Pancreatic pseudoaneurysms are uncommon complications of acute or chronic pancreatitis (7). They form from pseudocyst that erodes the adjacent arteries. Pseudoaneurysm formation is the commonest of these vascular accidents in the middle age population with the male to female ratio of 4.5:1. Pseudoaneurysms affect the arterial wall, the medial and intimal layers, and their prevalence is higher than that of true aneurysms (8).
Since pancreatic pseudoaneurysms associated with bleeding, the splenic artery is very vulnerable to bleeding when compared to the gastroduodenal arteries. The splenic artery runs along the bed of the pancreas and extends to the spleen, and thus, it is vulnerable to bleeding due to its close proximity to the pancreas (8). The gastroduodenal artery has a bleeding incidence rate of between 10 to 15% compared to the pancreaticoduodenal arterys 10% (8).
Overall, the small intrapancreatic, and left gastric arteries have the lowest incidence of bleeding. The pathogenesis of gastroduodenal artery aneurysm is unclear, but it usually occurs due to blunt trauma or secondary to pancreatitis (4). Given that pseudoaneurysm is deadly when it ruptures, early diagnosis and management is necessary (10). Thus, this case report aims to alert sonographers and ultimately improve the diagnosis and management of pancreatic pseudoaneurysm.
Case Study
A 72-year-old female with a history of alcohol abuse, a right frontal metastatic deposit in the brain, and adenocarcinoma of the lungs presented herself to Nepean hospital with recent acute epigastric pain, vomiting, and weakness. A physical assessment revealed that the patient had jaundice, high blood pressure (100/60mmHg) and HR of 110 per min. The pathology results indicated that she had high levels of amylase and lipase, which suggested acute pancreatitis, while hemoglobin level was 83g/L, (normal range 130170g/L).
An Abdominal ultrasound was requested to determine the presence of gallstones and was performed in the medical imaging department, Nepean Hospital. A Phillips IU22 ultrasound machine with a curved array 5MHz transducer was used for B-mode imaging. The patient was positioned supine for imaging of the abdomen.
A transverse scanning of her pancreas depicted a dilatation of a hypoechoic area (3 cm x 2.2 cm x 2.8 cm) with a solid rim containing cystic central portion was observed anterior to the head of the pancreas in conjunction with marginally dilated pancreatic duct measuring 3.8mm. In addition, Doppler sonography revealed that a typical swirl flow (Yin- Yang sign) within the central portion was consistent with the pseudoaneurysms with a trace of gastroduodenal artery (1).
Figure 1
The rest of the abdominal ultrasound scan showed that the liver measures 9.8 cm in length with normal echotexture. The portal vein was mildly dilated; it measured 1.5cm with intrahepatic while the common bile duct dilatation is 9.8mm. During the examination, the patient said that she had cholecystectomy seven years ago, which was a very important clinical information. The absence of gall bladder throughout the scanning confirmed the removal of the gall bladder.
The right kidney and left kidneys were normal in size, 10.4 and 9.4 cm respectively, with normal echotexture. The size of the spleen was also normal because it measured 7.5 cm in length, while the aorta showed a normal diameter of 2.3cm. Further scanning showed that the urinary bladder contained debris, which represented a possible urinary tract infection.
The ultrasound findings were reported as a pancreatic pseudocyst with pseudoaneurysm formation. The report was sent to the referring doctor, with a recommendation to confirm the findings using computed tomography (CT) of the abdominal angiogram.
CT scan was performed with a Siemens Somatom 64 slice CT scanner, using 100 ml of iodized intravenous contrast with an injection rate of 4ml/ second. Further evaluation with CT angiogram showed contrast enhancement of the hypoechoic region of the gastroduodenal artery, which confirmed that pseudoaneurysm was rising at its distal bifurcation.
Following this diagnosis, the patient was referred to as immediate Digital Subtraction Angiography. After confirmatory angiography, the lesion was embolised successfully by using embolization particles. The particles occluded the distal section, which reduced gastroduodenal aneurysm. After the procedure, the patient was admitted in the ward.
Figure 2
Discussion
The gastroduodenal artery branches from the hepatic artery. The gastroduodenal artery links with the pancreas at the superior and the right sides of the pancreas. It supplies blood to the pancreas, the stomach, the duodenum, and the distal bile duct. Over drinking and gallstones, which block the gall ducts, increase the risk of developing pancreatitis.
Ample evidence accumulated for over decades shows that gastroduodenal artery aneurysm, ethanol abuse, peptic ulcer disease, and cholecystectomy account for about 47%, 25%, 17%, and 3% of all cases of pancreatitis respectively (2). Congenital abnormalities like liver cirrhosis, Marfan syndrome, and Ehlers-Danlos syndrome are other causes of pancreatitis. Moreover, vascular abnormalities like polyarteritis nodosa, fibro-muscular dysplasia, septic emboli, and trauma predispose individuals to pancreatitis.
Obstruction of the pancreatic duct is believed to be responsible for increased intraductal pressure and release of pancreatic proteolytic enzymes such as amylase and lipase (7, 6). Pseudocysts are common complications that arise within or around the pancreas in patients with pancreatitis. These are walled off fluid collections containing pancreatic enzymes surrounded by a fibrous capsule, which lacks the epithelial lining (6).
The occurrence of pseudocyst varies according to the nature of pancreatitis because of 5 % to 15% of patients with acute pancreatitis and 20% to 40% of patients with chronic pancreatitis experience pseudocyst (2). Fundamentally, pseudoaneurysms and pseudocysts are pancreatic conditions, which arise from acute and chronic pancreatitis and complicate the treatment of pancreatitis. Due to high mortality rates of bleeding from a pseudocyst, medical researchers have extensively studied vascular complications.
The erosion and digestion of arterial walls cause pseudocyst to rapture and become a hemorrhagic pseudocyst, and then turn into pseudoaneurysms (4). The bleeding due to the erosion of the pseudocyst can rarely bleed internally from pseudoaneurysms, which can be an extremely serious complication. Since the rupture results in internal bleeding, the hemorrhagic cyst causes abdominal pain. The internal bleeding causes the hemorrhagic cyst to swell up and form a pseudocyst.
Pseudocysts affect many areas of the body, including the duodenum, the colon, the gastric wall, the groin area, and the mediastinum (4). In chronic pancreatitis, pseudocyst may cause thrombosis of the portal vein and its branches, leading to portal hypertension and variceal hemorrhage. Among these vascular complications, pseudoaneurysms are the commonest causes of gastrointestinal hemorrhage.
Pseudoaneurysms are detected incidentally on imaging because they can be either asymptomatic or symptomatic. The common symptom of gastroduodenal artery aneurysms is right upper quadrant pain. Recent advancements in the diagnostic imaging modalities have increased the chances of detecting aneurysms.
The sonography is the basic diagnostic procedure done when one experiences abdominal pain. It is an appropriate test because it is cheap and does not require radiopaque contrast material (2). The sonography plays an important role in evaluating the biliary tract for the presence of possible obstruction by gallstones, the existence of pseudocysts, and pseudoaneurysms. While greyscale US scan detects the existence of pseudoaneurysm, colour-Doppler ultrasound effectively detects the vascular nature of pseudocyst (9).
However, the limitation of the ultrasound is that obese patients and overlying bowel gas restrict the detection rate to as low as 33% (5). Some techniques can be used to overcome these problems include increased transducer pressure, varying patient position, and breathing techniques. Since vascular angiography accurate and sensitive in detecting pseudoaneurysms, it has become the gold standard (2).
Angiographic embolization and surgical intervention are two main treatment interventions for pseudoaneurysms. Multiple studies have documented the efficacy of angiographic embolization in the management of hemorrhagic pseudocysts, while the surgical procedure is effective because it entails surgical ligation of pseudoaneurysms (3, 2, 4, and 8). Thus, the surgical procedure is reliable because it removes the diseased pancreas and thus addresses the root cause of the disease.
Conclusion
Pseudoaneurysms are common among patients with acute and chronic pancreatitis. Their occurrence complicates the pancreatic pseudocysts, although they can occur on their own. In this view, early detection is imperative to the prevention of the rapture of aneurysms in the vessels and causes lethal complications.
The imaging techniques such as computed tomography, Doppler ultrasound, magnetic resonance imaging, and angiography are currently applicable in the diagnosis of aneurysms. The patient, in the case study, was very lucky because she received prompt and effective diagnosis using ultrasound and CT scan, and obtained successful treatment with angiographic micro-coil embolization.
This case study is important because of the following three reasons. Firstly, I noted that early diagnosis and critical imaging improve the detection rate of pseudoaneurysms and thus, saves the patient from fatal complications associated with pancreatitis. Secondly, the case study made me understand the essence of patient-doctor communication.
If poor communication occurs or referring doctors make mistakes, unnecessary imaging will arise and complicate the job of sonographers. In our workplace, poor communication is a common occurrence, which affects the diagnosis and treatment of patients. Thirdly, I was involved in all imaging procedures in the diagnosis and treatment process of angiographic embolization.
Hourani, S., Badour, N., Rashaideh, A., Nawayseh, R., Alasmar, A., Alakasasbeh, A. & Gazaleh, A. 2008, Pseudo Aneurysm complicates Pancreatic Pseudo Cyst: Importance of Early Detection and Management, Journal of Surgery Pakistan, vol. 13, no. 1, pp. 42 -45. Web.
Irwine, C., Kay, D., Kirsch, D., & Milburn, J. 2013, Renal artery embolization for the treatment of renal artery Pseudoaneurysm following partial nephrectomy, The Ochsner Journal, vol. 13, no. 2, pp. 259-263.
Jain, C., Joshi, S., Subramanyam, G. & Sinha, N. 2013, Rupture of Gastroduodenal Artery Pseudoaneurysm, International Journal of Case Reports in Medicine, vol. 2013, no. 2013, pp. 1-5. Web.
Matsuzaki, Y., Inoue, T., Kuwajima, K., Ito, Y., Okauchi, Y., Kondo, H., Horiuchi, N., Hasegawa, K., Iwata, M., & Yoden, M. 1998, Aneurysms of the Gastroduodenal Artery, Japanese Society of Internal Medicine, vol. 37, no. 11, pp. 930-933. Web.
Middleton, D., Kurtz, B. & Hertzberg, S. 2004, Ultrasound: The requisites, Mosby, Missouri.
Patel, B., Shah, R., Shah, S., Patel, B., Jain, S., & Kumar, A. 2003, Case report: Pseudoaneurysm from Gastroduodenal Artery Associated with Chronic Pancreatitis; An Unusual Complication. Indian Journal of Radiology Imaging, vol. 13, pp. 311- 313. Web.
Salinas, G. & Sickle, V. 2008, Intermitted Gastrointestinal Bleeding from Left Gastric Artery Pseudoaneurysm Successfully Treated with Coil Embolization, The Internet Journal of Surgery. Vol. 20, no. 1, pp. 1- 4.
Tandazo, W., Ortega, J., & Mariscal, C. 2013, Spontaneous regression of splenic artery pseudoaneurysm: A rare complication of acute pancreatitis, International Medical Case Reports Journal, vol. 6, no. 1, pp. 17-20.
