Shindlers List :: essays research papers

Through out the movie Shindlers List many changes take place. These changes happen in both society and in certain people. During WWII the German Nazi regime enslaved the Jewish communities on Europe. They were used as slave labor or were executed if seen unfit. Even though these atrocities were taking place on a daily basis some people tried to help the Jewish community. Isaac Stern was a member of the Jewish community and he wanted to help his people out as much as possible. He was a great accountant but because of his heritage he wouldn’t be allowed any form of power in Germany. For this he needed Oscar Shindler. Shindler was a very influential person and was very friendly. Even in the beginning of the movie he was able to walk into a room of German officers and walk out best friends with all of them. He was just the kind of man Stern needed. He needed someone with connections in the German government. Shindler may have had all of the connections but he had no money to invest into his business ventures. He spoke to Stern and they agreed upon a deal. Stern and other wealthy Jews would provide the funding and Shindler would provide the connections in the military in order to keep Jews safe in Shindlers factories. In the beginning Stern and Shindlers opinions of each other were strictly business. Both knew what hey had to do and they got the job done. But as time went on both men became very good friends. Shindler offered a drink to Stern after the deal was completed, stern refused it. Stern was under the impression that Shindler was just another Nazi taking advantage of his people. Shindler though that Stern was just another Jew. They both had stereotypes on each other. As they worked more closely together for longer and longer it became apparent that they had great admiration for each other and they both new what a horrible thing the Germans were doing. Later on in the move when they believe they will be separated Stern finally takes that drink from Shindler. A â€Å"master image† from this movie is when the little boy hides in the stalls. It shows very well to what lengths a person would go to survive. When it came down to it everyone that was in his position would do the same in order to make it out alive.

Project on Motivation of Nurses Essay

The most traumatic and stressful moments of an individual’s life are when he or she is taken ill. Nurses are synonymous with care and attention in times of need such as these. In a world mostly driven my personal ambition and corporate profit, nurses with their commitment to patient welfare and selfless service, provide a contrasting study. A nurse acts as a savior in distress and is often called upon to make great personal sacrifices in the discharge of her duties. The profession of nursing, is therefore, not merely a ‘job’ and the potentially powerfully insights about commitment to work that they could provide encouraged us to choose them as our subjects of study. As part of the Phase I of the project, we interviewed four nurses who were diverse in the amount of experience each had, the hierarchy in which they were working in the hospital and the backgrounds from which each of them came. This was done to study the commitment of employees towards an organization and understand the various factors which cause the same we have selected a study of nursing staff in hospitals. From the interviews, many broad themes emerged, all of which point correlate positively with their high commitment level to the organization. These points logically lead us to our hypothesis as to what keeps them committed to their place of work.   However, there were some key themes which we noted across all four of our respondents. All the nurses were very excited by the kind of recognition that the hospital was willing to give them. They seemed to treat this as a reward for their hard work and dedication and were motivated by it. All nurses were also impressed by their working relationship with their superiors (Head Nurse/Doctor) in the hospital who treated them as members of a family and with much respect. Nurses were also willing to stay on with the hospital because it provided them with opportunities for personal development. Accordingly our hypotheses are as follows: * There is a positive correlation between the amount of recognition that the nurses receive for their work and their commitment to the organization * There is a positive correlation between the positive relationship between the doctors/supervisors and the nurses and the commitment of the nurses to the organization * There is a positive correlation between the opportunity for learning and personal development that the organization provides and the commitment of the nurses to the organization RESEARCH METHODOLOGY Based on our earlier survey of 4 respondents, we determined that the following three variables play a key role in determining the commitment of nurses to their respective hospitals: * Recognition * Relationship with superiors * Learning and Development We have then tried to identify whether these three variables actually affect commitment levels of nurses at various nursing organizations. For the same, we carried out a survey of 30 nurses with diverse backgrounds (a detailed description of the respondents is covered in the following section) and questioned them on a scale of 5 to 1 (5: Strongly Agree, 1: Strongly Disagree) on 24 questions. Since our hypothesis determines 3 variables as affecting commitment, we tested the existence of each these three independent variables by framing four questions for each variables. Similarly, we determined commitment levels of the nurses through a set of 12 questions. By using a 5-point scale, we have captured not only the  existence, but the extent of existence of these variables. Since we found the responses to be reliable, we determined the correlation between the three independent variables and the dependent variable ‘commitment’ to see whether our hypothesis of is correct. Hospitals chosen for the survey We surveyed nurses from 4 different hospitals to ensure diversity. The organizations range from a large hospital located in a city like Bangalore, to mid-sized hospitals located in Tier-2 cities like Ajmer and Allahabad and a focused surgical-specialty hospital located in a smaller town like Varanasi. This selection lends diversity to our respondents through differences in location, specialization of hospitals, daily footfall (reflecting magnitude of work for the nurses), number of departments etc. Refer Appendix 1 for a description of the hospitals used for out survey. General Profile of the Nurses We have ensured diversity in our respondents while choosing nurses at all of the survey hospitals. The diversity ranges age, number of years worked at the organization and departments worked in. QUESTIONS IN THE SURVEY The questions in the survey were aimed at understanding the extent to which each of our three independent variables and our dependent variable ‘commitment’ was present in these organizations. We captured the different parameters relating to these variables by framing questions addressing various facets of these variables. Refer to Appendix 2 for detailed discussion on questions used for the survey. ANALYSIS OF RESULTS OF THE SURVEY Reliability of scales Reliability is used to check the consistency of the question set under consideration. In this survey we are testing if the 3 hypothesis that we have come up with are explaining the commitment of employees towards organization. Reliability in a survey is measured by lot of ways and here we are checking internal consistency reliability which indicates reliability within the survey for the responses of similar type of questions. Reliability of dependent variable * Affective Commitment: In affective commitment the questions that are all trying to test for one feature- Attachment to Organization. The questions are direct and straight forward bringing out the required feature thus making it a set of good reliability. We have obtained a reliability scale of 0.6 for this set which is the highest amongst the 3 different commitments scales that we have obtained. * Continuance Commitment: In this set we are trying to test the commitment by knowing the dependence of the person on the organization and how much of a change it would mean to him to switch jobs. The reliability that we obtained for this set is 0.53 which is a high value for a one time survey result. This is a good indication of question set focusing on the same core question. * Normative Commitment: This question set mainly tries to identify the belongingness the person has towards the organization. The question set is clear in conveying the same objective but this attribute is not so direct and easy to understand from an individual’s perspective. Hence the survey respondents’ answers in this set have a lower value reliability of 0.39. Reliability of independent variables For first and third variables (recognition and learning & development), the reliability is low at 0.46 and 0.47 respectively while for the second variable (relationship with superiors), the reliability is relatively high at 0.66. Recognition and Learning & Development It’s easy to see why responses to questions around Recognition and learning and development score so low in reliability. They are quite different from each other and same person can have very different responses to each of them, if they interpret the different questions to indicate different things. In comparison the questions related to relationships were fairly interrelated and are able to fetch more consistent responses. Overall reliability of all the responses is still lower than 0.7 which can be attributed to the fact that no pilot study was done, which could have been used as input for framing questions in a better way as to improve reliability of responses. Relationship with superiors We obtained highest reliability for responses for this hypothesis. Reliability for this was found to be 0.66, which is near acceptable range. The reason for higher reliability in this question set (Appendix 2) is attributable for ease of understanding the questions. Every person has a fair idea about