Essay On Bullying In Schools - 1825 Words

Bullying is no laughing matter and the fact that some people do not take it seriously is really depressing. It’s a real-world issue that needs to be dealt with. According to Jeremy Side and Kelley Johnson (2014), â€Å"Bullying in schools is an issue which, in spite of a strong body of research literature, and government guidance designed to reduce bullying, continues to affect an estimated 50-80% of young people† (p. 217). Side and Johnson believe that people who seem most affected by the situation are younger students who attend schools today. The authors then explain how there are children every year who commit suicide from being bullied. This evidence is relevant, because it provides more exposure as to why bullying is such a serious deal†¦show more content†¦For this solution to work, different people need to be involved with this such as the principal, the parents of that child, and the teacher that that child had. This problem will be easier to manage if the child that is being bullied, provided some sort of evidence for the teacher so that the principal knows that the teacher is not making up the situation. For this solution to happen, there needs to be a meeting between the principal and the child’s parents so that everyone can come to an agreement for their child to be put in a support group. From there, the principal will discuss with the child’s parents that if their child continues to repeat this same behavior towards another student then they will have to be taken to an alternative school. Support groups could be an option but it would not have to be required unless the parents want to consider it for their child. In Horne, Stoddard, and Bell’s (2007) view, â€Å"Counseling groups are more frequently offered in schools for targeted interventions in order to provide small group experiences for bullies, victims, and others experiencing more delineated problems with the behavior† (pg. 268). The authors then state that students learn different techniques to control their aggressive behavior while they are in their groups. This evidence is relevant because it explains what these groups consist of and how they will be effective in helping students.Show MoreRelatedBullying In Schools Essay1267 Words   |  6 PagesBullying in Schools Bullying is the act of using superior strength to intimidate someone, typically to force him or her to do what one wants. Bullying is in every school at every age level for variety of different reasons. A bully can be in many different forms and can be angry and looking for revenge for many different reasons, but two specific groups of people could work together to put an end to this abusive, hostile, and cruel thing that is bullying. These two different groups are the parentsRead MoreEssay on Bullying in School836 Words   |  4 Pagesof a gang. And so at the tender age of 14 he was already a part of the ‘Iggypura’. Good morning to you all. I want to tell you about bullying little children in school. Bullying can have a far worse outcome on the student than we could ever imagine. According to Time magazine, approximately 47% of sixth graders admitted to being bullied at least once in five school days. According to news 14 Carolina, victims being bullied may experience isolation and lower grades immediately and in the long runRead MoreEssay on Bullying in Schools737 Words   |  3 Pages Bullying in Schools ï‚ · Typically, bullying is thought of as aggressive behavior on the part of one child, directed toward another; however, playful tussling or normal childhood conflicts can be characterized the same way, resulting in mislabeling and misunderstanding of the problem. ï‚ · Bullying is â€Å"verbal or physical behavior designed to disturb someone less powerful† (Santrock 372)—â€Å"the most malicious and malevolent form of deviant behavior widely practiced in our schools† (TattumRead MoreBullying in Schools Essay1644 Words   |  7 PagesBullying in Schools: Every second and minute of the day a kid is bullied. Bullying is something that is not only happening here in the U.S. but all over the world. We need to put a stop to! As parents, school educators, and a community we need to stand up to bullies and give kids who are being bullied an outlet to reach out for help. According to No Bully.com bullying is defined as a form of repeated aggression that is directed by one or more people towards another person. One of the biggestRead More Bullying in Schools Essay1743 Words   |  7 PagesBullying in Schools Many people feel that some of the major issues that plague our schools are drug/alcohol use or violence, yet no one recognizes the significance of school bullying. For the victims of bullying, they go to school everyday facing harassment, taunting, and humiliation. For all potential educators, it is very important to realize that bullying is a problem, so that they can work to prevent it in the future. Since being at Middle School, I have realized how prevalentRead MoreBullying in Schools Essay1512 Words   |  7 PagesBullying is not something that can just be addressed inside one teachers classroom, it requires a comprehensive community effort to effectively stop bullying and the tolerance of bullying. Research shows only 4% of teachers intervene in a situation where a student is being bullied yet 50-75% of students with special needs are the main targets of bullying. These percentages do not add up. With more adult involvement and awareness of what to look for with st udents educators possess the power to notRead MoreEssay on Bullying in Schools2878 Words   |  12 PagesIntroduction Bullying has been a part of schooling for as long as children have been congregating. To some it seems like a natural, though uncomfortable, part of life and school experience, while to others it can mean terrifying experiences which spoiled and characterized otherwise happy years in school. Dan Olweus, a pioneer in bully behavior research documented that 2.7 million children are affected as victims, and that 2.1 children act as bullies (Fried, 1997, as cited in Aluedse, 2006). WithRead MoreSchool Bullying Essay2854 Words   |  12 Pagesnot realize how serious bullying has become. If you look at statistics suicides due to bullying have increased over just a few short years. This has become a very big problem for not only the victim but the bully as well as it affect both of them. School bullying is mentally destructive to not only the victims, but bullies because of the harmful words, harassment, and physical violence involved as well as the consequences for the bully. The general definition of bullying is, â€Å"†¦ [This] states thatRead More Bullying and School Violence Essay701 Words   |  3 Pages  Ã‚  Ã‚  Ã‚  Ã‚  The article title states exactly what the article talks about, the many different cases of bullying and violence in schools. The title tells you exactly what to expect from the abstract but does not give away any information on what it includes. The author did a good job deciding on the title because although it is simple, it grabs your attention, it certainly did mine. Bullying is a very common happening among young children so the title having the word bully in it, draws your attention. ItRead MoreEssay about Bullying in Schools961 Words   |  4 PagesBullying in Schools Elementary school marks the period whereby children begin to define themselves. Children build identities in which they can be distinguished. As children develop personalities begin to clash. Children may begin to taunt their peers because they appear different. The act of bullying demonstrates the use of superior strength or influence to intimidate someone. Schools seem to be the predominant outlet where the most severe bullying gives way to a change in the behavior of the

Summary Of The Night By Robert Wife Beulah - 884 Words

1. Plot: The narrator is telling a story about his wife friend who is blind man name Robert. Robert wife Beulah has recently died due to cancer. The narrator wife wants Robert to spend the night at their house. The narrator wife used to work for Robert, and she is explaining the relationship between Robert and her. The husband does not like Robert because he is blind. At the end of the night Robert shows the husband how it feels to be blind and changes his views about being blind. The main incidents are dinner with Robert, and the husband, wife, and Robert smoking marijuana, and later after his wife goes to sleep husband and Robert watching a show about Cathedrals’, and lastly the drawing of the Cathedral with the husband eyes closed. The Climax of the story would be when the narrator is attempting to draw the cathedral with his eyes closed. The ending of the story narrator and Robert connected. The narrator learned not to judge someone based on what he heard, and fear. 2. Structure: The story incidents happen chronologically. The flashbacks are when the narrator explains how the wife has met Robert ten years ago. When she worked for Robert as reader in Seattle. The narrator says on the last day she worked for Robert. Robert touched her face and wife wrote a poem about the experience. Second flashback was when the narrator describes the wife’s past. How she tried to commit suicide ones because she was unhappy about being an officer’s wife. The wife and Robert kept in

Does Macbeth deserve his fate Essay Example For Students

Does Macbeth deserve his fate? Essay At the onset of the play. Shakespeare purposely intends for Macbeth to be perceived as a hero. He is made out to be a strong and valiant warrior, who is feared by everyone on the battlefield. He was described as Bellonas bridegroom and Valours Minion. At the beginning of the play he killed the treacherous traitor who fled to the Norwegian rebels, the Merciless Macdonald Macbeth unseamed him from the nave to the chops. This shows that Macbeth has immense power and strength. Additionally he was a trustworthy thane to the king of Scotland, king Duncan. However by the end of the play he is seen as a dead butcher and a tyrant Macbeth had murdered his way through eight victims, the traitor Macdonald, king Duncan and his two grooms, Banquo and Macduffs wife and son and also young Siward. We love him at the beginning for slaying the traitor Macdonald, but when he kills Young Siward, a young innocent soldier who is fighting against Macbeth for Macduffs army we hate Macbeth for it. What happened to make this great man such a murderer and a tyrant? Who, or what influenced him? Macbeths personality at the beginning of the play was described by his wife as being too full of the milk of human kindness This suggests that he is too kind to do anything too malicious, especially towards his own king. But he can be persuaded easily by Lady Macbeth, and when the witches tell him what is in store for him, putting visions in his mind so that he thinks he will be the future king. He expects the Kings crown to simply fall into his lap Without my stir. When it doesnt and Duncan announces that his son will be the heir apparent. Macbeth realises he will have to start to stir but he tries to withhold his dark side as much as he can Stars hide your fires let not light see my black and deep desires. However his vaulting ambition is pushing him over the edge. Later on in the play when he has become king and he has reached a point where he has killed the former king and Banquo, and he has waded through so much blood that it would be just as hard to go back than to go on he says I am in blood stepped in so far that should I wade no more returning were as tedious as goor, If he had started to wade back then he could have been a respected king and start a clean sheet. He decided to carry on the slaughter and wade towards an early grave. Macbeths friend, Banquo has a contrasting personality with Macbeth. When Macbeth is shifting over to the dark side, Banquo wants to keep his bosom franchised and allegiance clear If only Macbeth had felt the same and had heeded his friends earlier warning. But still keep my bosom franchised and allegiance clear, I shall be counselled. The supernatural has a substantial influence on Macbeths personality. The witches add to the mind twisting persuasion that goes on inside his mind. they give him two prophecies which play on his mind. The dagger ,leading him to Duncans chamber which he eventually follows and kills the king Duncan is this a dagger I see here before me? and Banquos ghost seated in Macbeths place at the feast Avaunt and quit my sight! Let the earth hide thee! . These both tease Macbeths mind. Although these might have just been visions in his head, the witches must have conjured something up to put them there. Again the supernatural forces exploit these weaknesses in Macbeths personality. The main supernatural influences are the three witches who play with Macbeth feeding him riddling prophecies. Macbeth goes to see the three witches for a second time for reassura nce about his safety as he has dug himself into a great deal of trouble with armies forming in England against him. .ud2545498819996a69d874a3ce1f2cc60 , .ud2545498819996a69d874a3ce1f2cc60 .postImageUrl , .ud2545498819996a69d874a3ce1f2cc60 .centered-text-area { min-height: 80px; position: relative; } .ud2545498819996a69d874a3ce1f2cc60 , .ud2545498819996a69d874a3ce1f2cc60:hover , .ud2545498819996a69d874a3ce1f2cc60:visited , .ud2545498819996a69d874a3ce1f2cc60:active { border:0!important; } .ud2545498819996a69d874a3ce1f2cc60 .clearfix:after { content: ""; display: table; clear: both; } .ud2545498819996a69d874a3ce1f2cc60 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .ud2545498819996a69d874a3ce1f2cc60:active , .ud2545498819996a69d874a3ce1f2cc60:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .ud2545498819996a69d874a3ce1f2cc60 .centered-text-area { width: 100%; position: relative ; } .ud2545498819996a69d874a3ce1f2cc60 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .ud2545498819996a69d874a3ce1f2cc60 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .ud2545498819996a69d874a3ce1f2cc60 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .ud2545498819996a69d874a3ce1f2cc60:hover .ctaButton { background-color: #34495E!important; } .ud2545498819996a69d874a3ce1f2cc60 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .ud2545498819996a69d874a3ce1f2cc60 .ud2545498819996a69d874a3ce1f2cc60-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .ud2545498819996a69d874a3ce1f2cc60:after { content: ""; display: block; clear: both; } READ: Portrayal of women in Hamlet EssayThe witches give him three apparitions. The first one is an armed head chanting beware Macduff. the next goes on to say none of woman born shall harm him. This makes Macbeth think that that he cannot be killed by anyone. What the witches are saying is that no one born naturally will harm him. Of course Macduff was ripped untimely from his mothers womb and the third and final apparition says that Macbeth wont have to fear until Great Burnham Wood climbs up Dunsinane Hill. Macbeth thinks that there is no way in hell a wood is going to walk up the hill to the castle. ut again the witches are playing with him. What actually happens is that the opposing army camouflage themselves in with trees and branches from the wood and slowly climb up the hill as to go unnoticed. The prophecies are the equivocations at the feind that lie like truth the withces are paltering in a double sense Macbeth walks away from the apparitions thinking he is invincible, but really he will be doomed thanks to his naÃÆ'Â ¯ve mind and belief that the witches tell the truth. At the beginning of the play, if Macbeth had never of seen the three witches, he would never have known that he had a chance to be king and his dark, deep desires would have been kept at bay. Macbeths wife, Lady Macbeth ,had a small, but very influencial part to play in the tragedy. When she receives Macbeths letter informing her that he could become king, she knows exactly what she wants to do and what she has to do to make it happen. She will have to pour my spirits in thine ear which means she will have to influence Macbeth into doing the evil deed. She psychs herself up by praying an evil prayer unsex me here and fill from the crown to the toe topfull of direst cruelty; make thick blood my blood. to give her enough cruelty and will power to carry it out. When Macbeth has heard what she has to say, he thinks about it and gives her his verdict We will proceed no further in this business He has made his mind up and it seems that nothing will convince him otherwise. But in roughly a page and a half of script, Lady Macbeth has turned him full circle and he is ready to kill the king. She calls him a coward and tells him to act like a man instead of a wimp and she tells him that she would kill her own baby for a chance like this: How tender tis to love the babe that milks me:I would, whilest it was smiling in my face, have plucked my nipple from his boneless gums and dashed the brains out, had I so sworn as you have done to this After a while when the pressure is rising and Macbeth is ordering more and more people to be murdered she starts to weaken and let Macbeth take the lead. In the end she couldnt take the pressure and commits suicide. She was remembered as a fiend like queen and Macbeth is left alone to die as a butcher and a tyrant. In the end, there are many things that Macbeth was influenced by, like the witches and their apparitions and his wife, but he didnt have to listen to the persuasions or the teasing. if his personality had been a bit stronger then perhaps none of this would have happened . Yes, I think he did deserve his fate.

