COST-MANAGEMENT TECHNIQUES THAT CAN SAVE REAL MONEY IN HOSPITAL

pointer to succes:
• Outsourcing
Organizations that outsource are seeking to realize benefits or address the following issues:[11][12][13][14]
• Cost savings — The lowering of the overall cost of the service to the business. This will involve reducing the scope, defining quality levels, re-pricing, re-negotiation, cost re-structuring. Access to lower cost economies through offshoring called "labor arbitrage" generated by the wage gap between industrialized and developing nations.[15]
• Focus on Core Business — Resources (for example investment, people, infra structure) are focused on developing the core business. For example often organizations outsource their IT support to specialised IT services companies.
• Cost restructuring — Operating leverage is a measure that compares fixed costs to variable costs. Outsourcing changes the balance of this ratio by offering a move from fixed to variable cost and also by making variable costs more predictable.
• Improve quality — Achieve a steep change in quality through contracting out the service with a new service level agreement.
• Knowledge — Access to intellectual property and wider experience and knowledge.[16]
• Contract — Services will be provided to a legally binding contract with financial penalties and legal redress. This is not the case with internal services.[17]
• Operational expertise — Access to operational best practice that would be too difficult or time consuming to develop in-house.
• Access to talent — Access to a larger talent pool and a sustainable source of skills, in particular in science and engineering.[3][18]
• Capacity management — An improved method of capacity management of services and technology where the risk in providing the excess capacity is borne by the supplier.
• Catalyst for change — An organization can use an outsourcing agreement as a catalyst for major step change that can not be achieved alone. The outsourcer becomes a Change agent in the process.
• Enhance capacity for innovation — Companies increasingly use external knowledge service providers to supplement limited in-house capacity for product innovation.[19][20]
• Reduce time to market — The acceleration of the development or production of a product through the additional capability brought by the supplier.[21]
• Commodification — The trend of standardizing business processes, IT Services, and application services which enable to buy at the right price, allows businesses access to services which were only available to large corporations.
• Risk management — An approach to risk management for some types of risks is to partner with an outsourcer who is better able to provide the mitigation.[22]
• Venture Capital — Some countries match government funds venture capital with private venture capital for start-ups that start businesses in their country.[23]
• Tax Benefit — Countries offer tax incentives to move manufacturing operations to counter high corporate taxes within another country.
• Scalability — The outsourced company will usually be prepared to manage a temporary or permanent increase or decrease in production.
• Creating leisure time — Individuals may wish to outsource their work in order to optimise their work-leisure balance.[24]
Specific examples of corporate outsourcing
There are situations when a firm may consider outsourcing some of its R&D work to a contract research organizations or universities. In this context, the two most populous countries in the world, China and India, provide huge pools from which to find talent. Both countries produce over 200,000 engineers and science graduates each year. Moreover both countries are low cost sourcing countries.
Outsourcing in the information technology field has two meanings.[25] One is to commission the development of an application to another organization, usually a company that specializes in the development of this type of application. The other is to hire the services of another company to manage all or parts of the services that otherwise would be rendered by an IT unit of the organization. The latter concept might not include development of new applications.
Implications
Management, the corporation and consumers
Quality risk
Quality risk is the propensity for a product or service to be defective, due to operations-related issues. Quality risk in outsourcing is driven by a list of factors. One such factor is opportunism by suppliers due to misaligned incentives between buyer and supplier, information asymmetry, high asset specificity, or high supplier switching costs. Other factors contributing to quality risk in outsourcing are poor buyer-supplier communication, lack of supplier capabilities/resources/capacity, or buyer-supplier contract enforceability. Two main concepts must be considered when considering observability as it related to quality risks in outsourcing: the concepts of testability and criticality.
Quality fade is the deliberate and secretive reduction in the quality of labor in order to widen profit margins. The downward changes in human capital are subtle but progressive, and usually unnoticeable by the out sourcer/customer. The initial interview meets requirements, however, with subsequent support, more and more of the support team are replaced with novice or less experienced workers. Some IT shops[who?] will continue to reduce the quality of human capital, under the pressure of drying up labor supply and upward trend of salary, pushing the quality limits. Such practices are hard to detect, as customers may just simply give up seeking help from the help desk. However, the overall customer satisfaction will be reduced greatly over time[citation needed]. Unless the company constantly conducts customer satisfaction surveys, they may eventually be caught in a surprise of customer churn, and when they find out the root cause, it could be too late. In such cases, it can be hard to dispute the legal contract with the outsourcing company, as their staff are now trained in the process and the original staff made redundant. In the end, the company that outsources may find that it is worse off than before it outsourced its workforce.
Quality of service
Quality of service is measured through a service level agreement (SLA) in the outsourcing contract. In poorly defined contracts there is no measure of quality or SLA defined. Even when an SLA exists it may not be to the same level as previously enjoyed. This may be due to the process of implementing proper objective measurement and reporting which is being done for the first time. It may also be lower quality through design to match the lower price.
There are a number of stakeholders who are affected and there is no single view of quality. The CEO may view the lower quality acceptable to meet the business needs at the right price. The retained management team may view quality as slipping compared to what they previously achieved. The end consumer of the service may also receive a change in service that is within agreed SLAs but is still perceived as inadequate. The supplier may view quality in purely meeting the defined SLAs regardless of perception or ability to do better.
Quality in terms of end-user-experience is best measured through customer satisfaction questionnaires which are professionally designed to capture an unbiased view of quality. Surveys can be one of research.[26] This allows quality to be tracked over time and also for corrective action to be identified and taken.
Productivity
Offshore outsourcing for the purpose of saving cost can often have a negative influence on the real productivity of a company. Rather than investing in technology to improve productivity, companies gain non-real productivity by hiring fewer people locally and outsourcing work to less productive facilities offshore that appear to be more productive simply because the workers are paid less. Sometimes, this can lead to strange contradictions where workers in a developing country using hand tools can appear to be more productive than a U.S. worker using advanced computer controlled machine tools, simply because their salary appears to be less in terms of U.S. dollars.
In contrast, increases in real productivity are the result of more productive tools or methods of operating that make it possible for a worker to do more work. Non-real productivity gains are the result of shifting work to lower paid workers, often without regards to real productivity. The net result of choosing non-real over real productivity gain is that the company falls behind and obsoletes itself overtime rather than making investments in real productivity.
Staff turnover
The staff turnover of employee who originally transferred to the outsourcer is a concern for many companies. Turnover is higher under an outsourcer and key company skills may be lost with retention outside of the control of the company. In outsourcing offshore there is an issue of staff turnover in the outsourcer companies call centers. It is quite normal for such companies to replace its entire workforce each year in a call center.[27] This inhibits the build-up of employee knowledge and keeps quality at a low level.[citation needed]
Language skills
In the area of call centers end-user-experience is deemed to be of lower quality when a service is outsourced. This is exacerbated when outsourcing is combined with off-shoring to regions where the first language and culture are different.[28] The questionable quality is particularly evident when call centers that service the public are outsourced and offshored.[citation needed]
The public generally find linguistic features such as accents, word use and phraseology different which may make call center agents difficult to understand. The visual clues that are present in face-to-face encounters are missing from the call center interactions and this also may lead to misunderstandings and difficulties.[29] In addition to language and accent differences, a lack of local social and geographic knowledge is often present, leading to misunderstandings or mis-communications.[citation needed]
Failure to deliver business transformation
Business transformation promised by outsourcing suppliers often fails to materialize. In a commoditised market where many service providers can offer savings of time and money, smart vendors have promised a second wave of benefits that will improve the client’s business outcomes. According to Vinay Couto of Booz & Company “Clients always use the service provider’s ability to achieve transformation as a key selection criterion. It’s always in the top three and sometimes number one.” While failure is sometimes attributed to vendors overstating their capabilities, Couto points out that clients are sometimes unwilling to invest in transformation once an outsourcing contract is in place.[30][unreliable source?]
Security
Before outsourcing an organization is responsible for the actions of all their staff and liable for their actions. When these same people are transferred to an outsourcer they may not change desk but their legal status has changed. They no-longer are directly employed or responsible to the organization. This causes legal, security and compliance issues that need to be addressed through the contract between the client and the suppliers. This is one of the most complex areas of outsourcing and requires a specialist third party adviser.
Fraud is a specific security issue that is criminal activity whether it is by employees or the supplier staff. However, it can be disputed that the fraud is more likely when outsourcers are involved, for example credit card theft when there is scope for fraud by credit card cloning. In April 2005, a high-profile case involving the theft of $350,000 from four Citibank customers occurred when call center workers acquired the passwords to customer accounts and transferred the money to their own accounts opened under fictitious names. Citibank did not find out about the problem until the American customers noticed discrepancies with their accounts and notified the bank.[31]
Qualifications of outsourcers
The outsourcer may replace staff with less qualified people or with people with different non-equivalent qualifications.[32]
In the engineering discipline there has been a debate about the number of engineers being produced by the major economies of the United States, India and China. The argument centers around the definition of an engineering graduate and also disputed numbers. The closest comparable numbers of annual graduates of four-year degrees are United States (137,437) India (112,000) and China (351,537).[33][34]
Company knowledge
Outsourcing could lead to communication problems with transferred employees. For example, before a transfer the staff has access to broadcast company e-mail that informs them of new products, procedures etc. An outsourcing organization may not have the same e-mail access available to them. To reduce costs, outsourced employees may have new information delivered to them in team meetings.
Public opinion
There is a strong public opinion in the United States against outsourcing (especially when combined with offshoring) because it leads to job displacement.[citation needed] It is difficult to dispute that outsourcing has a detrimental effect on individuals who face job disruption and employment insecurity.[citation needed] However, outsourcing supporters[who?] draw on mainstream economics to argue that outsourcing should bring down prices, providing greater economic benefit to all. There are legal protections in the European Union regulations called the Transfer of Undertakings (Protection of Employment). Labor laws in the United States are not as protective as those in the European Union.[35] On June 26, 2009, Jeff Immelt, the CEO of General Electric, called for the United States to increase its manufacturing base employment to 20% of the workforce commenting that the U.S. has outsourced too much and can no longer rely on consumer spending to drive demand.[36]
Standpoint of labor
From the standpoint of labor outsourcing may represent a new threat, contributing to rampant worker insecurity, and reflective of the general process of globalization.[37] While the "outsourcing" process may provide benefits in some form and to some degree it may undermine the ability of labor to resist unwanted changes in the workplace. For example, a corporation may outsource a division of the company to a service provider, that may retain the workforce on worse conditions or discharge them in the short term. The affected workers thus often feel they are being "sold down the river." Outsourcing is thus often criticized for violating the American Dream.
By country
United States
'Outsourcing' became a popular political issue in the United States during the 2004 U.S. presidential election. The political debate centered on outsourcing's consequences for the domestic U.S. workforce. Democratic U.S. presidential candidate John Kerry criticized U.S. firms that outsource jobs abroad or that incorporate overseas in tax havens to avoid paying their "fair share" of U.S. taxes during his 2004 campaign, calling such firms "Benedict Arnold corporations".
Criticism of outsourcing, from the perspective of U.S. citizens, by-and-large, revolves around the costs associated with transferring control of the labor process to an external entity in another country. A Zogby International poll conducted in August 2004 found that 71% of American voters believed that “outsourcing jobs overseas” hurt the economy while another 62% believed that the U.S. government should impose some legislative action against companies that transfer domestic jobs overseas, possibly in the form of increased taxes on companies that outsource.[38] One given rationale is the extremely high corporate income tax rate in the U.S. relative to other OECD nations,[39][40][41] and the practice of taxing revenues earned outside of U.S. jurisdiction, a very uncommon practice. However, outsourcing is not solely a U.S. phenomenon as corporations in various nations with low tax rates outsource as well, which means that high taxation can only partially, if at all, explain US outsourcing. For example, the amount of corporate outsourcing in 1950 would be considerably lower than today, yet the tax rate was actually higher in 1950.[42]
It is argued that lowering the corporate income tax and ending the double-taxation of foreign-derived revenue (taxed once in the nation where the revenue was raised, and once from the U.S.) will alleviate corporate outsourcing and make the U.S. more attractive to foreign companies. However, while the US has a high official tax rate, the actual taxes paid by US corporations may be considerably lower due to the use of tax loopholes, tax havens, and attempts to "game the system".[43] Rather than avoiding taxes, outsourcing may be mostly driven by the desire to lower labor costs (see standpoint of labor above). Sarbanes-Oxley has also been cited as a factor for corporate flight from U.S. jurisdiction. Policy solutions to outsourcing are also criticized.
Outsourcing to the Philippines
Awarded as the top outsourcing destination for the years 2007 and 2009,[44] the Philippine government has implemented several laws that will grant tax holidays and other benefits to multinational companies who wish to setup operations in the country. It has export processing zones all over the country and is currently the host of several manufacturing firms including Texas Instruments, MOOG, and Microsoft.
The country also boasts of a high literacy rate, providing a large base of skilled and highly educated workers. Along with Filipino, English is recognized as an official language of the country and a de facto standard for official and commercial transactions. Most outsourced work to the Philippines consists of customer support services, web development and website design.
Outsourcing refers to a company that contracts with another company to provide services that might otherwise be performed by in-house employees. Many large companies now outsource jobs such as call center services, e-mail services, and payroll. These jobs are handled by separate companies that specialize in each service, and are often located overseas.
There are many reasons that companies outsource various jobs, but the most prominent advantage seems to be the fact that it often saves money. Many of the companies that provide outsourcing services are able to do the work for considerably less money, as they don't have to provide benefits to their workers and have fewer overhead expenses to worry about.
Outsourcing also allows companies to focus on other business issues while having the details taken care of by outside experts. This means that a large amount of resources and attention, which might fall on the shoulders of management professionals, can be used for more important, broader issues within the company. The specialized company that handles the outsourced work is often streamlined, and often has world-class capabilities and access to new technology that a company couldn't afford to buy on their own. Plus, if a company is looking to expand, outsourcing is a cost-effective way to start building foundations in other countries.
There are some disadvantages to outsourcing as well. One of these is that outsourcing often eliminates direct communication between a company and its clients. This prevents a company from building solid relationships with their customers, and often leads to dissatisfaction on one or both sides. There is also the danger of not being able to control some aspects of the company, as outsourcing may lead to delayed communications and project implementation. Any sensitive information is more vulnerable, and a company may become very dependent upon its outsource providers, which could lead to problems should the outsource provider back out on their contract suddenly.
Dapatkan Keunggulan Kompetitif dengan Outsourcing
Outsourcing dapat menjadi suatu strategi brilian bagi perusahaan, karena dengan outsourcing perusahaan memperoleh keuntungan finansial secara langsung, yaitu pemangkasan biaya secara dramatis. Tapi outsourcing bukanlah sekedar pemangkasan biaya saja. Outsourcing sangat berkaitan pula dengan masalah peningkatan efisiensi, pengurangan biaya modal dan biaya operasional, serta tentunya untuk lebih meningkatkan fokus bisnis suatu perusahaan. Sebuah perusahaan dapat memperoleh banyak manfaat ketika masalah teknologi informasi (TI) mereka diserahkan kepada ahli-ahli TI eksternal yang telah teruji, handal dan profesional.
Saltanera menawarkan solusi TI yang bersifat lengkap dan komprehensif. Dengan dukungan tenaga TI yang handal dan profesional, Saltanera dapat menjadi mitra tepat outsourcing TI perusahaan Anda. Kami dapat memberika sebuah solusi yang akan disesuaikan dengan kebutuhan perusahaan Anda, scalable, dengan biaya yang efisien, dan ditunjang dengan metodologi kami yang telah terbukti tangguh dan teruji, yaitu Saltanera Collaborative Process (SCP).
Dengan Layanan Outsourcing dari Saltanera, kami akan membantu Anda dalam menghadirkan solusi e-business dengan budget yang dapat diprediksi dan tanpa hidden-cost, meningkatkan performansi proses bisnis, meningkatkan cash flow, mengoptimalkan penggunaan resource yang tersedia, serta yang terpenting, mengembalikan fokus bisnis Anda kembali pada core business sesungguhnya, tanpa perlu memikirkan lagi masalah TI yang tentunya bukan merupakan core business Anda.
• Food services
Food service is a large industry which deals with the preparation and service of food outside the home. Catering a wedding, establishing a restaurant, and running a cafeteria are all forms of food service. Many people take advantage of the range of options provided by this industry all over the world, ranging from stopping at a franchise to pick up a burger and fries to eating a prescription diet while in the hospital.
A number of goods and services fall under the umbrella of food service, such as companies which transport food and related products like kitchen equipment, silverware, and so forth. Restauranteurs, waiters, bussers, chefs, and dietitians are some examples of people who work in the food service industry, along with people like architects who design facilities where food is made and served, company representatives who travel the road selling products related to the service and sale of food, and consultants who help people coordinate events at which food will be served.
Some people in this industry receive special training so that they can work in food service. Some colleges and trade schools offer hospitality programs which can include things like restaurant management, and people can also receive special training in issues like nutrition for hospitalized patients or children in schools. Other people start from the ground up, driving trucks for food distributors, waiting tables at restaurants, and so forth, gaining an understanding of the industry by working from within it.
Work in the food service industry can be grueling and demanding, even for managers and executives. The hours are often long and irregular, and people tend to spend a lot of time on their feet, dealing with varied and complex situations. As with other facets of the hospitality industry, people must also be highly attuned to the need for customer satisfaction, whether they are developing menus for a college dining hall or providing service at four star French restaurants.
Foodservice (US English) or catering industry (British English) defines those businesses, institutions, and companies responsible for any meal prepared outside the home. This industry includes restaurants, school and hospital cafeterias, catering operations, and many other formats.
Types of companies
The companies that supply foodservice operators are called foodservice distributors. Foodservice distributors sell goods like small wares (kitchen utensils) and bulk foods. Some companies manufacture products in both consumer and foodservice versions. The consumer version usually comes in individual-sized packages with elaborate label design for retail sale. The foodservice version is packaged in a much larger industrial size and often lacks the colorful label designs of the consumer version.
Providers
Foodservice sales to restaurants and institutions are estimated to be approximately $400 Billion, about equal with consumer sales of foods through grocery outlets. Major foodservice providers include Aramark, Brinker International, Compass Group, the Crown Group, Darden Restaurants, Sysco, McLane Company, US Foodservice and 3663 First for Foodservice.
Employment statistics
The foodservice industry is one of the largest employers in the United States. Over 805,360 people are currently working as servers and managers alone. 59% of these workers are under the age of 30, and over 66% hold only a high school diploma or less.[1]
Counter service