relationships and these questions although quite different from each other give a fairly good direction the responder in terms of what is being asked. So they maintain consistency and hence higher comparative reliability. Correlation between predictor and dependent variables a) Affective Commitment – According to our expectation before the actual test results we came up with all 3 predictors are going to affect the Affective commitment. Recognition was one factor because the appreciation helps the employee (nurse) develop a connect with the organization. Also opportunities for personal development and training opportunities to assist this makes employees feel good which is essential to improve the commitment levels. Good relationships with superiors definitely help people develop an emotional bond with the organization. b) Continuance Commitment Continuance commitment describes how the employee feel about staying longer in the organization and for this one of the most important reasons is economic considerations which are to some extent explained by rewards and recognition. The recognition obtained will motivate them to work better and stay longer in an organization. Also constant opportunities for growing and training will help them stay committed to organization. c) Normative Commitment This form of commitment mainly explains the sense of giving back to the organization and the predictor which we identified was most important was the relationships with supervisor (Head nurse/Doctor). Training and developments reflect investment done by organization on employees, so employees feel an obligation to stay committed to organization to pay it  back, which increases their normative commitment. Actual results: Statistical Significance of correlations With the acceptable alpha level being 0.05 for social science research and no. of responders being 30, (Dof = 28) gives critical value of correlation as 0.361. When compared with the results we obtained we notice that out of 9 correlations, 3 are not significant (value less than 0.361) and 6 are significant (Value higher than 0.361). When it’s significant we reject null hypothesis of no relationship and accept alternative hypothesis of existence of relationship. Hypothesis 1: From the results it’s apparent that hypothesis 1 is partially supported as only one correlation is significant out of 3. That is with affective commitment. So we can interpret that Recognition affects affective commitment but not the other two types of commitments. Hypothesis 2: For second hypothesis 2 out of 3 correlations are significant so it’s also partially supported. Relationship with doctors is not related to continuance commitment but related to affective and normative commitment. Hypothesis 3: Hypothesis 3 is completely supported as all the correlations are significant i.e. higher than 0.361. It means learning and development is related to all the dependent variables and affects all three dimensions of commitment i.e. Affective, Continuance, & Normative which are considered here. Plausible explanation of variations between correlations Recognition: Recognition showed the highest correlation with affective commitment, while significant correlations were not established with the continuance and normative commitment. When nurses are recognized by the organization they tend to develop an emotional connect with the organization. They feel happier working in the hospital and a sense of belonging is nurtured within them. The appreciation received for the work translates into an attachment with the organization. This explains the  correlation with affective commitment. The recognition is mostly in the form of awards and words of praise not monetary in nature. Therefore a significant continuance commitment has not been established. Similarly, recognition for work does not lead to a feeling of obligation towards the organization. Rather, the positivity generated by the appreciation of work manifests itself as an emotional attachment towards the organization, which is reflected in the correlation with affective commitment. Relationship with superiors: This independent variable showed highest correlation with normative commitment and lower correlations with affective commitment, while correlation with continuance commitment was insignificant. The nurses tend to view the exceptionally good relationships with the doctors as being facilitated by the hospital. They therefore feel indebted to the hospital for providing them with an excellent working environment, which would be missing at other places. The moral obligation that they feel towards their hospital for the respect and dignity with which doctors and supervisors treat them is translated into a high correlation for normative commitment. Learning and development: It is seen from the results of the survey that learning and development has a high correlation with Affective Commitment to the organization and comparatively low correlation with continuance and normative Commitment. Intuitively we expected high correlation between learning and development a nd normative commitment to the organization. This is because employees would feel an obligation towards an organization that invests time and resources to train its employees and ensure their personal development. However, we realize these may not necessarily hold true once we take into account the atypical nature of the nursing profession. Nurses feel sense of duty towards their patients and ethical and moral obligation to serve the sick to the best of their capacity. In fact, nurses who have been trained well, dealt with varied patient cases and experience a great deal of learning would perhaps experience higher motivation to the society. Hence perhaps they would experience low moral responsibility to staying back in the organization. We believe existence of a caring and people centric management could be the reason for the high correlation between affective commitment and learning and development. An organization that has caring and people friendly management would earn emotional loyalty from its employees due to care and good treatment given to employees. Such an  organization would also take efforts to ensure that its human resources constantly learn and develop so as to contribute to the success of the organization.

Racial Inequality And Affirmative Action - 900 Words

College is a privilege that is now accessible to many people. It has not always been this way though. Lack of money, being deprived of representation, or racism hindered one’s chances in to getting into higher education, especially a minority’s chance. In order to raise against the barriers, President John F. Kennedy created the affirmative action program to provide equal opportunities for everyone, whether in education or in the workforce. Even if this was a program created in the 1960’s, problems continue to present itself as shown through the many court cases, such as Brown vs. Board of Education, Fisher vs. University of Texas, Grutter vs. Bollinger et al, and Hopwood vs. State of Texas. Thus, racial inequality and affirmative action†¦show more content†¦It is the way that provides everyone with an opportunity, an opportunity to achieve their American dream. Though, on the flip side, the American dream would not be available to all with affirmative action. This program diminishes the opportunities for whites to achieve their dreams. From education to the workforce, affirmative action holds bias towards minorities over Caucasians. Despite being â€Å"more qualified,† the whites are not placed into certain colleges or workplaces because of race. Even if a Caucasian student receives a near perfect score on the SAT, a student being of color would be the same equivalence. In addition to this, the affirmative action’s policies give minority applicants a minor self-confidence that they do not need to perform better than their white counterparts, just racially distinguishable. This shows that affirmative action does not focus on abilities but rather demographics, thus, showing the controversy with this program today. Above all, affirmative action violates the Constitution. The Fourteenth Amendment forbids the states to restrict the basic rights of citizens to equal opportunities. However, accepting certain groups of applicants over others due to race proves that affirmative action endorses racism. Therefore, how is the program equal if only race is the factor? How can this program be equality for all, if the whites are being discriminated against? My response to this? I still believe affirmative action is necessary.Show MoreRelatedSupreme Court Ruling on the White Firefighters Case Study943 Words   |  4 PagesSupreme Court Ruling on White Firefighters Case Was Justified Affirmative Action was established during the Civil Rights era to address the problem of racial inequality in the workforce and the educational field. Advocates of affirmative action since have argued that it is necessary to maintain it to make sure that diversity in schools and the workplace is upheld. They also have argued that in the absence of affirmative action, minorities and members of underprivileged groups will have fewer chancesRead MoreAffirmative Action in Colleges1218 Words   |  5 PagesHispanics. In order to combat this gap, the Kennedy administration in 1961 instituted a policy called affirmative action aimed towards counteracting the racial and socioeconomic disadvantages that these minority groups have. Opponents of affirmative action argue that this violates the 14th Amendment, creates reverse discrimination and reinforces racial inequality. Meanwhile, the supporters of affirmative action claim that it is necessary to create equal opportunity for every person and as a way for addressingRead MoreAfrican Americans And The Civil War1309 Words   |  6 Pageseffects of racism dating back even before the Civil War. One of the fruition of these attempts is Affirmative Action, which was initially enforced â€Å"to ensure equality in hiring† among minorities. Later, Affirmative Action was amended to include education under its protection. Throughout its duration, however, it has alleviated the racial tension unsubstantially. Affirmative Action’s attempt