Distance Still Matterthe Hard Reality of Global Expansion Essay

CAGE Distance Framework Distance Still Matters analyses several factors that impact both success and failure in global expansion strategies. The challenges discussed are dimensions of distance. The four dimensions of distance discussed are cultural, administrative, geographic and economic. Cultural distance is essentially the differences in communication, interaction, religion, race and social norms. Administrative or Political distance refers to the absence of colonial ties, shared political association and institutional weaknesses. Examples of political barriers are tariffs, trade quotas and restrictions on foreign investment. Political associations between countries, typically that exist in a colony/colonizer relationship facilitates international trade due to similarities in administrative dynamics. Geographic distance is created due to remoteness or the lack of access due to transportation, communication limitations or differences in size and climate. Economic distance is created by a discrepancy in re sources such as financial, intellectual, human and natural. Star TV Star TV’s attempt to expand into the global media television market was given as an example of a failed initiative due to the lack of focus on dimensions of distance between foreign markets. Star TV was founded in 1991 with a mission to deliver television programming to Asian audiences. Their motivation was that they perceived the Asian audience as being starved for diverse media choices. Star projected that English language programming would transition into the Asian culture, especially with the socio-economic elite (top 5%). The strategy to gain a competitive advantage over broadcaster was to use satellite technology to transmit programming. Star’s expansion attempt failed, recording losses of $141 million in 1999 and $500 million between 1996 and 1999. Without extensive Asian market research this initiative was unrealistic. An assumption was made that cultural distance did not exist between Asia and the United States. The Asian media market was not as interested in English speaking programming as Star’s management projected. Additionally, Asian governments imposed barriers to politically driven programming which created even more political distance that initially existed. Star TV’s mistake was the lack of market research and a â€Å"go/no go† decision making process. Too many assumption were made that the international media television market was immune to dimensions of distance such and cultural and political. Recommendation Identify a sample market and run a pilot test with several typical English-speaking programming options. CPA Approach The CPA approach or the Country Portfolio Analysis looks at how the actual and potential markets measuring per capita income and per capita industry consumption. The two indicators plotted on a grid creating bubbles that represent the size of each country’s market Tricon Restaurants International (TRI) Tricon spun off from Pepsico in 1997. The company’s core business is managing fast food chains such as Pizza Hut, Taco Bell and KFC both domestically and internationally in 27 countries. In 1998 the company began evaluating the possibility of consolidating operations within high performing markets. Two thirds of TRI’s revenues and even a higher proportion of profits came from 7 of the 27 markets. Based solely on market size, TRI’s initially plan was to dispose of its investment in Mexico. Mexico fast food market ranked 16th of 20, with a total fast food consumption of $700 million. Using the CPA approach, TRI identified Mexico as a top 3 priority based on geographic distance from Dallas, TX (TRI’s Headquaters), common land borders and favorable trade agreements with the United States. (Beamish, 2011) References Beamish W. Paul and Bartlett Christopher, Transnational Management: Text, Cases, and Readings in Cross-Border Mangement, pg. 95-105

Pay for Performance Essay

Prior to the 2000s, fee-for-service systems dominated how health care providers received payment for providing care to patients. Under the fee-for-service system, physicians received payments, according to the volume of patients and the complexity of services. Two reports written by the Institute of Medicine clearly substantiated serious deficiencies in the quality of health care in the United States. The findings prompted the need to develop initiatives to pay health care workers based on quality. The following discussion defines pay-for-performance, explains the effects of reimbursement under this approach, details the impact of system cost reductions on the quality and efficiency of health care, the effects of this model on health care providers and customers, and the effect pay-for-performance will have on the future of health care. The Definition of Pay for Performance Pay for performance models reward providers, such as physicians, other health care providers, hospitals, and medical groups under contract for meeting pre-established performance measures to improve quality and efficiency in health care delivery. It is popular among policy makers and private and public payers, such as Medicare and Medicaid. The first initiative adopted by one of the nation’s largest health care plans, PacifiCare Health Systems, began paying medical groups in California bonuses for meeting or exceeding 10 clinical and service quality targets in 2003 (Meredith, Richard, Zhonghe, & Arnold, 2005). Service quality targets included five patient-reported measures of service quality, five ambulatory care quality indicators, and a set of hospital quality measures for referring patients to high-quality hospitals. The criteria in the first year required medical groups to acquire a minimum of 1000 PacifiCare Commercial and 100 Secure Horizons enrollees. Research showed the network of California medical groups, under contract to improve performance goals, outweighed the performance measure of another medical group not under contract, Pacific Northwest, for cervical cancer screening by a significance of 3.6%. Of 163 eligible physician groups, 97 (60%) received a distribution of funds from the program related to at least 1 physician group quality performance target in the first quarter of the QIP. In the last payout based on the original set of targets (April 2004), 129 of 172 (75%) groups reached at least 1 physician group quality target. (Meredith, Richard, Zhonghe, & Arnold, 2005, para. 26) Only 14 medical groups exceeded more than half of the performance targets. The pay-for-performance approach showed an inverse relationship where physician groups with lower performance improved the most whereas physician groups that previously achieved target goals improved the least. The Effects of Reimbursement under Pay for Performance The article Early Experience With Pay-For-Performance: From Concept to Practice (Meredith, Richards, Zhonghe, & Arnold, 2005) argues this approach to improving the quality of care fulfills multiple objectives. One positive impact of pay-for-performance suggests paying health care providers for meeting certain quality indicators increases performance. The authors claim low-performing health care providers improved because they viewed the landscape of health care delivery changing by the mounting pressure of payees to improve their health care systems and decided to remain in good standing. Low-performing health care providers contend they cannot achieve benchmark levels of performance because of barriers beyond their control, such as limited resources or low-socioeconomic, patient populations. A negative impact of pay-for-performance indicates high-performing health care providers meeting target levels have no incentive to improve their performance and thus offer status quo health care services to their patients. Another reason health care providers have no incentive to produce services beyond the norm indicates low rewards paid by insurance networks. â€Å"Paying for improvement fails to reward and even penalizes providers that have already achieved high levels of health care quality at the time a pay-for-performance program is initiated† (Meredith, Richards, Zhonghe, & Arnold, 2005, para. 32). For the reasons stated above, the distribution of rewards primarily goes to the group of providers with low-performing standards and increases the impact of pay-for-performance. Impact of System Cost Reductions on Quality and Efficiency of Health Care Evidence of pay-for-performance shows mixed results. One study, Premier Hospital Quality Incentive Demonstration, performed by Rachel M. Werner of the University of Pennsylvania, compared the improvements in quality for hospitals paid incentives to a control group of hospitals who did not receive incentives from 2004 – 2008. The results reflected minor significance in improvement in the quality and efficiency of health care. In fact, diminishing returns occurred after the fifth year (Health Policy Brief, 2012)(See Figure 1). Other pay-for-performance initiatives, such as the Medicare Premier Hospital Quality Incentive, rolled out at the same time as Werner’s study, which analysts profess as the reason behind the improvement in quality and efficiency of health care among hospitals. Like health care providers, hospitals did not want to endure the embarrassment of presenting an image lacking in quality care. They sought to clean up their acts in anticipation of the Centers for Medicare and Medicaid Services (CMS) implementing pay-for-performance measures in health care. A project conducted between 2005 and 2010, the Medicare Physician Group Practice Demonstration, focused on quality and cost. Researchers of Dartmouth College and the National Bureau for Economic Research analyzed doctors, who would receive bonuses for achieving lower cost growth and meeting quality targets, in 10 large physician group practices. They found improvement in the quality of care but little reduction in the growth of spending for most Medicare patients (Health Policy Brief, 2012). Effects on Health Care Providers and Customers Health care providers agree with the need to improve quality of care but have concerns with pay-for performance. It takes money to implement, maintain, and document quality measures. They reason if payees give modest payments as incentives, they cannot recoup additional administrative costs and provide quality care simultaneously. Others fear the implementation of health information technology for data collection and reporting will close the doors of their practices. The American Medical Association (AMA) believes providers should have the choice to volunteer in incentive programs, review, comment, and appeal performance data, and receive payment for participating (Health Policy Brief, 2012). Another issue health care providers have with this cost containment model lies on the premise that hospitals that care for patients from low-income backgrounds bear the burden of lower improvement scores compared to hospitals that care for patients from mid-level to high-level incomes. Lower improvement scores result from low-income patients’ lack of transportation, language barriers, and childcare among other barriers to access health care services. Limited access to care halts the prevention and treatment of chronic illnesses and increases readmission rates of patients to hospitals. As a result, hospitals incur penalties. Health care providers concerned with the impact these arrangements have on patients, oppose these programs because they think patient care will weaken at the expense of cost containment. Physicians have the power to control their pay by hand-picking the best patients to maintain or increase their performance measures. By selecting healthier patients, physicians widen the gap for racial and ethnic disparities in health care delivery. A study by Jha and colleagues of costs and quality in US hospitals found a group that consistently performed worse on both quality and cost metrics and that cares for proportionally greater numbers of elderly black and Medicaid patients than other institutions. (Health Policy Brief, 2012, para. 42) In comparison, a Yale study showed safety-net hospitals outperformed hospitals that treated less proportionate numbers of low-income patients. Effects on the Future of Health Care The implementation of the Affordable Care Act (ACA) will increase the need for pay-for-performance programs and incentives. The Affordable Care Act promises to increase the enrollment of Medicaid and Medicare patients. Health care workers will find challenges with a large generation of Baby Boomers who will need long-term care. Under the ACA health care providers’ scores will include indicators, which measure patient-centered care, family engagement, and the ability to address disparities in health care delivery. As well, under the ‘Value-Based Purchasing Incentive’ mandates of the ACA, the Centers for Medicare [and] Medicaid Services have not only proposed additional process-of-care quality and mortality outcome measures on which to base future payments but also an integration of patient experience scores, representing up to 30% of hospital incentive payments, financially penalizing those with low scores. (Liang & Mackey, 2011, p. 1427) Not only that but also hospitals will have to report efficiency measures to include Medicare spending per beneficiary. Mandates will not only require quality but also focus on reducing costs. New programs will measure the reduction of costly hospital readmissions, restrict Medicaid payments for hospital-acquired conditions, and reduce Medicare payments to hospitals with the highest rates of medical harm. Conclusion Reports and studies support evidence, which shows pay-for-performance does not improve the quality of care nor reduce the costs of health care. Researchers must find ways to improve quality of care over a substantial period, close racial and economic disparity gaps, and increase health care worker acceptance of pay-for-performance programs, and incentives, which motivate providers to produce more positive health outcomes. Developers of program incentives should use tools, which help monitor and evaluate health care outcomes aside from other factors with variations in health care markets. By collecting data, researchers can design programs that improve quality of care and reduce costs. References Health Policy Brief: Pay-for-Performance. (2012, October 11). Health Affairs. Retrieved from http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=78 Liang, B. A., & Mackey, T. (2011). Quality and Safety in Medical Care: What Does the Future Hold?. Archives Of Pathology & Laboratory Medicine, 135(11), 1425-1431. doi:10.5858/arpa.2011-0154-OA Meredith, B. R., PhD, Richard, G. F., PhD, Zhonghe, L., MA, & Arnold, M. E., MD, MA. (2005). Early experience with pay-for-performance: From concept to practice. The Journal of the American Medical Association, 294(14), 1788–1793. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=201673 Shaman, H. (2008). What you need to know about pay for performance. Hfm (Healthcare Financial Management), 62(10), 92-96.

