Wednesday, July 31, 2019

Othello Plot Points Essay

Othello’s Ensign, hates him cause he’s black, wants Cassio’s job, believes he would be better Cassio- Innocent Party, gets a job as Othello’s Lieutenant, gets into a fight and his stripped of rank, but goes to Desdemonia to try and win back Othello’s favour Roderigo- Loves Desdemonia, is persuaded by Iago to attempt to kill Cassio, is murdered by Iago to remain silent (d) Emilia- Married to Iago, gives iago the handkerchief that convinces Othello that Desdemonia and Cassio had a relationship (d) Plot Othello marries Desdemonia in secret. However Roderigo goes to her father and blows their cover. Othello is forced to defend himself from accusations of witchcraft. News of a Turkish invasion of Cyprus reaches Venice, and Othello, with Cassio his new Lieutenant, and Iago, his ensign, are deployed to Cyprus to defend against the Turkish fleet. Desdemonia is allowed to accompany Othello, and Emilia, Iago’s wife, accompanies her as her attendant. Th e enemy fleet is destroyed by a storm. Othello calls for a celebration, during which Iago gets Cassio drunk, who causes a fight. Othello strips him of his rank, and blames him for the disturbance caused by Iago. However, Iago tells Cassio to go to Desdemonia, and convince her to try to plead his case. Whilst Cassio does this, Iago goes to Othello and hints that Cassio and Desdemonia are having an affair. For the rest of the film, â€Å"Honest Iago† controls the actions of the characters, turning Othello against his wife and Roderigo against Cassio so that, at the end of the play, Roderigo attempts to murder Cassio, while Othello smothers his wife after accusing her of betraying him and having an affair with Cassio. Roderigo fails, and after he is identified as Cassio’s attacker Iago murders him, claiming to have been overcome with rage, but really silencing to cover his involvement. Othello then murders his wife, however Emilia walks in calls for help. As the truth comes out, Othello realises his wife was innocent. Iago murders his wife after she reveals what he has done. He is then captured and brought before Othello, who stabs him but does not murder him, saying he would prefer Iago live in pain for the rest of his life than die. Othello then kills himself out of guilt at what he has done. Iago is hauled off to be tortured, and Cassio is made Governer of Cyrpus. The end.

Defence Mechanisms in Guajiro Personality and Culture Essay

Defence is all efforts of the ego to render inoperative and instinctual wish or impulse. The instinctual object choice produces neurotic anxiety because it clashes with the superego, which arises from the internalisation of the parent’s moral values. Defences protect the individual from experiencing anxiety either by detaching the forbidden wish from conscious awareness or by distorting or falsifying its true meaning. Several methods were used in collecting data for this study. Structured methods of observation and interviewing were used to gather information relevant to behavioural systems having transtructural significance, such as sex, aggression, and responsibility. Rorschach and TAT tests were administered to supplement these data and to aid in uncovering elements and relationships in the personality that were not readily observable, especially in the areas of affective behaviour, cognitive organization and defensive functioning. This study called â€Å"Defence Mechanisms in Guajiro Personality and Culture† by Lawrence C. Watson conducted with Guajiro Indian subjects came up with exceptional results. Some general characteristics of defence mechanisms in the Guajiro society were found: * All of the basic defence mechanisms are present but some are more important than others. * All defence mechanisms assume a well-defined culturally defined form. * Defence mechanisms cluster around a few systems of behaviour that are most conflict-ridden culture. * Variations in the deployment of psychic defences are, to a degree, a function of a person’s age, sex, occupation and class position. * There is a basic continuity in defence functioning from one stage to another in the life cycle of the individual. This study shows that defence mechanisms formulated by Freud have widespread, if not universal occurrence in human personality processes, irrespective of variations in cultural context. It also shows that in every unique social setting, cultural factors determine the form in which defensive behaviour comes to be expressed. This study also gave the result which says that defence functioning must be studied in relationship to other prevailing modal personality factors (e.g., superego strength, level of emotional control, etc.), since it is quite  likely that certain defensive properties will be found only if they are compatible with these other elements.

Tuesday, July 30, 2019

Inclusion in education: a challenge to make rhetoric a reality Essay

During the last decade the efforts to provide a more equitable and all-embracing educational system aimed at meeting the needs of all children have mended their pace in the United Kingdom. The noble intention to ensure a more just societal environment which gives every growing person an opportunity to participate in full measure in all aspects of life of society has been a locomotive power behind most developments in the field of special education (Rose 2003, p.12). In particular, New Labour government has been actively promoting an agenda of inclusion and participation for pupils with special educational needs (SEN) in mainstream education (Atkinson et al. 2002, p. 4; Armstrong 2005, p. 135). This agenda of inclusion has not been limited to school placement but extends to the curriculum. Inclusion has been recognised by New Labour an important aspect of the call for high standards for all learners (Mittler 2000, p. 2). Although the process of steady development of the integration of children with physical and sensory disabilities from special to mainstream schools has been carried out in the UK since the early 1980s involving various spheres of social life and gaining extensive publicity, even to date for many lay observers of the educational context, the image of children in wheelchairs coming from the special school sector into the mainstream is what they imagine such integration to be (Corbett 2001, p. 16). Such interpretation of inclusion simplifies and emasculates its essence and purposes. At the same time, as Ainscow et al. (2006) so soundly remind us, the idea of inclusion cannot refer to just some students and not others. To be inclusive requires that society strives to identify and remove all barriers to learning for all children. This means that society must attend to increasing participation not just for disabled students but for all those experiencing disadvantage, whether this results from poverty, sexuality, minority ethnic status, or other characteristics assigned significance by the dominant culture in their society. To achieve this, as Booth and Ainscow (1998) argue, while working to understand inclusion society and responsible governmental bodies must give equal attention to understanding and removing the pressures for exclusion that exist within the cultures of both the schools and society. Thus, there is no surprising that recently policies of New Labour Government aimed at inclusive education have been subjected to sharp criticism as being superficial and inadequate to meet the real requirements of children with SEN (Corbett 2001, p. 39). In particular, Armstrong (2005, p. 149) argues that these policies â€Å"go no further than to redress the traditional deficit-driven discourse of special educational needs in the fashionable but illusionary language of inclusion†. Such criticism testifies that the issue of effectiveness of inclusion in education and in-depth substance of inclusive education is contentious and complicated one. The purpose of this study is to analyze the arguments by Armstrong and other critics of recent New Labour’s governmental policies, and to evaluate their relevance. Toward this end we will discuss existing legislative instruments and New Labour government’s initiatives on inclusive education, scrutinize the meaning of inclusion and its various interpretations, examine advantages and shortcomings of inclusive policies in force, and make the conclusion. A Concept of Inclusion in Education and Its Interpretations. Both among scholars and in society there are different views on what inclusion in education is, which suggest, as we mentioned above, that complex influences are at work in the development of this field (Armstrong 2005, p. 136). Some researchers view inclusive education as an ongoing development of special education (Farrell 2006, p. 24). Others believe that what is referred to as inclusion is, and should be, derived from mainstream approaches to instruction and school organization, creating an alternative to special education knowledge and practices (Skrtic 1995, p.194). From this latter perspective the idea of inclusion as a merger of special and regular education is seen as problematic because such an amalgamation appears likely to maintain a medical, curative model of education (which we will discuss in our study later) that excludes those labelled as children with SEN from the curriculum and from other experiences available to non-labelled students (Thomas & Loxley 2001, p.4). Mittler (2000, p. 2) in a very comprehensive manner defines inclusion in the field of education as the concept which involves: a process of reform and restructuring of the school as a whole, with the aim of ensuring that all pupils can have access to the whole range of educational and social opportunities offered by the school; [and which] [†¦ ] include the curriculum on offer, the assessment, recording and reporting of pupils’ achievements, the decisions that are taken on the grouping of pupils within schools or classrooms, pedagogy and classroom practice, sport and leisure and recreational opportunities. At the same time, application of the notion of inclusion to everything from school effectiveness to civil rights to political manifestos, which we witness recently, renders it vacuous and susceptible to those critiques which accuse it of masking inadequacies (Booth & Ainscow 1998). For example, Armstrong (2005, p. 136) admits that the statistics on academic achievements of children with SEN for the period, when New Labour government is in office actively promoting inclusion in every sphere of social life, do not demonstrate any â€Å"radical transformation of the social practices of inclusion/exclusion†. Besides, for the cynics, inclusive education means abandoning labelling and special resourcing for individual needs in order to cut costs in the name of equality. They emphatically ask the quality assurance questions of what it offers to enhance learning, how to measure its quality, and which strategies are selected as of proven value (Thomas & Vaughan 2004, p. 25). Addressing these types of questions is the current responsibility of any school which purports to be inclusive (Skrtic 1995, p. 206). The way in which inclusive education, or in its earlier incarnation – integration, has been researched over the last few years is an indicator of the political nature of research in any area in which ethical issues are paramount (Clough & Corbett 2000, p. 162). The shift of emphasis has been sequential albeit often complementary: from psychological and medical child-deficit models of integrating individual children; to a sociological critique of labelling and segregation; to inclusion being an integral element of school effectiveness; to a social model of disability, placing the onus on institutions to remove barriers which limit participation (Thomas & Loxley 2001). These tendencies demonstrate that inclusive education is an evolving and so to say ‘alive’ area influenced by prevailing educational trends, such as initiatives to reduce exclusions, and by the impact of external assessment measures and competition between schools (Clough & Corbett 2000, p. 152).

Monday, July 29, 2019

What if Toward Excellence in Reasoning by Hintikka & Bachman Thesis Proposal

What if Toward Excellence in Reasoning by Hintikka & Bachman - Thesis Proposal Example The statements have been distinguished under the following headings:  Ã¢â‚¬Å"And you don’t have to be a sociologist to recognize that the prime motivation for virtually everything Americans do is entertainment; remove the entertainment motive, and you make the prospect of learning to read resemble an exercise in stoicism.†Ã‚  The premise is the part of a statement that serves as a support to the conclusive part of the whole statement; on the other hand, the conclusion is the part that expresses the final theme of the statement with the help of premise. The argument analyses of the given passage are as under Statement: â€Å"If you want an explanation for declining literacy rates in the U.S.†Ã‚  Explanations: These lines explain that it is not only entertainment, which is sought out by the masses. Rather, books provide the readers with knowledge, wisdom, and information too. Thus, television may be a source of amusement, but it is not true that books have been re placed by television because of seeking entertainment only.  Statement: â€Å"look no further than the boob tube.† (Intermediate Conclusion)  Explanations: This part of the statement speaks out television as the root-cause of falling literacy rate. The writers have used the slang phrase i.e. boob tube to mention television. As this part is based on conclusive assumption and does not emphatically prove the truth and validity of the real picture, it is, therefore, it can be stated as the intermediate conclusion.  Statement: â€Å"Spend all the money you choose on studies in an attempt to address the problem, but if you want my advice, you’d be better off unplugging the TV set.† (Final Conclusion)  Explanations: These lines disclose the conclusion of the argument, where the writers have refuted the idea that television has led to low literacy rate. Moreover, they do not agree to the notion that unplugging TV might increase trend towards reading.

Sunday, July 28, 2019

Tech Article Essay Example | Topics and Well Written Essays - 250 words - 2

Tech Article - Essay Example This technology is really unique because the software can recognize only the user’s voice, even if there are some background noises. Although some mobile phones have such functions such as voice commands, being able to dictate notes is a novel idea that provides a lot of convenience. People can take down notes even while driving, which usually happens. The technology is already being used by medical encoders because it makes the work much efficient and prevents repetitive stress injury on their hand/wrist. This technology has potential applications in various settings. In schools, ESL learners can become aware of their pronunciation by using this technology. They can dictate their notes and see if the computer can properly recognize the word. In BPO services, writers can use this technology, which can prevent them from developing musculoskeletal disorders in their wrist or forearm. Scientists or researchers can use this to dictate observations and have them printed immediately . Indeed, speech to text applications would definitely be used in many ways by different industries, whether for scientific, operations, or entertainment in the coming years. References Misel, Eli. "Android Apps: Speech to Text."Â  Find Health, Education, Science & Technology Articles, Reviews, How-To and Tech Tips At Bright Hub - Apply To Be A Writer Today!. BrightHUb, 13 Sept. 2010. Web. 29 Mar. 2011.

