Environmental Science in Todays World Essay Example for Free

Environmental Science in Todays World Essay Humans so dominate today’s world that there is no ecosystem on earth that has not been influenced to a greater or lesser degree of human activities. And, as long as humans remain on earth, such influence will not end. Sustainability will depend on learning to channel our efforts so that we play a positive supporting role as opposed to a destructive role toward ecosystems (Nebel Wright, 1993). Environmental risk is a reality of today’s world. The seemingly endless supply of synthetic chemicals, consumer goods, energy, and waste create new risks through chemical contamination, pollution, and environmental degradation. Environmental disasters such as chemical spills or explosions threaten millions of people living in the vicinity of manufacturing or storage facilities. The uncertain risks of global warming and ozone depletion loom ahead. A central factor of environmental risk is that it is usually involuntary. People do not choose to ingest chemical pollutants such as pesticides or industrial solvents in their food and water, to undergo workplace exposures to dangerous chemicals, to breathe polluted air, or to experience radiation exposure from nuclear fallout or faulty nuclear power plants. These environmental risks pose a unique problem to regulators charged with protecting the public health. Limited information may be available on the health effects of these risks. Consequently, in an effort to protect the public’s health, various government agencies study these potential hazards to determine the level of risk they pose. This effort to understand these risks, and to quantify their impact on human health, is the field of risk analysis (Moore, 2002). The scale of human occupation and transformation of the environment is now truly global. The adverse health effects of this ignorance may have been limited, as the environmental damage was on a local scale. However, in today’s world our activities are having an impact at a global scale, and global environmental change will become a major theme in public health research, social policy and development, and political advocacy in the 21st century. The conceptualization of the environment as a global public good for health should go some way not only in increasing an appreciation for this heritage and dependency, but should also enhance the interface between research and policy. This increased awareness and interface between key stakeholders might lead to effective action to ensure a sustainable future for current and future generations (Hester Harrison, 2002).

Best Practices In Food And Beverage Marketing Essay

Best Practices In Food And Beverage Marketing Essay The Food Beverage department at hotels has evolved significantly over the past decades. Various studies and marketing techniques were employed to the department in order to improve the operations such as developing menu items or creating unique offers (Miller). A PKF consulting analysis of 214 hotels during the time-frame of 1994 to 2004, displayed an percentage growth in FB profit which increased almost twice as fast as the total net operating income growth (Miller). It has been proven that while hotels had improved their FB outlets and increased their emphasis to the quality of dining, they quickly became unprofitable considering the time and expertise needed for their management (Shoemaker, Lewis and Yesawich). In order to cut-down costs and gain significant revenue, companies in the hospitality industry prioritized research-based branding strategies, to their specific target group in order to acquire corporate identity and quality service (Morgan, Pritchard and Pride). Distinguishing their brand image and differentiation of their product became of primary importance for all hospitality firms (hotels, restaurants etc). In the recent years, many international hotel firms have turned to a major branding strategy called co-branding. In this concept an existing restaurant is incorporated within a hotel, a practice considered to have been started by Victor Bergen during the 1930s, establishing fast food outlets in hotels on the highway which had a customer base of American families travelling away from home. The incorporation of this model to the modern hotel industry has been observed to change dramatically both consumer attitude and hotel management (Rutherford). This review plans to analyze the current position of strategic co-branding in the hospitality sector and how the tourism industry could be benefited. Furthermore, possible problems are discussed and recommendations to potential managers wanting to employ strategic co-branding techniques are given. 2. Co-branding definition While co-branding doesnt have a single definition, it generally involves the strategic alliance of at least two firms (Knowles, Diamantis and El-Mourhabi). It has also been described as a form of cooperation between two or more brands with significant customer recognition, in which all the participants brand names are retained (Blackett, Boad and Interbrand). Furthermore, Hilyer (Hillyer and Tikoo) explains the definition of co-brading when a product features more than one brand name. Among all these definitions, some common characteristics can be identified. The fundamental part in co-branding is the requirement of two or more brands that are widely recognised while the brand name is kept intact and the duration of the whole project varies between medium to long (Kippenberger). Therefore, co-branding can be interpreted into reality in two manners: either joining two brand names together in forming a new or unique product or having two recognised brands under the same space, such as T.G.I Fridays within Holiday Inn hotel (Hahm and Khan). 3. Notable examples of Co-branding Based on the model used in the early 1930s, with Bergens restaurants and hotels, the hotel industry began to employ co-branding strategies when it was faced with unprofitable sales. Today a large variety of hotels and restaurants use co-branding as a means of enhancing distribution of products or services together with increasing the range of their customer base, helping them to reach maximum profitability (Boone). Marriot Hotels is considered on of the pioneers of the chain hotels to be the first to implement an internationally recognised brand such as Pizza Hut in 1989 (Boone; Kippenberger). Following their example, the co-branding of TGI Fridays within Holiday Inn hotels turned out to be a financial success. After the conversion of the Pennsylvania Holiday Inn restaurant to TGI Fridays, the increase from $450,000 to $4 million within the first year only marked a rapid improvement in revenue which persisted for consecutive years (Hahm and Khan). After reviewing the benefits, the co mpany expanded its co operations with other franchise such as Red Lobster, Pizzeria Uno, Good Eats Grill and many more (Boone). Other examples include the co-branding of Sheraton hotels with Starbucks coffee and Vie de France baked goods, Hilton with Benihana, Calrson Country Inn with Pizza Hut, The Garden Place and Nestle Toll House Cafà © among others. 4. The Co-branding mechanism The concepts of branding and co-branding involve basic principles associated with stimuli and responses, called classical conditioning. Combining the signal from a stimulus with a neutral effect (such as the word lemon) with a stimulus that elicits a natural response from a person (such as the image and taste of the lemon), the person gives a similar response when the neutral stimulus is presented without the need of the natural one. The same principle applies to branding and co-branding: the product is associated with a brand name and after successive associations either from personal experience or advertising, a favourable reaction towards the brand name or image is created. Specifically in co-branding, the combination of a neutral stimulus (like a brand image of one company) is coupled to another brand image which people have developed a liking towards it, the new product or service created by the combination of the previous ones is made equally amiable to the consumer. This manages to enhance the psychological impact of a newly formed product without the need of further branding. 5. Impact of Co-branding The implementation of co-branding techniques has been acknowledged to have positive and negative impacts on the companys process. Studies have shown that several advantages that can be categorized in financial, managerial, marketing and customer royalty. Creating a powerful head image for customers is critical in enhancing the competitive advantage of a firm and distinguishes its quality from others in the marketplace, making it easier to recognise through co-branding strategies (Panda and Kumar). Also, the costs of operations, production and investment can be shared and the risk of competition in the market can be diminished, creating an short term financial advantage to other firms (Boone). Also, when two well-established brands co-brand, a sense of security and loyalty is created to the customer, such as in the example of a hotel co-branded with Pizza Hut will expect that loyal customers will stay in hotels with known brands when travelling. Lastly, the co-branding of restaurants to hotels provides a constant flow of loyal customers from the hotel setting, which can also work vice-versa (Boone). Despite the advantages, co-branding strategies are not the solution to all problems and cannot guarantee market success (Panda and Kumar; Joseph Arthur; Hillyer and Tikoo). Incorrect use and lack of conductive research is able to affect business negatively. For example, if a clear image is not created by the alliance of brands, it can create confusion to the consumers (Joseph Arthur) while a loss of control of a brands identity can reduce their affinity to the original brand (Keller). Possible problems for restaurant managers can be either limited investment by their hotels or lack of expertise and experience on the hotel restaurant concept. 