Psychology Adrian Monk Essay

Adrian Monk, portrayed by actor Tony Shalhoub, is the main character in the USA Network series MONK. Monk is a former homicide detective for the San Francisco Police Department, suffering from an anxiety disorder known as obsessive-compulsive disorder (OCD), as well as numerous phobias. After Monk’s wife was murdered, his disorder worsened leading to his suspension from the police force. When the series opens, Monk works as a private police homicide consultant and undergoes therapy to overcome his anxiety disorder and phobias. He is assisted by a private nurse who helps him cope with his disability on the job. Part One—Case Study Character Background The episode â€Å"Happy Birthday Mr. Monk† shows that Monk, born October, 17, 1959, is a California man of Welsh ancestry. Monk is 50 years old, and was born in Marin County, CA. He stated, â€Å"His alma mater is the University of California, Berkley. † His parents were very strict and authoritarian. Monk’s father Jack Monk abandoned the family when Monk was eight years old. Jack said that he was going to get Chinese food, but he never came back. Ambrose Monk, Monk’s brother, is agoraphobic and afraid to go out in public. Monk’s mom died in 1994. Because of these childhood family events, Monk is already a very sensitive and fragile person. Mr. Monk dislikes unorganized, rude, dirty, and filthy people. He also dislikes murderers, people who commit evil acts, and criminals on the loose. That is the reason he became a homicide detective. Mr. Monk likes people who help others, such as his physician and Trudy. In addition, he likes organized, clean, and tidy people. Mr. Monk’s strength is that he is a very clever detective. Plus, he has an amazing photographic memory, which helps him catch criminals. His weakness is that he has many phobias, which affect his performance as a detective. Mr. Monk doesn’t have any friends because of the weird and odd behaviors caused by his OCD. His family consists of his assistants/nurses Sharona, and then Natalie. He also works with people in the homicide department, namely Captain Leland Stottlemeyer and Lieutenant Randy Disher. Stressors/Pathology Mr. Monk does not have any relationships with anyone, mainly because of his odd behaviors. He acts strangely in front people because of his OCD. In the episode â€Å"Mr. Monk Makes A New Friend† he annoys a new friend by calling him too much. Monk explains himself, stating, â€Å"I can’t not call him or hear his voice. † It is very annoying to call a friend every hour. That is one example of how Mr. Monk has difficulty with personal relationships. His wife, Trudy Monk, with whom he had a meaningful relationship, died in a car bomb. Before his wife’s death, Mr. Monk’s OCD symptoms had alleviated. After Trudy was murdered, the OCD symptoms intensified, and those around him could clearly see that he had issues, which affected his job performance and led to his isolation. When the series begins, Mr. Monk’s condition is somewhat stable, but his lives in an overly organized apartment. The battle Monk faces daily is how to make it through the day with his OCD. He tries to avoid everything that makes him uncomfortable or is viewed as a threat. Mr. Monk stresses over the fact that every room must be neat and tidy. Plus everything must be a multiple of 10; for example he buys a box of eggs, which contains 12 eggs and deliberately throws two eggs away. Mr. Monk doesn’t have any history of this disorder, but his brother was agoraphobic. Symptoms Other symptoms of OCD manifest themselves typically as ritual behavior such as repetitive hand washing. Mr. Monk needs to wash his hands every time he touches an object or shakes a hand. He becomes obsessed with shapes. For example, his toast has to be a perfect square. Numbers occupy his time. As mentioned above, everything must come in multiples of 10. He has the typical preoccupation with dirt and germs. For example, he can’t stay in an untidy or dirty room; he has to tidy it up. Mr. Monk is terrified of germs, milk, dust, and heights. So what Mr. Monk does all day is try to stay away from all of these fears. These symptoms never emerged in the series; rather, the viewer is led to believe that Mr. Monk had OCD since he was born. However, the viewer is also informed in conversations with the police sergeant and with Monk’s nurse and therapist that what triggered this disorder was the murder of his wife. Immediately after his wife died, his disorder worsened. Outcome of Case Monk’s treatment was to go to Dr. Charles Kroger for psychotherapy that would aid him to cope with his disorder. In the sessions, Mr. Monk talks about what he did during the day and the goals he accomplished. The treatment is not entirely effective, but it helps Mr. Monk relax and get all the stress out. In the long term, Mr. Monk cannot overcome his disorder because he cannot imagine that he can be cured. In addition, he is not a risk taker, meaning he could never do anything that would make him uncomfortable. Because of this, there is little hope that he will be able to completely overcome his disorder. This makes sense because his disorder is inherited, and not attributed to environmental causes. Part Two—Disease Diagnostic Criteria Obsessive Compulsive Disorder (OCD) is a pattern of recurring obsessions and compulsions that are severe enough to be time consuming and interfere with a person’s daily functioning. They must cause marked distress (such as pain or physical harm to the person) or significant impairment. Usually, they take more than one hour of a person’s time. It is important to specify whether or not the patient has poor insight, meaning that the person does not realize that the obsessions or compulsions are unreasonable or excessive. At some point, the person must realize that their obsessions and compulsions are not reasonable (i. e. , normal). â€Å"Obsessions are consistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or stress† (DSM IV-TR, 300. 3). Most common obsessions are about contamination with dirt or germs, repeated doubts, a need to have things in a particular order, horrible impulse, the need to shout obscene words, or sexual impulses. Compulsions are repetitive behaviors which people do to reduce the anxiety or distress of the obsessions. For example, repeated hand washing is a compulsion, which satisfies the obsession of repeated thoughts of contamination from dirt. For a complete list of Diagnostic Criteria from the DSM IV-TR, see Appendix A. Etiology (Causes) Nearly 1 to 2 percent of the population suffers from OCD. Most of those begin to be afflicted in early adulthood, and it is often preceded by a particularly stressful event such as pregnancy, childbirth, or family conflict. It may be closely associated with depression, with the disorder developing soon after a bout of depression or the depression developing as a  result of the disorder. Men and women are equally affected. A fairly high proportion (as much as 50 percent) do not marry (Baldridge 2001). Although Obsessive-Compulsive Disorder usually begins in adolescence or early adulthood, it may begin in childhood. Modal age at onset is earlier in males than in females: between ages 6 and 15 years for males and between ages 20 and 29 years for females. For the most part, onset is gradual, but acute onset has been noted in some cases. The majority of individuals have a chronic waxing and waning course, with exacerbation of symptoms that may be related to stress. About 15% show progressive deterioration in occupational and social functioning. About 5% have an episodic course with minimal or no symptoms between episodes (DSM IV-TR, 300. 3) No cause for OCD has been isolated. Four theories exist which try to explain the basis of OCD psychologically: guilt, anxiety, and superstition. 1) The theory of guilt has its origins in Freudian psychoanalysis. Freud believed that patients with OCD developed repetitive rituals, such as hand washing, to replace obsessive thoughts about sex. The obsessive ritual, then, was seen as a way to replace the guilt of being overwhelmed by forbidden, sexual thoughts. 2) The anxiety hypothesis poses that OCD behaviors develop to reduce anxiety. Many thought or action patterns emerge as a way of escape from stress, such as daydreaming during an exam or cleaning one’s room rather than studying for a test. If the stress is long lasting, then a compulsive behavior may set in. 3) The superstition theory proposes a connection between a chance association and a reinforcer that induces a continuation of that behavior. In other words, a particular obsessive-compulsive ritual may be reinforced when a positive outcome follows the behavior; anxiety results when the ritual is interrupted. 4) A fourth theory is accepted by those who believe that mental disorders are the result of something physically or physiologically amiss in the sufferer, employing data from brain structure studies, genetics, and biochemistry. Brain chemistry has been found to be altered in those suffering from OCD, along with increased metabolic activity. In addition, relatives of OCD sufferers are twice as likely as unrelated individuals to develop the same disorder, indicating that the tendency for the behavior could be inheritable (Baldridge 2001). Treatments OCD is one of the most difficult disorders to treat. Treatments usually fall into four categories: psychotherapy, behavioral therapy, drug therapy, and psychosurgery. The goal of psychotherapy in treating OCD is to find and then remove an assumed repression so that the patient can deal honestly and openly with whatever is actually feared. It is hoped that in dealing with the fear, the compulsions that have developed to replace the fear will lessen. The most effective type of psychotherapy for obsessive-compulsive disorder is behavioral therapy. It can help by desensitizing the patient to the feared object or situation. For example, the therapist will aid the patient in replacing the symptoms of the obsession or compulsion with preventive or replacement actions, such as a non vocal, internal shout of â€Å"stop! † when obsessive thoughts enter the mind or the action of snapping a rubber band on the wrist. Behavioral therapy may also help by gradually lengthening the time between the stimulus and response. For example, a patient may hold dirt and then gradually lengthen the amount of time after which he or she will wash his or her hands. While behavioral treatment can help to control OCD, it does not â€Å"cure† the disorder. Drugs used to treat OCD include antidepressants, tricyclic, monoamine oxidase inhibitors (MAOIs), LDS, and tryptophan. Antidepressants help by reducing depression by correcting the serotonin abnormality in the brain, which may decrease the need for compulsive behavior. MAOIs may help OCD associated with panic attacks, phobias, and severe anxiety. With drug therapy, it should be noted that when the drugs are stopped, the patient often returns to the obsessive-compulsive behavior. Psychosurgery to reduce OCD is a last resort. The patient would undergo a lobotomy in which the frontal cortex would be separated from the lower brain area in an 8-centimeter square area. A combination of behavioral therapy, psychotherapy and drug therapy is recommended. General Research Behavioral treatments are new ways to deal with the disorder. For example, someone with an obsession about germs might be asked to practice handling dirt and then not washing his hands for increasing lengths of time. With repeated exposure to the anxiety-provoking object or situation without performing the compulsion, usually the anxiety lessens, and the compulsion weakens its hold. Obsessions can fall into one of five categories: 1. Obsessive doubts, which are persistent doubts that a task has been completed. 