Arrowsmith by Sinclair Lewis :: Sinclair Lewis Arrowsmith

"Arrowsmith", by Sinclair Lewis In the novel "Arrowsmith", by Sinclair Lewis, written in 1925, one can read of our world's lack of idealism in science, most often found in the medical profession (Encarta, 1). This book portrays the times in terms of scientific advancement not being idealistic, mostly in the medical field. Our scientists could not come up with their own ideas and our progress was going nowhere, fast. Although, today we are advancing so rapidly that we have no choice but to move and experiment, there is no time to slow down and copy old works. Sinclair Lewis also combines his life and the life of a graduating microbiologists, who he interviewed to help him write this book, into his main character, Dr. Martin Arrowsmith. All of this goes into the book "Arrowsmith". Sinclair lewis was born on the seventh of February, 1885, in the town of Sauk Centre, Minnesota, to his warmhearted parents, Emma Kermont Lewis and Dr. Edwin J. Lewis. At a very young age Sinclair read widely in grade school and continued on in his studies for many years (Grebstein, 16). Lewis studied at Yale University form 1903 till 1906. There he studied literary writings and works to help him become a writer. His father had disagreed with his career choice, but he went on and did what he wanted to do most, write. At one time he was so disgusted with his father that he ran away and tried to join the Spanish-American War as a drummer boy (Cobletz, 248). He did not get far; his father caught him before he left town. Back to collage he went and even through collage Lewis still read many books. One professor was quoted as saying "He was drawing more books from the Yale library than, I believe, any undergraduates before or since." Lewis was known to read such books from authors Hardy, Meredith, James, Howells, Austen, Bronte, Tolstoy, Pushkin, Turgenev, Gogol, Flaubert, Zola, Huneker, Pinero, Jones, Shaw, d'Annunzio, Sudermann, Yeats, George Moore, Nietzsche, Haeckel, Huxley, Moody, Marx, Gorky, Blake, Pater, Shelley, Keats, Coleridge, Rossetti, Swinburne, Clough, and Ibsen. All of these authors were influential to him, but none more than the famous H. G. Wells (Grebstein 24). He accomplished all this during college while keeping two or more jobs at one time and writing for several papers along with his own books that he wrote. In October of 1906 he left school for a few months and stayed with his brother in his utopian colony in New Jersey. A few months later he remembered the work ethics his father taught him and went back to school and got his degree in 1907.

Kaiser Permanente Risk Management Executive Summary Essay

Organization Description Kaiser Permanente (KP) is the nation’s largest integrated health care delivery system. KP serves nine states and over nine million members, with an annual operating revenue in 2013 of 53.1 billion. KP is a leader in quality improvement efforts in the health care industry through participation in studies performed by the National Committee on Quality Assurance (NCQA), The Joint Commission (TJC) accreditations, and the implementation of a state of the art electronic health records system, which focuses on integration and quality of care standardization. The focus of this summary is on KP hospitals in the northern California region and will include topics such as the purpose of risk and quality management, risk identification and management, current risks, quality outcomes, organizational goals, and the relationship between risk and quality management. Risk and Quality Management Purpose General The purpose of risk management in health care is simply the process of protecting the assets and minimizing financial losses to the organization (Singh & Habeeb Ghatala, 2012). A comprehensive risk management strategy within a health care organization will include focus on continuous quality improvement (CQI). The purpose of CQI in health care, according to Sollecito and Johnson (2013), is to offer a â€Å"structured organizational process for involving personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceeds expectations† (p. 4). Through linking the processes of risk management and quality improvement the success of both processes is more likely to be realized. Kaiser Permanente The key concepts for risk and quality management at KP are commitment to quality, patient safety, privacy protection, and fraud prevention. KP risk management and quality management programs are central to their mission, values, and culture. Methods currently utilized to support these concepts  within KP are consumer surveys, the use of an integrated EHR with evidence based guidelines and clinical decision-making functionality, stringent patient privacy regulations and processes, continuous clinical and administrative staff training programs, and participation in studies focused on standardizing national quality measures (Kaiser Permanente, 2012). Risk Identification and Management Steps While KP is a leader in health care risk and quality management there are specific steps this consultant is recommending on a continual basis that will improve risk identification and management within the organization. 