6. Strategic Applications of Co-branding in International hotels and restaurants The main four applications of co-branding are called reaching in, reaching out, reaching up and reaching beyond. The selection of the strategy is based on the nature of the target market (if its newly formed or existing) and if both brands are absolutely necessary for product functioning. Reaching out is more commonly used if the co-brand has benefits for the product itself by entering a new market while if the co-brand can also contribute to the companys brand image then reaching beyond is implemented. Lastly, reaching in is implemented if the company wants to enhance the products core benefits. However, the brand image of a product in the long term can become very similar to others (panda) therefore maintenance of the brand is necessary. Strategic brand management is able to aim long term value and brand image maintenance in three different ways: Differentiating the brands nature from others in the marketplace Evaluating continuously the brands strategic position in the marketplace Branding based on the emphasis in the distinct qualities of the product/service Implementing information technology as well as internet marketing can also be helpful in managing co-branding. Via searching in internet databases, the target groups of each product or service can be directly targeted and informed about novel opportunities or offers, without the need of time-consuming and expensive research. Additionally, targeted promotions can monitor the needs of customers and adjust the products promoted accordingly (Oliva). 7. Suggestions In order to efficiently use co-branding, the respected hotels and restaurants must employ several different strategies to handle the emerging challenges. Hotel managers should firstly invest on the brand image and identity, while joining restaurant co-branding partners in strategic decision making processes about important issues and training programs. On the other hand, restaurant managers (Boone) must synchronize their operations and branding with the hotels standards, carefully choose a hotel that could potentially match the brand concept of the restaurant and offer various benefits and discounts to hotel residents in order to support customer loyalty to the brand (Lee and Decker). 8. Conclusion In retrospect, co-branding is a practise that can be successfully implemented for effective marketing in FB establishments of the hotel and result in elevated profit and diminished costs. However, due to the competitiveness in the current market and the continuous emergence of new strategies, the effectiveness of co-branding has greatly been challenged. Implementing novel technologies and adjusting the products or services on offers based on consumer needs, may be deemed sufficient to bypass any emerging challenges. Additionally, more empirical research in the hotel restaurant management is required. Future studies could analyse the attitude of international customers to co-branding as well as measuring brand equity between hotels and restaurants in need of co-branding.

Literature Review On Leadership Styles

Literature Review On Leadership Styles The leadership style is a contextual function which has direct relationship with the leadership approach of the leader. Based on the functionality assumption the leadership style can be identified as two dimensional ways independent of each other, where one of it is task oriented associated with supervision of the performance to ensure task completion in the form of keeping control within the organisation by providing direction and setting goal. The other form emphasizes motivating rather than controlling the subordinates comprises communication ,active listening, support and interaction. A major number of studies reveal that the primary function of the organisational leadership is the ability to influence person in the line of task performance using motivational methods rather than power of authority over a time(Kotler,1996,Yammarino et al).This definition clearly distinguishes relationship between leadership and coercive rules. It relates to some extent a formal authority with the presence of political environment in the organisation(Wang et al 2005) The recent theorists of transformational leadership has come out from the leader in internal context to extend its focus to a more broader one.(Higgs and Rouland,2003)However there is always presence of diverse behavioural pattern. It is useful to group them into three broad catagories- (1)Goal Oriented A set of behaviour which is conducive to play a significant role which eventually directs towards a goal and achieve the performance required for it. (2)Involving Involving is connected with more forces on achievement of goal setting and the direction for how to achieve the goal. (3)Engaging It acts as an facilitating nature of direction and means where the goal can be achieved. The leaders are similarly referred to as production oriented, production emphasizing, goal achieving, work facilitative or goal emphasizing(Black and Mouton,1964,Bass).There is high psychological difference between a leader and a follower with a concentration on task which is highly necessary for its achievement.(eg.Woffard,1970).Leaders have a great concern for the relationship with the followers tries to create a friendly and supportive environment which is a part of people oriented policy(eg . Beatty 1988, Katz et al 1950).Leaders are commonly interactive, facilitative and supportive and maintain the group concern with a central orientation towards people.(Anderson,1974,Bass1967,Black and Mouton,1964) Transformational Leadership Transformational leadership is responsible for bringing institutional change by making a compulsory stricture of vision and where the employees commitment can be mobilized by identifying and involving in person .In the cumulative business environment ,transformational leadership are useful in making provision of a compelling a clear vision by mobilisizing employee commitment through personal identification and involvement and institutionalisation of organizational change.The full range leadership model by Bass and Avolio defines the transformational leadership in terms of four Is such as Individualised consideration,Intellectual stimulation,Inspiritional motivation and Idealized influence. Burns (1978, p. 20) defined transformational leadership as a process in which leaders and followers raise one another to higher levels of morality and motivation. The transformation is not diverse from the follower it is centered upon to a capability to develop/encourage the wants/desires of a follower. Accountability as per the needs of the follower is the concern of the leader as per Burns. Burns at first made an assertion in the high moral grounds with a desire to win a cause by creating a strong drive. People wanted to be driven by a motivation with a organizational spiritual mission(Tichy and Devanna1986).The inconsistency present in the organisation should be made understandable by a transformational leader to its followers. In the case of transformational leaders they are had the advantage of a influencing position so that conflict can be manged and performance can be improved with a direction towards set a decision making team to manage conflict and therefore, to improve the performance to make a decision in team(Amason,Thompson,Hochwarter Harrison,1995).For example,a team leader can create an environment of disagreement to generate constructive and cognitive conflict(Schwent Kotlya,Karakowsky/Leader Behaviors and Team Conflict 39 Cosier 1993).The team members are informed about the structured conflict methodology and at the same time motivating them to engage in dialectical interaction.The motivation of making a good decision will lead the team members to likely clarify the objectives and find out and evaluate new alternatives.