Analysis of Hospital Quality Management Team

Analysis of Hospital Quality Management Team Contents INTRODUCTION BACKGROUND History Vision Mission Core values MAIN SERVICES AVAILABLE, HOW SERVICES ARE DELIVERED AND TARGET POPULATION ISSUES IDENTIFIED ANALYSIS OF QUALITY MANAGEMENT PROGRAM REFERENCES INTRODUCTION This is an in-depth analysis of quality management program conducted in Villingili hospital. Improving the quality of care management practice is a concern in many countries regardless of differences in definition, organization, and funding of services. Quality assurance involves a commitment to guaranteeing the quality of services, not as an additional element attached to the service, but as part of an ongoing system in which performance is monitored and achievement measured against set standards or benchmarks (Camp, 1989; Crosby, 1979; Oakland, 1993 cited in Clarkson Challis, 2003). First a brief introduction of the hospital will be presented followed by the discussion of various quality related issues that can be identified within the hospital. Followed by this, one quality management effort, which is the indoor environment of the hospital, will be analyzed. Subsequently, recommendations for any other strategies that could be implemented to improve the present situation and to overcome quality issues that are not part of any quality program at present will be elaborated. BACKGROUND History Villingili hospital was first opened as a health center in 21st April 1994. The health center was initially opened as a branch of Male’ Health center. The health center was set up in a four room building provided by Male’ municipality. On 15th April 2002, the government changed the health center to a three story building. On 14th August 2014, the health center was changed to a third grade hospital; same level as an atoll hospital. Vision: strive to provide healthcare services to people of Villingili and to make the community aware regarding health life styles and to provide ideal, quality and acceptable health care service to residents of Villingili. Mission: To provide an uninterrupted health care to residents of Villingili. To diagnose and treat different types of diseases and work towards the prevention of these diseases. To further develop the laboratory services. Core values: no core values are identified by the organization. Even though the Villingili Hospital have a rich history, it was depressing to find that the staff of the hospital was unaware of the vision, mission and core values of the organization. MAIN SERVICES AVAILABLE, HOW SERVICES ARE DELIVERED AND TARGET POPULATION The main services available in this hospital are, consultation services from general practitioners, consultation from specialized practitioners, laboratory services, community health care, vaccination and nursing care services. The target population is the residents of Villingili, whose population is around 17,000 people according to Villingili hospital. Specialized doctors’ consultations are on specific days. Gynecological consultations are done on Sundays and Wednesdays from 08:00am to 04:00pm. Orthopedics consultations are done on Sundays and Mondays at 08:00am to 04:00pm by Orthopeadician Dr. Hussain Faisal. Pediatrician consultations are done on Mondays and Tuesdays at 08:00am to 04:00 pm. All consultants are arranged sent from IGMH. Vaccination and child growth monitoring is done on all working days from 09:00 am to 01:00 pm. All available services are provided within the hospital. Even though they have a community health service unit, home visiting are not done. Services are provided 24 hours throughout the day, and shift duties are done by all consultants, nurses, receptionists, interpreters, ambulance drivers and attendants. Even though specialized consultations are done, it is evident that both the consultants and clients face enormous difficulty to diagnose and treat diseases and conditions as essential and compulsory diagnostic services such as ultra sound scanning and x-ray services are not available in the hospital. ISSUES IDENTIFIED After conducting surveys in the Villingili hospital and interpreting the results, I have identified some issues related to quality of service provided by the facility. Here are the results of the survey conducted in the facility. In the survey questionnaire, a question was used targeting to identify the staff response to patients need and their courteousness. The evaluation will be accurate if we analyze the situation in both directions. According to the hospital officials, clients can consult general practitioners through a walk in OPD. But the consultation for specialized practitioners such as the orthopeadician and gyneacologist, clients have to make appointment prior to consultation. Appointments are issued until the planned slots are filled. From the interviews conducted, we understood that the time delay dissatisfaction usually arose during busy situations where the doctor who is consulting in the OPD have to attend in patients or emergency cases. Some clients also noted that the doctors sometimes goes for break while more than 10 clients are waiting outside. A service provider have to consider suitable timings in order to provide a quality service to the clients. In order to evaluate this, we questioned whether they are satisfied with service timing of the facility, both general and specialized consultations. Among 10 clients, 2 clients (20%) informed that they are not satisfied with the time for specialized consultation while 3 clients (30%) told that they are moderately satisfied and 5 patients (50%) are fully satisfied with the service timing. Figure 1 Even though they get the appointment for specialized consultation and can consult the general practitioner through a walk in OPD, the time taken to consult the doctors vary. To verify the time taken to consult the doctor, we gave time ranges from 0-10 minutes, 20-30 minutes and more than 30 minutes. According to the clients who gave the interviews 5 clients (50%) informed that they had to wait between 0-10 minutes, 3 clients (30%) told that they waited between 20-30 minutes for the consultation and 2 clients (20%) stated that they waited for more than 30 minutes to consult the doctor. These findings are presented below in figure 2. Figure 2 Identification of the client satisfaction and dissatisfaction is crucial in order to upgrade and provide an ideal and acceptable quality service to the clients. In order to identify the overall satisfaction of the clients regarding the time they spent during consultation, we included questions targeting this issue. According to 7 clients, (70%) they are fully satisfied with the time they spent and 3 clients (30%) are not satisfied. These results are shown below in figure 3. According to the information we collected, we found that