Primary objective of management

Primary objective of management Introduction Milton Friedman’s claim that management’s main objective should be to expand shareholder wealth is misleading. It does not fully embrace certain business dynamics such as shareholder roles, obligations to other stakeholders, the moral minimum, effectiveness of the legal system, as well as sustainability of nonfinancial interests.Advertising We will write a custom essay sample on Primary objective of management specifically for you for only $16.05 $11/page Learn More The essay will discuss shareholder roles, the legal system, existence of other stakeholders, morality and plausibility of other objectives. More than shareholder wealth Scholars know Milton Friedman for believing in free enterprise; consequently, it is not a surprise that he advocated for the primacy of shareholder wealth (Wilcke 2004). He believed that such a goal was symptomatic of the freedoms and rights that cause voluntary exchange and economic success. However, Mi lton and his supporters may have ignored certain crucial elements of business that do not relate directly to shareholder wealth. First, Milton assumed that managers and shareholders are entirely separate entities (Husted Salazar 2006). In today’s business arena, entrepreneurs have so many business structures to choose. Some entrepreneurs may form limited liability firms, public corporations or partnerships. Depending on the structure chosen, a manager may also double as a shareholder and thus perform duties that extend beyond Friedman’s narrow limitation of management’s duties. Friedman’s interpretation of their role was a contractual obligation that placed them at the mercy of their shareholders (Wilcke 2004). He did not consider the fact that some managers may sometimes perform executive decisions on the basis of their equity in the firm. Some of them may decide how capital investments occur or engage in public relations. This implies that managers can be concerned with more than just shareholder’s value if they have practical ownership of an organisation. In this light, management has another key objective that it ought to consider; social performance (Husted Salazar 2006). As such, one can question Friedman’s assertions about the primary objective of management.Advertising Looking for essay on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More One can also criticise Milton’s ideas based on the roles and responsibilities of shareholders, as well. In Freidman’s articles, he assumed that shareholders were permanent, or at least interested in the long term interest of the firm. However, this is not always true; plenty of investors can buy and sell shares without attending shareholder meetings or weighing in managerial/ operational activities (Nesteruk 1990). Most stock markets in the world have stockbrokers who do not consider other in tricate aspects of a business before buying their stock. Theirs is to dwell on price and the immediate benefits they can get from the deal (Nesteruk 1990). As a result, company shareholders can change drastically within a short time. Management would be confused about whose wishes to follow if they focused solely on these shareholders’ interests. The internet age has made stock trading a common practice for inexperienced and short term traders. Companies would be overwhelmed if they tried to meet the needs of people who can come and go as they wish. Managers need to focus on more sustainable approaches to business through a shift to more long-term stakeholders (Wilcke 2004). This unpredictable behaviour of shareholders makes Friedman’s arguments difficult to practice, thus rendering them invalid. The assumption that shareholders’ needs come first because they are the owners of the business is also not consistent with today’s practices (Ghoshal 2005). Mode rn firms have complicated ownership arrangements at any one time. Unlike a real property owner who purchases and uses property as he or she sees fit, business owners (shareholders) do not have a claim over certain corporate asserts. Theoretically, one can treat shareholders as owners, but when one analyses shareholders’ duties carefully, one finds that shareholders do not fit into the ownership mould perfectly (Ghoshal 2005). First, because shareholders appoint managers to act on their behalf and make decisions for them, then managers may have significantly more discretionary power in the company than shareholders. Ownership and control are totally separate in the business environment. This means that shareholders do not possess all the characteristics required to grant them ownership. Shareholders do not make an actual impact on corporate decisions. They are merely beneficiaries of proper decisions. Consequently, their needs should not be the only point of focus for manageme nt.Advertising We will write a custom essay sample on Primary objective of management specifically for you for only $16.05 $11/page Learn More The issue of morality also neutralises this scholar’s arguments on the primary objective of business. If businesses follow Friedman’s assertions about focusing solely on profitability, then they would be reducing corporate morality to nothing more than their legal obligations. If their shareholder needs cause consequences that the law does not govern, then corporations would not be concerned about them. This perspective gives company executives too much power. According to Freidman, an executive who acts as a bureaucratic machine may make as much money as possible so long as the person does not act deceitfully or break the law (Cosans 2008). Friedman’s views fail to encompass the complex nature of morality and thus miss out on an important aspect of business objectives. When Freidman made his ass ertions about the primary objective of management, he had a lot of confidence in the legal system as well as the marketplace. His assumption was that the market had its own way of correcting imbalances in business. Furthermore, the law would ensure that business entities meet their respective obligations. However, the marketplace and the law have numerous flaws that allow disreputable managers to go about their business; this makes Milton’s theory shaky (Post 2003). One of the flaws lies in the degree of punishment that a corporate manager is eligible to when he or she acts wrongfully. Most of the time, judges will expect companies to pay only small amounts of money for their mistakes. Furthermore, law enforcers do not hold managers personally accountable during punishment. As if this is not enough, regulatory schemes designed to protect entities in business are sometimes inconsistent and difficult to implement. This means that management may get away with unfair conduct. Eve n the inherent nature of these laws impedes their effectiveness. Sometimes laws can become so complicated that managers themselves are not sure whether they should follow the law or not. Legislators are in charge of creating these laws, and sometimes a number of them may pursue their own interests when enacting them (Post 2003). Businesses must then surrender control to these self-seeking legislators. Since all the above flaws exist in the development of legal mechanisms, then one must question the ability of the system to protect business interests effectively. The law itself is not adequate enough to ensure that corporate managers behave