(e.g..Abelson Levi,1985)In this process it is more important to give more focus on person than the problem and help the team members to minimize the cognitive conflict so tha t it cannot further worsen into dysfunctional,affective conflict(Janssen ,Van De Vliert, Veenstra,1999) There is only a small number of researchers who has confined their studies to establish a relationship between leadership and information technology and less focus on knowledge management and transformational leadership.However , Klenke(1994),it is the combined actions of leadership and information technology that helps in formation of new organization. Emperical study aimed at examining the influence of transformational leadership (TL) on organizational innovation(OI) and performance(OP) depending on level of organisational learning. First- A close relationship between TL ,OP and OI has been detected Second-The relationships as shown in the first finding are prominent in a high learning organisation than a low learning organisation In practice Organisational learning is practiced in a group of people with an interaction on technology where the knowledge is evolved and widen up for a cognitive and behavioural change in a constant interaction between tacit and explicit form.Organisations with a high learning structure enable with a network making it easier to learn, innovate and propel to a competitive position as centre of technology. It can be understand that organisational learning improve relationship to a great extent between TL,OI and OP.However innovation is considered to be vital for a company to survive and grow(Hurley and Hult,1998).There has been different definition of innovation- According to product development and management association(PDMA,2004)-Innovation is synonymous with a new idea,it may be a new idea or device.Innovation is an act tries to create a product which is new or wants to bring new product which includes invention and ensures the work necessary to bring finally a new idea or concept. Although firm innovation is emphasized to improve performance of organization(OP) ,a number of firms donot and fails to develop in proper way.Researchers wants to concentrate on what has enable a firm to enable,it is the beyond semiautomatic response processes.(Zollo and Winter,2002,p-341) leadership style has the highest level of influence on the firm to innovate by bringing a new idea into the technological area ,setting up of goals which is definite and encouraging an initiative for subordinates with innovation (Kanter,1983,Senge et al,1994) In the transformational leadership (TL) it encourages OI and OP gets advantages from it and defines a leadership which increases the consciousness to achieve the collective interests among the members to achieve it. Transformational leaders have charisma,inspiration and intellectual stimulation (Bass1999,Conger1999 and Avolio 2000) Charisma-is the quality which encourages its workers,the leaders and technological organisations to bring a situation of pride,faith and respect. Inspiration- motivates the followers to a large extent through communications of high technological expectations. Intellectual stimulation- is a behaviour that is associated with the promotion of employees,intelligence,knowledge and learning for a innovative problem solving and solutions. The fundamental role of CEOs is to indulge in playing an important role in informing and moulding these variables(TL,OI and OP) by determining the types of behaviour that is upto the expectation and supported(Baer and Frese,2003) Four factors of transformational leadership (Four Is) can be discussed as below- Individualized consideration The first I in the transformational leadership is concerned with providing an umbrella of guidance in the part of leaders with an indivisualised consideration.The leader treats his followers with an individual approach,making explicit about his concerns,listening to his ideas and tries to know him well.The manager in this context sets standard as exemplary decision maker in the organization and gains respect as role model with idealized influence. The indication of his style can be realised by- As a good listener Self development is the key importance Exchange of views from both the sides is expected Individual needs and ability are reflected in the organizational decision The quality of possible amalgamation is adhered However the leader engaged in giving each individual access to teaching and coaching ,encourage them to participate in the project by delegating it and by constantly giving feedback. Intellectual stimulation Intellectual stimulation(IS) is a kind of motivation where the leaders motivate the followers to build up their own skills by signifying the problems and issues. This is a kind of situation like a parents pursue their child but in managers in most of the organisations prefer an approach where they are directed to do a job rather than made them accountable to it. The key indicators of this style can be drawn as- To rethink an assumption which is already preoccupied Ability to recognise the pattern which is hard to imagine This is an kind of entertaining and bring forward some trivial one Visualise an existing pattern by revisiting it However leaders engages himself with the subordinates by providing a series of new ideas and encouraging a new thought of followers by imputing some logic beforehand and problem solving are emphasized. Inspiritional motivation Inspirational motivation is associated with the encouragement of a high degree of performance stimulating motivation among the followers.Setting a future vision in the mind the leader sets a flow of communication through which a binding has been imposed in an exciting manner and provides a zeal to struggle for it.That is why leaders are sometimes successful to lift the expectation of the followers where key indicators of the style can be identified as- Foresee a future and confident of attaining it Making intelligible about the term of the meaning and shaping the expectations Reducing the complexities by simplifying the meaning Prioritise and grow the sense of purpose The leader imparts a sense of mission and vision; articulate a roadmap of pride .respect and faith,inculcates giving utmost importance towards pride,respect and faith,aspire and ignite the excitement of the subordinates. Idealized influence This is a leadership style in terms of influencing with the element of idealized form(ii) or become a role-model of people around him.There are specific and personal characteristics or charisma inherited and making it explicit through moral behaviour which can be followed on the grounds of trust,morality,honesty and integrity.The key indicators can be attributed as- The positive gain is achieved by utilising power Addresses crisis head on The followers achievement is a matter of celebration for him Proves extraordinary competency Leader imparts the vision and mission in a way to inspire and motivate the followers by put forward the challenge and establish what it actually mean. Transformational leader and vision Leadership authors have given more attention to emotional intelligence towards a competency which is interpersonal.in recent times leaders emotional competency can be effected by- Awareness about himself Emotional expressiviity Monitor ones function by himself Empathy Empirical evidence shows that leader with more emotional competencies shows to be visionary leadership behaviour. Akshkanesy and Tse(Theoritical article) defined the emotional leadership as- Management of emotion Assert that emotional language and communication Transformational leaders have intuition about the followers needs values leads to greater interpersonal sensitivity and higher quality relationship with followers. George(2000) describes how aspects of emotional intelligence, including the appraisal and expression of emotions facilitate a leaders ability to develop collective goals, communicate the importance of work activities with followers and motivate by generating enthusiasm, confidence and trust. The following hypothesis is presented which is dependent on emotional expressivity and visionary leadership. H1: A wide range of positive results including organisational performance has a positive link with the leaders emotional expressivity(Waldman etal,2001) H2:There is a positive relationship between visionary leadership and follower ratings of leadership effectiveness. Empirically it has direct effects on the attitude of the follower and ratings of leadership effectiveness of a leaders visionary behaviour may be viewed in terms of scale of organisational changes that are felicitated in the organisation. Furthermore visionary leaders who also acquires this skill where expressivity in terms of emotion is practiced will likely to articulate their vision in a strong way with more compulsion and persuasion that result in high magnitude of organisational changes than leaders who does not have such skill H3: A close bond between visionary leadership and organisational change will vary in degree depending on the level of leaders emotional expressivity. The regression analysis done through empirical analysis found that there is a strong relationship between visionary leadership and organisational change in magnitude under conditions of leaders high emotional expressivity. VISIONARY LEADERSHIP Frances Westley and henry Mintzberg formulated the theory of visionary leadershipn on the basis of Miss Follets work.There are three main assumptions of the visionary leadership. First assumption is associated with the dynamic nature of visionary leadership where the drama,action and communication occur at the same time.As the actor does his rehersal when he goes up to the step for the moment ,at that moment of time visionary leader practices the vision. The visionary leader connects the idea and action and at the same time