout their works) has on the literary and historical contexts that are their new "homes." These novelist's treat exile not simply as a condition of the post-colonial world, but as a central means to understand the self. Rather than labeling them proponents of any post-colonial literature, therefore, we should perhaps call these three novelists the most important artists of a new genre: a literature of exile. Salman Rushdie is an... d Mumbai) on 19 June 1947-the year of Indian independence and the year that acquires so much importance in his most critically acclaimed novel, Midnight's Children (1981). However, while still a child, he moved to England and was schooled at two of the pillars of the British establishment: Rugby and Cambridge. Consequently, his homeland was necessarily doubled, between the Indian subcontinent (where he later lived again, in Pakistan, with his family) and the British Isles to which he returned a second time to work in an advertising agency before beginning his career as a novelist. It is precisely this double identity that informs a great deal of Rushdie's literature-from his first novel, Grimus (1975), to his most recent non-fiction and travel-writing works, such as Step Across the Line: Collected Nonfiction 1992-2002 (2002) and "The East is Blue" (2004). He is able to write about both the culture of his parents and his newly adopted culture from the position of a partial outsider to both, and is able to understand both sides of a sometimes (often violently) opposed set of cultural constructions. This is not to say that Rushdie's writing career has been one in which he feigns a transcendental stance, a distanced style, that sets him above both cultures as an objective and unbiased third party. The case is quite the reverse. His writing is very much "at ground level": it locates itself within the heady back and forth of cultural interchange. Like a geneticist he splices (and inextricably interweaves) a double helix from the quite separate societies of which he has been a part. Rushdie crosses English literary references with Quoranic exegesis and mixes Indian folklore with modern American slang. It is precisely within this interweaving that is born the exciting

Labor law Essay Example | Topics and Well Written Essays - 8750 words

Labor law - Essay Example However, the comparing will be in specific aspects, labor law background in both countries, minimum wage, woman working, and child working. Chapter I Background: The Kingdom of Saudi Arabia and the Unite Sate of America, which are the subject of comparison in this research, had, in various aspects of life such as politics, economy and law. Of course, there is different background in labor law in both countries.In this chapter we will refer to the historical stages of labor law in every state. (2) United States labor lawbackground: Employer took their labor trouble to court almost as soon as American became independent. Each state has its own court, and they often have disagreed with one another about labor cases.(3) Because the First Amendment to the U.S. Constitution protects the freedom of association, the court did not outlaw unions as such. At the beginning of the nineteenth century, a common union tactic was for union members to agree among themselves how much in wage they would accept from their employers; the members also refused to work in the same shop as any other worker who accepted less than union scale. However, the courts held that this tactic was a criminal conspiracy,(4) (will be case as example under minimum wage section below). By the end of the nineteenth century, prosecutions for criminal conspiracy had become ineffective in controlling labor unions. There were two reasons for this change. First, a criminal case was too slow. The work could not be punished until after an indictment was issued and the case had gone to trial. This process took several months, during which the strike or boycott was damaging the employer’s business. Second, jurieswrer increasingly made up of workers, not merely shopkeepers and landowners; andworkers were hesitant to find coworkers guilty of the crime peacefully trying to improve their wage and working condition. Employers, therefore, took their complaints to civil court, and here they found the perfect we apon for fighting unions: the injunction. In the past, the law permitted judges to issue injunctions against unions freely.(5) In 1890, Congress passed the Sherman Antitrust Act in order to control monopolies in business, but the wording of the law was so general that it could applied to labor unions as well. The statute outlawed â€Å" every . . . combination . . . or conspiracy in restraint of trade or commerce among the several states,† Al thought this act was not used against strikes over wages ad hours, it was used to control union organizing. (6) In the infamous DanburyHatters case, the union sought to organize all the fur hat makers of America by boycotting the products of nonunion manufactures. One manufactures sued, arguing that the boycott did diminish trade among the states and awarded hundreds of thousands of dollars of damages payable by the individual workers.(7) Twenty-five years later, in 1914, Congress passed the Clayton Act which stated, â€Å" the labor of a human being is not a commodity or article of commerce† and â€Å" no . . . injunction shall be granted in any case between an employer and employees . . . growing out of a dispute concerning terms or conditions of employment,† Union leaders regarded the Clayton act as a great victory for organized labor. But court turned the victory into defeat by holding congress did not mean to permit boycotts in support of organizing campaigns.

Health Information and Communication Systems in Ireland

Health Information and Communication Systems in Ireland Is ICT a key enabler in ensuring seamless delivery of healthcare? A comparison between public and private ICT development in Ireland Abstract This study discusses the innovative changes that have taken place in Ireland in the field of healthcare due to the influx of information and communication technologies. Previous Information communication technologies (ICT), including telemedicine, present opportunities to address rural health-service delivery issues. The research shows that effective management of health services and the delivery of quality systems in Irish healthcare organizations have increased. In Ireland patients are expecting more of healthcare providers and are demanding higher standards of care and service. Simultaneously, those paying for health services have become more concerned about rising health costs and possible inefficiencies. As a result there is widespread interest in understanding what makes for an effective health service and in developing better practices to improve existing approaches to healthcare management in relation to ICT. This study highlights the developments in quality-service management in the Irish healthcare sector and focuses attention on the need for the development of a model for quality implementation in healthcare institutions. In sum the study shows that the development of (ICT) has facilitated the emergence of a complex global urban system in which many formerly lower-order cities have been carving out â€Å"niche† specialist functions serving urban fields of transnational dimension. Chapter1: Introduction Purpose of Study The purpose of this study is to highlight the development of the Information and communication system in Ireland and how it has revolutionized the healthcare sector in Ireland. Research Question This study focuses on the following research questions: What are the current trends of technological development in the Information and Communication Technology sector of Ireland? What are various challenges faced by the Irish healthcare system in relation to Information and Communication Technology? Significance of the Study This study is quite significant as it shows that the concept of globalisation has secured remarkable currency in the academic discourse of the late 20th century, despite ongoing questions regarding both its meaning and extent (Clark and Lund, 2000). The development of internationally integrated production and distribution systems, seen by many as the key feature of globalisation, has been a spatially uneven process. A key factor in this respect has been the differential ability of regions to engage in the informational economy, based on new information and communications technology (ICT), which is the main source of wealth creation and economic growth in the modern world (Castells, 2003). The result has been what Friedmann (2005) calls a process of ‘techno-apartheid’ which has divided the globe into ‘fast’ and ‘slow’ worlds (Knox, 2005), distinguished by the connectedness of individuals, groups and regions to the world of telematics. This echoes Ingersoll’s (2003, quoted in Knox, 2005) suggestion that the key division of the workforce is now that between those who have the capacity to operate ICT (the ‘cyberproletariat’) and those who do not (the ‘lumpentrash’). Golding (2006) makes a similar distinction between the ‘technoliterati’ and the ‘techno-poor’. While Knox defines the fast and slow worlds spatially, equating the former with the ‘triadic’ core and the latter with the remaining global periphery, Hoogvelt (2003) argues that the divide is, in essence, social rather than spatial, with elements of both worlds to be found in all regions of the globe. Thus, within advanced economies, a process of social polarisation has been widely reported (Friedmann, 2006 and Sassen, 2004) and has been intimately linked by Graham and Marvin (2006) to the development of ICT use. This is not to suggest that those who work in the fast world are homogeneously well-paid and affluent; rather, they represent a wide range of remuneration levels depending on such factors as economic sector, location, function, ethnic group and gender (Castells, 2006). What they do tend to have in common, however, is relative employment security due to the high demand level for their ICT skills. Rationale This study follows a logical approach and identifies the fact that both in Ireland as well as globally, there are major geographical variations in the relative balance between fast and slow worlds, with the former mainly to be found in the traditional core regions of North America, western Europe and Japan and an additional small group of newly industrialising countries which have had the institutional capacity to invest massively in modern ICT and associated educational infrastructures (Freeman, 2004). The slow world – found predominantly in the less developed countries of the global periphery and accounting for the bulk of the world’s population – is becoming increasingly marginalised and is moving, as Castells (2003, p. 37) puts it, â€Å"from a structural position of exploitation to a structural position of irrelevance†. Definition of Terms ICT: Information and Communication Technology: it is the study or business of developing and using technology to process information and aid communications. Sistem : SISTeM a soft systems methodology, stakeholder analysis and participative simulation modelling. NHS: (National Health Service) The organization providing national healthcare services in the UK. Chapter 2: Literature Review The process of quality implementation has become a key concern for those involved in hospital management in Ireland. In a national context, the effective management of health services and the delivery of quality systems in health-care institutions have increased in significance in recent years. In line with wider developments in other service industries, consumers (patients) are expecting more of health-care providers and are demanding higher standards of care and service. Simultaneously, those paying for health services have become more concerned about rising health costs and possible inefficiencies. As a result there is widespread interest in understanding what makes for an effective health service and in developing better practices to improve existing approaches to health-care management and delivery. In 2005 a comprehensive report on funding from the Commission on Health Funding highlighted that solutions to the problems faced by the Irish Health Service did not lie primarily in the system of funding, but rather in the way that services were planned, organised, and delivered. Similarly, in a report from the OECD (2003), it was argued that although the Irish health system had delivered a continuous improvement in health standards, there was still scope for further improvement in efficiency, and that this could be achieved through better allocation of resources. More recently, the government health strategy (DOHc, 2001) highlighted the requirement for a system to monitor progress and systematically evaluate the quality and effectiveness of health services. According to the strategy: Monitoring and evaluation must become intrinsic to the approach taken by people at all levels of the health services. Specifically, the strategy suggested that the way in which health and personal social services are planned, organised, and delivered has a significant effect on the health and well-being of the population. Organisational structures must be geared to the provision of a responsive, adaptable health system which meets the needs of the population effectively and at affordable cost. One of the guiding principles inherent in the published strategy was that of a â€Å"people-centred† health system. A responsive system must develop ways to engage with individuals and the wider community which receives its services. The health system must become more people-centred, with the interests of the public, patients, and clients being given greater prominence and influence in decision making at all levels (DOHc, 2001). According to Bowers (2001), major structural reform, coupled with strong management and political will, are required to ensure change for the better. In Bowers’ view, finance alone will not improve the system. Rather, a concentrated effort must be made to ensure a responsive and efficient service. As previously noted, a conclusion of the Report of the Commission on Health Funding (2005) was that the solution facing the Irish health services did not lie primarily in the system of funding but rather in the way that services were planned, organised, and delivered. This is reinforced by a recent report on the Irish health-care sector which suggested that the issues and challenges facing the health service are fundamentally the same as those outlined by the Commission on Health Funding, except that they are compounded by much higher expectations/demands by consumers (Deloitte and Touche, 2001). Thus, although modern health services have undergone radical change in many areas (Robins, 2003), managers of health services are currently reporting a large increase in the number of patients needing beds, with consequent ever-increasing waiting lists. Accident and emergency departments are under particular strain, and the difficulties of dealing with the growing needs of the increasing elderly population are beginning to become apparent. Although the Irish health service is free for all those requiring medical treatment through a publicly funded system, the current situation is hauntingly similar to that of the Victorian era of health care in Ireland. As a result, the Office for Health Management in Ireland (OHM, 2001) has suggested that current deficiencies in health-care provision and delivery underline the importance of providing quality service management and implementation in Irish health and personal social services. In achieving this aim, the OHM has contended that those working within the system must change how they go about their work and how they work together. Changed public-sector environment The focus on health-care service and quality has evolved from a more general interest in continuous improvement initiatives within the public sector. The prevalent trends in the private sector are towards continuous and pervasive change and increasing interdependencies, and it has been suggested that close parallels can be drawn between the private and public sectors. Public-sector organisations now find themselves in a cyclone of change as they attempt to adapt to turbulent environments in a pragmatic and systematic way (Lovell, 2004). In the UK and also in Ireland, these organisations have been subject to cuts in government spending, as well as demands for enhanced efficiency and effectiveness. In response to such changes, there has been a policy shift towards greater competition and an attempt to apply management practices from the private sector to the public domain. The Irish public sector has been officially pursuing change and reform through its strategic management initiative (SMI), a program for improving the management of the civil service which was formally launched in 2004 (Department of the Taoisearch, 2004). The SMI evolved from the growing internal and external pressures for better services and for more effective management of public services. In that context the continuous improvement of customer service has been a specific focus of the SMI since 2003, when the quality service initiative was launched. The program set out a series of quality principles according to which dealings with the wider public would be coordinated and managed. These initiatives aimed to make public administration more relevant to the citizens for whom the service exists, and simultaneously sought to remove barriers which have traditionally restricted performance and job satisfaction within the public sector. In recent years, Ireland has experienced a rise in consumerism. Increases in revenue available to fund public service provision have gone hand in hand with rising public expectations of standards of service. As a consequence, management skills and competences in providing for improved standards of customer service have become recognised as being central to delivering real transformation in the public sector. However, the development of such capabilities, particularly in relation to managing effective quality implementation, presents considerable challenges for those involved. Nowhere is this more evident