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The variable impact of new public management and budget cuts on the work intensification of nurses and doctors in one public hospital in South Australia between 1994 and 2000.
This paper explores the impact of new public management and budget cuts on the work intensification of nurses and doctors in one Australia public hospital during the 1990s. These were the time-based incentives built into the Medicare Agreements the 1993-1998 and 1998-2003, and casemix Diagnosis Related Groups. These two reforms were part of a broader micro-economic strategy underpinned by new public management processes employed by the state to increase the productivity of health professionals. The impact of these reforms on the labour of health professions was variable, however. Documentary evidence from a study conducted in a public acute hospital in South Australia, called 'Westernvale', illustrates that during the period 1994-2001, these reforms resulted in a longer period of work intensification, for the profession of nursing than that of medicine.
Introduction: Evidence for Work Intensification in the Healthcare Sector
During the 1990s the Australian government introduced two major funding reforms into the public healthcare system to bring about productivity and efficiency gains. These were incentive based funding linked to the Medicare Agreements and casemix Diagnosis Related Groups (DRGs).
This paper illustrates the impact of these reforms on the staffing levels for doctors and nurses in one public acute hospital in South Australia, called 'Westernvale'. Data for the paper are taken from a larger ethnographic study conducted between 1997 and 2002 at Westernvale. Data collection included six months participant observation on two wards, attendance at Australian Nursing Federation site meetings over a six month period, interviews with cleaning, clinical, administrative and management staff, participant observation with nursing outreach staff over the five year period and analysis of key in-house and State government documents and relevant evidenced-based literature. The paper is divided into two sections. Section one provides a brief discussion on work intensification and the reform process, situating the Medicare incentives and casemix DRGs as performance management tools of new public management processes. Section two demonstrates the impact of these reforms on Westernvale staffing levels over the eight year period from 1994 to 2000, arguing that the nursing division experienced a more protracted period of work intensification than other professional groups such as medicine or medical scientists.
Work intensification is not limited to the public health sector; claims are made that it has reached epidemic proportions in a number of industries, with negative impacts on the quality of work, family life and personal health (Burchielli, Pearson and Thanacoody 2005, Green 2004, Pocock, Wanrooy, Strazzari and Bridge 2001). Generally, work intensification is defined as having more work to do than previously, although more elaborated definitions include 'having extra roles, taking on more tasks with the same staff numbers, or coping with the same or heavier workloads with fewer staff (Allan, O'Donnell and Peetz 1999; Green 2004; Burchielle et al 2005, p. 96). Green and McIntosh (2001. p. 56) suggest that work intensification should be examined firstly in terms of the longer hours worked (extensive work effort) and secondly in terms of the work pace (intensive work effort).
Within the healthcare sector there have been numerous claims to increased workload (Allan 1998, Considine and Buchanan 2000, Willis 2002, White and Bray 2004), but, as White and Bray note, few authors have provided cohesive frameworks for examining these claims. In making a claim for work intensification in the healthcare sector White and Bray (p. 3) suggest that in many instances it is possible to provide direct evidence by comparing shifts in staffing numbers against increases in patient volume, increases in patient numbers can contribute to either intensive or extensive work effort. his evidence is particularly powerful when it is accompanied by other contributing factors such as increased technological and organisational change; the introduction of multi-skilling and functional flexibility; human resource management techniques designed to engender greater worker engagement; increased use of incentives; decreased power of unions; or rising job insecurity (Green 2004). Added to these factors is a flow on effect; in workplaces were the work is intensified for one occupational group, this is likely to impact on the work of other categories of workers, especially where multidisciplinary teamwork is required.
In the case of nursing, claims to work intensification can be seen to be the result of a number of these factors (White and Bray 2004). Importantly, the nursing case is bolstered by the impact of work intensification on other groups working alongside nurses, be they doctors, allied health professionals or cleaners. In this study, the case of Personal Service Attendants (PSAs) who do ward based cleaning and patient fetch-and-carry activities is used to demonstrate that nurses experienced more protracted work intensification than doctors at Westernvale Hospital. PSAs, a newly created occupational group created in 1995 by up-skilling orderlies, kitchen hands, nursing assistants and cleaners, work on the wards doing duties such as cleaning, transporting of patients and serving meals. The decision to create this new occupational group was motivated at Westernvale by a State government requirement to outsource all non-core duties. Clinicians felt that to do so would compromise care and argued that a multi-skilled worker assigned to each ward would aid in infection control and the smooth management of patients through the system. PSAs were allocated evenly across all wards and worked under the direction of the senior nurse.
The New Public Management and the Healthcare Sector
'Reform' within public health sector impacting on the various health professions is not isolated to Australia (Bach 2000). The trends are global, and the motivation is cost control. Some commentators suggest countries such as the USA, the UK, New Zealand and Australia have been more ruthless and determined in their efforts than many European States (Bosch 1998). The origins of the reforms instigated in the public health sector arose from the belief, held in the early 1980s in many western nations, that the sector underperformed and that a radical overhaul should include incorporating many of the competitive strategies of the market into the public/civil service (Cairney 2002). This belief led to a series of strategies broadly defined as the New Public Management (NPM) (Ferlie 1998). Ferlie defines the NPM under six headings: (1) privatisation of public utilities; (2) the introduction of market-like mechanisms into the public sector; (3) separating core (policy) from peripheral (service delivery) tasks: (4) outsourcing the service delivery, while maintaining government control over policy; (5) more active management such as performance management systems; and (6) labour market flexibility. Added to these is the emphasis on outputs over inputs and the break-up of large, uniform organisations into smaller business units (Bach 2000).
In applying the criteria of NPM to the healthcare sector, the evidence from the UK and New Zealand is more obvious. In both countries, the introduction of quasi markets via the purchaser/provider split that devolved purchasing power down to the level of Trusts or GP fundholders more clearly emulated market mechanisms (Harrison and Ahmad 2000). In Australia, control has remained more obviously centralised both at Federal and State levels. The imposition of the National Competition Policy, however, resulted in the privatisation and outsourcing of many public health services; particularly pathology and radiology, while the Medicare incentive funding and casemix benchmarking meant that State health organisations were forced to explore labour market flexibility and performance management systems in order to meet new productivity targets.
Work Intensification Through Performance Management
According to Morris (1996), in the late 1980s and early 1990s a proliferation of human resource consultants employed by major companies and government instrumentalities recommended outsourcing, downsizing and a range of workplace activities that encouraged flatter structures, team work, the generation of mission statements and increased quality assurance. Whatever approach is taken to increased productivity, be it new technology or re-arranging workplace processes, achieving it is problematic. One solution is for employers to supervise or control the activities of employees through direct surveillance, or technology such as production lines or the setting of targets, and to impose penalties for non-compliance. Direct surveillance can be costly and in some workplaces, particularly service industries, neo-Fordist production processes may be inappropriate, outdated or distasteful to the workers' sense of professionalism and autonomy. A seemingly democratic solution to the problem, which management faces when attempting broad-based control of the labour process and increased control of professional labour, is arrived at by combining 'best practice' and 'benchmarking' as performance management strategies.
In Australia benchmarking and best practice as performance management measures were initially/private sector strategies, but in 1990 they were introduced into the public sector. Both the Medicare agreements of 1993-1998 and 1998-2003 and casemix are examples of performance management reforms that combined incentive funding with benchmarking as cost containment strategies. The relationship between the drive to increased productivity and efficiencies through performance, management and work intensification is rarely acknowledge in the relevant healthcare literature dealing with benchmarking (National Health Minister's Benchmarking Working Group [NHMBWG] 1999). When it is, the argument proffered is that labour market flexibility such as up-skilling and multi-skilling or the reorganisation of work processes avoids the obvious pitfalls of work intensification because of workplace innovations or more efficient technology. What is not acknowledged is that the reorganisation of work processes in public acute hospitals is subject to the vagaries of emergency admissions and the complexities of treating human illness and disease, which are neither predictable nor subject to control.
Benchmarks and Incentive to Change: the Medicare Agreements
Funding for public hospitals in Australia is through a mix of Commonwealth and State grants. Since the introduction of Medicare in February 1984, the Commonwealth has entered into a range of agreements with the States and Territories in 5 five-year cycles: 1983-1988; 1988-1993; 1993-1998; 1998-2003; and 2003-2008. Over the last fifteen years, one of the most successful ways in which both Labor and Coalition governments have coerced health professionals into engaging in the 'reform' process is through the creation of financial incentive or innovation pools. This has been achieved by reducing the Medicare base funding to the States and Territories for the funding of public hospitals and tying additional funds to targets and benchmarks. It was the rationale behind the various demonstration programs in the 1990s, including the National Hospital Demonstration Programs instigated by Commonwealth from 1996-2003 and the Australian College of Physicians Clinical Support Systems program (Royal Australasian College of Physicians 2002).
