The Adkar Change Management Model Business Essay

The Adkar Change Management Model Business Essay Industrial Laboratory Problems with Production, Efficiency, and Flow. Continuous quality improvement is the focus of a quality based leader in an industrial QC laboratory, but laboratory leaders that are deficient in quality assurance knowledge can struggle with analyzing production, efficiency, or workflow problems. Major issues industrial QC laboratory leaders encounter are uneven workloads, poor work scheduling, lack of cross training, overstrained work activities, and inefficient wasteful processes (Reynolds, 2009). To combat these issues of poor laboratory efficiency and quality, assertive laboratory leaders may try to improve conditions by implementing an efficiency system, such as lean 5S. Problem recognition, by industrial QC laboratory leaders, is a valuable first step to continuous quality improvement. Insufficient understanding of the complexity involved in inefficient culture, the lean 5S system purpose, and change management leads to failure for most industrial laborator y leaders in sustaining a meaningful and successful lean 5S culture change. 5S Description as a Foundation to Lean, and 5S Failure 5S is a five step system for altering the environment of an industrial lab that is inefficient, wasteful, and displaying poor quality into a lab that is organized, experiences smooth work flow of product and personnel, and is visually enhanced; as a result, bringing wasteful issues to the forefront for continuous improvement. The 5S system is a quality improvement development originating in Japan; unequivocally, the five Ss are seiri, seiton, seiso, seiketsu, and shitsuke (Hirano,1992); however, in the English version the five Ss have been given the names sort, set in order, shine, standardize, and sustain (5S Supply, 2011). Each step of the 5S system works together. 5S starts with sort, where an industrial laboratory visually organizes and labels its entire inventory in groups of importance and categorical description; for instance, marking all laboratory equipment as essential, possible essential, and non-essential (Nilipour Jamshidian, 2005). All non-essential items are marked with a red tag and then taken to a holding area for non-value added item disposal. Sort is the step of removing waste that reduces clutter and improves organization for moving on to the next step in the 5S system, set in order. Set in order is the orderliness step where all value-added inventory items are organized and properly labeled for easy use and access. Access to items is determined by how often they are needed or used; for example, frequently used laboratory equipment and tools should be kept close to the area of need, and less frequently used items can be stored away in a properly labeled area for easy discovery (Froeh ling, 2009). Organizational tools are implemented such as labeling cabinets and shelves, color coding equipment and tools, and outlining and labeling work areas. Organizing, labeling, and placing laboratory tools and equipment in their designated locations allow for ease of the next 5S step of shine. Shine involves cleaning the laboratory, removing dirt and grime, and making the lab shine. Cleanliness and orderliness provides an industrial lab environment for easily identifying and eliminating waste and non-value added items. To make the 5S system part of everyday lab activities, the first three steps of 5S must become part of laboratory standard operating procedure; for this reason, the work needs to be standardized through work tasks (Froehling, 2009). Each employee of the lab must do his or her part in continually organizing, eliminating waste, and cleaning; subsequently, these tasks are done by implementing the fourth step of standardize. Once the 5S system is standardized, it must be reinforced through the sustain step which involves such activities as auditing, appraisal, and positive feedback; consequently, sustain is the step most practitioners neglect and do not fully implement, therefore leading to failure of this step. According to Hogg (2005), the sustain step, of the 5S system, is where the majority of 5S failure occurs. There are those that consider the 5S system as basic housekeeping, and if a practitioner were to look at the first three steps of 5S, it would be (Eaton, 2000). What the laboratory leaders fail to recognize is the true application of all five steps of 5S as the foundation to a lean laboratory and as a permanent culture change to a lab that has operated in the past as inefficient and wasteful. For example, if an industrial laboratory has been working for 10 years as inefficient, then inefficiency would be customary and the standard engrained in that laboratory culture. Because of this history, it would take more than housekeeping to break down the cultural barriers existing in this laboratory work environment to improve efficiency and quality long term. If 5S is labeled as housekeeping by laboratory leadership or upper management, then the 5S quality initiative most certainly falters (Hogg, 2005). 5S as a Culture Change, and Change Management Failure It is important for industrial laboratory leaders to realize that 5S implementation is more than housekeeping. 5S is a change in the following three areas; work flow of product and personnel, functioning of the lab in terms of inventory and equipment, and standard operating procedures and daily activities. Understanding the changes that take place through the implementation of the laboratory 5S system is crucial knowledge for laboratory leadership. 