A food counter service
Counter service is a form of service in restaurants, pubs, and bars where food or drinks are ordered at the counter. Counter service is also called "bar service" in the case of pubs and bars where the counter is also called the bar. Counter service is compared with table service where service is provided at the table. With counter service, the customer generally pays before consuming the food or drink. Some fast food restaurants offer only counter service while table service is the common form in most restaurants. For pubs and bars, bar service is the norm in the United Kingdom and the Republic of Ireland whereas table service is the norm in the United States and Continental Europe.
Table service
Table service is food service served to the customer's table by waiters. Table service is the norm in most restaurants, while for some fast food restaurants counter service is the common form. For pubs and bars, table service is the norm in the United States whereas counter service is the norm in the United Kingdom. With table service, the customer generally pays at the end of meal. Various methods of table service can be provided. See, for instance, silver service.
Gueridon service
Gueridon service is a form of food service provided by restaurants to their guests. This type of service encompasses preparing food (primarily salads, main dishes such as beef stroganoff, or desserts) in direct view of the guests, using a "Gueridon". A gueridon typically consists of a trolley that is well equipped to prepare, cook and serve the food to the guest. There will be a gas hob, chopping board, cutlery drawer, cold store (depending on the trolley type) and general working area.
• Environmental services
To my knowledge, the literature so far does not formally define PES, which contributes to some conceptual confusion. For our field work in Bolivia and Vietnam, we used five relatively simple criteria to describe the PES principle.
A PES is:
1. a voluntary transaction where
2. a well-defined ES (or a land-use likely to secure that service)
3. is being ‘bought’ by a (minimum one) ES buyer
4. from a (minimum one) ES provider
5. if and only if the ES provider secures ES provision (conditionality).

