Mental Illness among Homeless in London Borough of Tower Hamlet

Abstract: The aim of the essay plan at hand was to outline the mental health issues that are being faced by the homeless population in the UK, with specific references to the borough of Tower Hamlets. The plan covered the main contextual factors and determinants of the urban health issue, the main implications and public consequences of the issue in both the City of London in general and the UK, and offered an outline for the critique of current interventions to combat the issue. The plan concluded with speculated recommendations and conclusions for the extended essay. 1 Introduction London, United Kingdom is host to over 10,000 homeless members of society with common afflictions including mental illness, drug and alcohol issues and health concerns (Story et al, 2007). This number of specific homeless far exceeds other national indigent populations making it unique throughout the UK. Alongside the establishment of pervasive symptoms among the population rests the requirement of continuous evaluation of caregivers in order to maintain proper public support structures. The borough of Tower Hamlets has been identified as an area of historic and on-going homelessness as it is a highly deprived area of East London. Deprivation and severe poverty has been identified as one of the most significant determinants of physical and mental health (NHS Tower Hamlets Clinical Commissioning Group, 2013). Combined with a lack of public or private methods of remedy, many homeless have no feasible alternative to living in the streets. In accord, Tower Hamlets has a soaring prevalenc e of these determining factors, which encourage the development of mental health problems among the afflicted population. Further, poor living conditions have the potential to add to the stress experienced by some individuals, which in turn leads to a form of sickness (NHS Tower Hamlets Clinical Commissioning Group, 2013). As a result of this evaluation, homelessness has been identified as a significant aspect of poor mental health in this borough (NHS Tower Hamlets Clinical Commissioning Group, 2013). It has been suggested that mental health issues may actually be a leading factor in the onset of homelessness, where the stresses of homelessness further exacerbate existing psychological issues. At every level of assessment surrounding the mental health of the indigent population of Tower Hamlets, there is a continuous need to re-evaluate and adjust policy in order to address the rising concerns. 2 Rationales Epidemiological data shows that common mental health problems such as anxiety and depression have been found to be over twice as high, and psychosis has been found to be fifty to one hundred times more prevalent in the homeless (Bassuk et al, 1986). This illustrates the clear need to identify the factors that drive these persons to these stages. Further, with such a high number needing sustained medical attention in order to move away from the homeless issue, there is the perception of public burden, which adds to the need to find an effective method of addressing the issue (Wright, 2014). The lack of adequate research in this area of mental stability and determinants reveals the shallow depths of current knowledge, requiring the undertaking of modern reviews in order to accurately assess the next step. Another key rationale is the need to address common social issues including drug and alcohol abuse in the homeless (Dunne et al, 2013). Whether as a result of being homeless or the co nsequence of abuse, drugs and alcohol dependency are established factors that are common throughout the indigent population (Wright, 2014). This commonality has been wrongly cited as the prevalent determinant in the homeless condition, with many persons not finding the drugs or alcohol until after experiencing the loss of becoming homeless (Wright, 2014). Yet, the prevalence of alcohol and drug abuse has been found to be widespread within the homeless community (Fazel et al, 2008) thus the essay will aim to shed light upon this aspect of substance abuse as among the largest contributing factors to homelessness. This focus on elements that are considered determinant in the creation of the homeless population will enable a relevant series of recommendations that are aimed at reducing the phenomenon. Further, this essay also aims to provide further insight to how the statistics were found to be markedly higher in the borough of Tower Hamlets than the proportion across other London boro ughs all together than the proportion across other London boroughs all together (NHS Tower Hamlets, 2011). With a defined rise in the factors impacting the homeless in this area, it becomes essential to identify the primary components. Alongside the benefit that the local population will derive from this exercise will be the potential for this experience to translate into other social areas that will assist in developing long term solutions to pressing issues. In order to fully explore the goals of this essay; gender, ethnicity and the age aspect of homelessness will be discussed, as there are marked differences between genders and races in regard to the issues faced in homelessness (Wright, 2014). As with each outside element including financial standing and health, the disparity between the sexes in the homeless population requires investigation. For example, single men between the ages of 25-44 have been identified as the most common demographic group associated with homelessness (Hwang, 2001), yet children have also been found at a high risk of facing homelessness, accompanied by a high risk of developing mental health issues (Tischler et al, 2002). While the presence of the homeless conditions in these two demographics may withstand scrutiny, the question of how this condition arose creates the opportunity to avoid it. Further, with a sustained outreach to those in peril of becoming homeless before the fact, there is opportunity for developing past the hardship, making this study crucial (Buckman et al, 2013). In order to properly assess the societal position and expectations of the homeless, this essay will assess what is considered among the highest concerns among members of this population (Iversen et al, 2011). Despite the contention that specific determinants play a role in the indigent condition, others argue that it is the perception of adverse social conditions on the part of the person that serve to keep the person in the homeless state. With correlations among the indigent and common belief such as the desire for work and affordable housing, there are foundations for building a path to a more sustainable form of living for many currently in the homeless condition (Fitzpatrick et al, 2013). This is an indication of the importance of considering not only the external conditions associated with the homeless, mental health and drug abuse, but there must be a corresponding effort to address the internal perceptions held by these individuals. The situation for those living rough is int ensified when substance misuse is co-morbidly present with existing mental health problems (Rees, 2009). This combination of conditions is credited with sustaining the homeless condition, making the opportunity to rise above the stage complex and unlikely (Dunne et al, 2012). It is the perception of lack prospects and potential that is credited with keeping many individuals in the indigent state. Among the homeless male versus the general public, there is a higher association with illnesses including schizophrenia by a 50% v 34%, personality disorders 37% v. 11%, substance dependence issues 74%5 v. 19% further increasing the need to study and identify the specific factors surrounding this ratio (Dunne et al, 2012). These statistics indicate the much of the mental disorders are amplified in conjunction with the homeless population which raises another area of concern; where the individuals afflicted as result of becoming homeless or did they become homeless as a result of becoming il lThis critical consideration will add to the assessment of determinants and the manner in which they work to keep the indigent population on the rise (Wright, 2014). In accord, the essay aims to discuss how the borough of Tower Hamlets has been identified as having the highest mental health needs in the UK, with over 45% of the population of the borough claiming incapacity benefit due to their ill mental health. This very high rate indicates the presence of a set of conditions that are expected to be identifiable, adding to the appeal of this study. As the literature confirms that mental illness is a significant urban health issue accompanied by crucial repercussions such as homelessness, the essay will aim to highlight the ways in which this issue relates to the London borough of Tower Hamlets. As the results are directly relevant to those in the Tower Hamlets, many other indigent populations exhibit similar conditions, which this study will assist to illuminate. 3 Urban Context and Determinants The literature surrounding homelessness and mental health indicates that factors in the urban context play a major role in the development of this urban health issue (Fitzpatrick et al, 2012). This is an indication that this area of research is not only necessary but vital to the effort to sustain and improve the state of the homeless population. Determinants such as poverty, exclusion, attainment and wellbeing all hold significant implications for homelessness (Frankish, Hwang & Quantz, 2005). Elements that are cited to aid in the determination homeless population causation include the lack of general or low strata employment opportunities (Fitzpatricket al, 2013). This perception of no means to find work is compounded by ill health and the absence of health care. As those in the poorer classes fall sick, there is a trend to allow this sickness to become overriding, thereby adding to the detrimental factors surrounding a persons living situation (Dawson et al, 2013). Outside social factors can have distinct impact on the determinants surrounding the homeless populations. With natural disasters and war placing many of these individuals in the homeless situations due to associated factors, there is a need to quantify each new social influence in order to minimize the harmful impact. Feeding directly into the homeless epidemic and the mentally unstable is the common lack of disability services that will have the resources to aid them (Wright, 2014). This scenario of inadequate infrastructure only adds support to the contention that each new determinant in the homeless cycle increases the likelihood that the person will not be able to escape the condition. With evidence supporting the position that it becomes harder to function in day to day society the longer a person remains indigent, there is a clear and present time factor that must be added to the determinants of the homeless (Wright, 2014). Additional factors such as difficulties in maintaining secure and good quality accommodation due to mental illness will also be discussed in the essay as contributors to homelessness (Breaky, 1992). Determinants to the homeless condition have been attributed to the high rate of substance abuse and addiction among the indigent population (Wright, 2014). This is an indicati on that there is truth to the argument that many people choose their addictions over a place to live comfortably. Further, this very aspect is magnified by the lack of affordable, quality housing in many areas (Buckman et al, 2013). With no avenue to find a roof, the drive to work towards making their life better has a trend of stalling as these determinant continue to hold the person