Apollo Hospital Essay Example

Apollo Hospital Essay Example Apollo Hospital Essay Apollo Hospital Essay The ‘‘wow’’ factor in service relies on constant innovation and demands continuous and sensitive focus on all issues that may affect the patient’s stay in a hospital. Every touch point of the hospital needs to be ‘‘alive’’ and the client must be able to feel the warmth offered. The culture of service is imperative in today’s scenario, where the differentiators could just be the manner in which services are offered. All the major players could replicate infrastructure within a short span of time, but not the service culture. Dr. Umapathy Panyala, Chief Executive Officer, Apollo Hospitals, Bangalore (March 2013) Dr. Panyala, CEO, Apollo Hospitals, Bangalore believed that in the future, the hospitality aspect of hospitals- the service provided to patients- would differentiate Apollo Hospitals from a large number of equally competent competitors in the growing Indian healthcare industry. He had set up a quality department at the Apollo Hospital in Bangalore, headed by Dr. Ananth Rao. Apart from being an expert on Metabolic Diseases and Biochemistry, Dr. Rao was also a Lean Six-Sigma black belt from the Indian Statistical Institute, Chennai. You can’t manage what you don’t measure- although this may sound cliched; I am still a firm believer of this philosophy and want to apply this, especially in the hospitality part of hospitals. Clinical benchmarking is a compulsory requirement and is taken care of; however, patients have so many other touch points in their stay at hospitals- the hospitality part. Some of the world-class hotels (such as the Ritz–Carlton) have performed benchmarking to standardise their hospitality offerings; at the same time, its employees are allowed to use their judgment to provide whatever delights the customer in every visit. 1 We want to internalise this in our culture as well. – Dr. Ananth Rao, Head–Quality Department, Apollo Hospital, Bangalore (March 2013) Dr. Rao also believed that the hospitality aspect would differentiate Apollo Hospitals from its competitors. Patient cure and care played very important roles in hospitals. Many patients were generally anxious when in a hospital and the sense of disservice increased their anxiety level very easily. Integrating healthcare and hospitality was essential for creating patient-focused care. Hospitality aspects included a smooth admission procedure, friendly medical and non-medical staff, comfortable furniture, varied choices on the food menu, attractive surroundings, recreational facilities, privacy, clear signposting, adequate provisions for visitors, and so on. 2 Important aspects of hospitality were managed by the nursing staff and other non-medical staff, which meant inherent variability of service owingto human interventions. Dr. Panyala and Dr. Rao wanted to measure the hospitality aspects at Apollo Hospitals and improve hospitality to create a world-class hospital. Dr. Rao and his team collected feedback every day from the patients and received a number of complaints, ranging from not having a TV remote to long response time on the part of nursing staff in attending to requests from patients. For Apollo Hospitals, it was important that the patients’ experience in the hospital was not compromised, since it could have a significant financial impact. Managing the hospitality elements of the hospital was as important as managing the clinical aspects. Apollo Hospitals had a stringent process in place to take care of clinical aspects. Dr. Rao wanted to improve the hospitality at Apollo Hospitals by reducing the 1 Hall, J. M. and Johnson, M. E. , When should a process be art, not science, Harvard Business Review, 2009, 1–9. Hepple, J. ,Kipps, M. and Thomson, J. , The concept of hospitality and an evaluation of its applicability to the experience of hospital patients, International Journal of Hospitality Management, 1990, 9(4),305–318. 2 Suhruta Kulkarni, Kripa Makhija and U Dinesh Kumar, Professor of Quantitative Methods and Information Systems, prepared this case for classroom discussion. V Sandeep assisted in data collection and analysis. This case is not intended to serve as an endorsement or source of primary data, or to show effective or inefficient handling of decision or business processes. Copyright  © 2013 by the Indian Institute of Management Bangalore. No part of the publication may be reproduced or transmitted in any form or by any means – electronic, mechanical, photocopying, recording, or otherwise (including internet) – without the permission of Indian Institute of Management Bangalore. This document is authorized for use only by NIKITA VAIDYA in Nutrition 346 taught by Carol Blindauer, at Dominican University Illinois from January 2015 to May 2015. For the exclusive use of N. VAIDYA, 2015. Apollo Hospitals: Differentiation through Hospitality Page 2 of 20 number of complaints from patients; he also wanted to achieve significant improvement in sigma levels measured through the Six Sigma performance scale. According to Dr. Ananth Rao: The immediate challenge is to understand the patients’ sentiment towards the hospitality provided and to design a process improvement plan that is affordable. Apollo takes feedback from patients every day and the quality department staff interviews many patients every week to understand their needs. Dr. Rao was aware that improving hospitality at Apollo Hospitals was going to be a continuous exercise in improvement; collecting feedback was one way of approaching the process of continuous improvement. He treated every complaint as a â€Å"defect† and planned to use lean Six Sigma concepts to eliminate defects. Implementing Six Sigma in all departments was likely to be a challenge since departments such as housekeeping faced high attrition rates. His immediate objective was to introduce a system where future complaints related to hospitality could be reduced. Also, how much importance should be given to hospitality by Apollo Hospital was one of the dilemmas faced by Dr Rao and he wanted to set a realistic target for Sigma level in hospitality at Apollo. APOLLO HOSPITALS: THE TRENDSETTER Dr. Prathap C. Reddy, founder of Apollo Hospital Enterprises Ltd. (AHEL) had accomplished a successful medical career in the United States. He returned to India in 1972 to contribute to the healthcare system in India. Health infrastructure in India was very poorly developed in the 1970s. In 1971, there were 3,862 hospitals and 12,180 dispensaries with a total of 348,6553 beds for a population of 548,159,6524- a ratio of 6. 36 beds per 10,000 people as against the ratio of 9 beds per 10,000 people in 2011. 5 India’s first National Health Policy was declared in 1983,6 almost 36 years after independence, which was an indication of the neglect faced by the health sector in the country since independence. Dr. Reddy had set up a good medical practice in India and used to send patients outside the country for specific treatments. However, in 1979, a young patient died as he could not arrange the money for treatment in the United States. Dr. Reddy then decided to provide the best of medical treatment from the West to patients in India with an emotional touch, calling it â€Å"High Tech with High Touch. † Apollo was a doctor-promoted enterprise- 10,000 Indian doctors, 4,700 U. S. -based doctors, and 60 doctors from the United Kingdom invested approximately USD 5,000 to start the venture. Dr. Reddy selected the best of the talent available to ensure the best possible service and care. He also ensured that a clear distinction was maintained between business management and clinical management. 7Apollo pioneered world-class healthcare in India, which was later emulated by several other hospitals. Apollo focused on technological excellence and garnered many firsts to its credit in the country. Apollo was the first not only in India but also in South Asia to launch Oncological Robotic Surgery, G4 Cyberknife Robotic Radiosurgery System, 320-slice computed tomography scanner, 64-slice positron emission tomography-computed scan system, full-field digital mammography with tomosynthesis, and many such technologies. 8 According to Dr. Rao, Apollo intended to carry forward technological excellence in hospitality to provide patients with the best cure and care services. Dr Preetha Reddy, Managing Director, Apollo Hospitals Enterprises Limited has been the pioneer and chief architect of the tender loving care –TLC ‘‘mantra’’, a pillar of the Apollo way, which is affectionately applied to every patient at Apollo Hospitals. â€Å"The patients and staff comprehend this language better,† she points out. The concept of TLC integrates service delivery with clinical outcomes resulting in exceptional patient experiences9,10. 3 Background Papers: Financing and Delivery of Healthcare Services in India, National Commission on Macroeconomics and Health, Ministry of Health and Family Welfare Government of India, 2005, p. 47. 4 Source: http://cyberjournalist. org. in/census/cenpop. html, accessed on March11, 2013. 5 Source: globalhealthfacts. org/data/topic/map. aspx? ind=78, accessed on March11, 2013. 6 Health Research Policy, Indian Council of Medical Research, New Delhi, (October 2007). 7 Mitra, M. , The Apollo Mission, Corporate Dossier with The Economic Times, June 1, 2012. 8 Apollo Investor Presentation, www. apollohospitals. com, accessed in January 2013. 9 N Amarnath, and D Ghosh, The Voyage to Excellence: The Ascent of 21 Women Leaders of India Inc. , Pustak Mahal, pp. 80-95. 