2. Obsessive thinking, which is an almost infinite chain of thought, targeting future events. Obsessive impulses, which are very strong urges to perform certain actions, whether they be trivial or serious, that would likely be harmful to the obsessive person or someone else and that are socially unacceptable. 4. Obsessive fears, which are thoughts that the person has lost control and will act in some way that will cause public embarrassment. 5. Obsessive images, which are continued visual pictures of either a real or an imagined event. (DSM IV-TR, 300. 3) Compulsions on the other hand are repeated, ritualized behaviors. For example, fearing one has forgotten to turn off an appliance, such as a stove, is a common obsession. It is likely to be accompanied by a compulsion to check repeatedly, perhaps hundreds of times each day, perhaps to see if the appliance has been turned off. Compulsions are repetitive behaviors, the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification. In most cases, the person feels driven to perform the compulsion to reduce the distress that accompanies an obsession or to prevent some dreaded event or situation. For example, those with obsessions about being contaminated may reduce their mental distress by washing their hands until their skin is raw. There is difference between OCD and obsessive-compulsive personality disorder (OCPD). A personality disorder is, on the one hand, a type of mental illness characterized by serious and persistent distortions in the total personality. Every perception, attitude, feeling and behavior is affected. OCD, on the other hand, is an anxiety disorder. Like other anxiety disorders, fear is at its root—fear of a hot appliance burning down the house, for example, or fear of the body being contaminated by germs. The fear produces an anxiety which can only be alleviated by a ritual, or compulsion, which will reduce the fear. Conclusion— Evaluation of Case In conclusion, Adrian Monk has Obsessive-Compulsive Disorder. He satisfies the following OCD patterns of behavior: 1. Washer, because he is afraid of contamination; 2. Checker, because Mr. Monk repeatedly checks if the door is locked, or whether the oven is turned off. Mr. Monk checks everything a dozen time just to make sure. For example, he checks his oven if it is closed everyday at least twelve times; 3. Arranger, because he always arranges his utensils based on size and shape and his books based on color. He cannot function in a messy room or disorganized room. In addition, Mr. Monk has other phobias, such as fear of blood and fear of the woods. He is terrified of germs, milk, heights, and spiders. Mr. Monk has a rule that everything he has must come as a multiple of ten. When he buys milk, he gets 10 bottles even though he lives alone and the milk will expire before he has time to drink it all. Monk’s symptoms may improve with therapy, but his OCD will not completely resolve.

Ethics, politics and bio-pedagogy in physical education teacher education: easing the tension between the self and the group Essay

Art is a skill that has aesthetic results. There are different types of art like music and paintings that are similar in composition in a way since they convey certain messages and demonstrates creativity. Therefore, there are general standards that artists agree to that constitutes art that assists in distinguishing suitable art from unsuitable one. Evaluation of a particular artwork depends on a number of qualities that the art may exhibit. However, there is controversy when it comes determining whether a particular artwork has artistic merits. Whereas ethics is acceptable standards, people live by. More often than not, we disagree with ethical theories though we can all identify an unethical deed when we see one. Tower (2011) says that the values that distinguish noble art from awful art are as a result of reasons hence easy to reach an agreement about whereas evaluating a particular artwork depends solely on the individual’s emotion feelings which normally differ hence is bound to bring about conflict . In the case of ethics, however, the alternative is true since theories result from peoples’ feelings about specific ethical standards hence bound to bring conflict as everyone will interpret the situation differently but we all recognize an action that is unethical when we see one because there are undoubtable reasons to explain their relevance to the society (Coast, 2009). Art is open to debate, based on the fact we are all unique (Coast, 2009). What your neighbor prefers and likes might not be what appeals to you and that is the reason for the rise in different opinions when it comes to judging a particular artwork. The work is exposed to critics from anyone, and its judgment depends on the individual’s taste and preference that are uncontrollable. As much as people may accept the artwork the fact remains that not everyone would be on board with that decision. This is because the work may meet most of the general art standards such communicating the intended message appropriately but may fail to impress others maybe be due to visual impression in case it is a painting (Coast, 2009). Camacho & Fernandez (2006) agrees that reaching a consensus on issues that distinguishing noble art from bad awful art is less complicated since they consider a number of factors all directed to the importance of art in the society however deciding whether a particular art portrays artistic merits may result to dispute since there is difference in the interpretation of those standards when evaluating an individual’s work. For instance, artists agree that good art ought to exhibit a high level of the creativity, capture imagination as well as convey the message clearly and appropriately. However, people differed with the judgment of the film, Wonderful Life and Miracle on 34th Street directed by Bob Clark, because they were not able to come to an agreement concerning whether the message was clear for the audience intended and the degree of creativity. The standards dictate that a good art should be timeless, but people could not come to an agreement whether this film would stil l be relevant in the future since the society is dynamic. This is a clear indication that the application of these principles is not clear hence results to disputes. However in the case of ethics, the converse is true. Interpretations of ethical theories depends on individual’s perspective hence may result in disagreement due to different opinions but an unethical act is easy to spot. Indeed, we may agree to general standards in the in the arts but disagree as to whether a particular work has artistic merits. However, when it comes to ethics may disagree with ethical theories but know an unethical action when we see one. This is because, general art standards are facts and determining the value of a particular artwork requires application of these general standards that depends on Individual’s taste and preferences hence brought about by the unique nature of humans is bound to create controversy just as in the case of ethics, ethical standards are facts based on the acceptable moral behavior and ethical theories are notions that can be interpreted differently hence results to controversy. Moreover, the values that distinguish good art, and bad art are subjected to reason while evaluation of a particular art is subjected to emotions that are the opposite when it comes to ethics. References Camacho, A. S., & Fernandez Balboa, J. (2006). Ethics, politics and bio-pedagogy in physical education teacher education: easing the tension between the self and the group. Sport Education and Society. doi: 10.1080/13573320500255023 Coats, A. J. (2009). Ethical Authorship and Publishing. International Journal of Cardiology. Doi:10.1016/j.ijcard.2008.11.048 Tower C.N. (2011). An Evaluation of compositions for wind band according to specific criteria of serious artistic merits: A second update. Source document

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The most important aspects of the human resource development Essay Example for Free

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Din for his guidance and for giving us a project on Human Resource Management. We are grateful to Management of Shaukat Khanum Memorial Hospital for their cooperation. We would like to thank Miss. Amna, acting director HRD, who gave her precious time to provide us information on different aspects of the human resource development processes at SKMCHRC. We would not have been able to complete this project without her cooperation. SHAUKAT KHAUM MEMORIAL CANCER HOSPITAL AND RESEARCH CENTRE Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH RC) is a state-of-the-art cancer centre located in Lahore, Pakistan. It is a project of the Shaukat Khanum Memorial Trust, which is a charitable organization established under the Societies Registration Act XXI of 1860 of Pakistan. The institution is the brainchild of Pakistani cricket superstar, Imran Khan. The inspiration came after the death of his mother, Shaukat Khanum from cancer. The Hospital is a project of Shaukat Khanum Memorial Trust a non-profit legal entity established under the laws of Pakistan. The Board of Governors formulates overall policy and consists of bankers, researchers, businessmen and physicians. The hospital is managed by a professional team from clinical, administrative and nursing backgrounds. MISSION STATEMENT To act as a model institution to alleviate the suffering of patients with cancer through the application of modern methods of curative and palliative therapy irrespective of their ability to pay, the education of health care professionals and the public and perform research into the causes and treatment of cancer. Educational Programs Post-graduate training programs (recognized by College of Physicians and Surgeons of Pakistan) in the fields of: Nuclear Medicine, Radiation Therapy, Medical Oncology, Radiology, Pathology, Medicine Post-graduate training in Medicine recognized by the Royal College of Physicians (UK) Diploma Course in Oncology Nursing (recognized by the Nursing Council of Pakistan) Quarterly Basic and Advanced Cardiac Life Support Courses (BLS and ACLS) Course for Medical Technologists (EKG, PFTs and Respiratory technology) Electives for Medical Students and Physicians in training. JOB DESCRIPTION Occupational Summary: Direct and coordinate the preparation of the operational budget for Shaukat Khanum Memorial Cancer Hospital Administration; direct monitoring of fiscal operations for compliance with approved budget; implement University policies and guidelines as they relating to budget and payroll. Work Performed: