Hazel vs Oedipus Essay Example for Free

Hazel vs Oedipus Essay Tragedies often feature happiness developing into miseries through errors which ultimately reveal the cold hard truth. The hero suffers from human frailty (hamartia) which directs to his/her downfall. The hero suffers from catastrophic events, experiences peripeteia and is confronted with the magnitude of his/her actions. Two such heroes are Hazel Grace Lancaster from â€Å"The Faults in Our Stars† by John Green, and Oedipus in the play â€Å"Oedipus Rex† written by Sophocles. Both modern and classic articles of literature have a wide-reaching influence on people and inspire many through the centuries. Modern tragic hero Hazel is a teenage thyroid cancer patient who experiences twisting series of bitter losses. As an only child who has been diagnosed since the age of thirteen, she fears and worries what will happen to the loved ones after she dies and wants to minimize the pain her death will cause others. Classic hero Oedipus is destined to fulfill a prophecy that says he will kill his father and marry his mother, and thereby brings disaster on his city and family. He is blinded by the truth and hubris, powerlessly enduring the course of fate despite harsh and fearful confrontations. While both characters fulfill the role of a tragic figure, the modern hero Hazel evidently provides more hope for the audience than the classic hero Oedipus. This is shown when their character traits of determination, courage and ignorance are compared. Determination is a quality a hero cannot be considered one without, and both Hazel and Oedipus show this quality along their ways. Hazel shows determination as she combats cancer despite harsh reality. Augustus asks, With the trope of the stoic and determined cancer victim who heroically fights her cancer with inhuman strength and never complains or stops smiling even at the very end, etcetera? (Green 128). Gus and Hazel refuse to be tropes. Instead they create a new kind of cancer rhetoric, one that looks straight on at the unbearable fact that they are unbelievably unfortunate and stand a good chance of dying young. They are two doomed children who have not really had the chance to experience life, and who are determined to do so one way or another. Hazel demonstrates her strong determination once again as she sets out to Amsterdam with Augustus to find out the ending of her favourite book, â€Å"An Imperial Affliction†. She wants to know those answers and what happens to Anna’s mother after she dies. By using the lens of the novel, she wishes to reassure the fact that her own mother and family will be okay after her death, since directly thinking about it is too terrifying and upsetting. Hazel is told she â€Å"†¦cant go to Amsterdam† because her doctor â€Å"†¦thinks its a bad idea for she might encounter †¦ a probably fatal episode of deoxygenation† (Green 157). Knowing her death is near, Hazel does not pull back from flying out with her oxygen tank. Hazel shouts, â€Å"bullshit  ! That’s bullshit. Just tell me! Make something up! you promised! † (Green 192). Although she does not receive any good information from the author, she tries to pound out what she hopes to hear out of Peter Van Houten’s mouth when he refuses â€Å"†¦to pity [her] in the manner to which†¦Ã¢â‚¬  she is â€Å"†¦well accustomed’’(Green 192). On the other hand, Oedipus displays determination to seek, to know, and to pursue principle as he unwaveringly discovers the truth behind his birth. The evidence first shows when Oedipus is so determined to solve former King Laius’s murder. The citizens of Thebes gather to discuss solution to the plague while Creon returns from the oracle and tells that the murderer of Laius is in Thebes and must be driven out in order for the plague to end. He furiously curses Laius’s murderer who is himself; he states, â€Å"Nor do I exempt myself from imprecation: /Lie all the curses I have laid on others† (Sophocles 32). Oedipus proclaims that should he discover the murderer to be a member of his own family, that person should be struck by the same exile and harsh treatment that he has just wished on the murderer. Oedipus’s sense of justice and powerful determination to uncover the mystery of Laius’s murder ironically leads him to unintentionally curse himself. He acts eagerly and rashly, refusing to shield himself from the truth, as if he brings catastrophe upon himself willingly. Therefore, it is clear that in terms of determination, Hazel’s will to combat tough fate is far more positive than Oedipus’s cursing to resolve matters, delivering more hope to audience. In addition to determination, courage is an important trait for a hero to signify firmness and face difficulty, danger and pain. Both Hazel and Oedipus show their great courage, but Hazel’s courage appears to be more encouraging rather than Oedipus as it is more relatable to the audience. Living with cancer alone takes great bravery. While Hazel has to deal with hospitals, doctors, and imminent death every day, she recognizes how tough she needs to be and how courageous she has been. She says, â€Å"People talk about the courage of cancer patients, and I do not deny that courage. I have been poked and stabbed and poisoned for years, and still I trod on† (Green 74). She is all about not hurting others even if it hurts her and wants to be as passive as possible. Courage is especially evident when she overcomes her pain to prevent others’ suffering. She says, Im a grenade and at some point Im going to blow up and I would like to minimize the casualties, And I cant be a regular teenager, because Im a grenade† (Green 99). Since Hazel feels that she will soon die, she is motivated to be as insignificant as possible and desires to take the risks of others. She is much like a soldier rushing into battle knowing well that death awaits her. She chases her dreams from the hospital bed all the way to the plane to Amsterdam. Not the doctor nor her family’s disapproval and instructions could stop her from going after her dream. She provides faith to teenagers who are commonly trapped under parents’ umbrella to pursuit their own dreams for themselves. She even ignores the glances, whispering, and finger-pointing along her way. In spite of criticism, she acts in accordance to her own beliefs displaying admirable courage and selflessness of her. Young people can be benefit and inspired by her daring courageousness and overcome their obstacles with Hazel’s fearlessness in her battle in mind. Oedipus is also certainly a figure of remarkable courage. Upon arriving in Thebes, Oedipus displays his courage and lack of fear by facing the deadly Sphinx and solving its riddle: He sacrifices himself entirely in an effort to save Thebes which shows great bravery. He is courageous in his refusal to hide from the truth about himself, even when he realizes how horrible it will be. Facing the horror of personal guilt, especially guilt so enormous, takes extreme courage. In the end, Oedipus has to face his own failure to outrun his fate,

