Reaction Paper on SONA 2014 Essay

There were many highlights on the recent SONA President Benigno S. Aquino stated last July 28, 2014 and these are the 3 things that intrigued me the most: Under the controversial DAP, PNoy said that around P1.6 billion fund was given to Training-for-Work Scholarship Program of TESDA. A total of 223,615 beneficiaries have graduated with an equivalent of 146,731 graduates currently working. I would say I really applauded him for his insights on education. True, Education is very important in every country. A country consists of people, now if those people are mostly illiterate what do you think would the country become of? And yes, after spending a couple of pesos to those students through scholarships, how much do you think those students would pay for their taxes when the will graduate and have their own jobs? see more:sona 2017 reaction paper The ugly side of this though is the reaction of COA and politics involvement. Did you know that according to COA these amounts were not fully utilized by the agency, casting doubt on Aquino’s figures. COA said that out of the P1.1 billion funds from DAP obtained by TESDA in 2011 for TWSP, only 92.47% was utilized. Now how about that?! People and even projects are not perfect. When will they accept that?! I am still thankful though because at least he is showing positive numbers and facts. President Benigno S. Aquino III, during his 5th State of the Nation Address (SONA) on Monday, cited attainments in the country’s aviation industry as having contributed to the country’s steady economic growth the past year. First on the list of citations was when the International Civil Aviation Organization (ICAO) last March 2013 lifted the significant safety concerns it had previously issued for the Philippines.In the same year, the European Union lifted its ban on Philippine Airlines, allowing it to fly once again to Europe. But with the improved aviation system, President Aquino said, Filipinos can now fly directly from Manila to London. President Aquino also welcomed the FAA’s decision to upgrade the Philippines’ aviation status back to Category 1. He said that because of this upgrade, it is likely that there  will also be an increase in routes going to the United States â€Å"The increase in flights of our local airlines to the United States and participating countries in the EU is a big help to both tourism and business,† the President said in his speech. I am also thankful for this one. Philippines being an accessible country worldwide is a Go Go ! what I meant is its a definite plus for us if we don’t spend too much on connecting flights just for us to get to our destination. I not sure if ever you experienced connecting flights before and I really hope youd never do . Because, Oh my! it is such a hassle with time and money. Imagine you being excited but you need stopovers, sleeping in the airport just catch the earliest flight to your destination and pray to GOD the weather will cooperate or else you’re stuck! Meanwhile, President Aquino also pointed out how the country’s hosting of the World Economic Forum on East Asia this year was a huge success, showing the world the country’s capacity in business.â€Å"†¦With the APEC (Asia-Pacific Economic Cooperation) Summit the Philippines will be hosting next year, we will be able to inform even more people of our progress, and the opportunities that this has opened up for all,† he said. This is my biggest concern of them all. I hope he will exert more effort on this one. As a regular consumer I don’t see myself having a positive sides on this one. Yes I know we are eventually experiencing Mother Nature’s reminders on how we should take care of the resources she has given. But by God! even the spices that is very common and needed in every household (ex: GARLIC – my favourite spice with chicken) costs too much. Including our staple food which is rice. This one needs to be alleviated! Remember County c onsists of People, People needs Education but most of all it needs to FOOD in order to survive!

