Food Habits Changing After Food, Inc

The documentary Food, Inc was created to show viewers what is being put on their plates and has given me an altered view towards the food industry which has drastically changed my food habits. Many emotional scenes were shown on this film to give viewers empathy towards the problem that is occurring. The documentary shows many vivid details and explains what is in the food that consumers eat. The film food, Inc influenced my habits of consumption by eating organic meats, purchasing most foods in the farmers market, and checking for food labels. I have learned that there is a big difference in organic and non-organic meats.Animals raised organically are not allowed to be fed antibiotics or other drugs and cannot eat genetically modified foods. Eating organic meats is not only helping animals but also preventing the consumer from a possible disease outbreak that may occur due to the mistreatment of animals. The meat comes from a sustainable farm that uses the manure productively as org anic fertilizer. The manure is â€Å"pure,† coming from animals fed an organic diet which ensures consumers that there will not be any exposure to chemicals. Consumers feel safe knowing that the certified organic meat won’t hurt them in the long-run.Going to a farmers’ market helps consumers because everything is fresh, locally grown, and certified organic which gives the buyer no doubts. When purchasing meat from an organic farm stand at a farmer’s market, consumers support that farm. On the other hand, buying non-organic meat that isn’t local, free-range, or ranch-raised from a supermarket chain will most likely support a multinational food corporation. After the experience change in some of the famers’ supermarkets, I also started realizing the foods tasted better and after eating, I felt lighter and full at the same time.I also saw that costs were higher than the farmers’ markets but it truly made a difference to purchase organic produce and meats. It decreased health risks like diabetes and obesity. Food labels are essential to consumers because they stay alert with what they eat everywhere they go. I have always wondered how many calories are in the food in restaurants as well as other types of foods that I buy at the grocery store. Most restaurants don’t list the actual nutritional value of their food which is why it’s important for consumers’ to remember to check and be aware of what is going to be in their bodies.The film transmits this message to its viewers by showing consumers foods that have glucose and Trans fat than expected. There can be many ingredients or a high number of calories that a consumer may not know about but after looking at a label, it will give the consumer peace of mind or change their mind on whether they will eat it or not. Food, Inc helped me realize and understand that it’s critical for consumers to be cautious about how different foods can affect t heir overall health. This led me to change some of my eating habits such as buying organic meats, which helped me choose my foods wisely.Being aware lets consumers like me stay healthy. Food, Inc taught me a lot about buying organic animal products because it’s better for health, the community, and it can also benefit consumers in the long-run. I would recommend that all consumers watch this film and understand the positive aspects of it because it gives some critical points about the food industry and backs them up with evidence. Food is important for the body and it helps an individual survive every day, but it can also be deadly. It’s all about making the right decisions when it comes to the consumers’ food habits.

Demonstrative Communication Which Includes Nonverbal and Unwritten Communication Essay

Demonstrative Communication is a type of communication that observes non verbal cues. Examples of non-verbal cues include tone of voice, facial expressions, and body language. Demonstrative communication is one where gestures are employed. Better known as non-verbal communication, it deals with the sending and receiving of messages. Demonstrative communication can be formatted by one’s body language, written language, and some non verbal communication that can cause the main point of observe sing the key words of communication which deals with grasping the tone, facial expressions, voice communication which is the main part of communication. When interring the wrong concepts of communication that we all call listen which we do not when it comes to communication. Listen is a nonverbal communication which we all take as misunderstand of communication when sending, and receiving the main point of a message. Demonstrative communication can be ways of success by how well a person communicate with one’s views, and how people use their verbal, or nonverbal communication. The message of demonstrative communication encounters a person’s thoughts of communication that involves the way a person gasps the main points of the sender and the receiver. People have their own ways of processing one’s examples of communication such as listening; asking question to what is verbal or nonverbal of the sender and the receiver. Views has to be very sure of what the sender has produce of the main point of the message, and how well the receiver has listening to the meaning of the message to ensure that there is no misunderstanding of the concepts of the message. Receivers and senders can have positive, and negative meaning of how a message is giving and received because the sender who is producing the message can give some mislead information and the receiver can be mislead also by the wrong information. Using your body sing can also give off wrong sing of the way a person sending a message across to the receiver. The main and most important body sing a person can use when giving a direct message is eye contact so That the views are taken you serially about the most important message of what you are saying.

New product idea Essay Example | Topics and Well Written Essays - 2250 words

New product idea - Essay Example he possibility to easily consume your daily dose of fresh fruit juice at work, at school, †¦ Fruitness offers a small assortment of orange-based fruit juices to match everyone’s taste and it makes for the perfect refreshment during a break from working. The exclusivity of our business model lies in the concept of delivering fresh juices directly to companies. Fruitness will be established as a B.V.B.A. to limit liabilities for the owners. The money that has to be raised to start the business is â‚ ¬ 60.000, financed by five managers. Dividends will not be paid during the first 7 years. Profit will be re-invested in the company to finance internal growth. Some of our major direct competitors are Minute Maid (Coca Cola Co.) and Tropicana (Pepsi Co.). Their main advantages are their size and expertise. Their weakness is their disability to deliver a fresh juice to the market. â€Å"Fruitness provides a solution to increased awareness towards health and better-for-you products. All Fruitness juices are daily made with fresh fruit and delivered within 24 hours. Fruitness’ innovative business model ensures that Fruitness is available at the places where people spend most of their time and energy; at work or at school!† Fruitness produces fresh orange juice, squeezed the first day and directly delivered to the customer the second day. It is made of 100% fresh fruit, without addition of sugar, concentrate, preservatives or use of heat. The packaging consists of a white HDPE (high density polyethylene) bottle that helps maintain high Vitamin C levels (extra 15% retention rate over clear bottles). It is a high quality product aimed at health-conscious consumers. The juice is delivered to companies that want to provide their employees with a fresh, healthy and tasty alternative to the usual soft-drinks. To meet customer demand and taste, Fruitness produces different flavours. It focuses on citrus juices, all with an orange basis: Orange ² (100% orange), Orange & Lime

Reflective Nursing in ctitical care Account of an intubation Essay

Reflective Nursing in ctitical care Account of an intubation - Essay Example That is to say, nursing has a more active role to play in the health care delivery system than the past and nursing, as a profession is 'accountable' today. The patient in this case was admitted for an acute exacerbation of COPD with the complications of Atelectasis and Cor pulmonale. Chronic obstructive pulmonary disease (COPD), also known as chronic obstructive lung disease (COLD), is a term used to describe progressive lung diseases, which include emphysema, chronic bronchitis and chronic asthma.The common symptoms of COPD are progressive limitations of the airflow into and out of the lungs and shortness of breath. Emphysema and chronic bronchitis are closely related and patients with COPD may have both, which affects lung function, preventing the lungs from bringing oxygen to the body and getting rid of carbon dioxide. Atelectasis is a condition where there is a collapse of part or all of a lung by blockage of the bronchus or bronchioles or by very shallow breathing. Atelectasis can be both acute and chronic. Acute atelectasis is the recent collapse of the lung and is primarily notable only for airlessness. In chronic atelectasis, the affected area is often characterized by a complex mixture of airlessness, infection, bronchiectasis, and fibrosis. The most common cause of atelectasis is an obstruction of a large bronchus. Smaller airways also become blocked. The obstruction is caused by a plug of mucus, a tumor, or an inhaled foreign object inside the bronchus. Alternatively, the bronchus is also blocked by a tumor, enlarged lymph nodes, or a significant amount of pleural effusion or pneumothorax in the pleural space. When an airway becomes blocked, the air in the alveoli beyond the blockage is absorbed into the bloodstream, causing the alveoli to shrink and retract. The collapsed lung tissue commonly fills with blood cells, serum, and mucus and becomes infected. Acute atelectasis is a postoperative complication, especially after chest or abdominal surgery. Cor pulmonale is the failure of the right side of the heart caused by prolonged high blood pressure in the pulmonary artery and right ventricle of the heart.The left side of the heart exerts a higher level of blood pressure to pump blood to the body.Whereas, the right side pumps blood through the lungs with a lower pressure. Thus, any condition that leads to prolonged high blood pressure in the arteries or veins of the lungs causes a condition called pulmonary hypertension.This pulmonary hypertension is not tolerated by the right ventricle of the heart and thus fails to properly pump against these abnormally high pressures leading to cor pulmonale.Chronic lung diseases like COPD or other conditions like Obstructive sleep apnea,Central sleep apnea,Cystic fibrosis causing prolonged low blood oxygen can lead to cor pulmonale.The symptoms include shortness of breath,wheezing, coughing, swelling of the feet or ankles,exercise intolerance,chest discomfort, cyanosis,distension of the neck veins indicating high right-heart pressures,abnormal fluid collection in the abdomen, enlargement of the liver,swelling of the ankles and abnormal heart sounds.

Illegal Immigration in America Essay Example | Topics and Well Written Essays - 1000 words

Illegal Immigration in America - Essay Example Throughout most of American history, America has portrayed an existence of invasion, and has stepped foot into almost every battlefield and continent in the world. Taking this aggressive stance towards diplomacy, America should not be able to forget its past, and say that after destroying so much land and taking over so many peoples, it is now not going to let immigration happen. After all, this country was built on immigrants, and to not allow immigrants into this country is simply against all past policies of the United States. To invade so many lands, and then turn the other check and not allow other people into our own country is hypocrisy, and should not be the stance America takes. Even at the start of our own history, Americans looked towards the West. The idea of Manifest Destiny grew up in popular opinion, and people began to push the boundaries of the United States further and further West. This feeling of territorial claim that the United States has to the rest of the fron tier was used to justify many of our territorial expansions. Manifest Destiny "has also been used to advocate for or justify other territorial acquisitions. Advocates of Manifest Destiny believed that expansion was not only good, but that it was obvious ("manifest") and certain ("destiny")" (Manifest, 2007). This idea is still relevant today, when people feel that America has the right, or even the calling to police other areas of the world. However, America tends to expand without thinking or care towards the native people of the land. When America was first being colonized for example, some historians estimate that up to 80% of some Native populations died due to European diseases"(Native, 2007). This apparent lack of disregard continued through American history, as we took over Native American lands and put them on reservations, all trying to further expand our power. But now, when other peoples look to move into this country, we are not allowing them to do so. Even if this country was one taken on behalf of other people. As America continued to grow, so did its outward policies of getting involved in other countries. However, today we will not return the favor by allowing other counties to send their immigrants to our land. For instance, in 1989 the United States intruded upon Panama, disposing a leader we did not approve of. The United States "incursion into Panama began on December 20, 1989, at 0100 local time. The operation involved 27,684 U.S. troops and over 300 aircraft -including the AC-130 Spectre gunship, OA-37B Dragonfly observation and attack aircraft, and the F-117A Nighthawk stealth aircraft and AH-64 Apache attack helicopter, the AH-64 and the F-117A both seeing their first combat deployment. These were deployed against the 16,000 members of the Panama Defense Force" (United,2007). We also set up a new President, a President we approved of. However, we were really justified in taking action in this region Or was the 'father' idea of the United States getting the best of us Either way, i f we were to invade a country, one would think that we would then allow immigrants from that country. However, one can see today that that is not the case, and that America is

Values and Ethics Research Paper Example | Topics and Well Written Essays - 2000 words

Values and Ethics - Research Paper Example My personal mission statement is: to achieve a successful career as an ‘Emergency Medical Technician’ by following my personal ethical values and the professional ethics observed in the organization and the profession as a whole. It is apparent from my mission statement that I seek to pursue a successful career on the basis of my ethical values. I attach significant importance to the ethical values as they form the foundation for a successful career or a successful organization. Along with following my own ethical values through my career, I would also follow the ethical values observed in the profession as a whole and in the organization that I would be a part of. Ethical values hold a very important role in the success of an organization therefore in my career I would opt for organizations that hold strong ethical values and the ethical values that are appropriate in conformity with the overall profession. My personal ethical values that would guide me as a future manager include; professional behavior, objectivity, integrity, accountability, innovativeness, cooperation, encouragement, fairness, equality, and confidentiality. Professional behavior would help me put my best efforts in my career by working sincerely. Professional behavior would also help me conduct the tasks in my professional capacity in a better way. Objectivity means having an unprejudiced opinion and not being biased while making a professional decision. As a manager, objectivity would help me make decisions that are best for the organization as a whole and I would not be influenced by any factors that may impair my objectivity. Integrity would help me conduct my job without any immoral or fraudulent acts. Accountability means being responsible for all the acts conducted in the professional capacity. Due to accountability, I would be responsible for my acts as a manager. Because of being responsible, I would try to conduct my tasks in the best way possible. Therefore, accountability

