Medical Home Practice-Based Care Coordination

Medical Home Practice-Based Care Coordination: A Workbook By: Jeanne W. McAllister Elizabeth Presler W. Carl Cooley Center for Medical Home Improvement (CMHI) Crotched Mountain Foundation & Rehabilitation Center; Greenfield, New Hampshire Beyond the Medical Home: Cultivating Communities of Support for Children/Youth with Special Health Care Needs Funded by: H02MC02613-01-00 United States Maternal and Child Health Bureau, Integrated Services for CSHCN, HRSA June 2007Workbook Contents This workbook includes the tools and supports needed for a primary care practice to develop their capacity to offer a pediatric care coordination service; particularly for children with special health care needs. The health care team, determined to develop such an explicit service, makes an assessment of current care coordination practice and frames their improvement efforts to achieve proactive comprehensive practice-based care coordination.Tools included in this resource are: a definition of care coordi nation in the medical home, a care coordination position description, a framework for care coordination services including structures and processes, strategies for the protection of devoted staff time, and a logical sequence of care coordination improvement ideas offered in the context of the Model for Improvement (Langley, 1996). Each tool can be used as is or it can be customized in a manner which best fits your practice environment and the strategic plans your organization holds for medical home improvement activities.Table of Contents Medical Home Practice Based Care Coordination Medical Home Care Coordination A Definition & A Vision Is It Medical Home Care Coordination? A Checklist Medical Home (Practice Based) Care Coordination – Position Description – A Worksheet A Medical Home (MH) Care Coordination Framework – Framework – Worksheet Time Protection Tips & Strategies †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 3 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦5 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 6 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦7 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦8 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦9 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 10 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 11Care Coordination Development: The Model for Improvement †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦12 Care Coordination Aim Statement †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦13 Care Coordination Outcomes †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦14 Plan Do Stud y Act (PDSA) Worksheet & Examples †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦15 1) Care Coordination Role/System †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦16 2) Care Coordination – Needs Assessment †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦18 3) Comprehensive Care Planning †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦20 Medical Summary, Action & Emergency Plans 4) Transition to Adult Care & Services †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦22 5) Community Outreach & Resources †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦24 Appendices A.Websites and References †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦.. 26 2 Medical Home – Practice-Based Care Coordination This workbook is designed to suppor t practice-based quality improvement teams in their efforts to build comprehensive primary care â€Å"medical homes†. The focus is specifically upon the professional role development for the provision of practice-based care coordination. The ideal care scenario is one where the staff within the medical home is proactively prepared to support the central care giving role of families.The role of care coordination discussed within this workbook is one designed in the service of children/youth with special health care needs (CYSHCN). It is acknowledged that care coordinators in different environments will apply their skills and efforts toward the care of all children as well as adults with special needs or chronic health conditions; you should find the structures and processes offered within suitably applicable.Workbook Goals and Objectives: Goal: To put forth a practice-based medical home care coordination framework from which practices can select and suitably customize. Content s include a medical home care coordination checklist, definition, position description, model framework with structures and processes, and strategies for effective and successful care coordination development and implementation. Objectives: 1) Define practice-based care coordination for children with special health care needs in a medical home ) Select and appropriately modify a position description that fits each unique medical home improvement team environment 3) Use a care coordination model framework to fit the role well within each practice environment 4) Draw from a list of time protection and resource allocation strategies those with the best fit for the practice environment and related improvements 5) Develop tests of change (PDSA – plan, do, study, act) for the incremental development of a comprehensive care coordination service model to include: care services, assessment of needs, care planning, transition support, and community outreach with resource linkages.It is established in the literature that the medical home is meant to be a centralizing resource for children and families, particularly for CYSHCN (AAP Medical Home Advisory Committee, 2002) Evidence is building that care coordination is essential to a medical home (Antonelli, 2004). It has been suggested that you cannot be a strong medical home without the capacity to link families with a designated care coordinator; this is the ideal.The policy statement issued by the American Academy of Pediatrics on Care Coordination (CC) describes CC as complex, time consuming, even frustrating but as key to effective management of complex issues in a medical home; and states that a designated care coordinator is necessary to facilitate optimal outcomes and prevent confusion. Care coordination takes resources and time. Practices need to be reimbursed for this labor intensive role (AAP Committee on Children with Disabilities, 1999).Horst, Werner, and Werner (2000) state that in all types of systems, care coordination is an essential element to ensure quality and continuity of care for CSHCN and their families. In a 10 point strategy to 3 achieve transformational change within health care for all, issued by the Commonwealth Fund, care coordination is cited as one of ten key components to organize care and information around the patient (Davis, K. 2005). Ideal care coordination provides timely access to services, continuity of care, family support, strengths-based rather than deficit-based thinking and advocacy.This is very time consuming, whether accomplished by parents or by parent professional partnerships (Presler, 1998). At the front lines of care, in the medical home Antonelli (2004) states that without the ability to support care coordination at the level of the medical home, barriers to achieve the Healthy People 2010 objectives remain. In the Future of Children (2005) the author claims that care coordination requires (at the very least) adequate personnel and time and i s often limited in primary care by lack of the very time and resources necessary.This is substantiated by the AAP Periodic Survey of Fellows #44, (2000), by a national Family Voices Survey (2000) with parents reporting their physicians have the skill for coordination but are difficult to access and have minimal time available for care coordination activity/implementation. Similarly a survey of state Title V Directors and their perception of barriers to care coordination in the medical home includes: time, reimbursement, lack of physicians, lack of skill/training, and limited cultural effectiveness.Successful medical homes result when partnerships with families offer fully implemented practice-based care coordination. Proactive care coordination and care planning are fundamentally essential for improved care quality, access to services and resources, health and function of children and youth, and quality of life as well as improved systems of care. No medical home will achieve optima l comprehensive, coordinated and compassionate care without dedicated time and resources to develop, implement, and evaluate a complement of care coordination activities.Such an investment is favorable in terms of cost and benefit for children/youth and families, primary care practices and their broader health care systems. In summary, care coordination: Is accomplished everyday by families with and for their children and youth, but Support is desirable, feasible and beneficial coming from the medical home Requires critical funding and protected time Requires tested tools and strategies (some are included in this workbook, others have been developed and continue to evolve) Is a defining characteristic (element) of a fully implemented and comprehensive medical home Medical Home Care Coordination – A Definition The literature offers several definitions of care coordination but most have been written for application across varied health care environments such as hospitals, speci alty based centers, community & home health agencies. Few definitions focus exclusively on the distinctions found within the primary care medical home for the role of practice-based care coordinator.The focus of the Center for Medical Home Improvement is on the primary care practice with the provision of team-based care coordination, delivered from the centralizing resource of a primary care medical home with physician leadership and by experienced nurses, social workers, and/or comparable professionals. Care CoordinationPractice-based care coordination within the medical home is a direct, family/youth-centered, team oriented, outcomes focused process designed to: Facilitate the provision of comprehensive health promotion and chronic condition care; Ensure a locus of ongoing, proactive, planned care activities; Build and use effective communication strategies among family, the medical home, schools, specialists, and community professionals and community connections; and Help improve , measure, monitor and sustain quality outcomes (clinical, functional, satisfaction and cost (McAllister, et al, 2007)A Vision for Practice Based Care Coordination Children, youth, and families have seamless access to their team, enhanced by they availability of a designated care coordinator who facilitates a team approach to family-centered care coordination services. (McAllister, et al, 2007) 5 CC CHECKLIST Is It Medical Home Care Coordination? Checklist – how are you doing? What elements are in place, which require some additional attention? NO / PARTIALLY/ YES 1) Families know who their care coordinator is and how to access him or her (or their backup)? ) Values of family-centeredness are known to the medical home team and drive the development and provision of care coordination? 3) A medical home care coordination position description is established; roles/activities are clearly articulated and care coordination training and education is available? 4) Administrative lead ership helps to develop/support a care coordination service system; protected time allows for CC role development? 5) CYSHCN identification and assessment of child/family needs/unmet needs are completed; care planning is a core CC/medical home response? ) Education and counseling are offered as an essential part of medical home care coordination? 7) Care coordination includes comprehensive resource information, referrals, and cross agency/organization communication? 8) Child/family advocacy is a part of care coordination 9) Families are asked for feedback about their experiences with health services/care coordination? 10) Medical home system improvements are implemented simultaneously with the development of care coordination (care coordinator contributes to this quality improvement process)? 