back. This essay endeavours to shed light on recent changes to government policy, such as reforms in welfare support and social housing, the recession, and government cuts to public services in the UK had impacted those who were most vulnerable to homelessness. Each shift in public policy and perception has the potential to add or detract from the living situation of the indigent population (Wright, 2014). Yet, in many cases, available opportunities are overlooked due to the fact that the persons in question have no means to become acquainted with the policies. Individuals with mental health problems h ave faced considerable difficulties due to these changes such as understanding when they need to claim the benefits, how the new benefits work, and uncertainty about how the changes will affect their circumstances (Wright, 2014). Many times, the very complex nature of the policy or regulation diminishes the effectiveness of the intent by reducing access. As a further example of this issue raising modern concern, in some cases, individuals may also face difficulty getting access to, and using a computer to claim their benefits online (Dawson et al, 2013). These common issues that highlight the high risk of the mentally ill facing homelessness due to financial hardship and provide a possible explanation as to why there is such a high degree of mental illness among the homeless. Due to the fact that registration to a GP generally requires proof of a home address, homeless people are more likely to access healthcare through emergency services (Crisis & MORI, 2002). This creates many iss ues including access, payment, sustained care and exacerbated social expense. Further, this poses problems on both the individual and the general population as the individual may not receive the health advice and respect that they deserve for reasons such as the emergency department only being intended for emergency health conditions, and due to social stigma around homelessness; such as the homeless may be associated with mental ill health, substance abuse and lack of hygiene (Riley, Harding, Underwood & Carter, 2003). It is a common trend among the homeless to face a lack of insurance and the unwillingness to visit the doctor aside from the direst of circumstance. These factors have been cited as contributors of poor physical and psychological wellbeing which the homeless individual faces when trying to access public health care, which only serve to compound the homeless condition (Wright, 2014). In many cases social pressure to avoid using the medical services, serves to drive th e homeless even further from finding quality care, only serve to further add to the issue. A final determinant to be discussed in this essay is the cost of this urban health issue faced by the National health services, which in turn is passed on to the larger national population (Dunne et al, 2012). In many cases the variance of social support has changed alongside the political views of the ruling establishment. This condition causes many fits and starts to any existing system, which in turn serve to slow down both effective outreach and long-term strategy. Cost has the potential to become an overbearing feature of any policy creation effort (Dunne et al, 2012). In some cases the zeal to reduce the public budget for these issues is weighed against the need to devote time and resources to this part of the population (Fitzpatrick et al, 2013). With a common lack of representation among the law makers, the lower classes have often suffered the lack of finance and social support that is required to implement any effective strategy. Modern evidence shows that mental illness fo r the NHS is costly as it is the largest cause of disability in the UK. Social and informal care for the mentally ill is costing ?22.5 billion, where 13.8% of the national budget is spent on mental health (National Mental Health, 2012). This is a defining motivation for lawmakers on any side of the aisle to find a method of addressing the issue. Statistics also show that ?77 billion a year was being spent on welfare benefits for mental illnesses in 2009 (National Mental Health, 2012). This is a trend of rising cost that will only be reversed through study and relevant and considered implement of infrastructure. The lack of a coordinated strategy to reduce the homeless issue only creates a potential for the issue to become intractable and even harder to combat (Wright, 2014). The impact of these costs on the national economy was damaging, increasing national debts thus affecting the general population through increases in tax, public services, and as previously mentioned, cuts to nat ional healthcare (National Mental Health, 2012). This issue touches each person in society in a direct manner, meaning that with the easing of homeless condition there will be a corresponding easing of social pressure of the whole of society. Therefore it is necessary for these determinants to be discussed as contributing factors to the urban health issue. 4 Conclusions and Recommendations The aim of this paper is to critique strategies such as the Tower Hamlets Homelessness Statement 2013 to 2017, the Homelessness Act and other interventions that tackle homelessness and mental illness as separate entities (Crisis, 2009). This review of material will create the opportunity to identify strengths and weaknesses in the approaches that could in turn be amended. Further, this review will provide a basis for long term strategy based on the continuous need to refine public policy in order to reduce the burden on society as a whole (Wright, 2014). Yet, in every case the solution must be both ethical and motivated by the desire to enhance the homeless population’s potential to achieve stability. The recommendations that will evolve as a result of this study will involve coordinated treatment programs (Coldwell & Bender, 2007) such as Assertive Community Treatment (ACT), which aim to serve psychiatric outpatients whose mental illness causes serious functioning difficulties in aspects of life including work, social relationships, residential independence, money management, and physical health and wellness, all of which can have an impact on housing status (Dixon, 2000). Other possible avenues designed to create options including community housing initiatives, political action through policy reform, enhancing current infrastructure such as Habitat for Humanity and the National Coalition for the Homeless. This consideration of a wide range of evidence creates a variety of opportunities to explore and address the issues facing the modern homeless population (Iversen et al, 2011). It is expected that this study will conclude that the ACT is an effective measure in combating the co re issues which lead to and maintain homelessness, and aim to recommend that government funding should be utilised to promote programs such as ACT which will make lasting changes in the homeless community. Further, there is an expectation that there will be a combination of past and prior factors that have contributed to the homeless population and that it will require a well-rounded intervention method in order to provide better prospects. In the end, the base goal of this essay is to provide potential paths for further research which will in turn work to alleviate the dismal conditions associated with the indigent condition. 4 References Bassuk, E.L., Rubin, L. & Lauriat. A.S. (1986). Characteristics of sheltered homeless families. American Journal of Public Health. 76(9). 1097-1101. Breaky, W.R. (1992). Mental Health Services for Homeless People. pp101-107. Cited in: Homelessness: A National Perspective. Eds. Robertson, M.J. & Greenblatt, M. (1992). Buckman, J., Forbes, H., Clayton, T., Jones, M., Jones, N., Greenberg, N., Sundin, J., Hull, L., Wessely, S. and Fear, N. (2013). Early Service leavers: a study of the factors associated with premature separation from the UK Armed Forces and the mental health of those that leave early. The European Journal of Public Health, 23(3), pp.410–415.Coldwell, C.M. & Bender, W.S. (2007). The Effectiveness of Assertive Community Treatment for Homeless Populations With Severe Mental Illness: A Meta-Analysis. Am J Psychiatry. 164(3). 393-399.Communities and Local Government. (2009). Rough Sleeping England – Total Street Count. Retrieved from: http://webarchive.nationalarchives.gov.uk/20120919132719/http://www.communities.gov.uk/publications/corporate/statistics/roughsleeping2009 Accessed: 17th February 2014 Crisis & MORI. (2002). Critical condition: Homeless people’s access to GPs. London. Dawson, A., Jackson, D. and Cleary, M. (2013). Mothering on the margins: Homeless women with an SUD and complex mental health co-morbidities. Issues in mental health nursing, 34(4), pp.288–293. Dixon, L. (2000). Assertive community treatment: Twenty-five years of cold. Psychiatric Services, 51, 759-765. Dunne, E., Duggan, M. and O’Mahony, J. (2012). Mental health services for homeless: patient profile and factors associated with suicide and homicide. Mental health. Fazel, S; Khosla, V; Doll, H; Geddes, J (2008). â€Å"The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis†. PLoS Med 5 (12). doi:10.1371/journal.pmed.0050225 Fitzpatrick, S., Bramley, G. and Johnsen, S. (2013). Pathways into multiple exclusion homelessness in seven UK cities. Urban Studies, 50(1), pp.148–168. Frankish, C.J., Hwang, S.W. & Quantz, D. (2005). Homelessness and Health in Canada. Canadian Journal of Public Health. 2(96). 23-29. Hwang, S.W. (2001). Homelessness and health. CMAJ. 164(2). 229–233. Iversen, A., van Staden, L., Hughes, J., Greenberg, N., Hotopf, M., Rona, R., Thornicroft, G., National Mental Health. (2012). Development Unit. Factfile 3. The costs of mental ill health. Retrieved from: http://www.nmhdu.org.uk/silo/files/nmhdu-factfile-3.pdf Accessed: 16th February 2014 NHS Tower Hamlets. (2011). Homelessness: Factsheet. Tower Hamlets Joint Strategic Needs Assessment 2010 ­2011 . Retrieved from: http://www.towerhamlets.gov.uk/idoc.ashx?docid=f8390127-f61d-491b-8323-cea75d92a228&version=1. Accessed: 16th February 2014 Riley, A.J., Harding, G., Underwood, M.R., Carter, Y.H. (2003). Homelessness: a problem for primary careBritish Journal of General Practice. 473-479. Tischler, V., Vostanis, P., Bellerby, T. & Cumella, S. (2002). Evaluation of a mental health outreach service for homeless families. Arch Dis Child. 86. 158–163. Tower Hamlets Clinical Commissioning Group. (August 2013). Mental Health Joint Strategic Needs Assessment for Tower Hamlets. Tower Hamlets Health and Wellbeing Board. Tower Hamlets Homelessness Statement. (2013). 2013 to 2017 Consultation Draft. Retrieved from: http://www.towerhamlets.gov.uk/lgsl/851900/868_housing_strategy_and_polic/homelessness_strategy.aspx Accessed: 17th February 2014 Rees, S. (2009). Mental Ill Health in the Adult Single Homeless Population: A review of the literature. Crisis, PHRU. Retrieved from: http://www.crisis.org.uk/data/files/publications/Mental%20health%20literature%20review.pdf. Accessed: 16th February 2014 Story, A., Murad, S., Roberts, W., Verheyen, M. & Hayward, A.C. (2007). Tuberculosis in London: the importance of homelessness, problem drug use and prison. Thorax. 62(8). 