Carlill V. Carbolic Smoke Ball Co. Essay

Facts The Defendants were a medical company named â€Å"Carbolic Smoke Ball†. Who manufactured and sold a product called the â€Å"smoke ball†, a cure for influenza and a number of other diseases. The company published advertisements in the Pall Mall Gazette and other newspapers on November 13, 1891, claiming that it would pay  £100 to anyone who got sick with influenza after using its product three times a day for two weeks, according to the instructions provided with it. The advertisement also claimed that  £1000 was being deposited into the bank to demonstrate their sincerity. The plaintiff, Mrs Louisa Elizabeth bought one of these balls after seeing the advertisement. She used it three times daily for nearly two months until she contracted the flu on 17 January 1892. She sued the company to recover the money promised in the advertisement. Procedural history Appeal from decision of Hawkins J. wherein he held that the plaintiff, Ms. Carlill was entitled to recover  £100. Issue: Does an advertisement to the general public promising to pay money to anyone who does something create a binding contract between the parties? Arguments The Defendant argued that there was no contract between it and that there was no acceptance of its offer. So the contract was too vague to be enforced, there was no way to check the conditions were met, you cannot contract with everybody and the timeframe was not specified. Also the acceptance had not been communicated to the offeror. And the last argument was that there was no consideration: nudum pactum. The plaintiff’s argument was that she just followed the constructions. The advertisement was also an offer were under an obligation to fulfil because it was published so it would be read and abided. The promise was also not vague . Judgment The court rejected both arguments of the company, ruling that the advertisement was an offer of a unilateral contract between the Carbolic Smoke Ball Company and anyone who satisfies the conditions set out in the  advertisement. According to the judgment of lord justice Lindley, â€Å"†¦the person who makes the offer shows by his language and from the of the transaction that he does not expect and does not require notice of the acceptance apart from notice of the performance.† The advertisement was an express promise to pay 100 pounds to anyone who contracts flu after using the ball three times daily for two weeks. Also the ad was not a mere puff: â€Å" 1000 is deposited with the Alliance Bank, showing our sincerity in the matter† , which is a proof of sincerity to pay. The promise is binding even though not made particular, a unilateral offer. The advertisement is not so vague that it cannot be construed as a promise because the words can be reasonably construed . Notification of acceptance The notification of the acceptance need not precede the performance- â€Å" this offer is a continuing offer†. If notice of acceptance is required, the person who makes offer gets the notice of acceptance contemporaneously with the notice of the performance of the condition. Also when there is an offer to the world at large, acceptance is legally valid when the offeree communicates to the offeror notice of performance of the specified conditions. This means acceptance is not legally valid when notification of the performance of the specified conditions does not occur. Consideration There was consideration in this case for two reasons: first reason is that the carbolic received a benefit. In the sales directly beneficial to them by advertising the Carbolic smoke ball. The second reason is that the performance of the specified conditions constitutes consideration for the promise. The judgment of Lord Justice Bowen : How would an ordinary person construe this document? Was it intended that the 100 should, if the conditions were fulfilled, be paid? The advertisement says that 1000 is lodged at the bank for this purpose. Therefore the statement was not a mere puff, â€Å"I think it was intended to be understood by the public as an offer which was to be acted upon.† According to the judgment of Bowen LJ, the contract was not too vague to be enforced. Whereby an offer can be made to the whole world and will ripen into a contract with anybody who comes forward and performs the condition. Notification of acceptance There is no need for notification of acceptance of the offer ( Bowen LJ differs from Lindley LJ on this point). Because an inference should be drawn from the transaction itself that if he performs the condition there is no need for notification. Consideration Lord Justice Bowel founds that there was consideration for the problem for same reasons as Lindley LJ. The consideration was using the smoke ball and the reason of using the smoke balls would promote their sale. And finally Lord Justice AL Smith decides on same basis as Bowen LJ. Ratio decidendi: In unilateral contracts, communication of acceptance is not expected or necessary. Advertisements of unilateral contracts are treated as offers. Where the language is clear that an ordinary person would construe an intention to offer, anyone who relies on this offer and performs the required conditions thereby accepts the offer and forms an enforceable contract. Held: The contract was binding and the defendant was ordered to pay the 100 to the plaintiff. Appeal Dismissed.

Reflection ( Communication Around The World ) Essay

Reflection ( Communication Around The World ) - Essay Example I found it extraordinary the way the people there articulate sounds and give intonations to words. I recall at suppertime, while the whole family was dinning when I wanted salt because I felt the food did not have enough salt. I did not remember I was a visitor, and found myself speaking in my language. I only realized I was mistaken when all the family burst out in laughter. On inquiry, I learnt that the salt word in my language meant a frog in the new place. The experience embarrassed me and aroused an interest in studying the relationship between languages of the world and their cultures. What I learnt from my findings is that language is a unifying factor and an identity to people who can communicate effectively using it. However, behind this useful finding, there lies a barrier to the people of different languages. Along such lines, language ceases to unite, but instead becomes a tool of discriminating against each other (Chase & Shamo, 2013). A common language unites people, but a different language discriminates against others who do not understand it. Therefore, it is important to study the cultures of the people and relate with their

Philosophy - 2 Essay Example | Topics and Well Written Essays - 2500 words

Philosophy - 2 - Essay Example In the earlier days, when monarchy, autocracy and other form of government was the norm, people had to obey to all the laws of the land including unfair and draconian laws and any opposition will land them in trouble. Individuals tended to obey the laws even if it was unfair to them from the moral and personal point of view also. This what Socrates did, when he was unfairly accused of committing crimes against the State. Although, he valiantly fought against the charges throughout, in the end he accepted the State’s verdict and did not indulge in any ‘unlawful’ activities which would have given him personal freedom. So, this paper will analyze why Socrates was right to obey the orders of the state of Athens to take poison, by using Socrates’ arguments. The paper will then discuss how his decision would be supported by a Buddhist Socrates, one of the profound intellectuals the world has seen, was accused by three persons of committing civil crimes against the state, for which he was sentenced to death. Socrates was accused by Anytus, a poet, powerful politician Meletus and Lycon, a supposed orator. He was mainly indicted for being a ‘hyper curious’ person and for being an atheist, who is corrupting the youth. However, Socrates vouched and countered that he did not commit any mistakes against the state and cannot be considered as an enemy of the state. Socrates while refuting both the charges, firstly counters the charge of being a â€Å"hyper curious† person who is accused of spreading misinformation. That is, out of curiosity and not due to any ulterior motives, Socrates made inquiries about the origins and functioning of the earth and sky, which is quite contrary to the beliefs of the state or the kingdom. Socrates did not take the stance of an authority who knows and tells, but rather the stance of an inquirer who is curious and open to the ideas of others (Grube). The other charge

Trump Ltd Research Paper Example | Topics and Well Written Essays - 1500 words

Trump Ltd - Research Paper Example expense is utilized. Normally prepayments are made for items like rent of premises and payments are of current nature expense.First it necessary to define what is cash flow statements. Cash flows are useful addition to financial statements which describe the users that how much cash is there in the company. The statement shows the users that how much cash is out flowed and how much the company has received from there different activates.As we know that any company survival in the fast changing and tough competition environment, depend upon its ability to generate cash. cash flow accounting direct our attention toward this curtail issue.Cash flows full fill the needs of all users. Such as management will able to take more effective decision when they will know that what amount of cash will be present in the company. Management will be help through the cash flow forecast in taking expansion and investment decisions.... According to prepayments concept amount paid in advance for any expense will be treat as an asset until the expense is utilized. Normally prepayments are made for items like rent of premises and payments are of current nature expense. Discussion on cash flow forecast: First it necessary to define what is cash flow statements. Cash flows are useful addition to financial statements which describe the users that how much cash is there in the company. The statement shows the users that how much cash is out flowed and how much the company has received from there different activates. The main advantages of using cash flow forecast are as follow As we know that any company survival in the fast changing and tough competition environment, depend upon its ability to generate cash. cash flow accounting direct our attention toward this curtail issue. Cash flows are more comprehensive than accounting profits which are dependent on accounting concepts and conventions Cash flows forecast are easier to prepare and as well as more useful the profit forecast. Cash flows full fill the needs of all users. Such as management will able to take more effective decision when they will know that what amount of cash will be present in the company. Management will be help through the cash flow forecast in taking expansion and investment decisions. Cash flow forecast will be helpful for providing comparison with actual cash flows to see what variances has been incurred. Cash Flow Statement as on 31 Dec 2006 Month 1: Operating Activities cash from customers 6250 cash paid to staff wages -10000 interest paid ( 7% of 100000)/12 -583 cash

