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Let It Pour: My First Assignment as Executive Assistant

Who says rainy days and Mondays can get you down? It`s Monday and raining, and I`m on top of the world! On Saturday I got engaged, on Sunday we found a house that we`re going to bid on this coming weekend, today is the first day of my promotion to executive assistant to the chief executive officer (CEO), and this coming Saturday I`m graduating, having completed my bachelors at the University of Phoenix. Oh yeah! "Let it pour," I yell to myself as I pull into the hospital`s parking lot.
In fact, rain is good! Why do they always call anything but sunshine "bad weather"? After such a long dry spell, we need the moisture. It helps the crops grow, cleans the air, and fills the lakes. So, all the eaters, breathers, and water drinkers--that should cover us all--can`t live without it. Bad weather? What kind of thinking is that? Uh, oh! My thinking is bouncing around like the waves of the puddle I just stepped in.
Greetings and best wishes surround me as I make my way to the executive offices--my new place of employment. I discover my office to be a single desk in space shared with the CEO`s administrative assistant (AA). No problem! The AA is a great person, with a positive attitude, a good thinker, and very efficient. We`ll work well together.
"Good morning. Your new business cards are on your desk; here`s a writing pad, and the boss wants to see you in the executive meeting room ASAP," shoots out of the AA`s mouth as if from an automatic weapon. I throw my attaché case "on" my office--the desk--grab one of my new business cards, and hustle to the meeting room. I take a quick look at my card. There it is: Chris Smith, Executive Assistant, Faith Community Hospital.
As I reach for the door handle, it seems unusually low. I must be walking above the clouds. My moment of pride is cut short by the incredible panoramic view of our beautiful valley--that view, the clouds with their infinite variety of geometric patterns and shades of white and gray, rolling through the sky.
"Good morning, Chris," my new boss greets me. "Welcome aboard," Pat offers, more as an obligatory greeting than a real welcome. "These rainy days and Mondays really get me down. Have a seat." As I sit down, Pat continues by commenting, "I understand you`re about to get your degree."
"I am almost done! This Saturday is graduation," I answer, with a sense of pride and relief and somewhat nostalgically.
"Far from done; you`ve only just begun," the CEO clarifies. "But, before we go on with the task at hand, tell me: which courses did you enjoy the most?" Just as I begin to answer, Pat quickly adds, "Let me change that question: in which courses did you learn the most?"
I think, `Which ones do you want to hear?` but I answer, "Management, Public Speaking, Organizational Behavior, Ethics, and, of course, Critical Thinking."
"Great," answers the CEO, "because you`re going to need every one of those and more with the first assignment I`m about to give you. Are you ready to apply your newly developed skills?"
"Let the rain fall down on me," I respond, hoping Pat has a sense of humor.
"Oh it will, and I hope it doesn`t dissolve you." Yes, Pat does have sense of humor.
"I see you have your business card. Turn it over, please. Just in case you don`t have the mission statement memorized, you can always read it, right there on the back of the card "With toundation and commitment of our spiritual heritage and values, our mission is to promote the health and well-being of the people in the communities we serve through a

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comprehensive continuum of services provided in collaboration with the partners who share the same vision and values."
"What do you think?" asks Pat.

"I do believe it and I`ll certainly try hard to live by it. Plus, by having it on the back of our cards, we`re doing a great job at keeping it in front of everybody, so to speak," I chuckle.
"Nice play on words, Chris. Unfortunately, few Faith Community members and partners seem to be flipping for it lately," responds the CEO. We`ve got some interesting interpretations of the mission statement being made in all of our stakeholder groups. Very patchy, I must say. Chris, do you have any idea what`s going on out there?"
"It`s pouring," I respond bluntly.
"Yes it is!" Pat confirms. "It`s falling from every direction, and coming in all over the place. Here`s some of what I`m thinking about.
"Let`s start with this morning`s news headline that medical errors cause tens of thousands of deaths each year, close to 100,000 in hospitals alone. With that as the external panoramic view, let me paint the picture for you, from the inside out.
"I report directly to the Board of Directors of the Faith Foundation. Its diversity alone represents a kaleidoscope of thinking and decision-making. The grand point of commonality among the Board members is their support of the purpose, values, and survival of Faith Hospital. The entire community knows of our religious heritage and our commitment to the public. That openness attracts a wide variety of believers--Board of Directors, staff, patients and their families, as well as others--each with infinite influences on his or her own thinking. I`m not sure how many of our stakeholders realize or understand the differences between ethics, laws, beliefs, oaths, etc. If they do understand, how many accept the fact that we draw our value lines at diverse junctures when it comes to applying these ground rules?
"On one hand, we have particular patients who refuse to take certain medical services, and on the other hand, particular staff members who refuse to provide certain services. In both cases, they feel that medical intervention can go too far into conflict with their religious beliefs or personal moral convictions. We have a case in our Neo-Natal Ward, where Child Protective Services is in the process of taking custody of the baby and threatening to file charges against us because of the way we provided services or, as they allege, failed to provide services. All this trouble, despite our actions being in agreement with the parents` wishes. Last week, three staff members in the ICU initiated Do Not Resuscitate (DNR) directives. The only problem was that no written orders to that effect existed. At the same time, I have some sincere, qualified staff that are driven by a personal directive that says `we have to do all that we can.` In another recent incident, staff members did not follow DNR directives even though these were in place. Moreover, all three events had the support of the patients` families.
"And how are our doctors responding? Well, they`re putting patients first, I guess! From various interpretations of the Hippocratic oath, to assorted compassions and passions regarding the `right to die,` they are all over the place. From managed care to capitation, health care givers are experiencing a tremendous loss of power.
"Nonetheless, we have wonderful people who care very much about the well-being of their patients; so much so, in fact, that one of our hospital pharmacists is filling uninsured prescriptions by accepting payment in installments. Two of our counselors are treating some of their clients pro bono--unauthorized! At the other end of the spectrum, some staff members care so much about Faith`s survival that they refuse to serve patients unless they confirm insurance coverage first. You can imagine how popular that is with patients and the media alike. All we need is for someone to die because we didn`t service him or her! One of our residents is ordering fruitless exams for the terminally ill.