most clients highlighted that the biggest issue they face is the way the staff communicate with them. Some clients have informed that they were left feeling like a fool during consultations and some staff spoke rudely to them. Few noted they feel that the staff are overburdened with responsibilities and they seem very unenthusiastic. In addition to this, some clients informed that the staff seems to be involved in their personal things while attending the clients who goes to the counter for different things. Communication effectively with patient and family is a cornerstone of providing quality health care (Patient care improvement guide, 2008). The manner in which health care provider communicate information to a patient can be equally important as information being conveyed (Patient care improvement guide, 2008). Patient surveys have demonstrated when communication is lacking, it is palpably felt and can lead to patients feeling increased anxiety, vulnerability and powerlessness (Patient care improvement guide, 2008). Among 10 clients, 5 clients (50%) informed that the staff was poor in areas being respectful, friendly helpful and courteous. Another 3 clients (30%) noted that the staff was fair in this area while the remaining 2 clients (20%) informed that the staff was good in this area. It is depressing to note that not even one client told that the staff was great in this area. The information is shown in a pie chart below in figure 1. Figure 1 The next question was whether the staff explained the procedure and how they answer questions asked by clients. Among 10 clients, 6 clients (60%) informed that the staff was poor in explaining the procedure and answer questions asked by them. Another 3 clients (30%) noted that the staff was fair in this area. The remaining 1 clients (10%) informed that the staff was good in this area. The information is illustrated in figure 2. Figure 2. According to the information collected through survey, it is clear that most clients highlighted that the biggest issue they face is the way the staff communicate with them. Some clients have informed that they were left feeling like a fool during consultations and some staff spoke rudely to them. Few noted they feel that the staff are overburdened with responsibilities and they seem very unenthusiastic. In addition to this, some clients informed that the staff seems to be involved in their personal things while attending the clients who goes to the counter for different things. The issues identified through survey with clients of this facility that, may hinder the quality of service provided are, ineffective communication and unenthusiastic staff. Additionally, by conducting interview with the senior administrative officer of Villingili health center, it is evident that some staff lack knowledge in some areas such as care during emergency situations. Lack of knowledge is due to lack of practice as the institute have less inpatients who needs constant care. Communication effectively with patient and family is a cornerstone of providing quality health care (Patient care improvement guide, 2008). The manner in which health care provider communicate information to a patient can be equally important as information being conveyed (Patient care improvement guide, 2008). Patient surveys have demonstrated when communication is lacking, it is palpably felt and can lead to patients feeling increased anxiety, vulnerability and powerlessness (Patient care improvement guide, 2008). ANALYSIS OF QUALITY MANAGEMENT EFFORT As the Villingili Hospital is being rebuild to accommodate required facilities to function as a hospital, patients’ and staff are facing various difficulties. The major difficulty that most people face is that consultant rooms are situated in the first floor of the building. A person does not have to be elderly to have a difficulty to climb stairs, and because of this arrangement some patients have faced difficulty. It is evident that the changes to the present building is being brought on to provide a quality service to the customers. However, the effect of physical environment on healing process is evident through research. The arrangement of wards, labor rooms, consultant rooms and waiting areas and its physical environment such as ventilation, lighting, and temperature is important aspects to consider to provide a quality hospital environment. From my personal experience, it is clear that the physical environment of hospital is set to ease the staff only and patient prefer ence or perspective is rarely considered. As I have experienced, I have faced immense difficulty when I went for a consultation with high grade fever and wheezing. The consultant’s room air conditioner was set a temperature where it was difficult for me to utter a single word without clattering my teeth. Additionally, I have found that the present physical environment of the Villingili hospital can be considered dangerous for patient especially the elderly and young. The present construction activities and especially the smooth tiles put on the floor of the hospital is a hazard for falls. For this analysis, I will be looking into the extraneous factors of the hospital in order to deliver a quality service. Extraneous factor of hospital The physical work environment often influences (positively or negatively) the mindset of the service providers and their efficiency and capability to innovate in delivering expanded services (). Sometimes the aspects of the consultation rooms can have a negative impact. Such as the consultation room being too cold, hot, dark, noisy or unwelcoming (Moulton, 2007). Distractions in the room include visual distractions (eye catching photographs or art), auditory distractions (sounds from the waiting room or next consultation room) and olfactory distractions (bad odors or body odor of previous patients) (Moulton, 2007). Suboptimal seating arrangement also can be a negative extraneous factor of hospital, such as seats being hard and uncomfortable (Moulton, 2007). In recent years, the effects of the physical environment on the healing process and well-being have proved to be increasingly relevant for patients and their families as well as for healthcare staff (Huisman, Morales, Hool Korts, 2012) Studies have shown that excessive noise, glare and poor air quality can create stress as is evidenced by increased heart and blood pressure and reduced oxygen level in the blood in both adults and babies who are exposed to these environment (Blomkvist, Ericksen, Theorell, Ulrich, Rasmanis, 2005; Hagerman, Rasmanis, Blomkvist, Ulrich, Eriksen, Theorell, 2005;Zahr Traversay 1995 cited in Zborowsky Kreitzer, 2008). A healing environment with appropriate physical aspects contribute to patients’ outcome such as shorter length of stay, reduced stress, increased patients satisfaction and others (Ulrich et al., 2004 cited in Hussain Babalghith, 2014). REFERENCES Clarkson, P., Challis, D. (2003). Quality Assurance Practices in Care Management: A Perspective from the United Kingdom. Care Management Journals, 4, (3), 142-151. Huisman, E. R. C. M., Morales, E., Hool, J. V. Korts, H. S. M. (2012). Healing environment: A review of the impact of physical environmental factors on users. Building and Environment (58), 70–80. Moultan, L. (2007). The Naked Consultation: A Practical Guide to Primary Care Consultation Skill (1st ed). United Kingdom, UK: Radcliffe Publishing. WHO. (2004). Quality Improvement in Primary Health Care; A Practical Guide. WHO regional publication, Eastern Mediterranean Series 26. Zborowsky, T., Kreitzer, M. J. (2008). Creating Optimal Healing Environment in Health Care Setting. Clinical and Health Affairs, 91(3), 35-38. Saushan Rasheed Quality Assurance in Health Care Assignment 2