responsibly. Therefore, companies must take it upon themselves to become socially responsible.Advertising Looking for essay on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More This implies that they should not merely focus on maximisation of shareholder interests as their sole objective. Friedman’s assertions rested on the premise that the marketplace and the law were enough to regulate behaviour, yet this is not true. Unless companies have their own sense of responsibility, then financial prosperity alone will not be adequate. Management’s primary objective differs from Milton’s assertions because managers are not responsible to company owners alone. Employees and customers are other stakeholders that management owes an allegiance (Ghoshal 2005). A firm may choose to increase its wage bill or shrink its working hours purely for noneconomic reasons. This may be done in order to foster a sense of belonging with the organisation. Firms may choose to implement environmentally friendly work policies so as to foster a sustainable business environment; these are all illustrations of CSR. Corporate responsibility, therefore, becomes a crucia l part of conducting business. It implies that profit seeking may not be the primary objective (Wilcke 2004). When management merely focuses on profit maximising activities for shareholders, then it reduces itself to a short-sighted entity. If a company chooses to increase work days for employees, it may not be serving shareholder interests, but it will work towards improvement of the business climate. Corporate social responsibility is a response to the uncertainties that companies have to deal with in this highly dynamic, interconnected and technologically advanced world (Van Beurden and Gossling 2008). A relationship exists between long term profitability and business interests. Smith (2003) explains that companies can easily avoid legal sanctions if they embrace corporate social responsibility. They can also gain sustainable advantage if they do the same. Employees now look for firms with strong values. If a business has a strong belief in CSR, then it can gain sustainable advan tage over its peers through sourcing of better employees. Smith (2003) also adds that companies, which focus on other stakeholders other than shareholders, have the benefit of attracting exceptional talent. They can also enhance their business reputations. These are long term objectives that cannot be achieved if managers merely focus on expansion of shareholder wealth. In line with the latter point, a company owes allegiance to more people than just the shareholders. Customers’ demands are just as critical as any other expectations from share holders (Van Beurden and Gossling 2008). Buyers now expect firms to engage in sustainable business practices (Smith 2003). In other words, they require them to be competent corporate citizens. Since companies are crucial entities in society, then they need to embrace their responsibilities. They now know about business operations and demand more from various firms. For example, customers will research about the sourcing practices of a c ompany, such as Mecca Espresso quite seriously. If they realise that the company gets its coffee from countries which use child labour, then they may boycott the company’s products. Alternatively, if a clothing franchiser like Gucci employs sweatshop labour to produce its items, then customers may lobby against the use of their products. In this regard, social actions are just as significant as financial success to a corporation. In fact, rising consumer expectations have caused most companies to expand their primary objectives from financial ones to social ones (Van Beurden and Gossling 2008). Firms can enjoy the benefit of having a loyal consumer base if they do more than maximisation of shareholder wealth. The enlightenment of consumers has caused buyers to become crucial determinants of corporate policy, thus becoming other contributors to the objectives of doing business. Counters to Friedman’s critics believe that shareholders are different from employees and cus tomers, so equal treatment should not be expected (Post 2003). These advocates of shareholders’ interests affirm that, unlike suppliers or workers, whose contracts commit them to the company, shareholders have no such arrangements to protect them. They add that contracts are always subject to renewal thus allowing these stakeholders to renegotiate the terms of their agreement (Shaw 2009). Privileges accorded to other entities neutralise the benefits associated with being shareholders (Post 2003). However, what these advocates of Friedman’s theory do not realise is shareholders have privileges that other groups do not possess (Post 2003). Shareholders can appoint directors as they see fit. Furthermore, they can sell their shares and abandon a certain company if its performance dissatisfies them. Employees cannot jump from one firm to another as easily as shareholders do because jobs are hard to get. Suppliers have minimal control over their clients’ activities. O ther stakeholders do not posses the same rights that shareholders possess; consequently, management should not try to compensate for their lack of contractual coverage by making shareholder interests their primary objective. Failure to acknowledge other stakeholders in the business environment may cause companies to engage in business practices that have adverse consequences in society. This is because firms may focus only on finance and ignore other equally vital components of business, such as ethics. All firms have a moral minimum that they must uphold in business (Smith 2003). For example, obsession with profit seeking among companies contributed to the global recession. Organisations were willing to perform extreme acts in order to expand shareholder wealth (Bejou 2011). Many of these companies got carried away by short terms gains and failed to think about the long term repercussions of their actions. It was this short-sightedness that eventually led to their demise and distur bances in society, as well. Companies owe their communities some degree of allegiance (Nesteruk 1990). It is also in a firm’s best interest to take care of its community in order to enhance sustainability. Failure to acknowledge the importance of this group may eventually cause unwanted effects upon the business entity. For instance, some companies generate immense profits and hand out generous bonuses to their executives. However, by years end, these firms have also left minimal rewards to their constituents. Some of them have had to close down their businesses owing to the frustrations of their employees or other stakeholders (Bejou 2011). Corporate social responsibility provides a much needed balance in the corporate world because it gives companies a human side. If all organisations were to stick to Milton Friedman’s assertions about financial obligations, they would become cold and uncaring. Businesses would become nothing more than money-making machines with litt le concern for the humans that are the real purpose of the organisations existence. If companies only dwelt on maximisation of shareholder wealth, they would not act with integrity or follow the principles of corporate governance. At least, companies ought to prevent social injury, and when it has occurred, they should try to correct it (Smith 2003). Friedman’s