First, PES is a voluntary, negotiated framework, which distinguishes it from command-and-control measures. This presupposes that potential ES providers have real land-use
choices, something which in Vietnam, for instance, typically was not the case: payments
here were more to be seen as in integral part of the predominating command-and-control
system (Wunder, The, and Ibarra 2005). Secondly, what is bought needs to be well-
defined — it can be a directly measurable service (e.g. additional tons of carbon stored)
or land-use caps that are likely to help providing that service (e.g. “forest conservation provides clean water”). In fact, here the word “likely” hides important scientific insecurities and popular perceptions. Especially hydrological services are often based on beliefs rather than scientific proof (e.g. “forest cover always increases water availability”) (Kaimowitz 2004).
Also, external factors can interfere; Nature is not always ‘well-behaved’. For instance, even if forest conservation indeed increases the likelihood of clean local water provision, this increase may be subordinate if the general frequency of tropical storms and flooding is high, thus dominating water-quality outcomes. Payments that build on scientifically unlikely relationships, on likely relationship being unlikely to affect significantly the desired outcome, or on what has outright been proven to be a myth, might persist over a long time.
In many cases, we lack the knowledge base to classify objectively which ES provision cases are real and which ones are ‘imaginary’. However, we assume that a poor underpinning of ES will tend to decrease PES robustness and sustainability: the less realistic the scientific basis of a PES scheme, the more exposed it is to the risk of buyers questioning its rationale and abandoning payments.
In any PES, there should be resources going from at least one ES buyer (criterion 3) to at least one provider (criterion 4), though the transfer often occurs through an intermediary. Last but not least, in a PES scheme user payments need to be truly contingent upon the service being continuously provided (criterion 5). ES buyers thus normally monitor compliance, e.g. has hunting, deforestation or slash-and-burn agriculture really been contained in the manner stipulated in a given contract? In developed countries, supporting legal and enforcement apparatus can create the conditions for once-
off payments to provide future ES flows, for instance in permanent easements (e.g. Bayon 2004; Sokolow and Zurbrugg 2003). But in developing countries, this option is usually lacking — more so in agricultural frontier areas with weak governance. This feature implies that in the tropics PES normally need to be periodic (often with an infinite horizon) and tied to monitored compliance. Service buyers thus need to be able to withdraw from a PES contract if they do not get what they paid for.
Conversely, service providers may also have an interest in flexible contracts, so they can
pull out (or alter the terms) of a PES scheme if changing context conditions induce them to do so.
How many PES schemes with these five basic principles can one find in the tropics? In our assessment of two countries, Bolivia and Vietnam, no single scheme satisfied all five criteria, although several satisfi ed more than one (Robertson and Wunder 2005; Wunder, The, and Ibarra 2005). For instance, watershed payments were being made, but there was no free land-use choice (criterion 1). The more precise nature of the service provided often remained fuzzy (criterion 2). The money often came from donors rather than from service users (criterion 3). Conversely, sometimes users were charged, but the money had not been spent so far to pay potential ES suppliers (criterion 4).
However, clearly the hardest criterion to meet is conditionality (criterion 5): many initiatives are loosely monitored or not at all, payments are up front instead of periodic, and they are made in good faith rather than being truly contingent on monitored service provision. The business-like feature of contingent conservation payments raised some resistance in all study countries.
In sum, while the number of tropical PES-like initiatives is thus considerable — (Landell-
Mills and Porras 2002) reviewed 287 such schemes — there are probably very few ‘true
PES’ conforming to the theoretical concept developed in the literature and described in
the simple definition above.
If our field search thus produced barely any ‘true PES’ hits, is it perhaps because the
above PES definition was simply too narrow? Historically, many schemes of reforestation and soil-conservation subsidies were clearly justified in part by environmental services, even though the provision of the latter typically was assumed rather than monitored. Alternatively, one could choose to define PES by the additive meaning of the terms it contains: any “payment” somehow intended to promote “environmental services”
could be PES. In addition to reforestation and soil-conservation subsidies, things like salaries for local protected-area guards, wages for people working in conservation projects, and certainly all ICDPs would qualify. If, nevertheless, I prefer to maintain the above ‘pure PES’ definition, it is out of a belief that these five principles represent something new — a more direct approach that deserves to be tested on its own terms, before being added to the big pool of well-tested environmental spending types. Evaluating the different degrees of compliance with these five criteria of specific cases — though sometimes a task with subtle distinctions — can serve as an indicator to what extent these cases truly represent the underlying PES principle.

• Plant operations
Physical plant or mechanical plant (and where context is given, often just plant) refers to the necessary infrastructure used in support and maintenance of a given facility. The operation of these facilities, or the department of an organization which does so, is called "plant operations" or facility management. It should not be confused with manufacturing plant.
Plant usually includes air conditioning (both heating and cooling systems and ventilation) and other mechanical systems. It often also includes the maintenance of other systems, such as plumbing and lighting. The facility itself may be an office building, a school campus, military base, apartment complex, or the like.[1]
In broadcast engineering, the term transmitter plant is the part of the physical plant associated with the transmitter and its controls and inputs, the studio/transmitter link (if the radio studio is off-site), the radio antenna and radomes, feedline and desiccation/nitrogen system, broadcast tower and building, tower lighting, generator, and air conditioning. These are often monitored by an automatic transmission system, which reports conditions via telemetry (transmitter/studio link)
• Information technology
Information technology (IT) is "the study, design, development, implementation, support or management of computer-based information systems, particularly software applications and computer hardware", according to the Information Technology Association of America (ITAA).[1] IT deals with the use of electronic computers and computer software to convert, store, protect, process, transmit, and securely retrieve information.
Today, the term information has ballooned to encompass many aspects of computing and technology, and the term has become very recognizable. IT professionals perform a variety of duties that range from installing applications to designing complex computer networks and information databases. A few of the duties that IT professionals perform may include data management, networking, engineering computer hardware, database and software design, as well as the management and administration of entire systems. Information technology is starting to spread farther than the conventional personal computer and network technology, and more into integrations of other technologies such as the use of cell phones, televisions, automobiles, and more, which is increasing the demand for such jobs.
When computer and communications technologies are combined, the result is information technology, or "infotech". Information technology is a general term that describes any technology that helps to produce, manipulate, store, communicate, and/or disseminate information.
Information Technology – A Definition:
We use the term information technology or IT to refer to an entire industry. In actuality, information technology is the use of computers and software to manage information. In some companies, this is referred to as Management Information Services (or MIS) or simply as Information Services (or IS). The information technology department of a large company would be responsible for storing information, protecting information, processing the information, transmitting the information as necessary, and later retrieving information as necessary.
History of Information Technology:
In relative terms, it wasn't long ago that the Information Technology department might have consisted of a single Computer Operator, who might be storing data on magnetic tape, and then putting it in a box down in the basement somewhere. The history of information technology is fascinating! Check out these history of information technology resources for information on everything from the history of IT to electronics inventions and even the top 10 IT bugs.
Modern Information Technology Departments:
In order to perform the complex functions required of information technology departments today, the modern Information Technology Department would use computers, servers, database management systems, and cryptography. The department would be made up of several System Administrators, Database Administrators and at least one Information Technology Manager. The group usually reports to the Chief Information Officer (CIO).
Popular Information Technology Skills:
Some of the most popular information technology skills at the moment are:
• Computer Networking
• Information Security
• IT Governance
• ITIL
• Business Intelligence
• Linux
• Unix
• Project Management
For more information about technical skills that are popular in the job market, check out the IT Career Skills List..
Information Technology Certifications:
Having a solid education and specific specialty certifications is the best way to progress in an information technology career. Here are some of the more popular information technology certifications:
• Information Security Certifications
• Oracle DBA Certifications
• Microsoft Certifications
• Cisco Certifications
• PMP Certification
Jobs in IT:
There can be a lot of overlap between many of the job descriptions within information technology departments. In order to clarify the descriptions, skills and career paths of each, I have put together a Jobs in IT listing. The jobs in IT listing includes information on education and training required for each position. It also includes lists of companies that typically have IT jobs open, as well as links to IT-specific resumes, cover letters and IT interview questions.
Information Technology - Trends:
Information Technology Departments will be increasingly concerned with data storage and management, and will find that information security will continue to be at the top of the priority list. Cloud computing remains a growing area to watch. The job outlook for those within Information Technology is strong, with data security and server gurus amongst the highest paid techies. Check out the Information Security Certifications and Highest Paying Certifications for more information. In order to stay current in the Information Technology Industry, be sure you subscribe to top technology industry publications.
Information Technology - Find a New Job
• Resume Tips
• Cover Letters
• Job Search Sites
Information Technology - Also of Interest
• Job Interviews
• Salary Calculators
• Professional Information Security Organizations
Information Technology - Other Job Search Information
• Resignation Letters
• Thank You Letters
• Job Fairs
Related Articles
• Find a Job - How to Find a Job in the Technology Industry
• Operations / Technology Privacy Statement
• Computer Jobs - Information Technology System Network Programming
• IT Outsourcing - Information Technology Outsourcing and Your Career
• Information Technology - Careers in Information Technology
• Clinical services
Detailed Definitions
Teaching
i) Publicly Funded Teaching
• UK award/credit bearing courses
• All teaching activities like ESF, Erasmus, Tempus
• All levels of teaching - sub-degree, degree, Postgraduate Teaching (but not Postgraduate Research)
• Higher education, further education, teacher training, NHS (nursing) etc
• Holding lectures, seminars, tutorials
• Project, workshop and laboratory supervision
• Preparing materials for lectures, tutorials and laboratory classes
• Preparing materials for an agreed new course
• Editing and updating course materials
• Organising and visiting placements, fieldwork
• Supervision/contact time relating to projects and dissertations; and assessment
• Other student contact time relating to educational matters including remedial classes
• Preparing and marking examination papers, including re-sits
• Oral examinations/vivas
• Reading and assessing student dissertations, reading and marking essays and any other student work
• Invigilation of examinations including external examining
• Mentee meetings
• Outreach where Teaching is the underlying activity
ii) Non-Publicly Funded Teaching
• Short courses (full cost short courses; non credit/award bearing courses; overseas courses and other Non-Publicly Funded commercial teaching)
• Teaching carried out through trading units/commercial companies
• Activities as in Publicly Funded Teaching: preparing and running short courses where the institution receives the income
Research
All research sponsors including Research Councils, UK Charities, European Union & Others
For all the above:
Research is to include research and experimental development
• Fieldwork, laboratory, studio, classroom work
• Management of projects, informal discussions, progress reports etc.
• Recruitment and supervision of research staff
• Attendance at conferences, seminars and society meetings that are directly connected with specific research projects
• Production of research reports, papers, books
• Collaboration with other departments or institutions in any of the above
• Outreach where research is the underlying activity; Teaching Company Scheme
Institution/Own Funded Research
Institution/own funded or HEFCE funded work where there is no external sponsor commissioning the work
Activities as in Research Councils, whether identified as projects or not, including speculative research undertaken to investigate the potential of ideas before preparing grant or contract bids; or for publication
Training and Supervision of Postgraduate Research Students
Training and supervision of Postgraduate Research students including training in research methodology, review of drafts and preparation of thesis, and external examining
Other Activities
Activities other than Teaching, Research or Support.
DO NOT include long-term sickness and holidays, sabbaticals or maternity leave under this heading. See FAQ for additional guidance
Consultancy and Other Services
Consultancy (excluding private) i.e. that is contracted to the institution and carried out in institution time, including advisory work, journal editing, feasibility studies
Continuing education should be classified as Non-Publicly Funded Teaching
Work carried out through trading units/commercial companies that is not Teaching or Research
Technology transfer work if remunerated through the university (e.g. directorships of start-up companies and/or consultancy contracts for the companies). (If not remunerated then use Support for Other)
Outreach (where the outreach activity is not Teaching or Research)
Clinical Services
Services provided to the NHS under "Knock for Knock" arrangements with the Medical and Dental Services.
"Knock for Knock" is a term to reflect the interdependent relationship between the NHS and HEIs.
Clinical Academics provide patient services to the NHS, under contract, through local arrangements or as identified under job plans.
NHS Clinicians provide teaching sessions to HEIs
No formal cross-charging exists for these arrangements on the basis that
The presumption is that across the NHS as a whole the net effect is neutral (both NHS/HEIs receive the same level of service). This does not mean that in an individual arrangement between an NHS Trust and a HEI there is not an imbalance in the services provided and received.
The costs and bureaucracy of implementing a charging regime are onerous and would not provide significant benefit.
Therefore Clinical Services is services provided to patients in the NHS. There may be some teaching also taking place but that is not the principal action.
Support
i) Support for Teaching
• Timetabling
• Examination boards
• Preparing prospectuses
• Interviewing taught students, admissions and induction
• Course and other committees related to teaching
• Schools liaison
• Pastoral support (outside timetabled tutorials), counselling
• Initial course development (where the future of the course is not certain; preparing materials for an agreed new course is Teaching)
• Module reviews (but subsequent updating and editing etc. is Teaching)
• Institutions might also wish to include here scholarship/professional development and other Support (which are covered below) such as:
• Writing books and other publications for teaching purposes
• Advancement of knowledge and skills related to teaching
• Secondment to/academic exchanges with other universities for teaching activities
• Publicity for teaching facilities and opportunities.
ii) Support for Research
Interviewing research students, admissions and induction
Drafting and redrafting proposals for new work and supporting bids to external bodies where bids involve a significant amount of speculative research, that element can be attributed to Research)
Refereeing papers
Again this might also include scholarship/professional development and other Support to Research (which are covered below) such as:
• Advancement of knowledge and skills related to Research
• Unpaid work advising government departments or committees, professional bodies or agencies in relation to research matters
• Institute and department committee work supporting Research
• Block time in other institutions on research exchange schemes
• Publicity for research facilities and opportunities.
iii) Support for Other
Drafting and re-drafting proposals for new work and supporting bids to external bodies for consultancy and other services rendered activities (where bids involve a significant amount of speculative research, that element can be attributed to Research)
Negotiating contract terms and conditions with external bodies
Technology transfer work that is not private, nor remunerated through the institution (e.g. supporting patent applications, licence negotiations, formation of start-up companies)
iv) Management and Administration
• Membership of or participation at, school boards, senate, institution committees etc.
• Management duties such as deans, head of admissions, assistant deans etc.
• Staff management; appraisal etc.
• Publicity; representative work on behalf of the institution or department
• Careers advice
• Information returns
• Quality assurance
v) Professional Development and Scholarship
Maintenance and advancement of own personal knowledge and skills (reading literature, attending professional conferences, maintaining professional or clinical skills, acquiring new skills etc.)
Consultancy that is carried out in institute normal working hours, in agreement to the institution, but is not contracted to the institution, i.e., private consultancy in institutional time - e.g. maintenance and development of clinical or professional skills
Clinical services provided under knock-for-knock arrangements are not to be recorded here, but as described in Clinical Services.
Private consultancy, carried out in private time - is not to be included here (or anywhere).
vi) Contribution to the Sector and Economy as a Whole
• (Unpaid) committees
• Secondments to RAE panels
Emergency medical services (abbreviated to the initialism "EMS" in some countries) are type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency.[1] The use of the term emergency medical services may refer solely to the pre-hospital element of the care, or be part of an integrated system of care, including the main care provider, such as a hospital.
Emergency medical services may also be locally known as: first aid squad,[2] emergency squad,[3] rescue squad,[4] ambulance squad,[5] ambulance service,[6] ambulance corps[7] or life squad.[8]
The goal of most emergency medical services is to either provide treatment to those in need of urgent medical care, with the goal of satisfactorily treating the presenting conditions, or arranging for timely removal of the patient to the next point of definitive care. This is most likely an emergency department at a hospital or another place where physicians are available. The term emergency medical service evolved to reflect a change from a simple system of ambulances providing only transportation, to a system in which actual medical care is given on scene and during transport. In some developing regions, the term is not used, or may be used inaccurately, since the service in question does not provide treatment to the patients, but only the provision of transport to the point of care.[9]
In most places in the world, the EMS is summoned by members of the public (or other emergency services, businesses or authority) via an emergency telephone number which puts them in contact with a control facility, which will then dispatch a suitable resource to deal with the situation.[10]
In some parts of the world, the emergency medical service also encompasses the role of moving patients from one medical facility to an alternative one; usually to facilitate the provision of a higher level or more specialised field of care. In such services, the EMS is not summoned by members of the public but by clinical professionals (e.g. physicians or nurses) in the referring facility. Specialized hospitals that provide higher levels of care may include services such as neonatal intensive care (NICU),[11] pediatric intensive care (PICU), state regional burn centres,[12] specialized care for spinal injury and/or neurosurgery,[13] regional stroke centers,[14] specialized cardiac care[15][16] (cardiac catherization),[17] and specialized/regional trauma care.[18]
In some jurisdictions, EMS units may handle technical rescue operations such as extrication, water rescue, and search and rescue.[19] Training and qualification levels for members and employees of emergency medical services vary widely throughout the world. In some systems, members may be present who are qualified only to drive the ambulance, with no medical training.[9] In contrast, most systems have personnel who retain at least basic first aid certifications, such as Basic Life Support (BLS). Additionally many EMS systems are staffed with Advanced Life Support (ALS) personnel, including paramedics, nurses, or, less commonly, physicians.[20]
History
Main article: History of the ambulance
Emergency care in the field has been rendered in different forms since the beginning of recorded history. The New Testament contains the parable of the Good Samaritan, where a man who was beaten is cared for by a Samaritan. Luke 10:34 (NIV) - "He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, took him to an inn and took care of him." Also during the Middle Ages, the Knights Hospitaller were known for rendering assistance to wounded soldiers in the battlefield.[21]