Poet or artist Essay Example

Poet or artist Paper Poetry is the rhythm of the soul. The said notion has often been implied or made particularly evident in the variety of voices and themes which emanate from every lyric of ever poem. Like most art, poetry reflects the sentiments, ideology or persuasions of a poet or artist as he or she is experiencing it, and perhaps, trying to communicate to readers and the rest of the world at a particular point in time. Poetry ultimately and essentially reflects or defines, in crude terms, a piece of an individual. To American poets Walt Whitman and Emily Dickinson, this same reality applies. Although both poets emerged and gained significant recognition at the turn of the twentieth century, and both are highly regarded and acknowledged as prominent figures in literature, Walt Whitman and Emily Dickinson inevitably differ from each other, as evident in their writing and poetry. In Whitmans â€Å"A Noiseless Patient Spider,† and Dickinsons â€Å"A Narrow Fellow In the Grass,† this difference is further affirmed and illustrated. Where Whitmans poems are usually stretched and long drawn however, and Dickinsons is conversely short and seemingly rudimentary, â€Å"A Noiseless Patient Spider,† and â€Å"A Narrow Fellow In the Grass† departs from both of the poets usual mold and routine in terms of poem length and indulges in the opposite. Whitmans short poem of two stanzas appears to be summed up in the title; and in the initial part of the poem, this is what readers are made to believe. â€Å"A Noiseless Patient Spider† begins with his observation of the creature, as he writes â€Å" We will write a custom essay sample on Poet or artist specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Poet or artist specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Poet or artist specifically for you FOR ONLY $16.38 $13.9/page Hire Writer It stood, isolated; / It launchd forth filament, filament, filament, out of itself; / Ever unreeling them – ever tirelessly speeding them. † (Whitman). His observation of the â€Å"noiseless patient spider† ends with the arachnid engaged in laborious web spinning. The tone of the second stanza shifts abruptly when it pronounces quite beautifully, â€Å"And you, O my Soul, where you stand / Surrounded, surrounded in measureless oceans of space, / Ceaselessly musing, venturing, throwing, seeking the spheres to connect them † (Whitman). The verse picks up from the mundanity and apparent literal observation of a spider as it engages in a seeming routine and rudimentary activity which is to be expected of it. It then turns its focus to the writers soul, which exists much like the â€Å"noiseless patient spider† in that it tirelessly tries to weave meanings and experiences into being, a characteristic inherent to humanity, and in the human souls perhaps cliched quest for reason or meaning. Whitman speaks of the souls complex and boundless nature, of the â€Å"gossamer thread† which it appears to constitute, in reference and analogy to the poems title. Most of the poets writing, disguised, perhaps in crude terms, as â€Å"animal poetry† inevitably turn out as odes to humanity, much like â€Å"A Noiseless Patient Spider† illustrates. On a similar but nonetheless contrasting note, Emily Dickinsons â€Å"A Narrow Fellow In The Grass,† which recounts the poets observation of a snake in a lyrical six stanza poem, could also be conveniently pigeonholed upon initial regard to the crudeness and categorization of â€Å"animal poetry,† much like â€Å"A Noiseless Patient Spider. † Of course, Dickinson is able to deliver more than that; although she makes no explicit mention of the word â€Å"snake† in her poem, her descriptions regarding the less than favorable animal is evident in the extent of her poem, and her dislike or wariness of it is also expressed. She writes, about the snake, harping on danger and caution, â€Å"The grass divides as with a comb, / A spotted shaft is seen; / And then it closes at your feet / And opens further on. † (Dickinson). The tone which exists in the aforementioned lines is the same sentiment which dominates the entire poem, of a seeming villain afoot and lurking in every lines. She culminates the poem, perhaps with a playful or serious warning, â€Å"But never met this fellow, / Attended or alone, / Without a tighter breathing, / And zero at the bone. † Apart from the different choice of animal metaphor, words, rhythm, and structure which Whitman and Dickinson incorporate in their writing; in the incensed at times cryptic manner by which Whitman indulges his thoughts and musings, and in the seemingly simple and less flamboyant way in which Dickinson writes her poetry, both poets not only in their approach in writing poetry, but by the sentiment or ideology which their respective poems evoke as well. While Whitmans â€Å"A Noiseless Patient Spider† is not exactly optimistic, but nonetheless evokes a sense of beauty (albeit in sadness), familiarity, and maybe even hope because it muses on the instance of humanity, of the experiences of the soul, which every human being undoubtedly possesses, it affords its readers a different kind of elation, and a type of elevation in ones spirit; Dickinsons on the other hand, appears to evoke the opposite. â€Å"A Narrow Fellow In The Grass† appears devoid of this effective elation and spiritual elevation in the seeming cynical and skeptical way that it is told. It perhaps reflects the poets dim or pragmatic view of reality and existence as it unfolds to her. Ultimately both poets may not share the same worldview or ideology, and approach to poetry with regads to humanity and existence, but their distinct voices provide readers alternative points of view on the subject, affording individuals poetry in its beauty and variety. Works Cited Dickinson, Emily. â€Å"A Narrow Fellow In The Grass. † 7 February 2008 www. online- literature. com/dickinson/824/. Whitman, Walt. â€Å"A Noiseless Patient Spider. † 7 February 2008.

Career Episode Civil Essays

Career Episode Civil Essays Career Episode Civil Essay Career Episode Civil Essay Career Episode 3 a) Introduction This career episode describes my working activity from September till October 2xxx. I was working as a group leader at the design of water-supply and sewerage works and networks of the FFF Bauxite Mine and of a town situated in Komi Autonomous Republic. b) Background. After reviewing the background data I had to define water-supply sources, to calculate water consumption for domestic, industrial and fire safety purposes of the mine industrial area and the town. I also had to estimate sewage runoff and to select appropriate water and sewerage works. I had to foresee the measures devoted to environmental protection. As usual I closely collaborated with relative specialists- prospecting specialists, electrical engineers, water engineers and metallurgical specialists. For this design I carried out all the necessary calculations, developed the principal main water-supply and sewerage works schemes, water consumption and water removal balance schemes. All the calculations were carried out on a computer. While I was working on the project I took part in the negotiations with the customer, where we discussed the engineering and environmental protection problems. After completing my work I gave the explanatory note to my customer for approval. c) Personal workplace activity. For this design I studied a lot of materials which contained the information about hydrological, geological and climatic parameters of the designed industrial site area. I analysed accounts of preliminary and detailed groundwater prospecting for household water-supply. The careful study of this information made it possible for me to offer the disposition of water-intake works ( artesian wells ) not at the place recommended at the reliminary prospecting. That fact excluded the possibility of chemical and bacterial contamination of the water supply source. I carried out the calculations of water consumption for domestic, industrial and fire safety needs. On the basis of these calculations I developed the water-supply scheme. This scheme was as follows: Water from the water-intake wells is distributed by the pumps to the regulating reservoirs intended for the water collectin g before the pumping station of the second raising. The pumps at the pumping station of the second raising discharge water from the regulating reservoirs to the reservoirs where fire-proof, emergency and controlling reserve of water is kept. From the reservoirs the water flows under gravity to the circular network. I made provision for a special installation of the regulating valves with the electric drive in the wells near the tanks in order to pass the fire safety reserve of water. In this project I made an important decision regarding environmental protection. I offered to disinfect potable water at the bactericidal plants. Besides, I foresaw the reserved disinfection of water with the solution of natrium hypochlorite obtained from the solution of salt in the electrolyses. For this design we (my group under my direction) worked out the borders of sanitary protection zones for water-supply sources and water storage tanks. We kept in view the further development of our object. We also included all the sanitary steps around the zone territory according to the construction standards and rules. On the industrial areas of the mine I designed the recycling water supply systems for a diesel power station, for a crushed stone factory and for a car-washer. I estimated and selected the following works and networks of the recycling water supply systems: recycling water-supply pumping stations, water-cooling towers, car-washer sewage water treatment plants, recycling water pipe-lines. These recycling water supply systems allowed to reduce fresh water consumption. The recycling water supply systems make 92 percent of the whole mine water-supply in this design. I also calculated the following sewerage systems: household, industrially-storm and industrial ones. For the household sewerage system I estimated and selected sewerage pumping stations, domestic sewage treatment plants, sewerage networks. At the disposal works waste water passes step by step the intake chamber, the racks, the grit catchers and then enters the mixing chamber. The aluminium sulphate solution and chlorine water are fed there to improve oxidising of ammonia nitrogen. Then sewage enters the sedimentation tank, where settling takes place to separate the main part of pollutants. In order to remove residual organic pollutants and unsettled suspended matter the further sewage treatment goes on by the oxidation on the surface of the pores filter bed. Treated sewage water enters the contact chamber for the disinfection. In my explanatory note I gave the description of all the sewerage works and represented the tables of pollutants concentrations in household sewage before and after the purification. I also represented the results of the suspended matter and biological oxygen demand ( BOD ) sewage purification degree design taking into account the process of the mixing with water of the river, in which sewage is discharged after purification. Disposal works which I have selected ensure household sewage purification up to the maximum concentration limits that in turn permit to discharge sewage into basins important for fish industry. I also made provision for storm water treatment. Storm water full of black oil from the territory of lubricating materials storehouse, from a car park and garage, sewage from the repair shops enter the storm water treatment plants. Here sedimentation and purification take place on the filters. After purification storm water isn’t discharged into the basin but it is utilised in the hydraulic ash removal system of the boiler house and partly used to fill the recycling water supply systems of HPP ( heating power plant ). I also designed the second sewage utilisation for the industrial sewerage system. Sewage from the hydro-washing of the floors of crushed stone factory and of grinding-sorting factory enters the pumping station and then the sewage flows to the ash dump of HPP to fill the recycling water supply systems. In this project I had to solve the problem of the FFF bauxite mine quarry water treatment working together with the water engineer and the specialist of our institute scientific research department. I provided for the sewage treatment and the sewage discharge into the river belonging to the fish-industry basins of the extra quality, where the pollutants content was carefully controlled by the present legislation. The mine quarry water is a mixture of treated industrial water and water pumped from the mine underground roadways. The water is generally polluted by the suspended matter and the oil products. First the quarry water flows into the sedimentation tank. In the sedimentation tank the averaging of seasonal movements of water consumption and the partial suspended matter sedimentation takes place. To achieve the required purification degree I developed the process flow sheet with the reagent water treatment and the following filtration. The flow sheet includes: The suspended matter treatment in the sedimentation tank with natrium aluminate as a coagulant. Filtration. The pollutants content after the purification meets the specifications of the maximum permissible concentrations of the controlled components for fishing basins. To achieve the required purification degree I provided for the centralised control of the process, the automatic adjustment of the parameters and the analytic control of the quality of influents and effluents. To ensure reliable work and optimal sanitary-engineering conditions all the reservoirs equipment is provided by the special devices. These devices give warning signals if the limiting value is achieved. All the equipment and all the pipe-lines which are exposed to the aggressive medium acting are protected by the special corrosion proof coverage. d) Summary. In this design many tasks and problems were accomplished. They are closely connected with water-supply, water draining, sewage treatment, environmental protection of the designed object. Developing this design, I managed to apply all my knowledge and skills of a construction engineer. The design was approved and co-ordinated by the customer.