Health Information and Communication Systems in Ireland

Health Information and Communication Systems in Ireland Is ICT a key enabler in ensuring seamless delivery of healthcare? A comparison between public and private ICT development in Ireland Abstract This study discusses the innovative changes that have taken place in Ireland in the field of healthcare due to the influx of information and communication technologies. Previous Information communication technologies (ICT), including telemedicine, present opportunities to address rural health-service delivery issues. The research shows that effective management of health services and the delivery of quality systems in Irish healthcare organizations have increased. In Ireland patients are expecting more of healthcare providers and are demanding higher standards of care and service. Simultaneously, those paying for health services have become more concerned about rising health costs and possible inefficiencies. As a result there is widespread interest in understanding what makes for an effective health service and in developing better practices to improve existing approaches to healthcare management in relation to ICT. This study highlights the developments in quality-service management in the Irish healthcare sector and focuses attention on the need for the development of a model for quality implementation in healthcare institutions. In sum the study shows that the development of (ICT) has facilitated the emergence of a complex global urban system in which many formerly lower-order cities have been carving out â€Å"niche† specialist functions serving urban fields of transnational dimension. Chapter1: Introduction Purpose of Study The purpose of this study is to highlight the development of the Information and communication system in Ireland and how it has revolutionized the healthcare sector in Ireland. Research Question This study focuses on the following research questions: What are the current trends of technological development in the Information and Communication Technology sector of Ireland? What are various challenges faced by the Irish healthcare system in relation to Information and Communication Technology? Significance of the Study This study is quite significant as it shows that the concept of globalisation has secured remarkable currency in the academic discourse of the late 20th century, despite ongoing questions regarding both its meaning and extent (Clark and Lund, 2000). The development of internationally integrated production and distribution systems, seen by many as the key feature of globalisation, has been a spatially uneven process. A key factor in this respect has been the differential ability of regions to engage in the informational economy, based on new information and communications technology (ICT), which is the main source of wealth creation and economic growth in the modern world (Castells, 2003). The result has been what Friedmann (2005) calls a process of ‘techno-apartheid’ which has divided the globe into ‘fast’ and ‘slow’ worlds (Knox, 2005), distinguished by the connectedness of individuals, groups and regions to the world of telematics. This echoes Ingersoll’s (2003, quoted in Knox, 2005) suggestion that the key division of the workforce is now that between those who have the capacity to operate ICT (the ‘cyberproletariat’) and those who do not (the ‘lumpentrash’). Golding (2006) makes a similar distinction between the ‘technoliterati’ and the ‘techno-poor’. While Knox defines the fast and slow worlds spatially, equating the former with the ‘triadic’ core and the latter with the remaining global periphery, Hoogvelt (2003) argues that the divide is, in essence, social rather than spatial, with elements of both worlds to be found in all regions of the globe. Thus, within advanced economies, a process of social polarisation has been widely reported (Friedmann, 2006 and Sassen, 2004) and has been intimately linked by Graham and Marvin (2006) to the development of ICT use. This is not to suggest that those who work in the fast world are homogeneously well-paid and affluent; rather, they represent a wide range of remuneration levels depending on such factors as economic sector, location, function, ethnic group and gender (Castells, 2006). What they do tend to have in common, however, is relative employment security due to the high demand level for their ICT skills. Rationale This study follows a logical approach and identifies the fact that both in Ireland as well as globally, there are major geographical variations in the relative balance between fast and slow worlds, with the former mainly to be found in the traditional core regions of North America, western Europe and Japan and an additional small group of newly industrialising countries which have had the institutional capacity to invest massively in modern ICT and associated educational infrastructures (Freeman, 2004). The slow world – found predominantly in the less developed countries of the global periphery and accounting for the bulk of the world’s population – is becoming increasingly marginalised and is moving, as Castells (2003, p. 37) puts it, â€Å"from a structural position of exploitation to a structural position of irrelevance†. Definition of Terms ICT: Information and Communication Technology: it is the study or business of developing and using technology to process information and aid communications. Sistem : SISTeM a soft systems methodology, stakeholder analysis and participative simulation modelling. NHS: (National Health Service) The organization providing national healthcare services in the UK. Chapter 2: Literature Review The process of quality implementation has become a key concern for those involved in hospital management in Ireland. In a national context, the effective management of health services and the delivery of quality systems in health-care institutions have increased in significance in recent years. In line with wider developments in other service industries, consumers (patients) are expecting more of health-care providers and are demanding higher standards of care and service. Simultaneously, those paying for health services have become more concerned about rising health costs and possible inefficiencies. As a result there is widespread interest in understanding what makes for an effective health service and in developing better practices to improve existing approaches to health-care management and delivery. In 2005 a comprehensive report on funding from the Commission on Health Funding highlighted that solutions to the problems faced by the Irish Health Service did not lie primarily in the system of funding, but rather in the way that services were planned, organised, and delivered. Similarly, in a report from the OECD (2003), it was argued that although the Irish health system had delivered a continuous improvement in health standards, there was still scope for further improvement in efficiency, and that this could be achieved through better allocation of resources. More recently, the government health strategy (DOHc, 2001) highlighted the requirement for a system to monitor progress and systematically evaluate the quality and effectiveness of health services. According to the strategy: Monitoring and evaluation must become intrinsic to the approach taken by people at all levels of the health services. Specifically, the strategy suggested that the way in which health and personal social services are planned, organised, and delivered has a significant effect on the health and well-being of the population. Organisational structures must be geared to the provision of a responsive, adaptable health system which meets the needs of the population effectively and at affordable cost. One of the guiding principles inherent in the published strategy was that of a â€Å"people-centred† health system. A responsive system must develop ways to engage with individuals and the wider community which receives its services. The health system must become more people-centred, with the interests of the public, patients, and clients being given greater prominence and influence in decision making at all levels (DOHc, 2001). According to Bowers (2001), major structural reform, coupled with strong management and political will, are required to ensure change for the better. In Bowers’ view, finance alone will not improve the system. Rather, a concentrated effort must be made to ensure a responsive and efficient service. As previously noted, a conclusion of the Report of the Commission on Health Funding (2005) was that the solution facing the Irish health services did not lie primarily in the system of funding but rather in the way that services were planned, organised, and delivered. This is reinforced by a recent report on the Irish health-care sector which suggested that the issues and challenges facing the health service are fundamentally the same as those outlined by the Commission on Health Funding, except that they are compounded by much higher expectations/demands by consumers (Deloitte and Touche, 2001). Thus, although modern health services have undergone radical change in many areas (Robins, 2003), managers of health services are currently reporting a large increase in the number of patients needing beds, with consequent ever-increasing waiting lists. Accident and emergency departments are under particular strain, and the difficulties of dealing with the growing needs of the increasing elderly population are beginning to become apparent. Although the Irish health service is free for all those requiring medical treatment through a publicly funded system, the current situation is hauntingly similar to that of the Victorian era of health care in Ireland. As a result, the Office for Health Management in Ireland (OHM, 2001) has suggested that current deficiencies in health-care provision and delivery underline the importance of providing quality service management and implementation in Irish health and personal social services. In achieving this aim, the OHM has contended that those working within the system must change how they go about their work and how they work together. Changed public-sector environment The focus on health-care service and quality has evolved from a more general interest in continuous improvement initiatives within the public sector. The prevalent trends in the private sector are towards continuous and pervasive change and increasing interdependencies, and it has been suggested that close parallels can be drawn between the private and public sectors. Public-sector organisations now find themselves in a cyclone of change as they attempt to adapt to turbulent environments in a pragmatic and systematic way (Lovell, 2004). In the UK and also in Ireland, these organisations have been subject to cuts in government spending, as well as demands for enhanced efficiency and effectiveness. In response to such changes, there has been a policy shift towards greater competition and an attempt to apply management practices from the private sector to the public domain. The Irish public sector has been officially pursuing change and reform through its strategic management initiative (SMI), a program for improving the management of the civil service which was formally launched in 2004 (Department of the Taoisearch, 2004). The SMI evolved from the growing internal and external pressures for better services and for more effective management of public services. In that context the continuous improvement of customer service has been a specific focus of the SMI since 2003, when the quality service initiative was launched. The program set out a series of quality principles according to which dealings with the wider public would be coordinated and managed. These initiatives aimed to make public administration more relevant to the citizens for whom the service exists, and simultaneously sought to remove barriers which have traditionally restricted performance and job satisfaction within the public sector. In recent years, Ireland has experienced a rise in consumerism. Increases in revenue available to fund public service provision have gone hand in hand with rising public expectations of standards of service. As a consequence, management skills and competences in providing for improved standards of customer service have become recognised as being central to delivering real transformation in the public sector. However, the development of such capabilities, particularly in relation to managing effective quality implementation, presents considerable challenges for those involved. Nowhere is this more evident than in the health-care sector. A review of recent international evidence points to the challenges of implementing quality service in health-care institutions. Gaucher and Coffey (2000) confirmed that implementing a process of total quality management (TQM) in health care is a pragmatic, specific, and systematic methodology. However, this requires a firm commitment from the leadership to change their former ways of working and doing business. Gaucher and Coffey (2000) cited many reasons for TQM failing – including poor leadership and a lack of management commitment – but also noted that revitalisation can rejuvenate the process. These authors asserted that the role of those implementing the process is to nurture and breathe energy into the process when enthusiasm and commitment are declining. The importance of the support of senior management for quality-management projects is also advocated by Berwick et al. (2000). These authors undertook a national demonstration project in the USA in the late 2000s and described how organisations could implement the entire quality-improvement process – from defining the problem through to implementing a solution and consolidating the gains (Berwick et al., 2000). A literature review carried out by Jackson (2005) identified that much work had been undertaken in the UK in determining the clinical effectiveness of many health-care organisations, but that very little research had been implemented in the area of managerial effectiveness. Furthermore, West (2001) determined that, in organisations that outperform others on different dimensions of performance, there was evidence that management is important, as are the combined efforts of individual clinicians and teams. There have been several approaches espoused for achieving quality management in health-care institutions, many of which have been technical and generic in their approaches (Moeller et al., 2000). Specifically, Donabedian (2000) introduced the concepts of structure, process, and outcomes, along with the development of self-assessment and accreditation through the International Organization for Standardization (ISO). In many instances these programs have met with mixed reactions, and their implementation has varied. A criticism levelled at hospital performance is that it has been rather insular, and has paid little attention to developments in related fields, such as organisational sociology, organisational behaviour, management studies, and human-resource management (West, 2001). If quality programs are to have lasting and significant effects, that they must follow a systemic approach such that all aspects of an organisation are integrated and focused on continuous improvement and customer satisfaction (Joss, 2004). A variety of approaches has been used to improve quality and to ensure its delivery, but not all have been successful. Indeed, some have merely added bureaucracy and higher costs to health care (Jackson, 2005; Ennis and Harrington, 2001). Recent research has shown that 45 per cent of patients experience some â€Å"medical mismanagement† and that 17 per cent suffer events which lead to a longer stay or more serious problems (Ovretveit, 2000). This is increasingly caused by complex systems of care which do not appear to be managed effectively. Joss and Kogan (2005) strongly recommended that a comprehensive set of criteria