establishes a relationship with his followers.This kind of leader is capable of moulding strategy into vision. The second assumption is about the content as well as context strategic vision.The core of the vision is a strategic content and has a focus on organisations,markets,products or even services.The external influence on vision comes out with the context one.This aspect has been effected by the organisational variation in terms of structure,ownership and size etc. The third and the final assumption stresses on the variety of visions and it can visualise many shape and sizes.Mary Parker Follett emphasises that the leader should have the capability to identify the potential of its followers and with a cohesive bond they should be able to integrate them. There sould be reciprosity in the gtoup and the leader and the group members should influence each other.It is not only the leader who should have influence on group members but the group member should also influemce leaders(Follett,1930a,P213).The another point is repetation which drawn by Westley and Mintzberg(1989)it enables the visionary leaders to identify the issues.According to Folletts study the leader should harmonise the external and internal situation i case of group.Follett,1930a,p214 describes it as an functional unity.The leader should overcome the factionalism by uniting them. It is not only the leader who should have influence on group members but the group member should also influemce leaders(Follett,1930a,P213).The another point is repetation which is drawn by Westley and Mintzberg(1989)it enables the visionary leaders to identify the issues.According to Folletts study the leader should harmonise the external and internal situation i case of group.Follett,1930a,p214 describes it as an functional unity.The leader should overcome the factionalism by uniting them.The third important part is representation where the leader(ACTOR) should be able to communicate its follower(AUDIENCE) Leader should energise its followers.According to Miss Follett, the three main function of the CEO includes to define a organisations purpose,to maintain co-ordiantion of its activities.to foresee a future.The leader provides a long range vision by combining into a team effort and gives the purpose of the group. The final element is assistance where the audience or the followers should follow up the vision of the leader and take part to shape the vision. All of the analysis has come into a result of group power where the group is not like a team of uniformity but its a convergence of all opposites and Vision become live when it is shared and all the group member pull together to avhieve it and the leader should bring together all the group members to achieve the goal. Vision may be an outstanding achievement with a binding to a people in a society together,It may be an inspiring goal where involvement of people is spontaneous .Vision is deep rooted in cherished core ideology and at the sametime stimulates the progress and change in anything that is not part of the core ideology.There is some core values which is independent of time and enduring core purpose (which should never change) from the operating practices and business strategies(which should be changing constantly in response to a changing world). ARTICULATING A VISION A comprehensive vision consists of two major part Core ideology An envisioned future A good vision build on the interplay between two complementary Yin-and-Yang forces:it defines change(the core ideology) and sets forth What we aspire to become ,to achieve,to create that will require significant change and progress to attain(the envisioned future) THE VISION FRAMEWORK CORE IDEOLOGY Core ideology is authentic and been derived by looking inside not by external environment.The core ideology guides and inspire but doesnot differentiate with others . Core ideology bears and inspires the meaning of the people inside the organisation and people inside the organisations neednot compel by core values and tries to generate long term commitment.It is an intrinsic matter to the organisation. The basic difference between the core ideology and core competency can be derived as -core competence is a strategic concept that captures the organisational capability where you are particularly good at and core ideology is what you stand for and why you exist. ENVISIONED FUTURE It is the second primary component of the vision framework which consists of two parts- A ten to thirty year Big Hairy Audacious Goal A vivid descriptions of what it will be like when the organizations receives BHAG BIG HAIRY AUDACIOUS GOAL(BHAG) It is a term which was first proposed in a 1996 article with a title Building Your Companys Vision by James Collins and Jerry .A BHAG is a particular mechanism to stimulate progress.A true BHAG is distinct and creates immense team spirit by unfying the focal point and reaches out to the people and enhances their courage.It is tangible,energizing and highly focused and it is astimulation above the traditional corporate statement. 1.VISION LEVEL BHAG A vision level BHAG applies to entire organisation and requires 10 to 30 years to complete the cycle.BHAG stands for beyond the capabilities of organisation and current environmental trends,forces and conditions. 2.VIVID DESCRIPTION Vivid description is the second component of envisioned future necessary to achieve BHAG is a vibrant and specific component of the organisation. However there is a certain difference between core ideology and envisioned future. The first one is like a star in the horizon which cannot be reached wheres it guides and inspires and its the fundamental reason of existence. The second one is the specific goal to achieve to achieve a specific time frame.

Assisted Suicide :: essays papers

Assisted Suicide It is upsetting and depressing living life in the shadow of death. Many questions appear on this debatable topic, such as should we legalize euthanasia? What is euthanasia? What is assisted suicide? What is the difference between Passive and Active Euthanasia? What is Voluntary, Non-voluntary and Involuntary Euthanasia? What is Mercy Killing? What is "Death with dignity"? But if euthanasia was legalized, wouldn't patients then die peacefully rather than using plastic bags or other methods? And unfortunately the list continues. No one denies that there are many vulnerable persons who require the protection of the law. Take, for example, those in a temporary state of clinical depression, perhaps caused by a traumatic event in their lives. These persons will recover and go on to lead productive, happy lives, and it would be unconscionable to encourage or support them in a transitory wish to die. There are also many unemployed and unemployable, many disabled of all ages, and many senior citizens whose families might, for selfish or downright malicious reasons, encourage them to seek assisted suicide. All kinds of people in difficult situations could be at risk of being intimidated or forced into feeling their early death would be a convenience to society. Section 241 is doubly flawed. It is not an especially effective drawback against those who seek to prey on the vulnerable, but at the same time it forces persons enduring intolerable suffering to exist in that state against their own wishes, thus denying them their right of self-determination as citizens in a free democracy. Competent, rational human beings must have the right to determine their own health care according to their personal wishes, values and beliefs, as long as such a determination does not jeopardize the safety or well-being of any other person. We do not believe, for instance, that people have the right to kill themselves by driving recklessly and in so doing jeopardize the safety of others. To kill oneself by causing an explosion that will inevitably put others at risk is horror. It is also reproachable to end one's own life without regard to the trauma it might inflict on the vulnerable. People shall never forget the horror suffered by two young children who arrived home after school to find their mother hanging from the hall chandelier, or by a teen-age boy who found his father with his head blown apart from a self-inflicted shotgun wound in the kitchen of their home. We also need to consider the anguish of family members, friends and even health-care professionals who must continue to witness, day after day, Assisted Suicide :: essays papers Assisted Suicide It is upsetting and depressing living life in the shadow of death. Many questions appear on this debatable topic, such as should we legalize euthanasia? What is euthanasia? What is assisted suicide? What is the difference between Passive and Active Euthanasia? What is Voluntary, Non-voluntary and Involuntary Euthanasia? What is Mercy Killing? What is "Death with dignity"? But if euthanasia was legalized, wouldn't patients then die peacefully rather than using plastic bags or other methods? And unfortunately the list continues. No one denies that there are many vulnerable persons who require the protection of the law. Take, for example, those in a temporary state of clinical depression, perhaps caused by a traumatic event in their lives. These persons will recover and go on to lead productive, happy lives, and it would be