Saturday, July 27, 2019

Artifacts of our own cultures surround us. From art and music to Essay

Artifacts of our own cultures surround us. From art and music to architecture and literature, from philosophy and religion to laws and economics, we live among cultural artifacts that have deep roots - Essay Example The United States of America has its rich history that is being evidenced by the various artifacts that are seen in museums, which are preserved to serve as a symbol of the changes the nation has gone through the years. One of these significant artifacts is the Star-Spangled Banner, the flag that became the inspiration of Francis Scott Key in creating a poem, which is now America’s national anthem. The stars in the banner are about two feet across in size. The method used to create the cotton stars was the reverse applique’ method. The blue portion of the banner is canton or wool pigmented with indigo. There was a stain on one star that may have come from a metal buckle. Georgina Armistead Appleton sewed an inscription into the flag. Only fifteen stars were left since one star was cut out during the 1800s (Smithsonian National Museum of American History, n.d.). Wool pigmented with roots of madder plant make up its red stripes. One stripe and one star represented the fifteen states of the U.S during that period (â€Å"The Star-Spangled,† n.d.). The flag has deteriorated with its edges damaged, and it has undergone several repairs prior to reaching the Smithsonian museum, where it is now being preserved (Smithsonian National Museum of American History, n.d.). The Star-Spangled Banner is a legacy, a symbol of freedom and victory for the American people. If not because of this flag, the national anthem that America has in this day age will not be made. Americans live in a country, where there is liberty and diversity, and this is well embodied by this artifact. The banner has been made at that point in history, where the American soldiers were fighting for the country. Thus, it became a witness to some of the crucial points in American history. Americans are warriors, who value peace and benevolence. This is evidenced by the nation’s participation to worldwide

Friday, July 26, 2019

Report to the Board of Directors - 3M Company Coursework

Report to the Board of Directors - 3M Company - Coursework Example In case of determination of impairment of assets, the management has adopted separate measurement techniques of evaluating the different units by categorizing them as profit making or loss making. The price-earnings ratio method has been used for profit-making units, the discounted cash flow method has been used for the loss-making units and the relative fair value method has been used for the changes in products offerings of the different units (Sofat and Hiro, 2008, p.84). The influence of the institutional context and the social context on the measurement choices for accounting treatment have been considered in the process of financial reporting. The necessary changes in the accounting treatment of the company to comply and align with the norms under IFRS have been suggested to improve the process of accounting and financial reporting. ... The contingent assets are also considered for PPE valuation. The management takes into account the historical experiences in evaluating the property, plant and equipment of 3M Company (Khan, 2004, p.49). Based on the past experience and reasonable justification of the related factors, the PPE valuation is carried out by the management. The management, however, believes that the accounting of PPE and the reporting of PPE valuation may differ from the actual value of the total property, plant and equipment. The determination of the value of property, plant and equipment takes into account, the related losses and depreciation of the assets. The valuation of the asset includes the cost of purchase and the cost of installation and other expenses incurred in bring the fixed asset to the location of usage. The cost of maintenance and losses if incurred are also adjusted to determine the value of PPE (Baker and  Powell, 2009, p.68). Apart from the cost or risks, the management also takes i nto consideration the expected flow of money from the use of fixed assets. The reward or the benefits of the assets are also taken into consideration for the purpose of PPE valuation. Evaluation of selected measurement model 2: Differences permitted in Asset Impairment methods and accounting treatment The asset impairment is recognized by the management of 3M Company when the reported value of the assets of the company is greater than the intrinsic values of the assets. The impairment method includes the determination of fair value of assets of the individual units of 3M Company and then comparing with the reported value of the assets of the individual units. The method

Portrait of a Fourth Grade Classroom Coursework Example | Topics and Well Written Essays - 500 words

Portrait of a Fourth Grade Classroom - Coursework Example Gullon (2005) observes that â€Å"your classroom has to serve a variety of purposes for a variety of people and as such will need routines and rules.† There is also the need to ensure that there is maximum quietness at all times to facilitate individual learning and attentiveness during lesson delivery. Again, tidiness ensures safety and makes the class conducive for learning. Finally, in other to ensure that obedient students are encouraged to put up good behavior and disobedient ones are deterred from their bad behavior, it is important to constitute a reward and punishment mechanism. Establishing an effective learning environment where all students achieve learning outcomes relies on the implementation of a broad range of classroom organisation and management strategies (McBain, 2004, p.1). This tells of how important classroom organization is in the everyday upkeep the classroom environment.

Thursday, July 25, 2019

Mathematic Lesson Plans Essay Example | Topics and Well Written Essays - 2000 words

Mathematic Lesson Plans - Essay Example That means table A has the ratio of 2:3. Table B as cordial mix in three cups; the other two being with water. So the ratio on table B is 3:2. This helps the students in understanding the ratio concept Step-9: Once the students are able to spot the difference, they need to be told what it means when we go on increasing one part of the ratio, or increasing the value of numerator or denominator and how this makes the difference in the overall value of the ratio. Closure: In the closing part of the class, students should be encouraged to think about such cordial relations with the help of (say) 8 plastic cups. So that they get an idea about the manner in which values of the fractions can be varied. Introduction: To start with, student should be asked as to whether they have ever purchased something from the market. Depending upon the couple of responses, the teacher can ask did they ever make use of fractions and resources during such purchases. Subsequently, students need to be informed about the importance of mastering the ratio and fraction calculations in order to be able to do some worthwhile shopping for their friends and family. i. Two students can be asked to volunteer with their mark sheets to come out in front. (Note-It might be possible that students are bit reluctant to divulge the details of their marks. In such cases the teacher would tell provide them with some mark sheet awarding some marks out of the total of 50 or 100. Both the students must have different marks for better understanding the lesson). vi. Now some cases of discounts being offered by the shops or retail stores are brought before the class. The retail stores invariably come out with price discounts. The class is therefore told to figure out the best available deal for them. Closure: After the class, students can be asked to share their shopping experiences and what they felt had they known the concept of

Wednesday, July 24, 2019

Cross Cultural Management Assignment Example | Topics and Well Written Essays - 250 words

Cross Cultural Management - Assignment Example It has been observed that Aboriginal people who live away from their remote areas may adapt some cultures in order to survive. However, they occasionally get some time to practice their cultural practices such as hunting and gathering. For example, those Aboriginals living in urban areas can adapt European lifestyles, but their cultural craft skills and tribal knowledge remain paramount. Thinking and perception of life by the Aboriginal people is based on religious and spiritual beliefs. This means that aboriginal people respected spirits and supernatural powers hence deriving their thoughts from religious beliefs (Marshall 2004, p.87). They use spiritual aspects to unite their people and respect life, as well. However, Aboriginal cultural practices may at times get into conflict with the Anglo-European culture. This means that proper lines have to be drawn between different cultures to ensure that they exist without

Tuesday, July 23, 2019

American Memory of Holocaust Essay Example | Topics and Well Written Essays - 750 words

American Memory of Holocaust - Essay Example In the first decades after the war, Holocaust was quite trivial in both the American and the Jews consciousness (Novick, 1994). Many scholars suggest that the Holocaust awareness by most Americans was based on inaccurate, trivial, and vague representations. The Jews extermination was remembered in important ways such as through the Nuremberg trials, Second World War accounts, comparisons with the Soviet totalitarianism, philosophical works, Jewish and Christian reflections in theology, mass-media portrayals, and scholarly pioneering publications. These attempts in the postwar period to understand the Jewish tragedy in the prevailing cultural paradigms offered the foundation for the consequent comprehension of that event (Baron, 2003). In the late 1960s and 1970s, American memory of the Holocaust moved to a central position. The curve of memory slope may differ, but it is not steadily downward. The most vivid memory is the immediate aftermath of the Holocaust events that declined with the passage of time. With the Holocaust, it has been apparent social amnesia, virtual silence for an entire generation, then, the Rostovian move into self-sustained growth in the late 1960s and 1970s. For close to 20 years after the Second World War, Holocaust was largely ignored, and today, it is elaborated in the repression language. The Gentile guilt and the Jewish agony were too huge to be confronted. The very silence is often viewed as a testimony of the amount of feeling/sentiment that was being repressed (Novick, 1994). It is important to note that Holocaust became important in the American Jewish life â€Å"only after the Eichmann trial, Israel’s 1967 triumph in the Six-Day War, and the surprise attack by Egypt and costly victory by Israel in the 1973 Yom Kippur War† (Baron, 2003, p62). 3.B. The comic book â€Å"Maus: A Survivor’s Tale (1986)† subtitled as â€Å"My Father Bleeds History† was written by Spiegelman. The comic book narrates two stories; one story is about Artie’s current relationship with Vladek (his father) in Queens, New York. The other story is about the experiences of his parents during the occupation of Nazi in Poland. The text is preoccupied by the question of how Artie (or any other individual in the second generation) can come to possess their parents’ experiences, experiences they never witnessed. Towards the culmination of the first volume, Vladek and Artie are walking when Vladek bends over a trash container and takes an old piece of wire (Landsberg, 1997). Artie asks Vladek why he picked up the wire, Vladek responds by saying that inside the wire are other little wires, and they are good for trying things. Infuriated, Arties asks his father why he always picks up trash and why he cannot buy his own wires. Vladek responds by saying that why one has to buy if he can find some, and that the wires cannot be found in stores. He goes on to tell him that the wires he has picked are very useful. This scene involving Artie and Vladek functions as the metaphor for what the text itself does. The wire recirculation becomes an allegory for the Holocaust recirculation through a different medium. In this case, the recirculation is done by a comic book and this indicates that when the narrative is put into a different medium, new possibilities, and new insights appear (Landsberg, 1997). In this representation, the main theme is recirculation of the Holocaust. The recirculation of the wire serves as a metaphor for the potential value of the Holocaust in the American nation. It becomes a means