be included, against which to evaluate progress. These criteria should be based on the main requirements of TQM, and should include any additional factors generated by the organisation and/or by evaluators. A three-year evaluation of TQM in the National Health Scheme (NHS) indicated that there were clear factors which predicted successful implementation, the most important of which was the need to have a structured, pre-planned approach based on a thorough understanding of alternative approaches (Joss, 2004). Moreover, a recent study from the UK (O’Sullivan, 2005) demonstrated how one NHS Trust achieved continuous quality improvement through determination, education, and implementation, supported by visionary and involved leadership in all areas, a multi-talented enthusiastic clinical audit department, and a high-quality dedicated staff. Nabitz and Walburg (2000) suggested that possible solutions to quality problems might lie in the approach promoted by the European Foundation for Quality Management (EFQM). The EFQM has developed a model to structure and review the quality-management processes of organisations. Self-assessment, benchmarking, external review, and quality awards are essential elements of this model and, as reported by Sanchez (2000), this approach represents an important means of achieving excellence in health care. Within the literature there are also many studies showing the benefits of applying models of quality implementation in health-care organisations (Naylor, 2005; Ruiz et al., 2005). Such studies have pointed to the real benefits that accrue to organisations which have used such approaches (Pitt, 2005). Business excellence methodology for quality improvement The introduction of internationally respected quality frameworks – the Malcolm Baldrige National Quality Award (MBNQA) in 2003, followed by the EFQM in 2005 – has provided an opportunity for organisations to self-assess, using the models of TQM and business excellence which underpin these frameworks. In this process of self-assessment, an opportunity exists to identify the strengths and weaknesses in the current management of operations. In the USA, the effectiveness of the Baldrige process has been lauded by many (Gaucher and Coffey, 2000) who have indicated that organisations can learn about best practices from Baldrige-winning companies, and will thus be assisted in developing a composite for excellence. Although the Baldrige criteria were developed for commercial institutions, there has been keen interest in the adaptation of the model within health-care organisations in the USA following a pilot health-care project in 2005. To date, no health-care entity has yet achieved Baldrige-winner status, although Gaucher and Coffey (2000) have asserted that it is only a matter of time before there is a health-care winner. Moreover, these authors went on to say that the true benefit of the Baldrige process is not about winning an award. Rather, it is about the provision of a road map for a journey – a framework for both incremental and breakthrough improvement and business excellence. Within the European context, since its introduction in 2001, the EFQM model has been attracting considerable interest across all sectors, and has become a well-recognised quality-management framework. Stahr et al. (2001) concurred with Gaucher and Coffey (2000) in stating that the model provides a means by which organisations can assess their paths and develop solutions to achieve excellence. Other authors have espoused the model as being surprisingly effective, with awards being presented to those firms considered to be the most accomplished exponents of TQM in Europe (Wilkes and Dale, 2005). Across European health care at an institutional level, an increasing number of organisations are making direct investments in the training of staff in the concepts of business excellence (Stahr et al., 2001; Jackson, 2001). The NHS Executive in the UK has provided a central lead in endorsing the model as an important framework for delivering on the clinical governance agenda. Furthermore the British Association of Medical Managers (BAMM) has promoted its use as a tool for organisational self-assessment (Stahr et al., 2001). Its use and adoption has been further supported by the British Quality Foundation which provides a major educational and support role in the use and adoption of the model in health care and other sectors across the corporate landscape. Without doubt, the future performance of health-care organisations will be assessed against wider goals than previously. There will be a greater emphasis on measuring organisational performance and, if performance is below par, rapid investigation and appropriate intervention will ensue (Naylor, 2005). Moeller (2001) concurred with this, and identified evaluation of health services as a prerequisite. However, Zairi et al. (2005) warned that measuring organisational effectiveness in the delivery of health care is a challenging task. Joss and Kogan (2005) strongly recommended that a comprehensive set of criteria should be included, against which to evaluate progress. This should be based on the main requirements of TQM, supplemented by other organisational criteria thought to be important by the evaluators. A three-year evaluation of TQM in the NHS indicated that there are clear factors which predict successful implementation – including awareness of the need to have a structured, pre-planned approach based on a thorough understanding of alternative approaches (Joss, 2004). Moreover, as demonstrated by O’Sullivan (2005), successful implementation requires the support of visionary and involved leaders in all areas, together with dedicated and educated staff. Examining organisational effectiveness in Irish health care As suggested by Nabitz and Walburg (2000), the solution to quality problems might lie in the approach promoted by the EFQM. As reported by Sanchez (2000), this approach represents an important means of achieving excellence in health care which concurs with earlier descriptions by Gaucher and Coffey (2000). Self-assessment can examine current practice and establish capability, thus driving improvement rather than a reaction to weaknesses in the current system (Russell, 2005). There are also many studies in the literature which show the benefits of applying the business excellence model for quality implementation in health-care organisations (Naylor, 2005; Jackson, 2005a; Nabitz and Klazinga, 2005; Arcelay et al., 2005). Such studies have pointed to real benefits that have accrued to organisations using such an approach. Furthermore, Jackson (2005a) demonstrated that the adoption of the principles of self-assessment and business excellence can lead to the achievement of a culture of continuous improvement. Russell (2005) noted that the adoption of the â€Å"outside-in† approach of the EFQM model enabled organisations to use the model as a developmental and management framework. For Arcelay et al. (2005), the model provided a global, systematic regular analysis of the activities and results by comparing them with the criteria of the excellence model. Moreover, the process made it possible to make comparisons with other private and public organisations. Using a systems view of an organisation enables managers to focus on the processes between the parts of an organisation, rather than on the parts themselves, which is similar to physicians using a systematic model in which to analyse signs and symptoms, and thus make a diagnosis. An effective organisation is one in which the total organisation, through its significant subparts and individuals, manages its work against goals and plans with a view to achieving these goals within an open system. Methods of management that have been developed in manufacturing environments are naturally regarded with scepticism in non-manufacturing sectors. However, according to West (2001), studies that have been conducted on the link between the organisation and management of services and quality of patient care can be criticised both theoretically and methodologically because of the many different mechanisms that may be operating at once to produce the relationship between volume and quality. West (2001) asserted that a more rigorous body of work exists on the performance of firms in the private sector, often conducted within the disciplines of organisational behaviour or human resource management. Ireland and the International ICT System Dublin has, in the 2000s, carved out several niche international functions for itself, one of which, call centre activities, has been the principal focus of this study. According to a report in The Irish Times (August 20, 2003), Ireland accounts for 30% of all international call centres located in western Europe. The great bulk of these are to be found in Dublin. The central role of ICT in call centre activities has facilitated their centralisation in Ireland, from where markets spread across Europe and even further afield can readily be served. As Sassen (2005, p. 56) has observed: â€Å"Information technologies, often thought of as neutralising geography, actually contribute to spatial concentration†. Call centre activities, therefore, have helped Ireland to escape the bounds of geographical peripherality, thereby contradicting Wegener’s (2005) gloomy prognosis which visualised cities in the periphery as inevitable losers from growing inter-urban competition in Europe. This has been cleverly portrayed in an IDA advertisement which shows Ireland at the centre of a surrounding group of disembodied European countries ( Fig. 1). These latter are no longer seen as being more or less distant from Ireland, but as constituting a set of different language and market territories, all equally accessible from Ireland. However, Dublin’s growing international reach and the growing technological sophistication of its economic base should not mask the fact that, structurally, it retains a dependent position within the international division of labour. Its rapid recent economic expansion has been largely based on the attraction of branch plant operations which remain poorly embedded in the local economy (Breathnach, 2005). à Ã‚ nd, while the rising skill levels associated with recent inward investment have facilitated substantial improvement in living standards generally, in the specific case of the call centre sector, much of the employment which has been created remains relatively poorly paid – a fact which is directly linked with the high proportion of women workers in the sector, despite their high skill levels. Furthermore, the rapid growth of the call centre sector in the 2000s looks increasingly unsustainable as the end of the decade approaches. Growing labour shortages are driving up labour costs which, in conjunction with increasing housing and transportation problems, are beginning to attenuate Dublin’s attractiveness as a call centre location: according to a 2005 survey of call centre locations in Great Britain and Ireland, reported by Allen (2005), Dublin had fallen to the 29th position of 46 locations surveyed, having been in the top 10 in 2006. The response of the IDA has been to devote additional resources to promoting non-Dublin locations for call centre projects. However, even if this is successful in the short run, in the longer term the future of call centre employment will be increasingly threatened by technological developments, such as speech recognition technology and especially the rapidly growing use of the internet for making reservations, placing orders and seeking information. The IDA has justified its promotion of the call centre sector, despite the inferior nature of much of the employment involved, largely on the grounds that it provides an initial base upon which more sophisticated forms of employment can be built. Its long-term strategy, in other words, is to encourage firms which have established call centres in Ireland to add on additional functions, such as financial management and software development, to these initial operations. Already there has been some success in this area of ‘shared services’ back-office activities: by mid-2003, some 25 such operations had been established, and were projected to employ over 3000 people by the year 2000 (information supplied by Forfà ¡s). Ultimately, however, all of these activities remain as back-office activities, whose essential linkages are external to the Irish economy. In other words, their Irish location is not crucial to the parent companies of these operations; rather, it is contingent on the availability of certain attractions which may either be transient or reproducible elsewhere (Allen, 2005). As Wilson (2005) has noted, call centres are essentially a highly footloose sector, with few local economic linkages and little fixed investment in machinery and equipment: they therefore can be relocated quite readily in the light of changing comparative factor conditions. The National Health Service (NHS) in the UK published its NHS Plan in July 2000 (http://www.nhs.uk/thenhsexplained), saying that patients and people were central to its radical reform of healthcare and that although this included more hospitals and beds, shorter waiting times and improved care for older people, an essential element was that patients should have more power and information. As Grimson et al. (2000) rightly comment, healthcare is an information-intensive business, with data on an enormous scale gathered by way of hospitals, clinics, laboratories and primary care surgeries. Central to any information-intensive business is, naturally, the effective sharing of that information and, in order to empower and better engage the patient, how best that can be done. Funded by the UK’s Department of Health, the British Library’s integrated Telemedicine Information Service (TIS), described in the latest edition of the NHSMagazine (http://www.nhs.uk/nhsmagazine), is to improve the take-up of telemedicine technology in the UK, reinforcing the importance that information and communication technologies (ICTs) are seen to have in the sharing of information and the engagement of patients in their healthcare. By way of explanation, the word â€Å"telemedicine† has been coined as a way of capturing, in only one word, how ICT is being used in healthcare. However, as Curry et al. (2003) rightly comment, terms such as telemedicine, teleconferencing, health informatics and medical informatics seem to be used interchangeably, and that there is some confusion as to what is, and is not, involved, citing various studys, including those of Preston at al. (2002) and Mark and Hodges (2001) to support their claim. As there is some disagreement with the term, we use in this study the meaning assigned by Perednia and Allen (2005), that is, the use of information technologies in helping to provide medical information and services in healthcare. Whatever its name, or its definition, it concerns, in one way or another, the mediating role that technology plays in the interaction between humans, whether patient or healthcare professional. At the time of writing, there are 138 telemedicine projects in the UK (http://www.tis.port.ac.uk/tm/owa/projects.allUK), and they cover aspects of healthcare as diverse as mental health, diabetes, foetal monitoring and accident and emergency care. Indeed, it points to one of the advantages of telemedicine; its applicability across a wide range of clinical issues. However, while these projects certainly cover a diversity of issues, they have something in common, that is, they address only one of these clinical matters. Each system is designed differently, is unlikely to be compatible with another, and needs different technical support and user training. Whilst such individual systems have proved useful in a particular context (see, for example, Gilmour et al., 2005; Jones et al., 2006; Lesher et al., 2005; Loane et al., 2005; Lowitt et al., 2005; Oakley et