Financing the Short Term Obligations of The Business Coursework

Financing the Short Term Obligations of The Business - Coursework Example Sources of short term finances available to a business 1. Trade credit – this is also referred as suppliers’ credit, ledger credit or open book account. It is needed when commercial purchases are not to be cleared immediately. In this case the company holds an accounts payable for the amount it owes to the suppliers while in turn running business on not paid for bills. Trade credit varies in length, type of customers and terms prevailing in a particular industry. However, the customer has to forego any discounts that would have been offered on prompt payment. The company can resolve to one month single statement bill or even the open book; this is where they have an extra ten days to clear the bill (Guerard, 2007, 108). 2. Bank loans – companies source for commercial loans from banks in order to meet or cover temporary gross working capital needs. The loan can either be secured or nonsecured. Secured loans have a lien against a company’s asset e.g. invento ry, outstanding receivables et cetera, or a pledge of credit, to back the loan. Unsecured loans are issued depending on creditworthiness of the business. The cost of the loan varies with its size and rates charged on the loan. However, a prime rate is used as a benchmark for these types of loans. Other methods used are revolving line where money is lent on a recurring basis; letters of credit where the bank guarantees by writing, the payment of a company’s overdraft for a given period of time and for specified amounts (Gitman, 2003, 24). 3. Open market commercial papers – these are negotiable notes with maturities from a range of one to nine months which are floated on the market by big corporations. Commercial paper dealers sell the issues to pension funds, smaller commercial banks, corporations, insurance companies to raise funds. The rates on commercial papers are however, below the prime rate for loans. The advantage to the company using commercial papers for borro wing funds is that the issue is widely distributed in the national market. This frees the company from relying on commercial banks. 4. Finance companies and factors – large commercial companies are deemed as the departmental stores of the financial world. These companies have subsidiaries or branches where they practice direct sales financing. They are in close contact with dealers of their merchandise therefore can offer goods to be paid for on installments. Their rates are much higher than commercial banks. Factoring arrangements are based on an advance of funds to a company by the factor against an assignment of trade receivables. An agreement is signed between the two companies to govern their relation. This is usually on a continuous basis depending on the terms applied by the two companies. Nonrecourse factoring allows the factor to buy the accounts of the company and takes up the losses thereto. However, in recourse factoring, the factor does not take up the loss on ba d accounts. Either case, factoring charges are based on a firms daily balance, general interest rate, specific factoring agreement and outstanding credit (Guerard, 2007, 115). Question two a) Financing Mark and spencer uses short term borrowings from banks and medium term notes to source for funds. Trade credit has been used for meeting financial obligations. Morrison on the other hand, has applied trade credits, borrowings from banks to source for short term funds. b) Liquidity ratios liquidity ratios for Mark & spencer Current Ratio = Total

Franchisees are an important source of innovation Article

Franchisees are an important source of innovation - Article Example Next, it contemplates on how innovation has become a complex question and tries to explain it through the various models of innovation. Lastly, the various sources through which a franchising organization can practice innovation have been discussed. The franchising organization is one in which the franchisee has purchased the rights to use the business methods, ideas and values that the franchisor has built for his company, organization, product or shop. It is like a person sells his business philosophy to another. The franchisee usually opens up the franchise in some other geographical location than the one where the original brand exists. This actually lays the foundation for the franchisee to use innovation within the franchise. When the franchise will be in a different geographical location, the customers who will be coming to that franchise will be totally different, culture-wise, social-wise, and behavioural-wise. Thus, to bring changes within the franchise system would become easy. Examples of franchises are McDonalds (the food industry), Benetton (the clothing industry), the Starbucks (the food industry), television shows like Pop Idol, Who Wants to be a Millionaire (the media industry), Body Shop (the cosmetics industry), Onebiz Group (consultancy franchisee) and others. Therefore, be it be any industry, the franchising option is available to all and sundry. This is because franchising is a form of business beneficial to both the franchisee and the franchisor. The franchisee-franchisor relationship is complex, yet it is made up of basic components. Some of the basics of the brands of the franchisor need to be the same, so as to not eliminate the essence of the original brand. The various rights that the franchisee gets are that he can distribute the products of the franchisor, use the same techniques which they use to produce the products or market them. Moreover, even trademarks and patents are shared, since the franchisee becomes a representative of the franchisors product in some other geographical region. But when it comes to the invaluable intangible goods like trademarks and patents, the franchisee has to pay a certain amount of monthly fees for using them. This fee is separate from the fees that has to be paid for such rights in the first place. (Cox, 2007) Training is also one of the major things which the franchisor makes available to the franchisee as part of the rights that he gets. The franchisee-franchisor agreements will co ntinue for minimum five years and maximum thirty years, after which the agreement will have to be renewed, if felt suitable by both the parties. In cases where the franchisee does misuse of the rights granted to him by the franchisor, the agreement has such clauses through which it can be easily terminated, for the benefit of the franchisor. INNOVATION In a world of intense competition, where companies are going global and where numerous companies are making strenuous efforts to get the attention of the consumer, it is immensely important to differentiate oneself from the rest so as to become noticeable. Consumers are the one who decide the brand or the company which is the market leader. It is the sales of the product which will ultimately make a product gain market share and then declare itself as the market leader, chosen by the customers themselves. For this purpose, it is extremely essential to get inside the minds of the consumer so as to

Creativity, innovation Essay Example | Topics and Well Written Essays - 1000 words

Creativity, innovation - Essay Example It can also include the effect on the local community who might have to live in the shadow of their premises, and how they engage with the community, their customers and workforce. Social Accounting helps organizations to investigate its performances in relation to social, environmental and economic objectives ensuring that organizations core objectives are met in doing so. Focusing on the automobile Industry, almost all the large brands ensure that the keep CSR at par which includes Sustainability Reporting along with the Financial Statements. Most companies in the sector have CSR policies implemented throughout their operations including proper management system for the same. Following is the comparison of two of the industries’ brands; namely Toyota and Honda. Toyota has implemented a CSR policy throughout its operations that is based on the company’s Guiding Values. Furthermore, the company has also implemented a separate policy on Biodiversity, as well as a Code of Conduct, a Global Vision for 2020, and the Toyota Way 2001, which outlines the expectations of how employees should behave. It also has an environmental plan of action that includes design production and recycling. Toyota has a separate CSR department, as well as a CSR committee that includes members of the executive board. The company is a member of the World Business Council for Sustainable Development (WBCSD), but does not mention any of the relevant international standards in its international CSR report or CSR policy. Several regional divisions also publish their own annual CSR reports in accordance with GRI standards. Toyota annually produces its sustainability report including environmental aspects, social aspects, and economic aspect. â€Å"Its environmental aspect addresses Energy/ Global Warming, Recycling of resources, Substance of concern, Atmospheric Quality, Environmental

Trans-Disciplinary Integrated Knowledge Essay Example for Free

Trans-Disciplinary Integrated Knowledge Essay Trans-disciplinary integrated knowledge (TIK) is one dimension in which the universities of the world should look to for effective future coping for empowerment of talent. TIK is a very critical area in the present scenario because of changing trends in the flow of information and the related technologies in industry and services. Today more innovative teaching and learning processes are needed. There is a need to find a common ground on which all important disciplines such as engineering, social sciences, humanities, and so forth can see an association between each other to address the complexities of globalization. With this view in mind, it may be inquired how finding this common ground for trans-disciplinary collaboration can be possible. For this very reason, Ramalhoto (2006), tells us that at present it is positive to find chief executive officers of some multinational companies who now demand foresight and not hindsight. Today, they are not looking for marketing planners but for market strategists. To most CEO’s of modern companies globalization demands for diversification of culture and sees enterprises as a source for value creation. Thus it is important to look at things more holistically now than ever before to compete in the climate globalization especially considering the technological and scientific changes, which is possible by integration and interaction â€Å"across all relevant knowledge areas†. This is where the important of TIK falls in. The author further informs that it is a misconception to state that corporate demands and such media as the Internet and ICTs have decreased the demand for developing universities; indeed, empowerment of talent in globalization â€Å"calls for specific innovation inside the [university institutions] to address its new basic function: to teach students to be critical about all kinds of information† .