Sources Of Finance For Marks And Spencers

Sources Of Finance For Marks And Spencers Marks Spencer is one of the leading retailers in UK with average 21 million customers visiting per week in stores. They provide with quality clothing, home products and food which is supplied by approximately 2000 suppliers all over the world. The company has 75,839 employees as evaluated in 2008 and has about 700 stores in UK. The 49% of the sales is occupied by clothing and home products while 51% is occupied by food products. Outside UK the company operates in approximately 40 other countries which include India, China and Indonesia etc. The companies 90% business comes from sales in UK while rest comes from overseas sales. Marks Spencer values Quality, Value, Service, Innovation and Trust. The company generated an overall revenue of  £9062.1 million as on 28th March, 2009. The overall profit was  £768.9 million of which  £652.8 million was generated from operations in UK and  £116.1 million from operations overseas. The case study takes into consideration the analysis of financial reports of Marks and Spencer and relates the academic principles of Corporate Finance with the analysis of the report. 2. SOURCES OF FINANCE 2.1 SHORT MEDIUM TERM FINANCE Trade Credit Trade Credit is finance obtained from suppliers of goods and services over the period between delivery of goods and the subsequent settlement of the account by the recipient. (Pike Neale, 2006) It is sometimes also called spontaneous finance as the company can enjoy the goods or benefit from the service provided without having to pay up. Common way of expressing the credit term is- 2/10 : net 30 This implies that the supplier will provide 2% discount if the money is payed back in 10 days otherwise the company has to pay full payment in 30 days. The length of the trade credit depends on certain factors like industry custom and practice, relative bargaining power and type of products. Factoring- Sometimes the suppliers need payment earlier than expected. Institutions called factors help by offering to purchase a firms debtors for cash. Factoring involves raising immediate cash based on the security of the companys debtors, thus accelerating payments from customers. Bank Credit Bank lending to companies is predominantly short term, although now it is also a valuable source of medium term finance. Overdrafts Overdrafts specify the amount that a company may withdraw either in forms of cash or cheques. Interest is charged on a daily basis depending on how much the company is overdrawn each day. Bank generally takes security which can be fixed charge (where overdraft is secured against specific asset) or floating charge (which offers security over all of the companys assets) Short Term Loans Short term loans are generally provided for more than 1 year. The bank can charge variable or fixed rate of interest. Usually fixed rate of interest is quite high. Variable rate of interest can be also in various forms: Bullet Loans Balloon Loans Revolvers It allows the borrowers to borrow, repay and re-borrow over the life of loan facility. Securitisation This is the practice whereby instead of lending money to customers, banks raise finance for them by arranging and selling to customers their securities like commercial papers often allowing lower interest rates. Bill Finance Bill allows the company to pay out a specific amount after a specific period of time. Bills of Exchange Trader purchasing goods from suppliers draws up a bill stating a promise to pay at some future date and its up to the supplier to keep the bill or sell it in the market at a discount if he needs the money earlier. Acceptance Credit It is a tie up between the company and the bank. The bank issues a bill for the company and company can use it at a later date. The bank can sell the bill in the market at a discounted price. If it does then the company collects the money from the company which bought the bill from the bank. Hire Purchase It may be simply defined as hiring with the option to purchase. On payments of final installment ownership of the asset passes to the customer. The inland revenues will generally permit the customer to claim and retain capital allowances provided that the option to purchase fee is less than the market value at the end of the contract term. Leasing A leasing transaction is a commercial arrangement whereby an equipment owner conveys the right to use the equipment in return for payment by equipment user of a specified rental over a pre-agreed period of time. (Pike Neale, 2006) 2.2 LONG TERM FINANCE Equity Shares are described as permanent capital because the funds supplied for their acquisitions are non-returnable in most circumstances other than in the event of a liquidation. Shares are issued at nominal value and are sold at the market price. Shareholders have a share in ownership of company and also have voting rights. Dividends are payed as a percentage return on their nominal value. A company can receive equity finance from various sources like Business Angels: Private equity investor with spare funds to invest who wishes to gamble on the future prospects of young companies. Venture Capital: Sale of equity to a specialist institution that may also provide management assistance. For e.g. 3i. Obtaining a Quotation (IPO) Preference Shares Preference shares are entitled to a fixed percentage dividend, which is paid before any profits are distributed to ordinary shareholders. Participating preference shares may be entitled to some extra dividend, over and above their fixed dividend entitlement. Convertible preference shares can be converted to ordinary shares. Cumulative preference shares have unpaid dividends that are carried forward and must be paid before dividends are paid to ordinary shareholders. Preference share holders do not qualify for tax relief. Debt Debentures Debentures are basically loan secured on company assets with floating or fixed interest rate. It is a multiple loan to the company in the sense that it is contributed by several people opposed to just one individual. Debenture holders are creditors but not members of the company. Loan Stock is a kind of debenture that is issued at face value. It is not secured on assets but effectively secured on firms earning power, thus more risky and lower ranking of payment. Debentures issued at large discounts and redeemable at par or above are known as Deep Discount Bonds. They are generally issued at low rate of interest but have cost of redemption. Mortgages It is a form of secured loan placing the title deeds of property with a lender as security for a cash loan. The interest is payable on the amount borrowed. Warrants They are rights given to investors allowing them to buy new shares in a company at a future date, at affixed given price. They are generally issued alongside unsecured debt as a bribe to potential investors. 