In the 1988-1993 Medicare Agreement, the Federal Labor government established a base Hospital Funding Grant (Senate Inquiry 2000, p. 34). It also made it clear that it intended to move to casemix funding in the future, and began to implement some of the necessary information technology. The 1988-1993 round included additional funding via incentive programs for those States that increased the through-put in palliative care and same-day surgery, encouraged early discharge and aided the implementation of casemix information systems. As the Senate Inquiry into the funding of public hospitals in Australia noted, this provided the opportunity for the Commonwealth to encourage service innovation (Senate Inquiry 2000, p. 35).
Significant changes were introduced into the third round of the Medicare Agreement in 1993-1998, also brokered by the Labor government. The principles of Medicare as a universal program, free at the point of service, remained. The base grant, although calculated in the same way, was reduced by $400 million, however. This $400 million was transferred to two bonus incentive pools. Bonus Pool A was for additional public bed-days above a pre-set benchmark set for each State and Territory. If any State's percentage share of public bed-days was below this benchmark, financial penalties were incurred. Bonus B Pool funds were distributed to those States and Territories that increased their share of public bed-days above a set benchmark, but the incentives were paid only if that State performed better than other States (Senate Inquiry 2000). In effect, this intensified the work of health professionals as States and hospitals competed against each other for funds. For example, if a State or Territory increased its share of public bed-days from 53.5 per cent to 54 per cent, it was eligible for funds from this pool, but not necessarily as much as another State, if the other State s performance resulted in a higher percentage increase (Queensland Health 1996).
The 1998-2003 agreement brokered by the Liberal-National Coalition government is known as the Australian Health Agreement. A number of performance targets for elective surgery and Accident and Emergency waiting times were maintained at the levels achieved in the previous Medicare Agreements, although the incentives that pitted States against each other were abandoned. Conflict between the Commonwealth and the States over the base grant for hospitals continued during the 1998-2003 round, exacerbated by the reduction in the number of Australians with private hospital cover and a failure on the part of the Commonwealth to make up for the increase in population load. Principles of time management remained part of the agreement. Clause 13 (2) of the agreement stated that access to public hospital services by public patients must be based on clinical need and within a 'clinically appropriate period', and the benchmarks for this are evident in waiting times for elective surgery and waiting times for emergency admissions (NHMBWG 1999). Clause 20 and 21, Schedule C, committed the States to continuous benchmarking and the collection and sharing of data to achieve this aim; and Clause 67 committed the States to a continuous process of efficiency (Commonwealth Department of Health and Aged Care 2001a).
The overall direction of block grants and incentive funding, however, while requiring clinicians to intensify the pace of their work, did not demand changes to the way they organised this work or to clinical decision-making. Change in the organisation of work was more readily achieved during this time through casemix. This is a refined form of benchmarking: and a system for measuring the product mix and the types of patients admitted and procedures performed in hospitals and other healthcare settings. Its implementation had a profound impact on the organisation of hospital work and as a consequence, work intensification.
Intensifying Day to Day Work Through Casemix The introduction of casemix Diagnosis Related Groups (DRGs) into the Australian healthcare system in the early 1990s did not come as a surprise to observers within the system. The idea was floated in the National Health Strategy (1989-1992), and the 1988-1993 Medicare Agreement established the Casemix Development Project. The Commonwealth indicated in the 1993-1998 Medicare Agreement that it would move in the next round to funding all States and Territories through a nationally unified casemix system (Reid, Palmer and Aisbett 2000). Given this, States and individual public hospitals had no choice but to comply.
Casemix classification systems are not restricted to measuring output in public or private hospitals. They are used across a range off settings such as the Resident Classification Scales (RCS)--the basis for funding nursing hours of care for the aged; Ambulatory Patient Groups used for community care; and Diagnosis Related Groups (DRGs). DRGs are the casemix system used to determine the funding of public hospitals in Australia and throughout a number of other major developed countries (Draper 1992). The various casemix models are attempts to measure the production process within the healthcare system through categorising each product, case or patient episode of care. According to Hindle and Braitwaite (1998), it is the most sophisticated process for product costing, since it reduces the care to a commodity where the value of the output is determined through 'time'.
Under casemix DRGs, public hospitals in Australia are pre-paid an amount calculated on the average cost for a number of patients with a specific diagnosis. Before the introduction of casemix DRGs, funding was based on traditional or historical forms of allocation that sometimes bore little relationship to the hospitals' output. The rationale for casemix forms of funding is that a hospital s costs are directly related to the types and mix of patients it treats. DRGs are one tool for defining the complexity of cases for specific hospitals, and the severity and treatment protocols used in treating each patient. DRGs also record the output of the hospital, providing a measure for ongoing funding and input, resource allocation and the charging of services based on tangible and measurable outcomes (Commonwealth Department of Health and Aged Care 2001b). Behind casemix is the motivation to encourage hospitals to treat patients within an average cost structure. The measure of cost and resource intensity for casemix DRGs is determined through length of stair (LOS). If there are cost overruns outside of national or State benchmarks by individual hospitals, the assumption is made that inefficient work processes or special population factors are present. Hospitals are charged with responding to this through changing work practices, reorganising the production process, intensifying the labour of staff or arguing that their casemix deserves special pleading.
Introduction of Casemix into South Australian Public Acute Hospitals
Casemix funding was introduced into all hospitals in South Australia in the 1994-95 financial year, although the Health Commission had been using it since 1985 as the tool for dealing with morbidity data, established a clinical advisory committee in 1989 and completed the first nursing weights study in 1990. The accelerated introduction of casemix into all public hospitals in South Australia was a result of a change of government. The Liberal party came to office in late 1993 following the collapse of the State Bank. Their resounding win was seen as a mandate to reduce the State debt through curtailing public expenditure. Consequently, casemix was introduced at the same time as the public health sector sustained a budget reduction of $30 million over the three-year period from 1994 to 1996. Fifteen million dollars of this was carried by the public hospital sector; this represented a reduction of 4 per cent in real terms of the total healthcare budget for the State. This was achieved by reducing funding of predicted activity to below 1993-94 levels (South Australian Health Commission 1995). As a consequence, benchmark prices for each DRG were determined by the available funds, not the real costs (Brooker 1997).
Funding to individual hospitals was negotiated through Service Agreements, which in effect outlined for each hospital its share of the State debt and opened the way for other new public management strategies such as contestability (outsourcing) and the privatisation of non-core activities. Funding to public hospitals in South Australia following the introduction of casemix in 1994 was in three parts: an annual grant, an activity grant and an efficiency/incentive (or service pool) grant. The annual grant was fixed and covered infrastructure, education and research. The activity grant for each hospital was the benchmark price for each DRG, calculated by dividing the available funds for acute admitted patients by the number of weighted separations for that hospital. Initially the length of stay (LOS) remained constant for each DRG, but the reimbursement was reduced, thus producing in-built efficiency. Between 1995 and 1998 the LOS for many DRGs reduced, presumably in response to improvements in throughput, forcing many public hospitals with highly acute and elderly patients that prevented them from reducing LOS to intensify their labour, reduce staffing levels or re-design work processes.
Activity for 1994-1995 for each hospital was set at 1993-94 levels. For some hospitals the budget provided in 1994-1995 was less than they would have received for the 1993-1994 financial year. Where hospitals came in under the agreed target, they had to reimburse funds as if they were a loan; where they went over the target they had to fund this activity from within the activity grant, supplemented by a transitional grant (Brooker 1997). The transitional grants were dispensed with by 1996 and were paid at a rate of 50 per cent of the deficit. The Hospital Service Improvement Strategy (South Australian Health Commission 1994, p. 11) notes 'that this differential is a measure of the hospital's inefficiency. It is expected that all hospitals will operate at the efficient benchmark'.
The efficiency or service pool grants were drawn from the savings generated and were modelled on the Medicare incentives. There was a booking list pool, a through-put pool and a primary healthcare incentive pool. In order to access funds from the booking list pool, which was established for teaching hospitals, a hospital had to reduce waiting lists for elective surgery. This basically meant increasing throughput. In the first year of operation, one hospital received 70 per cent of the available funding, leaving the other hospital administrators with a sense that the funds were subject to 'gaming' and manipulation (Brooker 1997). Funds were also available for increased activity linked to service improvements such as establishing benchmarks for same-day surgery, reducing readmissions, implementing programs such as Hospital @ Home services that facilitated early discharge, and reducing surgery LOS (South Australian Health Commission 1994). In the first year, money from this pool was spent in the first quarter requiring hospitals to cap productivity for the remaining nine months.
