A Root Cause Analysis Essay

Healthcare facilities that are accredited by Joint Commission are required after a sentinel event to conduct a root cause analysis (RCA). A root cause analysis is conducted to determine the cause or factors that contributed to the sentinel event. A few things must be asked in the RCA such as who, what, where, why and how in order to identify the cause. After the cause of the sentinel event is determined and a corrective action plan has been put in place a failure mode and effects analysis (FMEA) could be conducted to reduce the likelihood that it should happen again. The scenario A 67 year old male (Mr. B) was brought into the emergency room for pain to left leg and left hip. The injury occurred when the patient had a fall due to him losing his balance after tripping over his dog. The hospital is a 60 bed rural hospital located in Mr. B’s hometown. Mr. B was brought in by his son and neighbor. Upon triage Mr. B was complaining of pain 10/10 on the numerical pain scale and his vitals were found to be stable. Mr. B has a history of impaired glucose tolerance, prostate cancer, and chronic pain which he is on oxycodone. The Patient states he had no known allergies or previous falls. Upon the nursing assessment Nurse J. has noticed that the patient has limited range in motion, his left leg has swelling and appears shortened in comparison to the right. Nurse J. has informed the ED physician which he came to his bedside for evaluation. Upon evaluation the physician decided that Mr. B needed to have a reduction of his left hip, due to the dislocation and will require a conscious sedation. Mr. B requires multiple doses of medication to achieve the desired sedation affect for the reduction. Once the reduction was successful Mr. B is left with son in the room where a full set of vitals were not continuously monitored and goes into respiratory failure which lead to the death of Mr. B. Staffing on this day is the day of the event consisted of a secretary, emergency department physician (Dr. T), and two nurses (one RN and one LPN). A respiratory therapist is in house and available as needed in this six bed ED and sixty bed hospital. Events At 3:30pm- Mr. B was taken to ED for left leg and left hip pain from a fall. Pain is a 10/10 vitals include 120/80 blood pressure (BP), 88 heart rate (HR) and regular, 98.6 temperature, (T), 32 respirations (R), 175 lbs.. At 4:05pm- Mr. B was given Diazepam 5mg IVP which had no affect after 5min. At 4:10pm- Dr. T orders 2mg of hydromorphone to be given to Mr. B. At 4:15pm- Mr. B was given 2mg of hydromorphone IVP. At 4:20pm- Dr. T is not satisfied with level of sedation and orders Mr. B to be given 2mg of hydromorphone, and diazepam 5mg IVP. At 4:25pm- Mr. B appears to be sedated and reduction of his (L) hip takes place. The patient remains sedated and appears to have tolerated the procedure. The procedures concludes at 4:30pm. No distress is noted, patient is placed on monitor for blood pressure to be taken every 5 minutes along with pulse oximeter but no supplemental oxygen or ECG leads (monitors cardiac rhythm and respirations) was placed on patient at this time. At 4:30pm- Nurse J allows Mr. B’s son to remain in the room with him as he is being monitor by blood pressure machine only. Nurse J leaves the room. At 4:35pm- Mr. B vitals are BP 110/62, O2 sat is 92% still no oxygen or ECG leads are on patient at this time. EMS is transporting a patient in respiratory distress, lobby is beginning to get congested. LPN and Nurse J. in the process of discharging 2 patients and are checking in the patient that EMS has transported in. LPN enters Mr. B’s room and resets his alarming monitor that was showing a sat of 85% and restarts the B/P to recycle. LPN does not supply oxygen and does not alert Nurse J at this time. Management is not notified that patient acuity and patient load is increasing. Nurse J is now fully engaged with the emergency care of the respiratory distress patient. At 4:43pm- Mr. B’s son comes out of room and informs the nurse that the monitor is alarming with vitas of B/P 58/80 O2 of 79%. The patient has no palpable pulse and is not breathing. A STAT code is called and the son is taken to the waiting room. The code teams arrives places Mr. B on cardiac monitor where he is in ventricular fibrillation and the team begins resuscitative efforts. CPR is started and the patient is intubated. Mr. B is defibrillated and reversal  agents, vasopressors and IV were started. At 5:13pm- After 30 min of interventions the ECG returns to a normal sinus rhythm with Mr. B’s B/P being 110/70. The patient is completely dependent on the ventilator, his pupils are fixed and dilated and there is no spontaneous movements. The family as asked for the patient to be transferred out to a tertiary facility for further advanced care. Outcome Seven Days later Mr. B has died. The family had requested that life-support be removed after brain death had been determined by EEG’s. This is a sentinel event. Investigation of sentinel event should begin with a Team and method of investigation. Interdisciplinary team included in the RCA should include the Director of Nurses, Nursing Supervisor, Risk management, Nursing Coordinator, and Manager of the department. Once the team is put together the RCA should be started. The team should set up interviews with all staff that was involved and present in the department the day the sentinel event happened. A complete chart review should be conducted by team. The policies on conscious sedation, staffing of department, and standardized work should be reviewed. When the cause is identified a corrective action plan should be