Deafness refers to the loss of hearing capacity either partially or completely. In other words, deafness is defined as a disorder that affects hearing ability. According to the National Association of the Deaf (NAD), deafness is an audiological state where one is not capable of hearing.
This includes those with limited hearing ability. Deafness is defined based on the part of the hearing system affected either as sensorineural or conductive. Sensorineural deafness is the deafness attributed to a failure of the nervous system. On the other hand, conductive deafness is due to the destruction of fibers (ossicles) transmitting sound to the nervous system. This inhibits the ossicles from conducting sound as well as the eardrum from detecting the sound (Dobie, Van Hemel, and National Research Council, 11).
Analysis
Deafness is a problem that can be traced throughout the evolution of mankind. There was even developed the culture of deaf people. This culture has concentrated much on the use of sign language in communicating with others. This forms the basis of interaction and socialization amongst the deaf. Deafness is a disorder featured with a global outlook. More specifically, deafness is not characterized as a disability; instead; it is viewed as an obstruction to verbal communication. Consequently, the deaf is considered as people within a certain language minority (Dobie et al. 42).
Deafness can be inborn (congenital) or acquired later in life. However, this only defines the time upon which it occurs, but it does not ascertain if the cause is genetic. Both the inborn and acquired deafness can be inherited. In regards to inborn deafness, heredity accounts for more than half of the congenital deafness cases. Apart from genetic conditions, other causes also result in congenital deafness. These include pregnancy infections, such as toxoplasmosis and birth defects. Relative to acquired deafness, genetics plays the main part, but mostly it is attributed to other various causes.
These are certain diseases, infections, medicines, aging, trauma, loud noise, earwax build-up, infectious fluids, foreign objects, and scars or holes in the eardrum. Sensorineural deafness is associated with aging, acoustic neuroma, certain medicines-aminoglycosides, Menieres disease, loud noise, and childhood infections. Childhood infections that result in deafness include meningitis, mumps, measles, and scarlet fever. Regarding the noise, the prevalence of background noise is a big challenge that contributes to deafness. Noise is common everywhere including workplaces, particularly, industries.
Exposure to such kinds of noise can lead to or intensify deafness. Conductive deafness is linked to earwax buildup, infectious fluids, foreign objects, and scars or holes in the eardrum. The conductive deafness causes are temporary whereas those of sensorineural are permanent. In regards to aging, hearing capacity reduces as the age increases. This is a normal occurrence that rarely leads to complete deafness. Mostly, it leads to Presbycusis where one becomes unable to hear higher frequency speech sounds like s , and t, and consider these sounds similar. Precisely, one can hear but not differentiate the sounds (Dobie et al. 42).
Deafness has significant effects on daily life activities. Auditory abilities are of much importance to people. The auditory barrier is attributed to the biggest obstacle affecting the deaf. Besides the hearing abilities, auditory tasks are influenced by background noise, room acoustic, competing signals, and situation familiarity (Dobie et al. 42). People with an injured or lacking sense of hearing miss the chance to evaluate the significant aspects of their surroundings, the sounds produced by human beings, and nature. For this reason, they are denied to fully enjoy their daily activities and the surrounding environment.
In order to examine the effect of deafness, the onset at which deafness was acquired is very instrumental. In instances where deafness is acquired early, probably, before the age of 2 years, it adversely affects language development, reading ability, educational achievements, and employment aspects. On the contrary, when deafness occurs as a result of aging or long exposure to noise after the ability to speak has been already developed, the cognitive skills amongst other competencies are minimally affected (Dobie et al. 47). Deafness hinders the individuals capacity to produce and control their speech as well as to learn the rules governing usage of speech sounds in their native language (Dobie et al. 47).
This is much devastating to the deaf children born of hearing parents especially when earlier interventions are not considered for the first 6-12 months. This can hinder development in many aspects of education in communication and language use. In the education set up, communication is based on the degree of deafness; students with profound deafness are typically set for sings based programs whereas those with mild deafness take on speech-based programs (Dobie et al. 47).
As far as education and employment are concerned, communication access matters a lot more so for the deaf. When provided with equal education and employment chances, the deaf can do as much as the non-deaf can do. However, this equality is mainly dependent on access to necessary information for learning or performing the task. Communication access is based on the needs of individuals and the auxiliary ways to cater to these needs (Dobie et al. 47).
In most workplaces, communication access between workers is based on telephone use and video conferencing. This presents a big challenge among deaf workers. As described by Dobie et al. the greatest challenge we face regarding communication access is neither technological nor legislative, but societal attitudes toward hearing loss attitudes that seem to be shared fully by many people with hearing losses (172). Therefore, a deaf worker will require enhanced communication access aids to enable them to communicate with others effectively. This has contributed to the deaf being discriminated against and losing their jobs in the workplace (Dobie et al. 165).
As earlier mentioned, their capacity is determined by the onset of their deafness. Relative to education, children with acquired deafness after learning, still perform well on the tests, as opposed to those with inborn or acquired deafness earlier. Unlike in education, deafness acquired after one has fully completed his/her education and has an already established career, deafness poses a problem in the performance and future mobility of the job. Most of the challenges are attributed to employer altitude towards the deaf. As described by NAD, an employers attitude plays a crucial role in enhancing these employment challenges. Many of the deaf are socially isolated and unsupported by their employers (Dobie et al. 165).
Conclusion
From a psychological perspective, deafness can lead to intensified distress levels. This is attributed to the fact that deafness disrupts communication as well as the perception of the surrounding sounds. This is common for those with acquired deafness as a result of aging and massive exposure to loud noise. Such individuals experience hardships in coping with this new state. Some are unwilling to accept and admit to this new state. This triggers frustrations and anger whenever they experience difficulties in communication which culminates to stress in the long run (Dobie et al. 165).