667-671. Wessely, S. and Fear, N. (2011). The stigma of mental health problems and other barriers to care in the UK Armed Forces. BMC health services research, 11(1), p.31. Wright, J. (2014). Health needs of the homeless. InnovAiT: Education and inspiration for general practice, 7(2), pp.91–98. Mental Illness Among Homeless In London Borough Of Tower Hamlet Abstract: The aim of the essay plan at hand was to outline the mental health issues that are being faced by the homeless population in the UK, with specific references to the borough of Tower Hamlets. The plan covered the main contextual factors and determinants of the urban health issue, the main implications and public consequences of the issue in both the City of London in general and the UK, and offered an outline for the critique of current interventions to combat the issue. The plan concluded with speculated recommendations and conclusions for the extended essay. Introduction: Where 10,000 of the UK’s homeless population can be found in London (Story, Murad, Roberts, Verheyen & Hayward, 2007), mental health issues have been established as prevalent among the homeless in specific urban areas in the city of London. The borough of Tower Hamlets has been identified as an area of historic and ongoing homelessness as it is a highly deprived area of East London. Deprivation and severe poverty has been identified as one of the most significant determinants of physical and mental health (NHS Tower Hamlets Clinical Commissioning Group, 2013). In accord, Tower Hamlets has a soaring prevalence of these determining factors, which encourage the development of mental health problems. Thus, homelessness has been identified as a significant aspect of poor mental health in this borough (NHS Tower Hamlets Clinical Commissioning Group, 2013). It has been suggested that mental health issues may actually be a leading factor in the onset of homelessness, where the stresse s of homelessness further exacerbate existing psychological issues. Rationale: Epidemiological data shows that common mental health problems such as anxiety and depression have been found to be over twice as high, and psychosis has been found to be fifty to one hundred times more prevalent in the homeless (Bassuk, Rubin & Lauriat, 1986). A local audit in East London has shown that serious mental illness is more prevalent in the black rather than the white population (NHS Tower Hamlets Clinical Commissioning Group, 2013). The prevalence of alcohol and drug abuse has been found to be widespread within the homeless community (Fazel, Khosla, Doll, Geddes, 2008) thus the essay will aim to shed light upon this aspect of substance abuse as the largest contributing factor to homelessness. The essay will also aim to provide further insight to how the statistics were found to be markedly higher in the borough of Tower Hamlets than the proportion across other London boroughs all together (alcohol 26%, drugs 36%) (NHS Tower Hamlets, 2011). Furthermore, the gender, ethnicit y and age aspect of homelessness will be discussed, as there are marked differences between genders and races in regard to the issues faced in homelessness. For example, single men between the ages of 25-44 have been identified as the most common demographic group associated with homelessness (Hwang, 2001), yet children have also been found at a high risk of facing homelessness, accompanied by a high risk of developing mental health issues (Tischler, Vostanis, Bellerby & Cumella, 2002). The situation for those living rough is intensified when substance misuse is co-morbidly present with existing mental health problems (Rees, 2009). In accord, the essay aims to discuss how the borough of Tower Hamlets has been identified as having the highest mental health needs in the UK, with over 45% of the population of the borough claiming incapacity benefit due to their ill mental health. Furthermore, certain groups such as rough sleepers, domestic violence victims, sex workers and ex offenders are at a higher risk of homelessness and 70% of these individuals will be likely to have a mental health condition (Tower Hamlets Homelessness Statement, 2013). As the literature confirms that mental illness is a significant urban health issue among the population of Tower Hamlet accompanied by crucial repercussions such as homelessness, the essay will aim to highlight the ways in which this issue relates to the London borough of Tower Hamlets. Urban Context and Determinants: The literature surrounding homelessness and mental health indicates that factors in the urban context play a major role in the development of this urban health issue. The essay will endeavour to discuss determinants such as poverty, exclusion, attainment and wellbeing, which all hold significant implications for homelessness (Frankish, Hwang & Quantz, 2005). Long term unemployment and overcrowded households have played a major role in the development of mental illnesses, and have even lead to homelessness (NHS Tower Hamlets Clinical Commissioning Group, 2013). Additional factors such as difficulties in maintaining secure and good quality accommodation due to mental illness will also be discussed in the essay as contributors to homelessness (Breaky, 1992). Moreover, light will also be shed on recent changes to government policy, such as reforms in welfare support and social housing, the recession, and government cuts to public services in the UK, and their impact on those who were mos t vulnerable to homelessness. Individuals with mental health problems have inevitably faced considerable difficulties due to these changes such as understanding when they need to claim the benefits, how the new benefits work, and uncertainty about how the changes will affect their circumstances. In some cases, individuals may also face difficulty getting access to, and using a computer to claim their benefits online (Crisis & MORI, 2002). These issues highlight the high risk of the mentally ill facing homelessness due to financial hardship, and provide an explanation to why there is mental illness among the homeless. Due to the fact that registration to a GP generally requires proof of a home address, homeless people are more likely to access healthcare through emergency services (Crisis & MORI, 2002). This poses problems on both the individual and the general population as the individual may not receive the health advice and respect that they deserve for reasons such as the emergen cy department only being intended for emergency health conditions, and due to social stigma around homelessness; such as the homeless may be associated with mental ill health, substance abuse and lack of hygiene (Riley, Harding, Underwood & Carter, 2003). These factors will be discussed as contributors of poor physical and psychological wellbeing which the homeless individual faces when trying to access public health care. Moreover, the waiting time in emergency departments will affect both the individual and the general public as the individual may not want to seek medical help due to long waiting hours and discrimination, and the general public may have to wait longer to be seen for an emergency due to homeless individuals being seen for general health concerns. Another factor that is aimed to be discussed in the essay is the cost of this urban health issue faced by the National health services. Evidence shows that mental illness for the NHS is costly as it is the largest cause of disability in the UK. Social and informal care for the mentally ill is costing ?22.5 billion, where 13.8% of the national budget is spent on mental health (National Mental Health, 2012). Statistics also show that ?77 billion a year was being spent on welfare benefits for mental illnesses in 2009. The impact of these costs on the national economy was damaging, increasing national debts thus affecting the general population through increases in tax, public services, and as previously mentioned, cuts to national healthcare. Therefore these determinants will also be discussed as contributing factors to the urban health issue. Strategies & Interventions for Critique; Speculated Recommendations & Conclusions: The aim of the paper will be to critique strategies such as the Tower Hamlets Homelessness Statement 2013 to 2017, the Homelessness Act and other interventions that tackle homelessness and mental illness as separate entities (Crisis, 2009). The recommendations I will make will involve coordinated treatment programs (Coldwell & Bender, 2007) such as Assertive Community Treatment (ACT), which aim to serve psychiatric outpatients whose mental illness causes serious functioning difficulties in aspects of life including work, social relationships, residential independence, money management, and physical health and wellness, all of which can have an impact on housing status (Dixon, 2000). I expect to conclude that ACT is an effective measure in combating the core issues which lead to and maintain homelessness, and aim to recommend that government funding should be utilised to promote programs such as ACT which will make lasting changes in the homeless community. References Bassuk, E.L., Rubin, L. & Lauriat. A.S. (1986). Characteristics of sheltered homeless families. American Journal of Public Health. 76(9). 1097-1101. Breaky, W.R. (1992). Mental Health Services for Homeless People. pp101-107. Cited in: Homelessness: A National Perspective. Eds. Robertson, M.J. & Greenblatt, M. (1992). Coldwell, C.M. & Bender, W.S. (2007). The Effectiveness of Assertive Community Treatment for Homeless Populations With Severe Mental Illness: A Meta-Analysis. Am J Psychiatry. 164(3). 393-399. Communities and Local Government. (2009). Rough Sleeping England – Total Street Count. Retrieved from: http://webarchive.nationalarchives.gov.uk/20120919132719/http://www.communities.gov.uk/publications/corporate/statistics/roughsleeping2009 Accessed: 17th February 2014 Crisis & MORI. (2002). Critical condition: Homeless people’s access to GPs. London. Dixon, L. (2000). Assertive community treatment: Twenty-five years of cold. Psychiatric Services, 51, 759-765. Fazel, S; Khosla, V; Doll, H; Geddes, J (2008). â€Å"The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis†. PLoS Med 5 (12). doi:10.1371/journal.pmed.0050225 Frankish, C.J., Hwang, S.W. & Quantz, D. (2005). Homelessness and Health in Canada. Canadian Journal of Public Health. 2(96). 23-29. Hwang, S.W. (2001). Homelessness and health. CMAJ. 164(2). 229–233. National Mental Health. (2012). Development Unit. Factfile 3. The costs of mental ill health. Retrieved from: http://www.nmhdu.org.uk/silo/files/nmhdu-factfile-3.pdf Accessed: 16th February 2014 NHS Tower Hamlets. (2011). Homelessness: Factsheet. Tower Hamlets Joint Strategic Needs Assessment 2010 ­2011 . Retrieved from: http://www.towerhamlets.gov.uk/idoc.ashx?docid=f8390127-f61d-491b-8323-cea75d92a228&version=1. Accessed: 16th February 2014 Riley, A.J., Harding, G., Underwood, M.R., Carter, Y.H. (2003). Homelessness: a problem for primary careBritish Journal of General Practice. 473-479. Tischler, V., Vostanis, P., Bellerby, T. & Cumella, S. (2002). Evaluation of a mental health outreach service for homeless families. Arch Dis Child. 86. 158–163. Tower Hamlets Clinical Commissioning Group. (August 2013). Mental Health Joint Strategic Needs Assessment for Tower Hamlets. Tower Hamlets Health and Wellbeing Board. Retrieved from: http://www.towerhamletsccg.nhs.uk/Get_Involved/Tower%20Hamlets%20Mental%20Health%20Joint%20Strategic%20Needs%20Assessment%20Part%20One%20-%20Population%20Needs.pdf Accessed: 17th February 2014 Tower Hamlets Homelessness Statement. (2013). 2013 to 2017 Consultation Draft. Retrieved from: http://www.towerhamlets.gov.uk/lgsl/851900/868_housing_strategy_and_polic/homelessness_strategy.aspx Accessed: 17th February 2014 Rees, S. (2009). Mental Ill Health in the Adult Single Homeless Population: A review of the literature. Crisis, PHRU. Retrieved from: http://www.crisis.org.uk/data/files/publications/Mental%20health%20literature%20review.pdf. Accessed: 16th February 2014 Story, A., Murad, S., Roberts, W., Verheyen, M. & Hayward, A.C. (2007). Tuberculosis in London: the importance of homelessness, problem drug use and prison. Thorax. 62(8). 667-671.