conducted. The corrective action plan will allow a series of projects can be put in place to help create or change polices if needed. The new or changed polices should be put into education models to teach to current and new staff as needed. The Root Cause Analysis Causative factors- (why it happened) determined cause Individual’s cause factors Nurse J did not follow procedure for conscious sedation. The patient was not placed on continuous B/P, ECG, and pulse oximeter throughout the procedure. Respiratory Therapist was not informed of the conscious sedation. LPN did not address low o2 saturation of 85% between the 4:35pm-4:43pm. Dr. T did not take in account of the patient’s weight and chronic pain medication use. Nurse J did not question the medication that Dr. T ordered. Team’s cause factors Management was not called and informed of staffing needs and acuity of patients. Back up staff was not called in to help when acuity and patient load had increased. Commination between Nurses and Dr. T were not present when the patient began to decompensate. Management /Organizational cause factors Unsafe Staffing at ED. There was not enough staff present to safely manage emergencies in the ED. RCA Findings: Errors and/or Hazards 1. Per protocol the patient was not hooked up to the proper monitoring equipment at the bedside. The facility procedure police called for continuous B/P ECG, and pulse oximetry during and after procedure until patient meet the discharge criteria. The nurse should have remained with patient during the recovery period. Crash cart with defibrillator was not present during the procedure nor was the proper reversal agents that could reverse the medication given for sedation. 2. Nursing staff communication was very poor. LPN did not notify Nurse J or ED physician when the patient’s o2 saturation dropped down to 85%. Oxygen was not placed on patient when O2 saturation dropped which led to respiratory failure causing the patient to code and eventually led to Mr. B’s death. 3. Communication between ED staff and management lacked when staffing needs increased. Patient safety was put at risk when the patient load and acuity increased in the ED and the staffing did not increase. Staffing shortage caused the nurse and nursing support staff to attend to other patients and leave Mr. B unmonitored which led to respiratory distress due to the patient being over medicated for sedation which led to respiratory failure and eventually led to Mr. B’s death. 4. The ED physician did not request the patient be transferred to the nearest trauma center due to lack of recourse’s in the emergency department. Recommended Corrective Action Plan/Change Theory/Improvement Plan 1. Improved patient safety during conscious sedation: Effective immediately all conscious sedation procedures will be conducted per protocol. Within 10 days the conscious sedation procedure should be evaluated by a committee to ensure the best practices are being used. Within 30 days of this RCA all  staff should be educated on conscious sedation protocol. All nursing staff should use review protocols for conscious sedation before a conscious sedation procedure is to take place. 2. Communication within the department should be evaluated immediately by a group of staff members to find out where the miscommunication failure lies. This could be that the nursing support staff is unaware of the parameters that should be reported to nurse or physician. With 10 days of this RCA a policy on documentation of communication should be put in place to ensure that all nursing staff are documenting the communication of a patients change in status has be reported to physician. Effective immediately all nursing support staff should be educated on parameters that should be reported to nursing staff and physicians. This should be put into a policy along with documentation of communication. 3. Improved patient to nurse ratios: Management should put in place a safe nurse to patient ratio for the emergency room. Communication policy between department and management should be put in place effective immediately to ensure that no other patient should be placed in harm’s way due to staffing shortage. The emergency department should be put on diversion if the patient load and acuity places patients at risk for harm in any manner. A copy of the RCA should be given to management and leadership. Management should share the finding with all emergency department staff. Feedback should be done 30 days after corrective action plan or change theory have been put in place to ensure that everything that has been put in place is effective for the department to improve patient safety. Constant reevaluation of patient safety should be conducted and feedback given to improve patient safety by all providers involved. Management will continue to ensure that all staff follow all protocols to ensure that patient care and safety are not compromised. At a 90 days bench mark after the corrective action plan has been put in place management should revisit the any changes made to protocols and polices to ensure compliance and effectiveness is still in place and reevaluate the process to ensure patient safety. Failure Mode and Effects Analysis (FMEA) A Failure Mode and Effects Analysis is proactive versus the RCA which is reactive. A FMEA assesses a process for risks of failures or adverse effects of a process and prevents them by correcting what is wrong proactively  (Institute for Heathcare Improvement, 2004). A Healthcare facility may use FMEA tools on the Institute for Healthcare Improvement website to evaluate a process in the facility. This tool will calculate a risk priority number (RNP) of a process, evaluate the impact of the process and the changes that are being considered, and tract the improvement over time (Institute for Heathcare Improvement, 2004). PRE-FMEA 1. Step one: Select a process to be evaluated with FMEA. The FMEA for this paper will focus on the conscious sedation protocol. 