Works Cited
Dobie, Robert A., Susan Van Hemel, and National Research Council. Hearing Loss: Determining Eligibility for Social Security Benefits. Washington, DC: The National Academies Press, 2004. Print.
A vulnerable population is a population that lives with an economic disadvantage, is in the racial or ethnic minority, suffers from a human immunodeficiency virus, is uninsured or homeless, and suffers from an incurable chronic health condition. The vulnerability of the population is usually outlined by race, gender, or ethnicity alongside with other factors like low income or lack of insurance coverage. The health issues connected to the vulnerable population are intertwined with the social aspects of their lives that include the absence of housing, poverty, or lack of proper education ( Vulnerable Populations: Who Are They? 348).
When it comes to the elderly as a vulnerable population, their vulnerability is often correlated with the term helplessness. Some older people can be vulnerable to abuse, which is interpreted as something unstable about their health conditions (their physical state, a particular learning disability, the state of their mental health). The individual circumstances of their lives make them unable to protect themselves from cases of outside abuse (Clough 1).
Because of the lack of awareness, the majority of cases of elder abuse and elder vulnerability have been overlooked. Moreover, there is a frightening number of cases of financial exploitation of the elderly, which means illegal use of the property or funds. Neglect is also a serious case of elderly abuse; for example, refusing to provide food or shelter for the vulnerable person may result in some tragic consequences.
The Theory of Change can strongly apply in the case of the elderly population. The most important aspect is the importance of human rights. According to Joseph M. Wronka, Human rights offer a kind of universal language and a set of agreements allowing those involved in helping to engage in a dialogue (2). The proponents of the Theory of Change are keen on encouraging making changes in programs or specific requirements (Vogel 4).
When it comes to the application of the Theory of Leadership to the vulnerable population of the elderly, the best aspect of it is the management of transformational theory. It is focused on the relationship between leaders and their followers. The elderly, due to their incapability and physical disadvantages, are unable to voice their opinions, thus, they are in need of a strong and engaging leader. Such a leader is able to motivate the followers to see the importance in themselves as well as encourage them to achieve the higher good (Wronka 2). According to Mark S. Homan, Working with others to promote change requires more than you being a leader and collecting a bunch of followers. To be successful, you will be working with others who are acting powerfully and in concert (11).
To sum up, the vulnerable elders are those older than sixty-five and those who are at very high risks of death (Developing Quality of Care Indicators for the Vulnerable Elderly 2). The application of theories of Change and Leadership with regards to the vulnerable elderly is useful for two reasons: some government policies that tend to overlook the importanct of the care about the elderly should be changed in favor of them, as well as the vulnerable population needs some strong and caring leaders that will encourage them to voice their opinions and as well as being strong and protective of themselves in cases of abuse.
Works Cited
Clough, R. What Makes Older People Vulnerable? What Sort of Events Trigger Requests or Need for Services and Support? 2010. Web.
Homan, M. Promoting Community Change: Making It Happen in the Real World (SW 381T Dynamics of Organizations and Communities). 5th ed. 2010. Bellmont, CA: Cengage Learning. Print.
Vulnerable Populations: Who Are They? The American Journal for Managed Care, 12 (2006): 13. Print.
Wronka, J. Human Rights and Social Justice: Social Action and Service for the Helping and Health Professions. Thousand Oaks, CA: Sage Publications, 2008. Print.
It is a well known fact that respiratory rates increase during moments of physical activity yet it must be noted that the subsequent increase in the amount of heartbeats per second differs from person to person (Drury, 2011).
As explained by Santtila, Keijo, Laura & Heikki (2008), the average adult heart beats at roughly 60 to 100 times per minute with a subsequent 20 to 30 percent increase during moments of physical exertion (Santtila, Keijo, Laura & Heikki, 2008). This statistical average is different in the case of athletes who usually have hearts beats of 40 to 60 per minute with only a minor increase in the overall number of beats.
Knez, Coombes, & Jenkins (2006) identifies the difference as being the result of variances in cardio-vascular endurance wherein athletes due to their greater amount of physical activity and endurance have far stronger heart muscles and a greater degree of oxygen saturation in their blood stream which causes a far lesser degree of stress on the body when performing various physically demanding activities (Knez, Coombes, & Jenkins, 2006).
Taking such viewpoints into consideration the purpose of this particular paper is simple: to examine the difference between the heart rates of athletes and non-athletes before and after periods of physical exertion. For the purposes of this examination the 3 step test will be utilized which Obert et al. (2003) defines as one of the more plausible methods of differentiating between performance levels of athletes and non-athletes (Obert et al., 2003).
The test will consist of the test subjects going up and down a raised platform at a particular rate to measure the resulting data from the physical activity. It is the hypothesis of this study that there will be a noticeable and measurable difference between the pulse rates of athletes and non-athletes when performing the same exercise at the same rate.
Method and Materials
For this particular experiment students were divided into six groups, there were four people in each group, and at least one member was an athlete and one was a non-athlete. The other two people were responsible for measuring pulse rates at the test subjects.
One was also responsible for and using a stop watch to count the seconds, while the other member recorded the data into a table. The experiment proceeded by first measuring the pulse rates of both test subjects (athlete and non-athlete) before the three step test and after the three step test. The results were cataloged by the group member responsible for recording the results.
Average pulse rate before step test
Average pulse rate after step test
Difference between pulse rates
Athlete
70
106
36
Non-Athlete
82
124
42
Conclusion
Based on the results of the experiment is was seen that there was definitely a noticeable and measurable difference in the pulse rates of athletes and non-athletes not only after the exercise but before as well. The inherent difference in results could be due to the fact that the overall physical and cardiovascular health of athletes enables them to have a more efficient and oxygen rich circulatory system which means that they dont need as many beats per second in order to get oxygen to where its needed during instances of physical activity.