Obama and His Decisions on Deportations of Illegal Inmigrants Essay

Obama and His Decisions on Deportations of Illegal Inmigrants - Essay Example Both parties wrote this legislation in 2011. While the Democrats passed the Dream Act, the Republicans never approved of it. The republicans shunned the bill after it got 55 votes in the Senate (Bray, 2006). The bill did not change in any way only politics changed. Obama’s decision would have both a positive and negative effect to the undocumented immigrants in the US. It would make no sense expel the â€Å"dreamers† who might be talented and be of enormous benefit to the economic development of the Nation. This is because they were raised as citizens of the US and they understand themselves as a part of it. Expelling such young talent would be a loss and unjust because they would serve the military or contribute in the economy as businesspersons. The fact that they were born of undocumented parents is not their fault. It is better focusing the immigration enforcement in the rightful places. It is better prioritizing border security (Gerber, 2011). The Department of hom eland security should focus on lifting the shadow of deportation from these â€Å"dreamers†. Individuals who are not a threat to US security are free to apply for work authorization. The congress should act rightfully. This year there is time for the Dream Act to be passage, because this would give these kids time to plan their lives in more than 2-year increments. The passage of the comprehensive immigration reform that will address the 21st century security and economic needs is crucial. This reform will give the ranchers and farmers certainty about their works. This reform should give technology and science sectors confidence the young immigrants who come Earn Ph.D.s. They, therefore, will not be forced to migrate and start their businesses in other countries. These reforms should improve the US border security and maintain their heritage of immigrants and law. This is the same reform that Ted Kennedy, John Mc Cain championed (Lopez, 2005). I believe that president Obama d id the right thing because personally I have been with such groups of young people. These people are dedicated to hard work and talk about what is best for the US. I know that some of them have live under the fear of deportation. Some of them have taken great risks and to their futures to contribute to the status of America. There have been stories of Americans in churches and schools and societies across the country that have supported them and rallied behind them. The have all guide them for better futures and careers and from fear, because this nation is more than just deporting innocent children. This is the right thing to do because if given a chance to live in America, the children will be extraordinary contributions to the economy. I have a relative who is working in the military, doing his best to protect this country. There is, therefore, no reason to treat them as expendables. This move has come in an election year. It will boost votes from Hispanics in a critical state li ke Florida, Nevada and Colorado. However, Latinos have been tempered by the slow economic recovery and Obama’s inability to win support for overhaul of immigration laws and the aggression of the administrations deportation policy ((Lopez, 2005). Activists against this policy went on a hunger strike at his campaign office in Denver. Congressional Republicans are likely to be against this move and would perceive Obama’

Take Your Vitamins Essay Example | Topics and Well Written Essays - 750 words - 2

Take Your Vitamins - Essay Example The foods called â€Å"functional foods,† or more scientifically nutraceuticals, offer greater benefits than the same standard foods do not. A really important element of the â€Å"functional foods† is that most people are probably not aware is that they are not directly regulated, at this time, by the FDA, the Food and Drug Administration. This means that no one, outside the company’s manufacturing the products, are really guaranteeing the absolute safety, purity, or quality of these products. (Manore and Thompson 189) Because the nutraceuticals are not drugs, and are not really capable of being dangerous, then there is no concern about where and to what they are added. To be perfectly honest, is not safety that is in question, but, whether, or not, they are in fact beneficial. Adding vitamins and minerals to granola bars, breakfast cereals, and dairy products is well and fine, ideally designed to encourage people to purchase those products. But is that really a cunning way to get people to â€Å"take their vitamins† or a clever way to get consumers to spend more on a product that benefits are potentially questionable at best. Also, as is the hypothetical case of Judy, she considers buying the soda with the vitamins added figuring that it must be better for her. (Manore and Thompson 189) But just because the given product has newly added ingredients does not mean that the food overall is healthier for you. If your favorite fast food restaurant added all the needed daily necessity of all the vitamins and minerals to their tastiest and greasiest french fries, would you start eating those fries everyday because they are healthier?

IT Project management Essay Example | Topics and Well Written Essays - 500 words

IT Project management - Essay Example In his article, Roetzheim writes about some of the simple methods used to estimate software development projects. Roetzheim begins by writing about estimating a project’s lifecycle and writes about the level of accuracy that can be achieved. Since inaccuracies in estimation result in uncertainties, it is always good to work and reduce inaccuracies in the early stages of software development. This means that once the project is later understood, the inaccuracy level will reduce. The author writes that one of the steps in estimation is estimating project volume. There exists different approaches to this but Roetzheim writes about Constructive Cost Model (COCOMO) that uses Source Lines of Code (SLOC) as a unit of measure. This method uses effort which is the product of Linear Productivity Factor and SLOC. Effort gives an estimate of the person months for the software development project. According to Dhilon, effort is also affected by the size of the project since for a smaller projects, less time is used for communications thus individual productivity is high. Roetzheim’s article goes ahead and explains how to estimate software size and he writes that one can use direct points approach or function points approach. Direct estimation involves breaking down the project and using expert assistance to determine the number of lines of code. Function points method involves creating function points which are later converted to lines of code by a process calle d backfiring. The first step is to determine a logical flow of the software to be developed by identifying the input, processing and output points. Then raw values are extracted from the logical steps created and they are multiplied by a factor to give function points. Lines of code are obtained from the product of these function points and common conversion values

Evolving Slavery Assignment Example | Topics and Well Written Essays - 1000 words

Evolving Slavery - Assignment Example This is a worldwide event which has existed for hundreds of centuries up to the present. During the ancient times, slavery was brought about by social backgrounds. Slavery was the term used during the ancient period until a certain period when human trafficking was used instead.1 In some cultures, slavery is a hereditary event. Children born to parents who are slaves will automatically be slaves. Thus, their future children will also have the same fate. Slavery has been noted to have occurred at all the ancient civilizations in 4 continents namely Africa, Asia, Europe and pre-Columbian America.2 There is that perception that once a slave, forever that person will remain a slave as well as his or her descendants. It has also been said in an ancient Sumerian code, The Code of Hammurabi, that when a non-slave helps a slave to get out of slavery, the non-slave will be put to death.3 In modern days, as previously stated, slavery is being pertained too, one example of which is human traffi cking.4 With the tradition of slavery being carried through in more recent decades, even if a person is still a child, that person is not free from slavery. However, this is not the only way by which a child becomes a victim of human trafficking. Besides the cultural and traditional factors, poverty is the main reason why there are increasing numbers of children being victimized by human traffickers or syndicates. Cultural influence is one of the factors in human trafficking. Another factor is age. Children can be abducted easier than adults as they are smaller and do not have the physical capabilities and intellectual maturity to fight back against abductors. These factors go together as culture teaches children to obey adults and not fight back. So this also makes abduction easier. Kidnapped children are then enslaved either to do hard works, seek alms on streets or worst be abused and killed.5 In human trafficking, when the victim is said to be a child, it means that it is below the age of 18. The phrase itself evolved from the term slavery by the middle of 20th century. Human trafficking was defined as â€Å"the recruitment, transportation, transfer, harbouring or recipient of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation.†6 On the other hand, slavery has been defined as â€Å"a relationship in which one person is controlled by another through violence, the threat of violence, or psychological coercion, has lost free will and free movement, is exploited economically, and is paid nothing beyond subsistence.†7 It is not just the term which has evolved through the ages. The definition itself has evolved. Bottom line is that whether it is slavery or human trafficking, it is a clear violation of human rights to live freely and improve a person’s way of living. In ancient times, slavery was inherited. There is no way out of slavery, no chance to improve the way of living as if slaves are not human. In recent decades, human trafficking is forcing a person to become a slave. One thing that is common between slavery then and human trafficking now is that both

Mike Tyson Research Paper Example | Topics and Well Written Essays - 1000 words

Mike Tyson - Research Paper Example He lived in the Bedford-Stuveyesant district of Brooklyn but his family experienced tremendous hardship in this area which eventuated a move to the Brownsville region. Tyson was a poor student and struggled in his daily life. This was only compounded by the death of his mother when Tyson was sixteen years old. This event had a tremendous impact on Tysons personal and professional life and it eventually led to his involvement in boxing. He would later say, â€Å""I never saw my mother happy with me and proud of me for doing something: She only knew me as being a wild kid running the streets, coming home with new clothes that she knew I didnt pay for. I never got a chance to talk to her or know about her. Professionally, it has no effect, but its crushing emotionally and personally" (Heller, pg. 79). During this period Tyson became involved with boxing trainer Cus DAmato who would work with Tyson and hone his boxing skills in the amateur ranks. This relationship would come to be a str ong bond that would result in DAmato becoming Tysons eventual legal guardian. Its also been argued that later in life the loss of DAmato would have a tremendous adverse impact on Tysons direction and professional career. After the death of Tysons mother he became increasingly involved with juvenile delinquency and fighting. Its been noted by a number of researchers that Tysons first fight was with another individual who had killed one of his prized birds (OConnor). This juxtaposition of Tysons ferocious side with an almost childlike and sensitive innocence have become a recurrent narrative throughout Tysons life. Tyson also experienced a great amount of conflict that is related to the rather unique, high-pitched voice, as children would oftentimes tease him resulting in furthered shows of aggression. Eventually Tyson was sent to the Tryon School for Boys juvenile detention center, where he was discovered by a former boxer that would

