Organizational Analysis Essay Example | Topics and Well Written Essays - 1500 words - 2

Organizational Analysis - Essay Example The company’s growth focus spread to women’s, men’s and children’s wear with time. According to finance.yahoo.com (2013), Nordstrom is today a leader in fashion and with specialized retailer service for shoes, apparel, accessories and cosmetics for women, children and men. Nordstrom operations are carried out in two segments namely Retail and credit. The retail segment is known for services in brand selection and commodities of private label. Conversely, the credit segment operates the organization’s federal savings bank which offers a credit card of the private label form, two Nordstrom credit cards of Visa form, and a debit card (Reuters, 2013). 1.1.2. What Nordstrom Inc. does Nordstrom is well established as a leading high-end attire trade corporation whose revenue is derived from the trade of premium quality shoes, clothing, accessories and cosmetics (Laughlin et al., 2006). Through these numerous retail channels, Nordstrom offers to its client- base a variety of private label commodities and trademark names whose main attention is inclined towards shoes, accessories, cosmetics and apparel (Reuters, 2013). 1.1.3. ... Customers are also served through a loyalty program that is based on shopping and that features Nordstrom credit and debit cards. A fashion reward program is also offered to Nordstrom card holders where points are accumulated depending on the amount of spending for 2,000 points, a twenty thousand dollars reward is issued to the customer in form of Nordstrom notes redeemable from Nordstrom stores or online (Reuters, 2013). 1.1.4. Size Finance.yahoo.com (2013) reveals that Nordstrom has a total of 61,000 full time employees led by various executives, officers and a board of members. Incorporated in 1946, Nordstrom is today a specialty retail leader owning about 245 stores in 31 of American States and is still in the process of expanding to other states and internationally (finance.yahoo.com, 2013). The company’s retail sector also has 124 Nordstrom Rack Stores and 117 recognized packed line stores. 2.0. Nordstrom mission and the role of HR in fostering the mission statement 2.0. 1. Nordstrom mission statement While operating through the Nordstrom retail stores, upscale shoppers are attracted and provided with nothing less than quality customer service and stylish experience (Team2misnordstrom, 2012). Nordstrom Rack appeals to bargain-conscious customers serving through discount stores. The operation of Nordstrom is in line with its mission of providing unique services daily and ensuring customers are served satisfactorily. Nordstrom also operates under informed decision making to best meet the interests of the customers and the interests of employees by embracing the richness of its workforce diversity (Team2misnordstrom, 2012). 2.0.2. HR’s role in fostering Nordstrom’s mission statement Human resource managers have the responsibility of building the overall

A Report on the High Cost of College Education in America Essay

A Report on the High Cost of College Education in America - Essay Example 9 October, 10, 2011. Dr. Morgan Bill Joint University students’ union Washington, CO 456007 Dear Mr. Houston: The union is submitting this report, due October, 10, 2011, that was requested by the education ministry. The report is entitled the High cost of College Education in America. The purpose of the report is to inform the stake holders in the education sector on the high cost of college tuition in America which has become a source of discouragement for students who would like to have a high level of Education. It further emphasizes on the need work on the lowering of the cost of college tuition. The content of this report centers on the price of college education which is not equivalent to future salaries and is not worth all loans and credits acquired to fund education. Any questions concerning this report can be sought by contacting Mr. Morgan Bill, the union secretary, at 453-6897. Very truly yours, Morgan Bill, Secretary General. Executive summary The cost of college education in America has over years increasingly gone too high. High tuition fee charges in colleges is now proving to be the biggest problem facing college students, parents and sponsors. In this hard economic time, students and parents are now struggling a lot sourcing for funds to meet this high cost of tuition fee. This has ranged from sourcing school loans from banks and including selling of property assets to fund education. This trend has negatively impacted on the concerned parties to an extent where students have almost lost hope for a better future. One very strong negative impact that has so far been noticed is the discouragement it has had on the students undertaking various courses in various universities. It is quite clear from studies conducted by this team that on completion of college education individuals who graduate hardly get well-paying jobs that match the cost incurred while in college. Moreover, a greater percentage of the little money earned from these jobs end up being used to repay the loans that were borrowed during school days leaving a minimal percentage for investment. This therefore renders a larger population of the newly employed and young hustling for their entire life. From these insights it is therefore paramount to consider the cry of the large young population and consider a thorough review of the entire fee payment systems in colleges with intent of lowering its cost for the benefit of the future generation. Methodology A sampled group of about 40 students from sampled universities and colleges in the United States of America were interviewed with a view of getting background information from the affected groups. Similarly, various employees who had just completed training was sampled and interviewed. The method selected aimed at collecting data that will enable the researchers identify the problem and propose potential solutions. Findings The cost of college tuition for many colleges has over time become so expensive. T he price for college studies has neither equated the future salary of those taking the courses nor has it equal the loans and many credits being spent on tuition fees. It is therefore imperative to present this report as a means of passing a message of discontent and outcry facing parents and students who pay dearly to get valuable education (Heller, 2001). The biggest problem for millions of people living in America while joining a college or university is