Young, R., Gagandeep, S., Grant, E., Palmer, S., Mateo, R., Selby, R., Genyk, Y. & Jabbour, N. 2004, Gastroduodenal Artery Pseudoaneurysm Secondary to Pancreatic Head Biopsy, Journal of Ultrasound Medicine, vol. 23, pp. 997-1001.
The quality of services offered in a nursing home defines its national ratings. According to Singh (2009), developing a quality assurance plan may help in improving the standards of services offered within these homes. In this plan, the researcher has identified specific items that will be included to help improve the quality of service delivery at this institution. The first item will be the maintenance of a high degree of cleanliness in this home. When conducting reviews, officials responsible for rating nursing homes always focus on the issue of hygiene at such institutions. This plan will not require any additional financial resources. The current team responsible for cleaning will have to double their efforts to achieve this objective. The second item will be the quality of service offered to the individual clients at this institution. This will require additional six nurses to be hired. It will require an additional $ 10,800 per month given that the monthly earning of a nurse is set at $1,800. The management will also make an effort to boost the morale of all the employees in the firm to improve their efficiency.
Implementing the plan will require additional funds. This nursing home relies on payments from private clients and reimbursements from the government based on the cost of maintaining Medicaid and Medicare clients. The management can identify some areas where costs can be cut to implement the suggested plan using the earnings from the reimbursements and payments from private clients. The hospital should enter into a strategic partnership with nearby hospitals to ensure that its clients can access medical services there. This way, it will eliminate the costs of rendering specialized medical care to these clients. It will only focus on providing quality nursing care to the clients.
Managing a Chain-Affiliated 110-Bed Facility
My superior officer aims to ensure that there is an increased cash flow into the firm from the payments made by the private-pay clients. However, this may be an unethical practice that may harm the ratings of this facility, especially if we are forced to turn away very needy clients. To address this issue, I will explain to my superior that the suggested move is not strategic in the long term. I will convince him that the move will paint a negative image of the firm that will not only harm the national ratings but also scare away private-pay clients that we are aiming to attract. The only way of increasing the number of private-pay clients is to improve on our service delivery. We should aim at promoting the popularity of this facility within the state or even nationally. With a good name, the reimbursements we receive shall increase and more patients will be coming for our services. Our capacity shall increase and so will the cash flow from private-pay clients. The proposal will help the firm achieve its long-term plans.
Medicare will pay for speech therapy, especially for those who are covered under Medicare Part A and B. However, Singh (2009) explains that this cover does not pay for personal services. The main reason for this is that people have different lifestyles and the cost of personal needs may not be universal. It is also more likely that people may abuse this cover by engaging in unnecessary expenses.
References
Singh, D. (2009). Effective Management of Long Term Care Facilities. Sudbury: Jones & Barlett.
Ferrons news article Advance Directives Help Patients Create End-of-Life Road Maps deals with the use of advance directives when it comes to end-of-life road maps. Ferron notes that advance directives are not common as only 27% of US patients have them, but they are instrumental in making the right decision when patients cannot speak for themselves, and their caregivers should decide (par. 13). One of the major barriers to the spread of these directives is the cultural beliefs and values existing in the contemporary society as people try not to think about the time of crisis.
The article in question is closely related to a broader topic of values and beliefs in healthcare. Ferron mentions that Americans, as well as other many other nations, do not like thinking of the death and the time of any kind of disability (par. 14). People focus on life and health, which is a good trend as they remain active and positive. Nonetheless, various crises have a tremendous impact on modern people as they are unprepared. Although death is a natural thing, people do not think about it even when they are getting old. Advance directives can become the path to get ready for major crises that can occur.
It is necessary to note that one of the central values in the contemporary society, as well as the US healthcare system, is that an individual has the right to make every choice concerning his/her health. In some culture states, there could be times when the individuals opinion could be even disregarded, but now the patient is the major decision maker. At that, patients may lose the ability to speak for themselves due to an injury or certain chronic conditions. Their caregivers become responsible for the life and wellbeing of their loved ones. The choice can often be very hard, and the advance directive can become a helpful tool. Some people claim that the advance directive should be a part of the Medicare plan as it makes the process of the healthcare services provision quite clear (Ferron 26).
Of course, it healthcare professionals can also benefit from the popularization of advance directives. They will be able to respond to various challenges in a more efficient way. For instance, a patient with a chronic illness can outline procedures that can or cannot be performed. The patient can also identify the point when certain procedures can or must be carried out. In case of severe injuries and loss of consciousness (or ability to talk), the patient can still be sure that his/her interests and wishes will be taken into account. Thus, the individual is central to the provision of healthcare services as the patient can make major decisions rather than caregivers or healthcare professionals. Another implication for healthcare units is concerned with purely legal issues. In some cases, caregivers or patients may sue hospitals personnel, but the existence of advance directives can decrease the number of lawsuits as there will be a particular road map to follow.
In conclusion, it is possible to note that the article in question deals with the concept of values and beliefs. The advance directive can become a road map for healthcare professionals and patients caregivers. It is consistent with the contemporary beliefs concerning the role of the individual in his/her own life. The US healthcare system sees the individual as the central agent whose decisions are particular directions to follow. The will of the patient is respected. At the same time, the article also touches upon peoples neglect of such issues as death or disability.
The article of choice is Rotavirus Surveillance in Urban and Rural Areas of Niger, April 2010-March 2012 by Page et al. (2014). This article indicates that severe gastroenteritis and more than 450,000 deaths among children less than 5years of age in less developed countries are attributed to rotavirus. There are four predominant genotypes of rotavirus: G1P, G2P, G3P, and G4P.
The article is a representation of surveillance data in 2 urban areas in Niger. In a country without rotavirus prevention vaccine, 30.6% of children had rotavirus. Children with rotavirus present symptoms of watery diarrhea and dehydration that last for three to7 days (Glass, Parashar, Patel, Gentsch & Jiang, 2014). The disease is mainly mild, and immunoassay is used to detect the rotaviral antigen in the stool because a specific diagnosis is rarely made.
Rotavirus enters the hosts body orally and replicates in the villous epithelium of the ileum. The gastrointestinal tract and fecal matter are the reservoirs of the rotavirus, but, in a study by Page et al. (2014), the numbers of rotavirus-positive specimens were lower in relation to rectal swab samples in comparison to stool samples (DOI: 10.3201/eid2004.131328). Rotavirus is transmitted through various channels: fecal-to-oral, person-to-person contact, and surfaces or equipment contaminated by stool, which is highly concentrated with rotavirus.
The seasonality of the rotavirus in relation to climate has not been fully established due to controversial results on the same. Some studies show no relationship between rotavirus infection and season, but most studies indicate that that rotavirus GE mainly occurs during the winter.
It is, however, important to note that the first epidemiological examination of rotavirus was observed in the temperate regions, and it was noted that most admissions due to diarrhea were distinct during the winter as opposed to the summer and fall. Rotavirus has a higher prevalence among children less than five years, with a peak in children between 6 months and two years (Glass, Parashar, Patel, Gentsch & Jiang, 2014).
There is no cure for rotavirus, but a preventative approach is imperative. Immunization with the rotavirus vaccine is useful in the prevention of rotavirus gastroenteritis (GE). The World Health Organization has prequalified two vaccines for rotavirus: Rotarix and Rotateq. The low income and middle-income countries are worst hit by this virus; hence, the two vaccines are largely used in these countries.
Some literature suggests that high levels of hygiene and sanitation are important to avoid the contamination of food, water, and surfaces with rotavirus. On the contrary Glass, Parashar, Patel, Gentsch & Jiang (2014) are of the opinion that hygiene and sanitation have no effect on rotavirus spread since children in both low resource settings and industrialized countries suffer from the virus early in their lives (p. S10). More research is required to verify these controversial opinions.
In Africa, only 12 countries are included in the surveillance network as per the surveillance regulations derived from the WHO protocol. I believe that these protocols are applied in other regions as well, and there is a need for literature to clarify this. The criteria used to select the African Rotavirus Surveillance Network include (Mwenda et al., 2012, p. S7):
Existence of a high-quality Expanded Program for Immunization alongside introducing novel vaccines such as those against H. influenza type b to enhance the efficacy
National commitment to engage resources to disease surveillance by health professionals and policy-makers
A participant in other AFRO supported disease surveillance networks such as polio and measles
An already well-established capacity for disease surveillance, in the country
According to Mwenda et al. (2010), ten enrolled surveillance networks have initiated surveillance activities, but only 8 have data for at least one year. More efforts to enhance surveillance of the disease should be emphasized to foster successful disease monitoring.
References
Glass, R. I., Parashar, U., Patel, M., Gentsch, J., Jiang, B. (2014). Rotavirus vaccines: Successes and challenges. Journal of Infection, 68, S9-S18.
Mwenda, J. M., Ntoto, K., Abebe, A., Enweronu-Laryea, C., Amina, I., Mchomvu, J., & Steele, A. (2010). Burden and epidemiology of rotavirus diarrhea in selected African countries: Preliminary results from the African Rotavirus Surveillance Network. The Journal of Infectious Diseases, 202(Supplement 1), S5-S11.
Page, A. L., Jusot, V., Mamaty, A. A., Adamou, L., Kaplon, J., Pothier, P.,&Grais, R. F. (2014). Rotavirus surveillance in urban and rural areas of Niger, April 2010March 2012. Emerging Infectious Diseases. doi: 10.3201/eid2004.131328
Holley, Jennings, and Wolters (2011) mention that staffing levels depending on the patients condition. Taking this into account, the Minnesota Nurses Association provided limitations for the nurses. In this way, the ratio is to be 1:1 in operating rooms and trauma units, etc., and 1:6 in uncomplicated postpartum (Registered nurse staffing for patient safety, 2009). Such a six-level division is said to allow the nurses to manage their duties successfully and enhance the results of the treatment, but the effect of its implementation seems to be different.
For now, patients are highly concerned about unsafe staffing, as they believe it to worsen health outcomes. So nurse to patient staffing ratio is said to be crucial for health facilities to provide the patients with high-quality services and bring positive outcomes (Minimum standards for patient safety, 2013). To prove this and that the division accepted in Minnesota works, the hospitals were ordered to prepare the report, which would allow studying this correlation (Minnesota session laws, 2013). As it turned out, the evidence failed to prove that patient outcomes depend on the staffing levels, and they were mostly influenced by the staff mix. So the efficiency of the legislated nurse to staff ratio remains only an assumption. The report also showed that the procedure of assessment was not well-designed, which prevented the measurement of staffing and outcomes even though it was discussed (Hospitals and nurses share the same goal, 2015). Moreover, the President of the Minnesota Hospital Association questioned the necessity of these ratios and claimed them to be not effective in his memo (Leaked memo, 2010). Still, the employees believe that staffing levels are one of the factors that influence outcomes.
Thus, it can be said that the nurse to patient ratio only looks advantageous for the patients. In real life, its positive effect on health outcomes was not proved. However, having even insignificant influence, tends to affect them in a way.
References
Holley, W., Jennings, K., & Wolters, R. (2011). The labor relations process. South Melbourne, Australia: Cengage Learning.