Sour Grapes

During the problem solving process, Quality Ice Cream Company will need to have a structured approach to determining a solution. There are seven tools that Quality can use to improve their processes during production of the ice cream. These tools are: flow charts, run charts, process-control charts, check sheets, Parent diagrams, cause-and-effect diagrams, and scatter diagrams (Shower, p. 182). Each of these will help the identification of the variation that is happening and will also aid in the analysis, documentation ND organization of the information.This will help with process improvement. â€Å"They are simple but powerful tools that can be of significant value throughout the problem-solving and continuous-improvement processes (Shower, p. 183). † The first place for Quality to start is with a flow chart. The flow chart can show the relationship between the activities and tasks for each process, and give a better idea of how the rejections are happening. Next, a scatter d iagram can be run from the data collected.This will show the link between he run time and viscosity of the ice cream. This type of tool can also determine how long the ice cream should be mixed to avoid soapiness and stiffness. From the ten days of data collected, it seems as though the run time is too short resulting in a too soupy mixture (Shower, p. 201-202). After a more suitable run time is determined Quality can then look into the other problems causing the rejects. Aside from the soapiness causing most of the rejects, there are other problems.

How unemployment is individual and social problem Essay

In this essay I will discuss how unemployment is an individual and a social problem and how Max Weber distinguished power, authority and coercion and how the functionalist, conflict theorist and symbolic interaction theory view the economy and by the mid century how they have evolved and the role of these theories to explain social and economic phenomenon. How unemployment is individual and social problem Unemployment is caused by many factors in a modern market economy. It can be caused by rapid technological change, business cycle or recessions, seasonal factors in some industries particularly such as changes in tastes and climatic conditions which affects demand for certain products and services, individual perceptions and willingness to work and search for jobs, their values and attitudes towards some jobs and about employers, accessibility for retraining and acquisition of work skills, willingness and perception of unemployed of the benefits of training and the possibility for them to get a job after the training even though they have a chance to get a job, discrimination in the workplace based on race, color. religion, ethnicity, age and class. It can be seen from the above causes unemployment in a particular period can be a combination of caused by social factors and how the economy as a whole works and also due to the subjective individual factors. In a sociological point of view according to functionalist and conflict theorists the unemployment is caused primarily by the social factors than by the individual factors. However according to Max Weber and symbolic interaction theories individuals construct their own social constructs and perception and they can be subjective in their behavior and there fore can become unemployed even though the actual condition they can get a job in the job market. In summary applying the sociological and the primary causes of unemployment unemployment is individual as well as a social problem in a market economy. As discussed above it is caused by the society as well as by individuals. Even the economy or societal factors are not present unemployment can be caused by individual perception and their own subjective behavior. . Max Weber’s distinction among power, authority and coercion Power can be defined as one person’s ability to influence others does what ever they want even though they don’t like to do what is demanded and they resist doing what is demanded. For example a professor can influence the students to assign work and demand them to do to satisfy some criteria. As well a dictator like Hitler can control all aspects of life because of this ability to impose his will on majority of people. In other words a person or group on other person or other groups can use power legitimately or illegitimately. That is power need not come from proper authority or legitimate authority. That is power and authority can be different in this respect. According to Max Weber authority can arise from tradition, charisma of certain powerful people or from legal-rational. That is authority need not come from any logical reason but likely to come from respect for the past. For example a monarchy in Western Europe can get authority because they ruled the populace over a long period of time. Even the traditional authority can exist in modern democracies because the people respect the monarchy or authority of monarchy at least in a limited symbolic head of states in Western Europe. Authority also can arise from charisma of some powerful people. They have authority because of their charisma. This arises because they have the ability to lead a vast number of people for a particular cause using their powerful charm and influence over ordinary people. For example Martin Luther King, Gandhi. Nelson Mandela is the modern examples of charismatic authority they had because of their ability to charm and influence a vast majority of people for a particular cause. Authority also can arise from legal-rational. That is in society authority is given to individuals and organization based on rationally enacted laws and regulations. This authority is impersonal and differs from charismatic authority because the legal-rational authority is impersonal and the charismatic authority is personal and admired by the people who accept that authority. In modern societies the authority is derived from the legal-rational compared to charismatic and traditional in varying degrees in industrialized societies in particular. Coercion is the extreme manifestation of power in a way threatens the person to complete obedience because it threatens the person coerced physically, financially and socially. This results in persons following the authority of another because of fear rather than will. Coercion is mostly linked with abuse and conflict. Coercion exists in many dictatorships in the past as well as in the present world in many parts of the world where citizens are forced to follow the regime of dictatorship. The view of the economy in the perspectives of functionalist, conflict theorists and symbolic interaction theory Functionalist perspective of the economy In the perspective of functionalist sociological theorist social systems including economy works like a biological organism where every part of the system work in a united manner so that smooth functioning is maintained and so that society builds consensus between different parts of the system.. In this change is evolutionary and the changes take place to minimize dysfunction and to enhance the stability and its survival in the future. In this respect Capitalism will not collapse and will endure in the future as the functions of the system will adjust and evolve so that it maintains the social order and stability without any radical overhaul of the economic system. In addition the social, legal, political, religious systems will not be in conflict with the economic system and work in unison with the economic system so the whole social organism survive and social order is maintained and their functions and their purpose even though different work as a unified system. As discussed above this is the functionalist view of the economy. Conflict theorist view of the economy In contrast conflict theorist believe society do not work as a unified system. Conflict and struggle take place as different groups work to maximize their benefit in the same time other groups loose. Functionalist view conflict in a negative manner. However the conflict theorist see the conflict to some extent is beneficial as it forces the parties to come to a common ground and make the economic system or the social system to change for the better and minimize the losers and maximizing the benefits for a greater number of groups as well make the power system in check so that abuse of power is minimized. In this context the economic system and social order changes continually and changes take place and shaped by different interest groups in varying degrees in a market economy. However Marxism as a conflict theory predicts radical change to the economic system to move towards a socialist system it has not eventuated. However Max Weber as a conflict theory predicts the viability of the market economy with some reform to minimize the negative aspects of capitalism like alienation and the negative impact of bureaucracy in capitalist economies and more democracy in society and continuous reform of the economic system to make it work efficiently but also effectively by legal, social and political reform appropriate to a countries historical, cultural, political and social context.

As a Sales Manager in today's difficult retail environment, what steps PowerPoint Presentation

As a Sales Manager in today's difficult retail environment, what steps do you take to ensure your team members achieve their sa - PowerPoint Presentation Example The Australian retail sales manager has to focus on the four major marketing strategy steps to succeed in the Australian retail market segment. First, the Australian retail sales manager has to focus on the product and service step of the company’s marketing strategy. According to Ritz (2007), the Australian retail company must implement some marketing changes to increase the clients’ demand for its products. The company must add additional shoe styles. The stores must offer the best service and sell high quality food, and other retail products based on the latest Australian retail market segment trends. The company must increase the store displays of the highly salable products in the food, grocery, and other retail products. The company must conduct a feasibility study to determine the current Australian retail product trends to determine what products to sell in the retail outlets. Second, the Australian retail sales manager has to focus on the price step of the Aust ralian retail company’s marketing strategy. Czinkota (2007) insists that the company must institute reasonable prices to increase its client base. The reasonable price is not the same as the lowest price.

Do you think political polarization is bad or good for democracy in Essay

Do you think political polarization is bad or good for democracy in the United States today - Essay Example pen are: ethnic or religious violence and counter attacks resulting in more violence; ideological integrity instead of taking opportunistic positions with the sole purpose of winning the ensuing election; fundamental changes in the electoral system making it inevitable for the candidate to encourage one’s core supporters than to appeal to the median voter; the system of proportional representation is conducive to the last choice. Political polarization is the normal process of democracy, but if it were to take an extreme posture it is bad for United States today, as the country has to tackle many issues at the global level. It is facing severe economic competition from China and the threat from the Muslim fundamentalists to its security is real. The need of the hour is not political polarization but total unity, irrespective of party affiliations. A strong opinion is expressed by the think-tanks and analysts of political situation in USA, that in recent times, increasing polarization is seen. Jim Jeffords’ resignation from the Republican Party in 2001 is one such instance. He felt that the party was increasingly on the verge of polarization and the moderate voices are not allowed say. Ex-President Bill Clinton expressed the view in Daily Show on 9/18/06 that he believes that the Republican Party stands for polarization. Democracy doesn’t mean that the ruling and the opposition parties need to be permanently at war with each other. The supreme objective is the good of the country, and the responsible parties understand this fact. At times, an ordinary citizen who has no deep understanding of the working styles of the politicians, thinks that some illusion of policy differences, some incidents of cross, are the harbingers of the split in the party. The Senators of the same party who sometimes cross swords in public through newspapers, electronic media, etc often have the hidden agenda. They wish to gauge the moods of the public and wish to please every

Work of Art Essay Example | Topics and Well Written Essays - 500 words - 1

Work of Art - Essay Example Next what the viewer sees is the man struggling under water to release his hands from the rope tied around, a life and death struggle in which he finally succeeds, and then daring the firing squad that pours bullets at him from above, he swims to the shore safely. The entire sequence is fraught with breath-stopping tension as at one moment, the man seems to be going to die and the next moment, he is again seen to be surviving some how in this race against death. The moment in which the man arrives at the shore of the river, totally exhausted and breathless, yet living and happy to be alive, he sees a small wild flower just near to where he was lying half-conscious. And he is in divine ecstasy seeing that beautiful manifestation of life, especially because the same life a moment before was slipping away from him. Thus the flower becomes a metaphor of his own survival and hope. The film next depicts the firing squad once again closing in on him and he running for life like a amad man. The hunter and the hunted become engaged in a intense saga of killer instinct and survival instinct. Then the film shows the viewer a gate which opens before the running man, and for a moment, it seems that his trial by fire is over and he has safely arrived at his house. The visuals of a woman and a child happily welcoming him reinforces this impression. He is seen running towards them in relief and immense joy. But, suddenly, something invisible seems to be pulling him back at one stroke and the next shot that the viewer sees is the man hanging on the bridge. It is only at this moment that the viewer realizes that the rope-breaking and escape sequence that he/she saw earlier was unreal and was just a last thought, vision or wishful thinking of the man being hanged. There was no escape possible and he died. The film ends here. While watching the film, I have been finding it difficult to even breath as the struggle of the

Four Circles of HR Professionalism Assignment Example | Topics and Well Written Essays - 2000 words

Four Circles of HR Professionalism - Assignment Example This involves having a knack for managing people and conducting activities which may include hiring and recruiting the staff, managing work culture and job performance within an organization, training the personnel working within an organization, assuring that the staff complies with the rules and regulations in an organization, and the overall management of the behaviour of personnel at the workplace (Sartain &Finney 2005). Thereby in a professional context, any HR manager does need to be astutely aware of as to how to conduct oneself at the workplace (Kulik 2004). There stand to be some predominant professional considerations related to the workplace that an HR manager does need to hold sacrosanct. As an HR I am well aware of the fact that within a professional environment it is not only the sacrosanct ‘best practices’ but also an array of rules and regulations that my conduct needs to be subservient to. I am well aware of the fact that for the personnel I manage, I am the actual company. Not only the staffs that I manage to view me as the management but in the courts of law, I will also be considered to be the actual employer (Muller 2012). This realization has a serious impact on my professional conduct. I am well aware of the fact that as an HR manager I will always be directly held responsible for the things I do or fail to do for the employees (Muller 2012). The other thing that I always keep in my mind is that employees never leave organizations; they mostly tend to leave bosses. Thereby I also keep in my mind that every employee that comes to work in the organization is not a passive toolbox, but rather a complete person with a heart and a mind and a soul. My approach towards employees is always imbued with concern and I hold very human expectations from them. I well understand the fact that employees do always need a feedback. Whether they are doing a good job or are not doing well, the employees are mostly not able to ascertain it until they are evinced an honest feedback (Slade 1994). I have also realized that extending a timely feedback to the employees does go a long way in assuring organizational efficiency and thereby as an HR professional I make it a point to be thorough and prompt with the feedback I extend to the employees.  