unconscionable to encourage or support them in a transitory wish to die. There are also many unemployed and unemployable, many disabled of all ages, and many senior citizens whose families might, for selfish or downright malicious reasons, encourage them to seek assisted suicide. All kinds of people in difficult situations could be at risk of being intimidated or forced into feeling their early death would be a convenience to society. Section 241 is doubly flawed. It is not an especially effective drawback against those who seek to prey on the vulnerable, but at the same time it forces persons enduring intolerable suffering to exist in that state against their own wishes, thus denying them their right of self-determination as citizens in a free democracy. Competent, rational human beings must have the right to determine their own health care according to their personal wishes, values and beliefs, as long as such a determination does not jeopardize the safety or well-being of any other person. We do not believe, for instance, that people have the right to kill themselves by driving recklessly and in so doing jeopardize the safety of others. To kill oneself by causing an explosion that will inevitably put others at risk is horror. It is also reproachable to end one's own life without regard to the trauma it might inflict on the vulnerable. People shall never forget the horror suffered by two young children who arrived home after school to find their mother hanging from the hall chandelier, or by a teen-age boy who found his father with his head blown apart from a self-inflicted shotgun wound in the kitchen of their home. We also need to consider the anguish of family members, friends and even health-care professionals who must continue to witness, day after day,

The Fool in William Shakespeares As You Like It Essay -- William Shak

The Fool in William Shakespeare's As You Like It The fool is one of the first character archetypes that any student of literature learns how to analyze. Despite his seemingly light or even pointless chatter, the fool usually manages to say some fairly important things. Upon further study, the student may perceive that it is because of his penchant for silliness that the fool is given leave to express even offensive truths about the other characters. What happens, though, when one fool encounters another? Fools are not used to being subject to one another’s wit; this experience of being held up to a sort of mirror is generally reserved for the characters who must undergo some change to further the plot. Touchstone and Jaques manage to break that rule, and merely by coexisting seem to compete. Both live up to some part of our expectation of the fool, but neither manages to fill the role entirely. Which one comes closer is a matter worthy of some debate. In her book The Fool: His Social and Literary History, Enid Welsford devotes a chapter to â€Å"The Court-Fool in Elizabethan Drama† and briefly discusses As You Like It specifically. She at one point describes fools as being â€Å"†¦partly within and partly outside the action of the drama.† (244). This idea is applicable to Touchstone and Jaques, but in a slightly different way than she intended it. She was describing characters placed by circumstance in that liminal state--characters with no desire to move to either side of their middle ground. Also, she describes the differences between Touchstone and Jaques, both in appearance and attitude. Most importantly, she mentions that Touchstone â€Å"†¦exposes affectation; but he is capable of†¦criticism, and his judgments are r... ... encroaching on his territory. Jaques is a sort-of fool in a sort-of court, but Touchstone’s presence brings in a glimmer of the rest of the world—a real fool from a real court—that shatters Jaques before he ever has a chance to throw a single stone at Touchstone. Jaques’ attempts to find a place for himself, then, simply read as a strange, lost man making faces in a glass. There is no way that Jaques can surpass Touchstone’s inherent liminality—where Touchstone slips seamlessly from one world to the next, in and out of the action, Jaques just hops jerkily back and forth like someone walking on hot coals. He never lands in any one place long enough to really establish himself. It is for this reason that Touchstone fills every facet of the fool’s role more ably than Jaques, up until the bitter end when Jaques takes the traditional fool’s ending and stands alone.

Emergency department patient satisfaction Essay

Customer service initiatives in healthcare have become a popular way of attempting to improve patient satisfaction. The effect of clinically focused customer service training on patient satisfaction in the setting of a 62,000-visit emergency department and level 1 trauma center is investigated. The most dramatic improvement in the patient satisfaction survey came in ratings of skill of the emergency physician, likelihood of returning, skill of the emergency department nurse and overall satisfaction. These results suggest that such training may offer a substantial competitive market advantage, as well as improve the patients’ perception of quality and outcome. A practitioner’s response to the case study is also included. Customer service initiatives in healthcare have become a popular way of attempting to improve patient satisfaction. The effect of clinically focused customer service training on patient satisfaction in the setting of a 62,000-visit emergency department a nd level 1 trauma center is investigated. The most dramatic improvement in the patient satisfaction survey came in ratings of skill of the emergency physician, likelihood of returning, skill of the emergency department nurse and overall satisfaction. These results suggest that such training may offer a substantial competitive market advantage, as well as improve the patients’ perception of quality and outcome. A practitioner’s repsonse to the case study is also included. You  have requested â€Å"on-the-fly† machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated â€Å"AS IS† and â€Å"AS AVAILABLE† and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors for your use of th e translation functionality and any output derived there from. Hide full disclaimerTranslations powered by LEC. Translations powered by LEC. Headnote visit emergency department and level I trauma center. Analysis of patient complaints, patient compliments, and a statistically verified patient-satisfaction survey indicate that (1) all 14 key quality characteristics identified in the survey increased dramatically in the study period; (2) patient complaints decreased by over 70 percent from 2.6 per 1,000 emergency department (ED) visits to 0.6 per 1,000 ED visits following customer service training; and (3) patient compliments increased more than 100 percent from 1.1 per 1,000 ED visits to 2.3 per 1,000 ED visits. The most dramatic improvement in the patient satisfaction survey came in ratings of skill of the emergency physician, likelihood of returning, skill of the emergency department nurse, and overall satisfaction. These results show that clinically focused customer service training improves patient satisfaction and ratings of physician and nurse skill. They also suggest that such training may offer a substantial competitive mar ket advantage, as well as improve the patients’ perception of quality and outcome. INTRODUCTION Recent changes in healthcare have led to increasing competition and the perceived commercialization of the healthcare provided to patients. At the same time, a need for reaffirmation of the importance of the patient-physician relationship has been expressed in the midst of such powerful forces (Laine and Davidoff 1996; Glass 1996; Pellegrino and Thomasma 1989). One aspect of the patient-physician relationship deserving further study is the role of customer service training in healthcare. While numerous customer service training tools exist in business and industry, no studies have clearly delineated the efficacy of customer service training for patients in a clinical setting. This study examines the effect of a required customer service training program taught by healthcare professionals on patient and family complaints, compliments, and satisfaction in a high-volume high-acuity emergency department. METHODS Patient Base All patients presenting to the Emergency Department at Inova Fairfax Hospital, Falls Church, Virginia, between May 1, 1994 and April 30, 1995 formed the control group, representing the period prior to emergency department customer service training. Patients presenting to the emergency department between May 1, 1995 and April 30, 1996 formed the study group, representing the period following customer service training intervention. The mechanism of patient complaint/compliment analysis and the survey criteria were identical in the control and study periods. Patient acuity was assessed by three measures: the number and percentage of patients admitted to the hospital; the number and percentage of patients with Current Procedural Terminology 1996 (CPT) evaluation and management (E/M) codes 99281-99285, (Kirschner et al. 1996); and a nursing acuity rating scale (EMERGE, Medicus Systems, Evanston, Illinois). Inova Fairfax Hospital is a 656-bed not-for-profit