The Wagner Act Essay Example for Free

The Wagner Act Essay Prior to the enactment of the Wagner Act, the United States already had several labors. The Railway Labor Act, which was passed in 1926, required employers to enter into collective bargaining agreements with unions. It also prohibited discrimination on the part of the company against the unions. The RLA however, only applied to railroads and was subsequently amended in order for airlines to be included. Thus during this period, while it was legal to form unions, companies were not prohibited from firing employees for being union members. In 1993, at the behest of then President Franklin Roosevelt, the National Industry Recovery Act was passed. Among the provisions, specifically Section 7(a), employees were not only given the right to form unions but that joining or non-joining of a union would not be used as a requirement for employment. That particular section also required companies to abide by conditions of employment such as the number of work hours and minimum wage as set by the President. However, the Act came under fire due to concerns of its effectiveness as was eventually overturned by the Supreme Court in May 1935. In order to address the issue of employers and unions, the Wagner Act or the National Labor Relations Act was passed in 1935. Named after its proponent, Sen. Robert F. Wagner, the Act incorporated Section 7(a) of the former NIRA. This particular section became the pillar of the Wagner Act. Aside from giving employees the right to form unions, the Wagner Act also defined what it considered as unfair labor practice by an employer. Under Section 8, an employer is said to have committed unfair labor practice if it: interferes, restraints or coerces an employee from joining, dominates or interferes in the formation of a union, discriminates an employee for being part of a union, seeks reprisal against an employees for filing unfair labor practice charges, and refuses to enter into a collective bargaining agreement with the unions. With the passing of the Wagner Act, two important things happened. First, membership in unions began to increase dramatically. From a mere 10% prior to the act, more than 30% of the total US workforce became union members by the 1950s. The second was the formation of the National Labor Relations Board. The NLRB is the agency that is tasked with overseeing the implementation of the Act. By approving the Wagner Act, it was seen that the government was ready to go against the private sector by giving employees the right to form unions and enter into collective bargaining agreements. All these however changed after World War II. As a result of the war, certain groups raised the issue of balancing the power enjoyed by both the labor sector and the companies. Thus in 1947, the Labor-Management Relations Act or Taft-Hartley Act was passed. The Taft-Hartley Act is considered as an amended to the Wagner Act. Although the Taft-Hartley Act retained some of the provisions of the Wagner Act there were also some changes implemented.   Notable changes include the delay or suspension of a strike if it would lead to a national emergency situation. The act also excluded employees who were at the supervisory level from being covered by the provisions of the Wagner Act. A closed shop or a company that hires only union members was also banned. The Taft-Hartley act also protected non-union members from being discriminated by union shops. A union shop is a company that although allows non-union employees to join, eventually requires these employees to eventually join a union. While maintaining the list of unfair labor practice by employers stated in the Wagner Act, the Taft-Hartley Act now included a list of unfair labor practices by unions.   Among others, the amendment required unions to give a 60 days notice to mediators of a planned strike and enter into good faith negotiations with employers. The Taft-Hartley Act further protected employers from facing reprisals from unions if it expressed adverse opinions against the unions. The Act also made it illegal for companies to practice featherbedding. That is, forcing employers pay certain individuals wages despite doing no work. Under the amendment, the primary functions of the NLRB was now to prevent and find solutions to unfair labor practices that is by either the employers or the unions.   The NLRB was also tasked to determine if employees prefer to be represented by union for the purpose of conducting collective bargaining with the company. Currently, the NLRB is divided into two sectors. The Board, which is composed of five individuals, has the task of deciding on cases based on records under administrative proceedings. The General Counsel on the other hand, is in charge of investigating and prosecuting unfair labor practice cases. The General Counsel is also the group tasked to supervise the processing of cases in the field offices. The Board and General Counsel is independent of each other. Another law worth mentioning is the Landrum-Griffin Act or the Labor Management Reporting and Disclosure Act of 1959. While it did not make sweeping changes like the Taft-Hartley, it nevertheless amended the Wagner Act by including additional unfair labor practices not included in the Taft-Hartley. The idea behind the Landrum-Griffin Act was to give further protection to the union members from their leaders. The Landrum-Griffin Act enabled a more open selection of union leaders. It also gave members the right to file legal charges against the union without fear of reprisal. While it is clear that the three laws mentioned are pro-labor, the passing of the Taft-Hartley Act tilted the scales somewhat in favor of the employers. However, membership in unions continued to increase despite the passage of the Taft-Hartley Act mainly because of the protection afforded by these laws. As seen from the laws that have been passed, the focus has always been on the employees. While the Wagner Act curtailed the abuses likely to be done by the companies, the Taft-Hartley Act restrained unions from becoming abusive and becoming a much bigger problem. The Landrum-Griffin Act effectively gave back the power of the union to its members and served as a warning for union leaders to ensure that their interests is in line with the general membership. While some sectors are saying that it may be time to repeal or amend these laws, particularly the Taft-Hartley Act, such a decision may not be good for now. While union membership may not be as high as it was before, the reason may not be entirely because of the provisions set forth in these laws. Currently, the labor force of the US is facing competitions form automation and outsourcing. Most companies nowadays prefer to use labor from countries outside the US since the wages are cheaper and the labor laws are lenient compared to those in the country. While the law encourages employers and unions to discuss collective bargaining agreements, it does not prevent companies from laying-off employees in the event of a financial problem. The labor union in the US has come a long way in order to be where it is right now. The laws, first and foremost, have always been there in order to protect the workers and ensure good working conditions. Union leaders should make good use of the provisions under the law. The Wagner Act and its amendments, the Taft-Hartley Act and Landrum-Griffin Act, were not enacted for aesthetic purposes. Unions should remind employers on why it was enacted in the first place. References National Labor Relations Act. National Labor Relations Board. 14 April 2008. http://www.nlrb.gov/about_us/overview/national_labor_relations_act.aspx