2.3 SOURCES OF FINANCE IN MARKS SPENCER 2.3.1 Current Non-Current Liabilities Current liabilities are the one MS needs to pay within 1 year time whereas non-current liabilities are the one MS can pay any time after 1 year. As per the annual report for MS, Current Liability MS has short term loans in the form of Bank Loans and overdrafts worth  £147.9 millions. Syndicated Bank Facility worth  £781.2 million which relates to a  £1.2 bn committed bank revolving credit facility set to mature on 26 March, 2013. Finance Lease liability worth  £13.7 million. The average lease term for the equipment is 6 years and 125 years for property. Interest rates are fixed. Non-Current Liability Bank Loans worth  £11.2 million. Finance lease liabilities worth  £88.2 million. Medium-term notes worth  £ 2018.5 million. 2.3.2 Net Assets Equity Ordinary Share Capital Shares  £m Allotted, called up and fully paid ordinary shares of 25p each At start of year 1,586,478,423 396.6 Shares issued on exercise of share options 2,217,763 0.5 Share purchased in buy-back (10,901,267) (2.7) At end of year 1,577,794,919 394.4 2,217,763 ordinary shares having nominal value were allotted during the year under two schemes namely Save As You Earn (SAYE) Share Option scheme and Executive Share Option Scheme. In SAYE, the board may offer options to purchase ordinary shares in the company once in each financial year to those employees who enter into an HM Revenue Customs approved (SAYE) savings contract. In terms of Executive Share Option Scheme, the Board may offer options to purchase ordinary shares in the company to executive directors and senior managers at the market price on a date to be determined prior to the date of the offer. 10.9 million shares having a nominal value of  £2.7m were bought back and subsequently cancelled during the year in accordance with the authority granted by the share holders at the Annual General Meeting in July 2007. Share Premium Account A reserve setup to account for the issue of new shares at a price above their par value. (Pike Neale, 2006) In MS, Share Premium Account had  £ 236.2 m as on 28th March, 2009 out of which  £ 231.4 m were carried forward from previous year and  £ 4.8 m was from share issued on exercise of employee share options. Capital Redemption Reserve It is a reserve established when the firm buys its own shares in a scenario that result in loss of share capital. In MS it was worth  £ 2202.6 m. As discussed earlier  £ 2.7 m worth were purchased in buy back, thus added to the capital redemption reserve. Hedging Reserve Hedging is an attempt to minimize the risk of loss stemming from exposure to adverse foreign exchange rate movements. MS as on 28th March,2009 had  £ 62.6 m in Hedging Reserve. 2.3.3 Net Debt Cash Cash Equivalents It includes short term deposits with banks and other financial institutions, with an initial maturity of three months or less and credit card payment received within 48 hours. It was worth  £ 422.9 m for MS. Financial Assets MS has current and non-current assets worth  £ 53.1 m that includes unlisted investments and Listed UK Securities. Bank Loans Overdraft MS has current and non-current loans overdrafts that include  £ 4.0 m loan from the Hedge End Park Limited joint venture. Syndicated Bank Facility It relates to a  £ 1.2 bn committed bank revolving credit facility set to mature on 26 March 2013 and is worth  £ 781.2 m. Medium Term Notes These are notes that actually retire in 5 to 10 years. A corporate note continuously offered by a company to investors through a dealer. Investors can choose from differing maturities, ranging from nine months to 30 years. (Forbes Digital) In MS these notes are issued under MS plcs  £ 3bn European Medium Term Note Program and all pay interest annually. The medium term notes are worth  £1848.1 m. Finance Leases It is groups policy to lease certain of its properties and equipments under finance leases and is worth  £ 101.9 m. 3. COST OF CAPITAL 3.1 Weighted Average Cost of Capital 3.2 Weighted Average Cost of Capital for MS As seen earlier MS has capital in the form of debt and equity. To evaluate the Weighted Average Cost of Capital, we need to evaluate Cost of Debt ( Kd) Cost of Equity ( Ke) Weight or proportion of debt equity Cost of Debt (Kd) To evaluate Kd, we need to find I = Interest paid for the debt MV(Market Value) = Total current Market Value of the Debt T = Corporate Tax if any As Kd = [I(1-T)] / MV X 100 Looking at the Annual Report we can see in Cash flows from financing activities that : I =  £ 197.1 m which is approximately 7.9% In Taxation Charges T = 28% In net Debt MV =  £ 2490.8 m Thus we can calculate Kd by putting in the values as: Kd = [ 197.1 m(1-.28)]/ 2490.8m X 100 = (141.912/2490.8) X 100 = 4.7 Cost of Equity To evaluate Ke, we need to evaluate D = Dividend on ordinary share capital MV = Market value of equity As Ke = (D/MV) X 100 Looking at the report we can find Net dividend = 22.5 p per share The total no. of shares at the end of the year = 1,577,794,919 The total Dividend D = .225 X 1,577,794,919 =  £ 355 m approx Market Value MV= .25 X 1,557,794,919 =  £ 394.4 m Therefore Ke = (D/MV) X 100 = (355/394.4) X 100 = 90 Weighted Average Cost of Capital (WACC) Weighted Average Cost of Capital can be calculated by formula WACC = Ke[ E/(E+D) ] + Kd [ D/(E+D) ] Where E = Market Value of Companys Equity D = Market Value of Companys Debt Therefore WACC = 90[394.4/(394.4 + 2490.8)] + 4.7[2490.8/(394.4 + 2490.8)] = (90 X 0.135) + (4.7 X .86) = 12.15 + 4.902 = 17.052 % 3.3 Gearing Indicators for MS To be done Capital Gearing Capital Gearing = 4. INVESTMENT APPRAISAL TECHNIQUES An investment project is a series of cash inflows and outflows, typically starting with cash outflows (the initial investment outlay) followed by cash inflows and/or cash inflows in later periods. (Gotze, Northcott, Schuster, 