Business in my words

My Lovely Daughters and Son (EPISODE 1-Ainnur Mardhiah)

noreply@blogger.com (Noor Azlin) — Mon, 15 Apr 2013 22:36:00 +0000

Salam, today I want to share my second daughter's picture. Huhu, got a lot of job to do nowadays. Today got the opportunity to gather her pictures. As for Farahiyya (the eldest one), I will need to make another post because her picture from baby is not in this hardisk (my computer). All this shots are taken with Samsung Camera. :)

Ainnur Mardhiah :)

We can live without BF, but can we live without FB ?

noreply@blogger.com (Noor Azlin) — Fri, 15 Mar 2013 13:48:00 +0000

Is it the same life without BF and FB?

Salam,
Just went back from pasar malam at Putra Perdana. Today I mark my Independence from Pantang (confinement period) . Well, already pantang rock2 starting the second week, but today I ate two bowl of Bakso! So yummy!

My last post, about my Facebook Profile being suspended has bring me to write this post. For the last two days, I felt like loosing some entangled wires around me. The feeling of sad slowly moved on to the feeling of being Independence. Yes, I did make another profile (so that I can update my pages), but I started to feel that I do not depend on it.

Feeling of Independence

Clients started to use email more effectively. I also feel that I don not need to re-check my FB every hour. I know that when my old profile is gone, they will go to my website, or my pages. Email will be use more frequently, and more efficiently. No more short PM me. Serious buyer will email me.

Sometime what happen has it reason :)

So, can you live without your FB?

Your account has been disabled (suspended as expected)

noreply@blogger.com (Noor Azlin) — Tue, 12 Mar 2013 06:08:00 +0000

Well, you will get this when you visit my Fb profile.

Salam,

This morning after Subuh, my customer message me about her profile being suspended.
Then I got another message, HER PAGE also got suspended. Not that I was not suprised, but this thing already happen yesterday, and luckily at that time I was still one of the admin of her page, so she can create another profile and I put her back in.

HOWEVER.
To my surprise

Great, just great

Yeah,my account got suspended too. Not One, two of my profile, one which is used only for page administration (I don't tag people etc with this one) also suspended. Why is this happen? Because I helped a person to get on her page back? Why? Why? I dont tag pictures, I don't promote overly (I think).

Now that I lost the two profiles, I lost access to some of my pages (totally gone !). Lost my admin rights in my customer pages (Now I cant help them if they are suspended too). I checked all my customer pages, luckily all are there except two. (one I was the only admin-not yet handed to the owner, another one, the owner is suspended too!!) What a lost! The customer who message me this morning got nearly 40k likes! Years of works into the drain...

Well , I have expected this to happen. Just dont know when. Facebook are changing. Its like the earth with thousands of populations (virtually). The Facebook Government is doing something. And we dont know (hoho...). Naaa... I dont think so. Its a free service ! What do you expect from a free service? That is why, as business owners...please please please... dont just relies on free service. Allocate some money, invest for own hosted blogs or websites.

I have this blogspot blog for networking, but I never expected it will last. It will be totally depend on google's policy. That's why I have wordpress blogs and websites too. I have once lost this blog, but blogger are kind enough to restore them (as I have good reasons).However... does Facebook give back suspended account? The chance is so thin...it is stated in their policies.

So My dear business friends, Do not depends on Facebook too much. Plan now. You'll never know its your turn. Although you never use your profile for business, you might end up loosing your business page too without reasons. If you're having business only on Facebook, have it on blog too. If you're using blogspot, always backup your post (on word file etc) AND BUY A DOMAIN. This way, if you lost you blogspot blog, you can still use the domain and buy a hosting.

Always , Always know that free is not always free :)

Being a WAHM is tiring, but WORTH living

noreply@blogger.com (Noor Azlin) — Fri, 01 Mar 2013 18:51:00 +0000

Asslamualaikum., Today was a very tiring day. I went to hospital Serdang for Fuad Najmi's Appointmnet and we are stuck there from morning till noon. Last night I slept at 5am in the morning, and adding today's schedule, I'm flat.

Tonight, I mean this morning, I need to finished my design for FB Site (Website dalam Facebook). Go to stay up again. I really need to fix my schedule! After giving birth to Fuad Najmi on February 2, 2013 (that was only 28 days ago), my working time get upside down. I started working back 8 days after giving birth, but my baby is not just ready as I am, so I waited for two weeks.

Week2, I started working back. Designing order forms, Fb Site, Blogs...Aside from the heavy (mind) design work, Fuad got breastfeeding jaundice, and going back and forth to the Government clinic and hospital consume my time and energy. Alhamdulillah, got a pleasent news from the doctor after last review on Fuad's urine, he is getting better and will need no hospital admission.

Some may say, what?working in your confinement time? have a rest! Yes, I know. But my responsibility is far beyond that. Design work is my bread and butter. No design, no bread and butter (haha). Yes, as my husband and I worked together for Zailin Business Solutions (ZBS), If we take a long vacation, then it will be more work pending in the list. My concern is also on my beloved customer. Thank you all !

Design for ZARRA

Just got design job from Zamzarina Zambri (TV personality, Founder of ZARRA). Alhamdulillah. She is a very nice women. Very business minded. She also have visions for work from home moms (like her portal e-Suri) and I just love how she handle AKPK (Apa Kata Wanita) at RTM.

Speaking of ZARRA, its a new skincare range from Zamzarina Zambri. Checkout their page at : ZARRA and dont forget to grab the chance to be their exclusive member and get privilege card and much more!
For WAHM, take the chance to be ZARRA's Business partner !

Okey dearies, Need to focus my energy to my design work now...

Being a WAHM is tiring, but WORTH living :)

Bertukang di rumah sendiri

noreply@blogger.com (Noor Azlin) — Thu, 24 Jan 2013 16:22:00 +0000

Salam,

Harini saya bertukang blog sendiri. Biasalah, bak kata orang, macam tukang rumah, rumah orang ditukangnya, rumah sendiri huhu, tak siap-siap.Tak ingat nak print screen sbelum dan selepas pembikinan haha...

Tahun 2013 dah nak masuk bulan kedua...Baby pun dah nak nunggu masa je nak keluar. Office kat rumah ni asik berubah-ubah kedudukannya. Tapi rasanya lepasni final dah, tak larat den nak ubah lagi. Ofis kat rumah ni ada bagus ada baiknya. Bagus, boleh tengok anak-anak depan mata. Tak bagusnya, anak juga boleh sepahkan barang-barang kerja depan mata haha...

Kerusi tu ada dua, satu untuk sesi perbincangan dengan Encik Zainal. Lepasni kena buat satu ofis asing untuk Encik Zainal. Waktu kerja pun tak boleh sama. Bila laki bini kerja dalam satu rumah, inilah jadinya, masa kena shift lepasni. Mana taknya, kalau dua2 ngadap komputer, alamatnya nanti ada anak yang menyelit kat celah2 kerusi... hehe especially si Ainnur Mardhiah.

Okeylah, nak kena off dulu computer ni, lepasni nak kena sambung kerja lak tgh malam nanti.

Fuh, berjaya up satu post huhu...

Bagaimana untuk mendaftar dgn SKMM bagi mendapatkan grant GMBO RM1000

noreply@blogger.com (Noor Azlin) — Thu, 03 Jan 2013 02:27:00 +0000

Bagaimana untuk mendaftar dgn SKMM bagi mendapatkan grant GMBO RM1000 Bagaimana untuk mendaftar dgn SKMM bagi mendapatkan grant RM1000

1) Mula2 pergi ke laman web SKMM di:
http://www.skmm.gov.my
Laman ini boleh diakses mengunakan mana2 browser tetapi terbaik anda gunakan FIREFOX. Chorme boleh akses tetapi bila proses borang kadang2 ada masalah.

2) klik Link yang ada di muka depan atau pergi ke
http://nbi.skmm.gov.my

3) Pilih GET MALAYSIAN BUSINESS ONLINE (Paling kanan) atau ke link

http://gmbo.skmm.gov.my

3) Pilih BORANG PERMOHONANAN DALAM TALIAN

Jika ingin baca lanjut syarat boleh klik yang tengah-Syarat2 kelayakan

4) Isi Maklumat yang diperlukan (langkah 1 hingga 5).

Oleh kerana anda kena isi step by step borang ini tanpa henti, pastikan anda telah siap sedia dengan dokumen berikut utk rujukan anda
-Nama, alamat dan No SSM Syarikat anda
-Pendapatan kasar syarikat anda pada tahun2 lepas (anggaran setahun berapa)
-Jenis perkhidmatan internet yang anda guna utk perniagaan anda (jenis, no akaun dan nama internet provider, contohnya wimax, Unifi celcome etc).
- No akaun bank syarikat atau persendirian
Berikut preview soalan2 yang diberi:

Paling akhir, tekan hantar dan tunggu borang anda diproses. Sila pastikan anda tidak menukar laman, refresh atau tekan tab ke laman lain, ia akan ganggu proses penghantaran.

========================================================
FAQ dan UPDATES

UPDATES 1: 5 January 2012 -

Kepada yang telah isi borang tetapi tak dapat get trough (hang/ status hantar berpanjangan etc) boleh email ke gmbo@cmc.gov.my dgn isi kandungan berikut. (edit dgn ayat sendiri atau copy pun boleh..sila2)

Tajuk email (contoh):

PERKARA: Ingin tahu status permohonan

Isi kandungan email:

Saya (NAMA PENUH ANDA) dengan No kad pengenalan (NO KAD PENGENALAN ANDA)

Saya telah isi borang di GMBO dan borang tersbut terus "hang" beberapa kali bila tekan hantar (ia kekal pada status permohonanan anda sedang diproses).

Saya telah cuba gunakan SEMAK STATUS PERMOHANAN, tetapi tidak berlaku apa apa.

Boleh saya tahu jika permohonana saya telah direkodkan dalam sistem? Terima kasih sekali lagi,

NAM PENUH ANDA
k/p: NO KAD PENGENALAN ANDA

tel: NO HSET ANDA
Syarikat NAMA SYARAIKAT DAN NO SSM ANDA
ALAMAT:
ALAMAT NIAGA ANDA

UPDATES 2: 5 January 2012 -

Ada dua cara utk dptkan website dgn domain .my.
1) Dengan berdaftar dptkan website percuma dihttp://www.getmybusinessonline.com.my/getstarted

- tetapi anda perlu membeli domain dgn harga Rm 23 (tahun pertama) dan juga beli Adwords Rm 50. Website percuma ini mmg basic fungsi dan Designnya amat terhad.

Saya ada cara kedua
2) Saya ada sediakn design website budget dgn domain .my pada harga RM 300.(custom design header, background, ada fungsi blog) Jika sesiapa berminat boleh hubungi saya.

--------------------------------------------------------------------------------------------------

FAQ:

1) Soalan: grant ni memang confirm semua boleh dapt ke kalau apply ? khas utk buat website ke fund ni?
Dalam Syarat dia stated duit tu boleh guna utk apa2 tujuan niaga online, tak semestinya utk pembangunan website.(nak guna bayar bil internet, modal niaga atau apa shj)

Cuma salahsatu syarat dlm borang tu kita mestilah mempunyai laman web dgn domain.my atau .com.my atau .net,my yang aktif utk mengisi application tersebut. Jika kita ada domain shj, tetapi tiada website, tak boleh. Ada Kuota utk org yang memohon , dan mestilah memenuhi syarat2 yang dinyatakan juga di https://gmbo.skmm.gov.my/plain/faqs.html

2) Dia akan bank in terus ke akaun kita ke ? kena bagi laporan kewangan, kurusu , bil ke apa kalau dah dapat tu supaya genap Rm1000 ?
Ya, duit akan dibank in terus ke akaun bank yang diisi pada borang.
Dlm T AND C Soalan No 13 di https://gmbo.skmm.gov.my/plain/faqs.html.
S: Adakah penerima geran perlu melaporkan penggunaan wang RM 1,000 yang diterima kepada SKMM ?
J: Penerima geran tidak perlu menghantar laporan. Pihak SKMM akan membuat pemantauan dan tinjauan berterusan mengenai keberkesanan program

3) Dah daftar jam 12 tadi...camne nak semak ye?..tipon pun..busy pulak...
Boleh semak dengan email kepada gmbo@cmc.gov.my dgn

tajuk PERKARA: Ingin tahu status permohonan.