perspective does not encompass the importance of business growth or innovation. Growth has the potential to enhance company profits, as well as society’s wellbeing in general. Therefore, it is smarter to seek growth as an objective rather than shareholder wealth alone (Ahlstrom 2010). A company that frequently innovates will introduce the market to cutting edge products; as a result, the company will become financially successful and also provide numerous benefits to the market. Social goals such as creation of new jobs and generation of enormous profits in business are just some of the many benefits of business growth and innovation. Essentially, communities with highly innovative firms tend to experience better standards of living over time (Ahlstrom 2010). Even economic growth can occur in a country if businesses concentrate on growth as a primary objective; a company that accurately illustrates this point is US Steel. It was the leading steel maker in the US during the early 1990s. At the time, smaller steel mills introduced an innovation that entailed the use of mini mills. It was a revolutionary product that pressured US Steel into adopting their mini mills. Accountants who believed in Freidman’s concerns for financial gain advised the company against it. They instead told them to dwell on their respective upmarket clientele. At the time, the stock market appeared to reward US steel through better equity rewards. However, with time, the smaller entrants began improving their mini mills and eventually altered US Steel’s dominance of the upmarket category. The company fai led to embrace growth and innovation, and this led to attrition of its market share (Ahlstrom 2010). One may assert that their failure stemmed from too much emphasis on profitability and minimal regard for innovation. More effective primary objectives like striving for business growth and innovation exist. Companies would put themselves in a greater position to succeed if they pursued this goal instead of focusing on profitability alone. Perhaps another way one can know that Milton Freidman’s assertions are not all encompassing is through case studies. Practical cases of social responsibility and financial success prove that profitability is not the only objective for businesses. Some of the most profitable organisations are also some of the most sustainable. This implies that they are not merely concerned about shareholders’ wealth. Firms like Coca Cola, Honda, and Adidas are among the most internationally sustainable institutions, yet they still satisfy shareholder n eeds by yielding substantial results (Jensen 2002). Their success is indicative of the fact that companies no longer see shareholder needs as their only objective. These firms have embraced and practiced obligations to other entities. Conclusion Companies can be profitable but still engage in wrong decisions; it is not enough to dwell on financial returns exclusively. Basing one’s decision solely on profits will not guarantee social responsibility, yet the phenomenon is imperative both for the benefit of society and business. Furthermore, a firm has several constituent groups such as suppliers, employees, communities and clients whose needs ought to be acknowledged. Companies can get a greater competitive advantage if the dwelt on more than their shareholders’ needs. A balance between a firm’s needs and others’ needs ought to be maintained in order to foster a degree of maturity in the industry. Opponents to Milton Friedman do not disregard the importance of financial success within an organisation; however, they do not think that it is the only plausible objective. Focusing on other objectives, in addition to shareholder needs, leads to more sustainable results. References Ahlstrom, D 2010, ‘Innovation and Growth: How Business Contributes to Society’, Academy of Management, 7 August, pp 11-24. Bejou, D 2011, ‘Compassion as the New Philosophy of Business’, Journal of Relationship Marketing, no. 10, pp 1-6. Cosans, C 2009, ‘Does Milton Friedman Support a Vigorous Business Ethics?’ Journal of Business Ethics, no. 87, pp 391-399. Ghoshal, S 2005, ‘Bad management theories are destroying good management practices’, Academy of Learning and Education, vol. 4, pp 75-91. Husted, B Salazar, J 2006, ‘Taking Friedman Seriously: Maximising Profits and Social Performance’, Journal of Management Studies, vol. 43 no.1, pp 76-91. Jensen, M 2002, ‘Value maximisation, stakeholder theory and the corporate objective function’, Business Ethics Quarterly, vol. 12, pp. 235-247. Nesteruk, J. 1990, ‘Persons, property, and the corporation: A proposal for a new paradigm’, DePaul Law Review, vol. 39, pp. 543-565. Post, F 2003, ‘A response to the social responsibility of corporate management: A classical critique’, Business Law, vol. 18 no. 1, pp 80-88. Shaw, W 2009, ‘Marxism, Business Ethics, and Corporate Social Responsibility’, Journal of Business Ethics, vol. 86, pp 565-576. Smith, C 2003, ‘Corporate Social Responsibility: Whether or How?’ California Management Review, vol. 45 no. 4, pp 52-76. Van Beurden, P Gossling, T 2008, ‘The Worth of Values – A Literature Review on the Relation Between Corporate Social and Financial Performance’, Journal of Business Ethics, vol. 82, pp 407-424. Wilcke, R 2004, ‘An Appropriate Ethical Model for Business and a Critique of Milton Friedmanâ€⠄¢s Thesis’, The Independent Review, vol. 9 no. 2, pp 187-209.

Spains American Colonies and the Encomienda System

Spains American Colonies and the Encomienda System In the 1500s, Spain systematically conquered parts of North, Central and South America as well as the Caribbean. With native governments such as the efficient Inca Empire in ruins, the Spanish conquistadors  needed to find a way to rule their new subjects. The encomienda system was put in place in several areas, most importantly in Peru. Under the encomienda system, prominent Spaniards were entrusted with native communities. In exchange for native labor and tribute, the Spanish lord would provide protection and education. In reality, however, the encomienda system was thinly-masked slavery and led to some of the worst horrors of the colonial era. The Encomienda System The word encomienda comes from the Spanish word encomendar, meaning to entrust. The encomienda system had been used in feudal Spain during the reconquest and had survived in some form ever since. In the Americas, the first encomiendas were handed out by Christopher Columbus in the Caribbean. Spanish conquistadors, settlers, priests or colonial officials were given a repartimiento, or grant of land. These lands were often quite vast. The land included any native cities, towns, communities or families that lived there. The natives were supposed to provide tribute, in the form of gold or silver, crops, and foodstuffs, animals such as pigs or llamas or anything else the land produced. The natives could also be made to work for a certain amount of time, say on a sugarcane plantation or in a mine. In return, the owner, or encomendero, was responsible for the well-being of his subjects and was to see to it that they were converted and educated about Christianity. A Troublesome System The Spanish crown reluctantly approved the granting of encomiendas because it needed to reward the conquistadors and establish a system of governance in the newly-conquered territories, and the encomiendas were a