Methods Of Waste Management And Recycling Environmental Sciences Essay

Methods Of Waste Management And Recycling Environmental Sciences Essay Waste management means collecting, transporting, processing, recycling and monitoring of the waste materials. The term waste management generally relates to those materials which are produced by human activity and is usually undertaken to reduce the effect of these activities on their health and environment. Waste management is also useful to recover useful resources from the waste. Waste management involves all solid, liquid and gaseous or radioactive substances which are managed with different methods and expertise is required for each of them. Waste management practices are different for different countries of the world be it developed or developing nations. The management is different for urban and rural areas, for residential and industrial waste producers. Management of residential and institutional waste in cities and metros is done by the local government authorities or what we call as Municipal Corporation, while management of non-hazardous commercial and industrial waste is done by the generator of such waste. Solid waste Management Plasma gasification Plasma is a highly ionized or electrically charged gas. An example in nature is lightning, capable of producing temperatures exceeding 12,600  Ã‚ °F (6,980  Ã‚ °C). A gasifier vessel utilizes proprietary plasma torches operating at +10,000  Ã‚ °F (5,540  Ã‚ °C) (the surface temperature of the Sun) in order to create a gasification zone of up to 3,000  Ã‚ °F (1,650  Ã‚ °C) to convert solid or liquid wastes into a sun gas. When municipal solid waste is subjected to this intense heat within the vessel, the wastes molecular bonds break down into elemental components. The process results in elemental destruction of waste and hazardous materials According to the U.S. Environmental Protection Agency, the U.S. generated 250 million tons of waste in 2008 alone, and this number continues to rise. About 54% of this trash (135,000,000  short tons (122,000,000 t)) ends up in landfills and is consuming land at a rate of nearly 3,500  acres (1,400 ha) per year. In fact, landfilling is currently the number one method of waste disposal in the US. Some states no longer have capacity at permitted landfills and export their waste to other states. Plasma gasification offers states new opportunities for waste disposal, and more importantly for renewable power generation in an environmentally sustainable manner. Landfill Disposing of waste in a landfill involves burying the waste, and this remains a common practice in most countries. Landfills were often established in abandoned or unused quarries, mining voids or borrow pits. A properly designed and well-managed landfill can be a hygienic and relatively inexpensive method of disposing of waste materials. Older, poorly designed or poorly managed landfills can create a number of adverse environmental impacts such as wind-blown litter, attraction of vermin, and generation of liquid leach ate. Another common byproduct of landfills is gas (mostly composed of methane and carbon dioxide), which is produced as organic waste breaks down anaerobic ally. This gas can create odour problems, kill surface vegetation, and is a greenhouse gas. Design characteristics of a modern landfill include methods to contain leachate such as clay or plastic lining material. Deposited waste is normally compacted to increase its density and stability, and covered to prevent attr acting vermin (such as mice or rats). Many landfills also have landfill gas extraction systems installed to extract the landfill gas. Gas is pumped out of the landfill using perforated pipes and flared off or burnt in a gas engine to generate electricity. Water Treatment Water treatment means all those processes which are used to make water acceptable for a desired end-use. These include use of water for drinking, medical, industrial processes and many other uses. The goal of all such water treatment is to remove the contaminants present in the water or reduce the concentration of contaminants so that the water becomes fit for consumption. One meaning to it is returning water to its natural environment without adversely impacting the ecology. The processes for treating water for drinking purpose can be solids separation by using physical processes such as settling and filtration, and chemical processes such as disinfection and coagulation and Biological processes if required. In general the process includes: Pre-chlorination for algae control and arresting any biological growth Aeration along with pre-chlorination for removal of dissolved iron and manganese Coagulation for flocculation Coagulant aids, also known as polyelectrolyte to improve coagulation and for thicker floc formation Sedimentation for solids separation, that is, removal of suspended solids trapped in the floc Filtration removing particles from water Desalination Process of removing salt from the water Disinfection for killing bacteria. There is no unique solution for any type of water. Also, it is difficult to standardize the solution in the form of processes for water from different sources. Treatability studies for each source of water in different seasons need to be carried out to arrive at most appropriate processes. Sewage treatment is the process which removes the majority of the contamination from wastewater or sewage and produces both a liquid effluent suitable for disposal to the natural environment. To be effective, sewage must be conveyed to a treatment plant by appropriate pipes and infrastructure and the process itself must be subject to regulation and controls. E-waste management Electronic waste is defined as all the secondary computers, entertainment devices, mobile phones, all other items like television, refrigerators, whether they are sold or donated or discarded by their original owners or users. In simple terms all those items mentioned above which are either dumped or disposed or discarded by their buyers rather than recycling and reusing them is called E-Waste. A major portion of this waste is generated through products like personal computers, laptops etc. According to recent estimates about 50 million tons of E-waste is produced each year around the globe. The USA alone discards 30 million computers each year and nearly 100 million phones are discarded in Europe each year. The reasons for these huge figures are that there are the rapid changes in technology, low cost of the product initially which encourages people to buy new instead of repairing and reusing and also the cost of modifying the features is much more than the original cost. Moreover t he electronic goods today are made in such a way that they follow something called as planned obsolescence which means they get obsolete with the passage of time. Electronic waste processing first involves dismantling the equipment or the electronic item into various parts i.e. metal frames, circuit boards, power supplies, plastics etc. and this is often done manually. The advantage of this process is that humans have the ability to recognize and save those parts which are working and are repairable which includes chips, RAM, transistors etc. The disadvantage of this process is that the labour might often be expensive in those countries which have high health and safety standards. An alternative to this is called bulk system; wherein a hopper conveys material meant for shredding into a very sophisticated mechanical separator which has screening and grinding machines to separate the constituents of metal and plastic fractions. These plastic fractions are then sold to plastics recycle rs or smelters. Emissions are caught by the scrubbers and screens. To separate glass, plastic, harmful and unharmful metals; magnets and eddy currents are used. Copper, gold silver, tin etc. valuable metals are sold to smelters for recycling purpose. Hazardous smoke and gases are captured, and then treated to remove the environmental threat. An ideal electronic waste recycling plant is one which combines dismantling for recovery of its components with increased cost-effectiveness of processing of bulk electronic waste. Reuse is an alternative option to recycling because it extends the life of the device. Recycling Reduce, Reuse, Recycle are known as the 3R of the waste hierarchy. Recycling involves processing used materials into new products to prevent waste of potentially useful materials, reduce the consumption of fresh raw materials, reduce energy usage, reduce air pollution and water pollution by reducing the need for conventional waste disposal, and lower greenhouse gas emissions as compared to virgin production Recycling is a key component of modern waste reduction and is the third component of Recyclable materials include many kinds of glass, paper, metal, plastic, textiles, and electronics. Although similar in effect, the composting or other reuse of biodegradable waste such as food or garden waste is not typically considered recycling. Materials to be recycled are either brought to a collection center or picked up from the curbside, then sorted, cleaned, and reprocessed into new materials bound for manufacturing. Recycling Saves money, energy, trees the planet Earth. In a strict sense, recycling of a material would produce a fresh supply of the same material-for example; used office paper would be converted into new office paper, or used foamed polystyrene into new polystyrene. However, this is often difficult or too expensive (compared with producing the same product from raw materials or other sources), so recycling of many products or materials involve their reuse in producing different materials (e.g., paperboard) instead. Another form of recycling is the salvage of certain materials from complex products, either due to their intrinsic value (e.g., lead from car batteries, or gold from computer components), or due to their hazardous nature. Critics dispute the net economic and environmental benefits of recycling over its costs, and suggest that proponents of recycling often make matters worse and suffer from confirmation bias. Specifically, critics argue that the costs and energy used in collection and transportation detract from (and outweig h) the costs and energy saved in the production process; also that the jobs produced by the recycling industry can be a poor trade for the jobs lost in logging, mining, and other industries associated with virgin production; and that materials such as paper pulp can only be recycled a few times before material degradation prevents further recycling. Proponents of recycling dispute each of these claims, and the validity of arguments from both sides has led to enduring controversy Recent developments: Jamshedpur Utilities Services Company (Jusco), which is a fully owned subsidiary of Tata Steel, recently bagged the Municipal Solid Waste management contract for Mysore city from the Mysore City Corporation and Municipal Solid Waste (MSW) management contract under the Kolkata metropolitan area for six municipalities. Under the project Jusco will construct 5transfer stations and 6 compost plants in the municipalities of Champdani, Baidyabati, Serampore, Rishra, Konnagar and Uttarapara-Kotrung which fall under Kolkata Metropolitan Development Authority (KMDA). The Rs 39 crore projects will be funded by Japan International Cooperation Agency (JICA). Jusco offers integrated solutions to municipal waste management which comprises of waste transfer, transfer station management, composting, engineered structured landfills, integrated waste recycling and reclamation, recycling of municipal and specialized wastes, etc. The utilities major also bagged the TPM Excellence A ward -2008 instituted by the Japan Institute of Plant Maintenance (JIPM) and has several other national and international awards like National Urban Water Awards (NUWA) in the citizen services governance category for 2009.

Role of Women in the Epic of Beowulf Essay -- Epic of Beowulf womenbeo

Role of Women in Beowulf As an epic tale of heroes and monsters, Beowulf gives its readers much excitement and adventure, but Beowulf's importance is more than just literary. It offers many insights into the beliefs and customs of seventh-century Anglo-Saxon culture. Among these insights is the Anglo-Saxon view of women and their role in society. Good Anglo-Saxon women are peaceful and unassertive, greeting guests and serving drinks to the warriors and other men in the meadhall. Wealhtheow, the queen of the Danes, represents a typical subservient Anglo-Saxon woman. As a foil to Wealhtheow, Grendel's mother is a strong and combative monster whom Beowulf must kill. By analyzing these two characters in Beowulf, we can understand the treatment and mistreatment of women in Anglo-Saxon society. The author of Beowulf generally supports the traditional Anglo-Saxon views of women by praising Wealhtheow, condemning Grendel's mother, and showing the need to suppress feminine forces like Wyrd; however, he does offer som e criticism of these views by creating sympathy for Grendel's mother, allowing Wealhtheow to assert herself in the interest of her husband and children, and revealing masculine fear of feminine power. The author creates Wealhtheow to embody the role of a traditional Anglo-Saxon woman, and he presents this role as the only appropriate one for Wealhtheow to fulfill. She serves as a peacekeeper in the ever-tumultuous Heorot meadhall. When the author first introduces Wealhtheow to his audience, she immediately falls into her role as peaceful greeter and cocktail waitress. The author writes, "Then Wealhtheow came forth / folk-queen of the Danes daughter of Helmingas / and Hrothgar's bedmate. She hailed all of them / spo... ...st darkness" (l. 73) to restore peace and order. Wyrd works to bring disorder and doom to Beowulf and the warriors of Heorot, just as Grendel's mother wages her war of destruction and death on Hrothgar and his kingdom. Beowulf subdues Grendel's mother permanently by killing her, but Wyrd can only be avoided temporarily, not destroyed once and for all. This suggests that the struggle against female authority and uprising is timeless, and the only way to deal with this problem is on an individual basis. The author's views on women may never be fully revealed, but it is clear that he believes in male superiority and that insurgent females ought to be suppressed. Like Wealhtheow, females should only exert minimal power and influence, but they should always keep the drinks coming. Work Cited Beowulf. Trans. Frederick Rebsamen. New York: HarperPerennial, 1991.

Constitutionality of Vouchers and School Choice :: Persuasive Argumentative Essay Examples

Constitutionality of School Vouchers Church and state absolutists believe that vouchers will violate the First Amendment of the Constitution. They argue that voucher systems give parents an incentive to send their kids to parochial school and thus represent an unconstitutional endorsement of religious education. As mentioned in the case study, the U.S. Supreme Court will address the Cleveland Scholarship Program's constitutionality. Many are anticipating what precedent will be set in this ruling because it inherently deals with defining the boundaries between church and state. Can taxpayer funds be allocated by the government to send children to a religiously-affiliated school? Consider the case of the Cleveland Scholarship Program. This program gives parents $2250 per year. Meanwhile, the cost of tuition at a religiously-affiliated private school is, on average, about $1200. The cost of tuition at a non-religious private school is, on average, about $5000. This price breakdown shows the implicit incentive in the Cleveland program--parents who cannot afford to pay more money out of their pocket will enroll their children in religiously-affiliated private schools. The founders of Cleveland's program argue that city parents are in no way encouraged to send their kids to religious schools. Parents can choose public magnet or charter schools, which are free and get far more funding per student than voucher schools. The importance of the Supreme Court decision that will be made should not be underestimated. "This is probably the most important church-state case in the last half-century," said Barry W. Lynn, executive director of Americans United for Separation of Church and State. "It will be a historic showdown over