1. Identify and analyze loss and exposure While there are many methods utilized within the health care industry in the identification and analysis of loss and exposure, the recommended methods for KP are as follows: a) Incident-reporting analysis b) Improvement on the current performance management process for employees to bring focus on risk mitigation and quality improvement. c) Quantitative analysis of patient complaints and satisfaction surveys. d) Review of the organizations past professional liability and workers compensation reports. e) Review of surveys completed by TJC and NCQA on other hospitals in order to identify risk areas that KP should focus on. (McCaffrey & Hagg-Rickert, 2009) 2. Research and propose alternative risk techniques To mitigate risks that are unavoidable at KP, a combination of alternative risk techniques will help reduce situations that might negatively affect the organization. A financial analysis and risk analysis should be performed in order to ascertain the likelihood of utilizing the exposure avoidance technique. This is not a likely option as the financial impact of eliminating services may out weigh the risks involved with continuing them. A loss reduction approach is more likely to be the technique chosen for this organization. The core prevention activities that must be present in the loss reduction technique are as follows: a.) Ongoing staff education b.) Current policy and procedure review and revision c.) Updates to the organizations current EHR system to ensure the data present in the clinical decision-making and evidence-based clinical guidelines technology is the most current data available. According to Chen, et al (2009), â€Å"a growing body of literature confirms the value of electronic health records (EHRs) in improving patient safety, improving coordination of care, enhancing documentation, and facilitating clinical decision making and adherence to evidence-based clinical guidelines† (p. 323). 3. Risk management technique selection This two-part process of risk management technique selection is accomplished through forecasting and application of an ongoing measurement process, which will allow KP to analyze the risk management technique with regard to outcome and cost effectiveness. Included in the measurement process both risk treatment and risk-financing techniques should be measured (McCaffrey & Hagg-Rickert 2009). 4. Implement the selected techniques Implementation of the chosen risk management techniques may include decisions on insurance coverage and policy changes, overall department workflow changes to ensure compliance with state and federally mandated regulations and guidelines, and elimination of processes that impede or hinder patient safety. 5. Monitor and improve upon the implemented risk management program In order to continue improving upon the newly implemented risk management program a comprehensive monitoring strategy should be employed. In fact, McCaffrey and Hagg-Rickert, (2009) stated, â€Å"a multidisciplinary approach to evaluating the risk management program ensures that the impact of additional opportunities to improve the risk management function are fully explored† (p. 21). a.) Prepare an annual risk management report b.) Compare the new annual report against prior years risk management data (McCaffrey & Hagg-Rickert 2009) Current Risks Three risks that KP should take special care to avoid are rejection of newly implemented risk management and CQI procedures by employees, statute and regulatory changes, and health care associated infections (HAIs). 1. Rejection Change implementation is never an easy task and without special care taken the rate of rejection to change by clinical and administrative employees is high. In order to achieve successful CQI changes the following guidelines and recommendations are presented. a.) Minimize employee rejection through easily implemented and followed CQI procedures. b.) Engage employees in planning to increase acceptance. c.) Ensure lateral linkages within the organization across specialty departments to improve communication (Sollecito and Johnson, 2013). 2. Statute and regulatory changes With the ever-changing landscape in state and federal statutes and regulations surrounding the health care industry, special attention to this risk area must be taken. In fact, Cohen (2009) stated that â€Å"health care is one of the most heavily regulated of all sectors of commerce† (p. 328). Failure to comply with state and federal statutes and regulations can bring about negative financial affects at KP, including but not limited to; fines, loss of accreditation and credentialing, and an increase in malpractice lawsuits, not to mention a decrease in quality of care. a.) Risk management and quality improvement officers stay current and involved in statute and regulation changes. b.) Mandate educational goals for risk management and quality management officers with regard to state and federal regulations. c.) Implement a monthly employee newsletter within which the risk management officer and quality improvement officer outline regulation changes. Include processes that emplo yees should expect to see implemented to maintain compliance. Include a signature page with those editions that include changes to policy and ensure all employees sign and return to the human resources department. d.) Ongoing training for clinical and administrative employees with regards to statute and regulation. The risk management and quality improvement officers will be responsible to work with the organizations education department to implement new workshops as needed. e.) Include these responsibilities in the performance monitoring strategy for the risk management and quality improvement officers. 