2. Step Two: Recruit a multidisciplinary team and include a member from every department that may be involved or affected. This team for the conscious sedation protocol should will include. Registered Nurse Physician Management Pharmacist Respiratory therapist A member from Legal Laboratory Tech Emergency Department Tech 3. Step Three: Information needs to be gathered by the team. A list of steps in the process being evaluated should be put together or even an outline of steps would be helpful to the team. All internal and external data, clinical practice guidelines, current policies and procedures, current literature and any other information that may pertain to the process that is being evaluated. For the purpose of this paper we would use data on outcomes of conscious sedation protocols, RCA’s on bad outcomes, clinical practice guidelines and any research documentation that would aid in best practices for conscious sedation. Team meetings should be structured with an agenda. A leader or primary person with extensive knowledge of the FMEA knowledge (Department of Defense Patient Safety Center, 2004) 4. Step Four: The Team should list the failure modes and causes. In each process all failure modes should be listed, and then for each failure mode a list of possible causes should be listed as well. In this scenario we will use this as an example Preparing medication Wrong medication prepared Wrong dose prepared 5. Step Five: A Risk Priority Number (RPN) will be assigned to each failure mode for the likelihood of occurrence, for the likelihood of detection, and for the severity. This step is also known as the three steps FMEA. The RPN is a numerical rating. For this scenario here is an example Likelihood of Occurrence: This will measure the likelihood a failure mode is to occur. The score range will be 1-10 with 1 meaning it is very unlikely to occur and 10 meaning very likely to occur. Example- Wrong medication prepared = 5 Likelihood of Detection: This will measure the likelihood a failure mode is to be detected if it should occur. The score range will be 1-10 with 1 meaning it is very likely to be detected and 10 meaning very unlikely to be detected. Example- Wrong medication prepared = 6 Severity of occurrence: This will measure the severity of the failure mode should it occur. The score range will be 1-10 with 1 meaning no effect and 10 will be death should a failure mode occur. Example- Wrong medication prepared= 9 6. Step Six: The team will evaluate the results. For each failure mode the three scores are multiplied with each other. The failure mode with the highest RPN will be the one that will be evaluated by the team to ensure patient safety. The higher the RPN a failure mode has the higher the potential for harm it may cause. The RPN score can be as high as 1,000 and as low at 3. Example- Wrong Medication Prepared Occurrence- 5 Detection- 6 Severity- 9 5x6x9= overall score =270 7. Step Seven: An improvement plan will be made based on the RPN. Likely to Occur. Have a triple check put in place. Have team attempt to eliminate all possible causes. Example-Have medication scanned when pulled from Pyxis to check providers order. Have patient scanned before medication may be prepared to check providers order. Have patient and medication scanned to ensure correct patient with the correct medication and proper providers order. Unlikely to be detected. Look for warning signs that the error may not be detected. Use data from any previous or prior errors. Severity. Use any data available to determine severity of error. Make available any and all resources to prevent further errors and severity of errors. Final Step- The final step in the FMEA is to plan an observation or test. A plan should be clear of its objections and should have some sort of predictions or outcomes. During the test all data should be documented. In this data collection phase all observations including problems or unexpected issues should be documented and later evaluated. After the test is complete and all data collected the team should meet for analysis of the data. A summary of the analysis should be documented. All changes or modifications to the process will be based on the test and analysis of data conducted. Any and all changes should be communicated to all staff members. These changes may or may not show improvement to the process, this is why constant reevaluation of all process should be conducted and any feedback should be given to leadership for the reevaluation of the process. Nurses play a vital role in health care. Nurses have the most contact with a patient. Nurses carry out any orders and or processes. A nurse is the patient advocate, they are the ones who will advocate for patient safety. Nurses are the advocates who will be looking for evidence base practices to improve patient care and patient safety. Improving quality of care for each patient will improve the outcomes for each patient. References Department of Defense Patient Safety Center. (2004, 12 26). Failure Mode and Effects Analysis. Retrieved from FMEA Info Centre: http://www.fmeainfocentre.com/handbooks/FMEA_Guide_V1.pdf Institute for Heathcare Improvement. (2004). Failure Modes and Effects Analysis (FMEA). Retrieved from Institute for Heathcare Improvement: http://www.ihi.org/resources/Pages/Tools/FailureModesandEffectsAnalysisTool.aspx

