Principles of the 1948 National Health Service

This assignment will outline the main principles of the 1948 National Health Service and will provide a commentary on the organisation and structure of the NHS.
To begin this assignment will provide context by briefly exploring healthcare provision prior to the development and implementation of the NHS.
Healthcare Pre-NHS
Godber (1988) suggests that prior to the development of the NHS the ‘Poor Law’ had provided health care support for the indigent in Britain for nearly a century and this included institutions and infirmary wards with a medical officer in charge to provide healthcare with the larger ones gradually taking on the functions of general hospitals for the acutely ill. Voluntary hospitals, which were often run by charitable organisations developed specialist services. Hospitals for patients with communicable diseases, tuberculosis, and mental illness and handicap had long been provided by local authorities; originally for public safety. Hospital surveys carried out during the Second World War revealed not only shortages of beds and buildings in a poor state, but that services were not provided in the areas which most needed them (Powell, 1992).
From 1911 personal health care for low income workers was provided through National Health Insurance; however this did not cover hospital care. Other medical care was often delivered by general practitioners and payment for services was a matter for the individual, therefore it was often the rich or affluent that had access to healthcare rather than the lower classes.
The Beveridge Report of 1942; which was a very influential report on social insurance and allied services, identified five evils within the society of the day: want, ignorance, disease, squalor and idleness. It was recommended in this report that a compulsory system of state insurance (to which employers, employees and the state would contribute) would be established to cover sickness, unemployment, retirement pensions and support for young families (National Archives, 2011a). The Beveridge Report (1942) pointed to the establishment of a comprehensive national health service as a necessary underpinning to a national social insurance scheme. The Labour Party had a long-standing commitment to a national health service and when they came into office in July 1945, Aneurin Bevan was appointed Minister of Health. Within a matter of weeks, Bevan produced a plan for a fully nationalized and regionalized National Health Service (National Archive, 2011b).

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At the conclusion of the Second World War Britons wanted a change in how healthcare was delivered particularly as medical care had made big advances in the war, soldiers had been offered higher standards of care than they were likely to encounter after demobilisation (Portillo, 1998). Civil servants and politicians had identified a growing momentum towards change and began looking at opportunities for transformation in how health care was provided.
The National Health Service
Britain’s National Health Service came into effect on the 5th of July 1948; it was the first health system to supply free medical care to the whole population and the first healthcare provision that was based not on an insurance principle but on the provision of services available to everyone (Klein, 2006). The transformation from fragmented and inadequate care provision to a structured and accessible body was unique and although planning had taken many years with varying obstacles; such as the outbreak of war and changes in political leadership, the implementation of a progressive and universal way of delivering care to all was finally introduced. As such, the new health service arguably constituted the single biggest organizational change and greatest improvement in health care ever experienced in the nation’s history (Webster, 1998).
The NHS brought together all of the hospitals; regardless of ownership, and also the doctors, nurses, pharmacists, opticians and dentists that were once paid through charity or private funds into one organization.
The Main Principles of the NHS
Underpinning the NHS is a set of core principles and Bevan (1952) stated that the essence of a satisfactory health service is that the rich and the poor are treated alike, that poverty is not a disability, and wealth is not advantaged. With the development of a national health service the three main core principles cited by Bevan (1948) were that it met the needs of everyone, it should be free at the point of delivery and that it should be based on clinical need, not on the ability to pay. These principles ensured that every member of the British nation from young to old and from rich to poor were able to receive free health care for any medical condition, a phenomena that was unusual to say the least in comparison to how heath care had been delivered previously. The introduction of the National Health Service ensured medical treatment and poor health was not overshadowed by concern regarding finances and payment or that members of society lived in fear of medical expenses they could not afford.
Beckett (2004) suggests that within a month of the vesting day of the National Health Service, in 1948, 97 per cent of the general public were “signed up” for treatment. This was viewed as a triumph for the minister of health, Aneurin Bevan, as it was perceived that he had built a system of care and disease prevention on a set of principles never seen before in any global society. These core principles ensured that everyone would have their healthcare needs met and even today the three principles remain the foundations from which modern health care services are delivered; in essence homeless people requiring care for frostbite or dental pain can receive access to health care as can wealthy property developers who have had a skiing accident or have the need for a wisdom tooth to be removed.
The National Health Service may be perceived to be free to those requiring medical care and treatment, however the service requires funding to ensure practitioners employed are pad and that resources such as medicines, equipment and treatment areas are funded. To do this from inception the NHS has been funded by a system of taxation levied by the government, contributions are made through systems of national insurance contributions and income tax with small amounts being made through private practice under the NHS umbrella (Rivett, 1998).
From 1948: The structure of the NHS
Under the 1946 National Health Service Act, it was recommended that the health minister had the duty to promote in England and Wales a comprehensive health service which was to be developed with the purpose of improving the physical and mental health of the population and to oversee the move towards prevention, diagnosis and treatment of disease and illness. The services to be provided to meet these aims were to be free of charge and for the first time, the Minister of Health was made personally accountable to Parliament for hospital and other specialised services in addition to being indirectly responsible for family practitioner and local health services (Levitt et al., 1999). He was indirectly responsible for family practitioner and local health services.
The structure of the newly formed National Health meant that all hospitals were nationalised and they were managed by either regional hospital boards or boards of governors who were accountable directly to the minister for health. Funding was provided directly by the ministry of health to the regional health boards and this in turn was given to the hospital management committee’s who had the responsibility for the management of budgets and funding for services (Levitt et al., 1999).
As family practitioner services had refused to be managed and overseen by the newly formed National Health Service and Ministry of Health, executive councils were formed to ensure services such as general medical, dental and ophthalmic resources were delivered, these were referred to as Primary Care services. Local authority departments were made responsible for community health services, including health visitors and district nurses, vaccinations and immunisations, maternal and child welfare, ambulance services and services for the mentally ill and those with learning disabilities who were not in hospital (Bristol Royal Infirmary Inquiry, 2001).
From 1948: The Changing Organisation of the NHS
During the early stages of the NHS it is identified that there was a three part structure that had three branches which included; hospitals, primary care and local authority health services. This structure prevailed until 1974 when a more integrated arrangement was introduced which held three distinct levels of management at a regional, area and district level. A change of government to conservative leadership in the 1970 general election meant that the three part structure of the NHS that had been prevalent since the beginning of the service implementation became replaced in favour of new local authority control. General practitioners, hospitals, health centres and nursing services were brought under the control of a single area health authority which reported to regional health authorities (National Archives, 2011c).
An American economist in the 1980’s produced a highly critical report of the NHS suggesting that it was inefficient, riddled with perverse incentives and also that it had become a culture that was resistant to change (Enthoven, 1985). Due to the damning nature of this report the organisation of the NHS once again changed and it was suggested by Enthoven (1985) that the NHS would be more efficient if it was organized on something more like economic market principles. Enthoven (1985) argued for a split between purchaser and provider, so that Health Authorities could exercise more effective control over costs and production as a result the NHS administration was broken up into trusts from which authorities bought services. The role of Regional Health Authorities was taken over by 8 regional offices of the NHS management executive and this process ensured that the NHS became truly a nationally administered and centralized service (Klein, 2006).
With changing governments there has been ongoing change reflected within the organizational structure of the NHS. Within recent years the labour government had attempted to alter the structure of the NHS by introducing strategic health authorities and Primary Care Trusts. In recent months with the election of the coalition conservative and liberal government yet more new organizational changes to the NHS have been identified.
Ramesh (2011) has identified that the NHS will undergo a radical pro-market shakeup with hospitals, private healthcare providers and family doctors competing for patients who will be able to choose treatment and care in plans laid out by the government today. These changes will aim to reduce the numbers of management staff that are present within the current labour determined legacy within the NHS and the new approach will also allow NHS hospitals to chase private patients as long as the money is “demonstrably” ploughed back into the health service (Ramesh, 2011).
Andrew Lansley, the health secretary for the current coalition government presented to parliament in July 2010 a white paper which set out ambitious plans for the NHS. These plans had a simple aim: to deliver health outcomes for patients which are among the best in the world, harnessing the knowledge, innovation and creativity of patients, communities and frontline staff in order to do so (Lansley, 2010). The White Paper, Liberating the NHS (Department of Health, 2010) suggests that it will abolish all of England’s 152 primary care trusts, which currently plan services and decide how money should be spent; these radical proposals would save the taxpayer more than £10bn over the next decade and under the plans, GPs will be responsible for buying in patient care from 2013, with a new NHS commissioning board overseeing the process (Department of Health, 2010).
The work of Beveridge and Bevan in the 1940’s was undoubtedly pioneering and visionary with many members of society being able to access healthcare for the first time regardless of their financial means. The implementation of the NHS ensured that healthcare was available to everybody regardless of means and that it would be free from the point of delivery, principles that remain in essence part of modern day healthcare and National Health Services.
The NHS has seen many governmental changes since 1948, it has been re-organized and the structure has altered, however regardless of this it has remained a service that all British people can access and a service that many other countries have been unable to replicate. The foundation of the NHS was challenging and there were many critics, however the foresight of political leaders such as Bevan and Beveridge ensured health care remains free at the point of delivery in this country.

Definition of Service Quality

According to Farlex Free Dictionary, a night club also known as a discotheque, or simply a club or disco is an establishment or an entertainment venue which usually operates late at night, provides entertainment such as dancing and generally opens until the early morning.’ In addition as per Wikipedia, ‘a nightclub is differed from bars, pubs or taverns by the inclusion of a dance floor and a Disc Jockey (DJ) booth, where a DJ plays recorded dance, hip hop, rock, reggae, dub step, pop music and a mix of songs played.

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1.2 Definition of Service Quality
Philip Kotler (1997) defined service as ‘an action or an activity which can be offered by a party to another party, which is basically intangible and can not affect any ownership. Service may be related to tangible product or intangible product’ On the other hand, Zeithaml and Bitner (2003:85) mentioned that, ‘Service quality is a focused evaluation that reflects the customer’s perception of specific dimensions of service namely reliability, responsiveness, assurance, empathy, tangibles.’ Based on the assessment of service quality provided to the customers, business operators are able to identify problem quickly, improve their service and better assess client expectation. (Business
1.3 Importance of Service quality
Londe et al, 1988 stated that it is the customer service management that will derive the importance of service. In services marketing, customer service is regarded as a component of marketing mix. Zeithaml and Bitner, 1996 mentioned that high quality customer service is not just customer service department but all levels of management and staffs need to accept and have a state of mind regarding customer care. On the other hand, Payne, 1995 added that there is pressure on customer service due to competition and technological. He also stated that higher standards of service are being demanded by consumers as they are becoming more sophisticated and updated in their requirements and to them service refers as customer satisfaction, customer delight, service delivery, customer relationship, hence, to provide good service to customers, service companies need to take into consideration the important variables of service quality namely, assurance, empathy, reliability, responsiveness and tangibles. Thus as per Payne, 1995 customer service and quality improvement initiatives are closely related to each other. Moreover, marketing, customer service and relationship marketing are brought together through relationship marketing and marketers are very concerned about the attainment of quality. (Christopher and Ballantyne, 1991)
However, different authors have stated that service quality has been associated as having clear relationships to the following factors:

Costs ( Crosby,1979)
Profitability ( Buzzell and Gale,1987;Rust and Zahorik,1993)
Customer Satisfaction ( Boltan and Drew,1991; Boulding et al,1993)
Customer retention (Reichheld and Sasser,1990)
Behavioural intention and positive word of mouth
(Anderson and Zeithmal, 1984; Philips, Chang and Buzzell, 1983)