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 1 2 2 3 3 1 2 3 1 2 3 Total score: _________/ out of 30. Notes: 6 Medical Home (Practice Based) Care Coordination – Position Description The care coor dinator works within the context of a primary care medical home, from a team approach, and in continuous partnership with families and physicians to promote: timely access to needed care, comprehension and continuity of care, and the enhancement of child and family well being.Care Coordination Qualifications: The care coordinator shall have: Bachelor’s preparation as a nurse, social worker, or the equivalent with appropriate past experience in health care Three years relevant experience, or the equivalent, in community based pediatrics or primary care, particularly in the care and service of vulnerable populations such as children/youth with special health care needs (CYSHCN) Essential leadership, advocacy, communication, education and counseling, and resource research skills Core philosophy or values consistent with a family-centered approach to care Culturally effective capabilities demonstrating a sensitivity and responsiveness to varying cultural characteristics and belie fs Medical Home Care Coordination Responsibilities The care coordinator will: 1) Demonstrate and apply knowledge of the philosophy/ principles of comprehensive, community based, family-centered, developmentally appropriate, culturally sensitive care coordination services 2) Facilitate family access to medical home providers, staff and resources 3) Assist with or promote the identification of patients in the practice with special health care needs (such as CYSHCN); add to registry and use to plan and monitor care 4) Assess child/patient and family needs and unmet needs, strengths and assets 5) Initiate family contacts; create ongoing processes for families to determine and request the level of care coordination support they desire for their child/youth or family member at any given point in time 6) Build care relationships among family and team; support the primary care-giving role of the family 7) Develop care plan with family/youth/team (emergency plan, medical summary and action p lan as appropriate) 8) Carry out care plans, evaluate effectiveness, monitor in a timely way and effect changes as needed; use age appropriate transition timetables for interventions within care plans 9) Serve as the contact point, advocate and informational resource for family and community partners / payers 10) Research, find, and link resources, services and supports with/for the family 11) Educate, ounsel, and support; provide developmentally appropriate anticipatory guidance; in a crisis, intervene or facilitate referrals appropriately 12) Cultivate and support primary care & subspecialty co-management with timely communication, inquiry, follow up and integration of information into the care plan 13) Coordinate inter-organizationally among family, medical home, and involved agencies; facilitate â€Å"wrap around† meetings or team conferences and attend community/school meetings with family as needed and prudent; offer outreach to the community related to the population o f CYSHCN 14) Serve as a medical home quality improvement team member; help to measure quality and to identify, test, refine and implement practice improvements 15) Coordinate efforts to gain family/youth feedback regarding their experiences of health care (focus groups, surveys, other means); participate in interventions which address family/youth articulated needs 7 Position Description WorksheetMedical Home (Practice Based) Care Coordination Position Description Responsibilities Worksheet – Customize for Your Practice Care Coordination in a Medical Home – The Care Coordinator will: 1) Demonstrate and apply knowledge of the philosophy/ principles of 2) 3) comprehensive, community based, family-centered, developmentally appropriate, culturally sensitive care coordination services Facilitate family access to medical home providers, staff and resources Assist with or promote the identification of those with special health care needs (such as CYSHCN); add them to the regi stry and use it to plan and monitor care Assess child/patient and family needs/unmet needs, strengths and assets Initiate family contacts; create ongoing processes for families to determine and request the level of care coordination support they desire for their child, youth or family member at any given point in time Build care relationships among family and team; support the primary care giving role of the family Develop care plan with family/youth/team (emergency plan, medical summary and action plan as appropriate) Carry out care plans, evaluate effectiveness, monitor in a timely way and make changes as needed; use age appropriate transition imetables for interventions within care plans Serve as contact point, advocate and informational resource for family and community partners/payers Research find, and link resources, services and supports with/for the family Educate, counsel, and support; provide developmentally appropriate anticipatory guidance; in a crisis, intervene or fac ilitate referrals appropriately Cultivate and support primary care & subspecialty co-management with timely communication, inquiry, follow-up and integration of information into the care plan Coordinate interorganizationally among family, the medical home, and involved agencies; facilitate â€Å"wrap around† meetings or team conferences and attend community/school meetings with family as needed and prudent; offer outreach to the community related to the population of CYSHCN Serve as a medical home quality improvement team member; help to measure quality and to identify, test, refine and implement practice improvements Coordinate efforts to gain family feedback regarding their experience with health care(focus groups, surveys, other means); participate in interventions that address family/youth articulated needs Accept Reject 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) *** Add additional key responsibilities here (use additional paper): 8 A Medical Home (MH), Team Based, Care Co ordination (CC) Framework Fundamental Tools Structures Medical Home Interventions Access to Medical Home, Health Care and Other Resources Identify and register the CYSHCN opulation Establish with families effective means for medical home/office access Provide accessible office contract for family and community agencies Catalog resources to link families to appropriate educational, information and referral sources Promote and â€Å"market† practice-based care coordination to families and others (e. g. brochures, posters, outreach efforts) Establish alliances with community partners Facilitate practice & family linkages with agencies (e. g. family support, schools, early intervention, home care, day care &agencies offering respite, housing, & transportation) Align transition support activities with schools & other groups Collaborate to improve systems of care for CYSHCN (families, payers, provides, and agencies) Community Connections Fundamental Processes Proactive Care Plannin g Medical Home Interventions Help to maintain health and wellness & prevent secondary disease complications Maximize outcomes (e. g. lleviation of the burden of illness, effective communication across organizations, enrollment in needed services, and school attendance/success) Listen, counsel, educate, & foster family skill building Screen for unmet family needs Develop written care plans; implement, monitor and update regularly Plan for future transition needs; incorporate into plan of care Facilitate subspecialty referrals, communication & help family integrate recommendations of specialists Link family, staff to educational/financial resources †¢ †¢ †¢ †¢ Establish alliances with community partners Facilitate practice & family linkages with agencies (e. g. family support, schools, early intervention, home care, day care & agencies offering respite, housing, & transportation) Align transition support activities with schools & other groups Collaborate with famil ies, payers, providers and community agencies to improve systems of care for CYSHCN Improving and Sustaining Quality 9 Framework Worksheet A Medical Home (MH) Care Coordination Framework – WORKSHEET Fundamental Structures Access to Medical Home, Health Care and Other Resources Who? How? Medical Home InterventionsIdentify and register the CYSHCN population Establish with families effective means for medical home/office access Provide accessible office contract for family and community agencies Catalog resources to link families to appropriate educational, information and referral sources Promote and â€Å"market† practice-based care coordination to families and others (e. g. brochures, posters, outreach efforts) Establish alliances with community partners Facilitate practice & family linkages with agencies (e. g. family support, schools, early intervention, home care, day care &agencies offering respite, housing, & transportation) Align transition support activities wit h schools & other groups Collaborate to improve systems of care for CYSHCN (families, payers, provides, and agencies) Community Connections Fundamental Processes Proactive Care Planning Medical Home InterventionsHelp to maintain health and wellness & prevent secondary disease complications Maximize outcomes (e. g. alleviation of the burden of illness, effective communication across organizations, enrollment in needed services, and school attendance/success) Listen, counsel, educate, & foster family skill building Screen for unmet family needs Develop written care plans; implement, monitor and update regularly Plan for future transition needs; incorporate into plan of care Facilitate subspecialty referrals, communication & help family integrate recommendations of specialists Link family, staff to educational/financial resources †¢ †¢ †¢ †¢ Establish alliances with community partners Facilitate practice & family linkages with agencies (e. g. amily support, schools, early intervention, home care, day care & agencies offering respite, housing, & transportation) Align transition support activities with schools & other groups Collaborate with families, payers, providers and community agencies to improve systems of care for CYSHCN Who? How? Improving and Sustaining Quality 10 Time Protection Tips & Strategies The statement (on page 4) that no medical home will achieve optimal comprehensive, coordinated and compassionate care without dedicated time and resources to develop, implement, and evaluate a complement of care coordination activities warrants a few tips about how to achieve such dedicated time.Ideas for the successful implementation of practice based care coordination include administratively supported techniques and the resulting implemented care coordination (systematic) processes. Consider the following suggestions for time protection and use them to craft your own strategic approaches. Administrative Strategies for Achieving Some  "Think† and Implementation Time Personnel – proactively allocate a block of dedicated time. This includes the number of hours, days and time blocks or hours and how those hours will be prepared for, spent and accounted for. (This can be done as a trial or test of change) You may need a private place, an office, or even a â€Å"my care coordination development hat is on today† sign!Clear activities – Use the position description and the CC framework on page 9 to select the focus and logical progression of this role development and how time will be spent Determine how you will document and/or account for this time Team based care coordination – determine how you will allow for the development of care coordinator – family partnership. Could there be a designated clinic time for specific group of CYSHCN, or a special condition focused approach with a care coordination protocol? Some practices have held what is referred to as a DIGMA (drop in grou p medical appointments) for a group of families with children with similar conditions. A DIGMA can take on many forms such as family education, community resource connections, or even time for care coordination introduction and development with the opportunity to meet, greet and complete care plans.Approaches Helpful to Building Time into Your System Use your population identification system to determine who needs care coordination Use the development of your CC role to establish systematized screening assessments and resulting care planning and monitoring Hold medical home related staff meetings; offer education regarding CYSHCN and gain buy-in and staff understanding for the value of providing care coordination Engage families who can educate staff about the complexity of their child’s needs Create a reporting line to senior leaders from the Care Coordinator so that CC development is built into their role expectation Develop the capacity for care coordination â€Å"roundsà ¢â‚¬  by discussing direct CC efforts around individual children and youth with staff; gaining the input of colleagues will help you with staff education and their buy in to the medical home and practice-based care coordination approach; all will then learn about complex health and community based needs and resources Maximizing Reimbursement for Care Coordination: Ensuring affordability and sustainability by: Developing smart legitimate up-coding; Tracking CC data (service/outcome) to negotiate new payment opportunities Prepare for the use of new codes (care plan oversight) Become aware of and access Title V supports 11 Care Coordination Development: 1) The Model for Improvement 2) Care Coordination