Roman Gladiators vs. the Gladiator Movie

Roman Gladiators vs. the Gladiator Movie In May 2000,  Gladiator  opened in movie theaters. Maximus Decimus Meridius (Russell Crowe) is a successful general from the Battle of the Danube under Marcus Aurelius (Richard Harris). Commodus (Joaquin Phoenix), son of Marcus Aurelius, condemns Meridius to probable death by sending him into the gladiatorial arena. Commodus isnt merely sending to an uncertain death the general he perceives as a threat to his throne. The new emperor himself enters the arena to ensure Meridius permanent  end. If the plot seems a bit far-fetched, its not- at least in the most obvious way, because Commodus and probably another half dozen emperors did indeed set foot in the arena. Emperor Gladiators The adulation of the crowds has to be among the most compelling reasons to become a gladiator. At first, gladiators were slaves, criminals condemned to death, and war prisoners. In time, free men volunteered to become gladiators. Brooklyn Colleges Roger Dunkle says it has been estimated that by the end of the Republic, half the gladiators were volunteers. There were even women gladiators. That Emperor Septimius Severus banned female gladiators suggests that by the beginning of the third century A.D., there was a sizable number of such Amazons. Two of the mad emperors, Caligula and Commodus, appeared as gladiators in the arena. Seven other emperors who werent demented, including Titus and Hadrian, either trained as gladiators or fought in the arena. The Gladiator Was Honored but Unrespectable Anyone who became a gladiator was, by definition, infamis (whence: infamy), not respectable, and beneath the law. Barbara F. McManus says gladiators had to swear an oath (sacramentum gladiatorium): â€Å"I will endure to be burned, to be bound, to be beaten, and to be killed by the sword.†Ã‚  This consigned the gladiator to possible death, but also conferred honor, much like that of a soldier. Not only was there honor for a gladiator, but there were adoring crowds, and, sometimes there was wealth (victors were paid with a laurel, monetary payment, and donations from the crowd) and a life of leisure. Some gladiators may have fought no more than two or three times a year and may have won their freedom within very few years. Because of the financial incentive, free men and even aristocrats who, having squandered their inheritance had no other comfortable means of support, would voluntarily become gladiators. At the end of his service, a freed gladiator (as a token, he received a rudis), could teach other gladiators or a he could become a freelance bodyguard. The plot is familiar: In todays movies, the ex-boxer, having survived dozens of bloody KOs with only a few disfigurements, becomes a manager or trainer at a boxing school. Some popular sports figures become sportscasters. occasionally, they become television or movie personalities or even politicians. Political Gladiator Fights An editor is a person who gives something forth into the public, like a public game. In the Republic, the Editores were politicians who, wishing to curry public favor, would put on fights between gladiators and animal shows. Today, municipalities build stadiums with tax dollars, a burden shared rather than being shouldered by a benefactor. The person with the status of the editor may be the owner of the sports team. Onto the floor of the amphitheater sand was poured to absorb blood. The word for sand in Latin is harena, from which our word arena comes. Sources depthome.brooklyn.cuny.edu/classics/gladiatr/gladiatr.htm, Roger Dunkle on Gladiators www.ualberta.ca/~csmackay/CLASS_378/Gladiators.html, Blood Sport

Analysis of Michel Foucault's theories of Power, Knowledge and Essay

Analysis of Michel Foucault's theories of Power, Knowledge and Technologies of the self - Essay Example Donnie Darko, a movie which was directed by Richard Kelly back in 2001, is a cult psychological thriller film. Basically, the main characters in the movie named Donnie Darko is a troubled teenager who was searching for the real meaning of life. Paranoid schizophrenia is a common type of schizophrenia which causes a person to experience a series of paranoid, delusions, and hallucinations related to auditory sensory or hearing. Due to the fact that Donnie is suffering from the symptoms of paranoid schizophrenia, he often encounters emotional and psychological disturbances due to the presence of auditory hallucination. For this reason, his outlook in life was totally different from what other teenagers are going through in life. Not only did he get much trouble inside the school compound but also within the family circle and the community. For this study, the researcher will focus on discussing Foucault’s technologies of self, power, and theory of knowledge. To enable the readers to have a better understanding of the subject matter, the first part of study has been divided into three major sections. As part of conducting a literature review, the first section will analyse and discuss about Foucault’s technologies of self. The second section of the study will tackle Foucault’s point-of-view regarding knowledge whereas the third section will discuss about Foucault’s theories behind power. The second part of the study will provide the readers with a brief summary regarding the movie Donnie Darko. Upon analyzing the thoughts of Foucault on technologies of self, power, and theory of knowledge, the researcher will examine the main characters behind the movie entitled Donnie Darko. In the process of discussing the movie, Foucault’s technologies of self, power, and the theory of knowledge will be used in analyzing the personal attitude and social behaviour of Donnie – the main characters of the movie

Statement of purpose Essay Example | Topics and Well Written Essays - 1000 words

Statement of purpose - Essay Example After a lot of discussions; through my persistency, I was able to convince the authorities to grant us special entry to the match. Born in Iran, I grew up in Canada where I completed my primary school education. I moved back to Iran for four years and attended the first years of high school. My parents then sent me to my sister in Germany where I encountered numerous challenges. Initially, I was to pursue an academic career but got misplaced in the lowest school track â€Å"Hauptschule† within the German tripartite school system. Nevertheless, I worked my way up the system to the â€Å"Gymnasium† and passed my A-levels. I then joined Georg-Simon-Ohm University for Applied Sciences in Nuremberg for my undergraduate studies majoring in International Business. I won the Persian Language Olympics and was a finalist in the German School Debating Championship is testimony of my hard work and positive attitude. In addition, the debating tournaments developed my effective commu nication skills and reasoned arguments, an ability useful in my current position to gain the buy in from stakeholders. I have been working in the Siemens Corporate Sustainability Office in a consulting capacity, in Germany, since April 2010. Siemens is a leading company in Sustainability. In Siemens we implement sustainability strategies, coordinate companywide programs and global initiatives. I am involved in program development, driving employee engagement activities and collaborating with internal and external stakeholders as part of my daily routine. I learnt of Sustainability during my internship at Fiat Professional where I developed the communication strategy and roll out plan for the communication campaign. It was then that I knew there were bigger prospects in the horizon. I got the urge to introduce something that would have an impact to future generations. During a project at Siemens Corporate supply & purchasing chain, I successfully developed and incorporated sustainabi lity criteria into the supplier evaluation process. It is while working on this that my passion in Sustainability was confirmed. I want to further my education in Sustainability Management since my plans are to engage in Sustainability throughout my career. I find your program appealing as it takes a holistic approach to Sustainability. Masters in Sustainability Management in Columbia University stands out because of its unique partnership with Earth Institute. This offers first class scientific perspective on Sustainability issues. In exchange, I would offer my expertise knowledge through my extensive work experience at Siemens Corporate Sustainability. My experience has given me the potential to make positive contributions to the courses as other learners would learn from me too. My international background has enabled me to understand and work with different perspectives and opinions which are significant for the topic of Sustainability. I have also established networks with othe r companies. For instance, the One Young World Conference in 2011, where young professionals from around the world gathered to discuss pressing global and environmental issues and Sustainability concerns. I was selected to be a Siemens delegate. In 2012, I will be a returning delegate for Siemens. After completing my studies, I plan to return to Siemens to share what I learnt at Columbia University and put in my persistency and ambitions to help Siemens keep