Rail Transport Track

Rail Transport Track SLOVENIAN RAILORADS Rail transport Is the transport of passengers and goods along railways or railroads. A railway can be broken down into two major components. Basically these are the items which move, the locomotives, passenger carrying vehicles (coaches), freight carrying vehicles (goods wagons / freight cars) and those which are fixed, usually referred to as its infrastructure. This category includes the permanent way (tracks) and buildings (stations, freight facilities, viaducts and tunnels). The operation of the railway is through a system of control, originally by mechanical means, nowadays, in most places, electronic and computerised. The volume of traffic on the line dictates the number of tracks required for its operation. These consist of short stretches of double track which allow trains to pass each another. Alternatively, and particularly on freight lines, there may be longer sections of the line that are double track. These sections must be able to accommodate the longest train which normally works on t hat line. Effective traffic control is carried out by a token system. where only one token is available for each single line section. Originally this token was physically exchanged between signalman and driver, later by mechanical means using a device on the locomotive cab side whilst nowadays this system has largely been replaced by an electronic system. The development path of Slovenske Ã… ¾eleznice leads us past old Austria, which Slovenia formed part of until 1918, when Slovenians could witness the start and flourishing of railways in their country. Therefore, the table unavoidably contains major events from the histories of both Austrian and Slovenian railways. Infrastructure Transport corridors Because of political and economical co-operation between European countries after 1990, the need emerged to design a trans-European transport network including all types of transport and to join all European countries by 2010. In railway transport, the network is composed of ten trans-European corridors: 5th corridor and 10th corridor Types of railway track Railway tracks are divided into main and local tracks. They are also divided by the number of tracks. One of them are one-track rails (trains use the same track for both directions) and the others are two-track rails (each track is used for train traffic in a certain direction. Superlatives and statistic dates In terms of the length of the lines and its infrastructure, it is difficult to compare Slovenian railroad with other railway in Europe. However, given Slovenias geographical variety our lines involve some interesting information. Some of those are: The steepest line is from PrvaÄ ina to Ã…  tanjel, the highest railway station is 582 above see level and the lowest is in Koper only 3 m above see level. The longest bridge is in Novo mesto (575 m). The highest bridge is in Most na SoÄ i which is 30 m high. The oldest line is form Ã…  entilj to Celje which was bild on 2 June 1846. Some statistics dates for Slovenian railway: The length of all lines of railway is 1228,6 km. There number of viaducts and culverts is 3.181 and there length is 13,1 km. There are also 93 tunnels and galleries and there length together is 37,3 km. In Slovenia we also have 128 stations, 11 of them are only for freight transport, 10 for passenger transport and 107 for combined transport. International transport In Slovenia passenger transportation is not as important as cargo transportation. That is especially because the trains in Slovenia are slow, uncomfortable, and quite old. Luka Koper is a very important factor for railways and the international transport in Slovenia. Cargo arrives to Slovenia by see and in the harbor it is unloaded of ships and it continues its way mostly by railways to countries like: Austria, Slovakia, Hungary,†¦ In Slovenia the biggest percent of passengers represent the students. And that is especially because of their economical condition. But in many countries across the Europe the trains travel with speeds up to 300 km/hour, are much more punctual, comfortable and also cheep. Slovenia has a direct railway connection with some of those countries. From Ljubljana it is possible to travel to some of European countries. TICKETS AND DISCOUNTS There are a lot of different kinds of tickets and discounts. Different companies give discount to different passengers. Mostly yang people to the age 26 have discounts, and also children and elderly. Some railway companies give discount also to larger groups. SLEEPING CARS AND COUCHETTES Because travelling abroad usually means that journeys will be long, passengers have a possibility to decide for sleeping cars or couchettes. Usually that is possible if the departure is at night. The advantage for travelling with night trains is that you are well-rested, because you are able to get some sleep. Night trains are very convenient if you travel from one city to a another city and you have a byssi schedule. TRANSPORTING CARS AND ANIMALS Cars and bicycles can be transported to trains, but only on certain stations, and at certain time. Cars must not be to high or to heavy. Reservations for cars must be made early enough, and you must be there early enough to load the vehicles. Animals can also be transported, but only smaller animals. The owners are fully responsible for their pet. But the animal must not disturb other passengers. Inland transport 1. DISCOUNTS: Special discounts have children and youth, the elderly and pensioners, families, bigger groups, groups of young people, groups of children,†¦ 2. TYPES OF TICKETS; One way: They sell one-way tickets for all types of trains, for all days of the week, up to two months in advance. Return: They sell return tickets for all types of trains, for all days of the week, up to two months in advance. School: For primary school pupils, secondary school pupils, apprentices and students of college and university programmes, for daily journeys from the place of ones residence to the place of schooling or of performing obligatory practice, and back. Semi-annual, Annual and Monthly: All passengers can buy tickets, whereas student tickets are reserved for pupils, students and apprentices upon submitting the appropriate evidence (certificate or application). Flat rate: For those wishing to travel on all lines of Slovenske Ã… ¾eleznice on all types of trains, first or second class. Slovenian Rail Pass: Slovenian Rail Pass is valid for an unlimited number of journies in Slovenia within 3, 4, 5, 6, 7 or 8 successive days. It is intended for  persons, who do not live in Slovenia. 3. WAGON OR TRAIN RENTAL-it is possible to rent special wagons attached to regular trains or even an entire special train. A special wagon must be ordered at least 8 days in advance and a special train at least 15 days in advance. 4. TRAIN AND BUS Combined Train Bus Ticket Combined train bus tickets (weekly and monthly tickets), in co-operation between Slovenian Railways and KAM-BUS since 1996, are available for the Ljubljana-Kamnik line.