Melville’s “Bartleby the Scrivener” Essay

In Melville’s â€Å"Bartleby the Scrivener,† Melville displays the life of a person, named Bartelby, who does almost nothing with his life except write. Even latter in the story, Bartelby gives up writing and on life itself. Melville’s story brings up two major themes, which include writing and freedom. The story revolves around scriveners whose job it is to constantly copy documents and in a sense become a slave to writing. Bartelby, though one of the scriveners, resists the command to do exactly what he is told and as the story unfolds, he consistently refused to do what he was told. This defiance leads the reader to question whether Bartelby was protecting his freedom or just setting himself up for an early demise. Barthe includes in his essay â€Å"The Death of the Author† that the author has no control over how his work is interpreted and the reader must decide what the work truly means. Authors are only limited to being authors when they are in the midst of writing but once they have finished their work and are not writing then the Authors are no longer authors. Freedom is constantly emphasized throughout Melville’s story because Bartelby chooses to quit writing do to the fact that he is not being a true author but only a â€Å"scriptor.† Most of â€Å"Bartelby and the Scrivener† centers on writing and how it is necessary in the law practice. Scriveners are law copyists which means their job is to copy law documents for the lawyer to have. At first, Bartelby was a dedicated worker who never stopped copying throughout the day. He did not even take the time to take a lunch break but rather had snacks delivered to him. But as the story continues, Bartelby deteriorates as a worker by first refusing to look over copied documents then finally giving up writing all together. Writing, in this story, seems to be a chore and does not require the person to be an individual in any way. The scriveners had to tediously copy documents, which explain why the scriveners were not exactly the best-qualified workers. Turkey couldn’t work in the afternoon and Nippers couldn’t work in the morning. In any other job that requires serious thought, these two would be fired due to their inability to work all day. According to Barthe, these scriveners are not authors but only scriptors because they mimic the writing and don’t create something original. Bartelby could no longer do this seemingly unimportant writing and finally just stopped writing at all. The only time Bartelby was considered a scriptor was while he was currently copying the documents because â€Å"the modern scriptor is born simultaneously with the text, is in no way equipped with a being preceding or exceeding the writing† (Barthe 145). To be a scriptor, the person must be constantly writing which explains why at the beginning of the story Bartelby never leaves his room but works throughout the day. Bartelby did this because he believed that the only time his life was worth something was when he had the title of a scriptor. Over time though having this title stopped meaning something to him and he eventually quit writing. When Bartelby lost his title of a scriptor, he lost his will to live and that is why when he was in jail he refused to eat. Freedom is an extremely complicated theme in â€Å"Bartelby and the Scrivener† because it is unclear who exactly is free. The scriveners are all slaves to writing because they must spend their time copying documents and don’t really do anything else that would lead another person to say the scriveners are living productive lives. But each scrivener exercises a bit of his or her own type of freedom. Turkey works well in the morning but as the day goes on, he tends to make more and more mistakes. The lawyer tries decides to only have Turkey work in the morning but Turkey refuses that request. This refusal shows that Turkey has a certain free will and doesn’t just spend his time mindlessly copying documents and doing exactly what the lawyer tells him to do. The much younger Nippers has the opposite problem that Turkey has and he cannot work well in the morning because Nippers needs time to get adjusted for work. At first, Bartelby looks to be the least free scrivener at work because he would work nonstop throughout the day without even taking a lunch break but as the story progressed the reader would see that this is untrue. Bartelby on several occasions refuses to do work for the lawyer and eventually stops writing all together. The lawyer is very curious with Bartelby’s response and actually seems to admire his unyielding response to looking over copies. â€Å"His steadiness, his freedom from all dissipation, his incessant industry†¦his great stillness, his unalter- ableness of demeanor under all circumstances, made him a valuable acquisition† (Melville 19). Bartelby’s decision to quit writing demonstrates his desire to become free from the tediousness of writing. Bartelby, however, cannot handle this freedom being captive by writing for so long. He needs to make choices with his freedom and he really didn’t know what to do with his life. This is why he stayed in the office until he was thrown in jail and then died of starvation because he refused to eat. Bartelby couldn’t decide what to do with his life without writing and it led to his death. The lesson learned about freedom from this story is that complete freedom means complete loneliness and helplessness. Barthes’ â€Å"Death of the Author† combines writing and freedom together in order to express how certain writings should be interpreted. Barthes explains to his readers that â€Å"a text is not a line of words releasing a single ‘Theological’ meaning but a multi-dimensional space in which variety of writings, none of them original, blend and clash† (Barthes 146). This quote iterates that the author does not come up with a work that is truly original but takes aspects of different works to create his own. Barthes emphasizes that the author should not instill his own opinions in his work but rather allow the reader to have the freedom to come up with his own interpretation. This is where freedom intertwines with writing. The author must give up control of his work and allow the reader to take authority and decide what exactly is meant be the work. But also, the author’s duty is to limit how much is actually expressed in the text. â€Å"To give a text an Author is to impose a limit on that text, to furnish it with a final signified, to close the writing† (Barthes 147). The readers must separate a literary work from the author in order to free the writing from being read only as the author’s opinion. Every work of writing contains multiple interpretations. Barthes compares text to textiles by explaining that â€Å"everything is to be disentangled, nothing deciphered; the structure can be followed, ‘run’ (like the thread of a stocking) at every point and at every level, but there is nothing beneath† (Barthes 147). This quote explains that much of writing read through thoroughly but conclusions don’t necessary need to be drawn. Reading a work is much different than figuring out a puzzle. To truly grasp writing, a reader must capture the actual literature and realize exactly what each word in the writing is trying to express. The meaning of the work is derived from the ideas of the reader, rather than the thoughts of the writer. The reader has the freedom to capture whatever meaning he desires from a work of writing. Barthes explains that the author cannot put his own opinions into his own work because the reader must come up with his own interpretation of the work. Melville’s â€Å"Bartelby and the Scrivener† emphasizes this concept by showing the role of a scrivener, who only copies documents and puts nothing of himself into it. Bartelby feels like his life has been wasted just copying documents and finally decides to quit writing. Once Bartelby loses his will to write, he completely loses his will to do anything of importance, even eat. Writing must be entangled like threads of a cloth, and the author must place a limit on how much can be inferred from the text. Bartelby is not an author but only a scriptor because he is not performing art by copying legal documents. This explains why Bartelby believes his life is useless because he wasted it away copying documents. Works Cited Barthes, Melville. â€Å"Death of an Author.† 1977. Melville, Herman. â€Å"Bartelby the Scrivener.† 1870.