A 1973 Cadillac Miller-Meteor ambulance. Note the higher roof, with more room for the attendants and patients
The first use of the ambulance as a specialized vehicle, in battle came about with the ambulances volantes designed by Dominique Jean Larrey (1766–1842), Napoleon Bonaparte's chief physician.[22][23] Larrey was present at the battle of Spires, between the French and Prussians, and was distressed by the fact that wounded soldiers were not picked up by the numerous ambulances (which Napoleon required to be stationed two and half miles back from the scene of battle) until after hostilities had ceased, and set about developing a new ambulance system.[22][23][24] Having decided against using the Norman system of horse litters, he settled on two- or four-wheeled horse-drawn wagons, which were used to transport fallen soldiers from the (active) battlefield after they had received early treatment in the field.[23] These 'flying ambulances' were first used by Napoleon's Army of the Rhine is 1793. Larrey subsequently developed similar services for Napoleon's other armies, and adapted his ambulances to the conditions, including developing a litter which could be carried by a camel for a campaign in Egypt.[23]
In civilian ambulances, a major advance was made (which in future years would come to shape policy on hospitals and ambulances) with the introduction of a transport carriage for cholera patients in London during 1832.[25] The statement on the carriage, as printed in The Times, said "The curative process commences the instant the patient is put in to the carriage; time is saved which can be given to the care of the patient; the patient may be driven to the hospital so speedily that the hospitals may be less numerous and located at greater distances from each other".[24] This tenet of ambulances providing instant care, allowing hospitals to be spaced further apart, displays itself in modern emergency medical planning.
The first known hospital-based ambulance service operated out of Commercial Hospital, Cincinnati, Ohio (now the Cincinnati General) by 1865.[24] This was soon followed by other services, notably the New York service provided out of Bellevue Hospital which started in 1869 with ambulances carrying medical equipment, such as splints, a stomach pump, morphine, and brandy, reflecting contemporary medicine.
In June 1887 the St John Ambulance Brigade was established to provide first aid and ambulance services at public events in London.[26] It was modelled on a military-style command and discipline structure.
The earliest emergency medical service was reportedly the rescue society founded by Jaromir V. Mundy, Count J. N. Wilczek, and E. Lamezan-Salins in Vienna after the disastrous fire at the Vienna Ring Theater in 1881. Named the "Vienna Voluntary Rescue Society," it served as a model for similar societies worldwide.[27]


A 1948 Cadillac Meteor ambulance. The Meteor Motor company purchased this car from Cadillac, then modified it to turn it into an ambulance. The resemblance to a hearse is obvious. (see text)
Also in the late 19th century, the automobile was being developed, and in addition to horse-drawn models, early 20th century ambulances were powered by steam, gasoline, and electricity, reflecting the competing automotive technologies then in existence. However, the first motorized ambulance was brought into service in the last year of the 19th century, with the Michael Reese Hospital, Chicago, taking delivery of the first automobile ambulance, donated by 500 prominent local businessmen, in February 1899.[24] This was followed in 1900 by New York city, who extolled its virtues of greater speed, more safety for the patient, faster stopping and a smoother ride. These first two automobile ambulances were electrically powered with 2 hp motors on the rear axle.[24]
American historians claim that the first component of pre hospital care on scene began in 1928, when "Julien Stanley Wise started the Roanoke Life Saving and First Aid Crew in Roanoke, Virginia, Virginia, which was the first land-based rescue squad in the nation." However the city of Toronto takes this claim stating "The first formal training for ambulance attendants was conducted in 1892."
During World War One, further advances were made in providing care before and during transport – traction splints were introduced during World War I, and were found to have a positive effect on the morbidity and mortality of patients with leg fractures.[28] Two-way radios became available shortly after World War I, enabling for more efficient radio dispatch of ambulances in some areas. Shortly before World War II, then, a modern ambulance carried advanced medical equipment, was staffed by a physician, and was dispatched by radio. In many locations, however, ambulances were hearses - the only available vehicle that could carry a recumbent patient - and were thus frequently run by funeral homes. These vehicles, which could serve either purpose, were known as combination cars.[29][30]
Prior to World War II, hospitals provided ambulance service in many large cities. With the severe manpower shortages imposed by the war effort, it became difficult for many hospitals to maintain their ambulance operations. City governments in many cases turned ambulance services over to the police or fire department. No laws required minimal training for ambulance personnel and no training programs existed beyond basic first aid. In many fire departments, assignment to ambulance duty became an unofficial form of punishment.
Advances in the 1960s, especially the development of CPR & defibrillation as the standard form of care for out-of-hospital cardiac arrest, along with new pharmaceuticals, led to changes in the tasks of the ambulances.[31] In Belfast, Northern Ireland the first experimental mobile coronary care ambulance successfully resuscitated patients using these technologies. One well-known report in the USA during that time was Accidental Death and Disability: The Neglected Disease of Modern Society. This report is commonly known as The White Paper.[32] These studies, along with the White Paper report, placed pressure on governments to improve emergency care in general, including the care provided by ambulance services. Part of the result was the creation of standards in ambulance construction concerning the internal height of the patient care area (to allow for an attendant to continue to care for the patient during transport), and the equipment (and thus weight) that an ambulance had to carry, and several other factors.
In the USA prior to the 1970s, ambulance service was largely unregulated. While some areas ambulances were staffed by advanced first-aid-level responders, in other areas, it was common for the local undertaker, having the only transport in town in which one could lie down, to operate both the local furniture store (where he would make coffins as a sideline) and the local ambulance service. However, after the release of the National Highway Traffic Safety Administration's study, "Accidental Death and Disability: The Neglected Disease of Modern Society", (known in the EMS trade as the White Paper)[33] a concerted effort was undertaken to improve emergency medical care in the pre-hospital setting.
In the late 1960s, Dr. R Adams Cowley was instrumental in the creation of the country's first statewide EMS program, in Maryland.[34]
Service providers


A volunteer ambulance crew in Modena, Italy


A city fire service ambulance from the Tokyo Fire Department.