Ceo Duality Essays - Corporate Governance, Management, Corporate Law

Ceo Duality Essays - Corporate Governance, Management, Corporate Law Ceo Duality October 22,1999 Term Paper Separating the Board Chairperson and Chief Executive Officer: Pro and Con & Rebecca Hundley I Introduction Numerous reports on corporate governance have emphasised the desirability of increasing the number of outside directors on boards. An equally important and related issue is a growing insistence that the role of chairman and chief executive should be separate, though on this issue there is less unanimity in the U.S. than in other countries. Choosing the right Chief Executive officer is the key task for the board of directors. Pressure on chief executives to perform in ever decreasing time frames makes it essential that the CEO and the Board work closely together. An effective chief Executive will drive company strategy, lead the top team and fulfill shareholder ambitions . A good CEO will transform Board dynamics by keeping an open line of communication, placing a high value on Board input, and promoting the belief that management and the Board is working toward common goals. The average Board size is between eight and nine members. It used to be that Boards were constructed of executives with one or two non-executives; but trends are swiftly driving executives out of the boardroom as even the CEOs familiar role as chairman has been called into question. There has been a notable shift from executive director to non-executive director in the boardroom. The supposed advantages to these changes are to provide greater board independence from management, greater objectivity, and a representation of multiple perspectives. Bosch believes that the fundamental principle underlying this composition is accountability; if you have strong independent directors, a separation of the Chair/ Chief executive role will safeguard accountability . An opinion widely held is that separating the role of chairman from chief executive- would secure a board sufficient power to challenge CEO dominance. Although in many cases that rationale holds true, there are considerable benefits to CEO duality. Researchers have suggested that chairman/chief executive duality is a double-edged sword . While some stockholders are put off by the absence of board control and checks and balances, others are reassured by the presence of unity of command and the absence of potentially acrimonious conflict between strong-minded individuals. Finkelsein and DAveni found that a major factor in divining the success of this duality was the level of CEO informal power. Either perceptual or objective data can be used to measure informal CEO power. Although some researchers have used perceptual measures of power, power is a sensitive subject for many managers. In using perceptual measures, a researcher assumes that social actors are knowledgeable about power within their organizations; informants are willing to divulge what they know about power distributions; and such a questioning process II Advantages of CEO Duality When it comes to insiders versus outsiders on the board, a predominant role for insiders finds support more often, probably because insiders are more familiar with the issues, the technology, and the practice of the firm . Only they who are deeply involved and can make it work add value. It is simply not viable for twice removed outsiders, no matter how expert, to provide anything other than a cursory perspective and maybe act as an eventual deterrent to abuses of executive power. According to organizational theory, this CEO duality can establish strong, unambiguous leadership . By consolidating two of the most prestigious offices in a company stakeholders are often reassured, because it clarifies decision-making authority . An additional problem with nonduality is that it weakens and disrupts CEOs ability to manage the task environments their organization faces. For example, several laboratory studies suggested that the participation of constituencies who review negotiator action lead to less effective and more difficult negotiation processes. As a result, The reasons the positions of chairman and CEO are usually combined is that this provides a single focal point for company leadership(Anderson/Anthony) A powerful and effective CEO creates an image of stability and instills a sense of well being to its employees as well as its shareholders, projecting a clear sense of direction. III Negative aspects of CEO Duality When a companys chief executive officer is also the chairperson of its board, directors often have contrary objectives . Boards of directors are charged with ensuring that Chief Executive Officers