Aim Statement 3) Plan Do Study Act (PDSA) cycles or â€Å"tests of change†Model for Improvement Questions 1) What are we trying to accomplish? Medical Home Improvement Responses Medical Home – Care Coordination 2) How will we know that a change is an improvement? Measures – Medical Home Index, Medical Home Family Index & Survey, Other 3) What changes can we make that will result in an improvement? Good ideas – ready for use (e. g. CC definition, job description, framework & activities, PDSA examples 12 2) Care Coordination Aim Statement A good aim statement includes the following elements: Population – CYSHCN Timeframe – by when Intent – what/why Stretch goals – e. g. identify 100% CSHCN Example: Overarching Aim – Care CoordinationBetween Learning Session 2 and spring of 2006 we will customize and use a model of medical home care coordination for children/youth with special health care needs so that a position description and framework of activities are explicit, with time protected and accounted for and ~ 75% (goal) of children, youth and families report that they: Know who their care coordinator is Know they are receiving care coordination Participate in decisions about the level of care coordination needed Are satisfied with their access to care, care coordination, and resources (most of the time) For Veterans – Advanced Care Coordination Aim Goals Youth and families report that: A transition timetable is shared among family, practice and community professionals They have coordinated support getting their child’s needs met within the community and from sub-specialists 13 Thinking Through Some Measurement Ideas – For Practice-Based Care Coordination – PDSA Cycles Care Coordination Outcomes Family satisfaction decrease in worry and frustration (CMHI survey tools) increased sense of partnership with professionals (CMHI survey tools) improved satisfaction with team communication (CMHI survey tools)Staff satisfaction improved communication and coordination of care improved efficiency of care elevated challenge and professional role Improved child/youth outcomes Decrease in ER visits, hospitalizations, & school absences (family, plan report) Increase in a ccess to needed resources (CMHI survey tools) Enhanced self-management skills (CMHI survey tools) Improved systems outcomes decreased duplication decreased fragmentation improved communication and coordination (CMHI Medical Home Index) 14 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen?How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 15 CMHI Plan-Do-Study-Act (PDSA) Worksheet PDSA Example Team: #1 Care Coordination Role/System Aim: Use from page 13 or create own PLAN: Objective: (Including details (who, what, where, when) We will develop and test a clearly defined system of care coordination (CC) services using strategies that fit our practice environment.This will include the use of a: 1) clear CC definition, 2) CC position description and 3) CC framework with an outline of activities. CC role, contact and access information will be explicit for families. {Our test of change will include dedicated time for the CC to share plans with staff and implement CC PDSA cycles (see examples in following pages). We will feed back lessons learned to our Medical Home Improvement team for guidance and direction. What additional information will you need to take action? Knowledge of and securing the availability of senior leader support with designation of one (or more) staff members to provide CC leadership What do you predict will happen?There will be false starts with â€Å"tyranny of the urgent† keeping us from our task; our will, ideas and execution will overcome this in the end. How will you know your ch ange is an improvement? Staff/families begin to ask for care coordination / CC activities (e. g. care plan); selected outcome measures improve (see page 14) DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 16 PDSA Worksheet PDSA Team: Aim:CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen? How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 17 CMHI Plan-Do-Study-Act Worksheet PDSA Example Team: #2 Care Coordination Needs Assessment Aim: Use from page 13 or create own PLAN:Objective: (Including details (who, what, where, when) With MH lead physician review pending CYSHCN visits; select 3 CYSHCN who will benefit from an assessment for care coordination. By â€Å"a week from next Tuesday† complete an assessment (e. g. parent/youth screening tool in appendices behind page 26) either before the office visit or by pre-visit phone call. Begin care planning process with child/youth and family What additional information will you need to take action? Listing of pending CYSHCN visits from the CYSHCN list or â€Å"registry† What do you predict will happen? Some false starts finding the right CYSHCN and with timing; we will succeed if persistent over slightly longer time span How will you know your change is an improvement?Follow up with 3 families in 2 weeks to determine if pre-visit assessm ent and follow-up planning are helpful and what needs to be added/improved; review value with lead physician as well. DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 18 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen?How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 19 CMHI Plan-D o-Study-Act Worksheet PDSA Example #3 Comprehensive Care Planning Team: Aim: Use from page 13 or create own PLAN: Objective: (Including details (who, what, where, when) 1) Develop/choose care plan medical summary and use with 5 identified CYSHCN/week. 2) Add an emergency plan if warranted. ) Study provider and family feedback and integrate to improve the plan and the process for plan use. Create immediate action plan for how to meet resource, educational and other needs of CYSHCN/patient and family 4) Use lessons learned to share, engage, educate and spread medical home to staff. What additional information will you need to take action? Sample care plans to choose from using team priorities; identified CYSHCN with pending visit to initiate plan with. Also identify educational needs of staff /families. What do you predict will happen? Will start slow, 1-2 per week and pick up speed to reach 5. Value will result in better preservation of care coordinator time to complete plans, thus i ncreased use of CC and team process.Ultimately, we may schedule comprehensive care planning â€Å"rounds† with team/staff; review 3-5 CYSHCN/patients who are receiving this care coordination. Use rounds to review successes, challenges, needs of child/family with staff and address questions. How will you know your change is an improvement? Review with families for benefit, follow up in 4-6 weeks; review also with staff DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 20 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN:Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen? How will you know your change is an improvement? DO : Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 21 CMHI Plan-Do-Study-Act Worksheet PDSA Example #4 Transition to Adult Care & Services; Up-coding to maximize reimbursement Team: Aim: Use from page 13 or create own PLAN:Objective: Have MD & Care Coordinator jointly see (2) YSHCN & family for transition visit; use a transition assessment (timetable) checklist to guide the visit and align activities with community partners. Bill for visit – document nature of complexity Details (who, what, where, when) CC Schedules 2 YSHCN for transition care plan visit next week, with family permission informs/communicates with key community partners about assets & needs. Codes for â€Å"99214† for 60 minute visit with established patient and document extent and complexity of the visit What additional information will we need to take action? – Extract from list of CYSHCN youth over 14 due for visit; communicate with family and learn community partners – Clarify with senior leaders ability to track reimbursement results for these visits What do we predict will happen? (E. g.May take time to match YSHCN with open slots; will need to follow up with payers for denials and use documentation to justify activities). How will you know your change is an improvement? Review with family staff; community partners. Select other ongoing measures (p14) DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 22 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Obj ective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen?How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 23 CMHI Plan-Do-Study-Act Worksheet PDSA Example #5 Community Outreach / Resources Team: Aim: Use from page 13 or create own PLAN: Objective: (Including details (who, what, where, when) Plan for care continuity across the: medical home, school, and community agencies with 4 families and children/youth over the next four weeks.Use a selected communication strategy (fax back, email, NCR paper, electronic forum, other) to centralize key information with strengths, goals, care plans, access information, an d releases fostering cross organizational communication; the CC performs as a â€Å"hub of the wheel function† in these activities. What additional information will you need to take action? Identification of children/youth and families in need of transition and/or community-based coordination; identification of key community partners; consensus on communication strategy What do you predict will happen? Territorial barriers will crop up and family will need to be front and central to the process.How will you know your change is an improvement? Review with family and agencies whether there has been improved care communication, also consider other systematized outcome measures (see page 14). DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of c hange: 24 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action?What do you predict will happen? How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 25 Appendices A. Key Websites for Care Coordination Tools 1) Center for Medical Home Improvement (CMHI): www. medicalhomeimprovement. org 2) National Center for Medical Home Initiatives (AAP) www. medicalhomeinfo. org 3) Utah Medical Home Portal www. medhomeportal. orgReferences 1) McAllister, J. W. , Cooley, W. C, Presler, E. Practice-Based Care Coordination: A Medical Home Essential. Pediatrics, Volume 120, Number 3, S eptember 2007, e1e11. 2) American Academy of Pediatrics, Medical Home Initiatives for Children with Special Health Care Needs Project Advisory Committee. The medical home. Pediatrics, 2002; 110:184-186. 3) American Academy of Pediatrics, Committee on Children with Disabilities. Care Coordination: Integrating Health and Related Systems of Care for Children with Special Health Care Needs, Pediatrics, 1999, Vol. 104:978-981. 4) American Academy of Pediatrics, Division of Health Policy Research.Periodic Survey of Fellows #44. Health Services for Children with and without Special Needs: The Medical Home Concept Executive Summary. Elk Grove Village, Illinois: American Academy of Pediatrics; 2000. Available at: www. aap. org/research/ps44aexs. htm. Accessed April, 2005. 5) Antonelli, R. , Antonelli, D. , Providing a Medical Home: The Cost of Care Coordination: Services in a Community-Based, General Pediatric Practice. Pediatrics (Supplement) 2004; Vol. 113: 1522-1528 6) Cooley, W. C. and M cAllister, J. W. Building Medical Homes: Improvement Strategies in Primary Care for Children with Special Health Care Needs. Pediatrics (Supplement) 2004; 113: 1499-1506. ) Davis, K. , Transformation Change: A Ten Point Strategy to Achieve Better Health Care for All. The Commonwealth Fund. Accessed at www. cmwf. org April 13, 2005. 8) Family Voices. What Do Families Say About Health Care for Children with Special Health Care Needs in California: Your Voice Counts. Boston, MA: Family Voices at the Federation for Children with Special Health Care Needs; 2000. 9) Future of Children, Health Insurance for Children; Care of children with Special Health Care Needs. Key Indicators of Program Quality. Available at www. futureofchildren. org/information2827/Accessed April 13, 2005. 10) Horst, , Werner, R. , & Werner, C. 2000) Case management for children and families Journal of Child and Family Nursing, 3, 5-14. 11) Langley, G. J. , et al. The Improvement Guide: A Practical Approach to Enhanc ing Organizational Performance. Jossey-Bass, San Francisco, 1996. 12) Lindeke, L. L. , Leonard, B. J. , Presler, B, Garwick, A, Family-centered Care Coordination for Children with Special Health Care Needs across Settings. Journal of Pediatric Health Care, Vol. 16, No. 6, November/December, 2002, 290-297 ** 13) Presler, B. (1998, March/April) Care Coordination for Children with Special Health Care Needs. Orthopedic Nursing, (Supplement), 45-51. 26 CMHI Center for Medical Home Improvement (CMHI) Crotched Mountain Foundation Greenfield, New Hampshire 2007 27