2008) The financial manager needs to employ appraisal techniques in order to decide which projects to accept and which to reject because these decisions largely shapes the future of the business and its ability to manage its future operations. The project accepted must meet the financial criteria of the company, generally its a return greater than the cost of capital needed to finance it. 4.1 Return on Investment (Accounting Rate of Return) This approach expresses the profit before tax arising from an investment as a percentage of the total outlay on the investment. When using the return on investment approach the project which gives the highest ARR is the one that should be accepted. Difficulties arise with the method when the duration of the investment extends for more than one year, as it then becomes necessary to determine some representative profit and investment value for the duration of the project. Other problem is that profits are the results of receipts and outgoings and they do not represent cash transactions and the cash flow arising is not taken into account during the term of the investment. 4.2 Return on Investment (ARR) related to MS As per the annual reports of MS from year 2006 to 2009, MS has invested on property. The investment, depreciation Net Profit are described in the annual report related to property. The tax budgeted profits are assumed accordingly. Year 2006 2007 2008 2009 Investment  £ 38.5 m  £ 24.1 m  £ 24.3 m  £ 24.3 m Budgeted Profits  £ 4 m  £ 4 m  £ 32 m  £ 8 m Less Depreciation ( £ .1 m) ( £ .2 m) ( £.3 m) ( £ .5 m) Tax ( £ 9.6 m) ( £ 1.9 m) ( £ 4.7m) ( £ 1.1m) Net Profit ( £ 4.7 m)  £ 1.9 m  £ 27 m  £ 6.4 m The average profit for the four years would be: Average Profit = [ (4.7) + 1.9 + 27 + 6.4] / 4 = 29.6 / 4 =  £ 7.4 m We can compare this with the original investment made in four years: Average investment = [ 38.5 + 24.1 + 24.3 + 24.3] /4 =  £ 28.55 m By comparing, Avg Profit/ Investment= (7.4/28.55) X 100 = 24.91 % Thus the company can decide on whether the investment is good or not. 4.3 Payback This method refers to how quickly the incremental benefits that accrues to a company from an investment project payback the initial capital invested. When faced with a straight accept or reject decision it can provide a rule where projects are accepted if they payback the initial investment outlay within a certain predetermined time. In addition, the payback method can provide a rule when a comparison is required of the relative desirability of several mutually exclusive investments (Lumby, 1988). This method simply measures the time period taken until the profits generated from the investment equal the initial cost of investment. The advantage of Payback is that it focuses on risks in considering the period during which the investment remains outstanding. The drawback is that the method takes no account of cash inflows after payback, neither is there any attempt to consider reinvestment possibilities for incoming funds during the period prior to payback. 4.4 Payback related to M S With relation to MS, we again take the project of investment in property, plant equipment. We take the 2 investments made in 2008 and 2009 and compare them with assumptions made for returns in the following years. 2009 2008 Investment Outflow Year 0 ( £ 540. 8 m) ( £ 958.4 m) Cash Inflows Year 1  £ 58.3 m  £ 91.6 m Year 2  £ 142.6 m  £ 400.4 m Year 3  £ 222.4 m  £ 300.2 m Year 4  £ 100.4 m  £ 286.7 m Year 5  £ 143.7 m  £ 123.2 m Total cash Inflow  £ 667.1 m  £ 1202.1 m Now comparing the two projects of 2008 2009 we can see that payback for 2009 is 5 years and payback for project in 2008 is 4 years. Thus project that MS invested is 2008 is better in terms of investment. 4.5 Net Present Value Net Present Value is the net monetary gain (or loss) from a project, computed by discounting all present and future cash inflows and outflows related to the project. (Gotze, Northcott, Schuster, 2008) Using the NPV method, all future cash flows related to investment project are discounted back to time 0. In order to establish the cash flows arising from a project into their present values, it is necessary to establish the cash inflows and outflows arising from it, and what cost of capital should be used to evaluate such projects. In order to determine the NPV of a project, we need to list all the cashflows related to the project. The net cash flows are then discounted at the cost of capital using the formulae: Discount factor = 1/ (1+i) n where n represents the number of periods and i represents the cost of capital per period The general rule is that if NPV is positive, the project is accepted else it is rejected. 4.6 Net Present Value related to MS We assume the example that taken in the pay back technique for the year 2009 and we assume the cost of capital to be 10 %. Year Net Cash Flows Formula Disc. Factor NPV  £  £ 2009 ( £ 540.8 m) 1  £ 540.8 m 2010  £ 58.3 m 1/(1+.1)1 .909  £ 52.99 m 2011  £ 142.6 m 1/(1+.1)2 .826  £ 117.78 m 2012  £ 222.4 m 1/(1+.1)3 .751  £ 167.02 m 2013  £ 100.4 m 1/(1+.1)4 .683  £ 68.57 m 2014  £ 143.7 m 1/(1+.1)5 .621  £ 89.094 m  £ 126.3 m ( £ 44.35 m) As we can see above the NPV for the project is negative thus this project should be rejected. 4.7 Internal Rate of Return (IRR) Internal Rate of Return of a Project is that cost of capital which makes the net present value of a project equal to zero. If the cost of capital required to reduce the future cash flows to zero is greater than the companys cost of capital, then the project will be accepted because it gives a positive return for the business. 4.8 Internal Rate of Return related to MS In internal rate of return we need to assume cost of capital so that NPV nears 0. Thus we assume the cost of capital as 9% first. Year Net Cash Flows Formula Disc. Factor NPV  £  £ 2009 ( £ 540.8 m) 1  £ 540.8 m 2010  £ 58.3 m 1/(1+.09)1 .917  £ 53.46 m 2011  £ 142.6 m 1/(1+.09)2 .842  £ 120.06 m 2012  £ 222.4 m 1/(1+.09)3 .772  £ 171.69 m 2013  £ 100.4 m 1/(1+.09)4 .708  £ 71.08 m 2014  £ 143.7 m 1/(1+.09)5 .650  £ 93.40 m  £ 126.3 m ( £ 31.10 m) Now we try with cost of capital as 7 % Year Net Cash Flows Formula Disc. Factor NPV  £  £ 2009 ( £ 540.8 m) 1  £ 540.8 m 2010  £ 58.3 m 1/(1+.07)1 .935  £ 54.51 m 2011  £ 142.6 m 1/(1+.07)2 .873  £ 124.48 m 2012  £ 222.4 m 1/(1+.07)3 .816  £ 181.48 m 2013  £ 100.4 m 1/(1+.07)4 .763  £ 76.6 m 2014  £ 143.7 m 1/(1+.07)5 .713  £ 102.45 m  £ 126.3 m ( £ 1.7 m) As we can see that with cost of capital as 9% the NPV is  £ 31.10 m and with cost of capital 7% the NPV is  £ 1.7 m, thus it shows that NPV will be zero between 6 and 7 % cost of capital. As the companys cost of capital is 10 % and the cost of capital to make the NPV zero is between 6 7 %, thus this project cant be accepted as its less than the companys cost of capital.