Pastikan anda sertakan nama penuh,no tepon, no kad peneganalan, no ssm dan alamat syarikat anda dalam email anda.

4) Nama pada akaun jalur lebar ada masalah ker atas nama orang lain?
Rasanya takde masalah Sbb tu hanya nak tahu kita ni boleh online selalau ke tak ? Tak semua org bil atas nama seniri. Lebih2 lagi yang WAHM (work from home mom)

5) kene ada web .my ke? .com tak boleh? Boleh convert tak .com sekarang jadi .my?Ada dua cara utk dptkan website dgn domain .my.
1) Dengan berdaftar dptkan website percuma dihttp://www.getmybusinessonline.com.my/getstarted

- tetapi anda perlu membeli domain dgn harga Rm 23 (tahun pertama) dan juga beli Adwords Rm 50. Website percuma ini mmg basic fungsi dan Designnya amat terhad.

*Saya ada menyediakan khidmat design utk website GMBO, sila HUBUNGI SAYA

Domain .com tidak dapat tukar kepada dot my.

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Please sleep

noreply@blogger.com (Noor Azlin) — Thu, 06 Sep 2012 18:18:00 +0000

This is what happen when i overwork my brain.the engine do not stop!
Pity my baby in womb...
The bigger babies sleepong soundly.

Goodnite ;)

Thats it girl!!!

noreply@blogger.com (Noor Azlin) — Thu, 06 Sep 2012 01:12:00 +0000

Today I made a complaint to SKMM against this girl who keep stalking my facebook accounts (me, my husband, my siblings), and also my facebook pages and twitter account.

This girl, has a rivalry with my sister about a guy, please!!!! I am not interested in your teenage stuff. For a long time keeping silence, now I have screen capture your threat, your actions and your writing (you have deleted it- but I have printed it. )

Dont stalk people , like as what you say on your blog that you don't like to be stalked.

Dont worry, my next step calling your college.
Last, a police report.

I dont care about your personal problems with my sister or what so ever,but blackmailing, stalking us, the family which have no problem with you, is not a good thing.

P/s: If your are HER, please stop what you do now and focus on your study lah.

Cyber Bullying In Business Space

noreply@blogger.com (Noor Azlin) — Tue, 07 Feb 2012 02:23:00 +0000

Tony Auth, The Philadelphia Inquirer Edited by Bizznurse

Salam and hi.

Today let's talk about bullies. Not those who grab our candies when we were tiny tots. These are about those big enough people who still bully others for their own profits.

Cyber bullying, how is that. I could give you and example. Mr A sells gadgets, and so do Mr B. Then Mr A realize that more customers go to Mr B instead of buying from him. So what he do? He post status in Facebook, Twitter, wrote in his blog, that Mr B is selling fake items. Worst than that, he make new Facebook account, and slanders Mr B as if Mr B has cheat him (as a customer).

This type of bully is not new in business cyberspace. Some people will say its normal, and just keep one eyes closed about it. What happen next, these bullies become more and more aggressive, making cyberspace a vulnerable world to new entrepreneurs who tried to break the market.

We have to know our rights. These bullies should be teach a lesson. if you have this kind of situation, report it to your state or country authorities. In Malaysia, we have Suruhanjaya Komunikasi dan Multimedia (SKMM). Please act by reporting your problem to them. They can trace who ever that person is. However, don't forget to print screen the things you have been slandered or bullied. How to do it? If you are using Windows, have a look at your keyboard, Look for the Prt Scr or Print Screen button on top right . Press it once while you have the screen you want to catch is on. open a Word document, and click paste (right click your mouse and select paste or just find the paste icon on the menu bar).

Start acting now. Stop cyber bullying in business space!

Do not just trust your computer, have an online backups!

noreply@blogger.com (Noor Azlin) — Wed, 01 Feb 2012 09:03:00 +0000

What? I say don't just trust your computer. Yes that was what I say. Why? Because you never know how long you can rely on them.Especially when you keep loading them everyday with pictures , videos and don't forget, those important documents you click the tab SAVE everyday.

When you hit the SAVE button, you rely on you computer to store them on your hard disk. Inside your CPU, the hard disk already saying, Okay, I keep them for you but don't blame me if anything happens .Yes, if you think that your files will be safe only by saving it on your hard disk, you're about to face disaster. I have experience repairing computer where data loss is non-avoidable.Another point you need to to also know, if your hard disk crash, you will loose everything, although you put in another compartment than the C drive (well some people believe that having data saved on different partitions in hard disc will secure their data).

So whats the solutions? I would definitely said online backup. Saving your data in external hard disk, floppy disc, or DVDs, is not a solution that you should pick. Why? because none of them offer you reliability and security. Imagine, you have important documents, photos and other things backup on your external hard disc. One day, a virus infected the whole hard disc, and all your files are gone! If not because of virus, maybe one day you have a drink and it accidentally spill on your external hard disc. Or you might also lost your external hard disc in floods... and the list goes on. Why, it is because the data is saved on an object that is also exposed to vulnerabilities.

That will be the reason you should look at the important of having an online backup. Storing your data online,is much more affordable and safer nowadays. There are lots of companies offering online backups nowadays. You can pick one and try (some of them have trial version). Maybe for some people they think that online backup is only a solutions for big business owners, well they are wrong.

I have been dealing with bloggers, sellers and web masters. The problem of data loss happens to everybody. You just cannot rely on your computers anymore. Either you are utilizing e-commerce website, hosting your blog with WordPress, or even relying on on Google for your blogspot sites, you still need to consider an online backup plan. Especially when you are not using your own hosting, like having your blog on Blogger.Please, backup your post guys! How to do it? Export your post using the export function in the SETTING> BASIC tab. After you have download it, save it somewhere safe.Does your computer safe enough to secure your backup?

Okay so where can we find the online backup companies? I bet some of you have Google the word online backup right now to find the best affordable online backups . There are sites that offers you reviews on these online backups providers. Some are rather to specific (with words you cannot understand) and some would be too simple. The best review I have found would be thetop10bestonlinebackup.com

This site offer you reviews on the top 10 online backup provider. The reviews are placed in tables and you can clearly make a comparison on each provider. If you need an in-depth review of each online backup provider, you can click on each of their logo. Then you will be arrive at the review page. The review of each company is not been made on theories, but real people, who have already utilizing the online backup service from each provider.Yes, this site really sign up all those they have listed. They also make reviews based on other user's experience. You can send them queries and contact them anytime, they are always listening what you would say.

You can spent your time making your own comparison between all the online backup provider you can find, but it is not that accurate. You cannot just sign in and off any accounts to test drive each of them right (that will take time, efforts, and of course money). You cannot just ask anybody " who have experience with is online backup company" without having various feedback, which could be affected by personal view and experience.

The site thetop10bestonlinebackup.com is the most affordable and accurate reviews you should be heading right now. All the review on online backup provider is made by real people, tested and updated each of them. You can make comparison based on ease-of-use, price, storage space, money back guarantee, speed and reliability. You can read all the real people reviews and ranks on each online backup provider. You save time and that is important as your data would be in great danger right now. Yes, I said right now. Tick Tok Tick Tok. Better be heading there now!

What you give you get back

noreply@blogger.com (Noor Azlin) — Sun, 08 Jan 2012 19:56:00 +0000

Alhamdulillah. Praise to Allah.
I am very happy :) I just teach someone how to make design out of powerpoint...
and Allah show me (in another way) how I can make animated banner...
Can't wait to make banners like this!!!
Okay this banner is for Aby :) I use slider (javascipt) for him.
Now I can make animated banners!!!
Alhamdulillah....

What Inspires you?

noreply@blogger.com (Noor Azlin) — Thu, 05 Jan 2012 20:10:00 +0000

What inspires you?

Assalamualaikum. The clock is showing 3.30 am. I was alone writing this entry, while my beloved husband and kids is still sleeping soundly (guess what, one is snoring hehe- well at least I don't feel lonely.).

When I start my designer profession, I was actually, not planning to go this deep (Never thought a nurse graduate would jump into designing).I was far from what I learn, since secondary school until in my university years. Sciences subject, biology, chemistry... nursing theories...non are related to what I am doing right now.Guess what? I am thankful to Allah to show me the way to be what I am now.

Talking about Inspiration.

It is the core thing for motivation.

inspiration makes you smile...makes you believe that nothing is impossible.

Like me, when I found it is impossible for me to cover all the htmls, css, coding etc (huh...those web jargon), I will stop for a while. Get some rest, and find my inspiration source.

Inspiration- get inspired.

Children, family- When I look my babies faces, I will think of a bright, comfortable future for them. I will imagine sending them to school, buy them new clothes, and of course buy them toys that I could not get when I was a child. When I look at my husband face (when he is sleeping of course, if he is awake, he will give that fishy look), I would imagine buying him new clothes and shoes. We have face our hard times since we are married-financially speaking. I will also imagine helping him set up his business dream-he want to be a gardener---mouth gasping? -- A gardener on his own land :).

Friends- I was blessed with lots of great friends. I have best friends, best schoolmates, best bridesmaids... huhu...lot of great friends, with great great great heart. Starting the list would be my Lely Mariati, which is my Kareena kapoor in RA. One (becoming my top movie now). How do she inspires me? Her patience! She is a cool person, got great job, blessed with a handsome, cool hubby, and cute daughter. I know her since I am in form 4 (MRSM KT), until now. I am so close to her, so close that I can call her parent ayah and ma :)

Successful WAHMs- I see a lot of successful women out there. Most of them started from scratch, while nursing their babies, while holding their babies in their laps... My list would start with Mawaddah Sabarudin. She's a mother, wife, entrepreneur... good friend, awesome seller..(okay to much credit and Mawaddah will also give me a fishy look).She is the one who inspires me to start my designing career. She is my source for answers when i'm in doubet about my designs... hehe...Mawaddah you really inspired me dear :)

Me- Hehe, how can people get inspired by themselves?

I am inspired of "me" because

- I love drawing and sketching since I was a child- A good start

- I love computers and designs since I know how to use them (it was quite late actually).