Netflix Strategic Management

| Netflix| Heather Murdock, Brian Wynn, Joseph Casey, Samuel Faulkner, Allen Porter, Josh Blum| | The University of Memphis| 4/13/2013| | â€Å"Netflix, Inc. is the world’s leading Internet television network with more than 33 million members in over 40 countries enjoying more than one billion hours of TV shows and movies per month, including original series. For one low monthly price, our members can watch as much as they want, anytime, anywhere, on nearly any Internet-connected screen.Additionally, in the United States, our subscribers can receive standard definition DVDs, and their high definition successor, Blu-ray discs, delivered quickly to their homes† (SEC Filings, 2013). Reed Hastings and Marc Randolph established Netflix in 1997 in order to offer online movie rentals. In 1999, the firm launched its infamous subscription service that offered unlimited rentals for a monthly subscription, but it was not until the year 2000 that Netflix gave their firm a true comp etitive advantage when it implemented its movie recommendation algorithm. Within two years, Netflix made its IPO at a net value of $82,000,000 on NASDAQ.From the IPO to present, Netflix has amassed more than thirty-three million members. During this continual climb, Netflix opened its streaming service in 2007, created major partnerships from 2009 until 2010 which allowed for Netflix widgets on electronic hardware systems, and since 2010 has been establishing international operations in primarily English speaking countries (Company Overview: Netflix Timeline, 2013). Knowing the background of the company, the individuals responsible for managing the company can be discussed with an understanding of what they have achieved.At the center of everything, Netflix related is Reed Hastings, the Co-Founder, and CEO. Prior to Netflix, Reed founded one of the 50 largest software companies, Pure Software. Reed has additionally served on the California State Board of Education from 2000 to 2004. Reed’s long-term determination has resulted in the company’s endured success despite serious dilemmas. Kelly Bennet is the Chief Marketing Officer. Prior to Netflix, Kelly served as VP of Interactive World Wide Marketing at Warner Brothers for nearly a decade. Additionally, he has served executive positions in Dow Jones International and Ignition Media.Kelly’s wide range of media experiences has provided the company with the effective understanding of the company is marketing channels. Tawni Cranz is the Chief Talent Officer. Prior to Netflix, Tawni was the HR director of Bausch & Lomb. Tawni has worked with Netflix since 2007. Jonathan Friedland is the Chief Communications Officer. Prior to Netflix, Jonathan was the SVP of Corporate Communication for The Walt Disney Company. Before his executive position, he spent 20 years as a foreign correspondent and editor. Bill Holmes is the Chief Business Development Officer.Prior to Netflix, Bill served as Vice Presiden t Business Development & Strategy at DivX, Inc. Neil Hunt is the Chief Product Officer. Prior to Netflix, Neil served in various engineering and product roles at the software test tool companies. Bill has been with Netflix since 1999. David Hyman is the General Counsel. Prior to Netflix, David was the General Counsel of Webvan. David has been with Netflix since 2002. Ted Sarandos is the Chief Content Officer. Prior to Netflix, Ted was an executive at ETD and Video City. Ted has been with Netflix since 2000. David Wells is the Chief Financial Officer.Prior to Netflix, David spent six years in senior roles across Deloitte Consulting. David has been with Netflix since 2004. Finally, there is an illustrations board of directors who monitor Netflix to ensure that the executive’s vision for the company is aligned with the stockholder’s needs. The important individuals on the board of directors are Ann Mather, Reed Hastings, and Timothy Haley (Company Overview: Management, 20 13). The combined corporate experience of all the executive members has provided Netflix with an invaluable brain trust to power their dominant market share.Knowing who runs Netflix and knowing what the individuals share, as a common mission and value system, will help clarify the company’s situation in future paragraphs. Netflix does not have an official mission statement or series of values known to the public. However, the company hiring policy does list company culture qualifiers, which are rather similar to an ad hoc value system. In a company where efficiency and responsiveness is everything, Netflix does not carry very many policies or mission statement related items because they believe policies are largely ineffective at producing desired results.Their concept centralizes around the idea that the Netflix corporate brand sustains itself by creating the highest quality product and service with the highest quality employee. This undetermined result orientated mission st atement means that the employees and management hold a great deal of ethical and work autonomy. This autonomy has generated a clarified list of desired employee values: Judgment, Communication, Impact, Curiosity, Innovation, Courage, Passion, Honesty, and Selflessness (‘Top Reasons to Work at Netflix’, 2013).Knowing the motivation behind Netflix being a result oriented methodology, it will be relatively easy to understand the major goals of the company. The core strategy of Netflix is to grow their streaming subscription business domestically and internationally. Netflix has established streaming services to more than 40 countries outside of the United States. Netflix executives believe streaming content online is a large long-term growth opportunity. Due to an economy of scales, Netflix current controls the majority of the content streaming market.The other primary strategies for Netflix includes maintaining the highest customer satisfaction in the market, providing Ne tflix’ streaming service on every device, and transitioning a larger market portion into international markets. It is understandable why Netflix has been willing to venture into unexplored business ventures, such as the online content streaming, with full confidence that these new ventures will carry their company into the next generation of entertainment consumption mediums when you compare their ventures to their values and person-embodied technologies.Netflix’ intention to be usable on every device is the company’s stretch goal. The effort to become primarily a content streaming company is a long-term challenge due to the mentioned content licensing liability that would adversely affect the business if obstructed (SEC Filings, 2013). Regardless of any ambitions, there are difficulties that the company has had to face, forcing Netflix to change their long-term strategy. â€Å"Prior to July 2011, in the (United States) †¦ subscribers could receive both st reaming content and DVDs under a single ‘hybrid’ plan† (SEC Filings, 2013).The hybrid plan was broken into two different subscription services, and subscribers could choose which services interested them the most. That decision was an emergent strategy that developed due to the implementation of DVD kiosks by Red Box and Block Buster. The Stock peaked at an all-time high of 295 during July 2011, and the decisions resulted in an 80% loss in stock value (Yahoo! Finance Inc. , 2013). The company continued to recover with a primarily international and streaming strategy (SEC Filings, 2013). Netflix has successfully established itself in several related industries.They are a powerful online media provider and well as the leading online movie and game rental distributor. Several recent changes in these industries have occurred due to the competition of big business. Some changes have had a positive and negative effect on Netflix. On the political side, Netflix and other entertainment providers have benefited greatly from the U. S. Department of Homeland Security recent initiatives on the seizing of dozens of illegal streaming and torrent sites due to copyright infringement. Over the past several years’ websites such as torrentfreak, alluc. org, dvdcollect. om, and watchnewfilms. com have been seized or shut down by the U. S. government. These initiatives were a product of the growing concern of copyright infringement from the TV and film industry. Similar to the massive seizures of programs such as limewire and napster in the mid 2000 is forced by the music industry. This has also helped the Legal side of the industry that was much more complicated six years ago than it is today. Copyrights, Trademarks, Patents, and licensing have become easier to obtain for legitimate businesses due to the confidence and maturity of the industry as a whole.An unforeseen change in copyright law could have an effect on Netflix and its competitors. The econom ic factors that affect this industry are unclear. Logic suggests that entertainment spending would decrease during a recession due to a decrease in disposable income. However, DVD rentals have continued to grow. This may be because consumers are seeing DVD rentals and online streaming as cheap entertainment alternatives to their counterparts, such as visits to the movie theater or the purchase of an expensive DVD. The sociocultural factors that have affected the industry are mostly related to the advancement of technology over the last decade.Consumers are more tech savvy and thus are purchasing more products and services that enhance the speed, quality, availability, and price of what they watch. One demographic concern is the aging of the population. As baby boomers grow older they may begin to pursue less visual entertainment. There are no substantial ecological factors affecting this industry. The energy used to run the Netflix’ servers might be a concerning factor if not for the large reduction of domestic shipping and transportation that companies such as Redbox are using instead of streaming.If anything this industry’s emergence has had a positive effect on the environment because it is transforming what used to be physical product with a life cycle into timeless packages of data. The technological advances in video streaming since Netflix first decided to be an instant video provider are astounding. From what was just an emerging technology just a decade ago is now a major function of every major website in the world. The most significant entry into the market was actual TV networks designing their own websites for content streaming.Not only does this erase content that Netflix would be potentially able to offer their customers but also creates new competitors. In reference to Netflix’ other side of the business, there has been several changes in the way consumers rent DVD’s. Redbox has emerged as an industry giant by establ ishing kiosks all over the U. S. making DVD rental cheap and extremely hassle free. Traditional brick and mortar establishments are practically nonexistent due to the convenience and price of by-mail, kiosk, and instant viewing channels.The five forces model for Netflix is complicated because the DVD rental business and online media streaming are two very separate markets with different customers and competitors. The threat of new entrants on the DVD rental side of the company is not as great as it is on the online streaming side. DVDs are an older technology and a large amount of capital is required to enter this market. It is also difficult to classify exactly who and what Netflix’ direct competitors are as this industry is rapidly evolving and shifting. Netflix competes with companies on several levels of the video entertainment industry.Netflix and its competitors serve consumers on a number of alternative channels for in-home entertainment such as: brick and mortar renta l businesses, DVD vending machine services, DVD mail delivery, online rental, pay-per view rental, video on-demand services, online video purchasing, and brick and mortar retail stores. This collection of competition makes it difficult to assign a particular competitor to a specific strategic group. The threat of new entrants is low. Capital requirements to enter this industry are high and existing competition have established brands and developed unique echnology. The main concern for Netflix is if a large indirect competitor with recourses suddenly decided it wanted to enter the market. The power of suppliers is high in this industry. Netflix obtains its product directly from studios. A broken relationship could cost them an immense amount of viewing content and in turn provide their competitors with that same content. There are no viable substitutes for the content they purchase from the major film and television studios. Supplier can and are forwardly integration themselves into the industry.The most notable example of this is from the premium cable networks such as: Starz, Encore, Showtime, and HBO. These networks have all established their own premium sites for content streaming with a log-in available through a customer’s cable provider. The power of buyers is moderate to low. The customers are individual consumers so they do not present a great deal of buyer power as a purchasing group. However, Netflix’ revenue is obtained completely form individual customers that are price sensitive. As a whole they are not capable of backward integration which gives them only moderate power.The threat of substitutes is very high. There is an abundance of different channels a customer could go through to replace Netflix. Netflix customers could simply turn to Cable and satellite television networks, movie theaters, other streaming sites, free sites, rental kiosks and purchasing DVDS to replace Netflix. The switching costs are all relatively low. The riv alry among existing competitors is also relatively high and should only continue to increase. Partnerships are occurring throughout the industry that will put pressure on Netflix not only for its customers but also its content.Verizon is now partners with Coinstar’s primary subsidiary, Redbox, to launch their own on-demand video streaming site called Redboxinstant. Redbox will now compete with Netflix directly on both sides of its business. If Time Warner allows HBO to offer its website HBOGO to customers without a cable subscription then HBO will transform