to halt the racial disparities in higher education that has burdened the African Americans constitutes an inconsequentialRead MoreArgumentative Essay - Affirmative Action1148 Words   |  5 Pagesthe ambition that was visible in his opponent. Who do you think was hired for the position? If this story took place before 1964, the answer would be obvious. However, with the adoption of the social policy known as affirmative action, the answer becomes unclear. Affirmative action is a pro duct of the civil rights era, that time from the late 1950s through the 1960s when African Americans fought to live as equal citizens in the country of their birth (Maltz, Leora, 2005). After the United StatesRead MoreDiscriminatory Practices And Natural Inequalities Essay1497 Words   |  6 Pages Whether individuals recognize it or not, the world is filled with discriminatory practices and natural inequalities. Even the â€Å"free† country, The United States, possesses many cringe worthy social inconsistencies in regards to: race or ethnicity, religion, gender, physical abilities, sexual identity, and sexual orientation. These discriminatory practices bring many circumstances to all dimensions of society. Particularly due to racist discrimination, minorities are left to a disadvantage in higherRead MoreAffirmative Action- Negative Team1486 Words   |  6 PagesModule 03: Group Position Paper: Affirmative Action Affirmative Action: Negative Team 1 Diversity in the Workplace Professor Linda Noeth Center for Distance Learning SUNY Empire State College Slavery in America can be traced all the way back to colonial times, or as historians have dated; 1619. Although slavery had technically been abolished by the late 1800’s, issues over race still remained prominent. Regulations such as â€Å"Jim Crow Laws†, that claimedRead More Affirmative Action and Racial Tension Essay1691 Words   |  7 PagesAffirmative Action and Racial Tension    Affirmative action. What was its purpose in the first place, and do we really need it now? It began in an era when minorities were greatly under represented in universities and respectable professions. Unless one was racist, most agreed with the need of affirmative action in college admissions and in the workplace. Society needed an active law that enforced equality during a period when civil rights bills were only effective in ink. With so much of America ¹sRead MoreEssay about Affirmative Action1384 Words   |  6 PagesAffirmative Action has been an issue of contention since its inception during the Civil Rights struggles of mid 20th century America. Discrimination could no longer be tolerated and the Unites States government had an obligation to encourage equality at all levels of the social infrastructure. The main type of discrimination being addressed by Affirmative Action programs was racial discrimination. The Merriam Webster dictionary defines racism as: ‘a belief that race is the primary determinant ofRead MoreAffirmative Action Should Be Changed or Ended All Together1605 Words   |  7 PagesAffirmative action should be changed or ended altogether In the late Sixties, Martin Luther King Jr. fought hard for equal rights. Before he was assassinated in 1968, he made a speech about his vision of human equality. I have a dream that my four children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character. (King) The Sixties were a turning point for racial equality. Because of leaders like King, many blacks and minorityRead More Its Time to Put and End to Affirmative Action Essay1586 Words   |  7 Pages Affirmative action should be changed or ended altogether In the late Sixties, Martin Luther King Jr. fought hard for equal rights. Before he was assassinated in 1968, he made a speech about his vision of human equality. â€Å"I have a dream that my four children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character.† (King) The Sixties were a turning point for racial equality. Because of leaders like King, many blacks and minority

Essay about When Are Immigrants Americans Too - 580 Words

Ever since people started coming to America, those that were here before them wondered why they came! Is it for freedom or for the idea that America is The Land of Opportunity? In this paper, I am going to look at the reasons Immigrants come to America. I will also discuss both their views of themselves and how Americans view them. The question I pose to answer throughout this paper is When will Immigrants not be Immigrants anymore and become Americans? So why do people come to America from other countries? Hugo Ortega, arrived in Texas in 1982 from Mexico. He worked his way from dishwashing jobs and briefly living on the streets to being named Chef of the Year at the 2002 Houston Culinary Awards for his work with his†¦show more content†¦Some feel that immigrants dont add to our economy while others do. In Jimmy Santiago Bacas poem, So Mexicans are Taking Jobs from Americans, he uses sarcasm when he implies that all immigrants, not only ones from Mexico are coming to America and taking jobs that are rightfully those that already live in America. He says that what Americans are really meaning to say is We arent giving the children a chance to live and Let them die, and the children too (Baca, 775). Most Americans believe that Immigrants who come to America are looking for a way out and a free ride. Some times this is true, but most of the time it is not. It is the false pretences and the hopes of many, such as Hugo O rtega, that get them to migrate here. I believe that many Americans are scared, scared of change, scared of being over taken by the immigrants and scared that the immigrants are going to take all their jobs. They are also scared when immigrants know more about their country than they do. Who wouldnt feel threatened? To analyze this further, let us look at a poem by Pat Mora entitled, Immigrants. In her poem she is painting the picture of what an American consists of and how immigrants try to make their children become Americanized. She says that immigrants try to make their children fit in as much as they can by giving them American names, feeding them American food, dressing them in American clothes and speakingShow MoreRelatedIllegals Are Costing Americans A Lot Of Money1289 Words   |  6 Pagesin our country today. Only about .5% is sent back to their home country. That is too many illegals for the U.S. to take care of, and a lot of them are taking American jobs increasing our unemployment rate. Most of these Illegals bring in many drugs so they can get money to start a new life. There are too many Illegals coming into our county its’s a problem and we need to change that. Illegals are costing Americans a lot of money. In 2000 Mexico proposed that its poor works should be able to immigrateRead MoreSo Mexicans Are Taking Jobs From Americans By Jimmy Santiago Baca1071 Words   |  5 PagesJimmy Santiago Baca wrote the poem, â€Å"So Mexicans are Taking Jobs from Americans,† in 1977. Baca wrote this piece while incarcerated in prison, there he learned how to read a write. Since the early 1900’s America saw an extreme increase in the amount of Mexicans crossing the border. Although most have a good intention of coming to America, the road to the â€Å"dream† is paved with many hardships. In America currently we see an influx of Mexicans crossing the border, the effect of this occurrence howeverRead MoreThe American Of The United States891 Words   |  4 PagesLikewise, the U.S. Government was built on greatness by immigrants such as the great scientist Albert Einstein, or the Chinese immigrants that help build the railroad system. The world is in turmoil and the U.S. must not loose sight on the country’s greatness, which is civility. Forever, the U.S. will be known for being the land of free, where people have the opportunity to get an education, or provide for their family. In all fairness, most immigrants do not want to hurt America, but seek an opportunityRead MoreImmigration Across The United States985 Words   |  4 Pagesthe idea of achieving the American dream. It brought men, women, and families from all over the world to America, in search for life, liberty and happiness. Those early immigrants brought with them their own cultures, traditions and languages. Most of us currently living in the United States of America recognize our history derives from these early immigrants. This has made America a wonderfully diverse country. However, for years, illegal immigrants and legal immigrants has become a dominant issueRead MoreEssay on Enough Immigration1520 Words   |  7 PagesImmigration Why should the United State’s allow any more immigrants to come in? There are enough people here as is; we don’t need the waste of other countries coming into ours to take up our space and use up all of our resources. We as American’s have rights to our land; the privilege to be an American is losing its sense of worthiness with the increased number of immigrants becoming Americans. The borders of the United States are too open, the U.S. should enforce a lot more security and responsibilityRead MoreImmigration to the United States: The German Immigrants Essay750 Words   |  3 PagesMany immigrants came to America seeking freedom, jobs, and land while others were running from famine and war. While immigrants ran from the problems of their native land, they were running into new problems in America. 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People need to separate the groups to realize that there are immigrants who help America and that they should be allowed to stay in America under certain circumstances. ImmigrantsRead MoreQuestionable Immigration Myths850 Words   |  4 Pagesthe author who believes Americans treat immigrants poorly. He introduces the reader to Know Nothings, or Native Americans, who blame every problem in America on the immigrants (Cole 189-90). In the introductory paragraph, Cole attempts to obtain the readers sympathetic feelings as he writes with great passion when he describes the mistreatment his Irish Catholic immigrant ancestors endured (190). This in turn raises the question of how objective he could remain when presenting his arguments

What Do Williams And Bell ( 2015 ) Say About The Image Of...