than in the health-care sector. A review of recent international evidence points to the challenges of implementing quality service in health-care institutions. Gaucher and Coffey (2000) confirmed that implementing a process of total quality management (TQM) in health care is a pragmatic, specific, and systematic methodology. However, this requires a firm commitment from the leadership to change their former ways of working and doing business. Gaucher and Coffey (2000) cited many reasons for TQM failing – including poor leadership and a lack of management commitment – but also noted that revitalisation can rejuvenate the process. These authors asserted that the role of those implementing the process is to nurture and breathe energy into the process when enthusiasm and commitment are declining. The importance of the support of senior management for quality-management projects is also advocated by Berwick et al. (2000). These authors undertook a national demonstration project in the USA in the late 2000s and described how organisations could implement the entire quality-improvement process – from defining the problem through to implementing a solution and consolidating the gains (Berwick et al., 2000). A literature review carried out by Jackson (2005) identified that much work had been undertaken in the UK in determining the clinical effectiveness of many health-care organisations, but that very little research had been implemented in the area of managerial effectiveness. Furthermore, West (2001) determined that, in organisations that outperform others on different dimensions of performance, there was evidence that management is important, as are the combined efforts of individual clinicians and teams. There have been several approaches espoused for achieving quality management in health-care institutions, many of which have been technical and generic in their approaches (Moeller et al., 2000). Specifically, Donabedian (2000) introduced the concepts of structure, process, and outcomes, along with the development of self-assessment and accreditation through the International Organization for Standardization (ISO). In many instances these programs have met with mixed reactions, and their implementation has varied. A criticism levelled at hospital performance is that it has been rather insular, and has paid little attention to developments in related fields, such as organisational sociology, organisational behaviour, management studies, and human-resource management (West, 2001). If quality programs are to have lasting and significant effects, that they must follow a systemic approach such that all aspects of an organisation are integrated and focused on continuous improvement and customer satisfaction (Joss, 2004). A variety of approaches has been used to improve quality and to ensure its delivery, but not all have been successful. Indeed, some have merely added bureaucracy and higher costs to health care (Jackson, 2005; Ennis and Harrington, 2001). Recent research has shown that 45 per cent of patients experience some â€Å"medical mismanagement† and that 17 per cent suffer events which lead to a longer stay or more serious problems (Ovretveit, 2000). This is increasingly caused by complex systems of care which do not appear to be managed effectively. Joss and Kogan (2005) strongly recommended that a comprehensive set of criteria be included, against which to evaluate progress. These criteria should be based on the main requirements of TQM, and should include any additional factors generated by the organisation and/or by evaluators. A three-year evaluation of TQM in the National Health Scheme (NHS) indicated that there were clear factors which predicted successful implementation, the most important of which was the need to have a structured, pre-planned approach based on a thorough understanding of alternative approaches (Joss, 2004). Moreover, a recent study from the UK (O’Sullivan, 2005) demonstrated how one NHS Trust achieved continuous quality improvement through determination, education, and implementation, supported by visionary and involved leadership in all areas, a multi-talented enthusiastic clinical audit department, and a high-quality dedicated staff. Nabitz and Walburg (2000) suggested that possible solutions to quality problems might lie in the approach promoted by the European Foundation for Quality Management (EFQM). The EFQM has developed a model to structure and review the quality-management processes of organisations. Self-assessment, benchmarking, external review, and quality awards are essential elements of this model and, as reported by Sanchez (2000), this approach represents an important means of achieving excellence in health care. Within the literature there are also many studies showing the benefits of applying models of quality implementation in health-care organisations (Naylor, 2005; Ruiz et al., 2005). Such studies have pointed to the real benefits that accrue to organisations which have used such approaches (Pitt, 2005). Business excellence methodology for quality improvement The introduction of internationally respected quality frameworks – the Malcolm Baldrige National Quality Award (MBNQA) in 2003, followed by the EFQM in 2005 – has provided an opportunity for organisations to self-assess, using the models of TQM and business excellence which underpin these frameworks. In this process of self-assessment, an opportunity exists to identify the strengths and weaknesses in the current management of operations. In the USA, the effectiveness of the Baldrige process has been lauded by many (Gaucher and Coffey, 2000) who have indicated that organisations can learn about best practices from Baldrige-winning companies, and will thus be assisted in developing a composite for excellence. Although the Baldrige criteria were developed for commercial institutions, there has been keen interest in the adaptation of the model within health-care organisations in the USA following a pilot health-care project in 2005. To date, no health-care entity has yet achieved Baldrige-winner status, although Gaucher and Coffey (2000) have asserted that it is only a matter of time before there is a health-care winner. Moreover, these authors went on to say that the true benefit of the Baldrige process is not about winning an award. Rather, it is about the provision of a road map for a journey – a framework for both incremental and breakthrough improvement and business excellence. Within the European context, since its introduction in 2001, the EFQM model has been attracting considerable interest across all sectors, and has become a well-recognised quality-management framework. Stahr et al. (2001) concurred with Gaucher and Coffey (2000) in stating that the model provides a means by which organisations can assess their paths and develop solutions to achieve excellence. Other authors have espoused the model as being surprisingly effective, with awards being presented to those firms considered to be the most accomplished exponents of TQM in Europe (Wilkes and Dale, 2005). Across European health care at an institutional level, an increasing number of organisations are making direct investments in the training of staff in the concepts of business excellence (Stahr et al., 2001; Jackson, 2001). The NHS Executive in the UK has provided a central lead in endorsing the model as an important framework for delivering on the clinical governance agenda. Furthermore the British Association of Medical Managers (BAMM) has promoted its use as a tool for organisational self-assessment (Stahr et al., 2001). Its use and adoption has been further supported by the British Quality Foundation which provides a major educational and support role in the use and adoption of the model in health care and other sectors across the corporate landscape. Without doubt, the future performance of health-care organisations will be assessed against wider goals than previously. There will be a greater emphasis on measuring organisational performance and, if performance is below par, rapid investigation and appropriate intervention will ensue (Naylor, 2005). Moeller (2001) concurred with this, and identified evaluation of health services as a prerequisite. However, Zairi et al. (2005) warned that measuring organisational effectiveness in the delivery of health care is a challenging task. Joss and Kogan (2005) strongly recommended that a comprehensive set of criteria should be included, against which to evaluate progress. This should be based on the main requirements of TQM, supplemented by other organisational criteria thought to be important by the evaluators. A three-year evaluation of TQM in the NHS indicated that there are clear factors which predict successful implementation – including awareness of the need to have a structured, pre-planned approach based on a thorough understanding of alternative approaches (Joss, 2004). Moreover, as demonstrated by O’Sullivan (2005), successful implementation requires the support of visionary and involved leaders in all areas, together with dedicated and educated staff. Examining organisational effectiveness in Irish health care As suggested