Moreover, Anderson and Zeithmal, 1984; Philips, Chang and Buzzell, 1983 claimed that, customer’s buying decisions are influenced by quality which is considered as the most important purchase decision factor and it also contributes to market share and return on investment.Garvin,1983 added that quality has strategic benefits in terms of improving productivity and lowering manufacturing costs.
1.4 Dimensions of Service Quality: SERVQUAL Model
According to A. Parasuraman, V.A.Zeithaml, and L.L.Berry, it is during the service delivery that the quality of services is assessed and the contact with each customer implies as a chance to satisfy or dissatisfy the customer, a moment of truth. They defined customer satisfaction with regards to service as ‘by comparing perceptions of service received with expectations of service desired.’ They also mentioned that an excellent quality of service is perceived when expectations are exceeded and on the other hand, service quality is considered as unacceptable when expectations are not met. Lastly, quality is satisfactory when perceived service confirmed expectations.
In addition, Parasuraman, Zeithaml, and Berry (PZB’s1988) introduced five dimensions which led to the development of SETVQUAL, these dimensions are as follows:
Tangibles: These include the appearance of employees, physical facilities being offered and equipment which form part of service experience.
Reliability: The way the service is being delivered, that is, the ability to deliver the promised service precisely and consistently.
Responsiveness: Willingness to help customers, respond to their queries and also to provide rapid service to them.
Assurance: Understanding and courtesy of staffs and their capability to inspire trust and confidence.
Empathy: Helpful, care about the customers’ requirements and the firm provides individualised attention to its customers with compassion.
Furthermore, as shown in the figure 1.1 below ‘A conceptual model of service quality with the dimensions of service quality’ was developed by A. Parasuraman, V.A.Zeithaml, and L.L.Berry. They based their research on several different service categories like for example retail banking, long distance telephone service, credit card companies. Thus, they identified that tangibles, reliability, responsiveness, assurance and empathy were the five main dimensions used by customers to judge service quality.
Perceived Service Quality:-
1. Expectation Exceeds
ES2. Expectation Met
ES = PS (Satisfaction Quality)
3. Expectation not met
ES>PS (Unacceptable Quality)
Dimensions of Service Quality:-
Word of Mouth
Service (PS)
Expected Service (ES)
As shown from the diagram above, A. Parasuraman, V.A.Zeithaml, and L.L.Berry added that customers’ judgements of service quality are based on a comparison between expected and perceived quality. They also stated that the gap between expected and perceived service is a measure of service quality that is satisfaction which is either negative or positive. They also found that in order to ensure consistent delivery of services organisations are faced with challenges to design their service delivery systems.
However, many authors have also put forward different conceptualisations over the time, like for instance three component structure- functional, reputational quality and technical by Gronroo’s (1984).Five components namely level of customer satisfaction, customer interaction/staff, internal organisation, corporate image and physical support given to service producing system.( Nguyen, 1988)

Mandatory National Service Debate in the US

Many countries require all young adults to serve two or more years in the military as a way of providing security to their country and as a rite of passage as a citizen. The United States however does not. The closest thing to mandatory service is selective service, and until recently that only applied to male citizens age 18-25. The idea of mandatory service has gained momentum in the last few years and many lawmakers have proposed that the United States adopt this policy. Some are opposed to the idea of mandatory military service, and I agree deciding to risk your life in the defense of your country should be a personal choice, not an obligation. However, the Peace Corps, AmeriCorps, Habitat for Humanity, and Teach for America are all programs that supports our country, develops unity, and teaches young adults valuable work skills. The pre-amble to the constitution talks about the responsibility we have as citizens to establish justice, provide for common defense, and promote general welfare, and “We the People” means everyone equally. Most will agree that democracy only works when citizens are involved and unified with a common purpose. John F. Kennedy once said, “ask not what your country can do for you-ask what you can do for your country” (Kennedy). Unity starts with equality and equality starts with mandatory national service. It is a simple idea; one or two years of national service should become a countrywide requirement for all young adults as way to build unity, develop a sense of identity and provide a valuable service to their community.

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Most people can agree that America is more divided than ever; we lack unity and commitment to our democracy. The only way we can effectively unify and regain our sense of community is through mandatory national service. Wars unfortunately bind people together, build a sense of community and provides a common purpose, “Veterans of any war share a common experience, the intensity of which creates strong and enduring relationships” (Grigsby). However, war is not what binds these people together, it is the sense of service to their nation, community, each other and the greater good.
Much like the military, programs like the Peace Corp and AmeriCorps show signs of creating loyalty and unity among participants. These programs bring together people of different races and backgrounds to solve complex problems that face their communities and if not for this program, their paths may have never crossed, “Service creates an opportunity to work on problems of public concern and participate in the lives of others whose paths one might otherwise never cross in a structured and supportive environment” (Frumkin and Miller). In addition, it garners respect and empathy for others, “Some evidence exists to suggest that full-time AmeriCorps members acquire valuable civic attributes, such as cultivating respect for others” (Reingold and Lenkowsky). Many great people have said, there is no greater honor than service to your country, and commitment to a cause greater than yourself.
Some argue that Americans should not have to earn their citizenship through mandatory service and is a violates their freedoms or a form of slavery; even if they choose how they serve. Many leverage the 13th amendment in opposition to mandatory national service, which states, “Neither slavery nor involuntary servitude, except as punishment for crime whereof the party shall have been duly convicted shall exist in the United States, or any place subject to their jurisdiction” (Pauwels).  I agree that our constitution affords us this right, and many other rights; the right to free speech, freedom of religion and the right to pursue life, liberty, and happiness. However, I feel that with these rights comes responsibility. The responsibility of all citizens to support and defend our constitution, be active in our communities and be involved in the democratic process. Today two things represent citizenship in America, voting and paying taxes. A government of the people, for the people and by the people certainly implies more commitment.
Others believe that mandatory service delays education and work opportunities. However, I contend that national service provides both. Many of the programs available provide current volunteers with opportunities to learn valuable life and work skills that will only enhance their education and growth, “One benefit of national service it thus thought to reside in its ability to open up the minds of young people to the full range of life choices available to them. While they may think, they are working for others, they may end up learning about themselves” (Frumkin and Miller). There is no greater life experience than witnessing and understanding the struggle of others.
Regardless of our position on mandatory national service, I think we can agree that it is vital to maintaining unity, equality, and our democracy. Mandatory national service ensures “We the People” are involved in protecting the freedoms we enjoy as Americans. In addition, the life skills, and the opportunity for young people to see issues from a different perspective only enhances the long-term education of our youth. I will agree, there are some issues with mandated national service, like mandated military service. As I stated before, the decision to risk your life for your country should be a choice one makes, not an obligation. However, believe that all Americans should be required to serve at least one or two years in other programs that support our country and protects our democracy.
Frumkin, Peter and Brendan Miller. “Visions of National Service.” Society 45.5 (2008): 436-443. ProQuest. Web. 20 Dec 2016.
Frumkin and Miller discuss how national service has alternatively been a way to promote an active and engaged citizenship, accelerate personal growth, social capital and meet critical social needs.
Grigsby, Carol A. “Binding the Nation: National Service in America.” Parameters 38.4 (2008): 109-123. ProQuest. Web. 14 Dec 2016.
Grigsby discusses how soldiers have a connection to each other because of war, a life-long bond because they have seen and experienced the same thing.
Kennedy, John F. Inagrual Address. 1961. Web. 22 Dec 2016. .
Kennedy’s inaugural address discusses issues that face all Americans regardless of party, and how we only succeed if we work together.
Pauwels, Andrew M. “Mandatory National Service: Creating Generations of Civic Minded Citizens.” Notre Dame Law Review 88.5 (2013). ProQuest. Web. 20 Dec 2016.
Pauwels discusses the legality of mandatory service and articles of the constitution that specifically address involuntary servitude.
Reingold, David A. and Leslie Lenkowsky. “The Future of National Service.” Public Administration Review 70.S1 (2010): S114-S121. ProQuest. Web. 20 Dec 2016.
Reingold discusses the pros and cons of national service and leverages several studies to show the benefits and issues with AmeriCorps.

Placement Reflection With Memory Service Health And Social Care Essay

This essay will include an introduction providing an overview of the placement undertaken and the relevant client group who access the service, a critical evaluation of three assessments that have been used within the service, one being Occupational Therapy specific, a discussion and examples given of how risk is assessed and managed within this practice setting, a discussion of the models of practice used, one intervention plan used with a particular client with an analysis of how the interventions were identified and prioritised, appraisal and justification of other potential intervention strategies, identification and evaluation of the impact of relevant legislation upon service provision within the practice setting, finally an evaluation of own performance as a student Occupational Therapist, and a conclusion.