Monday, July 22, 2019

The development of relationships is communication Essay Example for Free

The development of relationships is communication Essay One of the most vital componentsin the development of relationships is communication. It remains as one of the most important factors in people’s relationships, helping them develop in the attainment of their desired objectives as they form their own unique relationships. Similarly, it has been seen as a qualifying factor in the success of many important personalities. Thus, the process in which individuals communicate to one another is a critical process in determining sustenance and improvement in environments. I had always envisioned a borderless world, one where people will not be hindered by boundaries, language and color, without the presence of discrimination and prejudices. Despite the difficulty in tfulfilling this perspective, I know that by understanding and advancing our communication processes, such an instance can be possible. With these views and desires in mind, I would like to express my intention to apply for a communication major at the University of California. Given these facts, I will try to convince the admissions committee on the merits of my application. Given that there is a large number of applicants seeking acceptance in this prestigious learning institution, it is important for me to lay out good reasons how I can contribute and serve the purpose of the University, particularly in my relevant objectives and my short long term goals. All of this corresponds on the idea of what can reciprocate. My first interest in the communication process began in my early years in high school at the East Coast. Being an international student, I was faced with the everyday challenges that I have to deal with. New people, policies, environments, languages and cultures were all alien to me as I adjusted to my new surroundings. It was hard to learn when things just seemed to line up, waiting to be solved by a person who nary knew anything about them. By learning languages and cultures, communicating with people from different countries got easier, and from my first experience in resolving communication situations, the interest in the process of communication grew. I would like to seek admission to further develop my longstanding interest in the realm of communication. I consider it an amazing experience to know people from different cultures and languages. This was my same situation in my stay in the United States, dealing with different nationalities and a foreign language. As an international student living in the United States, a place with different kinds of people, learning their traditional cultures and styles is necessary to communicate with them. My wish is to gain the ability and knowldege to communicate with every single person. In my native Hong Kong, the relationships I had with friends and peers clearly established my intention to further grasp the process of communication, needing to understand the importance of both verbal and non-verbal styles. Similarly, I wanted to see how people’s behavior manifested in their interaction with others. This wide diversity of people’s attitudes and perceptions has given me the initiative in understanding their relationship with each other, kindling my interest in communication. Likewise, the numerous ways people engage with each other fascinates me. This setup, unique only to humans, has been the integral part in the formation of several communication and language theories. All of these are focused on one important goal – promote better understanding. With the development of new technologies, there are various methods and practices that can be exhausted in the process. Chatting, web conferencing, and emails has given the art of dialogue a new direction. Due to this, human beings have become closer amidst the presence of intangible and tangible boundaries. On the other hand, my academic study has given me substantial theoretical anchors essential to my understanding of the subject. Also, the relevant subjects that were facilitated during my academic years have been instrumental in giving me the necessary tools to accomplish my tasks, developing the training and enhancement of my personal capabilities and skills. With this, I can say that my study at Santa Monica Community College has given me the needed exposure to create my own interpretation of communication and dialogue. This understanding of communication has enabled me to create better and harmonious relationship with my peers. My inclination to both volunteer and civic activities clearly became a benchmark for creating my individual interpretation of dialogue. Also, being part of sports related endeavors, I understood the magnitude of communication. The thing about athletics is that it does not only focus on the values of sportsmanship and discipline. As a member of AGS at Santa Monica Community College, I saw the need to seek better opportunities. First of these was the value of service among different cultural and racial backgrounds. Back then, I only had to settle with a few minorities, our type t being the dominant one. Here at Santa Monica, I had the experience of being exposed to a wide array of cultures and beliefs. All these became integral to my overall perception of defining communication. Having said these, I feel that I am qualified to be included in the applicants list. I want to learn the knowledge of acquiring and learning new ideas and concepts. I feel the need to remove barriers within my personality and in others. From my expeience, it is to hard to talk to strangers. People think Im weird when I talk to them. But if given this degree, I can acquire the confidence and self esteem I need to convey my message. In the end, this communication degree is only a stepping stone of what I want to be as part of my goals in attaining my long term plans. Despite the challenges and hurdles that may come, I feel that I am ready and equipped with the necessary values and credentials to withstand everything.