-I love my ambition to pursue my studies in Health information system-

- I have face a lot of phases in life, which could hold me drowning, yet, I am still here, smiling and ticktacking the keyboard :)

On all the list I have said, there is one thing would be on top of all, which I couldn't rank, the blessings and guidance from Allah :)

Inspiring, how a little girl, love drawing, pursue studies in health science, jump into IT-and one day pursue my ambition to be a Health Informatics specialist :) What happens to my life, the ups and downs, the lost and found, the love and hate, the birth and lost... all has been a good thing, with His Guidance.Alhamdulillah :) Thank you Allah

Like to share one lyric

Munsyid : Maher Zain
http://liriknasyid.com
(Credit: http://www.liriknasyid.com/index.php/lirik/detail/4235/maher-zain-insya-allah.html )

Everytime you feel like you cannot go on
You feel so lost
That your so alone
All you is see is night
And darkness all around
You feel so helpless
You can`t see which way to go
Don`t despair and never loose hope
Cause Allah is always by your side
Insya Allah3x
Insya Allah you`ll find your way
Everytime you can make one more mistake
You feel you can`t repent
And that its way too late
Your`re so confused,wrong decisions you have made
Haunt your mind and your heart is full of shame
Don`t despair and never loose hope
Cause Allah is always by your side
Insya Allah3x
Insya Allah you`ll find your way
Insya Allah3x
Insya Allah you`ll find your way
Turn to Allah
He`s never far away
Put your trust in Him
Raise your hands and pray
OOO Ya Allah
Guide my steps don`t let me go astray
You`re the only one that showed me the way,
Showed me the way 2x
Insya Allah3x
Insya Allah we`ll find the way

------------------------------------

Ending this post with Maher Zain -Insya Allah :)--Get inspired ...

My New Facebook Welcome Page

noreply@blogger.com (Noor Azlin) — Sat, 26 Nov 2011 19:34:00 +0000

Bizznurse Social Media

Salam Maal Hjrah to all Muslim. I would like to update all of you my new welcome page for facebook. Well, it was a good practice as I am also having on going designs these few weeks.

I experimented on the use of left sidebar and maximizing columns for input.

Image Slider is based on javascript, resized to fit right column.

All the page found on this blog also are also available at the page, so that people do not need to be in two places if they don't want to.

Future updates:
Hem I really want to work on the icons ;)

See u again :) Wassalam...

Live your life. Other's will live theirs.

noreply@blogger.com (Noor Azlin) — Mon, 10 Oct 2011 04:25:00 +0000

Salam. Well, i don't really know much about Steve jobs. I just know that he was the founder of the fruit that has been known worldwide, The APPLE. Just a few weeks before I read about him handing over his place and cause rumors and riddles of the company he has his face familiarized with.

I take this quote from FACEBOOK, I don't really know who really created it. It was shared globally. As the words that was shared means a lot to anybody.

I have once living in the result's of other's thinking's, and it was painful. A painful dogma.

To have your inner voice stand up. You have to stand up and yourself, grab a microphone and speak your heart out (literally). Get ready to face bullets of disagreements, biased thoughts, and of course, personal quoted comments and opinions. Listen, collect and put them in trash bag. Throw them in incinerator far far away from your house, or better, far far away from your planet.Yes, you can listen, but never keep them in your heart. Just burn it.

Everything else is secondary. Yes. Start living your life, anything else will be on the runner up box.

-Noor Azlin Mohamad-

iBilik.com Launching Taxi Ads Campaign

noreply@blogger.com (Noor Azlin) — Tue, 06 Sep 2011 14:35:00 +0000

Salam,

Hello everyone! Selamat Hari Raya Aidilfitri to all Muslim, and best day wishes to all Bizznurse.com readers in Malaysia and the whole world. Today I would like to review a site called iBilik.my , a site where you can find places to rent or settle down. Want to find a place to stay? iBilik.my is the way!

Formerly known as CariBilik, this website aims to provide visitors with ample information on places they can rent for short or long term basis.

With over 70,000 listing posted all across hot spots in Malaysia, Ampang, Kuala Lumpur, Bangsar, Cheras, Setapak, Damansara, Petaling Jaya, and Penang, it will be a breeze to find a place to stay. For those who wanted to publish advertisements about their place for rent, this site provides space with zero cost- it’s FREE!

It is easy to browse trough the listing provided as numbers of place to rent are placed next to locations. You can also search locations by using keywords search tool provided. Short term rental are in separated tabs, making easy for you to distinguish which meet your needs.

So what’s new at iBilik.com?

ibilik.my is now launching their ads campaign! Now you can see taxis with these banners all around the town!

Have you seen these taxis? They were talk of the towns.

With ads running on public transport, iBilik.my is surely expanding their reach to more visitors, offline and online. This will further attract more people to put their places for rent at the website, intensifying the database for visitors to browse and search.

So, what are you waiting for? You don’t need taxis to find rooms at iBilik.my, its all at the tips of your fingers.

PropWall Singapore Property Website

noreply@blogger.com (Noor Azlin) — Mon, 20 Jun 2011 10:23:00 +0000

Salam. Today is my review day, so I would like to introduce you one Singapore base website that will help you in finding the right property in a very easy way. So, lets hop on to this website which can help you save a lot of time searching it manually or by asking people's opinion and direction. The website is located at http://www.propwall.sg/, which you can jump directly there by clicking the URL given.

PropWall, the easiest Property Market Search in Singapore

Okay, first of all, what are looking for ? Are you looking for property to buy or property to rent? Unlike most website, Propwall delivers both information, either about property to let or for sale. Well, this is good, because if you are not ready yet to buy any house in the area, you can always rent until you have make up your mind.

Find place to rent is easy at Propwall

PropWall provide information on everything you need to know, name it the size, developers' name, property type, price, amount of rooms and bathrooms, full address and information about the person you can contact if you're interested to rent the place. As you can see from the snapshot above, you can easily contact the person in charge by entering your name and contact number in the form provided.

Any properties you are searching for: Condominiums, houses,shops, factories and even lands.

PropWall is a database full of information on properties in Singapore. It provide information, not just price and contact number. Through this website, you can also see property analysis and even ask questions.

Details, facilities and analysis of properties in simple explanation.

Buying or renting properties is not like shopping. Although Singapore is the heaven for shopping apparels and gift, searching for one good property would sound pretty tough. One would spent a lot of time asking people about place to be recommended, and may end up lost in the jungle of information.


Google Map provided for easy navigation to the property searched

I would highly recommended this website for those who want to search information on properties in Singapore. Although the layout is quite simple, it provide ample information for us about the properties in Singapore. You can also follow their twitter pages at @Propwall for updates and recommendations.

Malaysia Auto Website

noreply@blogger.com (Noor Azlin) — Fri, 25 Feb 2011 19:53:00 +0000

Assalamualaikum.Where do search for information about cars? Magazine? Online Marketplace? Blogs or websites? Today I want to share with you a website which have loads of information regarding cars for sale and as easy as a ABC.Yup, what you have to do is log on to: http://www.carsifu.my/and you'll be wondering why you have not pass over it before. CarSifu.My is website dedicated for those who want to buy or sell their cars. It is easy, not clustered and the design is so simple, which also saves the loading time. With over thousands of cars to choose, you'll be amazed on how easy it works for you.

So, let s have a look at the page I'm mentioning about: Car Sifu.My. The first thing that come to my mind when I arrived at this page is how the home page is presented. Simple, compact and easy to navigate.

The Home page says "You're here, drivers"

Most website that provide this kind of information will surely add some charge whenever you want to post an advertisement. However, at CarSifu.my, you can advertise for free and you'll have your own personal page, like this:

Your own personal Advertisement page, awesome!

This personal page help car owners and buyers interact with each other. The pictures are clear and can be browse without changing pages. If you're a buyer, looking for a Proton Wira car for example. What you need to do is Proton Wira in the search box provided. If you're not sure about the model, just go to HOME page and click Proton Cars. There you'll be redirected to Proton Cars page and all Proton Models are listed at the sidebar. Click on the model and you'll find yourself hundreds of cars to choose from. Below is the example when I search the word WIRA:

Just key in the model at the search function

Well,you can also refine your search by using the place tab such as greater Kuala Lumpur,Penang, Johor and Others too.

As for my review, I found that this website lack some functionality in its "SEARCH" box. You can only search for car models, and not other than that. For example, if you're looking for Car in Kuantan, or in certain years such as 2010, you must search it through the results (As the search box will give you zero result for other than car names). I would suggest adding the the search function to keywords instead of car models, as some buyers would prefer searching through the specification they wanted or places they lived in. A price range search function would help much too.

Overall, I would give this website 2.5 out of 5 for functionality. However, if its regarding user friendliness and simplicity, it scores more. So, how about visiting the website to have a closer view? You'll appreciate how easy it is to search for cars using CarSifu.my!

Organizational Theory and Design as applied to health care system

noreply@blogger.com (Noor Azlin) — Thu, 17 Sep 2009 12:43:00 +0000

Organization

An organization is a collection of people working together under a defined structure for the purpose of achieving predetermined outcomes through the use of financial, human, and material resources. There are a number of approaches to the structure and management of organizations.

Classical or Scientific Theory

The oldest theory of management has a focus on efficiency and production. Evolved into classical organizational theory with the principals of chain of command, unity of command, span of control, specialization, and the use of a scalar chain or vertical levels of authority.The organizational design is bureaucracy.

Classical Theory

Work is divided into specialized tasks and standardized. The hierarchy of authority ( the right to direct ) and responsibility ( the obligation to perform ) is the chain of command. Line authority is linear and derived from position, staff authority is an advisory relationship.
The arrangement of the work group or organizational structure is based on departmentalization.
Span of control refers to how many employees a manager can effectively supervise.

Characteristics of Bureaucratic Structures

Authority and communication flow downward through a rigid chain of command.
The vertical growth represents many levels of supervision and indicates a one person one boss philosophy(unity of command)
The number of people supervised is small(span of control).

Bureaucratic Structure

Bureaucracy results in a line structure, so called because it is a chain of command or leader-follower relationship. It is also called a machine bureaucracy.
This type of structure facilitates large scale administration by coordinating the work of many personnel.

Complex Organizations

Highly structured, formal entities with uniform rules, policies and procedures.
People placed in functional specialty areas with standard pay structures,roles and responsibilities.
Authority clearly designated and centralized=a tall structure

Flat Structures

Less complex organizations have flat structures where authority is decentralized and the span of control is wider.

Other Classical Designs

Simple structure consists of a strategic apex ( executive- level management ) and an operating core ( the individuals responsible for the organizational work ). An example is a private physician’s office.

Classical Designs

A professional bureaucracy consists of an operating core of professionals with decentralized decision making and a well developed support staff. The technostructure ( individuals who standardize and improve the work, such as accountants ) is underdeveloped.Most hospitals are professional bureaucracies.
A divisionalized form is characterized by a number of independent divisions with one administration such as an integrated system.
Adhocracy is a fluid structure using shifting teams of management, staff, and experts.

Human Relations Era

Concern for profit and production along with the human or social elements of an organization.
Fosters cooperation between labor and management and strives for worker autonomy and growth.
Focus on the informal organization with its rewards of attention and recognition.

Neoclassical or Humanistic Theory

Less formal, less control.More participation in decision making with decision authority at the point of service.
Results in a flat structure developed along horizontal lines with fewer levels of management.
Communication is enhanced, but managers can be overburdened.

Neoclassical Theory

Seeks to validate aspects of human behavior in organizations through research; the Hawthorne study.
Views managers as coaches, not as authority figures.
Concerned with employee motivation, satisfaction, creativity.
Authority works with willing participants.

Systems Theory

A system is a set of interrelated parts arranged in a unified whole.
Productivity is viewed as a function of the interplay among people, structure, and the environment.
The organization is a complex social and technical open system that requires human, financial, and material resources.

Learning Organizations

Influenced by systems theory, learning organizations are characterized by five disciplines: systems thinking, personal mastery, mental models, shared vision, and team learning.
Participation, in these organizations, is the basis of learning.
The organizational design is a systems model based on the rapid sharing of information through computer technology. This design can be applied to both bureaucracies and organic structures.

Contingency Theory

The organization’s structure must be matched to its environment to enhance performance.
The optimal form of an organization is contingent on the circumstances faced by that organization including patients, third-party payers, regulators, and personnel.