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The practice placement setting was a city-wide Memory Service situated in North Yorkshire. The Memory Service is made up of a multi-disciplinary team of mental health professionals, working alongside the Alzheimer’s Society. The service facilitates early detection, diagnosis, and assessment of needs for older people with a memory problem, as well as giving support to their carer’s. Group support is also provided.
Client’s who are referred to the Memory Service are generally older adults who are experiencing early-stages of dementia. This essay will focus on one service-user who has been referred to the service diagnosed with Alzheimer’s Dementia, we will call him Max. The NHS website defines Alzheimer’s as being ‘the most common form of dementia, which is a group of symptoms associated with a decline in mental abilities, such as memory and reasoning’ (, 2010) Max is in the early/forgetfulness stage of dementia (Schneck, Reisberg, & Ferris, 1982) This includes mild impairment in memory and language, personality alterations, increased depression and anxiety, although there is no significant deterioration in ADL and is still able to live independently, however, it is apparent that Max is in need of some support. Moniz-Cook & Wood (1997) suggest that psychosocial interventions are more effective in the early stages of dementia and memory services have great potential to provide early interventions for the service user.
Max is experiencing difficulties in certain areas of his occupational performance, such as cooking/social isolation
Identify and critically evaluate 3 Ax’s that are/could be used with the client group.
The first step toward intervention is to assess the cognitive level of the client. An example of a standardised assessment is the Mini Mental State Examination 27/30 (MMSE) Folstein et al (1975) but in Memory Service the Addenbrooke’s cognitive examination (ACE-R) is used. The ACE-R is a brief cognitive test that assesses five cognitive areas: attention/orientation, memory, verbal fluency, language and visuo-spatial abilities. The total score is 100 of which Max scored 85/100. The ACE-R is easy to administer and only takes approximately 15 minutes to complete. The ACE-R results can vary depending on the intelligence of the client and their previous education, and also how literate they are.
The Hospital Anxiety and Depression Scale (HAD) was used to find out if Max was anxious or depressed. The results proved that Max was very anxious with him scoring 9/10 anxiety, however only 2/10 for depression which is not significant, therefore this score was discarded. it was highlighted that Max was anxious about beginning social contact again and integrating into the community
A kitchen assessment was undertaken with Max and the Occupational Therapist to assess and observe any risks to Max’s well-being. It was highlighted that Max often left pans on the gas cooker and ended up burning them, therefore setting off the smoke alarm, worrying the neighbours.
The unstructured observational assessment took place in Max’s kitchen at home which is a familiar environment and in keeping with his daily routine. Max decided to cook scrambled egg on toast as he felt comfortable making this. At the time the Occupational Therapist was also asking Max questions relevant to his daily routine and cooking, therefore also making it an informal interview. Although unstructured assessments cannot provide the reliability that structured assessments can, Kielhofner (2002) mentions several reasons that can justify the use of unstructured assessments, such as, to add to information previously gained through a structured assessment, lack of time, unacceptability of structured assessment by a client, lack of an appropriate structured assessment.
The negative points of carrying out a kitchen assessment are that quite often each client has a certain time of the day when they may function a lot better, Jack functions well around midday once he has taken his pain medication for arthritis and he is more able to focus on tasks. The client may also know that they are being assessed and may do things differently to how they would if they were alone.
The evidence gathered from these assessments showed the Occupational Therapist that Max is only slightly cognitively impaired and is still able to function relatively well and therefore it is important to support Max as much as we can in his own home.
Discuss relevance of risk AX and provide examples of how risk is assessed and managed
Risk assessment and management is an important part of professional processes in Occupational Therapy practice. Legislation and policies have been implemented to guide practice such as … Alzheimer’s Society
The risk profile section of the Functional Assessment of the Care Environment (FACE) assessment and outcomes system (Clifford, 1999) is used to allow the Occupational Therapist to assess and document any clinical risk that an individual may pose. FACE provides outcome data that enables a patient’s progress to be followed and also compared with other individuals. The FACE risk profile comprises of a ‘front sheet’ that summarises a patient’s contact details, and ratings of risk which are placed on a five-point scale ranging from 0=no apparent risk, through to 4=serious and apparent risk. The second sheet is a checklist of historical and current indicators of risk grouped into categories e.g. ‘clinical symptoms indicative of risk’ and treatment-related indicators of risk’. The third sheet comprises free text boxes where a description of the specific risk factors, both current warning signs and risk history, can be fully describes and individualised for the patient. The fourth sheet comprises relapse and risk management plan which can be specified and tailored for an individual.
Some specific events from Max’s past were documented:
Social isolation and exclusion. Max hardly ever left the house apart from to do a weekly shop on a Saturday morning; his wife died two years ago and has since been living alone. Max had very few leisure interests apart from painting, and there was no close family support. ‘As the course of Alzheimer’s progresses, the global function of individual’s with Alzheimer’s decline’. (Kuo, 2009) Max may therefore become increasingly unable to look after himself which could pose a risk in the future i.e. self-neglect?
Thom and Blair (1998) describe the role of Occupational Therapy in identifying actual risks to the individual through the use of functional assessment based on observation and interview. (MENTION ABOVE AX) It was observed that Max has limited mobility due to arthritis in his knees, this poses a physical risk of falls. Max is aware of his limited mobility, however does not walk with a stick unless outside as he feels a stick inside is a hindrance. All loose rugs have been removed and the access to Max’s house is flat. He is aware of falls prevention techniques but has requested a pendant alarm from Telecare, as he feels this is appropriate in case he has a fall at home. The furniture is placed so that Max can use this as an aid for walking from the lounge into the kitchen if he feels the need.
It was also highlighted that there was a risk operating household appliances safely after the Occupational Therapist carried out a kitchen assessment with Max. It was noted that once Max had started cooking he left the pans on the hob and went off to watch television because he got bored and then consequently forgot about the pan. From the kitchen assessment the Occupational Therapist was able to intervene and reduce the potential risk by suggesting Max engage himself in an activity in the kitchen whilst the food was cooking. Therefore Max could watch over the food but also read a newspaper, or do a jigsaw puzzle to keep himself entertained.
Explore application of a model of practice and a therapy approach that were/could be used
The Model of Human Occupation (Kielhofner, 1995) is founded on the belief that meaningful occupation is central to our well-being and that human occupation can best be understood as a dynamic system. (Duggan, 2004) This looks at physical and social environments, habituation, skills, and personal causation.
As dementia is a progressive disease, the physical environment may become less accessible. Dementia may also cause disorientation, making it harder for the individual to make their way around places they are not familiar with. Occupational Therapist’s focus on Occupational performance, therefore we are interested in how individual’s function on a day-to-day basis with their work, leisure, domestic life, and personal care. We follow a person-centred approach
A person-centred and holistic approach.; A holistic approach:leisure, personal care and occupation in relation to the physical, psychological, social, economic & spiritual aspects of life, (Reed & Sanderson, 1992) & Creek, 2002.
Kitwood describes: Personhood promotes older people as having the same basic rights to dignity, privacy, choice, independence & fulfilment as people of any other age group.
Social interaction will help maintain well-being (Kitwood & Bredin, 1992), preventing deterioration of mental function. People in a state of well-being are active & occupationally engaging by nature (Turner, 2001).
Provide 1 intervention plan which you have implemented and justify this with evidence and clinical reasoning
Following Max’s assessment, an occupational strengths and needs list was drawn up for Max and from this an intervention plan was made based on Max’s desired aims, including long-term goals. ‘Goals are targets that the client hopes to reach through involvement in occupational therapy’ (Creek, 2002, p.129)
Insight into condition
Socially isolated although Max is very easy to get on with
Enjoys drawing/painting-expresses interest in joining a local group
Lost wife 2 years ago-feels as though he has lost his role in life
Physically functions quite well apart from arthritic knees
Burnt Pans
Identifies positive qualities: kind, talkative, sense of humour
Appears anxious about social involvement
Prioritising the plan involved negotiating with Max and other members of the mental health team e.g. community support team, and making sure that Max’s goals were realistic in terms of being achieved within the 6 weeks. Cox (2007) states that ‘symptoms of dementia can significantly disrupt a person’s ability to set or meet realistic goals’, therefore it is important to make sure each goal is achievable within the six weeks.
By prioritising which goals Max wishes to achieve first this highlights the use of a person-centred approach, although risk factors must be taken into consideration e.g. Max’s top priority is to be able to make an evening meal safely and independently without burning pans, this is obviously a potential risk to Max and should be carried out with a member of the mental health team first.
To meet the following goals, SMART (specific, manageable, achievable, realistic and time specific) objectives were also established.
Long-term goal 1
Max to make some of his historically favourite meals safely and independently.
Week 1: Max and the Occupational Therapist will meet on Monday morning at Max’s house, to discuss the risks of cooking with a gas cooker and write these down.
Week 2: Max and Occupational Therapist to discuss whether Max would like some reading material in the kitchen to engage Max whilst his meal is cooking, therefore allowing Max to be occupied but also to check his food regularly to prevent burning pans and potential fire hazards.
Week 3: Max and Occupational Therapist to walk to the local shop on Monday morning, to gather ingredients for the meal Max has chosen and Occupational Therapist to write down basic instruction for making of the meal.
Week 4: Max and Occupational Therapist to make the meal together at 5.30 pm on Tuesday, using the gas cooker and ingredients that were previously bought
Due to the nature of dementia, cognitive abilities decrease over time, the environment must be adapted accordingly. People with dementia may be unable to learn new skills; however old skills and habits remain deeply ingrained, and these can be used long into the disease
Basic Living skills can be of more purposeful and value to the older person than leisure, PADL skills have been found to be important in the goals of treatment with early onset dementia as they value their independence, dignity & privacy (Willard & Spackman, 2001)
It is important to facilitate plenty of praise and encouragement, through positive reinforcement. It is easier for Max to complete a cooking task when it is broken down into sections, so putting out the ingredients on the worktop in the order they need to go in the pan. Achieving only one or two steps of a task may help to give Max a sense of achievement.
Max has a short attention span and finds it hard to remember instructions, so writing down a list of short instructions on how to make his favourite meal will facilitate him in the cooking process. When making the meal for the first time the Occupational Therapist gave tactful verbal reminders and simple instructions to encourage Max.
Long-term goal 2
Max will attend creative community based activities and social groups every week for 10 weeks.
Max is a friendly and sociable person once he is around people, and he shows a strong interest in art and has many paintings around the house. Aims of the art group: to meet new people and develop social interaction through art work.
Week 1: Provide Max with information about his local neighbourhood network, available Memory Service groups, and provide transport information so that Max can attend.
Week 2: Accompany Max to attend a local art gallery, and establish a therapeutic relationship with him. Allow Max to socialise with other people at the Art Gallery and start to build up his confidence whilst getting him to talk about his favourite interest.
Week 3: Support Max to access the service for the first time; attend a Memory Service lunch club on a Wednesday morning for two hours accompanied by the Occupational Therapist.
Week 4: Max to attend a local Memory Service Open Art group for service-users once a week on Monday morning for two hours for 10 weeks.
Week 5: Max to continue attending the open art group and aim to achieve a higher level of occupational performance, by grading activities.
For an occupation to have any therapeutic benefit it must have purpose, value and meaning to the individual (McLaughlin-Gray, 1998). For Max, this is taking part in Art based activities, in his past he was a strong artist and spent most of his free time outside painting, therefore attending a local art group with similar people with memory loss this is an ideal chance for Max to express his creativity and becoming more socially integrated into the community. It is important that we find out what Max wants to do and what he would enjoy, otherwise there will be little therapeutic benefit. This is an example of ‘Person-centred care: we look for the client to lead us into an understanding of what is good and right for them’. Perrin & May (2000, p.77)
Research is beginning to indicate the value of providing educational and supportive memory groups for people in the early stages of dementia. This can be seen as a cost effective, successful intervention that provides an alternative treatment for people in the early stages of dementia (Knapp, 2006) When looking at the College of Occupational Therapist’s online dementia clinical forum, there was evidence by Graff et al, 2006, for community based occupational therapy for people with dementia and their caregivers. It found that ten sessions of community occupational therapy over five weeks improved the daily functioning of patients with dementia.
Creative activity in groups has also been shown to reduce depression and isolation, offering the power of choice and decisions. Non-verbal therapy methods, such as painting, are able to influence the well-being of the patients positively. (Hannemann,2006)
The role of the OT with general goals is in promoting occupation, health & well-being taking into consideration that dementia is progressive when making intervention plans (Pedretti, 2001).
Analyse how the interventions implemented were identified and prioritised
Appraise and justify other potential intervention strategies
Another potential intervention strategy was to install ‘Just Checking’, a web-based activity monitoring system that provides a chart of daily living activity via the web, allowing the Occupational Therapist to track (via sensors in each room) where the individual has been, for how long, and at what time. A Just Checking system could be used for Max to establish his daily routine and activity levels during the day/night. Max states that he is anxious and sits on the sofa most of the day, Just Checking can monitor what he gets up to on a daily basis for 2-3 weeks and then the Occupational Therapist can be sure that the care plans and interventions that they put into place are based on objective information, rather than on supposition. They can be confident that the plan more closely meets Max’s needs. It may highlight that Max needs extra support which can be provided by the Community Support Team.
It was suggested to Max that he try a dosset box for his daily medication, as it was noted that Max was not always compliant with his medication. However, Max refused this idea as he was happy taking his medication from the packet, and he felt that a dosset box would upset his daily routine. Another suggestion for Max could be for him to keep a diary so he can note down everything that is important like taking medication at a certain time, and attending any necessary appointments.
The Occupational Therapist also gave Max some information about a Reminiscence group that is starting in the New Year. On nearly every visit Max would get round to talking about his past or photographs that he had on the wall, so it seemed like a good suggestion for Max to attend this group. When searching the Cochrane Library database, Woods et al (2005) looked at the effects of reminiscence therapy for older people with dementia and their care-givers. The results were statistically significant for cognition (at follow-up), mood (at follow-up) and on a measure of general behavioural function (at the end of the intervention period).
The use of reminiscence therapy with people with dementia has been linked with improvements in behaviour, well-being, social interaction, self-care and motivation (Gibson 1994) Although there is little specific evidence for the effectiveness of reminiscence in dementia care (Carr, Jarvis and Moniz-Cook 2009) Max has expressed an interest in joining because he feels as though he would gain some therapeutic benefit being able to talk about past events with people of a similar age and with memory problems.
The Cochrane review concluded that there was inconclusive evidence of the efficacy of reminiscence therapy for dementia. However, taking studies together, some significant results were identified, including improvements in mood and cognition, lessening of care giver strain and improved functional ability. No harmful effects were identified.
Identify and evaluate the impact of relevant legislation, health and social policy and clinical guidelines upon service provision overall
It is important that Occupational Therapists have a clear set of principles to work alongside when working with a person with Dementia. Also it is important to follow the Codes of Ethics and Professional Conduct (COT, 2010)
The Mental Capacity Act 2005 (MCA) is underpinned by 5 guiding principles which all staff must follow
These are
an assumption of capacity
supporting people to make their own decisions
people have the right to make eccentric or unwise decisions
where someone lacks capacity staff must act in the person’s best interests
where someone lacks capacity any action we take on their behalf must generally be the least restrictive option
The National Dementia Strategy for England (DoH, 2009a) is a five-year plan which has three main aims: to ensure better knowledge, to ensure early diagnosis and to develop services. The strategy has put a focus on improving support for this large and growing group of people. It sets out a vision to raise the standards of care for people with dementia and is of great significance to Occupational Therapists working in the Memory Service.
Occupational therapists can ensure that both the clients and their carers have a better understanding about the impact of dementia. Occupational Therapists working in the Memory Service get to see clients performing various activities that are directly or indirectly affected by memory and other cognitive functions through observation and assessment and are, therefore, able to identify early signs of cognitive impairments and raise awareness about the functional implications of memory and other cognitive impairments.
In the UK, the National Service Framework for Mental Health (DoH, 1999) has been the main guide for how services should be run. It is now being replaced by the ‘New Horizons’ strategy (DoH, 2009b), which aims to promote good mental health and well-being whilst improving services for people who have mental health problems. Occupational Therapist’s need Includes early intervention: to improve long-term outcomes, personalised care: ensuring that care is based on individuals’ needs and wishes, leading to recovery
New Horizons sets out an intention across a wide range of agencies to move towards a society where people understand that their mental well-being is as important as their physical health if they are to live their lives to the full. It describes some of the factors that affect well-being and some everyday strategies for preserving and boosting it.
It is important that Occupational Therapist’s specialising in the field of dementia ensure that they have a copy of the National Service Framework for Older People and use it a guide for the minimum level of service provided.
Analyse how evaluation of interventions was completed
Analyse your own performance as a student OT
Having completed this 7 week placement I feel as though I have grown in confidence and learned so around the field of Dementia. I have had the chance to observe and assess many people with different diagnosis of dementia and every single person has been different and unique, with different goals they want to achieve and what they wish to receive out of the service. I have learned that communicating with a person with dementia can be a slow process, it is important to be able to actively listen not only to the service-user but to the carer as well as they provide so much valuable information and they are usually so much involved in the care of the service-user.
Reflective practice has been identified as one of the key ways in which we can learn from our experiences. It helps to develop knowledge and skills towards becoming professional practitioners. (Jasper, 2003)   It is important that as a student Occupational Therapist I learn from my experiences on placement in order to understand and develop my practice, this involves consciously thinking about things I am doing, actively listening and making decisions. From what I have observed I can then start the reflective process and describe the experience and analyse it. I used Gibbs’s reflective cycle (Gibbs, 1988) that consists of six stages of the reflective process and asks cue questions to prompt the memory.
Provide summary of key points
Every individual has certain strengths and weaknesses, likes and dislikes, emotions and habits, needs and preferences, and this makes them unique. People with dementia are often denied these things as their disease progresses, therefore it is important to try and maintain as best as possible the individual characteristics that makes up that person. As Occupational Therapist’s we need to acknowledge the uniqueness of the person and realise that even if they have dementia they are still living their life.
Structure and predictability are important aspects of the environment in which people with dementia live.
Summarise how the interventions improved or maintained health and well being for the individual
Brooker p.44 (2007) states that ‘It is important to and appreciate that all people have a unique history and personality, physical and mental health, and social and economic resources, and that these will affect their response to dementia’.
There is good evidence that people with dementia can learn, and respond to their environment, and through groups they can experience an improvement in the quality of life. It may not be possible to reverse the effects of dementia, but some of the major difficulties for Dementia sufferers are caused by under-stimulation, withdrawal, depression, and anxiety, and these can be reduced. This can make a real difference to the person. Max has lost his motivation and he was anxious about leaving the house and becoming socially involved again because of his memory deficits and it took some gentle persuasion to get him involved again. However, the Occupational Therapist described to Max what was going to happen, and what he would be doing, and reminded him when to attend the group sessions so he did not need to worry. The Art Group is a closed group, and the same people meet for a number of sessions and they get to know each other and become familiar with the routine of the group. This is good for Max as he is able to make some new friends, return to a familiar environment each week, and start to establish a routine. The leaders of the group get to know the members and are able to plan activities according to each member. Max expressed a strong interest in watercolour painting, and the art group leader was able to accommodate this. The achievement of leisure goals helped Max to sustain his self-esteem and morale.