Reference List
Drury, T. 2011. The journey from hefty to healthy. Buffalo Law Journal. p. 3.
Knez, W. L., Coombes, J. S., & Jenkins, D. G. 2006. Ultra-Endurance Exercise and Oxidative Damage. Sports Medicine, 36(5): 429-441.
Obert, P. P., Mandigouts, S. S., Nottin, S. S., Vinet, A. A., NGuyen, L. D., & Lecoq, A. M. 2003. Cardiovascular responses to endurance training in children: effect of gender. European Journal Of Clinical Investigation, 33(3), 199-208.
Santtila, M., Keijo, H., Laura, K., & Heikki, K. 2008. Changes in Cardiovascular Performance during an 8-Week Military Basic Training Period Combined with Added Endurance or Strength Training. Military Medicine, 173(12): 1173-1179.
Appraising the level of participation of administrative personnel or the staff involved with processes in the consultation and education department at the Greenby Community Mental Health Center is one of the measures of evaluating processes. Considering that process evaluation is one type of evaluation, it precedes outcome evaluation. The type of outcome and its nature can be traced back to the number and nature of processes that were involved in the development of the project or the construct of services delivered.
For the Greenby Community Mental Health Center, the process involved in the consultation and education department includes the provision of education to caretakers in terms of how to manage the effects of mental instability of their patients or families. On the other hand, consultation involved the lookup of processes and procedures of approaching particular problems facing patients, caretakers, and the general public dealing with cases relevant to tasks addressed by mental health centers.
To evaluate the processes effectively, it is important to focus on the providers of services rather than the type of services offered. The consultation and education department is comprised of managers and employees who involve themselves more with the public than the managers do. In this case, the processes mentioned above can be monitored by appraising the performance levels of an individual employee or service provider for over 26 weeks.
Information to guarantee authentic data can be obtained from the service users upon which they are supplied with fliers in every consultation desk they visit. The fliers would require a service user to answer one or two questions regarding the effectiveness of the process and the process provider. The users will drop the fliers in a suggestion box or stand-alone mini office accessible by management and policymakers. To evaluate the processes, the performance of individual participating employees requires to be appraised to enable the synthesis of the processes by management.
Customer Satisfaction Analysis
As an outcome measure, the processes involved in the consultation and education department must be analyzed by their influence and control of the desired objectives and goals. In this case, the outcomes can be analyzed not only through the follow up of policy procedures, but also customer satisfaction. To evaluate the outcomes properly and effectively, the customer can be placed or considered the central focus of outcome evaluation (Lewis, Packard, and Lewis, 2007).
The consultation and education center has several objectives and two of these include: to provide sufficient and accountable service to customers through organized teamwork and informative systems; secondly, is to eliminate distraction from unnecessary processes that may mislead the whole team from achieving the ultimate goal of providing reliable, inexpensive, timely, and quality service to all.
As a measure to evaluate outcomes, changes made or modification of processes should only be implemented in certain phases that are not as productive as outlined by objectives. It is, therefore, important to implement the customer-satisfaction analysis outcome measure. This measure can be properly be effected by analyzing customer response, customer preferable of Greenby Mental Health Center, and retaining of customers. Through this measure, customer responses would determine whether the processes implemented are effective enough or not.
Scope and Purpose of Process and Outcome evaluation measures
The scope of the process evaluation measure, in this case, is 26 weeks upon which the participants of key interest include management and employees providing services. The purpose of this evaluation measure is to appraise the performance of individuals and their contribution to the departments objectives. On the other hand, the outcome evaluation measure would involve the customers as the participants and would run for the same duration as the process evaluation. The influence of the process and outcome evaluation measures to my design is limiting the project to its core variables and eliminating irrelevance in focus.
Issues and Challenges Likely to arise in evaluating Greenby Community Mental Health Center
Evaluation of processes in Greenby Health Center is not a challenge and many variables can be altered by management to steer the department towards the right direction. However, challenges are likely to arise in the evaluation of outcomes. Some of the outcomes include biased customers who may not give honest feedback, ignorance by customers to participate, service users that may not be in a position to provide reliable information, mixed positive and negative views on the same variable of analysis (Patti, 2008).
Importance of Evaluation
Medical institutions are not very different in form as compared to business corporations. Both of these models serve the public as their customers. The similarity comes in on the issue of customer interests and trends. Despite the policies and methods of management employed in this situation, customer trends define the departments position in delivering quality and reliable service. This evaluation helps the department director to assess readiness, team formation, level of empowerment, and the necessity of the policy amendment. If the director can trace holes in the design, full or trial strategies are applied to deal with the situation.
References
Lewis, J., Packard, T., and Lewis, M. (2007), Management of Human Service Programs, Belmont: Thomson.
Patti, R. (2008), The Handbook of Human Services Management, California: SAGE.
Usually people who love wine prefer white or red. Although both of them are produced by grape, there are several differences between those two noble beverages. According to a number of researchers, red wine contains elements good for heart; therefore, red wine is more helpful for health due to its capability to prevent heart diseases and protect arteries from damage.
Comparing the features of white and red wines, we can notice that both of them have a number of good qualities which make them attractive to people. Thus, white wine has crisp, fruity flavor and aroma, while red one has a richer flavor. Obviously, variety of colors is caused by the use of different grapes. Red wine is made from black and dark red grapes. Due to the different raw materials, and especially components from the skin of grapes, white and red wines differ in tannins that cause the color and flavor of red wines.