Free Essays on Suicide In Shakespeare

give me a immense feeling of sorrow and pity for Hamlet because it must take a lot of pain and suffering for someone to wish to take his own life. That is not something I fell is right, but I can understand the reason why Hamlet wants to die. Hamlet also expresses that there is nothing left in this world for him to live for. This feelings are not only expressed by Shakespeare through Hamlet, but it I have seen it the world today. For example, in the movie What Dreams May Come the death of a woman’s husband drives her to suicide because of the pain she feels, and she believes that there is nothing left for her to live for. She feels hollow and empty inside and decides the only way to end her pain and the feeling of emptiness is to take her own l... Free Essays on Suicide In Shakespeare Free Essays on Suicide In Shakespeare â€Å"O, that this too too solid flesh would melt, Thaw, and resolve itself into a dew! Or that the Everlasting had not fixed His canon ‘gainst self-slaughter! O God! God! How weary, stale, flat, and unprofitable Seem to me all the uses of this world!† -Hamlet -Act I, Scene 2, page 16 The topic of suicide is a controversial subject that many people choose to avoid, but Shakespeare approached the subject in his play Hamlet. I enjoyed reading how Shakespeare incorporated this subject into his play. He explores it mainly through the character of Hamlet. In the first four lines in the above passage, Hamlet wants to melt away, to disappear, or to exist no longer. He asks why God made suicide a sin because he does not want to cope with the grief of his father dying and his mother remarrying his uncle. The way Shakespeare conveys these feelings into the words of Hamlet are beautiful. He just does not say that I want to die, but uses eloquent words to allow the reader to visualize Hamlet’s thoughts in saying how he wants his flesh to melt, thaw and change to dew. I feel Hamlet’s strong feelings of pain when he asks why God had to make suicide a sin. Shakespeare’s words give me a immense feeling of sorrow and pity for Hamlet because it must ta ke a lot of pain and suffering for someone to wish to take his own life. That is not something I fell is right, but I can understand the reason why Hamlet wants to die. Hamlet also expresses that there is nothing left in this world for him to live for. This feelings are not only expressed by Shakespeare through Hamlet, but it I have seen it the world today. For example, in the movie What Dreams May Come the death of a woman’s husband drives her to suicide because of the pain she feels, and she believes that there is nothing left for her to live for. She feels hollow and empty inside and decides the only way to end her pain and the feeling of emptiness is to take her own l...

