The Positives And Negatives Of Pay For Performance Nursing Essay

The Positives And Negatives Of Pay For Performance Nursing Essay The purpose of this research essay will discuss aspects concerning the effects of pay-for-performance policies on quality improvement. The pay-for-performance policies are continually a debated issue concerning quality of care. This incentive program could open doors in a positive or negative way, but P4P, may lead to results of improving the quality of care; which the research in this essay will assess and analyse these perspectives. Also, reflect on pay-for-performance programs; will be a crucial aspect in the paper. Furthermore, the results that would show the successfulness of these programs, as well. In additional, do the P4P programs meet their goals and how effective they are will be share in the research essay. Other components, that will be mention such as the impact on quality improvement, unintended or negative consequences, and implications for cost containment. Introduction The purpose of this research essay is to discuss aspects of pay for performance from a positive and negative perspective. As the health sector, continue to move toward a positive path, in efforts to improve the quality of care. This quality issue has and will continue to affect many Americans patients nationwide in a positive or negative way, based on, the quality care they are receiving. Therefore, health care providers and managed care organizations (MCO) are encouraged by the monetary incentive programs, in order to give prestige quality of care (Anderson, Rice, Komininski, 2007; Laureate Education, 2009). The strong components of payment policies, such as pay-for-performance (P4P) are aspects of health care services and the influence of patients choice; in which led to quality initiatives (Hillman, 1991). In addition, the factors will help to assess the need of care for patients, and the health organization, which is a positive reinforcement of quality initiatives. For instances, an intention of the incentives program like (P4P) would reward high-quality of care and permit growth in the way of becoming more efficient and effective; when servicing clients with their care needs (Teitelbaum Wilensky, 2007). Also, this quality initiative will help providers to figure out what they need to do; in order to continue to improve quality care procedures on a proficient level. The next step in the pay-for-performance (P4P) policy will permit health organizations JCI (2010) to benefit in aspects of financial incentives; through organizational principles. Therefore, the organizational leaders would produce documents to offer a reliable outline to carry out these accountabilities. For instances, health care organizational leaders must examine the national and worldwide norms that consist of human-beings right, quality initiatives, and professional principles when forming the framework. This pay for performance quality initiatives of services for patients, could JCI (2010) examine access, convey, patient-centred, discharge regulations; correctly bill for services; and help in resolution of conflicts, which financial incentives and payments measures maybe negotiation in patient services (JCI, 2010). Pay-for- performance programs quality initiatives were organized by governmental; Young, Conrad, and Fallot (2007) also the private ownerships and organizations, in which support the aspects of quality performances. Author suggests there are over 100 incentive programs; that focus on quality initiatives and preventive care for consumers (Young, Conrad, Fallot, 2007). Research suggests; the centres for Medicare and Medicaid services (CMS) are one of organizations that started the pay-for- performance programs (Anderson, Rice, Kominski; Teitelbaum Wilensky, 2007). Author suggests there is a lot of evidence, which implies the pay-for-performance incentive program has improved the overall quality of care initiative (Kuhmerker Hartman, 2007). Also, there is evidence that Jarlier and Charvet-Protat (2000) pay- for-performance quality initiatives, are profitable and can save in the long term for all health care services. Nevertheless, there will always be various negatives issues of barriers that hinder the quality care Datz, (2012); Galvin (2006) progress and growth of stronger incentives for quality advantage. The approach of the pay-for-performance has features that involve the amount of the incentive payment that result into, additional incentives such as of education, patient satisfaction, organizational information technology abilities, health providers level of performance, and diagnostics sources (Young, Conrad, Fallot, 2007). Furthermore, special interest groups seemed to be a particular alarm about the barriers that relates to the less effective method of (P4P) incentive programs, which