al., Health Information and Communication Systems in Ireland Health Information and Communication Systems in Ireland Is ICT a key enabler in ensuring seamless delivery of healthcare? A comparison between public and private ICT development in Ireland Abstract This study discusses the innovative changes that have taken place in Ireland in the field of healthcare due to the influx of information and communication technologies. Previous Information communication technologies (ICT), including telemedicine, present opportunities to address rural health-service delivery issues. The research shows that effective management of health services and the delivery of quality systems in Irish healthcare organizations have increased. In Ireland patients are expecting more of healthcare providers and are demanding higher standards of care and service. Simultaneously, those paying for health services have become more concerned about rising health costs and possible inefficiencies. As a result there is widespread interest in understanding what makes for an effective health service and in developing better practices to improve existing approaches to healthcare management in relation to ICT. This study highlights the developments in quality-service management in the Irish healthcare sector and focuses attention on the need for the development of a model for quality implementation in healthcare institutions. In sum the study shows that the development of (ICT) has facilitated the emergence of a complex global urban system in which many formerly lower-order cities have been carving out â€Å"niche† specialist functions serving urban fields of transnational dimension. Chapter1: Introduction Purpose of Study The purpose of this study is to highlight the development of the Information and communication system in Ireland and how it has revolutionized the healthcare sector in Ireland. Research Question This study focuses on the following research questions: What are the current trends of technological development in the Information and Communication Technology sector of Ireland? What are various challenges faced by the Irish healthcare system in relation to Information and Communication Technology? Significance of the Study This study is quite significant as it shows that the concept of globalisation has secured remarkable currency in the academic discourse of the late 20th century, despite ongoing questions regarding both its meaning and extent (Clark and Lund, 2000). The development of internationally integrated production and distribution systems, seen by many as the key feature of globalisation, has been a spatially uneven process. A key factor in this respect has been the differential ability of regions to engage in the informational economy, based on new information and communications technology (ICT), which is the main source of wealth creation and economic growth in the modern world (Castells, 2003). The result has been what Friedmann (2005) calls a process of ‘techno-apartheid’ which has divided the globe into ‘fast’ and ‘slow’ worlds (Knox, 2005), distinguished by the connectedness of individuals, groups and regions to the world of telematics. This echoes Ingersoll’s (2003, quoted in Knox, 2005) suggestion that the key division of the workforce is now that between those who have the capacity to operate ICT (the ‘cyberproletariat’) and those who do not (the ‘lumpentrash’). Golding (2006) makes a similar distinction between the ‘technoliterati’ and the ‘techno-poor’. While Knox defines the fast and slow worlds spatially, equating the former with the ‘triadic’ core and the latter with the remaining global periphery, Hoogvelt (2003) argues that the divide is, in essence, social rather than spatial, with elements of both worlds to be found in all regions of the globe. Thus, within advanced economies, a process of social polarisation has been widely reported (Friedmann, 2006 and Sassen, 2004) and has been intimately linked by Graham and Marvin (2006) to the development of ICT use. This is not to suggest that those who work in the fast world are homogeneously well-paid and affluent; rather, they represent a wide range of remuneration levels depending on such factors as economic sector, location, function, ethnic group and gender (Castells, 2006). What they do tend to have in common, however, is relative employment security due to the high demand level for their ICT skills. Rationale This study follows a logical approach and identifies the fact that both in Ireland as well as globally, there are major geographical variations in the relative balance between fast and slow worlds, with the former mainly to be found in the traditional core regions of North America, western Europe and Japan and an additional small group of newly industrialising countries which have had the institutional capacity to invest massively in modern ICT and associated educational infrastructures (Freeman, 2004). The slow world – found predominantly in the less developed countries of the global periphery and accounting for the bulk of the world’s population – is becoming increasingly marginalised and is moving, as Castells (2003, p. 37) puts it, â€Å"from a structural position of exploitation to a structural position of irrelevance†. Definition of Terms ICT: Information and Communication Technology: it is the study or business of developing and using technology to process information and aid communications. Sistem : SISTeM a soft systems methodology, stakeholder analysis and participative simulation modelling. NHS: (National Health Service) The organization providing national healthcare services in the UK. Chapter 2: Literature Review The process of quality implementation has become a key concern for those involved in hospital management in Ireland. In a national context, the effective management of health services and the delivery of quality systems in health-care institutions have increased in significance in recent years. In line with wider developments in other service industries, consumers (patients) are expecting more of health-care providers and are demanding higher standards of care and service. Simultaneously, those paying for health services have become more concerned about rising health costs and possible inefficiencies. As a result there is widespread interest in understanding what makes for an effective health service and in developing better practices to improve existing approaches to health-care management and delivery. In 2005 a comprehensive report on funding from the Commission on Health Funding highlighted that solutions to the problems faced by the Irish Health Service did not lie primarily in the system of funding, but rather in the way that services were planned, organised, and delivered. Similarly, in a report from the OECD (2003), it was argued that although the Irish health system had delivered a continuous improvement in health standards, there was still scope for further improvement in efficiency, and that this could be achieved through better allocation of resources. More recently, the government health strategy (DOHc, 2001) highlighted the requirement for a system to monitor progress and systematically evaluate the quality and effectiveness of health services. According to the strategy: Monitoring and evaluation must become intrinsic to the approach taken by people at all levels of the health services. Specifically, the strategy suggested that the way in which health and personal social services are planned, organised, and delivered has a significant effect on the health and well-being of the population. Organisational structures must be geared to the provision of a responsive, adaptable health system which meets the needs of the population effectively and at affordable cost. One of the guiding principles inherent in the published strategy was that of a â€Å"people-centred† health system. A responsive system must develop ways to engage with individuals and the wider community which receives its services. The health system must become more people-centred, with the interests of the public, patients, and clients being given greater prominence and influence in decision making at all levels (DOHc, 2001). According to Bowers (2001), major structural reform, coupled with strong management and political will, are required to ensure change for the better. In Bowers’ view, finance alone will not improve the system. Rather, a concentrated effort must be made to ensure a responsive and efficient service. As previously noted, a conclusion of the Report of the Commission on Health Funding (2005) was that the solution facing the Irish health services did not lie primarily in the system of funding but rather in the way that services were planned, organised, and delivered. This is reinforced by a recent report on the Irish health-care sector which suggested that the issues and challenges facing the health service are fundamentally the same as those outlined by the Commission on Health Funding, except that they are compounded by much higher expectations/demands by consumers (Deloitte and Touche, 2001). Thus, although modern health services have undergone radical change in many areas (Robins, 2003), managers of health services are currently reporting a large increase in the number of patients needing beds, with consequent ever-increasing waiting lists. Accident and emergency departments are under particular strain, and the difficulties of dealing with the growing needs of the increasing elderly population are beginning to become apparent. Although the Irish health service is free for all those requiring medical treatment through a publicly funded system, the current situation is hauntingly similar to that of the Victorian era of health care in Ireland. As a result, the Office for Health Management in Ireland (OHM, 2001) has suggested that current deficiencies in health-care provision and delivery underline the importance of providing quality service management and implementation in Irish health and personal social services. In achieving this aim, the OHM has contended that those working within the system must change how they go about their work and how they work together. Changed public-sector environment The focus on health-care service and quality has evolved from a more general interest in continuous improvement initiatives within the public sector. The prevalent trends in the private sector are towards continuous and pervasive change and increasing interdependencies, and it has been suggested that close parallels can be drawn between the private and public sectors. Public-sector organisations now find themselves in a cyclone of change as they attempt to adapt to turbulent environments in a pragmatic and systematic way (Lovell, 2004). In the UK and also in Ireland, these organisations have been subject to cuts in government spending, as well as demands for enhanced efficiency and effectiveness. In response to such changes, there has been a policy shift towards greater competition and an attempt to apply management practices from the private sector to the public domain. The Irish public sector has been officially pursuing change and reform through its strategic management initiative (SMI), a program for improving the management of the civil service which was formally launched in 2004 (Department of the Taoisearch, 2004). The SMI evolved from the growing internal and external pressures for better services and for more effective management of public services. In that context the continuous improvement of customer service has been a specific focus of the SMI since 2003, when the quality service initiative was launched. The program set out a series of quality principles according to which dealings with the wider public would be coordinated and managed. These initiatives aimed to make public administration more relevant to the citizens for whom the service exists, and simultaneously sought to remove barriers which have traditionally restricted performance and job satisfaction within the public sector. In recent years, Ireland has experienced a rise in consumerism. Increases in revenue available to fund public service provision have gone hand in hand with rising public expectations of standards of service. As a consequence, management skills and competences in providing for improved standards of customer service have become recognised as being central to delivering real transformation in the public sector. However, the development of such capabilities, particularly in relation to managing effective quality implementation, presents considerable challenges for those involved. Nowhere is this more evident than in the health-care sector. A review of recent international evidence points to the challenges of implementing quality service in health-care institutions. Gaucher and Coffey (2000) confirmed that implementing a process of total quality management (TQM) in health care is a pragmatic, specific, and systematic methodology. However, this requires a firm commitment from the leadership to change their former ways of working and doing business. Gaucher and Coffey (2000) cited many reasons for TQM failing – including poor leadership and a lack of management commitment – but also noted that revitalisation can rejuvenate the process. These authors asserted that the role of those implementing the process is to nurture and breathe energy into the process when enthusiasm and commitment are declining. The importance of the support of senior management for quality-management projects is also advocated by Berwick et al. (2000). These authors undertook a national demonstration project in the USA in the late 2000s and described how organisations could implement the entire quality-improvement process – from defining the problem through to implementing a solution and consolidating the gains (Berwick et al., 2000). A literature review carried out by Jackson (2005) identified that much work had been undertaken in the UK in determining the clinical effectiveness of many health-care organisations, but that very little research had been implemented in the area of managerial effectiveness. Furthermore, West (2001) determined that, in organisations that outperform others on different dimensions of performance, there was evidence that management is important, as are the combined efforts of individual clinicians and teams. There have been several approaches espoused for achieving quality management in health-care institutions, many of which have been technical and generic in their approaches (Moeller et al., 2000). Specifically, Donabedian (2000) introduced the concepts of structure, process, and outcomes, along with the development of self-assessment and accreditation through the International Organization for Standardization (ISO). In many instances these programs have met with mixed reactions, and their implementation has varied. A criticism levelled at hospital performance is that it has been rather insular, and has paid little attention to developments in related fields, such as organisational sociology, organisational behaviour, management studies, and human-resource management (West, 2001). If quality programs are to have lasting and significant effects, that they must follow a systemic approach such that all aspects of an organisation are integrated and focused on continuous improvement and customer satisfaction (Joss, 2004). A variety of approaches has been used to improve quality and to ensure its delivery, but not all have been successful. Indeed, some have merely added bureaucracy and higher costs to health care (Jackson, 2005; Ennis and Harrington, 2001). Recent research has shown that 45 per cent of patients experience some â€Å"medical mismanagement† and that 17 per cent suffer events which lead to a longer stay or more serious problems (Ovretveit, 2000). This is increasingly caused by complex systems of care which do not appear to be managed effectively. Joss and Kogan (2005) strongly recommended that a comprehensive set of criteria