Chaos Theory

Based upon the belief in the uncertainty and unpredictability of the environment, chaos theory asserts that organizations are living, self-organizing systems that are complex and self-adaptive.
The system moves between order and chaos and is only stable temporarily.

Health Care Organizations

Health care organizations differ in ownership which can be either private or government, voluntary (not-for profit) or investor owned (for-profit), and sectarian or nonsectarian.
Health care organizations also differ in role, activity, and size.

Hospitals

Hospitals are classified by length of stay and type of service. Most are acute care facilities in which the average length of stay is less than 30 days; chronic or long-term hospitals have longer lengths of stay. The services offered may be general or special care such as pediatric or rehabilitative.

Long Term Care Facilities

Long term care facilities provide skilled nursing or rehabilitative services.
Nursing facilities provide daily care.
Residential facilities are sheltered environments in which no skilled care is provided.

Ambulatory Care Centers

Physicians’ offices, birthing centers, surgical centers, and imaging centers are examples of ambulatory care.

Home Health Care Agencies

Home health care is the temporary delivery of health care in the home by nurses, therapists, or aids. Some agencies also provide durable medical equipment.

Temporary Service Agencies

These agencies provide nurses and other health care workers to hospitals and individual patients in a variety of settings.

Managed Health Care Organizations

Health maintenance organizations(HMO’s)-prepaid group practice plans in which a group of providers is responsible for managing health care.
Preferred Provider Organizations(PPO’s)-health care contracts with various groups.
Point of Service Plans (POS).

Health Maintenance Organizations

Staff Model-Physicians are HMO employees and salaried.
Independent Practice Association-Physicians have a private practice but contract with HMO’s.
Group and Network Models-The HMO contracts with a specialty group to provide capitated services to enrollees.

Inter-organizational Relationships

Horizontal integration refers to arrangements between or among organizations that provide similar services.
Vertical integration refers to an arrangement between or among dissimilar but related organizations to provide a continuum of services.

Diversification

Diversification is the expansion of an organization into different arenas either by complementing existing services or by moving into areas that differ from the original product or service.
Multi-organizational Arrangements
Mergers-organizations combining assets to ensure profits and survival.
Acquisitions-buy out usually of a smaller facility.
Consolidated systems-large regional or national multi-hospital entities.

Future Trends

The growth of multi-hospital systems has challenged many principles of management and organization.
Decentralization is the trend and a challenge to nursing services.
Nursing must be able to contribute to corporate profits while meeting market demands.

Organizational Structure

Functional structures-employees are grouped in departments by specialty with all nursing tasks under nursing service and centralized decision making as the norm.
Service integrated structure-all functions needed to produce a product or service are grouped together.
Hybrid structure-both self-contained and functional units are organized in an attempt to provide functional coordination across service or product structures.
Parallel structure-the medical staff is separate and autonomous from the organization creating two lines of authority.

Matrix Structure

Matrix designs have a duel authority structure with both a functional manager and a project manager.
Product and functional structures are integrated and results in a dual organizational focus.
Shared governance, based on participatory management uses a committee structure whereby staff make either managerial or clinical decisions.
Professional practice or self-governance allows staff to govern themselves using specific councils with decision authority.
Participatory Management allows participation in decision making but the power over the final decision remains with the top executive.
Other designs include project management, collegial management, and the corporate model which has led to mergers,buyouts, etc.

Followership

The success of an organization depends on followers who view themselves as equals of the leaders and who work for the common good.
Followers are supportive of the leader but will also challenge the leader. They adhere to lines of communication and authority.

Key Concepts related to Organizational Structure

Strategic and Operational Planning:Strategic planning extends 3 to 5 years into the future and involves an analysis of the internal and external environment so as to determine the direction of the organization. Operational planning is short range and concerned with daily activities.

Key Concepts

Strategic planning in health care is relatively new and represents a paradigm shift from person as customer to population as customer; from illness care to wellness care; from revenue management to cost management; from professional autonomy to professional interdependence.
Strategic planning gives direction to an organization and clarifies beliefs and values. It results in a vision of the preferred future. This vision gives rise to a mission statement which is the stated purpose for which the organization exists, its aim and function.
Philosophy is a written statement, influenced by the mission, which provides a statement of beliefs and values. It includes approaches to care, beliefs about patients and workers, and level of responsiveness to the community.
Goals and objectives state actions for achieving the mission and philosophy.Goals are central to the whole management process and help focus attention on what is important.Goals are broad statements of expectations. Objectives are specific ways to reach the goal.
Policies explain how goals will be achieved and serve as guides that define the activities permissible for goal accomplishment.
Procedures are more specific guides to action. Procedures are a step by step protocol that standardizes various approaches to patient care.
Rules and regulations are part of both policy and procedure statements, they constitute the one and only one choice of action.

Organizational Climate and Culture

The climate of an organization is the perceived characteristics including the physical plant, lines of communication, and rule structure.
The culture of an organization is the norms and traditions maintained.

Components of Organizations: Review

Organizational Charts are the visual representation or blue print of an organizational structure showing how resources, departments, and personnel are grouped horizontally and vertically into lines of authority, communication, delegation, and decisions.

Charts

The chart designates areas of responsibility and areas of specialization
Charts show only formal relationships, the framework in which the management process takes place. The informal structure, personal and social relationships, is not depicted on the chart.

Chain of Command

The chain of command is the formal line of authority and communication. In bureaucratic structures or hierarchies authority and communication flow from the top downward.

Centrality

Centrality indicates the location of a position in an organization where frequent communication occurs.It is determined by organizational distance as depicted by the chart.

Unity of Command

Unity of command represents the managerial dictum of “ one person, one boss “. It is represented by the vertical solid line between positions on the organizational chart.

Span of Control

Span of control or span of management is the number of people the manager directs.The optimal span of management is highly variable. In general, managers in bureaucratic structures have a narrow span of control while those in flat structures have a broader span.

Centralized versus Decentralized

Centralization refers to the area where decisions are made. In autocratic structures decisions are made at the top and flow downward. There is a small span of control resulting in many layers of management and a tall structure.Decentralized structures are flat and decisions are made at the level where they occur.

Unit Level Organization

Case Method or Total Patient Care: Each patient is assigned to a nurse for all care while that nurse is on duty.
Functional Method: Based on scientific management, this method emphasizes efficiency. Each staff member is assigned a task. Care is fragmented.
Team Nursing:Patients are assigned to a team of staff led by an RN who plans, coordinates, and supervises care.
Modular or District Nursing: These are similar to team nursing except that patients are assigned by location and the RN is more actively involved in care.
Primary Nursing: This represents an extension of decentralization to the unit level. In this model the RN is completely responsible for 24 hour care of a group of patients for their entire length of stay.The RN establishes outcome criteria and is accountable for patient care.The care plan is the basis for coordination.
Case Management: This model focuses on an entire episode of illness, including all settings in which the patient receives care. The case manager coordinates services for the patient and family. The concern is on managing quality, access and cost. The critical path is the analysis tool.
Collaborative Practice: This model can include interdisciplinary teams, nurse-physician joint practice or collaboration.
Partners in Practice: A model based on collaborative practice in which an RN and an associate work together in care. The associate is cross trained.
Differentiated Practice: This model recognizes the competencies of baccalaureate versus technical nurses . The professional nurse is responsible for assessment, planning and evaluation while the technical nurse is responsible for implementation of care.
Patient centered care: A nursing care delivery system that is unit based. All patient care services take place on the unit and the focus is on cost containment, efficiency, quality, and decentralization. The R.N. is the patient care coordinator.

Organizational Theory in Health care System

noreply@blogger.com (Noor Azlin) — Thu, 17 Sep 2009 11:56:00 +0000

Assalamualaikum

This is another article that correlate with organizational theory by Kathryn Barzilai

Consider the following scenario in an Emergency Department at Queens Hospital Center and what you might do as a public health consultant to improve patient care:

“Currently 83 percent of patients at the Queens Hospital Center emergency room are treated and released. They wait six to eight hours for treatment. The goal is to decrease waiting time and the number of walkouts and to improve care and patient satisfaction. Current Procedure: (1) Patient seen by triage nurse. (2) Patient sent to registration. (3) Patient waits to be seen by physician. (4) Patient sent for any necessary lab or x-ray. (5) Patient waits for test results to be reviewed by MD. (6) Patient treated, discharged, or admitted.”⁶

This scenario would be a challenge to any public health consultant. Success at the task would most likely depend on how well the consultant grasped some basic principals about organizations.

An organization is “a structured social system consisting of groups of individuals working together to meet some agreed-on objectives."² Organizational theory (OT) is the study of organizations for the benefit of identifying common themes for the purpose of solving problems, maximizing efficiency and productivity, and meeting he needs of stakeholders. Broadly OT can be conceptualized as studying three major subtopics: individual processes, group processes and organizational processes.²

Why is OT important for public health professionals? Since organizations pervade the field of public health: from free clinics to refugee crisis support teams to research institutions, an understanding of organizations and how they work, helps public health professionals to be more effective participants in and leaders of organizations.

This paper will try to accomplish the enormous task of summarizing major concepts in organizational theory. The three broad concepts that will be explored include: individual processes, including motivation theory, personality theory, and role theory; group processes including working in groups/communication, leadership, and power and influence; and organizational processes, as it relates to organizational structure, and organizational culture. In the process a rudimentary introduction to select organizational models will also be presented.

Since the hope of the paper is to make OT relevant to work in the public health field, efforts have been made to end the discussion of each broad topic with a discussion of that topic’s relevance to practice. Following the last section, organizational processes, a suggested solution to the scenario presented at the beginning of the paper, will be provided.

Individual Processes

Motivational Theory

What makes us do the things we do? Why would two individuals, in similar circumstances, choose two different options? The answer, in part, is motivation. Motivation drives behavior; it is the force behind an individual’s decision to commit or not commit to certain acts or behaviors. The elements that make up what we call motivation are complex, unique for each individual, and generally dynamic through time.

Handy suggests that motivation is the intersection of assessed need and the likelihood or nature of results.⁶ An individual calculates an “E” (energy, enthusiasm, effort) the product of need, and prediction for liklihood of acheving the desired results. When a person enters into a contract with an organization some calculation will be made in regards to the individual’s “E” put forth. Organizations also put forth an “E”, either by resources alone (salary), or by other items such as prestige and stature. This exchange sets the limits of a physical and “psychological contract” between the organization and the person. The psychological contract can be defined as the shared and unshared expectations between the individual and the organization based on initial agreements and the individual’s motivation calculations. When both parties see the psychological contract clearly, (i.e., when it is fully understood and acknowledged by both parties), the motivation of the individual becomes transparent.

Motivation theory tells us a few things about managing groups of people. First, in order to find successful ways to change people’s behaviors in an organization you must understand the terms of the psychological contract for those individuals. When you understand the terms by which a person joins an organization, you can better secure meeting that demand and hopefully sustain an “E” input over time. If, however, an organization changes its “E”, or increases demands on the individual, “E” will change according to the person’s motivation calculation. Management must carefully consider how to maintain or adjust the psychological contract in order to keep that person a productive member of the team. This may mean an increase in salary or manpower and/or increased managerial responsibilities.

Role Theory

The roles we carry shape the way we see ourselves and help to define the behaviors we should exhibit, and those we should not. Roles also help us to communicate responsibilities and set expectations for appropriate responses from others. In an organization roles can help to clearly define boundaries between individuals and locis of power.