Sunday, July 21, 2019

Healthcare Reforms in England Issues of Efficiency

Healthcare Reforms in England Issues of Efficiency The healthcare service in England attempts to improve the overall healthcare service have been ongoing through some of the most radical reforms since its inception as a comprehensive public service since 1948. The noticeable need of a free healthcare service was essential after the state of the country due to the world war. Once the NHS was established it saw many reforms led by diverse types of governments at different times. Despite the scale of the reforms they have preserved their core principle of A free service at the point of delivery 1 till this very day. Even though they have adopted the core principle they still face huge challenges; as demands and costs are still rising, the entirety of the service is increasingly being looked at. This paper looks at the reforms the NHS has been through and analyses each reform in the light of Efficiency: the capability of the NHS, whether the reform made the NHS more competent, Equity: bringing fairness and equal right for the patients as well as the staff, Quality: whether adapting the reforms improved the patients ability to acquire different types of healthcare services without any predicament and obtain high-quality healthcare services. Methodology This paper was conjured up by the use of reports published by NHS Publications website. Journals and studies on NHS reform via the scientific database PubMed were also utilized. To gain info on the theories the NHS was formed on, management theory books by Max Weber, Henri Fayol and Frederic Winslow Taylor were used. Results/Discussion Each reform improvised the NHS in many ways, in relation to Efficiency the NHS since its inception has seen major investments and new hospitals built, employment of up to date technology allowing more patients to be seen within an applicable time and budgets been controlled efficiently with the aim to reduce costs each year allowing the NHS to run efficiently. In terms of Equity after the publication of the Black report, the NHS has improved on giving equal opportunities to its minor ethnic groups of staff. Also the equal treatment of patients regardless of their social class has been improved since the Blair era. The NHS in terms of quality has become one of the world leading healthcare providers. Measuring their services against standards set by the NHS ensured that they are meeting the set standards. The major investment in staff in 2000 saw a number of lives saved in the past 10 years. The NHS has met quality standards that are accepted by its patients and valued as a first class service. Conclusion Overall the NHS has seen many reforms which have lead to the NHS becoming a world class service. Since the reforms in the 1960s to the latest plans of the new coalition government the NHS has improved immensely in terms of efficiency, equity and quality and the future also looks bright for the NHS. Introduction: Healthcare service in England was launched in 1948 with an aim to provide universal healthcare to its citizens which is free at the point of use and available to everyone based on need, not ability to pay 1. The NHS was established after World War II where the country needed a stable healthcare service 2. The initial idea was that no-one should be deterred from seeking health services by a lack of resources and the founder Aneurin Bevan: Minster of Health stated A free service at the point of delivery 3. Till this day they have been providing free healthcare service to the citizens of England. In 1948 Sir William Beveridge, a British Economist and a Social Reformer conferred details of his radical plans for economic and social reform in post-war Britain. Sir William proposed major healthcare service changes on the basis that the country needed the abolition of want before the enjoyment of comfort and suggested a scheme where every kind of medical treatment would be available for everybody. 1,3 Pre NHS There has been some form of state-funded provision of health and social care in England prior to the NHS for 400 years.4 Prior to a health system being formed, attaining healthcare service in Britain in the 1930s and 1940s was difficult. Life expectancy was very low and thousands of people died of infectious diseases like pneumonia, meningitis, tuberculosis, diphtheria, and polio each year.4 The poor never had access to medical treatment and they relied instead on dubious and sometimes dangerous home remedies. Either that or they relied on doctors who gave their services free to the poor patients. The Hospitals charged for treatment and although the poor were reimbursed and before they received treatment they had to pay.4 Figure 1 shows the life expectancy that has changed since the NHS was introduced. Figure 1.Life expectancy changes since 1840 5 The need for free healthcare was widely recognised, but it was impossible to achieve without the support or resources of the government. A study showed that experts believed and have written extensively on the reasons of why a health service was needed.6 These included: The appearance of a view that health care was essential, not something just imparted erratically by charity The drastic effects of the war that made it possible to have a massive change of the healthcare service being provided, rather than just an incremental alteration As younger members of the country were becoming increasingly educated in the medical profession they had a view of things could be handle in a more efficient way. The hospitals having financial problems, funds not sufficing.6 Having looked at the reasons to why a health service was needed the government made plans and core principles were established: 6 Regardless of persons status they were eligible for health care, even people temporarily residing or visiting the country.ÂÂ   People could be referred to any hospital. The healthcare service was financed almost 100% from central taxationÂÂ   Care was entirely free at the point of use6 The main achievement was that the poor who in the past went without medical treatment now had access to free healthcare.6 NHS today and NHS employment NHS is one of the largest organisations in the world with an annual budget of around ÂÂ £80 billion employing more than 1.7 million people and treating over one million people every 36 hours.7 In general, healthcare service being provided within England to every single citizen is a difficult commission to undertake and consequently the system needs efficient health personnels to help run the system economically. Today the view of the healthcare service in England is that the NHS is a world leader and provides first class service that other countries envy. Countries all over the world seek to learn from the comprehensive system of general practice, and its role as the medical home for patients, providing continuity of care and coordination.8 Other countries look at English NHS system and use them as a guideline to run their healthcare system. NHS Structure The healthcare service in England has been run in a structural way with the Secretary of state and Department of Health controlling the overall NHS in England. The secretary of state for health has the responsibility of reporting to the prime minister. There are10 Strategic Health Authorities (SHAs) in England which are controlled by the Department of Health, they oversee all the activities within the NHS and the SHAs supervise all the NHS trusts in its area. Primary care plays a major role in community healthcare and is central to the NHS. Services under NHS trust (Secondary Care) include Hospitals, Mental Health services, Learning disability services and Ambulances. The overall structure of the NHS is shown below in Figure 2. 9 Although this is the current NHS structure with the new government in power, changes are to follow. Figure.2 overall structure of the Healthcare system in England 5 NHS Reforms Since its inception in 1948 the NHS has seen many reforms in terms of managing the way they provide healthcare service. The DoH has a lot of control and influence the major decisions taken in the reforms. The overall expectations of Healthcare service in England are of a high calibre, which requisites high-quality management capacity.10 In the 1980s and early 1990s prominence was on recuperating management. The recent focal point has been on development of leadership within NHS. With the new government, new ideas and plans will be imposed to see improvements in quality of healthcare being provided, cut down on costs making it more efficient and in terms of equity provide equal service to everyone. Table 1 briefly enlists the reforms that have taken place since its inception in 1948. Table.1 Reforms in the NHS: 1948-2010 Period the reforms were in place Reform and theory of Management 1948- 1960 Managers as diplomats 1960s Scientific Management and the Salmon report 1970s Classical Management, Systems Approaches and the 1974 Reorganization 1980s The Griffiths report and Managerialism 1990s Working for Patients and the Internal Market 2000 The NHS Plan (DOH 2000) and the Third Way. 2010 NHS White Paper 2010: Equity and excellence: Liberating the NHS Healthcare service and Reforms in other Developed Countries Healthcare reforms within developed countries can be analyzed in order to compare whether the healthcare services in England have been successful in its bid to ensure efficiency, equity and quality. Attempts to handle reforms of the healthcare system in the European countries have been an ongoing process for 30 years. Although the reforms have taken throughout the 30 years in different ways, their main emphasis has been on improving the cost-effectiveness of the healthcare service. In the early 1980s the EU countries were looking at cost containment. The feature in the 1990s was to endorse efficiency in terms of introducing competition and markets in the healthcare system. Since 2000 the focus has switched to effectiveness; promoting various notions of healthcare in terms of quality.11 Over the course of the 20th century the countries of Europe have established significant success in improving the healthcare service for their citizens. However they still face challenges in the form of restraining costs, improving quality and providing universal healthcare access, these have put the European healthcare services under immense pressure.11 Looking at another OECD: USA, A report on A review of health care reform in the United States assessed whether the USA have been successful in providing healthcare. The findings showed that United States spent more per capita on health care than any other OECD country, yet its health outcomes lagged behind other countries.12 This shows they are struggling with efficiency issues and are still countering challenges in providing quality healthcare service that is expected from the citizens of the USA. Especially in the last few years Healthcare reform has been a major activity of the federal government, in order to revolutionize and develop the service overall. The 3 goals of optimizing cost, access and quality still remain a challenge within the healthcare society in the U.S.12 They concluded that USA still faced many challenges in running the national healthcare service, a key challenge they face is the utter complexity of the system, with its numerous public and private providers.12 Another OECD country reviewed in terms of healthcare service being provided and the reforms that have taken place is China. A report from on From a national, centrally planned health system to a system based on the market: lessons from China concluded: China is the country that has undergone the highest number of health care reforms. Since 1978, China saw many reforms and they also followed the way as the EU countries, with the healthcare system starting from governmental, centrally planned and a collective system to ending up as a heavily market influenced system. Now, thirty years later, the Chinese government openly concede that the reforms were unsuccessful and seek innovative and fresh directions.13 This illustrates that China is also in a healthcare crisis and looking to implement different strategies in order to gain control of Chinas Healthcare system. Having reviewed the healthcare service being endowed in these developed countries, it demonstrates that they are all on an identical level as the healthcare service being provided in England and all face similar challenges. All these developed countries are looking to develop the countries overall healthcare service in terms of efficiency, equity and quality. NHS Plan 2000 and the future of NHS Since the last reform: The NHS plan 2000 14, a lot has transformed in terms of funding and operating the healthcare system in England. Especially with the new coalition governments idea of cutting budgets it is a difficult time the NHS is going through and will necessitate a lot of expertise and world class management to get through todays financial and economical predicament. An additional indication that will be taken into deliberation is the election of the new plans set out in the NHS White Paper 2010. As the new coalition government has come into authority there have been huge changes to overall budgets for the public services and this possibly will have a consequence on the way the NHS operates in England. 15 The reforms have encompassed a significant impact on the organisation and deliverance of health care service in England. Wide array of transformations have been pioneered in an attempt to ensure the NHS is managed more resourcefully and effectively. This report will examine whether these reforms have on the whole improved the healthcare system in England in terms of efficiency, equity and quality and if the publics requirements have been convened. Aims: To examine the healthcare reforms in England since its inception and to assess whether these reforms have improved factors of efficiency, equity and quality in providing healthcare. Objectives: To review the reforms in the NHS since its inception in 1948 To examine whether these reforms improved efficiency, equity and quality of healthcare To assess the key features of healthcare reforms proposed by the current government and their implications on the NHS To put forward plans for the future of the NHS Methodology: A number of sources were consulted to conjure up this paper and examine the healthcare reforms in the NHS. Scientific search engines and databases such as PubMed, Google Scholar and Science Direct (Date accessed 20/10/10) were used to gain literature reviews but results from Google Scholar and Science Direct were dismissed as they were too vague and irrelevant to this topic. With PubMed following keywords were inserted Healthcare, Reforms and England. The data was also set from 1948 to 2010 when searching for reports as this would set the inclusion criteria. The reports and journals since 1948, when the NHS was established were used. Even though history before 1948 was looked at for study purposes, reports before NHS establishment; these were regarded as the exclusion criteria as reports werent looked at prior to 1948. Healthcare service within Britain was looked at in general but for the results of this report, the inclusion criteria was healthcare service in England as it just look ed at the healthcare service being provided within England. The exclusion criterion was healthcare service in Scotland, Wales and Northern Ireland. For the first part of the report, the introduction: where the report looked at the history of the NHS. The resources used included looking at general management books looking at management theories. The classical theories of Max Weber, Frederic Taylor and Henri Fayol were the backbone of the NHS and that is why these were used. Another source to produce this paper was the Department of health (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/index.htm) where the publications and reports about the NHS in general were looked at. This paper used a lot of publications produced by the Department of health and the NHS publications as these sources are reliable; these were seen as good foundation to work from. One of the main publications used was The NHS white paper: Equity and excellence: Liberating the NHS presented to Parliament by the Secretary of State for Health, this was a key entity in writing up this paper. As the paper didnt contract with experiments and clinical trials, it didnt look at a lot of statistics; the majority of its content was obtained from qualitative data. Results/ Discussion Having carried out the required literature searches and reading journals, reports and Department of Health Publications, results were gathered and have been shown below with the discussion of the key topics. The results look at each reform taken place in the NHS and then goes onto analyse the plans set by the new government. Having looked at the reforms and the new plans the paper than talks about efficiency, equity and quality related to each reform. Reforms in the healthcare service in England The healthcare service in the UK has undergone a number of reforms since its inception in 1948. Prior to 1948, healthcare service was provided in England but due to the increasing pressures for efficiency and quality in health services it lead to these developments and reforms in healthcare being provided. A more overtly management-oriented approach to the healthcare service delivery was adopted based on classical management theories to gain more control of the healthcare service in England. 16,17 Classical theories and Scientific Management: 1960s The NHS was based on the classical theories of Frederic Winslow Taylor, Henri Fayol and Max Weber. 16-19 Table 1: Frederic Winslow Taylors four main scientific management principles. Replacing rule-of-work thumb methods with methods based on a scientific of the tasks Scientifically train each individual rather than leave them to train themselves Cooperate with each worker to ensure that the scientific method is being followed Divide workload equally between managers and staff Table 2: Henri Fayols Modern Operational Management approach. Division of work- Specialization for efficiency Authority Responsibility- Both are related, the latter arising from the former. Discipline-Requires good superiors at all levels Unity of Command- Employee should receive orders from one superior only Unity of Direction- Each group of activities with the same objective must have one head and one plan Subordination of individual to general interest- When the two are found to differ, management must reconcile them Remuneration-Should be fair and satisfactory Centralization-Extent to which authority is concentrated or dispersed Scalar chain/line of authority-Needs to be sensible, clear and understood Order : Right thing/person in the right place Equity- Equal opportunity for everyone Stability of tenure- Unnecessary turnover is both the cause and effect of bad management Initiative- Thinking out and execution of a plan Thinking out and execution of a plan Table 3. Max Webers Bureaucratic approach. Power-Ability to get things done, often by the use of threats or sanctions Authority- Ability to get things done because of the position that justified someone in terms of legitimacy Formal approach Hierarchical authority Extensive roles and procedures- Uniformity of decisions and actions Job description- Clear-cut division of labour and High level of specialization Discipline These classical theories contributed a lot to the healthcare service in England and still do to this day.16-19 The classical writers thought of the NHS in terms of purpose and formal structure. They created a formal structure on which the NHS could run on. They also looked at job design, scientific selection and development of workers. The classical theories generally serve as a backbone to the present day NHS management. Although the classical theories made a big contribution to the healthcare service in England it had its limitations and wasnt the most effective way. One drawback was that it wasnt evidence based; it didnt look at the way staff did their tasks and didnt look at the well being of staff, the human and social aspects of work. It just treated them like machines. The theories didnt look at motivating the staff and developing them in their own interests, had they done this staffs work quality wouldve enhanced thus providing an efficient service to patients and overall improve the quality of healthcare service in England. Overall the classical theories were too concrete and fully based on rules and procedures. In terms of efficiency the theories bought a set way of running the healthcare service in England. Once the NHS was established it introduced equity as well as healthcare service was now available to anyone. The NHS was just established and with these set in place in the 1960s the qua lity of service would improve from now with further reforms to come. Salmon Report: 1960s One of the first reforms took place since the NHS was established was in the 1960s. The Salmon Report bought findings and changes which included that workload should be equally distributed between managers and practitioners.20 The NHS would also get rid of matrons and replace them with a hierarchy of nurse managers. The introduction of several additional layers to the management hierarchy; in order to improve efficiency in operating the NHS. This lead to responsibility being equally distributed and the service met its aims and objectives more efficiently. Another change was that nurse managers would contribute to the overall management of the service through the medium of consensus management teams and thus improve efficiency and quality within the NHS. Having nurse managers lead to them taking control of set responsibilities and helped in general running of tasks at ward level leading to an improvement in general quality in the healthcare service being provided. 