What do Williams and Bell (2015) say about the image of the social work profession in the African American community? In an attempt to ascertain the image of the social work profession in the African-American community, Williams Bell (2015) conducted a study in order to examine the perceptions of community members regarding social work practice commitment to pertinent issues of African Americans. As discussed by Williams Bell (2015), the evolving identity of social work has been continually unclear among the general public and social workers themselves. Theoretically social work practice is thought to have abandoned its original ideals of community focus and collective betterment shifting its concentration to individualistic approaches. Since its inception, beginning with settlement houses and charity organizations in the 19th century, social work practice has endeavored for recognition as a profession in its own right not as a supplement to other professions in a secondary manner such as assisting doctors or lawyers etc. The history of social work can partly be attributed to the lack of clarity in best meeting needs of the African American community. Beginning with the foundation of organizations in the late 19th century that began social work practice and its necessary role in the black community to introduce former slaves into society as citizens; African Americans were still facing discrimination and prejudice which shadowed the progression of the socialShow MoreRelatedThe Impact of Corporate Social Responsibility on Consumer Behaviour: Does Csr Affect Consumer Decision Making and Buying Behaviour Within the Uk Supermarket Industry12140 Words   |  49 PagesABSTRACT Purpose: The purpose of implementing corporate social responsibility (CSR) has been a long debated topic. However there is a lack of literature within the supermarket industry. The aim of this project is to use previous research within the supermarket industry in investigating how aware and concerned consumers are of CSR practices, and how CSR activities affect consumer behaviour and their ethical decision making. Method: This study used a quantitative research approach with a semi-structuredRead MoreOrganisational Theory230255 Words   |  922 Pagesbook is, to my knowledge, the most comprehensive and reliable guide to organisational theory currently available. What is needed is a text that will give a good idea of the breadth and complexity of this important subject, and this is precisely what McAuley, Duberley and Johnson have provided. They have done some sterling service in bringing together the very diverse strands of work that today qualify as constituting the subject of organisational theory. Whilst their writing is accessible and engagingRead MoreManagement Challenges for the 21st Century.Pdf60639 Words   |  243 PagesContents Introduction: Tomorrow’s â€Å"Hot† Issues 1 Management’s New Paradigms 2 Strategy—The New Certainties 3 The Change Leader 4 Information Challenges 5 Knowledge-Worker Productivity 6 Managing Oneself Acknowledgments About the Author Books By Peter F. Drucker Credits Front Cover Copyright About the Publisher iii Introduction: Tomorrow’s â€Å"Hot† Issues Where, readers may ask, is the discussion of COMPETITIVE STRATEGY, of LEADERSHIP, of CREATIVITY, of TEAMWORK, of TECHNOLOGY in a book on MANAGEMENTRead MoreMarketing Mistakes and Successes175322 Words   |  702 Pagestheir ideas—and defend them against critical scrutiny. This is great practice for the arena of business to come. NEW TO THIS EDITION In contrast to the early editions, which examined only notable mistakes, and based on your favorable comments about recent editions, I have again included some well-known successes. While mistakes provide valuable learning insights, we can also learn from successes and find nuggets by comparing the unsuccessful with the successful. With the addition of GoogleRead MoreEssay on Fall of Asclepius95354 Words   |  382 Pagesjust to get out of all the infested areas around the world. There was problem about fleeing from infested areas. Everywhere was infested. There was no where anyone could go without encountering the walking plague. You know that phrase War is Hell? Well... its dead wrong. War at least has some organization to it. What was faced in the last days... by last days I mean the last days of civilization not life; itself. What was faced was hell. Everyone went ape shit insane. Everyone was killing andRead MoreProject Mgmt296381 Words   |  1186 PagesTopics Chapter 1 Modern Project Management Chapter 8 Scheduling resources and cost 1.2 Project defined 1.3 Project management defined 1.4 Projects and programs (.2) 2.1 The project life cycle (.2.3) App. G.1 The project manager App. G.7 Political and social environments F.1 Integration of project management processes [3.1] 6.5.2 Setting a schedule baseline [8.1.4] 6.5.3.1 Setting a resource schedule 6.5.2.4 Resource leveling 7.2 Setting a cost and time baseline schedule (1.3.5) [8.1.3] 6.5.2.3 Critical

Family Medicines a Strategic Weakness free essay sample

Recently the trends of urbanization and fast population increase expose several problems to healthcare system in Vietnam like shortage of healthcare manpower, low quality of care, unreasonable distribution of healthcare manpower in different geographic areas, particularly the serious shortage of physicians in Mekong Delta and North-west highland areas as specialists tend to locate their practices in urban medical centers where they could have access to advanced technology, supportive services and consultations from other specialists while rural areas are underserved and patient care becomes highly technocratic, fragmented and episodic. Furthermore, the shortage of physicians in major cities results in a seriously permanent overload at Central level and some specialty hospitals like Oncology, Pediatrics, Obstetrics and Gynecology .. etc.. In sustainable issues, deficit of Family medicine a basic foundation of modern healthcare in the world, is identified as one of main causes of such problems in Vietnam healthcare system. The purpose of this Essay is to provide a theoretical discussion and analysis about the Family medicine weakness in Healthcare system and Family physician insufficiency in Vietnam to better understand about their impacts to the healthcare system at present and some proposed solutions and recommendations to improve these deficits. 2. Family Medicine and its roles in global healthcare system. In contemporary medicine, Family medicine remains the foundation stone of healthcare service in the community. As the most interesting and challenging of medical disciplines it is based on six fundamental principles: * primary care * family care * domiciliary care * continuing care All above principles are all designed to achieve: * preventive care * personal care (Pereira Gray, 1980). In the contemporary climate where medical services are fragmented and there are competing interests there is a greater need than ever for generalists. In those principles, primary care is the backbone of the health care system and encompasses the following functions: * It is first – contact care, serving as a point of entry for the patient into the healthcare system * It includes continuity by virtue of caring for patients in sickness and health over some period * It is comprehensive care, drawing from all the traditional major disciplines for its functional content. It serves a coordinative function for all the healthcare needs of the patient * It assumes continuing responsibility for individual patient follow-up and community health problems * It is a high personalized type of care (Rakel 2011) In the 2008 report, the World Health Organization (WHO) reaffirmed the importance of primary health care with its report â€Å"Primary health care now more than ever† and its emphasizes that primary care is the best way of coping with the illnesses of the 21st century, and that better use of existing preventive measures could reduce the global burden of disease by as much as 70%. The commentary emphasizes that ‘primary care brings promotion and prevention, cure and care together in a safe, effective and socially productive way at the interface between the population and the health system’. The key challenge is to â€Å"put people first since good care is about people† (WHO, 2008). Rather than drifting from one short-term priority to another, countries