Adjusting to or meeting role expectations can however create problems. Role ambiguity is one such problem. Role ambiguity occurs when either the focal person or others around him/her are unclear about the nature or expectations of a role. Role ambiguity can plague employees endeavoring to successfully attain and maintain new responsibilities or goals. On the other hand, a person may not reach role objectives due to overloading of responsibilities or under utilization of talents and abilities. Role conflict may arise when two roles intersect creating tension or difficulty fulfilling one or both roles. For example, when a mother returns to work and attempts to maintain breast-feeding. Management may not support the amount of time taken during the day to pump milk, leaving the mother at a hazard of not meeting both role expectations fully. Role incompatibility may occur when the expectations/nature of the role is clear but is incompatible with other roles or a person’s sense of self.

Organizations need to acknowledge that its employees manage many roles and that problems or conflicts can arise since role conflicts create tensions that can change the ability of the individual to reach their goals. Organizations should be sure to support their team members in meeting new roles by giving time for transition, or offering training and support. In addition, when role conflict arises the organization can nurture employee’s ability to relieve tension by allowing time to devote to caring for roles outside the office. An example of this may be support for a breast pumping station in the office and management support of breaks for pumping.

Personality Theory

Personality is the unique and enduring traits, behaviors and emotional characteristics in an individual.³ Personality can either aid or hinder meeting work goals dependent on fit. For example, perhaps the best well know personality types are Type A vs. Type B. Type A personalities are competitive, impatient, seekers of efficiency and always seem to be in a hurry. Type B personalities are laid back and possess more patience and emotional stability, but tend to be less competitive. In a work environment Type A’s tend to be more productive in the short term and pursue more challenging work. However, they also have a greater tendency towards health risks and are less likely than Type B’s to be in top executive positions.³

The later fact might be suprising. Why would Type A’s tend to be in top executive positions more frequently than Type B’s? Daniel Goleman might suggest that the difference in performance by classic Type A vs. Type B personalities is less due to fixed personality traits as they are for propensities to grasp the concept of emotional intellect (EQ).⁴ Unlike IQ, EQ is the “capacity for recognizing our own feelings and those of others, for motivating ourselves, and for managing emotions well in ourselves and our relationships.” (Refer to Appendix A for a presentation of Goleman’s EQ Emotional Competence Framework.)

Another possibility is that these trends are less the product of an innate character as it is the interaction of experience, personality and circumstance. If this is the case, a person’s ability to work in groups or propensity for certain types of work may be task and time dependent, but can be changed with motivation and effort.

Organizations can play a role in developing their staff for success. Workshops, seminars, even book clubs that focus on developing EQ an strengthen organizational success. Allowing for a diverse set of experiences, with appropirate support can maximize and expand the capabilities of each employee.

Discussion

Do motivation, role theory and personality factor into our day-to-day experiences in an organization in a significant way? Three theorists would suggest individual processes are very important to the success of any organization. The Human Resource Model, as developed by the contributions of Likert in 1967, McGregor in 1960 and Argyris in 1957^3,6,8, proposes that the individual is the most important, indeed the central consideration for maximizing the success of an organization. According to The Human Resource Model each employee as an untapped well of creativity, talent and motivation, and the success of an organization depends on how well human resources are tapped. As an employee is placed in an environment where they becomes the originator and leader of their work, the organization’s goals and their individual goals become one. When organization goals are internalized the indiviudal’s satisfaction increases, as well as the amount of motivation to be efficient and productive. Therefore the motivation of the employee is key because talent and creativity flows when the person is motivated to do so by internalization of organizational goals.⁷

According to the human resource model, the challenge of growth and productivity in an organization is the challenge of assisting human resources in reaching their maximum potential. The multiple dimensions of individual processes, the calculation of motivation, role development and development of innate talent and abilities, are all factors that must be considered seriously and channeled appropriately for acheving success.

Group Processes

Leadership

Leadership is an important topic that is discussed at length in Chapter 14 of the On-Line Textbook. Please refer to that chapter for an in depth discussion of this topic.

Power and Influence

One needs only to superficially examine the tabloids and other media outlets to see the action of power and influence: Movie stars promoting everything from prostate exams to weight reduction pills or popular health guru’s preaching cures for all ills. These individuals, and others like them, wield great power and influence. Within the walls of an organization, power and influence also make an impact on individuals and groups. Although one may often think of power and influence in terms of how it is abused, it can also be used to do positive work within an organization to drive production and to meet goals. To that end we will consider its role within organizations and implications for change.

Influence is the action or force by an individual that modifies another person’s activity or behavior. Power is the force behind influence to make it effective.⁶ There are three fundamental principles regarding power. First, for power to be wielded it must have an identifiable and credible source; power would have no bearing on individuals without evidence to show that it can be used. Sources of power are those substances, physical or not, that can be mobilized to have influence. There are at least five broad sources of power: resource, position, expert, personal and negative power. Resource power derives from the control of wealth and resources: for example, the boy who owns the soccer ball gets to say if there will be a game. Position power is the power identified with fulfilling certain roles. A Chief Executive Officer easily wields decision-making power because it stems from his appointment responsibilities. Expert power is the power arising from knowledge and experience. Personal power is the innate charisma a person may possess, a type of magnetism. Finally negative power is the ability to not do something, and in so doing prevent another person(s) from gaining what they want.

Second, power is a balance between both parties. Both the person commanding influence and the person on whom the power is being exerted commands power, the later commanding at least negative power. Finally, power is relative. Power can be exerted only when those to whom you are trying to wield power recognize the source of it. Take for example the conundrum a professor of the arts would be in trying to guide decisions made by a Medicare policy review board. His credibility as leader is diminished because the professional source of power stems from expertise in the arts not public policy.

Once a power source (or sources) are established, influence must be communicated through recognizable methods. Each method chosen predisposes individuals to certain types of responses. Depending on how individuals respond, their new behavior may or may not be sustainable over time. Influence methods include, but are not limited to: the use of force and coercion, rules and procedures, exchange (bargaining, negotiating), persuasion/logic, and ecology.⁶ An example of ecology would be changing the environment people are in. Chatty employees moved to different floors will quickly influence their behavior by changing the amount of talking that can be done in the workday.

If the goal of power and influences is to increase productivity and the quality of services delivered by changing employee behavior, then the central measurement of outcome success is individual response. Depending on sources of power, certain individual responses are more desirable for organizational strategy because of the way they correlate with sustainability of the response over time. Compliance is the agreement to a behavior because of force – the “I have to” response. This implies the lack of self-initiated behavior because the person “has to” rather than “wants to”. Generally compliance will be the result of methods of force, rules and procedure and sometimes exchange methods, and must be maintained with continual supervision. Unlike compliance, identification and internalization have some degree of acceptance of the new behavior, however the sustainability of the behaviors are not the equal. Identification is a behavior adopted out of a desire to please or admiration for the person wielding the power. The manager exerting this type of power has great magnetism but must constantly be present for the behavior to continue. The organization becomes dependent on the power figure, making the employee action not sustainable independently. Internalization is for most situations the most desirable response because it is independent of the source of influence and is self-sustaining.⁶

Working in Groups

In the 1930’s and 40’s a set of experiments were done at the Western Electric’s Hawthorne plant.⁶ The initial round of experiments involved a select group of female employees, whom constructed telephone equipment, placed in a variety of environments (changes in lighting, quota demands, rest period frequent and duration) in order to measure their effect on productivity. To their astonishment, the research team found that the environment had little to no effect on productivity. In all simulated environment changes the level of productivity increased, and once back in their original environments the production level of the employees continued to remain at higher than pre-experiment levels. The team hypothesized that the major cause for increased productivity was the relationships formed between the employees and between the employees and the management.

A second round of experiments were conducted on male employees that involved in wiring and smoldering of telephone equipment at the same plant. No change of environment was made as in the first experiment, except to place the men under observation. The research team found what they called the “Hawthorne Effect”⁸: Regardless of quota set by the company, the empoyees neither under nor overproduced. In addition, work output was equal for all members of the group. The research team hypothesized that the workers created informal groups between themselves and their superiors, which tightly regulated production in order to maintain a group identify where no man excelled beyond the others.

This well-known experiment demonstrated for the first time in a controlled setting the role of informal groups on productivity, and that the effects of group culture in work environments could have positive or negative consequences.

Outside of the informal groups created by employees, administrators form groups in order to meet organization goals. The nature of these types of groups also deserves some discussion. Motivation for utilizing groups may include: (1) improved decision-making, (2). More risk taking, (and therefore presumably more innovation), and (3). Satisfying the need of individuals to be in a group.⁶

Groups, like children, go through stages of growth. According to Handy, there are four stages of growth: forming, storming, norming and performing.⁶ As managers you must be sensitive to the needs of the group at each stage in order to help the group reach its goals successfully. In the forming stage relationships are being built through the establishment of goals, role definition and time-line formation. Quickly groups move into the storming phase, where roles, procedures and goals are questioned. It is vital at this stage that conflicts be resolved effectively and efficiently. In the third phase, norming, members establish a formal or informal set of rules and procedures for group members to incorporate into their work. Open communication is vital for the norms defined to be accepted and uniformly applied. Only when the forming, storming and norming phases are completed will groups be able to move into a performing stage of growth.

A few thoughts on groups remain. As discussed in the leadership chapter of the On-Line Textbook, groups by anticipating the needs of the group, leaders can moitvate acitivites according to the stages the group is in. During the forming and storming stages leaders should assist group members by encouraging participation and viable communication. Leaders are key in maintaining group stability through effective negotiation during the storming phases. As the group matures, reaching the norming phase the leaders should practice foresight, promoting the next level of action by introducing effective evaluation methods and standard setting adjustments as necessary.

Perhaps one of the greatest challenges for working in groups is the element that can be its greatest strength, diversity. Those who have studied groups acknowledge that diversity in certain combinations can be key to success. RM Belbin¹ agrees, finding that teams do not need brilliance but balance for success. Specific character roles, noted in appendix B, can provide the recipe for success.

Discussion

Working in groups are building blocks for meeting organization goals. Managers should consider ways to develop leadership in team members. Training for versatility in leadership styles through workshops could encourage this growth. Encouraging self-growth through concepts of EQ or even Covey’s Seven Habits of Highly Effective People² can also provide the groundwork for leadership growth by mastering interpersonal skills. Managers should also be proactive about identifying and cultivating talent of his/her staff. When committees must be formed managers can help select individuals to create groups that have the balance of personalities and talents to maximize the likelihood of success.

Each manager must also consider diversifying their own talents by analyzing spheres of social competence and goals though which to improve these abilities, but also seeking to diversity sources of power and methods of influence. For example in an environment that is strictly managed with rules and procedures, implementing a democratic process can broaden influence by example. This method however would require a great deal of time, effort and must be approached with focused investment.

Organizational Processes

Organizational Structure and Design

If we were to look at any organization from a bird’s eye view we could observe its structure and design. In the biological sciences structure defines function, so too for human organizations. Important concepts to consider in the studying of organizational structure are the flow of information and sources of power. Consider the following diagrams:

In figure 1A all information flows through the CE either directly (before intersecting with a non-CE sphere) or indirectly with 1-2 intersections preceding. In this environment power is very well centralized and communication well controlled. Figure 1B is a variation of a centralized model. The managerial style in this model is more functional with formalized relationships. These organizational structures work best when the task is uniform, and predetermined and environment pressures are lessened; such as if a company has cornered and market and or has a stable product. In health care this might occur when a large tertiary care center that has cornered the market for a city or isolated region.