3. HAIs Health care associated infections are a serious risk in hospitals, as noted by Sydnor and Perl (2011), in their statement â€Å"HAIs are the most common complication seen in hospitalized patients† (para. 20). Improper prevention can lead to increased costs, lengthier hospital stays, and even patient death. Additionally, a Condition of Participation (CoP) (42 CFR 482.42) by CMS mandates hospital infection control programs to adhere to specific requirements. Recommendations are as follows. a.) Implement a house-keeping checklist to ensure proper sanitization of patient rooms. b.) Implement a sanitization checklist for clinical staff that will enforce hand washing before and after patient contact. c.) Develop a committee to review and revise the KP infection prevention and control program. Revisions should focus on compliance with TJC and the Center for Disease Control (CDC) regulations. Quality Outcomes Internal and external Three internal and external factors that influence quality outcomes are organization management of interpersonal relationships between physicians and patients, patient compliance, and continuity of care. Without proper management of interpersonal relationships between physicians and patients, the organization will face degradation in trust and openness. Patients should be involved in all treatment decisions, through proper education on their diagnosis and treatment options. This will bring about patient engagement in this decision making process. While KP cannot force their patients to comply with treatment guidelines, the external influence of patient compliance is crucial to quality outcomes. Programs focused on thorough training and education of patients and family members will improve the rate of compliance, thus improving the probability of positive quality outcomes for patients. Lack of patient compliance will hinder the treatment process and lower the level of quality outcomes standards at KP. Continuity of care is another internal influence that can affect quality outcomes. Regular follow up with patients will also increase patient compliance. Without improving continuity of care, the KP organization will see a reduction in positive quality outcomes and an increased in undesired outcomes (DeHarnais, 2013, chp 5). Goals Short-Term 1. Design new regulatory and statute training programs for all clinical and administrative employees. 2. Review and revise the KP infection prevention and control program 3. Revise the performance management system to include CQI measurements and risk management procedures as performance metrics. Long-Term 1. Increase adherence to state and federal regulations and statutes throughout the KP organization. 2. Reduce HAIs by 10% throughout KP hospitals in the northern California region. 3. Improve CQI measurement and risk management policy adherence throughout the northern California region by 20% among clinical employees. Risk and Quality Management Recommendations Risk management policies 1. Quarterly peer review The Health Care Quality Improvement Act (HCQIA) of 1986 â€Å"encourages hospitals, state licensing boards, and professional societies to identify and discipline physicians, dentists, and other health care providers who, after adequate, nondiscriminatory peer review, were found to have engaged in negligent or unprofessional conduct† (Cohen, 2013 p. 333). Through ongoing screening of new and current clinicians, KP will take responsibility for offering their patients that highest quality of care and reducing the risk of employing negligent clinical employees. 2. Zero tolerance adherence policy for all employees with regard to infection control procedures Part of the CMS CoP (42 CFR 482.42) regulation is the â€Å"designation of an infection control officer and development of relevant policies that address the identification and control of infections and communicable diseases. Without full compliance with all CoPs, KP could face the loss of their Medicare provider agreement. 3. Vulnerability analysis chart and emergency plan policy. According to Rawson and Hammond (2009) â€Å"by evaluating vulnerabilities and taking appropriate preventive action, loss can be minimized in an emergency†Ã‚  (p. 506). Health care facilities should include prevention measures in their emergency plans that include the risk of terrorist attacks. While terrorist attack risk cannot be completely mitigated, it is the responsibility of the health care facility to be prepared for such an emergency. Obtain additional information on including risk of terrorist attacks from the National Institute for Occupational Safety and Health (NIOSH). Quality management policies 1. Adherence to evidence-based clinical guidelines While it has been shown that â€Å"clinicians have customarily enjoyed a great deal of autonomy in their practices† (Argawal, 2010, para 3), it is imperative that clinicians follow evidence-based clinical guidelines. If exceptions should be made the details of, the patient diagnosis and variations should be presented for peer review prior to altering treatment plans. 2. Minimum score of 88% on customer satisfaction surveys Clinicians must maintain an average score of no less than 88% on customer satisfaction surveys quarterly. In today’s health care market, measurements of quality include consumer satisfaction. In fact, Bernard and Savitz (2009) state that in todays â€Å"competitive health care environment, consumers want and expect better health care services and hospital systems are concerned about maintaining their overall image† (p. 185). Relationship between risk and quality management In the past, risk management officers and quality improvement managers worked autonomously from one another, in fact they most often reported to different superiors. However, today healthcare organizations are realizing that in order to reach quality of care goals and maintain effective risk management programs these disciplines must work together closely. An example of how risk management efforts and quality improvement efforts complement one another is seen in the reduction of medical errors. The risk management plan must consider ways to reduce medical errors, while the quality