should make prevention equally important as cure and focus on the rise in chronic diseases that require long-term care and strong community support. Furthermore, at the 62nd World Health Assembly in 2009, WHO strongly reaffirmed the values and principles of primary health care as the basis for strengthening health care system worldwide. The essence of Family medicine is continuity of care and the evidence for its contribution to quality of care and better outcomes as follows: * Lower all cause morbidity * Better access to care * Less re-hospitalization * Fewer consultations with specialists * Less use of emergency service Better detective of adverse effects of medication interventions. Role definition of Family physician varies considerably both among family physicians and among people with whom they interact. Some individuals, particularly other medical specialists, see family medicine as merely another name of general practice. For others, family medicine is synonymous with primary care. A large proportion of family physicians further elaborate their role to include emphasis on personalized and humanized care. A smaller group adds a third component to their role: caring for families. The largest proportion who subscribes to this last notion refer to family physicians’ treating all members of a family (Cogswell, Sussman, 1982). In view of Family medicine, Family physicians are generalists who primarily draw their scientific medicine and technical expertise from five older specialties – internal medicines, pediatrics, surgery, obstetrics-gynecology and psychiatry-neurology. Compared to these specialties, family medicine is still a young field marked both by rapid expansion and by change, variety, ambiguity and conflict in the images and definition of the role of family physician. As the largest caring scope in healthcare services, the quality and quantity strengths of Family physician force play key roles to improve the health quality of national population. Globally the scope of Family medicine is extended with the recent view of global health care which is a field at the intersection of several disciplines: epidemiology, economics, demography and sociology. The term global health, as opposed to international health, implies consideration of the health needs of the people of the whole planet above the concerns of particular nations. That means global health has wide scope and reach to equity that the term of international health. The â€Å"global health† concept in Family medicine raises the changes in primary care nature as follows: * All population has to deal with the same risk of health due to the phenomena of traveling and immigration. Increase the gap between the poor amp; the rich globally. * The process of the urbanization/globalization. * Increase of the population in the world. * Decrease of the resources for health care. * Global warming phenomena. * Vaccination Era. * Evidence Based Medicine in daily practice. * Increase the bad behavior such as fast food, tobacco, stress, use alcohol†¦ * Primary health care change to Primary care concept  (Pham Le An, 2009). Such comprehensive changes upgrade the scale of Famil y medicine in healthcare. In order to promote the global health support as well as strengthen the co-operation of national members, the World Organization of National colleges and Academies (WONCA), World Organization of Family physicians in WHO, was officially established and based in Singapore after the Fifth World Conference on General Practice in Melbourne in 1972. 3. Family medicine situation in Vietnam Although Family medicine basis had been established in the world for over 40 years, Family physicians, the most recently recognized specialists in Vietnam, are in the enigmatic situation of developing the occupational role which they simultaneously occupy. Family medicine had been only approved for establishment by Vietnam Ministry of Health since 2000. Until 2003, Family medicine specialty was established at 3 Medical Universities of Hanoi, HCMC City and Thai Nguyen province to train Family physicians and its specialists. However, its development was spontaneous with 7 Family medicine clinics (in both public and private sectors) nationwide and not strategically organized at all levels so far. There are only 59 post-graduated specialists and around 1,1 General practitioners who partly handle the roles of family physicians per 10,000 people averagely. The imbalance between Family medicine and other specialists can be seen by the ratio of 7,2 Medical doctors per 10,000 people in overall (Vietnam General Statistics Office GSO – 2011) and the healthcare system only satisfies about 60- 70% of the demands and are lower than neighbor countries like Thailand, Singapore, Malaysia, Philippines.. tc. In 2011 report, Vietnam Ministry of Health forecasted the demand of 34,000 General practitioners more to obtain 10 Medical doctors/10,000 people in 2020 and this is a significant challenge to all 19 Medical educational Universities/Colleges to educate Medical doctors and post-graduate levels in medicine which capacities supply 4,800 graduated Medical doctors every year to add around 3,500 physicians more a year. Not only the quantity of family physicians is seriously insufficient, but also their quality to fulfill the roles of a family physician does not meet the needs of the patients and social development. The General practitioner training programs don’t orient student to the WHO’s critical requirements of â€Å"good doctors† in Family medicine, even though the criteria are more and more demanding by time, for example, the newer criteria of John Murtagh in 2001 â€Å"What makes a good General Practitioner? : * Develop rapport and good communication skills * Ask the right questions * Be astute and observant * Develop optimal ethical and professional standards * Have a fail-safe diagnostic strategy * Develop supportive networks * Know essential therapeutics * Develop basic procedural skills * Be well prepared for emergencies * Know yourself and your limitations including own general practitioners. The importance of certain specific competences and soft-skills in family physician force are emphasized in many studies. An interesting survey on patient care by representative health consumers conducted at St Vincent’s Hospital Melbourne revealed that the most important attributes of good doctors were (in some order of importance) caring, responsibility, empathy, interest, concern, competence, knowledge, confidence, sensitivity, perceptiveness, diligence, availability and manual skills. Additionally, there are neither comprehensive residency programs for Family physicians at Medical Universities/ Colleges in Vietnam nor supporting policy to them and general practitioners practicing at remote or rural areas so far. With effort to resolve the overload situation of Central hospitals in major cities, Project 1816 of Vietnam Ministry of Health deployed in 2008 with the purpose of â€Å"Fielding rotated professionals from upper level hospitals to lower levels to improve the quality of medical care† achieved some initial results such as transferring some technologies and conducting on-site training to improve skills and qualifications for lower level health care professionals; initially improving the quality of medical care at lower levels, especially in the mountainous, remote areas with staff shortage†¦etc, but its couldn’t obtain one of basic goals to reduce overcrowding for upper level hospitals, especially central level hospitals because it made the shortage of central level and specialty hospital more serious by the rotation. 