by Nabitz and Walburg (2000), the solution to quality problems might lie in the approach promoted by the EFQM. As reported by Sanchez (2000), this approach represents an important means of achieving excellence in health care which concurs with earlier descriptions by Gaucher and Coffey (2000). Self-assessment can examine current practice and establish capability, thus driving improvement rather than a reaction to weaknesses in the current system (Russell, 2005). There are also many studies in the literature which show the benefits of applying the business excellence model for quality implementation in health-care organisations (Naylor, 2005; Jackson, 2005a; Nabitz and Klazinga, 2005; Arcelay et al., 2005). Such studies have pointed to real benefits that have accrued to organisations using such an approach. Furthermore, Jackson (2005a) demonstrated that the adoption of the principles of self-assessment and business excellence can lead to the achievement of a culture of continuous improvement. Russell (2005) noted that the adoption of the â€Å"outside-in† approach of the EFQM model enabled organisations to use the model as a developmental and management framework. For Arcelay et al. (2005), the model provided a global, systematic regular analysis of the activities and results by comparing them with the criteria of the excellence model. Moreover, the process made it possible to make comparisons with other private and public organisations. Using a systems view of an organisation enables managers to focus on the processes between the parts of an organisation, rather than on the parts themselves, which is similar to physicians using a systematic model in which to analyse signs and symptoms, and thus make a diagnosis. An effective organisation is one in which the total organisation, through its significant subparts and individuals, manages its work against goals and plans with a view to achieving these goals within an open system. Methods of management that have been developed in manufacturing environments are naturally regarded with scepticism in non-manufacturing sectors. However, according to West (2001), studies that have been conducted on the link between the organisation and management of services and quality of patient care can be criticised both theoretically and methodologically because of the many different mechanisms that may be operating at once to produce the relationship between volume and quality. West (2001) asserted that a more rigorous body of work exists on the performance of firms in the private sector, often conducted within the disciplines of organisational behaviour or human resource management. Ireland and the International ICT System Dublin has, in the 2000s, carved out several niche international functions for itself, one of which, call centre activities, has been the principal focus of this study. According to a report in The Irish Times (August 20, 2003), Ireland accounts for 30% of all international call centres located in western Europe. The great bulk of these are to be found in Dublin. The central role of ICT in call centre activities has facilitated their centralisation in Ireland, from where markets spread across Europe and even further afield can readily be served. As Sassen (2005, p. 56) has observed: â€Å"Information technologies, often thought of as neutralising geography, actually contribute to spatial concentration†. Call centre activities, therefore, have helped Ireland to escape the bounds of geographical peripherality, thereby contradicting Wegener’s (2005) gloomy prognosis which visualised cities in the periphery as inevitable losers from growing inter-urban competition in Europe. This has been cleverly portrayed in an IDA advertisement which shows Ireland at the centre of a surrounding group of disembodied European countries ( Fig. 1). These latter are no longer seen as being more or less distant from Ireland, but as constituting a set of different language and market territories, all equally accessible from Ireland. However, Dublin’s growing international reach and the growing technological sophistication of its economic base should not mask the fact that, structurally, it retains a dependent position within the international division of labour. Its rapid recent economic expansion has been largely based on the attraction of branch plant operations which remain poorly embedded in the local economy (Breathnach, 2005). à Ã‚ nd, while the rising skill levels associated with recent inward investment have facilitated substantial improvement in living standards generally, in the specific case of the call centre sector, much of the employment which has been created remains relatively poorly paid – a fact which is directly linked with the high proportion of women workers in the sector, despite their high skill levels. Furthermore, the rapid growth of the call centre sector in the 2000s looks increasingly unsustainable as the end of the decade approaches. Growing labour shortages are driving up labour costs which, in conjunction with increasing housing and transportation problems, are beginning to attenuate Dublin’s attractiveness as a call centre location: according to a 2005 survey of call centre locations in Great Britain and Ireland, reported by Allen (2005), Dublin had fallen to the 29th position of 46 locations surveyed, having been in the top 10 in 2006. The response of the IDA has been to devote additional resources to promoting non-Dublin locations for call centre projects. However, even if this is successful in the short run, in the longer term the future of call centre employment will be increasingly threatened by technological developments, such as speech recognition technology and especially the rapidly growing use of the internet for making reservations, placing orders and seeking information. The IDA has justified its promotion of the call centre sector, despite the inferior nature of much of the employment involved, largely on the grounds that it provides an initial base upon which more sophisticated forms of employment can be built. Its long-term strategy, in other words, is to encourage firms which have established call centres in Ireland to add on additional functions, such as financial management and software development, to these initial operations. Already there has been some success in this area of ‘shared services’ back-office activities: by mid-2003, some 25 such operations had been established, and were projected to employ over 3000 people by the year 2000 (information supplied by Forfà ¡s). Ultimately, however, all of these activities remain as back-office activities, whose essential linkages are external to the Irish economy. In other words, their Irish location is not crucial to the parent companies of these operations; rather, it is contingent on the availability of certain attractions which may either be transient or reproducible elsewhere (Allen, 2005). As Wilson (2005) has noted, call centres are essentially a highly footloose sector, with few local economic linkages and little fixed investment in machinery and equipment: they therefore can be relocated quite readily in the light of changing comparative factor conditions. The National Health Service (NHS) in the UK published its NHS Plan in July 2000 (http://www.nhs.uk/thenhsexplained), saying that patients and people were central to its radical reform of healthcare and that although this included more hospitals and beds, shorter waiting times and improved care for older people, an essential element was that patients should have more power and information. As Grimson et al. (2000) rightly comment, healthcare is an information-intensive business, with data on an enormous scale gathered by way of hospitals, clinics, laboratories and primary care surgeries. Central to any information-intensive business is, naturally, the effective sharing of that information and, in order to empower and better engage the patient, how best that can be done. Funded by the UK’s Department of Health, the British Library’s integrated Telemedicine Information Service (TIS), described in the latest edition of the NHSMagazine (http://www.nhs.uk/nhsmagazine), is to improve the take-up of telemedicine technology in the UK, reinforcing the importance that information and communication technologies (ICTs) are seen to have in the sharing of information and the engagement of patients in their healthcare. By way of explanation, the word â€Å"telemedicine† has been coined as a way of capturing, in only one word, how ICT is being used in healthcare. However, as Curry et al. (2003) rightly comment, terms such as telemedicine, teleconferencing, health informatics and medical informatics seem to be used interchangeably, and that there is some confusion as to what is, and is not, involved, citing various studys, including those of Preston at al. (2002) and Mark and Hodges (2001) to support their claim. As there is some disagreement with the term, we use in this study the meaning assigned by Perednia and Allen (2005), that is, the use of information technologies in helping to provide medical information and services in healthcare. Whatever its name, or its definition, it