have to do with the lack of those who do not invest in the continue quality initiatives for the delivery of health care (Young, Conrad Fallot, 2007; Dudley Rosenthal, 2006). Pay-for-performance impacts vary stakeholders, which involves all parties such as, health organizations, government, payers, medical providers, public, and private sectors, so the investment in the aspects of quality initiatives is crucial to the care process. Research suggests some payment incentives programs like (P4P) purpose is for cost containment (IOM, 2001). Also, the negative aspect of the pay-for-performance; there is no clear intention concerning making sure quality care initiatives, or improvement plan, in which relates to this program. Also, there should be some initiatives developed, such as perspectives and goals, in order to improve the aspects of the incentive payment of the health care services; which to provide IOM (2001) higher quality care and to focus on cost containment (IOM, 2001). In summary The positive aspect of health care delivery service can certainly be more effective through the pay-for-performance incentive programs. Nevertheless, the effectiveness of sustainability through this incentives program it has to be a constant arrangement, in which rewards quality of care effectiveness. In addition, all parties involved must be willing to help improve quality policies and make this initiative one of the focal points for the (P4P) programs. These arrangements could consist of fair adequate payment for excellence managerial services and that applies to the care process; which relates to financial incentives. Furthermore, to make sure that (P4P) programs meets its attended goals is to have other primary sources for recognizing and assessments for the performance initiatives, such as the Joint Commission, National Committee for quality assurance, and other agencies (Dudley and Rosenthal, 2006). A priority focus is to motivate and promote standards and firmed bylaws, in ord er to continuous to improve and maintain the quality of care initiatives through aspects of accreditation and licensure, in which would be a great addition to the perspective of the (P4P). Sources Andersen, R. M., Rice, T. H., Kominski, G. F. (2007). Changing the U.S. health care system: Key issues in health services policy and management (3rd ed.). San Francisco, CA: Jossey-Bass. Classen, D. C., Pestotnik, S. L., Evans, R., Lloyd, J, F., Burke, J. P. (1997). Adverse Drug Events in Hospitalized Patients: Excess Length of Stay, Extra Costs, and Attributable Mortality. JAMA. 277(4), 301-306. Clemmer, T. P., Vicki, J. S., Thomas, A. O., Susan, D. H. (1999). Results of a Collaborative Quality Improvement Program on Outcomes and Costs in a Tertiary Critical Care Unit. Crit. Care Med, 27(9):1768-74. Conrad, D., Wickizer, T., Maynard, C., Klastorin, T., Lessler, D., Ross, A., Soderstrom, N., Sullivan, S., Alexander, J., Travis, K. (1996). Managing Care, Incentives and Information: An Exploratory Look Inside the Black Box of Hospital Efficiency. Health Services Research, 31(3), 235-59. Datz, T. (2012). No improvement in patient outcomes seen in hospitals with pay-for-performance programs. Health Insurance Law Weekly. Retrieved from: http://www.hsph.harvard.edu/news/press-releases/2012-releases/pay-for-performance-patient-outcomes.html Dudley, R. A. Rosenthal, M. B. (2006). Pay for Performance: A decision guide for purchasers. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from: http://www.ahrq.gov/qual/p4pguide.pdf Galvin, R. (2006). Pay-for-performance: Too much of a good thing? A conversation with Martin Roland. Health Affairs, 25, w412 w419. Hillman, A. L. (1991). Managing the Physician: Rules Versus Incentives. Health Affairs 10(4):138-46. Jarlier, A., Charvet-Protat, S. (2000). Can Improving Quality Decrease Hospital Costs? International Journal for Quality in Health Care, 12(2), 125-31. Joint Commission International, Inc. (2010). Joint Commission International Accreditation Standards for Hospitals. (4th ed.). Illinois, Chicago: Joint Commission International. Kuhmerker, K. Hartman, T. (2007). Pay-for-performance in state Medicaid programs: A survey of state directors and programs. The Commonwealth Fund. Retrieved October 24, 2012 from: http://www.commonwealthfund.org/Publications/Fund-Reports/2007/Apr/Pay-for-Performance-in-State-Medicaid-ProgramsA-Survey-of-State-Medicaid-Directors-and-Programs.aspx Laureate Education, Inc. (Executive Producer). (2009).  Health  Policy.  Access Challenges Baltimore, MD:  Author:  Ã‚  (Dr. Gerald Kominski and Jim Lott). Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. National Academy of Sciences. Young, G.J., Conrad, D.A., Fallat, A. (2007). Practical issues in the design and implementation of pay-for-quality programs. Journal of Healthcare Management, 52(1), 10-19.