5S is not a quality tool, but a lean quality system that requires change from all industrial laboratory personnel. According to Shil (2009), it is crucial for laboratory leadership and upper management to acknowledge lean 5S as a culture change to the organization, and not a simple task performed periodically. Now that the 5S system has been established successfully as a change in culture it is important for the 5S facilitator to understand the intricacies of implementing change, and sustaining the intended change as needed with lean 5S. The important issues needing to be addressed when implementing change are leadership support, employee resistance, and change reinforcement. Leadership support is very important to start the 5S implementation, so laboratory personnel must recognize that company management is serious about the changes being put forth, and feel confident in management to provide the resources and support that is needed to make the changes materialize and endure. Employee resistance can be a huge obstacle to the implementation of change; therefore, leadership cannot ignore resistance and must do all it can to change resistance to acceptance (Obrien, 2008). Engaging the employee is the first step to breaking down this barrier, and engagement is accomplished by effective commun ication and employee involvement. Communication is important for educating laboratory personnel on the reasons for the proposed change, and for their understanding of the root causes of laboratory inefficiencies that brought on the need for change. Effective communication brings a positive light to the employees perception of the change, gives them an understanding of the needed change, and starts the breakdown of resistance (Society for Human Resource Management, 2007). The next important aspect for leadership in employee engagement is to involve the laboratory personnel in the decision making and implementation planning of the 5S system. Involvement in the change gives the laboratory personnel a sense of ownership in the system, and continues to deplete the remaining resistance to change. According to Gallup Business Journal (2012), engaging employees builds passion within the workforce and that passion can turn employee resistance to employee innovation and promotion of change. Once a change has been implemented it is not necessarily secure; consequently, this uncertainty is a third reason 5S practitioners fail to sustain the intended quality improvements that lean 5S is meant for. 5S is a dynamic system that needs to be managed and measured. Most failure of 5S occurs in the fifth step of sustain because laboratory leaders lose focus on the 5S system. Because standards are in place and the laboratory is clean and organized, leaders think the laboratory will continue to operate this way. This thought process is a big mistake and causes the 5S system to deteriorate and result in laboratory personnel losing initial enthusiasm for the lean quality initiative. According to Bevan (2011), the major factor in successful change is not putting together a plan or understanding the change, but implementing and sustaining the change, yet many change leaders assume initial change will stick, therefore neglecting to preserve the change. Failure of the 5S system is not onl y a waste of resources, money and time, but also a loss of opportunity. The 5S system is the foundation of a lean laboratory, and if 5S fails it can result in an increase in laboratory personnel change resistance for any future lean initiatives. Understanding the intent of 5S as a culture change and demonstrating a clear understanding of the complexities of change management practice is extremely beneficial for any 5S practitioner. Change Management Success, and the ADKAR Change Management Model 5S is not a laboratory housekeeping task or quality tool; on the contrary, 5S is a lean system that requires culture change in the industrial laboratory. In order for a successful implementation and sustainable 5S culture change in an industrial laboratory, a change management model can be extremely important and vital for planning, educating, implementing, and sustaining the quality initiative. A change management model provides the structure that is missing from the 5S steps for successful and sustainable change. Research shows that change, such as 5S, breaks down due to poor planning and leadership, employee resistance and human resource neglect, and insufficient reinforcement of the change in culture (Song, 2009). One such change management model that has proven success is the ADKAR change management model developed by Jeffrey Hiatt from the Prosci Learning Center. The ADKAR change management model consists of five elements that build off of each other, and focus on important areas of change; such as, evaluation, management leadership, employee engagement, training, and reinforcement (Hiatt, 2006). Although some industry professionals may prefer an alternative change management model, the ADKAR model was chosen for its simplicity, structure, and ability to implement change ranging from change in individuals to more complex company-wide change. ADKAR Elements The ADKAR change management model has five elements in its structure, and the five elements are: Awareness, Desire, Knowledge, Ability, Reinforcement. Awareness Element of the ADKAR Model The element of awareness consists of some very important aspects in providing a solid foundation to a change initiative like lean 5S. One aspect is the ability to evaluate the organizations openness to change, and provide information for evaluating each element of the ADKAR model. For instance, determining how aware the organization is on its need to change, if management supports the proposed changes, and if the change has been communicated to the employees. Evaluation is a good starting point in determining which element of the ADKAR model is the weakest in respect to the organization making the changes. Evaluation could answer important questions like: What is the desire level of the employees to making this change happen? How knowledgeable are employees on the new processes and systems intended from the change? Are resources and workforce available to enable the laboratory to implement the changes? Is there a process for reinforcing the changes, and is the laboratory able to sustain the new systems and processes long term? Evaluation using the ADKAR change management model provides 5S leadership with a planning resource for making a strong plan prior to beginning the 5S system implementation. Awareness also promotes the importance of having strong management support for the planned 5S changes; subsequently, sponsorship is important for giving laboratory employees the feeling of being supported by upper management, and confidence knowing that resources are being provided for the full 5S implementation. Awareness likewise covers the very important process of communicating to employees the reasoning for the 5S system, and engaging employees on their concerns and ideas, and using their experience to build strong support for the 5S system. According to the survey by the Society of Human Resource Management (2007), the two highest reported barriers to successful change are employee resistance to change, and insufficient communication of the planned change. Hiatt (2006) lists the four strategies of developing awareness