10 apollohospitals. com/apollo_pdf/dr_preetha_reddy_managing_director. pdf This document is authorized for use only by NIKITA VAIDYA in Nutrition 346 taught by Carol Blindauer, at Dominican University Illinois from January 2015 to May 2015. For the exclusive use of N. VAIDYA, 2015. Apollo Hospitals: Differentiation through Hospitality Page 3 of 20. CLINICAL BENCHMARKING Apollo Hospitals had been using a clinical score card called [emailprotected] (Apollo Clinical Excellence), which measured and monitored clinical excellence among the group’s hospitals. [emailprotected] measured 25 clinical parameters (Exhibit 1) every month, which were benchmarked against global standards. [emailprotected] was launched on September18, 2008 and used across 32 hospitals of the group. Clinical benchmarks were published by various institutions and bodies such as Cleveland Clinic, Mayo Clinic, and National Healthcare Safety Network (NHSN), among others. Hospitals were grouped according to their bed strengths, locations, services offered, and so on. Group A hospitals had to report 25 parameters- 23 were common parameters, while two were location-specific. Group B and Group C hospitals had to report 15 and 10 parameters, respectively, out of which two were location-specific. [emailprotected] was an internally developed clinical scorecard, created by drawing upon the wealth of expertise available within Apollo. An audit committee at the corporate level was set up to validate the data, methodology, and definitions followed at each location. According to Sangita Reddy, Executive Director, Apollo Hospitals Group: We needed a yardstick like [emailprotected] that would pit us against international institutes like Cleveland Clinic, Mayo Clinic, and others, and position us on the global healthcare firmament for excellence in clinical quality. This also enables us to assess where we stand and where we need to 11 be, while pursuing excellence in clinical quality. Apart from this internal benchmarking exercise, seven of Apollo’s hospitals were accredited by the Joint Commission International (JCI); and it was the largest group in South Asia to be accredited by the JCI. The JCI was a U. S. -based accreditation body dedicated to improving healthcare quality and safety around the world and recognized as the gold standard for hospitals. Apollo was also accorded the Superbrand status by the Indian Consumer Superbrands Council, which recognised that the best practices were used in the brand. Apollo was the 12 only hospital that was accorded the Superbrand status in India. There were other accreditations that several Apollo hospitals had achieved (Exhibit 2). According to Dr. Panyala, Living the brand should be our focus in every initiative or activity we perform. Apollo Hospitals has been one of the consistent names among the Superbrands. The perceived value of a brand like Apollo Hospitals is set very high in the backdrop of the decades of service and excellence it has offered. Clients need to see and experience that value, and the gap between perceived value and obtained value must be zero at best or at a bare minimum. PATIENTS’ FEEDBACK AND REAL-TIME ACTION On average, a patient spends 80% of the time in hospital for the care part rather than the cure, and we need to focus on care to ensure speedy recovery and maximum satisfaction. Hospitality is critical in healthcare as the patient and his/her attendants are already distraught and highly anxious. Hospitality is driven mainly by human interventions- in nursing, housekeeping, as well as food and beverages. It is very difficult to ensure consistency of quality and hence, we want to benchmark these to ensure we provide the best quality of hospitality all the time. –Dr. Ananth Rao, Head–Quality Department, Apollo Hospital, Bangalore (December 2012) Dr. Rao believed that although clinical services formed the core of Apollo’s services and brand image, hospitality would support the brand, and in the long run, both would merge to form the Apollo brand (as shown in Exhibit 3). All services that did not require core clinical expertise were classified as hospitality services, including services such as billing, dietician service, food beverages, facility, housekeeping, nursing, facility, and overall operations. Each service was executed through a variety of processes. All the processes included in each service were identified and defined with regard to the procedure, timelines, required output, and so on. All the processes were mapped and the quality measures defined; these would be used as Sigma metrics. 11 12 Express Healthcare, (2010), http://healthcare. financialexpress. com/201009/strategy01. shtml Source: http://kolkata. apollohospitals. com/newsroom/271-apollo-hospitals-only-healthcare-super-brand-in-india. html This document is authorized for use only by NIKITA VAIDYA in Nutrition 346 taught by Carol Blindauer, at Dominican University Illinois from January 2015 to May 2015. For the exclusive use of N. VAIDYA, 2015. Apollo Hospitals: Differentiation through Hospitality Page 4 of 20 The Quality Department, established under the leadership of Dr. Rao, comprised two dedicated staff- Soumi Dutta and Nisha Maria- who looked after a variety of quality-related issues. Soumi and Nisha collected feedback from the patients between March 2011 and December 2012using the form presented in Exhibit 4. Patients were asked to rate each department on a scale of 1 to 10. Additionally, open-ended feedback such as patients’ comments, opinions, or suggestions was also collected. A schedule was developed for collecting feedback, which ensured that Soumi and Nisha collected feedback from a cross-section of patients; this also ensured that no biases crept into the feedback. The feedback collection methodology is shown in Exhibit 5. Soumi and Nisha were trained to collect frank, free-flowing feedback from the patients. If they received complaints while collecting feedback, they would immediately inform the department concerned and get the errors rectified, whenever possible; or ensure that the complaints were addressed to the patient’s satisfaction in real time. One of them recollected the following anecdote: A patient had complained that the door was not getting locked properly. I got in touch with the facility personnel and they worked on the door and the lock and fixed the problem- all in a matter of 25 minutes from the moment it was brought to my attention. The patient was satisfied with the immediate solution. However, we did not stop there. We teamed up with the facility team and checked every door of the hospital and repaired them if required. We wanted to ensure that such complaints were not repeated. The feedback collection process served multiple objectives such as collecting open-ended feedback from patients, resolving the issues in real time, and further auditing the actions of the service departments. The real-time escalation flowchart is shown in Exhibit 6. The feedback was saved on an MS Excel spread sheet, and stored on a monthly basis for easy retrieval. The data was then analyzed using various parameters and trends were plotted for each service. At Apollo, each service was related to a department; hence, it was easier to deal with the complaints and determine monthly improvements. FEEDBACK ANALYSIS From March 2011 to December 2012, 1,434 complaints were received from among the 1,38,600 in-patients treated during that period (approximately 1. 03%). A Pareto chart was plotted for these complaints (as shown in Exhibit 7). The housekeeping department received the maximum number of complaints, while the dietary service had the least number of complaints. The department-wise spread of complaints is shown in Exhibit 7. Some of the complaints were genuine concerns while some were related to minor discomfort. A few of the complaints were very specific, while some were generic. All of these were analyzed, which would enable the hospital to work towards reducing the overall number of complaints. Some of the sample complaints from each department are provided in Exhibit 8. According to Dr. Rao, Every complaint is an opportunity to improve. We keep looking for the smallest of the complaints, which will help us in improving our quality by several levels. Sometimes it is difficult to interpret the complaints and it is even more complex to develop strategies that will enable a better patient experience. The complete data set was analyzed to determine the word frequency count in the complaints section. The significant words with their frequencies are shown in Exhibit 9. This analysis was used to focus on specific tasks to ensure reduction in the number of complaints. For example, the most significant word was â€Å"time† and it was associated with delays in response time for the various services. The twenty-fourth most frequent word was â€Å"late,† which is again related to response time. Thus, the word frequency technique helped in focusing on problem areas. Based on the results of the analysis, benchmarks were set in consultation with the respective department for the response time of each service as shown in Exhibit 10. Apart from this quantitative analysis, another approach was used to analyze the feedback and obtain deeper insights for quality improvements. Dr. Rao used the term â€Å"defect-defective† from the Six Sigma methodology- one â€Å"defective† product/service could be caused by one or several â€Å"defects†. According to Dr. Rao, This document is authorized for use only by NIKITA VAIDYA in Nutrition 346 taught by Carol Blindauer, at Dominican University Illinois from January 2015 to May 2015. For the exclusive use of N. VAIDYA, 2015. Apollo Hospitals: Differentiation through Hospitality. Page 5 of 20 Any complaint from a patient is considered as a ‘‘defective’’. For example, consider the complaint: ‘‘Food is not served on time’’. This complaint may arise due to several reasons such as food not being prepared in time, food not being delivered on time, patient changing his/her order, etc. It is essential to identify these defects in order to eliminate the defective. On receiving a complaint from the patient, which was termed as â€Å"defective,† defects that led to the defective (complaint) were identified. Root-cause analysis was performed on all the processes of the identified defects. The processes were re-engineered to eliminate all the defects and a pilot study was conducted using the â€Å"Define Measure Analyse Improve Control† (DMAIC) cycle. Once the process was found acceptable, it was then deployed across locations. This was followed by routine and surprise audits to ensure that the process was being followed as defined to ensure customer satisfaction. The flowchart is shown in Exhibit 11a and b. All feedback related to medical services was escalated to the Medical Director’s office. In addition to this, the Quality Department at Apollo Bangalore developed a methodology called the Daily Point Average © or DPA ©. The ratings provided by patients for different departments were used to calculate the DPA ©. The departments had to improve these ratings over a period of time. The DPA © effectively captured the â€Å"mind of the customers† since the feedback was collected during the patients’ stay and not at the time of discharge. BENCHMARKING OF HOSPITALITY Hospitality required high human involvement and was very specific not only to local cultures but also to each individual. Since a patient had to stay in a hospital to get cured, hospitality automatically came into the picture. Hospitality in various hospitals was very different owing to the surroundings and differences in customer (patient) requirements. Patients did not walk into a hospital out of volition- they came in only because there was some problem. Under such conditions, the patient would be very agitated and any small thing that was out of place would become a big issue. Any kind of delay would be extremely intolerable and all the services had to be perfect all the time. Even in the hotel industry, hospitality was not standardized and benchmarks were not available. The Ritz–Carlton hotels, which are considered the gold standard in the hospitality industry, had used Six Sigma and benchmarking for their hospitality business. 