In his independent evaluation of the South Australian casemix program, Brooker (1997) notes that patient separations increased by 4 per cent in the 1994-95 financial year; there had also been a 9 per cent increase on the previous figures in the 1993-94 year, while the available beds reduced by 9 per cent between 1989 and 1995. This was due to a significant growth in same-day surgery, which increased by 13 per cent in 1994-95. The evidence also suggested that the severity and complexity levels of in-patients increased, so that hospitals were now treating these complex cases in a shorter time than they had previously (Brooker 1997). This was particularly so in the larger public acute hospitals, such as Westernvale, that focussed primarily on emergency admissions.
The Impact of Casemix Funding at Westernvale
Westernvale hospital did not come in on budget in the first year of casemix, nor in the subsequent six years. In May 1995, the Chief Executive Officer resigned and the hospital engaged in a program of staff reduction through voluntary separation packages under the Liberal State government's workforce reduction scheme. In 1995, the annual report noted that the number of redundancies was 255, with nursing and salaried medical staff numbers decreasing by 90 and 19 respectively, and the remainder coming from support staff such as orderlies and cleaners. In 1996, a further 67 staff took packages, and another 15 in 1998 and 1999. Total staff numbers went from 2316 to 2137; a loss of approximately 8 per cent.
The hospital reduced its patient length of stay from 6.0 to 5.1 days in the first year of casemix funding and increased through-put by 20 per cent, gaining funds from the through-put pool; but since these funds were exhausted in the first quarter, subsequent increases in through-put were unfunded. In February 1995, the hospital held a strategic management conference to deal with the implications of casemix and the State debt. Out of this conference came the new management structure of clinical divisions. By 1996, budgets had devolved to the newly created divisions. The new CEO noted in the annual report that 'clinicians who make decisions that drive our costs also have the authority to manage budgets and staff' and that the hospital was $597,000 over budget.
In the same year, following the recommendations of a consultancy firm, the catering and general cleaning services were outsourced, along with diagnostic laboratories. The orderlies, ard-based cleaners and kitchen staff were offered either a separation package or training as Personal Service Attendants (PSAs). The 1996 annual report also notes that the hospital took out a loan of $25,601,000 from the Government Financing Authority for debts incurred as a result of the financial stringencies, to be paid back over a five year period. In 1998, Westernvale Hospital entered into an eleven-year agreement with a private hospital close by for the provision of a number of procedural services for a small fee. This in effect became a further avenue for outsourcing and was also an attempt to persuade privately insured patients to use private facilities.
The Variable Impact of Casemix on Health Professionals: the Case of Nursing
The impact of the new funding model on the intensity and pace of work for the various health professionals can be gauged by examining staff numbers against patient through-put demonstrated in Table 1. These figures suggest that the percentage of nursing and hotel staff made redundant was sustained over a longer period than for doctors or medical scientists. Year 1994 is the first twelve months of casemix. The Annual Report (1995) indicates a drop in staff numbers of 90 nurses and 19 doctors. These are 10 per cent and 7 per cent reductions respectively. In 1996, medical staff were further reduced by 45 (20 per cent), but by 1997-98 their numbers increased to 308, with 22 Visiting Medical Officers (VMOs), and by 1999-2000 numbers had increased to 336. This is an increase of 15 per cent on 1994 figures, with only 4 years in which numbers were below 1994 levels. Nursing figures remained at 95 per cent of 1994 numbers until 2002--9 years, in all. The enterprise bargaining agreement then brought nursing numbers back to 1994 levels. All this occurred at time when the proportion of people with private health insurance continued to go down, putting more pressure on elective surgery lists. Further, as Table 1 demonstrates, the rate of same-day surgery increased significantly while the average length of stay remained relatively constant.
Table 1 also contains the category hotel staff (orderlies, kitchen staff) or Personal Service Attendants (PSAs). The category 'hotel staff' decreased by 22 per cent over the period from 1994 to 1999, with Westernvale's own annual report of 1998 indicating a reduction of 9 per cent to 122 in that year (Effective Full-time). Their number continued to decrease despite an internal review held in 2002--the result of high levels of injury amongst these workers. The review resulted in a redistribution of PSAs across the wards according to work intensity, but no increase in staffing levels. This occupational group comprises mainly middle-aged women, except for a small number of former orderlies. The data in Table 1 do not include cleaning staff who deal with the public areas of the hospital. These cleaning duties were outsourced to a private company, as was the preparation of meals, and, as previously noted, pathology services.
In the evaluation of the introduction of casemix into South Australian hospitals Brooker (1997,p. 67) notes a drop in overall numbers of inpatients and nursing staff, but an increase in the acuity of the patient load. He suggests that:
Despite the reduced number of bed days, nursing workload can be regarded to have increased ... there has been a trend to treating more complex patients and towards shorter hospital stays. Reducing the length of stay increases the average intensity of nursing care, as the later days of a patient s stay usually require less nursing care than earlier days.
The increase in same-day surgery also gives an indication of increased work intensity. Brooker makes no critical comment about the increase in medical staff numbers, which is a state-wide trend, except to indicate that there had been a 14 per cent increase in medical services and to point out that the reduction in hotel staff may also be a result of contracting out these services. He does note the following percentage changes in medical (+6 per cent), nursing (-13 per cent), hotel (-29 per cent) and scientific and technical (+1 per cent) staff across the State between 1989 and 1995 (Brooker 1997, p. 108). There is, however, little evidence to suggest that an increase in the work of doctors is not also an increase in work for nurses. Any increase in patient load is an increase to both groups; their work is interdependent.
What is clear in this case study is that the re-organisation of healthcare had a differential impact on health professionals. Overall, the numbers of doctors employed in public hospitals in South Australia, and at Westernvale, between 1994 and 2000 increased, with a dip in 1994-95. This was not the case for the profession of nursing. It was not until 2001 that nursing numbers across the State and at Westernvale returned to pre-1994 levels, and only then as a result of an enterprise bargaining agreement that tied staffing levels to productivity outcomes. The numbers of PSAs remained well below the previous levels for orderlies, cleaners and kitchen staff. The number of medical scientists, who work closely with doctors, remained stable up until 2001, then decreased due to a round of redundancies following increased hospital debt. These data suggest, in the absence of any ameliorating factors such as radical job re-redesign or labour substitution, that the pace of work for nursing staff was exacerbated over a longer period than that of doctors.
Discussion and Conclusion
This paper provides evidence of work intensification of nursing staff as a result of significant reduction in staff numbers during a time of increased patient acuity, rising rates of same-day surgery and reduced patient length of stay. As Brooker notes (above), all of these factors exacerbate the workload for all staff. The figures do suggest, however, that the burden fell on nursing staff and lower level workers such as the PSAs over a longer period of time than on medical staff or scientists, although during the period 1995-1996 the reduction in medical staff was more extreme. How these figures can be generalised to other hospitals in the State is a moot point. While the evaluation carried out by Brooker (1997) suggests that work intensification did occur for all occupational groups, not all hospitals applied the same internal reforms. Hotel and cleaning services were not outsourced in all hospitals, nor did all hospitals introduce PSAs. Some maintained cleaning services or outsourced all kitchen and cleaning activities. Brooker's data do show, however, an overall State reduction in nursing numbers during this period.
Critics could argue that work intensification includes extensive work loads as well as intensive work effort and that there is ample evidence that doctors, especially early career doctors, have experienced considerable increase in working hours over the last decade (AMA 1998, 2001). Finding evidence in support of this at the individual hospital level is difficult, requiring longitudinal or retrospective studies. What is clear is that, in workplaces where the work is intensified for one occupational group, this is likely to impact on the work of other categories of workers, especially where all groups are required to work closely together or some duties are interchangeable as is the case between nurses and PSAs and between doctors and nurses. It is not surprising that the Australian Nursing Federation was able to reverse the staffing levels at Westernvale once the nursing shortage became a national phenomenon (Willis 2002); or that the major South Australia hospitals find it difficult to attract sufficient junior medical staff. Nor is it surprising that the rate of injuries for PSAs rose dramatically over this period (Willis 2005). Where work is intensified, staff who can will vote with their feet, while those who cannot will become sick.
