The increased movement of both goods and people increases opportunities for the spread of disease around the world. There are also concerns about the following: potential public health problems due to market liberalisation, the emergence of new diseases globally and worsening of existing ones due to climate change and governmental oversight over economic policies that can affect spending on healthcare. International cooperation as a result of globalisation has also had a great impact on health practices in many countries including Europe.

In this backdrop, as a ‘healthcare management consultant’ working for an international organisation, you are asked to examine the implications and effects of globalisation on healthcare management.

Identify the effects of globalisation on healthcare

Globalization can be defined as a network of processes which nations, firms and business and people are getting more interdependent and connected across the global community through the increased and strengthened economic integration, exchange of communication, diffusion of the Western culture and travel as well as migration. We must give ample attention to the processes by which the connectivity and interdependence among nations are happening.

Globalization is akin to a new phenomenon where basic human drive comes into action. The history of human kind has evolved through crossing borders, exploring new heights, expanding horizons, trading commodities, conquering territories and assimiliation of culture and social practices.

Globalization involves people and their behaviours in a society. Similar to the trade and commerce benefits of globalization, the consequences and effects of globalization to healthcare is being magnified on a larger scale. The effects of globalization on healthcare might include the following:

Tourism brings gaps among borders and increases awareness among cultural differences and practices. Global tourism starts to grow and a lot of countries have the liberalization of their airline industries which makes travelling more affordable. According to Sutherst,2004(Sutherst R (2004) Global change and human vulnerability to vector-borne diseases. Clin Microbiol Rev 17: 136−173) there are approximately one million international travellers every day and a significant percentage of these people are travelling between developed and developing countries which can facilitate the spread of communicable diseases. With the increasing number of travellers, the possibility of acquiring infections and diseases is greater than those countries who are not that inclined towards global travelling. Globalization can dramatically improve healthcare through the development of policies rooted on equality and allocation of resources for all members of the society especially those services pertaining to health (UNDP, 1999; Ben-David et al., 1999; Cornia, 2001).

Globalization can foster protectionist policies, allocate subsidies and preserve livelihoods and rural life by which the European Union frequently advances. The benefits of these are the quality and health of the people. If there is proper funding of health projects, it can result into a healthier citizenry who can function at their best and contribute to the development of the society.

Through the process of globalization, healthcare settings are best influenced by the increased universal access to healthcare, legislation regarding exposure to hazardous wastes and environment. The stronger the economy, the better are the facilities for public health, water sanitation, health services and a lot more.

Through the globalization, the application and profound recognition of health as a human right are being brought into the consciousness of people from across the globe. People are now more aware of the interdependence and interrelationship of health with the various types of human rights such as cultural, social, political, economic and civil rights.

WORD COUNT: 459

Assess the influence of international institutions in healthcare settings

The diversity of services in terms of health care has been immensely affected by globalization itself. Developing countries has the ability to attract customers by providing quality healthcare at a lower cost than the counterparts in their own country. Within a short period of time there are a lot of changes by which health and the people are most concerned off. The development of global standards of excellence and quality will also bring forth the rise of processes in the accreditation and licensing of medical and healthcare medical education.

Through globalization, the circulation of services and goods are more efficient than before. Specific multilateral agreements between States often serve as a detrimental factor for countries of the developing world. Despite the economic benefits of globalization, there are several effects on the healthcare practices and settings from one country to the other.

One of the best indicators in the level of development of a country is health. The reflection by which the resources and wealth of the country are being allocated to, shared equally by the entire population.

International institutions can influence the delivery of health care through globalization. However, health itself cannot be assumed as significant similar to that of the basic needs of human. The movements of healthcare professionals, the exodus of the members of the health team are strongly related to the complex cultural, ethical, and human resources issues in their mother land. Thus it is imperative that health professional must promote health as a global human right.