13 Although benchmarks for clinical services were well-established, those for hospitality in hospitals were yet to be established. Apollo Bangalore developed benchmarks for several common complaints with three levels of services (as shown in Exhibit 10) by adopting the Kano model, which was developed by Noriaki Kano (Exhibit 12). This model was used across service industries and it helped in understanding customer expectations from any product or service. The threshold or the basic quality was the minimum requirement of the customer, which would be taken for granted even if it were present; however, if it were not there, the customer would complain about its absence. Normal or performance quality was something that the customer would expect because these were stated either by the product/service provider or by the customer as a requirement. This quality was observed by the customer and its absence would cause discomfort and disappointment. Exciting quality of the service or product was something that would not disappoint the customer; the presence of this would delight the customer, since the customer did not expect this quality. With time, the exciting quality would become performance quality and the performance quality would become a basic quality. Hence, the manufacturer or the service provider should always strive to provide new exciting qualities. Accordingly, several metrics were defined for benchmarking. For example, patients were informed that routine hospital-provided meals would be served within 10 to 20 minutes of every mealtime. This became a performance attribute. The threshold requirement of the patient would be that meals should be served within 20 minutes after placing the order. If the meal was served within 10 minutes, the patient would be delighted. However, if this customer (patient) were to come to the hospital again, she/he would expect the meal to be delivered within 10 minutes; this then would become a performance quality for her/him. 13 Source: qfdi. org/newsletters/six_sigma_qfd_hotel_application. html This document is authorized for use only by NIKITA VAIDYA in Nutrition 346 taught by Carol Blindauer, at Dominican University Illinois from January 2015 to May 2015. For the exclusive use of N. VAIDYA, 2015. Apollo Hospitals: Differentiation through Hospitality Page 6 of 20 FINANCIAL IMPLICATIONS The Quality Department required funding for data collection, analysis, and other related activities. These expenses affected the bottom line of the hospital. However, from March 2011 to December 2012, the number of re-visits increased, which implied that customer loyalty had increased. There was a 15% increase in the number of inpatients. Earlier, high discounts had been offered to dissatisfied patients owing to errors in service or poor quality of service. Gradually, there was a reduction in the discounts provided, which was a direct result of better satisfied patients. Additionally, owing to better processes, cost of quality (in terms of re-work and consumable wastage) had reduced, which helped in improving the bottom line. Further, owing to better service and higher levels of satisfaction, the patients acted as brand ambassadors for Apollo and provided word-of-mouth publicity, which improved the top line. Another example of decreased turnaround time and a resultant increase in profitability was seen in the Biochemistry Lab at the Apollo Bangalore Hospital. Dr. Rao headed this lab and he understood the patients’ requirement of receiving diagnostics reports in two hours instead of three. Dr. Rao and his team redesigned the process using 5S and lean concepts and managed to reach a turnaround time of two hours. Profits from the Biochemistry Lab nearly doubled after the decrease in turnaround time; while the cost of consumables increased by only 11%. Even though the Apollo team was trying to improve customer satisfaction, it still faced the question of how much satisfaction could be actually provided to the customer considering the room tariffs that were charged. As seen from Exhibit 13, the charges at the Apollo Bangalore Hospital ranged from USD 25 for a basic room to USD 120 for the Platinum Suite. A Ritz–Carlton basic room would cost USD 799 at Washington, U. S. A. and USD 165 at Kuala Lumpur, Malaysia (per person, per night). 14 The Apollo team might be able to provide high quality hospitality to patients in the Platinum Suites. However, the aspiration to provide the same service to patients in other rooms might not be financially feasible. The team was trying to build high levels of service for the Platinum Suites. However, the volumes in the other rooms were too high to be ignored, especially in the Indian context. Additionally, customer loyalty was extremely important to Apollo; in Dr. Panyala’s words, Customer loyalty and not mere retention is what we need to focus on. It is important to think ahead of the customer to identify issues that may compromise the experience. QUANTIFYING HOSPITALITY ACROSS APOLLO According to Dr. Rao, Once, we develop the benchmarks and the Sigma metrics, we want to replicate the system across all Apollo hospitals in the country. Each hospital will have to devise its own benchmark and Sigma metrics. However, we want to provide a framework for developing these and then measuring the outcomes. All the hospitals would then be compared by equalisation of scores and would benefit from one another’s learning†. After collecting the feedback and attempting to set benchmarks, Dr. Rao knew that he needed to go deeper and analyze each service through the complaints, set up relevant benchmarks, and target certain Sigma levels for each benchmark. He wondered whether they could collect and analyze data in a better manner. He wanted to arrive at the basis for the cost-benefit analysis of this activity. Looking at the complaints and the analysis, Dr. Rao had two major questions on his mind: 1. 2. 14 What strategy should be used to reduce the number of complaints and sustain the culture of excellence at Apollo Hospitals, Bangalore under the leadership of Dr. Panyala? Given the manual intensive processes involved in addressing the hospitality issues, what is a good Sigma level? Could Apollo set a target for Sigma level in hospitality? Source: www. ritzcarlton. com, accessed on April 15, 2013. This document is authorized for use only by NIKITA VAIDYA in Nutrition 346 taught by Carol Blindauer, at Dominican University Illinois from January 2015 to May 2015. For the exclusive use of N. VAIDYA, 2015. Apollo Hospitals: Differentiation through Hospitality Page 7 of 20 Exhibit 1 [emailprotected] parameters Sl. Parameter No. 1 Coronary artery bypass grafting (CABG) mortality rate. 2 Complication rate post coronary intervention(percutaneous transluminal coronary angioplasty; PTCA) 3 Average length of stay (ALOS) post angioplasty 4 Average length of stay (ALOS) post total hip replacement (THR) 5 Average length of stay (ALOS) post total knee replacement (TKR) 6 Complication rate for total knee replacement (TKR) 7 Average length of stay (ALOS) post renal transplant 8 Average turnaround per dialysis chair per day 9 Average length of stay (ALOS) post transurethral resection of the prostate(TURP) 10 Complication rate transurethral resection of the prostate(TURP) 11 Endoscopy complication rate. 12 Patient satisfaction with pain management 13 Door to thrombolysis time in ischemic stroke in emergency room (ER) 14 Percentage conversion of coronary angiographies to coronary artery bypass grafting (CABG) 15 Catheter-related blood stream infection (CR-BSI) 16 Ventilator associated pneumonia (VAP) 17 Catheter-related urinary tract infection (CR-UTI) 18 Average length of stay (ALOS) in hospital 19 Average length of stay (ALOS) in intensive care unit (ICU) 20 Door to CT time in stroke cases in emergency room (ER) 21 Surgical site infection (SSI – Clean wound) 22 Medication errors. 23 Average length of stay (ALOS) post modified radical mastectomy (MRM) 24 Average length of stay (ALOS) post microdisectomy 25 Average urea reduction ratio* 26 Percentage of patients achieving/maintaining haemoglobin level of 11gram or higher after 3 months of dialysis in end stage renal disease (ESRD) *Optional This document is authorized for use only by NIKITA VAIDYA in Nutrition 346 taught by Carol Blindauer, at Dominican University Illinois from January 2015 to May 2015. For the exclusive use of N. VAIDYA, 2015. Apollo Hospitals: Differentiation through Hospitality. Page 8 of 20 Exhibit 2 Accreditation of Apollo Hospitals Accreditation Joint Commission International (JCI) Delhi, Apollo Hospital Location Chennai, Hyderabad, Ludhiana, Bangalore, Kolkata, Dhaka National Accreditation Board for Hospitals Madurai, Chennai Healthcare Providers (NABH) National Accreditation Board for Laboratories (NABL) Chennai ISO 9002 Chennai Source: Apollo Investor Presentation (retrieved from www. apollohospitals. com in January 2013) Exhibit 3 Apollo Brand–Clinical and Hospitality Services Core Clinical Services Hospitality Source: Interview with Dr. Ananth Rao. This document is authorized for use only by NIKITA VAIDYA in Nutrition 346 taught by Carol Blindauer, at Dominican University Illinois from January 2015 to May 2015. For the exclusive use of N. VAIDYA, 2015. Apollo Hospitals: Differentiation through Hospitality Page 9 of 20 Exhibit 4 Feedback Form YOUR FEEDBACK Thank you for choosing Apollo Hospitals for your healthcare needs. As a quality improvement initiative, we are looking for improvements in parameters towards ‘‘Service Excellence’’ of our hospital. Please provide a few minutes of your valuable time for a personal interaction. How satisfied are you with your experience and the services provided by our hospital on a scale of 1 to 10? 1. MEDICAL SERVICES 1 2 3 4 5 6 Poor 2. NURSING SERVICES 1 2 3 7 8 Good 4 5 6 3. OPERATIONS ADMINISTRATION 1 2 3 8 5 6 7 1 2 3 1 2 4 3 5 6 7 1 2 3 10 Excellent 8 9 10 Good 4 5 6 Poor 6. FACILITY MAINTENANCE 9 Good Poor 5. HOUSEKEEPING SERVICES 10 Excellent 8 Poor 4. FOOD BEVERAGES 9 Good 4 7 Excellent 8 9 Good 4 Poor 5 6 10 Excellent 7 Poor 9 7 10 Excellent 8 Good 9 10 Excellent COMMENTS (OVERALL): Patient Name (Optional): UHID: Date of Admission: Room No: Signature: Date: This document is authorized for use only by NIKITA VAIDYA in Nutrition 346 taught by Carol Blindauer, at Dominican University Illinois from January 2015 to May 2015. For the exclusive use of N. VAIDYA, 2015. Apollo Hospitals: Differentiation through Hospitality Page 10 of 20 Exhibit 5 Feedback collection methodology A Typical Process Map: DPA Daily Data Collection Method 1:00pm–2:30pm Data consolidated; DPA Score developed* 11:00am–1:00pm Survey conducted Point of Data Colle ction Score given to IT Dept. disseminated to individual stakeholders via.