1974 Reorganization: 1970s The aim of this reform was to attain greater integration of the healthcare service in order to provide more stability and increase efficiency. The reorganisation also introduced more central control in order to: 21 ensure policies were implemented improve accountability encourage delegation develop democratic decision-making process These changes lead to a more structured way for managers to follow and enhance the quality of the healthcare service. By the mid 1970s quality was improving but there were still concerns of equity in the NHS. There were still clear differences of health sufferers in terms of social class; figures showed that people in lower social classes more likely suffered from diseases. There were several possible explanations for these inequalities. Natural and social selection. This would depend on the view that people who are fittest are most likely to succeed in society, and classes reflect this degree of selection. Poverty leads to ill health, through nutrition, housing and environment. Cultural and behavioural explanations. There are differences in the diet and fitness of different social classes, and in certain habits like smoking. 22,23 Overall in the 1970s the quality of healthcare service was still improving, equity issues were still a concern and in terms of efficiency they were recuperating the NHS. The Griffiths Report: 1980s This reform was a major point in NHS history, the Griffiths Report identified problems such as the healthcare service was institutionally inactive and that the local health authorities were filled with directives without being given any clear procedures to follow.24 The Griffiths report stated that changes were difficult to achieve but gave recommendations to improve the NHS. It introduced a more formal and modern way of management. It gave increased participation for managers in setting and controlling budgets. The report also gave greater emphasis on cost awareness in order to improve efficiency. A Clear and quick decision-making process was introduced to improve quality of service provided to patients. The managers in local authorities were given a more clearly defined direction and the overall staffs were better informed.24 The Internal Market Working For Patients: 1990s Another reform in the 1990s took place, this bought a new dimension to the NHS; large publicly-owned hospitals could opt to become self-managed trusts. This meant that health services could be bought by private investors i.e. patients themselves thus allowing them to take control of the way they want the service. Even large GPs could become fund holders and be both purchasers and providers of care.25 This reform lead to introduction of greater flexibility thus allowing more effective matching of patients needs and care. Money followed the patients through the system of purchasing and providing of healthcare service, this led to equity being improved as patients had more selection of services. This reform led to higher competition in providing quality healthcare service, the costs decreased and the general quality increased. The NHS Plan 2000 The NHS Plan 2000 made key findings : the NHS is a 1940s system operating in the 21st century and that it lacked of national standards. It also said that there were barriers between staff and providing services. There were a lack of clear guidelines and the NHS structure has over-centralization.14 Plans to diminish problems and propose new plans such as introducing Modern Matrons to improve the management of services, a strong leader with clinical experience and with clear authority at ward level, improve efficiency by setting standards and controlling resources these were there aims.14,26 The figure below shows the comparison of the 1948 and the new NHS model outlining the key differences. Figure.4 the key difference between the 1948 model and The NHS Plan 2000 model 14 The NHS Plan 2000: Achievements This reform set out specific targets which were achieved in order to improve efficiency, equity and quality of healthcare service in England: Over 100 new hospitals by 2010 and 500 new one-stop primary care centres Clean wards and better hospital food 7,000 extra beds in hospitals Over 3,000 GP premises modernized Modern IT systems in every hospital and GP surgery 7,500 more consultants and 2,000 more GPs 20,000 extra nurses and 6,500 extra therapists Childcare support for NHS staff with 100 on-site nurseries.26 These targets were achieved in 2008 and it led to the improvement of efficiency as the number of GPs and consultants employed were increased. The modernisation of technology and IT systems led to quality of service being improved as high investment in high quality equipment made the NHS one of the worlds top quality service. Since 2000 NHS has improved the overall service and met its objectives. NHS Implications: Equity and excellence: Liberating the NHS With the new coalition government coming into election another set of reforms have been proposed as they hope to improve the overall healthcare service in England. The main aims and objectives to improve the healthcare service are varied and very detailed but to summarise it these are the points covered:15 Increase health spending in real terms in each year of this Parliament 15and also that there goal is an NHS which achieves results that are amongst the best in the world 15. However the government will uphold the foundation that the NHS was formed on; a comprehensive service, available to all, free at the point of use and based on clinical need, not the ability to pay 15. The government than goes into detail of what they arrange to initiate to make an efficient healthcare service: acknowledge the fact that patients come first and therefore will give them greater choice and control. An example of this is that a patient will be able to choose any GP practice, consultant, and choice of treatment consequently improving equity of the service. The government endeavours to develop the healthcare outcomes: set objectives such as reduce mortality and morbidity, increase safety, and improve patient experience and outcomes for all 15. By doing this they are ensuring they are driving efficiency and improving the service. In order to achieve the objectives that the government sets, the ability for service providers to have more autonomy, responsibility and accountability will be a means to achieving efficient results. A big change will be the establishment of a NHS Commissioning Board. The board will be accountable for making sure health outcomes are achieved, allocate resources and have the lead on quality improvement and to tackle inequalities that exist in the NHS. Overall the reforms in the NHS Paper 2010 will provide the NHS with greater incentives to increase efficiency, equity and quality. Efficiency The healthcare system in England has on the whole perceived a huge improvement in terms of efficiency since its inception in 1948. A system has been established where it endows with one of the best services in the world but there are still room for improvements. An analysis of the services gives evidence such as the NHS building 100 new hospitals since 2000, therefore improving the efficiency and allowing better access for patients. 27 Even though there continue to be a lack of quality and accessibility to services across the country. The patients havent been able to impose enough pressure to force improvements. The NHS need to give patients more control over the health services they have access to improve efficiency. In 2008 investment in the NHS as a whole rose from ÂÂ £43.9bn per year in 2000, when the NHS Plan was launched, to ÂÂ £92.6bn. another measurement of efficiency is looking at numbers of early deaths from cancer, coronary heart disease and suicide; they continue to fall as services improve; over 98% of patients at Accident and Emergency (AE) Departments are seen within 4 hours; and hospital waiting lists are lower than ever, with half a million fewer patients waiting since lists were at their peak.28 One key way to achieve the set objectives is to cut down NHS managements costs by 45% over the next four years enabling them to free up investment for further improvements.28 Much has been achieved during the last five years of investment and reforms. For example, the significant investment in NHS staff, along with more flexible working, is facilitating healthcare professionals to take advantage of the freedom thus improving their commitment to the NHS. NHS staff working flexibly and using improved technology are better able to respond to patients needs and changing expectations and are achieving improvements in quality and productivity across the system.27 Since 1948, the NHS budget on average has risen over 4% in real terms each year; this is something they hope to resolve as the NHS will face a sustained and substantial financial constraint if it continues. They hope to avoid the financial crisis that happened in the NHS in the 1970s. The NHS hopes to release up to ÂÂ £20 billion of efficiency savings by 2014, which will be reinvested to suppor Healthcare Reforms in England Issues of Efficiency Healthcare Reforms in England Issues of Efficiency The healthcare service in England attempts to improve the overall healthcare service have been ongoing through some of the most radical reforms since its inception as a comprehensive public service since 1948. The noticeable need of a free healthcare service was essential after the state of the country due to the world war. Once the NHS was established it saw many reforms led by diverse types of governments at different times. Despite the scale of the reforms they have preserved their core principle of A free service at the point of delivery 1 till this very day. Even though they have adopted the core principle they still face huge challenges; as demands and costs are still rising, the entirety of the service is increasingly being looked at. This paper looks at the reforms the NHS has been through and analyses each reform in the light of Efficiency: the capability of the NHS, whether the reform made the NHS more competent, Equity: bringing fairness and equal right for the patients as well as the staff, Quality: whether adapting the reforms improved the patients ability to acquire different types of healthcare services without any predicament and obtain high-quality healthcare services. Methodology This paper was conjured up by the use of reports published by NHS Publications website. Journals and studies on NHS reform via the scientific database PubMed were also utilized. To gain info on the theories the NHS was formed on, management theory books by Max Weber, Henri Fayol and Frederic Winslow Taylor were used. Results/Discussion Each reform improvised the NHS in many ways, in relation to Efficiency the NHS since its inception has seen major investments and new hospitals built, employment of up to date technology allowing more patients to be seen within an applicable time and budgets been controlled efficiently with the aim to reduce costs each year allowing the NHS to run efficiently. In terms of Equity after the publication of the Black report, the NHS has improved on giving equal opportunities to its minor ethnic groups of staff. Also the equal treatment of patients regardless of their social class has been improved since the Blair era. The NHS in terms of quality has become one of the world leading healthcare providers. Measuring their services against standards set by the NHS ensured that they are meeting the set standards. The major investment in staff in 2000 saw a number of lives saved in the past 10 years. The NHS has met quality standards that are accepted by its patients and valued as a first class service. Conclusion Overall the NHS has seen many reforms which have lead to the NHS becoming a world class service. Since the reforms in the 1960s to the latest plans of the new coalition government the NHS has improved immensely in terms of efficiency, equity and quality and the future also looks bright for the NHS. Introduction: Healthcare service in England was launched in 1948 with an aim to provide universal healthcare to its citizens which is free at the point of use and available to everyone based on need, not ability to pay 1. The NHS was established after World War II where the country needed a stable healthcare service 2. The initial idea was that no-one should be deterred from seeking health services by a lack of resources and the founder Aneurin Bevan: Minster of Health stated A free service at the point of delivery 3. Till this day they have been providing free healthcare service to the citizens of England. In 1948 Sir William Beveridge, a British Economist and a Social Reformer conferred details of his radical plans for economic and social reform in post-war Britain. Sir William proposed major healthcare service changes on the basis that the country needed the abolition of want before the enjoyment of comfort and suggested a scheme where every kind of medical treatment would be available for everybody. 1,3 Pre NHS There has been some form of state-funded provision of health and social care in England prior to the NHS for 400 years.4 Prior to a health system being formed, attaining healthcare service in Britain in the 1930s and 1940s was difficult. Life expectancy was very low and thousands of people died of infectious diseases like pneumonia, meningitis, tuberculosis, diphtheria, and polio each year.4 The poor never had access to medical treatment and they relied instead on dubious and sometimes dangerous home remedies. Either that or they relied on doctors who gave their services free to the poor patients. The Hospitals charged for treatment and although the poor were reimbursed and before they received treatment they had to pay.4 Figure 1 shows the life expectancy that has changed since the NHS was introduced. Figure 1.Life expectancy changes since 1840 5 The need for free healthcare was widely recognised, but it was impossible to achieve without the support or resources of the government. A study showed that experts believed and have written extensively on the reasons of why a health service was needed.6 These included: The appearance of a view that health care was essential, not something just imparted erratically by charity The drastic effects of the war that made it possible to have a massive change of the healthcare service being provided, rather than just an incremental alteration As younger members of the country were becoming increasingly educated in the medical profession they had a view of things could be handle in a more efficient way. The hospitals having financial problems, funds not sufficing.6 Having looked at the reasons to why a health service was needed the government made plans and core principles were established: 6 Regardless of persons status they were eligible for health care, even people temporarily residing or visiting the country.ÂÂ   People could be referred to any hospital. The healthcare service was financed almost 100% from central taxationÂÂ   Care was entirely free at the point of use6 The main achievement was that the poor who in the past went without medical treatment now had access to free healthcare.6 NHS today and NHS employment NHS is one of the largest organisations in the world with an annual budget of around ÂÂ £80 billion employing more than 1.7 million people and treating over one million people every 36 hours.7 In general, healthcare service being provided within England to every single citizen is a difficult commission to undertake and consequently the system needs efficient health personnels to help run the system economically. Today the view of the healthcare service in England is that the NHS is a world leader and provides first class service that other countries envy. Countries all over the world seek to learn from the comprehensive system of general practice, and its role as the medical home for patients, providing continuity of care and coordination.8 Other countries look at English NHS system and use them as a guideline to run their healthcare system. NHS Structure The healthcare service in England has been run in a structural way with the Secretary of state and Department of Health controlling the overall NHS in England. The secretary of state for health has the responsibility of reporting to the prime minister. There are10 Strategic Health Authorities (SHAs) in England which are controlled by the Department of Health, they oversee all the activities within the NHS and the SHAs supervise all the NHS trusts in its area. Primary care plays a major role in community healthcare and is central to the NHS. Services under NHS trust (Secondary Care) include Hospitals, Mental Health services, Learning disability services and Ambulances. The overall structure of the NHS is shown below in Figure 2. 