Reflective journal Assignment Example | Topics and Well Written Essays - 250 words

Reflective journal - Assignment Example Before her, many women lost their lives while bring new lives in to the world. Nurses had to go through a basic nursing training before specializing in midwifery as a post-basic course, a process that was quite lengthy. The contributions of Gaskin towards safe motherhood initiatives sensitized Americans about the rising rates of maternal death. In my view, the project was a great success as there was a sharp decline in mortality rates. Teenage pregnancy rate in America is among the highest in the industrialized world. I however, find her initiatives narrow and one-sided because the focus is on safe delivery and not on safe sex behavior. Ina Gaskin’s contributions have transformed midwifery into a specialized field of nursing. We now have more midwives and midwifery training schools. The focus of midwifery is now on prenatal, peri-natal and postnatal health of the mother and child. More women are now seeking specialized midwifery services. Nurses can now manage shoulder dystocia competently giving them a greater role. Ian May Gaskin transformed midwifery into a specialized distinct field by starting the direct midwifery training. This taught me that nursing could specialize more as a profession to give the nurses a greater role in health care. Gaskin’s development of Gaskin’s maneuver made me realize that nurses can play a greater role in managing difficult labor because the nurses were viewed to be competent in managing normal labor alone. With a good foundation laid by Gaskin, I intend to broaden the focus of midwifery to deal with difficult labor. This will be achieved by introduction of training modules and workshops for pre-service and in-service midwives on the management of difficult labor. This will ensure that as the numbers of midwives rise, their competency in managing labor is also

Irish Educational System Essay Example | Topics and Well Written Essays - 1750 words

Irish Educational System - Essay Example This is a situation that could escalate unless dealt with. They also say though that the situation is so variable from place to place that it is difficult to generalize either as to the current situation or ways to deal with any problems. The Irish educational system is many ways very similar to that found in other western European countries. It provides primary, secondary, further and higher or tertiary education with children spending 6 hours a day or more in school 5 days a week, a high proportion of a child's waking hours, though they spend even more time out of school than in it. Nevertheless it has a massive influence upon the way children think and behave, especially if the values a child finds at school are reflected in their family and in the wider society. Education is compulsory for those between the ages of 6 and 15, though many 5 year olds attend school and further and higher education is on the increase, with some 50 per cent of students going on from school to further studies varying from adult literacy courses and those for the unemployed to formal university courses. Education in primary schools follows the 1999 Primary School Curriculum as described on the Irish Education web site. This curriculum document is unusual in educational circles in that it does not provide a religious curriculum, but leaves this to the churches that control the various schools. Its aim is to make the most of each individual's character:- as it is expressed in each child's personality, intelligence and potential for development. It is designed to nurture the child in all dimensions of his or her life -- spiritual, moral, cognitive, emotional, imaginative, aesthetic, social and physical... This idea of making the best of each child is contained within the Constitution of Ireland as laid down in 1937. In article 41 section 1 it states clearly that the people of Ireland feel that the family is 'the primary and natural educator of the child' and that it is both the right and the duty of parents to see that their child recieves an education religious, moral, intellectual, physical and social. There is provision for education at home, but rather oddly no minimum standards for this are laid down, though there is provision for the state to see that a child recieves education when , for whatever reason, the parents are unable to do this. If one looks at the curriculum in an Irish Primary School it is clear that social education is given its place alongside such traditional subjects as mathematics, languages and science. In fact it appears twice in the list provided on the Education Ireland web site. There are a number of different types of primary school - state-funded primary schools, special schools and private primary schools. State funded schools include religious schools, non-denominational schools, multi-denominational schools and Gaelscoileanna i.e schools which operate in the Irish language, but which are outside the usual Gaeltacht, i.e. the area where Gaelic is the first language. Social education is linked to environmental studies and science as well as to personal and health education. It is of course in the earliest years of a child's school life that correct behavior and values must be reinforced if a positive school career is

Controlling Carbon emissions Essay Example | Topics and Well Written Essays - 750 words

Controlling Carbon emissions - Essay Example Carbon sequestration is a component of CCS (carbon capture and storage). CCS aims at capturing carbon dioxide, transporting it to the place of storage and finally ensuring it is safely stored. Of all the available storage options, carbon geosequestration may be the most viable. This is because the process of geosequestration is characterized by ability to handle large volumes of gases at long periods of time. The process of geosequestration has not been commercially proven to be viable. However, it has been applied in processes of extraction oil. Carbon dioxide gas is injected into oil reservoirs. It pushes the oil up due to pressure improving the rate at which oil is flowing out. Carbon dioxide remains in the reservoirs hence, it is stored (Metz, B., Davidson, O., Swart, R., and Pan, J. 153). The process of carbon sequestration is being investigated in several parts of the world. Demonstrations are being undertaken to determine how safe and feasible this process is. The oldest demon stration has been operation since 1996 (Goulder. and Mathai, 36-37). This is the Sleipner project which store approximately 1 million tons of carbon dioxide annually. Canada has the largest project (Weyburn project) of carbon sequestration which stores about 1.5 million tons of carbon every year in its process of oil extraction. ... and Mathai, 38). Cost of Carbon Sequestration High costs pose a great challenge to carbon sequestration. It is estimated that a ton of carbon dioxide costs more than 30 dollars to sequestrate (Grubler, Nakicenovic, and Nordhaus, eds. 112). There are great technical difficulties in reducing these costs given current levels of technology. There is technological knowhow and mechanisms of separating carbon dioxide and hydrogen. However, the capital and costs of operations are quite high. This is mainly because these technologies are preferably applied in fossil fuel combustion. There are is need for more research and development in this field in order to reduce the costs of carbon sequestration. Costs of mitigating leakages of carbon dioxide form the ground are also very high. If this gas’ concentration is stabilized at double preindustrial levels, a 1% leakage is tantamount to around 850 billion dollars annually up to 2095 (Kauppi 98).therefore, a leakage of around 1 percent or l ess poses an intolerable transfer of cost to future generations. However, there is no empirical evidence that 1 % or less carbon dioxide is leaked from reservoirs. This further increases the uncertainty of costs meaning that the economic burden of carbon sequestration might even be higher than anticipated (Kauppi 105). Potential problems of carbon sequestration There are three main problems of carbon sequestration. These are; Storage security, heightened energy consumption and lack of large-scale practicality. Storage security involves the potential danger of storing carbon dioxide at very high pressure levels. Any technology used in injecting carbon dioxide is susceptible to human errors. Such an error would cause loses in property worth millions and thousands of

Compare and Contrast Essay Example for Free

Compare and Contrast Essay Religion is a great topic to develop and more when you compare and contrast them. Everyone has different views based on their belief. In this essay Im going to compare two basic religions that are still use in today’s society after so many years of development. These religions are buddhism and christianity. Considered to be the two great distinctive religions of the world, both Buddhism Christianity today covers a large section of the world population with numerous similarities and differences. There are huge differences on this religions that outstand all the others. The existence of a personal creator and Lord is denied by Buddhism. However, Christianity believes in a personal creator and each may have a relationship with the creator, Jesus. Buddhism believes the world operates under natural law and power and Christians believe that there is a divine order to the world. Some in Buddhism deify the Buddha and worship other gods as well. Christianity is clear that a personal God exists but He is to be the only object of worship. Buddist believe that through a blowing out of yourself, freeing you from desire, will you break the cycle of reincarnation. Christianity says that a relationship with God through belief in the sacrificial work of Jesus Christ on the cross is what allows people to go to heaven. This only comes when someone completely trusts in what God has done for us in the person of Jesus Christ. There is no such thing in Buddhism as sin against a supreme being. In Christianity sin is ultimately against God and affects man and this world. According to Buddhist belief, the human life is not consider to have much worth, having only temporary existence. Life is understood in such a way in getting rid of all desire (good and bad) and not placing any value on this life on earth and not to believe there is any eternal soul to a person. In Christianity people are of infinite worth, made in the image of God, and will exist eternally. The human body is a hindrance to the Buddhist while to the Christian it is an instrument for glorifying God as well as God will restore the body of those who commit their lives to him so that they can be in his presence forever. Also there are some things in which Buddhism and Christianity are really similar. Lord Buddha based His ethics on the golden rule, which was for the welfare of the human beings. Christianity, Jesus Christ also preached His ethics as per the golden rule, which was for the welfare of His people and easily approachable. Buddha, the founder of Buddhism rejected extreme asceticism and gave an emphasis on self-liberation through knowledge. On the other hand Jesus Christ also rejected extreme asceticism. The worship in Buddhism includes monasticism, ringing of bells, bowing, use of incense and rosary, erection of towers or stupas, prayers and meditation. Similarly, the Christians also follow almost same form of worship Monasticism, Confession, the cult of images, ringing of bells, use of rosary and incense and the erection of towers. The Buddhist doctrine gives an emphasis on love for the entire mankind and every other beings as well, no matter whether the being is a friend or an enemy!. The Christian doctrine is also based on the principle of Love the neighbour like into yourself, which means that love should be showered upon not only your friends, but the entire beings. In conclusion buddhism and christianity like any other religion have their similarities and their own differences.