Direct preparation of the annual budget for Shaukat Khanum Memorial Cancer Hospital Administration; consult with officials to determine policies, guidelines and program changes which may bear upon budget objectives; evaluate requests recommending changes, deletions and/or additions; prepare final budget for management review. Direct monitoring of revenues and expenditures for realization of and compliance with approved budget; consult with departments as necessary to deter-mine cause of major variances, remedial alternatives and effect on future operations; prepare reports for higher management with narrative explanation of deviations from approved budget. Direct financial analysis of major programs and capital projects. Review financial analysis and business plans prepared by analysts, department heads and Assistant Operating Officers for reasonableness. Provide data to Hospital Administration as necessary to assure accurate intra-institutional distributions of revenues and expenditures. Provide information to various federal, state, professional and University organizations or staff concerning Shaukat Khanum Memorial Cancer Hospital fiscal operations. Prepare various special reports for higher management. Plan and schedule departmental work, ensuring proper distribution of assignments and adequate manning, space and facilities for performance of duties. Direct departmental personnel functions including, but not limited to, hiring, rate recommendations, promotions, transfers and vacation schedules. Perform other related duties incidental to the work described herein. The above statements describe the general nature and level of work being performed by individuals assigned to this classification. This is not intended to be an exhaustive list of all responsibilities and duties required of personnel so classified. MINIMUM HIRING SPECIFICATIONS SKMCH RESEARCH CENTRE EDUCATION/TRAINING Work requires knowledge of accounting or business principles and practices generally obtained through completion of a bachelors degree program in an accounting or business-related field. Certified Public Accountant or Masters of Business Administration preferred. EXPERIENCE Work requires seven years related business or administrative experience to acquire competence in applying general accounting principles, personnel practices and coordination of major administrative functions. A masters degree in a related field, such as business or health administration, may be substituted for experience on a 1:1 basis. OR AN EQUIVALENT COMBINATION OF RELEVANT EDUCATION AND/OR EXPERIENCE SKILLS 1001 SUPERVISION 1003 BUDGET PROJECTIONS 1006 ANALYZE TRENDS 1007 INTERVIEWING SKILLS 1008 PERSONNEL PRACTICES 4105 ACCOUNTING/BOOKKEEPING 4106 DUKE PAYROLL SYSTEM 4108 OFFICE PROCEDURES 4109 DUKE ACCOUNTING SYSTEM 4112 BILLING/COLLECTIONS 4117 INSURANCE CLAIMS 4150 CORRESPONDENCE 6031 PC WORDPROCESSING SOFTWARE 6032 PC SPREADSHEET SOFTWARE 6033 PC DATABASE MGT SOFTWARE Human Resource Management Hiring Hiring Standards and Requirements Special attention should be given to hiring standards that reflect the norm of a communitys predominant group. The hiring unit must be prepared to demonstrate that its hiring standards do not automatically screen out applicants whose speech, dress, and personal work habits differ from those of the predominant group. It must be able to demonstrate that any employment tests or other job screening standards that are used, such as possession of a high school diploma, are reasonable measures of successful job performance. Hiring requirements not directly related to job performance, such as a height requirement in a position where height is not directly related to performance, are discriminatory. Employment Conditions The law against employment discrimination extends to virtually every aspect of the employer-employee relationship, including discrimination with respect to compensation, terms, conditions, or privileges of employment. Wages Discrimination with respect to compensation covers a variety of practices, such as: starting rates or merit increases based on race, color, sex, religion, or national origin rather than qualifications or performance, and different treatment of employees with respect to overtime pay opportunities when based on race, color, sex, religion, or national origin. Training and Promotion Employees of similar capabilities must be offered the same opportunities for training, promotion, transfer, and apprenticeship programs. Discriminatory Environment We maintain a working environment free of racial, sexual, or ethnic intimidation. This requirement includes positive action when necessary to redress or eliminate employee intimidation. If harassment of an employee by co-workers or a supervisor occurs, management is obligated to attempt to remedy the situation. Management must take steps to ensure that a strong non-harassment policy is observed at all levels. Work Assignments It is unlawful to give employees a disproportionately large share of the less desirable assignments or less favorable hours on the basis of race, color, sex, national origin, or religion. Facilities Facilities must be open on an integrated basis to all employees. Employer Reprisal We prohibit taking reprisals against employees who initiate, testify, or participate in proceedings against the employing institution. National Origin Discrimination Discrimination on the basis of the physical, cultural, or linguistic characteristics associated with a national origin group is prohibited. Job requirements such as fluency in English must be shown to be accurate measures of job performance and must fairly assess educational credentials from foreign institutions. In addition, a working environment must be maintained that is free from ethnic slurs, jokes, or other verbal or physical behavior which unreasonably interferes with an employees work performance. Religious Discrimination Religion is defined to include all aspects of religious observance, practice, and belief, such as: * grooming habits, * observance of mourning * Prohibition of medical examination. Reasonable accommodation may include practices such as prayer breaks, shift swaps, flexible scheduling, or change of job assignments which may differ from the employers or the potential employers requirements regarding schedules or other business-related conditions. SEX DISCRIMINATION Hiring standards are not permitted that prohibit women from: * carrying or lifting weights in excess of set limits, * working during certain night hours, * working more than a specified number of hours per day or week, or * Working for set time periods before or after childbirth. Rules that limit or restrict employment of married women but are not applicable to married men are not permitted. An employment policy that excludes applicants or employees (married or otherwise) due to pregnancy is not permitted. Testing Recruitment Policy No employee shall report to his or her work site impaired by drugs or alcohol, including drugs prescribed by a physician and over-the-counter medication. If an employee reports to his or her work site impaired by any drug or alcohol, this behavior shall be deemed unacceptable personal conduct, for which corrective action may be imposed, except that those impaired by a legally prescribed drug may be given appropriate work restrictions. Pre-Employment Testing Policy Testing for drugs and/or alcohol will be conducted on all applicants to whom an offer of employment has been extended. All offers of employment are subject to the terms and conditions of this policy. Failure to cooperate in such a test will result in a withdrawal of the offer of employment. Any applicant who refuses to submit to or tampers with a drug test shall be ineligible for hire. If the test is positive, the information will be forwarded to a Medical Review Officer for assessment. Unless satisfactory reasons exist for a positive test result (i.e. taking prescribed medications, false-positive result, etc.) the offer of employment will be withdrawn and the applicant may not reapply for employment for a period of 365 days. If the applicant suspects a false positive test result, the applicant may request a follow-up test to be administered within 48 hours. If satisfactory reasons appear for the false positive result, the individual may be subject to follow-up random testing for continued confirmation of appropriate use of medications. Test results will be reviewed in confidence by the HR Services Director or designee, (Manager of Employment), who will convey the results directly to those with a need to know. Refusal To Undergo Testing If the employee refuses testing, the supervisor should remind the employee that refusal may result in termination. If the employee continues to refuse, an immediate investigatory suspension (in accord with the Corrective Action Policy) until further notice should be implemented. If testing is accomplished, the employee should be placed on an investigatory suspension with pay until test results are received. Hiring Recruitment The Chief Executive Officer, the Chief Operating Officer, and Vice President for Human Resources are committed to hiring practices that are applied consistently and equitably, thereby demonstrating support for merit-based recruitment and selection. The Employment Office is responsible for recruitment, preliminary screening and referral to operating departments of applications for all vacancies. The Employment Office and the operating departments share responsibility for ensuring compliance with the Health Care System Equal Opportunity/Affirmative Action commitments and all applicable State and Federal policies, laws, and guidelines. The Employment Office advises departments regarding applicable policies and legal requirements. Employment counselors extend offers of employment only when department selections are consistent with policies and laws. In cases where an intra-department promotion is recommended, recruitment may be limited to current Health Care System employees. Such positions would be identified on the Employment Opportunities list as open to Health Care System employees only. The vacancy resulting from the promotion would then be open for recruitment, and subject to the priority considerations. Department of Nursing The Department of Nursing operates a separate nurse employment program for their Registered Nurses, Practical Nurses, and Nursing Assistants. Recruitment of Registered Nurses in other departments, as well as other non-licensed staff in the Department of Nursing is the responsibility of the Employment Office. The Department of Nursing is subject to all Health Care System personnel policies, including merit-based recruitment and selection. Advertising Each advertisement designed to attract candidates for staff employment must be approved in advance by the Assistant Human Resource Services Director Employment. This applies to any advertisement in any medium for any vacancy, Permanent or Temporary. Qualifications The employee or applicant must possess at least the minimum education and experience requirements, or their equivalent, as set forth in the class specification of the position for which the applicant has been hired. The candidate must