of change as: Operative Communication, Top Management Support, Leadership Instruction, Appropriate Information Access. Desire Element of the ADKAR Model People are naturally hesitant to change, and strategically communicating the need for 5S and showing strong management support is designed to create the next element of the ADKAR model; specifically, desire for the 5S system in the laboratory. Desire is the breaking down of change resistance and the barriers to change inherent in the laboratory employees, and engaging them to the point of turning resistance to enthusiasm. According to Zigarmi and Hoekstra (2011), resistance to change is created when change is forced on employees instead of performed with employees; furthermore, not involving the employees being affected by the change taking place is the largest obstruction to successful change. Jeffrey Hiatt (2006) lists the maneuvers for creating desire in the ADKAR model as: Sponsor the change successfully in collaboration with employees, Provide managers the ability to perform as change leaders, Appraise risk and expect resistance, Involve employees in the process, Align enticement programs to the goals. After the first two elements of ADKAR are implemented, the laboratory personnel are aware of the efficiency problems in the laboratory department, and the need for continuous quality improvement. Through effective communication and employee involvement the desire to change is strong, and employees are on board with the next step of learning about the five steps and structure of the 5S system. Not addressing the first two steps of awareness and desire is the first problem 5S practitioners make; as a result, they do not set a strong foundation for implementing a system as culturally complicated as 5S. Laboratory leaders can misinterpret the 5S system as a simple housekeeping activity or quality tool and then struggle mightily, because laboratory employees cannot understand the need for the system, and do not feel the presence of management support; accordingly, employees then naturally build a resistance to the implementation of 5S into the laboratory. Knowledge Element of the ADKAR Model Knowledge is the third element of the ADKAR change management model. Knowledge is the training element of the change management structure and consists of training all laboratory employees on the history, structure, and processes used in the 5S system. The knowledge element of the ADKAR model stresses the importance of robust instruction of how to implement and use each 5S step, and making sure laboratory employees are unified in implementing and following the procedures to be developed. Jeffrey Hiatt (2006) describes the exercises for building knowledge in the ADKAR model as: Train and educate with effectiveness, Provide work tools, Coach employees individually, Develop training groups and settings. According to the research paper by Korkut, Cakicier, Erdinler, Ulay, and Dogan (2009), 5S training by organizational leadership to the personnel executing the 5S implementation is a decisive factor in the successful 5S operation. Eaton and Caprenter (2000), reiterate the importance of training and emphasize that all affected employees need to understand how 5S works, how it is implemented, and what the results should be. Ability Element of the ADKAR Model Ability is the fourth element of the ADKAR model, and emphasizes the importance of providing resources in time, manpower, and equipment for a full implementation of all 5S steps. If time, manpower, and equipment are not adequate for implementing changes, then the whole 5S system can be compromised and each step may not be completed as the system is designed. Jeffrey Hiatt (2006) lists the exercises for crafting ability in the ADKAR model as: Support the change through daily supervisor involvement, Provide expert advice in subject material, Appraise performance, Involve employees in training exercises. According to Bevan (2011), monetary, workforce, and technological resources must be available and applied to empower the change to be executed, or the change will be impaired. Minimalizing resources on change implementation such as 5S into an industrial laboratory can weaken the sustainability of the intended changes; in summary, laboratory personnel need the tools and time to get the job done. Reinforcement Element of the ADKAR Model Reinforcement is the last element of the ADKAR change management model. This element is extremely important if the 5S system is to be sustainable for the long term in an industrial laboratory. Knowing that 5S failures happen most often when 5S practitioners neglect the last step of the 5S system, sustain, then the ADKAR model can provide the proper planning and focus needed on building a sustainable 5S system in the industrial laboratory. Reinforcement accentuates the importance of measuring the affects of 5S changes through auditing the 5S system. According to Bevan (2011), tracking the changes by comparing results with the planned vision of the 5S system and reassessing goals to promote continual improvement are critical factors in successful and sustainable change. Hiatt (2006) also underscores the importance of employee recognition for following new 5S standard operating procedures, being a team player, and enthusiastically promoting the 5S culture changes. Another point of reinf orcement is the continuation of management support, and keeping management involved with auditing and providing the needed positive feedback for employee recognition. Leaders of change must be aware of their role in successful change, and their responsibility in fostering the new system for continued growth and change in culture (Higgs Rowland, 2010). If the reinforcement of the industrial laboratory 5S system is planned for and followed, as the ADKAR model can provide, then the probability of 5S sustainability failure will extremely diminish, and the 5S culture change can become the norm. Reinforcement, Continuous Improvement, and PDSA Cycle The ADKAR model stresses the importance of a strong reinforcement process for sustainability and continuous improvement of implemented changes. An important quality and continuous improvement tool that provides a strong reinforcement process for 5S sustainability is the use of the continuous improvement cycle of PDSA (plan, do, study, act). With the inclusion of the PDSA cycle in the reinforcement element of the ADKAR model, 5S system audits, metrics, appraisals, and laboratory