4. Impacts of Family Medicine weakness in Healthcare system amp; Family physician insufficiency in Vietnam. Due to low reliability and poorly structured family physician network, patients tend to bypass to specialists/ central level hospitals (Vietnam Ministry of Health – 2011 Report), opposite with the trend in the world in which healthcare activities for chronic diseases such as diabetes, hypertension, asthma†¦are moved from in-patient to out-patient services with comprehensive treatment protocol at each level (Dang Van Phuoc, 2012) The irregular bypass causes the overload at Central level and specialty hospitals and the overloading condition becomes more serious, i. e, bed using capacity at Central hospitals increase from 116% (2009) to 120% (2010) and 118% (2011). It’s extremely high in some specialty hospitals such as K (Cancer) Hospital: 249%, Bach Mai Hospital: 168%; Cho Ray hospital: 154%; Central Obstetric and Gynaecological hospital: 124% .. etc. High capacity occurs in some specialties such as Oncology, Cardio-vascular, Orthopaedics (at 100% of hospitals), Obstetrics and Gynaecology, Paediatrics (at 70% of hospitals) while 36,8% of General hospitals are overloaded. The similar situation also happens in Consulting Departments with 80 exams/day/doctor while 60% 80% of patients at Central level hospitals could be examined at local level and 40% of surgery cases at Central level hospital could be performed at local levels (Ministry of Health – Plan to decrease workload of Central level hospitals 2012- 2020) With the cost in health care, the deficit of Family medicine in Vietnam is one of reason making the medical expenses of patient higher. Total Expenditure on health as % of GDP (5. 1) is fairly high while General Government expenditure on health as % of total expenditure on health (28. 5) is so low to neighbor countries (Susan, 2005). The most cost-effective healthcare systems depend on a strong primary care base. This has been confirmed by a variety of studies comparing the care given by physicians in different specialties because primary care provided by physicians specifically trained to care for the problems presenting to personal physicians, who know their patients over time, is of higher quality than care provided by other physicians. When hospitalized patients with pneumonia are cared for by family physicians or full-time specialist hospitalists, the quality of care is comparable, but the hospitalist incur higher hospital charges, longer lengths of stay, and use more resources (Smith et al. , 2002). Similarly, the greater quantity of primary care physicians practicing in a nation, the lower is the cost of health care. The cost of healthcare is inversely proportional to the percentages of generalists practicing in that nation. According to OECD Health (Organization for Economic Cooperation and Development OECD Health Data, June 2005), United Kingdom has twice the percentage of family physicians but half the cost to U. S.. Administrative overhead accounts for a major part of the high overhead cost (31%) of U. S. health care (Woolhandler et al. 2003). Countries with strong primary care have lower overall health care costs, improved health care outcomes, and healthier populations (Starfield, 2001; Phillips and Starfield, 2004). The shortage of Family physicians and Family medicine deficits also cause other problems in health care as follows: * Incomplete or unsuccessful Primary health care performance. * The gap between urban care and rural care in the health care network. * The competition among specialties: lack of cooperation in chronic disease care, increase the cost of management. * Barrier in teaching ambulatory care and doing out-patient’s research in academies (Pham Le An, 2009). In society, Family medicine meets some resistances of patients such as family hysicians are unfairly treated as â€Å"general consultants†, â€Å"home caring doctors† and even in medical community, they are considered as â€Å"incompetent doctor†, â€Å"poor specialist†, â€Å"unfair competitive doctor†.. e tc. Many other specialists and hospitals’ managements list Family physicians as one of financial losing causes to their hospitals. Such unfair treatments make many Family physicians feel uncomfortable with the specialty and their roles of Family physician. The reliability of patients and society to them is fairly low and this specialty does not attract the general practitioners to study. 5. Some proposed solutions amp; recommendations to improve Family medicine. In order to improve the Family medicine in Vietnam, it requires a comprehensive strategy with strong supports of government, educational institutes and society. Within the limit of this essay, I would like to propose some solutions and recommendations as follows: a. Increasing the quantity of Family physicians with additionally trained General practitioners and using the retired medical doctors: The greater the number of primary care physicians in a country, the lower is the mortality rate and the lower cost (Rakel, 2011). In the United States, a 20% increase in the number of primary care physicians is associated with a 5% decrease in mortality (40 fewer death per 100,000 population), but the benefit is even greater if the primary care physician is a family physician. Adding one more family physician per 10,000 people is associated with 70 fewer death per 100,000 population, which is a 9 reduction in mortality (Rakel 2011). A study of the major determinants of health outcomes in all 50 U. S. states found that when the number of specialty physicians increases, outcomes are worse, whereas mortality rates are lower where there are more primary care physicians (Starfield et al. , 2005). Starfield (2000) states, â€Å"the higher the primary care physician-to-population ratio, the better most health outcomes are† (p. 485). Researches in England reveal that with each Family doctor more in 10,000 people (about 20%), adjusted mortality will reduced about 5% in chronic diseases (Gulliford 2002). The increase of Family physicians obviously reduces the workload at Central level and specialty hospitals (49. 3% of out-patient and 59% of in-patient totally) because with many researches in the world, over 90% of patients are taken care with better service by Family physicians in developed medical or developed countries (Didier, 2011). They can help patients and their relatives in 80% health problems: acute or chronic diseases without complications or no need to transfer to Specialty hospitals (Dang Van Phuoc, 2012). To compensate the continuing decline of the number of students entering primary care as a common trend in the world (Bodenheimer et al. 2009) and insufficiency of graduated general practitioners, a policy to support general practitioners and retired medical doctors to practice as Family physicians such as additional training about Family medicine, financial supports, incentive†¦should be prepared and implemented. Rather than other countries where Family physicians usually work at home or their private clinics, Vietnam has a wide network of local level medical centers at wards/hamlets and popularly private clinics/medical units. This advantage allows Family physicians to practice and deploy the primary care programs easily and popularly. b. Family physician residency training programs: Quality of care and the inadequacy of medical training are two major concerns of Family physicians. Eventually, medical schools and residency programs graduated more specialists and fewer physicians trained for primary care. To improve their quality of care in accordance with global health principles, proposed solution is to build emerging curricula of family practice residency programs to envisioning family physicians as â€Å"horizontal specialists† who can deal with the large majority of patients’ needs on a continuing basis (Rakel, 2011) and envisioning this role as integrating humanized care with a high level of competence in scientific medicine. In contrast to the training of the general practitioner, the additional training that family physicians receive is intended to make them more proficient generalists in scientific medicine through formal training in appropriate interpersonal skills and in the behavioral and social sciences. Implementation of this role, however, requires reorganization within the medical system (Folsom, 1966) for continuing, comprehensive care by primary physician is difficult if not impossible within the normative organizational structures of highly specialized medical centers. As Family physicians play the important role in primary care, the Global health awareness program should be combined into General practitioner and Family physician’s training curriculum for being sure about the quality of â€Å"primary care† as follows: (i) Clerkship: adding knowledge of burden global disease in the world such as: tuberculosis, malaria, Preventive care: vaccination; improving skills such as clinical making decision, communication. ii) Orientation: Adding knowledge of new   emerging infectious disease like SARS, non communicable diseases, traumatism care, HIV/AIDS; (iii) Residents: adding knowledge of prenatal care,   neonatal care,   chronic care, mental health