Service Concept Profiling And The Servqual Model

In this assignment I am going to conduct a critique of the following service management ideas, theories, concepts and techniques; specifically with reference to their purpose, application and limitations and with regard to how these service management ideas, theories and techniques may contribute to the development of a successful business: Service concept, Service concept profiling and The SERVQUAL model.
Service concept
The service concept has been defined variously throughout the years, Haskett (1986), defines it as the way in which the “organisation would like to have its service perceived by its customers, employees, shareholders and lenders”, i.e. the organisation’s business proposition. It has also been defined as the elements of the service care package, this is related to what Collier (1994) named it as “customers benefit package”, i.e. the things that provide benefit and value to the customer. Another definition of a service concept states that “a service concept identifies the proposed nature of the business; it is the service in mind that the organisation wishes to create. The service concept helps the organisation focus on the value that it can provide to customers.”(Robert Johnston & Graham Clark, 2008, p 461).
A service concept can be broken down in to three stages, firstly the organising idea, this is “the essence of the service bought, or used, by the customer”. Secondly, the service experience, this is “the customer’s direct experience of the service process which concerns the way the service provider deals with the customer and finally the service outcome, this is “the result for the customer of the service (in particular, the benefits provided, the resulting emotions and assessment of value for money)”. (Robert Johnston & Graham Clark, 2008, p 42).

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An example of a successful on-going business in terms of ideas, theories, concepts and techniques is a company called Metso, they are global supplier of technology and services to customers in the process industries, including mining construction, pulp and paper, power, oil and gas. Their service concept consists of; performance services, this increases product efficiency, optimises quality and improves environmental performance; availability services, this maximises asset availability and optimises total life-cycle costs of assets and finally engineering services, this helps complete projects on time and within budget, also helps maintain and develop competency of personnel. (Metso automation, 2010)
Another example is Alton Towers, Organising idea: A great day out at a theme park. Service experience: exhilarating and entertaining, large car parks range of food outlets, good souvenir shops etc. Service outcome: Lots of rides, Great day out, Full day out etc’ (Robert Johnston & Graham Clark, 2008, p 43)
One other example is, they categories their service concept into three parts: firstly, before purchase- this is when the company offers information about the region and property portfolio, provides flight information and pick up service from the airport. Secondly, during purchase- this is when they provide full information about the area and buying procedures, and also organising all procedures such as opening a bank account, translator and preparing all necessary paperwork. Finally, after purchase- assisting with registration of utilities, recommending the best shops around, helping with insurance and applying for a residence permit. Furthermore, the company has another option called property care, in which membership holders can benefit from certain things while they are away such as bills being paid, taxes being paid routine security checks are made and they also deal with relevant companies for insurance, maintenance, engineering etc. (, 2012)
Contribute to the development of a business (benefit)
Service concept profiling
The service concept can also be used as a strategic tool, the service concept profiling tool is simply a diagnostic tool that will help an organisation to analyse its service concept. It is merely a tool – that can give an organisation a visual representation of their service concept, by doing this, a service organisation can decide whether they need to change their service concept in view of what the competitors are doing/achieving, so as a tool it can provide a basis for a new service concept.
“The service concept can be used to create organisational alignment by developing a shared understanding and making it explicit” (Robert Johnston & Graham Clark, 2008, p 65). Managers can also assess the implications of design changes using capability mapping. Furthermore developing a service concept can create differentiated services and drive strategic advantage.
An example of a business using a service concept profiling is ‘4sl consulting’, their profiling method identifies an organisation’s maturity and effectiveness through; effective management and governance for delivering IT change; service life cycle management from strategy through operations and continuous service improvements; cost transparency for service pricing and charge back. The company finds these results through one-to-one meetings or via workshops, each with a robust and comprehensive assessment method. “Service profiling results in an initial set of gaps, issues and constraints prepared alongside an action plan to bring immediate benefits.” (4sl consulting, 2012)
Contribute to the development of a business (benefit)
With regard to limitations with regard to the service concept profiling tool, it is only a tool and as such it is a good starting place and may indicate to an organisation what element of the service concept may need to change, but does not take into consideration external factors such as what is happening in the macroeconomic environment. It also does not take into consideration the change management activities that follow on from changing the service concept.
Further, I would suggest that it might be critical to get the customer involved in profiling – and i am not sure that organisations actually do this….
The SERVQUAL model
Various service quality models have been developed to measure service quality through firms in many businesses. Due to its relation with customer satisfaction it is very important to review service quality models. Moreover service quality has had a major impact on practitioners, managers and researchers because of its results in customer satisfaction, customer loyalty and company profitability. The most commonly known measuring tool in terms of service quality in the development of a successful business to reach success is an instrument called SERVQUAL.
This model was developed by Parasuraman et al (1985; 1988). The research based on this instrument has been used in marketing literature and also used in various industries in terms of the variety of factors which influence and contribute towards the development of a successful business. Along with Parasuraman, Zeithmal and Berry, these three authors made substantial contribution to the understanding the concept of service quality and the factors that influence it. The SERVQUAL model has been productively used for measuring service quality in many service businesses. It has been used inmany contexts for example, service quality in hospitals, telecommunications, insurance companies etc.
“They originally identified four “gaps” in the organisation that can cause quality problems. These quality problems cause a fifth gap, which is difference between customer expectations of service and perceptions of the service actually received.” (Jusuf Zekiri, 2011)
The SERVQUAL Model has five dimensions which are tangibles, reliability, responsiveness, assurance and empathy. If these dimensions remain constant this will unlock the door to consumer loyalty and provide outstanding levels of quality consumer care service within the service organization. However, not all dimensions are equal due to the fact that some dimensions are more towards the high levels of importance within the service organization as oppose to the other dimensions ‘All dimensions are important to customers, but some more than others. Service providers need to know which are which to avoid majoring in minors. At the same time they can’t focus on only one dimension and let the others suffer’ (Chris Arlen, 2008).
An example of a a sector using the SERVQUAL model is Mobile Telecommunication
In conclusion
These factors, theories and techniques collectively are part of the essential elements in terms of reaching the relevant necessary internal aims and objectives set, which help build, develop and improve an existing successful service organisation.50%of businesses don’t survive within the first few years so it’s absolutely critical that service organisations grow and flourish in exceptional high levels of quality they deliver. Performance targets must be smart, measurable, achievable, realistic and time constrained
In regards to the SERVQUAL model, it is an extensively used tool to assess external service quality, it can also be modified to assess the quality of the internal service provided by departments within a company to employees in other departments.

An Analysis of an Integrated Service Delivery Model in Schools

In the 21st century, the capacity of Australia to provide a high quality of life for its

citizens will depend on the ability to compete in the global economy on education and innovation

(MCEETYA, 2009).  Due to inclusion and increasing diversity in the school system, the nature

of teaching needs to change.  Educators want to improve their students’ learning and they know

that they cannot do it alone (Scherer, 2011).  Society has placed numerous demands to achieving

academic success and this cannot be fulfilled without support.  Inclusion provides an appropriate

quality education for students with disabilities and integrates them among peers without

disabilities in the general education classroom.  Inclusion is an attempt to establish collaborative,

supportive and nurturing learning experiences for students with disabilities that gives them the

services and accommodations that they need to learn (Hammond & Ingalls, 2003).  Support is

needed in the school system because teachers believe that they do not have sufficient training for

inclusionary services (Hammond & Ingalls, 2003).  There is inadequate levels of collaboration

and support from fellow teachers when problems arise in the classroom (Hammond & Ingalls,

2003).   All educators should participate in the planning and implementation of inclusionary

programs in the school system (Hammond & Ingalls, 2003). 

 There has been a diverse range of challenges driving change in educational settings. 

Since the early 1980s, educational reforms has been driven by globalization, equity and market

competitiveness (Savage & O’Connor, 2014).  Global pressures in education were exemplified

by an increase of international comparisons through standardized testing programs such as the

Organization for Economic Cooperation and Development‘s (OECD) Program for International

Student Assessment (Savage & O’Connor, 2014).  There is an assumption that students’ test

scores reflect their future capacity to compete in the global market (Savage & O’Connor, 2014).

In the early 1990s, there was a strong drive towards collaboration between the Commonwealth

and all the States and Territories to establish a national policy for the development of Curriculum

Statements and Profiles for each of the eight subjects- English, Studies of Society and

Environment, Mathematics, Science, Technology, Art, Health and Physical Education and

Languages Other Than English (Bruniges, 2005).  There was a large gap between high-

performing and low-performing students, failure to meet national goals of schooling,

deteriorating infrastructure of school buildings and an outflux of retiring teachers (Bruniges,

2005).  Educational systems are akin to ecosystems where there are interactions between

teachers, students, parents and community members (Bruniges, 2005).  They are influenced by

social, economic, political and cultural drivers (Bruniges, 2005).  Advances in technology,

economic prosperity, equality, cultural diversity and changing student needs helped to modify

the curriculum (Bruniges, 2005).  In 2008, the development of a national curriculum called the

Melbourne Declaration on Educational Goals for Young Australians (MCEETYA) and the

Australian Curriculum, Assessment and Reporting Authority (ACARA) was established (Savage

& O’Connor, 2014).  The MCEETYA provides all students access to high-quality education that

is free from discrimination based on gender, language, sexual orientation, pregnancy, culture,

ethnicity, religion, health or disability, socioeconomic class or geographic location (MCEETYA,

2009).  In Queensland, Australia, the inclusive education reforms provides an equitable

education for all students regardless of cultural, physical, socio-emotional and behavioral

differences (Bourke, 2010).  This was enacted by the state government through the Department

of Education and Training (Bourke, 2010).  Key policies and frameworks include inclusive

education (DET, 2017a), cultural and linguistic diversity (DET, 2017b), disability policy (DET,

2017c), student mental health and wellbeing (DET, 2016a), religious diversity (DET, 2017d) and

the learning and wellbeing framework (DET, 2015). 

 Schools need to review their service delivery models so they can be responsive to

changing needs of the students and to maintain an inclusive environment.  Support service

professionals such as psychologists, speech and language therapists, occupational therapists

and physical therapists offer their support and expertise in the school system.  In the direct

service model, services are provided directly to a student by a special education teacher or other

professional (Pacer Centre, 2018).  Direct services can be provided to an individual student or

small group of students with the same needs (Pacer Centre, 2018).  In the indirect service model,

services are not provided directly to the student (Pacer Centre, 2018).  Professionals provide

services to others who are working directly with a student such as consultation (Pacer Centre,

2018).  Students benefit when therapy is provided as both direct and indirect services (Case-

Smith & Holland, 2009).  An integrated service delivery model allows schools to be flexible,

responsive to the students’ needs, promotes collaboration and supports students in achieving

their educational goals (Brown, 2016). The integrated service delivery model is the most

effective way of achieving these educational goals for students in an inclusionary environment. 

Direct and indirect services will be analyzed and an integrated service delivery model such as

collaborative consultation will be explored with an example.

 The provision of direct and indirect support services in education is complex and

involves many stakeholders including parents, teachers, support service professionals,

community and the government.  Direct services can occur in a private area of the school or a

natural, interactive classroom (CCRESA, 2004).  Direct services may include an assessment of

student performance, student observation and how it occurs in the natural setting (CCRESA,

2004).  There are “pull-out” or “push in” direct services.  Pull-out service removes a student to

another setting on a schedule (CCRESA, 2004).  Push in service are services that occur in the

student’s natural school environment such as the general education classroom or playground

(CCRESA, 2004).  A term used in direct services is collaboration.  Cook and Friend (1991)

defined collaboration as “a style for direct interaction between at least two co-equal parties

voluntarily engaged in shared decision making as they work toward a common goal” (p.25). 