personnel feedback and recognition would be planned, implemented, studied for effectiveness, and continually improved by enacting changes to improve culture change reinforcement and 5S sustainably. According to the PDSA workbook from the State of Victoria Department of Health (2010), the PDSA cycle is an excellent model for continuous system improvement; furthermore, the workbook breaks down each phase of the PDSA cycle as follows: Plan Phase: The planning of the 5S improvement that answers, the who, what, when, why, and how of the initiative. Do Phase: The execution of the scheduled deliverables from the planning phase. Study Phase: The review phase of comparing where the 5S system was and where it is now since the planned improvement initiatives have been executed. Measurables are taken to determine if changes were beneficial, or if more changes are needed to meet intended plans. Act Phase: The moving forward phase to realize the gains from the cycle, determine opportunities that have risen from this initiative, and decide if the improvement cycle needs to be repeated or are new strategies apparent for improvement. The ADKAR reinforcement element employs five campaigns for reinforcing change: Celebration and Recognition, Rewards, Feedback from Employees, Audits and Performance Measurement Systems, Accountability Systems (Hiatt, 2006). To employ these reinforcement campaigns and continually improve these tactics, PDSA can provide the continuous improvement model for devising, implementing, measuring, and improving the five tactics of reinforcement that the 5S system needs for long term sustainability. Continuous quality improvement is a voyage, and the PDSA cycle provides the structure needed to verify the sustainability of 5S through recurring assessment, and prevention of disparities within the 5S system from its intentions (Quality Insights of Pennsylvania, 2011). Each PDSA cycle performed in the reinforcement element of ADKAR provides a learning experience that can be used for continually strengthening the 5S system, and sufficiently reacting to laboratory environment changes and new quality issues (Srivannaboon, 2009).

Republican Viewpoints on National Healthcare

Republican Views Towards Healthcare Reform From the Republican viewpoint, any form of nationalized or partially nationalized universal healthcare is unacceptable. Any public delivery system will limit ‘for profit’ free enterprise and thus violates our form of government. It will increase taxes and the overall cost of healthcare. Publicly delivered health care will cause the quality of care to go down by directly hindering the quantity of healthcare providers as well as the quality of care rendered by remaining healthcare providers. Republicans oppose a universal public health care delivery system primarily because of profit – free trade – constitutional issues, fiscal issues and quality of care issues. Further government meddling in the private practice of medicine and healthcare will be detrimental to many Americans. In the 1990’s, universal nationalized healthcare was proposed by the Clinton administration. The proposed law failed due to the fact that the Republican Party had gained control of the house and senate for the first time in over fifty years. During the 2008 presidential election, one of President Obama’s primary campaign promises was universal healthcare. The proposal has created a new national debate on the pros and cons of a universal healthcare system. Proposals from the House and Senate vary greatly and will have to be reconciled during the legislative reconciliation process. Interestingly, both parties favor some form of health care insurance reform but the concept of universal coverage offered through a single public payer or both private and public payer options has generated controversy. Republicans have adamantly opposed the public option because it alters the free enterprise ‘for profit’ healthcare system currently and traditionally in existence in the Untied States. The public option will radically alter the environment of the core constituency of the Republican Party. Looking at the constituency of the Republican Party, there are certain positions that the Republicans should put forward on the national healthcare debate to best represent the party’s core constituents. Traditionally, private practice physicians, ‘for profit’ hospitals and pharmaceutical manufacturers have been a core constituency of the Republican Party. The Huffington Post recently pointed out doctors’ traditional opposition to any form of expanded government health care or socialized medicine. â€Å"[The] AMA (American Medical Association) has fought almost every major effort at health care reform of the last 70 years. The group’s reputation on this matter is so notorious that historians pinpoint it with creating the ominous sounding phrase ‘socialized medicine’ in the early decades of the 1900s. The AMA used it to mean any kind of proposal that involved an increased role for the government in the health care system. (The Huffington Post) The American Medical Association has gone on record as opposing various provisions of the House’s current health care reform bill. Doctors, particularly private practice physicians, have long complained about any form of socialized medicine because they know it will substantially reduce the economic viability of the practice. Likewise, for-profit hospitals have a long history of opposing any form of socialized medicine. The American Hospital Association recently put out a formal statement on the house version of health care reform. Specifically, expanding the number of people in Medicaid program to 150 percent of the poverty level is problematic at a time when states are struggling with budget shortfalls and payment rates for hospitals continue to be cut. While a public option with negotiated rates for those above 150 percent of the poverty level is an improvement, we remain concerned that the program would still, in part, be based on historically low Medicare rates. † (Umbenstock) The American Hospital Association is concerned that any healthcare reform with an expanded public option may lower ‘already’ low payment rates. Moreover, the American Hospital Association is also concerned that payment rates under an expanded public option will be based on previously minimal Medicare rates. For this reason, for profit hospitals have long lobbied for and sided with the Republican Party knowing that their profitability and