There is now a general agreement in South Australia that casemix was introduced along with real budget cuts, so that the DRG price per patient LOS was reduced to below the previous year's benchmark (Brooker 1997). This was an additional factor contributing to work intensification. The reorganisation of administrative functions to medical and surgical divisions that included devolved budgets threw the onus for achieving these targets on to clinicians as part of the process of establishing internal markets, while the Medicare benchmarks for elective and emergency admissions assumed that rational responses could be provided for what are unpredictable illness events. What was required was a set of highly coordinated interactions that enabled beds to be emptied 'Just In Time' and re-made ready for the dozens of patients in Accident and Emergency or waiting for elective surgery. Failure to speed up this process meant that the hospital was not eligible for incentive pool monies and lost out. All staff at Westernvale experienced work intensification, but it appears that nurses' work was intensified over a longer time frame than that of doctors.
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Willis, E. (2002), 'Using Enterprise Bargaining to Control Health Professionals' Working Time: A Case Study in Reversing the Trends, New Zealand Journal of Industrial Relations vol. 26, pp. 221-232.
Willis, E. (2005), 'The Hidden Trap in Up-skilling: the Experience of Work Intensification for Personal Service Attendants in the Healthcare Sector', in Baird, M., Cooper, M. and Westcott, M. eds, Reworking Work, 19th Conference of the Association of Industrial relations Academics of Australia and New Zealand, Sydney 9th-11th February, pp 565-572.
Eileen Willis, School of Medicine, Flinders University
Table 1: Activity data and staffing numbers 1994/95-1999/2000 Westernvale Hospital Occupancy Same- Cost per Nursing Year (%) day separation staff 1994 N/A 13,186 $3,029 922 1995 86.9 14,232 $2,782 833 1996 87.8 N/A $3,417 857 1997/8 88.3 16,553 $3,790 882 1998/9 87.3 17,860 $2,505 918 1999/2 95.40 20,035 N/A 881 Hotel Medical staff- staff/ LOS Year PSAs VMOS * days 1994 314 292/26 5.10 1995 200 273/n/a 5.22 1996 180 238/n/a 5.30 1997/8 146 308/22 5.01 1998/9 150 324/21 4.72 1999/2 144 336/21 5.10 * Visiting Medical Officer
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The Home Cook program at Auguste Escoffier School of Culinary Arts offers a dynamic collection of hands-on, technique-focused cooking classes for enthusiast cooks, from French regional favorites to creative courses in cooking, baking, cake decorating and more. All courses are led by our very own professional Chef Instructors and are held in industry-current kitchens on campus in Boulder, Colorado, or online.
Our courses are designed for food-lovers of all types. Whether you're new to the kitchen or an accomplished home cook, we have a class for you!
Class Calendar
Class Calendar
Courses are generally offered on Saturdays from 10:00am – 1:00pm MNT.
View our class calendar to learn more and register online.
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Can't decide which class to purchase as a gift? Purchase a gift certificate and let them decide. We use Eventbrite to sell gift certificates – all payments will be conducted on Eventbrite's website.
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" I learned a lot, had fun and the food was delicious."
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Testimonial: Sarah
"So fun, instructor was AMAZING!"

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text: Added: 2008-06-26On November 12, Armstrong records the first of the classic hot fives with Lil Hardin on piano, Johnny Dodds on clarinet, Kid Ory on trombone and Johnny St. Cyr on banjo and guitar. First tune was the Lil Hardin composition My Heart. First scat solo was on the song Heebie Jeebies allegedly when Armstrong accidently dropped the sheet music. The recordings were originally issued on Okeh and can be found on Columbia/Sony Hot Fives and Sevens series CD's as well as on JSP.


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Book Search
Strategic Marketing Management
4th Edition
Where are we now? Where do we want to be? How do we get there? Which way is best? And how can we ensure arrival? Strategic Marketing Management earned its place as a classic textbook by building marketing strategy around a few simple questions. This immediately accessible structure has long made...
To Be Published February 28th 2016 by Routledge
Strategic Marketing Planning
3rd Edition
Strategic Marketing Planning is an evolution from Wilson and Gilligan's classic textbook Strategic Marketing Management for students or courses that are covering marketing strategy, but without the implementation or control aspects. Like its predecessor, its focus is on simple questions: Where are...
To Be Published January 31st 2016 by Routledge
Accounting Education Research
Prize-winning Contributions
An annual prize is awarded for the best paper appearing in Accounting Education: an international journal, and this book contains the prize-winning papers for every year from 1992 to 2012. The journal's primary mission since the first issue was published in March 1992 has been to enhance the...
To Be Published December 15th 2015 by Routledge
Communication in Accounting Education
Accounting, often described as "the language of business", requires a diverse set of written, listening and oral communication skills if those who practise it are to be effective. Given the pace of change relating to, for example, the evolution of international accounting standards and the demands...
Published November 28th 2014 by Routledge
Researching Accounting Education
Australian Contributions
There is no doubt that accounting education scholarship and research in Australia is not only thriving, but is amongst the best in the world. Nor is there any doubt that Australian scholars in this field punch well above their weight within the international arena. This book is not derived from a...
Published November 7th 2014 by Routledge
Personal Transferable Skills in Accounting Education RPD
Series: Special issue books from 'Accounting Education: an international journal'
The development of generic skills (often referred to as 'soft skills') in accounting education has been a focus of discussion and debate for several decades. During this time employers and professional bodies have urged accounting educators to consider and develop curricula which provide for the...
Published September 12th 2014 by Routledge
The Interface of Accounting Education and Professional Training
Series: Special issue books from 'Accounting Education: an international journal'
Over many decades the global development of professional accounting education programmes has been undertaken by higher education institutions, professional accounting bodies, and employers. These institutions have sometimes co-operated and sometimes been in conflict over the education and/or...
Published September 12th 2014 by Routledge
Teaching IFRS
Series: Special issue books from 'Accounting Education: an international journal'
The increasing pace of global conformance towards the adoption of International Financial Reporting Standards (IFRS) highlights the need for accounting students as well as accounting practitioners to be conversant with IFRS. Teaching IFRS offers expert descriptions of, and insights into, the IFRS...
Published August 15th 2014 by Routledge
Sustainability in Accounting Education
Accounting sustainably involves accounting for and to the natural environment, and accounting for and to society, including groups currently oppressed or disadvantaged by unsustainable processes and practices. This book creates a compelling case for the inclusion of sustainability at the heart of...
Published May 14th 2014 by Routledge
The Routledge Companion to Accounting Education
Series: Routledge Companions in Business, Management and Accounting
Many enquiries into the state of accounting education/training, undertaken in several countries over the past 40 years, have warned that it must change if it is to be made more relevant to students, to the accounting profession, and to stakeholders in the wider community. This book's over-riding...
Published April 10th 2014 by Routledge


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Argentina to make military drones
Argentina will manufacture locally designed military drones, according to an announcement Tuesday in the official government gazette.
Argentina will manufacture locally designed military drones, according to an announcement Tuesday in the official government gazette.
A union representing 15,000 Canadian government scientists said Wednesday their right to speak publicly about their work regardless of what they discover should be addressed in contract negotiations.
A judge on Thursday ordered US computer giant Hewlett-Packard to pay $58.8 million for bribing Moscow government officials to win a big-money contract with Russia's prosecutor general's office.
A US federal judge has reinstated a CIA cloud computing contract with Amazon, rejecting a challenge from IBM, according to court documents released Tuesday.
It was a contract that Amazon.com's business-technology group wasn't supposed to get. The CIA, an organization whose data is among the most protected in the world, asked for bids last year on a contract to provide the agency ...
Chinese telecoms giant Huawei has hit back at allegations by a former CIA chief that the company spies for Beijing, labelling them "defamatory" and "baseless".
Chinese telecoms giant Huawei will launch a new smartphone on Tuesday to better compete with high-end rivals like Apple and Samsung overseas, a company official said.
Edward Snowden, who admitted leaking details of secret U.S. government surveillance programs, was fired by his employer Tuesday while the U.S. government considers criminal charges against him.
A Japanese company is hoping to win a big slice of Asia's tuk-tuk market, it said Wednesday, betting battery-operated buggies could cut burgeoning city pollution.
The U.S. government has cleared VeriSign Inc. to manage the databases that house ".com" domain names for another six years, but the company won't be allowed to raise prices without approval.
(Phys.org)—The image of a "fiscal cliff" may give the wrong impression of the potential fallout should Congress fail to take action by the end of the year on the Budget Control Act. Iowa State economist Dave Swenson described ...
British oil giant BP was temporarily banned by the US Environmental Protection Agency from US government contracts Wednesday due to its behavior in the April 2010 Gulf of Mexico oil disaster.