be included, against which to evaluate progress. These criteria should be based on the main requirements of TQM, and should include any additional factors generated by the organisation and/or by evaluators. A three-year evaluation of TQM in the National Health Scheme (NHS) indicated that there were clear factors which predicted successful implementation, the most important of which was the need to have a structured, pre-planned approach based on a thorough understanding of alternative approaches (Joss, 2004). Moreover, a recent study from the UK (O’Sullivan, 2005) demonstrated how one NHS Trust achieved continuous quality improvement through determination, education, and implementation, supported by visionary and involved leadership in all areas, a multi-talented enthusiastic clinical audit department, and a high-quality dedicated staff. Nabitz and Walburg (2000) suggested that possible solutions to quality problems might lie in the approach promoted by the European Foundation for Quality Management (EFQM). The EFQM has developed a model to structure and review the quality-management processes of organisations. Self-assessment, benchmarking, external review, and quality awards are essential elements of this model and, as reported by Sanchez (2000), this approach represents an important means of achieving excellence in health care. Within the literature there are also many studies showing the benefits of applying models of quality implementation in health-care organisations (Naylor, 2005; Ruiz et al., 2005). Such studies have pointed to the real benefits that accrue to organisations which have used such approaches (Pitt, 2005). Business excellence methodology for quality improvement The introduction of internationally respected quality frameworks – the Malcolm Baldrige National Quality Award (MBNQA) in 2003, followed by the EFQM in 2005 – has provided an opportunity for organisations to self-assess, using the models of TQM and business excellence which underpin these frameworks. In this process of self-assessment, an opportunity exists to identify the strengths and weaknesses in the current management of operations. In the USA, the effectiveness of the Baldrige process has been lauded by many (Gaucher and Coffey, 2000) who have indicated that organisations can learn about best practices from Baldrige-winning companies, and will thus be assisted in developing a composite for excellence. Although the Baldrige criteria were developed for commercial institutions, there has been keen interest in the adaptation of the model within health-care organisations in the USA following a pilot health-care project in 2005. To date, no health-care entity has yet achieved Baldrige-winner status, although Gaucher and Coffey (2000) have asserted that it is only a matter of time before there is a health-care winner. Moreover, these authors went on to say that the true benefit of the Baldrige process is not about winning an award. Rather, it is about the provision of a road map for a journey – a framework for both incremental and breakthrough improvement and business excellence. Within the European context, since its introduction in 2001, the EFQM model has been attracting considerable interest across all sectors, and has become a well-recognised quality-management framework. Stahr et al. (2001) concurred with Gaucher and Coffey (2000) in stating that the model provides a means by which organisations can assess their paths and develop solutions to achieve excellence. Other authors have espoused the model as being surprisingly effective, with awards being presented to those firms considered to be the most accomplished exponents of TQM in Europe (Wilkes and Dale, 2005). Across European health care at an institutional level, an increasing number of organisations are making direct investments in the training of staff in the concepts of business excellence (Stahr et al., 2001; Jackson, 2001). The NHS Executive in the UK has provided a central lead in endorsing the model as an important framework for delivering on the clinical governance agenda. Furthermore the British Association of Medical Managers (BAMM) has promoted its use as a tool for organisational self-assessment (Stahr et al., 2001). Its use and adoption has been further supported by the British Quality Foundation which provides a major educational and support role in the use and adoption of the model in health care and other sectors across the corporate landscape. Without doubt, the future performance of health-care organisations will be assessed against wider goals than previously. There will be a greater emphasis on measuring organisational performance and, if performance is below par, rapid investigation and appropriate intervention will ensue (Naylor, 2005). Moeller (2001) concurred with this, and identified evaluation of health services as a prerequisite. However, Zairi et al. (2005) warned that measuring organisational effectiveness in the delivery of health care is a challenging task. Joss and Kogan (2005) strongly recommended that a comprehensive set of criteria should be included, against which to evaluate progress. This should be based on the main requirements of TQM, supplemented by other organisational criteria thought to be important by the evaluators. A three-year evaluation of TQM in the NHS indicated that there are clear factors which predict successful implementation – including awareness of the need to have a structured, pre-planned approach based on a thorough understanding of alternative approaches (Joss, 2004). Moreover, as demonstrated by O’Sullivan (2005), successful implementation requires the support of visionary and involved leaders in all areas, together with dedicated and educated staff. Examining organisational effectiveness in Irish health care As suggested by Nabitz and Walburg (2000), the solution to quality problems might lie in the approach promoted by the EFQM. As reported by Sanchez (2000), this approach represents an important means of achieving excellence in health care which concurs with earlier descriptions by Gaucher and Coffey (2000). Self-assessment can examine current practice and establish capability, thus driving improvement rather than a reaction to weaknesses in the current system (Russell, 2005). There are also many studies in the literature which show the benefits of applying the business excellence model for quality implementation in health-care organisations (Naylor, 2005; Jackson, 2005a; Nabitz and Klazinga, 2005; Arcelay et al., 2005). Such studies have pointed to real benefits that have accrued to organisations using such an approach. Furthermore, Jackson (2005a) demonstrated that the adoption of the principles of self-assessment and business excellence can lead to the achievement of a culture of continuous improvement. Russell (2005) noted that the adoption of the â€Å"outside-in† approach of the EFQM model enabled organisations to use the model as a developmental and management framework. For Arcelay et al. (2005), the model provided a global, systematic regular analysis of the activities and results by comparing them with the criteria of the excellence model. Moreover, the process made it possible to make comparisons with other private and public organisations. Using a systems view of an organisation enables managers to focus on the processes between the parts of an organisation, rather than on the parts themselves, which is similar to physicians using a systematic model in which to analyse signs and symptoms, and thus make a diagnosis. An effective organisation is one in which the total organisation, through its significant subparts and individuals, manages its work against goals and plans with a view to achieving these goals within an open system. Methods of management that have been developed in manufacturing environments are naturally regarded with scepticism in non-manufacturing sectors. However, according to West (2001), studies that have been conducted on the link between the organisation and management of services and quality of patient care can be criticised both theoretically and methodologically because of the many different mechanisms that may be operating at once to produce the relationship between volume and quality. West (2001) asserted that a more rigorous body of work exists on the performance of firms in the private sector, often conducted within the disciplines of organisational behaviour or human resource management. Ireland and the International ICT System Dublin has, in the 2000s, carved out several niche international functions for itself, one of which, call centre activities, has been the principal focus of this study. According to a report in The Irish Times (August 20, 2003), Ireland accounts for 30% of all international call centres located in western Europe. The great bulk of these are to be found in Dublin. The central role of ICT in call centre activities has facilitated their centralisation in Ireland, from where markets spread across Europe and even further afield can readily be served. As Sassen (2005, p. 56) has observed: â€Å"Information technologies, often thought of as neutralising geography, actually contribute to spatial concentration†. Call centre activities, therefore, have helped Ireland to escape the bounds of geographical peripherality, thereby contradicting Wegener’s (2005) gloomy prognosis which visualised cities in the periphery as inevitable losers from growing inter-urban competition in Europe. This has been cleverly portrayed in an IDA advertisement which shows Ireland at the centre of a surrounding group of disembodied European countries ( Fig. 1). These latter are no longer seen as being more or less distant from Ireland, but as constituting a set of different language and market territories, all equally accessible from Ireland. However, Dublin’s growing international reach and the growing technological sophistication of its economic base should not mask the fact that, structurally, it retains a dependent position within the international division of labour. Its rapid recent economic expansion has been largely based on the attraction of branch plant operations which remain poorly embedded in the local economy (Breathnach, 2005). à Ã‚ nd, while the rising skill levels associated with recent inward investment have facilitated substantial improvement in living standards generally, in the specific case of the call centre sector, much of the employment which has been created remains relatively poorly paid – a fact which is directly linked with the high proportion of women workers in the sector, despite their high skill levels. Furthermore, the rapid growth of the call centre sector in the 2000s looks increasingly unsustainable as the end of the decade approaches. Growing labour shortages are driving up labour costs which, in conjunction with increasing housing and transportation problems, are beginning to attenuate Dublin’s attractiveness as a call centre location: according to a 2005 survey of call centre locations in Great Britain and Ireland, reported by Allen (2005), Dublin had fallen to the 29th position of 46 locations surveyed, having been in the top 10 in 2006. The response of the IDA has been to devote additional resources to promoting non-Dublin locations for call centre projects. However, even if this is successful in the short run, in the longer term the future of call centre employment will be increasingly threatened by technological developments, such as speech recognition technology and especially the rapidly growing use of the internet for making reservations, placing orders and seeking information. The IDA has justified its promotion of the call centre sector, despite the inferior nature of much of the employment involved, largely on the grounds that it provides an initial base upon which more sophisticated forms of employment can be built. Its long-term strategy, in other words, is to encourage firms which have established call centres in Ireland to add on additional functions, such as financial management and software development, to these initial operations. Already there has been some success in this area of ‘shared services’ back-office activities: by mid-2003, some 25 such operations had been established, and were projected to employ over 3000 people by the year 2000 (information supplied by Forfà ¡s). Ultimately, however, all of these activities remain as back-office activities, whose essential linkages are external to the Irish economy. In other words, their Irish location is not crucial to the parent companies of these operations; rather, it is contingent on the availability of certain attractions which may either be transient or reproducible elsewhere (Allen, 2005). As Wilson (2005) has noted, call centres are essentially a highly footloose sector, with few local economic linkages and little fixed investment in machinery and equipment: they therefore can be relocated quite readily in the light of changing comparative factor conditions. The National Health Service (NHS) in the UK published its NHS Plan in July 2000 (http://www.nhs.uk/thenhsexplained), saying that patients and people were central to its radical reform of healthcare and that although this included more hospitals and beds, shorter waiting times and improved care for older people, an essential element was that patients should have more power and information. As Grimson et al. (2000) rightly comment, healthcare is an information-intensive business, with data on an enormous scale gathered by way of hospitals, clinics, laboratories and primary care surgeries. Central to any information-intensive business is, naturally, the effective sharing of that information and, in order to empower and better engage the patient, how best that can be done. Funded by the UK’s Department of Health, the British Library’s integrated Telemedicine Information Service (TIS), described in the latest edition of the NHSMagazine (http://www.nhs.uk/nhsmagazine), is to improve the take-up of telemedicine technology in the UK, reinforcing the importance that information and communication technologies (ICTs) are seen to have in the sharing of information and the engagement of patients in their healthcare. By way of explanation, the word â€Å"telemedicine† has been coined as a way of capturing, in only one word, how ICT is being used in healthcare. However, as Curry et al. (2003) rightly comment, terms such as telemedicine, teleconferencing, health informatics and medical informatics seem to be used interchangeably, and that there is some confusion as to what is, and is not, involved, citing various studys, including those of Preston at al. (2002) and Mark and Hodges (2001) to support their claim. As there is some disagreement with the term, we use in this study the meaning assigned by Perednia and Allen (2005), that is, the use of information technologies in helping to provide medical information and services in healthcare. Whatever its name, or its definition, it concerns, in one way or another, the mediating role that technology plays in the interaction between humans, whether patient or healthcare professional. At the time of writing, there are 138 telemedicine projects in the UK (http://www.tis.port.ac.uk/tm/owa/projects.allUK), and they cover aspects of healthcare as diverse as mental health, diabetes, foetal monitoring and accident and emergency care. Indeed, it points to one of the advantages of telemedicine; its applicability across a wide range of clinical issues. However, while these projects certainly cover a diversity of issues, they have something in common, that is, they address only one of these clinical matters. Each system is designed differently, is unlikely to be compatible with another, and needs different technical support and user training. Whilst such individual systems have proved useful in a particular context (see, for example, Gilmour et al., 2005; Jones et al., 2006; Lesher et al., 2005; Loane et al., 2005; Lowitt et al., 2005; Oakley et al.,

