Decision-Making Case Study Essay Example for Free

Decision-Making Case Study Essay The current grave state of the economy has had a significant impact on health care across The United States. Massive budget cuts, reduced services, and limited access to care significantly have affected Medicaid patients. Hennepin County Clinic (HCC), a facility that provides health care to Medicaid patients, is dealing with an additional 15% budget cut that will force management to make decisions about which services must be changed or eliminated while still meeting the basic needs of the clients. Stemming from consumers’ increased demands for enhanced quality of care and greater accountability from health care organizations, leaders must engage in decision-making that incorporates evidence from well-conducted research whenever possible. The Informed Decisions Toolbox (IDT), a process of evidence-based decision-making, involves six steps in the decision-making process (Rundall, et. al, 2007). While every step is consequential, step two, the process of gathering evidenced-based sources of information, is the most important tool in decision-making. The IDT plays an important role in increasing organizational accountability, facilitating knowledge transfer within a facility, and contributing to a questioning organization. Step One The first step in the IDT is formulating a question or questions behind the decision. This is done in such a way that will increase the likelihood of uncovering useful research studies. As a manager, one must discover what information is needed to make the best decision. When investigating the needs of Medicaid clients and deciding which clinical services to change or eliminate, it is vital to research information regarding the various services used by these patients. The manager must ask several questions. Do individuals enrolled in Medicaid have unique health needs that differ from the larger population? What are the services most utilized within HCC at any given time? In what ways will service cuts and elimination of resources   affect the clients? What services can be outsourced to other facilities that accept Medicaid? Can the current physician staff be reduced, and the use of nurse practitioners and physician’s assistants be implemented? Step Two After the questions are formulated, step two involves identifying credible sources of information to answer these questions. In an age of abundant technological resources, a large percentage of sources may be found on research-based websites, bibliographic databases, online academic and peer-reviewed journals, books or other publications, and government reports, to name a few (The Center for Health Research, 2011). It may also be helpful for the manager to locate internal information available within the clinic that will tailor to the unique needs of HCC. While the IDT mainly focuses on evidenced-based sources of information, the manager may also utilize supportive colloquial knowledge from and opinions of colleagues, employees, patients, and other health care professionals (Rundall, et. al, 2007). Steps Three, Four, and Five Steps three through five take the collected research and evaluate its accuracy, applicability, and â€Å"actionability.† First, step three emphasizes the accuracy of the research presented. The manager must question if the research is of high-quality, originates from a credible source, presents complete and balanced viewpoints, and comprises reliable and valid measurements (The Center for Health Research, 2011). Step four highlights the applicability of the research. The manager must ask if the research is relevant to his or her question at hand and whether or not it applies specifically to HCC. Step five focuses on the â€Å"actionability† of the research. The manager needs to know how the research is going to be implemented and who exactly is going to do it. Step five also pertains to the implications and importance of the research studied (The Center for Health Research, 2011). Step Six Finally, step six allows the manager to look at his or her organization’s needs and values to determine if the research fits the context of its unique situation. The manager must question if the collected research is adequate to make a useful decision and if there is a single best option, multiple  practical options, or even inadequate evidence to make a decision (The Center for Health Research, 2011). Most Valuable Tool Although every step in the IDT has much significance and step one builds the foundation on which to define the problem at hand, the tool that would be the most valuable is step two, identifying credible evidenced-based sources of information. Health care workers who provide care based on knowledge from evidenced-based studies deliver significantly better care and produce better outcomes (Melynk Fineout-Overholt, 2005). Because of this, the process of identifying these studies is vital to the survival of an organization. The knowledge discovered during research can be a valuable source of strength to the organization by combining it with the unique employee and patient opinions and preferences. This process of searching for information can also contribute to organizational growth through the sharpening of knowledge and skills of decision makers. With regard to HCC, step two is very valuable in deciding which clinical services need to be eliminated primarily because locating appropriate research studies is the foundation of finding the solution to the question. Through the selection of evidenced-based articles, the manager can compare and contrast how other organizations dealt with budget cuts and the solutions they implemented. Accountability Utilizing the IDT greatly affects organizational accountability. Hospital organizations and clinics have to function according to the strict rules and regulations of such agencies as JCAHO and CMS, and at the same time, respond to the ever increasing needs demands of consumers for improved quality of care (Rundall, et. al, 2007). These added pressures force management to make comprehensive, precise, and influential decisions that they cannot formulate with personal knowledge and experience alone. Because of this, management needs to apply the best evidence available in making these consequential decisions. Knowledge Transfer Knowledge transfer aims to deliver research-based information and guarantee its availability for future members within an organization (Pentland Forsyth, 2011). Within health care facilities, it is important for newfound  research evidence to be transferred into clinical practice and policy development. Management and decision makers must communicate clearly to the health care team and make them aware of decisions that are made and how the decisions will affect them. Team members are encouraged to share their understanding with others to expedite knowledge transfer within the facility. Knowledge transfer facilitates shared intelligence, improved employee performance, higher levels of innovation within the organization, and economic growth (Rundall, et. al, 2007). Questioning Organization The IDT affects an organization in a number of positive ways. Most important, it allows the decision-maker and the health care team to reflect on what was learned, what questions still need to be asked, and what should be done differently next time, which is critical to innovation (Buchen Rowley, 2000). Building a questioning culture within an organization inspires team members to search for answers within evidenced-based research studies and improving the lines of communication among members as well. Conclusion The IDT is an exceptional set of tools that assists management and decision-makers in utilizing evidenced-based research in confronting and responding to pressing questions that significantly affect an organization. The IDT plays an important role in increasing organizational accountability, facilitating knowledge transfer, and contributing to a questioning organization. In the case of HCC, the manager utilized the IDT by formulating questions to determine which clinical services to change or eliminate based on the various health care needs of Medicaid clients. The manager identified various credible sources of information to answer these questions, which has been determined the most valuable tool within the IDT. The research evidence was examined to determine its accuracy, applicability, and â€Å"actionability.† Finally, the manager assessed to see if the collected research was both adequate and met the specific needs of HCC, which is what the IDT was designed to do. References Buchen, I, Rowley, L. (2000). The questioning culture: Perpetual state of the art. Performance Improvement, (39)5, 26-30. Melynk, B., Fineout-Overholt, E. (2005). Evidence based practice in nursing and healthcare. Philadelphia, PA: Lippincott Williams Wilkins. Pentland, D., Forsyth, K. (2011). Key characteristics of knowledge transfer and exchange in healthcare: integrative literature review. Journal of Advanced Nursing, 67(7), 1408-25. Rundall, T., Martelli, P., Arroyo, L., McCurdy, R., Neuwirth, E., et al. (2007). The informed toolbox: Tools for knowledge transfer and performance improvement. Journal of Healthcare Management, 25(5), 325-341. The Center for Health Research. (2011). The informed decisions toolbox. Retrieved from http://www.toolbox.berkeley.edu/overview.