Dinosaur Extinction Essay examples -- essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  A number of different theories have been assessed throughout the course of this research to attempt to reach a conclusion as to the reason behind the extinction of the Tyrannosaurus Rex. Although all arguments are credible, and supportive with educated information and data, the most conclusive theory of all is The Alvarez Asteroid Impact theory.   Ã‚  Ã‚  Ã‚  Ã‚  Alvarez, a researcher at the University of California, discovered a pencil thin layer of Iridium around the rocks in Gubbio, Italy. (New Scientist, 1) Iridium is an element found in meteorites and asteroids. In 1980 it was proven that the layer if Iridium was evidence of a huge comet or meteorite that crashed into the earth sixty five million years ago. The normal amount of Iridium an area is to have is 0.001 on an average. The layer of Iridium found in Gubbio Italy was 0.003. Thirty times the average amount in parts per million. (New Scientist, 1) The theory of the Alvarez Asteroid states that the strength of this comet is at 10,000 times the explosive power of the global nuclear arsenal. The Alvarez Asteroid theory is the leading explanation as to why the amazing dinosaur creatures died millions of years ago, along with many other animals of the Earth's Crustaceous Period.   Ã‚  Ã‚  Ã‚  Ã‚  The extinction of the Tyrannosaurus Rex was obviously due to the same reason. Every other living species was killed sixty five million years ago. Although it is believed that the asteroid theory is the cause of extinction of the Crustaceous Period, we cannot be positive. The environmental effects of this problem were that the dinosaurs living during this period perished from the earth and their extinction remains a mystery to us to this day. All we can do to reenact what happened is use the technology we have in the twenty first century to find more evidence to see what went wrong so long ago. By discovering things like what happened to the Tyrannosaurus Rex we can use this information to prevent an event such as a mass extinction from happening a second time.   Ã‚  Ã‚  Ã‚  Ã‚  Although it is impossible to rewrite history, we still have to be careful to prevent a catastrophe like the asteroid said to have hit the earth sixty five million years ago. If there is ever a scare of an asteroid as big as the Alvarez Asteroid, one way of preventin... ...d at least seven tons and were over forty feet long. The T-Rex was the largest meat-eating dinosaur. The teeth of the T-Rex are thick and sharp for the killing of its prey. The T-Rex was also very fast; in fact it could outrun any species of dinosaur if it was hungry enough. Scientists have also found that the Tyrannosaurus was also very smart, it would outwit any prey if it needed a snack, even the Gigantosaurus the only dinosaur that is bigger than the T-Rex wasn't smarter than the king. (Highlights, 22)   Ã‚  Ã‚  Ã‚  Ã‚  The Tyrannosaurus Rex was a very smart and interesting dinosaur and it is unfortunate that we will never be able to see one. The extinction of dinosaurs was brought on by the Alvarez Theory. It is great to know what actually happened to them now, and also know how to prevent such an occurrence from happening again. If our country uses the technology it has available it will be possible to find out more about the mass extinction of the Crustaceous Period. As the years pass technology becomes more advanced and we will eventually know everything there is to know about what happened sixty five million years ago.   Ã‚  Ã‚  Ã‚  Ã‚  

Wembley vs Emirates Football Stadiums

Construction of Wembley stadium was supposed to be completed by May 2006, but completed in March 2007. There were several controversial between client, contractor, sub contractor, designer etc. and some cases end up in the court. The causes for these controversial were identified mainly due to adversarial contracts, unreasonable risk allocation, cash-flow problems, design changes, poor performance, poor site management and litigations.Several reasons were adduced for the successful delivery of the Emirates football stadium but the most overarching and notable of the reasons was the effective and selective supply chain created by the main contractor (Exceptional Performer, 2007). In both case studies one can clearly see good and bad practices demonstrated. While both cased had the same procurement routes, with only slight modifications to allow client to have greater input in design, they both had different outcomes. In all respects the Emirates Stadium is surely the winner as the mos t successfully executed project of the two.In both cases there were many challenges as well but it is how they were met with that determined their fate. The Wembley Stadium case was clearly a disaster in planning, financing and execution. This may be attributed to the lack of knowledge and experience on the part of the contractor, Mutliplex about the UK construction industry, which is why they possibly formed a consortium with Bovis in the beginning. Due to lack of a firm establishment in the UK industry, Multiplex was faced with much distrust from locally well established firms.The fact that so many disputes arose in terms of payments and court proceedings did not help much either. The Emirates Stadium on the other hand was a perfect example of best practice. They incorporated sustainability, collaborative working, and effective and selective supply chain management. The supply chain was a crucial ingredient that Sir Robert McAlpine had established through experience in the UK indu stry while working with various subcontractors and forming strong ties with them. This strong ties and trust between contractor and subcontractors was lacking in the Wembley case.However, contractors alone are not to bare the blame the construction clients have a role in the success of a project as well. In the Wembley case the construction client mismanaged money by expending too much in investigations and reviews. They also pointlessly hired management consultants and did not heed their advice. Therefore, the client’s attitude towards contractor selection is imperative and can lead to project failure if not done properly. This was the case in the Wembley Stadium where the Australian contractor was rushed into agreement.In the end collaborative working and an effective supply chain coupled with a proper decision making client are vital ingredients for a project to be executed effectively and efficiently. From the literature review found that, projects suited to GMP had the f ollowing characteristics; †¢ Cost certainty was a primary objective †¢ Time was a primary objective †¢ The scope was fully defined †¢ The project was simple †¢ It was a development project †¢ The parties had previous experience in GMP contracts †¢ There was a good team based relationship between the parties †¢ The personalities were appropriate (fair, reasonable and empathetic)