Comparing three poems from different cultures :: English Literature

Comparing three poems from different cultures Introduction The three poems that I will be comparing are ‘Presents from my aunts in Pakistan’ by Moniza Alvi, ‘Half-caste’ by John Agard and ‘Island Man’ by Grace Nichols. All of these poets have mixed-race backgrounds and all of these poems are linked in with the difficulties arising from having different cultural backgrounds. Story/theme ‘Presents from my aunts in Pakistan’ is reflective of Moniza Alvi’s childhood and her experiences of being from two different backgrounds â€Å"glass circles, recall the story how the three of us sailed to England.† She tells the reader about her experiences in Pakistan, the journey from Pakistan to England and about being in England. This shows that although she is confused about her background, she remembers everything from both cultures. ‘Half-Caste’, however, is a very confrontational poem and John Agard addresses the reader personally. â€Å"Excuse me†¦explain yuself†¦yu must come back†¦Ã¢â‚¬  Agard addresses the reader personally and confronts them about their opinions or beliefs of Half-caste people. He asks them to tell him what they mean by the phrase half-caste, then gives various scenarios about what they may mean which are incongruous. This puts his point across and makes people think about or change their beliefs. Conversely, ‘Island Man’ is the story of a man that used to live on an island, possibly the Caribbean, and then moved to London. This poem describes his feelings as he wakes up for the first day back in London â€Å"Comes back†¦to dull North Circular Road†¦Ã¢â‚¬  This poem also shows that he would much prefer to live on his â€Å"emerald island† than in London. This shows that the man has made a conscious decision about which part of his background he prefers and which part of his life he would like to fulfil. Emotions expressed ‘Presents from my aunts in Pakistan’ is a very sensitive poem and many emotions are expressed throughout the poem. In the first stanza, Moniza Alvi expresses excitement as she lists all of the wonderful things that her aunts have sent her from Pakistan. In the second stanza, she seems down heartened about everything and says, â€Å"never be as lovely as those clothes.† For the rest of the poem she seems confused about her background and indecisive about which background she prefers. ‘Half-Caste’, however, expresses a feeling of confrontation throughout the poem and it always seems as if John Agard wants the readers to respond to what he says but because of his hectoring tone the reader believes that they cannot. On the contrary, ‘Island Man’ has a pessimistic feel to the poem throughout. It seems as though the island man is constantly

Radcliffe and Wordsworth: Nature, Travel, and Memory Essay -- Traveli

Radcliffe and Wordsworth: Nature, Travel, and Memory In preparation for my presentation on the character of M. St. Aubert in Radcliffe's The Mysteries of Udolpho, I examined various passages from the novel's first few chapters which described St. Aubert's responses to nature in terms of the picturesque, the sublime, and sensibility. One passage which especially attracted my attention, but which ultimately fell outside the coverage of our group's presentation, is Radcliffe's account of St. Aubert's feelings about the "small estate in Gascony" (Radcliffe 6) where he and his family lived: To this spot he had been attached from his infancy. He had often made excursions to it when he was a boy, and the impressions of delight given to his mind . . . had not been obliterated by succeeding circumstances. The green pastures along which he had so often bounded in the exultation of health, and youthful freedom - the woods, under whose refreshing shade he had first indulged that pensive melancholy . . . the wild walks of the mountains, the river, on whose waves he had floated, and the distant plains, which seemed boundless as his early hopes - were never after remembered by St. Aubert but with enthusiasm and regret. (Radcliffe 6) This passage was interesting to me because many of the travel writings we have read so far tend to focus more on the travellers' immediate responses to relatively new and unfamiliar environments which they are visiting for the first time, rather than on a return to a familiar place or the memories evoked by those familiar places. However, St. Aubert's emotional responses to familiar places - as well as his responses to less familiar places he sees on his travels - form a significant part of his characte... ...remembered them when we had been there before - in a similar manner to the way in which Wordsworth does this in Tintern Abbey. As well, though on the more recent trips I have been more acutely aware of the ways in which my relationships with my family have changed over the years - perhaps a side effect of travelling with three other people in a small space for a period of ten days - it is still easy for me to sympathize with Radcliffe's evocation of "the memory of those we love . . . all tender and harmonious as this landscape" (47). Works Cited Radcliffe, Ann. The Mysteries of Udolpho. 1794. Ed. Jacqueline Howard. London: Penguin, 2001. Wordsworth, William. "Lines Written a Few Miles Above Tintern Abbey, on Revisiting the Banks of the Wye During a Tour, 13 July 1798." 1798. Romanticism: An Anthology. Ed. Duncan Wu. Oxford: Blackwell, 1998. 265-269.

Alienation in the lives of Arab Women :: Research Culture Arabic Essays

Alienation in the lives of Arab Women Alienation: al ·ien ·a ·tion ( l y -n sh n, l - -) n. The act of alienating or the condition of being alienated; estrangement; isolation or dissociation. Alienation is a concept that is universal to all people of all cultures in the world and throughout all time periods. These feelings of alienation, in some form or another, have affected every human begin that has ever taken a breath and will until the race is extinct. It is these feelings of alienation that influence so many of our activities, our thoughts, and the way we shape our lives and the manner in which we form our societies. It is these reactions to alienation that have played such a large role in the shaping of cultures and societies and for this reason it is important to study the alienation that is being discussed here. It is necessary to choose a group first of all and for our purpose here it will be women in the Arab culture. This is a very diverse culture and therefore we cannot deal with any specific society too in depth and so therefore we will look at examples provided from Arab women’s novels as well as look at the culture as a whole and over a large geogra phic region. We will be primarily concerned with the sources of alienation that bring these feelings and/or situations of alienation about and focusing on a socioanalytic evaluation of these sources. Also important in this discourse are the situations of the present that we will examine by looking at a few examples from the Arab women’s novels, but also the in-depth analyses of the situations and experiences. Finally, we will look at what these situations and analyses mean for the future of Arab women and the circumstances they may be provided with in years to come and how they might deal with new forms of alienation and at the same time different forms of dealienation or situations of being able to enter parts of society and the world that they have not been able to for numbers of years, and in some cases parts they have never experienced—historically speaking. In short, the purpose of this discourse is to understand the alienation that is a part of the lives of Arab women. This is not supposed to be a definitive analysis, but rather the introduction

Childhood Constructions