possess the specific job-related qualifications, as stated by the hiring department, required for a particular open position. This shall apply in cases of new appointments, promotions, demotions, transfers, and reinstatements. The education and experience statements serve as indicators of the possession of identified skills know ledges and abilities and as guides to primary sources of recruitment; reasonable substitutions of formal education and job-related experience, one for the other, will be made. It is recognized that a specific quantity of formal education or number of years of experience does not always guarantee possession of the identified skills, know ledges, and abilities for every position in a class. Qualifications necessary to perform successfully may be attained in a variety of combinations. Exceptions There are two exceptions to this policy: * If an employee is demoted to a position in the same field of work the employee is automatically qualified for the lower class. * If an employee is reinstated without a break in service to a position of the same class or to a lower class in the same field of work, the employee is automatically qualified Employment Office Referrals Refers to the Employment Office any person making direct contact with the department as an applicant or as a transfer candidate from another department. The department does not grant an employment interview at the time of such direct contact. Choosing Interviews Chooses applicants to be interviewed only from those referred by the Employment Office as suitably qualified. Final Screening and Selection Conducts final screening of applicants or transfer candidates and selects the most suitably qualified candidate based upon specific job-related criteria, giving appropriate consideration to the Health Care System Affirmative Action goals and other preferences as stated below. Candidate Evaluations Completes Candidate Evaluations for all candidates whose applications are referred. Returns these forms to the appropriate Employment Counselor. Commitment Has no authority to make a commitment to any candidate for employment, classification title, salary, or salary grade. The Health Care System will not honor any such purported commitment, if made. EMPLOYMENT OFFICE RESPONSIBILITIES Posting Posts on the Employment Opportunities list all classification titles from recruitment requests (may also post working titles when doing so would clarify the type of job available). Posting shall be for a minimum of 7 working days. Forwards a copy of the list to the Workforce Resources Division of the Office of State Personnel. Applicant Selection Selects and refers to the operating department the applications of applicants who are most qualified, based on the job-related qualifications identified in the vacancy announcement. Identifies those who should receive priority consideration as required by State policy or by Federal or State laws or by the Shaukat Khanum Care System Affirmative Action Plan. Monitoring/Evaluation Human Resources staff will periodically review program data across the SKMCHRC to ensure that recruitment and selection activities are in compliance with this policy. Human Resources staff will compile an annual report of selection activity, to include analysis of the impact on demographic groups, exceptions to policy, and other relevant factors. Human Resources staff will also comply with the merit-based reporting. Trainee Appointment: * A Trainee appointment may be made to a permanent position when: * The job specification includes special provisions for a Trainee progression leading to regular appointment. * Recruitment efforts fail to attract qualified candidates. * The recommended applicant fails to meet minimum State education and experience requirements. * The Trainee appointment, like the probationary period, is also an extension of the selection process, and provides the time for effective adjustment of the new employee or elimination of those whose performance will not meet acceptable standards. Employees with a Trainee appointment receive leave, total state service credit, retirement, and health benefits. When applicable, trainees who have completed 6 months of service or who had a Permanent appointment prior to entering a Trainee appointment may receive severance pay and priority reemployment consideration. Permanent Appointment: A Permanent appointment is a permanent full-time appointment to a permanently-full-time established position when the incumbent is expected to be retained in the position on a permanent basis. A Permanent appointment shall be given when: * The requirements of the probationary period have been satisfied. * An employee in a Trainee appointment has completed all training and experience requirements. * A time-limited permanent appointment extends beyond 3 years. Individuals receiving initial appointments at the SKMCHRC must first serve in a Probationary appointment before being eligible for a Permanent appointment. Time-Limited Permanent Appointment A Time-Limited Permanent appointment is an appointment that has a limited duration to: * A Permanent position that is vacant due to the incumbents leave of absence and when the replacement employees services will be needed for a period of one year or less. A Time-Limited Permanent appointment is an appointment that has a limited duration to: * A Permanent position that is vacant due to the incumbents leave of absence and when the replacement employees services will be needed for a period of one year or less. * A Time-Limited Permanent position. If an employee is retained in a Time-Limited Permanent position beyond 3 years, he or she shall be designated as having a Permanent position. A Time-Limited Permanent position. If an employee is retained in a Time-Limited Permanent position beyond 3 years, he or she shall be designated as having a Permanent position. This type of appointment is distinguished from a Temporary appointment by the longer length of time, and from a regular Permanent appointment by its limited duration. Employees with a Time-Limited Permanent appointment receive leave, total state service credit, retirement and health benefits. They are not eligible for severance pay and priority reemployment consideration. Individuals receiving initial appointments to SKMCHRC must first serve in a Time-Limited Probationary appointment before being eligible for a Time-Limited Permanent appointment. Temporary A Temporary appointment is for a limited term, normally not to exceed 3 to 6 months, to a Permanent or Temporary position. When sufficiently justified, a longer period of time may be requested; but in no case shall the Temporary employment period exceed 12 consecutive months. Temporary employees do not participate in SKMCHRC benefits. Employees with a Temporary appointment do not receive leave, total state service credit, health benefits, retirement credit, severance pay, or priority reemployment consideration. Temporary employees are not subject to the corrective action policy and do not have access to the Grievance and Alternative Dispute Resolution procedure. Permanent Trainee or Time-Limited Part-Time An appointment of less than full-time to a Permanent or Time-Limited Permanent full-time position or to a Permanent or Time-Limited Permanent part-time budgeted position on a continuing basis. Employees with appointments that are 20-29 hours per week earn leave benefits (prorated), total state service credit, and, when applicable, severance pay and priority reemployment consideration. They do not receive retirement credit or health benefits; however, they may belong to the group health plan by paying their own premiums. Employees with appointments that are 30-39 hours per week for at least 9 months per year earn leave benefits (prorated), total state service credit, retirement credit, health benefits, and, when applicable, severance pay and priority reemployment consideration. Employees with appointments less than 20 hours per week earn no benefits. Part-Time Temporary An appointment of less than full-time for a limited term normally not to exceed 3 to 6 months. When sufficiently justified, a longer period of time may be requested; but in no case shall the Temporary employment period exceed 12 consecutive months. NEW APPOINTMENTS A new appointment is the initial employment of an individual to a position or the reemployment of an individual who is either not eligible for reinstatement or, at the option of the SKMCHRC, is not offered reinstatement. Probationary or Trainee Periods An employee who begins work in a permanent or time-limited permanent position shall be given a probationary or trainee appointment unless the employee is eligible for and the SKM Health Care System chooses to make reinstatement with a permanent appointment. The probationary and trainee appointment periods are intended to serve as an extension of the selection process and are used to determine whether the person will be able to meet acceptable performance standards for the work for which he or she is employed. The employee will earn all the benefits of an employee with a permanent appointment during this time. Probationary employees are not subject to the corrective action policy. Probationary employees may receive counseling following performance issues or may be terminated at will. Use of the corrective action policy on probationary employees will be voided by HR Services. Any formal corrective action documentation on probationary employees sent to HR will be returned unprocessed to the originating department. Moving To A Permanent Position When an employee is given a permanent or time-limited permanent appointment after the successful completion of either the probationary period or the trainee period. * If the initial salary is at the hiring rate or trainee rate, it shall be increased to the minimum rate of the range and may be increased to a higher rate if justified based on the employees qualifications, equity, and availability of funds. * If the initial salary is above the hiring rate, the SKMCHRC may elect to increase the salary by 5% or to a higher rate if justified based on the employees qualifications, equity, and availability of funds. Firing Employees Discontinuation Of Employment With Notice At-will appointments are subject to discontinuation at any time at the discretion of the Chief Executive, provided that such a discontinuation (as distinguished from a Discharge for Cause) shall be subject to advance timely notice as follows: * During the first year of service, 30 days prior to discontinuation of employment; and * During the second and all subsequent years of continuous service, 90 days notice prior to discontinuation of employment. Expiration Of Term Employment Term Appointments expire automatically at the conclusion of the stated term; such an employment may be renewed or extended at the SKMCHRCs option, by written notice. If the SKMCHRC chooses not to renew a Term Appointment, * With respect to a term of one year or less, no notice of intent not to renew shall be required. * With respect to a term of more than one year, notice of intent not to renew shall be transmitted in writing at least 90 days prior to the expiration of the term. Failure to provide