quick-fix that killed both birds with one stone. The system essentially made landed nobility out of men whose only skills were murder, mayhem, and torture: the kings hesitated to set up a New World oligarchy which could later prove troublesome. It also swiftly led to abuses: encomenderos made unreasonable demands of the natives who lived on their lands, working them excessively or demanding tribute of crops that could not be grown on the land. These problems appeared quickly. The first New World haciendas, granted in the Caribbean, often had only 50 to 100 natives and even on such a small scale, it wasn’t long before the encomenderos had virtually enslaved their subjects. Encomiendas in Peru In Peru, where encomiendas were granted on the ruins of the rich and mighty Inca Empire, the abuses soon reached epic proportions. The encomenderos there showed an inhuman indifference to the suffering of the families on their encomiendas. They did not change the quotas even when crops failed or disasters struck: many natives were forced to choose between fulfilling quotas and starving to death or failing to meet quotas and facing the often-lethal punishment of the overseers. Men and women were forced to work in mines for weeks at a time, often by candlelight in deep shafts. The mercury mines were particularly lethal. During the first years of the colonial era, Peruvian natives died by the hundreds of thousands. Administration of the Encomiendas The owners of the encomiendas were not supposed to ever visit the encomienda lands: this was supposed to cut down on abuses. The natives instead brought the tribute to wherever the owner happened to be, generally in the larger cities. The natives were often forced to walk for days with heavy loads to be delivered to their encomendero. The lands were run by cruel overseers and native chieftains who often demanded extra tribute themselves, making the lives of the natives even more miserable. Priests were supposed to live on the encomienda lands, instructing the natives in Catholicism, and often these men became defenders of the people they taught, but just as often they committed abuses of their own, living with native women or demanding tribute of their own. The Reformers While the conquistadors were wringing every last speck of gold from their miserable subjects, the ghastly reports of abuses piled up in Spain. The Spanish crown was in a tough spot: the royal fifth, or 20% tax on conquests and mining in the New World, was fueling the expansion of the Spanish Empire. On the other hand, the crown had made it quite clear that the Indians were not slaves but Spanish subjects with certain rights, which were being flagrant, systematically and horrifically violated. Reformers such as Bartolomà © de las Casas were predicting everything from the complete depopulation of the Americas to the eternal damnation of everyone involved in the whole sordid enterprise. In 1542, Charles V of Spain finally listened to them and passed the so-called New Laws. The New Laws The New Laws were a series of royal ordinances designed to halt the abuses of the encomienda system, particularly in Peru. Natives were to have their rights as citizens of Spain and could not be forced to work if they did not want to. Reasonable tribute could be collected, but any additional work was to be paid for. Existing encomiendas would pass to the crown upon the death of the encomendero, and no new encomiendas were to be granted. Furthermore, anyone who abused natives or who had participated in the conquistador civil wars could lose their encomiendas. The king approved the laws and sent a Viceroy, Blasco Nà ºÃƒ ±ez Vela, to Lima with clear orders to enforce them. Rebellion The colonial elite was livid with rage when the provisions of the New Laws became known. The encomenderos had lobbied for years for the encomiendas to be made permanent and passable from one generation to another, something the King had always resisted. The New Laws removed all hope of perpetuity being granted. In Peru, most of the settlers had taken part in the conquistador civil wars and could, therefore, lose their encomiendas immediately. The settlers rallied around Gonzalo Pizarro, one of the leaders of the original conquest of the Inca Empire and brother of Francisco Pizarro. Pizarro defeated Viceroy Nà ºÃƒ ±ez, who was killed in battle, and basically ruled Peru for two years before another royalist army defeated him; Pizarro was captured and executed. A few years later, the second rebellion under Francisco Hernndez Girà ³n took place and was also put down. End of the Encomienda System The King of Spain almost lost Peru during these conquistador uprisings. Gonzalo Pizarros supporters had urged him to declare himself King of Peru, but he refused: had he done so, Peru might have successfully split from Spain 300 years early. Charles V felt it prudent to suspend or repeal the most hated aspects of the New Laws. The Spanish crown still steadfastly refused to grant encomiendas in perpetuity, however, so slowly these lands reverted to the crown. Some of the encomenderos managed to secure title-deeds to certain lands: unlike the encomiendas, these could be passed down from one generation to the next. Those families that held land would eventually become the native oligarchy. Once the encomiendas reverted to the crown, they were overseen by corregidores, royal agents who administered crown holdings. These men proved to be every bit as bad as the encomenderos had been: corregidores were appointed for relatively brief periods, so they tended to squeeze as much as they could out of a particular holding while they could. In other words, although the encomiendas were phased out eventually by the crown, the lot of the native workers did not improve. The encomienda system was one of the many horrors inflicted on the native people of the New World during the conquest and colonial eras. It was essentially slavery, given but a thin (and illusory) veneer of respectability for the Catholic education that it implied. It legally allowed the Spaniards to work the natives literally to death in the fields and mines. It seems counter-productive to kill off your own workers, but the Spanish conquistadors in question were only interested in getting as rich as they could as quickly as they could: this greed led directly to hundreds of thousands of deaths in the native population. To the conquistadors and settlers, the encomiendas were nothing less than their fair and just reward for the risks they had taken during the conquest. They saw the New Laws as the actions of an ungrateful king who, after all, had been sent 20% of Atahualpas ransom. Reading them today, the New Laws do not seem radical - they provide for basic human rights such as the right to be paid for work and the right to not be unreasonably taxed. The fact that the settlers rebelled, fought and died to fight the New Laws only shows how deeply they had sunk into greed and cruelty. Sources: Burkholder, Mark and Lyman L. Johnson. Colonial Latin America. Fourth Edition. New York: Oxford University Press, 2001. Hemming, John. The Conquest of the Inca London: Pan Books, 2004 (original 1970). Herring, Hubert. A History of Latin America From the Beginnings to the Present. New York: Alfred A. Knopf, 1962 Patterson, Thomas C. The Inca Empire: The Formation and Disintegration of a Pre-Capitalist State.New York: Berg Publishers, 1991.