Communication and collaboration among school staff is increased and students do not miss

instruction time in the classroom (CCRESA, 2014). Direct service delivery is not a stand-alone

method since it is not sufficient to meet the high demands for educational support (Case-Smith &

Holland, 2009). In indirect services, there are ongoing progress reviews, consultation, crisis

intervention, demonstration teaching, counselling of parents or teachers and curriculum

modification (CCRESA, 2014).  Consultation is a form of indirect service delivery and is a

triadic helping process (File & Kontos, 1992).  The consultant provides services to a student

indirectly through a mediator or consultee (File & Kontos, 1992).  The consultee attempts to

change the behavior of the student whereas the consultant is the professional who has the

expertise regarding the strategies to change the behavior (Cohen, Thomas, Sattler & Morsink,

1997).  Effective consultation is conceptualized as understanding the teacher’s concerns,

reframing the student’s behavior, using the teacher’s learning and teaching style, and

collaborating to determine how strategies are implemented in the classroom (Case-Smith &

Holland, 2009).  Students benefit in an integrated service delivery model consisting of both

direct and indirect services because students’ behaviour constantly changes, curricular demands

increase, the environment is dynamic and there needs to be consultation to effectively contribute

to the student’s educational program (Case-Smith &Holland, 2009).

 There are advantages and disadvantages to the direct service model and indirect service

model.  In the direct services model, push-in services happen in the general education classroom

(Morin, 2018).  The general education teacher, special education teacher and other professionals

work collaboratively and provide instruction directly to the student (Morin, 2018).  Services can

be provided through IEPs, response to interventions and informal supports (Morin, 2018).  The

advantages of push-in services are that students miss less instructional time, the student’s

schedule has less disruption and it occurs in the least restrictive environment (Morin, 2018).  The

disadvantages of push-in services are that there are differences in teaching styles and more

distractions in the general education classroom (Morin, 2018).  In the pull-out services,

specialists work with students outside of the general education classroom.  Services are provided

through IEPs, RTI and informal supports (Morin, 2018).  The advantages of pull-out services are

that students get more direct instruction suited to their needs, more emotional support and fewer

distractions.  The disadvantages of pull-out services are that there is less opportunity for

specialists and teachers to collaborate and the student misses general education classroom time

(Morin, 2018).  The advantages of the indirect service model (consultation model) are that

teachers’ attitudes and skills improve (Coben et al, 1997).  The specialists and teachers work

cooperatively and have a problem-solving relationship.  There is mutual trust, communication

and shared responsibilities when identifying problems, strategies and conducting evaluations

(Coben et al, 1997).  The disadvantages to the consultation model is that there is a lack of time to

consult and funding is a barrier (File & Kontos, 1992).  There is a lack of professional

preparation in consultation and roles need to be clarified (File & Kontos, 1992).  Strategies may

be rejected if they do not conform to the professionals’ conceptual framework (File & Kontos,

1992).  The consultant and the consultee may have difficulty maintaining a relationship based on

parity and a sense of hierarchy may arise (File & Kontos, 1992).  The consultant may have

unrealistic expectations of the consultee and this may cause resistance (File & Kontos, 1992).

 Consultation models recognize the interrelatedness between individuals and their social

environments.  The Mental Health Consultation model was developed as a preventive approach

to psychological disorders and was identified by Gerald Caplan (Brown, Pryzwansky & Schulte,

2011).  It has been accepted in the design of school-based services.  Schools use a three-tier

model paired with a response-to-intervention approach from universal instructional practices to

more individualized and intensive services (Brown et al, 2011).  Teachers are asked to

implement interventions at each tier.  In the Behavioral Consultation model, schools use 

collaborative functional behavioral analysis to treat students with disabilities (Brown et al, 2011).

This approach involves development of a behavioral definition, observations, assessments and

performance goals (Brown et al, 2011).  In the Solution-Focused model, the consultant shifts the

perspective of the consultee around skill deficiencies (Brown et al, 2011).  It is based on goal-

setting and finding potential solutions to problems (Brown et al, 2011).  It is applicable to

individual or group consultation with parents or teachers (Brown et al, 2011). The System’s

Theory Model of Consultation is based on interactions between clients and system in the

environment (Brown et al, 2011).  Collaboration aligns the school with the community to achieve

educational goals (Brown et al, 2011).  These models deliver indirect consultation services to

school settings and improves the functioning of teachers (consultees) to help their students.

 A whole school approach consists of direct and indirect services in which the school

community and the broader community feel a sense of belonging (Kids Matter, 2018).  The

whole school approach ensures that teaching is interactive and inclusive, the school community

is diverse and families are involved in the development of policies (Kids Matter, 2018).  All

members of the school community contribute to the planning and decision-making of an

initiative (Kids Matter, 2018).  For example, Schoolwide Positive Behavior Support (SWPBS) is

a whole school approach to creating a safe and supportive environment in Queensland state

schools (DET, 2016b).  These schools understand that problem behavior serves a purpose and

school members need to teach appropriate ways for students to express their needs (DET,


 Students need a flexible, integrated service delivery model that consists of both direct and

indirect services.  A collaborative consultation model enables professionals with different

expertise to produce solutions for effective programs for students (Idol, Paolucci-Whitcomb &

Nevin, 1995).  The consultant collaborates with other professionals and shares knowledge. 

There is a beneficial liaison with community agencies and parents (Idol et al, 1995). 

Collaborative consultation emphasizes a student-centred approach in which students receive

instruction for academic and social problems in the least restrictive environment (Idol et al,

1995).  Teachers and parents receive direct assistance in their natural environments (Idol et al,

1995).  Another benefit of collaborative consultation is the promotion of staff development

opportunities (Coben et al, 1995).  Professionals with different expertise share responsibility for

the design and implementation of programs for students.  However, there are limitations to the

collaborative consultation model.  Many consultants claim that they do not have enough time to

consult because both general and special education teachers have full-time teaching

responsibilities (Coben et al, 1995).  Conflict arises when educators cannot do what they want to

do because of time constraints.  There are language differences between special educators and

general educators (Coben et al, 1995).  Special educators use a certain type of jargon which

makes communication difficult.  There is lack of participation in team meetings which causes

problems in implementing a specialized program for students (Coben et al, 1995). Finally, there

is a lack of training for general and special educators which causes problems in implementing the

program for students (Coben et al, 1995).  For instance, a collaborative consultation model can

be used to improve educational services for mainstreamed students who are hearing-impaired

(Luckner, Rude & Sileo, 1989).  Teachers of students who are hearing-impaired can provide both

direct and indirect services to hearing-impaired students (Luckner et al, 1989).  Teachers of

hearing-impaired students can be consultants to general education teachers by sharing

information on auditory training systems, interpreters, tutors and notetakers (Luckner et al,

1989).  Speech language pathologists and guidance counsellors can provide direct services to

hearing-impaired students and consultative services to school staff and parents (Luckner et al,

1989).  Team teaching lessons with general education teachers, in-service workshops and

promoting schoolwide activities for hearing-impaired students are indirect services (Luckner et

al, 1989).  In Queensland, “Every student succeeding State Schools Strategy 2017-2021” is a

collaborative empowerment in which school staff work together to create inclusive environments

(DET, 2017e). Students receive the support they need in a culturally diverse environment.

 Therefore, a flexible and integrated service delivery model is fundamental to improving

students’ learning in a school setting.  An integrated approach consisting of direct and indirect

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models emphasize an inclusionary foundation in which students are accepted and accommodated

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resources and support from their community.  To make sure that no child is left behind in school,

consulting with professionals with different expertise and collaborating with administrators,

parents, colleagues, teachers and consultants is beneficial for optimal learning of students.  An

integrated approach to service delivery in schools meets the increasing demands of today’s



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Cloud Computing Service Level Agreement and Governance

Service Level Agreement and Governance for Cloud Computing
The contractual side of a service level agreement (SLA) and governance for cloud computing

In the world of information technology (IT), cloud computing has been the futuristic concept of modern computing for the last decade or more. Nevertheless, in the last few years this concept has become the mainstream. However, with the entire buzz and the evolutionary techniques the information technology companies developing and implementing, many overwhelming issues like interoperability, insecurity, and accessibility represents some of the most anticipated questions every decision maker has to consider before signing the contract of a Cloud Service agreement document. In addition to that, one key issue for every organization trying to make the big move to the world of cloud computing, is to provide governance for data that it no longer directly controls. During this research, I will try to illustrate and point the main ideas and practices of the contractual side of a service level agreement (SLA) and governance for cloud computing by trying to highlight a set of guidelines to help and assist organization in defining and constraining the governance plans for data they are willing to move into the cloud.
Keywords: cloud computing, SLA, IT, contract, agreement, constraining.
Word count: 4000 words.
Cloud computing is the new era of internet evolution, where this term usually refers to everything involves delivering hosted services and data over the internet to companies, individuals and even other computing systems. The idea of cloud computing started in 1950s when large-scale mainframes made available to schools and corporations (James, 2013). Few decades later, this concept started to become more alive by adopting this concept by some of the major technological companies like Google, Amazon and Microsoft where commercial cloud computing started to take place in the market. This new technology developed through a number of phases, this includes Software as a Service (SaaS), Grid and Utility Computing (GaUC), Application Service Provision (ASP) (Arif, 2014). Nevertheless, through the development of this concept, many issues and uncertainties like security, interoperability, vendor lock-in, and compliance were arising against adopting this technology (North Bridge, 2013). These problems are familiar even with the traditional Information Technology Outsourcing (ITO), and these issues usually treated at the agreement level between the service provider and the customer.

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– Cloud Computing Definitions
The National Institute Of Standards And Technology NIST Definition of Cloud Computing “Cloud computing is a model for enabling ubiquitous, convenient, on-demand network access to a shared pool of configurable computing resources (e.g., networks, servers, storage, applications, and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction. This cloud model is composed of five essential characteristics, three service models, and four deployment models.” (Peter Mell, 2011). Moreover, in his book The Big Switch: Rewiring the World from “Edison” to “Google” by Nicholas Carr, hundred years from now, the modern era of power grid has begun when corporations started to join the power grid leaving behind the traditional power generator systems every company used to have in order to satisfy the company’s need for electricity. This big transformation at that time is very similar to today’s switching from traditional computing and data handling to the cloud. Where with all the unusual concepts and worries about the security, actual data place and the stability of the services provided, companies will soon realize the emerging markets and services Cloud Computing can offer. The main motivation behind Cloud computing mostly represented by the benefits this technology can offer for its clients. Where features like ‘Service on Demand’, usually with a ‘pay as you go’ billing system and factors like the highly abstracted and shared resources, the instantaneous provisioning and scalability makes cloud computing the next power grid transformation.
– Risks and Issues
On the other hand, despite all the mentioned benefits and features cloud computing can offer, it has been realized that there are limits to the acceptance of cloud computing among enterprise companies, because of the level of complexity and dependability these service might become. Moreover, the data governance issues related to this technology represents some of the main difficulties the cloud computing market is facing right now. The European Network and Information Security Agency (ENISA) defines that the client responsibility of data governance is similar to the service provider responsibility in case of any data lose or corruption (Catteddu, 2009). Thus because customer should be aware of the risks that might imply by using this technology, and to encourage these companies to investigate farther in finding a more reliable providers. In addition to that, farther risks might imply to any cloud computing environment, such as hacking attacks or unauthorized access to the actual physical data locations. The Journal of Information Technology Management categorized this type of attacks in three main categories:

Attacks targets hosted application under a SaaS environment.
Attacks through the trusted network connection. This can be done from the customer side to the provider or from the provider side to the customer environment.
Attacks targets hosted server under a PaaS or IaaS environment.