care, adolescen t care;   Emergency care in disaster; improving skills such as: doing research and practice Emergency care in disaster, Behavioral care after disaster, Kangoroo’s program, Obs-Gyn care program; building up the relationship center care with WIN- WIN theory for both developed and developing countries to increase of cooperation and Team work. In addition, the cooperation among experts in different medical fields should be strengthened for teaching, managing, doing research to promote the concept â€Å"relationship center care† through many activities: * Establish Continue Medical Education, Patient’s clubs. * Build the bridge or integrate the teaching contents   in Family medicine   with the other specialties like Pediatrics, Traditional Medicine ( Oriental nutrition, Shiatsu), Cancerology (Palliative care), Multidiscipline (Disaster care, EBM, chronic care). Communication through Internet/ Video conference and Electronic medical: The WHO 2008 report emphasiz es the appropriate ‘use of information and communication technologies to improve access, quality and efficiency in primary care. The writer has made a small contribution to basic patient education (also known as doctor education) by the production of common patient handouts which are available for print out from General practitioners’ computers or for one page photocopying from the book ‘Patient Education’ (Murtagh J; 2008). Besides the residency training programs, on-going training courses to improve the competences and skills of Family physicians should be set for attributes considered most important for patient satisfaction (Stock Keister et al. , 2004a). Overall, people want their primary care doctor to meet five basic criteria: â€Å"to be their insurance plan, to be in a location that is convenient, to be able to schedule an appointment within a reasonable period of time, to have good communication skills, and to have a reasonable amount of experience in practice†. They especially want â€Å"a physician who listens to them, who takes the time to explain things to them, and who is able to effectively integrate their care† (Stock Keister et al. , 2004b, p. 2312). c. Others solutions and recommendations (i) Building an incentive scheme and financial supporting policy to Family physicians, especially whom working in remote and rural areas: The effectiveness of this model had been proved in many countries, particularly in Thailand and Malaysia where healthcare conditions are fairly similar to Vietnam. Contrarily, the recent P4P (Pay for Performance) policy of Thailand’s of Ministry of Health to replace the incentive scheme to Family physicians creates several problems to healthcare force and patients and is considered as a main cause leading the Family physicians moving to major cities. With relation between income and satisfaction, in an analysis of 33 specialties in U. S. , Leigh and associates (2002) found that physicians in high-income â€Å"procedural† specialties, such as Obs – Gyn, ENT, ophthalmology and orthopedics, were the most dissatisfied. Physicians in these specialties and those in internal medicine were more likely than family physicians to be dissatisfied with their careers. Among the specialty areas most satisfying was geriatrics. Because the population older than 65 years old in U. S. has doubled since 1960 and will double again by 2030, it is important to have sufficient primary care physician to care for them. The need for and the rewards of this type of practice must be communicated to students before they decide how to spend the rest of their professional lives. Patient satisfaction correlates strongly with physician satisfaction, and physicians satisfied with their careers are more likely to provide better health care than dissatisfied ones. Physician satisfaction is associated with quality of care, particularly as measured by patient satisfaction. The strongest factors associated with physician satisfaction are not personal income, but rather the ability to provide high-quality care to patients. Physicians are most satisfied with their practice when they can have an ongoing relationship with their patients, the freedom to make clinical decisions without financial conflicts of interest adequate time with patient and sufficient communication with specialist (DeVoe et al. , 2002). Landonamp; colleagues (2003) found that rather than declining income, the strongest predictor of decreasing satisfaction in practice is the loss of clinical autonomy. This includes the inability to obtain services for their patients, control their time with patients, and the freedom to provide high-quality care. ii) Compulsorily assigning General practitioners/ Family physicians to practice at local level hospitals, the servicing term at local level hospitals must be reasonable and acceptable. (iii) Improving facilitates of local level hospitals/clinics , enforcing the lower level hospitals to implement modern technologies and quality control. This allows Family physicians to better serve patients as some achievements of Project 1816 of Vietnam Ministry of Health. (iv) Involving patients for private and family health care and prevention, structured information supporting treatment. (v) Improving the reputation of Family medicine and physicians in society through public media channels like television, newspaper.. etc, medical education programs and medical community. Even after the specialty is formally acknowledged by institutionalized medicine, family physicians have experienced a variety of negative responses from medical colleagues in other specialties. Carmichael (1978) perceived 3 stages in the reactions of those in medicine to Family medicine: first, the field was ignored; second, it was actively opposed; and then, family medicine is entering a third stage of possible co-optation by medicine. 6. Conclusion The weakness of Family medicine and insufficiency of family physicians cause many strategic consequences to the healthcare system in Vietnam. Their correction requires a long-term strategy to increase the quantity of Family physicians, quality of care, revise the residency training programs, improve its reputation in the society .. etc. In conclusion it seems appropriate to paraphrase Dr Robert Rakel in his keynote presentation to the 14th WONCA World Conference to reaffirm the Family medicine era in the contemporary medicine: â€Å"Regardless of how computer literate we are or how high our technology or whether the setting is urban or rural, good medical care in the future will continue to depend on patient care provided by a concerned and compassionate family physician. The physician will be governed by ethics, not economics, by a partnership with the patient, not politics; and by compassion and communication, and not by capitation. Good medical care in the future will depend, as it does now and always has, on the quality of our interaction with the patient† Dr Robert Rakel – 14th WONCA World Conference) REFERENCES 1. Alain J. Montegut, The Power of Primary Care for the Future of health care: Is Family Medicine the Answer? 1st International PHC Conference Doha, Qatar 1 4 November 2008 2. Bodenheimer et al. , 2009. Bodenheimer  T. ,  Grumbach  K. ,  Berenson  R. A. :  A lifeline for primary care. N Engl J Med  Ã‚  2009;  360:2693-2696. 3. Cogswell BE, Sussman MB, Family Medicine: A new Approach to Healthcare (Marriage amp; Family review, ISSN 0149-4929; v. 4, no. 1/2), The Haworth Press Inc. 1982. 4. Dang Van Phuoc : Plan to decrease workload of Central level hospitals 2012- 2020 Vietnam Ministry of Health, 2012. 5. Didier L. Roles of Family medicine, Texbook of Family medicine for the co-operation between Liege University Brussel and Vietnam, Medicine Publisher, 2009. 6. DeVoe et al. , 2002. DeVoe  J. ,  Fryer  G. E. ,  Hargraves  L. ,  et al:  Does career dissatisfaction affect the ability of family physicians to deliver high-quality patient care?. J  Fam Pract  Ã‚  2002;  51:223-228. 7. Gulliford, J Public Health Med 2002; 24:252-4, and personal communication 9/04. 8. Landon et al. , 2003. Landon  B. E. ,  Reschovsky  J. ,  Blume nthal  D. :  Changes in career satisfaction among primary care and specialist physicians, 1997–2001. JAMA  Ã‚  2003;  289:442-449. 9. Leigh et al. , 2002. Leigh  J. P. ,  Kravitz  R. L. ,  Schembri  M. ,  et al:  Physician career satisfaction across specialties. Arch Intern Med  Ã‚  2002;  162:1577-1584. 