In these papers there are alot of difficult words and complicated Essay

In these papers there are alot of difficult words and complicated sentences , So please replace them by use simple words and simple sentences - Essay Example of leading green campus initiatives†; and emphasizing that â€Å"successful application of these approaches requires a high competency in listening, communication, relationship building, vision development, responsiveness and continuous strategic adaptation† ; among others. The author likewise explained the basic nature of universities that provided the reasons for current inability to invite widespread campus involvement on the subject. The theories and concepts learned from the reading could be applied in one’s role as administrator and educational leader through suggesting policies for environmental protection and conservation programs within the university level. As stressed, wide-scale involvement or campus participation on environmental programs should be taught at the whole organizational level and across different cultures. Also, it was stated that organizational change would be most effective if all academic personal share the same commitment to environmental preservation and conservation. One believes that through encouraging the participation and involvement of various persons in a campus setting could be difficult. However, the task is not impossible. It just requires commitment, dedication, and perseverance from administrators and educational leaders to encourage student involvement and to deeply establish the need to focus on environmental protection and social responsibility by starting with one’s personal action, guidance, and direction. This article is one of the greatest works that discusses the cultural, social, economic and political nature of colleges. In this respect it explores the possible issues that the administrators should consider for them to effectively run these institutions. The conflict resolution is well discussed in this article and mediation is quoted as the most favorable remedial approach. various arguments that point out how the administrators can formulate appropriate conflict resolution and manage the student

History Essay Example | Topics and Well Written Essays - 1500 words - 5

History - Essay Example Globalization is a continuous process that is yet to be realized in some developing nations. However, historians believe that it began in Europe, during the BCE. This discourse is about the history and the demand among other relevant aspects of globalization. History records that the earliest globalizations were realized when there was need to expand the trade links and capacities between two major trading partners, namely Indus and the summer during the 3rd millennium B.C.E. This occurred during the Hellenistic era, associated with the introduction of Greece culture into commercialized zones like India and Spain among others. Some historical records that Alexandria is among the first cities to embrace globalization, even though others believe it adopted globalization few decades after the initial globalization was recorded. Greece main force to expand its operations and trade with other regions was the issue of importing wheat among other major raw materials. The commodity was entir ely transported by the ships and canoe among other water transport vessels that existed during the Hellenistic era. Several trade links were later established and the three main links were the Han dynasty, the famous Roman Empire and the Parthian Empire among others. There was an expansion in transport routes from the borders of ancient China to Rome to enhance international trade. Furthermore, there was increase in Greece Ships sailed to the furthest corner of India among other Asian nations, in search of wheat among other raw materials. First globalization was meant to enhance international trade between the earliest Asian and European nations; however, it came with several negative implications to the societies involved. The Chinese from the Han Empire developed some conflicts that led to ancient war with other Asian Kingdoms like the Persians and the Indian Kingdoms among other Asian kingdoms. Han who was the ruler of Wu Empire declared war with the Yuezhi Kingdom, with the main aim of taking control of the Tarim Basin. Globalization was further enhanced by the Muslims during the golden age, when more trade routes or links were established between the Radhanites or Jewish and the Muslim community. The two communities developed their technology, trade and agricultural practices after some interactions. Muslims resolved in producing large volumes of Sugar, cotton and wheat among other crops. Small part was internally consumed while the rest was transported to European region, for international trade purposes. The second phase of globalization also called proto-globalization occurred in the 16th and 17th century when European Empires explored other developing regions and this resulted to influence of the European culture and trade among other aspects. Portuguese and Spanish empires were the first to make such movements or initiatives and they colonized the United States and Horn of Africa among other territories. The British and the Dutch also followed and th e expanded or rather global trade links which further led to establishment of multilateral companies like the Dutch East India among others. There was an increased trade trend in food and slaves to the European regions. Slave trade promoted the spread of communicable diseases in both Africa and Europe, more so along the trade routes. The final stage of

The Declaration of Independence Essay Example for Free

The Declaration of Independence Essay The Declaration of Independence maintained that the purpose of government is to protect their â€Å"unalienable rights,† chief among them being â€Å"life, liberty and the pursuit of happiness. † As such, government is merely an institution crafted by the people, whose existence is entirely contingent upon the people it is designed to serve towards these ends. Therefore it is the responsibility of citizens to be ever vigilant of this government because the Declaration explicitly states that its authority comes from â€Å"the consent of the governed. † Should this government prove to be dysfunctional with regards to the functions it was created for, it becomes the right of these ‘governed’ to abolish the government and institute a new one in its place that fulfills the abovementioned mandate of protecting those rights. It is this fundamental conception of the function of government that maintains relevance in the 21st century moreso, as has been said ad infinitum ad nauseum, in the wake of 9/11. In an attempt to address the security of the nation-space, the government has taken measures that have effectively diminished personal liberties if not curtailed them entirely. As such, the functions of the government have increasingly turned towards protection of the state for its own sake, at the expense of the inalienable rights of citizens. In effect, the government leans towards self-preservation, towards a rigid but abstract notion of patriotism and nationalism and away from empowering those institutions under its jurisdiction whose primary aim is the self-fulfillment of its citizens. More of the budget is geared away from citizen welfare and more towards the military and state controls. This is not to suggest that the government must be abolished with the sheer force of tumultuous revolt, but rather that citizens recognize this disheartening trend and take action to reorient it back towards the purposes it was designed for in the first place. It is through re-awakening interactions that make for a healthy democracy, including the ballot box and beyond it in critical discourse.

Essay on Poetry in Prose in Cold Mountain -- Cold Mountain Essays

Poetry in Prose in Cold Mountain Cold Mountain is poetry in prose, and the examples of this are infinite.   Every character met is described down to the last hair on their head; the war-torn countryside still lives on for Inman to relive and Ada to discover.   The field burning, the sunrises and sunsets, the rivers flowing and the eternal rocks and trees that make up the landscape are all characters in themselves.     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The definition of the word ‘poetry’ is allusive to say the least. Those in dictionaries run in circles from defining a poet as ‘one who writes poetry’ to defining a poetry as ‘the work of a poet’. It is more conclusive therefore, to describe what the poets themselves are aspiring to create: Coleridge distinguishes between prose – ‘the best words’- and poetry – ‘the best words in the best order’ – while Wordsworth said that poetry is ‘the breath and finer spirit of all knowledge.’ Therefore it is difficult to distinguish between the exact difference between prose and poetry. In some instances, such as translating foreign poetry, it has proved more satisfying to convert the poetry into prose to convey the meaning without worrying about the metre, which is often lost in translation anyway. However, ‘Cold Mountain’ is clearly one of the chosen few novels written in prose with poetic style. By describing scenes, be they uplifting or disturbing, in an innovative, different, detailed style, Frazier succeeds in surpassing other novels in library brilliance and ingenuity. From the first few words of the first chapter, the reader is captured. Different, or unusual words are used to describe what they do not usually do – morning ‘gesturing’, for instance, morning is not normally thought of as a gesture, b... ...head; the war-torn countryside still lives on for Inman to relive and Ada to discover.   The field burning, the sunrises and sunsets, the rivers flowing and the eternal rocks and trees that make up the landscape are all characters in themselves.   Frazier conveys his love of the land through every word of ‘Cold Mountain’ and uses unusual adjectives or verbs to explain his sight from a different angle.   (This is illustrated on page 215 as Inman is wedded to Lila; she ‘described little delighted circles in the dirt’.)   Matthew Arnold states that ‘genuine poetry is conceived and composed in the soul’, and Frazier has simply shared this genuine classic to give a hauntingly true-to-life insight in to the search for the American Dream, based on his own experience of the Appalachian Mountains. Works Cited: Frazier, Charles. Cold Mountain. New York: Vintage Books, 1998.