International institutions must be prepared before launching headlong into the challenges of globalization, M. Srinivasan,2006 et al. (Visualizing the Future: Technology Competency Development in Clinical Medicine, and Implications for Medical Education Acad Psychiatry, December 1, 2006; 30(6): 480 – 490.) The health practices being implored can be influenced by foreign relations and policies of a country. It is best that the challenges of globalization shall be faced with much ease and confidence so that there will be no room for errors which will compromise the health of the people.

Developed countries are tapping their international institutions to recruit and acquire trained graduates from poorer countries. With the movement of professionals, healthcare settings are improved through the expertise and carative characteristics of people from the poorer countries. These countries are improving their immigration policies to accommodate the influx of various members of the health care team.

Healthcare setting in developed countries are influenced by international institutions who are expecting reciprocity in terms of economic and social implications of globalizations. The increased of workers in the health care industry, can facilitate the health of the citizens.

WORD COUNT: 434

Evaluate the impact of European Union membership on workplace health practices.

Health will not transform how we think about the foreign policies and the health practices we implore. The establishment of the European Common Markets has brought about a lot of changes not only in free movement of goods and capitals but social and cultural aspects of the country. Through the European Union, services and persons are free to move. The principles of free movement can be applied in the health care industry as well. The members of the health sector have the following changes in terms of the influence of the European Union:

Through the membership with EU they can allow the free incorporation and inclusion of health care providers and professionals as well as the cross-border delivery of health care services. Since the year 1970, the European Union (EU) has passed a myriad of regulations regarding health practices. One of the regulations is to reinforce the mutual recognition of nurses, physicians and other members of the healthcare professionals in terms of their qualifications. Through this, the Member States will recognize the professionals who hail from among the members of the European Union which is considered to be an indispensable precondition for the non-restrictive movement of services. Thus , in reference to the establishment of the European job market for the members of the health care team, it has not led to the extensive migration among the member of the European Union (EU).

The accession of the Eastern and Central European countries to the European Union( EU)did hot stirred an alarm of brain drain. Brain drain is the major concern among authorities due to the imminent depletion of healthcare professionals to the better off countries located in the Northern and Western Europe.

The numerous potential effects of the European Union (EU) on the social protection systems in the applicant countries due to the variations and differences between the type of health care systems among the 25 Member States. A lot of authorities are expecting mass exodus of professionals from the accession countries.

Free movement of health care professionals and occupations has not paved the way into the expected transnational migration among the Member states of the European Union. The language barrier is one of the major reasons why the health care sector deal on a personal level and are quite sensitive about it. There are countries in Europe where English is not widely spoken. Thus, it will be very difficult to administer and render health care services.

WORD COUNT: 411

WORD COUNT: 1314

Question 2

You are employed by Sahara Oil Company based in Qatar as their Occupational Health expert. The company produces and refines oil; it also explores gas deposits. There has not been a recent review of the environmental effects of the company’s operations. You have responsibilities for the environmental health issues of Sahara Oil’s operations in Qatar. As well, one important responsibility you have been given is to be conversant with the impact of environmental legislation, directives and guidance and the processes that organisations need to adopt in order to provide health protection to the employees of the company, their families and the members of the local community who are affected by Sahara Oil’s operations in Qatar.

Identify the economics of adopting a policy of environmental awareness in heath care settings.

All of the above lead to improved QOL and increased life expectancy. However, all this come with a cost to human health and the environment.

Effects on health:

Such activities and their impact on the environment have serious effects on health of communities,, esp. Chdn’s health. However, there is uncertainty of the effects of such activities or technologies on health as there is no scientific evidence that directly links such activities to disease causation. E.g., there is still ongoing debate about the scientific evvidence linking greenhouse gases to global warming.

Governments’ inaction is because they fear that taking action would affect trade. E.g. taking action to prevent bon-fossil fuels :-charcoal and oil burning- in order to reduce CO2 emission into the atmosphere by developing nations i.e., China and India would collapse their industries and economy.

However, the economic cost of technological development on the environment and human health is higly significant.