improvement plan will offer solid steps toward minimizing medical errors (Sollecito and Johnson, 2013). Conclusion This summary focused on topics such as the purpose of risk and quality management, risk identification and management, current risks, quality outcomes, organizational goals, and the relationship between risk and quality management. While KP is the nation’s largest integrated health care delivery systems and leader in CQI standardization, there is always room for improvements. This consultant understands the importance of improvement at KP, thus humbly presents this summary and recommendations to the board of directors. References Agarwal, R. (2010, May). A Guideline for Quality Accreditation in Hospitals. Quality Digest, (), 1-4. Retrieved from http://www.qualitydigest.com/inside/twitter-ed/guideline-quality-accreditation-hospitals.html Chen, C., Garrido, T., Chock, D., Okawa, G., & Liang, L. (2009). The Kaiser Permanente electronic health record: Transforming and streamlining modalities of care. Health Affairs, 28(2), 323-33. Retrieved from http://search.proquest.com/docview/204522974?accountid=458 Cohen, M. (2009). Statutes, Standards, and Regulations (chp 10) in McCaffrey, J. J., & Hagg-Rickert, S. (2009) Risk Management Handbook (5th ed.). San Francisco, CA: Jossey-Bass. DesHarnais, S. I. (2013). The outcome model of quality (chp 5) in Sollecito, W. A. and Johnson, J. K. (2013). McLaughlin and Kaluzny’s Continuous Quality Improvement In Health Care (4th ed.). Jones and Bartlett Publishers. Emily R. M. Sydnor, Trish M. Perl (2011, January). Clin Microbiol, 24(1): 141–173. Retrieved from http: //www.ncbi.nlm.nih.gov/pmc/articles/PMC3021207/ Kaiser Permanente. (2014). Kaiser Permanente, Retrieved from http://share.kaiserpermanente.org/article/history-of-kaiser-permanente/ McCaffrey, J. J., & Hagg-Rickert, S. (2009, Chp 1) Developing of a Risk Management Program in Risk Management Handbook (5th ed.). San Francisco, CA: Jossey-Bass. Rawson, M. L. and Hammond, H. Y,. (2009) Emergency Management in McCaffrey, J. J., & Hagg-Rickert, S. (2009, Chp 7) Developing of a Risk Management Program in Risk Management Handbook (5th ed.). San Francisco, CA: Jossey-Bass. Singh, B., & Habeeb Ghatala, M. (2012, August). Risk Management in Hospitals. International Journal of Innovation, Management and Technology, 3(4). Sollecito, W. A. and Johnson, J. K. (2013). McLaughlin and Kaluzny’s Continuous Quality Improvement In Health Care (4th ed.). Jones and Bartlett Publishers.

Unit 8 Written Assignment A Summary Of The Paper “The

Unit 8 Written Assignment: A Summary of the Paper â€Å"The transmission mechanism of monetary policy† Introduction to Finance University of the People In England, the party responsible for setting the short-term interest rate is called the Monetary Policy Committee, or MPC. The channels through which the interest rate that the MPC sets affect the economy and affect inflation, are often referred to as the transmission mechanisms of monetary policy. In this essay, which summarizes the paper called â€Å"The transmission mechanism of monetary policy†, the Bank of England illustrates the transmission mechanisms that the MPC believes to be true. The paper â€Å"The transmission mechanism of monetary policy† is divided into two†¦show more content†¦Official interest rate changes will also influence asset prices. For example, bond prices are inversely influenced by long-term interest rates. Finally, the official interest rate will also affect the exchange rate which the paper defines as â€Å"the relative price of domestic and foreign money† (George et. al, n.d.). When the official interest rate rises, domest ic currency (the GBP) will see appreciation making investors want to invest in pounds. Another key point is that with changes in the exchange rate, there will also be a change in the value of domestic and foreign exports and imports. Finally, a change in the official interest rate can also affect people’s expectations and confidence in the economy. For example, some may believe that an increase in interest rates is a signal that the MPC thinks that the economy is expanding thus making further growth likely or, a contradictory interpretation may be that the MPC thinks that the MPC may need to slow growth in order to control inflation (George, n.d). Change in interest rates, asset prices, and exchange rates also affects the spending and saving habits of individuals and firms. Changes in these three factors change the interest rates on their debts and savings and the change felt the most is a change in the interest rate on personal debt which is usually held in the form of a mor tgage where 80% of mortgages in the UK are on a floating-rate. The higher prices of goods and services dueShow MoreRelatedTuition Free Online University Essay1691 Words   |  7 PagesAbout Us Policies University Catalog Student Handbook Study Process Support Student Portal My Courses Page path Home /My courses /Current Term (Term 2, 2016-2017) /UNIV 1001B - AY2017-T2 /17 November - 23 November /Written Assignment Unit 2 /Assessing submission Written Assignment Unit 2 Assessed submission Companions in Artificial Intelligence submitted on Saturday, 19 November 2016, 6:37 PMmodified on Monday, 21 November 2016, 6:39 PM Companions in Artificial Intelligence Ruben DamianRead Moreapplication of theory2229 Words   |  9 PagesApplication of Theory Paper Guidelines Scoring Rubric Purpose: The purpose of this assignment is to synthesize one strategy for the application of a specific nursing theory to resolving a problem or issue of nursing practice in nursing leadership, nursing education, nursing informatics, or health policy. 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