Life of a Homeless Man Essay Example for Free

Life of a Homeless Man Essay To whom it may concern, Imagine all the events that occurred in your life today. You woke up from your warm bed, took a shower, got dressed, and went to school, work, or both. Then you came home, you had dinner, and went to sleep. These are all basic needs that many people in the United States today dont have. Most people would agree that a day like this is fairly ordinary. Shelter, clothes, food, education, and family are all things that we usually take for granted and things that every person deserves. Now imagine your normal, everyday, routine being taken away from you. All in all you would essentially have my life. I have been facing an intense struggle just to stay alive despite the fact that society turns its head on me. The government has made laws that discriminate against me, which makes it almost illegal for me to co-exist with society. The mistreatment of homeless people is an issue that is often ignored by my community. When you see me on the streets how do you react? Do you turn your head and ignore me? Do you become angry that I am living on the streets? Do you feel frightened and avoid confrontation with me all together? Or do you see me as a human being and treat me in that way? Imagine if you were homeless, living everyday on the streets, having to go through constant judgments and listening to criticizing comments everyday like Get a job, or Ew, stay away. Imagine how hard it would be getting a job, especially in these times. Imagine living in a world with the You need money to get money philosophy; applying for jobs, yet the employer wont hire you because of your lack of clean clothes. So now you need to get new clothes, yet you dont have money. You need money, yet you dont have a job. It is a vicious cycle. Just think of how it would be, being homeless and not even having a mailing address. No family, no friends, being around drugs and violence 24/7. No roof to stand under in case of a storm. You dont even have time to think about getting food, yet that’s all you think about. Imagine living in a world where your best friends, and even your country, had left you behind. It would be tough, and it will change your perspective on me and how I live my life. I try not to accept my situation, but what other choice do I have? I used to ask for spare change and you think that I would have been asking for a kidney. For a country who likes to watch other people’s problems on TV, you think I would live in a country that would be more willing to at least hear what I have to deal with each day, if for entertainment at the very least. When people see me they assume I am more capable of committing violent crimes than a normal person. The only luxury I really have is the newspaper, and you would be shocked on how little we turn up vs. ormal Americans when it comes to violent crimes. Given the chance I would steal to survive another day, yet most believe it is ok to steal bread to feed one’s family. Hypocrites are normally the ones who have no problem passing judgment to me, yet we are not so different. As a homeless man, I don’t get to interact with many exciting things. You’d be surprised what I’d give if I had o ne friend that would visit me for as little as an hour a week. Considering that, since society looks down on me on a 24/7 basis, I don’t get a day off for fun. Congress issues American citizens â€Å"freedom of speech†, however I am still waiting on my chance to be heard. I would like people to know how it feeling of freezing rain feels every winter. The smell of molding cardboard is something I have to deal with on a monthly basis, until I can move to a new home. Some of the things that I’ve seen are not for the faint of heart; along with some of the things I’m left to eat in order to make it another day. You may read this letter and assume it to be the voice of the homeless firing back at society. You may read this letter and find it as a cry for help. Chances are is that you are probably interpreting this letter as a complaint against the community I live in. Why all those could be true consider the intent of this letter as a reminder of how bad it could be. I can guarantee you that the extent of your problems can be solved, so the next time you think about giving up, complaining about your relationship or job, or even get upset when your favorite sports team doesn’t win the big game; it can get worse.

Opposites Attract :: essays research papers

Opposites Attract On November 17, 1998, I walked into the halls of Towers High School for the very first time. Nervous and afraid, I was introduced to the eight grade class president, John Hamilton. John was both charismatic and charming. He was the type of guy everyone wanted to be around because he gave off a feeling of security and warmth. When I first met Him, John made me feel welcomed. He opened his heart to me and from that day on, I looked for friends willing to do the same. As I grew older, I met two of the most converse individuals in the world. When I was first introduced to Chris and Desmond, I did not know what to think. Everyone said that they were best friends, but for some strange reason I just could not understand why. As time passed we became closer and we grew fonder of each other. We did just about everything together. Then finally, after all the years of questioning their relationship, it finally hit me, opposites attract. Chris grew up in a stable home with a mother, a father, a sister, and an older brother. He learned how to live life very differently than anyone I’ve every met because he had to learn how to provide and to survive on his own. Even though he had both a mother and a father living with him, they still did not have enough money to provide everything for him immediately after his birth. He learned how to be independent and that has made him the person he is today. When he was fourteen, his family moved from a low income neighborhood to an upper middle class neighborhood. From rages to riches, some people might say, but that was not the case. Chris was still the same cheap guy. Chris has the type of personality that I absolutely hated when I first met him. He said things that were true, but uncalled for at the time. He just told the truth no matter what or who might got hurt. I honestly could not stand him for that. As we became closer I began to understand that was a very outspoken individual, who never held back. And now I really appreciate that about his character. Chris is my balance in life. Whenever I’m on cloud nine, he always brings me back to reality. Desmond is also my best friend.

The World Is an Apple

The play â€Å"The World is an Apple† is one of the most famous Filipino play by famed playwright, Alberto S. Florentino. In the story, it was shown how the main character Mario was forced to choose a path that he has long promised to not walk through again because of poverty. The story shows one sad reality of life that when an individual was backed up on a wall, he will do anything even if it's not accepted in his society. The scenario of the story is not far from what's happening with members of our society now that due to limited educational attainment that would qualify them for a proper-paying job that would be adequate for their families' needs. The sequence of the story and the technical aspect of the play should be commended. This has shown what Florentino is capable of. It's as if that the fluidity of the dialogues used in the play could have no fault and it came freely out from the playwright's mind into the sheets he spread out in front of him. It's no wonder that the play † The World is an Apple† is still one of the most used plays in the Philippines. This is a story of how wrong decisions become greater burdens to a family. Mario’s family happens to be in the lower bracket of society. He cannot even provide for his family’s basic needs. Albeit all this hardships, his wife Gloria, still manages to keep her good virtuous. She insists that the way they are living is a much better than the one they will have if they do wrong acts. But Gloria’s entire constant reminder to Mario did not prosper. Mario decided to come back to his old life of crime when he lost his job when he tried to steal an apple for his daughter. He keeps on insisting that his priority is to provide what his wife and daughter needs. He left with Pablo, his old crime buddy, even if Gloria pleaded very hard for him not to go with the man. This is a sad representation of what is happening in the society today. Due to lack of better opportunities to heighten one’s standard of living, some become entangled with the wrong crowd. By doing so, these individuals do not help their family at all; instead, they end up worsening their family’s problem. It is man’s basic instinct that drives him towards his survival. But, no matter what, he should not forget that society expects him to conform to its norms. One’s action is weighed right or wrong and thus should be kept towards the proper action. Another User Said: â€Å"This is a story of how wrong decisions become greater burdens to a family. Mario's family happens to be in the lower bracket of society. He cannot even provide for his family's basic needs. Albeit all this hardships, his wife Gloria, still manages to keep her good virtuous. She insists that the way they are living is a much better than the one they will have if they do wrong acts. But Gloria's entire constant reminder to Mario did not prosper. Mario decided to come back to his old life of crime when he lost his job when he tried to steal an apple for his daughter. He keeps on insisting that his priority is to provide what his wife and daughter needs. He left with Pablo, his old crime buddy, even if Gloria pleaded very hard for him not to go with the man. This is a sad representation of what is happening in the society today. Due to lack of better opportunities to heighten one's standard of living, some become entangled with the wrong crowd. † Another Users Summary: Mario's family happens to be in the lower bracket of society. As Mario got home one night, Gloria, his wife, asked for money, which they needed to feed their daughter. Mario told her that he doesn't have money. Gloria didn't believe him, and asked him to tell the truth. Mario told his wife the truth – he was fired from his job. The reason is because of an apple. He stole an apple for his daughter because he thought that she would like it – this part shows his love for his daughter. He left with Pablo, his old crime buddy, even if Gloria pleaded very hard for him not to go with the man. Another User Said: When Mario got home. Gloria saw Mario and she was asking for some money to feed there children to Mario. Mario said that he have no money because he did something. Gloria didn't believe on what Mario said and said to tell the truth. When Mario answered it, Gloria was shocked on what she heard because Mario lost his job. Gloria asked Mario if how he lost his job and Mario answered it and Gloria was shocked again because Mario said that he lost his job because of an apple. Gloria said that how can he loose his job by just taking one not a dozen not a crate but one apple and Mario answered that he just saw it rolling and he found himself putting it in his bag because Tita would love to have it, and Mario told Gloria that there's no need to worry because he found a new job. Suddenly Pablo was there ruining the whole conversation and asked them if how is there daughter doing and he'll loan a few pesos to help there daughter and Gloria said that no thank you because Mario stopped depending on Pablo. Pablo said that Mario's new job was with Pablo and when Gloria heard it he told Mario that it's a bad doing and risky. But Mario didn't listen and walks away with Pablo and told Gloria not to worry because he will come back early morning and don't wait for him. Gloria cries and shouting Mario, while Tita was crying also because he heard the conversation. This story is written by a Filipino author Alberto Florentino and has many morals, but one major point stands out: no matter what circumstances you are facing in life (failed marriage, infidelity, illness, poverty) you have a role†¦ responsibility and you have the power to choose to do the right thing; In the end we all have the power of choice. Plot Summary: An apple factory worker is fired from work after stealing an apple. He claims that he stole it to feed his sick daughter, what he left out is that he actually had been using his salary to pay for prostitutes, hence, the money that was intended for the family was diverted to satisfy his selfish desire for sex.