into a direct competitor of on-demand subscription. Amazon has jumped into the market with their launch of Amazon Prime. Users pay a yearly fee and have access to instant movies, television series, e-books, and a whole array of other value adding services.Wal-Mart has purchased VuDu, another streaming service that integrates into devices such as Sony’s Playstation 3 to provide instant viewing to subscribing members. Unlike other services Vudu offers titles available the same day they are released on DVD. Google, Apple, and BlockBuster have all also joined the market with their own version of on-demand entertainment. The competition remains high because these are all powerful companies with equal strengths striving for market leadership. Capabilities| Valuable? | Rare? | Costly to Imitate? Organized to capture value? | Competitive Advantage? | Mail-in DVD Rental| Yes| Yes| Yes| Yes| Temporary due to product life cycle. Sustainable for now| Convenience| Yes| No| Yes| Yes| Sustainable/Temporary| Title Variety| Yes| Yes| Yes| Yes| Sustainable| Online streaming| Yes| No| Yes| Yes| Competitive Parity/ Temporary Advantage| Instant queue | Yes| Yes| Yes| Yes| Sustainable advantage| Physical Distribution| Yes| Yes| Yes| Yes| Temporary due to product life cycle. Sustainable for now| Strengths| Weaknesses| Opportunities| Threats|Instant queue system that makes movie recommendations to customers. | Potent ial liability for negligence, copyright, or trademark infringement. | Investing in viewing material and streaming content. | Changes in consumer viewing habits| Content can be accessed via hardware applications i. e. Xbox, PlayStation, Ipad, Wii. | Declining subscriptions to domestic DVD rental service. | Adoption and growth of internet TV. | Online subscription-based entertainment video market segment saturation| Brand awareness| Customer information could be accessed by unauthorized personnel. Future of the Consumer Electronic Ecosystem: â€Å"Internet on Every Screen†| Content providers refusing to license streaming content upon acceptable terms. | Largest collection of premium content. | Operational failure in any of the key systems. | International streaming segment represents a significant long-term growth| Changes in U. S. postal rates| Netflix is confident that expansion into more markets worldwide will help the business continue to grow. This is evident because Netfl ix cites its expansive reach as a major component of its success, as well as, an important factor in the company’s plan for the future.A goal promoted on the company’s investor relationship website is the intention to provide Netflix video streaming services to any and all screens with Internet connection. So far, the company has managed to reach subscribers in 40 countries while supplying a library of over one billion hours of video (Netflix). This wide reaching and easily available nature of this service has been the source of much of Netflix’ success since the company began. Based on the statements included with the Netflix financial releases, the company views an economic perspective of competitive advantage and the industry as a whole.This perspective is less focused on accounting ratios and data than the fundamental value-added philosophy. The main concern from this perspective is value creation. Netflix has added value to the videos they license by provid ing a convenient system for streaming the video to the end user and then made that system available to individuals worldwide. The availability of Netflix in so many areas is the primary method being utilized to capture the value already created by the working system born here in the United States. Netflix holds a primary concern in the continuous presence in the technologically developing areas of the world.In these areas, the economic value added to videos is great. Far from electronic stores and Hollywood, the ease and convenience of Netflix video providing service becomes more and more significant. Netflix respects this philosophy and has responded by continuing to advance into new areas around the globe (Netflix). Triple Bottom Line Netflix has differentiated itself from the competition in both video streaming and rental. Netflix began by changing the video rental market. It entered the industry with the plan to dispense movies across America directly to its subscribers’ homes.Not long after, Netflix began adding on online method of viewing video instantly. According to the company website, members can play; pause; and resume watching, all without commercials or interruptions. There are many video-streaming services available, most of which are free. Hardly any competitor can match Netflix’ boast of no commercials because of their reliance on ad stream revenue. Netflix also differentiates itself in that the software remembers your video selections. With this memory of video selections, it can then recommend new videos that you have not seen.The most notable form of differentiation in the video streaming industry is exclusivity. This deals with what video is actually viewable by the users. The provider makes video available legally by contracting with the rights holders of the videos. This severely limits free services already available because they centralize their business model on revenue through advertising. This issue may provide Netflix with its biggest advantage. Because Netflix charges its members a subscription cost, it can then use the greater funds to negotiate with video rights holders.While Netflix cannot be considered a cost leader when compared to the free video streaming services available, it still utilizes cost management to compete with other pay services that may try to enter the market and those already available. The company advertises that for one low monthly price, Netflix members can watch as much as they want, anytime and anywhere. This low monthly price is due to four factors. One, Netflix has already overcome the cost of input. This regards the substantial investment required to launch a video streaming program on a massive scale and complete negotiations with video rights holders.Two, Netflix is also developing its economy of scale. The Netflix streaming service is spreading into 40 countries, and each new market can be reached with already developed software and without having to invest in a completely new process. Three, Netflix is further along the learning curve than competitors. The company has been ironing out kinks in the video streaming process much longer than most competitors. Four, Netflix experience gives it a viable source of advantage against industry newcomers. Netflix’ competitive scope is very broad in the video streaming market.The company is working to reach any and all potential customers with an Internet connected screen. The American market is somewhat segmented between the more tech savvy video streamers and delivery service recipients. For its video streaming service, Netflix is approaching the market with a fast pace, expanding into most areas where internet is available. Netflix’ generic strategy is integration though it leans more towards service differentiation than cost leadership. It strays from a cost position due to the many free video providers already available online.However, other pay services have difficulty competing b ecause Netflix’ success with economies of scale and experience in the industry. Many factors differentiate the Netflix service from the rest of the market. These videos are available to members on-demand without commercials. Netflix also provides its members with video recommendations based on the customer’s past selections. Furthermore, Netflix has been successful at reaching more and more developing areas that are beginning to go online. In these areas, Netflix’ product has even more differentiation due to the low competitor presence.There are positives and negatives to the Netflix business strategy. The negatives begin with the cost of premium video rights. It is difficult to differentiate via better video because they will cost more to distribute. This causes trouble because it becomes a tradeoff between more exclusive video selection and cost management. All the while, free services are looming putting together more and more comparable video selections. The benefits of Netflix strategy stem from its heightened revenue when compared to competitors.Because Netflix charges members, it can spend more on rights to show videos, and its lack of advertising diminishes the threat posed by free services. With Netflix current cost structure, it can benefit greatly from spreading to the markets becoming available due to the expansion of the Internet. A key suggestion to made for improvement to Netflix’ business strategy would be to move along the productivity frontier towards differentiation and away from cost leadership. With a higher price, Netflix can provide better videos that are more exclusive.This is crucial in order to take advantage of the vulnerability of video limitation within the free video-streaming services. Netflix’ already industry-leading experience should put to use in maximizing the already unique service it provides. It is also possible that segmenting the video-streaming service could benefit the company by div ersifying its competitive position. Netflix could provide a free service, with commercials for revenue and limited video offerings. It could then simultaneously offer a low cost subscription with no commercials but limited video offerings.Its final offering could be a premium subscription with a higher price. This membership would benefit from the higher cost because it would have a greater variety of video offerings afforded by the new revenue. This option continues to differentiate Netflix’ service while still offering low cost options to the price conscious customer. It will be very important that any raise in subscription cost be met with identifiable upgrades to video selection in order to retain subscribers. Netflix Inc. is still very much in the growth stage of the ndustry life cycle. Currently the company seeks to expand operations in Latin American countries, Europe, and South America. Their international subscribers grew from 4. 3 million in the third quarter of las t year to 6. 1 million in the fourth quarter (Forbes, 2013). In fact, with all of the success overseas,  Netflix has actually started to slow their international expansion, so that they may better analyze new potential markets before officially entering. Netflix uses the advantages of its long tail business model to overcome problems like thin markets.Through online services, Netflix has risen above competitors like Blockbuster, with advantages like unlimited inventory space through digitization and its multiple process innovations (Parr, 2010). Including such advantages as being available on multiple platforms (mobile, Xbox, Apple TV, etc. ), and having the ability to quickly add or remove products from its database. The technology utilized by Netflix to stream its products to consumers on multiple platforms has expanded rapidly. The online streaming service from Netflix was introduced in 2007, and in 2010 Blockbuster filed for bankruptcy (Parr, 2010).The technology is so widespr ead and compatible a subscriber can view a program from their office computer, to their mobile phone, and then to their Blue-Ray player or tablet. The speed of diffusion in the movie/television industries was due to the advances in internet services, similar to what is occurring in the music and book industries. Netflix’ internet streaming service is currently the dominant technology on the industries S-curve today. The remainder of its DVD mail order service is in the decline stage, even though Netflix still holds on to that service.The biggest paradigm threat that  Netflix faces is the emergence of Redbox and the ability to stream movies and TV shows from other sources like HBO Go. Netflix has several trademarks and copyrights that it protects vigorously. Its advantages like online software and no late fees have given it quite the competitive advantage. Netflix has even filed a lawsuit against Blockbuster in recent years for copyright infringement of their new online serv ices (Sander, 2013). Vertical value chain: Stage 1 raw materials: Netflix receives most of its product through the production of outside film studios such as Warner Bros. Disney, Viacom media networks, DreamWorks classics, 20th television, Hasbro studios, Saban Brands, The Weinstein Company, Open Road films, Relative Media (Reuters, 2013). The contracts made with each studio provide Netflix with the physical inventory necessary to meet the demand of consumers, and the rights to digital streaming for its online services. Netflix also participates in this upstream activity through the production of their very own television series. Stage 2 Component and Intermediate Goods: Philips and Sony jointly manage the patent for optical media cd manufacturing (CD Manufacture, 2013).Although, in North America the patent is expired, so any cd production in Canada or the United States of America is not subject to license fees. However, worldwide the patent still applies, so licensing fees would ap ply on arrival to any merchandise shipped internationally where the patent is still in effect (CD Manufacturing, 2013). After acquiring DVD’s for the still remaining physical distribution side of the business, Netflix must then package the merchandise appropriately so that its logo and trademarks are clearly visible when received by consumers. Stage 3 Final Assembly:For Netflix this requires the challenge of taking its finished product and delivering it with convenience and ease to subscribers. Outbound logistics plays a major role for success in customer satisfaction. Netflix must keep executing well in the delivery of their physical products if it wishes to maintain a key provider in mail order services. Stage 4 Marketing and Sales: Netflix has several mediums it can use to reach consumers. Of these, television commercials, internet ads, newspaper/magazine ads, and even video game consoles are crucial ways Netflix reaches its consumers.Netflix also utilizes discounts as a w ay to attract new customers, mainly its one month free trial if offers to new users. Netflix is also implementing