Capital Punishment has NO Place in Civilized Society :: Argumentative Persuasive Essays

Capital Punishment has no Place in Civilized Society Since our nation's founding, the government -- colonial, federal and state -- has punished murder and, until recent years, rape with the ultimate sanction: death. More than 13,000 people have been legally executed since colonial times, most of them in the early 20th Century. By the 1930s, as many as 150 people were executed each year. However, public outrage and legal challenges caused the practice to wane. By 1967, capital punishment had virtually halted in the United States, pending the outcome of several court challenges. In 1972, in _Furman v. Georgia_, the Supreme Court invalidated hundreds of scheduled executions, declaring that then existing state laws were applied in an "arbitrary and capricious" manner and, thus, violated the Eighth Amendment's prohibition against cruel and unusual punishment, and the Fourteenth Amendment's guarantees of equal protection of the laws and due process. But in 1976, in _ Gregg v. Georgia_, the Court resuscitated the death penalty: It ruled that the penalty "does not invariably violate the Constitution" if administered in a manner designed to guard against arbitrariness and discrimination. Several states promptly passed or reenacted capital punishment laws. Thirty-seven states now have laws authorizing the death penalty, as does the military. A dozen states in the Middle West and Northeast have abolished capital punishment, two in the last century (Michigan in 1847, Minnesota in 1853). Alaska and Hawaii have never had the death penalty. Most executions have taken place in the states of the Deep South. More than 2,000 people are on "death row" today. Virtually all are poor, a significant number are mentally retarded or otherwise mentally disabled, more than 40 percent are African American, and a disproportionate number are Native American, Latino and Asian. The ACLU believes that, in all circumstances, the death penalty is unconstitutional under the Eighth Amendment, and that its discriminatory application violates the Fourteenth Amendment. Here are the ACLU's answers to some questions frequently raised by the public about capital punishment. Doesn't the Death Penalty deter crime, especially murder? No, there is no credible evidence that the death penalty deters crime. States that have death penalty laws do not have lower crime rates or murder rates than states without such laws. And states that have abolished capital punishment, or instituted it, show no significant changes in either crime or murder rates. Claims that each execution deters a certain number of murders have been discredited by social science research. The death penalty has no deterrent effect on most murders because people commit murders largely in the heat of passion, and/or under the influence of alcohol or drugs, giving little thought