ACT Ambulance Service Command Vehicle
Some countries closely regulate the industry (and may require anyone working on an ambulance to be qualified to a set level), whereas others allow quite wide differences between types of operator.
1. Government Ambulance Service – Operating separately from (although alongside) the fire and police service of the area, these ambulances are funded by local, provincial or national government. In some countries, these only tend to be found in big cities, whereas in countries such as Great Britain almost all emergency ambulances are part of a national health system.[35]
2. Fire or Police Linked Service – In countries such as the U.S., Japan, France, and parts of India; ambulances can be operated by the local fire or police service. This is particularly common in rural areas, where maintaining a separate service is not necessarily cost effective. In some cases this can lead to an illness or injury being attended by a vehicle other than an ambulance, such as a fire truck.
3. Volunteer Ambulance Service – Charities or non-profit companies operate ambulances, both in an emergency and patient transport function. This may be along similar lines to volunteer fire companies, providing the main service for an area, and either community or privately owned. They may be linked to a voluntary fire service, with volunteers providing both services. There are charities who focus on providing ambulances for the community, or for cover at private events (sports etc.). The Red Cross provides this service across the world on a volunteer basis.[36] (and in others as a Private Ambulance Service), as do other smaller organisations such as St John Ambulance[37] and the Order of Malta Ambulance Corps.[38] These volunteer ambulances may be seen providing support to the full time ambulance crews during times of emergency. In some cases the volunteer charity may employ paid members of staff alongside volunteers to operate a full time ambulance service, such in some parts of Australia, Ireland and most importantly Germany and Austria.
4. Private Ambulance Service – Normal commercial companies with paid employees, but often on contract to the local or national government. Private companies may provide only the patient transport elements of ambulance care (i.e. non urgent), but in some places, they are contracted to provide emergency care, or to form a 'second tier' response, where they only respond to emergencies when all of the full-time emergency ambulance crews are busy. This may mean that a government or other service provide the 'emergency' cover, whilst a private firm may be charged with 'minor injuries' such as cuts, bruises or even helping the mobility impaired if they have for example fallen and just need help to get up again, but do not need treatment. This system has the benefit of keeping emergency crews available all the time for genuine emergencies. These organisations may also provide services known as 'Stand-by' cover at industrial sites or at special events .[39]
5. Combined Emergency Service – these are full service emergency service agencies, which may be found in places such as airports or large colleges and universities. Their key feature is that all personnel are trained not only in ambulance (EMT) care, but as a firefighter and a peace officer (police function). They may be found in smaller towns and cities, where size or budget does not warrant separate services. This multi-functionality allows to make the most of limited resource or budget, but having a single team respond to any emergency.
6. Hospital Based Service – Hospitals may provide their own ambulance service as a service to the community, or where ambulance care is unreliable or chargeable. Their use would be dependent on using the services of the providing hospital.
7. Charity Ambulance – This special type of ambulance is provided by a charity for the purpose of taking sick children or adults on trips or vacations away from hospitals, hospices or care homes where they are in long term care. Examples include the UK's 'Jumbulance' project.[40]
8. Company Ambulance - Many large factories and other industrial centres, such as chemical plants, oil refineries, breweries and distilleries have ambulance services provided by employers as a means of protecting their interests and the welfare of their staff. These are often used as first response vehicles in the event of a fire or explosion.
Purpose


6 points on the Star of Life
Emergency medical services exists to fulfill the basic principles of first aid, which are to Preserve Life, Prevent Further Injury, and Promote Recovery.
This common theme in medicine is demonstrated by the "star of life". The Star of Life shown here, where each of the 'arms' to the star represent one of the 6 points. These 6 points are used to represent the six stages of high quality pre-hospital care, which are:[41]
1. Early Detection[41] - Members of the public, or another agency, find the incident and understand the problem
2. Early Reporting[41] - The first persons on scene make a call to the emergency medical services and provide details to enable a response to be mounted
3. Early Response[41] - The first professional (EMS) rescuers arrive on scene as quickly as possible, enabling care to begin
4. Good On Scene Care[41] - The emergency medical service provides appropriate and timely interventions to treat the patient at the scene of the incident
5. Care in Transit[41] - the emergency medical service load the patient in to suitable transport and continue to provide appropriate medical care throughout the journey
6. Transfer to Definitive Care[41] - the patient is handed over to an appropriate care setting, such as the emergency department at a hospital, in to the care of physicians
Levels of care


Responding to an emergency


EMS in Ireland


Patient arriving at hospital
Emergency Medical Service is provided by a variety of individuals, using a variety of methods. To some extent, these will be determined by country and locale, with each individual country having its own 'approach' to how EMS should be provided, and by whom. In some parts of Europe, for example, legislation insists that efforts at providing advanced life support (ALS) Mobile Intensive Care Units (MICU)services must be physician-staffed, while other permit some elements of that skill set to specially trained nurses, but have no paramedics. Elsewhere, as in North America, the UK and Australia, ALS services are performed by paramedics, but rarely with the type of direct "hands-on" physician leadership seen in Europe. Increasingly, particularly in the UK and in South Africa, the role is being provided by specially-trained paramedics who are independent practitioners in their own right. Beyond the national model of care, the type Emergency Medical Service will be determined by local jurisdictions and medical authorities, based upon the needs of the community, and the economic resources to support it.
A category of emergency medical service which is known as 'medical retrieval' or rendez vous MICU protocol in some countries (Australia, NZ, Great Britain) refers to critical care transport of patients between hospitals (as opposed to pre-hospital). Such services are a key element in regionalised systems of hospital care where intensive care services are centralised to a few specialist hospitals. An example of this is the Emergency Medical Retrieval Service in Scotland.
Generally speaking, the levels of service available will fall into one of three categories; Basic Life Support (BLS), Advanced Life Support (ALS), and care by traditional healthcare professionals, meaning nurses and/or physicians working in the pre-hospital setting and even on ambulances. In some jurisdictions, a fourth level, Intermediate Life Support (ILS), which is essentially a BLS provider with a moderately expanded skill set, may be present, but this level rarely functions independently, and where it is present may replace BLS in the emergency part of the service. When this occurs, any remaining staff at the BLS level is usually relegated to the non-emergency transportation function. Job titles typically include Emergency Medical Technician, Ambulance Technician, or Paramedic. These ambulance care givers are generally professionals or paraprofessionals and in some countries their use is controlled through training and registration]. While these job titles are protected by legislation in some countries, this protection is by no means universal, and anyone might, for example, call themselves an 'EMT' or a 'paramedic', regardless of their training, or the lack of it.[42] In some jurisdictions, both technicians and paramedics may be further defined by the environment in which they operate, including such designations as 'Wilderness', 'Tactical', and so on.
Basic Life Support
First Responder
A first responder is a person who arrives first at the scene of an incident, and whose job is to provide early critical care such as CPR or using an AED.[43] First responders may be dispatched by the ambulance service, may be passers-by, citizen volunteers, or may be members of other agencies such as the police, fire department, or search and rescue who have some medical training—commonly CPR, basic first aid, and AED use.[44]


Scottish Ambulance Service "First Responder" vehicle
Ambulance Driver
Some jurisdictions separate the 'driver' and 'attendant' functions, employing ambulance driving staff with no medical qualification (or just a first aid certificate), whose job is to drive the ambulance. While this approach persists in some countries, such as India, it is generally becoming increasingly rare. Ambulance drivers may be trained in radio communications, ambulance operations and emergency response driving skills.[45]
Ambulance Care Assistant (ACA)
Ambulance Care Assistants have varying levels of training across the world. In many countries, such staff are usually only required to perform patient transport duties (which can include stretcher or wheelchair cases), rather than acute care. However, there remain both countries and individual jurisdictions in which economics will not support ALS service, and the efforts of such individuals may represent the only EMS available. Dependent on the provider (and resources available), they may be trained in first aid or extended skills such as use of an AED, oxygen therapy and other live-saving or palliative skills. In some services, they may also provide emergency cover when other units are not available, or when accompanied by a fully qualified technician or paramedic.[46][47]