Advantages And Disadvantages Of Jvc Versus Wholly Owned Management Essay

Advantages And Disadvantages Of Jvc Versus Wholly Owned Management Essay When companies enter the international market, they are facing a very important decision-making. That is they enter the target market in which appropriate entry model. There are several entry modes to enter the international market. Two of them were discussed in the report: international Joint Venture Companies (JVCs) and wholly-owned subsidiaries. In light of the influence of the WTO with respect to relaxation of restrictions on foreign ownership across many industries in countries such as China and India, anecdotal evidence suggests that many companies are now opting to set-up wholly-owned subsidiaries rather than international Joint Venture Companies. Reasons they select wholly-owned subsidiaries were analyzed in the report. Disney Paris was taken as the case and the failed joint venture case shows that it is a key issue for companies to select appropriate entry mode to target country when they choose the target market. Advantages and disadvantages of the JVC versus the wholly-own ed subsidiary were analyzed in several aspects. In a wholly owned subsidiary, senior managers almost have the same cultural background and cultural differences and cultural conflicts could be avoided in management, while this cultural differences and cultural conflicts has been there at the time in JVCs. wholly owned subsidiaries have higher control right than JVCs and they can protect commercial secrets in order to avoid losing to the partner and competitors. They put higher investment and get higher returns than JVCs. While compared with JVCs, wholly-owned subsidiaries have some disadvantages in operational risks, higher opportunity cost, relatively large political risk and disadvantage of exit. Wholly-owned subsidiaries have higher operational risks than JVCs due to uncertain factors in operation and higher opportunity cost because they develop new sales channels and advertising channels to operate effectively under the host environment. Political risk is higher as they depend on the host countrys political environment and political stability. Wholly-owned subsidiaries could exit the host country difficultly because the full investment while JVCs are easier to end. More and more companies select a wholly-owned subsidiary as a few reasons discussed above. They hope get appropriate recognition and support from the host country, at the time get larger profit. 2.0 Theory and entry mode Entering the international market is that a business participates in global market competition and international business development with capital, products, technologies, services and policy. Market heterogeneity induces a positive correlation between firms decisions that can be spuriously confounded with positive strategic interactions. (Victor, Mira, Roman, 2007, p.449). Enterprises should elect the appropriate entry mode in understanding various factors. The factors are including companys strategy, international experience, and inherent technology, economies of scale, culture, pricing, promotion, investment costs, market size and market growth, political and legal, risk and so on. It can be seen in figure 1. Figure 1 the Factors of selecting entry mode Political Legal Economic Marketing Research Competitive Analysis Promotions Logistics and Distribution Products Services Pricing Culture Market Entry Strategy Organising/ Restructuring Disney opened the Euro Disney theme park in Paris, France, selecting the joint venture companies with the investment of 1.8 billion U.S. dollars, and 49% of total shares. Which the equity brought about was a considerable control on management and operation. The operating results of Disneyland Paris are not satisfactory so far. The number of tourists in Paris was much lower than expected during the first year and the per capita spending was below the expected level. All these made operating loss reach 900 million U.S. dollars of the Paris theme park, forced the closure of a Paris park hotel, and fired 950 employees. The failed joint venture case shows that it is a key issue for companies to select appropriate entry mode to target country when they choose the target market. The motive of selecting entry mode was to entering the market as fast as possible and to obtain benefit from the existing market share of the local firm.( Estrin et al.,1997, p.136). Enterprises should elect the appropriate entry mode in understanding various factors. The factors are including Unified strategic actions, international experience, and Exit barriers, economies of scale, culture, Control right, Profits received, Trade Secrets, market size and market growth, Limited market size, risk and so on. 2.1 International Joint Venture Companies The joint venture enterprise refers to joint investment, management and shares options and a total risk. The Joint venture partners can take advantage of a mature marketing network and they are easily accepted by the host country because of the participation of local enterprises. 2.2 Wholly-owned subsidiaries An enterprise directly invested to set up wholly-owned subsidiary in other countries. They can use a variety of forms such as brand, trademark, patented technology and other investment. 3.0 Reasons for wholly-owned subsidiaries When a company enters the international market, they do not know whether the selected entry mode is the optimal. They make decision and select an entry mode according to various factors. More and more companies now select wholly-owned subsidiaries when they enter the target country. For example, company with internal funds, or low leverage, are more likely to choose wholly-owned subsidiaries while they need to raise investment. (Klaus Meyer Saul Estrin, 1998. p.9). There are several reasons: firstly, technical content and differentiation in their products are so high. Once other companies master technology, they would lose their competitive advantages. So they select wholly-owned subsidiaries in order to avoid these assets and technology used and obtained by competitors. Secondly, products are difficult to imitate by competitors. They can not b e replaced, so the company does not regard to market share when they plan to enter the target countries. Thirdly, their products are scarce in target countries, and they are easily accepted and applied properly once they enter in. they do not need to rely on local sales channels and political relations. On the other hand, wholly-owned subsidiary is better than joint venture. Firstly, setting-up wholly-owned subsidiaries can help companies retain more easily technology and knowledge to increase corporate brand value. Secondly, setting-up wholly-owned subsidiaries can establish good mechanisms for operational control, handling disputes and optimizing resources to enhance the marketing control. For example, American and Japanese manufacturing companies, financial services companies and tourism companies set up wholly-owned subsidiaries can help in Australia. When they chose Australia as the target country, they analyzed all kinds of factors, and finally they took full advantages in the service and quality, the original brand and trademark, to establish wholly-owned subsidiaries. The subsidiary has the same business model a nd service methods with parent company. Relative advantages and disadvantages of the JVC versus the wholly-owned subsidiary When companies enter the international market, they are facing a very important decision-making. That is they enter the target market in which appropriate entry model. The following will discuss and analyze the advantages and disadvantages of two modes. Table 1 advantages and disadvantages of the JVC versus wholly-owned subsidiary Wholly-owned subsidiaries JVCs Control right High Low Trade Secrets Remain Known by others Unified strategic actions High Low Profits received High Low Risk High low Resources Cost High Low Cultural Differences High Low Limited market size High Low Exit barriers High low 4.0 Advantages and disadvantages of the JVC versus the wholly-owned subsidiary 4.1 Advantages of the JVC versus the wholly-owned subsidiary 4.1.1 Cultural Differences Social and cultural factors have a very important effect on international market entry mode, and it is mainly on the cultural differences between the home country and host country. The cultural value pattern may strengthen the relative importance of one of these values over the other one. (Piotr, Agnieszka Krystyna, 2008, p.227). The cultural differences are from language, values, life and work patterns, management and business model. If the cultural differences are obvious, the home country needs to spend more to adapt to cultural distance. In a wholly owned subsidiary, all senior managers come from the home country. They have the same cultural background and the same management philosophy, the same way of thinking and behavior patterns. When they consider the strategic objectives and strategic interests, they take the parent companys strategic objectives and long-term direction as goals. So cultural differences and cultural conflicts could be avoided in management. While in the joint venture company, managers and employees come from different countries with different cultural backgrounds, they have different values, different management attitudes and different operational practices. Unavoidable conflict happens as long as they work together. The stronger partner usually represents their economic achievements, so at rules, which are proposed by globalization and which would become an assumption not only for development of universal market, but also for standards of appropriate cultural behavior that would be suitable for representatives of all cultures. (Hofstede, G. 2001).And this cultural differences and cultural conflicts has been between partners from the beginning of joint venture, discussing cooperation, deciding to cooperate, establishing joint ventures to co-management and co -operation. 4.1.2 Control right Parent company participates in the management and decision-making, according to the Articles of Association, because they are the controlling shareholder of wholly-owned subsidiaries. All of these companies would benefit from a framework for decision making to determine if entry into this market is feasible for them. (Dennis Chwen, 2002, p.332).The principal leaders are appointed by the parent company, and their appointment, assessment, rewards and punishments are done by parent company. On the other hand, the parent company should regulate the business development plan, the orientation of investment and management activities, while the wholly-owned subsidiaries should formulate or revise their own development strategies and recent planning under the guidance of parent company. On the third, the parent company should supervise operating conditions and asset quality in order to security, value-added and profit of invested assets. At the same time, wholly-owned subsidiaries should rep ort the financial condition and ensure the authenticity and accuracy of the provided information of the production, management and financial operations. The company can accept the common control when they select the entry mode of Joint ventures, and they will find the right partner and selecting lower ownership. Joint ventures companies could not control the company because they are in minority equity position. They could not control the management and operation, and they could not control the productions sales and t infringement of copyright and paten. It is hard to find a reasonable partner who is fully meet the conditions. On the other hand, limited resources could not be used rationally because of contention for control right. The lack of resources are caused scattered resources and new contention for resources started, again and again, leading to a vicious cycle. Finally, they lost their core competitiveness. This will cause instability of the joint venture, which ultimately lead to instability of the dissolution of the joint venture. JVCs Wholly-owned subsidiaries High control right High stockholding Low control right Low stockholding Table 2 the control right and stockholding 4.1.3 Protection of commercial secrets Wholly-owned subsidiary have large advantage in trademarks, and other technology to prevent meddle in its technical and business secrets, protection of basic monopoly position. Running a business of wholly owned subsidiary can be a simple assembly or complex manufacturing activities, and they have total control-right. The company could completely control the entire management and sales, production and promotion. They could independently dispose profits, and they can protect technology and commercial secrets. For the joint venture company, the local partners contributions are often the local knowledge, local government relations, market share, sales organizations and customer groups, which are the knowledge and understanding of environmental conditions, while foreign partners contributions are typically including technology, management and international support. For example, Australian companies established joints venture with China or India, they increased business investment, as well as provided a number of high value-added products and technologies. Therefore, it is possible that technical secrets and commercial secrets are lost to the partner, and develop into the competitors. 