Mri Notes

Bringing MRI to Your Community Hospital A Community Hospital White Paper 04-201-XO-491_Bringing_MR5. qxd 12/10/04 10:05 AM Page 1 Bringing MRI to Your Community Hospital CONTENTS Introduction †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 1 Making the Business Case †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 2 The Business Plan †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 2 Reasons for Bringing MRI to your Hospital†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦ Financial Considerations †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 3 Selecting the Equipment †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 8 Comparing Te chnologies †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 8 Equipment Features †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 10 Search Process †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 11 Managing the MRI Program †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 12 Operations †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 12 Staffing†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 12 Siting †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 13 Marketing the Program †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 14 Conclusion †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 15 04-201-XO-491_Bringing_MR5. qxd 12/10/04 10:05 AM Page 3 Bringing MRI to Your Community Hospital 1 INTRODUCTION MRI is one of today’s fastest growing imaging modalities, spurred in part by rapid advances in technology and important new applications in patient care. Recent statistics also suggest that expanding Medicare reimbursements and the growing demands of an informed and aging population for healthcare services are elevating MRI utilization to new levels.Is your community hospital considering adding this exp anding and often lucrative modality? This paper will help you answer that question. It looks at the business and financial aspects of an MRI program, reviews MRI technologies and features, and discusses management of an MRI program. Overall, it shows how implementing an MRI program will enhance existing medical services and better meet community needs. 04-201-XO-491_Bringing_MR5. qxd 12/10/04 10:05 AM Page 1 Bringing MRI to Your Community Hospital 5 ProfitabilityPerforming a number of standard financial analyses will help determine the potential profitability of your proposed MRI program. Generally, the financial analyses should cover the first five years of your program. The standard financial analyses are: Breakeven analysis. A breakeven analysis will show how many examinations must be performed to cover MRI program costs. The specific breakeven point is calculated by dividing the fixed costs (such as equipment, space, personnel, maintenance, and utilities) by the payment per exam minus the variable costs (such as supplies, fees, and billing costs) per exam.It may turn out that your breakeven point is 1,000 exams, but your market analysis indicates demand for only 700 exams. In this case, you may want to analyze growth trends to determine when or whether your MRI program could break even in the future. You may also want to look at restructuring your proposed program to make it financially feasible. Return on investment (ROI). ROI is one of the most common measures of profitability and can indicate whether spending money on an MRI program is a good use of your hospital’s resources. It is calculated by dividing net income by the cost of the investment.Net income can be approximated by looking at the demand, payer mix, and utilization rate for various MRI procedures in your market and estimating your revenues. The investment number includes not only the cost of the equipment under each financing option, but also the costs of running the program (includin g the costs of staffing, marketing, any needed construction, and administration). Given the number of variables contributing to the ROI calculation, changing the structure of your proposed MRI program can increase your return on your MRI investment.Internal rate of return (IRR) and net present value (NPV). IRR and NPV are commonly used to analyze whether a capital expenditure (such as the purchase of MRI equipment) will yield the revenue wanted in the future; they can also be used to choose among various investment proposals (such as different types of MRI equipment or different financing options). Net present value is calculated by a mathematical process involving the estimated revenues and expenses of an investment. The calculation can help determine whether the anticipated cash flows 04-201-XO-491_Bringing_MR5. xd 12/10/04 10:05 AM Page 5 6 A Community Hospital White Paper will cover the cost of capital and recover the costs of the investment. IRR (defined as the rate of interest at which the incremental NPV of a proposal is zero) is another way to look at the value of a capital expenditure – by looking at the rate of return on the investment. If a calculation shows that the IRR is above the cost of capital, the proposed investment should be profitable. These two calculations help determine whether the investment is economically feasible for the hospital.Again, the information needed for these analyses can be obtained from equipment vendors, commercial databases, and outside suppliers. Financing Options Hospitals can use a number of methods or creative hybrids from these methods to acquire both fixed and mobile MRI. Deciding how you will pay for your MRI system requires achieving the right balance between using available cash and accessing debt. Using available cash may make sense if there are few other capital projects on the horizon and cash flow from operations is strong.Using debt instruments, such as bonds, bank loans, or leases, however, may pr eserve available cash for other capital projects, provide a better financial return on the capital project, or simply make the project affordable by reducing the capital outlay to a monthly operating expense. Consider the following options: Cash Purchase. The main advantage of a cash purchase is that your hospital would own the equipment outright; the equipment becomes an asset on your balance sheet and no debt or liability is created.Making the purchase, however, would involve the use of a significant amount of available cash, which would then no longer be available to support other projects or for future financial needs. Leasing. Leasing moves much of the funding to your operational budget and minimizes credit requirements. In addition, it provides better matching of revenues and expenses on a monthly basis. Some types of leases allow you to build equity into the lease and purchase the MRI equipment for a small capital outlay at the end of your agreement. 04-201-XO-491_Bringing_MR 5. qxd 12/10/04 10:05 AM Page 6 Bringing MRI to Your Community Hospital Bonds. Using bonds allows your hospital to raise significant capital to fund long-term and short-term projects through one debt issue. The bond offering can be made on a tax-exempt basis, so the interest due on the principal is typically calculated at a very attractive rate. A bond offering may take six to nine months to execute, however, and may involve significant costs. More importantly, including assets that have economic and useful lives shorter than the term of the bond in a bond issue produces debt without any continuing benefit to your hospital; there would be a mismatch between revenues and expenses.Bank Loans. If your hospital has an existing relationship with a bank, it may be quickest and easiest to fund your technology acquisitions through a bank line of credit. Given banks’ size and access to capital, they typically offer attractive finance rates for full payout loans. Your hospital may be r equired to keep a compensating balance at your bank, however, and one technology purchase may consume available credit lines that your hospital may need for other capital projects or working capital needs.Another drawback to using a bank loan is that banks will only finance the technology acquisition itself; they will not pay for the installation or the costs of professional services associated with the equipment. Your hospital may want to purchase MRI equipment independently to meet your own imaging needs. You could then lease access to the equipment part time to other facilities at fees that could help pay for the purchase. Your hospital may also consider a shared purchase of MRI equipment.Partnering with other local hospitals or independent imaging centers offers the advantages of sharing financial burdens and risks, while acquiring the ability to provide MRI services. Frequently, the participating facilities form a partnership or limited liability corporation to serve as the umb rella for the purchase, and the financial arrangements and responsibilities would be specified in the formal agreement. This arrangement reduces the costs and financial risk for each partner, while allowing each partner to provide MRI services. Co-funded MRI acquisitions may be either direct purchases or leases. 