9 Although this is the current NHS structure with the new government in power, changes are to follow. Figure.2 overall structure of the Healthcare system in England 5 NHS Reforms Since its inception in 1948 the NHS has seen many reforms in terms of managing the way they provide healthcare service. The DoH has a lot of control and influence the major decisions taken in the reforms. The overall expectations of Healthcare service in England are of a high calibre, which requisites high-quality management capacity.10 In the 1980s and early 1990s prominence was on recuperating management. The recent focal point has been on development of leadership within NHS. With the new government, new ideas and plans will be imposed to see improvements in quality of healthcare being provided, cut down on costs making it more efficient and in terms of equity provide equal service to everyone. Table 1 briefly enlists the reforms that have taken place since its inception in 1948. Table.1 Reforms in the NHS: 1948-2010 Period the reforms were in place Reform and theory of Management 1948- 1960 Managers as diplomats 1960s Scientific Management and the Salmon report 1970s Classical Management, Systems Approaches and the 1974 Reorganization 1980s The Griffiths report and Managerialism 1990s Working for Patients and the Internal Market 2000 The NHS Plan (DOH 2000) and the Third Way. 2010 NHS White Paper 2010: Equity and excellence: Liberating the NHS Healthcare service and Reforms in other Developed Countries Healthcare reforms within developed countries can be analyzed in order to compare whether the healthcare services in England have been successful in its bid to ensure efficiency, equity and quality. Attempts to handle reforms of the healthcare system in the European countries have been an ongoing process for 30 years. Although the reforms have taken throughout the 30 years in different ways, their main emphasis has been on improving the cost-effectiveness of the healthcare service. In the early 1980s the EU countries were looking at cost containment. The feature in the 1990s was to endorse efficiency in terms of introducing competition and markets in the healthcare system. Since 2000 the focus has switched to effectiveness; promoting various notions of healthcare in terms of quality.11 Over the course of the 20th century the countries of Europe have established significant success in improving the healthcare service for their citizens. However they still face challenges in the form of restraining costs, improving quality and providing universal healthcare access, these have put the European healthcare services under immense pressure.11 Looking at another OECD: USA, A report on A review of health care reform in the United States assessed whether the USA have been successful in providing healthcare. The findings showed that United States spent more per capita on health care than any other OECD country, yet its health outcomes lagged behind other countries.12 This shows they are struggling with efficiency issues and are still countering challenges in providing quality healthcare service that is expected from the citizens of the USA. Especially in the last few years Healthcare reform has been a major activity of the federal government, in order to revolutionize and develop the service overall. The 3 goals of optimizing cost, access and quality still remain a challenge within the healthcare society in the U.S.12 They concluded that USA still faced many challenges in running the national healthcare service, a key challenge they face is the utter complexity of the system, with its numerous public and private providers.12 Another OECD country reviewed in terms of healthcare service being provided and the reforms that have taken place is China. A report from on From a national, centrally planned health system to a system based on the market: lessons from China concluded: China is the country that has undergone the highest number of health care reforms. Since 1978, China saw many reforms and they also followed the way as the EU countries, with the healthcare system starting from governmental, centrally planned and a collective system to ending up as a heavily market influenced system. Now, thirty years later, the Chinese government openly concede that the reforms were unsuccessful and seek innovative and fresh directions.13 This illustrates that China is also in a healthcare crisis and looking to implement different strategies in order to gain control of Chinas Healthcare system. Having reviewed the healthcare service being endowed in these developed countries, it demonstrates that they are all on an identical level as the healthcare service being provided in England and all face similar challenges. All these developed countries are looking to develop the countries overall healthcare service in terms of efficiency, equity and quality. NHS Plan 2000 and the future of NHS Since the last reform: The NHS plan 2000 14, a lot has transformed in terms of funding and operating the healthcare system in England. Especially with the new coalition governments idea of cutting budgets it is a difficult time the NHS is going through and will necessitate a lot of expertise and world class management to get through todays financial and economical predicament. An additional indication that will be taken into deliberation is the election of the new plans set out in the NHS White Paper 2010. As the new coalition government has come into authority there have been huge changes to overall budgets for the public services and this possibly will have a consequence on the way the NHS operates in England. 15 The reforms have encompassed a significant impact on the organisation and deliverance of health care service in England. Wide array of transformations have been pioneered in an attempt to ensure the NHS is managed more resourcefully and effectively. This report will examine whether these reforms have on the whole improved the healthcare system in England in terms of efficiency, equity and quality and if the publics requirements have been convened. Aims: To examine the healthcare reforms in England since its inception and to assess whether these reforms have improved factors of efficiency, equity and quality in providing healthcare. Objectives: To review the reforms in the NHS since its inception in 1948 To examine whether these reforms improved efficiency, equity and quality of healthcare To assess the key features of healthcare reforms proposed by the current government and their implications on the NHS To put forward plans for the future of the NHS Methodology: A number of sources were consulted to conjure up this paper and examine the healthcare reforms in the NHS. Scientific search engines and databases such as PubMed, Google Scholar and Science Direct (Date accessed 20/10/10) were used to gain literature reviews but results from Google Scholar and Science Direct were dismissed as they were too vague and irrelevant to this topic. With PubMed following keywords were inserted Healthcare, Reforms and England. The data was also set from 1948 to 2010 when searching for reports as this would set the inclusion criteria. The reports and journals since 1948, when the NHS was established were used. Even though history before 1948 was looked at for study purposes, reports before NHS establishment; these were regarded as the exclusion criteria as reports werent looked at prior to 1948. Healthcare service within Britain was looked at in general but for the results of this report, the inclusion criteria was healthcare service in England as it just look ed at the healthcare service being provided within England. The exclusion criterion was healthcare service in Scotland, Wales and Northern Ireland. For the first part of the report, the introduction: where the report looked at the history of the NHS. The resources used included looking at general management books looking at management theories. The classical theories of Max Weber, Frederic Taylor and Henri Fayol were the backbone of the NHS and that is why these were used. Another source to produce this paper was the Department of health (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/index.htm) where the publications and reports about the NHS in general were looked at. This paper used a lot of publications produced by the Department of health and the NHS publications as these sources are reliable; these were seen as good foundation to work from. One of the main publications used was The NHS white paper: Equity and excellence: Liberating the NHS presented to Parliament by the Secretary of State for Health, this was a key entity in writing up this paper. As the paper didnt contract with experiments and clinical trials, it didnt look at a lot of statistics; the majority of its content was obtained from qualitative data. Results/ Discussion Having carried out the required literature searches and reading journals, reports and Department of Health Publications, results were gathered and have been shown below with the discussion of the key topics. The results look at each reform taken place in the NHS and then goes onto analyse the plans set by the new government. Having looked at the reforms and the new plans the paper than talks about efficiency, equity and quality related to each reform. Reforms in the healthcare service in England The healthcare service in the UK has undergone a number of reforms since its inception in 1948. Prior to 1948, healthcare service was provided in England but due to the increasing pressures for efficiency and quality in health services it lead to these developments and reforms in healthcare being provided. A more overtly management-oriented approach to the healthcare service delivery was adopted based on classical management theories to gain more control of the healthcare service in England. 16,17 Classical theories and Scientific Management: 1960s The NHS was based on the classical theories of Frederic Winslow Taylor, Henri Fayol and Max Weber. 16-19 Table 1: Frederic Winslow Taylors four main scientific management principles. Replacing rule-of-work thumb methods with methods based on a scientific of the tasks Scientifically train each individual rather than leave them to train themselves Cooperate with each worker to ensure that the scientific method is being followed Divide workload equally between managers and staff Table 2: Henri Fayols Modern Operational Management approach. Division of work- Specialization for efficiency Authority Responsibility- Both are related, the latter arising from the former. Discipline-Requires good superiors at all levels Unity of Command- Employee should receive orders from one superior only Unity of Direction- Each group of activities with the same objective must have one head and one plan Subordination of individual to general interest- When the two are found to differ, management must reconcile them Remuneration-Should be fair and satisfactory Centralization-Extent to which authority is concentrated or dispersed Scalar chain/line of authority-Needs to be sensible, clear and understood Order : Right thing/person in the right place Equity- Equal opportunity for everyone Stability of tenure- Unnecessary turnover is both the cause and effect of bad management Initiative- Thinking out and execution of a plan Thinking out and execution of a plan Table 3. Max Webers Bureaucratic approach. Power-Ability to get things done, often by the use of threats or sanctions Authority- Ability to get things done because of the position that justified someone in terms of legitimacy Formal approach Hierarchical authority Extensive roles and procedures- Uniformity of decisions and actions Job description- Clear-cut division of labour and High level of specialization Discipline These classical theories contributed a lot to the healthcare service in England and still do to this day.16-19 The classical writers thought of the NHS in terms of purpose and formal structure. They created a formal structure on which the NHS could run on. They also looked at job design, scientific selection and development of workers. The classical theories generally serve as a backbone to the present day NHS management. Although the classical theories made a big contribution to the healthcare service in England it had its limitations and wasnt the most effective way. One drawback was that it wasnt evidence based; it didnt look at the way staff did their tasks and didnt look at the well being of staff, the human and social aspects of work. It just treated them like machines. The theories didnt look at motivating the staff and developing them in their own interests, had they done this staffs work quality wouldve enhanced thus providing an efficient service to patients and overall improve the quality of healthcare service in England. Overall the classical theories were too concrete and fully based on rules and procedures. In terms of efficiency the theories bought a set way of running the healthcare service in England. Once the NHS was established it introduced equity as well as healthcare service was now available to anyone. The NHS was just established and with these set in place in the 1960s the qua lity of service would improve from now with further reforms to come. Salmon Report: 1960s One of the first reforms took place since the NHS was established was in the 1960s. The Salmon Report bought findings and changes which included that workload should be equally distributed between managers and practitioners.20 The NHS would also get rid of matrons and replace them with a hierarchy of nurse managers. The introduction of several additional layers to the management hierarchy; in order to improve efficiency in operating the NHS. This lead to responsibility being equally distributed and the service met its aims and objectives more efficiently. Another change was that nurse managers would contribute to the overall management of the service through the medium of consensus management teams and thus improve efficiency and quality within the NHS. Having nurse managers lead to them taking control of set responsibilities and helped in general running of tasks at ward level leading to an improvement in general quality in the healthcare service being provided. 1974 Reorganization: 1970s The aim of this reform was to attain greater integration of the healthcare service in order to provide more stability and increase efficiency. The reorganisation also introduced more central control in order to: 21 ensure policies were implemented improve accountability encourage delegation develop democratic decision-making process These changes lead to a more structured way for managers to follow and enhance the quality of the healthcare service. By the mid 1970s quality was improving but there were still concerns of equity in the NHS. There were still clear differences of health sufferers in terms of social class; figures showed that people in lower social classes more likely suffered from diseases. There were several possible explanations for these inequalities. Natural and social selection. This would depend on the view that people who are fittest are most likely to succeed in society, and classes reflect this degree of selection. Poverty leads to ill health, through nutrition, housing and environment. Cultural and behavioural explanations. There are differences in the diet and fitness of different social classes, and in certain habits like smoking. 22,23 Overall in the 1970s the quality of healthcare service was still improving, equity issues were still a concern and in terms of efficiency they were recuperating the NHS. The Griffiths Report: 1980s This reform was a major point in NHS history, the Griffiths Report identified problems such as the healthcare service was institutionally inactive and that the local health authorities were filled with directives without being given any clear procedures to follow.24 The Griffiths report stated that changes were difficult to achieve but gave recommendations to improve the NHS. It introduced a more formal and modern way of management. It gave increased participation for managers in setting and controlling budgets. The report also gave greater emphasis on cost awareness in order to improve efficiency. A Clear and quick decision-making process was introduced to improve quality of service provided to patients. The managers in local authorities were given a more clearly defined direction and the overall staffs were better informed.24 The Internal Market Working For Patients: 1990s Another reform in the 1990s took place, this bought a new dimension to the NHS; large publicly-owned hospitals could opt to become self-managed trusts. This meant that health services could be bought by private investors i.e. patients themselves thus allowing them to take control of the way they want the service. Even large GPs could become fund holders and be both purchasers and providers of care.25 This reform lead to introduction of greater flexibility thus allowing more effective matching of patients needs and care. Money followed the patients through the system of purchasing and providing of healthcare service, this led to equity being improved as patients had more selection of services. This reform led to higher competition in providing quality healthcare service, the costs decreased and the general quality increased. The NHS Plan 2000 The NHS Plan 2000 made key findings : the NHS is a 1940s system operating in the 21st century and that it lacked of national standards. It also said that there were barriers between staff and providing services. There were a lack of clear guidelines and the NHS structure has over-centralization.14 Plans to diminish problems and propose new plans such as introducing Modern Matrons to improve the management of services, a strong leader with clinical experience and with clear authority at ward level, improve efficiency by setting standards and controlling resources these were there aims.14,26 The figure below shows the comparison of the 1948 and the new NHS model outlining the key differences. Figure.4 the key difference between the 1948 model and The NHS Plan 2000 model 14 The NHS Plan 2000: Achievements This reform set out specific targets which were achieved in order to improve efficiency, equity and quality of healthcare service in England: Over 100 new hospitals by 2010 and 500 new one-stop primary care centres Clean wards and better hospital food 7,000 extra beds in hospitals Over 3,000 GP premises modernized Modern IT systems in every hospital and GP surgery 7,500 more consultants and 2,000 more GPs 20,000 extra nurses and 6,500 extra therapists Childcare support for NHS staff with 100 on-site nurseries.26 These targets were achieved in 2008 and it led to the improvement of efficiency as the number of GPs and consultants employed were increased. The modernisation of technology and IT systems led to quality of service being improved as high investment in high quality equipment made the NHS one of the worlds top quality service. Since 2000 NHS has improved the overall service and met its objectives. NHS Implications: Equity and excellence: Liberating the NHS With the new coalition government coming into election another set of reforms have been proposed as they hope to improve the overall healthcare service in England. The main aims and objectives to improve the healthcare service are varied and very detailed but to summarise it these are the points covered:15 Increase health spending in real terms in each year of this Parliament 15and also that there goal is an NHS which achieves results that are amongst the best in the world 15. However the government will uphold the foundation that the NHS was formed on; a comprehensive service, available to all, free at the point of use and based on clinical need, not the ability to pay 15. The government than goes into detail of what they arrange to initiate to make an efficient healthcare service: acknowledge the fact that patients come first and therefore will give them greater choice and control. An example of this is that a patient will be able to choose any GP practice, consultant, and choice of treatment consequently improving equity of the service. The government endeavours to develop the healthcare outcomes: set objectives such as reduce mortality and morbidity, increase safety, and improve patient experience and outcomes for all 15. By doing this they are ensuring they are driving efficiency and improving the service. In order to achieve the objectives that the government sets, the ability for service providers to have more autonomy, responsibility and accountability will be a means to achieving efficient results. A big change will be the establishment of a NHS Commissioning Board. The board will be accountable for making sure health outcomes are achieved, allocate resources and have the lead on quality improvement and to tackle inequalities that exist in the NHS. Overall the reforms in the NHS Paper 2010 will provide the NHS with greater incentives to increase efficiency, equity and quality. Efficiency The healthcare system in England has on the whole perceived a huge improvement in terms of efficiency since its inception in 1948. A system has been established where it endows with one of the best services in the world but there are still room for improvements. An analysis of the services gives evidence such as the NHS building 100 new hospitals since 2000, therefore improving the efficiency and allowing better access for patients. 27 Even though there continue to be a lack of quality and accessibility to services across the country. The patients havent been able to impose enough pressure to force improvements. The NHS need to give patients more control over the health services they have access to improve efficiency. In 2008 investment in the NHS as a whole rose from ÂÂ £43.9bn per year in 2000, when the NHS Plan was launched, to ÂÂ £92.6bn. another measurement of efficiency is looking at numbers of early deaths from cancer, coronary heart disease and suicide; they continue to fall as services improve; over 98% of patients at Accident and Emergency (AE) Departments are seen within 4 hours; and hospital waiting lists are lower than ever, with half a million fewer patients waiting since lists were at their peak.28 One key way to achieve the set objectives is to cut down NHS managements costs by 45% over the next four years enabling them to free up investment for further improvements.28 Much has been achieved during the last five years of investment and reforms. For example, the significant investment in NHS staff, along with more flexible working, is facilitating healthcare professionals to take advantage of the freedom thus improving their commitment to the NHS. NHS staff working flexibly and using improved technology are better able to respond to patients needs and changing expectations and are achieving improvements in quality and productivity across the system.27 Since 1948, the NHS budget on average has risen over 4% in real terms each year; this is something they hope to resolve as the NHS will face a sustained and substantial financial constraint if it continues. They hope to avoid the financial crisis that happened in the NHS in the 1970s. The NHS hopes to release up to ÂÂ £20 billion of efficiency savings by 2014, which will be reinvested to suppor