Portrait of the Artist as Filipino Scene I

So far, A Portrait of the Artist as Filipino has been a story about the lives of the Marasigan sisters, Candida and Paula, and their father Don Lorenzo, a well known painter. The story is centered around Don Lorenzo's latest creation, a rather disturbing painting of Aeneas carrying Anchises on his back as they flee from the sacked and burning city of Troy. The painting is a self portrait of Don Lorenzo's younger self carrying his present self, and seems to leave everyone who has gazed upon it a touch unsettled, including the two sisters, who blame the painting for their misfortunes and for their impoverished state.In spite of the fact that the sisters are in need of money for the up keep of themselves and the house, they refuse to sell it for two thousand dollars and dont seem to want to get rid of it for any price at all or even to have it placed on a gallery for display. They have thus far in the story refused to be parted from it, even though they look to it with contempt. The fac t that they do not wish to sell it under their current situation perplexes me.Why not just get rid of it for the substantial amount of money offered by Tony's employer who is willing to pay two thousand dollars for it? If they really are indeed so desperately poor, that they waste their time looking through news paper articles for jobs, taking in strange men to live with them for fifteen pesos a month, and coming up with strange ideas. They could have gotten the money, kicked that Tony character out and lived in a state of dignity once again for a little while before they all died in Intramuros.In the first scene Candida even says something like â€Å"What's the use in having a talent when you cant make any money out of it? † Well, there you go, Don Lorenzo produced something worth two grand, why not make money out of that? Pair of crazy dames indeed. The fact that the painting brings out different reactions in people is very interesting. Others would be ready to throw it in the trash, and for the rest, it's worth a fortune. Some are afraid of it, and it takes people back to their past. Most of the reactions seem to be on a negative side, which is interesting.What is it about the double self portrait of Don Lorenzo that seems to unsettle everyone so much, and why is it called A Portrait of the Artist as Filipino? There's apparently nothing Filipino about it, except for Don Lorenzo, who in the painting is portraying himself as characters from Greek and Roman epics. I can't help but guess at the meaning of his terrible creation, and think that the painting is about a great burden, the burden being Don Lorenzo himself. He paints those eyes with such mastery that everyone in the room, and even beyond it feels the weight of its silent glare. Portrait of the Artist as Filipino Scene I So far, A Portrait of the Artist as Filipino has been a story about the lives of the Marasigan sisters, Candida and Paula, and their father Don Lorenzo, a well known painter. The story is centered around Don Lorenzo's latest creation, a rather disturbing painting of Aeneas carrying Anchises on his back as they flee from the sacked and burning city of Troy. The painting is a self portrait of Don Lorenzo's younger self carrying his present self, and seems to leave everyone who has gazed upon it a touch unsettled, including the two sisters, who blame the painting for their misfortunes and for their impoverished state.In spite of the fact that the sisters are in need of money for the up keep of themselves and the house, they refuse to sell it for two thousand dollars and dont seem to want to get rid of it for any price at all or even to have it placed on a gallery for display. They have thus far in the story refused to be parted from it, even though they look to it with contempt. The fac t that they do not wish to sell it under their current situation perplexes me.Why not just get rid of it for the substantial amount of money offered by Tony's employer who is willing to pay two thousand dollars for it? If they really are indeed so desperately poor, that they waste their time looking through news paper articles for jobs, taking in strange men to live with them for fifteen pesos a month, and coming up with strange ideas. They could have gotten the money, kicked that Tony character out and lived in a state of dignity once again for a little while before they all died in Intramuros.In the first scene Candida even says something like â€Å"What's the use in having a talent when you cant make any money out of it? † Well, there you go, Don Lorenzo produced something worth two grand, why not make money out of that? Pair of crazy dames indeed. The fact that the painting brings out different reactions in people is very interesting. Others would be ready to throw it in the trash, and for the rest, it's worth a fortune. Some are afraid of it, and it takes people back to their past. Most of the reactions seem to be on a negative side, which is interesting.What is it about the double self portrait of Don Lorenzo that seems to unsettle everyone so much, and why is it called A Portrait of the Artist as Filipino? There's apparently nothing Filipino about it, except for Don Lorenzo, who in the painting is portraying himself as characters from Greek and Roman epics. I can't help but guess at the meaning of his terrible creation, and think that the painting is about a great burden, the burden being Don Lorenzo himself. He paints those eyes with such mastery that everyone in the room, and even beyond it feels the weight of its silent glare.

jazz in America

Ever since the beginnings of jazz in America at the turn of the twentieth century jazz was a music form that northerners were not exposed to because slavery, for the most part, took place in the south. And that is where jazz in America came from, the slaves. The focal point for jazz in the states became and remained New Orleans for the first part of the 1900s. This remained unchanged for about 20 years. But because Chicago was such a big stop for most of the traveling shows that originated in New Orleans the music started to move at a rapid pace. And Marshall Stearns specifically stated the hypothetical peak of jazz intensity shifted from New Orleans to Chicago sometime before 1920(Ostransky 63). And as I will discuss later, through a phenomenon known as the Harlem Renaissance, New York became another hub for the jazz culture. Because Chicago was an important center for railroad and shipping it attracted many transients and travelers (Ostransky 63). Many of these people were musicians, particularly piano players. As these people arrived in Chicago they realized that a hint of ragtime was there already. As a matter of fact it may have been introduced there as early as 1893 at The Worlds Fair (Ostransky, 67). At there fair it was thought that professors had introduced the music style and it formed a pretty good foundation. In 1906, Tony Jackson came to Chicago and about two years later Jelly Roll Morton arrived. The two continued to build the foundation that had been started at the fair. The two performed at popular nightspots and it was said by Eileen Southern: because of their efforts Chicago became the center of ragtime playing that St. Louis had been a decade earlier(Ostransky, 63). Another big contributing factor was that as mentioned before, New Orleans was an important starting point for many traveling shows. But a lot of these traveling shows ended in Chicago. The city was also a ...