How to write a business plan, FM World - Emphasis

How to write a business plan, FM World How to write a business plan, FM World Whether youre setting up a new business venture or want the go-ahead for a project, theres one essential document you need. Robert Ashton gives a step-by-step guide to writing a good business plan. Theres a memorable conversation in the famous Lewis Carroll novel Alice in Wonderland, where Alice asks the Cheshire cat for directions. Unfortunately, Alice doesnt know where she wants to go, stating that it doesnt matter where she gets to, as long as she gets somewhere. This leads the cat to respond that it doesnt matter which way she turns. If you dont have a crystal clear vision of where you want your business to go, youll be as confused as Alice when you hit a crossroads. Your business plan is your road-map. But in order to write it, you have to decide what you really want to achieve. This means youll have to spend time immersed in the strengths and weaknesses of your business, a process which, in itself, has numerous pay-offs. Studying and researching your company helps you to take a critical look at what you have to offer and who your competitors are. This enables you to better navigate the industry minefields and gives you a benchmark against which to measure success. Many people think of business plans as a necessary evil, written only to gain external funding. Instead, look at them as an essential planning tool, whatever your financial situation. Remember, if you dont plan where to go, youre inadvertently planning on going nowhere. Crafting your business plan Heres a seven step guide to writing a winning business plan. Work through each section and youll have an ordered, content-rich document that gets you to where you want to go. Step one Description of the business After the executive summary (see step seven), the first thing youll need is to describe your business. Get started by asking the following questions: What do I sell or offer? And why? Whom do I sell to? What is the history of the business? What is my vision for the future? What is different about the services I offer? What is the legal structure of the company? Think about your audience carefully before you write the description. Ask yourself what words and phrases they will understand and be careful not to include too much jargon. Step two Market research Think about your industry and what you think the future trends will be. Then analyse your competition. Determine what size of the market they hold and then clearly define where you fit into the mix. Step three Marketing and sales strategy Ask yourself why companies buy what you offer and how you plan to sell it. Think about how you are going to reach the organisations that need facilities management support and what pricing plans youll offer. Whether youre an in-house department, specialist contractor or a large multi-service company, therell be a variety of ways to reach prospects. Step four Management and personnel team Many facilities management companies claim that people are their best asset. Think carefully about your management team and outline the background, experience and qualifications of each individual. The people on your team will often make or break your success. Fully evaluate their credentials and look out for any weak skill sets that could be improved with training. Step five Operations Analyse the location of your business, in terms of advantages and disadvantages. Your own premises, production facilities and IT systems must be excellent. Make sure you address any weaknesses in your plan with recommendations for improvement. Step six Financial forecast This section requires you to translate the contents of your plan into numbers. Include cash flow statements, profit and loss forecasts and a sales forecast. Dont forget that if youre looking for funding: you need to spell out how much you need and how youll repay the loan. Step seven The executive summary Leave this until last, even though it goes right at the beginning. Once youve followed all the other steps youre in a position to write this stand alone document, which outlines the key points in your entire plan. Keep it to a maximum of two pages. And remember, some people will only read this section so make it shine. Tip: rather than trying to distil the full document down, follow your original document plan (see Style tips box). Just write less in each section this time (a couple of sentences or a paragraph, rather than several pages). Finally, the ink may be dry but your business and the facilities management industry is constantly changing. Your business plan is a dynamic document, so you need to update it regularly.

The music business has changed radically. Can an employee whos been an Essay

The music business has changed radically. Can an employee whos been an Industry Legend Keep Up - Essay Example Helping business managers make rational decisions when faced with an ethical dilemma calls for determination and sophistication (McCullough and Faught, 2005). In the case study of Powerful Entertainment, the major ethical dilemma facing Noel Klein, the company’s CEO is on whether to lay Bob off or keep him. Noel argues that Bob has been in the company for so long as the sales managers although at present he is not selling anything. Despite the great changes in the industry within which Bob operates over the past 20 years, Bob has not changed at all (Guterman, 2010). He does not know anything about digital marketing although technology is moving towards this. Moreover he does not add to the sales of the company although he is the highest paid employee in the company. The CEO argues that Bob is taking up a vacancy for another sales person who would be able to achieve the targets. On the other hand, Bob has so much to offer to the company. Noel concedes that he has valuable inter personal skills. Bob is an icon in the company linking it to the past. Furthermore, he is the one responsible of keeping Mark Sender in the company. Mark Sender is an important figure in the company since he helps make almost 30 percent more revenues than other performers (Guterman, 2010). The other reason that makes it had for the CEO to decide on the way to handle Bob is given the fact that he is loved by most employees and therefore his exit may lead to loss of other critical employees or affect their effectiveness. He motivates other employees to work although this cannot be quantified. He is imaginative and adored by other workers and young employees have a lot to learn from him. Rita who has called upon by the CEO is expected to give her decision on the case of Bob Antice.... This research is the best example of comparison of the utilitarian, libertarian, deontological and virtue ethics perspective on the ethical dilemma facing Powerful Company. From an evaluation of the different ethical perspectives, the researcher proposes that Noel should adopt a combination of utilitarian and libertarian perspective to demystify the ethical dilemma facing the company. By employing the utilitarian perspective, the CEO would take time to evaluate the impacts of his actions. Utilitarian perspective like a social cost benefit analysis carries out any evaluation of the impacts of an action before it is implemented to help avoid costly mistakes in the process of making decisions. As such the CEO would be able to quantify the impacts of sacking Bob for not achieving the sales targets in relation to his benefits to the company. Since the perspective views the good of an individual as independent from their rights, it would be easy to conclude on whether to replace Bob or ret ain him in the organization. If his value in the organization does not match the pay, he should be replaced. From a libertarian perspective, Noel’s decision should be geared towards ensuring that maximum benefits to the shareholders of the company. In light of this statement, the decision adopted must ensure there will be maximum returns to the shareholders. From this perspective, it would be critical to evaluate the value of Bob to the company, does he actually motivate staff? Or does he help young guys to the company learn and how the two add value to company.