written notice shall result in the automatic extension of employment for a period of 90 days beyond the scheduled expiration date of the term. Termination of Employment Due To Financial Exigency Employment within a Senior Administrative position for a stated definite term may be terminated prior to the expiration of the stated term because of: * Demonstrable, bona fide institutional financial exigency; or * Major curtailment or elimination of a program Financial exigency means a significant decline in the financial resources of the Health Care System that compels a reduction of the institutions budget. The determination of this situation and of major curtailment or elimination of a program shall be made by the Chief Executive, with advance notice to and approval by the Board of Directors. Discharge For Cause Causes for discharge shall include, but not be limited to: * Incompetence * Unsatisfactory performance * Neglect of duty * Misconduct that interferes with the capacity of the employee to effectively perform the requirements of his or her employment. Discharge for cause is to be preceded by written notice of the intent to discharge and is subject to the grievance procedure below. Suspension When a Senior Administrative employee has been notified of the intent to discharge him or her for cause, the Chief Executive may suspend his or her employment at any time and continue the suspension until a final decision concerning discharge has been reached. Suspension shall only be used in exceptional circumstances, and shall be with full pay. A Senior Administrative employee shall automatically be retired SKMCHRC employment (without notice) on July 1 coincident with or following his or her 60th birthday. Attendance Tardiness SKMCHRC is committed to providing the best patient care possible with its available staff. To attain this patient-oriented goal, it is important that all staff report to work as scheduled. This policy establishes standards for permanent employees, regardless of appointed hours, by which managers can determine that individual employee attendance has become a performance problem. The policy requires that supervisors maintain and regularly review attendance records. The policy assures that supervisors have consistent guidelines for the purpose of counseling, warning, suspending, demoting, or terminating an employee for unsatisfactory attendance. This policy applies to absenteeism, tardiness, and a combination of the two. Tardiness Tardiness is defined as an unexcused absence from the assigned work area of six (6) or more minutes but less than half the shift time. This includes reporting late at the start of a shift, upon return from meal breaks, and/or upon return from other breaks. This also includes leaving early prior to the end of a shift. Tardiness, for any reason, is recorded as tardiness. It is the managers obligation to assign meal breaks so that employees are aware of the appropriate meal time parameters Training Education Employee Orientation Purpose: First impressions have a profound influence on the way new employees support our mission, vision, and values. A well-designed orientation program provides a dynamic and effective way to prepare employees for work. During the orientation process, employees are introduced to essential information, including information on benefits that will continually assist them in being an active and productive part of the organization. Our most important asset is our people, and the ongoing success of the SKMCHRC is dependent upon well-trained personnel being employed in every position. SKMCHRC makes a commitment at the time of employment to welcome, inform, and train new employees. Most of this responsibility resides with the departmental manager or supervisor Orientation Program Components: There are two distinct parts to the comprehensive orientation program. The first involves a two-day orientation containing a series of general information sessions about the SKMCHRC. The second part concerns the specific job assignment, and begins at the time that any employee reports to work in a new department. Within the second part of the orientation program the employee is oriented to departmental procedures and issues. For new employees, this part of the Orientation Program is circumscribed by the Probationary Period. For transferring employees, departments may define the orientation period but it should not exceed six months. This continuum approach to orientation is designed to give the optimum number of opportunities for the new employee to learn not only about specific job duties and responsibilities, but also the way that proper job performance contributes to the overall success of the Employee, the Unit, the Department, and the SKMCHRC. General Session: All new employees attend the SKMCHRCs New Employee Orientation Program. Employees who are not eligible for benefits are not required to attend the parts of orientation related to benefit selection. New employee includes all new hires, reemployment and agency transfers. Employees involved in status change actions (i.e. change from Temporary appointment to Permanent, Part-Time to Full-Time or Full-Time to Part-Time) are not required to attend a second session of the Orientation. These employees are, however, required to make an appointment with the Benefits Office to complete the documents required to effect the change and to enroll in the desired benefits. HR Role in Orientation: The Human Resource Development (HRD) Office will coordinate the New Employee Orientation. All new employees are registered at the beginning of the orientation session. Attendance records are maintained in the HRD Office NEW APPOINTMENTS A new appointment is the initial employment of an individual to a position or the reemployment of an individual who is either not eligible for reinstatement or, at the option of the SKMCHRC, is not offered reinstatement. Probationary Or Trainee Periods An employee who begins work in a permanent or time-limited permanent position shall be given a probationary or trainee appointment unless the employee is eligible for and the SKMCHRC chooses to make reinstatement with a permanent appointment. The probationary and trainee appointment periods are intended to serve as an extension of the selection process and are used to determine whether the person will be able to meet acceptable performance standards for the work for which he or she is employed. The employee will earn all the benefits of an employee with a permanent appointment during this time. Qualifications The employee must possess at least the minimum education and experience requirements, or their equivalent, as set forth in the class specification. This applies to full-time and part-time permanent, probationary, trainees, time-limited permanent and temporary appointments. Salary Rate The hiring rate of pay for a class, or trainees rate where applicable, shall normally be paid a qualified new employee Trainee A Trainee appointment may be made to a permanent position when: the job specification includes special provisions for a Trainee progression leading to regular appointment; recruitment efforts fail to attract qualified candidates; operating needs warrant a trainee, or the recommended applicant fails to meet minimum education and experience requirements. The Trainee appointment, like the probationary period, is also an extension of the selection process, and provides the time for effective adjustment of the new employee or elimination of those whose performance will not meet acceptable standards. Employees with a Trainee appointment receive leave, total service credit, retirement, and health benefits. When applicable, trainees who have completed 6 months of service or who had a Permanent appointment prior to entering a Trainee appointment may receive severance pay and priority reemployment consideration. Competency Assessment A systematic, ongoing, organization-wide competency assessment program ensures that the right person is performing the right job in the right way to deliver optimal patient care. Competency assessment includes the determination of qualifications, competencies, and staffing necessary to carry out the mission of SKMCHRC. Competency assessment also includes developing and implementing processes to ensure that the competence of all employees is assessed, maintained, improved and demonstrated throughout their association with the Hospital. Competency assessment integrates the processes of Position Design/Classification, Hiring, Orientation/Training/Education, and Performance Management. An effective competency assessment program requires collaboration and cooperation from all levels of management. Human Resource departments assist department managers in position design/classification (Position Management) Hiring (Employment), orientation/training/education (Employee Benefits and Human Resource Development) and performance evaluation (Position Management). The Director of Human Resources provides an annual report with aggregate data that reflects levels of competence and competence maintenance activities to the SKMCHRC Board of Directors. Department managers are responsible for the following competency assessment activities: Recommending to their Division Director a sufficient number of qualified and competent staff to provide care/service. Providing current job descriptions to Position Management. Job descriptions include job functions, specific duties, knowledge set, skills and ability required to perform the duties and minimal education and experience required, including necessary licenses, certifications, or registrations. For patient care positions, job descriptions define the necessary competencies related to the special needs and behaviors of specific age groups with whom the employee will work. Job descriptions should be reviewed annually and revised as necessary. For examples of documentation for this function, see Appendices 5 and 6. Evaluating the competence of applicants for vacant positions according to pre-determined criteria for hiring. Orienting new employees, according to policies for Employee Orientation, and documenting department-level employee orientation and Initial Skills Verification. Develop and implement a plan for assessing the ongoing competency of department staff to perform required job functions. A priority for competency assessment may be high risk, problem-prone or seldom used skills. Provide continuing education and other staff development opportunities to maintain or improve performance. Establishing policies and procedures for safe and effective use of department equipment, training of employees to use equipment, and assessing the competency of employees to use the equipment according to policies, procedures and/or predetermined performance criteria. Education Any Full-time or Part-time Permanent (scheduled to work 20 hours per week or more) employee with at least 6 months of continuous service prior to the first day of classes is eligible for tuition assistance. Eligible employees must be continuously employed through completion of the course. Employees in temporary or probationary status are ineligible for tuition assistance. Courses from any accredited high school, business school, community