ability to compete will be eventually dissolved if the pending ‘public option’ is passed. Pharmaceutical Manufacturers have been a traditional core constituency of the Republican Party because of the Party’s past opposition to any form of nationalized or socialized medicine. The primary trade group for pharmaceutical manufacturers has also put forth a statement on the house health care reform bill. The Pharmaceutical Research and Manufacturers of American (PhRMA) policy statement says: â€Å"The 1,990-page House draft bill, which we are currently reviewing, contains a number of problematic provisions for seniors, patients, and the continued development of new therapies that not only improve or save lives, but ultimately help reduce the burden of health care costs in America† (Johnson). Democrats have long vilified Pharmaceutical companies for their ‘for profit’ business practices and commercial interests. Thus, Pharmaceutical companies are one of the largest campaign donors to the Republican Party. Many portions of the currently proposed bill will dramatically limit their profit and therefore their ability to participate in and compete with new health care products. Universal health care is inconsistent with the traditional American private, for profit, free enterprise system based health care business model. From a physician’s perspective, a system of universal health care could be compared to indentured servitude. The government would be in complete control of whom the physician treats, what modalities they use to treat the patient, and how much they are paid. Moreover, for the individual health care worker, limiting or mandating the service contracts would limit the workers freedom to do business in a free market. The New England Journal of Medicine recently conducted a survey of physician views on new public insurance option and Medicare expansion. The survey was a statistically randomized sampling based on 5,157-physician questionnaire responses. The survey presented three methods of expanding coverage, including expanding the current public provider Medicare along with private options, private options only and public options only. Ninety-two percent of private practice physicians (practice owners) oppose socializing all health care into one single public option. Thirty-two percent of private practice physicians (practice owners) favor abolishing all public options which would presumably include Medicare. Over half of all of the physicians in the study favored expanding care through private options and the, â€Å"†¦ expansion of Medicare to include adults between the ages of 55 and 64 years† (Keyhani). The randomized physician survey demonstrates that physicians are extremely skeptical of any public option beyond expanding Medicare. Physicians fear a public option will reduce their personal income as well as their ability to recommend and deliver a full range of medical services. Physicians are well aware of the longstanding low Medicare reimbursement rates and limitations of coverage. Physicians do not want to see more of the same with a public option that will further lower the amount paid for care and limit the amount of care that the government will pay, despite a patient’s actual medical needs. Pharmaceutical Manufacturers and ‘for profit’ hospitals also are strongly concerned that any public option beyond a slight expansion of Medicare will effectively put them out of business. PhRMA says that, â€Å"†¦the Congressional Budget Office (CBO) has warned that the House bill †¦ would ultimately lead to a 20 percent increase in Part D premiums paid by beneficiaries. What’s more, according to CBO, imposing a mandatory rebate on Part D prescription drugs would reduce incentives to invest in the research and development of new discoveries for diseases†¦Ã¢â‚¬  (Johnson) Simply put, pharmaceutical manufacturers will not invest if it is not profitable. For-profit hospitals are also concerned that a public option will ultimately translate to less coverage and lower reimbursement rates. The American Hospital Association, which has over 5000 member hospitals, has stated that the bill will further cut reimbursement rates. â€Å"AHA†) The current bill also specifically restricts physicians from owning hospitals and referring their office patients to their own hospitals. This directly affects their profit as well as raising free enterprise and trade issues. Historically and culturally, the United States health care system has been based on a ‘for profit’ private enterprise. The public option puts government in what has tradi tionally been a private ‘for profit’ enterprise. Just fifty years ago, Americans would have screamed communism at the concept of national socialized medicine. In 1961 when the idea of Medicare came along American Medical Association spoke out against it through Ronald Reagan. Reagan said: â€Å"One of the traditional methods of imposing state-ism or socialism on a people has been through medicine. It is very easy to disguise a medical program as a humanitarian project. Most people are reluctant to oppose anything that suggests medical care for people who possibly can’t afford it. † (The Huffington Post). Essentially, he was stating that the most common way of inflicting socialism is through a government run healthcare. Legally, restrictions that limit the free market may be interpreted as a violation of the constitution. The American Bar Association states, â€Å"Whatever President Obama and the Congress decide to do with health care reform, they must do within the constitutional limits off their respective branch – and our nation’s courts will ensure that those limits are respected† (Lamm). Although health care insurance companies are not subject to antitrust (monopoly) laws as state laws govern them, a ederal option, which is included with universal health care, may create unfair competition and violate anti trust laws as well as the commerce clause of the constitution. Interestingly, the proposed bill mandates that every American must pay a tax for ‘free’ health insurance even Americans that don’t want health insurance coverage. The Wall Street Journal says that, â€Å"the requirement in the plan laid out by Max Baucus, that every American have health in surance, makes current proposals unconstitutional. Not just unconstitutional, mind you, but profoundly unconstitutional† (Jones). Republicans must do all in their power to preserve constitutional rights that will be affected by a public healthcare option. The