LG Mobile Essay Example for Free

LG Mobile Essay Founded January 5, 1947 Headquarters Address LG Twin Towers, 20 Yoido-dong, Youngdungpogu, Seoul, South Korea Our Businesses Electronics, Chemicals, Telecommunications and Service (Number of Companies: 53) LG Electronics LG Display LG Innotek Hiplaza Hi Logistics System Air-Con Engineering Siltron Lusem LG Chem SEETEC Coca ·Cola Beverage Company LG Hausys LG TOSTEM BM HAUSYS ENG LG Life Sciences LG MMA LG TeleCom CS Leader A†¢IN LG Dacom LG Powercom DACOM Crossing CS ONE Partner LG CNS LG N-Sys 1947 1953 1958 1967 1970 1974 1995 †¢Chairman In Hwoi Koo founds LG by establishin g Lak Hui Chemical Industrial Corp. (now LG Chem) †¢Lak Hui Industry establishe d (now LG Internatio nal Corp.) †¢Goldstar Co. establishe d (now LG  Electronics) †¢Honam Oil Refinery Co. establishe d (now GS Caltex of GS Group) †¢Cha Kyung Koo takes office as Chairman †¢Lak Hui changes its name to Lucky Co., Ltd †¢Bon Moo Koo takes office as Chairman †¢ New Corporate Identity (CI) establishe d (Lucky Goldstar LG) Goldstar produced first electronics in Korea. 1959 1960 1961 1965 1966 1968 1969 1973 1974 1979 1981 1982 1983 1984 1985 †¢First radio †¢First electronic fan †¢First telephone †¢First refrigerator †¢First black and white TV †¢First air room conditioner †¢First elevator, escalator, washing machine †¢First cassette recorder †¢First PMC single station equipment †¢First videotape recorder †¢first electronic VTR †¢First color video camera †¢First compact disc player in Korea †¢First multiplex television with sound and color in Korea †¢First laser machines in Korea, single unit video 8 mm VTR in Korea 1958-1995 1962 1975 1976 †¢ Goldstar introduces private loans for the first time in Korea †¢ Goldstar establishes the Central Research and Development Institute †¢ Goldstar Precision Industry (currently LG Innotek Co., Ltd.) established 1977 1978 1989 †¢ Goldstar develops color television †¢ Goldstar achieves exports to the amount of 100 million USD †¢ Goldstar Industrial Systems develops the fourth direct drive ultra precision robot in the world 1995 †¢ LG Electronics Inc. acquires Zenith, the largest electronics company in the United States 1995-Today 1995 †¢Chairman Bon Moo Koo created and enforced Jeong-Do Management* and No. 1 LG as the companys core management goals. 1996 †¢LG Electronics Inc. establishes the LG-IBM PC company 1999 †¢LG Electronics Inc. develops the thinnest plasma display panel in the world 2001 †¢LG Electronics becomes the worlds first to develop organic EL for IMT-2000 2004 †¢LG Electronics develops the worlds first land-based digital multimedia broadcasting phone †¢LG Electronics unveils 3G mobile phones for Hutchison 2005 †¢For eight years in a row, LG Electronics is number one in the world for sales of optical storage devices †¢LG Electronics opens the LG Digital Reading Room in the National Library of Russia †¢LG Electronics develops the worlds fastest 3D game phone 2006 †¢LG Electronics wins the 2006 Hong Kong Design Award for its Chocolate phone †¢LG Electronics unveils the worlds thinnest ceiling-bound system air conditioner †¢LG Electronics unveils the worlds slimmest (33-cm) flat-panel TV 2007 †¢LG Electronics is ranked first in the global CDMA market for two consecutive years ï  ½ ï  ½ ï  ½ Revenues: $12.1 billion (FY 2008) that increased 10.3% compared with FY 2007  Collaboration with Microsoft Corporation,  Android software under Google Inc., Wal-Mart, EBay, Toyota Threat Case of LG 830 Spyder cell phone ï  ½ ï  ½ ï  ½ ï  ½ ï  ½ Jeong-Do Management and LGs management principles Increase the value for the shareholders and investors Improve reliability, flexibility and responsibility Increase the speed of responding to the consumers’ feedbacks Human recourses (Attract Foster) Music ï  ½ business mobility Nokia software communication game Global Market Local Market But in the United States, Nokias market share has been steadily declined. Nokia has to develop more CDMA mobile phones. Because the U.S. wireless operators have a strong control on the market, while the wireless technology in the United States has also been less advanced than Europe. ï  ½ Motorola was founded in 1928. It is the leader in the world’s chip manufacturing and electronic the communications. direct US Veriz on sales Gove rnme nt WalMart distribut ors products widely sold through Retailers dealers licensees Main customers of Motorola ï  ½ ï  ½ ï  ½ Because of lacking of compelling new phones, the market share of Motorola’s mobile phones continue to depress. Samsung replaced the location of Motorola becoming the secondlargest mobile phone marker. Now Motorola can only rank at third. Samsung slips into No.1 mobile phone slot in US Leaves Motorola sadly Second ï  ½ Just as LG, Samsung Group is also a South Korean company which offering various industries including electronics and mobile phones. In 1973ï ¼Å'Martin Cooper invented the first mobile phone in the world. The 1G phone looks boxy and can only be served as movable but hardly portable. Many people call this cell phone as bricks and mortar or â€Å"KINGBOX†. Future mobile phones will be emphasis on security and data communication. On the one hand it will strengthen the protection of personal privacy, on the other hand the data services will enhanced by more researches and development. ï  ½ ï  ½ A large-scale of 3G networks is sweeping the whole global mobile phone market. At the same time, the global market of mobile phones is facing its biggest threat. Some common tools of International phony such as Skype, Icq and MSN are more and more convenient and popular. The future of Internet telephony will become a mainstream form of network communication which is under the trend of scientific and technological progress and perfection instead of mobile phones. General Outline Troubles Advantages Milestones 1997: 1962: 1958: Goldstar Established (LGE) LGE expands business to the U.S. with radio’s. Supplied United state’s Ameri-tech with mobiles phones. ï  ½ ï  ½ ï  ½ ï  ½ ï  ½ 115 companies: 84 subsidiaries, 34 liaison offices (250 companies total) Workforce: 84,000 36 RD and Design Centers: 30 RD, 6 design Workforce: 17,000 63% of workforce employed overseas. (101,000 of 160,000 total) Global Subsidiaries/Companies: Europe: 22 China: 16 Middle East Africa: 11 Asia: 10 CIS: 7 South America Central America: 10 United States: 7 (Currently number 2 in U.S. market behind Motorola) Japan: 1 Global Sales KRW in BS Trillions 4.6 50 45 5 40 35 30 25 20 15 10 5 6 5 10 10 10 10 11 10 13 12 11 Home Ent. AC 16 Home App. 4.5 8.6 15.8 D.Media D.Display D.App. Mobile 0 2005 2006 2007 2008 2008 Q2 % Market Share Others, 16.6 SonyEricsson, 8.2 Nokia Nokia, 41 Motorola LG, 9.3 Samsung, 15.4 Motorola, 9.5 Samsung LG SonyEricsson Others ï  ½ Fluctuations in KRW: (Competitive exports) 2005: $1(USD)= 1,103 won 2006: $1(USD)= 955 won 2007: $1(USD)= 929 won 2008: $1(USD)= 1,103 won 2009: $1(USD)= 1,183 won ï  ½ NAFTA 1994/WTO 1995 ï  ½ Late Start (counter: RD, Design, Localization) ï  ½ High-End/Quality (counter: LG Chocolate consignment, PBL) ï  ½ PRADA – Luxurious PRADA phone ï  ½ Microsoft – Windows Mobile 6.0/Smartphones ï  ½ Mark Levinson (Audio Systems) – Music Phones (Chocolate) ï  ½ Google – Pre-installments in phones. ï  ½ Schneider – Mobile phone camera lenses. ï  ½ ï  ½ ï  ½ LGE sports sponsorships/partnerships Formula 1 Multi-year partnership 1/09. Official consumer electronics, mobile phones and tech. Viewed by 588 million. ï  ½ ï  ½ International Cricket Council Official Sponsor from (ICC) 2002-2015. Following of 2-3 Billion: U.K., Australia, India, South Africa and other British Commonwealth countries. Football Club Sponsors: ï  ½ ï  ½ ï  ½ ï  ½ ï  ½ ï  ½ ï  ½ ï  ½ ï  ½ ï  ½ Sao Paulo Fulham Liverpool Olympic Lyon Hungary National Team Iraq National Team Greece National Team Russia National Team LG Amsterdam Tournament LG World Cup Most Popular Sports in the world: (approx. 6.71 billion people) 1. Soccer – 3.5 billion 2. Cricket – 2-3 billion 3. Field Hockey – 2 billion 4. Tennis – 1 billion 5. Volleyball – 900 million 6. Table Tennis – 800 million 7. Formula 1 – 588 million 8. Baseball – 500 million 9. Golf – 400 million 10.Gridiron Football – 400 million 1995 †¢Acquired U.S. based Zenith 1997 †¢CDMA (3G) Handsets produced 1998 †¢60’’ plasma T.V. 2000 †¢Launched the world’s first Internet refrigerator 2001 †¢World’s first internet washing machine 2003 †¢Number 1 global producer of CDMA phones 2004 †¢Advertised world’s first 71† plasma T.V. 2005 †¢ 4th largest mobile phone supplier globally †¢ 18 million Chocolate phones sold. 2008 †¢ LG Mobile selected as the supplier for the â€Å"World Phone† †¢ World’s first 3G watch phone with full touch screen. †¢ LG Dare phone wins CES â€Å"Best of Innovations† award 2009 †¢ LG Secret phone wins â€Å"red dot design† award †¢ LG KS 360 phone wins â€Å"iF Design’ award. FEATURED PRODUCTS ï  ½ Brand Name ââ€" ¦ top 10 brand in electronics 2008 ï  ½ Marketing in UK ââ€" ¦ LG hired Alcone Marketing ââ€" ¦ 10% of market share for mobile phones ï  ½ Design ââ€" ¦ LG Prada: top 10 Fashion designs in Europe ââ€" ¦ Bluetooth Handsets : drive and talk ï  ½ Consumers’ satisfaction ââ€" ¦ J.D. Powder and Associates’ study ï  ½ Supply management †¢ Fashion phone designs ï  ½ Contracts with football clubs ââ€" ¦ Liverpool ââ€" ¦ Fulham †¢ Global Recession ï  ½ Competitors ââ€" ¦ Nokia Corporation ââ€" ¦ Motorola, Inc ââ€" ¦ Samsung Group ï  ½ Global Recession ï  ½ Short-term: ââ€" ¦ Improve supply management ââ€" ¦ Satisfy lower market ââ€" ¦ Bluetooth Handsets : drive and talk ï  ½ Long term: ââ€" ¦ ââ€" ¦ ââ€" ¦ ââ€" ¦ Increasing fashion designers field American Football in USA Increase market share in Asia Buying small companies or stocks