How to Express Future Time in English

How to Express Future Time in English Legend has it that the final words of French grammarian Dominique Bouhours were, Je vais ou je vas mourir; lun et lautre se dit, ou se disent. In English that would be, I am about to or I am going to die. Either expression is used. As it happens, there are also multiple ways of expressing future time in English. Here are six of the most common methods. the simple present: We leave tonight for Atlanta.the present progressive: Were leaving the kids with Louise.the modal verb will (or shall) with the base form of a verb: Ill leave you some money.the modal verb will (or shall) with the progressive: Ill be leaving you a check.a form of be with the infinitive: Our flight is to leave at 10:00 p.m.a semi-auxiliary such as to be going to or to be about to with the base form of a verb: We are going to leave your father a note. But time is not quite the same as grammatical tense, and with that thought in mind, many contemporary linguists insist that properly speaking, the English language has no future tense. [M]orphologically English has no future form of the verb, in addition, to present and past forms. . . . In this grammar, then, we do not talk about the future as a formal category . . ..(Randolph Quirk et al., A Grammar of Contemporary English. Longman, 1985)[W]e do not recognize a future tense for English. . . . [T]here is no grammatical category that can properly be analyzed as a future tense. More particularly, we argue that will (and likewise shall) is an auxiliary of mood, not tense.(Rodney Huddleston and Geoffrey K. Pullum, The Cambridge Grammar of the English Language. Cambridge University Press, 2002)There is no future tense ending for English verbs as there is in other languages . . ..(Ronald Carter and Michael McCarthy, Cambridge Grammar of English. Cambridge University Press, 2006)English has no future tense, because it has no future tense inflections, in the way that many other languages do, nor any other grammatical form or combination of forms that can exclusively be ca lled a future tense.(Bas Aarts, Oxford Modern English Grammar. Oxford University Press, 2011) Such denials of a future tense may sound paradoxical (if not downright pessimistic), but the central argument hinges on the way we mark and define tense. Ill let David Crystal explain: How many tenses of the verb are there in English? If your automatic reaction is to say three, at least, past, present, and future, you are showing the influence of the Latinate grammatical tradition. . . .[I]n traditional grammar, [t]ense was thought of as the grammatical expression of time, and identified by a particular set of endings on the verb. In Latin there were present tense endings . . ., future tense endings . . ., perfect tense endings . . ., and several others marking different tense forms.English, by contrast, has only one inflectional form to express time: the past tense marker (typically -ed), as in walked, jumped, and saw. There is therefore a two-way tense contrast in English: I walk vs I walked: present tense vs past tense. . . .However people find it extremely difficult to drop the notion of future tense (and related notions, such as imperfect, future perfect, and pluperfect tenses) from their mental vocabulary, and to look for other ways of talking about the gramm atical realities of the English verb.(The Cambridge Encyclopedia of the English Language. Cambridge University Press, 2003) So from this perspective (and keep in mind that not all linguists wholeheartedly agree), English doesnt have a future tense. But is this something that students and instructors need to be concerned about? Consider Martin Endleys advice for EFL teachers: [T]here is no harm done if you continue to refer to the English future tense in your classroom. Students have quite enough to think about without being troubled by such matters and there is little sense in adding to their burden needlessly. Yet, underlying the dispute is an important issue that does have an obvious bearing on the classroom, namely, the difference between the way the present and past tenses are marked on the one hand, and the way the (so-called) future tense is marked on the other.(Linguistic Perspectives on English Grammar: A Guide for EFL Teachers. Information Age, 2010) Fortunately, English does have a future with plenty of ways of expressing future time.

The changing market environment Essay Example | Topics and Well Written Essays - 2500 words

The changing market environment - Essay Example The markets have transformed to international from local. With the increase in the exposure to masses and increased geographical market coverage, the need of quick and up to date information has also increased. With the changing business environment the buyers are also changing. With the increasing incomes the buyers have become more selective. For a company to launch its product in a new market it has become important to have the information from the buyer needs to buyer wants. On the other hand it is also important to have the knowledge of how to present the product in effective manner in order to reach the customer in an effective manner. With the changing business needs the new marketing techniques such as product differentiation, branding and advertising are also gaining immense importance. This paper is aimed at finding out the appropriate marketing communication strategy for Jalsberg cheese which is a famous branded cheese in American Market and ready to be marketed in new Eur opean market. Norseland Inc. was founded in 1978. The purpose of the company was to market and distribute Jarlsberg and other Norwegian cheese in United States. The Company is a 100% owned subsidiary of TINE Norwegian Diaries, which has the main responsibility for the production and marketing of Jarlsberg cheese. Introduction of Product: Jalsberg cheese has some snob appeal. Customers want to show they have 'good taste'. Without complaining they accept the higher price of Jalsberg compared to other competitive products. The mild and creamy taste appeals to Americans, and many think that the taste of the traditional Swiss cheese, Emmenthaie is too sharp Present market: Jalsberg cheese has a major supply share in the US cheese market. The characteristics of typical Jalsberg buyer are: Female Earning more than US$ 80,000 per year. Over 40 years Now the company is aiming to introduce its Cheese brand Jalsberg in the newly extended European market. In order to undertake successful brand positioning Norseland has to design a marketing communication strategy, which should be crafted according to the European market conditions and consumer behaviour. The successful product positioning and promotion is only possible if all the required information in this lieu is gathered and used in the right direction. In order to fulfil modern information needs, new information technologies have also been evolved. The information regarding the buyer preferences and behaviour plays an important part in helping the management to take important decisions regarding the product such as

Software Procurement Strategies Essay Example | Topics and Well Written Essays - 750 words - 1

Software Procurement Strategies - Essay Example Lack of enough expertise internally has been shown to cause huge application delays on the delivery time, high cost of procuring and deploying the application and lack of proper documentation. When applications are developed in house there will be need to have technical member(s) of staff (Hunt & Westfall, n.d.). This will increase the operating cost of the school. When developing applications in-house most businesses are only concerned with the functionality of application. While applications need to work correctly there is a sense in that some standard methods of developing an application must be followed (Lin & Tsui, 2000). Developing an application internally there are risks of developing an application that does not meet industry accepted standards is high. The danger of not having a standardized application is that one changes need to be done on the application it could turn into a catastrophic collapse of the entire application. Computer applications grow, as businesses grow. With this in mind, developing an application must follow standards that will allow easy evolution of the application without requiring a full re-development in case changes are required except where business requirements have changed. Customization is a process which an institution procures an application with general specifications or requirements and then modifies it to meet its specific need (Nelson, et al., 1998). When the school intends to procure an application using this method they will have some challenges they have to overcome. The risks involved in such procurement are: Applications that are acquired in this method need to be easy to customize. This is only a desire that is not met many times. Applications that have been developed elsewhere may have classes, interface, or methods that are difficult to customize. This will lead to low