DISCUSSION BOARD Essay Example | Topics and Well Written Essays - 500 words

DISCUSSION BOARD - Essay Example al accountants are primarily focused on what the enterprise has done and how it has performed, managerial accountants are also concerned with what is happening now and what may happen in the future. Because they have different roles and different audiences, they also have different reporting methods, statements, and standards. Financial accounting has, as its basic goal, to provide clear and accurate information to external parties that will make decisions on credit and investment. Because this audience is wide and unknown to the preparer of the information, it is mandatory that the financial accountant follows traditional and acceptable conventions. The financial accountant will file income statements, balance sheets, cash flow, and earnings statements. To standardize the reporting process and give credibility to the reports, the financial accountant is required to follow Generally Accepted Accounting Procedures (GAAP). These reports are generated at set intervals, such as quarterly or yearly, and audited by independent auditors. These procedures insure that the decision-makers will have a reference point with which to make an informed decision. Managerial accountants, more focused on current and future business decisions, prepare statements to be used by internal decision-makers. These reports assess past performance as well as forecast the future direction of the enterprise. Because this information is used by management and directors to make daily decisions, it is focused on timeliness and centered on efficiency and return. The frequency that these reports are generated is set by the internal needs of the enterprise and may be daily or even on a real time or as needed basis. The reports are more apt to center on budgets, costs, forecasts, and efficiency than income or cash flow. An enterprise may have many custom statements and reports tailored to their individual requirements and because the information is only used internally, the only reporting standards

Evaluation argument Essay Example | Topics and Well Written Essays - 500 words

Evaluation argument - Essay Example However, the pathway to the dream becomes a nightmare. One of the aspects that make the movie rather exceptional is emanates from the storyline. Starring Al Pacino as Tony Montana, the movie contains not even a slight scrap of anything that can be mistaken for over-romanticizing, which the movie further scorn devoid of any mercy. As long as it is, it mainly demonstrates the impact of a single gasping story about the rapid rise and fall of a young lad in a cocaine industry. Unlike the original version of the movie that was rather emotional, Scarface presents a persistently vicious, ironic account of greed in which all the emotions that one is supposed to deem decent, are brought out in a manner that can be misrepresented. The movie is also remarkable in its casting especially in terms of the role given to Tony Montana who is depicted as intelligent yet hollow-eyed individual who seems to lack a promising future, however, his greediness and ambitions are so intense that they can at the same time be viewed as heroic in magnitude. Although many people may the dispute the cruelty of Tony Montana, this can be regarded as one of the strongest points of the movie in the sense that, after first developing a strong emotional attachment with the viewers, it reaches a point where Tony’s character starts to putrefy. Tony has absolutely no hesitation about taking a life for any profitable course that ironically makes him adored by the Florida drug baron. Another strong point of the movie can be derived from the fact that unlike other films where the climax is marked by the main character achieving the best out of all possible situations, in Scarface, Tony’s fall marks the high point of the movie. The last quarter of the movie treats the viewers to the scene of a paranoid Tony Montana whose addiction to cocaine has seen him losing control of himself and his business in general. The extent of his lack of control