Providing quality healthcare

Providing quality healthcare Health Care Quality 1.0 Background To The Study The Client enters the health care delivery service with needs, concerns and expectations, requiring various interventions. Identifying and providing appropriate care to meet these needs in a cost effective way without compromising the standard of care is one of the challenges facing health care providers today. Other challenges facing them include consumer’s demands, professional demand for excellence, high cost of healthcare and demographic shifts. In order to provide quality care that meets the client’s need and increase his satisfaction the client’s views must be respected and his preferences taken into consideration. Studies to identify clients’ preferences have shown that providing physical comfort adequate and timely information, coordinated and integrated care, emotional support, respect for clients’ values and rights are powerful predictors of client satisfaction (Gerteis, 1993; Potter and Perry, 2001). Other studies also showed that irrespective of cultural background and beliefs, providers’ behavioural attributes such as showing respect, politeness, provision of privacy and reduction in clients’ waiting time influence clients’ satisfaction with care (Population Report, 1998). Clients satisfied with the care they received have been found to pay compliments, comply with instructions, keep clinic appointments and recommend the hospital to friends and family members (Larson and Ferketich, 1993; Kotler and Armatrong, 1997, in contrast, those not satisfied have been found to complain, take legal actions, change providers or even leave the orthodox health care services for complementary therapies or alternate medicine (Luthert, 1990; World Bank Report, 2000; Jegede, 2001). These activities have affected the health care delivery system. In recent times, several changes have also emerged. This includes a change in the stereotyped image of the patients. Historically the patient had been viewed as a passive recipient of healthcare in a paternalistic relationship with the caregiver. This is no longer the case, as today the client is a well-informed consumer with a strong negotiating power of choice, which he uses to his advantage (Melville, 1997, Alagba 2001). This position was strengthened by the Consumers’ Bill of Rights of 1965 and the Patients’ Bill of Rights of 1975 (smelther and Bare, 2000, Alagba, 2001). The Bills emphasized Client satisfaction with services provided more so as satisfaction has been accepted as a major indicator of quality care. Furthermore, as consumer of the services the client is in the best position to say if a service has met his needs or not. The client’s perception of care is therefore of paramount importance to any provider. However, in spite of all these, healthcare workers’ care alone may be inadequate to meet all the client’s needs. Client-centered care required that healthcare delivery system provide client-friendly hospital policies, adequate number of professionals, safe and clean environment, appropriate equipments and functional laboratories. These facilities provided at affordable prices are necessary to complement healthcare workers’ efforts and guarantee client’s satisfaction. Unfortunately the major hindrance to the achievement of this goal is the high cost of healthcare services, for example, Stanhope and Lancaster (1996), Potter and Perry (2001) reported that there was a great hike in health care delivery system in United States of America. Then the health care costs inflation was said to have been higher and faster than the consumer price index between 1950 – 1980, and in 1993 it was said to have increased twice above the national inflation index. This hyper inflation, Stanhope and Lancaster (1996) further stated led to consumers’ outcry and great demands for cost effective healthcare services. Chapter Two Literature Review Concept of Satisfaction Several authors have defined the word satisfaction severally, for example Webster’s dictionary defines satisfaction as â€Å"the fulfillment of a need or demand and the attainment of a desired end†. The Oxford Advanced Learner’s Dictionary defines it as â€Å"the feeling of contentment felt when one has or achieves what one needs or desires†. Satisfaction can also be simply defined as a sense of contentment emanating from perceived needs met. These definitions suggest the need for needs identification and goal setting before satisfaction can be attained. It would also appear that satisfaction is subjective with only the individual attesting to his/her satisfaction. In today’s provider-client relationship the onus lies on the providers to strive at client satisfaction. Studies to identify the antecedents of client satisfaction have shown that client satisfaction is one of the results of the provisions of good quality service; consequently it has become an important quality indicator (Filani, 2001; Vuori, 1987). The need to provide quality care is based on several factors including the principle of equity. Clients and consumers who pay for services are entitled to value for money paid. Satisfaction is also found to depend on client’s expectations. Each individual has an expectation of the outcome of an interaction, a relationship or an exchange. Positive outcome engenders client satisfaction. This view is well articulated by Kotler and Armstrong (1997) who stated that â€Å"when a client’s expectations are not met, the client is dissatisfied, when it is met the client is satisfied and when it is exceeded, the client is delighted, and keeps coming back†. Consequently service providers should assess clients’ expectation at the inception of a relationship in order to consciously plan to satisfy the client. Sometimes clients may not be sure of what to expect, it becomes necessary for service providers to develop an expectation of good quality in the client so that they can insist on it. Otherwise the client may be satisfied with relatively poor services (Shyer and Hossan, 1998). This is not in the interest of the client or the service providers. Therefore counseling the client and informing the public on what constitutes appropriate care or service should be seen as efforts to develop and sustain client satisfaction. This is especially important in the light of current reforms in the health care delivery system. Recently, certain forces have occasioned reforms in the healthcare delivery system; these forces include population demographics such as increasing number of the aging population, cultural diversity, changing patterns of disease, technology, economic changes and clients’ demand for quality care (Smeltzer and Bare, 2000). These forces demanded that care providers developed innovative ways to meet clients’ needs and increase clients’ satisfaction. Today healthcare is viewed as a product to be purchased and patients hitherto seen as passive recipients of healthcare have metamorphosed into empowered consumers. As consumers the clients command the attention of providers and healthcare managers who have a duty to ensure their satisfaction. This view was supported by the British Government when dealing with the National Health Service (NHS) inability to cope with problems increasing demand on it by the aging population, the advancements in medical technology and the rising expectations of healthcare users (Melville 1997). Also like consumers it has been noted that healthcare clients are getting increasingly associated with rights, power and empowerment. Their present status enables them to take control of their circumstances and achieve their own goals. Adams (1990) observed that it also enables them to work towards the maximization of the quality of their lives. Using their power, clients demand for good quality healthcare: their demand is supported by the World Health Organization, Alma Ata declaration of 1978, and the constitution of the World Health Organisation (1966). The latter, stated that, â€Å"good health is a right of all people†. This is interpreted to mean a right to availability, accessibility and affordability of good quality health care. It follows that healthcare should be provided in a way that is acceptable and satisfactory to the consumer, who also has the power of choice. Literatures abound on the clients’ power of choice (Rogers, 1993, Melville 1997). However, suffice it to note that the client as a consumer uses this power to select between alternatives and chooses what gives him/her best satisfaction. This fact was also noted by Alagbe (2001), who citing the Law of marginal utility stated that â€Å"Consumers are rational and have the ability to measure the utility or satisfaction they derive from each commodity consumed, and given a total rationality consumers elect a combination of goods and services that will maximize their satisfaction†. This stresses the fact that consumers choose what will give them maximum satisfaction. The power of choice has numerous benefits for clients, including the fact that the client is frequently consulted by the provider or producer (Melville 1997). This also creates a relationship of partnership rather than the paternalistic one that had characterized the healthcare delivery system. The goal before all healthcare providers is to develop and maintain a client-centered service in order to provide quality service and ensure client satisfaction, more so as clients are becoming more knowledgeable and health conscious (Smeltzer and Bare 2000). Their interest was stimulated and sustained by the television, internet, newspapers and magazines other communication media and by political debates. Their increasing demand for quality care based on this increase in knowledge was however catalyzed by the consumers’ awareness campaigns of the 1960s and 1970s, which subsequently led to the formulation of the Patients’ Bill of Right. This will be reviewed later following a review of the historical background of consumerism. Historical background of consumerism The early 1960’s saw the American public agitating for quality service for every dollar spent. Most business executives regarded the agitation as transitory threats. The consumerists however continued and became extremely vocal in their criticisms and protests against escalating cost of services without corresponding improvement in the quality of goods. According to Alagbe (2001) in 1962, the American consumer movement received a major boost with a presentation to the congress of the consumers’ Bill of Rights; by President John F. Kennedy the bill contained four items namely, that the consumers should have: The right to safety: This refers to protection against products hazardous to health and life. The right to be informed: This refers to protection against fraudulent, deceitful or misleading information in advertising or elsewhere and by also providing people with facts necessary to make informed choices. The right to choose: This refers to assurance of reasonable access where possible to a variety of products and services at competitive prices with government regulations to assure satisfaction, quality and service at fair prices. The right to be heard: This refers to the right of redress with the assurance that the consumer’s interest will receive full and sympathetic consideration by government’s expeditious actions. Based on this the American Hospital Association in 1972 published a list of rights for hospitalized patients. The patients’ bill of rights was devised to inform patients about what they should expect from a caregiver-patient, and a hospital-patient relationship. The patients’ bill rights The patients’ Bill of Rights have strong implications for the healthcare worker, who is involved in independent, dependent and interdependent care of the patient. The care giver (Doctor, Nurse, Physiotherapist etc) form the most central and important part of the patients’ stay in the hospital. The care giver respecting patients’ right will ensure his satisfaction with care. Every healthcare worker therefore has a responsibility to ensure that the client’s right as enunciated by the Bill of Rights is always respected. The bill includes that, a patient has the right to considerate and respectful care. This implies that health services providers should consider such facts as individual preferences, developmental needs, cultural and religious practices and age differences in their care of the patient. S/he also has the responsibility of ensuring that their assistants offer the same level of care. The patient has the right to obtain from his physician, complete current information concerning his diagnosis, treatment and prognosis, in the terms that the patient can reasonably understand. When it is not medically advisable to give such information to the patient, the information should be made available to an appropriate and reliable person on his behalf. He has a right to know by name the physician, responsible for coordinating his care. The patient has the right to receive from his physician the information to give informed consent. Some patients may not want to know everything about them, so the care giver has the responsibility to explain to the client that it is their right to know all, as it is a legal requirement. This helps the patient appreciate his responsibility for his health. The average client also appreciates the honesty of these explanations in the long run, because he is being treated as a partner with decision power. The patient has the power to refuse treatment to the extent permitted by the law, and to be informed of the medical consequences of his action. It is difficult for healthcare workers to understand why clients refuse treatment that can benefit them, but this is a reality. Often, explaining in simple language the purpose solves the problem. If after the explanation of purpose and procedure, the patient still refuses, the care giver should remember that such action is the patients’ right. However, good planning of care that includes the patient in planning has tended to reduce the problem of refusing therapy. The patient has the right to consideration of his privacy. The patients’ right to privacy is readily violated on busy wards especially where there are no curtains as is the case in most government hospitals in many third-world nations because of the current economic crunch. Healthcare workers as patients’ advocates should ensure that their rights to privacy are respected. Efforts to ensure clients privacy should include having discussions with clients conducted in private areas not at their bedsides for all to hear. Also patients’ conditions should not be discussed in the hearing of other patients. Class assignments must not identify a patient by name or position. The patient has a right to expect all communications and records pertaining to his care to be treated as confidential. Patients’ charts should not be left to be read and discussed by unauthorized personnel. Laboratory result should be well documented and stored. Healthcare workers need to remind other aids that patients records are confidential and not to be discussed at home with friends and relatives. The patient has a right to expect that within its capacity, a hospital must make reasonable response to the request of a patient for services. Nurses are often in charge of coordinating services for the patient such as x-rays, appointments with specialists, such as physiotherapist, etc. these should be available and provided in the order that is convenient for the patient. Also in the event of a transfer, the nurse should emphasize this