Hospitals and nurses share the same goal. (2015). Web.
Leaked memo: Hospital execs plan to ignore public promise; will work instead to undermine patient safety efforts. (2010). Web.
Minimum standards for patient safety. (2013). Web.
Many states in the U.S. are in the process of implementation of various health insurance policies or they have already implemented the policies following the signing of Obamacare. A good example is California, which has established the State Childrens Health Insurance Program (SCHIP) that specifically caters to children. Each state has established its own Medicaid policies based on federal government requirements. This leads to many similarities and differences when the eligibility requirements and services within different states are analyzed (Sommers, 2010).
Comparison with Pennsylvania Medicaid policy
The various policies in existence within California and Pennsylvania share a variety of similarities and differences. There are many services applied by each state. For instance, California offers the SCHIP policy to assist children in need of medical cover. The eligibility to be considered for the SCHIP program in California depends on families with children. Therefore, families without children are not eligible for the programs support. Eligibility is also restricted to families that have sufficient finances but considered too high to be eligible for Medicaid. The SCHIP plan is still based on Medicaid, which caters to individuals with incomes below the Federal Poverty Level (FPL). This is determined by the use of modified adjusted gross income (MAGI). Individuals are also ranked according to a percentage of the FPL. Moreover, the monthly dollars earned by a family and the family size are also factors that influence eligibility. The federal government is usually involved in the establishment of Medicaid eligibility requirements. Furthermore, each state is allowed to determine its individual coverage policies as, well as determine the financial criteria used to establish eligibility (Mortensen, 2010).
The SCHIP program can be compared to the Temporary Assistance for Needy Families (TANF) program used in Pennsylvania. The Medicaid eligibility program within this state varies greatly in comparison to the program within California. This leads to various differences that arise when it comes to the kind of program applied, although the eligibility requirements can have various similarities. The TANF program in Pennsylvania caters to children less than 21 years old. It is similar to the SCHIP program, although it also depends on the finances a family has. The income that a family receives and the household size are analyzed before a family can have access to aid. In both states, the minimum income that determines whether a family is eligible for assistance is $2000 per year. Household composition is also considered. This is used to determine the relationship between different family members to identify the individual needs of each family member (Kaiser Commission on Medicaid and the Uninsured, 2011).
In Pennsylvania, the state government also offers various services related to Medicaid. One such initiative is the Supplementary Security Income (SSI). This caters to individuals who are over 65 years of age. It is also applicable in a case where the individual is disabled and blind. This service is similar to the SSI program in California. The program also caters to children. Moreover, the individual should apply for all the available cash benefits provided by the state. An individual who receives the SSI is automatically guaranteed to get medical assistance through Medicaid (Mortensen, 2010). In Pennsylvania, the Medicaid eligibility requirements also consider a person with high medical bills. The individual is seen as unable to finance their medical costs, resulting in the need to be covered by Medicaid. This is different from the Medicaid eligibility requirement applied by Californias state government. In this case, it is not a requirement to have high medical bills (Decker, 2009). Moreover, the person must receive SSI for them to be automatically enrolled in the program.
Background of the SCHIP
The State Childrens Health Insurance Program (SCHIP) of California, also known as Healthy Families, is health insurance formulated to cater for children. President Obama signed into law the reauthorization and development of the SCHIP in 2009. Every state covered by the program has a specific payer who is involved in administering the insurance program. In Californias case, the Partnership Health Plan of California does this role. The insurance program has been vital in registering almost 900,000 California children. Moreover, it also provides thousands of children with easier access to health care services (Sommers, 2010).
The SCHIP caters to the child for almost nineteen years, ensuring financial stability for Healthy Families. Funding for the program is received from the federal government. The program receives two-thirds of its funding from the federal government. The government of California has used more than five billion US dollars within the last decade to provide medical care to children from poor families. Many low-income families have been able to gain from this policy (Kaiser Commission on Medicaid and the Uninsured, 2011).
Services offered
The Affordable Care Act has been able to facilitate the process through which individuals can easily access affordable insurance. There are various services offered in this program. Many of these services are created to cater to kids from low-income families. The services range from preventive health care services to the general well-being of the child. Services offered also include dental care. SCHIP also covers pregnant women. Children who do not have full insurance cover from private providers can be covered under the SCHIP program. The regulations governing the Medicaid program are somewhat applicable in the SCHIP program. The SCHIP program widens the coverage of medical cover given to children. The costs of coverage are shared between the respective state that has the SCHIP and the employer. The program has been able to offer services ranging from dental plans, health plans, and vision plans, which depend on where the covered individual lives (Decker, 2009).
Difference with Medicaid
In California, the SCHIP differs from Medicaid based on eligibility requirements. SCHIP is a special form of Medicaid because it considers families with children. In many cases, SCHIP is applicable in situations whereby the family cannot have access to Medicaid. California uses a state-based marketplace where individuals can choose various Medicaid policies placed on the website. This provides an avenue for choosing insurance covers that an individual prefers. The marketplace is structured in the form of a quasi-government. In California, Medicaid is known as Medi-Cal. The state government uses SCHIP funds to encourage improvements and enhance Medi-Cal programs (Decker, 2009). The Secretary in Charge of Health and Human Services (HHS) is tasked with the development of a model application in which people can utilize in the application of coverage through the marketplace, SCHIP, and Medicaid. States can either adopt the Secretarys model or apply an alternative derived from the secretarys model. Models from the HHS secretary characterize many states, or they have continued to modify the models (Kaiser Commission on Medicaid and the Uninsured, 2011).
In conclusion, the Medicaid programs in California are similar to those applied in Pennsylvania because they are both based on an established federal policy on medical coverage. Despite this, differences arise based on the eligibility requirements formulated by each state. In California, the SCHIP is a vital health policy that has played an integral role in ensuring that many Californian children have access to medical cover. This policy has been important in ensuring that there is a sustained effort by the government to provide children with health coverage. The program is different from the Medicaid program, but it is basically a modification of Medicaid.
References
Decker, S. (2009). Changes in Medicaid physician fees and patterns of ambulatory care. Inquiry, 46(3), 291-304. Web.
Kaiser Commission on Medicaid and the Uninsured. (2011). Key questions about Medicaid and its role in state/federal budgets and health reform. Web.
Kaiser Family Foundation (2012). Medicaid 101. Web.
Mortensen, K. (2010). Copayments did not reduce Medicaid enrollees nonemergency use of emergency departments. Health Affairs, 29(9), 1643-1650. Web.
Sommers, B. (2010). Enrolling eligible children in Medicaid and CHIP: A research update. Health Affairs, 29(7), 1350-1355. Web.
A lot of attention has been paid to incident reporting. Health care facilities have to follow specific requirements to ensure patients safety. Thus, Utah and Minnesota Incident reporting mandates are quite similar and are aimed at detecting potential hazards to patients safety and developing plans to prevent such incidents.
In both regions, departments, where incidents occurred, must provide their reports. Thus, according to Minnesota Statutes , each facility shall report to the department within fifteen working days (2013 Minnesota Statutes, 2013). Likewise, according to Utah Administrative Code, health care professionals have to report about incidents though the terms are different as facilities have to report within 72 hours or in no event later than four hours prior to conveying a formal root cause analysis (Utah Administrative Code, 2013). Admittedly, the frontiers in reporting are frontline personnel (especially nurses and physicians). Though, the healthcare facility is responsible for providing their reports to the specific department.
It is necessary to note that the incidents which should be reported are quite similar in both regions. This can be easily explained by existing national laws and requirements imposed. Thus, all health care facilities are required to have incident reporting mandates which cover the most common incidents (Kavaler, 2012). Hence, health care facilities report on surgical, product or device, patient protection, care management, environmental, potentially criminal, and radiologic events.
Nonetheless, there are certain minor differences. For instance, according to the Utah Administrative Code, facilities have to report about suicides of patients who are in the facility or within 72 hours of discharge (Utah Administrative Code, 2013). At the same time, in Minnesota, facilities have to report on patients suicide while in the facility only (2013 Minnesota Statutes, 2013). All facilities have to report about broken microneedles during surgery according to the Utah Administrative Code. Though, in Minnesota, broken microneedles are not mentioned.
It is necessary to note that the mandates do not specify who exactly investigates reported incidents at facilities. In practice, each facility has a committee that analyses incidents ( A national survey , 2008). The committee includes managers as well as practitioners.
Importantly, incident reporting is protected by mandates. Thus, facilities send electronic versions of their reports to the Department. At that, the confidentiality of patients is ensured by a number of acts. It is necessary to note that only members of the committee can access reports.
Facilities also provide a root cause analysis which is analyzed at the committee. Root cause analyses are potent tools that can be utilized to develop correcting measures and action plans. The root analysis reveals mistakes that led to malfunction and contains a correcting plan. This plan includes a set of specific steps to undertake to avoid similar situations in the future. Correcting plans developed on the basis of the root analysis are employed to develop training for the staff.
A Voluntary or Mandatory Incident Reporting
Patients safety and high quality of services provided are core goals of healthcare facilities. Therefore, voluntary as well as mandatory incident reporting is aimed at achieving the goals mentioned above. Kalra (2011) stresses that both reporting systems (if implemented effectively) are potent tools in detecting, analyzing, and preventing medical errors. It is necessary to note that both reporting systems have advantages and certain downsides.
One of the major advantages of both reporting systems is their effectiveness in developing action plans and training sessions. Proper analysis of a variety of incidents can help develop a comprehensive action plan which can result in better performance and higher quality of services provided (Healy, 2011). It is also necessary to note that both reporting systems can supplement each other. Furthermore, several employees can report on certain incidents (especially when it comes to voluntary reports). This can help obtain a more complete picture and implement an in-depth analysis of several factors and numerous details.
As far as the advantages of voluntary reporting systems are concerned, health care professionals can be encouraged to report about incidents. At some facilities, there are certain motivation strategies aimed at encouraging employees to provide reports. Remarkably, health care professionals are not afraid of negative consequences and they can provide all the necessary details on the matter. When it comes to the mandatory reporting system, one of the most important advantages is that employees have to provide specific reports on certain incidents. Therefore, this system ensures that serious incidents will be analyzed.
However, both reporting systems are also associated with some drawbacks. For instance, people are reluctant to provide comprehensive mandatory reports. Employees are concerned about possible punishment and sanctions (Healy, 2011). Hence, the data provided are not full or even distorted. This negatively affects analysis and can lead to erroneous conclusions and ineffective action plans. It is also necessary to add that mandatory reports are not numerous. A lot of incidents remain unnoticed, which leads to repeated errors.
Voluntary reports are also characterized by certain downsides. For example, only some cases are reported. Thus, when employees assume that an incident can cause negative consequences for them, they are likely to refrain from reporting about it. On the other hand, employees can report about insignificant incidents, which can lead to an abundance of reports with little valuable information. Such reports require time for analysis and there is less time to consider more relevant incidents. Moreover, the data provided can be incomplete, distorted, or insufficient. It can be difficult to develop an effective plan on the basis of such kind of analysis.