04-201-XO-491_Bringing_MR5. xd 12/10/04 10:05 AM Page 7 8 A Community Hospital White Paper SELECTING THE EQUIPMENT Rapid developments in MRI technology mean that your hospital will be faced with an array of equipment and features. Your selection will depend on your business objectives and clinical requirements. Your goal is to select the equipment most appropriate and cost-effective for delivering the high-quality images you need today, while allowing for new applications and upgrades in the future. Equipment vendors can help you sort through your options to acquire the capabilities you need without paying for features you will not use.The sections below discuss some of the basic technologies and features available to you. Comparing Technologies Magnet Given the growth in the number of MRI applications and rapid advances in MRI technology, MRI may become your radiology department’s workhorse. Therefore, your hospital should start with a solid, proven platform. While some applications still use a sub-1T magnet, a 1. 5T magnet is now the standard, because it can both handle current applications and accommodate future applications and upgrades. A 3T magnet is available, but it represents truly innovative technology and might be more powerful than most hospitals need.Mobile vs. Fixed MRI As noted above, mobile MRI is housed in a specialized van and can readily be shared among hospitals and healthcare facilities. Mobile MRI is frequently acquired when a hospital expects a small volume of exams, when the hospital wants to test an MRI program before leasing or purchasing, or when the hospital does not have the financial resources to purchase fixed equi pment. Some hospitals use mobile MRI to supplement overburdened fixed MRI equipment, provide capacity while waiting to purchase additional fixed equipment, extend radiology services into other geographic areas, or maintain service during building projects.A main drawback of mobile MRI is its accessibility – the equipment may not be available when it is needed. Patients and referring physicians may have to wait for several days or even weeks for procedures. 04-201-XO-491_Bringing_MR5. qxd 12/10/04 10:05 AM Page 8 Bringing MRI to Your Community Hospital 9 Fixed MRI may be located inside the hospital or in a nearby building. Because it is right at the hospital, it is very convenient to use. Patients may be able to get their exams within a day, emergency room doctors can get studies the same day, and diagnoses can be made or confirmed very quickly.Physicians can use in-house equipment to confirm results and to make sure that proper care is given and they can draw on the medical s ervices provided by other departments in the hospital, if needed. Fixed MRI facilitates patient care. It is easier to move seriously ill, elderly, or emergency room patients to an in-house MRI than to transport them to mobile or distant equipment. In-house and fixed facilities also tend to be more comfortable and attractive than mobile ones and patients can use other hospital services and facilities at the same time. Open vs. Closed MRIApproximately 28% of MRI installations are of open MRI (according to the IMV 2002/03 MRI Census Market Summary Report ). Open MRI is considered more comfortable for patients, particularly children, the elderly, the obese, and the claustrophobic, and may thus reduce the need for patient sedation and the number of incomplete exams. Until now, the strength of the magnet in most open MRI systems has been comparatively weak (no more than 0. 7T), which has limited the quality of the images and has not supported a full range of applications. A new class of M RI systems was introduced in the summer of 2004, called Open Bore MRI, with stronger 1. T magnets and the ability to offer 60% of exams with the patient’s head outside the magnet. These new systems have the same image quality as closed MRI systems and are able to support as many applications. Closed MRI has traditionally used a stronger magnet, which has led to clearer images and has allowed closed MRI systems to support a broader range of applications and many new technological advances and upgrades. Some newer closed MRI equipment has been designed to be more comfortable for patients and to reduce the acoustic noise level by up to 97%. The technological advances in open MRI may reduce the differences in technological capabilities between open and closed MRI systems. *Results may vary. Data on file. 04-201-XO-491_Bringing_MR5. qxd 12/10/04 10:05 AM Page 9 10 A Community Hospital White Paper Equipment Features Image Quality Image quality is one of the primary MRI consideratio ns. Factors affecting quality include strength of the magnet, high field computer performance, sequence selections, and 3D postprocessing. Differences in image quality can be seen by comparing sample images produced by all the equipment being considered.Workflow and Productivity MRI benefits from a broad range of new productivity-enhancing tools that may allow you to serve more patients and make the best use of your equipment and staff. Advanced scanners have the ability to do seamless whole-body imaging with a single coil, eliminating the need to reconfigure coils and reposition patients. These can cut scanning time by as much as 50% to 75%. * Others allow simultaneous scanning of more limited anatomical areas with up to four integrated coils, delivering similar benefits.Both allow the user to select exams, not coils, and provide the highest acquisition speed without image artifacts, while promoting patient comfort. This enhanced workflow enables more patients to be seen during a d ay and often paves the way for handling of a greater patient volume and increased profits. Additionally, recent advances in MRI technologies allow the processing of MRI images during, rather than following, the ex amination, which produces results faster. Others automatically position slices for reproducible, consistent results.New developments also promote clinical efficiency by improving workflow and eliminating duplicate tasks. This includes reducing examination set-up time through single-mouse-click coil positioning. Another new technology eliminates the need to reenter patient exam parameters by allowing existing images to be dragged and dropped onto the patient list and even to be transferred from images on email or CDs. Some manufacturers provide a common interface across all modalities and applications, including MRI, to reduce learning curves and facilitate practice management. *Results may vary. Data on file. 4-201-XO-491_Bringing_MR5. qxd 12/10/04 10:05 AM Page 10 Bringin g MRI to Your Community Hospital 11 Patient Comfort Some new technologies make MRI procedures more comfortable for patients, which in turn makes clinical time more productive. These technologies may reduce noise level, eliminating the need for ear protection; reduce scan time, which makes the procedure less stressful for patients; allow for more comfortable horizontal loading; or allow patients to keep their heads outside the bore, minimizing claustrophobia. Open MRI technology accommodates anxious, obese, or claustrophobic patients, particularly children.Search Process A multifunctional search team, including radiologists, technologists, administrators, and IT professionals, should be appointed to analyze the equipment options and make recommendations. The search should be driven by the goals of your program in terms of improved patient care and financial feasibility, the technological features specified by radiologists, and the procedure needs of referring physicians. The search p rocess should include detailed comparisons of the features and image quality of the equipment made by different vendors.Members of the team should visit sites where the equipment is used, interview radiologists and technologists working with the equipment, and request and review a range of images made by the equipment. Some equipment vendors may allow a short-term trial of the equipment or special features before purchase. Many hospitals consider it important to purchase as much equipment as possible from the same vendor. For smaller hospitals, where technologists may perform many different types of procedures, having one vendor makes cross-training on different modalities easier.The relationship with a single vendor may also contribute to the efficient running of the radiology department and may expedite repairs and other needed services. At the end of the search process, the team should make recommendations on which specific equipment and features to purchase. The team may also se t out a schedule for making regular upgrades to the equipment or for purchasing additional features or applications. 