Questions Assignment Example | Topics and Well Written Essays - 250 words - 26

Questions - Assignment Example tion or Nursing could use the Internet to search for jobs through online recruitment agencies and through the official websites of organizations where candidates intend to apply. Some organizations even encourage sending of resumes online to facilitate the job screening process. Only those applications who meet the qualifications of the organizations are called for interview and eventual placement. 2) Sometimes in technical writing, it is necessary to categorize or group elements into appropriate categories. There are three techniques for categorizing: classification, division, and partition. Please explain what each of these means and why it is advantageous. Classification means grouping elements according to similar characteristics. As emphasized, â€Å"classification is the act of locating a specimen of all the different kinds of objects that possess a given characteristic or characteristics† (Nikko par. 4). The advantage of using classification is to highlight the presentation of items into a more structured manner. It is also revealed that â€Å"classification answers the question: What are the main types or kinds of this group of things? Division answers the question: What are the parts or characteristics that make up this single thing?† (Duncan 1). Thus, the advantage of division is providing additional details on the things that were initially classified. Further, partition means â€Å"the act of dividing a unit into its components. The parts do not have necessarily had anything in common beyond the fact that they belong to the same unit† (Nikko par. 8). The technique of partition is beneficial in terms of pr oviding information on the parts of the object or item that was previously identified under the division

Grey Intelligence Essay Example | Topics and Well Written Essays - 750 words

Grey Intelligence - Essay Example This has forced the government of the United States of America to use unconventional styles to counter terrorism. Intelligence had been converted into a private service. Private companies are playing a prominent role in the interrogation of prisoners besides sending intelligence signals1. It is now official that 70 per cent of United States budget on intelligence services goes to these private companies. The government of United States has heavily invested in paramilitary forces posing the question of reliability and the threat of leakage of government secrets. The concept of grey intelligence or privatization of intelligence has introduced the fears of conflict of interest between the private sector and intelligence agencies2. The United States senate encouraged the relationship between private sector and intelligence community three years after the September 2001 terrorist attack. The contractors outnumber the employees of United States government in Pakistan. The private companies are now involved in water boarding the war crimes detainees using the CIA facilities. The private intelligence companies seem to be allowed to use lethal force in some environments3. Questions have been raised over the use of the United States Special Forces in the paramilitary forces. Many people are increasingly viewing privatization of intelligence as a strategy to use force without an accountability framework. In the military terms, the term intelligence refers to the analytical product of private companies or intelligence agencies. The activities of these private companies are said to be reinforced by covert operations. The use of outsourced or privatized intelligence has spread the use of terrorists surveillance program (TSP). The program enables these companies to intercept electronic messages including phone calls. It is clear that the contractors are involved in water boarding the Al Qaeda detainees. The yielding of

4 short questions Movie Review Example | Topics and Well Written Essays - 250 words

4 short questions - Movie Review Example The play was a major success because of the great measure of its development and the subsequent production offered by the Steppenwolf Theatre in Chicago. As a result the play was made into a film based on the audience reaction (Letts, 12). The poet T.S. Eliot is quoted and referenced in the play due to the fact that the main concept put across is that of life. Letts uses quotes from one of his poems ‘The Hollow men’ which is a poem that talks more about broken souls. The reason for this is because the play focuses on a dysfunctional family that is in a crisis and is broken. The theme of broken souls based on the poem is followed throughout the play as the drama unfolds. ‘Life is very Long’, this is a quote that is referenced by Beverly when she expounds about life and poetry to Johnna (Lett, 14). Based on the interview conducted on Letts, I do not agree with the blogger’s statement. This is because most of the people in Oklahoma are of the Native American background and thus for Letts to include this character there was strong thematic resonance involved. There was also need to connect with most of the audience that were within that background. Johnna character purpose was to be that of a carer to the family and thus her roles were aimed at providing care and support service especially to Violet who was an addict of prescriptions medicine. Her presence does not affect me as a reader as her character represents a real life situation in Oklahoma (Letts, 16). The character that I identified with is that of Barbara, the eldest daughter. This is due to the fact that she portrayed the role of being a devoted daughter despite the crisis that was in the family and the fact that her mother was an addict. For instance, during a family dinner in act two she stood up in front of everyone and declared that she was going to run things from then henceforth. This scene shows that she