(Cochran & Witman, 2011)
Cloud Computing Governance Components
In the Information Technology Outsourcing, describing the product or the service specifications to be delivered are usually drafted via a contract is in the form of Service Level Agreement (SLA), this agreement defines the all the important and legal parts of the service between the service provider and the service recipients. The same concept can be implemented with the cloud computing, since most of the main agreement parts involves providing an information technology service. However, cloud computing includes many different ideas and concepts, where in cloud computing agreement the service have to treat different concepts and behaviors like unknown data physical location, rapid scaling, lower IT upfront, and even different way of paying for the service such as monthly or annual subscriptions. In addition to that, in a cloud environment, usually the services are hosted and owned by a separate party. Where in most cases the owner of the application can be different from the owner of the server (Cochran & Witman, 2011).
– Nondisclosure and Confidentiality Agreements
These two terms are used in many other areas and through all types in contracts, agreements and forms, but the basic understanding of those two terms refers to the confidentiality of the agreement in general. Therefore, at the level of a service level agreement, a nondisclosure agreement usually means a confidential agreement. Margaret Rouse in her article about Nondisclosure Agreements she defines NDA as “A non-disclosure agreement (NDA) is a signed formal agreement in which one party agrees to give a second party confidential information about its business or products and the second party agrees not to share this information with anyone else for a specified period of time.” (Margaret, 2005). Similarly, David V. Radack in his article Understanding Confidentiality Agreements, he defines confidential agreement as “Confidentiality agreements, are contracts entered into by two or more parties in which some or all of the parties agree that certain types of information that pass from one party to the other or that are created by one of the parties will remain confidential.” (David, 2014). From the two provided definitions, we can see that a confidential or nondisclosure agreement force all participated parties to protect and never disclose any of the information passed between the parties while building the service.
– Legal location
In general, the actual physical location of the server or the data in a Cloud Computing environment is not important from the technical point of view. However, from a legal point of view a Service Level Agreement requires clearly identifying the actual location of the servers handling the data and services. Thus in case of a security breach from the provider side, punishments or penalties could be issued through the provider’s local authority. For that reason, if the breach resulted the data to be moved into an offshores location, the local government regulations might have no effects towards that (Steele 2010). On the other hand, a civil case could be issued in the right of the vendor or attacker in case of such risks. For that reason, defining the legal location is very important in a service level agreement because it represents a legal cover to the actual data that might get stolen or destroyed.
– The Restrictions of a Software License
Software License Restrictions is a very imperative factor in any Software License Agreement because it might affect the main tasks of the whole system in case of storing on an unknown devices or servers. This might occurs because sometimes software license might get violated when stored or hosted via remote hardware infrastructure. This issue might results a side effects like not being able to run the system as a whole or a part because software licenses might have a security features at the level of linking the software to a special machine MAC address or a processor serial number.
– User based exposures
User based exposures might occurs when an end user posts some data in a secure interface or website in the system, after submitting the data to the main data server, the data might get through a third party communication systems or servers. During this stage, a security breach might occurs were data can be lost, stolen or disclosed. At this level, the Service Level Agreement investigates what administrators at this level have access to during the transmission stage. This point might cover different types and techniques for encrypting the data, or include the third party providers in the agreement to insure the security and safety of the data.
– Communicating With Remote Networks and Services.
The system’s integration and incorporation with the cloud software as a service is one the most important factors any cloud based services have to offer for any system. However, integrating these services with the organization’s internal system sometimes means giving these services the possibility to become a part of the internal system. This can be an issue concerning the security the internal system. Mathias Thurman in his article Tightening Up SaaS Security, discusses how these concerns increase when the security of the SaaS is unidentified or unknown. Basically because when integrating the internal system with the SaaS, the SaaS network becomes a part of the internal system, and when reaching this level of integration, any attacks of security failures from the side of the SaaS provider well results the local network to be at risk too (Mathias, 2010).
Cloud Service Level Agreement Components
Service Level Agreement Template
To illustrate the main parts and layout of a Service Level Agreement in a cloud-computing environment, in the following template we can see the main parts, layout, and definitions of the Service Level Agreement content, made by Certainly, a Service Level Agreement can includes hundreds of pages describing every single specification. However, for the sake of illustrating the sample main part of the agreement we have the following template represents the most important parts of an SLA for a Cloud Computing system.
Service Level Agreement (SLA)
for Customer
Company name
Effective Date: 10-08-2010

Document Owner:

Company name








Service Level Agreement

Name (Bob Smith)



Service Level Agreement Revised

Name (Dave Jones)

(By signing below, all Approvers agree to all terms and conditions outlined in this Agreement.)




Approval Date

Company name

Service Provider







Table of Contents
1. Agreement Overview
2. Goals & Objectives
3. Stakeholders
4. Periodic Review
5. Service Agreement
1. Agreement Overview
This Agreement represents a Service Level Agreement (“SLA” or “Agreement”) between Company name. and Customer for the provisioning of IT services required to support and sustain the Product or service.
This Agreement remains valid until superseded by a revised agreement mutually endorsed by the stakeholders.
This Agreement outlines the parameters of all IT services covered as they are mutually understood by the primary stakeholders. This Agreement does not supersede current processes and procedures unless explicitly stated herein.
2. Goals & Objectives
The purpose of this Agreement is to ensure that the proper elements and commitments are in place to provide consistent IT service support and delivery to the Customer(s) by the Service Provider(s).
The goal of this Agreement is to obtain mutual agreement for IT service provision between the Service Provider(s) and Customer(s).
The objectives of this Agreement are to:

Provide clear reference to service ownership, accountability, roles and/or responsibilities.
Present a clear, concise and measurable description of service provision to the customer.
Match perceptions of expected service provision with actual service support & delivery.

3. Stakeholders
The following Service Provider(s) and Customer(s) will be used as the basis of the Agreement and represent the primary stakeholders associated with this SLA:
IT Service Provider(s): Company name. (“Provider”)
IT Customer(s): Customer (“Customer”)
4. Periodic Review
This Agreement is valid from the Effective Date outlined herein and is valid until further notice. This Agreement should be reviewed at a minimum once per fiscal year; however, in lieu of a review during any period specified, the current Agreement will remain in effect.
The Business Relationship Manager (“Document Owner”) is responsible for facilitating regular reviews of this document. Contents of this document may be amended as required, provided mutual agreement is obtained from the primary stakeholders and communicated to all affected parties. The Document Owner will incorporate all subsequent revisions and obtain mutual agreements / approvals as required.
Business Relationship Manager: Company name
Review Period: Bi-Yearly (6 months)
Previous Review Date: 01-08-2010
Next Review Date: 01-12-2011
5. Service Agreement
The following detailed service parameters are the responsibility of the Service Provider in the ongoing support of this Agreement.
5.1. Service Scope
The following Services are covered by this Agreement;
o Manned telephone support
o Monitored email support
o Remote assistance using Remote Desktop and a Virtual Private Network where available

Planned or Emergency Onsite assistance (extra costs apply)
Monthly system health check

5.2. Customer Requirements
Customer responsibilities and/or requirements in support of this Agreement include:

Payment for all support costs at the agreed interval.
Reasonable availability of customer representative(s) when resolving a service related incident or request.

5.3. Service Provider Requirements
Service Provider responsibilities and/or requirements in support of this Agreement include:

Meeting response times associated with service related incidents.

Appropriate notification to Customer for all scheduled maintenance.

5.4. Service Assumptions
Assumptions related to in-scope services and/or components include:

Changes to services will be communicated and documented to all stakeholders.

6. Service Management
Effective support of in-scope services is a result of maintaining consistent service levels. The following sections provide relevant details on service availability, monitoring of in-scope services and related components.
6.1. Service Availability
Coverage parameters specific to the service(s) covered in this Agreement are as follows:

Telephone support : 9:00 A.M. to 5:00 P.M. Monday – Friday

Calls received out of office hours will be forwarded to a mobile phone and best efforts will be made to answer / action the call, however there will be a backup answer phone service

Email support: Monitored 9:00 A.M. to 5:00 P.M. Monday – Friday

Emails received outside of office hours will be collected, however no action can be guaranteed until the next working day

Onsite assistance guaranteed within 72 hours during the business week

6.2. Service Requests
In support of services outlined in this Agreement, the Service Provider will respond to service related incidents and/or requests submitted by the Customer within the following time frames:

0-8 hours (during business hours) for issues classified as High priority.
Within 48 hours for issues classified as Medium priority.
Within 5 working days for issues classified as Low priority.

Remote assistance will be provided in-line with the above timescales dependent on the priority of the support request.
“(SLA template, 2010)

Carr, N. G., January 2008. The Big Switch: Rewiring the World, from Edison to Google. s.l.:s.n.
COCHRAN, M. & WITMAN, P. D., 2011. GOVERNANCE AND SERVICE LEVEL AGREEMENT ISSUES IN A CLOUD COMPUTING ENVIRONMENT. Journal of Information Technology Management Volume XXII, Number 2, pp. 41-55.
Peter Mell, T. G., 2011. The NIST Definition of Cloud Computing. [Online] Available at:
Arif Mohamed, A history of cloud computing. 2014. [ONLINE] Available at: [Accessed 5 March 2014].
James, A Brief History of Cloud Computing | SoftLayer Blog. 2013. [ONLINE] Available at: [Accessed 10 March 2014].
North Bridge, 2013 Cloud Computing Survey | North Bridge. 2014. [ONLINE] Available at: [Accessed 11 May 2014].
Peter Mell. The NIST Definition of Cloud Computing 2011. [ONLINE] Available at: [Accessed 11 May 2014].
Catteddu, D. and G. Hogben, Cloud Computing – Benefits, risks and recommendations for information security 2009, European Network and Information Security Agency: Heraklion, Crete, Greece. 125 pp.
Margaret Rouse, What is non-disclosure agreement (NDA)? – Definition from [ONLINE] Available at: [Accessed 11 May 2014].
David V. Radack, Understanding Confidentiality Agreements. 2014. [ONLINE] Available at: [Accessed 11 May 2014].
Steele, C., City of Monrovia, California, personal communication, 2010.
Mathias Thurman, Tightening Up SaaS Security – Computerworld. 2010. [ONLINE] Available at: [Accessed 11 May 2014]., Service Level Agreement Template (SLA). 2010. [ONLINE] Available at: [Accessed 11 May 2014].


Big Data as an e-Health Service

Bigdata in healthcare relates to electronic health records, patients reported outcomes all other data sets.It is not possible to maintain large and complex data with traditional database tools. After many innovation researches done by researchers Big Data is regenerating the health care, business data and finally society as e-Health .The study on bigdata e-health service. In this paper we come to know why the current technologies like STORM, hadoop, MapReduce can’t be applied directly to electronic-health services. It describes the added capabilities required to make the electronic-health services to become more practical. Next this paper provides report on architecture of bigdata e-health services that provides meaning of e-services, management operations and compliance.
Keywords: Introduction to big data, different types of technologies of bigdata, advantages of bigdata, applications of big data, solutions of e-health services, big data as a service provider, e-health data operation management.
What is bigdata?
Bigdata consisting of extremely huge amount of data sets which consists all kinds of data and it is difficult to extract. It can be described by the characteristics like variety, velocity, volume and variability.

– It consists of data like structured, unstructured and semi structured data
– Structured data consists of databases, small scale health personal records, insurances, data wares, Enterprise Systems(like CRM, ERP etc)
– Unstructured data consists of analog data, Audio/video streams. Treatment data, research data
– Semi Structured data consists of XML, E-Mail, EDI.

– Velocity depends on time Sensitivity
– It also depends on streaming

– It may consists of large quantities of files or small files in quantity
– for example , now a days single person can have more than one Gmail account. When he wants to login into a gmail accounts the system generates log files .
If a person login into gmail account multiple times through his different accounts then , the system generates huge number of log files that is stored in a servers using bigdata.

– It shows the inconsistency of data depends on variation of time period .It may be a problem for analyzing the data.
Historically Bigdata in health care industries generate huge amount of electronic health datasets are so complex and difficult to manage by using the traditional software’s or hardware nor by using some database management tools. Now the current trend is to make these huge amount of data as Digitalization so that this whole digital healthcare system will transform the whole healthcare process will become more efficient and highly expensive cost will be reduced. In other words Bigdata in healthcare is evolving into a propitious field for providing perception from large set of data and it produces outcomes which reduces the cost.
Bigdata in healthcare industry is stunning not only because of huge volume of datasets like clinical records of patients health reports, patient insurance report, pharmacy, prescriptions , medical imaging , patient data in electronic patient records etc but also multiplicity of data types and the speed of increasing the records.
Some of the reports generated by researchers on the health care systems shows that, one of the health care system alone has reached in 2011, 150 Exabyte. At this rate of increase of growth, in future the bigdata reaches Zettabyte scale and soon it reaches to Yottabyte from various sources like electronic medical records Systems, social media reports, Personal health reports, mobile health care records, analytical reports on large array of biomedical sensors and smart phones.

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The electronic-health medical reports generated by single patient generates thousands of medical reports which includes medical reports, lab reports, insurances, digital image reports , billing details etc.All these records are needed to be stored in database for validating , integrating these records for meaningful analysis. If these reports are generated by multiple patients across the whole world of healthcare processing system then we have to combine these whole data into a single system which is a big challenge for Big Data.
As the volume and Source of storing the data increases rapidly then we can utilize the e-health data to reduce the cost and improves the treatment. We can achieve it by investigating the big data e-health System that satisfies Big Data applications.
The Following Figure 1 shows the bigdata service environment architecture that provides the support for electronic-health applications from different sources like testing center, individual patients, insurance facilitator and government agencies .All these produces some standard health records are connected commonly to a national healthcare network.

Figure 1. e-Health Big Data Service Environments
Different types of Data sources :
The different types of data sources may include structured database, unstructured datasets and semi structured information

Some of the standard structured data that deals with the drug insurance policy by NCPDP (National Council for Prescription Drug Program) and NCPDP SCRIPT for messaging the electronic prescription for validating the interaction between drug to drug, medical database records, dosage of drug, maintain the records.

The semi structured data related to radiology pictures are changed over the IP networks is provided by DICOM(Digital Imaging and communication in Medicine).
The e-Health system store, gather the medical information, patient information to the doctors unexpectedly includes medical information, vaccination details, diagnostics’ reports.
HDWA Healthcare Data Warehousing Association it provides the environment for from others. They work collaboratively which helps them to deliver accurate results or solutions from their own organizations
A strong relationship and interaction from test facilitators and technical team is maintained within the organization.
We have to face the challenges for utilizing the unstructured data related to different concepts, sharing and accessing the data.