way that national health care is set up could be financially damaging if the bill, H. R. -676, were to be passed. As Avery Johnson states in the Wall street Journal, â€Å"TennCare runway costs show that the public health-insurance proposal by House Democrats could bankrupt the federal government. † (Johnson, â€Å"Tennessee†). Tennessee’s arranged a public insurance program that was similar to a statewide health care to insure those without insurance. It started in 1994 and by 2005 Tennessee was forced to shut the program down due to high expenses. Basically, Tennessee tried to have a statewide health insurance system similar to national health care and they went bankrupt. This is a reasonable model of what would happen on a more widespread scale. There are multiple financial reasons that cause a universal health care system to not work. To achieve the amount of money to make it possible to have a universal health care system there are many sacrifices that must be made. Payroll tax, which is a 7% social security tax that we pay when we buy something, will go up. Income tax will also go up dramatically, affecting many lives. In fact, there may have to be new taxes set into place just to be able to maintain the universal healthcare or the required payments will go down. This will in turn affect the doctors by decreasing incentive. Another factor that will affect their incentive is coverage benefits. Coverage benefits will be decreased as a result of universal healthcare. For example, insurance will not cover elective care treatments, such as breast augmentations, cosmetics, chiropractics, etc. Payment to the specialists, such as brain surgeons, heart surgeons, etc. , will be lowered dramatically. Progression in the field of medicine will dwindle due to a lack of money for clinical research. A physician to learn more about a procedure or to experiment usually does clinical research. It takes a lot of money and time and is not funded by the government; it comes from the physician’s pocket. If the physician’s pay lowers by so much they will not be able to do research. All of this will lead to a diminishing rate of medical progression that may ultimately come to an absolute halt. Furthermore the government will provide us, if the bill passes, with inexpensive generic drugs. This will cause the name brand companies to lose customers and money and will prevent them from developing any new prescription medicine. When funding inevitably runs low, rationing of people will begin to occur. Old people won’t get care because they are old, and smokers won’t get lung surgery because they are smokers. This rationing is unethical in many different ways but would be unavoidable. Even more unethical, is that insidious rationing, that happens in Canada, would come into play. Insidious rationing is ‘hidden rationing’ where, for example, a cancer patient would wait for treatment because they were about to die. The cancer patient would wait long enough that death occurred before the needed chemotherapy. Sadly, this often occurs in Canada, due to their system of universal health care. If this happens in the United States, it would be too late to take back the legislation. However, if properly informed, there would be less supporters of the health care bill because the general populace would be unwilling to commit to a plan that denied them needed coverage. Likewise, instituting torte form will partly generate expenses for this costly health plan. This is a lawsuit cap used in some other countries. If a drunken doctor accidentally cuts a healthy patient’s leg off, the doctor will only be able to be sued for a low set amount of money. This will save the government a minute amount of money that would be used to support everybody’s health care, while that patient would be handicapped forever without adequate compensation. Even so, Tim Foley has stated â€Å"the nonpartisan Congressional Budget Office in 2004 conceded that the legislation for tort reform, even if it instituted a federal cap, would barely dent health care costs† (Foley). The cause and effect impact on health care worker profitability including nurse pay, private practice physician pay, for profit hospitals, for profit health care insuring systems, pharmaceutical companies and other health care workers and entities will be enormous. No doubt lawyers will litigate for years the constitutionality of various healthcare reform provisions. Another concern from the Republican viewpoint is the fiscal issue of how to pay for either universal health care or a public option. Simply put, where will the money come from to pay for healthcare particularly given the current economic crisis? Next, how will a universal public option effect access to care, quality of care and cost of care. As the financial aid towards funding universal health care bottoms out, the quality and accessibility of health care would go down. With government in control of health care and providing insurance for all they will have less money to spend on better quality hospitals. In the TennCare experiment it showed before and after pictures of the work places that were used. Hospitals had turned into rundown trailers barely big enough for an examination room with outdated computers and equipment. Lowering the Quality of facilities means the lowering of quality of care given to the patients thereby increasing the number of people who go to a doctor and are unable to receive quality treatment. Thus quality of life becomes worse, and one would hope proper treatment came quickly enough to evade more serious conditions and/or death. Access to patients is denied as the quality and quantity of health care providers is decreased by the inadequate organization and funding of a public option. One such thing noted about doctors faced with a decision to participate in a public option is that â€Å"†¦often the ones who care for our most vulnerable patients are the most severely impacted. In communities across this nation, physicians are faced with early retirement or leaving patients that need them. The bottom line: access to care is compromised. †(â€Å"AHA†). The Health Care Associations of America view this is as a topic of controversy that would indeed change lives greatly. Many associations including the American Hospital Association, American Heart Association, and even the American Bar Association have spoke out against health care reform including universal health care and a public option. In Conclusion, the Republican Party views the aspects of a system of universal healthcare from a cynical viewpoint. It seems that free healthcare is to good to be true and they say it is. Universal healthcare or a public option is unconstitutional by violation of the free enterprise system. With the economy in its current recession it is believed, by reforming ealthcare, the government will financially cripple the United States permanently. Also, almost like reverting back to a primitive state, quality of care and the access thereof could decline to unbearable standards. Now the republicans uphold the struggle against any bill passing through senate. Works Cited â€Å"AHA : Issues : Liability Reform. † American Hospital Association. American Hospital Associ ation, 15 Oct. 2009. Web. 3 Nov. 2009. . Foley, Tim. â€Å"Avoid Tort Reform in the Health Care Bill at All Costs! | Universal Health Care | Change. org. † Universal Health Care | Change. rg. 17 Mar. 2009. 