Christian View of Business and its Purpose in Society Personal Statement

Christian View of Business and its Purpose in Society - Personal Statement Example The paper also identifies if trade action needs to be involved exclusively by means of antagonistic visionary means which would be enthusiastically embraced (Duzer, 2012). One of the most appealing aspects stated by the authors has been related to the definition of business and its relation with the theological perspective. The article asserts that business is a form of institution since it is a means through which a group chooses to resolve one of its social problems. From the views of theology, the main objective of business is to assist in the creation of God’s empire. The unique role that the business has to play in that effort is to serve the society by manufacturing the goods and the services required to facilitate the pursuance of the main objective and the creation of the giftedness of the person in the business. The article tends to lay theological framework for comprehending business in terms of God’s creativity, human depravity as well as Christ’s rede mption. The article is well written and is also quite significant and thus contributes meaningfully to the understanding of the readers and inspires in accomplishment of their daily work within the noble calling of business. It can be reflected that the redemption view of business leads an individual to the particular situation that is valued by the Christians. The authors state the fact that instead of just restricting the acceptable business conduct, it forces the individuals to enter into business as a type of service offered to the neighbor and finally the individual’s participation in creating the sovereignty of God. The individual is capable of freely entrusting upon the Spirit of God in order to give wisdom, competence, creativity as well as compassion for their involvement in business since the people tend to fulfill the redemption purpose of God. In the absence of the solid theology, the Christians in business do not have a proper sense of purpose and a comprehension of the spiritual environment in which they tend to function. When the way of doing business lacks moral, then its sole objective of attaining the organizational goals might be eradicated and hence the focus is generally upon the accomplishment of the personal goals. Therefore, it is quite significant to inculcate theology with the help of which the business man will be competent of operating morally and thus will also be capable of conducting business in an ethical way. The focus of the businessman must not solely be on maximizing the profitability factor but also on serving the society according to the directions demonstrated by god (Duzer, Franz, Karns, Dearborn, Daniels, & Wong, n.d.). Article 2: The Social Responsibility of Business is to make its Profits The article â€Å"The Social responsibility of Business is to make its Profits† has been written by Milton Friedman. The key intention of the article is to demonstrate the fact that the main objective of social responsi bility is to enhance the profitability factor of business. The author in his article describes the social responsibility of not the businesses but of the corporate executives, which is his main thesis statement. Friedman has argued that the supporters of the social responsibility of business were generally moralizing socialism. However, in the present times, the debate is generally regarding the characteristic of capitalism. The most relevant point that has been noticed in the article is that the corporation is an