Big data solutions and products:
Bigdata investigation requires knowledge about storing, inspecting, discovering, visualizing the data and providing security by making some changes to some of technologies like Hadoop, MapReduce, STORM and with combinations.
STROM is a distributed, open source , real time and fault-tolerant computational system. It can process the large amount of data on different machines and in real time each message will be processed. Strom programs can be developed by using any programming languages but especially it uses java , python and other.
Strom is extremely fast and has the capability to process millions of records per second per node as it is required for e-health services. It combines with the message queuing and database technologies. From the figure 2 we can observe that a Strom topology takes huge amount of data and process the data in a typical manner and repartitioning the streams of data between each stage of process.
A strom topology consists of spout and bolts that can process huge amount of data. In terms of strom components the spout reads the incoming data and it can also read the data from existing files .if the file is modified then spout also enters the modified data also. Bolt is responsible for all processing what happens on the topology , it can do anything from filtering to joins, aggregations, talking to database. Bolts receive the data from spout for processing.

Figure 2. Illustration of STORM Architecture
Some of the important characteristics of Strom for data processing are:

Fast-It can process one million 100 bytes per second per node
Scalable-with parallel calculations that runs across the machine
Fault-tolerant-if a node dies strom will automatically restart them
Reliable-strom can process each unit of data alleast once or exactly once
Easy to operate-once deployed strom can be operated easily

Hadoop for batch processing:
Hadoop was initially designed for batch processing i.e., it takes inputs as a large set of data at once, process it and write the output. Through this batch processing and HDFS(hadoop distributed file system) it produce high throughput data processing.Hadoop is another framework , runs on MapReduce technology to do distributed computations on different servers.
(ref diagram:

Figure 3. Hadoop Processing Systems
From the figure 3 we can observe that a hadoop multi-node cluster , it consists of single master node and slave node. A master node has different trackers like task tracker for scheduling the tasks , job tracker server handles with the job appointments in a order. Master also acts like a data node and name node. The slave node acts like a task tracker and data node which process the data only by slave-node only. HDFS layer deals with large cluster of nodes manage the name node server which prevents the corruption of file by taking the snapshots of the name node memory structure.
Many top companies uses the hadoop technology plays a prominent role in the market.The Vendors who uses Hadoop technology will produce accurate results with high performance, scalability in output and cost is reduced. Some of the companies like Amazon, IBM, Zettaset, Dell and other uses Hadoop technology for easy analysis, provides security, user friendly solutions for complex problems.(
In 2004, Google released a framework called Hadoop MapReduce. This framework is used for writing the applications which process huge amount of multi-terabyte data sets in parallel on large number of nodes. MapReduce divides the work loads into multiple tasks that can be executed parallel. Computational process can be done on both file system and database.
MapReduce code is usuallay written in java program and it can also can write in another programming languages. It consists of two fundamental components like Map and Reduce. The input and output generated by MapReduce is in the form of key and value pair. The map node will take the input in the form of large clusters and divides it into smaller clusters were the execution process is easy. Rather Mapreduce provides support for hadoop distributed file system can store the data in different servers. This framework provides support for thousands of computational applications and peg bytes of data.
Some of the important features of mapreduce are scale-out architecture , security and authentication, resource manager, optimized scheduling, flexibility and high availability.
Additional tools are needed to add and should be trained for e-Health files to reduce the complexity because some of the compressed files like electronic-health DICOM picture file should be mapped to a singler Map Reducer so it reduces the BigdData effectiveness. The Hadoop big data applications has imposed a limitations on big data technologies has focused on the applications like offline informatics systems.
4) Programming Tools:
The other solution for the e-Health bigdata is MUMPS, it is an programming tool. MUMPS is abbreviated as Massachusetts General Hospital Utility Multi-Programming System. It is also known as M programming language. M is a multi user and it is designed to control the huge amount of database. M programming can produce high performance in health cares and in financial applications.
M provides simple data considerations in which the data is given in the form of string of characters and the given data is structured in a multidimensional array. M requires support for sparse data.Accorrding to the research done by the scientist in US hospitals they are maintaing the electronic Health records (HER) using M language including Vista(Veterans Health Information Systems and Technology Architecture) which manages all hospitals care facilities run by the Department of Veterans.
In future some of the analytical algorithms are developed to solve the problems faced with the big data applications
Additional e-Health (Big Data) Capabilities:
The additional capabilities provided by the Big data e-Health services are Data Federation and aggregation, Security and Regulatory Concerns and Data Operational Management. The bigdata provides the services which helps to organize and store the huge amount of data. Those data is is digitalization , consists of large amount of datasets consists information related to patients all reports.
1) Data Federation and Aggregation:
Data Federation is a type of software which collections the data from the multiple users and integrates the data.Typically traditional software cannot given the solution to store the huge amount of data in hardwares or by some database management tools.But the Data federation will provide a solution based upon the bigdata architecture is based by collecting the data inside and outside of the enterprise through the layer.
Some of the important data federation tools are Sysbase federation, IBM InfoSphere Federation server and so on.
2) Security and Regularity Concerns:
Security is one of the important requirement to describe bidgata e-health services.Security plays a important role because patient share their personl information with the doctors which help the physician to give the correct treatment
3) Data Operational Management

Nigerian Civil Service History

In tracing the emergence and growth of the civil service in Nigeria, Nwosu (1977) started from 1900 when Britain formally established the authority in most of the administrative purposes. They were in the colony of Lagos and the protectorate of Northern and Southern Nigeria. Later in 1906, the Lagos colony was merged with the southern protectorate and renamed the colony and protectorate of Southern Nigeria. In 1914, the two protectorates were amalgamated and subsequently became known as the colony and protectorate of Nigeria.

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In order to be able to administer the territory, Britain imposed a unified alien civil service on Nigeria without giving much thought to its impact on the Nigerian traditional communities with their conflicting values, interest, norms and authority structure (Kingsley 1963). It must be pointed out that despite the amalgamation and its attendant unification of the civil services of the North and South, the two are still developed at their own pace.
The major function of civil service at the time was mainly the maintenance of law and raising enough revenue to sustain the colonial authority. According to Okoli & Onah (2002), the service was geared towards the negative policy of preventing trouble in the areas under its administration. Economic and social development was never a major objective of the administration.
The colonial civil service according to Nwosu 1977 had its structure; at the Head of Public Service was the Governor-General, who was accountable to the colonial secretary in London. The colonial secretary was himself accountable to the British cabinet and the parliament. The governor-general delegated his authority to the Chief Secretary, who was the effective head of the service. The chief secretary coordinated the whole service which was divided into two major parts – the departmental and the political administration. The departmental administration covers the technical and professional functions of the colonial regime. These include education, health, treasury, agriculture, forestry, public works and audit.
The various heads assisted the chief secretary. They not only advised the Governor but initiated policies, participated in legislation and supervised the execution of enacted bills and approved policies. While the head of technical department operated from Lagos. Their subordinates were in charge of field offices. The field officers included the lieutenant-governor, the resident and district officers, the officers who are pillars of colonial civil service were fully responsible for maintenance of law and order and the mobilization of resources which were the main object of colonial administration.
The field officer did not rule the people directly, rather they owned the people and that is indirect rule. In the north, it was completely successful because of the indigenous political and administrative structure on ground. In the west, it was partially successful because of the peoples contact with western education and in the east; it was a complete failure because of the republican nature of the people’s government.
The fusion of western administration with the traditional African system produced a new structure which Nwosu (1977) says corresponded with Fred Riggs description of the pattern of role differentiation in a traditional society. At this early period, Nigerians were restricted to the lower echelons of the civil service. The south and the north; though amalgamated, still had their separate civil services.
Principles of the Civil Service
The civil service is guided by the triple maxims of anonymity, neutrality and impartiality. The principles of permanence are also seen as part of the maxims (Obiajulu & Obi 2004).
Anonymity: this states that civil servants should be seen and not heard. Though they advise political office holders on issues relating to government, they neither take the blame nor the glory of such policies. They are not expected to be seen defending such policies. Civil servants as far as possible are anonymous and should not be seen as craving for publicity.
Neutrality: the civil servant must be politically neutral. His job is to serve the government of the day irrespective of what he feels about that particular government. He should not allow his personal prejudices color his dedication to his duty. He is not expected to be a card carrying member of a political party or get involved in partisan politics though he is expected to vote at election times.
Impartiality: Civil servants are paid from tax payer’s money which does not belong to anybody or group in particular. They are therefore expected to discharge their duties without fear or favor in rendering such service to the public. The civil servant is expected to treat everybody with a high degree of impartiality.
Permanence: the civil service is often defined as a permanent body of officials that carryout government decisions. It is permanent and its life is not tied to the life of any particular government. Government come and goes but the civil service remains.
Functions of the Civil Service
According to Obiajulu & Obi (2004), the major function of the civil service is the implementation of government policies. Civil servants are not policy makers and are not really in a position to question government policies. Whenever a policy is made, it becomes the role of the civil servants to implement the policy the way the government of the day wants it to be.
The federal and state civil servants play important role in policy formulation and advice. They play a major economic, social and educational objective of both the federal and state governments.
The civil service also gathers statistical information for the activities of the government. Senior civil servants also have to inform the public about the achievements, abilities and problems facing the government.
Also, Ezeani (2005) noted that the civil service is a store of knowledge of past government decisions and procedures. Thus, it plays an educative role by assisting professionals and military political executives (as is the case in Nigeria), especially the new ones “to adapt themselves to the realities of their offices” (This Week, 1988:19). The civil servants also play investigative and regulatory functions.
Structure of the Nigerian Civil Service
The civil service is mainly organized around the federal ministries headed by a minister appointed by the president, who must include at least one member of the 36 states in his cabinet. President’s appointment is confirmed by the senate of Nigeria.
There are less than 36 ministries. In some cases, a federal minister is responsible for more than one ministry and a minister may be assisted by one or more ministers of state. Each ministry has a permanent secretary who is a senior civil servant.
The ministries are responsible for various parastatals (government owned corporations) such as education, National Broadcasting Commission (information) and Nigeria National Petroleum Corporation (NNPC). Other parastatals are the responsibility of the office of the presidency such as the Independent Electoral Commission, the Federal Civil Service Commission, etc.
Role of the Civil Service in National Development
The civil service is a vital part of government machinery and its role is decisive in ensuring the stability of governance, its quality and ability to perform and push the frontiers of national development.
According to Edozien, a former permanent secretary, the civil service inherited from the British was effective, efficient offered a socially responsible service and was well respected and regarded by the political class. So also was the civil service under phase one of the national development plan covering 1960 – 1975).
He said that phase two 1975 – 1999 started with a blow of the morale of the civil service as permanent secretaries were compulsorily retired and were barred form accompanying their ministers to federal executive council (FEC) meetings, while job security was no longer guaranteed.
Engr. Ebele Okeke described the civil service as a critical contact between the government and the people in the area of good government and the people in the area of good governance and service delivery. The success of any government depends on a virile civil service.
Hence, the civil service remains very crucial and critical to national development and democratic stability. In developing states, why years of military and authoritarian rule in most developing societies have impacted negative political culture on the character and philosophy of the service, yet its role in national development cannot be undervalued.
However, since military regimes and authoritarian rule have lost their appeal in modern government. The need to reform civil and public service to be in tune with democratic values becomes highly imperative. An efficient civil service acts as a catalyst in the development of all nations. While on the other hand, its inefficiency can constitute as one of the heaviest mill stones round the neck of developing nations.
Therefore, it is important to most that the civil service must be efficient to service the newly found democratic project for stability and survival of the polity. Since it is the vehicle and machinery of public policy formulation and implementation, it is also to be noted that democracy with its attractive values will enhance the workings of the public service and redefine, reorient and reposition it to be more affective, mobile and productive partner in national reconstruction agenda (Ayodele and Bolaji).
Bureaucratic bottleneck, high levels of corruption and personalization of governmental affairs exhibited hitherto by the civil service are highly anti-democratic. Democracy is expected to bear on the attitude and change this negative democratic attitude to service. Democracy has rekindled the expectation and optimism of the people in the ability of the civil service to be relevant to he challenges of growth and development.
The strategic relevance of civil service in policy formulation and implementing cannot be over emphasized. In the developing societies especially in the immediate past independence era the public service assumed the pivotal roles as the vehicle of development. In fact, Ejifor (2003) posits that civil service in the developing societies is everything and that the most important catalyst of development is an efficient service while at the same time its inefficient constitute the heaviest millstones of any nation. This is similar to the view of Agagu (1997:233) who contends that public and civil service is the continuously active business part of government concerned with carrying out the law, as made by the legislative bodies in the process of organization and management.
In scope, the influence of the civil service is not debatable; it remains definitely a major force in today’s governance. The civil service contains a network of human relationships and associations extending from the highly influential government officials to the lowest paid and powerless individual charged with all resources, natural and human and all other aspects of the life of the society with which the government is concerned (Nnoli, 2000:44). In essence, public service is the totality of how progress and development are made in the society.
The Nigerian civil service has faced a number of challenges, which has considerably undermined its capacity to serve as agent of national development. Such challenges include those of achieving technical competence, coping with public expectation and change, behaving ethically and maintaining constitutional order. The truth is that all these problems are inextricably linked to failure of the civil service to play its rightful role in system maintenance and continuity.
Again, in order to enhance the nation’s development, the civil service under the auspices of the public service can partner with the private sector. In Nigeria and other developing countries, sustainable access to healthcare and other socio-economic services and products can be accomplished through public-private partnerships, where the government delivers the minimum standard of services, products and care, the private sector brings skills and core competencies while donors and business bring funding and other resources. Such collaborations will be especially productive in promoting poverty alleviation through partnerships as has been the case with polio eradication and other child immunization efforts.
However, this public-private partnership would help to highlight perspectives on development, from leaders in civil society, government, business and the media, share information of development alternatives, provide forums for informed debate on related issues; seek to accomplish better understanding of the nature of relationships between governmental and non-governmental organizations and introduce conceptual frameworks for understanding such relationships.
Intrinsic in the aforementioned objectives of typical public-private partnerships is the mission to contribute to the economic integration of a country/region accelerate its economic growth and sustainable development, engender and sustain private sector participation in traditionally public sector projects; and expand local assess to international markets, thereby ensuring the country’s deeper integration into the global economy. For Nigeria in particular, this could be done within the official NEPAD structure, ECOWAS and other regional economic communities in Africa, governments, private sector, civil society and other stakeholders.
Finally, a vibrant and healthy civil service is the key to good governance and national development.
Challenges of the Nigerian Civil Service
According to Ezeani (2005), the Nigerian Civil Service has over the years been plagued by a number of problems which adversely affected its role as an instrument for socio-economic and political development of the country. The problems include:
The nature of political competition in the Nigerian environment. The Nigerian civil service has been transformed into a theatre of sharing the national cake among the major ethnic and sub ethnic groups, a factor responsible for the unending demand for fragmentation of governmental structure units of ministries, divisions of major departments etc.) despite the obvious difficulties in sustaining the existing ones.
The conflictual relationship between politicians and administrations
Corruption e.g. looting of national treasury and lack of accountability
Poor remuneration of civil servants
Politicization of the civil service. As Olowu et al (1997) rightly points out “politicization of the top civil services in an environment of high political instability and high turnover of officials has not only been wasteful of personnel, it has also led to a weakened role for the civil service in the development process.”
Ethnicity and indiscipline. A family local ethnic and other primordial ties and loyalties, sometimes compete on take precedence over loyalty to the nation and the service (Nwosu 1997)
Social distance existing between the senior civil servants and the masses. Most senior civil servants have contacts with the masses and therefore do not experience their problems
Lack of flexibility among bureaucrats. Civil servants cling tenaciously to routine well established procedures for doing things or red-tapism.
The Military Rule and Nigeria Civil Service
The history of post colonial Nigeria is fraught with military authoritarianism. This has reflected in its bureaucracy. Scholars agree that since 1966 when the military intervened in the Nigeria government and politics up to 1999 civil service has enjoyed enormous popularity due to the inability of the military class to dictate the pace of government without recourse to bureaucrats’ wealth of experience. It should be noted that civil servants are often used as stabilizers of the staff under military regimes.
Generally, military administration manifests certain characteristics which are hallmarks of military regimes, these are:
Method of Civil Service Appointment: The civil service has laid down rules and regulations guiding appointment, discipline and promotions. Under the military these processes are rubbished. Merit and seniority are relegated and mediocrity celebrated. This has brought into the service deep hatred among the rank and file of the system. This has undermined professionalism in the civil service.
Decision Making Process: This under the military is usually centralized. There is no constitution, no rule of law, absence of separation of power, no democratic institution with the legislature, executive and judiciary. The decision making process are vested in one centralized body like the Supreme Military Council or Armed Forces Ruling Council. Related to the above is the military often acted with dispatch in administration. The tradition military culture has affected their method of operation even in official bus. By their training and due to their low educational background, they don’t know their power limitations. Thus, most of them give appointment, promotions, contract and other forms of state privileges without due process.
Absence of Separation of Powers and Function: over-concentration of power and function in one body is another feature of military regime. Military governments don’t subscribe to separation of powers. Hence the issue of rule of law is out of the question. The doctrine of separation of powers presupposes that whatever power accruing to one organ shouldn’t be interfered with by another. But the precepts of the military regime all governmental powers i.e. legislature, executive and to some extent, the judiciary, are concentrated in few hands.
Prevalence of Spoilt System in Appointment: Often, appointments under the military are not done on merit. Successive military regimes often adopted some faithful members of the public into public administration without regard to their qualification. By this arrangement, sensitive federal and state positions were left for people who aren’t competent. This is in line with the military belief that any person can do the art of administration. Again because of military governments could be ousted any day it becomes a tradition among staff office occupiers to appropriate or personalize the trappings of their office.
How can National Development be fully Realized?
Development has become more crucial in the developing countries to avert the lingering problem of bureaucratic maze paralyzed by partisan politics and ideological imperatives, poor coordination, implementation and sheer miscalculation that bedevil many administrative issues in the developing countries. These problems can be tackled through better monitoring accountability checks and more rigorous project evaluation.
Development does not take place in a vacuum but in an “environment”, the environment in the field of development is a country’s socio-economic and political set up. To be conducive to national development, the civil service as an environment has to have minimum level of stability, peace and order. (Obi & Obikeze 2004).
National development is crucial in developing countries such as Nigerian to help them enhance their level of political economic, social and cultural wellbeing with the aid and instrumentality of the civil service.
Today’s civil service needs to rediscover the time-honoured inbuilt system of training, retraining and adaptive skills in consonance with modern work practices and processes. It must imbibe the culture of innovation both in imagination and routine works as well as in developing appropriate tools for anticipating change and challenges. It must be able to institutionalize change in modern governance and societal development. It must see itself as a tool for the promotion of growth, peace, stability, development and democracy.
In conclusion, for the civil service to be both relevant and effective, it must rediscover its cherished tradition of service, loyalty and excellence and complement them with integrity, credibility, leadership, innovation and transparency in the management of scarce resources. With this, the Nigerian civil service can be capable of meeting modern challenges of national development.