John constable :: John constable

John constable What made Constable different from the majority of his contemporaries was his attitude towards the things that he saw. He was not, like so many other landscape artists, a conscious seeker of the picturesque. As an artist he was virtually self-taught and his periods of formal study amounted to little more than process of directive discipline. His real master was his own sensitive and perceptive eye (Peacock, 15). It was through a study of nature rather than by a study of academic principles that his artistic philosophy was evolved. It was at East Bergholt on the Suffolk side of the river Stour on 11 June 1776 that artist John Constable was born. The house where John was born is now disappeared, but its prosperous Georgian solidity exists for us in a number of his paintings (Peacock, 15). Golding, Jonh’s father, was a miller and the owner of water mills at Flatford and Dedham, and two windmills at East Bergholt (Taylor, 10). The Constables were a large family, John was the fourth of six children. Though much is not recorded of John’s first school experince , he was sent to Lavenham at age seven (Shirley, 39). There like most of the pupils, ill-used, he finished it in Dedham grammar school under a Dr. Thomas Grimwood. John did not do well in his studies to justify seeking a career in the church like his father had wished (Taylor, 11). In fact, Constable’s only record of excellence at Dedham was in penmanship, and so he was quickly directed into the family business, becoming locally kno wn as â€Å"the handsome miller† (Shirly, 39). For a year John worked in his father’s mills and so acquired first-hand knowledge of the miller ’s trade. In the mills what John learned probably stood him in a better stead that all the formal instruction in art he would ever receive (Peacock, 16). In 1796 he went on an apprenticeship in London. John apprenticeship to John Thomas Smith, a draughtsman and engraver, known as â€Å"Antiquity Smith†. Constable assisted by making sketches that might be used as subjects for his work. Golding Constable grew impatient and dismissed his son’s taste for painting as a young man’s whim, and with the need for help in the mills, Golding summons John back to Bergholt (Taylor, 17).

Fiat’s Entry Mode Into China

2. Fiat’s strategy: a. Entry mode: The main entry mode FIAT has been applying in China Market is joint venture. In 1995, FIAT tried to break into the Chinese market. Indeed it is the first host country of foreign investments, so China is an inescapable market. FIAT made an attempt to introduce there with a joint-venture with a local firm: NANJING in 1999. This Italian automaker quit the company in 2007 citing a lack of investment on the part of its Chinese partner. Probably the main problem in this alliance is the lack of confidence in the partner.Indeed, FIAT did not trust NANJING because given that the Italian company reduced the number of models given to the Chinese one for of stealing. The most important in business for Chinese people is the trust. Without it, it cannot work. The second joint venture is with Cherry Automobile Co. The joint venture has come to an end due to Fiat signing up with Guangzhou Auto and planning to invest 500 million USD into the Chinese market. U p till now, Fiat has been in a third joint venture with Guangzhou Auto to make cars for the Chinese market.The joint venture between the two companies will see each contribute â‚ ¬400 million towards building a new assembly plant in Changsha, Hunan province. The plant is expected to be operational by late 2011, and inital production is estimated to be in the region of 140,000 cars and 220,000 engines per year. b. Product line and revenue: In the past, Fiat seems to target the medium class by introducing the low price products. At first, Nanjing-Fiat produced and sold 24,000 vehicles in 2002, bringing a sales revenue of 2. billion yuan (US$280 million). Nanjing-FIAT produce four models: Fiat Palio, Fiat Palio Weekend, Fiat Siena, designed by IDeA and Fiat Perla the first model jointly designed by Fiat and Nanjing Fiat Automobile. Fiat had previously planned to invest 500 million euros in the joint venture over five years in a drive toward meeting the company's 2010 sales goal of 3 00,000 vehicles in China. Nanjing Fiat sold only 30,668 vehicles in 2006. After that, from 2007, when they sign the joint venture contract with Guangzhou Automobile Co. they invest euro400 million ($556 million), The plant initially will produce 140,000 cars and 220,000 engines a year, with the potential to increase to a maximum 250,000 cars and 300,000 engines a year, Fiat said. It seems fairly clear that Fiat will target the same young, â€Å"entry-level luxury† demographic. Considering they’re relatively new to the China market, and priced comparatively high for their petite size (particularly compared to their domestic Chinese counterparts).Fiat’s small cars and green technology are entirely applicable to the Chinese market. Fiat launch the Fiat 500 into the Chinese market, it is a small car that appear to certain niche buyers. According to our own internal estimates the Fiat 500 should be able to achieve sales of 700 to 10,000 units. Their goal is to set up the brand, we’re chasing branding value and not sales. The cars that will sell in big numbers will be our Chinese made cars from Guangzhou-Fiat.