US security fears over two China telecom firms have spotlighted Western suspicions Chinese companies are state-influenced, a culture clash analysts say could loom larger as the country's businesses look overseas.
(AP) -- A Democratic senator from Connecticut is writing a bill that would stop the practice of employers asking job applicants for their Facebook or other social media passwords, he told The Associated Press on Thursday ...
Having a powerful member of congress could have unintended consequences for a state's economy, according to a study published today in the Journal of Political Economy.


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TwinView in Fedora not working --- PLEASE HELP!
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Join Date: Jul 2002
Location: Netherlands, Europe
Posts: 2,105
Re: TwinView in Fedora not working --- PLEASE HELP!
XFree86 4.3 is good enough for most people. What you want is twinview, what LordMorgul is more talking about is likely Xinerama. Redhat would never support setting up Twinview.
To get twinview working you basicly need to do the following:
add the following lines to the screen or device section of your config file (it doesn't matter in which of the two you put them):
Option "SecondMonitorVertRefresh" "a-b" (a-b needs to be vertical sync range)
Option "SecondMonitorHorizSync" "c-d" (c-d needs to be the horizontal sync range)
Option "Twinview" "1"
Option "TwinviewOrientation" "RightOf" (default is RightOf, other values are Clone, LeftOf, Above ..)
Option "Metamodes" "1024x768, 1024x768" (describes what resolution to use on screen1 and screen2)
Option "ConnectedMonitor" "CRT, CRT" (depends on what displays you have, the first one is the primary display)
These lines should get twinview working. For more info about the options check the Readme file of the drivers.
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You won't be able to dismiss this by usual means (escape or click button), but you can close it programatically based on user choices or actions.
"Customer service was so helpful and sweet when I called to fix a text error. I put down my ceremony time as 4:30 in the morning OOPS! They arrived so so soooo quick and are absolutely beautiful. Perfect for a rustic shabby chic wedding theme!"
"These invitations swept me away! I almost cried just seeing them because they met my every expectation and exceeded it! The card stock is so high quality I could seriously be a weirdo and rub the invitation between my fingers all day that's how good it feels! Everyone that's seen here commented how perfect they are! I'm excited to send these out!"
"These invitations turned out beautiful. I was a little nervous about ordering online, plus with this specific invitation, I was unable to order a sample which made me really question how it would turn out. The photo I uploaded turned out good,as clear I think it could have since it was a far away picture, even after I zoomed in a little bit. I asked if they would capitalize the initials in the upper left corner, which they did. I also questioned the ink color about if it was coppery or what it would like on paper, I preferred that it be gold. She actually sent me a proof with marigold ink along with the ink shown on the website, I ended up choosing the marigold. It looked perfect. I love my invitations and am so excited to send them out! They are a great price too, compared to going to invitation shops in person, I saved a lot of money and got exactly what I wanted!"
"We couldn't be happier with our invitations! The design is so beautiful and the quality is excellent. We received so many compliments on them. The service was amazing, too. I made a few modifications to the text and layout and Wedding Paper Divas was wonderful enough to do it all in a very timely manner at no extra charge! I would recommend these invitations (and Wedding Paper Divas as a whole) to anyone."
"This card was the first card I wanted when we first got engaged. It is just beautiful! When we ordered the sample we were very impressed with the quality of the paper and the design was more beautiful in person. After we ordered our invites and they came, I could not be happier they are stunning!! The customer service was awesome too. They reviewed the invitation and they were quick to send them! I got them within a week! I would most definitely recommend this invitation and Wedding Paper Divas to create your invitation!"


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About Hoyos CorporationHoyos Corporation is a global company with shareholders from across the world. It was incorporated in San Juan, Puerto Rico in November of 2005 as an intellectual property holding company with a world class R&D operation. Today, Hoyos is revolutionizing the access control and identity management industry. The global reliance upon electronic data and transactions has created an increasing need to secure identity and control access to physical locations, electronic networks and the devices that connect to them in order to combat the very costly threats of identity theft and financial fraud. Hoyos delivers a vastly different operating model where privacy, convenience and security are synonymous. Media Contacts:Sharron Silvers / Samantha Wolf KCSA Strategic Communications(212) 896-1282 / (212) firstname.lastname@example.com / firstname.lastname@example.com
|SOURCE Hoyos Corporation
Copyright©2010 PR Newswire.
All rights reserved


text:
We survived the entire week of Bible school and the program on Sunday morning, with no major mishaps. We even managed to make it through the pizza party! (Which for a kid with her particular food allergies, was a really BIG DEAL!)
The teachers in her class thought--and I quote--that my child was hilarious when they talked to her. I'm not quite sure what they meant...
As for school...
I bought her some more math toys--100 blocks, dry erase math books, things to count, etc. Her latest 'thing' (this week) is going through the stores counting floor tiles, aisles, and...well...her daddy took her to Walmart Saturday, and she decided she was going to count (at the top of her lungs, no less) all the 'old mans' she saw. Yeah. That's my kid!
I really am a bit stumped with her though. She's determined to write the alphabet, and will sit there forever, with a notebook and pen trying to make letters.
But when I sit down and try to show her using the lined preschool paper, etc. she does not want ME helping her at all. She practices her 'scribbles' and then brings them to me when she has the letters the way she wants. Does not want taught ANYTHING, she has to figure it out for herself.
And now she's making the letters completely different than all the 'sites' say they should be taught. I'm not sure if this is because she's a leftie? Will it cause problems down the road?
I thought about HWOT but she is so young that I don't know...I'm not sure she'd even let me sit down with her to do something like HWOT. And I'm leery of formal programs at her age, anyway.
We bought some of the various dry erase writing books out there and she loves doing those--but not with help.
Do we need to be worried about HOW she's making the letters or just let her teach herself? Ugh. Anyone experienced this?
She's 31 months old, if that helps any. (She does know the entire alphabet, upper/lower, in order/out of order, sounds/vowels. Now she wants to write them!)
I totally don't know what to do with this kid!


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Hi. My name is Kathy and I need to renew NRP asap. could you possibly tell me about this class so I can get scheduled? I live in Worthington. Thanks!
This post was from almost 2 years ago. I'm hosting her class in michigan if you're interested. Go to http://www.newbornbreath.com/workshoplist.html and find one near you. If you can make it to the Flint area one, paypal your deposit and application ASAP.
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NFLPA to appeal suspensions ruling
Updated: May 27, 2009, 5:54 PM ETAssociated Press
MINNEAPOLIS -- The NFL Players Association plans to appeal a judge's ruling in the case of five players facing suspensions over positive drug tests.
The union filed its notice of appeal Wednesday with the 8th U.S. Circuit Court of Appeals.
The players association wants the appeals court to reconsider a judge's dismissal last week of a lawsuit filed by the union on behalf of Vikings star defensive tackles Kevin Williams and Pat Williams, and New Orleans Saints' Charles Grant and Will ...
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I grew up on a diet of TV shows like Knight Rider and The A Team. I saw Ferrari and McLaren produce faster cars as time went by. I admired how the car industry kept on trying to improve.
But it seems like some carmakers have lost the fun of innovation. BMW and Daimler once led the world in building cars that were fit for the future. But as the impacts of climate change get more and more severe across the planet, they've been pressing politicians to keep our cars locked in to using fossil fuels.
Last week, that pressure saw Angela Merkel drive a wedge into the progress of a fuel efficiency law to make car companies build more efficient cars. The law could have cut CO2 emissions from new cars in half and saved Europe 17.3 billion barrels of oil. Now that law is in limbo.
While BMW and Daimler would have been preparing for a frantic final week of lobbying to postpone the clean car law, Paul Drayson broke the electric world land speed record at over 204 mph.
Although BMW has plans to produce two electric models next year, it doesn't want to introduce hybrid engines across the rest of its fleet. And although Daimler has produced the Smart car, the EU may be about to sue it for breaking a law to use more climate-friendly chemicals in its air conditioning. Meanwhile VW, Ford and Nissan have all backed the planned CO2 cuts of the regulations.
Car companies and engineers only innovate when they are truly challenged. From the rollout of unleaded petrol and catalytic converters (which Germany forced through) to the London congestion charge zone, politicians have often had to force these decisions. You can see how history makes the case for these decisions this handy timeline.
Today is no different. We've heard that the vote on the clean car law could now be delayed for months - leaving Germany able to try to weaken them even more. So we'll come back fighting.
Over half a million of us have come together to get Europe's carmakers to clean up their cars. We got Volkswagen to commit to do just that. But to make sure the whole industry does the same, we need more support. Share this blog and ask your friends to join the movement for clean cars at www.EUvsCO2.org.