concerns, in one way or another, the mediating role that technology plays in the interaction between humans, whether patient or healthcare professional. At the time of writing, there are 138 telemedicine projects in the UK (http://www.tis.port.ac.uk/tm/owa/projects.allUK), and they cover aspects of healthcare as diverse as mental health, diabetes, foetal monitoring and accident and emergency care. Indeed, it points to one of the advantages of telemedicine; its applicability across a wide range of clinical issues. However, while these projects certainly cover a diversity of issues, they have something in common, that is, they address only one of these clinical matters. Each system is designed differently, is unlikely to be compatible with another, and needs different technical support and user training. Whilst such individual systems have proved useful in a particular context (see, for example, Gilmour et al., 2005; Jones et al., 2006; Lesher et al., 2005; Loane et al., 2005; Lowitt et al., 2005; Oakley et al., Health Information and Communication Systems in Ireland Health Information and Communication Systems in Ireland Is ICT a key enabler in ensuring seamless delivery of healthcare? A comparison between public and private ICT development in Ireland Abstract This study discusses the innovative changes that have taken place in Ireland in the field of healthcare due to the influx of information and communication technologies. Previous Information communication technologies (ICT), including telemedicine, present opportunities to address rural health-service delivery issues. The research shows that effective management of health services and the delivery of quality systems in Irish healthcare organizations have increased. In Ireland patients are expecting more of healthcare providers and are demanding higher standards of care and service. Simultaneously, those paying for health services have become more concerned about rising health costs and possible inefficiencies. As a result there is widespread interest in understanding what makes for an effective health service and in developing better practices to improve existing approaches to healthcare management in relation to ICT. This study highlights the developments in quality-service management in the Irish healthcare sector and focuses attention on the need for the development of a model for quality implementation in healthcare institutions. In sum the study shows that the development of (ICT) has facilitated the emergence of a complex global urban system in which many formerly lower-order cities have been carving out â€Å"niche† specialist functions serving urban fields of transnational dimension. Chapter1: Introduction Purpose of Study The purpose of this study is to highlight the development of the Information and communication system in Ireland and how it has revolutionized the healthcare sector in Ireland. Research Question This study focuses on the following research questions: What are the current trends of technological development in the Information and Communication Technology sector of Ireland? What are various challenges faced by the Irish healthcare system in relation to Information and Communication Technology? Significance of the Study This study is quite significant as it shows that the concept of globalisation has secured remarkable currency in the academic discourse of the late 20th century, despite ongoing questions regarding both its meaning and extent (Clark and Lund, 2000). The development of internationally integrated production and distribution systems, seen by many as the key feature of globalisation, has been a spatially uneven process. A key factor in this respect has been the differential ability of regions to engage in the informational economy, based on new information and communications technology (ICT), which is the main source of wealth creation and economic growth in the modern world (Castells, 2003). The result has been what Friedmann (2005) calls a process of ‘techno-apartheid’ which has divided the globe into ‘fast’ and ‘slow’ worlds (Knox, 2005), distinguished by the connectedness of individuals, groups and regions to the world of telematics. This echoes Ingersoll’s (2003, quoted in Knox, 2005) suggestion that the key division of the workforce is now that between those who have the capacity to operate ICT (the ‘cyberproletariat’) and those who do not (the ‘lumpentrash’). Golding (2006) makes a similar distinction between the ‘technoliterati’ and the ‘techno-poor’. While Knox defines the fast and slow worlds spatially, equating the former with the ‘triadic’ core and the latter with the remaining global periphery, Hoogvelt (2003) argues that the divide is, in essence, social rather than spatial, with elements of both worlds to be found in all regions of the globe. Thus, within advanced economies, a process of social polarisation has been widely reported (Friedmann, 2006 and Sassen, 2004) and has been intimately linked by Graham and Marvin (2006) to the development of ICT use. This is not to suggest that those who work in the fast world are homogeneously well-paid and affluent; rather, they represent a wide range of remuneration levels depending on such factors as economic sector, location, function, ethnic group and gender (Castells, 2006). What they do tend to have in common, however, is relative employment security due to the high demand level for their ICT skills. Rationale This study follows a logical approach and identifies the fact that both in Ireland as well as globally, there are major geographical variations in the relative balance between fast and slow worlds, with the former mainly to be found in the traditional core regions of North America, western Europe and Japan and an additional small group of newly industrialising countries which have had the institutional capacity to invest massively in modern ICT and associated educational infrastructures (Freeman, 2004). The slow world – found predominantly in the less developed countries of the global periphery and accounting for the bulk of the world’s population – is becoming increasingly marginalised and is moving, as Castells (2003, p. 37) puts it, â€Å"from a structural position of exploitation to a structural position of irrelevance†. Definition of Terms ICT: Information and Communication Technology: it is the study or business of developing and using technology to process information and aid communications. Sistem : SISTeM a soft systems methodology, stakeholder analysis and participative simulation modelling. NHS: (National Health Service) The organization providing national healthcare services in the UK. Chapter 2: Literature Review The process of quality implementation has become a key concern for those involved in hospital management in Ireland. In a national context, the effective management of health services and the delivery of quality systems in health-care institutions have increased in significance in recent years. In line with wider developments in other service industries, consumers (patients) are expecting more of health-care providers and are demanding higher standards of care and service. Simultaneously, those paying for health services have become more concerned about rising health costs and possible inefficiencies. As a result there is widespread interest in understanding what makes for an effective health service and in developing better practices to improve existing approaches to health-care management and delivery. In 2005 a comprehensive report on funding from the Commission on Health Funding highlighted that solutions to the problems faced by the Irish Health Service did not lie primarily in the system of funding, but rather in the way that services were planned, organised, and delivered. Similarly, in a report from the OECD (2003), it was argued that although the Irish health system had delivered a continuous improvement in health standards, there was still scope for further improvement in efficiency, and that this could be achieved through better allocation of resources. More recently, the government health strategy (DOHc, 2001) highlighted the requirement for a system to monitor progress and systematically evaluate the quality and effectiveness of health services. According to the strategy: Monitoring and evaluation must become intrinsic to the approach taken by people at all levels of the health services. Specifically, the strategy suggested that the way in which health and personal social services are planned, organised, and delivered has a significant effect on the health and well-being of the population. Organisational structures must be geared to the provision of a responsive, adaptable health system which meets the needs of the population effectively and at affordable cost. One of the guiding principles inherent in the published strategy was that of a â€Å"people-centred† health system. A responsive system must develop ways to engage with individuals and the wider community which receives its services. The health system must become more people-centred, with the interests of the public, patients, and clients being given greater prominence and influence in