The Importance Of Going Green

The Importance Of Going Green A definition of green management according to is the process within an organisation of applying innovation in order to achieve sustainability, waste reduction, social responsibility and a competitive advantage by the aids of continuous learning and development. Organisations shall be doing such developments, by implementing environmental goals and strategies which match the goals and strategies of the organization. This will therefore help the organization to stay focused to its mission and vision. Nowadays, it is found that companies advertise their products by promoting their environmentally friendly behaviour. It does not matter whether it is on TV or on banner; the message of go green is almost always used. But why green? Green is not simply a color. Going green is a way of making changes in the lifestyle of some organizations as well as the society also. This implies bringing in some changes which are friendlier towards the environment. It is to note that the mere truth while doing every simple thing impacting on the planet good or bad, an individual has all the right to make choices, thus the later can control the impact generated. (Team Treehugger, HTGG, 2007) 2.1.1 Importance of going green Moreover, another main thing is the importance of going green. Not many organisations have realized the importance that going green can have on their business. Firstly, adopting green management system means that it will be here forever. Other forms of energy are all finite, but green system will never be depleted. The renewable source of energy will always be here to keep the human needs ongoing. Secondly, by using green materials and workmanship it helps to keep the environment safe as compared to the energy imports which is quite costly. It has been therefore proved that in the United States, green technologies have been able to provide a boost to the economy`s trade deficit. Thirdly, going green will surely benefits the company in terms of its savings. Paying bills online means less money when companies go paperless, it is also a form of savings in terms of postages and paper costs. Hence both the individual and the businesses benefit from the green initiative. Similarly, if you use compact fluorescent light (CFLs) bulbs, you are like to save money on each bulb you purchase. According to Energy Star, replacing a fluorescent bulb you with an incandescent bulb consumes 75 percent less energy. Thus, if you replace a 100-watt incandescent bulb with a 25-watt CFL, you will save over $100 per year, based on U.S. Department of Energy figures. (Chris Dinesen Rogers, 2010) According to (Chris Dinesen Rogers 2010) going green can be beneficial to economic growth. Following the National Recycling Coalition, the recycling industry employing over 1 million people and generating approximately $200 billion in annual revenues is extremely good for the economy. It is also stated that that When you recycle, you are contributing to the sustained growth of the economy. In addition to the above, while using recyclable or organic products implies that toxic materials are removed from the production process hence it can be considered as an environmentally-friendly activity. This explains why organisations must reduce their disposal rates, because the more they dispose of, the more valuable and costly materials are being wasted, as well as producing more greenhouse gases as these landfills decompose. (Green Energy Choice 2013) Going green also means a more sustainable world. According to an article published on (All-recycling-facts.com 2009-2012) the rate at which we are utilizing the world`s resources and deteriorating the globe with several kind of pollution could be very disastrous. A result of these dreadful action is leading to the destruction of the earth`s ecosystem which implies that, we will soon be left with no clean air, water, land and food. It is also stated that the day we reach such a stage, there would be nothing which will be able to save us or even nothing to talk about. Our very lives would be threatened since there will be an atmosphere of impure air, undrinkable water, unhygienic food and probably nothing to save us from the ruthless climate change. Hence, it is primordial that each and every one of us contributes equally as a human community towards a greener environment and promotes green behaviour as something which others must follow. Following the competitive market in companies operates; organisations found it necessary to go divert their production towards greener products since consumers are becoming far more aware of green products are ready to move to competitors. The fact that a company uses a product which has already been used simply reduces the cost of production while at the same time reducing the needs for power as the company is consuming less energy. (Madhurjya Bhattacharyya 2011) also pointed out the fact that the Bank of America now uses much less paper as a result of which has lead to an increase in its customers. The bank also recycles paper internally and gives cash back offer facilities to employees up to a certain limit if ever they decide to buy hybrid vehicles in other words ecological vehicles. Few are those who moved from being traditional, but successful are those who took the risk and implemented the new green management system. Furthermore, with the evolution of the technologies, companies have begun to adopt the EMS approach. This can be referred to as Environmental Management System. This approach helps in gathering information, formulating goals, making the right choices while at the same time improving performance. In other words, EMS is a broader version of quality programs to managing the environment. Hence over the past decades, increasing number of companies has initiated new strategies to integrate the environment into their business strategy so as to improve both their environmental and business performance (Porter 1991; Smart 1992; Porter and van der Linde 1995a, 1955b; Hart and Ahuja 1994). To set the ball rolling on, while some managers are investing in the environment and this is most welcomed by the society, others will have to derive ideas about how to identify circumstances which will be favoring both the public benefits and corporate benefits. Some may want just the ISO 14001 label on their product while simultaneously for some other firms better utilizing their resources may be beneficial to the environment as a whole. All this gave rise to competitive advantage between firms. In the 1990s there was a big debate in the field of Business and Environment about whether it pays to be green. According to the following strategies put forward; free lunch, double dividend and win-win hypothesis, chances for businesses to be profitable in the environmental investments is uprising. However on the other hand, Reinhardt (1998) argued that, the question is not whether companies will be able to do it, but it was about the time factor, that is, when the companies will be able t o implement such strategies and when they will begin to benefit from such investments. 2.1.2 Porter`s Strategies Similarly, Michael Porter identified two different types of competitive advantage generated by firms in 1980; Low cost and differentiation. According to Porter, selling products or services with the lowest costs in the industry would be beneficial to the company in terms of competitive advantage. Hence the firm will be selling its product either at the price prevailing in the industry in order to earn higher profits than that of rival or adopting a price which is below the average price in the industry so as to gain in terms of market share. Such a situation is called a price war among firms in the same industry. During such a situation, a firm can maintain its profitability level to the detriment of its competitive edge on the market. However, it is to note that even if there is no such price war, as the industry grows older, price will decline as a result of which; the firm producing at the lowest cost will remain profitable for a longer time period. The differentiation strategy is when the organisation develops a particular product which offers unique attributes that are valued by consumers and the same product is seen differently from the products of the competitors. According to Porter (1985: 13), a cost leader cannot ignore differentiation. This means that differentiation is as important as lowering the cost of production. Similarly, Levitt (1980) pointed out that everything can be differentiated even a commodity. He says this can be applied for industries dealing in primary metals, grains, chemicals, plastics, and money also. However, Peters and Austin (1985: 61) did not totally agree on this theory. They argued that if we put the label of commodity on a product it becomes a self-fulfilling prophecy. Buzzell and Gale (1987: 113) supported this idea with their argument: if you think of your product/service offering as a commodity, thats what it will bea commodity. 2.1.3 Spending Green With regard to green marketing in practice, the health report are somewhat uncertain. A surge in products and services claiming more or less legitimate claims to environmental friendliness was noted in the 1990s, when a significant proportion of consumer advertising campaigns in many countries contained messages related to the environment (Banerjee et al., 1995; Carlson et al., 1993) Today, however, observation suggests a decline in green claims for mainstream products. In some developed countries, this has at least resulted in a correspondingly less widespread occurrence of vague claims related to doubtful green product attributes, meaning that consumers are now more aware about green products. Consecutively, it is found that when it comes to green consumption, women are doing their part of responsibility when making purchases (i.e.) they are making much more green purchases than men do. While doing so, they also promote their products and services to be environmentally-friendly. Following a study on the purchasing habits of consumers, it was found that women are more environmentally-conscious when it comes to decision making in business that their male counterparts. Women clearly disagreed on the fact that some business owners still believe that promoting their products and services as being environmentally-friendly has little impact on consumers buying habits. It even goes further when Dr. Myra Hart, reported that environmental friendliness was ranked in the top three factors by women business owners, influencing consumer purchasing decision of consumers. It was ranked just below quality (98%) and price (85%) and finally cited environmental friendliness as a moderate infl uencer (76%). As a result of this study, it showed that consumers do take into consideration the environmental factor when making purchases either for them or their business (Lahle Wolfe 2013) Likewise, it is quite obvious that cannot consume the same thing for a long period of time. Consumers always tend to move to other new products and sometimes their behaviour are affected by means of advertising or even their past experience they had with a particular product. By consuming more of less environmentally harmful products and services, consumers can bring in positive changes and therefore lessen the impacts on Earth. Consumers don`t realise, but they have enormous power to improve the world. While on one hand, consumers are advised to consume less in order to protect the environment, on the other hand the money saved can be utilized in order to advance the green economy. Green shopping can be termed as a situation where consumers normally spend money on products that are less harmful towards the environment which is likely to build a more sustainable world. Small changes in consumer behaviour like adopting products that comes with less packaging and those which are made w ith plastics can improve the green economy. Hence, the spending pattern of consumers will determine the type of world they will create in the future. (Richard Matthews 2012) In addition to the above, according to (Debra Atlas 2013) 71% of consumer consider the welfare of the environment when they shop. He also claimed that green thinking has been increased among consumers minds. Environmental concerns are now becoming important to firms also since they have the opportunity to develop their green products demanded by consumers and therefore position their company on the market as a being a green company. This will also help the firm in terms of competitive advantage and increased performance. (Singh 2010) Following globalization, consumers now have access to information which raise their awareness about the manufacturing processes of the products and this made them seek green products. (Hailes 2007) For example; consumers may be interested in the green attributes (whether the product is recyclable, biodegradable, etc) of a product as well as the manufacturing process (whether environmental norms have been respected during the process). (Singh 2008) Practically, with the new trend of green management, consumers are willing even more to spend greener. This means that consumers tend to behave more positive towards the sustainability of the environment than the green movement. In other words, the green products will gradually replace the traditional power products because of their environmental benefits. This is likely to be a successful venture because according to (Wiser 1998) consumers are willing to pay for green products. As a result of this, it will generate a new market for renewable energy products. Hence, this may help to put forward green marketing as a successful tool in the energy market. However, sometimes it not about meeting the consumers expectation; businesses have to surpass the expectations to meet quality products demanded by consumers (Gupta Lehman, 2002; Blackwell et al., 2001; Naumann et al., 2001; Foreman, 2000). Another option which may help the company to build a relationship with its customers` is to create a strong brand image so that it the purchaser decision will rely more on perceptions than on reality. (Vrontiss Thrassou, 2007) This also helped organizations to realise the fact that they have to shape the perceptions of consumer in regard to their products by making use of every marketing communication tools at their disposal. This has therefore led to a situation where consumers were overflowed with adverts and became unresponsive over a period of time. As a result of this, the job of producers to influence the mind of the consumers became much harder and needed extra effort. (Blackwell et al., 2006) Hence it can be said that consumer decision m aking is therefore based on information processing (Johnson Puto, 1987) Also, when it comes to accountability, Robins (2008) points out that a company must be ready to accept its responsibility for its operations and their impact on society and natural environment. Companies should work for welfare of the society as a whole and therefore towards a greener world. Similarly, (Sirsly, 2008) recommended that Corporate Social Responsibility is not always generating the monetary and economic value for the firms, but it help firms to differentiate among themselves. When a third party endorsed its corporate efforts, the reputation of a firm is reinforced in the eyes of both market and non-market stakeholders Sirsly and Lametrz(2008). Eventually, Karna et al. (2003) argued that environmental issues were all in the hands of the government. Hence marketing strategies along with government aids can help to build strong green marketing campaign and therefore helps to protect the environment in better and efficient way. If a firm is introducing a highly differentiated product, it is maximizing the stockholders returns and effectively using environmental strategy. A firm engaged in the cause related marketing because of its long term benefits i.e. to attract and retain consumer for longer period of time. In such type of marketing activity, consumers are emotionally motivate to take part and because they wanted to feel different from other members of society or in their groups Ottman (1993, p.91). 