On balance, it is possible to note that mandatory and voluntary reporting systems can be effective in enhancing the quality of services provided. These reporting systems help collect data that are utilized to develop effective action plans. At the same time, there are certain downsides. Thus, employees are likely to provide incomplete or distorted data when they feel that blame can be put on them. Besides, these systems do not ensure that all incidents are considered. Therefore, it is important to use both systems at any facility. It is also necessary to improve the reporting systems to make them more efficient.
Root Cause Analysis and Sentinel Events Variant 1
Root cause analysis is required when sentinel events occur. Sentinel events are unexpected events which result in death or serious physical or psychological harm (Kalra, 2011, p. 57). Admittedly, these events need special attention and analysis. Root cause analysis can help identify the cause of the event. In its turn, this can help avoid similar errors in the future. For instance, a team of health care professionals tried to reduce the rate of infant abduction (Kavaler, 2012). They brainstormed possible scenarios and tried to come up with ideas to address them. Clearly, this can be effective. However, analysis of a specific case can help identify stages when something went wrong. More so, it is also possible to analyze the effectiveness of measures undertaken. It can be effective to reveal errors made and define the most optimal way to solve issues.
It is possible to consider the example of an Australian hospital. Surgeons had not reported about near misses before the number of such cases increased significantly (Healy, 2011). Surgeons understood that near-misses could show potential for serious errors which could lead to patients death. Surgeons considered the three most recent near misses and came up with a number of important ideas. Notably, it had a positive impact as the number of near misses decreased and surgeons had the necessary plans to use in certain cases.
Root Cause Analysis and Sentinel Events Variant 2
Sentinel events are unexpected incidents that lead to death or serious injury of patients. These events are often analyzed in terms of cause root analysis. Health care professionals analyze a variety of factors that led to negative consequences. These factors include patients health conditions, measures undertaken, errors made, etc. Notably, analysis of these factors can help prevent the reoccurrence of such events. However, it is also important to remember that an analysis of such events does not always result in effective action plans. Sometimes it is still unclear whether this or that preventive measure can be effective. Each patient has individual peculiarities and different clinical courses. Even though some measures can be effective with one patient, they can be hazardous with another patient. Though, reporting about sentinel events can help health care professionals be ready for numerous situations.
Reference List
2013 Minnesota Statutes. (2013). Web.
A national survey of medical error reporting laws. (2008). Yale Journal of Health Policy, Law, and Ethics, IX(I), 201-286.
Healy, J. (2011). Improving health care safety and quality: Reluctant regulators. Burlington, VT: Ashgate Publishing, Ltd.
Kalra, J. (2011). Medical errors and patient safety: Strategies to reduce and disclose medical errors and improve patient safety. New York, NY: Walter de Gruyter.
Kavaler, F. (2012). Risk management in health care institutions. Burlington, MA: Jones & Bartlett Publishers.
The supply chains of any organization should be safeguarded. Many times, the supply chains are compromised by trust issues, interdependence, and information sharing. The ascending of expense for working together is another challenge and this can be ascribed to numerous reasons. One reason being the new regulations from the health division that for the most part oblige the medical centers to keep up a given measure of assets. The cost of developing and acquiring medical products and equipment has become too high due to globalization and fast-paced development. There is a shortage or lack of sufficient medical personnel to tend to the hospitals.
The doctor-patient ratio is very low, whereby one doctor tends to an overwhelming number of patients. Trust and standard practices should guarantee that the medical facilities are very much ensured and their part to the general public is recognized. There is the problem of mismanagement, whereby the hospital proprietors misuse the organizations resources for their gain. This creates a problem of misplaced priorities and lost needs. Another issue is how to understand and deal with manageability measurements and natural concerns and its connection to productivity (Cho & Pucik, 2005). This paper will seek to analyze the effectiveness of trust, interdependence, and information sharing on the performance of Sheikh Khalifa Medical City.
Impacts of Trust, Interdependence, and Information Sharing
Any given supply chain network relies on trust among the partners to be successful. Besides trust, sharing of information and interdependence among the partners is very beneficial.
Trust
In the field of business, firms have much of the time made intentional attempts to build up more grounded associations with suppliers and clients. As a method for decreasing expenses, expanding productivity, enhancing quality and innovation, and keeping in tow with the competitors, numerous organizations are moving far from customary safe distance business connections and are manufacturing closer and more shared ties with supply chain accomplices (Cho & Pucik, 2005). Rivalry from international producers, mechanical developments, and shorter life cycles of products has changed the purchaser-seller connections. The conventional safe distance contractual connections no more suffice, yet closer community-oriented methodologies are required. The advancement of organizational connections is a methodology that consolidates the merits of vertically incorporated distribution frameworks (control, coordination, and data preparing) with the benefits of frameworks using free chain members (adaptability, scale economies, proficiency, and low overheads) (Crossan & Dusya, 2004).
Be that as it may, the organizational connections have related expenses and dangers. Medical facilities like Sheikh Khalifa Medical City (SKMC) are for the most part thought to be subordinate and defenseless in such connections as a result of asset imbalances, corruption, and the misuse of unbalanced authority to seize restrictive resources and acquire concessions from the other accomplice. The trust exists if one partner trusts that the other partner is straightforward or big-hearted. The desire weakens the suspicion that one partner in the transaction will act artfully. In this way, if there is trust in a contract, the contracting partners will be persuaded that they will not be casualties of conduct, for example, unfriendly determination, moral hazard, or any kind of contractual peril (Haley, 1986).
Interdependence
Interdependence has just been managed in supply chain management to an extremely constrained degree and as a rule in an intra-hierarchical setting, examining how works inside of a firm rely upon each other. The level of interdependence in the supply chain network has to some extent been managed regarding how the included firms are successively dependent. Along these lines, the firms need to facilitate their exercises while the relationship among the supply chains has just been somewhat touched upon in the supply chain management literature. One unequivocal idea of this sort of relationship non-part connections can be of significance to consider (Cho & Pucik, 2005). The non-part connections are portrayed as connections between individuals from the central organizations supply chain network and non-individuals from the production network that are of significance to the central organization. For instance, a supplier of the central organization can likewise be a supplier to its principal rival; this is why this connection gets to be essential to think seriously about (Haley, 1986).
What is fascinating is that these sorts of connections have not been further considered in the supply chain management of SKMC. Additionally, when contemplating the types of reliance that exist, the role classifications, for example, contenders get to be tricky to apply because they may likewise tackle a few different parts in connection to diverse firms in a specific supply chain network.
Moreover, in connection to a specific firm in this chain, a contender may add to the central companys productivity if their exercises use normal assets. Considering reliance similar to the instance of SKMC, supply chains cannot be streamlined (Haley, 1986).
Attempts to advance individual supply chains without checking the association among chains may affect the productivity in the system, which may need responses. Moreover, exercises, assets, or items can be viewed as given when supply chains are composed and overseen since conditions for movement coordination and asset use continually change. Different firms, specifically or in an indirect way associated with a specific supply chain network may transform the courses in which they compose and deal with their portions of the supply chains. Hence, firms are never in full control of the parts of the unpredictable examples of supply chains they are included in (Crossan & Dusya, 2004).
Information Sharing
Data sharing can drastically enhance the way worldwide organizations and their accomplices work together, particularly in the wake of progressive globalization and outsourcing, which has and will keep on profoundly affecting store network operations. By trading data, for example, stock levels, estimating information, and deals patterns, organizations can decrease process durations, satisfy the orders all the more rapidly, save much money in overabundance stock, and enhance prediction exactness and client administration (Crossan & Dusya, 2004). Data sharing can be connected to all the central areas of corporate operational exercises. Beginning from the improvement chain process where data sharing can happen in the item outline stages and item life cycle administration exercises with both inner and outer accomplices (Cho & Pucik, 2005).
In the supply chain process, data sharing can offer in figuring clients some assistance with experiencing methodologies; expand client administration viability and operations. The mental obstructions around data sharing are genuine and basic. Some of the time there is genuine and legitimized dread that data sharing over the corporate limits can transform into an aggressive hindrance. By detailing successful business approaches, understandings, and strategies for success that a venture can use to build up rules and standards for the trade of data with inventory network accomplices can alleviate those hindrances. This will at last moderate the trepidation of data sharing and enhance productivity and make new open doors for all partners (Haley, 1986).
Data sharing can be best and minimum problematic for all concerned when done by executing the accessible innovative devices, which would achieve the procedure in a controlled and secured way along these lines streamlining the worldwide production network operations. Cooperative planning, prediction, and replenishment work processes and arrangements are present in the inventory network procedure (Crossan & Dusya, 2004). They aim to upgrade the supply chain network joining and information sharing among enterprises; however, not very many organizations successfully utilize it to their upper hand. The present difficulties that associations face in actualizing these work processes truly spin around non-incorporated procedures and frameworks with retailers and makers working out of their storehouse and diverse information planning. This produces unreasonable reaction times, expenses, and stock because of incorrectness in prediction. Retailers on one side deal with stock shortages, raw material deficiencies, lost deals, and poor client administration. Then again producers get tormented by out of date quality and stock expenses affecting the profit margins (Crossan & Dusya, 2004).
History and Profile of the Sheikh Khalifa Medical City
The principal objective of any business is to expand the shareholders riches. In this undertaking, we have picked the health segment and contemplated Sheik Khalifa Medical City as an illustration. Because of globalization and high specialized improvement in the area and intense rivalry between opponents in this part, we will investigate the difficulties that meet this hospital conglomerate. These challenges apply to any medical facility around the globe. One challenge that medical centers face is meeting a legitimate level of income for the speculators. The standard measure of profit for value is at least 12%. There is a genuine challenge for the hospital facilities to pull in extra capital to perform their part in undertaking monetary development (Barney, 1991).
Sheikh Khalifa Medical City started in the year 2005. The medical city was formed as a merger of all the health facilities that are in Abu Dhabi. The entities that were merged include the Abu Dhabi Central Hospital, which was established in the 1960s. It started as a hospital with 200 beds before it was later down-scaled to be just an outpatient emergency center. The second entity was the Abu Dhabi Psychiatric Hospital, which was established as a 120-bed medical facility. The third entity was the Abu Dhabi Rehabilitation Center, which was established as a nursing home for vulnerable individuals like the elderly or people with special needs. It had 88 beds. The fourth entity was the Al Jazeera Hospital which was a 300-bed facility established in the 1970s. It was mainly open for emigrants who dwelled in Abu Dhabi. The other remaining three entities included the Preventive Medicine Clinic, Primary Healthcare Clinics (9 in number), and the Sheikh Khalifa Medical Center which was established in 2000 with 250 beds (Crossan & Dusya, 2004).
The new merger of the entities was called the Sheikh Khalifa Medical City (SKMC). The name was a representative of the real nature of the hospital. As a result of the merger, various transformational changes came about intending to make the merger stronger and solid. The Cleveland Clinic took over the management of SKMC in 2007. Cleveland Clinic is a top Hospital in the United States. In 2008, SKMC received an award from the Joint Commission International as recognition of its outpatient facilities and surgical pavilions. Figure 1.1 below summarizes the SKMC financials.