Materialism vs Idealism :: essays papers

Materialism vs Idealism History tells us very little of Titus Lucretius Carus, but one can see from reading his work that he has a strong dislike towards religious superstition, which he claims is the root of human fear and in turn the cause of impious acts. Although he does not deny the existence of a god, his work is aimed at proving that the world is not guided or controlled by a divinity. Lucretius asserts that matter exists in the form of atoms, which move around the universe in an empty space. This empty space, or vacuity, allows for the movement of the atoms and without it everything would be one mass. He explains that matter and vacuity can not occupy the same space, "...where there is empty space, there matter is not...", and these two things make up the entire universe. These invisible particles come together to form material objects, you and I are made of the same atoms as a chair or a tree. When the tree dies or the chair is thrown into a fire the atoms do not burn up or die, but are dispersed back into the vacuity. The atoms alone are without mind or secondary qualities, but they can combine to form living and thinking objects, along with sound, color, taste, etc... Atoms form life, consciousness, and the soul, and when our body dies there is nothing left of the latter except for its parts, which randomly become parts of other forms. Matter is never ending reality, only changing in its form. In the philosophical system developed by Irish philosopher George Berkeley, Idealism, Berkeley states that physical objects, matter, do not exist independent of the mind. The pencil that I am writing this essay with would not exist if I were not perceiving it with my senses, but in the dialogue between Hylus and Philonous Berkeley attempts to show things can and do exist apart from the human mind and our perception, but only because there is a mind in which all ideas are perceived or a deity that creates perception in the human mind, either way its God. He says that the external world can not be understood by thought, but "sensible things", objects that we perceive, can be reduced to ideas in the mind. These ideas, or "objects before the mind", possess primary qualities, the main structure, and secondary qualities, what we derive from our senses, which are inseparable. I'm confused about this, if I'm thinking about a star in a different galaxy, which makes the star an "object" before my mind, then where are the secondary qualities?

Story About Myself

It was a struck twelve at midnight on 20th April 1994, one loving couple of husband and wife had been taken to the hospital by the ambulance, because the they will have their second son from their marriage. It was rainig cat and dog. When they arrived at the emergency section case, a gorgeous 9 month pregnant woman were taken out from the ambulance and was rushed to the labour room by the nurse. When the clock 4. 08 in the morning, one cute and adorable baby boy with 3. 45kg weight was born to the world. After one week get home from the hospital, my parents took 6 days to find a suitable name for me and at last they found a suitable and interesting name to me, the name that they gives to me is Muhamad Afifuddin bin Mat Husin. On year 2011, at 3rd January I registeread as a form 5 student after 1 at one of the school in Kompleks Sekolah-sekolah Wakaf Mek Zainab, Kota Bharu, Kelantan it was SMK Putera and also known as Kelantan Sport School. It was my first day at school as a senior student. On these year I will face a national examination known as Sijil Pelajaran Malaysia ( SPM ) examination that will decide my life in the future after I finished my study at school. First and foremost, I would like to tell about my family background . In my family I have 3 siblings 2 boys and 1 girl, include me. The first one is my brother, his name is Muhamad Akmal he was born on 15th July 1991 at Sungai Petani Hospital, Kedah. He know studied at Tun Hussein Onn University of Malaysia ( UTHM ), Johor on 4th January 2011 he registered at the university and start his second semester. The second one is me Muhamad Afifuddin I was born 20th April 1994 at Baling Hospital, Kedah. On 20th April also the date of birth of our prophet Muhammad s. a. w. The last one is my sister Nur Nadiah she was born on 16th March 1998. She was studied at Maahad Muhammadi Perempuan, Kota Bharu, Kelantan. On 3rd January 2011 she registered as Form 1 student at there. I also have 2 loving parents that take care all of my siblings, my fathers name is Mat Husin bin Lebai Mat he was born on 19th December 1957. he works as health care assistant at Klinik Kesihatan Badang. My mothers name is Zainon binti Mamat, she was born on 10th June 1960 and she work as a community nurse at Klinik Desa Kijang. The next things that I want tell is about my characteristics. First one is I’m was a friendly person, I like to make new friend at every place that I visit. I’m also not choosing when I make new friend, now I have a lot of friend and some of them are from different races like Thai,Indian, Christian and Chinese people. Some of my friend I met at school, taekwondo training centre and taekwondo tournament, all of them also a friendly person. The second one is, I’m also a helpful person I like to help all people especially people in trouble. When I’m at school I always help my friend that have problem in study and problem in other thing, I also like to help the teachers when they need a help from me. If we help other people that have problem and in trouble they will help us when we need their help. The last one about my characteristics is I’m also an active person. At school I join Fire Cadet I participate all the event that have been held by the Fire Cadet and school. Join the Fire Cadet was the one of the co-curiculum at school. I also active in taekwondo, I partipate in all the tournament that have been held. In tournament win and lost was the custom in a tournament, if we lost we must redouble our efforts to win in the other tournament and if we win we must maintain winning in every tournament and always increase our performance. In addition, I’m also have many hobbies that gave many benefits to me. My first hobby is playing football, I’ll play football at 5. 0pm everyday at my village near Kelantan’s River. I’ll play football with my friend, we play football for our health sometimes we held a tournament among us and the winner will get present. When we held a tournament like that we can increase our stamina, sporting spirit and join our friendship. My other hobbies is playing cyber games, I’ll play cyber games once a week on Saturday because when school season I’ll focus on my study. When the school holidays coming I’ll play cyber games every day but I also spend my time on my study. Sometimes I play the cyber games at the cyber games and sometimes I’ll play the cyber games at my house, normally I always play at my house. I play those cyber games with my cyber friends that comes from the entire world, I’ll also get many friend when I play those cyber games. I like visit interesting and historic place like Melaka, Pulau Langkawi, Terengganu and other place, that’s also one of my hobbies, when I visits those place I’ll know information about it like history of those place. On the other hands, I have many favourites things likes favourites food, drinks, colour and sport. First is about my favourite food, I like to eat maggie tom yam because I like spicy food, I also like nasi lemak because some state in Malaysia have their own nasi lemak. In state of kedah their nasi lemak is spicy because all people that lives at the north likes spicy food. My last favourite food is char kuey teow original made from Penang their char kuey teow was so delicious. Next, my favourite drinks is orange juice because orange juice has many vitamin C that’s helps in absorb iron. I also like â€Å" teh tarik † because it can prevent iron in the body. My favourite colour is blue, black, orange and white and I always ensure that things that I bought have at least one of those colour. The last of my favourite is sport, my favourite sports is rugby and football in those sports they play as one team and the must have collaboration among the team members if they want to win in every tournament they played. The team also should have a head of an efficient and caring of his team mate. I also like taekwondo because in this game we must have agility of the body and quickly make the right decisions when we sparring in the ring. Last but not least, my ambition or career when I finished my studied at university. I want to be a professional photographer because I likes to takes picture people, scenery and animal, I hope I can have my own photo studio world-class that have all equipment for photoshoot session . I likes these profession when I saw a programs in television that show a professional photographer snap a picture of people, animal and others, their artwork were respected by everyone in the world and some of them celebrities comes up for grabs because of their beautiful artwork. All of them become success person in his life and his profession. Their life full of wealth and luxury but that not the points I like these profession, I like these profession because I want to show my artwork to the whole world and I want they respected and revered it. I also want to be the first Malaysian professional photographer that show to the world that Malaysian people also can be a famous people the world and success in their profession and life.