10. Murtagh J: The road to excellence. Australian doctor 3 2008, 46-8. 11. Murtagh J: Paradigms of Family medicine: bringing traditions with new concepts; meeting the challenge of being the good doctor from 2011, Asia Pacific Family Medicine, 2011, 10:9 12. Murtagh J: Patient education. 5 edition. Sydney: McGraw-Hill; 2008. 13. Pereira Gray DJ: Just a GP. J R Coll Gen Pract 1980, 30:231-239 14. Pham Le An, Integrate the issue of global health in FM curriculum: promising solution for improving the quality f Primary care in Hochiminh city, Vietnam  , Introducion FM concept: global healh, texbook of Family medicine, Vietnamese version, Medicine Publisher, 2009. 15. Pham Le An, Global health perspective in Vietnam, A â€Å"Train the Trainer’s Workshop†   WONCA   ASIAN PACIFIC Vietnam Ho Chi Minh city, 2008 16. Phillips and Starfield, 2004. Phillips  R. L. ,  Starfield  B. :  Why does a U. S. primary care physician workforce crisis matter?. Am Fam Physician  Ã‚  2004;  70:440-446. 17. Rakel RE: Family medicine-meeting new challenges. Australian Family Physician 1996, 25(9 Suppl 2):S91-6. 18. Rakel RE: The Family Physician, Textbook of Family Medicine, Eight Edition, Elsevier Saunders, 2011, pp4-15 19. Rivo et al. , 1994. Rivo  M. L. ,  Saultz  J. W. ,  Wartman  S. A.   et al:  Defining the generalist physician’s training. JAMA  Ã‚  1994;  271:1499-1504. 20. Smith et al. , 2002. Smith  P. C. ,  Westfall  J. M. ,  Nicholas  R. A. :  Primary care family physicians and 2 hospitalist models: comparison of outcomes, processes, and costs. J Fam Pract  Ã‚  2002;  51:1021-1027. 21. Starfield, 1994. Starfield  B. :  Is primary care essential?. Lancet  Ã‚  1994;  344:1129-1133. 22. Starfield, 2000. Starfield  B. :  Is U. S. hea lth really the best in the world?. JAMA  Ã‚  2000;  284:483-485. 23. Starfield, 2001. Starfield  B. :  New paradigms for quality in primary care. Br J Gen Pract  Ã‚  2001;  51:303-309. 24. Starfield et al. , 2002. Starfield  B. ,  Forrest  C. B. ,  Nutting  P. A.   et al:  Variability in physician referral decisions. J Am Board Fam Pract  Ã‚  2002;  15:473-480. 25. Starfield et al. , 2005. Starfield  B. ,  Shi  L. ,  Grover  A. ,  et al:  The effects of specialist supply on populations’ health: assessing the evidence. Health Aff (Millwood)  Ã‚  2005;  24:W5-97-W5-107 26. Stock Keister et al. , 2004a. Stock Keister  M. C. ,  Green  L. A. ,  Kahn  N. B. ,  et al:  What people want from their family physician. Am Fam Physician  Ã‚  2004;  69:2310. 27. Stock Keister et al. , 2004b. Stock Keister  M. C. ,  Green  L. A. ,  Kahn  N. B. ,  et al:  Few people in the United States can identify primary care physicians. Am Fam Physician  Ã‚  2004;  69:2312. 28. Susan JA, Vietnam’s Healthcare system: A Macroeconomic Perspective, Paper Prepared for the International Symposium on Health Care Systems in Asia Hitotsubashi University, Tokyo, 2005. 29. Vietnam Ministry of Health: Plan to decrease workload of Central level hospitals 2012- 2020, 2012. 30. Woolhandler et al. , 2003. Woolhandler  S. ,  Campbell  T. ,  Himmelstein  D. U. :  Costs of health care administration in the United States and Canada. N Engl J Med  Ã‚  2003;  349:768-775. 31. World Health Organisation: The World Health Report 2008: Primary Health Care now more than ever Geneva; 2008. 32. World Health Organisation: World Health Report 2009: Promoting health and development-closing the implement gap Geneva; 2009. -oOo-

Special Education Collaboration and Communication free essay sample

In the past, special professionals have serviced children with disabilities. This type of special servicing was needed to optimize the socialization that children with disabilities were getting by being integrated into the structure of an existing educational mainstream. It was needed because the mainstream structure is designed to meet the socialization needs of the majority rather than the individual. The† inclusion† philosophy is that classrooms, or the educational mainstream, must be restructured to meet the individual needs of all students, thereby accommodating individual differences. In such a set-up, I could advocate a process that involves a support system that would include reading specialists, physical therapists, speech-language pathologists, and psychologists. These specialists would come to the regular classroom instead of pulling the child out for services. I would advocate for a team-up in the monitoring and evaluation of these special children. Another possible issue, which I can advocate for these special students, could be the provision of appropriate interactive activities such as cooperative learning. We will write a custom essay sample on Special Education: Collaboration and Communication or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Cooperative learning as an educational goal structure here would involve a set of strategies that organizes students into small groups of five or six and gives them a task to constructively work with others. The child with disabilities can be part of the group, making a contribution according to the ability (Kirk, Gallagher Anastasiow, 1993).   Cooperative learning structures also provide opportunities for reinforcement and tutoring. Similarly, knowing that reinforcement increases the chance of a behavior being repeated, children without disabilities can reinforce certain behaviors in children with disabilities. While helping children to learn, tutoring or direct instruction also provides an opportunity for close social interaction. The learner gets instruction, and the tutor gains sensitivity to others, communication skills, and an opportunity to nurture. While the learner gains individual attention and an opportunity for cognitive growth, the tutor gains self-confidence and esteem. This would be more of a peer-to-peer set-up but one that would have to be properly supervised yet generate a healthy sense of fulfillment for everyone. Meanwhile, some of the ways I could advocate on the families’ behalf is by empowering them to become involved in school and education when they vote. There is an important need to elect people to serve on the local school board to make decisions about educational goals, school facilities, budget allocations, personnel, student standards of achievement and conduct, and evaluation methods. Obviously, this advocacy is indirect, but nonetheless influential. Another advocacy issue is to collaborate with the parents and empower them by implementing assignment monitoring and workshops that enable them to learn how to help their underachieving students. This program demonstrates that the school cares about the parents and the success of their children (Hyde, 1992). The factors that may hamper efforts are conflict, confusion, lack of consensus in goals or mismatch in motivation or cognitive skills (Hess Holloway, 1984). For instance, a mismatch in the way language is used in a special education set-up in school and the community can result in learning problems for the child (Heath, 1983). Moreover, the school’s effectiveness as a socializing agent is affected by the community where the child lives, the child’s family’s socioeconomic status and attitude toward education, the size of the school, the size of the child’s class, the arrangement of the classroom environment, certain psychological characteristics of the child, the child’s peers and the type of program that is the educational environment for the child. These are some of the factors that could stop the ability to affect them. Indeed, the key to complementary goals in a special education set-up is communication. The school and the community need to interact with the family so that goals for the child are complementary rather than contradictory. The school and the family need to constantly talk to each other about their attitudes regarding education of their special children. REFERENCES Heath, S. B. (1983). Ways with words: Language, life and work in communities and  classrooms. Cambridge, MA: Cambridge University Press. Hess, R.D.   Holloway, S.D. (1984). Family and school as educational institutions. In R.D. Parke (ed) Review of Child Development Research. Vol. 7: The Family,  Chicago: University of Chicago Press. Hyde, D. (1992). School-parent collaboration results in academic achievement. NASSP  Bulletin, 76(543), 39-42. Kirk, S., Gallagher, J.J. Anastasiow, N.J.   (1993). Educating exceptional children (7th  ed). Boston: Houghton Mifflin.