college, technical institute, college or university, correspondence school, or other educational source may be approved for tuition assistance. Approved courses must be directly related to improving performance in the employees present job or must be directly related to the employees profession or field of work. Courses required for completion of a job or professional-related degree program may also be approved. Courses for personal enrichment do not qualify and must be taken by employees at their own time and expense. Courses considered to be a required prerequisite for a degree program are not eligible for reimbursement under the Tuition Reimbursement Program. These prerequisite courses are eligible for reimbursement under a departments Travel Reimbursement Program, and supervisors should be approached for information and approval on these types of reimbursements. The approved course must be taken on the employees own time unless the course is not offered after working hours. For a course taken during work time, it is up to the discretion of the Department Head or designee to determine work/non-work pay time. Regardless of the pay status, eligible employees may be granted time during work hours for not more than one course per term not to exceed 5 semester hours credit when the course is not offered after working hours. Approval to take a course during working hours must be received prior to starting the course. Revised work schedules should not adversely affect departmental services or employee job performance. Tuition Assistance Request forms must be signed and dated by the employee and supervisor prior to starting the course. Eligible employees may receive reimbursement for required academic costs not to exceed the maximum amount charged within the Hospitals University program for a similar course. Reimbursement is limited to a maximum of 10 semester hours per academic term, but not for more than 20 semester hours in a fiscal year, OR for more than 4 courses in a fiscal year. Members of the Division of Nursing should obtain approval from Nursing Education and Research. Transfer Promotion System Transfer The Transfer-Promotion System provides orderly procedures for an employee to move within a department and among departments and affords career and upward mobility opportunities on a hospital-wide basis. The system is provided to help employees realize their individual career potentials and respond to the needs of underemployed persons. This system is designed to facilitate the transfer, as feasible, of employees with satisfactory records of work performance and conduct, and who possess requisite qualifications. It is not used in lieu of appropriate corrective action. Responsibility for implementation of this policy is shared by operating departments and the Employment Office. Whether a Transfer can be effected is contingent upon the existence of an opening and the employees qualifications, ability, and work performance, length of Continuous Service, and overall competitive status compared to that of other employee candidates and, as appropriate, outside applicants. For a Transfer to be effected, the employee must be selected by the operating department as most suitable for the open position. Thus, it is not possible to guarantee a Transfer to every employee requesting one. Promotion Promotion is a change in status upward documented according to customary professional procedure, resulting from assignment to a position associated with a higher pay grade. Selection should be based upon demonstrated capacity, quality, and length of service (if applicants are equally qualified). The purpose of a promotional pay increase is to reward the employee for the assumption of duties more responsible and more difficult than those in the current position. Subject to the availability of funds, salary increases, not to exceed the maximum of the range, may be given in accordance with this policy. If the employee is promoted to a position within the same class series or occupational group, the salary * May be increased by up to 5% for each grade provided by the promotion; or * May be established in accordance with the New Appointments policy Temporary Promotions Temporary promotions may be made when an employee is placed in an acting capacity for a period of time. When an employee is placed in an acting capacity, at the discretion of management and in collaboration with the Assistant Human Resource Services Director Employment, one of the following may occur: * The employee may be placed in the higher level position (if vacant) with an understanding that he or she will return to the former position and salary when the position is filled. PROFESSIONAL BUSINESS ATTIRE Appropriate good taste, good grooming, safety, and consideration for others should govern the appearance of all employees, contract employees, residents, volunteers, students, Medical Staff of Shaukat Khanum Medical Centre Hospitals, and research personnel utilizing Shaukat Khanum Medical Centre HCS facilities. Neatness and cleanliness are evidence of concern for our patients, their families, the public, and each other. Shaukat Khanum Medical Centre Health Care System believes that personal neatness and appropriate attire provide an atmosphere of professionalism and inspire confidence in our ability to deliver services. The provisions of this policy apply to all personnel operating in the Shaukat Khanum Medical Centre HCS. Department policies may specify additional requirements as appropriate for employee and patient safety. All employees, staff members, volunteers, as well as visitors to the Shaukat Khanum Medical Centre HCS shall be required to wear appropriate identification as defined in the Identification of Employees, Staff Members, Patients and Visitors Policy in the Shaukat Khanum Medical Centre Health Care System Policy Manual. An employees name and picture must be visible at eye level at all times. Uniforms Employees for whom uniforms are required for the job must wear the appropriate uniform. Alterations to the uniform or alternatives to uniforms are allowed only if prior approval has been obtained from a Department Head and if the intent of this policy is not violated. Scrub Suits Scrub suits, masks, shoe covers, and gloves should be worn only in areas designated by relevant departmental policies and only by those designated to wear them as part of their personal protective equipment. Please refer to departmental policies regarding the use of scrub suits Non-Uniform Clothing Clothing should be clean, pressed, and in good condition. Shorts (or similar attire), denim, tank tops, midriffs, revealing apparel, and the wearing of patient garb over a uniform or outerwear are considered inappropriate for the work place and are not permitted under this policy. Hats should be worn only when part of an approved uniform. Logos which identify the SKMCHRC or units within the Hospital Health Care System is the only acceptable logos to be worn on collarless shirts. Safety As required by the Occupational Safety and Health Act, the SKMCHRC shall provide appropriate personal protective equipment for employees who perform hazardous work. The equipment will protect the face, eyes, head, and extremities. The Infection Control policies and the Employee Handbook must be used to guide departmental dress requirements where appropriate. Reference the SKMCHRC Infection Control Manual and the Employee Handbook for specific guidelines. Protective equipment, shields, and respiratory devices shall be used whenever the employee has the potential of being exposed to a hazardous environment, chemical, radiation, or mechanical irritant capable of causing injury or impairment in the function of any part of the body through absorption, inhalation, or physical contact. The use of protective glasses and shoes is covered in the Personal Protective Equipment Requirements Policy in the SKMCHRC Safety Policy Manual. For safety reasons, all employees must wear shoes which are appropriate to their jobs. Grooming Standard Cleanliness is an essential part of providing high-quality service to our customers. A neat, clean, business-like and professional appearance is a requirement for all jobs. In most instances, an employee may wear his or her hair the way he or she chooses while working, as long as it remains well-trimmed, well-groomed, and business-like in appearance. Other Considerations Supervisors will inform employees if business needs warrant additional requirements for the employees position. Chewing gum is not considered appropriate in the presence of patients, visitors, or guests. Hygiene Standards Good personal hygiene is required. Other employees, as well as patients and guests, have a right to expect general cleanliness and good dental hygiene from the staff. Employees must refrain from using body fragrances such as cologne, talc powder, and after-shave lotions, which may have an adverse effect on patient care, on co-workers and on visitors. Employee Health Safety The SKM meets its responsibilities regarding employee health and safety by constantly trying to improve the quality of the workplace and to provide a safe and healthful place of employment. The SKM is committed to complying with the law in spirit as well as in deed. It is, however, the responsibility of every employee and staff member to report any situation or condition that appears to be a safety, environmental, or health hazard. To report a hazard, an employee should advise his or her supervisor immediately or contact the Environmental Safety Department directly. Children in the Work Place Employees shall not bring children into clinical work areas at any time. Employees shall not bring children into non-clinical work areas except in extreme emergency situations. This will minimize interference with performance of job duties, minimize lost time due to exposure to communicable diseases, and maintain the SKM Health Care Systems professionalism. Exposure to communicable disease To the extent practicable, the SKM Health Care System protects patients and employees from exposure to communicable diseases. When such work-related exposure occurs, employees may be directed to take paid Administrative Leave by the Director of Operations of designated member of the Management Council. If illness results from on-the-job exposure, the Workers Compensation Policy applies. Family Practice Center The Center is staffed by faculty physicians and resident physicians in the SKM Department of Family Medicine. There is an enrollment procedure, and enrolled members and their families may use the Center for all health care requirements. Services available include routine and acute health care, health maintenance, obstetrics, counseling, and care for chronic problems Employee Recreational Services Employee Recreation Services offers a variety of activities within the following areas: athletics, wellness; hobbies, clubs, and classes; discounts and services; and travel for employees and their families. Some of these opportunities include: * Athletic leagues, tournaments, and classes; * Health promotion and exercise classes; * Clubs for photography, running, golf, musicians, and retirees; * Arts/crafts and special interest classes; * Vacation