institution that is a teaching h ospital, regional referral center, and level I trauma center. Customer Service Training All emergency department staff involved in patient contact (physicians,  nurses, ED technicians, registration personnel, core secretaries, social workers, ED radiology, and ED respiratory therapy) were required to attend an eight-hour customer service training program. The numbers and types of staff involved in training are listed in Table 1. Because of logistic limitations, emergency medicine residents attended a focused fourhour required training course. The eight-hour program consisted of the following modules: basic customer service principles, recognition of patients and customers (Are they patients or customers?), service industry benchmarking leaders, stress recognition and management, communication skills, negotiation skills, empowerment, customer service proactivity, service transitions, service fail-safes, change management, and specific customer service core competencies. (More detailed information on the content of these modules is listed in Appendix 1.) These core comp etencies follow: making the customer service diagnosis (in addition to the clinical diagnosis) and providing the right treatment; negotiating agreement resolution of patient expectations; and building moments of truth into the clinical encounter. Following the initial required training, new physicians or ED employees were required to attend identical customer service training within four months of their initial employment. Additional mandatory customer service training updates were offered three times per year and included modules of conflict resolution, customer service skill updates, advanced communication skills, and assertiveness training. Patient Satisfaction Data Patient satisfaction data in both the control and study groups consisted of patient complaints, patient compliments, and a telephone patientsatisfaction survey conducted by an independent research firm (Shugoll Associates, Rockville, Maryland) that was blinded to the study hypothesis and course content. Patient complaints and/or compliments were systematically identified from all available means, including verbal, written, telephone, or electronic mail sources. Sources of patient complaints, data analysis, and categorization of complaints were identical in the control and study groups, which was coordinated by hospital quality improvement analysts. ED  staff were instructed to report all potential complaints and concerns, regardless of how minor, to appropriate physician or nurse managers in both the control and study periods. Complaints were logged into a central office and were investigated initially by three authors (TM, RC, DR). In cases where classification of type of complaint differed, additional information and/or clarification was sought from staff, patients, and family. Any discrepancies were resolved by group-consensus techniques. All complaints and the classification thereof were independently reviewed and verified by quality-improvement analysts. Patient complaint and compliment letters were referred for comment or clarification to appropriate ED staff in both the control and study periods. Outpatient satisfaction surveys were conducted by an independent research firm (completely blinded to the study and its hypothesis) utilizing a 50-item questionnaire to identify key factors in customer satisfaction. This survey instrument was validated on a sample of more than 3,000 patients prior to implementation in either the control or study group. The study used a telephone survey on a randomized number table basis to 100 ED outpatients per quarter (Appendix 2). Logistic regression analysis performed on these data identified 14 areas of more important/key attributes in the ED (see Table 2). Patient compliment and complaint data, as well as acuity data, were subjected to a two-tailed ttest and the Fisher Exact test. Patient satisfaction surveys were subjected to a two-tailed t-test with a 95 percent confidence level. Patient Turnaround Times Patient turnaround times (TAT) were calculated from time of initial arrival in the ED to either discharge or transfer to an inpatient unit. Turnaround times were routinely calculated on each patient and on an aggregate basis by day, month, quarter, and year. RESULTS ED Volume/Acuity Neither ED volume nor acuity changed to a statistically significant degree between the control and study periods, based on both admission percentage and nursing acuity (see Table 3). Analysis of CPT 96 Evaluation and Management Codes showed a statistically significant increase in codes 99283 and 99285, with a similar decrease in codes 99281 and 99284. The number of pediatric patients did not change in a statistically significant fashion during the study period. The only payor mix category to rise in a statistically significant fashion was managed care (p < .01), with a nearly identical decrease in commercial insurance. Neither compliments nor complaints correlated with payor category. Patient Turnaround Time Mean patient turnaround time dropped from three hours and 24 minutes (204 minutes) to three hours and seven minutes (187 minutes), but this difference was not statistically significant, nor did the percent of patients at one and two standard deviations from the mean change in a statistically significant fashion. Patient Compliments The total number of patient compliments rose from 69 in the control period to 141 in the study period, an increase of more than 100 percent (p < .00001) (see Table 3). Patient compliment letters consistently mentioned warmth, compassion, and skill of the emergency care provider as the reason for contacting management to praise the ED staff. There was no statistical difference between males and females among patient compliments. Patient Complaints Patient complaints dropped from 153 in the control period (2.5 complaints per 1,000 ED visits) to 36 in the study period (0.6 complaints per 1,000 ED visits), (p < .00001) (see Table 3). Complaints about perceived rudeness, insensitivity, or lack of compassion on the part of ED staff dropped most dramatically. Two-thirds of complaints in the study period were a result of waiting times, billing, or delays in obtaining an inpatient bed, compared to 30 percent in the control period. Nevertheless, complaints regarding waiting times, billing, and wait time for an inpatient bed still decreased 50 percent in the study period (p < .001). There were no significant differences in patient complaints based on age or sex, confirming results of the study by Hall and Press (1996). Patient Satisfaction Survey Data Baseline survey data were subjected to logistical regression analysis that indicated that 14 surveyed areas formed a core group of key satisfaction attributes. All of these 14 attributes showed increases in the study period (p < .001, see Table 2). The largest increases were in the following areas: skill of the emergency physician, skill of the nurse, likelihood of returning, overall quality of medical care, doctor’s ability to explain condition, diagnosis, and treatment options, and triage nurse’s sensitivity to pain. DISCUSSION The patient-physician and patient-nurse relationships are arguably the oldest in the history of medicine. These relationships have recently been described as being under siege because of an increase in the tension between the art and science of medicine, as well as the strains attendant to changes in the economic structure of healthcare (Glass 1996). To this list may be added a third causative factor: the lack of rigorous, formal training for healthcare professionals in the customer service fundamentals of the patient-provider relationship. The fundamentals of such training are closely tied to what has traditionally been described as the art of medicine or the concept of beneficence (Pellegrino and Thomasma 1989). Physicians have for the most part learned appropriate patient interaction skills through observing their mentors and peers during the course of graduate medical education. However, there has only recently been substantial study of this important subject (Buller and Buller 1987; Aharony and Strasser 1993). While customer service has been emphasized in American business and industry in recent years (Zeithamal, Parasuraman, and Berry 1990; Jones and Sasser 1995; Reichheld 1996; Berry and Parasuraman 1991; Berry 1995), few training modules are specifically targeted toward physicians and healthcare professionals. For this reason, the authors created an eight-hour customer  service training course for their ED providers, based on principles of adult education, benchmarks from the customer service industry (Sanders 1995; Spectre and McCarthy 1995; Carlzon 1987; Connelan 1997), experience in the clinical setting, and the existing literature on patient satisfaction (Pelligrino and Thomasma 1989; Thompson and Yarnold 1995; Thompson et al. 1996; Bursh, Beezy, and Shaw 1993; Rhee and Bird 1996; Dansk and Miles 1997; Hall and Press 1996; Eisenberg 1997). This literature emphasizes the importance of communication skills, managing information flow, actual versus perceived waiting times, and the ex pressive quality of physicians and nurses. All of these concepts were built into the training