Measurement of Sevice Quality of Apollo Using Servqual

Dissertation Project Report On Measurement of Quality at Apollo Hospitals using Servqual Submitted by Richa Kumari A0102208164 MBA (M&S) 2010 Under the Supervision of Faculty Mentor Prof. (Dr. ) P. K. Bansal Faculty Amity Business School AMITY BUSINESS SCHOOL AMITY UNIVERSITY UTTAR PRADESH SECTOR 125, NOIDA – 201303, UTTAR PRADESH, INDIA 2010 DECLARATION I Richa Kumari, student of Master of Business Administration (Marketing &Sales), Class of 2010from Amity Business School, Amity University, Uttar Pradesh hereby declare that the dissertation done by me on the topic â€Å"Measurement of Quality at Apollo Hospital using Servqual† is true to my knowledge. The information collected by me is authentic & is done through data analysis & interpretation & I have a thorough knowledge of the project. The content of this report is based on the information collected from visiting Indraprastha Apollo hospitals in Delhi. I further declare that the matter embodied in this project report has not been submitted to any other university or institute for the award of any degree or diploma. PLACE: Noida DATE : Richa Kumari Amity Business School Amity University, Uttar Pradesh CERTIFICATE FROM FACULTY GUIDE This is to certify that Richa kumari, student of MBA (M&S), Amity Business School, Amity University; Uttar Pradesh has successfully completed the dissertation project under my guidance. The project report and data submitted by her is authentic and genuine to my knowledge. Prof. Dr. P. K. Bansal Faculty guide Faculty, Amity Business School Amity University, Uttar Pradesh ACKNOWLEDGEMENT It takes immense pleasure for me to express my sincere gratitude to all the helping experience I had during my dissertation. The Project was done by me under the guidelines of my Faculty Guide Prof. Dr. P. K. Bansal was a source of enormous learning for me. I am highly obliged to him for their continuous unconditional support & guidelines. A special word of thanks from me to all the respondents whose cooperation and interaction was a great help. As a student of AMITY BUSINESS SCHOOL, NOIDA I got the golden opportunity to work on the topic â€Å"Measurement of Quality of Apollo Hospital using Servqual†. I also feel highly obliged to my program leader Mrs. Aparna Goel and some of the faculties in ABS who in several ways were my inspiration & helped me to put in the best of my efforts. I am deeply indebted to my parents, family members & friends for their support during the course of my dissertation. Last but not the least; the report was completed successfully because of the grace of God. Richa Kumari Amity Business School EXECUTIVE SUMMARY Service firms like other organizations are realizing the significance of customer-centered philosophies and are turning to quality management approaches to help manage their businesses. This paper starts with the concept of service quality and demonstrates the model of service quality gaps. SERVQUAL as an effective approach has been studied and its role in the analysis of the difference between customer perceptions and expectations has been highlighted with support of measurement of quality at Apollo Hospital. Outcomes of the study outline the fact that although SERQUAL could close one of the important service quality gaps associated with external customer services, it could be extended to close other major gaps and therefore, it could be developed in order to be applied for internal customers, i. e. mployees and service providers. Quality Health Care  is an achievement of optimal physical and mental health through accessible, cost-effective care that is based on best evidence, is responsive to the needs and preferences of patients and populations, and is respectful of patients’ families, personal values and beliefs. The report covers the survey of Apollo Hospital Services, Delhi. It focuses on the dynamics of the the overall service provided, the trends over a period of time, and the key challenges faced by the industry. TABLE OF CONTENTS DECLARATION I * CERTIFICATE FROM FACULTY MENTOR II * ACKNOWLEDGEMENT III * EXECUTIVE SUMMARY IV * CHAPTER 1 INTRODUCTION * CHAPTER 2 LITERATURE REVIEW * CHAPTER 3 METHODOLOGY * SAMPLE DESIGN * RESEARCH DESIGN * DATA COLLECTION METHOD * SAMPLE SIZE CHAPTER 4 DATA INTERPRETATION * DATA ANALYSIS * FINDINGS * LIMITATIONS * CHAPTER 5 CONCLUSION &RECOMMENDATION * APPENDICES V * REFERENCES VI * BIBLIOGRAPHY VII CHAPTER 1 INTRODUCTION Earlier in the medical literature, the quality of service i. e. the  characteristics that shape the experience of care was rarely discussed beyond technical  competence. This research measures and analyzes  some routine encounters in Apollo, a hospital of international standard from a service quality point  of view. The study has led to the following two premises: First, if high-quality service had a greater presence  in practices and institutions, it would improve clinical  outcomes and increased satisfaction of patient and doctors while reducing  cost. It will also create competitive advantage for those who  are expert in its application. Second, many other industries  in the service sector have taken service quality to a high level,  their techniques are readily transferable to health care, and caring for patients can learn from them. Healthcare industry The healthcare industry in India comprising of hospital and allied sectors, is projected to grow at 23 per cent per annum and to touch US$ 77 billion by 2012 from the current estimated size of US$ 35 billion, according to a Yes Bank and ASSOCHAM report. The sector has registered a growth of 9. 3 per cent between 2000-2009, when compared with the growth rate of other emerging economies such as China, Brazil and Mexico. According to the report, the growth in the sector would be driven by healthcare facilities, private and public sector, medical diagnostic and pathlabs and the medical insurance sector. Today Hospital industry is an important component of the value chain in Indian Healthcare industry. It renders services and is recognized as healthcare delivery segment of the healthcare industry. It is growing at an annual rate of 14%. The hospital industry accounts for half the healthcare sector’s revenues and was estimated to be worth USD $25 billion in 2008. The dismal performance by the Indian government in providing healthcare infrastructure has created tremendous opportunities in the private sector. The huge pent up demand for quality healthcare and increase in healthcare spending in the long-term are fundamentally strong drivers in this market. The factors contributing to its bright future is based on increased healthcare  consumption, increasing instances of lifestyle-related diseases, medical tourism, and growing  health  insurance. The key challenges for the industry include significant capital requirements and a shortage of medical professionals. Ensuring high quality of healthcare service is another key issue for service providers. Healthcare spending in India accounts for over 5 per cent of the country’s GDP. Of which the public spending in percentage is around 1 per cent of GDP. The presence of public health care is not only weak but also under-utilized and inefficient. Meanwhile, private sector is quite dominant in the healthcare sector. Around 80 percent of total spending on healthcare in India comes from the private sector. Inadequate public investment in health infrastructure has given an opportunity to private hospitals to capture a larger share of the market. In addition the demand for hospital services has been increasing due to the rise in lifestyle related diseases that accompany prosperity. Hospitals serve an important function in India’s healthcare system. They provide in-patient and out-patient services and also support the training of health workers and research. Indian hospitals can be broadly classified as public hospitals, private and not-for-profit hospitals. Corporate hospital chains that provide tertiary healthcare services in large towns and cities have also been established. However, the number of hospital beds in India is around 1. 1 per thousand people. This is significantly lower when compared to most developed economies. The current outlook for the hospital services is positive. Technological innovations in service delivery, increased affordability, improved service quality and supportive government policy initiatives are some of the factors that are likely to impact growth of the sector. This is a pointer to significant opportunities that exist for service providers. Moreover, the future of healthcare is not restricted to the large domestic market alone. Emerging trend of medical tourism indicates the possibility of Indian healthcare services opening to the whole world. Health Care and Service delivery Health  Service delivery  refers to the way inputs such as finance, staff, treatment, equipment and drugs all deliver a range of health interventions to consumers seeking to access health care. Improving Service delivery  depends on having key resources that are well organized and managed. Health services include personal health services that are preventive, diagnostic, therapeutic or rehabilitative; whilst non-personal services cover areas such as mass health education/ promotion programs, health legislation and the provision of basic sanitation facilities. Incompetence or breakdown in the process of care-giving may be the result of problems in practice, products, procedures or systems. A key issue facing development agencies is the utilization of health services as they are often inaccessible or mistrusted by consumers. Lack of managerial capacity at all levels of the health system is increasingly cited as a binding constraint to scaling up services and achieving the Millennium Development Goals. Apollo Hospitals With over  8065 beds across 46 hospitals in India and overseas, neighborhood diagnostic clinics, an extensive chain of Apollo Pharmacies, medical BPO as well as health insurance services and clinical research divisions working on the cutting edge of medical science, Apollo Hospitals is a healthcare powerhouse one can trust with their life. Apollo Hospitals, India is a union of exceptional clinical success rates and superior technology with centuries-old traditions of Eastern care and warmth, with 16 million patients from 55 countries. Apollo Hospitals Group is at the Forefront of Medical Tourism to make India the Global Healthcare Destination. Its mission is to bring healthcare of international standards within the reach of every individual. They are committed to the achievement and maintenance of excellence in education, research and healthcare for the benefit of humanity. Dr. Prathap C Reddy is the Founder & Chairman, Apollo Hospitals Group. Led by Apollo Hospitals Group, Indian Healthcare today has developed International delivery capabilities and has demonstrated International excellence in all specialties with major cost advantages for people from overseas. Apollo Hospitals has successfully treated over 60000 foreign patients from across the world in last five years and the numbers are looking up every year. By constantly measuring our deliverables, they have succeeded in creating infrastructure that meets the needs of the future that incorporates the latest technology and provides superior healthcare delivery systems. Their immediate agenda includes setting up of healthcare facilities in all major Indian cities, 23-hour hospitals, pharmacies, a pharmaceuticals business and finally, a Health Maintenance Organization that will give millions of people access to all these facilities. The telemedicine technology that has been successfully introduced by Dr. Reddy in India will be a key enabler in transforming the healthcare delivery in India. His blueprint for the nation includes setting up of many rural hospitals. Apollo Hospitals Group is the acknowledged leader in bringing super speciality world-class healthcare to India. It is presently the largest integrated healthcare company in Asia. Apollo Hospital  would mean any of the hospitals owned by  Apollo Hospitals, a  healthcare  corporation that operates 38 hospitals in South Asia. It is the largest healthcare provider in Asia and the third largest in the world and is headquartered in  Chennai, India. Apollo Hospital  Delhi  is the first hospital in India to be accredited by the JCAHO and is affiliated with  Johns Hopkins  international, the  Mayo Clinic, and many major hospitals in the United States and Europe. In addition to hospitals, Apollo operates Nursing and Hospital Management colleges,  pharmacies, diagnostic clinics, medical transcription, third-party administration and telemedicine. Through its wholly owned subsidiary, Apollo Health and Life Science Limited, the Apollo Group has set up a chain of nearly 60 branded day-to-day retail clinics on a franchised basis across India and the  Middle East. This is the first time healthcare delivery has been successfully franchised in India. Indraprastha Apollo Hospitals, the largest healthcare group in Asia. Indraprastha Apollo is one of the largest corporate hospitals in the world. It is the third super specialty tertiary care hospital set by the Apollo Hospitals Group, jointly with the Government of New Delhi, India's capital. It is a 695 bedded hospital, with the provision for expansion to 1000 beds in future. The hospital is at the forefront of medical technology and expertise. It provides a complete range of latest diagnostic, medical and surgical facilities for the care of its patients. The hospital started functioning from July 1996, its mission being Medical Excellence with a Human Touch. Cost of treatment Apollo Hospitals is considered one of the most expensive treatment facilities when compared to their local counterparts. A similar treatment and care in a regular hospital would cost significantly lesser. However, their facilities, infrastructure and quality of medical faculty are far superior to anything else in the country, seemingly justifying this increased cost. Medical Milestones * Employs over 4000 specialists and super-specialists and 3000 medical officers spanning 53 clinical departments in patient care * Achieved a 99. 