and resort discounts; * Discounted tickets for local and regional attractions; * Employee Privileges for SKMCHRC gyms/pool; * Faculty/Staff season pass for SKMCHRC home athletic events; * Employee Recreation Association; * Employee Discount Card. Workers Compensation SKMCHRC has a Workers Compensation Office dedicated to the administration of workers compensation claims. The injured employee or his representative is responsible for reporting all work-related illnesses, injuries, or exposures to occupational diseases to their immediate supervisor or the designee immediately following the incident. Neither medical payments nor compensation are payable before the employees written notice of injury is given. If thirty days has passed from the date of the accident or injury before notice is given by the employee, compensation is not payable unless a reasonable excuse for not giving a written notice is made to the satisfaction of the Industrial Commission. Medical Benefits The SKMCHRC provides payment of all medical, surgical, hospital, nursing, sick travel, prescription drugs, and rehabilitation services prescribed by the treating physician to treat the injury as it relates to the job. It is the employees responsibility to ensure that all bills and medical reports are forwarded to the Workers Compensation Office for consideration and payment. Leave Benefits If an employee is put off work more than 7 calendar days by the treating physician, the employee will receive Workers Compensation leave benefits. The leave benefit is equivalent to two-thirds of the employees average weekly wage and not above the maximum established by the SKMCHRC Commission. The maximum compensation rate is adjusted annually by the SKM. Employee Incident Report The injured employee and his supervisor or designee shall complete the Employee Incident Report. The report is then given to the health care provider who first examines the employee for medical information to be added. This health care provider may be in Occupational Health Services or in the SKMCHRC Emergency Room. Completed incident report forms not already there should be sent to Occupational Health Services for review and submission to the SKMCHRC Workers Compensation Office. The incident report form must state the following: * treatment rendered; * days employee placed off work; * any restriction to employees normal duty; * referral to a specialty area or to Occupational Health Service; * hospitalization; * Medication prescribed, etc. To avoid a delay or denial, the Employee Incident Report should be completed in full. It is the intent of the SKMCHRC to provide a workplace for all employees which is free from violence. The Health Care System is committed to working with its employees to maintain a work environment free from violence, threats of violence, harassment, intimidation, and other disruptive behavior. While this kind of conduct is not pervasive in our facilities, no hospital or clinic area is immune. Violence, threats, harassment, intimidation, and other disruptive behavior in our workplace will not be tolerated; that is, all reports of incidents will be taken seriously and will be dealt with appropriately. Such behavior can include oral or written statements, gestures, or expressions that communicate a direct or indirect threat of physical harm. Individuals who commit such acts may be removed from the premises and may be subject to disciplinary action, criminal penalties, or both. Group term life insurance The SKMCHRC makes a group term life insurance policy, underwritten by Metropolitan Life, available to eligible employees, their spouses, and their dependents. Participation is voluntary. Employees must pay the full cost of coverage through automatic payroll deductions. Supplemental Insurances The SKMCHRC provides access to an extensive selection of supplemental life insurance policies based on an employees needs. Enrollment in these programs is voluntary, and is paid by the employee. Carriers and programs may vary from year to year. Contact the Employee Benefits Office for more information on these policies. Supplemental Accident Insurance The SKMCHRC provides access to an extensive selection of supplemental accident insurance policies based on an employees needs. Enrollment in these programs is voluntary, and is paid by the employee. Carriers and programs may vary from year to year. Contact the Employee Benefits Office for more information on these policies. Supplemental Cancer Insurance The SKMCHRC provides access to a Cancer insurance plan. Enrollment in this program is voluntary, and is paid by the employee. Contact the Employee Benefits Office for more information on this policy. Supplemental ICU/CCU Insurance The SKMCHRC provides access to an Intensive Care/Coronary Care insurance plan. Enrollment in this program is voluntary, and is paid by the employee. Contact the Employee Benefits Office for more information on this policy Retirement System Benefits Cost of Participation Cost of participation is shared between the employee and the SKMCHRC. The employee contributes 6% of his or her gross salary automatically through payroll deduction. Contributions are tax-sheltered for Federal and State income tax purposes. The SKMCHRC contributes a larger share of the cost, based on the systems actuarial needs. Both of these contributions combine to provide funding for the Retirement System Pension Fund, the Death Benefit, the Disability Income Plan, and the Retirees Health Plan. Old-Age Benefit Plan SKMCHRC also has an old-age benefit plan running for its retired employees. Annual Benefit Determination The annual retirement benefit is based on a formula which takes into consideration a percentage of the members average salary during the highest-paid 48 consecutive months multiplied by years of creditable service. The percentage rate is set forth by the General Assembly and subject to change. (Currently the rate is under 2%) The average for the 48 consecutive months of highest earnings is the Average Final Compensation. Creditable Service Determination Creditable Service means any period during which a member contributed to the Retirement System. Unused sick or catastrophic leave and certain purchased service credits also are included as creditable service. For each 20 days (or portion thereof) of unused sick or catastrophic leave, one month of credit is allowed Death Benefit If a member dies while in active status after one year of contributing membership, the beneficiary will receive a single lump sum payment. This payment equals the highest 12 months salary in a row earned during the 24 months before death, but no less than $100,000 and no more than $2500, 000. The death benefit is paid in addition to the members retirement accumulation or, if applicable, the Survivors Alternate Benefit described below. Survivors Alternate Benefit If a member dies while in active status after completing 20 years of credit or reaching age 60 with 5 years of credit, the principal beneficiary named to receive a refund of retirement contributions may choose to receive a monthly benefit for life instead of a refund. Early Retirement A reduced monthly retirement benefit is available at age 50 with 20 years of creditable service, or age 60 with 5 years of creditable service Service Retirement An unreduced monthly retirement benefit is available after 30 years of creditable service, after age 60 with 25 years of creditable service, or after age 65 with 5 years of service. Retirement Payment Options A member may elect to receive the maximum retirement income or a reduced income through one of several payment options which provide payment to a beneficiary after the members death. Conclusion SKMCHRC is an equal opportunity employer. As such, SKM Health Care System offers equal employment opportunities without regard to race, color, religion, sex, national origin, age, or disability. To extend these opportunities, they shall: * Recruit, hire, train, and promote persons in all job classifications without regard to race, color, sex, religion, national origin, age, disabilities or political affiliation/influence. * Base selection, hiring, and promotion decisions upon valid requirements and criteria which are, reduction-in-force, terminations, and promotions objectively, without regard to race, related and necessary to perform the work * Administer all personnel actions including compensation, benefits, tuition assistance, training, transfers color, religion, sex, national origin, age, or disability

Expenditure Cycle

Expenditure Cycle Learning Outcomes Describe and discuss the business activities that related to data processing operations that performed in the expenditure cycle and identify the information needed to make those decisions. Spot and dealing with the major threats and estimate the adequacy of various control procedures in the expenditure cycle. Understand and familiar with a data model (REA diagram) of the expenditure cycle. Introduction What Should You Know!! The Expenditure Cycle The expenditure cycle involves interactions with your suppliers. You buy goods or services and pay cash. The primary objective of the expenditure cycle is to minimize the total cost of acquiring and maintaining inventory, supplies, and services. Also to ensure that all goods and services are ordered as needed, receive and verify that they are in good condition as were ordered. Accounting for expenditures is an answer for all questions related to activity in any organization. Accounting entities have increased requirements due to budgetary reporting needs and the variety of different fund types related to the expenditure cycle. The recording of expenditure related transactions must be carefully monitored and controlled to meet these requirements. Objectives of the Expenditure Cycle The primary objective of the expenditure cycle is to minimize the total cost of acquiring and maintaining inventory, supplies, and services. Other objectives related to expenditure cycle: To ensure that all goods and services are ordered as needed To receive all ordered goods and verify that they are in good condition To safeguard goods until needed To ensure that invoices pertaining to goods and services are valid and correct To record and classify the expenditures promptly and accurately To post obligations and cash disbursements to proper suppliers’ accounts in the accounts payable ledger To ensure that all cash disbursements are related to authorized expenditures To record and classify cash disbursements promptly and accurately Figure 3.1: Context Diagram of the Expenditure Cycle Figure 3.2: Level of Expenditure Cycle Basic Activities for Expenditure Cycle There are three basic activities performed in the expenditure cycle are: 1. Ordering goods, supplies, and services the Key decisions in this process involve identifying what, when, and how much to purchase from whom to purchase. Weaknesses in inventory control can create significant problems on inaccurate records cause shortages and one of the key factors affecting this process is the inventory control method to be used. We will consider three alternate approaches to inventory control: Economic Order Quantity (EOQ)-traditional approach to managing inventory just