Hugh Mouser is a Digital Co-ordinator at Greenpeace UK.
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My new toy.
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Re: My new toy.
When you can sail those desert lakes without capsizing a dinghy, then you can sail most anywhere. Sometimes, especially in the spring, the wind can come at you in two different directions all at once. And the gusts, especially in Elephant Butte can be tremendous requiring instantaneous reaction to keep from dumping.
Be happy you are still young while learning these techniques. The sensory inputs you learn now will be with you forever. It took me a long lime to relax during gusts when I started sailing a keel boat as I was always over reacting and not letting the boat take care of itself and sail on.
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Created in this Craftsy class
Learn how versatile fondant can be in this video class! Make ribbons and flowers and add texture, sparkle and detail to your fondant and gum paste designs.
Other projects made as part of this class:
Offer some kudos...
Join the conversation...
Ask a question...
Add your comment...
|Here are some details about my project:
|Cake Decorating
|Three Tiers or More
Share a little about the materials, processes and techniques used to create this cake: Gumpaste for the shoe and fondant for the shoe box
Check that shoe out! Amazing.
very nice <3 it!


text:
Here is my latest demonstration: project collaboration. What I'm showing is the common scenario of a few people just wanting to work together on a project and get more from Microsoft Office SharePoint Server 2007 and some of the desktop applications. I go through:
To watch the video just click here and then I strongly suggest you hit ctrl-shift-G to watch it speeded up :-)
If you like this video why not try out some of the other ones I've done


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Pronunciation: Mathgamain
Added on: 2011-02-16 Listened: 241 timesin: mythology, older Irish spelling
Pronunciation in Irish [ga]
- Pronunciation by Brendan (Male from Ireland)
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Business Finance Consultant
United States - Last active: 6 days ago - Tests: 8 - Portfolio: 1
My unique approach to financial management is designed to reveal both insights and opportunities. Building upon a background of National Account Management, Commercial Banking, Brokerage Services, and Senior-Level Financial Consulting, I draw upon a wealth of practical, first-hand experience to benefit clients in the ways that matter most: A broad-based understanding of business finance that achieves defined, sustainable goals. A common theme linking disparate industries at different stages of development and maturity comes courtesy of an understanding of the flow of every dollar, from sales to expense to operating income. Examined through a lens that is customized for every client and each business, and reflects their unique challenges and competitive advantages. The result is what I call Functional Financial Management. It's not merely the numbers, but the story inside the numbers. Customized, relevant, and with a practical utility that can be nothing short of game-changing. These are also the hallmarks of financial management guidance provided through Business Expedition Partners, the financial consulting firm I founded to offer clients around the world specialized financial consulting. From start-ups to mature companies, it is an honest, hard-working, unrelenting attention to detail that delivers results exceeding expectations. Top 5% Odesk Contractor!
Serbia - Last active: 1 day ago - Tests: 11 - Portfolio: 17
Over the years I have developed myself and others in various business and leadership skills. My recent clients were family owned small businesses, but also Fortune 500 companies whose brands are in our homes wherever we might live at the moment. I studied and worked in several countries around the world - US, Switzerland, Middle East and Europe - in start-ups and operations management of multinationals. I consult and coach international clients mostly in business management and marketing. Am often writing or editing training or other manuals for them. Since Nov 2012. I am also the principal consultant for WiFi Austria Institute's 'HR Manager' course. This is 9 month course for which I also develop training material. My blog is No Panic Management and if you Google me you will find few more websites I made, with copies I wrote. My name is on first page of Google (when searching for it.) My objective is to work only on things I like, with people I like. They are professionals with integrity and attitude. It means they like and respect business, as well as others they work with. Do not work for companies who do not treat employees well. Ultimately I am looking for ways to help business grow and create jobs, whether it is mine or anyone else's company. That is a greater mission behind any ''small'' task I undertake. I take different jobs at my spare time, those I can do well, enjoy, and those that enhance my business experience while delivering result. Should you have a good business proposal or idea for me, I'd be happy to hear it. Am always welcoming new opportunities for business development and mutually beneficial partnerships.
United States - Last active: 1 day ago - Tests: 6 - Portfolio: 21
Recognized top 5% oDesk contractors. I have the skills and experience necessary to complete any of the following jobs: complex research, writing, editing, basic websites, business consulting (online marketing strategies for small businesses) or other similar projects. One of my specialties is helping people develop well-written informational content that brings organic and natural traffic to their sites. I provide writing, editing and formatting services for online website content. [Note - if you are trying to view my actual website from my profile, I am in the process of changing hosting providers so my site is temporarily unavailable. As a result, some of the links in my odesk profile many not be working. Just ask if you need to see more work samples and I will get them to you.] I am fortunate to have a gift with writing and truly enjoy it. Over my lifetime I have met many people with brilliant ideas and thoughts who struggle with getting them into writing in a way that effectively conveys the message. I have a passion for helping people take their ideas and putting words on paper so that the ideas can be shared with others. There is a great sense of satisfaction that I get when a client tells me "that's exactly what I wanted to say!" Although I have not been formally hired as a writer until recently, I have an extensive writing history. I am conscientious and thorough in all that I do, often going above and beyond employer expectations. I have an inner passion for knowledge and answers. If I don't know something, want new information or want to learn how to do something, I do whatever is necessary to find the answers. My preferred jobs are advanced Research and Writing projects that require someone with great attention to detail and an analytical approach to finding information, not just "collecting data." {Don't get me wrong, I enjoy the data collection process, but typically simple research jobs don't pay equivalent to my experience & expertise.} Outside of freelance work as a writer, I provide business consulting, web design and online marketing services for small businesses, "from one small business owner, to another." As an entrepreneur who has been through the struggles of learning how to succeed when resources were limited, I understand what it is like to build a small business from the ground up. My formal training is in Psychology and this background gives me a unique perspective on the world of marketing and behavior. I have been a work-at-home mother since 2002 and absolutely love the freedom that being self employed provides. Let me be upfront - if you are looking for someone to work at "outsourcer rates" or to provide any work that is unethical or "black hat," then I am not that person. But if you are looking for a person who will provide HIGH QUALITY and ORIGINAL work, completed by someone with both an attention to detail and a creative mind, then that's me. I stand by all my work and won't work on anything that I wouldn't be proud to put my name on. As a business consultant, it is my job to Research and Find Solutions for my clients, as well as find information relevant for their business/industry. As a web/internet consultant, with knowledge of how content and keywords affect search engine results, I have a full understanding that there is "much more to be found" beyond the first Google results pages. On the educational level, I have a Master's Degree "plus" in Counseling Psychology from a school that was extremely research oriented, preparing students for Doctoral Programs. Not only did the regular coursework require routine research and report writing, but the program included completion of a Master's Thesis. I also have an undergraduate minor in statistics. Prior to becoming a freelancer, I have over twenty years of experience working with children in social and school settings. My specialty was working with children with emotional and learning disabilities. As the Director of a Youth Shelter, I also have experience supervising and managing teams. In 2002, after 20 years in the corporate world, working full time "plus," I made the decisision to change focus. With these New Priorities I started down the path of being a "work from home mother" (WAHM) and home business owner. "Enjoy Life Enterprises" is the umbrella for all of my entrepreneurial and freelance endeavors. Because I am completely self-employed, I have flexibility in the hours that I can provide, based upon what is required. I am located in the United States (North Carolina) and can be reached by email or if you are US based, we can talk by phone. I have also set up a Skype account if you are outside of the US.
Business Plans, Pitch Decks, Start-up Consulting, Finance & Marketing
Canada - Last active: 14 hours ago - Tests: 8 - Portfolio: 6
A strong business leader, I have 15 years of senior management experience with several Fortune 500 companies. In addition, I am a top performer and contractor for oDesk Enterprise Solutions and a recipient of the oDesk Top 10% Award. My expertise includes: -Business strategy/pitch decks -Business plans & proposals -Financial Forecasts, Analysis, Business Valuations -Marketing Strategy and Plans -Project Management & Six Sigma My objective is to build a consulting practice and deliver to you, the client, the best knowledge, expertise and results that our team has to offer. I am energetic, dedicated and will deliver 100% to each and every project. I look forward to the opportunity to work with you, sharing my expertise and making us both a success! Skills Summary: Business Strategy/Business Plans; Start-up consulting, Business Plans, Investor plans, Pitch decks, Market Research, Executive and Investor presentations Finance; Financial Budgeting and Forecasting, Business Plan Development and Financial Analysis, Margin, Income Statement & Balance Sheet Management, Month End Closing, Analytical Expertise, Audit and Internal Control, Marketing; Online Channel Management, Strategic Planning, Brand Development, Mass Media Strategy and Execution, Management of Direct Marketing and Telemarketing Channels, New Product Development, Market and Consumer Research, Retail Marketing, Marketing and Statistical Analysis Project Management: Recruitment, Business Process Development and Facilitation, Vendor Management, Team Management, Lean Six Sigma, Senior Project Management
- Business Planning
- Startup Consulting
- Strategic planning
- Business Proposal Writing
- Business Coaching
- Business Modeling
- Business Analysis
- Venture Capital Consulting
- Business intelligence
- Project management
- Financial analysis
- Market research
- Marketing strategy
- Six Sigma
Associated with: CORE Consulting Services Inc.