EMT's loading a patient
Emergency Medical Technician (EMT)
Emergency medical technicians, also known as Ambulance Technicians in the UK and EMT in the United States. Technicians are usually able to perform a wide range of emergency care skills, such as Automated defibrillation, care of spinal injuries and oxygen therapy.[48][49] In few jurisdictions, some EMTs are able to perform duties as IV and IO cannulation, administration of a limited number of drugs, more advanced airway procedures, CPAP, and limited cardiac monitoring.[50] Most advanced procedures and skills are not within the national scope of practice for an EMT-B.[51] As such most states require additional training and certifications to perform above the national curriculum standards.[52][53]
Emergency Medical Dispatcher (EMD)
An increasingly common addition to the EMS system is the use of highly trained dispatch personnel who can provide "pre-arrival" instructions to callers reporting medical emergencies. They use carefully structured questioning techniques and provide scripted instructions to allow callers or bystanders to begin definitive care for such critical problems as airway obstructions, bleeding, childbirth, and cardiac arrest. Even with a fast response time by a first responder measured in minutes, some medical emergencies evolve in seconds. Such a system provides, in essence, a "zero response time," and can have an enormous impact on positive patient outcomes.
Advanced Life Support (ALS)
Paramedic (EMT-P)
A paramedic has a high level of prehospital medical training and usually involves key skills not performed by technicians, often including cannulation (and with it the ability to use a range of drugs such as morphine), cardiac monitoring, tracheal intubation, needle decompression and other skills such as performing a cricothyrotomy.[54] In many countries, this is a protected title, and use of it without the relevant qualification may result in criminal prosecution.[55] In the United States, paramedics represent the highest licensure level of prehospital emergency care. In addition, several certifications exist for Paramedics such as Wilderness ALS Care,[56] Flight Paramedic Certification (FP-C),[57] and Critical Care Emergency Medical Transport Program certification.[58]
Critical Care Paramedic (CCEMTP)
A critical care paramedic, also called an advanced practice Paramedic in some US States, represents a higher level of licensure above that of the DOT and NREMT-Paramedic curriculum.[58] These Paramedics receive additional training beyond normal EMS medicine in a Critical Care Emergency Medical Transport Program,[58] including critical care use of devices and life support systems normally restricted to the ICU or critical care hospital setting, placement and use of UVCs (Umbilical Venous Catheter), UACs (Umbilical Arterial Catheter), surgical airways, Rapid Sequence Intubation (RSI), blood administration, and chest tube insertion. The Critical Care Transport role exists in the U.S., and also in a number of other countries (including Canada). The training, permitted skills, and certification requirements vary from one jurisdiction to the next.
Paramedic Practitioner or Emergency Care Practitioner
In the United Kingdom and South Africa, some serving paramedics receive additional university education to become practitioners in their own right, which gives them absolute responsibility for their clinical judgement, including the ability to autonomously prescribe medications, including drugs usually reserved for doctors, such as courses of antibiotics. An emergency care practitioner is a position sometimes referred to as a 'super paramedic' and is designed to bridge the link between ambulance care and the care of a general practitioner. ECPs are university graduates in Emergency Medical Care or qualified paramedics who have undergone further training,[59] and are authorized to perform specialized techniques. Additionally some may prescribe medicines (from a limited list) for longer term care, such as antibiotics. With respect to a Primary Health Care setting, they are also educated in a range of Diagnostic techniques.
'Traditional' Healthcare Professions
Registered Nurse (RN)
The use of registered nurses in the pre-hospital setting is more common in countries that have a limited EMS infrastructure in place. Some European countries such as France or Italy, which do not use paramedics as we understand them, also use nurses as a means of providing ALS services. These nurses may work under the direct supervision of a physician, or, in rarer cases, independently. In some places in Europe, notably Norway, paramedics do exist, but the role of the 'ambulance nurse' continues to be developed,[60] as it is felt that nurses may bring unique skills to some situations encountered by ambulance crews. In North America, and to a lesser extent elsewhere in the English-speaking world, some jurisdictions use specially trained nurses for medical transport work. These are mostly air-medical personnel or critical care transport providers, often working in conjunction with a technician or paramedic or physician on emergency interfacility transports. In the United States, the most common uses of ambulance-based Registered nurses is in the Critical Care/Mobile Intensive Care transport, and in Aeromedical EMS. Such nurses are normally required by their employers (in the US) to seek additional certifications beyond basic nursing registration. In Estonia 60% of ambulance teams are led by nurse. Ambulance nurses can do almost all emergency procedures and administer medicines pre-hospital such as physicians in Estonia.
Physician
There are many places in Europe, most notably in France, Italy, and the German-speaking countries (Germany, Switzerland, Austria) where the model of EMS is different, and physicians take a more direct, 'hands-on' approach to pre-hospital care. In France and Italy, response to high-acuity emergency calls is physician-led, as with the French SMUR teams. Paramedics do not exist within those systems, and most ALS is performed by physicians. In the German-speaking countries, paramedics do exist, but special physicians (called Notarzt) respond directly to high-acuity calls, supervising the paramedics ALS procedures directly. Indeed, in these countries paramedics are not typically legally permitted to practice their ALS procedures unless the physician is physically present, unless they face immediate life-threatening emergencies.[61] Some systems - most notably air ambulances in the UK.[62][63] will employ physicians to take the clinical lead in the ambulance; bringing a full range of additional skills such as use of medications that are beyond the paramedic skill set. The response of physicians to emergency calls is routine in many parts of Europe, and not uncommon in the UK.
This 'hands-on' approach is less common in the United States. While one will occasionally see a physician with an ambulance crew on an emergency call, this is much more likely to be the Medical Director or an associate, precepting newly trained paramedics, or performing routine medical quality assurance. In some jurisdictions adult or pediatric critical care transports sometimes use physicians, but generally only when it appears likely that the patient may require surgical or advanced pharmacologic intervention beyond the skills of an EMT, paramedic or nurse during transport. Physicians are leaders of medical retrieval teams in many western countries, where they may assist with the transport of a critically ill, injured, or special needs patient to a tertiary care hospital, particularly when longer transport times are involved.


A typical Rescue Unit for a fire department
Prehospital Delivery of care
Depending on country, area within in country, or clinical need, emergency medical services may be provided by one or more different types of organisation. This variation may lead to large differences in levels of care and expected scope of practice.
The most basic emergency medical services are provided as a transport operation only, simply to take patients from their location to the nearest medical treatment. This was often the case in a historical context, and is still true in the developing world, where operators as diverse as taxi drivers[9] and undertakers may operate this service.
Most developed countries now provide a government funded emergency medical service, which can be run on a national level, as is the case in the United Kingdom, where a national network of ambulance trusts operate an emergency service, paid for through central taxation, and available to anyone in need,[64] or can be run on a more regional model, as is the case in the United States, where individual authorities have the responsibility for providing these services.


Typical scene at a local emergency room
Ambulance services can be stand alone organisations, but in some cases, the emergency medical service is operated by the local fire[65] or police[66] service. This is particularly common in rural areas, where maintaining a separate service is not necessarily cost effective. This can lead, in some instances, to an illness or injury being attended by a vehicle other than an ambulance, such as fire truck.[67][68][69] In some locales, firefighters are the first responders to calls for emergency medical aid, with separate ambulance services providing transportation to hospitals when necessary.[70]
Some charities or non-profit companies also operate emergency medical services, often alongside a patient transport function.[71] These often focus on providing ambulances for the community, or for cover at private events, such as sports matches. The Red Cross provides this service in many countries across the world on a volunteer basis (and in others as a Private Ambulance Service), as do some other smaller organizations such as St John Ambulance.[37] and the Order of Malta Ambulance Corps.[72] In some countries, these volunteer ambulances may be seen providing support to the full time ambulance crews during times of emergency, or simply to help cover busy periods.[73]
There are also private ambulance companies, with paid employees, but often on contract to the local or national government. Many private companies provide only the patient transport elements of ambulance care (i.e. non urgent), although in some places these private services are contracted to provide emergency care, or to form a 'second tier' response, where they only respond to emergencies when all of the full-time emergency ambulance crews are busy or to respond to non-emergency home calls.[citation needed] Private companies are often contracted by private clients to provide event specific cover, as is the case with voluntary EMS crews.[74]
Many colleges and universities, especially in the United States, maintain their own EMS organizations. These organizations operate at capacities ranging from first response to ALS transport. Campus EMS in the United States is overseen by the National Collegiate Emergency Medical Services Foundation.
Strategies for delivering care
The essential decision in prehospital care is whether the patient should be immediately taken to the hospital, or advanced care resources are taken to the patient where they lie. The "scoop and run" approach is exemplified by the MEDEVAC aeromedical evacuation helicopter, whereas the "stay and play" is exemplified by the French and Belgian SMUR emergency mobile resuscitation unit.


Ambulance in Ottawa, Ontario, Canada
The strategy developed for prehospital trauma care in North America is based on the Golden Hour theory, i.e., that a trauma victim's best chance for survival is in an operating room, with the goal of having the patient in surgery within an hour of the traumatic event. This appears to be true in cases of internal bleeding, especially penetrating trauma such as gunshot or stab wounds. Thus, minimal time is spent providing prehospital care (spine immobilization; "ABCs", i.e. ensure airway, breathing and circulation; external bleeding control; endotracheal intubation) and the victim is transported as fast as possible to a trauma centre.[75]
The aim in "Scoop and Run" treatment is generally to transport the patient within ten minutes of arrival, hence the birth of the phrase, "the platinum ten minutes" (in addition to the "golden hour"), now commonly used in EMT training programs. The "Scoop and Run" is a method developed to deal with trauma, rather than strictly medical situations (e.g. cardiac or respiratory emergencies), however, this may be changing. Increasingly, research into the management of S-T segment elevation myocardial infarctions (STEMI) occurring outside of the hospital, or even inside community hospitals without their own PCI labs, suggests that time to treatment is a clinically significant factor in heart attacks, and that trauma patients may not be the only patients for whom 'load and go' is clinically appropriate. In such conditions, the gold standard is the door to balloon time. The longer the time interval, the greater the damage to the myocardium, and the poorer the long-term prognosis for the patient.[76] Current research in Canada has suggested that door to balloon times are significantly lower when appropriate patients are identified by paramedics in the field, instead of the emergency room, and then transported directly to a waiting PCI lab.[77] The STEMI program has reduced STEMI deaths in the Ottawa region by 50 per cent.[78] In a related program in Toronto, EMS has begun to use a procedure of 'rescuing' STEMI patients from the Emergency Rooms of hospitals without PCI labs, and transporting them, on an emergency basis, to waiting PCI labs in other hospitals.[79]