There are three sorts of trust. These are contractual trust, capability trust, and goodwill trust. Contractual trust lays on a mutual good standard of positivity and guarantees keeping while ability trust requires a common comprehension of expert behavior, specialized and administrative norms. Goodwill trust exists when there is an accord on the standard of objectivity. There is a chain of the importance of trust whereby satisfying a base arrangement of commitments incorporates contractual trust while respecting a more extensive set incorporates goodwill trust. In this way, a development from the contractual trust to goodwill trust includes a steady extension in the consistency of convictions about what is adequate conduct (Cho & Pucik, 2005).
The more one party controls the organization together through power advantage, the more prominent the probability that the cooperation would perform inadequately. The communication in the middle of trust and power demonstrates that the presence of trust influences the relationship between power equalization and execution. On account of the relationship between power parity and execution, it is demonstrated that trust houses a positive relationship (Haley, 1986). Trust and power parity serve to some degree as intermediaries for one another in the expectation of relationship execution. Where a firm can believe its accomplice, the adjusting of power is not as basic for upgraded execution. Trusting connections are seen to advance union execution and the vicinity of PowerPoint of preference negatively affects collusion execution, which is further exacerbated by the lack of trust (Crossan & Dusya, 2004).
Trust cannot turn a bad relationship to be better; however, everything it can do is improving a decent relationship. The SKMC underlines that sound monetary standards decide the long-haul eventual fate of their contribution to the suppliers. Essentially, the mediators who are included in the supply chain network with the medical facility showed that they would just keep on supplying equipment and products so long as it reflected the most successful assignment of their assets, in regards to their inclination. The trust union between the suppliers and SKMC raises their net revenue because it decreases their exchange costs. In any case, the extension for expense diminishment is constrained and cannot adjust for wasteful asset use. Trust, along these lines, is an aftereffect of the advantages the people acknowledge in the relationship (Haley, 1986).
However, organizational connections have related expenses and dangers. Medical facilities like Sheikh Khalifa Medical City (SKMC) are for the most part thought to be subordinate and defenseless in such connections as a result of asset imbalances, corruption, and the misuse of unbalanced authority to seize restrictive resources and acquire concessions from the other accomplice. The trust exists if one partner trusts that the other partner is straightforward or big-hearted. The desire weakens the suspicion that one partner in the transaction will act artfully. In this way, if there is trust in a contract, the contracting partners will be persuaded that they will not be casualties of conduct, for example, unfriendly determination, moral hazard, or any kind of contractual peril (Haley, 1986).
Effectiveness of Sharing Information
Sharing Information among production network individuals may convey various advantages to commercial ventures. Among these advantages, the noteworthy points of interest of data sharing are in two ways; either expected expense diminishment or stock decrease. If data sharing is utilized proficiently, the producers can decrease the stock expenses by 5% to 35% when the administration level may be kept up or expanded to the retailers (Barney, 1991). At the point when extra data gets to be accessible inside a supply chain inventory network, accomplices may profit by this enhanced reflectivity to modify existing plans or detail future operations. Case in point, sharing demand data empowers each of the store network individuals to make precise expectations because of genuine demand. Individuals may achieve flawless data about them in a supply chain, yet will not have such immaculate data about the other individuals (Lundberg, 2001).
Vulnerabilities may emerge as an aftereffect of this absence of data about the other individuals. When an individual has the capacity and eagerness to impart data to other individuals, instabilities can be altogether decreased. The bullwhip impact may be brought on by the absence of information balance in distributed frameworks. The stream of information inside of supply chain network individuals might essentially diminish or even dispose of the negative effect of the bullwhip impact (Lundberg, 2001). The preferences that accompany effective sharing of data include 1) Efficient stock administration through enhanced correspondence, 2) Cost lessening in requests administration through proficient correspondence, 3) Increased profitability and benefit through the most productive finish of requests, and, 4) Improved asset usage through the better administration of the work distribution (Barney, 1991).
By sharing information between the partners inside of the supply chain system, or production network administration, a business can be made. Data sharing inside of a production network causes an incredible change in the business associations. The mutual data constructs and reinforces connections and social bonds among the data collectors and suppliers. Hierarchical effectiveness and execution are other advantages that come with information sharing (Lundberg, 2001; Haspeslagh & Jemison, 1991).
There are some difficulties associated with information sharing in a supply chain network. Among these hindrances is the classification of the data shared, lack of proper incentives, the high cost of the ICT equipment, restrictions by anti-trust policies, Inaccuracy and lack of reliability of the information, lastly the complexities caused by the innovation and advancement of new ways of sharing information among partner companies. One of the fundamental hindrances of interpersonal data sharing may be worried about data security. A trusted system ought to be made for people to share data (Barney, 1991). Association individuals may need trust in one another which may obstruct data sharing. Figuring out how to utilize IT frameworks for people in an inventory network is expensive and time-consuming. The introduction of easy-to-understand IT applications may enhance data sharing. A wasteful and non-easy-to-use framework would negatively affect data sharing bringing about fewer data and information to be shared (Lundberg, 2001).
The center of the exploration in the supply chain management territory has been on monetary perspectives and particularly on proficiency. Likewise, one region of interest has been the estimation of the execution of the supply chain. Thus, there has been an emphasis on the upgrading of the supply chains with a specific end goal to enhance effectiveness. In connection to this, one central region has been that of how to choose the most proper supply chain network. This suggests a perspective of the individuals of the supply chains as free and compatible. Critical fundamental confidence in this sort of point of view on supply chain management is that it is conceivable to recognize and set up the most effective supply chain network by selecting the best group of individuals. Moreover, the attention has been on firms utilizing long-linked advancements, i.e. every phase of the generation utilizes as its inputs the output of the preceding phase (Lundberg, 2001).
What is left out is the fact that each of the included firms is additionally included in numerous other supply chains through its trade associations with different partners, in this manner framing a one of a kind connection to every supply chain network. Besides, that medical facilities frequently adjust to one anothers assets and exercises, and in this manner make partnerships (Barney, 1991). If this had been recognized as a focal viewpoint, the rearrangement of supply chains would seemingly have been viewed and examined as riskier than what is regularly the case. Considering the association inside and among supply chains infers that all supply chains should be managed as exceptional. Following this, there is no most ideal approach to overseeing supply chains (Lundberg, 2001). This is because of the way that the physical structures of supply chains are altogether different. Every case shows generally pretty many degrees of many-sided quality, with an assortment of stages and with wide differences of members at every production network stage. There are additionally fluctuating degrees of the dispute over the assets that must be given at every phase of the physical inventory network, and noteworthy contrasts in the capacity of medical facilities to proper quality from their position inside of the chain (Barney, 1991).
Success of Interdependence
While having concentrated on auxiliary parts of supply systems, the speculations alluded to might likewise give further direction to managing administrative angles in these structures. This kind of movement is bland to its character and helps to characterize or delimiting the change exercises of importance for any production network (Lundberg, 2001). This is because sorting is the choice part of showcasing that guides items in supply chains to distinctive assets used to perform change exercises. Sorting consequently is the fundamental element that connects the supply chains. For instance, exercises, for example, sales prediction, planning of production, and medical facility of collections are firmly identified with how sorting is done (Barney, 1991).
What are the suggestions for further investigations of supply chains and administration? To start with, where investigations of structures are concerned this paper recommends investigations that begin from specific exercises, assets, or items keeping in mind the end goal to recognize and examine their reliance on different exercises, assets, and items (Lundberg, 2001). Investigations of this kind license investigation of structures and examination of reliance patterns reaching past the firm and dyadic levels of investigation. Where investigations or procedures in these structures are concerned this paper recommends attention on connection designs as investigations of this kind may enhance the comprehension of firms effort to impact their partners.
Thus, even though there are no straightforward arrangements accessible in these mind-boggling structures, lessons from attempts to effectuate change in them are crucial to building up the comprehension of their motion. Henceforth, top to bottom contextual investigations of structures and procedures considering association inside and crosswise over supply chains, by making utilization of the hypothetical ideas proposed, would ostensibly add to the improvement of the field of independence in the supply chain network administration (Lundberg, 2001).
Attempts to advance individual supply chains without checking the association among chains may affect the productivity in the system, which may need responses. Moreover, exercises, assets, or items can be viewed as given when supply chains are composed and overseen since conditions for movement coordination and asset use continually change. Different firms, specifically or in an indirect way associated with a specific supply chain network may transform the courses in which they compose and deal with their portions of the supply chains. Hence, firms are never in full control of the parts of the unpredictable examples of supply chains they are included in (Crossan & Dusya, 2004).
The expanding level of coordination among organizations in supply chains has prompted attention to the courses in which organizations connect. Connections and organizations between organizations included in supply chains have in this manner getting to be highlighted and examined by a few works of literature (Barney, 1991). An expanding spotlight on connections and organizational connection rather than vertical integration and the market connection is focused on numerous works of writing. Market coordination is portrayed by control, taking into account systems administration and reconciliation of procedures across practical, geographical, and authoritative interfaces. This perspective is altogether different from the perspective of control because of order.
Since the transaction cost approach can clarify why these connections or hybrid structures happen, this methodology has of late been broadly utilized as a part of the supply chain management range. The utilization of this methodology may likewise be a legacy from supply chain managements roots in logistics as exchange expense methodology is, for the most part, acknowledged among logistics analysts as a helpful hypothetical structure for examining vital logistics choices. In the writing, there are a few cases of hypothetical and experimental studies, in light of benefits specificity, administration structures, and elimination of opportunism (Lundberg, 2001).
Be that as it may, the transaction cost approach may not be instrumental with an end goal to distinguish reliance across supply chains attributable to its attention on dyadic connections. To manage circumstances where a few firms in distinctive ways are included, a system that allows for an examination of more extensive structures is required. Most models of complex associations accept the relationship of hierarchical parts. There are three sorts of relationships: (1) pooled, (2) successive, and (3) proportional to facilitate the activity of associated components inside of an association (Lundberg, 2001). A pooled relationship is a circumstance in which every part renders a discrete commitment to the whole. A successive relationship occurs when direct reliance can be pinpointed between segments and the request of that association can be determined. The third type of reliance can be marked as proportional, alluding to the circumstance in which the yields of each get to input for the others. Diverse parts inside of an association should be joined given the relationship among their operations. The relationship can be overseen inside of the association (Barney, 1991).
With a pooled relationship, coordination by institutionalization is suitable. With corresponding reliance coordination by shared modification is essential. This reliance system identifies with various types of advancements: (1) ling-linked, (2) intervening, and (3) serious. The long-linked innovation encompasses serial association as in act Z can be performed strictly upon fruitful finishing of act Y, which, thus, depends on act X (Lundberg, 2001). In this manner, long-linked innovation is firmly identified with the large scale manufacturing mechanical production system, which is regularly found in the car business. The attention is on changing inputs (e.g. crude materials and transitional items) into yields as items that are sent to clients. The sequential construction system is intended to deliver standard items, fully and at a consistent rate, in this way gaining economies of scale.