04-201-XO-491_Bringing_MR5. qxd 12/10/04 10:05 AM Page 11 12 A Community Hospital White Paper MANAGING THE MRI PROGRAMWhen bringing MRI to your community hospital, you will have to make decisions about overall management of the program. Planning should cover four areas – operations, staffing, siting, and marketing. Operations Patients and physicians both want the MRI program to run smoothly, efficiently, and in a timely manner. When implementing the program, the hospital will have to keep an eye on the scheduling of patients for efficient utilization of equipment, patient throughput, patient comfort and education, efficient handling of paperwork and archiving of images, and timely communication.A Picture Archiving and Communication System (PACS) has become a necessity in managing an MRI program. The hospital should plan on monitoring the operations of the progr am and should expect to make changes to increase operating effectiveness. For example, the hospital may find that it wants to extend hours of service or hire additional personnel to handle paperwork and scheduling. Staffing For a community hospital, an MRI program requires one or more radiologists, technologists, administrators, and possibly also technologist aides.There is currently a shortfall in the number of available radiology professionals, so it may be necessary to develop a recruiting program that sets out how the hospital supports and meets the needs of its employees. Radiology professionals will look for a competitive salary and benefits, good working conditions, flexible and reasonable schedules and workloads, and opportunities for growth and development within the profession. They are particularly interested in keeping up with technological advances and in having opportunities to learn new modalities.During recruiting visits and interviews, most radiology professionals c heck whether a hospital has the latest technologies and equipment. Many radiologists look for the use of a nighthawk service at night or over weekends to make their workloads manageable. Nighthawks, who can be located anywhere in the world, are sent images digitally over the Internet for remote reading. A PACS system facilitates the sharing of images betw een the hospital and the nighthawks. 04-201-XO-491_Bringing_MR5. qxd 12/10/04 10:05 AM Page 12Bringing MRI to Your Community Hospital 13 The hospital may also need to consider whether it will be able to pursue a number of the standard options for making sure that it has sufficient staff: Using temporary or short-term workers, provided by a healthcare staffing company or recruited from locum tenens services Sharing radiology professionals among joint venture partners or local radiology practices Using creative scheduling, such as job-sharing or part-time arrangements Cross-training technologists on different modalitiesGiven the shor tfall in available radiology professionals, a hospital will want to pay attention to retaining its staff. An effective retention program must be built into the staffing plan for the MRI program. Retention strategies may include giving staff opportunities for career growth through learning new technologies and modalities, creating a supportive work environment, and following through on all the commitments made during the recruiting process. Siting Given the physical requirements of fixed MRI equipment, administrators will have to decide where they want to site the program.Existing vs. New Space An MRI’s powerful magnetic field limits the possible locations for the equipment. The magnet room must be built with specific construction materials and can contain only certain fixtures and additional equipment. An existing site within the hospital will need significant structural renovation to eliminate all ferrous metals to ensure patient safety and protect your equipment. It is nece ssary to compare the costs of renovating and of building new space to help contain expenses associated with the program.Equipment vendors are a good source of information on the requirements of a magnet room and the work needed to create a safe and comfortable site for your MRI program. 04-201-XO-491_Bringing_MR5. qxd 12/10/04 10:05 AM Page 13 14 A Community Hospital White Paper Inside-the-Hospital vs. Freestanding Outpatient Facility MRI exams are frequently outpatient procedures. Locating your MRI program in an outpatient facility has the obvious advantages of reducing hospital crowding, enhancing throughput, and reducing the complications of hospital visits for ambulatory patients.Other outpatient facility siting benefits include flexibility in financing, through joint ventures and shared equipment, and larger physical space with the possibility of expansion. However, if your primary goal is to meet in-patient imaging needs, an inside-the-hospital location is safer and easier, pa rticularly for critically ill patients. Other advantages are the availability of the full range of on-site medical services and the proximity to in-house physicians and referring physicians with offices near the hospital.Marketing the Program A community hospital can best market its new MRI program by involving the community during the development of the program and by using specific marketing techniques. Community Involvement Many community hospitals have found that creating strong community involvement in the program leads to high patient volume. It may be effective to: Draw local businesses and business associations, such as a Chamber of Commerce, into the planning process and any necessary fundraisingCreate a hospital website that keeps the community informed about progress, educates potential future patients about your new services and the benefits of MRI, shows pictures of the new equipment, and links to the equipment vendor’s website for additional information Speak ab out the program and MRI to local community groups and at school programs Hold an open house and give tours of your new facilities Media Relations Given the strong popular interest in healthcare issues, it may be possible to interest local newspapers, magazines, television, and radio stations into reporting on your new MRI program and its benefits.Distributing a press release describing your program, making hospital administrations and radiology professionals available for interviews, and hosting media events may be effective in publicizing your program. 04-201-XO-491_Bringing_MR5. qxd 12/10/04 10:05 AM Page 14 Bringing MRI to Your Community Hospital 15 Marketing Communications Some hospitals have found it effective to develop written materials that explain and publicize their program and the new MRI technology.These materials can include brochures that educate patients and answer questions about MRI technology and benefits, brochures for referring physicians that describe the new im aging services, handouts with contact and procedural information, and print advertisements for local media. Equipment manufacturers are a good source of cost-effective assistance in developing marketing communications. CONCLUSION MRI technology can provide numerous benefits to your hospital by enhancing the speed and accuracy of diagnoses, facilitating earlier and more accurate treatment of medical conditions, and generating additional revenue.Making the decision to implement an MRI program involves analyzing the marketplace and the financial aspects of the program and planning for managing and marketing the program. A critical decision is which MRI equipment and applications will meet the needs of the hospital and the community. Many of the newest technologies provide significant benefits in terms of quality, efficiency, and patient comfort. Given the cost of the equipment, the hospital should compare various financing options, including direct purchase, leasing, and joint ventures .