28 Oct. 2009 . â€Å"GOP Health Care Talking Points. † GOP. gov – The Website of Republicans in Congress. N. p. , 11 May 2009. Web. 3 Nov. 2009. . Huffington Post, The. â€Å"American Medical Association Trying To Torpedo Health Care Reform Again. † http://www. huffingtonpost. com/. N. p. , 11 June 2009. Web. 28 Oct. 2009. . Johnson, Ken. â€Å"PHRMA – PhRMA Statement on House Tri-Committee Health Reform Bill. † PHRMA – Home. N. p. , 14 July 2009. Web. 3 Nov. 2009. . Jones, Ashby. † Is Health-Care Reform Unconstitutional (Part II) – Law Blog – WSJ. WSJ Blogs – WSJ. The Wall Street Journal, 18 Sept. 2009. Web. 3 Nov. 2009. . JOHNSON, AVERY. â€Å"Tennessee Experiment's High Cost Fuels Health-Care Debate â €“ WSJ. com. † Business News & Financial News – The Wall Street Journal – WSJ. com. 17 Aug. 2009. 28 Oct. 2009 . Keyhani, Salomeh , and Alex Federman. â€Å"NEJM — Doctors on Coverage — Physicians' Views on a New Public Insurance Option and Medicare Expansion. † The New England Journal of Medicine: Research & Review Articles on Diseases & Clinical Practice. N. p. , 1 Oct. 2009. Web. 3 Nov. 2009. . Lamm, Carolyn. Our Constitution, Debate it, Discuss it, Understand it. † ABAnow. N. p. , 16 Sept. 2009. Web. 27 Oct. 2009. . McArdle, Megan. â€Å"Why I Oppose National Health Care – The Atlantic Business Channel. † The Atlantic Business Channel. 28 July 2009. 29 Oct. 2009 . â€Å"National health insurance – Wikipedia, the free encyclopedia. † Wikipedia, the free encyclopedia. 6 Oct. 2009. 28 Oct. 2009 . Shear, Michael D.. â€Å"Obama Pushes Insurance Reforms – washingtonpost. com. † washingtonpost . com – nation, world, technology and Washington area news and headlines. 15 Aug. 2009. 8 Oct. 2009 . Umbenstock, Rich. â€Å"AHA : Press Release : AHA Statement on House Health Reform Proposal. † American Hospital Association. American Hospital Association, 29 Oct. 2009. Web. 3 Nov. 2009. . Time Magazine. â€Å"Medicine: Debate Over National Health Insurance – TIME. † Breaking News, Analysis, Politics, Blogs, News Photos, Video, Tech Reviews – TIME. com. 12 Oct. 1970. 28 Oct. 2009 . Wall Street Journal. â€Å"The Public Option Makes a Comeback – WSJ. com. † Business News & Financial News – The Wall Street Journal – WSJ. com. 22 Oct. 2009. 28 Oct. 2009 .

Intro to ethics Essay

The career field that I have chosen is public relations which also has a focus in journalism. Since journalism is often known as the 4th government branch because it watches over the actions of the other branches there are many controversial issues involved which required applied ethics to work through. Business ethics can be seen very strongly in public relations and journalism because there are often conflicts between advertisers which is here the largest amount of revenue comes from and editorial. For example, an article may be getting ready to run about how someone was killed by a person who illegally obtained a gun. The article may spark some gun control arguments and opinions. In the same issue of the paper there might be a firearm store placing a large display advertisement for a sale they are having. There is a dilemma there that will need applied business ethics to decide what to do. Do they run both anyways, or stick with the advertiser and trim down the details of the article so there is not as much focus on gun control? There are legal rights issues that required applied ethics reasoning also associated with public relations and journalism. There are certain details and name and things that can only be printed based on specific things such as a person being certain age and circumstances. Some areas consider it illegal to print in the obituaries that someone committed suicide. Sometimes though if it is a public matter that many people witnessed it is had to avoid printing that a suicide occurred without people know there is information being with held. In addition to this there is also always the possibility of sources being incorrect and the information you print being libelous to someone. Finally there is computer and information ethics in applied ethics. This category can be seen in public relations and journalism in much the same way as legal issues with being slanderous or libelous to someone or a company. Depending on what sources one use there may be false information coming from the computer and information. A professional in public relations of journalism has to take the responsibility to fact check and check the credentials of the sources they are using. The responsibility to check facts does not lay with the source, but with the journalist. If they received incorrect information that could have been spotted if fact checking was done they are negligent and can face very serious consequences. Fact checking cannot only hurt the legally, but also ethically. The people, businesses and other things that are written about are affected deeply. Sometimes there has to be a choice made as to whether a story is worthy of printing if it is going to harm someone or someone’s family members. Most of the time the ethical choices that have to be made in public relations and journalism stem from not which side of a topic to be on, but what to put out to the public on topics. For example, even if a reporter feels that abortion is completely wrong they cannot express this opinion. They have to write for both sides just giving the facts to what things each side says. They could be thinking abut writing to persuade people on why abortion is wrong, but the ethical decision is to step back and understand where both sides of the argument are coming from.