4.1.4 Higher returns In the long term strategic objectives, parent companies pursue to maximize the total value of foreign market, and they speed up the penetration and more control to put effectively wholly-owned subsidiaries into global system. Setting up wholly-owned subsidiaries could get a full return as the increasing experience overseas, fully using companys abilities and cultivating international competitive advantage. A firms return on capital is increasing its industrys state of demand, so it can takes advantage of favorable economic conditions.( Jose M. Pleth-Dujowich, 2008, p.2). Wholly-owned subsidiaries could introduce more advanced technology and equipment and management methods to produce highly competitive products. And parent companies adjust business strategy according to business activities to obtain the overall maximum benefit. In addition, the profits and other legitimate rights and interests which foreign investors obtained after investment in the host country are protected by the laws of the host. The legitimate profit and other lawful income can be remitted back to the home countries. On the other hand, wholly-owned subsidiaries may enjoy tax reduction or exemption preferential treatment in accordance with the provisions of the host country tax revenue. Relatively speaking, Joint venture companies put lower investment, and therefore, they get back low control right and lower return. The home countries are mainly investment of technology and capital, as well as the training on production and management of local staff to get successful conversion on technology and knowledge. Joint venture companies must be in win-win state. That means the return of each joint venture partner is larger and enough, if they are in win-win state so as to work hard for the next success. If a companys return is not in the win-win state, which shows one investment is failure and maybe the two investments are failure. the joint venture partners could not accept the strategic mistake and they should restructure or abandon the joint venture. The lower risk means lower profit for the joint venture companies, especially when productions of a joint venture company are for export, the profit of return will not be very high and even less. 4.2 Disadvantages of the JVC versus the wholly-owned subsidiary 4.2.1 Operational risks Wholly-owned subsidiaries have higher operational risks than JVCs due to uncertain factors in operation. There are some problems in the management of wholly-owned subsidiaries, such as imperfect governance structure, inadequate organizational structure, and inappropriate personnel selection. All these problems could cause wrong decisions, collusion, and low efficiency. On the one hand, subsidiaries engaged in related transactions or matters beyond approval authority or the scope of business, which might result in investment failures, litigation and loss of assets. On the other hand, the elected directors, managers and chief accountants and other senior managers can not plenipotentiary the parent company and they did not make strategies and consider the interests from the perspective of the parent company, and these would result in incorrect formulation and implementation of accounting methods and inaccurate information on the consolidated financial statements. The inaccurate informat ion and methods would bring out high risk on investors, and the company and investors would make decision-making mistakes and face to legal proceedings and other aspects of risks. The joint venture company has generally no problems above. On the one hand, the home country needs to learn and adapt to local environmental conditions to better understand the host countrys economic, political, social, cultural, etc., so as to help investors make the right decisions. They can absorb partners business management skills, experienced business and promotion channel to changes in demand and market share. Nippa1, Beechler and Klossek (2007) studied IJV success to find IJV regard to the foreign parent-local parent fit in. On the other hand, every decision-making need to be recognized by both home and host country managers. Once one partner that the other one harms the interests of the joint venture resulting in damage to the company, they would make recommendations to board of directors in order to improve co-operation. The two sides are fighting for the maximizing interests to avoid operational risks. 4.2.2 Higher opportunity cost Wholly owned company needs to develop their own knowledge and capacity, develop new sales channels and advertising channels to operate effectively under the host environment. For example, sales representatives need to look for good advertisers, and communicate with the advertising and coordination. Finding a good advertiser needs time and money, because advertisers are producers of goods and services who are interested in selling their products to customers and post ads on the media support. (Claude, Carole Bruno,2009, p.5). So the home country needs to go through best efforts to develop new business, and achieve the certain level in the strategic mode of a wholly owned subsidiary. They have to pass a long-term cultivation to get new business skills and required knowledge, so there is a higher opportunity cost. Joint venture company has low opportunity cost. They can more easily access the local market knowledge, understanding competitors and the local government policy from the partners. Companies develop network relationships with important customers, suppliers that the local business partners possessed through mutual commitments and learning.(Lee, Jun and Johanson, 2006,p.62). The Joint venture partners can take advantage of a mature marketing network, branding, economic relations, political status, consumer preferences, etc. and they are easily accepted by the host country because of the participation of local enterprises. 4.2.3 High input costs and high risk Establishing wholly-owned subsidiary, the parent company would face new challenges in strategic planning, marketing strategy, organizational design, and resource allocation, especially in financial management and internal control and other aspects. The parent company invests greatly on capital and resources for wholly-owned subsidiary, because the parent company pays the total investment in the host country, so it is extremely risky. The wholly-owned subsidiary has more affected by environmental uncertainties and greater risk. All the capital investment results in difficult changes in the capital, and further results in assets sunk costs. The full amount of capital investment and sunk costs would limit the strategic flexibility and increase the investment risk. At the meantime, large-scale investment of resources will lead to high switching costs, which in turn generates a high risk. So the higher control right, the more capital investment and the higher risk. But the host countries like wholly-owned subsidiaries, because they want to attract foreign investment without their own capital, and they increases tax revenues without the business risk. There is smaller capital and human capital investment for joint venture companies, and relatively speaking, the risk is lower. Risks should be taken to entering international market. Most companies decided to establish joint venture with the local business, because they want to reduce the risk of entering new markets. So they are looking for joint venture partners who are operating related product lines and have a good understanding of local markets. The foreign parent and the local company combined their resources so as to create competitive advantages and create dominant in marke. (Contractor and Lorange, 2002). Firstly the foreign partners started the cooperation from simple sales and marketing operations to a further risk reduction measures. Secondly, they can increase product sales. Finally, the foreign partners can improve or re-design products in order to better adapt to the local market and make large-scale investment. 4.2.4 Relatively large political risk The establishment of a wholly owned subsidiary has very stringent requirements for the host countrys political environment and political stability. The parent company can set up wholly owned subsidiary when the target country is under the situation of political stability, sound legal system, liberal investment policies, and exchange rate stability. In addition, the profits and other legitimate rights and interests which foreign investors obtained after investment in the host country are protected by the laws of the host. The legitimate profit and other lawful income can be remitted back to the home countries. On the contrary, the wholly owned subsidiary would be significant losses if the host country has political instability and investment policies and investment environment get some changes, which might result in the dissolution of wholly owned subsidiary. Joint venture companies get supported by the host governments. For the host countries, on the one hand, Joint venture companies can bring a number of high value-added products and technologies, and new management style. On the other hand, the local companies provide local government relations, market share, sales organizations and customer groups, and they could not lost their control right and equity. While for the home countries, JVCs can reduce the risk of operation and politics in different countries, regions and industries. They could get the support and cooperation on the tax barriers and preferential policies. 4.2.5 Disadvantage of exit For the wholly owned subsidiary, the parent company has to bear all the resources and costs, including costs of human resources, employment, labor costs, the investment of technical support, sales channel development and advertising costs and so on. They have high switching costs. Serious losses would be resulted in if they exit the target countries for some reason. For example, political situation of the host country has undergone drastic changes, and the wholly owned subsidiary can not maintain their normal production and operation, so the parent company had to close wholly owned subsidiary. The parent company may not fully recover the investment cost before they exit the host country, without mention profit. So it is very obvious disadvantage of exit. The joint venture companies are easier to end. JVCs entered the host country with lower cost of investment and some were into target country only with technology. They could end relationship of cooperation and exit target country when political environment changed and economic deterioration was serious. And they end the relationship with lower cost. On the other hand, they can terminate the agreements when market conditions or the business itself have also changed with lower price or cost 5.0 Conclusion Entering the international market is that a business participates in global market competition and international business development with capital, products, technologies, services and policy. The home countries should select the right entry mode for the international strategy and they should clear their own objectives firstly to choose entry mode. Entry mode provides information about the consequences of enter international relating shifts in market demand to changes in the equilibrium number of firms. (Timothy and Peter, 2008, p.978). Two of them were discussed in the report: international Joint Venture Companies (JVCs) and wholly-owned subsidiaries. Different entry mode means different control right. Enterprises should elect the appropriate entry mode in understanding various factors. The factors are including Unified strategic actions, international experience, and Exit barriers, economies of scale, culture, Control right, Profits received, Trade Secrets, market size and market g rowth, Limited market size, risk and so on. Compared with JVCs, wholly-owned subsidiaries has advantages in cultural differences, control right, protection of commercial secrets and higher returns. On the other hand, wholly-owned subsidiaries have some disadvantages versus JVCs. In the long term strategic objectives, parent companies pursue to maximize the total value of foreign market, and they speed up the penetration and more control to put effectively wholly-owned subsidiaries into global system. While, as for the joint venture, the local joint venture partners contributions are local knowledge, local government relations, market share, sales and customer groups because they have well-known about the local market, culture and knowledge and the understanding of economic environment. The foreign partner invested in technology, management and international support. This combination can reduce opportunity cost and switching costs to have clear business and promotion objectives and win the market share. However, there is no general optimal entry mode when enterprises enter the international market, because the international economic environment is perplexing and political environment is complex. The parent companies should select the reasonable entry mode acc ording to their own resources and strategic objectives and strategic policy.