The intervening innovation is the connecting of customers or clients who wish to be reliant. Samples of such associations are banks (connecting investors and borrowers), phone organizations, and so on, who encourage connections among distinctive clients dispersed in time and space. The interceding innovation requires working in institutionalized ways, which infers that clients can be arranged into totaled gatherings and joined (Lundberg, 2001). This third assortment named escalated to connote that an assortment of methods is attracted upon request to accomplish an adjustment in some particular article; yet the determination, blend, and request of use are controlled by criticism from the item itself. The concentrated innovation is represented with samples from healing centers and the development business, where a customer or a client issue is illuminated by a particular blend of exercises and assets (Barney, 1991). A fruitful utilization of the serious innovation plays both on the accessibility of the entire limit conceivably required, yet just as on the suitable blend of limits as required by the particular task. The ideas advanced in supply chain investigation are versatile past the conventional assembling connection to which its depiction and sequencing of exercises are most appropriate (Lundberg, 2001).
Implications of Trust in Operations
Trust can be portrayed in a lot of ways. These different portrayals rely upon the zone of specialization under study. Trust is addressing the needs of the present era without trading off the capacity of future eras to address their issues. It includes enhancing the nature of human life while living inside of the conveying limit of supporting biological systems. Trust involves financial development that gives decency and chance to the majority of the people in the world, not only the special few without further annihilating the worlds restricted common assets. It is, in this manner, consistent to say that trust incorporates various needs and measurements, for example, ecological stewardship, protection of assets, lessening of carbon pollutants, money related saving and suitability, and social obligation (Haley, 1986).
The medical centers and additionally other medical foundations are taking an amazing look after executing the above measurements in their operation and production network. Medical centers, for example, Sheik Khalifa Medical City can empower trust improvement. The medical center contributes to a great extent by appending higher value and rates and applying premium separation on the organizations that are not executing trust arrangements and not ecological situated. The fundamental motivation behind why medical facilities ought to do that is because ecological dangers will be related by money related danger that may emerge because of distinctive reasons, for example, changing government strategies and high movement to the urban communities because of globalization.
Also, security may decrease in quality if there were environmental dangers. At long last, the significant impact will be reflected as a reputation danger which is an imperative component in the success of the operations of the hospitals.
Executing the trust will expand mindfulness towards objective utilization of assets and decreasing the waste which will be translated into lessening the expense and expanding the productivity. Sheik Khalifa Medical City possesses a gigantic space and expends a considerable measure of materials and vitality which can be controlled and streamlined by adjusting the maintainability policies (Lundberg, 2001).
Sharing of information can be problematic for all concerned when done by executing the accessible innovative devices, which would achieve the procedure in a controlled and secured way along these lines streamlining the worldwide production network operations. Compliant planning, prediction, and replenishment work processes and arrangements are present in the inventory network procedure. They aim to upgrade the supply chain network joining and information sharing among enterprises; however, not very many organizations successfully utilize it to their upper hand (Lundberg, 2001). The present difficulties that associations face in actualizing these work processes truly spin around non-incorporated procedures and frameworks with retailers and makers working out of their storehouse and diverse information planning. This produces unreasonable reaction times, expenses, and stock because of incorrectness in prediction. Retailers on one side deal with stock shortages, raw material deficiencies, lost deals, and poor client administration. Then again producers get tormented by out of date quality and stock expenses affecting the profit margins (Lundberg, 2001).
Methodology
The methodology is the process of instructing the ways to do the research. It is, therefore, convenient for conducting the research and for analyzing the research questions. The process of methodology insists that much care influences the kinds and nature of procedures to observe in accomplishing a given set of procedures or an objective (Haspeslagh & Jemison, 1991). The purpose of this research was to analyze the trust in Sheikh Khalifa Medical City. The exploratory research study provides researchers an opportunity to assess areas that do not have extensive research. Therefore, engaging in exploratory study contributes to the development of additional knowledge on the issue or phenomenon under investigation. This goal comes by testing the stipulated hypotheses. To undertake the research study, a comprehensive research methodology is necessary. This part includes the research design, the sample, and the methods used in gathering information. It also contains the data analysis methods, validity and reliability of data, and the limitation of the study.
Quantitative Approach and ANOVA
The quantitative research approach refers to the use of statistical techniques, mathematical methods, and calculation techniques to analyses data (Haspeslagh & Jemison, 1991). The quantitative methodology aims at utilizing mathematical and statistical theories and models to analyze the data. The quantitative method validates the hypotheses and conclusions that stem from the qualitative methodology. The scientific procedures and processes that help in quantitative methodology encompass deriving models and theories; designing instruments for data gathering; controlling the variables empirically; and analyzing data using models.
The quantitative approach is mostly concerned with human motives and the reasons behind such motives (Haspeslagh & Jemison, 1991). The main questions that come with the qualitative approach are why? and how? in addition to what?, where? and when? Concerning this, a researcher utilizing the qualitative approach will tend to use smaller samples rather than larger samples. The qualitative approach strictly generates only information that applies to the designated case study; any additional information is guessed. Once the hypotheses stem from a qualitative approach, they filter through the quantitative approach.
Research Design
There are three types of research design: exploratory research, descriptive research, and causal research (Haspeslagh & Jemison, 1991). This study utilized the exploratory research design. The exploratory research design mainly explores the nature of the problem to draw inferences. In this scenario, the researcher is in a good position to understand the problem under investigation. The flow of exploratory research involves identifying the problem and seeking to find the appropriate solutions and new ideas. Exploratory research is mostly applicable in circumstances where the structure of the research problem is not definite. The interview is a good example of the methods that help to gather information in this kind of research.
Considering the exploratory nature of the research study, the research will adopt a mixed research design. The study will take into account qualitative and quantitative research designs. The choice of mixed research design has arisen from the need to improve the quality of the research study. First, the integration of the qualitative research design will aid in the generation of adequate data from the field to support the study. Moreover, the research will have an opportunity to collect data from the natural setting, hence improving the relevance of the research study. In the course of implementing the qualitative research design, the study will take into account the grounded theory.
Subsequently, incorporation of the grounded theory in the qualitative research design will enable the research to elucidate the issue under investigation. For example, the research study will contribute to a further understanding of the importance of adopting a multi-dimensional approach in formulating employee compensation policies. Conversely, the quantitative research design will aid in improving the effectiveness with which the research data are analyzed and interpreted by the target research audience such as organizations human resource managers.
Population and Sampling
There are two popularly used procedures for sampling. The sampling procedures include prospect sampling and non-prospect sampling. In a probability sampling procedure, the samples are representative of the population. This is because all the entries have a chance of selection. On the other hand, items in the non-probability sampling do not have an equal chance. In this scenario, not all the items in the population have equal chances of selection. The data for the study came from the employees of the organizations understudy. The employees had profiles that fit the context of this study. Therefore, the employees were an excellent choice because many of them have had the organization experience. Because not all the employees could be accessible, a non-probability sampling procedure was important in this study.
A pilot test was needed to ensure that the questionnaires were reliable and valid. After the pre-test, questionnaire editing was important to remove and change some words. Another pre-test was then important to be sure that the questionnaire was now very reliable and very valid. Conducting a study on the entire population is not manageable due to the high cost and the amount of time required. Consequently, the research study will take into account the sampling technique. To make the study manageable scholars found that the research will integrate the simple random sampling technique in constructing the research sample (Haspeslagh & Jemison, 1991). This technique will ensure that there is no bias in conducting the study.
Data Collection and Instrumentation
In any research, there are basic stages that are involved in regards to the shaping of the research. These stages include understanding the research problem, the conceptual framework of the research, data collection, data analysis, and interpretations, and drawing inferences, and making recommendations. In this study, the quantitative research method helps to test the hypotheses formulated. The quantitative research method is very instrumental in harnessing mathematical models that are enshrined in natural facts. The existing theories construct a conceptual framework that measures this type of research.
The adoption of primary sources played a fundamental role in improving the relevance of the research findings. The integrated interviewing technique helped to collect data from the field. Consequently, a set of questionnaires was developed. The questionnaires acted as a guide in conducting the interview. The questionnaires were mainly composed of open-ended questionnaires to provide the respondents an opportunity to answer the required issues based on their opinion. The respondents received the questionnaires directly via online media. Thus, the data collection method entailed an online survey. Adopting this method of administration validates the need to minimize the cost of the study. This is because respondents stay sparsely.
Questionnaire Survey
Questionnaires are a pre-formulated set of questions that require the respondents to record their answers usually within closely defined alternatives. The respondents can receive the questionnaires from the researcher via mail or through personal delivery. Before designing a questionnaire, there are three principles to pay attention to, these principles include principles of wording, principles of measurement, and the general set-up of the questionnaire. The principle of text entails the content and purpose of the questions, for instance, the researcher needs to understand the nature of variables to consider. If a variable is subjective such as satisfaction where it measures a respondents beliefs, perceptions, and attitudes, the questions should draw the dimensions and elements of the concepts. Besides, when tapping the objective variables such as age and income, a single direct question would be appropriate. The wording and language are other elements of the principle of text, for instance, the language of the questionnaire should approximate the level of understanding of respondents. Consequently, the choice of words should depend on the degree of education of the respondents.
The principle of measurement encompasses the principles to ensure that the data collected are appropriate to test the hypotheses. These principles include categorization, which entails the adjustment of negative questions to become positive issues, coding, using scales and scaling techniques, and reliability and validity. Reliability indicates how stable and consistent the instrument taps the variable. The general set-up of the questionnaire encompasses the introduction to respondents, length of the questionnaire, instructions for completion, and the overall appearance of the questionnaire.
Data Analysis and Presentation
The collected data will be analyzed quantitatively. This goal comes by incorporating quantitative data analysis tools such as tabulation, use of graphs, percentages, and charts. Because the research study has integrated the qualitative research design, the data analysis and presentation method will entail the adoption of the textual presentation technique. This technique comes about by using statements that comprise numerals. One of the textual presentation tools that are important in analyzing the research data entails the Likert scale. By using this tool, the research will be in a position to evaluate the qualitative data using point scales such as the 5-point Likert scale. In addition to the above technique, the research will integrate the Microsoft Excel data analysis technique. The adoption of this technology played a fundamental role in improving the effectiveness and efficiency with which the collected data will be analyzed using tables, charts, and graphs. Moreover, the incorporation of the Microsoft technique played a fundamental role in improving the ease with which the research data translates.
Findings, Data Analysis, and Interpretation
This section covers the analysis of the data, presentation, and interpretation. The results were analyzed using SPPS, ANOVA, regression, and correlation analysis.
Sample Characteristics
The sampling procedures include prospect sampling and non-prospect sampling. In a probability sampling procedure, the samples are representative of the population. This is because all the entries have a chance of selection. On the other hand, items in the non-probability sampling do not have an equal chance. In this scenario, not all the items in the population have equal chances of selection. The data for the study came from the employees of Sheikh Khalifa Medical City. These three individuals were chosen because they are the core staff implementing the Hong Kong Rugby Seven 2014. They were involved in the named three stages, preparation, process, and evaluation of the event.