The Precautionary Principle states that in the case of serious or irreversible threats to the health of humans or the ecosystem, acknowledged scientific uncertainty should not be used as a reason to postpone preventive measures.

The concept of a universal precautionary principle apparently has its origins in early German and Swedish thinking about environmental policy, particularly the need for policymakers to practice foresight in order to prevent long-range environmental problems. The concept was included in the Amsterdam Treaty–an important step toward establishment of the European Union–but the concept was left undefined and was applied only to environmental policy. In the past 20 years, there have been numerous references to precaution in various international treaties, statements of advocacy groups, and academic writings, but the significance of the principle in international law remains uncertain.

The EIB considers the need for applying the precautionary principle when there is a risk that a project may cause significant and irreversible damage to the environment. In such cases, measures should be taken by the promoter to avoid in the first place and if a feasible alternative is not available to reduce that risk to an acceptable degree.

Assess the actions that need to be taken by organisations to maintain the environment.

Pollution of the aquatic environment occurs from many different sources including from oil refineries. Oil refinery effluents contain many different chemicals at different concentrations including ammonia, sulphides, phenol and hydrocarbons. The exact composition cannot however be generalised as it depends on the refinery and which units are in operation at any specific time. It is therefore difficult to predict what effects the effluent may have on the environment. Toxicity tests have shown that most refinery effluents are toxic but to varying extents. Some species are more sensitive and the toxicity may vary throughout the life cycle. Sublethal tests have found that not only can the effluents be lethal but also they can often have sublethal effects on growth and reproduction. Field studies have shown that oil refinery effluents often have an impact on the fauna, which is usually restricted to the area close to the outfall. The extent of the effect is dependent on the effluent composition, the outfall’s position and the state of the recipient environment. It is possible to detect two effects that oil refinery effluent has on the environment. Firstly it has a toxic effect close to the outfall, which is seen by the absence of all or most species. Secondly there is an enrichment effect which can be distinguished as a peak in the abundance or biomass. These effects are not limited to just oil refinery effluents, which make it difficult to distinguish the effects an oil refinery effluent has from other pollution sources. The discharge from oil refineries has reduced in quantity and toxicity over recent decades, allowing many impacted environments in estuaries and coasts to make a substantial recovery.

Specify the measures that exist to improve workplace health and safety practices

When oil refineries do not practice workplace safety, it can result in numerous problems. These problems can force a refinery to trim production or shut down completely. For example, dozens of oil refineries were shut down in 2007 due to fires, leaks, spills and power failures.

Crude Oil Pre-treatment (Desalting)

Fire Prevention and Protection: The potential exists for a fire due to a leak or release of crude oil from heaters in the crude desalting unit. Low boiling point components of crude may also be released if a leak occurs.

Safety: Inadequate desalting can cause fouling of heater tubes and heat exchangers throughout the refinery. Fouling restricts product flow and heat transfer and leads to failures due to increased pressures and temperatures. Corrosion, which occurs due to the presence of hydrogen sulfide, hydrogen chloride, naphthenic (organic) acids, and other contaminants in the crude oil, also causes equipment failure. Neutralized salts (ammonium chlorides and sulfides), when moistened by condensed water, can cause corrosion. Overpressuring the unit is another potential hazard that causes failures.

Health: Because this is a closed process, there is little potential for exposure to crude oil unless a leak or release occurs. Where elevated operating temperatures are used when desalting sour crudes, hydrogen sulfide will be present. There is the possibility of exposure to ammonia, dry chemical demulsifiers, caustics, and/or acids during this operation. Safe work practices and/or the use of appropriate personal protective equipment may be needed for exposures to chemicals and other hazards such as heat, and during process sampling, inspection, maintenance, and turnaround activities.

Depending on the crude feedstock and the treatment chemicals used, the wastewater will contain varying amounts of chlorides, sulfides, bicarbonates, ammonia, hydrocarbons, phenol, and suspended solids. If diatomaceous earth is used in filtration, exposures should be minimized or controlled. Diatomaceous earth can contain silica in very fine particle size, making this a potential respiratory hazard.