modules, including practical clinical examples of behaviors reflecting these and other concepts. Our philosophy in designing this course was simple. Customer service is a skill for which we hold our staff accountable but in which they had never formally been trained. We believed that this dilemma required, at a minimum, two sentinel events to occur. First, the department needed to have a clearly articulated and easily understood cultural transformation to a solid commitment to customer service. Second, staff members needed education in a practical, pragmatic fashion regarding precisely how such customer service principles could be applied in the clinical setting. Just as advanced cardiac life support, advanced trauma life support, and pediatric advanced life support courses can be used to improve cardiac, trauma, and pediatric resuscitation, respectively, we believed customer service outcomes could be improved by well-designed, mandatory, rigorous application of customer service training. The training was provided by active clinicians involved in day-to-day patient care activities (TAM, RJC). We believe this clinical credibility may have played an important part in the customer service transformation, inasmuch as the staff knew the trainers were well aware of the inherent problems of applying pragmatic customer service skills in a busy emergency department. The data from this study strongly support the hypothesis that clinically based, formal customer service training grounded on these principles can  dramatically decrease patient complaints, increase patient compliments, and improve patient satisfaction, at least in a high-volume, high-acuity ED. Patient complaints dropped by over 70 percent and compliments more than doubled during the study period, such that patient compliments actually exceed complaints in our 62,000 patient visit emergency department and level I trauma center. National data indicate that ED complaints average between three to five per 1,000 emergency department patients, although no data are available regarding rates of patient compliments (Culhane and Harding 1994). Our emergency department was slightly below that national standard level even during the control period. Analysis of the patient satisfaction survey data revealed an extremely important trend. Specifically, patients rated skill of the emergency physician, overall quality of medical care, and skill of the ED nurse as three of the most improved areas during the study period compared to the control period, despite the fact that there were no changes in the ED physician staff during the study and there was very little turnover among ED nurses. This strongly implies that patients rate the quality of care and the skill of the physician and nurse based on elements of the customer service interaction. These data suggest an important causal relationship between the technical component of care and the patient caregiver interaction, which has not been previously demonstrated. It is important to recognize that both customer service and technical skills are competencies to which hospitals and healthcare systems should hold their staff accountable on a daily basis. Hospitals spend substantial dollars to ensure that their staffs are technically competent to deliver quality medical care (Herzlinger 1997). However, to ensure that customer service is effective, clinically based customer service training is essential to give staff the appropriate skills in the clinical setting to deliver service competently. This concept is indirectly supported by data from Mack and colleagues (1995), who found that satisfaction with interactive aspects of emergency medical care produced higher correlations with measures of future intention to use the service than did satisfaction with medical outcomes themselves. Their study, however, did not undertake interventions to improve the interactive,  communicative aspect of healthcare in that setting. Similarly, Smith and colleagues (1995) evaluated the effect of a four-week training program, focusing on patient interviewing, somatization, patient education, and self-awareness, that was taught to first year internal medicine and family practice residents. Their data were not conclusive, but suggested that some but not all aspects of patient satisfaction could be improved by such training. This study tends to confirm the work of Thompson and colleagues (1996) that demonstrated in a much smaller sample size that expressive quality and management of informatio n flow to the patient had an effect on patient satisfaction. However, their study did not assess the impact of strategies and techniques for ED staff to improve patient satisfaction by improving expressive quality. While several studies (Thompson et al. 1996; Thompson and Yarnold 1996; Dansk and Miles 1997; Hall and Press 1996) have emphasized the importance of waiting time and exceeding patient expectations regarding length of waiting time, our study demonstrates a dramatic improvement in patient satisfaction without a statistically significant reduction in patient turnaround time. This supports the work of Bursch and colleagues (1993), who found in a study of 258 patients that the five most important variables for patient satisfaction were the amount of time it took before being cared for in the ED, patient ratings of how caring the nurses were, how organized the ED staff was, how caring the physicians were, and the amount of information provided to the patient and family. However, the study did not assess strategies to improve satisfaction based on this knowledge. All of this information was built into the training modules to assist staff with practical strategies to manage waiting time effe ctively using information flow, queuing theory, and verbal skill training. The implications of the higher ratings of the skill of the emergency physicians and nurses are intriguing and could have a far-reaching impact on healthcare. Perhaps the strongest implication is that perceived skill stands as a marker for quality and/or outcome in the mind of patients and their families. It has been shown repeatedly that patient compliance increases with confidence in the physician (Frances, Korsch, and Morris 1969;  Sharfield et al. 1981; Waggoner, Jackson, and Kern 1981; Schmittdiel et al. 1997). While our study did not directly assess improvements in outcome, quality of care, or appropriateness of care, it certainly appears that patients rated the skill of the healthcare providers as a key quality characteristic in this survey. Furthermore, the fact that ratings of quality of medical care and likelihood of returning also increased dramatically speaks to the importance that effective customer service training may have in offering a competitive market advantage to hospitals and healthcare institutions. This is particularly important as the concept of customer loyalty is closely tied to the likelihood of a patient or their family returning to that healthcare institution. As the focus on outcomes management and evidence-based medicine increases, it is important to take into account the effect that customer service skills have on patients’ perceptions of quality and outcome. This study may be subject to several criticisms. First, while statistical data on patient compliments and complaints obtained substantial statistical significance, the number of patients contacted for the outpatient satisfaction telephone survey may have resulted in sampling bias. While a larger sampling is planned in the future, the patient satisfaction survey data trends were consistent throughout all quarters and appear to be a valid statistical tool, despite the number of patients sampled. Second, it was not possible to blind those responsible for investigating and classifying complaints and compliments. However, we did attempt to reduce or eliminate possible reporting or observer bias by identifying complaints from all sources and ensuring that all complaints and their classification were reviewed and approved by an author who was not involved in ED operations and by quality improvement analysts. Third, information is not available on national or regional trends of patient compl aints and/or satisfaction during the study period. It is possible that the data in this study may reflect local, regional, or national trends toward decreased complaints and increased satisfaction, either globally throughout healthcare or in ED patients specifically. However, this is highly unlikely as no such trends have been previously reported, nor would such trends fully explain the data from this study, even if they were present. The data on patient acuity  indicated an increase in CPT codes 99283 and 99285, suggesting a slight trend toward higher patient acuity. This could mean that patients with higher levels of acuity are more satisfied and less likely to complain. No data are available to either prove or disprove this possibility, but the trend toward higher acuity would not appear to completely explain the dramatic improvement seen in this study. Furthermore, the patient-satisfaction telephone survey excluded inpatients, who comprise a larger percentage of patients in the 99285 service code. Further study is needed to delineate the relationship of ED patient acuity to satisfaction. Despite these