decision making at all levels (DOHc, 2001). According to Bowers (2001), major structural reform, coupled with strong management and political will, are required to ensure change for the better. In Bowers’ view, finance alone will not improve the system. Rather, a concentrated effort must be made to ensure a responsive and efficient service. As previously noted, a conclusion of the Report of the Commission on Health Funding (2005) was that the solution facing the Irish health services did not lie primarily in the system of funding but rather in the way that services were planned, organised, and delivered. This is reinforced by a recent report on the Irish health-care sector which suggested that the issues and challenges facing the health service are fundamentally the same as those outlined by the Commission on Health Funding, except that they are compounded by much higher expectations/demands by consumers (Deloitte and Touche, 2001). Thus, although modern health services have undergone radical change in many areas (Robins, 2003), managers of health services are currently reporting a large increase in the number of patients needing beds, with consequent ever-increasing waiting lists. Accident and emergency departments are under particular strain, and the difficulties of dealing with the growing needs of the increasing elderly population are beginning to become apparent. Although the Irish health service is free for all those requiring medical treatment through a publicly funded system, the current situation is hauntingly similar to that of the Victorian era of health care in Ireland. As a result, the Office for Health Management in Ireland (OHM, 2001) has suggested that current deficiencies in health-care provision and delivery underline the importance of providing quality service management and implementation in Irish health and personal social services. In achieving this aim, the OHM has contended that those working within the system must change how they go about their work and how they work together. Changed public-sector environment The focus on health-care service and quality has evolved from a more general interest in continuous improvement initiatives within the public sector. The prevalent trends in the private sector are towards continuous and pervasive change and increasing interdependencies, and it has been suggested that close parallels can be drawn between the private and public sectors. Public-sector organisations now find themselves in a cyclone of change as they attempt to adapt to turbulent environments in a pragmatic and systematic way (Lovell, 2004). In the UK and also in Ireland, these organisations have been subject to cuts in government spending, as well as demands for enhanced efficiency and effectiveness. In response to such changes, there has been a policy shift towards greater competition and an attempt to apply management practices from the private sector to the public domain. The Irish public sector has been officially pursuing change and reform through its strategic management initiative (SMI), a program for improving the management of the civil service which was formally launched in 2004 (Department of the Taoisearch, 2004). The SMI evolved from the growing internal and external pressures for better services and for more effective management of public services. In that context the continuous improvement of customer service has been a specific focus of the SMI since 2003, when the quality service initiative was launched. The program set out a series of quality principles according to which dealings with the wider public would be coordinated and managed. These initiatives aimed to make public administration more relevant to the citizens for whom the service exists, and simultaneously sought to remove barriers which have traditionally restricted performance and job satisfaction within the public sector. In recent years, Ireland has experienced a rise in consumerism. Increases in revenue available to fund public service provision have gone hand in hand with rising public expectations of standards of service. As a consequence, management skills and competences in providing for improved standards of customer service have become recognised as being central to delivering real transformation in the public sector. However, the development of such capabilities, particularly in relation to managing effective quality implementation, presents considerable challenges for those involved. Nowhere is this more evident than in the health-care sector. A review of recent international evidence points to the challenges of implementing quality service in health-care institutions. Gaucher and Coffey (2000) confirmed that implementing a process of total quality management (TQM) in health care is a pragmatic, specific, and systematic methodology. However, this requires a firm commitment from the leadership to change their former ways of working and doing business. Gaucher and Coffey (2000) cited many reasons for TQM failing – including poor leadership and a lack of management commitment – but also noted that revitalisation can rejuvenate the process. These authors asserted that the role of those implementing the process is to nurture and breathe energy into the process when enthusiasm and commitment are declining. The importance of the support of senior management for quality-management projects is also advocated by Berwick et al. (2000). These authors undertook a national demonstration project in the USA in the late 2000s and described how organisations could implement the entire quality-improvement process – from defining the problem through to implementing a solution and consolidating the gains (Berwick et al., 2000). A literature review carried out by Jackson (2005) identified that much work had been undertaken in the UK in determining the clinical effectiveness of many health-care organisations, but that very little research had been implemented in the area of managerial effectiveness. Furthermore, West (2001) determined that, in organisations that outperform others on different dimensions of performance, there was evidence that management is important, as are the combined efforts of individual clinicians and teams. There have been several approaches espoused for achieving quality management in health-care institutions, many of which have been technical and generic in their approaches (Moeller et al., 2000). Specifically, Donabedian (2000) introduced the concepts of structure, process, and outcomes, along with the development of self-assessment and accreditation through the International Organization for Standardization (ISO). In many instances these programs have met with mixed reactions, and their implementation has varied. A criticism levelled at hospital performance is that it has been rather insular, and has paid little attention to developments in related fields, such as organisational sociology, organisational behaviour, management studies, and human-resource management (West, 2001). If quality programs are to have lasting and significant effects, that they must follow a systemic approach such that all aspects of an organisation are integrated and focused on continuous improvement and customer satisfaction (Joss, 2004). A variety of approaches has been used to improve quality and to ensure its delivery, but not all have been successful. Indeed, some have merely added bureaucracy and higher costs to health care (Jackson, 2005; Ennis and Harrington, 2001). Recent research has shown that 45 per cent of patients experience some â€Å"medical mismanagement† and that 17 per cent suffer events which lead to a longer stay or more serious problems (Ovretveit, 2000). This is increasingly caused by complex systems of care which do not appear to be managed effectively. Joss and Kogan (2005) strongly recommended that a comprehensive set of criteria be included, against which to evaluate progress. These criteria should be based on the main requirements of TQM, and should include any additional factors generated by the organisation and/or by evaluators. A three-year evaluation of TQM in the National Health Scheme (NHS) indicated that there were clear factors which predicted successful implementation, the most important of which was the need to have a structured, pre-planned approach based on a thorough understanding of alternative approaches (Joss, 2004). Moreover, a recent study from the UK (O’Sullivan, 2005) demonstrated how one NHS Trust achieved continuous quality improvement through determination, education, and implementation, supported by visionary and involved leadership in all areas, a multi-talented enthusiastic clinical audit department, and a high-quality dedicated staff. Nabitz and Walburg (2000) suggested that possible solutions to quality problems might lie in the approach promoted by the European Foundation for Quality Management (EFQM). The EFQM has developed a model to structure and review the quality-management processes of organisations. Self-assessment, benchmarking, external review, and quality awards are essential elements of this model and, as reported by Sanchez (2000), this approach represents an important means of