Childhood is the period of time stretching from infancy to adolescence (teenage) stage of life. Issues, theories and concepts have been put forth attempting to put some meaning to childhood. For instance the modern society perceives children as passive and surviving at the mercies of the wider society. Adults do not seek to learn anything from the children and they assume that childhood is a period meant to transform kids into dependable adults. There is a need to view childhood differently to be able to respond positively to their needs and to understand the stage as crucial in helping us understand adulthood and humanity in general. As a matter of fact, childhood experiences, plays a vital role in shaping the later stages of life. Childhood is perceived as a social structure, which determines the ideal institutions where proper childhood development would be ensured. Generally, social structures offer both opportunities one is exposed to and limitations are determined by a child’s socio-economic background and its physical endowments (Stearns, 2003). A child in ideal situation is expected to have two parents who provide everything and ensure moral uprightness. The child is given enough time to relax and has siblings. The parents are expected to provide security and facilities for play. Parents commence preparations for the infant long way before the mother delivers the kid. However, in terms of childhood development, from a historical perspective, the early American society never celebrated infancy. Childhood was characterized by missing parental care, high rate of infant mortality. There was not time for taking the kid through all the stages of growth and development. Where parents were missing due to reasons like death, young children were charged with the task of taking care of the others. However, good morals were upheld all through. Child labour was prevalent as well as early marriages. In the late 1700s and early 1800 there was growing concern on childhood. Between 1840s and 1900s socio-economic changes taking place revolutionized the ideal of child upbringing. Parents became more concerned about children; they started emphasizing on child education. A scientific aspect was incorporated in child rearing whereby child development was closely monitored. Racial concerns arose. Industrial development led to improved standards of life and reduced childhood deaths. However, some children especially of immigrant families were still in slavery. These children were poorly treated subjected to much work and not allowed to go through formal education. Some children ended up in orphanages where proper care was ensured. Other children went missing and still others would end up dying. In the twentieth century children were regarded as of economic value. They offered cheap labour earning highly needed wages in the family. There was a rising need to occupy the kids with work to discourage laxity. In the contemporary society children are perceived as of less economic value. Infact childhood is regarded as an economic liability. Children, spend more of parents’ financial resources than they contribute to the same. Young children’s perception of things in the US and the world at large has been subjected to a number of influences. Their access to information materials and gadgets like TV, video and computer exposes them to a wide field of knowledge. These triggers and stimulate a mental process that generates a diversified perception of issues to do with life. For instance, programmes on TV and videos showing modern family life would touch issues like children rights. Children acquire knowledge on family issues like the role of parents in a family, career, and family conflicts among other issues at a very tender age. It is not amazing to realize that some programmes highlighting crucial family issues like divorce, separation, child abuse appear on screen long way before the kids succumb to sleep. As a matter of fact, the media has made the children to feel like they are their own caretakers. It is worth noting that in some programmes, adult voices and perceptions have been superimposed on very young children. Romantic movie clips and actual programmes are not rare on TVs in the early evening hours. This most assuredly influences children’s perception of issues to do with sexuality, love, hate and social conflicts. In some movies, a character commits suicide, murder or causes chaos in their attempt to either express themselves or to get out of trouble. All these happenings are bound to model the character and personality of children since they are also exposed to similar circumstances in this world. No wonder cases of young snipers have been reported in the recent past in our society. The greatest challenge and risk is that parents and guardians cannot exercise full control over what their children go through and their exposure to information materials. Children can virtually access any information anywhere even if they are denied access at home. Due to social-economic problems some parents have ended up in serious conflicts. A man and his wife settle scores physically when reason fails to avail solutions for their pressing issues. This has exposed many children to utter violence and most of them perceive this world as a harsh and chaotic place and some develop aggression in their bid to conquer life’s challenges. Other end up violent when their tactics fail to work. Children face challenging and conflicting situations both at home and away from home. With increasing social-economic challenges, children of the world are exposed to situations that influence their character and personality very early. Many parents who are especially keen on child development are very anxious and rather troubled due to the deteriorating morals and social values. Evil is inculcated in children’s lie s at very early stages of child’s development and some caretakers are simply watching desperately as their children vanish in the mire of moral rottenness. Parents and guardians are increasingly concerned about the eventualities given the direction the current (modern) society has taken. For instance, drug use and abuse at childhood stages. Drug use is a commonplace thing in schools. It is a matter of great concern since a drug addicted young generation spells doom to the future of the society. Lack of sobriety among the youths would result to stagnating social-economic systems. The other nagging issue is about the dwindling interest in schooling. Children seem to pursue entertainment and quick money earners at the expense of a formal system of learning, which incorporates all aspects of human growth development. This produces a dull; dump and unrealistic clique that would lack the remotest idea of how to progressively run the socio-economic aspects of our society. Fun centers are always congested. Youngsters are pursuing fame and money (wealth) at all costs in some instances with dire consequences. The young generation seems to be dragging the entire society into Hades. Learning institutions seem to design their programmes to suit the whims of the learners this basically being a result of constant expression of fear and anxiety by parents whose children’s performance grow dismal. The fear by the parents is that the children are bound to develop disinterest in education if their performance worsens. There is an increasing desire to score high grades and join better and highly ranked higher learning institutions. Those who fail to measure up resort to entertainment parlors. A mention of physical growth, fitness or posture would cause some emotional tremor. This is an issue of great concern among Americans. High economic development rate has made many young people afford high calorific foods. Eating habits have changed and cases of obesity have been increasing day after day. However, the increasing concerns about the issue of body size, weight, posture and fitness is the reason behind the fast rate of growth of the fashion beauty and modeling industry. This raises a myriad of questions about the extent to which the children should be allowed to make decisions about their physical and emotional development. Most parents are extremely anxious about the developments that may arise during the course of growth and development of their children. Streets trodden by youngsters struggling to bear massive weight are commonplace in America. The issue of physical development among other social challenges affects a child’s self esteem. For instance, an obesed child is likely to develop low self-esteem. Poor academic performance would also have similar effects on the self-esteem of a child. Parents are especially concerned about eating habits of their children but it still remains an evasive issue since many eateries are being put up offering high calorie and very attractive foods. What leads the youngsters to such eating habits and poor dietary programmes remains a very tricky puzzle. As the parents battle with the issue of food, one would point an accusing finger at them since some abandon their duty as mothers at very early stages of child development. For instance, some due to careers quit breastfeeding a couple of days after delivery. The responsibility of feeding the child rests squarely on baby sitters, some of who might either lack crucial knowledge on proper diet or others out of defiance dump unhealthy foods into the child’s tummy. A child graduates to teenage with the same problem. Boredom is a feeling that would quite well describe the emotional orientation of most youths in our society. Every formal system seems to be a bore to the young generation. Schoolwork is boring and many are reluctant to pursue higher education. Parents are very much concerned about the amount of homework assigned to the children. On one hand the children feeling bored by the too much task given by the teachers to be tackled at home by the children; on the other hand, the parents feel that too much homework denies them control over the activities performed by their children during their time with them at home. Teachers still feel that they have an obligation to steer learning among the children to greater heights. How a compromise would be struck given the above situations remains a hard nut to crack. This concern revolves around not only the issue of homework assigned by teachers to children but also around other chores both at home and away from home. The government is on very high alert concerning issues to do with child