Is humanitarian intervention justifiable? Essay

The view that humanitarian intervention is justifiable is debatable. This is due to the fact that in many cases there are two sides to a judgement, the side of the country or countries intervening and the side of the country that is being subjected to intervention. An example is the Iraq war in which the USA and Great Britain intervened, the US and UK may have viewed intervention as inevitable and necessary while the Iraqi’s had many other views and in hindsight many see intervention as a way of worsening matters. Furthermore the idea that humanitarian intervention is justifiable could indeed always depend on the situation and to what extent is intervention needed. Intervention can be justified by the idea of ‘common humanity’, this is the idea that moral responsibilities cannot be limited to a country’s own people and country but essentially to the whole of humanity. This can also be called indivisible humanity due to the claim that we are all humans no matter where we are on the planet. For example the Syrians may be different in geography and language to citizens of the western countries however; this doesn’t mean that they should be subjected to mass murder. As a result there seems to be a necessity for able countries to intervene, able in reference to resources and money and therefore humanitarian intervention can be viewed to be justifiable However, this can be argued against by the possibility of countries intervening for themselves and to pursue their own national interests rather than the country which they are supposedly offering help to. There is an argument that states that countries wouldn’t deploy a great amount of soldiers overseas if there wasn’t a possibility or even a certainty of personal gain and also it is argued that on the subject of whether to intervene or not, some countries calculate national interest and decide then to carry out the intervention or not. A possible example of this occurring is when the US sent troops to Iraq and there was a general view that this happened due to the possibility of gaining oil. This therefore shows political untruthfulness due to the fact that nations are using humanitarian intervention as a cover for their personal interest. Additionally, there is also a view that the citizens and the issues of a certain country are of that county’s business only and outside intervention is unnecessary. Therefore, this shows that humanitarian intervention isn’t justifiable Moreover, the idea of humanitarian intervention can be justified by the fact that in some cases countries act out of a need to prevent a conflict occurring in another country that could have an effect on the country’s own citizens. This is related to the idea of global interconnectedness, currently there are several countries that depend on another for a key reason, for example the exporting and importing of goods. As a result this leads to these countries siding with each other in matters of hardship for either one of them. Also the idea of global interdependence is important because it sheds light to the other side of self-interest; enlightened self-interest. An example of this is ‘Operation Provide Comfort’ (1991) which is when the US intervened in Iraq to defend Kurds that were fleeing their homes in the aftermath of the Iran-Iraq war. On the other hand, the issue of double standards arises that argues against the justification of humanitarian intervention. This is when there is clearly a pressing humanitarian emergency but certain countries decide not to intervene and go to the extent of ruling intervention out completely. For example, the Rwandan genocide in 1994, the USA had just come out of a terrible peacekeeping mission in Somalia and vowed never to get involved in a conflict between clans and tribes where there was no national interest. This shows that although the Rwandan genocide was such a pressing situation as there was no national interest in getting involved the US avoided it showing that they had double standards as years later they involved themselves in Iraq where there was a possibility of personal gain and national interest in the form of oil. Additionally, humanitarian intervention can be justified due to the concept of regional stability. This means that when one country is being affected to the extent of there being a need for intervention it will have a certain effect on the countries surrounding it. As a result many neighbouring countries of an affected country will support humanitarian intervention in fear of the effect that regional instability may have on them. If there is severe unrest then this may call for intervention from major powers such as the USA in order to prevent a possible regional war. For example, the humanitarian crisis in Syria is posing a threat to regional stability due to the rivalry between Iran and Saudi Arabia. The two countries are in dispute because Iran is adamantly backing the Syrian president Bashar Al-Assad while Saudi Arabia is strongly anti-Assad. This is causing regional instability due to the fact that several Middle Eastern countries are now forming two sides; pro-Assad and anti-Assad, for example the highly influential religious group Hezbollah are on Assad’s side as they sided with Iran on the matter. Furthermore this issue is severe due to its highly religious nature. This is shown in the fact that Shi’ite Iran and Hezbollah are supporting the Alawite Assad while Saudi Arabia a Sunni country are against him. Religion is a hugely influential and motivating factor for war and dispute and this issue is emphasising this further. Therefore the need for regional stability is key, and it justifies the need for humanitarian intervention as it seems like it is an important factor in preventing regional unrest and possible wars. On the other hand, it can be argued that humanitarian intervention isn’t justifiable due to the matter of ‘simplistic politics.’ This is when conflicts have been simplified to a basic good versus bad concept in which complexities of potential intervention and its consequences are ignored or belittled and certain aspects have been exaggerated such as the amount of atrocities committed or murders that have occurred. This then results in a distorted view of humanitarian intervention which leads to devastation once it happens as things are underestimated or overestimated. Distortion has a key role in the argument against humanitarian intervention being justifiable. This is because of the fact that the west have a false view of human rights in other parts of the world, for example the USA may have a different set of human rights to those of a middle eastern country and this distorted view can have many disastrous consequences as humanitarian intervention may occur due to a misinterpretation of the human rights of the countries involved. This shows that humanitarian intervention isn’t justifiable because of the different political systems around the world. In conclusion, the evidence shows that whether humanitarian intervention is justifiable depends mostly on the situation. There are views that support intervention as it is viewed as an act for the greater good and must happen to prevent mass murder occurring, while others view it negatively as a seed of double standards and national interest as shown in Rwanda in 1994 where the US didn’t intervene due to no personal gain being offered in return. As a result humanitarian intervention is justifiable according to the situation. Is humanitarian intervention justifiable?

Characteristics Effective Leader Has to Possess

Characteristics Effective Leader Has to Possess Effective leaders are such people, whom it is almost impossible to replace. In order to lead their company/group to success, they have to possess different characteristics and profound knowledge not only in their field of competence, but also in psychology, management and other spheres. First of all, leader has to know what his mission is. When he starts some initiative, he has to understand what results he wants to achieve. He has to know how to define goals, and, what is more important, how to achieve them. It is necessary to take into account any possible outcome of actions and find the ways of solving any arising problems. Second, an effective leader has to be worthy of respect. All his workers and colleagues should hold him in esteem, but not due to fear, but due to the way he manifests himself as organizer and a person. Leader has to respect his workers as well, as he won’t be able to manage people whom he considers to be not competent enough. In fact, there is simply no use in even trying to do it. That is why it is important for a leader to be able to choose his staff wisely and determine if a person will suit his team and in what way he/she will help his company flourish. Third, he has to be sure of his success. The leader who is always grumbling and is not satisfied with everything will not achieve any goals. He has to be sure that he can cope with anything and that eventually his company will be the most prosperous one. And he has to be able to infect his people with the same idea. On balance, it is clear that being a leader is a hard and responsible task and there are not so many people who are able to do it. Still, I am sure that if a person has an ambition to become a leader, he will find a way to develop the necessary traits and will surely succeed.

Human Resource Management A Theoretical Perspective

Human Resource Management in 21st Century: A Theoretical Perspective Dr.Sushma Tiwari,Faculty,Deptt.of MBA(HRD),A.P.S.University,Rewa(M.P.) ABSTRACT- This article focuses upon role of human resource management practice in 21st century. This theoretical paper is aiming the importance of human resource managers, HR practices and its influencing factors. In addition to that, this article also elaborates the upcoming challenges which are faced by 21st century HR managers. Author has conducted HR literature analysis in order to present emerging issues, challenges and practices of human resource management discipline in context of 21st c. Keywords:- importance of HRM 21st Century, HR manager, HR challenges, globalization, issues, strategies,†¦show more content†¦With the 21st century in motion human resource management will face some of the old struggles and HR will be forced to face many new challenges. The main objective of HR is to recruit, retain, train, retrain and keep workers satisfied. Indeed, these responsibilities can be challenging in the 21st century, especially with changing roles, a multi-generational workforce, a nd globalization. Parallel with the change in the global arena, the qualification of the workforce has been changed. The changes of the workforce required a shift from traditional personal management to human resource management. With the evolution of HRM, this field has gain a more strategic perspective in both academic literature and practice. Human resources have started to be seen as an inimitable and most valuable factor for organizations to gain competitive advantage. With this perspective, HRM department has gain more importance and become strategic players in the organization. Today, the new HRM requires being strategic partner in the organization by aligning all the HR functions with the mission, vision and strategies of the organization. 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