Nurses Benefits On Quality Improvement Teams Nursing Essay

Nurses Benefits On Quality Improvement Teams Nursing Essay As part of a randomized control trial to improve the delivery of preventive services, the authors studied the effect on clinic nurses in the roles of team leaders or facilitators of multidisciplinary, continuous quality improvement (CQI) teams. Our goal was to learn how these nurses felt about their experience with this project, specifically their satisfaction with process improvement, acquired knowledge and skills, and the impact on their nursing role. Overall, the nurses involved in this study reported significant gains in all three areas. This study suggests that CQI can be a valuable vehicle for improving and expanding the nursing role for clinic nurses. QUALITY improvement (QI), also referred to as Continuous QI (CQI), Total Quality Management (TQM), and other terms, has undergone an explosive growth in health care over the last 10 years.1,2 This growth has been accompanied by the publication of a steadily increasing number of articles. However, review of these articles would lead one to believe that nearly all of this QI activity has occurred in hospitals and large medical organizations and, until recently, most has involved administrative processes rather than clinical ones.3-6 Very few articles have addressed smaller ambulatory care settings and almost none have described the QI role of clinic nurses or the impact of these activities on nurses. Is involvement on QI teams helpful to nurses and do the changes in care processes produced by these teams improve the ability of nurses to provide better patient care? What is the potential for QI to affect the often-restricted role of nurses in ambulatory care? Our involvement in a large scientific trial of QI as a way to create more systematic delivery of preventive services in private medical clinics has provided us with an opportunity to begin answering these questions. This involvement brought us into frequent contact with all types of clinic personnel, but particularly with the nurses who often served in leadership roles on the clinics QI teams. As we provided training or consulting with these nurses, we noted that many of them seemed to enjoy the opportunity and reported anecdotes about how it had expanded their abilities. We conducted a systematic series of interviews and a survey with the clinic nurses who were involved in the trial as leaders or facilitators of the QI teams established in these clinics for preventive services. This studys goal was to learn how these nurses felt about their experience in three areas: 1. satisfaction with the process and its results for them 2. acquisition of specific knowledge and skills 3. impact on the nursing role Back to Top BACKGROUND The trial was called IMPROVE (IMproving PRevention through Organization, Vision, and Empowerment) and it was funded by the Agency for Health Care Policy and Research as a randomized controlled trial.7,8 Sponsored by two normally competing managed care plans (Blue Plus and HealthPartners), it was designed to test the hypothesis that such plans could improve the delivery of specific adult preventive services in contracted clinics by using CQI methods to develop prevention systems. Forty-four individual primary care medical clinics in the Twin Cities region of Minnesota were recruited for the trial from 33 of the 71 medical groups eligible to participate by reason of a contract with one or both plans and location within 50 miles. No financial incentives were provided to the clinics to participate other than reimbursement for the research evaluation efforts (eg, pulling charts for audits, providing patient appointment lists for sampling, etc.). The clinics ranged in size from 2 to 15 primary care clinicians (except for one residency-training clinic with 28), with an average of 8. At the time of recruitment, only an average of 19 percent of their patients were members of the two sponsoring plans. Thus, they were fairly typical of this regions clinics except perhaps in having a particularly strong interest in working on improvement of their preventive services and in learning how to use CQI. At the start of the trial in September 1994 each of the 22 clinics randomized to the intervention arm was asked to form a multidisciplinary QI team with a management sponsor and a leader and facilitator for the team. We suggested that they name a physician as leader and a nurse as facilitator but in this, as in all aspects of the trial, all decisions were up to the clinic. The IMPROVE team provided just-in-time group training to the leaders and facilitators in six sessions over seven months for a total of 26 hours. The training was focused on the specific knowledge and skills needed to use a seven-step CQI process to improve preventive services. During and after the training, IMPROVE project nurses provided periodic telephone and on-site consultation. After an 11-month training period, additional periodic opportunities were provided to network with other clinic leaders and facilitators and to obtain additional group consultations about areas of particular concern. Back to Top METHODS In June of 1996 (22 months after starting the intervention), two of the authors obtained written surveys and conducted individual interviews with each of the nurses who had served as leader or facilitator for one of the clinic teams. One nurse practitioner and two nurses who became facilitators after the completion of the training were excluded in order to provide a more homogeneous group and experience. This left 13 nurses to participate in the study, 9 of whom had served as facilitators and 4 as leaders for their teams. All agreed and signed consents, although one nurse could not find time for the interview and only completed the questionnaire. Other nurses participated as members of some teams, but we felt that the views of those with more project training and experience were especially valuable. The questionnaire was designed to assess the respondents attitudes and beliefs in each of the areas of focus for this study as well as to obtain relevant demographic information. It contained 55 close-ended questions that were developed from learning objectives for the training and a literature review of previous research on the nursing role in ambulatory care settings.9-12 Questions about skills and activities asked for a six-point Likert-scale response from none to very much choices and those asking about satisfaction and nursing roles asked for a five-point scale response from strongly agree to strongly disagree. After pretesting and revision, the questionnaire was mailed to the nurses to complete before the interview. The questionnaire is included in the Appendix. The interviews were structured to obtain qualitative data to expand on the questions in the survey. Eleven interviews were conducted in person at the clinical site and one was conducted over the telephone. Each was tape-recorded and transcribed later. Survey responses were simply summarized and reported directly for the small numbers involved. Questions that were stated negatively in order to improve response validity have been reworded for ease of comparing the answers. The interviews were analyzed for themes and for examples to illustrate questionnaire responses. Back to Top RESULTS Most of the nurses studied had already been involved in some degree of management in their clinics prior to the study. Only four were clinic nurses while two each were clinic manager, patient care manager, and nursing coordinator. The other three nurses were vice president of information services, medical services director, and health educator. Eight held positions that involved supervision of others, and an overlapping eight worked in direct patient care at least part time. As might be expected from such a group, 12 had been nurses more than 10 years and 10 had worked at their present clinics for at least 5 years. Educationally, seven nurses were registered nurses (RNs) (2 with bachelors of science in nursing, two with diplomas, and three with associate degrees) and six were licensed practical nurses (LPNs). All were female. Only four nurses reported that they had received previous formal training in CQI, although another four reported informal on-the-job training as part of a process improvement team. However, only the latter four and one additional other reported previous participation in QI. Three of these had been team leaders, one had been a facilitator, and one was a member of a team. Back to Top Satisfaction with the IMPROVE process improvement experience Table 1 suggests that, even after working on this process for 22 months, most nurses reported high levels of satisfaction associated with this experience of process improvement. That is particularly true for questions about obtaining personal value and improving patient care. Positive recognition from their clinics and greater job security are much less strongly supported. Table 1 From the interviews, several comments reinforced the written survey results concerning the opportunity to learn and grow: I was looking for the experience of a CQI project. I had done some reading on Dr. Deming on my own. I knew he was very successful and I didnt know how. This was just very fascinating to me. Learning something new was probably one of the greatest things that attracted me to this. My mind is just constantly going all the time and I really like getting involved in new things. The nurses also reported high scores in task significance. Questions included, The time spent on this process improvement has been worth it, I feel like what I am doing with my team is worthwhile, and I believe that our process improvement activities have resulted in our patients receiving better care. Comments around task significance centered largely on the perceived benefit to their clinics patients. One nurse responded to the question, What are the three most positive benefits of your involvement in process improvement? by answering: Number one is that we actually focused on those eight preventive services and that when you take a look at them they are actually going to improve somebodys life. And thats going to continue here even after were formally finished. Another repeated theme focused on participation-the opportunity provided to interact in a positive way, not only within each clinic site, but with other clinics involved in the project: Youre not in this alone, youre working with a lot of good people, and not just health professionals. We have good people like _____ who is not a health professional. She works in the business part, but I cant imagine doing this without her because they have the skills of getting the word out when youre busy with patients. So we need each other. It has been fun to be involved with other people. This has given me an awareness of not only my own clinic site, but awareness of the broader picture of health care within the Twin Cities. Back to Top Acquisition of specific knowledge and skills Overall, these nurses reported increasing a wide variety of knowledge and skills relevant to process improvement and working with people as a result of this experience. Table 2 summarizes these reported changes between self-perceived skills before and after the 22-month project. The largest improvements involved learning how to make use of data, managing change, and managing meetings. Even the eight respondents with previous training in QI reported gains, even though they had rated their previous overall QI knowledge and skills as average (3 nurses) to above average (5 nurses). Table 2 From the interviews, several themes emerged as to what the nurses perceived as skills gained from participating in process improvement. The most frequently mentioned skill was the ability to apply a model for problem solving (the seven-step model): I think really learning how to problem solve was very beneficial because we had tried to solve some situational process problems in our clinic before and it gets to a certain point where everyone complains about something and they decide to do something about it and we would set up some basic rules or policies and three or four months later no one was doing it anymore because it didnt work. There never was a lot of follow through, so I think this really gave us a good role model on how to go about problem solving in the clinic. Another frequently cited skill was the ability to effectively conduct meetings: One of the major things I learned was how to run a meeting. It is so effective and we use it so much in other meetings now. People come out of those meetings and say, This is a great way to do a meeting we get out of here on time and we get something done. Other themes cited were around skills gained in interpersonal relationships, specifically the ability to directly deal with coworkers or others on solving problems: I now am being more direct and am looking at things more from a process point of view rather than a personal point of view. Another nurse reported: Overall, now if someone is not following the standard, I approach them now by going over what the protocol is or what the process is, rather than honing in on the fact that the person may not be a good nurse. Back to Top Impact on the nursing role As illustrated in Table 3, these nurses reported that they believe QI is important for nurses and that nurses have a crucial contribution to make to QI. With a few exceptions, they believe that QI will improve the ability of nurses to control their work and many of them feel that their work on process improvement has helped them to be better nurses. However, when asked about each of nine specific areas of nursing activities (room preparation, technical activities, nursing process, telephone communications, patient advocacy, patient education, care coordination, expert practice, and quality improvement), only in QI did more than 3 of the 13 nurses report that they had experienced a significant change in the frequency with which they performed that type of activity after working on this project. Table 3 During the interviews, the nurses were asked whether they saw a role for process improvement in the nursing profession. The majority of the responses revolved around the value they perceived in being able to approach problems in a systematic way: I dont think nurses training ever gave us the skills to deliberately study something and improve it. Yet we get out and we become head nurses. It has helped the role of the nursing supervisors in dealing with their staff. It has helped them work through problems and problem solve rather than just coming to me for an answer. Many of the nurses reported that