New Garments Business Plan Essay Example for Free

New Garments Business Plan Essay Though agriculture has always been the one of the most anticipated sectors in budgets, discussions, lectures and books but in true sense garments industry in Bangladesh is the most essential sector in terms of employment of comparatively less educated people. Employing almost 4.2 million people of whom 80% are women and thus contributing to empowerment of rural women. Let alone employment even if we consider foreign currency inflow this has been one of the most potential source. RMG covers around 80% of the total foreign exchange earnings of Bangladesh. According to a survey it contributes around 8 billion dollars which is around 13% of GDP. Starting in 1970s earning from it has increased by 8 times which is around 16.5% per annum. SWOT analysis Weakness: 1. Limited financial investment, 2. Insufficient infrastructural facility, 3. Less educated work-force 4. Negative impression on foreign buyers due to both political and unrest within the industry among the labor 5. Lack of legal enforcement 6. Lack of brand awareness 7. Poverty Threats: 1. High level of inflation 2. China, Pakistan and India. 3. Increasing competition 4. Capital investment availability, 5. Political instability 6. Corruption 7. Workplace unrest Strengths: 1. Labor intensive industry and labor cost is cheaper in Bangladesh compared to most countries 2. Plenty of labor available 3. Quality products 4. Competitive pricing Opportunities 1. Becoming a major hub 2. Tax reduction/govt. incentives 3. Planned Infrastructural development should improve supply chain a lot Company: Elegance Our company will be a garment company. Estimations are done based on square textile ltd and a small company named triangle fashion wear in Dhaka. Vision Provide quality clothing for every class of people and become one of the leading names in garments sector in the country and abroad as well. Mission Capture and satisfy the needs of customers through cost leadership and quality assurance and thus expand gradually. Introduction: Our company in the initial stage will go for sewing shirts only assuming monthly demand of 4000 shirts. As we will only produce ordered volume so the assumed demand is also our total production in units. We will take orders from other garments. As we will do the sewing only we won’t be having any inventory cost other than the raw materials. Reason behind being the designing and the cutting in these scenarios are normally done by the garment giving the order and we will complete the sewing and the collars. Buttons will be done afterwards elsewhere. For the electrical arrangements such as getting the business line for industrial purpose and placing meters the cost is assumed as 40000 and for wearing, stabilizers for machines sockets and other expenditure 40000 more is added with the initial cost. We will have 22 machines for which a 1000-1200 square feet space will be require. For hiring the place advance with 1st months’ rent is assumed as 115000. Loan of 200,000(27.54%of initial investment) will be taken at a rate of 15% which is close to 30% of the total investment amount. (Basic bank) (Small scale enterprise: The enterprise will be termed as small if in today’s market condition the replacement cost of plant, machinery and other components excluding land and building amounts to tk 15 million or less-Policy strategies for small and medium enterprises development in Bangladesh) Inventory: The raw materials should include, needles, pastes used in collars and threads. Ordering volume will be our production so there will be no additional inventory cost Machines: Taking the demand into account we will start with 22 machines of which 18 are single needle plain machines 2 over locks and two three needle machines. Ratios of plain machine to over locks and three needle is 10:2 Single needle is for basic sewing, three needle takes 1/3 time compared to single needle for obvious reasons but are very expensive, and over locks are sewing machines with blades that cuts the additional threads after sewing. Changes in demand and consequences: According to the owner of the triangle fashion wear in the winter time the demand for shirts decrease by 20-25%.duration of this shortage in demand is around 2 months. During this period there are obvious lay-offs so there is decrease in demand, in salaries and ultimately decrease in COGS and sales as well. Sales and COGS: Sales growth for our company is taken as 17%, based on the average of 5 years growth in sales of square textiles which is close to 20% and of triangle fashion wear which is close to 15%. As for COGS, for our company the growth assumed is 10%.for square text. Average growth in cogs is less than 15. NWC is assumed as 15% of sale for our company for each of five years. For square text. It is close to 18%. Salvage value For the over locks and single needle SV is assumed at an average of 5500tk after 5 years for each of the machines and for the 3 needle machine it is 8000 tk each Depreciation and tax: As for depreciation we deducted salvage value from total machine cost and deducted the amount by 10 which is the total lifetime for the machines. We used straight line depreciation for the other years. Corporate tax rate is assumed as 35% of the EBT amount. Calculating WACC: Market return of 10% is taken from the stock Bangladesh web site on 12th April, US risk free rate is taken for the measurement which is close to 3% and beta of 1.26 is taken from the stock Bangladesh website as well for the textile industries. Calculating CAPEX: Capital expenditure is calculated by summing up all the fixed assets for the 1st year which is close to 7% of the total sales for the same year. For the rest of years the growth rate is assumed as same as the sales which is 15%. After that we deducted fixed asset amount of the previous year from the amount of current year. 4P analysis: Product: As we said earlier our only product will be shirts. Pricing: Rate for sewing shirts in the market now is close to 90tk per shirt, we will start with 85tk to capture the market in the first place and then will focus on maintaining the quality. As we will only sew shirts so the calculated cost for each shirt will also be our production cost/unit.it is calculated as 49.5 by dividing COGS by demand. Promotion Promotion: We will do it by ourselves as the owner of the business so we won’t be having any additional cost for advertising and there will be experienced supervisors too, to initiate promotion. Place/Location and delivery: We will choose a place close to the companies we are expecting to get orders from. For the delivery of raw products to us and delivery of the sewed shirts to the companies ordering, companies themselves will be responsible.so again there will be no additional transportation cost for our company.