to the reference hospital. The client has the right to obtain information as to any relationship of his hospital to any other healthcare and educational institutions or hospital personnel. Sometimes hospitals are affiliated to or are owned by some religious organizations and universities; this has implications for the client care. He therefore has a right to be informed about it. The patient has the right to be advised if the hospital proposes to engage in, or perform human experimentation affecting his care or treatment. He has the right to refuse to participate in such research projects. Most clinical trials take place without the clients’ knowledge, or even when explained the language may be too technical for the client to understand. After explicit explanation, a client should be asked to sign a separate consent in addition to his consent for care if an experimental therapy is proposed to him. He can also withdraw at will without any reprisals. The patient has a right to refuse permission to any one to touch his body. His basic responsibility is to himself and not to the advancement of science or learning. A patient has a right to expect reasonable continuity of care. Healthcare must to continuous and of the same quality. A change in shift should not result in negligence. The patient has a right to examine and receive an explanation of his bill, regardless of the source of payment. In places where bills are paid by third parties and insurance, it is easy to assume that clients should not care about charges. The client has a right to receive explanations and demand for rational charges. The patient has a right to know what hospital rules and regulations apply to his conduct as a patient. Some hospital rules are very restrictive, however, if they are written down and given to patients, the patients are more likely to remember them. Patients’ have the right to be properly informed; having the booklets to review at his leisure time and reminding them of these rules will help compliance. It is important that a client has access to the bill of rights as the consumer’s access to the bill of rights ensures that he is able to demand for his rights. However as the patients’ advocate, the healthcare worker has a responsibility of ensuring that these rights are respected as provided. These rights ensure that the consumer/client’s basic needs are met. To guarantee this, Haskel and Brown (1998) recommended that hospitals should create a culture that focuses on patients. This, they argued will allow health workers to respond to patients’ needs and even go beyond their expectations. The Health care system determines the quality or services provided. Unfortunately today, healthcare financing is more economy driven than patient-centered. (World Bank Report, 2000). This portends a danger for client care and needs to be examined. Healthcare systems This can be defined as the organ that organizes and funds health care services. Its goal is to provide an optional mix of access, quality and cost. Kielhorn and Schulenburg (2000) identified three basic models of health care system. These are the â€Å"Beveridge† model, the public-private mixed model and the private insurance model. The differentiating factor appears to be the funding and the coverage. Beveridge Model This is funded through taxation and usually covers everybody who wishes to participate in the state. Countries using this model include United Kingdom, Canada, Demark, Finland, Greece and Norway; In this model healthcare budgets compete with other government spending priorities such as education, housing and defence. Consequently budget cuts and run away inflation lead to high costs of healthcare services. One of the resultant effects is shortage of healthcare professionals, like doctors, nurses, physiotherapists etc. Regrettably this is feared to have affected the quality of healthcare. For example, Ferlman (2000), after a poll conducted on 2,000 adults for the British medical association reported that, the number of people satisfied with the health service dropped to 58% as compared with 72% percent in 1998. The population who were â€Å"very dissatisfied† or â€Å"fairly dissatisfied rose from 17 percent to 28 percent This result may not be unconnected to the decline in the quality of healthcare services. Public Private Mix Mode This model is funded primarily by a premium-financed social mandatory insurance, it has a mix of private and public providers, which allows for more flexible spending on healthcare. (Kielhorn and Schulenburg, 2000). Participants are expected to pay insurance premium into competing non-profit funds and the physicians and hospital are paid through negotiated contracts. The funds can also be supplemented through additional voluntary payments. Countries that use this model according to Kielhorn and Schulenburg (2000) include France, Germany, Australia, Switzerland and Japan. Private Insurance Model This model exists exclusively in its pure form in the United State of America (USA). Healthcare there is funded through premium paid into private insurance companies. The health insurance is not mandatory, so most often people with low income and high-anticipated healthcare cost, like people with chronic diseases are often unable to afford insurance. This makes healthcare in this system selective and non-equitable. An estimated 15% of the population in USA where this model is practiced are said to be unable to have any insurance cover. (Kielhorn and Schulenburg, 2000). Any of these three basic healthcare funding models are utilized by most healthcare organizations to fund the healthcare delivery system. However due to the global changes occasioned by various factors healthcare organizational developments became necessary, in order to contain costs and ensure quality care. (Stanhope and Lancaster 1996: Yoderwise, 1999). The United Kingdom Health System In a bid to provide free healthcare services for all UK residents, National Health Service (NHS) was founded in 1948. Funds for running the NHS was got through general taxation and this fund is administered by the department of health. Essentially, consumers of healthcare services do not pay at the point of receiving the services. Apart from the NHS, Private healthcare providers also exist in the UK but the consumers of their services either pay at the point of service or through insurance. The NHS: Considerable changes have occurred in the structure of the NHS over time. There is however no considerable differences in the structure and functions of the NHS among the countries which make up the UK. In England for example, the department of health in collaboration with other regional bodies or agencies take charge of the overall strategy while the local branch of a particular NHS takes the key decisions about local healthcare. The secretary of state for health is the minister overseeing the NHS and he reports to or is accountable to the Parliament. The overall healthcare management is the duty of the department of health, which formulates and decides the direction of healthcare. England has about 28 strategic health authorities which are concerned with the healthcare of their regions. They are the intermediary between the NHS and Department of health. Types of trusts Local NHS are called Trusts and they provide primary and secondary healthcare. England has about 300 Primary care trusts and these altogether receive  ¾ of the total NHS budget. NHS Trusts: these are responsible for specialized patient care and services. They run most hospitals in the UK. There are different types of NHS trust: Acute trusts providing short term care e.g. accident and emergency care, maternity, x-rays and surgeries etc; Care trusts; mental health trusts and ambulance trusts. Foundation trusts: ownership of these trusts is by the local community, employees, local residents. Patients here have more power to shape their healthcare based on their perceived health needs to their satisfaction. Private Healthcare This sub-sector of the UK healthcare system is not as big as the NHS and does not enjoy similar structure of accountability as the NHS. They may be similar to the NHS in service provision but are not bound to follow any national treatment guideline and are not saddled with responsibility of the healthcare of the larger community. Regulation and inspection of healthcare system in the UK are carried out by a number of designated bodies. Some of these are the national institute for clinical excellence; the healthcare commission; the commission for social care inspection and the national patients’ safety agency. Community Satisfaction with Healthcare System World Bank (2000) identified three basic types of healthcare organizations providers in the healthcare system. These are: the market or for profit co-operations, the government, and the not for-profit organizations. The last group includes the mission hospitals run by religious and non-governmental organizations. For them their main objective is to provide quality care for the citizens. Although scarce resources often limit their efforts, they are reported to be providing quality care to clients within their means. (World Report, 2000). In Government run systems especially in many resource-constrained nations, the main complaint is the failure of the Government run systems, which are supposed to be the most equitable and cheapest system for providing care, is being run down for ideological reasons in some countries, (World Bank, 2000). This jeopardizes the availability of healthcare services to the individual, resulting in the client’s non-satisfaction with one. Lastly, are the for-profit co-operations. These, according to World Bank (2000) have problems of care and affordability, which parallel their profit. The affordability is noted to be most acute in the market-listed companies. This is because the prime objective of these groups entering the health market is to make profit from the sickness the most costly and least affordable healthcare providers. Unfortunately while share holders are getting profit the clients for whom health care is provided are receiving poor quality care. World Report (2000) documented declining care and increasing dissatisfaction with healthcare in most countries. The greatest dissatisfaction was reported in the market-based systems and when market placed systems replaced state funded ones. The market system in the USA, which was supposed to help the citizens, is criticized for deliberately exploiting them. Critics argued that the strong competitive measures encouraged, have destroyed the ethics of USA’s hospitals’ Samaritan culture and the professionals of the healthcare providers. Patients were reported to have had to suffer as a result. Equity was also said to have become a problem, as healthcare is no more available to all citizens. This was attributed to the effect of the market systems on the health care delivery service. The market based systems are also reported to have wide spread incidences of denial of care of patients, mis-use of patients for profit and neglect of the frail and vulnerable (World Bank, 2000). These were said to have occurred when profits were being earned and shared by corporate bodies to shareholders. Information from the market place were said to have revealed receptive marketing, and mis-information which covered up the misdeeds of the corporate bodies. In response proponents of the market system defended their policies and argued for its usefulness, and value in healthcare reforms. For examples Samuel (2000) argued that competition, a fall out of the market system encourages efficiency, reduces costs, enhances responses to consumer demands and favours innovations. Consumer empowerment, he stressed is one of the dividends of competitive healthcare systems. He added that introducing competition would provide consumers the freedom to choose between different services and different delivery mechanisms that meet their needs. It is also expected that this would increase their satisaction. Competitive pressures, Samuel (2000) pointed out will break down self-regulatory practices by service providers, developed essentially to serve their interest, so that clients interest will eventually be served. While the above argument is appreciated, it is also observed that the problem of equity is more profound here, as it appears that only the few that can afford quality care can get it. In the light of the what Alma Ata declaration of 1978, all nations have a responsibility and an obligation to attend to the health needs of all their citizens. It is obligatory to make healthcare available, accessible, affordable and acceptance to all. These places on the government of every nation the responsibility to ensure that there is equity in health care services distribution. In order to ensure this, countries like the United Kingdom entirely funded the National Health Service (Kielhorn and Schulenburg, 2000). As a result, even in the face of health care cuts and shortages the NHS clients were found to be very supportive of the system. (Walsh, 1999). In most other countries, clients have reacted to the healthcare system and services provided in various ways. In some places, they have responded with an observable move away from conventional medical care. This trend, most argue, can be traced to the high cost of the latter. There is also the argument that clients’ expectations are no longer met through conventional healthcare services. This is said to be so especially for clients with less serious disorders. For example, Manga (1993) found that clients were considerably less satisfied with medical physician’s management of their low back pain than chiropractic management of the same ailment. These observations, were also corroborated by Cherkin and Maccomak, (1989) and Harris Poll, (1994). Processes of a health service system The processes of a healthcare service system refer to the actual performance of the activities of care. Stanfeld (1992) identified two components of the processes. These are the activities of the providers of care and the activities of the population. Activities of health care providers Every interaction between an individual or community and a care provider begins with need or problem identification. Starfield (1992) stated that the problem recognition implies an awareness of the existence of situations requiring attention in a health context. Diagnosis, planning and intervention follows after that assessment, is carried out. Evaluation is done intermittently and the end of the intervention to determine if the original diagnosis, plan and interventions were appropriate and adequate for the recognized need. In nursing, models of care such as the nursing process are utilized to facilitate systematic and scientific provision of quality care and client satisfaction. Also care provided is guided by established institutional standards of care. Effective assessment of client’s needs and its resolution is expected to have an outcome of client satisfaction. It is therefore important that the healthcare provider’ intervention should be client centered, in order to achieve the set goal. Activities of the client People decide whether or not, and when to use the health care system (Starfield 1992). It is in coming in contact with the health care system that clients recognize what services are offered and the quality of the services offered. The clients’ experiences enable them to form their opinions, deciding if they are satisfied or not (Starfield 1992). The caring process involves the performance of the activities of car