Health benefits of red wines are the major argument of those people who like red more than white. Although red wine helps preventing heart diseases and protecting arteries due to its antioxidants, white wine contains fewer calories. However, their level can vary according to the concrete wine. French people have less level of heart diseases due to their habit of drinking a glass of red wine every day. The strongest antioxidants contained in red wine such as reservatrol make it healthier than white one.
Reservatrol prevents the damage of blood vessels and the blood clots that are very dangerous for live. Taking into account the caloric content, we can say that both types have almost the same per cent. However, mostly, white wine contains fewer ratios of calories than red wine. Nevertheless, this characteristic does not provide the serious arguments in support of white wine. Besides, white wine is more acidic and more dangerous for the teeth.
In culinary, red wine is more popular than white one. There are docents of recipes of cooking with red wine. As it had been mentioned before, red wine has stronger flavor and aroma. As cooks want to make their dish more intensive and to enhance its taste, aroma and color, they usually use red wine as a marinade, cooking liquid or additional ingredient to a finished dish.
For instance, this type of wine tastes good with meat, while white is used with fish. Red wine paints a sauce to the purple color and brings the special taste. However, it is difficult to state upon one assertion due to the different tastes of people and hundreds of methods and recopies. Thereby, a good cook can use any kind of wine, trying to create a new taste of the dishes.
White and red wines are very different due to the materials of production. Red wine is healthier and helps preventing heart diseases and protecting arteries from damage. Due to the intensive color and aroma, red wine is more popular in culinary. However, many people prefer white wine because of its taste.
The level of calories in the both types is almost the same. In any situation, it is important to remember that both red and white wines have the same effect on the human body and mind. Therefore, in is necessary to control the use of wine, limiting it to one glass per day.
Organ transplants are a necessary lifesaving procedure, however, due to the limited quantity of available organs most people have to be placed on an organ donor list before they can receive a transplant. The end result of such actions is that it often takes a considerable period of time before an organ becomes available. Unfortunately, between the span of time that an organ is available and the point when it can be transplanted, the person that needed it may have already died. It is due to this that there is the current debate surrounding the possible commercialization of organ transplants in order to expedite the process for a person to get their much needed transplant. Those in favor of commercialization point to the fact that by doing so people that need the organs immediately would be able to acquire them when they need them. On the other end of the spectrum, those against commercialization point towards the unethical nature of selling organs to the highest bidder which would restrict the availability of a much needed resource to a select number of individuals that can afford it. Based on these two stances, this paper will tackle the issue of organ transplant commercialization. It is the assumption of this paper that the commercialization of organ transplants is highly unethical and should not be put into practice.
Position on the Debate
The main issue with the commercialization of organ transplants is that this sets the stage for the creation of a buyers market . To better understand why such a development can considered as socially regressive and adverse towards the common good, it is necessary to take into consideration the concept of supply and demand and how it applies to organ transplants. The rules associated with supply and demand are concentrated on the concept of achieving an equilibrium wherein the amount of demand for a particular type of product is matched by the amount of supply currently in existence. However, creating an equilibrium is not often achieved and in the case of organ transplants there is far more demand than there is supply. In cases where demand far outstrips the supply of a particular product, the end result is often a considerable increase in the price of the product. It is within this context that attempting to commercialize organ transplants becomes unethical since the incredibly limited supply would result in an astronomical increase in the price of organs. The end result is that only people with sufficient funds (i.e. the rich) would be able to afford organs if such a practice were put into effect. From a socio-economic standpoint, such a situation would be normal given the current disparities between social classes and the finite nature of resources, however, from a medical ethics standpoint, such a process can be considered as abominable and in direct violation of common decency and morality.
Moral Argument- The Right to Life and Organ Transplants
From the perspective of Cohen (2012), organ transplants are intrinsically connected to an individuals right to life and, as such, their commercialization should be considered an unethical practice. What must be understood is that unlike other forms of medical treatment (i.e. chemotherapy, medicines, IV bags, etc.) organs cannot be mass produced or created on the spot in a factory. The limited availability creates a unique medical circumstance wherein organs become an invaluable resource since a transplant can mean the difference between the life or death of a patient. It is from this perspective that the concept of the right to life comes into play. Cohen (2012) explained that since organs cannot be replicated, their disbursement and use within the medical profession is placed outside the context of price (aside from the surgery fee). While this may seem against the for profit nature of many medical institutions, what must be understood is that the reason behind this arrangement is connected to the very source of present day organs that go to patients.
The most common primary source of organs is usually from individuals that have organ donor cards and are willing to give their organs should they die. Other sources often come from family members or friends of the patient who are willing to do what they can to help their loved one. It is due to the charitable nature of the source of organs that are given freely for the sake of letting other people live that placing a price on the available organs was considered unethical. When taking the source of present day organs and the concept of the right to life into consideration, it can thus be stated that limiting organ transplants primarily to people that can afford it can be considered a direct violation of human rights as well as a violation of the trust that organ donors had given to medical institutions to utilize their organs ethically. Another factor involving the commercialization of organ transplants that was brought up by Stempsey (2000) was the fact that if people with organ donor cards knew that upon their death their organs would be utilized in a commercial venture with the patient having to potentially pay several thousand dollars for their organs, it is unlikely that they would donate organs in the first place.
Kolnsberg (2003) explains that the altruistic nature of present day organ donors is heavily influenced by the concept of contributing towards what can be defined as the social good (i.e. utilitarianism). This concept can be thought of as an individuals contribution to society in order to make it better. Within this context, when taking into consideration the possible commercialization of organ donations, it is unlikely that people would continue with their level of altruism in giving up their organs after death if it was learned that a commercial entity would profit from it. The end result would be a rapid dwindling of available organs to the extent that the supply would be a fraction of what it is at the present. From this perspective, it can be seen that there is a distinct connection between altruism and organ transplants wherein the former is needed to keep the latter process going.