In contrast, consider figure 1C where the division of duties is highly specialized leading to two separate functional units. In this model work and the division of duties is highly specialized so power is widely distributed. Communication flows in a centralized fashion within units, but no one unit controls all communication or has all power, making power decentralized. This model may serve best in the situation where innovation and the ability to respond to environmental change quickly is key.

The challenge for all managers will be to balance the need for uniformity with the demands for diversity. Uniformity guarantees ease of control and supervision, ease of integrating work of multiple subgroups or teams (such as between offices) and economy since it is easier to pay for and maintain one system rather than many (one type of form verse multiple forms). However the environment in which the organization is based, and for which the product is being delivered, is constantly changing making it unpredictable. Organizations must than manage responses to these changes- diversifying their processes and thinking.

Organizations may tend to seek too much uniformity, following the classic futile fight against the law of entropy- that all things move towards greater disorder. An organization should recognize the many demands for diversity classify their importance and decide on which to pursue, maximizing the cost of diversity with the achievement of goals carefully.⁵

Open Systems Theory (OST) has integrated these conflicting pressures. According to OST organizations live within dynamic environments and are shaped by them. The organization is an organism with external (resource availability, changes of needs and demand) and internal (employee characteristics, adaptation to organizational change teams and individuals) environmental influences. The organization evolves according to the pressure exerted by these sources and therefore is evolving by successful adaptation within this dynamic, changing and an open system. The challenges to managers are to identify appropriate sources of influence by prioritizing them, and to guide successful adaptation by the organization.⁷

Organizational Culture

Organizational culture is “a cognitive framework consisting of attitudes, values, behavioral norms, and expectations shared by the organization’s members.”⁹ Organizational cultures help to establish a sense of identity for employees within the organization and therefore can facilitate comfort and a greater likelihood of internalizing organization goals. Organizational culture also provides a status quo and maintains stability in processes, communication and role interaction.

Culture is enforced in a number of ways, such as by ceremony, symbols and language. Ceremonies that commemorate employees demonstrating “excellence” as evidenced by exemplifying organizational values demonstrate in front of a large audience those values to be celebrated while also reinforcing them. Symbols, such as mission statements or encouragement slogans can constantly reinforce the vision the organization wants each individual to be guided by. Special language can also help to define a culture and allow an individual to identify with it.

The presence of culture demands uniformity. Managers must consider the consequence of paradigm shifts and plan in detail implementing changes. Implement new paradigms require the complete support of the administration, and should be able to address the needs of the employee working body.

Discussion

The two major organizational processes do not stand diaposed end of organizational theory in practice. In fact, organizational structure and culture must reflect one another in order to reinforce the goals and mission of the organization. Imagine an international refugee mission seeking to initiate programs for maternal child wellness in which people at the front lines aren’t in the community with the individuals divvying the resources. Although the goal of the organization values may be to respond to the needs of the community, administers, isolated from certain staff (organizational structure) leads to the inability to reach goals.

Review of Case Study

Refering back to the scenario presented at the start of the paper, Queens Hospital hospital wants your input on how to improve the Emergency Department’s patient care, and to maximize efficiency and quality. Utilizing OT there are a few questions we might want to ask to diagnosis the problem.

Staff related issues: How well does staff feel supported and able to pursue work related issues. What are staffing levels? Are these ratios sufficient for patient workload? If staffing levels are low this can contribute to the problem of efficiency and quality. If this seems likely to be a problem, further questions should include: What is staff turn over, and what is the wait time for obtaining new staff? How well are human resources retaining staff, what are the problem areas? What are the incentives motivating work participation, and what pools are applicants are applying? Whom, what talents and skills do we want to aim for?

Organizational Issues: How well do the different units of care delivery fit with one another? For example if the laboratory was contracted out to a lab three miles away, the hospital may be limited by the time it takes for blood to be collected, transported, analyzed and transported back. This process may also be on a schedule, (on the hour or half hour) which then adds the wait time for transportation. An in-house lab staff might be considered, although cost of overhead and staffing would have to be considered for its cost. What also is the climate in the organization, are works overall satisfied, dedicated, feel empowered to deliver excellent care? Has the organization build and supported a culture of excellence?

Where is decision-making centralized, and what would be the benefits and disadvantages of diversifying sources of power? In light of the patient population needs, what types of problems are most commonly seen? Uniform vs. diversity pressures help to guide modes of action. If a lot of non-acute conditions are presented to the hospital we might want to consider the utilization of an Urgent care model ancillary to maintaining the ER for acute conditions.

Consider other more "acute" conditions as well: What glitches to the staff frequently comment as a problem? Maybe the computer system is archaic and redundant. Maybe there are frequent errors in obtaining and reporting labs, consults, and obtaining patient records. One glitch could create a myriad of small, but recurrent problems, troubling staff and overall efficiency of the practice.

We will assume that acute issues, and staff related issues are not the problem, since resolving them would be self-explanatory. We will consider only adjustments in organizational structure and design for the sake of relevance to the topic of OT. I suggest that Queens Hospital consider a new model of care delivery, in which the Emergency Department diversifies to a decentralized model of management and adds new modes for care delivery. The new process would look something like this: When a patient enters the hospital they are seen immediately by a Triage nurse. The nurse has the option, after registration is complete, to one of three routes: the nurse can channel a patient through the traditional method, to be seen by Emergency room physicians according to priority. The nurse can also decide to transfer non-acute patients to urgent care center (an initiative of this hospital or a close center), or to initiate pre-approved protocols for common illnesses, (such as asthma) prior to visitation from the physician.

Utilizing this model has a few advantages. By increasing the structural complexity, patients can have treatment initiated and completed at a faster rate. This not only allows the hospital to see more patients, but it will improve patient satisfaction. Redesigning job roles and responsibilities may also increase the motivation of staff by maximizing their control of patient care. Nurses can more effictively utilizie their triage skills and doctors can focus on patients with conditions or complications that require their skill and training.

Changing Paradigms in Malaysian Health Care: What future managed care portends for Malaysian doctors

noreply@blogger.com (Noor Azlin) — Thu, 17 Sep 2009 10:48:00 +0000

Assalamualaikum,

I got these article in my endeavor to find organizational theory assignment. Dr David's criticism really lights up some issues regarding health care system in Malaysia. Especially When our Prime Minister had suggested the copratization of Health Care System In Malaysia. This article may not be current, but it have some glimpse on the idea.

Dr David KL Quek

dquek@pc.jaring.my or drquek@mailcity.com

"The archetype of a profession with an ethical creed and special privileges based on service to society and intellectual advancement is still best personified by the physician as healer and scientist, freed from narrow self-interest by the expectation of earning a generous income from a grateful citizenry."

Thomas E Getrzen; Health Economics: Fundamentals and Flow of Funds; 1997, John Wiley & Sons, Inc. New York: p 17

As of end March 2000, some 49 Managed Care Organizations have been formed and registered in Malaysia. The spiralling growth of these MCOs attest to the belief that Malaysia’s health care system is moving towards some great paradigmatic shift which somehow benefits their existence.

In many ways, this is hardly surprising. Our Health care expenditure has reached a critical mass, which now must be reckoned with. Many entrepreneurs have almost suddenly awakened from their fitful slumber and rapaciously realized that the time is now ripe for the pickings—healthcare spending can become another tasty morsel for corporate dealing and wheeling.

The many contradictory messages on corporatization and privatization by the government, have whetted rather than stifled the appetites of would-be players who have jumped into the bandwagon of trying to apportion for themselves larger and larger slices of the healthcare pie. Perceived uncertainty and vulnerability in the sea of change only serves to attract various sharks and predators of opportunity.

It appears that only the inherent players have been left out of the loop. Worse, the intended benevolent purpose has now become so perverted that the patient on the receiving end has been left in a lurch, carrying the short end of the stick of managed care plan—some so skimpy and inadequate, that it is a shame it is allowed at all.

In their usual if not totally immersed roles as direct providers of healthcare—doctors have once again been relegated to being bit players, and pawns in the game of one-upmanship. Does anyone else care, for that matter? Have we lost our collective voice?

Are our opinions and views as a profession no longer relevant? Does not our concept and vision of the healthcare climate of the nation, matter, or is it slowly amounting to naught? Or are we reaping what we have sown by being too complacent, too individualistic, about these earthshaking moves, for too long? Are we becoming irrelevant in a changing society where we no longer can be counted to do the right thing?

Will our professionalism become at risk of transforming into that of circumscribed skilled craftsman dictated to, by the real powers of business and global conglomerates? Crudely put, will we be relegated to being just skilled labourers and artisans, eking out our living at the beck and call of managers and corporate players? Am I painting too bleak and pessimistic a picture? Or has this scenario already arrived?

Why indeed is Malaysia so enamoured with the entry of Health Maintenance Organizations (HMOs) and managed care into our healthcare equation? Why is a cost-containment system that is raking up storms of protests, even in the USA, (and adopted no where else in the world!) so warmly embraced by our government and authorities that be? In spite of its growing presence in the last 30 years there, healthcare cost has continued to climb to its present 15% of the gross domestic product—some US$1.5 trillion! There were only 33 HMOs in 1970 but 546 in 1994, peaking in 1987 with some 700! Despite this huge spending and flirtation with managed care, some 43 million Americans are presently left uninsured with no access to medical or health care.

Compare this with Malaysia, where almost everyone has reasonable access to health care. True, the government is presently the largest provider of this service, some 60-70% are being treated in public hospitals and health care centres, under a heavily subsidized scheme. Where else can one get a coronary bypass surgery for a maximum of RM 500? A liver transplant for RM 500? Of course, taxpayers indirectly pay for this. Of course, there is also some degree of wait-listing and rationing of healthcare particularly of expensive tertiary care. But no one Malaysian is deprived of reasonably affordable care, to date, save for some heroic and super-specialized therapies or surgeries.

This is truly amazing because, in Malaysia the healthcare spending is already among the lowest in the world, at 3% of the gross domestic product. We have been spending so little and have been providing such great productivity in terms of healthcare returns that it makes us wonder why we are embarking on such a perilous and uncertain road of managed care.

"Medicine has now turned into the proverbial Leviathan, comparable to the military machine or the civil service, and is in many cases no less business- and money-oriented than the great oligopolistic corporations."

Roy Porter: The Greatest Benefit to Mankind – The Medical History of Humanity: 1997, WW Norton & Co, New York, chapter 20, p628.

What then is the attraction of the Managed Care Paradigm? In purely economic terms, our current indemnity fee-for-service model is the least constrained form of financing, which is conceivably the main unchecked area for potential abuse of limited resources. Existing and previous insurance schemes on the other hand, are purely passive financiers, which do not have sufficient control of whatever charges they are billed with. In theory, in the managed care paradigm, such financial responsibility for medical and health care is shifted to the MCO—hence, it has a very strong incentive to provide care efficiently. In order to compete then, the MCO must provide both quality and cost benefits.

With this model, a more stringent evaluation process is employed, known as the utilization review (UR). This evaluation process is meant to be restrictive and hence to possibly cut down on unnecessary and unproven expenses related to healthcare. Some common UR procedures include: second opinion, pre-certification (approval before elective surgery), pre-admission testing (requirement for outpatient investigations so that patients spend fewer days in hospital), concurrent review (regular evaluation to authorize continued stay in hospital), database profiling (scrutiny of services provided by doctor or hospital to curb excessive patterns of utilization), intensive care management (individual and close attention on high-paying cases), generic substitution, discharge planning (facilitating rapid transfer home), retrospective review (evaluation post-discharge to deny payment on any medically unnecessary services), audits (ensuring that all services billed were actually performed).