Hotel Reservation

I. Statement of Scope and Objectives A. Introduction Technological innovation cause changes in the way people live. They have made lives of people easier, more comfortable and convenient and even hoteliers and services oriented companies find ways how to satisfy their customers, But how these hoteliers manage their transaction with fast and more convenient way. The Columban College Hotel & Resort is founded Dr. Susan P. Alegoria, the Dean of the College of Business Administration, with the recommending approval of the school treasurer Fr. Amado S. Censon and Rev. Fr. Daniel O.Presto the school President to the Board of Trustees – Most Reverent Bishop Florentino G. Lavarias, DD, as Chairman of the Board. Hotel now are having a hard time keeping their files in place. The procedure implemented is slow in billing. Manual handling of information may lead to inaccuracy of information because humans are prone to errors. In their reservation transaction there is a problem in shifting of schedules of the staff because the records is place only in the logbook and sometimes the staff is not aware that there is a reservation in a specific room because of it is difficult for them to find the room immediately.The proposed computerization system can reduced if not totally eliminates the errors that will be encountering. This system provides efficient and precise output because of the transaction for computation of bills. Accessing and updating records in reservation can be done with relative. It would then be easier for this company to go about their work with less effort and high efficiency. For Columban College Hotel & Resort, a manual-based transaction is still applied that serves as their primary system & when it comes to their data management which is record keeping and report generating.Such processes are done using logbooks, worksheets, price lists, calculators and a lot of human intervention. By doing so, the company has been encountering human errors such as i naccurate calculation, when turns out to be an inconvenience for them as it requires greater effort and time. To complement the need for capability to control, it is essential to develop an information system that will serve as the company’s backbone. Background of the Study Columban College Hotel & Resort was built on the premise of putting aLaboratory facility for BSHRM – Bachelor of Science in Hotel and Restaurant Management and BST – Bachelor of Science in Tourism students. After two years of deliberate construction, a five storey, 15 rooms building complete with three star class facilities finally open its doors on April 15, 2004. A team of experts manage and operate the Hotel Laboratory for the students to experience a first class hospitality education, making them equipped and at par with their counterparts.All Laboratory classes/subjects are done in the hotel; Front Office, Housekeeping, Kitchen Operations, Bar Tending/Cocktail Mixing, Baking with Cake D ecoration, International Cuisine, Events and Catering Management, and Culinary Arts. These specialized subjects are taught by experts from the industry and with NC II certification by TESDA. The Columban College Hotel & Resort, is the first educational hotel in Zambales and Bataan Provinces, it is located at Barrio Barretto, Olongapo City. It is ten minutes away from Subic Bay Freeport Zone, thus making it ideal for conferences, retreats and other gatherings.Nestled in the nature rich area of the Barrio Barretto with a spectacular view of Subic Bay and the mountains. This hotel and resort features very affordable room rates; one can choose from standard to deluxe rooms ranging from Php. 1,200. 00 to Php. 3,600. 00. It has function room that can accommodate 200 guests, and dining areas. The swimming pool – a mini –Olympic size pool with kiddy pool with lush tropical gardens and a roof deck overlooking the Barretto campus and Subic Bay will definitely make your stay wort hwhile. As educational hotel and resort, our tradition of impeccable service will make your stay memorable.The Columban College Hotel & Resort continues to set itself apart with its excellence in Hospitality Service and education as evidence by the result of regional culinary skills competition. The existing system in the organization contains many manual operations, including a manual registration and reservation performed by the guest which creates a problem on the receptionists recording the data that has been gathered, manual transactions of payment also created problem in paying the bills in the hotel. The Columban College Hotel & Resort is having a hard time keeping their files in place. The procedure implemented is slow in billing.Manual handling of information may lead to inaccuracy of information because humans are prone to errors. In their reservation transaction there is a problem in shifting of schedules of the staff because the records is place only in logbook and somet imes the staff is not aware that there is a reservation in a specific room because of it is difficult for them to find the room immediately. Another problem also is the marketing of the hotel because of its location and finding the prospect guests. The proposed computerization system can reduced if not totally eliminates the errors that will be encountering.This system provides efficient and precise output because of the transaction for computation of bills. Accessing and updating records in reservation can be done with relative. Reports are being generated depending on the list required by the management. It would then be easier for the company to go about their work with less effort and with high efficiency. B. Statement of the Problem MAJOR PROBLEM: Based on observation and interview done by the proponents, this study identified that the major problems experienced by the management lies on the manual process of all their operation.SPECIFIC PROBLEMS: 1. Slow Process – It ta kes time to prepare a billing report and billing statement of the clients and unable to determine quickly the availability of the rooms in order to assign new clients to their respective rooms because they are still using manual process. 2. Data Security – Their records will get lost or damaged because their data is not secured and sometimes the receptionists overlooks the records of the reservations and assigns different clients on the same room and same date which makes the manual system unreliable. 3.Intensive labor – They have difficulties on searching clients’ records and scanning the log books for the availability of the rooms it also needs effort in order to compute the billing statement. C. Objectives of the Study GENERAL OBJECTIVE: The general objective is to design and develop a Hotel Management System for Columban College Hotel & Resort, Barrio Barretto, Olongapo City. SPECIFIC OBJECTIVES: 1. To be able to develop a system that will speed up the proce ss of operation. The receptionists will have an ease using this system because our proposed system is capable on computing the payments that clients have made. . To be able to secure a program by creating a different user level of security The proposed system will have a capability to create a back-up of the recent database and the records are protected because the only person who can access their records is the receptionists. 3. To be able to develop a system that will ease the job of different user. With one glance the room’s status will be shown whether it is available, occupied and reserved. The receptionists would no longer look throughout all the rooms’ information on the log book one by one. D. Scope and Limitations ScopeThis study will cover the management of the rooms, the system will show the information of the room if it is occupied or available. The system will provide the computerization of the costumers’ total. The system will record the clientsâ⠂¬â„¢ information and the transaction they settled. Limitations The system limits the direct usage of the system by the clients, only the receptionists can operate the system. Editing guest information & transactions can only be made by the receptionists. E. Locale of the Study Figure 1. 0 The Columban College Hotel & Resort is located at Rizal Ext. Barrio Barretto, Olongapo City, near the Columban College, Barretto Campus. F. Significance of the Study This study aims to provide a Hotel Management System for Columban College Hotel & Resort. With regards to the billing of the guest, the system will be responsible in computing their payment and checking the availability of all rooms. Receptionists: They will consume less time and effort interacting with their clients. Having this system, they can easily access or check the status of the rooms depending on its types. And they can easily give the bill of the clients because it was already computed by the system.Clients: Their clients wi ll not have to wait for a long period of time for the room that will be assigned to them and their bill. Company: The hotel will have a better transaction process and ease in their guest management. II. Review of Related Literature and Studies A. Related Literature This chapter is a discussion of the background, aims and objectives of the present study. This chapter deals with the review of related literature. The purpose of the study of research works done in the same field is to understand what type of study has been done and what exactly has been explored before the present research work started.The system provide the reception an easy way for searching on rooms, listing off rooms, inserting the client information, making reservation for rooms and doing payment process. This will be created by four students of Columban College. They are Jon Roel Lasala(BSCS), Kristian Castillo(BSCS), Steven Ocampo(BSIT) and Rosendo Luy(BSIT). B. RELATED STUDIES Foreign Webraydian (2007) asserted that to run a hotel successfully it is important that the hotel management should be good before making any change in the trends one should take a look to every aspects as any changes in the trend also have a wide impact on the diverse industries.Rutherford (2009) asserted that the hotel business should be done in terms of the guest interest as well because of the growing concern over environment friendly service. O’Fallon (2010) asserted that the hotel business is one of the most competitive businesses in the world or the better words is â€Å"most cut throat†. Michael said that hotel reservations software allows hotels and resorts to manage reservation software allows hotels and resorts to manage reservations, set rates, offer discounts and monitor room allocations. Most otel reservation systems include hotel management software, hotel reservation and billing software, hotel reception software and hotel accounting software modules. Global Marketing asserted that comm unicating with all of these channels in order to keep them current on your inventory and rates, requires in some cases, daily manual intervention with multiple faxes and phone calls. More importantly, verifying the accuracy of each channel’s current allotment and rate by property is critical but rarely automated. Most times hotel operators do not know where or how their rooms are being sold or at what rate until the booking confirmation arrives.Waller said that is hotel hotel reservation software is really a necessary need. Pencil and paper booking sheets for example tend to get the job done, yes? That may be so, but also considers that with hotel reservation software, such booking sheets can be printed out, and many software packages can be configured to most any language. Martindale, asserted that another great feature about using hotel reservation is you can select from any hotel in the area that you want to stay at, even of your budget wouldn’t normally allow you t o afford it.With the online system you can browse the different hotels available in the area, and see if they have only a discounted price or if they will allow you to create your own price. This many sound strange, but especially during off peak times many hotel want people to spend something to stay in their room to help increase their annual revenue. Charya, asserted that Hotel Management system helps the hotel administrators to accommodate special request, booking checkouts, etc. They keep sending reminders highlight the important dates for the benefits of the customers.It also gives the hotel administration leverage in terms of making immediate adjustments as and when something unexpected turn ups. Schneider said that room management is simple and cost effective because a guest room management system can ensure maximum user-friendly and cost effectiveness. Assuresoftware. com testified that the management software can help your people get more out of every minute, every hour, a nd every workday. It is designed to boost productivity by simplifying scheduling rooms and resources. LocalValenzuela (2003) asserted that computer-based hotel reservation and billing system can reduce errors that will be encountered. This system provides efficient and precise output because of the transaction for computation of bills. Reports are being generated depending on the list required by the management since computerization of all companies are being encourage; there is need for hotels to adapt computerized operation too. Razal (2004) testified that the reservation and information are essential to attract clients and customers, so when they see that the establishment that can be added to their success.Wong (2004) concluded that reservation system will lessen the work of the employees and would really help them a lot in managing the hotel and it would be much easy to organize all transactions of the hotel. Capistrano (2005) asserted that reservation system enhance the existi ng business operation and give further improvement for the business process. Fuerte (2005) concluded that an application of IT technology in any business firms hold the key to competitiveness towards development and success in the business.Ramirez (2005) asserted that reservation system will benefit not only the company but customers as well, because it will increase the efficiency of the employees working operation. Daduya (2006) claimed that organized and fast retrieval of information computerization of their reservation and registration process is need, for them to have fast and accessible transaction. Mirador (2007) asserted that