Inclusion Of Visually Impaired Students

Inclusion Of Visually Impaired Students Education aims to ensure that that all students gain access to skills, knowledge and information that will prepare them in life. Education becomes more challenging as schools accommodate students with diverse backgrounds and SEN needs. Meeting these challenges demands schools to have an inclusive education. Inclusive education brings all students together in one classroom and community, regardless of their strengths or weaknesses in any area, and seeks to maximize the potential of all students. There is now greater recognition that the special needs agenda should be viewed as a significant part of the drive for Inclusive Education (Ainscow, M 1995). The idea is that the concept of integration is being replaced by a move towards inclusive schooling/education. Integration demands that additional arrangements will be made to accommodate pupils with disabilities within a system of schooling that remains largely unchanged (Ainscow, M 1995 p 2). Inclusive education, on the other hand, is a larger and prior concept (Flavell, L 1996, p 5) and aims to restructure schools in order to respond to the learning needs of all children (Male D, 1997). An Inclusive school ask teachers to provide individualised support without the stigmatisation thats comes with separation, and to provide opportunities where all students can learn together in an unrestrictive environment where the quality of their education is not compromised. Appendix 1.1 shows a model of inclusive provision (Dyson, A et al, 2004). Inclusion is not just for student and staff but for governors, parents and the local community (Flavell, L 2002). Research on effective inclusive schooling has shown schools improve thorough whole school responses and not just by teaching strategies that include all learners (Ainscow,M 1994). Appendix 1.2 shows characteristics of these schools (Ainscow, M 1991; Hopkins, Ainscow and West, 1994) 1.2 Legislative Context The amendments to the 1995 Disability Discrimination Act (DDA) Part IV regulations came into effect on 1 September 2002 via the Special Education and Disability Act (SENDA, 2001). It requires school to implement the part of the Act that prevents such institutions from discriminating against students on the grounds of their disability. It is therefore mandatory for all teachers, including MFL teachers to make reasonable adjustments to allow full participation by students with disabilities. Appendix 1.3 is the overview introduction to the DDA while Appendix 1.4 is the DDA Part VI. 1.3 Fullhurst Community School Policy The legislation makes it clear that all teaching staff is responsible for the provision for students with SEN and/or disabilities. (TDA, 1999) Appendix 1.5 shows specific duties under the DDA outlined by the TDA (TDA, 1999) for use by schools. Thomas (1992) states that the whole school community should be involved in developing a policy on the organisation of support in the classroom. The Code of Practice (DfE 1994) calls for all schools to have a special Education needs Policy with outlines the agreed practice at each stage in meeting the needs of pupils. As required by law all schools who receive government funding are expected to have a written SEN policy with regard to the Code of Practice. Fullhurst Community School has a comprehensive policy which is mandatory for all staff to be familiar with. It includes their guidelines, accessibility, definitions, SEN status, provisions, referral information, learning needs and conditions. Appendix 1.6 is a partial copy of the Fullhurst Community School Guide to SEN. 2. Visually Impaired Students 2.1 Inclusion of visual impaired students It is estimated that there are around 25,000 children and young people in Britain from birth to 16 with a visual impairment of sufficient severity to require specialist education service support. (www.rnib.co.uk) In the report entitled Education of the Visually Handicapped (Department of Education and Science, 1972) commissioned by the British government in 1968, it recommends that blind and partially sighted children would benefit from being educated in the same schools. It did, however, also support the general concept of integration of children with visual impairments (VI) into mainstream schools. Further reports, such as The Warnock Report (Department of Education and Science 1978) and the subsequent Education Act (1981) consolidated that right of children with SEN to placement in local schools, with the consideration of the efficient use of resources. During the 70-80s there was a steep rise in the LEA services for children with VI (visual impairment) and an increase in local schools education of VI students supported by qualified in school support workers or peripatetic specialised teachers (Douglas et al, 2009). As this enrolment increased in mainstream schools, specialised schools for the blind were closing or adapting encompassing students with more complex needs (McCall, 1997). The Code of Practice for SEN (Department of Education) accepted that the needs of most children with SEN could be met within mainstream schools but took a moderate stance on inclusion by emphasising the importance of maintaining a continuum of provision for a continuum of needs (Hornby, 1999, p 153). By 2000 inclusion of VI children in mainstream schools had become well documented in policy and practice. Legislation continued to strengthen the rights of SEN children in local schools, culminating in the previously mentioned SENDA (2001) amendments to the 1995 DDA. Appendix 1.7 and 1.8 highlight research and statistics pertaining to VI students in local schools. 2.2 Visual Impairment and Modern Foreign Languages No matter what their educational level, the visually handicapped often display a marked talent for learning foreign languages. This seems to be the result of a particular aural sensitivity and the memory training which forms part of the rehabilitation process. (Nikolic, 1986 p222) The major aspect of work in the modern languages is that while other curriculum areas use communication to teach the subject content, MFL use content to teach communication (Couper, 1996). MFL classrooms rely heavily on non-verbal method of communication and in most classrooms the visual sense plays a dominant though not exclusive role (Couper, 1996 p 7). 2.3 Adaption of teaching practise and materials In traditional MFL learning, teachers use visual projectors, flashcards, wall posters, gesturing, mime and facial expressions to teach, however literature on teaching MFL to VI advocates using different means. Realia, enlarges pictures, mobiles are recommended to introduce new vocabulary and using games such as noughts and crosses, hangman and board games to enhance knowledge. Price (1994) and Couper (1996) show that the adaption of materials for use in class is a time consuming and costly process and as such teachers often have to adapt materials themselves. Appendix 1.9 shows a self-audit for inclusive modern languages lessons: planning teaching, learning and support provided by the TDA (2009) which allows teacher to observe and try out certain methods to keep their classroom inclusive. Lewin-Jones and Hodgson (2005) outline strategies which can be used by teachers to ensure an inclusive classroom. Strategies such as using students names more frequently or touch (once pre-approved before) have been known to work effectively (Jones, 2004). Adapting the way you ask questions e.g what is the man in green doing? to what is the angry man doing? Teachers have to adapt the lesson to include repetition other than using the white boards but through the speaking and listening skills. AFL strategies such as thumbs up or down can be used simply instead of traffic lightsystem where VI students may have difficulty colour differentiating (Appendix 1.9a). McCall (1997) postulates that these changes help, not only the learning of the VI students, but potentially all students learning. From the skills in language learning: reading, writing, listening and speaking; reading and writing can be troublesome for VI students as it is difficult to skim/scan text or move between text and answers or locate specific information within texts quickly. Nikolic (1986) compounds this difficulty adding that that trouble lies in the infrequent contact a VI student has with the written form. Ways must be found for students to access these skills. In MFL it is important for mixed skill activities. This will allow VI students to team up listening and speaking, where traditionally they may be stronger with reading and writing where they may be weaker (Couper, 1996). 2.4 The learning Support Worker VI students often get accompanied to lessons by classroom assistants or specialist teachers (LSW). Their role is not to take the job of the teacher but to enable the learning of the student. It is fundamentally important that students continue to be independent and in control of their learning, the LSW can provide aid in practising dialogues, spontaneous and reading from cue cards. Studies show that the quality and quantity of the work provided by LSWs who speak French fluently is greater than those who dont (Lewin-Jones and Hodgson, 2005). 3. Inclusive Teaching in Year 7 with a Visual Impaired student 3.1 Student X My year 7 French class contains a VI student. On learning this I set about making steps to better inform my planning. I accessed the school SEN policy taking particular attention to the section on visual impairments. Appendix 1.10 shows the SEN guide pertaining to VI. I organised a meeting with the school SENCO and with the students LSW. Appendix 1.11 outlines the material provided by the school SENCO to all teachers of student X. It includes details pertaining to what s/he can see, what s/he needs in the classroom brailler, laptop, hardcopies in font N48 of anything taught on a PowerPoint or at a distance. Appendix 1.12 shows information I learned from the SENCO and the LSW in our meetings and Appendix 1.13 shows student Xs school IEP. From this information I was able to start planning knowing students Xs needs and limitations implementing inclusive strategies. 3.2 Implementation of inclusive strategies ~ Differentiation by support: LSW Student X is entitled to extra disability related funding. This allowed them to have a full time LSW with fluent French accompany her to her French classes. From my meeting with the LSW we were able to work with the scheme of work module 2 and produce a comprehensive vocab list that the LSW was able to adapt in preparation for the term. Appendix 1.14 has the schools Yr 7 SOW. In order for all materials to be correctly adapted lesson plans had to be submitted minimally 1 week in advance. However, having a fluent French speaker as an LSW allowed for ad-hoc French learning for student X. The LSW was able to explain to student X additional tasks. Appendix 1.15 is a lesson evaluation showing how the LSW explained an ad-hoc task I had the students do on something which they were having problems. (avoir v etre). My Teaching I had to adapt my teaching style. As I had no training and the school provided me with some information I had to use what I had learned from the meetings and from learn as you go and learn from your mistakes approaches. Spelling out words I was writing and also reading aloud everything that was being written on or projected onto the white board were things I quickly picked up after hearing the LSW spelling out what I was writing in my first lesson. Appendix 1.16 is a lesson evaluation form from my first lesson teaching this Yr7 class. As student X is an invaluable source of how s/he learns I had 2 meetings with student X and the LSW. Appendix 1.17 included minutes of the first meeting. Regarding AFL I implemented thumb up or thumb down policy. Appendix 1.18 shows lesson plan showing this ~ Differentiation by resource: ICT All power point and ICT work was sent to students X LSW before each class. It allowed student X to use her JAWS software (appendix 1.19) to access the information. An example of such use is appendix 1.20 where student X was able to access one of the lesson tasks and submit her answer by print while the other students handwrote theirs. As the term progressed I was adapting to use aural repetition to strengthen knowledge of vocabulary and phrases. Appendix 1.20 shows an ERF form during my placement highlighting increased use of repetition. Braille Assistive technology benefit the VI but according to Argyropoulos, Martos, and Leotskakou (2005, p 185) the cultivation of literacy skills may be delayed significantlyà ¢Ã¢â€š ¬Ã‚ ¦., and illiteracy may be increased. Because of this it is important for student X to use braille to have exposure to the written form of French while would ensure written accuracy. Appendix 1.22 has various examples of work adapted into Braille while some of them have been corrected by the LSW, as I cannot do this. In assessment student X is therefore no longer at an advantage at spelling as they have been viewing and using the correct version through braille. Tactile Pictures One of Students X preferred methods to learn new vocab is using tactile images. This allows student X to mentally perceive the image using touch. S/he is in essence picturing the same image as the students who are seeing the image. Appendix 1.23 is a photocopy of the tactile images of animals I used while teaching animal vocabulary. Handouts As previously discussed all handouts are in a font N48. Appendix 1.24 illustrates examples of adapted hand outs for students Xs exercise book and also for listening tasks completed in class. ~ Differentiation by task: An area where some of the more reasonable adjustments were made within the classroom. Student X has no problems engaging in listening and speaking tasks once the hand outs/instructions are in braille / correct font size. However when the student is using ICT /power point to do tasks it had to be adopted for student X. Appendix 1.25. shows an example where student used information on the overhead to match questions with possible answers , while student X had the questions and answers were separately printed for them and then could join them up. Appendix 1.26 shows examples of the Differentiated by section of lesson plan where the tasks are differentiated by the students needs. The subject content is still the same just different how they work with it. Concerning assessment feedback it was essential to go through it verbally with the student. While giving positive award postcards I was able to liaise with the LSW to get the material out into braille. An example of this is shown in appendix 1.27 Student X is then able to access the feedback and comments whenever is convenient. 4. Implications of teaching a student with VI Some of the key highlights and finding I learned with my practical experience teaching VI students are outlined below. A comprehensive and effective school policy The more adaptable teachers can make their classes the more schools can become inclusive. Adapting lessons to with certain SEN can have a benefit for other SEN and all students in general. It becomes clear that planning is the key element and the earlier you have it done the easier adapting the material by experts can be. Similarly it means the easier you can change your lessons as required Teachers have to allow extra time for preparation of classes, assessments tests and exams (Ornsin- Jones, Courtney, and Dickinson, 2005). Teachers have to allow additional time for VI students to complete their work Appropriate training should be provided where there are resources and sessions within the MFL department. It is not enough for meeting but teachers need to observe strategies for inclusion of VI in practise. In terms of MFL teaching there are little resources or sharing of experiences (Stephens and Marsh, 2005). By extension schools should be able to keep on file work done in braille and differentiated resources for future use. Teachers must be confident engaging students with disabilities, especially those with additional support. Prior discussion with the support workers can help strengthen your ability to do so during the lessons and allow you to improve you teaching practices both within and outside the classroom. 5. Conclusion The success of children and young people with visual impairment in mainstream schools is heavily dependent upon the quality of support that is available to them (Mason and McCall, 1997 p 412 ) As figures show more and more VI students are being educated in mainstream schools it is therefore important to have systems in place to help train and educate teachers who are teaching VI students. Evidence shows that special schools have played roles in supporting and training when necessary (McCall et al, 2009). As children with more complex needs enter local schools, the demands on the professional skills of those supporting them can only increase. According to Sutcliffe (1997) Effective inclusion of students with VI relies not only on the provision and appropriate access using differentiated resources, support or tasks but also on the administrative and day-to-day management of the learning environment. Schools need effective policies, a drive for inclusion behaviour, and training for all staff. Also required is a creative, hardworking staff that put the needs of all their students at the top of their agenda. For individual teachers, Orsini-Jones, Courtney, and Dickinson (2005) advise that there may be tension at times due to reasonable adjustments but that if teachers can identify the barriers and remove them for SEN students then you are creating an inclusive environment and positive atmosphere. References Ainscow, M. (1994). Special Needs in the Classroom: A Teacher Education Guide. Kingsley/UNESCO. Ainscow, M. (1995). Education for All: Making It Happen. Keynote address presented at the International Special Education Congress, Birmingham, UK, 10-13 April 1995. Ainscow, M. (Ed.) (1991). Effective Schools for All. London: Fulton. Argyropoulos, V., A. Martos and B. Leotskakou. 2005. Blind students and spelling: An investigation into Braille literacy skills. Proceedings of the ICEVI conference 2005: Education- Aiming for Excellence, 180-5. http://www.icevi-europe.org/chemnitz2005/iveci-chemnitz2005.pdf. Bender, R. (1970). The Conquest of Deafness. Cleveland: Western Reserve University. Bray, M., Clarke, P .B. and Stephens, D. (1986). Education and Society in Africa. London: Edward Arnold. Carmen, R. (1996). Autonomous Development: Humanizing the Landscape An Excursion into Radical Thinking and Practice. London: Zed Books. Cole-Hamilton, I Vale, D. (2000) Shaping the Future The Experiences of Blind and Partially Sighted Children and Young People in the UK London: RNIB Department for Education (1994) Code of Practice on the Identification and Assessment of Speical Education Needs. London: HSMO Department for Education and Science (DfES) (2001a) The Special Educational Needs and Disability Act London: HMSO DfES (2001b) The Special Educational Needs Code of Practice Nottingham: DfES Dickinson, A. 2005. Dont panic (smile)! How visually impaired students access online learning and giving realistic guidelines to academic staff at Coventry University. International Congress Series 1282 :386-40 Dovey, K. A. (1994). Non-formal educational strategies as a means of effecting positive change in instructions of formal education in South Africa. Journal of Practice in Education and Development, Vol. 1, No.1, pp. 15-20. Flavell, L. (2001) Preparing to Include Special Children in Mainstream School: A Practical Guide London: David Fulton Hmilton, Elizbeth, Kathleen Prime, Christine Gibson, Eric Caron, Jeffrey Rathlef, and HeidiFischer. 2006. Students who are blind or visually impaired accessing foreign languages. Mobility International USA. http://www.miusa.org/ncde/tipsheets/foreignlang/. Kilnkosv W., Sekowski, and M. Brambring. 2006. Academic achievement and personality in University students who are visually impaired. Journal of the visual impairment and blindness 100, no. 11: 666-7 Lewin-Jones, J. and Hodgson, J. (2004) Differentiation strategies relating to the inclusion of a student with severe visual impairment in higher education (modern foreign languages) British Journal of Visual Impairment 22/1:32-36 Lewin-Jones, J., and J. Hodgson. 2004. Differentiation strategies relating to the inclusion of student with a severe visual impairment in higher education (modern foreign languages). British Journal of visual impairment 22, no. 1: 32-6 Lomas, Janet. 1997. Support for pupils within Mainstream Provision. In Visual Impairment: Access to education for children and young people, ed. Christine Arter, Heather Mason, Steve Mc Call, Mike McLinden, and Juliet Stone,. London: David Fulton Male, D. (1997) Including pupils with profound and multiple and severe learning difficulties in Smith, B. (ed) The SLD Experience; Kidderminster: British Institute of Learning Disabilities (BILD). Mc Call, Steve. 1999. Acccessing the curriculum. In Children with visual impairment in mainstream settings, ed. Christine Arter, Heather Mason, Steve Mc Call, Mike McLinden, and Juliet Stone, 29-40. London: David Fulton Milligan, J. (2002) DDA Part IV Implications for visually impaired students, Visability, Winter 2002 Nicolic, T. (1986) Teaching a foreign language to visually impaired children in school, Language Teaching. Nikolic, T. 1986. Teaching a foreign language to visually impaired children in school. Language Teaching 19, no. 3: 218-31 Orinsi-Jones, M., C. Courtney, and A. Dickinson. 2005. Supporting foreign language learning for a blind student: A case study from Coventry University. Support for learning 20, no. 3: 146-52 Richardson, J., and A.W.N Roy. 2002. The representation and attainment of students with a visual impairment in higher education. British Journal of visual Impairment 20, no. 1: 37-48 Richardson,J. Roy, A. (2002) The representation and attainment of students with a visual impairment in higher education, British Journal of Visual Impairment 20/1 Stevens, A., and D. Marsh. 2005. Foreign language teaching within special needs education: Learning from Europe-wide experience. Support for learning 20, no. 3: 109-14 UNESCO (1993). Special Needs in the Classroom: Teacher Resource Pack. Paris: UNESCO. www.rnib.co.uk