Normative Theories that Support Conclusion
Based on an assessment of the arguments given, it can be stated that natural rights and utilitarianism help to justify the position of this paper on organ transplants. For instance the concept of the right to life is a natural life theory and helps to justify why organs should be freely available. Also, the altruistic actions that bring about organ donation in the first place are a manifestation of utilitarianism. It is based on these theories and the arguments given that it can be stated that the commercialization of organ transplants is highly unethical and should not be put into practice.
Reference List
Cohen, I. G. (2012). Can the Government Ban Organ Sale? Recent Court Challenges and the Future of US Law on Selling Human Organs and Other Tissue. American Journal Of Transplantation, 12(8), 1983-1987.
Kolnsberg, H. R. (2003). An economic study: should we sell human organs?. International Journal Of Social Economics, 30(9/10), 1049-1069.
Stempsey, S. E. (2000). Organ Markets and Human Dignity: On Selling Your Body and Soul. Christian Bioethics: Non-Ecumenical Studies In Medical Morality, 6(2), 195-204.
Maine state attempted to develop a new system for handling patients and providers claims to meet the compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The system was expected to give online access to the users and process the claims more accurately with a high processing rate. When the system was launched, it ended up with a loss and despair causing billions of payback by the government and leaving the providers frustrated. The state officials invested capital and manpower to recover the system due to which it was proven to be highly expensive than it was anticipated. The current paper discusses the points of failure of the system and what could have been done to prevent such loss.
Background
In the late 19th century, the states were very enthusiastic in upgrading their Medicaid claim processing systems. It should be noted that HIPPA played an imperative role in governing the changes that took place in the management of health records of patients. At the same time, it was observed that the records were kept private. Like other states, Maine also had to improve its basic claim handling system to meet HIPAA requirements. The federal Medicaid programs were also getting more demanding due to the additional health services. The purpose for improving the systems was to save states money that is spent on handling number of calls to the Bureau of medical Services by launching more effective systems and giving online access to the users.
On Jan 21, 2005, the state of Maine launched its brand new Web-based Maine Medicaid Claims System. The system was designed to facilitate the processing of Medicaid claims and payments. The fact remains that the previous Act that was implied for management of medical aid was Honeywell Framework. Later on, the Act was replaced with new frameworks because it was merely limited in terms of its operational pace. The system was also meant to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) which the state was not in compliance with. After declaring the need of a new system instead of upgrading the previous one, the state awarded the contract to CNSI for building a new high-end processing system for handling medical claims. When the system went, live, it met severe collapse causing a loss of around 30 million to the state. Right from the beginning, the system offered complicated issues and was unable to process the claims on time which resulted in thousands of complaints and system failure (Holmes, 2006).
According to Health Insurance Portability and Accountability Act of 1996 (HIPAA), all states have to upgrade their systems for data management related to patient health. In Maine the Honeywell mainframe was implemented which had certain glitches due to which it did not comply with HIPAA, therefore, the state decided to launch a completely new high tech system to improve health record management for the providers and patients. State officials realized that upgrading the existing software would be more troublesome as it was a very basic system (1970 vintage Honeywell mainframe) which would not be able to process around 12000 claims every week. So the IT experts of the state claimed that developing a new system would be cost effective and as well as easy to operate. However, states other than Maine concluded different results for improving their systems. Therefore, the state planned to give away the construction orders to the IT experts in DHS. The aim was to allow the IT experts to come up with rules based system that could be updated without a lot of hassle (Holmes, 2006).
The failure of Medicaid claim processing system occurred due to multiple reasons that made its success impossible. Right from the very beginning when the decision was made that instead of hiring professional claim processing system developers DHS will be building its system; things started to get absurd. DHS had intense lack of manpower and no experience for developing a system. Based on the fact that they have been operating the previous software for 25 years, they can build a new system. The claim proved wrong when in the first few weeks 50% of the claims were directed to suspend instead of being accepted or rejected. Although it was suggested that companies having experience in Medicaid system designing should be outsourced for such a huge project. Outsourcing is a process in which organizations hire external experts to take the service instead of using its internal resources (Laudon & Laudon, 2014). In the case of Maines Medicaid system designing the DHS team had no experience of developing a new program, and CNSI had no track record in developing Medicaid systems so the decision for not outsourcing the professionals proved to be very wrong.
The process of selecting the appropriate vendor against the quotation has to be conducted very carefully as it is the base of initiating a new project. For the development of a system package, the evaluation effort is a part of system analysis. The key elements which should be analyzed before commencing a project are resources, user friendliness, database requirements, documentation, vendor quality, cost effectiveness, installation efforts, maintenance requirements and flexibility in the system. The process of package evaluation is based on Request of Proposal (RFP), it a descriptive document which entails all the requirements of the software program and is submitted to the packaged software vendors (Laudon & Laudon, 2014). Therefore, preparing a practical and realistic RFP is an integral step in system development. When the state issued an RFP for a new system only two proposals were obtained. It can be notes that one is from CNSI ($ 15 million) and the other from Keane ($ 30 million).
Receiving only two proposals was a clear indication that the requirements of the RFP are not reasonable according to the relevant professionals. At this instant, the state IT experts should have reconsidered the demands of the project they have set up in order to make it more realistic and practical. As building a hi-tech system was not required, it was necessary that the system must be easy to use, more efficient and practical. The HIPAA act did not ask for any particular technology to be implemented rather the target was to improve patient health record maintenance and management for the users. If the project is failed to achieve its core target, it is considered as a failed project. For any technology to be adapted and operated successfully it is important that it should meet its objective as well as fulfill user requirements (Laudon & Laudon, 2014).