This technique will ensure that there is no bias in conducting the study. The study had a sample of 4 respondents for data collection. The study will take into account both males and females in constructing the research sample. The study assumes that the selected research sample will be representative of the workforce perception of the relationship between pay and performance. The choice of these regions has arisen from the need to understand the impact of social and cultural diversity on employee perception and hence performance. To understand the demographic information about the participants, the distribution of gender, age, education level, income, and period employed in the organization are in the following sections.
Reliability Analysis
Reliability analysis evaluates whether the multiple instrument items are measuring the same variable or concept (Haspeslagh & Jemison, 1991). In SPSS, the Cronbachs Alpha value measures the reliability of the various variables. The minimum requirement for the value of Cronbachs Alpha is 0.7 to ensure that the items are internally consistent and reliable. In the exploratory study, Cronbachs Alpha value of 0.6 is valid. In this study, the various measurement items are from previous studies, thus, the minimum value is set at 0.7. The corrected-item total correlation (CITC) is also included to evaluate the reliability of the individual item. If the CICT is below 0.5, then the item cannot reliably measure the corresponding variable and is invalid for further analysis. The Cronbachs Alpha if item deleted indicate whether the Cronbachs Alpha value goes up or down after excluding this item. Thus, if this value is above Cronbachs Alpha value for the variable, the item is invalid for further analysis. Table 4.6 summarizes the results.
Table 4.6. Reliability Analysis for Variables.
Variables
Item
CITC
Cronbachs Alpha if Item Deleted
Cronbachs Alpha
Trust
V1
0.646
0.822
0.836
V2
0.725
0.747
V3
0.725
0.746
Interdependence
V4
0.611
0.781
0.817
V5
0.738
0.719
V6
0.725
0.727
V7
0.486
0.806
Information sharing
V8
0.577
0.698
0.761
V9
0.577
0.696
V10
0.623
0.644
External factors
V11
0.581
0.634
0.739
V12
0.620
0.585
V13
0.594
0.733
Sustainable supply chain
V14
0.770
0.872
0.898
V15
0.780
0.868
V16
0.631
0.801
V17
0.777
0.871
V18
0.800
0.864
Workplace management
V19
0.709
0.751
0.833
V20
0.675
0.786
V21
0.694
0.767
Economic performance
V22
0.723
0.750
0.837
V23
0.691
0.782
V24
0.684
0.789
According to the results, the Cronbachs alpha value of the trust, interdependence, information sharing, external factors, sustainable supply chain, workplace management, and economic performance are 0.836, 0.817, 0.761, 0.739, 0.898, 0.833, and 0.837, which are all above the minimum requirement of 0.7. Also, the CICT for individual items is all above the minimum requirement of 0.5, and the Cronbachs Alpha, if deleted for individual items, are all below the Cronbachs Alpha value. These results demonstrate that these items are internally consistent and reliable, and are valid for further analysis.
Frequency Analysis
Trust
Table 4.7. Trust frequency analysis.
Question
Response
Mean scores
Supply chain relationships are based on mutual trust
Strongly Disagree
3.8047
Disagree
Neutral
Agree
Strongly Agree
When making decisions, supply chain partners consider our welfare as well as their own
Strongly Disagree
3.6213
Disagree
Neutral
Agree
Strongly Agree
We are sure that what suppliers say is true
Strongly Disagree
3.6568
Disagree
Neutral
Agree
Strongly Agree
The suppliers always keep their promises
Strongly Disagree
3.6568
Disagree
Neutral
Agree
Strongly Agree
Total
3.69
Table 4.8. ANOVA results for Trust.
ANOVA
Trust
Sum of Squares
df
Mean Square
F
Sig.
Between Groups
7.750
5
1.550
7.971
.013
Within Groups
1.167
6
.194
Total
8.917
11
As can be seen from Table 4.7 and Table 4.8, more than half of the participants are familiar with trust. There are 52.1% of the participants indicate, Supply chain relationships are based on mutual trust and 46.2% of the participants indicate, When making decisions, supply chain partners consider our welfare as well as their own . From the total score of these three items measuring Trust, a large group of participants has a score of 11 or 12. To gain a clearer picture of the participants Trust, there was the aggregation of the items measuring Trust. The aggregated mean value was 3.69, suggesting that participants have a medium level of trust.
Interdependence Frequency Analysis
Table 4.9. Interdependence frequency analysis.
Question
Response
Mean scores
Our operations are solely dependent on a suppliers cooperation
Strongly Disagree
3.8284
Disagree
Neutral
Agree
Strongly Agree
We are having the best suppliers in our hotel supply chain
Strongly Disagree
3.6095
Disagree
Neutral
Agree
Strongly Agree
We have long term and indispensable relationship with our suppliers
Strongly Disagree
3.6805
Disagree
Neutral
Agree
Strongly Agree
Allying and operating with the suppliers have beneficial potential
Strongly Disagree
3.9053
Disagree
Neutral
Agree
Strongly Agree
Supply chain partners are willing to spend a higher amount of time and effort with us
Strongly Disagree
3.6805
Disagree
Neutral
Agree
Strongly Agree
Total
3.76
Table 4.10. ANOVA results for Interdependence.
ANOVA
Interdependence
Sum of Squares
df
Mean Square
F
Sig.
Between Groups
10.417
4
2.604
1.105
.425
Within Groups
16.500
7
2.357
Total
26.917
11
Table 4.8 shows the overall responses to the interdependence among participants. According to the results, the mean value of all measurement items was between three and four. Thus, the participants attitude, concern was at a medium level. By analyzing the frequency, more than half of the participants have expressed their concern regarding the trust of Sheikh Khalifa Medical City. To gain a more detailed picture of the level of interdependence, the aggregate mean score was classified into three levels: low (below 2), medium (2-4), and high (4-5). The aggregate mean score was 3.76, suggesting a medium level of interdependence. There was a summary of the overall scores of the items measuring interdependence. The results reveal the range to be 16, with scores ranging from five to 20. The majority of the participants have an overall score between 14 and 16.
Information Sharing Frequency Analysis
Table 4.11. Information sharing frequency analysis.
Question
Response
Mean scores
Inventory data are visible at all partners in the supply chain
Strongly Disagree
3.8876
Disagree
Neutral
Agree
Strongly Agree
Actual sales data are visible at all partners in the supply chain
Strongly Disagree
3.9231
Disagree
Neutral
Agree
Strongly Agree
Performance metrics are shared across the supply chain
Strongly Disagree
4.1361
Disagree
Neutral
Agree
Strongly Agree
Demanding forecasts are shared across the supply chain
Strongly Disagree
3.8876
Disagree
Neutral
Agree
Strongly Agree
Total
3.98
Table 4.12. ANOVA results for Information sharing.
ANOVA
Sharing
Sum of Squares
df
Mean Square
F
Sig.
Between Groups
4.667
5
.933
.622
.690
Within Groups
9.000
6
1.500
Total
13.667
11
Table 4.11. summarizes the frequency analysis for items measuring information sharing. According to the results, the majority of the participants agree or strongly agree that Inventory data are visible at all partners in the supply chain , Actual sales data are visible at all partners in the supply chain , Performance metrics are shared across the supply chain and Demanding forecasts are shared across the supply chain . The aggregated mean value of information sharing is 3.98, nearly 4, suggesting that participants have a positive attitude towards the information sharing of the services. Table 4.12 summarized the score of the items measuring information sharing. As can be seen from the results, the majority of the score ranged between 10 and 15, indicating a relatively higher-level positive attitude towards information sharing.
Conclusion
Sheikh Khalifa Medical City started in the year 2005. The medical city was formed as a merger of all the health facilities that are in Abu Dhabi. The entities that were merged include the Abu Dhabi Central Hospital, which was established in the 1960s. It started as a hospital with 200 beds before it was later down-scaled to be just an outpatient emergency center. Medical centers, for example, Sheik Khalifa Medical City can empower trust improvement. The medical center contributes to a great extent by appending higher value and rates and applying premium separation on the organizations that are not executing trust arrangements and not ecological situated.
The supply chains of any association ought to be shielded. Quite often, the supply chains are traded off by trust issues, interdependence, and information sharing. The rising cost for cooperating is another test and this can be credited to various reasons. One reason being the new regulations from the medical sector that generally oblige the health facilities to keep up a given measure of advantages. The expense of creating and obtaining therapeutic items and equipment has turned out to be too high because of globalization and quick-paced improvement. There is a deficiency or absence of an adequate medicinal workforce to tend to the doctors facilities.
The doctor to patient ratio is low, whereby one doctor tends to a staggering number of patients. Trust and standard practices ought to ensure that the medicinal offices are all that much guaranteed and their part to the overall population is perceived. There is the issue of corruption, whereby the medical facility proprietors abuse the associations assets for their increase. This makes an issue of misplaced priorities of needs. Another issue is the way to comprehend and manage reasonability estimations and common concerns and its association with profitability (Cho & Pucik, 2005). This paper will look to break down the adequacy of trust, association, and data sharing on the execution of Sheik Khalifa Medical City.
SKMC has actualized ISO 9001 and 14001 while much emphasis is given to executing ISO 27001. This may be credited to the way that the data is the most basic component and can be liable to numerous risks from numerous segments. The danger and harm came about because entering the data framework would have a high effect on the organizations picture and would prompt high money related misfortunes. The results of the study revealed that trust, interdependence, information sharing, external factors, sustainable supply chain, and workplace management all affected economic performance.
Rivalry from international producers, mechanical developments, and shorter life cycles of products has changed the purchaser-seller connections. The conventional safe distance contractual connections no more suffice, yet closer community-oriented methodologies are required. The advancement of organizational connections is a methodology that consolidates the merits of vertically incorporated distribution frameworks (control, coordination, and data preparing) with the benefits of frameworks using free chain members (adaptability, scale economies, proficiency, and low overheads).
Sharing of information can be problematic for all concerned when done by executing the accessible innovative devices, which would achieve the procedure in a controlled and secured way along these lines streamlining the worldwide production network operations. Compliant planning, prediction, and replenishment work processes and arrangements are present in the inventory network procedure. They aim to upgrade the supply chain network joining and information sharing among enterprises; however, not very many organizations successfully utilize it to their upper hand. The present difficulties that associations face in actualizing these work processes truly spin around non-incorporated procedures and frameworks with retailers and makers working out of their storehouse and diverse information planning. This produces unreasonable reaction times, expenses, and stock because of incorrectness in prediction. Retailers on one side deal with stock shortages, raw material deficiencies, lost deals, and poor client administration. Then again producers get tormented by out of date quality and stock expenses affecting the profit margins.
References
Barney, J. (1991). Firm Resources and Sustained Competitive Advantage. Journal of Management, 17(1), 99-120.
Cho, H., & Vladimir P. (2005). Relationship between Innovativeness, Quality, Growth, Profitability, and Market Value. Strategic Management Journal, 26(6), 555-575.
Crossan, M., & Vera, D. (2004). Strategic Leadership and Organizational Learning. The Academy of Management Review, 29(1), 226-227.
Haley, J. (1986). Economic Dynamics of Work. Strategic Management Journal, 7(1), 459-471.
Haspeslagh, P., & Jemison, D.B. (1991). Managing Acquisitions: Creating Value through Corporate Renewal. New York: Free Press.