6% success rate in cardiac bypass surgeries, over 91% of these were beating heart surgeries * Conducted over 55,000 cardiac surgeries First Indian hospital group to introduce new techniques in Coronary Angioplasty, Stereotactic Radiotherapy and Radiosurgery. Performed over 7,50,000 major surgeries and over 10,00,000 minor surgical procedures with exceptional clinical outcomes * Pioneered orthopaedic procedures like hip and knee replacements, the Illizarov procedure and the Birmingham hip re-surfacing technique * Pioneered the concept of preventive healthcare in India * First ho spital group to bring the 64 Slice CT-Angio scan system * First hospital group in South-East Asia to introduce the 16 Slice PET-CT Scan * First to perform liver, multi-organ and cord blood transplants in India * Equipped with the largest and most sophisticated sleep laboratory in the world CHAPTER 2 LITERATURE REVIEW Kotler (1999) points out an unchangeable principle for a successful business are to satisfy the customers’ need. Consumer service is closely related to customer satisfaction and consumer satisfaction has a critical influence on the profits and performance of institutions and organizations (Fornell, 1992; Mittal & Lassar, 1998; Wong, 2000). That is why organizations emphasize the importance of consumer service and satisfaction. Just as the dashboard of a car provides timely feedback on vital performance measures, so should an organization’s dashboards inform decision makers and board members on where the organization is headed and how it is progressing toward its strategic objectives. The consumer service perspective is closely associated with the evolution of the business strategies in the Health Care industry. To manage and improve quality, these successful organizations are coming to the conclusion that quality must be measured. This ensures accurate measurement of customer satisfaction versus that delivered by competitors. Service Quality is a service that is consistent with customer expectations and stated obligation in Customer Care, performance & Value. Quality itself has been defined as fundamentally relational:   ‘Quality is the ongoing process of building and sustaining relationships by assessing, anticipating, and fulfilling stated and implied needs. ‘ One cannot separate the process and the human factor, therefore there is a believe that Quality, when built into a product, generates emotions and feelings within those who have taken part in it's creation. Quality is doing the right things right and is uniquely defined by each individual. Error-free, value-added care and service that meets and/or exceeds both the needs and legitimate expectations of those served as well as those within the Medical Center. Organizations that constantly measure themselves in relation to competitors are able to quickly capitalize on their emerging strengths and address weaknesses before they become problems. Service Quality Quality applies to every product either it is physical product, information product or service product. But when Service Quality is talked about it is all about satisfying the targeted customers through meeting their requirements (Zulfikar Ali). Quality cannot be measured without a clear definition or standard. Likewise, Measuring Quality leads directly to the identification of areas for improvement or enhancement—the first step in Improving Quality. Service Quality models There are a number of models which try to capture and define Service Quality. Each has their strengths, and weaknesses. The core definition of Service Quality is â€Å"Customers thinking they're getting better service than expected†. This is often referred to as the perception gap, i. e. the gap between what the customer expects and what they think they got. It's worth noting that both sides of the gap are in the customers mind. You may actually deliver better Service then your competitors, but if the customer thinks that your Service is worse then that's all that matters. Because the perception gap is based on the difference between what a customer expects to receive from a Service and what they think they received both sides of the gap are â€Å"soft† – they are based on customer impressions rather than a â€Å"hard† definable quality. This means the perception gap is difficult to measure, difficult to manage and is likely to change with time and experience. Nevertheless it's vital to business success. Elements of the model A management model should identify and relate those key elements that require systematic management attention (Brogowicz et al. , 1990). The elements proposed to fit in the model are: * Management’s perceptions of customer expectations and perceptions about the service; * Vision, mission, service strategy and directions to eliminate the gaps; * Service analysis, translation of perceptions into service quality specifications and service design; * Financial and human resources (HR) management; * External communication; * Service delivery system (production, delivery and ‘part-time’ marketing). Some models which are the result of some significant research are: The KANO Model states â€Å"What do customers expect as a minimum standard†, and â€Å"what actually makes a difference if the service provider does it better†. Professor Noriaki Kano (1984, the Japanese quality guru), introduced a two-factor quality model, commonly known as â€Å"Kano's Curve†. The curve illustrates the difference between must-be attractive and linear quality elements. The strength of the Kano model is that it identifies that some aspects of service are simply required to be there whereas others serve to genuinely provide competitive advantage and that there are diminishing returns to be gained from simply focusing on must-be qualities. However Kano does not provide diagnostic tools to identify or measure the different aspects, and suggested the changes with time or environment. The PZB Service Quality Model The service quality model and the role of consumers’ and learners’ satisfaction is an essential part of service quality studies. The â€Å"GAP† model of service quality from Parasuraman et al. (Zithaml & Bitner 1996) offers an integrated view of the consumer-company relationship. It is based on substantial research amongst a number of service providers. According to the PZB model, there are five gaps. The first gap refers to the difference between customers’ expected service and management’s perceptions of customers’ expectations. This gap means that management may not correctly perceive customer expectations. The second gap refers to the difference between management perceptions of customers’ expectations and service quality specifications. This gap means that although the people in management level may perceive the correct expectations of the customers, they may not have suitable and sufficient service quality specifications. The third gap refers to the difference between service quality specifications and the real service delivery. This gap means that although the service providers may have suitable and sufficient service quality specifications, they may not have the satisfactory service delivery in the real situation. That may be because service providers lack well-trained employees to deliver satisfactory service. The fourth gap refers to the difference between the service delivered and external communication about the service with customers. That is, the service providers may not have suitable and sufficient communication with the customers or the service providers may have commitments that exceed what they can do or they may not sufficiently inform the customers of what they have done. The fifth gap is the difference between consumer expectation and their perception of service quality – measured by the difference between what customers expect and what customers perceive about the service. In addition, gap 5 is a function of gap 1, gap 2, gap 3, and gap 4; that is, Gap 5= f (gap1, gap2, gap3, gap4). This means that the service quality is closely related to management perception, marketing, personnel management, communications with customers, service specifications and delivery. Based on theoretical development of the PZB Service Quality Model, the SERVQUAL (SERVice QUALity) instrument was proposed. RATER A complementary analysis of the perception gap is the RATER model also produced by Zeithaml (1990). RATER identifies the 5 key areas which together form the qualities of a service offering from a customer perspective. Where the Gap model describes how the provider can minimize the perception gap. RATER focuses on the dimensions of customers expectations. The RATER factors help provide specific dimensions which can be used to analyse and measure customer expectation. Figure 1: PZB Service Quality Model A Conceptual Model of Service Quality and its Implications for Future Research. Journal of Marketing, 49(4), 41-50. Source: Parasuraman, A. , Zeithaml, V. A. & Berry, L. L. (1985). | RATER dimensions sorted by relative importance (Zeithaml 1990)| Dimension| Description| Relative importance| Reliability| Ability to perform the promised service dependably and accurately| 32%| Responsiveness | Willingness to help customers and provide prompt service| 22%| Assurance | Knowledge and courtesy of employees and their ability to convey trust and confidence| 19%| Empathy| Caring individualised attention the firm provides its customers| 16%| Tangibles | Appearance of physical facilities, equipment, personnel and communication materials| 11%| THE ASSESSMENT INSTRUMENTS-The SERVQUAL and SERVPERF Based on preliminary knowledge about the service quality model and the consumer satisfaction concept, there are two major assessment instruments (SERVQUAL and SERVPERF). The SERVQUAL (SERVice QUALity) instrument was proposed by the Parasuraman et al. (1988). They initially developed a 97-item instrument to measure the service quality attribute. After eliminating the items with low correlation, they extracted five factors (tangibles, reliability, responsiveness, assurance, and empathy) with 22 service quality items, and claimed the generic nature of the five-dimension instrument. Because the disconfirmation-based SERVQUAL instrument has advantages such as better diagnostic power (Jain & Gupta, 2004), and the parsimony of the instrument (Rohini & Mahadevappa, 2006), most researchers in the service quality area tend to prefer the disconfirmation-based SERVQUAL instrument (Abdullah, 2006; Brady, 2001). However, some researchers have been questioning its drawbacks related to the disconfirmation-based model (Redman & Mathews, 1998), process orientation, dimensionality, measuring scale, and the gap scores (Buttle, 1996; Coulthard, 2004; Clewes, 2003; Wetzels, Ruyter, & Lemmink, 2000). To resolve problems related to the disconfirmation-based SERVQUAL instrument, Cronin and Taylor (1992) propose the performance-only SERVPERF (SERVice PERFormance) instrument to measure service quality. Comparing the validity and reliability of the SERVPERF with that of the disconfirmation-based SERVQUAL, they claim that SERVPERF is better than SERVQUAL in overall service quality measurement in empirical tests (Cronin & Taylor, 1992; Brady, Cronin, Brand, 2002; Jain & Gupta, 2004). The debate related to adoption of SERVQUAL or SERVPERF in service quality studies is not yet resolved. SERVPERF has better explanatory power in overall service quality measurement. On the other hand, SERVQUAL has better diagnostic power because of the P-E score measurement. Thus, selection of the service quality instruments will be determined by the intention of the researchers, service providers or decision-makers (Jain & Gupta, 2004). Research Papers â€Å"Provider Competition and Health Care Quality: Challenges and Opportunities for Research†, by HERBERT S. WONG, PEGGY, M NAMARA states that during the last several years, health care quality issues have emerged as important considerations in developing and implementing public policy. This report highlighted health care delivery problems, patient safety concerns, and health disparities issues. Health care quality is difficult to define because different audiences view health care quality from. Clinicians may define quality based on medical outcomes or processes. Economists may define quality based on concepts of social welfare and may include features that consumers happen to care about, but that clinicians do not (e. g. , the appearance and size of hospital rooms). Health plans may further differ and focus on concepts of preventive care or organizational efficiencies. Researchers need to understand what their measures are capturing and should interpret their findings accordingly. Once health care quality has been defined, investigators interested in conducting applied empirical research are confronted with the challenges of creating proxy measures that capture the essence of the health care quality of interest. An initial problem is whether data even exist to create proxy measures for quality. The physician services market was one of the two health care provider groups on which the conference focused. However, the lack of available data about the care administered by physicians has stymied research on physician competition and quality. With literally hundreds of thousands of patient care physicians, current data systems are not structured in a way that makes accessing data and using data for research purposes pragmatic. Even if data were available, researchers must still overcome the challenges of how best to measure physician quality—an area that is currently not well understood. Patient satisfaction measures, which seek to quantify patients’ experiences with healthcare services, represent another dimension of quality still in the developmental stages. The article by Patrick Romano and Ryan Mutter in this supplement documents the studies that examined hospital competition and hospital quality, identifies the variety of hospital quality measures employed, and highlights the challenges of measuring hospital quality. As Romano and Mutter noted, the science of creating hospital quality measures has focused primarily on the clinical definition of quality, and such research is still largely in its infancy. At the heart of the challenges confronting researchers is determining whether observed differences in hospital quality measures are â€Å"true† differences. Confounding factors that may influence their accuracies include severity of illness, underlying patient risk, and the hospital’s overall case mix. Moreover, how well specific data elements are coded varies widely and ultimately affects the accuracy of the corresponding hospital quality measures. Many observers of medical markets believe that hospitals should compete on the basis of health care quality. However historically, hospital merger cases have focused on their effects on prices, costs, and the nature of the competitive environment, largely discounting health care quality issues. Health care markets are unique and extremely complex. While this invitational conference focused only on hospital and physician providers, the research opportunities and challenges outlined here apply to other health care markets as well. Mark Pauly’s article provides some preliminary thoughts on the concepts and the history of the relationship between competition and quality in health care markets. Health care markets are complex. Hospitals compete with one another, physicians compete with one another, and hospitals and physicians interact in many ways. Multiple external factors may influence hospital and physician competitive behavior. Measurement Challenges As mentioned earlier, the science of quality measurement is largely in its infancy and will continue to develop. The main challenges confronting researchers are determining the validity of the current set of measures and improving or developing new measures. The research field involved in inpatient quality measurement appears to be moving in three broad directions. First, researchers are exploring ways to further evaluate and validate the current set of inpatient quality measures. One approach being considered compares existing inpatient quality measures based on administrative data with information from medical records. Organizations such as individual health plans and veterans’ hospitals often have access to a richer source of clinical information, which could be used for this type of assessment. Second, current inpatient quality measures could be improved if the quality of the information collected is better. For example, in their article, Patrick Romano and Ryan Provider Competition And Health Care Quality Mutter mentioned that external-cause-of-injury codes (i. e. , â€Å"E Codes†) are sometimes under reported and vary substantially across the different organizations collecting such data. Many inpatient quality measures rely on accurate coding to identify the relevant observations. Existing measures could be improved if E Codes are collected more consistently. Finally, another broad approach is to supplement current administrative information with additional clinical information that could be used to refine or to create new measures. The availability of this clinical information could be used to improve measures of quality. As the science for better quality measures advances, analysts face a number of important research questions. While some critics argue that existing measures do not capture all clinical