reservation system is deemed significant because it will be different from the traditional process of reservation.This will reinstate the manual process of reservation which probably creates difficulty for the people the who are responsible in reservation. C. Analysis on Related Literature and Studies As summary, Hotel Reservation System is an advance p rocess of managing hotel reservation; check in, check out of costumers. It is a user friendly and helps the hotel receptionist to accommodate special request, booking, checkouts. They keep sending reminders and highlight the important dates for the benefits of the costumers.Therefore, hotel that uses Computer based system needs to conduct day training for the users/receptionist to be literate in hotel management system and to avoid difficulties in making reservation of costumers. It lessens the time consume doing the hotel reservation. It is a replacement for manual reservation. A system more convenient and user friendly and compiling of files is more accurate and more sufficient than compiling it manually. It is more easy-driven to ensure faster and reliable data by processing of information in database. III. Methodologies A. Methods of Research StudyIn this chapter, the proponents described the method of research used and data gathering procedure, tools and data processing techniq ues. The Proponents used the different gathering materials like internet, books and previous study similar to the proposed study. After collecting and analyzing the data that we gather we found out some of the problems and establish our main objectives that served to be our guidelines for pursuing the system. Those gathered information from questionnaire, surveys and interviews can solved to the problem of the Columban College Hotel & Resort for their manual process. B.Data Gathering Techniques The proponents used the Descriptive Method; it is designed to investigate and to gather information about the present situation. This was the chosen method of the proponents because the method can help the proponents obtain the information they need. There are different ways to gather the information needed for the proponents to understand more about the current system of Columban College and how can the people adjust in the new system that is going to be implemented. The facts and informatio n that was gathered by the proponents was obtained by the use of Observation, Interview and Survey.Observation – this first stage to be done because before doing the interview and survey the proponents needs to observe what kind of environment the locale of the study have, what kind of people is involved and the educational attainment of each people. This technique is very helpful in gathering the needed data because conducting the observation opened some issues and problems that the study will encounter. Interview – by conducting the interview, all the questions and issues of the proponents was brought up and was answered.Interviews were done with the different people who are involves and in-charge of the Columban College Hotel & Resort. Survey – this was used by proponents to determine the percentages of the students who agree and disagree on the proposed system. Using this technique gives the proponents the opportunity to understand the situation of the stude nts in the existing system. The techniques/ways discussed above will not be obtained without the instruments used in data gathering. These instruments were performed carefully and accurately to have a very reliable result in the study.The instruments used to gather the information needed are the Library and the Internet. Library – the proponents used the Library to gather some important information that can help improve the study. It also played a very big part in the study itself; the Library contains a lot of reliable information regarding the study that helped the proponents. Internet – the internet played a vital role in gathering the information needed. The internet nowadays contains information that are not that reliable and accurate, the proponents carefully compared the results and comments of the other readers in the internet to have a result that is reliable.The proponents used survey form as one of the most important method in data gathering. A set of survey questions was given to at least 30 respondents including employee and guests of Columban College Hotel & Resort, who gives the proponents a specific knowledge and help us in identifying the common problems they are facing in a relation to the study. The proponents used Percentile Method to determine the quantities and percentage of the responses in the survey. 1. Sampling Design A project for: Columban College Hotel & Resort Rizal Ext. , Barrio Barretto, Olongapo CityDear respondents, This survey aims to collect data in accordance to the study â€Å"Columaban College Hotel & Resort Management System†. Kindly answer the question honestly and accurately. Please do not leave any statement unmarked. Your response will be highly appreciated. Thank you very much. God Bless! I. Personal Information Name (Optional):_____________________________________________ Age: 12- 16 17- 21 21- 30 30 & above Gender: Male Female II. Questionnaires 1. Is the reservation process on the hotel fast enough? 3D YesNo 2.Was your reservation handled courteously and correctly? 3D YesNo 3. Was the check-in process was timely and efficient? YesNo 4. Was your suite clean and properly maintained? YesNo 5. Were your arrival and departure experiences handled courteously and efficiently? YesNo 6. Do you think that the computerization of the reservation can affect the performance of the hotel? YesNo 7. Did the resort exceed your expectations? YesNo 8. Would you stay at the resort if you were to return to this area? YesNo Letter of Interview Columban College Hotel & Resort Rizal Ext. , Barrio Barretto Olongapo City Dear Sir/Madam:Greetings! We are graduating students of College of Computer Studies taking up Bachelor of Science in Information Technology and Computer Science. Currently, we are enrolled in our Thesis Writing Technology where we are required to design a system for a particular organization or industry. In relation to this, we planned to design â€Å"Columban College Hotel & Re sort Management System† and we are seeking for your assistance for us to conduct an interview and data gathering at your most convenient time. Rest assured that the information that we will get will be treated with much confidentiality.We are looking forward for the consideration that you can give to our request. You may reach us through the following number: 09072316910 or email us at [email  protected] com Sincerely, _________________ Noted by: Jon Roel Lasala ________________________ _________________ Mr. Ronnie D. Luy Kristian Castillo Thesis Adviser _________________ Steven Nicco Carangalan _________________ Rosendo Luy 2. Respondents Figure 2. 0 The receptionist of Columban College Hotel & Resort Figure 3. 0 Readying for interview on Mr.Elmer Callo, Assistant Manager of the CCHR Receptionist The receptionist will be observed by the proponents to know what is the possible problems that are occurring in performing the manual operations in the hotel. Guests The proponents will conduct a survey of how the manual operations of hotel affect the satisfaction of the guests. Administrators The proponents will interview the administrators of the hotel to know what problems they are experiencing in the hotel. C. Statistical Treatment of Data 1. Percentile Method to determine the quantities and percentage of the responses in the survey.Survey forms will be given to the employees and some guests of the Columban College Hotel & Resort. N N Formula: P = f x 100 Where: % = Percentage f = Frequency N = Total Number of Respondents D. Collected Data and Information Result of Survey The results of the survey were discussed on this study and the following questions that were answered by the respondents: 1. Is the reservation process on the hotel fast enough? | | Frequency| Percentage| Yes| 7| 23%| No| 23| 77%| Total| 30| 100%| Table 1. 0 Figure 2. 0 2. Was your reservation handled courteously and correctly? | | Frequency| Percentage|Yes| 17| 56%| No| 13| 44%| Total| 30| 100%| Table 1. 1 Figure 2. 1 3. Was the check-in process was timely and efficient? | | Frequency| Percentage| Yes| 11| 36%| No| 19| 64%| Total| 30| 100%| Figure 2. 2 4. Was your suite clean and properly maintained? | | Frequency| Percentage| Yes| 22| 73%| No| 8| 27%| Total| 30| 100%| Table 1. 3 Table 2. 3 5. Were your arrival and departure experiences handled courteously and efficiently? | | Frequency| Percentage| Yes| 18| 60%| No| 12| 40%| Total| 30| 100%| Table 1. 4 Figure 2. 4 6. Do you think that the computerization of the reservation can affect the performance of the hotel? | Frequency| Percentage| Yes| 28| 93%| No| 2| 7%| Total| 30| 100%| Table 1. 5 Figure 2. 5 7. Did the resort exceed your expectations? | | Frequency| Percentage| Yes| 15| 50%| No| 15| 50%| Total| 30| 100%| Table 1. 6 Figure 2. 6 8. Would you stay at the resort if you were to return to this area? | | Frequency| Percentage| Yes| 21| 70%| No| 9| 30%| Total| 30| 100%| Table 1. 7 IV. Modelling and Technical Ba ckground A. Software Model The proponents adopt the System Development Life Cycle because this will act as the proponent’s guide in creating the proposed system. Figure 3. 0SDLC is a process used by IT analysts in order to develop or redesign high quality software system which meets both the customer and the real world requirement taking into consideration all associated aspects of pros and cons of software testing, analysis and post process maintenance. B. Theoretical Framework This chapter will discuss the different process and methods of creating the needed system of the organization through the guidelines that the proponents created in their researches and findings. This chapter also involves the different phases that will act as guide that will be an essential to the creation of the proposed system.Additional information Additional information PLANNING PLANNING DISCOVEERY DISCOVEERY INFORMATION GATHERING INFORMATION GATHERING REPORTING REPORTING Figure 4. 0 Theoretical F ramework C. Conceptual Framework Proposed System Proposed System Check for room availability Check for room availability Show and compute for the bills Show and compute for the bills Create a back-up for database Create a back-up for database Give the needed information Give the needed information Give the room desired by the client Give the room desired by the client Give the payment Give the payment Client Client Receptionist ReceptionistFigure 5. 0 Conceptual Framework This figure shows the concept of the proposed system, It will tackles how the process of interaction between the receptionist and the guests. 1. Paradigm/IPO Diagram Figure 6. 0 Paradigm The IPO model has many interdisciplinary applications, and is used to convey systems fundamentals in  IT  overview  education  and as a brainstorming, preliminary investigation tool in  systems development processes  such as the  SDLC. V. Systems Analysis and Design A. Systems Analysis 1. Existing System Columban Coll ege Hotel & Resort is currently performing all their process in manual operation. . User Requirements/ Requirements Specifications User Requirements | Developer Requirement| Automated Billing Statement| Create a system that will automatically generate billing statement| Computer-based viewing Room Status| Include the room status in the features of the program| Computer Reservation| Create a Database Management System| Computer-based Check in/out| Create a system that will manage the Check in/out of the clients| Computerized Adding/Viewing of Clients’ information| Create a Database Management System| Table 2. 0 User Requirements 3. Feasibility Study 3. Technical Feasibility Columban College Hotel & Resort is in need of a computer-based system to be able to operate faster and more efficiently. The system project primarily intends to avoid inconsistencies during operation. Also, implying the use of computerized processes avoids inaccurate report of billing amounts and miscalcula tion of transactions. Microsoft Office 2010 offers flexible and powerful new ways to deliver your best work—at the office, at home, or at school. Create standout reports and presentations with tools that help you capture your ideas more creatively.Stay connected to your projects, even when you’re away from your computer, with access to Office files via Web browser or Windows phone. 1  Work efficiently with others by sharing, editing, and reviewing files at the same time—even across geographies and time zones. Adobe Photoshop  is a  graphics editing program  developed and published by  Adobe Systems. Photoshop files have default file extension as  . PSD, which stands for â€Å"Photoshop Document. † A PSD file stores an image with support for most imaging options available in Photoshop.These include layers with  masks,  color spaces,  ICC profiles, CMYK Mode (used for commercial printing), transparency, text,  alpha channels  and  sp ot colors,  clipping paths, and  duotone  settings. This is in contrast to many other file formats (e. g. .JPG or . GIF) that restrict content to provide streamlined, predictable functionality. A PSD file has a maximum height and width of 30,000 pixels, and a length limit of 3 Gigabytes. Visual Basic  is a  third-generation  event-driven programming language  and  integrated development environment  (IDE) from  Microsoft  for its  COM programming model first released in 1991.Visual Basic is designed to be relatively easy to learn and use. Visual Basic was derived from BASIC  and enables the  rapid application development (RAD)  of  graphical user interface (GUI)  applications, access to  databases  using  Data Access Objects,  Remote Data Objects, or  ActiveX Data Objects, and creation of  ActiveX  controls and objects. VBA  is effectively the same language as Visual Basic but VBA-code is tied to Microsoft Office and can only run wit hin that environment. The  scripting languageVBScript  is a subset of Visual Basic. . 