Death and Dylan Thomas Essay -- Literary Analysis

Dylan Thomas, a famous 20th century poet from Wales once said that poetry is â€Å"the rhythmic, inevitably narrative, movement from an over clothed blindness to a naked vision† and that it â€Å"must drag further into the clear nakedness of light† (â€Å"Dylan Marlais Thomas† 189). Though his poetry, Thomas often sought to reveal aspects of life that are often overlooked in order to reveal important truths about them. Like many authors, his experiences influenced his writing and revealed many important themes such as the â€Å"celebration of the divine purpose that he saw in all human and natural processes†(â€Å"Dylan Marlais Thomas† 189). Growing up and living during the times of the bombings of London and the massive death tolls of World War II, Thomas’ poetry depicts a war torn society, which contributes to his themes dealing with death- the inevitability of death and the acceptance of death as part of the cycle of nature. In Thomas’ poem â€Å"Do Not Go Gentle Into that Good Night,† a child urges his dying father to â€Å"rage, rage against the dying of light†(3). This poem acts as a reflection of Thomas’ own feelings towards the death of his own father from cancer. This poem reflects Thomas’ own â€Å"raging against and rejoicing in both the limits and possibilities of all human forms† as well as a â€Å"vivid declaration of love and fear†(Persoon 2). Although many people wish for their relatives to die in peace, this son wishes his father to fight off the evilness of death and fight toward the light showing the paradoxical nature of the poem. For example, the speaker says â€Å"dark is right†(4), â€Å"blinding sight†(13), and â€Å"curse, bless, me now†(17). All of these phrases contribute to the paradoxical nature of the poem and reveal the overall sentiment that although deat... ... to mourn the death, by fire, of a child in London,† and â€Å"Ceremony After A Fire Raid,† Dylan Thomas sought to describe the realities he faced such as death and shed light onto the acceptance of death as a part of the cycle of nature. His poems catch the â€Å"imagination and the spirit [and] understanding of the people who endured the Depression and World War II† and embody a â€Å"fearless†¦search for reality and a limited hope in a world bereft of its traditional theological certainties†(Knepper 3838). In a world where many people fear death and the consequences that death presents, we must accept it as part of the cycle of nature and realize that we can try to fight death, but in the end, death is inevitable. Mankind must remember that â€Å"human beings will die in many ways and places† but in the end, â€Å"their bodies will return to the elements and be scattered†(Knepper 3839).