Crude Oil Distillation (Fractionation)

Fire Prevention and Protection: Even though these are closed processes, heaters and exchangers in the atmospheric and vacuum distillation units could provide a source of ignition, and the potential for a fire exists should a leak or release occur.

Safety: An excursion in pressure, temperature, or liquid levels may occur if automatic control devices fail. Control of temperature, pressure, and reflux within operating parameters is needed to prevent thermal cracking within the distillation towers. Relief systems should be provided for overpressure and operations monitored to prevent crude from entering the reformer charge.

The sections of the process susceptible to corrosion include (but may not be limited to) preheat exchanger (hydrogen chloride (HCl) and hydrogen sulfide (H2S)), preheat furnace and bottoms exchanger (H2S and sulfur compounds), atmospheric tower and vacuum furnace (H2S, sulfur compounds, and organic acids), vacuum tower (H2S and organic acids), and overhead (H2S, HCl, and water). Where sour crudes are processed, severe corrosion can occur in furnace tubing and in both atmospheric and vacuum towers where metal temperatures exceed 450° F. Wet H2S also will cause cracks in steel. When processing high-nitrogen crudes, nitrogen oxides can form in the flue gases of furnaces. Nitrogen oxides are corrosive to steel when cooled to low temperatures in the presence of water.

Chemicals are used to control corrosion by hydrochloric acid produced in distillation units. Ammonia may be injected into the overhead stream prior to initial condensation and/or an alkaline solution may be carefully injected into the hot crude oil feed. If sufficient wash-water is not injected, deposits of ammonium chloride can form and cause serious corrosion. Crude feedstock may contain appreciable amounts of water in suspension which can separate during startup and, along with water remaining in the tower from steam purging, settle in the bottom of the tower. This water can be heated to the boiling point and create an instantaneous vaporization explosion upon contact with the oil in the unit.

Health: Atmospheric and vacuum distillation are closed processes and exposures are expected to be minimal. When sour (high-sulfur) crudes are processed, there is potential for exposure to hydrogen sulfide in the preheat exchanger and furnace, tower flash zone and overhead system, vacuum furnace and tower, and bottoms exchanger. Hydrogen chloride may be present in the preheat exchanger, tower top zones, and overheads. Wastewater may contain water-soluble sulfides in high concentrations and other water-soluble compounds such as ammonia, chlorides, phenol, mercaptans, etc., depending upon the crude feedstock and the treatment chemicals. Safe work practices and/or the use of appropriate personal protective equipment may be needed for exposures to chemicals and other hazards such as heat and noise, and during sampling, inspection, maintenance, and turnaround activities.

Solvent Extraction and Dewaxing

Fire Prevention and Protection: Solvent treatment is essentially a closed process and, although operating pressures are relatively low, the potential exists for fire from a leak or spill contacting a source of ignition such as the drier or extraction heater. In solvent dewaxing, disruption of the vacuum will create a potential fire hazard by allowing air to enter the unit.

Health: Because solvent extraction is a closed process, exposures are expected to be minimal under normal operating conditions. However, there is a potential for exposure to extraction solvents such as phenol, furfural, glycols, methyl ethyl ketone, amines, and other process chemicals. Safe work practices and/or the use of appropriate personal protective equipment may be needed for exposures to chemicals and other hazards such as noise and heat, and during repair, inspection, maintenance, and turnaround activities.

Thermal Cracking

Fire Protection and Prevention: Because thermal cracking is a closed process, the primary potential for fire is from leaks or releases of liquids, gases, or vapors reaching an ignition source such as a heater. The potential for fire is present in coking operations due to vapor or product leaks. Should coking temperatures get out of control, an exothermic reaction could occur within the coker.

Safety: In thermal cracking when sour crudes are processed, corrosion can occur where metal temperatures are between 450° and 900° F. Above 900° F coke forms a protective layer on the metal. The furnace, soaking drums, lower part of the tower, and high-temperature exchangers are usually subject to corrosion. Hydrogen sulfide corrosion in coking can also occur when temperatures are not properly controlled above 900° F.