In addition, another flaw that was noted was when the orders for construction was given to the low bidder CNSI. It was noted that the bidders had little or no understanding of the medical aid. On the other hand, Keane had some experience in building Medicaid systems. Competitive bidding makes the decision making more rational and validated (Laudon & Laudon, 2014). The multiple bids offer a chance for detailed evaluation and risk analysis. This factor lacks in case of Maines Medicaid system as there were only two bids received against the RFP. The difference between the two bids also indicates that the low bid must not have taken all the aspects and intricacies of developing a Medicaid system into account. These factors should have been monitored in the initial phase before assigning the contract in order to ensure the practicality of the system.
For meeting the scalability scale asked by state officials, CNSI suggested using J2EE software language. It was a very risky decision to use such high technology in a complicated project. Medicaid claim systems involve various codes and decodes for tackling rules, services and rates. To translate all those codes into a system developed from scratch was again very difficult. Selection of appropriate software language is very important to ensure system efficiency and reduce errors. The Medicaid system must have been developed on programming language that runs successfully on Medicaid claim processing software. Easy software language makes the process smooth and more effective (Laudon & Laudon, 2014). The selection of high technology language again increased error probability in the system that was apparent in the system flaws.
Another big issue related to the project was narrow timeline for building such a project. In order to meet the target date given by HIPAA, the DHSs head did not take the time for revisiting RFP although if the problems associated with the system and the loss it has caused are considered taking time for revising the RFP was worth investing. It could have prevented million of Dollars to the state if the project details had been reconsidered at that instant. Due to the understaffed DHS and CNSI representatives the team would not be able to meet the deadline because there was enormous data that had to be translated into a new language. As a result, the team started to take their decisions on satisfying Medicaid requirements and then reprogram the system after having guidance from Medicaid experts. This further delayed the development process of the system (Holmes, 2006).
Narrow timelines have been declared as one of the four main factors which result in system failure. Around 30 to 40 percent software technology projects are declared as runaway projects as they have surpassed their target dates and anticipated budgets (Laudon & Laudon, 2014).
Another key issue related to the system design was its extreme intricacy. A lot of details had been incorporated into the system so that it could comply with HIPAA security requirements and become more accurate. The legacy system used to check the claims for three basic things: entry of the provider in the system, patient eligibility and if the service is claimable. The new Medicaid system was designed to check very minute details of the claims. It has 13 checks to verify before a claim is accepted. This made the system more sensitive and complicated which was beyond the Medicaid system requirement.
As the DHS and CNSI programmers could not meet the target date given by HIPAA, they started to look for shortcuts to get the system launched. It was another huge mistake. For instance: To save time rechecking of the system from end to end was not performed. A pilot test was conducted to check the processing with ten providers. Since most of the system was not ready by that time therefore; the claims were not checked to clear all the points in the system (Holmes, 2006). This is very important to invest time before giving a green signal to the main project (Laudon & Laudon, 2014). In this case, the state officials did not consider the importance of pilot testing and let the system go live; however, the c0onsequences they faced made them realize their big mistake.
The combined department of Health and Human Service HHS also did not provide any official training or guidance for operating the system to the providers and the staff who had to answer the calls in the Bureau of Medical Services (Holmes, 2006). For such a complex technology implementation staff training should have been given to avoid human errors (Laudon & Laudon, 2014). A number of errors would have been appeared due to mishandling and improper use of the system.
The state officials planned to pay back the providers if the system could not run successfully. As planned, a timeline was considered to make sure that all the claims are approved. In the case, there were some of the claims unapproved then the provider had to be paid by the state. After the system had gone live in the very first week, it was found that around 24000 of the claims were declared as suspended and could not be processed. The suspended claims are those which could not be regarded as approved due to lack of certain elements and could not be rejected as well. So, these files made a huge pile in the system which was a warning sign for the developers (Holmes, 2006).
Such an error could have been corrected, but the high percentage of unprocessed claims made it difficult. The reason was very complicated system design with detailed codes which kept the claims unprocessed declaring them suspended. This shows the importance of system design and language used to build the software. It should be compatible and user friendly to increase the efficiency of the system. The basic legacy system although was not very high tech but it had a percentage of 20% of the suspended claims. Again, this shows the incompetency of the developers who selected inappropriate programming language for the system that did not comply with the requirements of the Medicaid claim processing system. This decision making in the initial level is very important to ensure the implementation of technology and prevent its failure (Laudon & Laudon, 2014).
This system error resulted in thousands of unprocessed claims with each passing day, and tons of complaints about pending payment claims were received at the Bureau of Medical Service. The number of suspended claim was very high because of another system design flaw. It was programmed that if a claim is declared as suspended than each time it is entered in the system it will be directly rejected. As a matter of fact, there were only 1000 claims that were being considered. This raised a concern that the implementation of operations would require more than six months to visit all claims. On rechecking the issue, it was found that there was a severe problem in code and design of the system. An example could be taken about the claims that were 1000 lines. The system could only take the claims that were 1000 lines long. Any claim that was more than 1000 lines was programmed to get rejected automatically by the software.
Considering the problems that appeared in the system due to system design flaw it is found that developing a prototype before launching a project is extremely necessary. The preliminary model can be rechecked and transformed according to the requirements and it also saves a lot of money and time. Investing some time to build a prototype after finalizing the design would have been worthy particularly in this case where incomplete pilot testing and no prototype resulted in massive destruction and system failure. With planned iteration process, one can replace the unexpected rework which reflects providers requirements (Laudon & Laudon, 2014).