Knowledge of Programming Fundamentals

The article â€Å"Future Developments: Tomorrow’s IT Stars Will Need More Than Mere Skills† published in eWeek (2004) likens the science of application development to basic reading and writing skills that all educated people have developed.   This is not to say that all people are today equipped with the knowledge of programming fundamentals.   Rather, the author of the article makes the point that since writing an enterprise application requires a mere set of rules and directions such as those that car drivers are acquainted with, it is possible that every educated person in the near future will be equipped with the knowledge of programming fundamentals.By following a set of rules and directions, therefore, every person who needs to write an enterprise application or software program would be able to find his way.   In that case, what would be the job of trained programmers?   The author describes the programmers of tomorrow as masters in their science.   Lik e â€Å"master tour guides,† these individuals would be akin to the â€Å"Formula 1 racers who can push their enabling technology to new limits.†Ã‚   So yes, there will be need in the days to come for trained computer scientists.   All the same, today’s programmer must seek to be a master in the science – one who knows more about the technology than laymen who merely follow the guidelines to programming.Given that the layman, too, should be able to follow specific rules to write applications, it is wise to let the computer software be divided into operating systems and applications.   This makes it easier for anyone who is not a master in computer science to easily use both operating systems and applications, each with their own guidelines for operation.   If applications and  operating systems were integrated, the layman would have to learn much more than he would be willing to learn about programming anyhow.Lastly, Coffee (2004) asks if knowledg e of programming fundamentals would be required in the same way in the future that reading and writing are taken for granted today as basic skills.   Based on the summary of the article above, the answer to the question is: Yes, every working professional who wishes to follow the set of rules and directions to write his own program in the future would be able to do so almost perfectly.   However, unlike reading and writing skills that are acquired by both working and unemployed people, the skill of writing programs by following a set of guidelines is not expected to be acquired by all people.

Essay on Contemporary American Class Structure - 1328 Words

Contemporary American Class Structure Social class is defined as people having the same social or economic status (Wordnet). In contemporary American society, social class is based on the amount of money and property you have and also prestige. Prestige is given to a person through the line of work or the family that they come from. For example, upper-upper class member Jennifer Lopez reeks of prestige not only because she has millions of dollars in her bank account, but she has very expensive luxuries, cars, and houses. There are four categories of class in contemporary American society: upper, middle, working and lower. Of these four categories of classes, two are subdivide. These two are: upper class and the middle class.†¦show more content†¦Of this group, about 1/3rd belongs to the upper-middle class. The annual income of person belonging to this group is $70-$75,000. The jobs that the typical upper-middle class person holds would have a prestige rating of 65 or higher. 2/3rd?s of the middle-class population is the lower-middle class. White-collared individuals make up the majority of this class, earning anywhere from $30,000 to $60,000 a year. Lower-middle class Americans have a set standard of priorities. They take pride in the fact that they are financially stable, and promote hard work, and press on education. Without education, the members feel that they would not be where they are economically, and preach the importance to their children so that they, too, can live a life style very similar to that of theirs (Norton). Working class, mostly blue-collar, makes up 20% of the American population. The average annual income is from poverty level up to $45,000. Members of this group have little to no prestige. This is partially due to the fact that their income is solely income; they do not have investments. Education was not always highly preached, but sports for boys were and still are. It is seen as a form of ?moving up? for their sons (Norton). Among all the classes, education level, wealth, income and occupation decide which class a person belongs to (W.W. Norton, Co.). To obtain wealth, incomeShow MoreRelatedThe Nuclear Family910 Words   |  4 Pageswas highly valued in the American culture during the 1950s, where romantic love was the central reason for marriage in America; however, love in modern America is not enough to make a marriage last. Likewise, the 1950s was the time for many American marriages to undergo many socioeconomic changes including the rise of the gender minority in the workplace. Due to these developments, marriage is under enormous socioeconomic pressures have given the rise to family structures such as those headed byRead MoreIs it a Good Thing to have Class-Based Political Parties?1100 Words   |  5 PagesIs it a Good Thing to have Class-Based Political Parties? 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