Undoubtedly all these are laudable processes, which can help reduce cost, but in practice there have seen serious breaches of what constitutes good medical practice. Arbitrary denials, delays in approvals for expensive medications, tests or hospitalizations, severely truncated hospital stays, poor supervision of the case-control nurse or medical review, late or non-payment of services actually rendered on whimsical grounds, etc. It is no wonder that victims of such mismanagement have protested so loudly. More worrying is the trend to exclude enrollees who are elderly, with genetic disorders, those chronically ill, psychiatric patients, etc. Who will take care of these potentially more expensive patients to look after?

Notwithstanding this, the managed care model for health care is now well entrenched in the USA, despite serious attempts to further protect the patients against such excesses and unethical conduct. Alas, too many large business and insurance corporations have too much influence in the political scene, and this has prevented any realistic review and overhaul of this much-maligned model. It is not difficult to understand why. Over the past decade or so, these companies have seen their fortunes escalate beyond their wildest dreams. Just consider the scale of this model run amuck.

Fortune 500 (17 April, 2000) recently released data on the top 1000 largest corporations in the United States. Among the Health Care group there were 35 companies within the top 1000. Their total revenues for 1999 were more than 190 billion dollars, with the largest—Aetna, having a turnover of 26.4 billion and the next five largest with over 10 billion dollars, each—these include Cigna, UnitedHealth group, Columbia/HCA Healthcare, Yenet Healthcare, and Humana. Importantly, profits ranged from US$249 millions for Yenet Healthcare to US$717 millions for Aetna and a staggering US$1.77 billion for Cigna!

Of course, some of the other companies are also heavily indebted, with Sun Healthcare group, Integrated Health Services and Mariner Post-acute Network posting losses of more than US$1.7 billions each!! One begins to wonder how these companies would survive, and if they would be bailed out in the long term. More importantly, if these companies fold-up what happens to their members who have paid and contributed to these health plans. What is surprising is that as a group, the 35 corporations together made an overall net loss of more than US$2.034 billions for the year 1999.

So healthcare management is not necessarily a sure thing, as many in Malaysia are supposing it to be. For those of us in the know, we are amazed that so many companies are still jumping into the scene without adequate planning or long-term vision.

It is from studying the American model and debacle, that we have sounded the alarm for caution against the unbridled entry of the MCO model into Malaysia. However, despite the negative posturing of the MMA vis-à-vis the MCO paradigm, our Malaysian authorities have been surprisingly unconvinced. These negative reports on the failure and miscalculations of the MCO paradigm were dismissed as biased, because the we have been perceived as being self-serving to protect our own turf and territory.

Disappointingly, with the perceived tacit if not complicit encouragement of the government, the seed of managed care has been allowed to germinate in Malaysia. Consequently, the past 3 to 4 years has seen such a rash outcropping of self-styled MCOs, most with purported linkages to insurance companies.

These are now offered to the public as attractive packages which apparently cover myriad medical expenses at selected healthcare facilities (except, of course, that fine print minutiae of exclusions were conveniently obfuscated!). Up to the present time there has been no mechanism to protect the unwitting purchaser of such glossily attractive if disingenuous plans.

Therefore, the time is perhaps ripe for some action to be taken. For medical practitioners and the authorities concerned (i.e. the MOH), there has been increasingly a clarion call for better regulatory mechanisms or legislation, to encompass all these concerns—the safety and protection of the patient and his welfare, being the ultimate goal. Over the recent years, the MMA has stridently become the strongest and most vocal advocate for protecting our patients’ interests and their legitimate health concerns (Health For All – Reforming Health Care in Malaysia, 1999).

There is another area of concern that we have to consider. This is the uncertain viability of the MCO model. In historical terms, most of the private hospitals in Malaysia have been posting very marginal profits for years, with a sizeable number losing money but kept afloat by charitable trusts and philanthropy. Only a few star players have consistently been profitable and even there the profit margin has almost never exceeded 10%. A reasonably well-run hospital might make on average of 5-6% which is pathetically a poor return for most investors, compared to other businesses. It is reported that on average American MCOs make about 5% profit, with another 15-20% off the top being channelled to administrative expenses and managers!

However, there can be no denying that the size of our healthcare spending is growing, and at about 1.5 to 2 billion ringgit annually, it is certainly attractive enough for players to gamble on the prestige of adding a medical centre to their diversified interests. These entrepreneurs could conceivably be tempted to experiment with the hope and hype that skimming off some of the spending from the middle or the top, might still be worthwhile.

After all, ironically, the medical practitioners at these hospitals or medical centres have always made good money, without previous constraints, or so they thought. Riding on the concerns of overcharging, exorbitant or unchecked fees, perhaps even perceived excessive investigations and surgeries, these managed care groups disingenuously slip into the middle-man position with the hype that they can cap further the rising costs, while at the same time collecting a fee for the effort. Alas, the only groups shortchanged would be the patients under their plans, and the doctors themselves!

But memories for such fall-outs or debacles even in Malaysia, are often conveniently short-lived. Have we forgotten that one managed care company, which only 2 years ago, failed so miserably to live up to its obligations that nearly all the medical centres in the Klang Valley, effectively barred their enrollees from any service? Order was only restored when the parent corporation itself undertook and reimbursed the backlog of unpaid bills. Doctors, panel clinics, and hospitals were all repaid, albeit some as late as 14-18 months! Will this delaying and delinquent tactic be the way of the future experience of medical establishments, inexorably entangled with such third party payers or MCOs?

Another health plan management group recently folded its operations after owing a huge debt to innumerable clinics and hospitals. Some speculation has it that this came about because it had a parting of ways with its insurer. No matter the actual failure, the losers were the contributing members. Will this scenario be re-enacted again in the future when one party or the other, find their bottom-lines stretched beyond fiscal prudence to stay afloat? Who will protect the patients and the enrollees who have subscribed to these plans?

Many third party payers (TPPs) and MCOs are already becoming delinquent with impunity. From personal experience, delays in reimbursement up to 9 months to one year have already taken place, despite reminders, pleas, and even threats of barring further service. Some have been withholding reimbursement on unbelievable excuses of lost invoices, bills, inadequate documentation, etc. Some credit-control officers of these TPPs, even have the cheek to ask incredulously if the doctors who complained, wanted their continued custom—as if being on their panel was a big deal! I had to remind them that I am not ever registered on their list of panels, and that the patient just happened to fall ill under their schemes, which have been purchased by their employers or corporations.

It is good to know that in the United states, doctor groups in several class actions, have begun suing some of these MCOs for deliberate delay in reimbursement, despite the contractual processing time of less than 60 days. It is perhaps time for doctors here likewise to consider this legal option. At the very least some recourse for late payment interests should be allowed, but punitive measures are probably needed to expedite the demise of such bad business tactics.

What indeed if any are the fiduciary responsibilities of such MCOs, to their clients i.e. the patients and also to the doctors, the contracted providers? Do we have adequate regulations or laws to ensure that such MCOs behave themselves? Can or should we allow these MCOs to be set up without these safeguards in place? Surely we must be more accountable, and the government can be more responsible and circumspect.

Heavy penalties while being a needed deterrent, are not enough, because a bankrupt company cannot repay anything. What is needed is perhaps a tightening of the ease of setting up many fly-by-night MCOs? A huge re-insurable premium with a Central Bank may be a mandatory requirement, which can then serve to protect plan-buyers. Better still, scrap all such plans for managed care until some final scheme is devised which encompasses all these safeguards.

The MMA has been urging for a National Health Financing Scheme which will hopefully cover all Malaysians, and which the government of Malaysia will guarantee. With a statutory or mandatory contribution into either the EPF or SOCSO schemes, this could become a realistic option. This will be the best hope for Malaysians.

We urge the government and people of Malaysia to resist the temptation to seek some easy way out i.e. short-term healthcare plans, with no foreseeable continuity into the future, especially beyond the elderly age group. We must actively lobby the government to work harder towards finding a just and equitable solution, to ensure universal and comprehensive health care coverage for all Malaysians into the next century.

"Every health services system has two main goals. The first is to optimize the health of the population by employing the most advanced knowledge about the causation of disease, illness management, and health maximization. The second, and equally important, goal is to minimize the disparities across population subgroups to ensure equal access to health services and the ability to achieve optimal health." Starfield 1992

Make up Tips#1

noreply@blogger.com (Noor Azlin) — Tue, 15 Sep 2009 22:55:00 +0000

Assalamualaikum
For those who asked me about makeup tips, let me tell you some points to emphasize

Make up can hide you skin imperfection but can never change your face
If you want to have a super smooth skin, make sure you you prep your face before applying make up
Never sleep with a a makeup!
For Muslim Women, make sure you got those make up remover in your bag everywhere you go. Those waterproof lines and mascara wouldn't fade away with only soap or cleanser.
A super flawless face after makeup= a super clean and healthy face before make up. Means, ensure that you always take care of your skin before, during or after make up. Those pimples can be hide with concealer, but be extra careful, it might cause it to spread more. Always have these regime 2 times a day: A cleanser, a toner and moisturizer/ sunblock.(night-use night cream)
If you think you don't need make up right now, just prepare your face for one! Those who never make up always have problem to know their best matching foundations at first.
Don't let those unprofessional people make up you for your dinner. You'll end up with extra red lips, extra layers of powder and worst of all, extra bright pink shade on your cheek.
Minimize attention. If you got great eyes, flaunt it with mascara and liners. Line only the upper lid if you are a super study chick. Lining the lower lids will only cause your eye bags emphasized. Remember, when you focus extra attention to certain part, make the others minimal. This means, super smokey eyes can only be smoothed by a little tint on your lips.
Invest on a good foundation. You can by cheap mascara (work best on everyone as long it is waterproof), but never ever buy foundations that is too cheap or unknown. You might end up having pimples then flawless.
Foundation like ZA, Revlon (Just to name some) may be quite expensive (for students) but actually they are more cost effective. Example, I bought this Brand X two way cake (foundation in a form of pressed powder. It cost me only RM 25.00. I have to put enormous amount of foundation to cover my whole face and end up with an extra cakey face. If i buy this ZA foundation, I just need half the sponge for each face of my face and usually it take me three month before I ran out of foundation.

That's all for now, See you next time!
p/s: Always wash your face before you sleep, apply a toner and sleep with anight cream. You'll wake an extra fresh anf moistened face!

NoorAzlin

Homoepoetic Stem Cell Transplantation

noreply@blogger.com (Noor Azlin) — Wed, 09 Sep 2009 12:11:00 +0000

Oncology Nursing

Homoeopathic Stem Cell Transplantation

Today I learnt lot of interesting things from my guest lecture. I will share you about

Homoeopathic Stem Cell Transplantation , the latest intervention that used worldwide to help cancer patient that need stem cell transplant.

Stem Cell Transplant

There are 2 type of transplant that are used currently in health care systems that are bone marrow transplant and Stem Cell Transplant. To further describe stem cell, it is defined as unspecialized cell that do not yet have any function. It will develop to be specialized cell and when it proliferate, it will become mature cell such as blood cells and other type of human body cells. This stem cells can be found in large amount in bone marrow and less amount in blood circulation.

Bone Marrow Transplant (BMT)

In treating disease using BMT, damaged bone marrow will be replaced with normal bone marrow. However, because of the bizarre side effects and expensive treatment, BMT is not currently used and will only applied when chance of cure is high. BMT is now replaced with Peripheral Blood Stem Cell Transplantation ( PBSC). Al tough the site for extraction is different, the transplant procedure and methods remain the same.