United Holidays Essay Example | Topics and Well Written Essays - 1000 words

United Holidays - Essay Example It is considerably easy to carry out. Disadvantages It is time consuming Written sources 3 b. Discuss the purpose and features of a CASE tool, which could support the development of the required system for United Holidays Purpose: They enhance software development. They generate codes automatically and also used in normalization.Diagramming tools are used to draw the system models required or recommended in most methodologies. Description tools are used to record, delete, edit, and output non-graphical documentation and specifications. Prototyping tools are used construct system components including inputs, outputs, and programs. Inquiry and reporting tools are used to extract models, descriptions, and specifications from the repository. Quality management tools analyze models, descriptions, and prototypes for consistency, completeness, or conformance to accepted 'rules' of the methodologies that the CASE tools support. 4 a. What are the typical job roles that exist within the software development lifecycle, and at which stage(s) of the lifecycle will they each be active Systems Analyst Programmers: these are the people who develop the codes Users. They give information. Project Manager b. Who are the stakeholders in an information system, and what are their individual priorities System owners. These can be individuals or organizations. System Users. These are the staff or employees who interact with the system on a daily basis System Designers. System builders. Are the programmers Vendors. Are the ones who are in the business of selling and distributing these systems 5 a. What are the relevant advantages and disadvantages of Software Prototyping and the Waterfall with Iteration approach to software development Advantages of... United Holidays In object programming the practice to combine simple objects is referred to as composition for example the classes in the airline can not exist if the class airline is removed This allows the investigator to develop empathy for the study population through listening and participating. Additionally, observation allows the observer to become an "insider. The method is also very useful where no records of previous studies exist Data can be collected quickly on specific items; these data can be easily transferred into forms allowing quantified and computerized analyses; and data collection tasks can be delegated to less expensive field staff. Questionnaires also compel the adoption of some "organized structure" upon data collection (Fowler, M. 2003) Transition: in this phase the goal is to system and user test the system to ensure that it is ready to be deployed into production, to make needed corrections, and to actually deploy the system (Fowler, M. 2003). This leads to the fact that data programmers and other professionals need to be prepared to change and grow their models, including their database schema over time. Furthermore, iterations lead to the discovery of the need to re-factor their schema to reflect the needs of new requirements (Fowler, M. 2003). If your system needs to interface with existing legacy systems, and it often does, data professionals will likely be needed to be involved with legacy integration efforts. Data models are very likely needed, but they're not needed up front.

Decisions in Paradise, Part I Assignment Example | Topics and Well Written Essays - 750 words

Decisions in Paradise, Part I - Assignment Example sters’ affected country where main threats are natural calamities such as earthquakes, Tsunami, Typhoons/Hurricanes, Tornadoes,  Floods and  Volcanic eruptions. In addition, there are other possible threats of HIV, Petroleum spill, Avian flu and Terrorism. Secondly, the economic evaluation and assessment have made it clear that KAVA is heavily dependent on agricultural products. It becomes evident that there are very few industries and thus there is a huge business scope due to availability of cheap quality labor. The third issue is that my company is greatly affected from the goods and services produced and sold by KAVA because it is a provider of raw-materials especially cocoa. Fourth issue is about the fact that my company might find good business opportunities in KAVA if we take part in its construction and rehabilitation. Apparently, one of the major forces involved in problem formulation in Kava is its immunity to natural threats that I have already mentioned above. Furthermore, the potential risks associated with this country may include poor purchasing power because the country is heavily dependent on agriculture, tourism, fishing and other natural resources instead of manufacturing and selling of finished products. Undoubtedly, industrialization results in more jobs and better purchasing power that further leads to creation of a new market of various products. Secondly, in order to accomplish our goals and objectives of accomplishing a clear and distinctive image in the mind of Kava residents, a mammoth sum of money have to be allocated to initiate a solid Corporate Responsibility Program. The company may face some internal and external ground factors in execution of its program which will be developed on the principles of Corporate Philanthropy. In addition, Kava is turning out to be ‘melt ing pot’ so marketing and selling tactics or tools have to prudently employed to win the attention of potential consumers. Special attention has to be paid

A Critique of Frye’s, Jordan’s, and Miller’s Feminist Theories Essay Example for Free