Is College Degree Essential Essay

Is college degree really worth all the money spent and the effort put in it? Right now in our socirty a college education is no longer a option or a privilege. Without a college degree, you might as well becomes a homeless because if you don’t have a college degree you really aren’t anybody in this society.With a college degree, you get a good job, people give you more respect and you broraden up your knowledge. To me a college degree is essential for my future in order to be successful. First reason, college degree is essential is that it will lead me to get a really good job in the future. Being a college student perhaps more respectable role than being a janitor, lunch lady or a cook in a restaurant. When people know you as a college graduate, they give you more respect than just any ordinary person. With a college degree you get nice well-paying careers where you don’t have to break your neck and working your body to death. Even my parents motivate me more to stay in college because I don’t want to grow up and do the job that they doing now. Second reason why college is important is you gain respectful from people. For example my older brother who is a college graduate from Northwestern university gets more respect from all my family members and outsiders too. They look at him as not any ordinary person, but as a person who has accomplished a major goal that not everybody who starts finish. I know I will hain the same respect from people once I get my college degree. A degree is not just any other paper. It’s a special dcosument that will lead me to the right places in the future. It’s not good to be labeled as a college dropout or high school dropout. I would rather be preferred to be labeled as a college graduate not drop out. Another reason why college is essential is not only leading you to a good job, but also it prepares you with academic knowledge about the around you.  Most people are irerlate and don’t even know much about the world they live in due to the fact they didn’t finish high school or go to college. Most people excuse for not going to college is money. Yes that’s true but, there are so many resources out there to help you get into college if you’re willing to go. The way things are going now, the only way to make it through is by getting a college degree. Even with some simple jobs out there, you need some sort of degree in order to be hired. College degree is really essential for my future because I want to make a difference and help out my family in Ghana who didn’t have the same opportunity as me to go to college. Most teens out there take education for granted and don’t care much about it. In conclusion having a college degree is for your own benefit. It will lead you to many grate places in the career industry. Yes is a lot of money and work but it’s really worth it. I know that in four years from now I will be really happy that I went to college and didn’t play around with it. Nobody can ever take your education from you it’s your god given rights.

Food Adulteration

Effect of food adulteration on the health of people Abstract of the report: Introduction to Food Adulteration: Adulteration – is a term legally used to define any kind of food product that does not meet the standards set by the centre or the state. The Prevention of Food Adulteration Act states that any substance that may be used for adulteration can be called as an adulterant. †¢ Adulteration could mean any of the below: Substitution with a cheaper or inferior quality substance – in part or whole †¢ Articles being packaged and kept under conditions that are classified as insanitary †¢ Any food article infested with insects, or consisting of decomposed , rotten or filthy stuff †¢ Substance being obtained from an animal affected from disease †¢ Articles containing poisonous materials †¢ Articles that contain coloring substance that has not been prescribes for use or contains a prescribed coloring substance beyond the prescribed limits †¢ The above point is true for preservatives as well Quality of an article is not up to the prescribed standards As a part of this report, we intend to explore the effects that food adulteration has on the health and lives of the victims, look at some of the most common forms of food adulteration that takes place in our country as well as around the globe. We will also briefly look at the laws that are in place to protect us from food adulteration and their implications on controlling food adulteration. Another major focus point of our report will be to identify ways that enable people to identify whether a food product is adulterated or not.

St. Jerome as Cardinal essays

St. Jerome as Cardinal essays As you enter the fascinating Frick Collection- a labyrinth like art museum held in the former mansion of Henry Clay Frick- you come across some of the best known paintings by some of the greatest European artists in history. Among the paintings, major works of sculpture, eighteenth century French furniture and porcelains, enamels, oriental rugs, and other works of remarkable quality (like mansions own rich architecture, neoclassical design, and elegant decorations), you come across the most eye catching painting in the collection: St. Jerome as Cardinal. This portrait can be found in the mansions Living Hall, which is one of the nineteen rooms displaying art in the collection. This room only displays portraits of a single person; instead of presenting group portraits or portraits of un-personified subjects. High in the center of the Living Hall, painted by El Greco, stands the portrait of St. Jerome as a Cardinal. This centerpiece painted around 1590-1600 depicts a fourth century Roman Scholar dressed in the robe of a cardinal and resting his hands on the Vulgate his Latin translation of the Bible. In fact, as explained by the museums Acostguide Inform Audio Tour, St. Jerome spent many years of his life devoted to the scriptures, translating the Greek and Hebrew writings into Latin. Furthermore, it is believed that he lived as an acetic in the dessert praying for what he thought would forgive him for his love of pagan writings. St. Jeromes non-expressive, elongated face and long beard sets the serious tone denoted in the room. Do to where and how it is displayed (above eye level and lit as if it were on center stage), the painting tends to attract the attention of visitors before the other portraits do so. Aside from these facts, the paintings illuminating colors tend to glow out of the portrait like a neon sign ...