strategies where they are now starting to offer individual service so that customers may choose which service to pay for (Schneider, 2010). The new service will provide the option for consumers to choose between the DVD rental by mail or the online streaming services. Progress is still being made on a combination package for users that use both services. Stage 5 After-Sales service and support:For Netflix, service and support may be the most crucial part to maintaining its customer base. The challenge for Netflix lies in that it must provide service and support for two completely different services. For mail order customers, Netflix must provide expedient deliveries consistently and be able to handle issues such as lost deliveries and theft. Online streaming customers have their own range of service and support that is required to accommodate. For example, Netflix must h ave a wide selection readily available for its users, and it must constantly update their library with new material.Netflix must also rely on Amazon for this portion if their business since Netflix uses Amazon’s web services (AWS) for online streaming. Netflix has a unique vertically/horizontally disintegrated system. In the past Netflix has used several horizontal integrated techniques that have led to their success by acquiring multiple studio contracts and controlling industries that deal in video distribution (Schneider, 2010). It is dynamic in the sense that most of its products where manufactured, created, and marketed at some point through an outside entity.This creates a marketing advantage where several consumers already have developed favorites and genre preferences leaving Netflix with the task of compiling the merchandise needed for shipment related services and securing the rights with major film studios to stock their digital library for online subscribers on mu ltiple platforms. On the other hand, Netflix has begun to produce and provide some of its own programming, like their new hit series â€Å"House of Cards† (Funding Universe, 2013).This for many is ground breaking because it is the first television show to bypass the cable network system, and the entire first season is available for viewing instantly which is also unprecedented for a television series. It would seem that Netflix is moving to be more fully vertically integrated with the increase of success it is having from its own studios, but for the time being taper integration would apply with most of their digital products being produced from an outside source. The only acquisition that Netflix has had in the past 3 years is with a company that is named DreamBox Learning.Netflix has not been interested in growing based on acquisitions and mergers thus far in their venture. The acquisition of DreamBox Learning is thought to be a philanthropic move for Netflix due to this de al involving a partnership with the non-profit organization known as The Charter School Fund (Dreambox, 2010). Dream Box Learning is a company that makes interactive schooling software for kids of all ages. Netflix saw this as opportunity to distribute learning throughout school systems while also boosting the reputation of Netflix. The software is also in use for kids from kindergarten all the way thru the 12th grade.This investment made by Netflix gave DreamBox Learning the ability to reach more kids and wider range of students. Netflix has a couple over very strong strategic alliances; one of their top strategic alliances is with a company we all know very well, Apple. The availability of Netflix on the iPad and Iphones has helped Netflix gain more users who are looking to watch movies or download shows onto their devices. Along with these devices, Netflix is also available on the Apple TV device so that users are able to watch the movies directly through their TVs.Blackberry and RIM tried entering an alliance but were never able to finalize a deal. This would most likely hurt blackberry since the amount of recent users of Netflix is on the rise. Another strategic alliance you have probably seen with Netflix is the availability of it on your TV’s, DVD players and Blu-ray Players. These all work over hardwire or wifi network allowing you to view movies and shows via the Internet through your TV and or players. Netflix has done this to gain the people who do not want to wait on the videos to reach them through the mail.This is the latest technology which includes smart TV’s and Blu-ray players which both have apps pre installed on them so all you have to do is hook them up to an internet connection and you are able to view the movies or shows that you would like (HD TV Test, 2012). This was a great opportunity for Netflix to enter the apps game and really push them to the top. This alliance has defiantly helped Netflix get to their goal of milli ons of users by making it easier to get the movies right in your home without having to wait.As the TV prices have dropped recently and more people buying smart TVs this was a great move for Netflix to really get their name out to the people who had not previously used them. Netflix does not seem to be a company who has an alliance management origination but is just looking at technology and developing ways to enter the market all the time. They are always looking for new and improved ways to get the product into the hands of their users more effectively and efficiently. Netflix is a company that has spread its seed internationally they just recently expanded into Latin America.This was their first international release of Netflix and has proven to be a hard market to corner because of the competition that is out there (LA Times, 2012). Since then they have now emerged in countries such as Norway, Denmark, Finland, and Sweden. They have also reached out to people in Canada, Ireland, and Great Britain. These markets, which already have companies supplying them with videos on demand, have proven to be harder for Netflix than originally anticipated. Is this going to discourage Netflix from entering the market in other countries is the biggest question people are asking right now.Growth in these regions has been slower for Netflix than anticipated and they are currently looking into new ways to distribute their videos in these countries. One of the main problems that Netflix has had in Latin America is that some of the DVDs were not carrying subtitles, making it undesirable for people to rent. In order to compete with their competitors in this market Netflix now makes sure that all of the movies or shows being distributed in Latin America have subtitles. So far, in Canada, Ireland, and Great Britain Netflix has been successful and is looking to spread out across Europe.The next question you ask yourself while doing research is how is Netflix going to reach the mar ket of China or Japan or when are they going to try. According to research, the time has not been much insight as to whether Netflix will even attempt to enter these markets. Just recently, the Chinese government launched a video service much like Netflix (Reuters, 2012). Trying to compete with the Chinese government is really going to be difficult and this might be one reasons that Netflix has decided not to enter those markets.Netflix is using an International Strategy based on the fact they have to have movies in different languages or with sub titles in order to reach these markets. They are doing their best to make sure that every market they enter is going to be a successful journey. This one of the main reasons people have stated they have yet to enter both the Japanese or Chinese markets due to the control the government has over what is entering their markets. The strategy has proven to be effective for Netflix and they have succeeded in the countries they have entered.The changes they have had to make in the markets show their willingness to succeed and just how driven Netflix really is. Netflix currently has two separate services that are DVD’s by mail and the online streaming of movies and shows. As of the fourth quarter of 2012, Netflix had 27. 15 million subscribers worldwide. Revenues for the Online streaming service were $589 million and $254 million for DVD’s by mail. However, the contribution profit/loss for the online streaming service was $-105 million and $125 million for DVD’s by mail.While the online streaming service brings in more revenue for Netflix, the costs of operating it surpass those of the DVD service. The DVD service has fixed costs, while the online streaming service must negotiate licenses with each individual company on a case-by-case basis. With this knowledge, it is obvious that Netflix must make a strategic change in order for the company to have a long life. The major issue the subscribers have with the online streaming service of Netflix is that it does not offer newer releases.If Netflix were to offer newer releases then they could then charge higher prices with justification and make more of a profit on the online streaming service. Considering the major competitors such as, Redbox and Amazon already offer newer releases, Netflix would need to make this change within the next year or they could go out of business. Netflix is collaborating with major media companies such as, Paramount Pictures, Lions Gate, and MGM, so they would be able to work out a deal with them in order to enact this change.Netflix has released statements about making this change and they say they do not want to offer newer releases and follow their competition (Daily Finance, 2012). The culture and values of the company is to have their low monthly rate of $7. 99 for unlimited streaming and they do not want to drive away potential customers by increasing the prices. An alternative for increasing the ove rall price would be to have tiered pricing where they can keep the original price but also have an option for newer releases plus the originals for either $8. 99 or $9. 99.This way they could still say that their prices start at $7. 99. This change could increase profits and bring in more subscribers. The resources that Netflix would need would be to have the rights to the majority of the new releases and the media companies, which is already in place. They have deals with some of the most known media companies in the business, so this would not be a problem for them. In addition, there would not need to be any new policies or procedures in order to implement this change. There are seven members on the Board of Directors, two of which are women.There are no minorities on the board. The CEO, Reed Hastings, is also the chairman and has been since inception. The largest direct shareholders of Netflix are all of the people on the Board of Directors. However, the largest institutional ho lders include Icahn, Vanguard, and Goldman Sachs. One of the latest legal issues Netflix has had has been a privacy violation of its customers. There was a class action lawsuit against the company because they were disclosing records of what the customers were watching. This is an ethical issue for the company considering it deals with a violation of privacy.Netflix made a $9 million settlement which resulted in a 14% decrease in the net income for the fourth quarter of 2012. The CEO, Reed Hastings, is not a Level 5 manager. He does not make good strategic decisions for the company or for the customers considering he is not willing to offer newer releases, which could eventually be what saves Netflix in the end. After all that has been discussed about Netflix, I would not invest in the company because the company could potentially not survive the next five years. Works Cited Company Overview: Management. (n. d. . Netflix. Retrieved March 8, 2013. https://signup. netflix. com/MediaCe nter/Management Company Overview: Netflix Timeline. (n. d. ). Netflix. Retrieved March 8, 2013. https://signup. netflix. com/MediaCenter/Timeline Yahoo! Finance Inc, NFLX: Summary for Netflix, Inc. – Yahoo! Finance. (n. d. ). Business Finance, Stock Market, Quotes, News. Retrieved March 8, 2013. http://finance. yahoo. com/q? s=NFLX SEC Filings (Form 10-K). (n. d. ). Investor Relations: Netflix, Inc. Retrieved March 5, 2013. http://ir. netflix. com/sec. cfm Top Reasons to Work at Netflix. n. d. ). Netflix Jobs. Retrieved March 8, 2013. jobs. netflix. com/jobs. html Munarriz, R. (n. d. ). Netflix: No, We Won't Stream New Releases – DailyFinance. DailyFinance – News and Advice for a Lifetime of Financial Decisions. Retrieved April 14, 2013, from http://www. dailyfinance. com/2012/12/24/netflix-no-we-wont-stream-new-releases/ DreamBox Learning Acquired by Charter Fund in Partnership with Education Philanthropist and Netflix CEO Reed Hastings | DreamBox Learning ®. (2010, April 20). Intelligent Adaptive Learningâ„ ¢ | DreamBox Learning ®.Retrieved April 14, 2013, from  http://www. dreambox. com/press-release-20100420 Fritz, B. (2012, May 16). Netflix faces problems in Latin America – Los Angeles Times. Featured Articles From The Los Angeles Times. Retrieved April 14, 2013, from  http://articles. latimes. com/2012/may/16/entertainment/la-et-ct-netflix-latin-america20120516 Monday, R. C. , 2012, 1. J. , ; BST  , 1. p. (n. d. ). Netflix App Debuts On Samsung Smart TV Apps Store. TV Reviews – Best LED LCD, 3D Plasma ; Smart TVs. Retrieved April 14, 2013, from  http://www. hdtvtest. o. uk/news/netflix-app-samsung-smart-tv-201201161616. htm Zeidler, S. , ; Grover, R. (2012, June 28). China to launch Netflix-like movie service| Reuters. Business News – Indian Stock Market, Stock Market News, Business ; Finance, Market Statistics | Reuters India. Retrieved April 14, 2013, from http://in. reuters. com/article/2012/06/ 28/hollywood-china-jiaflix-idINL2E8HP1F420120628 â€Å"CD Manufacturing | Audio CD Manufacturing | CD Manufacturers | Music CD Manufacturing | CD Glass Mastering | Glass Mastered CDs | CD Pressing Services. CD Manufacturing | Audio CD Manufacturing | CD Manufacturers | Music CD Manufacturing | CD Glass Mastering | Glass Mastered CDs | CD Pressing Services. N. p. , n. d. Web. 16 Apr. 2013. . FundingUniverse. â€Å"History of Netflix, Inc. â€Å" FundingUniverse. † Find Funding with Banks, Investors, and Other Funding Sources | FundingUniverse. N. p. , n. d. Web. 16 Apr. 2013. . Parr, Ben. â€Å"The Fall of Blockbuster; the Rise of Netflix,