Carta de invitación para sacar la visa de turista EE.UU

Las cartas de invitacià ³n se utilizan frecuentemente como parte de la documentacià ³n que se entrega a una embajada o consulado americano cuando se solicita una visa de turista para Estados Unidos. No es un documento necesario, pero sà ­ que es  frecuente  porque puede ayudar a que el oficial consular se decida aprobar la visa que se solicita. Pero es importante entender que, por sà ­ sola, la carta de invitacià ³n no es suficiente para obtener la visa, sino que es un elemento mà ¡s a tener en cuenta y para inclinar la balanza a favor del solicitante.   Asimismo, si no se presenta una carta de invitacià ³n eso no quiere decir que la visa no pueda obtenerse. En otras palabras, es un documento de presentacià ³n voluntaria que puede ayudar a obtener la visa. En este artà ­culo se informa sobre quià ©nes pueden escribir la carta de invitacià ³n, quià ©n es el destinatario de la misma, cuà ¡l es el formato adecuado y quà © documentos adicionales se pueden incluir en apoyo de la veracidad de la carta. Quià ©nes pueden escribir la carta de invitacià ³n para sacar la visa de turista La carta de invitacià ³n no la escribe la persona que solicita la visa, sino otra distinta que es a quien se va a visitar en Estados Unidos. En este punto, es fundamental el estatus migratorio de dicha persona en Estados Unidos ya que determina si tiene capacidad para redactar este tipo de documento. Pueden hacerlo las siguientes personas: En primer lugar, los ciudadanos americanos, que deberà ¡n acreditar tal situacià ³n mediante documentos como copia del pasaporte americano o del certificado de nacimiento en Estados Unidos. En realidad, cualquier documento oficial que pruebe su condicià ³n de estadounidenses. En segundo lugar, los residentes permanentes legales. En este caso, deberà ¡n incluir con la carta una fotocopia legible por los dos lados  de su tarjeta de residencia, tambià ©n conocida como green card. Y, en tercer lugar, pueden redactar la carta de invitacià ³n los extranjeros que se encuentran legalmente en Estados Unidos  porque tienen una visa vigente. En este caso  deberà ¡n adjuntar a la carta de invitacià ³n su certificado original de nacimiento, fotocopia de todas las hojas de su pasaporte y, si su visa estuviera en otro ya expirado, tambià ©n incluir copias de à ©ste. Si la visa està ¡ expirada pero se ha pedido su renovacià ³n, una copia de dicha peticià ³n. Ademà ¡s de esos documentos los extranjeros con visas L1 de transfer entre sedes de una misma empresa  o H1  para profesionales deberà ¡n incluir su à ºltimo I-797, una carta que reciben del Servicio de Inmigracià ³n y Ciudadanà ­a (USCIS, por sus siglas en inglà ©s). Por otro lado,  los migrantes que està ©n en situacià ³n de ajuste de estatus pendiente  se recomienda que envà ­en junto a la carta de invitacià ³n una copia del documento que pruebe tal situacià ³n, como por ejemplo el permiso de trabajo, conocida en inglà ©s como  EAD card. Por à ºltimo, tener en consideracià ³n que si la invitacià ³n se hace a favor de un familiar por razà ³n de matrimonio, como por ejemplo un suegro o un cuà ±ado, deberà ¡ acompaà ±arse la carta de invitacià ³n con una fotocopia del certificado de boda de la persona que invita y fotocopia del pasaporte de su marido o de su mujer. Por ejemplo, si un ciudadano americano està ¡ casado con una mexicana y quiere invitar a su suegra a que les visite en EEUU con ocasià ³n del bautizo de su hijo deberà ¡ incluir no sà ³lo prueba de su ciudadanà ­a estadounidense, sino tambià ©n de estar casado con su esposa mexicana y copia del pasaporte de à ©sta. Finalmente, los migrantes indocumentados no deben  escribir una carta de invitacià ³n. No facilitarà ­a la solicitud de visa del solicitante y, por otro lado, servirà ­a para revelar la situacià ³n de indocumentado de dicho migrante y datos importantes como, por ejemplo, dà ³nde vive. Ademà ¡s, si una persona invita a sus padres a visitar Estados Unidos y esos padres tienen mà ¡s hijos en ese paà ­s, deberà ¡ tambià ©n acreditarse el estatus legal de todos los hijos que viven en el paà ­s y no sà ³lo el del hijo que extiende la invitacià ³n. Destinatario de la carta