It is very common that systems do come up with errors, but these are fixed in order to keep it running. In the case of Medicaid system developed by DHS and CNSI the problem was that the number of errors was many, and the programmers were unable to resolve them. The programmers tried their best but could not find a solution to halt the continuously rising number of unprocessed claims that made the payback of $ 310 million to the providers by the state. Finally, the DHS department and state officials hired XWave for project consultancy and changed the project leader. The new team leader and consultancy firm found out that the reason behind so many issues related to the system and its repair are due to poor project management and lack of communication between the staff (Holmes, 2006).
Laudon declares that the reason for poor project management in most of the cases comes with restricted budget and timeline. Both of these can be observed in the case of Maines Medicaid system failure. Projects are launched with missing functional features due to lack of time that poses errors later in operating the system. It is reported that only 29 percent of the IT projects are delivered on time and within the budget with all the requirements met (Laudon & Laudon, 2014).
Conclusion
Maines Medicaid system of claim processing resulted in total failure in terms of cost effectiveness, efficiency and even in the output. A number of reasons have appeared on closely analyzing the facts that resulted in technology failure. The most important among them are the system design flaws which caused major issues in operating the system. Use of improper program language which could not meet the Medicaid requirements further enhanced the chances of errors in the system. The inappropriate RFP which caused low number of bids also show the impracticality of the project requirements.
The choice of vendor made on the basis of budget ignoring the expertise and experience was another major factor which lead to the disaster, Maine Medicaid system failure was not only a software collapse affecting an organization rather it crumpled the entire health care system of the state affecting the patients, providers as well as the state officials. The state also had to bear enormous capital loss as a result of system failure. The providers clearly declared the system flop and ineffective in accomplishing its claims that are to be easier, efficient and accurate. Although the state officials put efforts and money to recover the system and make it efficient but still it could not satisfy the users expectations.
Giving birth to a child is the most important event in the life of every woman. That is why it is necessary to pay attention to every detail of this significant process, to take into account all the aspects of the procedure and hope for the better.
However, every pregnant woman wants to be sure that her labors will be successful and everything will be all right. It is that point on which American doctors accentuate in their speeches. There are few problems which can experience a pregnant woman when she is preparing for one of the most significant moments in her life.
Nevertheless, the real situations and facts support the idea that the health care system of the USA is not perfect, and there are many controversial questions which require their immediate solutions. This opinion can be considered as a decisive one for the analysis of Marsden Wagners Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First in which the author provides the detailed examination of the most typical and influential problems of the maternity and health care system in the USA.
In his book, Marsden Wagner focuses on such problematic questions as the state of the hospitals in the USA, the aspects of the American maternity care system, difficulties in providing the effective care for mothers and their babies.
The most controversial question is about the fact that the USA health care system provides the most expensive care services for pregnant women in the world, but the level of the quality of these services does not follow the principles of the highest standards which are stated in the programs about the health care system in the country. Moreover, the author pays attention to the issues of midwifery and the womens safety in hospitals.
There can also be different visions of the question of the main goal of the book. Angelo P. Giardino accentuates that the author of the book specifically states that the purpose of the book is to further an understanding of problems in the system with an eye toward ultimately moving beyond defining the issues and toward suggesting solutions (Giardino 38).
Moreover, the most interesting detail of the work is the high level of the criticism expressed in the book. Thus, Marsden Wagner is strict about the role of physicians in the life of a pregnant woman. Physicians, however, will find the book a difficult read because of the level of criticism lobbed at their profession (Giardino 39).
One more important detail which also requires the further investigation is the point that Wagner uses the allusion to the physicians as priests of a cult of science runs counter to that view (Giardino 39). Marsden Wagner openly and rather sarcastically discusses the problems of the health care system in the USA.
Nevertheless, why can this book be useful for pregnant women who face the problem of following the principles of the modern maturity care system in the USA? Examining the structure of obstetrical care more thoroughly than most books about childbirth, it helps readers understand why present maternity care services are often unsatisfactory, why choices are limited, and why womens basic human rights ignored or abused (Pincus 185).
In his book, Marsden Wagner also concentrates on those risks which pregnant women can experience during their labors. He is extremely honest in his description of all the possible problems which they can face in the hospitals. The author also pays attention to the necessity of the conveniences for the further mothers and to the ways which women can use for creating the best conditions for the childbirth.
Moreover, Dr. Wagner accentuates the rights which women should know when they choose the best variant for their labors. Thus, a pregnant woman who finds that her hospital is not willing to comply with her wishes for her labor and birth can also file a complaint with the chief compliance officer of the hospital (Wagner 179).
He also focuses on the fact that pregnant women should not blindly follow the doctors instructions, and it is necessary for them to know as much information about labors as possible because there are many situations when women are treated wrongly due to the lack of the physicians competence.
For instance, Cytotec can be considered as a rather dangerous medicine with a lot of negative effects for the majority of women. The author focuses on the fact that we have very little solid information on the use and outcomes of procedures and drugs, such as Cytotec for inducing labor, that have not been adequately tested for safety (Wagner 184).
That is why it is useful for pregnant women to collect as much information about the aspects of labors as possible and have the strict opinion according to the medicines and the other ways of treatment which can be used for their case. Nevertheless, in spite of the fact that the level of health care services in hospitals can be considered as unsatisfied, the risks which women experience while giving birth to their children at home is much higher.
Thus, the book written by Dr. Wagner is helpful for women who are pregnant because it gives the truthful vision of the aspects which are connected with the health care system in the USA, and it provides definite useful solutions for the most controversial problems.
Works Cited
Giardino, Angelo P. Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First . Medscape General Medcine 9.1 (2007): 37-46. Print.
Pincus, Jane. Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First . Birth 34.2 (2007): 185-186. Print.
Wagner, Marsden. Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First. USA: University of California Press, 2007. Print.