Type of Transplant

There are 2 types of transplant that are autologous and allogenic . Autologous transplant transplant is the term used when patent's own bone marrow or stem cells are harvested and placed in the frozen storage (cyropreserved) and re-infused into the patient. Alogenic in other hand, refer to transplant received from someone's else bone marrow or stem cells. Transplants can be found in bone marrow cavities and peripherals blood .

Disease treated with BMT & Stem Cell Transplant
Example: Acute Mylegenous Leukemia, Acute lymphocyte leukemia, Chronic Mylegenic leukemia , Mielodyplastic syndrome, Hodgkin's disease, Non- Hodgkin's lymphoma, Neuroblastoma and etc. However, in the advent of technology, these transplant is aimed to treat other disease such as diabetes and others.

Peripherals Blood Stem Cell Transplant (PBSC)

In peripherals blood, the amount of stem cell are low and need to be stimulated by a process called Mobilization. This process will create more stems cells proliferation's. Peripherals blood stems, although found in low quantity then found in bone marrow, are more easily harvested and implanted.

The advantages of PBSC

Among the advantages of PBSC are it can be done as outpatient. This means patient do not need to have a hospital stay to get treatment. PBSC is done under Local analgesic and cause lesser pain than BMT. It also can be done although the patent's bone marrow are fibrotic, hypercellular or have disease. Tumour cells also has less ability to proliferate. Patient undergoing PBSC have rapid recovery, pay less amount of cost, and decreased possibility of having infections due to procedure. As the risk of infection is low, patient will have shorter lenght of stay in the hospital and consume less blood product and antibiotics.

The Disadvantages of PBSC

PBSC is a very complex procedure that uses a lot of labour using processing. The stem cells harvested need to be cryopreseve and may present with malignant cells. It also requires a large bore double lumen central venous control.

Process of PBSC

There two process of PBSC that are Mobilization and Apheresis. During mobilization, peripheral blood are stimulated to produce more stem cells for collection. This can cause side effect to patient such as pain, headache, fatigue and insomnia. These symptoms however, can be treated with oral analgesic.

Apheresis refers to the process of how peripheral blood stem cells are collected.. It utilize the peripheral vein at anticubital vein for venous process. The side effects of Apheresis is 30% to 50% drop in platelet count. Apheresis take 1 to 10 minutes time to perform and can be done for 3 to 4 hour a day and platelets count will take 1 week to recover.

Stages of PBSC

1) Pretreatment Workout

All recipients and donors have to be assessed to ensure that they are fit physically and psychosocially. For Allogenic transplant, assessment is done in outpatient and variety of test and procedures will be carried out such as history taking. physical examination and various blood tests.

2) Conditioning Regimen (1-10 days)

Process of preparing the patient to receive bone marrows or stem cells. It serves three important function that are:

a-Obliterates malignant disease

b- it destroy pre-existing immunologic state

c-Create space in bone marrow cavity for the proliferation of the transplanted cell.

As conditioning regimen will destroy all patient own bone marrow, proliferation of new eritrocytes, leukocytes, platelet cant occurs unless new functioning bone marrows or stem cells are given to patient. After completion of regime, patient must receive bone marrow or stem cells or patient will die.

Regimens used:

Radiotherapy and chemotherapy such as: Cyclophosphamide, Etoposide, Bussulfan and other chemotherapy drugs. Regimen are choose based on type of disease, amount and response to previous treatments of radiation or chemotherapy. Patient will experience side effect that varies according to chemotherapy drug used. Common side effects are mylosuppression, nausea and vomiting, diarrhoea and hair loss. The stem cell must be infused within 72 hours after completing conditioning regimen.

3) Transplantation

This process will take 20 to 30 minutes, depends on volume of cells transplanted. Among problem that are encountered during transplant are:Shortness of breath (Because rapid transfusion of stem cells) and Nausea and vomiting. Total time need for infusion is 5 to 10minutes and side effects from allogenic transplant same as blood transfusion such as chest pain and shortness of breathe.

4)Engraftment Period

Time immediately after transplant when stem cells start to migrate and started the regeneration process. It will takes 2 to 3 hours. During the process, patient will encounter pancytopenia and immunosuppression that will lead to infection and bleeding.

Well, that's all I can share this time as the class will start in any minute from now.

See you again!

Nursenoorazlin.

Computer in Nursing

noreply@blogger.com (Noor Azlin) — Sun, 30 Aug 2009 00:08:00 +0000

Computers affects every sphere of human activity and bring in many advancement in industry, education, health care, scientific research, social science, law and even in arts, music and painting. In Malaysia it may not be felt in the community and small clinics. However, the impact of computer technology can be felt only in modern hospitals such as Selayang Medical Center.

IMPLEMENTATION OF COMPUTERS APPLICATION IN CLINICAL NURSING PRACTICE:

a) Admission, Discharge and Transfer (ADT)

ADT system allows Nurses to obtain basic biographical information on clients before they arrive to the unit.

When a discharge or transfer is entered in the computer, all the appropriate departments (Eg: dietary, house keeping, pharmacy) are automatically notified, thus, saving the Nurses from many phone calls. Information about beds and a client's location on the unit is also readily available.

b) Nursing Documentation:

Nursing assessments, clients' care plans, medication, administration records, nursing notes and discharge plans are some of the forms of Nursing documentation that are computerized. Computerized documentation has many advantages. It is typed and therefore legible. The computer can be programmed to identify the data and time of all entries as well as the initials or the name of the person making the entry.

The computer can store standard nursing care plans in a format determined by the institution, to be used by Nurses as the basis for developing individualized client care plan. The computer is often programmed to automatically print a list of medication to be administered at pre determined times, during the day. A Nurse using a printout for a particular client, administers the medication and then charts it on the computer (If the medication is not charted and given within a specified time after the scheduled time, the computer prints a reminder that the medication is over due). Computer can perform drug dosage calculation faster and more accurately. Nurses' notes can be entered quickly by choosing statements, appropriate for a particular client from multiple pre programmed choices.

USE OF COMPUTERS IN NURSING EDUCATION.

Computer is a useful tool in Education because it allows for an individual a self paced learning. Computed Assisted Instruction (CAI) is a method of teaching that involves interaction between the learner and the computer. The computer takes on the role of a teacher.

There are three different types of CAI programmes:

a) Drill and Practice: It is the most common and least complex type of CAI. A learner is presented with a series of questions or problems about materials that have already been learnt. Drug dosage calculation, intravenous drip rate calculation and medical terminology and abbreviations are some. of the topics that drill and practice CAT is well suited for.

b) Tutorial Programs: Display new materials that are similar to programmed instructions. Tutorials present information and provide the learner the feed back.

c) Simulations : Present before learners the 'real - life' situations that are designed to assist learners in developing problem solving and decision making skills in a safe environment. Interactive Video Instruction (IAV) can provide learners. with "true -to - life" simulation. IAV combines CAI with a videotape or videodisc player so that video pictures as well as graphics can be incorporated in the design of the software.

NURSING RESEARCH:

Computers facilitate the research process in a number of ways. Computerized literature searches are a particular advantage to the researchers because they save time and can increase the scope of the search and the number of data base that can be searched. The computer can also help researchers collect and analyze data, prepare research reports, and disseminate research findings.

NURSING ADMINISTRATION:

Computers are useful tools for Nurse administrators. A number of computer programmes are designed to assist Nurse administrators. Computerized patients' classification system can be used to assign Nursing staff based on how severely ill clients are. Clients are assessed on a number of criteria and their abilities or need for Nursing care are rated. A client's total rating score indicates how much Nursing care the client requires. Computerized inventory system keeps track of supplies received and disbursed. They can also be integrated with the client billing system. General computer application software such as word processing, electronic spread sheets and data based management system help Nurse administrator to prepare reports and letters, create budgets and maintain personnel records and mailing lists. Computers can calculate daily the number of Nurses needed on each unit, computer can be used to schedule Nurses' days off so that an optional number of Nurses are working at one time.

This article is taken from FindArticles.Com

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Organizational Theory and Design as applied to health care system

An organization is a collection of people working together under a defined structure for the purpose of achieving predetermined outcomes through the use of financial, human, and material resources. There are a number of approaches to the structure and management of organizations.

Classical or Scientific Theory

Classical Theory

Work is divided into specialized tasks and standardized. The hierarchy of authority ( the right to direct ) and responsibility ( the obligation to perform ) is the chain of command. Line authority is linear and derived from position, staff authority is an advisory relationship.

The arrangement of the work group or organizational structure is based on departmentalization.

Span of control refers to how many employees a manager can effectively supervise.

Characteristics of Bureaucratic Structures

Authority and communication flow downward through a rigid chain of command.

The vertical growth represents many levels of supervision and indicates a one person one boss philosophy(unity of command)

The number of people supervised is small(span of control).

Bureaucratic Structure

Bureaucracy results in a line structure, so called because it is a chain of command or leader-follower relationship. It is also called a machine bureaucracy.

This type of structure facilitates large scale administration by coordinating the work of many personnel.

Complex Organizations

Highly structured, formal entities with uniform rules, policies and procedures.

People placed in functional specialty areas with standard pay structures,roles and responsibilities.

Authority clearly designated and centralized=a tall structure

Flat Structures

Less complex organizations have flat structures where authority is decentralized and the span of control is wider.

Other Classical Designs

Simple structure consists of a strategic apex ( executive- level management ) and an operating core ( the individuals responsible for the organizational work ). An example is a private physician’s office.

Classical Designs

A divisionalized form is characterized by a number of independent divisions with one administration such as an integrated system.

Adhocracy is a fluid structure using shifting teams of management, staff, and experts.

Human Relations Era

Concern for profit and production along with the human or social elements of an organization.

Fosters cooperation between labor and management and strives for worker autonomy and growth.

Focus on the informal organization with its rewards of attention and recognition.

Neoclassical or Humanistic Theory

Less formal, less control.More participation in decision making with decision authority at the point of service.

Results in a flat structure developed along horizontal lines with fewer levels of management.

Communication is enhanced, but managers can be overburdened.

Neoclassical Theory

Seeks to validate aspects of human behavior in organizations through research; the Hawthorne study.

Views managers as coaches, not as authority figures.

Concerned with employee motivation, satisfaction, creativity.

Authority works with willing participants.

Systems Theory

A system is a set of interrelated parts arranged in a unified whole.

Productivity is viewed as a function of the interplay among people, structure, and the environment.

The organization is a complex social and technical open system that requires human, financial, and material resources.

Learning Organizations

Influenced by systems theory, learning organizations are characterized by five disciplines: systems thinking, personal mastery, mental models, shared vision, and team learning.

Participation, in these organizations, is the basis of learning.

The organizational design is a systems model based on the rapid sharing of information through computer technology. This design can be applied to both bureaucracies and organic structures.

Contingency Theory

The organization’s structure must be matched to its environment to enhance performance.

The optimal form of an organization is contingent on the circumstances faced by that organization including patients, third-party payers, regulators, and personnel.

Chaos Theory

Based upon the belief in the uncertainty and unpredictability of the environment, chaos theory asserts that organizations are living, self-organizing systems that are complex and self-adaptive.

The system moves between order and chaos and is only stable temporarily.

Health Care Organizations

Health care organizations differ in ownership which can be either private or government, voluntary (not-for profit) or investor owned (for-profit), and sectarian or nonsectarian.

Health care organizations also differ in role, activity, and size.

Hospitals

Long Term Care Facilities

Long term care facilities provide skilled nursing or rehabilitative services.

Nursing facilities provide daily care.

Residential facilities are sheltered environments in which no skilled care is provided.

Ambulatory Care Centers

Physicians’ offices, birthing centers, surgical centers, and imaging centers are examples of ambulatory care.