The Silence of the Cellphone essays

The Silence of the Cellphone essays During the recent decade our society underwent many different changes. It became more advanced in different types of fields. The cellular telephone is now engrained in our everyday lives as useful and convenient tool. However, society debates whether the use of the cellphones should be controlled and should cellphone silencers be used. The answer is no. Cellphone silencers should not be legalized by the federal government because their use will cause denial of rights of freedom, unnecessary expenses as well as unanswered emergency calls. But what is a cellular phone silencer? It is a device, also known as "Radio jamming device", that sends out an electronic signal to disable a phone from ringing. The jammers are illegal in Canada, except for use by law-enforcement and public-safety officials, but might be popular for operators of restaurants, theatres and other large public-gathering places. However, widespread marketing of this technology will be dangerous and an infringement on citizen's needs and abilities to communicate in sometimes very critical situations. Cellphones have become vital tools in today's world and blocking them in public places will result in a gross violation of personal freedom. Their use has become such an important part of urban citizens' daily lives that it will have a huge impact on the society if cellphones are banned from public places where they are not threatening the well being of others. Our Charter of Rights and Freedoms states that we have the right to freedom of expression wherever we please. By legalizing silencers, we are limiting this right of freedom to choose and communicate. The cellphone allows people to have some degree of independence to leave home and still be assured to receive "the call". However, it should not be used as a tool to control and limit the freedom and right of Canadians. In other words, the implantation of silencers will, in ...

Introduction to Bipedal Locomotion

Introduction to Bipedal Locomotion Bipedal locomotion refers to walking on two legs in an upright position, and the only animal to do that all the time is the modern human. Our ancestor primates lived in trees and rarely set foot on the ground; our ancestor hominins moved out of those trees and lived primarily in the savannas. Walking upright all the time is thought to have been an evolutionary step forward if you will, and one of the hallmarks of being human. Scholars have often argued that walking erect is an enormous advantage. Walking erect improves communication, allows visual access to farther distances, and changes throwing behaviors. By walking upright, a hominins hands are freed to do all sorts of things, from holding babies to making stone tools to throwing weapons. American neuroscientist Robert Provine has argued that sustained voiced laughter, a trait which greatly facilitates social interactions, is only possible in bipeds because the respiration system is freed to do that in an upright position. Evidence for Bipedal Locomotion There are four main ways scholars have used to figure out whether a particular ancient hominin is primarily living in the trees or walking upright: ancient skeletal foot construction, other bone configurations above the foot, footprints of those hominins, and dietary evidence from stable isotopes. The best of these, of course, is foot construction: unfortunately, ancient ancestral bones are difficult to find under any circumstances, and foot bones are very rare indeed. Foot structures associated with bipedal locomotion include a plantar rigidity- flat foot- which means the sole stays flat from step to step. Secondly, hominins that walk on the earth generally have shorter toes than hominins who live in trees. Much of this was learned from the discovery of a nearly complete Ardipithecus ramidus, an ancestor of ours who apparently walked upright sometimes, some 4.4 million years ago. Skeletal constructions above the feet are slightly more common, and scholars have looked at the configurations of the spine, the tilt, and structure of the pelvis, and the way the femur fits into the pelvis to make assumptions about a hominins ability to walk upright. Footprints and Diet Footprints are also rare, but when they are found in a sequence, they hold evidence that reflects the gait, length of stride, and weight transfer during walking. Footprint sites include Laetoli in Tanzania (3.5-3.8 million years ago, probably Australopithecus afarensis; Ileret (1.5 million years ago) and GaJi10 in Kenya, both likely Homo erectus; the Devils Footprints in Italy, H. heidelbergensis about 345,000 years ago; and Langebaan Lagoon in South Africa, early modern humans, 117,000 years ago. Finally, a case has been made that diet infers environment: if a particular hominin ate a lot of grasses rather than fruit from trees, it is likely the hominin lived primarily in grassed savannas. That can be determined through stable isotope analysis. Earliest Bipedalism So far, the earliest known bipedal locomotor was Ardipithecus ramidus, who sometimes- but not always- walked on two legs 4.4 million years ago. Fulltime bipedalism is currently thought to have been achieved by Australopithecus, the type fossil of which is the famous Lucy, approximately 3.5 million years ago. Biologists have argued that foot and ankle bones changed when our primate ancestors came down from the trees, and that after that evolutionary step, we lost the facility to regularly climb trees without the aid of tools or support systems. However, a 2012 study by human evolutionary biologist Vivek Venkataraman and colleagues points out that there are some modern humans who do regularly and quite successfully climb tall trees, in pursuit of honey, fruit, and game. Climbing Trees and Bipedal Locomotion Venkataraman and his colleagues investigated behaviors and anatomical leg structures of two modern-day groups in Uganda: the Twa hunter-gatherers and Bakiga agriculturalists, who have coexisted in Uganda for several centuries. The scholars filmed the Twa climbing trees and used movie stills to capture and measure how much their feet flexed while tree-climbing. They found that although the bony structure of the feet is identical in both groups, there is a difference in the flexibility and length of soft tissue fibers in the feet of people who could climb trees with ease compared with those who cannot. The flexibility that allows people to climb trees only involves soft tissue, not the bones themselves. Venkataraman and colleagues caution that the foot and ankle construction of Australopithecus, for example, does not rule out tree-climbing, even though it does allow upright bipedal locomotion.   Sources Been, Ella, et al. Morphology and Function of the Lumbar Spine of the Kebara 2 Neandertal. American Journal of Physical Anthropology 142.4 (2010): 549-57. Print. Crompton, Robin H., et al. Human-Like External Function of the Foot, and Fully Upright Gait, Confirmed in the 3.66 Million Year Old Laetoli Hominin Footprints by Topographic Statistics, Experimental Footprint-Formation and Computer Simulation. Journal of The Royal Society Interface 9.69 (2012): 707-19. Print. DeSilva, Jeremy M., and Zachary J. Throckmorton. Lucys Flat Feet: The Relationship between the Ankle and Rearfoot Arching in Early Hominins. PLoS ONE 5.12 (2011): e14432. Print. Haeusler, Martin, Regula Schiess, and Thomas Boeni. New Vertebral and Rib Material Point to Modern Bauplan of the Nariokotome Homo Erectus Skeleton. Journal of Human Evolution 61.5 (2011): 575-82. Print. Harcourt-Smith, William E. H. Origin of Bipedal Locomotion. Handbook of Paleoanthropology. Eds. Henke, Winfried, and Ian Tattersall. Berlin, Heidelberg: Springer Berlin Heidelberg, 2015. 1919-59. Print. Huseynov, Alik, et al. Developmental Evidence for Obstetric Adaptation of the Human Female Pelvis. Proceedings of the National Academy of Sciences 113.19 (2016): 5227-32. Print. Lipfert, Susanne W., et al. A Model-Experiment Comparison of System Dynamics for Human Walking and Running. Journal of Theoretical Biology 292.Supplement C (2012): 11-17. Print. Mitteroecker, Philipp, and Barbara Fischer. Adult Pelvic Shape Change Is an Evolutionary Side Effect. Proceedings of the National Academy of Sciences 113.26 (2016): E3596-E96. Print. Provine, Robert R. Laughter as an Approach to Vocal Evolution: The Bipedal Theory. Psychonomic Bulletin Review 24.1 (2017): 238-44. Print. Raichlen, David A., et al. Laetoli Footprints Preserve Earliest Direct Evidence of Human-Like Bipedal Biomechanics. PLoS ONE 5.3 (2010): e9769. Print. Venkataraman, Vivek V., Thomas S. Kraft, and Nathaniel J. Dominy. Tree Climbing and Human Evolution. Proceedings of the National Academy of Sciences (2012). Print. Ward, Carol V., William H. Kimbel, and Donald C. Johanson. Complete Fourth Metatarsal Andarches in the Foot of Australopithecus Afarensis. Science 331 (2011): 750-53. Print. Winder, Isabelle C., et al. Complex Topography and Human Evolution: The Missing Link. Antiquity 87 (2013): 333-49. Print.