Renaissance Corridor On The Second Floor Of The Museum

Introduction: From most of the pieces on display in the early renaissance corridor on the second floor of the museum, Lorenzo Monaco’s â€Å"Madonna and Child† caught my eye in very radical manner. A medium-sized tempera piece layered on panel placed right of the second room of the corridor. As stated on the panel below the painting, it was conceived and crafted between the years of 1370-1371 in Florence, Italy during the early renaissance. Against the wishes of the museum I laid my hands upon the painting and felt along both the painting and frame to get a feel for the material. It was grainy to the touch when I moved my hand gently across the painting but I couldn’t make out a specific material. According to the National Gallery of Art’s website, the painting was conceived using vertical grain wood which was lined with fabric with a red bole preparation used to ensure a smooth glide. Interestingly enough, the website also states that the paintings origin al frame has been long lost and replaced along with trimmed edges that are also now present on the painting. Now that we have a basic understanding of the painting itself we can now move into a more in-depth formal analysis of the painting. Formal Analysis: As stated in the previous section, the painting is composed of vertical wood that is aligned with the fabric. This is to ensure a smooth transition between the coating of the fabric and the actual process of painting the work. The dimensions of the work as stated on theShow MoreRelated`The Italian Retreat from Modern Architecture: Gio Ponti, Neoliberty and others3151 Words   |  13 PagesApril-May 1957, content page with image of project in Le Havre by Perret Edoardo Persico, Sala della Vittoria (Victory Room), VI Triennale, Milan, 1936 Adalberto Libera, Casa Malaparte, Capri island, Naples, 1938-40 Window Frames- full of matter Floor- not a functionist type of modernist Window back of fireplace, sense of merging with the sun and the yellow orange flames of the fire. Gio Ponti born 1891-1979, generation of Le Corbs product of Italy TM most prominent architect that triedRead MoreCase Studies67624 Words   |  271 Pagesdivide our discussion of a moderately structured case analysis method framework into four sections. First, we describe the importance of understanding the skills active learners can acquire through effective use of the case analysis method. In the second section, we provide you with a process-oriented framework. This framework can be of value in your efforts to analyse cases and then present the results of your work. Using this framework in a classroom setting yields valuable experiences that canRead MoreExploring Corporate Strategy - Case164366 Words   |  658 Pageselectronic music of the gay clubs of Chicago and New York. The new style had been picked up by British DJs in Ibiza, who combined it with the drug Ecstasy to create a new ‘blissed-out’ sound. Dance music arrived in the UK during 1988, the so-called ‘Second Summer of Love’, strongly associated with recreationa l drugs. By the early 1990s, drug-dealing in its most ugly sense had become part of the dance culture. Palumbo recalled: When I came into this business, with my bonuses and my nice City suits,Read MoreCase Study148348 Words   |  594 Pagescase study together with the questions provided to the students in the examination setting or shortly before it. The problem here is that students’ speed of reading can vary considerably – particularly if they are reading the case in English as a second language. †¢ Project based assessment involves students (or groups of students) applying the concepts and techniques in the book to real organisation. This could be done, for example, by part time students working on their own organisations. Or itRead MoreStrategic Marketing Management337596 Words   |  1351 PagesBOSTON †¢ HEIDELBERG †¢ LONDON †¢ NEW YORK †¢ OXFORD PARIS †¢ SAN DIEGO †¢ SAN FRANCISCO †¢ SINGAPORE †¢ SYDNEY †¢ TOKYO Elsevier Butterworth-Heinemann Linacre House, Jordan Hill, Oxford OX2 8DP 200 Wheeler Road, Burlington, MA 01803 First published 1992 Second edition 1997 Reprinted 1998, 1999, 2001, 2003 Third edition 2005 Copyright  © 1992, 1997, 2005, Richard M.S. Wilson and Colin Gilligan. All rights reserved The right of Richard M.S. Wilson and Colin Gilligan to be identified as the authors of this