potential limitations, this study demonstrates that clinically based customer training for ED staff can decrease patient complaints and increase patient satisfaction in a large volume, high-acuity ED, and that satisfaction is independent of patient turnaround times. Furthermore, the data support the concept that patients rate the skill of the emergency physician, overall quality of medical care, and skill of the ED nurse significantly higher after such training is provided to the ED staff. Additional studies in ED with different volumes, acuities, and geographic locations are needed to demonstrate whether these results can be duplicated. Studies of the impact of customer service training in other healthcare settings would also be of benefit. Nonetheless, clinically focused customer service training has been shown in this study to improve patient satisfaction and ratings of the skill of physicians and nurses. If verified by other studies, customer service training should be considered an important part of graduate and undergraduate medical education to improve both the art and science of the patient-physician relationship. The clinically based customer service training described in this study is now a required part of competency based orientation for all physicians, nurses, residents, and support staff in the emergency department. All professional and non-professional staff interviewed for positions in the emergency department are advised of the institution’s strong commitment to customer service training and the necessity of attending the required training course. As healthcare increasingly emphasizes accountability for customer service in its staff, it is increasingly important that practical and effective customer service training is provided. While not directly addressed in this study, the data on ratings of quality of medical care, skill of the physician and nurses, and likelihood of returning strongly suggest that effectively completing the customer service transition offers a competitive market advantage to hospitals and healthcare systems. References Aharony, L., and S. Strasser. 1993. â€Å"Patient Satisfaction: What We Know About and What We Still Need to Explore.† Medical Care Review 50 (1): 49-79. Berry, L. L. 1995. On Great Service: A Framework for Action. New York: Free Press. Berry, L. L., and A. Parasuraman. 1991. Marketing Services: Competing Through Quality. New York: Free Press. Butler, M. K., and D. B. Buller. 1987. â€Å"Physician’s Communication Style and Patient Satisfaction.† Journal of Health and Social Behavior 28 (4): 375-88. Bursh, B., J. Beezy, and R. Shaw. 1993. â€Å"Emergency Department Satisfaction: What Matters Most?† Annals of Emergency Medicine 22: 586-91. Carlzon, J. 1987. Moments of Truth: New Strategies for Today’s Customer-Driven Economy. New York: Ballinger Publishing. Connelan, T. 1997. Inside the Magic Kingdom. Austin, TX: Bard Press. Culhane, D. E., and P. J. Harding. 1994. â€Å"Quality in Customers: Great Expectations.† Presented to the American College of Emergency Physicians Management Academy, Boston, Massachusetts, May 19, 1994. Dansk, K. H., and J. Miles. 1997. â€Å"Patient Satisfaction with Ambulatory Healthcare Services: Waiting Time and Follow-up Time.† Hospitals and Health Services Administration 42 (2): 165-77. Eisenberg, B. 1997. â€Å"Customer Service in Healthcare.† Hospitals and Healthcare Services Administration 42 ( 1 ): 17-32. Frances, V, B. M. Korsch, and M. J. Morris. 1969. â€Å"Gaps in Doctor-Patient Communication. Patient’s Response to Medical Advice.† New England Journal of Medicine. 280: 535-49. Glass, R. M. 1996. â€Å"The Patient-Physician Relationship: JAMA Focuses on the Center of Medicine.† Journal of the American Medical Association 275: 147-48. Hall, M. F., and I. Press. 1996. â€Å"Keys to Patient Satisfaction in the Emergency Department: Results of a Multiple Facility Study.† Hospitals and Healthcare Administration 41 (4): 515-32. Herzlinger, R. 1997. Market-Driven Health Care. New York: Free Press. Inova Health System. 1997. â€Å"Outpatient Satisfaction Research.† Shugoll Research. Rockville, MD. Jones, T. O., and W. E. Sasser, Jr. 1995. â€Å"Why Satisfied Customers Defect.† Harvard Business Review 73: 88-99. Kirschner, C. G., R. C. Burkett, G. M. Kotowicz, et al. 1996. Physicians’ Current Procedural Terminology-CPT 96, ed 5. Chicago: American Medical Association. Laine, C., and F. Davidoff. 1996. â€Å"PatientCentered Medicine: A Professional Evolution† lournal of the American Medical Association 275: 152-56. Mack, J. L., K. M. File, J. E. Horwitz, and R. A. Prince. 1995. â€Å"The Effect of Urgency on Patient Satisfaction and Future Emergency Department Choice.† Health Care Management Review 20: 7-15. Pellegrino, E. D., and D. C. Thomasma. 1989. For the Patient’s Good: The Restoration of Beneficence in Health Care. New York: Oxford University Press. Rhee, K., and J. Bird. 1996. â€Å"Perceptions in Satisfaction with Emergency Department Care.† Journal of Emergency Medicine 14: 679-83. Reichheld, E E 1996. â€Å"Learning from Customer Defections.† Harvard Business Review 74: 56-69. Sanders, B. 1995. Fabled Service: Ordinary Acts, Extraordinary Outcomes. San Diego: Pfeiffer and Company. Schmittdiel, J., J. V. Selby, K. Grumbach, and C. P. Quesenberry. 1997. â€Å"Choice of a Personal Physician and Patient Satisfaction in a Health Maintenance Organization.† Journal of the American Medical Association 278 (19): 1596-1612. Sharfield, B., C. Wray, K. Hess, and E. M. Smith. 1981. â€Å"The Influence of Patient-Practitioner Agreement on Outcome of Care.† American Journal of Public Health 71: 127-31. Smith, R. C., J. S. Lyles, J. A. Mettler, et al. 1995. â€Å"A Strategy for Improving Patient Satisfaction by the Intensive Training of Residents in Psychosocial Medicine: A Controlled, Randomized Study† Academic Medicine 70: 729-32. Spectre, R., and P. D. McCarthy. 1995. The Nordstrom Way: The Inside Story of America’s #1 Customer Service Co mpany. New York: John Wiley and Sons. Thompson, D. A., P. R. Yarnold, D. R. Williams, and S. L. Adams. 1996. â€Å"Effects of Actual Waiting Time, Perceived Waiting Time, Information Delivery, and Expressive Quality on Patient Satisfaction in the Emergency Department† Annals of Emergency Medicine 28: 657-65. Thompson, D. A., and P. R. Yarnold. 1995. â€Å"Relating Patient Satisfaction to Waiting Time Perceptions and Expectations: The Disconfirmation Paradigm.† Academic Emergency Medicine 2: 1057-62. Thompson, D. A., P. R. Yarnold, S. L. Adams, and A. B. Spaccone. 1996. â€Å"How Accurate Are Waiting Time Perceptions of Patients in the Emergency Department?† Annals of Emergency Medicine 28: 652-56. Waggoner, D. M., E. B. Jackson, and D. E. Kern. 1981. â€Å"Physician Influence on Patient Compliance: A Clinical Trial.† Annals of Emergency Medicine 10: 348-52. Zeithamal, V. A., A. Parasuraman, and L. L. Berry. 1990. Delivering Quality Service: Balancing Customer Perceptions and Expectations. New York: Free Press. You have requested â€Å"on-the-fly† machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated â€Å"AS IS† and â€Å"AS AVAILABLE† and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors fo r your use of the translation functionality and any output derived there from. Hide full disclaimerTranslations powered by LEC. Translations powered by LEC.

Can You Find Me Now

How is a Nintendo Wii game console able to determine the location of a Wii Remote while a player interacts with a game? The answer is triangulation, a process that determines the location of any object by measuring the angles from two or more fixed points. Surveyors often use triangulation to measure distance. Starting at a known location and elevation, surveyors measure a length to create a base line and then use a theodolite to measure an angle to an unknown pint from each side of the base line (Jains, 2012, pp. 30-48). The length of the base line and the two known angles allow a computer or person to determine the location of a third point. Similarly, the Nintendo Wii game console uses triangulation to determine the location of a Wii Remote. A player places a sensor bar, which contains two infrared transmitters, near or on top of a television. While the player uses the Wii Remote, the Wii game console determine the remote’s location by calculating the distance and angles between the Wii Remote and the two transmitters on the sensor bar. Determining the location of a Wii Remote is relatively simple because the sensor bar contains only two fixed points: the transmitters. A more complex application of triangulation occurs in a global positioning system (GPS). A GPS consists of one or more earth-based receivers that accept and analyze signals sent by satellites to determine a receiver’s geographic location. GPS receivers, found in handled navigation devices and many vehicles, use triangulation to determine their location relative to at least three geostationary satellites. According to Sanders, the geostationary satellites are the fixed points in the triangulation formula (Understanding Satellites and Global Positioning Systems). The next time you pass a surveyor, play a Nintendo Wii, or follow a route suggested by a vehicle’s navigation system, keep in mind that none of it might have been possible without the concept of triangulation. ?