Innovation and Technology Management in Apple Inc Essay

Innovation and Technology Management in Apple Inc - Essay Example Apple is fully geared to take advantage of these developments. While making radical product innovations, Apple takes the pain in quickly updating and adding incremental changes while taking feedback from the customers. At Apple, ‘Time is Essence’ while developing and launching new products in quick succession. Innovative culture has percolated downwards extensively in Apples all processes and activities. Apple takes extreme precautions in creating patents for its technology products to prevent competition taking undue advantage. Apple is equally conscious in developing its human capital. ‘Apple University’ is the brainchild of Steve Jobs to continue with the same spirit of innovations in future that Apple is known for. Apple has been consistently scoring the top place on the American Consumer Satisfaction Index (ACSI) for the last several years among all technology companies; the brand Apple has become synonymous to innovative ideas, designs and products. Apple Inc. is US-based consumers electronics company with headquarter in Cupertino, California. The company designs manufacture and sells software and hardware products such as iMac, iPod, iPhone, iPad, iTunes. Apple notched worldwide sales of $182 billion in the year ended October 30, 2014. By market capitalization (shareholders worth), Apple occupies a top place among technology companies for the last several years. Apple employs over 72000 full-time employees worldwide and operates over 425 retail stores across the world. The company is known for its innovation in design, and product development creating one of the most satisfying user experiences. The above mission statement from Steve Jobs was created when the company was in its early phase and when a great many products had not taken any shape. However, in later years, Steve Jobs proved what he meant.

Realist Theories of IR Essay Example | Topics and Well Written Essays - 500 words

Realist Theories of IR - Essay Example The strong point of this view is the accommodation of the element of conflict that exists even within an individual. Human nature is constantly waging war against itself with the desires of a person mostly conflicting with outside influences such as learning. A political realist is holistic in thought because of the acknowledgement of the existence and relevance of standards other than the political ones. The political realist refutes the â€Å"legalistic moralistic approach† to international politics and cannot subordinate standards of other schools of thought to those of politics. The realists vehemently defend the autonomy of the political sphere against its subversion by other modes of thought without disregarding their existence and importance (Morgenthau 14). Kenneth Waltz also had a realist perspective to international relations which he called neorealism or structural or defensive realism. This theorist used the turmoil inherent in international relations to restrict the global â€Å"net† to its classical international component (Waltz 29). From the neorealist approach examination of the structures of international systems is the best way to understand international politics. The structures of the international system are reflected alliances and other cooperative arrangements between nations (Mearsheimer 32). The polarity of the system becomes the key factor in international relations; and depending on the number of dominant superpowers, a system might be unipolar bipolar or multipolar. John Measheimer took a different view which he referred to as â€Å"offensive realism†. Measheimer’s perspective follows on the principles of Kenneth Waltz’s theory to utilize the â€Å"structure† of the international system to derive the behavior of states (Mearsheimer 25). The theoretical foundation of Measheimer outlines that: the international system in anarchic, all

Public Cultural Event Research Paper Example | Topics and Well Written Essays - 2000 words