achieving excellence in health care. Within the literature there are also many studies showing the benefits of applying models of quality implementation in health-care organisations (Naylor, 2005; Ruiz et al., 2005). Such studies have pointed to the real benefits that accrue to organisations which have used such approaches (Pitt, 2005). Business excellence methodology for quality improvement The introduction of internationally respected quality frameworks – the Malcolm Baldrige National Quality Award (MBNQA) in 2003, followed by the EFQM in 2005 – has provided an opportunity for organisations to self-assess, using the models of TQM and business excellence which underpin these frameworks. In this process of self-assessment, an opportunity exists to identify the strengths and weaknesses in the current management of operations. In the USA, the effectiveness of the Baldrige process has been lauded by many (Gaucher and Coffey, 2000) who have indicated that organisations can learn about best practices from Baldrige-winning companies, and will thus be assisted in developing a composite for excellence. Although the Baldrige criteria were developed for commercial institutions, there has been keen interest in the adaptation of the model within health-care organisations in the USA following a pilot health-care project in 2005. To date, no health-care entity has yet achieved Baldrige-winner status, although Gaucher and Coffey (2000) have asserted that it is only a matter of time before there is a health-care winner. Moreover, these authors went on to say that the true benefit of the Baldrige process is not about winning an award. Rather, it is about the provision of a road map for a journey – a framework for both incremental and breakthrough improvement and business excellence. Within the European context, since its introduction in 2001, the EFQM model has been attracting considerable interest across all sectors, and has become a well-recognised quality-management framework. Stahr et al. (2001) concurred with Gaucher and Coffey (2000) in stating that the model provides a means by which organisations can assess their paths and develop solutions to achieve excellence. Other authors have espoused the model as being surprisingly effective, with awards being presented to those firms considered to be the most accomplished exponents of TQM in Europe (Wilkes and Dale, 2005). Across European health care at an institutional level, an increasing number of organisations are making direct investments in the training of staff in the concepts of business excellence (Stahr et al., 2001; Jackson, 2001). The NHS Executive in the UK has provided a central lead in endorsing the model as an important framework for delivering on the clinical governance agenda. Furthermore the British Association of Medical Managers (BAMM) has promoted its use as a tool for organisational self-assessment (Stahr et al., 2001). Its use and adoption has been further supported by the British Quality Foundation which provides a major educational and support role in the use and adoption of the model in health care and other sectors across the corporate landscape. Without doubt, the future performance of health-care organisations will be assessed against wider goals than previously. There will be a greater emphasis on measuring organisational performance and, if performance is below par, rapid investigation and appropriate intervention will ensue (Naylor, 2005). Moeller (2001) concurred with this, and identified evaluation of health services as a prerequisite. However, Zairi et al. (2005) warned that measuring organisational effectiveness in the delivery of health care is a challenging task. Joss and Kogan (2005) strongly recommended that a comprehensive set of criteria should be included, against which to evaluate progress. This should be based on the main requirements of TQM, supplemented by other organisational criteria thought to be important by the evaluators. A three-year evaluation of TQM in the NHS indicated that there are clear factors which predict successful implementation – including awareness of the need to have a structured, pre-planned approach based on a thorough understanding of alternative approaches (Joss, 2004). Moreover, as demonstrated by O’Sullivan (2005), successful implementation requires the support of visionary and involved leaders in all areas, together with dedicated and educated staff. Examining organisational effectiveness in Irish health care As suggested by Nabitz and Walburg (2000), the solution to quality problems might lie in the approach promoted by the EFQM. As reported by Sanchez (2000), this approach represents an important means of achieving excellence in health care which concurs with earlier descriptions by Gaucher and Coffey (2000). Self-assessment can examine current practice and establish capability, thus driving improvement rather than a reaction to weaknesses in the current system (Russell, 2005). There are also many studies in the literature which show the benefits of applying the business excellence model for quality implementation in health-care organisations (Naylor, 2005; Jackson, 2005a; Nabitz and Klazinga, 2005; Arcelay et al., 2005). Such studies have pointed to real benefits that have accrued to organisations using such an approach. Furthermore, Jackson (2005a) demonstrated that the adoption of the principles of self-assessment and business excellence can lead to the achievement of a culture of continuous improvement. Russell (2005) noted that the adoption of the â€Å"outside-in† approach of the EFQM model enabled organisations to use the model as a developmental and management framework. For Arcelay et al. (2005), the model provided a global, systematic regular analysis of the activities and results by comparing them with the criteria of the excellence model. Moreover, the process made it possible to make comparisons with other private and public organisations. Using a systems view of an organisation enables managers to focus on the processes between the parts of an organisation, rather than on the parts themselves, which is similar to physicians using a systematic model in which to analyse signs and symptoms, and thus make a diagnosis. An effective organisation is one in which the total organisation, through its significant subparts and individuals, manages its work against goals and plans with a view to achieving these goals within an open system. Methods of management that have been developed in manufacturing environments are naturally regarded with scepticism in non-manufacturing sectors. However, according to West (2001), studies that have been conducted on the link between the organisation and management of services and quality of patient care can be criticised both theoretically and methodologically because of the many different mechanisms that may be operating at once to produce the relationship between volume and quality. West (2001) asserted that a more rigorous body of work exists on the performance of firms in the private sector, often conducted within the disciplines of organisational behaviour or human resource management. Ireland and the International ICT System Dublin has, in the 2000s, carved out several niche international functions for itself, one of which, call centre activities, has been the principal focus of this study. According to a report in The Irish Times (August 20, 2003), Ireland accounts for 30% of all international call centres located in western Europe. The great bulk of these are to be found in Dublin. The central role of ICT in call centre activities has facilitated their centralisation in Ireland, from where markets spread across Europe and even further afield can readily be served. As Sassen (2005, p. 56) has observed: â€Å"Information technologies, often thought of as neutralising geography, actually contribute to spatial concentration†. Call centre activities, therefore, have helped Ireland to escape the bounds of geographical peripherality, thereby contradicting Wegener’s (2005) gloomy prognosis which visualised cities in the periphery as inevitable losers from growing inter-urban competition in Europe. This has been cleverly portrayed in an IDA advertisement which shows Ireland at the centre of a surrounding group of disembodied European countries ( Fig. 1). These latter are no longer seen as being more or less distant from Ireland, but as constituting a set of different language and market territories, all equally accessible from Ireland. However, Dublin’s growing international reach and the growing technological sophistication of its economic base should not mask the fact that, structurally, it retains a dependent position within the international division of labour. Its rapid recent economic expansion has been largely based on the attraction of branch plant operations which remain poorly embedded in the local economy (Breathnach, 2005). à Ã‚ nd, while the rising skill levels associated with recent inward investment have facilitated substantial improvement in living standards generally, in the specific case of the call centre sector, much of the employment which has been created remains relatively