Costa Rica

Costa Rica Costa Rica By: Micah Shibley Ever since I got home from my trip to Costa Rica I haven’t been able to take my mind off the amazing things I did there. Whenever I’m at school learning stuff I already now or stuff I have no idea what it means I just image myself snorkeling or taking a hike or watching animals in the wild that I normally have to go the zoo to see. I have decided that I am going to save all the money I get or make for when I’m older so I can go back.I know your probably thinking Micah your only 13 years old and you are already saving money for something you are probably not even gonna do. I just can’t get Costa Rica off my mind and I went 2 years ago!!!!!! So I’m gonna try to write some of my ideas for the future down. High school class ideas: * Spanish * Art * Theater * Language Arts * Math * Choir * Social Studies * English * ScienceThis is the trickiest thing I think because I can’t go to college in Costa Rica well I can only I don’t want to and I promised my best friend Tayah that we would share an apartment through are college years only what if I meet an amazing guy or get an awesome job So now I’m going to write some places I might go to college†¦ * Portland State University * Oregon State University * University of Portland * Lewis and Clark College * University of Oregon * University of Virginia * University of Idaho * Harvard University * University of New YorkOkay I also was thinking about once I go to Costa Rica how am I gonna make money to stay there? I have a couple good ideas but I don’t know†¦ * Yoga Instructor * Tour Guide * Waitress * Art Teacher * Therapist * Kid Doctor * Life Guard * Professional Soccer Player * Owner of a Gift Shop Now I’m going to write everything that I remember even the littlest details from that trip. Ok here it goes†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ When we first touched down in Costa Rica (sorry can’t remember the c ity name) I will never forget the humidity and warmth!!!!

Business Ethics Case Study Example | Topics and Well Written Essays - 750 words - 3

Business Ethics - Case Study Example The principle seeking the greatest good for greatest number matches with the alternative to hire and interpreter and provide English language classes for the Angolans in that it would allow the majority Angolans to gain communication abilities with the Expats and government officials and chefs. The principle enhancing the welfare of society overall matches with this alternative since it would enhance overall communication in â€Å"Explorer 4† ring by establishing a common language of communication. The principle seeking the greatest good for greatest number matches with the alternative of developing and adopting a detailed antidiscrimination policy since the policy will benefit the majority Angolans that are suffering from discrimination. The principle enhancing the welfare of the overall society matches with this alternative because the policy will promote equality in â€Å"Explorer 4† ring. The principle seeking the greatest good for greatest number matches with the a lternative to understand and comply with the antidiscrimination and all labor laws applicable in Angola because it would allow the majority Angolans to enjoy better working conditions. The principle enhancing the welfare of the overall society also matches with this alternative because it ensures all workers at â€Å"Explorer 4† ring enjoy the benefits and conditions offered by the antidiscrimination and all labor laws applicable in Angola. The Utilitarian Approach is the most relevant to the dilemma and matches with each alternative. Ideally, the Utilitarian Approach focuses on the consequences that actions or policies have on the well-being ("utility") of all persons directly or indirectly affected by the action or policy (Velasquez et al.1). The approach notes that the benefits in the most ethical action or policy supersede the harms (Velasquez et al.1). Notably, the Utilitarian Approach matches with the alternative to hire an

Theories of Development Essay Example | Topics and Well Written Essays - 500 words