de invitacià ³n para sacar la visa de turista La carta se envà ­a a la persona que se desea invitar y  no al consulado  o embajada que debe tramitar el visado. Este punto da lugar a mucha confusià ³n ya que es comà ºn creer que el consulado es el destinatario de esta carta. Sin embargo, esa creencia es equivocada. En todos los casos, la persona que invita debe enviar la carta a la persona invitada. Formato de la carta de invitacià ³n para la visa de turista para EE.UU. No hay una forma determinada que diga expresamente cà ³mo tiene que ser la carta. Es decir, cada persona puede escribir lo que quiera, pero utilizando un lenguaje formal, respetuoso y claro. Ademà ¡s, deberà ­a seguir las siguientes pautas: Estar escrita en inglà ©s.  Incluir la fecha en la que se escribeNo olvidarse de firmarIdentificar expresamente  a la persona que se quiere invitar. Por ejemplo, si son padre e hijo, hermanos o simplemente amigos.Redactarla en una computadora e imprimir el documento. Documentacià ³n adicional que deberà ­a aà ±adirse a la carta de  invitacià ³n Se recomienda enviar documentacià ³n que pruebe la capacidad econà ³mica de la persona que invita a un extranjero a visitar EEUU y puede ser uno o varios de los documentos siguientes: Copia de la declaracià ³n de impuestos federales de los à ºltimos tres aà ±os. Si no se tienen tantos aà ±os declarados, los que se tengan. Y tambià ©n copias de los W2. Si se es empresario por cuenta propia, enviar prueba de tal situacià ³n y cuentas bancarias corporativas. Tambià ©n serà ­a apropiado enviar una copia de los extractos bancarios de al menos los à ºltimos seis meses. Deben demostrar cierta fortaleza econà ³mica. Otra opcià ³n es incluir una carta en papel oficial de la empresa que emplee a la persona que hace la invitacià ³n y que identifique al empleado, desde cuà ¡ndo trabaja allà ­, cuà ¡l es su salario y si su contrato es temporal o no. Finalmente, tambià ©n es và ¡lido una carta del banco en papel oficial en el que se diga cuà ¡ndo la persona que redacta la carta de invitacià ³n abrià ³ la cuenta en una de sus oficinas, cuà ¡nto dinero se deposità ³ el aà ±o anterior y el saldo en el momento actual. Ejemplos de cartas de invitacià ³n Aquà ­ se puede consultar  ejemplos de cartas de invitacià ³n. Està ¡n en inglà ©s porque es el idioma en el que deben escribirse.   Consejos migratorios para turistas en Estados Unidos No todos los extranjeros necesitan sacar una visa de turista para ingresar a Estados Unidos. Y es que los ciudadanos de los paà ­ses acogidos al Programa de Exencià ³n de Visas  pueden ingresar solicitando una Autorizacià ³n Electrà ³nica conocida como ESTA si llegan al paà ­s por avià ³n o llenando el formulario I-94 si llegan por barco o se presentan en una frontera terrestre. Como no necesitan visa, tampoco precisan de una carta de invitacià ³n. Por à ºltimo, destacar que las visas de turista se pueden negar por muchas causas, pero que pueden resumirse en dos grandes categorà ­as: por ser inadmisible para ingresar a Estados Unidos y/o por ser inelegible.   La causa mà ¡s comà ºn de rechazo de la aprobacià ³n de la visa de turista es que el oficial consular considere que no se ha probado mà ¡s allà ¡ de toda duda que el solicitante tiene lazos familiares y econà ³micos fuertes en su paà ­s de origen o de residencia habitual. Carga pà ºblica En relacià ³n a la negacià ³n de las visas, el gobierno de Donald Trump ha creado unas nuevas reglas por las que se puede rechazar cualquier peticià ³n de visa y de residencia por causa de carga pà ºblica. Para ello se tienen en cuenta factores diversos como edad, enfermedad, seguro mà ©dico, situacià ³n familiar, ingresos, estudios, historial laboral, etc. Està ¡ nueva polà ­tica no puede, al menos por el momento, implementarse por USCIS o por el Departamento de Seguridad Interna, a la espera de una decisià ³n judicial. Sin embargo, el Departamento de Estado sà ­ puede aplicarla. En otras palabras, desde el 15 de octubre de 2019 embajadas y consulados de EE.UU. pueden negar por razones de carga pà ºblica visas de inmigrante y tambià ©n de no inmigrante, como turista, estudiante o trabajo.. Este es un artà ­culo informativo. No es asesorà ­a legal.