A new ambulance in Italy
Models of care
Although a variety of differing philosophical approaches are used in the provision of EMS care around the world, they can generally be placed into one of two categories; one physician-led and the other led by pre-hosital specialists such as emergency medical technicians or paramedics (which may, or may not have accompanying physician oversight). These models are typically identified by their locations of origin.[80]
The Franco-German model is physician-led, with doctors responding directly to all major emergencies requiring more than simple first aid. In some cases in this model, such as France, paramedics, as they exist in the Anglo-American model, are not used, although the term 'paramedic' is sometimes used generically, and those with that designation have training that is similar to an U.S. EMT-B.[81] The team's physicians and in some cases, nurses, provide all medical interventions for the patient, and non-medical members of the team simply provide the driving and heavy lifting services. In other applications of this model, as in Germany, a paramedic equivalent does exist, but is sharply restricted in terms of scope of practice; often not permitted to perform Advanced Life Support (ALS) procedures unless the physician is physically present, or in cases of immediate life-threating conditions.[61] Ambulances in this model tend to be better equipped with more advanced medical devices, in essence, bringing the emergency department to the patient. High-speed transport to hospitals is considered, in most cases, to be unnecessarily unsafe, and the preference is to remain and provide definitive care to the patient until they are medically stable, and then accomplish transport. In this model, the physician and nurse may actually staff an ambulance along with a driver, or may staff a rapid response vehicle instead of an ambulance, providing medical support to multiple ambulances.
The second care structure, termed the Anglo-American model, utilizes pre-hospital care specialists, such as emergency medical technicians and paramedics, to staff ambulances, which may be classified according to the varying skill levels of the crews. In this model it is rare to find a physician actually working routinely in the pre-hospital setting, although they may be utilised on complex or major injuries or illnesses. In this system, a physicians involvment is most likely to be the provision of medical oversight for the work of the ambulance crews, which may be accomplished in terms of off-line medical control, with protocols or 'standing orders' for certain types of medical procedures or care, or on-line medical control, in which the technician must establish contact with the physician, usually at the hospital, and receive direct orders for various types of medical interventions. In some cases, such as in the UK, South Africa and Australia, a paramedic may be an autonomous health care professional, and does not require the permission of a physician to administer interventions or medications from an agreed list, and can perform roles such as suturing or prescribing medication to the patient.[82]
In this model, patients may still be treated at the scene up to the skilll level of the attending crew, and subsequently transported to definitive care, but in many cases the reduced skill set of the ambulance crew and the needs of the patient indicate a shorter interval for transport of the patient than is the case in the Franco-German model.
Clinical governance
Paramedics normally function under the authority (medical direction) of one or more physicians charged with legally establishing the emergency medical directives for a particular region. Paramedics are credentialed and authorized by these physicians to use their own clinical judgment and diagnostic tools to identify medical emergencies and to administer the appropriate treatment, including drugs that would normally require a physician order. Credentialing may occur as the result of a State Medical Board examination (U.S.) or the National Registry of Emergency Medical Technicians (U.S.). In England, and in some parts of Canada, credentialing may occur by means of a College of Paramedicine.[83] In these cases, paramedics are regarded as a self-regulating health profession. The final common method of credentialing is through certification by a Medical Director and permission to practice as an extension of the Medical Director's license to practice medicine. The authority to practice in this semi-autonomous manner is granted in the form of standing order protocols (off-line medical control) and in some cases direct physician consultation via phone or radio (on-line medical control). Under this paradigm, paramedics effectively assume the role of out-of-hospital field agents to regional emergency physicians, with clinical decision-making authority using standing orders or protocols. In some parts of Europe and the United States, most notably in Germany, those in the paramedic role are only permitted to practise many of their advanced skills while assisting a physician who is physically present, or they face cases of immediately life-threatening emergencies.[61] In other parts of Europe, most notably in France, all ALS skills in the pre-hospital setting are performed by physicians and nurses, and the role of paramedic is unknown. In certain other jurisdictions, such as the United Kingdom and South Africa, paramedics may be entirely autonomous practitioners capable of prescribing medications.[84] In other jurisdictions, such as Australia and Canada this expanded scope of practice is under active consideration and discussion.[85]
Equipment and practices
• Ambulance
• Cardiopulmonary resuscitation (CPR)
Similar practices and professions
• Prehospital Medicine
• Emergency medicine
• Battlefield medicine
• Wilderness medicine
Emergency telephone numbers
• Emergency telephone numbers
o 1-1-2 (European Union, Colombia, Croatia, GSM networks)
o 1-1-9 (parts of Asia, and in Jamaica)
o 999 (emergency telephone number) (many nations)
o 9-1-1 (North American Numbering Plan)
o 000 Australia
o 100 India This is the number to call the police.
o 100 Israel This is the number to call the police.
o 101 India This number is used for medical emergency and fire emergency.
o 101 Israel This number is used to call for medical emergency services.
o 190 Brazil This number is used to call for medical emergency services, fire emergency and call to police.
Legal and reports
• Good Samaritan law
• CEN 1789
• The White Paper (Official title "Accidental Death and Disability: The Neglected Disease of Modern Society" - a 1966 report that prompted the development of organized EMS in the United State)
Other
• In case of emergency, a programme that enables EMS workers to identify victims and contact their next of kin to obtain important medical information
• Public Utility Model, a model for organizing Emergency Medical Services
Case Management - Definition
social clinical care services clients assessment providers managers client process
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There has been considerable discussion about what is an appropriate name for case management. In some programs the case management function is called "care management," "care coordination," or "care planning." There is an ongoing concern that the term "case management," conveys an undesired sense of bureaucracy. Clients and caregivers have expressed their view that they "are not cases and do not want to be managed." Although widely used, the term "case management" remains unclear and confusing, describing benefit management, management of an acute event or of communitybased interventions, or other types of client management across the continuum of care.
The overall goal of care or case managers is to facilitate collaborative and cost-efficient interactions among providers that effectively integrate medical, psychological, and social services in order to provide timely, appropriate, and beneficial service delivery to the client. Such integration can encompass clients and their families, health care providers, community agencies, legal and financial resources, third-party payers, and employers (Gross and Holt).
At the most general level, case management can be defined as a coordinating function that is designed to link clients with various services based on assessed need. Case management has evolved in recognition of the fact that the fragmented and complex systems of care create formidable obstacles for older, disabled individuals and their families. There is a need for coordination of care because caregivers and chronically ill older persons may require services from several providers. Although operationalized in various ways, case management has a common set of core components that includes outreach, screening, comprehensive assessment, care planning, service arrangement, monitoring, and reassessment (Applebaum and Austin; White).
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Outreach activities are designed to identify persons likely to qualify for and need health and social support services as well as case management. Case-finding efforts help ensure that eligible individuals are served. Screening is a preliminary assessment of the client's circumstances and resources to determine presumptive eligibility. Potential clients are screened by means of standardized procedures to determine whether their status and situation meet the program's target population definition. Accurate screening is critical. Effective outreach and screening are necessary for efficient program operation and management.
Comprehensive assessment is a systematic and standardized process for collecting detailed information about a person's physical, mental, and psychological functioning and informal support system that facilitates the identification of the person's strengths and care needs (Schneider and Weiss; Gallo et al.). Typically, comprehensive assessment focuses on physical health, mental functioning, ability to perform activities of daily living, social supports, physical environment, and financial resources. Many programs have adopted rigorous standardized multidimensional instruments.
Information collected during the assessment process is used to develop a plan of care. Care planning requires clinical judgment, creativity, and sensitivity as well as knowledge of community resources. Case managers consider the willingness and availability of informal caregivers to provide care. Balance between formal and informal services is a major consideration in the care planning process. Clients and caregivers participate in the process. The care plan specifies services, providers, and frequency of delivery. Costs of the care plan are also determined. Care planning is a key resource allocation process and is a critical case management function. Service arrangement involves contacting formal and informal providers to arrange services specified in the care plan. Case managers often must negotiate with providers for services when making referrals to other agencies. When they have the authority to purchase services on their clients' behalf, case managers order services directly from providers.
Case managers monitor changes in clients' situations and modify care plans to meet clients' needs. Ongoing monitoring combined with timely modification of care plans helps ensure that program expenditures reflect current client needs and are not based on outdated assessment data. Reassessment involves determining whether there have been changes in the client's situation since the last assessment. Systematic and regularly scheduled reassessment also helps in evaluating the extent to which progress has been made toward accomplishing outcomes specified in the care plan.
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Read more: Case Management - Definition - Social, Clinical, Care, Services, Clients, Assessment, Providers, and Managers http://medicine.jrank.org/pages/250/Case-Management-Definition.html#ixzz0xd50q0qC

At Mount Auburn, our patients receive care that is first-rate, as well as compassionate. Mount Auburn Hospital's Clinical Services include:
Anesthesiology
Bariatric Medicine
Cancer Care
Cancer Treatment Center
Hematology/Oncology/Radiology
Patient and Caregiver Support
The Barron Center for Men's Health
The Hoffman Breast Center
Cardiac Care
Cardiac Electrophysiology Unit
Zir Cardiac Catheterization Laboratory
Cardiothoracic Surgery
Stress Testing
Vascular Laboratory
Diabetes Education Program
Emergency Department
Employee Assistance Program
Endocrinology & Metabolism
Family Practice
Gastroenterology
General Surgery
Geriatrics
Gynecology



Hand Surgery
Home Care
Hospitalists
Intensive Care Service
Infectious Diseases
Laboratory and Pathology Services
Midwifery
Nephrology
Neurology
Multiple Sclerosis Care Center
Sleep Clinic
Stroke Center
Nursing
Nutrition Services
Obstetrics
Occupational Health
Orthopedic Surgery
Ophthalmology
Otolaryngology
Pediatrics
Pharmacy
Plastic Surgery
Prevention and Recovery
Primary Care
Psychiatry
Pulmonary Medicine
Quality and Safety
Radiology
Rehabilitation
Rheumatology
Travel Medicine
Urogynecology
Urology
Vascular Surgery
Walk-In Clinic


Outsourcing Clinical Services to O2I
Healthcare organizations in the U.S and U.K are facing an acute shortage of clinical experts. Outsourcing clinical services to India can help you overcome this shortage and at the same time you can benefit from cost-effective services. Outsource clinical services to O2I and benefit from high-quality services. Since we are strategically located in India, you can benefit from the time zone advantage between U.S and India. We can provide clinical services within a quick turnaround time because our day is your night. Outsource to India and benefit from a seamless and efficient clinical process.
Outsource2india's Clinical Services
At Outsource2india, we offer a wide range of clinical services. Apart from providing proficient and efficient services, we also offer innovative solutions to help you optimize your clinical process.
• 3D Reconstruction & Processing Services - We provide 3D anatomical models for MR / CT Angiographies, on a 'per case basis'.
• Collaborative Reporting Solution - We provide collaborative web based reporting workflow to help you enhance the productivity gains of Radiology groups up to 40%.
• Teleradiology services - We have a certified team of teleradiologists who can provide proficient services on a 24x7x365 basis.
• Oncology Services - Our oncology services include IMRT Treatment Planning and 2D/ 3D Conformal Therapy Planning.
• Orthopedics Services - Our orthopedics services include 3D anatomical models, Implant assessments and digital prosthetic templates.
• Medical Management Services - Our medical management services include nurse call centers with medical management devices.
Why is there a growing need for clinical services?
The following factors have increased the need for clinical services. Outsourcing clinical services to O2I can help you avail of competent services at a cost-effective price.
• National cancer rate is expected to grow faster than the national population growth.
• Overall costs for cancer estimated at $107 billion p.a.
• Direct Medical Costs: 40%
• Cost of low productivity due to illness: 12%
• Lost productivity due to death: 64%
• Estimated new cancer cases and deaths: 1,334,100.
• Lack of availability of trained manpower to meet these growing needs.
• Start up costs for new technology cancer treatments (IMRT etc) are not available in many treatment centers.
Why outsource clinical services to O2I?
At Outsource2india, we offer the following specialized clinical services
• IMRT Treatment Planning
• 2D/ 3D Conformal Therapy Planning
• Training and Consulting Service
Orthopedic
• Specialized applications which enhance the speed of surgical planning
• Visualization and analysis of complex orthopedic problems
• Advanced Measurements and digital prosthetic templates
What are the benefits of outsourcing clinical services to O2I?
• Increase your patient volume, with Outsource2india's increased work efficiency.
• Get access to more flexibility and convenience in your workflow (Web-based remote planning and viewing).
• Get access to advanced clinical application packages (e.g. advanced spine planning).
• Benefit from reduced materials and storage costs.
Outsourcing Clinical Services to India
Find out more about the need to outsource radiology and the specialized teleradiology services that Outsource2india's radiologists can offer.
If you would like to outsource any part of your clinical process to O2I, please fill in our inquiry form. Outsource2india's Client Engagement Team will contact you within 24 hours or by the next working day.
• Use of pharmaceutical and medical supply formularies
Textbook
Managing Drug Supply: The Selection, Procurement, Distribution, and Use of Pharmaceuticals. 2nd edition. Management Sciences for Health in collaboration with the World Health Organization. Kumarian Press. 1997. ISBN 1-56449-047-9.