information, proponents argue that if there are no systematic biases across hospitals, precise patient-level information may not be needed. Consequently, is the science of quality measurement â€Å"good enough† for aggregate studies of competition and quality? Are they good enough for individual hospital comparisons? How will new measures with better information compare with existing measures? The Evolving Science of Quality Measurement for Hospitals: Implications for Studies of Competition and Consolidation PATRICK S. ROMANO The literature on hospital quality is young; most studies have focused on few conditions and outcomes. Measures of in-hospital mortality and complications are susceptible to bias from unmeasured severity and transfer/discharge practices. We describe the strengths and limitations of various approaches to quality measurement; summarize how quality has been operationalized in studies of hospital competition. three mechanisms by which competition may affect hospital quality, and propose measures appropriate for testing each mechanism. To evaluate the effects of competition and consolidation in health care markets on quality of care, it is essential to understand the capabilities and limitations of the tools currently available for measuring quality. The number and scope of these tools have grown considerably over the past two decades. These developments have created new opportunities to understand how competition and consolidation affect quality of care, although critics may still challenge the validity of any particular quality measure. The fundamental problem is that quality of care has multiple dimensions, and organizations that perform well on one dimension may not perform well on others. It is all too easy to arrive at the wrong conclusion if one focuses on a single measure, or even on multiple measures of a single dimension. In this paper, a standard definition of health care quality and an associated typology of quality problems is set. It describes the three general approaches to quality measurement, focusing on their strengths and limitations for studies of the impact of hospital competition and consolidation. Next summarizes how these measures have been applied in previous studies, and how the authors of those studies have dealt with concerns about confounding and endogeneity. It describes a conceptual framework that may be helpful in identifying promising measures for future studies in this area. 1. Definitions of Quality and Quality Problems In this paper, they have adopted a clinical perspective on quality of care. Avedis Donabedian (1980), one of the founders of the modern science of health care quality measurement, defined the quality of medical care as â€Å"the management that is expected to achieve the best balance of health benefits and risks (taking) into account the patient’s wishes, expectations, valuations, and means the social distribution of that benefit within the population. † The American Medical Association (1984) defined high-quality care more narrowly as care that â€Å"consistently contributes to the improvement or maintenance of the quality and/or duration of life. Perhaps the most authoritative definition was published by the Institute of Medicine (1990), which defined quality of care as â€Å"the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with curren t professional knowledge. † All of these definitions attempt to distinguish between quality and other non-price aspects of service, which might be classified as â€Å"amenities. † Amenities include aspects of appearance, comfort, and convenience, such as the number of television channels available to hospital patients, the number of menu choices, and the quality of decoration. In making this distinction, they acknowledge that the line between amenities and quality may become blurred, especially with important patient-centered measures such as telephone response time, wait time for appointments, clinic hours, prompt complaint resolution and claims payment, and patient satisfaction. Nonetheless, this distinction is useful because it focuses attention on whether provider organizations expend resources in ways that were likely to improve patient outcomes, or in ways that are designed to give the appearance of quality. this paper, also follow the Institute of Medicine’s (1999) typology of quality problems (Chassin et al. , 1998) as involving inappropriate overuse (i. e. too much care), inappropriate underuse (i. e. , too little care), and misuse. Although this conceptualization may state Pauly’s (2003) definition of quality as â€Å"everything about some good or service relevant to consumers’ well-being that is not measured by quantity,â⠂¬  we prefer to place all provider judgments and recommendations regarding appropriate care in the category of â€Å"quality† rather than â€Å"quantity. † 2. Approaches to Quality Measurement Donabedian (2003) has described the three broad approaches to quality measurement as structure, process, and outcomes. This useful schema has been widely adopted by the health services research and quality improvement communities. Structural measures describe the conditions under which care is provided, and encompass material resources such as facilities and equipment, human resources such as the credentials and experience of health care providers, and organizational characteristics such as patient volume and team nursing. Process measures describe the content of health care, and encompass health care providers’ activities in the realms of screening, diagnosis, pharmacotherapy, surgery, rehabilitation, patient education, and prevention. Finally, outcome measures describe changes attributable to health care, and encompass mortality, morbidity, functional status and pain, as well as patients’ health-related knowledge, behaviors, and satisfaction. Although this schema remains conceptually useful, it is sometimes difficult to apply. For example, the shared features of â€Å"high-reliability organizations† (Reason, 2000) include both the structural conditions under which professionals work and how that work is performed. 3. Integrating Outcome and Process Measures of Quality Given that quality of care is a complex and multidimensional concept, no single measure of either process or outcome is likely to provide an adequate summary of the effects of competition and consolidation. Hospitals that perform well on risk-adjusted outcomes for one condition often perform poorly for unrelated conditions (Rosenthal, 1997; Chassin et al. , 1989), making it useful to consider a spectrum of conditions. Similarly, explicit process measures must be developed and implemented on a condition-specific basis (Ashton et al. , 1994). It may be particularly useful to consider outcome and process measures together, as an integrated approach would offer a more complete assessment of quality and elucidate the pathways by which market forces affect patient outcomes. Observed agreement between process and outcome measures at the provider level would support the construct validity of each measure. Disagreement would suggest: (1) information bias attributable to misclassification on either measure; (2) confounding of outcome measures due to unmeasured severity of illness; (3) selection bias due to selective enrollment or dropout of high-risk patients; or (4) an incorrect conceptual model, based on an assumed process-outcome linkage that does not actually exist Competition in Medical Services and the Quality of Care: Concepts and History MARK V. PAULY Consumers of medical services care about both the price they pay (directly, or indirectly through insurance) for that care and the quality of the care for which they pay. While both an unambiguous measurement of quality and the process by which quality is produced are in many ways unknown, it is surely possible for producers, consumers, and regulators to detect and analyze large (enough) variations in relevant qualitative characteristics. Sometimes, in some places, and with some providers, quality is higher than at other times, places, and providers. To some extent the final level of quality is (from an analyst’s perspective) going to be random; some quality variation is bound to be due to unknown forces and accidents. However, to some extent as well the supplier decisions which affect quality are explicit and rational, and likewise the consumer choices about which provider or which supplier to use depends on perceived quality. Economically Efficient (Optimal) Quality From an economist’s perspective, â€Å"quality† in its most general sense just means anything and everything about some good or service relevant to consumers’ (actual and perceived) well being that is not measured by quantity. Since the definition of quantity is somewhat arbitrary—for hospitalization for example, is it the number of hospital admissions, the number of hospital days, or some amalgam of inpatient services and outpatient services? the definition of quality will depend on how we define quantity. If we define quantity by surgical admissions, then average length of stay would be one dimension of quality, prevalence of wound infections would be another, and patient satisfaction would be a third. Th ere can also be qualities that do not have this ordering—for example, the color of the walls, the temperature of the room, or even the length of stay—but these factors are usually not very important. It is focus on â€Å"ordered† qualities. However, just because people prefer more of some characteristic to less does not necessarily mean (or even usually mean) that the market will or should â€Å"maximize quality† in that dimension. If we think of some unequivocally-ordered characteristic, from an economic viewpoint the optimal level of quality, given some total quantity, is that level at which the marginal benefit from additional quality (measured in money) just equals the marginal cost of adding to quality. The optimal length of stay is not infinite, the optimal amount of space in a patient’s room is not enormous, the optimal number of medical errors is not zero (though it could be much lower than at present). Of course, it is possible, indeed, likely, that optimal quality will be different at different quantities (quality and quantity can be substitutes or complements). It is certain that the optimal level of quality, given quantity, will be different for different people, depending on the value they attach to quality. The â€Å"right† quality depends on the patient as well as on the illness or procedure, and it depends on the patient’s preferences (backed up by ability to pay) as well as on the patient’s physiological state. A more complex question is the optimal variety of quality levels when people have different preferences but it is too costly to produce a different quality level for each person. This definition of optimal quality when applied to medical services certainly includes everything that would be embodied in a clinical definition of quality. However, there are some differences between the economic and what we might call the â€Å"health services research† perspective. One difference is that the economic definition will probably include more features (that consumers happen to care about but clinicians do not). One can think of cases in which consumer preferences about such things as â€Å"travel time,† â€Å"bedside manner,† â€Å"respect,† and â€Å"discomfort† do become important. The other difference is that the economic definition will probably require a more careful consideration of marginal cost relative to marginal benefit than would be embodied in the clinical view of â€Å"ideal quality. † 2. Quality Options with Inefficient Suppliers: A Diagrammatic Analysis Although the foregoing seems fairly basic, there are some aspects of the normative notion of optimal quality that may be controversial in both health policy and health services research, and some aspects of the positive aspects of market supply that are both confusing and contentious. A key issue for much of the literature is that of the existence of tradeoffs. The previous discussion implicitly assumed that higher quality costs more—that cost (which really just represents an index of the sacrifice of all other goods consumers value) and quality trade off. Yet many observers of medical care markets in the United States have the strong opinion that cost and quality don’t usually trade off—that higher quality implies lower cost or that it is at least an open question (Leatherman et al. ,2003). Improving the Service Quality of Distance Education( Rui-Ting Huang,USA / Taiwan) states that the success of a distance learning program is dependent on the quality of supporting services. This research relates to services, gaps in service, business models, continuous quality improvement, and maintaining a competitive edge. Distance Learning has become an important learning option for education systems (Yilmaz, 2005) and training solutions in the Human Resource Development (HRD) area (Felix, 2006). The growth of the distance learning industry has been faster than expected (Huynh, Umesh & Valacich, 2003). Most importantly, in terms of organizational training, an investigation from the Fortune-500 companies indicates that over 80% of companies use distance learning or plan to do so (Hammond, 2001). Through distance learning, organizations have a more convenient, practical and cost-effective way to train the employees (Hammond, 2001; Whitney, 2006; David, 2006). Due to the growth and competition in the distance learning market (Huynh, Umesh & Valacich, 2003), DL research includes the study f consumer aspects such as consumer services and satisfaction (Shaik, 2005; Granitz & Greene, 2003; Huynh, Umesh & Valacich, 2003). Feedback from learner give the instructor important data to determine how well the instr uctional program satisfies individual learner needs (Steyn & Schulze, 2003; Long, Tricker, Rangecroft, Gilroy, 1999). This in turn offers service providers in the marketplace important information to streamline the business process to improve the quality of distance learning services (Granitz & Greene, 2003; Steyn & Schulze, 2003). Quality services and support will help the service providers, institutions and organizations in DL get a competitive advantage in the marketplace (Shaik, 2005). As the distance learning industry has become mature in the educational marketplace (Huynh, Umesh & Valacich, 2003), it is providing learners with convenient and flexible learning alternatives (Alexander, 1999; Tarr, 1998). It is also giving organizations alternative cost-effective and timely training solution to effectively and efficiently implement the human resource development plans (Hammond, 2001; Whitney, 2006; David, 2006). ). The focus on consumer service may offer the service providers new insights (Moisio & Smeds, 2004) to help them streamline the business process, improve the quality of future service in distance learning (Granitz & Greene, 2003; Steyn & Schulze, 2003) and gain long-term competitive advantages (Shaik, 2005). Mary Nugent ( 2002, vice president and general manager of Subscription Services for BMC Software Inc. a leading provider of enterprise management)said that an increasing number of companies are relying on service providers to manage their mission-critic al applications, service providers are realizing that they need an improved method for consistently delivering reliable and highly available service at a competitive cost. Measuring the performance and availability of Web and enterprise applications is inherently difficult. Without accurate and timely measurements it is all but impossible to measure customer satisfaction and Quality of Service (QoS). Due to the cost of developing and implementing such a solution, service providers are finding they need to partner with others in the marketplace to ensure service level agreements (SLAs) are being met and the end-user experience is optimized. A quality end-user experience is what service provider clients require service providers must deliver in order to survive. Online shoppers are not tied by brand loyalty since they can get what they need at many different sites. Companies that want to achieve customer loyalty must deliver value through the customer experience. By outsourcing to service providers for this expertise, companies are entrusting their business and reputation on the solutions they offer. This makes it doubly important that service providers choose solutions that deliver on their SLAs. Principles Of Quality Customer Service 1. Quality Service Standards -Publish a statement that outlines the nature and quality of service which customers can expect, and display it prominently at the point of service delivery. 