2 Economical Feasibility The Economic Feasibility will be the basis if the said proposal is economically feasible; Every company knows that cost is one of the major problems to be considered in making a proposed system, if it affordable or not. However, the only thing that the shop need is hosting the proposed system and it is less expensive. The proposed system just need to acquire an internet connection and have knowledge on computer and it will be possible for them to get their needs and information by just browsing.The economic feasibility will illustrate the expenses needed to be able to implement the proposed system successfully below. Since the Columban College Hotel & Resort has already has a one (1) complete set of personal computer, there is no need to buy a new one. Software Specification Software Components| Description| | Windows 7| | Microsoft Office 2010| | Visual Basic 6. 0| Har dware Specification Hardware Components| Description| | Intel DUAL CORE E5300 2. 6Processor| | INTEL DG41RQ DDR800/ 6CHN/ GLAN/ QUAD/| | 2 GB DDR2 PC800| Hard disk SEAGATE 250GB 7200 SATA| | Monitor AOC9315l 18. 5† Black| | AVR 500 watts| | A4Tech Slim PS2 KBS-720 Black| | A4tech Optical Mouse OP6200 USB| 3. 3 Operational Feasibility Operational feasibility is this will focus whether the system will be productive if it is being developed and implemented. Whether there will be affect from user or there will be possible application benefits. Operational feasibility, this is how the system will solve the following problem or how it satisfies the requirements analysis phase of the development.ITEM| UNIT| PRICE| QTY. | FREQ. (1 Acad. Yr. )| TOTAL| Bond Paper| Ream| Php. 200. 00| 1| 20pcs. | Php. 4,000. 00| Ink| Cartridge| Php. 350. 00| 1| 1| Php. 350. 00| Log Book| | Php. 35. 00| 1| 12pcs. | Php. 420. 00| Total| | | | | Php. 4,770. 00| Table 4. 0 Operational Feasibility Electricity Consumption and Cost Rate/kW = Php. 5. 90 (based on ZAMECO II) Amount = (unit’s watt/1,000kW) *rate *hours usage ITEM| UNIT WATTS(1 Acad. Yr. )| HOURS USAGE| COST| Personal Computer| 225W| 24hrs. (min)| Php. 4,032. 00| Table 4. 1 Operational Feasibility 3. 4 Time FeasibilityTime feasibility will say the schedule if the project being done. And how many months it is being cover. This Gantt chart show how does data gathering being done and even the design phase and maintenance are show in the Gantt chart. Bars show the time being consumed in one task to other task until we fulfil all the requirements needed by the clients. Figure 7. 0 Gantt Chart 3. 5 Feasibility Analysis Executive Summary After the proponents gather all the essential information needed, the proponents is convinced that the proposed system will be feasible in implementing.The proposed system requires both hardware and software components to keep the system running. For the receptionists, the Visual Basic 6. 0 i s needed to run the system. It is important to create a back-up of database to keep the information and transactions safely. Since the needed software and hardware were available in the hotel, the proponents will only now focus in implementing the system to know whether the proposed system will truly help the Columban College Hotel & Resort. 4. Risk Analysis Risk| Source| Action| Risk level|Data corruption through loss or alteration of data without the application’s knowledge and consent| Receptionist error (accidental file deletion)| Recover file| High| | Software bugs (unexpected conditions and responded to incorrectly| Update anti-virus, delete any virus founds| Medium| Data corruption through willful action| Externally, from viruses and worms| Create back-up data| Medium| Acts of God| Earthquake, floods, etc. | Create back-up data| Low| Table 5. 0 Risk Analysis B. System Design 1. Proposed System This research describes an adaption of a hotel reservation system in Columba n College Hotel & Resort.Computer technology has made our lives much easier and convenient. Years ago, people had to manually input important information of their guest, now you just use the computer to find this information. In just one click, instantly find the guest name, rooms & rates, address, email address, phone numbers and so on. By investigating their existing reservation, the guest input the information manually in reservation form. It is hassle for the guest to do a reservation as well as to the receptionist. It is time a waste of time, effort and the things that is needed for the reservation.Proponents will implement the proposed system in Columban College Hotel and Resort. All you need is computer and a user, by just opening the application. It is a very reliable, efficient and convenient. It is much easier to for the receptionist to look at the database and see if the guests are already paid or if the room is already occupied or unoccupied and so on and so forth. 2. Ob ject-Oriented Analysis and Design 2. 1 UML Class Diagram Figure 8. 0 Class Diagram 2. 2 Use Case Diagram System System Check Room Information Check Room Information Input Customer InformationInput Customer Information Update System Update System Edit information Edit information Add Subcharges Add Subcharges Total Payment Total Payment Figure 9. 0 Use Case Diagram 2. 3 Use Case Description Use Case| Input reserved information| Actor| Receptionist| Description| Input data information about room reserved| Trigger| When a customer wants to reserve for room| Pre-conditions| Customers wants to reserve room| Post-conditions| System will be updated| Normal Flow| All information about reservation must be encoded| Priority| High| Frequency of Use| In all guest to booked in the hotel|Table 6. 4 Use Case| Updates System| Actor| Receptionist| Description| Updating of system in every time there is new booking schedule| Trigger| New inputs/booking schedule is given| Pre-conditions| Guest requeste d for room reservation| Post-conditions| Input/information given is updates to the system| Priority| High| Frequency of Use| In all guest to booked in the hotel| Table 6. 5 Use Case| Edit information| Actor| Receptionist| Description| Editing of customer and room information| Trigger| When information needs to be updated| Post-conditions| System will update changes|Normal Flow| Editing is always done when changes are needed to be done in the customer information| Includes| Data Verification| Table 6. 6 Use Case| Total payment| Actor| Receptionist| Description| Adding all the expenses in the information| Post-conditions| Payment will be done according to the total amount| Normal Flow| | Includes| | Priority| | Frequency of Use| | Business Rules| | Table 6. 8 2. 4 System Sequence Diagram 3. Network Diagram/System Architecture Proposed System Proposed System Receptionist Receptionist Database Management System Database Management SystemFigure 11. 0 Network Diagram Network Diagram  is the  conceptual model  that defines the  structure and behaviour of a  system. 4. Database Structure 4. 1 Entity Relationship Diagram 4. 2 Data Dictionary 4. 3 Relational Databases 5. System Interfaces 5. 1 System Inputs Guest Reservation Form This is where the receptionist will input the essential information of the guest, it will also show how much the guest will pay about the chosen room. This is where the additional necessity will be ordered by the guest and the receptionist will process the transaction 5. 2 System Outputs . 3 Process Specifications 5. 4 Integrity Controls All bits of information or data that are gathered in the guest will be stored in the system and its database. Only the receptionist can modify the system in the server through the approval of who might be the one should be approving it. That person who will be approving it will depend on the agreement of the company or policy. 5. 5 Security Controls The proposed system has the capability to back-up th e database of all it saved information. The system will have passwords where only receptionist can access it.Any antivirus programs with high integrity will be used to protect the system. 6. Automation Boundary The proposed system will be about reservation of room accommodation and other services. The system will not be providing automated billing. 7. Initial Gap Analysis The existing system is all about manual operation by filling up form of reservation, unlike the proposed system all you need to do is encode the information. Other advantage of the proposed system its more efficient if compiling reservation form. It is also more accurate in reviewing data information about the previous accommodations.Chapter VI A. Implementation Activities In order to successfully implement the proposed system for Columban College Hotel & Resort, the proponents need to orient the Receptionist, Manager and Owner on how the process of the proposed system works and on how the system should be handled, after orientation and installation the system will be tested and will be evaluated for further revisions or enhancement that are still needed to include on the proposed system. B. Testing 1. Unit Testing The system administrator and other users will be involved in testing the program.The users are allowed to explore the system then let them take notes if there are any flaws in it or if there are anything that needs to improve. Then the proponents will debug the system then re-run the testing for further adjustment and debugging until the system will be fully operational. ALPHA TESTING Alpha testing is a form of preliminary software field test carried out by a team of users in order to find bugs that were not found previously through other tests. The main purpose of alpha testing is to refine the software product by finding and fixing the bugs that were not discovered through previous tests.This indicate the stages of the process how the system response to its given task. The testin g is conducted in order to know how the systems deliver the required response regarding with its performance. Based from the test that has been establish in using alpha testing, the proponents comes up from the first part of testing the system, there were things that must be change. One of the changes that need to be change is the abolishing of the manual procedure of the hotel, 2. Integration Testing 3. Usability TestingAfter all operation testing are done, the Hotel Management System receptionist will seek for questions regarding the improvements of the system. After gathering some information, adjustment or improvements will be done in the system depending on how big are the problems need to be change in the system. 4. User Acceptance Test As all the adjustment or improvements are done, the system will be tested again by the Users and will be re-evaluated if the system already fulfilled the User’s satisfaction. C. Change Request and Error Reports D. Deployment 1. Deploymen t Approaches 2. User’s TrainingIn order for the system to fully-implement in the oraganization, the users must undergo training in order to gain enough knowledge in computer. The training will be about familiarizing in the operating system which is the Windows7 so that the user wil use will know where to go in accessing the system, then the Microsoft Visual Basic. net in order for them to easily understand the environment of the syetm because the system is made through the said software. Then, also most importantly is the users must be trained on how to use the system. The training will be conducted in their free time.In terms of the untoward incident that will happen in the system during the operation, the users are obligued to go out series of trainings for the debugging of the system as well as the system’s maintenace. 3. System Maintenance 1. Problem Report During the previous process, the problems aroused in the system are the following: 2. Manual Changing and Upd ating of records The Hotel’s office consists of many files of the clients and inventories. Since, the office piled up with many files there are many records that needed to be recorded in a new form and add to the database.And also the files are not be placed consequently because the files are only been placed to the filling cabinet in the office. 3. Employees are not Computer Confident The Front Desk Employees does not have sufficient knowledge about computer. Regarding with this, the proponents suggested to have leave and conduct training or seminar. 1. Policies and Procedures Policies Policies may vary depending on the desire of Columban College Hotel & Resort Management, but the proponents suggest the following policies: 1. Only the Admin are in charge of adding, editing and deleting the System Users 2.The system data base should be backed-up every week in case of data crash or other unexpected circumstances 3. The Computer should be place in a nice atmosphere to prevent o verheating. 4. No other employee other than the Receptionist, Manager and owner can directly use the system. 5. In the reservation transaction, down payment is needed in order to confirm the reservation, the receptionist will inform the client that the registration will be cancelled if the guest didn’t arrive 2 hours after the expected time of arrival and the down payment will serve as the registration fee. Chapter VIIConclusion and Recommendation A. Conclusion The Hotel Management System have already been completed. It really made a significant difference as compared with the present existing system of the hotel since it was done through interfaces of computers. The usage of the system truly provides the advancement of technology, towards a fast access of information. The proponents therefore conclude that it is more reliable to make use of the proposed system as it is able to reduce data redundancies and inconsistencies, in which the administrator and receptionist experienc ed while using the existing system.The proposed system is guaranteed to be secured and will make the work of the receptionist faster and more convenient. B. Recommendation The proponents recommend the implementation of the system as it would speed up and make more efficient the processes involved in managing rooms. Full testing before implementation is suggested. The system will not cover how the payment will be done, whether they will use credit card or bank transactions.Stand-alone computer unit is used in the system but in the future purposes the respondents can use two or more computer unit for the manager and the management if needed. The user level must be considered always for the security of the files and every transaction. Because of technology the needed for improvement never stop, therefore the proponents recommend to the next future proponents to add more features to the system to become more useful and to satisfy the future needs of the business.