their environment was changing and that their role had changed. Because of this changing environment, they reported needing new skills and a new way of thinking: Everything is changing. We need to improve for our patients. I think the scope of nursing has changed and that the nurses need to look at the whole system, you know what goes on with the patient besides just with the hands-on things. I think it (process improvement) is a blend of how you clinically take care of somebody, but I think it kind of helps you to critically look at other things. Youre dealing with so many systems with the patient and how they move through these systems. We were never trained to deal with the system, we were only trained to deal with each patient. In the clinic setting, we need to be aware of what we are doing and why we are doing it. There is a lot of time and wasted effort. Back to Top DISCUSSION Although the sample is small, this study helps to document the generally positive feelings of ambulatory practice nurses involved in leading or facilitating their local clinic QI effort to improve the process of providing preventive services. Both their questionnaire responses and their interview comments and anecdotes suggest that they feel they benefited from their involvement with this project, despite the fact that it required a great deal of time and energy from them. Overall, they report that they were very satisfied with the experience and that it provided them with increased knowledge and skills as well as enhancements for their nursing role. In light of the reported knowledge, skill, and role enhancements, it is not surprising that these nurses would feel satisfied with their experience. Even though most of these nurses were already working at higher-level positions, nursing in ambulatory practice has traditionally been viewed as less prestigious and challenging than hospital nursing, both by nurses and by the public generally. Hackbarths study showed that ambulatory nurses reported more frequent performance of lower-level work dimensions and less frequent performance of dimensions requiring disciplinary knowledge and critical thinking, despite the growing complexity of care in ambulatory settings.12 Capell and Leggats comment that the traditional view of the nurse as one only involved in the accomplishment of tasks prescribed by others is no longer fitting in todays health care environment, does not mean that traditional role is disappearing.13(p39) Thus, anything that promises improvement in the nursing role is likely to find appeal. Counte has shown that in the hospital setting, personal participation in a TQM program was associated with higher job satisfaction.14 McLaughlin and Kaluzny feel that the new set of decision-making skills required by TQM includes not only technical skills like data management and statistical analysis, but also the ability to work well in multidisciplinary teams.15 Despite previous QI training and/or experience, all of the nurses in this project reported gains in skills, and most of these skills were gained in the areas noted above, along with change management. Another aspect of the current health care environment that lends both importance and urgency to acquiring new skills is the extreme degree of turmoil in health care, especially in the Twin Cities. As Magnan has documented for these clinics involved in the IMPROVE trial, enormous change is going on.16 Within a one-year time period during the process improvement efforts described here, 64 percent of the clinics were purchased, merged, or underwent a major shift in affiliations; 77 percent of the clinics changed at least one major internal system; and 45 percent of the clinics changed their medical director and/or their clinic manager. This turmoil may explain why so few respondents reported that the experience provided them with more job security in their current clinic (question 12 in Table 1), even though it gave them more job opportunities for the future (question 9). Clearly QI is very important to health care improvement and reform. Phoon et al.17 believe that the success of health care delivery depends on the successful integration and coexistence of QI and managed care. Moreover, they believe that nurses play a key role in this integration, although they tend to emphasize primarily nurse managers and practitioners. Spoon et al., on the other hand, use their experience with 45 CQI process improvement teams in a community hospital to highlight the potential for this experience to empower typical hospital nurses.18 They also point out the many ways nurses are essential to most of the steps in the improvement process. Corbett and Pennypacker go on to describe a process improvement effort that took place entirely within a hospital nursing department,19 although that is not particularly consistent with the interdisciplinary needs for most QI efforts. It is worth highlighting that the training in this project was very action oriented. It focused not on theory, but on the application of process improvement and team skills. For example, the trainees learned to flow chart their own clinics prevention process and to collect and analyze their own data in order to learn the root causes for the problems with that process. Role plays of meeting management skills and audits of dummy charts prepared them for applying those skills with their own clinic teams. A basic assumption governing the intervention with these trainees and their teams was that they could act their way into a new way of thinking by applying specific skills in a structured way. These new ways of thinking derive from a real understanding of work as process and include recognizing that problems are generally due to systems deficiencies rather than to individual workers. In other words, we were teaching systems thinking-what Peter Senge describes in The Fifth Discipline as the discipline for seeing wholes.20(p68) We believe that we saw this type of fundamental change in thinking in these nurses and others involved in this improvement process. Over time, the language of the group began to change and to include terms and statements that reflected systems thinking. For example, one rather taciturn physician remarked after the third training session that I never realized how many people were involved in getting the patient ready to be seen by me Aside from the knowledge and skills acquired from the training and the task, it was clear that most of these participants highly valued the opportunity to talk with others in similar environments. They liked to share frustrations as well as to learn from the efforts of peers in other situations. Most clinic personnel are surprisingly isolated, with few opportunities to attend broadening learning experiences, much less to learn first-hand how their way of doing things compares with that of others. We believe that this study and our experience with providing training and consulting for 60 clinics show that there is a great deal about the concepts and techniques of QI that appeals to nurses and other health care professionals. It appeals to both their scientific orientation and their desire to help improve things, in particular their customers-each patient. The acquisition and the application of these concepts and techniques appear to be both satisfying and broadens their views of how they can contribute to health care. Finally, it is worth noting that besides enhancing the skills and satisfaction of nurses, the QI projects in which they work are often likely to lead to role enhancements for nurses, especially those in ambulatory care settings. QI teams interested in improving prevention or other clinical areas of focus, like those we had the privilege to work with, will find that they cannot do this without expanding the role of nurses. McCarthy et al.,21 among others, have demonstrated the power of empowering clinic nurses to offer and arrange for mammography as patients are seen. The Oxford Project in England has carried this even further by creating a new profession for facilitators to help primary care practices improve their prevention activities by training practice nurses to fill an expanded role in performing health checks and facilitating practice system changes.22 Most of these external facilitators are also nurses and it is recommended that all of them have that background.23 Astrops des cription of the facilitators activities within a practice sound very similar to those of the nurses involved in this project and paper. Both this project and the literature suggest that QI concepts and techniques can be important vehicles for improvements in both patient care and in the skills, roles, and job satisfaction of nurses. This can be stimulated and assisted by managed care plans and others external to individual practice settings, but ultimately its success will depend on individual nurses, like those in this study, using their creativity and energy to make it happen. Back to Top REFERENCES 1. Berwick, D.M. Continuous Improvement as an Ideal in Health Care. New England Journal of Medicine 320, no. 1 (1989): 53-56. UvaLinker Bibliographic Links [Context Link] 2. Laffel, G., and Blumenthal, D. The Case for Using Industrial Quality Management Science in Health Care Organizations. Journal of the American Medical Association 262, no. 20 (1989): 2869-2873. [Context Link] 3. Barsness, Z.I., Shortell, S.M., and Gillies, R.R. National Survey of Hospital Quality Improvement Activities. Hospitals and Health Networks 67, no. 23 (1993): 52-55. UvaLinker [Context Link] 4. Shortell, S.M., OBrien, J.L., Carman, J.M., et al. Assessing the Impact of Continuous Quality Improvement/Total Quality Management: Concept versus Implementation. Health Services Research 30, no. 2 (1995): 377-401. [Context Link] 5. Shortell, S.M., Levin, D.Z., OBrien, J.L., and Hughes, E.F. Assessing the Evidence on CQI: Is the Glass Half Empty or Half Full? Hospital and Health Services Administration 40, no. 1 (1995): 4-24. [Context Link] 6. Carman, J.M., Shortell, S.M., Foster, R.W., Hughes, E.F., et al. Keys for Successful Implementation of Total Quality Management in Hospitals. Health Care Management Review 21, no. 1 (1996): 48-60. Ovid Full Text UvaLinker Request Permissions Bibliographic Links [Context Link] 7. Solberg, L.I., Isham G., Kottke, T.E., et al. Competing HMOs Collaborate to Improve Preventive Services. The Joint Commission Journal on Quality Improvement 21, no. 11(1995): 600-610. [Context Link] 8. Solberg, L.I., Kottke, T.E., Brekke, M.L., et al. Using CQI to Increase Preventive Services in Clinical Practice-Going Beyond Guidelines. Preventive Medicine 25, no. 3 (1996): 259-267. [Context Link] 9. Solberg, L.I., and Johnson, J.M. The Office Nurse: A Neglected but Valuable Ally. Family Practice Research Journal 2, no. 2 (1982): 132-141. UvaLinker [Context Link] 10. Flarcy, D.L. Redesigning Management Roles, The Executive Challenge. Journal of Nursing Administration 21, no. 2 (1991): 40-45. UvaLinker Request Permissions Bibliographic Links [Context Link] 11. Haas, S.A., Hackbarth, D.P., Kavanagh, J.A., and Vlasses, F. Dimensions of the Staff Nurse Role in Ambulatory Care: Part II-Comparison of Role Dimensions in Four Ambulatory Settings. Nursing Economics 13, no. 3 (1995): 152-165. [Context Link] 12. Hackbarth, D.P., Haas, S.A., Kavanagh, J.A., and Vlasses, F. Dimensions of the Staff Nurse Role in Ambulatory Care: Part I-Methodology and Analysis of Data on Current Staff Nurse Practice. Nursing Economics 13, no. 2 (1995): 89-97. [Context Link] 13. Capell, E., and Leggat, S. The Implementation of Theory-Based Nursing Practice: Laying the Groundwork for Total Quality Management Within A Nursing Department. Canadian Journal of Nursing Administration 7, no. 1 (1994): 31-41. UvaLinker Bibliographic Links [Context Link] 14. Counte, M.A., Glandon, G.L., Oleske, D.M., and Hill, J.P. Total Quality Management in a Health Care Organization: How are Employees Affected? Hospital and Health Services Administration 37, No. 4 (1992): 503-518. UvaLinker [Context Link] 15. McLaughlin, C.P., and Kaluzny, A.D. Total Quality Management in Health: Making it Work. Health Care Management Review 15, no. 3 (1990): 7-14. [Context Link] 16. Magnan, S., Solberg, L.I., Giles, K., et al. Primary Care, Process Improvement, and Turmoil. Journal of Ambulatory Care Management 20, no. 4 (1997): 32-38. Ovid Full Text UvaLinker Request Permissions Bibliographic Links [Context Link] 17. Phoon, J., Corder, K., and Barte, M. Managed Care and Total Quality Management: A Necessary Integration. Journal of Nursing Care Quality 10, no. 2 (1998): 25-32. Ovid Full Text UvaLinker Request Permissions Bibliographic Links [Context Link] 18. Spoon, B.D., Reimels, E., Johnson, C.C., and Sale, W. The CQI Paradigm: A Pathway to Nurse Empowerment in a Community Hospital. Health Care Supervisor 14, no. 2 (1995): 11-18. Ovid Full Text UvaLinker Request Permissions Bibliographic Links [Context Link] 19. Corbett, C., and Pennypacker, B. Using a Quality Improvement Team to Reduce Patient Falls. Journal of Healthcare Quality 14, no. 5 (1992): 38-54. [Context Link] 20. Senge, P.M. The Fifth Discipline: The Art and Practice of the Learning Organization, New York: Doubleday, 1990. [Context Link] 21. McCarthy, B.D., Yood, M.U., Bolton, M.B., et al. Redesigning Primary Care Processes to Improve the Offering of Mammography. The Use of Clinic Protocols by Nonphysicians. Journal of General Internal Medicine 12, no. 6 (1997): 357-363. [Context Link] 22. Fullard, E., Fowler, G., and Gray, M. Promoting Prevention in Primary Care: Controlled Trial of Low Technology, Low Cost Approach. British Medical Journal 294, no. 6579 (1987): 1080-2. UvaLinker Bibliographic Links [Context Link] 23. Astrop, P. Facilitator-The Birth of a New Profession. Health Visitor 61, no. 10 (1988): 311-312. [Context Link] The authors would like to thank the 46 clinics that participated in the IMPROVE project. These included the two demonstration clinic sites; Kasson Mayo Family Practice Clinic and HealthPartners St. Paul Clinic. Intervention Clinics Apple Valley Medical Center Aspen Medical Group, W. St. Paul Aspen Medical Group, W. Suburban Chanhassen Medical Center Chisago Medical Center Creekside Family Practice Douglas Drive Family Physicians Eagle Medical Fridley Medical Center Hastings Family Practice Hopkins Family Practice Interstate Medical Center Metropolitan Internists Mork Clinic, Anoka North St. Paul Medical Center Ramsey Clinic, Amery Ramsey Clinic, Baldwin River Valley Clinic, Farmington River Valley Clinic, Northfield Southdale Family Practice Stillwater Clinic United Family Medical Center Comparative Clinics Aspen Medical Group, Bloomington East Main Physicians