Continuous thermal changes can lead to bulging and cracking of coke drum shells. In coking, temperature control must often be held within a 10°-20° F range, as high temperatures will produce coke that is too hard to cut out of the drum. Conversely, temperatures that are too low will result in a high asphaltic-content slurry. Water or steam injection may be used to prevent buildup of coke in delayed coker furnace tubes. Water must be completely drained from the coker, so as not to cause an explosion upon recharging with hot coke. Provisions for alternate means of egress from the working platform on top of coke drums are important in the event of an emergency.

Health: The potential exists for exposure to hazardous gases such as hydrogen sulfide and carbon monoxide, and trace polynuclear aromatics (PNAs) associated with coking operations. When coke is moved as a slurry, oxygen depletion may occur within confined spaces such as storage silos, since wet carbon will adsorb oxygen. Wastewater may be highly alkaline and contain oil, sulfides, ammonia, and/or phenol. The potential exists in the coking process for exposure to burns when handling hot coke or in the event of a steam-line leak, or from steam, hot water, hot coke, or hot slurry that may be expelled when opening cokers. Safe work practices and/or the use of appropriate personal protective equipment may be needed for exposures to chemicals and other hazards such as heat and noise, and during process sampling, inspection, maintenance, and turnaround activities. (Note: coke produced from petroleum is a different product from that generated in the steel-industry coking process.)

Fire Prevention and Protection: The potential exists for a fire due to a leak or release of crude oil from heaters in the crude desalting unit. Low boiling point components of crude may also be released if a leak occurs.

Safety: Inadequate desalting can cause fouling of heater tubes and heat exchangers throughout the refinery. Fouling restricts product flow and heat transfer and leads to failures due to increased pressures and temperatures. Corrosion, which occurs due to the presence of hydrogen sulfide, hydrogen chloride, naphthenic (organic) acids, and other contaminants in the crude oil, also causes equipment failure. Neutralized salts (ammonium chlorides and sulfides), when moistened by condensed water, can cause corrosion. Overpressuring the unit is another potential hazard that causes failures.

Health: Because this is a closed process, there is little potential for exposure to crude oil unless a leak or release occurs. Where elevated operating temperatures are used when desalting sour crudes, hydrogen sulfide will be present. There is the possibility of exposure to ammonia, dry chemical demulsifiers, caustics, and/or acids during this operation. Safe work practices and/or the use of appropriate personal protective equipment may be needed for exposures to chemicals and other hazards such as heat, and during process sampling, inspection, maintenance, and turnaround activities.

Depending on the crude feedstock and the treatment chemicals used, the wastewater will contain varying amounts of chlorides, sulfides, bicarbonates, ammonia, hydrocarbons, phenol, and suspended solids. If diatomaceous earth is used in filtration, exposures should be minimized or controlled. Diatomaceous earth can contain silica in very fine particle size, making this a potential respiratory hazard.

( Word count :1300 )

Question 3

You have been appointed consultant to a pharmaceutical company in Mumbai that sources clinical trial contracts from abroad, especially the United States of America and western Europe. Because of its international operations, the work force of the company is also varied with employees from various countries around the world. You are asked to explore the issues that affect the company’s operations in the current economic environment when implementing healthcare management practices.

Analyse the responsibilities of organisations in improving work place health and safety.

The following are recommended practical activities that executives can do at each stage of their personal journey to understanding the value of diversity.

1. Discovery. Executives must become aware of the need to view racial and ethnic diversity as a significant strategic issue. They should thoroughly read this timely study and review many of the excellent references outlined at the end of the study.

2. Assessment. Executives must determine where their organizations are on the road to capitalizing on racial and ethnic diversity. The Tables in the article present a series of best practices against which an organization can benchmark its responsiveness to diversity practices. Another useful exercise during the assessment stage would be to determine what data their organizations have access to regarding the diversity of the population of the community they serve, their organization’s patient demographics, and their organization’s workforce.