2.1.4 The Cost Factor While going green, several factors influencing the financial aspect of the project should be taken into consideration; one of the most important one is the energy cost. It is found that over time, energy costs usually change and thus it becomes difficult to reap profit from the investment. It is assumed that if the energy costs are low, then the cost benefit of implementing the green system will be low too, but on the contrary assuming fluctuations in the economy, the energy costs might increase which will result in striking payback in the future. For example; the cost of buying a hybrid car may be as the same as a normal car for a long term basis assuming a constant price of gas, but suppose the price of gas experience an increase in the future, then the hybrid car will help one to save much more money than expected. (Gregory Hamel, 1999; 2013) Besides, (Rebecca Lake, 2010) pointed out the fact that several practices and behaviours of going green slogan are all motives of saving money, but still there are still ways while adopting green living can be from moderate to very expensive. It is found that, the technology associated with green living is not beneficial to the environment but often at a much higher cost than their traditional counterparts. For instance: let`s consider the installation of solar panel. It can be very useful in saving money on a long term basis, but at the same time it may cost thousands of dollars to install the equipment. Energy saving appliances is normally to be used so as to save water and energy, but they usually come in a high priced package which sometimes is very costly to organisations. Similarly, eating organic food is another to go green, but in order to get these; one has to pay a significant price unless you decide to grow your own food. Basically, (Chris Joseph, 2013) put forward the fact that when companies implement environmental norms within the organisation, it always ends in costlier products. This implies the switch from the traditional way of production to producing green products which can lead to expensive products to the consumers. It can affect the organisation`s source of revenue if it is operating in developing country, since consumers in developing country have less buying power compared to those in developed country. Similarly, according to Jon Kaplan who owns a Greenworks Cabinetry in Florida manufactures eco-friendly furniture products. Since he has to get most of his materials from the West-Coast and Asian countries too, his products cost much more on the market. This means that he has to sell his products at higher prices which may lead to a situation where consumers will obviously shift to competitors. As a whole, while companies decide to go green, many consumers would like to see the organisation actively doing things so as to prevent the depletion of natural resources. Going green does not happens in a matter of minutes, it is a whole process and it involves huge costs which is not always effective for the company. (Admin, 2013), stated that deciding on whether being environmentally responsible or the level of spending is more will be crucial. If ever the spending out way the desire to be eco-friendly, then it will not be a successful project. Problems may pop up on the side of suppliers also. The company will now need to find new suppliers who will be providing materials on time; else significant losses will be incurred by the company. Producing the same quality of finish product will be primordial for the organisation in order to maintain its image on the market failure to do so will be disastrous. Similarly, implementing the green system within the company will mean; trainin g the employees. Employees will have to be trained to deal with the new approach and different method of work. Training may be costly and at the same time lowering productivity while employees are at their training session. 2.2 Supply Chain Management Supply chain management was views years ago, as the process of converting raw materials to finished products and finally delivered to the end-user (Bearmon, 1999). This process can therefore be defined as the extraction and exploitation of the natural resources gifted by the nature (Srivastava, 2007). It is hence very important to note that environmental sustainability has been something primordial since the last decades in business practice. Since the early 1990`s companies were faced with the dilemma of implementing Environmental Management in their supply chains (Wu Dann, 1995) which is however not an easy task. Therefore the green concept to the supply chain of business increases the level of competitiveness among firms which will have a direct relation to the environment. This therefore gave rise to the Green Supply Chain Management. (GrSCM) 2.2.1 Green Supply Chain Management Green Supply Chain Management is the revolutionized version of the traditional supply chain. This involves a direction relationship with the environment. The quality revolution in the late 1980s and the supply chain revolution in the early 1990s has awaken several business conscience to become environmental friendly (Srivastava, 2007, p. 53). Green Supply Chain Management became not just a simple fad, as it aimed at both practionners and academics in waste-reduction programs as well as preserving the quality of the products` life and the natural resource. In order to achieve excellence in business, Eco-Efficiency and renewably processes became something most businesses shall be adopting (Ashley, 1993; Srivastava, 2007). Businesses are bearing the pressure of both governmental and global market demands to become more sustainable (Guide Srivastava, 1998; Gungor Gupta, 1999). Waste management is another topic that pop up from the GrSCM literature. This proved its importance with the work of Roy and Whelan (1992). It therefore gave rise to a standardized model for reducing electronic waste without harming the environment. As a result of this, different waste management issues came into context which emphasized mainly on recycling and remanufacturing. Owen (1930), Hannah and Newman (1995); Sarkis and Cordeiro (2001) and Nagorney and Toyasaki (2005) are all examples of trends of waste management becoming an issue. 2.2.2 Green Design Green design is an important sub-part in the Green Supply Chain Management. It states that each product or service should be design in such a way that it encourages environmental awareness. Beamon (1999) developed ISO14000 which was introduced as a result of the Rio Summit on the Environment in 1992. Tremendous pressure groups were for the fact that firms should encourage greening in their respective supply chain. In 1991, the first green design literature came to existence. NavinChandras (1991) pointed out the first literature in order to reduce the number of wastage that is more businesses going green. Works of Ashley (1993); Allenby and Richards (1994) and Zhang, Kuo, Lu and Huang (1997) came into context and expanded the framework of green design. Life-cycle analysis was an example of a framework that came out of green design. Works of Arena, Mastellone and Perugini (2003), Beamon (1999) and De Ron Penev (1995) all discussed life-cycle analysis as a framework. 2.2.3 Reverse Logistics Reverse Logistics (RL) is the complete reversal of the traditional or forward logistics (Beamon, 1999). Reverse logistics was defined as a process where manufacturers accept products which were shipped from the previous point for consumption which will be possibly use for recycling and re-manufacturing Dowlatshahi (2000) and Carter and Ellram (1998). Fiksel (1996) argues that becoming eco-friendly towards products re-manufacturing had a chance to emerge in some firms. Heavy industries having complex supply chains should see that they benefit from the reverse logistics (RL). Thierry, Wassenhove, Van Nunen and Salomon (1995) supported the fact that automobile industries were making full use of reverse logistics; examples would be: BMW and General Motors. The trend does not end only with those companies, Hewlett Packard, Storage Tek and TRW were also using reverse logistics as a supply chain process. All this were done in the simple main aim to remain competitive in their respective ind ustries (Srivastava, 2007). (Srivastava, 2007) stated that collection is the first stage in every recovery process. Products are then selected, assembled and transported to facilities for re-manufacturing. Used products came from various sources, but then had to be transferred to one particular place so that the converging process can begin (Thierry et al., 1995). It was also claimed that sorting and recycling are very essential mechanism in the process of sorting reusable products. The collection schemes were done on the basis of whether the materials were separated by the consumer (separation at source) or centralized (mixed waste) Cairncross (1992) and Srivastava (2007). Hence the main aim was to sort products so that it can be reused to reduce costs of making new products which is diagrammatically represented on the next page: Source: Jamal Fortes. (2009). Green Supply Chain Management: A Literature Review, Otago Management Graduate Review 2.3 Empirical Literature Review According to the empirical studies carried on in order to test the relationship between the firm`s performance and environmental concerns it was found that the results varied. Some results delivered positive results (Judge and Douglas, 1998; King and Lenox, 2002; Melnyk et al., 2003) while on the contrary some did not identified positive outcomes of environmental proactivity on businesses` performance (Cordeiro and Sarkis, 1997; Gilley et al., 2000; Link and Naveh, 2006). In addition to the above, it was found that firms are facing various pressures from both within the company and governmental parties to become more responsible and at the same time greener. Those pressures have as main aim to reduce the level of impact of firms on the natural environment and the society as a whole. As a matter of fact, social responsibility and being conscious about the environment are being integral among nowadays firms. Hence, the most important issue is about these aspects and the financial performance of the business. That is, in other words, are firms being able to protect the environment as well as being profitable? Bowen (1953) supported the fact that corporate social responsibility is not the remedy and thus it will not cure the society of all its ills immediately, but he thinks that it a new venture that should be supported and implemented by each organization who wants to survive in the industry. He also argued that the social responsibilities of businessme n also known as the obligations of firms must follow the policies which will be beneficial to the society as a whole. Josà © F. Molina-Azorà ­n, Enrique Claver-Cortà ©s, Maria D. Là ³pez-Gamero, Juan J. Tarà ­, (2009),Green management and financial performance: a literature review, Management Decision, Vol. 47 Iss: 7 pp. 1080 1100 Moreover, it is found that, the pressure exerted by environmental management on firm performance, this influence can really help firms to cut down on their costs while at the same time respecting the environment. Reducing or if possible prevent pollution will allow the firm to save on control costs, input, and energy consumption, and to recycle used materials (Hart, 1997; Taylor, 1992). Thus, producing and delivering goods while simultaneously reducing the ecological impact and use of resources will surely help the firm to attain eco-efficiency (Schmidheiny, 1992; Starik and Marcus, 2000). However, on the contrary, those firms which continue to pollute the environment are therefore regarded as a sign of inefficiency (Porter and Van der Linde, 1995). Companies must learn to view environmental improvement in terms of resource productivity. Managers should not only focus on the costs of eliminating or treating pollution, they should review their approach, and thus pay more attention to the cost they have forgone while polluting the environment, in other words, the opportunity of pollution. (wasted resources, wasted effort, and diminished product value to the customer). In addition to the above, it is found that by using practical environmental strategies, firms can eliminate wastages, redesign existing product systems to reduce life cycle impacts, and therefore develop new products with lower life cycle costs (Hart, 1995). If ever organizations go deeper to extend their strategies, this will surely help them to achieve organizational efficiency. In fact, by responding to market pressures firms may save costs so as to achieve greater production efficiency and gathering gains which are easily obtained associated with reducing excessive wastes, material, and energy use. (Hart and Ahuja, 1996) Therefore, it should be noted that green management can provide opportunities to lessen costs while simultaneously increase revenues. Ambec and Lanoie (2008) argued the fact that there are four possible opportunities for companies to use in order to reduce costs (risk management and relations with external stakeholders; cost of material, energy, and services; cost of capital; and cost of labor) and three opportunities to increase revenues (better access to certain markets; differentiating products; and selling pollution-control technology). Furthermore, environmental management can help to maintain and improve relationships between the different stakeholders as well as reducing the level of conflicts between them which can sometimes prove to be costly (Hull and Rothenberg, 2008). Organizations maintaining good relationships with their stakeholders are likely to achieve success much more effectively than competitors (Donaldson and Preston, 1995). Similarly, while creating, developing and maintaining ties with the stakeholders it will surely help to better financial performance of the companies (Jones, 1995; Brammer and Millington, 2008). In the case of the influence of green management impacting on corporate environmental performance, did not generate a clear result. While some studies showed positive impacts. For example, Dasgupta et al. (2000) found positive effects of green management measures on self-assessed compliance with environmental regulations. Anton et al. (2004) found that the Environment Management System helps to reduce the level of toxic emission, and Potoski Prakash (2005) found that companies which have been already certified ISO 14001 reduce their level of pollution more than non-certified ones. Hence, these studies point out to possible problems with regard to their measures of green management and therefore try to develop approaches which shall be useful to such problems. However, their instruments based on cross-sectional data are not fully convincing. In the sense that, Dahlstrà ¶m et al. (2003) did not find that the ISO 14001 certification improves the compliance with environmental regulatio ns and Lenox and Nash (2003) even showed that firms which are less environmental friendly are more attracted to public voluntary environmental programs. Besides, it should be noted that the measures for corporate environmental performance such as toxic emissions or the compliance with environmental regulations are mostly one-dimensional indicators, meaning they look at one facet of the coin. There is more technological environmental performance whi