in Time Inventory (JIT)*-seeks to reduce inventory levels by improving the accuracy of forecasting techniques Materials Requirements Planning (MRP)*-to minimize or eliminate inventory by purchasing or producing only in response to actual sales The order processing typically begins with a purchase request followed by the generation of a purchase order for inventory control system. The demanding to purchase goods or supplies is triggered by the inventory control function or an employee noticing a shortage. For advanced inventory control systems, initiate purchase were automatically requests when quantity falls below the reorder point. The need to purchase goods typically results in the creation of a purchase requisition. The purchase requisition is a paper document or electronic form that identifies: Who is requesting the goods Where they should be delivered When they’re needed Item numbers, descriptions, quantities, and prices Possibly a suggested supplier Department number and account number to be charged The purchase requisition is received by a purchasing buyer (Agent) in the purchasing department that typically performs the purchasing activity and the detail on the suppliers and the items purchased can be pulled from the supplier and inventory master files. A crucial decision is the selection of supplier and basic considerations are price, quality and dependability. Based on this three criteria’s, the supplier has should selected and identify a product so its can become part of the product inventory master file so the supplier does not have to be carried out and repeated every time for every purchasing for products that are seldom ordered. It’s also important to track and periodically evaluate supplier performance including data on purchase prices, rework and scrap costs and supplier delivery performance to make sure the process it’s done on time. Purchase Order A purchase order is a document or electronic form that formally requests a supplier to sell and deliver specified products at specified prices. The PO is both a contract and a promise to pay. It includes: Names of supplier and purchasing agent Order and requested delivery dates Delivery location Shipping method Details of the items ordered Multiple purchase orders may be completed for one purchase requisition if multiple vendors will fill the request. The ordered quantity may also differ from the requested quantity to take advantage of quantity discounts. Blanket Order A blanket order is a commitment to buy specified items at specified prices from a particular supplier for a set time period. Reduces buyer’s uncertainty about reliable material sources Helps supplier plan capacity and operations Information Technology on ordering In AIS, Information technology also can help and improve for efficiency and effectiveness of purchasing function based on time and cost using: Electronic Data Interchange(EDI) to transmit purchase orders vendor-managed inventory systems reverse auctions pre-award audits procurement cards for small purchases 2. Receiving and storing these items The receiving department is responsible to accepts deliveries from vendor or suppliers and reports it to warehouse manager that who reports to Vice President (VP) of Manufacturing. Inventory stores department typically stores the goods and also reports to warehouse manager. The receipt of goods must be communicated to the inventory control function to update inventory records. The two major responsibilities of the receiving department are deciding whether to accept delivery and verifying the quantity and quality of delivered goods.The first decision is based on whether there is a valid purchase order is accepting an unordered goods wastes time, handling and storage. Verifying the quantity of delivered goods is really important so the company only pays for goods received and inventory records are updated accurately Companies must an effectively and clearly communicate with their staff especially receiving clerk so that all deliveries counting accurately. The receiving clerk need to sign receiving report, record the quantity received and also carefully examine each delivery for signs of obvious damage before routing the inventory to the warehouse. The receiving report is the primary document used in this process: It documents the date goods received, shipper, supplier, and Purchase Order (PO) number Shows item number, description, unit of measure, and quantity for each item Provides space for signature and comments by the person who received and inspected Receipt of services is typically documented by supervisory approval of the supplier’s invoice. When goods arrive; a receiving clerk compares the PO number on the packing slip with the open PO file to verify the goods were ordered. Then counts the goods Examines for damage before routing to warehouse or factory Three possible exceptions in this process: The quantity of goods is different from the amount ordered The goods are damaged The goods are of inferior quality If one of these exceptions occurs, the purchasing agent resolves the situation with the supplier and typically allows adjustment to the invoice for quantity discrepancies. If goods are damaged or inferior, a debit memo is prepared after the supplier agrees to accept a return or grant a discount. One copy goes to supplier, who returns a credit memo in acknowledgment and other copy to accounts payable to adjust the account payable and other one go to shipping to be returned to supplier with the actual goods. IT can help improve the efficiency and effectiveness of the receiving activity: Bar-coding RFID EDI and satellite technology Audits 3. Paying for these items There are two basic sub-processes involved in the payment process: Approval of vendor invoices-by the accounts payable department, which reports to the controller. The legal obligation to pay arises when goods are received and the basic approach for processing vendor invoices are non-voucher system and voucher system Actual payment of the invoices-Payment of the invoices is done by the cashier, who reports to the treasurer.The cashier receives a voucher package, which consists of the vendor invoice and supporting documentation, such as purchase order and receiving report. Internal Control for Expenditure Cycle Before we move on to discuss internal controls in the expenditure cycle, let’s do a brief review of the organization chart, including: Who does what in the expenditure cycle To whom they typically report Purchasing: selects suitable suppliers and issues purchase orders. Receiving: decides whether to accept deliveries and counts and inspects deliveries. Inventory Stores: stores goods that have been delivered and accepted. Account Payable: approves invoices for payment Cashier: Issues payment to vendors. Figure 3.3: Partial organization chart for units involved in expenditure cycle In the expenditure cycle, Accounting Information System (AIS) should provide internal and external controls to ensure that the following objectives are met: All transactions are properly authorized All recorded transactions are valid All valid and authorized transactions are recorded All transactions are recorded accurately Assets are safeguarded from loss or theft Business activities are performed efficiently and effectively The company is in compliance with all applicable laws and regulations All disclosures are full and fair Threat and Control There are several actions a company can take with respect to any cycle to reduce threats of errors or irregularities. These include: Using simple, easy to complete documents with clear instructions Using appropriate application controls, such as validity checks and field checks Providing space on forms to record who completed and who reviewed the form Pre-numbering documents to encourages recording of valid and only valid transactions. Restricting access to blank documents (reduces risk of unauthorized transaction). The threats that may arise in the three major steps of the expenditure cycle, as well as general threats, Electronic Data Interchange (EDI) related threats, and threats related to purchases of services. Before we discuss specific threats, it may be helpful to have some background on a form of occupational fraud and abuse which is broadly referred to as corruption. Corruption cases often involve arrangements between a company’s purchasing agent and a sales representative for one of the company’s vendors. The vendor’s representative may try to induce the purchasing agent to buy goods that are over-priced, inferior quality. Aren’t even needed and also aren’t even delivered. In exchange, the vendor’s rep typically offers the purchasing agent something of value. That â€Å"something† might be money, payment of a debt, a job offer, an expensive vacation, or anything the purchasing agent might value. According to the Fraud Examiner’s Manual published by the Association of Certified Fraud Examiners, these schemes usually take four forms: Bribery Conflict of interest Economic extortion Illegal gratuities Information Needs for Expenditure Cycle: Information is needed for the following operational tasks in the expenditure cycle, including Deciding when and how much inventory to order Deciding on appropriate suppliers Determining if vendor invoices are accurate Deciding whether to take purchase discounts Determining whether adequate cash is available to meet current obligations Information is also needed for the following strategic decisions based on setting prices for products/services, establishing policies on returns and warranties, deciding on credit terms, determining short-term borrowing needs and planning new marketing campaigns. The AIS needs to provide information to evaluate purchasing efficiency and effectiveness, supplier performance, time taken to move goods from receiving to production and percent of purchase discounts taken. Both financial and operating information are needed to manage and evaluate these activities. Both external and internal information are needed when the AIS integrate information from the various cycles, sources, and types, the reports that can be generated are unlimited. They include reports on: Supplier performance Outstanding invoices Performance of expenditure cycle employees Number of POs processed by purchasing agent Number of invoices processed by A/P clerk Number of deliveries handled by receiving clerk Number of inventory moves by warehouse worker Inventory turnover Classification of inventory based on contribution to profitability We also know that an accountant should continually refine and improve these performance reports Summary In this subtopic, we really learned about the basic business activities and data processing operations that are performed in the expenditure cycle on: Ordering goods, supplies, and services Receiving and storing them Approving invoices and paying for them We also learned how IT can improve the efficiency and effectiveness of these processes and learned about decisions that need to be made in the expenditure cycle and what information is required to make these decisions. This subtopic also discuss about the major threats that present themselves in the expenditure cycle and the controls that can mitigate those threats