Advice on Writing an Effective Personal Statement

Advice on Writing an Effective Personal Statement Definition A personal statement is an autobiographical essay that many colleges, universities, and professional schools require as part of the admissions process. Also called a  statement of purpose, admissions essay, application essay, graduate school essay, letter of intent, and goals statement. The personal statement is generally used to determine a students ability to overcome obstacles, achieve goals, think critically, and write effectively. See Observations and Recommendations below. Also see: Compose a Narrative Essay or Personal StatementCritical ThinkingIllustrationNarrationPersonal EssayPersonal LetterRevision and Editing Checklist for a Narrative Essay Observations and  Recommendations Get good advice[T]he essay or personal statement began as a gauge of student enthusiasm (Why in particular do you wish to attend Bates College?). Over the years, it has been called upon to do other work: to capture how the applicant thinks; to reveal how he or she writes; to uncover information about values, spirit, personality, passions, interests, and maturity. . . .Admissions officers, counselors, teachers, and students in my survey rated what matters most in an application essay. All four groups agreed that the most important criteria are correctness, organization, specific evidence, and an individual style. . . .As an applicants best chance to plead his or her own case, the essay is a valuable piece in the admissions puzzle. Students need the advice of someone who knows them well to put together a convincing case, and parents are great resources, with their firsthand information about and commitment to their children.(Sarah Myers McGinty, The Application Essay. Chronicle of Hig her Education, January 25, 2002) Get startedIts difficult for most people to write about themselves, especially something personal or introspective. The following suggestions may help your creative juices to flow.Consult friends and relatives for ideas. . . .Take inventory of your unique experience, major influences, and abilities. . . .Write an experimental creative essay in which you are the main character. . . .Assemble your applications and determine how many essays you must write. . . .Get feedback from others before completing your final draft.(Mark Allen Stewart, How to Write the Perfect Personal Statement, 4th ed. Petersons, 2009) Keep it realAuthenticity is what matters in personal statements, in my experience. Strong writing and scrupulous proofreading are essential, but most of all, the topic and the expression must bring alive in the minds and hearts of the readers some aspect of the real teenager writing the statement. . . .Writing a strong personal statement calls upon you to observe your real life, a s it is, and get it on paper. Your best writing will emerge when you slow down to notice and record not just what happened, but also the small sensory details that make up the important and challenging events of your life. In a nutshell: Keep it real; show, don’t tell.(Susan Knight, director of college placement at the Urban Assembly School for Law and Justice in Brooklyn. The New York Times, September 11, 2009) Make it relevantWith so many students getting similar grades, personal statements are often all that universities have to go on, says Darren Barker of the Universities and Colleges Admissions Service (Ucas). That’s why we advise applicants to take them seriously. . . .â€Å"You need to express yourself concisely and give thought to what universities are likely to regard as relevant, he says. If you have done work-shadowing in the field in which you have chosen an academic course, that’s obviously a plus. But even extra-curricular things on your CV can be worth including. . . .Personal statements are just that, personal. . . . This is about youwho you are, where you have come from and where you want to go. Bluff, spin a line, pretend you are something you are not and you will be found out.(Julie Flynn, Ucas Form: A Very Personal Statement of Intent. The Daily Telegraph, October 3, 2008) Be specificA possible area of discussion in your personal statement might be around what led you to pursue medicine as a career. You could discuss the courses, people, events or experiences that have influenced you and why. Discuss your extracurricular activities and why you participated. Tell about your educational experiences and summer internships. When doing so, write chronologically. . . .Be specific and do not exaggerate. Be philosophical and idealistic, but be realistic. Express your concern for others and share your unique experience that had a profound effect on your career choice. Express all of these things, but show your sense of value, partnership, independence and determination.(William G. Byrd, A Guide to Medical School Admission. Parthenon, 1997) FocusStatements may be weak for several reasons. The most foolish thing you can do probably is not to proofread what you write. Who wants to hire someone who turns in a statement with spelling, grammatical, or capitalization errors? An unfocused statement is also not likely to help you. Hiring institutions like to see focus, clarity, and coherence, not a stream-of-consciousness approach that seems incoherent to the reader, however coherent it may seem to you. Also, do not just say what you are interested in. Say what you have done about your interests.(Robert J. Sternberg, The Job Search. The Portable Mentor, ed. by M. J. Prinstein and M. D. Patterson. Kluwer Academic/Plenum, 2003) Know yourselfAdmissions officers say the most successful essays show curiosity and self-awareness. Says Cornells [Don] Saleh: Its the only thing that really lets us see inside your soul. While theres no one right formula for soul baring, there are many wrong ones. Its disastrous to write, as a Rice applic ant did, of what he could bring to the University of California. A self-absorbed or arrogant tone is also a guaranteed turnoff. Exhibit A: a Rice essay beginning, I have accumulated a fair amount of wisdom in a relatively limited time of life. Exhibit B: a Cornell applicant who set out to describe the indescribable essence of myself.(Jodie Morse et al., Inside College Admissions. Time, October 23, 2000)

The Benefits of Gender Diversity in the Workplace Research Paper

The Benefits of Gender Diversity in the Workplace - Research Paper Example Owing to such reasons, it is deemed to be necessary for both profit oriented as well as non-profit organizations to engage and accept the notion of diversity with regard to gender for the reason of attaining increased creativeness as well as productivity (Rosado, 2006). Gender Diversity in Workplace The idea of gender is primarily based on the dissimilarities of features amid the individuals of different sex. These features act as a basis which discerns the males from the females. It is also based on the feelings of an individual of being a male or a female. Gender diversity generally relates to the proportion or ratio of the overall males to the overall females. The degree of diversity signifies whether the distribution of the genders is equal or it is distributed unevenly (Walter, 2012). Greater degree of diversity within a certain organization with regard to age is known to offer increased viewpoints as well as generation of fresh ideas. It is even considered imperative for the re ason of augmenting the competence in terms of comprehending the requirements of the customers. The aspect of diversity in relation to gender in the workplace assists in triggering an ensuring increased degree of sales for the organization. Gender diversity is also considered important for an organization for the reason of ensuring the sustenance of their respective operations. The notion of gender diversity relates to the actuality of the existence of variation in terms of the genes with regard to a species. The factor of genetic diversity makes it likely for a specific populace to become accustomed to the surroundings along with responding to the usual selection. The degree in relation to genetic disparity is considered to be the foundation of speciation. This specific factor is known to pose an influence regarding the ways individuals act together and perform or conduct oneself with respect to the other individuals present in the organization (Green, Lopez, Wysocki, & Kenper, 2011 ).. As a result of the mounting globalization in the industrial sector gender diversity has surfaced as quite an essential aspect for the modern business organizations. Gender diversity with regard to workplace has been defined as the comprehension and recognition of employees of both the genders. The major guiding forces of gender diversity within the workplace are the women employees. It is worth mentioning that during the recent days, business organizations have noticed the highest level of female employees in the workplace. Consequently, the number of families possessing dual income sources has also augmented along with the numbers in relation to working mothers who are single (Green, Lopez, Wysocki, & Kenper, 2011). Gender Diversity and Its Implications Gender diversity with regard to the workplace is noticed to prove gainful for the employers as well as the employees. The employees working in the same organization are likely to be quite reliant upon each other in terms of thei r work. In this context, the individuals of different genders significantly require to develop mutual respect for the reason of enhancing their productivity. Diversity in the work place can work quite effectively in boosting the marketing opportunities of the organization. It can further facilitate in encouraging creative activities amid the individuals and can also aid in recruitment activities

Strategy Implementation - NIKE Essay Example | Topics and Well Written Essays - 750 words

Strategy Implementation - NIKE - Essay Example For a large capital company, these continued gains are an amazing performance. This paper is a strategy implementation for Nike. (Nike Inc., 2012) While the statistics above shows strength in Nike’s strategy, this ratio has several limitations. It does not account for the money’s time-value, in addition to the risk associated, with an investment or stock (Harper, 2012). The ratio also overvalues investments as the equation overlooks long-term costs in favor of short-term savings. Finally, since they can be calculated using different criteria, these ratios have a problem with consistency. The Inventory Turnover of a company, in accounting, is a measure of the frequency at which inventory is used or sold in a set period, for example, a year (Ozyasar, 2012). The equation for its calculation involves dividing the cost of goods sold by average inventory. It is also referred to as stock turnover or inventory turns. For Nike, the inventory turnover has been dropping, although not drastically. These ratios show that while Nike does well with money collection, it has much slower in selling or using inventory in the past three years. (Nike Inc., 2012) This ratio has several limitations. ... Finally, low inventory levels could lead to lost sales. The inventory turnover ratio fails to tell the organization if it could have sold extra if it had higher stocks. Nike intends to move its global organization into organizational learning and sustainable practices with an aim to increase sales (Balch, 2012). These strategies are also aimed at spreading the appreciation of sustainability through the entire organization, as well as demonstrate value to customers and business. In the 21st century, successful integration of corporate responsibility with the heart of the business is mandatory. Nike is adopting environmental efforts aimed at being part of its wider sustainability program. Nike is striving to minimize the negative impacts, which their processes have on the environment during the product life cycle from design all the way to manufacturing. They are also extending this to the products post-consumer use, as well as the product’s ultimate disposal. They have institut ed a program called NEAT that strives to recycle manufacturing waste left over from shoes (Balch, 2012). The solid waste from Nike shoes, especially cured rubber used for the manufacture of soles, is now converted into new soles This is expected to create value addition to the consumer since they are environmentally friendly, which is now a major global issue. This builds on one of the company’s core values; doing things with a difference as standing still is seen as dangerous while failure to take risks is seen as more dangerous. For Nike, collaboration is vital if they are to stay ahead with innovation (Balch, 2012). They are thus continually seeking insight from regular athletes and partners from inside and outside the industry, with an aim to improve