poorly paid – a fact which is directly linked with the high proportion of women workers in the sector, despite their high skill levels. Furthermore, the rapid growth of the call centre sector in the 2000s looks increasingly unsustainable as the end of the decade approaches. Growing labour shortages are driving up labour costs which, in conjunction with increasing housing and transportation problems, are beginning to attenuate Dublin’s attractiveness as a call centre location: according to a 2005 survey of call centre locations in Great Britain and Ireland, reported by Allen (2005), Dublin had fallen to the 29th position of 46 locations surveyed, having been in the top 10 in 2006. The response of the IDA has been to devote additional resources to promoting non-Dublin locations for call centre projects. However, even if this is successful in the short run, in the longer term the future of call centre employment will be increasingly threatened by technological developments, such as speech recognition technology and especially the rapidly growing use of the internet for making reservations, placing orders and seeking information. The IDA has justified its promotion of the call centre sector, despite the inferior nature of much of the employment involved, largely on the grounds that it provides an initial base upon which more sophisticated forms of employment can be built. Its long-term strategy, in other words, is to encourage firms which have established call centres in Ireland to add on additional functions, such as financial management and software development, to these initial operations. Already there has been some success in this area of ‘shared services’ back-office activities: by mid-2003, some 25 such operations had been established, and were projected to employ over 3000 people by the year 2000 (information supplied by Forfà ¡s). Ultimately, however, all of these activities remain as back-office activities, whose essential linkages are external to the Irish economy. In other words, their Irish location is not crucial to the parent companies of these operations; rather, it is contingent on the availability of certain attractions which may either be transient or reproducible elsewhere (Allen, 2005). As Wilson (2005) has noted, call centres are essentially a highly footloose sector, with few local economic linkages and little fixed investment in machinery and equipment: they therefore can be relocated quite readily in the light of changing comparative factor conditions. The National Health Service (NHS) in the UK published its NHS Plan in July 2000 (http://www.nhs.uk/thenhsexplained), saying that patients and people were central to its radical reform of healthcare and that although this included more hospitals and beds, shorter waiting times and improved care for older people, an essential element was that patients should have more power and information. As Grimson et al. (2000) rightly comment, healthcare is an information-intensive business, with data on an enormous scale gathered by way of hospitals, clinics, laboratories and primary care surgeries. Central to any information-intensive business is, naturally, the effective sharing of that information and, in order to empower and better engage the patient, how best that can be done. Funded by the UK’s Department of Health, the British Library’s integrated Telemedicine Information Service (TIS), described in the latest edition of the NHSMagazine (http://www.nhs.uk/nhsmagazine), is to improve the take-up of telemedicine technology in the UK, reinforcing the importance that information and communication technologies (ICTs) are seen to have in the sharing of information and the engagement of patients in their healthcare. By way of explanation, the word â€Å"telemedicine† has been coined as a way of capturing, in only one word, how ICT is being used in healthcare. However, as Curry et al. (2003) rightly comment, terms such as telemedicine, teleconferencing, health informatics and medical informatics seem to be used interchangeably, and that there is some confusion as to what is, and is not, involved, citing various studys, including those of Preston at al. (2002) and Mark and Hodges (2001) to support their claim. As there is some disagreement with the term, we use in this study the meaning assigned by Perednia and Allen (2005), that is, the use of information technologies in helping to provide medical information and services in healthcare. Whatever its name, or its definition, it concerns, in one way or another, the mediating role that technology plays in the interaction between humans, whether patient or healthcare professional. At the time of writing, there are 138 telemedicine projects in the UK (http://www.tis.port.ac.uk/tm/owa/projects.allUK), and they cover aspects of healthcare as diverse as mental health, diabetes, foetal monitoring and accident and emergency care. Indeed, it points to one of the advantages of telemedicine; its applicability across a wide range of clinical issues. However, while these projects certainly cover a diversity of issues, they have something in common, that is, they address only one of these clinical matters. Each system is designed differently, is unlikely to be compatible with another, and needs different technical support and user training. Whilst such individual systems have proved useful in a particular context (see, for example, Gilmour et al., 2005; Jones et al., 2006; Lesher et al., 2005; Loane et al., 2005; Lowitt et al., 2005; Oakley et al.,

My Christian Life Essays -- essays research papers

My Christian Life has been â€Å"pleasurable pain† (I will explain what that refers to in detail later). I was born on June 9, 1984. I was blessed to be in a family of Christian. Therefore, I was destined to become a true follower of Christ. I was baptized on August 12 of that year at St. Rose De Lima. Most people say that from the moment I was blessed, I became a disciple of Jesus, a light bearer, but I believe I was a disciple for my Lord and Savior the moment I was born. I was conceived into a Christian family with a strong Christian background. I thank the Lord to this day for blessing me as He did. As it was when I was born and still to this day, I was brought to Church every Sunday. As an infant and a child, I did not understand the true meaning of this. I thought it was just a day I was force to wear â€Å"uncomfortable† clothes and told to be quite (even though I rarely did). I was like most other children, as are some teenagers, I did not want to go to Church. I would run, play sick or try to do anything I could to not attend Church. For this misunderstanding, I only can credit that to my ignorance of my faith. If you were not dying in my house you was presumed to go to Church even if you was not apart on our family. I remember one instance when I slept by a friend’s house and his family, unfortunately, was not a regular participant in Church (I think I knew this). My mother came and picked me up that morning to go to Church. I remember this moment in my life because it showed how strong my family was and will always be in Faith. As me being a Christian, I was taught in a Catholic School. I attended St. Leo the Great Elementary. There, I learned a broad description of my faith and why my faith entitled me to do and act a certain way. I receive my Holy Communion when I was in First Grade I believe. Even then, I did not really understand the true concept of what I embarked on. For this reason, I â€Å"kind of† go against receiving certain sacraments at a young age. Age is a vital part in the strength of our beliefs (a younger person may be weaker than an older one). How many young Christians â€Å"really† understand what they are doing or even saying? If a person does not understand what they are taking apart of, then why should they be included. Today, a person is read their rights and asked at the end, do you understand all of things that were being said. I believe th... ...er away from me. I felt cheated. Until one day I talk to a friend of the family (we call him Uncle Jessey). He made me understand the cycle of death. After all the classes I have sat through dealing with my faith and all I have learned, nothing could have prepared me for this tragedy. I thank God for my Uncle Jessey kind words and for helping me to overcome my grandmother’s death. Another instance I remember is seeing Coach Deleica and Coach Griff at my grandmother’s funeral. At that moment I felt the true presence of my St. Augustine family. A couple of days ago, I attended my senior trip. When I first got there I was just glad to be out of class but as the day progressed I began to talk to God. I began to hear the music of the Lord. I felt lifted at the end of the day. After I leave Church, I always feel lifted (if I go to the right church). I attend St. Peter Claver Church. St. Peter Claver is a predominant black church. It has a gospel type of choir. Mass is last a minimum of 90 minutes. Without this service I would not be able to go on with life. â€Å"I hope that God will forever keep blessing me and watch over my love ones and friends,† St. Joseph and St. Augustine Pray For Us.