Confidentiality of Health Information Essay Example | Topics and Well Written Essays - 500 words

Confidentiality of Health Information - Essay Example When should the computerized medical database be online to the computer terminal The medical database should be online to computers when authorized computer programs for the data are used. Anyone outside the facility should not have online access to database of medical records. When the computer service bureau destroys or erases records, should the erasure be verified by the bureau to the physician There should be no mixing of a physician's computerized patient records with those of other computer service bureau clients. In addition, procedures should be developed to protect against inadvertent mixing of individual reports or segments thereof. Should individuals and organizations with access to the databases be identified to the patient Dissemination of confidential data is limited to only individuals or organizations with a real use for the data. Only necessary data should be released. Patient identity should be removed where appropriate. The release of confidential information from the database should be only for the specific purpose for which it is to be used and limited to a specified time frame.

The causes that lead to the crisis and discuss how it has affected the Essay

The causes that lead to the crisis and discuss how it has affected the New Zealand financial system and economy - Essay Example However, even wealthiest governments were forced to declare diverse rescue packages in order to bail out and thereby ensure the safety of their financial systems. The decade witnessed a series of collapses in the American banking sector, which were directly attributed to the crisis. The most challenging issue associated with the global crisis was that the institutions responsible for the financial difficulties were the ones being largely bailed out. This paper intends to explore the major causes that led to the crisis and how it affected New Zealand’s financial system and economy. Facts of the financial crisis Davies (2009) says that the financial crisis widely struck the global financial markets and its first impacts were seen in the United States’ sub-prime mortgage market. As a result of this crisis, the prices of bonds and other financial assets were considerably declined by which the generated losses largely hit the financial system. In the view of Davies (2009), i n this period, number of financial institution underwent bankruptcy mainly due to the collapse in credit; this situation adversely affected the economic confidence of business houses/entrepreneurs and thereby the overall economic growth of nations. A gigantic expansion in credit and asset prices just prior to the collapse increased its severity. This adverse credit as well as asset price expansion was more visible in the housing markets of US. Davies (2009) points that the situation of immense global imbalances between corporate giants created huge reserve accumulations. The aftereffects of these accumulations led to the fall of real and nominal interest rates. Naturally, this economic condition produced an environment that offered excess liquidity and very easy credit; hence, borrowers began to take advantages of this favorable situation. Subsequently, companies also increased their leverage with intent to exploit the situation. In the view of Davies (2009), households got the oppo rtunity to borrow more and more under this economic situation; and consequently, the ‘household debt rose to unprecedented levels in relation to GDP’. The banks and other financial institution were willing to approve this increased demand for credit and allowed credit even to vulnerable and very risky borrowers. Obviously, this massive and thoughtless credit creation hurt the financial stability of the credit sector. Causes of the global financial crisis Prior to the emergence of global financial crisis, it seemed that America had struggled with productivity and competitiveness in the Asian markets. The speculative economy has also notably contributed to this financial turbulence since the relationship of the international money supply did not commensurate with the actual production of goods. We know that energy consumption significantly increased by the beginning of 21st century. Since the existed reserve levels could not meet the increasing energy requirements, it cau sed energy crisis. Scholars opine that this energy crisis has also played a vital role intensifying the crisis. Davies (2009) argues that the irresponsible and passive trade room practices have also contributed to the crisis. Many of the economists are of the opinion that severe feeding problems or food crisis are also factors that fueled the global financial crisis. However, the major cause of the 2007 global economic crisis can be directly