Management Information Systems in Process-Oriented Healthcare Organisations

Linkoping Studies in Science and Technology Thesis No. 1015 Management Information Systems in Process-oriented Healthcare Organisations by Anna Andersson Submitted to the School of Engineering at Linkoping University in partial fulfilment of the requirements for the degree of Licentiate of Philosophy Department of Computer and Information Science Linkopings universitet SE-581 83 Linkoping, Sweden Linkoping 2003 Management Information Systems in Process-oriented Healthcare Organisations by Anna Andersson Maj 2003 ISBN 91-7373-654-6 Linkopings Studies in Science and Technology Thesis No. 015 ISSN 0280-7971 LiU-Tek-Lic-2003:14 ABSTRACT The aim of this thesis work was to develop a management information system model for process-oriented healthcare organisations. The study explores two questions: â€Å"What kinds of requirements do healthcare managers place on information systems? † and â€Å"How can the work and information systems of healthcare managers and care providers be inc orporated into process-oriented healthcare organisations? † The background to the study was the process orientation of Swedish healthcare organisations. The study was conducted at the paediatric clinic of a county hospital in southern Sweden. Organisational process was defined as â€Å"a sequence of work procedures that jointly constitute complete healthcare services†, while a functional unit was the organisational venue responsible for a certain set of work activities. A qualitative research method, based on a developmental circle, was used. The data was collected from archives, interviews, observations, diaries and focus groups. The material was subsequently analysed in order to categorise, model and develop small-scale theories about information systems. The study suggested that computer-based management information systems in processoriented healthcare organisations should: (1) support medical work; (2) integrate clinical and administrative tools; (3) facilitate the ability of the organisation to measure inputs and outcomes. The research effort concluded that various healthcare managers need the same type of primary data, though presented in different ways. Professional evelopers and researchers have paid little attention to the manner in which integrated administrative, financial and clinical systems should be configured in order to ensure optimal support for process-oriented healthcare organisations. Thus, it is important to identify the multiple roles that information plays in such an organisation. Department of Computer and Information Science Linkopings universitet SE-581 83 Linkoping, Sweden Co n te n ts 1. Introduction †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 1 1. . 1. 2. Organisational and work process models in medical informatics †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 2 Aims of the study†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 3 2. Research methods†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 4 2. 1. The setting of the case study†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 4 2. 2. The data collection†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 2. 2. 1. Archival data †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 2. 2. 2. Interviewing †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 6 2. 2. 3. Diary method †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 2. 2. 4. Observation†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 7 2. 2. 5. Focus groups †¦Ã¢ € ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 7 2. . 6. Feedback loops †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 8 2. 3. Analyses†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 8 2. 4. Modelling†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 9 3. Results†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 9 3. 1. 3. 2. 3. 3. The requirements of healthcare managers for an HIS†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. Interpretation of organisational and work processes in relation to HIS†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 10 A management information system model for process-oriented healthcare†¦. 12 4. Discussion †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 14 5. Conclusions †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã ¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 15 6. Future work †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 15 7. References †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 7 Management Information Systems in Process-oriented Healthcare Organisations 1. Introduction Swedish healthcare organisations are required by law to maintain a holistic view of their processes (Prop. 1999/2000:149). Thus, such organisations need to have an overview of the entire scope of health service delivery. As a result, system thinking is vital (Senge, 1990). An organisation must be able to collect data from its operational processes and furnish health service management with data concerning the way in which th ey have utilised their resources (Kaplan & Norton, 1996). As a response to this imperative, many healthcare providers have begun to introduce process-oriented structures recently. There are a number of theories about how to design such structures. One theory is based on Business Process Reengineering (BPR), the purpose of which is to identify and redesign organisational processes (Davenport, 1993). Another approach is to analyse a healthcare organisation as a Complex Adaptive System (CAS), an interdisciplinary method that focuses on the self-organisation of systems and patterns, as well as the way in which outcomes emerge. The purpose of a CAS analysis is to resolve issues associated with adaptable systems (Zimmerman, Lindberg & Plsek, 2001). Regardless of whether a BPR or CAS approach is employed, process-oriented organisational structures face difficulties stemming from the fact that healthcare organisations operate on multiple levels, including county councils, hospital management, clinical management, and care providers, each with its own information requirements (Andersson, Vimarlund & Timpka, 2002). Each level struggles to survive under difficult economic constraints, limited growth and the constant threat of regulation (Luce & Elixhauser, 1990). Healthcare organisations need an integrated structure in order to quickly disseminate information among managers and care providers (Van de Velde, 2000). The first challenge is to structure information systems such that they support the workflow in a healthcare environment (Strauss et al. , 1985). Thus, it is not surprising that healthcare managers are increasingly seeking help from health information systems (HIS). Their objective is to minimise the overall costs of healthcare delivery, to improve the quality of their services (Greenes & Lorenzi 1998; Clayton & van Mullingen, 1996) and to correlate costs with resources consumed (Stead & Lorenzi, 1999). One option for gathering data in an 1 Management Information Systems in Process-oriented Healthcare Organisations HIS is to use censors and other devices that continuously furnish the healthcare organisation with data about its finances, quality, competence and level of satisfaction. However, before an HIS can be designed, both managers and developers need to be familiar with work routines, information requirements, and other key parameters at the clinical level, given that medical information is linked to the environment in which it is generated (Berg & Goorman, 1999). Thus, the organisation must outline its information requirements and work procedures. The HIS that ultimately emerges will be embedded in the organisation’s processes and must satisfy the care provider’s information needs (Berg, 1999). To sum up, in order to design an HIS in process-oriented healthcare organisations, attention must be paid to issues such as patient focus, cost effectiveness, service quality, adaptability to the constraints of the organisation, and integrated use of information at both the hospital and clinic level (Ovretveit, 1992; Flarey, 1995). Moreover, a holistic overview based on system thinking is vital, including the gathering of data from multiple sources in order to correlate costs with the utilisation of resources. The challenge is to define models that can support the design of an HIS. 1. 1. 1. Organisational and work process models in medical informatics The main purpose of reengineering was to focus on the processes rather than the functions or an organisation (Hammer, 1990). Further organisational enhancement could be achieved with quality methods such as Total Quality Management (TQM), which included process-oriented models. Another approach is to modify the business culture such that it becomes a learning organisation (Senge, 1990). In the financial area, Balanced Scorecard has been used to translate mission and strategy statements into operational objectives and measurement variables (Kaplan & Norton, 1996). When it comes to medical informatics, attempts have been made to design various kinds of organisational models, such as socio-technical modelling (Berg et al. ,1998). The rationale for introducing these models is to gain a greater understanding of the ways in which an HIS will affect the allocation and content of work tasks. Changes in work activities require modification of information management (Berg, 2001). The validity of a technology rests not only on the fulfilment of functional specifications, but also on the interaction of the technical system with its 2 Management Information Systems in Process-oriented Healthcare Organisations organisational environment (Brender, 1998). The resulting conclusion that has been drawn today is that social, organisational, cultural and contextual issues should be taken into consideration at an early stage of the development process (Kaplan, 2001). Moreover, approaches such as cultural-historical activity theory have been used to perform contextual analyses of clinical cognition and activity. Culturalhistorical activity theory argues that studying the present healthcare setting is insufficient – a researcher must also become acquainted with the history of the setting, given that clinical cognition is embedded in broader institutional structures and longstanding evolution (Engestrom, 1995). One method was to highlight patient data on the presumption that the objective of any healthcare organisation is to improve the health of individuals (Engestrom, 1999). Other researchers argue for a framework that allows for a constant interplay of different models, theories and perspectives (Maij et al. , 2002). The advantages of integrated frameworks are that methods and models can be optimised during the development process, while methods with specific weaknesses can be reinforced by others (Timpka, 1995). Finally, there are approaches for exploring the ways in which healthcare providers tend to reason in clinical contexts – such as situated action, an emerging perspective for studying human cognition and behaviour in order to design intelligent systems (Patel, Kaufman & Arocha, 1995). Such models address the clinical tasks that are to be performed within specific guidelines and define criteria for selecting appropriate options when there is a set of potentials (Wang et al. , 2002). 1. 2. Aims of the study The aim of this thesis is to develop a management information system model for process-oriented healthcare organisations, based on two questions: â€Å"What kinds of requirements do healthcare managers place on information systems? † and â€Å"How can the work and information systems of healthcare managers and care providers be incorporated into process-oriented healthcare organisations? The work is based on a circular process, during which models are developed by collecting and categorising data, as well as by designing small-scale theories about information systems. Organisational process is defined as â€Å"a sequence of work procedures that jointly constitute complete healthcare services†. A work 3 Management Information Systems in Process-orie nted Healthcare Organisations activity is defined as a set of work procedures that are closely related by virtue of their purpose and means of performance. A functional unit is the organisational venue responsible for a certain set of work activities. Healthcare Information Systems (HIS), Management Information Systems (MIS) and Information and Communication Technology (ICT) all define computer-based information systems. 2. Research methods A qualitative research strategy, based on an idiographic case study, was employed. Qualitative research, which has evolved within several disciplines, consists of a set of interpretive practices. It does not accord priority to any single methodology for data collection and analysis, nor does it have a theory or paradigm that is distinctly its own (Denzin & Lincoln, 1998). Qualitative research is best suited for understanding the processes inherent to a situation, along with the beliefs and perceptions of the people involved. Nevertheless, qualitative researchers can make their findings more widely applicable (Firestone, 1993). Furthermore, a case study is both a process of inquiry and the product of that inquiry (Stake, 2000). The researcher needs a wide array of information about the case in order to provide an in-depth assessment (Creswell, 1998). A primary distinction is between single-case and multiple–case designs of such studies (Yin, 1994). A case study whose primary mode of research is hermeneutic is idiographic in a natural setting – its main type of data is qualitative and its fundamental level of analysis is holistic (Fishman 1999). Interpretive studies are well served by a considerable degree of openness to field data, along with willingness to re-examine initial assumptions and theories. The result is an iterative process of data collection and analysis during which initial theories are expanded upon, revised or abandoned altogether (Walsham, 1995). 2. 1. The setting of the case study The setting of the study was a paediatric clinic at a county hospital in Sweden. In 1996, the county council adopted a wide-ranging quality program based on TQM and a Plan-Do-Check-Act (PDCA) cycle. In 2000, the county council started using Balanced Scorecard to measure the healthcare organisation’s outcomes. At the time of the study, the county’s development and change program for 4 Management Information Systems in Process-oriented Healthcare Organisations organisational quality was based on a CAS strategy. Furthermore, a processoriented healthcare information system was being designed. With some 30 clinics and 3,200 employees, the hospital had identified its main organisational objectives as the delivery of emergency and specialist healthcare, as well as county-wide rehabilitation and habilitation services. The purpose of habilitation is to enable someone with a congenital impairment, whereas rehabilitation focuses on recovering lost ability. Above and beyond the responsibilities of healthcare managers in accordance with the functional structure, all clinics at the hospital (including paediatrics) had developed work processes for specific groups of patients. These Patient Need Group Processes (PNGPs) centred on the healthcare needs of individual patients. The main objective of the PNGPs was to cultivate and maintain a high level of knowledge about medical care at the paediatric clinic. The scope of the processes varied considerably. However, a PNGP unit always comprised at least a doctor, nurse and secretary. If necessary, several clinics, hospitals and county councils could collaborate on the same process. In order to improve nursing care, development teams, staffed by practitioners interested in development work, were set up. Specific development areas included palliative care and the use of technical equipment. The teams produced documents concerning their specific areas that could prove of value for their co-workers. New work routines were developed for nursing care and for activities that are indirectly related to the patient care process, such as meal delivery, ordering medication and play therapy. The teams had contact people at each ward who were prepared to step in whenever nursing care problems arose. The team members normally attended meetings during their free time – or overlapping time when two shifts were on duty simultaneously. The paediatric clinic also cooperated with maternity wards and a total of 13 Child Health Centres (CHCs) throughout the county. The clinic was part of a network of specialist clinics in southern Sweden that focused on the exchange of knowledge and experience. At the time of the study, the paediatric clinic employed 12 senior physicians, 21 physicians, 91 nurses, 77 paediatric nurses (specialist nurse’s aides) and 13 secretaries. The management team consisted of six senior physicians, seven nurses and one secretary from the clinic. During the period of the study, the paediatric clinic supplied approximately 16,000 bed-days to inpatients, performed 5,000 scheduled surgical interventions and handled 5 Management Information Systems in Process-oriented Healthcare Organisations 6,000 emergency room visits by children. The paediatric clinic comprised one surgical unit and three wards, each with a physician responsible for medical matters and a nurse as manager. The ward for neonatal patients had eight beds for intensive care and ten for prenatal care. The ward for contagious patients had 16 isolation rooms for newborn babies and contagious children. The institutional care ward for children older than a year had 18 beds. The clinic used 15 PNGPs. 2. 2. The data collection The collection of data was conducted throughout documents, archives, interviews, observations, diaries, focus groups and feedback loops. 2. 2. 1. Archival data Archival data was used to place the research into context before, during and after the studies at the clinical site (Drury, 2002). An obvious danger posed by fixed data is that it can easily become outdated unbeknownst to the researcher. In these studies, archival data was related to: 1) annual reports by the clinic; 2) the county council’s quality pronouncements; 3) the government’s bill for the healthcare organisation; 4) the physical and mental health survey of hospital employees; 5) reports concerning the county council’s development plans for an HIS. 2. 2. 2. Interviewing A common interviewing technique is to meet face to face (Fontana & Frey, 1998). The interview may be structured, semi-structured or unstructured. The scope of an interview can range from five minutes to the lifetime of the subject (Fontana & Frey, 2000). This study involved semi-structured interviews with four doctors and four nurses. A series of open-ended questions addressed daily work routines and communication patterns. 2. 2. 3. Diary method The holistic perspective of this approach identifies connections among the individual, societal and organisational levels. One of the techniques that have evolved is the diary method, which proceeds from subjective assessments of time utilisation. The various steps require a practitioner to enter time, activity, Management Information Systems in Process-oriented Healthcare Organisations location, the names of co-workers with whom they interact and other comments during a specified period (Ellegard, Nordell & Westermark, 1999). In this study, a ward nurse kept a diary during one workweek. She entered the nature of her work tasks, the times that she performed them and the names of the co -workers with whom she interacted. 2. 2. 4. Observation Observation involves gathering impressions of the surrounding world. Qualitative observational research is fundamentally naturalistic (Adler & Adler, 1998). There is â€Å"descriptive observation†, in which the researcher assumes that he or she knows nothing about what is going on and takes nothing for granted. He or she employs â€Å"focused observation†, ignoring that which is defined as irrelevant. Finally there is â€Å"selective observation†, the most systematic approach, during which the researcher concentrates on the attributes of various activities (Angrosino & Mays de Perez, 2000). This type of observation requires a notebook, a storage location for the data that is collected during the process (Ely, 1993). The researcher observes and interacts with care providers at the paediatric wards before and after their rounds. Alongside the observations, the clinical staffs were interviewed again about what they were doing, why they were doing it, what they hoped to gain from an HIS and what benefits they expected. Field notes were entered into a log during the observation study. 2. 2. 5. Focus groups A focus group’s planning process should begin as soon as it is set up. The process includes the following steps: establish research objectives, appoint a moderator, develop moderator guidelines and draw up procedures. The moderator plays an important role during the group session. He or she conducts the interviews. It is important that the moderator not be the same person that put together the moderator guidelines and questions. In this study, a focus group session was held with seven nurses and three paediatric nurses, all of whom were women selected by a ward nurse. The participants had various duties at the paediatric clinic, where they had been employed for anywhere from 9? to 32 years. Five nurses were ward managers and two also managed development teams. They all had experience at each ward, as well as the paediatric surgery. The researcher had furnished the group moderator with 7 Management Information Systems in Process-oriented Healthcare Organisations guidelines and questions (Greenbaum, 1993). The questions were based on the clinic’s profile of itself: administrative activities, care provision and development work. Questions also dealt with work activities and the exchange of information with other units. Some questions focused in on a patient’s relations with the care providers, as well as the time and place for the performance of care activities. The entire focus group session was videotaped and transcribed. . 