Theories of Development - Essay Example Jacques Derrida can be considered as the most influential person in relation to poststructuralist theory. The poststructuralist theory revolves around the concept of decentralization of language (Crain, 2005). According to poststructuralist theory, language has no center. It is without any center. Saussure looked at language as a structure but Derrida emphasized that all structures are required to have centers while language has no center. Derrida claims that there is no present moment (Crain, 2005). As soon as we talk about a present moment or think about it, it is already past. Poststructuralist can be related to deconstruction that considers that there is no fixed meaning (Escobar, 1995). Language is considered in the same frame. There is no central meaning for any word in language (Crain, 2005). According to Derrida, language is a free play of meaning (Crain, 2005). Poststructuralist theory challenges the existence of each and every thing in the world whether living or nonliving (Escobar, 1995). After analyzing the points discussed in poststructuralist theory, the theory seems most compelling as all the aspects raised in the theory are persuasive and influential. Not only one critic but many critics and theorists are involved in the evaluation of poststructuralist theory. Postcolonial and postmodern theories are also persuasive but as compared to poststructuralist theory, they appear somehow weak. Post-colonial theorists are unable to regard themselves as fully post-colonial (Escobar, 1995). According to them, they are still under the control of colonial powers. Postcolonial theorists regard nationality, language and regionalism as most important aspects that an individual should have (Crain, 2005). Like poststructuralist theory, postmodern theory is also a response to modern theory. This also deals with a set of perspectives related to society,

The Presence of Racism is Shakespeare's Othello Essay

The Presence of Racism is Shakespeare's Othello - Essay Example Therefore, after the Reformation, it represented an antagonistic political and religious force against Protestantism in England. At that time, Italy was the site of classical Roman history and civilization which paved the way for the "Renaissance" of European culture from the fifteenth to the seventeenth century. (Nostbakken, 2000) Differences matter. Othello was not a Venetian by birth and therefore his status is ambivalent: he both belongs and does not belong to the city of Venice. He belongs because he is Venice's military general whose main role was to defend the city from possible invaders, and he is a Christian who shared a common religion with his fellow Venetian citizens. However, he is also a real stranger from a strange country, a foreigner and an outsider. The play manifests the inherent tension which exists between the differences that set him apart and the qualities that allow him to play a respected and vital role in the city's day-to-day life. Cassio, another key character of this play, is an outsider but he is less of a stranger compared to Othello for he is a European gentleman. Cassio comes from the beautiful Italian city of Florence. Othello, in contrast comes from the unknown and misunderstood world of Africa. (Nostbakken, 2000) The courtesans of Venice were prostitutes serving an upper-c... In this play, Shakespeare presents the strong positive and negative impact of identity by exploiting many degrees of difference between various characters of the play as distinguished by their rank and status, and by their places of origin, adoption, or conquest. Shakespeare wrote this play for English audiences in the early seventeenth century and this play reflected and responded to problems, situations, and problems of the period. Hence, the play showed identities defined by differences as well as similarities. In a sense, the responses of English audiences were also influenced by their own sense of identity as a nation.Iago's character speaks for the corruption and intrigue in Venice. In the first scene, he implies the practice of political prejudice, as opposed to impartiality, by explaining that friendship gained Cassio the title of lieutenancy while Iago's attempts had failed. Iago acts as a model of self-interest rather than duty. Iago's advice to Roderigo to "put money in th y purse" exemplified the naked greed that foreigners identified with Venice's highly prosperous merchant economy. Iago is inherently revengeful, scheming, and manipulative. His dominance in the play mirrors the dark side of humanity and also the dark side of Venice. Iago is a true native of Venice and he belongs there in a way that Othello, the outsider, does not. (Nostbakken, 2000) Venetian women were perceived to be very deceptive. Desdemona was shown as a "super-subtle Venetian" and suspects practically every man and woman as being unfaithful, adulterous, or promiscuous. However, Desdemona does not fit the Venetian stereotype of infidelity and deception. She was a faithful woman.

BUSINESS FINANCE Assessment 1 Research Paper Example | Topics and Well Written Essays - 4250 words

BUSINESS FINANCE Assessment 1 - Research Paper Example Q3) Face Value = $1000 N= 30 years Coupon rate = 8% (a) YTM if Price is $900. Since Price YTM > coupon rate. Price at 9%: 80 x PVIFA (9%, 25yr) + 80/ (1.09) ^26 + 80/ (1.09) ^27 + 80/ (1.09) ^28 + 80 / (1.09) ^29 + 1080/ (1.09)30 = $ 897.3 Price at 7%: 80 x PVIFA (7%, 25yr) + 80/ (1.07) ^26 + 80/ (1.07) ^27 + 80/ (1.07) ^28 + 80/ (1.07) ^29 + 1080/ (1.07)30 = $ 1123.8 Price at 8%: $1000 By interpolation, YTM = 8% + (1000-900)/ (1000-897.3) YTM = 8.97% (b) YTM if Price is $1000. Since Price = Face value YTM = Coupon Rate Hence YTM = 8%. (c) YTM if Price is $1,100 Since Price > Face Value YTM Price at 7% = $1123.8 Price at 9% = $897.3 By interpolation, YTM = 7% + (1123.8-1100)/ (1123.8-897.3) YTM = 7.11% (d) The relationship between yield to maturity and bond price is that the yield to maturity is that discount rate that makes the present value of the bond's coupon payments equal to its price. Q4) a) Eps = $6, r = 15%, ROE = 15%, G =, Price = (i) Plowback ratio = 0 % g = ROE x Plowback ratio = 0.15 x 0 g = 0% Po = Div/ r -g Since nothing is plowed back in the firm, all the earnings are given out as dividends, therefore Div = 6 Po = 6/ 0.15-0 Po = $ 40 (ii) Plowback ratio = 40% g = ROE x Plowback ratio = 0.15 x 0.4 g = 0.06 or 6% Po = Div/ r -g Since 40% is plowed back, 60% is given out as dividends, therefore Div = 6 x 0.6 = 3.6 Po = 3.6/0.15-0.06 Po = $ 40 (iii) Plowback ratio = 60% g = ROE x Plow back ratio = 0.15 x 0.6 g = 0.09 or 9% Po= Div/r-g Since 60 % is plowed back, 40% is given out as dividends, therefore Div = 6 x 0.4 = 2.4 Po = 2.4/ 0.15 - 0.09 Po = $ 40 b) Eps =$6, r =15%, ROE = 20%, g =, P = i) Plowback ratio 0% g = ROE x Plowback ratio = 0.2 x 0 g = 0% Po =... Since project E has the highest profitability index, it should be chosen first and then project C. Since the investment budget is of $ 8 million, investing in these two projects would also equal to $ 8 million. Since X Ltd has a higher standard deviation, it means there is more risk and a greater variation of returns and thus a high chance that the expected return will not originate. Co-efficient of variance is another measure of determining riskiness of a business and since X Ltd also has a higher co-efficient of variance, it signifies that it's a more risky business. Thus 100% investment in Y Ltd is a better investment. Other than that, if recession hits the economy, X Ltd will completely go out of business. This is one more reason for not opting for investment in X Ltd. d) Value investors are those who use dividends to value their investments. Regular income is wanted by them and they look for quality companies with earnings records and projects they believe the market has under-valued. They tend to hold the under valued stocks for a longer duration and eventually take advantage of the rise in share price that the earnings growth brings in the long run. Growth investors are those who use stock prices to value their investments.

Security system at the United States airports Research Paper

Security system at the United States airports - Research Paper Example The FAA was mandated with the responsibility of setting the least security requirements needed to govern the airport as well as the air carriers. In addition to this, the FAA has the power to ensure the standards set are met through issuing of fine, undertaking inspections, and revoking operating certificates. The responsibilities undertaken by the air carriers were preventing unauthorized entry to the plane, screening of baggage, passengers and cargo and training of the crewmembers on emergency tactics and procedures. The airports on their part had the responsibility of ensuring ample security is provided within the airport premises by stationing of law enforcement officers. The congress is also mandated with the responsibility of legislating aviation security law and undertakes partial implementation of the same laws (Johnstone & National Commission on Terrorist Attacks upon the United States, 2006, p. 24). In the past, the security policies in United States and the world at large have mainly been established after a public’s reactions to different incidents of insecurity. A good example is the use of air marshals in the 1960s by airlines due to the numerous hijacking that were taking place at that time. It was soon after, that the U.S. government established laws to tackle the air piracy. Transportation security One of the main aspects that surround the national security of United States is the transportation process from and to the United States. In addition to this transportation within the borders of the nation is also part and parcel of the national security aspects. The September 11, attacks not only indicated the weaknesses of United states air port security systems but also the role that the air transport plays in the national security of America. Privatization of airport security is said to have raised a debate in the public domain. The approach used by United States in tackling the issue of airport security is much more different as compared to its European allies. In the European nations, the security inspection is normally undertaken by private contractors, while in America government control on airport operations has become visible especially after the terrorist attacks of September 11. The mare fact that terrorists had access to the airport facilities and airlines and thus using the airlines as their weapons of mass destruction only goes on to indicate the drastic measures needed to tackle the weaknesses of our airport security systems. According to Verkuil, this airport security system has incorporated private employees who are working on the behalf of the airlines and over seen by the Federal Aviation Administration. Previously, the airlines perceived and regarded the security function as one of the item of cost control and passed on its quality measures downwards. This is one of the reasons that makes the security systems fail in their critical purposes (Verkuil, 2007, p. 57 & 58). The largest aviation system of security was implemented in 2001 in response to the terrorist attacks of September 11, 2001. These terrorist attacks were not only a wakeup call to the American government but also to the world as well. The public debate still lingers on whether the government could have taken extra steps to prevent the terrorist att