labour. The problem is how to determine what amounts to child labour. Determining how much work a child should be given at home and elsewhere is an issue to be debated upon. With the growing enlightenment on children rights is bound to be a bone of contention. However, hiring of children to work in the manufacturing and processing industries remains out of question and punitive measures should be meted on whoever commits such a disorderly thing. A great deal of anxiety rests in the hearts of parents and guardians when an issue of special needs arises. How such children are handled matter a lot. There is a need for more schools that can handle such cases. But parents are more concerned about their welfare. Children with both physical and mental disadvantages are not easy to cater for and the number and capacity of the institutions handling such might not be adequate and this has been the essence of parental concerns. Another issue arises when a consideration is made on whether to surrender the disabled children or other children with special needs full time to such special institutions or part timely. With the busy parent schedules this becomes a big issue. Children are also exposed to traffic risks. How roads and streets are manned determines how safe or unsafe children can be on the roads. Children use roads frequently on foot either from schools or other events and occasions. Road safety for children is an issue of concern among parents. Issues range from delays in traffic snirl-ups to accidents both in public service vehicles or private cars. Though rare, parents are also afraid in case a child sneaks a car out of the homestead. Concerns about children safety do not only arise on the roads but also at home and elsewhere. Safety in the house, on the compound and away from home arouses great concern among parents. Parents strictly and keenly monitor the activities of the children whenever they are around them. At times they are concerned about the punitive measures taken by teachers against the children. Another issue about safety arises when a babysitter comes into the scene. Fear engulfs parents concerning the level of safety a babysitter would ensure on children. Babysitters might not have a deep emotional attachment to the child. Negligence by a babysitter would pose a safety risk and also physical and psychological anomalies. There is also a risk of child abductions. Parents are afraid of situations whereby after allowing their children to move around freely, they end up under the custody of strangers who later turn up demanding hefty amounts of cash before they release them. This is not uncommon with the escalating crime levels. Other concerns include infant sexual exploitation. There have been a number of cases of infant sexual exploitation in the American society. The worst is when a close relative is implicated in the vice. Children are constantly exposed to such dangers, especially with the weakening social ties and parents busy schedules which rob them of the opportunity to constantly and consistently monitor their children’s activities. Many self-confessed victims of sexual harassment have brought to our attention the looming danger. The society has almost reached a state of moral decantation. Some people seem to have lost their sense of reason. Children below five years of age have fallen victims. Other concerns that leave parents torn between issues touch the areas of toilet training. How it is conducted at that tender age determines the psychological development of the child. Some parents lose their patience when the child turns out to be a slow learner. This according to psychoanalysts tends to behavioral maladjustments later in a child’s life. This again raises the issue of whether or not the mother is the one charged with the responsibility of conducting the exercise. Babysitters are known to be harsh especially when the children are unco-operative. However some mothers subject their children to harsh toile training. Many parents are usually anxious about how fast their children learn to control their bowel movements. Another issue of paramount concern is breast-feeding. The stage of growth and development at which an infant is weaned (or stops breastfeeding) contributed a great deal to the physical and psychological development of the infant. A child who stops breastfeeding early than expected is likely to develop poorly physically and psychologically. This also tampers with the emotional attachment between the child and the mother and the child is likely to develop defiant behaviour later in life. Parents are afraid and anxious about future development of their children given their early administration of bottled foods. The changing social structures coupled with the negative publicity carried out by the media have also caused too much anxiety among parents. Family ties are weakening and many parents are opting for divorce or separation. Children are majorly the sufferers. Media never ceases to feature movies that uphold violent behaviour and crime. Infact movie stars are perceived even by youngsters, as heroes who murder many and commit the vilest things. Children have their role models in movies. Romantic movies are filled with scenes portraying hatred, jealousy, obscenity, murder, suicide and revenge. The young children are adopting the same negative traits and some are living out the characters they see in the movies. Family feuds are not rare occurrences in our society. To sum up, childhood development and child upbringing are issues that parents are very much concerned in America. Parents face numerous anxious moments in their efforts to bring up their children in the most ideal conditions and ways. Readership of publications highlighting issues concerning childhood is growing tremendously as parents battle with the challenges they encounter in control over their lives of their children. The wider society on the other hand has a major role to play in shaping the character of the young. There is a tag of war as the two scrambles for control. Parent’s concerns and anxiety is genuine and valid. Every adult in the US should feel responsible for the upbringing of the upcoming young generations. The media should be instrumental in promoting proper childhood development by designing programs that uphold acceptable childhood behaviour as well as educating all childhood social institutions on the most ideal ways of bringing up children. And the government should provide structures that promote proper childhood development. A central issue that has been raised over time is about childhood innocence. In the earlier times infants were perceived as innocent. However with the emerging issues in the society and exposure of sexual materials by the media, children are exposed to sexual issues and abuse at tender stages of growth and development. One would wonder whether children are innocent as earlier perceived or not. The society, including media should feel responsible for shaping childhood. The fashion industry should be more responsible to admit the right ages. A fairer comparison should be drawn between children and adults. Children should be enlightened on their right, and the dangers and risks they are exposed to. Much light should be she on the existing opportunities available for the children to fully exploit their talents.

Reading Cap 3 Market Leader

READING CAP 3 A) What area of business do you think the company American International Group (AIG) is envolved in’ a) Tobacco b) Insurance c) Oil d) Packaging B) What dot he following people mentioned in the article: Maurice Greenberg: Chairman Corneluis Vander: founder Edmund Tse: Runs Asian operations C) What do the following numbers in the main fthe article refers to? 166. – capitalisation 1992- Graduate licence 1919- Year of foundation in shangai 80,000- # of employees 130. -# of countries D) According to the article what are the main factors responsible for AIG? s success in Asia?R= because relationships in government E) Read the article and answer these questions 1. -What objective does AIG have in china? Increase the share 2. -What does Mr Greenberg see as his role in the company? As a employee 3. – Why in Asia important to AIG? The respect and valuies F) Find three verbs in the article which combine with the noun relationships to mean develop. Build Turni ng Success G) Find phrases (adjective and noun) in the article which mean the following 1. -Unused possibilities -odds 2. -continuing in the same place for a great length of time- permanency 3. -unlimited entry- . -representative connected to a company– image 5. -developing sales areas – develop training 6. -important talks- discussion 7. -most important countries – main advantage H) Discuss these questions 1. -what can spoil relations between companies? -. – missunderstoods 2. -a foreign company is opening a branch in your country. What factors should it consider? .- share of market 3. – In your experience are certain nationalities better at building relationship than others? If so which ones? American and japannesse 4. -How can you build good business relationships?. Favours and respect