Lundberg, C. (2001). Toward Theory More Relevant for Practice. Current Topics in Management, 6(1), 15-24.
Medicaid is a public health policy that provides quality and widespread health care to low income earning families. It is a policy that has been endorsed by both the state and the federal governments. Medicaid varies from one state to another due to the different state rules and priorities. Even though many people have benefited from Medicaid, children are the biggest beneficiaries of this policy. The policy focused on the children of the poor in an attempt to help curb the low infant mortality rate that was common in the late 60s (Wachino, Schneider & Rousseau, 2004). Others who have benefited from this policy include the elderly and the disabled. Medicaid is very different from Medicare, which does not target the low income earning families but people who are over the age of 65 (Mitchell, 2012). Medicaid does not give the patients the funds that they need to get treated directly. It, however, pays hospitals and other health facilities such that those who have qualified for the aid do not have to pay anything when they visit such facilities. This paper will look into the different ways in which Medicaid is financed and the role of both the state and the federal governments in ensuring the success of this policy.
How Medicaid is financed
Medicaid is funded by both the state and the federal governments. According to Mitchell (2012), both the state and the federal governments used approximately 400 million dollars in Medicaid in 2011. This policy was established in such a way that the state has full control of the Medicaid program, including how the finances are used.
FMAP is the term used to refer to the fixed amount of money that the federal government pays the states in its efforts to fund the Medicaid project. The federal government does not, however, give equal amounts of money to all the states. The less prosperous states get a larger FMAP share than the prosperous states. In the same breath, the federal government pays approximately 75% of all the Medicaid finances in the less prosperous states. The rest of the money is provided by the state itself. In the richer states, the state pays up to 57% of the finances. Recently, however, the federal government agreed to let the states charge the beneficiaries of the project a considerable premium. This is attributed to the fact that the program has been suffering heavy losses financially (Wachino, Schneider & Rousseau, 2004).
Even though some states have not officially started charging premiums on the beneficiaries of the project, they do charge a minimal amount of money for medical services. This is mainly the case with lower income earning families. All these contribute to how the Medicaid program is funded. In the past, the program experienced a lot of losses and got into huge debts. In more recent years, however, the program has been able to run more smoothly (Iritani, 2009).
The role of the federal and state governments in the operation and design of Medicaid
As mentioned earlier, both the federal and state governments have a role to play in the design and operation of Medicaid. The federal government is mainly involved in providing funds for the project. It is the federal government that gives the most amount of financial support for the project. The federal government has no jurisdiction whatsoever over which health departments the money that it gives is used in (Wachino, Schneider & Rousseau, 2004).
The state has more responsibilities compared to the federal government in terms of controlling Medicaid. It is up to the state to determine those who are eligible for the policy once the state gets the cash from the federal government. As mentioned, different states have different ways of determining those who are eligible for the policy (Smith & Moor 2011). The state is also responsible for the number of premiums that the beneficiaries of the policy have to pay. In some states, the beneficiaries of the policy do not pay anything because the policy caters for all their medical needs. However, there are states where the beneficiaries are required to pay some amount of money.
The state also determines the punishment for people who misuse Medicaid funds. This includes people who became eligible for aid through illegal means and those who use the funds for other benefits. According to Iritani (2009), there have been cases of people using the policy to purchase medical drugs, which they then sell to make profits. This type of criminal activity is punishable by the state.
The impact of the Patient Protection and Affordable Care Act on the eligibility and coverage of Medicaid
The Patient Protection and Affordable Care Act, which is commonly known as Obamacare, is a health policy that targets both the low income earning and well-earning citizens. The health policy was introduced to improve the general quality of the health care services that are provided in all states. The policy does not offer free medical services to low income earning families. Instead, it offers lower, but insurance policies with wider coverage for everyone (CCH Incorporated Law, 2010).
The Obamacare Act uses lower premiums and wide insurance coverage as a way of controlling the amount of money that people pay for insurance. The Act also requires the insurance firms not to use past insurance premiums and other insurance risk factors to determine the insurance rates of their clients. Insurance risk factors have been used to raise or reduce insurance premiums. For example, elderly people get low premiums for car insurance, but very high premiums for health insurance (Iritani, 2009). This is the opposite of what young people get. This is attributed to the fact that the elderly drive more carefully, but they get sick easily. The young adults, on the other hand, drive recklessly and fall sick less frequently than the elderly.
Even though Obamacare has its advantages, it has negative impacts on Medicaid. One of the ways in which it has negatively affected Medicaid is that it has made it harder to determine those who need Medicaid. Previously, Medicaid was given to lower-income families, but lower-income earning families might be able to afford health insurance with the reduction of the premiums. The Act has also been highly supported by well-off citizens because they also get reduced premiums (CCH Incorporated Law, 2010). This means that the state will have difficulties creating revenue, yet it is from this revenue that the state and the federal governments fund Medicaid.
Conclusion
In conclusion, Medicaid is one of the health policies that were put in place in an attempt to help the less fortunate get access to quality health services. The program is funded by both the state and the federal governments. The federal government funds up to 75% of all the Medicaid services in the poor states. The introduction of Obamacare has a negative impact on the Medicaid program because it has reduced the level of funding that the project gets. It has also made it harder to determine the people who need Medicaid the most.
References
CCH Incorporated Law (2010). Explanation and analysis of the Patient Protection and Affordable Care Act. Chicago, IL: Aspen Publishers
Iritani, K. M. (2009). Medicaid: Ongoing federal oversight of payments to offset uncompensated hospital care costs is warranted. GAO, pp 34 41
Mitchell, A. (2012). Medicaid financing and expenditures. Congressional Research Service. Web.
Smith, D. G., & Moor D. J. (2011). Medicaid politics and policy. Piscataway, NJ: Transaction Books
Wachino, V., Schneider, A., & Rousseau, D. (2004). Financing the Medicaid Program: The many roles of federal and state matching funds. Kaiser Family Foundation. Web.
Patient safety event reporting systems are paramount in hospitals as a fraction of the attempts to detect and prevent the patients problems. Incident reporting is used as a safety tool for voluntary patients. The personnel involved in such events provide full information to the inquiry team. Some state health codes command that hospitals and nursing amenities must investigate the occurrences regarding patient care. In addition to that, such codes require that certain events must be reported as prescribed by the regulations. Reportable occurrences often include those events that have lead to a patients severe hurt or death. Based on a case incident, reports should be placed in the medical record and directed to the guidance for lawful advice. This would help prevent discovery on the basis of client-attorney privilege. In some states, the court would not permit incident reports to be discovered, whereas others would do so. This paper discusses the Root Cause Analysis as the healthcare tool, which determines a patients problems and prevents them from reoccurring in the future.
What is RCA? When it is used?
RCA is a broad and orderly method of identifying the spaces in hospital structures and the processes of the health care that may not instantly be noticed; and which may have added to the happening of an incident. The RCA targets the structures and procedures, and not personal performances. It does extensive checking for the underlying supporting agents and the main causes. The RCA recognizes variations that would be needed to advance the systems and processes to stop re-happening of the same episodes. Lastly, RCA finds safe and adequate methods to provide the patients care. The use of the RCA builds suggestions and procedures for organizations. Therefore, RCA minimizes the danger of sentinel events occurrences in the future. The RCA has answers for questions like what has occurred, why it has occurred, and what should be done to prevent it the next time. Investigations about RCA are carried out by multi-disciplinary squads. These teams inquire about the main cause of the episode and recommend approaches to stop such occurrences in the future. A root cause analysis should be performed at the time a mistake or a variance has happened. Failure to do so, some crucial information might not be reached. All personnel involved in the error ought to be present in the analysis to avoid dilution of facts (Patient Safety sentinel event, 2011).
Case study: clarification of the problem that might stimulate RCA.
The root cause analysis was triggered by the wrong identification and treatment of the two patients. It indicated that the two patients were under the wrong medication as a result of wrong identification by the personnel. It also indicated that there might have been such mistakes in the previous, and they were likely to be repeated in the future. The application of RCA was needed to prevent such situations from re-occurring in the future (Hall, 2008).
Investigation of the problem
Once a problem has occurred, it is needed to be assessed, evaluated, and analyzed for counteractive action. The frequency of occurrence of that event should be established. All these events seek to help determine the source of a problem. The likely recommendations for the problem are made to prevent further re-occurrence of that event. In this regard, problem investigation is important because it reveals the unknown sentinel events so that appropriate measures can be taken to prevent future occurrences. In addition to that, when the investigation is not done, it means the healthcare systems would not be performance efficient. This means that the healthcare workers would be reluctant to perfect their work resulting in poor service delivery to the patients. The RCA helps the healthcare workers adhere to their code of ethics because they would not risk causing an injury or death, which would trigger investigations. Lastly, investigations equip the healthcare teams with the procedures of handling problems.
Purposes and drawbacks of RCA
The RCA concentrates on the problems, causes, and impacts of a problem. This approach is impractical because various problems take various shapes from diverse standpoints. What is observed as a problem for one group is not automatically observed as the problem to the other group; therefore, this would result in a disagreement. More so, if the stronger group succeeds the argument, the result would be based on the problem as observed by the stronger group. This creates new problems.
The RAC will be a success in the problem management if all the concerned functionaries will provide the necessary support. The success of the RCA program in the problem management is single-minded by the policy of the company in the management of risks, the approach of the investigator and the method adopted, and information at hand. If all these elements are not strictly followed, the RCA will fail at the initial stage. Another problem of RAC is its linear postulations, which give room for the increased possibility of errors.
There is also the occurrence of the cause and the effect of association, which makes investigation difficult and unreliable. Lastly, the system can be disintegrated into sections and every part is analyzed independently (Limitations of Root Cause Analysis, 2001). The goal of RCA is to study from undesirable episodes and stop them from happening in the future. RCA also helps the medical personnel to study and improve on the effectiveness of RCA usage in the health care setting. It makes the staff adhere to its roles with a lot of responsibility keeping in mind that they would be answerable for any offense committed on duty. Lastly, RCA helps to reduce and alleviate medical errors by identifying problems and implementing solutions to improve patient safety.
Steps to perform an RCA
A small operational team is chosen to spot the occurrence for analysis. Then, a team is prepared to perform the RCA, and it concurs in terms of reference. It studies the processes and concurs on the methods of collecting evidence. This team collects the details by questioning, arguing, and securitizing the evidence collected. This team does research on the causes of the problem and outlines the suggestions for future improvement. An action is taken to alleviate the problem. Lastly, the action employed is evaluated to determine its value in problem resolution (Bowie et al, 2013).
Conclusion
The RCA system is a necessary tool in a health care setting. This is because it enables the medical personnel to formulate the source of a problem. The possible actions are suggested to prevent the problems future re-occurrence. Therefore, this tool enables the health care teams to adhere to their responsibilities for they would be held responsible for any unethical conduct. As a result, many lives of patients would be saved. However, this system has some limitations, which would lead to the manipulation of the outcomes of the problems. This indicates that, at times, such systems might lead to wrong ways of handling problems.
References
Bowie et al (2013). The seven steps for root cause analysis (RCA) team investigation detail: Table 1. Web.