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"Those who request our services (i.e., our clients, the public) come to us from all points of the compass...."
"...Or spectrums of the rainbow," I interject.
"O.K.," the CEO responds slowly. "From all spectrums of the rainbow. But I`m not talking as much about ethnicity, culture, or physical stuff--stuff, one of those biomed-tech terms, you know--as I am about the range of responsibility. Between their needs and wants, our patients bring a massive flood of service demands through our doors. Sure, we all want to live healthier and longer, but who has the greatest responsibility for health maintenance? And when someone`s well

being is in distress, we at Faith had better provide the perfect remedy. Heck, it`s like blaming the rain for getting wet, or the umbrella if you`re not totally dry.
"If we had more time and stamina, I could also tell you about so-called especially wonderful collaborations with insurance companies and the regulators--HMOs, PPOs, and other TLAs--you know, three-letter acronyms such as AMA, AHA, HHS, etc. Who gets covered, how much and when we get paid, seem to be totally out of our hands at times. At the same time, we get so-called supportive intervention that goes something like, `I`m from Medicare and Medicaid, and I`m here to save you.` And, if they don`t, we, of course, have our own insurance coverage. I bet you wouldn`t believe me if I told you that our premium costs are decreasing. Good, because they`re not!
"Look at how much our costs have increased compared to last year. A year ago, our costs were $217.00 per patient per day. On the last report that I received from accounting, that figure had risen to $240.00. Two questions came immediately to mind when I saw this number: Are we running a less efficient operation? Can we reduce costs without impacting quality?
"I asked the financial analyst for an evaluation, and he indicated that we`ve had a 7% decrease in patient population. Roughly 28% of our costs are fixed costs--costs that do not vary with the fluctuating patient population. This tells me that our costs do not change proportionally with the number of patients that we treat. If we can`t do something to increase the patient count, then we will have to make some tough cost-reduction decisions. Assuming that we are not able to increase our patient count, we will have to reduce our fixed cost to break even."
As I listen to Pat, I try not to let my mounting stress show in my face. At this point, I wish I had paid more attention in those accounting and finance courses I took....
Pat picks up a paper from the desk. "Here is some data that you might find interesting, Chris. If we hold steady at 7,863 patients and 39,866 patient days, we will be forced to reduce our fixed costs by 15% just to break even. That assumes that our average reimbursement rate does not change. That is one heck of a big reduction!"
"I`m sorry, it`s just that I`m getting showered with chaos. I really don`t believe everyone is against us. We may have a written unifying mission statement, but everyone thinks about it differently. We may all be in the same boat during the same storm, but no two people are rowing in the same way or in the same direction. In fact, some don`t even have their oars in the water! Harsh as it may sound, I`ve got a business to run here. We may be a not-for-profit, but we have people to serve, bills to pay, a mission to live by--as if I need the Board to remind me--and it is pouring.
"I`m not sure of my role any more. I mean, where should I be spending most of my time and energy, not to mention other resources? Should I fight for healthcare reform or reform the healthcare fight? I`m not trying to play word games here, but are the answers from the outside in, or vice versa?"
Pat takes a slow and deliberate pause, and then turns to me appearing ready and eager to solve the problems before us.
"Here, then, is your first assignment," says Pat. "I want you to put together a preliminary report that will form the basis for my presentation at that meeting. Two weeks from today, we will hold the first all-member staff meeting I`ve attempted during my ten years at Faith."

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Pat is ready and eager to solve the problems before us by first delegating them to me.
"We will also tape the meeting for those who can`t be there in person or who need to review the message a few times. And, guess what added bonus we`ll have? Members of the media are requesting permission to attend.
"I`m not asking you to write a speech. I can create my own message. But I do want you to give me some ideas about what to say. If I talk about all the stuff going on, I`ll have everyone running for a storm shelter; therefore, capture the essential components. Just as importantly, though, I want some specifics on how to say it. What I`d like you to do is to give me a strategic overview that offers a look from three angles: what`s going on right now, what we can do about it, and what we should do about it.""These are the three main elements of a case study," I proclaim.

"Great! Our investment in your schooling is paying off already," adds Pat, somewhat sarcastically.
"I want you to use your critical-thinking skills in addressing the main topics that I need to cover in this presentation. To me, these appear to be organizational processes, ethics issues, and communication systems. I also want you to address--to paraphrase what it says at the end of a job description--any other particulars not identified at this time.
"Oh, by the way, Chris, I hate to rain on your parade, but I want to go over that report with you next Monday. Good luck on your first week."
As I leave the executive office my legs move as if I have 20-pound ankles weights on each foot. I quietly whisper to myself, "Rainy days and Mondays still don`t get me down. Let it pour."

Here`s what I came up with....
1. Define the problems that appear in this case study.
2. Propose the appropriate solution(s).
3. Describe your rationale for the proposed solution(s).
Use the appropriate format for your paper.

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