TOPIC READINGS


Session 1: The Global Context of Pharmaceutical Products and Under-served Populations
Required MSH Managing Drug Supply: Part 1 Introduction
• Toward Sustainable Supply and Rational Use of Drugs (pp. 3-16)
• Historical and Institutional Perspectives (pp. 17-25)
• Economics for Drug Management (pp.26-37)
• Pharmaceutical Supply System Management (pp. 38-52)
Recommended WHO Essential Medicines Library (EMLib). Available at: http://mednet3.who.int/eml/ - contains a Model Formulary, Model list of Essential Drugs
Lofland JH and Lyles A. Pharmacy Practice and Health Policy within the United States: An Introduction and Overview [Chapter 20] in Managing Pharmacy Practice: Principles, Strategies, and Systems, Andrew Peterson, Editor. CRC Press LLC. Boca Raton, Fl. 2004.
Health, United States, 2004. With Chart book on Trends in the Health of Americans with Special Feature on Drugs. Available at: http://www.cdc.gov/nchs/hus.htm



Session 2: International Policy and Legal Framework
Required MSH Managing Drug Supply Part II: Policy and Legal Framework
• National Drug Policies (pp. 55-67)
o Country Study 5.1 The Philippines
o Country Study 5.2 Australia
• Drug Supply Strategies (pp. 68-88)
o Country Study 6.3 Direct Delivery, Prime Vender and Mixed Supply Arrangements
• Pharmaceutical Legislation and Regulation (pp. 89-100)
• Legal Aspects of Drug Management (pp. 101-107)
Explore and familiarize yourself with this resource for future use: WHO Essential Drugs and Medicines Policy. Available at: http://www.who.int/medicines/

Recommended National Institute for Clinical Excellence (NICE). Available at: http://www.nice.org.uk
Canadian Agency for Drugs and Technology in Health. Available at: http://www.cadth.ca/index.php/en/home



Session 3: Drug Manufacture, Industrial Pharmacy Considerations, Quality Assurance, and Regulation
Required MSH Managing Drug Supply: Part 1 Introduction
• Pharmaceutical Production Policy (pp. 108-115)
o Country Study 9.3 Promoting Local Production of Essential Drugs in Bangladesh
• Small-scale local production (pp. 288-303)
• Small Scale Hospital Pharmaceutical Production 592
JE and Trueman P. 'Fourth Hurdle Reviews,' NICE and Database Applications. Pharmacoepidemiology and Drug Safety 2001;10:429-438.

Recommended U.S. Food and Drug Administration: Good Manufacturing Practices (GMP) / Quality System (QS) Regulation. Available at: http://www.fda.gov/cdrh/devadvice/32.html



Session 4: The Drug Management Cycle: Selection
Required MSH Managing Drug Supply Part III: Section A. Selection
• Managing Drug Selection (pp. 121-136)
o Country Study 10.1 Approaches to updates essential drugs * formulary lists
o Country Study 10.2 Updating the National Essential Drugs List of Kenya
• Treatment Guidelines and Formulary Manuals (pp. 137-149)
o Note Figure 11.2 Sample annotated Page from Malawi Standard Treatment Guidelines
• Essential Medical Supplies and Equipment (pp. 150-160)
o Note Box 12.1 ECHO: Nonprofit Equipment Supplier, but see Dec 2002: http://www.echohealth.org.uk/intro.html

Recommended Lyles A. Formulary Decision-Maker Perspectives: Responding to Changing Environments [Chapter 7] in Economic Evaluation in U.S. Health Care. Jones and Bartlett Publishers, Boston. 2006. ISBN 0-7637-2746-6
Sullivan SD, Lyles A, Luce B and Gricar J. AMCP Guidance for Submission of Clinical and Economic Evaluation Data to Support Formulary Listing in United States Health Plans and Pharmacy Benefits Management Organizations. Journal of Managed Care Pharmacy 7(4):272-282,2001.
The AMCP Format for Formulary Submissions,Version 2. 1 April 2005. A Format for Submission of Clinical and Economic Data in Support of Formulary Consideration by Health Care Systems in the United States. Available at: http://www.fmcpnet.org/data/resource/Format~Version_2_1~Final_Final.pdf



Session 5: Forecasting and Quantification
Required MSH Managing Drug Supply Part III: Section B. Procurement
• Inventory Management (pp. 207-231)
o Country Study 15.1 Scheduled Purchasing in the Eastern Carribean
• Quantifying Drug Requirements (pp. 184-206)
• Use these methods to estimate actual need and
Action Programme on Essential Drugs and Vaccines. Essential Drugs Monitor: Managing Drug Supply. 1998, No.s 25 & 26.
Recommended Management Sciences for Health. International Drug Price Indicator Guide, 2004 edition. Available at: http://www.msh.org/resources/publications/IDPIG_2004.html



Session 6: The Drug Management Cycle: Procurement
Required MSH Managing Drug Supply Part III: Section B. Procurement
• Managing Procurement (pp. 163-183)
o Country Study 13.2 Pooled Procurement through the Eastern Carribean Drug Service
o Country Study 13.3 Problems with Lack of Transparency in Tenders
• Managing the Tender Process (pp. 232-255)
o Note Annex 16.2 Criteria for Evaluating Current or Past Suppliers
• Action Programme on Essential Drugs and Vaccines. Essential Drugs Monitor: Managing Drug Supply. 1998, No.s 25 & 26. Contracting for Drugs and Services (pp. 256-270)
• Quality Assurance for Drug Procurement (pp. 271-287)
o Country Study 18.2 Quality Assurance in Selected Countries
o Figure 18.7 Sample Drug and Supply Evaluation Form


Session 7: Drug Donations
Required MSH Managing Drug Supply Part III: Section B. Procurement
• Drug donations (pp. 304-312)
o Note: Country Study 19.1 The role of Private NGOs in Providing Health Care Services in Zaire
WHO Guidelines for Drug Donations, revised 1999. Available at: http://whqlibdoc.who.int/hq/1999/WHO_EDM_PAR_99.4.pdf



Session 8: The Drug Management Cycle: Distribution
Required MSH Managing Drug Supply Part III: Section C. Distribution
• Managing Distribution (pp. 315-333)
• Importation and Port Clearing (pp. 334-340)
• Medical Stores Management (pp. 341-363)
• Drug Management for Health Facilities (pp. 364-377)
o Country Study 24.1 Zimbabwe Monthly Ordering System
• Discuss cold chain for vaccines
• Transport Management (pp. 393-406)
• Kit System Management (pp. 407-418)
o Country Study 27.4 Cambodia
o Country Study 27.5 Solomon Islands
Recommended MSH Managing Drug Supply
• Planning and Building Storage Facilities (pp. 378-392)
o Note: Figure 25.3 Typical Elements of a Project Brief


Session 9: Drug Management Cycle: Use
Required MSH Managing Drug Supply Part III: Section D. Use
• Managing for Rational Drug Use (pp. 421-429)
• Investigating Drug Use (pp.430-449)
• Drug and Therapeutics Information (pp. 450-463)
• Promoting Rational Drug Prescribing (pp. 464-482)
• Ensuring Good Dispensing Practices (pp. 483-495)
o Note: Figure 32.10 Sample Inspection Checklist
• Encouraging Appropriate Drug Use by the Public and Patients (pp. 496-512)
o Country Study 33.1 Mexico
Recommended Lyles A. Direct Marketing of Pharmaceuticals to Consumers. Annual Review of Public Health 2002;23:73-91.
Cabana MD, Rand CS, Powe NR, et al. Why Don't Physicians Follow Clinical Practice Guidelines? A Framework for Improvement. JAMA 1999;282(15):1458-1465.



Session 10: Budgeting and Cost Control
Required MSH Managing Drug Supply Part IV: Section B. Financing and Sustainability
• Drug Financing Strategies (pp. 607-627)
• Analyzing and Controlling Drug Expenditures (pp. 628-653)
• Financial Planning and Management (pp. 654-672)


Session 11: Management Support Systems: Planning Cycle
Required MSH Managing Drug Supply Part IV: Section A. Organization and Management
• Managing Drug Programs (pp. 517-534)
o Country Study 34.1 Kenya
• Planning for Drug Management (pp. 535-552)
o Focus = 35.4
• Monitoring and Evaluation (pp. 553-568)
o Country Study 36.1 Zimbabwe
o Country Study 36.2 Kenya
Tutorial: Gantt Chart and Timeline: Available at:
http://www.smartdraw.com/specials/projectchart.asp?id=3FGPhwtl%22t
and
http://www.smartdraw.com/tutorials/gantt/tutorial1.htm

Recommended MSH Managing Drug Supply Force Field Analysis (pp. 527-528, 533, 544)
Sample Gantt Chart (Excel). Available at: http://www.hyperion.ie/SampleGanttChart.xls



Session 12: Access to Essential Drugs
Required MSH Managing Drug Supply Part IV: Section A. Organization and Management
• Community Participation (pp. 569-581)
o Focus = 37.5 Facilitating community participation in health programming
o Country Study 37.1 Canada
o Country Study 37.2 Thailand
Recommended MSH. Strategies for Enhancing Access to Medicines. Available at: http://www.msh.org/programs/seam.html



Session 13: Pharmaceutical Care and Drug Utilization in an HIV/AIDS Clinic
Recommended Lyles CA, Zuckerman IH, DeSipio SM and Fulda T. When Warnings Are Not Enough: Primary Prevention through Ambulatory Drug Use Review. Health Affairs, 17(4):175-183; 1998.
Harjivan C and Lyles A. Improved Medication Use in Long Term Care: Building on the Consultant Pharmacist's Drug Regimen Review. American Journal of Managed Care 2002;8(4):318-326.
Lyles A, Sleath B, Fulda TR and Collins TM. Ambulatory Drug Utilization Review: Opportunities for Improved Prescription Drug Use. [Continuing Medical Education] American Journal of Managed Care 7(1):75-81, 2001.



Session 14: Financing and Sustainability
Required MSH Managing Drug Supply Part IV: Section B. Financing and Sustainability
• Donor Financing (pp. 673-685)
• Revolving Drug Funds (pp. 687-710)
Umenai T and Narula IS. Revolving Drug Funds: A Step Towards Health Security. Bulletin of the World Health Organization 1999;77(2):167-171

Recommended Emmanuel Healthcare. Medicines for Overseas Programme. Available at: http://www.emms.org/support/subindex.php?type=Medicines


yang di bawah ini akan ditambahin kemudian (itupun kalau sempat):
• Establishment of a committee to evaluate new medical products


• Supply chain management


• Supply chain automation (e-commerce)


• Inventory management (reduced warehousing, increased just-in-time processing)


• Accounts payable and supply chain audits


• Use of operational audits to support cost management efforts


• Overhead cost reduction review and analysis


• Training that supports cost-management efforts