Executive Director/ Business Consultant/ Senior Project Leader
United States - Last active: 3 days ago - Tests: 11
Justin DeWitt is a highly recognized and accomplished consulting industry operating executive with experience in sales strategy, technology, IT services, marketing, construction and manufacturing industries. He has deep driven expertise in mobility, cloud computing, and executive leadership. Justin is a highly effective, strategic leader with a proven track record of leading global organizations and operations through successful transformations and growth. He has extensive P&L experience with the proven skills to drive growth and revenue on a global scale utilizing international expansion and managing a global footprint in the industry. Justin is characterized as a strategist with in-depth visionary and tactical skills which is backed by a consistent track record of delivering extraordinary results in growth, revenue, operational performance, and profitability. He is known for his unique business model development, customer centric approach, passion for his craft and deep candor. Justin believes that "value comes from within ones own ability to lead successfully" and is known for turning an idea into an operational plan that generates positive results. He has a proven track record in successfully leading teams in architecting and implementing clients ROI driven enterprise solutions and successfully developing and deploying internal dynamics that bolster growth in the marketplace and help to keep clients on the leading edge of their respectable industries.
- Business Development
- Business Coaching
- Project management
- Management Development
- Franchise Consulting
- Startup Consulting
- Venture Capital Consulting
- B2B Marketing
- Marketing strategy
- Brand Ambassador
Associated with: Premier Business Advisors, Inc. Agency, CMS Outsourcing Agency
Entrepreneur and Author
India - Last active: 10 days ago - Tests: 2 - Portfolio: 5
Need high-impact results for your business? I'm a Marketing specialist who help drive your online marketing, increase sales and bring innovative strategies to elevate your company to new levels of success. I posses 14+ years of experience in online marketing and business strategy development. Areas of expertise: 1. Demand analysis and ideation 2. Content strategy, planning and execution 3. Email marketing and funnel optimization 4. Website conversion optimization
- Business Coaching
- Internet Marketing
- Marketing strategy
- Direct marketing
- B2B Marketing
- Viral marketing
- Inbound marketing
- Email Marketing
- Business Planning
Associated with: Fourth Media Technologies Pvt. Ltd
Project Management, and Service Management,
Cyprus - Last active: 2 months ago - Tests: 7 - Portfolio: 4
Demonstrable skills and experience in both Enterprise and SME (MSP Clients) Project and Programme Management, based on the principles and methodologies of industry standards such as PRINCE 2 and PMP. With further demonstrable experience of managing teams in excess of 30 members including local hire and remote resources, together with all aspects of annual performance appraisals, and contractor negotiation, with an excellent understanding of the latest ITIL methodologies for ITSM. This specific experience has been gained from over 10 years of managing distributed teams and environments across multiple time zones and cultural forums, through Application and Infrastructure Support and Project and Change Management to have a complete understanding of the both SDLC and ITSM and how to make them successfully coexist. I have developed and managed enterprise grad SLA's, OLA's, UC's and KPI's framework, for both internal IT staff and external supplier resources to meet with industry and global regulatory requirements. Responsible for ALL Sarbanes Oxley (SOX) reporting and owner of ALL SOX controls for UK. I have a professional, adaptable, and competent approach to both Resource and Stakeholder management. I am more than comfortable with working in an integrated IT environment or as a consultant. I have a strong mix of corporate enterprise, SME and entrepreneurial experience, and to expand on that, my experience has afforded me the ability to learn the complex matrix management structures and business models which predominantly gained within Global Financial Services Industries (Investment Banking and Global, Corporate and Specialty Insurance). Where conversely some of my most recent and earlier career experience was based in one of the most competitive customer service industries, and to achieve success in this, I had to be flexible to market conditions, so that I could maintain strategic focus so as to continually meet my financial targets. The combination of my career experience has provided me with the opportunities of working in USA, Belgium, France, Spain, Gibraltar, Abu Dhabi and secondments to Brazil, Mexico and APAC, for projects that I was either managing or transferring to local piers and latterly I had responsibilities for USA, Germany, Italy, Switzerland and Denmark. I am confident that I have a strong comprehension of global business environments and managing diverse IT Departments across a multicultural platform. I feel that I am confident and excellent communicator and am completely at ease with interacting and influencing piers, partners, subordinates and executive management, both internally and externally to my working environment. Throughout my career, I have remained technically competent, complemented by my training and experience with Prince 2 and ITIL methodologies. I am a strong communicator, who is confident and experienced in influencing business and IT stakeholders-up to and including-CIO/Managing Director Level.
- Project management
- technical analysis
- Nagios
- Account Management
- Microsoft Exchange Server
- Virtualization
- Microsoft Virtual Server
- Direct marketing
- Social Media Marketing
- Google Apps
- Google Docs
- Blackberry app development
- Data Backup
- Data Center Operations
- database management
- Insurance Consulting
- Risk management
- Yahoo! Messenger
- Skype
- Requirement Management
- Requirements analysis
- Vendor Management Systems
- Budgeting & Forecasting
- Helpdesk
- Service Level Management
- Oracle E-Business Suite
- Microsoft Hyper-V Server
- VMware Administration
- VMware ESX Server
- Adobe Dreamweaver
- Disaster recovery
- Business Continuity Planning
- FreePBX
- Domain Migration
- Network Security
- Network Administration
- Network Planning
- Agile software developmennt
- Basecamp
- Business Process Modeling
- Business intelligence
- Business Analysis
- Business IT Alignment
- Business Coaching
Recruitment Manager and Project/Pipeline Manager
Philippines - Last active: 1 day ago - Tests: 7
Over the last 10 years, I have extensive experience in recruitment, human resources management, employee relations, training and development, compensation and benefits, and organizational development. Have successfully hired several IT and non-IT practitioners (Developer and Support for Java, C++, RPG, Cobol, Cognos, SAP [FICO, SD, MM, HR, PP], etc.; IT Administrators i.e., Network, Systems, Dialer, Cognos, Sharepoint, SAP Basis, etc.; QA/Testers; Business Analysts; Project Managers; IT Managers; Development Managers; QA/Test Managers; Engineering, Manufacturing, Banking/Finance, Operations, Auditors, Sales/Marketing, BPO/Call Center Executives, etc.) Five years of my HR experience have been into online/freelance work through oDesk. I also manage a recruitment/HR team, handling the training of the new hires and promoted employees, employee relations, compensation and benefits, and organizational development. I also have more than 5 years of experience in administrative work; more than 3 years experience in sales/customer service; almost 8 years experience in handling operations management; and 16 years experience in data entry and transcription.
Angel/Equity Investor Business Plan, Market Research
India - Last active: 1 day ago - Tests: 12 - Portfolio: 8
I Sivaramakrishnan working as a Consultant & Researcher have 4 years of experience in creating market research reports, business plans marketing plans, strategy documents, competition analysis report, financial projections etc. I have worked with clients from a gamut of sectors including IT, Healthcare, FMCG, e-commerce, Education, OTC , Hospitality, Retail and Real estate, both from India and worldwide. I pride myself in providing a customized approach to the preparation of business plans and research reports which has benefited a number of entrepreneurs in new product launches, raising capital, determining USP, effectively reaching target segments, streamlining operations and devising marketing/financial strategies.