The following procedure is provided to establish a clear direction for resolving problems concerning an employees substandard performance. A nurse, Susie, has shown the lack of acceptable work performance and chronically unsatisfactory results that prevent her from maintaining job standards. When necessary, our medical establishment reserves the right to charge a disciplinary action against employees who willingly violate established organizational rules (Traynor, Stone, Cook, Gould, & Maben, 2014). Disciplinary measures include:
Initial counseling
Oral warning for minor offenses
Written warning for more severe violations
Suspension without pay as a means to demonstrate the insufficiency of previous warnings
Discharge
Initial counseling was used as the first step in correcting the nurses unacceptable behavior. The supervisor nurse reviewed the pertinent facts with the employee and made a reprimand regarding Susies complaints about other workers and poor performance on September 14. The fact of ill performance was brought to the supervisor nurses attention on September 15 by Helen, a charge nurse. The occurrence of violations, however, did not stop at that stage. On September 16, two other employees, Fred and Cindy, brought another issue to the supervisors attention stating that Susies low performance was still evident. Based on their report, the second step was taken, and Susie was given an oral warning. Both the current unacceptable behavior and the employees past performance were considered and closely discussed. The case was documented by the supervisor in the employees file. Probation was postponed on the condition that there would be no further violations.
A report provided by a charge nurse, Helen, on October 1 showed that Susie was still barely performing her work duties. A charge nurse insisted that Susie was not getting along with the team members and that stricter punishment procedure was therefore required. The supervisor then moved to the third step of disciplinary action: the written warning. The warning clearly stated the safety policy that was violated and the measures that the employee must take to return to standard performance. The procedure was documented following the existing standards of work for medical units.
Another issue was observed on October 2, when two employees, Fred and Cindy, reported Susie had not been performing her tasks the night before. The issue led to an immediate reaction, and the nurse was subject to the fourth stage of disciplinary action: suspension without pay. The supervisor nurse, Helen, placed the employee on probationary status subject to dismissal. However, the measures that were taken still appeared to be insufficient to improve the nurses behavior. The occurrence that took place on October 10, when Susie quarreled with her teammate, Charlie, led the supervisor nurse to take the measure of last resort. Thus, the decision about the employees discharge was made on October 10, based on repeated misconduct, poor performance, and violation of the basic safety rules (Harcourt, Hannay, & Lam, 2013).
The example above demonstrates that strict punitive measures are sometimes the only means to resort to when dealing with systematic violations. The corrective measures should follow an infraction as soon as possible to demonstrate a companys intolerance for disobedience and the consequences it may lead to. The measures should, however, begin with the least severe. Skipping the steps leading up to an employees termination may result in employees voluntary dismissal due to the fear of being unjustly fired. Senior executives require that all no disciplinary action be taken without HR department involvement. This is done so that the HR department can monitor an employees performance during possible probation and, thus, make decisions on whether the termination procedure is reasonable or not.
References
Harcourt, M., Hannay, M., & Lam, H. (2013). Distributive justice, employment-at-will and just-cause dismissal. Journal of Business Ethics, 115(2), 311-325.
Traynor, M., Stone, K., Cook, H., Gould, D., & Maben, J. (2014). Disciplinary processes and the management of poor performance among UK nurses: Bad apple or systemic failure? A scoping study. Nursing Inquiry, 21(1), 51-58.
The article clarifies some issues regarding prenatal cocaine. This author was informed by the understanding that in the past, pregnant women who used cocaine predisposed their unborn kids to health risks (Terranella par. 1). Specifically, the author wanted to clarify the issue by explaining how the issue has been misunderstood in American society (Terranella par. 2). The author has also tried to link some signs previously associated with prenatal cocaine to other issues such as poverty and other drugs like nicotine, marijuana, and alcohol.
Therefore according to this article, recent scientific exploration on the impacts of cocaine during pregnancy indicates that there is no tangible proof that exposure to prenatal cocaine is connected or associated with harmful developmental impacts in children below the age of six. He indicates that pregnant women should avoid any drugs as they have the potential to impose negative effects on the health of children. Using research information, the author indicates that these findings do not mean that pregnant women have been given the green light to start taking prenatal cocaine (Terranella par. 11).
The type of drug, in this case, is prenatal cocaine and the affected population is the unborn kids who get through their mothers (Terranella 1). In fact, according to the article, there many developmental problems associated with prenatal cocaine on babies and some of these problems include growth problems, language complications, mental ability challenges, motor skills challenges and finally behavioral problems (Terranella par. 3).
The article is interesting in the sense that it contains information that dispels some misperceptions regarding the use of prenatal cocaine on the unborn children. In the past, as the number of women using cocaine increased particularly in the 1990s, the affected children were described the media as ruined, meaning that these children were not able to love and even learn (Terranella par. 5). The other interesting thing is how the author indicates that according to recent studies, poverty is more harmful or destructive in the lives of these kids than exposure to prenatal cocaine. This is interesting as I have never heard that poverty leads to problems such as language complications, mental ability challenges, motor skills challenges, and finally, behavioral problems in unborn children. If that were so, it would mean that most kids who are born to poor parents would be having these problems.
The other interesting thing is how the author has treated the issue of cocaine casually. Even though it may not be having some negative effects on kids as earlier thought, cocaine is still a hard drug, and as such it has unenthusiastic impacts both on the lives of the child and mother (Terranella par. 3). Another interesting thing is that when the author in his article is not able to find the differences in terms of effects between cocaine and other drugs such as nicotine on the unborn child. That is, both drugs affect the functioning of the vessels supplying blood in the placenta.
The main reason why I chose this article is that it contains information that has been in the mainstream for decades. More so, the way the author has prosecuted and presented the issue. Most important, the author does not rely on or give his personal opinion regarding the issue but attributes all his finding to past researches which makes the information presented more credible.