Research Strategy of Service Quality Assessment

For this study survey, strategy will be used in order to collect data. Survey researchers are quite distinct from the general surveys conducted for different purposes, including marketing survey. According to Tanur(1982) surveys are generally meant of collecting data related to “characteristics, actions, or opinions of a large group of people, referred to as a population.” The surveys conducted for research purposes are focused on advancement of knowledge within a specific domain. Research survey data can be collected through different methods, including interviews, questionnaires and observations. In terms of questionnaires, the data can be collected either through open-ended questions in which participants need to provide details answer or closed questions in which participants need to provide select single or multiple answers from the choice of answers. According to Groves et al. (2013) survey data will be biased if the process of the survey is not properly followed, which includes designing, writing, collecting and analysing sub-processes. Figure 1 presents the typical data collection process as describe by Groves et al.(2013)   

Figure 1: A survey from process prospective (Groves et. al. 2013,pp.149)
For the research survey, strategy will be used and data will be collected through set of questionnaires which respondent will be able to complete themselves. The reason for using questioner as data collection method was because, firstly, this research is using survey strategy and according to Saunders et al. (2012) “questioner is one of the most widely used data collection methods within survey strategy.” Secondly, since this research will be providing the closed answers which will be used for quantitative data analysis, therefore, questionnaire data collection method is more suited for this research.

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In terms of sampling, since its pilot data collection and research is focused on general consumer perception about the service delivery and expected quality evaluated through the prism of culture, therefore, as describe by Saunders et al. (2012) ‘probability based sampling’ technique will be used to identify a group from population for data collection. For quality of data, research has applied ‘stratified random sampling’ by using the one attribute that has the basic level of experience in terms of service delivery from the population. The validity or according to Saunders et al. (2012) ‘content validity’, questions in a survey provide adequate representation for research questions. As describe by Saunders et al. (2012) validity of the content can be evaluated through literature review, which has been provided for this research. For the reliability and consistency in response to the questionnaire, the research is confined to only closed questions with multiple-choice single selection answers, and questions are all design using simple language. The questions on the survey are design based upon the research questions, and all the questions in the survey are closed question that is multiple-choice single selection in order to collect consistent data. The order and flow of the questions are carefully design to avoid confusion and misinterpretation. Similarly, in order to avoid blank or missed questions the questions are presented on the same page, Please see the Appendix for actual questionnaire in the survey. Although the research is evaluating the research question using qualitative research methodology, but the data collected through a survey is processed by quantitative data analysis. The data collected through a survey is considered to numerical data, and ‘exploratory data analysis(EDA)’ approach will be used to process it. According to Saunders et al. (2012) EDA approach for data analysis emphasis on using diagrams and tables for understanding and exploring data. Since this is pilot research, therefore, as describe by Saunders et al. (2012) EDA approach is useful for initially stages of the research.
Research instrument and data collection:
The survey is divided into two sections first section contains demographic questions two get more understandings about the respondent and their classification. The second section contains the statement about the service encounter which participants had to rate using 7-points Likert scale starting from 1 (strongly disagree) to 7 (strongly agree). Before attempting to rate the statements participants were asked to think of the service they have received from the industries like banks, retail, etc. and use the experience to rate the statements. The survey is conducted electronically by creating the questionnaire on a free online survey conducting website which provides functionality to share a link to the survey. The link to the survey is shared through email and also via different electronic forums, The data collected through the survey is analysed and evaluated after downloading it from the website. Sample data comprised of two sources that is the student of universities and colleges. A total of hundred responses was received out of several hundred survey requests. As the research aims to analyse the effect of culture on customer perception of service, therefore, the sampling framework was clustered into two major group based on their ethnicity that is white and non-white. Population targeted for this research was local consumers living in UK and had received service from industries like banks, retail, etc. in last few months. Participants from the sample are chosen using researcher’s own intuition and chosen with purpose. (Tellstrom et al., 2006). In order to further evaluate participant demographic information like age and education has also been collected.
In order to measure a perception of service quality and evolution process, in this SERVQUAL scale will be used, which was developed by Parasuraman et al. (1991). SERQUAL provides 22-items scale, spanning five dimensions (tangibles, reliability, responsiveness, assurance, and empathy), of service quality expectations and, which has been evaluated and validated in numerous studies (Donthu and Yoo, 1998). Although researchers have identified some shortcoming in using SERVQUAL, but the model is most widely referenced and practiced among various industries. The questionnaires in this study were design to capture the customer perceptions of service quality based on five quality dimension of SERVQUAL. For gauging the culture of the survey participant, the study will use the Hofstede’s framework of cultural dimensions. Several scholars have proposed alternative frameworks to conceptualize and operational culture to overcome the shortcoming of Hofstede’s framework. However, Hofstede’s framework is still the most widely used cultural framework in different fields of study, including “psychology, sociology, marketing, or management” (Soares et al., 2007). The research has used the approach of grouping the participant according to their individual scores on Hofstede’s cultural dimension scale resulting in better understanding the role of culture in shaping service perception (Guesalaga et al ., 2016). The survey has been conducted within UK, and participants predominantly belong to western culture but some of the participant involved has a different culture which can give better understand of cultural effect on service quality perception.
Guesalaga, R.; Pierce, M. and Scaraboto, D. (2016), Cultural influences on expectations and evaluations of service quality in emerging markets, International Marketing Review, 33(1), pp. 88-111
Parasuraman, A.; Berry, L. and Zeithaml, V.A. (1991), Refinement and reassessment of the SERVQUAL scale, Journal of Retailing, .67(4), pp. 420-450.
Saunders, M., Lewis, P. and Thornhill, A. (2012) Research methods for business students. 6th edn. Harlow: Pearson.
Tanur, J.M.(1982) Advances in methods for large-scale surveys and experiments, in R. Mcadams, N.J. Smelser, & D.J. Treiman (eds.), Behavioral and Social Science Research: A National Resource, Part II. Washington, D.C.: National Academy Press.
Groves,R. M., Fowler, F.J., Couper, M.P. Jr., Lepkowski, J. M., Singer, E. and Tourangeau, R. (2013), Survey Methodology, First Edition,John Wiley & Sons
Donthu, N. and Yoo, B. (1998),Cultural Influences on Service Quality Expectations, Journal of Service Research,1(2), pp.178-186
Soares, A. M.; Farhangmehr, M. and Shoham, A. (2007), Hofstede’s dimensions of culture in international marketing studies, Journal of Business Research, 60, pp. 277 – 284