Public Cultural Event - Research Paper Example I cannot call Dubai a developing country because as soon as you arrive at the airport, the terminal is exactly like the ones you will find back in the States. Honestly, it is even better than back home. I was new here, but they were used to seeing 'aliens' like me all the time, which is why I was not given a second glance. For me, these Arabs were strangely beautiful to look at, with their gleaming white 'gowns' and turban-like headgear. I was truly in a modern desert with crystal clear glass for a terminal roof. I was greeted by a man who touched my nose with his, which honestly speaking, greatly alarmed me at first, but apparently that is how everyone here greets one another as it is a part of their culture. As I had arrived just days before the Dubai Shopping Festival officially began, the airport was lit with banners showing the symbol of the festival; a red and green shopping bag with a family drawn on it. Names, dates and venues of various shows were also advertised with bright pictures on these banners; Dubai was certainly proud of its famous cultural festival and wasted no space to inform visitors of what fun they would be experiencing in the upcoming days. I was driven to a hotel that really matches the likes of those back in States, the hotel I was to stay at could have really given The Trump Towers a run round the windmill. On the way to the hotel, I kept clicking away at the skyscrapers looming above; Dubai can easily be called New York 2.0 or maybe even 3.0. All along the road the streets were brightened with streetlights linked with trails of red, green and white lighting; the official colors of this festival. Seeing them gave me butterflies, making me realize how badly I was anticipating the famous Dubai Shopping Festival. Yes, this festival that everyone kept talking about back home was the only reason I was here. A festival of color, lights and people from all around the world, it truly is a cultural phenomenon. As a travel enthusiast this was a must see for me and I had been planning to visit since it first began. At the hotel I was greeted by the manager himself, who was so pleased at having a western national lodge at his hotel; they really respect the West and its inhabitants in this city. The view from my room was something I could have only dreamed off; the whole city was lit up. Dubai, during this festival, really looked like something out of an episode of Star Trek minus the floating cars. This hotel was really growing on to me and I was already thinking about apartment shopping, which would be no problem at all thanks to the amazing deals and bargains this festival offers to shoppers throughout its month long fiesta. The Dubai Shopping Festival kicks off with a stunning display of fireworks, illuminating the night sky and the city with hundreds of breathtaking colors and designs and leaving all the watchers awe-struck. These spectacular fireworks brighten up the city every night throughout the duration of the fes tival, but are especially electrifying on the opening and closing nights of the

The Milgram experiment Essay Example | Topics and Well Written Essays - 500 words

The Milgram experiment - Essay Example This particular aspect also contravenes ethical principal A: Beneficence and Nonmaleficence ("Ethical Principles", 2003). However it should be commended that when offering payment of $4.50 an hour, the participants were told that they would receive the payment whether or not they completed the experiment, this was the most ethical thing to do as then payment wouldn't be the motivator of the participants actions. Looking at all the facts given above, it can be argued that the researchers should have been honest with the participants about the nature of the experiment being a study in obedience and not that of memory and learning and that the experimenter should have reminded the participant/teacher that they are free to leave at anytime, instead of using verbal prods to ensure they continue with the experiment. While this is correct we should keep in mind that the experiment results would not have been accurate if the above suggestions were followed even though it may have made the experiment more ethical.

Felony Criminal Charge Procedure Term Paper Example | Topics and Well Written Essays - 2000 words

Felony Criminal Charge Procedure - Term Paper Example This essay will be focussed on the criminal procedures stages that are common among the two level of government in bringing felony suspects to justice. It will make an in-depth discussion of the process right from the initial stage of the investigation until sentence of the case is determined (Moak & Carlson, 2012). A criminal case is essentially one that an individual is accused of causing harm or destruction to the general society through one or more of his actions. They usually take two forms either misdemeanour or felony charges (McCord, McCord, & Bailey, 2012). A misdemeanour is a less serious case and thus magistrate judges handle it. Often it is punishable by a fine of less than one year imprisonment in jail. On the other hand, felonies are perceived to be more grievous cases that require more attention. They are usually handled by district judges in district courts. These crimes are punishable of incarceration in state correction centres (Champion, 1988). A felony charge is committed when an individual acts in a manner that contravenes the state or federal laws thus causing harm or destruction to the general public. A suspect of a felony charge may be arrested depending on the scenario (Moak & Carlson, 2012). First an individual can be arrested by police responding to a reported crime if he/she around the crime scene where the incidence has been reported, alternatively after a crime has been reported police will commence investigations to determine the perpetrators. In the process of piecing together the available evidence an individual may be implicated by either the fingerprints, which were found at the scene of the crime, DNA samples found at the crime scene or CCTV footage of the premise where the crime occurred. In the first scenario the suspect is arrested, the police officer responsible for the arrest signs a sworn affidavit and complaint sheet that