2. 6. Feedback loops Feedback loops throughout the research project permitted the generation of reports for evaluating data collection. A total of four reports were sent to the practitioners as a result of the case study. In addition, four seminars were held with the practitioners, the purpose of which was to discuss the research findings. The practitioners discussed and critiqu ed the results. 2. 3. Analyses There was no theory at the beginning as to how the material should be analysed. The first step was to break down healthcare management into the hospital, clinical and care process levels. Statements from the various management levels were interpreted on the basis of information requirement, i. e. main objectives, system functions, expected benefits and risks to be avoided. The second step was the analysis of three main work activities, each with three work procedures, at the clinic level. The third step involved the design of a management information system model. All empirical data was categorised. Various themes were identified and classified. After the categories had been cross-compared and clustered, abstract new categories were defined (Strauss & Corbin, 1990). The final analysis started with a category-by-category comparison, which enabled the identification of core categories that were sent to the paediatric clinic as a preliminary report for comment and critique (Glaser, 1978). Finally, the categories were modified in response to the comments. The focus was to come up with a context-based, process-oriented description and explanation of the phenomena (Orlikowski, 1993). The categories were incorporated into two small-scale theories. The first theory interpreted the information requirements of three management levels. The second theory interpreted the work processes employed by institutional care. 8 Management Information Systems in Process-oriented Healthcare Organisations 2. 4. Modelling In order to conduct the final analysis, the two small-scale theories were applied to the modelling of a management information system. Various possible approaches included data modelling (Connolly, Begg & Strachan, 1996), function modelling and object-oriented modelling (Booch, Rumbaugh & Jacobson, 1999). To handle such approaches, various modelling languages have been developed, including the object-oriented Unified Modelling Language (UML) (Fowler & Kendall 1999). The symbols and notations of the various languages can be difficult for the uninitiated to grasp (Sommerville & Sawyer, 2000). Furthermore, the notation and logic for modelling a system must work in tandem with the people involved in the development process. Thus, it is useful to visualise the information flow by means of a modelling approach, using notation and logic that have been established by consensus. As a result, the management information system models were designed in dialog with the practitioners in the case study. The notation was taken from Eriksson & Penker’s (2000) business processes but modified on the basis of the discussions. 3. Results The results are presented in accordance with the three sub-analyses. The first sub-analysis focused on the requirements of healthcare managers for an HIS. The second sub-analysis focused on interpreting organisational and work processes in relation to the HIS. The third sub-analysis focused on designing a management information system model for process-oriented healthcare. 3. 1. The requirements1 of healthcare managers for an HIS Hospital management expressed its intention to use an HIS to empower patients while maintaining control of resource utilisation. Thus, the planned HIS was expected to encourage a greater overall awareness of cost effectiveness with respect to the services provided by various units of the hospital. The biggest risk noted was that of a mismatch between the system and the existing organisational culture, in which it was easy to identify and reward employees who handled 1 Requirements and demands are used as synonym in this chapter and in article 1. 9 Management Information Systems in Process-oriented Healthcare Organisations mergencies. As a result, some of the staff appeared to resist a new way of transmitting information throughout the various levels of the organisation. The goals of the functional units (i. e. clinic management) focused on patients and the introduction of leadership based on co-determination. While management accepted patient empowerment and cost effectiveness as the their main objectives, they thought it was important that employees be allowed to make their own organisational decisions. Management wanted to see a new approach to measuring the activities of their organisational unit. In order to achieve these goals, they sought a way to define the data that is essential to making a reliable estimate. In managing the healthcare process, the objectives of an HIS centred on developing and maintaining specific clinical competence by enhancing support for decision-making and co-operation on the part of care providers. While all the process managers agreed that sharing information and knowledge was important to improving the decision-making process, they were unaware of resource competition issues. However, the withholding of information was not always intentional. Due to limited resources and full schedules, process managers were often unable to share their knowledge with other employees. 3. 2. Interpretation of organisational and work processes in relation to HIS Work activities included: (1) co-ordination of information exchange management; (2) care, including documentation of the care provided and the practice that had evolved at the clinic; (3) supply, including patient assistance and psychosocial support. The work procedures of the various activities were often related to and dependent on each other. Co-ordination activities were oriented toward management of the wards and the clinic. The activities focused on co-ordinating various types of information in order to support the care effort. External co-ordination is related to the exchange of information between the paediatric clinic and other care units. This coordination continued after the patients had been discharged from the clinic. Thus, the coordination of external resources and inter-organisational collaboration was important to the management of the clinic. Patient co-ordination started before a patient was admitted to institutional care. There were two 10 Management Information Systems in Process-oriented Healthcare Organisations easons for such approaches. First, the amount of time that patients stayed at the wards proved expensive for the healthcare organisation. Thus, such approaches saved money. Second, these approaches enhanced the relationship between care providers and caretakers, assuming that patients and their families were kept well informed. Internal co-ordination was related to management and planning activities at the clinic and the wards. Such activities were linked to external and patient co-ordination, given that providers needed to cooperate with other units and patients in order to manage ward care. Care activities were underpinned by what had been agreed upon during the coordination of work activities and the information that was to be used by various co-ordination procedures. Care provision involved medical and nursing care performed by physicians, nurses and paediatric nurses. Care activities were broken down among the various professions. But care was regarded as teamwork from the point of view of the patients. Thus, the work tasks of the various professions cumulatively became what are referred to as the outcome of care provision. Practice development took in both medical and nursing care issues. The knowledge and information cultivated was incorporated into the ordinary work routines of the paediatric clinic. Care documentation activities were linked to care work and development efforts. Documentation provides protection for both care providers and patients. Care documentation served as a means of communication among care providers. Supply activities were indirectly related to care activities. Among employees who performed supply activities were nurses, paediatric nurses, kitchen staff, cleaning staff, play therapists and teachers. Material provision furnished care activities with pharmaceuticals, equipment and materials. Based on the resources that material provision furnished to care activities on a daily basis, estimates were prepared concerning the resources the activities would require over time. Bandages, diapers, syringes, etc. were also a part of material provision. Material provision also included equipment and supplies for play and school activities, such as games, videotapes and textbooks, as well as kitchen and cleaning supplies. Psychosocial support activities called for an information system that could offer emotional support, such as administrative tasks associated with permitting patients to have their own personal phones. Thus, psychosocial support depended on the ability of patient co-ordination efforts to proceed smoothly, assuming that both patients and their families could be kept well 11 Management Information Systems in Process-oriented Healthcare Organisations informed. The main purpose of Patient assistance, which included both material provision and psychosocial activities, was to assist care activities. Such activities were related to supporting the physical and mental well-being of patients while undergoing medical and nursing care. 3. 3. A management information system model for process-oriented healthcare The county council formally required that hospital management monitor and report on service production with regard to quality and cost. As a result, hospital management needed data about resource utilisation and healthcare quality from the hospital organisation, along with information systems that could support methods such as Total Quality Management (TQM) and Balanced Scorecard. To monitor costs and quality, hospital management needed data from the functional units after determining what needed to be collected. The focus of process management was developing and maintaining a high level of quality in the medical and nursing care processes. The process unit was responsible for documentation and quality control operations. Process management needed directives from the functional management unit about both data collection templates and quality for medical and nursing care. Process management generated information about medical and nursing quality data for functional unit management. Best practice guidelines and decision support protocols for clinical practitioners were involved in the clinical process. The HIS application required by process management was a service quality control system that could extract data from and support decision making for medical and nursing care. Functional unit management comprised managers at both the clinic and ward levels. Clinic management organised the monitoring of the clinic’s resources, while ward managers co-coordinated the exchange of information at the wards. Functional unit management requested information about resource allocation specifications and templates for expenditure reports, as well as for patient satisfaction and staff work satisfaction data, from hospital management. Functional unit management needed data concerning the perceptions of patients and staff with regard to the services provided by the unit. Management was also looking for a way to relate its expenditures to resources utilised. In other words, its primary needs were in the areas of data collection, storage and access tools. 12 Management Information Systems in Process-oriented Healthcare Organisations Thus, functional unit management required data from clinical activities, but not at an individual or contextual level. The systems it was seeking were to supply data for use at a composite level, including the volume of financial and human resources that specified care activities necessitated. To monitor service delivery, management units in process-oriented healthcare organisations need data in three distinct areas: (1) medical and nursing care, (2) patient flows and (3) the utilisation of human and material resources. Although the management units may have access to a common data warehouse, requirements for data analysis and presentation vary considerably. Similarly, data collected from the healthcare organisation during daily work routines can be shared, but the primary data must be converted into a format that is usable by healthcare managers. The data that is collected should ideally be located where it can be made available to ordinary healthcare activities. For instance, networked devices can be used to monitor pharmaceutical use. Intelligent devices can also be connected to equipment in order to track their use, and material storage and use (diapers, sheets, etc. ) can be traced by bar-code systems. Furthermore, patients and healthcare staff can be registered with smart cards as they come and go. However, computerised patient records (CPRs) are the most logical central resource for data collection in the clinical setting. The data that is documented in the records can be used to monitor the clinical activities that have been performed. CPRs can also furnish data about work activities at the healthcare organisation. Such data is of little value as long as it is limited to individual patients. What is useful is to analyse cumulative data, such as the number of radiology examinations that have been conducted on leukaemia patients. The purpose of the data warehouse is to store what has been collected from various sources. The application and its interface are the parts of the HIS with which healthcare managers interact and with which users most readily identify. Thus, the application must help healthcare managers use information and must supply the right information to the right healthcare managers. Moreover, the application must support the specific analysis methods, tools and data formats required by current organisational analysis procedures, such as Balanced Scorecard and quality assurance methods. 13 Management Information Systems in Process-oriented Healthcare Organisations 4. Discussion The aim of this thesis was to develop a management information system model for process-oriented healthcare organisations. The research effort employed qualitative methods such as archival data analyses, interviews, observations, diary analyses and focus group analyses. Constant feedback loops among the participants in an idiographic case study helped establish a balanced interpretation. Meanwhile, categorising and modelling formed the pattern of interpretation for the management information system model. The main findings of the study are that an HIS in a process-oriented organisation must support the medical work, integrate clinical and administrative tools, and furnish information that allows for the measurement of organisational inputs and outcomes. As a result, it is important to identify the multiple roles that information plays in a process-oriented healthcare organisation. Most of the organisational development methods that healthcare currently takes advantage of, such as reengineering and quality management, include process definitions. However, the interaction between various groups of processes has seldom been analysed. Several recent organisational methods, such as Balanced Scorecard (Kaplan & Norton, 1996), address the problem of relating costs to resources. The areas in which information systems are expected to enhance care delivery range from access to medical knowledge bases, patient and clinician communication, and the minimisation of medical errors. Nevertheless, little attention has been paid to how integrated administrative, financial and clinical systems should be configured in order to support process-oriented healthcare organisations in an optimal manner. Internal co-ordination is informed by and dependent on documentation of care activities, particularly by monitoring the way in which human resources are harnessed to take care of patients. Furthermore, such co-ordination relies on information about the utilisation of material resources, i. e. durable equipment and disposables. Thus, internal coordination must obtain information from care activities in order to synchronise the work of the clinic, as well as to track costs associated with care and supply activities. The various processes monitor costs and allocate resources, relating them to the kinds of care activities that have been provided. 4 Management Information Systems in Process-oriented Healthcare Organisations The third sub-analysis discovered that the various management levels in process-oriented healthcare organisations need the same type of primary data, though in differing formats. An HIS for healthcare management in a processoriented healthcare setting can adhere to its structure and practice activities. Moreover, CPRs and other tools can be used to directly collect management data where and when the activities take place. But the data is useful only if healthcare management has the opportunity to examine it with its own analysis tools. For instance, while computerised ordering systems are regarded as important, the fit between organisational and information system models is not identified as a success factor. Clearly, there is a need for systems that optimise clinical workflow, as well as those that support the maintenance of equipment and supplies. However, systems provide optimal organisational value only if they support an integrated organisational model and business plan. 5. Conclusions This thesis points out that healthcare managers at different levels in an organisation all need the same primary data. The differences among the various management levels all concern the ways in which they compile the data that they need for their work. One problem when developing management information systems for healthcare organisations has been a lack of interest in integrating administrative, financial and clinical systems. In process-oriented healthcare organisations, integration is essential to obtaining the full benefits of such a structure. System thinking must also pervade the development of healthcare management information systems. As a result, the multiple roles played by information in process-oriented healthcare organisations must be identified. 6. Future work Identifying the multiple roles played by information in a process-oriented healthcare setting requires additional research about the process of designing an HIS. In the complex environment that healthcare organisations represent, various practitioners are required to pinpoint data sources and information 15 Management Information Systems in Process-oriented Healthcare Organisations requirements, as well as to advocate for the process of change in the organisational and information structure. Healthcare managers have differing preferences when it comes to information requirements, organisational processes and work activities. Thus, the development process relies on tools that can incorporate those divergent needs into system thinking. As a result, primary data is refined into information differently at the various levels of a processoriented healthcare organisation. More research is required concerning information system models and their notation. Though various groups (system analysts, designers, programmers and healthcare managers) can employ models and modelling activities during a development process, their objectives differ. Healthcare managers need to visualise their work environment and organisational processes, system analysts are interested in developing information systems in collaboration with designers, and programmers are looking for coding specifications. They may share a vision in terms of designing a healthcare information system, but their perspectives vary. Thus, the modelling effort should be based on at least two dimensions: (1) furnishing models with notations and objectives oriented towards specific groups; (2) ensuring that the models visualise the same system but address varying interpretations. Arguments based on the cognitive and practice perspective have identified prototyping as a fruitful approach to the development process (Houde &Hill, 1997). Prototyping is often used when the design calls for a high degree of involvement on the part of practitioners and end-users (Bodker & Gronb? k, 1991). Modelling, on the other hand, is linked to an organisational perspective and is frequently employed by system analysis methods. Thus, there is an opportunity to combine these two perspectives during the development process. Modelling is useful as part of a design theory with a high degree of practitioner involvement alongside of system analysts, designers and programmers. The process can subsequently be analysed based on the representations in the models that emerge from the requirements of the various groups. Additional research should examine what the groups need when it comes to the substance of the models, how the models are to be visualised and the ways in which they can interact with the differing requirements of the groups in order to ensure a fruitful development process. 16 Management Information Systems in Process-oriented Healthcare Organisations 7. References Adler P. A. , Adler P. , (1998), Observational Techniques, in Denzin N. K. , Lincoln Y. S. , (eds), Collecting and Interpreting Qualitative Material, Thousand Oaks, Sage Publication. 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