A scarcer and more diverse workforce. As a result, healthcare organizations (HCOs) must develop policies and practices aimed at recruiting, retaining, and managing a diverse workforce and must meet the demands of a more diverse patient population by providing culturally appropriate care and improving access to care for racial/ethnic minorities. Ultimately, the goal of managing diversity is to enhance workforce and customer satisfaction, to improve communication

among members of the workforce, and to further improve organizational performance.

Research on diversity management practices in HCOs is scarce, providing few guidelines for practitioners. This study attempted to close that gap. Results show that hospitals in Pennsylvania have been relatively inactive with employing diversity management practices, and equal employment requirements are the main driver of diversity management policy. The number and scope of diversity management practices used were not influenced by organizational or market characteristics. The results suggest that hospitals need to adopt diversity management practices for their workforces and need to pay particular attention to marketing and service planning activities that meet the needs of a diverse patient population.

Diversity has become a crucial subject in the field of management as organizations pay increased attention to major demographic shifts in the U.S. population. As of 1999, 28 percent of the U.S. population was a member of a racial or ethnic minority group, and it is projected that by 2030, 40 percent of the U.S. population will be members of a racial or ethnic minority group (U.S. Census Bureau 1999). These changes are resulting in an increasingly diverse labor pool and customer base.

Policymakers are also being more attentive to racial/ethnic disparities in access to care and health status. While such disparities are well documented, relatively less is known about the underlying causes for the disparities. Researchers have examined financial barriers, racism and discrimination, and patient preferences as potential sources of these disparities (Williams and Rucker 2000).

To respond to the demographic shifts of the workforce and patient population and address racial/ethnic disparities in access and outcomes of care, healthcare organizations (HCOs) will need to become culturally competent organizations. Cultural competency has been defined as an “ongoing commitment or institutionalization of appropriate practice and policies for diverse populations” (Brach and Fraser 2000). While cultural competence is the goal, diversity management is the process leading to culturally competent organizations. Diversity management is .a strategically driven process” whose emphasis is on building skills and creating policies that will address the changing demographics of the workforce and patient populations (Svehla 1994).

Diversity management and leadership practices are known to enhance workforce and customer satisfaction, to improve communication among members of the workforce, and to further improve organizational performance (Cox 1994; Dreachslin 1996). However, only some organizations choose to respond to workforce and customer demographics by initiating diversity management practices and becoming diversity leaders (Dreachslin 1999). Others resist, making only those changes necessary to comply with affirmative action guidelines.

A recent survey on career attainment among healthcare executives across different races/ethnicities confirms that much improvement is still needed in the cultural and diversity climates of HCOs (De Anda et al. 1998). Research examining diversity management practices in HCOs is scarce. To date, only three prior studies have examined diversity management practices in HCOs-one using case study methodology (Muller and Haase 1994) and two others using survey methodology (Motwani, Hodge, and Crampton 1995; Wallace, Ermer, and Motshabi 1996). These studies have focused on human resources issues in diversity management. Each of the three studies found that relatively few hospitals had implemented diversity management programs even when hospitals considered diversity management an important organizational issue. Furthermore, Muller and Haase (1994) found that all hospitals in their study fitted the “pluralistic” profile in which they were not actively managing diversity but employing diversity management policies and programs that were primarily compliance-oriented strategies.

Compare organisational approaches to ensuring positive policies of work place diversity.

Cultural diversity in the workplace is not only the right thing to do, it is the expeditious thing to do. It ensures responsiveness and responsiveness is synonymous with survival.

Diversity in the workplace is important because of its contribution to organization decisionmaking, effectiveness, and responsiveness. Those from diverse populations have experiences, insights, approaches, and values from which can come many different perspectives on and alternative approaches to problems, and knowledge about consequences of each alternative. From a leadership position (for example, an executive, managerial, and/or supervisory position), suggestions and recommendations of such alternatives and