2. Equality/Diversity -Ensure the rights to equal treatment established by equality legislation, and accommodate diversity, so as to contribute to equality for the groups covered by the equality legislation (under the grounds of gender, marital status, family status, sexual orientation, religious belief, age, disability, race and membership of the Traveller Community). Identify and work to eliminate barriers to access to services for people experiencing poverty and social exclusion, and for those facing geographic barriers to services. 3. Physical Access -Provide clean, accessible public offices that ensure privacy, comply with occupational and safety standards and, as part of this, facilitate access for people with disabilities and others with specific needs. 4. Information -Take a proactive approach in providing information that is clear, timely and accurate, is available at all points of contact, and meets the requirements of people with specific needs. Ensure that the potential offered by Information Technology is fully availed of and that the information available on public service websites follows the guidelines on web publication. Continue the drive for simplification of rules, regulations, forms, information leaflets and procedures. 5. Timeliness and Courtesy -Deliver quality services with courtesy, sensitivity and the minimum delay, fostering a climate of mutual respect between provider and customer. Give contact names in all communications to ensure ease of ongoing transactions. 6. Complaints -Maintain a well-publicised, accessible, transparent and simple-to-use system of dealing with complaints about the quality of service provided. 7. Appeals -Similarly, maintain a formalised, well-publicised, accessible, transparent and simple-to-use system of appeal/review for customers who are dissatisfied with decisions in relation to services. 8. Consultation and Evaluation -Provide a structured approach to meaningful consultation with, and participation by, the customer in relation to the development, delivery and review of services. Ensure meaningful evaluation of service delivery. 9. Choice -Provide choice, where feasible, in service delivery including payment methods, location of contact points, opening hours and delivery times. Use available and emerging technologies to ensure maximum access and choice, and quality of delivery. 10. Internal Customer -Ensure staff are recognised as internal customers and that they are properly supported and consulted with regard to service delivery issues. Performance measurement In Health care, the patients’ satisfaction has been widely used as a critical dependent variable to evaluate success of the service provider. The patient is one of the important stakeholders in the health care arena (Yeung, 2001; Yang & Cornelious, 2004). And it is reasonable that the patients’ perception will be considered as a crucial indicator to evaluate the quality of service(Steyn & Schulze, 2003). In the business area, consumer satisfaction often denotes whether the service provider met the consumers’ need (Steyn, & Schulze, 2003). Anderson, Fornell and Lehman (1994) propose there are at least two viewpoints in the definition of consumer satisfaction. The first viewpoint is a transaction-specific perspective, which refers to the consumers’ post-purchase appraisal or judgment of the products or service based on expectations at the specific purchasing time or location. The second viewpoint is cumulative satisfaction, which refers to consumers’ overall appraisal of purchasing and consuming experience toward the products or service. Therefore, we may regard patients’ satisfaction as the patients’ overall post-use evaluation toward the health care service. Performance measurement is a fundamental building block of TQM and a total quality organisation. Historically, organisations have always measured performance in some way through the financial performance, be this success by profit or failure through liquidation. However, they do not map process performance and improvements seen by the customer. In a successful total quality organisation, performance will be measured by the improvements seen by the customer as well as by the results delivered to other stakeholders, such as the shareholders. A simple performance measurement framework includes more than just measuring, but also defining and understanding metrics, collecting and analysing data, then prioritising and taking improvement actions. It is important to know where the strengths and weaknesses of the organisation lie, and measurement plays a key role in quality and productivity improvement activities. The main reasons it is needed are: to ensure customer requirements have been met, to be able to set sensible objectives and comply with them, to provide standards for establishing comparisons, to provide visibility and a â€Å"scoreboard† for people to monitor their own performance level, to highlight quality problems and determine areas for priority attention,to provide feedback for driving the improvement effort Quality-related activities that will incur costs may be split into prevention costs, appraisal costs and failure costs. Prevention costs are associated with the design, implementation and maintenance of the TQM system. They are planned and incurred before actual operation, and could include: Product or service requirements – setting specifications for incoming materials, processes, finished Products/services;Quality planning – creation of plans for quality, reliability, operational, production, inspection; Quality assurance – creation and maintenance of the quality system; Training – development, preparation and maintenance of programmes. Appraisal costs are associated with the suppliers’ and customers’ evaluation of purchased materials, processes, products and services to ensure they conform to specifications. They could include: Verification – checking of incoming material, process set-up, products against agreed specifications; Quality audits – check that the quality system is functioning correctly; Vendor rating – assessment and approval of suppliers, for products and services. Failure costs can be split into those resulting from internal and external failure. Internal failure costs occur when the results of work fail to reach designed quality standards and are detected before they are transferred to the customer. They could include: Waste – doing unnecessary work or holding stocks as a result of errors, poor organisation or communication; Scrap – defective product or material that cannot be repaired, used or sold; Rework or rectification – the correction of defective material or errors; Failure analysis – activity required to establish the causes of internal product or service failure. External failure costs occur when the products or services fail to reach design quality standards, but are not detected until after transfer to the customer. They could include: Repairs and servicing – of returned products or those in the field; Warranty claims – failed product that are replaced or services re-performed under a guarantee; Complaints – all work and costs associated with handling and servicing customers’ complaints; Returns – handling and investigation of rejected or recalled products, including transport costs Effective quality improvements should result in a future stream of benefits, such as: †¢ Reduced failure costs †¢ Lower appraisal costs †¢ Increased market share †¢ Increased customer base †¢ More productive workforce Service Quality Management (SQM) Service quality can be defined as â€Å"the collective effect of service performances which determine the degree of satisfaction of a user of the service†. In other words, quality is the customer’s perception of a delivered service. Service-quality management, refers to the monitoring and maintenance of end-to-end services for specific customers or classes of customers. As larger varieties of services are offered to customers, the impact of network performance on the quality of service will be more complex. It is vital that service engineers identify network-performance issues that impact customer service. They also must quantify revenue lost due to service degradation. The service-mapping tool comes in next. Performance data is mapped onto service-quality data. Take a customer using Multimedia Messaging Services, or MMS. If a video download is interrupted many times during a session, the customer will lose interest. The operator’s revenue will be lost with it. To avoid this situation, key quality indicators (KQIs) like availability can monitor the QoS offered to customers. From a customer’s point of view, the availability KQI measures how successfully he or she can access and use the MMS service. With the service mapping tool, it’s possible to combine KQIs from multiple key performance indicators (KPIs) across different service resources. KPIs measure a specific aspect of the performance of either a service resource or a group of service resources of the same type. A KPI is restricted to a specific resource type and derived from network measurements. By following this top-down approach, the service-mapping tool provides several benefits. It helps operators manage end-to-end quality of service from a customer’s perspective. It also allows them to reuse key performance indicators and key quality indicators across services and products. Lastly, it helps operators drill down to the service elements that are responsible for quality degradations. Service quality also demands a simple and easy-to-use user interface. With this interface, Network Operations Center (NOC) staff and service managers can monitor service-quality objectives against thresholds. These thresholds may be internal targets for the network operator. Or they could be derived from Service Level Agreement (SLA) definitions. When the service quality falls below the contracted levels, managers could then initiate corrective actions. They could focus on the service degradations that affect the greatest number of customers. A set of standard reports for different user communities should also be available. For new services, marketing and sales may be interested in reports on service usage and service uptake. National regulators may also request historical service quality against given service objectives. CHAPTER 3 METHODOLOGY Cooper and Emory (1995) defined research as a systematic inquiry aimed at providing information to solve problem. This chapter will present a detailed idea about how the research will be conducted. In this chapter research methodology, the sample selection methods, data collection methods & data extraction from the Questionnaire and data analysis will be studied and explained. At the end of this chapter validity and reliability issues will be discussed to follow the quality standards of the research. Research strategy will be a general plan of how researcher will go about answering the research questions that has been set by researcher. It will contain clear objectives, derived from research questions specify the sources from which researcher intend to collect data and consider the constraints that researcher will inevitably have such as access to data, time, location and money, ethical issues. (Thornhill et. al. , 2003) Based on three conditions 1) form of research question 2) requires control over behavioral events and 3) focus on contemporary events Yin (1994) identified five research strategies in social science. These are – experiments, surveys, archival analysis, histories and case studies Most important condition for selecting research strategy is to identify the type of research question being asked. â€Å"Who†, â€Å"What†, â€Å"Where†, â€Å"how† and â€Å"Why† are the categorization scheme for the types of research questions. Two possibilities need to investigate by asking the â€Å"what† question. First, some types of what questions are justifiable for conducting an exploratory study and the goal is to develop pertinent hypotheses and propositions for further inquiry. Any of the five research strategies can be used in that situation- exploratory survey, exploratory experiment, or an exploratory case study. The second type of what question is actually form a â€Å"how many† or â€Å" how much† line of inquiry and the outcomes from a particular situation. The survey or archival analysis is more favorable than other strategies. If the researcher needs to know the â€Å"how† question, the better strategy will be doing history or a case study. (Yin 1994) Research Purpose Research can be classified in terms of their purpose. Accordingly, they are most often classified as exploratory, descriptive or explanatory (Saunders, Lewis & Thornhill 2003). Exploratory research is useful when the research questions are vague or when there is little theory available to guide predictions. At times, researcher may find it impossible to formulate a basic statement of the research problem. Exploratory research is used to develop a better understanding (Hair, Babin, Money & Samouel 2003). Exploratory studies are a valuable means of finding out what is happening, to seek new insight, to ask questions and to assess phenomena in a new light. It is particularly useful if researcher wish to clarify the understanding of a problem. There are three principle ways of conducting exploratory research: a search of the literature, talking to experts in the subject, conducting focus group interviews (Saunders, Lewis & Thornhill 2003). Descriptive research describes some situation. Generally things are described by providing measures of an event or activity. Descriptive research designs are usually structured and specifically designed to measure the characteristics described in a research question. Hypotheses, derived from the theory, usually serve to guide the process and provide a list of what needs to be measured (Hair, Babin, Money & Samouel 2003). The object of descriptive research is to portray an accurate profile of persons, events of situations. It is necessary to have a clear picture of the phenomena on which researcher wish to collect data prior to the collection of the data (Saunders, Lewis & Thornhill 2003). Explanatory Research establishes causal relationships between variables. The emphasis here is on studying a situation or a problem on order to explain the relationship between variables (Saunders, Lewis & Thornhill 2003). Explanatory studies are designed to test whether one event causes another (Hair, Babin, Money & Samouel 2003). The purpose of the research is mainly descriptive and explanatory. It is descriptive because descriptive data has been collected through detailed interviews and it is also explanatory since we will explain the relationship between the service quality variables and customer satisfaction and how these dimensions affect customer satisfaction. It is somewhat exploratory nature since Data Collection Method Data was collected by primary as well as by secondary data c