How has the Zapatista Army of National Liberation contributed to Research Paper

How has the Zapatista Army of National Liberation contributed to Democracy in Mexico - Research Paper Example They started out as a small group of progressive Indians which eventually grew into thousands. They organized themselves in the jungle, away from the prying eyes of the government and its ruthless military. The EZLN’s history did not happen overnight. It was the product of careful and clandestine planning and organizing. â€Å"We did that for many years, and we did it in secret, without making a stir.   In other words, we joined forces in silence.3† After ten years of organizing and training in the jungles of Chiapas, The Ejercito Zapatista de Liberacion or EZLN was born, otherwise known as the Zapatista Army of National Liberation. They took the name of Emiliano Zapata, a Mexican Revolution hero who championed land reform in Mexico and is also celebrated as the champion of the indigenous people in Southern Mexico.4 EZLN is a revolutionary group that adheres to the ideals of non-violence. Throughout their history, the only instance of violence on record is the 12 days of armed fighting following the January 1, 1994 takeover of four municipalities in Chiapas, namely, San Cristobal de las Casas, las Margaritas, Altamiro, and Ocosingo.5 Almost apologetic to the affected citizens and civilians, they put great emphasis on their declaration that the armed struggle was a measure of last resort because their previous nonviolent actions received little to no government attention and response.6 After 12 days of armed fighting and bloodshed on both sides, the Mexican government and the Zapatista entered into a ceasefire to make way for a peace process. Since then, the EZLN have successfully continued on the fight without shedding blood, combatant or civilians although they have continued with their member’s training in the handling of weapons and arsenals. Nevertheless, the Zapatista is still a military movement. Oxymoron as it may sound, but the Zapatista is an armed movement that carries its struggle in nonviolent ways.7 In the very same way that the EZLN seem to contradict itself on its position on the issues of violence and rebellion, their ideology is also a subject of debate. This confusion is brought by the lack of a categorical statement from the Zapatistas themselves as to their specific ideology. Their enumeration of goals and demands which could be identified with the ideals and ends sought by groups from both ends, including those in between of the political spectrum does little to no help either. In their various declarations, they merely refer to themselves as the â€Å"simple and humble† â€Å"Zapatistas of the EZLN.†8 On the one hand, there are some who observes that the EZLN rose out of the ranks of the leftist movements that espouse Marxist-Leninist ideals. It is argued that their demands enumerated in the First Declaration of the Lancandon Jungle are in accord with the leftist sentiments. The EZLN’s demands include "work, land, housing, food, health, education, independence, liberty, dem ocracy, justice, and

Felony Criminal Charge Procedure Term Paper Example | Topics and Well Written Essays - 2000 words

Felony Criminal Charge Procedure - Term Paper Example This essay will be focussed on the criminal procedures stages that are common among the two level of government in bringing felony suspects to justice. It will make an in-depth discussion of the process right from the initial stage of the investigation until sentence of the case is determined (Moak & Carlson, 2012). A criminal case is essentially one that an individual is accused of causing harm or destruction to the general society through one or more of his actions. They usually take two forms either misdemeanour or felony charges (McCord, McCord, & Bailey, 2012). A misdemeanour is a less serious case and thus magistrate judges handle it. Often it is punishable by a fine of less than one year imprisonment in jail. On the other hand, felonies are perceived to be more grievous cases that require more attention. They are usually handled by district judges in district courts. These crimes are punishable of incarceration in state correction centres (Champion, 1988). A felony charge is committed when an individual acts in a manner that contravenes the state or federal laws thus causing harm or destruction to the general public. A suspect of a felony charge may be arrested depending on the scenario (Moak & Carlson, 2012). First an individual can be arrested by police responding to a reported crime if he/she around the crime scene where the incidence has been reported, alternatively after a crime has been reported police will commence investigations to determine the perpetrators. In the process of piecing together the available evidence an individual may be implicated by either the fingerprints, which were found at the scene of the crime, DNA samples found at the crime scene or CCTV footage of the premise where the crime occurred. In the first scenario the suspect is arrested, the police officer responsible for the arrest signs a sworn affidavit and complaint sheet that

GNU Public License and its Role Essay Example for Free

GNU Public License and its Role Essay The LINUX software and other products are restricted with a License or patents to keep individual from altering or modifying the software. Developers usually release their software programs the way they think it best suit the potential business owner or users. The General Public License (GNU) role is to ensure when new software is released that it remains free to everyone to use as they please. The GNU role is to remove any software that has no source code. The parts that do not contain a source code are called binary blob and firmware generally redistributable, do not give the user the freedom to modify or study them. General Public License know as (GNU) General Public License was created by Richard M. Stallman in 1970 when he was a programmer at MIT’s Artificial Intelligence lab. The General Public License (GNU/ GPL) is a copy left license for software and other kinds of work that are free to the public The General Public License is the most popular free and open source software (FOSS) license today. According to Ronald free software and open source are often interchangeably used (and the respective movements share many common goals (2006). The General Public License purpose is to guarantee individual or developers the freedom to share and alter any version of a program to ensure it remains free and available to every individual. The General Public License is used by the Free Software Foundation( FSF), for most of their software programs; it also applies to other work made public by the author. Free software refer to political movement while open source refer to software development method ology. When talking about free software program it is speaking of freedom not an amount of money. The General Public License were created to assure that people have the freedom to hand out copies of software and make a profit for  them if you desire. When an individual receive a source code the GNU allow the individual to change the software or use part of it in newer free programs and know you can do these things. The GNU protects individual right with two steps that are assert copyright of the software and offers license that gives legal permission to copy, distribute, or modify it. The GNU monitor individual that want to go in a different direction. This means that contrast, individuals, groups an or organization offers software and other work to the public with access for modification and distribution. LINUX type across the computer world was changed by individuals across the computer world and when this was done the changes made it more efficient. The role of GNU is to allow individu al to run a program for any purpose and also personalize each one as their own. . Reference Ronald J. Mann, Commercializing Open Source Software: Do Property Right Still Matter?, 20 HARV. J. LAW TECH. 1, 11 (2006) Tsai, J. (2008). FOR BETTER OR WORSE: INTRODUCING THE GNU GENERAL PUBLIC LICENSE VERSION 3. Berkeley Technology Law Journal, 23(1), 547-581

Health Information and Communication Systems in Ireland

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