A Critique of Frye’s, Jordan’s, and Miller’s Feminist Theories Essay Marilyn Frye’s feminist theory is based on a mix of art and philosophy as well as a presentation of her own ideas in the context of the world. Frye’s theory stresses among other things, the fact that the power of feminism is embedded in the capability of making women’s lives and their experiences understood by a vast majority of the people (Frye, 1983). On the other hand, Jordan’s feminist theory lays emphasis on the woman’s self with reference to her relational well-being (Jordan, 1991). Closely related to this, Miller’s theory is based on the view that there is need to address women’s experiences and make the world understand them better. Thus, Miller suggests that in order to understand women, there is need to understand their lives and values (Miller, 1987; Davis, 1999). This paper will examine and appraise the aforementioned theories and draw a conclusion based on the flaws or incongruence depicted by the theories, and will thus suggest whether the theories can be used together or as separate entities. Frye’s Feminist Theory Frye affirms that in order to understand women fully, that is in terms of their feelings, motivations, ambitions and how they are likely to react to different situations, there is need to understand their driving forces, which are the determining factors in various responses (Frye, 1983). Frye’s feminist theory thus presents an attempt to explain the forces and how they apply to different women. While it may be true that there are deciding forces behind every woman’s response to different situations, it is also evident that the forces cannot be studied conclusively. This viewpoint is instigated by the fact that women live in different conditions, and these conditions are likely to affect how they react to different circumstances. Thus, a generalization cannot be used to describe women’s attitudes. In view of sex and sexuality, Frye notes that sex roles have inhibited men and women from being in charge of their choices since the activities involved in sex are already predetermined (Hoagland Frye 2000). However, this supposition fails to address the sex drives involved among same-sex partners. Thus, even though Frye notes that women are sexually oppressed, it is difficult to concur with the argument since sexual freedom has increased tremendously in the world over the past few years. Frye’s likening of women to a birdcage in which if one observes one wire of the cage, she or he is likely not to see the other wires present in the cage (Davis, 1999) presents an interesting point of discussion. This is true given that in there are instances when women are ignored, for example in restaurants when waiters expect men in company of women to pay the bills. This implies that much attention is paid to men, who are perceived to be a superior sex. Jordan’s Feminist Theory This theory emphasizes the connections among different aspects of women’s lives, which are developed through relationships. It dwells on factors such as sexism and heterosexism, which separate women and alienate them from the rest of the society, thus subjecting them to a lot of suffering (Jordan, 1991). In view of this, while it is true that women are more affected by issues that concern sex it is also imperative to note that such issues are not just limited to women. Concisely, men also suffer from issues related to sex. Jordan’s theory also dwells on the self-condition of women in relation to their relational wellbeing. Jordan emphasizes that most Western psychological theories tend to point too much on the woman’s self rather than her relations with others (Jordan, 1997). Along this line, Jordan asserts that men have subordinated women and view them as their subjects, thereby undermining women’s relation capacity. This presumption has some substance with reference to how women were treated in the past. However, it may loose significance in the contemporary world where women have taken more leadership positions and have better control of their undertakings. Jordan addresses desire by relating it to adolescent sexuality, noting that it arises from people’s integration with others and creation of relationships (Jordan, 1997). This is true in the context of what people commonly refer to as â€Å"real love† that develops between men and women through their continued association. On the other hand, since relationships commonly break, there is an indication of a flaw in Jordan’s theory. Nevertheless, Jordan’s point of challenging the tendency by men to be dominant over women (Jordan, 1991) stresses the need for equality between men and women. Miller’s Feminist Theory Miller focuses on the concern of men’s domination over women and their tendency to subordinate them (Miller, 1987). She asserts that the propensity by men to be dominant over women causes conflict between the two sexes because men fail to understand women. Miller also notes that in dealing with conflict, women, who are usually the subordinates revert to overt conflict, a phenomenon that is prevalent in the present day (Miller, 1987). Miller therefore questions why men should be dominant over women yet women have equal capabilities do what men can do. Miller’s feminist theory is important in addressing gender disparity in the world. It also supports women in having voices to do what pleases them irrespective of what men think about them. However, its flaw lies in the fact that it fails to address why men have higher propensity to be dominant over women and why women usually revert to overt conflict when dealing with men. Conclusion The feminist theories by Frye, Jordan and Miller all address issues that though not congruent are closely related. Frye’s theory is centered on understanding women; Jordan’s theory recognizes the woman’s self worth and the importance of women’s participation in relations; whereas Miller’s theory in centered on understanding women and why men should not treat them as subordinates. All these issues are closely related since they address the status of women and their role in the society, which is paramount in eliminating injustices against them. Hence the theories should treated together to achieve the objective. References Davis, F. (1999). Moving the mountain: The women’s movement in America since 1960: Chicago: University of Illinois Press Frye, M. (1983). Politics of reality: Essays on feminist theory. New York: Ten Speed Press Frye, M. (1992). Willful Virgin: Essays in Feminism, 1976-1992. New York: The Crossing Press, Inc. Hoagland, S. L. Frye M. (2000). Feminist interpretations of Mary Daly. Pennsylvania: Penn State Press Jordan, J. (1991). Women’s growth in connection: New York: Guilford Publications, Inc Jordan, J. (1997). Women’s growth in diversity. New York: Guilford Press Miller, J. (1987). Toward a new psychology of women. Boston, MA: Beacon.

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.,