Agile Project Manager | Certified Scrum Master | UI Wireframe Expert
Bulgaria - Last active: 14 hours ago - Tests: 7
Senior Project Manager with 13+ years experience - direction, coordination, implementation, execution, quality control and completion of web projects. Agile Project Manager / Certified ScrumMaster / Accredited Kanban Practitioner. Agile Coach. Jira Admin Expert & Trainer. Axure wireframing expert. Reliable agile professional with 5000+ hours at odesk and perfect feedbacks, I have experience in the full cycle of project management, including but not limited to: - clients communication, requirements gathering, proposal building - software architect / UI designer / wireframing: hotgloo, balsamiq and axure - project documentation building - functional specifications, diagrams etc. - programming teams management and supervising - onsite and offsite - design teams management and supervising - onsite and offsite - quality assurance teams management; high level quality assurance by myself; browsers compatibilities experience - building company standards, methodologies and practices - basic PHP / MySQL / HTML / CSS skills. I have been a successful PHP programmer in the beginning of my carrier. - experience with different project management and issues/bugs management softwares and online tools - defining goals, managing team time and staying within the budget; monitoring and analyzing progress; business management - project management methodologies / practices: Waterfall, Iterative Waterfall, Agile / Scrum / Kanban / Scrumban, Continuous Integration I hold Master of Science in Computer Sciences. I have excellent English, which I have studied in Florida State University. I also know French and some Russian. 60+ perfect feedbacks prove the quality of my work. They can be shown on request.


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Mississauga, ON - Canada
Member Since:
January 10th, 2011
About Ryan Demaree
Born and raised in Columbus, OH [USA]- October 28th 1991. In my work I like to focus on topics of Primitivism, Science-Fiction, and Mythology. I create my own personal mythologies and symbolism in my art that conveys my Surreal vision of the world. My work is heavily inspired by both my personal daily experiences in life, as well as by Science, and Science-Fiction. I work in various outlets of creation [Painting, Drawing, Sculpture, Video, Photography etc.] but I am primarily a Painter.
I am a child of the 90�s, a product of lower-middle class Suburbia, and North American culture.
I consider myself a Modern-Surrealist.
2008- Artwork displayed in Highschool Showcase - Pickerington, OH [USA] [GROUP]
2008- Rock Factory Studios Art/Music Lessons - GRAND OPENING! - Pickerington, OH [USA] [GROUP]
2008- Rock Factory Studios Art/Music Lessons - Solo show - Pickerington, OH [USA] [SOLO]
2012- Avant Garde Arts & Crafts Show - First annual show - Columbus, OH [USA] [GROUP]
2013- Imagination Gallery - GRAND OPENING! - Winchester, VA [USA] [GROUP]
2013- 'See/ME - Creatives Rising' - Digital slideshow exhibition - Queens, NY [USA] [GROUP]
2014- Saatchi Gallery show/event - Los Angeles, CA [USA] [GROUP]
2013- 'Inspired by Dali' - Saatchionline.com -DIGITAL COLLECTION
2013- 'Inspired by Picasso' - Saatchionline.com -DIGITAL COLLECTION
2014- 'Inspired by Jackson Pollock' - Saatchionline.com -DIGITAL COLLECTION
2014- Saatchi Art Collection - Saatchi inc. - Los Angeles, California [USA]
2010- ArtStudio54.com- Artist ad feature!
2012- 'Amateur Astrophotography' Spotlight! - Front-Page-Feature- Youtube.com
2013- 'Original Artwork for $500 and under' Front-Page-Feature- Saatchionline.com
2013- WearThatART.com- Artist ad feature!
2013- 'International Contemporary Artists - VOL. 7' - ICA Publishing - Art book
2013- 'State Of The Art- Artist's Book' - Galeria Aberta Publishing - International Artist's Book
2015- CapriceMag.com - Front-Page-Feature!
2015- 'Caprice Magazine MARCH 2015 | ISSUE #35 - VOLUME 3'- Painting feature + short interview - Caprice Magazine
2011- 1st Place- $150 Prize- 'First Social Media Contest' - FineArtAmerica.com [FAA]
2012- Visual Art Competitions- 1st place- 'Free4All'- Website Feature - FineArtAmerica [FAA]
2014- Custom Framing Associate- Michael�s Arts & Crafts- September-December 2014
Highschool - Pickerington High School Central [PHSC]- Columbus, OH [USA] - 2006-2010
College/ University - Ontario College of Art and Design University- [OCADU] [ON,CA] - Bachelor of Fine Art [BFA] - Drawing & Painting - 2013 - 2017
- http://1-ryan-demaree.artistwebsites.com/ - My Personal Artist website
- http://www.zazzle.com/ryandemaree - My Zazzle
- http://rev-ryan.deviantart.com/ - My DeviantART
- http://www.saatchionline.com/RyanDemaree - My Saatchionline
- http://wearthatart.com/index.php?route=information/information&information_id=40 - My WearThatArt
- http://www.youtube.com/user/RyanDemaree - My youtube channel
- http://www.facebook.com/#!/profile.php?id=100000486121797 - My facebook account
- http://www.facebook.com/#!/pages/Ryan-Demaree/119542394826361 - My facebook page
- http://abstractsurrealism.blogspot.com/ - My Blogger [blog]
- https://twitter.com/#!/Ryan_Demaree - My twitter
- [647] 609-8800 [My cell #]
- email@example.com - My email
If you are interested in purchasing an original painting, or a custom photo reproduction featuring my artwork MADE BY ME please contact me through the info I have provided above as contact information.
I will take commissions and am open to ideas, feel free to send me a message if youd like me to make you something and we can work on an idea/ price for it and get a project started!!!
Thank you for your time, have a good day.
-Ryan Demaree
create & buy custom products at Zazzle
The face of Peace by Ryan Demaree
Truth Beyond by Ryan Demaree
Workshop by Ryan Demaree
Onward by Ryan Demaree
Ode to Pollock by Ryan Demaree
Zurascention by Ryan Demaree
The birth of time by Ryan Demaree
Light fragments by Ryan Demaree
Lunas replacement by Ryan Demaree
Recurring Face by Ryan Demaree
Apock by Ryan Demaree
Contemplative Stupor by Ryan Demaree
Time is coming to an end by Ryan Demaree
The puppeteer by Ryan Demaree
Self-Portrait- Meme by Ryan Demaree
Abiogenic Memetics by Ryan Demaree
Cult Erie by Ryan Demaree
Umbilical Nest with Pine Tree by Ryan Demaree
Understanding Everything Full by Ryan Demaree
Page #4 of 4
Beverly Hills, CA (United States)
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Mon-Fri: 7am-1am EST / Sat-Sun: 7am-11pm EST
ApplianceFrigidaire Oven
Level of DifficultyEasy
Time to do repairMore than 2 hours
Age of Appliance5 - 10 years
My oven went out the day before Christmas. After calling around and getting high quotes from several 24/7 repairmen I decided to do the repair myself. I searched YouTube and found the video from PartSelect on how to repair my oven and decided to order my part. Due to the holidays there was a shipping delay but once I got the replacement part it was easy to repair. Just make sure that you are aware of the tools needed to do your repair. You save a LOT of time that way. My repair probably would have taken me only 30 mins but it took over 2 hrs due to 2 trips to the hardware store.
Help other customers find the most helpful instructions.
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Part Number: PS2332301
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The PartSelect logo is a Registered Trademark of Atlantic Laundry Centres, Ltd.
Copyright © 1999-2015 , Eldis Group Partnership. All rights reserved.


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LIMA – It appears to be business as usual for the girls basketball side of the Northwest Central Conference, as play begins this season.
Upper Scioto Valley and Waynesfield-Goshen seem to be likely contenders for the league title after the Tigers and Fairbanks finished tied for the championship last year with 5-1 league records.
The Rams and Perry were close behind, as each team posted 4-2 records.
"I think it will be Waynesfield-Goshen and Upper Scioto Valley battling for the championship again this year," Perry coach Herb Lane. "USV is very athletic and has a couple of starters back. Waynesfield has two outstanding freshmen in Emily Patton and Alicia Kessler."
Any success for Perry will depend on the development of its guard play, as the Commodores return 6-foot-2 post player Lexie Davis to provide a strong inside game.
"We have some potential with our good post play but we are very young at the guard position." Lane said. "Any success we have will depend on how quickly our guards grow up."
Veteran Waynesfield-Goshen coach Ted Patton thinks USV will be the team to beat in the NWCC this season.
"I would expect USV to be at the top," Patton said. "Mike (Risner) just does such a good job with those girls. We (W-G) should be good and competitive. We are very young, but have a lot of talent. I also see (Sidney) Lehman being in the mix."
Patton says that his daughter, Emily, and fellow freshman Alicia Kessler have played well in the early going for the Tigers.
Veteran USV coach Mike Risner has three returning starters from last season and, as a result, expectations are high for the Rams.
"Waynesfield has four starters, plus two outstanding freshmen. We get to play them at home and that could be the game of the year," Risner said. "We lost our top three scorers to graduation but have a nice freshman, Shelby Spradlin, who is averaging 17 points out first two games. Also, don't forget Lehman Catholic, who could sneak in."